Risk Factors for Type 2 Diabetes in the Multiethnic Cohort

OBJECTIVES

In this report, we investigated the association between established risk factors and type 2 diabetes (T2D) across 5 distinct ethnic groups and explored differences according to T2D definition within the Multiethnic Cohort (MEC) Study.

METHODS

Using the full MEC, with participants in Hawaii and Los Angeles (N=172,230), we applied Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). All participants completed questionnaires asking about demographics, anthropometrics, lifestyle factors, and regular diet. T2D status was determined from self-reported diagnosis/medication and Medicare claims. We assessed the associations between well-established risk factors and T2D in the full cohort, after stratification by ethnic group, according to the T2D definition, and in a biorepository subset. Effect modification by ethnicity was evaluated using Wald's tests.

RESULTS

Overall, 46,500 (27%) participants had an incident T2D diagnosis after a mean follow-up of 17.1±6.9 years. All predictors were significantly associated with T2D: overweight (HR=1.74), obesity (HR=2.90), red meat intake (HR=1.15), short (HR=1.04) and long (HR=1.08) sleep duration, and smoking (HR=1.26) predicted a significantly higher T2D incidence, whereas coffee (HR=0.90) and alcohol (HR=0.78) consumption, physical activity (HR=0.89), and diet quality (HR=0.96) were associated with lower T2D incidence. The strength of these associations was similar across ethnic groups with noteworthy disparities for overweight/obesity, physical activity, alcohol intake, coffee consumption, and diet quality.

CONCLUSIONS

These findings confirm the importance of known risk factors for T2D across ethnic groups, but small differences were detected that may contribute to disparate incidence rates in some ethnic groups, especially for obesity and physical activity.

Patterns and Patients' Characteristics Associated With Use of Sodium-Glucose Cotransporter-2 Inhibitors Among Adults With Type 2 Diabetes: A Population-based Cohort Study

OBJECTIVES

Our aim in this study was to describe patterns and patient-level factors associated with use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) among adults with diabetes being treated in Alberta, Canada.

METHODS

Using linked administrative data sets from 2014 to 2019, we defined a retrospective cohort of adults with prevalent or incident type 2 diabetes with indications for SGLT2i use and who did not have advanced kidney disease (glomerular filtration rate <30 mL/min per 1.73 m²) or previous amputation. We describe medication dispensation patterns of SGLT2is over time in the overall cohort and among the subgroup with cardiovascular disease (CVD). Multivariable logistic regression was used to determine patients' characteristics associated with SGLT2i use.

RESULTS

Of the 341,827 patients with diabetes (mean age, 60.7 years; 45.6% female), 107,244 (31.3%) had CVD. The proportion of patients with an SGLT2i prescription increased in a linear fashion to a maximum of 10.8% (95% confidence interval [CI], 10.7% to 10.9%) of the eligible cohort by the end of the observation period (March 2019). The proportion of filled prescriptions was similar for patients with CVD (10.4%; 95% CI, 10.1% to 10.6%) and for those without CVD (10.9%; 95% CI, 10.8% to 11.0%). Patients' characteristics associated with lower odds of filling an SGLT2i prescription included female sex, older age and lower income.

CONCLUSIONS

The use of SGLT2is is increasing among patients with diabetes but remains low even in those with CVD. Policy and practice changes to increase prescribing, especially in older adults, may help to reduce morbidity and mortality related to cardiovascular and renal complications.

Body mass index and risk of cardiovascular disease, cancer and all-cause mortality

OBJECTIVES

To determine the dose-response relationship between body mass index (BMI) and cause-specific mortality among Canadian adults.

METHODS

The sample includes 10,522 adults 18-74 years of age who participated in the Canadian Heart Health Surveys (1986-1995). Participants were divided into 5 BMI categories (< 18.5, 18.5-24.9, 25-29.9, 30-34.9, and > or = 35 kg/m2). Multivariate-adjusted (age, sex, exam year, smoking status, alcohol consumption and education) hazard ratios for all-cause, cardiovascular disease (CVD) and cancer mortality were estimated using Cox proportional hazards regression.

RESULTS

There were 1,149 deaths (402 CVD; 412 cancer) over an average of 13.9 years (range 0.5 to 19.1 years), and the analyses are based on 145,865 person-years. The hazard ratios (95% CI) across successive BMI categories for all-cause mortality were 1.25 (0.83-1.90), 1.00 (reference), 1.06 (0.92-1.22), 1.27 (1.07-1.51) and 1.65 (1.29-2.10). The corresponding hazard ratios for CVD mortality were 1.30 (0.60-2.83), 1.00 (reference), 1.57 (1.22-2.01), 1.72 (1.27-2.33) and 2.09 (1.35-3.22); and for cancer, the hazard ratios were 1.02 (0.48-2.21), 1.00 (reference), 1.14 (0.90-1.44), 1.34 (1.01-1.78) and 1.82 (1.22-2.71). There were significant linear trends across BMI categories for all-cause (p = 0.0001), CVD (p < 0.0001) and cancer mortality (p = 0.003).

CONCLUSIONS

The results demonstrate significant relationships between BMI and mortality from all causes, CVD and cancer. The increased risk of all-cause, CVD and cancer mortality associated with an elevated BMI was significant at levels above 30 kg/m2; however, overweight individuals (BMI 25-29.9 kg/m2) also had an approximately 60% higher risk of CVD mortality.