Association of body mass index and blood pressure variability with 10-year mortality and renal disease progression in type 2 diabetes

BACKGROUND

Variability in biological parameters may be associated with adverse outcomes. The aim of the study was to determine whether variability in body mass index (BMI) and blood pressure is associated with all-cause, cardiovascular mortality and cancer mortality or with renal disease progression in subjects with type 2 diabetes.

METHODS

The diabetes database was accessed, and all the information on patient visits (consultations) carried out in the study period (1 January 2008-31 December 2019) was extracted and linked to the laboratory database and the mortality register.

RESULTS

The total number of patients included in the study population was 26,261, of whom 54.4% were male. Median (interquartile range, IQR) age was 60.2 (51.8-68.3) years. The coefficient of variability of BMI was independently associated with increased all-cause and cardiovascular, but not cancer, mortality. Glycated haemoglobin (HbA1c) was associated with increased all-cause, cardiovascular, and cancer mortality as well as with renal progression. Variability in systolic blood pressure, diastolic blood pressure, and pulse pressure was associated with increased all-cause and cardiovascular mortality in bivariate, but not in multivariate, analyses.

CONCLUSIONS

Variability in BMI was associated with increased all-cause and cardiovascular, but not cancer, mortality in a large real-world contemporary population. Our results also confirm the association of HbA1c with increased all-cause, cardiovascular, and cancer mortality as well as with renal progression.

Time trajectories of key cardiometabolic parameters and of cardiovascular risk in subjects with diabetes in a real world setting

BACKGROUND AND AIMS

Diabetes is associated with increased cardiovascular risk. Glycated haemoglobin (HbA_1c), lipid parameters and blood pressure are known risk factors for adverse outcome. The aim of the study was to explore the time trajectories of these key parameters and of the associated cardiovascular risk.

METHODS

We linked the diabetes electronic health records to the laboratory information system so as to investigate the trajectories of key metabolic parameters from 3 years prior to the diagnosis of diabetes to 10 years after diagnosis. We calculated the cardiovascular risk at the different time points during this period using the United Kingdom Prospective Study (UKPDS) risk engine.

RESULTS

The study included 21,288 patients. The median age at diagnosis was 56 years and 55.3% were male. There was a sharp decrease in HbA_1c after diagnosis of diabetes, but there was a progressive rise thereafter. All lipid parameters after diagnosis also improved in the year of diagnosis, and these improvements persisted even up to 10 years post-diagnosis. There was no discernible trend in mean systolic or diastolic blood pressures following diagnosis of diabetes. There was a slight decrease in the UKPDS-estimated cardiovascular risk after diagnosis of diabetes followed by a progressive increase. Estimated glomerular filtration rate declined at an average rate of 1.33 ml/min/1.73 m²/year.

CONCLUSIONS

Our data suggest that lipid control should be tightened with increasing duration of diabetes since this is more readily achievable than HbA_1c lowering and since other factors such as age and duration of diabetes are unmodifiable.

Does optimal HbA1c in diabetes differ according to drug treatment? An evaluation of national electronic database in Malta

BACKGROUND AND AIMS

A J-shaped relationship between HbA_1c and mortality has been reported in subjects with type 2 diabetes. The postulated mechanism linking low HbA_1c with increased mortality is increased hypoglycaemia risk. We tested this hypothesis by comparing the relationship between low HbA_1c to mortality in patients on therapies with different hypoglycaemia risk.

METHODS

We selected patients on any type of treatment for diabetes from a national electronic database (n = 25,743) and linked to other databases, including laboratory database and the national mortality register.

RESULTS

We observed a J-shaped or U-shaped association between HbA_1c and all-cause mortality in the whole type 2 diabetes patient cohort as well as in patients on metformin monotherapy and in those on metformin-sulphonylurea combination therapy, but not in subjects on sulphonylurea monotherapy or in those on insulin.

CONCLUSIONS

Our data confirm the J-shaped relationship between HbA_1c and mortality in type 2 diabetes, but suggest that a low HbA_1c is deleterious even in absence of hypoglycaemia and that subjects with type 2 diabetes might require a slightly elevated blood glucose for optimal outcome. Our data also suggest that the increased mortality associated with sulphonylureas cannot be mediated solely through increased hypoglycaemia risk.

Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty-two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not-permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self-regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.

All-cause mortality in patients on sulphonylurea monotherapy compared to metformin monotherapy in a nation-wide cohort

BACKGROUND

Type 2 diabetes is associated with increased mortality. There is some data that sulphonylurea therapy may contribute to this.

AIMS

To compare all-cause 3-year mortality of patients on sulphonylurea monotherapy to that of patients on metformin monotherapy after adjusting for potential confounders.

METHODS

We searched the Maltese national electronic database for diabetes treatment in April 2014. This is an electronic database of all treatment that patients are prescribed through the local National Health Service. We identified patients on metformin or sulphonylurea monotherapy and linked this to the national mortality database and the laboratory information system.

RESULTS

There were 25,792 persons who were on treatment for diabetes in April 2014. Of these, 9977 were on metformin monotherapy and 1717 on sulphonylurea monotherapy. This cohort was followed up until April 2017. There were 2518 deaths (9.76%) during this period, giving an average of 32.5 deaths per 1000 persons with diabetes. Logistic regression showed that persons on sulphonylurea monotherapy were 2.03 (95% CI 1.68-2.44, p < .001) times more likely to die within 3 years than persons on metformin monotherapy, after adjusting for age, eGFR and HbA1c. The logistic regression model was statistically significant, p < .001. Additional adjustment for LDL-cholesterol, HDL-cholesterol and urinary albumin-creatinine ratio did not alter the results.

CONCLUSION

Our data shows that sulphonylurea monotherapy is associated with higher all-cause mortality when compared to metformin monotherapy after adjusting for potential confounders.

Television food advertising to children in Malta

To undertake a cross-sectional survey of the extent and nature of food and beverage advertising to children on Maltese national television stations. Seven national free-to-air channels were recorded for seven consecutive days in March 2014 between 07:00 and 22:00 h. Advertisements were coded according to predefined categories, with a focus on advertisements aired during 'peak' children's viewing times, defined as periods during which more than 25% of children were likely to be watching television on any channel. Food and beverage advertisements were classified as core (healthy), non-core (unhealthy) or miscellaneous foods. Malta. Whole population, with a focus on children. Food and drinks were the most heavily advertised product category (26.9% of all advertisements) across all channels. The proportion of non-core food/drink advertisements was significantly greater during peak compared with non-peak children's viewing times (52 vs 44.6%; p ≤ 0.001). A majority of advertisements aimed at children are for non-core foods, and are typically shown during family-oriented programmes in the late evening rather than being restricted to children's programmes. 'Taste', 'enjoyment' and 'peer status' were the primary persuasive appeals used in adolescent and child-focused advertisements. This first content analysis of television advertising in Malta suggests that there is scope for the implementation of statutory regulation regarding advertising of foods high in fat, sugar and salt (HFSS) during times when children are likely to watch television, rather than during children's programmes only. Ongoing, systematic monitoring is essential for evaluation of the effectiveness of regulations designed to reduce children's exposure to HFSS food advertising on television.

Psychophysiological characteristics of narcissism during active and passive coping

This study provides the first psychophysiological analysis of narcissism by measuring autonomic responses during active and passive anticipatory coping in 40 undergraduate men who scored high or low on the Narcissistic Personality Inventory (NPI). Compared to the low NPI group, the high NPI group showed greater preejection period (PEP) shortening, cardiac deceleration, and skin conductance response (SCR) habituation during anticipation of an aversive stimulus (p < .02). As expected, SCR and PEP reactivity were greater during active than passive coping. In the case of PEP, this effect emerged only in the low NPI group; the high NPI group showed the greatest PEP reactivity during the first task, regardless of coping demands. These data support hypothesized relationships among narcissism, psychopathy, and psychological predictors of cardiovascular disease, and suggest that a psychobiological dimension may underlie important features of narcissism.

Prevalence and co-occurrence of health risk behaviors among high-risk drinkers in a primary care population

BACKGROUND

Approximately 10% of patients seen in the primary care setting meet criteria for high-risk (HR) drinking. Little data are available about the co-occurrence of other risk behaviors (RBs) in this population. This study examines the co-occurrence of smoking, poor diet, and sedentariness, and several change-related variables, among 479 HR drinkers participating in Project Health, a NIAAA-funded study testing the effectiveness of a provider-delivered intervention to reduce HR drinking.

METHOD

Data were collected at study entry via standardized interview and questionnaire.

RESULTS

The prevalence of additional RBs among HR drinkers was smoking, 35%; poor diet, 28%; and sedentariness, 44%. In addition to HR drinking, 67% of participants had at least one RB, and 61% reported smoking, sedentariness, or both. Perception of drinking as a problem was generally low (20%), as was intention to change drinking. Seventy-two percent of participants with multiple RBs perceived at least one of these RBs as a problem. Younger, unmarried, less-educated, blue-collar, and non-working participants were more likely to have multiple RBs than white-collar workers.

CONCLUSION

Additional RBs are common among HR drinkers and may increase their already elevated health risks. Implications of these findings for interventions integrating multiple RBs into primary care settings are discussed.

Classical conditioning of the human blood pressure response

The object of this experiment was to demonstrate that blood pressure responses could be classically conditioned in human subjects and to describe the topography of the conditioned response. Despite clear evidence for classical blood pressure conditioning in animals there is little evidence concerning a clear demonstration of the phenomenon in human subjects, and no description of the form of the conditioned response. A 'neutral' 8-s 70-db tone (CS) was paired with a 500-ms electric shock (UCS) in a delay conditioning paradigm. Conditioned subjects were compared to a control group that received the CS and UCS on a truly random schedule. The subjects in the conditioning group showed a conditioned blood pressure response that emerged during the last 4 s of the 8-s CS. The results differ from those obtained from animals, where the CR typically emerges during the first half of the CS. These data may have implications for the role of learning in hypertensive disorders.

The ensemble-averaged impedance cardiogram: an evaluation of scoring methods and interrater reliability

The interrater reliability and concurrent validity of two methods of scoring the ensemble-averaged impedance cardiogram were evaluated. Impedance cardiographic and electrocardiographic signals were recorded from 40 undergraduate men and women during a baseline rest period and a vocal mental arithmetic task period. Recordings were scored by four rates using a conventional method, involving ensemble averaging after careful editing of beat-to-beat waveforms, and a streamlined method, involving ensemble averaging without beat-to-beat editing. Intraclass correlations for interrater reliability exceeded .92, whereas intraclass correlations for concurrent validity exceeded .97, indicating excellent agreement between rates and scoring methods for all cardiac measures. The streamlined method was significantly faster than the conventional method. The results indicate that variations in beat-to-beat editing do not constitute a serious source of error in the ensemble-averaged impedance cardiogram and support the interrater reliability and concurrent validity of the two scoring methods.

Comparison of utilization of medical services by alcoholics and non-alcoholics

To determine whether medical costs for alcoholics are higher than those for non-alcoholics, inpatient and outpatient costs for medical services of 191 alcoholics with 191 non-alcoholic matched controls were compared over four years. Results confirm that alcoholics are higher-cost users of medical services than non-alcoholics. (Am J Public Health 1982; 72:600-602.)

Utilization of medical services by alcoholics participating in a health maintenance organization outpatient treatment program: three-year follow-up

IN a cumulative 3-yr follow-up study of utilization of medical services by alcoholics participating in a health insurance maintenance organization (HMO) outpatient alcoholism treatment program, expenditures of 59 alcoholics were compared with those of 78 alcoholics who chose not to participate. Results show significant differences in dollar cost per patient per year between groups in inpatient expenditures (p = 0.03). When alcoholism clinic costs were excluded from combined inpatient and outpatient expenditures, significance was maintained over the 3 yr (p = 0.02). In combined inpatient and outpatient expenditures including alcoholism treatment costs, the dollar differential between groups was substantial but not statistically significant.

Utilization of medical services by alcoholics participating in an outpatient treatment program

Utilization of medical services by alcoholics participating in an outpatient alcoholism treatment program was examined, comparing these with alcoholics who chose not to participate.