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Hou WH, Wu JL, Lu CL, Sulistyorini L, Isfandiari MA, Chiu CT, Li CY. Associations of hyperglycemic emergency and severe hypoglycemia incidences with seasonality and ambient temperature among pregnant women with diabetes: a nested case-control study in Taiwan. Environ Health Prev Med 2022; 27:11. [PMID: 35288489 PMCID: PMC9093638 DOI: 10.1265/ehpm.22-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Associations of acute glycemic complications with season and ambient temperature have been reported in general population with diabetes. However, little is known about the risks of acute glycemic complications in relation to season and ambient temperature in pregnant women, who are likely to be even more vulnerable. This work aimed to investigate the associations of season and ambient temperature with pregnancies complicated with hyperglycemia emergency or severe hypoglycemia. Methods Two separate case-control studies were nested within 150,153 pregnancies by women with type 1, type 2, or gestational diabetes between 2009 and 2014 in Taiwan. Hyperglycemia emergency (mainly diabetic ketoacidosis and hyperosmolar hyperglycemic state) and severe hypoglycemia occurred in 77 and 153 diabetic pregnancies (cases), respectively. Ten control pregnancies were randomly selected for each case by matching each case pregnancy on type of diabetes (i.e., T1DM, T2DM, or GDM), maternal age on the date of acute glycemic complication occurrence (i.e., index date), and “length of gestation at risk” (i.e., period between conception and index date). Meteorological parameters were retrieved from 542 meteorological monitoring stations across Taiwan during 2008–2014. Conditional logistic regression analysis with generalized estimation equation was separately performed to estimate the covariate adjusted odds ratios (ORs) of each of the two acute glycemic complications in association with season and ambient temperature within 30 days prior to the index date. Results Compared to summer, winter season was associated with a significantly elevated risk of severe hypoglycemia with an OR of 1.74 (95% confidence interval (CI) 1.08–2.79). The OR of hyperglycemic emergency was also elevated in winter season at OR of 1.88, but the significance is only marginal (95% CI 0.97–3.64, p = 0.0598). Subgroup analyses further noted that such seasonal variation was also observed in pregnancies with pre-pregnancy type 1 diabetes and gestational diabetes. On the other hand, ambient temperature was not significantly associated with the two acute glycemic complications. Conclusions A moderately but significantly elevated risk of severe hypoglycemia was found in pregnant women with diabetes during winter season, and such increased risk was more evident in pregnancies with T1DM. Supplementary information The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00003.
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Affiliation(s)
- Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital
| | - Jia-Ling Wu
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Chin-Li Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University
| | - Lilis Sulistyorini
- Department of Environmental Health, Faculty of Public Health, Universitas Airlangga
| | | | - Chang-Ta Chiu
- Department of Dentistry, An Nan Hospital, China Medical University
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University
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Takai M, Ishikawa M, Maeda H, Kubota A, Iemitsu K, Umezawa S, Kawata T, Takuma T, Takeda H, Tanaka K, Machimura H, Minagawa F, Mokubo A, Motomiya T, Kanamori A, Matsuba I. A Study of Seasonal Variation in the Effect of Add-On Sitagliptin on Blood Glucose Control in Insulin-Treated Patients With Type 2 Diabetes. J Clin Med Res 2020; 12:200-208. [PMID: 32231757 PMCID: PMC7092762 DOI: 10.14740/jocmr4103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/21/2020] [Indexed: 01/21/2023] Open
Abstract
Background There are several reports of seasonal variation in hemoglobin A1c (HbA1c) in patients with type 2 diabetes (T2DM), but no reports of seasonal variation in the effect of add-on drugs on blood glucose control in insulin-treated patients. Methods Using data collected from 630 patients in a multicenter study, we compared the amount of change in HbA1c after 1, 3, 6, 9, and 12 months of add-on administration of sitagliptin in insulin-treated patients divided into four groups based on the month when sitagliptin was started. Results A significantly larger decrease in HbA1c at 6 months from baseline was observed in the group that started add-on sitagliptin in February to April than in the other three groups. However, the amount of change in HbA1c at 12 months did not differ among the groups. Conclusions The consideration of seasonal variation enables more accurate evaluation of a drug’s short-term effect on blood glucose control.
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Affiliation(s)
- Masahiko Takai
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Masashi Ishikawa
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Hajime Maeda
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Akira Kubota
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Kotaro Iemitsu
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Shinichi Umezawa
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Takehiro Kawata
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Tetsuo Takuma
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Hiroshi Takeda
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Keiji Tanaka
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Hideo Machimura
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Fuyuki Minagawa
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Atsuko Mokubo
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Tetsuya Motomiya
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Akira Kanamori
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
| | - Ikuro Matsuba
- Diabetes Committee Study Group, Kanagawa Physicians Association, 1-3 Fujimichou, Nakaku, Yokohama, Kanagawa 231-0037, Japan
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Lai SW, Chang WC, Lin CL, Chou IC, Tsai FJ, Lai YJ. Low ambient temperatures correlate with increased risk of hypoglycemia in patients with type 2 diabetes: An ecological study in Taiwan. Medicine (Baltimore) 2020; 99:e19287. [PMID: 32080143 PMCID: PMC7034721 DOI: 10.1097/md.0000000000019287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Little evidence is available about the relationship between ambient temperatures and hypoglycemia in Taiwan. The purpose of the present paper is to investigate whether there is an association between ambient temperatures and hypoglycemia in patients with type 2 diabetes.An ecological study was conducted to analyze the type 2 diabetes dataset of the Taiwan National Health Insurance Program. Every episode of hypoglycemia diagnosed at emergency department among subjects with type 2 diabetes was identified monthly between 2006 and 2013. Average monthly ambient temperatures in Celsius between 2006 and 2013 were measured according to the database of the Central Weather Bureau in Taiwan.The incidence rates of hypoglycemia were higher during the period of cold ambient temperatures (from December to March) than the period of warm ambient temperatures (from April to November). The peak period of hypoglycemia always occurred in winter months (January and February).Patients with type 2 diabetes in Taiwan are more susceptible to hypoglycemia during the period of cold ambient temperatures, particularly in winter months. Clinicians in Taiwan should remind patients to make a preventive strategy for hypoglycemia during the periods of cold ambient temperatures.
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Affiliation(s)
- Shih-Wei Lai
- School of Medicine, College of Medicine, China Medical University
- Department of Family Medicine
| | | | - Cheng-Li Lin
- School of Medicine, College of Medicine, China Medical University
- Management Office for Health Data, China Medical University Hospital
| | - I-Ching Chou
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University
- Division of Pediatric Neurology, China Medical University Children's Hospital
| | - Fuu-Jen Tsai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung
| | - Yen-Jen Lai
- Experimental Forest, College of Bio-Resources and Agriculture, National Taiwan University, Nantou County, Taiwan
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