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Tomic D, Morton JI, Chen L, Salim A, Gregg EW, Pavkov ME, Arffman M, Balicer R, Baviera M, Boersma-van Dam E, Brinks R, Carstensen B, Chan JCN, Cheng YJ, Fosse-Edorh S, Fuentes S, Gardiner H, Gulseth HL, Gurevicius R, Ha KH, Hoyer A, Jermendy G, Kautzky-Willer A, Keskimäki I, Kim DJ, Kiss Z, Klimek P, Leventer-Roberts M, Lin CY, Lopez-Doriga Ruiz P, Luk AOY, Ma S, Mata-Cases M, Mauricio D, McGurnaghan S, Imamura T, Paul SK, Peeters A, Pildava S, Porath A, Robitaille C, Roncaglioni MC, Sugiyama T, Wang KL, Wild SH, Yekutiel N, Shaw JE, Magliano DJ. Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study. Lancet Diabetes Endocrinol 2022; 10:795-803. [PMID: 36183736 PMCID: PMC10988609 DOI: 10.1016/s2213-8587(22)00252-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. METHODS For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20-100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005-19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. FINDINGS Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6-17·0) for Scottish women to 59·6% (58·5-60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017-18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2-59·3) for men and 64·1 years (64·0-64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013-14 in Lithuania (43·7 years [42·7-44·6]) for men and in 2010-11 in Latvia (54·2 years [53·4-54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010-11 to 2015-16 and in the USA from 2009-10 to 2014-15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015-16) to 12·9 years (Israel Clalit Health Services; 2015-16) for 20-year-old men and from 3·1 years (Finland; 2011-12) to 11·2 years (Israel Clalit Health Services; 2010-11 and 2015-16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009-10 and 2014-15 for 20-year-old men (a decrease of 2·7 years). INTERPRETATION Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. FUNDING US Centers for Disease Control and Prevention and Diabetes Australia.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Jedidiah I Morton
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Lei Chen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Agus Salim
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Martti Arffman
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Elise Boersma-van Dam
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany; Institute for Medical Biometry and Epidemiology, University Witten/Herdecke, Witten, Germany
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Yiling J Cheng
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sonsoles Fuentes
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Hélène Gardiner
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Hanne L Gulseth
- Department for Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School EWL, Bielefeld University, Bielefeld, Germany
| | - György Jermendy
- Third Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Alexandra Kautzky-Willer
- Department of Medicine III, Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; Gender Institute, Gars am Kamp, Austria
| | - Ilmo Keskimäki
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- Second Department of Medicine and Nephrological Center, University of Pécs, Pécs, Hungary
| | - Peter Klimek
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria; Complexity Science Hub Vienna, Vienna, Austria
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Dídac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain; Department of Endocrinology, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Sanjoy K Paul
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | - Cynthia Robitaille
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan; Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Butterly E, Wei L, Adler AI, Almazam SAM, Alsallumi K, Blackbourn LAK, Dias S, Hanlon P, Hughes K, Lewsey J, Lindsay R, McGurnaghan S, Petrie J, Phillippo D, Sattar N, Tomlinson LA, Welton N, Wild S, McAllister D. Calibrating a network meta-analysis of diabetes trials of sodium glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor analogues and dipeptidyl peptidase-4 inhibitors to a representative routine population: a systematic review protocol. BMJ Open 2022; 12:e066491. [PMID: 36302574 PMCID: PMC9621152 DOI: 10.1136/bmjopen-2022-066491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Participants in randomised controlled trials (trials) are generally younger and healthier than many individuals encountered in clinical practice. Consequently, the applicability of trial findings is often uncertain. To address this, results from trials can be calibrated to more representative data sources. In a network meta-analysis, using a novel approach which allows the inclusion of trials whether or not individual-level participant data (IPD) is available, we will calibrate trials for three drug classes (sodium glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP1) receptor analogues and dipeptidyl peptidase-4 (DPP4) inhibitors) to the Scottish diabetes register. METHODS AND ANALYSIS Medline and EMBASE databases, the US clinical trials registry (clinicaltrials.gov) and the Chinese Clinical Trial Registry (chictr.org.cn) will be searched from 1 January 2002. Two independent reviewers will apply eligibility criteria to identify trials for inclusion. Included trials will be phase 3 or 4 trials of SGLT2 inhibitors, GLP1 receptor analogues or DPP4 inhibitors, with placebo or active comparators, in participants with type 2 diabetes, with at least one of glycaemic control, change in body weight or major adverse cardiovascular event as outcomes. Unregistered trials will be excluded.We have identified a target population from the population-based Scottish diabetes register. The chosen cohort comprises people in Scotland with type 2 diabetes who either (1) require further treatment due to poor glycaemic control where any of the three drug classes may be suitable, or (2) who have adequate glycaemic control but are already on one of the three drug classes of interest or insulin. ETHICS AND DISSEMINATION Ethical approval for IPD use was obtained from the University of Glasgow MVLS College Ethics Committee (Project: 200160070). The Scottish diabetes register has approval from the Scottish A Research Ethics Committee (11/AL/0225) and operates with Public Benefit and Privacy Panel for Health and Social Care approval (1617-0147). PROSPERO REGISTRATION NUMBER CRD42020184174.
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Affiliation(s)
- Elaine Butterly
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lili Wei
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | - Khalid Alsallumi
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Luke A K Blackbourn
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, Select State, UK
| | - Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Katherine Hughes
- Department of Diabetes, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UK
| | - Jim Lewsey
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Lindsay
- University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Glasgow, UK
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - John Petrie
- University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Glasgow, UK
| | - David Phillippo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Laurie A Tomlinson
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicky Welton
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Sarah Wild
- Public Health Sciences, University of Edinburgh, Edinburgh, UK
| | - David McAllister
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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McKeigue PM, McGurnaghan S, Blackbourn L, Bath LE, McAllister DA, Caparrotta TM, Wild SH, Wood SN, Stockton D, Colhoun HM. Relation of Incident Type 1 Diabetes to Recent COVID-19 Infection: Cohort Study Using e-Health Record Linkage in Scotland. Diabetes Care 2022; 46:921-928. [PMID: 35880797 DOI: 10.2337/dc22-0385] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Studies using claims databases reported that SARS-CoV-2 infection >30 days earlier was associated with an increase in the incidence of type 1 diabetes. Using exact dates of diabetes diagnosis from the national register in Scotland linked to virology laboratory data, we sought to replicate this finding. RESEARCH DESIGN AND METHODS A cohort of 1,849,411 individuals aged <35 years without diabetes, including all those in Scotland who subsequently tested positive for SARS-CoV-2, was followed from 1 March 2020 to 22 November 2021. Incident type 1 diabetes was ascertained from the national registry. Using Cox regression, we tested the association of time-updated infection with incident diabetes. Trends in incidence of type 1 diabetes in the population from 2015 through 2021 were also estimated in a generalized additive model. RESULTS There were 365,080 individuals who had at least one detected SARS-CoV-2 infection during follow-up and 1074 who developed type 1 diabetes. The rate ratio for incident type 1 diabetes associated with first positive test for SARS-CoV-2 (reference category: no previous infection) was 0.86 (95% CI 0.62, 1.21) for infection >30 days earlier and 2.62 (95% CI 1.81, 3.78) for infection in the previous 30 days. However, negative and positive SARS-CoV-2 tests were more frequent in the days surrounding diabetes presentation. In those aged 0-14 years, incidence of type 1 diabetes during 2020-2021 was 20% higher than the 7-year average. CONCLUSIONS Type 1 diabetes incidence in children increased during the pandemic. However, the cohort analysis suggests that SARS-CoV-2 infection itself was not the cause of this increase.
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Affiliation(s)
- Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK.,Public Health Scotland, Glasgow, Scotland, UK
| | - Stuart McGurnaghan
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK
| | - Luke Blackbourn
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK
| | - Louise E Bath
- Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - David A McAllister
- Public Health Scotland, Glasgow, Scotland, UK.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Thomas M Caparrotta
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK.,Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Sarah H Wild
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK.,Public Health Scotland, Glasgow, Scotland, UK
| | - Simon N Wood
- School of Mathematics, University of Edinburgh, Scotland, UK
| | | | - Helen M Colhoun
- Public Health Scotland, Glasgow, Scotland, UK.,Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK
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McKeigue PM, McAllister DA, Caldwell D, Gribben C, Bishop J, McGurnaghan S, Armstrong M, Delvaux J, Colville S, Hutchinson S, Robertson C, Lone N, McMenamin J, Goldberg D, Colhoun HM. Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study. BMC Med 2021; 19:149. [PMID: 34158021 PMCID: PMC8219469 DOI: 10.1186/s12916-021-02021-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. METHODS In a matched case-control design, all 178,578 diagnosed cases of COVID-19 in Scotland from 1 March 2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression. RESULTS With those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020. CONCLUSIONS The effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.
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Affiliation(s)
- Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David A McAllister
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - David Caldwell
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Ciara Gribben
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Jen Bishop
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland
| | - Matthew Armstrong
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Joke Delvaux
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Sam Colville
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Sharon Hutchinson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Chris Robertson
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
- Department of Mathematics and Statistics, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, Scotland
| | - Nazir Lone
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Jim McMenamin
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - David Goldberg
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland
| | - Helen M Colhoun
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, Scotland.
- Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, EH4 2XUC, Scotland.
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Jeyam A, Colhoun H, McGurnaghan S, Blackbourn L, McDonald TJ, Palmer CNA, McKnight JA, Strachan MWJ, Patrick AW, Chalmers J, Lindsay RS, Petrie JR, Thekkepat S, Collier A, MacRury S, McKeigue PM. Erratum. Clinical Impact of Residual C-Peptide Secretion in Type 1 Diabetes on Glycemia and Microvascular Complications. Diabetes Care 2021;44:390-398. Diabetes Care 2021; 44:1072. [PMID: 33731365 DOI: 10.2337/dc21-er04b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Sidore C, Orrù V, Cocco E, Steri M, Inshaw JR, Pitzalis M, Mulas A, McGurnaghan S, Frau J, Porcu E, Busonero F, Dei M, Lai S, Sole G, Virdis F, Serra V, Poddie F, Delitala A, Marongiu M, Deidda F, Pala M, Floris M, Masala M, Onengut-Gumuscu S, Robertson CC, Leoni L, Frongia A, Ricciardi MR, Chessa M, Olla N, Lovicu M, Loizedda A, Maschio A, Mereu L, Ferrigno P, Curreli N, Balaci L, Loi F, Ferreli LA, Pilia MG, Pani A, Marrosu MG, Abecasis GR, Rich SS, Colhoun H, Todd JA, Schlessinger D, Fiorillo E, Cucca F, Zoledziewska M. PRF1 mutation alters immune system activation, inflammation, and risk of autoimmunity. Mult Scler 2021; 27:1332-1340. [PMID: 33566725 DOI: 10.1177/1352458520963937] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Defective alleles within the PRF1 gene, encoding the pore-forming protein perforin, in combination with environmental factors, cause familial type 2 hemophagocytic lymphohistiocytosis (FHL2), a rare, severe autosomal recessive childhood disorder characterized by massive release of cytokines-cytokine storm. OBJECTIVE The aim of this study was to determine the function of hypomorph PRF1:p.A91V g.72360387 G > A on multiple sclerosis (MS) and type 1 diabetes (T1D). METHODS We cross-compare the association data for PRF1:p.A91V mutation derived from GWAS on adult MS and pediatric T1D in Sardinians. The novel association with T1D was replicated in metanalysis in 12,584 cases and 17,692 controls from Sardinia, the United Kingdom, and Scotland. To dissect this mutation function, we searched through the coincident association immunophenotypes in additional set of general population Sardinians. RESULTS We report that PRF1:p.A91V, is associated with increase of lymphocyte levels, especially within the cytotoxic memory T-cells, at general population level with reduced interleukin 7 receptor expression on these cells. The minor allele increased risk of MS, in 2903 cases and 2880 controls from Sardinia p = 2.06 × 10-4, odds ratio OR = 1.29, replicating a previous finding, whereas it protects from T1D p = 1.04 × 10-5, OR = 0.82. CONCLUSION Our results indicate opposing contributions of the cytotoxic T-cell compartment to MS and T1D pathogenesis.
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Affiliation(s)
- Carlo Sidore
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Valeria Orrù
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public health, Multiple Sclerosis Centre, University of Cagliari, Cagliari, Italy
| | - Maristella Steri
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Jamie Rj Inshaw
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, Oxford, UK/Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Maristella Pitzalis
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Antonella Mulas
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Stuart McGurnaghan
- Diabetes Medical Informatics and Epidemiology, The University of Edinburgh, Edinburgh, Scotland
| | - Jessica Frau
- Department of Medical Sciences and Public health, Multiple Sclerosis Centre, University of Cagliari, Cagliari, Italy
| | - Eleonora Porcu
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland/Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Fabio Busonero
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Mariano Dei
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Sandra Lai
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Gabriella Sole
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Francesca Virdis
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Valentina Serra
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Fausto Poddie
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Alessandro Delitala
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy/Department of Surgical, Medical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Michele Marongiu
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Francesca Deidda
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Mauro Pala
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Matteo Floris
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Marco Masala
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Suna Onengut-Gumuscu
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | | | - Lidia Leoni
- Center for Advanced Studies, Research and Development in Sardinia (CRS4), Parco Scientifico e Tecnologico della Sardegna, Pula, Italy
| | | | | | - Margherita Chessa
- Struttura Complessa di Pediatria, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Nazario Olla
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Mario Lovicu
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Annalisa Loizedda
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Andrea Maschio
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Luisa Mereu
- Unità Operativa di Pediatria, Ospedale San Martino di Oristano, Oristano, Italy
| | - Paola Ferrigno
- Reparto di Neurologia, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Nicolo Curreli
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Lenuta Balaci
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Francesco Loi
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Liana Ap Ferreli
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Maria Grazia Pilia
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Antonello Pani
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy/Struttura Complessa di Nefrologia e Dialisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Maria Giovanna Marrosu
- Department of Medical Sciences and Public health, Multiple Sclerosis Centre, University of Cagliari, Cagliari, Italy
| | - Goncalo R Abecasis
- Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Helen Colhoun
- Diabetes Medical Informatics and Epidemiology, The University of Edinburgh, Edinburgh, Scotland
| | - John A Todd
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, Oxford, UK/Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - David Schlessinger
- Laboratory of Genetics and Genomics, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, MD, USA
| | - Edoardo Fiorillo
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Francesco Cucca
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy/Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Magdalena Zoledziewska
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cittadella Universitaria di Monserrato, Monserrato, Italy
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Jeyam A, Colhoun H, McGurnaghan S, Blackbourn L, McDonald TJ, Palmer CNA, McKnight JA, Strachan MWJ, Patrick AW, Chalmers J, Lindsay RS, Petrie JR, Thekkepat S, Collier A, MacRury S, McKeigue PM. Erratum. Clinical Impact of Residual C-Peptide Secretion in Type 1 Diabetes on Glycemia and Microvascular Complications. Diabetes Care 2021;44:390-398. Diabetes Care 2021:dc21er04b. [PMID: 33547206 DOI: 10.2337/dc21er04b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Jeyam A, Colhoun H, McGurnaghan S, Blackbourn L, McDonald TJ, Palmer CNA, McKnight JA, Strachan MWJ, Patrick AW, Chalmers J, Lindsay RS, Petrie JR, Thekkepat S, Collier A, MacRury S, McKeigue PM. Clinical Impact of Residual C-Peptide Secretion in Type 1 Diabetes on Glycemia and Microvascular Complications. Diabetes Care 2021; 44:390-398. [PMID: 33303639 DOI: 10.2337/dc20-0567] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/03/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To quantify the relationship of residual C-peptide secretion to glycemic outcomes and microvascular complications in type 1 diabetes. RESEARCH DESIGN AND METHODS C-peptide was measured in an untimed blood sample in the Scottish Diabetes Research Network Type 1 Bioresource (SDRNT1BIO) cohort of 6,076 people with type 1 diabetes monitored for an average of 5.2 years. RESULTS In regression models adjusted for age at onset and duration, effect sizes for C-peptide ≥200 vs. <5 pmol/L were as follows: insulin dose at baseline, 27% lower (P = 2 × 10-39); HbA1c during follow-up, 4.9 mmol/mol lower (P = 3 × 10-13); hazard ratio for hospital admission for diabetic ketoacidosis during follow-up, 0.44 (P = 0.0001); odds ratio for incident retinopathy, 0.51 (P = 0.0003). Effects on the risk of serious hypoglycemic episodes were detectable at lower levels of C-peptide, and the form of the relationship was continuous down to the limit of detection (3 pmol/L). In regression models contrasting C-peptide 30 to <200 pmol/L with <5 pmol/L, the odds ratio for self-report of at least one serious hypoglycemic episode in the last year was 0.56 (P = 6 × 10-8), and the hazard ratio for hospital admission for hypoglycemia during follow-up was 0.52 (P = 0.03). CONCLUSIONS These results in a large representative cohort suggest that even minimal residual C-peptide secretion could have clinical benefit in type 1 diabetes, in contrast to a follow-up study of the Diabetes Control and Complications Trial (DCCT) intensively treated cohort where an effect on hypoglycemia was seen only at C-peptide levels ≥130 pmol/L. This has obvious implications for the design and evaluation of trials of interventions to preserve or restore pancreatic islet function in type 1 diabetes.
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Affiliation(s)
- Anita Jeyam
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Edinburgh, U.K
| | - Helen Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Edinburgh, U.K
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Edinburgh, U.K
| | - Luke Blackbourn
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Edinburgh, U.K
| | | | | | | | | | | | | | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | | | | | - Sandra MacRury
- National Health Service Highland Diabetes Centre, Inverness, U.K
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9
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McMeekin P, Geue C, Mocevic E, Hoxer CS, Ochs A, McGurnaghan S, Colhoun HM, Wild SH, Wu O. The cost of prevalent and incident cardiovascular disease in people with type 2 diabetes in Scotland: data from the Scottish Care Information-Diabetes Collaboration. Diabet Med 2020; 37:1927-1934. [PMID: 31989661 DOI: 10.1111/dme.14253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/07/2023]
Abstract
AIM To compare costs for three groups of people with type 2 diabetes, those at high risk of future cardiovascular disease, those without cardiovascular disease and those with established cardiovascular disease, and to also compare costs incurred by people with type 2 diabetes with an incident cardiovascular disease event with those who remain incident event-free over a 3-year period. METHODS Data about people with type 2 diabetes in Scotland were obtained from the Scottish Care Information Diabetes registry. Data linkage was used to retrieve information on healthcare utilization, care home use and deaths. Productivity effects were estimated for those of non-pensionable age. We estimated costs over 12 months (prevalent cardiovascular disease) and 3 years from incident cardiovascular disease event. RESULTS Mean annual cost per person with established cardiovascular disease was £6900, £3300 for a person at high risk of future cardiovascular disease, and £2500 for a person without cardiovascular disease and not at high risk. In year 1, the cost of an incident cardiovascular disease event was £16 700 compared with £2100 for people without an incident event. Over 2 years, the cumulative costs were £21 500 and £4200, and by year 3, £25 000 and £5900, respectively. CONCLUSIONS Cardiovascular disease in people with type 2 diabetes places a significant financial burden on healthcare and the wider economy. Our results emphasize the financial consequences of cardiovascular disease prevention strategies.
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Affiliation(s)
- P McMeekin
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, UK
- Northumbria University, Faculty of Health and Life Sciences, Newcastle, UK
| | - C Geue
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, UK
| | | | | | - A Ochs
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - S McGurnaghan
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - H M Colhoun
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - S H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - O Wu
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, UK
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10
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Whittaker E, Read SH, Colhoun HM, Lindsay RS, McGurnaghan S, McKnight JA, Sattar N, Wild SH. Socio-economic differences in cardiovascular disease risk factor prevalence in people with type 2 diabetes in Scotland: a cross-sectional study. Diabet Med 2020; 37:1395-1402. [PMID: 32189372 DOI: 10.1111/dme.14297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 11/27/2022]
Abstract
AIM To describe the association between socio-economic status and prevalence of key cardiovascular risk factors in people with type 2 diabetes in Scotland. METHODS A cross-sectional study of 264 011 people with type 2 diabetes in Scotland in 2016 identified from the population-based diabetes register. Socio-economic status was defined using quintiles of the area-based Scottish Index of Multiple Deprivation (SIMD) with quintile (Q)1 and Q5 used to identify the most- and least-deprived fifths of the population, respectively. Logistic regression models adjusted for age, sex, health board, history of cardiovascular disease and duration of diabetes were used to estimate odds ratios (ORs) for Q1 compared with Q5 for each risk factor. RESULTS The mean (sd) age of the study population was 66.7 (12.8) years, 56% were men, 24% were in Q1 and 15% were in Q5. Crude prevalence in Q1/Q5 was 24%/8.8% for smoking, 62%/49% for BMI ≥ 30 kg/m2 , 44%/40% for HbA1c ≥ 58 mmol/mol (7.5%), 31%/31% for systolic blood pressure (SBP) ≥ 140 mmHg, and 24%/25% for total cholesterol ≥ 5 mmol/l, respectively. ORs [95% confidence intervals (CI)] were 3.08 (2.95-3.21) for current smoking, 1.48 (1.44-1.52) for BMI ≥ 30 kg/m2 , 1.11 (1.08-1.15) for HbA1c ≥ 58 mmol/mol (7.5%), 1.03 (1.00-1.06) for SBP ≥ 140 mmHg and 0.87 (0.84-0.90) for total cholesterol ≥ 5 mmol/l. CONCLUSIONS Socio-economic deprivation is associated with higher prevalence of smoking, BMI ≥ 30 kg/m2 and HbA1c ≥ 58 mmol/mol (7.5%), and lower prevalence of total cholesterol ≥ 5 mmol/l among people with type 2 diabetes in Scotland. Effective approaches to reducing inequalities are required as well as reducing risk factor prevalence across the whole population.
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Affiliation(s)
| | - S H Read
- Centre for Population Health Sciences, Edinburgh, UK
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - H M Colhoun
- Institute of Genetics and Molecular Medicine, Edinburgh, UK
| | - R S Lindsay
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S McGurnaghan
- Institute of Genetics and Molecular Medicine, Edinburgh, UK
| | - J A McKnight
- Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - N Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S H Wild
- Centre for Population Health Sciences, Edinburgh, UK
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McAllister DA, Read SH, Kerssens J, Livingstone S, McGurnaghan S, Jhund P, Petrie J, Sattar N, Fischbacher C, Kristensen SL, McMurray J, Colhoun HM, Wild SH. Incidence of Hospitalization for Heart Failure and Case-Fatality Among 3.25 Million People With and Without Diabetes Mellitus. Circulation 2019; 138:2774-2786. [PMID: 29950404 PMCID: PMC6287897 DOI: 10.1161/circulationaha.118.034986] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Recent clinical trials of new glucose-lowering treatments have drawn attention to the importance of hospitalization for heart failure as a complication of diabetes mellitus. However, the epidemiology is not well described, particularly for type 1 diabetes mellitus. We examined the incidence and case-fatality of heart failure hospitalizations in the entire population aged ≥30 years resident in Scotland during 2004 to 2013. Methods: Date and type of diabetes mellitus diagnosis were linked to heart failure hospitalizations and deaths using the national Scottish registers. Incidence rates and case-fatality were estimated in regression models (quasi-Poisson and logistic regression respectively). All estimates are adjusted for age, sex, socioeconomic status, and calendar-year. Results: Over the 10-year period of the study, among 3.25 million people there were 91, 429, 22 959, and 1313 incident heart failure events among those without diabetes mellitus, with type 2, and type 1 diabetes mellitus, respectively. The crude incidence rates of heart failure hospitalization were therefore 2.4, 12.4, and 5.6 per 1000 person-years for these 3 groups. Heart failure hospitalization incidence was higher in people with diabetes mellitus, regardless of type, than in people without. Relative differences were smallest for older men, in whom the difference was nonetheless large (men aged 80, rate ratio 1.78; 95% CI, 1.45–2.19). Rates declined similarly, by 0.2% per calendar-year, in people with type 2 diabetes mellitus and without diabetes mellitus. Rates fell faster, however, in those with type 1 diabetes mellitus (2.2% per calendar-year, rate ratio for type 1/calendar-year interaction 0.978; 95% CI, 0.959–0.998). Thirty-day case-fatality was similar among people with type 2 diabetes mellitus and without diabetes mellitus, but was higher in type 1 diabetes mellitus for men (odds ratio, 0.96; 95% CI, 0.95–0.96) and women (odds ratio, 0.98; 95% CI, 0.97–0.98). Case-fatality declined over time for all groups (3.3% per calendar-year, odds ratio per calendar-year 0.967; 95% CI, 0.961–0.973). Conclusions: Despite falling incidence, particularly in type 1 diabetes mellitus, heart failure remains ≈2-fold higher than in people without diabetes mellitus, with higher case-fatality in those with type 1 diabetes mellitus. These findings support the view that heart failure is an under-recognized and important complication in diabetes mellitus, particularly for type 1 disease.
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Affiliation(s)
- David A McAllister
- Institute of Health and Wellbeing (D.A.M.), University of Glasgow, United Kingdom.,NHS National Services Scotland, Edinburgh, United Kingdom (D.A.M., J.K., C.F.)
| | - Stephanie H Read
- Usher Institute of Population Health Sciences and Informatics (S.H.R, S.H.W)
| | - Jan Kerssens
- NHS National Services Scotland, Edinburgh, United Kingdom (D.A.M., J.K., C.F.)
| | | | | | - Pardeep Jhund
- Institute of Cardiovascular and Medical Sciences (P.J., J.P., N.S., J.M.), University of Glasgow, United Kingdom
| | - John Petrie
- Institute of Cardiovascular and Medical Sciences (P.J., J.P., N.S., J.M.), University of Glasgow, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (P.J., J.P., N.S., J.M.), University of Glasgow, United Kingdom
| | - Colin Fischbacher
- NHS National Services Scotland, Edinburgh, United Kingdom (D.A.M., J.K., C.F.)
| | | | - John McMurray
- Institute of Cardiovascular and Medical Sciences (P.J., J.P., N.S., J.M.), University of Glasgow, United Kingdom
| | - Helen M Colhoun
- MRC Institute of Genetics and Molecular Medicine (S.M., H.M.C)
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics (S.H.R, S.H.W)
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12
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McKeigue PM, Spiliopoulou A, McGurnaghan S, Colombo M, Blackbourn L, McDonald TJ, Onengut-Gomuscu S, Rich SS, A Palmer CN, McKnight JA, J Strachan MW, Patrick AW, Chalmers J, Lindsay RS, Petrie JR, Thekkepat S, Collier A, MacRury S, Colhoun HM. Persistent C-peptide secretion in Type 1 diabetes and its relationship to the genetic architecture of diabetes. BMC Med 2019; 17:165. [PMID: 31438962 PMCID: PMC6706940 DOI: 10.1186/s12916-019-1392-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The objective of this cross-sectional study was to explore the relationship of detectable C-peptide secretion in type 1 diabetes to clinical features and to the genetic architecture of diabetes. METHODS C-peptide was measured in an untimed serum sample in the SDRNT1BIO cohort of 6076 Scottish people with clinically diagnosed type 1 diabetes or latent autoimmune diabetes of adulthood. Risk scores at loci previously associated with type 1 and type 2 diabetes were calculated from publicly available summary statistics. RESULTS Prevalence of detectable C-peptide varied from 19% in those with onset before age 15 and duration greater than 15 years to 92% in those with onset after age 35 and duration less than 5 years. Twenty-nine percent of variance in C-peptide levels was accounted for by associations with male gender, late age at onset and short duration. The SNP heritability of residual C-peptide secretion adjusted for gender, age at onset and duration was estimated as 26%. Genotypic risk score for type 1 diabetes was inversely associated with detectable C-peptide secretion: the most strongly associated loci were the HLA and INS gene regions. A risk score for type 1 diabetes based on the HLA DR3 and DQ8-DR4 serotypes was strongly associated with early age at onset and inversely associated with C-peptide persistence. For C-peptide but not age at onset, there were strong associations with risk scores for type 1 and type 2 diabetes that were based on SNPs in the HLA region but not accounted for by HLA serotype. CONCLUSIONS Persistence of C-peptide secretion varies widely in people clinically diagnosed as type 1 diabetes. C-peptide persistence is influenced by variants in the HLA region that are different from those determining risk of early-onset type 1 diabetes. Known risk loci for diabetes account for only a small proportion of the genetic effects on C-peptide persistence.
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Affiliation(s)
- Paul M McKeigue
- Usher Institute of Population Health and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Athina Spiliopoulou
- Usher Institute of Population Health and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, UK
| | - Marco Colombo
- Usher Institute of Population Health and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - Luke Blackbourn
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, UK
| | | | | | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, USA
| | | | | | | | | | | | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh, UK
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13
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Mair C, Wulaningsih W, Jeyam A, McGurnaghan S, Blackbourn L, Kennon B, Leese G, Lindsay R, McCrimmon RJ, McKnight J, Petrie JR, Sattar N, Wild SH, Conway N, Craigie I, Robertson K, Bath L, McKeigue PM, Colhoun HM. Glycaemic control trends in people with type 1 diabetes in Scotland 2004-2016. Diabetologia 2019; 62:1375-1384. [PMID: 31104095 PMCID: PMC6647722 DOI: 10.1007/s00125-019-4900-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to examine whether glycaemic control has improved in those with type 1 diabetes in Scotland between 2004 and 2016, and whether any trends differed by sociodemographic factors. METHODS We analysed records from 30,717 people with type 1 diabetes, registered anytime between 2004 and 2016 in the national diabetes database, which contained repeated measures of HbA1c. An additive mixed regression model was used to estimate calendar time and other effects on HbA1c. RESULTS Overall, median (IQR) HbA1c decreased from 72 (21) mmol/mol [8.7 (4.1)%] in 2004 to 68 (21) mmol/mol (8.4 [4.1]%) in 2016. However, all of the improvement across the period occurred in the latter 4 years: the regression model showed that the only period of significant change in HbA1c was 2012-2016 where there was a fall of 3 (95% CI 1.82, 3.43) mmol/mol. The largest reductions in HbA1c in this period were seen in children, from 69 (16) mmol/mol (8.5 [3.6]%) to 63 (14) mmol/mol (7.9 [3.4]%), and adolescents, from 75 (25) mmol/mol (9.0 [4.4]%) to 70 (23) mmol/mol (8.6 [4.3]%). Socioeconomic status (according to Scottish Index of Multiple Deprivation) affected the HbA1c values: from the regression model, the 20% of people living in the most-deprived areas had HbA1c levels on average 8.0 (95% CI 7.4, 8.9) mmol/mol higher than those of the 20% of people living in the least-deprived areas. However this difference did not change significantly over time. From the regression model HbA1c was on average 1.7 (95% CI 1.6, 1.8) mmol/mol higher in women than in men. This sex difference did not narrow over time. CONCLUSIONS/INTERPRETATION In this high-income country, we identified a modest but important improvement in HbA1c since 2012 that was most marked in children and adolescents. These changes coincided with national initiatives to reduce HbA1c including an expansion of pump therapy. However, in most people, overall glycaemic control remains far from target levels and further improvement is badly needed, particularly in those from more-deprived areas.
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Affiliation(s)
- Colette Mair
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Wahyu Wulaningsih
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Anita Jeyam
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Stuart McGurnaghan
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Luke Blackbourn
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Brian Kennon
- Department of Diabetes, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Graham Leese
- Department of Public Health, NHS Fife, Kirkcaldy, UK
| | - Robert Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rory J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - John McKnight
- Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Ian Craigie
- GGC Children's Diabetes Service, Glasgow, UK
| | | | - Louise Bath
- NHS Lothian, Royal Hospital for Sick Children, Edinburgh, UK
| | - Paul M McKeigue
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
- Department of Public Health, NHS Fife, Kirkcaldy, UK.
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14
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McGurnaghan S, Blackbourn LAK, Mocevic E, Haagen Panton U, McCrimmon RJ, Sattar N, Wild S, Colhoun HM. Cardiovascular disease prevalence and risk factor prevalence in Type 2 diabetes: a contemporary analysis. Diabet Med 2019; 36:718-725. [PMID: 30246473 PMCID: PMC6585697 DOI: 10.1111/dme.13825] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 01/01/2023]
Abstract
AIMS To describe the prevalence of major cardiovascular disease (CVD) and risk factor control in a contemporary population with Type 2 diabetes. METHODS We used data from the national registry in Scotland, Scottish Care Information-Diabetes, linked to hospital admissions. Using descriptive statistics and logistic regression we described associations of risk factors with CVD. CVD was defined based on diagnostic codes in primary or secondary care data for ischaemic heart disease, cerebrovascular disease peripheral arterial disease, heart failure, cardiac arrhythmia, hypertensive heart disease and revascularization procedures. RESULTS Among 248 400 people with Type 2 diabetes with a median age of 67.5 years (IQR 58.2, 76.1) and median diabetes duration of 7.8 years (3.8, 13.0), 32% had prior CVD (35% of men, 29% of women). Median HbA1c overall was 55 mmol/mol (7.2%), median SBP was 132 mmHg, median total cholesterol was 4.1 mmol/l and mean BMI was 32 kg/m2 . Overall two-thirds (65% of men, 68% of women) have two or more of the following CVD risk factor thresholds: HbA1c ≥ 53 mmol/mol (7%), SBP > 130 mmHg or DBP > 80 mmHg, total cholesterol ≥ 5 mmol/l or BMI ≥ 30 kg/m2 , or were currently smoking. Overall 84% were taking anti-hypertensives and 75% a statin. Use of metformin was common at 58%, but other diabetes drugs that reduce CVD were rarely used. CONCLUSIONS There continues to be a high prevalence of CVD among people with Type 2 diabetes and a high level of unmet need for risk factor control. This implies substantial scope for reducing the excess risk of CVD in diabetes through improved management of known risk factors.
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Affiliation(s)
- S. McGurnaghan
- MRC Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
| | - L. A. K. Blackbourn
- MRC Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
| | | | | | | | - N. Sattar
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgow
| | - S. Wild
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - H. M. Colhoun
- MRC Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
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15
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Akbar T, McGurnaghan S, Palmer CNA, Livingstone SJ, Petrie J, Chalmers J, Lindsay RS, McKnight JA, Pearson DWM, Patrick AW, Walker J, Looker HC, Colhoun HM. Cohort Profile: Scottish Diabetes Research Network Type 1 Bioresource Study (SDRNT1BIO). Int J Epidemiol 2018; 46:796-796i. [PMID: 28338705 DOI: 10.1093/ije/dyw152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Tahira Akbar
- Institute of Genetics and Molecular Medicine (IGMM), University of Edinburgh, Edinburgh, UK
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine (IGMM), University of Edinburgh, Edinburgh, UK
| | - Colin N A Palmer
- Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | | | - John Petrie
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - John Chalmers
- Cameron Hospital, National Health Service (NHS) Fife, Kirkcaldy, UK
| | - Robert S Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - Donald W M Pearson
- JJR Macleod Centre for Diabetes, Endocrinology and Metabolism, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Alan W Patrick
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | | | - Helen C Looker
- Diabetes Epidemiology Unit, University of Dundee, Dundee, UK
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine (IGMM), University of Edinburgh, Edinburgh, UK.,Department of Public Health, NHS Fife, Kirkcaldy, UK
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16
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Vadiveloo T, Jeffcoate W, Donnan PT, Colhoun HC, McGurnaghan S, Wild S, McCrimmon R, Leese GP. Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study. Diabetologia 2018; 61:2590-2597. [PMID: 30171278 PMCID: PMC6223842 DOI: 10.1007/s00125-018-4723-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/30/2018] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('high-risk foot'), and to compare different subcategories of high-risk foot. METHODS Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups. RESULTS The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively. CONCLUSIONS/INTERPRETATION In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.
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Affiliation(s)
- Thenmalar Vadiveloo
- Division of Population Health Sciences, Medical Research Institute, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK.
| | | | - Peter T Donnan
- Division of Population Health Sciences, Medical Research Institute, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK
| | - Helen C Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Sarah Wild
- Usher Institute for Public Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rory McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Graham P Leese
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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17
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Wild SH, Walker JJ, Morling JR, McAllister DA, Colhoun HM, Farran B, McGurnaghan S, McCrimmon R, Read SH, Sattar N, Byrne CD, Wild SH, Walker JJ, Morling JR, McAllister DA, Colhoun H, Farran B, McGurnaghan S, McCrimmon R, Read SH, Sattar N, Byrne CD, Lindsay R, Leese G, McKnight J, Petrie J, Chalmers J, Fischbacher C, Cunningham S, Wu O, Philip S. Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission. Diabetes Care 2018; 41:341-347. [PMID: 29167212 DOI: 10.2337/dc17-1590] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people aged 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and ICD-10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors. RESULTS A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality. CONCLUSIONS Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.
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Affiliation(s)
- Sarah H. Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Jeremy J. Walker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Joanne R. Morling
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, U.K
| | - David A. McAllister
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Helen M. Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Bassam Farran
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Rory McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, U.K
| | - Stephanie H. Read
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Christopher D. Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, U.K
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, U.K
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18
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Read SH, McAllister DA, Colhoun HM, Farran B, Fischbacher C, Kerssens JJ, Leese GP, Lindsay RS, McCrimmon RJ, McGurnaghan S, Philip S, Sattar N, Wild SH. Incident ischaemic stroke and Type 2 diabetes: trends in incidence and case fatality in Scotland 2004-2013. Diabet Med 2018; 35:99-106. [PMID: 29044687 DOI: 10.1111/dme.13528] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/27/2022]
Abstract
AIM To describe trends in first ischaemic stroke incidence and case fatality in adults with and without a diagnosis of Type 2 diabetes prior to their ischaemic stroke event in Scotland between 2004 and 2013. METHODS Using population-wide hospital admission, death and diabetes datasets, we conducted a retrospective cohort study. Negative binomial and logistic regression models were used to calculate year-specific incidence and case-fatality rates for people with Type 2 diabetes and for people without diabetes. RESULTS During 41.0 million person-years of follow-up there were 69 757 ischaemic stroke events. Type 2 diabetes prevalence among patients who experienced ischaemic stroke increased from 13.5% to 20.3% between 2004 and 2013. Stroke incidence rates declined by 2.7% (95% CI 2.4, 3.0) annually for people with and without diabetes [diabetes/year interaction: rate ratio 0.99 (95% CI 0.98, 1.01)]. Type 2 diabetes was associated with an increased risk of ischaemic stroke in men [rate ratio 1.23 (95% CI 1.17, 1.30)] and women [rate ratio 1.41 (95% CI 1.35, 1.48)]. Case-fatality rates were 14.2% and 12.7% in people with Type 2 diabetes and without diabetes, respectively. Case fatality declined by 3.5% (95% CI 2.7, 4.5) annually [diabetes/year interaction: odds ratio 1.01 (95% CI 0.98, 1.02)]. CONCLUSIONS Ischaemic stroke incidence declined no faster in people with a diagnosis of Type 2 diabetes than in people without diabetes. Increasing prevalence of Type 2 diabetes among stroke patients may mean that declines in case fatality over time will be less marked in the future.
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Affiliation(s)
- S H Read
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - D A McAllister
- Institutes of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - H M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - B Farran
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Fischbacher
- Information Services Division, NHS National Services, Edinburgh, UK
| | - J J Kerssens
- Information Services Division, NHS National Services, Edinburgh, UK
| | - G P Leese
- Department of Diabetes and Endocrinology, University of Dundee, Dundee, UK
| | - R S Lindsay
- Institutes of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - R J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - S McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - S Philip
- Department of Diabetes and Endocrinology, NHS Grampian, Aberdeen, UK
| | - N Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Farran B, McGurnaghan S, Looker HC, Livingstone S, Lahnsteiner E, Colhoun HM, McKeigue PM. Modelling cumulative exposure for inference about drug effects in observational studies. Pharmacoepidemiol Drug Saf 2017; 26:1527-1533. [DOI: 10.1002/pds.4327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/19/2017] [Accepted: 09/05/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Bassam Farran
- Institute of Genetics and Molecular Medicine; University of Edinburgh; Edinburgh UK
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine; University of Edinburgh; Edinburgh UK
| | | | | | | | - Helen M. Colhoun
- Institute of Genetics and Molecular Medicine; University of Edinburgh; Edinburgh UK
- NHS Fife; Kirkcaldy UK
| | - Paul M. McKeigue
- Usher Institute for Population Health Sciences and Informatics; University of Edinburgh; Edinburgh UK
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20
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Bell S, Farran B, McGurnaghan S, McCrimmon RJ, Leese GP, Petrie JR, McKeigue P, Sattar N, Wild S, McKnight J, Lindsay R, Colhoun HM, Looker H. Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study. BMC Nephrol 2017; 18:163. [PMID: 28526011 PMCID: PMC5437411 DOI: 10.1186/s12882-017-0579-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/11/2017] [Indexed: 02/07/2023] Open
Abstract
Background Whether metformin precipitates lactic acidosis in patients with chronic kidney disease (CKD) remains under debate. We examined whether metformin use was associated with an increased risk of acute kidney injury (AKI) as a proxy for lactic acidosis and whether survival among those with AKI varied by metformin exposure. Methods All individuals with type 2 diabetes and available prescribing data between 2004 and 2013 in Tayside, Scotland were included. The electronic health record for diabetes which includes issued prescriptions was linked to laboratory biochemistry, hospital admission, death register and Scottish Renal Registry data. AKI events were defined using the Kidney Disease Improving Global Outcomes criteria with a rise in serum creatinine of at least 26.5 μmol/l or a rise of greater than 150% from baseline for all hospital admissions. Cox Regression Analyses were used to examine whether person-time periods in which current metformin exposure occurred were associated with an increased rate of first AKI compared to unexposed periods. Cox regression was also used to compare 28 day survival rates following first AKI events in those exposed to metformin versus those not exposed. Results Twenty-five thousand one-hundred fourty-eight patients were included with a total person-time of 126,904 person years. 4944 (19.7%) people had at least one episode of AKI during the study period. There were 32.4 cases of first AKI/1000pyrs in current metformin exposed person-time periods compared to 44.9 cases/1000pyrs in unexposed periods. After adjustment for age, sex, diabetes duration, calendar time, number of diabetes drugs and baseline renal function, current metformin use was not associated with AKI incidence, HR 0.94 (95% CI 0.87, 1.02, p = 0.15). Among those with incident AKI, being on metformin at admission was associated with a higher rate of survival at 28 days (HR 0.81, 95% CI 0.69, 0.94, p = 0.006) even after adjustment for age, sex, pre-admission eGFR, HbA1c and diabetes duration. Conclusions Contrary to common perceptions, we found no evidence that metformin increases incidence of AKI and was associated with higher 28 day survival following incident AKI.
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Affiliation(s)
- Samira Bell
- Renal Unit, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Bassam Farran
- Institute of Genetics and Molecular Medicine University of Edinburgh, Edinburgh, UK
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine University of Edinburgh, Edinburgh, UK
| | - Rory J McCrimmon
- Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Graham P Leese
- Department of Medicine, University of Dundee, Dundee, UK
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Paul McKeigue
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Sarah Wild
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
| | - John McKnight
- Department of Medicine, Western General Hospital, Edinburgh, UK
| | - Robert Lindsay
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine University of Edinburgh, Edinburgh, UK
| | - Helen Looker
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
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