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Wang Z, Yu D, Osuagwu UL, Pickering K, Baker J, Cutfield R, Cai Y, Orr-Walker BJ, Sundborn G, Qu B, Zhao Z, Simmons D. Cancer risk following onset of type 2 diabetes in New Zealanders with impaired glucose tolerance over 25 years: a matched prospective cohort study. BMC Cancer 2024; 24:892. [PMID: 39048990 PMCID: PMC11270939 DOI: 10.1186/s12885-024-12637-4] [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: 01/21/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND In people with prediabetes, the link between developing type 2 diabetes (T2D) and cancer risk among those with impaired glucose tolerance (IGT) remains uncertain. We examined this association in IGT individuals from primary care in South and West Auckland, New Zealand, spanning 1994-2019, assessing 5- and 10-year cancer risks. METHODS Study cohorts were extracted from the Diabetes Care Support Service in Auckland, New Zealand, linking it with national registries for death, cancer, hospital admissions, pharmaceutical claims, and socioeconomic status. We compared cancer risks in individuals with IGT newly diagnosed with or without T2D within a 1-5-year exposure window. Employing tapered matching and landmark analysis to address potential confounding effects, we formed comparative IGT cohorts. Weighted Cox regression models were then employed to assess the association between T2D onset and 5- and 10-year cancer risks. RESULTS The study included 26,794 patients with IGT, with 629 newly diagnosed with T2D within 5 years and 13,007 without such a diagnosis. Those progressing to T2D had similar 5-year cancer risk but significantly higher 10-year risk (HR 1.35; 95% CI 1.09-1.68). This association was stronger in older individuals, the socioeconomically deprived, current smokers, those with worse metabolic measures, and lower renal function. Patients with IGT of NZ European ethnicity had lower 10-year cancer risk. CONCLUSIONS T2D diagnosis influences cancer risk in individuals with IGT. Developing risk scores for high-risk IGT individuals and implementing cancer screening and structured diabetes prevention, especially in deprived or minority ethnic populations, is essential.
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Affiliation(s)
- Zheng Wang
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
| | - Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
- Henan Institute of Interconnected Intelligent Health Management, First Affiliated Hospital, Zhengzhou University, Jianshe Road, Zhengzhou, Henan, 450052, China.
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Sydney NSW, 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, Sydney NSW, 2751, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | | | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, the University of Auckland, Auckland, New Zealand
| | - Bingjie Qu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China.
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Sydney NSW, 2560, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Sydney NSW, 2751, Australia.
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Tatsuno M, Wada T, Kato E, Hirayama K, Fujisawa M, Kimura Y, Ishimoto Y, Hirosaki M, Nose M, Yamada C, Kohori-Segawa H, Kasahara Y, Yamamoto N, Okumiya K, Matsubayashi K, Sakamoto R. Association between glucose tolerance and mortality among Japanese community-dwelling older adults aged over 75 years: 12-year observation of the Tosa Longitudinal Aging Study. Geriatr Gerontol Int 2023; 23:341-347. [PMID: 36992614 DOI: 10.1111/ggi.14572] [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: 09/18/2022] [Revised: 01/11/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
AIM Although the relationship between impaired glucose tolerance (IGT) and mortality has been investigated in diverse populations, few studies have focused on older populations. This study aimed to investigate the relationship between glucose tolerance and overall mortality among populations aged ≥75 years. METHODS Data were obtained from the Tosa Longitudinal Aging Study, a community-based cohort survey conducted in Kochi, Japan. According to the results of a 75-g oral glucose tolerance test conducted in 2006, the participants were classified into four categories: normal glucose tolerance (NGT), impaired fasting glucose (IFG)/IGT, newly diagnosed diabetes mellitus (NDM), and known diabetes mellitus (KDM). The primary endpoint was overall mortality. Differences in overall mortality among the four categories were evaluated using the Cox proportional hazards model. RESULTS During a median of 11.5 years of observation, 125 deaths of the 260 enrolled participants were recorded. The cumulative overall survival rate was 0.52, and the survival rates of NGT, IFG/IGT, NDM, and KDM were 0.48, 0.49, 0.49, and 0.25, respectively (log-rank test, P = 0.139). Adjusted hazard ratios (HRs) for mortality in the IFG/IGT and NDM groups compared with the NGT group were 1.02 (95% confidence interval [CI], 0.66-1.58) and 1.11 (95% CI, 0.56-2.22), while mortality in the KDM group was significantly higher than that in the NGT group (HR, 2.43; 95% CI, 1.35-4.37). CONCLUSION Mortality did not differ significantly between the IFG/IGT, NDM, and NGT groups, but was higher in the KDM group than in the NGT group. Geriatr Gerontol Int 2023; ••: ••-••.
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Affiliation(s)
- Mai Tatsuno
- Department of Field Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taizo Wada
- Department of Field Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Emiko Kato
- Department of Field Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiichi Hirayama
- Department of Field Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiko Fujisawa
- Department of Field Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Yumi Kimura
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Yasuko Ishimoto
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
- Department of Health and Sports Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Mayumi Hirosaki
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
- Department of Nursing, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Mitsuhiro Nose
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Chika Yamada
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Hiromi Kohori-Segawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoriko Kasahara
- Department of Fundamental Nursing, Division of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Kiyohito Okumiya
- Department of Field Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Kozo Matsubayashi
- Department of Field Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Ryota Sakamoto
- Department of Field Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
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Fang F, Wang N, Yan S, Wang L, Lu Y, Li J, Li H, Pham G, Li C, Leng SX, Tian H. Impaired glucose tolerance predicts all-cause mortality among older men at high risk for cardiovascular disease in China. Prim Care Diabetes 2019; 13:495-504. [PMID: 30862424 DOI: 10.1016/j.pcd.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 01/06/2023]
Abstract
AIMS To investigate the potential association between impaired glucose tolerance (IGT) and all-cause mortality among older men at high risk for cardiovascular disease (CVD) in China. METHODS In this prospective observational study, 460 older men aged ≥60 years were determined to have either IGT or normal glucose tolerance (NGT) based on an oral glucose tolerance test conducted between May 2005 and May 2007. IGT and NGT were diagnosed according to the 1999 WHO diagnostic criteria. All subjects were followed until March 2017. The primary outcome studied was all-cause mortality. Multivariate Cox models were used to estimate relative risk for all-cause mortality. RESULTS During a mean follow-up of 11.2 years, forty-three (21.4%) subjects in the IGT group and twenty-nine (11.2%) subjects in the NGT group died (HR 2.05, 95% CI 1.28-3.28, P=0.003). Multivariate Cox proportional-hazards analysis demonstated that IGT was significantly associated with increased risk for all-cause mortality, composite cardiovascular outcome, nonfatal stroke and heart failure after adjusting for potential confounding factors. Logistic regression analysis showed that IGT at baseline (P<0.05) rather than incident type 2 diabetes was a risk factor of all-cause mortality. CONCLUSIONS IGT was significantly associated with all-cause mortality in older Chinese men at high risk for CVD.
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Affiliation(s)
- Fusheng Fang
- Department of Health Care, Chinese PLA General Hospital, Beijing, China; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ning Wang
- Department of Health Care, Chinese PLA General Hospital, Beijing, China
| | - Shuangtong Yan
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Liangchen Wang
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Yanhui Lu
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Jian Li
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Huifen Li
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gabriel Pham
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chunlin Li
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Sean Xiao Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hui Tian
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, China.
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Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ 2016; 355:i5953. [PMID: 27881363 PMCID: PMC5121106 DOI: 10.1136/bmj.i5953] [Citation(s) in RCA: 577] [Impact Index Per Article: 72.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality. DESIGN Meta-analysis of prospective cohort studies. DATA SOURCES Electronic databases (PubMed, Embase, and Google Scholar). SELECTION CRITERIA Prospective cohort studies from general populations were included for meta-analysis if they reported adjusted relative risks with 95% confidence intervals for associations between the risk of composite cardiovascular disease, coronary heart disease, stroke, all cause mortality, and prediabetes. REVIEW METHODS Two authors independently reviewed and selected eligible studies, based on predetermined selection criteria. Prediabetes was defined as impaired fasting glucose according to the criteria of the American Diabetes Association (IFG-ADA; fasting glucose 5.6-6.9 mmol/L), the WHO expert group (IFG-WHO; fasting glucose 6.1-6.9 mmol/L), impaired glucose tolerance (2 hour plasma glucose concentration 7.8-11.0 mmol/L during an oral glucose tolerance test), or raised haemoglobin A1c (HbA1c) of 39-47 mmol/mol : (5.7-6.4%) according to ADA criteria or 42-47 mmol/mol (6.0-6.4%) according to the National Institute for Health and Care Excellence (NICE) guideline. The relative risks of all cause mortality and cardiovascular events were calculated and reported with 95% confidence intervals. RESULTS 53 prospective cohort studies with 1 611 339 individuals were included for analysis. The median follow-up duration was 9.5 years. Compared with normoglycaemia, prediabetes (impaired glucose tolerance or impaired fasting glucose according to IFG-ADA or IFG-WHO criteria) was associated with an increased risk of composite cardiovascular disease (relative risk 1.13, 1.26, and 1.30 for IFG-ADA, IFG-WHO, and impaired glucose tolerance, respectively), coronary heart disease (1.10, 1.18, and 1.20, respectively), stroke (1.06, 1.17, and 1.20, respectively), and all cause mortality (1.13, 1.13 and 1.32, respectively). Increases in HBA1c to 39-47 mmol/mol or 42-47 mmol/mol were both associated with an increased risk of composite cardiovascular disease (1.21 and 1.25, respectively) and coronary heart disease (1.15 and 1.28, respectively), but not with an increased risk of stroke and all cause mortality. CONCLUSIONS Prediabetes, defined as impaired glucose tolerance, impaired fasting glucose, or raised HbA1c, was associated with an increased risk of cardiovascular disease. The health risk might be increased in people with a fasting glucose concentration as low as 5.6 mmol/L or HbA1c of 39 mmol/mol.
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Affiliation(s)
- Yuli Huang
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
| | - Xiaoyan Cai
- Clinical Medicine Research Centre, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, China
| | - Weiyi Mai
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Meijun Li
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
- Department of Cardiology, Graduate College, Guangdong medical university, Zhanjiang, China
| | - Yunzhao Hu
- Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China
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Suemoto CK, Lebrao ML, Duarte YA, Danaei G. Effects of body mass index, abdominal obesity, and type 2 diabetes on mortality in community-dwelling elderly in Sao Paulo, Brazil: analysis of prospective data from the SABE study. J Gerontol A Biol Sci Med Sci 2015; 70:503-10. [PMID: 25209254 PMCID: PMC6281307 DOI: 10.1093/gerona/glu165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 08/07/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The majority of studies on the effects of adiposity on mortality in the elderly have been conducted in developed countries with mixed results. We investigated the association between adiposity and mortality in a cohort of community-dwelling elderly in Sao Paulo, Brazil. METHODS Body mass index (BMI), waist circumference, waist-to-hip ratio, and type 2 diabetes were evaluated in 1,882 participants (mean age 71.0 ± 8.3 years old, 61% female). Mortality was confirmed by national vital statistics records during a maximum of 10 years of follow-up. Proportional hazards models were used to estimate hazard ratios (HRs) for mortality after adjusting for sociodemographics and comorbidities. In a subsample of 897 participants, the effects of changes in measures of adiposity on mortality were investigated during a median follow-up of 4.6 years. RESULTS Having type-2 diabetes at baseline was associated with increased mortality (HR = 1.44, 95% CI: 1.17-1.77), with a higher HR among men. When compared with normal weight participants (BMI = 20-<25kg/m(2)), overweight and obesity were not associated with mortality (overweight: HR = 0.84 [0.70, 1.02]; obesity: HR = 0.82 [0.64, 1.06]), whereas participants with low-normal weight (BMI = 18.5<20 kg/m(2)) had increased risk of death (HR = 1.51 [1.08-2.10]). Higher waist circumference and waist-to-hip ratio were not associated with increased mortality. Weight gain was protective against mortality in all BMI categories, except in obese participants, and weight loss increased the risk of death in all BMI categories by 42-63%. CONCLUSIONS In community-dwelling elderly in Sao Paulo, overweight and obesity were not associated with a higher risk of death, and weight gain seemed to reduce mortality, except in the obese.
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Affiliation(s)
- Claudia K Suemoto
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Discipline of Geriatrics, University of Sao Paulo Medical School, Brazil.
| | | | - Yeda A Duarte
- Medical Surgical Nursing Department, School of Nursing, University of Sao Paulo, Brazil
| | - Goodarz Danaei
- Department of Global Health and Population and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
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Huang Y, Cai X, Chen P, Mai W, Tang H, Huang Y, Hu Y. Associations of prediabetes with all-cause and cardiovascular mortality: a meta-analysis. Ann Med 2014; 46:684-92. [PMID: 25230915 DOI: 10.3109/07853890.2014.955051] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reports on the association of prediabetes with all-cause mortality and cardiovascular mortality are inconsistent. Objective. To evaluate the risk of all-cause and cardiovascular mortality in association with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). METHODS Prospective cohort studies with data on prediabetes and mortality were included. The relative risks (RRs) of all-cause and cardiovascular mortality were calculated and reported with 95% confidence intervals (95% CIs). RESULTS Twenty-six studies were included. The risks of all-cause and cardiovascular mortality were increased in participants with prediabetes defined as IFG of 110-125 mg/dL (IFG 110) (RR 1.12, 95% CI 1.05-1.20; and RR 1.19, 95% CI 1.05-1.35, respectively), IGT (RR 1.33, 95% CI 1.24-1.42; RR 1.23, 95% CI 1.11-1.36, respectively), or combined IFG 110 and/or IGT (RR 1.21, 95% CI 1.11-1.32; RR 1.21, 95% CI 1.07-1.36, respectively), but not when IFG was defined as 100-125 mg/dL (RR 1.07, 95% CI 0.92-1.26; and RR 1.16, 95% CI 0.94-1.42, respectively). CONCLUSIONS Prediabetes, defined as IFG 110, IGT, or combined IFG 110 and/or IGT, was associated with increased all-cause and cardiovascular mortality.
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Affiliation(s)
- Yi Huang
- Clinical Medicine Research Institute, the Affiliated Hospital at Shunde, Southern Medical University , Foshan , PR China
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Huang Y, Cai X, Qiu M, Chen P, Tang H, Hu Y, Huang Y. Prediabetes and the risk of cancer: a meta-analysis. Diabetologia 2014; 57:2261-9. [PMID: 25208757 DOI: 10.1007/s00125-014-3361-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/31/2014] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS The results from prospective cohort studies of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) and risk of cancer are controversial. We conducted a meta-analysis to evaluate the risk of cancer in association with impaired fasting glucose and impaired glucose tolerance. METHODS The PubMed, EMBASE and Cochrane Library databases were searched for prospective cohort studies with data on prediabetes and cancer. Two independent reviewers assessed the reports and extracted the data. Prospective studies were included if they reported adjusted RRs with 95% CIs for the association between cancer and prediabetes. Subgroup analyses were conducted according to endpoint, age, sex, ethnicity, duration of follow-up and study characteristics. RESULTS Data from 891,426 participants were derived from 16 prospective cohort studies. Prediabetes was associated with an increased risk of cancer overall (RR 1.15; 95% CI 1.06, 1.23). The results were consistent across cancer endpoint, age, duration of follow-up and ethnicity. There was no significant difference for the risk of cancer with different definitions of prediabetes. In a site-specific cancer analysis, prediabetes was significantly associated with increased risks of cancer of the stomach/colorectum, liver, pancreas, breast and endometrium (all p < 0.05), but not associated with cancer of the bronchus/lung, prostate, ovary, kidney or bladder. The risks of site-specific cancer were significantly different (p = 0.01) and were highest for liver, endometrial and stomach/colorectal cancer. CONCLUSIONS/INTERPRETATION Overall, prediabetes was associated with an increased risk of cancer, especially liver, endometrial and stomach/colorectal cancer.
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Affiliation(s)
- Yi Huang
- Clinical Medicine Research Center, The First People's Hospital of Shunde, Penglai Road, Daliang Town, Shunde District, Foshan, 528300, People's Republic of China
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Kim NH, Kim DJ, Park SW, Oh JY, Park JY, Shin C, Lee HK, Park Y. Plasma glucose regulation and mortality in Korea: a pooled analysis of three community-based cohort studies. Diabetes Metab J 2014; 38:44-50. [PMID: 24627827 PMCID: PMC3950194 DOI: 10.4093/dmj.2014.38.1.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/09/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although diabetes is a well-known risk factor for death, its impact on cancer death is not clearly understood. Furthermore, it remains controversial whether impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are associated with increased risk of mortality. We investigated the impact of diabetes or glucose tolerance categories on all cause and cause-specific mortality. METHODS Mortality analysis was conducted in three population-based cohort studies of 3,801 participants, divided according to fasting plasma glucose (FPG) (normal; stage 1 IFG [5.6≤FPG<6.1 mmol/L]; stage 2 IFG [6.1≤FPG<7.0 mmol/L]; diabetes mellitus [DM]-FPG); or 2-hour glucose after 75 g glucose loading (2hPG) (normal; IGT; DM-2hPG), or a combination of FPG and 2hPG criteria. RESULTS During a median follow-up of 11.0 years, 474 subjects died from all causes. Hazard ratios (HRs) for all cause death were higher in those with diabetes as defined by either FPG or 2hPG criteria than their normal counterparts (HR, 2.2, 95% confidence interval [CI], 1.6 to 2.9 for DM-FPG; HR, 2.0, 95% CI, 1.5 to 2.7 for DM-2hPG). Similarly, diabetes defined by either FPG or 2hPG was associated with cancer death (HR, 2.9, 95% CI, 1.7 to 5.0; and HR, 2.1, 95% CI, 1.2 to 3.9, respectively). Although neither IFG nor IGT conferred higher risk for death, when combining stage 2 IFG and/or IGT, the risk of all cause death was higher than in subjects with normal glucose regulation (HR, 1.3; 95% CI, 1.0 to 1.6). CONCLUSION Diabetes is associated with higher risk of death from all causes and cancer. In subjects without diabetes, stage 2 IFG and/or IGT confers increased risk for mortality.
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Affiliation(s)
- Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Seok Won Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jee-Young Oh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Joong-Yeol Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hong Kyu Lee
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Yongsoo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine and Bioengineering, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
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Soulimane S, Simon D, Herman WH, Lange C, Lee CMY, Colagiuri S, Shaw JE, Zimmet PZ, Magliano D, Ferreira SRS, Dong Y, Zhang L, Jorgensen T, Tuomilehto J, Mohan V, Christensen DL, Kaduka L, Dekker JM, Nijpels G, Stehouwer CDA, Lantieri O, Fujimoto WY, Leonetti DL, McNeely MJ, Borch-Johnsen K, Boyko EJ, Vistisen D, Balkau B. HbA1c, fasting and 2 h plasma glucose in current, ex- and never-smokers: a meta-analysis. Diabetologia 2014; 57:30-9. [PMID: 24065153 PMCID: PMC4240946 DOI: 10.1007/s00125-013-3058-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/09/2013] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS The relationships between smoking and glycaemic variables have not been well explored. We compared HbA1c, fasting plasma glucose (FPG) and 2 h plasma glucose (2H-PG) in current, ex- and never-smokers. METHODS This meta-analysis used individual data from 16,886 men and 18,539 women without known diabetes in 12 DETECT-2 consortium studies and in the French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) and Telecom studies. Means of three glycaemic variables in current, ex- and never-smokers were modelled by linear regression, with study as a random factor. The I (2) statistic was used to evaluate heterogeneity among studies. RESULTS HbA1c was 0.10% (95% CI 0.08, 0.12) (1.1 mmol/mol [0.9, 1.3]) higher in current smokers and 0.03% (0.01, 0.05) (0.3 mmol/mol [0.1, 0.5]) higher in ex-smokers, compared with never-smokers. For FPG, there was no significant difference between current and never-smokers (-0.004 mmol/l [-0.03, 0.02]) but FPG was higher in ex-smokers (0.12 mmol/l [0.09, 0.14]). In comparison with never-smokers, 2H-PG was lower (-0.44 mmol/l [-0.52, -0.37]) in current smokers, with no difference for ex-smokers (0.02 mmol/l [-0.06, 0.09]). There was a large and unexplained heterogeneity among studies, with I (2) always above 50%; I (2) was little changed after stratification by sex and adjustment for age and BMI. In this study population, current smokers had a prevalence of diabetes that was 1.30% higher as screened by HbA1c and 0.52% lower as screened by 2H-PG, in comparison with never-smokers. CONCLUSION/INTERPRETATION Across this heterogeneous group of studies, current smokers had a higher HbA1c and lower 2H-PG than never-smokers. This will affect the chances of smokers being diagnosed with diabetes.
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Affiliation(s)
- Soraya Soulimane
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of diabetes, obesity and chronic kidney diseases over the lifecourse, Villejuif, France
- Université Paris Sud 11, UMRS 1018, Villejuif, France
| | - Dominique Simon
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of diabetes, obesity and chronic kidney diseases over the lifecourse, Villejuif, France
- Groupe Hospitalier Pitié Salpetrière, Diabetes Department, Paris, France
- Université Pierre et Marie Curie, Paris, France
| | | | - Celine Lange
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of diabetes, obesity and chronic kidney diseases over the lifecourse, Villejuif, France
- Université Paris Sud 11, UMRS 1018, Villejuif, France
| | - Crystal MY Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | - Stephen Colagiuri
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Paul Z Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Dianna Magliano
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Sandra RS Ferreira
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Yanghu Dong
- Department of Endocrinology and Metabolism, Qingdao Endocrine & Diabetes Hospital, Qingdao, China
- Weifang Medical University, Weifang, China
| | - Lei Zhang
- Department of Endocrinology and Metabolism, Qingdao Endocrine & Diabetes Hospital, Qingdao, China
- Weifang Medical University, Weifang, China
| | - Torben Jorgensen
- Research Centre for Prevention and Health, The Capitol Region of Denmark, Glostrup, Denmark
| | - Jaakko Tuomilehto
- Danube University Krems, Krems Austria,
- Center for Vascular Prevention Red RECAVA Grupo, Hospital Universitario La Paz, 28046 Madrid, Spain
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Viswanathan Mohan
- Dr.Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation Chennai, India
| | | | - Lydia Kaduka
- Centre for Public Health Research, KEMRI, Nairobi, Kenya
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Giel Nijpels
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Coen DA Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Wilfred Y Fujimoto
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Donna L Leonetti
- Department of Anthropology, University of Washington, Seattle, Washington, USA
| | | | | | - Edward J Boyko
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Dorte Vistisen
- Steno Diabetes Center A/S, Niels Steensens vej 2-4, 2820 Gentofte, Denmark
| | - Beverley Balkau
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of diabetes, obesity and chronic kidney diseases over the lifecourse, Villejuif, France
- Université Paris Sud 11, UMRS 1018, Villejuif, France
| | - DETECT-2 Study Group
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
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10
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Miller ME, Williamson JD, Gerstein HC, Byington RP, Cushman WC, Ginsberg HN, Ambrosius WT, Lovato L, Applegate WB. Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD Trial. Diabetes Care 2013; 37:634-43. [PMID: 24170759 PMCID: PMC3931381 DOI: 10.2337/dc13-1545] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/19/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We explore the effect of randomized treatment, comparing intensive to standard glucose-lowering strategies on major cardiovascular outcomes, death, and severe adverse events in older versus younger participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS Participants with type 2 diabetes (n = 10,251) with a mean age of 62 years, a median duration of diabetes of 10 years, and a median A1C of 8.1% (65 mmol/mol) were randomized to treatment strategies targeting either A1C <6.0% (42 mmol/mol) or 7.0-7.9% (53-63 mmol/mol) and followed for a mean of 3.7 years. Outcomes were analyzed within subgroups defined by baseline age (<65 vs. ≥65 years). RESULTS Older and younger ACCORD participants achieved similar intensive-arm A1C levels and between-arm A1C differences. Within the older subgroup, similar hazards of the cardiovascular primary outcome and total mortality were observed in the two arms. While there was no intervention effect on cardiovascular mortality in the older subgroup, there was an increased risk in the intensive arm for the younger subgroup (older hazard ratio [HR] = 0.97; younger HR = 1.71; P = 0.03). Regardless of intervention arm, the older subgroup experienced higher annualized rates of severe hypoglycemia (4.45% intensive and 1.36% standard) than the younger subgroup (2.45% intensive and 0.80% standard). CONCLUSIONS Intensive glucose lowering increased the risk of cardiovascular disease and total mortality in younger participants, whereas it had a neutral effect in older participants. The intensive to standard relative risk of severe hypoglycemia was similar in both age subgroups, with higher absolute rates in older participants within both treatment arms.
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Abstract
The role of diabetes in the pathogenesis of cardiovascular disease (CVD) was unclear until 1979 when Kannel et al used data from the Framingham Heart Study (FHS) to identify diabetes as a major cardiovascular risk factor. It was also one of the first studies to demonstrate the higher risk of CVD in women with diabetes compared to men with diabetes. Since then, multiple studies have been done to recognize and curtail cardiovascular risk factors such as smoking, obesity, hypertension, hyperlipidemia, and insulin resistance. This review will examine the contribution of the Kannel article and subsequent studies in defining the contribution of several risk factors on cardiovascular disease.
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12
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Muraja-Murro A, Eskola K, Kolari T, Tiihonen P, Hukkanen T, Tuomilehto H, Peltonen M, Mervaala E, Töyräs J. Mortality in middle-aged men with obstructive sleep apnea in Finland. Sleep Breath 2013; 17:1047-53. [PMID: 23361136 DOI: 10.1007/s11325-012-0798-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/13/2012] [Accepted: 12/24/2012] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) has been associated with an elevated rate of cardiovascular mortality. However, this issue has not been investigated in patients with elevated proneness to cardiovascular diseases. Our hypothesis was that OSA would have an especially adverse effect on the risk of cardiovascular mortality in Finnish individuals exhibiting elevated proneness for coronary heart diseases. METHODS Ambulatory polygraphic recordings from 405 men having suspected OSA were retrospectively analyzed. The patients were categorized regarding sleep disordered breathing into a normal group (apnea hypopnea index (AHI) < 5, n = 104), mild OSA group (5 ≤ AHI < 15, n = 100), and moderate to severe OSA group (AHI ≥ 15, n = 201). In addition, basic anthropometric and health data were collected. In patients who died during the follow-up period (at least 12 years and 10 months), the primary and secondary causes of death were recorded. RESULTS After adjustment for age, BMI, and smoking, the patients with moderate to severe OSA suffered significantly (p < 0.05) higher mortality (hazard ratio 3.13) than their counterparts with normal recordings. The overall mortality in the moderate to severe OSA group was 26.4 %, while in the normal group it was 9.7 %. Hazard ratio for cardiovascular mortality was 4.04 in the moderate to severe OSA and 1.87 in the mild OSA group. CONCLUSIONS OSA seems to have an especially adverse effect on the cardiovascular mortality of patients with an elevated genetic susceptibility to coronary heart diseases. When considering that all our patients had possibility of continuous positive airway pressure treatment and our reference group consisted of patients suffering from daytime somnolence, the hazard ratio of 4.04 for cardiovascular mortality in patients with moderate to severe disease is disturbingly high.
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Affiliation(s)
- A Muraja-Murro
- Department of Clinical Neurophysiology, Kuopio University Hospital, POB 1777, Kuopio, Finland.
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13
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Bozorgmanesh M, Hadaegh F, Sheikholeslami F, Ghanbarian A, Azizi F. Shadow of diabetes over cardiovascular disease: comparative quantification of population-attributable all-cause and cardiovascular mortality. Cardiovasc Diabetol 2012; 11:69. [PMID: 22704235 PMCID: PMC3461411 DOI: 10.1186/1475-2840-11-69] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 06/15/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We contrasted impacts on all-cause and cardiovascular disease (CVD) mortality of diabetes vs. CVD. METHODS Among participants the Tehran lipid and glucose study aged ≥ 30 years (n = 9752), we selected those who participated in the follow-up study until 20 March 2009 (n = 8795). Complete data on covariate were available for 8, 469 participants, contributing to a 67935 person-year follow up. In the analysis of outcomes (all-cause and CVD mortality), diabetes and CVD were assessed using Cox proportional hazard regression model adjusting for established CVD risk factors. We used population attributable hazard fraction (PAHF) and rate advancement period (RAP) that expresses how much sooner a given mortality rate is reached among exposed than among unexposed individuals. RESULTS Ten percent of the participants self-reported to have pervious CVD, and diabetes was ascertained in 17% of participants at baseline examination. During a median follow-up of 9 years 386 participants died of which 184 were due to CVD. All-cause and CVD mortality rate (95% CIs) were 5.5 (5.0-6.1) and 2.6 (2.3-3.0) per 1000 person-year, respectively. The PAHF of all-cause mortality for diabetes 9.2 (7.3-11.1) was greater than the one for CVD 3.5 (1.1-5.5). RAP estimates for all-cause mortality associated with diabetes ranged from 7.4 to 8.6 years whereas the RAP estimates for all-cause mortality associated with CVD ranged from 3.1 to 4.3 years. The PAHF of CVD mortality for diabetes 9.4 (6.8-12.0) was greater than the one for CVD 4.5 (1.8-7.0). RAP estimates for CVD mortality associated with diabetes ranged from 8.2 to 9.8 years whereas the RAP estimates for CVD mortality associated with CVD ranged from 4.7 to 6.7 years. CONCLUSIONS We demonstrated that diabetes, which was shown to be keeping pace with prevalent CVD in terms of conferring excess risk of incident CVD, is currently causing more deaths in the population than does CVD.
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Affiliation(s)
- Mohammadreza Bozorgmanesh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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14
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Chiang PH, Liu CL, Lin MH, Peng LN, Chen LK, Chen JD, Hou SM. Survival benefits of metabolic syndrome among older men aged 75 years and over in Taiwan. J Nutr Health Aging 2012; 16:520-4. [PMID: 22659989 DOI: 10.1007/s12603-011-0344-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) was common in the elderly, but its prognostic significance in older old population remained unclear. The main purpose of this study was to evaluate the survival impact of MetS among older men aged 75 and over in Taiwan. METHODS From 2008, residents aged 75 years and older of Banciao Veterans Home were invited for study and were followed for 3 years. All participants received history taking, physical examinations, and laboratory tests. Mortality was determined by Veteran Affairs Death Registry, which was linked to the National Death Registry. RESULTS Overall, 680 men (mean age: 82.5±4.7 years) were enrolled for study and the prevalence of MetS was 31.6%. During the follow-up period, 140 (20.6%) participants died, and the causes of death included infectious diseases (62, 9.1%), cardiovascular disease (37, 5.4%), cancer (20, 2.9%), and others (21, 3.1%). MetS subjects had a significantly higher prevalence of hypertension, diabetes mellitus, and having higher body mass index, waist circumferences, systolic blood pressure, fasting blood glucose, serum triglyceride and lower HDL-C level than non-MetS subjects. However, MetS subjects were less likely to die during study period (16.3% vs. 22.6%, P=0.059). Multivariate logistic regression showed that older age (OR:1.04, 95% C.I.: 1.00-1.08, P=0.04), diabetes mellitus (OR: 2.10, 95% CI: 1.34-3.30, P=0.001) were independent risk factors for mortality; and serum total cholesterol and triglyceride were protective factors (OR: 0.99, 95% CI: 0.99-1.00, P=0.037 for cholesterol; OR: 0.99, 95% CI: 0.99-1.00, P=0.013 for triglyceride). Adjusted for age, diabetes mellitus, serum levels of total cholesterol, and triglyceride, MetS played a potential trend of survival benefits among study subjects (HR: 0.71, 95% CI: 0.45-1.12, P=0.144). CONCLUSIONS The prevalence of MetS among men aged 75 years and over was 31.6%, and the 3-year mortality rate was 20.6%. Older age, diabetes mellitus, lower serum cholesterol and lower serum triglyceride were independent risk factors for mortality. Further investigation is needed to clarify the prognostic impact of MetS in older adults.
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Affiliation(s)
- P-H Chiang
- Department of Family Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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15
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Okada S, Morimoto T, Ogawa H, Kanauchi M, Nakayama M, Uemura S, Doi N, Jinnouchi H, Waki M, Soejima H, Sakuma M, Saito Y. Differential effect of low-dose aspirin for primary prevention of atherosclerotic events in diabetes management: a subanalysis of the JPAD trial. Diabetes Care 2011; 34:1277-83. [PMID: 21515838 PMCID: PMC3114321 DOI: 10.2337/dc10-2451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Recent reports showed that low-dose aspirin was ineffective in the primary prevention of cardiovascular events in diabetic patients overall. We hypothesized that low-dose aspirin would be beneficial in patients receiving insulin therapy, as a high-risk group. RESEARCH DESIGN AND METHODS This study is a subanalysis of the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial-a randomized, controlled, open-label trial. We randomly assigned 2,539 patients with type 2 diabetes and no previous cardiovascular disease to the low-dose aspirin group (81 or 100 mg daily) or to the no-aspirin group. The median follow-up period was 4.4 years. We investigated the effect of low-dose aspirin on preventing atherosclerotic events in groups receiving different diabetes management. RESULTS At baseline, 326 patients were treated with insulin, 1,750 with oral hypoglycemic agents (OHAs), and 463 with diet alone. The insulin group had the longest history of diabetes, the worst glycemic control, and the highest prevalence of diabetic microangiopathies. The diet-alone group had the opposite characteristics. The incidence of atherosclerotic events was 26.6, 14.6, and 10.4 cases per 1,000 person-years in the insulin, OHA, and diet-alone groups, respectively. In the insulin and OHA groups, low-dose aspirin did not affect atherosclerotic events (insulin: hazard ratio [HR] 1.19 [95% CI 0.60-2.40]; OHA: HR 0.84 [0.57-1.24]). In the diet-alone group, low-dose aspirin significantly reduced atherosclerotic events, despite the lowest event rates (HR 0.21 [0.05-0.64]). CONCLUSIONS Low-dose aspirin reduced atherosclerotic events predominantly in the diet-alone group and not in the insulin or OHA groups.
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Affiliation(s)
- Sadanori Okada
- First Department of Internal Medicine, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
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16
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Tan HH, McAlpine RR, James P, Thompson P, McMurdo MET, Morris AD, Evans JMM. Diagnosis of type 2 diabetes at an older age: effect on mortality in men and women. Diabetes Care 2004; 27:2797-9. [PMID: 15562187 DOI: 10.2337/diacare.27.12.2797] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the mortality of people who were diagnosed with type 2 diabetes over 65 years of age with that of nondiabetic individuals. RESEARCH DESIGN AND METHODS Using a population-based diabetes information system for an observational cohort study in Tayside, Scotland, people who were diagnosed with type 2 diabetes over the age of 65 years between 1993 and 2002 were identified. Nondiabetic comparators, matched for age and sex, were identified from the nondiabetic population. The two cohorts were followed up for mortality and cardiovascular mortality according to death certification records. RESULTS There were 3,594 people with type 2 diabetes (48% male) and 7,188 matched comparators identified in the study. Over a mean follow-up period of 4.6 +/- 2.9 years for 3,594 people with type 2 diabetes and 7,188 comparators, 909 (25.3%) patients in the diabetic cohort and 1,651 (23.0%) in the nondiabetic cohort died. The adjusted relative risk for mortality in the diabetic cohort compared with the nondiabetic cohort was 1.06 (95% CI 0.94-1.19) for men and 1.29 (1.15-1.45) for women. Cardiovascular deaths accounted for 49.4% of the deaths in people with and 45.2% in those without diabetes (adjusted relative risk 1.01 [0.93-1.10]). CONCLUSIONS Men diagnosed with type 2 diabetes over the age of 65 years have no excess mortality compared with their nondiabetic counterparts, a finding that was not replicated for women.
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Affiliation(s)
- Hwee H Tan
- Section of Public Health, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, Scotland
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17
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Katakura M, Naka M, Kondo T, Nishii N, Komatsu M, Sato Y, Yamauchi K, Hiramatsu K, Ikeda M, Aizawa T, Hashizume K. Prospective analysis of mortality, morbidity, and risk factors in elderly diabetic subjects: Nagano study. Diabetes Care 2003; 26:638-44. [PMID: 12610014 DOI: 10.2337/diacare.26.3.638] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To clarify mortality and morbidity of intensively managed elderly diabetic individuals and to explore factors predicting mortality and diabetes-related end points. RESEARCH DESIGN AND METHODS A total of 390 elderly (>or=65 years of age) outpatients with type 2 diabetes ( 173 men and 217 women, mean age 73.0 years) were analyzed. The mean HbA(1c) upon entry was 6.8% (332 receiving oral hypoglycemics and/or insulin) and blood pressure upon entry was 136/74 mmHg (219 receiving antihypertensive drugs). The patients have been followed-up for 3 years with HbA(1c) <7.0% and blood pressure <145/80 mmHg as targets, with mortality and an aggregate of fatal and nonfatal diabetes-related events as end points. Mortality rate and causes of mortality, as well as risk factors for mortality and morbidity, were determined. RESULTS The mortality rate, 2.9% per year, was comparable to that of the age- and sex-matched general population. Stroke was a leading cause of mortality after malignancy. By the univariate Cox proportional hazards model, only high serum creatinine and prior stroke were highly significant and strong risks for both end points. In those without prior stroke and receiving antihypertensive agents, the incidence of the diabetes-related end point based on their systolic blood pressure (SBP) quartile was U-shaped, with the nadir at the 3rd (SBP, 137-147 mmHg) and the peak at the 1st (SBP <or= 125 mmHg) quartile. CONCLUSIONS In well-controlled elderly diabetic subjects, there was no excessive mortality compared to the age- and sex-matched general population. Renal dysfunction and prior stroke were independent risks for mortality and morbidity. In those without prior stroke, a risk of too much lowering of blood pressure was suggested.
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18
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Bertoni AG, Krop JS, Anderson GF, Brancati FL. Diabetes-related morbidity and mortality in a national sample of U.S. elders. Diabetes Care 2002; 25:471-5. [PMID: 11874932 DOI: 10.2337/diacare.25.3.471] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although the number of elders with diabetes has increased dramatically, there are few data on rates of mortality and serious complications in older populations with diabetes. To determine such rates, we conducted a population-based, nonconcurrent cohort study using claims data from the 1994-1996 Medicare 5% Standard Analytical File. RESEARCH DESIGN AND METHODS Codes from the ICD-9 were used to identify diabetes and the following complications: amputation, lower extremity infection, gangrene, blindness, acute myocardial infarction, ischemic heart disease, stroke, and metabolic disorders. Using these codes, we assembled a cohort of 148,562 Medicare Part A and B beneficiaries who were > or = 65 years of age, who were alive on 1 January 1995, who were not in managed care in 1994, and who had a diabetes-related claim in 1994. Age-specific rates of death and complications were then calculated. RESULTS During 24 months of follow-up, 22,044 (14.8%) elders with diabetes died. Death rates in men and women increased significantly with age. Compared with their counterparts in the general U.S. population, elders with diabetes suffered excess mortality at every age group, corresponding to an overall standardized mortality ratio of 1.41 (95% CI 1.39,1.43). The incidence of ischemic heart disease and stroke was 181.5 and 126.2 per 1,000 person-years, respectively, which was higher than the incidence of all other diabetes-related complications. CONCLUSIONS In every age group, elders with diabetes have significantly higher all-cause mortality rates than the general population. Medicare data may be useful in monitoring trends in diabetes-related morbidity and total mortality in U.S. elders with diabetes.
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Affiliation(s)
- Alain G Bertoni
- Department of Medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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Casiglia E, Mazza A, Tikhonoff V, Pavei A, Privato G, Schenal N, Pessina AC. Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll. J Hum Hypertens 2002; 16:21-31. [PMID: 11840226 DOI: 10.1038/sj.jhh.1001288] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2001] [Revised: 07/18/2001] [Accepted: 08/02/2001] [Indexed: 11/09/2022]
Abstract
The aim of the CASTEL, a population-based (n=3282) prospective study which began 14 years ago, was to identify those items which had a prognostic impact in the elderly, and to evaluate whether the typical cardiovascular risk factors, particularly arterial hypertension, play a role after the age of 65 years. Initial screening, final follow-up and annual detection of mortality were performed. Mantel-Hanszel approach and multivariate Cox model were used for statistics. Cardiovascular mortality was 23.3% in normotensive, 23.3% in borderline, and 25% in the sustained hypertensive subjects (insignificant difference). In women, the incidence of stroke and coronary artery disease weakly depended on pulse pressure. Historical stroke and myocardial infarction predicted cardiovascular mortality in women; diabetes, uricaemia and high heart rate in men. In the very old, the predictors were less numerous, and blood pressure was not a predictor whatsoever; pulse blood pressure and murmurs at the neck were especially predictive in women, historical heart failure, proteinuria and tachycardia in men, historical stroke and myocardial infarction, pulmonary disease, left ventricular hypertrophy, diabetes and uricaemia in both genders. The elderly have a different cardiovascular risk pattern compared to younger people. Hypertension is not a predictor of coronary and stroke mortality. Prognosis depends on pulse pressure rather than on the label 'hypertension'. Hypercholesterolaemia is not a risk factor. This could simply indicate that elderly persons are the survivors in a population where significant mortality has already made its mark, eliminating those with the worst risk pattern. The two genders have a different risk profile due to sex-specific susceptibility to risk factors.
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Affiliation(s)
- E Casiglia
- Department of Clinical and Experimental Medicine, Laboratory of Epidemiology, University of Padova, Italy.
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20
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Saydah SH, Miret M, Sung J, Varas C, Gause D, Brancati FL. Postchallenge hyperglycemia and mortality in a national sample of U.S. adults. Diabetes Care 2001; 24:1397-402. [PMID: 11473076 DOI: 10.2337/diacare.24.8.1397] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although postchallenge hyperglycemia is a well-established feature of type 2 diabetes, its association with risk of mortality is uncertain. Therefore, the aim of this study was to assess the independent association of fasting and 2-h glucose levels with all-cause and cardiovascular disease (CVD) mortality. RESEARCH DESIGN AND METHODS We analyzed data from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study, a prospective cohort study of U.S. adults examined in the NHANES II, and focused on the 3,092 adults aged 30-74 years who underwent an oral glucose tolerance test at baseline (1976-1980). Deaths were identified from U.S. national mortality files from 1976 to 1992. To account for the complex survey design, we used SUDAAN statistical software for weighted analysis. RESULTS Compared with their normoglycemic counterparts (fasting glucose [FG] < 7.0 and 2-h glucose < 7.8 mmol/l), adults with fasting and postchallenge hyperglycemia (FG > or =7.0 and 2-h glucose > or =11.1 mmol/l) had a twofold higher risk of death after 16 years of follow-up (age- and sex-adjusted relative hazard [RH] 2.1, 95% CI 1.4-3.2). However, adults with isolated postchallenge hyperglycemia (FG < 7.0 and 2-h glucose > or =11.1 mmol/l) were also at higher risk of death (1.6, 1.0-2.6). In proportional hazards analysis, FG (fully adjusted RH 1.10 per 1 SD; 95% CI 1.01, 1.22) and 2-h glucose (1.14, 1.00-1.29) showed nearly identical predictive value for mortality. Similar trends were observed for CVD mortality. CONCLUSIONS These results suggest that postchallenge hyperglycemia is associated with increased risk of all-cause and CVD mortality independently of other CVD risk factors.
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Affiliation(s)
- S H Saydah
- Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA
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21
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Saydah SH, Loria CM, Eberhardt MS, Brancati FL. Subclinical states of glucose intolerance and risk of death in the U.S. Diabetes Care 2001; 24:447-53. [PMID: 11289466 DOI: 10.2337/diacare.24.3.447] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although clinically evident type 2 diabetes is a well-established cause of mortality, less is known about subclinical states of glucose intolerance. RESEARCH DESIGN AND METHODS Data from the Second National Health and Nutrition Examination Survey Mortality Study, a prospective study of adults, were analyzed. This analysis focused on a nationally representative sample of 3,174 adults aged 30-75 years who underwent an oral glucose tolerance test at baseline (1976-1980) and who were followed up for death through 1992. RESULTS Using 1985 World Health Organization criteria, adults were classified as having previously diagnosed diabetes (n = 248), undiagnosed diabetes (n = 183), impaired glucose tolerance (IGT) (n = 480), or normal glucose tolerance (n = 2,263). For these groups, cumulative all-cause mortality through age 70 was 41, 34, 27, and 20%, respectively (P < 0.001). Compared with those with normal glucose tolerance, the multivariate adjusted RR of all-cause mortality was greatest for adults with diagnosed diabetes (RR 2.11, 95% CI 1.56-2.84), followed by those with undiagnosed diabetes (1.77, 1.13-2.75) and those with IGT (1.42, 1.08-1.87; P < 0.001). A similar pattern of risk was observed for cardiovascular disease mortality. CONCLUSIONS In the U.S., there was a gradient of mortality associated with abnormal glucose tolerance ranging from a 40% greater risk in adults with IGT to a 110% greater risk in adults with clinically evident diabetes. These associations were independent of established cardiovascular disease risk factors.
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Affiliation(s)
- S H Saydah
- Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA
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Hoogeveen EK, Kostense PJ, Jakobs C, Dekker JM, Nijpels G, Heine RJ, Bouter LM, Stehouwer CD. Hyperhomocysteinemia increases risk of death, especially in type 2 diabetes : 5-year follow-up of the Hoorn Study. Circulation 2000; 101:1506-11. [PMID: 10747342 DOI: 10.1161/01.cir.101.13.1506] [Citation(s) in RCA: 177] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A high serum total homocysteine (tHcy) concentration is a risk factor for death, but the strength of the relation in patients with type 2 (non-insulin-dependent) diabetes mellitus compared with nondiabetic subjects is not known. A cross-sectional study suggested that the association between tHcy and cardiovascular disease is stronger in diabetic than in nondiabetic subjects. We therefore prospectively investigated the combined effect of hyperhomocysteinemia and type 2 diabetes on mortality. METHODS AND RESULTS Between October 1, 1989, and December 31, 1991, serum was saved from 2484 men and women, 50 to 75 years of age, who were randomly selected from the town of Hoorn, The Netherlands. Fasting serum tHcy concentration was measured in 171 subjects who died (cases; 76 of cardiovascular disease) and in a stratified random sample of 640 survivors (control subjects). Mortality risks were calculated over 5 years of follow-up by means of logistic regression. The prevalence of hyperhomocysteinemia (tHcy >14 micromol/L) was 25. 8%. After adjustment for major cardiovascular risk factors, serum albumin, and HbA(1c), the odds ratio (95% CI) for 5-year mortality was 1.56 (1.07 to 2.30) for hyperhomocysteinemia and 1.26 (1.02 to 1. 55) per 5-micromol/L increment of tHcy. The odds ratio for 5-year mortality for hyperhomocysteinemia was 1.34 (0.87 to 2.06) in nondiabetic subjects and 2.51 (1.07 to 5.91) in diabetic subjects (P=0.08 for interaction). CONCLUSIONS Hyperhomocysteinemia is related to 5-year mortality independent of other major risk factors and appears to be a stronger (1.9-fold) risk factor for mortality in type 2 diabetic patients than in nondiabetic subjects.
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Affiliation(s)
- E K Hoogeveen
- Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
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Qureshi AI, Giles WH, Croft JB. Impaired glucose tolerance and the likelihood of nonfatal stroke and myocardial infarction: the Third National Health and Nutrition Examination Survey. Stroke 1998; 29:1329-32. [PMID: 9660382 DOI: 10.1161/01.str.29.7.1329] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although diabetes mellitus (DM) is known to increase the risk of cardiovascular disease (CVD), the effect of impaired glucose tolerance (IGT) on the risk remains unclear. We determined whether IGT was associated with an increased likelihood for stroke and myocardial infarction in a nationally representative sample of US adults. METHODS We evaluated the association between IGT (defined as a fasting glucose level of < 140 mg/dL and a plasma glucose level of between 140 and 200 mg/dL 2 hours after administration of 75 grams of an oral glucose load) and DM (defined as the current use of insulin or an oral hypoglycemic medication, a fasting plasma glucose level of > 140 mg/dL, or a plasma glucose level of > 200 mg/dL 2 hours after administration of an oral glucose load) with a self-reported physician diagnosis of stroke and myocardial infarction in 6547 adults aged 40 to 74 years participating in the Third National Health and Nutrition Examination Survey. Multivariate logistic regression analyses were used to investigate these relationships. RESULTS IGT and DM were observed in 1494 and 1532 adults, respectively. After adjustment for differences in age, gender, race/ethnicity, education, hypertension, cholesterol, body mass index, and cigarette smoking, IGT was not associated with stroke (odds ratio [OR], 0.9; 95% confidence interval [CI], 0.5 to 1.6) or myocardial infarction (OR, 1.1; 95% CI, 0.7 to 1.6). DM was associated with both stroke (OR, 1.6; 95% CI, 1.0 to 2.6) and myocardial infarction (OR, 1.9; 95% CI, 1.3 to 2.8). CONCLUSIONS In contrast to DM, IGT was not associated with an increased likelihood of prevalent nonfatal stroke or myocardial infarction.
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Affiliation(s)
- A I Qureshi
- Cardiovascular Health Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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24
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Koskinen SV, Reunanen AR, Martelin TP, Valkonen T. Mortality in a large population-based cohort of patients with drug-treated diabetes mellitus. Am J Public Health 1998; 88:765-70. [PMID: 9585742 PMCID: PMC1508922 DOI: 10.2105/ajph.88.5.765] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This paper presents detailed cause-specific data about excess mortality among diabetic persons in Finland, by age and sex. METHODS Five-year follow-up data on the Finnish population aged 30 through 74 years were analyzed. During these 5 years, 11,215 persons with diabetes and 102,843 persons without diabetes died. The diabetic population was defined as people who were entitled to free medication for diabetes at the beginning of the follow-up period, that is, at the end of 1980. RESULTS The relative mortality of persons with drug-treated diabetes compared with nondiabetic persons was higher among women (3.4) than among men (2.4). Almost three quarters of the mortality excess was due to circulatory diseases. For most other causes of death, too, diabetic persons had higher than average mortality. The exceptions were lung cancer, chronic obstructive pulmonary disease, and alcohol poisoning. CONCLUSIONS Diabetes is a general risk factor for untimely death and makes a significant contribution to overall national death rates, particularly for circulatory diseases. Lower than average mortality from smoking-related diseases and alcohol poisoning, however, warrant optimism about the effects of health education among diabetic persons.
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Affiliation(s)
- S V Koskinen
- Department of Health and Disability, National Public Health Institute, Helsinki, Finland.
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25
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Lindberg O, Tilvis RS, Strandberg TE, Valvanne J, Sairanen S, Ehnholm C, Tuomilehto J. Impacts of components of the metabolic syndrome on health status and survival in an aged population. Eur J Epidemiol 1997; 13:429-34. [PMID: 9258549 DOI: 10.1023/a:1007325609315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The clinical significances of different components of the multiple metabolic syndrome were studied in a five-year follow-up study of random persons (n = 1,199) of four birth cohorts at ages 65, 75, 80, and 85 years. The subjects were examined clinically and their serum lipids, blood glucose, plasma insulin, blood pressure, and health score were determined. The health score was measured using a visual analogue scale. All subjects were followed for 5 years. Health score, diastolic blood pressure and body mass index declined over age, but serum triglycerides, and blood glucose were similar, whilst serum high density lipoprotein (HDL)-cholesterol increased. Among women fasting plasma insulin was lowest in the age group of 65 years. The associations of components of the multiple metabolic syndrome varied by age. In the age groups of 65 and 75 years high body mass index, plasma insulin, glucose, triglycerides and low HDL-cholesterol were associated with impaired health. In the age group of 85 years high blood pressure, total cholesterol, and HDL-cholesterol were associated with good health. The baseline health score was consistently lower in the decedents than survivors of all age groups, but components of the metabolic syndrome were generally not associated with impaired survival.
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Affiliation(s)
- O Lindberg
- Department of Medicine, University of Helsinki, Finland
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26
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de Fine Olivarius N, Andreasen AH. Five-year all-cause mortality of 1323 newly diagnosed middle-aged and elderly diabetic patients. Data from the population-based study, diabetes care in general practice, Denmark. J Diabetes Complications 1997; 11:83-9. [PMID: 9101392 DOI: 10.1016/s1056-8727(96)00096-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The 5- to 6-year all-cause mortality is analyzed in 1323 newly diagnosed diabetic patients aged 40 years or over. The median age at diagnosis is lower for men (63.6 years) than for women (67.5 years), but more men (24.7%) than women (20.0%) have died (p = 0.04). This male excess mortality can be attributed mainly to the 60- to 79-year-old men. With increasing diabetes duration, both male and female diabetic patients exhibit an increasing excess mortality in comparison with the Danish population. For men, this excess mortality becomes statistically significant 4 years after diagnosis for the 40- to 59-year-old patient and 6 years after diagnosis for the 60- to 79-year-old patient. For women and very old men, no statistically significant excess mortality is observed. After 2-4 years, however, there is a tendency for the survival curve of 40- to 79-year-old women to separate from that of the Danish female population to show an excess mortality. In this population-based study, the disadvantageous mortality experience of even newly diagnosed diabetic patients is clearly demonstrated.
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Affiliation(s)
- N de Fine Olivarius
- Central Research Unit of General Practice, Panum Institute, Copenhagen, Denmark
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Muggeo M, Verlato G, Bonora E, Bressan F, Girotto S, Corbellini M, Gemma ML, Moghetti P, Zenere M, Cacciatori V. The Verona diabetes study: a population-based survey on known diabetes mellitus prevalence and 5-year all-cause mortality. Diabetologia 1995; 38:318-25. [PMID: 7758879 DOI: 10.1007/bf00400637] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This population-based survey aimed to determine the prevalence of known diabetes mellitus on 31 December 1986, and to assess all-cause mortality in the subsequent 5 years (1987-1991) in Verona, Italy. In the study of prevalence, 5996 patients were identified by three independent sources: family physicians, diabetes clinics, and drug prescriptions for diabetes. Mortality was assessed by matching all death certificates of Verona in 1987-1991 with the diabetic cohort. Overall diabetes prevalence was 2.61% (95% confidence interval 2.56-2.67). Prevalence of insulin-dependent and non-insulin-dependent diabetes mellitus was 0.069% (0.059-0.078) and 2.49% (2.43-2.54), respectively. Diabetes prevalence sharply increased after age 35 years up to age 75-79, and finally declined. Prevalence was higher in men up to age 69 years, in women after age 75 years. Of the diabetic cohort 1260 patients (592 men, 668 women) died by 31 December 1991, yielding an overall standardized mortality ratio of 1.46 (CI 1.38-1.54). Even though the differences narrowed with age, mortality rates in the diabetic cohort were higher than in the non-diabetic population at all ages. Women aged 65-74 years showed observed/expected ratio higher than men (2.27, CI 1.92-2.66, vs 1.50, CI 1.30-1.72), while in other age groups the sex-related differences were not significant. Pharmacological treatment of diabetes was associated with an excess mortality, while treatment with diet alone showed an apparent protective effect on mortality (observed/expected ratio 0.73, CI 0.58-0.92).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Muggeo
- Institute of Metabolic Diseases, University of Verona, Italy
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Dornan T. Diabetes in the Elderly: Epidemiology. Med Chir Trans 1994; 87:609-12. [PMID: 7966112 PMCID: PMC1294854 DOI: 10.1177/014107689408701016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T Dornan
- Hope Hospital, Salford Manchester, UK
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