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Lee H, Fernandes M, Lee J, Merino J, Kwak SH. Exploring the shared genetic landscape of diabetes and cardiovascular disease: findings and future implications. Diabetologia 2025; 68:1087-1100. [PMID: 40088285 PMCID: PMC12069157 DOI: 10.1007/s00125-025-06403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 01/28/2025] [Indexed: 03/17/2025]
Abstract
Diabetes is a rapidly growing global health concern projected to affect one in eight adults by 2045, which translates to roughly 783 million people. The profound metabolic alterations often present in dysglycaemia significantly increase the risk of cardiovascular complications. While genetic susceptibility plays a crucial role in diabetes and its vascular complications, identifying genes and molecular mechanisms that influence both diseases simultaneously has proven challenging. A key reason for this challenge is the pathophysiological heterogeneity underlying these diseases, with multiple processes contributing to different forms of diabetes and specific cardiovascular complications. This molecular heterogeneity has limited the effectiveness of large-scale genome-wide association studies (GWAS) in identifying shared underlying mechanisms. Additionally, our limited knowledge of the causal genes, cell types and disease-relevant states through which GWAS signals operate has hindered the discovery of common molecular pathways. This review highlights recent advances in genetic epidemiology, including studies of causal associations that have uncovered genetic and molecular factors influencing both dysglycaemia and cardiovascular complications. We explore how disease subtyping approaches can be critical in pinpointing the unique molecular signatures underlying both diabetes and cardiovascular complications. Finally, we address critical research gaps and future opportunities to advance our understanding of both diseases and translate these discoveries into tangible benefits for patient care and population health.
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Affiliation(s)
- Hyunsuk Lee
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- Genomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Maria Fernandes
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jeongeun Lee
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Jordi Merino
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA.
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.
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2
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Luk AOY, Wu H, Fan Y, Fan B, O CK, Chan JCN. Young-onset type 2 diabetes-Epidemiology, pathophysiology, and management. J Diabetes Investig 2025. [PMID: 40411309 DOI: 10.1111/jdi.70081] [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: 04/10/2025] [Revised: 05/22/2025] [Accepted: 05/09/2025] [Indexed: 05/26/2025] Open
Abstract
The prevalence and incidence of young-onset type 2 diabetes is increasing globally, especially in low- and middle-income countries, and predominantly affects non-White ethnic and racial populations. Young-onset type 2 is heterogeneous in terms of the genetic and environmental contributions to its underlying pathophysiology, which poses challenges for glycemic management. Young at-risk individuals remain underrepresented in clinical trials, including diabetes prevention studies, and there is still an insufficient evidence base to inform practice for this age group. Improvements in diabetes care delivery have not reached young people who will progress to have disabling complications at an age when they are most productive. This review summarizes recent studies on the epidemiology of young-onset type 2 diabetes and its complications. We discuss the genetic and environmental risk factors that act in concert to promote glycemic dysregulation and early onset of type 2 diabetes. We provide perspectives on diabetes prevention and management, and propose strategies to address the unique medical and psychosocial issues associated with young-onset type 2 diabetes. The Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes Randomized Controlled Trial (PRISM-RCT) is the first large-scale clinical trial designed to evaluate the effect of a structured care model that integrates biogenetic markers with communication and information technology on attaining strict metabolic targets and improving clinical outcomes in individuals with young-onset type 2 diabetes. The results of this study will inform the scientific community about the impact of multifactorial intervention and precision care in young patients, for whom the legacy effect is particularly significant.
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Affiliation(s)
- Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Phase 1 Clinical Trial Centre, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Yingnan Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Baoqi Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Chun Kwan O
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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3
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Scilletta S, Di Marco M, Miano N, Capuccio S, Musmeci M, Bosco G, Di Giacomo Barbagallo F, Martedì M, La Rocca F, Vitale A, Scicali R, Piro S, Di Pino A. Cardiovascular risk profile in subjects with diabetes: Is SCORE2-Diabetes reliable? Cardiovasc Diabetol 2025; 24:222. [PMID: 40399956 PMCID: PMC12096474 DOI: 10.1186/s12933-025-02769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Accepted: 05/02/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND People living with type 2 diabetes (T2D) are at a two- to four-fold higher risk of developing cardiovascular disease (CVD) compared with those without T2D, making early assessment of their CV risk essential. European Society of Cardiology (ESC) has developed a new model to estimate 10-year CV risk in people with T2D aged ≥ 40 years: SCORE2-Diabetes. Despite its advantages, several aspects remain to be clarified. This study evaluated the association between CV risk stratified by SCORE2-Diabetes and early CV damage assessed through arterial stiffness, intima-media thickness (IMT), and carotid atherosclerosis. Additionally, it examined the agreement between risk stratification by SCORE2 and SCORE2-Diabetes and their concordance with vascular damage. METHODS Pulse wave velocity (PWV), IMT, and carotid atherosclerosis were assessed in 179 individuals with T2D aged 40-69 years, categorized into SCORE2-Diabetes risk groups: Low (n = 20), Moderate (n = 29), High (n = 44), and very high (n = 37). Patients with a history of atherosclerotic cardiovascular disease (ASCVD) or severe target organ damage (TOD) constituted another group (ASCVD/TOD, n = 49). RESULTS PWV was significantly increased from Low to very high and ASCVD/TOD groups (7.2 ± 1.1, 8.7 ± 1.9, 9.8 ± 2.3, 12.8 ± 5.1 and 11.5 ± 3.8 m/s, respectively). Similarly, IMT showed a stepwise increase with risk class (0.68 ± 0.11, 0.78 ± 0.13, 0.83 ± 0.12, 0.86 ± 0.19 and 0.87 ± 0.15 mm, respectively). Patients in very high or ASCVD/TOD group showed a higher prevalence of carotid atherosclerosis than other groups (0%, 17.24%, 11.40%, 37.83% and 40.81%, respectively). No significant differences were found between the very high and ASCVD/TOD groups in any parameter. The correlation between PWV values and increasing CV risk was stronger for SCORE2-Diabetes than for SCORE2. ROC curve analysis showed SCORE2-Diabetes had superior predictive performance for carotid atherosclerosis and high PWV compared to SCORE2 (p = 0.048). CONCLUSIONS Higher PWV, IMT, and carotid atherosclerosis prevalence were associated with increasing CV risk stratified by SCORE2-Diabetes, with no significant differences between the very high and ASCVD/TOD groups. SCORE2-Diabetes demonstrated a better identification of preclinical vascular damage compared to SCORE2, supporting its use as a reliable tool for identifying vascular damage in T2D patients without ASCVD or TOD.
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Affiliation(s)
- Sabrina Scilletta
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Maurizio Di Marco
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Nicoletta Miano
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Stefania Capuccio
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Marco Musmeci
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Giosiana Bosco
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
- Department of Medicine and Surgery, "Kore" University of Enna, Enna, Italy
| | - Francesco Di Giacomo Barbagallo
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
- Department of Medicine and Surgery, "Kore" University of Enna, Enna, Italy
| | - Marina Martedì
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Francesca La Rocca
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Alessio Vitale
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy
| | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy.
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Mesa A, Franch-Nadal J, Navas E, Mauricio D. Cardiovascular disease in women with type 1 diabetes: a narrative review and insights from a population-based cohort analysis. Cardiovasc Diabetol 2025; 24:217. [PMID: 40399939 PMCID: PMC12093901 DOI: 10.1186/s12933-025-02791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2025] [Accepted: 05/14/2025] [Indexed: 05/23/2025] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality among people with type 1 diabetes (T1D), with cardiovascular mortality rates 2-5 times higher than in the general population. A concerning sex disparity exists within this high-risk population, as the cardioprotective advantage typically observed in women without diabetes appears attenuated or eliminated in individuals with T1D. This disparity is evident across the CVD spectrum, including coronary artery disease, stroke, heart failure, and cardiovascular mortality, with women consistently experiencing an excess burden of disease. These differences are particularly pronounced in women with early-onset T1D, leading to a substantial loss of life-years-approximately 18 years for women compared to 14 for men. Several factors may contribute to this sex disparity. First, the effect of hyperglycemia on CVD appears to have a sex-based differential impact and women with T1D often demonstrate more difficulties to achieve optimal glycemic control. Second, although women with T1D generally exhibit a more favorable CVD risk factor profile than men with T1D, the presence of hypertension, smoking or diabetic kidney disease seem to have a strong impact on CVD in women. Diabetes also appears to diminish sex-based differences in lipid metabolism, and a trend towards increased obesity rates among women with T1D has been observed. Lastly, female-specific factors, which are more prevalent in T1D, exacerbate cardiovascular risk. These include premature menopause, pregnancy-related disorders (such as preeclampsia), polycystic ovary syndrome, and autoimmune diseases, which disproportionately affect women. This narrative review examines the epidemiological evidence highlighting the aspects regarding the excess risk of CVD in women with T1D and evaluates sex disparities in both traditional and female-specific risk factors. Finally, we include a sex-based analysis from the Catalan Registry, which highlights the critical need for greater awareness and enhanced early detection and management of CVD risk factors in this population.
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Affiliation(s)
- Alex Mesa
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí 89, 08041, Barcelona, Spain.
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
| | - Josep Franch-Nadal
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Diabetis en Atenció Primaria (DAP-Cat) Group, Unitat de Suport a la Recerca Barcelona, Fundació IDIAP Jordi Gol I Gurina, Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Elena Navas
- Diabetis en Atenció Primaria (DAP-Cat) Group, Unitat de Suport a la Recerca Barcelona, Fundació IDIAP Jordi Gol I Gurina, Barcelona, Spain
| | - Dídac Mauricio
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí 89, 08041, Barcelona, Spain.
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
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5
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Figtree GA, Gray MP. Heart matters: the unique landscape of cardiovascular health in women. Climacteric 2025:1-6. [PMID: 40377107 DOI: 10.1080/13697137.2025.2497419] [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: 02/19/2025] [Revised: 04/10/2025] [Accepted: 04/21/2025] [Indexed: 05/18/2025]
Abstract
Cardiovascular disease (CVD) remains the leading cause of death globally, despite significant public health efforts. The identification and targeting of modifiable risk factors - including hypertension, dyslipidemia, diabetes mellitus, smoking and obesity - have led to significant improvements in patient outcomes over the past 60 years. However, current strategies based on this model have been shown to underestimate CVD risk in women and they are less frequently targeted compared to men. In addition, female-specific biological differences known to contribute to CVD are frequently understudied or excluded from risk stratification efforts. This review explores the unique epidemiological burden, pathobiology and outcomes of CVD in women; the influence of traditional and sex-specific risk factors; and both diagnostic and therapeutic strategies that may improve clinical outcomes in the future.
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Affiliation(s)
- Gemma A Figtree
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Michael P Gray
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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6
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Yang Y, Wu S, Zhang J, Liu Y, Yin M, Huo Z, Chen S, Wang G, Xiao Y, Wang Y, Li Y, Deng J, Geng T, Zhang H. Time in target range for systolic blood pressure and stroke in people with and without diabetes: the Kailuan prospective cohort study. Front Endocrinol (Lausanne) 2025; 16:1537343. [PMID: 40438396 PMCID: PMC12116358 DOI: 10.3389/fendo.2025.1537343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Accepted: 04/22/2025] [Indexed: 06/01/2025] Open
Abstract
Objective Systolic blood pressure time in target range (SBP-TTR) is an independent risk factor for stroke. We aimed to investigate the associations of SBP-TTR with stroke among participants with or without diabetes using data from the Kailuan study. Methods We included 28,591 participants [mean age, 57.5 years; 83.8% men; 23.2% with diabetes] from the Kailuan Study. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of SBP-TTR on stroke in individuals with and without diabetes. Results After a median of 8.7 years follow-up, 2,206 stroke cases occurred. Among participants with diabetes, those with SBP-TTR 75%-100% (HR [95%CI]: 0.64 [0.49, 0.84]) had a lower risk of stroke compared to those with SBP-TTR 0%-25%. Among participants without diabetes, those with SBP-TTR 50%-75% (HR 0.75, 95% CI 0.64-0.88) and 75%-100% (HR [95%CI]: 0.62 [0.52, 0.73]) had a significantly lower risk of stroke. A significant interaction between diabetes status and SBP-TTR was observed (P for interaction = 0.03). Additionally, the restricted cubic spline analysis showed a non-linear relationship between SBP-TTR and stroke risk among participants with diabetes (P for non-linearity = 0.001), and a linear relationship among those without diabetes (P for non-linearity = 0.035). Conclusion Higher SBP-TTR was associated with a reduced risk of stroke among participants with or without diabetes. The findings underscore the importance of maintaining blood pressure within the target range to mitigate stroke risk, particularly emphasizing the need for stringent blood pressure control in diabetic patients.
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Affiliation(s)
- Yuxin Yang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jingdi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yang Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Mingjie Yin
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhenyu Huo
- Department of Epidemiology and Biostatistics, School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yao Xiao
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Wang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuanyuan Li
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiawen Deng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tingting Geng
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hong Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
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Goldney J, Melson E, Verma A, Khunti K, Zaccardi F, Davies MJ, Seidu S. The association between ethnicity and complications in individuals with early-onset type 2 diabetes: A systematic review. Prim Care Diabetes 2025:S1751-9918(25)00104-4. [PMID: 40374437 DOI: 10.1016/j.pcd.2025.05.006] [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: 03/24/2025] [Revised: 05/08/2025] [Accepted: 05/09/2025] [Indexed: 05/17/2025]
Abstract
It remains unclear whether the prevalence and incidence of complications varies with ethnicity in individuals with early-onset type 2 diabetes. We undertook a systematic review to investigate. We identified sparse published data, with no clear findings. More prospective studies are needed. Epidemiological studies should routinely stratify by ethnicity.
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Affiliation(s)
- Jonathan Goldney
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK.
| | - Eka Melson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK; Medical Research Council Laboratory of Medical Sciences and Imperial College London, London W12 0HS, UK
| | - Ansh Verma
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Samuel Seidu
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
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Syed I, Sluis K, Aryal P, Solomon Z, Patel R, Konduri S, Siegel D, Smith U, Kahn BB. Specific FAHFAs Predict Worsening Glucose Tolerance in Non-Diabetic Relatives of People with Type 2 Diabetes. J Lipid Res 2025:100819. [PMID: 40334782 DOI: 10.1016/j.jlr.2025.100819] [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: 03/25/2025] [Revised: 05/01/2025] [Accepted: 05/02/2025] [Indexed: 05/09/2025] Open
Abstract
There is a growing need for early biomarkers for Type 2 diabetes (T2D). Fatty-Acid-Hydroxy-Fatty-Acids (FAHFAs) are bioactive lipids with >580 regioisomers in human tissues. FAHFAs such as Palmitic Acid Hydroxy Stearic Acids (PAHSAs) are anti-diabetic and anti-inflammatory. PAHSA concentrations in human serum and adipose tissue strongly correlate with insulin-sensitivity. Since PAHSAs and palmitic acid hydroxy oleic acids (PAHOAs) are among the most abundant FAHFAs in human serum, we investigated whether they predict worsening glucose tolerance in first-degree relatives of people with T2D. All participants had normal glucose tolerance (NGT) at baseline; 27 remained NGT (NGT-NGT) and 21 developed impaired glucose tolerance (NGT-IGT). In NGT-NGT, total PAHSA and PAHSA regioisomer concentrations were unchanged from baseline to follow up, while in NGT-IGT participants, most PAHSA regioisomers decreased. The initial total PAHSAs, 5-PAHSA, and 9-PAHSA, and changes in these correlated inversely with worsening glucose tolerance. Low total PAHSA concentrations at baseline and the decrease in total PAHSAs, 5-PAHSAs and 9-PAHSAs over time predicted IGT independent of initial BMI or %body fat, change in BMI or %body fat, initial fasting glucose, fasting insulin or triglyceride/HDL ratio. In contrast, baseline and follow up total PAHOA and PAHOA regioisomer levels were higher in NGT-IGT than NGT-NGT and some PAHOA regioisomers increased during follow up in NGT-IGT. Higher initial total PAHOAs predicted IGT independent of the same clinical variables. Thus, lower serum PAHSAs and higher PAHOAs predict worsening glucose tolerance/IGT independent of BMI, %body fat or change in these parameters even in lean, relatively young people.
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Affiliation(s)
- Ismail Syed
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ken Sluis
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Pratik Aryal
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary Solomon
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Rucha Patel
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Srihari Konduri
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Dionicio Siegel
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ulf Smith
- The Lundberg Laboratory for Diabetes Research, Departments of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Barbara B Kahn
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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9
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Jeong S, Lin L, Leone AP, Hsu YH. Type 2 diabetes and late-onset Alzheimer's disease and related dementia: A longitudinal cohort study integrating polygenic risk score. J Alzheimers Dis 2025; 105:107-119. [PMID: 40129417 DOI: 10.1177/13872877251326107] [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] [Indexed: 03/26/2025]
Abstract
BackgroundThe inherent genetic effects were not established between type 2 diabetes (T2DM) and Alzheimer's disease and related dementia (ADRD).ObjectiveWe aimed to investigate the association between T2DM and ADRD by integrating T2DM polygenic risk score (PRS) and applying matching in every subgroup.MethodsWe utilized UK Biobank First-occurrences datasets. T2DM were 1:1 matched to non-T2DM using propensity scores generated by 8 covariates; age at diagnosis, sex, cerebrovascular disease, ischemic heart disease, hypertensive disorders, lipid disorders, obesity, and mood disorders. T2DM PRS was additionally matched in T2DM PRS matched analysis. Subgroup analyses by age at diagnosis, sex, and APOE4 genotype were performed with the same matching criteria within each subgroup. Cox proportional hazard and Fine & Gray competing risk model were utilized.ResultsIn T2DM PRS unmatched cohort, 24,583 T2DM were 1:1 matched to non-T2DM. The mean age at diagnosis was around 62 years old, with females constituting around 40%. Up to 25-year follow-up, ADRD rate/1000 person-years was 0.88 versus 1.52 (Non-T2DM versus T2DM); PRS unmatched (cHR: 1.72, 95% CI: 1.46-2.03) and matched (cHR:1.75, 95% CI: 1.47-2.09). Except for older age onset (≥75 years), the other subgroups demonstrated significantly increased ADRD risks in T2DM. T2DM PRS was higher in non-ADRD group across all subgroups. Contrarily, T2DM PRS was higher in ADRD in younger onset group (<55 years).ConclusionsT2DM is one of the strong risk factors of ADRD but genetic T2DM effect does not contribute to ADRD risk. However, a genetic link might be present in younger age onset group.
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Affiliation(s)
- Sohyun Jeong
- Department of Pharmacy Practice, College of Pharmacy, Massachusetts College of Pharmacy and Health Science, Boston, MA, USA
| | - Lisha Lin
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Alvaro-Pascual Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Yi-Hsiang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard University, Cambridge, MA, USA
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10
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Xu Z, Tao Z, Guo Y. The role of tea in managing cardiovascular risk factors: potential benefits, mechanisms, and interventional strategies. Front Nutr 2025; 12:1530012. [PMID: 40342365 PMCID: PMC12058793 DOI: 10.3389/fnut.2025.1530012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 03/21/2025] [Indexed: 05/11/2025] Open
Abstract
Traditional major cardiovascular disease (CVD) risk factors include dyslipidemia, hypertension, smoking, diabetes, and obesity. Tea is rich in various bioactive substances such as tea polyphenols, theaflavins, and tea polysaccharides. Due to the regulatory effects on multiple pathways and its anti-inflammatory and antioxidant properties, these active substances have shown significant efficacy in regulating dyslipidemia, hypertension, diabetes, obesity, and cardiac autonomic function. Additionally, tea possesses anti-inflammatory and antithrombotic properties, making it a promising dietary supplement for nutritional interventions in the primary and secondary prevention of CVDs. However, the complex composition of tea, although shown to have certain effects in vivo, does not fully elucidate the specific mechanisms of action. Moreover, the varying application methods across different studies lead to differences in intervention effects and dose-response relationships, sometimes resulting in contradictory findings. This article reviews the potential benefits, mechanisms of action, and application methods of tea for cardiovascular risk factors, elucidating its potential as a nutritional intervention.
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Affiliation(s)
- Ziming Xu
- Xiyuan Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhu Tao
- Xiyuan Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
- The Chinese Journal of Integrated Traditional and Western Medicine Press, Beijing, China
| | - Yan Guo
- Xiyuan Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing, China
- The Chinese Journal of Integrated Traditional and Western Medicine Press, Beijing, China
- WHO Collaborating Center for Traditional Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
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11
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Molavizadeh D, Asgari S, Assarian BA, Azizi F, Hadaegh F. Association between diabetes phenotypes with hypertension and cardiovascular diseases, using single-sample confirmatory testing: a national study. Acta Diabetol 2025:10.1007/s00592-025-02484-5. [PMID: 40261368 DOI: 10.1007/s00592-025-02484-5] [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: 11/03/2024] [Accepted: 02/28/2025] [Indexed: 04/24/2025]
Abstract
AIM To investigate, for the first time, the association between undiagnosed diabetes-using a single-sample confirmatory definition-and prevalent hypertension and cardiovascular diseases (CVD) in an Iranian national population. A few studies on this topic have been limited to Western populations. METHODS The study included 16328 adults aged ≥ 30 years. Diabetes phenotypes were classified as: 1-no diabetes: fasting plasma glucose (FPG) < 7 mmol/L (126 mg/dL) and glycated hemoglobin (HbA1c) < 6.5% (48 mmol/mol), as reference; 2-unconfirmed undiagnosed diabetes: having elevated levels of either FPG or HbA1c; 3-confirmed undiagnosed diabetes: having elevated levels of both tests; 4-known diabetes: self-reported history of glucose-lowering medications. Hypertension was defined using American Heart Association criteria. Self-reported history of CVD is defined as prevalent CVD. Multivariable logistic regression models were applied to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between diabetes phenotypes with hypertension and CVD. RESULTS Prevalence of unconfirmed undiagnosed-, confirmed undiagnosed-, and known -diabetes was calculated as 2.70, 3.10, and 5.64%, respectively. Unconfirmed undiagnosed-, confirmed undiagnosed-, and known -diabetes were associated with hypertension with corresponding OR were, 1.30, 1.37, and 1.62; the related values for CVD were 1.80, 1.61, and 2.38; and for the coexistence of CVD and hypertension were 1.86, 1.79, and 2.80, respectively (all P values < 0.05). Furthermore, isolated HbA1c elevation was significantly associated with prevalent CVD [2.04 (1.20-3.45)], and coexistence of hypertension and CVD [1.89 (1.00-3.55)]. CONCLUSIONS Both unconfirmed- and confirmed- undiagnosed -diabetes were significantly associated with hypertension and CVD, the issue that was mainly attributable to high HbA1c.
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Affiliation(s)
- Danial Molavizadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Metabolic and Obesity Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Islamic Republic of Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Metabolic and Obesity Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Islamic Republic of Iran
| | - Borna Ali Assarian
- University Hospital Southampton NHS Foundation Trust, Southampton, SO166YD, UK
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Metabolic and Obesity Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Islamic Republic of Iran.
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12
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He S, Qian X, Wang J, Shen X, An Y, Zhang B, Chen B, Li H, Chen X, Chen Y, Wang Y, Jin C, Gong Q, Li G. Younger-onset type 2 diabetes associated with increased long-term cancer risk in Chinese adults: A 30-year follow-up of the Da Qing Diabetes Study. BJC REPORTS 2025; 3:24. [PMID: 40263628 PMCID: PMC12015435 DOI: 10.1038/s44276-025-00142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 03/05/2025] [Accepted: 04/01/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND We investigated the association between younger-onset type 2 diabetes, duration of diabetes, and cancer risk based on data from the Da Qing Diabetes Prevention Outcome Study (DQDPOS). METHODS The analysis recruited 620 younger-onset (age≤50 years) and 649 older-onset (age>50 years) patients with type 2 diabetes, and 310 younger non-diabetes controls (age≤50 years). Multiple regression analysis was used to test the influence of younger-onset diabetes and duration of diabetes on the long-term risk of cancer. RESULTS The annual incidence of all cancer among the non-diabetes, younger-, and older-onset type 2 diabetes was significantly different (3.7, 5.5, and 4.0/1000 person-years, respectively). The standard Cox analysis revealed that the patients with younger-onset diabetes had a significantly higher risk of cancer than those with older-onset diabetes (hazard ratio [HR]:1.81; 95% confidence interval [CI]:1.20-2.73) and younger non-diabetic controls (HR:2.43; 95% CI:1.34-4.41) after adjustment for diabetes duration and other confounders. Stepwise general linear regression model analysis revealed that a longer diabetes-free time was associated with longer lifetime cancer-free years (partial R2 = 0.36, p < 0.001), in addition to the non-modifiable predictor duration of diabetes. CONCLUSIONS Younger-onset type 2 diabetes was significantly associated with an increased risk of cancer beyond the influence of diabetes duration.
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Affiliation(s)
- Siyao He
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Qian
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Xiaoxia Shen
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yali An
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Bo Chen
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Li
- Department of Cardiology, Da Qing First Hospital, Da Qing, China
| | - Xiaoping Chen
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Yanyan Chen
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Qiuhong Gong
- Endocrinology Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwei Li
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
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Rodríguez Cabalé G, Rodríguez Cabalé E, Pubul Núñez V, Ruibal Morell Á. Model to predict the risk of cardiac death based on clinical characteristics and Gated-SPECT parameters. Rev Esp Med Nucl Imagen Mol 2025:500132. [PMID: 40204127 DOI: 10.1016/j.remnie.2025.500132] [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: 10/22/2024] [Accepted: 03/03/2025] [Indexed: 04/11/2025]
Abstract
BACKGROUND Coronary artery disease is a complex, multifactorial process with high prevalence and morbidity-mortality. Single photon emission computed tomography (SPECT) myocardial perfusion imaging synchronized with the electrocardiogram (gated-SPECT) is a non-invasive imaging technique that has demonstrated high sensitivity and specificity for diagnosis and staging. To better predict the risk of adverse events, it is necessary to analyze the simultaneous behavior of clinical elements and diagnostic tests, a type of study that is scarce in the current literature. This research evaluated the relationship between clinical characteristics and gated-SPECT myocardial perfusion parameters with progression to cardiac death; subsequently, a model was built to predict the risk of such an outcome. METHODS An observational, longitudinal, and retrospective study was conducted with 2 230 patients who underwent this test due to suspected coronary artery disease. Clinical characteristics, test parameters, and progression to cardiac death were collected and the relationships between them were studied. A logistic regression model was built to study the relationships between the variables and their influence on the probability of progression to cardiac death. RESULTS Clinical characteristics associated with a higher probability of cardiac death were male sex (OR = 5.104, p = 0.004), peripheral arterial disease (OR = 7.175, p < 0.001), and diabetes mellitus (OR = 3.159, p = 0.013). The gated-SPECT parameters associated with a higher risk of this outcome were VTS ≥70 ml (OR = 12.257, p < 0.001), EF < 50% (OR = 10.757, p < 0.001), VTD ≥140 ml (OR = 8.884, p < 0.001), ventricular dilation (OR = 8.959, p < 0.001), and reversible defects (OR = 7.454, p = 0.001). Fixed defects, parietal motility abnormalities, the presence of both reversible and fixed defects, and the hyperdynamic gated state were also associated with a higher risk of cardiac death but with lower ORs. The logistic regression model showed good overall performance and high ability to determine progression to cardiac death, close to perfect predictive capacity (AUC = 0.9656).
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Affiliation(s)
| | | | - Virginia Pubul Núñez
- Departamento de Medicina Nuclear, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Álvaro Ruibal Morell
- Departamento de Medicina Nuclear, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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14
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Clement NS, Abul A, Farrelly R, Murphy HR, Forbes K, Simpson NAB, Scott EM. Pregnancy outcomes in type 2 diabetes: a systematic review and meta-analysis. Am J Obstet Gynecol 2025; 232:354-366. [PMID: 39662865 DOI: 10.1016/j.ajog.2024.11.026] [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: 08/07/2024] [Revised: 11/13/2024] [Accepted: 11/28/2024] [Indexed: 12/13/2024]
Abstract
OBJECTIVE Type 2 diabetes (T2D) now accounts for the majority of pre-existing diabetes affecting pregnancy in the UK. Our aim was to determine its impact on pregnancy outcomes compared to type 1 diabetes (T1D), gestational diabetes (GDM), and nondiabetes pregnancies. DATA SOURCES PubMed was searched 1 January 2009 to 2024. STUDY ELIGIBILITY CRITERIA Cohort observational studies reporting original data on at least one of the primary outcomes in ten or more T2D pregnancies were eligible for inclusion. Comparative diabetes and nondiabetes pregnancies were also collected. METHODS Primary outcomes included congenital anomalies, stillbirths, neonatal and perinatal mortality, birthweight, rates of large for gestational age (LGA), small for gestational age (SGA), and macrosomia. PROSPERO ID CRD42023411057. RESULTS Forty seven studies were analyzed. The number of pregnancies in each analysis varied depending on the available data from the outcome being analyzed but ranged from 723 to 4,469,053 pregnancies. When compared with T1D pregnancies, T2D were more likely to have SGA babies as well as greater neonatal and perinatal mortality (OR 2.29, 95% CI 1.12-4.67; OR 1.53 95% CI 1.20-1.94, and OR 1.31 95% CI 1.07-1.61, respectively). When compared with GDM, T2D were more likely to have babies with congenital anomalies (OR 1.91, 95% CI 1.04-3.50), LGA (OR 3.49, 95% CI 2.49-4.89), neonatal mortality (OR 3.96, 95% CI 3.38-4.64), and stillbirth (OR 16.55, 95% CI 5.69-48.11). In comparison to nondiabetic pregnancy, T2D were more likely to have babies with congenital anomalies (OR 1.76, 95% CI 1.11-2.79), LGA (OR 2.79, 95% CI 1.93-4.04), perinatal mortality (OR 4.18, 95% CI 2.91-6.01), and stillbirth (OR 7.27, 95% CI 3.01-17.53). CONCLUSION T2D pregnancies are associated with a greater perinatal mortality than other forms of diabetes in pregnancy. Given its increasing prevenance, greater awareness of the adverse pregnancy outcomes associated with T2D is needed, by both healthcare providers and policy makers, to improve care.
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Affiliation(s)
- Naomi S Clement
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Ahmad Abul
- Division of Surgical and Interventional Sciences, University College London, London, UK
| | - Rachel Farrelly
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Karen Forbes
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Nigel A B Simpson
- Department of Women's and Children's Health, University of Leeds, Leeds, UK
| | - Eleanor M Scott
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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15
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Loh WJ, Watts GF. Cardiometabolic risk factors in women: what's sauce for the goose is not sauce for the gander. Curr Opin Endocrinol Diabetes Obes 2025; 32:59-65. [PMID: 39221620 DOI: 10.1097/med.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW The aim of this review was to discuss cardiometabolic risk factors that affect women. RECENT FINDINGS Recent calls to action to address cardiometabolic risk factors specific to women relate to increasing evidence of sex-specific differences in patient-related, drug-related, and socio-demographic factors leading to sub-optimal care of women. SUMMARY Certain aspects of common modifiable cardiovascular risk factors (e.g. smoking, hypertension, dyslipidaemia and diabetes) affect female individuals more adversely. Additionally, there are risk factors or enhancers that particularly affect cardiometabolic health in women [e.g. premature menopause, polycystic ovarian syndrome (PCOS), familial partial lipodystrophy, socio-cultural factors]. Understanding these risk factors may provide insight on how to improve cardiometabolic outcomes in women.
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Affiliation(s)
- Wann Jia Loh
- Department of Endocrinology, Changi General Hospital
- Duke-NUS Medical School, Singapore
- Medical School, University of Western Australia
| | - Gerald F Watts
- Medical School, University of Western Australia
- Department of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia
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16
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Ahmad MS, Alharbi AOM, Tawakul A, Alturiqy AM, Alzahrani M, Shaik RA. A Case-Control Study on Risk Factors and Outcomes in Congestive Heart Failure. Rev Cardiovasc Med 2025; 26:26601. [PMID: 40160581 PMCID: PMC11951482 DOI: 10.31083/rcm26601] [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] [Received: 09/17/2024] [Revised: 01/04/2025] [Accepted: 01/07/2025] [Indexed: 04/02/2025] Open
Abstract
Background Congestive heart failure (CHF) represents an important health issue characterised by considerable morbidity and mortality. This study sought to identify risk factors for CHF and to evaluate clinical outcomes between CHF patients and control subjects. Methods Data were obtained through interviews, physical examinations, and medical records. Risk variables encompassed hypertension, diabetes, dyslipidaemia, tobacco use, alcohol use, sedentary lifestyle, dietary practices, age, gender, and familial history of cardiovascular disease. The outcomes were all-cause mortality, cardiovascular mortality, hospitalisation, major adverse cardiovascular events (MACE), quality of life as measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and functional level according to the New York Heart Association (NYHA) classification. Statistical analyses including t-tests, Chi-square tests, logistic regression and Cox regression. Results The findings indicated that hypertension (71.8% vs. 38.5%, p < 0.001), diabetes (47.9% vs. 28.2%, p = 0.002), dyslipidaemia (54.7% vs. 41.0%, p = 0.04), smoking (42.7% vs. 29.1%, p = 0.03), and physical inactivity (65.8% vs. 41.9%, p < 0.001) were more prevalent in cases. Cases exhibited increased hospitalisations (1.8 ± 1.2 vs. 0.7 ± 0.9, p < 0.001), prolonged stays (10.5 ± 5.4 vs. 6.2 ± 3.8 days, p < 0.001), elevated 30-day rehospitalisation rates (21.4% vs. 8.5%, p = 0.007), and a greater incidence of intensive care units (ICU) admissions (17.1% vs. 6.0%, p = 0.01). All-cause mortality (35.9% vs. 17.1%, p = 0.001), cardiovascular mortality (25.6% vs. 10.3%, p = 0.003), and MACE (51.3% vs. 25.6%, p < 0.001) were greater in cases. Quality of life (45.8 ± 12.4 vs. 25.6 ± 10.3, p < 0.001) and functional status (55.6% vs. 23.9%, p < 0.001) were inferior in cases. Conclusion CHF patients had greater rates of modifiable risk variables and worse clinical outcomes than controls, underscoring the necessity for comprehensive risk management.
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Affiliation(s)
- Mohammad Shakil Ahmad
- Department of Family and Community Medicine, College of Medicine, Majmaah University, 11952 Majmaah, Saudi Arabia
| | | | - Abdullah Tawakul
- Internal Medicine Department at Faculty of Medicine, Umm Al-Qura University, 21955 Makkah, Saudi Arabia
| | | | - Mansour Alzahrani
- Department of Family and Community Medicine, College of Medicine, Majmaah University, 11952 Majmaah, Saudi Arabia
| | - Riyaz Ahamed Shaik
- Department of Family and Community Medicine, College of Medicine, Majmaah University, 11952 Majmaah, Saudi Arabia
- Department of Community Medicine, Koppal Institute of Medical Sciences, 583231 Koppal, Karnataka, India
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Xu L, Ran J, Shao H, Chen M, Tang H, Li Y, Xu Y, Huang Y, Tao F, Liu Z, Zhong VW. Incidence and Risk Factors of Diagnosed Young-Adult-Onset Type 2 Diabetes in the U.S.: The National Health Interview Survey 2016-2022. Diabetes Care 2025; 48:371-380. [PMID: 39752552 DOI: 10.2337/dc24-1699] [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: 08/12/2024] [Accepted: 11/13/2024] [Indexed: 02/22/2025]
Abstract
OBJECTIVE To estimate the incidence and identify risk factors for diagnosed type 2 diabetes (T2D) among young U.S. adults. RESEARCH DESIGN AND METHODS We analyzed 142,884 adults aged 18-79 years with self-reported diabetes type from the cross-sectional National Health Interview Survey in 2016-2022, representing the noninstitutionalized U.S. civilian population. Incidence of diagnosed T2D was calculated for three age groups: young-adult onset (18-44 years), middle-age onset (45-64 years), and older-adult onset (65-79 years); the latter two groups were included to highlight the distinct risk factor profile of young-adult-onset T2D. Multivariable logistic regressions were used to identify risk factors for young-adult-onset T2D. RESULTS The estimated incidence of diagnosed young-adult-onset T2D was 3.0 per 1,000 adults (95% CI 2.6-3.5). Minority groups, socioeconomically disadvantaged individuals, and people with cardiometabolic diseases or psychological conditions had a higher incidence of diagnosed young-adult-onset T2D compared with their counterparts. Lipid-lowering medication use (adjusted odds ratio [aOR] 13.15, 95% CI 8.85-19.55), antihypertensive medication use (aOR 11.89, 95% CI 7.97-17.73), and obesity (BMI ≥30 vs. <25 kg/m2, aOR 10.89, 95% CI 6.69-17.7) were the strongest risk factors for young-adult-onset T2D; these risk factors, along with hypertension, hyperlipidemia, and coronary heart disease, were more strongly associated with young-adult-onset T2D compared with later-onset T2D, with up to 4.5 times higher aORs. CONCLUSIONS This study quantified the incidence of diagnosed young-adult-onset T2D in U.S. adults and identified its distinct risk factor profile. Targeted prevention strategies for young-adult-onset T2D are needed for minority and socioeconomically disadvantaged people and those with cardiometabolic diseases.
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Affiliation(s)
- Lan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinjun Ran
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Shao
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, GA
| | - Meng Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongxuan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaqing Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Tao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhenxiu Liu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Victor W Zhong
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Li K, Zhu F, Shi S, Wu D, Zhong VW. Trends and Racial/Ethnic Differences in Age at Diagnosis of Adult-Onset Type 1 and Type 2 Diabetes in the United States, 2016-2022. Am J Prev Med 2025; 68:571-579. [PMID: 39645156 DOI: 10.1016/j.amepre.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 11/27/2024] [Accepted: 12/01/2024] [Indexed: 12/09/2024]
Abstract
INTRODUCTION Age at diagnosis of diabetes is important for informing public health planning and treatment strategies. This study aimed to estimate trends and racial/ethnic differences in age at diagnosis of adult-onset diabetes by type in the U.S. METHODS This serial nationwide cross-sectional study used data from the National Health Interview Survey in 2016-2022. Adults aged ≥18 years with self-reported age at diagnosis of adult-onset type 1 diabetes or type 2 diabetes were included. Trends in mean age at diagnosis of type 1 diabetes and type 2 diabetes and in proportions of people with type 1 diabetes or type 2 diabetes diagnosed at different ages were assessed by linear and logistic regressions. Racial/ethnic differences in mean age at diagnosis of type 1 diabetes and type 2 diabetes were determined. RESULTS Included were 1,224 type 1 diabetes cases and 14,221 type 2 diabetes cases. From 2016 to 2022, the mean age at diagnosis of type 2 diabetes increased by 0.18 years annually (95% CI=0.05, 0.30 years, p=0.005), but no significant trend was observed for type 1 diabetes. The proportion of type 2 diabetes cases with diagnosis age ≥60 years increased by 3.17% and with diagnosis age in 18-29 years decreased by 5.62% annually (p≤0.01). On average, Hispanic individuals had type 1 diabetes diagnosed 3.2 years older and minority groups had type 2 diabetes diagnosed 2.0-6.1 years younger than non-Hispanic White individuals (p≤0.02). CONCLUSIONS Among U.S. adults, the mean age at diagnosis of adult-onset type 1 diabetes remained stable, and of adult-onset type 2 diabetes increased significantly from 2016 to 2022. Substantial and opposite differences in mean diagnosis age of type 1 diabetes and type 2 diabetes by race/ethnicity were identified.
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Affiliation(s)
- Kexin Li
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Zhu
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Shuxiao Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deshan Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Victor W Zhong
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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19
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Huang L, Zeng J, Luo Y, Wang H, Zhang Z, Zeng Y. The comorbidity burden of diabetes and stroke: a retrospective study in Beijing, China. BMC Public Health 2025; 25:546. [PMID: 39930417 PMCID: PMC11812224 DOI: 10.1186/s12889-025-21705-8] [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: 10/13/2024] [Accepted: 01/30/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND The high costs associated with diabetes management, coupled with the increasing prevalence of comorbidities, present a significant challenge to China's healthcare system, with cardiovascular complications being particularly prominent. The purpose of this study was to evaluate the comorbidities of diabetic patients with stroke in Beijing from 2016 to 2018 and the impact on treatment options and associated costs. METHODS This retrospective cohort study included diabetic patients enrolled in Beijing's medical insurance with outpatient medical records. We compared comorbidities, medications, and related treatment costs between stroke and non-stroke patients. RESULTS A representative sample of 2,853,036 patients with diabetes was identified from the data collected from 2016 to 2018, of which an average of 21.18% of patients reported stroke. A higher percentage of diabetic patients with stroke reported other comorbidities including hypertension, coronary artery disease, dyslipidemia, chronic respiratory disease, and osteoporosis as compared to those without stroke(all p's < 0.0001). The costs increased dramatically if diabetic patients developed comorbidities, including hypertension, CAD, dyslipidemia, CRD, and osteoporosis. Annual costs of medications were higher for diabetic patients with stroke and any types of comorbidity compared to diabetic patients without stroke (p <.0001, respectively). More types of drugs were used for diabetic patients with stroke and any types of comorbidity. CONCLUSIONS The needs of individuals with diabetes and stroke, including their comorbidity patterns and medical burdens, must be carefully taken into account. Health systems will need to address the increasing demand for diagnosing and managing comorbidities in individuals with diabetes and stroke.
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Affiliation(s)
- Linyan Huang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong, 510280, China
| | - Jiadong Zeng
- Department of Organ Transplantation, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong, 510280, China
| | - Ying Luo
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong, 510280, China
| | - Hanming Wang
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou, 510006, P. R. China
| | - Zhen Zhang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong, 510280, China.
| | - Yi Zeng
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, Guangdong, 510280, China.
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Ohkuma T, Harris K, Woodward M, Hamet P, Harrap S, Mancia G, Marre M, Poulter N, Chalmers J, Zoungas S. Intensive Glucose Lowering and Its Effects on Vascular Events and Death According to Age at Diagnosis and Duration of Diabetes: The ADVANCE Trial. Diabetes Care 2025; 48:279-284. [PMID: 39661106 DOI: 10.2337/dc24-1516] [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: 07/22/2024] [Accepted: 11/08/2024] [Indexed: 12/12/2024]
Abstract
OBJECTIVE To compare the vascular effects of pursuing more versus less glucose lowering in patients with younger or older age at diabetes diagnosis, and with shorter or longer diabetes duration. RESEARCH DESIGN AND METHODS We studied 11,138 participants from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial, classified into subgroups defined by age at diabetes diagnosis (≤50, >50-60, and >60 years) and diabetes duration (≤5, >5-10, and >10 years). RESULTS Intensive glucose lowering significantly lowered the risk of the primary composite outcome of major macrovascular and microvascular events (hazard ratio 0.90, 95% CI 0.82-0.98) with no evidence of heterogeneity in the proportional effects across subgroups defined by age at diagnosis or diabetes duration (P for heterogeneity = 0.86 and 0.47, respectively). Similar consistent treatment effects were also observed for all-cause death, cardiovascular death, and the components of major vascular events. CONCLUSIONS Intensive glucose lowering may be recommended irrespective of age at diagnosis or diabetes duration.
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Affiliation(s)
- Toshiaki Ohkuma
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, U.K
| | - Pavel Hamet
- Centre de Recherche, Center Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Stephen Harrap
- Department of Anatomy and Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | | | - Michel Marre
- Clinique Ambroise Paré, Neuilly-sur-Seine, France
- Institut Necker Enfants Malades, INSERM, Université Paris Cité Universite, Paris, France
| | - Neil Poulter
- School of Public Health, Imperial College, London, U.K
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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21
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Aponte Ribero V, Efthimiou O, Abolhassani N, Alwan H, Bauer DC, Henrard S, Christiaens A, O’Mahony D, Knol W, Peters MJL, Chiolero A, Aujesky D, Waeber G, Rodondi N, Del Giovane C, Gencer B. Diabetes and the risk of cardiovascular events and all-cause mortality among older adults: an individual participant data analysis of five prospective studies. Eur J Clin Invest 2025; 55:e14340. [PMID: 39465996 PMCID: PMC11744924 DOI: 10.1111/eci.14340] [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: 05/16/2024] [Accepted: 10/11/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND Guidelines and studies provide conflicting information on whether type 2 diabetes (T2D) should be considered a coronary heart disease risk (CHD) equivalent in older adults. METHODS We synthesized participant-level data on 82,723 individuals aged ≥65 years from five prospective studies in two-stage meta-analyses. We estimated multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D (presence versus absence) on a primary composite outcome defined as cardiovascular events or all-cause mortality. Secondary outcomes were the components of the composite. We evaluated CHD risk equivalence by comparing outcomes between individuals with T2D but no CHD versus CHD but no T2D. RESULTS The median age of participants was 71 years, 20% had T2D and 17% had CHD at baseline. A total of 29,474 participants (36%) experienced the composite outcome. Baseline T2D was associated with higher risk of cardiovascular events or all-cause mortality versus no T2D (HR 1.44, 95% CI [1.40-1.49]). The association was weaker in individuals aged ≥75 years versus 65-74 years (HR 1.32 [1.19-1.46] vs. 1.56 [1.50-1.62]; p-value for interaction = .032). Compared to individuals with CHD but no T2D, individuals with T2D but no CHD had a similar risk of the composite outcome (HR 0.95 [0.85-1.07]), but a lower risk of cardiovascular events (HR 0.76 [0.59-0.98]). CONCLUSIONS T2D was associated with increased risk of cardiovascular events and all-cause mortality in older adults, but T2D without CHD conferred lower risk of cardiovascular events compared to CHD without T2D. Our results suggest that T2D should not be considered a CHD risk equivalent in older adults.
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Affiliation(s)
- Valerie Aponte Ribero
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
- Graduate School for Health SciencesUniversity of BernBernSwitzerland
| | - Orestis Efthimiou
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Nazanin Abolhassani
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
| | - Heba Alwan
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
- Graduate School for Health SciencesUniversity of BernBernSwitzerland
| | - Douglas C. Bauer
- Department of Medicine and Epidemiology & BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Séverine Henrard
- Clinical Pharmacy research group, Louvain Drug Research Institute (LDRI)Université catholique de LouvainBrusselsBelgium
- Institute of Health and Society (IRSS)Université catholique de LouvainBrusselsBelgium
| | - Antoine Christiaens
- Clinical Pharmacy research group, Louvain Drug Research Institute (LDRI)Université catholique de LouvainBrusselsBelgium
- Fonds de la Recherche Scientifique – FNRSBrusselsBelgium
| | | | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old PersonsUniversity Medical Center Utrecht, Utrecht UniversityUtrechtNetherlands
| | - Mike J. L. Peters
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old PersonsUniversity Medical Center Utrecht, Utrecht UniversityUtrechtNetherlands
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
- Population Health Laboratory (#PopHealthLab), Department of Community HealthUniversity of FribourgFribourgSwitzerland
- School of Population and Global HealthMcGill UniversityMontrealCanada
| | - Drahomir Aujesky
- Department of General Internal MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Gérard Waeber
- Department of MedicineLausanne University Hospital (CHUV), University of LausanneLausanneSwitzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
- Department of General Internal MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
- Department of Medical and Surgical Sciences for Children and AdultsUniversity‐Hospital of Modena and Reggio EmiliaModenaItaly
| | - Baris Gencer
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
- Cardiology DivisionGeneva University HospitalsGenevaSwitzerland
- Service of CardiologyLausanne University HospitalsLausanneSwitzerland
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Goldney J, Barker MM, Sargeant JA, Daynes E, Papamargaritis D, Shabnam S, Goff LM, Khunti K, Henson J, Davies MJ, Zaccardi F. Burden of vascular risk factors by age, sex, ethnicity and deprivation in young adults with and without newly diagnosed type 2 diabetes. Diabetes Res Clin Pract 2025; 220:112002. [PMID: 39800277 DOI: 10.1016/j.diabres.2025.112002] [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: 09/12/2024] [Revised: 01/07/2025] [Accepted: 01/08/2025] [Indexed: 01/15/2025]
Abstract
AIMS Do associations between age at diagnosis of type 2 diabetes and vascular risk factors vary by ethnicity and deprivation? METHODS Utilising the Clinical Practice Research Datalink, we matched 16-50-year-old individuals with newly diagnosed type 2 diabetes to ∼10 individuals without using sex, age and primary care practice. Differences in BMI, obesity, LDL-cholesterol, HbA1c, and hypertension between individuals with vs without type 2 diabetes across sex, age, ethnicity and deprivation quintiles were explored using generalised linear models. RESULTS We included 108,061 individuals (45.6% women) with newly diagnosed type 2 diabetes and 829,946 controls. BMI, obesity, LDL-cholesterol, and hypertension were higher in individuals with vs without type 2 diabetes. Across both sexes, all ethnic groups and deprivation quintiles, these differences were larger with an earlier age, particularly for BMI and obesity. Association between age and HbA1c were variable across subgroups. Differences in BMI, obesity, and hypertension (individuals with vs without diabetes) were largest in White individuals and with less deprivation. CONCLUSIONS The increased vascular risk phenotype associated with an earlier age of diagnosis of type 2 diabetes was consistent across ethnic and deprivation groups. Population-based strategies are needed to address the risk associated with early-onset type 2 diabetes, especially weight-management-based strategies.
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Affiliation(s)
- Jonathan Goldney
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK.
| | - Mary M Barker
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Jack A Sargeant
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW UK
| | - Enya Daynes
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK; Department of Respiratory Sciences, University of Leicester, Glenfield Hospital, Leicester LE3 9QP UK
| | - Dimitris Papamargaritis
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK
| | - Sharmin Shabnam
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK
| | - Louise M Goff
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Applied Research Collaboration East Midlands (ARC-EM), Leicester Diabetes Centre, University of Leicester LE5 4PW UK
| | - Joseph Henson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW UK
| | - Francesco Zaccardi
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW UK
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23
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Liu C, Xiang G, Liang D, Zhao X, Xiao K, Xie L. Association of oxidative balance score with the risk of all-cause and CVD mortality in younger US adults with diabetes. Sci Rep 2025; 15:3609. [PMID: 39875577 PMCID: PMC11775326 DOI: 10.1038/s41598-025-88132-y] [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: 09/19/2024] [Accepted: 01/24/2025] [Indexed: 01/30/2025] Open
Abstract
Oxidative balance score (OBS) is a composite measures that assess the balance between pro-oxidant and antioxidant factors in an individual's diet and lifestyle, with higher scores indicating greater antioxidant exposure. Despite its potential significance, there is a limited body of research exploring the relationship between OBS and all-cause and cardiovascular disease (CVD) mortality specifically in younger patients with diabetes. We aimed to investigate the possible relationship between OBS and all-cause and CVD mortality in younger patients with diabetes. Data for this study were obtained from the 2003-2018 NHANES. This study enrolled 3501 participants. The endpoints were all-cause and CVD mortality, determined by the National Death Index (NDI). OBS, which consists of 16 dietary factors and 4 lifestyle factors, is categorized into pro-oxidants and antioxidants. The OBS was categorized into four quartiles (Q1-Q4). We used multivariable Cox proportional hazards regression models to examine the association between continuous and quartile measures of OBS, lifestyle OBS (lifestyle antioxidants such as physical activity, etc., and lifestyle pro-oxidants such as alcohol, smoking, etc.), and dietary OBS (dietary antioxidants such as fiber, β-carotene, riboflavin, etc., and dietary pro-oxidants, such as total fat, etc.) with all-cause and CVD mortality. Additionally, we explored restricted cubic spline (RCS) analysis and also performed subgroup analyses and interaction tests. The occurrence of 409 all-cause deaths (11.7%) and 108 CVD-related deaths (3.1%) was recorded during the follow-up period. Our results found that OBS, lifestyle OBS, and dietary OBS were negatively associated with patients' all-cause and CVD mortality. The RCS analysis further validated the association of a linear negative correlation between OBS and all-cause and CVD mortality. The results of our subgroup analyses revealed that the negative association between OBS and CVD mortality may be influenced by alcohol use. In conclusion, results from a nationally representative study of younger American patients with diabetes suggest a negative association between OBS, lifestyle OBS, and dietary OBS and all-cause and CVD mortality. Antioxidant-rich diets and lifestyle improvements are essential for reducing all-cause and CVD mortality in patients.
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Affiliation(s)
- Chang Liu
- School of Medicine, Nankai University, Tianjin, China.
- College of Pulmonary & Critical Care Medicine, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Guoan Xiang
- College of Pulmonary & Critical Care Medicine, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dan Liang
- Department of Endocrine, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China.
- West China Medical College of Sichuan University, Sichuan, China.
| | - Xuanbo Zhao
- Clinical Medicine College of Henan University of Traditional Chinese Medicine, Henan, China
| | - Kun Xiao
- College of Pulmonary & Critical Care Medicine, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Lixin Xie
- School of Medicine, Nankai University, Tianjin, China.
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24
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Khurshid MR, Manzoor S, Sadiq T, Hussain L, Khan MS, Dutta AK. Unveiling diabetes onset: Optimized XGBoost with Bayesian optimization for enhanced prediction. PLoS One 2025; 20:e0310218. [PMID: 39854291 PMCID: PMC11760023 DOI: 10.1371/journal.pone.0310218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/27/2024] [Indexed: 01/26/2025] Open
Abstract
Diabetes, a chronic condition affecting millions worldwide, necessitates early intervention to prevent severe complications. While accurately predicting diabetes onset or progression remains challenging due to complex and imbalanced datasets, recent advancements in machine learning offer potential solutions. Traditional prediction models, often limited by default parameters, have been superseded by more sophisticated approaches. Leveraging Bayesian optimization to fine-tune XGBoost, researchers can harness the power of complex data analysis to improve predictive accuracy. By identifying key factors influencing diabetes risk, personalized prevention strategies can be developed, ultimately enhancing patient outcomes. Successful implementation requires meticulous data management, stringent ethical considerations, and seamless integration into healthcare systems. This study focused on optimizing the hyperparameters of an XGBoost ensemble machine learning model using Bayesian optimization. Compared to grid search XGBoost (accuracy: 97.24%, F1-score: 95.72%, MCC: 81.02%), the XGBoost with Bayesian optimization achieved slightly improved performance (accuracy: 97.26%, F1-score: 95.72%, MCC:81.18%). Although the improvements observed in this study are modest, the optimized XGBoost model with Bayesian optimization represents a promising step towards revolutionizing diabetes prevention and treatment. This approach holds significant potential to improve outcomes for individuals at risk of developing diabetes.
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Affiliation(s)
| | - Sadaf Manzoor
- Department of Statistics, Islamia University College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Touseef Sadiq
- Centre for Artificial Intelligence Research (CAIR), Department of Information and Communication Technology, University of Agder, Kristiansand, Grimstad, Norway
| | - Lal Hussain
- Department of Computer Science & IT, Neelum Campus, The University of Azad Jammu and Kashmir, Athmuqam, Azad Kashmir, Pakistan
- Department of Computer Science & IT, King Abdullah Campus, The University of Azad Jammu and Kashmir, Muzaffarabad, Azad Kashmir, Pakistan
| | | | - Ashit Kumar Dutta
- Department of Computer Science and Information Systems, College of Applied Sciences, AlMaarefa University, Ad Diriyah, Riyadh, Kingdom of Saudi Arabia
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25
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Liu SQ, Wang D, Tang CC. Association between age at diagnosis of diabetes and ocular disease: Insights from a recent article. World J Diabetes 2025; 16:94846. [PMID: 39817215 PMCID: PMC11718463 DOI: 10.4239/wjd.v16.i1.94846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 09/19/2024] [Accepted: 11/01/2024] [Indexed: 11/29/2024] Open
Abstract
In this article, we discuss Ye et al's recent article on the association between age at diabetes diagnosis and subsequent risk of age-related ocular diseases. The study, which utilized United Kingdom Biobank data, highlighted a strong link between early diabetes onset and major eye conditions, such as cataracts, glaucoma, age-related macular degeneration, and vision loss, independent of glycemic control and disease duration. This finding challenges the previous belief that diabetic eye disease primarily correlates with hyperglycemia. As lifestyles evolve and the age of diabetes diagnosis decreases, understanding this relationship may reveal the complex pathogenesis underlying diabetes-related complications. This editorial summarizes potential mechanisms connecting the age of diabetes onset with four types of ocular diseases, emphasizing the significance of early diagnosis.
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Affiliation(s)
- Shi-Qi Liu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Dong Wang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Cheng-Chun Tang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
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26
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Zhang FS, Li HJ, Yu X, Song YP, Ren YF, Qian XZ, Liu JL, Li WX, Huang YR, Gao K. Global trends and hotspots of type 2 diabetes in children and adolescents: A bibliometric study and visualization analysis. World J Diabetes 2025; 16:96032. [PMID: 39817223 PMCID: PMC11718446 DOI: 10.4239/wjd.v16.i1.96032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/30/2024] [Accepted: 11/19/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Epidemiological surveys indicate an increasing incidence of type 2 diabetes mellitus (T2DM) among children and adolescents worldwide. Due to rapid disease progression, severe long-term cardiorenal complications, a lack of effective treatment strategies, and substantial socioeconomic burdens, it has become an urgent public health issue that requires management and resolution. Adolescent T2DM differs from adult T2DM. Despite a significant increase in our understanding of youth-onset T2DM over the past two decades, the related review and evidence-based content remain limited. AIM To visualize the hotspots and trends in pediatric and adolescent T2DM research and to forecast their future research themes. METHODS This study utilized the terms "children", "adolescents", and "type 2 diabetes", retrieving relevant articles published between 1983 and 2023 from three citation databases within the Web of Science Core Collection (SCI, SSCI, ESCI). Utilizing CiteSpace and VoSviewer software, we analyze and visually represent the annual output of literature, countries involved, and participating institutions. This allows us to predict trends in this research field. Our analysis encompasses co-cited authors, journal overlays, citation overlays, time-zone views, keyword analysis, and reference analysis, etc. RESULTS A total of 9210 articles were included, and the annual publication volume in this field showed a steady growth trend. The United States had the highest number of publications and the highest H-index. The United States also had the most research institutions and the strongest research capacity. The global hot journals were primarily diabetes professional journals but also included journals related to nutrition, endocrinology, and metabolism. Keyword analysis showed that research related to endothelial dysfunction, exposure risk, cardiac metabolic risk, changes in gut microbiota, the impact on comorbidities and outcomes, etc., were emerging keywords. They have maintained their popularity in this field, suggesting that these areas have garnered significant research interest in recent years. CONCLUSION Pediatric and adolescent T2DM is increasingly drawing global attention, with genes, behaviors, environmental factors, and multisystemic interventions potentially emerging as future research hot spots.
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Affiliation(s)
- Fang-Shuo Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Hai-Jing Li
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xue Yu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yi-Ping Song
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yan-Feng Ren
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xuan-Zhu Qian
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jia-Li Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wen-Xun Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yi-Ran Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Kuo Gao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
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27
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Wang P, Fan Y, Gao H, Wang B. Body roundness index as a predictor of all-cause and cardiovascular mortality in patients with diabetes and prediabetes. Diabetes Res Clin Pract 2025; 219:111958. [PMID: 39675484 DOI: 10.1016/j.diabres.2024.111958] [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: 10/01/2024] [Revised: 11/27/2024] [Accepted: 12/10/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND There are limited population-based studies examining the correlation between body roundness index (BRI) and mortality in diabetes and prediabetes patients. METHOD Our final analysis encompassed 15,848 patients with diabetes and prediabetes sourced from the National Health and Nutrition Examination Survey(NHANES) spanning from 2003 to 2018. Cox proportional hazards model and restricted cubic splines (RCS) were utilized to assess the correlation between BRI and both all-cause mortality and cardiovascular mortality. RESULTS During an average follow-up period of 92.9 months, 2655 participants (12.73 %) died, including 730 (3.44 %) from cardiovascular diseases. RCS demonstrated a U-shaped nonlinear association between BRI with all-cause mortality and cardiovascular mortality, with threshold values of 5.54 and 5.21, respectively. When BRI was below the threshold, a negative correlation was observed between BRI and all-cause mortality (HR 0.87, 95 % CI 0.81-0.93).The correlation with cardiovascular mortality is not significant. Conversely, when BRI was above the threshold, a positive correlation was observed between BRI with all-cause mortality (HR 1.10, 95 % CI 1.06-1.14) and cardiovascular mortality (HR 1.13, 95 % CI 1.07-1.20). CONCLUSION Our research indicates that among US adults with diabetes or prediabetes, BRI exhibits a U-shaped relationship with all-cause and cardiovascular mortality, with threshold values of 5.54 and 5.21, respectively.
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Affiliation(s)
- Peipei Wang
- Department of Respiratory, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongqiang Fan
- Department of General Surgery, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Haoyue Gao
- Department of Respiratory, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bei Wang
- Department of Respiratory, The Second Hospital of Shanxi Medical University, Taiyuan, China.
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Tian X, Chen S, Zhang Y, Xu Q, Xia X, Wu S, Wang A. Age-Specific Effect and Pathways of Risk Factors on the Risk of Incident Type 2 Diabetes: A 13-Year Prospective Cohort Study. Diabetes Metab Res Rev 2025; 41:e70028. [PMID: 39742467 DOI: 10.1002/dmrr.70028] [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: 04/15/2024] [Revised: 10/25/2024] [Accepted: 11/28/2024] [Indexed: 01/03/2025]
Abstract
AIM To assess risk profiles and pathways for incident type 2 diabetes by age at onset. MATERIALS AND METHODS Based on the Kailaun study, 92,020 participants without type 2 diabetes were enrolled and classified into four age-onset groups as < 55, 55 to < 65, 65 to < 75, and ≥ 75 years. Clinical risk factors and serum biomarkers were examined. Cox regression and Bayesian network analysis were performed. RESULTS Of the clinical risk factors, metabolic syndrome had the highest hazard ratio [HR] for type 2 diabetes onset at any age, ranging from 4.17; 95% confidence interval [CI], 3.89-4.06) at onset in those < 55 years to 2.97 (95% CI, 2.57-3.44) at onset in those ≥ 75 years. Among biomarkers, insulin resistance evaluated by triglyceride-glucose index had the highest HR (1.66; 95% CI, 1.61-1.70) for onset < 55 years. In comparison, weaker but significant associations with diabetes in onset < 55 years were noted for most lipids, metabolic, and inflammatory biomarkers. Most risk factors had attenuated relative rates at older ages. Bayesian network showed that the most important pathway to incident diabetes was through insulin resistance and metabolic syndrome, with conditional probabilities ranging from 62.1% in onset < 55 years, and attenuated to 16.3% for onset ≥ 75 years. CONCLUSIONS Most risk factors for diabetes had attenuated relative rates at older ages. Metabolic syndrome and insulin resistance, in addition to prediabetes, obesity, hypertension, and dyslipidemia, tended to be stronger risk factors.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yijun Zhang
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
| | - Xue Xia
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Anxin Wang
- Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
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Wu D, Yu Y, Zheng H, Xiang L, Wang X, Zhang Y, Sun Z, Miao D, Zhou J, Pan E, Hu W. Analysis of the risk of death and its associated risk factors in Chinese patients with young-onset type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1451364. [PMID: 39749021 PMCID: PMC11693590 DOI: 10.3389/fendo.2024.1451364] [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: 06/19/2024] [Accepted: 12/03/2024] [Indexed: 01/04/2025] Open
Abstract
Objectives To examine the association between the age at onset of diabetes and the risk of all-cause mortality in a population of individuals diagnosed with type 2 diabetes mellitus (T2DM) and to identify risk factors associated with all-cause mortality in young-onset T2DM (YOD) patients in China. Methods This study utilized a cohort of 9759 patients who were diagnosed with T2DM and who were registered and enrolled in the National Basic Public Health Service Management Program in Qinghe District (now Qingjiangpu District) and Huai'an District, Huai'an City, Jiangsu Province, China. The patients were observed from November 2013 to July 2014, and all-cause mortality data were obtained by comprehensive matching with the Huai'an City Resident Mortality Database as of December 31, 2019. A Cox proportional hazards model was used to compute the hazard ratios (HRs) and their corresponding 95% confidence intervals (95% CIs) for all-cause mortality risk during the follow-up period among patients with varying disease onset ages. Additionally, subgroup analyses were conducted based on sex, age, lifestyle factors, and baseline clinical parameters. Results A total of 7572 patients with T2DM, including 2874 men and 4698 women aged 57.9 ± 8.0 years, were ultimately included in the study. 1) At baseline, a greater proportion of YOD patients were engaged in high-intensity activities, had a longer sleep duration, had a longer duration of T2DM, had a family history of T2DM, had microvascular complications (kidney disease, retinopathy, neuropathy, diabetic foot, etc.), and received glucose-lowering treatment. Moreover, patients in the YOD group also had significantly greater baseline HbA1c, FBG, and estimated glomerular filtration rate (eGFR) than did those in the onset at 41-60 years (MD) group and the onset at 61-75 years (SD) group. 2) During the six-year follow-up period, a total of 1057 deaths were documented. After adjusting for confounding factors and utilizing SD as the reference group, the HRs for deaths occurring in the YOD and MD groups were 1.383 (95% CI: 0.717-2.667) and 1.006 (95% CI: 0.763-1.326), respectively. Moreover, the risk of death in the YOD group remained highest in the sensitivity analysis that excluded patients with coronary heart disease at baseline, stroke patients, and patients who died within the first three years of follow-up. 3) Sleep duration was identified as an independent risk factor for mortality in the YOD group, with a notable increase in the risk of all-cause mortality when sleep duration exceeded 9 hours per day. Conclusion The risk of all-cause mortality in YOD patients was 1.38 times greater than that in MD and SD patients, and the longer the sleep duration was, the greater the risk of death, especially when sleep duration exceeded 9 hours per day.
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Affiliation(s)
- Dan Wu
- Department of Endocrinology, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China
| | - Yang Yu
- Department of Endocrinology, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China
| | - Haoran Zheng
- Department of Endocrinology, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China
| | - Ling Xiang
- Department of Endocrinology, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China
| | - Xiaoqing Wang
- Department of Endocrinology, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China
| | - Yong Zhang
- Department of Endocrinology, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China
| | - Zhongming Sun
- Department of Chronic Disease Prevention and Control, Huai’an City Center for Disease Control and Prevention, Huai’an, China
| | - Dandan Miao
- Department of Chronic Disease Prevention and Control, Huai’an City Center for Disease Control and Prevention, Huai’an, China
| | - Jinyi Zhou
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai’an City Center for Disease Control and Prevention, Huai’an, China
| | - Wen Hu
- Department of Endocrinology, Huai’an Hospital Affiliated to Xuzhou Medical University and Huai’an Second People’s Hospital, Huai’an, Jiangsu, China
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Hoyos W, Hoyos K, Ruiz R, Aguilar J. An explainable analysis of diabetes mellitus using statistical and artificial intelligence techniques. BMC Med Inform Decis Mak 2024; 24:383. [PMID: 39695649 DOI: 10.1186/s12911-024-02810-x] [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: 12/12/2023] [Accepted: 12/06/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a chronic disease prevalent worldwide, requiring a multifaceted analytical approach to improve early detection and subsequent mitigation of morbidity and mortality rates. This research aimed to develop an explainable analysis of DM by combining sociodemographic and clinical data with statistical and artificial intelligence (AI) techniques. METHODS Leveraging a small dataset that includes sociodemographic and clinical profiles of diabetic and non-diabetic individuals, we employed a diverse set of statistical and AI models for predictive purposes and assessment of DM risk factors. The statistical tests used were Student's t-test and Chi-square, while the AI techniques were fuzzy cognitive maps (FCM), artificial neural networks (ANN), support vector machines (SVM), and XGBoost. RESULTS Our statistical models facilitated an in-depth exploration of variable associations, while the resulting AI models demonstrated exceptional efficacy in DM classification. In particular, the XGBoost model showed superior performance in accuracy, sensitivity and specificity with values of 1 for each of these metrics. On the other hand, the FCM stood out for its explainability capabilities by allowing an analysis of the variables involved in the prediction using scenario-based simulations. CONCLUSIONS An integrated analysis of DM using a variety of methodologies is critical for timely detection of the disease and informed clinical decision-making.
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Affiliation(s)
- William Hoyos
- Grupo de Investigación ISI, Universidad Cooperativa de Colombia, Montería, Colombia.
- Grupo de Investigación en I+D+i en TIC, Universidad EAFIT, Medellín, Colombia.
- GIMBIC, Universidad de Córdoba, Montería, Colombia.
| | - Kenia Hoyos
- Laboratorio Clínico Humano, Clínica Salud Social, Sincelejo, Colombia
| | - Rander Ruiz
- Grupo de Investigación Interdisciplinario del Bajo Cauca y Sur de Córdoba, Universidad de Antioquia, Medellín, Colombia
| | - Jose Aguilar
- Grupo de Investigación en I+D+i en TIC, Universidad EAFIT, Medellín, Colombia
- CEMISID, Universidad de Los Andes, Merida, Venezuela
- IMDEA Networks Institute, Madrid, Spain
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Lan NSR, Dwivedi G, Fegan PG, Game F, Hamilton EJ. Unravelling the cardio-renal-metabolic-foot connection in people with diabetes-related foot ulceration: a narrative review. Cardiovasc Diabetol 2024; 23:437. [PMID: 39696281 PMCID: PMC11657306 DOI: 10.1186/s12933-024-02527-1] [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: 09/14/2024] [Accepted: 11/26/2024] [Indexed: 12/20/2024] Open
Abstract
Diabetes-related foot ulceration (DFU), a serious but preventable complication of diabetes, is a leading cause of hospitalisation, lower extremity amputation and disability worldwide. People with DFU have a greater burden of cardiovascular risk factors, heart failure and chronic kidney disease, resulting in over two-fold higher risk of cardiovascular death compared with people with diabetes without DFU. Here, we propose a "cardio-renal-metabolic-foot" connection in people with diabetes based on shared pathophysiological mechanisms linking DFU with cardiovascular and renal disease. Whilst these mechanistic links remain to be fully elucidated, systemic inflammation and infection in the context of DFU are postulated as key mediators in the development, and progression of, cardiovascular and renal disease. However, cardiovascular and renal disease are also implicated in the pathogenesis of DFU, highlighting the multi-directional interplay between conditions. The impact of screening, prevention, and early management of cardiovascular complications associated with DFU requires further research. Multi-modality cardiac imaging could play a role in unravelling disease mechanisms leading to novel therapeutic strategies, as well as facilitating personalised risk assessment and management. Recent clinical trials have transformed the therapeutic landscape for people with type 2 diabetes, by demonstrating that sodium glucose co-transporter 2 inhibitors, glucagon-like peptide-1 agonists and non-steroidal mineralocorticoid receptor antagonists improve cardiovascular and renal outcomes. Although dedicated research in people with DFU is warranted, these therapies could target multiple facets of the "cardio-renal-metabolic-foot" connection. The holistic, person-centred approach to managing DFU should incorporate new multidisciplinary models of care focusing on the prevention and management of cardiovascular and kidney disease.
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Affiliation(s)
- Nick S R Lan
- Centre of Excellence for Cardiometabolic Health, Fiona Stanley Hospital, Perth, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
- Medical School, The University of Western Australia, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
| | - Girish Dwivedi
- Centre of Excellence for Cardiometabolic Health, Fiona Stanley Hospital, Perth, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
- Medical School, The University of Western Australia, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
| | - P Gerry Fegan
- Centre of Excellence for Cardiometabolic Health, Fiona Stanley Hospital, Perth, Australia
- Medical School, Curtin University, Perth, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
| | - Fran Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Emma J Hamilton
- Medical School, The University of Western Australia, Perth, Australia.
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia.
- Centre of Excellence Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley and Fremantle Hospitals Group, 11 Robin Warren Drive, Murdoch, Perth, Australia.
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Zhang J, Li L, Luo D, Huo Z, Zhang X, Xu Y, Jiang J, Liu T, Wu S, Huang Z. Traditional versus intensive blood glucose control: long-term target range duration and cardiovascular disease risk and all-cause mortality - a real-world cohort study. Front Endocrinol (Lausanne) 2024; 15:1449925. [PMID: 39720249 PMCID: PMC11666366 DOI: 10.3389/fendo.2024.1449925] [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: 06/16/2024] [Accepted: 11/22/2024] [Indexed: 12/26/2024] Open
Abstract
Objective For a long time, the dispute about whether improved glycemic control can bring significant benefits has remained unresolved. We aimed to investigate the association of time spent in different fasting glucose target ranges with cardiovascular risk and all-cause mortality in a population with type 2 diabetes (T2DM). Method A total of 3460 T2DM patients in the Kailuan cohort were included in this study. The Time in Target Range (TITRE) was calculated as the proportion of time that fasting blood glucose (FBG) was within the usual glycemic control range and the intensive glycemic control range between 2006 and 2016. The Cox proportional hazards regression model analyzed the relationship between TITRE, defined by different glucose ranges, and cardiovascular disease and all-cause mortality. Results During a median follow-up of 4.23 years, a total of 360 CVDs and 238 deaths were recorded. After correcting for traditional risk factors, we observed that in the conventional blood glucose control group, each increase of 1 standard deviation in TITRE was associated with a 23% (HR, 0.77; 95%CI, 0.68-0.87) reduction in CVD risk and a 20% reduction in all-cause mortality (HR, 0.80; 95%CI, 0.69-0.92). Similar results were also observed in the intensified blood glucose control group. In the conventional blood glucose control group, participants with TITRE of 50% or more had an absolute incidence rate of CVD of 16.77%, whereas in the intensified blood glucose control group, participants with TITRE of 50% or more had an absolute incidence rate of CVD of 11.82%. Conclusions In patients with type 2 diabetes, achieving near-normal blood glucose levels appears to significantly reduce the risk of diabetes-related cardiovascular outcomes.
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Affiliation(s)
- Jingdi Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, China
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Liuxin Li
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Donglei Luo
- Department of Cardiology, Chengde Central Hospital/Second Clinical College of Chengde Medical University, Chengde, Hebei, China
| | - Zhenyu Huo
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Xiaoxue Zhang
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Yiran Xu
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Jingyuan Jiang
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Tiantian Liu
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Zhe Huang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
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Du Z, Wang S, Yang O, He J, Yang Y, Zheng J, Zhao H, Cai Y. Machine-learning-based prediction of cardiovascular events for hyperlipidemia population with lipid variability and remnant cholesterol as biomarkers. Health Inf Sci Syst 2024; 12:51. [PMID: 39534649 PMCID: PMC11551092 DOI: 10.1007/s13755-024-00310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 10/01/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose Dyslipidemia poses a significant risk for the progression to cardiovascular diseases. Despite the identification of numerous risk factors and the proposal of various risk scales, there is still an urgent need for effective predictive models for the onset of cardiovascular diseases in the hyperlipidemic population, which are essential for the prevention of CVD. Methods We carried out a retrospective cohort study with 23,548 hyperlipidemia patients in Shenzhen Health Information Big Data Platform, including 11,723 CVD onset cases in a 3-year follow-up. The population was randomly divided into 70% as an independent training dataset and remaining 30% as test set. Four distinct machine-learning algorithms were implemented on the training dataset with the aim of developing highly accurate predictive models, and their performance was subsequently benchmarked against conventional risk assessment scales. An ablation study was also carried out to analyze the impact of individual risk factors to model performance. Results The non-linear algorithm, LightGBM, excelled in forecasting the incidence of cardiovascular disease within 3 years, achieving an area under the 'receiver operating characteristic curve' (AUROC) of 0.883. This performance surpassed that of the conventional logistic regression model, which had an AUROC of 0.725, on identical datasets. Concurrently, in direct comparative analyses, machine-learning approaches have notably outperformed the three traditional risk assessment methods within their respective applicable populations. These include the Framingham cardiovascular disease risk score, 2019 ESC/EAS guidelines for the management of dyslipidemia and the 2016 Chinese recommendations for the management of dyslipidemia in adults. Further analysis of risk factors showed that the variability of blood lipid levels and remnant cholesterol played an important role in indicating an increased risk of CVD. Conclusions We have shown that the application of machine-learning techniques significantly enhances the precision of cardiovascular risk forecasting among hyperlipidemic patients, addressing the critical issue of disease prediction's heterogeneity and non-linearity. Furthermore, some recently-suggested biomarkers, including blood lipid variability and remnant cholesterol are also important predictors of cardiovascular events, suggesting the importance of continuous lipid monitoring and healthcare profiling through big data platforms.
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Affiliation(s)
- Zhenzhen Du
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong China
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong China
- FuWai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Shuang Wang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong China
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong China
- FuWai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Ouzhou Yang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong China
| | - Juan He
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong China
| | - Yujie Yang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong China
| | - Jing Zheng
- Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong China
| | - Honglei Zhao
- FuWai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Yunpeng Cai
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong China
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Li M, Zhang L, Wang Y, Xu X. Exploration of fractional flow reservation score based on artificial intelligence post-processing for coronary artery lesions in patients with diabetes and coronary heart disease. SLAS Technol 2024; 29:100196. [PMID: 39313159 DOI: 10.1016/j.slast.2024.100196] [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: 05/21/2024] [Revised: 09/06/2024] [Accepted: 09/20/2024] [Indexed: 09/25/2024]
Abstract
In order to evaluate the relationship between coronary heart disease (CHD) and fractional flow reservation (FFR) in patients with different levels of CHD and diabetes, this paper used AI (artificial intelligence) post-processing technology to detect CHD and FFR. In this paper, 94 patients suspected of CHD who underwent coronary arteriography (CAG) in a hospital between December 2022 and February 2023 were examined by coronary computed tomography angiography (CCTA) and FFR. Based on CCTA, AI software is used to process CCTA images, diagnose coronary plaques, coronary stenosis, corresponding stenosis of different types of plaques, and FFR values. The diagnostic performance of AI was evaluated using expert diagnosis, CAG diagnosis, and FFR examination results as the "gold standard". According to the diagnosis results, the relationship between FFR and CHD patients with diabetes at different levels was studied. The research results showed that AI image diagnosis has high sensitivity, specificity, and accuracy, and has good diagnostic effects on coronary plaques, coronary stenosis, stenosis corresponding to different types of plaques, and FFR values. The fasting blood glucose levels and FFR values of three groups of CHD patients were statistically significant, and correlation analysis revealed a negative correlation between the two. Using AI for CCTA diagnosis can efficiently, conveniently, and accurately obtain the required data, improving clinical diagnostic efficiency and accuracy. The analysis of AI recognition results found that in patients with CHD, the FFR value of patients with diabetes decreased, and the FFR value was negatively correlated with the fasting blood glucose concentration, indicating that CHD patients may lead to myocardial ischemia in the blood supply area due to the decline of their coronary blood flow reserve.
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Affiliation(s)
- Mei Li
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, Shandong, PR China.
| | - Likun Zhang
- Endocrinology Department, Qingdao Municipal Hospital (Group), Qingdao Geriatric Hospital, Qingdao 266000, Shandong, PR China.
| | - Yingcui Wang
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, Shandong, PR China.
| | - Xiaohong Xu
- Department of Rheumatology and Immunology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, Shandong, PR China.
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Lin B, Coleman RL, Bragg F, Maddaloni E, Holman RR, Adler AI. Younger-onset compared with later-onset type 2 diabetes: an analysis of the UK Prospective Diabetes Study (UKPDS) with up to 30 years of follow-up (UKPDS 92). Lancet Diabetes Endocrinol 2024; 12:904-914. [PMID: 39461360 DOI: 10.1016/s2213-8587(24)00242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/19/2024] [Accepted: 07/30/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND Younger-onset type 2 diabetes is associated with accelerated complications. We assessed whether complications and mortality rates differed for younger age compared with older age at diagnosis over 30 years of follow-up. METHODS In this study, we used data from the UKPDS, collected between 1977 and 2007, of participants aged 25-65 years with newly diagnosed type 2 diabetes with younger-onset (younger than 40 years) or later-onset (40 years or older), and without diabetes autoantibodies. We analysed standardised mortality ratios (SMR) using UK general population data, and incidence rates of prespecified outcomes by 10-year age intervals at diagnosis. FINDINGS Of 4550 participants testing negative to all measured autoantibodies, 429 (9·4%) had younger-onset type 2 diabetes. 2704 (59·4%) were male, and mean HbA1c was 76 mmol/mol (SD 24·6). The median follow-up was 17·5 years (IQR 12·7-20·8). SMR for younger-onset type 2 diabetes was higher (3·72 [95% CI 2·98-4·64]) compared with later-onset type 2 diabetes (1·54 [1·47-1·61]). The incidence rate was higher for all outcomes in later-onset type 2 diabetes, except for microvascular disease (younger-onset 14·5 (11·9-17·7) vs later-onset 12·1 (11·3-13·0) per 1000 person-years). However, at any given age, the 5-year incidence of any diabetes-related endpoint, all-cause mortality, microvascular disease, and myocardial infarction was higher with younger age at diagnosis. Annual mean HbA1c was higher in the first 20 years in younger-onset compared with later-onset type 2 diabetes. Among participants randomised to intensive versus conventional glycaemic control, we observed no interactions by subgroup of younger-onset versus later-onset type 2 diabetes for any outcome. INTERPRETATION The risk of dying relative to the general population is even greater for people diagnosed with type 2 diabetes at younger ages. The increased risk of complications and poorer glycaemic control in younger-onset type 2 diabetes calls for the development of services to identify and manage these individuals. FUNDING National Institute of Health and Care Research's Biomedical Research Centre.
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Affiliation(s)
- Beryl Lin
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ruth L Coleman
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Health Data Research UK Oxford, University of Oxford, Oxford, UK
| | - Ernesto Maddaloni
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Amanda I Adler
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
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Zhang HJ, Feng J, Zhang XT, Zhang HZ. Age at type 2 diabetes diagnosis and the risk of mortality among US population. Sci Rep 2024; 14:29155. [PMID: 39587196 PMCID: PMC11589141 DOI: 10.1038/s41598-024-80790-8] [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: 07/10/2024] [Accepted: 11/21/2024] [Indexed: 11/27/2024] Open
Abstract
To examine the relationship between age at diagnosis of type 2 diabetes (T2DM) with cardiovascular and all-cause mortality in the U.S. population. Data was used from NHANES 1999 ~ 2018, which were screened to include a total of 8,654 participants with a diagnosis of diabetes for the study. We estimated the association between age at diagnosis and cardiovascular and all-cause mortality using weighted multivariate Cox regression analyses. Subgroup analyses and sensitivity analyses were performed to ensure the robustness of the data analysis. The number of participants diagnosed with diabetes at ages < 40, between 40 and 59, and > 60 are 1,492, 3,970, and 3,192, respectively, with median ages of 44.04, 57.59, and 72.24. Among patients diagnosed with T2DM, the relative risk of all-cause mortality increased with younger age at diagnosis: compared to patients with late-onset diabetes (age at type 2 diabetes diagnosis ≥ 60), the hazard ratio for all-cause mortality was 2.72 (95% CI 1.83-4.05) in those with early-onset diabetes (age at type 2 diabetes diagnosis < 40). Similarly, the risk of cardiovascular disease death was observed to be a higher relative risk with younger age at diagnosis. Exposure-effect analysis indicated that younger age at diagnosis is associated with higher risk of all-cause mortality. Subgroup analysis found that the association between age at diagnosis and cardiovascular and all-cause mortality was stronger in the current smokers and hypertensive population. The results of this study suggest that younger age at diagnosis of T2DM is associated with higher risk of death in patients. Younger patients diagnosed with T2DM had a higher risk of cardiovascular and all-cause mortality. These findings strengthen the understanding of the risk of death from T2DM and emphasize the importance of early prevention of diabetes.
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Affiliation(s)
- Hong-Jin Zhang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Jie Feng
- Department of Cardiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Xiang-Tao Zhang
- Department of Cardiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Hong-Zhou Zhang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, Jiangxi, China.
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Qi X, Zhu Z, Luo H, Schwartz MD, Wu B. Age at diagnosis of diabetes, obesity, and the risk of dementia among adult patients with type 2 diabetes. PLoS One 2024; 19:e0310964. [PMID: 39535979 PMCID: PMC11559992 DOI: 10.1371/journal.pone.0310964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/10/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND While Type 2 Diabetes Mellitus (T2DM) prevalence is increasing among younger individuals, few studies have examined how age at T2DM diagnosis relates to dementia risk in diabetic populations. We aimed to investigate the association between age at T2DM diagnosis and subsequent dementia risk, and to determine whether obesity moderates this relationship. METHODS We conducted a prospective cohort study using data from the Health and Retirement Study (2002-2016) matched with its 2003 Diabetes Mail-Out Survey. The study included 1,213 dementia-free adults aged ≥50 with diagnosed T2DM. Primary exposures were age at T2DM diagnosis (categorized as <50, 50-59, 60-69, and ≥70 years) and obesity status (BMI ≥30 kg/m2). The outcome was incident dementia, assessed using the Telephone Interview for Cognitive Status. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sociodemographic factors, health behaviors, health status, and diabetes medication use. RESULTS Over a median follow-up of 10 (interquartile range, 6-14) years, 216 (17.8%) participants developed dementia. Compared to participants diagnosed with T2DM at age ≥70 years, those diagnosed at younger ages had increased dementia risk: HR 1.70 (95% CI, 1.03-2.80) for 60-69 years, 1.72 (95% CI, 1.06-2.79) for 50-59 years, and 1.90 (95% CI, 1.14-3.18) for <50 years. Obesity significantly moderated this relationship, with obese individuals diagnosed with T2DM before age 50 showing the highest dementia risk (HR 3.05; 95% CI 1.23-7.56) compared to non-obese individuals diagnosed at ≥50 years. CONCLUSIONS Younger age at diagnosis of T2DM was significantly associated with a higher risk of dementia, particularly among individuals with obesity. Interventions specifically targeting obesity may be more effective in preventing dementia for adults with a younger onset of T2DM.
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Affiliation(s)
- Xiang Qi
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
| | - Zheng Zhu
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- School of Nursing, Fudan University, Shanghai, China
| | - Huabin Luo
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
| | - Mark D. Schwartz
- Grossman School of Medicine, New York University, New York, New York, United States of America
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
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Deng D, Nie Z, Wang J, Chen C, Wang W, Zhu Y, Guan Q, Ou Y, Feng Y. Association between metabolic phenotypes of overweight/obesity and cardiovascular diseases in postmenopausal women. Nutr Metab Cardiovasc Dis 2024; 34:2562-2569. [PMID: 39174425 DOI: 10.1016/j.numecd.2024.04.001] [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: 10/31/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND AND AIM Obesity and metabolic abnormalities were associated with an increased risk of cardiovascular disease. However, it is unclear how metabolic weight phenotypes relate to cardiovascular diseases in postmenopausal women. This study aimed to explore the relationships in postmenopausal women. METHODS AND RESULTS We included 15,575 postmenopausal women aged 35-75 years (median age, 60.6) without cardiovascular disease at baseline from a subcohort of the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project. Metabolically unhealthy phenotype was defined as having ≥2 risk factors of metabolic syndrome: blood pressure ≥130/85 mm Hg or current use of antihypertensive drugs, fasting glucose ≥5.6 mmol/L or current use of antidiabetic agents, triglycerides ≥1.7 mmol/L, and high-density lipoprotein cholesterol <1.3 mmol/L. Cox regression analysis was used to evaluate the risks of cardiovascular diseases. Over a median follow-up period of 3.55 (interquartile range, 2.59-4.44) years, a total of 1354 cardiovascular events occurred. Compared to metabolically healthy normal weight, the multivariate-adjusted hazard ratios and their 95% confidence intervals were 1.41 (1.16-1.72) for metabolically unhealthy normal weight, 1.42 (1.16-1.73) for metabolically healthy overweight/obesity, and 1.75 (1.48-2.08) for metabolically unhealthy overweight/obesity. Subdividing overweight/obesity into separate groups revealed higher total cardiovascular disease risk only in metabolically unhealthy individuals across body mass index categories. CONCLUSION In postmenopausal women, both metabolically healthy overweight/obesity and metabolically unhealthy normal weight were associated with a higher risk of cardiovascular disease compared to metabolically healthy normal weight, and the greatest risk was observed in the metabolically unhealthy overweight/obesity category.
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Affiliation(s)
- Danying Deng
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhiqiang Nie
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiabin Wang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chaolei Chen
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Wenbin Wang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yanchen Zhu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Qingyu Guan
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yanqiu Ou
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yingqing Feng
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China.
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Cases A, Broseta JJ, Marqués M, Cigarrán S, Julián JC, Alcázar R, Ortiz A. La definición del síndrome cardiovascular-reno-metabólico (cardiovascular-kidney-metabolic syndrome) y su papel en la prevención, estatificación del riesgo y tratamiento. Una oportunidad para la Nefrología. Nefrologia 2024; 44:771-783. [DOI: 10.1016/j.nefro.2024.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
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Henson J, Ibarburu GH, Drebert Z, Slater T, Hall AP, Khunti K, Sargeant JA, Zaccardi F, Davies MJ, Yates T. Sleep disorders in younger and middle-older age adults with newly diagnosed type 2 diabetes mellitus: A retrospective cohort study in >1million individuals. Diabetes Res Clin Pract 2024; 217:111887. [PMID: 39419118 DOI: 10.1016/j.diabres.2024.111887] [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: 07/11/2024] [Revised: 10/07/2024] [Accepted: 10/08/2024] [Indexed: 10/19/2024]
Abstract
AIMS To explore the 5-year incidence and relative rates of sleep disorders in younger (16-≤40 years) and middle-older (=>40 years) age adults with and without newly diagnosed type 2 diabetes. METHODS This retrospective, observational cohort study utilised data from the US Collaborative Network within the TriNetX database. We compared 5-year cumulative incidence of sleep disorders in younger (n = 110,088) and middle-older populations (n = 1,185,961). RESULTS The absolute risk of developing any type of sleep disorder was greater in individuals with type 2 diabetes vs. those without. Over the 5-year follow-up period, 14.2 % of younger adults and 18.5 % of middle-older age adults with newly diagnosed type 2 diabetes developed any form of sleep disorder, compared to 4.5 % and 7.9 % propensity matched individuals without diabetes. We observed a more pronounced relative rate across the observed sleep disorders in younger adults. CONCLUSIONS The 5-year risk of sleep disorders is higher in those with newly diagnosed type 2 diabetes vs. those without. A higher absolute risk was seen in middle-older adults, but relative rates were consistently higher in younger adults with type 2 diabetes. Sleep should be regularly discussed as part of a holistic approach to diabetes care, particularly in those aged ≤40.
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Affiliation(s)
- Joseph Henson
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK.
| | | | | | - Tommy Slater
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK
| | - Andrew P Hall
- Hanning Sleep Laboratory, Leicester General Hospital, University Hospitals of Leicester NHS Trust, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; NIHR Applied Health Research Collaboration - East Midlands (NIHR ARC-EM), Leicester Diabetes Centre, Leicester, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK
| | - Jack A Sargeant
- NIHR Leicester Biomedical Research Centre, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, UK
| | - Francesco Zaccardi
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, UK
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Cases A, Broseta JJ, Marqués M, Cigarrán S, Julián JC, Alcázar R, Ortiz A. Cardiovascular-kidney-metabolic syndrome definition and its role in the prevention, risk staging, and treatment. An opportunity for the Nephrology. Nefrologia 2024; 44:771-783. [PMID: 39645511 DOI: 10.1016/j.nefroe.2024.11.011] [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: 02/13/2024] [Revised: 04/27/2024] [Accepted: 05/05/2024] [Indexed: 12/09/2024] Open
Abstract
The recent conceptualization of the cardiovascular-kidney-metabolic (CKM) syndrome by the American Heart Association (AHA) opens an opportunity for a multidisciplinary and lifelong approach in the risk stratification, early prevention, and treatment of the vicious circle generated by the interaction of cardiovascular, renal and metabolic risk factors and aggravated by the development of cardiovascular diseases (including their full spectrum: heart failure, atrial fibrillation, coronary heart disease, stroke, and peripheral arterial disease), chronic kidney disease or type 2 diabetes mellitus, with the excess or dysfunctional adiposity as the trigger. Three publications offer the rational basis of a conceptual decalogue and action plan and a new cardiovascular risk stratification equation since the age of 30 that includes measures of renal function/damage, among others, to promote effective cardiovascular, renal, and metabolic prevention. In Spain, we must leverage this momentum to adapt these new concepts to our reality with greater and improved collaboration between primary care and the specialties involved in CKM syndrome, including the formation of multidisciplinary units for the optimal management using a patient-centred approach.
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Affiliation(s)
- Aleix Cases
- Servei de Nefrologia i Trasplantament Renal, Hospital Clínic, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Jose Jesus Broseta
- Servei de Nefrologia i Trasplantament Renal, Hospital Clínic, Barcelona, Spain.
| | - Maria Marqués
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Roberto Alcázar
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Alberto Ortiz
- Universidad Autónoma de Madrid, Madrid, Spain; Servicio de Nefrología e Hipertensión, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (iiS-FJD), Madrid, Spain; Red de Investigación Cooperativa Orientada a Resultados en Salud b0d0 (RICORSb0d0), Madrid, Spain
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Li Y, Luo J, Bao K, Wei Q, Wang X, Chen J, Zhang T, Wang F, Zhu Y. Association of age at diagnosis of type 2 diabetes mellitus with the risks of the morbidity of cardiovascular disease, cancer and all-cause mortality: Evidence from a real-world study with a large population-based cohort study. Diabetes Res Clin Pract 2024; 217:111870. [PMID: 39341371 DOI: 10.1016/j.diabres.2024.111870] [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: 06/12/2024] [Revised: 08/09/2024] [Accepted: 09/24/2024] [Indexed: 10/01/2024]
Abstract
AIMS To investigate the impact of diagnosis age of type 2 diabetes mellitus (T2DM) on subsequent adverse outcomes within the Chinese population. METHODS 549,959 eligible T2DM patients were included from Ningbo and Jinhua city in Zhejiang province, China. Standardized ratio was used to evaluate the risks of coronary heart disease (CHD), stroke, cancer and all-cause death in different T2DM diagnosis age groups. RESULTS For all adverse outcomes, higher excess risks were observed in the youngest age group (30-39) than in the oldest age group (≥80) with T2DM. The standardized incidence ratios (SIR) were 5.93 (95% CI: 3.46, 10.14) for CHD, 5.45 (95% CI: 3.72, 7.99) for stroke and 1.85 (95% CI: 1.38, 2.49) for cancer in the youngest age group, and were 1.32 (95% CI: 1.08, 1.60) for CHD, 1.25 (95% CI: 1.08, 1.44) for stroke, and 0.78 (95% CI: 0.56, 1.09) for cancer, respectively, in the oldest age group. The standardized mortality ratios (SMR) for all-cause death were 3.15 (1.69, 5.84) vs. 1.12 (0.88, 1.43). These excess risks decreased with increasing diagnosis age (all P value < 0.001). Consistent results were observed when individuals were stratified by sex or further excluded with the time from T2DM diagnosis to endpoints less than 1 or 2 years. CONCLUSIONS Th earlier the diagnosis of T2DM, the higher the risk for subsequent adverse outcomes. It is imperative to enhance the management and monitoring of early-onset patients during follow-up.
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Affiliation(s)
- Yuhao Li
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinbin Luo
- Jinhua Center for Disease Control and Prevention, 1366 Jinou Road, Jindong District, Jinhua, Zhejiang, China
| | - Kaifang Bao
- Ningbo Center for Disease Control and Prevention, 1166 Fanjiang'an Road, Haishu District, Ningbo, Zhejiang, China
| | - Qiaohui Wei
- Department of Epidemiology & Biostatistics and Teaching Experiment Center, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaohong Wang
- Jinhua Center for Disease Control and Prevention, 1366 Jinou Road, Jindong District, Jinhua, Zhejiang, China
| | - Jieping Chen
- Ningbo Center for Disease Control and Prevention, 1166 Fanjiang'an Road, Haishu District, Ningbo, Zhejiang, China
| | - Tao Zhang
- Ningbo Center for Disease Control and Prevention, 1166 Fanjiang'an Road, Haishu District, Ningbo, Zhejiang, China.
| | - Fengying Wang
- Jinhua Center for Disease Control and Prevention, 1366 Jinou Road, Jindong District, Jinhua, Zhejiang, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
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Marek-Iannucci S, Palazzuoli A, Babarto M, Lazarevic Z, Beltrami M, Fedele F. Integrated Cardiorespiratory Rehabilitation and Its Impact on Cardio-Renal-Metabolic Profile After Cardiac Surgery. Nutrients 2024; 16:3699. [PMID: 39519532 PMCID: PMC11547743 DOI: 10.3390/nu16213699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 10/15/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are common causes of morbidity and mortality. However, the impact of changes in lifestyle and rehabilitation programs on the progression of cardiovascular, renal, and metabolic (CRM) conditions, remains unclear. METHODS In a retrospective manner, we analyzed charts of 200 patients admitted for cardiorespiratory rehabilitation at our facility in 2023. A 6 min walk test, echocardiographic features, and laboratory values were investigated to evaluate the impact of cardiorespiratory rehabilitation in patients post cardiac surgery. This study examined the impact of combined lifestyle and exercise scores (diet, alcohol consumption, smoking, aerobic physical activity, sedentary behavior, sleep duration, and social connection) on cardio-renal-metabolic profiles and on a quality-of-life score measured by the Borg Scale. RESULTS During the rehabilitation program, left ventricular ejection fraction (LVEF) significantly increased (51.2 vs. 54.3%, SEM 0.51 p = 0.001). The six-minute walk test (6 MWT) significantly improved in terms of meters (133 vs. 373 m, SEM 6.41, p < 0.001) and Borg scale (6.6 vs. 2.5, SEM 0.06, p < 0.001). Glycemia levels reduced significantly (114.5± vs. 107.4± mg/dL, SEM 2.45, p = 0.001). While total cholesterol levels (119.4 vs. 129.6 mg/dL, SEM 2.4, p < 0.001) as well as HDL levels (29.9 vs. 40 mg/dL, SEM 0.62, p < 0.001) significantly increased, triglyceride levels significantly decreased (128.5 vs. 122.1 mg/dL, SEM 3.8, p = 0.048). There was no change in LDL levels. Creatinine levels remained stable throughout the period of rehabilitation. CONCLUSIONS Cardiorespiratory rehabilitation has a significant impact on myocardial function, quality of life in terms of exercise capacity and symptoms (6 MWT) as well as laboratory levels relevant for cardiovascular prevention such as glycemia and lipid profile.
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Affiliation(s)
- Stefanie Marek-Iannucci
- Department of Cardiovascular Rehabilitation, San Raffaele, Monte Compatri, 00040 Rome, Italy; (S.M.-I.); (Z.L.)
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital University of Siena, 53100 Siena, Italy;
| | - Matteo Babarto
- Department of Cardiovascular Rehabilitation, San Raffaele, Monte Compatri, 00040 Rome, Italy; (S.M.-I.); (Z.L.)
| | - Zlatan Lazarevic
- Department of Cardiovascular Rehabilitation, San Raffaele, Monte Compatri, 00040 Rome, Italy; (S.M.-I.); (Z.L.)
| | - Matteo Beltrami
- Department of Arrhythmia and Electrophysiology, Careggi University Hospital, 50134 Florence, Italy
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Hashemi R, Rabizadeh S, Yadegar A, Mohammadi F, Rajab A, Karimpour Reyhan S, Seyedi SA, Esteghamati A, Nakhjavani M. High prevalence of comorbidities in older adult patients with type 2 diabetes: a cross-sectional survey. BMC Geriatr 2024; 24:873. [PMID: 39448921 PMCID: PMC11515473 DOI: 10.1186/s12877-024-05483-3] [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: 01/06/2024] [Accepted: 10/16/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Diabetes is a global health problem, and its incidence and complications increase with the duration of the disease and over time. This increase in complications in older patients can lead to disability and a lower quality of life. This study aimed to investigate the rate of diabetes control and complications in older adults. METHOD This was a cross-section of an ongoing cohort of patients with type 2 diabetes mellitus (T2DM) aged 65 years and older. The clinical and laboratory characteristics of older adult patients with T2DM in good and intermediate health conditions were collected between 2010 and 2022. RESULTS A total of 2,770 older adult patients with T2DM were enrolled, including 1,530(55.3%) female and 1,240 (44.7%) male participants. Metabolic syndrome, hypertension, and coronary artery disease were the most common comorbidities, affecting 1,889 (71.4%), 1,495 (54.4%), and 786 (29.2%) patients, respectively. Albuminuria was present in 626 (22.6%) patients, while retinopathy was detected in 408 (14.7%) patients, including 6% with proliferative retinopathy. Most patients were treated with oral antidiabetic agents (88.9%), with metformin being the most prescribed medication (85.6%). Statins were prescribed to 71.8% of the patients. The most prescribed antihypertensive medications were angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, prescribed to 54% and 15% of patients, respectively. The hemoglobin A1c (HbA1c) goal (HbA1c < 7.5%) was achieved in 1,350 (56.4%) patients, and the low-density lipoprotein cholesterol (LDL-C) goal (LDL < 100) was achieved in 1,165 (45.6%) patients. Blood pressure control (BP < 140/90) was achieved in 1,755 (65.4%) patients. All three goals were achieved in 278 (10.3%) patients. There were no significant differences in clinical laboratory results and the patients' characteristics based on gender. CONCLUSION The rate of progression of complications in older adult patients is higher than the effectiveness of the treatment, indicating the need for increased social support for this age group.
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Affiliation(s)
- Rana Hashemi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Yadegar
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohammadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Rajab
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Karimpour Reyhan
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Arsalan Seyedi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran.
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Tao S, Yu L, Li J, Huang L, Xue T, Yang D, Huang X, Meng C. Multiple triglyceride-derived metabolic indices and incident cardiovascular outcomes in patients with type 2 diabetes and coronary heart disease. Cardiovasc Diabetol 2024; 23:359. [PMID: 39402572 PMCID: PMC11472491 DOI: 10.1186/s12933-024-02446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/16/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Triglyceride (TG) and its related metabolic indices are recognized as important biomarker gauging cardiovascular diseases. This study aimed to explore the association between multiple TG-derived metabolic indices including the atherogenic index of plasma (AIP), triglyceride-glucose (TyG) index, triglyceride glucose-body mass index (TyG-BMI) and cardiovascular outcomes to identify valuable predictors for cardiovascular prognosis in patients with type 2 diabetes (T2DM) and coronary heart disease (CHD). METHODS Data of 1034 patients with T2DM and CHD from China-Japan Friendship Hospital between January 2019 and March 2022 were collected and analyzed. Multivariate Cox proportional hazards models and restricted cubic spline (RCS) analysis were conducted to examine the associations between AIP, TyG index, TyG-BMI and major adverse cardiac and cerebrovascular events (MACCEs). The area under the receiver operating characteristic (ROC) curve (AUC) was used to screen the most valuable predictor. Kaplan-Meier curve analysis was employed to examine the relationship between the predictor and prognosis. The goodness-of-fit of models was evaluated using the calibration curve and χ2 likelihood ratio test. Subgroup analysis and interaction test were performed to control for confounding factors. RESULTS The overall incidence of MACCEs was 31.04% during a median of 13.3 months of follow-up. The results showed that AIP, TyG index and TyG-BMI were all positively correlated with the risk of MACCEs in patients with T2DM and CHD (P < 0.05). Furthermore, ROC (AUC = 0.899) suggested that AIP had the strongest ability to predict the risk of MACCEs, and the highest AIP values enhanced the risk by 83.5% in the population. RCS model demonstrated that AIP was nonlinearly associated with the incident cardiovascular outcomes (P for nonlinear = 0.0118). The Kaplan-Meier analysis for MACCEs grouped by the AIP tertiles indicated that the probability of cumulative incidences of MACCEs was significantly higher in patients with a higher AIP (all Log rank P < 0.001). Meanwhile, the calibration curve demonstrated an excellent goodness-of-fit of the multivariate model (χ2 = 13.210, P = 0.105). Subgroup analysis revealed that the trend of positive association of AIP with cardiovascular risk was similar across subgroups except in non-hypertensive individuals. CONCLUSION Our study, for the first time, may provide valuable information that multiple TG-derived metabolic indices play a crucial role in the risk of MACCEs and it is recommended to monitor the AIP for lipid management in patients with established T2DM and CHD.
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Affiliation(s)
- Shiyi Tao
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Lintong Yu
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jun Li
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Li Huang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Tiantian Xue
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Deshuang Yang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xuanchun Huang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Chao Meng
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
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Moon J, Kim E, Jang H, Song I, Kwon D, Kang C, Oh J, Park J, Kim A, Choi M, Cha Y, Kim H, Lee W. Long-term exposure to PM2.5 and mortality: a national health insurance cohort study. Int J Epidemiol 2024; 53:dyae140. [PMID: 39417708 DOI: 10.1093/ije/dyae140] [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: 01/09/2024] [Accepted: 10/03/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Previous studies with large data have been widely reported that exposure to fine particulate matter (PM2.5) is associated with all-cause mortality; however, most of these studies adopted ecological time-series designs or have included limited study areas or individuals residing in well-monitored urban areas. However, nationwide cohort studies including cause-specific mortalities with different age groups were sparse. Therefore, this study examined the association between PM2.5 and cause-specific mortality in South Korea using the nationwide cohort. METHODS A longitudinal cohort with 187 917 National Health Insurance Service-National Sample Cohort participants aged 50-79 years in enrolment between 2002 and 2019 was used. Annual average PM2.5 was collected from a machine learning-based ensemble model (a test R2 = 0.87) as an exposure. We performed a time-varying Cox regression model to examine the association between long-term PM2.5 exposure and mortality. To reduce the potential estimation bias, we adopted generalized propensity score weighting method. RESULTS The association with long-term PM2.5 (2-year moving average) was prominent in mortalities related to diabetes mellitus [hazard ratio (HR): 1.03 (95% CI: 1.01, 1.06)], circulatory diseases [HR: 1.02 (95% CI: 1.00, 1.03)] and cancer [HR: 1.01 (95% CI: 1.00, 1.02)]. Meanwhile, circulatory-related mortalities were associated with a longer PM2.5 exposure period (1 or 2-year lags), whereas respiratory-related mortalities were associated with current-year PM2.5 exposure. In addition, the association with PM2.5 was more evident in people aged 50-64 years than in people aged 65-79 years, especially in heart failure-related deaths. CONCLUSIONS This study identified the hypothesis that long-term exposure to PM2.5 is associated with mortality, and the association might be different by causes of death. Our result highlights a novel vulnerable population: the middle-aged population with risk factors related to heart failure.
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Affiliation(s)
- Jeongmin Moon
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Ejin Kim
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hyemin Jang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Insung Song
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Dohoon Kwon
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Cinoo Kang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jieun Oh
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jinah Park
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Ayoung Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Moonjung Choi
- Health Insurance Research Institute, Wonjoo, Republic of Korea
| | - Yaerin Cha
- Health Insurance Research Institute, Wonjoo, Republic of Korea
| | - Ho Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Pusan, Republic of Korea
- Research and Management Center for Health Risk of Particulate Matter, Seoul, Republic of Korea
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Huang S, Zou S, Hee J, Gongye R, Xu S, Tang K. Pregnancy loss and risk of cardiometabolic multimorbidity in Chinese women: the China Kadoorie Biobank study. BMC Public Health 2024; 24:2694. [PMID: 39358758 PMCID: PMC11448432 DOI: 10.1186/s12889-024-20199-0] [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: 07/05/2023] [Accepted: 09/26/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND While the association between pregnancy loss and individual cardiometabolic diseases (CMDs) is well-established, its impact on the risk of coexisting CMDs remains unclear. Therefore, the aim of this study is to investigate the association between pregnancy loss with the risk of cardiometabolic multimorbidity in Chinese women. METHOD We analyzed the cross-sectional data of 299,582 female participants aged 30-79 years old from the China Kadoorie biobank. Cardiometabolic multimorbidity was defined as the coexistence of two or more CMDs, including coronary heart disease, stroke, hypertension, and diabetes. Multivariable logistic regression was used to evaluate the odds ratios (ORs) between the number and type of pregnancy loss with the risk of cardiometabolic multimorbidity, characterized by the number and type of CMD. RESULTS After adjusting for confounding factors, pregnancy loss was found to be significantly associated with increased cardiometabolic multimorbidity risk (OR, 1.13 95% CI 1.08-1.19). Specifically, pregnancy loss due to spontaneous and induced abortion (OR 1.10, 95% CI 1.03-1.18 and OR 1.13, 95% CI 1.08-1.19, respectively). In contrast, no significant association was found between stillbirth and cardiometabolic multimorbidity (OR 1.03, 95% CI 0.95-1.11). The risk of cardiometabolic multimorbidity increases as the number of pregnancy loss increases (one pregnancy loss: OR 1.10, 95% CI 1.05-1.16, two or more pregnancy loss: OR 1.16, 95% CI 1.10-1.22). Similarly, the diagnosis of multiple CMDs increases with increasing number of pregnancy loss. Pregnancy loss was related to higher risk of cardiometabolic multimorbidity across most CMD combinations of CMDs. CONCLUSION Pregnancy loss, in particular, spontaneous and induced abortion was significantly associated with greater risk of cardiometabolic multimorbidity. The associations were stronger among those with recurrent pregnancy loss.
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Affiliation(s)
- Sha Huang
- School of Environmental Science and Engineering, Hainan University, Haikou, Hainan, 570228, China.
| | - Siyu Zou
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing, 100084, China
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA
| | - Jiayi Hee
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing, 100084, China
| | - Ruofan Gongye
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing, 100084, China
| | - Shunqing Xu
- School of Environmental Science and Engineering, Hainan University, Haikou, Hainan, 570228, China.
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Zhongguancun North Street, Haidian District, Beijing, 100084, China.
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Goldney J, Barker MM, Thomas M, Slater T, Mickute M, Sargeant JA, Khunti K, Davies MJ, Zaccardi F. Age at onset of type 2 diabetes and prevalence of vascular disease and heart failure: Systematic review and dose-response meta-analysis. J Diabetes Complications 2024; 38:108849. [PMID: 39213715 DOI: 10.1016/j.jdiacomp.2024.108849] [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: 06/07/2024] [Revised: 07/18/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
AIM To investigate the relationship between age at diagnosis of type 2 diabetes and the risk of macrovascular disease, heart failure, and microvascular disease. METHODS In August 2022, PubMed/EMBASE were searched for articles reporting (i) coronary artery disease, cerebrovascular disease, peripheral vascular disease, amputation; (ii) heart failure; and (iii) retinopathy, neuropathy, nephropathy (albuminuria, chronic kidney disease [CKD], end-stage renal disease) by age at diagnosis of type 2 diabetes. Random effects, non-linear dose-response meta-analysis was undertaken for each outcome to assess the association with age at diagnosis (40 years = reference), using both crude and maximally adjusted odds ratios separately, with and without adjustment for current age (age at sampling). RESULTS We identified 42 articles (230,003 to 3,465,590 participants; 1035 to 391,140 events). Age at diagnosis was positively associated with the risk of macrovascular diseases, heart failure, and CKD, independent of current age, and negatively associated with retinopathy. For other microvascular outcomes, when adjusting for current age, a "reverse U" relationship was observed (peak risk = 55-60 years). DISCUSSION Retinopathy was negatively associated with age at diagnosis, highlighting the importance of retinopathy screening in early-onset type 2 diabetes. The implications of other associations were unclear due to the heterogeneity in methodologies and findings.
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Affiliation(s)
- Jonathan Goldney
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK.
| | - Mary M Barker
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Martha Thomas
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Tommy Slater
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Monika Mickute
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Jack A Sargeant
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
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Clara TSH, Huili Z, Jian-Jun L, Liu S, Janus LWL, Xiang KK, Gurung RL, Yiamunaa M, Keven AKL, Yi-Ming S, Subramaniam T, Fang SC, Chi LS. Association of major candidate protein biomarkers and long-term diabetic kidney disease progression among Asians with young-onset type 2 diabetes mellitus. Diabetes Res Clin Pract 2024; 216:111821. [PMID: 39142520 DOI: 10.1016/j.diabres.2024.111821] [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: 05/29/2024] [Revised: 07/21/2024] [Accepted: 08/12/2024] [Indexed: 08/16/2024]
Abstract
AIMS We aim to determine the association of seven major candidate protein biomarkers and diabetic kidney disease (DKD) progression among Asians with young-onset type 2 diabetes mellitus (T2DM). METHODS 824 T2DM patients (onset ≤ 40 years old) were classified as DKD progressors based on yearly estimated glomerular filtration rate (eGFR) decline of >3 ml/min/1.73 m2 or >40 % from baseline. Plasma leucine-rich α-2-glycoprotein 1 (pLRG1), tumor necrosis factor-receptor 1 (pTNF-R1), pigment epithelium-derived factor (pPEDF), urinary α-1-microglobulin (uA1M), kidney injury molecular 1 (uKIM-1), haptoglobin (uHP) and uromodulin (uUMOD) were measured using enzyme-linked immunoassays. RESULTS Over 5.7 years of follow-up, 25.2 % of patients were DKD progressors. Elevated levels of pLRG1, pTNF-R1, pPEDF, uA1M, uKIM-1 and uHP were associated with DKD progression. The association between pTNF-R1 levels and DKD progression persisted after adjusting for clinical covariates (OR 1.84, 95 %CI 1.44-2.34, p < 0.001). The effects of pTNF-R1 were partially mediated through hyperglycemia (8 %) and albuminuria (10 %). Inclusion of pTNF-R1 in a clinical variable-based model improved the area under the receiver operating characteristics curve for predicting DKD progression by 0.02, from 0.72 (95 %CI 0.68-0.76) to 0.74 (95 %CI 0.70-0.78), p = 0.099. CONCLUSIONS Among seven major candidate proteins, pTNF-R1, partially mediated through hyperglycemia and albuminuria, robustly predicted DKD progression among Asians with young-onset T2DM.
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Affiliation(s)
| | - Zheng Huili
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Liu Jian-Jun
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Sylvia Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | | | - Kee Kai Xiang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Resham Lal Gurung
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - M Yiamunaa
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | | | - Shao Yi-Ming
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Tavintharan Subramaniam
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Singapore
| | - Sum Chee Fang
- Diabetes Centre, Admiralty Medical Centre, Singapore
| | - Lim Su Chi
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Singapore; Saw Swee Hock School of Public Heath, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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50
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Vitale M, Orsi E, Solini A, Garofolo M, Grancini V, Bonora E, Fondelli C, Trevisan R, Vedovato M, Penno G, Nicolucci A, Pugliese G. Association between age at diagnosis and all-cause mortality in type 2 diabetes: the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study. Acta Diabetol 2024; 61:1107-1116. [PMID: 38714557 PMCID: PMC11379756 DOI: 10.1007/s00592-024-02294-1] [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: 02/29/2024] [Accepted: 04/14/2024] [Indexed: 05/10/2024]
Abstract
AIMS It is unclear whether type 2 diabetes diagnosed in young adulthood is associated with increased severity than that occurring later in life beyond longer lifetime exposure to hyperglycemia. This study aimed at assessing the independent association of age at type 2 diabetes diagnosis with all-cause mortality. METHODS This prospective cohort study enrolled 15,773 Caucasian patients with type 2 diabetes in 19 Italian centers in 2006-2008. Cardiometabolic risk profile and presence of complications and comorbidities were assessed at baseline and participants were stratified by quartiles of age at diabetes diagnosis. All-cause mortality was verified on 31 October 2015. RESULTS Valid information on vital status was retrieved for 15,656 participants (99.3%). Patients in the lowest quartile had the longest diabetes duration, the worst glycemic control and the highest prevalence of insulin treatment, obesity, atherogenic dyslipidemia, and smoking habits. All complications were inversely associated with age at diabetes diagnosis after adjustment for age and sex, but not after further adjustment for diabetes duration. Percentages of death, Kaplan-Meier estimates, and unadjusted hazard ratios and mortality rates increased from the lowest to the highest quartile. In contrast, when adjusting for age and sex, participants falling in the lowest quartile, showed the highest mortality risk [hazard ratio 1.321 (95% confidence interval 1.196-1.460), P < 0.0001]. However, differences among quartiles disappeared after adjustment for diabetes duration, complications/comorbidities, or other cardiovascular risk factors. CONCLUSIONS Type 2 diabetes onset in young adulthood is associated with increased mortality that is mainly driven by longer diabetes duration favoring the development of complications. TRIAL REGISTRATION ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.
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Affiliation(s)
- Martina Vitale
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Emanuela Orsi
- Diabetes Unit, Fondazione IRCCS "Cà Granda - Ospedale Maggiore Policlinico", Milan, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Monia Garofolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Grancini
- Diabetes Unit, Fondazione IRCCS "Cà Granda - Ospedale Maggiore Policlinico", Milan, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | | | - Roberto Trevisan
- Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Vedovato
- Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
| | - Giuseppe Penno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy.
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