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Chen T, Xiao S, Chen Z, Yang Y, Yang B, Liu N. Risk factors for peripheral artery disease and diabetic peripheral neuropathy among patients with type 2 diabetes. Diabetes Res Clin Pract 2024; 207:111079. [PMID: 38154538 DOI: 10.1016/j.diabres.2023.111079] [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: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
AIMS To investigate the prevalence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN) and the associated risk factors among Chinese patients with type 2 diabetes mellitus. METHODS A cross-sectional study was conducted using data between November 1, 2018, and December 31, 2022. PAD was defined as ABI ≤ 0.9. DPN diagnosis involved specialized physician assessments using questionnaires and vibration perception threshold tests. Logistic regression analysis was used to identify related factors. We also evaluated the association between the clustering of risk factors and disease incidence. RESULTS The study population comprised 13,315 patients (mean age: 63.3 years). 4.9 % of the patients had PAD and 43.9 % had DPN. Multivariate regression analysis revealed advanced age, smoking, hypertension, coronary heart disease, dyslipidemia, elevated HbA1c, and uric acid levels as independent risk factors for PAD. For DPN, independent risk factors included advanced age, female gender, hypertension, coronary heart disease, elevated total cholesterol, triglycerides, lipoprotein(a), fasting plasma glucose, HbA1c, alkaline phosphatase, cystatin C, albumin-to-creatinine ratio, and elevated homocysteine levels, whereas apolipoprotein A was a protective factor. The clustering of risk factors was prevalent and associated with higher disease risk. CONCLUSIONS Our study contributed to identifying high-risk individuals and improving lower limb health among diabetic individuals.
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Affiliation(s)
- Tian Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Shengjue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zhengdong Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yiqing Yang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Bingquan Yang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
| | - Naifeng Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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2
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Yen FS, Hsu CC, Su YC, Wei JCC, Hwu CM. Impacts of early insulin treatment vs glimepiride in diabetic patients with background metformin therapy: A nationwide retrospective cohort study. Medicine (Baltimore) 2021; 100:e25085. [PMID: 33655987 PMCID: PMC7939219 DOI: 10.1097/md.0000000000025085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Type 2 diabetes mellitus (T2DM) is a progressive disease. After metformin failure, the addition of insulin or sulfonylureas might increase the risk of hypoglycemia and cardiovascular (CV) morbidity. Here, the risk of all-cause mortality was compared between early insulin treatment and glimepiride use in T2DM patients with background metformin therapy.We conducted a 9-year retrospective cohort study from the population-based National Health Insurance Research Database in Taiwan. A total of 2054 patients with T2DM under insulin or glimepiride treatment were enrolled during 2004 to 2012. Overall event rates of all-cause mortality were compared between 1027 insulin users and 1027 matched glimepiride users.After the propensity score matching, the mortality rates were 72.5 and 4.42 per 1000 person-years for insulin users and glimepiride users. The adjusted hazard ratio of mortality was 14.47 (95% CI: 8.64-24.24; P value <.001) as insulin compared with glimepiride users. The insulin users had significantly higher risk of CV death (adjusted hazard ratio 7.95, 95% CI 1.65-38.3, P = .01) and noncardiovascular death (adjusted hazard ratio 14.9, 95% CI 8.4-26.3, P < .001).The nationwide study demonstrated that metformin plus insulin therapy was associated with higher risk of all-cause mortality.
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Affiliation(s)
- Fu-Shun Yen
- Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan
- Department of Health Services Administration, China Medical University, Taichung
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University, Taichung
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University
- Department of Medicine, Chung Shan Medical University Hospital
- Graduate Institute of Integrated Medicine, China Medical University, Taichung
| | - Chii-Min Hwu
- Department of Medicine, National Yang-Ming University School of Medicine
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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3
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Khokhar B, Quan H, Kaplan GG, Butalia S, Rabi D. Exploring novel diabetes surveillance methods: a comparison of administrative, laboratory and pharmacy data case definitions using THIN. J Public Health (Oxf) 2019; 40:652-658. [PMID: 28977382 DOI: 10.1093/pubmed/fdx096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 01/17/2023] Open
Abstract
Background The objective of this study was to identify patients with diabetes in a comprehensive primary care electronic medical records database using a number of different case definitions (clinical, pharmacy, laboratory definitions and a combination thereof) and understand the differences in patient populations being captured by each definition. Methods Data for this population-based retrospective cohort study was obtained from The Health Information Network (THIN). THIN is a longitudinal, primary care medical records database of over 9 million patients in UK. Primary outcome was a diagnosis of diabetes, defined by the presence of a diabetes read code, or an abnormal laboratory result, or a prescription for an Oral Anti-diabetic drug or insulin. A 2-year washout period was applied prior to the index of diabetes to avoid inclusion of prevalent cases for each case definition. Results This study demonstrated that different case definitions of diabetes identify different sub-populations of patients. When the cohorts were observed based on any measure of central tendency, each of the cohorts were reasonably comparable to each other. However, the distribution of each of the cohorts when grouped by age categories and sex, reveal differences. For example, using pharmacy case definition results in a bimodal distribution among women, one between 1-19 year and 35-39 age categories, and then again between 60-64 and 85 years-however, the histogram becomes more normally distributed when metformin was removed from the case definition. Conclusion Our results suggest that clinical, pharmacy, laboratory case definitions identify different sub-populations and using multiple case definitions is likely required to optimally identify the entire diabetes population within THIN. Our study also suggests that age and sex of patients may affect the indexing of diabetes in THIN and is critical to better understand these variations.
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Affiliation(s)
- Bushra Khokhar
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Sonia Butalia
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,Division of Endocrinology, Department of Medicine, 1820 Richmond Road SW, Calgary, Alberta, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada.,Division of Endocrinology, Department of Medicine, 1820 Richmond Road SW, Calgary, Alberta, Canada
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4
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Zghebi SS, Steinke DT, Rutter MK, Emsley RA, Ashcroft DM. Comparative risk of major cardiovascular events associated with second-line antidiabetic treatments: a retrospective cohort study using UK primary care data linked to hospitalization and mortality records. Diabetes Obes Metab 2016; 18:916-24. [PMID: 27177784 DOI: 10.1111/dom.12692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 02/05/2023]
Abstract
AIMS To examine the risk of major cardiovascular events associated with second-line diabetes therapies, in patients with type 2 diabetes, after adjusting for known cardiovascular risk factors. METHODS This was a retrospective cohort study of patients prescribed second-line regimens between 1998 and 2011 after first-line metformin. The UK Clinical Practice Research Datalink, with linked national hospitalization and mortality data, for the period up to December 2013, was used. Inverse probability of treatment-weighted time-varying Cox regression models was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for developing a major cardiovascular event (cardiovascular death, myocardial infarction, stroke, acute coronary syndrome, unstable angina, or coronary revascularization) associated with second-line therapies. Analyses adjusted for patient demographic characteristics, comorbidities, glycated haemoglobin, socio-economic status, ethnicity, smoking status and concurrent medications. RESULTS A total of 10 118 initiators of a second-line add-on to metformin of either a sulphonylurea (n = 6740), dipeptidyl peptidase-4 (DPP-4) inhibitor (n = 1030) or thiazolidinedione (n = 2348) were identified. After a mean (standard deviation) of 2.4 (1.9) years of follow-up, 386, 36 and 95 major cardiovascular events occurred in sulphonylurea-, DPP-4 inhibitor- and thiazolidinedione-initiators, respectively. In comparison with the metformin-sulphonylurea regimen, adjusted HRs were 0.78 (95% CI 0.55; 1.11) for the metformin-DPP-4 inhibitor regimen and 0.68 (95% CI 0.54; 0.85) for the metformin-thiazolidinedione regimen. CONCLUSIONS Thiazolidinedione add-on treatments to metformin were associated with lower risks of major cardiovascular disease or cardiovascular death compared with sulphonylurea add-on treatment to metformin. Lower, but non-statistically significant, risks were also found with DPP-4 inhibitor add-on therapies.
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Affiliation(s)
- S S Zghebi
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK
- Department of Pharmaceutics, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya
| | - D T Steinke
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - M K Rutter
- Endocrinology and Diabetes Research Group, Institute of Human Development, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R A Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK
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5
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Home PD, Dain MP, Freemantle N, Kawamori R, Pfohl M, Brette S, Pilorget V, Scherbaum WA, Vespasiani G, Vincent M, Balkau B. Four-year evolution of insulin regimens, glycaemic control, hypoglycaemia and body weight after starting insulin therapy in type 2 diabetes across three continents. Diabetes Res Clin Pract 2015; 108:350-9. [PMID: 25825361 DOI: 10.1016/j.diabres.2015.01.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/24/2014] [Accepted: 01/18/2015] [Indexed: 10/24/2022]
Abstract
AIMS It is of interest to understand how insulin therapy currently evolves in clinical practice, in the years after starting insulin in people with type 2 diabetes. We aimed to describe this evolution prospectively over 4 years, to assist health care planning. METHODS People who had started any insulin were identified from 12 countries on three continents. Baseline, then yearly follow-up, data were extracted from clinical records over 4 years. RESULTS Of the 2999 eligible people, 2272 were followed over 4 years. When starting insulin, mean (SD) duration of diabetes was 10.6 (7.8) years, HbA1c 9.5 (2.0)% (80 [22]mmol/mol) and BMI 29.3 (6.3)kg/m(2). Initial insulin therapy was basal 52%, premix 23%, mealtime+basal 14%, mealtime 8% and other 3%; at 4 years, 30%, 25%, 33%, 2% and 5%, respectively, with 5% not on insulin. Insulin dose was 20.2U/day at the start and 45.8U/day at year 4. There were 1258 people (55%) on their original regimen at 4 years, and this percentage differed according to baseline insulin regimen. HbA1c change was -2.0 (2.2)% (-22 [24]mmol/mol) and was similar by final insulin regimen. Hypoglycaemia prevalence was <20% in years 1-4. Body weight change was mostly in year 1, and was very variable, mean +2.7 (7.5)kg at year 4. CONCLUSION Different insulin regimens were started in people with differing characteristics, and they evolved differently; insulin dose, hypoglycaemia and body weight change were diverse and largely independent of regimen.
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Affiliation(s)
- Philip D Home
- Newcastle University, Newcastle upon Tyne, United Kingdom.
| | | | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, United Kingdom
| | - Ryuzo Kawamori
- Department of Medicine, Juntendo University, Tokyo, Japan
| | - Martin Pfohl
- Evangelisches Bethesda-Krankenhaus zu Duisburg GmbH, Duisburg, Germany
| | | | | | - Werner A Scherbaum
- Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Giacomo Vespasiani
- Diabetology and Metabolic Disorders Centre, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | | | - Beverley Balkau
- INSERM, U1018, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
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6
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Dailey G, Wang E. A review of cardiovascular outcomes in the treatment of people with type 2 diabetes. Diabetes Ther 2014; 5:385-402. [PMID: 25515096 PMCID: PMC4269651 DOI: 10.1007/s13300-014-0091-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a common and serious complication of type 2 diabetes mellitus (T2DM) often linked to the increased morbidity and mortality associated with T2DM. Monitoring and treating risk factors for CVD are important elements of diabetes management. This review aims to examine CV risk in people with relatively early and mild diabetes who are at substantial risk of CVD; it considers the impact of insulin therapy on this risk by focusing on key studies in patients with diabetes. METHODS A literature search was carried out using PubMed to identify key publications, between 2008 and 2013, related to insulin and its possible effect on CVD. This review examines CV risk in diabetes and the impact of insulin therapy on this risk. RESULTS Studies have shown that treatment with insulin glargine is associated with marked improvement in the lipid profile of people with T2DM. Intensive insulin therapy has been shown to lower mortality rates in people with diabetes following acute myocardial infarction after 1 year. Retrospective data also indicate that insulin reduces the risk of CVD events, regardless of whether people had comorbidities known to increase CV risk. The prospective ORIGIN (Outcome Reduction with Initial Glargine Intervention) trial found that treatment with insulin glargine had a neutral effect with regard to CV outcomes in people with prediabetes or early diabetes, compared with standard care. CONCLUSIONS Other ongoing, large-scale studies of insulin therapy should provide further insights into whether or not insulin therapy can influence long-term CV outcomes.
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7
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Golledge J, Quigley F, Velu R, Walker PJ, Moxon JV. Association of impaired fasting glucose, diabetes and their management with the presentation and outcome of peripheral artery disease: a cohort study. Cardiovasc Diabetol 2014; 13:147. [PMID: 25361884 PMCID: PMC4230372 DOI: 10.1186/s12933-014-0147-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/20/2014] [Indexed: 01/09/2023] Open
Abstract
Background Pre-diabetes and untreated diabetes are common in patients with peripheral artery disease however their impact on outcome has not been evaluated. We examined the association of impaired fasting glucose, diabetes and their treatment with the presentation, mortality and requirement for intervention in peripheral artery disease patients. Methods We prospectively recruited 1637 patients with peripheral artery disease, measured fasting glucose, recorded medications for diabetes and categorised them by diabetes status. Patients were followed for a median of 1.7 years. Results At entry 22.7% patients were receiving treatment for type 2 diabetes by oral hypoglycaemics alone (18.1%) or insulin (4.6%). 9.2% patients had non-medicated diabetes. 28.1% of patients had impaired fasting glucose (5.6-6.9 mM). Patients with non-medicated diabetes had increased mortality and requirement for peripheral artery intervention (hazards ratio 1.62 and 1.31 respectively). Patients with diabetes prescribed insulin had increased mortality (hazard ratio 1.97). Patients with impaired fasting glucose or diabetes prescribed oral hypoglycaemics only had similar outcomes to patients with no diabetes. Conclusions Non-medicated diabetes is common in peripheral artery disease patients and associated with poor outcomes. Impaired fasting glucose is also common but does not increase intermediate term complications. Peripheral artery disease patients with diabetes requiring insulin are at high risk of intermediate term mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12933-014-0147-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia, 4811. .,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia.
| | - Frank Quigley
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia.
| | - Ramesh Velu
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia.
| | - Phillip J Walker
- Discipline of Surgery and Centre for Clinical Research, University of Queensland School of Medicine, Brisbane, Australia. .,Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia, 4811.
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Currie CJ, Holden SE. Optimizing clinical outcomes resulting from glucose-lowering therapies in type 2 diabetes: increased confidence about the DPP-4 inhibitors and continued concerns regarding sulphonylureas and exogenous insulin. Diabetes Obes Metab 2014; 16:881-4. [PMID: 25040702 DOI: 10.1111/dom.12349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 12/22/2022]
Affiliation(s)
- C J Currie
- Cochrane Institute of Public Health & Primary Care, School of Medicine, Cardiff University, Cardiff, UK
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9
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Associations between different types of hypoglycemic agents and the clinical outcome of percutaneous coronary intervention in diabetic patients-From the FU-Registry. J Cardiol 2014; 65:390-6. [PMID: 25128368 DOI: 10.1016/j.jjcc.2014.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 05/29/2014] [Accepted: 06/20/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is not clear whether it is reasonable to use particular drugs for glycemic control in preference to other hypoglycemic agents in terms of the clinical outcome of percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM). METHODS AND RESULTS Among 2148 patients (2568 lesions) in the FU-Registry, DM patients who underwent PCI (n=758; 922 lesions) were investigated to clarify the effects of various drugs for glycemic control on the clinical outcome [major adverse cardiac events (MACEs): death, myocardial infarction (MI), and target lesion revascularization (TLR)] over approximately 300 days of follow-up (UMIN000005679). The MACEs(+) group (n=165) had a higher usage of insulin (p<0.001) and a lower usage of biguanides (BG, p<0.05) and dipeptidyl peptidase-IV inhibitors (p<0.05) at PCI, compared to the MACEs(-) group (n=593). A multivariate logistic regression analysis showed that low-density lipoprotein cholesterol, insulin use, atherosclerosis obliterans, and lesion reference might be significantly associated with MACEs, while BG use was negatively correlated with MACEs (p=0.04). The cumulative frequency of MACEs in the insulin-treated group was significantly higher (p<0.05) than that in the non-insulin group, and the strongest association between insulin with MACEs was seen in the hemoglobin (Hb) A1c 6.5-7.5% group. There tended to be a negative correlation between the use of insulin and MACEs, with risk ratios of <1, for the HbA1c >8.5% groups. CONCLUSIONS Among different hypoglycemic agents, treatment with insulin was associated with poor mid-term clinical outcomes in DM patients who underwent PCI, while BG use was negatively correlated with MACEs. It may be reasonable for patients with HbA1c >8.5% to avoid hyperglycemia and glucotoxicity, even through the use of insulin.
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10
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Patterns of Prescription of Antidepressants and Antipsychotics Across and Within Pregnancies in a Population-Based UK Cohort. Matern Child Health J 2013; 18:1742-52. [DOI: 10.1007/s10995-013-1419-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mamtani R, Haynes K, Finkelman BS, Scott FI, Lewis JD. Distinguishing incident and prevalent diabetes in an electronic medical records database. Pharmacoepidemiol Drug Saf 2013; 23:111-8. [PMID: 24375925 DOI: 10.1002/pds.3557] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 11/03/2013] [Accepted: 11/18/2013] [Indexed: 11/09/2022]
Abstract
PURPOSE To develop a method to identify incident diabetes mellitus (DM) using an electronic medical records (EMR) database and test this classification by comparing incident and prevalent DM with common outcomes related to DM duration. METHODS Incidence rates (IRs) of DM (defined as a first diagnosis or prescription) were measured in 3-month intervals through 36 months after registration in The Health Improvement Network, a primary care database, from 1994 to 2012. We used Joinpoint regression to identify the point where a statistically significant change in the trend of IRs occurred. Further analyses used this point to distinguish those likely to have incident (n = 50 315) versus prevalent (n = 28 337) DM. Incident and prevalent cohorts were compared using Cox regression for all-cause mortality, cardiovascular disease (CVD), diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Analyses were adjusted for age, sex, smoking, obesity, hyperlipidemia, hypertension, and calendar year. RESULTS Trends in DM IRs plateaued 9 months after registration (p = 0.04). All cause-mortality was increased (hazard ratio (HR) 1.62, 95% CI 1.53-1.70) among patients diagnosed with DM prior to 9 months following registration (prevalent DM) compared to those diagnosed after 9 months (incident DM). Similarly, the risk of DM-related complications was higher in prevalent versus incident DM patients [CVD, HR 2.24 (2.08-2.40); diabetic retinopathy, HR 1.31 (1.24-1.38); diabetic nephropathy, HR 2.30 (1.95-2.72); diabetic neuropathy, HR 1.28 (1.16-1.41)]. CONCLUSION Joinpoint regression can be used to identify patients with newly diagnosed diabetes within EMR data. Failure to exclude patients with prevalent DM can lead to exaggerated associations of DM-related outcomes.
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Affiliation(s)
- Ronac Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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12
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Hall GC, McMahon AD, Dain MP, Wang E, Home PD. Primary-care observational database study of the efficacy of GLP-1 receptor agonists and insulin in the UK. Diabet Med 2013; 30:681-6. [PMID: 23330649 PMCID: PMC3698690 DOI: 10.1111/dme.12137] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 11/26/2012] [Accepted: 01/15/2013] [Indexed: 01/14/2023]
Abstract
AIMS We investigated use and efficacy of glucagon-like peptide-1 (GLP-1) receptor agonists in UK practice. METHODS People starting a GLP-1 receptor agonist (exenatide, liraglutide) or insulin (glargine, detemir, NPH) after a regimen of two or three oral glucose-lowering agents were identified from The Health Information Network observational primary care database (2007-2011). Mean change in HbA1c and body weight were compared at 1 year between cohorts, adjusting for baseline characteristics. RESULTS Baseline characteristics of GLP-1 receptor agonist (n = 1123) vs. insulin (n = 1842) users were HbA1c 78 vs. 84 mmol/mol (9.3 vs. 9.8%) and BMI 38.2 vs. 30.9 kg/m². The GLP-1 receptor agonist cohort was younger, had shorter diabetes duration and follow-up, less microvascular disease and heart failure, higher estimated glomerular filtration rate and more use of oral glucose-lowering agents. Lower HbA1c reduction on GLP-1 receptor agonist [7 vs. 13 mmol/mol (0.6 vs. 1.2%) (n = 366 vs. 892)] was not statistically significant [adjusted mean difference -1.4 (95% CI -4.1, 1.2) mmol/mol], except in the highest HbA1c quintile [>96 mmol/mol (>10.9%); adjusted mean difference -17.8 (-28.6, -7.0) mmol/mol]. GLP-1 receptor agonist users lost weight [-4.5 vs. +1.5 kg; adjusted mean difference 4.7 (3.7, 5.8) kg; n = 335 vs. 634]. A UK 6-month target reduction for GLP-1 receptor agonists of 11 mmol/mol (1.0%) HbA1c and 3% weight was reached by 24.9% of those continuing treatment. CONCLUSIONS Those starting GLP-1 receptor agonists are heavier with better glycaemic control than those starting basal insulin. Subsequently, they have improved weight change, with similar HbA1c reduction unless baseline HbA1c is very high. The UK 6-month GLP-1 receptor agonist target is usually not reached.
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13
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Hall GC, McMahon AD, Carroll D, Home PD. Observational study of the association of first insulin type in uncontrolled type 2 diabetes with macrovascular and microvascular disease. PLoS One 2012; 7:e49908. [PMID: 23166795 PMCID: PMC3498210 DOI: 10.1371/journal.pone.0049908] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/15/2012] [Indexed: 12/27/2022] Open
Abstract
Aims To compare the risk of vascular disease, HbA1c and weight change, between first prescribed insulins in people with type 2 diabetes. Methods People included in THIN United Kingdom primary care record database who began insulin (2000–2007) after poor control on oral glucose-lowering agents (OGLD) were grouped by the number of OGLDs in their treatment regimen immediately before starting insulin (n = 3,485). Within OGLD group, Cox regression compared macrovascular (all-cause mortality, myocardial infarction, acute coronary syndrome and stroke) and microvascular disease (peripheral neuropathy, nephropathy, and retinopathy) between insulin type (basal, pre-mix or Neutral Protamine Hagedorn, NPH) while ANCOVAs compared haemoglobin A1c (HbA1c) and weight change. Results Mean follow-up was 3.6 years. Rates of incident macrovascular events were similar when basal insulin was compared to pre-mix or NPH, adjusted hazard ratio versus basal: pre-mix 1.08 (95% CI 0.73, 1.59); NPH 1.00 (0.63, 1.58) after two OGLDs, and pre-mix 0.97 (0.46, 2.02); NPH 0.77 (0.32, 1.86) after three OGLDs. An increased risk of microvascular disease in NPH versus basal after 3 OGLDs, adjusted hazard ratio1.87 (1.04, 3.36), was not seen after two agents or in comparisons of basal and pre-mix. At one year, after two OGLDs, weight increase was less with basal compared with pre-mix. After three OGLDs, mean HbA1c had reduced less in basal versus pre-mix or NPH at 6–8 and at 9–11 months, and versus pre-mix at 12–14 months. Conclusion We found no difference in the risk of macrovascular events between first insulins in the medium term when started during poor glycaemia control. The increased risk of microvascular events with NPH warrants further study. In certain groups, first use of basal insulin was associated with less gain in weight and decrease in HbA1c compared to other insulins.
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