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Angriman F, Saoraya J, Lawler PR, Shah BR, Martin CM, Scales DC. Preexisting Diabetes Mellitus and All-Cause Mortality in Adult Patients With Sepsis: A Population-Based Cohort Study. Crit Care Explor 2024; 6:e1085. [PMID: 38709081 DOI: 10.1097/cce.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVES We assessed the association of preexisting diabetes mellitus with all-cause mortality and organ support receipt in adult patients with sepsis. DESIGN Population-based cohort study. SETTING Ontario, Canada (2008-2019). POPULATION Adult patients (18 yr old or older) with a first sepsis-related hospitalization episode. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The main exposure of interest was preexisting diabetes (either type 1 or 2). The primary outcome was all-cause mortality by 90 days; secondary outcomes included receipt of invasive mechanical ventilation and new renal replacement therapy. We report adjusted (for baseline characteristics using standardization) risk ratios (RRs) alongside 95% CIs. A main secondary analysis evaluated the potential mediation by prior metformin use of the association between preexisting diabetes and all-cause mortality following sepsis. Overall, 503,455 adults with a first sepsis-related hospitalization episode were included; 36% had preexisting diabetes. Mean age was 73 years, and 54% of the cohort were females. Preexisting diabetes was associated with a lower adjusted risk of all-cause mortality at 90 days (RR, 0.81; 95% CI, 0.80-0.82). Preexisting diabetes was associated with an increased risk of new renal replacement therapy (RR, 1.53; 95% CI, 1.46-1.60) but not invasive mechanical ventilation (RR, 1.03; 95% CI, 1.00-1.05). Overall, 21% (95% CI, 19-28) of the association between preexisting diabetes and reduced risk of all-cause mortality was mediated by prior metformin use. CONCLUSIONS Preexisting diabetes is associated with a lower risk of all-cause mortality and higher risk of new renal replacement therapy among adult patients with sepsis. Future studies should evaluate the underlying mechanisms of these associations.
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Affiliation(s)
- Federico Angriman
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Jutamas Saoraya
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- McGill University Health Centre, Montreal, QC, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Patrick R Lawler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- McGill University Health Centre, Montreal, QC, Canada
| | - Baiju R Shah
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
- McGill University Health Centre, Montreal, QC, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Claudio M Martin
- Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Luppa PB, Zeller M, Pieper M, Kaiser P, Weiss N, Vierbaum L, Freckmann G. Quality assessment of glucose measurement with regard to epidemiology and clinical management of diabetes mellitus in Germany. Front Mol Biosci 2024; 11:1371426. [PMID: 38572446 PMCID: PMC10987728 DOI: 10.3389/fmolb.2024.1371426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
Background During the last decade, Germany has seen an increased prevalence and a redistribution from undetected to diagnosed diabetes mellitus. Due to this substantial epidemiological development, the number of people with documented type 2 diabetes was 8.7 million in 2022. An estimated two million undiagnosed subjects are to be added. Beyond that, the life expectancy of diabetic subjects is increasing due to more responsive health systems in terms of care. Possible reasons include improved screening of at-risk individuals, the introduction of HbA1c for diagnosis in 2010, and the higher use of risk scores. Additionally, quality aspects of the laboratory methodology should be taken into consideration. Methods Epidemiology and clinical management of diabetes in Germany are presented in the light of publications retrieved by a selective search of the PubMed database. Additionally, the data from German external quality assessment (EQA) surveys for the measurands glucose in plasma and HbA1c in whole blood, reviewed from 2010 until 2022, were evaluated. Above this, data concerning the analytical performance of near-patient glucometer devices, according to the ISO norm 15197:2013, were analyzed. Results Two laboratory aspects are in good accordance with the observation of an increase in the diabetes mellitus prevalence when retrospectively reviewing the period 2010 to 2022: First, the analytical performance according to the ISO norm 15197:2013 of the glucometer devices widely used by patients with diabetes for the glucose self-testing, has improved during this period. Secondly, concerning the EQA program of INSTAND, the number of participating laboratories raised significantly in Germany. The spreads of variations of the specified results for plasma glucose remained unchanged between 2010 and 2022, whereas for HbA1c a significant decrease of the result scattering could be observed. Conclusion These retrospectively established findings testify to an excellent analytical quality of laboratory diagnostics for glucose and HbA1c throughout Germany which may be involved in a better diagnosis and therapy of previously undetected diabetes mellitus.
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Affiliation(s)
- Peter B. Luppa
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technische Universität München, Munich, Germany
| | - Michael Zeller
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technische Universität München, Munich, Germany
| | - Marija Pieper
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technische Universität München, Munich, Germany
| | - Patricia Kaiser
- INSTAND e.V., Gesellschaft zur Förderung der Qualitätssicherung in Medizinischen Laboratorien e.V., Düsseldorf, Germany
| | - Nathalie Weiss
- INSTAND e.V., Gesellschaft zur Förderung der Qualitätssicherung in Medizinischen Laboratorien e.V., Düsseldorf, Germany
| | - Laura Vierbaum
- INSTAND e.V., Gesellschaft zur Förderung der Qualitätssicherung in Medizinischen Laboratorien e.V., Düsseldorf, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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Holland D, Fryer AA, Stedman M, Hanna FWF, Duff CJ, Green L, Scargill J, Halsall I, Gaskell N, Howe JD, Heald AH, Wu P. Is the Current Cut Point for Glycated Haemoglobin (HbA1c) Correct for Diagnosing Diabetes Mellitus in Premenopausal Women? Evidence to Inform Discussion. Diabetes Ther 2024; 15:99-110. [PMID: 37777677 PMCID: PMC10786809 DOI: 10.1007/s13300-023-01482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION Women are on average diagnosed with diabetes mellitus at later age than men but have higher mortality. As the diagnosis of diabetes mellitus is primarily based on HbA1c, the use of a non-specific reference range and cut point for diabetes mellitus that does not account for gender differences in diabetes could potentially lead to underdiagnosis of diabetes mellitus in women and missed opportunities for intervention. We investigated whether a contributing factor to the later diagnosis in women may be a difference in distribution of HbA1c in premenopausal women versus men of the same age by comparing HbA1c values in men and women across multiple sites in the UK. METHODS We analysed the HbA1c levels of 146,907 individuals who underwent single testing only and had HbA1c ≤ 50 mmol/mol between 2012 and 2019 in one laboratory (cohort 1). This was replicated in six laboratories with 938,678 individuals tested between 2019 and 2021 (cohort 2). RESULTS In cohort 1, women < 50 years old had an HbA1c distribution markedly lower than that in men by a mean of 1.6 mmol/mol (p < 0.0001), while the difference in the distribution of HbA1c for individuals aged ≥ 50 years was less pronounced (mean difference 0.9 mmol/mol, p < 0.0001). For individuals under the age of 50, HbA1c in women lagged by up to 10 years compared to men. Similar findings were found in cohort 2. We estimated an additional 17% (n = 34,953) of undiagnosed women aged < 50 years in England and Wales could be reclassified to have diabetes mellitus, which may contribute to up to 64% of the difference in mortality rates between men/women with diabetes mellitus aged 16-50 years. CONCLUSION The HbA1c cut point for diagnosis of diabetes mellitus may need to be re-evaluated in women under the age of 50 years. Early identification of diabetes mellitus in women has the potential to improve women's health outcomes in the longer term.
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Affiliation(s)
| | - Anthony A Fryer
- School of Medicine, Keele University, Keele, ST5 5BG, Staffordshire, UK
| | | | - Fahmy W F Hanna
- Centre for Health & Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, Staffordshire, UK
- Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, Staffordshire, UK
| | - Christopher J Duff
- School of Medicine, Keele University, Keele, ST5 5BG, Staffordshire, UK
- Department of Clinical Biochemistry, North Midlands and Cheshire Pathology Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, Staffordshire, UK
| | - Lewis Green
- Department of Clinical Biochemistry, St. Helens & Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, L35 5DR, UK
| | - Jonathan Scargill
- Department of Clinical Biochemistry, The Royal Oldham Hospital, The Northern Care Alliance, Oldham, OL1 2JH, UK
| | - Ian Halsall
- Core Biochemical Assay Laboratory, Department of Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Neil Gaskell
- Department of Pathology, Warrington & Halton Teaching Hospitals NHS Foundation Trust, Warrington, WA5 1QG, UK
| | - Jonathon D Howe
- Department of Clinical Biochemistry, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK.
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, M13 9PL, UK.
| | - Pensee Wu
- School of Medicine, Keele University, Keele, ST5 5BG, Staffordshire, UK
- Department of Obstetrics & Gynaecology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, Staffordshire, UK
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Li X, Liu R, Chen Y, Han Y, Wang Q, Xu Y, Zhou J, Jiang S. Patterns and Trends in Mortality Associated With and Due to Diabetes Mellitus in a Transitioning Region With 3.17 Million People: Observational Study. JMIR Public Health Surveill 2023; 9:e43687. [PMID: 37665630 PMCID: PMC10507522 DOI: 10.2196/43687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 06/20/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) imposes a significant disease burden in economically transitioning regions. Most transitioning regions share similar experience in urbanization processes. Shanghai's Pudong district serves as a representative area of such regions. OBJECTIVE We aimed to assess the burden of and trends in DM mortality in Shanghai's Pudong district and analyze the impact of aging and multimorbidity. METHODS A longitudinal, population-based study was conducted to analyze DM mortality in Pudong from 2005 to 2020. We used joinpoint regression to analyze epidemiological features and long-term trends in crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), and years of life lost (YLL). Furthermore, the decomposition method was used to evaluate the contribution of demographic and nondemographic factors associated with mortality. RESULTS There were 49,414 deaths among individuals with DM, including 15,512 deaths due to DM. The CMR and ASMRW were 109.55/105 and 38.01/105 person-years, respectively. Among the mortality associated with and due to DM, the total annual ASMRW increased by 3.65% (95% CI 3.25%-4.06%) and 1.38% (95% CI 0.74%-2.02%), respectively. Additionally, the total annual YLL rate increased by 4.98% (95% CI 3.92%-6.05%) and 2.68% (95% CI 1.34%-4.04%). The rates of YLL increase in persons aged 30 to 44 years (3.98%, 95% CI 0.32%-7.78%) and 45 to 59 years (4.31%, 95% CI 2.95%-5.69%) were followed by the increase in persons aged 80 years and older (10.53%, 95% CI 9.45%-11.62%) for deaths associated with DM. The annual CMR attributable to demographic factors increased by 41.9% (95% CI 17.73%-71.04%) and 36.72% (95% CI 16.69%-60.2%) for deaths associated with and due to DM, respectively. Hypertension, cerebrovascular disease, and ischemic heart disease were the top 3 comorbidities. CONCLUSIONS Aging and multimorbidity played essential roles in changing the burden of DM in an urbanizing and transitioning region. There is an increasing disease burden among young and middle-aged people, emphasizing the need for greater attention to these groups. Health management is an emerging method that holds important implications for alleviating the future burden of DM.
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Affiliation(s)
- Xiaopan Li
- Department of Health Management Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ru Liu
- Department of Health Management Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yichen Chen
- Office of Scientific Research and Information Management, Center for Disease Control and Prevention, Pudong New Area, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Yan Han
- Department of Health Management Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qizhe Wang
- Department of Health Management Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yaxin Xu
- Department of Health Management Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Zhou
- Department of Health Management Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sunfang Jiang
- Department of Health Management Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China
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Abushanab D, Marquina C, Morton JI, Al-Badriyeh D, Lloyd M, Magliano DJ, Liew D, Ademi Z. Projecting the Health and Economic Burden of Cardiovascular Disease Among People with Type 2 Diabetes, 2022-2031. PHARMACOECONOMICS 2023; 41:719-732. [PMID: 36944908 PMCID: PMC10163134 DOI: 10.1007/s40273-023-01258-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The aim was to project the health and economic outcomes of cardiovascular disease (CVD) among people with type 2 diabetes from Australian public healthcare and societal perspectives over the next decade. METHODS A dynamic multistate model with yearly cycles was developed to project cardiovascular events among Australians with type 2 diabetes aged 40-89 years from 2022 to 2031. CVD risk (myocardial infarction [MI] and stroke) in the type 2 diabetes population was estimated using the 2013 pooled cohort equation, and recurrent cardiovascular event rates in the type 2 diabetes with established CVD population were obtained from the global Reduction of Atherothrombosis for Continued Health (REACH) registry. Costs and utilities were derived from published sources. Outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total healthcare costs, and total productivity losses. The annual discount rate was 5%, applied to outcomes and costs. RESULTS Between 2022 and 2031, a total of 83,618 non-fatal MIs (95% uncertainty interval [UI] 83,170-84,053) and 58,774 non-fatal strokes (95% UI 58,458-59,013) were projected. Total years of life lived and QALYs (discounted) were projected to be 9,549,487 (95% UI 9,416,423-9,654,043) and 6,632,897 (95% UI 5,065,606-7,591,679), respectively. Total healthcare costs and total lost productivity costs (discounted) were projected to be 9.59 billion Australian dollars (AU$) (95% UI 1.90-30.45 billion) and AU$9.07 billion (95% UI 663.53 million-33.19 billion), respectively. CONCLUSIONS CVD in people with type 2 diabetes will substantially impact the Australian healthcare system and society over the next decade. Future work to investigate different strategies to optimize the control of risk factors for the prevention and treatment of CVD in type 2 diabetes in Australia is warranted.
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Affiliation(s)
- Dina Abushanab
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Clara Marquina
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Jedidiah I Morton
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - Melanie Lloyd
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dianna J Magliano
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Danny Liew
- The Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Zanfina Ademi
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Gregg EW, Buckley J, Ali MK, Davies J, Flood D, Mehta R, Griffiths B, Lim LL, Manne-Goehler J, Pearson-Stuttard J, Tandon N, Roglic G, Slama S, Shaw JE. Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact. Lancet 2023; 401:1302-1312. [PMID: 36931289 PMCID: PMC10420388 DOI: 10.1016/s0140-6736(23)00001-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/17/2022] [Accepted: 12/20/2022] [Indexed: 03/15/2023]
Abstract
The Global Diabetes Compact is a WHO-driven initiative uniting stakeholders around goals of reducing diabetes risk and ensuring that people with diabetes have equitable access to comprehensive, affordable care and prevention. In this report we describe the development and scientific basis for key health metrics, coverage, and treatment targets accompanying the Compact. We considered metrics across four domains: factors at a structural, system, or policy level; processes of care; behaviours and biomarkers such as glycated haemoglobin (HbA1c); and health events and outcomes; and three risk tiers (diagnosed diabetes, high risk, or whole population), and reviewed and prioritised them according to their health importance, modifiability, data availability, and global inequality. We reviewed the global distribution of each metric to set targets for future attainment. This process led to five core national metrics and target levels for UN member states: (1) of all people with diabetes, at least 80% have been clinically diagnosed; and, for people with diagnosed diabetes, (2) 80% have HbA1c concentrations below 8·0% (63·9 mmol/mol); (3) 80% have blood pressure lower than 140/90 mm Hg; (4) at least 60% of people 40 years or older are receiving therapy with statins; and (5) each person with type 1 diabetes has continuous access to insulin, blood glucose meters, and test strips. We also propose several complementary metrics that currently have limited global coverage, but warrant scale-up in population-based surveillance systems. These include estimation of cause-specific mortality, and incidence of end-stage kidney disease, lower-extremity amputations, and incidence of diabetes. Primary prevention of diabetes and integrated care to prevent long-term complications remain important areas for the development of new metrics and targets. These metrics and targets are intended to drive multisectoral action applied to individuals, health systems, policies, and national health-care access to achieve the goals of the Global Diabetes Compact. Although ambitious, their achievement can result in broad health benefits for people with diabetes.
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Affiliation(s)
- Edward W Gregg
- School of Population Health, RCSI, University of Medicine and Health Sciences, Dublin, Ireland; School of Public Health, Imperial College London, London, UK.
| | - James Buckley
- School of Public Health, Imperial College London, London, UK
| | - Mohammed K Ali
- Hubert Department of Global Health and Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Roopa Mehta
- Unidad de Investigacion en Enfermedades Metabolicas, Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ben Griffiths
- School of Public Health, Imperial College London, London, UK
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Jonathan Pearson-Stuttard
- School of Public Health, Imperial College London, London, UK; Health Analytics, Lane Clark & Peacock, London, UK
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Gojka Roglic
- Department of Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Slim Slama
- Department of Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute and School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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7
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Ling S, Zaccardi F, Vlacho B, Li P, Real Gatius J, Mata-Cases M, Franch-Nadal J, Kosiborod MN, Gillies C, Fenici P, Mauricio D, Shah BR, Khunti K. All-cause and cardiorenal mortality in 6 million adults with and without type 2 diabetes: A comparative, trend analysis in Canada, Spain, and the UK. Diabetes Obes Metab 2023; 25:132-143. [PMID: 36056765 PMCID: PMC10087715 DOI: 10.1111/dom.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
AIMS To understand geographical and temporal patterns in the diabetes gap, the excess mortality risk associated with type 2 diabetes (T2D), in three high-income countries. METHODS Using databases from Canada (Ontario), Spain (Catalonia) and the UK (England), we harmonized the study design and the analytical strategy to extract information on subjects aged over 35 years with incident T2D between 1998 and 2018 matched to up to five subjects without diabetes. We used Poisson models to estimate age-specific mortality trends by diabetes status and rate ratios and rate differences associated with T2D. RESULTS In more than 6 million people, 694 454 deaths occurred during a follow-up of 52 million person-years. Trends in all-cause mortality rates differed between Ontario and England; yet, the diabetes gaps were very similar in recent years: in 2018, we estimated 1.3 (95% confidence interval: 0.8, 1.8) and 0.8 (0.2, 1.5) more deaths per 1000 person-years in 50-year-old men with diabetes in Ontario and England, respectively, and 8.9 (6.1, 11.7) and 12.1 (9.1, 15.1) in 80-year-old men; between-country differences were small also in women. In Catalonia, rate ratios comparing T2D with no diabetes in men in 2018 were 1.53 (1.11, 2.11) at 50 years old, 0.88 (0.72, 1.06) at 60 years old, 0.74 (0.60, 0.90) at 70 years old and 0.81 (0.66, 1.00) at 80 years old, indicating lower mortality rates in men with T2D from the age of 60 years; rates were similar in women with and without diabetes at all ages. The diabetes gaps in cardiorenal mortality mirrored those of all-cause mortality: we observed consistent reductions in the proportions of cardiorenal deaths in subjects aged 80 years but variations in subjects aged ≤70 years, regardless of the presence of diabetes. CONCLUSIONS By reducing the confounding impact of epidemiological and analytical differences, this study showed geographical similarities and differences in the diabetes gap: an excess risk of all-cause and cardiorenal mortality in subjects with T2D is still present in Ontario and England in recent years, particularly in elderly subjects. Conversely, there were very small gaps in young men with T2D or even lower mortality rates in older subjects with T2D in Catalonia.
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Affiliation(s)
- Suping Ling
- Leicester Diabetes Research Centre, University Hospital Leicester, Leicester General Hospital, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology & Population Health, The London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Zaccardi
- Leicester Diabetes Research Centre, University Hospital Leicester, Leicester General Hospital, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ping Li
- Institute for Clinical Evaluative Sciences (ICES), Burnaby, Canada
| | - Jordi Real Gatius
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri, Kansas City, Missouri, USA
| | - Clare Gillies
- Leicester Diabetes Research Centre, University Hospital Leicester, Leicester General Hospital, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Peter Fenici
- AstraZeneca, Cambridge, UK
- Medical Innovation, AstraZeneca SpA, Milan, Italy
- Catholic University, School of Medicine and Surgery, Rome, Italy
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
| | - Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Baiju R Shah
- Institute for Clinical Evaluative Sciences (ICES), Burnaby, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kamlesh Khunti
- Leicester Diabetes Research Centre, University Hospital Leicester, Leicester General Hospital, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
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8
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Asiri R, Todd A, Robinson-Barella A, Husband A. Ethnic disparities in medication adherence? A systematic review examining the association between ethnicity and antidiabetic medication adherence. PLoS One 2023; 18:e0271650. [PMID: 36812177 PMCID: PMC9946219 DOI: 10.1371/journal.pone.0271650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES Adherence to prescribed medication is an essential component of diabetes management to obtain optimal outcomes. Understanding the relationship between medication adherence and ethnicity is key to optimising treatment for all people with different chronic illnesses, including those with diabetes. The aim of this review is to examine whether the adherence to antidiabetic medications differed by ethnicity among people with diabetes. METHODS A systematic review was conducted of studies reporting adherence to antidiabetic medication amongst people from different ethnic groups. MEDLINE, Embase, CINAHL, and PsycINFO were searched from their inception to June 2022 for quantitative studies with a specific focus on studies assessing adherence to antidiabetic medications (PROSPERO: CRD42021278392). The Joanna Briggs Institute critical appraisal checklist and a second checklist designed for studies using retrospective databases were used to assess study quality. A narrative synthesis approach was used to summarize the results based on the medication adherence measures. RESULTS Of 17,410 citations screened, 41 studies that included observational retrospective database research and cross-sectional studies were selected, each of which involved diverse ethnic groups from different settings. This review identified a difference in the adherence to antidiabetic medications by ethnicity in 38 studies, despite adjustment for several confounding variables that may otherwise explain these differences. CONCLUSION This review revealed that adherence to antidiabetic medication differed by ethnicity. Further research is needed to explore the ethnicity-related factors that may provide an explanation for these disparities.
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Affiliation(s)
- Rayah Asiri
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
- School of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Andy Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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9
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Tomic D, Morton JI, Chen L, Salim A, Gregg EW, Pavkov ME, Arffman M, Balicer R, Baviera M, Boersma-van Dam E, Brinks R, Carstensen B, Chan JCN, Cheng YJ, Fosse-Edorh S, Fuentes S, Gardiner H, Gulseth HL, Gurevicius R, Ha KH, Hoyer A, Jermendy G, Kautzky-Willer A, Keskimäki I, Kim DJ, Kiss Z, Klimek P, Leventer-Roberts M, Lin CY, Lopez-Doriga Ruiz P, Luk AOY, Ma S, Mata-Cases M, Mauricio D, McGurnaghan S, Imamura T, Paul SK, Peeters A, Pildava S, Porath A, Robitaille C, Roncaglioni MC, Sugiyama T, Wang KL, Wild SH, Yekutiel N, Shaw JE, Magliano DJ. Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study. Lancet Diabetes Endocrinol 2022; 10:795-803. [PMID: 36183736 PMCID: PMC10988609 DOI: 10.1016/s2213-8587(22)00252-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. METHODS For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20-100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005-19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. FINDINGS Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6-17·0) for Scottish women to 59·6% (58·5-60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017-18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2-59·3) for men and 64·1 years (64·0-64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013-14 in Lithuania (43·7 years [42·7-44·6]) for men and in 2010-11 in Latvia (54·2 years [53·4-54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010-11 to 2015-16 and in the USA from 2009-10 to 2014-15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015-16) to 12·9 years (Israel Clalit Health Services; 2015-16) for 20-year-old men and from 3·1 years (Finland; 2011-12) to 11·2 years (Israel Clalit Health Services; 2010-11 and 2015-16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009-10 and 2014-15 for 20-year-old men (a decrease of 2·7 years). INTERPRETATION Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. FUNDING US Centers for Disease Control and Prevention and Diabetes Australia.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Jedidiah I Morton
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Lei Chen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Agus Salim
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Martti Arffman
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Elise Boersma-van Dam
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany; Institute for Medical Biometry and Epidemiology, University Witten/Herdecke, Witten, Germany
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Yiling J Cheng
- Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sonsoles Fuentes
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Hélène Gardiner
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Hanne L Gulseth
- Department for Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School EWL, Bielefeld University, Bielefeld, Germany
| | - György Jermendy
- Third Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Alexandra Kautzky-Willer
- Department of Medicine III, Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; Gender Institute, Gars am Kamp, Austria
| | - Ilmo Keskimäki
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- Second Department of Medicine and Nephrological Center, University of Pécs, Pécs, Hungary
| | - Peter Klimek
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria; Complexity Science Hub Vienna, Vienna, Austria
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, Hong Kong Institute of Diabetes and Obesity, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Dídac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain; Department of Endocrinology, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Sanjoy K Paul
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | - Cynthia Robitaille
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan; Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Hallström S, Wijkman MO, Ludvigsson J, Ekman P, Pfeffer MA, Wedel H, Rosengren A, Lind M. Risk factors, mortality trends and cardiovasuclar diseases in people with Type 1 diabetes and controls: A Swedish observational cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 21:100469. [PMID: 35898332 PMCID: PMC9309414 DOI: 10.1016/j.lanepe.2022.100469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Historically, the incidence of cardiovascular disease and mortality in persons with Type 1 diabetes (T1D) has been increased compared to the general population. Contemporary studies on time trends of mortality and cardiovascular disease are sparse. METHODS In this observational study, T1D persons were identified in the Swedish National Diabetes Registry (n=45,575) and compared with matched controls from the general population (n=220,141). Incidence rates from 2002 to 2019 were estimated with respect to mortality and cardiovascular disease in persons with T1D overall and when stratified for prevalent cardiovascular and renal disease relative to controls. FINDINGS Mean age in persons with T1D was 32.4 years and 44.9% (20,446/45,575) were women. Age- and sex- adjusted mortality rates declined over time in both groups but remained significantly higher in those with T1D compared to controls during 2017-2019, 7.62 (95% CI 7.16; 8·08) vs. 2.23 (95% CI 2.13; 2.33) deaths per 1,000 person years. Myocardial infarction, heart failure and stroke decreased over time in both groups, with persistent excess risks in the range of 3.4-5.0 times from 2017 to 2019 in those with T1D. T1D persons ≥45 years without previous renal or cardiovascular complications had standardized mortality rates similar or even lower than controls 5.55 (4.51; 6.60) vs.7.08 (6.75; 7.40) respectively in the last time period. INTERPRETATION Excess mortality persisted over time in persons with T1D, largely in patients with cardiorenal complications. Improved secondary prevention with a focus on individualized treatment is needed to close the gap in mortality for individuals with T1D. FUNDING This study was financed by grants from the ALF-agreement, NovoNordisk Foundation and the Swedish Heart and Lung Foundation.
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Affiliation(s)
- Sara Hallström
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Corresponding author at: Department of Internal Medicine, Sahlgrenska University Hospital, Diagnosvägen 11, 416 85 Gothenburg, Sweden.
| | - Magnus Olof Wijkman
- Department of Internal Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Johnny Ludvigsson
- Crown Princess Victoria Children´s Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Ekman
- Statistiska Konsultgruppen, Gothenburg, Sweden
| | - Marc Alan Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hans Wedel
- Department of Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Lind
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- NU-Hospital Group, Uddevalla, Sweden
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11
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Esposito D, Olsson DS, Franzén S, Miftaraj M, Nåtman J, Gudbjörnsdottir S, Johannsson G. Effect of Diabetes on Morbidity and Mortality in Patients With Acromegaly. J Clin Endocrinol Metab 2022; 107:2483-2492. [PMID: 35779017 PMCID: PMC9387713 DOI: 10.1210/clinem/dgac400] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Diabetes is a major risk factor for cardiovascular disease and death but its effect on outcomes in acromegaly is unknown. OBJECTIVE This work aimed to study whether diabetes affects morbidity and mortality in patients with acromegaly. METHODS A nationwide (Sweden), observational, matched-cohort study was conducted. Patients diagnosed with acromegaly between 1987 and 2020 were identified in the Swedish National Patient Registry and those with concomitant type 2 diabetes in the National Diabetes Registry and Drug Registry. The risk of overall mortality, and cardiovascular mortality and morbidity were estimated using Cox regression. RESULTS The study included 254 patients with acromegaly and concomitant type 2 diabetes (ACRO-DM group) and 532 without diabetes (ACRO group). Mean (SD) age at baseline was 62.6 (11.4) and 60.0 (12.1) years (P = .004) and the mean (SD) duration of acromegaly was 6.8 (8.1) and 6.0 (6.2) years (P = .098) in the ACRO-DM and ACRO groups, respectively. Overall mean follow-up was 9.2 years. The unadjusted overall mortality rate per 1000 person-years was 35.1 (95% CI, 27.2-44.7) and 20.1 (95% CI, 16.5-24.3) in the respective groups. The hazard ratio (HR) for overall mortality adjusted for multiple confounders was 1.58 (95% CI, 1.12-2.23) in the ACRO-DM group compared with the ACRO group. Cardiovascular mortality (HR 2.11; 95% CI, 1.09-4.10) and morbidity (HR 1.49; 95% CI, 1.21-1.82) were also increased in the ACRO-DM group. CONCLUSION The presence of diabetes in patients with acromegaly was associated with increased overall mortality as well as increased cardiovascular mortality and morbidity.
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Affiliation(s)
- Daniela Esposito
- Correspondence: Daniela Esposito, MD, PhD, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology at Sahlgrenska University Hospital, Gröna Stråket 8, 41345 Gothenburg, Sweden.
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Stefan Franzén
- Health Metrics Group, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Mervete Miftaraj
- National Diabetes Register, Centre of Registers, 41345 Gothenburg, Sweden
| | - Jonatan Nåtman
- National Diabetes Register, Centre of Registers, 41345 Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- National Diabetes Register, Centre of Registers, 41345 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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12
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Liu J, Bai R, Chai Z, Cooper ME, Zimmet PZ, Zhang L. Low- and middle-income countries demonstrate rapid growth of type 2 diabetes: an analysis based on Global Burden of Disease 1990-2019 data. Diabetologia 2022; 65:1339-1352. [PMID: 35587275 PMCID: PMC9118183 DOI: 10.1007/s00125-022-05713-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS The study aims to quantify the global trend of the disease burden of type 2 diabetes caused by various risks factors by country income tiers. METHODS Data on type 2 diabetes, including mortality and disability-adjusted life years (DALYs) during 1990-2019, were obtained from the Global Burden of Disease Study 2019. We analysed mortality and DALY rates and the population attributable fraction (PAF) in various risk factors of type 2 diabetes by country income tiers. RESULTS Globally, the age-standardised death rate (ASDR) attributable to type 2 diabetes increased from 16.7 (15.7, 17.5)/100,000 person-years in 1990 to 18.5 (17.2, 19.7)/100,000 person-years in 2019. Similarly, age-standardised DALY rates increased from 628.3 (537.2, 730.9)/100,000 person-years to 801.5 (670.6, 954.4)/100,000 person-years during 1990-2019. Lower-middle-income countries reported the largest increase in the average annual growth of ASDR (1.3%) and an age-standardised DALY rate (1.6%) of type 2 diabetes. The key PAF attributing to type 2 diabetes deaths/DALYs was high BMI in countries of all income tiers. With the exception of BMI, while in low- and lower-middle-income countries, risk factors attributable to type 2 diabetes-related deaths and DALYs are mostly environment-related, the risk factors in high-income countries are mostly lifestyle-related. CONCLUSIONS/INTERPRETATION Type 2 diabetes disease burden increased globally, but low- and middle-income countries showed the highest growth rate. A high BMI level remained the key contributing factor in all income tiers, but environmental and lifestyle-related factors contributed differently across income tiers. DATA AVAILABILITY To download the data used in these analyses, please visit the Global Health Data Exchange at http://ghdx.healthdata.org/gbd-2019 .
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Affiliation(s)
- Jinli Liu
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ruhai Bai
- School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Zhonglin Chai
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Paul Z Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia.
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
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13
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Williams BA, Brady JP, Voyce S, Kumar N, Paprocki Y, Rajpura J. Changes over time in the cardiovascular risk profile of type 2 diabetes from 2007 to 2020: A community-based study. Diabetes Obes Metab 2022; 24:1216-1223. [PMID: 35257457 DOI: 10.1111/dom.14686] [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: 12/17/2021] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
AIMS To quantify changes over time in cardiovascular (CV) risk factor control and in the uptake of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors from 2007 to 2020 in a real-world community-based cohort of type 2 diabetes (T2D) patients. MATERIALS AND METHODS This study identified 95 461 T2D patients, who were followed for an average of 6.4 years through a single healthcare organization's electronic health record. The primary outcome was global risk factor control according to four factors ("ABCS"): glycated haemoglobin (HbA1c [<8%]); Blood pressure (systolic/diastolic <140/90 mmHg); Cholesterol (non-HDL cholesterol <130 mg/dL); and Smoking (not). Concomitant presence of microvascular complications and commonly used medication classes were tracked. RESULTS According to the ABCS metric, global risk factor control did not appreciably change over time; in 2020, 40.9% (95% confidence interval 40.2, 41.5) of patients had all four factors controlled. Among individual components, HbA1c control (<8%) worsened over time from 84% in 2007 to 78% in 2020, while lipid control (non-HDL cholesterol <130 mg/dL) improved from 59% to 72%. Coexisting microvascular complications were more prevalent over time; for example, neuropathy prevalence increased from 21% (2007) to 35% (2020). Use of thiazolidinediones and sulphonylureas decreased over time while metformin, insulin, dipeptidyl peptidase-4 inhibitor, GLP-1RA and SGLT2 inhibitor use increased. In 2020, GLP-1RAs and SGLT2 inhibitors were each used by 13% of T2D patients. CONCLUSIONS In this community-based study, global CV risk factor control in T2D did not improve, although glycaemic control worsened and lipid control improved. Given increased uptake of GLP-1RAs and SGLT2 inhibitors, the collective effect of these changes on CV outcomes warrants evaluation.
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Affiliation(s)
| | | | - Stephen Voyce
- Geisinger Health System, Danville, Pennsylvania, USA
| | - Neela Kumar
- Janssen Pharmaceuticals, Titusville, New Jersey, USA
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14
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Non-HDL cholesterol as a predictor for incident type 2 diabetes in community-dwelling adults: longitudinal findings over 12 years. Transl Res 2022; 243:52-59. [PMID: 34979322 DOI: 10.1016/j.trsl.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/16/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
Non-HDL cholesterol is a simple measure to analyze the total amount of proatherogenic lipoproteins in the blood and to predict development of cardiovascular disease. However, it is unclear whether non-HDL cholesterol has a relationship with incident type 2 diabetes. This study aimed to evaluate the association between non-HDL cholesterol and incident type 2 diabetes with a large-sample, community-based Korean cohort over a 12-year period. Among the 10,038 total participants, 7608 (3662 men and 3946 women) without diabetes were selected from the Korean Genome and Epidemiology Study (KoGES). Their non-HDL cholesterol level was divided into quartiles. The hazard ratios (HRs) with 95% confidence intervals (CIs) for incident type 2 diabetes were calculated using multivariate Cox proportional hazards regression models after adjusting for potentially confounding variables. In total, 1442 individuals (18.9%: 1442 of 7608) developed type 2 diabetes during the 12-year follow up period, with an incident rate of 3.0-5.0. Compared to the reference first quartile, the HRs (95% CIs) of incident type 2 diabetes for the second, third, and fourth quartiles increased in a dose-response manner after adjusting for potentially confounding variables, including the HOMA-IR marker. Non-HDL cholesterol level at baseline could be a future predictor of type 2 diabetes even when prior glucose or insulin (HOMA-IR) levels are normal.
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15
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Zhang D, Tu H, Hu W, Duan B, Zimmerman MC, Li YL. Hydrogen Peroxide Scavenging Restores N-Type Calcium Channels in Cardiac Vagal Postganglionic Neurons and Mitigates Myocardial Infarction-Evoked Ventricular Arrhythmias in Type 2 Diabetes Mellitus. Front Cardiovasc Med 2022; 9:871852. [PMID: 35548411 PMCID: PMC9082497 DOI: 10.3389/fcvm.2022.871852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveWithdrawal of cardiac vagal activity is associated with ventricular arrhythmia-related high mortality in patients with type 2 diabetes mellitus (T2DM). Our recent study found that reduced cell excitability of cardiac vagal postganglionic (CVP) neurons is involved in cardiac vagal dysfunction and further exacerbates myocardial infarction (MI)-evoked ventricular arrhythmias and mortality in T2DM. However, the mechanisms responsible for T2DM-impaired cell excitability of CVP neurons remain unclear. This study tested if and how elevation of hydrogen peroxide (H2O2) inactivates CVP neurons and contributes to cardiac vagal dysfunction and ventricular arrhythmogenesis in T2DM.Methods and ResultsRat T2DM was induced by a high-fat diet plus streptozotocin injection. Local in vivo transfection of adenoviral catalase gene (Ad.CAT) successfully induced overexpression of catalase and subsequently reduced cytosolic H2O2 levels in CVP neurons in T2DM rats. Ad.CAT restored protein expression and ion currents of N-type Ca2+ channels and increased cell excitability of CVP neurons in T2DM. Ad.CAT normalized T2DM-impaired cardiac vagal activation, vagal control of ventricular function, and heterogeneity of ventricular electrical activity. Additionally, Ad.CAT not only reduced the susceptibility to ventricular arrhythmias, but also suppressed MI-evoked lethal ventricular arrhythmias such as VT/VF in T2DM.ConclusionsWe concluded that endogenous H2O2 elevation inhibited protein expression and activation of N-type Ca2+ channels and reduced cell excitability of CVP neurons, which further contributed to the withdrawal of cardiac vagal activity and ventricular arrhythmogenesis in T2DM. Our current study suggests that the H2O2-N-type Ca2+ channel signaling axis might be an effective therapeutic target to suppress ventricular arrhythmias in T2DM patients with MI.
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Affiliation(s)
- Dongze Zhang
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Huiyin Tu
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Wenfeng Hu
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Bin Duan
- Mary and Dick Holland Regenerative Medicine Program, Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Matthew C. Zimmerman
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Yu-Long Li
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
- *Correspondence: Yu-Long Li
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Wijeratne DT, Housin A, Lajkosz K, Lougheed MD, Yu Xiong P, Barber D, Doliszny KM, Archer SL. Validating Health Administrative data to Identify Patients with Pulmonary HypertensionUsing Health Administrative data to Identify Patients with Pulmonary Hypertension:
A single center, proof of concept validation study in Ontario, Canada. Pulm Circ 2022; 12:e12040. [PMID: 35506095 PMCID: PMC9052993 DOI: 10.1002/pul2.12040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/16/2021] [Accepted: 01/18/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Don Thiwanka Wijeratne
- Department of Medicine Queen's University, Kingston Ontario, Canada
- Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston Ontario
| | - Ahmad Housin
- Department of Medicine Queen's University, Kingston Ontario, Canada
| | - Katherine Lajkosz
- Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston Ontario
| | - M. Diane Lougheed
- Department of Medicine Queen's University, Kingston Ontario, Canada
- Institute for Clinical Evaluative Sciences Queen's, Queen's University, Kingston Ontario
- Department of Public Health Sciences Queen's University, Kingston Ontario, Canada
| | - Ping Yu Xiong
- Department of Medicine Queen's University, Kingston Ontario, Canada
| | - David Barber
- Department of Medicine Queen's University, Kingston Ontario, Canada
| | | | - Stephen L Archer
- Department of Medicine Queen's University, Kingston Ontario, Canada
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Wang JS, Wu YL, Ou HY, Yang YS, Hsu CC, Hwu CM. Trends in all-cause mortality and major causes of death between 2007 and 2018 among patients with diabetes in Taiwan. Front Endocrinol (Lausanne) 2022; 13:984137. [PMID: 36017319 PMCID: PMC9396277 DOI: 10.3389/fendo.2022.984137] [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: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 11/22/2022] Open
Abstract
Optimal control of diabetes and relevant risk factors substantially reduce the risks of chronic complications and mortality. We investigated all-cause mortality rate and major causes of death between 2007 and 2018 in patients with diabetes in Taiwan. This study was conducted using data from Taiwan National Health Insurance Research Database. We selected patients with diabetes diagnosed between 2007 and 2017 (grouped according to the year of diabetes diagnosis 2007-2010 vs. 2011-2017). Information on mortality and causes of death by the end of 2018 was confirmed through linking to the National Death Registry. Standardized mortality rate (SMR) were calculated by weighting the World Health Organization (WHO) standard population (WHO 2000-2025). More than 2.7 million of patients with diabetes were analyzed and a total of 566121 deaths were identified. Overall, the SMR was 11.72 per 1000 person-years. Patients with diabetes diagnosed in 2011-2017 had a lower SMR (8.42 vs. 12.92 per 1000 person-years) than those diagnosed in 2007-2010. Similar finding were noted regarding the major causes of death (cancer, diabetes, heart disease, hypertensive disease, and cerebrovascular disease). Compared with patients who were diagnosed in 2008-2010, those who were diagnosed in 2011-2014 and 2015-2018 had a higher 3-year survival rate (0.9356 vs. 0.9438 vs. 0.946, log-rank test p<0.001) after the diagnosis of diabetes. Patients who were diagnosed with diabetes after 2011 had a lower rate of all-cause mortality and major causes of death, compared with those who were diagnosed before 2010 in Taiwan.
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Affiliation(s)
- Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Ling Wu
- Institute of Population Health Sciences, National Health Research Institute, Miaoli, Taiwan
| | - Horng-Yih Ou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sun Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institute, Miaoli, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
- *Correspondence: Chih-Cheng Hsu, ; Chii-Min Hwu,
| | - Chii-Min Hwu
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- *Correspondence: Chih-Cheng Hsu, ; Chii-Min Hwu,
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Kozioł M, Towpik I, Żurek M, Niemczynowicz J, Wasążnik M, Sanchak Y, Wierzba W, Franek E, Walicka M. Predictors of Rehospitalization and Mortality in Diabetes-Related Hospital Admissions. J Clin Med 2021; 10:jcm10245814. [PMID: 34945110 PMCID: PMC8704926 DOI: 10.3390/jcm10245814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
The risk factors of rehospitalization and death post-discharge in diabetes-related hospital admissions are not fully understood. To determine them, a population-based retrospective epidemiological survey was performed on diabetes-related admissions from the Polish national database. Logistic regression models were used, in which the dependent variables were rehospitalization due to diabetes complications and death within 90 days after the index hospitalization. In 2017, there were 74,248 hospitalizations related to diabetes. A total of 11.3% ended with readmission. Risk factors for rehospitalization were as follows: age < 35 years; male sex; prior hospitalization due to acute diabetic complications; weight loss; peripheral artery disease; iron deficiency anemia; kidney failure; alcohol abuse; heart failure; urgent, emergency, or weekend admission; length of hospitalization; and hospitalization in a teaching hospital with an endocrinology/diabetology unit. Furthermore, 7.3% of hospitalizations resulted in death within 90 days following discharge. Risk factors for death were as follows: age; neoplastic disease with/without metastases; weight loss; coagulopathy; alcohol abuse; acute diabetes complications; heart failure; kidney failure; iron deficiency anemia; peripheral artery disease; fluid, electrolytes, and acid–base balance disturbances; urgent or emergency and weekend admission; and length of hospitalization. We concluded that of all investigated factors, only hospitalization within an experienced specialist center may reduce the frequency of the assessed outcomes.
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Affiliation(s)
- Milena Kozioł
- Department of Analyses and Strategies, Polish Ministry of Health, 00-952 Warsaw, Poland; (M.K.); (M.Ż.); (J.N.); (M.W.)
| | - Iwona Towpik
- Department of Internal Diseases, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
| | - Michał Żurek
- Department of Analyses and Strategies, Polish Ministry of Health, 00-952 Warsaw, Poland; (M.K.); (M.Ż.); (J.N.); (M.W.)
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Jagoda Niemczynowicz
- Department of Analyses and Strategies, Polish Ministry of Health, 00-952 Warsaw, Poland; (M.K.); (M.Ż.); (J.N.); (M.W.)
| | - Małgorzata Wasążnik
- Department of Analyses and Strategies, Polish Ministry of Health, 00-952 Warsaw, Poland; (M.K.); (M.Ż.); (J.N.); (M.W.)
| | - Yaroslav Sanchak
- Department of Internal Diseases, Endocrinology and Diabetology Central, Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 02-507 Warsaw, Poland; (Y.S.); (E.F.)
| | - Waldemar Wierzba
- Satellite Campus in Warsaw, University of Humanities and Economics in Lodz, 01-513 Warsaw, Poland;
| | - Edward Franek
- Department of Internal Diseases, Endocrinology and Diabetology Central, Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 02-507 Warsaw, Poland; (Y.S.); (E.F.)
- Department of Human Epigenetics, Mossakowski Medical Research Institute, 02-106 Warsaw, Poland
| | - Magdalena Walicka
- Department of Internal Diseases, Endocrinology and Diabetology Central, Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 02-507 Warsaw, Poland; (Y.S.); (E.F.)
- Department of Human Epigenetics, Mossakowski Medical Research Institute, 02-106 Warsaw, Poland
- Correspondence:
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19
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Gao T, Agho KE, Piya MK, Simmons D, Osuagwu UL. Analysis of in-hospital mortality among people with and without diabetes in South Western Sydney public hospitals (2014-2017). BMC Public Health 2021; 21:1991. [PMID: 34732173 PMCID: PMC8567571 DOI: 10.1186/s12889-021-12120-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/25/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and data on hospital outcomes and/or what common factors influence mortality rate in people with and without diabetes in Australia using a representative sample is lacking. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. METHODS Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 1 July 2014-30 June 2015 to 1 July 2016-30 June 2017). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. RESULTS Over three years, 8.7% (48,038 people) of admissions involved people with diabetes. This increased from 8.4% in 2014-15 to 8.9% in 2016-17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3-21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5-12.1) and more in men than women (23.1, 95%CI 21.2-25.0 vs 17.9, 95%CI 16.2-19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78-4.48) and 1.79 (95%CI 0.77-2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: older age (> 54 years), male sex, marital status (divorced/widowed), length of stay in hospital (staying longer than 4 days), receiving intensive care in admission and being admitted due to primary respiratory and cardiovascular diagnoses. The odds of death in admission was increased in polymorbid patients without diabetes (28.68, 95%CI 23.49-35.02) but not in those with diabetes. CONCLUSIONS In-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes, but significantly more people with diabetes had two or more co-morbidities, suggesting that hospital mortality may be driven by those with pre-existing health/comorbidities. Urgent measures in primary care to prevent admissions among people with multiple co-morbidities are needed.
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Affiliation(s)
- Tina Gao
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Milan K Piya
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - David Simmons
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - Uchechukwu L Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa.
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20
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Yun JS, Ko SH. Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes. Metabolism 2021; 123:154838. [PMID: 34333002 DOI: 10.1016/j.metabol.2021.154838] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023]
Abstract
With the advances in diabetes care, the trend of incident cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) has been decreasing over past decades. However, given that CVD is still a major cause of death in patients with diabetes and that the risk of CVD in patients with T2DM is more than twice that in those without DM, there are still considerable challenges to the prevention of CVD in diabetes. Accordingly, there have been several research efforts to decrease cardiovascular (CV) risk in T2DM. Large-scale genome-wide association studies (GWAS) and clinical cohort studies have investigated the effects of factors, such as genetic determinants, hypoglycaemia, and insulin resistance, on CVD and can account for the unexplained CV risk in T2DM. Lifestyle modification is a widely accepted cornerstone method to prevent CVD as the first-line strategy in T2DM. Recent reports from large CV outcome trials have proven the positive CV effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with high CVD risk. Overall, current practice guidelines for the management of CVD in T2DM are moving from a glucocentric strategy to a more individualised patient-centred approach. This review will discuss the current epidemiologic trends of CVD in T2DM and the risk factors linking T2DM to CVD, including genetic contribution, hypoglycaemia, and insulin resistance, and proper care strategies, including lifestyle and therapeutic approaches.
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Affiliation(s)
- Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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21
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Pearson-Stuttard J, Buckley J, Cicek M, Gregg EW. The Changing Nature of Mortality and Morbidity in Patients with Diabetes. Endocrinol Metab Clin North Am 2021; 50:357-368. [PMID: 34399950 DOI: 10.1016/j.ecl.2021.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The number of adults living with diabetes has increased substantially globally over the past 40 years, driven by a combination of increased age-standardized prevalence, population growth, aging, and increases in obesity prevalence. Patients with diabetes in high-income countries are living longer, with large declines in vascular disease mortality rates. This appears to be resulting in a diversification of cause of death, complications, and comorbidities that those with diabetes live with. This has large implications for prevention and management approaches, which should be reviewed to update the breadth of conditions that patients with diabetes are at excess risk of throughout their life. These trends have not yet been seen in low- and middle-income countries, where evidence is also more scarce.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London W2 1PG, UK; Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London W1U 1DQ, UK; Northumbria Healthcare NHS Foundation Trust, North Shields NE27 0QJ, UK.
| | - James Buckley
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Meryem Cicek
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, Imperial College London, Norfolk Place, London W2 1PG, UK
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22
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Sacre JW, Harding JL, Shaw JE, Magliano DJ. Declining mortality in older people with type 2 diabetes masks rising excess risks at younger ages: a population-based study of all-cause and cause-specific mortality over 13 years. Int J Epidemiol 2021; 50:1362-1372. [PMID: 33462587 PMCID: PMC10452956 DOI: 10.1093/ije/dyaa270] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Excess mortality in people with vs without type 2 diabetes (T2DM) has fallen, but it is unclear whether men/women at all ages have benefited and which causes of death have driven these trends. METHODS All-cause and cause-specific mortality rates and excess mortality [by mortality rate ratios (MRRs) relative to the non-diabetic general population] were examined in 1 268 018 Australians with T2DM registered on the National Diabetes Services Scheme (2002-2014). RESULTS Age-standardized mortality decreased in men (-2.2%/year; Ptrend < 0.001) and women with T2DM (-1.3%/year; Ptrend < 0.001) throughout 2002-14, which translated to declines in the MRRs (from 1.51 to 1.45 in men; 1.59 to 1.46 in women; Ptrend < 0.05 for both). Declining mortality rates in T2DM were observed in men aged 40+ years and women aged 60+ years (Ptrends <0.001), but not at younger ages. However, the only age group in which excess mortality declined relative to those without diabetes was 80+ years (Ptrends < 0.05); driven by reductions in excess cancer-related deaths in men and cardiovascular disease (CVD) in women. Among age groups <80 years, CVD and cancer MRRs remained similar or increased over time, despite falls in both CVD and cancer mortality rates. MRRs for non-CVD/non-cancer-related deaths increased in 60-79 year-olds, but were otherwise unchanged. CONCLUSIONS Declining excess mortality attributable to T2DM from 2002-14 was driven entirely by reductions in those aged 80+ years. Declines in total mortality among those with T2DM were apparent in more age groups, but often to a lesser extent than in the general population, thereby serving to increase the excess risk associated with T2DM.
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Affiliation(s)
- Julian W Sacre
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jessica L Harding
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan E Shaw
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Trends in type 2 diabetes mellitus disease burden in European Union countries between 1990 and 2019. Sci Rep 2021; 11:15356. [PMID: 34321515 PMCID: PMC8319179 DOI: 10.1038/s41598-021-94807-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022] Open
Abstract
This observational study aimed to assess trends in type 2 diabetes mellitus (T2DM) disease burden in European Union countries for the years 1990–2019. Sex specific T2DM age-standardised prevalence (ASPRs), mortality (ASMRs) and disability-adjusted life-year rates (DALYs) per 100,000 population were extracted from the Global Burden of Disease (GBD) Study online results tool for each EU country (inclusive of the United Kingdom), for the years 1990–2019. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2019, increases in T2DM ASPRs were observed for all EU countries. The highest relative increases in ASPRs were observed in Luxembourg (males + 269.1%, females + 219.2%), Ireland (males + 191.9%, females + 165.7%) and the UK (males + 128.6%, females + 114.6%). Mortality trends were less uniform across EU countries, however a general trend towards reducing T2DM mortality was observed, with ASMRs decreasing over the 30-year period studied in 16/28 countries for males and in 24/28 countries for females. The UK observed the highest relative decrease in ASMRs for males (− 46.9%). For females, the largest relative decrease in ASMRs was in Cyprus (− 67.6%). DALYs increased in 25/28 countries for males and in 17/28 countries for females between 1990 and 2019. DALYs were higher in males than females in all EU countries in 2019. T2DM prevalence rates have increased across EU countries over the last 30 years. Mortality from T2DM has generally decreased in EU countries, however trends were more variable than those observed for prevalence. Primary prevention strategies should continue to be a focus for preventing T2DM in at risk groups in EU countries.
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24
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Lind M, Imberg H, Coleman RL, Nerman O, Holman RR. Historical HbA 1c Values May Explain the Type 2 Diabetes Legacy Effect: UKPDS 88. Diabetes Care 2021; 44:dc202439. [PMID: 34244332 PMCID: PMC8740943 DOI: 10.2337/dc20-2439] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes all-cause mortality (ACM) and myocardial infarction (MI) glycemic legacy effects have not been explained. We examined their relationships with prior individual HbA1c values and explored the potential impact of instituting earlier, compared with delayed, glucose-lowering therapy. RESEARCH DESIGN AND METHODS Twenty-year ACM and MI hazard functions were estimated from diagnosis of type 2 diabetes in 3,802 UK Prospective Diabetes Study participants. Impact of HbA1c values over time was analyzed by weighting them according to their influence on downstream ACM and MI risks. RESULTS Hazard ratios for a one percentage unit higher HbA1c for ACM were 1.08 (95% CI 1.07-1.09), 1.18 (1.15-1.21), and 1.36 (1.30-1.42) at 5, 10, and 20 years, respectively, and for MI was 1.13 (1.11-1.15) at 5 years, increasing to 1.31 (1.25-1.36) at 20 years. Imposing a one percentage unit lower HbA1c from diagnosis generated an 18.8% (95% CI 21.1-16.0) ACM risk reduction 10-15 years later, whereas delaying this reduction until 10 years after diagnosis showed a sevenfold lower 2.7% (3.1-2.3) risk reduction. Corresponding MI risk reductions were 19.7% (22.4-16.5) when lowering HbA1c at diagnosis, and threefold lower 6.5% (7.4-5.3%) when imposed 10 years later. CONCLUSIONS The glycemic legacy effects seen in type 2 diabetes are explained largely by historical HbA1c values having a greater impact than recent values on clinical outcomes. Early detection of diabetes and intensive glucose control from the time of diagnosis is essential to maximize reduction of the long-term risk of glycemic complications.
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Affiliation(s)
- Marcus Lind
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, NU-Hospital Group, Uddevalla, Sweden
| | - Henrik Imberg
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Ruth L Coleman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
| | - Olle Nerman
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Rury R Holman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
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Shi J, Gao Y, Ming L, Yang K, Sun Y, Chen J, Shi S, Geng J, Li L, Wu J, Tian J. A bibliometric analysis of global research output on network meta-analysis. BMC Med Inform Decis Mak 2021; 21:144. [PMID: 33941172 PMCID: PMC8094555 DOI: 10.1186/s12911-021-01470-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Network meta-analysis (NMA) has been widely used in the field of medicine and health, but the research topics and development trends are still unclear. This study aimed to identify the cooperation of countries and institutes and explore the hot topics and future prospects in the field of NMA. Methods Data of publications were downloaded from the Web of Science Core Collection. We used CiteSpace V, HistCite 2.1, and Excel 2016 to analyze literature information, including years, journals, countries, institutes, authors, keywords, and co-cited references. Results NMA research developed gradually before 2010 and rapidly in the following years. 2846 NMA studies were published in 771 journals in six languages. The PLoS One (110, 3.9%) was the most productive journal, and N Engl J Med (5904 co-citations) was the most co-cited journal. The most productive country was the United States (889, 31%) and the most productive institute was the University of Bristol (113, 4.0%). The active collaborations were observed between developed countries and between productive institutes. Of the top 10 authors, four were from the UK, and among the top 10 co-cited authors, six were from the UK. Randomized evidence, oral anti-diabetic drugs, coronary artery bypass, certolizumab pegol, non-valvular atrial fibrillation, and second-line antihyperglycemic therapy were the hot topics in this field. Conclusions NMA studies have significantly increased over the past decade, especially from 2015 to 2017. Compared with developing countries, developed countries have contributed more to these publications and have closer cooperation, indicating that cooperation between developed and developing countries should be further strengthened. The treatment of diabetes, cardiovascular diseases, and immune rheumatism are the main hot topics.
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Affiliation(s)
- Jiyuan Shi
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou City, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, China
| | - Liu Ming
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, China
| | - Kelu Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou City, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing City, China
| | - Ji Chen
- Mianyang hospital of traditional Chinese medicine, Mianyang City, China
| | - Shuzhen Shi
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, China
| | - Jie Geng
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou City, China
| | - Lun Li
- Second Xiangya Hospital, Central South University, Changsha City, China
| | - Jiarui Wu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing City, China
| | - Jinhui Tian
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou City, China. .,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, China. .,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou City, China.
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26
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Hogervorst S, Adriaanse MC, Hugtenburg JG, Bot M, Speight J, Pouwer F, Nefs G. Medication Intake, Perceived Barriers, and Their Correlates Among Adults With Type 1 and Type 2 Diabetes: Results From Diabetes MILES – The Netherlands. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:645609. [PMID: 36994341 PMCID: PMC10012124 DOI: 10.3389/fcdhc.2021.645609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/24/2021] [Indexed: 11/13/2022]
Abstract
PurposeThe purpose of this study is to investigate medication intake, perceived barriers and their correlates in adults with type 1 or type 2 diabetes.MethodsIn this cross-sectional study, 3,383 Dutch adults with diabetes (42% type 1; 58% type 2) completed the 12-item ‘Adherence Starts with Knowledge’ questionnaire (ASK-12; total score range: 12-60) and reported socio-demographics, clinical and psychological characteristics and health behaviors. Univariable and multivariable logistic regression analyses were used.ResultsAdults with type 1 diabetes had a slightly lower mean ASK-12 score (i.e. more optimal medication intake and fewer perceived barriers) than adults with non-insulin-treated type 2 diabetes. After adjustment for covariates, correlates with suboptimal intake and barriers were fewer severe hypoglycemic events and more depressive symptoms and diabetes-specific distress. In type 2 diabetes, correlates were longer diabetes duration, more depressive symptoms and diabetes-specific distress.ConclusionsAdults with type 1 diabetes showed slightly more optimal medication intake and fewer perceived barriers than adults with non-insulin treated type 2 diabetes. Correlates differed only slightly between diabetes types. The strong association with depressive symptoms and diabetes-specific distress in both diabetes types warrants attention, as improving these outcomes in some people with diabetes might indirectly improve medication intake.
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Affiliation(s)
- Stijn Hogervorst
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
- *Correspondence: Stijn Hogervorst, , orcid.org/0000-0001-9276-2675
| | - Marce C. Adriaanse
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Jacqueline G. Hugtenburg
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (UMC), Amsterdam, Netherlands
| | - Mariska Bot
- Department of Psychiatry and the Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
| | - Giesje Nefs
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Rotterdam, Netherlands
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27
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Pearson-Stuttard J, Bennett J, Cheng YJ, Vamos EP, Cross AJ, Ezzati M, Gregg EW. Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care records. Lancet Diabetes Endocrinol 2021; 9:165-173. [PMID: 33549162 PMCID: PMC7886654 DOI: 10.1016/s2213-8587(20)30431-9] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prevalence of diabetes has increased in the UK and other high-income countries alongside a substantial decline in cardiovascular mortality. Yet data are scarce on how these trends have changed the causes of death in people with diabetes who have traditionally died primarily of vascular causes. We estimated how all-cause mortality and cause-specific mortality in people with diabetes have changed over time, how the composition of the mortality burden has changed, and how this composition compared with that of the non-diabetes population. METHODS In this epidemiological analysis of primary care records, we identified 313 907 individuals with diabetes in the Clinical Practice Research Datalink, a well described primary care database, between 2001 to 2018, and linked these data to UK Office for National Statistics mortality data. We assembled serial cross sections with longitudinal follow-up to generate a mixed prevalence and incidence study population of patients with diabetes. We used discretised Poisson regression models to estimate annual death rates for deaths from all causes and 12 specific causes for men and women with diabetes. We also identified age-matched and sex matched (1:1) individuals without diabetes from the same dataset and estimated mortality rates in this group. FINDINGS Between Jan 1, 2001, and Oct 31, 2018, total mortality declined by 32% in men and 31% in women with diagnosed diabetes. Death rates declined from 40·7 deaths per 1000 person-years to 27·8 deaths per 1000 person-years in men and from 42·7 deaths per 1000 person-years to 29·5 deaths per 1000 person-years in women with diagnosed diabetes. We found similar declines in individuals without diabetes, hence the gap in mortality between those with and without diabetes was maintained over the study period. Cause-specific death rates declined in ten of the 12 cause groups, with exceptions in dementia and liver disease, which increased in both populations. The large decline in vascular disease death rates led to a transition from vascular causes to cancers as the leading contributor to death rates in individuals with diagnosed diabetes and to the gap in death rates between those with and without diabetes. INTERPRETATION The decline in vascular death rates has been accompanied by a diversification of causes in individuals with diagnosed diabetes and a transition from vascular diseases to cancers as the leading contributor to diabetes-related death. Clinical and preventative approaches must reflect this trend to reduce the excess mortality risk in individuals with diabetes. FUNDING Wellcome Trust.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK.
| | - James Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Yiling J Cheng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eszter P Vamos
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK
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Ling S, Brown K, Miksza JK, Howells LM, Morrison A, Issa E, Yates T, Khunti K, Davies MJ, Zaccardi F. Risk of cancer incidence and mortality associated with diabetes: A systematic review with trend analysis of 203 cohorts. Nutr Metab Cardiovasc Dis 2021; 31:14-22. [PMID: 33223399 DOI: 10.1016/j.numecd.2020.09.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022]
Abstract
AIM Whether the relative risk of cancer incidence and mortality associated with diabetes has changed over time is unknown. DATA SYNTHESIS On August 12th, 2020, we electronically searched for observational studies reporting on the association between diabetes and cancer. We estimated temporal trends in the relative risk of cancer incidence or mortality associated with diabetes and calculated the ratio of relative risk (RRR) comparing different periods. As many as 193 eligible articles, reporting data on 203 cohorts (56,852,381 participants; 3,735,564 incident cancer cases; 185,404 cancer deaths) and covering the period 1951-2013, were included. The relative risk of all-site cancer incidence increased between 1980 and 2000 [RRR 1990 vs.1980: (1.24; 95% CI: 1.16, 1.34); 2000 vs.1990: (1.23; 1.15, 1.31)] and stabilised thereafter at a relative risk of 1.2; the relative risk of all-site cancer mortality was constant at about 1.2 from 1980 to 2010. Both magnitudes and trends in relative risk varied across cancer sites: the relative risk of colorectal, female breast, and endometrial cancer incidence and pancreatic cancer mortality was constant during the observed years; it increased for bladder, stomach, kidney, and pancreatic cancer incidence until 2000; and decreased for liver while increased for prostate, colon and gallbladder cancer incidence after 2000. CONCLUSIONS Alongside the increasing prevalence of diabetes, the temporal patterns of the relative risk of cancer associated with diabetes may have contributed to the current burden of cancer in people with diabetes.
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Affiliation(s)
- Suping Ling
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - Karen Brown
- Leicester Cancer Research Centre, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
| | - Joanne K Miksza
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - Lynne M Howells
- Leicester Cancer Research Centre, Clinical Sciences Building, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
| | - Amy Morrison
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - Eyad Issa
- Leicester HPB Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - Thomas Yates
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - Melanie J Davies
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | - Francesco Zaccardi
- Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
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29
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Guan S, Fang X, Gu X, Zhang Z, Tang Z, Wu X, Liu H, Wang C. The link of depression, untreated hypertension, and diabetes with mortality in postmenopausal women: A cohort study. Clin Exp Hypertens 2021; 43:1-6. [PMID: 32715792 DOI: 10.1080/10641963.2020.1790584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the association of depression, as well as untreated hypertension or diabetes with all-cause death in community-based postmenopausal women in Beijing. METHODS A cohort of 863 community-based postmenopausal women with no history of cardiovascular heart disease (CHD), stroke, cancer, or dementia was investigated on 20 July-28 September 2009 at baseline. Depression was diagnosed using the 30-item Center for Epidemiologic Studies Depression (CES-D) scale with CES-D ≥ 11. Meanwhile, data on health behavior, physical comorbidity, and social support at baseline were collected. These individuals were followed up from 20 July to 30 August 2014. All-cause mortality and cause of death were surveyed. RESULTS After a median follow-up of 4.97 years, 120 subjects died of all-cause. Twenty-four died of stroke, 19 died of myocardial infarction, 21 died of cancer. The others died of aging, infection, and accident. Depression and untreated HP were significantly associated with all-cause mortality in Cox models after full adjustment for all of the potential confounders (Depression HR: 2.16, 95%CI: 1.35-3.46; Untreated hypertension HR: 1.84, 95%CI: 1.12-3.02). However, negative correlation of untreated diabetes on all-cause mortality was observed in this population (HR: 1.36, 95%CI: 0.75-2.49). When depression was co-existing with hypertension/diabetes, the HR for mortality elevated significantly (Depression co-existing with hypertension HR = 3.87, 95% CI: 2.07-7.23; Depression co-existing with diabetes HR = 5.02, 95% CI: 1.5-16.79). CONCLUSIONS It is suggested we should take sufficient care of postmenopausal females with depression and control blood pressure and glucose more effectively. Abbreviations: HP: Hypertension; DM: Diabetes; TC: Cholesterol; TG: Triglyceride; BMI: Body-Mass Index; CES-D: Center for Epidemiologic Studies Depression; CDC: Centers for Disease Control and Prevention; HR: Hazard Ratio; CI: Confidence Interval; ADL: Activities of daily living scale.
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Affiliation(s)
- Shaochen Guan
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Xianghua Fang
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Xiang Gu
- Division of Geriatric Nephrology, Beijing Friendship Hospital, Capital Medical University , Beijing, Xicheng, China
| | - Zhongying Zhang
- Department of Geriatrics, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China
| | - Zhe Tang
- Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Xiaoguang Wu
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Hongjun Liu
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
| | - Chunxiu Wang
- Department of Evidence-Based Medicine, Xuan Wu Hospital, Capital Medical University , Beijing, Xicheng, China.,Key Laboratory for Neurodegenerative Disease of Ministry of Education , Beijing, Xicheng, China
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30
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Anjana RM, Mohan V, Rangarajan S, Gerstein HC, Venkatesan U, Sheridan P, Dagenais GR, Lear SA, Teo K, Karsidag K, Alhabib KF, Yusoff K, Ismail N, Mony PK, Lopez-Jaramillo P, Chifamba J, Palileo-Villanueva LM, Iqbal R, Yusufali A, Kruger IM, Rosengren A, Bahonar A, Zatonska K, Yeates K, Gupta R, Li W, Hu L, Rahman MO, Lakshmi PVM, Iype T, Avezum A, Diaz R, Lanas F, Yusuf S. Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study. Diabetes Care 2020; 43:3094-3101. [PMID: 33060076 PMCID: PMC7770267 DOI: 10.2337/dc20-0886] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35-70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 ± 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58-2.27] to 1.78 [1.36-2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.
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Affiliation(s)
- Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ulagamadesan Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Patrick Sheridan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Gilles R Dagenais
- Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kubilay Karsidag
- Department of Internal Medicine, Division of Endocrinology, Istanbul, Turkey
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Yusoff
- Department of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.,Department of Medicine, UCSI University, Cheras, Selangor, Malaysia
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Prem K Mony
- Division of Epidemiology and Population Health, St. John's Medical College and Research Institute, Bangalore, India
| | | | - Jephat Chifamba
- College of Health Sciences, Physiology Department, University of Zimbabwe, Harare, Zimbabwe
| | | | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Afzalhussein Yusufali
- Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Iolanthe M Kruger
- Africa Unit for Transdisciplinary Health Research, Department of Medicine, Faculty of Health Sciences, North-West University, Mmabatho, South Africa
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ahmad Bahonar
- Hypertension Research Center, Cardiovascular Research Institute, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Lihua Hu
- Nanchang County Center for Disease Prevention and Control, Nanchang, Jiangxi Province, China
| | | | - P V M Lakshmi
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Thomas Iype
- Health Action by People and Government Medical College, Thiruvanthapuram, Kerala, India
| | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
| | - Rafael Diaz
- Estudios Clínicos Latino America, Instituto Cardiovascular de Rosario, Rosario, Santa Fe, Argentina
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Chan BC, Campbell KE. An economic evaluation examining the cost-effectiveness of continuous diffusion of oxygen therapy for individuals with diabetic foot ulcers. Int Wound J 2020; 17:1791-1808. [PMID: 33189100 PMCID: PMC7754389 DOI: 10.1111/iwj.13468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/02/2023] Open
Abstract
Continuous delivery of oxygen therapy has been observed to improve healing for individuals with an advanced diabetic foot ulcer (DFU). However, this intervention requires the purchasing of an oxygen delivery device and moist dressings. It is unknown whether this upfront financial investment represents good value for money. Thus the aim of this project is to evaluate the cost-effectiveness of treating advanced DFU using continuous delivery of oxygen compared with negative pressure wound therapy from the perspective of the public health care payer in Ontario, Canada. A microsimulation model was constructed with inputs from peer-reviewed journal publications and publicly available reports. The 5-year costs and quality-adjusted life-years were compared between treatment and comparator. Sensitivity analyses were conducted to evaluate the robustness of results. The model predicted that continuous delivery of oxygen would cost $4800 less compared with negative pressure wound therapy and increased quality-adjusted life years by 0.025. Lower cost and improved outcomes were observed in most scenario analyses. The results of this economic evaluation suggest that CDO therapy may reduce health care economic burden with a modest increase in quality of life outcomes. Health care decision-makers should consider the inclusion of CDO for the treatment of DFU.
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Affiliation(s)
- Brian C.‐F. Chan
- KITE – Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
| | - Karen E. Campbell
- School of Physical Therapy, Faculty of Health ScienceWestern UniversityLondonCanada
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Pietraszek A. Cardiovascular Effects of Hypoglycemic Agents in Diabetes Mellitus. Curr Drug Saf 2020; 16:32-51. [PMID: 32881674 DOI: 10.2174/1574886315666200902154736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite substantial improvements over the years, diabetes mellitus is still associated with cardiovascular disease, heart failure, and excess mortality. OBJECTIVE The objective of this article is to examine existing data on the reduction of cardiovascular morbidity and mortality in diabetes. Control of glycemia, lipid levels, and blood pressure are described in brief. The main scope of this article is, however, to review the glucose-independent cardiovascular effect of antidiabetic pharmacological agents (mainly other than insulin). METHODS The article is a narrative review based on recently published reviews and meta-analyses complemented with data from individual trials, when relevant. RESULTS AND DISCUSSION Older data suggest a cardioprotective role of metformin (an inexpensive and safe drug); a role to date not convincingly challenged. The cardiovascular effects of thiazolidinediones, sulphonylurea, and glinides are debatable. Recent large-scale cardiovascular outcome trials suggest a neutral profile of dipeptidyl peptidase 4 inhibitors, yet provide compelling evidence of cardioprotective effects of glucagon-like 1 receptor antagonists and sodium-glucose transporter 2 inhibitors. CONCLUSION Metformin may have a role in primary and secondary prevention of cardiovascular disease; glucagon-like 1 receptor antagonists and sodium-glucose co-transporter 2 inhibitors play a role in secondary prevention of atherosclerotic cardiovascular disease. Sodium-glucose transporter 2 inhibitors have a role to play in both primary and secondary prevention of heart failure; yet, they carry a small risk of the potentially dangerous adverse effect, euglycemic diabetic ketoacidosis.
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Affiliation(s)
- Anna Pietraszek
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Aalborg, Denmark
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Isaranuwatchai W, Fazli GS, Bierman AS, Lipscombe LL, Mitsakakis N, Shah BR, Wu CF, Johns A, Booth GL. Universal Drug Coverage and Socioeconomic Disparities in Health Care Costs Among Persons With Diabetes. Diabetes Care 2020; 43:2098-2105. [PMID: 32641377 DOI: 10.2337/dc19-1536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether neighborhood socioeconomic status (SES) is a predictor of non-drug-related health care costs among Canadian adults with diabetes and, if so, whether SES disparities in costs are reduced after age 65 years, when universal drug coverage commences as an insurable benefit. RESEARCH DESIGN AND METHODS Administrative health databases were used to examine publicly funded health care expenditures among 698,113 younger (20-64 years) and older (≥65 years) adults with diabetes in Ontario from April 2004 to March 2014. Generalized linear models were constructed to examine relative and absolute differences in health care costs (total and non-drug-related costs) across neighborhood SES quintiles, by age, with adjustment for differences in age, sex, diabetes duration, and comorbidity. RESULTS Unadjusted costs per person-year in the lowest SES quintile (Q1) versus the highest (Q5) were 39% higher among younger adults ($5,954 vs. $4,270 [Canadian dollars]) but only 9% higher among older adults ($10,917 vs. $9,993). Adjusted non-drug costs (primarily for hospitalizations and physician visits) were $1,569 per person-year higher among younger adults in Q1 vs. Q5 (modeled relative cost difference: 35.7% higher) and $139.3 million per year among all individuals in Q1. Scenarios in which these excess costs per person-year were decreased by ≥10% or matched the relative difference among seniors suggested a potential for savings in the range of $26.0-$128.2 million per year among all lower-SES adults under age 65 years (Q1-Q4). CONCLUSIONS SES is a predictor of diabetes-related health care costs in our setting, more so among adults under age 65 years, a group that lacks universal drug coverage under Ontario's health care system. Non-drug-related health care costs were more than one-third higher in younger, lower-SES adults, translating to >$1 billion more in health care expenditures over 10 years.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Health Intervention and Technology Assessment Program, Bangkok, Thailand
| | - Ghazal S Fazli
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Arlene S Bierman
- ICES, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Ashley Johns
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Gillian L Booth
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada .,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chen L, Islam RM, Wang J, Hird TR, Pavkov ME, Gregg EW, Salim A, Tabesh M, Koye DN, Harding JL, Sacre JW, Barr ELM, Magliano DJ, Shaw JE. A systematic review of trends in all-cause mortality among people with diabetes. Diabetologia 2020; 63:1718-1735. [PMID: 32632526 PMCID: PMC11000245 DOI: 10.1007/s00125-020-05199-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/29/2020] [Indexed: 01/18/2023]
Abstract
AIMS/HYPOTHESIS We examined all-cause mortality trends in people with diabetes and compared them with trends among people without diabetes. METHODS MEDLINE, EMBASE and CINAHL databases were searched for observational studies published from 1980 to 2019 reporting all-cause mortality rates across ≥2 time periods in people with diabetes. Mortality trends were examined by ethnicity, age and sex within comparable calendar periods. RESULTS Of 30,295 abstracts screened, 35 studies were included, providing data on 69 separate ethnic-specific or sex-specific populations with diabetes since 1970. Overall, 43% (3/7), 53% (10/19) and 74% (32/43) of the populations studied had decreasing trends in all-cause mortality rates in people with diabetes in 1970-1989, 1990-1999 and 2000-2016, respectively. In 1990-1999 and 2000-2016, mortality rates declined in 75% (9/12) and 78% (28/36) of predominantly Europid populations, and in 14% (1/7) and 57% (4/7) of non-Europid populations, respectively. In 2000-2016, mortality rates declined in 33% (4/12), 65% (11/17), 88% (7/8) and 76% (16/21) of populations aged <40, 40-54, 55-69 and ≥70 years, respectively. Among the 33 populations with separate mortality data for those with and without diabetes, 60% (6/10) of the populations with diabetes in 1990-1999 and 58% (11/19) in 2000-2016 had an annual reduction in mortality rates that was similar to or greater than in those without diabetes. CONCLUSIONS/INTERPRETATION All-cause mortality has declined in the majority of predominantly Europid populations with diabetes since 2000, and the magnitude of annual mortality reduction matched or exceeded that observed in people without diabetes in nearly 60% of populations. Patterns of diabetes mortality remain uncertain in younger age groups and non-Europid populations. REGISTRATION PROSPERO registration ID CRD42019095974. Graphical abstract.
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Affiliation(s)
- Lei Chen
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Rakibul M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanna Wang
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Thomas R Hird
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Agus Salim
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Mathematics and Statistics, La Trobe University, Bundoora, VIC, Australia
| | - Maryam Tabesh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Digsu N Koye
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jessica L Harding
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julian W Sacre
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Elizabeth L M Barr
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
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Carstensen B, Rønn PF, Jørgensen ME. Components of diabetes prevalence in Denmark 1996-2016 and future trends until 2030. BMJ Open Diabetes Res Care 2020; 8:8/1/e001064. [PMID: 32784246 PMCID: PMC7418686 DOI: 10.1136/bmjdrc-2019-001064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Incidence rates of diabetes have been increasing and mortality rates have been decreasing. Our aim is the quantification of the effects of these on the prevalence and prediction of the future burden of diabetes. RESEARCH DESIGN AND METHODS From population-based registers of Denmark, we derived diabetes incidence and mortality rates and mortality rates for persons without diabetes for the period 1996-2016. Rates were modeled by smooth parametric terms using Poisson regression. Estimated rates were used to assess the relative contribution of incidence and mortality to changes in prevalence over the study period as well as for prediction of future rates and prevalence 2017-2040. RESULTS The major contributors to prevalence was increasing incidence (22%) and epidemiological imbalance between incidence and mortality (27%). The decrease in mortality rates over the period 1996-2016 contributes only 9% of the prevalent cases at 2016. We estimated that 467 000 persons in Denmark would be living with diabetes in 2030. The age distribution of patients in the period 2017-2030 is predicted to change toward older ages. The total number of persons needing diabetes care will increase by 67% over the next 13 years, an average annual increase of 4.0%. CONCLUSIONS Lowering mortality among patients with diabetes even further is not likely to influence the prevalence substantially. Since the size and the increase in incidence of diabetes are major drivers of the increasing prevalence, the prevention of new cases of diabetes is required.
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Affiliation(s)
- Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Pernille Falberg Rønn
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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Zghebi SS, Steinke DT, Rutter MK, Ashcroft DM. Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data. BMJ Open 2020; 10:e033866. [PMID: 32611677 PMCID: PMC7358107 DOI: 10.1136/bmjopen-2019-033866] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To compare the patterns of 18 physical and mental health comorbidities between people with recently diagnosed type 2 diabetes (T2D) and people without diabetes and how these change by age, gender and deprivation over time between 2004 and 2014. Also, to develop a metric to identify most prevalent comorbidities in people with T2D. DESIGN Population-based cohort study. SETTING Primary and secondary care, England, UK. PARTICIPANTS 108 588 people with T2D and 528 667 comparators registered in 391 English general practices. Each patient with T2D aged ≥16 years between January 2004 and December 2014 registered in Clinical Practice Research Datalink GOLD practices was matched to up to five comparators without diabetes on age, gender and general practice. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of 18 physical and mental health comorbidities in people with T2D and comparators categorised by age, gender and deprivation. Odds for association between T2D diagnosis and comorbidities versus comparators. A metric for comorbidities with prevalence of ≥5% and/or odds ≥2 in patients with T2D. RESULTS Overall, 77% of patients with T2D had ≥1 comorbidity and all comorbidities were more prevalent in patients with T2D than in comparators. Across both groups, prevalence rates were higher in older people, women and those most socially deprived. Conditional logistic regression models fitted to estimate (OR, 95% CI) for association between T2D diagnosis and comorbidities showed that T2D diagnosis was significantly associated with higher odds for all conditions including myocardial infarction (OR 2.13, 95% CI 1.85 to 2.46); heart failure (OR 2.12, 1.84 to 2.43); depression (OR 1.75, 1.62 to 1.89), but non-significant for cancer (OR 1.12, 0.98 to 1.28). In addition to cardiovascular disease, the metric identified osteoarthritis, hypothyroidism, anxiety, schizophrenia and respiratory conditions as highly prevalent comorbidities in people with T2D. CONCLUSIONS T2D diagnosis is associated with higher likelihood of experiencing other physical and mental illnesses. People with T2D are twice as likely to have cardiovascular disease as the general population. The findings highlight highly prevalent and under-reported comorbidities in people with T2D. These findings can inform future research and clinical guidelines and can have important implications on healthcare resource allocation and highlight the need for more holistic clinical care for people with recently diagnosed T2D.
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Affiliation(s)
- Salwa S Zghebi
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
- Department of Pharmaceutics, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
| | - Douglas T Steinke
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
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Sivachandran N, Ahmad A, Qian J, Moinul P, Barbosa J, Farrokhyar F, Chaudhary V. Baseline Diabetes Knowledge Assessment Amongst Adults With Type 1 and Type 2 Diabetes Receiving Eye Care at a Tertiary Ophthalmic Centre in Canada. Can J Diabetes 2020; 45:22-26. [PMID: 32800763 DOI: 10.1016/j.jcjd.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/28/2020] [Accepted: 04/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this work was to assess the current state of baseline knowledge of diabetes and diabetic retinopathy (DR) in new patients referred to a tertiary retina service from their primary eye care provider. METHODS This single-centre, prospective, observational study included patients presenting to the retina clinic at the Hamilton Regional Eye Institute, a major tertiary referral centre, for their initial consultation for diabetes- or DR-associated complications. Upon recruitment into the study, patients were asked to complete a 35-item questionnaire regarding diabetes and associated complications. All data were coded and analyzed using statistical software. RESULTS A total of 98 patients participated in the study, which included 50 men and 48 women. Seventy-eight patients (79.6%) were Caucasian. We found that 56.1% (n=55) of the patients did not know the meaning of "HbA1C" (glycated hemoglobin) and only 26.5% of patients sampled were aware of their DR status. Bivariate analysis revealed that patients who had postsecondary education (p<0.001) or those who had education on complications of diabetes (p<0.05) were more likely to know their DR status. More importantly, it was found that 56.1% of patients expressed interest in a future diabetes seminar. CONCLUSIONS It is evident that a significant proportion of patients do not have adequate knowledge of diabetes or DR, and this is related to their level of education and lack of being taught about diabetes complications. Our findings may guide prevention initiatives by primary eye care providers and promote increased awareness about diabetes and DR for prevention of disease complications, including blindness.
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Affiliation(s)
- Nirojini Sivachandran
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada.
| | - Afreen Ahmad
- Department of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jenn Qian
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Prima Moinul
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Joshua Barbosa
- Wayne State School of Medicine, Detroit, Michigan, United States
| | - Forough Farrokhyar
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Varun Chaudhary
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada; McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
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Jermendy G, Kiss Z, Rokszin G, Fábián I, Wittmann I, Kempler P. Changes in mortality rates and ratios in people with pharmacologically treated type 2 diabetes mellitus between 2001 and 2016 in Hungary. Diabetes Res Clin Pract 2020; 163:108134. [PMID: 32272189 DOI: 10.1016/j.diabres.2020.108134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) is associated with a higher risk of all-cause mortality; however, detailed analyses of subgroups are rare. In this study we analyzed the changes of age- and gender-specific all-cause mortality rates and ratios in T2DM subjects (aged > 40 years) in Hungary between 2001 and 2016. METHODS We used the central database of the National Institute of Health Insurance Fund. All-cause mortality rates in patients with T2DM and ratios (T2DM/non-T2DM) were determined in males/females and in different age-groups. Age-adjusted values were used for standardized mortality rates. RESULTS Among pharmacologically treated T2DM subjects we found 117,700 and 329,845 males, 232,143 and 391,382 females in 2001 and 2016, respectively. Standardized all-cause mortality rate was higher in males than in females in 2001 (4540/100,000 vs. 3365/100,000) which decreased to 4125/100,000 in males (total change: -11.8%, p < 0.0001) and to 2977/100,000 in females (total change: -9.2%; p = 0.0558) in 2016. We found a significant increase (8.35%; p = 0.0272) in standardized all-cause mortality ratios between 2001 and 2016 which was higher in males (11.44%; p = 0.0096) than in females (2.78%; p = 0.3288). We observed the most pronounced increase in younger age-groups (age 41-60 years) in both genders (change varied from 54.2% to 101.8%; p < 0.05) which was due to distinct tendencies in changes of mortality curves. CONCLUSIONS Pharmacologically treated T2DM subjects in lower age-groups (41-60 years) had the highest increase in all-cause mortality ratios between 2001 and 2016 in Hungary. These data indicate that relatively younger patients with T2DM need special attention for improving long-term outcomes.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, 1106 Budapest, Hungary.
| | - Zoltán Kiss
- University of Pécs, Faculty of Medicine, 2(nd) Department of Medicine, Nephrological and Diabetes Center, Pacsirta út 1, 7624 Pécs, Hungary.
| | - György Rokszin
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - Ibolya Fábián
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - István Wittmann
- University of Pécs, Faculty of Medicine, 2(nd) Department of Medicine, Nephrological and Diabetes Center, Pacsirta út 1, 7624 Pécs, Hungary.
| | - Péter Kempler
- Semmelweis University, Faculty of Medicine, 1(st) Department of Medicine, Korányi Sándor út 2, 1083 Budapest, Hungary.
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Carstensen B, Rønn PF, Jørgensen ME. Prevalence, incidence and mortality of type 1 and type 2 diabetes in Denmark 1996-2016. BMJ Open Diabetes Res Care 2020; 8:8/1/e001071. [PMID: 32475839 PMCID: PMC7265004 DOI: 10.1136/bmjdrc-2019-001071] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/03/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The objective of this study was to give an overview of prevalence, incidence and mortality of type 1 (T1D) and type 2 diabetes (T2D) in Denmark, and their temporal trends. RESEARCH DESIGN AND METHODS We constructed a diabetes register from existing population-based healthcare registers, including a classification of patients as T1D or T2D, with coverage from 1996 to 2016. Using complete population records for Denmark, we derived prevalence, incidence, mortality and standardized mortality ratio (SMR). RESULTS The overall prevalence of diabetes at 2016 was 0.5% for T1D and 4.4% for T2D, with annual increases since 1996 of 0.5% for T1D and 5.5% for T2D. Incidence rates of T1D decreased by 3.5% per year, with increase for persons under 25 years of age and a decrease for older persons. T2D incidence increased 2.5% per year until 2011, decreased until 2014 and increased after that, similar in all ages. The annual decrease in mortality was 0.3% for T1D and 2.9% for T2D. The mortality rate ratio between T1D and T2D was 1.9 for men and 1.6 for women. SMR decreased annually 2% for T1D and 0.5% for T2D. CONCLUSIONS Incidence and prevalence of diabetes is increasing, but mortality among patients with diabetes in Denmark is decreasing faster than the mortality among persons without diabetes. T1D carries a 70% higher mortality than T2D.
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Affiliation(s)
- Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Pernille Falberg Rønn
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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Bracco PA, Gregg EW, Rolka DB, Schmidt MI, Barreto SM, Lotufo PA, Bensenor I, Chor D, Duncan BB. A nationwide analysis of the excess death attributable to diabetes in Brazil. J Glob Health 2020; 10:010401. [PMID: 32257151 PMCID: PMC7101024 DOI: 10.7189/jogh.10.010401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Data on mortality burden and excess deaths attributable to diabetes are sparse and frequently unreliable, particularly in low and middle-income countries. Estimates in Brazil to date have relied on death certificate data, which do not consider the multicausal nature of deaths. Our aim was to combine cohort data with national prevalence and mortality statistics to estimate the absolute number of deaths that could have been prevented if the mortality rates of people with diabetes were the same as for those without. In addition, we aimed to estimate the increase in burden when considering undiagnosed diabetes. Methods We estimated self-reported diabetes prevalence from the National Health Survey (PNS) and overall mortality from the national mortality information system (SIM). We estimated the diabetes mortality rate ratio (rates of those with vs without diabetes) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), an ongoing cohort study. Joining estimates from these three sources, we calculated for the population the absolute number and the fraction of deaths attributable to diabetes. We repeated our analyses considering both self-reported and unknown diabetes, the latter estimated based on single point-in-time glycemic determinations in ELSA-Brasil. Finally, we compared results with diabetes-related mortality information from death certificates. Results In 2013, 65 581 deaths, 9.1% of all deaths between the ages of 35-80, were attributable to known diabetes. If cases of unknown diabetes were considered, this figure would rise to 14.3%. In contrast, based on death certificates only, 5.3% of all death had diabetes as the underlying cause and 10.4% as any mentioned cause. Conclusions In this first report of diabetes mortality burden in Brazil using cohort data to estimate diabetes mortality rate ratios and the prevalence of unknown diabetes, we showed marked underestimation of the current burden, especially when unknown cases of diabetes are also considered.
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Affiliation(s)
- Paula A Bracco
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Edward W Gregg
- Department of Diabetes and Cardiovascular Disease Epidemiology, School of Public Health, Imperial College London, UK
| | - Deborah B Rolka
- National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, Center of Disease Control, Atlanta, Georgia, USA
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sandhi M Barreto
- Department of Preventive and Social Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo A Lotufo
- Department of Internal Medicine, School of Medicine, University of Sao Paulo, São Paulo, SP, Brazil
| | - Isabela Bensenor
- Department of Internal Medicine, School of Medicine, University of Sao Paulo, São Paulo, SP, Brazil
| | - Dora Chor
- Department of Epidemiology and Health Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Wu H, Lau ESH, Ma RCW, Kong APS, Wild SH, Goggins W, Chow E, So WY, Chan JCN, Luk AOY. Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001-2016: a retrospective cohort study. Diabetologia 2020; 63:757-766. [PMID: 31942668 DOI: 10.1007/s00125-019-05074-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/21/2019] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS The aim of the study was to describe trends in all-cause and cause-specific mortality rates in Hong Kong Chinese people with diabetes from 2001 to 2016. METHODS The Hong Kong Diabetes Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from the Hong Kong Hospital Authority electronic medical record system. Deaths between 2001 and 2016 were identified from linkage to the Hong Kong Death Registry. We used Joinpoint regression analysis to describe mortality patterns among people with diabetes by age and sex, and standardised mortality ratios (SMRs) to compare all-cause mortality rates in people with and without diabetes. RESULTS Between 2001 and 2016, a total of 390,071 men and 380,007 women aged 20 years or older with diabetes were included in the HKDSD. There were 96,645 deaths among men and 88,437 deaths among women. Mortality rates for all-cause, cardiovascular disease and cancer among people with diabetes declined by 52.3%, 72.2% and 65.1% in men, respectively, and by 53.5%, 78.5% and 59.6% in women, respectively. Pneumonia mortality rates remained stable. The leading cause of death in people with diabetes has shifted from cardiovascular disease to pneumonia in the oldest age group, with cancer remaining the most common cause of death in people aged 45-74 years. The all-cause SMRs for men declined from 2.82 (95% CI 2.72, 2.94) to 1.50 (95% CI 1.46, 1.54), and for women, they declined from 3.28 (95% CI 3.15, 3.41) to 1.67 (95% CI 1.62, 1.72). However, among people aged 20-44 years, the declines in all-cause mortality rates over the study period were not statistically significant for both men (average annual per cent change [AAPC]: -3.2% [95% CI -7.3%, 1.0%]) and women (AAPC: -1.2% [95% CI -6.5%, 4.4%]). The SMRs in people aged 20-44 years fluctuated over time, between 7.86 (95% CI 5.74, 10.5) in men and 6.10 (95% CI 3.68, 9.45) in women in 2001, and 4.95 (95% CI 3.72, 6.45) in men and 4.92 (95% CI 3.25, 7.12) in women in 2016. CONCLUSIONS/INTERPRETATION Absolute and relative mortality has declined overall in people with diabetes in Hong Kong, with less marked improvements in people under 45 years of age, calling for urgent action to improve care in young people with diabetes.
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Affiliation(s)
- Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - William Goggins
- Jockey Club School of Public Health and Family Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, People's Republic of China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Hospital Authority, Hong Kong Special Administrative Region, People's Republic of China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
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Sinclair A, Saeedi P, Kaundal A, Karuranga S, Malanda B, Williams R. Diabetes and global ageing among 65-99-year-old adults: Findings from the International Diabetes Federation Diabetes Atlas, 9 th edition. Diabetes Res Clin Pract 2020; 162:108078. [PMID: 32068097 DOI: 10.1016/j.diabres.2020.108078] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 12/23/2022]
Abstract
AIMS The main aims are: (a) to draw attention to the nature and pattern of recent global and regional prevalence estimates and projections of diabetes in older adults (65-99 years), and (b) to describe the societal health implications of these changes on a global scale. METHODS Diabetes prevalences and projections were estimated using a logistic regression method to generate smoothed age- and sex-specific prevalence estimates for 5-year age groups. RESULTS In 2019, it is estimated that 19.3% of people aged 65-99 years (135.6 million, 95% CI: 107.6-170.6 million) live with diabetes. It is projected that the number of people older than 65 years (65-99 years) with diabetes will reach 195.2 million by 2030 and 276.2 million by 2045. For the regional distribution, the highest prevalence in 2019 being the North America and Caribbean Region at 27.0%. Countries with the highest number of people older than 65 years with diabetes are China, the United States of America and India. CONCLUSIONS There is a need for more data from national and regional sources on those aged 65 years and over, but the prevailing evidence points to diabetes being a considerable global chronic illness burden in ageing societies.
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Affiliation(s)
- Alan Sinclair
- King's College, London, and Diabetes Frail Ltd, Luton, United Kingdom
| | - Pouya Saeedi
- International Diabetes Federation, Brussels, Belgium.
| | - Abha Kaundal
- International Diabetes Federation, Brussels, Belgium
| | | | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | - Rhys Williams
- Diabetes Research Unit Cymru, Swansea University, Swansea, United Kingdom
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Raghavan S, Vassy JL, Ho YL, Song RJ, Gagnon DR, Cho K, Wilson PWF, Phillips LS. Diabetes Mellitus-Related All-Cause and Cardiovascular Mortality in a National Cohort of Adults. J Am Heart Assoc 2020; 8:e011295. [PMID: 30776949 PMCID: PMC6405678 DOI: 10.1161/jaha.118.011295] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Diabetes mellitus is a risk factor for cardiovascular disease ( CVD ) and has been associated with 2- to 4-fold higher mortality. Diabetes mellitus-related mortality has not been reassessed in individuals receiving routine care in the United States in the contemporary era of CVD risk reduction. Methods and Results We retrospectively studied 963 648 adults receiving care in the US Veterans Affairs Healthcare System from 2002 to 2014; mean follow-up was 8 years. We estimated associations of diabetes mellitus status and hemoglobin A1c (HbA1c) with all-cause and CVD mortality using covariate-adjusted incidence rates and multivariable Cox proportional hazards regression. Of participants, 34% had diabetes mellitus. Compared with nondiabetic individuals, patients with diabetes mellitus had 7.0 (95% CI , 6.7-7.4) and 3.5 (95% CI, 3.3-3.7) deaths/1000-person-years higher all-cause and CVD mortality, respectively. The age-, sex-, race-, and ethnicity-adjusted hazard ratio for diabetes mellitus-related mortality was 1.29 (95% CI, 1.28-1.31), and declined with adjustment for CVD risk factors (hazard ratio, 1.18 [95% CI, 1.16-1.19]) and glycemia (hazard ratio, 1.03 [95% CI, 1.02-1.05]). Among individuals with diabetes mellitus, CVD mortality increased as HbA1c exceeded 7% (hazard ratios, 1.11 [95% CI, 1.08-1.14], 1.25 [95% CI, 1.22-1.29], and 1.52 [95% CI, 1.48-1.56] for HbA1c 7%-7.9%, 8%-8.9%, and ≥9%, respectively, relative to HbA1c 6%-6.9%). HbA1c 6% to 6.9% was associated with the lowest mortality risk irrespective of CVD history or age. Conclusions Diabetes mellitus remains significantly associated with all-cause and CVD mortality, although diabetes mellitus-related excess mortality is lower in the contemporary era than previously. We observed a gradient of mortality risk with increasing HbA1c >6% to 6.9%, suggesting HbA1c remains an informative predictor of outcomes even if causality cannot be inferred.
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Affiliation(s)
- Sridharan Raghavan
- 1 Department of Veterans Affairs Eastern Colorado Healthcare System Aurora CO.,2 Division of Hospital Medicine University of Colorado School of Medicine Aurora CO.,3 Colorado Cardiovascular Outcomes Research Consortium Aurora CO
| | - Jason L Vassy
- 4 Department of Veterans Affairs Boston Healthcare System Boston MA.,5 Department of Medicine Harvard Medical School Boston MA
| | - Yuk-Lam Ho
- 4 Department of Veterans Affairs Boston Healthcare System Boston MA
| | - Rebecca J Song
- 4 Department of Veterans Affairs Boston Healthcare System Boston MA
| | - David R Gagnon
- 4 Department of Veterans Affairs Boston Healthcare System Boston MA.,6 Department of Biostatistics Boston University School of Public Health Boston MA
| | - Kelly Cho
- 4 Department of Veterans Affairs Boston Healthcare System Boston MA.,5 Department of Medicine Harvard Medical School Boston MA
| | - Peter W F Wilson
- 7 Department of Veterans Affairs Atlanta Medical Center Atlanta GA.,8 Division of Cardiology Emory University School of Medicine Atlanta GA
| | - Lawrence S Phillips
- 7 Department of Veterans Affairs Atlanta Medical Center Atlanta GA.,9 Division of Endocrinology Emory University School of Medicine Atlanta GA
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Thunander M, Lindgren A, Petersson C, Landin-Olsson M, Holmberg S. Standard mortality rates and years of life lost for serologically defined adult-onset type 1 and type 2 diabetes - A fifteen year follow-up. Diabetes Res Clin Pract 2020; 160:107943. [PMID: 31765685 DOI: 10.1016/j.diabres.2019.107943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/08/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
AIMS The Diabetes Incidence in Kronoberg (DIK) study of adult-onset diabetes used serological classification. Standard Mortality Rates (SMR) and Years of Life Lost (YLL) 15 years after adult-onset (18-100 years) of diabetes were compared to the population of Kronoberg. METHODS Of 1609/1660 (97%) patients, 112 (7%) had type 1 (T1D) (GADA+ and/or ICA+, and/or C-peptide < 0.25 nmol/l), and 1497 (93%) had type 2 diabetes (T2D) (antibody- and C-peptide ≥ 0.25 nmol/l). The National Swedish Mortality Register provided time of death. RESULTS For T1D SMR did not differ from the Kronoberg population in any age group. In T2D SMR was 1.20 (1.12-1.29). After 15 years 26% (29/112) T1D and 52% (785/1497) T2D patients had died, p < 0.0001. In T2D SMR was 5.6 (30-39 years), 2 (40-59 years), 1.4 (60-69 years), and thereafter no difference. There were no significant sex differences in mortality, and no YLL to adult-onset T1D, but five YLL to T2D for onset at ages 20-60 years. CONCLUSIONS For adult-onset T1D SMR did not differ from the general population, in contrast to previous findings in childhood-onset (< 30 years of age) T1D. The difference in mortality between persons with diabetes and the general population was due to higher mortality in T2D.
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Affiliation(s)
- Maria Thunander
- Department of Clinical Sciences, Diabetes and Endocrinology, Lund University, Lund, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Internal Medicine, Endocrinology and Diabetes, Central Hospital, Växjö, Sweden.
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Christer Petersson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden; Primary Care, Region Kronoberg, Växjö, Sweden
| | - Mona Landin-Olsson
- Department of Clinical Sciences, Diabetes and Endocrinology, Lund University, Lund, Sweden; Department of Endocrinology and Diabetes, Skane University Hospital, Lund, Sweden
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, Växjö, Sweden; Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Collier A, Meney C, Hair M, Cameron L, Boyle JG. Cancer has overtaken cardiovascular disease as the commonest cause of death in Scottish type 2 diabetes patients: A population-based study (The Ayrshire Diabetes Follow-up Cohort study). J Diabetes Investig 2020; 11:55-61. [PMID: 31267699 PMCID: PMC6944844 DOI: 10.1111/jdi.13067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/24/2019] [Accepted: 05/03/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION The increased mortality risk associated with diabetes is well established. The aim of the present study was to determine the causes of death of people with type 2 diabetes in Ayrshire and Arran, Scotland, between 2009 and 2014, and compare them with the national mortality rates. MATERIALS AND METHODS The primary causes of death were collated. The causes of death were clustered into nine categories: heart disease, stroke, infection, renal failure, respiratory disorders, cancer, mental health, decompensated diabetes and other. The total rates were compared with national rates using the standardized mortality ratio (SMR), and then individually with heart disease, cerebrovascular disease and cancer. RESULTS There were 2116 deaths with the SMR, and 145 of those were caused by type 2 diabetes (n = 16,643; 95% confidence interval 139-152; P < 0.01). The SMR was >100 in all age bands, particularly in the younger age bands (P < 0.01). The SMR was consistently higher for women (P < 0.01). The SMR for heart disease was significantly >100 for both sexes in all age bands <65 years (P < 0.05). There was no difference in mortality causes related to the duration of diabetes. The most common cause of death was cancer (27.8%), followed by heart disease (24.1%). The SMR for cancer deaths was significantly elevated in women (120, 95% CI 104-137; P < 0.05). CONCLUSIONS This study confirmed increased mortality risk in type 2 diabetes patients, and suggests that where cardiovascular risk factors are being treated aggressively, cancer takes on a greater importance in the cause of death. Should greater consideration now be given for cancer as a complication of diabetes?
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Affiliation(s)
| | | | - Mario Hair
- NHS Ayrshire and ArranUniversity HospitalAyrUK
| | - Lyall Cameron
- Primary Care Quality and DevelopmentNHS Ayrshire and ArranAilsa HospitalAyrUK
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Clements JM, West BT, Yaker Z, Lauinger B, McCullers D, Haubert J, Tahboub MA, Everett GJ. Disparities in diabetes-related multiple chronic conditions and mortality: The influence of race. Diabetes Res Clin Pract 2020; 159:107984. [PMID: 31846667 PMCID: PMC6959124 DOI: 10.1016/j.diabres.2019.107984] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/21/2019] [Accepted: 12/13/2019] [Indexed: 01/03/2023]
Abstract
AIMS The aims of this study are to confirm disparities in diabetes mortality rates based on race, determine if race predicts combinations of diabetes and multiple chronic conditions (MCC) that are leading causes of death (LCD), and determine if combinations of diabetes plus MCC mediate the relationship between race and mortality. METHODS We performed a retrospective cohort study of 443,932 Medicare beneficiaries in the State of Michigan with type 2 diabetes mellitus and MCC. We applied Cox proportional hazards regression to determine predictors of mortality. We applied multinomial logistic regression to determine predictors of MCC combinations. RESULTS We found that race influences mortality in Medicare beneficiaries with Type 2 diabetes mellitus and MCC. Prior to adjusting for MCC combinations, we observed that Blacks and American Indian/Alaska Natives have increased risk of mortality compared to Whites, while there is no difference in mortality between Hispanics and Whites. Regarding MCC combinations, Black/African American beneficiaries experience increased odds for most MCC combinations while Asian/Pacific Islanders and Hispanics experience lower odds for MCC combinations, compared to Whites. When adjusting for MCC, mortality disparities observed between Whites, Black/African Americans, and American Indians/Alaska Natives persist. CONCLUSIONS Compared to Whites, Black/African Americans in our cohort had increased odds of most MCC combinations, and an increased risk of mortality that persisted even after adjusting for MCC combinations.
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Affiliation(s)
- John M Clements
- Central Michigan University, College of Medicine, 1280 East Campus Dr., Mount Pleasant, MI 48859, United States.
| | - Brady T West
- Survey Research Center, Institute for Social Research, University of Michigan-Ann Arbor, United States
| | - Zachary Yaker
- Central Michigan University, College of Medicine, 1280 East Campus Dr., Mount Pleasant, MI 48859, United States
| | - Breanna Lauinger
- Central Michigan University, College of Medicine, 1280 East Campus Dr., Mount Pleasant, MI 48859, United States
| | - Deven McCullers
- Central Michigan University, College of Medicine, 1280 East Campus Dr., Mount Pleasant, MI 48859, United States
| | - James Haubert
- Central Michigan University, College of Medicine, 1280 East Campus Dr., Mount Pleasant, MI 48859, United States
| | - Mohammad Ali Tahboub
- Central Michigan University, College of Medicine, 1280 East Campus Dr., Mount Pleasant, MI 48859, United States
| | - Gregory J Everett
- Central Michigan University, College of Medicine, 1280 East Campus Dr., Mount Pleasant, MI 48859, United States
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Lee YB, Han K, Kim B, Lee SE, Jun JE, Ahn J, Kim G, Jin SM, Kim JH. Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study. Cardiovasc Diabetol 2019; 18:157. [PMID: 31733656 PMCID: PMC6858684 DOI: 10.1186/s12933-019-0953-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background Both type 1 and type 2 diabetes are well-established risk factors for cardiovascular disease and early mortality. However, few studies have directly compared the hazards of cardiovascular outcomes and premature death among people with type 1 diabetes to those among people with type 2 diabetes and subjects without diabetes. Furthermore, information about the hazard of cardiovascular disease and early mortality among Asians with type 1 diabetes is sparse, although the clinical and epidemiological characteristics of Asians with type 1 diabetes are unlike those of Europeans. We estimated the hazard of myocardial infarction (MI), hospitalization for heart failure (HF), atrial fibrillation (AF), and mortality during follow-up in Korean adults with type 1 diabetes compared with those without diabetes and those with type 2 diabetes. Methods We used Korean National Health Insurance Service datasets of preventive health check-ups from 2009 to 2016 in this retrospective longitudinal study. The hazard ratios of MI, HF, AF, and mortality during follow-up were analyzed using the Cox regression analyses according to the presence and type of diabetes in ≥ 20-year-old individuals without baseline cardiovascular disease (N = 20,423,051). The presence and type of diabetes was determined based on the presence of type 1 or type 2 diabetes at baseline. Results During more than 93,300,000 person-years of follow-up, there were 116,649 MIs, 135,532 AF cases, 125,997 hospitalizations for HF, and 344,516 deaths. The fully-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MI, hospitalized HF, AF, and all-cause death within the mean follow-up of 4.6 years were higher in the type 1 diabetes group than the type 2 diabetes [HR (95% CI) 1.679 (1.490–1.893) for MI; 2.105 (1.901–2.330) for HF; 1.608 (1.411–1.833) for AF; 1.884 (1.762–2.013) for death] and non-diabetes groups [HR (95% CI) 2.411 (2.138–2.718) for MI; 3.024 (2.730–3.350) for HF; 1.748 (1.534–1.993) for AF; 2.874 (2.689–3.073) for death]. Conclusions In Korea, the presence of diabetes was associated with a higher hazard of cardiovascular disease and all-cause death. Specifically, people with type 1 diabetes had a higher hazard of cardiovascular disease and all-cause mortality compared to people with type 2 diabetes.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul, 06978, Republic of Korea
| | - Seung-Eun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Konkuk University Medical Center, 210-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Ji Eun Jun
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Slater M, Green ME, Shah B, Khan S, Jones CR, Sutherland R, Jacklin K, Walker JD. First Nations people with diabetes in Ontario: methods for a longitudinal population-based cohort study. CMAJ Open 2019; 7:E680-E688. [PMID: 31767570 PMCID: PMC6944142 DOI: 10.9778/cmajo.20190096] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To improve diabetes care, First Nations leaders and others need access to population-level health data. We provide details of the collaborative methods we used to describe the prevalence and incidence of diabetes in First Nations people in Ontario and present demographic data for this population compared to the rest of the Ontario population. METHODS To identify the population of First Nations people and other people in Ontario, we created annual cohorts of the Ontario population for each year between Apr. 1, 1995, and Mar. 31, 2015. Through a partnership between First Nations and academic researchers, we linked provincial population-based health administrative data stored at ICES with the Indian Register, which identifies all Status First Nations people. Our collaborative process was guided by the First Nations principles of ownership, control, access and possession (OCAP). RESULTS Demographic characteristics for the 2014/15 cohort (n = 13 406 684) are presented here. The cohort includes 158 241 Status First Nations people and 13 248 443 other people living in Ontario. Using postal codes, we were able to identify virtually all (99.9%) First Nations people in Ontario as living in (n = 55 311) or outside (n =102 889) a First Nations community. First Nations people were younger and more likely to live in semiurban or rural areas than the rest of Ontario's population. INTERPRETATION The collaborative methodology used in this study is applicable to many jurisdictions working with Indigenous groups who have access to similar data. The Ontario cohort defined here is being used to conduct analyses of health outcomes and use of health care services among First Nations people with diabetes in Ontario.
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Affiliation(s)
- Morgan Slater
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Michael E Green
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Baiju Shah
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Shahriar Khan
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Carmen R Jones
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Roseanne Sutherland
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Kristen Jacklin
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Jennifer D Walker
- Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.
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Tönnies T, Röckl S, Hoyer A, Heidemann C, Baumert J, Du Y, Scheidt-Nave C, Brinks R. Projected number of people with diagnosed Type 2 diabetes in Germany in 2040. Diabet Med 2019; 36:1217-1225. [PMID: 30659656 DOI: 10.1111/dme.13902] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2019] [Indexed: 12/17/2022]
Abstract
AIMS To project the number of people with Type 2 diabetes in Germany between 2015 and 2040. METHODS Based on data from 65 million insurees of the German statutory health insurance, we projected the age-specific prevalence of diabetes using mathematical relations between prevalence, incidence rate and mortality. We compared several scenarios regarding temporal trends in the incidence and mortality rate. The projected age-specific prevalence was applied to the projected age structure of the German population between 2015 and 2040 to calculate the number of people with Type 2 diabetes. RESULTS Application of current age-specific prevalence estimates to the projected age structure in 2040, although ignoring temporal trends in incidence and mortality, yielded an increase in the number of Type 2 diabetes cases from 6.9 million in 2015 to 8.3 million (+21%) in 2040. More realistic scenarios that account for decreasing mortality rates and different trends in the incidence rates project between 10.7 million (+54%) and 12.3 million (+77%) Type 2 diabetes cases in 2040. CONCLUSIONS For the first time, we projected the number of future Type 2 diabetes cases for the whole adult population in Germany. The results indicate a relative increase in the number of Type 2 diabetes cases of between 54% and 77% from 2015 to 2040. Temporal trends in the incidence rate are the main drivers of this increase. Simply applying current age-specific prevalence to the future age structure probably underestimates the future number of Type 2 diabetes cases.
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Affiliation(s)
- T Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - S Röckl
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - A Hoyer
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - C Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - J Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Y Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - C Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - R Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Düsseldorf, Germany
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