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Hafeez S, Shakil-Ur-Rehman S, Riaz S, Hafeez S, Hafeez JS, Mumtaz H. Consensus-Driven Development of an Exercise Base Manual Programme for Prediabetic Patients: A Delphi Study. J Multidiscip Healthc 2025; 18:2461-2476. [PMID: 40330602 PMCID: PMC12051977 DOI: 10.2147/jmdh.s503455] [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: 11/16/2024] [Accepted: 03/27/2025] [Indexed: 05/08/2025] Open
Abstract
Background Prediabetes is a medical condition characterized by increased levels of glucose in the bloodstream. There are some lifestyle modifications like exercise, dietary patterns and prevention that can reverse prediabetes. Exercise plays an important role in controlling hyperglycemia and insulin sensitivity in prediabetes. Purpose The objective of the study is to develop a consensus driven exercise base manual programme for the prediabetic population using the Delphi Method. Methods A three-rounded Delphi study was conducted with 40 panelists either as Patient panelists (n = 20) or expert panelists (n=20). Round 1 included initial items selected from a systemic literature review . Initial recommendations were rated by panalists through a 5-point Likert scale. Additional items were also added by suggestion of Panelists in Round 1. Rounds 2 and 3 included all items from Round 1. All selected items were included in the final set of recommendations in Round 3 and rated as "Important" or "Very important" by at least 70% of all respondents. Descriptive data was analyzed by using SPSS version 25. Results 36 panellists (patients n = 17, professionals n = 19) completed Round 3. After three rounds of the Delphi process, panelists reached a consensus on the final version of the recommendations. Sixty-two items reached consensus in Round 1. In round 2 and 3 a total of sixty-four and sixty-three items were added, respectively. Fifty-seven of these reached consensuses in round 3. Conclusion The exercise-based manual programme developed by Modified Delphi study provided disease prevention education, physical activity and dietary recommendations to improve glycemic control in the prediabetic population. The exercise manual programme along with lifestyle modifications contribute to public health by improving prediabetes levels and also addressing the modifiable risk factors. An exercise protocol needs time to mitigate hyperglycemia in prediabetic individuals and to help provide information at community level.
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Affiliation(s)
- Sana Hafeez
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, 54000, Pakistan
- Department of Physical Therapy and Rehabilitation Sciences, University of Management and Technology, Lahore, 54000, Pakistan
| | - Syed Shakil-Ur-Rehman
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, 54000, Pakistan
| | - Saima Riaz
- Ayesha Bakht Institute of Medical Sciences, Lahore, 54000, Pakistan
| | - Sidra Hafeez
- Department of Obstetrics and Gynecology, Services Hospital, Lahore, 54000, Pakistan
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Kong X, Wang W. Prediabetes Phenotypes and All-Cause or Cardiovascular Mortality: Evidence From a Population-Based Study. Endocr Pract 2025; 31:486-493. [PMID: 39837477 DOI: 10.1016/j.eprac.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 01/07/2025] [Accepted: 01/13/2025] [Indexed: 01/23/2025]
Abstract
OBJECTIVE Fasting plasma glucose (FPG), glycated hemoglobin A1C (HbA1C), and 2-hour postload plasma glucose (2h PG) are all currently used to define prediabetes. We aimed to determine whether a higher number of prediabetes defects correspond to an increased all-cause and cardiovascular disease (CVD) mortality. METHODS Individuals with prediabetes and available information on FPG, HbA1C, 2h PG, and mortality data were derived from the 2005-2016 National Health and Nutrition Examination Survey. Kaplan-Meier survival curves, Cox proportional hazards regression analysis, and stratified analysis were used to compare all-cause and CVD mortality among participants with one, two, and all three defects. RESULTS Among the 4511 individuals included, 76.31%, 30.89%, and 41.65% met the FPG-, 2h PG-, and HbA1C-defined criteria for prediabetes, respectively. There were 2609 (60.78%), 1420 (29.60%), and 482 (9.62%) adults meeting one, two, and all three criteria for prediabetes, respectively. During a median follow-up of 100 months, a total of 534 (180 CVD-related) deaths occurred. The multivariable-adjusted hazard ratios and 95% confidence intervals in those meeting two and three criteria were 1.341 (1.042-1.727) and 1.369 (1.027-1.824), respectively, for all-cause mortality (P for trend = 0.006), and 1.836 (1.228-2.744) and 2.037 (1.092-3.801), respectively, for CVD mortality (P for trend = 0.002), with those meeting only one criterion as the reference. In subgroup analysis, the association between the number of diagnostic criteria for prediabetes and CVD mortality was observed only in men. CONCLUSIONS A higher number of diagnostic criteria for prediabetes was associated with increased all-cause and CVD mortality.
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Affiliation(s)
- Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Nephrology, Shanghai Tenth People's Hospital, Shanghai, China.
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Ortz CL, Duncan MS, Leshi O, Burrows WB, Smalls BL. Influence of perceived health provider communication, diabetes duration and age at diagnosis with confidence in diabetes self-care. BMJ Open Diabetes Res Care 2025; 13:e004645. [PMID: 40169275 PMCID: PMC11962801 DOI: 10.1136/bmjdrc-2024-004645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 02/25/2025] [Indexed: 04/03/2025] Open
Abstract
INTRODUCTION Several factors influence individuals' confidence to perform diabetes-related self-care activities, including perceived patient-provider communication, diabetes duration and age at diagnosis. It has been well-documented that patient-provider communication is essential when managing chronic diseases such as diabetes; however, the impact of this communication with diabetes duration and age at diabetes diagnosis on confidence in performing self-care behaviors is obscure. RESEARCH DESIGN AND METHODS We utilized data from the 2021 Household Component of the Medical Expenditure Survey among participants 18 years or older who had completed the Diabetes Care Survey. Ordinal logistic regression models were utilized to assess the association between confidence in performing diabetes self-care (outcome) and perceived communication with healthcare providers (exposure). Age at diabetes diagnosis and diabetes duration were secondary exposures of interest. RESULTS 1231 participants were included in the analyses. In primary analyses, we observed that greater perceived healthcare provider communication resulted in greater confidence in diabetes self-care (OR (95% CI) 1.14 (1.08, 1.21)). Results also showed that patients who were diagnosed at older ages have less confidence in managing their diabetes than patients diagnosed at younger ages (OR (95% CI) 0.93 (0.88, 0.99)); correspondingly, longer diabetes duration was associated with greater confidence in diabetes self-care (OR (95% CI) 1.09 (1.01, 1.17)). CONCLUSIONS Confidence in self-care is greatly influenced by perceptions of patient-provider communication, age at diagnosis and diabetes duration. Specifically, having healthcare providers clearly explain things to patients is vital to increasing diabetes self-care. Because self-care is important when managing chronic diseases such as diabetes, future studies should tailor interventions for optimal outcomes.
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Affiliation(s)
- Courtney L Ortz
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Meredith S Duncan
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Oluwatosin Leshi
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - William B Burrows
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky, USA
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Brittany L Smalls
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Kim C, Park DH, Lee Y, Kim EC, Oh CG, Lee DH, Jeon JY. Meeting physical activity and resistance exercise guidelines associated with significantly reduced prevalence of diabetes in older adults. Age Ageing 2025; 54:afaf109. [PMID: 40285346 DOI: 10.1093/ageing/afaf109] [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: 07/05/2024] [Revised: 12/09/2024] [Accepted: 04/03/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND The global prevalence of diabetes is rising. Lack of physical activity is a known risk factor, and older adults with diabetes face a higher risk of complications compared to other age groups. Additionally, the risk of mortality increases with longer duration of diabetes. OBJECTIVE This study aimed to investigate how meeting physical activity guidelines is associated with diabetes prevalence in older adults. METHODS We analysed data from 5679 men and women (aged ≥65 years) who participated in the Korea National Health and Nutrition Examination Survey (2016-19). Physical activity levels were measured using the Global Physical Activity Questionnaire, including an assessment of weekly resistance exercise duration. Multivariable adjusted logistic regression analysis was conducted to examine the association between meeting leisure-time physical activity and resistance exercise guidelines with diabetes prevalence. RESULTS Meeting either the leisure-time physical activity guideline [odds ratio (OR): 0.72, 95% confidence interval (CI): 0.58-0.88] or the resistance exercise guideline (OR: 0.69, 95% CI: 0.59-0.80) was associated with a lower prevalence of diabetes. Notably, participants who met both guidelines had a 37% lower risk of diabetes (95% CI: 0.47-0.84) compared to those who met none. CONCLUSIONS Adherence to physical activity guidelines, especially leisure-time physical activity and resistance exercise, is associated with a reduced prevalence of diabetes in older adults. Meeting both sets of guidelines may significantly lower the risk of diabetes compared to not meeting any. These findings highlight the crucial role of regular physical activity in preventing diabetes amongst older individuals, with the potential for a significant public health impact.
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Affiliation(s)
- Chiho Kim
- Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Dong-Hyuk Park
- Center for Exercise medicine and Salutogenesis, Institute of Convergence of Science (ICONS), Yousei university, Seoul, Repulic of Korea
| | - YongJun Lee
- Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Eun Chan Kim
- Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Chang-Geun Oh
- Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Dong Hoon Lee
- Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
- Center for Exercise medicine and Salutogenesis, Institute of Convergence of Science (ICONS), Yousei university, Seoul, Repulic of Korea
| | - Justin Y Jeon
- Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
- Center for Exercise medicine and Salutogenesis, Institute of Convergence of Science (ICONS), Yousei university, Seoul, Repulic of Korea
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Huang X, Hu L, Li J, Wang X. U-shaped association of uric acid to HDL cholesterol ratio (UHR) with ALL-cause and cardiovascular mortality in diabetic patients: NHANES 1999-2018. BMC Cardiovasc Disord 2024; 24:744. [PMID: 39725874 DOI: 10.1186/s12872-024-04436-3] [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: 08/07/2024] [Accepted: 12/18/2024] [Indexed: 12/28/2024] Open
Abstract
OBJECTIVE To investigate the relationship between the uric acid to high-density lipoprotein cholesterol ratio (UHR) and ALL-cause and cardiovascular mortality among diabetic patients. METHODS This study utilized health data from diabetic patients included in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The Kaplan-Meier curves was employed to preliminarily explore the association between UHR, its components, and all-cause and cardiovascular mortality in diabetic patients, as well as to analyze UHR levels and mortality across different genders. Subsequently, the Cox proportional hazards model was used to further investigate the relationship between UHR, its components, and mortality in diabetic patients. Restricted cubic spline (RCS) curves were applied to examine the nonlinear relationship between UHR, its components, and mortality, with a particular focus on the association between UHR and mortality across different genders. RESULTS This longitudinal cohort study included a total of 6,370 participants, comprising 3,268 males and 3,102 females. Kaplan-Meier analysis revealed a positive correlation between UHR, UA, and mortality in diabetic patients, while the association between HDL and mortality was negligible. The Cox proportional hazards model demonstrated a positive association between UHR and mortality in the diabetic population, while the statistical effects of UA and HDL on mortality were less pronounced compared to UHR. When analyzed by gender, no significant linear relationship was observed between UHR and mortality in either males or females. Subsequently, RCS analysis indicated a U-shaped nonlinear relationship between UHR and mortality in the overall diabetic population and among female patients, with a similar trend observed in males. Furthermore, stratified RCS analysis confirmed the persistence of the U-shaped relationship between UHR and prognosis across most subgroups. CONCLUSION This study found a U-shaped relationship between UHR and both ALL-cause and cardiovascular mortality in diabetic population. This suggests that clinicians should control UHR around 9-10 to improve the long-term prognosis of diabetic patients.
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Affiliation(s)
- Xuanchun Huang
- Guang'anmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Lanshuo Hu
- Xiyuan Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Jun Li
- Guang'anmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China.
| | - Xuejiao Wang
- Guang'anmen Hospital, China Academy of Traditional Chinese Medicine, Beijing, China.
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Gao Q, Wang Q, Gan Z, Wang M, Lu D, Zhan B. Fasting plasma glucose levels are associated with all-cause and cancer mortality: A population-based retrospective cohort study. PLoS One 2024; 19:e0311150. [PMID: 39561141 PMCID: PMC11575760 DOI: 10.1371/journal.pone.0311150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 09/13/2024] [Indexed: 11/21/2024] Open
Abstract
Despite a growing body of research indicating a link between fasting glucose levels and mortality, the relationship between fasting glucose and all-cause and cancer mortality remains inconsistent. In this study, we used Cox regression and restricted cubic spline models to analyze the association and dose-response relationship between fasting plasma glucose levels and all-cause and cancer mortality in a retrospective cohort based on data from the 2015 health check-ups of residents in Quzhou City. After a mean follow-up of 5.31 years for 148,755 study participants, 10,345 deaths occurred, with an all-cause mortality density of 131.09/10,000 person-years, of which 2,845 were cancer deaths, with a cancer mortality density of 36.05/10,000 person-years. There was a "J" shaped dose-response relationship between fasting plasma glucose levels and all-cause and cancer mortality. Relative to normal fasting glucose (NFG), the risk of all-cause mortality (HRs and 95% CIs) in the impaired fasting glucose (IFG) and diabetes mellitus (DM) groups was 1.11 (1.06, 1.16) and 1.43 (1.35, 1.52), respectively, and the risk of cancer mortality in the DM group was 1.22 (1.09, 1.37). In this cohort study, we found that fasting plasma glucose levels were significantly associated with the risk of all-cause and cancer mortality.
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Affiliation(s)
- Qing Gao
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Qi Wang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Zhijuan Gan
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang Province, China
| | - Meng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Dafeng Lu
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang Province, China
| | - Bingdong Zhan
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang Province, China
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Tretyakova E, Heise NV, Csuk R, Kazakova O. Inhibitory properties of quinopimaric acid derivatives towards cholinesterases. Nat Prod Res 2024; 38:3893-3901. [PMID: 37812150 DOI: 10.1080/14786419.2023.2266107] [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: 05/03/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
A series of new diterpene quinopimaric acid derivatives modified at the hydroxyl group with different pharmacophore fragments has been synthesised and their (along with previously obtained compounds) inhibitory properties towards cholinesterases were studied. Thereby an indole-3-acetyl derivative 7 and a propargyl substituted compound 28 were shown to be excellent and acetylcholinesterase-selective inhibitors. Both compounds inhibited the enzyme as a mixed type inhibitor, and Ki values of 0.41 and 0.44 µM and Ki' values of 0.98 and 2.26 µM were determined. The binding interactions between all active compounds and ligands protein were confirmed through molecular docking study.
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Affiliation(s)
- Elena Tretyakova
- Ufa Institute of Chemistry of the Ufa Federal Research Centre of the Russian Academy of Sciences, Ufa, Russian Federation
| | - Niels V Heise
- Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - René Csuk
- Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Oxana Kazakova
- Ufa Institute of Chemistry of the Ufa Federal Research Centre of the Russian Academy of Sciences, Ufa, Russian Federation
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Tian Y, Qiu Z, Wang F, Deng S, Wang Y, Wang Z, Yin P, Huo Y, Zhou M, Liu G, Huang K. Associations of Diabetes and Prediabetes With Mortality and Life Expectancy in China: A National Study. Diabetes Care 2024; 47:1969-1977. [PMID: 39255435 DOI: 10.2337/dca24-0012] [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: 03/07/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE To investigate the excess mortality and life-years lost associated with diabetes and prediabetes in China. RESEARCH DESIGN AND METHODS This national cohort study enrolled 135,405 participants aged 18 years or older from the general population in China. Cox proportional hazards regression models were used to estimate adjusted mortality rate ratio (RR). The life table method was used to estimate life expectancy. RESULTS Among the 135,405 participants, 10.5% had diabetes and 36.2% had prediabetes in 2013. During a median follow-up of 6 years, 5517 deaths were recorded, including 1428 and 2300 deaths among people with diabetes and prediabetes, respectively. Diabetes and prediabetes were significantly associated with increased risk of all-cause (diabetes: RR, 1.61 [95% CI 1.49, 1.73]; prediabetes: RR, 1.08 [95% CI 1.01, 1.15]), and cardiovascular disease (diabetes: RR, 1.59 [95% CI 1.41, 1.78]; prediabetes: RR, 1.10 [95% CI 1.00, 1.21]) mortality. Additionally, diabetes was significantly associated with increased risks of death resulting from cancer, respiratory disease, liver disease, and diabetic ketoacidosis or coma. Compared with participants with normoglycemia, life expectancy of those with diabetes and prediabetes was shorter, on average, by 4.2 and 0.7 years at age 40 years, respectively. The magnitude of the associations of diabetes and prediabetes with all-cause and cardiovascular disease mortality varied by age and residence. CONCLUSIONS In this national study, diabetes and prediabetes were significantly associated with reduced life expectancy and increased all-cause and cause-specific mortality risks. The disparities in excess mortality associated with diabetes and prediabetes between different ages and residences have implications for diabetes and prediabetes prevention and treatment programs.
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Affiliation(s)
- Yunli Tian
- Department of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zixin Qiu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feixue Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shan Deng
- Department of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Wang
- Department of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zi Wang
- Liyuan Cardiovascular Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Prevention and Therapeutic Center for Cardiovascular Diseases, Wuhan, Hubei, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China; Hypertension Precision Diagnosis and Treatment Research Center, Peking University First Hospital, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Huang
- Department of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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Rico Fontalvo J, Soler MJ, Daza Arnedo R, Navarro-Blackaller G, Medina-González R, Rodríguez Yánez T, Cardona-Blanco M, Cabrales-Juan J, Uparrela-Gulfo I, Chávez-Iñiguez JS. Prediabetes and CKD: Does a causal relationship exist. Nefrologia 2024; 44:628-638. [PMID: 39547776 DOI: 10.1016/j.nefroe.2024.11.005] [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: 04/28/2024] [Accepted: 06/17/2024] [Indexed: 11/17/2024] Open
Abstract
The relationship between diabetes and the development of kidney complications is well known, but the understanding of prediabetes and insulin resistance with impaired kidney function has been scarcely assessed. Various factors could explain this phenomenon, from the lack of standardization in the definitions of prediabetes, to the erratic and inconsistent evidence in large-scale epidemiological and cohort studies. It seems that the pathophysiological pathway of prediabetes could be related to inflammation and neurohormonal hyperactivation, factors present even before the onset of diabetes, which might be the main drivers of glomerular hyperfiltration, albuminuria, and impaired glomerular filtration rate. It is possible that existing treatments for the management of diabetes, as metformin or SGLT2 inhibitors may also be useful in patients with prediabetes with evidence of functional and structural kidney damage. The purpose of this review is to summarize the evidence regarding the relationship between prediabetes (preDM) and the development of CKD.
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Affiliation(s)
- Jorge Rico Fontalvo
- Asociación Colombiana de Nefrología e HTA, Bogotá, Colombia; Facultad de Medicina, Departamento de Nefrología, Universidad Simón Bolívar, Barranquilla, Colombia.
| | - María José Soler
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain.
| | | | - Guillermo Navarro-Blackaller
- Servicio de Nefrología Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
| | - Ramón Medina-González
- Servicio de Nefrología Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
| | - Tomas Rodríguez Yánez
- Facultad de Medicina, Departamento de Medicina Interna, Universidad de Cartagena, Cartagena, Colombia
| | | | | | | | - Jonathan S Chávez-Iñiguez
- Servicio de Nefrología Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico.
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Li K, Yang L, Zhao D. The relationship between HbA1c control pattern and atherosclerosis progression of diabetes: a prospective study of Chinese population. Diabetol Metab Syndr 2024; 16:127. [PMID: 38858794 PMCID: PMC11163799 DOI: 10.1186/s13098-024-01370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND This study aims to comprehensively explain of glycosylated Hemoglobin (HbA1c) control patterns and help determine the causal relationship between glycemic control patterns and atherosclerosis progression, thereby contributing to the effective management of diabetes complications. METHOD All participants registered at the National Metabolic Management Center (MMC) of Beijing Luhe Hospital. The HbA1c pattern was described by HbA1c variability and trajectory groups of HbA1c. Then we examined the associations between the HbA1c pattern and the changes of intima-media thickness (ΔIMT) using covariate-adjusted means (SE) of ΔIMT, which were calculated by multiple linear regression analyses adjusted for the covariates. Finally, a cross-lagged panel model (CLPM) was performed to further verify the bidirectional relationship between IMT and HbA1c. RESULTS After data cleaning, a total of 1041 type 2 diabetes patients aged 20-80 years were included in this study. Except for average real variability (ARV), the other variation variables of HbA1c were associated with ΔIMT% (P < 0.05). Four discrete trajectories of HbA1c were identified in trajectory analysis. Comparing with the low-stable trajectory group of HbA1c, the covariate-adjusted means (SE) of ΔIMT% were significantly higher in Moderate-increase, U-shape and relative high trajectory groups, the mean (SE) were 7.03 (0.031), 15.49 (0.185), 14.15 (0.029), respectively. Meanwhile, there were significant bidirectional cross-lagged associations between HbA1c and IMT after adjusting for covariates. CONCLUSION We found four discrete trajectory groups of HbA1c during the long-term follow-up of diabetes. There was a positive association between HbA1c variability and the progression of atherosclerosis. Our study suggested that patients with diabetes should avoid roller coaster changes in glucose over a long period when controlling blood glucose.
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Affiliation(s)
- Kun Li
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
- Beijing Key Laboratory of Diabetes Research and Care, No.82, Xinhua South Road, Beijing, 101149, China
| | - Longyan Yang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China.
- Beijing Key Laboratory of Diabetes Research and Care, No.82, Xinhua South Road, Beijing, 101149, China.
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China.
- Beijing Key Laboratory of Diabetes Research and Care, No.82, Xinhua South Road, Beijing, 101149, China.
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Barron E, Sharp SJ, Khunti K, Bakhai C, Wareham NJ, Valabhji J. Prediabetes, participation in the English National Health Service Diabetes Prevention Programme, and associations with COVID-19-related mortality: A whole population study. Diabetes Res Clin Pract 2024; 212:111692. [PMID: 38723673 DOI: 10.1016/j.diabres.2024.111692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
AIMS To assess the effects of non-diabetic hyperglycaemia (NDH, also known as pre-diabetes), including the impact of the NHS Diabetes Prevention Programme (NHS DPP), on COVID-19-related mortality during the pandemic. METHODS This study included all 61,438,225 individuals registered with General Practices in England and alive on 1st March 2020. We assessed COVID-19-related mortality in the 2,290,280(3.7 %) individuals with diagnosed NDH between March 2020 and February 2022 compared to those without diagnosed NDH or diabetes using Cox regression to adjust for demographic factors and cardiovascular comorbidities. Individuals with diagnosed NDH were further sub-categorised based on their contact with the NHS DPP (N = 376,590). Analyses were stratified by age (years) (<50, 50-69 and ≥ 70). RESULTS There were 158,070 COVID-19 deaths; 17,280(11 %) for people with diagnosed NDH. The adjusted hazard ratio (HR) was 0.95(0.93-0.96),p < 0.001 for those with diagnosed NDH compared to those without diagnosed diabetes or NDH. By age (years), HRs were, 2.53(2.23-2.88),p < 0.001 for < 50, 1.29(1.24-1.35),p < 0.001 for 50-69 and 0.87(0.85-0.89),p < 0.001 for ≥ 70. NHS DPP attendance was associated with lower COVID-19 mortality with a dose-response relationship with engagement. CONCLUSIONS Younger people with diagnosed NDH were at higher relative risk of COVID-19 mortality. Attendance at the NHS DPP was associated with significantly lower COVID-19-related mortality.
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Affiliation(s)
- Emma Barron
- NHS England, Wellington House, 122-135 Waterloo Road, London SE1 8UG, UK; Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington, London; Chelsea and Westminster hospital NHS Foundation Trust, London, UK.
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Chirag Bakhai
- NHS England, Wellington House, 122-135 Waterloo Road, London SE1 8UG, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jonathan Valabhji
- NHS England, Wellington House, 122-135 Waterloo Road, London SE1 8UG, UK; Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington, London; Chelsea and Westminster hospital NHS Foundation Trust, London, UK
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12
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Zhao LZ, Li WM, Ma Y. Prevalence and risk factors of diabetes mellitus among elderly patients in the Lugu community. World J Diabetes 2024; 15:638-644. [PMID: 38680701 PMCID: PMC11045422 DOI: 10.4239/wjd.v15.i4.638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/29/2024] [Accepted: 02/27/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Age is a significant risk factor of diabetes mellitus (DM). With the develop of population aging, the incidence of DM remains increasing. Understanding the epidemiology of DM among elderly individuals in a certain area contributes to the DM interventions for the local elderly individuals with high risk of DM. AIM To explore the prevalence of DM among elderly individuals in the Lugu community and analyze the related risk factors to provide a valid scientific basis for the health management of elderly individuals. METHODS A total of 4816 elderly people who came to the community for physical examination were retrospectively analyzed. The prevalence of DM among the elderly was calculated. The individuals were divided into a DM group and a non-DM group according to the diagnosis of DM to compare the differences in diastolic blood pressure (DBP) and systolic blood pressure (SBP), fasting blood glucose, body mass index (BMI), waist-to-hip ratio (WHR) and incidence of hypertension (HT), coronary heart disease (CHD), and chronic kidney disease (CKD). RESULTS DM was diagnosed in 32.70% of the 4816 elderly people. The BMI of the DM group (25.16 ± 3.35) was greater than that of the non-DM group (24.61 ± 3.78). The WHR was 0.90 ± 0.04 in the non-DM group and 0.90 ± 0.03 in the DM group, with no significant difference. The left SBP and SBP in the DM group were 137.9 mmHg ± 11.92 mmHg and 69.95 mmHg ± 7.75 mmHg, respectively, while they were 126.6 mmHg ± 12.44 mmHg and 71.15 mmHg ± 12.55 mmHg, respectively, in the non-DM group. These findings indicate higher SBP and lower DBP in DM patients than in those without DM. In the DM group, 1274 patients were diagnosed with HT, accounting for 80.89%. Among the 3241 non-DM patients, 1743 (53.78%) were hypertensive and 1498 (46.22%) were nonhypertensive. The DM group had more cases of HT than did the non-DM group. There were more patients with CHD or CKD in the DM group than in the non-DM group. There were more patients who drank alcohol more frequently (≥ 3 times) in the DM group than in the non-DM group. CONCLUSION Older adults in the Lugu community are at a greater risk of DM. In elderly individuals, DM is closely related to high BMI and HT, CHD, and CKD. Physical examinations should be actively carried out for elderly people to determine their BMI, SBP, DBP, and other signs, and sufficient attention should be given to abnormalities in the above signs before further diagnosis.
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Affiliation(s)
- Li-Zhen Zhao
- Lugu Community Health Service Center, West Campus Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Wei-Min Li
- Lugu Community Health Service Center, West Campus Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Ying Ma
- Lugu Community Health Service Center, West Campus Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100043, China
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13
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Sasaki N, Maeda R, Ozono R, Yoshimura K, Nakano Y, Higashi Y. Differences in the impact of newly diagnosed type 2 diabetes on cardiovascular mortality between normotensive and hypertensive individuals. J Hypertens 2024; 42:610-619. [PMID: 38441184 DOI: 10.1097/hjh.0000000000003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE We investigated the interrelationship between hyperglycemia and hypertension on cardiovascular mortality in the middle-aged and elderly people. METHODS In this retrospective cohort study that used data from the Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases, we included 16,564 participants without cardiovascular disease (mean age: 65.8 years; 6179 normoglycemic people, 3017 people with newly diagnosed type 2 diabetes, and 7368 people with prediabetes per the 75-g oral glucose tolerance test). Hypertension was defined as the use of antihypertensive medications and/or having a systolic/diastolic blood pressure of at least 140/90 mm Hg. RESULTS During a median follow-up period of 12.4 years, a total of 1513 cardiovascular death occurred. Cardiovascular death rates per 1000 participant-years were 4.01, 4.98, 8.33, 8.22, 8.81, and 11.1 among normotensive participants with normal glycemia, prediabetes, and diabetes and hypertensive participants with normal glycemia, prediabetes, and diabetes, respectively. Prediabetes was significantly associated with a high risk of cardiovascular mortality in normotensive individuals [hazard ratio: 1.24, 95% confidence interval (95% CI): 1.02-1.50] but not in hypertensive individuals. Type 2 diabetes was associated with a high risk of cardiovascular mortality in both normotensive (hazard ratio: 1.94, 95% CI: 1.55-2.43) and hypertensive individuals (hazard ratio: 1.35, 95% CI: 1.13-1.62). Stratified analyses revealed no significant impact of type 2 diabetes on cardiovascular mortality in hypertensive individuals aged at least 65 years. CONCLUSION The effect of hyperglycemia on cardiovascular death differed with age and the presence or absence of hypertension, demonstrating the clinical importance of case-specific risk assessments.
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Affiliation(s)
- Nobuo Sasaki
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Ryo Maeda
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
| | - Ryoji Ozono
- Department of General Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kenichi Yoshimura
- Department of Biostatistics, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukihito Higashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
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14
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Siddiqui ZS, Xiao Y, Ansong PO, Muthu SS, Sony A, Doghouz S, Godavarthi A. A 22-Year Study to Assess Disparities in Place of Death Among Patients With Diabetes. Cureus 2023; 15:e49929. [PMID: 38179373 PMCID: PMC10764296 DOI: 10.7759/cureus.49929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Background This study examines disparities in the place of death in patients in the United States with diabetes mellitus (DM) using data from the CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) database covering a 22-year period (1999-2020). Looking at age, gender, ethnicity, and census location, among other variables, the study aims to understand trends and determinants of mortality at home or hospice care compared to mortality at a medical or nursing facilities. Materials and methods An online freely accessible mortality database, CDC WONDER database, was used to collect information regarding DM-related mortality, using the International Classification of Diseases, 11th Revision (ICD-11) code range E10-E14. To investigate patterns in location of death, the research population was split by census regions, racial categories, age groups, and gender. Statistical techniques such as univariate logistic regression and graphical representations were employed. Results Based on a study of 1,674,724 DM-related deaths, medical or nursing facilities recorded higher deaths (1,041,602) compared to home or hospice deaths (572,567). The highest number of deaths in home or hospice setting was recorded for the age group of 75-84 years (146,820), male gender (324,325), Census Region 3 (South) (225,636), and white race (458,690). Among the patients with death at home or a hospice center; the odds were highest for the age group of 55-64 years, male gender, Census Region 4 (West), and American Indian or Alaska Native race. Discussion The results showed a general upward trend in DM patients' deaths at home and in hospice care in the United States. Males, white people, and those in the age group of 75-84 years notably had the highest death rates. Regional differences also came into play, with the South showing the biggest trend in mortality. To better understand the underlying causes of these changes and to increase at-risk groups' access to healthcare facilities, more research is required. Conclusion There is an overall rising trend in home and hospice deaths in the United States for patients with DM, but with a steady dip between the years 2005 and 2010. Patient deaths from DM were categorized by age groups, gender, race, and census regions. The highest mortality trends are exhibited in whites, males, and those aged 75-84 years. Out of the census regions, the South has the highest mortality trend. Further studies could be carried out to determine the reasons for the rising trends in home or hospice deaths in the aforementioned groups and how to provide these groups with better access to healthcare facilities.
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Affiliation(s)
- Zuhair S Siddiqui
- Internal Medicine, Medical School, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Yingxia Xiao
- Medicine, King Edward Medical University, Lahore, Lahore, PAK
| | - Prince O Ansong
- Internal Medicine, School of Medicine, University of Cape Coast, Cape Coast, GHA
| | | | - Angelina Sony
- Family Medicine, Christian Medical College, Vellore, Vellore, IND
- Internal Medicine, K. S. Hegde Medical Academy, Mangalore, IND
| | - Shan Doghouz
- Internal Medicine, First Faculty of Medicine, Charles University, Prague, CZE
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Karra P, Hardikar S, Winn M, Anderson GL, Haaland B, Krick B, Thomson CA, Shadyab A, Luo J, Saquib N, Strickler HD, Chlebowski R, Arthur RS, Summers SA, Holland WL, Jalili T, Playdon MC. New-Onset Diabetes after an Obesity-Related Cancer Diagnosis and Survival Outcomes in the Women's Health Initiative. Cancer Epidemiol Biomarkers Prev 2023; 32:1356-1364. [PMID: 37590895 PMCID: PMC11002976 DOI: 10.1158/1055-9965.epi-23-0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Individuals diagnosed with an obesity-related cancer (ORC survivors) are at an elevated risk of incident diabetes compared with cancer-free individuals, but whether this confers survival disadvantage is unknown. METHODS We assessed the rate of incident diabetes in ORC survivors and evaluated the association of incident diabetes with all-cause and cancer-specific mortality among females with ORC in the Women's Health Initiative cohort (N = 14,651). Cox proportional hazards regression models stratified by exposure-risk periods (0-1, >1-3, >3-5, >5-7, and >7-10 years) from ORC diagnosis and time-varying exposure (diabetes) analyses were performed. RESULTS Among the ORC survivors, a total of 1.3% developed diabetes within ≤1 year of follow-up and 2.5%, 2.3%, 2.3%, and 3.6% at 1-3, 3-5, 5-7, and 7-10 years of follow-up, respectively, after an ORC diagnosis. The median survival for those diagnosed with diabetes within 1-year of cancer diagnosis and those with no diabetes diagnosis in that time frame was 8.8 [95% confidence interval (CI), 7.0-14.5) years and 16.6 (95% CI, 16.1-17.0) years, respectively. New-onset compared with no diabetes as a time-varying exposure was associated with higher risk of all-cause (HR, 1.27; 95% CI, 1.16-1.40) and cancer-specific (HR, 1.17; 95% CI, 0.99-1.38) mortality. When stratified by exposure-risk periods, incident diabetes in ≤1 year of follow-up was associated with higher all-cause (HR, 1.76; 95% CI, 1.40-2.20) and cancer-specific (HR0-1, 1.82; 95% CI, 1.28-2.57) mortality, compared with no diabetes diagnosis. CONCLUSIONS Incident diabetes was associated with worse cancer-specific and all-cause survival, particularly in the year after cancer diagnosis. IMPACT These findings draw attention to the importance of diabetes prevention efforts among cancer survivors to improve survival outcomes.
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Affiliation(s)
- Prasoona Karra
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - Sheetal Hardikar
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Maci Winn
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | | | - Benjamin Haaland
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Benjamin Krick
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Aladdin Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Juhua Luo
- Indiana University, Bloomington, Indiana
| | - Nazmus Saquib
- Sulaiman AlRajhi University, Kingdom of Saudi Arabia, Al Bukayriyah, Saudi Arabia
| | | | | | | | - Scott A. Summers
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - William L. Holland
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Thunder Jalili
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Mary C. Playdon
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
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16
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Golding J, Hope SV, Chakera AJ, Puttanna A. The evolving continuum of dysglycaemia: Non-diabetic hyperglycaemia in older adults. Diabet Med 2023; 40:e15177. [PMID: 37452769 DOI: 10.1111/dme.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Identifying non-diabetic hyperglycaemia (NDH) and intervening to halt the progression to type 2 diabetes has become an essential component of cardiovascular and cerebrovascular risk reduction. Diabetes prevention programs have been instigated to address the increasing prevalence of NDH and type 2 diabetes by targeting lifestyle modifications. Evidence suggests that the risk of progression from NDH to type 2 diabetes declines with age, and that a diagnosis of type 2 diabetes in older adults is not associated with the same risk of adverse consequences as it is in younger age groups. The current definition of NDH is not adjusted based on a person's age. Therefore, there is debate about the emphasis that should be placed upon a diagnosis of NDH in older adults. This article will explore the evidence and current clinical practice surrounding dysglycaemia through the spectrum of different age ranges, and the potential implications this has for older adults.
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Affiliation(s)
- J Golding
- Department of Diabetes and Endocrinology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - S V Hope
- College of Medicine and Health, University of Exeter, Exeter, UK
- Department of Healthcare for Older People, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - A J Chakera
- Department of Diabetes and Endocrinology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - A Puttanna
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Kashyap SR, Desouza C, Aroda VR, Kim SH, Neff LM, Wu SS, Raskin P, Pratley R. Glycemic and metabolic sub-classification of prediabetes and risk factors for cardiovascular disease in the D2d cohort. Am J Prev Cardiol 2023; 15:100525. [PMID: 37650052 PMCID: PMC10462804 DOI: 10.1016/j.ajpc.2023.100525] [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: 08/17/2022] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives Prediabetes represents a spectrum of metabolic abnormalities, including insulin resistance and secretory impairment, that carries increased cardiovascular disease (CVD) risk. It is unclear whether specific glycemic and metabolic sub-classifications are associated with CVD risk. This cross-sectional analysis of 3946 participants from the Vitamin D and Type 2 Diabetes (D2d) study cohort aimed to determine the associations between various baseline CVD risk factors, glycemic sub-classifications of prediabetes (FPG, 2hPG, and HbA1c), and measures of insulin sensitivity and secretion from an OGTT. Methods The metabolic syndrome and atherosclerotic cardiovascular disease (ASCVD) risk scores were determined for tertiles of insulin sensitivity (HOMA2S) and insulinogenic index (IGI). Unadjusted analyses showed elevated CVD risk factors in the lowest tertile for both IGI and HOMA2S. Results After adjustment for age, gender, race, obesity, and smoking status, the association remained between HOMA2S and ASCVD score (r = -0.11, p< 0.001) but not for IGI. Those who met at least 2 diagnosic criteria for prediabetes had the largest proportion (> 40%) of participants with high ASCVD risk score >20. A higher percentage of individuals that met all 3 criteria for prediabetes had metabolic syndrome and ASCVD risk score >20 (87.2% and 15.3%, respectively) than those who only met 1 prediabetes criterion (51.6% and 7.1%, respectively). Conclusions In conclusion, multiple metabolic (HOMA2S, IGI) and glycemic criteria of prediabetes (FPG, 2hPG, & HbA1c) are needed to fully recognize the elevated CVD risk profile that can manifest in prediabetes.
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Affiliation(s)
| | - Cyrus Desouza
- Omaha VA Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vanita R. Aroda
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sun H. Kim
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Shannon S. Wu
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Philip Raskin
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Richard Pratley
- AdventHealth Translational Research Institute, Orlando, FL, USA
| | - D2d Research Group
- Cleveland Clinic, Cleveland, OH, USA
- Omaha VA Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Chicago, IL, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- AdventHealth Translational Research Institute, Orlando, FL, USA
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18
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Li W, Wen CP, Li W, Ying Z, Pan S, Li Y, Zhu Z, Yang M, Tu H, Guo Y, Song Z, Chu DTW, Wu X. 6-Year trajectory of fasting plasma glucose (FPG) and mortality risk among individuals with normal FPG at baseline: a prospective cohort study. Diabetol Metab Syndr 2023; 15:169. [PMID: 37574540 PMCID: PMC10424387 DOI: 10.1186/s13098-023-01146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Higher fasting plasma glucose (FPG) levels were associated with an increased risk of all-cause mortality; however, the associations between long-term FPG trajectory groups and mortality were unclear, especially among individuals with a normal FPG level at the beginning. The aims of this study were to examine the associations of FPG trajectories with the risk of mortality and identify modifiable lifestyle factors related to these trajectories. METHODS We enrolled 50,919 individuals aged ≥ 20 years old, who were free of diabetes at baseline, in the prospective MJ cohort. All participants completed at least four FPG measurements within 6 years after enrollment and were followed until December 2011. FPG trajectories were identified by group-based trajectory modeling. We used Cox proportional hazards models to examine the associations of FPG trajectories with mortality, adjusting for age, sex, marital status, education level, occupation, smoking, drinking, physical activity, body mass index, baseline FPG, hypertension, dyslipidemia, cardiovascular disease or stroke, and cancer. Associations between baseline lifestyle factors and FPG trajectories were evaluated using multinomial logistic regression. RESULTS We identified three FPG trajectories as stable (n = 32,481), low-increasing (n = 17,164), and high-increasing (n = 1274). Compared to the stable group, both the low-increasing and high-increasing groups had higher risks of all-cause mortality (hazard ratio (HR) = 1.18 (95% CI 0.99-1.40) and 1.52 (95% CI 1.09-2.13), respectively), especially among those with hypertension. Compared to participants with 0 to 1 healthy lifestyle factor, those with 6 healthy lifestyle factors were more likely to be in the stable group (ORlow-increasing = 0.61, 95% CI 0.51-0.73; ORhigh-increasing = 0.20, 95% CI 0.13-0.32). CONCLUSIONS Individuals with longitudinally increasing FPG had a higher risk of mortality even if they had a normal FPG at baseline. Adopting healthy lifestyles may prevent individuals from transitioning into increasing trajectories.
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Affiliation(s)
- Wanlu Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chi Pang Wen
- National Institute for Data Science in Health and Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
| | - Wenyuan Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhijun Ying
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sai Pan
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yizhan Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zecheng Zhu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Min Yang
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Huakang Tu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi Guo
- Department of Health Management Center and Department of General Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhenya Song
- Department of Health Management Center and Department of General Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | | | - Xifeng Wu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- National Institute for Data Science in Health and Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China.
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China.
- Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
- School of Medicine and Health Science, George Washington University, Washington, DC, USA.
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19
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Li C, Sun J, Zhang X, Zhou M, Gan X. Implications of MCU complex in metabolic diseases. FASEB J 2023; 37:e23046. [PMID: 37389546 DOI: 10.1096/fj.202300218r] [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: 02/07/2023] [Revised: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
Metabolic diseases are considered the primary culprit for physical and mental health of individuals. Although the diagnosis of these diseases is relatively easy, more effective and convenient potent drugs are still being explored. Ca2+ across the inner mitochondrial membrane is a vital intracellular messenger that regulates energy metabolism and cellular Ca2+ homeostasis and is involved in cell death. Mitochondria rely on a selective mitochondrial Ca2+ unidirectional transport complex (MCU complex) in their inner membrane for Ca2+ uptake. We found that the channel contains several subunits and undergoes dramatic transformations in various pathological processes, especially in metabolic diseases. In this way, we believe that the MCU complex becomes a target with significant potential for these diseases. However, there is no review linking the two factors, thus hindering the possibility of new drug production. Here, we highlight the connection between MCU complex-related Ca2+ transport and the pathophysiology of metabolic diseases, adding understanding and insight at the molecular level to provide new insights for targeting MCU to reverse metabolism-related diseases.
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Affiliation(s)
- Chen Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu, China
| | - Jiyu Sun
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu, China
| | - Xidan Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu, China
| | - Min Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu, China
| | - Xueqi Gan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, School of Chemical Engineering, Sichuan University, Chengdu, China
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20
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Han Y, Hu Y, Yu C, Sun D, Pang Y, Pei P, Yang L, Chen Y, Du H, Liu J, Schmidt D, Avery D, Chen J, Chen Z, Li L, Lv J. Duration-dependent impact of cardiometabolic diseases and multimorbidity on all-cause and cause-specific mortality: a prospective cohort study of 0.5 million participants. Cardiovasc Diabetol 2023; 22:135. [PMID: 37308998 PMCID: PMC10262418 DOI: 10.1186/s12933-023-01858-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/12/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The association of incident cardiometabolic multimorbidity (CMM) with mortality risk is rarely studied, and neither are the durations of cardiometabolic diseases (CMDs). Whether the association patterns of CMD durations with mortality change as individuals progress from one CMD to CMM is unclear. METHODS Data from China Kadoorie Biobank of 512,720 participants aged 30-79 was used. CMM was defined as the simultaneous presence of two or more CMDs of interest, including diabetes, ischemic heart disease, and stroke. Cox regression was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the duration-dependent associations of CMDs and CMM with all-cause and cause-specific mortality. All information on exposures of interest was updated during follow-up. RESULTS During a median follow-up of 12.1 years, 99,770 participants experienced at least one incident CMD, and 56,549 deaths were documented. Among 463,178 participants free of three CMDs at baseline, compared with no CMD during follow-up, the adjusted HRs (95% CIs) between CMM and all-cause mortality, mortality from circulatory system diseases, respiratory system diseases, cancer, and other causes were 2.93 (2.80-3.07), 5.05 (4.74-5.37), 2.72 (2.35-3.14), 1.30 (1.16-1.45), and 2.30 (2.02-2.61), respectively. All CMDs exhibited a high mortality risk in the first year of diagnosis. Subsequently, with prolonged disease duration, mortality risk increased for diabetes, decreased for IHD, and sustained at a high level for stroke. With the presence of CMM, the above association estimates inflated, but the pattern of which remained. CONCLUSION Among Chinese adults, mortality risk increased with the number of the CMDs and changed with prolonged disease duration, the patterns of which varied among the three CMDs.
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Affiliation(s)
- Yuting Han
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yizhen Hu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Dianjianyi Sun
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Yuanjie Pang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jingchao Liu
- NCDs Prevention and Control Department, Wuzhong CDC, Suzhou, Jiangsu China
| | - Dan Schmidt
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel Avery
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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21
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Alimbayev A, Zhakhina G, Gusmanov A, Sakko Y, Yerdessov S, Arupzhanov I, Kashkynbayev A, Zollanvari A, Gaipov A. Predicting 1-year mortality of patients with diabetes mellitus in Kazakhstan based on administrative health data using machine learning. Sci Rep 2023; 13:8412. [PMID: 37225754 DOI: 10.1038/s41598-023-35551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/19/2023] [Indexed: 05/26/2023] Open
Abstract
Diabetes mellitus (DM) affects the quality of life and leads to disability, high morbidity, and premature mortality. DM is a risk factor for cardiovascular, neurological, and renal diseases, and places a major burden on healthcare systems globally. Predicting the one-year mortality of patients with DM can considerably help clinicians tailor treatments to patients at risk. In this study, we aimed to show the feasibility of predicting the one-year mortality of DM patients based on administrative health data. We use clinical data for 472,950 patients that were admitted to hospitals across Kazakhstan between mid-2014 to December 2019 and were diagnosed with DM. The data was divided into four yearly-specific cohorts (2016-, 2017-, 2018-, and 2019-cohorts) to predict mortality within a specific year based on clinical and demographic information collected up to the end of the preceding year. We then develop a comprehensive machine learning platform to construct a predictive model of one-year mortality for each year-specific cohort. In particular, the study implements and compares the performance of nine classification rules for predicting the one-year mortality of DM patients. The results show that gradient-boosting ensemble learning methods perform better than other algorithms across all year-specific cohorts while achieving an area under the curve (AUC) between 0.78 and 0.80 on independent test sets. The feature importance analysis conducted by calculating SHAP (SHapley Additive exPlanations) values shows that age, duration of diabetes, hypertension, and sex are the top four most important features for predicting one-year mortality. In conclusion, the results show that it is possible to use machine learning to build accurate predictive models of one-year mortality for DM patients based on administrative health data. In the future, integrating this information with laboratory data or patients' medical history could potentially boost the performance of the predictive models.
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Affiliation(s)
- Aidar Alimbayev
- Department of Electrical and Computer Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Kabanbay Batyr Avenue 53, Astana, Kazakhstan
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans Street 5/1, Astana, Kazakhstan
| | - Gulnur Zhakhina
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans Street 5/1, Astana, Kazakhstan
| | - Arnur Gusmanov
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans Street 5/1, Astana, Kazakhstan
| | - Yesbolat Sakko
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans Street 5/1, Astana, Kazakhstan
| | - Sauran Yerdessov
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans Street 5/1, Astana, Kazakhstan
| | - Iliyar Arupzhanov
- Department of Electrical and Computer Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Kabanbay Batyr Avenue 53, Astana, Kazakhstan
| | - Ardak Kashkynbayev
- Department of Mathematics, Nazarbayev University, Kabanbay Batyr Avenue 53, Astana, Kazakhstan
| | - Amin Zollanvari
- Department of Electrical and Computer Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Kabanbay Batyr Avenue 53, Astana, Kazakhstan
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans Street 5/1, Astana, Kazakhstan.
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22
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Zhou Z, Curtis AJ, Owen A, Wolfe R, Murray AM, Tonkin AM, Ernst ME, Orchard SG, Zhu C, Carr PR, Reid CM, Espinoza SE, Shah RC, Woods RL, Ryan J, McNeil JJ, Nelson MR, Zoungas S. Prediabetes, diabetes and loss of disability-free survival in a community-based older cohort: a post-hoc analysis of the ASPirin in Reducing Events in the Elderly trial. Age Ageing 2023; 52:7136745. [PMID: 37097768 PMCID: PMC10128162 DOI: 10.1093/ageing/afad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Evidence for the prognostic implications of hyperglycaemia in older adults is inconsistent. OBJECTIVE To evaluate disability-free survival (DFS) in older individuals by glycaemic status. METHODS This analysis used data from a randomised trial recruiting 19,114 community-based participants aged ≥70 years, who had no prior cardiovascular events, dementia and physical disability. Participants with sufficient information to ascertain their baseline diabetes status were categorised as having normoglycaemia (fasting plasma glucose [FPG] < 5.6 mmol/l, 64%), prediabetes (FPG 5.6 to <7.0 mmol/l, 26%) and diabetes (self-report or FPG ≥ 7.0 mmol/l or use of glucose-lowering agents, 11%). The primary outcome was loss of disability-free survival (DFS), a composite of all-cause mortality, persistent physical disability or dementia. Other outcomes included the three individual components of the DFS loss, as well as cognitive impairment-no dementia (CIND), major adverse cardiovascular events (MACE) and any cardiovascular event. Cox models were used for outcome analyses, with covariate adjustment using inverse-probability weighting. RESULTS We included 18,816 participants (median follow-up: 6.9 years). Compared to normoglycaemia, participants with diabetes had greater risks of DFS loss (weighted HR: 1.39, 95% CI 1.21-1.60), all-cause mortality (1.45, 1.23-1.72), persistent physical disability (1.73, 1.35-2.22), CIND (1.22, 1.08-1.38), MACE (1.30, 1.04-1.63) and cardiovascular events (1.25, 1.02-1.54) but not dementia (1.13, 0.87-1.47). The prediabetes group did not have an excess risk for DFS loss (1.02, 0.93-1.12) or other outcomes. CONCLUSIONS Among older people, diabetes was associated with reduced DFS, and higher risk of CIND and cardiovascular outcomes, whereas prediabetes was not. The impact of preventing or treating diabetes in this age group deserves closer attention.
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Affiliation(s)
- Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne M Murray
- Division of Geriatrics, Department of Medicine Hennepin HealthCare, Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Sara E Espinoza
- Sam and Ann Barshop Institute, UT Health San Antonio, San Antonio, TX, USA
- Geriatrics Research, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Raj C Shah
- Department of Family and Preventive Medicine, The Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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23
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Ford JH, Lage MJ, Boye KS, Bae JP, Terrell KA, Bunck MC. Five-year morbidity and mortality rates in a U.S. population with obesity with and without prediabetes. J Diabetes Complications 2023; 37:108454. [PMID: 37004499 DOI: 10.1016/j.jdiacomp.2023.108454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/15/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
AIMS This research examines the prevalence of morbidity and mortality among people with obesity with or without prediabetes. METHODS This observational study uses Optum® Market Clarity deidentified data from 2007 to 2020. Individuals with obesity without prediabetes (obesity only) were matched 1:1 to adults with prediabetes plus obesity based upon age, sex, race, ethnicity, and region. Age and sex adjusted prevalence rates and 95 % CIs were calculated for morbidity and mortality for each 365-day period post index date and over the entire 5-year post-period. RESULTS After 5-years, the adjusted mortality rate was 10.1 % for adults with obesity plus prediabetes and 6.9 % for adults with obesity only (p < 0.05). Five years post index date, the prevalence of type 2 diabetes was 25.3 % for people with obesity plus prediabetes and 9.2 % for people with obesity only (p < 0.05). Prevalence rates after 5 years for atherosclerotic cardiovascular disease (13.1 % v 8.1 %), composite cardiovascular outcome (7.0 % v 4.4 %) and composite cardio-renal outcome (8.9 % v 5.0 %) were significantly higher for adults with obesity plus prediabetes compared to adults with obesity only (all p < 0.05). CONCLUSIONS Results of this study indicate that the presence of prediabetes contributes to the development of additional morbidity and mortality in adults with obesity.
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Affiliation(s)
- Janet H Ford
- Value, Evidence and Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 36255, United States of America.
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 17 Benton's Knoll, Guilford, CT 06437, United States of America.
| | - Kristina S Boye
- Value, Evidence and Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 36255, United States of America.
| | - Jay P Bae
- Value, Evidence and Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46226, United States of America.
| | - Kendra A Terrell
- Value, Evidence and Outcomes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46226, United States of America.
| | - Mathijs C Bunck
- Medical Development, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46226, United States of America.
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24
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He Y, Lu H, Ling Y, Liu J, Yu S, Zhou Z, Chang T, Liu Y, Chen S, Chen J. Prediabetes and all-cause mortality in young patients undergoing coronary artery angiography: a multicenter cohort study in China. Cardiovasc Diabetol 2023; 22:42. [PMID: 36859269 PMCID: PMC9979507 DOI: 10.1186/s12933-023-01776-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/19/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The prevalence of prediabetes is increasing in young adults and patients undergoing coronary angiography. However, whether prediabetes is a considerable risk factor for all-cause mortality remains undetermined in young patients undergoing coronary angiography. METHODS In this study, we retrospectively included 8868 young patients (men aged < 45 years, women aged < 55 years) who underwent coronary angiography (CAG). Patients were categorized as normoglycemic, prediabetes and diabetes according to the HbA1c level or documented history of diabetes. The association of all-cause mortality with diabetes and prediabetes was detected by Cox proportional hazards regression analysis. RESULTS A total of 3240 (36.5%) among 8868 young patients receiving CAG were prediabetes and 2218 (25.0%) were diabetes. 728 patients died during a median follow-up of 4.92 years. Compared to the normoglycemic group, prediabetes increased the risk of all-cause mortality in young CAG patients by 24%(adjusted HR: 1.24, 95% CI: 1.04-1.49, p = 0.019) and diabetes increased the risk of all-cause mortality by 46%(adjusted HR:1.46, 95% CI:1.2-1.79, p < 0.001). Subgroup analysis showed that diabetes and prediabetes increased the risk of death mainly in patients without comorbidities. CONCLUSION Prediabetes accounts for more than one-third of the young adults undergoing CAG and was associated with an increased risk of all-cause mortality, active prevention strategy should be considered for these patients.
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Affiliation(s)
- Yibo He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Hongyu Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Yihang Ling
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Sijia Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Ziyou Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.,School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Tian Chang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.,School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China. .,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Shiqun Chen
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China. .,Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou, 510100, China.
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China. .,Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
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25
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Yu W, Li X, Zhong W, Dong S, Feng C, Yu B, Lin X, Yin Y, Chen T, Yang S, Jia P. Rural-urban disparities in the associations of residential greenness with diabetes and prediabetes among adults in southeastern China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 860:160492. [PMID: 36435247 DOI: 10.1016/j.scitotenv.2022.160492] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 06/16/2023]
Abstract
AIMS Greenness offers health benefits to prevent diabetes in urban areas. However, urban-rural disparities in this association have not been explored, with the underlying pathways understudied as well. We aimed to investigate and compare the associations and potential pathways between residential greenness and the risks for diabetes and prediabetes in urban and rural areas. METHODS Diabetes and prediabetes were diagnosed by fasting blood glucose (FBG). The participants' residential greenness exposure was estimated by the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). The association of residential greenness with the risks for diabetes and prediabetes was estimated by logistic regression and the generalized additive model. The potential mediation effects of air pollution, body mass index (BMI), and physical activity (PA) were examined by causal mediation analysis. RESULTS Of the 50,593 included participants, and the prevalence of prediabetes and diabetes were 21.22 % and 5.63 %, respectively. Each 0.1-unit increase in EVI500m and NDVI500m for healthy people reduced the risk for prediabetes by 12 % and 8 %, respectively, and substantially reduced the risk for diabetes by 23 % and 19 %, respectively. For those with prediabetes, each 0.1-unit increase in EVI500m and NDVI500m reduced the diabetes risk by 14 % and 12 %, respectively. Compared to the risks for diabetes at the 25th percentile of EVI500m/NDVI500m, such risks significantly reduced when EVI500m (NDVI500m) increased over 0.43 (0.48) and 0.28 (0.39) in urban and rural areas, respectively. The residential greenness-prediabetes/diabetes associations were mediated by air pollution and PA in urban areas and by air pollution and BMI in rural areas. CONCLUSIONS Exposure to residential greenness was associated with a lower risk for prediabetes and diabetes in urban areas and, more strongly, in rural areas, which were partly mediated by air pollution, PA, and BMI.
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Affiliation(s)
- Wanqi Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaoqing Li
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Wenling Zhong
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Shu Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
| | - Xi Lin
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Yanrong Yin
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Tiehui Chen
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu, China.
| | - Peng Jia
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
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26
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Shao X, Liu H, Hou F, Bai Y, Cui Z, Lin Y, Jiang X, Bai P, Wang Y, Zhang Y, Lu C, Liu H, Zhou S, Yu P. Development and validation of risk prediction models for stroke and mortality among patients with type 2 diabetes in northern China. J Endocrinol Invest 2023; 46:271-283. [PMID: 35972686 DOI: 10.1007/s40618-022-01898-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Stroke is one of the leading causes of disability and mortality in patients with type 2 diabetes mellitus (T2DM). Risk models have been developed for predicting stroke and stroke-associated mortality among patients with T2DM. Here, we evaluated risk factors of stroke for individualized prevention measures in patients with T2DM in northern China. METHODS In the community-based Tianjin Chronic Disease Cohort study, 58,042 patients were enrolled between January 2014 and December 2019. We used multiple imputation (MI) to impute missing variables and univariate and multivariate Cox's proportional hazard regression to screen risk factors of stroke. Furthermore, we established and validated first-ever prediction models for stroke (Model 1 and Model 2) and death from stroke (Model 3) and evaluated their performance. RESULTS In the derivation and validation groups, the area under the curves (AUCs) of Models 1-3 was better at 5 years than at 8 years. The Harrell's C-index for all models was above 0.7. All models had good calibration, discrimination, and clinical net benefit. Sensitivity analysis using the MI dataset indicated that all models had good and stable prediction performance. CONCLUSION In this study, we developed and validated first-ever risk prediction models for stroke and death from stroke in patients with T2DM, with good discrimination and calibration observed in all models. Based on lifestyle, demographic characteristics, and laboratory examination, these models could provide multidimensional management and individualized risk assessment. However, the models developed here may only be applicable to Han Chinese.
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Affiliation(s)
- X Shao
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - H Liu
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - F Hou
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - Y Bai
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Z Cui
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
| | - Y Lin
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - X Jiang
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - P Bai
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Y Wang
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Y Zhang
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - C Lu
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - H Liu
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - S Zhou
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - P Yu
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China.
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China.
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Painkra B, Anwar M, Singh AK, Singh V, Rao AR, Rao A, Thakral M, Chakrawarty A, Chatterjee P, Dey AB. Predictors of Survival Among the Oldest Old Following Acute Hospital Admission: Insights From Clinical and Biochemical Factors. Gerontol Geriatr Med 2023; 9:23337214231208077. [PMID: 37885898 PMCID: PMC10599112 DOI: 10.1177/23337214231208077] [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: 07/22/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
Understanding the factors influencing survival in oldest old population is crucial for providing appropriate care and improving outcomes. This prospective observational study aimed to investigate the determinants of survival in acutely ill oldest old patients during acute hospitalization and 1-month follow-up. Various geriatric domains and biochemical markers were assessed. Among the 70 included patients with a median age of 87 (Inter quartile range: 85-90), the presence of diabetes, delirium, tachypnea, and high sirtuin-5 levels were associated with reduced in-hospital survival. Non-survivors had raised levels of Sirtuin 1 and Sirtuin 5, with an increase of 43% and 70%, respectively. At 1 month, delirium and diabetes were still associated with reduced survival. These findings suggest that type-2 diabetes, delirium, tachypnea, and high sirtuin-5 levels could serve as predictors of reduced survival in acutely ill, hospitalized oldest old patients.
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Affiliation(s)
| | - Masroor Anwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Akshata Rao
- All India Institute of Medical Sciences, New Delhi, India
| | - Meenal Thakral
- All India Institute of Medical Sciences, New Delhi, India
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28
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Kim KS, Hong S, Hwang YC, Ahn HY, Park CY. Evaluating Triglyceride and Glucose Index as a Simple and Easy-to-Calculate Marker for All-Cause and Cardiovascular Mortality. J Gen Intern Med 2022; 37:4153-4159. [PMID: 35676587 PMCID: PMC9708968 DOI: 10.1007/s11606-022-07681-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/20/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The triglyceride and glucose (TyG) index is a useful marker of insulin resistance and is a predictor of several metabolic diseases. The aim of this study was to evaluate the association between the TyG index and all-cause or cardiovascular mortality using a large population-based cohort study database. METHODS A total of 255,508 subjects in the Kangbuk Samsung Health Study cohort were enrolled. Cox proportional hazards models were used to analyze the risk of mortality. RESULTS During a median 5.7-year follow-up, the cumulative all-cause and cardiovascular mortality was 0.47% and 0.07%. There was a nonlinear relationship between the TyG index and death, and moving from moderate to high, the TyG index levels were associated with an increase in the risk of death. The hazard ratio (HR) for all-cause and cardiovascular mortality of the TyG index was 1.21 [95% confidence interval (CI) 1.14-1.28] and 1.45 (95% CI 1.26-1.66) in the unadjusted model, respectively. After adjustment for covariates, the association between the TyG index and all-cause and cardiovascular mortality was attenuated. In the multivariable-adjusted model, the TyG index was associated with an elevated risk of all-cause mortality in women (HR 1.13, 95% CI 1.02-1.26) and a decreased risk in men (HR 0.92, 95% CI 0.85-0.99). The association between cardiovascular mortality and the TyG index was not statistically significant among either men or women in the multivariable-adjusted model. CONCLUSIONS The TyG index in a young, relatively healthy, population is associated with an elevated risk of all-cause and cardiovascular mortality. This association between the TyG index and all-cause mortality persists in women after multivariable adjustment.
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Affiliation(s)
- Kyung-Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Sangmo Hong
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - You-Cheol Hwang
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Cheol-Young Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
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29
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Tretyakova E, Smirnova I, Kazakova O, Nguyen HTT, Shevchenko A, Sokolova E, Babkov D, Spasov A. New Molecules of Diterpene Origin with Inhibitory Properties toward α-Glucosidase. Int J Mol Sci 2022; 23:13535. [PMID: 36362322 PMCID: PMC9655717 DOI: 10.3390/ijms232113535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 10/10/2023] Open
Abstract
The incidence of diabetes mellitus (DM), one of the most common chronic metabolic disorders, has increased dramatically over the past decade and has resulted in higher rates of morbidity and mortality worldwide. The enzyme, α-Glucosidase (α-GLy), is considered a therapeutic target for the treatment of type 2 DM. Herein, we synthesized arylidene, heterocyclic, cyanoetoxy- and propargylated derivatives of quinopimaric acid (levopimaric acid diene adduct with p-benzoquinone) 1-50 and, first, evaluated their ability to inhibit α-GLy. Among the tested compounds, quinopimaric acid 1, 2,3-dihydroquinopimaric acid 8 and its amide and heterocyclic derivatives 9, 30, 33, 39, 44, with IC50 values of 35.57-65.98 μM, emerged as being good inhibitors of α-GLy. Arylidene 1β-hydroxy and 1β,13α-epoxy methyl dihydroquinopimarate derivatives 6, 7, 26-29, thiadiazole 32, 1a,4a-dehydroquinopimaric acid 40 and its indole, nitrile and propargyl hybrids 35-38, 42, 45, 48, and 50 showed excellent inhibitory activities. The most active compounds 38, 45, 48, and 50 displayed IC50 values of 0.15 to 0.68 μM, being 1206 to 266 more active than acarbose (IC50 of 181.02 μM). Kinetic analysis revealed the most active diterpene indole with an alkyne substituent 45 as a competitive inhibitor with Ki of 50.45 μM. Molecular modeling supported this finding and suggested that the indole core plays a key role in the binding. Compound 45 also has favorable pharmacokinetic and safety properties, according to the computational ADMET profiling. The results suggested that quinopimaric acid derivatives should be considered as potential candidates for novel alternative therapies in the treatment of type 2 diabetes.
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Affiliation(s)
- Elena Tretyakova
- Ufa Institute of Chemistry, Ufa Federal Research Centre, Russian Academy of Sciences, 71 Prospect Oktyabrya, 450054 Ufa, Russia
| | - Irina Smirnova
- Ufa Institute of Chemistry, Ufa Federal Research Centre, Russian Academy of Sciences, 71 Prospect Oktyabrya, 450054 Ufa, Russia
| | - Oxana Kazakova
- Ufa Institute of Chemistry, Ufa Federal Research Centre, Russian Academy of Sciences, 71 Prospect Oktyabrya, 450054 Ufa, Russia
| | - Ha Thi Thu Nguyen
- Institute of Chemistry, Vietnamese Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Dist., Hanoi 100000, Vietnam
| | - Alina Shevchenko
- Scientific Center for Innovative Drugs, Volgograd State Medical University, Novorossiyskaya Str. 39, 400087 Volgograd, Russia
| | - Elena Sokolova
- Scientific Center for Innovative Drugs, Volgograd State Medical University, Novorossiyskaya Str. 39, 400087 Volgograd, Russia
| | - Denis Babkov
- Scientific Center for Innovative Drugs, Volgograd State Medical University, Novorossiyskaya Str. 39, 400087 Volgograd, Russia
| | - Alexander Spasov
- Scientific Center for Innovative Drugs, Volgograd State Medical University, Novorossiyskaya Str. 39, 400087 Volgograd, Russia
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30
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Cao Q, Xin Z, He R, Wang T, Xu M, Lu J, Dai M, Zhang D, Chen Y, Zhao Z, Wang S, Lin H, Wang W, Ning G, Bi Y, Xu Y, Li M. Age-specific difference in the association between prediabetes and subclinical atherosclerosis: an analysis of a chinese prospective cohort study. Cardiovasc Diabetol 2022; 21:153. [PMID: 35948892 PMCID: PMC9364510 DOI: 10.1186/s12933-022-01592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Prediabetes is an important risk factor of cardiovascular disease (CVD) and is associated with subclinical atherosclerosis. However, the evidence of prediabetes as a cardiovascular risk factor is mainly derived from middle-aged adults. Recently, multiple studies supported that prediabetes in older adults would not lead to higher risk of CVD or mortality. We aimed to investigate the age-specific difference in the association between prediabetes and subclinical atherosclerosis in a Chinese prospective cohort study. Methods We included 4739 individuals aged ≥ 40 years and without diagnosed diabetes or CVD history, and divided them into middle-aged adults (age < 60) and older adults (age ≥ 60). Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2 h-PPG) and glycated hemoglobin (HbA1c) were measured at baseline to identify prediabetes status. At follow-up visits, subclinical atherosclerosis status was assessed by branchial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (CIMT). Logistic regression analysis, restricted cubic splines and cross-lagged path analysis were used in statistical analysis. Results 1634 participants aged over 60 years, and 64.3% of them had prediabetes. 3105 participants aged 40–59 years, and 49.3% of them had prediabetes. We found that prediabetes was associated with increased risk of subclinical atherosclerosis in middle-aged adults, but the association attenuated substantially in older adults. Impaired glucose tolerance (IGT), compared to normal glucose tolerance, was associated with 39% lower risk of increased baPWV only in older adults. In accordance, the association between 2 h-PPG and risk of increased baPWV was “U-shaped” in older adults, while risk of elevated baPWV increased linearly with 2 h-PPG in middle-aged adults. In the cross-lagged analysis, increase in FPG and 2 h-PPG tended not to precede increase in baPWV in older adults, but appeared to increase simultaneously with baPWV in middle-aged ones. Conclusion Our results indicated that prediabetes might be less related to subclinical atherosclerosis in older adults than in middle-aged adults and suggested that age was important to consider in the care of adults with prediabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01592-8.
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Affiliation(s)
- Qiuyu Cao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhuojun Xin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruixin He
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng Dai
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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31
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Tran Ngoc Hoang P, Kadota A, Yuichiro Y, Akiko H, Takehito H, Shohei O, Miyagawa N, Kondo K, Nagako O, Kita Y, Okayama A, Yukihiro F, Maegawa H, Miura K, Okamura T, Ueshima H. Effect of diabetes and prediabetes on the development of disability and mortality among middle-aged adult Japanese: a 22-year follow-up of NIPPON DATA90. J Diabetes Investig 2022; 13:1897-1904. [PMID: 35717665 PMCID: PMC9623524 DOI: 10.1111/jdi.13871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction To examine the association between diabetes and prediabetes at baseline, and disability, mortality over a 22‐year period among middle‐aged Japanese adults. Materials and Methods Participants consisted of 1,788 adults aged 45–64 years at baseline from the cohort study National Integrated Project for Prospective Observation of Non‐communicable Disease and its Trends in the Aged 1990 (NIPPON DATA90). Disability, defined as having a decline in activities of daily living (ADL), was assessed by a modified Katz questionnaire at four time points. Disability and death without disability for 22‐year follow up were used as outcomes to test the association with a diagnosis of diabetes or prediabetes at baseline, using multinomial logistic regression. Adjusted odds ratios (ORs) were obtained from four models that contained appropriate adjustment factors, such as age, sex, smoking status, drinking status, body mass index and cardiovascular risk factors (hypertension, hypercholesterolemia, triglycerides, low serum high‐density lipoprotein), at baseline. Results In the present study, 334 participants (18.7%) reported at least one disability, and 350 (19.6%) were reported dead without observation of disability during follow up. Adjusting sex and other risk factors, participants with diabetes and prediabetes had a higher risk for disability (OR 1.43, 95% confidence interval [CI] 1.07–1.91 and OR 1.66, 95% CI 1.10–2.50, respectively) and for mortality (OR 1.56, 95% CI 1.16–2.08 and OR 1.77, 95% CI 1.18–2.65, respectively) than individuals with normal glucose tolerance. Conclusions In middle‐aged Japanese adults, individuals with diabetes and prediabetes were more likely to be associated with disability and mortality. Our findings suggest that prediabetes and diabetes in middle‐aged adults should be paid more attention, and requires more intervention to prevent disability and mortality in later life.
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Affiliation(s)
- Phap Tran Ngoc Hoang
- Department of Medicine, Shiga University of Medical science.,Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | - Aya Kadota
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science.,NCD Epidemiology Research Center, Shiga University of Medical science, Seta Tsukinowa-cho, Otsu, Shiga, 521-0092, Japan
| | - Yano Yuichiro
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | - Harada Akiko
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | - Hayakawa Takehito
- Research Center for Social Studies of Health and Community, Ritsumeikan University
| | - Okamoto Shohei
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
| | - Naoko Miyagawa
- Department of Public health, Shiga University of Medical science
| | - Keiko Kondo
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | | | | | | | | | | | - Katsuyuki Miura
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Hirotsugu Ueshima
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
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Choi G, Yoon H, Choi HH, Ha KH, Kim DJ. Association of prediabetes with death and diabetic complications in older adults: the pros and cons of active screening for prediabetes. Age Ageing 2022; 51:6612689. [PMID: 35737599 DOI: 10.1093/ageing/afac116] [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: 01/04/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND active screening can improve health outcomes for people with prediabetes. However, its efficacy in older adults remains uncertain. OBJECTIVE the study aimed to analyse the progression from prediabetes to diabetes in older adults, including associated complications and mortality rates, to determine the benefits of active screening. DESIGN retrospective cohort study. SETTING Korean National Health Insurance Service claims database. SUBJECTS a total of 36,946 adults aged ≥65 years who underwent national health examinations from 2006 to 2008. METHODS follow-up was until 31 December 2015. Cox's proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for death and diabetic complications. RESULTS over a median follow-up of 8.2 years, 19.3% of older adults with prediabetes progressed to diabetes. Compared with normoglycaemic adults, the multivariable-adjusted HRs (95% CI) for major adverse cardiovascular events were 1.01 (0.95-1.07), 1.08 (0.95-1.23), 1.14 (1.05-1.23) and 1.50 (1.35-1.68) in adults with prediabetes, newly diagnosed diabetes, diabetes not on insulin and diabetes on insulin, respectively. The corresponding HRs (95% CI) for diabetic retinopathy risk were 1.28 (1.15-1.43), 3.16 (2.71-3.69), 6.58 (6.02-7.19) and 9.17 (8.21-10.24). Diabetic nephropathy risk also significantly increased. CONCLUSIONS progression from prediabetes to diabetes is an important concern among older adults. Prediabetes is associated with the risk of microvascular complications, but not cardiovascular complications and mortality. Therefore, active regular screening for prediabetes is necessary to prevent microvascular complications.
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Affiliation(s)
- Giwoong Choi
- Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hojun Yoon
- Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Ho Choi
- Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
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Liu H, Chen S, Li Z, Xing A, Liu Y, Yu J, Li D, Li Y, Zhou X, Yang Q, Wu S, Lei P. Long-term risks for cardiovascular disease and mortality across the glycaemic spectrum in a male-predominant Chinese cohort aged 75 years or older: the Kailuan study. Age Ageing 2022; 51:6596557. [PMID: 35647762 DOI: 10.1093/ageing/afac109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ageing and diabetes are growing global health burdens. The current understanding of cardiovascular disease (CVD) and mortality risk across the glycaemic spectrum in older populations is limited. OBJECTIVES This study sought to characterise CVD and all-cause mortality risk across the glycaemic spectrum among Chinese adults aged 75 years or older in a community-based setting over10 years. METHODS The 3,989 adults in the Kailuan Study were aged over 75 years (median age was 79 years [interquartile range: 76-82]; 2,785 normoglycaemic, 691 prediabetic and 513 diabetic, determined by fasting blood glucose levels) at baseline, predominantly male (92.9% male) and followed until December 2019. Time-varying Cox regression and competing-risk models were used to examine the hazard ratio (HR) of incident CVD and mortality across the glycaemic exposures. RESULTS During median follow-up of 11.3 years, 433 first CVD and 2,222 deaths were recorded. Compared with normoglycaemia, multivariable-adjusted models revealed the following: (i) prediabetes was not associated with future risks for CVD (HR: 1.17; 95% CI 0.82-1.69) and all-cause mortality (HR 1.06; 95% CI 0.70-1.60); (ii) diabetes-associated enhanced risks for CVD and all-cause mortality were mainly confined to those exhibiting low-grade inflammation (high-sensitivity C-reactive protein ≥2.0 mg/L) levels. The results were consistent after multiple sensitivity analyses. CONCLUSIONS Among a male-predominant Chinese population aged 75 years or older, compared with normoglycaemic participants, prediabetes was not associated with an enhanced 10-year CVD and all-cause mortality risk, and diabetes-associated enhanced 10-year risk was mainly confined to individuals exhibiting low-grade inflammation.
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Affiliation(s)
- Hangkuan Liu
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital , Tangshan 063001, Hebei, China
| | - Ziping Li
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Aijun Xing
- Department of Cardiology, Kailuan General Hospital , Tangshan 063001, Hebei, China
| | - Yan Liu
- Department of Cardiology, Kailuan General Hospital , Tangshan 063001, Hebei, China
| | - Jiaxin Yu
- Department of Cardiology, Tangshan Worker’s Hospital , Tangshan 063003, Hebei, China
| | - Dai Li
- Department of Geriatrics, Tianjin Medical University General Hospital; Tianjin Geriatrics Institute , Tianjin 300052, China
| | - Yongle Li
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital , Tianjin 300052, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital , Tangshan 063001, Hebei, China
| | - Ping Lei
- Department of Geriatrics, Tianjin Medical University General Hospital; Tianjin Geriatrics Institute , Tianjin 300052, China
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Swislocki AL. Glucose Trajectory: More than Changing Glucose Tolerance with Age? Metab Syndr Relat Disord 2022; 20:313-320. [DOI: 10.1089/met.2021.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Arthur L.M. Swislocki
- Medical Service, VA Northern California Health Care System (612/111), Martinez, California, USA
- Division of Endocrinology and Metabolism, Department of Internal Medicine, UC Davis School of Medicine, Sacramento, California, USA
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Wang S, Zuo A, Jiang W, Xie J, Lin H, Sun W, Zhao M, Xia J, Shao J, Zhao X, Liang D, Yang A, Sun J, Wang M. JMJD1A/NR4A1 Signaling Regulates the Procession of Renal Tubular Epithelial Interstitial Fibrosis Induced by AGEs in HK-2. Front Med (Lausanne) 2022; 8:807694. [PMID: 35186975 PMCID: PMC8850412 DOI: 10.3389/fmed.2021.807694] [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: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
Diabetic kidney disease (DKD) is one of the most serious complications of diabetic patients. Advanced glycation end products (AGEs) induce epithelial-mesenchymal transformation (EMT) of renal tubular epithelial cells (HK-2), resulting in renal tubulointerstitial fibrosis. However, the underlying epigenetic mechanisms remain to be further investigated. In this work, we investigated the functional role of JMJD1A involved in DKD progression. The molecular mechanism study was performed in AGEs-induced HK-2 cells by gene expression analysis, RNA sequencing (RNA-seq), and JMJD1A lentiviral knockdown and overexpression particle transfection. The results showed that AGEs could upregulate JMJD1A, and the expressions of related fibrotic factor were also increased. At the same time, in the DKD animal model induced by unilateral nephrectomy plus streptozotocin (STZ), IHC immunohistochemical staining showed that compared with the control group, the expressions of JMJD1A, FN, and COL1 in the model group were all increased, masson staining results also show that the model group has typical fibrotic changes. This is consistent with the results of our in vitro experiments. In order to determine the downstream pathway, we screened out JMJD1A downstream transcription factors by RNA-seq. Further analysis showed that JMJD1A overexpression could accelerate the progression of AGEs-induced renal fibrosis by reducing the expression of NR4A1 in HK-2 cells. Meanwhile, NR4A1 inhibitor can promote the expression of fibrosis-related factors such as VIM, a-SMA in HK-2 cells, and aggravate the process of fibrosis. Taken together, JMJD1A/NR4A1 signaling can regulate the procession of renal tubular epithelial interstitial fibrosis induced by AGEs in HK-2.
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Affiliation(s)
- Shaoting Wang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Anna Zuo
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Weiqiang Jiang
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiarun Xie
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Haoyu Lin
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Wei Sun
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Min Zhao
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jinjin Xia
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Junqiao Shao
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Xiaoshan Zhao
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Donghui Liang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Aicheng Yang
- The Affiliated Jiangmen Traditional Chinese Medicine Hospital, Jinan University, Guangzhou, China
- Aicheng Yang
| | - Jia Sun
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Jia Sun
| | - Ming Wang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Ming Wang
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Wang F, Wang W, Yin P, Liu Y, Liu J, Wang L, Qi J, You J, Lin L, Zhou M. Mortality and Years of Life Lost in Diabetes Mellitus and Its Subcategories in China and Its Provinces, 2005-2020. J Diabetes Res 2022; 2022:1609267. [PMID: 35493611 PMCID: PMC9054436 DOI: 10.1155/2022/1609267] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To analyze diabetes mellitus (DM) mortality and years of life lost (YLL) in different years and different subgroups at the national and regional levels in China from 2005 to 2020. METHODS We estimated mortality and YLL of DM and its subcategories for 31 provinces in China during 2005-2020 using multisource data from the National Mortality Surveillance System (NMSS). RESULTS The age standardized mortality rate (ASMR) of DM increased from 12.18 per 100,000 in 2005 to 13.62 per 100,000 in 2020, which was an increase of 11.86%. The ASMR of type 2 diabetes mellitus (T2DM) was much higher than that of type 1 diabetes mellitus (T1DM). The ASMR of T1DM remained stable, but the rate of T2DM increased, and the increase in male patients was higher than that in their female counterparts. At the same time, the burden of premature death was highest in the group ≥ 80 years old, and ASMR increased from 236.02 per 100,000 in 2005 to 358.86 per 100,000 in 2020. In 2005, the eastern region had the highest ASMR of DM, but the western region's ASMR grew faster and eventually became the highest in 2020. In addition, the YLL rate in the eastern region showed a downward trend; however, in the middle and western regions the YLL rate continued to rise, with that of the western region rapidly increasing. CONCLUSION A dramatically upward trend in DM deaths can be seen in China from 2005 to 2020. DM remains a chronic disease in urgent need of prevention and control, especially in the elderly and people in less-affluent provinces. We must put forward more targeted policies to effectively allocate medical resources and focus on high-risk groups to reduce the premature-mortality burden of DM and its subcategories.
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Affiliation(s)
- Feixue Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlin You
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Lin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Wang Y, Wang Y. Accelerated Ovarian Aging Among Type 2 Diabetes Patients and Its Association With Adverse Lipid Profile. Front Endocrinol (Lausanne) 2022; 13:780979. [PMID: 35432199 PMCID: PMC9005646 DOI: 10.3389/fendo.2022.780979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of diabetes on reproductive function is still not clearly defined. This study aimed to evaluate accelerated ovarian aging in women with type 2 diabetes mellitus (T2DM) and its association with adverse lipid profile. METHODS Female patients with T2DM (n=964) and non-T2DM controls (n=263) aging from 18-80 years were included. Levels of circulating sex hormones were measured at the follicular phase in menstruating women. We analyzed the age-specific trends in the levels of sex hormones between T2DM and controls. The correlations of sex hormones with the lipid profile, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglycerides (TG) were also evaluated. RESULTS In the temporal trends analysis, LH and FSH both started to increase obviously approximately from the age of 45 years among patients with T2DM, and displayed peaks of LH and FSH among patients with T2DM aged between 61 and 65, both of which were obviously earlier than that in non-T2DM controls and proved the accelerated ovarian aging among patients with T2DM. E2 of patients with T2DM was continuous lower than that of non-T2DM controls from approximately 45 years old, and LH and FSH of patients with T2DM were higher than those of non-T2DM controls between the age of 55 to 65 years. Multiple linear regression analyses revealed that LH was positively correlated with LDL-C (Coefficient=0.156, P=0.001) and TC (Coefficient=0.134, P=0.025), and was negatively correlated with HDL-C (Coefficient =-0.065, P=0.001) in patients with T2DM aged between 51 and 60, which was independent of age, T2DM duration, body mass index (BMI), glycosylated hemoglobin (HbA1c), FSH, E2 and other potential confounders. Higher E2 level was significantly and independently correlated with lower LDL-C (Coefficient= -0.064, P=0.033) in patients with T2DM aged between 51 and 60. CONCLUSIONS This study suggests that patients with T2DM have accelerated ovarian aging, and it is correlated with the occurrence of disturbed lipid profile in patients with T2DM. With an ever increasing number of female patients with T2DM diagnosed at younger ages, the accelerated ovarian aging and its adverse impacts in T2DM need to be carefully managed.
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Affiliation(s)
- Yahao Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
- Huashan Hospital, Fudan University, Shanghai, China
| | - Yangang Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Yangang Wang,
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Leung V, Wroblewski K, Schumm LP, Huisingh-Scheetz M, Huang ES. Reexamining the Classification of Older Adults With Diabetes by Comorbidities and Exploring Relationships With Frailty, Disability, and 5-year Mortality. J Gerontol A Biol Sci Med Sci 2021; 76:2071-2079. [PMID: 34003280 PMCID: PMC8514058 DOI: 10.1093/gerona/glab141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Limited research has been conducted to risk stratify older adults with diabetes. Our objective was to reexamine the 2005-2006 classification systems in participants who are now 5 years older. METHODS We examined a subsample of 884 community-residing older adults with the diagnosis of diabetes from the National Social Life, Health, and Aging Project. The primary objective was to utilize a latent class analysis (LCA) to fit a model to 11 comorbidities, comparing the 2010-2011 LCA model to that of 2005-2006. The secondary objective was to evaluate the association of the identified classes with frailty, disability, and 5-year mortality. RESULTS Both 2005-2006 LCA and the 2010-2011 LCA model fit 3 similar comorbidity profiles: Class 1 with the lowest rates of nearly all comorbidities, Class 2 had highest rates of obesity, hypertension, arthritis, and incontinence, and Class 3 had the higher rates of myocardial infarctions, congestive heart failure, and stroke. When compared to the healthier Class 1 (class probability = 0.67), participants with a comorbidity profile with more prevalent cardiovascular conditions (Class 3; 0.09) were at higher risk of frailty and mortality, but not disability; whereas participants with a comorbidity profile with more prevalent geriatric syndrome conditions (Class 2; 0.24) were at higher risk of frailty and disability, but not mortality. CONCLUSIONS We reconfirmed 3 latent classes with distinct comorbidity profiles among older adults with diabetes. However, the complex relationships between comorbidity classes with frailty, disability, and mortality will likely require revision of the current rationale for stratified goal setting and treatment selection.
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Affiliation(s)
- Vania Leung
- Department of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Illinois, USA
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Illinois, USA
| | | | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Illinois, USA
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39
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Lee SH, Han K, Kwon HS, Kim MK. Frequency of Exposure to Impaired Fasting Glucose and Risk of Mortality and Cardiovascular Outcomes. Endocrinol Metab (Seoul) 2021; 36:1007-1015. [PMID: 34674499 PMCID: PMC8566122 DOI: 10.3803/enm.2021.1218] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Metabolic abnormalities, such as impaired fasting glucose (IFG), are dynamic phenomena; however, it is unclear whether the timing of IFG exposure and cumulative exposure to IFG are related to cardiovascular disease (CVD) and mortality risk. METHODS Data were extracted from a nationwide population-based cohort in South Korea for adults (n=2,206,679) who were free of diabetes and had 4 years of consecutive health examination data. Fasting blood glucose levels of 100 to 125 mg/dL were defined as IFG, and the number of IFG diagnoses for each adult in the 4-year period was tabulated as the IFG exposure score (range, 0 to 4). Adults with persistent IFG for the 4-year period received a score of 4. RESULTS The median follow-up was 8.2 years. There were 24,820 deaths, 13,502 cases of stroke, and 13,057 cases of myocardial infarction (MI). IFG exposure scores of 1, 2, 3, and 4 were associated with all-cause mortality (multivariable-adjusted hazard ratio [aHR], 1.11; 95% confidence interval [CI], 1.08 to 1.15; aHR, 1.16; 95% CI, 1.12 to 1.20; aHR, 1.20; 95% CI, 1.15 to 1.25; aHR, 1.18; 95% CI, 1.11 to 1.25, respectively) compared with an IFG exposure score of 0. Adjusting for hypertension and dyslipidemia attenuated the slightly increased risk of MI or stroke associated with high IFG exposure scores, but significant associations for allcause mortality remained. CONCLUSION The intensity of IFG exposure was associated with an elevated risk of all-cause mortality, independent of cardiovascular risk factors. The association between IFG exposure and CVD risk was largely mediated by the coexistence of dyslipidemia and hypertension.
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Affiliation(s)
- Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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40
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Zhuo M, Hawley CE, Paik JM, Bessette LG, Wexler DJ, Kim DH, Tong AY, Kim SC, Patorno E. Association of Sodium-Glucose Cotransporter-2 Inhibitors With Fracture Risk in Older Adults With Type 2 Diabetes. JAMA Netw Open 2021; 4:e2130762. [PMID: 34705014 PMCID: PMC8552056 DOI: 10.1001/jamanetworkopen.2021.30762] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Whether sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are associated with an increased risk of fractures in older adults with type 2 diabetes (T2D) outside of clinical trials remains unknown. OBJECTIVE To examine the association of incident fracture among older adults with T2D with initiating an SGLT-2i compared with initiating a dipeptidyl peptidase 4 inhibitor (DPP-4i) or a glucagon-like peptide 1 receptor agonist (GLP-1RA). DESIGN, SETTING, AND PARTICIPANTS This is a population-based, new-user cohort study including older adults (aged ≥65 years) with T2D enrolled in Medicare fee-for-service from April 2013 to December 2017. Data analysis was performed from October 2020 to April 2021. EXPOSURES New users of an SGLT-2i, DPP-4i, or GLP-1RA without a previous fracture were matched in a 1:1:1 ratio using 3-way propensity score matching. MAIN OUTCOMES AND MEASURES The primary outcome was a composite end point of nontraumatic pelvic fracture, hip fracture requiring surgery, or humerus, radius, or ulna fracture requiring intervention within 30 days. After 3-way 1:1:1 propensity score matching, multivariable Cox proportional hazards regression models were used to generate hazard ratios (HRs) for SGLT-2i compared with DPP-4i and GLP-1RA and Kaplan-Meier curves to visualize fracture risk over time across groups. RESULTS Of 466 933 new initiators of study drugs, 62 454 patients were new SGLT-2i users. After 3-way matching, 45 889 (73%) new SGLT-2i users were matched to new users of DPP-4i and GLP-1RA, yielding a cohort of 137 667 patients (mean [SD] age, 72 [5] years; 64 126 men [47%]) matched 1:1:1 for analyses. There was no difference in the risk of fracture in SGLT-2i users compared with DPP-4i users (HR, 0.90; 95% CI, 0.73-1.11) or GLP-1RA users (HR, 1.00; 95% CI, 0.80-1.25). Results were consistent across categories of sex, frailty (nonfrail, prefrail, and frail), age (<75 and ≥75 years), and insulin use (baseline users and nonusers). CONCLUSIONS AND RELEVANCE In this nationwide Medicare cohort, initiating an SGLT-2i was not associated with an increased risk of fracture in older adults with T2D compared with initiating a DPP-4i or GLP-1RA, with consistent results across categories of frailty, age, and insulin use. These findings add to the evidence base evaluating the potential risks associated with SGLT-2i use for older adults outside of randomized clinical trials.
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Affiliation(s)
- Min Zhuo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Chelsea E. Hawley
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- New England Geriatric Research, Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts
| | - Julie M. Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Lily G. Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deborah J. Wexler
- Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Dae H. Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Angela Y. Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Seoyoung C. Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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41
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Rooney MR, Selvin E. The Importance of Considering Frailty in Research on Older Adults-Reply. JAMA Intern Med 2021; 181:1260. [PMID: 34125136 DOI: 10.1001/jamainternmed.2021.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mary R Rooney
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Hammad MO, Alseoudy MM. The sex-related discrepancy in laboratory parameters of severe COVID-19 patients with diabetes: A retrospective cohort study. Prim Care Diabetes 2021; 15:713-718. [PMID: 34006475 PMCID: PMC8114673 DOI: 10.1016/j.pcd.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023]
Abstract
AIM This study aimed at providing evidence to consider sex differences in interpretations of laboratory parameters of severe COVID-19 patients with diabetes. METHODS For 118 diabetic patients, laboratory measurements and clinical outcomes were compared between males and females. This study also compared inflammatory ratios obtained from combinations of six inflammatory markers between the two groups. The risk factors for mortality were identified through logistic regression. RESULTS Males were 54 (45.8%) and females were 64 (54.2%). Males showed a significant increase in ALT (P = 0.003), CRP (P = 0.03), mean platelet volume (MPV)-to-lymphocyte ratio (P = 0.001), and C-reactive protein-to-albumin ratio (P = 0.044), whereas females had a significant increase in lymphocytes (P < 0.005) and MPV (P = 0.01). In all participants, multivariate analysis illustrated that older age, male sex, increased serum total bilirubin, and decreased PO2 were significant independent predictors of mortality (P < 0.05). CONCLUSION In severe COVID-19 patients with diabetes, there were significant sex differences in many laboratory characteristics with a higher risk of mortality among males.
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Affiliation(s)
- Maha O Hammad
- Department of Medical Biochemistry, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Mahmoud M Alseoudy
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Rooney MR, Tang O, Echouffo Tcheugui JB, Lutsey PL, Grams ME, Windham BG, Selvin E. American Diabetes Association Framework for Glycemic Control in Older Adults: Implications for Risk of Hospitalization and Mortality. Diabetes Care 2021; 44:1524-1531. [PMID: 34006566 PMCID: PMC8323179 DOI: 10.2337/dc20-3045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The 2021 American Diabetes Association (ADA) guidelines recommend different A1C targets in older adults that are based on comorbid health status. We assessed risk of mortality and hospitalizations in older adults with diabetes across glycemic control (A1C <7%, 7 to <8%, ≥8%) and ADA-defined health status (healthy, complex/intermediate, very complex/poor) categories. RESEARCH DESIGN AND METHODS Prospective cohort analysis of older adults aged 66-90 years with diagnosed diabetes in the Atherosclerosis Risk in Communities (ARIC) study. RESULTS Of the 1,841 participants (56% women, 29% Black), 32% were classified as healthy, 42% as complex/intermediate, and 27% as very complex/poor health. Over a median 6-year follow-up, there were 409 (22%) deaths and 4,130 hospitalizations (median [25th-75th percentile] 1 per person [0-3]). In the very complex/poor category, individuals with A1C ≥8% (vs. <7%) had higher mortality risk (hazard ratio 1.76 [95% CI 1.15-2.71]), even after adjustment for glucose-lowering medication use. Within the very complex/poor health category, individuals with A1C ≥8% (vs. <7%) had more hospitalizations (incidence rate ratio [IRR] 1.41 [95% CI 1.03-1.94]). In the complex/intermediate group, individuals with A1C ≥8% (vs. <7%) had more hospitalizations, even with adjustment for glucose-lowering medication use (IRR 1.64 [1.21-2.24]). Results were similar, but imprecise, when the analysis was restricted to insulin or sulfonylurea users (n = 663). CONCLUSIONS There were substantial differences in mortality and hospitalizations across ADA health status categories, but older adults with A1C <7% were not at elevated risk, regardless of health status. Our results support the 2021 ADA guidelines and indicate that <7% is a reasonable treatment goal in some older adults with diabetes.
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Affiliation(s)
- Mary R Rooney
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Olive Tang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Justin B Echouffo Tcheugui
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, Baltimore, MD
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Morgan E Grams
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - B Gwen Windham
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
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44
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Barbu E, Popescu MR, Popescu AC, Balanescu SM. Phenotyping the Prediabetic Population-A Closer Look at Intermediate Glucose Status and Cardiovascular Disease. Int J Mol Sci 2021; 22:6864. [PMID: 34202289 PMCID: PMC8268766 DOI: 10.3390/ijms22136864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023] Open
Abstract
Even though the new thresholds for defining prediabetes have been around for more than ten years, there is still controversy surrounding the precise characterization of this intermediate glucose metabolism status. The risk of developing diabetes and macro and microvascular disease linked to prediabetes is well known. Still, the prediabetic population is far from being homogenous, and phenotyping it into less heterogeneous groups might prove useful for long-term risk assessment, follow-up, and primary prevention. Unfortunately, the current definition of prediabetes is quite rigid and disregards the underlying pathophysiologic mechanisms and their potential metabolic progression towards overt disease. In addition, prediabetes is commonly associated with a cluster of risk factors that worsen the prognosis. These risk factors all revolve around a common denominator: inflammation. This review focuses on identifying the population that needs to be screened for prediabetes and the already declared prediabetic patients who are at a higher risk of cardiovascular disease and require closer monitoring.
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Affiliation(s)
| | - Mihaela-Roxana Popescu
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 011461 Bucharest, Romania; (E.B.); (S.-M.B.)
| | - Andreea-Catarina Popescu
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 011461 Bucharest, Romania; (E.B.); (S.-M.B.)
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45
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Liang Y, Wang M, Wang C, Liu Y, Naruse K, Takahashi K. The Mechanisms of the Development of Atherosclerosis in Prediabetes. Int J Mol Sci 2021; 22:ijms22084108. [PMID: 33921168 PMCID: PMC8071517 DOI: 10.3390/ijms22084108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Lifestyle changes, such as overeating and underexercising, can increase the risk of prediabetes. Diabetes is one of the leading causes of atherosclerosis, and recently it became clear that the pathophysiology of atherosclerosis progresses even before the onset of diabetic symptoms. In addition to changes in platelets and leukocytes in the hyperglycemic state and damage to vascular endothelial cells, extracellular vesicles and microRNAs were found to be involved in the progression of prediabetes atherosclerosis. This review discusses the cellular and molecular mechanisms of these processes, with an intention to enable a comprehensive understanding of the pathophysiology of prediabetes and atherosclerosis.
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46
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Saadeddine D, Itani L, Kreidieh D, El Masri D, Tannir H, El Ghoch M. Association between Levels of Physical Activity, Sarcopenia, Type 2 Diabetes and the Quality of Life of Elderly People in Community Dwellings in Lebanon. Geriatrics (Basel) 2021; 6:28. [PMID: 33803509 PMCID: PMC8005975 DOI: 10.3390/geriatrics6010028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 01/14/2023] Open
Abstract
There is a lack of data from developing countries on the link between physical activity (PA) on health outcomes. This study examines the association between the level of PA and sarcopenia, cardiovascular risk factors (i.e., dyslipidemia, type 2 diabetes (T2D), and cardiovascular diseases), and the health-related quality of life (HRQoL) among elderly people, in community dwellings in Lebanon. In this cross-sectional, observational study, body composition, levels of PA, and the HRQoL of 243 elderly people living in community dwellings, are obtained. The participants are then categorized based on a PA cut-off point of 600 metabolic equivalent task minutes per week (MET-min/week). In our sample, the prevalence of physical inactivity, defined as performing less than 600 MET-min/week, is 51.44% (125/243 participants).They displayed a higher prevalence of sarcopenia (36.0% vs. 18.6%), T2D (39.6% vs. 21.1%), as well as a lower physical (65.67 ± 20.72 vs. 75.08 ± 17.29) and mental (67.58 ± 21.51 vs. 76.95 ± 17.16) HRQoL. On the other hand, regression analysis shows that an increased rate of PA to ≥600 MET-min/week is associated with a lower risk of T2D (OR = 0.43, 95% CI: 0.22-0.84, p = 0.013) and sarcopenia (OR= 0.40, 95% CI: 0.22-0.73, p = 0.003) by 60%, and higher scores of the physical (β = -7.65; -11.87, -3.43, p = 0.0004) and mental (β = -8.47; -13.08, -3.85, p = 0.0004) HRQoL by nearly eight points. Our results show a high prevalence of physical inactivity in Lebanese adults over the age of 60; however, an adequate level of PA among this population seemed to be associated with a lower risk of sarcopenia and T2D, as well as a better HRQoL. However, future longitudinal studies are still needed to clarify if intervention based on increasing levels of PA can determine improvement in these clinical outcomes. If this is shown to be the case, it emphasizes the importance of implementing strategies to increase physical activity within this population.
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Affiliation(s)
| | | | | | | | | | - Marwan El Ghoch
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon; (D.S.); (L.I.); (D.K.); (D.E.M.); (H.T.)
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47
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De Silva K, Mathews N, Teede H, Forbes A, Jönsson D, Demmer RT, Enticott J. Clinical notes as prognostic markers of mortality associated with diabetes mellitus following critical care: A retrospective cohort analysis using machine learning and unstructured big data. Comput Biol Med 2021; 132:104305. [PMID: 33705995 DOI: 10.1016/j.compbiomed.2021.104305] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical notes are ubiquitous resources offering potential value in optimizing critical care via data mining technologies. OBJECTIVE To determine the predictive value of clinical notes as prognostic markers of 1-year all-cause mortality among people with diabetes following critical care. MATERIALS AND METHODS Mortality of diabetes patients were predicted using three cohorts of clinical text in a critical care database, written by physicians (n = 45253), nurses (159027), and both (n = 204280). Natural language processing was used to pre-process text documents and LASSO-regularized logistic regression models were trained and tested. Confusion matrix metrics of each model were calculated and AUROC estimates between models were compared. All predictive words and corresponding coefficients were extracted. Outcome probability associated with each text document was estimated. RESULTS Models built on clinical text of physicians, nurses, and the combined cohort predicted mortality with AUROC of 0.996, 0.893, and 0.922, respectively. Predictive performance of the models significantly differed from one another whereas inter-rater reliability ranged from substantial to almost perfect across them. Number of predictive words with non-zero coefficients were 3994, 8159, and 10579, respectively, in the models of physicians, nurses, and the combined cohort. Physicians' and nursing notes, both individually and when combined, strongly predicted 1-year all-cause mortality among people with diabetes following critical care. CONCLUSION Clinical notes of physicians and nurses are strong and novel prognostic markers of diabetes-associated mortality in critical care, offering potentially generalizable and scalable applications. Clinical text-derived personalized risk estimates of prognostic outcomes such as mortality could be used to optimize patient care.
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Affiliation(s)
- Kushan De Silva
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, 3168, Australia.
| | - Noel Mathews
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, 3168, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, 3168, Australia
| | - Andrew Forbes
- Biostatistics Unit, Division of Research Methodology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, 3004, Australia
| | - Daniel Jönsson
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, 21119, Sweden; Swedish Dental Service of Skane, Lund, 22647, Sweden
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; Mailman School of Public Health, Columbia University, New York, USA
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, 3168, Australia
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Rapoport M, Chetrit A, Cantrell D, Novikov I, Roth J, Dankner R. Years of potential life lost in pre-diabetes and diabetes mellitus: data from a 40-year follow-up of the Israel study on Glucose intolerance, Obesity and Hypertension. BMJ Open Diabetes Res Care 2021; 9:9/1/e001981. [PMID: 33692115 PMCID: PMC7949441 DOI: 10.1136/bmjdrc-2020-001981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/23/2021] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION We examined years of potential life lost (YPLL) associated with pre-diabetes as compared with either normoglycemia or diabetes, using data of the Israel cohort of Glucose intolerance, Obesity and Hypertension 40-year follow-up. RESEARCH DESIGN AND METHODS Men and women (N=2844, mean age 52.0±8.2 years) who underwent oral glucose tolerance test and anthropometric measurements, during 1976-1982, were followed for mortality until May 2019. Multiple imputation procedures for missing mortality dates and multivariable regression mixed models were applied. RESULTS At baseline, 35.8%, 48.8% and 15.4% individuals were found with normoglycemia, pre-diabetes, and diabetes, respectively. The average difference in YPLL associated with pre-diabetes as compared with normoglycemia was 4.3 years (95% CI 3.3 to 5.2; p<0.001). YPLL were 1 year higher in women with pre-diabetes than in men with pre-diabetes. These differences persisted mainly in individuals younger than 60 years, and those with body mass index (BMI) <25 kg/m2, at baseline. Adjusting for age, sex, country of origin, smoking status, BMI, and blood pressure, the average difference in YPLL associated with pre-diabetes as compared with normoglycemia was 2.0 years (95% CI 1.2 to 2.8; p<0.001). Significant reductions of 5.9 years (95% CI 4.8 to 7.0) on average were observed for diabetes as compared with pre-diabetes and 7.9 years (95% CI 6.7 to 9.1) as compared with individuals with normoglycemia. CONCLUSIONS This study reveals that life expectancy of middle-aged individuals with pre-diabetes is shorter than of normoglycemic ones. These findings are especially relevant in view of the rising worldwide prevalence of pre-diabetes within younger age groups and underscore the crucial importance of interventions by either lifestyle modification or drug therapy capable of delaying progression from pre-diabetes to diabetes to reduce the YPLL in this high-risk group.
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Affiliation(s)
- Micha Rapoport
- Internal Medicine 'C' and Diabetes Service, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Tel HaShomer, Israel
| | - Dror Cantrell
- Internal Medicine 'C' and Diabetes Service, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Novikov
- Unit for Biostatistics and Mathematics, Gertner Institute for Health Policy and Epidemiology, Tel HaShomer, Israel
| | - Jesse Roth
- Feinstein Research Institute, Albert Einstein College of Medicine Department of Neurology, Bronx, New York, USA
- Laboratory of Diabetes, Obesity and Other Metabolic Disorders, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Tel HaShomer, Israel
- Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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49
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Qian X, He S, Wang J, Gong Q, An Y, Li H, Chen Y, Li G. Prediction of 10-year mortality using hs-CRP in Chinese people with hyperglycemia: Findings from the Da Qing diabetes prevention outcomes study. Diabetes Res Clin Pract 2021; 173:108668. [PMID: 33453295 DOI: 10.1016/j.diabres.2021.108668] [Citation(s) in RCA: 8] [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: 09/15/2020] [Revised: 12/24/2020] [Accepted: 01/07/2021] [Indexed: 12/29/2022]
Abstract
AIMS To examine whether high-sensitivity C-reactive protein (hs-CRP) can predict all-cause death in Chinese adults with hyperglycemia. METHODS All the 237 diabetes and 49 prediabetes recruited in the study were evolved from the participants with impaired glucose tolerance in the original Da Qing Diabetes Study. Blood hs-CRP level was measured at 2006. Ten-year outcome of death was traced from 2006 to 2016. Cox model was used to analyse the association between hs-CRP level and the risk of all-cause death occurred over the subsequent 10 years. RESULTS During the follow-up, death occurred in 36 (37.9%) subjects in the highest hs-CRP tertile group (hs-CRP > 2.16 mg/L) and 19 (20.0%) in the lowest hs-CRP tertile group (hs-CRP < 0.82 mg/L, p < 0.05). The corresponding incidence of all-cause death (per 1,000 person-years) was 44.7 (95% CI 30.1-59.3) and 21.6 (95% CI 11.9-31.3) in the two groups respectively (p < 0.0001). The highest hs-CRP tertile was associated with the increased risk of all-cause death significantly (hazard ratio 1.88, 95% CI 1.07-3.32) after controlling for traditional risk factors. CONCLUSIONS Serum hs-CRP was predictive of 10-year all-cause death in Chinese adults with hyperglycemia, suggesting the impact of low-grade inflammation on mortality deserves more attention.
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Affiliation(s)
- Xin Qian
- Endocrinology and Cardiovascular Metabolism Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyao He
- Endocrinology and Cardiovascular Metabolism Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, Daqing, China
| | - Qiuhong Gong
- Endocrinology and Cardiovascular Metabolism Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yali An
- Endocrinology and Cardiovascular Metabolism Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Li
- Department of Cardiology, Da Qing First Hospital, Daqing, China
| | - Yanyan Chen
- Endocrinology and Cardiovascular Metabolism Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwei Li
- Endocrinology and Cardiovascular Metabolism Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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50
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Kowall B, Rathmann W, Kuß O, Herder C, Roden M, Stang A, Erbel R, Huth C, Thorand B, Meisinger C, Jöckel KH, Peters A. Associations between haemoglobin A 1c and mortality rate in the KORA S4 and the Heinz Nixdorf Recall population-based cohort studies. Diabetes Metab Res Rev 2021; 37:e3369. [PMID: 32558166 DOI: 10.1002/dmrr.3369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/30/2020] [Accepted: 06/12/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is limited knowledge about mortality risk in persons with increased haemoglobin A1c (HbA1c ) levels below the diabetes threshold. Moreover, little is known about how associations between increased HbA1c and mortality depend on the length of follow-up. Therefore, we studied associations between HbA1c and mortality over long-term follow-up in persons with and without known diabetes. METHODS We used data from two German population-based cohort studies: KORA S4 Study (Southern Germany, n = 1458, baseline visits in 1999 to 2001, baseline age 55 to 74 years, mortality follow-up 16.8 years) and Heinz Nixdorf Recall (HNR) Study (Ruhr area, n = 4613, baseline visits in 2000 to 2003, baseline age 45 to 75 years, mortality follow-up 17.8 years). Adjusted log-linear models were fitted to estimate relative risks (RRs) with 95% confidence intervals (CI). RESULTS In both cohorts, participants with HbA1c 39 to 41 mmol/mol (5.7%-5.9%) and HbA1c 42 to 46 mmol/mol (6.0% to 6.4%) did not have a larger overall mortality risk than participants with HbA1c < 39 mmol/mol (5.7%): the corresponding adjusted RRs were 1.00 (95% CI: 0.83-1.21) and 1.01 (0.80-1.27) in KORA and 0.99 (0.82-1.21) and 0.83 (0.65-1.07) in the HNR Study. For the pooled cohorts, the RR for HbA1c 39 to 46 mmol/mol (5.7%-6.4%) was 0.96 (0.85-1.07). Associations between newly detected diabetes (HbA1c ≥ 6.5%) and mortality were weak after 4 and 8 years of follow-up, but were stronger after 12 years of follow-up, whereas associations between previously known diabetes (baseline) and mortality decreased. CONCLUSIONS HbA1c -defined pre-diabetes is not associated with overall mortality. For newly detected and previously known diabetes, mortality risks vary with length of follow-up.
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Affiliation(s)
- Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Düsseldorf, Germany
| | - Oliver Kuß
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Düsseldorf, Germany
| | - Christian Herder
- German Center for Diabetes Research, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Cornelia Huth
- German Center for Diabetes Research, Düsseldorf, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Barbara Thorand
- German Center for Diabetes Research, Düsseldorf, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- Department of Epidemiology, Ludwig-Maximilian-Universität München, UNIKA-T Augsburg, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Annette Peters
- German Center for Diabetes Research, Düsseldorf, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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