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Andrés-Rebollo FJS, Cárdenas-Valladolid J, Abanades-Herranz JC, Vich-Pérez P, de Miguel-Yanes JM, Guillán M, Salinero-Fort MA. A different perspective on studying stroke predictors: joint models for longitudinal and time-to-event data in a type 2 diabetes mellitus cohort. Cardiovasc Diabetol 2025; 24:165. [PMID: 40241150 PMCID: PMC12004838 DOI: 10.1186/s12933-025-02713-9] [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: 01/26/2025] [Accepted: 03/26/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Most predictive models rely on risk factors and clinical outcomes assessed simultaneously. This approach does not adequately reflect the progression of health conditions. By employing joint models of longitudinal and survival data, we can dynamically adjust prognosis predictions for individual patients. Our objective was to optimize the prediction of stroke or transient ischemic attack (TIA) via joint models that incorporate all available changes in the predictive variables. METHODS A total of 3442 patients with type 2 diabetes mellitus (T2DM) and no history of stroke, TIA or myocardial infarction were followed for 12 years. Models were constructed independently for men and women. We used proportional hazards regression models to assess the effects of baseline characteristics (excluding longitudinal data) on the risk of stroke/TIA and linear mixed effects models to assess the effects of baseline characteristics on longitudinal data development over time. Both submodels were then combined into a joint model. To optimize the analysis, a univariate analysis was first performed for each longitudinal predictor to select the functional form that gave the best fit via the deviance information criterion. The variables were then entered into a multivariate model using pragmatic criteria, and if they improved the discriminatory ability of the model, the area under the curve (AUC) was used. RESULTS During the follow-up period, 303 patients (8.8%) experienced their first stroke/TIA. Age was identified as an independent predictor among males. Among females, age was positively associated with atrial fibrillation (AF). The final model for males included AF, systolic blood pressure (SBP), and diastolic blood pressure (DBP), with albuminuria and the glomerular filtration rate (GFR) as adjustment variables. For females, the model included AF, blood pressure (BP), and renal function (albuminuria and GFR), with HbA1c and LDL cholesterol as adjustment variables. Both models demonstrated an AUC greater than 0.70. CONCLUSIONS Age, AF, and SBP have been confirmed as significant predictive factors in both sexes, whereas renal function was significant only in women. Interestingly, an increase in DBP may serve as a protective factor in our cohort. These factors were particularly relevant in the last 3-7 years of follow-up.
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Affiliation(s)
- F J San Andrés-Rebollo
- Las Calesas Health Centre, Madrid, Spain
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
- Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community- Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain
| | - J Cárdenas-Valladolid
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
- Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community- Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain
- Alfonso X El Sabio University, Madrid, Spain
| | - J C Abanades-Herranz
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
- Monóvar Health Centre, Madrid, Spain
| | - P Vich-Pérez
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
- Los Alpes Health Centre, Madrid, Spain
| | - J M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - M Guillán
- Department of Neurology, Neurovascular Unit, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - M A Salinero-Fort
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain.
- Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community- Hospital La Paz Institute for Health Research IdiPAZ, Madrid, Spain.
- Alfonso X El Sabio University, Madrid, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain.
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Wu C, Li Y, Li N, Chan KK, Piao C. Body Mass Index and Risk of All-Cause and Cardiovascular Disease Mortality in Patients With Type 2 Diabetes Mellitus. Endocrinology 2025; 166:bqaf040. [PMID: 40036849 DOI: 10.1210/endocr/bqaf040] [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: 10/24/2024] [Revised: 01/29/2025] [Accepted: 02/27/2025] [Indexed: 03/06/2025]
Abstract
CONTEXT The correlations between body mass index (BMI) and risk of all-cause and cardiovascular disease (CVD) mortality in patients with type 2 diabetes mellitus (T2DM) are still controversial. OBJECTIVE To explore the correlation between BMI and the risk of all-cause and CVD mortality in patients with T2DM. METHODS The data sources China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed, Web of Science, Embase, and The Cochrane Library were searched up until May 25, 2024. After adjusting for confounding factors, the original study on the association between BMI and all-cause and CVD mortality in patients with T2DM was analyzed. Number of all-cause and CVD mortality events, BMI, and basic characteristics were extracted. RESULTS Twenty-eight papers with a total of 728 321 participants were finally included. Compared to normal-weight patients with T2DM, the risk of all-cause (HR = 1.61; 95% CI [1.51, 1.72]; P = .000) and CVD (HR = 1.31; 95% CI [1.10, 1.54]; P = .002) mortality were increased in underweight patients; however, they were reduced (HR = 0.85; 95% CI [0.81, 0.89]; P = .000) and (HR = 0.86; 95% CI [0.78, 0.96]; P = .007), respectively in patients with overweight. Also, there were significant reductions in the risk of all-cause (HR = 0.85; 95% CI [0.78, 0.92]; P = .000) and CVD (HR = 0.81; 95% CI [0.74, 0.89]; P = .000] mortality in patients with mild obesity. The difference in the risk of all-cause mortality (HR = 0.98; 95% CI [0.80, 1.21]; P = .881) in patients with moderate obesity was not statistically significant. CONCLUSION We found that there were correlations between BMI and the risk of all-cause and CVD mortality in patients with T2DM. The obesity paradox remains.
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Affiliation(s)
- Cui Wu
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, Jilin, China
| | - Yuandong Li
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, Jilin, China
| | - Na Li
- Department of Endocrinology, Shenzhen Hospital (Fu Tian) of Guangzhou University of Chinese Medicine, Shenzhen 518034, Guangdong, China
| | - Ka Kei Chan
- Department of Endocrinology, Shenzhen Hospital (Fu Tian) of Guangzhou University of Chinese Medicine, Shenzhen 518034, Guangdong, China
| | - Chunli Piao
- Department of Endocrinology, Shenzhen Hospital (Fu Tian) of Guangzhou University of Chinese Medicine, Shenzhen 518034, Guangdong, China
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Newson RS, Divino V, Boye KS, Chen J, DeKoven M, Vallarino C, Ranta K, Mount JE. Glycemic Control and Obesity Among People With Type 2 Diabetes in Europe and Australia: A Retrospective Cohort Analysis. Diabetes Ther 2024; 15:1435-1449. [PMID: 38683494 PMCID: PMC11096291 DOI: 10.1007/s13300-024-01583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/04/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION In people with type 2 diabetes (PwT2D) who also have obesity, efforts targeting weight loss, including lifestyle, medication and surgical interventions, are recommended. The objective of this study was to explore the relationship between glycemic control and obesity among PwT2D in Europe and Australia using recent real-world data and applying consistent methodology across countries. METHODS Retrospective study utilizing IQVIA electronic medical records (EMR) databases grouped into panels based on specialty of contributing physicians. General practitioner (GP) and endocrinologist/diabetologist (E/D) panels were used in Germany and France, while GP panels were used in Italy, UK and Australia. The Spanish database included all physician specialties. The sample included PwT2D with glycated hemoglobin A1c (HbA1c) and body mass index (BMI) values measured within 90 days of each other between January 2015 and December 2018 (second record termed the 'index date'). PwT2D had a 1-year baseline period and a recorded HbA1c at the end of the 1-year post-index period. RESULTS The final sample comprised 194,729 PwT2D. At baseline, across countries/panels, 36.8-58.0% were above HbA1c target (HbA1c ≥ 7%) and 39.4-56.7% had obesity (BMI ≥ 30.0 kg/m2). Mean HbA1c ranged from 6.9 to 7.6% and mean BMI ranged from 29.3-31.6 kg/m2. At baseline, a higher proportion of PwT2D with obesity (40.8-64.2%) were above HbA1c target compared to their counterparts without obesity (32.2-52.4%). A higher proportion of patients with obesity at baseline (38.1-60.6%) had post-index HbA1c above target compared to their counterparts without obesity (30.9-56.0%). In logistic regression, patients with obesity had substantially lower odds of post-index HbA1c below target compared to those without obesity in all countries/panels except for France (E/D), Spain and Australia. CONCLUSIONS This study presents data on HbA1c and BMI among type 2 diabetes (T2D) populations in Europe and Australia. A notable proportion of PwT2D had obesity and were above HBA1c target. Higher BMI was associated with poorer glycemic control.
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Affiliation(s)
- Rachel S Newson
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Victoria Divino
- IQVIA, 3110 Fairview Park Drive, Suite 400, Falls Church, VA, 22042, USA.
| | - Kristina S Boye
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Justin Chen
- IQVIA, 3110 Fairview Park Drive, Suite 400, Falls Church, VA, 22042, USA
| | - Mitch DeKoven
- IQVIA, 3110 Fairview Park Drive, Suite 400, Falls Church, VA, 22042, USA
| | - Carlos Vallarino
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Kari Ranta
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Julie E Mount
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
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Boye KS, Shinde S, Kennedy-Martin T, Robinson S, Thieu VT. Weight Change and the Association with Adherence and Persistence to Diabetes Therapy: A Narrative Review. Patient Prefer Adherence 2022; 16:23-39. [PMID: 35023906 PMCID: PMC8747793 DOI: 10.2147/ppa.s328583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Type 2 diabetes (T2D) medication adherence is poor and is impacted by individual drug characteristics. Treatment-associated weight change can affect medication-taking behavior. This review aimed to explore weight change on T2D therapy and consider its impact on adherence and discontinuation. METHODS Searches were conducted in MEDLINE and EMBASE (2005 to September 2020), and among recent congress abstract books for studies providing data on medication adherence or discontinuation and weight change in people with T2D (PwD). RESULTS Nine studies meeting the inclusion criteria were identified from 9188 bibliographic records. All three studies exploring weight change and discontinuation reported weight loss to be associated with higher persistence. Seven studies of varying design explored weight change and adherence. Four reported absolute weight change (kg) and adherence: one pooled data from different diabetes medications and demonstrated that self-reported adherence was significantly associated with weight loss; however, three studies found that weight change in adherent PwD was in the direction of the known weight profile (loss/gain) of the evaluated drug. Categorical weight loss (≥3%) and adherence were reported in two studies: one reported that numerically more adherent versus non-adherent PwD lost ≥3% weight regardless of the drug's weight profile, the other showed that early weight loss with a glucagon-like peptide-1 agonist was significantly associated with better adherence. One study reported adherence by categorical weight change; as weight loss increased, adherence scores improved, regardless of drug type. CONCLUSION Findings suggest that discontinuation rates may be lower in PwD who lose as compared to those who gain weight on T2D treatment. The evidence base on adherence and weight change is more challenging to interpret due to the range of study designs. Given the importance of weight control in T2D, further research exploring the individual's treatment, weight journey, and behaviors over time should be undertaken.
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Affiliation(s)
- Kristina S Boye
- Eli Lilly and Company, Indianapolis, IN, USA
- Correspondence: Kristina S Boye Eli Lilly and Company, Indianapolis, IN, USATel +1-317-651-4039 Email
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Shang X, Zhu Z, Zhang X, Huang Y, Tan Z, Wang W, Tang S, Ge Z, Shi D, Jiang Y, Yang X, He M. Adiposity by Differing Measures and the Risk of Cataract in the UK Biobank: The Importance of Diabetes. Invest Ophthalmol Vis Sci 2021; 62:19. [PMID: 34797907 PMCID: PMC8606797 DOI: 10.1167/iovs.62.14.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the association between adiposity by differing measures and incident cataract and identify important factors contributing to the association. Methods Our analysis included 153,139 adults from the UK Biobank, aged 40 to 70 years at baseline (2006-2010). Cataract was ascertained using hospital inpatient, and self-reported data until the early of 2021. Anthropometric measures, body fat percentage, and glycosylated hemoglobin (HbA1c) were measured at baseline. Results During a median follow-up of 10.9 years, 15,255 cases of incident cataract were documented. HbA1c was an important contributor to the association between obesity and incident cataract. Obesity; defined by body mass index was associated with an increased risk of cataract (hazard ratio [HR], 1.21 95% confidence interval [CI], 1.16-1.26), and this association was attenuated but remained significant after additional adjustment for HbA1c (HR, 1.05; 95% CI, 1.00-1.10). Similar results were observed for obesity defined by waist circumference or waist-to-hip ratio. Obesity defined by fat percentage was associated with an increased risk of cataract before but not after adjustment for covariates. The association between obesity defined by body mass index and incident cataract was positively significant in individuals with normal HbA1c (HR, 1.07; 95% CI, 1.02-1.13), but inversely significant in those with prediabetes (HR, 0.80; 95% CI, 0.67-0.96) or diabetes (HR, 0.74; 95% CI, 0.61-0.89). Conclusions Anthropometric measurements are more predictive of cataract than bioelectrical impedance measures. Diabetes plays an important role in the association between obesity and incident cataract.
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Affiliation(s)
- Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangzhou, China
| | - Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangzhou, China
| | - Xueli Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangzhou, China
| | - Zachary Tan
- Centre for Eye Research Australia, Victoria, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shulin Tang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zongyuan Ge
- Monash e-Research Center, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Center, Monash University, Melbourne, Victoria, Australia
| | - Danli Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yu Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Yang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Centre for Eye Research Australia, Victoria, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Jodar E, Artola S, Garcia-Moll X, Uría E, López-Martínez N, Palomino R, Martín V. Incidence and costs of cardiovascular events in Spanish patients with type 2 diabetes mellitus: a comparison with general population, 2015. BMJ Open Diabetes Res Care 2020; 8:8/1/e001130. [PMID: 32747385 PMCID: PMC7398090 DOI: 10.1136/bmjdrc-2019-001130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cardiovascular (CV) disease affects a high percentage of patients with type 2 diabetes mellitus (T2DM), especially in the hospital setting, impacting on mortality, complications, quality of life and use of health resources. The aim of this study was to estimate the incidence, mean length of hospital stay (LOHS) and costs attributable to hospital admissions due to CV events in patients with T2DM versus patients without diabetes mellitus (non-DM) in Spain. RESEARCH DESIGN AND METHODS Retrospective observational study based on the Spanish National Hospital Discharge Database for 2015. Hospital admissions for patients aged ≥35 years with a diagnosis of CV death, non-fatal acute myocardial infarction (AMI), non-fatal stroke, unstable angina, heart failure and revascularization were evaluated. The International Classification of Diseases, Ninth Revision (250.x0 or 250.x2) coding was used to classify records of patients with T2DM. For each CV complication, the hospital discharges of the two groups, T2DM and non-DM, were precisely matched and the number of hospital discharges, patients, LOHS and mean cost were quantified. Additional analyses assessed the robustness of the results. RESULTS Of the 276 925 hospital discharges analyzed, 34.71% corresponded to patients with T2DM. A higher incidence was observed in all the CV complications studied in the T2DM population, with a relative risk exceeding 2 in all cases. The mean LOHS (days) was longer in the T2DM versus the non-DM group for: non-fatal AMI (7.63 vs 7.02, p<0.001), unstable angina (5.11 vs 4.78, p=0.009) and revascularization (7.96 vs 7.57, p<0.001). The mean cost per hospital discharge was higher in the T2DM versus the non-DM group for non-fatal AMI (€6891 vs €6876, p=0.029) and unstable angina (€3386 vs €3304, p<0.001). CONCLUSIONS Patients with T2DM had a higher incidence and number of hospital admissions per patient due to CV events versus the non-DM population. This generates a significant clinical and economic burden given the longer admission stay and higher costs associated with some of these complications.
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Affiliation(s)
- Esteban Jodar
- Department of Endocrinology and Nutrition, Quirón Salud Madrid and Ruber Juan Bravo University Hospitals, Universidad Europea de Madrid, Madrid, Spain
| | - Sara Artola
- José Marvá Health Centre, RedGDPS Foundation, Madrid, Spain
| | - Xavier Garcia-Moll
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, IIB-Sant Pau Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Li YH, Sheu WHH, Lee IT. Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:907-914. [PMID: 32273742 PMCID: PMC7102910 DOI: 10.2147/dmso.s246032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/11/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE An "obesity paradox" has been observed in patients with type 2 diabetes. However, the optimal body mass index (BMI) for survival may be influenced by the stage of diabetes. We examined the relationship between BMI and mortality in patients with type 2 diabetes and the influence of diabetic retinopathy (DR). PATIENTS AND METHODS This is a retrospective cohort composing patients with type 2 diabetes who were admitted due to poor glucose control. Presence of DR was confirmed by ophthalmologists. The primary outcome was all-cause mortality. The association between BMI and mortality was assessed using a Cox proportional hazards model with adjustment for age, sex, and traditional risk factors. RESULTS A total of 2053 patients were enrolled. Over median follow-up of 6.7 years, there were 1060 deaths. Patients were classified into five categories based on admission BMI (kg/m2): <18.5, 18.5‒23, 23‒25, 25‒27 (reference), 25‒30 and >30. Mortality risk was significantly higher in the <18.5 kg/m2, 18.5-23 kg/m2, and 23-25 kg/m2 categories than in the reference category (P <0.001). The similar obesity paradox was observed in the subgroup of patients without DR. However, in patients with DR, only patients with BMI <18.5 kg/m2 had significantly increased mortality than those in the reference category. The presence of DR significantly modified the shape of the association between BMI and mortality (P = 0.019). CONCLUSION The obesity paradox exists in patients with poorly controlled type 2 diabetes. The presence of DR appears to significantly influence the shape of the association between BMI and mortality.
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Affiliation(s)
- Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung40705, Taiwan
- Graduate Institute of Data Science, Taipei Medical University, Taipei11031, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung40705, Taiwan
- School of Medicine, National Yang-Ming University, Taipei11221, Taiwan
- Rong Hsing Research Center for Translational Medicine, College of Life Sciences, National Chung Hsing University, Taichung40227, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung40705, Taiwan
- School of Medicine, National Yang-Ming University, Taipei11221, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung40201, Taiwan
- College of Science, Tunghai University, Taichung40704, Taiwan
- Correspondence: I-Te Lee Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung40705, TaiwanTel +886-4-23741300Fax +886-4-23593662 Email
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Ma J, Wang X, Zheng M, Yu H, Ma J, Li X, Pan J, Huang Y. A Multicenter Large-Scale Retrospective Analysis of the Correlation between Body Mass Index and All-Cause Mortality in Patients with Type 2 diabetes Mellitus: A Seven-Year Real-World Study. Endocr Res 2019; 44:103-109. [PMID: 30773948 DOI: 10.1080/07435800.2019.1573826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Aims: To investigate the association between body mass index (BMI) and all-cause mortality in patients with type 2 diabetes mellitus (T2DM) and to determine any sex-specific differences in this association. Methods: We retrospectively enrolled patients with T2DM and investigated the annual death data for seven years starting from 2010. All-cause mortality was calculated using Life Tables analysis. Multivariate Cox proportional hazards analysis was performed to identify the association between BMI and mortality. Results: During a mean survey period of 7.33 ± 1.42 years (X± SD), 996 of the 17259 patients enrolled died, resulting in an all-cause mortality rate of 5.77%, with no significant difference between women and men (6.04% vs. 5.56%; x2 = 1.766, P = 0.184). The top three causes of death were ischemic heart disease, cerebrovascular disease, and chronic kidney failure. A total of 87, 266, 332, and 311 patients with a BMI of <18.5, 18.5-23.99, 24.0-27.99, and ≥28.0 kg/m2, respectively, died, with the corresponding mortality rate calculated at 15.45%, 3.30%, 5.80%, and 10.70%, respectively. The BMI value associated with the highest all-cause mortality was <18.5 kg/m2, but this association was only significant in women aged <50 years (HR: 3.12; 95% CI, 1.62-4.34; P < 0.001). Conclusions: In patients with T2DM, a low BMI in women aged <50 years predicted high all-cause mortality.
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Affiliation(s)
- Jihong Ma
- a Department of Intensive Care Unit , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , P.R. China
| | - Xiaodong Wang
- b Center of Infectious Disease , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , P.R. China
| | - Mao Zheng
- c Department of Endocrinology , An Hui Provincial Hospital , Hefei , Anhui , P.R. China
| | - Haizhu Yu
- d General medical department , Zhejiang Hospital , Hangzhou , Zhejiang , P.R. China
| | - Junmin Ma
- e Department of Endocrinology , The First People's Hospital of Wuhu , Wuhu , Anhui , P.R. China
| | - Xiaohang Li
- a Department of Intensive Care Unit , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , P.R. China
| | - Jingye Pan
- a Department of Intensive Care Unit , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , P.R. China
| | - Yueyue Huang
- a Department of Intensive Care Unit , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , Zhejiang , P.R. China
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Safiri S, Ayubi E. Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Methodological issues. Eur J Intern Med 2018; 47:e27. [PMID: 28822605 DOI: 10.1016/j.ejim.2017.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Erfan Ayubi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Salinero-Fort MÁ, San-Andrés-Rebollo FJ, Jiménez-García R, de Miguel-Yanes JM. Body mass index and all-cause mortality among type 2 diabetes mellitus patients. Eur J Intern Med 2018; 47:e28. [PMID: 28893521 DOI: 10.1016/j.ejim.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 11/15/2022]
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de Miguel-Yanes JM, Jiménez-García R, Hernández-Barrera V, Méndez-Bailón M, de Miguel-Díez J, Lopez-de-Andrés A. Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002-2014). Cardiovasc Diabetol 2017; 16:126. [PMID: 29017514 PMCID: PMC5635492 DOI: 10.1186/s12933-017-0609-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/03/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients. METHODS Retrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year. RESULTS We selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for "all cardiovascular events combined", than non-diabetic matched controls. CONCLUSIONS The number of hospital admissions for stroke, aortic aneurysm and dissection and acute lower limb ischemia increased overtime, but remained stable for myocardial infarction. T2DM is associated to higher IHM after major cardiovascular events. Further research is needed to help us understand the reasons for an apparently increased mortality in T2DM patients when admitted to hospital for some major cardiovascular events.
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Affiliation(s)
- José M. de Miguel-Yanes
- Medicine Department, Hospital Universitario Gregorio Marañon, Madrid, Comunidad De Madrid Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922 Alcorcon, Madrid, Comunidad De Madrid Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922 Alcorcon, Madrid, Comunidad De Madrid Spain
| | - Manuel Méndez-Bailón
- Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Comunidad De Madrid Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital Universitario Gregorio Marañon, Madrid, Comunidad De Madrid Spain
| | - Ana Lopez-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922 Alcorcon, Madrid, Comunidad De Madrid Spain
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