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Palma L, Stern D, Zamora-Muñoz S, Monge A, Gómez-Flores-Ramos L, Hernández-Ávila JE, Lajous M. Overall glycaemic index and dietary glycaemic load and all-cause and cause-specific mortality in women from the Mexican Teachers' Cohort. Br J Nutr 2024:1-10. [PMID: 39290109 DOI: 10.1017/s0007114524001569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Previous studies have found direct associations between glycaemic index (GI) and glycaemic load (GL) with chronic diseases. However, this evidence has not been consistent in relation to mortality, and most data regarding this association come from high-income and low-carbohydrate-intake populations. The aim of this study was to evaluate the association between the overall GI and dietary GL and all-cause mortality, CVD and breast cancer mortality in Mexico. Participants from the Mexican Teachers' Cohort (MTC) study in 2006-2008 were followed for a median of 10 years. Overall GI and dietary GL were calculated from a validated FFQ. Deaths were identified by the cross-linkage of MTC participants with two national mortality registries. Cox proportional hazard models were used to estimate the impact of GI and GL on mortality. We identified 1198 deaths. Comparing the lowest and highest quintile, dietary GI and GL appeared to be marginally associated with all-cause mortality; GI, 1·12 (95 % CI: 0·93, 1·35); GL, 1·12 (95 % CI: 0·87, 1·44). Higher GI and GL were associated with increased risk of CVD mortality, GI, 1·30 (95 % CI: 0·82, 2·08); GL, 1·64 (95 % CI: 0·87, 3·07) and with greater risk of breast cancer mortality; GI, 2·13 (95 % CI: 1·12, 4·06); GL, 2·43 (95 % CI: 0·90, 6·59). It is necessary to continue the improvement of carbohydrate quality indicators to better guide consumer choices and to lead the Mexican population to limit excessive intake of low-quality carbohydrate foods.
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Affiliation(s)
- Leticia Palma
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Dalia Stern
- CONAHCYT - Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Salvador Zamora-Muñoz
- Institute for Research in Applied Mathematics and Systems, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Adriana Monge
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Liliana Gómez-Flores-Ramos
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
- CONAHCYT - Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Juan E Hernández-Ávila
- Center for Research on Evaluation and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Gomez-Figueroa E, Ruiz-Sandoval JL, De Alba-Sánchez AM, Cárdenas-Sáenz O, Zúñiga-Ramírez C, Amavisca-Espinosa R, Macías-Ortiz F, Jímenez-Ruiz A. Contribution of Stroke to Long-Term All-Cause and Cause-Specific Mortality in Mexico City. Neurology 2024; 103:e209778. [PMID: 39151103 DOI: 10.1212/wnl.0000000000209778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke mortality is more common in low-income and middle-income nations such as Mexico. Prognosis data typically rely on short-term hospital follow-ups, revealing high mortality rates due to systemic complications and early recurrence. We aim to explore stroke's long-term impact by examining all-cause and cause-specific mortality. METHODS We analyzed data from the Mexico City Prospective Study (1998-2004) with known mortality outcomes until December 2022. Baseline variables were compared between participants who had stroke and nonstroke participants. Cox proportional hazard regression assessed each variable's contribution to overall mortality. Subsequent analysis within the stroke subgroup aimed to identify unique risk factors of mortality, using Cox regression models adjusted for age, sex, and time since stroke. RESULTS Among 145,537 eligible participants, 1,492 (1.0%) had a history of stroke. Participants who had stroke were older (57.58 vs 50.16, p < 0.001); had lower mean weekly income ($108.24 vs $176.14, p < 0.001); had higher alcohol intake and smoking frequency; and had more frequent comorbidities such as hypertension (48.9 vs 19.3%, p < 0.001), diabetes (23.4 vs 12.9%, p < 0.001), and ischemic heart disease (5.4 vs 1.0%, p < 0.001). They had a significantly increased risk of death from any cause (hazard ratio [HR] 2.59, 95% CI 2.37-2.83, p < 0.001). Deceased participants with stroke were more likely to be male, with a higher prevalence of diabetes, hypertension, and abnormal waist-hip index. Stroke increased the risk of death from cardiac (HR 3.56, 95% CI 3.02-4.19, p < 0.001), renal (HR 2.05, 95% CI 1.58-2.66, p < 0.001), and pulmonary (HR 2.29, 95% CI 1.79-2.92, p < 0.001) causes. DISCUSSION This study confirms stroke's association with higher mortality rates, especially from cardiac, renal, and pulmonary causes in Mexico. It underscores the elevated prevalence of cardiovascular comorbidities and adverse socioeconomic profiles among participants who had stroke and those who died with a history of stroke.
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Affiliation(s)
- Enrique Gomez-Figueroa
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - José Luis Ruiz-Sandoval
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | | | - Omar Cárdenas-Sáenz
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - Carlos Zúñiga-Ramírez
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - Raúl Amavisca-Espinosa
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - Fátima Macías-Ortiz
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - Amado Jímenez-Ruiz
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
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Ramírez-García D, Fermín-Martínez CA, Sánchez-Castro P, Núñez-Luna A, Basile-Alvarez MR, Fernández-Chirino L, Vargas-Vázquez A, Díaz-Sánchez JP, Kammar-García A, Almeda-Valdés P, Berumen-Campos J, Kuri-Morales P, Tapia-Conyer R, Alegre-Díaz J, Seiglie JA, Antonio-Villa NE, Bello-Chavolla OY. Smoking, all-cause, and cause-specific mortality in individuals with diabetes in Mexico: an analysis of the Mexico city prospective study. BMC Public Health 2024; 24:2383. [PMID: 39223469 PMCID: PMC11370065 DOI: 10.1186/s12889-024-19536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE Evidence from low- and middle-income countries regarding the effect of smoking in people with diabetes is lacking. Here, we report the association of smoking with mortality in a large cohort of Mexican adults with diabetes. METHODS Participants with diabetes mellitus (self-reported diagnosis, use of antidiabetic medications or HbA1c ≥ 6.5%) aged 35-74 years when recruited into the Mexico City Prospective Study were included. Cox regression confounder-adjusted mortality rate ratios (RRs) associated with baseline smoking status were estimated. RESULTS Among 15,975 women and 8225 men aged 35-74 years with diabetes but no other comorbidities at recruitment, 2498 (16%) women and 2875 (35%) men reported former smoking and 2753 (17%) women, and 3796 (46%) men reported current smoking. During a median of 17 years of follow-up there were 5087 deaths at ages 35-74 years. Compared with never smoking, all-cause mortality RR was 1.08 (95%CI 1.01-1.17) for former smoking, 1.11 (95%CI 1.03-1.20) for current smoking, 1.09 (95%CI 0.99-1.20) for non-daily smoking, 1.06 (95%CI 0.96-1.16) for smoking < 10 cigarettes/day (median during follow-up 4 cigarettes/day), and 1.28 (95% CI 1.14-1.43) for smoking ≥ 10 cigarettes/day (median during follow-up 15 cigarettes/day). Mortality risk among daily smokers was greatest for COPD, lung cancer, cardiovascular diseases, and acute diabetic complications. CONCLUSION In this cohort of Mexican adults with diabetes, low-intensity daily smoking was associated with increased mortality, despite observing smoking patterns which are different from other populations, and over 5% of total deaths were associated with smoking.
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Affiliation(s)
- Daniel Ramírez-García
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A Fermín-Martínez
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico
- (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Paulina Sánchez-Castro
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandra Núñez-Luna
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Martín Roberto Basile-Alvarez
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luisa Fernández-Chirino
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico
| | | | - Juan Pablo Díaz-Sánchez
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico
- (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ashuin Kammar-García
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico
| | - Paloma Almeda-Valdés
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jaime Berumen-Campos
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Pablo Kuri-Morales
- Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Roberto Tapia-Conyer
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jesus Alegre-Díaz
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Omar Yaxmehen Bello-Chavolla
- Division of Research, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, Mexico City, 10200, Mexico.
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Silverman-Retana O, Brinks R, Hoyer A, Witte DR, Tönnies T. Using the illness-death model to estimate age- and sex-standardized incidence rates of diabetes in Mexico from 2003 to 2015. BMC Public Health 2024; 24:1882. [PMID: 39010051 PMCID: PMC11247887 DOI: 10.1186/s12889-024-19281-4] [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: 02/05/2024] [Accepted: 06/26/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND We aimed to estimate the age-specific and age-standardized incidence rate of diabetes for men and women in Mexico between 2003 and 2015, and to assess the relative change in incidence of diabetes between 2003 and 2015. METHODS We use a partial differential equation describing the illness-death model to estimate the incidence rate (IR) of diabetes for the years 2003, 2009 and 2015 based on prevalence data from National Health Surveys conducted in Mexico, the mortality rate of the Mexican general population and plausible input values for age-specific mortality rate ratios associated with diabetes. RESULTS The age-standardized IR of diabetes per 1000 person years (pryr) was similar among men (IRm) and women (IRw) in the year 2003 (IRm 6.1 vs. IRw 6.5 1000/pryr), 2009 (IRm: 7.0 vs. IRw: 8.4 1000/pryr), and in 2015 (IRm 8.0 vs. IRw 10.6 1000/pryr). The highest incident rates were observed among men and women in the 60-69 age group. CONCLUSIONS Overall, the incidence rate of diabetes in Mexico between the years 2003 and 2015 remained stable. However, rates were markedly higher among women in the age group 40-49 and 50-59 in the year 2015 compared with rates in 2003.
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Affiliation(s)
- Omar Silverman-Retana
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich-Heine-University Duesseldorf, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- Chair for Medical Biometry and Epidemiology, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich-Heine-University Duesseldorf, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
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Itoh K, Kuwata A, Tsutani H, Mitsuke Y, Iwasaki H. Polymicrobial bloodstream infection involving Oligella urethralis and Trueperella bernardiae: a case report and literature review. Int J Infect Dis 2024; 147:107175. [PMID: 39009112 DOI: 10.1016/j.ijid.2024.107175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/17/2024] Open
Abstract
Oligella urethralis and Trueperella bernardiae are rare causes of bacteremia. A 96-year-old female nursing home resident with diabetes presented with polymicrobial bloodstream infection comprising these organisms and obstructive urinary tract infection. O. urethralis identified from blood cultures was resistant to fluoroquinolones and non-fourth-generation cephalosporins. Cases must be accumulated to define the clinical features of these organisms for infection control.
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Affiliation(s)
- Kazuhiro Itoh
- Department of Internal Medicine, NHO Awara National Hospital, Awara, Fukui, Japan; Division of Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan.
| | - Atsushi Kuwata
- Department of Internal Medicine, NHO Awara National Hospital, Awara, Fukui, Japan
| | - Hiroshi Tsutani
- Department of Internal Medicine, NHO Awara National Hospital, Awara, Fukui, Japan
| | - Yasuhiko Mitsuke
- Department of Internal Medicine, NHO Awara National Hospital, Awara, Fukui, Japan
| | - Hiromichi Iwasaki
- Division of Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
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Oguntade AS, Taylor H, Lacey B, Lewington S. Adiposity, fat-free mass and incident heart failure in 500 000 individuals. Open Heart 2024; 11:e002711. [PMID: 38964877 PMCID: PMC11227841 DOI: 10.1136/openhrt-2024-002711] [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: 04/14/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND AND AIMS The independent role of body fat distribution and fat-free mass in heart failure (HF) risk is unclear. We investigated the role of different body composition compartments in risk of HF. METHODS Present analyses include 428 087 participants (mean age 55.9 years, 44% male) from the UK Biobank. Associations of long-term average levels of body composition measures with incident HF were determined using adjusted Cox proportional hazards regression models. RESULTS Over a median follow-up of 13.8 years, there were 10 455 first-ever incident HF events. Overall, HF risk was more strongly associated with central adiposity (waist circumference (WC) adjusted for body mass index (BMI); HR 1.38, 95% CI 1.32 to 1.45) than general adiposity (BMI adjusted for WC; HR 1.22, 95% CI 1.16 to 1.27). Although dual X-ray absorptiometry-derived body fat remained positively related to HF after adjustment for fat-free mass (HR 1.37, 95% CI 1.18 to 1.59), the association of fat-free mass with HF was substantially attenuated by fat mass (HR 1.12, 95% CI 1.01 to 1.26) while visceral fat (VAT) remained associated with HF independent of subcutaneous fat (HR 1.20, 95% CI 1.09 to 1.33). In analyses of HF subtypes, HF with preserved ejection fraction was independently associated with all fat measures (eg, VAT: HR 1.23, 95% CI 1.12 to 1.35; body fat: HR 1.36, 95% CI 1.17 to 1.57) while HF with reduced ejection fraction was not independently associated with fat measures (eg, VAT: HR 1.29, 95% CI 0.98 to 1.68; body fat: HR 1.29, 95% CI 0.80 to 2.07). CONCLUSIONS This large-scale study shows that excess adiposity and fat mass are associated with higher HF risk while the association of fat-free mass with HF could be explained largely by its correlation with fat mass. The study also describes the independent relevance of body fat distribution to HF subtypes, suggesting different mechanisms may be driving their aetiopathogenesis.
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Affiliation(s)
- Ayodipupo S Oguntade
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Cardiology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Hannah Taylor
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ben Lacey
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank, Stockport, UK
| | - Sarah Lewington
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
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Petermann-Rocha F, Apolinar E, Nazar G, Diaz-Toro F, Celis A, Deo S, Ferrari G, O'Donovan G. Associations of diabesity with all-cause and cardiovascular disease mortality: Findings from the Mexico City Prospective Study. Diabetes Obes Metab 2024; 26:2199-2208. [PMID: 38439662 DOI: 10.1111/dom.15528] [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: 01/23/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
AIM To investigate the joint associations of diabetes and obesity with all-cause and cardiovascular disease (CVD) mortality in the Mexico City Prospective Study. MATERIALS AND METHODS In total, 154 128 participants (67.2% women) were included in this prospective analysis. Diabetes was self-reported, while body mass index was used to calculate obesity. Using diabetes and obesity classifications, six groups were created: (a) normal (no diabetes and normal weight); (b) normal weight and diabetes; (c) overweight but not diabetes (overweight); (d) overweight and diabetes (prediabesity); (e) obesity but not diabetes (obesity); and (f) obesity and diabetes (diabesity). Associations between these categories and outcomes were investigated using Cox proportional hazard models adjusted for confounder factors. RESULTS During 18.3 years of follow-up, 27 197 (17.6%) participants died (28.5% because of CV causes). In the maximally adjusted model, participants those with the highest risk {hazard ratio (HR): 2.37 [95% confidence interval (CI): 2.24-2.51]}, followed by those with diabesity [HR: 2.04 (95% CI: 1.94-2.15)]. Similar trends of associations were observed for CVD mortality. The highest CV mortality risk was observed in individuals with diabesity [HR: 1.80 (95% CI: 1.63-1.99)], followed by normal weight and diabetic individuals [HR: 1.78 (95% CI: 1.60-1.98)]. CONCLUSION This large prospective study identified that diabetes was the main driver of all-cause and CVD mortality in all the categories studied, with diabesity being the riskiest. Given the high prevalence of both conditions in Mexico, our results reinforce the importance of initiating prevention strategies from an early age.
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Affiliation(s)
- Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Evelia Apolinar
- Unidad de Metabolismo y Nutrición, Departamento de Investigación, Hospital Regional de Alta Especialidad del Bajío, Secretaría de Salud, León, Mexico
| | - Gabriela Nazar
- Departamento de Psicología, Universidad de Concepción, Concepción, Chile
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
| | - Felipe Diaz-Toro
- Facultad de Enfermeria, Universidad Andrés Bello, Santiago, Chile
| | - Andrés Celis
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
| | - Salil Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Case School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gerson Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - Gary O'Donovan
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
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8
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Ferrari G, de Maio Nascimento M, Petermann-Rocha F, Rezende LFM, O'Donovan G, Gouveia ÉR, Cristi-Montero C, Marques A. Lifestyle risk factors and all-cause and cause-specific mortality in the Mexico City prospective study: Assessing the influence of reverse causation. J Affect Disord 2024; 352:517-524. [PMID: 38408614 DOI: 10.1016/j.jad.2024.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND We examined the association between individual lifestyle risk factors with all-cause and cause-specific mortality. METHODS Prospective cohort study including 155,002 participants from the Mexico City Prospective Study. Cox regression models were used to estimate the association between individual lifestyle risk factors and all-cause and cause-specific mortality. Participants with prevalent diseases at baseline and participants who died during the first 2, 5, 10, and 15 years of follow-up were excluded to account for reverse causation. RESULTS 27,469 people died during 18.3 years of follow-up years. Overweight and moderate alcohol consumption were inversely associated with all-cause mortality, while low physical activity and smoking were positively associated when all participants were included, regardless of prevalent disease or duration of follow-up. The direction of the association of overweight with all-cause mortality changed from inverse to positive after excluding the first 10 years of follow-up. Compared with normal weight, the hazard ratio (95 % confidence interval) was 1.17 (1.13,1.22) for obesity after excluding those who died in the first 5 years of follow-up and 1.71 (1.59,1.84) after excluding the first 15 years of follow-up. The magnitude of the association of alcohol intake, low physical activity, and smoking with mortality attenuated, whereas for fruits and vegetables increased, after excluding longer periods of follow-up. LIMITATIONS The data were collected exclusively in Mexico City; lifestyle risk factors were self-reported and thus prone to misclassification bias. CONCLUSIONS Reverse causation may influence both the magnitude and the direction of the associations between lifestyle risk factors and mortality.
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Affiliation(s)
- Gerson Ferrari
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia, Chile; Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile.
| | | | - Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Leandro F M Rezende
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gary O'Donovan
- Instituto Masira, Universidad de Santander, Bucaramanga, Colombia; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Élvio R Gouveia
- Department of Physical Education and Sport, University of Madeira, Funchal, Portugal; Laboratory of Robotics and Engineering Systems (LARSYS), Interactive Technologies Institute, Funchal, Portugal
| | - Carlos Cristi-Montero
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal; Faculdade de Medicina, ISAMB, Universidade de Lisboa, Lisbon, Portugal
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Ahmed YH, Elbadawi HS, Sultan I, Mohammed RA, Aljedaani H, Abozeid HE, Badawy M. Implementation and Outcomes of Multidisciplinary Diabetes Management Program Among Type 2 Diabetic Patients: A Comparative Study. Cureus 2024; 16:e60979. [PMID: 38910761 PMCID: PMC11193887 DOI: 10.7759/cureus.60979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Current guidelines recommend shifting physician-led care (PLC) for type 2 diabetes mellitus (T2DM) to more effective multidisciplinary health care (MHC). However, few researchers have studied its real-life implementation in Saudi Arabia. Therefore, we aimed to assess the implementation and compare the outcomes of an MDC diabetes management program (DMP) among T2DM patients to a PLC at a general hospital after one year of follow-up in a real-world practice setting. METHODS We conducted this comparative patient files review study by analyzing medical records of all T2DM patients at two private care centers. Both were compared for their effectiveness in achieving two outcomes: the glycated hemoglobin (HbA1c) <7% and low-density lipoprotein-cholesterol (LDL-c) <70 mg/dl at the end of the first year. Additionally, we assessed the implementation of the DMP. RESULTS Eight hundred thirty-four medical records were reviewed, 537 from DMP, and 279 from the PLC center. The personal health coordination was almost complete (97.8%) in the DMP, but the implementation was incomplete regarding nutrition (65.7%), dental exam (64.8%), and foot care (58.3%). Both care groups were matched for age (p = 0.056), gender (p = 0.085), duration of diabetes (p = 0.217), and basal glycemic control (p = 0.171). The DMP showed a significant net decrease in HbA1c (-0.5 [IQR 1.47%] vs -0.2 [IQR 3.05%], p = 0.0001) and LDL-c (-10 [IQR 50] vs -5 [IQR 60.5] mg/dl, p = 0.004) compared to PLC. A higher percentage of patients achieved glycemic control in the DMP than in the PLC (49.4% vs 38.7%, p = 0.038). However, both programs demonstrated similar outcomes in lipid control (28.7% vs. 30%, p = 0.695). CONCLUSION Despite some gaps in implementation, one year of DMP showed better glycemic control among T2DM patients compared to PLC. Both programs were comparable in terms of lipid control. Further studies identifying the gaps in care implementation could improve sustainability, future replication, and generalizability of similar programs to other healthcare systems in Saudi Arabia.
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Affiliation(s)
- Youssef H Ahmed
- Department of Health Sciences, Syreon Middle East LLC, Alexandria, EGY
| | | | - Intessar Sultan
- Department of Internal Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Rehab A Mohammed
- Department of Internal Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
- Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
| | - Huda Aljedaani
- Department of Obstetrics and Gynecology, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Hanaa E Abozeid
- Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
| | - Mayar Badawy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, EGY
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Fermín-Martínez CA, Bello-Chavolla OY, Paz-Cabrera CD, Ramírez-García D, Perezalonso-Espinosa J, Fernández-Chirino L, Vargas-Vázquez A, Díaz-Sánchez JP, Méndez-Labra PN, Núñez-Luna A, Basile-Alvarez MR, Sánchez-Castro P, Bragg F, Friedrichs LG, Aguilar-Ramírez D, Emberson JR, Berumen-Campos J, Kuri-Morales P, Tapia-Conyer R, Alegre-Díaz J, Seiglie JA, Antonio-Villa NE. Prediabetes as a risk factor for all-cause and cause-specific mortality: a prospective analysis of 115,919 adults without diabetes in Mexico City. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.15.24305840. [PMID: 38699295 PMCID: PMC11065040 DOI: 10.1101/2024.04.15.24305840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND Prediabetes has been associated with increased all-cause and cardiovascular mortality. However, no large-scale studies have been conducted in Mexico or Latin America examining these associations. METHODS We analyzed data from 115,919 adults without diabetes (diagnosed or undiagnosed) aged 35-84 years who participated in the Mexico City Prospective Study between 1998 and 2004. Participants were followed until January 1 st , 2021 for cause-specific mortality. We defined prediabetes according to the American Diabetes Association (ADA, HbA 1c 5.7% to 6.4%) and the International Expert Committee (IEC, HbA 1c 6.0-6.4%) definitions. Cox regression adjusted for confounders was used to estimate all-cause and cause-specific mortality rate ratios (RR) at ages 35-74 years associated with prediabetes. FINDINGS During 2,085,392 person-years of follow-up (median in survivors 19 years), there were 6,810 deaths at ages 35-74, including 1,742 from cardiovascular disease, 892 from renal disease and 108 from acute diabetic crises. Of 110,405 participants aged 35-74 years at recruitment, 28,852 (26%) had ADA-defined prediabetes and 7,203 (7%) had IEC-defined prediabetes. Compared with those without prediabetes, individuals with prediabetes had higher risk of all-cause mortality at ages 35-74 years (RR 1.13, 95% CI 1.07-1.19 for ADA-defined prediabetes and RR 1.28, 1.18-1.39 for IEC-defined prediabetes), as well as increased risk of cardiovascular mortality (RR 1.22 [1.10-1.35] and 1.42 [1.22-1.65], respectively), renal mortality (RR 1.35 [1.08-1.68] and 1.69 [1.24-2.31], respectively), and death from an acute diabetic crisis (RR 2.63 [1.76-3.94] and 3.43 [2.09-5.62], respectively). RRs were larger at younger than at older ages, and similar for men compared to women. The absolute excess risk associated with ADA and IEC-defined prediabetes at ages 35-74 accounted for6% and 3% of cardiovascular deaths respectively, 10% and 5% of renal deaths respectively, and 31% and 14% of acute diabetic deaths respectively. INTERPRETATION Prediabetes is a significant risk factor for all-cause, cardiovascular, renal, and acute diabetic deaths in Mexican adults. Identification and timely management of individuals with prediabetes for targeted risk reduction could contribute to reducing premature mortality from cardiometabolic causes in this population. FUNDING Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, UK Medical Research Council. Instituto Nacional de Geriatría (Mexico City). RESEARCH IN CONTEXT Evidence before this study: We conducted a literature search in PubMed to identify articles published in English before February 27 th , 2024 that reported on prospective studies examining the association between prediabetes with all-cause or cause-specific mortality or progression to diabetes in a Mexican or Latin American population, using the terms ("prediabetes" OR "impaired fasting glucose" OR "impaired glucose tolerance") AND ("mortality" OR "death") AND ("Mexico" OR "Mexican" OR "Latin America" OR "Latin American"). There were no studies examining risk associated with prediabetes definitions and mortality among adults in Mexico. We identified one study from Peru that included 988 participants and investigated only all-cause mortality for impaired fasting glucose and HbA 1c -based definitions of prediabetes from ADA and IEC; this study reported increased mortality risk related to ADA-defined prediabetes based on HbA 1c measures. Generalizability of these findings to other Latin American countries and regions with distinct cardiometabolic profiles in unclear. Added value of this study: Our study included 115,919 participants without diabetes from Mexico City, of whom (26%) had ADA-defined prediabetes and 7,203 (7%) had IEC-defined prediabetes. We found that prediabetes is associated with higher risks of all-cause and cause-specific mortality (cardiovascular, renal, and acute diabetic causes) than among participants without prediabetes. We found RRs to be larger at younger than at older ages, and largely similar for men compared to women. Among those without previously diagnosed diabetes, we found that the excess risk associated with ADA- and IEC-defined prediabetes at ages 35-74 years accounted for 6% and 3% of cardiovascular deaths, 10% and 5% of renal deaths, and 31% and 14% of acute diabetic deaths, respectively. .Implications of all the available evidence: Our results show that prediabetes is a significant risk factor for cardiovascular, kidney, and acute diabetic deaths among Mexican adults and accounts for a notable fraction of such deaths. Identification of individuals with prediabetes should be prioritized for optimized management to improve cardiometabolic outcomes in Mexican adults.
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Alcalde-Ortiz ML, Jaramillo-Arriaga F, Ibarra-Orenday D, González-Domínguez SI, Calzada-Gallegos HD, Pinales-Jiménez AA, Carrillo-Aguilera IA, Flota-Marin DA, Collazo-Zamores MG, Aguirre-Moreno PD, Gutiérrez-Hernández SD, Del Toro-Delgado V, Delgadillo-Castañeda R, Sánchez-Ortiz MDR, Sánchez-González I, Ramos-Medellin CL, Chew-Wong A, Macias-Díaz DM, Arreola-Guerra JM. Pediatric kidney dimensions and risk of persistent albuminuria in Mexican adolescents. Kidney Int 2024; 105:824-834. [PMID: 38280517 DOI: 10.1016/j.kint.2023.11.034] [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: 08/13/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 01/29/2024]
Abstract
In Mexico, chronic kidney disease of unknown origin is highly prevalent. Screening studies in adolescents have shown persistent microalbuminuria (pACR), adaptive podocytopathy and decreased kidney volume (KV). Here, we sought to develop normality tables of kidney dimensions by ultrasound in the Mexican state of Aguascalientes pediatric population (0 to 18y) and evaluate the relationship between the KV and pACR among the region's adolescents in a cross-sectional study. Kidney length (KL) and KV were determined by ultrasound. Our findings were compared with those in international literature of different populations where tables and graphs of normal kidney dimensions by ultrasound were reported. We compared organ dimensions in individuals above the age of 11 without albuminuria with those in patients with pACR recruited through screening studies in adolescents in Aguascalientes. This included 1068 individuals to construct percentile tables and graphs of the KL. Kidney dimensions were significantly lower when compared with all international comparisons. From a total 14,805 screen individuals, we compared 218 adolescents with pACR and 377 individuals without significant albuminuria. The Total KV adjusted to body surface (TKVBS) was significantly associated with pACR (odds ratio 1.03, 95% confidence interval 1.02-1.03). The upper quartile of TKVBS was highly associated with pACR (7.57, 4.13-13.87), hypertension (2.53, 1.66-3.86), and hyperfiltration (26 vs 11.5%). Thus, TKVBS is directly associated with pACR while greater KV, arterial hypertension, and hyperfiltration in patients with pACR suggest that the increase in volume is secondary to kidney hypertrophy. Additionally, the adaptative podocytopathy with low fibrosis seen on kidney biopsy which was performed in a subset of patients, and the smaller kidney dimensions in our population point to prenatal oligonephronia as the primary cause of the detected kidney disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Chew-Wong
- Department of Nephrology, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico
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12
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Sattar N, Presslie C, Rutter MK, McGuire DK. Cardiovascular and Kidney Risks in Individuals With Type 2 Diabetes: Contemporary Understanding With Greater Emphasis on Excess Adiposity. Diabetes Care 2024; 47:531-543. [PMID: 38412040 DOI: 10.2337/dci23-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 02/29/2024]
Abstract
In high-income countries, rates of atherosclerotic complications in type 2 diabetes have declined markedly over time due to better management of traditional risk factors including lipids, blood pressure, and glycemia levels. Population-wide reductions in smoking have also helped lower atherosclerotic complications and so reduce premature mortality in type 2 diabetes. However, as excess adiposity is a stronger driver for heart failure (HF), and obesity levels have remained largely unchanged, HF risks have not declined as much and may even be rising in the increasing number of people developing type 2 diabetes at younger ages. Excess weight is also an underrecognized risk factor for chronic kidney disease (CKD). Based on evidence from a range of sources, we explain how excess adiposity must be influencing most risks well before diabetes develops, particularly in younger-onset diabetes, which is linked to greater excess adiposity. We also review potential mechanisms linking excess adiposity to HF and CKD and speculate on how some of the responsible pathways-e.g., hemodynamic, cellular overnutrition, and inflammatory-could be favorably influenced by intentional weight loss (via lifestyle or drugs). On the basis of available evidence, we suggest that the cardiorenal outcome benefits seen with sodium-glucose cotransporter 2 inhibitors may partially derive from their interference of some of these same pathways. We also note that many other complications common in diabetes (e.g., hepatic, joint disease, perhaps mental health) are also variably linked to excess adiposity, the aggregated exposure to which has now increased in type 2 diabetes. All such observations suggest a greater need to tackle excess adiposity earlier in type 2 diabetes.
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Affiliation(s)
- Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - Calum Presslie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, U.K
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center and Parkland Health, Dallas, TX
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O'Donovan G, Petermann-Rocha F, Ferrari G, Lee IM, Hamer M, Stamatakis E, Sarmiento OL, Ibáñez A, Lopez-Jaramillo P. Associations of the 'weekend warrior' physical activity pattern with all-cause, cardiovascular disease and cancer mortality: the Mexico City Prospective Study. Br J Sports Med 2024; 58:359-365. [PMID: 38302280 DOI: 10.1136/bjsports-2023-107612] [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] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES The objective was to investigate the benefits of the 'weekend warrior' physical activity pattern in Latin America, where many people take part in high levels of non-exercise physical activity. METHODS Participants in the Mexico City Prospective Study were surveyed from 1998 to 2004 and resurveyed from 2015 to 2019. Those who exercised up to once or twice per week were termed weekend warriors. Those who exercised more often were termed regularly active. Analyses were adjusted for potential confounders. RESULTS The main analysis included 26 006 deaths in 154 882 adults (67% female) aged 52±13 years followed for 18±4 years (mean±SD). Compared with those who reported no exercise, the HR (95% CI) was 0.88 (0.83 to 0.93) in the weekend warriors and 0.88 (0.84 to 0.91) in the regularly active. Similar results were observed for cardiovascular disease and cancer mortality, but associations were weaker. Stratified analyses showed that substantial reductions in all-cause mortality risk only occurred when the duration of exercise sessions was at least 30-60 min. The repeated-measures analysis included 843 deaths in 10 023 adults followed for 20±2 years. Compared with being inactive or becoming inactive, the HR was 0.86 (95% CI 0.65 to 1.12) when being a weekend warrior or becoming a weekend warrior and 0.85 (95% CI 0.70 to 1.03) when being regularly active or becoming regularly active. CONCLUSIONS This is the first prospective study to investigate the benefits of the weekend warrior physical activity pattern in Latin America. The results suggest that even busy adults could benefit from taking part in one or two sessions of exercise per week.
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Affiliation(s)
- Gary O'Donovan
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Instituto Masira, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Gerson Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago, Chile
- Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - I-Min Lee
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Hamer
- Institute Sport Exercise Health, Division Surgery Interventional Science, University College London, London, UK
| | - Emmanuel Stamatakis
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Olga L Sarmiento
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
- Cognitive Neuroscience Center (CNC) and CONICET, Universidad de San Andrés, Buenos Aires, Argentina
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Rojas-Martínez R, Escamilla-Nuñez C, Aguilar-Salinas CA, Castro-Porras L, Romero-Martínez M, Lazcano-Ponce E. Trends in the mortality of diabetes in Mexico from 1998 to 2022: a joinpoint regression and age-period-cohort effect analysis. Public Health 2024; 226:128-137. [PMID: 38056400 DOI: 10.1016/j.puhe.2023.10.038] [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: 05/17/2023] [Revised: 10/04/2023] [Accepted: 10/22/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. STUDY DESIGN Joinpoint regression and age-period-cohort effect analysis. METHODS Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. RESULTS From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). CONCLUSION The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.
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Affiliation(s)
- R Rojas-Martínez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - C Escamilla-Nuñez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - C A Aguilar-Salinas
- Direction of Investigation, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - L Castro-Porras
- Policies, Population and Health Research Center, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - M Romero-Martínez
- Center for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - E Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Dávila-Cervantes CA. The burden of type 2 diabetes in adolescents and young adults in Mexico: analysis from the Global Burden of Disease Study, 1990 to 2019. J Diabetes Metab Disord 2023; 22:1673-1684. [PMID: 37975094 PMCID: PMC10638125 DOI: 10.1007/s40200-023-01299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/03/2023] [Indexed: 11/19/2023]
Abstract
Purpose The aim was to analyze the findings from the 2019 Global Burden of Disease (GBD-2019) study on type-2 diabetes in Mexico's adolescents and young adults, at a national and subnational scale from 1990 to 2019, and to assess its association with the socio-demographic, and the healthcare access and quality indices. Methods Following the GBD-2019 study, young-onset type 2 diabetes mortality, premature mortality, years lived with disability and disability-adjusted life-years (DALYs) are reported. Results A significant increase in the overall number of deaths attributed to young-onset T2D was found. There was a non-significant decrease in mortality rates for both sexes across most age groups. DALYs in men were greater than that in women, with almost half attributed to premature death in males, while disability accounted for two thirds of DALYs in females. The DALY rate increased significantly in most states. Premature mortality decreased, while disability increased across all age-groups, and in all states for both sexes. Conclusion The surge in disability corresponded to the upsurge in obesity and overweight rates in Mexico among the younger population. This happened despite improvements in socio-economic status and healthcare access in Mexico which underscores the need for diabetes education in the public health sector.
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Affiliation(s)
- Claudio Alberto Dávila-Cervantes
- Latin American Faculty of Social Sciences (FLACSO-Mexico), Carretera al Ajusco 377, Colonia Héroes de Padierna Tlalpan, C.P. 14200 Ciudad de México, México
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Ortega-Montiel J, Montoya A, Soria-Saucedo R, Gallegos-Carrillo K, Ramírez-Palacios P, Salmerón J, Salazar-Martínez E. Trends of Antihypertensive, Antidiabetic, and Nonsteroidal Anti-Inflammatory Drugs Use among the Health Workers Cohort Study, Mexico 2004 to 2018. Adv Pharmacol Pharm Sci 2023; 2023:5555274. [PMID: 38035129 PMCID: PMC10684324 DOI: 10.1155/2023/5555274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
Background Hypertension and type 2 diabetes (T2D) are the most prevalent noncommunicable diseases in Mexico and worldwide. According to international practice management guidelines, the principal chronic management therapy is daily oral medication. Aim We aim to describe the trends of antihypertensive, antidiabetic, and nonsteroidal anti-inflammatory (NSAID) drugs use among the Mexican adult population from 2004-2018. Methods We analyzed data from the Health Workers Cohort Study (HWCS) for males and females aged >18 years. We calculated the prevalence of chronic diseases and utilization for every kind of antihypertensive, antidiabetic, and NSAIDs (measured by self-reported utilization) at baseline and two follow-ups (2004, 2010, and 2017). Trends were analyzed using Fisher's exact test. Results Hypertension prevalence increased from 19.8 to 30.3%, higher than T2D prevalence from 7.0 to 12.8% through fourteen years of follow-up. Like the self-reported dual therapy, the proportion of patients using beta-blockers and angiotensin II receptor blockers increased. Regarding T2D, the prevalence of metformin utilization increased to 83.9%. The utilization of common NSAIDs, mainly for muscular pain, remained around 13 to 16%. Conclusions Our findings showed a changing prevalence of drug utilization for hypertension and T2D between 2004 and 2018 and consistent use of NSAIDs in the adult Mexican population.
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Affiliation(s)
- Janinne Ortega-Montiel
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - Katia Gallegos-Carrillo
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Paula Ramírez-Palacios
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Jorge Salmerón
- Research Centre in Policy, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Lim LL, Abdul Aziz A, Dakin H, Buckell J, Woon YL, Roope L, Chandran A, Mustapha FI, Gregg EW, Clarke PM. Trends in all-cause mortality among adults with diagnosed type 2 diabetes in West Malaysia: 2010 - 2019. Diabetes Res Clin Pract 2023; 205:110944. [PMID: 37804999 PMCID: PMC10701628 DOI: 10.1016/j.diabres.2023.110944] [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: 07/24/2023] [Revised: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
AIMS We determined 10-year all-cause mortality trends in diagnosed type 2 diabetes (T2D) population in West Malaysia, a middle-income country in the Western-Pacific region. METHODS One million T2D people aged 40-79 registered in the National Diabetes Registry (2009-2018) were linked to death records (censored on 31 December 2019). Standardized absolute mortality rates and standardized mortality ratios (SMRs) were estimated relative to the Malaysian general population, and standardized to the 2019 registry population with respect to sex, age group, and disease duration. RESULTS Overall all-cause standardized mortality rates were unchanged in both sexes. Rates increased in males aged 40-49 (annual average percent change [AAPC]: 2.46 % [95 % CI 0.42 %, 4.55 %]) and 50-59 (AAPC: 1.91 % [95 % CI 0.73 %, 3.10 %]), and females aged 40-49 (AAPC: 3.39 % [95 % CI 1.32 %, 5.50 %]). In both sexes, rates increased among those with 1) > 15 years disease duration, 2) prior cardiovascular disease, and 3) Bumiputera (Malay/native) ethnicity. The overall SMR was 1.83 (95 % CI 1.80, 1.86) for males and 1.85 (95 % CI 1.82, 1.89) for females, being higher in younger age groups and showed an increasing trend in those with either > 15 years disease duration or prior cardiovascular disease. CONCLUSIONS Mortality trends worsened in certain T2D population in Malaysia.
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Affiliation(s)
- Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Asia Diabetes Foundation, Hong Kong SAR, China.
| | - Alia Abdul Aziz
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Helen Dakin
- Health Economics Research Centre, Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom
| | - John Buckell
- Health Economics Research Centre, Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom
| | - Yuan-Liang Woon
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institute of Health, Selangor, Malaysia
| | - Laurence Roope
- Health Economics Research Centre, Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom
| | - Arunah Chandran
- Non-communicable Disease Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Feisul I Mustapha
- Non-communicable Disease Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom.
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How to share data - not just equally, but equitably. Nature 2023; 622:431-432. [PMID: 37848525 DOI: 10.1038/d41586-023-03239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
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Addey T, Alegre-Díaz J, Bragg F, Trichia E, Wade R, Santacruz-Benitez R, Ramirez-Reyes R, Garcilazo-Ávila A, Gonzáles-Carballo C, Bello-Chavolla OY, Antonio-Villa NE, Aguilar-Ramirez D, Friedrichs LG, Lewington S, Peto R, Collins R, Berumen J, Emberson JR, Kuri-Morales P, Tapia-Conyer R. Educational and social inequalities and cause-specific mortality in Mexico City: a prospective study. Lancet Public Health 2023; 8:e670-e679. [PMID: 37633676 PMCID: PMC7615266 DOI: 10.1016/s2468-2667(23)00153-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Social inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify social, including educational, inequalities in mortality among adults in Mexico City. METHODS The Mexico City Prospective Study recruited 150 000 adults aged 35 years and older from two districts of Mexico City between 1998 and 2004. Participants were followed up until Jan 1, 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 years associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors. FINDINGS Among 143 478 participants aged 35-74 years, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 1·84; 95% CI 1·71-1·98), equivalent to approximately 6 years lower life expectancy, with an RR of 1·78 (1·67-1·90) among participants with incomplete primary, 1·62 (1·53-1·72) with complete primary, and 1·34 (1·25-1·42) with secondary education. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 3·65; 95% CI 3·05-4·38 for no education vs tertiary education) and from infectious diseases (2·67; 2·00-3·56), but there was an apparent higher rate of death from all specific causes studied with lower education, with the exception of cancer for which there was little association. Lifestyle factors (ie, smoking, alcohol drinking, and leisure time physical activity) and related physiological correlates (ie, adiposity, diabetes, and blood pressure) accounted for about four-fifths of the association of education with premature mortality. INTERPRETATION In this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality. FUNDING Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit.
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Affiliation(s)
- Thomas Addey
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jesus Alegre-Díaz
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eirini Trichia
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Wade
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rogelio Santacruz-Benitez
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Raúl Ramirez-Reyes
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Adrián Garcilazo-Ávila
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Carlos Gonzáles-Carballo
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | - Diego Aguilar-Ramirez
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Louisa Gnatiuc Friedrichs
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jaime Berumen
- Experimental Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jonathan R Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Pablo Kuri-Morales
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Roberto Tapia-Conyer
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
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Fierro I, Gallardo-Mora O, Alba-Leonel A, Carvajal A, Molina-Guarneros JA. Prescription of oral antidiabetics in Mexico. A cross-sectional study. PLoS One 2023; 18:e0288699. [PMID: 37498817 PMCID: PMC10373993 DOI: 10.1371/journal.pone.0288699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
In 2016 diabetes was declared an epidemic and a health emergency in Mexico. As the rationale of the treatment is to achieve target glycemia levels, the appropriateness of the medications used is important. The aim of this study is to learn the pattern of antidiabetic drug prescription and factors associated with inappropriate prescription in Mexico. A retrospective cross-sectional drug utilization study has been conducted. A randomly selected sample was carefully examined. Out of 3600 clinical records of patients diagnosed with type 2 diabetes mellitus (T2DM), 196 records were revised. As far as control is concerned, 36.7% had their glycemia values in the recommended range. A combination of different antidiabetics was the most common pattern observed (60.7%); the most frequent was that of the association of metformin with whatever oral antidiabetics. Prescriptions were considered as inappropriate in 149 cases (76.0%); younger age and lack of nutritional assessment was significantly related to inappropriate prescription. A trend to use more drugs for treating T2DM has been consistently observed. Despite using so many drugs, most of the patients are not controlled. Avoiding inappropriate prescription by following current guidelines may contribute to a better control and, in turn, decrease morbidity and mortality for this cause.
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Affiliation(s)
- Inmaculada Fierro
- Departamento de Ciencias de la Salud, Universidad Europea Miguel de Cervantes, Valladolid, Spain
| | - Osiel Gallardo-Mora
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México (UNAM), Mexico, Mexico
| | - Adela Alba-Leonel
- Escuela Nacional de Enfermería y Obstetricia, Universidad Nacional Autónoma de México (UNAM), Mexico, Mexico
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Cahuana-Hurtado L, Gómez-Dantés H, De la Cruz-Góngora V, Chiquete E, Cantú-Brito C. Unveiling the Burden of Miscoding and Misclassification in Stroke Mortality: Analysis of Multiple Cause-of-Death Data in Mexico. Neuroepidemiology 2023; 57:284-292. [PMID: 37399787 DOI: 10.1159/000531537] [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: 11/30/2022] [Accepted: 05/04/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The prevalence of risk factors for cerebrovascular diseases in Mexico is increasing although stroke mortality declined from 1990 to 2010, without meaningful changes afterward. While improving access to adequate prevention and care could explain this trend, miscoding and misclassification in death certificates need to be assessed to unveil the true burden of stroke in Mexico. Practices in death certification along with the presence of multi-morbidity could contribute to this distortion. Analyses of multiple causes of death could reveal ill-defined stroke deaths, providing a glimpse of this bias. METHODS Cause-of-death information from 4,262,666 death certificates in Mexico from 2009 to 2015, was examined to determine the extent of miscoding and misclassification on the true burden of stroke. Age-standardized mortality rates per 100,000 inhabitants (ASMR) were calculated for stroke as underlying and multiple causes of death, by sex and state. Deaths were classified following international standards as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and unspecified, which were kept as an independent category to measure miscoding. To approximate misclassification, we compared ASMR under three misclassification scenarios: (1) current (the status quo); (2) moderate, which includes deaths from selected causes mentioning stroke; and (3) high which includes all deaths mentioning stroke. National and subnational data were analyzed to search for geographical patterns. RESULTS The burden of stroke in Mexico is underreported due to miscoding and misclassification. Miscoding is an important issue since almost 60% of all stroke deaths are registered as unspecified. Multiple cause analysis indicates that stroke ASMR could increase 39.9%-52.9% of the current ASMR under moderate and high misclassification scenarios, respectively. Both problems indicate the need to improve death codification procedures and cause-of-death classification. CONCLUSIONS Miscoding and misclassification lead to underestimation of the burden of stroke in Mexico. Stroke deaths are underreported when other important causes coexist, being diabetes the most frequent.
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Affiliation(s)
- Lucero Cahuana-Hurtado
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Héctor Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Santa María Ahuacatitlán, Cuernavaca, Mexico
| | - Vanessa De la Cruz-Góngora
- Center for Evaluation and Survey Research, National Institute of Public Health, Santa María Ahuacatitlán, Cuernavaca, Mexico
| | - Erwin Chiquete
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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22
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Mendivil CO, Gnecco-González S, Herrera-Parra LJ, Hernández Vargas JA, Ramírez-García N, Acuña-Merchán L. MDRD is the eGFR equation most strongly associated with 4-year mortality among patients with diabetes in Colombia. BMJ Open Diabetes Res Care 2023; 11:e003495. [PMID: 37474261 PMCID: PMC10360417 DOI: 10.1136/bmjdrc-2023-003495] [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: 04/29/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION We compared the association of glomerular filtration rate (GFR) estimated with the Cockcroft-Gault, Modification of Diet in Renal Disease study (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), or the new CKD-EPI without race (CKD-EPI-NR) equations, with 4-year all-cause mortality in patients with diabetes. RESEARCH DESIGN AND METHODS We analyzed a nationwide, centralized database of all adults diagnosed with diabetes assisted by the Colombian Health System between July 1, 2015, and June 30, 2019. Plasma creatinine was used to calculate baseline estimated glomerular filtration rate (eGFR) and classify each patient in a chronic kidney disease (CKD) stage, by each of the four equations. We used multivariate logistic regression to compare the association between CKD stage and mortality, and receiver operating characteristic (ROC) analyses to assess the overall association of eGFR by each equation and mortality. RESULTS The study included 758,219 patients (58% female, 7.2% black race, mean age 62.3, Glycated hemoglobin A1c [HbA1c] 7.4%). There were 35,296 deaths over the study follow-up. Considering eGFR by each equation as a continuous variable, the odds of death decreased by 1.1%-1.5% for each additional mL/min. Compared with CKD stage 1 of each equation, being placed in CKD stages 3a, 3b, or 4 by MDRD or CKD-EPI-NR was associated with greater odds of death than being categorized in the same stages by CKD-EPI. Among patients of black race, the adjusted OR of mortality for CKD stage 4 relative to stage 1 was 4.63 (95% CI 3.39 to 6.35) for MDRD, 3.66 (2.85 to 4.69) for CKD-EPI-NR, 3.01 (2.38 to 3.81) for CKD-EPI, and 2.82 (2.29 to 3.49) for Cockcroft-Gault. The area under the ROC curve to discriminate by survival status was greatest for MDRD, followed by CKD-EPI-NR, CKD-EPI, and Cockcroft-Gault, in that order (p<0.001 for all differences). CONCLUSIONS Compared with other eGFR equations, MDRD showed the strongest association with all-cause mortality in a sample of Latin-American patients with diabetes. This difference was most pronounced among patients of black race.
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Affiliation(s)
- Carlos O Mendivil
- School of Medicine, Universidad de los Andes, Bogota, Colombia
- Endocrinology Section, Fundación Santa Fe de Bogotá, Bogota, DC, Colombia
| | | | - Lina J Herrera-Parra
- Research Department, Fondo Colombiano de Enfermedades de Alto Costo, Bogota, DC, Colombia
| | | | - Nathaly Ramírez-García
- Research Department, Fondo Colombiano de Enfermedades de Alto Costo, Bogota, DC, Colombia
| | - Lizbeth Acuña-Merchán
- Research Department, Fondo Colombiano de Enfermedades de Alto Costo, Bogota, DC, Colombia
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23
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Neri-Rosario D, Martínez-López YE, Esquivel-Hernández DA, Sánchez-Castañeda JP, Padron-Manrique C, Vázquez-Jiménez A, Giron-Villalobos D, Resendis-Antonio O. Dysbiosis signatures of gut microbiota and the progression of type 2 diabetes: a machine learning approach in a Mexican cohort. Front Endocrinol (Lausanne) 2023; 14:1170459. [PMID: 37441494 PMCID: PMC10333697 DOI: 10.3389/fendo.2023.1170459] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction The gut microbiota (GM) dysbiosis is one of the causal factors for the progression of different chronic metabolic diseases, including type 2 diabetes mellitus (T2D). Understanding the basis that laid this association may lead to developing new therapeutic strategies for preventing and treating T2D, such as probiotics, prebiotics, and fecal microbiota transplants. It may also help identify potential early detection biomarkers and develop personalized interventions based on an individual's gut microbiota profile. Here, we explore how supervised Machine Learning (ML) methods help to distinguish taxa for individuals with prediabetes (prediabetes) or T2D. Methods To this aim, we analyzed the GM profile (16s rRNA gene sequencing) in a cohort of 410 Mexican naïve patients stratified into normoglycemic, prediabetes, and T2D individuals. Then, we compared six different ML algorithms and found that Random Forest had the highest predictive performance in classifying T2D and prediabetes patients versus controls. Results We identified a set of taxa for predicting patients with T2D compared to normoglycemic individuals, including Allisonella, Slackia, Ruminococus_2, Megaspgaera, Escherichia/Shigella, and Prevotella, among them. Besides, we concluded that Anaerostipes, Intestinibacter, Prevotella_9, Blautia, Granulicatella, and Veillonella were the relevant genus in patients with prediabetes compared to normoglycemic subjects. Discussion These findings allow us to postulate that GM is a distinctive signature in prediabetes and T2D patients during the development and progression of the disease. Our study highlights the role of GM and opens a window toward the rational design of new preventive and personalized strategies against the control of this disease.
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Affiliation(s)
- Daniel Neri-Rosario
- Human Systems Biology Laboratory, Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Maestría y Doctorado en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | | | | | - Jean Paul Sánchez-Castañeda
- Human Systems Biology Laboratory, Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Maestría y Doctorado en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Cristian Padron-Manrique
- Human Systems Biology Laboratory, Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Aarón Vázquez-Jiménez
- Human Systems Biology Laboratory, Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
| | - David Giron-Villalobos
- Human Systems Biology Laboratory, Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Maestría y Doctorado en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Osbaldo Resendis-Antonio
- Human Systems Biology Laboratory, Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Coordinación de la Investigación Científica – Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
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He Y, Li Z, Yu L, Liu Y, Li L, Yang R, Wang X, Gao S, Yu C. Association between the atherogenic index of plasma and carotid artery plaques in patients with coronary heart disease in different glucose metabolism states: an RCSCD-TCM study in Tianjin, China. Endocrine 2023:10.1007/s12020-023-03389-5. [PMID: 37231238 DOI: 10.1007/s12020-023-03389-5] [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: 09/24/2022] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The atherogenic index of plasma (AIP) is considered a powerful biomarker of dyslipidemia and atherosclerosis (AS). However, limited evidence is available regarding the relationship between the AIP and carotid artery plaques (CAPs) in patients with coronary heart disease (CHD). METHODS This retrospective study included 9281 patients with CHD who underwent carotid ultrasound. Participants were divided according to the AIP tertiles: T1, AIP < 1.02; T2, 1.02 ≤ AIP < 1.25; and T3, AIP ≥ 1.25. The presence or absence of CAPs was assessed using carotid ultrasound. Logistic regression was used to analyze the relationship between the AIP and CAPs in patients with CHD. The relationship between the AIP and CAPs was assessed according to sex, age, and glucose metabolic status. RESULTS The baseline characteristics revealed significant differences in related parameters among patients with CHD after stratification into the three groups according to the AIP tertiles. Compared with T1, the odds ratio (OR) of T3 in patients with CHD was 1.53 (95% confidence interval [CI]:1.35-1.74). The association between AIP and CAPs was higher in females (OR: 1.63; 95% CI: 1.38-1.92) than in males (OR: 1.38; 95% CI: 1.12-1.70). The OR for patients aged ≤60 years (OR: 1.40; 95% CI: 1.14-1.71) was lower than that for patients aged >60 years (OR: 1.49; 95% CI: 1.26-1.76). AIP was significantly associated with the risk of CAPs formation in different glucose metabolic states, with diabetes having the highest OR value (OR: 1.31; 95% CI: 1.19-1.43). CONCLUSION The AIP and CAPs were significantly associated in patients with CHD, and the association was higher in female than in male patients. The association was lower in patients aged ≤60 years than in patients aged >60 years. Under different glucose metabolism statuses, the association between the AIP and the CAPs among patients with CHD was highest in patients with diabetes.
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Affiliation(s)
- Yuanyuan He
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Zhu Li
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Lu Yu
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Yijia Liu
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Lin Li
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Rongrong Yang
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Xianliang Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Shan Gao
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China.
| | - Chunquan Yu
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China.
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Wang JL, Hsu CR, Wu CY, Lin HH. Diabetes and obesity and risk of pyogenic liver abscess. Sci Rep 2023; 13:7922. [PMID: 37193729 DOI: 10.1038/s41598-023-34889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
Few literatures discussed the relationship of glycemic control and body mass index (BMI) with the risk of pyogenic liver abscess. We conducted a population-based cohort study using participants of a community-based health screening program in Taiwan from 2005 to 2008 (n = 125,865). Information on fasting plasma glucose (FPG), BMI, and other potential risk factors of liver abscess were collected at baseline. Incidence of pyogenic liver abscess was ascertained using inpatient records from the National Health Insurance database. During a median 8.6 years of followed up, 192 incident cases of pyogenic liver abscess were reported. The incidence rate of pyogenic liver abscess was 70.2 and 14.7 per 100,000 in the diabetic and non-diabetic population respectively. In multivariable Cox regression analysis, the adjusted hazard ratio (HR) was 2.18 (95% confidence interval (CI) 1.22-3.90) in patients with diabetes with good glycemic control (FPG ≤ 130 mg/dl) and 3.34 (95% CI 2.37-4.72) in those with poor glycemic control (FPG > 130 mg/dl), when compared with non-diabetics. In the dose-response analysis, the risk of liver abscess increased monotonically with increasing FPG. After adjusting for diabetes and other comorbidities, overweight (25 ≤ BMI < 30) (adjusted HR: 1.43, 95% CI 1.05-1.95) and obese (BMI ≥ 30) (adjusted HR: 1.75, 95% CI 1.09-2.81) populations had a higher risk of liver abscess when compared to people with normal weight. Diabetes, especially poorly controlled disease, and high BMI were associated with higher risk of pyogenic liver abscess. Improving glycemic control and weight reduction may reduce the risk of developing pyogenic liver abscess.
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Affiliation(s)
- Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chun-Ru Hsu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan
| | - Chieh-Yin Wu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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26
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Sun Y, Dai W, He W. Identification of key immune-related genes and immune infiltration in diabetic nephropathy based on machine learning algorithms. IET Syst Biol 2023. [PMID: 36919187 DOI: 10.1049/syb2.12061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) is a complication of diabetes. This study aimed to identify potential diagnostic markers of DN and explore the significance of immune cell infiltration in this pathology. METHODS The GSE30528, GSE96804, and GSE1009 datasets were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified by merging the GSE30528 and GSE96804 datasets. Enrichment analyses of the DEGs were performed. A LASSO regression model, support vector machine recursive feature elimination analysis and random forest analysis methods were performed to identify candidate biomarkers. The CIBERSORT algorithm was utilised to compare immune infiltration between DN and normal controls. RESULTS In total, 115 DEGs were obtained. The enrichment analysis showed that the DEGs were prominent in immune and inflammatory responses. The DEGs were closely related to kidney disease, urinary system disease, kidney cancer etc. CXCR2, DUSP1, and LPL were recognised as diagnostic markers of DN. The immune cell infiltration analysis indicated that DN patients contained a higher ratio of memory B cells, gamma delta T cells, M1 macrophages, M2 macrophages etc. cells than normal people. CONCLUSION Immune cell infiltration is important for the occurrence of DN. CXCR2, DUSP1, and LPL may become novel diagnostic markers of DN.
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Affiliation(s)
- Yue Sun
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weiran Dai
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenwen He
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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27
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Annan E, Nguyen USDT, Treviño J, Wan Yaacob WF, Mangla S, Pathak AK, Nandy R, Haque U. Moderation effects of serotype on dengue severity across pregnancy status in Mexico. BMC Infect Dis 2023; 23:147. [PMID: 36899304 PMCID: PMC9999597 DOI: 10.1186/s12879-023-08051-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/02/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Pregnancy increases a woman's risk of severe dengue. To the best of our knowledge, the moderation effect of the dengue serotype among pregnant women has not been studied in Mexico. This study explores how pregnancy interacted with the dengue serotype from 2012 to 2020 in Mexico. METHOD Information from 2469 notifying health units in Mexican municipalities was used for this cross-sectional analysis. Multiple logistic regression with interaction effects was chosen as the final model and sensitivity analysis was done to assess potential exposure misclassification of pregnancy status. RESULTS Pregnant women were found to have higher odds of severe dengue [1.50 (95% CI 1.41, 1.59)]. The odds of dengue severity varied for pregnant women with DENV-1 [1.45, (95% CI 1.21, 1.74)], DENV-2 [1.33, (95% CI 1.18, 1.53)] and DENV-4 [3.78, (95% CI 1.14, 12.59)]. While the odds of severe dengue were generally higher for pregnant women compared with non-pregnant women with DENV-1 and DENV-2, the odds of disease severity were much higher for those infected with the DENV-4 serotype. CONCLUSION The effect of pregnancy on severe dengue is moderated by the dengue serotype. Future studies on genetic diversification may potentially elucidate this serotype-specific effect among pregnant women in Mexico.
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Affiliation(s)
- Esther Annan
- Department of Biostatistics & Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA. .,Center for Health and Wellbeing, School of Public and International Affairs, Princeton University, Princeton, NJ, USA.
| | - Uyen-Sa D T Nguyen
- Department of Biostatistics & Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jesús Treviño
- Department of Urban Affairs at the School of Architecture, Universidad Autónoma de Nuevo León, 66455, San Nicolás de los Garza, Nuevo Léon, México
| | - Wan Fairos Wan Yaacob
- Mathematical Sciences Studies, College of Computing, Informatics and Media, Universiti Teknologi MARA Cawangan Kelantan, Lembah Sireh, Kampus Kota Bharu, 15150, Kota Bharu, Kelantan, Malaysia.,Institute for Big Data Analytics and Artificial Intelligence (IBDAAI), Universiti Teknologi MARA, Kompleks Al- Hawarizmi, 40450, Shah Alam, Selangor, Malaysia
| | - Sherry Mangla
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Ashok Kumar Pathak
- Department of Mathematics and Statistics, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Rajesh Nandy
- Department of Biostatistics & Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ubydul Haque
- Rutgers Global Health Institute, New Brunswick, NJ, USA.,Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
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Bragg F, Kuri-Morales P, Berumen J, Garcilazo-Ávila A, Gonzáles-Carballo C, Ramírez-Reyes R, Santacruz-Benitez R, Aguilar-Ramirez D, Gnatiuc Friedrichs L, Herrington WG, Hill M, Trichia E, Wade R, Collins R, Peto R, Emberson JR, Alegre-Diaz J, Tapia-Conyer R. Diabetes and infectious disease mortality in Mexico City. BMJ Open Diabetes Res Care 2023; 11:11/2/e003199. [PMID: 36889802 PMCID: PMC10008442 DOI: 10.1136/bmjdrc-2022-003199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Although higher risks of infectious diseases among individuals with diabetes have long been recognized, the magnitude of these risks is poorly described, particularly in lower income settings. This study sought to assess the risk of death from infection associated with diabetes in Mexico. RESEARCH DESIGN AND METHODS Between 1998 and 2004, a total of 159 755 adults ≥35 years were recruited from Mexico City and followed up until January 2021 for cause-specific mortality. Cox regression yielded adjusted rate ratios (RR) for death due to infection associated with previously diagnosed and undiagnosed (HbA1c ≥6.5%) diabetes and, among participants with previously diagnosed diabetes, with duration of diabetes and with HbA1c. RESULTS Among 130 997 participants aged 35-74 and without other prior chronic diseases at recruitment, 12.3% had previously diagnosed diabetes, with a mean (SD) HbA1c of 9.1% (2.5%), and 4.9% had undiagnosed diabetes. During 2.1 million person-years of follow-up, 2030 deaths due to infectious causes were recorded at ages 35-74. Previously diagnosed diabetes was associated with an RR for death from infection of 4.48 (95% CI 4.05-4.95), compared with participants without diabetes, with notably strong associations with death from urinary tract (9.68 (7.07-13.3)) and skin, bone and connective tissue (9.19 (5.92-14.3)) infections and septicemia (8.37 (5.97-11.7)). In those with previously diagnosed diabetes, longer diabetes duration (1.03 (1.02-1.05) per 1 year) and higher HbA1c (1.12 (1.08-1.15) per 1.0%) were independently associated with higher risk of death due to infection. Even among participants with undiagnosed diabetes, the risk of death due to infection was nearly treble the risk of those without diabetes (2.69 (2.31-3.13)). CONCLUSIONS In this study of Mexican adults, diabetes was common, frequently poorly controlled, and associated with much higher risks of death due to infection than observed previously, accounting for approximately one-third of all premature mortality due to infection.
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Affiliation(s)
- Fiona Bragg
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pablo Kuri-Morales
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- Monterrey Institute of Technology and Higher Education, Nuevo Leon, Mexico
| | - Jaime Berumen
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Adrián Garcilazo-Ávila
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Carlos Gonzáles-Carballo
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Raúl Ramírez-Reyes
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rogelio Santacruz-Benitez
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Diego Aguilar-Ramirez
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Louisa Gnatiuc Friedrichs
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - William G Herrington
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Hill
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eirini Trichia
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Wade
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan R Emberson
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jesus Alegre-Diaz
- Experimental Research Unit from the Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Roberto Tapia-Conyer
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Bai S, Lin C, Jiao R, Cai X, Hu S, Lv F, Yang W, Zhu X, Ji L. Is the steady-state concentration, duration of action, or molecular weight of GLP-1RA associated with cardiovascular and renal outcomes in type 2 diabetes? Eur J Intern Med 2023; 109:79-88. [PMID: 36628824 DOI: 10.1016/j.ejim.2023.01.008] [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: 10/26/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Disparities were found in the cardiovascular and renal outcomes among different glucagon-like peptide 1 receptor agonist (GLP-1RA) subtypes. However, whether the characteristics of GLP-1RA itself are associated with these disparities remains unclear. OBJECTIVE To assess the association between the steady-state concentration, duration of action, or molecular weight of GLP-1RA and the risks of cardiovascular and renal outcomes in patients with type 2 diabetes (T2D). DATA SOURCES PubMed, MEDLINE, EMBASE, Cochrane and Clinicaltrial.gov from inception to April 2022. STUDY SELECTION Randomized controlled trials (RCTs) investigating GLP-1RAs in patients with T2D were included. DATA EXTRACTION AND SYNTHESIS Literature screening and data extraction were performed independently by 2 researchers. The outcomes were computed as odds ratio (OR) and its 95% confidence interval (CI). Subgroup analyses were conducted according to steady-state concentration, duration of action and molecular weight of GLP-1RAs. MAIN OUTCOMES AND MEASURES Primary outcomes were major adverse cardiovascular events (MACE), composite renal outcome and all-cause mortality. RESULTS In all, 61 RCTs were included. When compared with non-GLP-1RA agents, GLP-1RAs with high steady-state concentration were associated with greater risk reduction in MACE (p for subgroup difference = 0.01) and the composite renal outcome (p for subgroup difference = 0.008) in patients with T2D. Greater risk reductions in MACE between GLP-1RA users versus non-GLP-RA users were observed in long acting stratum when compared with short acting stratum (p for subgroup difference = 0.04) in patients with T2D. The molecular weight of GLP-1RAs was not associated with the risk of cardiovascular and renal outcomes. CONCLUSIONS AND RELEVANCE GLP-1RAs with high steady-state concentrations might be associated with greater risk reductions in cardiovascular and renal outcomes in patients with T2D. Long acting GLP-1RAs might outperform short acting ones in reducing the risk of cardiovascular outcomes. These findings provided new insights for guiding the clinical applications of GLP-1RAs in patients with T2D.
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Affiliation(s)
- Shuzhen Bai
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Chu Lin
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Ruoyang Jiao
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Suiyuan Hu
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Fang Lv
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Wenjia Yang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Xingyun Zhu
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
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30
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Payne CF, Liwin LK, Wade AN, Houle B, Du Toit JD, Flood D, Manne-Goehler J. Impact of diabetes on longevity and disability-free life expectancy among older South African adults: A prospective longitudinal analysis. Diabetes Res Clin Pract 2023; 197:110577. [PMID: 36780956 PMCID: PMC10023447 DOI: 10.1016/j.diabres.2023.110577] [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: 08/22/2022] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
AIMS We seek to understand the coexisting effects of population aging and a rising burden of diabetes on healthy longevity in South Africa. METHODS We used longitudinal data from the 2015 and 2018 waves of the "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI) study to explore life expectancy (LE) and disability-free life expectancy (DFLE) of adults aged 45 and older with and without diabetes in rural South Africa. We estimated LE and DFLE by diabetes status using Markov-based microsimulation. RESULTS We find a clear gradient in remaining LE and DFLE based on diabetes status. At age 45, a man without diabetes could expect to live 7.4 [95% CI 3.4 - 11.7] more years than a man with diabetes, and a woman without diabetes could expect to live 3.9 [95% CI: 0.8 - 6.9] more years than a woman with diabetes. Individuals with diabetes lived proportionately more years subject to disability than individuals without diabetes. CONCLUSIONS We find large and important decrements in disability-free aging for people with diabetes in South Africa. This finding should motivate efforts to strengthen prevention and treatment efforts for diabetes and its complications for older adults in this setting.
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Affiliation(s)
- Collin F Payne
- School of Demography, Research School of Social Sciences, The Australian National University, Canberra, Australia; Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, USA
| | - Lilipramawanty K Liwin
- School of Demography, Research School of Social Sciences, The Australian National University, Canberra, Australia
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian Houle
- School of Demography, Research School of Social Sciences, The Australian National University, Canberra, Australia; MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques D Du Toit
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala.
| | - Jennifer Manne-Goehler
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
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31
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Gnatiuc Friedrichs L, Wade R, Alegre‐Díaz J, Ramirez‐Reyes R, Garcilazo‐Ávila A, Gonzáles‐Carballo C, Santacruz‐Benitez R, Chiquete E, Herrington W, Collins R, Peto R, Clarke R, Berumen J, Emberson JR, Kuri‐Morales P, Tapia‐Conyer R. Body Composition and Risk of Vascular-Metabolic Mortality Risk in 113 000 Mexican Men and Women Without Prior Chronic Disease. J Am Heart Assoc 2023; 12:e028263. [PMID: 36695315 PMCID: PMC9973642 DOI: 10.1161/jaha.122.028263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/14/2022] [Indexed: 01/26/2023]
Abstract
Background Body-mass index is the sum of fat mass index (FMI) and lean mass index (LMI), which vary by age, sex, and impact on disease outcomes. We investigated the separate and joint relevance of FMI and LMI with vascular-metabolic causes of death in Mexican adults. Methods and Results A total of 113 025 adults aged 35 to 74 years and free from diabetes or other chronic diseases when recruited into the Mexico City Prospective Study were followed for 19 years. Cox models estimated sex-specific death rate ratios from vascular-metabolic causes after adjustment for confounders and exclusion of the first 5 years of follow-up. To account for the strong correlation between FMI and LMI, additional models estimated rate ratios associated with "residual FMI" and "residual LMI" (ie, the residuals from linear regression analyses of FMI on LMI, or vice versa). In both sexes, higher FMI and LMI were associated with higher risks of vascular-metabolic mortality. For a given (ie, fixed) level of LMI, the rate ratio (95% CI) for vascular-metabolic mortality per 1 kg/m2 higher residual FMI strengthened and was higher in women (1.52 [1.38-1.68]) than in men (1.19 [1.13-1.25]). By contrast, for a given level of FMI, higher residual LMI was inversely associated with vascular-metabolic mortality (rate ratio per 1 kg/m2 0.67 [0.56-0.80] in women and 0.94 [0.90-0.98] in men). Conclusions In this study, higher residual FMI was more strongly associated with vascular-metabolic mortality in women than in men. Conversely, higher residual LMI was inversely associated with vascular-metabolic mortality, particularly in women.
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Affiliation(s)
- Louisa Gnatiuc Friedrichs
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Rachel Wade
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Jesus Alegre‐Díaz
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Raúl Ramirez‐Reyes
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Adrián Garcilazo‐Ávila
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Carlos Gonzáles‐Carballo
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Rogelio Santacruz‐Benitez
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Erwin Chiquete
- Instituto Nacional de Ciencias Médicas y de la Nutrición, Salvador Zubirán HospitalMexico CityMexico
| | - William Herrington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Jaime Berumen
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Jonathan R. Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Pablo Kuri‐Morales
- School of MedicineNational Autonomous University of MexicoMexico CityMexico
- Instituto Tecnológico y de Estudios Superiores de MonterreyMonterreyMexico
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Pazarín-Villaseñor L, García-Salas Y, Yanowsky-Escatell FG, Pacheco-Moisés FP, Andrade-Sierra J, Campos-Bayardo TI, Román-Rojas D, García-Sánchez A, Miranda-Díaz AG. Oxidation State in Peritoneal Dialysis in Patients with Type 2 Diabetes Mellitus. Int J Mol Sci 2023; 24:ijms24032669. [PMID: 36768992 PMCID: PMC9916940 DOI: 10.3390/ijms24032669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
End-stage renal disease (ESRD) progression is closely related to oxidative stress (OS). The study objective was to determine the oxidant and antioxidant status in peritoneal dialysis (PD) patients with type 2 diabetes mellitus (DM). An analytical cross-sectional study from the PD program was carried out with 62 patients, 22 with and 40 without DM. Lipoperoxides (LPO) levels in patients with DM, 3.74 ± 1.09 mM/L, and without DM, 3.87 ± 0.84 mM/L were found to increase compared to healthy controls (HC) 3.05 ± 0.58 mM/L (p = 0.006). The levels of the oxidative DNA damage marker (8-OH-dG) were found to be significantly increased in patients with DM, 1.71 ng/mL (0.19-71.92) and without DM, 1.05 ng/mL (0.16-68.80) front to 0.15 ng/mL (0.15-0.1624) of HC (p = 0.001). The antioxidant enzyme superoxide dismutase (SOD) activity was found to be significantly increased in patients with DM, 0.37 ± 0.15 U/mL, and without DM, 0.37 ± 0.17 compared to HC, 0.23 ± 0.05 U/mL (p = 0.038). The activity of the enzyme glutathione peroxidase (GPx) showed a significant increase (p < 0.001) in patients with DM, 3.56 ± 2.18 nmol/min/mL, and without DM, 3.28 ± 1.46 nmol/min/mL, contrary to the activity obtained in HC, 1.55 ± 0.34 nmol/min/mL. In conclusion, we found an imbalance of oxidative status in patients undergoing PD with and without DM through the significant increase in LPO oxidants and the marker of oxidative damage in DNA. The activity of the antioxidant enzymes SOD and GPx were significantly increased in patients with and without DM undergoing PD, possibly in an attempt to compensate for the deregulation of oxidants. Antioxidant enzymes could be promising therapeutic strategies as a complement to the management of chronic kidney diseases.
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Affiliation(s)
- Leonardo Pazarín-Villaseñor
- Nephrology Service, Civil Hospital of Guadalajara “Dr. Juan I Menchaca”, Guadalajara 44280, Jalisco, Mexico
- Nephrology Specialty, Regional General Hospital No. 46 of the IMSS, Guadalajara 44910, Jalisco, Mexico
| | - Yessica García-Salas
- Nephrology Service, Civil Hospital of Guadalajara “Dr. Juan I Menchaca”, Guadalajara 44280, Jalisco, Mexico
| | - Francisco Gerardo Yanowsky-Escatell
- Nephrology Service, Civil Hospital of Guadalajara “Dr. Juan I Menchaca”, Guadalajara 44280, Jalisco, Mexico
- Department of Health Sciences-Illness as an Individual Process, University Center of Tonala, University of Guadalajara, Guadalajara 45425, Jalisco, Mexico
| | - Fermín Paul Pacheco-Moisés
- Department of Chemistry, University Centre for Exact and Engineering Sciences, University of Guadalajara, Guadalajara 44430, Jalisco, Mexico
| | - Jorge Andrade-Sierra
- Nephrology Service, Civil Hospital of Guadalajara “Dr. Juan I Menchaca”, Guadalajara 44280, Jalisco, Mexico
- Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara 44360, Jalisco, Mexico
| | - Tannia Isabel Campos-Bayardo
- Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara 44360, Jalisco, Mexico
| | - Daniel Román-Rojas
- Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara 44360, Jalisco, Mexico
| | - Andrés García-Sánchez
- Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara 44360, Jalisco, Mexico
| | - Alejandra Guillermina Miranda-Díaz
- Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara 44360, Jalisco, Mexico
- Correspondence:
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Bello-Chavolla OY, Antonio-Villa NE, Fermín-Martínez CA, Fernández-Chirino L, Vargas-Vázquez A, Ramírez-García D, Basile-Alvarez MR, Hoyos-Lázaro AE, Carrillo-Larco RM, Wexler DJ, Manne-Goehler J, Seiglie JA. Diabetes-Related Excess Mortality in Mexico: A Comparative Analysis of National Death Registries Between 2017-2019 and 2020. Diabetes Care 2022; 45:2957-2966. [PMID: 36286591 PMCID: PMC7613876 DOI: 10.2337/dc22-0616] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate diabetes-related mortality in Mexico in 2020 compared with 2017-2019 after the onset of the coronavirus disease 2019 (COVID-19) pandemic. RESEARCH DESIGN AND METHODS This retrospective, state-level study used national death registries of Mexican adults aged ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes listing diabetes as the primary cause of death, excluding certificates with COVID-19 as the primary cause of death. Spatial and negative binomial regression models were used to characterize the geographic distribution and sociodemographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared with average 2017-2019 rates. RESULTS We identified 148,437 diabetes-related deaths in 2020 (177 per 100,000 inhabitants) vs. an average of 101,496 deaths in 2017-2019 (125 per 100,000 inhabitants). In-hospital diabetes-related deaths decreased by 17.8% in 2020 versus 2017-2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes (130 per 100,000 inhabitants). Compared with 2018-2019 data, hyperglycemic hyperosmolar state and diabetic ketoacidosis were the two contributing causes with the highest increase in mortality (128% and 116% increase, respectively). Diabetes-related excess mortality clustered in southern Mexico and was highest in states with higher social lag, rates of COVID-19 hospitalization, and prevalence of HbA1c ≥7.5%. CONCLUSIONS Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately outside the hospital, and were largely attributable to type 2 diabetes and hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020.
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Affiliation(s)
| | - Neftali Eduardo Antonio-Villa
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A. Fermín-Martínez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luisa Fernández-Chirino
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniel Ramírez-García
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Martín Roberto Basile-Alvarez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana Elena Hoyos-Lázaro
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Deborah J. Wexler
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jennifer Manne-Goehler
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jacqueline A. Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Flood D, Edwards EW, Giovannini D, Ridley E, Rosende A, Herman WH, Jaffe MG, DiPette DJ. [Integrating hypertension and diabetes management in primary health care settings: HEARTS as a toolIntegrando o manejo da hipertensão e do diabetes na atenção primária à saúde: uso do HEARTS como instrumento]. Rev Panam Salud Publica 2022; 46:e213. [PMID: 36415785 PMCID: PMC9673610 DOI: 10.26633/rpsp.2022.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
Hypertension and diabetes are modifiable cardiovascular disease (CVD) risk factors that contribute to nearly one-third of all deaths in the Americas Region each year (2.3 million deaths). Despite advances in the detection and clinical management of hypertension and diabetes, there are substantial gaps in their implementation globally and in the Region. The considerable overlap in risk factors, prognosis, and treatment of hypertension and diabetes creates a unique opportunity for a unified implementation model for management at the population level. This report highlights one such high-profile effort, the Pan American Health Organization's "HEARTS in the Americas" program, based on the World Health Organization's HEARTS Technical Package for Cardiovascular Disease Management in Primary Health Care. The HEARTS program aims to improve the implementation of preventive CVD care in primary health systems using six evidence-based, pragmatic components: Healthy-lifestyle counseling, Evidence-based protocols, Access to essential medicines and technology, Risk-based CVD management, Team-based care, and Systems for monitoring. To date, HEARTS implementation projects have focused primarily on hypertension given that it is the leading modifiable CVD risk factor and can be treated cost-effectively. The objective of this report is to describe opportunities for integration of diabetes clinical care and policy within the HEARTS hypertension framework. A substantial global burden of disease could be averted with integrated primary care management of these conditions. Thus, there is an urgency in applying lessons from HEARTS to close these implementation gaps and improve the integrated detection, treatment, and control of diabetes and hypertension.
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Affiliation(s)
- David Flood
- Departamento de Medicina InternaUniversidad de MichiganAnn ArborEstados Unidos de AméricaDepartamento de Medicina Interna, Universidad de Michigan, Ann Arbor, Estados Unidos de América.
| | - Elizabeth W. Edwards
- Departamento de Medicina InternaFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaDepartamento de Medicina Interna, Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América
| | - David Giovannini
- Prisma Health-MidlandsColumbiaEstados Unidos de AméricaPrisma Health-Midlands, Columbia, Estados Unidos de América
| | - Emily Ridley
- Prisma Health-MidlandsColumbiaEstados Unidos de AméricaPrisma Health-Midlands, Columbia, Estados Unidos de América
| | - Andres Rosende
- Iniciativa HEARTS en las AméricasOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaIniciativa HEARTS en las Américas, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América
| | - William H. Herman
- Departamento de EpidemiologíaUniversidad de MichiganAnn ArborEstados Unidos de AméricaDepartamento de Epidemiología, Universidad de Michigan, Ann Arbor, Estados Unidos de América
| | - Marc G. Jaffe
- The Permanente Medical GroupSan Francisco Medical CenterSan FranciscoEstados Unidos de AméricaThe Permanente Medical Group, San Francisco Medical Center, San Francisco, Estados Unidos de América
| | - Donald J. DiPette
- Departamento de Medicina InternaFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaDepartamento de Medicina Interna, Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América
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Nag A, Dhindsa RS, Mitchell J, Vasavda C, Harper AR, Vitsios D, Ahnmark A, Bilican B, Madeyski-Bengtson K, Zarrouki B, Zoghbi AW, Wang Q, Smith KR, Alegre-Díaz J, Kuri-Morales P, Berumen J, Tapia-Conyer R, Emberson J, Torres JM, Collins R, Smith DM, Challis B, Paul DS, Bohlooly-Y M, Snowden M, Baker D, Fritsche-Danielson R, Pangalos MN, Petrovski S. Human genetics uncovers MAP3K15 as an obesity-independent therapeutic target for diabetes. SCIENCE ADVANCES 2022; 8:eadd5430. [PMID: 36383675 PMCID: PMC9668288 DOI: 10.1126/sciadv.add5430] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/27/2022] [Indexed: 05/30/2023]
Abstract
We performed collapsing analyses on 454,796 UK Biobank (UKB) exomes to detect gene-level associations with diabetes. Recessive carriers of nonsynonymous variants in MAP3K15 were 30% less likely to develop diabetes (P = 5.7 × 10-10) and had lower glycosylated hemoglobin (β = -0.14 SD units, P = 1.1 × 10-24). These associations were independent of body mass index, suggesting protection against insulin resistance even in the setting of obesity. We replicated these findings in 96,811 Admixed Americans in the Mexico City Prospective Study (P < 0.05)Moreover, the protective effect of MAP3K15 variants was stronger in individuals who did not carry the Latino-enriched SLC16A11 risk haplotype (P = 6.0 × 10-4). Separately, we identified a Finnish-enriched MAP3K15 protein-truncating variant associated with decreased odds of both type 1 and type 2 diabetes (P < 0.05) in FinnGen. No adverse phenotypes were associated with protein-truncating MAP3K15 variants in the UKB, supporting this gene as a therapeutic target for diabetes.
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Affiliation(s)
- Abhishek Nag
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Ryan S. Dhindsa
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Waltham, MA, USA
| | - Jonathan Mitchell
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Chirag Vasavda
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Waltham, MA, USA
| | - Andrew R. Harper
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Dimitrios Vitsios
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Andrea Ahnmark
- Bioscience Metabolism, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Bilada Bilican
- Discovery Biology, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Katja Madeyski-Bengtson
- Discovery Biology, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Bader Zarrouki
- Bioscience Metabolism, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anthony W. Zoghbi
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Waltham, MA, USA
| | - Quanli Wang
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Waltham, MA, USA
| | - Katherine R. Smith
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Jesus Alegre-Díaz
- Faculty of Medicine, National Autonomous University of Mexico, Copilco Universidad, Coyoacán, 4360 Ciudad de México, Mexico
| | - Pablo Kuri-Morales
- Faculty of Medicine, National Autonomous University of Mexico, Copilco Universidad, Coyoacán, 4360 Ciudad de México, Mexico
| | - Jaime Berumen
- Faculty of Medicine, National Autonomous University of Mexico, Copilco Universidad, Coyoacán, 4360 Ciudad de México, Mexico
| | - Roberto Tapia-Conyer
- Faculty of Medicine, National Autonomous University of Mexico, Copilco Universidad, Coyoacán, 4360 Ciudad de México, Mexico
| | - Jonathan Emberson
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, England, UK
| | - Jason M. Torres
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, England, UK
| | - Rory Collins
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, England, UK
| | - David M. Smith
- Emerging Innovations, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Benjamin Challis
- Translational Science and Experimental Medicine, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Dirk S. Paul
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Mohammad Bohlooly-Y
- Discovery Biology, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Mike Snowden
- Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - David Baker
- Bioscience Metabolism, Early CVRM, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | | | | | - Slavé Petrovski
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
- Department of Medicine, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
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36
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Rojas Alvarez A, Vazquez CE, Lopez-Ortega M, Angel JL. A comparison of rural-urban differences in out-of-pocket expenses among older Mexicans with diabetes. Front Public Health 2022; 10:1025159. [PMID: 36339153 PMCID: PMC9634568 DOI: 10.3389/fpubh.2022.1025159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/28/2022] [Indexed: 01/28/2023] Open
Abstract
Objective To compare total out-of-pocket expenses for physician visits and medications among older adults living with diabetes in Mexico from urban, semi-urban, and rural areas. Methods The sample included 2,398 Mexicans aged 65 years and older with self-reported diabetes from the 2018 Mexican Health and Aging Study. Out-of-pocket expenses for physician visits and medications were regressed on locality, controlling for several factors. Results The profile of those with higher out-of-pocket medication expenditures included rural localities, higher education, unmarried, depressive symptoms, participation in Seguro Popular, and lacking insurance. In the multivariate analysis, rural older adults with diabetes paid a higher amount in medication expenditures compared with other localities. Conclusion Differences in locality are closely tied to the effective implementation of Seguro Popular. Although this program has improved access to care, participants have higher out-of-pocket expenditures for medications than those on employer-based plans across all localities. Among all groups, the uninsured bare the highest burden of expenditures, highlighting a continued need to address health inequities for the most underserved populations.
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Affiliation(s)
- Alfonso Rojas Alvarez
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX, United States,*Correspondence: Alfonso Rojas Alvarez
| | - Christian E. Vazquez
- School of Social Work, University of Texas at Arlington, Arlington, TX, United States,Christian E. Vazquez
| | | | - Jacqueline L. Angel
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX, United States
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37
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Russo GT, Manicardi V, Rossi MC, Orsi E, Solini A. Sex- and gender-differences in chronic long-term complications of type 1 and type 2 diabetes mellitus in Italy. Nutr Metab Cardiovasc Dis 2022; 32:2297-2309. [PMID: 36064685 DOI: 10.1016/j.numecd.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
AIMS This review summarizes the contribution of Italian diabetologists devoted to a better understanding of the complex relationship linking sex/gender and long-term complications of type 1 (T1DM) and type 2 diabetes (T2DM) over the last fifteen years. DATA SYNTHESIS Microvascular and macrovascular complications of diabetes show sex- and gender-related differences, involving pathophysiological mechanisms, epidemiological features and clinical presentation, due to the interaction between biological and psychosocial factors. These differences greatly impact on the progression of diabetes and its long-term complications, especially in the cardiovascular, renal and liver districts. CONCLUSION A better knowledge of such sex- and gender-related characteristics is required for a more precise patient phenotypization, and for the choice of a personalized antihyperglycemic treatment. Despite such mounting evidence, current diabetes clinical guidelines do not as yet adequately consider sex/gender differences.
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Affiliation(s)
- G T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Italy.
| | | | - M C Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - E Orsi
- IRCCS Foundation Cà Grande Ospedale Maggiore, Milan, Italy
| | - A Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy.
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38
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Flood D, Edwards EW, Giovannini D, Ridley E, Rosende A, Herman WH, Jaffe MG, DiPette DJ. Integrating hypertension and diabetes management in primary health care settings: HEARTS as a tool. Rev Panam Salud Publica 2022; 46:e150. [PMID: 36071915 PMCID: PMC9440730 DOI: 10.26633/rpsp.2022.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
Hypertension and diabetes are modifiable cardiovascular disease (CVD) risk factors that contribute to nearly one-third of all deaths in the Americas Region each year (2.3 million deaths). Despite advances in the detection and clinical management of hypertension and diabetes, there are substantial gaps in their implementation globally and in the Region. The considerable overlap in risk factors, prognosis, and treatment of hypertension and diabetes creates a unique opportunity for a unified implementation model for management at the population level. This report highlights one such high-profile effort, the Pan American Health Organization's "HEARTS in the Americas" program, based on the World Health Organization's HEARTS Technical Package for Cardiovascular Disease Management in Primary Health Care. The HEARTS program aims to improve the implementation of preventive CVD care in primary health systems using six evidence-based, pragmatic components: Healthy-lifestyle counseling, Evidence-based protocols, Access to essential medicines and technology, Risk-based CVD management, Team-based care, and Systems for monitoring. To date, HEARTS implementation projects have focused primarily on hypertension given that it is the leading modifiable CVD risk factor and can be treated cost-effectively. The objective of this report is to describe opportunities for integration of diabetes clinical care and policy within the HEARTS hypertension framework. A substantial global burden of disease could be averted with integrated primary care management of these conditions. Thus, there is an urgency in applying lessons from HEARTS to close these implementation gaps and improve the integrated detection, treatment, and control of diabetes and hypertension.
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Affiliation(s)
- David Flood
- Department of Internal MedicineUniversity of MichiganAnn ArborUnited States of AmericaDepartment of Internal Medicine, University of Michigan, Ann Arbor, United States of America.
| | - Elizabeth W. Edwards
- Department of Internal MedicineUniversity of South Carolina School of MedicineColumbiaUnited States of AmericaDepartment of Internal Medicine, University of South Carolina School of Medicine, Columbia, United States of America
| | - David Giovannini
- Prisma Health-MidlandsColumbiaUnited States of AmericaPrisma Health-Midlands, Columbia, United States of America
| | - Emily Ridley
- Prisma Health-MidlandsColumbiaUnited States of AmericaPrisma Health-Midlands, Columbia, United States of America
| | - Andres Rosende
- HEARTS in the Americas InitiativePan American Health OrganizationWashington, D.C.United States of AmericaHEARTS in the Americas Initiative, Pan American Health Organization, Washington, D.C., United States of America
| | - William H. Herman
- Department of EpidemiologyUniversity of MichiganAnn ArborUnited States of AmericaDepartment of Epidemiology, University of Michigan, Ann Arbor, United States of America
| | - Marc G. Jaffe
- The Permanente Medical GroupSan Francisco Medical CenterSan FranciscoUnited States of AmericaThe Permanente Medical Group, San Francisco Medical Center, San Francisco, United States of America
| | - Donald J. DiPette
- Department of Internal MedicineUniversity of South Carolina School of MedicineColumbiaUnited States of AmericaDepartment of Internal Medicine, University of South Carolina School of Medicine, Columbia, United States of America
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39
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Choi D, Gujral UP, Patel SA. Mortality differentials by previous diagnosis of diabetes and glycemic status in the United States. J Diabetes Complications 2022; 36:108250. [PMID: 35905509 PMCID: PMC10420970 DOI: 10.1016/j.jdiacomp.2022.108250] [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: 12/19/2021] [Revised: 06/04/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
AIMS This study examines mortality differences associated with current glycemic status in mortality by current glycemic status among adults with a previously diagnosed diabetes. Using previous clinical diagnosis of diabetes (diagnosed diabetes) and laboratory measures of hemoglobin A1c (HbA1c) measured at baseline, we estimated mortality differentials simultaneously by diagnosed diabetes and baseline glycemic status in the United States. METHODS Data were from 39,491 adults aged 30-84 years assessed in the National Health and Nutrition Examination Survey (NHANES) III and continuous NHANES 1999-2014 linked to mortality data. We categorized participants into four mutually exclusive groups based on diagnosed diabetes and glycemic control measured by HbA1c ≥6.5 % at baseline. Relative hazard ratio (HR) of all-cause death among these four groups were estimated using Cox proportional models. RESULTS There was no significant difference in mortality by glycemic control status among adults with diagnosed diabetes. The same finding was observed among adults without diagnosed diabetes. Adults with diagnosed diabetes had higher mortality than adults without diagnosed diabetes independent of their baseline glycemic control. CONCLUSIONS Once diagnosed with diabetes, US adults with normal- and hyper-glycemia showed no significant difference in all-cause mortality. This finding emphasizes the importance of primary prevention interventions among adults with a sign of early-stage diabetes.
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Affiliation(s)
- Daesung Choi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Unjali P Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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40
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Akbari P, Sosina OA, Bovijn J, Landheer K, Nielsen JB, Kim M, Aykul S, De T, Haas ME, Hindy G, Lin N, Dinsmore IR, Luo JZ, Hectors S, Geraghty B, Germino M, Panagis L, Parasoglou P, Walls JR, Halasz G, Atwal GS, Jones M, LeBlanc MG, Still CD, Carey DJ, Giontella A, Orho-Melander M, Berumen J, Kuri-Morales P, Alegre-Díaz J, Torres JM, Emberson JR, Collins R, Rader DJ, Zambrowicz B, Murphy AJ, Balasubramanian S, Overton JD, Reid JG, Shuldiner AR, Cantor M, Abecasis GR, Ferreira MAR, Sleeman MW, Gusarova V, Altarejos J, Harris C, Economides AN, Idone V, Karalis K, Della Gatta G, Mirshahi T, Yancopoulos GD, Melander O, Marchini J, Tapia-Conyer R, Locke AE, Baras A, Verweij N, Lotta LA. Multiancestry exome sequencing reveals INHBE mutations associated with favorable fat distribution and protection from diabetes. Nat Commun 2022; 13:4844. [PMID: 35999217 PMCID: PMC9399235 DOI: 10.1038/s41467-022-32398-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/28/2022] [Indexed: 12/13/2022] Open
Abstract
Body fat distribution is a major, heritable risk factor for cardiometabolic disease, independent of overall adiposity. Using exome-sequencing in 618,375 individuals (including 160,058 non-Europeans) from the UK, Sweden and Mexico, we identify 16 genes associated with fat distribution at exome-wide significance. We show 6-fold larger effect for fat-distribution associated rare coding variants compared with fine-mapped common alleles, enrichment for genes expressed in adipose tissue and causal genes for partial lipodystrophies, and evidence of sex-dimorphism. We describe an association with favorable fat distribution (p = 1.8 × 10-09), favorable metabolic profile and protection from type 2 diabetes (~28% lower odds; p = 0.004) for heterozygous protein-truncating mutations in INHBE, which encodes a circulating growth factor of the activin family, highly and specifically expressed in hepatocytes. Our results suggest that inhibin βE is a liver-expressed negative regulator of adipose storage whose blockade may be beneficial in fat distribution-associated metabolic disease.
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Affiliation(s)
- Parsa Akbari
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Olukayode A. Sosina
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Jonas Bovijn
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Karl Landheer
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Jonas B. Nielsen
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Minhee Kim
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Senem Aykul
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Tanima De
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Mary E. Haas
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - George Hindy
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Nan Lin
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Ian R. Dinsmore
- grid.280776.c0000 0004 0394 1447Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA USA
| | - Jonathan Z. Luo
- grid.280776.c0000 0004 0394 1447Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA USA
| | - Stefanie Hectors
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Benjamin Geraghty
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Mary Germino
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Lampros Panagis
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Prodromos Parasoglou
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Johnathon R. Walls
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Gabor Halasz
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Gurinder S. Atwal
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | | | | | - Marcus Jones
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Michelle G. LeBlanc
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Christopher D. Still
- grid.280776.c0000 0004 0394 1447Geisinger Obesity Institute, Geisinger Health System, Danville, PA USA
| | - David J. Carey
- grid.280776.c0000 0004 0394 1447Geisinger Obesity Institute, Geisinger Health System, Danville, PA USA
| | - Alice Giontella
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden ,grid.5611.30000 0004 1763 1124Department of Medicine, University of Verona, Verona, Italy
| | - Marju Orho-Melander
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Jaime Berumen
- grid.9486.30000 0001 2159 0001Unidad de Medicina Experimental de la Facultad de Medicina de la Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Pablo Kuri-Morales
- grid.9486.30000 0001 2159 0001Unidad de Medicina Experimental de la Facultad de Medicina de la Universidad Nacional Autónoma de México, Mexico City, Mexico ,grid.419886.a0000 0001 2203 4701Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Jesus Alegre-Díaz
- grid.9486.30000 0001 2159 0001Unidad de Medicina Experimental de la Facultad de Medicina de la Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jason M. Torres
- grid.4991.50000 0004 1936 8948MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948Clinical Trial Service Unit & Epidemiological Studies Unit Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan R. Emberson
- grid.4991.50000 0004 1936 8948MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948Clinical Trial Service Unit & Epidemiological Studies Unit Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit & Epidemiological Studies Unit Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel J. Rader
- grid.25879.310000 0004 1936 8972Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Brian Zambrowicz
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Andrew J. Murphy
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Suganthi Balasubramanian
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - John D. Overton
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Jeffrey G. Reid
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Alan R. Shuldiner
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Michael Cantor
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Goncalo R. Abecasis
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Manuel A. R. Ferreira
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Mark W. Sleeman
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Viktoria Gusarova
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Judith Altarejos
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Charles Harris
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Aris N. Economides
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA ,grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Vincent Idone
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Katia Karalis
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Giusy Della Gatta
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Tooraj Mirshahi
- grid.280776.c0000 0004 0394 1447Geisinger Obesity Institute, Geisinger Health System, Danville, PA USA
| | | | - Olle Melander
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden ,grid.411843.b0000 0004 0623 9987Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Jonathan Marchini
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Roberto Tapia-Conyer
- grid.419886.a0000 0001 2203 4701Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Adam E. Locke
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Aris Baras
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA.
| | - Niek Verweij
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
| | - Luca A. Lotta
- grid.418961.30000 0004 0472 2713Regeneron Genetics Center, Regeneron Pharmaceuticals Inc, Tarrytown, NY USA
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41
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Kim DK, Ko GJ, Choi YJ, Jeong KH, Moon JY, Lee SH, Hwang HS. Glycated hemoglobin levels and risk of all-cause and cause-specific mortality in hemodialysis patients with diabetes. Diabetes Res Clin Pract 2022; 190:110016. [PMID: 35870571 DOI: 10.1016/j.diabres.2022.110016] [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: 04/08/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
AIM Adequate glycemic control is fundamental for improving clinical outcomes in hemodialysis patients with diabetes. However, the target for glycated hemoglobin (HbA1c) level and whether cause-specific mortality differs based on HbA1c levels remain unclear. METHODS A total of 24,243 HD patients with diabetes were enrolled from a multicenter, nationwide registry. We examined the association between HbA1c levels and the risk of all-cause and cause-specific mortality. RESULTS Compared to patients with HbA1c 6.5%-7.5%, patients with HbA1c 8.5-9.5% and ≥9.5% were associated with a 1.26-fold (95% CI, 1.12-1.42) and 1.56-fold (95% CI, 1.37-1.77) risk for all-cause mortality. The risk of all-cause mortality did not increase in patients with HbA1c < 5.5%. In cause-specific mortality, the risk of cardiovascular deaths significantly increased from small increase of HbA1c levels. However, the risk of other causes of death increased only in patients with HbA1c > 9.5%. The slope of HR increase with increasing HbA1c levels was significantly faster for cardiovascular causes than for other causes. CONCLUSIONS There was a linear relationship between HbA1c levels and risk of all-cause mortality in hemodialysis patients, and the risk of cardiovascular death increased earlier and more rapidly, with increasing HbA1c levels, compared with other causes of death.
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Affiliation(s)
- Dae Kyu Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Gang Jee Ko
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yun Jin Choi
- Biomedical Research Institute, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ju Young Moon
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Valdez Ortiz R, Escorza-Valdivia S, Benitez-Renteria S, Lopez-Alvarenga JC, Pérez Navarro LM. Factors of Poor Prognosis Associated with Chronic Kidney Disease by Stage in Ambulatory Patients: A Cross-sectional Study. Arch Med Res 2022; 53:524-532. [DOI: 10.1016/j.arcmed.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
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43
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Li X, Song Y, Guo T, Xiao G, Li Q. Effect of Glucagon-like Peptide 1 Receptor Agonists on the Renal Protection in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. DIABETES & METABOLISM 2022; 48:101366. [PMID: 35760374 DOI: 10.1016/j.diabet.2022.101366] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND . - Glucagon-like peptide 1(GLP-1) receptor agonists are used in patients with type 2 diabetes as hypoglycemic drugs; a growing body of evidence has clarified their renoprotective benefits. We performed a meta-analysis to summarize the most recent evidence on the renal benefits of GLP-1 receptor agonists from clinical trials of patients with type 2 diabetes. METHODS . - This meta-analysis used a fixed-effects model to estimate the risk ratio (RR) with 95% confidence intervals (CIs) to investigate the effect of GLP-1 receptor agonists on the renal protection. The outcomes were a composite renal outcome, estimated glomerular filtration rate (eGFR) decrease, new macroalbuminuria, doubling of serum creatinine, end-stage renal disease (ESRD) and renal death. We also checked the composite renal outcome of the patient subgroups based on the structural source of human GLP-1 or exendin-4. RESULTS . - Among the 12 articles screened, seven studies involving 48101 patients met pre-specified criteria and were included. In general, the use of GLP-1 receptor agonists reduced the risk of the composite renal outcome by 17% (RR 0•83 [95% CI 0•79-0•88]; P < 0•00001), with no significant interaction in subgroups analysis (P = 0.66); the risk of new-onset of persistent macroalbuminuria was reduced by 25% (RR 0•75 [95%CI 0•69-0•81]; P < 0•00001) compared to placebo. However, GLP-1 receptor agonists had no significant effect on eGFR decrease (RR 0•92 [95% CI 0•83-1.01]; P = 0•09), doubling of serum creatinine (RR 0•97 [95% CI 0•78-1.21]; P = 0•79), or end-stage renal disease (RR 0•81 [95% CI 0•62-1.06]; P = 0•12) compared to placebo or insulin glargine (AWARD-7) in patients with type 2 diabetes. CONCLUSION . - GLP-1 receptor agonists, regardless of their structural homology, have significant benefits in reducing the risk of the composite renal outcome, especially in new macroalbuminuria compared with placebo or insulin glargine in patients with type 2 diabetes.
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Affiliation(s)
- Xiang Li
- Department of Endocrinology and Metabolic Diseases, Dalian University Affiliated Xinhua Hospital, Dalian Liaoning 116021, China
| | - Yujie Song
- Department of Endocrinology and Metabolic Diseases, Dalian University Affiliated Xinhua Hospital, Dalian Liaoning 116021, China
| | - Tao Guo
- Department of Endocrinology and Metabolic Diseases, Dalian University Affiliated Xinhua Hospital, Dalian Liaoning 116021, China
| | - Guiying Xiao
- Department of Endocrinology and Metabolic Diseases, Dalian University Affiliated Xinhua Hospital, Dalian Liaoning 116021, China
| | - Qiumei Li
- Department of Endocrinology and Metabolic Diseases, Dalian University Affiliated Xinhua Hospital, Dalian Liaoning 116021, China.
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44
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Trends and effect of marginalization on diabetes mellitus-related mortality in Mexico from 1990 to 2019. Sci Rep 2022; 12:9190. [PMID: 35654853 PMCID: PMC9163326 DOI: 10.1038/s41598-022-12831-z] [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: 12/15/2021] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Diabetes mellitus (DM) is currently one of the leading causes of mortality worldwide. However, the disease evolves differently across countries. This study intends to characterize the trends and assess the potential effects of marginalization on DM mortality between 1990 and 2019 in Mexico. We analyzed death certificates that listed DM as the underlying cause of death (N = 1,907,173), as well as the extent to which DM mortality changes were associated with marginalization through an age-period-cohort analysis. DM mortality increased in Mexico between 1990 and 2019; the change was faster in the first half and slowed down after 2004. The highest marginalization quintiles drove the changes in DM mortality trends during the study period, with a higher risk of dying in these quintiles as age increased. In recent cohorts, the highest marginalization quintiles doubled the risk of dying from DM as compared to the lowest. Renal complications was the main death driver among persons with DM, with a marked increase between 1999 and 2001. In conclusion, Mexico continues to have a substantially high DM mortality, but its pace slowed over time. Moreover, subnational differences in marginalization can partially explain such a trend.
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45
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Cruz-Góngora VDL, Chiquete E, Gómez–Dantés H, Cahuana-Hurtado L, Cantú-Brito C. Trends in the burden of stroke in Mexico: A national and subnational analysis of the global burden of disease 1990-2019. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100204. [PMID: 36777683 PMCID: PMC9904132 DOI: 10.1016/j.lana.2022.100204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Scarce epidemiological information on stroke in Mexico impedes evidence-based decisions and debilitates the design of effective prevention programmes at the local level. Methods Ecological and secondary analysis of Global Burden of Disease national and subnational data for Mexico, from 1990 to 2019. We analysed the incidence, prevalence, deaths, premature mortality, disability, and DALYs due to cerebrovascular disease included to identify the differences in the burden of stroke in Mexico by type of stroke (ischaemic [IS], intracerebral haemorrhage [ICH] and subarachnoid haemorrhage [SAH]), sex, age groups, and state levels ordered by quartiles of Sociodemographic Index (SDI). Means and 95% uncertainty intervals are reported. Findings Reductions in all metrics of total stroke occurred during the 1990 to 2005 period; however, this declining trend was followed up by stagnation of progress from 2006 to 2019, except for premature mortality. This pattern of the declining trend was observed also for IS and to a lesser extent for ICH, while SAH showed no major changes during the 1990-2019 period. The magnitude of decline was higher in females for total stroke for incidence, prevalence and YLDs rates. The less developed states by SDI exhibited the lowest improvements during the period, particularly for ICH metrics. Interpretation The reduction in stroke burden in Mexico did not follow the same pace for all types of stroke, with regional differences by SDI and by sex. Study findings reveal the need for strengthening prevention policies to address health disparities in the burden of stroke by sex and states, within the fragmented Mexican Healthcare System. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology, The Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México
| | - Héctor Gómez–Dantés
- Health Systems Research Centre, National Institute of Public Health, Cuernavaca, Mexico
| | - Lucero Cahuana-Hurtado
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Cantú-Brito
- Department of Neurology, The Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México
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46
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Ali MK, Pearson-Stuttard J, Selvin E, Gregg EW. Interpreting global trends in type 2 diabetes complications and mortality. Diabetologia 2022; 65:3-13. [PMID: 34837505 PMCID: PMC8660730 DOI: 10.1007/s00125-021-05585-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/03/2021] [Indexed: 12/16/2022]
Abstract
International trends in traditional diabetes complications (cardiovascular, renal, peripheral vascular, ophthalmic, hepatic or neurological diseases) and mortality rates are poorly characterised. An earlier review of studies published up to 2015 demonstrated that most data come from a dozen high-income countries (HICs) in North America, Europe or the Asia-Pacific region and that, in these countries at least, rates of acute glycaemic fluctuations needing medical attention and amputations, myocardial infarction and mortality were all declining over the period. Here, we provide an updated review of published literature on trends in type 2 diabetes complications and mortality in adults since 2015. We also discuss issues related to data collection, analysis and reporting that have influenced global trends in type 2 diabetes and its complications. We found that most data on trends in type 2 diabetes, its complications and mortality come from a small number of HICs with comprehensive surveillance systems, though at least some low- and middle-income countries (LMICs) from Africa and Latin America are represented in this review. The published data suggest that HICs have experienced declines in cardiovascular complication rates and all-cause mortality in people with diabetes. In parallel, cardiovascular complications and mortality rates in people with diabetes have increased over time in LMICs. However, caution is warranted in interpreting trends from LMICs due to extremely sparse data or data that are not comparable across countries. We noted that approaches to case ascertainment and definitions of complications and mortality (numerators) and type 2 diabetes (the denominator) vary widely and influence the interpretation of international data. We offer four key recommendations to more rigorously document trends in rates of type 2 diabetes complications and mortality, over time and worldwide: (1) increasing investments in data collection systems; (2) standardising case definitions and approaches to ascertainment; (3) strengthening analytical capacity; and (4) developing and implementing structured guidelines for reporting of data.
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Affiliation(s)
- Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Health Analytics, Lane Clark & Peacock LLP, London, UK
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
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47
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Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, Lau ESH, Eliasson B, Kong APS, Ezzati M, Aguilar-Salinas CA, McGill M, Levitt NS, Ning G, So WY, Adams J, Bracco P, Forouhi NG, Gregory GA, Guo J, Hua X, Klatman EL, Magliano DJ, Ng BP, Ogilvie D, Panter J, Pavkov M, Shao H, Unwin N, White M, Wou C, Ma RCW, Schmidt MI, Ramachandran A, Seino Y, Bennett PH, Oldenburg B, Gagliardino JJ, Luk AOY, Clarke PM, Ogle GD, Davies MJ, Holman RR, Gregg EW. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2021; 396:2019-2082. [PMID: 33189186 DOI: 10.1016/s0140-6736(20)32374-6] [Citation(s) in RCA: 303] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China.
| | - Lee-Ling Lim
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Ping Zhang
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric S H Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council Centre for Environment and Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Disease, Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jean Adams
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paula Bracco
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gabriel A Gregory
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jingchuan Guo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Xinyang Hua
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Boon-Peng Ng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - David Ogilvie
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenna Panter
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Meda Pavkov
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nigel Unwin
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin White
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Constance Wou
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Maria I Schmidt
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - Yutaka Seino
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of NCDs, University of Melbourne, Melbourne, VIC, Australia
| | - Juan José Gagliardino
- Centro de Endocrinología Experimental y Aplicada, UNLP-CONICET-CICPBA, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Edward W Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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Cione E, Cannataro R, Gallelli L, De Sarro G, Caroleo MC. Exosome microRNAs in Metabolic Syndrome as Tools for the Early Monitoring of Diabetes and Possible Therapeutic Options. Pharmaceuticals (Basel) 2021; 14:ph14121257. [PMID: 34959658 PMCID: PMC8706321 DOI: 10.3390/ph14121257] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Exosomes are nano-sized extracellular vesicles produced and released by almost all cell types. They play an essential role in cell-cell communications by delivering cellular bioactive compounds such as functional proteins, metabolites, and nucleic acids, including microRNA, to recipient cells. Thus, they are involved in various physio-pathological conditions. Exosome-miRNAs are associated with numerous diseases, including type 2 diabetes, a complex multifactorial metabolic disorder linked to obesity. In addition, exosome-miRNAs are emerging as essential regulators in the progression of diabetes, principally for pancreatic β-cell injury and insulin resistance. Here, we have clustered the recent findings concerning exosome-miRNAs associated with β-cell dysfunction to provide a novel approach for the early diagnosis and therapy of diabetes.
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Affiliation(s)
- Erika Cione
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
- GalaScreen Laboratories, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
- Correspondence:
| | - Roberto Cannataro
- GalaScreen Laboratories, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
| | - Luca Gallelli
- Department of Health Science, University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, CZ, Italy; (L.G.); (G.D.S.)
| | - Giovambattista De Sarro
- Department of Health Science, University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, CZ, Italy; (L.G.); (G.D.S.)
| | - Maria Cristina Caroleo
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
- GalaScreen Laboratories, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
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49
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Ruiz-Noa Y, Ibarra-Reynoso LDR, Ruiz-Padilla AJ, Alonso-Castro AJ, Ramírez-Morales MA, Zapata-Morales JR, Orozco-Castellanos LM, Solorio-Alvardo CR, Lara-Morales A. Use of herbal medicine for diabetes mellitus in adults from the central-western region of Mexico. Prim Care Diabetes 2021; 15:1095-1099. [PMID: 34462240 DOI: 10.1016/j.pcd.2021.08.010] [Citation(s) in RCA: 2] [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: 12/15/2020] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to assess the prevalence of herbal medicine (HM) use and factors influencing HM usage including the identification of the main plants consumed by patients with type 2 diabetes mellitus (T2DM) in central-western Mexico. DESIGN A total of 1862 patients with diabetes were surveyed in public and private hospitals in four states (Guanajuato, Jalisco, Michoacan, and San Luis Potosi) of the central-western region of Mexico. The chi-square test was used to assess associations between HM use and demographic characteristics, such as glucose levels, presence of complications and comorbidities, as well as the selected therapy to treat T2DM. RESULTS The prevalence of HM use (59.2%) in patients with T2DM was mainly associated with education level (p = 0.001), time of diagnosis of T2DM (p = 0.004), presence of complications (p < 0.001) and comorbidities (p = 0.018) and the use of insulin (p < 0.001). These patients report a higher consumption of herbal medicine compared to those on glycemic control (p < 0.001). The most frequently used medicinal plants to treat T2DM were nopal (54.9%), moringa (26.7%), and aloe (22.1%). CONCLUSION The prevalence of HM use to treat T2DM in west-central Mexico is high (59.2%) and its consumption is mostly carried out without the recommendation of a health professional (91.9%). The use of HM increases mainly when the patient uses insulin, during complications of the disease or in patients with an inadequate glycemic control.
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Affiliation(s)
- Yeniley Ruiz-Noa
- Departamento de Ciencias Médicas, División de Ciencias de la Salud, Universidad de Guanajuato, León, Guanajuato, Mexico
| | | | - Alan Joel Ruiz-Padilla
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico.
| | - Angel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico
| | | | - Juan Ramón Zapata-Morales
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico
| | | | | | - Alfredo Lara-Morales
- Departamento de Enfermería y Obstetricia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico
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A Competing Risk-based Prognostic Model to Predict Cancer-specific Death of Patients with Spinal and Pelvic Chondrosarcoma. Spine (Phila Pa 1976) 2021; 46:E1192-E1201. [PMID: 34714793 DOI: 10.1097/brs.0000000000004073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The aim of this study was to develop and validate a competing-risk-based prognostic model and a nomogram for predicting the three- and five-year probability of cancer-specific death (CSD) in patients with spinal and pelvic chondrosarcoma. SUMMARY OF BACKGROUND DATA The issue of competing risk has rarely been addressed and discussed in survival analysis of bone sarcoma. In addition, the Fine and Gray model, a more accurate method for survival analysis in the context of competing risk, has also been less reported in prognostic study of chondrosarcoma. METHODS A total of 623 patients with spinal or pelvic chondrosarcoma were identified from the SEER database and were divided into a training and a validation cohort. These two cohorts were used to develop and validate a prognostic model to predict the 3- and 5-year probability of CSD, considering non-CSD as competing risk. The C-index, calibration plot, and decision curve analysis were used to assess the predictive performance and clinical utility of the model. RESULTS Older age (subdistribution hazards ratio [SHR]: 1.02, 95% confidence interval [CI]: 1.01∼1.03; P = 0.013), high grade (SHR: 2.68, 95% CI: 1.80∼3.99; P < 0.001), regional involvement (SHR: 1.66, 95% CI: 1.06∼2.58; P = 0.026), distant metastasis (SHR: 5.18, 95% CI: 3.11∼8.62; P < 0.001) and radical resection (SHR: 0.38, 95% CI: 0.24∼0.60; P < 0.001) were significantly associated with the incidence of CSD. These factors were used to build a competing-risk-based model and a nomogram to predict CSD. The C-index, calibration plot, and decision curve analysis indicated that the nomogram performs well in predicting CSD and is suitable for clinical use. CONCLUSION A competing-risk based prognostic model is developed to predict the probability of CSD of patients with spinal and pelvic chondrosarcoma. This nomogram performs well and is suitable for clinical use.Level of Evidence: 4.
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