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Abonyi-Tóth Z, Rokszin G, Fábián I, Kiss Z, Jermendy G, Kempler P, Lengyel C, Wittmann I, Molnár GA, Sütő G. Incident Cancer Risk in Patients with Incident Type 2 Diabetes Mellitus in Hungary (Part 1). Cancers (Basel) 2024; 16:1745. [PMID: 38730697 PMCID: PMC11083545 DOI: 10.3390/cancers16091745] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Patients with type 2 diabetes mellitus (T2DM) are at higher risk of cancer but how these two diseases associate is still debated. The goal of this study was the assessment of the overall incidence of cancer among patients with newly diagnosed T2DM in Hungary. (2) Methods: A nationwide, retrospective, longitudinal study was performed using a Hungarian database. After exclusion of cases of age < 18 years, with gestational diabetes, with polycystic ovary syndrome, and with type 1 and prevalent type 2 diabetes mellitus, the incident T2DM (approx. 50,000 cases yearly) and for comparison, the diabetes-free Hungarian adult population (approx. 7,000,000 cases yearly) was included in the study. The primary endpoints were the overall and site-specific incidence and annual percentage change of the incidence of cancer in both populations. (3) Results: The overall incidence of cancer in patients amounted to 29.4/1000 and 6.6/1000 with or without T2DM, respectively, and the OR (95%CI) of cancer of the T2DM group was 4.32 (4.14-4.53), p < 0.0001. The risk of having cancer was age dependent. The incidence of cancer was declining in the non-diabetic but was unchanged in the T2DM population. The average lag time of diagnosing cancer after the detection of T2DM was 3.86 months. (4) Conclusions: Incident T2DM is associated with a significantly higher overall risk of incident cancer, with a reverse correlation of age. Newly registered T2DM patients were suggested to be screened for cancer within 6 months.
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Affiliation(s)
- Zsolt Abonyi-Tóth
- RxTarget Ltd., 5000 Szolnok, Hungary; (Z.A.-T.); (G.R.); (I.F.)
- Department of Biostatistics, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - György Rokszin
- RxTarget Ltd., 5000 Szolnok, Hungary; (Z.A.-T.); (G.R.); (I.F.)
| | - Ibolya Fábián
- RxTarget Ltd., 5000 Szolnok, Hungary; (Z.A.-T.); (G.R.); (I.F.)
- Department of Biostatistics, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - Zoltán Kiss
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, 7624 Pécs, Hungary; (Z.K.); (G.A.M.); (G.S.)
| | - György Jermendy
- Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, 1106 Budapest, Hungary;
| | - Péter Kempler
- Department of Medicine and Oncology, Faculty of Medicine, Semmelweis University, 1089 Budapest, Hungary;
| | - Csaba Lengyel
- Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary;
| | - István Wittmann
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, 7624 Pécs, Hungary; (Z.K.); (G.A.M.); (G.S.)
| | - Gergő A. Molnár
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, 7624 Pécs, Hungary; (Z.K.); (G.A.M.); (G.S.)
| | - Gábor Sütő
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, 7624 Pécs, Hungary; (Z.K.); (G.A.M.); (G.S.)
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Jermendy G, Rokszin G, Fábián I, Kempler P, Wittmann I. Morbidity and mortality of patients with diabetic neuropathy treated with pathogenetically oriented alpha-lipoic acid versus symptomatic pharmacotherapies - a nationwide database analysis from Hungary. Diabetes Res Clin Pract 2023:110734. [PMID: 37257759 DOI: 10.1016/j.diabres.2023.110734] [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: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
AIMS Diabetic neuropathy is associated with increased risk of morbidity and all-cause mortality. It is unclear whether these outcomes differ in patients with diabetic neuropathy treated with pathogenetically oriented vs symptomatic pharmacotherapies. METHODS We performed a retrospective (2009-2019) database analysis of patients treated with pathogenetically oriented alpha-lipoic acid (ALA) or symptomatic pharmacotherapies for diabetic neuropathy. We investigated clinical outcomes in propensity score matched patients in Hungary. Changes in hazard ratios and annualized event rates were assessed and sensitivity analyses performed. RESULTS Hazard ratios favored treatment with ALA vs symptomatic pharmacotherapies regarding acute myocardial infarction (HR 0.73, 95%CI: 0.60-0.89, p = 0.0016), stroke (HR 0.71, 95%CI: 0.62-0.82, p<0.0001), hospitalization for heart failure (HR 0.72, 95%CI: 0.66-0.78, p<0.0001), cancer events (HR 0.83, 95% CI: 0.76-0.92, p = 0.0002) and all-cause mortality (HR 0.55, 95% CI: 0.49-0.61, p<0.0001), but not for lower limb amputation (HR 1.05, 95%CI: 0.89-1.25, p = 0.5455). This association was supported by results of evaluating annual event rates and sensitivity analyses. CONCLUSIONS This retrospective database analysis revealed a lower occurrence of cardio- and cerebrovascular morbidity, cancer events and all-cause mortality in patients with diabetic neuropathy treated with pathogenetically oriented ALA vs symptomatic pharmacotherapies. This hypothesis-generating result requires further investigations.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital, 3(rd) Department of Medicine, Maglódi út 89-91, 1106, Budapest, Hungary.
| | - György Rokszin
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - Ibolya Fábián
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - Péter Kempler
- Semmelweis University, Faculty of Medicine, Department of Medicine and Oncology, Korányi Sándor út 2, 1083 Budapest, Hungary.
| | - István Wittmann
- University of Pécs, Medical School, 2(nd) Department of Medicine, Nephrology-Diabetes Center, Pacsirta út 1, 7624 Pécs, Hungary.
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Tomic D, Morton JI, Chen L, Salim A, Gregg EW, Pavkov ME, Arffman M, Balicer R, Baviera M, Boersma-van Dam E, Brinks R, Carstensen B, Chan JCN, Cheng YJ, Fosse-Edorh S, Fuentes S, Gardiner H, Gulseth HL, Gurevicius R, Ha KH, Hoyer A, Jermendy G, Kautzky-Willer A, Keskimäki I, Kim DJ, Kiss Z, Klimek P, Leventer-Roberts M, Lin CY, Lopez-Doriga Ruiz P, Luk AOY, Ma S, Mata-Cases M, Mauricio D, McGurnaghan S, Imamura T, Paul SK, Peeters A, Pildava S, Porath A, Robitaille C, Roncaglioni MC, Sugiyama T, Wang KL, Wild SH, Yekutiel N, Shaw JE, Magliano DJ. Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study. Lancet Diabetes Endocrinol 2022; 10:795-803. [PMID: 36183736 PMCID: PMC10988609 DOI: 10.1016/s2213-8587(22)00252-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. METHODS For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20-100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005-19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. FINDINGS Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6-17·0) for Scottish women to 59·6% (58·5-60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017-18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2-59·3) for men and 64·1 years (64·0-64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013-14 in Lithuania (43·7 years [42·7-44·6]) for men and in 2010-11 in Latvia (54·2 years [53·4-54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010-11 to 2015-16 and in the USA from 2009-10 to 2014-15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015-16) to 12·9 years (Israel Clalit Health Services; 2015-16) for 20-year-old men and from 3·1 years (Finland; 2011-12) to 11·2 years (Israel Clalit Health Services; 2010-11 and 2015-16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009-10 and 2014-15 for 20-year-old men (a decrease of 2·7 years). INTERPRETATION Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. FUNDING US Centers for Disease Control and Prevention and Diabetes Australia.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Jedidiah I Morton
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Lei Chen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Agus Salim
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Martti Arffman
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Elise Boersma-van Dam
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany; Institute for Medical Biometry and Epidemiology, University Witten/Herdecke, Witten, Germany
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Yiling J Cheng
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sonsoles Fuentes
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Hélène Gardiner
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Hanne L Gulseth
- Department for Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School EWL, Bielefeld University, Bielefeld, Germany
| | - György Jermendy
- Third Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Alexandra Kautzky-Willer
- Department of Medicine III, Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; Gender Institute, Gars am Kamp, Austria
| | - Ilmo Keskimäki
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- Second Department of Medicine and Nephrological Center, University of Pécs, Pécs, Hungary
| | - Peter Klimek
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria; Complexity Science Hub Vienna, Vienna, Austria
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Dídac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain; Department of Endocrinology, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Sanjoy K Paul
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | - Cynthia Robitaille
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan; Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Jermendy G. A nem alkoholos hasnyálmirigy-elzsírosodás klinikai jelentősége. Orv Hetil 2022; 163:1735-1742. [DOI: 10.1556/650.2022.32638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/16/2022] [Indexed: 11/20/2022]
Abstract
A pancreaticus lipidakkumuláció – amelyet egyre gyakrabban NAFPD (non-alcoholic
fatty pancreas disease) néven említenek az angol nyelvű szakirodalomban – az
elmúlt néhány évben került az érdeklődés előterébe. Az elváltozást több, eltérő
névvel illették korábban; a NAFPD megnevezést hazánkban még ma is csak ritkán
használjuk, magyar nyelvű megfelelője sem kristályosodott ki. A pancreaticus
lipidfelhalmozódást az ectopiás zsírszövet-akkumuláció egyik megjelenési
formájaként tartják számon. A NAFPD felismerése képalkotó vizsgálatokkal
lehetséges, a klinikai gyakorlatban leginkább az ultrahangvizsgálat és a
komputertomográfia jön szóba, de a kvantifikáció még nem kiforrott. A NAFPD
prevalenciája a felnőtt lakosság körében 30–35%-ra tehető, előfordulására
elhízott gyermekek/serdülők körében is számíthatunk. A NAFPD érinti a pancreas
endokrin és exokrin funkcióját. A NAFPD és a 2-es típusú diabetes/metabolikus
szindróma összefüggését több tanulmány igazolta, a NAFPD lokális
következményeiről még kevés ismerettel rendelkezünk. Adatok szólnak amellett,
hogy a NAFPD-nak szerepe lehet a heveny és az idült pancreatitis, illetve a
pancreascarcinoma kialakulásában, a pancreas exokrin diszfunkciójában. A NAFPD-t
előnyösen befolyásolja a testsúly csökkenése, ami elhízottak körében
életmód-terápiával, gyógyszeres intervencióval vagy bariátriai sebészeti
beavatkozással érhető el. Fontos, hogy a 2-es típusú diabetesben szenvedő,
testsúlyfelesleggel rendelkező betegek antihyperglykaemiás kezelése olyan
antidiabetikumokkal történjen, amelyek a jó glykaemiás kontroll mellett
testsúlyredukciót is eredményeznek. A NAFPD feltehetően gyakori, de ritkán
felismert, viszonylag új klinikai entitás, amely a belgyógyászaton belül több
szubspecialitás (gasztroenterológia, diabetológia, lipidológia, obezitológia),
illetve a sebészet területén tevékenykedő szakemberek érdeklődési körébe esik.
Orv Hetil. 2022; 163(44): 1735–1742.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Kórház és Rendelőintézet Budapest, Maglódi út 89–91., 1106 Magyarország
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Jermendy G, Kiss Z, Rokszin G, Abonyi-Tóth Z, Lengyel C, Kempler P, Wittmann I. Changing Patterns of Antihyperglycaemic Treatment among Patients with Type 2 Diabetes in Hungary between 2015 and 2020-Nationwide Data from a Register-Based Analysis. Medicina (Kaunas) 2022; 58:medicina58101382. [PMID: 36295543 PMCID: PMC9612371 DOI: 10.3390/medicina58101382] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/17/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
Background and objectives: In the last couple of years, pharmacological management of patients with type 2 diabetes mellitus (T2DM) have been markedly renewed. The aim of this study was to analyse the changes in prescribing patterns of antidiabetic drugs for treating patients with T2DM in Hungary between 2015 and 2020. Material and Methods: In this retrospective, nationwide analysis, we used the central database of the National Health Insurance Fund. We present annual numbers and their proportion of T2DM patients with different treatment regimens. Results: In the period of 2015−2020, the number of incident cases decreased from 60,049 to 29,865, while prevalent cases increased from 682,274 to 752,367. Patients with metformin (MET) monotherapy had the highest prevalence (31% in 2020). Prevalence of insulin (INS) monotherapy continuously but slightly decreased from 29% to 27% while that of sulfonylurea (SU) monotherapy markedly decreased from 37% to 20%. Dipeptidyl peptidase (DPP-4) inhibitors remained popular in 2020 as monotherapy (5%), in dual combination with MET (12%) and in triple combination with MET and SU (5%). The prevalence of patients with sodium-glucose co-transporter-2 (SGLT-2) inhibitors increased from 1% to 4% in monotherapy, from <1% to 6% in dual combination with MET, and from <1% to 2% in triple oral combination with MET and SU or DPP-4-inhibitors. The prevalence of patients using glucagon-like peptide-1 receptor agonists (GLP-1-RAs) also increased but remained around 1−2% both in monotherapy and combinations. For initiating antihyperglycaemic treatment, MET monotherapy was the most frequently used regime in 2020 (50%), followed by monotherapy with SUs (16%) or INS (10%). After initial MET monotherapy, the incidence rates of patients with add-on GLP-1-RAs (2%, 3%, and 4%) and those of add-on SGLT-2 inhibitors (4%, 6%, and 8%) slowly increased in the subsequent 24, 48, and 72 months, respectively. Conclusions: In the period of 2015−2020, we documented important changes in trends of antihyperglycaemic therapeutic patterns in patients with T2DM which followed the new scientific recommendations but remained below our expectations regarding timing and magnitude. More efforts are warranted to implement new agents with cardiovascular/renal benefits into therapeutic management in time, in a much larger proportion of T2DM population, and without delay.
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Affiliation(s)
- György Jermendy
- Department of Internal Medicine, Bajcsy-Zsilinszky Teaching Hospital and Outpatient Clinic, Maglódi út 89-91, 1106 Budapest, Hungary
- Correspondence: ; Tel.: +36-20-9282445
| | - Zoltán Kiss
- Nephrology-Diabetes Center, 2nd Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pacsirta út 1, 7624 Pécs, Hungary
| | - György Rokszin
- RxTarget Ltd., Bacsó Nándor utca 10, 5000 Szolnok, Hungary
| | | | - Csaba Lengyel
- Department of Internal Medicine, Faculty of Medicine, University of Szeged, Kálvária sgt. 57, 6725 Szeged, Hungary
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi Sándor út 2, 1082 Budapest, Hungary
| | - István Wittmann
- Nephrology-Diabetes Center, 2nd Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pacsirta út 1, 7624 Pécs, Hungary
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Magliano DJ, Chen L, Carstensen B, Gregg EW, Pavkov ME, Salim A, Andes LJ, Balicer R, Baviera M, Chan JCN, Cheng YJ, Gardiner H, Gulseth HL, Gurevicius R, Ha KH, Jermendy G, Kim DJ, Kiss Z, Leventer-Roberts M, Lin CY, Luk AOY, Ma S, Mata-Cases M, Mauricio D, Nichols GA, Pildava S, Porath A, Read SH, Robitaille C, Roncaglioni MC, Lopez-Doriga Ruiz P, Wang KL, Wild SH, Yekutiel N, Shaw JE. Trends in all-cause mortality among people with diagnosed diabetes in high-income settings: a multicountry analysis of aggregate data. Lancet Diabetes Endocrinol 2022; 10:112-119. [PMID: 35026157 DOI: 10.1016/s2213-8587(21)00327-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes. METHODS In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdictions (in six data sources in Asia, eight in Europe, one from Australia, and four from North America) for the period from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in people with diagnosed total or type 2 diabetes. We collected data from administrative sources, health insurance records, registries, and a health survey. We estimated excess mortality using the standardised mortality ratio (SMR). FINDINGS In our dataset, there were approximately 21 million deaths during 0·5 billion person-years of follow-up among people with diagnosed diabetes. 17 of 19 data sources showed decreases in the age-standardised and sex-standardised mortality in people with diabetes, among which the annual percentage change in mortality ranged from -0·5% (95% CI -0·7 to -0·3) in Hungary to -4·2% (-4·3 to -4·1) in Hong Kong. The largest decreases in mortality were observed in east and southeast Asia, with a change of -4·2% (95% CI -4·3 to -4·1) in Hong Kong, -4·0% (-4·8 to -3·2) in South Korea, -3·5% (-4·0 to -3·0) in Taiwan, and -3·6% (-4·2 to -2·9) in Singapore. The annual estimated change in SMR between people with and without diabetes ranged from -3·0% (95% CI -3·0 to -2·9; US Medicare) to 1·6% (1·4 to 1·7; Lombardy, Italy). Among the 17 data sources with decreasing mortality among people with diabetes, we found a significant SMR increase in five data sources, no significant SMR change in four data sources, and a significant SMR decrease in eight data sources. INTERPRETATION All-cause mortality in diabetes has decreased in most of the high-income countries we assessed. In eight of 19 data sources analysed, mortality decreased more rapidly in people with diabetes than in those without diabetes. Further longevity gains will require continued improvement in prevention and management of diabetes. FUNDING US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
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Affiliation(s)
- Dianna J Magliano
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lei Chen
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Agus Salim
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Yiling J Cheng
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Helene Gardiner
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Hanne L Gulseth
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - György Jermendy
- 3rd Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Departments of Pediatrics and Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Gregory A Nichols
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health, Ben Gurion University, Beer-Sheva, Israel
| | | | - Cynthia Robitaille
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, Latrobe University, Melbourne, VIC, Australia
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7
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Ziegler D, Porta M, Papanas N, Mota M, Jermendy G, Beltramo E, Mazzeo A, Caccioppo A, Striglia E, Serhiyenko V, Serhiyenko A, Rosta L, Stirban OA, Putz Z, Istenes I, Horváth V, Kempler P. The Role of Biofactors in Diabetic Microvascular Complications. Curr Diabetes Rev 2022; 18:e250821195830. [PMID: 34433401 PMCID: PMC10155884 DOI: 10.2174/1871527320666210825112240] [Citation(s) in RCA: 8] [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: 02/25/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022]
Abstract
Microvascular complications are responsible for a major proportion of the burden associated with diabetes contributing to substantial morbidity, mortality, and healthcare burden in people with diabetes. Retinopathy, nephropathy, and neuropathy constitute the leading causes of blindness, end-stage renal disease, and lower-extremity amputations, respectively. Since the efficacy of causal therapies of diabetic microvascular complications is limited, especially in type 2 diabetes, there is an unmet need for adjunct treatments which should be effective despite ongoing hyperglycemia. Experimental studies have indicated that diabetic microvascular complications can be prevented or ameliorated by various biofactors in animal models by interfering with the pathophysiology of the underlying condition. Some of the findings related to biofactors, like α-lipoic acid and benfotiamine, could be translated into the clinical arena and confirmed in clinical trials, especially in those focusing on diabetic polyneuropathy. Given the micronutrient nature of these compounds, their safety profile is excellent. Thus, they have the potential to favorably modify the natural history of the underlying complication, but long-term clinical trials are required to confirm this notion. Ultimately, biofactors should expand our therapeutic armamentarium against these common, debilitating, and even life-threatening sequelae of diabetes.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Mota
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, Romania
| | - György Jermendy
- Third Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Elena Beltramo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Mazzeo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Caccioppo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Elio Striglia
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Victoria Serhiyenko
- Department of Endocrinology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Alexandr Serhiyenko
- Department of Endocrinology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | | | | | - Zsuzsanna Putz
- Semmelweis University, Department of Medicine and Oncology, Budapest, Hungary
| | - Ildikó Istenes
- Semmelweis University, Department of Medicine and Oncology, Budapest, Hungary
| | - Viktor Horváth
- Semmelweis University, Department of Medicine and Oncology, Budapest, Hungary
| | - Peter Kempler
- Semmelweis University, Department of Medicine and Oncology, Budapest, Hungary
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8
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Rokszin G, Kiss Z, Sütő G, Kempler P, Jermendy G, Fábián I, Szekanecz Z, Poór G, Wittmann I, Molnár GA. Sodium-Glucose Co-Transporter 2 Inhibitors May Change the Development of Urinary Tract and Hematological Malignancies as Compared With Dipeptidyl Peptidase-4 Inhibitors: Data of the Post-Hoc Analysis of a Nationwide Study. Front Oncol 2021; 11:725465. [PMID: 34778040 PMCID: PMC8581296 DOI: 10.3389/fonc.2021.725465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/29/2021] [Accepted: 09/30/2021] [Indexed: 01/02/2023] Open
Abstract
Background In diabetes mellitus, during the last years, cancer became of equivalent importance as a cardiovascular disease in terms of mortality. In an earlier study, we have analyzed data of the National Health Insurance Fund (NHIF) of Hungary with regards all patients treated with sodium-glucose co-transporter 2 (SGLT2) inhibitors (SGLT2is) vs. those treated with dipeptidyl peptidase-4 (DPP-4) inhibitors (DPP-4is) in a given timeframe. In propensity score-matched groups of SGLT2i- vs. DPP-4i-treated patients, we found a lower incidence of cancer in general. In this post-hoc analysis, we aimed to obtain data on the incidence of site-specific cancer. Patients and Methods All patients starting an SGLT2i or a DPP-4i between 2014 and 2017 in Hungary were included; the two groups (SGLT2i vs. DPP-4i) were matched for 54 clinical and demographical parameters. The follow-up period was 639 vs. 696 days, respectively. Patients with a letter “C” International Classification of Diseases, 10th Revision (ICD-10) code have been chosen, and those with a known malignancy within a year before the onset of the study have been excluded from the analysis. Results We found a lower risk of urinary tract [HR 0.50 (95% CI: 0.32–0.79) p = 0.0027] and hematological malignancies [HR 0.50 (95% CI: 0.28–0.88) p = 0.0174] in patients treated with SGLT2i vs. those on DPP-4i. Risk of other types of cancer (including lung and larynx, lower gastrointestinal (GI) tract, rectum, pancreas, non-melanoma skin cancers, breast, or prostate) did not differ significantly between the two groups. When plotting absolute risk difference against follow-up time, an early divergence of curves was found in case of prostate, urinary tract, and hematological malignancies, whereas late divergence can be seen in case of cancers of the lung and larynx, the lower GI tract, and the breast. Conclusions Urinary tract and hematological malignancies were less frequent in patients treated with SGLT2i vs. DPP-4i. An early vs. late divergence could be observed for different cancer types, which deserves further studies.
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Affiliation(s)
| | - Zoltán Kiss
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | - Gábor Sütő
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Ibolya Fábián
- RxTarget Ltd, Szolnok, Hungary.,Faculty of Mathematics, University of Veterinary Medicine, Budapest, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gyula Poór
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - István Wittmann
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | - Gergő Attila Molnár
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
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9
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Molnár AÁ, Kolossváry M, Lakatos B, Tokodi M, Tárnoki ÁD, Tárnoki DL, Kovács A, Szilveszter B, Voros S, Jermendy G, Maurovich-Horvat P, Merkely B. Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study. Medicina (Kaunas) 2021; 57:medicina57090935. [PMID: 34577858 PMCID: PMC8470958 DOI: 10.3390/medicina57090935] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: No data are available on whether the heritability of left ventricle (LV) systolic and diastolic parameters are independent of each other. Therefore, our aim was to assess the magnitude of common and independent genetic and environmental factors defining LV systolic and diastolic function. Materials and Methods: We analyzed 184 asymptomatic twins (65% female, mean age: 56 ± 9 years). Transthoracic echocardiography was performed to measure LV systolic (global longitudinal and circumferential strain; basal and apical rotation) and diastolic (early diastolic velocity of mitral inflow and lateral mitral annulus tissue; deceleration time and early diastolic strain rate) parameters using conventional and speckle-tracking echocardiography. Genetic structural equation models were evaluated to quantify the proportion of common and specific genetic (Ac, As) and environmental factors (Ec, Es) contributing to the phenotypes. Results: LV systolic parameters had no common genetic or environmental heritability (Ac range: 0-0%; Ec range: 0-0%; As range: 57-77%; Es range: 24-43%). Diastolic LV parameters were mainly determined by common genetic and environmental effects (Ac range: 9-40%; Ec range: 11-49%; As range: 0-29%; Es range: 0-51%). Systolic parameters had no common genetic or environmental factors (Ac = 0%; Ec = 0%) with diastolic metrics. Conclusions: Systolic LV parameters have a strong genetic predisposition to any impact. They share no common genetic or environmental factors with each other or with diastolic parameters, indicating that they may deteriorate specifically to given effects. However, diastolic functional parameters are mainly affected by common environmental influences, suggesting that pathological conditions may deteriorate them equally. Estimation of the genetic and environmental influence and interdependence on systolic and diastolic LV function may help the understanding of the pathomechanism of different heart failure classification types.
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Affiliation(s)
- Andrea Ágnes Molnár
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (M.K.); (B.L.); (M.T.); (A.K.); (B.S.); (P.M.-H.); (B.M.)
- Correspondence: ; Tel.: +36-30-8285078
| | - Márton Kolossváry
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (M.K.); (B.L.); (M.T.); (A.K.); (B.S.); (P.M.-H.); (B.M.)
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (M.K.); (B.L.); (M.T.); (A.K.); (B.S.); (P.M.-H.); (B.M.)
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (M.K.); (B.L.); (M.T.); (A.K.); (B.S.); (P.M.-H.); (B.M.)
| | - Ádám Domonkos Tárnoki
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Hungary; (Á.D.T.); (D.L.T.)
| | - Dávid László Tárnoki
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Hungary; (Á.D.T.); (D.L.T.)
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (M.K.); (B.L.); (M.T.); (A.K.); (B.S.); (P.M.-H.); (B.M.)
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (M.K.); (B.L.); (M.T.); (A.K.); (B.S.); (P.M.-H.); (B.M.)
| | - Szilard Voros
- Scientific Affairs, Global Institute for Research, LLC, Richmond, VA 23219, USA;
| | - György Jermendy
- 3rd Department of Internal Medicine, Bajcsy Zsilinszky Hospital, 1106 Budapest, Hungary;
| | - Pál Maurovich-Horvat
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (M.K.); (B.L.); (M.T.); (A.K.); (B.S.); (P.M.-H.); (B.M.)
- Medical Imaging Center, Semmelweis University, 1082 Budapest, Hungary; (Á.D.T.); (D.L.T.)
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (M.K.); (B.L.); (M.T.); (A.K.); (B.S.); (P.M.-H.); (B.M.)
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10
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Magliano DJ, Chen L, Islam RM, Carstensen B, Gregg EW, Pavkov ME, Andes LJ, Balicer R, Baviera M, Boersma-van Dam E, Booth GL, Chan JCN, Chua YX, Fosse-Edorh S, Fuentes S, Gulseth HL, Gurevicius R, Ha KH, Hird TR, Jermendy G, Khalangot MD, Kim DJ, Kiss Z, Kravchenko VI, Leventer-Roberts M, Lin CY, Luk AOY, Mata-Cases M, Mauricio D, Nichols GA, Nielen MM, Pang D, Paul SK, Pelletier C, Pildava S, Porath A, Read SH, Roncaglioni MC, Lopez-Doriga Ruiz P, Shestakova M, Vikulova O, Wang KL, Wild SH, Yekutiel N, Shaw JE. Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings. Lancet Diabetes Endocrinol 2021; 9:203-211. [PMID: 33636102 PMCID: PMC10984526 DOI: 10.1016/s2213-8587(20)30402-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time. METHODS In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time. FINDINGS Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions. INTERPRETATION The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources. FUNDING US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
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Affiliation(s)
- Dianna J Magliano
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lei Chen
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Rakibul M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Elise Boersma-van Dam
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi Xian Chua
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sonsoles Fuentes
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Hanne L Gulseth
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Thomas R Hird
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - György Jermendy
- 3rd Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Mykola D Khalangot
- Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences, Kyiv, Ukraine; Endocrinology Department, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Victor I Kravchenko
- Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences, Kyiv, Ukraine
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics and Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; DAP-Cat Group, Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; DAP-Cat Group, Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Gregory A Nichols
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Mark M Nielen
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Deanette Pang
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine Pelletier
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health, Ben Gurion University, Beer-Sheva, Israel
| | | | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Olga Vikulova
- Diabetes Institute, Endocrinology Research Center, Moscow, Russia
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, Latrobe University, Bundoora, VIC, Australia
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11
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Sütő G, Molnár GA, Rokszin G, Fábián I, Kiss Z, Szekanecz Z, Poór G, Jermendy G, Kempler P, Wittmann I. Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study. BMJ Open Diabetes Res Care 2021; 9:9/1/e001765. [PMID: 33472796 PMCID: PMC7818813 DOI: 10.1136/bmjdrc-2020-001765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Mortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 diabetes mellitus was studied. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes treated with DPP-4i or SGLT2i during a 3-year period were identified in the database of the National Institute of Health Insurance Fund in Hungary. All-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA) and cancer were assessed. Outcomes of add-on SGLT2i to DPP-4i treatment in comparison with switching DPP-4i therapy to SGLT2i were also evaluated. After propensity score matching, survival analysis was performed with a Cox proportional hazards model. RESULTS After propensity score matching, both SGLT2i and DPP-4i groups included 18 583 patients. All-cause mortality (HR, 0.80; 95% CI 0.68 to 0.94; p=0.0057), HHF (HR, 0.81; 95% CI 0.71 to 0.92; p=0.0018), and risk of cancer (HR, 0.75; 95% CI 0.66 to 0.86; p<0.0001) were lower in the SGLT2i population compared with DPP-4i. Risk of LLA was higher in the SGLT2i group (HR, 1.35; 95% CI 1.03 to 1.77; p=0.0315). SGLT2i in combination with DPP-4i results in lower all-cause mortality (HR, 0.46; 95% CI 0.31 to 0.67; p=0.0001), with a lower trend in stroke, LLA, HHF and cancer, but without any statistical difference. CONCLUSIONS SGLT2i treatment leads to a lower risk of overall mortality, HHF and cancer when compared with DPP-4i treatment. Adding SGLT2i to DPP-4i instead of switching from DPP-4i to SGLT2i further lowers the risk of all-cause mortality.
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Affiliation(s)
- Gábor Sütő
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | - Gergő A Molnár
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | | | | | - Zoltan Kiss
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gyula Poór
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | - Peter Kempler
- First Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - István Wittmann
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
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12
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Ogundipe O, Mazidi M, Chin KL, Gor D, McGovern A, Sahle BW, Jermendy G, Korhonen MJ, Appiah B, Ademi Z, De Bruin ML, Liew D, Ofori-Asenso R. Real-world adherence, persistence, and in-class switching during use of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis involving 594,138 patients with type 2 diabetes. Acta Diabetol 2021; 58:39-46. [PMID: 32809070 DOI: 10.1007/s00592-020-01590-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/16/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022]
Abstract
AIMS Medication adherence and persistence are important determinants of treatment success in type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis evaluated the real-world adherence, persistence, and in-class switching among patients with T2DM prescribed dipeptidyl peptidase-4 (DPP4) inhibitors. METHODS MEDLINE, EMBASE, Cochrane Library, PsychINFO, and CINAHL were searched for relevant observational studies published in the English language up to 20 December 2019. This was supplemented by manual screening of the references of included papers. Random-effects meta-analysis was performed. RESULTS Thirty-four cohort studies involving 594,138 patients with T2DM prescribed DPP4 inhibitors from ten countries were included. The pooled proportion adherent (proportion of days covered (PDC) or medication possession ratio (MPR) ≥ 0.80) was 56.9% (95% confidence interval [CI] 49.3-64.4) at one year and 44.2% (95% CI 36.4-52.1) at two years. The proportion persistent with treatment decreased from 75.6% (95% CI 71.5-79.5) at six months to 52.8% (95% CI 51.6-59.8) at two years. No significant differences in adherence and persistence were observed between individual DPP4 inhibitors. At one year, just 3.2% (95% CI 3.1-3.3) of patients switched from one DPP4 inhibitor to another. Switching from saxagliptin and alogliptin to others was commonest. CONCLUSIONS Adherence to and persistence with DPP4 inhibitors is suboptimal but similar across all medications within the class. While in-class switching is uncommon, saxagliptin and alogliptin are the DPP4 inhibitors most commonly switched. Interventions to improve treatment adherence and persistence among patients with T2DM prescribed DPP4 inhibitors may be warranted.
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Affiliation(s)
| | - Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Ken Lee Chin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Deval Gor
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois At Chicago, Chicago, USA
| | - Andrew McGovern
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Exeter Medical School, The Institute of Biomedical and Clinical Science,, Exeter, UK
| | - Berhe W Sahle
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Maarit Jaana Korhonen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Bernard Appiah
- School of Public Health, Texas A&M University Health Science Center, TAMU, College Station, TX, USA
- Centre for Science and Health Communication, Accra, Ghana
| | - Zanfina Ademi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Copenhagen, Denmark
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Copenhagen, Denmark.
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13
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Papp S, Bárczi G, Karády J, Kolossváry M, Drobni ZD, Simon J, Boussoussou M, Vattay B, Szilveszter B, Jermendy G, Merkely B, Maurovich-Horvat P. Coronary plaque burden of the left anterior descending artery in patients with or without myocardial bridge: A case-control study based on coronary CT-angiography. Int J Cardiol 2020; 327:231-235. [PMID: 33276021 DOI: 10.1016/j.ijcard.2020.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The clinical significance of myocardial bridging (MB) on the left anterior descending artery (LAD) is debated. We aimed to assess the association between MB and LAD plaque volumes/compositions in a case-control set up. METHODS In our retrospective analysis we investigated 50 cases with incidentally recognized LAD MB and 50 matched controls without LAD MB on coronary computed tomography angiography. We quantified plaque volumes proximal to the MB and beneath it in patients with MB and in the corresponding coronary segments in patients without MB. RESULTS In total, we have included 100 patients (mean age 60.6 ± 10.8 years, males: 80%). Plaque volume was similar in the LAD segments proximal to the MB in cases vs. controls (150.0 mm3 [IQR: 90.7-194.5 mm3] vs. 132.8 mm3 [IQR: 94.2-184.3 mm3], respectively; p = 0.95) while the plaque volume was smaller beneath LAD MB vs. control segment (16.2 mm3 [IQR: 12.6-25.8 mm3] vs. 21.1 mm3 [IQR: 14.0-42.4 mm3], respectively; p = 0.002). No significant differences were found regarding different plaque components in segments proximal to the MB while fatty plaque and necrotic core volumes were smaller or negligible in coronary segment beneath MB than in controls (0.07 mm3 [IQR: 0.005-0.27 mm3] vs. 12.7 mm3 [IQR: 7.4-24.4 mm3] and 0.00 mm3 [IQR: 0.00-0.04 mm3] vs. 0.06 mm3 [IQR: 0.03-2.8 mm3], respectively (p < 0.001). CONCLUSION Comparing patients with MB vs. matched controls without it, MB was not associated with increased plaque volumes in LAD segment proximal to MB and plaque quantity was smaller in the MB segment. Our data are supportive of benign nature of incidentally recognized LAD MB.
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Affiliation(s)
- Sára Papp
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Bárczi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia D Drobni
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - György Jermendy
- Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
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14
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Consoli A, Czupryniak L, Duarte R, Jermendy G, Kautzky-Willer A, Mathieu C, Melo M, Mosenzon O, Nobels F, Papanas N, Roman G, Schnell O, Sotiropoulos A, Stehouwer CDA, Tack CJ, Woo V, Fadini GP, Raz I. Positioning sulphonylureas in a modern treatment algorithm for patients with type 2 diabetes: Expert opinion from a European consensus panel. Diabetes Obes Metab 2020; 22:1705-1713. [PMID: 32476244 DOI: 10.1111/dom.14102] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/31/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022]
Abstract
The large number of pharmacological agents available to treat type 2 diabetes (T2D) makes choosing the optimal drug for any given patient a complex task. Because newer agents offer several advantages, whether and when sulphonylureas (SUs) should still be used to treat T2D is controversial. Published treatment guidelines and recommendations should govern the general approach to diabetes management. However, expert opinions can aid in better understanding local practices and in formulating individual choices. The current consensus paper aims to provide additional guidance on the use of SUs in T2D. We summarize current local treatment guidelines in European countries, showing that SUs are still widely proposed as second-line treatment after metformin and are often ranked at the same level as newer glucose-lowering medications. Strong evidence now shows that sodium-glucose co-transporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with low hypoglycaemia risk, promote weight loss, and exert a positive impact on vascular, cardiac and renal endpoints. Thus, using SUs in place of SGLT-2is and GLP-1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT-2is and/or GLP-1RAs should be used as part of diabetes management, in the absence of contraindications. Routine utilization of SUs as second-line agents continues to be acceptable in resource-constrained settings.
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Affiliation(s)
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Rui Duarte
- Associação Protectora dos Diabéticos de Portugal (APDP), Lisbon, Portugal
| | | | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, University and Hospital Center of Coimbra, Coimbra, Portugal
- Medical Faculty, University of Coimbra, Coimbra, Portugal
| | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Hebrew University Hospital, The Faculty of Medicine, Jerusalem, Israel
| | | | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Gabriela Roman
- "Iuliu Hatieganu" University of Medicine & Pharmacy, Clinical Centre of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca, Romania
| | - Oliver Schnell
- Forschergruppe Diabetes e.V., Helmholtz Centre, Munich, Germany
| | | | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Vincent Woo
- Section of Endocrinology and Metabolism, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Itamar Raz
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Hebrew University Hospital, The Faculty of Medicine, Jerusalem, Israel
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15
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Jermendy G, Kolossváry M, Dudás I, Jermendy ÁL, Panajotu A, Suhai IF, Drobni ZD, Karády J, Tárnoki ÁD, Tárnoki DL, Voros S, Merkely B, Maurovich-Horvat P. Effect of genetic and environmental influences on hepatic steatosis: A classical twin study based on computed tomography. Imaging 2020. [DOI: 10.1556/1647.2020.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractBackground and aimsNon-alcoholic fatty liver disease (NAFLD) increases cardiovascular morbidity and mortality, and carries poor long-term hepatic prognosis. Data about the role of genetic and environmental factors in the hepatic lipid accumulation are limited. The aim of the study was to evaluate the genetic and environmental impact on the hepatic lipid accumulation within a cohort of adult twin pairs.Patients and methodsWe investigated 182 twin subjects [monozygotic (MZ, n = 114) and dizygotic (DZ, n = 68) same-gender twins (age 56.0 ± 9.6 years; BMI 27.5 ± 5.0 kg/m2; females 65.9%)] who underwent computed tomography (CT) with a 256-slice scanner. Using non-enhanced CT-images, we calculated the average value of hepatic attenuation [expressed in Hounsfield unit (HU)] suggesting hepatic lipid content. Crude data were adjusted to age, sex, BMI and HbA1c values. Intra-pair correlations were established, and structural equation models were used for quantifying the contribution of additive genetic (A), common environmental (C) and unique environmental (E) components to the investigated phenotype.ResultsThe study cohort represented a moderately overweight, middle-aged Caucasian population. There was no significant difference between MZ and DZ twin subjects regarding hepatic CT-attenuation (57.9 ± 12.6 HU and 59.3 ± 11.7 HU, respectively; p = 0.747). Age, sex, BMI and HbA1c adjusted co-twin correlations between the siblings showed that MZ twins have stronger correlations of HU values than DZ twins (rMZ = 0.592, p < 0.001; rDZ = 0.047, p = 0.690, respectively). Using the structural equation model, a moderate additive genetic dependence (A: 38%, 95% CI 15–58%) and a greater unique environmental influence (E: 62%, 95% CI 42–85%) was found. Common environmental influence was not identified (C: 0%).ConclusionThe results of our classical CT-based twin study revealed moderate genetic and greater environmental influences on the phenotypic appearance of hepatic steatosis, commonly referred to as NAFLD. Favorable changes of modifiable environmental factors are of great importance in preventing or treating NAFLD.
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Affiliation(s)
- György Jermendy
- 1Bajcsy-Zsilinszky Hospital and Outpatient Department, Budapest, Hungary
| | - Márton Kolossváry
- 2MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ibolya Dudás
- 2MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ádám L. Jermendy
- 2MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexisz Panajotu
- 2MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Imre F. Suhai
- 3Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Zsófia D. Drobni
- 2MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Júlia Karády
- 2MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- 4Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ádám D. Tárnoki
- 3Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Dávid L. Tárnoki
- 3Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- 2MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- 2MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- 3Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
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16
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Jermendy G, Kolossváry M, Drobni Z, Papp S, Jermendy ÁL, Panajotu A, Dudás I, Tárnoki ÁD, Tárnoki DL, Voros S, Merkely B, Maurovich-Horvat P. Environmental Factors Slightly Outweigh Genetic Influences in the Development of Pancreatic Lipid Accumulation: A Classical Twin Study. Metab Syndr Relat Disord 2020; 18:413-418. [PMID: 32721180 DOI: 10.1089/met.2020.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Several studies showed that lipid accumulation in the pancreas (NAFPD: nonalcoholic fatty pancreas disease) may lead to different pancreatic disorders, including beta-cell dysfunction. The role of genetic and environmental factors in pancreatic lipid accumulation is unclear. We evaluated the magnitude of genetic and environmental impact on pancreatic lipid content within a cohort of adult twin pairs. Patients and Methods: We investigated 136 twin subjects [monozygotic (MZ, n = 86) and dizygotic (DZ, n = 50) same-gender twins (age 57.7 ± 9.1 years; body mass index [BMI] 28.0 ± 4.4 kg/m2; females 64.7%)] with a 256-slice computed tomography (CT)-scanner. Using nonenhanced CT images, we calculated the average value of pancreatic attenuation expressed in Hounsfield unit (HU) suggesting pancreatic lipid content. Crude data were adjusted to age, sex, BMI, and hemoglobinA1c values. Intrapair correlations were established, and structural equation models were used for quantifying the contribution of additive genetic (A), common environmental (C), and unique environmental (E) components to the investigated phenotype. Results: The study cohort represented a moderately overweight, middle-aged Caucasian population. Average pancreatic attenuation was 48.9 ± 11.9 HU in MZ and 49.0 ± 13.0 HU in DZ twins (P = 0.934). The intrapair correlation between HU values was stronger in MZ compared to DZ twins (rMZ = 0.536, P < 0.001; rDZ = 0.115, P = 0.580). Using the structural equation model, a greater unique environmental influence [E: 54%, 95% confidence interval (CI) 19%-66%] and a moderate additive genetic dependence (A: 46%, 95% CI 34%-81%) were found. Conclusions: The results of our classical twin study indicate that environmental (lifestyle) influences slightly outweigh genetic effects on the phenotypic appearance of pancreatic lipid accumulation known as NAFPD.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital and Outpatient Department, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Drobni
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sára Papp
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ádám L Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ibolya Dudás
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Ádám D Tárnoki
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Dávid L Tárnoki
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
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17
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Boussoussou M, Borzsak S, Kolossváry M, Drobni Z, Á. J, Á. T, Jermendy G, Merkely B, Maurovich-Horvat P, Szilveszter B. Heritability Of Left Ventricular Morphology: Results From A Classical Twin Study. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Jermendy G, Kiss Z, Rokszin G, Fábián I, Wittmann I, Kempler P. Changes in mortality rates and ratios in people with pharmacologically treated type 2 diabetes mellitus between 2001 and 2016 in Hungary. Diabetes Res Clin Pract 2020; 163:108134. [PMID: 32272189 DOI: 10.1016/j.diabres.2020.108134] [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: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) is associated with a higher risk of all-cause mortality; however, detailed analyses of subgroups are rare. In this study we analyzed the changes of age- and gender-specific all-cause mortality rates and ratios in T2DM subjects (aged > 40 years) in Hungary between 2001 and 2016. METHODS We used the central database of the National Institute of Health Insurance Fund. All-cause mortality rates in patients with T2DM and ratios (T2DM/non-T2DM) were determined in males/females and in different age-groups. Age-adjusted values were used for standardized mortality rates. RESULTS Among pharmacologically treated T2DM subjects we found 117,700 and 329,845 males, 232,143 and 391,382 females in 2001 and 2016, respectively. Standardized all-cause mortality rate was higher in males than in females in 2001 (4540/100,000 vs. 3365/100,000) which decreased to 4125/100,000 in males (total change: -11.8%, p < 0.0001) and to 2977/100,000 in females (total change: -9.2%; p = 0.0558) in 2016. We found a significant increase (8.35%; p = 0.0272) in standardized all-cause mortality ratios between 2001 and 2016 which was higher in males (11.44%; p = 0.0096) than in females (2.78%; p = 0.3288). We observed the most pronounced increase in younger age-groups (age 41-60 years) in both genders (change varied from 54.2% to 101.8%; p < 0.05) which was due to distinct tendencies in changes of mortality curves. CONCLUSIONS Pharmacologically treated T2DM subjects in lower age-groups (41-60 years) had the highest increase in all-cause mortality ratios between 2001 and 2016 in Hungary. These data indicate that relatively younger patients with T2DM need special attention for improving long-term outcomes.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, 1106 Budapest, Hungary.
| | - Zoltán Kiss
- University of Pécs, Faculty of Medicine, 2(nd) Department of Medicine, Nephrological and Diabetes Center, Pacsirta út 1, 7624 Pécs, Hungary.
| | - György Rokszin
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - Ibolya Fábián
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - István Wittmann
- University of Pécs, Faculty of Medicine, 2(nd) Department of Medicine, Nephrological and Diabetes Center, Pacsirta út 1, 7624 Pécs, Hungary.
| | - Péter Kempler
- Semmelweis University, Faculty of Medicine, 1(st) Department of Medicine, Korányi Sándor út 2, 1083 Budapest, Hungary.
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Barkai L, Kiss Z, Rokszin G, Abonyi-Tóth Z, Jermendy G, Wittmann I, Kempler P. Changes in the incidence and prevalence of type 1 and type 2 diabetes among 2 million children and adolescents in Hungary between 2001 and 2016 - a nationwide population-based study. Arch Med Sci 2020; 16:34-41. [PMID: 32051703 PMCID: PMC6963129 DOI: 10.5114/aoms.2019.88406] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aim of the present study was to assess changes in the incidence and prevalence of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in children and adolescents in Hungary during the period 2001 to 2016 in order to provide nationwide population-based epidemiology data on diabetes in youths aged 0-18 years. MATERIAL AND METHODS This was a retrospective cohort study of Hungarian children and adolescents aged 18 years or younger. Pharmacologically treated diabetes cases were obtained through a population-based registry of the Hungarian National Health Insurance Fund. Time series analysis was used to evaluate the changing patterns of the incidence and prevalence for type 1 and type 2 diabetes covering a 16-year period. RESULTS During the study period, 6,138 and 1,997 new T1DM and T2DM cases were observed, respectively. Newly diagnosed T2DM cases accounted for 24.5% of all incident diabetes cases. Incidence of T1DM increased from 16/100,000 to 23/100,000 (R 2 = 0.7681; p < 0.0001). The male-to-female ratio among newly diagnosed T1DM patients did not change over the study period. Prevalence of T1DM rose from 114/100,000 to 209/100,000 (R 2 = 0.9909; p < 0.0001). The prevalent T1DM cases showed significant male predominance in every year (p < 0.05). Incidence of T2DM decreased from 8/100,000 to 5/100,000 (R 2 = 0.4977; p < 0.0014). The overall prevalence of T2DM did not change significantly. Prevalent T2DM cases showed significant female predominance in every year (p < 0.0001). A significant decrease in male-to female ratio was observed among newly diagnosed T2DM cases over the study period (p < 0.0001). CONCLUSIONS According to these population-based Hungarian data of children and adolescents with diabetes, T1DM is still the most common form and its frequency continues to rise, affecting more males than females. A high proportion of patients have T2DM, affecting more females than males, but the occurrence of medically treated cases is not increasing. The decrease in male-to-female ratio in newly diagnosed T2DM cases needs further investigations.
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Affiliation(s)
- László Barkai
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Zoltán Kiss
- 2 Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | | | | | | | - István Wittmann
- 2 Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Péter Kempler
- 1 Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Kiss Z, Rokszin G, Abonyi-Tóth Z, Jermendy G, Kempler P, Barkai L, Wittmann I. Young adult patients with type 1 diabetes have a higher risk of mortality than those of similar age with type 2 diabetes: A nationwide analysis in Hungary. Diabetes Metab Res Rev 2019; 35:e3190. [PMID: 31140677 DOI: 10.1002/dmrr.3190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/22/2018] [Revised: 04/11/2019] [Accepted: 05/22/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are few papers comparing complications of type 1 diabetes with those of a similarly young age with type 2 diabetes. The aim of our nationwide study was to compare the risks of mortality and morbidities between the two types of diabetes (age ≤ 40). METHODS We identified all young adult patients with type 1 diabetes who were recorded in the database of the Hungarian National Health Insurance Fund between 2001 and 2014 (n = 11 863) and compared them with a population of similar age with young adult type 2 diabetes (n = 47 931). The incidence of all-cause mortality, myocardial infarction, stroke, any type of cancer, diabetic ketoacidosis, and hypoglycemia was followed from the onset of diabetes to the date of death or end of study period. RESULTS The risks of all-cause mortality were significantly higher in patients with type 1 compared with patients with type 2 diabetes (hazard ratio, 95%CI; 2.17, 1.95-2.41; P < .0001). The risks of myocardial infarction (0.90, 0.71-1.13; P = 0.36) and stroke (1.06, 0.87-1.29; P = .582) were not significantly different in type 1 compared with type 2. In contrast, the risk of cancer (1.35, 1.15-1.59; P = .0003), dialysis (2.20, 1.76-2.75; P < .0001), hypoglycemia (7.70, 6.45-9.18; P < .0001), and ketoacidosis (22.12, 19.60-25.00; P < .0001) was higher among patients with type 1 compared with those with type 2 diabetes. CONCLUSIONS A comparatively higher incidence of diabetic ketoacidosis and hypoglycemia and higher risk of cancer and dialysis in patients with type 1 diabetes than in those with type 2 may play a role in the higher risk of mortality.
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Affiliation(s)
- Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- University of Veterinary Medicine, Budapest, Hungary
| | | | - Péter Kempler
- 1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - László Barkai
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - István Wittmann
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
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Jermendy G, Kiss Z, Rokszin G, Abonyi-Tóth Z, Wittmann I, Kempler P. Decreasing incidence of pharmacologically treated Type 2 diabetes in Hungary from 2001 to 2016: A nationwide cohort study. Diabetes Res Clin Pract 2019; 155:107788. [PMID: 31326457 DOI: 10.1016/j.diabres.2019.107788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/19/2019] [Revised: 06/17/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022]
Abstract
AIMS Incidence and prevalence of Type 2 diabetes mellitus (T2DM) vary in different regions. Long-term nationwide epidemiological data are useful to assess trends over time. The aim of the study was to analyze the epidemiological changes of pharmacologically treated T2DM among people aged over 18 years in Hungary between 2001 and 2016. METHODS Annual incidence, prevalence and all-cause mortality rate of pharmacologically treated T2DM patients were evaluated from 2001 to 2016 using the central database of the National Institute of Health Insurance Fund Management. Data were adjusted to age using the 2013 European Standard Population. RESULTS Incident rate of pharmacologically treated T2DM decreased from 931.6 cases/100,000 person-years to 350.7 cases/100,000 person-years resulting in a -62.4% change (annual average change: -6.46% [95% CI: -7.64%; -5.67%]) between 2001 and 2016. The prevalence rate continuously increased from 4949.9 cases/100,000 persons in 2001 to the highest rate (8135.0 cases/100,000 persons) in 2011, which plateaued during the next 3 years and slightly decreased thereafter. Standardized all-cause mortality rate in people with T2DM decreased between 2001 and 2016 by 11.9% (annual average change: -0.84% [95% CI: -1.22%; -0.39%]). CONCLUSIONS Despite a clearly decreasing incidence of pharmacologically treated T2DM in patients aged over 18 years, the prevalence rate increased from 2001 to 2011 followed by a 3-year-long plateau and a slight decrease thereafter. These long-term trends with the reduced mortality rate may indicate favorable effects of health promotional activities for preventing and treating T2DM.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, 1106 Budapest, Hungary.
| | - Zoltán Kiss
- University of Pécs, Faculty of Medicine, 2nd Department of Medicine and Nephrologica1 Center, Pacsirta út 1, 7624 Pécs, Hungary
| | - György Rokszin
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | | | - István Wittmann
- University of Pécs, Faculty of Medicine, 2nd Department of Medicine and Nephrologica1 Center, Pacsirta út 1, 7624 Pécs, Hungary.
| | - Péter Kempler
- Semmelweis University, Faculty of Medicine, 1st Department of Medicine, Korányi Sándor út 2, 1083 Budapest, Hungary.
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Aroda VR, González-Galvez G, Grøn R, Halladin N, Haluzík M, Jermendy G, Kok A, Őrsy P, Sabbah M, Sesti G, Silver R. Durability of insulin degludec plus liraglutide versus insulin glargine U100 as initial injectable therapy in type 2 diabetes (DUAL VIII): a multicentre, open-label, phase 3b, randomised controlled trial. Lancet Diabetes Endocrinol 2019; 7:596-605. [PMID: 31189519 DOI: 10.1016/s2213-8587(19)30184-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/07/2019] [Accepted: 05/15/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Durability of glycaemic control might reduce disease burden and improve long-term outcomes. DUAL VIII investigated the durability of insulin degludec plus liraglutide (IDegLira) versus insulin glargine 100 units/mL (IGlar U100) in patients with type 2 diabetes with the use of a visit schedule that mirrored routine clinical practice. METHODS In this 104-week international, multicentre, open-label, phase 3b randomised controlled trial, insulin-naive patients aged 18 years and older, with HbA1c between 7·0-11·0% (53-97 mmol/mol), BMI of 20 kg/m2 or higher, on stable doses of oral antidiabetic drugs, were recruited from outpatient clinics. Patients were randomly assigned 1:1, with a simple sequential allocation randomisation schedule (block size of four), to IDegLira or IGlar U100, each treatment being an add-on to existing therapy. The internal safety committee, the independent external committee, and the personnel involved in defining the analysis sets were masked until the database was released for statistical analysis. Patients and all other investigators were not masked. In the IDegLira group, patients were given degludec 100 units/mL plus liraglutide 3·6 mg/mL in a 3 mL prefilled PDS290 pen for subcutaneous injection; in the IGlar U100 group, patients were given IGlar U100 solution, in a 3 mL prefilled Solostar pen for subcutaneous injection. Both treatments were given once daily at any time of day and it was recommended that the time of day remained the same throughout the trial. The primary endpoint was time from randomisation to need for treatment intensification (HbA1c ≥7·0% [53 mmol/mol] at two consecutive visits, including week 26). Once patients met this criterion, the trial product was permanently discontinued and patients were not withdrawn from trial but rather remained on follow-up for the entire treatment and follow-up period. The primary analysis was in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT02501161. FINDINGS From Jan 8, 2016, to Oct 3, 2018, 1345 patients were screened, of which 1012 (75·2%) were eligible and randomly assigned to either IDegLira (n=506) or IGlar U100 (n=506). 484 (96%) of 506 in the IDegLira group and 481 (95%) of 506 in the IGlar U100 group completed the trial. Baseline characteristics were similar and representative of patients eligible for basal insulin intensification (overall mean diabetes duration 10 years; HbA1c 8·5% [69 mmol/mol]; fasting plasma glucose 10 mmol/L). Patients in the IDegLira group had significantly longer time until intensification was needed than those in the IGlar U100 group (median >2 years vs about 1 year). Fewer patients in the IDegLira group needed treatment intensification over 104 weeks than those in the IGlar U100 group (189 [37%] of 506 vs 335 [66%] of 506). The preplanned sensitivity analyses of the primary endpoint were in agreement with the primary analysis (hazard ratio 0·45 [95% CI 0·38-0·54]) in the proportional hazards regression model and the generalised log-rank test was also in favour of IDegLira (p<0·0001). No new or unexpected safety and tolerability issues were identified and there were no treatment-related deaths. INTERPRETATION In patients with uncontrolled type 2 diabetes on oral antidiabetic drugs, initial injectable therapy with IDegLira resulted in fewer patients reaching the treatment intensification criterion during 104 weeks versus IGlar U100, with longer durability of the treatment effect with IDegLira. FUNDING Novo Nordisk.
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Affiliation(s)
- Vanita R Aroda
- Brigham and Women's Hospital, Boston, MA, USA; MedStar Health Research Institute, Hyattsville, MD, USA.
| | | | | | | | - Martin Haluzík
- Institute for Clinical and Experimental Medicine and Institute of Endocrinology, Prague, Czech Republic
| | | | - Adri Kok
- Union and Clinton Hospitals in Alberton, Gauteng, South Africa
| | | | | | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Robert Silver
- Southern New Hampshire Diabetes and Endocrinology, Nashua, NH, USA
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Abstract
Type 2 diabetes - due to its natural course - should be considered as a progressive chronic disease. Owing to this fact, antihyperglycemic treatment should be continuously increased stepwise in order to achieve proper glycemic control. Lifestyle modification should be initiated immediately after manifestation, shortly followed by metformin monotherapy, and later, dual or triple combinations and, finally, injectable derivatives - only insulin in the past - should be used for appropriate glycemic control. Guidelines about treatment approach of patients with type 2 diabetes unequivocally emphasize and describe in detail the need of treatment intensification, in other words, stepwise escalation in clinical practice. In the last couple of years, evidences provided that step down therapy, simplification of complex treatment regimens should also be considered in certain cases. This approach was generally called de-escalation in antihyperglycemic treatment which should be considered in patients with type 2 diabetes 1) after bariatric (metabolic) surgery; 2) with significant weight reduction irrespective of its origin; 3) with complex insulin regimens where re-evaluation of this treatment was missed; 4) with continuously decreasing renal function; 5) among elderly patients with comorbidities; 6) in social deprivation. In this article, data about therapeutic de-escalation of antihyperglycemic treatment in patients with type 2 diabetes and first experiences with this treatment approach are summarized. Orv Hetil. 2019; 160(31): 1207-1215.
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Kiss Z, Rokszin G, Abonyi-Tóth Z, Jermendy G, Kempler P, Wittmann I. Different Changes of Risks for Stroke and Myocardial Infarction in Patients With Type 2 Diabetes in Hungary Between the Two Periods of 2001-2004 and 2010-2013. Front Endocrinol (Lausanne) 2019; 10:170. [PMID: 30949133 PMCID: PMC6437040 DOI: 10.3389/fendo.2019.00170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/28/2019] [Indexed: 01/09/2023] Open
Abstract
Objective: In recent decades several studies reported significant changes in the mortality and morbidity of patients with type 2 diabetes. In this Hungarian nationwide study, we assessed the changes of mortality and cardiovascular risks comparing a group of patient diagnosed during the two periods of 2001-2004 and 2010-2013. Research Design and Methods: We identified patients with type 2 diabetes recorded in the database of the Hungarian National Health Insurance Fund aiming to assess changes of risks for all-cause mortality, myocardial infarction, and stroke during the follow-up periods of 48 months. Results: We included 274,109 patients with newly diagnosed type 2 diabetes between 2001 and 2004, while only 152,678 in the 2010-2013 period. The risk of all-cause mortality at the beginning of the follow-up was not different comparing 2010-2013 to 2001-2004 (HR 1.03), and a mild but significant decrease could be detected (HR 0.87) after 48 months. A lower risk for myocardial infarction was documented in the second month after the diagnosis of diabetes (HR 0.67), which remained constant during the study period and almost the same after 48 months (HR 0.73). On the contrary, our study verified a slightly increased risk for stroke close to the diagnosis [HR 1.06 (1.00-1.13)] and a decreased one [HR 0.72 (0.69-0.79)] at the end of the study. Conclusions: An increased risk for stroke followed by a sharp decrease, and an unchanged risk for myocardial infarction in the Hungarian population with type 2 diabetes possibly resulted in a mild decrease of all-cause mortality between 2001 and 2013.
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Affiliation(s)
- Zoltan Kiss
- Second Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biomathematics and Informatics, University of Veterinary Medicine, Budapest, Hungary
| | - György Jermendy
- Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Péter Kempler
- First Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - István Wittmann
- Second Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
- *Correspondence: István Wittmann
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Jermendy G, Kovács G. [Effectiveness of one-year insulin glargine and insulin glulisine basal-bolus treatment in people with type 2 diabetes. An analysis from drug reimbursement perspective]. Orv Hetil 2018; 159:2122-2128. [PMID: 30545262 DOI: 10.1556/650.2018.31214] [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] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Being entitled for no patient co-payment, the Hungarian reimbursement condition of analogue insulins as part of basal-bolus treatment in type 2 diabetes mellitus (T2DM) requires that two HbA1c levels should achieve <8.0% target value within 12 months (measured two months apart) after switching from treatment with human insulins. Achieving this target, the treatment should be considered effective from drug reimbursement perspective. AIM The aims of the study were to investigate the effectiveness of insulin glargine + insulin glulisine basal-bolus regimen from the payer's perspective and to investigate the ability to maintain the achieved glycaemic control in previously uncontrolled T2DM patients (HbA1c >9.0%). METHOD This one-year, non-interventional study included patients with T2DM inadequately controlled (HbA1c >9.0%) on previous human basal-bolus treatment. The main outcomes were the proportion of patients who achieved the adequate glycaemic control (defined by the reimbursement rules) and the proportion of patients who achieved reimbursement rules defined HbA1c <8.0% target value by the 6 months after switch and could maintain this glycaemic control for upcoming further 6 months. As safety outcome, the hypoglycaemic events were recorded. RESULTS Out of the 557 patients enrolled, 287 had available data to be included in the efficacy analysis. Out of the 287 efficacy analysis patients, 169 (58.9%) achieved the reimbursement rules defined glycaemic control. At 6 months, 167 patients had HbA1c value <8.0% and 152 (91.0%) remained in this target range until the end of the 12-month observational period. Overall, 1221 non-severe and 6 severe hypoglycaemic events were reported. CONCLUSIONS More than half of the patients with T2DM who were newly switched to insulin glargine + glulisine basal-bolus treatment could achieve the reimbursement rule criteria requiring for prescription of the analogue insulins with no co-payment beyond 1 year of treatment in Hungary. However, the results revealed that glycaemic control assessment with HbA1c measurements had not met the reimbursement requirements in a significant part of patients. Orv Hetil. 2018; 159(50): 2122-2128.
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Affiliation(s)
| | - Gábor Kovács
- Medico-Pharmecon Kft. Budapest, Madarász V. u. 13., 1. ép. 5. em. 85., 1131
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Jermendy G, Kiss Z, Rokszin G, Abonyi-Tóth Z, Wittmann I, Kempler P. Persistence to Treatment with Novel Antidiabetic Drugs (Dipeptidyl Peptidase-4 Inhibitors, Sodium-Glucose Co-Transporter-2 Inhibitors, and Glucagon-Like Peptide-1 Receptor Agonists) in People with Type 2 Diabetes: A Nationwide Cohort Study. Diabetes Ther 2018; 9:2133-2141. [PMID: 30120754 PMCID: PMC6167279 DOI: 10.1007/s13300-018-0483-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Adequate persistence to antidiabetic treatment is highly important to achieve proper glycemic control. In this study we evaluate the persistence to treatment with dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists in a nationwide cohort of patients with type 2 diabetes. METHODS Using a central database in Hungary, we analyzed the persistence to the treatment with dipeptidyl peptidase-4 inhibitors (n = 59,900), sodium-glucose co-transporter-2 inhibitors (n = 26,052), and glucagon-like peptide-1 receptor agonists (n = 17,332) at treatment intensification between 2014 and 2016. We also compared the persistence of dipeptidyl peptidase-4 inhibitors (n = 9163) and sodium-glucose co-transporter-2 inhibitors (n = 1257) in initial therapy to that of metformin (n = 79,305) or sulfonylureas (n = 29,057). The rates of persistence to treatment and risk of non-persistence are reported. RESULTS The persistence rates of dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists at treatment intensification were 69.6%, 67.8%, and 66.3% at year 1 which decreased to 57.3%, 56.8%, and 52.1% by year 2, respectively. The risk of non-persistence was higher by 6.6% (95% CI 3.6-9.6) for sodium-glucose co-transporter-2 inhibitors and by 8.3% (95% CI 5.0-11.5) for glucagon-like peptide-1 receptor agonists as compared to dipeptidyl peptidase-4 inhibitors. Novel oral antidiabetic drugs in fixed versus free add-on combinations with metformin had higher persistence. The persistence to treatment with novel oral antidiabetic drugs in initial therapy was better (dipeptidyl peptidase-4 inhibitors, 59.6% and 47.6%; sodium-glucose co-transporter-2 inhibitors, 61.9% and 47.0%) than that of initial monotherapy with metformin (47.0% and 39.1%) or sulfonylureas (52.4% and 41.8%) at years 1 and 2, respectively. CONCLUSION Analysis of persistence of treatment with novel glucose-lowering medications revealed differences between drug classes, favoring dipeptidyl peptidase-4 inhibitors vs. sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Persistence data of novel antihyperglycemic agents may be useful for guiding the decision at initiation of antidiabetic treatment. FUNDING Hungarian Diabetes Association. Plain language summary available for this article.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, 1106, Budapest, Hungary.
| | - Zoltán Kiss
- Faculty of Medicine, 2nd Department of Medicine and Nephrological Center, University of Pécs, Pacsirta út 1, 7624, Pécs, Hungary
| | - György Rokszin
- RxTarget Ltd, Bacsó Nándor út 10, 5000, Szolnok, Hungary
| | | | - István Wittmann
- Faculty of Medicine, 2nd Department of Medicine and Nephrological Center, University of Pécs, Pacsirta út 1, 7624, Pécs, Hungary
| | - Péter Kempler
- Faculty of Medicine, 1st Department of Medicine, Semmelweis University, Korányi Sándor út 2, 1083, Budapest, Hungary
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Drobni ZD, Kolossvary M, Jermendy AL, Karady J, Szilveszter B, Tarnoki AD, Tarnoki DL, Jermendy G, Voros S, Merkely B, Maurovich-Horvat P. P6210Heritability of coronary plaque composition and plaque burden: a classical twin study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Z D Drobni
- Semmelweis University Heart Center, MTA-SE Cardiovascular Imaging Research Group, Budapest, Hungary
| | - M Kolossvary
- Semmelweis University Heart Center, MTA-SE Cardiovascular Imaging Research Group, Budapest, Hungary
| | - A L Jermendy
- Semmelweis University Heart Center, MTA-SE Cardiovascular Imaging Research Group, Budapest, Hungary
| | - J Karady
- Semmelweis University Heart Center, MTA-SE Cardiovascular Imaging Research Group, Budapest, Hungary
| | - B Szilveszter
- Semmelweis University Heart Center, MTA-SE Cardiovascular Imaging Research Group, Budapest, Hungary
| | | | | | - G Jermendy
- Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - S Voros
- Global Genomics Group, Richmond, United States of America
| | - B Merkely
- Semmelweis University Heart Center, MTA-SE Cardiovascular Imaging Research Group, Budapest, Hungary
| | - P Maurovich-Horvat
- Semmelweis University Heart Center, MTA-SE Cardiovascular Imaging Research Group, Budapest, Hungary
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Kiss Z, Rokszin G, Abonyi-Tóth Z, Jermendy G, Kempler P, Aradi D, Wittmann I. Dissimilar impact of type 2 diabetes on cardiovascular outcomes according to age categories: a nationwide population study from Hungary. Cardiovasc Diabetol 2018; 17:107. [PMID: 30053870 PMCID: PMC6062985 DOI: 10.1186/s12933-018-0751-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022] Open
Abstract
Background The excess risks of mortality and cardiovascular morbidity among patients with type 2 diabetes mellitus (T2DM) is well known. In this nationwide study, we assessed risks of mortality and cardiovascular events comparing patients with T2DM and matched controls. Methods We identified patients with T2DM in a retrospective cohort study using the database of the National Health Insurance Fund between 1 January 2010 and 31 December, 2013. Controls were randomly included and matched according to age, gender, and zip code of residence. Patients were divided into subgroups according to age decades for outcome analyses. Results During the mean follow-up period of 2.3 years, 152,678 patients with T2DM and 305,356 matched controls were included. Patients with T2DM showed significantly higher risk for all-cause mortality (HR 1.26, 95% CI 1.22–1.29, p < 0.0001), myocardial infarction (HR 1.81, 95% CI 1.69–1.94, p < 0.0001) and stroke (HR 1.40, 95% CI 1.35–1.46, p < 0.0001) compared to matched controls. The higher risk associated with T2DM for mortality, myocardial infarction and stroke differed significantly between age groups (pinteraction < 0.05 for all outcomes) with significantly higher risk observed in younger patients. Conclusions The risk of cardiovascular outcomes and all-cause mortality is significantly higher in patients with T2DM. Notably, the relative hazard increases with decreasing age suggesting that younger patients with T2DM should receive more attention for cardiovascular prevention.
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Affiliation(s)
- Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pacsirta str. 1, Pecs, 7624, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary.,University of Veterinary Medicine, Budapest, Hungary
| | | | - Péter Kempler
- I. Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Dániel Aradi
- Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - István Wittmann
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pacsirta str. 1, Pecs, 7624, Hungary.
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Kovács A, Molnár AÁ, Kolossváry M, Szilveszter B, Panajotu A, Lakatos BK, Littvay L, Tárnoki ÁD, Tárnoki DL, Voros S, Jermendy G, Sengupta PP, Merkely B, Maurovich-Horvat P. Genetically determined pattern of left ventricular function in normal and hypertensive hearts. J Clin Hypertens (Greenwich) 2018; 20:949-958. [PMID: 29741807 DOI: 10.1111/jch.13271] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 01/08/2023]
Abstract
We sought to assess the inheritance of left ventricular (LV) function using speckle-tracking echocardiography and the impact of hypertension on modifying the genetically determined pattern of contraction in a population of twins. We recruited 92 Caucasian twin pairs, including 74 hypertensive (HTN) siblings. Beyond standard echocardiographic protocol, a speckle-tracking analysis was performed, including global longitudinal strain (GLS). Systolic function, as assessed by ejection fraction, showed moderate heritability (61%); however, GLS showed higher and dominant heritability (75%). Heterogeneity models revealed that there were no differences between the HTN and non-HTN subjects regarding the heritability of GLS. However, the heritability estimates of diastolic function parameters, including early diastolic strain rate, were low. LV systolic biomechanics is highly heritable. GLS shows dominant heritability, despite the presence of early-stage hypertensive heart disease. Early diastolic parameters are rather determined by environmental factors. These findings suggest the presence of a genetic framework that conserves systolic function despite the expression of diastolic dysfunction and may underlie the phenotypic progression towards heart failure with preserved ejection fraction.
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Affiliation(s)
- Attila Kovács
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Ágnes Molnár
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Károly Lakatos
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Ádám Domonkos Tárnoki
- Hungarian Twin Registry, Budapest, Hungary.,Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
| | - Dávid László Tárnoki
- Hungarian Twin Registry, Budapest, Hungary.,Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
| | | | - György Jermendy
- III. Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | | | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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30
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Jermendy G. [Randomized, controlled clinical trials with observational follow-up investigations for evaluating efficacy of antihyperglycaemic treatment. II. Features of and lessons from the follow-up investigations]. Orv Hetil 2018; 159:615-619. [PMID: 29658280 DOI: 10.1556/650.2018.31042] [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] [Indexed: 11/19/2022]
Abstract
Although the outcomes of the follow-up investigation period of the randomized clinical studies for evaluating the efficacy of a treatment or an antidiabetic drug may be confounded or potentially biased by several factors, the results are widely accepted by the diabetes community. In line with the theory of metabolic memory or metabolic legacy, early and intensive antihyperglycaemic treatment should be provided for all diabetic patients as this strategy can result in beneficial effects even in the long run. The recent cardiovascular safety trials with new, innovative antidiabetic drugs differ in several aspects from the former efficacy studies. Ten cardiovascular safety trials were completed so far enabling to define their unique and common features. It can be anticipated that the era of randomized, controlled efficacy studies with observational follow-up investigations came to an end in diabetes research. Nowadays, cardiovascular safety trials are in the focus of clinical research in diabetology and results of several ongoing studies are expected with interest in the near future. Orv Hetil. 2018; 159(16): 615-619.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Kórház és Rendelőintézet Budapest, Maglódi út 89-91., 1106
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31
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Jermendy G. [Randomized, controlled clinical trials with observational follow-up investigations for evaluating efficacy of antihyperglycaemic treatment. I. Main results of the studies]. Orv Hetil 2018; 159:575-582. [PMID: 29631425 DOI: 10.1556/650.2018.31041] [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] [Indexed: 11/19/2022]
Abstract
The effect of antihyperglycaemic (antidiabetic) treatment on the late diabetic complications is one of the most important research areas in clinical diabetology. The relationship between glycaemic control and late micro- and macrovascular complications was highlighted by the results of the DCCT (Diabetes Control and Complications Trial) with type 1 and by the UKPDS (United Kingdom Prospective Diabetes Study) with type 2 diabetic patients. In these studies, observational follow-up investigations were also performed after the close-out of the randomized phase of the trial. In addition to these landmark studies, other randomized, controlled efficacy trials were also performed with observational follow-up investigations resulting in the development of the concept of metabolic memory or metabolic legacy. In this article, the main results of the studies are summarized. Orv Hetil. 2018; 159(15): 575-582.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Kórház és Rendelőintézet Budapest, Maglódi út 89-91., 1106
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32
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Maurovich-Horvat P, Kolossvary M, Jermendy A, Karady J, Drobni Z, Tarnoki A, Tarnoki D, Merkely B, Jermendy G. 2852Genetic and environmental effects on eutopic and ectopic adipose tissue quantities: a classical twin study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.2852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Molnar A, Kovacs A, Kolossvary M, Lakatos B, Tarnoki A, Tarnoki D, Maurovich-Horvat P, Jermendy G, Sengupta P, Merkely B. P1446Common genetic background of left ventricular global longitudinal strain and diastolic function: new insights into the understanding of heart failure with preserved ejection fraction? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Kiss LZ, Bagyura Z, Vadas R, Polgár L, Lux Á, Édes E, Szenczi O, Soós P, Szelid Z, Becker D, Jermendy G, Merkely B. Signs of subclinical atherosclerosis in asymptomatic patients at increased risk of type 2 diabetes mellitus. J Diabetes Complications 2017; 31:1293-1298. [PMID: 28576484 DOI: 10.1016/j.jdiacomp.2017.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 01/11/2017] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 12/18/2022]
Abstract
AIMS We aimed to study carotid intima media thickness (CIMT) in asymptomatic patients with an increased risk of type 2 diabetes mellitus (T2DM) and in a pre-diabetic state. METHODS Diabetes risk assessment was performed in 2420 participants in a voluntary screening program between 2011 and 2013. The risk of T2DM was estimated by the Findrisc scoring system (FR). A FR≥12 was considered as increased risk. HbA1c% between 5.7 and 6.4% signified a pre-diabetic state. Carotid duplex scan was performed and CIMT above 0.9 mm was regarded as pathological. Patients with T2DM or a history of cardiovascular disease were excluded. RESULTS Overall 1475 subjects were included. Four groups were compared: "control" (normal HbA1c, FR<12), "HbA1c only" (HbA1c: 5.7-6.4%, FR<12), "Findrisc only" (normal HbA1c, FR≥12) and "combined" (HbA1c: 5.7-6.4%, FR≥12). Frequency of pathological maximal CIMT was 9.4%, 19.7%, 27.4% and 36.4% in the groups, respectively (p<0.001). Logistic regression analysis revealed that compared to control subjects, sex and risk factor-adjusted Odds Ratios for the presence of pathological maximal CIMT were 2.2 (p<0.001), 3.4 (p<0.001) and 5.1 (p<0.001) for the groups, respectively. CONCLUSIONS Evaluation of Findrisc score and HbA1c at population level may facilitate early recognition of subclinical vascular complications even in the pre-diabetic state.
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Affiliation(s)
- Loretta Zsuzsa Kiss
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Zsolt Bagyura
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Réka Vadas
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Lívia Polgár
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Árpád Lux
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Eszter Édes
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Orsolya Szenczi
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Pál Soós
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Zsolt Szelid
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
| | - György Jermendy
- Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest H-1106, Hungary.
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor Street 68, Budapest H-1122, Hungary.
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Németh N, Putz Z, Istenes I, Körei AE, Vági OE, Kempler M, Gandhi R, Jermendy G, Tesfaye S, Tabák ÁG, Kempler P. Is there a connection between postprandial hyperglycemia and IGT related sensory nerve dysfunction? Nutr Metab Cardiovasc Dis 2017; 27:609-614. [PMID: 28676377 DOI: 10.1016/j.numecd.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/27/2016] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS To assess the risk factors for sensory nerve dysfunction in subjects with isolated impaired glucose tolerance (IGT). METHODS AND RESULTS Seventy-two people with isolated IGT (WHO 1999 criteria) and 39 gender and age-matched healthy volunteers underwent detailed clinical and neurological assessment including quantitative sensory testing using the Neurometer device (current perception threshold measurement on four limbs at three different frequencies). Sensory nerve dysfunction was defined as at least two abnormalities on any frequencies on the upper or lower limbs. Sensory nerve dysfunction was more prevalent among subjects with IGT compared to controls (58.3 vs. 10.3%, OR: 11.23, 95%CI: 3.57-35.35). This association was not influenced by BMI, systolic and diastolic blood pressure, heart rate and autonomic neuropathy (multiple adjusted OR: 13.87, 95%CI: 3.18-60.58), but further adjustment for glycaemic measures abolished the association (OR: 1.58, 95%CI: 0.07-35.68). Assessing the components of glycaemic measures separately, the association between sensory nerve dysfunction and IGT was not affected by HbA1c (OR: 13.94, 95%CI: 1.84-105.5). It was, however, substantially attenuated by fasting plasma glucose (OR: 6.75, 95%CI: 1.33-34.27) while the significance was lost after adjustment for 120 min postload glucose level (OR: 3.76, 95%CI: 0.26-54.10). In the pooled population assessed, independent determinants of sensory nerve dysfunction were older age, 120 min glucose, higher height and cardiovascular autonomic neuropathy at near significance. CONCLUSIONS Sensory nerve dysfunction amongst subjects with IGT was not explained by cardiovascular covariates, only by glycaemic measures. In addition to 120 min glucose, cardiovascular autonomic neuropathy at borderline significance, age, and height were the independent determinants of sensory nerve dysfunction.
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Affiliation(s)
- N Németh
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
| | - Z Putz
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - I Istenes
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - A E Körei
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - O E Vági
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - M Kempler
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary; 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - R Gandhi
- Royal Hallamshire Hospital, Sheffield, UK
| | - G Jermendy
- 3rd Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - S Tesfaye
- Royal Hallamshire Hospital, Sheffield, UK
| | - Á G Tabák
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary; Department of Epidemiology and Public Health, University College London, London, UK
| | - P Kempler
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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Várkonyi T, Körei A, Putz Z, Martos T, Keresztes K, Lengyel C, Nyiraty S, Stirban A, Jermendy G, Kempler P. Advances in the management of diabetic neuropathy. Minerva Med 2017; 108:419-437. [DOI: 10.23736/s0026-4806.17.05257-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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37
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Jermendy G, Kiss Z, Rokszin G, Abonyi-Tóth Z, Wittmann I, Kempler P. A 2-es típusú diabetes antihyperglykaemiás kezelésének alakulása Magyarországon 2001–2014 között – az Országos Egészségbiztosítási Pénztár adatbázis-elemzésének eredményei. Orv Hetil 2017; 158:770-778. [DOI: 10.1556/650.2017.30769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract: In the last couple of years, significant developments in antidiabetic treatment have influenced the pharmacological treatment of type 2 diabetes mellitus (T2DM). The aim of this study was to analyze the changes in prescribing patterns of glucose-lowering drugs for T2DM patients in Hungary between 2001 and 2014. The number of patients with newly diagnosed T2DM decreased from 75,700 (2001) to 33,700 (2014), while prevalent T2DM cases continuously increased and plateaued in 2014 with a number of registered patients of 727,000. Sulfonylurea-monotherapy decreased from 64% to 35% while metformin-monotherapy increased from 19% to 42% in this period. The most frequently used drug at first treatment initiation was metformin (66%) and sulfonylurea (16%) as monotherapy in 2014. DPP4-inhibitors were newly administered in 20,362 cases while GLP1-mimetics were newly used by 4,996 patients in 2014. Five years later after initiating sulfonylurea therapy between 2010 and 2014, metformin was more frequently used as second drug (39%) than sulfonylurea in patients with previous metformin treatment (22.9%). The prescribing patterns of glucose-lowering drugs have changed over time in accordance with new guidelines. Further changes in prescribing habits can be expected in the near future. Orv Hetil. 2017; 158(20): 770–778.
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Affiliation(s)
| | - Zoltán Kiss
- II. Belgyógyászati Klinika és Nephrológiai Centrum, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | | | | | - István Wittmann
- II. Belgyógyászati Klinika és Nephrológiai Centrum, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Péter Kempler
- I. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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Domján BA, Ferencz V, Tänczer T, Szili-Janicsek Z, Barkai L, Hidvégi T, Jermendy G, Kempler P, Winkler G, Gerő L, Tabák AG. Large increase in the prevalence of self-reported diabetes based on a nationally representative survey in Hungary. Prim Care Diabetes 2017; 11:107-111. [PMID: 27669637 DOI: 10.1016/j.pcd.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 03/28/2016] [Revised: 08/22/2016] [Accepted: 09/03/2016] [Indexed: 11/19/2022]
Abstract
AIMS To estimate and compare the prevalence of self-reported diabetes based on nationally representative surveys of the Hungarian adult population in 2002 (published data - Hungarostudy) and a survey in 2012. METHODS A cross-sectional computer-assisted telephone interview survey on a stratified representative sample of community-dwelling adults (n=1000) in 2012. To describe self-reported diabetes prevalence and its temporal changes generalized linear models were used and results were compared to figures from Hungarostudy. RESULTS Age standardized prevalence of self-reported type 2 diabetes was 11.7% (95%CI 10.0-13.8%) without gender or rural-urban differences in 2012. People with self-reported diabetes were older than controls (mean [SE]: 63.9 [0.9] vs. 45.9 [0.3] years, p<0.0001). The prevalence of diabetes sharply increased after 40 years of age and peaked at age 70 (27.7% [2.5], page*age<0.0001). The prevalence of self-reported diabetes increased by 89% (OR 1.89, 95%CI 1.53-2.32) from 6.2 to 11.7% between the two surveys with the most pronounced increase in the age group 55-64 years (from 11.6 to 24.4%). CONCLUSIONS We reported an alarming increase in the prevalence of self-reported type 2 diabetes in the last decade that mostly affects working age people. If this trend continues, a major public health crisis in Hungary can be envisaged.
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Affiliation(s)
- Beatrix A Domján
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Viktória Ferencz
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Tímea Tänczer
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Zsófia Szili-Janicsek
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - László Barkai
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Egyetem út, Miskolc H-3515, Hungary; Velkey László Center for Child Health, Borsod County University Hospital, Szentpéteri kapu 72-76, Miskolc H-3526, Hungary; Postgraduate Institute of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen H-4032, Hungary.
| | - Tibor Hidvégi
- Department of Internal Medicine, Aladár Petz County Hospital, Vasvári Pál utca 2-4, Győr H-9023, Hungary.
| | - György Jermendy
- Department of Medicine, Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, Budapest H-1106, Hungary.
| | - Péter Kempler
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Gábor Winkler
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Egyetem út, Miskolc H-3515, Hungary; Department of Medicine and Diabetology, Saint John's Hospital, Diós árok 1, Budapest H-1125, Hungary.
| | - László Gerő
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Adam G Tabák
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary; Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Jermendy G, Kempler P, Abonyi-Tóth Z, Rokszin G, Wittmann I. [Changes in features of diabetes care in Hungary in the period of years 2001-2014. Aims and methods of the database analysis of the National Health Insurance Fund]. Orv Hetil 2017; 157:1259-65. [PMID: 27499284 DOI: 10.1556/650.2016.30519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the last couple of years, database analyses have become increasingly popular among clinical-epidemiological investigations. In Hungary, the National Health Insurance Fund serves as central database of all medical attendances in state departments and purchases of drug prescriptions in pharmacies. Data from in- and outpatient departments as well as those from pharmacies are regularly collected in this database which is public and accessible on request. The aim of this retrospective study was to investigate the database of the National Health Insurance Fund in order to analyze the diabetes-associated morbidity and mortality in the period of years 2001-2014. Moreover, data of therapeutic costs, features of hospitalizations and practice of antidiabetic treatment were examined. The authors report now on the method of the database analysis. It is to be hoped that the upcoming results of this investigation will add some new data to recent knowledge about diabetes care in Hungary. Orv. Hetil., 2016, 157(32), 1259-1265.
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Affiliation(s)
| | - Péter Kempler
- I. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | | | | | - István Wittmann
- II. Belgyógyászati Klinika és Nephrologiai Centrum, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
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Nagy B, Zsólyom A, Nagyjánosi L, Merész G, Steiner T, Papp E, Dessewffy Z, Jermendy G, Winkler G, Kaló Z, Vokó Z. Cost-effectiveness of a risk-based secondary screening programme of type 2 diabetes. Diabetes Metab Res Rev 2016; 32:710-729. [PMID: 26888326 DOI: 10.1002/dmrr.2791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 05/28/2015] [Revised: 11/25/2015] [Accepted: 02/09/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study was to develop a long-term economic model for type 2 diabetes to describe the entire spectrum of the disease over a wide range of healthcare programmes. The model evaluates a public health, risk-based screening programme in a country specific setting. METHODS The lifespan of persons and important phases of the disease and related interventions are recorded in a Markov model, which first simulates the effect of screening, then replicates important complications of diabetes, follows the progression of individuals through physiological variables and finally calculates outcomes in monetary and naturalistic units. RESULTS The introduction of the screening programme nearly doubled the proportion of diagnosed patients at the age of 50 and prolonged life expectancy. Three-yearly screening gained 0.0229 quality adjusted life years for an additional €83 per person compared with no screening and resulted an incremental cost-effectiveness ratio of €3630/quality adjusted life years. CONCLUSION From the economic perspective introduction of the 3-yearly screening programme is justifiable and it provides a good value for money. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Balázs Nagy
- Syreon Research Institute, Budapest, Hungary.
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary.
| | - Adriána Zsólyom
- Syreon Research Institute, Budapest, Hungary
- Faculty of Social Sciences, Social Policy Ph.D. Programme, Eötvös Loránd University, Budapest, Hungary
| | - László Nagyjánosi
- Health Sciences Doctoral School, University of Debrecen, Debrecen, Hungary
| | | | - Tamás Steiner
- Faculty of Social Sciences, Social Policy Ph.D. Programme, Eötvös Loránd University, Budapest, Hungary
- 2nd Department of Internal Medicine-Diabetology, St. John's Hospital and North-Buda United Institutions, Budapest, Hungary
- Department of Endocrinology, St. Christopher's Clinic, Budapest, Hungary
| | - Eszter Papp
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | | | - György Jermendy
- 3rd Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Gábor Winkler
- 2nd Department of Internal Medicine-Diabetology, St. John's Hospital and North-Buda United Institutions, Budapest, Hungary
- Faculty of Health Care, Institute of Theoretical Sciences, University of Miskolc, Miskolc, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
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Kovács A, Molnár AÁ, Celeng C, Tóth A, Vágó H, Apor A, Tárnoki ÁD, Tárnoki DL, Kósa J, Lakatos P, Voros S, Jermendy G, Merkely B, Maurovich-Horvat P. Hypertrophic Cardiomyopathy in a Monozygotic Twin Pair: Similarly Different. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004794. [PMID: 27259341 DOI: 10.1161/circimaging.116.004794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Attila Kovács
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Andrea Ágnes Molnár
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Csilla Celeng
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Attila Tóth
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Hajnalka Vágó
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Astrid Apor
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Ádám Domonkos Tárnoki
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Dávid László Tárnoki
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - János Kósa
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Péter Lakatos
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Szilard Voros
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - György Jermendy
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Béla Merkely
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.)
| | - Pál Maurovich-Horvat
- From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K., A.Á.M., C.C., A.T., H.V., A.A., B.M., P.M.-H.); Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary (Á.D.T., D.L.T.); PentaCore Laboratory, Budapest, Hungary (J.K.); First Department of Medicine, Semmelweis University ,Budapest, Hungary (P.L.); Global Genomics Group (G3), Richmond, VA (S.V.); and III Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary (G.J.).
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Abstract
In the last couple of years incretin-based antidiabetic drugs became increasingly popular and widely used for treating patients with type 2 diabetes. Immediately after launching, case reports and small case series were published on the potential side effects of the new drugs, with special attention to pancreatic disorders such as acute pancreatitis or pancreatic cancer. As clinical observations accumulated, these side-effects were noted with nearly all drugs of this class. Although these side-effects proved to be rare, an intensive debate evolved in the literature. Opinion of diabetes specialists and representatives of pharmaceutical industry as well as position statements of different international scientific boards and health authorities were published. In addition, results of randomized clinical trials with incretin-based therapy and meta-analyses became available. Importantly, in everyday clinical practice, the label of the given drug should be followed. With regards to incretins, physicians should be cautious if pancreatitis in the patients’ past medical history is documented. Early differential diagnosis of any abdominal pain during treatment of incretin-based therapy should be made and the drug should be discontinued if pancreatitis is verified. Continuous post-marketing surveillance and side-effect analysis are still justified with incretin-based antidiabetic treatment in patients with type 2 diabetes. Orv. Hetil., 2016, 157(14), 523–528.
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Jermendy G. Az inkretintengelyen ható antidiabetikumokkal végzett cardiovascularis biztonságossági tanulmányok eddigi tapasztalatai. Orv Hetil 2016; 157:603-10. [DOI: 10.1556/650.2016.30416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Several randomized, controlled clinical trials were initiated some years ago in order to evaluate the cardiovascular safety of the new antidiabetic drugs in patients with type 2 diabetes due to requirements from regulatory bodies. Four trials with incretin-based drugs (saxagliptin, alogliptin, sitagliptin and lixisenatide) have been completed so far. Based on the primary outcome endpoints of these trials no cardiovascular risks were found with incretins in patients with type 2 diabetes. As for saxagliptin, the hospitalization for heart failure was investigated as a secondary endpoint, and an increased risk was observed in the respective trial; however, this observation was widely debated later in the literature. Together with ongoing trials of other novel antihyperglycemic agents, these data will provide more robust evidence about the cardiovascular safety of incretin-based antidiabetic treatment in patients with type 2 diabetes. Orv. Hetil., 2016, 157(16), 603–610.
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Abstract
The classification of diabetes mellitus in adolescents and young adults is often difficult. The diagnosis of the monogenic form of diabetes may have substantial influence on quality of life, prognosis and the choice of the appropriate treatment of affected patients. Among MODY (maturity-onset of diabetes in the young) MODY-1 is rarely detected, only 13 families were described in 2000, and 103 different mutations in 173 families were known in 2013 worldwide. The authors present the first Hungarian case of a monogenic form of diabetes due to HNF4α mutation (MODY-1). The diabetes of the index patient No. 1 (42-year-old woman with insulin treated diabetes) was diagnosed as gestational diabetes at age of 20 when she was treated with diet only. Later, insulin treatment has been initiated when marked hyperglycaemia was detected during an episode of acute pneumonia at age of 26. The diabetes of the index patient No. 2 (20-year-old daughter of the index patient No. 1, treated also with insulin) was diagnosed as type 2 diabetes at age of 13 and the patient was treated with diet only. Later the classification was modified to type 1 and insulin therapy was initiated at age of 14. The manifestation of diabetes, the familial occurrence and the low dose insulin requirement were suggestive for monogenic diabetes. Using molecular genetic method a mutation (c.869G>A, p.R290H) of HNF4α gene was found and MODY-1 was diagnosed in both cases. Insulin therapy was switched to treatment with low dose sulfanylurea and an excellent glycaemic control was achieved and sustained at follow-up of 1-year. No further positive cases were found during screening of other family members.
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Affiliation(s)
- György Jermendy
- III. Belgyógyászati Oktató Osztály, Bajcsy-Zsilinszky Kórház Budapest, Maglódi út 89-91., 1106
| | - István Balogh
- Laboratóriumi Medicina Intézet, Klinikai Genetikai Tanszék, Debreceni Egyetem Debrecen
| | - Zsolt Gaál
- IV. Belgyógyászati Osztály, Jósa András Egyetemi Oktatókórház, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház Nyíregyháza
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Kolossváry M, Drobni ZD, Littvay L, Hörcsik D, Jermendy Á, Karády J, Tárnoki ÁD, Jermendy G, Merkely B, Maurovich-Horvat P. Effect of adipose tissue compartments on the presence of coronary artery disease. J Cardiovasc Comput Tomogr 2016. [DOI: 10.1016/j.jcct.2015.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Strojek K, Raz I, Jermendy G, Gitt AK, Liu R, Zhang Q, Jacober SJ, Milicevic Z. Factors Associated With Cardiovascular Events in Patients With Type 2 Diabetes and Acute Myocardial Infarction. J Clin Endocrinol Metab 2016; 101:243-53. [PMID: 26595100 DOI: 10.1210/jc.2015-1962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Decreasing risk of cardiovascular (CV) disease remains a challenge to survival in type 2 diabetes. OBJECTIVE The objective was to assess the association between demographic, glycemic, and other clinical factors and CV risk in the Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus trial. DESIGN, SETTINGS, PARTICIPANTS, AND INTERVENTION: We used discrete-time survival tree analysis to examine data collected for up to 4.6 years in 1115 patients with type 2 diabetes mellitus experiencing acute myocardial infarction (MI) less than or equal to 18 days before enrollment. MAIN OUTCOME MEASURES The primary objective was to identify demographic, glycemic, and CV risk factors best separating survival curves over time for a composite end point: CV death, nonfatal MI, nonfatal stroke, hospitalization for acute coronary syndromes, or coronary revascularization planned after randomization. RESULTS Average change across visits in mean 2-hour blood glucose level after meals was associated with the greatest difference in event-free survival probability for the primary end point: mean time to 75% event-free survival for an average change across visits less than or equal to -0.14 mmol/L, 73.48 weeks; for visits with average change more -0.14 mmol/L, 29.10 weeks. An average change across visits in the hemoglobin A1c level less than or equal to -0.92% (-10.06 mmol/mol) and the absence of a history of stroke or acute MI increased CV event-free survival time further. Fasting blood glucose and randomized insulin treatment strategy were weak predicting factors of event-free survival. CONCLUSIONS Postprandial glycemia should be considered a potential target in trials to reduce CV morbidity and mortality in type 2 diabetes mellitus.
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Affiliation(s)
- Krzysztof Strojek
- Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria
| | - Itamar Raz
- Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria
| | - György Jermendy
- Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria
| | - Anselm K Gitt
- Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria
| | - Rong Liu
- Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria
| | - Qianyi Zhang
- Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria
| | - Scott J Jacober
- Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria
| | - Zvonko Milicevic
- Internal Diseases (K.S.), Diabetology and Cardiometabolic Diseases, Silesian Centre of Heart Diseases, Silesian Medical University, 41-800 Zabrze, Poland; Diabetes Unit (I.R.), Internal Medicine Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; Medical Department (G.J.), Bajcsy-Zsilinszky Teaching Hospital, Budapest, 1106 Hungary; Cardiology (A.K.G.), Herzzentrum Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen, Germany; Eli Lilly and Company (R.L., Q.Z., S.J.J.), Indianapolis, Indiana 46285; and Lilly Regional GmbH (Z.M.), Eli Lilly and Company, 1030 Vienna, Austria
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Winter R, Fazlinezhad A, Martins Fernandes S, Pellegrino M, Iriart X, Moustafa S, Stolfo D, Bieseviciene M, Patel S, Vriz O, Sarvari SI, Santos M, Berezin A, Stoebe S, Benyounes Iglesias N, De Chiara B, Soliman A, Oni O, Ricci F, Tumasyan LR, Kim KH, Popa BA, Yiangou K, Olsen RH, Cacicedo A, Monti L, Holte E, Orlic D, Trifunovic D, Nucifora G, Casalta AC, Cavalcante JL, Keramida K, Calin A, Almeida Morais L, Bandera F, Galli E, Kamal HM, Leite L, Polte CL, Martinez Santos P, Jin CN, Generati G, Reali M, Kalcik M, Cacicedo A, Nascimento H, Ferreiro Quero C, Kazum S, Madeira S, Villagra JM, Muraru D, Gobbo M, Generati G, D'andrea A, Azevedo O, Nucifora G, Cruz I, Lozano Granero VC, Stampfli SF, Marketou M, Bento D, Mohty D, Hernandez Jimenez V, Gascuena R, Ingvarsson A, Cameli M, Werther Evaldsson A, Greiner S, Michelsen MM, El Eraky AZZA, Kamal HM, D'ascenzi F, Spinelli L, Stojanovic S, Mincu RI, Vindis D, Mantovani F, Yi JE, Styczynski G, Battah AHMED, O'driscoll J, Generati G, Velasco Del Castillo S, Voilliot D, Scali MC, Garcia Campos A, Opitz B, Herold IHF, Veiga CESAR, Santos Furtado M, Khan UM, Leite L, Leite L, Leite L, Keramida K, Molnar AA, Rio P, Huang MS, Papadopoulos C, Venneri L, Onut R, Casas Rojo E, Bayat F, Aggeli C, Ben Kahla S, Abid L, Choi JH, Barreiro Perez M, Lindqvist P, Sheehan F, Vojdanparast M, Nezafati P, Teixeira R, Generati G, Bandera F, Labate V, Alfonzetti E, Guazzi M, Dinet ML, Jalal Z, Cochet H, Thambo JB, Ho TH, Shah P, Murphy K, Nelluri BK, Lee H, Wilansky S, Mookadam F, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, Ramani F, Zecchin M, Sinagra G, Vaskelyte JJ, Mizariene V, Lesauskaite V, Verseckaite R, Karaliute R, Jonkaitiene R, Li L, Craft M, Danford D, Kutty S, Pellegrinet M, Zito C, Carerj S, Di Bello V, Cittadini A, Bossone E, Antonini-Canterin F, Rodriguez M, Sitges M, Sepulveda-Martinez A, Gratacos E, Bijnens B, Crispi F, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Samura T, Kremzer A, Tarr A, Pfeiffer D, Hagendorff A, Van Der Vynckt C, Gout O, Devys JM, Cohen A, Musca F, D'angelo L, Cipriani MG, Parolini M, Rossi A, Santambrogio GM, Russo C, Giannattasio C, Moreo A, Moharram M, Gamal A, Reda A, Adebiyi A, Aje A, Aquilani R, Dipace G, Bucciarelli V, Bianco F, Miniero E, Scipioni G, De Caterina R, Gallina S, Adamyan KG, Chilingaryan AL, Tunyan LG, Cho JY, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Popa A, Cerin G, Azina CH, Yiangou A, Georgiou C, Zitti M, Ioannides M, Chimonides S, Pedersen LR, Snoer M, Christensen TE, Ghotbi AA, Hasbak P, Kjaer A, Haugaard SB, Prescott E, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Garcia Cuenca E, Zugazabeitia Irazabal G, Romero Pereiro A, Nardi B, Di Giovine G, Malanchini G, Scardino C, Balzarini L, Presbitero P, Gasparini GL, Tesic M, Zamaklar-Trifunovic D, Vujisic-Tesic B, Borovic M, Milasinovic D, Zivkovic M, Kostic J, Belelsin B, Ostojic M, Krljanac G, Savic L, Asanin M, Aleksandric S, Petrovic M, Zlatic N, Lasica R, Mrdovic I, Muser D, Zanuttini D, Tioni C, Bernardi G, Spedicato L, Proclemer A, Galli E, Szymanski C, Salaun E, Lavoute C, Haentjens J, Tribouilloy C, Mancini J, Donal E, Habib G, Delgado-Montero A, Dahou A, Caballero L, Rijal S, Gorcsan J, Monin JL, Pibarot P, Lancellotti P, Kouris N, Kostopoulos V, Giannaris V, Trifou E, Markos L, Mihalopoulos A, Mprempos G, Olympios CD, Mateescu AD, Rosca M, Beladan CC, Enache R, Gurzun MM, Varga P, Calin C, Ginghina C, Popescu BA, Galrinho A, Branco L, Gomes V, Timoteo AT, Daniel P, Rodrigues I, Rosa S, Fragata J, Ferreira R, Generati G, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Leclercq C, Samset E, Donal E, Oraby MA, Eleraky AZ, Yossuef MA, Baptista R, Teixeira R, Ribeiro N, Oliveira AP, Barbosa A, Castro G, Martins R, Elvas L, Pego M, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Vilacosta I, Batlle Lopez E, Sanchez Sauce B, Jimenez Valtierra J, Espana Barrio E, Campuzano Ruiz R, De La Rosa Riestra A, Alonso Bello J, Perez Gonzalez F, Wan S, Sun JP, Lee AP, Bandera F, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Cimino S, Salatino T, Silvetti E, Mancone M, Pennacchi M, Giordano A, Sardella G, Agati L, Yesin M, Gunduz S, Gursoy MO, Astarcioglu MA, Karakoyun S, Bayam E, Cersit S, Ozkan M, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Quintana Razcka O, Romero Pereiro A, Zugazabeitia Irazabal G, Braga M, Flores L, Ribeiro V, Melao F, Dias P, Maciel MJ, Bettencourt P, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Sanchez Fernandez J, Duran Jimenez E, Morenate Navio C, Romero M, Pan M, Suarez De Lezo J, Vaturi M, Weisenberg D, Monakier D, Valdman A, Vaknin- Assa H, Assali A, Kornowski R, Sagie A, Shapira Y, Ribeiras R, Abecasis J, Teles R, Castro M, Tralhao A, Horta E, Brito J, Andrade M, Mendes M, Avegliano G, Ronderos R, Matta MG, Camporrotondo M, Castro F, Albina G, Aranda A, Navia D, Siciliano M, Migliore F, Cavedon S, Folino F, Pedrizzetti G, Bertaglia M, Corrado D, Iliceto S, Badano LP, Merlo M, Stolfo D, Losurdo P, Ramani F, Barbati G, Pivetta A, Pinamonti B, Sinagra GF, Di Lenarda A, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Di Palma E, Baldini L, Verrengia M, Vastarella R, Limongelli G, Bossone E, Calabro' R, Russo MG, Pacileo G, Cruz I, Correia E, Bento D, Teles L, Lourenco C, Faria R, Domingues K, Picarra B, Marques N, Muser D, Gianfagna P, Morocutti G, Proclemer A, Gomes AC, Lopes LR, Stuart B, Caldeira D, Morgado G, Almeida AR, Canedo P, Bagulho C, Pereira H, Pardo Sanz A, Marco Del Castillo A, Monteagudo Ruiz JM, Rincon Diaz LM, Ruiz Rejon F, Casas E, Hinojar R, Fernandez-Golfin C, Zamorano Gomez JL, Erhart L, Staehli BE, Kaufmann BA, Tanner FC, Kontaraki J, Parthenakis F, Maragkoudakis S, Zacharis E, Patrianakos A, Vardas P, Domingues K, Correia E, Lopes L, Teles L, Picarra B, Magalhaes P, Faria R, Lourenco C, Azevedo O, Boulogne C, Magne J, Damy T, Martin S, Boncoeur MP, Aboyans V, Jaccard A, Saavedra Falero J, Alberca Vela MT, Molina Blazquez L, Mata Caballero R, Serrano Rosado JA, Elviro R, Di Gioia C, Fernandez Rozas I, Manzano MC, Martinez Sanchez JI, Molina M, Palma J, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Righini FM, Sparla S, Di Tommaso C, Focardi M, D'ascenzi F, Tacchini D, Maccherini M, Henein M, Mondillo S, Ingvarsson A, Waktare J, Thilen U, Stagmo M, Roijer A, Radegran G, Meurling C, Jud A, Aurich M, Katus HA, Mereles D, Faber R, Pena A, Mygind ND, Suhrs HE, Zander M, Prescott E, Handoka NESRIN, Ghali MONA, Eldahshan NAHED, Ibrahim AHMED, Al-Eraky AZ, El Attar MA, Omar AS, Pelliccia A, Alvino F, Solari M, Cameli M, Focardi M, Bonifazi M, Mondillo S, Giudice CA, Assante Di Panzillo E, Castaldo D, Riccio E, Pisani A, Trimarco B, Deljanin Ilic M, Ilic S, Magda LS, Florescu M, Velcea A, Mihalcea D, Chiru A, Popescu BO, Tiu C, Vinereanu D, Hutyra M, Cechakova E, Littnerova S, Taborsky M, Lugli R, Bursi F, Fabbri M, Modena MG, Stefanelli G, Mussini C, Barbieri A, Youn HJ, O JH, Yoon HJ, Jung HO, Shin GJ, Rdzanek A, Pietrasik A, Kochman J, Huczek Z, Milewska A, Marczewska M, Szmigielski CA, Abd Eldayem SOHA, El Magd El Bohy ABO, Slee A, Peresso V, Nazir S, Sharma R, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Anton Ladislao A, Gomez Sanchez V, Cacidedo Fernandez Bobadilla A, Onaindia Gandarias JJ, Rodriguez Sanchez I, Romero Pereira A, Quintana Rackza O, Jimenez Melo O, Zugazabeitia Irazabal G, Huttin O, Venner C, Deballon R, Manenti V, Villemin T, Olivier A, Sadoul N, Juilliere Y, Selton-Suty C, Simioniuc A, Mandoli GE, Dini FL, Marzilli M, Picano E, Martin-Fernandez M, De La Hera Galarza JM, Corros-Vicente C, Leon-Aguero V, Velasco-Alonso E, Colunga-Blanco S, Fidalgo-Arguelles A, Rozado-Castano J, Moris De La Tassa C, Stelzmueller ME, Wisser W, Reichenfelser W, Mohl W, Saporito S, Mischi M, Bouwman RA, Van Assen HC, Van Den Bosch HCM, De Lepper A, Korsten HHM, Houthuizen P, Rodrigues A, Leal G, Silvestre O, Andrade J, Hjertaas JJ, Greve G, Matre K, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Oliveira AP, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Kouris N, Kostopoulos V, Markos L, Olympios CD, Kovacs A, Tarnoki AD, Tarnoki DL, Kolossvary M, Apor A, Maurovich-Horvat P, Jermendy G, Sengupta P, Merkely B, Viveiros Monteiro A, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Timoteo A, Abreu J, Leal A, Varela F, Cruz Ferreira R, Yang LT, Tsai WC, Mpaltoumas K, Fotoglidis A, Triantafyllou K, Pagourelias E, Kassimatis E, Tzikas S, Kotsiouros G, Mantzogeorgou E, Vassilikos V, Calicchio F, Manivarmane R, Pareek N, Baksi J, Rosen S, Senior R, Lyon AR, Khattar RS, Marinescu C, Onciul S, Zamfir D, Tautu O, Dorobantu M, Carbonell San Roman A, Rincon Diez LM, Gonzalez Gomez A, Fernandez Santos S, Lazaro Rivera C, Moreno Vinues C, Sanmartin Fernandez M, Fernandez-Golfin C, Zamorano Gomez JL, Alirezaei T, Karimi AS, Kakiouzi V, Felekos I, Panagopoulou V, Latsios G, Karabela M, Petras D, Tousoulis D, Abid L, Abid D, Kammoun S, Ben Kahla S, Lee JW, Martin Fernandez M, Costilla Garcia SM, Diaz Pelaez E, Moris De La Tassa C. Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Maurovich-Horvat P, Tárnoki DL, Tárnoki ÁD, Horváth T, Jermendy ÁL, Kolossváry M, Szilveszter B, Voros V, Kovács A, Molnár AÁ, Littvay L, Lamb HJ, Voros S, Jermendy G, Merkely B. Rationale, Design, and Methodological Aspects of the BUDAPEST-GLOBAL Study (Burden of Atherosclerotic Plaques Study in Twins-Genetic Loci and the Burden of Atherosclerotic Lesions). Clin Cardiol 2015; 38:699-707. [PMID: 26492817 DOI: 10.1002/clc.22482] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/11/2015] [Indexed: 12/18/2022] Open
Abstract
The heritability of coronary atherosclerotic plaque burden, coronary geometry, and phenotypes associated with increased cardiometabolic risk are largely unknown. The primary aim of the Burden of Atherosclerotic Plaques Study in Twins-Genetic Loci and the Burden of Atherosclerotic Lesions (BUDAPEST-GLOBAL) study is to evaluate the influence of genetic and environmental factors on the burden of coronary artery disease. By design this is a prospective, single-center, classical twin study. In total, 202 twins (61 monozygotic pairs, 40 dizygotic same-sex pairs) were enrolled from the Hungarian Twin Registry database. All twins underwent non-contrast-enhanced computed tomography (CT) for the detection and quantification of coronary artery calcium and for the measurement of epicardial fat volumes. In addition, a single non-contrast-enhanced image slice was acquired at the level of L3-L4 to assess abdominal fat distribution. Coronary CT angiography was used for the detection and quantification of plaque, stenosis, and overall coronary artery disease burden. For the primary analysis, we will assess the presence and volume of atherosclerotic plaques. Furthermore, the 3-dimensional coronary geometry will be assessed based on the coronary CT angiography datasets. Additional phenotypic analyses will include per-patient epicardial and abdominal fat quantity measurements. Measurements obtained from monozygotic and dizygotic twin pairs will be compared to evaluate the genetic or environmental effects of the given phenotype. The BUDAPEST-GLOBAL study provides a unique framework to shed some light on the genetic and environmental influences of cardiometabolic disorders.
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Affiliation(s)
- Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dávid L Tárnoki
- Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
| | - Ádám D Tárnoki
- Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
| | - Tamás Horváth
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ádám L Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Viktor Voros
- Scientific Affairs, Global Institute for Research, LLC, Richmond, Virginia
| | - Attila Kovács
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Á Molnár
- Department of Cardiology, Military Hospital, Budapest, Hungary
| | - Levente Littvay
- Department of Political Science, Central European University, Budapest, Hungary
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Szilard Voros
- Scientific Affairs, Global Institute for Research, LLC, Richmond, Virginia
| | - György Jermendy
- Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Leibowitz G, Cahn A, Bhatt DL, Hirshberg B, Mosenzon O, Wei C, Jermendy G, Sheu WHH, Sendon JL, Im K, Braunwald E, Scirica BM, Raz I. Impact of treatment with saxagliptin on glycaemic stability and β-cell function in the SAVOR-TIMI 53 study. Diabetes Obes Metab 2015; 17:487-94. [PMID: 25656169 DOI: 10.1111/dom.12445] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 12/01/2014] [Revised: 01/18/2015] [Accepted: 01/31/2015] [Indexed: 12/20/2022]
Abstract
AIMS To study the effects of saxagliptin, a dipeptidyl peptidase-4 inhibitor, on glycaemic stability and β-cell function in the SAVOR-TIMI 53 trial. METHODS We randomized 16,492 patients with type 2 diabetes (T2D) to saxagliptin or placebo, added to current antidiabetic medications, and followed them for a median of 2.1 years. Glycaemic instability was defined by: (i) a glycated haemoglobin (HbA1c) increase of ≥ 0.5% post-randomization; (ii) the initiation of new antidiabetic medications for ≥ 3 months; or (iii) an increase in dose of oral antidiabetic medication or ≥ 25% increase in insulin dose for ≥ 3 months. β-cell function was assessed according to fasting homeostatic model 2 assessment of β-cell function (HOMA-2β) values at baseline and at year 2 in patients not treated with insulin. RESULTS Compared with placebo, participants treated with saxagliptin had a reduction in the development of glycaemic instability (hazard ratio 0.71; 95% confidence interval 0.68-0.74; p < 0.0001). In participants treated with saxagliptin compared with placebo, the occurrence of an HbA1c increase of ≥ 0.5% was reduced by 35.2%; initiation of insulin was decreased by 31.7% and the increases in doses of an oral antidiabetic drug or insulin were reduced by 19.5 and 23.5%, respectively (all p < 0.0001). At 2 years, HOMA-2β values decreased by 4.9% in participants treated with placebo, compared with an increase of 1.1% in those treated with saxagliptin (p < 0.0001). CONCLUSIONS Saxagliptin improved glycaemia and prevented the reduction in HOMA-2β values. Saxagliptin may reduce the usual decline in β-cell function in T2D, thereby slowing diabetes progression.
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Affiliation(s)
- G Leibowitz
- The Diabetes Unit, Hadassah University Hospital, Jerusalem, Israel; The Endocrine Service, Hadassah University Hospital, Jerusalem, Israel
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Barkai L, Hâncu N, Jermendy G, Konstantinova M, Lichiardopol R, Moţa M, Tankova C, Temelkova N, Winkler G. The Importance of Postprandial Hyperglycemia Position Statement of the Danube Mco Experts. Romanian Journal of Diabetes Nutrition and Metabolic Diseases 2015. [DOI: 10.1515/rjdnmd-2015-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Both the prevalence and incidence of type 2 diabetes are increasing worldwide and over 60% of people with T2DM develop cardiovascular disease. There are many data supporting the view that glycaemic control plays a role in reducing cardiovascular complications. The relationship between hyperglycaemia and cardiovascular disease is complex with evidence suggesting that an acute increase of glycaemia, particularly after a meal, may have a direct detrimental effect on cardiovascular disease. Although control of fasting hyperglycaemia is necessary, it is usually insufficient to obtain optimal glycaemic control. A growing body of evidence suggests that reducing post meal plasma glucose excursions is as important, or perhaps more important for achieving HbA1c goals. New classes of therapies for managing post meal plasma glucose in people with diabetes (glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors) have shown significant benefits in reducing post meal plasma glucose excursions andlowering HbA1c. The individual properties of the various GLP‑1 receptor agonists might enable incretin-based treatment of type 2 diabetes mellitus to be tailored to the needs of each patient.
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Affiliation(s)
- László Barkai
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj Napoca
| | - Nicolae Hâncu
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj Napoca
| | - György Jermendy
- 3rd Teaching Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | | | | | - Maria Moţa
- University of Medicine and Pharmacy Craiova
| | | | | | - Gábor Winkler
- 2nd Department of Internal Medicine-Diabetology, St. John's Hospital, Budapest, University of Miskolc, Faculty of Health Care, Institute of Theoretical Health Sciences, Hungary
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