Characteristics and outcomes of patients with type 1 diabetes admitted with acute coronary syndromes

Impact of type 1 diabetes mellitus on mortality rate and outcome of hospitalized patients with myocardial infarction

INTRODUCTION

Type 1 diabetes mellitus (T1D) is associated with an increased cardiovascular risk. We aimed to investigate the influence of T1D on myocardial infarction (MI) patients' mortality.

MATERIALS AND METHODS

The German nationwide inpatient sample 2005-2016 was used for statistical analysis. Hospitalized MI patients were stratified for T1D and impact of T1D on in-hospital outcomes was investigated.

RESULTS

In total, 3,307,703 hospitalizations of MI patients (37.6 % females, 56.8 % aged ≥70 years) were counted in Germany 2005-2016 and included in this analysis. In 18,625 (0.6 %) of the cases additionally T1D was coded. Overall, 410,737 (12.4 %) in-hospital deaths occurred within the investigation period. MI patients with T1D were younger (64.0 [IQR 52.0-75.0] vs. 73.0 [62.0-81.0] years, P < 0.001), more often female (38.7 % vs. 37.6 %, P < 0.001) and obese (13.2 % vs. 9.3 %, P < 0.001). Comorbidities like peripheral arterial (14.2 % vs. 6.4 %, P < 0.001) and kidney disease (38.5 % vs. 27.2 %, P < 0.001) were more prevalent in MI patients with T1D. T1D was an independent risk factor for in-hospital death (OR 1.23 [95%CI 1.18-1.29], P < 0.001), recurrent MI (OR 1.56 [95%CI 1.35-1.80], P < 0.001), and stroke (OR 1.75 [95%CI 1.63-1.88], P < 0.001). While percutaneous coronary intervention (PCI, 37.8 % vs. 42.0 %, P < 0.001) was less often, coronary artery bypass grafting (CABG, 7.4 % vs. 4.6 %, P < 0.001) was more often performed in MI patients with T1D, confirmed by regression analysis (PCI: OR 0.66 [95%CI 0.64-0.68], P < 0.001; CABG: OR 1.54 [95%CI 1.45-1.63], P < 0.001).

CONCLUSIONS

T1D represents an important and independent risk factor for mortality in MI patients. The results emphasize the high vulnerability of T1D patients who suffer from MI.

The association between leptin and diabetes: A meta-analysis

PURPOSE

The study object was to determine the relationship between leptin and diabetes.

METHODS

We searched for the literature on the relationship between leptin and diabetes from PubMed, EMBASE, Cochrane Library, and CNKI databases. We carried out the meta-analysis by calculating the Std. Mean Difference (SMD) and 95% confidence intervals (CIs) to study the relationship between leptin and diabetes. We performed the Chi-square-based Q test and I2 statistics to evaluate the potential heterogeneity, and the sensitivity analysis was performed to evaluate the stability of our results. Moreover, Begg's test was performed to evaluate the publication bias.

RESULTS

There are 10 studies in this study for meta-analysis, which include 1879 patients (diabetic (n = 1024); and nondiabetic patients (n = 855)). The results indicated that the levels of serum leptin were significantly increased in patients with diabetes (SMD = 1.78, 95% CI [0.81, 2.76]), especially those with gestational diabetes mellitus compared with controls (SMD = 3.03, 95% CI [1.21, 4.86]). However, the results showed that there was no difference in serum leptin levels between type 2 diabetes and controls (SMD = 0.34, 95% CI [-1.06, 1.74]).

CONCLUSIONS

Our analysis indicated that the levels of serum leptin were significantly elevated in patients with diabetes especially those with gestational diabetes mellitus compared with controls.