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Jiménez A, Vlacho B, Mata-Cases M, Real J, Mauricio D, Franch-Nadal J, Ortega E. Sex and age significantly modulate cardiovascular disease presentation in type 2 diabetes: a large population-based cohort study. Front Endocrinol (Lausanne) 2024; 15:1344007. [PMID: 38828412 PMCID: PMC11140096 DOI: 10.3389/fendo.2024.1344007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
Aims We aimed to describe and compare the incidence of the first cardiovascular event and its major subtypes, coronary heart disease (CHD), cerebrovascular disease, heart failure (HF), or peripheral artery disease (PAD), according to age and sex in a population-based cohort of individuals with type 2 diabetes (T2D) from a Mediterranean region. Material and methods We used linked primary care electronic medical reports, pharmacy-invoicing data, and hospital admission disease registry records from the SIDIAP database, which contains linked data for 74% of the Catalonian population. We selected individuals with T2D aged 30 to 89 years free of cardiovascular disease (CVD). The primary outcome was the first presentation of CVD. Results The study cohort included 247,751 individuals (48.6% women, 66.8 ± 11.9 years). During a 6.99-year follow-up, the cumulative incidence of the first cardiovascular event was 23.4%. Men were at higher risk for CVD (hazard ratio [HR]: 1.47 95%CI: 1.45-1.50), CHD (HR: 1.52 95%CI: 1.47-1.57), cerebrovascular disease (HR:1.07 95%CI: 1.03-1.10) and PAD (HR: 2.30 95%CI: 2.21-2.39) than women but at a lower risk for HF (HR:0.70 95%CI: 0.68-0.73). CHD and PAD were the most frequent CVD presentations among men (28.1% and 27.5%) and HF (40.1%) in women. CHD predominated among young participants of both sexes, while HF predominated among women older than 65 and men older than 75. Conclusions In individuals with T2D, the overall risk and the type of first CVD manifestation largely varied by sex and age. This epidemiological evidence should be considered in clinical practice.
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Affiliation(s)
- Amanda Jiménez
- Department of Endocrinology & Nutrition, Hospital Clinic Barcelona, Barcelona, Spain
- CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Jordi Real
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Emilio Ortega
- Department of Endocrinology & Nutrition, Hospital Clinic Barcelona, Barcelona, Spain
- CIBER of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Keong F, Gander J, Wilson D, Durthaler J, Pimentel B, Barzilay JI. Albuminuria Screening in People With Type 2 Diabetes in a Managed Care Organization. AJPM FOCUS 2023; 2:100133. [PMID: 37790952 PMCID: PMC10546502 DOI: 10.1016/j.focus.2023.100133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Albuminuria-an increased amount of urine albumin, in milligrams, adjusted for grams of urine creatinine-is an early marker of diabetic kidney disease. Several new classes of medications are now available that effectively lower albuminuria levels with the potential to delay or prevent the progression of diabetic kidney disease. However, screening for albuminuria in the U.S. is low in population-based studies (<10% to ∼50% at most). In this study, we examine whether screening for albuminuria was improved in an integrated model of healthcare delivery following the recommendations of the National Committee for Quality Assurance mandate (an umbrella group for the managed healthcare industry) to screen for albuminuria. Methods We examined screening for albuminuria over a 2-year period among people with Type 2 diabetes in a U.S. HMO with an electronic medical record, onto which automated laboratory ordering for albuminuria could be added when a patient appeared at the laboratory (for any reason) if albuminuria testing had not been obtained within the previous 365 days. Participants under this plan received diabetes education at no cost and panel managers to guide their diabetes care. Logistic regression using data from 2020 and 2021, separately, evaluated the relationship between patient characteristics and the likelihood of albuminuria screening. Results There were 20,688 and 22,487 participants with Type 2 diabetes mellitus in 2020 and 2021, respectively, who were analyzed. Approximately 80% were screened for albuminuria in both years. African American participants and those aged >64 years were more likely to have completed albuminuria screening. Screened individuals had lower HbA1c, blood pressure, and low-density lipoprotein cholesterol levels than those who were not screened. Conclusions In an integrated healthcare model, it is possible to achieve consistently high rates of albuminuria screening in people with Type 2 diabetes, especially in groups at high risk for kidney disease.
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Affiliation(s)
- Farrah Keong
- Business Intelligence Group, Kaiser Permanente of Georgia, Atlanta, Georgia
| | - Jennifer Gander
- Center for Research and Evaluation, Kaiser Permanente of Georgia, Atlanta, Georgia
| | - Daniel Wilson
- Division of Cardiorenal Medicine, U.S. Medical Affairs, Bayer Pharmaceuticals, LLC, Whippany, New Jersey
| | - Jeffrey Durthaler
- Division of Cardiorenal Medicine, U.S. Medical Affairs, Bayer Pharmaceuticals, LLC, Whippany, New Jersey
| | - Belkis Pimentel
- Department of Adult Medicine, Kaiser Permanente of Georgia, Atlanta, Georgia
- Department of Population Care Management, Kaiser Permanente of Georgia, Atlanta, Georgia
| | - Joshua I. Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Atlanta, Georgia
- Division of Endocrinology Metabolism and Lipids, Department of Medicine, Emory School of Medicine, Atlanta, Georgia
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Vriz O, Mushtaq AH, Elshaer AN, Shaik A, Landi I, Alzahrani T. Takotsubo Syndrome in Black Americans: Insights From the National Inpatient Sample. Tex Heart Inst J 2023; 50:e228055. [PMID: 37853912 PMCID: PMC10658156 DOI: 10.14503/thij-22-8055] [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] [Indexed: 10/20/2023]
Abstract
BACKGROUND Data on race-related differences in the clinical outcomes of Takotsubo syndrome are limited, particularly for Black patients. This study aimed to assess whether race and sex may have an additional impact on the inpatient mortality of patients with Takotsubo syndrome. METHODS A total of 4,628 patients from the United States' National Inpatient Sample from 2012 to 2016 were identified; propensity score analysis revealed a similar propensity score between Black patients (n = 2,314) and White patients (n = 2,314), which was used to balance observed covariates. Sex and age distributions were identical between the 2 groups. The groups were also similar in baseline characteristics, including cardiovascular risk factors. White patients were compared with Black patients on in-hospital outcomes and inpatient mortality. A logistic regression analysis was conducted to measure the difference in mortality based on race and sex. RESULTS Compared with White patients, Black patients had a higher percentage of in-hospital complications, including cerebrovascular accidents (4.9% vs 2.5%, P ≤ .01), acute kidney injury (25% vs 19%, P ≤ .01); longer lengths of stay (8 vs 7 days, P ≤ .01); and higher inpatient mortality (6.1% vs 4.5%, P < .01). When analysis was conducted with race and sex combined, inpatient mortality was higher among Black men than among White women (odds ratio, 2.7 [95% CI, 1.80-3.95]; P ≤ .01). CONCLUSION This study showed that Black patients with Takotsubo syndrome have higher in-hospital complications and inpatient mortality rates. When race and sex were combined, inpatient mortality was significantly higher among Black men than among either White men and women or Black women.
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Affiliation(s)
- Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of Cardiology and Sport Medicine, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Ali Hassan Mushtaq
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed Nahid Elshaer
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Shaik
- School of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Talal Alzahrani
- Department of Medicine, College of Medicine, Taibah University, Medina, Saudi Arabia
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Moore JX, Andrzejak SE, Bevel MS, Jones SR, Tingen MS. Exploring racial disparities on the association between allostatic load and cancer mortality: A retrospective cohort analysis of NHANES, 1988 through 2019. SSM Popul Health 2022; 19:101185. [PMID: 35990411 PMCID: PMC9382324 DOI: 10.1016/j.ssmph.2022.101185] [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: 05/08/2022] [Revised: 06/24/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Methods Results Conclusions Impact Allostatic load (AL) is a biologic measure for the ‘wear and tear’ of chronic stress. Studies suggests that racial minorities have higher allostatic load. There is limited knowledge on the association between allostatic and cancer, by race. We observed that AL may increase the risk of cancer death by 14%. Among those aged <40 years, high AL increased cancer death risk by more than 80%.
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Affiliation(s)
- Justin Xavier Moore
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Corresponding author. Cancer Prevention, Control & Population Health Program, Georgia Cancer Center, Department of Medicine, Institute of Public and Preventive Health, Medical College of Georgia at Augusta University, 1410 Laney Walker Blvd. CN-2135, Augusta, GA, 30912, USA.
| | - Sydney Elizabeth Andrzejak
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Malcolm S. Bevel
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Samantha R. Jones
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Martha S. Tingen
- Cancer Prevention, Control, & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, GA, USA
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吴 俊, 武 轶, 吴 瑶, 王 紫, 吴 涛, 秦 雪, 王 梦, 王 小, 王 伽, 胡 永. [Incidence and risk factors of ischemic stroke in patients with type 2 diabetes among urban workers in Beijing, China]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:249-254. [PMID: 35435187 PMCID: PMC9069034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To explore the incidence of ischemic stroke after the onset of type 2 diabetes, and further analyze the risk factors, so as to provide a basis for further research. METHODS The data were obtained from the database of the Beijing Urban Employee Basic Medical Insurance Database. The study used a prospective design to describe the incidence of ischemic stroke in patients with type 2 diabetes. In our study, these patients were followed up for seven years. Multivariate Logistic regression models were used to analyze the risk factors of ischemic stroke in patients with type 2 diabetes. RESULTS A total of 185 813 newly diagnosed type 2 diabetes patients were enrolled, with an average age of (58.5±13.2) years, and 49.0% of them were males. A total of 10 393 patients with newly diagnosed ischemic stroke occurred in 7 years, with a cumulative incidence of 5.6% and an incidence density of 8.1/1 000 person-years. Ischemic stroke occurred in all age groups in patients with type 2 diabetes. The cumulative incidence was 1.5% (95%CI: 1.3%-1.6%) in group ≤44 years old, 3.6% (95%CI: 3.4%-3.7%) in group 45-54 years old, 5.4% (95%CI: 5.2%-5.5%) in group 55-64 years old, and 9.2% (95%CI: 9.0%-9.4%) in group ≥65 years old, and the cumulative incidence increased with age (P < 0.05). Cumulative incidence rate of the males (6.8%, 95%CI: 6.7%-7.0%) was higher than the females (4.4%, 95%CI: 4.3%-4.6%). Among the patients < 80 years old, the cumulative incidence rate of the males was higher than that of the females in all the age groups. In the patients ≥80 years of age, the cumulative incidence was higher in the females (9.2%) than in the males (7.9%). Further analysis revealed that complications, such as coronary heart disease (OR=3.18, 95%CI: 2.72-3.72), heart failure (OR=1.53, 95%CI: 1.32-1.79) and kidney failure (OR=1.45, 95%CI: 1.20-1.75) were associated with ischemic stroke in the patients with type 2 diabetes. CONCLUSION The incidence level of ischemic stroke in patients with type 2 diabetes is high. It is necessary to strengthen the management of risk factors in elderly patients, screen the complications of type 2 diabetes as early as possible, and take active preventive and control measures.
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Affiliation(s)
- 俊慧 吴
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 轶群 武
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 瑶 吴
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 紫荆 王
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 涛 吴
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 雪英 秦
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 梦莹 王
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 小文 王
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 伽婷 王
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 永华 胡
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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吴 俊, 武 轶, 吴 瑶, 王 紫, 吴 涛, 秦 雪, 王 梦, 王 小, 王 伽, 胡 永. [Incidence and risk factors of ischemic stroke in patients with type 2 diabetes among urban workers in Beijing, China]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:249-254. [PMID: 35435187 PMCID: PMC9069034 DOI: 10.19723/j.issn.1671-167x.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the incidence of ischemic stroke after the onset of type 2 diabetes, and further analyze the risk factors, so as to provide a basis for further research. METHODS The data were obtained from the database of the Beijing Urban Employee Basic Medical Insurance Database. The study used a prospective design to describe the incidence of ischemic stroke in patients with type 2 diabetes. In our study, these patients were followed up for seven years. Multivariate Logistic regression models were used to analyze the risk factors of ischemic stroke in patients with type 2 diabetes. RESULTS A total of 185 813 newly diagnosed type 2 diabetes patients were enrolled, with an average age of (58.5±13.2) years, and 49.0% of them were males. A total of 10 393 patients with newly diagnosed ischemic stroke occurred in 7 years, with a cumulative incidence of 5.6% and an incidence density of 8.1/1 000 person-years. Ischemic stroke occurred in all age groups in patients with type 2 diabetes. The cumulative incidence was 1.5% (95%CI: 1.3%-1.6%) in group ≤44 years old, 3.6% (95%CI: 3.4%-3.7%) in group 45-54 years old, 5.4% (95%CI: 5.2%-5.5%) in group 55-64 years old, and 9.2% (95%CI: 9.0%-9.4%) in group ≥65 years old, and the cumulative incidence increased with age (P < 0.05). Cumulative incidence rate of the males (6.8%, 95%CI: 6.7%-7.0%) was higher than the females (4.4%, 95%CI: 4.3%-4.6%). Among the patients < 80 years old, the cumulative incidence rate of the males was higher than that of the females in all the age groups. In the patients ≥80 years of age, the cumulative incidence was higher in the females (9.2%) than in the males (7.9%). Further analysis revealed that complications, such as coronary heart disease (OR=3.18, 95%CI: 2.72-3.72), heart failure (OR=1.53, 95%CI: 1.32-1.79) and kidney failure (OR=1.45, 95%CI: 1.20-1.75) were associated with ischemic stroke in the patients with type 2 diabetes. CONCLUSION The incidence level of ischemic stroke in patients with type 2 diabetes is high. It is necessary to strengthen the management of risk factors in elderly patients, screen the complications of type 2 diabetes as early as possible, and take active preventive and control measures.
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Affiliation(s)
- 俊慧 吴
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 轶群 武
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 瑶 吴
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 紫荆 王
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 涛 吴
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 雪英 秦
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 梦莹 王
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 小文 王
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 伽婷 王
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 永华 胡
- />北京大学公共卫生学院流行病与卫生统计学系, 北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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Zagon IS, Sassani JW, McLaughlin PJ. Sex Differences in Diabetic Ocular Surface Complications and Dysregulation of the OGF-OGFr Pathway. JOURNAL OF DIABETES AND CLINICAL RESEARCH 2022; 4:20-24. [PMID: 36274979 PMCID: PMC9583621 DOI: 10.33696/diabetes.4.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Diabetes is a chronic disorder that affects more than 500 million individuals worldwide. It is a life-long disease with complications that attack nearly all other systems within the body. Although there is a slight increase in the prevalence of diabetes in males, ocular surface complications are equally present in males and females. Aim This review provides a discussion on preclinical studies related to the dysregulation of a biological pathway that appears to be causally related to diabetic ocular surface complications including dry eye, delayed corneal epithelial healing, and decreased corneal sensitivity. Most basic science and clinical studies focus on male sex in animal models in order to avoid confounders related to hormonal cycling. However, with approximately 10.2% of all women in the US aged 18-44 being diagnosed with diabetes and nearly 4% additional women having undiagnosed disease, it is prudent to examine the onset of these dysregulations also in females and to note any sex-related differences in the timing of onset or severity of ocular surface complications. Summary Data from several well-controlled investigations have documented that female rats with type 1 diabetes develop ocular surface complications before male rats. In part, this finding may be due to the increase in the inhibitory peptide Opioid Growth Factor (OGF) that occurs within 2 weeks of the induction of hyperglycemia in female animals in comparison to the changes in OGF levels in male rats which occur at 4 weeks. It was noted that estrogen levels drop within weeks of induction of hyperglycemia and could serve as another marker for the onset of disease activity and/or its complications. Finally, insulin does not appear to protect against early changes in OGF levels or estrogen secretion in diabetic female rats, setting the stage for a distinction in the disease profile of diabetes between males and females. These data encourage further studies on both sexes in order to establish a complete understanding of the underlying pathologies associated with complications associated with diabetes.
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Affiliation(s)
- Ian S. Zagon
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, Pennsylvania 17033, USA
| | - Joseph W. Sassani
- Department of Ophthalmology, Penn State University College of Medicine, Hershey, Pennsylvania 17033, USA
| | - Patricia J. McLaughlin
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, Pennsylvania 17033, USA,Correspondence should be addressed to Dr. Patricia J. McLaughlin,
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Turner CD, Lindsay R, Heisler M. Peer Coaching to Improve Diabetes Self-Management Among Low-Income Black Veteran Men: A Mixed Methods Assessment of Enrollment and Engagement. Ann Fam Med 2021; 19:532-539. [PMID: 34750128 PMCID: PMC8575516 DOI: 10.1370/afm.2742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We undertook a study to ascertain patient characteristics associated with enrollment and engagement in a type 2 diabetes peer health coaching program at an urban health care facility serving predominantly Black veteran men, to improve the targeting of such programs. METHODS A total of 149 patients declined enrollment in a randomized controlled trial but provided sociodemographic, clinical, and psychosocial information. A total of 290 patients enrolled and were randomized to 2 peer coaching programs; they provided sociodemographic, clinical, and survey data, and were analyzed according to their level of program engagement (167 engaged, 123 did not engage) irrespective of randomization group. Qualitative interviews were conducted with 14 engaged participants. RESULTS Patients who enrolled were more likely to be Black men, have higher levels of education, have higher baseline hemoglobin A1c levels, describe their diabetes self-management as "fair" or "poor," and agree they "find it easy to get close to others" (P <.05 for each). At the program's end, patients who had engaged were more likely than those who had not to describe their peer coaches as being supportive of their autonomy (mean score, 85.4 vs 70.7; P <.001). The importance of coaches being encouraging, supportive, and having common ground/shared experiences with participants also emerged as key themes in interviews with engaged participants. CONCLUSION Individuals with greatest perceived need were more likely to enroll in our trial of peer coaching, but the only factor associated with engagement was finding one's coach to support autonomy. Our findings reinforce the importance of training and ensuring fidelity of peer coaches to autonomy-supportive communication styles for participant engagement. In tailoring peer support programs for Black men, future research should elucidate which shared characteristics between participant and peer coach are most important for engagement and improved outcomes.Visual abstract.
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Affiliation(s)
- Cassie D Turner
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan .,Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan
| | - Rebecca Lindsay
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
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9
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Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, García-Hermoso A. Racial differences in all-cause mortality and future complications among people with diabetes: a systematic review and meta-analysis of data from more than 2.4 million individuals. Diabetologia 2021; 64:2389-2401. [PMID: 34455457 DOI: 10.1007/s00125-021-05554-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to quantify racial/ethnic differences in risk for future diabetic complications and all-cause mortality by performing a meta-analysis of prospective studies. METHODS A systematic search in PubMed and EMBASE was performed from inception to May 2021. Prospective cohort studies that reported HRs and associated 95% CIs of diabetes complications and all-cause mortality among racial/ethnic groups, with White people as the reference group, were included. Study characteristics and HR estimates were extracted from each study. Estimates were pooled using random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman variance estimator. RESULTS A total of 23 studies were included, comprising 2,416,516 individuals diagnosed with diabetes (White 59.3%, Black 11.2%, Asian 1.3%, Hispanic-American 2.4%, Native American 0.2%, East Asian 1.9%, South Asian 0.8%, Pacific Islander 2.3%, Māori 2.4% and others 18.2%). Compared with White individuals with diabetes, individuals of Māori ethnicity were at higher risk for all-cause mortality (HR 1.88 [95% CI 1.61, 2.21]; I2 = 7.1%), Hispanic-American individuals had a significantly lower risk for CVD (HR 0.66 [95% CI 0.53, 0.81]; I2 = 0%) and Black individuals had higher risk for end-stage renal disease (HR 1.54 [95% CI 1.05, 2.24]; I2 = 95.4%). No significant higher risk for diabetes complications was found in other racial/ethnic groups relative to White people. CONCLUSIONS/INTERPRETATION Racial/ethnic differences exist in the risk for future diabetic complications and all-cause mortality. Our results support the use of such categories for international diabetes clinical guideline recommendations until better predictors become available. Efforts to identify high-risk groups and to better control cardiovascular risk factors across ethnically diverse populations are therefore needed. REGISTRATION PROSPERO registration ID CRD42021239274.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), IdiSNA, Pamplona, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
- Sciences of Physical Activity, Sports and Health School, University of Santiago of Chile (USACH), Santiago, Chile.
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10
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Purushothaman I, Zagon IS, Sassani JW, McLaughlin PJ. Ocular surface complications in diabetes: The interrelationship between insulin and enkephalin. Biochem Pharmacol 2021; 192:114712. [PMID: 34324868 PMCID: PMC8478878 DOI: 10.1016/j.bcp.2021.114712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
Diabetes is a multi-faceted disorder with increasing prevalence and rising healthcare costs. The burden of diabetes is increased because of associated complications affecting nearly all organs including the eye. The underlying pathophysiology for the onset of these ocular surface disorders is not well known. Enkephalins are endogenous opioids that originate in the brain and have numerous actions in the human body. Opioid growth factor (OGF), chemically termed [Met5]-enkephalin, binds to a novel, nuclear-associated receptor and mediates cellular homeostasis. Serum OGF levels are elevated in diabetic individuals and rodent models of diabetes. Sustained blockade of the OGF receptor (OGFr) with opioid receptor antagonists, such as naltrexone (NTX), reverses many complications of diabetes in the animal model, including delayed cutaneous wound healing, dry eye, altered corneal surface sensitivity, and keratopathy. The increased enkephalin levels observed in diabetes suggest a relationship between endogenous opioid peptides and the pathophysiology of diabetes. It is common for diabetic patients to undergo insulin therapy to restore normal blood glucose levels. However, this restoration does not alter OGF serum levels nor ameliorate ocular surface complications in the animal model of diabetes. Moreover, sex differences in the prevalence of diabetes, response to insulin therapy, and abnormalities in the OGF-OGFr axis have been reported. This review highlights current knowledge on the dysregulation of the OGF-OGFr pathway and possible relationships of insulin and enkephalins to the development of ocular surface defects in diabetes. It proposes that this dysregulation is a fundamental mechanism for the pathobiology of diabetic complications.
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Affiliation(s)
- Indira Purushothaman
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Ian S Zagon
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Joseph W Sassani
- Department of Ophthalmology, Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Patricia J McLaughlin
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA.
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11
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Rao D, Meyer J, Maurer M, Shiyanbola OO. Perceptions of psychosocial and interpersonal factors affecting self-management behaviors among African Americans with diabetes. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100057. [PMID: 35480599 PMCID: PMC9029920 DOI: 10.1016/j.rcsop.2021.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Deepika Rao
- Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, United States of America
| | - Jodi Meyer
- School of Pharmacy, University of Wisconsin-Madison, United States of America
| | - Martha Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, United States of America
| | - Olayinka O. Shiyanbola
- Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, United States of America
- Corresponding author at: School of Pharmacy, University of Wisconsin, 777 Highland Avenue, Madison, WI 53705, United States of America.
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12
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Alvarado M, Schaubel DE, Reddy KR, Bittermann T. Black Race Is Associated With Higher Rates of Early-Onset End-Stage Renal Disease and Increased Mortality Following Liver Transplantation. Liver Transpl 2021; 27:1154-1164. [PMID: 33733570 PMCID: PMC8355050 DOI: 10.1002/lt.26054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
Black race is a risk factor for end-stage renal disease (ESRD). Racial disparities in the risks of early and long-term renal complications after liver transplantation (LT) have not been systematically studied. This study evaluated racial differences in the natural history of acute and chronic renal insufficiency after LT. This was a retrospective single-center cohort study of 763 non-Hispanic White and 181 Black LT recipients between 2008 and 2017. Black race was investigated as an independent predictor of the following outcomes: (1) receipt and duration of early post-LT hemodialysis and (2) time to post-LT ESRD. The interaction of race and post-LT ESRD on survival was also studied. Black recipients had higher rates of pre-LT hypertension (P < 0.001), but diabetes mellitus and renal function before LT were not different by race (all P > 0.05). Overall, 15.2% of patients required early hemodialysis immediately after LT with no difference by race (covariate-adjusted odds ratio, 0.89; P = 0.71). Early dialysis discontinuation was lower among Black recipients (covariate-adjusted hazard ratio [aHR], 0.47; P = 0.02), whereas their rate of post-LT ESRD was higher (aHR, 1.91; P = 0.005). Post-LT survival after ESRD was markedly worse for Black (aHR, 11.18; P < 0.001) versus White recipients (aHR, 5.83; P < 0.001; interaction P = 0.08). Although Black and White LT recipients had comparable pretransplant renal function, post-LT renal outcomes differed considerably, and the impact of ESRD on post-LT survival was greater for Black recipients. This study highlights the need for an individualized approach to post-LT management to improve outcomes for all patients.
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Affiliation(s)
- Meagan Alvarado
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA
| | - Douglas E. Schaubel
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - K. Rajender Reddy
- Division of Gastroenterology / Transplant Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Therese Bittermann
- Division of Gastroenterology / Transplant Hepatology, University of Pennsylvania, Philadelphia, PA
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13
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Hong D, Fort D, Shi L, Price-Haywood EG. Electronic Medical Record Risk Modeling of Cardiovascular Outcomes Among Patients with Type 2 Diabetes. Diabetes Ther 2021; 12:2007-2017. [PMID: 34143415 PMCID: PMC8266923 DOI: 10.1007/s13300-021-01096-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Increased utilization of electronic health records (EHR) has enriched databases for creating risk models. We used machine learning techniques to develop an EHR-based risk model locally fitted to patients with type 2 diabetes mellitus (T2DM) for predicting cardiovascular disease. METHODS This retrospective observational study was conducted within Ochsner Health, Louisiana, USA, between 2013-2017. Data analysis included 6245 patients who had two outpatient diagnoses of T2DM recorded on separate days or a diagnosis recorded during an inpatient encounter. Baseline clinical data were limited to 180 days before the index diagnosis. Cardiovascular outcomes were coronary heart disease (CHD), heart failure and stroke. Machine learning approaches were used to select predictor variables into Cox proportional hazards models for each outcome. Locally fit equations were compared to "generalized" risk equations (RECODe, AS-CVD, QRISK3) using model discrimination and calibration. RESULTS Among factors identified in the Ochsner (n = 11), RECODe (n = 14), AS-CVD (n = 15) and QRISK3 (n = 23), only age was common to all four risk equations. The Ochsner model had high internal discrimination for CHD (C-statistics 0.85) and better discrimination than RECODe (C-statistics 0.45), the QRISK3 (C-statistics 0.72) and AS-CVD (C-statistics 0.54). CONCLUSIONS The Ochsner model overestimated 5-year CHD risk, but had relatively higher calibration than the other models in CHD. Risk equations fitted for local populations improved cardiovascular risk stratification for patients with T2DM. Application of machine learning simplified the models compared to "generalized" risk equations.
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Affiliation(s)
- Dongzhe Hong
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Daniel Fort
- Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, LA, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Eboni G Price-Haywood
- Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, LA, USA.
- University of Queensland Ochsner Clinical School, New Orleans, LA, USA.
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14
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Practical use of electronic health records among patients with diabetes in scientific research. Chin Med J (Engl) 2021; 133:1224-1230. [PMID: 32433055 PMCID: PMC7249716 DOI: 10.1097/cm9.0000000000000784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Electronic health (medical) records, which are also considered as patients’ information that are routinely collected, provide a great chance for researchers to develop an epidemiological understanding of disease. Electronic health records systems cannot develop without the advance of computer industries. While conducting clinical trials that are always costly, feasible and reasonable analysis of routine patients’ information is more cost-effective and reflective of clinical practice, which is also called real world study. Real world studies can be well supported by big data in healthcare industry. Real world studies become more and more focused and important with the development of evidence-based medicine. These big data will definitely help in making decisions, making policies and guidelines, monitoring of effectiveness and safety on new drugs or technologies. Extracting, cleaning, and analyzing such big data will be a great challenge for clinical researchers. Successful applications and developments of electronic health record in western countries (eg, disease registries, health insurance claims, etc) have provided a clear direction for Chinese researchers. However, it is still at primary stages in China. This review tries to provide a full perspective on how to translate the electronic health records into scientific achievements, for example, among patients with diabetes. As a summary in the end, resource sharing and collaborations are highly recommended among hospitals and healthcare groups.
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15
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Kala S, Meteleva K, Serghides L. ACE2, TMPRSS2 and L-SIGN expression in placentae from HIV-positive pregnancies exposed to antiretroviral therapy-implications for SARS-CoV-2 placental infection. J Infect Dis 2021; 224:S631-S641. [PMID: 33880537 PMCID: PMC8083191 DOI: 10.1093/infdis/jiab166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binding receptor ACE2 and the spike protein priming protease TMPRSS2 are coexpressed in human placentae. It is unknown whether their expression is altered in the context of HIV infection and antiretroviral therapy (ART). Methods We compared mRNA levels of SARS-CoV-2 cell-entry mediators ACE2, TMPRSS2, and L-SIGN by quantitative polymerase chain reaction in 105 placentae: 45 from pregnant women with HIV (WHIV) on protease inhibitor (PI)-based ART, 17 from WHIV on non-PI–based ART, and 43 from HIV-uninfected women. Results ACE2 levels were lower, while L-SIGN levels were higher, in placentae from WHIV on PI-based ART compared to those on non-PI–based ART and to HIV-uninfected women. TMPRSS2 levels were similar between groups. Black race was significantly associated with lower expression of ACE2 and higher expression of L-SIGN. ACE2 levels were significantly higher in placentae of female fetuses. Conclusions We identified pregnant women of black race and WHIV on PI-based ART to have relatively lower expression of placental ACE2 than those of white race and HIV-uninfected women. This may potentially contribute to altered susceptibility to COVID-19 in these women, favorably by reduced viral entry or detrimentally by loss of ACE2 protection against hyperinflammation.
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Affiliation(s)
- Smriti Kala
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ksenia Meteleva
- Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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16
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Shen Y, Zhou J, Shi L, Nauman E, Katzmarzyk PT, Price-Haywood EG, Horswell R, Bazzano AN, Nigam S, Hu G. Association between visit-to-visit HbA1c variability and the risk of cardiovascular disease in patients with type 2 diabetes. Diabetes Obes Metab 2021; 23:125-135. [PMID: 32965068 PMCID: PMC9092602 DOI: 10.1111/dom.14201] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/07/2020] [Accepted: 09/20/2020] [Indexed: 02/02/2023]
Abstract
AIM To investigate the association between visit-to-visit HbA1c variability and the risk of cardiovascular disease in patients with type 2 diabetes. MATERIALS AND METHODS We performed a retrospective cohort study of 29 260 patients with at least four HbA1c measurements obtained within 2 years of their first diagnosis of type 2 diabetes. Different HbA1c variability markers were calculated, including the standard deviation (SD), coefficient of variation (CV) and adjusted SD. Cox proportional hazards regression models were used to estimate the association of these HbA1c variability markers with incident cardiovascular disease. RESULTS During a mean follow-up of 4.18 years, a total of 3746 incident cardiovascular disease cases were diagnosed. Multivariate-adjusted hazard ratios for cardiovascular disease across the first, second, third and fourth quartiles of HbA1c SD values were 1.00, 1.30 (95% confidence interval [CI] 1.18-1.42), 1.40 (95% CI 1.26-1.55) and 1.59 (95% CI 1.41-1.77) (P for trend <.001), respectively. When we utilized HbA1c CV and adjusted HbA1c SD values as exposures, similar positive associations were observed. HbA1c variability was also associated with the risk of first and recurrent severe hypoglycaemic events. A mediating effect of severe hypoglycaemia was observed between HbA1c variability and incident cardiovascular disease. CONCLUSIONS Large visit-to-visit HbA1c variability is associated with an increased risk of cardiovascular disease in patients with type 2 diabetes. Severe hypoglycaemia may mediate the association between HbA1c variability and incident cardiovascular disease.
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Affiliation(s)
- Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth Peopleʼs Hospital, Shanghai, China
| | - Jian Zhou
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth Peopleʼs Hospital, Shanghai, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | - Eboni G. Price-Haywood
- Ochsner Health System Center for Outcomes and Health Services Research, New Orleans, Louisiana
| | - Ronald Horswell
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Alessandra N. Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Somesh Nigam
- Blue Cross and Blue Shield of Louisiana, Baton Rouge, Louisiana
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
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17
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Does the Encounter Type Matter When Defining Diabetes Complications in Electronic Health Records? Med Care 2020; 58 Suppl 6 Suppl 1:S53-S59. [PMID: 32011424 DOI: 10.1097/mlr.0000000000001297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electronic health records (EHRs) and claims records are widely used in defining type 2 diabetes mellitus (T2DM) complications across different types of health care encounters. OBJECTIVE This study investigates whether using different EHR encounter types to define diabetes complications may lead to different results when examining associations between diabetes complications and their risk factors in patients with T2DM. RESEARCH DESIGN The study cohort of 64,855 adult patients with T2DM was created from EHR data from the Research Action for Health Network (REACHnet), using the Surveillance Prevention, and Management of Diabetes Mellitus (SUPREME-DM) definitions. Incidence of coronary heart disease (CHD) and stroke events were identified using International Classification of Diseases (ICD)-9/10 codes and grouped by encounter types: (1) inpatient (IP) or emergency department (ED) type, or (2) any health care encounter type. Cox proportional hazards regression was used to estimate associations between diabetes complications (ie, CHD and stroke) and risk factors (ie, low-density lipoprotein cholesterol and hemoglobin A1c). RESULTS The incidence rates of CHD and stroke in all health care settings were more than twice the incidence rates of CHD and stroke in IP/ED settings. The age-adjusted and multivariable-adjusted hazard ratios for incident CHD and stroke across different levels of low-density lipoprotein cholesterol and hemoglobin A1c were similar between IP/ED and all settings. CONCLUSION While there are large variations in incidence rates of CHD and stroke as absolute risks, the associations between both CHD and stroke and their respective risk factors measured by hazard ratios as relative risks are similar, regardless of alternative definitions.
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18
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Network Engagement in Action: Stakeholder Engagement Activities to Enhance Patient-centeredness of Research. Med Care 2020; 58 Suppl 6 Suppl 1:S66-S74. [PMID: 32412955 DOI: 10.1097/mlr.0000000000001264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stakeholders (ie, patients, policymakers, clinicians, advocacy groups, health system leaders, payers, and others) offer critical input at various stages in the research continuum, and their contributions are increasingly recognized as an important component of effective translational research. Natural experiments, in particular, may benefit from stakeholder feedback in addressing real-world issues and providing insight into future policy decisions, though best practices for the engagement of stakeholders in observational studies are limited in the literature. METHODS The Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) network utilizes rigorous methods to evaluate natural experiments in health policy and program delivery with a focus on diabetes-related outcomes. Each of the 8 partnering institutions incorporates stakeholder engagement throughout multiple study phases to enhance the patient-centeredness of results. NEXT-D2 dedicates a committee to Engagement for resource sharing, enhancing engagement approaches, and advancing network-wide engagement activities. Key stakeholder engagement activities include Study Meetings, Proposal Development, Trainings & Educational Opportunities, Data Analysis, and Results Dissemination. Network-wide patient-centered resources and multimedia have also been developed through the broad expertise of each site's stakeholder group. CONCLUSIONS This collaboration has created a continuous feedback loop wherein site-level engagement approaches are informed via the network and network-level engagement efforts are shaped by individual sites. Emerging best practices include: incorporating stakeholders in multiple ways throughout the research, building on previous relationships with stakeholders, enhancing capacity through stakeholder and investigator training, involving stakeholders in refining outcome choices and understanding the meaning of variables, and recognizing the power of stakeholders in maximizing dissemination.
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19
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Doumas M, Patoulias D, Katsimardou A, Stavropoulos K, Imprialos K, Karagiannis A. COVID19 and increased mortality in African Americans: socioeconomic differences or does the renin angiotensin system also contribute? J Hum Hypertens 2020; 34:764-767. [PMID: 32669668 PMCID: PMC7363409 DOI: 10.1038/s41371-020-0380-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece.
| | - Dimitrios Patoulias
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Alexandra Katsimardou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Konstantinos Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
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20
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Shen Y, Zhou J, Shi L, Nauman E, Katzmarzyk PT, Price-Haywood EG, Horswell R, Chu S, Yang S, Bazzano AN, Nigam S, Hu G. Effectiveness of sodium-glucose co-transporter-2 inhibitors on ischaemic heart disease. Diabetes Obes Metab 2020; 22:1197-1206. [PMID: 32166884 PMCID: PMC7547648 DOI: 10.1111/dom.14025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Abstract
AIM To compare the cardiovascular risks between users and non-users of sodium-glucose co-transporter-2 (SGLT2) inhibitors based on electronic medical record data from a large integrated healthcare system in South Louisiana. MATERIALS AND METHODS Demographic, anthropometric, laboratory and medication prescription information for patients with type 2 diabetes who were new users of SGLT2 inhibitors, either as initial treatments or as add-on treatments, were obtained from electronic health records. Mediation analysis was performed to evaluate the association of use of SGLT2 inhibitors and changes of metabolic risk factors with the risk of incident ischaemic heart disease. RESULTS A total of 5338 new users of SGLT2 inhibitors were matched with 13 821 non-users. During a mean follow-up of 3.26 years, 2302 incident cases of ischaemic heart disease were defined. After adjusting for multiple confounding factors, patients using SGLT2 inhibitors had a lower risk of incident ischaemic heart disease compared to patients not using SGLT2 inhibitors (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.54-0.73). Patients using SGLT2 inhibitors also had a lower risk of incident ischaemic heart disease within 6 months (HR 0.36, 95% CI 0.25-0.44), 12 months (HR 0.40, 95% CI 0.32-0.49), 24 months (HR 0.53, 95% CI 0.43-0.60) and 36 months (HR 0.65, 95% CI 0.54-0.73), respectively. Reductions in systolic blood pressure partly mediated lowering risk of ischaemic heart disease among patients using SGLT2 inhibitors. CONCLUSIONS The real-world data in the present study show the contribution of SGLT2 inhibitors to reducing risk of ischaemic heart disease, and their benefits beyond glucose-lowering.
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Affiliation(s)
- Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jian Zhou
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | | | - Eboni G. Price-Haywood
- Ochsner Health System Center for Outcomes and Health Services Research, New Orleans, LA, USA
| | | | - San Chu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Shengping Yang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Alessandra N. Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Somesh Nigam
- Blue Cross and Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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21
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Shen Y, Shi L, Nauman E, Katzmarzyk P, Price-Haywood E, Bazzano A, Nigam S, Hu G. Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes. J Stroke 2020; 22:87-98. [PMID: 32027794 PMCID: PMC7005352 DOI: 10.5853/jos.2019.01704] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/10/2019] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose The association between hemoglobin A1c (HbA1c) and stroke risk along with its subtypes is rarely reported. We aimed to investigate the association between HbA1c and the risk of incident stroke in patients with type 2 diabetes based on real world data from three healthcare systems.
Methods We performed a retrospective cohort study of 27,113 African Americans and 40,431 whites with type 2 diabetes. Demographic, anthropometric, laboratory, and medication information were abstracted from the National Patient-Centered Clinical Research Network common data model. Incident stroke events including both ischemic and hemorrhagic stroke were defined.
Results During a mean follow-up period of 3.79±1.68 years, 7,735 patients developed stroke (6,862 ischemic and 873 hemorrhagic). Multivariable-adjusted hazard ratios across levels of HbA1c at baseline (<6.0%, 6.0% to 6.9% [reference group], 7.0% to 7.9%, 8.0% to 8.9%, 9.0% to 9.9%, and ≥10%) were 1.07, 1.00, 1.13, 1.23, 1.27, and 1.37 (Ptrend <0.001) for total stroke, 1.02, 1.00, 1.13, 1.20, 1.24, and 1.35 (Ptrend <0.001) for ischemic stroke, and 1.40, 1.00, 1.14, 1.47, 1.47, and 1.51 (Ptrend=0.002) for hemorrhagic stroke. When we used an updated mean value of HbA1c, the U-shaped association of HbA1c with stroke risk did not change. This U-shaped association was consistent among patients of different subgroups. The U-shaped association was more pronounced among patients taking antidiabetic, lipid-lowering, and antihypertensive medications compared with those without these medications.
Conclusions These data suggest that diabetes management may have to be individualized according to the guideline recommendations rather than intensively attempting to lower HbA1c.
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Affiliation(s)
- Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Lizheng Shi
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | | | - Eboni Price-Haywood
- Ochsner Health System Center for Outcomes and Health Services Research, New Orleans, LA, USA
| | - Alessandra Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Somesh Nigam
- Blue Cross and Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Shen Y, Shi L, Nauman E, Katzmarzyk PT, Price-Haywood EG, Bazzano AN, Nigam S, Hu G. Association between Body Mass Index and Stroke Risk Among Patients with Type 2 Diabetes. J Clin Endocrinol Metab 2020; 105:5570275. [PMID: 31529060 PMCID: PMC6936963 DOI: 10.1210/clinem/dgz032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/09/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Very few studies focused on the association between body mass index (BMI) and stroke risk among patients with diabetes. OBJECTIVE We aimed to investigate the association between BMI and stroke risk in patients with type 2 diabetes. DESIGN Demographic, anthropometric, laboratory, and medication information were extracted from the National Patient-Centered Clinical Research Network common data model. PARTICIPANTS We performed a retrospective cohort study of 67 086 patients with type 2 diabetes. MAIN OUTCOME MEASURES Incident stroke including both ischemic and hemorrhagic stroke were defined. RESULTS During a mean follow up of 3.74 years. 8918 incident stroke events occurred. Multivariable-adjusted hazard ratios across different categories of BMI at baseline (18.5-24.9 [reference group], 25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40 kg/m2) were 1.00, 0.92, 0.85, 0.74, and 0.63 (Ptrend <0.001) for total stroke; 1.00, 0.93, 0.88, 0.77, and 0.65 (Ptrend <0.001) for ischemic stroke; and 1.00, 0.79, 0.50, 0.50, and 0.41 (Ptrend <0.001) for hemorrhagic stroke, respectively. When we used an updated mean value of BMI, the graded inverse association of body mass index with stroke risk did not change. This linear association was consistent among patients of different subgroups. Further sensitivity analysis excluding patients who were diagnosed stroke within 6 months after first diagnosis of type 2 diabetes or including non-smokers only also confirmed our findings. CONCLUSION The present study found an inverse association between BMI and the risk of total, ischemic, and hemorrhagic stroke among patients with type 2 diabetes. More clinical and molecular insights are still needed in explaining these findings.
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Affiliation(s)
- Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | | | - Eboni G Price-Haywood
- Ochsner Health System Center for Outcomes and Health Services Research, New Orleans, LA, USA
| | - Alessandra N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Somesh Nigam
- Blue Cross and Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Correspondence and Reprint Requests: Gang Hu, Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808.
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