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Hoang YN, Nguyen TH, Ho DKN, Bai CH, Lin WL, Phan HD, Phan HH, Tran NL, Chang JS. Dietary glycemic index and glycemic load predict longitudinal change in glycemic and cardio-metabolic biomarkers among old diabetic adults living in a resource-poor country. Int J Food Sci Nutr 2024; 75:550-561. [PMID: 38946436 DOI: 10.1080/09637486.2024.2368843] [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: 08/28/2023] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
This study aims to investigate longitudinal associations between the dietary glycemic index (GI) and glycemic load (GL) and changes in glycemic and cardio-metabolic outcomes. A 28-month retrospective cohort study included 110 Vietnamese diabetic patients, collecting their dietary GI and GL values along with blood biochemical data from baseline 24-h dietary recall and medical records. Latent class growth modelling identified three distinct HbA1c trajectories during the follow-up period, with 51% of patients achieving good glycemic control. The adjusted linear mixed-effect model showed that 1 unit increase in logarithms in dietary GL was associated with a 0.14% increase in the log-HbA1c. Among poorly controlled diabetic patients, baseline GL values were positively correlated with increases in HbA1c; GI showed effects on changes in fasting plasma glucose and the triglyceride-glucose (TyG) index. No significant association was observed in patients with good glycemic control.
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Affiliation(s)
- Yen Nhi Hoang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Trong Hung Nguyen
- Department of Adult Nutrition Counselling, National Institute of Nutrition, Hanoi, Vietnam
- Department of Clinical Nutrition and Dietetics, National Hospital of Endocrinology, Hanoi, Vietnam
| | - Dang Khanh Ngan Ho
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Ling Lin
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan
| | | | | | | | - Jung-Su Chang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Chinese Taipei Society for the Study of Obesity (CTSSO), Taipei, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
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Johari SM, Razalli NH, Chua KJ, Shahar S. The efficacy of self-monitoring of blood glucose (SMBG) intervention package through a subscription model among type-2 diabetes mellitus in Malaysia: a preliminary trial. Diabetol Metab Syndr 2024; 16:135. [PMID: 38902819 PMCID: PMC11191324 DOI: 10.1186/s13098-024-01379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The aim of this study was to determine the effect of a Self-Monitoring Blood Glucose (SMBG) intervention package through a subscription model in improving HbA1c and health parameters among type-2 diabetes mellitus (T2DM) individuals in Malaysia. METHODS This is a quasi-experimental study involving a total number of 111 individuals with T2DM (mean age 57.0 ± 11.7 years, 61% men) who were assigned to intervention (n = 51) and control (n = 60) groups. The intervention group participants were the subscribers of SugO365 program which provided a personalized care service based on self-recorded blood glucose values. Subscribers received a Contour® Plus One glucometer which can connect to Health2Sync mobile app to capture all blood glucose readings as well as physical and virtual follow up with dietitians, nutritionists, and pharmacists for 6 months. Outcome measures were body weight, body mass index (BMI), random blood glucose (RBG), glycated haemoglobin (HbA1c) and health-related quality of life (HRQoL, assessed by SF-36 questionnaire). Data were measured at baseline, third and sixth months. RESULTS Repeated-measure analysis of covariance showed significant improvement in HbA1c level (ƞp2 = 0.045, p = 0.008) in the intervention (baseline mean 7.7% ± 1.1%; end mean 7.3% ± 1.3%) as compared to control (baseline mean 7.7% ± 0.9%; end mean 8.1% ± 1.6%) group. Similar trend was observed for Role Emotional domain of the quality of life (ƞp2 = 0.047, p = 0.023) in the intervention (baseline mean 62.8 ± 35.1, end mean 86.3 ± 21.3) compared to control (baseline mean group 70.5 ± 33.8; end mean 78.4 ± 27.3) group. Negative association was found in HbA1c changes using Z-score and Physical Function domain (r = - 0.217, p = 0.022). CONCLUSION A 6 months SMBG intervention package through a subscription model improved blood glucose control as measured by HbA1c and health-related quality of life, particularly the Role Emotional domain. Elevated HbA1c levels are correlated with decreased physical function.There is a need to further examine the efficacy of SMBG intervention package using a larger sample and a longer period of intervention and to determine its cost efficacy.
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Affiliation(s)
| | - Nurul Huda Razalli
- Dietetic Program, Centre for Healthy Aging and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | | | - Suzana Shahar
- Dietetic Program, Centre for Healthy Aging and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
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Nicolaisen SK, le Cessie S, Thomsen RW, Witte DR, Dekkers OM, Sørensen HT, Pedersen L. Longitudinal HbA1c patterns before the first treatment of diabetes in routine clinical practice: A latent class trajectory analysis. Diabetes Res Clin Pract 2024; 212:111722. [PMID: 38815656 DOI: 10.1016/j.diabres.2024.111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/25/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
AIMS To examine the longitudinal heterogeneity of HbA1c preceding the initiation of diabetes treatment in clinical practice. METHODS In this population-based study, we used HbA1c from routine laboratory and healthcare databases. Latent class trajectory analysis was used to classify individuals according to their longitudinal HbA1c patterns before first glucose-lowering drug prescription irrespective of type of diabetes. RESULTS Among 21,556 individuals initiating diabetes treatment during 2017-2018, 20,733 (96 %) had HbA1c measured (median 4 measurements [IQR 2-7]) in the 5 years preceding treatment initiation. Four classes with distinct HbA1c trajectories were identified, with varying steepness of increase in HbA1c. The largest class (74 % of the individuals) had mean HbA1c above the 48 mmol/mol threshold 9 months before treatment initiation. Mean HbA1c was 52 mmol/mol (95 % CI 52-52) at treatment initiation. In the remaining three classes, mean HbA1c exceeded 48 mmol/mol almost 1.5 years before treatment initiation and reached 79 mmol/mol (95 % CI 78-80), 105 mmol/mol (95 % CI 104-106), and 137 mmol/mol (95 % CI 135-140) before treatment initiation. CONCLUSION We identified four distinct longitudinal HbA1c patterns before initiation of diabetes treatment in clinical practice. All had mean HbA1c levels exceeding the diagnostic threshold many months before treatment initiation, indicating therapeutic inertia.
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Affiliation(s)
- Sia Kromann Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
| | - Saskia le Cessie
- Department of Clinical Epidemiology & Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Daniel R Witte
- Steno Diabetes Center Aarhus, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Olaf M Dekkers
- Department of Clinical Epidemiology & Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Aziz F, Sternad C, Sourij C, Knoll L, Kojzar H, Schranz A, Bürger A, Sourij H, Aberer F. Glycated haemoglobin, HOMA2-B, C-peptide to glucose ratio and type 2 diabetes clusters as predictors for therapy failure in individuals with type 2 diabetes without insulin therapy: A registry analysis. Diabetes Obes Metab 2024; 26:1082-1089. [PMID: 38151754 DOI: 10.1111/dom.15409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
AIM Some people with type 2 diabetes mellitus (T2D) and declining β-cell function do require insulin over time. Various laboratory parameters, indices of glucose metabolism or phenotypes of T2D (clusters) have been suggested, which might predict future therapy failure (TF), indicating the need for insulin therapy initiation. This analysis evaluated glycated haemoglobin (HbA1c), homeostatic model assessment (HOMA)2-B, C-peptide to glucose ratio (CGR) and diabetes clusters as predictive parameters for the occurrence of glycaemic TF in individuals diagnosed with T2D without previous insulin therapy. MATERIALS AND METHODS In total, 159 individuals with T2D [41% female, median age 50 (IQR: 53-69) years, diabetes duration 9 (5-15) years], without insulin therapy were prospectively evaluated for the occurrence of a composite primary endpoint, including HbA1c increasing or remaining >8.0% (64 mmol/mol) 3 months after baseline on non-insulin glucose-lowering agents, insulin initiation or hospital admissions because of acute hyperglycaemic events. Diabetes clusters were formed according to previously described characteristics. Only severe autoimmune diabetes clusters were excluded because of a small amount of glutamate decarboxylase antibody-positive participants. The other clusters were distributed as mild age-related diabetes 33%; severe insulin-deficient diabetes 31%; mild obesity-related diabetes 20%; and severe insulin-resistant diabetes 15%. RESULTS During a median observation of 57 months, higher tertiles of HbA1c at baseline, HOMA2-B, as well as a lower CGR were significantly predictive for the occurrence of the primary endpoint. The probability of meeting the primary endpoint was the highest for mild obesity-related diabetes [hazard ratio 3.28 (95% confidence interval 1.75-6.2)], followed by severe insulin-deficient diabetes [hazard ratio 2.03 (95% confidence interval 1.1-3.7)], mild age-related diabetes and the lowest for severe insulin-resistant diabetes. The best performance to predict TF with an area under the curve (AUC) of 0.77 was HbA1c at baseline, followed by HOMA2-B (AUC 0.69) and CGR (AUC 0.64). CONCLUSION HbA1c, indices of insulin secretion capacity (HOMA2-B and CGR) and T2D clusters might be applicable tools to guide practitioners in the decision of whether insulin is required in people already diagnosed with T2D. These findings need to be validated in prospective studies.
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Affiliation(s)
- Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Christoph Sternad
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Lisa Knoll
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Anna Schranz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Alexandra Bürger
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Davis TME, Davis W. The relationship between glycated haemoglobin and blood glucose-lowering treatment trajectories in type 2 diabetes: The Fremantle Diabetes Study Phase II. Diabetes Obes Metab 2024; 26:283-292. [PMID: 37795655 DOI: 10.1111/dom.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
AIMS To examine the relationships between glycaemia and treatment complexity over 6 years in well-characterized community-based people with type 2 diabetes. MATERIALS AND METHODS Fremantle Diabetes Study Phase II participants who had type 2 diabetes with glycated haemoglobin (HbA1c) and blood glucose-lowering therapy (BGLT) data over 6 years were included. Group-based multi-trajectory modelling identified combined HbA1c/BGLT trajectory subgroups for diabetes durations of ≤1.0 year (Group 1; n = 160), >1.0 to 10.0 years (Group 2; n = 382;) and >10.0 years (Group 3; n = 357). Multinomial regression was used to identify baseline associates of subgroup membership. RESULTS The optimum numbers of trajectory subgroups were three in Group 1 (low, medium, high) and four in Groups 2 and 3 (low, low/high medium, high). Each low trajectory subgroup maintained a mean HbA1c concentration of <53 mmol/mol (<7.0%) on lifestyle measures, or monotherapy (Group 3). All five medium subgroups had stable HbA1c trajectories at <58 mmol/mol (<7.5%) but required increasing oral BGLT, or insulin (Group 3, high medium). The Group 1 high subgroup showed a falling then increasing HbA1c with steady progression to insulin. The high subgroups in Groups 2 and 3 showed stable HbA1c profiles at means of approximately 64 mmol/mol (8.0%) and 86 mmol/L (10.0%), respectively, on insulin. Non-Anglo Celt ethnicity, central obesity and hypertriglyceridaemia were strongly associated with Group 1 high subgroup membership. Younger age at diagnosis and central obesity were independent associates of the most adverse HbA1c trajectories in Groups 2 and 3. CONCLUSIONS These data demonstrate diabetes duration-dependent heterogeneity in glycaemic and treatment profiles and related clinical and laboratory variables, which have implications for management.
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Affiliation(s)
- Timothy M E Davis
- University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy Davis
- University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Western Australia, Australia
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Erbakan AN, Arslan Bahadir M, Kaya FN, Güleç B, Vural Keskinler M, Faydaliel Ö, Mesçi B, Oğuz A. The effect of close and intensive therapeutic monitoring of patients with poorly controlled type 2 diabetes with different glycemic background. Medicine (Baltimore) 2023; 102:e36680. [PMID: 38115271 PMCID: PMC10727544 DOI: 10.1097/md.0000000000036680] [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: 10/12/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
Patients with type 2 diabetes who have HbA1c values ≥ 10% have different previous glycemic trends, including new diagnosis of diabetes. We aimed to assess the efficacy of 3 months of intensive and facilitated antihyperglycemic treatment in patients with different glycemic backgrounds. In this observational study, patients with type 2 diabetes and poor glycemic control (indicated by an HbA1c level of > = 10%) were divided into groups based on their previous HbA1c levels (group 1; newly diagnosed type 2 diabetics, group 2; patients with previously controlled but now deteriorated HbA1c levels, group 3; patients whose HbA1c was not previously in the target range but was now above 10%, and group 4; patients whose HbA1c was above 10% from the start). Patients received intensive diabetes management with close monitoring and facilitated hospital visits. For further analysis, patients who were known to have previously had good metabolic control (either did not have diabetes or had previously had an HbA1c value < =7) and patients who had prior poor metabolic control were analyzed separately. Of the 195 participants [female, n = 84 (43.1%)], the median age was 54 years (inter-quantile range [IQR] = 15, min = 29, max = 80) and the median baseline HbA1c was 11.8% (IQR = 2.6%, min = 10%, max = 18.3%). The median duration of diabetes was 10 years (IQR = 9, min = 1, max = 35) when newly diagnosed patients were excluded. The ≥ 20% reduction in HbA1c at month 3 was observed in groups 1 to 4 in 97%, 88.1%, 69.1%, and 55.4%, respectively. The percentage of patients who achieved an HbA1c level of 7% or less was 60.6%, 38.1%, 16.4%, and 6.2% in the groups, respectively. The rate of those who achieved an HbA1c of 7% or less was nearly 50% of patients with type 2 diabetes mellitus who had previously had good metabolic control, whereas successful control was achieved in only 1 in 10 patients with persistently high HbA1c levels. Patients' glycemic history played an important role in determining their HbA1c levels at 3 months, suggesting that previous glycemic management patterns may indicate future success in diabetes control.
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Affiliation(s)
- Ayşe Naciye Erbakan
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Müzeyyen Arslan Bahadir
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatoş Nimet Kaya
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Büşra Güleç
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Miraç Vural Keskinler
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Özge Faydaliel
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Banu Mesçi
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Aytekin Oğuz
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Halalau A, Roy S, Hegde A, Khanal S, Langnas E, Raja M, Homayouni R. Risk factors associated with glycated hemoglobin A1c trajectories progressing to type 2 diabetes. Ann Med 2023; 55:371-378. [PMID: 36621941 PMCID: PMC9833406 DOI: 10.1080/07853890.2022.2164347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The notion of prediabetes, defined by the ADA as glycated hemoglobin A1c (HbA1c) of 5.7-6.4%, implies increased vascular inflammatory and immunologic processes and higher risk for developing diabetes mellitus and major cardiovascular events. We aimed to determine the risk factors associated with rapid progression of normal and prediabetes patients to type 2 diabetes mellitus (T2DM). METHODS Retrospective cohort study in a single 8-hospital health system in southeast Michigan, between 2006 and 2020. All patients with HbA1c <6.5% at baseline and at least 2 other HbA1c measurements were clustered in five trajectories encompassing more than 95% of the study population. Multivariate linear regression analysis was performed to examine the association of demographic and comorbidities with HbA1c trajectories progressing to diabetes. RESULTS A total of 5,347 prediabetic patients were clustered based on their HbA1c progression (C1: 4,853, C2: 253, C66: 102, C12: 85, C68: 54). The largest cluster (C1) had a baseline median HbA1c value of 6.0% and exhibited stable HbA1c levels in prediabetic range across all subsequent years. The smallest cluster (C68) had the lowest median baseline HbA1c value and also remained stable across subsequent years. The proportion of normal HbA1c in each of the pre-diabetic trajectories ranged from 0 to 12.7%, whereas 81.5% of the reference cluster (C68) were normal HbA1c at baseline. The C2 (steady rising) trajectory was significantly associated with BMI (adj OR 1.10, 95%CI 1.03-1.17), and family history of DM (adj OR 2.75, 95%CI 1.32-5.74). With respect to the late rising trajectories, baseline BMI was significantly associated with both C66 and C12 trajectory (adj OR 1.10, 95%CI 1.03-1.18) and (adj OR 1.13, 95%CI 1.05-1.23) respectively, whereas, the C12 trajectory was also significantly associated with age (adj OR 1.62, 95%CI 1.04-2.53) and history of MACE (adj OR 3.20, 95%CI 1.14-8.93). CONCLUSIONS We suggest that perhaps a more aggressive preventative approach should be considered in patients with a family history of T2DM who have high BMI and year-to-year increase in HbA1c, whether they have normal hemoglobin A1c or they have prediabetes.KEY MESSAGESProgression to diabetes from normal or prediabetic hemoglobin A1c within four years is associated with baseline BMI.A steady rise in HbA1c during a four-year period is associated with age and family history of T2DM, whereas age and personal history of MACE are associated with a rapid rise in HbA1c.A more aggressive preventative approach should be considered in patients with a family history of T2DM who have high BMI and year-to-year increase in HbA1c.
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Affiliation(s)
- Alexandra Halalau
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Sujoy Roy
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Arpitha Hegde
- Department of Electrical and Computer Engineering, Oakland University, Rochester, MI, USA
| | - Sumesh Khanal
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Emily Langnas
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Maidah Raja
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ramin Homayouni
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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McCoy RG, Faust L, Heien HC, Patel S, Caffo B, Ngufor C. Longitudinal trajectories of glycemic control among U.S. Adults with newly diagnosed diabetes. Diabetes Res Clin Pract 2023; 205:110989. [PMID: 37918637 PMCID: PMC10842883 DOI: 10.1016/j.diabres.2023.110989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/27/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023]
Abstract
AIMS To identify longitudinal trajectories of glycemic control among adults with newly diagnosed diabetes, overall and by diabetes type. METHODS We analyzed claims data from OptumLabs® Data Warehouse for 119,952 adults newly diagnosed diabetes between 2005 and 2018. We applied a novel Mixed Effects Machine Learning model to identify longitudinal trajectories of hemoglobin A1c (HbA1c) over 3 years of follow-up and used multinomial regression to characterize factors associated with each trajectory. RESULTS The study population was comprised of 119,952 adults with newly diagnosed diabetes, including 696 (0.58%) with type 1 diabetes. Among patients with type 1 diabetes, 52.6% were diagnosed at very high HbA1c, partially improved, but never achieved control; 32.5% were diagnosed at low HbA1c and deteriorated over time; and 14.9% had stable low HbA1c. Among patients with type 2 diabetes, 67.7% had stable low HbA1c, 14.4% were diagnosed at very high HbA1c, partially improved, but never achieved control; 10.0% were diagnosed at moderately high HbA1c and deteriorated over time; and 4.9% were diagnosed at moderately high HbA1c and improved over time. CONCLUSIONS Claims data identified distinct longitudinal trajectories of HbA1c after diabetes diagnosis, which can be used to anticipate challenges and individualize care plans to improve glycemic control.
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Affiliation(s)
- Rozalina G McCoy
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; University of Maryland Institute for Health Computing, Bethesda, MD, United States; OptumLabs, Eden Prairie, MN, United States; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States.
| | - Louis Faust
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States
| | - Herbert C Heien
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States
| | - Shrinath Patel
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States
| | - Brian Caffo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Che Ngufor
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, United States; Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
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Tee C, Xu H, Fu X, Cui D, Jafar TH, Bee YM. Longitudinal HbA1c trajectory modelling reveals the association of HbA1c and risk of hospitalization for heart failure for patients with type 2 diabetes mellitus. PLoS One 2023; 18:e0275610. [PMID: 36662791 PMCID: PMC9858041 DOI: 10.1371/journal.pone.0275610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 09/20/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Inconsistent conclusions in past studies on the association between poor glycaemic control and the risk of hospitalization for heart failure (HHF) have been reported largely due to the analysis of non-trajectory-based HbA1c values. Trajectory analysis can incorporate the effects of HbA1c variability across time, which may better elucidate its association with macrovascular complications. Furthermore, studies analysing the relationship between HbA1c trajectories from diabetes diagnosis and the occurrence of HHF are scarce. METHODS This is a prospective cohort study of the SingHealth Diabetes Registry (SDR). 17,389 patients diagnosed with type 2 diabetes mellitus (T2DM) from 2013 to 2016 with clinical records extending to the end of 2019 were included in the latent class growth analysis to extract longitudinal HbA1c trajectories. Association between HbA1c trajectories and risk of first known HHF is quantified with the Cox Proportional Hazards (PH) model. RESULTS 5 distinct HbA1c trajectories were identified as 1. low stable (36.1%), 2. elevated stable (40.4%), 3. high decreasing (3.5%), 4. high with a sharp decline (10.8%), and 5. moderate decreasing (9.2%) over the study period of 7 years. Poorly controlled HbA1c trajectories (Classes 3, 4, and 5) are associated with a higher risk of HHF. Using the diabetes diagnosis time instead of a commonly used pre-defined study start time or time from recruitment has an impact on HbA1c clustering results. CONCLUSIONS Findings suggest that tracking the evolution of HbA1c with time has its importance in assessing the HHF risk of T2DM patients, and T2DM diagnosis time as a baseline is strongly recommended in HbA1c trajectory modelling. To the authors' knowledge, this is the first study to identify an association between HbA1c trajectories and HHF occurrence from diabetes diagnosis time.
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Affiliation(s)
- Clarence Tee
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Haiyan Xu
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Xiuju Fu
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
| | - Di Cui
- Systems Science Department, Institute of High-Performance Computing, Singapore, Singapore
- Department of Advanced Design and Systmes Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Tazeen H. Jafar
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
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Manzini E, Vlacho B, Franch-Nadal J, Escudero J, Génova A, Reixach E, Andrés E, Pizarro I, Portero JL, Mauricio D, Perera-Lluna A. Longitudinal deep learning clustering of Type 2 Diabetes Mellitus trajectories using routinely collected health records. J Biomed Inform 2022; 135:104218. [DOI: 10.1016/j.jbi.2022.104218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/08/2022] [Accepted: 10/03/2022] [Indexed: 10/31/2022]
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11
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Gungabissoon U, Broadbent M, Perera G, Ashworth M, Galwey N, Stewart R. The Impact of Dementia on Diabetes Control: An Evaluation of HbA 1c Trajectories and Care Outcomes in Linked Primary and Specialist Care Data. J Am Med Dir Assoc 2022; 23:1555-1563.e4. [PMID: 35661655 DOI: 10.1016/j.jamda.2022.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/25/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Diabetes self-care may become increasingly challenging as cognition declines. We sought to characterize glycated hemoglobin A1c (HbA1c) trajectories, markers of diabetes-related management, health care utilization, and mortality in people with preexisting type 2 diabetes (T2D) with and without dementia and based on the extent of cognitive impairment at the time of dementia diagnosis. DESIGN Retrospective matched cohort study. SETTING AND PARTICIPANTS Using a linkage between a primary care (Lambeth DataNet) and a secondary mental healthcare database, up to 5 individuals aged ≥65 y with preexisting T2D without dementia were matched to each individual with dementia based on age, sex, and general practice. METHODS Comparisons were made for HbA1c trajectories (linear mixed effects models), markers of diabetes-related management and severity at dementia diagnosis (logistic regression), mortality (Cox regression), and health care utilization (multilevel mixed effects binomial regression). RESULTS In 725 incident dementia and 3154 matched comparators, HbA1c trajectories differed by dementia status; HbA1c increased over time for mild dementia and non-dementia, but the increase was greater in the mild dementia group; for those with moderate-severe dementia, HbA1c decreased over time. Despite individuals with dementia having increased health care utilization around the time of dementia diagnosis, they were less likely to have had routine diabetes-related management. Patients with dementia had a higher prevalence of macrovascular complications and diabetes foot morbidity at dementia diagnosis and a higher mortality risk than those without dementia; these relationships were most marked in those with moderate-severe dementia. CONCLUSIONS AND IMPLICATIONS Our study has highlighted important differences in the monitoring, management, and control of diabetes in people with dementia. The effects of frailty and the extent of cognitive impairment on the ability to self-manage diabetes and on glycemic control may need to be considered in treatment guidelines and by primary care.
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Affiliation(s)
- Usha Gungabissoon
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; Epidemiology, Value, Evidence and Outcomes, Global Medical, GlaxoSmithKline (GSK) R&D, London, United Kingdom.
| | - Matthew Broadbent
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | | | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
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O'Connor S, Blais C, Mésidor M, Talbot D, Poirier P, Leclerc J. Great diversity in the utilization and reporting of latent growth modeling approaches in type 2 diabetes: A literature review. Heliyon 2022; 8:e10493. [PMID: 36164545 PMCID: PMC9508412 DOI: 10.1016/j.heliyon.2022.e10493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The progression of complications of type 2 diabetes (T2D) is unique to each patient and can be depicted through individual temporal trajectories. Latent growth modeling approaches (latent growth mixture models [LGMM] or latent class growth analysis [LCGA]) can be used to classify similar individual trajectories in a priori non-observed groups (latent groups), sharing common characteristics. Although increasingly used in the field of T2D, many questions remain regarding the utilization of these methods. Objective To review the literature of longitudinal studies using latent growth modeling approaches to study T2D. Methods MEDLINE (Ovid), EMBASE, CINAHL and Wb of Science were searched through August 25th, 2021. Data was collected on the type of latent growth modeling approaches (LGMM or LCGA), characteristics of studies and quality of reporting using the GRoLTS-Checklist and presented as frequencies. Results From the 4,694 citations screened, a total of 38 studies were included. The studies were published beetween 2011 and 2021 and the length of follow-up ranged from 8 weeks to 14 years. Six studies used LGMM, while 32 studies used LCGA. The fields of research varied from clinical research, psychological science, healthcare utilization research and drug usage/pharmaco-epidemiology. Data sources included primary data (clinical trials, prospective/retrospective cohorts, surveys), or secondary data (health records/registries, medico-administrative). Fifty percent of studies evaluated trajectory groups as exposures for a subsequent clinical outcome, while 24% used predictive models of group membership and 5% used both. Regarding the quality of reporting, trajectory groups were adequately presented, however many studies failed to report important decisions made for the trajectory group identification. Conclusion Although LCGA were preferred, the contexts of utilization were diverse and unrelated to the type of methods. We recommend future authors to clearly report the decisions made regarding trajectory groups identification.
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Affiliation(s)
- Sarah O'Connor
- Research Centre, Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Ch. Ste-Foy, Quebec City, Quebec, G1V 4G5, Canada
- Faculty of Pharmacy, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada
| | - Claudia Blais
- Faculty of Pharmacy, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada
- Bureau D'information et D’études en Santé des Populations, Institut National de Santé Publique Du Québec, 945, Wolfe Avenue, Quebec City, Quebec, G1V 5B3, Canada
| | - Miceline Mésidor
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada
- Research Centre, CHU de Québec – Université Laval, 2400 D'Estimauville Avenue, Québec, QC, G1E 6W2, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada
- Research Centre, CHU de Québec – Université Laval, 2400 D'Estimauville Avenue, Québec, QC, G1E 6W2, Canada
| | - Paul Poirier
- Research Centre, Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Ch. Ste-Foy, Quebec City, Quebec, G1V 4G5, Canada
- Faculty of Pharmacy, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada
| | - Jacinthe Leclerc
- Research Centre, Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval (IUCPQ-UL), 2725 Ch. Ste-Foy, Quebec City, Quebec, G1V 4G5, Canada
- Faculty of Pharmacy, Université Laval, Ferdinand Vandry Pavillon, 1050 de La Médecine Avenue, Quebec City, Quebec, G1V 0A6, Canada
- Department of Nursing, Université Du Québec à Trois-Rivières, 3351 des Forges Boulevard, Trois-Rivières, Quebec, G8Z 4M3, Canada
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13
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Lavikainen P, Aarnio E, Linna M, Jalkanen K, Tirkkonen H, Rautiainen P, Laatikainen T, Martikainen J. Data-driven long-term glycaemic control trajectories and their associated health and economic outcomes in Finnish patients with incident type 2 diabetes. PLoS One 2022; 17:e0269245. [PMID: 35648780 PMCID: PMC9159579 DOI: 10.1371/journal.pone.0269245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Treatments should be customized to patients to improve patients’ health outcomes and maximize the treatment benefits. We aimed to identify meaningful data-driven trajectories of incident type 2 diabetes patients with similarities in glycated haemoglobin (HbA1c) patterns since diagnosis and to examine their clinical and economic relevance. Materials and methods A cohort of 1540 patients diagnosed in 2011–2012 was retrieved from electronic health records covering primary and specialized healthcare in the North Karelia region, Finland. EHRs data were compiled with medication purchase data. Average HbA1c levels, use of medications, and incidence of micro- and macrovascular complications and deaths were measured annually for seven years since T2D diagnosis. Trajectories were identified applying latent class growth models. Differences in 4-year cumulative healthcare costs with 95% confidence intervals (CIs) were estimated with non-parametric bootstrapping. Results Four distinct trajectories of HbA1c development during 7 years after T2D diagnosis were extracted: patients with “Stable, adequate” (66.1%), “Slowly deteriorating” (24.3%), and “Rapidly deteriorating” glycaemic control (6.2%) as well as “Late diagnosed” patients (3.4%). During the same period, 2.2 (95% CI 1.9–2.6) deaths per 100 person-years occurred in the “Stable, adequate” trajectory increasing to 3.2 (2.4–4.0) in the “Slowly deteriorating”, 4.7 (3.1–6.9) in the “Rapidly deteriorating” and 5.2 (2.9–8.7) in the “Late diagnosed” trajectory. Similarly, 3.5 (95% CI 3.0–4.0) micro- and macrovascular complications per 100 person-years occurred in the “Stable, adequate” trajectory increasing to 5.1 (4.1–6.2) in the “Slowly deteriorating”, 5.5 (3.6–8.1) in the “Rapidly deteriorating” and 7.3 (4.3–11.8) in the “Late diagnosed” trajectory. Patients in the “Stable, adequate” trajectory had lower accumulated 4-year medication costs than other patients. Conclusions Data-driven patient trajectories have clinical and economic relevance and could be utilized as a step towards personalized medicine instead of the common “one-fits-for-all” treatment practices.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- * E-mail:
| | - Emma Aarnio
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Kari Jalkanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Hilkka Tirkkonen
- Siun Sote – Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Päivi Rautiainen
- Siun Sote – Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Tiina Laatikainen
- Siun Sote – Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Ma C, Zhang W, Xie R, Wan G, Yang G, Zhang X, Fu H, Zhu L, Lv Y, Zhang J, Li Y, Ji Y, Gao D, Cui X, Wang Z, Chen Y, Yuan S, Yuan M. Effect of Hemoglobin A1c Trajectories on Future Outcomes in a 10-Year Cohort With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2022; 13:846823. [PMID: 35450420 PMCID: PMC9016129 DOI: 10.3389/fendo.2022.846823] [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: 12/31/2021] [Accepted: 02/28/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Hemoglobin A1c (HbA1c) variability may be a predictor of diabetic complications, but the predictive values of HbA1c trajectories remain unclear. We aimed to classify long-term HbA1c trajectories and to explore their effects on future clinical outcomes in a 10-year cohort with type 2 diabetes mellitus (T2DM). METHODS A total of 2,161 participants with T2DM from the Beijing Community Diabetes Study were included. The 10-year follow-up was divided into two stages for the present data analysis. Stage I (from 2008 to 2014) was used to identify the HbA1c trajectories and to calculate the adjusted SD of HbA1c (HbA1c-adjSD), or the coefficient of variation of HbA1c (HbA1c-CV). Stage II (from 2014 to 2018) was used to collect the records of the new occurrence of diabetes-related clinical outcomes. Latent growth mixture models were used to identify HbA1c trajectories. Cox proportional hazards models were used to explore the relationship between HbA1c trajectories, HbA1c-adjSD, or HbA1c-CV and the future outcomes. RESULTS Three HbA1c trajectories were identified, including low stable (88.34%), gradual decreasing (5.83%), and pre-stable and post-increase (5.83%). Either the risk of death or the chronic complications were significantly higher in the latter two groups compared to the low stable group after adjustment for average HbA1c and other traditional risk factors, the adjusted hazard ratios (HRs) for renal events, composite endpoint, and all-cause death for the pre-stable and post-increase group were 2.83 [95%CI: 1.25-6.41, p = 0.013], 1.85 (95%CI: 1.10-3.10, p = 0.020), and 3.01 (95%CI: 1.13-8.07, p = 0.028), respectively, and the adjusted HR for renal events for the gradual decreasing group was 2.37 (95%CI: 1.08-5.21, p = 0.032). In addition, both univariate and multivariate Cox HR models indicated that participants in the fourth and third quartiles of HbA1c-CV or HbA1c-adjSD were at higher risk of renal events compared to participants in the first quartile. CONCLUSIONS HbA1c trajectories, HbA1c-CV, and HbA1c-adjSD could all predict diabetes-related clinical outcomes. HbA1c trajectories could reflect long-term blood glucose fluctuation more intuitively, and non-stable HbA1c trajectories may predict increased risk of renal events, all-cause death, and composite endpoint events, independent of average HbA1c.
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Affiliation(s)
- Chifa Ma
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Weinan Zhang
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rongrong Xie
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- Medical Records and Statistics Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Guangran Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xuelian Zhang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hanjing Fu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liangxiang Zhu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yujie Lv
- Department of General Practice, Cuigezhuang Community Health Service Center, Beijing, China
| | - Jiandong Zhang
- Department of General Practice, Jinsong Community Health Service Center, Beijing, China
| | - Yuling Li
- Department of General Practice, Xinjiekou Community Health Service Center, Beijing, China
| | - Yu Ji
- Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, China
| | - Dayong Gao
- Department of General Practice, Aerospace Central Hospital, Beijing, China
| | - Xueli Cui
- Department of General Practice, Sanlitun Community Health Service Center, Beijing, China
| | - Ziming Wang
- Department of General Practice, Jiangtai Community Health Service Center, Beijing, China
| | - Yingjun Chen
- Department of General Practice, Majiapu Community Health Service Center, Beijing, China
| | - Shenyuan Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mingxia Yuan
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Mingxia Yuan,
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15
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Trajectories of glycemic control with clinical pharmacy specialist management of veterans with type 2 diabetes. Res Social Adm Pharm 2021; 18:3064-3071. [PMID: 34481747 DOI: 10.1016/j.sapharm.2021.08.010] [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: 02/23/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improved control of glycemic control likely lowers the risk of diabetes complications and clinical pharmacy specialist (CPS) services can improve glycemic control. Though the pattern of control may also matter in terms of outcomes. OBJECTIVES The objective of this study was to examine the longitudinal trajectories of HbA1c among a large population of Veterans with type 2 diabetes who received CPS-led diabetes management. METHODS This is an observational, multicenter cohort study of Veterans with type-2 diabetes managed by CPSs between 7/1/2013 and 7/1/2017 with baseline glycosylated hemoglobin (HbA1c) level ≥8%. Two years of HbA1c measurements were used to group patients into distinct patterns of HbA1c trajectories over time using group-based trajectory modeling. Characteristics associated with successful HbA1c trajectories and association of assigned trajectories with all-cause and diabetes-related hospitalizations were analyzed using logistic regression. RESULTS A total of 4119 Veterans were included and able to be successfully segmented into six distinct HbA1c trajectory groups over time: High Gradually Decreasing (n = 325, 7.9%), Moderate Early Decline (n = 1692, 41.1%), Large Early Decline (n = 231, 5.6%), Uncontrolled Stable (n = 1468, 35.6%), Early Decline/Subsequent Increase (n = 266, 6.5%), and Very Uncontrolled Stable (n = 137, 3.3%). The distinguishing factor between successful and less successful trajectories appears to be the progress made within the first six months of pharmacist management. CONCLUSIONS Significant variability exists in the pattern of glycemic control over time of type 2 diabetes patients managed by clinical pharmacy specialists. Limited resources should be first prioritized to managing patients with very elevated HbA1c and into the first six months of CPS management.
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Oh W, Steinbach MS, Castro MR, Peterson KA, Kumar V, Caraballo PJ, Simon GJ. A Computational Method for Learning Disease Trajectories From Partially Observable EHR Data. IEEE J Biomed Health Inform 2021; 25:2476-2486. [PMID: 34129510 PMCID: PMC8388183 DOI: 10.1109/jbhi.2021.3089441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diseases can show different courses of progression even when patients share the same risk factors. Recent studies have revealed that the use of trajectories, the order in which diseases manifest throughout life, can be predictive of the course of progression. In this study, we propose a novel computational method for learning disease trajectories from EHR data. The proposed method consists of three parts: first, we propose an algorithm for extracting trajectories from EHR data; second, three criteria for filtering trajectories; and third, a likelihood function for assessing the risk of developing a set of outcomes given a trajectory set. We applied our methods to extract a set of disease trajectories from Mayo Clinic EHR data and evaluated it internally based on log-likelihood, which can be interpreted as the trajectories' ability to explain the observed (partial) disease progressions. We then externally evaluated the trajectories on EHR data from an independent health system, M Health Fairview. The proposed algorithm extracted a comprehensive set of disease trajectories that can explain the observed outcomes substantially better than competing methods and the proposed filtering criteria selected a small subset of disease trajectories that are highly interpretable and suffered only a minimal (relative 5%) loss of the ability to explain disease progression in both the internal and external validation.
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17
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Seng JJB, Monteiro AY, Kwan YH, Zainudin SB, Tan CS, Thumboo J, Low LL. Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review. BMC Med Res Methodol 2021; 21:49. [PMID: 33706717 PMCID: PMC7953703 DOI: 10.1186/s12874-021-01209-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients. Methods The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed. Results Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients’ race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies. Conclusions Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01209-w.
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Affiliation(s)
- Jun Jie Benjamin Seng
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore
| | | | - Yu Heng Kwan
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Sueziani Binte Zainudin
- Department of General Medicine (Endocrinology), Sengkang General Hospital, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Julian Thumboo
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore. .,SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore. .,Department of Family Medicine and Continuing Care, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. .,SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore. .,Outram Community Hospital, SingHealth Community Hospitals, 10 Hospital Boulevard, Singapore, 168582, Singapore.
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Sia HK, Kor CT, Tu ST, Liao PY, Chang YC. Predictors of treatment failure during the first year in newly diagnosed type 2 diabetes patients: a retrospective, observational study. PeerJ 2021; 9:e11005. [PMID: 33717708 PMCID: PMC7934644 DOI: 10.7717/peerj.11005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background Diabetes patients who fail to achieve early glycemic control may increase the future risk of complications and mortality. The aim of the study was to identify factors that predict treatment failure (TF) during the first year in adults with newly diagnosed type 2 diabetes mellitus (T2DM). Methods This retrospective cohort study conducted at a medical center in Taiwan enrolled 4,282 eligible patients with newly diagnosed T2DM between 2002 and 2017. Data were collected from electronic medical records. TF was defined as the HbA1c value >7% at the end of 1-year observation. A subgroup analysis of 2,392 patients with baseline HbA1c ≥8% was performed. Multivariable logistic regression analysis using backward elimination was applied to establish prediction models. Results Of all study participants, 1,439 (33.6%) were classified as TF during the first year. For every 1% increase in baseline HbA1c, the risk of TF was 1.17 (95% CI 1.15–1.20) times higher. Patients with baseline HbA1c ≥8% had a higher rate of TF than those with HbA1c <8% (42.0 vs 23.0%, p < 0.001). Medication adherence, self-monitoring of blood glucose (SMBG), regular exercise, gender (men), non-insulin treatment, and enrollment during 2010–2017 predicted a significant lower risk of TF in both of the primary and subgroup models. Conclusions Newly diagnosed diabetes patients with baseline HbA1c ≥8% did have a much higher rate of TF during the first year. Subgroup analysis for them highlights the important predictors of TF, including medication adherence, performing SMBG, regular exercise, and gender, in achieving glycemic control.
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Affiliation(s)
- Hon-Ke Sia
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Healthcare Administration, Asia University, Taichung City, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua City, Taiwan
| | - Shih-Te Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Pei-Yung Liao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City, Taiwan
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Raghavan S, Liu WG, Berkowitz SA, Barón AE, Plomondon ME, Maddox TM, Reusch JEB, Ho PM, Caplan L. Association of Glycemic Control Trajectory with Short-Term Mortality in Diabetes Patients with High Cardiovascular Risk: a Joint Latent Class Modeling Study. J Gen Intern Med 2020; 35:2266-2273. [PMID: 32333313 PMCID: PMC7403288 DOI: 10.1007/s11606-020-05848-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/29/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The relationship between risk factor or biomarker trajectories and contemporaneous short-term clinical outcomes is poorly understood. In diabetes patients, it is unknown whether hemoglobin A1c (HbA1c) trajectories are associated with clinical outcomes and can inform care in scenarios in which a single HbA1c is uninformative, for example, after a diagnosis of coronary artery disease (CAD). OBJECTIVE To compare associations of HbA1c trajectories and single HbA1c values with short-term mortality in diabetes patients evaluated for CAD DESIGN: Retrospective observational cohort study PARTICIPANTS: Diabetes patients (n = 7780) with and without angiographically defined CAD MAIN MEASURES: We used joint latent class mixed models to simultaneously fit HbA1c trajectories and estimate association with 2-year mortality after cardiac catheterization, adjusting for clinical and demographic covariates. KEY RESULTS Three HBA1c trajectory classes were identified: individuals with stable glycemia (class A; n = 6934 [89%]; mean baseline HbA1c 6.9%), with declining HbA1c (class B; n = 364 [4.7%]; mean baseline HbA1c 11.6%), and with increasing HbA1c (class C; n = 482 [6.2%]; mean baseline HbA1c 8.5%). HbA1c trajectory class was associated with adjusted 2-year mortality (3.0% [95% CI 2.8, 3.2] for class A, 3.1% [2.1, 4.2] for class B, and 4.2% [3.4, 4.9] for class C; global P = 0.047, P = 0.03 comparing classes A and C, P > 0.05 for other pairwise comparisons). Baseline HbA1c was not associated with 2-year mortality (P = 0.85; hazard ratios 1.01 [0.96, 1.06] and 1.02 [0.95, 1.10] for HbA1c 7-9% and ≥ 9%, respectively, relative to HbA1c < 7%). The association between HbA1c trajectories and mortality did not differ between those with and without CAD (interaction P = 0.1). CONCLUSIONS In clinical settings where single HbA1c measurements provide limited information, HbA1c trajectories may help stratify risk of complications in diabetes patients. Joint latent class modeling provides a generalizable approach to examining relationships between biomarker trajectories and clinical outcomes in the era of near-universal adoption of electronic health records.
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Affiliation(s)
- Sridharan Raghavan
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, CO, USA. .,Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA. .,Colorado Cardiovascular Outcomes Research Consortium, Aurora, CO, USA. .,Rocky Mountain Regional VA Medical Center Medicine Service (111), 1700 North Wheeling Street, Aurora, CO, 80045, USA.
| | - Wenhui G Liu
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Seth A Berkowitz
- Division of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Anna E Barón
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Mary E Plomondon
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jane E B Reusch
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, CO, USA.,Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - P Michael Ho
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, CO, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Liron Caplan
- Department of Veterans Affairs, Eastern Colorado Healthcare System, Aurora, CO, USA.,Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
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20
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Bharmal SH, Cho J, Alarcon Ramos GC, Ko J, Stuart CE, Modesto AE, Singh RG, Petrov MS. Trajectories of glycaemia following acute pancreatitis: a prospective longitudinal cohort study with 24 months follow-up. J Gastroenterol 2020; 55:775-788. [PMID: 32494905 DOI: 10.1007/s00535-020-01682-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND New-onset diabetes is the most common sequela of acute pancreatitis (AP). Yet, prospective changes in glycaemia over time have never been investigated comprehensively in this study population. The primary aim was to determine the cumulative incidence of new-onset prediabetes and new-onset diabetes after AP over 24 months of follow-up in a prospective cohort study. The secondary aim was to identify trajectories of glycaemia during follow-up and their predictors at the time of hospitalisation. METHODS Patients with a prospective diagnosis of AP and no diabetes based on the American Diabetes Association criteria were followed up every 6 months up to 24 months after hospital discharge. Incidence of new-onset prediabetes/diabetes over each follow-up period was calculated. Group-based trajectory modelling was used to identify common changes in glycaemia. Multinomial regression analyses were conducted to investigate the associations between a wide array of routinely available demographic, anthropometric, laboratory, imaging, and clinical factors and membership in the trajectory groups. RESULTS A total of 152 patients without diabetes were followed up. The cumulative incidence of new-onset prediabetes and diabetes was 20% at 6 months after hospitalisation and 43% over 24 months of follow-up (p trend < 0.001). Three discrete trajectories of glycaemia were identified: normal-stable glycaemia (32%), moderate-stable glycaemia (60%), and high-increasing glycaemia (8%). Waist circumference was a significant predictor of moderate-stable glycaemia. None of the studied predictors were significantly associated with high-increasing glycaemia. CONCLUSIONS This first prospective cohort study of changes in glycaemia (determined at structured time points in unselected AP patients) showed that at least one out of five patients develops new-onset prediabetes or diabetes at 6 months of follow-up and more than four out of ten-in the first 2 years. Changes in glycaemia after AP follow three discrete trajectories. This may inform prevention or early detection of critical changes in blood glucose metabolism following an attack of AP and, hence, reduce the burden of new-onset diabetes after acute pancreatitis.
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Affiliation(s)
- Sakina Huseni Bharmal
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Jaelim Cho
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | | | - Juyeon Ko
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Charlotte Elizabeth Stuart
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Andre Eto Modesto
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Ruma Girish Singh
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand
| | - Maxim Sergey Petrov
- School of Medicine, University of Auckland, Room 12.085 A, Level 12, Auckland City Hospital, Auckland, 1142, New Zealand.
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21
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Kwint M, Stam B, Proust-Lima C, Philipps V, Hoekstra T, Aalbersberg E, Rossi M, Sonke JJ, Belderbos J, Walraven I. The prognostic value of volumetric changes of the primary tumor measured on Cone Beam-CT during radiotherapy for concurrent chemoradiation in NSCLC patients. Radiother Oncol 2020; 146:44-51. [DOI: 10.1016/j.radonc.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/05/2019] [Accepted: 02/05/2020] [Indexed: 02/09/2023]
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22
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Tello-Flores VA, Valladares-Salgado A, Ramírez-Vargas MA, Cruz M, Del-Moral-Hernández O, Cahua-Pablo JÁ, Ramírez M, Hernández-Sotelo D, Armenta-Solis A, Flores-Alfaro E. Altered levels of MALAT1 and H19 derived from serum or serum exosomes associated with type-2 diabetes. Noncoding RNA Res 2020; 5:71-76. [PMID: 32346662 PMCID: PMC7183231 DOI: 10.1016/j.ncrna.2020.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/07/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Environmental, genetic and epigenetic risk factors have been closely related to the development of type-2 diabetes (T2D). It has been reported that the expression in H19 and MALAT1 are related to metabolic diseases. To analyze the relationship between the expression of H19 and MALAT1 lncRNAs with diabetic patients. A study was conducted in subjects with T2D and nondiabetic controls, residents of Mexico City. Anthropometric measurements were made, and serum concentrations of glucose, glycosylated hemoglobin, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol were analyzed. Total RNA was extracted from serum and serum exosomes. The H19 and MALAT1 expression levels were quantified by RT-qPCR. A significant reduction in the expression of MALAT1 from serum or serum exosomes were found in patients with T2D, metabolic syndrome and low levels of HDL-c. Significant increase in H19 levels was found in diabetic subjects with poor glycemic control. Additionally, the principal component analyzes showed that serum MALAT1 expression was associated with total cholesterol and HDL-c levels, and the exosomes H19 expression was associated with waist circumference. The results obtained suggest that MALAT1 expression levels could be an epigenetic biomarker of diabetes risk or of its comorbidities.
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Affiliation(s)
- Vianet Argelia Tello-Flores
- Facultad de Ciencias Químico-Biológicas y Facultad de Medicina, Universidad Autónoma de Guerrero, 39087, Chilpancingo, GRO., Mexico
| | - Adán Valladares-Salgado
- Unidad Medica en Bioquímica, Hospital de Espacialidades, Centro Médico Nacional "Siglo XXI," Instituto Mexicano del Seguro Social, 06720, CDMX, Mexico
| | - Marco Antonio Ramírez-Vargas
- Facultad de Ciencias Químico-Biológicas y Facultad de Medicina, Universidad Autónoma de Guerrero, 39087, Chilpancingo, GRO., Mexico
| | - Miguel Cruz
- Unidad Medica en Bioquímica, Hospital de Espacialidades, Centro Médico Nacional "Siglo XXI," Instituto Mexicano del Seguro Social, 06720, CDMX, Mexico
| | - Oscar Del-Moral-Hernández
- Facultad de Ciencias Químico-Biológicas y Facultad de Medicina, Universidad Autónoma de Guerrero, 39087, Chilpancingo, GRO., Mexico
| | - José Ángel Cahua-Pablo
- Facultad de Ciencias Químico-Biológicas y Facultad de Medicina, Universidad Autónoma de Guerrero, 39087, Chilpancingo, GRO., Mexico
| | - Mónica Ramírez
- Facultad de Ciencias Químico-Biológicas y Facultad de Medicina, Universidad Autónoma de Guerrero, 39087, Chilpancingo, GRO., Mexico
| | - Daniel Hernández-Sotelo
- Facultad de Ciencias Químico-Biológicas y Facultad de Medicina, Universidad Autónoma de Guerrero, 39087, Chilpancingo, GRO., Mexico
| | - Adakatia Armenta-Solis
- Facultad de Ciencias Químico-Biológicas y Facultad de Medicina, Universidad Autónoma de Guerrero, 39087, Chilpancingo, GRO., Mexico
| | - Eugenia Flores-Alfaro
- Facultad de Ciencias Químico-Biológicas y Facultad de Medicina, Universidad Autónoma de Guerrero, 39087, Chilpancingo, GRO., Mexico
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Nagaraj SB, Sidorenkov G, van Boven JFM, Denig P. Predicting short- and long-term glycated haemoglobin response after insulin initiation in patients with type 2 diabetes mellitus using machine-learning algorithms. Diabetes Obes Metab 2019; 21:2704-2711. [PMID: 31453664 PMCID: PMC6899933 DOI: 10.1111/dom.13860] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/30/2019] [Accepted: 08/20/2019] [Indexed: 01/04/2023]
Abstract
AIM To assess the potential of supervised machine-learning techniques to identify clinical variables for predicting short-term and long-term glycated haemoglobin (HbA1c) response after insulin treatment initiation in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS We included patients with T2DM from the Groningen Initiative to Analyse Type 2 diabetes Treatment (GIANTT) database who started insulin treatment between 2007 and 2013 and had a minimum follow-up of 2 years. Short- and long-term responses at 6 (±2) and 24 (±2) months after insulin initiation, respectively, were assessed. Patients were defined as good responders if they had a decrease in HbA1c ≥ 5 mmol/mol or reached the recommended level of HbA1c ≤ 53 mmol/mol. Twenty-four baseline clinical variables were used for the analysis and an elastic net regularization technique was used for variable selection. The performance of three traditional machine-learning algorithms was compared for the prediction of short- and long-term responses and the area under the receiver-operating characteristic curve (AUC) was used to assess the performance of the prediction models. RESULTS The elastic net regularization-based generalized linear model, which included baseline HbA1c and estimated glomerular filtration rate, correctly classified short- and long-term HbA1c response after treatment initiation, with AUCs of 0.80 (95% CI 0.78-0.83) and 0.81 (95% CI 0.79-0.84), respectively, and outperformed the other machine-learning algorithms. Using baseline HbA1c alone, an AUC = 0.71 (95% CI 0.65-0.73) and 0.72 (95% CI 0.66-0.75) was obtained for predicting short-term and long-term response, respectively. CONCLUSIONS Machine-learning algorithm performed well in the prediction of an individual's short-term and long-term HbA1c response using baseline clinical variables.
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Affiliation(s)
- Sunil B. Nagaraj
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Grigory Sidorenkov
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
- Department of Epidemiology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
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Nijpels G, Beulens JWJ, van der Heijden AAWA, Elders PJ. Innovations in personalised diabetes care and risk management. Eur J Prev Cardiol 2019; 26:125-132. [DOI: 10.1177/2047487319880043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes is associated with an increased risk of developing macro and microvascular complications. Nevertheless, there is substantial heterogeneity between people with type 2 diabetes in their risk of developing such complications. Personalised medicine for people with type 2 diabetes may aid in efficient and tailored diabetes care for those at increased risk of developing such complications. Recently, progress has been made in the development of personalised diabetes care in several areas. Particularly for the risk prediction of cardiovascular disease, retinopathy and nephropathy, innovative methods have been developed for prediction and tailored monitoring or treatment to prevent such complications. For other complications or subpopulations of people with type 2 diabetes, such as the frail elderly, efforts are currently ongoing to develop such methods. In this review, we discuss the recent developments in innovations of personalised diabetes care for different complications and subpopulations of people with type 2 diabetes, their performance and modes of application in clinical practice.
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Affiliation(s)
- Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, The Netherlands
| | - Joline WJ Beulens
- Department of Epidemiology and Biostatistics, Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, The Netherlands
| | - Amber AWA van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, The Netherlands
| | - Petra J Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, The Netherlands
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25
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Rathmann W, Schwandt A, Hermann JM, Kuss O, Roden M, Laubner K, Best F, Ebner S, Plaumann M, Holl RW. Distinct trajectories of HbA 1c in newly diagnosed Type 2 diabetes from the DPV registry using a longitudinal group-based modelling approach. Diabet Med 2019; 36:1468-1477. [PMID: 31392761 DOI: 10.1111/dme.14103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/09/2023]
Abstract
AIM To identify groups of heterogeneous HbA1c trajectories over time in newly diagnosed Type 2 diabetes. METHODS The study comprised 6355 adults with newly diagnosed Type 2 diabetes (55% men, median age 62 years, baseline BMI 31 kg/m2 ) from the Diabetes Patienten Verlaufsdokumentation (DPV) prospective multicentre diabetes registry (Germany, Austria). Individuals were assessed during the first 5 years after diabetes diagnosis if they had ≥ 3 aggregated HbA1c measurements during follow-up. Latent class growth modelling was used to determine distinct subgroups that followed similar longitudinal HbA1c patterns (SAS: Proc Traj). Multinomial logistic regression models were used to investigate which variables were associated with the respective HbA1c trajectory groups. RESULTS Four distinct longitudinal HbA1c trajectory (glycaemic control) groups were found. The largest group (56% of participants) maintained stable good glycaemic control (HbA1c 42-45 mmol/mol). Twenty-six percent maintained stable moderate glycaemic control (HbA1c 57-62 mmol/mol). A third group (12%) initially showed severe hyperglycaemia (HbA1c 97 mmol/mol) but reached good glycaemic control within 1 year. The smallest group (6%) showed stable poor glycaemic control (HbA1c 79-88 mmol/mol). Younger age at diabetes diagnosis, male sex, and higher BMI were associated with the stable moderate or poor glycaemic control groups. Insulin therapy was strongly associated with the highly improved glycaemic control group. CONCLUSIONS Four subgroups with distinct HbA1c trajectories were determined in newly diagnosed Type 2 diabetes using a group-based modelling approach. Approximately one-third of people with newly diagnosed Type 2 diabetes need either better medication adherence or earlier intensification of glucose-lowering therapy.
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Affiliation(s)
- W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - A Schwandt
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - J M Hermann
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - O Kuss
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - M Roden
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - K Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre, University of Freiburg, Germany
| | - F Best
- Diabetes Practice Dr. Best, Essen, Germany
| | - S Ebner
- Medical Campus III, Clinic for Internal Medicine 2, Kepler University Hospital, Linz, Austria
| | - M Plaumann
- Specialist Diabetes Practice Hannover, Hannover, Germany
| | - R W Holl
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
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Hertroijs DFL, Brouwers MCGJ, Elissen AMJ, Schaper NC, Ruwaard D. Relevant patient characteristics for estimating healthcare needs according to healthcare providers and people with type 2 diabetes: a Delphi survey. BMC Health Serv Res 2019; 19:575. [PMID: 31419980 PMCID: PMC6698036 DOI: 10.1186/s12913-019-4371-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/25/2019] [Indexed: 01/02/2023] Open
Abstract
Background Recently, there has been growing interest in providing more tailored, patient-centered care for the treatment of type 2 diabetes mellitus (T2DM). Yet it remains unclear which patient characteristics should be determined to guide such an approach. Therefore, the opinions of healthcare providers (HCP) and people with T2DM about relevant patient characteristics for estimating healthcare needs of people with T2DM were assessed and compared. Methods Two separate online Delphi studies were conducted according to the RAND-UCLA Appropriateness Method: one with HCPs (n = 22) from Dutch primary and secondary care and one with people with T2DM treated in Dutch primary care (n = 46). The relevance of patient characteristics for estimating healthcare needs, defined as the number of yearly consultations, was assessed on a 5-point Likert scale. Characteristics with a median of 4 or 5 and an interquartile range ≤ 1.5 were considered relevant with consensus. Participants were also asked to select the top 5 of most relevant patient characteristics. To determine the overall top 5, the mean relative importance score of each characteristic was calculated. Results In two Delphi rounds, 28 and 15 patient characteristics were rated by HCPs and people with T2DM, respectively. Both HCPs and people with T2DM found health-related characteristics relevant for estimating healthcare needs of people with T2DM. However, HCPs preferred to estimate healthcare needs using person- and context-related characteristics. They ranked self-efficacy as the most relevant estimator. In contrast, people with T2DM were more in favor of health-related characteristics and ranked HbA1c as the most relevant estimator. Conclusions The findings show that there is discrepancy in opinions on relevant patient characteristics for estimating healthcare needs between HCPs and people with T2DM. To achieve more tailored, patient-centered care, it is important that both groups agree on the topics to be discussed during patient consultations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4371-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorijn F L Hertroijs
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands.
| | - Martijn C G J Brouwers
- Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
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Low S, Zhang X, Wang J, Yeoh LY, Liu YL, Ang SF, Subramaniam T, Sum CF, Lim SC. Impact of haemoglobin A1c trajectories on chronic kidney disease progression in type 2 diabetes. Nephrology (Carlton) 2019; 24:1026-1032. [DOI: 10.1111/nep.13533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Serena Low
- Clinical Research UnitKhoo Teck Puat Hospital Yishun Singapore
| | - Xiao Zhang
- Clinical Research UnitKhoo Teck Puat Hospital Yishun Singapore
| | - Jiexun Wang
- Clinical Research UnitKhoo Teck Puat Hospital Yishun Singapore
| | - Lee Y Yeoh
- Department of MedicineSengkang General Hospital Singapore Singapore
| | - Yan L Liu
- Department of MedicineKhoo Teck Puat Hospital Yishun Singapore
| | - Su F Ang
- Clinical Research UnitKhoo Teck Puat Hospital Yishun Singapore
| | | | - Chee F Sum
- Diabetes CentreKhoo Teck Puat Hospital Singapore Singapore
| | - Su C Lim
- Clinical Research UnitKhoo Teck Puat Hospital Yishun Singapore
- Diabetes CentreKhoo Teck Puat Hospital Singapore Singapore
- Saw Swee Hock School of Public HealthNational University of Singapore Singapore Singapore
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't Hart LM, Vogelzangs N, Mook-Kanamori DO, Brahimaj A, Nano J, van der Heijden AAWA, Willems van Dijk K, Slieker RC, Steyerberg EW, Ikram MA, Beekman M, Boomsma DI, van Duijn CM, Slagboom PE, Stehouwer CDA, Schalkwijk CG, Arts ICW, Dekker JM, Dehghan A, Muka T, van der Kallen CJH, Nijpels G, van Greevenbroek MMJ. Blood Metabolomic Measures Associate With Present and Future Glycemic Control in Type 2 Diabetes. J Clin Endocrinol Metab 2018; 103:4569-4579. [PMID: 30113659 DOI: 10.1210/jc.2018-01165] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We studied whether blood metabolomic measures in people with type 2 diabetes (T2D) are associated with insufficient glycemic control and whether this association is influenced differentially by various diabetes drugs. We then tested whether the same metabolomic profiles were associated with the initiation of insulin therapy. METHODS A total of 162 metabolomic measures were analyzed using a nuclear magnetic resonance-based method in people with T2D from four cohort studies (n = 2641) and one replication cohort (n = 395). Linear and logistic regression analyses with adjustment for potential confounders, followed by meta-analyses, were performed to analyze associations with hemoglobin A1c levels, six glucose-lowering drug categories, and insulin initiation during a 7-year follow-up period (n = 698). RESULTS After Bonferroni correction, 26 measures were associated with insufficient glycemic control (HbA1c >53 mmol/mol). The strongest association was with glutamine (OR, 0.66; 95% CI, 0.61 to 0.73; P = 7.6 × 10-19). In addition, compared with treatment-naive patients, 31 metabolomic measures were associated with glucose-lowering drug use (representing various metabolite categories; P ≤ 3.1 × 10-4 for all). In drug-stratified analyses, associations with insufficient glycemic control were only mildly affected by different glucose-lowering drugs. Five of the 26 metabolomic measures (apolipoprotein A1 and medium high-density lipoprotein subclasses) were also associated with insulin initiation during follow-up in both discovery and replication. The strongest association was observed for medium high-density lipoprotein cholesteryl ester (OR, 0.54; 95% CI, 0.42 to 0.71; P = 4.5 × 10-6). CONCLUSION Blood metabolomic measures were associated with present and future glycemic control and might thus provide relevant cues to identify those at increased risk of treatment failure.
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Affiliation(s)
- Leen M 't Hart
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden ZA, Netherlands
- Section of Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden ZA, Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam HV, Netherlands
| | - Nicole Vogelzangs
- Cardiovascular Research Institute Maastricht and Maastricht Centre for Systems Biology, Maastricht University, Maastricht LK, Netherlands
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden ZA, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden ZA, Netherlands
| | - Adela Brahimaj
- Department of Epidemiology, Erasmus Medical Center, Rotterdam GD, Netherlands
| | - Jana Nano
- Department of Epidemiology, Erasmus Medical Center, Rotterdam GD, Netherlands
- Institute of Epidemiology, German Research Center for Environment Health, Helmholtz Zentrum Munich, Munich, Germany
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung), Munich, Germany
| | - Amber A W A van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Ko Willems van Dijk
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden ZA, Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden ZA, Netherlands
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden ZA, Netherlands
| | - Roderick C Slieker
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden ZA, Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam HV, Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden ZA, Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam GD, Netherlands
| | - Marian Beekman
- Section of Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden ZA, Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam HV, Netherlands
| | | | - P Eline Slagboom
- Section of Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden ZA, Netherlands
| | - Coen D A Stehouwer
- Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University, Maastricht LK, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht LK, Netherlands
| | - Casper G Schalkwijk
- Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University, Maastricht LK, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht LK, Netherlands
| | - Ilja C W Arts
- Cardiovascular Research Institute Maastricht and Maastricht Centre for Systems Biology, Maastricht University, Maastricht LK, Netherlands
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam HV, Netherlands
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus Medical Center, Rotterdam GD, Netherlands
- Department of Biostatistics and Epidemiology, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Taulant Muka
- Department of Epidemiology, Erasmus Medical Center, Rotterdam GD, Netherlands
| | - Carla J H van der Kallen
- Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University, Maastricht LK, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht LK, Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Marleen M J van Greevenbroek
- Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University, Maastricht LK, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht LK, Netherlands
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Luo M, Tan KHX, Tan CS, Lim WY, Tai E, Venkataraman K. Longitudinal trends in HbA 1c patterns and association with outcomes: A systematic review. Diabetes Metab Res Rev 2018; 34:e3015. [PMID: 29663623 PMCID: PMC6175395 DOI: 10.1002/dmrr.3015] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/03/2018] [Accepted: 04/05/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study aimed to review studies that identified patterns of longitudinal HbA1c trends in patients with diabetes and to summarize factors and outcomes associated with distinct trajectory patterns. METHODS PubMed and Web of Science were systematically searched for studies examining HbA1c trends among patients with diabetes from database inception through September 2017. Articles were included if they met the following inclusion criteria: (a) longitudinal study of subjects with diabetes only, (b) use of serial measurements of HbA1c , and (c) analysis of the trend of HbA1c using group-based trajectory approaches. RESULTS Twenty studies were included, 11 on type 1 diabetes and 9 on type 2 diabetes. These studies identified 2 to 6 HbA1c trajectory patterns. The most commonly identified patterns included stable HbA1c around 7.0% and at levels between 8.0% and 9.9%, which usually captured the HbA1c pattern among the majority of subjects in the study population. Unstable patterns identified included increasing HbA1c trend, decreasing HbA1c trend, and non-linear patterns. These patterns were associated with differential risk of disease outcomes, over and beyond single-point HbA1c measures. Age, gender, ethnicity, diabetes duration, disease management frequency, cardiovascular risk factors, insulin treatment, family environment, and psychosocial factors were the most frequently reported factors associated with membership of specific HbA1c pattern groups. CONCLUSION Common patterns of longitudinal HbA1c trends were identified despite heterogeneity among the studies. A better understanding of what underlies these different patterns may provide opportunities to tailor therapies and care for these patients to reduce adverse outcomes.
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Affiliation(s)
- Miyang Luo
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | | | - Chuen Seng Tan
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Wei Yen Lim
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - E‐Shyong Tai
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
- Division of EndocrinologyNational University HospitalSingapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
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Sidorenkov G, van Boven JFM, Hoekstra T, Nijpels G, Hoogenberg K, Denig P. HbA1c response after insulin initiation in patients with type 2 diabetes mellitus in real life practice: Identifying distinct subgroups. Diabetes Obes Metab 2018; 20:1957-1964. [PMID: 29687577 PMCID: PMC6055847 DOI: 10.1111/dom.13332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/06/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
AIMS To identify subgroups of patients with type 2 diabetes mellitus (T2DM) following distinct trajectories of HbA1c after insulin initiation and explore underlying differences in clinical characteristics. MATERIALS AND METHODS A cohort study was conducted in patients with T2DM initiating insulin in 2007-2013 with a follow-up of 2 to 4 years. Data were collected from the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) database. The primary outcome was subgroups with different trajectories of HbA1c patterns after insulin initiation, as identified by latent class growth modeling. Differences between subgroups were tested using one-way ANOVA, Kruskal-Wallis or chi-square tests, where appropriate. RESULTS From 1459 patients, three subgroups with distinct HbA1c patterns were identified. Group 1 (8%) initially showed a moderate decrease followed by an increase in HbA1c 2 years later, despite receiving more comedication. Group 2 (84%) showed a stable decrease. Group 3 (8%) had a high initial level of HbA1c and a rapid decline within the first year, followed by a slow increase thereafter. Group 1 patients were on average 6-7 years younger than patients in groups 2 and 3 and were more likely to receive sulfonylureas than Group 3 patients. Group 3 patients had a shorter diabetes duration and were less well-controlled for HbA1c, systolic blood pressure and LDL-cholesterol at insulin initiation. CONCLUSIONS Most patients showed a stable HbA1c response, but one out of six patients showed either a poor response, or a rapid initial response only after insulin initiation. Response patterns were associated with age, diabetes duration and risk-factor controls at the time of insulin initiation.
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Affiliation(s)
- Grigory Sidorenkov
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of EpidemiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Trynke Hoekstra
- Center for Human Movement SciencesUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of Health Sciences, Faculty of ScienceAmsterdam Public Health Research Institute, VU University Medical CenterAmsterdamThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research Institute, VU University Medical CenterAmsterdamThe Netherlands
| | - Klaas Hoogenberg
- Department of Internal MedicineMartini HospitalGroningenThe Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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31
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Hertroijs DFL, Elissen AMJ, Brouwers MCGJ, Schaper NC, Köhler S, Popa MC, Asteriadis S, Hendriks SH, Bilo HJ, Ruwaard D. A risk score including body mass index, glycated haemoglobin and triglycerides predicts future glycaemic control in people with type 2 diabetes. Diabetes Obes Metab 2018; 20:681-688. [PMID: 29095564 PMCID: PMC5836941 DOI: 10.1111/dom.13148] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/10/2017] [Accepted: 10/29/2017] [Indexed: 12/12/2022]
Abstract
AIM To identify, predict and validate distinct glycaemic trajectories among patients with newly diagnosed type 2 diabetes treated in primary care, as a first step towards more effective patient-centred care. METHODS We conducted a retrospective study in two cohorts, using routinely collected individual patient data from primary care practices obtained from two large Dutch diabetes patient registries. Participants included adult patients newly diagnosed with type 2 diabetes between January 2006 and December 2014 (development cohort, n = 10 528; validation cohort, n = 3777). Latent growth mixture modelling identified distinct glycaemic 5-year trajectories. Machine learning models were built to predict the trajectories using easily obtainable patient characteristics in daily clinical practice. RESULTS Three different glycaemic trajectories were identified: (1) stable, adequate glycaemic control (76.5% of patients); (2) improved glycaemic control (21.3% of patients); and (3) deteriorated glycaemic control (2.2% of patients). Similar trajectories could be discerned in the validation cohort. Body mass index and glycated haemoglobin and triglyceride levels were the most important predictors of trajectory membership. The predictive model, trained on the development cohort, had a receiver-operating characteristic area under the curve of 0.96 in the validation cohort, indicating excellent accuracy. CONCLUSIONS The developed model can effectively explain heterogeneity in future glycaemic response of patients with type 2 diabetes. It can therefore be used in clinical practice as a quick and easy tool to provide tailored diabetes care.
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Affiliation(s)
- Dorijn F. L. Hertroijs
- Department of Health Services Research, Care and Public Health Research InstituteFaculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtThe Netherlands
| | - Arianne M. J. Elissen
- Department of Health Services Research, Care and Public Health Research InstituteFaculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtThe Netherlands
| | - Martijn C. G. J. Brouwers
- Department of Internal Medicine, Division of Endocrinology and Metabolic DiseasesMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Nicolaas C. Schaper
- Department of Internal Medicine, Division of Endocrinology and Metabolic DiseasesMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience, Maastricht UniversityMaastrichtThe Netherlands
| | - Mirela C. Popa
- Department of Data Science and Knowledge Engineering, Faculty of Humanities and SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Stylianos Asteriadis
- Department of Data Science and Knowledge Engineering, Faculty of Humanities and SciencesMaastricht UniversityMaastrichtThe Netherlands
| | | | - Henk J. Bilo
- Diabetes CentreIsalaZwolleThe Netherlands
- Department of Internal MedicineUniversity Medical Centre Groningen and University of GroningenGroningenThe Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research InstituteFaculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtThe Netherlands
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32
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Slieker RC, van der Heijden AAWA, van Leeuwen N, Mei H, Nijpels G, Beulens JWJ, 't Hart LM. HbA 1c is associated with altered expression in blood of cell cycle- and immune response-related genes. Diabetologia 2018; 61:138-146. [PMID: 29159468 PMCID: PMC6448931 DOI: 10.1007/s00125-017-4467-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Individuals with type 2 diabetes are heterogeneous in their glycaemic control as tracked by blood HbA1c levels. Here, we investigated the extent to which gene expression levels in blood reflect current and future HbA1c levels. METHODS HbA1c levels at baseline and 1 and 2 year follow-up were compared with gene expression levels in 391 individuals with type 2 diabetes from the Hoorn Diabetes Care System Cohort (15,564 genes, RNA sequencing). The functions of associated baseline genes were investigated further using pathway enrichment analysis. Using publicly available data, we investigated whether the genes identified are also associated with HbA1c in the target tissues, muscle and pancreas. RESULTS At baseline, 220 genes (1.4%) were associated with baseline HbA1c. Identified genes were enriched for cell cycle and complement system activation pathways. The association of 15 genes extended to the target tissues, muscle (n = 113) and pancreatic islets (n = 115). At follow-up, expression of 25 genes (0.16%) associated with 1 year HbA1c and nine genes (0.06%) with 2 year HbA1c. Five genes overlapped across all time points, and 18 additional genes between baseline and 1 year follow-up. After adjustment for baseline HbA1c, the number of significant genes at 1 and 2 years markedly decreased, suggesting that gene expression levels in whole blood reflect the current glycaemic state and but not necessarily the future glycaemic state. CONCLUSIONS/INTERPRETATION HbA1c levels in individuals with type 2 diabetes are associated with expression levels of genes that link to the cell cycle and complement system activation.
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Affiliation(s)
- Roderick C Slieker
- Department of Molecular Cell Biology, Leiden University Medical Center, Postal Box 9600, 2300 RC, Leiden, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Amber A W A van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Nienke van Leeuwen
- Department of Molecular Cell Biology, Leiden University Medical Center, Postal Box 9600, 2300 RC, Leiden, the Netherlands
| | - Hailiang Mei
- Sequencing Analysis Support Core, Leiden University Medical Center, Leiden, the Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Leen M 't Hart
- Department of Molecular Cell Biology, Leiden University Medical Center, Postal Box 9600, 2300 RC, Leiden, the Netherlands.
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands.
- Molecular Epidemiology Section, Leiden University Medical Center, Leiden, the Netherlands.
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33
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Luo M, Lim WY, Tan CS, Ning Y, Chia KS, van Dam RM, Tang WE, Tan NC, Chen R, Tai ES, Venkataraman K. Longitudinal trends in HbA1c and associations with comorbidity and all-cause mortality in Asian patients with type 2 diabetes: A cohort study. Diabetes Res Clin Pract 2017; 133:69-77. [PMID: 28898713 DOI: 10.1016/j.diabres.2017.08.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/07/2017] [Accepted: 08/17/2017] [Indexed: 02/01/2023]
Abstract
AIMS This study examined longitudinal trends in HbA1c in a multi-ethnic Asian cohort of diabetes patients, and the associations of these trends with future risk of acute myocardial infarction (AMI), stroke, end stage renal failure (ESRD) and all-cause mortality. METHODS 6079 participants with type 2 diabetes mellitus in Singapore were included. HbA1c measurements for the five years previous to recruitment were used to identify patterns of HbA1c trends. Outcomes were recorded through linkage with the National Disease Registry. The median follow-up for longitudinal trends in HbA1c was 4.1years and for outcomes was between 7.0 and 8.3years. HbA1c patterns were identified using latent class growth modeling, and associations with outcomes were analyzed using Cox proportional hazards models. RESULTS Four distinct HbA1c patterns were observed; "low-stable" (72·2%), "moderate-stable" (22·0%), "moderate-increase" (2·9%), and "high-decrease" (2·8%). The risk of comorbidities and death was significantly higher in moderate-increase and high-decrease groups compared to the low-stable group; the hazard ratios for stroke, ESRD, and death for moderate increase group were 3.22 (95%CI 1.27-8.15), 4.76 (95%CI 1.92-11.83), and 1.88 (95%CI 1.15-3.07), respectively, and for high-decrease group were 2.16 (95%CI 1.02-4.57), 3.05 (95%CI 1.54-6.07), and 2.79 (95%CI 1.97-3.95), respectively. Individuals in the moderate-increase group were significantly younger, with longer diabetes duration, and greater proportions of Malays and Indians. CONCLUSIONS Deteriorating HbA1c pattern and extremely high initial HbA1c are associated with increased risk of long-term comorbidities and death. Therapeutic interventions to alter longitudinal HbA1c trends may be helpful in reducing this risk.
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Affiliation(s)
- Miyang Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore
| | - Wei Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore
| | - Yilin Ning
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore; NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore; National University Health System, 1E Kent Ridge Rd, 119228, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north South Tower, # 05-10, 138543, Singapore
| | - Ngiap Chuan Tan
- Singhealth Polyclinics, 167 Jalan Bukit Merah Tower 5, #15-10, 150167, Singapore
| | - Richard Chen
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore; Division of Endocrinology, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore.
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Trajectories of Glycemic Change in a National Cohort of Adults With Previously Controlled Type 2 Diabetes. Med Care 2017; 55:956-964. [PMID: 28922296 DOI: 10.1097/mlr.0000000000000807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individualized diabetes management would benefit from prospectively identifying well-controlled patients at risk of losing glycemic control. OBJECTIVES To identify patterns of hemoglobin A1c (HbA1c) change among patients with stable controlled diabetes. RESEARCH DESIGN Cohort study using OptumLabs Data Warehouse, 2001-2013. We develop and apply a machine learning framework that uses a Bayesian estimation of the mixture of generalized linear mixed effect models to discover glycemic trajectories, and a random forest feature contribution method to identify patient characteristics predictive of their future glycemic trajectories. SUBJECTS The study cohort consisted of 27,005 US adults with type 2 diabetes, age 18 years and older, and stable index HbA1c <7.0%. MEASURES HbA1c values during 24 months of observation. RESULTS We compared models with k=1, 2, 3, 4, 5 trajectories and baseline variables including patient age, sex, race/ethnicity, comorbidities, medications, and HbA1c. The k=3 model had the best fit, reflecting 3 distinct trajectories of glycemic change: (T1) rapidly deteriorating HbA1c among 302 (1.1%) youngest (mean, 55.2 y) patients with lowest mean baseline HbA1c, 6.05%; (T2) gradually deteriorating HbA1c among 902 (3.3%) patients (mean, 56.5 y) with highest mean baseline HbA1c, 6.53%; and (T3) stable glycemic control among 25,800 (95.5%) oldest (mean, 58.5 y) patients with mean baseline HbA1c 6.21%. After 24 months, HbA1c rose to 8.75% in T1 and 8.40% in T2, but remained stable at 6.56% in T3. CONCLUSIONS Patients with controlled type 2 diabetes follow 3 distinct trajectories of glycemic control. This novel application of advanced analytic methods can facilitate individualized and population diabetes care by proactively identifying high risk patients.
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van der Heijden AAWA, Rauh SP, Dekker JM, Beulens JW, Elders P, ‘t Hart LM, Rutters F, van Leeuwen N, Nijpels G. The Hoorn Diabetes Care System (DCS) cohort. A prospective cohort of persons with type 2 diabetes treated in primary care in the Netherlands. BMJ Open 2017; 7:e015599. [PMID: 28588112 PMCID: PMC5729999 DOI: 10.1136/bmjopen-2016-015599] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE People with type 2 diabetes (T2D) have a doubled morbidity and mortality risk compared with persons with normal glucose tolerance. Despite treatment, clinical targets for cardiovascular risk factors are not achieved. The Hoorn Diabetes Care System cohort (DCS) is a prospective cohort representing a comprehensive dataset on the natural course of T2D, with repeated clinical measures and outcomes. In this paper, we describe the design of the DCS cohort. PARTICIPANTS The DCS consists of persons with T2D in primary care from the West-Friesland region of the Netherlands. Enrolment in the cohort started in 1998 and this prospective dynamic cohort currently holds 12 673 persons with T2D. FINDINGS TO DATE Clinical measures are collected annually, with a high internal validity due to the centrally organised standardised examinations. Microvascular complications are assessed by measuring kidney function, and screening feet and eyes. Information on cardiovascular disease is obtained by 1) self-report, 2) electrocardiography and 3) electronic patient records. In subgroups of the cohort, biobanking and additional measurements were performed to obtain information on, for example, lifestyle, depression and genomics. Finally, the DCS cohort is linked to national cancer and all-cause mortality registers. A selection of published findings from the DCS includes identification of subgroups with distinct development of haemoglobin A1c, blood pressure and retinopathy, and their predictors; validation of a prediction model for personalised retinopathy screening; the assessment of the role of genetics in development and treatment of T2D, providing options for personalised medicine. FUTURE PLANS We will continue with the inclusion of persons with newly diagnosed T2D, follow-up of persons in the cohort and linkage to morbidity and mortality registries. Currently, we are involved in (inter)national projects on, among others, biomarkers and prediction models for T2D and complications and we are interested in collaborations with external researchers. TRIAL REGISTRATION ISRCTN26257579.
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Affiliation(s)
- Amber AWA van der Heijden
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Simone P Rauh
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Joline W Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Petra Elders
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Leen M ‘t Hart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Molecular Cell Biology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Molecular Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Nienke van Leeuwen
- Department of Molecular Cell Biology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Giel Nijpels
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
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Ahmad T, Ulhaq I, Mawani M, Islam N. Microalbuminuria in Type-2 Diabetes Mellitus; the tip of iceberg of diabetic complications. Pak J Med Sci 2017; 33:519-523. [PMID: 28811763 PMCID: PMC5510095 DOI: 10.12669/pjms.333.12537] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To determine the prevalence of microalbuminuria and its association with hypertension and other diabetic complications among Type-2 diabetic patients attending at Aga Khan University Hospital Karachi. METHODS 1280 Type-2 diabetes patients who visited the outpatient department of Aga Khan University Hospital from September 2014 to August 2016 were included in the study. Microalbuminuria was diagnosed if spot urinary microalbumin excretion was confirmed to be more than 20mg/l. Hypertension was diagnosed if BP >140/90 or already on antihypertensive medications. Other demographic, clinical and laboratory data were also recorded. RESULTS Microalbuminuria was diagnosed in 404(31.56%) patients and among these albuminuric patients 335(82.9%) had hypertension. They were also dyslipidemic, having raised triglyceride levels, lower HDL levels, with more prevalence of background diabetic retinopathy and peripheral neuropathy. They also showed higher HbA1C levels and longer duration of diabetes. CONCLUSION The prevalence of the microalbuminuria in our patients with Type-2 diabetes is 31.56% and is not only an early sign of diabetic nephropathy but also a host of other diabetic complications and should be dealt early with strict control of their hyperglycemia and hypertension to help prevent the future complications.
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Affiliation(s)
- Tauseef Ahmad
- Dr. Tauseef Ahmad, FCPS. Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Imran Ulhaq
- Dr. Imran Ulhaq, FCPS. Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Minaz Mawani
- Minaz Mawani, M.Sc. (Epidemiology and Biostatistics). Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Najmul Islam
- Dr. Najmul Islam, FRCP. Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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McEwan P, Bennett H, Qin L, Bergenheim K, Gordon J, Evans M. An alternative approach to modelling HbA1c trajectories in patients with type 2 diabetes mellitus. Diabetes Obes Metab 2017; 19:628-634. [PMID: 28026908 DOI: 10.1111/dom.12865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
Abstract
AIMS Time-dependent HbA1c trajectories in health economic models of type 2 diabetes mellitus (T2DM) are typically informed by the UK Prospective Diabetes Study (UKPDS). However, this approach may not accurately predict HbA1c progression in patients who do not conform to the demographic profile of the original UKPDS cohort. This study aimed to develop an alternative mathematical model (MM) to simulate HbA1c progression in T2DM. MATERIALS AND METHODS A systematic literature review identified studies, published between 2005 and 2015, that reported HbA1c in adult T2DM patients over a minimum duration of 18 months. Pooled data from eligible studies were used to develop an alternative MM equation for HbA1c progression, which was then contrasted with the UKPDS 68 progression equation in illustrative scenarios. RESULTS A total of 68 studies were eligible for data extraction (mean follow-up time 4.1 years). HbA1c progression was highly heterogeneous across studies, varying with baseline HbA1c, treatment group and patient age. The MM equation was fitted with parameters for mean baseline HbA1c (8.3%), initial change in HbA1c (-0.62%) and upper quartile of maximum observed HbA1c (9.3%). Differences in HbA1c trajectories between the MM and UKPDS approaches altered the timing of therapy escalation in illustrative scenarios. CONCLUSIONS The MM represents an alternative approach to simulate HbA1c trajectories in T2DM models, as UKPDS data may not adequately reflect the heterogeneity of HbA1c profiles observed in clinical studies. However, the choice of approach should ultimately be determined by the characteristics of individual patients under consideration and the clinical face validity of the modelled trajectories.
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Affiliation(s)
- Phil McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | | | - Lei Qin
- Global Health Economics and Payer Analytics, AstraZeneca, Gaithersburg, Maryland
| | - Klas Bergenheim
- Global Health Economics and Payer Analytics, AstraZeneca, Gothenburg, Sweden
| | - Jason Gordon
- Health Economics and Outcomes Research Ltd, Cardiff, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Marc Evans
- University Hospital Llandough, Cardiff, UK
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Schwandt A, Hermann JM, Rosenbauer J, Boettcher C, Dunstheimer D, Grulich-Henn J, Kuss O, Rami-Merhar B, Vogel C, Holl RW. Longitudinal Trajectories of Metabolic Control From Childhood to Young Adulthood in Type 1 Diabetes From a Large German/Austrian Registry: A Group-Based Modeling Approach. Diabetes Care 2017; 40:309-316. [PMID: 28007778 DOI: 10.2337/dc16-1625] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/23/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Worsening of glycemic control in type 1 diabetes during puberty is a common observation. However, HbA1c remains stable or even improves for some youths. The aim is to identify distinct patterns of glycemic control in type 1 diabetes from childhood to young adulthood. RESEARCH DESIGN AND METHODS A total of 6,433 patients with type 1 diabetes were selected from the prospective, multicenter diabetes patient registry Diabetes-Patienten-Verlaufsdokumentation (DPV) (follow-up from age 8 to 19 years, baseline diabetes duration ≥2 years, HbA1c aggregated per year of life). We used latent class growth modeling as the trajectory approach to determine distinct subgroups following a similar trajectory for HbA1c over time. RESULTS Five distinct longitudinal trajectories of HbA1c were determined, comprising group 1 = 40%, group 2 = 27%, group 3 = 15%, group 4 = 13%, and group 5 = 5% of patients. Groups 1-3 indicated stable glycemic control at different HbA1c levels. At baseline, similar HbA1c was observed in group 1 and group 4, but HbA1c deteriorated in group 4 from age 8 to 19 years. Similar patterns were present in group 3 and group 5. We observed differences in self-monitoring of blood glucose, insulin therapy, daily insulin dose, physical activity, BMI SD score, body-height SD score, and migration background across all HbA1c trajectories (all P ≤ 0.001). No sex differences were present. Comparing groups with similar initial HbA1c but different patterns, groups with higher HbA1c increase were characterized by lower frequency of self-monitoring of blood glucose and physical activity and reduced height (all P < 0.01). CONCLUSIONS Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA1c courses.
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Affiliation(s)
- Anke Schwandt
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany .,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Julia M Hermann
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Claudia Boettcher
- Division of Pediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | | | | | - Oliver Kuss
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Vogel
- Department of Pediatrics, Children's Hospital Chemnitz, Chemnitz, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Matsui N, Washida K, Shoji M, Nakaizumi D, Kitagawa T, Terada S, Uchiyama K. Decrease in Self-Efficacy for Exercise at 12 Weeks after Exercise Education in Diabetic Patients. Health (London) 2017. [DOI: 10.4236/health.2017.94046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Martono DP, Hak E, Lambers Heerspink H, Wilffert B, Denig P. Predictors of HbA1c levels in patients initiating metformin. Curr Med Res Opin 2016; 32:2021-2028. [PMID: 27552675 DOI: 10.1080/03007995.2016.1227774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim was to assess demographic and clinical factors as predictors of short (6 months) and long term (18 months) HbA1c levels in diabetes patients initiating metformin treatment. RESEARCH DESIGN AND METHODS We conducted a cohort study including type 2 diabetes patients who received their first metformin prescription between 2007 and 2013 in the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) database. The primary outcome was HbA1c level at follow-up adjusted for baseline HbA1c; the secondary outcome was failing to achieve the target HbA1c level of 53 mmol/mol. Associations were analyzed by linear and logistic regression. Multiple imputation was used for missing data. Additional analyses stratified by dose and adherence level were conducted. RESULTS The cohort included 6050 patients initiating metformin. Baseline HbA1c at target consistently predicted better HbA1c outcomes. Longer diabetes duration and lower total cholesterol level at baseline were predictors for higher HbA1c levels at 6 months. At 18 months, cholesterol level was not a predictor. Longer diabetes duration was also associated with not achieving the target HbA1c at follow-up. The association for longer diabetes duration was especially seen in patients starting on low dose treatment. No consistent associations were found for comorbidity and comedication. CONCLUSIONS Diabetes duration was a relevant predictor of HbA1c levels after 6 and 18 months of follow-up in patients initiating metformin treatment. Given the study design, no causal inference can be made. Our study suggests that prompt treatment intensification may be needed in patients who have a longer diabetes duration at treatment initiation.
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Affiliation(s)
- Doti P Martono
- a Unit of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
- b School of Pharmacy , Institut Teknologi Bandung , Bandung , Indonesia
| | - Eelko Hak
- c Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Hiddo Lambers Heerspink
- d Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Bob Wilffert
- a Unit of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
- d Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Petra Denig
- d Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Davis TME, Chubb SAP, Davis WA. The relationship between estimated glomerular filtration rate trajectory and all-cause mortality in type 2 diabetes: the Fremantle Diabetes Study. Eur J Endocrinol 2016; 175:273-85. [PMID: 27418062 DOI: 10.1530/eje-16-0327] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 07/14/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the association between estimated GFR (eGFR) and all-cause mortality, including the contribution of temporal eGFR changes, in well-characterised community-based patients with type 2 diabetes. DESIGN Longitudinal observational study. METHODS Participants from the Fremantle Diabetes Study Phase 1 were assessed between 1993 and 1996 and followed until end-December 2012. Cox proportional hazards modelling was used to assess the relationship between baseline eGFR category (Stage 1-5) and all-cause death, and between eGFR trajectories assigned by semiparametric group-based modelling (GBM) and all-cause death in patients with five post-baseline annual eGFR measurements. RESULTS In the full cohort (1296 patients; mean±s.d. age 64.1±11.3years, 48.6% males), 738 (56.9%) died during 12.9±6.1years of follow-up. There was a U-shaped relationship between all-cause death and eGFR category. With Stage 3 (45-59mL/min/1.73m(2)) as reference, the strongest association was for eGFR ≥90mL/min/1.73m(2) (hazard ratio (95% CI) 2.01 (1.52-2.66); P<0.001). GBM identified four linear trajectories ('low', 'medium', 'high', 'high/declining') in 532 patients with serial eGFR measurements. With medium trajectory as reference, eGFR trajectory displaced baseline eGFR category as an independent predictor of death, with low and high/declining trajectories associated with more than double the risk (2.03 (1.30-3.18) and 2.24 (1.31-3.83) respectively, P≤0.003) and associated median reductions in survival of 6.5 and 8.7years respectively. CONCLUSION There is a nonlinear relationship between eGFR and death in type 2 diabetes, which is at least partially explained by a sub-group of patients with an initially high but then rapidly declining eGFR.
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Affiliation(s)
- Timothy M E Davis
- School of Medicine and PharmacologyUniversity of Western Australia, Fremantle, Western Australia, Australia
| | - S A Paul Chubb
- School of Medicine and PharmacologyUniversity of Western Australia, Fremantle, Western Australia, Australia Department of Clinical BiochemistryPathWest Laboratory Medicine WA, Perth, Western Australia, Australia School of Pathology and Laboratory MedicineUniversity of Western Australia, Nedlands, Western Australia, Australia
| | - Wendy A Davis
- School of Medicine and PharmacologyUniversity of Western Australia, Fremantle, Western Australia, Australia
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Rauh SP, Rutters F, Thorsted BL, Wolden ML, Nijpels G, van der Heijden AAWA, Walraven I, Elders PJ, Heymans MW, Dekker JM. Self-reported hypoglycaemia in patients with type 2 diabetes treated with insulin in the Hoorn Diabetes Care System Cohort, the Netherlands: a prospective cohort study. BMJ Open 2016; 6:e012793. [PMID: 27645557 PMCID: PMC5030618 DOI: 10.1136/bmjopen-2016-012793] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Our aim was to study the prevalence of self-reported hypoglycaemic sensations and its association with mortality in patients with type 2 diabetes (T2D) treated with insulin in usual care. METHODS Demographics, clinical characteristics and mortality data were obtained from 1667 patients with T2D treated with insulin in the Hoorn Diabetes Care System Cohort (DCS), a prospective cohort study using clinical care data. Self-reported hypoglycaemic sensations were defined as either mild: events not requiring help; or severe: events requiring help from others (either medical assistance or assistance of others). The association between hypoglycaemic sensations and mortality was analysed using logistic regression analysis. RESULTS At baseline, 981 patients (59%) reported no hypoglycaemic sensations in the past year, 612 (37%) reported only mild sensations and 74 (4%) reported severe hypoglycaemic sensations. During a median follow-up of 1.9 years, 98 patients (5.9%) died. Reporting only mild hypoglycaemic sensations was associated with a lower mortality risk (OR 0.48, 95% CI 0.28 to 0.80), while reporting severe sensations was not significantly associated with mortality (OR 0.76, 95% CI 0.33 to 1.80), compared with reporting no hypoglycaemic sensations, and adjusting for demographic and clinical characteristics. Sensitivity analyses showed an OR of 1.38 (95% CI 0.31 to 6.11) for patients reporting severe hypoglycaemic sensations requiring medical assistance. CONCLUSIONS Self-reported hypoglycaemic sensations are highly prevalent in our insulin-treated T2D population. Patients reporting hypoglycaemic sensations not requiring medical assistance did not have an increased risk of mortality, suggesting that these sensations are not an indicator of increased short-term mortality risk in patients with T2D.
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Affiliation(s)
- Simone P Rauh
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | | | | | - Giel Nijpels
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Amber A W A van der Heijden
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Iris Walraven
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Petra J Elders
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Ye S, Ruan P, Yong J, Shen H, Liao Z, Dong X. The impact of the HbA1c level of type 2 diabetics on the structure of haemoglobin. Sci Rep 2016; 6:33352. [PMID: 27624402 PMCID: PMC5022022 DOI: 10.1038/srep33352] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 08/24/2016] [Indexed: 11/30/2022] Open
Abstract
This study explores the impact of HbA1c levels on the structure of haemoglobin (Hb) in patients with type 2 diabetes. Seventy-four diabetic patients were classified into the following two groups based on their level of HbA1c: group A, patients with good glycaemic control (HbA1c < 7.0%, n = 36); group B, patients with persistent hyperglycaemia (HbA1c ≥ 9.0%, n = 38). Thirty-four healthy people served as controls (group H). Hb structure was examined by Fourier transform infrared spectroscopy (FTIR), and diabetic erythrocytes were modelled to estimate the impact of glucose on these cells and Hb. Increasing glucose concentrations altered both erythrocyte parameters and the Hb secondary structure. Group B differed significantly from group H (p < 0.05): in the former, the ordered Hb secondary structure had a strong tendency to transform into a disordered secondary structure, decreasing structural stability. We presumed here that high HbA1c levels might be a factor contributing to Hb structural modifications in diabetic patients. FTIR spectral analysis can provide a novel way to investigate the pathogenesis of type 2 diabetes mellitus.
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Affiliation(s)
- Shaoying Ye
- Department of Occupational and Environmental Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Ping Ruan
- Department of Biomedical Engineering, Guangdong Pharmaceutical University, Guangzhou, China
| | - Junguang Yong
- Department of Endocrinology, the affiliated outpatient department, Guangdong Pharmaceutical University, Guangzhou, China
| | - Hongtao Shen
- College of Physics and Technology, Guangxi Normal University, Guilin, China
| | - Zhihong Liao
- Department of Endocrinology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaolei Dong
- Department of Occupational and Environmental Health, Guangdong Pharmaceutical University, Guangzhou, China
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Davis TME, Chubb SAP, Bruce DG, Davis WA. Metabolic memory and all-cause death in community-based patients with type 2 diabetes: the Fremantle Diabetes Study. Diabetes Obes Metab 2016; 18:598-606. [PMID: 26936654 DOI: 10.1111/dom.12655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/12/2016] [Accepted: 02/28/2016] [Indexed: 12/18/2022]
Abstract
AIMS To validate the findings, in a usual care setting, of glycaemic intervention trials, which have shown that tight control in patients with recently diagnosed type 2 diabetes protects against death during post-study monitoring, but that it may be deleterious in long-duration diabetes with vascular complications. METHODS A subset of 531 patients with type 2 diabetes from the community-based observational Fremantle Diabetes Study Phase 1, who attended ≥5 annual reviews (mean follow-up 15.9 years), were categorized by baseline diabetes duration [<1 year (Group 1); 1 to <5 years (Group 2); and ≥5 years (Group 3)]. Glycated haemoglobin (HbA1c) trajectories over the first 5 years were determined [low, medium and high; equivalent to mean HbA1c ≤6.6% (<49 mmol/mol), 6.7-8.0% (50-64 mmol/mol) and ≥8.0% (>64 mmol/mol), respectively]. Kaplan-Meier analysis was used to assess survival by duration and HbA1c trajectory. Cox proportional hazards modelling identified predictors of all-cause death. RESULTS There was greater mortality in patients with a medium versus those with a low trajectory in Group 1: hazard ratio (HR) 1.99 [95% confidence interval (CI) 1.003-3.94; p = 0.049], and in patients with a high versus a low trajectory in Group 2: HR 2.02 (95% CI 1.11-3.71; p = 0.022). In Group 3, both medium [HR 0.57 (95% CI 0.35-0.92; p = 0.022)] and high [HR 0.56 (95% CI 0.32-0.96); p = 0.035] trajectories were independently and inversely associated with death. CONCLUSIONS In community-based patients with newly or recently diagnosed type 2 diabetes, poor glycaemic control was an adverse prognostic indicator. Tight control was independently associated with death in patients with diabetes duration ≥5 years. These data parallel intervention trial findings and support individualization of HbA1c targets.
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Affiliation(s)
- T M E Davis
- School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - S A P Chubb
- School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - D G Bruce
- School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - W A Davis
- School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia
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Abstract
AIMS In order to eventually improve blood pressure (BP) management, the aim of this study was to identify subgroups of type 2 diabetes mellitus (T2DM) patients with distinct trajectories of SBP levels. Identifying subgroups with distinct SBP trajectories helps to better understand the course of SBP levels in T2DM patients and its associated consequences. Subgroup characteristics were determined and the prevalence of complications and mortality rates over time in the different subgroups was investigated. METHODS Five thousand, seven hundred and eleven T2DM patients with at least two SBP follow-up measurements were selected from a prospective T2DM cohort of 9849 T2DM patients. The mean follow-up period was 5.7 years (range 2-9 years). Latent Class Growth Modeling, as currently the most flexible cluster analysis available, was performed to identify subgroups of patients with distinct SBP trajectories. Subgroup characteristics were determined by multinomial logistic regression analyses. RESULTS Four subgroups with distinct SBP trajectories were identified. The largest subgroup (85.6%) showed adequate SBP control (at or around 140 mmHg) over time. The second subgroup (5.6%) were hypertensive in the first years, responded slowly to BP management and eventually reached SBP control. The third subgroup (3.4%) showed deteriorating hypertension during the first 4 years, then showed insufficient response to BP management. The fourth subgroup (5.4%) showed deteriorating hypertension over time. Patients within subgroups 2-4 were significantly older, comprised more women, used more antihypertensive medication and had a higher prevalence of retinopathy, microalbuminuria and cardiovascular disease (CVD) mortality. CONCLUSION More than 85% reached and maintained adequate SBP control. Subgroups with a more unfavourable course of SBP control also showed higher rates of microvascular complications and CVD mortality over time. This study identified important subgroups to target in order to improve BP management in T2DM patients.
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Mast R, Danielle Jansen AP, Walraven I, Rauh SP, van der Heijden AAWA, Heine RJ, Elders PJM, Dekker JM, Nijpels G, Hugtenburg JG. Time to insulin initiation and long-term effects of initiating insulin in people with type 2 diabetes mellitus: the Hoorn Diabetes Care System Cohort Study. Eur J Endocrinol 2016; 174:563-71. [PMID: 26837781 DOI: 10.1530/eje-15-1149] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/02/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to assess the time to insulin initiation in type 2 diabetes mellitus (T2DM) patients treated with oral glucose-lowering agents and to determine the baseline characteristics associated with time to insulin initiation. This was evaluated in T2DM patients with HbA1c levels consistently ≥7.0% during total follow up and in those with fluctuating HbA1c levels around 7.0%. DESIGN AND METHODS Prospective, observational study was performed, comprising 2418 persons with T2DM aged ≥40 years who entered the Diabetes Care System between 1998 and 2012 with a minimum follow up of at least 3 years, following the first HbA1c level ≥7.0%. Cox regression analyses were performed to assess the determinants of time to insulin initiation. Data related to long-term effects of insulin initiation were studied at baseline and at the end of follow up using descriptive summary statistics. RESULTS Two-thirds of the patients initiated insulin during follow up. The time to insulin varied from 1.2 years (range 0.3-3.1) in patients with HbA1c levels consistently ≥7.0% to 5.4 years (range 3.0-7.5) in patients with fluctuating HbA1c levels around 7.0%. Longer diabetes duration (hazard ratio (HR) 1.04 95% CI 1.03-1.05) and lower age (HR 1.00 95% CI 0.99-1.00) at baseline were associated with a shorter time to initiation. More insulin initiators had retinopathy compared with patients that remained on oral glucose-lowering agents during follow up. CONCLUSION The time to insulin initiation was short, and most of the patients with HbA1c levels consistently ≥7.0% were initiating insulin. Longer diabetes duration and younger age shortened the time to insulin.
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Affiliation(s)
- Ruth Mast
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - A P Danielle Jansen
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - Iris Walraven
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - Simone P Rauh
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - Amber A W A van der Heijden
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - Robert J Heine
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - Petra J M Elders
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - Jacqueline M Dekker
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - Giel Nijpels
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
| | - Jacqueline G Hugtenburg
- EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA EMGO Institute for Health and Care ResearchDepartments of Clinical Pharmacology and PharmacyGeneral Practice and Elderly Care MedicineEpidemiology and BiostatisticsOphthalmologyVU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The NetherlandsEli Lilly and Company893 S Delaware St, Indianapolis, Indiana, USA
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Profiling Patients' Healthcare Needs to Support Integrated, Person-Centered Models for Long-Term Disease Management (Profile): Research Design. Int J Integr Care 2016; 16:1. [PMID: 27616957 PMCID: PMC5015555 DOI: 10.5334/ijic.2208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: This article presents the design of PROFILe, a study
investigating which (bio)medical and non-(bio)medical patient characteristics
should guide more tailored chronic care. Based on this insight, the project aims
to develop and validate ‘patient profiles’ that can be used in
practice to determine optimal treatment strategies for subgroups of chronically
ill with similar healthcare needs and preferences. Methods/Design: PROFILe is a practice-based research comprising four
phases. The project focuses on patients with type 2 diabetes. During the first
study phase, patient profiles are drafted based on a systematic literature
research, latent class growth modeling, and expert collaboration. In phase 2,
the profiles are validated from a clinical, patient-related and statistical
perspective. Phase 3 involves a discrete choice experiment to gain insight into
the patient preferences that exist per profile. In phase 4, the results from all
analyses are integrated and recommendations formulated on which patient
characteristics should guide tailored chronic care. Discussion: PROFILe is an innovative study which uses a uniquely
holistic approach to assess the healthcare needs and preferences of chronically
ill. The patient profiles resulting from this project must be tested in practice
to investigate the effects of tailored management on patient experience,
population health and costs.
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Traina SB, Slee A, Woo S, Canovatchel W. The Importance of Weight Change Experiences for Performance of Diabetes Self-Care: A Patient-Centered Approach to Evaluating Clinical Outcomes in Type 2 Diabetes. Diabetes Ther 2015; 6:611-625. [PMID: 26608510 PMCID: PMC4674477 DOI: 10.1007/s13300-015-0145-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The aim of this study was to examine the influence of weight change experiences over time on motivation to perform diabetes self-care behaviors using data from a study of canagliflozin (an agent that inhibits sodium glucose co-transporter 2) versus glimepiride in dual therapy with metformin and background diet/exercise. METHODS Weight and motivation for performing healthy behaviors were collected at baseline and over time. The motivation questionnaire enabled categorization into two groups: those performing or not performing health behaviors. Four distinct patterns of weight change were determined: losing weight, gaining weight, and two patterns for fluctuating weight. The relationships between these patterns and motivation for weight loss, following a diet, and exercise were examined using logistic regression models. RESULTS Of 1182 subjects, more than half were already performing behaviors to lose weight, diet, and exercise at baseline. Among those who were not, 52% (246/474) started taking action to lose weight after baseline, 54% (241/448) started following a diet, and 42% (232/556) started exercising. Weight change patterns were significantly related to performance of healthy behaviors at follow-up (week 36). Compared to the weight gain pattern, those who experienced a continuous weight loss pattern from baseline to week 36 were 2.2 (95% confidence interval 1.49, 3.37) times more likely to perform the healthy behaviors. Baseline behavior and confidence were also predictive of performing healthy behaviors. CONCLUSION The current work highlights the importance of weight change patterns for performance of diabetes self-care. Tracking weight patterns over time, assessing confidence for performance of healthy behaviors, and being aware of the relationship between weight changes and diabetes self-care behaviors are viable, concrete ways to practice patient-centered care. FUNDING Janssen Global Services, LLC.
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