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Gudjonsdottir H, Tynelius P, Stattin NS, Méndez DY, Lager A, Brynedal B. Undiagnosed type 2 diabetes is common - intensified screening of established risk groups is imperative in Sweden: the SDPP cohort. BMC Med 2024; 22:168. [PMID: 38637767 PMCID: PMC11027361 DOI: 10.1186/s12916-024-03393-0] [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: 11/17/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Undiagnosed type 2 diabetes (T2D) is a global problem. Current strategies for diagnosis in Sweden include screening individuals within primary healthcare who are of high risk, such as those with hypertension, obesity, prediabetes, family history of diabetes, or those who smoke daily. In this study, we aimed to estimate the proportion of individuals with undiagnosed T2D in Stockholm County and factors associated with T2D being diagnosed by healthcare. This information could improve strategies for detection. METHODS We used data from the Stockholm Diabetes Prevention Programme (SDPP) cohort together with information from national and regional registers. Individuals without T2D aged 35-56 years at baseline were followed up after two ten-year periods. The proportion of diagnosed T2D was based on register information for 7664 individuals during period 1 and for 5148 during period 2. Undiagnosed T2D was assessed by oral glucose tolerance tests at the end of each period. With logistic regression, we analysed factors associated with being diagnosed among individuals with T2D. RESULTS At the end of the first period, the proportion of individuals with T2D who had been diagnosed with T2D or not was similar (54.0% undiagnosed). At the end of the second period, the proportion of individuals with T2D was generally higher, but they were less likely to be undiagnosed (43.5%). The likelihood of being diagnosed was in adjusted analyses associated with overweight (OR=1.85; 95% CI 1.22-2.80), obesity (OR=2.73; 95% CI 1.76-4.23), higher fasting blood glucose (OR=2.11; 95% CI 1.67-2.66), and self-estimated poor general health (OR=2.42; 95% CI 1.07-5.45). Socioeconomic factors were not associated with being diagnosed among individuals with T2D. Most individuals (>71%) who developed T2D belonged to risk groups defined by having at least two of the prominent risk factors obesity, hypertension, daily smoking, prediabetes, or family history of T2D, including individuals with T2D who had not been diagnosed by healthcare. CONCLUSIONS Nearly half of individuals who develop T2D during 10 years in Stockholm County are undiagnosed, emphasizing a need for intensified screening of T2D within primary healthcare. Screening can be targeted to individuals who have at least two prominent risk factors.
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Affiliation(s)
- Hrafnhildur Gudjonsdottir
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Per Tynelius
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nouha Saleh Stattin
- Academic Primary Healthcare Centre, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Diego Yacamán Méndez
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anton Lager
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Boel Brynedal
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Zhu Y, Dekker LH, Mierau JO. Socio-economic gradients in diagnosed and undiagnosed Type 2 diabetes and its related health complications. Nutr Metab Cardiovasc Dis 2023; 33:90-94. [PMID: 36336549 DOI: 10.1016/j.numecd.2022.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIMS Diagnosed and undiagnosed Type 2 Diabetes (T2D) remains a challenge in high-income countries. In addition, the presence of T2D can cause further disease burden because of its high susceptibility to complications. Nevertheless, there is limited evidence of socio-economic gradients in undiagnosed T2D and its complications in a large population cohort. We investigated this using the Dutch Lifelines Cohort Study (Lifelines). METHODS AND RESULTS Within Lifelines, baseline data of 102 163 adults aged 30 and above were collected from 2007 to 2013. The associations of Socio-Economic Status (SES), indicated by monthly household income, with the prevalence of T2D status and the number of T2D complications were assessed using multinomial Poisson and linear regressions with adjustments for age and sex. The prevalence of diagnosed and undiagnosed T2D was, respectively, 3.0% and 3.0% in the low SES group compared to 1.1% and 1.8% in the high SES group. Individuals with lower SES were at higher risk of having undiagnosed T2D (relative risk ratio (rrr) [95% CI]: 1.63 [1.47-1.81] for low SES and 1.16 [1.05-1.29] for middle SES) and diagnosed T2D, compared with those with high SES. Lower SES was positively associated with the number of T2D complications (low SES vs. high SES (ref); B [95% CI]: 0.15 [0.13-0.16]). CONCLUSION Complementing the known socio-economic gradients in diagnosed T2D, we document socio-economic gradients in undiagnosed T2D and T2D complications in a single, large general representative population. Furthermore, individuals with low SES with diagnosed or undiagnosed T2D were more susceptible to T2D complications.
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Affiliation(s)
- Yinjie Zhu
- Division of Nephrology, Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Louise H Dekker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jochen O Mierau
- Department of Economics, Econometrics & Finance, Faculty of Economics and Business, University of Groningen, University Complex, 9747 AJ, Groningen, the Netherlands; Lifelines Cohort Study and Biobank, Groningen, the Netherlands; Team Strategy & External Relations, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
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Pengpid S, Peltzer K. Prevalence and factors associated with undiagnosed type 2 diabetes among adults in Iraq: analysis of cross-sectional data from the 2015 STEPS survey. BMJ Open 2022; 12:e064293. [PMID: 36418142 PMCID: PMC9684960 DOI: 10.1136/bmjopen-2022-064293] [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] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of the study was to assess the prevalence and correlates of undiagnosed type 2 diabetes (UT2D) among adults (aged 18 years and older) in Iraq. DESIGN Cross-sectional, population-based study. SETTING Nationally representative sample of general community-dwelling adult population in Iraq from the 2015 Iraq STEPS survey. PARTICIPANTS The sample included 3853 adults (mean age 41.8 years, SD=15.8), with complete fasting blood glucose values, from the 2015 Iraq STEPS survey. OUTCOME MEASURES Data collection included: (1) social and behavioural information, (2) physical parameters and blood pressure measurements and (3) biochemical measurements. UT2D was classified as not being diagnosed with T2D and fasting plasma glucose level ≥126 mg/dL. Multivariable multinomial and logistic regression was used to identify factors associated with UT2D. RESULTS The prevalence of UT2D was 8.1% and the prevalence of diagnosed T2D (DT2D) was 8.9%. Participants aged 50 years and older (adjusted relative risk ratio (ARRR): 2.11, 95% CI 1.30 to 3.43) and those with high cholesterol (ARRR: 1.54, 95% CI 1.05 to 2.24) had a higher risk of UT2D. Older age (≥50 years) (ARRR: 17.90, 95% CI 8.42 to 38.06), receipt of healthcare advice (ARRR: 2.15, 95% CI 1.56 to 2.96), history of cholesterol testing (ARRR: 2.17, 95% CI 1.58 to 2.99), stroke or heart attack (ARRR: 1.81, 95% CI 1.13 to 2.92), and high cholesterol (ARRR: 1.55, 95% CI 1.17 to 2.06) were positively associated with DT2D, and high physical activity (ARRR: 0.57, 95% CI 0.38 to 0.84) was negatively associated with DT2D. Higher than primary education (adjusted OR (AOR): 2.02, 95% CI 1.21 to 3.37) was positively associated with UT2D versus DT2D, while older age (≥50 years) (AOR: 0.12, 95% CI 0.06 to 0.25), healthcare advice (AOR: 0.45, 95% CI 0.29 to 0.70), and history of cholesterol screening (AOR: 0.37, 95% CI 0.24 to 0.58) were inversely associated with UT2D versus DT2D. CONCLUSION Almost one in ten adults in Iraq had UT2D, and various associated factors were identified that could be useful in planning interventions.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Healthcare Aministration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Prevalence and correlates of undiagnosed, diagnosed, and total type 2 diabetes among adults in Morocco, 2017. Sci Rep 2022; 12:16092. [PMID: 36168026 PMCID: PMC9515107 DOI: 10.1038/s41598-022-20368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/12/2022] [Indexed: 11/24/2022] Open
Abstract
The study aimed to estimate the prevalence and associated factors of undiagnosed type 2 diabetes (T2D) among adults in Morocco. Cross-sectional data were analyzed from 4779 people (≥ 18 years, mean age 41.7 years) who participated in the Morocco STEPS nationally representative survey in 2017 and had completed fasting blood glucose measurement. The results indicate that the prevalence of undiagnosed T2D was 5.9% (44.7% of total T2D), diagnosed T2D 7.3% and total T2D 13.2%. In the adjusted multinomial logistic regression analysis, older age (≥ 50 years), receipt of health care advice, and obesity were positively associated with undiagnosed T2D. Older age (≥ 50 years), urban residence, receipt of health care advice, ever cholesterol screening, moderate sedentary behaviour, obesity, hypertension, and elevated total cholesterol were positively associated with diagnosed T2D. In adjusted logistic regression analysis, older age (≥ 50 years), receipt of health care advice and cholesterol screening were negatively associated with undiagnosed T2D versus diagnosed T2D. A significant proportion of adults in Morocco had undiagnosed T2D and several associated factors were identified that can help guide interventions.
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Ruiz PLD, Hopstock LA, Eggen AE, Njølstad I, Grimnes G, Stene LC, Gulseth HL. Undiagnosed diabetes based on HbA 1c by socioeconomic status and healthcare consumption in the Tromsø Study 1994-2016. BMJ Open Diabetes Res Care 2021; 9:9/2/e002423. [PMID: 34782335 PMCID: PMC8593698 DOI: 10.1136/bmjdrc-2021-002423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/21/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION We aimed to investigate whether the proportion of undiagnosed diabetes varies by socioeconomic status and healthcare consumption, in a Norwegian population screened with glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS In this cohort study, we studied age-standardized diabetes prevalence using data from men and women aged 40-89 years participating in four surveys of the Tromsø Study with available data on HbA1c and self-reported diabetes: 1994-1995 (n=6720), 2001 (n=5831), 2007-2008 (n=11 987), and 2015-2016 (n=20 170). We defined undiagnosed diabetes as HbA1c ≥6.5% (48 mmol/mol) and no self-reported diabetes. We studied the association of education, income and contact with a general practitioner on undiagnosed diabetes and estimated adjusted prevalence ratio (aPR) from multivariable adjusted (age, sex, body mass index) log-binomial regression. RESULTS Higher education was associated with lower prevalence of diagnosed and undiagnosed diabetes. Those with secondary and tertiary education had lower prevalence of undiagnosed diabetes (aPR for tertiary vs primary: 0.54, 95% CI: 0.44 to 0.66). Undiagnosed as a proportion of all diabetes was also significantly lower in those with tertiary education (aPR:0.78, 95% CI: 0.65 to 0.93). Household income was also negatively associated with prevalence of undiagnosed diabetes. Across the surveys, approximately 80% of those with undiagnosed diabetes had been in contact with a general practitioner the last year, similar to those without diabetes. CONCLUSIONS Undiagnosed diabetes was lower among participants with higher education. The hypothesis that those with undiagnosed diabetes had been less in contact with a general practitioner was not supported.
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Affiliation(s)
- Paz Lopez-Doriga Ruiz
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Laila Arnesdatter Hopstock
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
- Pandemic Unit, Tromsø Municipality, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, The Artic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Lars C Stene
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Hanne L Gulseth
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Who is getting screened for diabetes according to body mass index and waist circumference categories in Peru? a pooled analysis of national surveys between 2015 and 2019. PLoS One 2021; 16:e0256809. [PMID: 34449806 PMCID: PMC8396776 DOI: 10.1371/journal.pone.0256809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At the population level we would expect that people with obesity undergo diabetes screening tests more often than people with overweight and much more often than people with normal weight. We described the trends of diabetes screening according to body mass index (BMI) and waist circumference (WC) in Peru. METHODS Pooled analysis of health national surveys (2015-2019); men and women aged 35-70 years. We used relative frequencies to study: among those who have had a glucose test in the last year, how many there were in each BMI and WC category. We fitted a Poisson model to study whether people with high BMI or WC were more likely to have had a glucose test. RESULTS People with overweight (PR = 1.34; 95% CI: 1.29-1.38), obesity (PR = 1.57; 95% CI: 1.51-1.63) and central obesity (PR = 1.63; 95% CI: 1.35-1.96) were more likely to have had a glucose test. At the sub-national level, there was one (of twenty-five) region in which men with obesity were more often screened for diabetes than men with overweight and much more than men with normal weight. There were seven regions in which women with obesity were the most often screened for diabetes. CONCLUSIONS Consistent with a risk-based prevention approach, people with obesity would be screened for diabetes more often than those with overweight and those with normal weight. This ideal profile was only observed in few regions. Diabetes screening strategies should be strengthened and homogenised, so that they reach those at high risk of diabetes.
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Sørensen AL, Hasselbalch HC, Bjørn ME, Nielsen CH, Cordua S, Skov V, Kjær L, Poulsen HE, Ellervik C. Elevated levels of oxidized nucleosides in individuals with the JAK2V617F mutation from a general population study. Redox Biol 2021; 41:101895. [PMID: 33621788 PMCID: PMC7907890 DOI: 10.1016/j.redox.2021.101895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
It is unknown if the somatic mutations in chronic myeloproliferative neoplasms (MPNs), JAK2V617F and Calreticulin, are associated with oxidative stress, or impaired mitochondrial defense against reactive oxygen species. In the Danish General Suburban Population Study (GESUS), including 116 JAK2V617F-mutated, 8 CALR-mutated, and 3310 mutation-negative participants without overt MPN, and in a study of 39 patients with myelofibrosis, the most advances type of MPNs, and 179 matched controls, we compared the urinary concentration of oxidized nucleosides – 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG) and 8-oxo-7,8-dihydroguanosine (8-oxoGuo) – as markers of oxidative stress. In GESUS, we performed Mendelian randomization analyses, using the Ala16Val single nucleotide polymorphism in the superoxide dismutase2 (SOD2) gene. In the multivariate analyses in GESUS, the 8-oxodG and 8-oxoGuo concentration were 13% (95%CI: 6–21%, p < 0.001) and 6% (95%CI: 0.4–11%, p = 0.035) higher in mutation-positive than in mutation-negative participants, respectively. Each SOD2 T allele was associated with an odds ratio of being mutation-positive of 1.69 (95%CI: 1.12–2.55, p = 0.013) through 8-oxodG. The 8-oxodG and 8-oxoGuo concentrations were 77% (95%CI: 49–110%, p < 0.001) and 105% (95%CI: 80–133%, p < 0.001) higher in myelofibrosis patients than in controls, respectively. In conclusion, an impaired mitochondrial antioxidative defense, that is causatively associated with markers of oxidative stress, may contribute to the development of mutations associated with MPNs.
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Affiliation(s)
- Anders L Sørensen
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark; Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Hans C Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Mads Emil Bjørn
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Claus H Nielsen
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Sabrina Cordua
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Vibe Skov
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Lasse Kjær
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Henrik E Poulsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Frederiksberg Hospitals, Copenhagen, Denmark
| | - Christina Ellervik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Production, Research, and Innovation, Region Zealand, Sorø, Denmark
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Du Y, Baumert J, Paprott R, Teti A, Heidemann C, Scheidt-Nave C. Factors associated with undiagnosed type 2 diabetes in Germany: results from German Health Interview and Examination Survey for Adults 2008-2011. BMJ Open Diabetes Res Care 2020; 8:e001707. [PMID: 33067247 PMCID: PMC7569997 DOI: 10.1136/bmjdrc-2020-001707] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/01/2020] [Accepted: 09/05/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION To identify characteristics of people with undiagnosed type 2 diabetes (T2D) among adults in Germany. RESEARCH DESIGN AND METHODS The study population comprised participants aged 40-79 years of the German Health Interview and Examination Survey for Adults 2008-2011. Glycemic status was categorized as undiagnosed T2D (glycated hemoglobin A1c (HbA1c) ≥48 mmol/mol (6.5%), n=135), diagnosed T2D (n=518) and normoglycemia (HbA1c<48 mmol/mol (6.5%), n=4451). Multinomial logistic regression models including glycemic status as the outcome variable and sociodemographic characteristics, living alone, diabetes risk factors and healthcare services utilization as independent variables were used to identify factors associated with undiagnosed T2D compared with normoglycemia and diagnosed T2D. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported as measure of association between the outcome and independent variables. RESULTS The prevalence of undiagnosed T2D was 2.9% (95% CI 2.2% to 3.9%) at an overall prevalence of 12.3% (11.0% to 13.6%) of persons with undiagnosed or diagnosed T2D. In multivariable analyses, factors associated with undiagnosed as well as diagnosed T2D in comparison to normoglycemia were older age (OR 1.04, 95% CI 1.01 to 1.06, per year, for undiagnosed T2D; OR 1.08, 1.07 to 1.10 for diagnosed T2D), male sex (3.33, 2.18 to 5.07; 1.91, 1.43 to 2.56), obesity (3.47, 2.17 to 5.56; 2.68, 2.04 to 3.52), hypertension (1.66, 1.09 to 2.53; 2.04, 1.42 to 2.95) and parental history of diabetes (2.04, 1.24 to 3.35; 3.16, 2.30 to 4.34). Variables independently associated with undiagnosed T2D but not diagnosed T2D included living alone (2.20; 1.36 to 3.56) and not seeing a doctor within the past year (2.57; 1.34 to 4.93). People with undiagnosed T2D were further younger and more likely to be male sex and reside in the western part of Germany than people with diagnosed T2D. CONCLUSION Apart from major known risk factors of diabetes, characteristics specific to undiagnosed diabetes among adults in Germany will serve to inform the national education and communication strategy on diabetes mellitus in Germany.
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Affiliation(s)
- Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Andrea Teti
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Institute for Gerontology, University of Vechta, Vechta, Lower Saxony, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Auvinen AM, Luiro K, Jokelainen J, Järvelä I, Knip M, Auvinen J, Tapanainen JS. Type 1 and type 2 diabetes after gestational diabetes: a 23 year cohort study. Diabetologia 2020; 63:2123-2128. [PMID: 32725280 PMCID: PMC7476985 DOI: 10.1007/s00125-020-05215-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to examine the progression to type 1 and type 2 diabetes after gestational diabetes mellitus (GDM) in a 23 year follow-up study. METHODS We carried out a cohort study of 391 women with GDM diagnosed by an OGTT or the use of insulin treatment during pregnancy, and 391 age- and parity-matched control participants, who delivered in 1984-1994 at the Oulu University Hospital, Finland. Diagnostic cut-off levels for glucose were as follows: fasting, ≥4.8 mmol/l; 1 h, ≥10.0 mmol/l; and 2 h, ≥8.7 mmol/l. Two follow-up questionnaires were sent (in 1995-1996 and 2012-2013) to assess the progression to type 1 and type 2 diabetes. Mean follow-up time was 23.1 (range 18.7-28.8) years. RESULTS Type 1 diabetes developed (5.7%) during the first 7 years after GDM pregnancy and was predictable at a 2 h OGTT value of 11.9 mmol/l during pregnancy (receiver operating characteristic analysis: AUC 0.91, sensitivity 76.5%, specificity 96.0%). Type 2 diabetes increased linearly to 50.4% by the end of the follow-up period and was moderately predictable with fasting glucose (AUC 0.69, sensitivity 63.5%, specificity 68.2%) at a level of 5.1 mmol/l (identical to the fasting glucose cut-off recommended by the International Association of Diabetes and Pregnancy Study Groups [IADPSG) and WHO]). CONCLUSIONS/INTERPRETATION All women with GDM should be intensively monitored for a decade, after which the risk for type 1 diabetes is minimal. However, the incidence of type 2 diabetes remains linear, and therefore individualised lifelong follow-up is recommended.
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Affiliation(s)
- Anna-Maaria Auvinen
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, Medical Research Centre, University of Oulu, Oulu, Finland
| | - Kaisu Luiro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO 140 (Haartmaninkatu 2E), 00029, Helsinki, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Ilkka Järvelä
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Mikael Knip
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.
- PEDEGO Research Unit, Medical Research Centre, University of Oulu, Oulu, Finland.
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO 140 (Haartmaninkatu 2E), 00029, Helsinki, Finland.
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Ezquerra-Lázaro I, Cea-Soriano L, Giraldez-García C, Ruiz A, Franch-Nadal J, Diez-Espino J, Nogales P, Carramiñana F, Javier Sangros F, Regidor E. Lifestyle factors do not explain the difference on diabetes progression according to type of prediabetes: Results from a Spanish prospective cohort of prediabetic patients. Diabetes Res Clin Pract 2019; 153:66-75. [PMID: 31152806 DOI: 10.1016/j.diabres.2019.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/29/2019] [Accepted: 05/23/2019] [Indexed: 12/19/2022]
Abstract
AIMS We studied the role of lifestyle factors associated to type 2 diabetes (T2DM) onset according to type of prediabetes. METHODS We used data from the observational prospective cohort study in Primary Health Care on the Evolution of Patients with Prediabetes in Spain (PREDAPS). Participants were classified by American Diabetes Association criteria using either fasting plasma glucose levels (100-125 mg/dL) (group 1), HbA1c (5.7%-6.4%) (group 2) or both impaired parameters (group 3). Relationship between lifestyles and diabetes onset according to prediabetes at third year of follow up were estimated by Hazard Ratios (HRs) using three sequential models. RESULTS Incidence rate of diabetes was 2.27 cases per 1000 person-years (95% CI: 1.4-3.6) for group 1, 1.18 (95% CI: 0.65-2.13) for group 2 and 6.68 (95% CI: 5.71-8.23) for group 3. The most important risk factors were: abdominal obesity (HR: 2.29 (95% CI: 1.49-3.52)) and hypertension (HR: 2.16 (95% CI: 1.41-3.30)). Using as reference group 2, group 3 had a HR of 5.82 (3.13-10.82) and 1.83 (95% CI: 0.85-3.93) for group 1, estimates remained constant when adjusting by lifestyle and metabolic factors. CONCLUSIONS Lifestyle and metabolic do not seem to explain the differences on T2DM onset by type of prediabetes.
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Affiliation(s)
- Isabel Ezquerra-Lázaro
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Spain; redGDPSFoundation, Madrid, Spain.
| | | | - Antonio Ruiz
- redGDPSFoundation, Madrid, Spain; Centro de Salud Pinto, Madrid, Spain
| | - Josep Franch-Nadal
- redGDPSFoundation, Madrid, Spain; USR Barcelona ciutat - IDIAP Jordi Gol, Barcelona, Spain; CIBER Diabetes y EnfermedadesMetabólicasAsociadas (CIBERDEM), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Javier Diez-Espino
- redGDPSFoundation, Madrid, Spain; Centro de Salud Tafalla, Navarra, Spain
| | - Pedro Nogales
- redGDPSFoundation, Madrid, Spain; Centro de Salud Las Águilas, Madrid, Spain
| | | | - F Javier Sangros
- redGDPSFoundation, Madrid, Spain; Centro de Salud Torrero-La Paz, Zaragoza, Spain
| | - Enrique Regidor
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Spain; redGDPSFoundation, Madrid, Spain; CIBER Epidemiología y SaludPública (CIBERESP), Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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11
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Sørensen AL, Hasselbalch HC, Nielsen CH, Poulsen HE, Ellervik C. Statin treatment, oxidative stress and inflammation in a Danish population. Redox Biol 2018; 21:101088. [PMID: 30594900 PMCID: PMC6307042 DOI: 10.1016/j.redox.2018.101088] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 01/14/2023] Open
Abstract
Background While statins may have anti-inflammatory effects, anti-oxidative effects are controversial. We investigated if statin treatment is associated with differences in oxidatively generated nucleotide damage and chronic inflammation, and the relationship between nucleotide damage and chronic inflammation. Methods We included 19,795 participants from the Danish General Suburban Population Study. In 3420 participants, we measured urinary 8-oxodG and 8-oxoGuo by liquid chromatography-tandem mass spectrometry as markers of oxidatively generated damage to DNA and RNA, respectively. We used a composite score for chronic inflammation (INFLA score) of hsCRP, WBC, platelet count, and neutrophil granulocyte to lymphocyte ratio. Associations were assessed using multivariate linear regression models. Results Compared with non-users, statin users had 4.3–6.0% lower 8-oxodG in three separate models (p < 0.05); there were no differences in 8-oxoGuo. Among participants aged > 60 y, statin users had 11.4% lower 8-oxodG (95%CI: 6.7–15.9%, pinteraction<0.001) and 3.9% lower 8-oxoGuo (95%CI: 0.1–7.5%, pinteraction = 0.002), compared with non-users. Compared with non-users, statin users had 11.1% (95%CI: 5.4–16.5%, pinteraction<0.001) lower 8-oxodG in participants treated for hypertension, and 18.6% (95%CI: 6.8–28.9%, pinteraction<0.001) lower 8-oxodG in participants with decreased renal function. Compared with non-users, statin users had significantly lower INFLA score (p < 0.001). 8-oxodG and 8-oxoGuo associated positively with markers of chronic inflammation. Conclusions Oxidatively generated DNA damage and inflammatory burden are lower in statin users compared with non-users. Together, anti-oxidative and anti-inflammatory effects may contribute to the beneficial effects of statins. Statin users have lower oxidatively generated DNA damage than non-users. The protective effect of statins is more pronounced in high-risk groups. Statin users have lower levels of chronic inflammation than non-users.
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Affiliation(s)
- Anders L Sørensen
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark; Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Hans C Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Claus H Nielsen
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik E Poulsen
- Department of Clinical Pharmacology, Bispebjerg Frederiksberg Hospitals, Copenhagen, Denmark
| | - Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Production, Research and Innovation, Region Zealand, Sorø, Denmark
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Maeta K, Nishiyama Y, Fujibayashi K, Gunji T, Sasabe N, Iijima K, Naito T. Prediction of Glucose Metabolism Disorder Risk Using a Machine Learning Algorithm: Pilot Study. JMIR Diabetes 2018; 3:e10212. [PMID: 30478026 PMCID: PMC6288596 DOI: 10.2196/10212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 08/16/2018] [Accepted: 10/17/2018] [Indexed: 01/10/2023] Open
Abstract
Background A 75-g oral glucose tolerance test (OGTT) provides important information about glucose metabolism, although the test is expensive and invasive. Complete OGTT information, such as 1-hour and 2-hour postloading plasma glucose and immunoreactive insulin levels, may be useful for predicting the future risk of diabetes or glucose metabolism disorders (GMD), which includes both diabetes and prediabetes. Objective We trained several classification models for predicting the risk of developing diabetes or GMD using data from thousands of OGTTs and a machine learning technique (XGBoost). The receiver operating characteristic (ROC) curves and their area under the curve (AUC) values for the trained classification models are reported, along with the sensitivity and specificity determined by the cutoff values of the Youden index. We compared the performance of the machine learning techniques with logistic regressions (LR), which are traditionally used in medical research studies. Methods Data were collected from subjects who underwent multiple OGTTs during comprehensive check-up medical examinations conducted at a single facility in Tokyo, Japan, from May 2006 to April 2017. For each examination, a subject was diagnosed with diabetes or prediabetes according to the American Diabetes Association guidelines. Given the data, 2 studies were conducted: predicting the risk of developing diabetes (study 1) or GMD (study 2). For each study, to apply supervised machine learning methods, the required label data was prepared. If a subject was diagnosed with diabetes or GMD at least once during the period, then that subject’s data obtained in previous trials were classified into the risk group (y=1). After data processing, 13,581 and 6760 OGTTs were analyzed for study 1 and study 2, respectively. For each study, a randomly chosen subset representing 80% of the data was used for training 9 classification models and the remaining 20% was used for evaluating the models. Three classification models, A to C, used XGBoost with various input variables, some including OGTT data. The other 6 classification models, D to I, used LR for comparison. Results For study 1, the AUC values ranged from 0.78 to 0.93. For study 2, the AUC values ranged from 0.63 to 0.78. The machine learning approach using XGBoost showed better performance compared with traditional LR methods. The AUC values increased when the full OGTT variables were included. In our analysis using a particular setting of input variables, XGBoost showed that the OGTT variables were more important than fasting plasma glucose or glycated hemoglobin. Conclusions A machine learning approach, XGBoost, showed better prediction accuracy compared with LR, suggesting that advanced machine learning methods are useful for detecting the early signs of diabetes or GMD. The prediction accuracy increased when all OGTT variables were added. This indicates that complete OGTT information is important for predicting the future risk of diabetes and GMD accurately.
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Affiliation(s)
- Katsutoshi Maeta
- Faculty of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Yu Nishiyama
- Faculty of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
| | - Kazutoshi Fujibayashi
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshiaki Gunji
- Center for Preventive Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Noriko Sasabe
- Center for Preventive Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kimiko Iijima
- Center for Preventive Medicine, NTT Medical Center Tokyo, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
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Heltberg A, Siersma V, Andersen JS, Ellervik C, Brønnum-Hansen H, Kragstrup J, de Fine Olivarius N. Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP). BMC Endocr Disord 2017; 17:75. [PMID: 29216868 PMCID: PMC5721594 DOI: 10.1186/s12902-017-0227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes. METHODS The Diabetes Care in General Practice (DCGP) study is a cluster-randomized trial involving a population-based sample of 1381 patients with newly diagnosed type 2-diabetes mellitus. We investigated how education, employment, cohabitation status and residence influenced the effectiveness of 6 years of intervention with structured personal diabetes care, resembling present day recommendations. Outcomes were incidence of any diabetes-related endpoint and death during 19 years after diagnosis, and cardiovascular risk factors, behaviour, attitudes and process-of-care variables 6 years after diagnosis. RESULTS Structured personal care reduced the risk of any diabetes-related endpoint and the effect of the intervention was modified by geographical area (interaction p = 0.034) with HR of 0.71 (95%CI: 0.60-0.85) and of 1.07 (95%CI: 0.77-1.48), for patients in urban and rural areas, respectively. Otherwise, there was no effect modification of education, employment and civil status on the intervention for the final endpoints. There were no noticeable socio-demographic differences in the effect of the intervention on cardiovascular risk factors, behaviour, attitudes, and process-of-care. CONCLUSION Structured personal care reduced the aggregate outcome of any diabetes-related endpoint and independent of socio-demographic factors similar effect on cardiovascular risk factors, behaviour, attitudes and process of care, but the intervention did not change the existing inequity in mortality and morbidity. Residence modified the uptake of the intervention with patients living in urban areas having more to gain of the intervention than rural patients, further investigations is warranted. TRIAL REGISTRATION ClinicalTrials.gov registration no. NCT01074762 (February 24, 2010).
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Affiliation(s)
- Andreas Heltberg
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Production, Research, and Innovation, Sorø, Region Zealand Denmark
| | - Volkert Siersma
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Sahl Andersen
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - Christina Ellervik
- Department of Production, Research, and Innovation, Sorø, Region Zealand Denmark
- Department of Laboratory Medicine, Boston Children’s Hospital Study, Boston, MA USA
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Kragstrup
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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