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Hoyek K, Libman I, Mkparu N, Hong YH, Arslanian S, Vajravelu ME. Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes. BMJ Open Diabetes Res Care 2024; 12:e003968. [PMID: 38631820 PMCID: PMC11029253 DOI: 10.1136/bmjdrc-2023-003968] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Among youth with type 1 diabetes (T1D), longitudinal poor glycemic control is associated with adverse socioeconomic conditions at the neighborhood level. Child Opportunity Index (COI), which encompasses measures of education, health, environment, social, and economic factors, is associated with obesity in youth but has not been evaluated in youth with new-onset T1D or type 2 diabetes (T2D). We hypothesized that lower COI would be associated with adverse clinical outcomes at diabetes diagnosis, and due to differing risk factors and pathophysiology, that youth with new-onset T2D would have lower COI than youth with T1D. RESEARCH DESIGN AND METHODS Retrospective cohort of youth with new-onset diabetes admitted to a large academic pediatric hospital. COI was compared by diabetes type using t-tests and Χ2 tests. Multivariable linear and logistic regression analyses were used to evaluate associations between COI and clinical characteristics, stratified by diabetes type and adjusted for age and sex. RESULTS The cohort (n=484) differed in race and age by diabetes type (T1D: n=389; 10.0% black, 81.2% white; age 9.6±0.2 years; T2D: n=95; 44.2% black, 48.4% white; age 14.8±0.3 years). Youth with T2D had lower COI (p<0.001). Low COI was associated with diabetic ketoacidosis in T1D and T2D. Black youth with low COI had the highest hemoglobin A1c among youth with T2D and the highest obesity prevalence among youth with T1D. CONCLUSIONS COI is associated with differing characteristics at diagnosis in youth-onset T1D and T2D but is worse among youth with T2D overall. These findings underscore the need to address socioeconomic adversity when designing interventions to reduce T2D risk and to improve outcomes at diabetes diagnosis in youth.
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Affiliation(s)
- Kim Hoyek
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ingrid Libman
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nkeiruka Mkparu
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yong Hee Hong
- Pediatrics, Soonchunhyang University Hospital Bucheon, Bucheon, Gyeonggi-do, Korea (the Republic of)
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Sivadas A, Sahana S, Jolly B, Bhoyar RC, Jain A, Sharma D, Imran M, Senthivel V, Divakar MK, Mishra A, Mukhopadhyay A, Gibson G, Narayan KV, Sivasubbu S, Scaria V, Kurpad AV. Landscape of pharmacogenetic variants associated with non-insulin antidiabetic drugs in the Indian population. BMJ Open Diabetes Res Care 2024; 12:e003769. [PMID: 38471670 PMCID: PMC10936492 DOI: 10.1136/bmjdrc-2023-003769] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Genetic variants contribute to differential responses to non-insulin antidiabetic drugs (NIADs), and consequently to variable plasma glucose control. Optimal control of plasma glucose is paramount to minimizing type 2 diabetes-related long-term complications. India's distinct genetic architecture and its exploding burden of type 2 diabetes warrants a population-specific survey of NIAD-associated pharmacogenetic (PGx) variants. The recent availability of large-scale whole genomes from the Indian population provides a unique opportunity to generate a population-specific map of NIAD-associated PGx variants. RESEARCH DESIGN AND METHODS We mined 1029 Indian whole genomes for PGx variants, drug-drug interaction (DDI) and drug-drug-gene interactions (DDGI) associated with 44 NIADs. Population-wise allele frequencies were estimated and compared using Fisher's exact test. RESULTS Overall, we found 76 known and 52 predicted deleterious common PGx variants associated with response to type 2 diabetes therapy among Indians. We report remarkable interethnic differences in the relative cumulative counts of decreased and increased response-associated alleles across NIAD classes. Indians and South Asians showed a significant excess of decreased metformin response-associated alleles compared with other global populations. Network analysis of shared PGx genes predicts high DDI risk during coadministration of NIADs with other metabolic disease drugs. We also predict an increased CYP2C19-mediated DDGI risk for CYP3A4/3A5-metabolized NIADs, saxagliptin, linagliptin and glyburide when coadministered with proton-pump inhibitors (PPIs). CONCLUSIONS Indians and South Asians have a distinct PGx profile for antidiabetes drugs, marked by an excess of poor treatment response-associated alleles for various NIAD classes. This suggests the possibility of a population-specific reduced drug response in atleast some NIADs. In addition, our findings provide an actionable resource for accelerating future diabetes PGx studies in Indians and South Asians and reconsidering NIAD dosing guidelines to ensure maximum efficacy and safety in the population.
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Affiliation(s)
- Ambily Sivadas
- St John's Research Institute, Bangalore, Karnataka, India
| | - S Sahana
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Bani Jolly
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Rahul C Bhoyar
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Abhinav Jain
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Disha Sharma
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Mohamed Imran
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Vigneshwar Senthivel
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Mohit Kumar Divakar
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Anushree Mishra
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | | | - Greg Gibson
- Georgia Institute of Technology, Atlanta, Georgia, USA
| | | | - Sridhar Sivasubbu
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Vinod Scaria
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Heathcote LE, Pollard DJ, Brennan A, Davies MJ, Eborall H, Edwardson CL, Gillett M, Gray LJ, Griffin SJ, Hardeman W, Henson J, Khunti K, Sharp S, Sutton S, Yates T. Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes: an economic evaluation of the 48-month PROPELS randomized controlled trial. BMJ Open Diabetes Res Care 2024; 12:e003516. [PMID: 38471669 DOI: 10.1136/bmjdrc-2023-003516] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D. MATERIALS AND METHODS We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective. RESULTS Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years. CONCLUSIONS We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect. TRIAL REGISTRATION NUMBER ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245.
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Affiliation(s)
| | - Daniel J Pollard
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Melanie J Davies
- Diabetes Research Department, University of Leicester, Leicester, UK
| | - Helen Eborall
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Michael Gillett
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | | | | | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Department, University of Leicester, Leicester, UK
| | | | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Montero AR, Nassar CM, Ahmed S, Magee M. Pilot feasibility and efficacy of a strategy to sustain A1C improvement among diverse adults with type 2 diabetes completing a diabetes care management program. BMJ Open Diabetes Res Care 2024; 12:e003788. [PMID: 38471671 DOI: 10.1136/bmjdrc-2023-003788] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Evidence-based strategies are needed to sustain improvements in outcomes following diabetes care management (DCM) programs. We examined the impact of Boot Camp-Plus (BC-Plus), an innovative sustaining strategy, on A1C among adults with type 2 diabetes completing a 3-month Diabetes Boot Camp (DBC). This health system sponsored program consisted of diabetes self-management education and support, medical nutrition therapy and antihyperglycemic medications management. RESEARCH DESIGN AND METHODS From March 2019 to July 2021, adult DBC completers with Medicare or a health system Medicaid or employee commercial plan were enrolled in BC-Plus for 9 months. DBC completers not meeting insurance eligibility or who declined to participate in BC-Plus acted as controls. During the first 3 months, BC-Plus participants received ongoing daily remote blood glucose (BG) monitoring; and during all 9 months, they received monthly check-in calls with BG review by a medical assistant who addressed needs for supplies/drugs, whether participants were checking BGs, and self-care encouragement. Escalation to a nurse practitioner occurred if the monthly BG trend was >200 mg/dL and/or several BG <80 mg/dL and/or new A1C >9.0% were identified. A1C was followed for an additional 9 months post-BC-Plus. A longitudinal mixed effects analysis was used to assess change in A1C from month 0 to month 21 of follow-up between BC-Plus participants versus controls. RESULTS A total of 838 DCM completers were identified, among whom 281 joined the BC-Plus intervention and 557 acted as controls. Mean age was 55.9 years; 58.2% were women; 66.2% were black; and 30.6% insured by Medicare. BC-Plus participants experienced significantly lower A1C compared with controls and remained below 8.0% to month 18. CONCLUSIONS Among completers of a 3-month DCM program, a low intensity 9-month sustaining strategy maintained A1C under 8.0% (HEDIS (Healthcare Effectiveness Data and Information Set) threshold for diabetes control) compared with controls for 15 months after completion of the initial DCM intervention.
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Affiliation(s)
- Alex Renato Montero
- MedStar Diabetes Institute, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
- Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Carine M Nassar
- MedStar Diabetes Institute, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Saba Ahmed
- Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Michelle Magee
- MedStar Diabetes Institute, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- MedStar Washington Hospital Center, Washington, DC, USA
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Aroda VR, Nielsen N, Mangla KK, Multani J, Divino V, Namvar T, Rajpura J. Greater persistence and adherence to basal insulin therapy is associated with lower healthcare utilization and medical costs in patients with type 2 diabetes: a retrospective database analysis. BMJ Open Diabetes Res Care 2024; 12:e003825. [PMID: 38442988 DOI: 10.1136/bmjdrc-2023-003825] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION We aimed to assess persistence and adherence to basal insulin therapy, their association with all-cause healthcare resource utilization (HCRU) and direct medical costs, and predictors of persistence and adherence in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS A retrospective cohort study was conducted with US adults with type 2 diabetes initiating basal insulin therapy between January 1, 2016, and December 31, 2018, using IQVIA PharMetrics Plus claims data. Persistence and adherence were assessed during 1 year post-initiation per previous definitions. Demographic/clinical characteristics were assessed during the 1 year pre-initiation. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding variables. Post-IPTW, all-cause HCRU and direct medical costs were assessed during the first-year and second-year post-initiation by persistence and adherence status. Multivariable logistic regression was used to identify predictors of persistence and adherence. RESULTS The final sample comprised 64,953 patients; 56.8% demonstrated persistence and 41.9% demonstrated adherence. Patients demonstrating persistence and adherence were significantly less likely to have a hospitalization than patients demonstrating non-persistence or non-adherence, respectively. In the second-year post-initiation, total mean all-cause direct medical costs per patient were lower for patients demonstrating persistence and significantly lower for patients demonstrating adherence. Prior use of both oral and injectable antidiabetic medication predicted persistence and adherence compared with patients with only prior oral antidiabetic medication use (persistence OR, 1.50 (95% CI, 1.44 to 1.57); adherence OR, 1.48 (95% CI, 1.42 to 1.55)). CONCLUSIONS Persistence and adherence to basal insulin was associated with fewer hospitalizations and lower direct medical costs.
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Affiliation(s)
- Vanita R Aroda
- Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Iriarte-Campo V, de Burgos-Lunar C, Mostaza J, Lahoz C, Cárdenas-Valladolid J, Gómez-Campelo P, Taulero-Escalera B, San-Andrés-Rebollo FJ, Rodriguez-Artalejo F, Salinero-Fort MA. Incidence of T2DM and the role of baseline glycaemic status as a determinant in a metropolitan population in northern Madrid (Spain). Diabetes Res Clin Pract 2024; 209:111119. [PMID: 38307139 DOI: 10.1016/j.diabres.2024.111119] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
AIM To estimate the incidence of T2DM and assess the effect of pre-T2DM (isolated impaired fasting glucose [iIFG], isolated impaired glucose tolerance [iIGT] or both) on progress to T2DM in the adult population of Madrid. METHODS Population-based cohort comprising 1,219 participants (560 normoglycaemic and 659 preT2DM [418 iIFG, 70 iIGT or 171 IFG-IGT]). T2DM was defined based on fasting plasma glucose or HbA1c or use of glucose-lowering medication. We used a Cox model with normoglycaemia as reference category. RESULTS During 7.26 years of follow-up, the unadjusted incidence of T2DM was 11.21 per 1000 person-years (95 %CI, 9.09-13.68) for the whole population, 5.60 (3.55-8.41) for normoglycaemic participants and 16.28 (12.78-20.43) for pre-T2DM participants. After controlling for potential confounding factors, the baseline glycaemic status was associated with higher primary effect on developing T2DM was iIGT (HR = 3.96 [95 %CI, 1.93-8.10]) and IFG-IGT (3.42 [1.92-6.08]). The HR for iIFG was 1.67 (0.96-2.90). Obesity, as secondary effect, was strongly significantly associated (HR = 2.50 [1.30-4.86]). CONCLUSIONS Our incidence of T2DM is consistent with that reported elsewhere in Spain. While baseline iIGT and IFG-IGT behaved a primary effect for progression to T2DM, iIFG showed a trend in this direction.
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Affiliation(s)
- V Iriarte-Campo
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain; Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community - Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain
| | - C de Burgos-Lunar
- Department of Preventive Medicine, San Carlos Clinical University Hospital, Madrid, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
| | - J Mostaza
- Lipid and Vascular Risk Unit, Department of Internal Medicine, Hospital Carlos III, Madrid, Spain
| | - C Lahoz
- Lipid and Vascular Risk Unit, Department of Internal Medicine, Hospital Carlos III, Madrid, Spain
| | - J Cárdenas-Valladolid
- Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community - Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain; Alfonso X El Sabio University, Madrid, Spain
| | - P Gómez-Campelo
- Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community - Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain; La Paz University Hospital Biomedical Research Foundation, Madrid, Spain
| | - B Taulero-Escalera
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain; Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community - Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain
| | - F J San-Andrés-Rebollo
- Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community - Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain; Centro de Salud Las Calesas, Madrid, Spain
| | - F Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain; CIBERESP, Madrid, Spain; IMDEA-Food, CEI UAM+CSIC Madrid, Spain
| | - M A Salinero-Fort
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain; Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community - Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain.
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Hansotte E, Andrea SB, Weathers TD, Stone C, Jessup A, Staten LK. Impact of community health workers on diabetes management in an urban United States Community with high diabetes burden through the COVID pandemic. Prev Med Rep 2024; 39:102645. [PMID: 38370984 PMCID: PMC10869924 DOI: 10.1016/j.pmedr.2024.102645] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Community Health Worker (CHW) interventions are promising approaches to increasing access to health care, garnering better health outcomes, and decreasing health inequities for historically marginalized populations. This study examines the impact of a health system-based CHW program embedded in the Diabetes Impact Project - Indianapolis Neighborhoods (DIP-IN), a large, place-based, multi-year intervention to reduce diabetes burden. We assessed the CHW program's effectiveness in managing glucose control and reducing diabetes-associated complications across the COVID timeline. Methods We examined the association between the CHW intervention and diabetes management in 454 CHW patients and 1,020 propensity score-matched comparison patients. Using electronic medical records for encounters between January 1, 2017, and March 31, 2022, we estimated the CHW program effect using a difference-in-difference approach through generalized linear mixed models. Results Participation was associated with a significant reduction (-0.54-unit (95 % CI: -0.73, -0.35) in glycosylated hemoglobin (A1C) on average over time that was beyond the change observed among comparison patients, higher odds of having ≥ 2 A1C measures in a year (OR = 2.32, 95 % CI: 1.79, 3.00), lower odds of ED visits (OR: 0.88; 95 % CI: 0.73, 1.05), and lower odds of hospital admission (OR: 0.81; 95 % CI: 0.60,1.09). When analyses were restricted to a pre-pandemic timeframe, the pattern of results were similar. Conclusion This program was effective in improving diabetes management among patients living in diabetes-burdened communities, and the effects were persistent throughout the pandemic timeline. CHW programs offer crucial reinforcement for diabetes management during periods when routine healthcare access is constrained.
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Affiliation(s)
- Elinor Hansotte
- Marion County Public Health Department, 3838 N. Rural St., Indianapolis, IN 46205, United States
| | - Sarah B. Andrea
- Oregon Health & Science University-Portland State University School of Public Health, Vanport Building, 1810 SW 5 Ave., Suite 510, Portland, OR 97201, United States
| | - Tess D. Weathers
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| | - Cynthia Stone
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| | - Alisha Jessup
- Eskenazi Health, 720 Eskenazi Ave., Indianapolis, IN 46202, United States
| | - Lisa K. Staten
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
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Lenzi J, Messina R, Rosa S, Iommi M, Rucci P, Pia Fantini M, Di Bartolo P. A multi-state analysis of disease trajectories and mental health transitions in patients with type 2 diabetes: A population-based retrospective cohort study utilizing health administrative data. Diabetes Res Clin Pract 2024; 209:111561. [PMID: 38325659 DOI: 10.1016/j.diabres.2024.111561] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
AIMS To investigate the risk of major depression and dementia in patients with type 2 diabetes, including dementia resulting from depression, and their impact on diabetes-related complications and mortality. METHODS We conducted a population-based retrospective cohort study including 11,441 incident cases of diabetes in 2015-2017, with follow-up until 2022. A multi-state survival analysis was performed on a seven-state model with 15 transitions to capture disease progression and onset of mental disorders. RESULTS Eight-year probabilities of depression, dementia, diabetes-related complications, and death were 9.7% (95% CI 8.7-10.7), 0.9% (95% CI 0.5-1.3), 10.4% (95% CI 9.5-11.4), and 14.8% (95% CI 13.9-15.7), respectively. Depression increased the risk of dementia up to 3.7% (95% CI 2.0-5.4), and up to 10.3% (95% CI 0.3-20.4) if coupled with diabetes complications. Eight-year mortality was 37.5% (95% CI 33.1-42.0) after depression, 74.1% (95% CI 63.7-84.5) after depression plus complications, 76.4% (95% CI 68.8-83.9) after dementia, and 98.6% (95% CI 96.1-100.0) after dementia plus complications. CONCLUSIONS The interconnections observed across depression, dementia, complications, and mortality underscore the necessity for comprehensive and integrated approaches in managing diabetes. Early screening for depression, followed by timely and targeted interventions, may mitigate the risk of dementia and improve diabetes prognosis.
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Affiliation(s)
- Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Di Bartolo
- Diabetes Unit, Local Healthcare Authority of Romagna, Ravenna, Italy
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Oviedo SA, McDonald B, Gander JC, Ali MK, Harding JL. Access to telehealth and changes in diabetes care patterns during the pandemic: evidence from a large integrated health system in the Southeast USA. BMJ Open Diabetes Res Care 2024; 12:e003882. [PMID: 38413175 PMCID: PMC10900384 DOI: 10.1136/bmjdrc-2023-003882] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION To examine the role of telehealth in diabetes care and management during versus pre-COVID-19 pandemic. RESEARCH DESIGN AND METHODS We included adults (≥18 years) with prevalent diabetes as of January 1, 2018, and continuously enrolled at Kaiser Permanente Georgia through December 31, 2021 (n=22,854). We defined pre (2018-2019) and during COVID-19 (2020-2021) periods. Logistic generalized estimating equations (GEEs) assessed the within-subject change in adherence to seven annual routine care processes (blood pressure (BP), hemoglobin A1C (HbA1c), cholesterol, creatinine, urine-albumin-creatinine ratio (UACR), eye and foot examinations) pre versus during COVID-19 among telehealth users (ie, more than one telehealth visit per year per period) and non-telehealth users. Linear GEE compared mean laboratory measurements pre versus during COVID-19 by telehealth use. RESULTS The proportion of telehealth users increased from 38.7% (2018-2019) to 91.5% (2020-2021). During (vs pre) the pandemic, adherence to all care processes declined in telehealth (range: 1.6% for foot examinations to 12.4% for BP) and non-telehealth users (range: 1.9% for foot examinations to 40.7% for BP). In telehealth users, average HbA1c (mean difference: 0.4% (95% CI 0.2% to 0.6%), systolic BP (1.62 mm Hg (1.44 to 1.81)), and creatinine (0.03 mg/dL (0.02 to 0.04)), worsened during (vs pre) COVID-19, while low density lipoprotein (LDL) cholesterol improved (-9.08 mg/dL (-9.77 to -8.39)). For UACR, odds of elevated risk of kidney disease increased by 48% (OR 1.48 (1.36-1.62)). Patterns were similar in non-telehealth users. CONCLUSIONS Telehealth use increased during the pandemic and alleviated some of the observed declines in routine diabetes care and management.
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Affiliation(s)
- Sofia A Oviedo
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | | | - Mohammed K Ali
- Family and Preventive Medicine, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Jessica L Harding
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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10
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LeBlanc ES, Pittas AG, Nelson J, Chatterjee R, Rasouli N, Rhee MK, Pratley RE, Desouza CV, Neff LM, Peters AM, Dagogo-Jack S, Hsia DS. Racial differences in measures of glycemia in the Vitamin D and Type 2 Diabetes (D2d) Study: a secondary analysis of a randomized trial. BMJ Open Diabetes Res Care 2024; 12:e003613. [PMID: 38350671 PMCID: PMC10862329 DOI: 10.1136/bmjdrc-2023-003613] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Understanding how race may influence the association between A1c and glycemia can improve diabetes screening. We sought to determine whether, for a given A1c level, glucose levels during an oral glucose tolerance test (OGTT) differed by race. RESEARCH DESIGN AND METHODS From data collected at 22 US clinical sites, we conducted a cross-sectional study of concurrently measured A1c and OGTT and observational longitudinal follow-up of the subset with high-risk pre-diabetes. Numerical integration methods were used to calculate area under the glycemic curve (AUCglu) during OGTT and least squares regression model to estimate A1c for a given AUCglu by race, controlling for potential confounders. RESULTS 1016 black, 2658 white, and 193 Asian persons at risk of diabetes were included in cross-sectional analysis. Of these, 2154 with high-risk pre-diabetes were followed for 2.5 years. For a given A1c level, AUCglu was lower in black versus white participants. After adjustment for potential confounders, A1c levels for a given AUCglu quintile were 0.15-0.20 and 0.02-0.19 percentage points higher in black and Asian compared with white participants, respectively (p<0.05). In longitudinal analyses, black participants were more likely to be diagnosed with diabetes by A1c than white participants (28% vs 10%, respectively; p<0.01). Black and Asian participants were less likely to be diagnosed by fasting glucose than white participants (16% vs 15% vs 37%, respectively; p<0.05). Black participants with A1c levels in the lower-level quintiles had greater increase in A1c over time compared with white participants. CONCLUSIONS Use of additional testing beyond A1c to screen for diabetes may better stratify diabetes risk in the diverse US population.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jason Nelson
- Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Neda Rasouli
- Endocrinology, Metabolism and Diabetes, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
- Endocrinology, VA Eastern Colorado Health Care System, Denver, Colorado, USA
| | - Mary K Rhee
- Medicine/Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Richard E Pratley
- Translational Research Institute, AdventHealth Research Institute, Orlando, Florida, USA
| | | | - Lisa M Neff
- Northwestern Medicine, Chicago, Illinois, USA
| | - Anne M Peters
- Endocrinology, USC, Manhattan Beach, California, USA
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism General Clinical Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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11
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Chang R, Philip J, Javed U, Titus A, Gardezi SK, Kundi H, Yousefzai R, Hyder AA, Mossialos E, Nasir K, Javed Z. Unfavorable social determinants of health and risk of mortality in adults with diabetes: findings from the National Health Interview Survey. BMJ Open Diabetes Res Care 2024; 12:e003710. [PMID: 38290988 PMCID: PMC10828867 DOI: 10.1136/bmjdrc-2023-003710] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Understanding the role of social determinants of health as predictors of mortality in adults with diabetes may help improve health outcomes in this high-risk population. Using population-based, nationally representative data, this study investigated the cumulative effect of unfavorable social determinants on all-cause mortality in adults with diabetes. RESEARCH DESIGN AND METHODS We used data from the 2013-2018 National Health Interview Survey, linked to the National Death Index through 2019, for mortality ascertainment. A total of 47 individual social determinants of health were used to categorize participants in quartiles denoting increasing levels of social disadvantage. Poisson regression was used to report age-adjusted mortality rates across increasing social burden. Multivariable Cox proportional hazards models were used to assess the association between cumulative social disadvantage and all-cause mortality in adults with diabetes, adjusting for traditional risk factors. RESULTS The final sample comprised 182 445 adults, of whom 20 079 had diabetes. In the diabetes population, mortality rate increased from 1052.7 per 100 000 person-years in the first quartile (Q1) to 2073.1 in the fourth quartile (Q4). In multivariable models, individuals in Q4 experienced up to twofold higher mortality risk relative to those in Q1. This effect was observed similarly across gender and racial/ethnic subgroups, although with a relatively stronger association for non-Hispanic white participants compared with non-Hispanic black and Hispanic subpopulations. CONCLUSIONS Cumulative social disadvantage in individuals with diabetes is associated with over twofold higher risk of mortality, independent of established risk factors. Our findings call for action to screen for unfavorable social determinants and design novel interventions to mitigate the risk of mortality in this high-risk population.
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Affiliation(s)
- Ryan Chang
- Baylor College of Medicine, Houston, Texas, USA
| | - Jerrin Philip
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Umair Javed
- Combined Military Hospital Lahore, Lahore, Pakistan
| | - Anoop Titus
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Harun Kundi
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Raman Yousefzai
- AT Still University Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Adnan A Hyder
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Elias Mossialos
- Health Policy, The London School of Economics and Political Science, London, UK
| | - Khurram Nasir
- Houston Methodist Academic Institute, Houston, Texas, USA
- Center for Cardiovascular Computational Health and Precision Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Zulqarnain Javed
- Houston Methodist Academic Institute, Houston, Texas, USA
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Cardiovascular Computational Health and Precision Medicine, Houston Methodist Hospital, Houston, Texas, USA
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12
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Doran W, Tunnicliffe L, Muzambi R, Rentsch CT, Bhaskaran K, Smeeth L, Brayne C, Williams DM, Chaturvedi N, Eastwood SV, Dunachie SJ, Mathur R, Warren-Gash C. Incident dementia risk among patients with type 2 diabetes receiving metformin versus alternative oral glucose-lowering therapy: an observational cohort study using UK primary healthcare records. BMJ Open Diabetes Res Care 2024; 12:e003548. [PMID: 38272537 PMCID: PMC10823924 DOI: 10.1136/bmjdrc-2023-003548] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION 4.2 million individuals in the UK have type 2 diabetes, a known risk factor for dementia and mild cognitive impairment (MCI). Diabetes treatment may modify this association, but existing evidence is conflicting. We therefore aimed to assess the association between metformin therapy and risk of incident all-cause dementia or MCI compared with other oral glucose-lowering therapies (GLTs). RESEARCH DESIGN AND METHODS We conducted an observational cohort study using the Clinical Practice Research Datalink among UK adults diagnosed with diabetes at ≥40 years between 1990 and 2019. We used an active comparator new user design to compare risks of dementia and MCI among individuals initially prescribed metformin versus an alternative oral GLT using Cox proportional hazards regression controlling for sociodemographic, lifestyle and clinical confounders. We assessed for interaction by age and sex. Sensitivity analyses included an as-treated analysis to mitigate potential exposure misclassification. RESULTS We included 211 396 individuals (median age 63 years; 42.8% female), of whom 179 333 (84.8%) initiated on metformin therapy. Over median follow-up of 5.4 years, metformin use was associated with a lower risk of dementia (adjusted HR (aHR) 0.86 (95% CI 0.79 to 0.94)) and MCI (aHR 0.92 (95% CI 0.86 to 0.99)). Metformin users aged under 80 years had a lower dementia risk (aHR 0.77 (95% CI 0.68 to 0.85)), which was not observed for those aged ≥80 years (aHR 0.95 (95% CI 0.87 to 1.05)). There was no interaction with sex. The as-treated analysis showed a reduced effect size compared with the main analysis (aHR 0.90 (95% CI 0.83 to 0.98)). CONCLUSIONS Metformin use was associated with lower risks of incident dementia and MCI compared with alternative GLT among UK adults with diabetes. While our findings are consistent with a neuroprotective effect of metformin against dementia, further research is needed to reduce risks of confounding by indication and assess causality.
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Affiliation(s)
- William Doran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Louis Tunnicliffe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rutendo Muzambi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Susanna J Dunachie
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rohini Mathur
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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13
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Molnár GA, Vokó Z, Sütő G, Rokszin G, Nagy D, Surján G, Surján O, Nagy P, Kenessey I, Wéber A, Pálosi M, Müller C, Kásler M, Wittmann I, Kiss Z. Effectiveness of SARS-CoV-2 primary vaccines and boosters in patients with type 2 diabetes mellitus in Hungary (HUN-VE 4 Study). BMJ Open Diabetes Res Care 2024; 12:e003777. [PMID: 38267204 PMCID: PMC10823926 DOI: 10.1136/bmjdrc-2023-003777] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus is a risk factor for severe COVID-19 infection and is associated with increased risk of complications. The present study aimed to investigate effectiveness and persistence of different COVID vaccines in persons with or without diabetes during the Delta wave in Hungary. RESEARCH DESIGN AND METHODS Data sources were the national COVID-19 registry data from the National Public Health Center and the National Health Insurance Fund on the total Hungarian population. The adjusted incidence rate ratios and corresponding 95% CIs were derived from a mixed-effect negative binomial regression model. RESULTS A population of 672 240 cases with type 2 diabetes and a control group of 2 974 102 non-diabetic persons free from chronic diseases participated. Unvaccinated elderly persons with diabetes had 2.68 (95% CI 2.47 to 2.91) times higher COVID-19-related mortality rate as the 'healthy' controls. Primary immunization effectively equalized the risk of COVID-19 mortality between the two groups. Vaccine effectiveness declined over time, but the booster restored the effectiveness against mortality to over 90%. The adjusted vaccine effectiveness of the primary Pfizer-BioNTech against infection in the 14-120 days of postvaccination period was 71.6 (95% CI 66.3 to 76.1)% in patients aged 65-100 years with type 2 diabetes and 64.52 (95% CI 59.2 to 69.2)% in the controls. Overall, the effectiveness tended to be higher in individuals with diabetes than in controls. The booster vaccines could restore vaccine effectiveness to over 80% concerning risk of infection (eg, patients with diabetes aged 65-100 years: 89.1 (88.1-89.9)% with Pfizer-on-Pfizer, controls 65-100 years old: 86.9 (85.8-88.0)% with Pfizer-on-Pfizer, or patients with diabetes aged 65-100 years: 88.3 (87.2-89.2)% with Pfizer-on-Sinopharm, controls 65-100 years old: 87.8 (86.8-88.7)% with Pfizer-on-Sinopharm). CONCLUSIONS Our data suggest that people with type 2 diabetes may have even higher health gain when getting vaccinated as compared with non-diabetic persons, eliminating the marked, COVID-19-related excess risk of this population. Boosters could restore protection.
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Affiliation(s)
- Gergő A Molnár
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Gábor Sütő
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | | | - Dávid Nagy
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - György Surján
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
| | - Orsolya Surján
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Péter Nagy
- National Institute of Oncology, Budapest, Hungary
- Institute of Oncochemistry, University of Debrecen, Debrecen, Hungary
| | - István Kenessey
- National Institute of Oncology, Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - András Wéber
- National Institute of Oncology, Budapest, Hungary
| | | | - Cecília Müller
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Miklós Kásler
- National Institute of Oncology, Budapest, Hungary
- Central-Eastern European Academy of Oncology, Budapest, Hungary
| | - István Wittmann
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Zoltan Kiss
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
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14
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Hu H, Nakagawa T, Honda T, Yamamoto S, Mizoue T. Should insulin resistance (HOMA-IR), insulin secretion (HOMA-β), and visceral fat area be considered for improving the performance of diabetes risk prediction models. BMJ Open Diabetes Res Care 2024; 12:e003680. [PMID: 38191206 PMCID: PMC10806829 DOI: 10.1136/bmjdrc-2023-003680] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/19/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Insulin resistance and defects in pancreatic beta cells are the two major pathophysiologic abnormalities that underlie type 2 diabetes. In addition, visceral fat area (VFA) is reported to be a stronger predictor for diabetes than body mass index (BMI). Here, we tested whether the performance of diabetes prediction models could be improved by adding HOMA-IR and HOMA-β and replacing BMI with VFA. RESEARCH DESIGN AND METHODS We developed five prediction models using data from a cohort study (5578 individuals, of whom 94.7% were male, and 943 had incident diabetes). We conducted a baseline model (model 1) including age, sex, BMI, smoking, dyslipidemia, hypertension, and HbA1c. Subsequently, we developed another four models: model 2, predictors in model 1 plus fasting plasma glucose (FPG); model 3, predictors in model 1 plus HOMA-IR and HOMA-β; model 4, predictors in model 1 plus FPG, HOMA-IR, and HOMA-β; model 5, replaced BMI with VFA in model 2. We assessed model discrimination and calibration for the first 10 years of follow-up. RESULTS The addition of FPG to model 1 obviously increased the value of the area under the receiver operating characteristic curve from 0.79 (95% CI 0.78, 0.81) to 0.84 (0.83, 0.85). Compared with model 1, model 2 also significantly improved the risk reclassification and discrimination, with a continuous net reclassification improvement index of 0.61 (0.56, 0.70) and an integrated discrimination improvement index of 0.09 (0.08, 0.10). Adding HOMA-IR and HOMA-β (models 3 and 4) or replacing BMI with VFA (model 5) did not further materially improve the performance. CONCLUSIONS This cohort study, primarily composed of male workers, suggests that a model with BMI, FPG, and HbA1c effectively identifies those at high diabetes risk. However, adding HOMA-IR, HOMA-β, or replacing BMI with VFA does not significantly improve the model. Further studies are needed to confirm our findings.
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Affiliation(s)
- Huan Hu
- Research Center for Prevention from Radiation Hazards of Workers, National Institute of Occupational Safety and Health, Kawasaki, Kanagawa, Japan
| | - Tohru Nakagawa
- Hitachi Health Care Center, Hitachi, Ltd, Hitachi, Ibaraki, Japan
| | - Toru Honda
- Hitachi Health Care Center, Hitachi, Ltd, Hitachi, Ibaraki, Japan
| | | | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Heath and Medicine, Tokyo, Japan
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15
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Song SH. Young-onset type 2 diabetes and retinopathy: evidence of an adverse phenotype. BMJ Open Diabetes Res Care 2024; 12:e003899. [PMID: 38167607 PMCID: PMC10773418 DOI: 10.1136/bmjdrc-2023-003899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Soon H Song
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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16
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Tibballs K, Jenum AK, Kirkebøen L, Berg TJ, Claudi T, Cooper JG, Nøkleby K, Sandberg S, Straand J, Buhl ES. High prevalence of retinopathy in young-onset type 2 diabetes and possible sex differences: insights from Norwegian general practice. BMJ Open Diabetes Res Care 2024; 12:e003624. [PMID: 38167605 PMCID: PMC10773319 DOI: 10.1136/bmjdrc-2023-003624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION People with young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, have a high lifetime risk of vascular complications. We aimed to estimate the prevalence of YOD among adults with type 2 diabetes (T2D) in Norwegian general practice and explore associations between age at diabetes diagnosis and retinopathy overall and in men and women. RESEARCH DESIGN AND METHODS We collected cross-sectional data from general practice electronic medical records of 10 241 adults with T2D in 2014, and repeated measurements of hemoglobin A1c (HbA1c) from 2012 to 2014. Using multivariate logistic regression, we assessed associations between YOD and later-onset T2D, sex and retinopathy. RESULTS Of all individuals with T2D, 10% were diagnosed before 40 years of age in both sexes. Compared with later-onset T2D, HbA1c increased faster in YOD, and at the time of diagnosis HbA1c was higher in men, particularly in YOD. Retinopathy was found in 25% with YOD, twice as frequently as in later onset. After adjustments for confounders (age, country of origin, education, body mass index), OR of retinopathy was increased in both men with YOD (OR 2.6 (95% CI 2.0 to 3.5)) and women with YOD (OR 2.2 (1.5 to 3.0)). After further adjustments for potential mediators (diabetes duration and HbA1c), the higher OR persisted in men with YOD (OR 1.8 (1.3 to 2.4)) but was attenuated and no longer significant for women with YOD. CONCLUSIONS Retinopathy prevalence was more than twice as high in YOD as in later-onset T2D. The increased likelihood of retinopathy in YOD was partly mediated by higher HbA1c and longer T2D duration, but after accounting for these factors it remained higher in men with YOD.
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Affiliation(s)
- Katrina Tibballs
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | | | - John Graham Cooper
- Norwegian Organization for Quality Improvement of Laboratory Examinations, Bergen, Norway
| | - Kjersti Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations, Bergen, Norway
| | - Jørund Straand
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- General Practice Research Unit, Oslo, Norway
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Abstract
Glucagon-like peptide-1 receptor (GLP-1R) agonists are approved treatments for Type 2 diabetes mellitus, with liraglutide and semaglutide also approved for the treatment of obesity. The natural gut hormone oxyntomodulin is a weak dual agonist of the glucagon receptor (GCGR) and GLP-1R. Development of poly-agonists mimicking oxyntomodulin, such as the novel dual GCGR/GLP-1R agonist survodutide, represents an important step towards a more effective treatment for people with Type 2 diabetes mellitus and obesity. Survodutide is a 29-amino acid peptide derived from glucagon, with the incorporation of potent GLP-1 activities. It contains a C18 diacid which mediates binding to albumin, thereby prolonging the half-life to enable once-weekly subcutaneous dosing. The utilisation of GCGR agonism aims to enhance body weight-lowering effects by increasing energy expenditure in addition to the anorectic action of GLP-1R agonists. Glucose-lowering efficacy of survodutide has been demonstrated in a Phase II trial in patients with Type 2 diabetes mellitus and obesity and was associated with clinically meaningful body weight loss. These data highlight the potential of dual GCGR/GLP-1R agonism for reducing glycated haemoglobin and body weight in patients with Type 2 diabetes mellitus, and for greater therapeutic efficacy compared with GLP-1R agonism alone.
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Affiliation(s)
- Thomas Klein
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Strasse 65, 88397, Biberach an der Riss, Germany
| | - Robert Augustin
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Strasse 65, 88397, Biberach an der Riss, Germany
| | - Anita M Hennige
- Boehringer Ingelheim International GmbH, Birkendorfer Strasse 65, 88397, Biberach an der Riss, Germany.
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18
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Hu T, Li C, Wang T, Liu H, Geng J, Gong A. Serum osmolality was non-linearly associated with the risk of all-cause and cardiovascular mortality in patients with diabetes. BMJ Open Diabetes Res Care 2023; 11:e003826. [PMID: 38135453 DOI: 10.1136/bmjdrc-2023-003826] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 12/24/2023] Open
Abstract
AIMS This study aimed to evaluate the relationship between both low and high osmolarity and the risk of all-cause and cause-specific mortality in diabetic population. METHODS All participants were included from the National Health and Nutrition Examination Survey 1999-2014. Baseline serum osmolality was determined from laboratory tests and cause of death from national death records. HRs and 95% CIs for all-cause mortality and cardiovascular mortality in diabetes were estimated using Cox proportional regression analysis. The non-linear relationship was explored using restricted cubic splines regression. RESULTS Among 7622 individuals with diabetes, 1983 (12.4%) died during a total of 3.26 thousand person-years of follow-up. Compared with the reference category (281-284 mmol/kg), the multivariable-adjusted HRs and 95% CIs for all-cause mortality were 1.27 (1.16-1.40; p<0.001) in the lowest osmolality category (<201 mmol/kg) and 1.18 (1.09-1.28; p<0.001) in the highest osmolality category (>312 mmol/kg). Restricted cubic splines results showed that serum levels of osmolality had a U-shaped association with the risk of all-cause mortality, and L-shaped relationship with the risk of cardiovascular death. CONCLUSIONS Both low osmolality and high osmolality were predictive of increased all-cause mortality in patients with diabetes, supporting a U-shaped relationship. Also, a lower serum osmolality increased the risk of cardiovascular mortality.
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Affiliation(s)
- Tingting Hu
- Departmet of Cardiology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu, China
| | - Chenglin Li
- Department of Cardiothoracic Surgery, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Tao Wang
- Jiangsu College of Nursing, Huai'an, Jiangsu, China
| | - Hailang Liu
- Departmet of Cardiology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu, China
| | - Jin Geng
- Departmet of Cardiology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu, China
| | - Aifeng Gong
- Department of General Practice, The Affiliated Hospital Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
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Gašparini D, Zuljani A, Wensveen FM, Turk Wensveen T. A cross-sectional study in type 2 diabetes patients reveals that elevated pulse wave velocity predicts asymptomatic peripheral arterial disease associated with age and diabetes duration. Int J Cardiol Heart Vasc 2023; 49:101308. [PMID: 38173786 PMCID: PMC10761307 DOI: 10.1016/j.ijcha.2023.101308] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024]
Abstract
Background Peripheral arterial disease (PAD) reduces functional capacity and raises cardiovascular risks, but underdiagnosis is common, resulting in less comprehensive care than other cardiovascular conditions. While diabetes has long been viewed as a key risk factor for PAD, recent studies indicate that its impact is influenced by the presence of concurrent cardiovascular risk factors. The aim of this study is to elucidate the intricate relationship between the prevalence of PAD, diabetic complications, and cardiovascular risk factors among asymptomatic patients with type 2 diabetes mellitus (T2DM). Methods Ninety-one patients with T2DM and no symptoms or previous diagnosis of PAD were recruited from the outpatient diabetic clinic. Clinical data were extracted from electronic medical records, and the screening for PAD was conducted using MESI mTABLET. Results Screening for PAD among asymptomatic individuals with T2DM revealed that 5.49 % of patients exhibit a low ankle-brachial index (ABI). Patients who had previously experienced major adverse cardiovascular events or exhibited albuminuria displayed lower ABI values. Furthermore, a striking 45.05 % of the participants displayed an abnormally high carotid-femoral pulse wave velocity (cfPWV) value, with elevated PWV values correlating with advanced age and longer diabetes duration. Conclusions The prevalence of elevated cfPWV is more pronounced than that of decreased ABI in T2DM patients with asymptomatic PAD and is associated with older age and longer diabetes duration, therefore measurement of both ABI and PWV is crucial for the cardiovascular risk assessment protocol for patients with T2DM and timely PAD diagnosis.
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Affiliation(s)
- Dora Gašparini
- Center for Diabetes, Endocrinology and Cardiometabolism, Special Hospital for Medical Rehabilitation of Cardiac, Pulmonary and Rheumatic diseases Thalassotherapia Opatija, Maršala Tita 188/1, 51410 Opatija, Croatia
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Anamaria Zuljani
- Department of Emergency Medicine, Clinical Hospital Center Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia
| | - Felix M. Wensveen
- Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Tamara Turk Wensveen
- Center for Diabetes, Endocrinology and Cardiometabolism, Special Hospital for Medical Rehabilitation of Cardiac, Pulmonary and Rheumatic diseases Thalassotherapia Opatija, Maršala Tita 188/1, 51410 Opatija, Croatia
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
- Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
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20
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Alexopoulos AS, Parish A, Olsen M, Batch BC, Moylan C, Crowley MJ. Prescribing of evidence-based diabetes pharmacotherapy in patients with metabolic dysfunction-associated steatohepatitis. BMJ Open Diabetes Res Care 2023; 11:e003763. [PMID: 38030391 PMCID: PMC10689360 DOI: 10.1136/bmjdrc-2023-003763] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Metabolic dysfunction-associated steatohepatitis (MASH) is highly prevalent in type 2 diabetes (T2D). Pioglitazone and glucagon-like peptide-1 receptor agonists (GLP-1RA) are medications used in T2D that can resolve MASH and should be considered in all patients with T2D and MASH. We assessed prescription rates of evidence-based T2D pharmacotherapy (EBP) in MASH, and ascertained racial/ethnic disparities in prescribing. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study on patients in Duke University Health System with diagnosis codes for T2D and MASH between January 2019 and January 2021. Only patients with ≥1 primary care or endocrinology encounter were included. The primary outcome was EBP, defined as ≥1 prescription for pioglitazone and/or a GLP-1RA during the study period. A multivariable logistic regression model was used to examine the primary outcome. RESULTS A total of 847 patients with T2D and MASH were identified; mean age was 59.7 (SD 12) years, 61.9% (n=524) were female, and 11.9% (n=101) and 4.6% (n=39) were of Black race and Latino/a/x ethnicity, respectively. EBP was prescribed in 34.8% (n=295). No significant differences were noted in the rates of EBP use across racial/ethnic groups (Latino/a/x vs White patients: adjusted OR (aOR) 1.82, 95% CI 0.78 to 4.28; Black vs White patients: aOR 0.76, 95% CI 0.44 to 1.33, p=0.20). CONCLUSIONS EBP prescriptions, especially pioglitazone, are low in patients with T2D and MASH, regardless of race/ethnicity. These data underscore the need for interventions to close the gap between current and evidence-based care.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Maren Olsen
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
| | - Cynthia Moylan
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - Matthew J Crowley
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
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Acosta-Gutiérrez MN, Hernández-Torres AP, Escamilla-Nuñez MC, Blanco-Muñoz J, Camarillo-Nava VM, Atrisco-Olivos R, Rodriguez-Garcia JDC. [Basic health indicators in the NutrIMSS program: a retrospective study]. Rev Med Inst Mex Seguro Soc 2023; 61:728-735. [PMID: 37995283 DOI: 10.5281/zenodo.10064287] [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] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/17/2023] [Indexed: 11/25/2023]
Abstract
Background The NutrIMSS program is granted to populations with chronic conditions to improve basic health indicators and its effectiveness in this population is unknown. Objective To analyze the change in the basic health indicators of patients who attended the NutrIMSS Program, at the UMF No. 2 of the IMSS in Mexico City, during the period 2018 to 2019. Material and methods From 105 files of IMSS beneficiaries, a retrospective cohort study was carried out considering two measurements, before and after the NutrIMSS program. To evaluate the average change over time of health indicators, GEE models (Generalized Estimation Equations) and multiple linear regression models were used. Statistical analysis was used using the statistical program StataCorp 2015. Results Patients who attended the Program showed changes between the beginning and end of the period with an average of three months of follow-up. They presented a decrease in the following health indicators: body weight of 1 kg, body mass index: 0.8 kg/m2, glucose of 13 mg/dL, triglycerides of 57 mg/dL and cholesterol of 17 mg/dL (p < 0.005 in all cases). There was no difference in the level of blood pressure. Conclusions The NutrIMSS program influenced the improvement of the health indicators of the population of the program and is an ally to improve the health of the IMSS beneficiary population.
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Affiliation(s)
- María Nayeli Acosta-Gutiérrez
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Unidad de Atención Médica, Coordinación de Unidades de Primer Nivel. División de Promoción a la Salud. Ciudad de México, México
| | - Alma Patricia Hernández-Torres
- Instituto Nacional de Salud Pública, Centro de Investigación en Salud Poblacional, Dirección de Salud Ambiental. Cuernavaca, Morelos, México
| | - María Consuelo Escamilla-Nuñez
- Instituto Nacional de Salud Pública, Centro de Investigación en Salud Poblacional, Dirección de Salud Ambiental. Cuernavaca, Morelos, México
| | - Julia Blanco-Muñoz
- Instituto Nacional de Salud Pública, Centro de Investigación en Salud Poblacional, Dirección de Salud Ambiental. Cuernavaca, Morelos, México
| | - Víctor Manuel Camarillo-Nava
- Instituto Mexicano del Seguro Social, Órgano de Operación Administrativa Desconcentrada Estatal Ciudad de México Norte, Coordinación Auxiliar Médica de Investigación en Salud. Ciudad de México, México
| | - Rosaura Atrisco-Olivos
- Instituto Nacional de Salud Pública, Escuela Nacional Escuela de Salud Pública de México, Coordinación de la Maestría en Salud Pública. Cuernavaca, Morelos, México
| | - Julia Del Carmen Rodriguez-Garcia
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Unidad de Atención Médica, Coordinación de Unidades de Primer Nivel. División de Promoción a la Salud. Ciudad de México, México
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Pagán L, Yang W, Shao H, Wang Y, Zhang P. Medical expenditure trajectory and HbA1c progression prior to and after clinical diagnosis of type 2 diabetes in a commercially insured population in the USA. BMJ Open Diabetes Res Care 2023; 11:e003397. [PMID: 37914345 PMCID: PMC10626875 DOI: 10.1136/bmjdrc-2023-003397] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/08/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Medical expenditures of individuals with type 2 diabetes escalate before clinical diagnosis. How increases in medical expenditures are related to glucose levels remains unclear. We examined changes in HbA1c and medical expenditures in years prior to and shortly after type 2 diabetes diagnosis. RESEARCH DESIGN AND METHODS Using insurance claims and laboratory test results from a commercially insured population in the USA, we built three (2014, 2015, 2016) longitudinal cohorts with type 2 diabetes up to 10 years before and 2 years after the diagnosis (index year). We identified diabetes diagnosis using International Classification of Diseases, Ninth Revision and Tenth Revision codes and antidiabetic medication use. We ran two individual fixed regression models with annual total medical expenditures and average HbA1c values as dependent variables and number of years from diagnosis as the main independent variable and examined the risk-adjusted movement of the outcomes. RESULTS Our study included 9847 individuals (83 526 person-years). Medical expenditures and HbA1c levels increased before and peaked at the diagnosis year. Medical expenditures were $8644 lower 10 years and $5781 lower 1 year before diagnosis compared with the index year. HbA1c was 12.18 mmol/mol (1.11 percentage points) and 3.49 mmol/mol (0.32 percentage points) lower, respectively. Average annual increases in medical expenditures and HbA1c values over the prediagnosis period were $318 and 0.97 mmol/mol (0.09 percentage points), respectively. CONCLUSIONS Medical expenditures and HbA1c values followed similar trajectories before and after diabetes diagnosis. Our results can inform economic evaluations of programs and policies aimed at preventing type 2 diabetes.
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Affiliation(s)
| | - Wenya Yang
- The Lewin Group, Falls Church, Virginia, USA
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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23
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Hessain D, Andersen A, Fredslund EK. Inequalities in healthcare utilisation among adults with type 2 diabetes. Diabetes Res Clin Pract 2023; 205:110982. [PMID: 37890705 DOI: 10.1016/j.diabres.2023.110982] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
AIMS To examine inequality in dentist, ophthalmologist, and podiatrist attendance among adults with type 2 diabetes in a country with varying degrees of co-payment. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study with a population of 41,181 people with type 2 diabetes resident in the Central Denmark Region in 2019, identified through Danish registers using a prespecified diabetes algorithm. Descriptive statistics and multiple logistic regression were used to examine the attendance at dentist, ophthalmologist, and podiatrist, controlling for sociodemographic and clinical factors. Attendance at dentist, ophthalmologist, and podiatrist were examined separately. RESULTS The majority (59.7 %) had attended the ophthalmologist at least once in the preceding year, whereas 46.5 % and 34.2 % had visited the dentist/dental hygienist and podiatrist, respectively. Disposable household income increased attendance significantly, with a clear gradient in the OR of attending the dentist (p < 0.001), whereas age significantly magnified the OR of podiatrist and ophthalmologist attendance (p < 0.001). CONCLUSIONS This study provides circumstantial evidence that co-payment can increase inequality in health care attendance, especially for dental attendance, and it further shows that there is significant sociodemographic inequality in healthcare utilisation among people with type 2 diabetes.
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Affiliation(s)
- Dunia Hessain
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Eskild Klausen Fredslund
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
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Bush KJ, Papacosta AO, Lennon LT, Rankin J, Whincup PH, Wannamethee SG, Ramsay SE. Influence of neighborhood-level socioeconomic deprivation and individual socioeconomic position on risk of developing type 2 diabetes in older men: a longitudinal analysis in the British Regional Heart Study cohort. BMJ Open Diabetes Res Care 2023; 11:e003559. [PMID: 37907278 PMCID: PMC10619023 DOI: 10.1136/bmjdrc-2023-003559] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Evidence from longitudinal studies on the influence of neighborhood socioeconomic deprivation in older age on the development of type 2 diabetes mellitus (T2DM) is limited. This study investigates the prospective associations of neighborhood-level deprivation and individual socioeconomic position (SEP) with T2DM incidence in older age. RESEARCH DESIGN AND METHODS The British Regional Heart Study studied 4252 men aged 60-79 years in 1998-2000. Neighborhood-level deprivation was based on the Index of Multiple Deprivation quintiles for participants' 1998-2000 residential postcode. Individual SEP was defined as social class based on longest-held occupation. A cumulative score of individual socioeconomic factors was derived. Incident T2DM cases were ascertained from primary care records; prevalent cases were excluded. Cox proportional hazard models were used to examine the associations. RESULTS Among 3706 men, 368 incident cases of T2DM were observed over 18 years. The age-adjusted T2DM risk increased from the least deprived quintile to the most deprived: HR per quintile increase 1.14 (95% CI 1.06 to 1.23) (p=0.0005). The age-adjusted T2DM HR in social class V (lowest) versus social class I (highest) was 2.45 (95% CI 1.36 to 4.42) (p=0.001). Both associations attenuated but remained significant on adjustment for other deprivation measures, becoming non-significant on adjustment for body mass index and T2DM family history. T2DM risk increased with cumulative individual adverse socioeconomic factors: HR per point increase 1.14 (95% CI 1.05 to 1.24). CONCLUSIONS Inequalities in T2DM risk persist in later life, both in relation to neighborhood-level and individual-level socioeconomic factors. Underlying modifiable risk factors continue to need to be addressed in deprived older age populations to reduce disease burden.
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Affiliation(s)
- Kathryn J Bush
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - A Olia Papacosta
- Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Primary Care and Population Health, University College London, London, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Primary Care and Population Health, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Mohammad A, Ziyab AH, Mohammad T. Anthropometric and DXA-derived measures of body composition in relation to pre-diabetes among adults. BMJ Open Diabetes Res Care 2023; 11:e003412. [PMID: 37793678 PMCID: PMC10551999 DOI: 10.1136/bmjdrc-2023-003412] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Abdominal obesity is the most common risk factor of pre-diabetes and diabetes. Currently, several types of indices are used for the determination of visceral fat-related abdominal obesity. To better understand the effect of the different adiposity indices, we sought to evaluate the association of different adiposity measurements, assessed using dual-energy X-ray absorptiometry (DXA), and pre-diabetes. RESEARCH DESIGN AND METHODS This cross-sectional study included 1184 adults between 18 and 65 years who participated in the Kuwait Wellbeing Study. Anthropometry measurements included body mass index (BMI) and waist-to-hip ratio. Total body fat (TBF) mass, android fat mass, gynoid fat, and visceral adipose tissue (VAT) mass were measured using the Lunar iDXA. Pre-diabetes was defined as 5.7≤HbA1c%≤6.4. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated. Area under the curve (AUC) was estimated for each adiposity measurement as predictor of pre-diabetes. RESULTS A total of 585 (49.4%) males and 599 (50.6%) females were enrolled in the study. Increased BMI (aPR obese vs normal=1.59, 95% CI: 1.19 to 2.12), waist-to-hip ratio (aPR Q4 vs Q1=1.25, 0.96 to 1.61), TBF (aPR Q4 vs Q1=1.58, 1.20 to 2.07), android fat (aPR Q4 vs Q1=1.67, 1.27 to 2.20), gynoid fat (aPR Q4 vs Q1=1.48, 1.16 to 1.89), android-to-gynoid fat ratio (aPR Q4 vs Q1=1.70, 1.27 to 2.28), and VAT mass (aPR Q4 vs Q1=2.05, 1.49 to 2.82) were associated with elevated pre-diabetes prevalence. Gynoid fat was associated with pre-diabetes among males (aPR Q4 vs Q1=1.71, 1.22 to 2.41), but not among females (aPR Q4 vs Q1=1.27, 0.90 to 1.78). Moreover, in terms of AUC, VAT had the highest estimated AUC of 0.680, followed by android-to-gynoid fat ratio (AUC: 0.647) and android fat (AUC: 0.646). CONCLUSIONS Pre-diabetes prevalence increased as adiposity measurements increased, with VAT mass demonstrating the highest AUC for pre-diabetes.
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Affiliation(s)
- Anwar Mohammad
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, College of Medicine, Kuwait University, Kuwait City, Kuwait
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Mandal S, Jaganathan S, Kondal D, Schwartz JD, Tandon N, Mohan V, Prabhakaran D, Narayan KMV. PM 2.5 exposure, glycemic markers and incidence of type 2 diabetes in two large Indian cities. BMJ Open Diabetes Res Care 2023; 11:e003333. [PMID: 37797962 PMCID: PMC10565186 DOI: 10.1136/bmjdrc-2023-003333] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Exposure to fine particulate matter has been associated with several cardiovascular and cardiometabolic diseases. However, such evidence mostly originates from low-pollution settings or cross-sectional studies, thus necessitating evidence from regions with high air pollution levels, such as India, where the burden of non-communicable diseases is high. RESEARCH DESIGN AND METHODS We studied the associations between ambient PM2.5 levels and fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and incident type 2 diabetes mellitus (T2DM) among 12 064 participants in an adult cohort from urban Chennai and Delhi, India. A meta-analytic approach was used to combine estimates, obtained from mixed-effects models and proportional hazards models, from the two cities. RESULTS We observed that 10 μg/m3 differences in monthly average exposure to PM2.5 was associated with a 0.40 mg/dL increase in FPG (95% CI 0.22 to 0.58) and 0.021 unit increase in HbA1c (95% CI 0.009 to 0.032). Further, 10 μg/m3 differences in annual average PM2.5 was associated with 1.22 (95% CI 1.09 to 1.36) times increased risk of incident T2DM, with non-linear exposure response. CONCLUSIONS We observed evidence of temporal association between PM2.5 exposure, and higher FPG and incident T2DM in two urban environments in India, thus highlighting the potential for population-based mitigation policies to reduce the growing burden of diabetes.
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Affiliation(s)
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, Delhi, India
| | - Joel D Schwartz
- Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, Delhi, India
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Ning Y, Pan D, Guo J, Su Z, Wang J, Wu S, Gu Y. Association of prognostic nutritional index with the risk of all-cause mortality and cardiovascular mortality in patients with type 2 diabetes: NHANES 1999-2018. BMJ Open Diabetes Res Care 2023; 11:e003564. [PMID: 37865393 PMCID: PMC10603407 DOI: 10.1136/bmjdrc-2023-003564] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/19/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION There is little bulk clinical evidence on nutritional status and mortality in patients with diabetes. The purpose of this study was to examine the relationship between prognostic nutritional index (PNI) and all-cause mortality and cardiovascular mortality in adults with diabetes. RESEARCH DESIGN AND METHODS This study included 5916 adult patients with diabetes from the National Health and Nutrition Examination Survey 1999-2018. Cox proportional risk models were used to estimate risk ratios (HRs) and 95% CIs for all-cause mortality, cardiovascular disease (CVD) mortality. RESULTS During a mean follow-up of 8.17 years, there were 1248 deaths from all causes and 370 deaths from CVD. After multivariate adjustment, the risk of all-cause mortality was reduced by 24%, 38%, and 28% in Q2 (49.0-52.99), Q3 (53.0-57.99), and Q4 (≥58.0), respectively, compared with Q1 (PNI<49.0). The risk of cardiovascular mortality was reduced by 30%, 27%, and 26%, respectively. Consistent results were observed in the subgroup analysis. CONCLUSIONS Lower serum PNI levels were significantly associated with higher all-cause and CVD mortality. These findings suggest that maintaining an appropriate range of serum PNI status may reduce the risk of death in patients with diabetes.
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Affiliation(s)
- Yachan Ning
- Department of Intensive Care Medicine, Xuanwu Hospital, Beijing, China
| | - Dikang Pan
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Julong Guo
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhixiang Su
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingyu Wang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Sensen Wu
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Vascular Department, Xuanwu Hospital, Capital Medical University, Beijing, China
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Trischitta V, Mastroianno M, Scarale MG, Prehn C, Salvemini L, Fontana A, Adamski J, Schena FP, Cosmo SD, Copetti M, Menzaghi C. Circulating metabolites improve the prediction of renal impairment in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2023; 11:e003422. [PMID: 37734903 PMCID: PMC10514631 DOI: 10.1136/bmjdrc-2023-003422] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Low glomerular filtration rate (GFR) is a leading cause of reduced lifespan in type 2 diabetes. Unravelling biomarkers capable to identify high-risk patients can help tackle this burden. We investigated the association between 188 serum metabolites and kidney function in type 2 diabetes and then whether the associated metabolites improve two established clinical models for predicting GFR decline in these patients. RESEARCH DESIGN AND METHODS Two cohorts comprising 849 individuals with type 2 diabetes (discovery and validation samples) and a follow-up study of 575 patients with estimated GFR (eGFR) decline were analyzed. RESULTS Ten metabolites were independently associated with low eGFR in the discovery sample, with nine of them being confirmed also in the validation sample (ORs range 1.3-2.4 per 1SD, p values range 1.9×10-2-2.5×10-9). Of these, five metabolites were also associated with eGFR decline (ie, tiglylcarnitine, decadienylcarnitine, total dimethylarginine, decenoylcarnitine and kynurenine) (β range -0.11 to -0.19, p values range 4.8×10-2 to 3.0×10-3). Indeed, tiglylcarnitine and kynurenine, which captured all the information of the other three markers, improved discrimination and reclassification (all p<0.01) of two clinical prediction models of GFR decline in people with diabetes. CONCLUSIONS Further studies are needed to validate our findings in larger cohorts of different clinical, environmental and genetic background.
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Affiliation(s)
- Vincenzo Trischitta
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
- Experimental Medicine, University of Rome La Sapienza, Rome, Italy
| | - Mario Mastroianno
- Scientific Direction, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Maria Giovanna Scarale
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Cornelia Prehn
- Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Lucia Salvemini
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Jerzy Adamski
- Institute of Experimental Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Biochemistry, National University Singapore Yong Loo Lin School of Medicine, Singapore
| | | | - Salvatore De Cosmo
- Unit of Internal Medicine, IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Claudia Menzaghi
- Research Unit of Diabetes and Endocrine Diseases, Istituti di Ricovero e Cura a Carattere Scientifico Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Ding Q, Lu Y, Herrin J, Zhang T, Marrero DG. Uncovering heterogeneous cardiometabolic risk profiles in US adults: the role of social and behavioral determinants of health. BMJ Open Diabetes Res Care 2023; 11:e003558. [PMID: 37699720 PMCID: PMC10503393 DOI: 10.1136/bmjdrc-2023-003558] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Social and behavioral determinants of health (SBDH) have been linked to diabetes risk, but their role in explaining variations in cardiometabolic risk across race/ethnicity in US adults is unclear. This study aimed to classify adults into distinct cardiometabolic risk subgroups using SBDH and clinically measured metabolic risk factors, while comparing their associations with undiagnosed diabetes and pre-diabetes by race/ethnicity. RESEARCH DESIGN AND METHODS We analyzed data from 38,476 US adults without prior diabetes diagnosis from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. The k-prototypes clustering algorithm was used to identify subgroups based on 16 SBDH and 13 metabolic risk factors. Each participant was classified as having no diabetes, pre-diabetes or undiagnosed diabetes using contemporaneous laboratory data. Logistic regression was used to assess associations between subgroups and diabetes status, focusing on differences by race/ethnicity. RESULTS Three subgroups were identified: cluster 1, primarily middle-aged adults with high rates of smoking, alcohol use, short sleep duration, and low diet quality; cluster 2, mostly young non-white adults with low income, low health insurance coverage, and limited healthcare access; and cluster 3, mostly older males who were the least physically active, but with high insurance coverage and healthcare access. Compared with cluster 2, adjusted ORs (95% CI) for undiagnosed diabetes were 14.9 (10.9, 20.2) in cluster 3 and 3.7 (2.8, 4.8) in cluster 1. Clusters 1 and 3 (vs cluster 2) had high odds of pre-diabetes, with ORs of 1.8 (1.6, 1.9) and 2.1 (1.8, 2.4), respectively. Race/ethnicity was found to modify the relationship between identified subgroups and pre-diabetes risk. CONCLUSIONS Self-reported SBDH combined with metabolic factors can be used to classify adults into subgroups with distinct cardiometabolic risk profiles. This approach may help identify individuals who would benefit from screening for diabetes and pre-diabetes and potentially suggest effective prevention strategies.
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Affiliation(s)
- Qinglan Ding
- College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Yuan Lu
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeph Herrin
- Division of Cardiology, Yale University, New Haven, Connecticut, USA
| | - Tianyi Zhang
- Department of Computer Science, Purdue University, West Lafayette, Indiana, USA
| | - David G Marrero
- School of Public Health, Indiana University, Bloomington, Indiana, USA
- Department of Medicine, The University of Arizona, Tucson, Arizona, USA
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Marcuzzi A, Caceres-Matos R, Åsvold BO, Gil-Garcia E, Nilsen TIL, Mork PJ. Interplay between chronic widespread pain and lifestyle factors on the risk of type 2 diabetes: longitudinal data from the Norwegian HUNT Study. BMJ Open Diabetes Res Care 2023; 11:e003249. [PMID: 37739420 PMCID: PMC10533697 DOI: 10.1136/bmjdrc-2022-003249] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Chronic widespread pain (CWP) and diabetes commonly co-occur; however, it is unclear whether CWP infers an additional risk for diabetes among those with known risk factors for type 2 diabetes. We aimed to examine if CWP magnifies the effect of adverse lifestyle factors on the risk of diabetes. RESEARCH DESIGN AND METHODS The study comprised data on 25 528 adults in the Norwegian HUNT Study without diabetes at baseline (2006-2008). We calculated adjusted risk ratios (RRs) with 95% CIs for diabetes at follow-up (2017-2019), associated with CWP and body mass index (BMI), physical activity, and insomnia symptoms. The relative excess risk due to interaction (RERI) was calculated to investigate the synergistic effect between CWP and adverse lifestyle factors. RESULTS Compared with the reference group without chronic pain and no adverse lifestyle factors, those with BMI ≥30 kg/m2 with and without CWP had RRs for diabetes of 10.85 (95% CI 7.83 to 15.05) and 8.87 (95% CI 6.49 to 12.12), respectively; those with physical activity <2 hours/week with and without CWP had RRs for diabetes of 2.26 (95% CI 1.78 to 2.88) and 1.54 (95% CI 1.24 to 1.93), respectively; and those with insomnia symptoms with and without CWP had RRs for diabetes of 1.31 (95% CI 1.07 to 1.60) and 1.27 (95% CI 1.04 to 1.56), respectively. There was little evidence of synergistic effect between CWP and BMI ≥30 kg/m2 (RERI=1.66, 95% CI -0.44 to 3.76), low physical activity (RERI=0.37, 95% CI -0.29 to 1.03) or insomnia symptoms (RERI=-0.09, 95% CI -0.51 to 0.34) on the risk of diabetes. CONCLUSIONS These findings show no clear interaction between CWP and adverse lifestyle factors on the risk of diabetes.
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Affiliation(s)
- Anna Marcuzzi
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rocio Caceres-Matos
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Bjørn Olav Åsvold
- Department of Endocrinology, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
| | - Eugenia Gil-Garcia
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Tom I L Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Li CI, Liu CS, Lin CH, Yang SY, Li TC, Lin CC. Association of body indices and risk of mortality in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2023; 11:e003474. [PMID: 37607771 PMCID: PMC10445358 DOI: 10.1136/bmjdrc-2023-003474] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION A body shape index (ABSI) is independently associated with mortality in general population, but studies on the predictability of ABSI in the risk of mortality in patients with type 2 diabetes (T2D) are limited. We aimed to examine the independent and joint association of ABSI, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body roundness index (BRI) with mortality in patients with T2D. RESEARCH DESIGN AND METHODS The study included 11 872 patients (46.5% women) aged 30 years and older and who took part in diabetes care management program of a medical center in Taiwan. Body indices were evaluated by anthropometric measurements at baseline between 2001 and 2016, and their death status was followed up through 2021. Multivariate Cox regression models were used to assess the effect of body indices on mortality. RESULTS During a mean follow-up of 10.2 years, 560 cardiovascular disease (CVD) deaths and 3043 deaths were recorded. For ABSI, WC, WHR, WHtR and BRI, all-cause mortality rates were statistically significantly greater in Q4 versus Q2. For BMI and WHtR, all-cause mortality rates were also statistically significantly greater in Q1 versus Q2. The combination of BMI and ABSI exhibited a superiority in identifying risks of all-cause mortality and CVD mortality (HRs: 1.45 and 1.37, both p<0.01). CONCLUSIONS Combined use of ABSI and BMI can contribute to the significant explanation of the variation in death risk in comparison with the independent use of BMI or other indices.
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Affiliation(s)
- Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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Barlow KJ, Fahey PP, Atlantis E. Glycaemic monitoring and control among high-risk patients with type 2 diabetes in Australian general practice during COVID-19. Fam Med Community Health 2023; 11:e002271. [PMID: 37567729 PMCID: PMC10423797 DOI: 10.1136/fmch-2023-002271] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted general practice worldwide, primarily due to public health measures that restricted access to care for chronic diseases, such as type 2 diabetes. These measures disproportionately affected higher risk groups with type 2 diabetes, such as older people and those with obesity. This study aims to identify factors that may have influenced the rates of compliance with testing guidelines and target glycaemic control in Australian general practice settings during the COVID-19 pandemic. METHODS We used a serial cross-sectional study design of patient record data from general practices representative of the Nepean Blue Mountains Local Health District between 2020 and 2022. Aggregated patient records were analysed to determine percentages of subgroups with a blood glycaemic testing interval consistent with guidelines (≥1 within 15 months) and achieving target glycaemic control (by glycated haemoglobin of ≤7%). Linear regression models were used to test the association between independent and dependent variables, and to generate regression coefficients and 95% CI, corrected for time trends. RESULTS Of the average 14 356 patient records per month, 55% were male, 53% had a body mass index (BMI) <30 and 55% were aged 55-74 years. Compliance to testing guidelines slightly decreased (75-73%) but was positively associated with male sex (2.5%, 95% CI 1.7%, 3.4%), BMI≥30 (9.6%, 95% CI 8.8%, 10.4%) and 55-74 years (7.5%, 95% CI 6.6%, 8.5%) and 75 years and over age groups (7.1%, 95% CI 6.2%, 7.9%). Mean percentage of patient records achieving target glycaemic control slightly increased and was negatively associated with male sex (-3.7%, 95% CI -5.2%, -2.2%), but positively associated with 55-74 years (4.5%, 95% CI 3.8%, 5.1%) and 75 years and over age groups (12.2%, 95% CI 4.5%, 20.0%). Compliance to testing guidelines increased with each additional general practice per 10 000 persons (8.4%, 95% CI 4.9%, 11.8%). CONCLUSIONS During the COVID-19 pandemic, people with type 2 diabetes in Australia continued to follow glycaemic testing guidelines at the same rate. In fact, there was a slight improvement in glycaemic control among all subgroups of patients, including those at higher risk. These findings are encouraging, but the longer term impact of COVID-19 on type 2 diabetes care is still unclear.
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Affiliation(s)
- Kirrilee Jane Barlow
- School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia
| | - Paul P Fahey
- School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia
- Discipline of Medicine, Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Nepean, New South Wales, Australia
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Gracen L, Muthukumara W, Aikebuse M, Russell A, O'Beirne J, Irvine KM, Williams S, Puri G, Valery PC, Hayward KL, Powell EE. Lower prevalence of elevated liver stiffness measurements in people with type 2 diabetes taking sodium-glucose co-transporter 2 inhibitors or glucagon-like peptide-1 receptor agonists. Ann Hepatol 2023:101142. [PMID: 37468097 DOI: 10.1016/j.aohep.2023.101142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Among people with type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD) is very common and has an increased risk of clinically significant liver disease. The use of sodium-glucose co-transporter 2 (SGLT2i) inhibitors and glucagon-like peptide-1 (GLP-1a) receptor agonists is endorsed to reduce major cardiovascular events and/or progression of chronic kidney disease. Their prevalence of use in people with T2D and co-existent NAFLD remains unclear. We sought to determine the prevalence of use of these medications at two different time periods, and their association with prevalence of clinically significant liver disease. MATERIALS AND METHODS Consecutive people with type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD) were recruited from diabetes clinics between Jun-2021 and Jun-2022 ('current' cohort). Liver stiffness measurements (LSM) using FibroScan were performed. Medication data were collected prospectively at recruitment and verified with the dispensing pharmacy or general practitioner medical records. Data for a historical cohort with NAFLD and T2D recruited from the same clinics during 2015-2017 ('historical' cohort) were available. Logistic regression was used to evaluate factors associated with LSM <8.0 or ≥8 kPa (clinically significant fibrosis). RESULTS There were 292 participants, 177 in the historical cohort and 115 in the current cohort. In the current cohort, 57.4% of patients with T2D and NAFLD were taking a GLP-1a and 42.6% were taking a SGLT2i; a 2.6 to 3.4-fold higher prevalence than in 2015-2017. A lower proportion of the current cohort (23.9% compared to 38.4%) had clinically significant fibrosis (LSM ≥8 kPa; p=0.012). When the cohorts were pooled and differences adjusted for in multivariable logistic regression analysis, patients taking a GLP-1a or a SGLT2i were 2 times more likely to have a lower LSM (<8 kPa) compared to patients not taking these drugs (OR=2.05, 95%CI 1.07-3.94, p=0.03 and OR 2.07 95%CI 1.04-4.11, p=0.04, respectively). CONCLUSIONS The observation of a lower LSM in people taking SGLT2i and/or GLP-1a following adjustment for other relevant clinico-demographic variables provides support for clinical trials to assess their efficacy in reducing the progression of NAFLD.
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Affiliation(s)
- Lucy Gracen
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Withma Muthukumara
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Melanie Aikebuse
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Anthony Russell
- Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, 3004, Australia; Faculty of Medicine, Monash University, Melbourne, 3800, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia
| | - James O'Beirne
- Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Sunshine Coast, 4560, Australia
| | - Katharine M Irvine
- Mater Research, Translational Research Institute, Brisbane, 4102, Australia
| | | | - Gaurav Puri
- Department of Endocrinology and Diabetes, Logan hospital, Brisbane, 4131, Australia; HIU Clinical Excellence Queensland, Brisbane, 4131, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Kelly L Hayward
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, 4102, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, 4102, Australia; QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia.
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Harding JL, Wang Y, McDonald B, Gander JC, Oviedo SA, Ali MK. Disruption to routine diabetes care processes during the pandemic: evidence from a large integrated health system in the Southeast United States. BMJ Open Diabetes Res Care 2023; 11:e003466. [PMID: 37433697 DOI: 10.1136/bmjdrc-2023-003466] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION We investigated the impact of the COVID-19 pandemic on annual adherence to seven diabetes care guidelines and risk factor management among people with diabetes. RESEARCH DESIGN AND METHODS We included all adults (aged ≥18 years) with prevalent diabetes as of 1 January 2018, who were continuously enrolled at Kaiser Permanente Georgia (KPGA) through 31 December 2021 (n=22 854). Prevalent diabetes was defined as a history of at least one of a diagnosis code for diabetes, use of antihyperglycemic medication, or at least one laboratory value of HbA1c, fasting plasma glucose or random glucose in the diabetic range. We defined pre-COVID (2018-2019) and during COVID (2020-2021) cohorts. Cohort-specific laboratory measurements (ie, blood pressure (BP), HbA1c, cholesterol, creatinine, urine-albumin-creatinine ratio (UACR)) and procedures (ie, eye and foot examinations) were determined from KPGA's electronic medical record data. We used logistic generalized estimating equations (GEE), adjusted for baseline age, to assess the within-subject change in guideline adherence (ie, at least one measurement per year per period) from pre-COVID to during COVID era overall, and by age, sex, and race. Linear GEE compared mean laboratory measurements pre and during COVID. RESULTS The proportion of adults meeting each of the seven diabetes care guidelines decreased significantly during (vs pre) COVID (range in absolute reductions: -0.8% to -11.2%) with greatest reductions seen for BP (-11.2%) and cholesterol (-8.8%). Declines were similar across age, sex, and race subgroups. Average HbA1c and systolic BP increased 0.11% and 1.6 mmHg, respectively, while low-density lipoprotein cholesterol declined 8.9 mg/dL. The proportion of adults at high risk of kidney disease (ie, UACR ≥300 mg/g) increased from 6.5% to 9.4%. CONCLUSIONS In an integrated healthcare system, the proportion of people with diabetes meeting guideline-recommended screenings decreased during the pandemic, coinciding with worsening glucose, kidney, and (some) cardiovascular risk profiles. Follow-up is needed to assess the long-term implications of these care gaps.
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Affiliation(s)
- Jessica L Harding
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Yanan Wang
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Bennett McDonald
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Jennifer C Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Sofia A Oviedo
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Mohammed K Ali
- Family and Preventive Medicine; Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
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Lin Htun H, Lian W, Pin Phua H, Yidong Lim M, Peng Lim Quek T, Ek Kwang Chew Conceptualisation D, Lim WY. Glycated haemoglobin trajectories and one-year risk of potentially avoidable hospitalisations among adult type 2 diabetes patients seeking care at specialist outpatient clinics of a tertiary hospital: a cohort study. Diabetes Res Clin Pract 2023:110737. [PMID: 37285967 DOI: 10.1016/j.diabres.2023.110737] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
AIM To evaluate the association between trajectories of glycated haemoglobin (HbA1c) and potentially avoidable hospitalisations (PAH). METHODS We performed a cohort study in a tertiary hospital in Singapore among adult type 2 diabetes patients with ≥3HbA1c tests over two years. Then, we followed up for one year after the last HbA1c reading. Glycaemic control was analysed by (1)HbA1c trajectories through group-based trajectory modelling, and (2)mean HbA1c. PAH was defined using the Agency of Healthcare Research and Quality criteria, categorising as overall, acute, chronic, diabetes-composites. RESULTS A total of 14923 patients (mean age:62.9±12.8 years;55.2% men)were included. Four HbA1c trajectories were observed; low-stable(n=9854,66.0%), moderate-stable(n=3125,20.9%), high-decrease(n=1017,6.8%) and high-persistent(n=927,6.2%). Compared to the low-stable trajectory, one-year risk ratio(RR) and 95%CI, respectively for moderate-stable, high-decrease and high-persistent trajectories were as follows:(1)overall PAH:1.15(1.00-1.31),1.53(1.31-1.80),1.96(1.58-2.43);(2)diabetes PAH:1.30(1.04-1.64),1.98(1.55-2.53),2.24(1.59-3.15);(3)acute PAH:1.14(0.90-1.44),1.29(0.95-1.77),1.75(1.17-2.62); and (4)chronic PAH:1.21(1.02-1.43),1.62(1.34-1.97),2.14(1.67-2.75). Mean HbA1c was significantly associated with overall and chronic-composites of PAH whilst evidence of a non-linear relationship with diabetes-composite of PAH was noted. CONCLUSION Patients with high-decrease trajectory had a risk lower than those with persistently-high HbA1c, highlighting that a greater risk of hospitalisation conferred by poor glycaemic control is potentially reversible. Determining HbA1c trajectories could help to identify the high-risk individuals for targeted and intensive management to improve care and reduce hospitalisations.
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Affiliation(s)
- Htet Lin Htun
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Weixiang Lian
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Hwee Pin Phua
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Moses Yidong Lim
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | | | | | - Wei-Yen Lim
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore.
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Bain SC, Carstensen B, Hyveled L, Seremetis S, Flindt Kreiner F, Amadid H, Clark A. Glucagon-like peptide-1 receptor agonist use is associated with lower blood ferritin levels in people with type 2 diabetes and hemochromatosis: a nationwide register-based study. BMJ Open Diabetes Res Care 2023; 11:e003300. [PMID: 37328273 PMCID: PMC10277078 DOI: 10.1136/bmjdrc-2022-003300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023] Open
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Shestakova M, Kvasnikov B, Erina E, Isachenko E, Andreev A. Efficacy and safety of luseogliflozin in Caucasian patients with type 2 diabetes: results from a phase III, randomized, placebo-controlled, clinical trial. BMJ Open Diabetes Res Care 2023; 11:e003290. [PMID: 37328272 PMCID: PMC10277051 DOI: 10.1136/bmjdrc-2022-003290] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/23/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Most data demonstrating the efficacy and safety of luseogliflozin (luseo) in people with type 2 diabetes mellitus (T2DM) originate from the Japanese population. This study evaluated luseo versus placebo (PCB) as add-on to metformin in a Caucasian population with inadequately controlled T2DM. RESEARCH DESIGN AND METHODS This was a multicenter, randomized, double-blind, PCB-controlled, parallel-group study. Patients aged 18-75 years with inadequately controlled T2DM (glycated hemoglobin (HbA1c) ≥7% to ≤10% (≥53 to ≤86 mmol/mol)) despite a diet and exercise program and on a stable metformin regimen were eligible. Patients were randomized to one of three luseo groups (2.5, 5.0 and 10.0 mg) or PCB for 12 weeks (W12). The primary endpoint was change in HbA1c expressed as least-square means from baseline (W0) to W12. RESULTS A total of 328 patients were randomized: PCB (n=83) and luseo 2.5 mg (n=80), 5.0 mg (n=86), and 10.0 mg (n=79). Mean age (±SD) was 58.5±8.8 years; 64.6% were women; body mass index was 31.5±3.4 kg/m2; and HbA1c was 8.54±0.70. At W12, mean reductions in HbA1c from W0 were -0.98%, -1.09%, -1.18%, and -0.73% in the luseo 2.5, 5.0 and 10.0 mg, and PCB groups, respectively, all of which were statistically significant. Compared with PCB, HbA1c levels were significantly decreased by 0.25% (p=0.045), 0.36% (p=0.006), and 0.45% (p=0.001) in the luseo 2.5, 5.0, and 10.0 mg groups, respectively. In all luseo dose groups, reductions in body weight were statistically significant compared with PCB. Data from the safety analysis were consistent with the known luseo safety profile. CONCLUSIONS All doses of luseo as add-on to metformin in Caucasian patients with uncontrolled T2DM demonstrated significant efficacy in decreasing HbA1c after W12 of treatment. TRIAL REGISTRATION NUMBER ISRCTN39549850.
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Affiliation(s)
| | | | | | | | - Alexander Andreev
- Cardiology and functional&ultrasound diagnostics department, First Moscow State Medical University, Moscow, Russia
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Cleal B, Nexø MA, Willaing I. We can work it out: A qualitative study of the work-life experiences of people living with type 2 diabetes. Diabet Med 2023:e15150. [PMID: 37218388 DOI: 10.1111/dme.15150] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023]
Abstract
AIMS People with type 2 diabetes experience a range of negative work-related outcomes at a time when people are expected to remain active within the labour market for longer. This study sought to identify the work-related challenges faced by people with type 2 diabetes and ways to address them. METHODS Recruitment was undertaken in two contexts and focussed on people living with type 2 diabetes of working age (18-67). A further inclusion criterion for participants was that they were registered as having at least one diabetes-related complication. Qualitative data was gathered via semi-structured interviews and interactive workshops and analysed using systematic text condensation. RESULTS Three themes were identified. The first theme highlighted that participants did not generally believe that their diabetes caused them any problems in the context of work, though this was not fully supported in their own accounts. The second theme pointed to the positive value attached to work, simultaneously indicating that work could negatively impact diabetes management and general health. The final theme highlighted the ways that both participants and their healthcare providers considered diabetes in isolation from other aspects of life, potentially delaying remedial actions. CONCLUSIONS Epidemiological data indicate that there are serious issues linked to living with type 2 diabetes and work-related outcomes. The extent to which these issues are recognised and understood may be obfuscated or contained by the value which people attach to work-life. More needs to be done to tease out work-related challenges for people with type 2 diabetes to better initiate timely remedial actions.
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Affiliation(s)
- Bryan Cleal
- Steno Diabetes Center Copenhagen, Denmark, Health Promotion Research, Copenhagen
| | - Mette Andersen Nexø
- Steno Diabetes Center Copenhagen, Denmark, Health Promotion Research, Copenhagen
| | - Ingrid Willaing
- Steno Diabetes Center Copenhagen, Denmark, Health Promotion Research, Copenhagen
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López-Burgos CP, Cruz-Domínguez MDP, López-Zamora B, Medina-García G, Montiel-Cervantes LA, Colorado-Cruz MF, Vera-Lastra O, Montes-Cortés DH, Morales-Montalvo SI, Ordoñez-González I. [Impact of hyperglycemia on the prognosis of patients hospitalized for severe pneumonia in COVID-19]. Rev Med Inst Mex Seguro Soc 2023; 61:335-341. [PMID: 37216668 PMCID: PMC10437238] [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] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/30/2022] [Indexed: 05/24/2023]
Abstract
Background Adequate glycemic control improves the prognosis of patients hospitalized for pneumonia associated with severe COVID-19. Objective To evaluate the impact of hyperglycemia (HG) on the prognosis of patients hospitalized for severe pneumonia associated with COVID-19 in unvaccinated patients. Material and methods Prospective cohort study. We included patients hospitalized from August 2020 to February 2021, with severe COVID-19 pneumonia, not vaccinated against SARS-CoV-2. Data was collected from admission to discharge. We used descriptive and analytical statistics according to the data distribution. ROC curves were used to determine the cut-off points with the highest predictive performance for HG and mortality, with the IBM SPSS program, version 25. Results We included 103 patients, 32% women, 68% men, age 57 ± 13 years; 58% were admitted with HG (191, IQR 152-300 mg/dL) and 42% with normoglycemia (NG < 126 mg/dL). Mortality was higher in HG at admission 34 (56.7%) than in NG 13 (30.2%) (p = 0.008). HG was associated with diabetes mellitus 2 and neutrophilia (p < 0.05). The risk of death increases 1.558 times (95% CI 1.118-2.172) if HG is at admission and 1.43 times (95% CI 1.14-1.79) during hospitalization. Maintaining NG throughout the hospitalization contributed independently to survival (RR = 0.083 [95% CI 0.012-0.571], p = 0.011). Conclusion HG significantly impacts prognosis by increasing mortality more than 50% during hospitalization for COVID-19.
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Affiliation(s)
- Cinthya Paola López-Burgos
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco. Comalcalco, Tabasco, MéxicoUniversidad Juárez Autónoma de TabascoMéxico
| | - María del Pilar Cruz-Domínguez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", División de Investigación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Berenice López-Zamora
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Campus Casco de Santo Tomás, Sección de Estudios de Posgrado de Investigación. Ciudad de México, MéxicoInstituto Politécnico NacionalMéxico
| | - Gabriela Medina-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Investigación en Medicina Traslacional en Enfermedades Hemato-oncológicas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Laura Arcelia Montiel-Cervantes
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Investigación en Medicina Traslacional en Enfermedades Hemato-oncológicas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - María Fernanda Colorado-Cruz
- Universidad Veracruzana, Campus Veracruz, Facultad de Medicina. Veracruz, MéxicoUniversidad Veracruzana, Campus VeracruzMéxico
| | - Olga Vera-Lastra
- Instituto Mexicano del Seguro Social, Hospital de Especialidades “Dr. Antonio Fraga Mouret” Centro Médico Nacional La Raza, Departamento de Medicina Interna. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Daniel Hector Montes-Cortés
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital General “Dr. Gaudencio González Garza”, Servicio de Urgencias. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Susana Isabel Morales-Montalvo
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Campus Casco de Santo Tomás, Sección de Estudios de Posgrado de Investigación. Ciudad de México, MéxicoInstituto Politécnico NacionalMéxico
| | - Irvin Ordoñez-González
- Universidad Veracruzana, Campus Veracruz, Facultad de Medicina. Veracruz, MéxicoUniversidad Veracruzana, Campus VeracruzMéxico
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Silva PGBD, Guimarães L, Oliveira F, Miranda LO, Esteves RP. The effect of antimicrobial photodynamic therapy adjunct to non-surgical periodontal therapy on the treatment of periodontitis in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2023; 42:103573. [PMID: 37062511 DOI: 10.1016/j.pdpdt.2023.103573] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND The purpose of the present systematic review and meta-analysis was to assess the impact of antimicrobial photodynamic therapy adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were carried out in six databases without restriction regarding publication year. Studies comparing periodontal clinical parameters among individuals submitted to non-surgical periodontal therapy associated with antimicrobial photodynamic therapy and a control group of individuals submitted to only non-surgical periodontal treatment were included. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. RESULTS Two hundred and five studies were identified and 11 studies were included. The meta-analysis demonstrated that antimicrobial photodynamic therapy adjunctive to periodontal therapy, in individuals with diabetes, resulted in a greater reduction of bleeding on probing at 6 months and in probing depth at 3 and 6 months in comparison to periodontal treatment alone (p<0.05). The included studies exhibited low risk of bias. CONCLUSION Antimicrobial photodynamic therapy adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameter bleeding on probing and probing depth in individuals with type 2 diabetes mellitus.
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Affiliation(s)
- Pierre Geraldo Braz da Silva
- Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, School of Dentistry, Federal University de Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901
| | - Lucas Guimarães
- Department of Child and Adolescent Oral Health, School of Dentistry, Federal University of Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901
| | - Fernando Oliveira
- Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, School of Dentistry, Federal University de Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901
| | - Luís Otávio Miranda
- Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, School of Dentistry, Federal University de Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901
| | - Rafael Paschoal Esteves
- Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, School of Dentistry, Federal University de Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901.
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Gulanski BI, Butera NM, Krause-Steinrauf H, Lichtman JH, Harindhanavudhi T, Green JB, Suratt CE, AbouAssi H, Desouza C, Ahmann AJ, Wexler DJ, Aroda VR. Higher burden of cardiometabolic and socioeconomic risk factors in women with type 2 diabetes: an analysis of the Glycemic Reduction Approaches in Diabetes (GRADE) baseline cohort. BMJ Open Diabetes Res Care 2023; 11:e003159. [PMID: 37094945 PMCID: PMC10151943 DOI: 10.1136/bmjdrc-2022-003159] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/18/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). RESEARCH DESIGN AND METHODS GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017. RESULTS Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m2), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes. CONCLUSIONS This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01794143).
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Affiliation(s)
- Barbara I Gulanski
- Department of Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Section of Endocrinology, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Nicole M Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota Health, Minneapolis, Minnesota, USA
| | - Jennifer B Green
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Colleen E Suratt
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, Maryland, USA
| | - Hiba AbouAssi
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Cyrus Desouza
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew J Ahmann
- Division of Endocrinology Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- MedStar Health Research Institute, Hyattsville, Maryland, USA
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Horii T, Otsuka M, Yasu T. Risk of non-hypoglycemic agents for hypoglycemia-related hospitalization in patients with type 2 diabetes: a large-scale medical receipt database analysis. BMJ Open Diabetes Res Care 2023; 11:11/2/e003177. [PMID: 37085279 PMCID: PMC10124227 DOI: 10.1136/bmjdrc-2022-003177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/01/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Hypoglycemia is listed as an adverse effect in the package inserts of not only hypoglycemic agents but also many other drugs. We aimed to clarify real-world factors related to an increased risk of hypoglycemia-related hospitalization (HRH) in Japanese patients with type 2 diabetes (T2D) on non-hypoglycemic agents that have been associated with hypoglycemia. RESEARCH DESIGN AND METHODS This cross-sectional study was performed using data from the Medical Data Vision administrative claims database. We identified patients with T2D who were enrolled in the database between April 2014 and October 2019. Logistic regression analyses were performed to identify clinical factors associated with HRH due to non-hypoglycemic agents. RESULTS Among 703 745 patients with T2D, 10 376 patients (1.47%) experienced HRH. The use of 332 non-hypoglycemic agents was associated with hypoglycemia. Multivariate analysis was performed to calculate OR for HRH. Seventy-five drugs had an OR greater than 1, and the values were significant. The OR was the highest for diazoxide (OR 15.5, 95% CI 4.87 to 49.3). The OR was higher than 2.0 for methylphenidate (OR 5.15, 95% CI 1.53 to 17.3), disulfiram (OR 4.21, 95% CI 2.05 to 8.62) and hydrocortisone (OR 2.89, 95% CI 1.11 to 7.51). CONCLUSION This large retrospective analysis revealed that the risk of HRH from some non-hypoglycemic agents in patients with T2D may be increased. The results of this study are expected to support treatment planning by physicians and healthcare professionals involved in diabetes care.
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Affiliation(s)
- Takeshi Horii
- Department of Pharmacy, Musashino University, Nishitokyo, Japan
| | - Mai Otsuka
- Laboratory of Pharmacy Practice and Science 1, Division of Clinical Pharmacy, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Minato, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Kiyose, Japan
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Pasqualotto E, Maintinguer RDS, van de Sande-Lee S, Araujo GND, Leal FS, Pinheiro CEA. EFFICACY AND SAFETY OF BEXAGLIFLOZIN IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Diabetes Obes Metab 2023. [PMID: 36929659 DOI: 10.1111/dom.15051] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
AIM To assess the efficacy of bexagliflozin in reducing glycated hemoglobin (HbA1c) and the occurrence of side effects in patients with type 2 diabetes (DM2). METHODS We searched PubMed, Embase, Cochrane and ClinicalTrials.gov databases for placebo-controlled, randomized clinical trials until February 15, 2023. The primary outcome was change in HbA1c. We computed weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). RESULTS A total of 6 studies and 3,111 patients were included, of whom 1,951 were prescribed bexagliflozin. Compared to placebo, bexagliflozin significantly reduced HbA1c levels (WMD -0.53%; 95% CI -0.75,-0.31), fasting plasma glucose levels (WMD -1.45 mmol/L; 95% CI -2.32,-0.57), systolic blood pressure (WMD -4.66 mmHg; 95% CI -6.41,-2.92), diastolic blood pressure (WMD -2.12 mmHg; 95% CI -3.94,-0.30), body weight (WMD -1.61 Kg; 95% CI -2.14,-1.07), and body weight in patients with a body mass index > 25 kg/m2 (WMD -2.05 Kg; 95% CI -2.78,-1.31). The proportion of patients who achieved HbA1c < 7% was higher in patients who received bexagliflozin as compared with placebo (OR 1.94; 95% CI 1.36-2.78). There were no significant differences between groups regarding side effects as hypoglycemia, genital mycotic infection, urinary tract infection, diarrhea, headache, náusea, polyuria, diabetic ketoacidosis, or all-cause mortality. CONCLUSIONS In this meta-analysis, the use of bexagliflozin was associated with improved clinical and laboratory measures in patients with DM2 compared to placebo, with a similar profile of side effects. These findings support the efficacy of bexagliflozin in the treatment of DM2. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | - Gustavo Neves de Araujo
- Institute of Cardiology of Santa Catarina, São José, Brazil
- Imperial Charity Hospital, Florianopolis, Brazil
| | - Fidel Silveira Leal
- Institute of Cardiology of Santa Catarina, São José, Brazil
- Imperial Charity Hospital, Florianopolis, Brazil
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Zhang Y, Bian Z, Lu H, Wang L, Xu J, Wang C. Association between tea consumption and glucose metabolism and insulin secretion in the Shanghai High-risk Diabetic Screen (SHiDS) study. BMJ Open Diabetes Res Care 2023; 11:11/2/e003266. [PMID: 36931660 PMCID: PMC10030497 DOI: 10.1136/bmjdrc-2022-003266] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION The relationship between tea consumption and glucose metabolism remains controversial. This study investigated the associations of tea consumption with impaired glucose regulation, insulin secretion and sensitivity in Shanghai High-risk Diabetic Screen project. RESEARCH DESIGN AND METHODS A total of 2337 Chinese subjects were enrolled in the study from 2014 to 2019. Each participant conducted a 75 g oral glucose tolerance test (OGTT) with five-point glucose and insulin level examined. They also completed a nurse-administered standard questionnaire including tea, coffee, and alcohol consumption, smoking habit, physical activity, education, sleep quality, etc. RESULTS: The result showed that tea consumption was positively associated with plasma glucose levels during OGTT after adjusting for confounder (Ps <0.05) and was associated with worsening glucose tolerance (OR 1.21, 95% CI 1.01-1.44; p=0.034). Strong tea consumption or long-term tea intake (>10 years) had an increased risk of glucose intolerance (all p<0.05). These associations did not vary in participants drinking green tea. In addition, insulin secretion indexes were decreased 7.0%-13.0% in tea consumption group. Logistic regression analysis showed that tea consumption was independently associated with lower insulin secretion (homeostasis model assessment of β-cell function (HOMA-β) (OR 0.81, 95% CI 0.68-0.97; p=0.021); Stumvoll first-phase index (OR 0.81, 95% CI 0.68-0.97; p=0.020)) in a fully adjusted model. Green tea consumption showed a negative association with insulin secretion (HOMA-β (OR 0.77, 95% CI 0.62-0.96; p=0.019)). CONCLUSIONS Tea intake is associated with an increased risk of glucose intolerance in a large high-risk diabetic Chinese population. Habitual tea consumption subjects might have lower pancreatic β-cell function.
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Affiliation(s)
- Yinan Zhang
- The Metabolic Disease Biobank, Shanghai Key Laboratory of Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhouliang Bian
- Department of Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Lu
- The Metabolic Disease Biobank, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lili Wang
- Department of Endocrinology and Metabolism, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jinfang Xu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Congrong Wang
- Department of Endocrinology and Metabolism, Shanghai Fourth People's Hospital, school of medicine, Tongji University, Shanghai, China
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Bragg F, Kuri-Morales P, Berumen J, Garcilazo-Ávila A, Gonzáles-Carballo C, Ramírez-Reyes R, Santacruz-Benitez R, Aguilar-Ramirez D, Gnatiuc Friedrichs L, Herrington WG, Hill M, Trichia E, Wade R, Collins R, Peto R, Emberson JR, Alegre-Diaz J, Tapia-Conyer R. Diabetes and infectious disease mortality in Mexico City. BMJ Open Diabetes Res Care 2023; 11:11/2/e003199. [PMID: 36889802 PMCID: PMC10008442 DOI: 10.1136/bmjdrc-2022-003199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Although higher risks of infectious diseases among individuals with diabetes have long been recognized, the magnitude of these risks is poorly described, particularly in lower income settings. This study sought to assess the risk of death from infection associated with diabetes in Mexico. RESEARCH DESIGN AND METHODS Between 1998 and 2004, a total of 159 755 adults ≥35 years were recruited from Mexico City and followed up until January 2021 for cause-specific mortality. Cox regression yielded adjusted rate ratios (RR) for death due to infection associated with previously diagnosed and undiagnosed (HbA1c ≥6.5%) diabetes and, among participants with previously diagnosed diabetes, with duration of diabetes and with HbA1c. RESULTS Among 130 997 participants aged 35-74 and without other prior chronic diseases at recruitment, 12.3% had previously diagnosed diabetes, with a mean (SD) HbA1c of 9.1% (2.5%), and 4.9% had undiagnosed diabetes. During 2.1 million person-years of follow-up, 2030 deaths due to infectious causes were recorded at ages 35-74. Previously diagnosed diabetes was associated with an RR for death from infection of 4.48 (95% CI 4.05-4.95), compared with participants without diabetes, with notably strong associations with death from urinary tract (9.68 (7.07-13.3)) and skin, bone and connective tissue (9.19 (5.92-14.3)) infections and septicemia (8.37 (5.97-11.7)). In those with previously diagnosed diabetes, longer diabetes duration (1.03 (1.02-1.05) per 1 year) and higher HbA1c (1.12 (1.08-1.15) per 1.0%) were independently associated with higher risk of death due to infection. Even among participants with undiagnosed diabetes, the risk of death due to infection was nearly treble the risk of those without diabetes (2.69 (2.31-3.13)). CONCLUSIONS In this study of Mexican adults, diabetes was common, frequently poorly controlled, and associated with much higher risks of death due to infection than observed previously, accounting for approximately one-third of all premature mortality due to infection.
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Affiliation(s)
- Fiona Bragg
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pablo Kuri-Morales
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- Monterrey Institute of Technology and Higher Education, Nuevo Leon, Mexico
| | - Jaime Berumen
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Adrián Garcilazo-Ávila
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Carlos Gonzáles-Carballo
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Raúl Ramírez-Reyes
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rogelio Santacruz-Benitez
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Diego Aguilar-Ramirez
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Louisa Gnatiuc Friedrichs
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - William G Herrington
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Hill
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eirini Trichia
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Wade
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan R Emberson
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jesus Alegre-Diaz
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Roberto Tapia-Conyer
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Hu YW, Yeh CM, Liu CJ, Chen TJ, Huang N, Chou YJ. Adapted Diabetes Complications Severity Index and Charlson Comorbidity Index in predicting all-cause and cause-specific mortality among patients with type 2 diabetes. BMJ Open Diabetes Res Care 2023; 11:11/2/e003262. [PMID: 36977521 PMCID: PMC10069524 DOI: 10.1136/bmjdrc-2022-003262] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Adapted Diabetes Complications Severity Index (aDCSI) is a commonly used severity measure based on the number and severity of diabetes complications using diagnosis codes. The validity of aDCSI in predicting cause-specific mortality has yet to be verified. Additionally, the performance of aDCSI in predicting patient outcomes compared with Charlson Comorbidity Index (CCI) remains unknown. RESEARCH DESIGN AND METHODS Patients aged 20 years or older with type 2 diabetes prior to January 1, 2008 were identified from the Taiwan National Health Insurance claims data and were followed up until December 15, 2018. Complications for aDCSI including cardiovascular, cerebrovascular and peripheral vascular disease, metabolic disease, nephropathy, retinopathy and neuropathy, along with comorbidities for CCI, were collected. HRs of death were estimated using Cox regression. Model performance was evaluated by concordance index and Akaike information criterion. RESULTS 1,002,589 patients with type 2 diabetes were enrolled, with a median follow-up of 11.0 years. After adjusting for age and sex, aDCSI (HR 1.21, 95% CI 1.20 to 1.21) and CCI (HR 1.18, 1.17 to 1.18) were associated with all-cause mortality. The HRs of aDCSI for cancer, cardiovascular disease (CVD) and diabetes mortality were 1.04 (1.04 to 1.05), 1.27 (1.27 to 1.28) and 1.28 (1.28 to 1.29), respectively, and the HRs of CCI were 1.10 (1.09 to 1.10), 1.16 (1.16 to 1.17) and 1.17 (1.16 to 1.17), respectively. The model with aDCSI had a better fit for all-cause, CVD and diabetes mortality with C-index of 0.760, 0.794 and 0.781, respectively. Models incorporating both scores had even better performance, but the HR of aDCSI for cancer (0.98, 0.97 to 0.98) and the HRs of CCI for CVD (1.03, 1.02 to 1.03) and diabetes mortality (1.02, 1.02 to 1.03) became neutral. When aDCSI and CCI were considered time-varying scores, the association with mortality was stronger. aDCSI had a strong correlation with mortality even after 8 years (HR 1.18, 1.17 to 1.18). CONCLUSIONS The aDCSI predicts all-cause, CVD and diabetes deaths but not cancer deaths better than the CCI. aDCSI is also a good predictor for long-term mortality.
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Affiliation(s)
- Yu-Wen Hu
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Hematology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Hematology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
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Leonel LDS, Brum GD, Alberton CL, Delevatti RS. Aquatic training improves HbA1c, blood pressure and functional outcomes of patients with type 2 diabetes: A systematic review with meta-analysis. Diabetes Res Clin Pract 2023; 197:110575. [PMID: 36780954 DOI: 10.1016/j.diabres.2023.110575] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
AIM This study aimed to summarize the effects of aquatic training on the health outcomes of type 2 diabetes (T2D) patients. METHODS This is a systematic review with meta-analysis that followed the PRISMA recommendations. Searches were performed in four databases in April 2021. The following eligibility criteria were adopted: adults with T2D; aquatic training (AT) intervention in an upright position; pre- and post-intervention assessments of the following outcomes: HbA1c, SBP and DBP, functional capacity, VO2peak. The random-effects meta-analysis results are presented as mean differences and 95% confidence intervals. RESULTS Of the 375 studies, 12 studies were eligible and included in the meta-analysis. Favorable effects of AT post-intervention were observed in HbA1c (-0.62 %), VO2peak (2.16 mL.Kg-1.min-1), SBP (-5.55 mmHg), DBP (-4.99 mmHg), and the 6-minute walk test (76.64 m). AT also revealed superior effects when compared to the control group (CG) and similar effects to land training (LT) in HbA1c (AT vs CG = -0.67 % and AT vs LT = -0.40 %), VO2peak (AT vs CG = 3.78 mL.Kg-1.min-1; AT vs LT = -0.12 mL/Kg-1.min-1), SBP (AT vs LT = -0.85 mmHg), and DBP (AT vs LT = 2.12 mmHg). CONCLUSION AT improves HbA1c, VO2peak, SBP, DBP, and functional capacity in T2D patients. Beneficial effects favored AT over CG, while similar effects were verified between AT and LT on HbA1c, VO2peak, and blood pressure.
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Affiliation(s)
- Larissa Dos Santos Leonel
- Federal University of Santa Catarina, Department of Physical Education, Florianopolis, Santa Catarina, Brazil.
| | - Guilherme de Brum
- Federal University of Santa Catarina, Department of Physical Education, Florianopolis, Santa Catarina, Brazil.
| | | | - Rodrigo Sudatti Delevatti
- Federal University of Santa Catarina, Department of Physical Education, Florianopolis, Santa Catarina, Brazil.
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Yang Q, Liu Y, Peng J, Pan J, Chen L, Cui J, Yi B. High levels of serum C-peptide are associated with a decreased risk for incident renal progression in patients with type 2 diabetes: a retrospective cohort study. BMJ Open Diabetes Res Care 2023; 11:11/2/e003201. [PMID: 36958752 PMCID: PMC10040069 DOI: 10.1136/bmjdrc-2022-003201] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION C-peptide has been reported to provide renoprotective effects. This study aims to explore the relationship between C-peptide and progression of renal function in patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We retrospectively collected clinical data from 854 T2DM patients over a median follow-up of 5 years. Renal events included an annual decline in estimated glomerular filtration rate (eGFR), a rapid kidney function decline and a renal composite endpoint. A linear mixed-effects model and Cox regression analysis were used to investigate the effect of C-peptide on renal events, and a subgroup analysis was performed after stratification by risk factors. RESULTS The highest-level C-peptide group had a smaller annual eGFR decline compared with those in the group with the lowest level (p<0.05). Higher levels of 2 h postprandial C-peptide (2hPCP) (adjusted HR 0.53; 95% CI 0.31 to 0.92), difference between 2 h postprandial and fasting C-peptide (ΔCP) (adjusted HR 0.39; 95% CI 0.22 to 0.69), and 2 h postprandial C-peptide-to-glucose ratio (PCGR) (adjusted HR 0.44; 95% CI 0.24 to 0.82) were independently related to a decreased risk for the renal composite endpoint. 2hPCP <2.92 ng/mL, ΔCP <1.86 ng/mL, and PCGR <1.11 significantly increased the risk of progression in kidney function (adjusted HRs <0.50, p<0.05) among T2DM patients with male sex, an age of <65 years old, a disease course of <10 years, an glycosylated hemoglobin value of ≥7%, or a history of hypertension. CONCLUSIONS Higher levels of 2hPCP, ΔCP and PCGR could protect T2DM patients from renal progression, especially in the aforementioned population with diabetes.
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Affiliation(s)
- Qi Yang
- Department of Nephrology, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Yan Liu
- Department of Nephrology, Central South University, Changsha, Hunan, China
| | - Juan Peng
- Department of Nephrology, Central South University, Changsha, Hunan, China
| | - Jinting Pan
- Department of Nephrology, Central South University, Changsha, Hunan, China
| | - Li Chen
- Department of Nephrology, Central South University, Changsha, Hunan, China
| | - Jing Cui
- Department of Nephrology, Central South University, Changsha, Hunan, China
| | - Bin Yi
- Department of Nephrology, Central South University, Changsha, Hunan, China
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49
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Lui DTW, Wu T, Tang EHM, Au ICH, Lee CH, Woo YC, Tan KCB, Wong CKH. Fracture risks associated with sodium-glucose cotransporter-2 inhibitors in type 2 diabetes patients across eGFR and albuminuria categories: A population-based study in Hong Kong. Diabetes Res Clin Pract 2023; 197:110576. [PMID: 36780955 DOI: 10.1016/j.diabres.2023.110576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/22/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
AIMS To evaluate major osteoporotic fracture (MOF) risk among type 2 diabetes patients treated with sodium-glucose cotransporter-2 inhibitors (SGLT2i) across eGFR and albuminuria categories. METHODS A population-based cohort of type 2 diabetes patients started on SGLT2i or dipeptidyl peptidase-4 inhibitors (DPP4i) during 2007-2020 was identified from Hong Kong Hospital Authority database. One-to-one propensity score matching was applied to match each SGLT2i user with one DPP4i user. The primary outcomes were 180- and 365-day risks of MOF. Cox proportional hazard regression models were used to estimate hazard ratios (HR). RESULTS A total of 28,696 patients (14,348 in each group) were included. Over 180-day follow-up, MOF occurred in 25 (0.17 %) SGLT2i users and 24 (0.17 %) DPP4i users (incidence of 4.07 and 3.63/1,000 person-years, respectively). At 365 days, MOF occurred in 43 (0.30 %) SGLT2i users and 44 (0.31 %) DPP4i users (incidence of 4.16 and 3.64/1,000 person-years, respectively). Risks of MOF were comparable between two groups at both 180 days (HR = 1.13, 95 %CI 0.65-1.98, P = 0.67) and 365 days (HR = 1.15, 95 %CI 0.75-1.75, P = 0.52). Subgroup analyses were consistent across age, sex, eGFR, albuminuria, or KDIGO categories. CONCLUSIONS Our study did not reveal a statistically significant increase in fracture risk with SGLT2i use compared with DPP4i among type 2 diabetes patients, across eGFR and albuminuria categories.
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Affiliation(s)
- David Tak Wai Lui
- Division of Endocrinology and Metabolism, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tingting Wu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Ho Man Tang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ivan Chi Ho Au
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chi Ho Lee
- Division of Endocrinology and Metabolism, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yu Cho Woo
- Division of Endocrinology and Metabolism, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kathryn Choon Beng Tan
- Division of Endocrinology and Metabolism, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health Limited (D(2)4H), Hong Kong Science Park, New Territories, Hong Kong SAR, China.
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50
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Moon KA, Nordberg CM, Orstad SL, Zhu A, Uddin J, Lopez P, Schwartz MD, Ryan V, Hirsch AG, Schwartz BS, Carson AP, Long DL, Meeker M, Brown J, Lovasi GS, Adhikari S, Kanchi R, Avramovic S, Imperatore G, Poulsen MN. Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples. BMJ Open Diabetes Res Care 2023; 11:11/2/e003120. [PMID: 36858436 PMCID: PMC9980357 DOI: 10.1136/bmjdrc-2022-003120] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Inequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment. RESEARCH DESIGN AND METHODS We conducted analyses in three study samples: the national Veterans Administration Diabetes Risk (VADR) cohort comprising electronic health records (EHR) of 4.1 million T2D-free veterans, the national prospective cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) (11 208 T2D free), and a case-control study of Geisinger EHR in Pennsylvania (15 888 T2D cases). New-onset T2D was defined using diagnoses, laboratory and medication data. We harmonized neighborhood-level variables, including exposure, confounders, and effect modifiers. We measured NSEE with a summary index of six census tract indicators. The LTPA environment was measured by physical activity (PA) facility (gyms and other commercial facilities) density within street network buffers and population-weighted distance to parks. We estimated natural direct and indirect effects for each mediator stratified by community type. RESULTS The magnitudes of the indirect effects were generally small, and the direction of the indirect effects differed by community type and study sample. The most consistent findings were for mediation via PA facility density in rural communities, where we observed positive indirect effects (differences in T2D incidence rates (95% CI) comparing the highest versus lowest quartiles of NSEE, multiplied by 100) of 1.53 (0.25, 3.05) in REGARDS and 0.0066 (0.0038, 0.0099) in VADR. No mediation was evident in Geisinger. CONCLUSIONS PA facility density and distance to parks did not substantially mediate the relation between NSEE and T2D. Our heterogeneous results suggest that approaches to reduce T2D through changes to the LTPA environment require local tailoring.
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Affiliation(s)
- Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cara M Nordberg
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Stephanie L Orstad
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Aowen Zhu
- Department of Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Jalal Uddin
- Department of Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Priscilla Lopez
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Mark D Schwartz
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
- The Department of Veterans Affairs, New York Harbor Healthcare System, New York, NY, USA
| | - Victoria Ryan
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Annemarie G Hirsch
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - April P Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - D Leann Long
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Melissa Meeker
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Janene Brown
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- The Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Samranchana Adhikari
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Rania Kanchi
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Sanja Avramovic
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, USA
| | - Giuseppina Imperatore
- Surveillance, Epidemiology, Economics, and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Melissa N Poulsen
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
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