Diabetes epidemiology and management最新文献

Type 2 diabetes is associated with a higher risk of cardiac arrhythmias, especially in presence of cardiovascular disease and/or heart failure. Ventricular arrhythmias (VA: tachycardia/fibrillation) may lead to sudden cardiac arrest/death (SCA/SCD). Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) exert a remarkable protection against cardiovascular disease, especially hospitalisation for heart failure, yet their effects on malignant cardiac arrhythmias are poorly known. Nevertheless, findings derived from experimental animal and clinical studies suggested that SGLT2is could reduce the risk of not only supraventricular but also ventricular cardiac arrhythmias. A trend for less VA and SCA/SCD events was reported in post hoc analyses of randomised controlled trials/cardiovascular outcome trials versus placebo, yet statistical significance was not reached presumably because of too few events in both treatment groups. Retrospective observational cohort studies that reported malignant cardiac arrhythmias in patients treated with SGLT2is versus other glucose-lowering agents are scare, compared to the numerous ones that focused on atrial fibrillation/flutter. Further studies specifically devoted to the effects of SGLT2is on malignant cardiac arrhythmias are needed to confirm positive effects in patients with diabetes and/or heart failure and if possible to carefully dissect the underlying anti-arrhythmic protective mechanisms.

Background

Previous literature suggests a lower prevalence of diabetes mellitus (DM) in patients with systemic lupus erythematosus (SLE).

Study question

We aimed to investigate the impact of hydroxychloroquine (HCQ) on the risk of DM in patients with SLE.

Study design

We queried The TriNetX database for all patients aged >18 years diagnosed with SLE from January 1, 2000, until January 1, 2021. We identified patients with SLE using disease–specific International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code (M32). At the time of enrollment, we excluded all patients who were diagnosed with diabetes mellitus (ICD-10 code: E08-E13) either prior to or at the initial visit.

Measures and outcomes

Patients were classified into two groups according to treatment with HCQ. The primary objective was to compare the impact of HCQ over a consecutive 10-year period on the risk of DM in an SLE population.

Results

Following propensity matching an equal cohort, 19025 SLE patients on HCQ and 19025 SLE controls, were included with a mean period of follow-up of 10 years. Patients who were adherent to HCQ had lower rates of DM (event rate: 13.3% vs 18.5%) with relative risk (RR) 72.0% (68.7% to 75.4%). In Kaplan-Meier survival analysis the cumulative probability of survival was significantly higher in the HCQ subjects compared to control (78.1% vs 68.3%; log-rank, p<0.001).

Conclusion

We provide further evidence for the antidiabetic effect of hydroxychloroquine in a lupus cohort. We suggest a unifying hypothesis linking the pharmacologic effect of hydroxychloroquine with its favorable effects on glucose metabolism.

Background

: Type 2 diabetes (T2DM) increases the risk for chronic kidney disease (CKD). The objective of this study was to describe the characteristics of patients with T2DM and assess their cardiovascular (CV) and renal outcomes as well as survival in a real-life setting in Finland. The study aimed to map the use of diagnostic and monitoring measures in the management of T2DM patients in clinical practice and to assess the proportion of patients that could benefit from SGLT2 inhibitor treatment.

Methods

: This retrospective registry study included 29,628 adult T2DM patients gathered from national registries in Finland between 2012 and 2018. Patients were included from primary and specialized care. From all patients, all available health care data, including laboratory results, degree of albuminuria, and eGFR data, was gathered. The occurrence of CV events and end-stage kidney disease (ESKD) was assessed using a multivariable Cox proportional hazards model. All-cause and CV deaths were visualized using Kaplan-Meier plots.

Results

: Overall, patients were more frequently male (54%), and their mean age was 66 (SD = ±12.4) years. eGFR status was available for 21,889 patients, and among these patients CKD stage 3–5 was observed in 3,945 (13.3%) patients. Data on albuminuria was available in less than half (45.5%) of the cohort. In patients with available urinary albumin measurement, increased albumin excretion was present in 12% of patients with CKD class 1–2, of whom 1.6% had severe albuminuria. Of all comorbidities, atrial fibrillation was independently associated with the risk of CV events and ESKD.

Conclusions

: This large real-world study confirms that CV morbidity and mortality are substantial within T2DM patients, and that age, prior kidney function, albuminuria and prior diagnosis of AF were associated with the risk of CV events, including death, and progression to ESKD. Despite guideline recommendations, monitoring and treatment of T2DM was suboptimal leaving patients at risk of inadequate treatment.

Aims

The objective of this study is to determine the risks of macrosomia, LGA, and Caesarean section associated with a diagnosis of pre-gestational diabetes or gestational weight gain.

Methods

This is a retrospective cohort study utilizing data from the Perinatal Surveillance Database of Newfoundland & Labrador from 2001 – 2020. Multivariate logistic regression analyses were used to determine odds ratios (OR) associated with GWG and pre-gestational diabetes for the outcomes macrosomia, LGA, and CS, while controlling for other known risk factors.

Results

There were 234 pregnancies complicated by pre-gestational diabetes and 22,048 without diabetes included. There was no significant difference in absolute GWG between groups (15.2 kg vs. 15.5 kg, p = 0.12), however more women with pre-gestational diabetes had excessive GWG (85.1% vs. 78.5%, p = 0.04). Pre-gestational diabetes was a significant predictor of LGA (OR 5.21, 95% CI 3.96 – 6.87), macrosomia (OR 2.63 95% CI 1.98 – 3.48), and Caesarean section (OR 3.44, 95% CI 2.60 – 4.56). The OR associated with excessive GWG were lower for these same outcomes (LGA OR 2.73, 95% CI 2.40 – 3.11; macrosomia 2.38, 95% CI 2.12 – 2.69; Caesarean section OR 1.29, 95% CI 1.19 – 1.39).

Conclusions

We have identified that pre-gestational diabetes is the most significant risk factor for poor outcomes such as LGA, macrosomia, and Caesarean section, although excessive GWG also plays a role.

Aim

The aim of the present study was to build a classification of diabetes according to the time-sequence of treatment. A second aim was to describe the diversity of drugs prescribed for diabetes and associated conditions in a nation-wide cohort of patients with diabetes.

Patients and method

LRx is an outpatient care nation-wide medication dispense database. It consists of a panel of 10,000 retail pharmacies in France. We developed an algorithm to find out the number of patients treated for diabetes from July 2018 to June 2019 and to classify diabetes types and the sequence of drugs dispense over the years, including treatments for the control of diabetes itself and drugs for associated conditions.

Results

A raw number of 2.3 million patients was studied, corresponding to an extrapolated 3.9 million patients in mainland France. Seven percent were classified as having Type 1 Diabetes, 86% Type 2 Diabetes (T2D), 0.5% insulin-treated gestational diabetes, and 6% remained unclassified. In subjects with T2D, metformin was the most frequently prescribed glucose lowering drug, followed by DPP4 inhibitors and sulfonylureas. Main coprescribed medication classes were lipid-modifying agents and antihypertensive agents. Of note, about a third of the patients received neuropsychiatric drugs and 40% a proton-pump inhibitor. We also had an unbiased view of compliance to treatment, that was below 50%.

Conclusion

The algorithm we built could be used to monitor changes of strategies to control blood glucose and comorbidities. Our findings highlight the burden of polypharmacy in patients with diabetes.

The benefits of a hybrid closed loop insulin pump system are generally compared to non-automated insulin pump treatment of type 1 diabetics whose glycemic control was often unsatisfactory. Here we report the results of a monocentric cohort of type 1 diabetics with a good glycemic control before the switch to the hybrid system. 83 adult patients were followed up for 12 months after the implementation and training of the hybrid system. We observed a significant improvement in the glycemic mean index at 3 and 6 months but not at 12 months, accompanied by a 10% increase in insulin requirements over the first few months. Surprisingly, the time spent in hypoglycemia did not decrease. An analysis shared with patients leads us to propose several measures to consider before switching to a hybrid closed loop system.

Type 2 diabetes mellitus (T2DM) effect quality of life very much and causes various complications. Diabetic autonomic neuropathy (DAN) is one of the common complications in diabetes. The taste threshold affected by various factors such as age, ethnic backgrounds, drugs, local and systemic diseases, consumption of alcohol, smoking, and tobacco chewing. The present study is undertaken with the objectives to compare the alteration in taste threshold for four primary sensations in Type 2 DM with autonomic neuropathy. 60 patients of T2DM with autonomic neuropathy and 60 healthy controls were taken for the study. Autonomic neuropathy was assessed clinically. Chemical taste test using four solutions of basic tastes (sweet, sour, salty, bitter) were done. Taste dysfunction for sweet was significant in T2DM with uncontrolled hyperglycemia. The taste dysfunction in T2DM patients was not related to gender, disease duration, and type of treatment taken. The study found a significant correlation between taste dysfunction, HbA1C level and blood sugar fasting level in T2DM patients. The taste dysfunction was mainly for sweet. Sour and bitter did not show any difference in case groups compared to controls.

Introduction

Impaired adiposity function, Insulin resistance (IR), and β-cell dysfunction predispose to type 2 diabetes (T2D). Some indices, such as the Visceral Adiposity Index (VAI), Dysfunctional Adiposity Index (DAI), and Atherogenic Index of Plasma (AIP), have been developed as surrogates of dysfunctional adiposity. However, the association of these indices with IR and β-cell dysfunction in primary prevention for T2D has not been fully studied.

Materials and Methods

This was a cross-sectional study that included 401 asymptomatic subjects with at least two risk factors for T2D that underwent an oral glucose tolerance test. A HOMA-IR ≥2.5 and a Disposition Index ≤1.24 were used to define IR and β-cell dysfunction, respectively.

Results

Mean age of the subjects was 50.4 ± 9.6 years, 71.6% were women, had a mean BMI of 30.3 ± 6.4 kg/m² 27.6% and 11.6% had newly diagnosed T2D. After multiple regression analysis the VAI, DAI, and AIP were associated with IR (1.218 [1.103–1.345], 1.355 [1.150–1.597], and 2.533 [1.733–3.703], respectively), and β-cell dysfunction (1.119 [1.029–1.217], 1.193 [1.034–1.376], and 1.960 [1.357–2.830], respectively). Likewise, the AIP was the only index associated for newly T2D diagnosis (1.974 [1.224–3.184]).

Conclusions

The VAI, DAI and AIP were independently associated with IR and β-cell dysfunction in patients at high risk for T2D.

Aims

Assess the incidence and prevalence of diabetic retinopathy (DR) among all persons registered with diabetes in the electronic medical records (EMR) from 2016 to 2020 and investigate factors associated with both incident and prevalent DR.

Methods

We calculated the five-year incidence rate of DR per 1000 person years, and calculated the prevalence of DR, using Poisson regression analysis. We calculated the incidence rate ratios (IRR) in univariate and multivariate Poisson regression analysis, to assess risk factors associated with incident DR. We calculated the Odds ratios (OR) to assess risk factors of prevalent DR in univariate and multivariate Logistic regression analyses.

Results

We found 10.4% persons developed incident DR during follow-up, equivalent to an incidence rate of DR of 29.2 pr. 1000 (95%CI: 22.9–37.3) person years. The total prevalence of DR was 13.6%. Higher HbA₁c levels and longer diabetes duration were significantly associated with incident and prevalent DR. Higher levels of LDL cholesterol were significantly associated with a lower risk of incident DR.

Conclusion

The incidence and prevalence of DR in Greenland is lower than in most other parts of the world. In agreement with previous studies on risk factors for DR, HbA₁c levels and diabetes duration were associated with incident/prevalent DR.