Pub Date : 2025-01-18DOI: 10.1016/j.diabet.2025.101607
Boyuan Wang , Ivy Lynn Mak , Kiki Sze Nga Liu , Edmond Pui Hang Choi , Cindy Lo Kuen Lam , Eric Yuk Fai Wan
Objective
This study aimed to evaluate the association between type 2 diabetes mellitus (T2DM) onset age and risk of cardiovascular disease (CVD) and mortality.
Method
Two retrospective cohort studies were conducted using the electronic health records from the United Kingdom (UK) and Hong Kong (HK) on adults without CVD. During 2008-2013, 128,918 and 185,646 patients with new-onset T2DM were assigned to the T2DM group, and 5,052,770 and 3,159,396 patients without T2DM were included as controls in the UK and HK cohort, respectively. Patients were stratified into six age groups. Multivariable Cox regression, adjusted for baseline characteristics and fine stratification weights, was used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for each outcome.
Results
New-onset T2DM was associated with increased CVD and mortality risk, but the risks decreased with age. Compared to those without T2DM in the same age groups, the HR (95 % CI) for CVD in the UK cohort was 3.22 (2.80, 3.71), 1.21 (1.15, 1.26), and 0.99 (0.93, 1.05) for T2DM individuals at ages 18–39, 60–69, and ≥ 80, respectively. Similarly, the HR (95 % CI) for mortality among new-onset T2DM patients was 2.41 (2.06, 2.83) for age 18–39, 1.40 (1.34, 1.46) for age 60–69, and 1.12 (1.08, 1.16) for age ≥ 80. Results from the HK cohort showed a similar pattern.
Conclusion
Young onset of T2DM is associated with a significant impact on cardiovascular health later in life. This highlights the importance of the prevention of DM in young adults.
{"title":"Association between Type 2 Diabetes onset age and risk of cardiovascular disease and mortality: Two cohort studies from United Kingdom and Hong Kong","authors":"Boyuan Wang , Ivy Lynn Mak , Kiki Sze Nga Liu , Edmond Pui Hang Choi , Cindy Lo Kuen Lam , Eric Yuk Fai Wan","doi":"10.1016/j.diabet.2025.101607","DOIUrl":"10.1016/j.diabet.2025.101607","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the association between type 2 diabetes mellitus (T2DM) onset age and risk of cardiovascular disease (CVD) and mortality.</div></div><div><h3>Method</h3><div>Two retrospective cohort studies were conducted using the electronic health records from the United Kingdom (UK) and Hong Kong (HK) on adults without CVD. During 2008-2013, 128,918 and 185,646 patients with new-onset T2DM were assigned to the T2DM group, and 5,052,770 and 3,159,396 patients without T2DM were included as controls in the UK and HK cohort, respectively. Patients were stratified into six age groups. Multivariable Cox regression, adjusted for baseline characteristics and fine stratification weights, was used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for each outcome.</div></div><div><h3>Results</h3><div>New-onset T2DM was associated with increased CVD and mortality risk, but the risks decreased with age. Compared to those without T2DM in the same age groups, the HR (95 % CI) for CVD in the UK cohort was 3.22 (2.80, 3.71), 1.21 (1.15, 1.26), and 0.99 (0.93, 1.05) for T2DM individuals at ages 18–39, 60–69, and ≥ 80, respectively. Similarly, the HR (95 % CI) for mortality among new-onset T2DM patients was 2.41 (2.06, 2.83) for age 18–39, 1.40 (1.34, 1.46) for age 60–69, and 1.12 (1.08, 1.16) for age ≥ 80. Results from the HK cohort showed a similar pattern.</div></div><div><h3>Conclusion</h3><div>Young onset of T2DM is associated with a significant impact on cardiovascular health later in life. This highlights the importance of the prevention of DM in young adults.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101607"},"PeriodicalIF":4.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used in subjects with type 2 diabetes (T2D) and obesity. However, concerns over their association with acute pancreatitis (AP) have emerged. Our aim was to evaluate the risk of recurrence of AP in subjects on GLP-1RAs with a history of AP.
Methods
This retrospective study deployed the TriNetX platform. We identified adult cohorts of subjects with a history of AP and analyzed the impact of individual medications (GLP-1RAs, SGLT2i, or DPP4i) on the risk of recurrence of AP. To adjust for baseline differences, propensity score matching was done in cohorts with and without risk factors for AP.
Results
Our analysis of 672,069 patients with a history of AP and T2D revealed significant risk reductions associated with GLP-1RAs compared to other treatments. Over one to five years, GLP-1RAs consistently showed a lower risk of AP recurrence compared to SGLT2i and DPP-4i. Specifically, over a one-year period, GLP-1RAs users had a risk reduction of -0.071 (95 % CI:0.085 to -0.057) (p < 0.001) compared to SGLT2i, and -0.064 (95 % CI:0.080 to -0.048) (p< 0.001) compared to DPP-4i. These trends persisted, with the risk differences further widening by the fifth year to -0.086 and -0.094, respectively.
Conclusion
Based on our findings, we conclude that GLP-1RAs may be safely used in subjects with a history of acute pancreatitis. While our analysis showed that there was a significantly lower risk of AP recurrence in subjects on GLP-1compared to DPP-IV inhibitors and SGLT2 inhibitors, as this is a retrospective analysis we suggest that these findings need to be confirmed in prospective studies.
{"title":"Use of glucagon-like peptide-1 receptor agonists in people with history of acute pancreatitis: TriNetX analysis","authors":"Mahmoud Nassar , Hazem Abosheaishaa , Anoop Misra , Paresh Dandona , Husam Ghanim , Ajay Chaudhuri (Prof.)","doi":"10.1016/j.diabet.2025.101613","DOIUrl":"10.1016/j.diabet.2025.101613","url":null,"abstract":"<div><h3>Introduction</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used in subjects with type 2 diabetes (T2D) and obesity. However, concerns over their association with acute pancreatitis (AP) have emerged. Our aim was to evaluate the risk of recurrence of AP in subjects on GLP-1RAs with a history of AP.</div></div><div><h3>Methods</h3><div>This retrospective study deployed the TriNetX platform. We identified adult cohorts of subjects with a history of AP and analyzed the impact of individual medications (GLP-1RAs, SGLT2i, or DPP4i) on the risk of recurrence of AP. To adjust for baseline differences, propensity score matching was done in cohorts with and without risk factors for AP.</div></div><div><h3>Results</h3><div>Our analysis of 672,069 patients with a history of AP and T2D revealed significant risk reductions associated with GLP-1RAs compared to other treatments. Over one to five years, GLP-1RAs consistently showed a lower risk of AP recurrence compared to SGLT2i and DPP-4i. Specifically, over a one-year period, GLP-1RAs users had a risk reduction of -0.071 (95 % CI:0.085 to -0.057) (p < 0.001) compared to SGLT2i, and -0.064 (95 % CI:0.080 to -0.048) (p< 0.001) compared to DPP-4i. These trends persisted, with the risk differences further widening by the fifth year to -0.086 and -0.094, respectively.</div></div><div><h3>Conclusion</h3><div>Based on our findings, we conclude that GLP-1RAs may be safely used in subjects with a history of acute pancreatitis. While our analysis showed that there was a significantly lower risk of AP recurrence in subjects on GLP-1compared to DPP-IV inhibitors and SGLT2 inhibitors, as this is a retrospective analysis we suggest that these findings need to be confirmed in prospective studies.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101613"},"PeriodicalIF":4.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.diabet.2025.101612
André J. Scheen
Background
Obesity is an increasing public health problem because of its high prevalence and associated morbidity and mortality. Two weight-loss strategies are currently used, either bariatric surgery or pharmacological therapy with glucagon-like peptide-1 receptor agonists (GLP-1RAs). Preclinical studies in rodents suggested an increased risk of additive disorders after bariatric surgery contrasting with a reduced risk with GLP-1RAs.
Methods
An extensive literature search to detect clinical studies that investigated the prevalence of addictive disorders (food addiction, alcohol abuse, smoking, cannabis, cocaine, opioid use) following bariatric surgery or GLP-1RA therapy in obese patients.
Results
In observational cohort studies, the prevalence of alcohol use disorder was twofold higher after > 2 years following surgery (eleven studies, mainly with gastric bypass) whereas it was reduced roughly by half with GLP-1RA therapy (five studies, mainly with semaglutide). Similar findings were reported with other addictive disorders. An addiction transfer from food addiction to other addictive disorders is hypothesized to explain the increased risk after bariatric surgery. Several mechanisms are proposed to explain the favorable findings reported with GLP-1RAs, i.e. effects on the dopamine reward pathway, central GABA (gamma-aminobutyric acid) release, negative emotional stress associated with food/drug restriction and/or neuronal inflammation.
Conclusion
Available data from observational cohort studies confirm an increased risk of addictive disorders following bariatric surgery, contrasting with a reduced risk with GLP-1RA therapy. Both physicians and patients should be informed of the higher risk post-surgery whereas available promising results with GLP-1RAs should be confirmed in ongoing dedicated randomized controlled trials before any official indication.
{"title":"Weight loss therapy and addiction: Increased risk after bariatric surgery but reduced risk with GLP-1 receptor agonists","authors":"André J. Scheen","doi":"10.1016/j.diabet.2025.101612","DOIUrl":"10.1016/j.diabet.2025.101612","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is an increasing public health problem because of its high prevalence and associated morbidity and mortality. Two weight-loss strategies are currently used, either bariatric surgery or pharmacological therapy with glucagon-like peptide-1 receptor agonists (GLP-1RAs). Preclinical studies in rodents suggested an increased risk of additive disorders after bariatric surgery contrasting with a reduced risk with GLP-1RAs.</div></div><div><h3>Methods</h3><div>An extensive literature search to detect clinical studies that investigated the prevalence of addictive disorders (food addiction, alcohol abuse, smoking, cannabis, cocaine, opioid use) following bariatric surgery or GLP-1RA therapy in obese patients.</div></div><div><h3>Results</h3><div>In observational cohort studies, the prevalence of alcohol use disorder was twofold higher after > 2 years following surgery (eleven studies, mainly with gastric bypass) whereas it was reduced roughly by half with GLP-1RA therapy (five studies, mainly with semaglutide). Similar findings were reported with other addictive disorders. An addiction transfer from food addiction to other addictive disorders is hypothesized to explain the increased risk after bariatric surgery. Several mechanisms are proposed to explain the favorable findings reported with GLP-1RAs, i.e. effects on the dopamine reward pathway, central GABA (gamma-aminobutyric acid) release, negative emotional stress associated with food/drug restriction and/or neuronal inflammation.</div></div><div><h3>Conclusion</h3><div>Available data from observational cohort studies confirm an increased risk of addictive disorders following bariatric surgery, contrasting with a reduced risk with GLP-1RA therapy. Both physicians and patients should be informed of the higher risk post-surgery whereas available promising results with GLP-1RAs should be confirmed in ongoing dedicated randomized controlled trials before any official indication.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101612"},"PeriodicalIF":4.6,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-13DOI: 10.1016/j.diabet.2025.101606
Jean-Baptiste Bonnet , Claire Duflos , Helena Huguet , Antoine Avignon , Ariane Sultan
Objective
The out-of-hospital care pathways of people with DFU have been little studied. We used the French National Health Data System (SNDS) to collect refund and care pathway data for all French residents. The aim of this study was to determine the incidence of major lower limb amputation (MA) and associated risk factors in a population with an incident DFU.
Research Design and Methods
We included any person living with diabetes and incident DFU. The primary endpoint was the occurrence of MA within one year. We considered the course and consumption of care one year before and one year after the initial event.
Results
In 2018, 133,791 people were included, and during the follow-up, MA was performed in 4,733 (3.5 %). Among these people with MAs, 16.4 % were included via the out-of-hospital part of the protocol, and their first contact with the hospital led to MA. Factors associated (hazard ratio, HR [95 % confidence interval, CI]) with MA were: being male (1.92 [1.78;2.08]), arteriopathy of the lower limb (10.16 [9.36;11.03]), psychiatric disease (1.10 [1.01;1.20]) and end-stage renal disease (2.12 [1.93;2.33]).
Regarding the care pathway, associations (HR [95 %CI]) were observed between lower MA rates and people with more general practitioner (0.83 [0.75–0.91]), private nurse (0.88 [0.81–0.95]) and diabetologist (0.88 [0.81–0.95]) visits.
Living in the most disadvantaged municipalities was associated (HR [95 %CI]) with a higher MA rate (1.17[1.06–1.29]).
Conclusion
This is the first national study of the care pathways followed by people with DFU. Failures in the care pathway, precariousness and several comorbidities were identified, with an impact on the MA risk.
{"title":"Epidemiology of major amputation following diabetic foot ulcer: Insights from recent nationwide data in the french national health registry (SNDS)","authors":"Jean-Baptiste Bonnet , Claire Duflos , Helena Huguet , Antoine Avignon , Ariane Sultan","doi":"10.1016/j.diabet.2025.101606","DOIUrl":"10.1016/j.diabet.2025.101606","url":null,"abstract":"<div><h3>Objective</h3><div>The out-of-hospital care pathways of people with DFU have been little studied. We used the French National Health Data System (SNDS) to collect refund and care pathway data for all French residents. The aim of this study was to determine the incidence of major lower limb amputation (MA) and associated risk factors in a population with an incident DFU.</div></div><div><h3>Research Design and Methods</h3><div>We included any person living with diabetes and incident DFU. The primary endpoint was the occurrence of MA within one year. We considered the course and consumption of care one year before and one year after the initial event.</div></div><div><h3>Results</h3><div>In 2018, 133,791 people were included, and during the follow-up, MA was performed in 4,733 (3.5 %). Among these people with MAs, 16.4 % were included via the out-of-hospital part of the protocol, and their first contact with the hospital led to MA. Factors associated (hazard ratio, HR [95 % confidence interval, CI]) with MA were: being male (1.92 [1.78;2.08]), arteriopathy of the lower limb (10.16 [9.36;11.03]), psychiatric disease (1.10 [1.01;1.20]) and end-stage renal disease (2.12 [1.93;2.33]).</div><div>Regarding the care pathway, associations (HR [95 %CI]) were observed between lower MA rates and people with more general practitioner (0.83 [0.75–0.91]), private nurse (0.88 [0.81–0.95]) and diabetologist (0.88 [0.81–0.95]) visits.</div><div>Living in the most disadvantaged municipalities was associated (HR [95 %CI]) with a higher MA rate (1.17[1.06–1.29]).</div></div><div><h3>Conclusion</h3><div>This is the first national study of the care pathways followed by people with DFU. Failures in the care pathway, precariousness and several comorbidities were identified, with an impact on the MA risk.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101606"},"PeriodicalIF":4.6,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-07DOI: 10.1016/j.diabet.2025.101605
Yun Kyung Cho , Sehee Kim , Myung Jin Kim , Woo Je Lee , Ye-Jee Kim , Chang Hee Jung
Aim
We aimed to investigate whether sodium-glucose cotransporter-2 inhibitors (SGLT2is) are associated with a decreased risk of gastrointestinal (GI) cancers in patients with type 2 diabetes (T2D) compared to other glucose lowering medications (oGLMs).
Methods
This active-comparator, new-user cohort study used the nationwide National Health Insurance Service database of the Republic of Korea from September 2014 to June 2020. From 79,423 new users of SGLT2is and 294,707 new users of oGLMs, we used a propensity score to match 59,954 from each of these two treatment groups. We calculated hazard ratios (HRs) and 95 % confidence intervals (CIs) for the incidence of GI cancers, encompassing stomach, colorectal, liver, and pancreatic cancers.
Results
During the observation period, there were 814 and 916 GI cancers, and 794 and 1,140 deaths in the SGLT2is and oGLMs treatment groups, respectively. The use of SGLT2is was associated with a statistically significant reduction in the incidence of GI cancers, with an adjusted HR of 0.90 (95 % CI: 0.82 to 0.99). However, only the incidence of pancreatic cancer was significantly lower in SGLT2is users compared to non-users, with an adjusted HR of 0.72 (95 % CI: 0.55 - 0.95). In the entire cohort, the multivariable-adjusted HR for pancreatic cancer was 0.70 (95 % CI: 0.56 to 0.88).
Conclusion
For T2D patients, SGLT2i use was associated with a diminished pancreatic cancer risk compared to oGLMs. Future studies should ascertain the potential protective effect of SGLT2is against pancreatic cancer.
{"title":"New users of sodium-glucose cotransporter 2 inhibitors are at low risk of incident pancreatic cancer: A nationwide population-based cohort study","authors":"Yun Kyung Cho , Sehee Kim , Myung Jin Kim , Woo Je Lee , Ye-Jee Kim , Chang Hee Jung","doi":"10.1016/j.diabet.2025.101605","DOIUrl":"10.1016/j.diabet.2025.101605","url":null,"abstract":"<div><h3>Aim</h3><div>We aimed to investigate whether sodium-glucose cotransporter-2 inhibitors (SGLT2is) are associated with a decreased risk of gastrointestinal (GI) cancers in patients with type 2 diabetes (T2D) compared to other glucose lowering medications (oGLMs).</div></div><div><h3>Methods</h3><div>This active-comparator, new-user cohort study used the nationwide National Health Insurance Service database of the Republic of Korea from September 2014 to June 2020. From 79,423 new users of SGLT2is and 294,707 new users of oGLMs, we used a propensity score to match 59,954 from each of these two treatment groups. We calculated hazard ratios (HRs) and 95 % confidence intervals (CIs) for the incidence of GI cancers, encompassing stomach, colorectal, liver, and pancreatic cancers.</div></div><div><h3>Results</h3><div>During the observation period, there were 814 and 916 GI cancers, and 794 and 1,140 deaths in the SGLT2is and oGLMs treatment groups, respectively. The use of SGLT2is was associated with a statistically significant reduction in the incidence of GI cancers, with an adjusted HR of 0.90 (95 % CI: 0.82 to 0.99). However, only the incidence of pancreatic cancer was significantly lower in SGLT2is users compared to non-users, with an adjusted HR of 0.72 (95 % CI: 0.55 - 0.95). In the entire cohort, the multivariable-adjusted HR for pancreatic cancer was 0.70 (95 % CI: 0.56 to 0.88).</div></div><div><h3>Conclusion</h3><div>For T2D patients, SGLT2i use was associated with a diminished pancreatic cancer risk compared to oGLMs. Future studies should ascertain the potential protective effect of SGLT2is against pancreatic cancer.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 2","pages":"Article 101605"},"PeriodicalIF":4.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.diabet.2024.101595
Sophie E. Claudel , Ashish Verma
Aim
To examine the association between adiposity and mortality in U.S. adults without major cardiovascular risk factors.
Methods
We analyzed 7,948 adults (4,123 women, 3,825 men) aged > 20 years from the National Health and Nutrition Examination Survey (2003–2004, 2011–2016). Participants with cardiovascular disease, estimated glomerular filtration rate < 60 ml/min/1.73m², diabetes, hypertension, or pregnancy were excluded. Adiposity measures, assessed by dual-energy x-ray absorptiometry or anthropometrics, included android and gynoid fat mass index (FMI), android-to-gynoid ratio, subcutaneous, abdominal, and visceral FMI, BMI, and waist circumference. We employed multivariable-adjusted Cox regression and restricted cubic spline models to assess sex-specific associations between adiposity measures and all-cause mortality.
Results
Over a median follow-up of 7.8 years, there were 83 deaths among women and 119 among men. In women, BMI, waist circumference, and gynoid FMI showed non-linear associations with all-cause mortality, while in men, BMI, waist circumference, and android-to-gynoid ratio demonstrated similar non-linear associations. In final adjusted models, a 1-SD increase in visceral, subcutaneous, and abdominal FMI among women was associated with 61 % (HR 1.61, 95 % CI 1.17–2.21), 87 % (HR 1.87, 95 % CI 1.13–3.08), and 89 % (HR 1.89, 95 % CI 1.19–2.99) higher mortality risk, respectively. Women in the lowest tertile of gynoid FMI had an 82 % (HR 1.82, 95 % CI 1.01–3.29) higher mortality risk compared to those in the middle tertile. In final adjusted models, a 1-SD increase in gynoid, android, visceral, subcutaneous, and abdominal FMI among men was associated with 30 % (HR 1.30, 95 % CI 1.02–1.65), 41 % (HR 1.41, 95 % CI 1.09–1.83), 54 % (HR 1.54, 95 % CI 1.04–2.28), 69 % (HR 1.69, 95 % CI 1.25–2.29), and 76 % (HR 1.76, 95 % CI 1.25–2.48) higher mortality risk, respectively. Additionally, men in the middle tertile of android-to-gynoid ratio had a 2.68-fold higher mortality risk compared to the lowest tertile, while men in the highest BMI tertile had an 83 % higher mortality risk compared to the lowest tertile. Sex modified the association between gynoid FMI and mortality (P-interaction = 0.008).
Conclusion
Imaging-based adiposity measures have distinct prognostic value for mortality beyond traditional anthropometrics in adults without cardiovascular risk factors.
目的：研究无主要心血管危险因素的美国成年人肥胖与死亡率之间的关系。方法：对2003-2004年、2011-2016年全国健康与营养检查调查（National Health and Nutrition Examination Survey）中7948名年龄在100 ~ 20岁的成年人（女性4123人，男性3825人）进行分析。排除心血管疾病、肾小球滤过率< 60 ml/min/1.73m²、糖尿病、高血压或怀孕的参与者。通过双能x线吸收测量法或人体测量法评估的肥胖测量包括机器人和女性的脂肪质量指数（FMI）、机器人与女性的比例、皮下、腹部和内脏的脂肪质量指数、BMI和腰围。我们采用多变量校正Cox回归和限制性三次样条模型来评估肥胖测量与全因死亡率之间的性别特异性关联。结果：在中位7.8年的随访中，女性死亡83人，男性死亡119人。在女性中，BMI、腰围和雌核FMI与全因死亡率呈非线性关系，而在男性中，BMI、腰围和机器人与雌核之比也表现出类似的非线性关系。在最终调整的模型中，女性内脏、皮下和腹部FMI增加1-SD分别与61% （HR 1.61, 95% CI 1.17-2.21）、87% （HR 1.87, 95% CI 1.13-3.08）和89% （HR 1.89, 95% CI 1.19-2.99）的死亡风险升高相关。低分位的女性与中分位的女性相比，低分位的女性死亡风险高82% （HR 1.82, 95% CI 1.01-3.29）。在最终调整的模型中，男性女性生殖器、android、内脏、皮下和腹部FMI增加1-SD分别与30% （HR 1.30, 95% CI 1.02-1.65）、41% （HR 1.41, 95% CI 1.09-1.83）、54% （HR 1.54, 95% CI 1.04-2.28）、69% （HR 1.69, 95% CI 1.25-2.29）和76% （HR 1.76, 95% CI 1.25-2.48）的死亡风险升高相关。此外，与最低的四分之一相比，中等四分之一的男性死亡风险高出2.68倍，而BMI最高的四分之一的男性死亡风险高出最低的83%。性别改变了雌核FMI与死亡率之间的关系（P-interaction = 0.008）。结论：在没有心血管危险因素的成年人中，基于成像的肥胖测量比传统的人体测量对死亡率有明显的预后价值。
{"title":"Association between adipose deposition and mortality among adults without major cardiovascular risk factors","authors":"Sophie E. Claudel , Ashish Verma","doi":"10.1016/j.diabet.2024.101595","DOIUrl":"10.1016/j.diabet.2024.101595","url":null,"abstract":"<div><h3>Aim</h3><div>To examine the association between adiposity and mortality in U.S. adults without major cardiovascular risk factors.</div></div><div><h3>Methods</h3><div>We analyzed 7,948 adults (4,123 women, 3,825 men) aged > 20 years from the National Health and Nutrition Examination Survey (2003–2004, 2011–2016). Participants with cardiovascular disease, estimated glomerular filtration rate < 60 ml/min/1.73m², diabetes, hypertension, or pregnancy were excluded. Adiposity measures, assessed by dual-energy x-ray absorptiometry or anthropometrics, included android and gynoid fat mass index (FMI), android-to-gynoid ratio, subcutaneous, abdominal, and visceral FMI, BMI, and waist circumference. We employed multivariable-adjusted Cox regression and restricted cubic spline models to assess sex-specific associations between adiposity measures and all-cause mortality.</div></div><div><h3>Results</h3><div>Over a median follow-up of 7.8 years, there were 83 deaths among women and 119 among men. In women, BMI, waist circumference, and gynoid FMI showed non-linear associations with all-cause mortality, while in men, BMI, waist circumference, and android-to-gynoid ratio demonstrated similar non-linear associations. In final adjusted models, a 1-SD increase in visceral, subcutaneous, and abdominal FMI among women was associated with 61 % (HR 1.61, 95 % CI 1.17–2.21), 87 % (HR 1.87, 95 % CI 1.13–3.08), and 89 % (HR 1.89, 95 % CI 1.19–2.99) higher mortality risk, respectively. Women in the lowest tertile of gynoid FMI had an 82 % (HR 1.82, 95 % CI 1.01–3.29) higher mortality risk compared to those in the middle tertile. In final adjusted models, a 1-SD increase in gynoid, android, visceral, subcutaneous, and abdominal FMI among men was associated with 30 % (HR 1.30, 95 % CI 1.02–1.65), 41 % (HR 1.41, 95 % CI 1.09–1.83), 54 % (HR 1.54, 95 % CI 1.04–2.28), 69 % (HR 1.69, 95 % CI 1.25–2.29), and 76 % (HR 1.76, 95 % CI 1.25–2.48) higher mortality risk, respectively. Additionally, men in the middle tertile of android-to-gynoid ratio had a 2.68-fold higher mortality risk compared to the lowest tertile, while men in the highest BMI tertile had an 83 % higher mortality risk compared to the lowest tertile. Sex modified the association between gynoid FMI and mortality (<em>P</em>-interaction = 0.008).</div></div><div><h3>Conclusion</h3><div>Imaging-based adiposity measures have distinct prognostic value for mortality beyond traditional anthropometrics in adults without cardiovascular risk factors.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 1","pages":"Article 101595"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since the pionneer work of Meerwaldt and the Groningen team, who related skin autofluorescence (SAF) to the dermal concentrations of advanced glycation end-products (AGEs), hundreds of articles have been devoted to its application in diabetes. Due to the slow turnover of the AGEs formed on collagen of the skin, the SAF can reflect the progressive accumulation of AGEs and hence be a marker of long-term glucose exposure. Accordingly, relations with HbA1c from the previous 3–10 years have been established in both type 1 and type 2 diabetes, and even in gestational diabetes mellitus. Other important determinants of SAF exist however, notably age, renal function, diet, and genetics. SAF is also related to current and future micro- and macrovascular complications of diabetes, as expected for a marker of glycemic memory. It is also related to some important emerging diabetes complications and comorbidities such as cancer, cognitive decline and liver disease. Quantitative information on glucose exposure during the previous years may be pertinent to personnalize care for patients with diabetes: priority for glucose control when SAF is low, and for screening for complications once SAF is high.
{"title":"Skin autofluorescence of advanced glycation end-products, glycemic memory, and diabetes complications","authors":"Vincent Rigalleau , Yann Pucheux , Thierry Couffinhal , Frederic J Tessier , Michael Howsam , Sébastien Rubin , Catherine Helmer , Fadi Alkhami , Alice Larroumet , Laurence Blanco , Marie-Amélie Barbet-Massin , Amandine Ferriere , Kamel Mohammedi , Ninon Foussard","doi":"10.1016/j.diabet.2024.101600","DOIUrl":"10.1016/j.diabet.2024.101600","url":null,"abstract":"<div><div>Since the pionneer work of Meerwaldt and the Groningen team, who related skin autofluorescence (SAF) to the dermal concentrations of advanced glycation end-products (AGEs), hundreds of articles have been devoted to its application in diabetes. Due to the slow turnover of the AGEs formed on collagen of the skin, the SAF can reflect the progressive accumulation of AGEs and hence be a marker of long-term glucose exposure. Accordingly, relations with HbA1c from the previous 3–10 years have been established in both type 1 and type 2 diabetes, and even in gestational diabetes mellitus. Other important determinants of SAF exist however, notably age, renal function, diet, and genetics. SAF is also related to current and future micro- and macrovascular complications of diabetes, as expected for a marker of glycemic memory. It is also related to some important emerging diabetes complications and comorbidities such as cancer, cognitive decline and liver disease. Quantitative information on glucose exposure during the previous years may be pertinent to personnalize care for patients with diabetes: priority for glucose control when SAF is low, and for screening for complications once SAF is high.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 1","pages":"Article 101600"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.diabet.2024.101597
Anthony Albouy , Céline Lambert , Pierre Bernard , Catherine Laporte , Frédéric Fortin
Objectives
To describe glycemic control in diabetic patients monitored by glycated hemoglobin (HbA1c) before, during and after COVID-19 confinement. To identify factors, measured before confinement, associated with HbA1c testing during confinement and those associated with a 1 % increase in HbA1c after confinement.
Method
Retrospective, descriptive study of diabetic patients over 18 years old who underwent at least one HbA1c test before and after confinement. The data were collected from medical analysis laboratories in the Auvergne region (France) and included HbA1c measurements between March 17, 2019, and May 11, 2021, age, sex, residential area, and medical specialty of the prescribing physician.
Results
70,286 patients were included (54.1 % men, mean age 71.7 ± 13.1 years). The average preconfinement HbA1c level (6.80 % ± 1.16) was similar to the average post-confinement HbA1c level (6.80 % ± 1.14). A larger median reduction of 0.90 % points in HbA1c level in the year following confinement was observed in patients whose preconfinement HbA1c level was ≥ 9 %. Only 24.5 % of the patients had an HbA1c test performed during confinement, the majority of whom were over 80 years of age and had an average HbA1c level between 7 and 9 % before confinement. For 5.1 % of the patients, the average HbA1c level increased by one percentage point or more after confinement. Patients ≤ 64, those with an insufficient number of blood tests before confinement and those with an imbalance in HbA1c before confinement were at risk of glycemic imbalance after confinement.
Conclusion
Confinement had no impact on HbA1c levels in diabetic patients.
{"title":"Analysis of glycemic control in diabetic patients by monitoring HbA1c levels before, during and after Covid-19 confinement in Auvergne, France","authors":"Anthony Albouy , Céline Lambert , Pierre Bernard , Catherine Laporte , Frédéric Fortin","doi":"10.1016/j.diabet.2024.101597","DOIUrl":"10.1016/j.diabet.2024.101597","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe glycemic control in diabetic patients monitored by glycated hemoglobin (HbA1c) before, during and after COVID-19 confinement. To identify factors, measured before confinement, associated with HbA1c testing during confinement and those associated with a 1 % increase in HbA1c after confinement.</div></div><div><h3>Method</h3><div>Retrospective, descriptive study of diabetic patients over 18 years old who underwent at least one HbA1c test before and after confinement. The data were collected from medical analysis laboratories in the Auvergne region (France) and included HbA1c measurements between March 17, 2019, and May 11, 2021, age, sex, residential area, and medical specialty of the prescribing physician.</div></div><div><h3>Results</h3><div>70,286 patients were included (54.1 % men, mean age 71.7 ± 13.1 years). The average preconfinement HbA1c level (6.80 % ± 1.16) was similar to the average post-confinement HbA1c level (6.80 % ± 1.14). A larger median reduction of 0.90 % points in HbA1c level in the year following confinement was observed in patients whose preconfinement HbA1c level was ≥ 9 %. Only 24.5 % of the patients had an HbA1c test performed during confinement, the majority of whom were over 80 years of age and had an average HbA1c level between 7 and 9 % before confinement. For 5.1 % of the patients, the average HbA1c level increased by one percentage point or more after confinement. Patients ≤ 64, those with an insufficient number of blood tests before confinement and those with an imbalance in HbA1c before confinement were at risk of glycemic imbalance after confinement.</div></div><div><h3>Conclusion</h3><div>Confinement had no impact on HbA1c levels in diabetic patients.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 1","pages":"Article 101597"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.diabet.2024.101602
Yueru Yang , Shuhui Wan , Linling Yu , Wei Liu , Jiahao Song , Da Shi , Yongfang Zhang , Weihong Chen , Weihong Qiu , Bin Wang
Aim
To estimate the individual and combined influences of phthalates and biological aging on insulin resistance (IR), prediabetes, and diabetes in population with metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods
Data on 3,045 US adults with MASLD were collected to outline the individual and mixed effects of urinary phthalate metabolites on prevalent IR, prediabetes, and diabetes by survey-weighted logistic regression and weighted quantile sum (WQS) regression, as well as the interaction effects between phthalates and biological aging.
Results
We discovered positive relationships – odds ratio (OR) and 95 % confidence interval [CI] – of mono-2-ethyl-5-carboxypentyl phthalate 1.147 [1.041;1.264], mono-(2-ethyl-5-hydroxyhexyl) phthalate 1.175 [1.073;1.288], and mono-(2-ethyl-5-oxohexyl) phthalate 1.140 [1.040;1.250] with IR, and of mono-isobutyl phthalate with prediabetes 1.216 [1.064;1.390] (all FDR-adjusted P < 0.05). WQS analyses indicated significantly mixed effects of phthalate metabolites on the elevated risks of IR 1.166 [1.034;1.315], prediabetes 1.194 [1.006;1.416], and diabetes 1.214 [1.026;1.437]. Biological age (BA) and phenotypic age (PA) were positively associated with IR, prediabetes, and diabetes and further significantly interacted with phthalates on the outcomes; typically, compared to participants with low levels of phthalates mixture and PA, those with high levels of phthalates mixture and PA had the highest risks of IR 2.468 [1.474;4.133] (Pinteraction = 0.031), prediabetes 1.975 [1.189;3.278] (Pinteraction = 0.009), and diabetes 6.065 [3.210;11.460] (Pinteraction = 0.013).
Conclusion
Phthalates exposure of MASLD adults was related to increased risks of IR, prediabetes, and diabetes, which were interactively aggravated by biological aging. Controlling phthalates exposure and biological aging probably hold significant relevance for the prevention of diabetes in the MASLD population.
{"title":"Phthalates exposure, biological aging, and increased risks of insulin resistance, prediabetes, and diabetes in adults with metabolic dysfunction-associated steatotic liver disease","authors":"Yueru Yang , Shuhui Wan , Linling Yu , Wei Liu , Jiahao Song , Da Shi , Yongfang Zhang , Weihong Chen , Weihong Qiu , Bin Wang","doi":"10.1016/j.diabet.2024.101602","DOIUrl":"10.1016/j.diabet.2024.101602","url":null,"abstract":"<div><h3>Aim</h3><div>To estimate the individual and combined influences of phthalates and biological aging on insulin resistance (IR), prediabetes, and diabetes in population with metabolic dysfunction-associated steatotic liver disease (MASLD).</div></div><div><h3>Methods</h3><div>Data on 3,045 US adults with MASLD were collected to outline the individual and mixed effects of urinary phthalate metabolites on prevalent IR, prediabetes, and diabetes by survey-weighted logistic regression and weighted quantile sum (WQS) regression, as well as the interaction effects between phthalates and biological aging.</div></div><div><h3>Results</h3><div>We discovered positive relationships – odds ratio (OR) and 95 % confidence interval [CI] – of mono-2-ethyl-5-carboxypentyl phthalate 1.147 [1.041;1.264], mono-(2-ethyl-5-hydroxyhexyl) phthalate 1.175 [1.073;1.288], and mono-(2-ethyl-5-oxohexyl) phthalate 1.140 [1.040;1.250] with IR, and of mono-isobutyl phthalate with prediabetes 1.216 [1.064;1.390] (all FDR-adjusted <em>P</em> < 0.05). WQS analyses indicated significantly mixed effects of phthalate metabolites on the elevated risks of IR 1.166 [1.034;1.315], prediabetes 1.194 [1.006;1.416], and diabetes 1.214 [1.026;1.437]. Biological age (BA) and phenotypic age (PA) were positively associated with IR, prediabetes, and diabetes and further significantly interacted with phthalates on the outcomes; typically, compared to participants with low levels of phthalates mixture and PA, those with high levels of phthalates mixture and PA had the highest risks of IR 2.468 [1.474;4.133] (<em>P</em><sub>interaction</sub> = 0.031), prediabetes 1.975 [1.189;3.278] (<em>P</em><sub>interaction</sub> = 0.009), and diabetes 6.065 [3.210;11.460] (<em>P</em><sub>interaction</sub> = 0.013).</div></div><div><h3>Conclusion</h3><div>Phthalates exposure of MASLD adults was related to increased risks of IR, prediabetes, and diabetes, which were interactively aggravated by biological aging. Controlling phthalates exposure and biological aging probably hold significant relevance for the prevention of diabetes in the MASLD population.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 1","pages":"Article 101602"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.diabet.2024.101601
Yann Brousse , Patrick Gérardin , Dina Filali , Victorine Lenclume , Hind Aissaoui , Marie-Christine Jaffar Bandjee , Estelle Nobecourt , Léa Bruneau
Aim
2019-Coronavirus reached the French island of Reunion, which is marked by a very high prevalence of metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM), in March 2020. The objective was to determine the metabolic factors associated with the severity of SARS-CoV-2 infection in Reunion Island.
Methods
This retrospective observational cohort study enrolled patients who were hospitalized on the island from March 11th, 2020 to August 4th, 2021. Severe Covid-19 was defined according to the WHO's definition, including deaths. A multilevel logistic model with the circulation period of the variants as a random effect was performed.
Results
The median age of the 681 patients enrolled was 56 years [42–68] and 54% were men. Obese patients and patients who were both diabetic and obese had an increased risk of developing severe Covid-19: 2.64 [1.46;4.78] and 2.96 [1.47;5.93], aOR [CI95%] respectively. Diabetic inpatients did not when adjusting for individual characteristics and accounting the period of circulation of variants: 1.24 [0.68;2.24] (P = 0.471).
Conclusion
This study reveals an unexpected prominence of obesity on T2DM (without precision) in the development of severe Covid-19. Despite a high prevalence of T2DM, this finding may partially explain why Covid-19 did not have an even greater impact on the island. Further studies should also consider the treatment of diabetes, diabetic complications, glycemic imbalance or stratify by the novel subgroups of T2DM to better understand the link between T2DM and severe Covid-19 in the Reunionese population.
{"title":"Obesity rather than diabetes impacted severe Covid-19 on reunion island: A retrospective cohort study from a frontline hospital, 2020–2021","authors":"Yann Brousse , Patrick Gérardin , Dina Filali , Victorine Lenclume , Hind Aissaoui , Marie-Christine Jaffar Bandjee , Estelle Nobecourt , Léa Bruneau","doi":"10.1016/j.diabet.2024.101601","DOIUrl":"10.1016/j.diabet.2024.101601","url":null,"abstract":"<div><h3>Aim</h3><div>2019-Coronavirus reached the French island of Reunion, which is marked by a very high prevalence of metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM), in March 2020. The objective was to determine the metabolic factors associated with the severity of SARS-CoV-2 infection in Reunion Island.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study enrolled patients who were hospitalized on the island from March 11th, 2020 to August 4th, 2021. Severe Covid-19 was defined according to the WHO's definition, including deaths. A multilevel logistic model with the circulation period of the variants as a random effect was performed.</div></div><div><h3>Results</h3><div>The median age of the 681 patients enrolled was 56 years [42–68] and 54% were men. Obese patients and patients who were both diabetic and obese had an increased risk of developing severe Covid-19: 2.64 [1.46;4.78] and 2.96 [1.47;5.93], aOR [CI95%] respectively. Diabetic inpatients did not when adjusting for individual characteristics and accounting the period of circulation of variants: 1.24 [0.68;2.24] (<em>P</em> = 0.471).</div></div><div><h3>Conclusion</h3><div>This study reveals an unexpected prominence of obesity on T2DM (without precision) in the development of severe Covid-19. Despite a high prevalence of T2DM, this finding may partially explain why Covid-19 did not have an even greater impact on the island. Further studies should also consider the treatment of diabetes, diabetic complications, glycemic imbalance or stratify by the novel subgroups of T2DM to better understand the link between T2DM and severe Covid-19 in the Reunionese population.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"51 1","pages":"Article 101601"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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