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Shen Z, Liu Z, Wang H, Landrock D, Noh JY, Zang QS, Lee C, Farnell YZ, Chen Z, Sun Y. Fructose induces inflammatory activation in macrophages and microglia through the nutrient-sensing ghrelin receptor. FASEB J 2025; 39:e70412. [PMID: 39985299 PMCID: PMC11846021 DOI: 10.1096/fj.202402531r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/20/2025] [Accepted: 02/12/2025] [Indexed: 02/24/2025]
Abstract
High fructose corn syrup (HFCS) is a commonly used sweetener in soft drinks and processed foods, and HFCS exacerbates inflammation when consumed in excess. Fructose, a primary component of HFCS; however, it is unclear whether fructose directly activates inflammatory signaling. Growth hormone secretagogue receptor (GHSR) is a receptor of the nutrient-sensing hormone ghrelin. We previously reported that GHSR ablation mitigates HFCS-induced inflammation in adipose tissue and liver, shifting macrophages toward an anti-inflammatory spectrum. Since inflammation is primarily governed by innate immune cells, such as macrophages in the peripheral tissues and microglia in the brain, this study aims to investigate whether GHSR autonomously regulates pro-inflammatory activation in macrophages and microglia upon fructose exposure. GHSR deletion mutants of RAW 264.7 macrophages and the immortalized microglial cell line (IMG) were generated using CRISPR-Cas9 gene editing. After treating the cells with equimolar concentrations of fructose or glucose for 24 h, fructose increased mRNA and protein expression of GHSR and pro-inflammatory cytokines (Il1β, Il6, and Tnfα) in both macrophages and microglia, suggesting that fructose activates Ghsr and induces inflammation directly in macrophages and microglia. Remarkably, GHSR deletion mutants (Ghsrmutant) of macrophages and microglia exhibited reduced inflammatory responses to fructose, indicating that GHSR mediates fructose-induced inflammation. Furthermore, we found that GHSR regulates fructose transport and fructose metabolism and mediates fructose-induced inflammatory activation through CREB-AKT-NF-κB and p38 MAPK signaling pathways. Our results underscore that fructose triggers inflammation, and reducing HFCS consumption would reduce disease risk. Moreover, these findings reveal for the first time that the nutrient-sensing receptor GHSR plays a crucial role in fructose-mediated inflammatory activation, suggesting that targeting GHSR may be a promising therapeutic approach to combat the immunotoxicity of foods that contain fructose.
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Affiliation(s)
- Zheng Shen
- Department of NutritionTexas A&M UniversityCollege StationTexasUSA
| | - Zeyu Liu
- Department of NutritionTexas A&M UniversityCollege StationTexasUSA
| | - Hongying Wang
- Department of NutritionTexas A&M UniversityCollege StationTexasUSA
| | - Danilo Landrock
- Department of NutritionTexas A&M UniversityCollege StationTexasUSA
| | - Ji Yeon Noh
- Department of NutritionTexas A&M UniversityCollege StationTexasUSA
| | - Qun Sophia Zang
- Department of SurgeryLoyola University Chicago Health Science CampusMaywoodIllinoisUSA
| | - Chih‐Hao Lee
- Genomics Research Center, Academia SinicaTaipeiTaiwan
| | - Yuhua Z. Farnell
- Department of Poultry ScienceTexas A&M UniversityCollege StationTexasUSA
| | - Zheng Chen
- Department of Biochemistry and Molecular BiologyThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Yuxiang Sun
- Department of NutritionTexas A&M UniversityCollege StationTexasUSA
- Department of Biochemistry & BiophysicsTexas A&M UniversityCollege StationTexasUSA
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Lu S, Kuang M, Qiu J, Li W, Zhang M, Sheng G, Zou Y, Peng X. Lipids as the link between central obesity and diabetes: perspectives from mediation analysis. BMC Endocr Disord 2024; 24:229. [PMID: 39468602 PMCID: PMC11514969 DOI: 10.1186/s12902-024-01764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 10/22/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND Central obesity is a well-recognized risk factor for diabetes, yet the potential role of lipids in the diabetes risk associated with central obesity remains unclear. This study aimed to explore the possible mediating role of 11 lipid parameters [high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), non-high-density lipoprotein cholesterol (Non-HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), remnant cholesterol (RC), and ratios of Non-HDL-C/HDL-C, RC/HDL-C, LDL/HDL-C, TG/HDL-C, TC/HDL-C] in the association of central obesity with diabetes risk. METHODS We utilized data from 15,453 participants in the NAGALA longitudinal cohort to assess the association of baseline central obesity indicators [waist-height ratio (WHtR), waist circumference (WC)] and the 11 lipid parameters with diabetes risk. Mediation analysis models were constructed to explore the mediating role of lipid parameters in the association of WC/WHtR with diabetes. RESULTS Confirmatory associative analysis using multivariable Cox regression showed that, except for Non-HDL-C, TC and LD-C, the remaining eight lipid parameters were significantly associated with WC/WHtR and diabetes risk. Mediation analysis indicated that TG, RC, HDL-C, and lipid ratios such as Non-HDL-C/HDL-C ratio, RC/HDL-C ratio, TG/HDL-C ratio, TC/HDL-C ratio and LDL/HDL-C ratio are potential lipids affecting the diabetes risk related to central obesity. Among these, the RC/HDL-C ratio seemed to contribute the most in the WC/WHtR-related diabetes risk association, with a mediation percentage of about 37%. Additionally, lipid ratio parameters appeared to play a more mediating role in the association of central obesity-related diabetes risk than individual lipids. CONCLUSIONS In central obesity-related diabetes risk, most lipids, especially lipid ratio parameters, play a significant mediating role. Given these findings, we advocate for increased efforts in multifactorial risk monitoring and joint management of diabetes. The evaluation of lipids, particularly lipid ratio parameters, may be holds substantial value in the prevention and management of diabetes risk under close monitoring of central obesity.
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Affiliation(s)
- Song Lu
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Maobin Kuang
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, China
| | - Jiajun Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, China
| | - Wenjuan Li
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, 330047, China
| | - Min Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, China.
| | - Xiaoping Peng
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
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Abdul-Ghani M, Maffei P, DeFronzo RA. Managing insulin resistance: the forgotten pathophysiological component of type 2 diabetes. Lancet Diabetes Endocrinol 2024; 12:674-680. [PMID: 39098317 DOI: 10.1016/s2213-8587(24)00127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/29/2024] [Indexed: 08/06/2024]
Abstract
Glucagon-like peptide-1 (GLP-1) receptor agonists have gained widespread use in the treatment of individuals with type 2 diabetes because of their potent weight loss promoting effect, ability to augment β-cell function, and cardiovascular protective effects. However, despite causing impressive weight loss, GLP-1 receptor agonists do not normalise insulin sensitivity in people with type 2 diabetes and obesity, and the long-term effects of this class of antidiabetic medication on muscle mass, frailty, and bone density have been poorly studied. Although GLP-1 receptor agonists improve insulin sensitivity secondary to weight loss, the only true direct insulin-sensitising drugs are thiazolidinediones. Because of side-effects associated with type 2 diabetes therapy, these drugs have not gained widespread use. In lieu of the important role of insulin resistance in the cause of type 2 diabetes and in the pathogenesis of atherosclerotic cardiovascular disease in type 2 diabetes, development of potent insulin-sensitising drugs that can be used in combination with GLP-1 receptor agonists remains a large unmet need in the management of individuals with type 2 diabetes.
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Thornburg KL, Valent AM. Maternal Malnutrition and Elevated Disease Risk in Offspring. Nutrients 2024; 16:2614. [PMID: 39203750 PMCID: PMC11357549 DOI: 10.3390/nu16162614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/31/2024] [Accepted: 08/03/2024] [Indexed: 09/03/2024] Open
Abstract
US populations have seen dramatic increases in the prevalence of chronic disease over the past three generations. Rapid increases in type 2 diabetes and obesity have occurred in all the states but have been particularly striking in the Deep South. These increases have contributed to decreases in life expectancy and to painful elevations in health care costs. The causes of worsening population health are complex and incompletely understood. However, there is strong evidence that vulnerability to chronic conditions is determined in early life. Most chronic diseases are developmentally driven. There are specific stressors experienced in early life that influence epigenetic and structural changes during development. These include malnutrition, severe levels of social stress, toxic chemicals, and low oxygen levels. Most US populations have experienced a decrease in the quality of the food they consume as industrial foods have replaced garden-grown foods. Thus, the consumption of too few nutrients before and during pregnancy and during lactation influences the growth of the placenta and fetal organs and their level of resilience when faced with stresses in postnatal life and particularly as adults. Animal studies have shown that the effects of poor nutrition can be passed on to future generations. The most powerful way that the current epidemics of obesity and insulin resistance can be reversed is by providing key nutrients to prospective mothers and those already pregnant.
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Affiliation(s)
- Kent L. Thornburg
- OHSU Bob and Charlee Moore Institute for Nutrition and Wellness, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA;
- Center for Developmental Health, Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Amy M. Valent
- OHSU Bob and Charlee Moore Institute for Nutrition and Wellness, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA;
- Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
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Dhokte S, Czaja K. Visceral Adipose Tissue: The Hidden Culprit for Type 2 Diabetes. Nutrients 2024; 16:1015. [PMID: 38613048 PMCID: PMC11013274 DOI: 10.3390/nu16071015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by insulin resistance in various tissues. Though conventionally associated with obesity, current research indicates that visceral adipose tissue (VAT) is the leading determining factor, wielding more influence regardless of individual body mass. The heightened metabolic activity of VAT encourages the circulation of free fatty acid (FFA) molecules, which induce insulin resistance in surrounding tissues. Individuals most vulnerable to this preferential fat deposition are older males with ancestral ties to Asian countries because genetics and sex hormones are pivotal factors for VAT accumulation. However, interventions in one's diet and lifestyle have the potential to strategically discourage the growth of VAT. This illuminates the possibility that the expansion of VAT and, subsequently, the risk of T2D development are preventable. Therefore, by reducing the amount of VAT accumulated in an individual and preventing it from building up, one can effectively control and prevent the development of T2D.
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Affiliation(s)
| | - Krzysztof Czaja
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA;
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Gui SY, Wang XC, Qiao JC, Lin SY, Wang QQ, Zhang MY, Xu YY, Huang ZH, Tao LM, Hu CY, Tao FB, Jiang ZX, Liu DW. Association of retinopathy with risk of all-cause and specific-cause mortality in the National Health and Nutrition Examination Survey, 2005 to 2008. Front Public Health 2023; 11:1200925. [PMID: 37680275 PMCID: PMC10482412 DOI: 10.3389/fpubh.2023.1200925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Objective This study aimed to elucidate the relationship between retinopathy status or severity and the all-cause and specific-cause mortality risk based on the updated National Health and Nutrition Examination Survey (NHANES) database and 2019 Public Access Link mortality file. Methods In this prospective cohort study, a total of 6,797 participants aged over 40 years based on NHANES 2005-2008 were analyzed. The severity of retinopathy was classified into 4 grades-no retinopathy, mild non-proliferative retinopathy (NPR), moderate to severe NPR, and proliferative retinopathy (PR). Multiple covariate-adjusted Cox proportional hazards regression models and Fine and Gray competing risk regression models were used to assess the all-cause and cause-specific mortality risks, respectively. The propensity score matching (PSM) approach was also applied additionally to adequately balance between-group covariates to validate our findings. Results A final total of 4,808 participants representing 18,282,772 United States (US) non-hospitalized participants were included for analysis, 50.27% were male (n = 2,417), 55.32% were non-hispanic white (n = 2,660), and mean [SE] age, 56.10 [0.40] years. After a median follow-up of 12.24 years (interquartile range, 11.16-13.49 years), 1,164 participants died of all-cause mortality, of which 941 (80.84%) died without retinopathy and 223 (19.16%) died with retinopathy at baseline. The presence of retinopathy was associated with increased all-cause mortality, cardiovascular disease (CVD), and diabetes mellitus (DM)-specific mortality, and the results remain consistent after PSM. Severity analysis showed that only mild NPR was associated with an increased all-cause mortality risk (hazard ratio (HR) = 2.01; 95% confidence interval (CI), 1.00-4.03), while increased CVD and DM-specific mortality risk were associated with all grades of retinopathy and were exponentially greater with increasing retinopathy severity, and the trend test was also significant (P for trend 0.004 and 0.04, respectively). Discussion Our findings suggest that the diagnosis of retinopathy is an independent risk factor for all-cause mortality in people over 40 years old. Retinopathy grading is significantly associated with the survival risk of patients with CVD or DM, it can be a valuable predictor in the stratified management and risk warning of CVD or DM patients, as well as in the monitoring of systemic vasculopathy status.
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Affiliation(s)
- Si-Yu Gui
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin-Chen Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jian-Chao Qiao
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Si-Yu Lin
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qian-Qian Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Meng-Yue Zhang
- Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Yue-Yang Xu
- Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Zhi-Hao Huang
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Li-Ming Tao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, Hefei, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Zheng-Xuan Jiang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong-Wei Liu
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, Lee WH, Shamambo L, Weber MB, Narayan KMV. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023; 11:509-524. [PMID: 37356445 PMCID: PMC11070656 DOI: 10.1016/s2213-8587(23)00129-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.
| | - Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rakale C Quarells
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Jane Obi
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wei-Hsuan Lee
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Luwi Shamambo
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - K M Venkat Narayan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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Berger JS, Ashton V, Laliberté F, Germain G, Bookhart B, Lejeune D, Boudreau J, Lefebvre P, Weir MR. Healthcare Resource Utilization and Costs of Rivaroxaban Versus Warfarin Among Non-valvular Atrial Fibrillation (NVAF) Patients with Diabetes in a US Population. Adv Ther 2023; 40:1224-1241. [PMID: 36658454 PMCID: PMC9988717 DOI: 10.1007/s12325-022-02422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The healthcare resource utilization (HRU) and costs of oral anticoagulant-naïve patients with non-valvular atrial fibrillation (NVAF) and diabetes initiated on rivaroxaban or warfarin in the United States (US) has not been previously evaluated. METHODS This retrospective study used data from the Optum's de-identified Clinformatics® Data Mart Database (1 January, 2012 to 30 September, 2021) to evaluate the HRU and costs of adult patients with NVAF and diabetes newly initiated on rivaroxaban or warfarin (on or after January 2013). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding between cohorts. HRU and costs (USD 2021) were assessed per patient-year (PPY) post-treatment initiation. Weighted cohorts were compared using rate ratios (RR) from Poisson regression models, odds ratios (OR) from logistic regression models, and cost differences; 95% confidence intervals (CI) and p values were generated using non-parametric bootstrap procedures. RESULTS After IPTW, 17,881 and 19,274 patients initiated on rivaroxaban and warfarin were included, respectively (mean age: 73 years; 40% female). During 12 months of follow-up, the rivaroxaban cohort had lower all-cause HRU PPY across all components, including lower rates of inpatient stays (RR: 0.84, 95% CI 0.81, 0.88), outpatient visits (RR: 0.67, 95% CI 0.66, 0.68), and 30 day hospital readmission (OR: 0.75, 95% CI 0.66, 0.83; all p < 0.001) compared to the warfarin cohort. Moreover, rivaroxaban was associated with medical cost savings PPY (mean cost difference: - $9306, 95% CI - $11,769, - $6607), which compensated for higher pharmacy costs relative to warfarin (mean cost difference: $5518, 95% CI $5193, $5839), resulting in significantly lower all-cause total healthcare costs for rivaroxaban versus warfarin (mean cost difference: - $3788, 95% CI - $6258, - $1035; all p < 0.001). CONCLUSION Among NVAF patients with diabetes in a real-world US setting, rivaroxaban was associated with lower healthcare costs compared to warfarin.
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Affiliation(s)
| | | | - François Laliberté
- Groupe d'analyse, Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Guillaume Germain
- Groupe d'analyse, Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada.
| | | | - Dominique Lejeune
- Groupe d'analyse, Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Julien Boudreau
- Groupe d'analyse, Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Patrick Lefebvre
- Groupe d'analyse, Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Matthew R Weir
- University of Maryland School of Medicine, Baltimore, MD, USA
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Su X, Li K, Yang L, Yang Y, Gao Y, Gao Y, Guo J, Lin J, Chen K, Han J, Liu L. Associations between abdominal obesity and the risk of stroke in Chinese older patients with obstructive sleep apnea: Is there an obesity paradox? Front Aging Neurosci 2022; 14:957396. [PMID: 36172486 PMCID: PMC9510899 DOI: 10.3389/fnagi.2022.957396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeAbdominal obesity (AO) is a well-known independent risk factor for stroke in the general population although it remains unclear in the case of the elderly, especially in Chinese older patients with obstructive sleep apnea (OSA), considering the obesity paradox. This study aimed to investigate the association between AO and stroke among Chinese older patients with OSA.MethodsData were collected from January 2015 to October 2017, and 1,290 older patients (age 60–96 years) with OSA (apnea–hypopnea index ≥ 5 events/h on polysomnography) were consecutively enrolled from sleep centers at six hospitals, evaluated for AO defined as waist circumference (WC) using the standardized criteria for the Chinese population, and followed up prospectively for a median period of 42 months. Logistic regression and Cox regression analyses were used to determine the cross-sectional and longitudinal associations between AO and stroke risk in these participants and different groups of the severity of OSA.ResultsParticipants with AO had a higher prevalence of stroke at baseline. A higher incidence of stroke during a median follow-up period of 42 months in participants with AO than in participants without AO (12.4% vs. 6.8% and 8.3% vs. 2.4%, respectively; both P < 0.05) was predicted. Cross-sectional analysis revealed an association between AO and stroke (odds ratio [OR]1.96, 95% confidence interval [CI] 1.31–2.91), which was stronger among participants with moderate OSA only (OR 2.16, 95%CI 1.05–4.43). Cox regression analysis showed that, compared to participants without AO, participants with AO had a higher cumulative incidence of stroke (hazard ratio [HR] 2.16, 95% CI 1.12–4.04) during a median follow-up of 42 months, and this association was observed in patients with severe OSA only (HR 3.67, 95% CI 1.41–9.87) but not for individuals with mild OSA (HR = 1.84, 95% CI 0.43–6.23) and moderate OSA (HR = 1.98, 95% CI 0.73–6.45).ConclusionThe risk of stroke is associated with AO among Chinese older patients who have OSA, both at baseline and during follow-up, and the strength of the association varied by OSA severity. Active surveillance for early detection of AO could facilitate the implementation of stroke-preventive interventions in the Chinese older OSA population.
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Affiliation(s)
- Xiaofeng Su
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Sichuan College of Traditional Chinese Medicine, Mianyang, China
- Medical College, Yan’an University, Yan’an, China
| | - Kailiang Li
- Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ling Yang
- Medical College, Yan’an University, Yan’an, China
| | - Yang Yang
- Medical College, Yan’an University, Yan’an, China
| | - Yinghui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Yan Gao
- Department of General Practice, 960th Hospital of PLA, Jinan, China
| | - JingJing Guo
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, China
| | - Junling Lin
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kaibing Chen
- Sleep Center, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
- *Correspondence: Lin Liu,
| | - Jiming Han
- Medical College, Yan’an University, Yan’an, China
- Jiming Han,
| | - Lin Liu
- Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Kaibing Chen,
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Zheng M, Bernardo CDO, Stocks N, Gonzalez-Chica D. Diabetes Mellitus Diagnosis and Screening in Australian General Practice: A National Study. J Diabetes Res 2022; 2022:1566408. [PMID: 35372584 PMCID: PMC8968388 DOI: 10.1155/2022/1566408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 12/02/2022] Open
Abstract
Aims To investigate the epidemiology of diabetes diagnosis and screening in Australian general practice. Methods Cross-sectional study using electronic health records of 1,522,622 patients aged 18+ years attending 544 Australian general practices (MedicineInsight database). The prevalence of diagnosed diabetes and diabetes screening was explored using all recorded diagnoses, laboratory results, and prescriptions between 2016 and 2018. Their relationship with patient sociodemographic and clinical characteristics was also investigated. Results Overall, 7.5% (95% CI 7.3, 7.8) of adults had diabetes diagnosis, 0.7% (95% CI 0.6, 0.7) prediabetes, and 0.3% (95% CI 0.3, 0.3) unrecorded diabetes/prediabetes (elevated glucose levels without a recorded diagnosis). Patients with unrecorded diabetes/prediabetes had clinical characteristics similar to those with recorded diabetes, except for a lower prevalence of overweight/obesity (55.5% and 69.9%, respectively). Dyslipidaemia was 1.8 times higher (36.2% vs. 19.7%), and hypertension was 15% more likely (38.6% vs. 33.8%) among patients with prediabetes than with diabetes. Diabetes screening (last three years) among people at high risk of diabetes was 55.2% (95% CI 52.7, 57.7), with lower rates among young or elderly males. Conclusions Unrecorded diabetes/prediabetes is infrequent in Australian general practice, but prediabetes diagnosis was also lower than expected. Diabetes screening among high-risk individuals can be improved, especially in men, to enhance earlier diabetes diagnosis and management.
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Affiliation(s)
- Mingyue Zheng
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Carla De Oliveira Bernardo
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE) Centre of Research Excellence, NHMRC, Adelaide, Australia
- EMPOWER: Health Systems, Adversity and Child Well Being Centre of Research Excellence, NHMRC, Adelaide, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, Australia
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11
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Low glucose metabolizing capacity and not insulin resistance is primary etiology of Type 2 Diabetes Mellitus: A hypothesis. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Turcotte V, Potvin O, Dadar M, Hudon C, Duchesne S. Birth Cohorts and Cognitive Reserve Influence Cognitive Performances in Older Adults. J Alzheimers Dis 2021; 85:587-604. [PMID: 34864667 DOI: 10.3233/jad-215044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Evidence suggests birth cohort differences in cognitive performance of older adults. Proxies of cognitive reserve (CR), such as educational attainment and occupational complexity, could also partly account for these differences as they are influenced by the sociocultural environment of the birth cohorts. OBJECTIVE To predict cognitive performance using birth cohorts and CR and examine the moderating influence of CR on cognitive performance and structural brain health association. METHODS Using ADNI data (n = 1628), four birth cohorts were defined (1915-1928; 1929-1938; 1939-1945; 1946-1964). CR proxies were education, occupational complexity, and verbal IQ. We predicted baseline cognitive performances (verbal episodic memory; language and semantic memory; attention capacities; executive functions) using multiple linear regressions with CR, birth cohorts, age, structural brain health (total brain volume; total white matter hyperintensities volume) and vascular risk factors burden as predictors. Sex and CR interactions were also explored. RESULTS Recent birth cohorts, higher CR, and healthier brain structures predicted better performance in verbal episodic memory, language and semantic memory, and attention capacities, with large effect sizes. Better performance in executive functions was predicted by a higher CR and a larger total brain volume, with a small effect size. With equal score of CR, women outperformed men in verbal episodic memory and language and semantic memory in all cohorts. Higher level of CR predicted better performance in verbal episodic memory, only when total brain volume was lower. CONCLUSION Cohort differences in cognitive performance favor more recent birth cohorts and suggests that this association may be partly explained by proxies of CR.
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Affiliation(s)
- Valérie Turcotte
- École de psychologie, Faculté des SciencesSociales, Université Laval, Québec, QC, Canada.,CERVO Brain Research Centre, Centre Intégré Universitaire en Santé et Services Sociaux de laCapitale Nationale, Québec, QC, Canada
| | - Olivier Potvin
- CERVO Brain Research Centre, Centre Intégré Universitaire en Santé et Services Sociaux de laCapitale Nationale, Québec, QC, Canada
| | - Mahsa Dadar
- CERVO Brain Research Centre, Centre Intégré Universitaire en Santé et Services Sociaux de laCapitale Nationale, Québec, QC, Canada.,Département de Radiologie et MédecineNucléaire, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Carol Hudon
- École de psychologie, Faculté des SciencesSociales, Université Laval, Québec, QC, Canada.,CERVO Brain Research Centre, Centre Intégré Universitaire en Santé et Services Sociaux de laCapitale Nationale, Québec, QC, Canada
| | - Simon Duchesne
- CERVO Brain Research Centre, Centre Intégré Universitaire en Santé et Services Sociaux de laCapitale Nationale, Québec, QC, Canada.,Département de Radiologie et MédecineNucléaire, Faculté de Médecine, Université Laval, Québec, QC, Canada
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13
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Wang L, Li X, Wang Z, Bancks MP, Carnethon MR, Greenland P, Feng YQ, Wang H, Zhong VW. Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018. JAMA 2021; 326:2781620. [PMID: 34170288 PMCID: PMC8233946 DOI: 10.1001/jama.2021.9883] [Citation(s) in RCA: 335] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/31/2021] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. OBJECTIVE To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. DESIGN, SETTING, AND PARTICIPANTS Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. EXPOSURES Survey cycle. MAIN OUTCOMES AND MEASURES Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. RESULTS Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend < .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend < .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]). CONCLUSIONS AND RELEVANCE Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.
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Affiliation(s)
- Li Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoguang Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Michael P. Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Victor W. Zhong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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14
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Yang R, Xu H, Pedersen NL, Li X, Yu J, Bao C, Qi X, Xu W. A healthy lifestyle mitigates the risk of heart disease related to type 2 diabetes: a prospective nested case-control study in a nationwide Swedish twin cohort. Diabetologia 2021; 64:530-539. [PMID: 33169206 PMCID: PMC7864843 DOI: 10.1007/s00125-020-05324-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS We aimed to examine the association between type 2 diabetes and major subtypes of heart disease, to assess the role of genetic and early-life familial environmental factors in this association and to explore whether and to what extent a healthy lifestyle mitigates the risk of heart disease related to type 2 diabetes. METHODS In this prospective nested case-control study based on the Swedish Twin Registry, 41,463 twin individuals who were aged ≥40 and heart disease-free were followed up for 16 years (from 1998 to 2014) to detect incident heart disease. Type 2 diabetes was ascertained from self-report, the National Patient Registry and glucose-lowering medication use. Heart disease diagnosis (including coronary heart disease, cardiac arrhythmias and heart failure) and onset age were identified from the National Patient Registry. Healthy lifestyle-related factors consisted of being a non-smoker, no/mild alcohol consumption, regular physical activity and being non-overweight. Participants were divided into three groups according to the number of lifestyle-related factors: (1) unfavourable (participants who had no or only one healthy lifestyle factor); (2) intermediate (any two or three); and (3) favourable (four). Generalised estimating equation models for unmatched case-control design and conditional logistic regression for co-twin control design were used in data analyses. RESULTS Of all participants, 2304 (5.5%) had type 2 diabetes at baseline. During the observation period, 9262 (22.3%) had any incident heart disease. In unmatched case-control analyses and co-twin control analyses, the multi-adjusted OR and 95% CI of heart disease related to type 2 diabetes was 4.36 (3.95, 4.81) and 4.89 (3.88, 6.16), respectively. The difference in ORs from unmatched case-control analyses vs co-twin control analyses was statistically significant (OR 1.57; 95% CI 1.42, 1.73; p < 0.001). In stratified analyses by type 2 diabetes, compared with an unfavourable lifestyle, an intermediate lifestyle or a favourable lifestyle was associated with a significant 32% (OR 0.68; 95% CI 0.49, 0.93) or 56% (OR 0.44; 95% CI 0.30, 0.63) decrease in heart disease risk among patients with type 2 diabetes, respectively. There were significant additive and multiplicative interactions between lifestyle and type 2 diabetes on heart disease. CONCLUSIONS/INTERPRETATION Type 2 diabetes is associated with more than fourfold increased risk of heart disease. The association still remains statistically significant, even after fully controlling for genetic and early-life familial environmental factors. However, greater adherence to a healthy lifestyle may significantly mitigate the risk of heart disease related to type 2 diabetes. Graphical abstract.
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Affiliation(s)
- Rongrong Yang
- Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Big Data and Engineering Research Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Xuerui Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jing Yu
- Department of Physiology and Pathophysiology, School of Basic Medicine, Tianjin Medical University, Tianjin, China
| | - Cuiping Bao
- Department of Radiology, Tianjin Union Medical Centre, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
- Aging Research Center, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
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15
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Brinks R, Tönnies T, Hoyer A. Impact of diagnostic accuracy on the estimation of excess mortality from incidence and prevalence: simulation study and application to diabetes in German men. F1000Res 2021; 10:49. [PMID: 34136129 PMCID: PMC8170531 DOI: 10.12688/f1000research.28023.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
Aggregated data about the prevalence and incidence of chronic conditions is becoming more and more available. We recently proposed a method to estimate the age-specific excess mortality in chronic conditions from aggregated age-specific prevalence and incidence data. Previous works showed that in age groups below 50 years, estimates from this method were unstable or implausible. In this article, we examine how limited diagnostic accuracy in terms of sensitivity and specificity affects the estimates. We use a simulation study with two settings, a low and a high prevalence setting, and assess the relative importance of sensitivity and specificity. It turns out that in both settings, specificity, especially in the younger age groups, dominates the quality of the estimated excess mortality. The findings are applied to aggregated claims data comprising the diagnoses of diabetes from about 35 million men in the German Statutory Health Insurance. Key finding is that specificity in the lower age groups (<50 years) can be derived without knowing the sensitivity. The false-positive ratio in the claims data increases linearly from 0.5 per mil at age 25 to 2 per mil at age 50. As a conclusion, our findings stress the importance of considering diagnostic accuracy when estimating excess mortality from aggregated data using the method to estimate excess mortality. Especially the specificity in the younger age-groups should be carefully taken into account.
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Affiliation(s)
- Ralph Brinks
- Institute for Biometry and Epidemiology, German Diabetes Center, Duesseldorf, 40225, Germany
- Chair for Medical Biometry and Epidemiology, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, 58448, Germany
- Department of Statistics, Ludwig Maximilian University of Munich, Munich, 80539, Germany
| | - Thaddäus Tönnies
- Institute for Biometry and Epidemiology, German Diabetes Center, Duesseldorf, 40225, Germany
| | - Annika Hoyer
- Department of Statistics, Ludwig Maximilian University of Munich, Munich, 80539, Germany
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16
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Maula A, Kendrick D, Kai J, Griffiths F. Evidence generated from a realist synthesis of trials on educational weight loss interventions in type 2 diabetes mellitus. Diabet Med 2021; 38:e14394. [PMID: 32871624 DOI: 10.1111/dme.14394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Obesity and diabetes are major public health problems. Current approaches to weight loss show varying success. Complex community-based interventions work through several interconnected stages. An individual's actions in response to an intervention depend on many known and unknown factors, which vary among individuals. AIM To conduct a realist synthesis to identify in which context, for whom, in what circumstances, and how weight loss interventions work in obese or overweight individuals with type 2 diabetes. METHODS A total of 49 trials identified during a systematic review were subsequently analysed using realist methodology. This iterative process involved hypothesis generation about how participants within a particular context respond to an intervention's resources producing the outcomes. We used established behaviour change theory to look for repeating themes. Theory and 'mechanisms' were tested against the literature on what is shown to be effective. Where established theory was lacking, we discussed issues during discussion groups with individuals living with the condition to generate our own programme theories. RESULTS Mechanisms that were repeatedly identified included high-frequency contact with those delivering the intervention, social support, education increasing awareness of diabetes-related modifiable risk factors, motivational interviewing and counselling, goal-setting, self-monitoring and feedback and meal replacements. The central theme underlying successful mechanisms was personalising each intervention component to the participants' gender, culture and family setting. CONCLUSION This is the first comprehensive realist synthesis in this field. Our findings suggest that, for weight loss interventions to be successful in those with diabetes, they must be personalized to the individual and their specific context.
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Affiliation(s)
- Asiya Maula
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joe Kai
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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17
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Ryu KS, Kang HYJ, Lee SW, Park HW, You NY, Kim JH, Hwangbo Y, Choi KS, Cha HS. Screening Model for Estimating Undiagnosed Diabetes among People with a Family History of Diabetes Mellitus: A KNHANES-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8903. [PMID: 33266117 PMCID: PMC7730533 DOI: 10.3390/ijerph17238903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Abstract
A screening model for estimating undiagnosed diabetes mellitus (UDM) is important for early medical care. There is minimal research and a serious lack of screening models for people with a family history of diabetes (FHD), especially one which incorporates gender characteristics. Therefore, the primary objective of our study was to develop a screening model for estimating UDM among people with FHD and enable its validation. We used data from the Korean National Health and Nutrition Examination Survey (KNHANES). KNAHNES (2010-2016) was used as a developmental cohort (n = 5939) and was then evaluated in a validation cohort (n = 1047) KNHANES (2017). We developed the screening model for UDM in male (SMM), female (SMF), and male and female combined (SMP) with FHD using backward stepwise logistic regression analysis. The SMM and SMF showed an appropriate performance (area under curve (AUC) = 76.2% and 77.9%) compared with SMP (AUC = 72.9%) in the validation cohort. Consequently, simple screening models were developed and validated, for the estimation of UDM among patients in the FHD group, which is expected to reduce the burden on the national health care system.
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Affiliation(s)
- Kwang Sun Ryu
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Ha Ye Jin Kang
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Sang Won Lee
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Hyun Woo Park
- Healthcare AI Team, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (H.W.P.); (Y.H.)
| | - Na Young You
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Jae Ho Kim
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (H.W.P.); (Y.H.)
- Division of Endocrinology, Department of Internal Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea
| | - Kui Son Choi
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea
| | - Hyo Soung Cha
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
- Healthcare AI Team, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (H.W.P.); (Y.H.)
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea
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18
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Ziogas IA, Zapsalis K, Giannis D, Tsoulfas G. Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know! World J Hepatol 2020; 12:709-721. [PMID: 33200011 PMCID: PMC7643217 DOI: 10.4254/wjh.v12.i10.709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Metabolic syndrome (MS) is defined as the constellation of obesity, insulin resistance, high serum triglycerides, low high-density lipoprotein cholesterol, and high blood pressure. It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare, cost, and quality of life associated consequences. MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease. Conservative treatment, which includes diet, exercise, and antidiabetic agents, is the mainstay of treatment, but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations. Bariatric surgery has recently emerged as an appropriate alternative treatment with promising long-term results. Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates. Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with non-alcoholic steatohepatitis has increased more than fivefold over the past 15 years. In this review, we summarize current state of evidence on the surgical treatment of MS.
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Affiliation(s)
- Ioannis A Ziogas
- Aristotle University School of Medicine, Thessaloniki 54124, Greece
| | | | - Dimitrios Giannis
- Center for Health Innovations and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Manhasset, NY 11030, United States
| | - Georgios Tsoulfas
- The First Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
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Maula A, Kai J, Woolley AK, Weng S, Dhalwani N, Griffiths FE, Khunti K, Kendrick D. Educational weight loss interventions in obese and overweight adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabet Med 2020; 37:623-635. [PMID: 31785118 PMCID: PMC7154644 DOI: 10.1111/dme.14193] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/31/2022]
Abstract
AIM The worldwide prevalence of type 2 diabetes mellitus is increasing, with most individuals with the disease being overweight or obese. Weight loss can reduce disease-related morbidity and mortality and weight losses of 10-15 kg have been shown to reverse type 2 diabetes. This review aimed to determine the effectiveness of community-based educational interventions for weight loss in type 2 diabetes. METHODS This is a systematic review and meta-analysis of randomized controlled trials (RCT) in obese or overweight adults, aged 18-75 years, with a diagnosis of type 2 diabetes. Primary outcomes were weight and/or BMI. CINAHL, MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardized mean difference (SMD) (from baseline to follow-up) and 95% confidence intervals (95% CI) between trial groups (difference-in-difference) were estimated through random-effects meta-analyses using the inverse variance method. Heterogeneity was quantified using I2 and publication bias was explored visually using funnel plots. RESULTS Some 7383 records were screened; 228 full-text articles were assessed and 49 RCTs (n = 12 461 participants) were included in this review, with 44 being suitable for inclusion into the meta-analysis. Pooled estimates of education combined with low-calorie, low-carbohydrate meal replacements (SMD = -2.48, 95% CI -3.59, -1.49, I2 = 98%) or diets (SMD = -1.25, 95% CI -2.11, -0.39, I2 = 95%) or low-fat meal replacements (SMD = -1.15, 95%CI -2.05, -1.09, I2 = 85%) appeared most effective. CONCLUSION Low-calorie, low-carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with type 2 diabetes.
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Affiliation(s)
- A. Maula
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - J. Kai
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - A. K. Woolley
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - S. Weng
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
| | - N. Dhalwani
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Real World EvidenceEvideraLondonUK
| | - F. E. Griffiths
- Division of Health SciencesWarwick Medical SchoolUniversity of WarwickCoventryUK
- School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa
| | - K. Khunti
- Leicester Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - D. Kendrick
- Division of Primary CareSchool of MedicineThe University of NottinghamNottinghamUK
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20
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Yefet E, Jeda E, Tzur A, Nachum Z. Markers for undiagnosed type 2 diabetes mellitus during pregnancy-A population-based retrospective cohort study. J Diabetes 2020; 12:205-214. [PMID: 31498952 DOI: 10.1111/1753-0407.12985] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To examine possible markers for undiagnosed type 2 diabetes in early-onset gestational diabetes mellitus (GDM). METHODS A population-based retrospective cohort study of women with GDM diagnosed prior to the 24th week, who delivered between 2005 and 2018, was conducted. The results of the 50-g glucose challenge test, 100-g oral glucose tolerance test, and the first available glycosylated hemoglobin (HbA1c) were examined as markers for type 2 diabetes diagnosed 6 to 12 weeks post pregnancy, which is suggestive of pregestational diabetes. This was done by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for each marker. These markers and additional ones were evaluated for independency by stepwise multivariate logistic regression. RESULTS Of 69 417 pregnancies, 3321 (5%) pregnancies were with GDM. Of them, in 261 (8%) women GDM was diagnosed prior to the 24th week, and 219 (84%) women had available data for analysis. Among them, 11 (5%) women had type 2 diabetes post pregnancy. Elevated HbA1c was the most accurate marker for undiagnosed type 2 diabetes (AUC 91% with 95% CI [81%-100%]) and the only independent marker for undiagnosed type 2 diabetes in multivariate analysis (odds ratio [OR] 19; 95% CI [3.2-109], C statistic = 88%). Using the ROC curve, a cutoff of 5.8% predicted type 2 diabetes with 89% sensitivity, 86% specificity, 99.4% negative predictive value, and 23% positive predictive value. CONCLUSIONS Early-onset GDM with HbA1c ≥ 5.8% should be managed as type 2 diabetes. Definitive diagnosis should be done after delivery.
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Affiliation(s)
- Enav Yefet
- Department of Obstetrics & Gynecology, Baruch Padeh Medical Center Poriya, Tiberias, Israel
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel
- Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel
| | - Elad Jeda
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel
| | - Ayellet Tzur
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel
| | - Zohar Nachum
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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21
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Brinks R, Kaufmann S, Hoyer A, Gregg EW, Saal J. Analysing detection of chronic diseases with prolonged sub-clinical periods: modelling and application to hypertension in the U.S. BMC Med Res Methodol 2019; 19:213. [PMID: 31775635 PMCID: PMC6880443 DOI: 10.1186/s12874-019-0845-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/03/2019] [Indexed: 11/20/2022] Open
Abstract
Background We recently introduced a system of partial differential equations (PDEs) to model the prevalence of chronic diseases with a possibly prolonged state of asymptomatic, undiagnosed disease preceding a diagnosis. Common examples for such diseases include coronary heart disease, type 2 diabetes or cancer. Widespread application of the new method depends upon mathematical treatment of the system of PDEs. Methods In this article, we study the existence and the uniqueness of the solution of the system of PDEs. To demonstrate the usefulness and importance of the system, we model the age-specific prevalence of hypertension in the US 1999–2010. Results The examinations of mathematical properties provide a way to solve the systems of PDEs by the method of characteristics. In the application to hypertension, we obtain a good agreement between modeled and surveyed age-specific prevalences. Conclusions The described system of PDEs provides a practical way to examine the epidemiology of chronic diseases with a state of undiagnosed disease preceding a diagnosis.
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Affiliation(s)
- Ralph Brinks
- University Hospital, Department and Hiller research unit for Rheumatology, Moorenstr. 5, Düsseldorf, 40225, Germany. .,German Diabetes Center, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düesseldorf, 40225, Germany.
| | - Sophie Kaufmann
- German Diabetes Center, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düesseldorf, 40225, Germany.,Heinrich-Heine-University Düsseldorf, Mathematical Institute, Düsseldorf, Germany
| | - Annika Hoyer
- German Diabetes Center, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düesseldorf, 40225, Germany
| | - Edward W Gregg
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.,Imperial College London, School of Public Health, London, United Kingdom
| | - Jürgen Saal
- Heinrich-Heine-University Düsseldorf, Mathematical Institute, Düsseldorf, Germany
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22
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Khokhar B, Quan H, Kaplan GG, Butalia S, Rabi D. Exploring novel diabetes surveillance methods: a comparison of administrative, laboratory and pharmacy data case definitions using THIN. J Public Health (Oxf) 2019; 40:652-658. [PMID: 28977382 DOI: 10.1093/pubmed/fdx096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 01/17/2023] Open
Abstract
Background The objective of this study was to identify patients with diabetes in a comprehensive primary care electronic medical records database using a number of different case definitions (clinical, pharmacy, laboratory definitions and a combination thereof) and understand the differences in patient populations being captured by each definition. Methods Data for this population-based retrospective cohort study was obtained from The Health Information Network (THIN). THIN is a longitudinal, primary care medical records database of over 9 million patients in UK. Primary outcome was a diagnosis of diabetes, defined by the presence of a diabetes read code, or an abnormal laboratory result, or a prescription for an Oral Anti-diabetic drug or insulin. A 2-year washout period was applied prior to the index of diabetes to avoid inclusion of prevalent cases for each case definition. Results This study demonstrated that different case definitions of diabetes identify different sub-populations of patients. When the cohorts were observed based on any measure of central tendency, each of the cohorts were reasonably comparable to each other. However, the distribution of each of the cohorts when grouped by age categories and sex, reveal differences. For example, using pharmacy case definition results in a bimodal distribution among women, one between 1-19 year and 35-39 age categories, and then again between 60-64 and 85 years-however, the histogram becomes more normally distributed when metformin was removed from the case definition. Conclusion Our results suggest that clinical, pharmacy, laboratory case definitions identify different sub-populations and using multiple case definitions is likely required to optimally identify the entire diabetes population within THIN. Our study also suggests that age and sex of patients may affect the indexing of diabetes in THIN and is critical to better understand these variations.
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Affiliation(s)
- Bushra Khokhar
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Sonia Butalia
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,Division of Endocrinology, Department of Medicine, 1820 Richmond Road SW, Calgary, Alberta, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,Division of Endocrinology, Department of Medicine, 1820 Richmond Road SW, Calgary, Alberta, Canada
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23
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Kamat S, Gousse Y, Muzumdar J, Gu A. Trends and Disparities in Quality of Diabetes Care in the US: The National Health and Nutrition Examination Survey, 1999-2016. Innov Pharm 2019; 10. [PMID: 34007599 PMCID: PMC8051907 DOI: 10.24926/iip.v10i4.2064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objectives: To examine trends and disparities in the quality of diabetes care among US adults with diabetes. Methods: Individuals aged 20 years or older with diabetes from NHANES (1999-2016) were included in the study. Quality indicators for diabetes care included Hemoglobin A1c (HbA1c) < 8%, Blood Pressure (BP) < 130/80 mm Hg, Low-Density Lipoprotein (LDL-C) < 100 mg/dL, triglycerides < 150 mg/dL, receiving eye and foot examinations in the past year, and meeting with a diabetes educator in the past year. Results: A total of 7,521 adults with diabetes were identified. During the 18-year study period, significant improvements in diabetes care were observed in the overall study sample. Adjusted regression analyses showed that compared with their White counterparts, Blacks were more likely to have received eye (OR=1.37; P=0.01) and foot (OR=1.42;P=0.01) examinations and met a diabetes educator (OR=1.40;P<0.01) over the past year. However, Blacks were significantly less likely to achieve treatment goals for HbA1c (OR=0.77, P=0.02), BP (OR=0.75, P<0.01), LDL-C (OR=0.68, P<0.01). Hispanics in general had suboptimal healthcare utilization for diabetes but the Hispanic-white disparities in diabetes care outcomes were attenuated after controlling for patient sociodemographic, clinical and utilization characteristics. Overall, suboptimal quality of diabetes care were particularly prominent among adults without health insurance and those with lower educational attainment. Conclusions: In the United States, despite persistent efforts, racial disparities in quality of diabetes care still persist. Lack of health insurance and lower socioeconomic status are among the strongest predictors of poor quality of diabetes care. These findings provide valuable information in developing policies and practices to promote racial equity in diabetes care.
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Affiliation(s)
| | | | | | - Anna Gu
- St. John's University, Queens, NY
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24
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Pessoa BM, Browning MG, Mazzini GS, Wolfe L, Kaplan A, Khoraki J, Campos GM. Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery. J Am Coll Surg 2019; 230:7-16. [PMID: 31672669 DOI: 10.1016/j.jamcollsurg.2019.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/19/2019] [Accepted: 09/16/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Defining factors associated with remission and relapse of type 2 diabetes (T2D) after Roux-en-Y gastric bypass (RYGB) can allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. STUDY DESIGN We conducted a retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medication discontinuation and/or hemoglobin A1c <6.5%. Relapse was defined as recurrence medication use and/or hemoglobin A1c ≥6.5%. Independent correlates of T2D remission and relapse were identified using logistic regression. RESULTS Six hundred and twenty-one patients (aged 46.7 ± 10.6 years; 30% on insulin; BMI 49.8 ± 8.3 kg/m2) had at least 1-year follow-up. Median follow-up was 4.9 years (range 1 to 23.6 years). Prevalence of T2D remission was 74% at 1 year, 73% from 1 to 3 years, 63% between 3 and 10 years, and 47% beyond 10 years. Ninety-three percent of remissions occurred within 3 years of RYGB, 25% relapsed. Median time to relapse was 5.3 years (interquartile range 3 to 7.8 years) after remission. Higher 1-year percentage total body weight loss, lack of preoperative insulin use, and younger age at operation were independently associated with T2D remission. Preoperative insulin use, lower percentage total body weight loss at 1 year, and greater percentage total body weight regain after 1 year were independently associated with T2D relapse. CONCLUSIONS This longitudinal retrospective analysis shows that preoperative insulin use and age, 1-year weight loss, and regain after that influence T2D remission and relapse after RYGB. Referring patients at a younger age, before insulin is needed, and optimizing weight loss and preventing weight regain after RYGB can improve the rates and durability of T2D remission.
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Affiliation(s)
- Bernardo M Pessoa
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Matthew G Browning
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Guilherme S Mazzini
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Luke Wolfe
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Amy Kaplan
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Jad Khoraki
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Guilherme M Campos
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA.
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25
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Yang R, Pedersen NL, Bao C, Xu W, Xu H, Song R, Qi X, Xu W. Type 2 diabetes in midlife and risk of cerebrovascular disease in late life: a prospective nested case-control study in a nationwide Swedish twin cohort. Diabetologia 2019; 62:1403-1411. [PMID: 31172222 PMCID: PMC6647245 DOI: 10.1007/s00125-019-4892-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/10/2019] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS We aimed to examine the association between midlife type 2 diabetes mellitus and cerebrovascular disease (CBD) in late life, and further to explore whether genetic and early-life familial environmental factors (such as shared childhood socioeconomic status and adolescent environment) play a role in this association. METHODS In this prospective nested case-control study based on the Swedish Twin Registry, 33,086 twin individuals who were born in 1958 or earlier and were CBD-free before the age of 60 were included. Midlife (40-59 years) type 2 diabetes was ascertained from self-report, the National Patient Registry (NPR) and glucose-lowering medication use. CBD diagnosis (cerebral infarction, occlusion of cerebral arteries, subarachnoid haemorrhage, intracerebral haemorrhage and unspecified CBD) and onset age were identified from the NPR. Late-life CBD was defined as CBD onset age ≥60 years. Generalised estimating equation (GEE) models were used to analyse unmatched case-control data (adjusted for the clustering of twins within a pair). Conditional logistic regression was used in co-twin matched case-control analyses in CBD-discordant twin pairs. RESULTS Of all the participants, 1248 (3.8%) had midlife type 2 diabetes and 3121 (9.4%) had CBD in late life. In GEE models adjusted for age, sex, education, BMI, smoking, alcohol consumption, marital status, hypertension and heart disease, the ORs (95% CIs) of type 2 diabetes were 1.29 (1.03, 1.61) for cerebral infarction, 2.03 (1.20, 3.44) for occlusion of cerebral arteries, 0.52 (0.12, 2.21) for subarachnoid haemorrhage and 0.78 (0.45, 1.36) for intracerebral haemorrhage. In multi-adjusted conditional logistic regression, the OR of the type 2 diabetes-cerebral infarction association was 0.96 (0.51, 1.80). The differences in ORs from the GEE and co-twin control analyses were not statistically significant (p = 0.780). CONCLUSIONS/INTERPRETATION Midlife type 2 diabetes is significantly associated with increased risk of cerebral infarction and occlusion of cerebral arteries, but not intracerebral haemorrhage or subarachnoid haemorrhage in late life. Genetic and early-life familial environmental factors do not appear to account for the type 2 diabetes-cerebral infarction association, but further clarification is needed.
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Affiliation(s)
- Rongrong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, People's Republic of China
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Cuiping Bao
- Department of Radiology, Tianjin Union Medical Centre, Tianjin, People's Republic of China
| | - Weige Xu
- Department of Radiology, Tianjin Gongan Hospital, Tianjin, People's Republic of China
| | - Hui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, People's Republic of China
| | - Ruixue Song
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, People's Republic of China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, People's Republic of China.
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, 300070, Tianjin, People's Republic of China.
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Tomtebodavägen 18A Floor 10, SE-171 65, Solna, Stockholm, Sweden.
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26
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Siebold B, Heike CL, Leroux BG, Speltz ML, Drake AF, Johns AL, Kapp-Simon KA, Magee L, Luquetti DV. Evaluation of prenatal diabetes mellitus and other risk factors for craniofacial microsomia. Birth Defects Res 2019; 111:649-658. [PMID: 30927385 PMCID: PMC6602800 DOI: 10.1002/bdr2.1502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/03/2019] [Accepted: 03/13/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Craniofacial microsomia (CFM) is a congenital condition that typically involves hypoplasia of the ear and jaw. It is often associated with adverse effects such as hearing loss and sleep-disordered breathing. There is little research on its etiology. METHODS We conducted a case-control study from maternal interview data collected from mothers of infants with and without CFM. The study included 108 children with and 84 children without CFM. Logistic regression with adjustment for demographic factors was used to evaluate associations between maternal exposures of interest and risk for CFM overall, as well as for different phenotypic sub-groups of children on the CFM spectrum. RESULTS We found a statistically significant association between diabetes mellitus (DM) and CFM (OR 4.01, 95% CI 1.6-10.5). The association was slightly attenuated after adjustment for BMI. Higher parity was also associated with increased risk for CFM (OR 2.0, 95% CI 1.0-4.0). Vitamin A consumption and/or liver consumption was associated with a 70% lower risk compared with non-users (OR 0.3, 95% 0.1-0.8). Maternal age at the time of pregnancy was not associated with CFM. CONCLUSIONS These analyses contribute evidence linking maternal DM with an elevated risk of having an infant with CFM, which is consistent with previous research and adds to the body of knowledge about the strength of this association. Further study is warranted to understand the potential mechanisms underlying the effect of DM in the developing embryo.
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Affiliation(s)
- Babette Siebold
- Seattle Children’s Research Institute, Seattle, WA
- Seattle Children’s Hospital, Seattle, WA
| | - Carrie L. Heike
- Seattle Children’s Research Institute, Seattle, WA
- Seattle Children’s Hospital, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | | | - Matthew L. Speltz
- Seattle Children’s Research Institute, Seattle, WA
- Seattle Children’s Hospital, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | | | | | - Kathleen A. Kapp-Simon
- Shriners Hospital for Children, Chicago, IL
- University of Illinois at Chicago, Chicago, IL
| | - Leanne Magee
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Daniela V. Luquetti
- Seattle Children’s Research Institute, Seattle, WA
- Seattle Children’s Hospital, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
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27
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Lee S, Park H, Lee Y, Choi O, Kim J, Gray HL, Song K. Relationships between the diabetes awareness and clinical indices/nutrient intakes in Korean adults: Based on the 2012-2013 Korea National Health and Nutrition Examination Survey Data. Nutr Res Pract 2019; 13:240-246. [PMID: 31214292 PMCID: PMC6548712 DOI: 10.4162/nrp.2019.13.3.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/18/2019] [Accepted: 05/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Diabetes is diagnosed after an average of 10-12 years of diabetic development. Strict glycemic control in diabetic patients promotes the normalization of blood glucose and reduces cardiovascular diseases (CVDs) and diabetic complications. Therefore, early diagnosis in non-aware individuals is very important. SUBJECTS/METHODS Clinical indices and nutrient intakes in Korean diabetic adults aged 19-64 years were examined according to the awareness of diabetes, using 2012 and 2013 Korea National Health and Nutrition Examination Survey (KNHANES) data. The aware group was defined as individuals who were aware of having diabetes from diagnosis by physician before the survey and the non-aware group as individuals who were not aware of having diabetes. RESULTS The average age was higher in the aware group compared to the non-aware group in both men (P = 0.002) and women (P = 0.004). The prevalences of hypertension and dyslipidemia were not different between the two groups, but the diagnosis rate was significantly lower in the non-aware group. In the non-aware group, total and LDL-cholesterol were significantly higher (P < 0.001), the risk for total cholesterol over 240 mg/dL was 3.4 times (95% CI: 1.58-7.52) higher (P = 0.002) and the risk for LDL-cholesterol over 160 mg/dL was 4.59 times (95% CI: 2.07-10.17) higher (P < 0.001). The calorie intake of the female non-aware group was significantly higher compared to the female aware group (P = 0.033). CONCLUSION The results suggested that the recommendation of screening test is necessary even for young adults. Studies on the methodology for early diagnosis of diabetes are also needed.
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Affiliation(s)
- Seul Lee
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Haeryun Park
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Youngmi Lee
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Onjeong Choi
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Jiwon Kim
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Heewon L Gray
- Department of Community and Family Health, University of South Florida 13201, Florida, USA
| | - Kyunghee Song
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
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De Alba A, Britigan DH, Lyden E, Johansson P. Assessing the Prevalence and Association of Acculturation and Health Literacy Levels in Spanish-Speaking Hispanic Patients at Midwestern Community Health Centers in the USA. J Racial Ethn Health Disparities 2019; 6:701-706. [PMID: 30756258 DOI: 10.1007/s40615-019-00568-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Predictions from the US census indicate that by 2060 one of every three individuals living in the nation will be of Hispanic origin. Hispanics experience health disparities manifested with higher rates of chronic conditions such as hypertension and diabetes in contrast with other US population groups. Health literacy and acculturation have been well identified as key contributors for this issue. However, very few studies have examined the association between health literacy and levels of acculturation in Spanish-speaking Hispanics living in rural and urban areas of the USA. OBJECTIVE To assess the prevalence and association of acculturation with low levels of health literacy and demographic variables in Spanish-speaking Hispanics in the US Midwest. METHODS We measured levels of acculturation in Spanish-speaking adult Hispanics (N = 401) accessing community health centers in rural and urban Nebraska. We used a survey that included the Bidimensional Acculturation Scale for Hispanics/Linguistic Proficiency Subscale (BAS/LP) and the Short Assessment of Health Literacy in Spanish (SAHL-S). RESULTS We observed similar acculturation levels with rural and urban status participants. A total of 85% of the total participants had low levels of acculturation to US culture. Of the 15% of the participants who showed themselves to be bicultural, 81% reported adequate levels of health literacy in Spanish. CONCLUSIONS Our findings are consistent with previous studies that report the associations between acculturation and health literacy levels are significant. This study underscores the importance of considering the cultural aspects of the Hispanic community for the development of health literacy interventions and education programs.
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Affiliation(s)
- Armando De Alba
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4373, USA.
| | - Denise H Britigan
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4373, USA
| | - Elizabeth Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Patrik Johansson
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4373, USA
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Fang M. Trends in the Prevalence of Diabetes Among U.S. Adults: 1999-2016. Am J Prev Med 2018; 55:497-505. [PMID: 30126668 DOI: 10.1016/j.amepre.2018.05.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/05/2018] [Accepted: 05/16/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The prevalence of diabetes has increased substantially over the past three decades. This study sought to estimate recent trends in the prevalence of diabetes among U.S. adults. METHODS This paper estimated trends in the prevalence of diagnosed, undiagnosed, and total diabetes among U.S. adults from 1999-2000 to 2015-2016 (analyzed in 2017). Data come from 42,554 respondents aged ≥20 years who participated in the National Health and Nutrition Examination Survey. Diagnosed diabetes was measured through self-report, undiagnosed diabetes was measured as never being diagnosed with diabetes but having glycated hemoglobin levels ≥6.5%, and total diabetes was measured as the sum of individuals with diagnosed and undiagnosed diabetes. RESULTS In the overall U.S. adult population, the unadjusted prevalence of total diabetes increased from 7.7% in 1999-2000 to 13.3% in 2015-2016 (p<0.001 for trend). Growth was observed for all subgroups, though the rate of change was higher in older adults, racial minorities, and those who were obese compared with their peers. Increasing prevalence among Mexican-American adults was particularly pronounced, rising by 10.1 percentage points during the study period (8.3% to 18.4%, p<0.001). Roughly 40% of the increase in total diabetes was accounted for by changes in the age and rates of obesity in the U.S. POPULATION CONCLUSIONS From 1999 to 2016, the prevalence of diabetes among U.S. adults increased at a substantial rate. This growth occurred differentially across subgroups, particularly impacting Mexican-American adults, and was driven in large part by population aging and increasing obesity rates.
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Affiliation(s)
- Michael Fang
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
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Geiss LS, Bullard KM, Brinks R, Gregg EW. Considerations in Epidemiologic Definitions of Undiagnosed Diabetes. Diabetes Care 2018; 41:1835-1838. [PMID: 30135196 DOI: 10.2337/dc17-1838] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/31/2018] [Indexed: 02/03/2023]
Abstract
Accurately quantifying undiagnosed type 2 diabetes is an important challenge for conducting diabetes surveillance and identifying the potential missed opportunities for preventing complications. However, there has been little focused attention on how undiagnosed diabetes is defined in epidemiologic surveys and how limitations in methods used to ascertain undiagnosed diabetes may impact our understanding of the magnitude of this important public health problem. This Perspective highlights weaknesses in how undiagnosed diabetes is quantified in epidemiologic research and the biases and caveats that should be considered when using estimates of undiagnosed diabetes to influence public health policy.
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Affiliation(s)
- Linda S Geiss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ralph Brinks
- German Diabetes Center, Institute for Biometry and Epidemiology, Duesseldorf, Germany
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Bujang MA, Kuan PX, Tiong XT, Saperi FE, Ismail M, Mustafa FI, Abd Hamid AM. The All-Cause Mortality and a Screening Tool to Determine High-Risk Patients among Prevalent Type 2 Diabetes Mellitus Patients. J Diabetes Res 2018; 2018:4638327. [PMID: 30116741 PMCID: PMC6079498 DOI: 10.1155/2018/4638327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 01/17/2023] Open
Abstract
AIMS This study aims to determine the all-cause mortality and the associated risk factors for all-cause mortality among the prevalent type 2 diabetes mellitus (T2DM) patients within five years' period and to develop a screening tool to determine high-risk patients. METHODS This is a cohort study of T2DM patients in the national diabetes registry, Malaysia. Patients' particulars were derived from the database between 1st January 2009 and 31st December 2009. Their records were matched with the national death record at the end of year 2013 to determine the status after five years. The factors associated with mortality were investigated, and a prognostic model was developed based on logistic regression model. RESULTS There were 69,555 records analyzed. The mortality rate was 1.4 persons per 100 person-years. The major cause of death were diseases of the circulatory system (28.4%), infectious and parasitic diseases (19.7%), and respiratory system (16.0%). The risk factors of mortality within five years were age group (p < 0.001), body mass index category (p < 0.001), duration of diabetes (p < 0.001), retinopathy (p = 0.001), ischaemic heart disease (p < 0.001), cerebrovascular (p = 0.007), nephropathy (p = 0.001), and foot problem (p = 0.001). The sensitivity and specificity of the proposed model was fairly strong with 70.2% and 61.3%, respectively. CONCLUSIONS The elderly and underweight T2DM patients with complications have higher risk for mortality within five years. The model has moderate accuracy; the prognostic model can be used as a screening tool to classify T2DM patients who are at higher risk for mortality within five years.
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Affiliation(s)
- Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Pei Xuan Kuan
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Xun Ting Tiong
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Fatin Ellisya Saperi
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Mastura Ismail
- Health Clinic Seremban 2, Ministry of Health, Seremban, Malaysia
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Khan A, Uddin S, Srinivasan U. Comorbidity network for chronic disease: A novel approach to understand type 2 diabetes progression. Int J Med Inform 2018; 115:1-9. [PMID: 29779710 DOI: 10.1016/j.ijmedinf.2018.04.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 04/01/2018] [Accepted: 04/07/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic diseases management outside expensive hospital settings has become a major target for governments, funders and healthcare service providers. It is well known that chronic diseases such as Type 2 Diabetes (T2D) do not occur in isolation, and has a shared aetiology common to many other diseases and disorders. Diabetes Australia reports that it is associated with a myriad of complications, which affect the feet, eyes, kidneys, and cardiovascular health. For instance, nerve damage in the lower limbs affects around 13% of Australians with diabetes, diabetic retinopathy occurs in over 15% of Australians with diabetes, and diabetes is now the leading cause of end-stage kidney disease. Our research focus is therefore to understand the comorbidity pattern, which in turn can enhance our understanding of the multifactorial risk factors of chronic diseases like Type 2 Diabetes. Our research approach is based on utilising valuable indicators present in pre-existing administrative healthcare data, which are routinely collected but often neglected in health research. One such administrative healthcare data is the hospital admission and discharge data that carries information about diagnoses, which are represented in the form of ICD-10 diagnosis codes. Analysis of diagnoses codes and their relationships helps us construct comorbidity networks which can provide insights that can be used to understand chronic disease progression pattern and comorbidity network at a population level. This understanding can subsequently enable healthcare providers to formulate appropriate preventive health policies targeted to address high-risk chronic conditions. METHODS AND FINDINGS The research utilises network theory principles applied to administrative healthcare data. Given the high rate of prevalence, we selected Type 2 Diabetes as the exemplar chronic disease. We have developed a research framework to understand and represent the progression of Type 2 diabetes, utilising graph theory and social network analysis techniques. We propose the concept of a 'comorbidity network' that can effectively model chronic disease comorbidities and their transition patterns, thereby representing the chronic disease progression. We further take the attribution effect of the comorbidities into account while generating the network; that is, we not only look at the pattern of disease in chronic disease patients, but also compare the disease pattern with that of non-chronic patients, to understand which comorbidities have a higher influence on the chronic disease pathway. The research framework enables us to construct a baseline comorbidity network for each of the two cohorts. It then compares and merges these two networks into single comorbidity network to discover the comorbidities that are exclusive to diabetic patients. This framework was applied on administrative data drawn from the Australian healthcare context. The overall dataset contained approximately 1.4 million admission records from 0.75 million patients, from which we filtered and sampled the records of 2300 diabetics and 2300 non-diabetic patients. We found significant difference in the health trajectory of diabetic and non-diabetic cohorts. The diabetic cohort exhibited more comorbidity prevalence and denser network properties. For example, in the diabetic cohort, heart and liver-related disorders, cataract etc. were more prevalent. Over time, the prevalence of diseases in the health trajectory of diabetic cohorts were almost double of the prevalence in the non-diabetic cohort, indicating entirely different ways of disease progression. CONCLUSIONS The paper presents a research framework based on network theory to understand chronic disease progression along with associated comorbidities that manifest over time. The analysis methods provide insights that can enable healthcare providers to develop targeted preventive health management programs to reduce hospital admissions and associated high costs. The baseline comorbidity network has the potential to be used as the basis to develop a chronic disease risk prediction model.
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Affiliation(s)
- Arif Khan
- Complex Systems Research Group, Project Management Program, The University of Sydney, Sydney, NSW, Australia; Health Market Quality Research Stream, Capital Markets CRC, Level 3, 55 Harrington Street, Sydney, NSW, Australia.
| | - Shahadat Uddin
- Complex Systems Research Group, Project Management Program, The University of Sydney, Sydney, NSW, Australia
| | - Uma Srinivasan
- Health Market Quality Research Stream, Capital Markets CRC, Level 3, 55 Harrington Street, Sydney, NSW, Australia
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Lee JW, Kang HT, Lim HJ, Park B. Trends in diabetes prevalence among Korean adults based on Korean National Health and Nutrition Examination Surveys III-VI. Diabetes Res Clin Pract 2018; 138:57-65. [PMID: 29412145 DOI: 10.1016/j.diabres.2018.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/08/2017] [Accepted: 01/17/2018] [Indexed: 01/02/2023]
Abstract
AIMS The purpose of this study was to investigate trends in diabetic prevalence over the past 11 years using Korea National Health and Nutrition Examination Survey (KNHANES) data. In addition, we aimed to examine trends in diagnosed and undiagnosed diabetes after stratification. METHODS We used data from the KNHANES III (2005), IV (2007-2009), V (2010-2012), and VI (2013-2015). 46,157 participants were included in this study. Diabetes was defined as follows: (1) an answer of 'yes' to whether the participants had ever been diagnosed with diabetes by a physician, (2) fasting plasma glucose (FPG) ≥126 mg/dL, or (3) taking oral hypoglycemic agents or insulin. All sampling and weight variables were stratified, and analysis to account for the complex sampling design. The prevalence of diabetes was standardized by the 2005 Korean Housing Census. RESULTS In men, the crude prevalence of total and undiagnosed diabetes were significantly increased with KNHANES phase (P for trend = 0.002 and 0.004, respectively). The age-standardized prevalence of total, diagnosed and undiagnosed diabetes of both sexes increased with the KNHANES phase (all P for trend < 0.001). Compared with the KNHANES III, the age-adjusted odds ratios (ORs) for the crude-prevalence of undiagnosed diabetes in KNHANES IV, V, and VI were 1.00 (0.72-1.41), 1.08 (0.78-1.51), and 1.42 (1.04-1.96) for men. CONCLUSIONS The prevalence of total, diagnosed and undiagnosed diabetes steadily increased and public efforts should focus on screening for the detection of diabetes, especially in men.
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Affiliation(s)
- Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
| | - Hyoung-Ji Lim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Byoungjin Park
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University, Yongin, Republic of Korea
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Di Camillo B, Hakaste L, Sambo F, Gabriel R, Kravic J, Isomaa B, Tuomilehto J, Alonso M, Longato E, Facchinetti A, Groop LC, Cobelli C, Tuomi T. HAPT2D: high accuracy of prediction of T2D with a model combining basic and advanced data depending on availability. Eur J Endocrinol 2018; 178:331-341. [PMID: 29371336 DOI: 10.1530/eje-17-0921] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/25/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Type 2 diabetes arises from the interaction of physiological and lifestyle risk factors. Our objective was to develop a model for predicting the risk of T2D, which could use various amounts of background information. RESEARCH DESIGN AND METHODS We trained a survival analysis model on 8483 people from three large Finnish and Spanish data sets, to predict the time until incident T2D. All studies included anthropometric data, fasting laboratory values, an oral glucose tolerance test (OGTT) and information on co-morbidities and lifestyle habits. The variables were grouped into three sets reflecting different degrees of information availability. Scenario 1 included background and anthropometric information; Scenario 2 added routine laboratory tests; Scenario 3 also added results from an OGTT. Predictive performance of these models was compared with FINDRISC and Framingham risk scores. RESULTS The three models predicted T2D risk with an average integrated area under the ROC curve equal to 0.83, 0.87 and 0.90, respectively, compared with 0.80 and 0.75 obtained using the FINDRISC and Framingham risk scores. The results were validated on two independent cohorts. Glucose values and particularly 2-h glucose during OGTT (2h-PG) had highest predictive value. Smoking, marital and professional status, waist circumference, blood pressure, age and gender were also predictive. CONCLUSIONS Our models provide an estimation of patient's risk over time and outweigh FINDRISC and Framingham traditional scores for prediction of T2D risk. Of note, the models developed in Scenarios 1 and 2, only exploited variables easily available at general patient visits.
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Affiliation(s)
- Barbara Di Camillo
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Liisa Hakaste
- EndocrinologyAbdominal Centre, University of Helsinki and Helsinki University Hospital, Research Program for Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Folkhälsan Research CenterHelsinki, Finland
| | - Francesco Sambo
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Rafael Gabriel
- Department of International HealthNational School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Asociación Española Para el Desarrollo de la Epidemiología Clínica (AEDEC)Madrid, Spain
| | - Jasmina Kravic
- Lund University Diabetes CentreDepartment of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Bo Isomaa
- Folkhälsan Research CenterHelsinki, Finland
| | - Jaakko Tuomilehto
- Asociación Española Para el Desarrollo de la Epidemiología Clínica (AEDEC)Madrid, Spain
- Dasman Diabetes InstituteDasman, Kuwait City, Kuwait
- Department of Neuroscience and Preventive MedicineDanube-University Krems, Krems, Austria
- Saudi Diabetes Research GroupKing Abdulaziz University, Jeddah, Saudi Arabia
| | - Margarita Alonso
- Department of International HealthNational School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Asociación Española Para el Desarrollo de la Epidemiología Clínica (AEDEC)Madrid, Spain
| | - Enrico Longato
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Andrea Facchinetti
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Leif C Groop
- Lund University Diabetes CentreDepartment of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
- Institute for Molecular Medicine Finland (FIMM)University of Helsinki, Helsinki, Finland
| | - Claudio Cobelli
- Department of Information EngineeringUniversity of Padova, Padova, Italy
| | - Tiinamaija Tuomi
- EndocrinologyAbdominal Centre, University of Helsinki and Helsinki University Hospital, Research Program for Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Folkhälsan Research CenterHelsinki, Finland
- Institute for Molecular Medicine Finland (FIMM)University of Helsinki, Helsinki, Finland
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Rhee MK, Safo SE, Jackson SL, Xue W, Olson DE, Long Q, Barb D, Haw JS, Tomolo AM, Phillips LS. Inpatient Glucose Values: Determining the Nondiabetic Range and Use in Identifying Patients at High Risk for Diabetes. Am J Med 2018; 131:443.e11-443.e24. [PMID: 28993187 DOI: 10.1016/j.amjmed.2017.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 07/31/2017] [Accepted: 09/12/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Many individuals with diabetes remain undiagnosed, leading to delays in treatment and higher risk for subsequent diabetes complications. Despite recommendations for diabetes screening in high-risk groups, the optimal approach is not known. We evaluated the utility of inpatient glucose levels as an opportunistic screening tool for identifying patients at high risk for diabetes. METHODS We retrospectively examined 462,421 patients in the US Department of Veterans Affairs healthcare system, hospitalized on medical/surgical services in 2000-2010, for ≥3 days, with ≥2 inpatient random plasma glucose (RPG) measurements. All had continuity of care: ≥1 primary care visit and ≥1 glucose measurement within 2 years before hospitalization and yearly for ≥3 years after discharge. Glucose levels during hospitalization and incidence of diabetes within 3 years after discharge in patients without diabetes were evaluated. RESULTS Patients had a mean age of 65.0 years, body mass index of 29.9 kg/m2, and were 96% male, 71% white, and 18% black. Pre-existing diabetes was present in 39.4%, 1.3% were diagnosed during hospitalization, 8.1% were diagnosed 5 years after discharge, and 51.3% were never diagnosed (NonDM). The NonDM group had the lowest mean hospital RPG value (112 mg/dL [6.2 mmol/L]). Having at least 2 RPG values >140 mg/dL (>7.8 mmol/L), the 95th percentile of NonDM hospital glucose, provided 81% specificity for identifying incident diabetes within 3 years after discharge. CONCLUSIONS Screening for diabetes could be considered in patients with at least 2 hospital glucose values at/above the 95th percentile of the nondiabetic range (141 mg/dL [7.8 mmol/L]).
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Affiliation(s)
- Mary K Rhee
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
| | - Sandra E Safo
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Sandra L Jackson
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Ga; Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Wenqiong Xue
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Ga; Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn
| | - Darin E Olson
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Qi Long
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Ga; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Diana Barb
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Florida College of Medicine, Gainesville
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Anne M Tomolo
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Lawrence S Phillips
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
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Bao C, Pedersen NL, Yang R, Marseglia A, Xu W, Wang Y, Qi X, Xu W. Diabetes in midlife and risk of cancer in late life: A nationwide Swedish twin study. Int J Cancer 2018; 143:793-800. [PMID: 29566433 DOI: 10.1002/ijc.31365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/14/2018] [Accepted: 02/28/2018] [Indexed: 12/11/2022]
Abstract
The association between diabetes and cancer risk remains controversial. Hence, we examined whether midlife diabetes is related to the risk of cancer in late-life, and whether genetic and early-life environmental factors play a role in this association. This study included 25,154 twin individuals born in 1958 or earlier from the Swedish Twin Registry. Information on cancer diagnosis in late life (aged ≥ 65) during 1998-2014, was derived from the National Patient and Cancer Registries. Diabetes was ascertained based on self- or informant-reported history, patient registry and antidiabetic medication use. Midlife diabetes was defined when diabetes was diagnosed before 65 years. Data were analyzed following two strategies: (i) unmatched case-control analysis for all participants using generalized estimating equation (GEE) models, and (ii) co-twin control analysis for cancer-discordant twin pairs using conditional logistic regression. Overall, 1,766 (7.0%) had midlife diabetes and 5,293 (21.0%) had cancer in late-life. In multiadjusted GEE models, the odds ratios (95% CIs) of diabetes were 10.55 (2.95-37.67) for pharynx cancer, 5.78 (1.72-19.40) for small intestine cancer, 2.37 (1.14-4.91) for liver cancer and 0.48 (0.35-0.67) for prostate cancer. In people with diabetes, diabetes duration was dose-dependently associated with cancer risk. In conditional logistic regression analysis of 176 prostate cancer-discordant twin pairs, the association between midlife diabetes and prostate cancer in later life became stronger. Midlife diabetes increases the risk of pharynx, small intestine and liver cancers, but reduces prostate cancer risk in late life. Genetic and early-life environmental factors may partially contribute to the diabetes-prostate cancer association.
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Affiliation(s)
- Cuiping Bao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, University of Southern California, Los Angeles, California
| | - Rongrong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Weige Xu
- Department of Radiology, Tianjin Gongan Hospital, Tianjin, China
| | - Yaogang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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The Association of Recently Diagnosed Diabetes and Long-term Diabetes With Survival in Pancreatic Cancer Patients: A Pooled Analysis. Pancreas 2018; 47:314-320. [PMID: 29401167 PMCID: PMC5807116 DOI: 10.1097/mpa.0000000000000989] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES It is unclear whether long-standing diabetes or new-onset pancreatogenic diabetes contributes to poor prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS We investigated the influence of diabetes diagnosed shortly before PDAC and long-term diabetes on overall survival in 2792 PDAC patients who had participated in 3 PDAC case-control studies in the Pancreatic Cancer Case-Control Consortium. There were 300 patients with long-term diabetes of more than 3 years' duration (11%) and 418 patients with recently diagnosed diabetes of 3-year duration or less (15%). We performed Cox regression to determine the association of long-term diabetes and recently diagnosed diabetes with overall survival, adjusting for study site, age, sex, race, stage of disease, surgery, chemotherapy, smoking history, and body mass index at diagnosis. RESULTS In the overall population, neither long-term diabetes (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.97-1.26) nor recently diagnosed diabetes (HR, 1.06; 95% CI, 0.94-1.18) was associated with shorter survival. When stratified by stage of disease, long-term diabetes was associated with 42% increase in rate of death in persons with resectable PDAC (HR, 1.42; 95% CI, 1.13-1.78), whereas it was not associated with survival in PDAC patients with more advanced disease. CONCLUSION Long-term diabetes was associated with increased rate of death in patients with resectable PDAC.
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Liu T, Li C, Shen L, Shen Y, Mao W, Li S. Heterogeneity in effects of genetically determined adiposity on insulin resistance and type 2 diabetes: The atherosclerosis risk in communities study. J Diabetes Complications 2018; 32:330-334. [PMID: 29395842 PMCID: PMC5820121 DOI: 10.1016/j.jdiacomp.2017.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/05/2017] [Accepted: 12/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND A recent genome-wide association study has identified 12 genetic variants robustly associated with body fat percentage (BF%) with diverse cardiometabolic consequences. We developed three genetic risk scores (GRSs) according to the associations of the 12 individual variants with type 2 diabetes (T2D) and test the GRSs' associations with insulin resistance and T2D in the Atherosclerosis Risk in Communities Study. METHODS In 6895 European-American participants, we calculated GRS-I as the number of BF%-increasing alleles from variants associated with increased risk of T2D, GRS-D from variants associated with decreased risk of T2D, and GRS-ALL from all 12 variants. Linear and logistic regression models were used to evaluate associations of the GRSs with insulin resistance and risk of T2D, respectively, adjusted for age, sex, smoking, and drinking, and additionally for body mass index (BMI). RESULTS GRS-D was significantly associated with decreased levels of fasting insulin (P = 0.014) and homeostasis assessment of insulin resistance (P = 0.023). While GRS-I was not associated with insulin resistance measures, it was with T2D (P = 0.002). Further adjustment for BMI did not substantially change the above associations. GRS-ALL was inversely associated with insulin resistance after controlling for covariates including BMI; GRS-ALL was not associated with T2D. CONCLUSION Genetically determined BF% has differential effects on cardiometabolic risk, which may partly explain the heterogeneity in obesity-induced cardiometabolic risk and have implications for developing new strategies mitigating obesity-induced cardiometabolic consequences.
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Affiliation(s)
- Tingting Liu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States; Eleanor Mann School of Nursing, University of Arkansas College of Education and Health Professions, Fayetteville, AR, United States
| | - Changwei Li
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, GA, United States.
| | - Luqi Shen
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, GA, United States
| | - Ye Shen
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, GA, United States
| | - Weibo Mao
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, GA, United States
| | - Shengxu Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States.
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Luo B, Zhang J, Hu Z, Gao F, Zhou Q, Song S, Qin L, Xu H. Diabetes-related behaviours among elderly people with pre-diabetes in rural communities of Hunan, China: a cross-sectional study. BMJ Open 2018; 8:e015747. [PMID: 29362243 PMCID: PMC5786133 DOI: 10.1136/bmjopen-2016-015747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To explore diabetes-related behaviours and their influencing factors among elderly individuals with pre-diabetes in rural areas of China. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey was conducted among elderly individuals (≥60 years) in rural communities in Yiyang City of China. Multistaged cluster random sampling was carried out to select 42 areas, and interviews were conducted among 434 elderly individuals with pre-diabetes (fasting plasma glucose 6.1-7.0 mmol/L and/or 2-hour post-glucose load of 7.8-11.1 mmol/L) using questionnaires on diabetes-related behaviours. The diabetes-related behaviours included eight categories: average daily sedentary time; frequency of physical activities per week; regular or irregular diet; whether paying attention to diet control or not; daily dietary preferences; frequency of physical examinations per year; current smoking status; and current consumption of alcohol. Each of the risky behaviours was scored -1 and each of the healthy behaviours was scored +1. Each individual's score of diabetes-related behaviours was the sum of the score for all behaviours. MAIN OUTCOME MEASURES Participants were asked about general information (age, gender, marital status, history of hyperglycaemia, family history of diabetes mellitus, presence of other diseases, body mass index, waist-to-hip ratio and education) and their diabetes-related behaviours. Multivariate linear regression analysis was performed to identify the risk factors for diabetes-related behaviour among elderly individuals with pre-diabetes. RESULTS The average score of diabetes-related behaviours of elderly individuals with pre-diabetes in rural China was 2.7. The prevalences of risky diabetes-related behaviours were as follows: <1 physical examination per year (57.6%), insufficient physical activities (55.3%), lack of attention paid to diet control (51.4%), high-salt and high-fat diets (41.0%), sedentary lifestyle (35.9%), smoking (22.8%), regular alcohol uptake (15.0%) and irregular diet (3.9%). Gender and a history of hyperglycaemia were found to be influencing factors of the diabetes-related behaviour score. CONCLUSIONS The prevalence of risky diabetes-related behaviours was high among pre-diabetic elderly individuals in rural China. More effort should be made to promote the prevention and control of diabetes in rural China. Future studies should be undertaken on diabetes prevention strategies tailored specially for this population. TRIAL REGISTRATION NUMBER ChiCTR-IOR-15007033; Results.
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Affiliation(s)
- Bangan Luo
- Department of Mental Health, Brain Hospital of Hunan Province, Changsha, China
| | - Jianglin Zhang
- Xiangya Hospital of Central South University, Changsha, China
| | - Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Fan Gao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Qiuhong Zhou
- Xiangya Hospital of Central South University, Changsha, China
| | - Shuang Song
- Xiangya Hospital of Central South University, Changsha, China
| | - Lulu Qin
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Department of Preventive Medicine, Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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López L, Grant RW, Marceau L, Piccolo R, McKinlay JB, Meigs JB. Association of Acculturation and Health Literacy with Prevalent Dysglycemia and Diabetes Control Among Latinos in the Boston Area Community Health (BACH) Survey. J Immigr Minor Health 2018; 18:1266-1273. [PMID: 26898955 DOI: 10.1007/s10903-016-0362-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study assessed the effect of acculturation on type 2 diabetes and whether health literacy may mediate this association. The Boston Area Community Health cohort is a multi-stage stratified random sample of adults from Boston including 744 Latinos. We defined dysglycemia as a HbA1c ≥5.7 %. Multivariable analyses examined the associations between acculturation and health literacy adjusting for demographic and clinical variables. Similar analyses were performed among participants with HbA1c ≥7.0 % to assess the association between acculturation and diabetes control. Among an insured primarily foreign born Spanish speaking Latino population, with a long residence period in the US and good healthcare utilization, higher levels of acculturation were not associated with dysglycemia. Lower levels of acculturation were associated with worse diabetes control. Health literacy level did not modify these associations. Elucidating the components of heterogeneity among Latinos will be essential for understanding the influence of acculturation on diabetes.
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Affiliation(s)
- Lenny López
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lisa Marceau
- New England Research Institutes, Boston, MA, USA
| | | | | | - James B Meigs
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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Geiss LS, Bullard KM, Brinks R, Hoyer A, Gregg EW. Trends in type 2 diabetes detection among adults in the USA, 1999-2014. BMJ Open Diabetes Res Care 2018; 6:e000487. [PMID: 29379608 PMCID: PMC5783029 DOI: 10.1136/bmjdrc-2017-000487] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/05/2017] [Accepted: 12/13/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To examine recent trends in type 2 diabetes detection among adults in the USA. RESEARCH DESIGN AND METHODS We used data from the 1999-2014 National Health and Nutrition Examination Surveys on non-pregnant adults (aged ≥18 years) not reporting a diagnosis of diabetes (n=16 644 participants, averaging about 2000 for each 2-year cycle). We defined undiagnosed diabetes as a fasting plasma glucose ≥126 mg/dL or a hemoglobin A1c ≥6.5% (48 mmol/mol). We measured case detection as the probability of finding undiagnosed type 2 diabetes among the population without diagnosed diabetes. Linear regression models were used to examine trends overall and by sociodemographic characteristics (ie, age, gender, race/ethnicity, education, poverty-income ratio (PIR)). RESULTS Age-standardized probability of finding undiagnosed type 2 diabetes was 3.0% (95% CI 2.1% to 4.2%) during 1999-2000 and 2.8% (2.2%-3.6%) during 2013-2014 (P for trend=0.52). Probability increased among Mexican-Americans (P for trend=0.01) but decreased among adults aged 65 years or older (P for trend=0.04), non-Hispanic (NH) white (P for trend=0.02), and adults in the highest PIR tertile (P for trend=0.047). For all other sociodemographic groups, no significant trends were detected. CONCLUSIONS We found little evidence of increased detection of undiagnosed type 2 diabetes among adults in the USA during the past 15 years. Although improvements were seen among NH white, older, and wealthy adults, these improvements were not large. As the scope of primary prevention efforts increases, case detection may improve.
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Affiliation(s)
- Linda S Geiss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ralph Brinks
- Institute for Biometry and Epidemiology, German Diabetes Center, Dusseldorf, Germany
| | - Annika Hoyer
- Institute for Biometry and Epidemiology, German Diabetes Center, Dusseldorf, Germany
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wu L, Lin H, Gao J, Li X, Xia M, Wang D, Aleteng Q, Ma H, Pan B, Gao X. Effect of age on the diagnostic efficiency of HbA1c for diabetes in a Chinese middle-aged and elderly population: The Shanghai Changfeng Study. PLoS One 2017; 12:e0184607. [PMID: 28886160 PMCID: PMC5591004 DOI: 10.1371/journal.pone.0184607] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/28/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND AIMS Glycated hemoglobin A1c (HbA1c) ≥6.5% (or 48mmol/mol) has been recommended as a new diagnostic criterion for diabetes; however, limited literature is available regarding the effect of age on the HbA1c for diagnosing diabetes and the causes for this age effect remain unknown. In this study, we investigated whether and why age affects the diagnostic efficiency of HbA1c for diabetes in a community-based Chinese population. METHODS In total, 4325 participants without previously known diabetes were enrolled in this study. Participants were stratified by age. Receiver operating characteristic curve (ROC) was plotted for each age group and the area under the curve (AUC) represented the diagnostic efficiency of HbA1c for diabetes defined by the plasma glucose criteria. The area under the ROC curve in each one-year age group was defined as AUCage. Multiple regression analyses were performed to identify factors inducing the association between age and AUCage based on the changes in the β and P values of age. RESULTS The current threshold of HbA1c (≥6.5% or 48mmol/mol) showed low sensitivity (35.6%) and high specificity (98.9%) in diagnosing diabetes. ROC curve analyses showed that the diagnostic efficiency of HbA1c in the ≥75 years age group was significantly lower than that in the 45-54 years age group (AUC: 0.755 vs. 0.878; P<0.001). Pearson correlation analysis showed that the AUCage of HbA1c was negatively correlated with age (r = -0.557, P = 0.001). When adjusting the red blood cell (RBC) count in the multiple regression model, the negative association between age and AUCage disappeared, with the regression coefficient of age reversed to 0.001 and the P value increased to 0.856. CONCLUSIONS The diagnostic efficiency of HbA1c for diabetes decreased with aging, and this age effect was induced by the decreasing RBC count with age. HbA1c is unsuitable for diagnosing diabetes in elderly individuals because of their physiologically decreased RBC count.
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Affiliation(s)
- Li Wu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
- Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Clinical Nutrition, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Li
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingfeng Xia
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Dan Wang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiqige Aleteng
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Ma
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Baishen Pan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
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Stokes A, Preston SH. The contribution of rising adiposity to the increasing prevalence of diabetes in the United States. Prev Med 2017; 101:91-95. [PMID: 28579501 PMCID: PMC5540312 DOI: 10.1016/j.ypmed.2017.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/02/2017] [Accepted: 05/28/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We assessed the contribution of increasing adiposity to the rising prevalence of diabetes in the United States over the period 1988-2014. RESEARCH DESIGN AND METHODS Data from NHANES III (1988-1994) and continuous waves (1999-2014) were pooled for the current study. Diabetes status was assessed using data on Hemoglobin A1c. We estimated a multivariable logistic regression model that predicted the odds of having diabetes as a function of age, sex, racial/ethnic group, educational attainment, and period of observation. At a second stage, we introduced measures of general and abdominal adiposity into the model. Changes in coefficients pertaining to period of observation between the first and second models were interpreted as indicating the extent to which adiposity can account for trends in the prevalence of diabetes. Sensitivity analyses were conducted to investigate how alternative definitions of adiposity and diabetes status would affect results. RESULTS The predicted prevalence of diabetes rose by 2.59%/yr between 1988 and 2014 after adjusting for changes in population composition. Increasing adiposity explained 72% of the rise in diabetes. Results were consistent for men and women. CONCLUSIONS Rising levels of adiposity explained the large majority of the rise in diabetes prevalence between 1988 and 2014.
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Affiliation(s)
- Andrew Stokes
- Department of Global Health, Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
| | - Samuel H Preston
- Department of Sociology, Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
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Not performing an OGTT results in significant underdiagnosis of (pre)diabetes in a high risk adult Caucasian population. Int J Obes (Lond) 2017; 41:1615-1620. [PMID: 28720876 DOI: 10.1038/ijo.2017.165] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 04/13/2017] [Accepted: 04/23/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Type 2 diabetes (T2DM) is known to be underdiagnosed. Tests for diagnosis include fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) and HbA1c. HbA1c can be tested in non-fasting conditions. Therefore, general practitioners almost no longer execute OGTT's. We evaluated the performance of OGTT versus HbA1c in a population consisting of overweight and obese subjects, which can be considered a 'high risk' population. RESEARCH DESIGN AND METHODS A total of, 1241 overweight and obese subjects without a history of diabetes (male/female: 375/866, age 44±13 years, body mass index 38.0±6.1 kg m-2) were tested for glucose tolerance status using FPG, OGTT and HbA1c. RESULTS Exactly, 46.8% were found to have prediabetes and 11.9% were newly diagnosed with T2DM (male/female=18.9/8.9%) using ADA criteria. Testing only HbA1c would have resulted in 78 subjects being diagnosed with T2DM, but 47.3% of newly diagnosed patients would have been missed if OGTT would not have been done. Exactly 581 subjects were diagnosed with prediabetes, 1.4% subjects had impaired fasting glucose (IFG) 30.5% had impaired glucose tolerance (IGT), 5.1% subjects had a combined IFG+IGT, and 9.8% had an isolated elevated HbA1c (5.7-6.4%). Of the 581 subjects with prediabetes, 257 had an HbA1c <5.7%. Therefore, 44.2% subjects would have been missed when OGTT would not have been done. CONCLUSION In a population with only overweight and obese adult subjects, 46.8% were diagnosed with prediabetes and 11.9% were newly diagnosed with diabetes. Exactly, 5.6 and 20.7% of total population met the diagnostic criteria of the OGTT for diabetes and prediabetes, respectively, but did not meet the diagnostic criteria of the HbA1c. These data suggest that not performing an OGTT results in significant underdiagnose of T2DM in an overweight and obese adult population.
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Albrecht SS, Mayer-Davis E, Popkin BM. Secular and race/ethnic trends in glycemic outcomes by BMI in US adults: The role of waist circumference. Diabetes Metab Res Rev 2017; 33. [PMID: 28198145 DOI: 10.1002/dmrr.2889] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 12/16/2016] [Accepted: 02/03/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND For the same body mass index (BMI) level, waist circumference (WC) is higher in more recent years. How this impacts diabetes and prediabetes prevalence in the United States and for different race/ethnic groups is unknown. We examined prevalence differences in diabetes and prediabetes by BMI over time, investigated whether estimates were attenuated after adjusting for waist circumference, and evaluated implications of these patterns on race/ethnic disparities in glycemic outcomes. METHODS Data came from 12 614 participants aged 20 to 74 years from the National Health and Nutrition Examination Surveys (1988-1994 and 2007-2012). We estimated prevalence differences in diabetes and prediabetes by BMI over time in multivariable models. Relevant interactions evaluated race/ethnic differences. RESULTS Among normal, overweight, and class I obese individuals, there were no significant differences in diabetes prevalence over time. However, among individuals with class II/III obesity, diabetes prevalence rose 7.6 percentage points in 2007-2012 vs 1988-1994. This estimate was partly attenuated after adjustment for mean waist circumference but not mean BMI. For prediabetes, prevalence was 10 to 13 percentage points higher over time at lower BMI values, with minimal attenuation after adjustment for WC. All patterns held within race/ethnic groups. Diabetes disparities among blacks and Mexican Americans relative to whites remained in both periods, regardless of BMI, and persisted after adjustment for WC. CONCLUSIONS Diabetes prevalence rose over time among individuals with class II/III obesity and may be partly due to increasing waist circumference. Anthropometric measures did not appear to account for temporal increases in prediabetes, nor did they attenuate race/ethnic disparities in diabetes. Reasons underlying these trends require further investigation.
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Affiliation(s)
- Sandra S Albrecht
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
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Brinks R, Hoyer A, Rolka DB, Kuss O, Gregg EW. Comparison of surveillance-based metrics for the assessment and monitoring of disease detection: simulation study about type 2 diabetes. BMC Med Res Methodol 2017; 17:54. [PMID: 28399821 PMCID: PMC5387346 DOI: 10.1186/s12874-017-0328-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/23/2017] [Indexed: 11/23/2022] Open
Abstract
Background Screening and detection of cases are a common public health priority for treatable chronic conditions with long subclinical periods. However, the validity of commonly-used metrics from surveillance systems for rates of detection (or case-finding) have not been evaluated. Methods Using data from a Danish diabetes register and a recently developed illness-death model of chronic diseases with subclinical conditions, we simulate two scenarios of different performance of case-finding. We report different epidemiological indices to assess case-finding in both scenarios and compare the validity of the results. Results The commonly used ratio of detected cases over total cases may lead to misleading conclusions. Instead, the ratio of undetected cases over persons without a diagnosis is a more valid index to distinguish the quality of case-finding. However, incidence-based measures are preferable to prevalence based indicators. Conclusion Prevalence-based indices for assessing case-finding should be interpreted with caution. If possible, incidence-based indices should be preferred. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0328-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ralph Brinks
- German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düsseldorf, 40225, Germany. .,University Hospital at the Heinrich-Heine-University Düesseldorf, Hiller Research Unit for Rheumatology, Moorenstrasse 5, Düsseldorf, 40225, Germany.
| | - Annika Hoyer
- German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düsseldorf, 40225, Germany
| | - Deborah B Rolka
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, USA
| | - Oliver Kuss
- German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düsseldorf, 40225, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Edward W Gregg
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, USA
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Zhang N, Yang X, Zhu X, Zhao B, Huang T, Ji Q. Type 2 diabetes mellitus unawareness, prevalence, trends and risk factors: National Health and Nutrition Examination Survey (NHANES) 1999-2010. J Int Med Res 2017; 45:594-609. [PMID: 28415936 PMCID: PMC5536674 DOI: 10.1177/0300060517693178] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/19/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives To determine whether the associations with key risk factors in patients with diagnosed and undiagnosed type 2 diabetes mellitus (T2DM) are different using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. Methods The study analysed the prevalence and association with risk factors of undiagnosed and diagnosed T2DM using a regression model and a multinomial logistic regression model. Data from the NHANES 1999-2010 were used for the analyses. Results The study analysed data from 10 570 individuals. The overall prevalence of diagnosed and undiagnosed T2DM increased significantly from 1999 to 2010. The prevalence of undiagnosed T2DM was significantly higher in non-Hispanic whites, in individuals <30 years old and in those with near optimal (130-159 mg/dl) or very high (≥220 mg/dl) non-high-density lipoprotein cholesterol levels compared with diagnosed T2DM. Body mass index, low economic status or low educational level had no effect on T2DM diagnosis rates. Though diagnosed T2DM was associated with favourable diet/carbohydrate intake behavioural changes, it had no effect on physical activity levels. Conclusion The overall T2DM prevalence increased between 1999 and 2010, particularly for undiagnosed T2DM in patients that were formerly classified as low risk.
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Affiliation(s)
- Nana Zhang
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China
| | - Xin Yang
- Department of Information Systems, Statistics, and Management Science, Culverhouse College of Commerce and Business Administration, The University of Alabama,Tuscaloosa, AL, USA
| | - Xiaolin Zhu
- MSD China Holding Company, Xuhui District, Shanghai, China
| | - Bin Zhao
- MSD China Holding Company, Xuhui District, Shanghai, China
| | - Tianyi Huang
- Department of Medicine, Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Qiuhe Ji
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China
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Allen AJ, Snowden JM, Lau B, Cheng Y, Caughey AB. Type-2 diabetes mellitus: does prenatal care affect outcomes? J Matern Fetal Neonatal Med 2017; 31:93-97. [DOI: 10.1080/14767058.2016.1276558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Allison J. Allen
- Department of Obstetrics and Gynecology, Oregon Health and Science University, OR, USA
| | - Jonathan M. Snowden
- Department of Obstetrics and Gynecology, Oregon Health and Science University, OR, USA
| | - Bernard Lau
- Department of Obstetrics and Gynecology, Oregon Health and Science University, OR, USA
| | - Yvonne Cheng
- Department of Obstetrics and Gynecology, California Pacific Medical Center, CA, USA
- Department of Surgery, University of California Davis, CA, USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, OR, USA
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Kwon Y, Kim HJ, Park S, Park YG, Cho KH. Body Mass Index-Related Mortality in Patients with Type 2 Diabetes and Heterogeneity in Obesity Paradox Studies: A Dose-Response Meta-Analysis. PLoS One 2017; 12:e0168247. [PMID: 28046128 PMCID: PMC5207428 DOI: 10.1371/journal.pone.0168247] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
Objective We conducted a systematic review and meta-analysis of studies to quantify the association between body mass index (BMI) and the risks of all-cause and cardiovascular mortality in patients with type 2 diabetes. Methods We included studies assessing the impact of BMI on all-cause and cardiovascular mortality in patients with type 2 diabetes. Data were combined using a random-effects dose-response model. Results Sixteen cohort studies on all-cause mortality (n = 445,125) and two studies on cardiovascular mortality (n = 92,841) were evaluated in the meta-analysis. A non-linear association was observed between BMI and all-cause mortality among patients with type 2 diabetes. With a BMI nadir of 28–30 kg/m2, the risk of all-cause mortality displayed a U-shaped increase. With a BMI nadir of 29–31 kg/m2, the risk of cardiovascular mortality exhibited a gradual non-linear increase for BMI > 31 kg/m2. Subgroup analyses suggested that study location, diabetes duration, and smoking history may have contributed to heterogeneity among the studies. Conclusions An obesity paradox exists for patients with type 2 diabetes with respect to all-cause and cardiovascular mortality. Study location, diabetes duration, and smoking history might contribute to heterogeneity among obesity paradox studies of patients with type 2 diabetes.
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Affiliation(s)
- Yeongkeun Kwon
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, The Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sungsoo Park
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Yong-Gyu Park
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
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Gu A, Yue Y, Desai RP, Argulian E. Racial and Ethnic Differences in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003166. [DOI: 10.1161/circoutcomes.116.003166] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/28/2016] [Indexed: 01/13/2023]
Abstract
Background—
A key to reduce and eradicate racial disparities in hypertension outcomes is to understand their causes. We aimed at evaluating racial differences in antihypertensive drug utilization patterns and blood pressure control by insurance status, age, sex, and presence of comorbidities.
Methods and Results—
A total of 8796 hypertensive individuals ≥18 years of age were identified from the National Health and Nutrition Examination Survey (2003–2012) in a repeated cross-sectional study. During the study period, all 3 racial groups (whites, blacks, and Hispanics) experienced substantial increase in hypertension treatment and control. The overall treatment rates were 73.9% (95% confidence interval [CI], 71.6%–76.2%), 70.8% (95% CI, 68.6%–73.0%), and 60.7% (95% CI, 57.0%–64.3%) and hypertension control rates were 42.9% (95% CI, 40.5%–45.2%), 36.9% (95% CI, 34.7%–39.2%), and 31.2% (95% CI, 28.6%–33.9%) for whites, blacks, and Hispanics, respectively. When stratified by insurance status, blacks (odds ratio, 0.74 [95% CI, 0.64–0.86] for insured and 0.59 [95% CI, 0.36–0.94] for uninsured) and Hispanics (odds ratio, 0.74 [95% CI, 0.60–0.91] for insured and 0.58 [95% CI, 0.36–0.94] for uninsured) persistently had lower rates of hypertension control compared with whites. Racial disparities also persisted in subgroups stratified by age (≥60 and <60 years of age) and presence of comorbidities but worsened among patients <60 years of age.
Conclusions—
Black and Hispanic patients had poorer hypertension control compared with whites, and these differences were more pronounced in younger and uninsured patients. Although black patients received more intensive antihypertensive therapy, Hispanics were undertreated. Future studies should further explore all aspects of these disparities to improve cardiovascular outcomes.
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Affiliation(s)
- Anna Gu
- From the Department of Pharmacy Administration and Public Health, St. John’s University, Queens, NY (A.G., R.P.D.); Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York (Y.Y.); and Division of Cardiology, Mt Sinai St. Luke’s Hospital, New York, NY (E.A.)
| | - Yu Yue
- From the Department of Pharmacy Administration and Public Health, St. John’s University, Queens, NY (A.G., R.P.D.); Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York (Y.Y.); and Division of Cardiology, Mt Sinai St. Luke’s Hospital, New York, NY (E.A.)
| | - Raj P. Desai
- From the Department of Pharmacy Administration and Public Health, St. John’s University, Queens, NY (A.G., R.P.D.); Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York (Y.Y.); and Division of Cardiology, Mt Sinai St. Luke’s Hospital, New York, NY (E.A.)
| | - Edgar Argulian
- From the Department of Pharmacy Administration and Public Health, St. John’s University, Queens, NY (A.G., R.P.D.); Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York (Y.Y.); and Division of Cardiology, Mt Sinai St. Luke’s Hospital, New York, NY (E.A.)
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