Evidence of an accelerating increase in prevalence of diagnosed Type 2 diabetes in British men, 1978-2005

Performance and costs of multiple screening strategies for type 2 diabetes: two population-based studies in Shanghai, China

INTRODUCTION

To compare the performance and the costs of various assumed screening strategies for type 2 diabetes mellitus (T2DM) among Chinese adults, and identify an optimal one for the population.

RESEARCH DESIGN AND METHODS

Two multistage-sampling surveys were conducted in Shanghai, China, in 2009 and 2017. All participants were interviewed, had anthropometry, measured fasting plasma glucose (FPG), hemoglobin A1c (A1c) and/or postprandial glucose. The 1999 WHO diagnostic criteria was used to identify undiagnosed T2DM. A previously developed Chinese risk assessment system and a specific risk assessment system developed in this study were applied to calculate diabetes risk score (DRS) 1 and 2. Optimal screening strategies were selected based on the sensitivity, Youden index and the costs using the 2009 survey data as the training set and the 2017 survey data as the validation set. A twofold cross-validation was also performed.

RESULTS

Of numerous assumed strategies, FPG ≥5.6 mmol/L alone performed well (Youden index of 71.8%) and cost least (US$18.4 for each case detected), followed by the strategy of DRS2 ≥8 combining with FPG ≥5.6 mmol/L (Youden index of 71.7% and US$20.2 per case detected) and the strategy of DRS1 ≥17 combining with FPG ≥5.6 mmol/L (Youden index of 72.0% and US$21.6 per case detected). However, FPG alone resulted in more subjects requiring oral glucose tolerance test (OGTT) than did combining with DRS. The strategy of FPG ≥5.6 mmol/L combining with A1c ≥4.7% achieved a Youden index of 72.1%, but had a cost as high as US$48.8 for each case identified. Twofold cross-validation also supported the use of FPG alone, but with an optimal cut-off of 6.1 mmol/L.

CONCLUSIONS

Our results support the use of FPG alone in T2DM screening in Chinese adults. DRS may be used combining with FPG in populations with available electronic health records to reduce the number of OGTT and save costs of screening.

Post-war (1946-2017) population health change in the United Kingdom: A systematic review

We systematically reviewed the evidence on secular trends in main chronic conditions, disability and self-assessed general health among adults in the United Kingdom, as reported in primary/secondary care databases and population-based surveys. Searches were conducted separately for: (1) trends in age-standardised or age-specific prevalence of major non-communicable diseases, disability, and self-reported general health; (2) trends in health expectancy. The databases searched were MEDLINE, EMBASE/EMBASE Classic and Web of Science (all from 1946/7). The evidence was synthesised narratively. There were 39 studies reporting trends in prevalence of health conditions and 15 studies in health expectancy. We did not find evidence for improvement in the age-standardised or age-specific prevalence of any of the studied major chronic conditions over the last few decades, apart from Alzheimer's disease and other dementias. Both increasing or stable prevalence rates with simultaneous rising life expectancy support the expansion of morbidity theory, meaning that people are expected to spend a greater number of years with chronic condition(s). The evidence on disability-expressed as prevalence or health expectancy-was mixed, but also appeared to support the expansion of morbidity among those aged 65 or over. The evidence on trends in disability for younger age is lacking. Across the studied period (1946-2017), the UK population endured more years with chronic morbidity and disability, which may place a serious strain on the health care system, the economy and the society.

Genetic Variants of the Receptor for Advanced Glycation End-products in Susceptibility to Type 2 Diabetes Mellitus in Primary Hypertensive Patients

Diabetes mellitus is frequently comorbid with hypertension, which is approximately twice as common as diabetes mellitus in China. We designed a case-control association study to inspect the susceptibility of the receptor for advanced glycation end-products (RAGE) gene 6 variants to type 2 diabetes mellitus (T2DM) in 2199 patients with primary hypertension (1252 diabetic cases and 947 nondiabetic controls). The genotypes/alleles of −429T > C and 82Gly > Ser variants differed significantly between the two groups, and their associations with T2DM were significant after Bonferroni correction. Two variants, −374T > A and I/D, showed only marginal associations with T2DM. Haplotype analysis of above 4 significant variants indicated that a low-penetrance haplotype simultaneously bearing −429C and 82Ser alleles was overrepresented in cases relative to controls (4.75% vs. 1.72%, P < 0.001). Moreover, the predictive capability of 6 variants was significantly superior to available risk factors, with better goodness-of-fit. A predictive nomogram of 4 baseline risk factors and 2 variants of statistical significance was structured, with a good predictive accuracy (C-index = 0.761, P < 0.001). Taken together, our findings highlighted a contributory role of the RAGE gene, especially its two functional variants −429T > C and 82Gly > Ser, in susceptibility to T2DM in primary hypertensive patients, which may aid early detection and risk assessment for high-risk individuals.

Validity of diabetes self-reports in the Saku diabetes study

BACKGROUND

Diabetes is an important risk factor for cardiovascular disease, certain types of cancer, and death, and self-reports are one of the most convenient methods for ascertaining diabetes status. We evaluated the validity of diabetes self-reports among Japanese who participated in a health checkup.

METHODS

Self-reported diabetes was cross-sectionally compared with confirmed diabetes among 2535 participants aged 28 to 85 years in the Saku cohort study. Confirmed diabetes was defined as the presence of at least 1 of the following: fasting plasma glucose (FPG) level of 126 mg/dL or higher, 2-hour post-load glucose (2-hPG) level of 200 mg/dL or higher after a 75-gram oral glucose tolerance test, glycated hemoglobin (HbA1c) level of 6.5% or higher, or treatment with hypoglycemic medication(s).

RESULTS

Of the 251 participants with self-reported diabetes, 121 were taking hypoglycemic medication(s) and an additional 69 were classified as having diabetes. Of the 2284 participants who did not self-report diabetes, 80 were classified as having diabetes. These data yielded a sensitivity of 70.4%, a specificity of 97.3%, a positive predictive value of 75.7%, and a negative predictive value of 96.5%. The frequency of participants with undiagnosed diabetes was 3.0%. Of these, 64.2% had FPG within the normal range and were diagnosed by 2-hPG and/or HbA1c.

CONCLUSIONS

Our findings provide additional support for the use of self-reported diabetes as a measure of diabetes in epidemiologic studies performed in similar settings in Japan if biomarker-based diagnosis is difficult.

HbA1c for screening and diagnosis of diabetes mellitus

HbA1c has become the gold standard for monitoring glycemic control in patients with diabetes mellitus. The use of this test has been expanded to diagnose and screen for diabetes mellitus with the endorsement of influential diabetes societies and the World Health Organization. The literature on the use of HbA1c for the diagnosis and screening of diabetes mellitus was critically examined. There is substantial recent literature on this topic with strong advocates for the use of HbA1c to diagnose and screen for diabetes and equally strong detractors for its use. Advocates of the use of HbA1c cite challenges in respect of patient compliance and the analysis of glucose and inconsistency of diagnosis with glucose-based diabetes diagnosis with the elimination or reduction in these challenges in HbA1c-based diagnosis. Detractors of its use cite increased cost, concerns about the availability of HbA1c testing, and the influence of demographic and clinical factors on HbA1c results that make the use of a single-threshold values questionable for different ethnic and age groups. Despite the recommendation of many international diabetes societies that HbA1c be used for screening and diagnosis of diabetes mellitus, there is a wide divergence of opinion on this use.

A UK analysis of the cost-effectiveness of Humalog Mix75/25 and Mix50/50 versus long-acting basal insulin

INTRODUCTION

As healthcare spending on diabetes and its complications continues to rise, the optimization of prescribed insulin regimens is becoming increasingly important from both clinical and economic perspectives. The aim of the present study was to evaluate the cost-effectiveness of 75/25 biphasic insulin lispro and 50/50 biphasic insulin lispro (Humalog® Mix75/25 and Humalog® Mix50/50, respectively; Eli Lilly and Company, Indianapolis, IN, USA) compared with a long-acting analog insulin regimen in patients with type 2 diabetes.

METHODS

A published and validated computer simulation model of diabetes was used to evaluate the cost-effectiveness of 75/25 and 50/50 biphasic insulin lispro versus a long-acting analog insulin (insulin glargine) from the perspective of a healthcare payer in the UK. Treatment effects in terms of glycated hemoglobin (HbA1c) benefits were taken from a recent meta-analysis. Direct medical costs including pharmacy, complication, and patient management costs were obtained from published sources. All costs were expressed in 2008 British pounds sterling (GBP), and future costs and clinical benefits were discounted at 3.5% per annum. Sensitivity analyses were performed.

RESULTS

75/25 and 50/50 biphasic insulin lispro were associated with improvements in life expectancy of 0.09 and 0.13 years, respectively, improvements in quality-adjusted life expectancy of 0.09 quality-adjusted life years (QALYs) and 0.12 QALYs, respectively, and reductions in cost of GBP 1,217 and GBP 430, respectively, when compared with long-acting analog insulin.

CONCLUSION

Based on a recently published meta-analysis, biphasic analog insulins are likely to improve clinical outcomes and reduce costs versus long-acting analog insulins in the longterm treatment of patients with type 2 diabetes in the UK.

Increasing socio-economic inequality in type 2 diabetes prevalence--repeated cross-sectional surveys in England 1994-2006

BACKGROUND

This study aimed to evaluate the association of rising type 2 diabetes prevalence with socio-economic inequality in diabetes.

METHODS

Data from the Health Survey for England were analysed for 1994, 1998, 2003 and 2006. This is a nationally representative annual survey of private households. Data for 41,643 individuals aged ≥35 years were included. The prevalence of self-reported diabetes diagnosed by a doctor was analysed in relation to household income, occupational social class and educational qualifications. Data were standardized for age using the European Standard Population for reference.

RESULTS

Prevalence of diagnosed diabetes increased in men from 3.74% in 1994 to 7.25% in 2006, and in women from 2.28% to 4.88%. In 1994, there were no associations between social class or educational level and diabetes prevalence evident. In 2006, there was evidence of a negative association in women [prevalence ratio for social class (IV + V vs. I) = 4.54, P-value for trend = 0.005; prevalence ratio for educational level ('none' vs. 'A-levels') = 1.96, P-value for trend = 0.001]. The Slope Index of Inequality (SII) for social class in women increased from -1.65 in 1994 to -4.95 [95% Confidence Interval (95% CI -8.52 to -1.38)] in 2006 and for level of education from -1.39 to -6.48 (95% CI -9.03 to -3.93). In men, diabetes prevalence was not associated with social class or level of education.

CONCLUSION

Increasing prevalence of type 2 diabetes has been associated with an increase of socio-economic inequality in women. There was no socio-economic gradient observed in men.