Secular changes in the age-specific prevalence of diabetes among U.S. adults: 1988-2010

Trends of diabetes in Beijing, China

BACKGROUND

The global rise in diabetes prevalence is a pressing concern. Despite initiatives like "The Healthy Beijing Action 2020-2030" advocating for increased awareness, treatment, and control, the specific situation in Beijing remains unexplored. This study aimed to analyze the trends in diabetes prevalence, awareness, treatment, and control among Beijing adults.

METHODS

Through a stratified multistage probability cluster sampling method, a series of representative cross-sectional surveys were conducted in Beijing from 2005 to 2022, targeting adults aged 18-79 years. A face-to-face questionnaire, along with body measurements and laboratory tests, were administered to 111,943 participants. Data from all survey were age- and/or gender-standardized based on the 2020 Beijing census population. Annual percentage rate change (APC) or average annual percentage rate change (AAPC) was calculated to determine prevalence trends over time. Complex sampling logistic regression models were employed to explore the relationship between various characteristics and diabetes.

RESULTS

From 2005 to 2022, the total prevalence of diabetes among Beijing adults aged 18-79 years increased from 9.6% (95% CI: 8.8-10.4%) to 13.9% (95% CI: 13.1-14.7%), with an APC/AAPC of 2.1% (95% CI: 1.1-3.2%, P <0.05). Significant increases were observed among adults aged 18-39 years and rural residents. Undiagnosed diabetes rose from 3.5% (95% CI: 3.2-4.0%) to 7.2% (95% CI: 6.6-7.9%) with an APC/AAPC of 4.1% (95% CI: 0.5-7.3%, P <0.05). However, diabetes awareness and treatment rates showed annual declines of 1.4% (95% CI: -3.0% to -0.2%, P <0.05) and 1.3% (95% CI: -2.6% to -0.2%, P <0.05), respectively. The diabetes control rate decreased from 21.5% to 19.1%, although not statistically significant (APC/AAPC = -1.5%, 95% CI: -5.6% to 1.9%). Overweight and obesity were identified as risk factors for diabetes, with ORs of 1.65 (95% CI: 1.38-1.98) and 2.48 (95% CI: 2.07-2.99), respectively.

CONCLUSIONS

The prevalence of diabetes in Beijing has significantly increased between 2005 and 2022, particularly among young adults and rural residents. Meanwhile, there has been a concerning decrease in diabetes awareness and treatment rates, while control rates have remained stagnant. Regular blood glucose testing, especially among adults aged 18-59 years, should be warranted. Furthermore, being male, elderly, overweight, or obese was associated with higher diabetes risk, suggesting the needs for targeted management strategies.

Multiple long-term conditions as the next transition in the global diabetes epidemic

Several transitions, or new patterns and dynamics in the contributors and health outcomes, have altered the character and burden of the multi-decade, worldwide growth in prevalence of type 2 diabetes (T2DM). These changes have led to different needs for prevention and care. These dynamics have been driven by diverse demographic, socio-economic, behavioural, and health system response factors. In this Perspective, we describe these transitions and how their attributes have set the stage for multimorbidity, or multiple long-term conditions (MLTCs), to be the next major challenge in the diabetes epidemic. We also describe how the timing and character of these stages differ in high-, middle-, and low-income countries. These challenges call for innovation and a stronger focus on MLTCs across the spectrum of cause, effectiveness, and implementation studies to guide prevention and treatment priorities.

Unveiling inequalities: Racial, ethnic, and socioeconomic disparities in diabetes: Findings from the 2007-2020 NHANES data among U.S. adults

Objective

Despite persistent disparities in diabetes prevalence among racial and ethnic minorities, there remains a significant lack of understanding regarding the intersectionality of racial and ethnic groups and socioeconomic status (SES) with diabetes.

Methods

The data came from the National Health and Nutrition Examination Survey (NHANES; N = 30,754, mean age = 47.4) using cross-sectional survey cycles from 2007 to 2008 through 2017-2020. Diabetes status was self-reported by physician diagnosis. Sociodemographic factors included racial and ethnic groups and SES. Weighted Poisson models were used to examine the association of racial and ethnic groups and SES with diabetes, stratified by age groups (20-44, 45-64, 65-79), sex, and racial and ethnic groups for SES, separately.

Results

Non-Hispanic Black, Hispanic, and other adults had a 47 %, 31 %, and 76 % higher prevalence of diabetes than non-Hispanic White adults, while adults from low and middle SES compared to high SES had a 37 % and 22 % higher prevalence of diabetes. Non-Hispanic Black, Hispanic, and other adults aged 45-64 years had a 45 %, 34 %, and 78 % higher prevalence of diabetes, and low and middle SES had a 57 % and 32 % higher prevalence of diabetes. Similar patterns were observed for adults aged 65-79. Males among non-Hispanic Black, Hispanic, and other adults and females from low and middle-SES families had a higher prevalence of diabetes.

Conclusion

Minority groups, middle and older-aged adults, males from minority groups, and females from low SES had a greater prevalence of diabetes. Effective interventions should prioritize tailoring efforts to specific minoritized and low SES groups to address diabetes disparities.

The rat as an animal model in chronic wound research: An update

The increasing global prevalence of chronic wounds underscores the growing importance of developing effective animal models for their study. This review offers a critical evaluation of the strengths and limitations of rat models frequently employed in chronic wound research and proposes potential improvements. It explores these models in the context of key comorbidities, including diabetes, venous and arterial insufficiency, pressure-induced blood flow obstruction, and infections. Additionally, the review examines important wound factors including age, sex, smoking, and the impact of anesthetic and analgesic drugs, acknowledging their substantial effects on research outcomes. A thorough understanding of these variables is crucial for refining animal models and can provide valuable insights for future research endeavors.

Effects of Non-Face-to-Face Chronic Care Management on Service Utilization and Outcomes Among US Medicare Beneficiaries with Diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) results in heavy economic and disease burdens in Louisiana. The Centers for Medicare and Medicaid Services has reimbursed non-face-to-face chronic care management (NFFCCM) for patients with two or more chronic conditions since 2015.

OBJECTIVE

To assess the impacts of NFFCCM on healthcare utilization and health outcomes.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study included Medicare fee-for-service beneficiaries with T2DM and at least one additional chronic disease between 2014 and 2018.

EXPOSURES

At least one record of NFFCCM Current Procedural Terminology codes.

MAIN MEASURES

The health outcomes in the study included major adverse cardiovascular events (MACE), all-cause mortality, and heart failure. The monthly service utilization and continuity of care index for primary care were also included. The propensity score method was used to balance the baseline differences between the two groups. Weighted multivariate regression models were developed using propensity score weights to assess the impacts of NFFCCM on outcomes.

KEY RESULTS

During the 5 years of study period, 8415 patients among the 118,643 Medicare beneficiaries received at least one NFFCCM. Patients receiving any NFFCCM had reduced healthcare utilization compared with patients not receiving NFFCCM, including 0.012 (95% CI - 0.014 to - 0.011; p < 0.001) fewer monthly hospital admissions, 0.017 (95% CI - 0.019 to - 0.016; p < 0.001) fewer monthly ED visits, and 0.399 (95% CI 0.375 to 0.423; p < 0.001) more monthly outpatient encounters. Patients receiving NFFCCM services had lower MACE event rates of 7.4% (95% CI 7.1 to 7.8%; p < 0.001), all-cause mortality rate of 7.8% (95% CI 7.4 to 8.1%; p < 0.001), and heart failure rate of 0.3% (95% CI 0.2 to 0.5%; p < 0.001), respectively.

CONCLUSIONS AND RELEVANCE

These findings suggest that reimbursement for NFFCCM was associated with the shifting high-cost utilization to lower-cost primary health care settings among patients with diabetes in Louisiana.

The association of adolescent fitness with cardiometabolic diseases in late adulthood: A 45-year longitudinal study

OBJECTIVES

The aim of this study was to examine the associations of adolescent cardiorespiratory fitness (CRF), muscular fitness (MF), and speed-agility fitness (SA) with middle-aged cardiometabolic disease risk and explore sex differences.

METHODS

This 45-year prospective cohort study examined the associations between objectively measured fitness at adolescence (12-19 years) and physician-ascertained diabetes mellitus, elevated blood pressure (BP), and coronary heart disease reported either in early (37-44 years) or late (57-64 years) middle age, and self-measurement of waist circumference (WC) in late middle age. Fitness measurements for healthy adolescents in baseline included CRF (1.5 km [girls] and 2 km [boys] run), MF (standing broad jump, sit-ups, pull-ups [boys], and flexed-arm hang [girls]), and SA (50 m dash and 4 × 10 m shuttle run). Logistic regression and general linear models were adjusted for baseline age, sex, and body mass index (BMI), involving data from baseline and at least one follow-up measurement (N up to 1358, 47% males).

RESULTS

Adolescent CRF was inversely, and regardless of adiposity, associated with middle age accumulated burden of cardiometabolic conditions in the whole sample (N = 562, ß = -0.10, 95% confidence intervals [CI] [-0.18, -0.03], p = 0.006), and elevated BP in females (N = 256, OR = 0.71, 95% CI [0.51, 0.91]). Overall, we observed stronger associations in females than in males. An inverse association of adolescent MF and SA with middle-aged WC was observed, but it did not show as consistent associations as with CRF.

CONCLUSIONS

In this study, adolescent fitness, particularly CRF, was inversely associated with the burden of cardiometabolic conditions up to 45 years. Promotion of fitness in youth may be beneficial in preventing adulthood cardiometabolic diseases.

Diabetes Mellitus Mortality Trends in Brazil From 2000 to 2021: An In-Depth Joinpoint Analysis

Diabetes mellitus (DM) is a public health concern in Brazil, with deleterious effects on quality of life and increasing mortality rates. The prevalence of diabetes in Brazil is on the rise, and it is imperative to understand its effects on mortality rates in the last two decades in order to effectively mitigate the detrimental impact of diabetes on public health. This study aims to analyze mortality trends related to diabetes in Brazil from 2000 to 2021, encompassing both type 1 and type 2 diabetes, across sex and various age cohorts. Using joinpoint regression analysis, temporal trends in Brazil were assessed, while also incorporating findings from previous studies and considering potential influencing factors, such as government initiatives and cuts in healthcare investment. The study revealed a general upward trend in mortality rates associated with DM1 and DM2 over the study period, in both males and females, with men showing a higher AAPC (average annual percent change), which translated into significantly increased mortality difference at the end of the study. Additionally, it revealed elevated mortality values for extreme age groups in the age cohorts studied, with the exception of middle-aged cohort groups in DM2, which showed an expected higher APC (annual percent change), considering the age of highest incidence of DM2 in those age groups. This comprehensive analysis provides critical insights into the escalating impact of diabetes on mortality rates in Brazil and highlights the urgent need for healthcare strategies. It is expected that the increased prevalence of diabetes in the Brazilian population adds an additional economic burden to healthcare expenditure by the Brazilian government, further worsening the health disparities among different social groups. Unless several political decisions to reduce healthcare expenditure are reversed, greater difficulties in accessing treatments will be detrimental for vulnerable social groups in Brazil. By understanding the nuanced patterns of diabetes-related mortality, healthcare providers and policymakers can allocate resources effectively and implement tailored interventions to better address diabetes in Brazil.

Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Cerebral small vessel disease (cSVD) is a major contributing factor to ischemic stroke and dementia. However, the vascular pathologies of cSVD remain inconclusive. The aim of this systematic review and meta-analysis was to characterize the associations between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS).

METHODS AND RESULTS

MEDLINE, Web of Science, and Embase were searched from inception to September 2023 for studies reporting CVR, cerebral autoregulation, or AS in relation to radiological markers of cSVD. Data were extracted in predefined tables, reviewed, and meta-analyses performed using inverse-variance random effects models to determine pooled odds ratios (ORs). A total of 1611 studies were identified; 142 were included in the systematic review, of which 60 had data available for meta-analyses. Systematic review revealed that CVR, cerebral autoregulation, and AS were consistently associated with cSVD (80.4%, 78.6%, and 85.4% of studies, respectively). Meta-analysis in 7 studies (536 participants, 32.9% women) revealed a borderline association between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99-5.14]; P=0.05). In 37 studies (27 952 participants, 53.0% women) increased AS, per SD, was associated with cSVD (OR, 1.24 [95% CI, 1.15-1.33]; P<0.01). Meta-regression adjusted for comorbidities accounted for one-third of the AS model variance (R2=29.4%, Pmoderators=0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18-1.70]; P<0.01).

CONCLUSIONS

The collective findings of the present systematic review and meta-analyses suggest an association between cSVD and impaired CVR and elevated AS. However, longitudinal investigations into vascular stiffness and regulatory function as possible risk factors for cSVD remain warranted.

Prevalence of metabolic syndrome in the United States National Health and Nutrition Examination Survey 2011-18

PURPOSE

To estimate the prevalence of metabolic syndrome (MetS) in the US National Health and Nutrition Examination Survey (NHANES) 2011-18.

METHODS

This study included 8183 eligible nonpregnant participants aged ≥20 years from the NHANES 2011-18. MetS was defined as the presence of at least three of the following components: central obesity, reduced high-density lipoprotein cholesterol, elevated triglycerides, elevated blood pressure, and elevated fasting blood glucose. The prevalence of MetS was estimated taking into account the complex sampling. The time trend was evaluated using logistic regression.

RESULTS

The total prevalence of MetS increased from 37.6% [95% confidence interval (CI): 34.0%-41.4%] in 2011-12 to 41.8% (95% CI: 38.1%-45.7%) in 2017-18 (P for trend = .028). Among the MetS components, the prevalence of elevated glucose increased from 48.9% (95% CI: 45.7%-52.5%) in 2011-12 to 64.7% (95% CI: 61.4%-67.9%) in 2017-18 (P for trend <.001). The prevalence of MetS in participants with low educational attainment increased from 44.4% (95% CI: 38.8%-50.1%) in 2011-12 to 55.0% (95% CI: 50.8%-59.1%) in 2017-18 (P for trend = .01).

CONCLUSION

The prevalence of MetS increased during 2011-18, notably in participants with low educational attainment. Lifestyle modification is needed to prevent MetS and the associated risks of diabetes and cardiovascular disease. Key messages What is already known on this topic: Prevalence of metabolic syndrome is an index of the cardiometabolic health of a population. What this study adds: The prevalence of metabolic syndrome in US adults increased during 2011-18, notably in participants with low educational attainment. How this study might affect research, practice, or policy: Lifestyle modification is needed to prevent metabolic syndrome and the associated risks of diabetes and cardiovascular disease.

Food Diary Completion Does Not Significantly Impact Glycemic Control in an Observational Single-Institution Pilot Study of Patients with Type 2 Diabetes Mellitus

INTRODUCTION

Hemoglobin A1c is frequently used to monitor glycemic control in patients with type 2 diabetes mellitus (T2DM). There is an association between dietary habits and hemoglobin A1c. Food diaries are often used to assist in dietary management and have been associated with modification of dietary habits. We aimed to investigate the impact of completing a seven-day food diary on hemoglobin A1c in subjects with T2DM. We hypothesized that patients who completed a food diary might independently modify their dietary habits, resulting in a clinically significant change in hemoglobin A1c.

METHODS

Forty-five subjects with T2DM who completed a seven-day food diary were included in this observational study. Subjects had a mean hemoglobin A1c at baseline of 7.56 ± 1.43 and a body mass index of 33.6 ± 7.6 kg/m². A majority were female (57.8%) and insulin-dependent (71.1%). The primary outcome of interest was a clinically significant change in hemoglobin A1c (≥0.5%). Outcomes were assessed before and within six months after the food diary completion. Chi-square, independent-sample t-tests, and logistic regression were used to analyze the data.

RESULTS

Twelve patients demonstrated a clinically significant decrease in hemoglobin A1c; however, this was not statistically significant regardless of gender (p = 0.5), baseline body mass index (p = 0.5), insulin use (p = 0.3), or community needs index (p = 0.7).

CONCLUSIONS

Although some patients had clinically significant improvements in their hemoglobin A1c, our findings suggest that the use of food diaries alone without goal-directed initiatives is insufficient to achieve differences in hemoglobin A1c in patients with T2DM and an average A1c within the range of 6%-8%.

Reticular Pseudodrusen Are Associated With More Advanced Para-Central Photoreceptor Degeneration in Intermediate Age-Related Macular Degeneration

Purpose

The purpose of this study was to examine retinal topographical differences between intermediate age-related macular degeneration (iAMD) with reticular pseudodrusen (RPD) versus iAMD without RPD, using high-density optical coherence tomography (OCT) cluster analysis.

Methods

Single eyes from 153 individuals (51 with iAMD+RPD, 51 with iAMD, and 51 healthy) were propensity-score matched by age, sex, and refraction. High-density OCT grid-wise (60 × 60 grids, each approximately 0.01 mm2 area) thicknesses were custom-extracted from macular cube scans, then compared between iAMD+RPD and iAMD eyes with correction for confounding factors. These "differences (µm)" were clustered and results de-convoluted to reveal mean difference (95% confidence interval [CI]) and topography of the inner retina (retinal nerve fiber, ganglion cell, inner plexiform, and inner nuclear layers) and outer retina (outer plexiform/Henle's fiber/outer nuclear layers, inner and outer segments, and retinal pigment epithelium-to-Bruch's membrane [RPE-BM]). Differences were also converted to Z-scores using normal data.

Results

In iAMD+RPD compared to iAMD eyes, the inner retina was thicker (up to +5.89 [95% CI = +2.44 to +9.35] µm, P < 0.0001 to 0.05), the outer para-central retina was thinner (up to -3.21 [95% CI = -5.39 to -1.03] µm, P < 0.01 to 0.001), and the RPE-BM was thicker (+3.38 [95% CI = +1.05 to +5.71] µm, P < 0.05). The majority of effect sizes (Z-scores) were large (-3.13 to +1.91).

Conclusions

OCT retinal topography differed across all retinal layers between iAMD eyes with versus without RPD. Greater para-central photoreceptor thinning in RPD eyes was suggestive of more advanced degeneration, whereas the significance of inner retinal thickening was unclear. In the future, quantitative evaluation of photoreceptor thicknesses may help clinicians monitor the potential deleterious effects of RPD on retinal integrity.

Trends in Excess Winter Mortality (EWM) from 1900/01 to 2019/20-Evidence for a Complex System of Multiple Long-Term Trends

Trends in excess winter mortality (EWM) were investigated from the winter of 1900/01 to 2019/20. During the 1918-1919 Spanish flu epidemic a maximum EWM of 100% was observed in both Denmark and the USA, and 131% in Sweden. During the Spanish flu epidemic in the USA 70% of excess winter deaths were coded to influenza. EWM steadily declined from the Spanish flu peak to a minimum around the 1960s to 1980s. This decline was accompanied by a shift in deaths away from the winter and spring, and the EWM calculation shifted from a maximum around April to June in the early 1900s to around March since the late 1960s. EWM has a good correlation with the number of estimated influenza deaths, but in this context influenza pandemics after the Spanish flu only had an EWM equivalent to that for seasonal influenza. This was confirmed for a large sample of world countries for the three pandemics occurring after 1960. Using data from 1980 onward the effect of influenza vaccination on EWM were examined using a large international dataset. No effect of increasing influenza vaccination could be discerned; however, there are multiple competing forces influencing EWM which will obscure any underlying trend, e.g., increasing age at death, multimorbidity, dementia, polypharmacy, diabetes, and obesity-all of which either interfere with vaccine effectiveness or are risk factors for influenza death. After adjusting the trend in EWM in the USA influenza vaccination can be seen to be masking higher winter deaths among a high morbidity US population. Adjusting for the effect of increasing obesity counteracted some of the observed increase in EWM seen in the USA. Winter deaths are clearly the outcome of a complex system of competing long-term trends.

Beyond Sarcopenia: older adults with type II diabetes mellitus tend to experience an elevated risk of poor dynamic balance-a case-control study

Background

People with type 2 diabetes mellitus (T2DM) tend to be vulnerable to geriatric syndromes such as sarcopenia and frailty. Reduced physical activity also accompanies sarcopenia and frailty, which is generally typical of patients with T2DM. However, a comprehensive assessment of physical fitness in patients with T2DM has seldom been carried out and verified. This study is thus an attempt to determine the associations among sarcopenia, frailty, and the SFT in diabetic patients and non-diabetic controls to provide a more comprehensive understanding of such associations in future evaluations of T2DM in older individuals.

Methods

Sarcopenia, frailty, and the senior fitness test (SFT) were compared between 78 older men with T2DM (66.5 ± 9.0 years) and 48 age-matched normoglycemic controls (65.8 ± 5.3 years) in this case–control study. The skeletal muscle index (SMI), grip strength, and 4-m walk test were employed to assess for sarcopenia. Frailty was evaluated using the Study of Osteoporotic Fractures index (SOF). The SFT comprises five components, including body composition, muscle strength, flexibility, balance, and aerobic endurance.

Results

The risk level of sarcopenia was significantly higher (p < 0.05) in the T2DM group as compared to the control group. No significant difference between-group differences were found in SMI and grip strength in the T2DM and control groups. However, the T2DM group showed a significant decrease in gait speed (p < 0.01) in comparison with the control group, as well as significant increases in frailty (p < 0.01) and depression (p < 0.05). With respect to the SFT, obvious elevation in BMI, significant declines in extremity muscle strength (elbow extensor, knee flexor, hip abductor, hip flexor, sit to stand), static/dynamic balance (single leg stand: p < 0.05; up-and-go: p < 0.01) and aerobic endurance (2-min step: p < 0.01; 6-min walk: p < 0.01) were found in the T2DM group. Furthermore, the SOF (OR = 2.638, 95% CI = 1.333–5.221), BMI (OR = 1.193, 95% CI = 1.041–1.368) and up-and-go (OR = 2.089, 95% CI = 1.400–3.117) were found to be positively and significantly associated with T2DM.

Conclusions

The findings of this study indicated the importance of countering frailty and maintaining physical fitness, especially dynamic balance, during the early physical deterioration taking place in diabetic patients.

Quality of life among type II diabetic patients attending the primary health centers of King Saud Medical City in Riyadh, Saudi Arabia

Background/Aim

Type 2 diabetic patients (T2DM) have lower quality of life (QoL) compared to the general population. This study was conducted to determine QoL of T2DM patients and analyze factors that affect patients' QoL.

Methods

We conducted this cross-sectional study in January to February of 2019 at several primary care health centers (PCHC) in Riyadh, Saudi Arabia. All adult T2DM patients were invited to participate in the study. We used the EQ-5D-3L and EQ VAS tools to determine the patients' health state and their self-rated overall health.

Results

A total of 274 T2DM patients were surveyed, 149 (54.4%) were males. The mean age was 59.7 ± 10.4 years. Of the five EQ-5D-5L domains, self-care had the highest proportion that reported no problem (n = 183, 66.8%). The mobility domain had the highest proportion of reported severe problems (n = 37, 13.5%) and extreme problems (n = 7, 2.6%). Nineteen (6.9%) patients reported with a full state of health. The mean EQVAS was 65.9 ± 22.1, with only 24.1% reported as between 81-100%. Females, patients above 75 years old, those who are in the low socioeconomic income, unemployed, widow had lower EQ VAS.

Conclusion

Males, with higher socioeconomic status, employed, married and younger patients experience better QoL compared to their counterparts. The overall health related QoL among our diabetic patients is low. These findings suggest improvement of health-related QoL, and more efforts should be invested in patient education particularly among patients who are in the low socioeconomic status, the elderly, females and the unemployed.

Biomarkers of geroprotection and cardiovascular health: An overview of omics studies and established clinical biomarkers in the context of diet

The slowdown, inhibition, or reversal of age-related decline (as a composite of disease, dysfunction, and, ultimately, death) by diet or natural compounds can be defined as dietary geroprotection. While there is no single reliable biomarker to judge the effects of dietary geroprotection, biomarker signatures based on omics (epigenetics, gene expression, microbiome composition) are promising candidates. Recently, omic biomarkers started to supplement established clinical ones such as lipid profiles and inflammatory cytokines. In this review, we focus on human data. We first summarize the current take on genetic biomarkers based on epidemiological studies. However, most of the remaining biomarkers that we describe, whether omics-based or clinical, are related to intervention studies. Then, because of their promising potential in the context of dietary geroprotection, we focus on the effects of berry-based interventions, which up to now have been mostly described employing clinical markers. We provide an aggregation and tabulation of all the recent systematic reviews and meta-analyses that we could find related to this topic. Finally, we present evidence for the importance of the "nutribiography," that is, the influence that an individual's history of diet and natural compound consumption can have on the effects of dietary geroprotection.

Impact of overlapping risks of type 2 diabetes and obesity on coronavirus disease severity in the United States

The impact of overlapping risk factors on coronavirus disease (COVID-19) severity is unclear. To evaluate the impact of type 2 diabetes (T2D) and obesity on COVID-19 severity, we conducted a cohort study with 28,095 anonymized COVID-19 patients using data from the COVID-19 Research Database from January 1, 2020 to November 30, 2020. The mean age was 50.8 ± 17.5 years, and 11,802 (42%) patients were male. Data on age, race, sex, T2D complications, antidiabetic medication prescription, and body mass index ≥ 30 kg/m² (obesity) were analysed using Cox proportional hazard models, with hospitalization risk and critical care within 30 days of COVID-19 diagnosis as the main outcomes. The risk scores were 0–4 for age ≥ 65 years, male sex, T2D, and obesity. Among the participants, 11,294 (61.9%) had obesity, and 4445 (15.8%) had T2D. T2D, obesity, and male sex were significantly associated with COVID-19 hospitalization risk. Regarding hospitalization risk scores, compared with those for hospitalization risk score 0 and critical care risk score 0, hazard ratios [95% confidence intervals] were 19.034 [10.470–34.600] and 55.803 [12.761–244.015] (P < 0.001) (P < 0.001), respectively, for risk score 4. Complications from diabetes and obesity increased hospitalization and critical care risks for COVID-19 patients.

Developing explanatory models for life course shifts in the burden of substance use to inform future policy and practice

Past approaches to policy and practice for substance use have focused heavily on young people, but recent trends indicate this approach may not be where the future lies. The crises with escalating overdose mortality in several countries, particularly overdoses related to opioids, have drawn attention to life course shifts in the burdens of substance use. Overdose mortality rates for individuals in midlife have considerably outpaced those of adolescents and individuals in early adulthood. These diverging life course trends are occurring not only in the United States, but in other countries with growing overdose problems as well. The future of effective policy and practice depend upon evidence and analyses that adapt to emerging data on shifting life course trends in drug related mortality. Within this manuscript, we consider a range of theoretical possibilities on the divergence of midlife drug mortality trends from those of young people for the purpose of outlining an agenda for future research and practice. Specifically, we consider the following theoretical approaches to move research forward in this area: Changes in Medical Context hypothesis; Emergent Comorbidities hypothesis; Cohort hypothesis; Generational Forgetting hypothesis; Legal Regulation hypothesis; Strength of Life Course Bonds hypothesis; Deepening Inequality hypothesis; Measurement Reliability hypothesis. These theoretical frameworks attend specifically to the overdose crisis but extend to other aspects of substance use. Beyond setting an agenda for research by providing empirically verifiable hypotheses, this manuscript also identifies future directions in policy and practice that are attentive to life course trends.

Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study

AIMS/HYPOTHESIS

More than 25% of older adults (age ≥75 years) have diabetes and may be at risk of adverse events related to treatment. The aim of this study was to assess the prevalence of intensive glycaemic control in this group, potential overtreatment among older adults and the impact of overtreatment on the risk of serious events.

METHODS

We conducted a retrospective, population-based cohort study of community-dwelling older adults in Ontario using administrative data. Participants were ≥75 years of age with diagnosed diabetes treated with at least one anti-hyperglycaemic agent between 2014 and 2015. Individuals were categorised as having intensive or conservative glycaemic control (HbA_1c <53 mmol/mol [<7%] or 54-69 mmol/mol [7.1-8.5%], respectively), and as undergoing treatment with high-risk (i.e. insulin, sulfonylureas) or low-risk (other) agents. We measured the composite risk of emergency department visits, hospitalisations, or death within 30 days of reaching intensive glycaemic control with high-risk agents.

RESULTS

Among 108,620 older adults with diagnosed diabetes in Ontario, the mean (± SD) age was 80.6 (±4.5) years, 49.7% were female, and mean (± SD) diabetes duration was 13.7 (±6.3) years. Overall, 61% of individuals were treated to intensive glycaemic control and 21.6% were treated to intensive control using high-risk agents. Using inverse probability treatment weighting with propensity scores, intensive control with high-risk agents was associated with nearly 50% increased risk of the composite outcome compared with conservative glycaemic control with low-risk agents (RR 1.49, 95% CI 1.08, 2.05).

CONCLUSIONS/INTERPRETATION

Our findings underscore the need to re-evaluate glycaemic targets in older adults and to reconsider the use of anti-hyperglycaemic medications that may lead to hypoglycaemia, especially in setting of intensive glycaemic control.

Prevalence of Diagnosed Diabetes Among Employed US Adults by Demographic Characteristics and Occupation, 36 States, 2014 to 2018

OBJECTIVE

To assess the prevalence of diagnosed diabetes among employed US adults from 36 states by occupation group using data from 2014 to 2018 Behavioral Risk Factor Surveillance System.

METHODS

Prevalence of diabetes was calculated by 22 broad and 93 detailed occupation groups among a sample of 366,633 employed respondents. Wald chi-square values were used to determine the significance of associations between diabetes and occupation groups after adjusting for sex, age, and race/ethnicity.

RESULTS

The prevalence of diabetes was 6.4% among employed US adults. The three broad occupation groups with the highest adjusted prevalence of diabetes were protective services (8.9%), farming, fishing, and forestry (8.8%), and community and social services (8.4%).

CONCLUSIONS

Prevalence of diabetes differed by occupation. Work-related factors (eg, shift work, job stress) should be further examined in relation to risk of developing diabetes.

Optimizing drug therapy in frail patients with type 2 diabetes mellitus

BACKGROUND

Type 2 diabetes mellitus (T2DM) is closely linked with ageing. In frail diabetic patients, the risks of intensive antidiabetic therapy outweigh the potential benefits.

AIMS

To study the prevalence of T2DM in frail elderly patients, to identify inappropriate prescription (IP) of antidiabetic drugs and to study the relationship between patients' frailty index (FI) with polypharmacy and IP.

METHODS

This was a prospective, descriptive, observational study of elderly patients. Each patient's antidiabetic treatment was analysed by applying the patient-centred prescription model (PCP), which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal.

RESULTS

210 patients with T2DM were included (25.15% prevalence). They were characterised by high multimorbidity and frailty. 93.3% presented polypharmacy and 51% excessive polypharmacy. IP was identified in 66.2% of patients. A statistically significant relationship was found between the progression in FI degree and IP prevalence (p < 0.05. During the admission, drug therapy regimens were modified in 97.1% of cases with IP (n = 136).

DISCUSSION

These results suggest that in clinical practice T2DM treatment is not individualised, but rather is based on the same general recommendations for the population as a whole.

CONCLUSIONS

There is a high prevalence of T2DM in the elderly. As the frailty of patients increases, so does the prevalence of IP. The application of PCP model enables drug therapy optimization in frail patients according to their main therapeutic goal, and contributes to provide clinical evidences on the applicability of a set of knowledge areas from the theoretical framework to the daily clinical practice.

microRNA-128 mediates CB1 expression and regulates NF-KB/p-JNK axis to influence the occurrence of diabetic bladder disease

Background

Diabetic bladder disease is common complications of diabetes, its symptoms are diverse, can be due to different stages. In this study we investigate the mechanism of miR-128 targeting CB1 expression to mediate the occurrence of diabetic bladder disease.

Methods

Bioinformatics analysis predicts related regulatory factors of miR-128 in diabetic bladder disease. Models of diabetic bladder lesions were constructed in male SD rats by intraperitoneal injection of streptozotocin at 65 mg/kg body weight. The expression of miR-128 and CB1 mRNA in bladder tissues of each group was detected by RT-qPCR, and CB1, NF-KB, p-JNK and Bcl2 protein expression was detected by Western Blotting. We tested the function of the bladder by urodynamics, detected the pathological characteristics of the bladder tissue by HE staining, and verified the targeting relationship between miR-128 and CB1 through the prediction of the biological website, dual luciferase reporter gene assay and RIP.

Results

miR-128 was highly expressed in the bladder tissue of diabetic rats. Inhibition of miR-128 could improve the occurrence of diabetic bladder lesions in rats. miR-128 could target the inhibition of CB1 expression, and high expression of CB1 could antagonize miR-128 against diabetic bladder. In the diabetic bladder, miR-128 can regulate the expression of NF-KB and p-JNK through CB1 and affect the level of apoptosis. miR-128 regulates NF-KB/p-JNK through CB1, thus affecting the occurrence of diabetic bladder disease.

Conclusion

The high expression of miR-128 can down-regulate the expression of CB1, promote the activation of NF-KB and p-JNK, increase the level of apoptosis and promote the occurrence of diabetic bladder disease.

Absence of GIP secretion alleviates age-related obesity and insulin resistance

Glucose-dependent insulinotropic polypeptide (GIP) is an incretin secreted from enteroendocine K cells after nutrient ingestion. Fat strongly induces GIP secretion, and GIP hypersecretion is involved in high-fat diet-induced obesity and insulin resistance. Aging also induces GIP hypersecretion, but its effect on body weight gain and insulin sensitivity remains unclear. In the present study, we investigated the effect of GIP on age-related body weight gain and insulin resistance using GIP-knockout homozygous (GIP-/-) and heterozygous (GIP+/-) mice, which have entirely absent and 50% reduced GIP secretion compared to wild-type (WT) mice, respectively. Under 12% fat-containing normal diet feeding condition, body weight was significantly lower in GIP-/- mice compared to that in WT and GIP+/- mice from 38 weeks of age, while there was no significant difference between WT and GIP+/- mice. Visceral and s.c. fat mass were also significantly lower in GIP-/- mice compared to those in WT and GIP+/- mice. During oral glucose tolerance test, blood glucose levels did not differ among the three groups. Insulin levels were significantly lower in GIP-/- mice than those in WT and GIP+/- mice. During insulin tolerance test, GIP-/- mice showed higher insulin sensitivity than that of WT and GIP+/- mice. Adiponectin mRNA levels were increased and leptin mRNA levels tended to be decreased in adipose tissue of GIP-/- mice. These results demonstrate that GIP is involved in age-related obesity and insulin resistance and that inhibition of GIP secretion alleviates age-related fat mass gain and insulin resistance under carbohydrate-based diet feeding condition.

The association between health care coverage and prevalence of cardiovascular diseases and diabetes over a 10-year period

Persons without health care coverage have poorer health outcomes. We investigated the association between health care coverage and trends in the prevalence of cardiovascular disease (CVD) and diabetes pre- and post-Affordable Care Act (ACA) periods. Using data from 3,824,678 surveyed adults in the Behavioral Risk Factor Surveillance System survey from 2007 - 2016, we calculated the yearly prevalence of CVD and diabetes. Using logistic regression, we investigated the association between health care coverage and CVD and diabetes, controlling for sociodemographic factors (age, sex, race, marital status, education and income). The mean age of participants was 55.3 ± 18.9 years. Health care coverage increased from 88.6% in 2007 to 93% in 2016. The prevalence of CVD and diabetes increased from pre- to post-ACA periods. After adjustment, in pre-ACA period, the odds ratio (OR) for the association between health care coverage and CVD and diabetes was 1.32 (95% CI:1.30-1.34) and 1.44 (95% CI:1.41-1.46), respectively; in the post-ACA period, the OR was 1.26 (95% CI:1.22-1.30) and 1.48 (95% CI:1.44-1.52), respectively. We found a significant association between health care coverage and trends in the prevalence of CVD and diabetes in the pre- and post-ACA periods.

Diabetes-associated infections: development of antimicrobial resistance and possible treatment strategies

Diabetes mellitus is associated with various types of infections notably skin, mucous membrane, soft tissue, urinary tract, respiratory tract and surgical and/or hospital-associated infections. The reason behind this frequent association with infections is an immunocompromised state of diabetic patient because uncontrolled hyperglycemia impairs overall immunity of diabetic patient via involvement of various mechanistic pathways that lead to the diabetic patient as immunocompromised. There are specific microbes that are associated with each type of infection and their presence indicates specific type of infections. For instance, E. coli and Klebsiella are the most common causative pathogens responsible for the development of urinary tract infections. Diabetic-foot infections commonly occur in diabetic patients. In this article, we have mainly focused on the association of diabetes mellitus with various types of bacterial infections and the pattern of resistance against antimicrobial agents that are frequently used for the treatment of diabetes-associated infections. Moreover, we have also summarized the possible treatment strategies against diabetes-associated infections.

Impact of hip fracture on all-cause mortality in Japanese patients with type 2 diabetes mellitus: The Fukuoka Diabetes Registry

AIMS/INTRODUCTION

Patients with type 2 diabetes mellitus have an increased hip fracture risk. We investigated the relationship between hip fracture and all-cause death in patients with type 2 diabetes in comparison with cardiovascular disease (CVD) or end-stage renal disease (ERSD).

MATERIALS AND METHODS

In total, 4,923 Japanese participants with type 2 diabetes (mean age 65 years, 2,790 men, 2,133 women) were followed for a median of 5.3 years (follow-up rate 99.5%). We evaluated the associations between the presence of hip fracture (n = 110), upper limb fracture (n = 801), CVD (n = 1,344), ESRD (n = 104) and all-cause death by logistic regression analysis.

RESULTS

A total of 309 participants died during follow up. Multivariate-adjusted odds ratios (ORs) for all-cause mortality were significantly higher in participants with hip fractures than those without hip fractures (OR 2.67, 95% confidence interval [CI] 1.54-4.41), whereas the ORs for upper limb fracture were not significant. The ORs for all-cause mortality were significantly higher in participants with CVD than those without CVD (OR 1.78, 95% CI, 1.39-2.70) and ESRD (OR 2.36, 95% CI 1.32-4.05). The ORs for all-cause mortality of hip fracture were not affected by further adjustment for CVD and ESRD (OR 2.74, 95% CI 1.58-4.54). The cause of death was infection (40.0%), malignant neoplasm (25.0%) and CVD (15.0%) among participants with hip fracture.

CONCLUSIONS

Hip fractures were associated with an increased risk of death among Japanese patients with type 2 diabetes, independently of CVD and ESRD.

Delivering family planning and preconception care to women with diabetes: Implementation challenges and promising strategies

Diabetes is increasingly prevalent among women of reproductive age and during pregnancy. The American Diabetes Association, which has called for improvements in the patient-centeredness of care, recommends preconception counseling and care for women of reproductive age with diabetes. However, data suggests this care is not sufficiently delivered. In this article, we describe demographic shifts in the need for preconception care and outline several changes at the clinical encounter as well as the health system- and community-levels that can help improve the delivery of diabetes-specific preconception care.

Nutritional Supplementation for the Prevention and/or Treatment of Gestational Diabetes Mellitus

PURPOSE OF REVIEW

Gestational diabetes mellitus (GDM) is a common pregnancy complication that has short- and long-term health implications for both the mother and child. While lifestyle modifications, insulin therapy, and oral agents such as metformin are effective, they can be difficult to adhere to, and there remain concerns over long-term effects of oral agents on the infant. Further, GDM has no proven preventive strategies, which could be more effective than treatment postdiagnosis. Nutritional supplements are an appealing, potentially safer, and better tolerated alternative to pharmaceuticals to treat and/or prevent GDM. Here, we review the existing evidence for nutritional supplementation for treatment and prevention of GDM.

RECENT FINDINGS

There is limited evidence that myo-inositol, vitamins D and B6, magnesium, selenium, zinc, fatty acids, and probiotics might be beneficial for the prevention or treatment of GDM. There are very few studies for each nutrient, and the existing studies tend to have few participants. Where multiple studies of a nutrient exist, often those studies were conducted within the same country, limiting the generalizability of the findings, or alternatively there was no consensus across findings. There is limited evidence that nutritional supplementation of myo-inositol, vitamins D and B6, magnesium, selenium, zinc, fatty acids, and probiotics could improve glycemic control or prevent GDM. Our understanding is constrained by the small number of studies, small sample sizes in most studies, and by lack of consistency across findings. Further large, high-quality, randomized controlled trials are required to determine the efficacy of nutritional supplements to treat or prevent GDM.

Evaluation of Counseling Practices and Patient's Satisfaction Offered by Pharmacists for Diabetics Attending Outpatient Pharmacies in Al Ahsa

Introduction

Patient counseling can be helpful in improving the outcome of disease management, particularly chronic diseases such as diabetes mellitus, which is common in Saudi Arabia. The present study looks to investigate the levels of counseling and satisfaction among patients attending diabetic clinics in outpatient hospital pharmacy in Al Ahsa, Saudi Arabia.

Method

This is a cross-sectional investigation, carried out by using interview-structured questionnaire, targeting diabetes mellitus patients with or without comorbid states. The questionnaire was divided into 3 parts comprising of demographics, counseling types given while collecting prescription, and satisfaction rating of services provided.

Result

More males than females participated; most of whom were college graduates older than 51 years. Sixty-three percent of the entire participants are type 1 diabetic patients, while 37% are type 2 diabetes mellitus patients. Coexistence of hypercholesterolemia was higher among type 1 diabetes patients with 51.9%, while hypertension was more common among type 2 diabetic patients representing 68.2%. Findings also showed that counseling was provided for medication use among type 1 diabetic patients but was deficient in the case of type 2 diabetic patients. Patients received low level of counseling on side effects and healthy lifestyle living. Satisfaction level was only 11.1%, indicating that counseling services might be deficient.

Conclusion

This study has revealed poor counseling practices and low satisfaction levels in services provided by outpatient hospital pharmacies to diabetic patients. In the face of increasing prevalence of diabetes and comorbidity, counseling of diabetic patients is critical.

Changes in prescription pattern, pharmaceutical expenditure and quality of care after introduction of reimbursement restriction in diabetes in Korea

Background

To ensure effective prescription practices and reduce diabetes-related pharmaceutical expenditures, Korea adopted a clinical practice guideline for the reimbursement system. Health care providers cannot receive reimbursement from National Health Insurance(NHI) unless it is for an appropriate prescription under the predefined clinical condition. The aim of this study was to evaluate prescription patterns in oral hypoglycemic agents, costs and effects on patient care since the introduction of the diabetes reimbursement restriction.

Methods

We used claim data from 2008 to 2013, which included 26 315 diabetes patients and 9907 hospitals. An interrupted time series study design using generalized estimating equations was used to evaluate changes in patterns of single and combination therapy, brand name drug prescriptions, cost and hospital admission following the reimbursement restriction.

Results

Following reimbursement restriction initiation, we found a statistically significant decrease in the average prescription rate of brand name drugs (-6.2%), whereas single therapy prescription increased (9.9%). There was also a reduction in trend change in the monthly prescription rate for combination therapy (-1.7%) and brand name drugs (-0.8%). For single therapy, the trend change in prescription rate increased after the intervention (0.8%). A reduction of trend change in pharmaceutical costs (-0.3%) was observed. However, we did not find a significant change in hospital admission for diabetes.

Conclusions

Reimbursement restriction affects both pharmaceutical costs and physicians' decisions to prescribe oral hypoglycemic agents. We did not observe a significant reduction in quality of care following the intervention. Collectively, these findings indicate that reimbursement restriction has improved effective drug utilization and decreased health expenditures.

Fractal characterization of retinal microvascular network morphology during diabetic retinopathy progression

OBJECTIVE

The study aimed to characterize morphological changes of the retinal microvascular network during the progression of diabetic retinopathy.

METHODS

Publicly available retinal images captured by a digital fundus camera from DIARETDB1 and STARE databases were used. The retinal microvessels were segmented using the automatic method, and vascular network morphology was analyzed by fractal parametrization such as box-counting dimension, lacunarity, and multifractals.

RESULTS

The results of the analysis were affected by the ability of the segmentation method to include smaller vessels with more branching generations. In cases where the segmentation was more detailed and included a higher number of vessel branching generations, increased severity of diabetic retinopathy was associated with increased complexity of microvascular network as measured by box-counting and multifractal dimensions, and decreased gappiness of retinal microvascular network as measured by lacunarity parameter. This association was not observed if the segmentation method included only 3-4 vessel branching generations.

CONCLUSIONS

Severe stages of diabetic retinopathy could be detected noninvasively by using high resolution fundus photography and automatic microvascular segmentation to the high number of branching generations, followed by fractal analysis parametrization. This approach could improve risk stratification for the development of microvascular complications, cardiovascular disease, and dementia in diabetes.

Comorbid hypertension and diabetes among U.S. women of reproductive age: Prevalence and disparities

AIMS

Diabetes is associated with significant pregnancy complications, which can be further exacerbated by comorbid hypertension. Racial/ethnic differentials in the burden of comorbid hypertension and diabetes among women of reproductive age have not been described.

METHODS

Using Wave IV of the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health), we analyzed survey and biological data from 6576 non-pregnant women who were aged 24-32 in 2007-2008. Hypertension and diabetes were identified by self-report of diagnosis and biological measurements taken during in-home interviews. We used logistic regression models to predict the presence of comorbid hypertension and diabetes and whether each was diagnosed.

RESULTS

Over a third (36.0%) of women with diabetes had comorbid hypertension. Compared to non-Hispanic white women, more non-Hispanic black women had comorbid hypertension and diabetes (adjusted odds ratio (aOR) 5.93, 95% CI 3.84-9.16), and, if comorbid, were less likely to have a diabetes diagnosis (aOR 0.03, 95% CI 0.007-0.1) or hypertension diagnosis (aOR 0.22, 95% CI 0.08-0.65).

CONCLUSION

Comorbid hypertension and diabetes are more common among non-Hispanic black women and less likely to be diagnosed, signaling disparities threatening maternal and child health among women with diabetes.

Assessing Baseline and Temporal Changes in Cardiometabolic Risk Using Metabolic Syndrome Severity and Common Risk Scores

Background Type 2 diabetes mellitus (T2 DM ) is considered a cardiovascular disease ( CVD ) risk equivalent, thereby linking assessment of cardiometabolic risk with that of CVD risk over time. Our goal was to determine how commonly used CVD risk scores and metabolic syndrome (MetS) severity performed in predicting T2 DM with and without ultimate CVD . Methods and Results We assessed data from 8273 participants of the ARIC (Atherosclerosis Risk in Communities) Study, using the pooled cohort atherosclerotic CVD risk score, the Framingham Risk Score, and a MetS severity Z score to assess their association with future risk for CVD alone, T2 DM alone, or both over 20 years of follow-up. Baseline levels of all scores were significantly associated with isolated incident T2 DM (odds ratios [ OR s] for each 1- SD increase: atherosclerotic CVD =1.7, Framingham risk score=1.7, MetS Z score=5.1). All 3 baseline scores were also significantly associated with isolated incident CVD (atherosclerotic CVD OR =2.4, Framingham risk score OR =2.3, MetS Z-score OR =1.8), with the 2 CVD scores remaining significant independent of MetS severity. MetS severity was strongly associated with future T2 DM leading to CVD (MetS Z-score OR =7.0, atherosclerotic CVD OR =3.9, Framingham risk score OR =3.5). Furthermore, changes in MetS severity were independently associated with future T2 DM - CVD progression. Conclusions CVD risk scores are associated with risk for future isolated T2 DM in addition to isolated CVD . However, MetS severity (both baseline and changes over time) was more strongly associated with T2 DM , including T2 DM ultimately leading to CVD . Following MetS severity within patients over time may identify those at greatest risk of combined cardiometabolic disease.

Recreational soccer as sport medicine for middle-aged and older adults: a systematic review

Background

Strategies to prevent or attenuate the age-related decline in physical and physiological function and reduce chronic disease risk factors are of clinical importance.

Objective

To examine the health benefits of recreational soccer in middle-aged and older adults.

Design

Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources

All available records up until 9 June 2017 in PubMed, Web of Science, SPORTDiscus, MEDLINE, Embase, CINAHL Plus, PsycINFO and Cochrane Library databases.

Eligibility criteria for selecting studies

All randomised trials with or without a control group (randomised controlled trials or randomised uncontrolled trials) and non-randomised controlled trials that used recreational soccer, which includes small-sided soccer games, as the sole or principal intervention, and reported relevant effects in untrained/sedentary, healthy or unhealthy adults aged 40 years and above were included.

Results

Five trials described in 13 articles were included, which scored 6–9 out of 12 points on the modified Delphi quality rating scale. The duration was from 12 to 52 weeks, with various frequencies, volumes and game formats performed both outdoors and indoors with men and women. The trials indicate that recreational soccer may result in improvement in cardiovascular function, body composition and functional ability, although no significant changes were observed in postural balance.

Conclusion

Recreational soccer should be considered an alternative exercise modality for untrained, healthy or unhealthy middle-aged and older adults of both sexes to maintain an active lifestyle and mitigate a wide array of physical and physiological age-related changes.

Prevalence, risk factors and burden of diabetic retinopathy in China: a systematic review and meta-analysis

Background

Diabetic retinopathy (DR), the primary retinal vascular complication of diabetes mellitus (DM), is a leading cause of vision impairment and blindness in working-age population globally. Despite mounting concerns about the emergence of DM as a major public health problem in the largest developing country, China, much remains to be understood about the epidemiology of DR. We aimed to investigate the prevalence of and risk factors for DR, and estimate the burden of DR in China in 2010.

Methods

China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Biomedicine Literature Database (CBM-SinoMed), PubMed, Embase and Medline were searched for studies that reported the prevalence of and risk factors for DR in Chinese population between 1990 and 2017. A random-effects meta-analysis model was adopted to pool the overall prevalence of DR. Variations in the prevalence of DR in different age groups, DM duration groups and settings were assessed by subgroup meta-analysis and meta-regression. Odds ratios (ORs) of major risk factors were pooled using random-effects meta-analysis. The number of people with DR in 2010 was estimated by multiplying the age-specific prevalence of DR in people with DM with the corresponding number of people with DM in China. Finally, the national number of people with DR was distributed into six geographic regions using a risk factor-based model.

Results

A total of 31 studies provided information on the prevalence of DR and 21 explored potential risk factors for DR. The pooled prevalence of any DR, nonproliferative DR (NPDR) and proliferative DR (PDR) was 1.14% (95% CI = 0.80-1.52), 0.90% (95% CI = 0.56-1.31) and 0.07% (95% CI = 0.02-0.14) in general population; In people with DM, the pooled prevalence rates were 18.45% (95% CI = 14.77-22.43), 15.06% (95% CI = 11.59-18.88) and 0.99% (95% CI = 0.40-1.80) for any DR, NPDR and PDR, respectively. The prevalence of any DR in DM patients peaked between 60 and 69 years of age, and increased steeply with the duration of DM. DM patients residing in rural China were at a higher risk to have DR than those in urban areas. In addition, insulin treatment, elevated FBG level and higher HbA1c concentration were confirmed to be associated with a higher prevalence of DR in people with DM, with meta-ORs of 1.99 (95% CI = 1.34-2.95), 1.33 (95% CI = 1.12-1.59) and 1.15 (95% CI = 1.09-1.20) respectively. In 2010, a total of 13.16 million (95% CI = 8.95-18.00) Chinese aged 45 years and above were living with DR, among whom the most were in South Central China and the least were in Northwest China.

Conclusions

DR has become a serious public health problem in China. Optimal screening of and interventions on DR should be implemented. Improved epidemiological studies on DR are still required.

Racial/Ethnic Disparities in Diabetes Diagnosis and Glycemic Control Among Women of Reproductive Age

BACKGROUND

Types 1 and 2 diabetes mellitus complicate pregnancies and threaten the health of women of reproductive age and their children. Among older adults, diabetes morbidity disproportionately burdens racial/ethnic minorities, but diabetes emergence among younger adults has not been as well characterized. The objective of this study was to describe the distribution of diagnosed diabetes, undiagnosed diabetes, suboptimal preconception glycemic control, and prediabetes among women of reproductive age across racial/ethnic backgrounds.

MATERIALS AND METHODS

We analyzed data collected in 2007-2008 from 6774 nonpregnant women, ages 24-32, in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Prediabetes and undiagnosed diabetes were identified by fasting glucose and glycosylated hemoglobin (A1C) and diagnosed diabetes by self-report or antihyperglycemic medication use. We used multinomial regression models to predict prediabetes or diabetes versus normoglycemia. Within women with diabetes, we used logistic regression to predict those being undiagnosed and having suboptimal preconception glycemic control based on A1C.

RESULTS

The estimated prevalence of diabetes was 6.8%, of which 45.3% was undiagnosed. Diabetes prevalence varied by race/ethnicity (p < 0.001): 15.0% of non-Hispanic black women (75.6% undiagnosed), 7.5% of Hispanic women (48.1% undiagnosed), 4.8% of non-Hispanic white women (22.8% undiagnosed), and 4.5% of Asian women (11.4% undiagnosed). The prevalence of prediabetes was highest in non-Hispanic black (38.5%), followed by Hispanic (27.8%), Asian (25.1%), Native American (20.3%), and non-Hispanic white (16.6%) women.

CONCLUSIONS

Racial/ethnic disparities exist among women of reproductive age with prediabetes and diabetes. Meeting their healthcare needs requires addressing health inequities and coordination of diabetes management with reproductive health.

Prevalence of Major Behavioral Risk Factors for Type 2 Diabetes

OBJECTIVE

We examined the proportion of American adults without type 2 diabetes that engages in lifestyle behaviors known to reduce type 2 diabetes risk.

RESEARCH DESIGN AND METHODS

We conducted a cross-sectional analysis of 3,679 nonpregnant, nonlactating individuals aged ≥20 years without diabetes (self-reported diagnosis or glycated hemoglobin ≥6.5% [8 mmol/mol] or fasting plasma glucose ≥126 mg/dL) and who provided 2 days of reliable dietary data in the 2007-2012 National Health and Nutrition Examination Surveys (NHANES). We used the average of 2 days of dietary recall and self-reported leisure-time physical activity to assess whether participants met type 2 diabetes risk reduction goals (meeting four or more MyPlate recommendations [adequate consumption of fruits, vegetables, dairy, grains, meat, beans, and eggs]; not exceeding three maximum allowances for alcoholic beverages, added sugars, fat, and cholesterol; and meeting physical activity recommendations [≥150 min/week]).

RESULTS

Approximately 21%, 29%, and 13% of individuals met fruit, vegetable, and dairy goals, respectively. Half (51.6%) met the goal for total grains, compared with 18% for whole grains, and 54.2% met the meat/beans goal and 40.6% met the oils goal. About one-third (37.8%) met the physical activity goal, and 58.6% met the weight loss/maintenance goal. Overall, 3.1% (95% CI 2.4-4.0) of individuals met the majority of type 2 diabetes risk reduction goals. Younger age and lower educational attainment were associated with lower probability of meeting goals.

CONCLUSIONS

A small proportion of U.S. adults engages in risk reduction behaviors. Research and interventions targeted at young and less-educated segments of the population may help close gaps in risk reduction behaviors.

Obesity Progression Between Young Adulthood and Midlife and Incident Diabetes: A Retrospective Cohort Study of U.S. Adults

OBJECTIVE

Understanding how changes in weight over the life course shape risk for diabetes is critical for the prevention of diabetes. Using data from the National Health and Nutrition Examination Survey (NHANES), we investigated the association between self-reported weight change from young adulthood to midlife and incident diabetes.

RESEARCH DESIGN AND METHODS

We categorized individuals into four weight-change groups: those who remained nonobese (stable nonobese), those who moved from an obese BMI to a nonobese BMI (losing), those who moved from a nonobese BMI to an obese BMI (gaining), and those who remained obese (stable obese). Diabetes status was determined by self-report of a prior diagnosis, and age at diagnosis was used to establish time of diabetes onset. Hazard ratios (HRs) relating weight change to incident diabetes over 10 years of follow-up were calculated using Cox models adjusting for covariates.

RESULTS

Those who were obese and lost weight exhibited a significantly lower risk (HR 0.33; 95% CI 0.14, 0.76) of diabetes compared with those with stable obesity. We also observed lower risk among those who were stable nonobese (HR 0.22; 95% CI 0.18, 0.28) and those in the gaining category (HR 0.70; 95% CI 0.57, 0.87). Further, there was evidence of an increased incidence of diabetes among obese individuals who lost weight compared with individuals who were stable nonobese; however, weight loss was rare, and the association was not statistically significant. If those who were obese had become nonobese during the 10-year period, we estimate that 9.1% (95% CI 5.3, 12.8) of observed diabetes cases could have been averted, and if the population had maintained a normal BMI during the period, 64.2% (95% CI 59.4, 68.3) of cases could have been averted.

CONCLUSIONS

The findings from this study underscore the importance of population-level approaches to the prevention and treatment of obesity across the life course of individuals.

Store operated calcium channels are associated with diabetic cystopathy in streptozotocin‑induced diabetic rats

Store operated calcium channels (SOCCs) have been suggested to play a critical role in many diabetic complications. Diabetic cystopathy (DCP) is common in patients with diabetes, but the role of SOCCs in DCP is still unclear. The aim of the present study was to investigate the role of SOCCs in DCP with streptozocin (STZ)-induced diabetic rats. Specifically, the authors investigated whether SOCCs were altered in streptozocin (STZ)-induced diabetic rats and, if so, how this may contribute to the contraction of bladder detrusor strips and the intracellular Ca²⁺ concentration of bladder smooth muscle cells in diabetic rats. Cyclopiazonic acid (CPA, 10 µM) and SKF-96365 (10 µM) were used to activate and inhibit SOCCs respectively, to research the effects of SOCCs on the contraction of the bladder detrusor strips in normal and STZ-induced diabetic rats at the 4th, 8th and 12th week after the diabetic rat model was established. The changes of intracellular Ca²⁺ were also evaluated under confocal microscopy with pretreated Fluo-4AM. In addition, the expressions of Orai1 and STIM1 were detected by reverse transcription-quantitative polymerase chain reaction and western blotting at different time points. According to the results, the contractive frequency of diabetic bladder muscle strips was higher than that of controls in the 4th and 8th week. The increased fluorescence intensity was detected after using CPA and SKF-96365 in diabetic groups. The expressions of Orai1 and STIM1 changed in a time-dependent manner.

The Evolving Epidemiology of Atherosclerotic Cardiovascular Disease in People with Diabetes

Atherosclerotic cardiovascular disease (ASCVD) is a leading global cause of death and accounts for most deaths among individuals with diabetes. This article reviews the latest observational and trial data on changes in the relationship between diabetes and ASCVD risk, remaining gaps in how the role of each risk factor is understood, and current knowledge about specific interventions. Differences between high-income countries and low-income and middle-income countries are examined, barriers and facilitators are discussed, and a discussion around the concept of ideal cardiovascular health factors (Life's Simple 7) is focused on.

Prevalence of and secular trends in diagnosed diabetes in Italy: 1980-2013

BACKGROUND AND AIMS

The aim of this research was to examine the prevalence of diabetes in Italy over a 34-year period.

METHODS AND RESULTS

Self-reported diabetes was assessed in eight health interview surveys of representative samples of Italian population aged 20 years and over. Crude and standardised prevalence were calculated by age, sex, educational level and area of residence. Logistic models were fitted to calculate the contribution of age and BMI to the trend in prevalence. In 2013 nearly 3.4 million Italians had a diagnosis of diabetes, more than twice as many as in 1980. The crude prevalence of diabetes in men rose from 3.3% in 1980 to 7.1% in 2013 (+115%), and from 4.7% to 6.8% in women (+45%). The prevalence was almost stable during the eighties, and started to rise from the beginning of the nineties. One third of the increase in men and two thirds in women is due to the ageing of the population, since the age-standardised prevalence increased by 79% in men and 14% in women. The prevalence of overweight and obesity increased less steeply than diabetes, and their contribution to the trend in diabetes is less relevant than age. Prevalence rose more in the elderly, in low-educated men, and in high-educated women.

CONCLUSION

Given that the ageing population plays a considerable role in explaining the trend, and that the number of people in the oldest age groups will continue to grow, the rise in the number of individuals with diabetes will represent a severe challenge for the national health system.

Fractal dimension and lacunarity analysis of retinal microvascular morphology in hypertension and diabetes

Hypertension and diabetes mellitus represent modifiable risk factors for vascular disease. They cause microvascular remodeling, and ultimately result in end-organ damage. Therefore, development of methods for noninvasive quantification of the effects of hypertension and diabetes mellitus on microvasculature is of paramount importance. The two goals of the study were: 1) to characterize the geometric complexity and inhomogeneity of retinal vasculature in hypertensive retinopathy (HR) and in proliferative diabetic retinopathy (PDR) by using box counting fractal dimension and lacunarity analysis, and 2) to determine if the combination of these two parameters can be used to describe differences in the vascular tree geometry between HR and PDR. The extended set of retinal images from the publicly available STARE database was manually segmented by our expert, validated, and made available for other researchers to use. The healthy retinal vascular network has a higher complexity (fractal dimension) compared to that in HR and in PDR. However, there is no difference in microvascular complexity between HR and PDR. The inhomogeneity of the retinal microvascular tree (lacunarity) was higher in PDR compared to HR. Lacunarity and fractal dimension together quantitatively characterize microvascular geometry in the retina with higher specificity than fractal analysis alone.

Trends in cardiovascular risk factor and disease prevalence in patients undergoing non-cardiac surgery

OBJECTIVES

Cardiovascular risk factors are prevalent in the population undergoing non-cardiac surgery. Changes in perioperative cardiovascular risk factor profiles over time are unknown. The objective of this study was to evaluate national trends in cardiovascular risk factors and atherosclerotic cardiovascular disease (ASCVD) among patients undergoing non-cardiac surgery.

METHODS

Adults aged ≥45 years old who underwent non-cardiac surgery were identified using the US National Inpatient Sample from 2004 to 2013. The prevalence of traditional cardiovascular risk factors (hypertension, dyslipidaemia, diabetes mellitus, obesity and chronic kidney disease) and ASCVD (coronary artery disease, peripheral artery disease and prior stroke] were evaluated over time.

RESULTS

A total of 10 581 621 hospitalisations for major non-cardiac surgery were identified. Between 2008 and 2013, ≥2 cardiovascular risk factors and ASCVD were present in 44.5% and 24.3% of cases, respectively. Over time, the prevalence of multiple (≥2) cardiovascular risk factors increased from 40.5% in 2008-2009 to 48.2% in 2012-2013, P<0.001. The proportion of patients with coronary artery disease (17.2% in 2004-2005 vs 18.2% in 2012-2013, P<0.001), peripheral artery disease (6.3% in 2004-2005 vs 7.4% in 2012-2013, P<0.001) and prior stroke (3.5% in 2008-2009 vs 4.7% 2012-2013, P<0.001) also increased over time. The proportion of patients with a modified Revised Cardiac Risk Index score ≥3 increased from 6.6% in 2008-2009 to 7.7% in 2012-2013 (P<0.001).

CONCLUSIONS

Among patients undergoing major non-cardiac surgery, the burden of cardiovascular risk factors and the prevalence of ASCVD increased over time. Adverse trends in risk profiles require continued attention to improve perioperative cardiovascular outcomes.

Nonalcoholic fatty liver disease burden - Saudi Arabia and United Arab Emirates, 2017-2030

BACKGROUND/AIM

Due to epidemic levels of obesity and type 2 diabetes mellitus (DM), nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) will be driving factors in liver disease burden in the coming years in Saudi Arabia and United Arab Emirates (UAE).

MATERIALS AND METHODS

Models were used to estimate NAFLD and NASH disease progression, primarily based on changes in adult prevalence rates of adult obesity and DM. The published estimates and expert interviews were used to build and validate the model projections.

RESULTS

In both countries, the prevalence of NAFLD increased through 2030 parallel to projected increases in the prevalence of obesity and DM. By 2030, there were an estimated 12,534,000 NAFLD cases in Saudi Arabia and 372,000 cases in UAE. Increases in NASH cases were relatively greater than the NAFLD cases due to aging of the population and disease progression. Likewise, prevalent cases of compensated cirrhosis and advanced liver disease are projected to at least double by 2030, while annual incident liver deaths increase in both countries to 4800 deaths in Saudi Arabia and 140 deaths in UAE.

CONCLUSIONS

Continued high rates of adult obesity and DM, in combination with aging populations, suggest that advanced liver disease and mortality attributable to NAFLD/NASH will increase across both countries. Reducing the growth of the NAFLD population, along with potential therapeutic options, will be needed to reduce liver disease burden.

Mechanisms of Aerobic Exercise Impairment in Diabetes: A Narrative Review

The prevalence of diabetes in the United States and globally has been rapidly increasing over the last several decades. There are now estimated to be 30.3 million people in the United States and 422 million people worldwide with diabetes. Diabetes is associated with a greatly increased risk of cardiovascular mortality, which is the leading cause of death in adults with diabetes. While exercise training is a cornerstone of diabetes treatment, people with diabetes have well-described aerobic exercise impairments that may create an additional diabetes-specific barrier to adding regular exercise to their lifestyle. Physiologic mechanisms linked to exercise impairment in diabetes include insulin resistance, cardiac abnormalities, mitochondrial function, and the ability of the body to supply oxygen. In this paper, we highlight the abnormalities of exercise in type 2 diabetes as well as potential therapeutic approaches.

Favourable changes in mortality in people with diabetes: US NHANES 1999-2010

AIMS

Diabetes-related complications have declined during the past two decades. We aimed to examine whether mortality in people with diabetes improved over time in the 1999 to 2010 National Health and Nutrition Examination Survey (NHANES).

METHODS

We conducted a prospective cohort study using 1999 to 2004 and 2005 to 2010 data from the NHANES. For primary analyses, we compared the unadjusted, age-adjusted and multivariable-adjusted hazard ratios (HR) for mortality outcomes (total, cardiovascular, cardiac and cancer deaths) of the participants with diabetes with those without diabetes using Cox proportional hazard models.

RESULTS

For each mortality outcome, HR (95% confidence interval) in diabetic participants during the period 2005 to 2010 was lower than that during the period 1999 to 2004 (all-cause death, 2.76 [1.87-4.08] vs 4.23 [2.57-6.98]; cardiovascular death, 2.70 [1.20-6.04] vs 8.82 [3.28-23.70]; cardiac death, 2.45 [0.98-6.09] vs 15.55 [7.01-34.50]; cancer death, 2.33 [0.87-6.23] vs 3.03 [1.20-7.65]). Compared with mortality outcome during the period 1999 to 2004, greater declines in mortality during the period 2005 to 2010 were observed for cardiovascular (-54.0%) and cardiac deaths (-64.8%). In age-adjusted and multivariable-adjusted models, the cumulative event rates for total, cardiovascular and cardiac deaths were not significantly different between participants with and without diabetes during the period 2005-2010; this was not the case during the period 1999-2004. The leading cause of death was malignant neoplasm during the period 2005-2010.

CONCLUSION

Considerably improved outcomes for total, cardiovascular and cardiac deaths were observed in people with diabetes during the 2005 to 2010 NHANES compared to the 1999 to 2004 NHANES.

The Impact of a Mobile Diabetes Health Intervention on Diabetes Distress and Depression Among Adults: Secondary Analysis of a Cluster Randomized Controlled Trial

Background

Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activities, and provider visits, has an impact on patients’ emotional well-being. Diabetes distress and depression are two important components of emotional well-being that may negatively affect diabetes outcomes.

Objective

The aim was to determine the impact of the 1-year Mobile Diabetes Intervention Study cluster randomized clinical trial on emotional well-being measured by diabetes distress and depression among adults with type 2 diabetes (T2D).

Methods

A total of 163 adults with not-well-managed T2D were enrolled from community primary care practices. Primary care practices were cluster randomized into either a usual care control group or intervention group. Intervention participants were given a mobile phone with coaching software including a Web portal to communicate with providers. A priori established secondary outcomes included distress measured by the Diabetes Distress Scale (DDS), with subscales measuring emotional burden, interpersonal distress, physician-related distress, and regimen-related distress, as well as depression measured by the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to calculate the effect of the intervention on diabetes distress levels over time, both overall and separately by sex, and to determine if the intervention affected distress or depression. The impact of total DDS on changes in HbA_1c was also studied.

Results

There were no significant treatment group effects for DDS total (baseline: P=.07; differences over time: P=.38) or for depression (P=.06 over time). Significant declines in total DDS were observed over the 12-month intervention period (P=.01). Regimen-related distress significantly decreased for all study participants (P<.001), but no significant change over time was observed for emotional burden (P=.83), interpersonal distress (P=.64), or physician-related distress (P=.73). Women in both the usual care and intervention groups were more likely to have higher overall DDS, emotional burden, physician-related distress, and regimen-related distress, but not interpersonal distress. Women also reported higher baseline depression compared to men (P=.006). Overall, depression decreased over the treatment period (P=.007), but remained unaffected by group assignment (P=.06) or by sex (P=.97). Diabetes distress had no effect on the change in HbA_1c (P=.91) over the treatment period.

Conclusions

Although we found no definitive overall or sex-specific effect of the intervention on diabetes distress or depression, this study makes an important contribution to the understanding of mobile health interventions and the impact on emotional health. Our study verified previous work that although diabetes distress and depression are highly correlated, these measures are not evaluating the same construct. Design of future mobile technology provides an opportunity to personalize, contextualize, and intervene in the emotional well-being of persons with diabetes.

Trial Registration

Clinicaltrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6vVgRCLAF)