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1.
Laura E. Britton Diane C. Berry Jon M. Hussey 《Journal of diabetes and its complications》2018,32(12):1148-1152
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. 相似文献2.
Ivana Dedinská Nadežda Mäčková Daniela Kantárová Lea Kováčiková Karol Graňák Ľudovít Laca Juraj Miklušica Petra Skálová Peter Galajda Marián Mokáň 《Journal of diabetes and its complications》2018,32(9):863-869
Introduction
Obese patients have increased leptin production and selective resistance to its central anti-adipogenic effects, yet its pro-inflammatory immunostimulating effects persist.Material and methods
In a group of 70 patients who underwent primary kidney transplantation (KT) we examined adiponectin and leptin levels at the time of KT and 6?months post-transplantation. Patients with diabetes mellitus type 1 or type 2 at the time of KT were excluded from the study.Results
We found that leptin levels significantly increased during the post-transplant period (P?=?0.0065). Overall, leptin levels were positively correlated with the level of triacylglycerols, post-transplant diabetes mellitus (PTDM) development and acute rejection (AR). We discovered that, in particular, high leptin levels were associated with AR [OR 2.1273; 95% CI 1.0130–4.4671 (P?=?0.0461)] and PTDM development [OR 7.200; 95% CI 1.0310–50.2836 (P?=?0.0465)], whereas, low adiponectin levels represent a risk factor for the development of insulin resistance [HR 38.6135; 95% CI 13.3844–67.7699 (P?<?0.0001)] and obesity [HR 3.0821; 95% CI 0.8700–10.9192 (P?=?0.0053)].Conclusion
We found that a high serum concentration of leptin before KT is associated with both PTDM development and AR and merits further investigation in relation to KT. 相似文献3.
Henrik Ø. Hjortkjær Tonny Jensen Jannik Hilsted Ulrik M. Mogensen Helle Corinth Peter Rossing Lars Køber Klaus F. Kofoed 《Journal of diabetes and its complications》2019,33(2):171-177
Aims
Type 1 diabetes is associated with increased cardiovascular (CV) morbidity and mortality, and cardiovascular autonomic neuropathy (CAN) is an important CV risk factor. The study aimed to explore associations between CAN and altered cardiac chamber sizes in persons with type 1 diabetes.Methods
This was a cross-sectional study of 71 asymptomatic, normoalbuminuric participants with long-term type 1 diabetes (39 with CAN, determined by >1 abnormal autonomic function test) examined with cardiac multi detector computed tomography scans, which allowed measurements of left ventricular mass and all four cardiac chamber volumes. Cardiac chambers were indexed according to body surface area (ml/m2 or g/m2).Results
Persons with and without CAN had mean?±?SD age of 57?±?7 and 50?±?8?years (p?<?0.001) and diabetes duration of 36?±?11 and 32?±?9?years (p?<?0.05), respectively. Increasing autonomic dysfunction, evaluated by decrease in heart rate variability during deep breathing (in beats per minute), was associated with larger right (?0.5, 95% CI ?1.0 to ?0.0, p?<?0.05) and trend towards larger left (?0.4, 95% CI ?0.8–0.0, p?<?0.1) ventricular volumes in multivariable linear regression.Conclusions
Our results suggest that impaired autonomic function may be associated with modest enlargement of ventricular volumes; this might be an early sign of progression towards heart failure. 相似文献4.
Suzanne V. Arnold Darren K. McGuire Silvio E. Inzucchi Fengming Tang Sanjeev N. Mehta Carolyn S.P. Lam Abhinav Goyal Laurence S. Sperling Nathan D. Wong Niklas Hammar Peter Fenici Mikhail Kosiborod 《Journal of diabetes and its complications》2018,32(11):1035-1039
Background
Although practice guidelines stress individualization of glucose management in patients with type 2 diabetes (T2D), the extent to which providers take patient factors into account when selecting medications is not well known.Methods
Diabetes Collaborative Registry (DCR) is an outpatient diabetes registry including primary care, cardiology, and endocrinology practices. T2D medications were grouped as those which may be suboptimal for key patient subgroups, and we examined patient factors associated with use of these agents using hierarchical, multivariable Poisson models.Results
In DCR, 157,551 patients from 374 US practices were prescribed a glucose-lowering medication. Patients with morbid obesity were more likely treated with medications prone to cause weight gain (relative rate [RR] 1.09, 95% CI 1.07–1.11). Older patients were more likely to be treated with medications with increased risk of hypoglycemia (RR 1.04 per 5 years, 95% CI 1.04–1.05). Patients with CKD 4/5 were less likely to be treated with agents with known risk in patients with advanced CKD (RR 0.74, 95% CI 0.71–0.77). Patients with coronary artery disease were no more or less likely to be treated with medications with potential cardiovascular safety issues (RR 0.99, 95% CI 0.96–1.01).Conclusions
We observed some targeted use of glucose-lowering therapies in certain subgroups but also identified potential opportunities for better personalization of treatment. Data sources such as the DCR can highlight potential areas for improving targeted approaches to pharmacologic therapy in order to optimize selection of patients most likely to benefit (and least likely to be harmed) from treatments. 相似文献5.
Jingchuan Guo Rachel G. Miller Tina Costacou William P. Follansbee Trevor J. Orchard 《Journal of diabetes and its complications》2018,32(3):298-304
Objectives
We aimed to assess association between abnormal LVEF, in the absence of coronary artery disease (CAD), and 25-year incidence of major outcomes of diabetes (MOD) in a cardiology substudy of the Pittsburgh Epidemiology of Diabetes Complications cohort of childhood-onset type 1 diabetes.Methods
115 normotensive type 1 diabetes individuals without known CAD, underwent a baseline exercise radionuclide ventriculography. Abnormal LVEF was defined as a resting ejection fraction <50% or a failure to increase ejection fraction with exercise by >5% (men) or a fall in ejection fraction with exercise (women). Cox proportional hazards models were used to predict the composite endpoint of MOD (first instance of major CAD, stroke, end-stage renal disease, blindness, amputation or diabetes-related death).Results
Mean baseline age was 28 and diabetes duration 19?years. In a mean follow-up of 19?years, 50 MOD events were identified. Allowing for established risk factors at baseline, abnormal LVEF (n?=?22) independently predicted MOD incidence (HR?=?2.12, 95% CI: 1.12–4.00, p?=?0.022) but not major CAD (HR?=?1.33, 95% CI: 0.53–3.33, p?=?0.539).Conclusions
An abnormal LVEF may identify diabetic cardiomyopathy and predict long term risk of MOD (but not CAD alone) in type 1 diabetes individuals, consistent with it reflecting microvascular disease. 相似文献6.
Jhen-Hao Jhan Hsin-Chih Yeh Yu-Han Chang Shiao-Jin Guu Wen-Jeng Wu Yii-Her Chou Ching-Chia Li 《Journal of diabetes and its complications》2018,32(7):688-692
Introduction
Androgen-deprivation therapy (ADT) is important in the treatment of prostate cancer. However, the relationship between ADT and the risk of diabetes remains unclear, and the association between duration and types of ADT has not been fully investigated.Aim
To examine the risk of developing type 2 diabetes mellitus (T2DM) in men who underwent ADT for prostate cancer.Methods
Data were collected retrospectively from the Longitudinal Health Insurance Database of Taiwan. In total, 4604 prostate cancer patients ≥40?years old who underwent ADT were included in the study cohort, and 4604 prostate cancer patients without ADT were included as controls, after adjusting for age and other comorbidities.Results
During the four-year follow-up period, the incidence of new-onset T2DM was 27.49 and 11.13 per 1000 person-years in the ADT and ADT-never cohorts, respectively. The ADT cohort was 2.19 times more likely to develop T2DM than the control group (95% CI 1.90–2.53, P?<?0.001). Furthermore, the association was particularly striking in the subgroup of patients receiving complete androgen blockade (adjusted HR 2.33, 95% CI 1.96–2.78, P?<?0.001).Conclusions
Men with prostate cancer who received ADT are at risk for developing diabetes. 相似文献7.
Aims
To identify the prevalence and mortality of type 2 diabetes in Asian Americans (Asians) vs. non-Hispanic whites (Whites).Methods
We analyzed a nationally representative sample of 237,354?U.S. adults aged ≥30?years using National Health Interview Survey data from 2000 to 2014 to estimate the prevalence and trends of type 2 diabetes. Additionally, 144,638 Asians and Whites represented in surveys from 2000 to 2009 were included in the mortality analysis with follow-up to 2011.Results
Type 2 diabetes was higher in Asians than Whites (7.0–11.2 vs. 5.6–8.3%) and increased over time. Prevalence rates increased from 8.1 (2000?2002) to 9.6% (2012–2014) in Asians and from 6.0 (2000–2002) to 7.9% (2012–2014) in Whites (both P?<?0.05). The age-standardized mortality rates were 72.7 and 138.8 per 1000?person-years in Asians and Whites with diabetes, respectively, and 58.1 and 77.8 per 1000?person-years, respectively, in those without diabetes. Among Asians and Whites with diabetes, hazard ratios for total and CVD mortality were 0.7 (95% CI: 0.5–0.9) and 0.3 (95% CI: 0.1–0.6), respectively, with no difference in cancer mortality. Asians and Whites without diabetes exhibited no differences in total or cause-specific mortality.Conclusions
Type 2 diabetes was more prevalent in Asians, with a significant upward trend since 2000, but overall mortality was lower in Asians than Whites with diabetes. Asians are susceptible to type 2 diabetes; thus, prevention programs are still needed. 相似文献8.
The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes
Anna R. Kahkoska Scott Isom Jasmin Divers Elizabeth J. Mayer-Davis Lawrence Dolan Amy S. Shah Maryam Afkarian David J. Pettitt Jean M. Lawrence Santica Marcovina Sharon H. Saydah Dana Dabelea David M. Maahs Amy K. Mottl 《Journal of diabetes and its complications》2018,32(12):1160-1168
Aims
To determine among adolescents and young adults with youth-onset type 1 diabetes and type 2 diabetes the rates and risk factors for albuminuria regression and progression.Methods
Data from SEARCH, a longitudinal observational study of youth-onset type 1 diabetes (N?=?1316) and type 2 diabetes (N?=?143) were analyzed. Urine albumin:creatinine ratio (UACR) was measured from random urine specimens at baseline and follow-up visits (mean 7?years later). Albuminuria regression was defined as halving of baseline UACR when baseline UACR was ≥30?μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30?μg/mg, respectively. Multivariable regression assessed risk factors associated with low-risk albuminuria category (combined persistently-low albuminuria and regression) versus moderate-risk albuminuria category (combined persistently-high albuminuria and progression).Results
Albuminuria progression was more common in type 2 diabetes versus type 1 diabetes (15.4% versus 6.0%, p<0.001). Moderate-risk albuminuria was associated with increasing HbA1c (adjusted OR (aOR)?=?1.3, 95% CI 1.1–1.6) and lack of private health insurance (aOR?=?2.7, 95%CI 1.1–6.5) in type 1 diabetes; and African American race (OR?=?4.6, 95% CI 1.2–14.2), lower estimated insulin sensitivity score (aOR?=?2.1, 95% CI 1.4–3.3), baseline UACR (aOR?=?3.2, 95% CI 1.7–5.8), and follow-up estimated glomerular filtration rate (eGFR) (10-unit increase aOR?=?1.3, 95% CI 1.0, 1.5) in type 2 diabetes.Conclusions
In the first decade of diabetes duration, kidney complications in type 2 diabetes are significantly more aggressive than in type 1 diabetes and may be associated with less modifiable risk factors including race, insulin sensitivity, and eGFR. Early interventions may help reduce long-term kidney complications. 相似文献9.
Ahmed Abuzaid Carly Fabrizio Kevin Felpel Haitham S. Al Ashry Pragya Ranjan Ayman Elbadawi Ahmed H. Mohamed Kirolos Barssoum Islam Y. Elgendy 《The American journal of medicine》2018,131(6):693-701
Objective
Oxygen therapy is frequently used for patients with acute myocardial infarction. The aim of this study is to perform a systematic review and meta-analysis to compare the outcomes of oxygen therapy versus no oxygen therapy in post–acute myocardial infarction settings.Methods
A systematic search of electronic databases was conducted for randomized studies, which reported cardiovascular events in oxygen versus no oxygen therapy. The evaluated outcomes were all-cause mortality, recurrent coronary events (ischemia or myocardial infarction), heart failure, and arrhythmias. Summary-adjusted risk ratios (RRs) were calculated by the random effects DerSimonian and Laird model. The risk of bias of the included studies was assessed by Cochrane scale.Results
Our meta-analysis included a total of 7 studies with 3842 patients who received oxygen therapy and 3860 patients without oxygen therapy. Oxygen therapy did not decrease the risk of all-cause mortality (pooled RR, 0.99; 95% confidence interval [CI], 0.81-1.21; P = .43), recurrent ischemia or myocardial infarction (pooled RR, 1.19; 95% CI, 0.95-1.48; P = .75), heart failure (pooled RR, 0.94; 95% CI, 0.61-1.45; P = .348), and occurrence of arrhythmia events (pooled RR, 1.01; 95% CI, 0.85-1.2; P = .233) compared with the no oxygen arm.Conclusions
This meta-analysis confirms the lack of benefit of routine oxygen therapy in patients with acute myocardial infarction with normal oxygen saturation levels. 相似文献10.
Vasilios Papademetriou Eric S. Nylen Michael Doumas Jeff Probstfield Johannes F.E. Mann Richard E. Gilbert Hertzel C. Gerstein 《The American journal of medicine》2017,130(12):1465.e27-1465.e39
Background
Early stages of chronic kidney disease are associated with an increased cardiovascular risk in patients with established type 2 diabetes and macrovascular disease. The role of early stages of chronic kidney disease on macrovascular outcomes in prediabetes and early type 2 diabetes mellitus is not known. In the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial, the introduction of insulin had no effect on cardiovascular outcomes compared with standard therapy. In this post hoc analysis of ORIGIN, we compared cardiovascular outcomes in subjects without to those with mild (Stages 1-2) or moderate chronic kidney disease (Stage 3).Methods
Τwo co-primary composite cardiovascular outcomes were assessed. The first was the composite end point of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes; and the second was a composite of any of these events plus a revascularization procedure, or hospitalization for heart failure. Several secondary outcomes were prespecified, including microvascular outcomes, incident diabetes, hypoglycemia, weight, and cancers.Results
Complete renal function data were available in 12,174 of 12,537 ORIGIN participants. A total of 8114 (67%) had no chronic kidney disease, while 4060 (33%) had chronic kidney disease stage 1-3. When compared with nonchronic kidney disease participants, the risk of developing the composite primary outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) in those with mild to moderate chronic kidney disease was 87% higher; hazard ratio (HR) 1.87; 95% confidence interval (CI), 1.71-2.04 (P < .0001). The presence of chronic kidney disease 1-3 was also associated with a greater than twofold higher risk for both all-cause mortality (HR 2.17; 95% CI, 1.98-2.38; P < .0001) and cardiovascular mortality (HR 2.39; 95% CI, 2.13-2.69; P < .0001). Moreover, patients with mild to moderate chronic kidney disease had significantly higher risk for nonfatal myocardial infarction (50%), nonfatal stroke (68%), any stroke (84%), the above composite primary end point plus revascularization or heart failure requiring hospitalization (59%), or a major coronary artery disease event (56%). Furthermore, in patients with chronic kidney disease and early diabetes mellitus type 2, the primary end point occurred 83% more frequently as compared with nonchronic kidney disease participants (HR 1.83; 95% CI, 1.67-2.01; P < .001) and in patients with prediabetes and chronic kidney disease 67% more frequently (HR 1.67; 95% CI,1.25-2.24; P < .001).Conclusions
In high-risk patients with dysglycemia (prediabetes and early diabetes), mild and moderate chronic kidney disease significantly increased cardiovascular events. 相似文献11.
Simone P. Rauh Femke Rutters Amber A. W. A. van der Heijden Thomas Luimes Marjan Alssema Martijn W. Heymans Dianna J. Magliano Jonathan E. Shaw Joline W. Beulens Jacqueline M. Dekker 《Journal of general internal medicine》2018,33(2):182-188
Background
Chronic cardiometabolic diseases, including cardiovascular disease (CVD), type 2 diabetes (T2D) and chronic kidney disease (CKD), share many modifiable risk factors and can be prevented using combined prevention programs. Valid risk prediction tools are needed to accurately identify individuals at risk.Objective
We aimed to validate a previously developed non-invasive risk prediction tool for predicting the combined 7-year-risk for chronic cardiometabolic diseases.Design
The previously developed tool is stratified for sex and contains the predictors age, BMI, waist circumference, use of antihypertensives, smoking, family history of myocardial infarction/stroke, and family history of diabetes. This tool was externally validated, evaluating model performance using area under the receiver operating characteristic curve (AUC)—assessing discrimination—and Hosmer–Lemeshow goodness-of-fit (HL) statistics—assessing calibration. The intercept was recalibrated to improve calibration performance.Participants
The risk prediction tool was validated in 3544 participants from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab).Key Results
Discrimination was acceptable, with an AUC of 0.78 (95% CI 0.75–0.81) in men and 0.78 (95% CI 0.74–0.81) in women. Calibration was poor (HL statistic: p?<?0.001), but improved considerably after intercept recalibration. Examination of individual outcomes showed that in men, AUC was highest for CKD (0.85 [95% CI 0.78–0.91]) and lowest for T2D (0.69 [95% CI 0.65–0.74]). In women, AUC was highest for CVD (0.88 [95% CI 0.83–0.94)]) and lowest for T2D (0.71 [95% CI 0.66–0.75]).Conclusions
Validation of our previously developed tool showed robust discriminative performance across populations. Model recalibration is recommended to account for different disease rates. Our risk prediction tool can be useful in large-scale prevention programs for identifying those in need of further risk profiling because of their increased risk for chronic cardiometabolic diseases.12.
Recurrent hospitalizations for severe hypoglycemia and hyperglycemia among U.S. adults with diabetes
Rozalina G. McCoy Jeph Herrin Kasia J. Lipska Nilay D. Shah 《Journal of diabetes and its complications》2018,32(7):693-701
Aims
Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes.Methods
Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia.Results
After 6419 index hypoglycemia hospitalizations, 1.2% were readmitted for recurrent hypoglycemia, 0.2% for hyperglycemia, and 8.6% for other causes. Multimorbidity was the strongest predictor of recurrent hypoglycemia. After 6872 index hyperglycemia hospitalizations, 4.0% were readmitted for recurrent hyperglycemia, 0.4% for hypoglycemia, and 5.4% for other causes. Recurrent hyperglycemia was less likely in older patients (OR 0.6, 95% CI 0.5–0.9 for 45–64 vs. <45?years) and with the addition of a new glucose-lowering medication at index discharge (OR 0.40; 95% CI 0.2–0.7). New hypoglycemia readmissions were most likely among patients ≥75?years (OR 13.3, 95% CI 2.4–73.4, vs. <45?years).Conclusions
Patients hospitalized for hyperglycemia are often readmitted for recurrent hyperglycemia, while patients hospitalized for hypoglycemia are generally readmitted for unrelated causes. Early recognition of high risk patients may identify opportunities to improve post-discharge management and reduce these events. 相似文献13.
Masaya Koshizaka Renato D. Lopes L. Kristin Newby Robert M. Clare Phillip J. Schulte Pierluigi Tricoci Kenneth W. Mahaffey Hisao Ogawa David J. Moliterno Robert P. Giugliano Kurt Huber Stefan James Robert A. Harrington John H. Alexander 《The American journal of medicine》2017,130(10):1170-1176
Background
Most diabetes and cardiovascular studies have been conducted in white patients, with data being extrapolated to other population groups.Methods
For this analysis, patient-level data were extracted from 5 randomized clinical trials in patients with acute coronary syndrome; we compared obesity levels between Asian and white populations, stratified by diabetes status. By using an adjusted Cox proportional hazards model, hazard ratios (HRs) for cardiovascular outcomes after an acute coronary syndrome were determined.Results
We identified 49,224 patient records from the 5 trials, with 3176 Asians and 46,048 whites. Whites with diabetes had higher body mass index values than those without diabetes (median 29.3 vs 27.2 kg/m2; P < .0001), whereas Asians with diabetes and without diabetes had similar body mass index (24.7 vs 24.2 kg/m2). Asians with diabetes (HR, 1.63; 95% confidence interval [CI], 1.32-2.02), whites with diabetes (HR, 1.15; 95% CI, 1.06-1.25), and Asians without diabetes (HR, 1.36; 95% CI, 1.14-1.64) had higher rates of the composite of death, myocardial infarction, or stroke at 30 days than whites without diabetes. Asians with diabetes (HR, 1.84; 95% CI, 1.47-2.31), whites with diabetes (HR, 1.47; 95% CI, 1.33-1.62), and Asians without diabetes (HR, 1.38; 95% CI, 1.11-1.73) had higher rates of death at 1 year compared with whites without diabetes. There were no significant interactions between race and diabetes for ischemic outcomes.Conclusions
Although Asians with diabetes and acute coronary syndrome are less likely to be obese than their white counterparts, their risk for death or recurrent ischemic events was not lower. 相似文献14.
Aisha James Seth A. Berkowitz Jeffrey M. Ashburner Yuchiao Chang Daniel M. Horn Sandra M. O’Keefe Steven J. Atlas 《Journal of general internal medicine》2018,33(4):463-470
Background
Healthcare systems use population health management programs to improve the quality of cardiovascular disease care. Adding a dedicated population health coordinator (PHC) who identifies and reaches out to patients not meeting cardiovascular care goals to these programs may help reduce disparities in cardiovascular care.Objective
To determine whether a program that used PHCs decreased racial/ethnic disparities in LDL cholesterol and blood pressure (BP) control.Design
Retrospective difference-in-difference analysis.Participants
Twelve thousdand five hundred fifty-five primary care patients with cardiovascular disease (cohort for LDL analysis) and 41,183 with hypertension (cohort for BP analysis).Intervention
From July 1, 2014–December 31, 2014, 18 practices used an information technology (IT) system to identify patients not meeting LDL and BP goals; 8 practices also received a PHC. We examined whether having the PHC plus IT system, compared with having the IT system alone, decreased racial/ethnic disparities, using difference-in-difference analysis of data collected before and after program implementation.Main Measures
Meeting guideline concordant LDL and BP goals.Key Results
At baseline, there were racial/ethnic disparities in meeting LDL (p?=?0.007) and BP (p?=?0.0003) goals. Comparing practices with and without a PHC, and accounting for pre-intervention LDL control, non-Hispanic white patients in PHC practices had improved odds of LDL control (OR 1.20 95% CI 1.09–1.32) compared with those in non-PHC practices. Non-Hispanic black (OR 1.15 95% CI 0.80–1.65) and Hispanic (OR 1.29 95% CI 0.66–2.53) patients saw similar, but non-significant, improvements in LDL control. For BP control, non-Hispanic white patients in PHC practices (versus non-PHC) improved (OR 1.13 95% CI 1.05–1.22). Non-Hispanic black patients (OR 1.17 95% CI 0.94–1.45) saw similar, but non-statistically significant, improvements in BP control, but Hispanic (OR 0.90 95% CI 0.59–1.36) patients did not. Interaction testing confirmed that disparities did not decrease (p?=?0.73 for LDL and p?=?0.69 for BP).Conclusions
The population health management intervention did not decrease disparities. Further efforts should explicitly target improving both healthcare equity and quality.Clinical Trials #: NCT02812303 (ClinicalTrials.gov).15.
Muhammad Imtiaz Ahmad Yabing Li Elsayed Z. Soliman 《Journal of electrocardiology》2018,51(6):1125-1130
Objective
Increasing evidence doubts the benign nature of metabolically healthy obesity (MHO). An investigation of the association of MHO and other obesity phenotypes with electrocardiographic left ventricular hypertrophy (ECG-LVH), a risk factor for cardiovascular disease (CVD), can give insight into the pathophysiological basis for increased risk of CVD linked to these phenotypes.Methods
This analysis included 3997 participants (58.7?±?13.6?years; 51.8% women) without CVD from the NHANES-III. Metabolic syndrome was defined according to the Adult Treatment Panel III. Obesity was defined as body mass index ≥30?kg/m2. Multivariable logistic regression was used to examine the cross-sectional association between 4 obesity phenotypes (metabolically healthy non-obese (MHNO) (reference), metabolically unhealthy non-obese (MUNO), MHO and metabolically unhealthy obese (MUO) with Cornell voltage ECG-LVH.Results
There was an incremental increase in the prevalence of ECG-LVH across obesity phenotypes with the highest prevalence in the MUO followed by MHO, MUNO and then MHNO (ECG-LVH?=?6.45%, 5%, 4.71%, and 1.69%, respectively, trend p-value?<?0.001). Also, there was incremental increase in the strength of associations with ECG-LVH across obesity phenotypes with higher odds of ECG-LVH in the MUO (OR (95% CI): 4.12 (2.30–7.39) followed by MUNO (OR (95% CI): 2.62 (1.45–4.73) then MHO (OR (95% CI): 2.45 (1.11–5.43) compared to MHNO. The MHO association with ECG-LVH was stronger in men than women (OR (95% CI): 5.55 (1.49–20.70) vs. 1.94 (0.71–5.24) respectively; interaction p-value?=?0.04).Conclusions
Obesity phenotypes including MHO are associated with ECG-LVH, thus further questioning the concept of benign obesity. 相似文献16.
Kirsten A. Berk Reyhana Yahya Adrie J. M. Verhoeven Jeanette Touw Frank P. Leijten Elisabeth F. van Rossum Vincent L. Wester Mirjam A. Lips Hanno Pijl Reinier Timman Gertraud Erhart Florian Kronenberg Jeanine E. Roeters van Lennep Eric J. G. Sijbrands Monique T. Mulder 《Diabetologia》2017,60(6):989-997
Aims/hypothesis
Elevated levels of lipoprotein(a) [Lp(a)] are an independent risk factor for cardiovascular disease (CVD), particularly in individuals with type 2 diabetes. Although weight loss improves conventional risk factors for CVD in type 2 diabetes, the effects on Lp(a) are unknown and may influence the long-term outcome of CVD after diet-induced weight loss. The aim of this clinical study was to determine the effect of diet-induced weight loss on Lp(a) levels in obese individuals with type 2 diabetes.Methods
Plasma Lp(a) levels were determined by immunoturbidimetry in plasma obtained before and after 3–4 months of an energy-restricted diet in four independent study cohorts. The primary cohort consisted of 131 predominantly obese patients with type 2 diabetes (cohort 1), all participants of the Prevention Of Weight Regain in diabetes type 2 (POWER) trial. The secondary cohorts consisted of 30 obese patients with type 2 diabetes (cohort 2), 37 obese individuals without type 2 diabetes (cohort 3) and 26 obese individuals without type 2 diabetes who underwent bariatric surgery (cohort 4).Results
In the primary cohort, the energy-restricted diet resulted in a weight loss of 9.9% (95% CI 8.9, 10.8) and improved conventional CVD risk factors such as LDL-cholesterol levels. Lp(a) levels increased by 14.8 nmol/l (95% CI 10.2, 20.6). In univariate analysis, the change in Lp(a) correlated with baseline Lp(a) levels (r = 0.38, p < 0.001) and change in LDL-cholesterol (r = 0.19, p = 0.033). In cohorts 2 and 3, the weight loss of 8.5% (95% CI 6.5, 10.6) and 6.5% (95% CI 5.7, 7.2) was accompanied by a median increase in Lp(a) of 13.5 nmol/l (95% CI 2.3, 30.0) and 11.9 nmol/l (95% CI 5.7, 19.0), respectively (all p < 0.05). When cohorts 1–3 were combined, the diet-induced increase in Lp(a) correlated with weight loss (r = 0.178, p = 0.012). In cohort 4, no significant change in Lp(a) was found (?7.0 nmol/l; 95% CI -18.8, 5.3) despite considerable weight loss (14.0%; 95% CI 12.2, 15.7).Conclusions/interpretation
Diet-induced weight loss was accompanied by an increase in Lp(a) levels in obese individuals with and without type 2 diabetes while conventional CVD risk factors for CVD improved. This increase in Lp(a) levels may potentially antagonise the beneficial cardiometabolic effects of diet-induced weight reduction.17.
Dagfinn Aune Sabrina Schlesinger Teresa Norat Elio Riboli 《Journal of diabetes and its complications》2018,32(12):1169-1174
Background
Diabetes mellitus has been associated with reduced risk of abdominal aortic aneurysm in a number of epidemiological studies, however, until recently little data from prospective studies have been available. We therefore conducted a systematic review and meta-analysis of prospective studies to quantify the association.Material and methods
Two investigators searched the PubMed and Embase databases for studies of diabetes and abdominal aortic aneurysm up to May 8th 2018. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (95% CIs) of abdominal aortic aneurysm associated with a diabetes diagnosis. Summary relative risks were estimated by use of a random effects model.Results
We identified 16 prospective studies with 16,572 cases among 4,563,415 participants that could be included in the meta-analysis. The summary RR for individuals with diabetes compared to individuals without diabetes was 0.58 (95% CI: 0.51–0.66, I2?=?40.4%, pheterogeneity?=?0.06). The results persisted when stratified by sex, duration of follow-up, and in most of the other subgroup analyses. There was no evidence of publication bias with Egger's test, p?=?0.64 or by inspection of the funnel plots.Conclusions
These results suggest that individuals with diabetes mellitus are at a reduced risk of abdominal aortic aneurysm, however, whether pharmacological agents for diabetes mellitus explain this observation needs to be clarified in future studies. 相似文献18.
Rebecka Hjort Emma Ahlqvist Per-Ola Carlsson Valdemar Grill Leif Groop Mats Martinell Bahareh Rasouli Anders Rosengren Tiinamaija Tuomi Bjørn Olav Åsvold Sofia Carlsson 《Diabetologia》2018,61(6):1333-1343
Aims/hypothesis
Excessive weight is a risk factor for type 2 diabetes, but its role in the promotion of autoimmune diabetes is not clear. We investigated the risk of latent autoimmune diabetes in adults (LADA) in relation to overweight/obesity in two large population-based studies.Methods
Analyses were based on incident cases of LADA (n?=?425) and type 2 diabetes (n?=?1420), and 1704 randomly selected control participants from a Swedish case–control study and prospective data from the Norwegian HUNT Study including 147 people with LADA and 1,012,957 person-years of follow-up (1984–2008). We present adjusted ORs and HRs with 95% CI.Results
In the Swedish data, obesity was associated with an increased risk of LADA (OR 2.93, 95% CI 2.17, 3.97), which was even stronger for type 2 diabetes (OR 18.88, 95% CI 14.29, 24.94). The association was stronger in LADA with low GAD antibody (GADA; <median) (OR 4.25; 95% CI 2.76, 6.52) but present also in LADA with high GADA (OR 2.14; 95% CI 1.42, 3.24). In the Swedish data, obese vs normal weight LADA patients had lower GADA levels, better beta cell function, and were more likely to have low-risk HLA-genotypes. The combination of overweight and family history of diabetes (FHD) conferred an OR of 4.57 (95% CI 3.27, 6.39) for LADA and 24.51 (95% CI 17.82, 33.71) for type 2 diabetes. Prospective data from HUNT indicated even stronger associations; HR for LADA was 6.07 (95% CI 3.76, 9.78) for obesity and 7.45 (95% CI 4.02, 13.82) for overweight and FHD.Conclusions/interpretation
Overweight/obesity is associated with increased risk of LADA, particularly when in combination with FHD. These findings support the hypothesis that, even in the presence of autoimmunity, factors linked to insulin resistance, such as excessive weight, could promote onset of diabetes.19.
Rebecca K. Simmons Daniel R. Witte Knut Borch-Johnsen Marit E. Jørgensen Annelli Sandbæk Torsten Lauritzen 《Diabetologia》2017,60(6):1016-1021
Aims/hypothesis
Within a trial of intensive treatment of people with screen-detected diabetes, we aimed to assess a potential spillover effect of the trial intervention on incident cardiovascular disease (CVD) and all-cause mortality among people who screened positive on a diabetes risk questionnaire but who were normoglycaemic.Methods
In the Anglo–Danish–Dutch Study of Intensive Treatment In People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark trial, 175 general practices were cluster-randomised into: (1) screening plus routine care of individuals with screen-detected diabetes (control group); or (2) screening plus training and support in intensive multifactorial treatment of individuals with screen-detected diabetes (intervention group). We identified all individuals who screened positive on a diabetes risk questionnaire in ADDITION-Denmark but were normoglycaemic following biochemical testing for use in this secondary analysis. After a median 8.9 years follow-up, we used data from national registers to compare rates of first CVD events and all-cause mortality in individuals in the routine care group with those in the intensive treatment group.Results
In total, 21,513 individuals screened positive for high risk of diabetes but were normoglycaemic on biochemical testing in ADDITION-Denmark practices between 2001 and 2006 (10,289 in the routine care group and 11,224 in the intensive treatment group). During 9 years of follow-up, there were 3784 first CVD events and 1748 deaths. The incidence of CVD was lower among the intensive treatment group compared with the routine care group (HR 0.92 [95% CI 0.85, 0.99]). This association was stronger among individuals at highest CVD risk (heart SCORE?≥?10; HR 0.85 [95% CI 0.75, 0.96]). There was no difference in mortality between the two treatment groups (HR 1.02 [95% CI 0.92, 1.14]).Conclusions/interpretation
Training of general practitioners to provide target-driven intensive management of blood glucose levels and other cardiovascular risk factors showed some evidence of a spillover effect on the risk of CVD over a 9 year period among individuals at high risk of diabetes. The effect was particularly pronounced among those at highest risk of CVD. There was no effect on mortality.Trial registration:
ClinicalTrials.gov NCT0023754920.
Amena Keshawarz Andrew R. Piropato Talia L. Brown Lindsey M. Duca Rachel M. Sippl R. Paul Wadwa Janet K. Snell-Bergeon 《Journal of diabetes and its complications》2018,32(11):975-981