Telomere length predicts all-cause mortality in patients with type 1 diabetes

Aims/hypothesis  

Type 1 diabetic patients with diabetic nephropathy have increased mortality and morbidity compared with normoalbuminuric patients. Telomere length in proliferative cells is inversely related to the total number of cell divisions, and therefore to biological age. We aimed to evaluate differences in telomere length in patients with type 1 diabetes with or without diabetic nephropathy; we also evaluated the prognostic value of telomere length.     

Variability in hemoglobin A1c predicts all-cause mortality in patients with type 2 diabetes

BackgroundTo evaluate the relationship between hemoglobin A1c variability and all-cause mortality in type 2 diabetic patients.MethodsThis was a retrospective cohort study in type 2 diabetic patients followed for at least 2 years between 2003 and 2009. A1C variability was determined from the standard deviation or coefficient of variation of serial A1C values (A1C_SD or A1C_CV). Subjects were categorized into either the high or low A1C variability group according to their A1C_CV median. Hazard ratios (HRs) of various factors for all-cause mortality were determined from Cox's proportional hazard models.ResultsA total of 881 subjects (422 men, 459 women) were included and 73 (8.3%) died during follow-up. The follow-up period was 4.7 ± 2.3 years. All-cause mortality was higher in subjects with high A1C_CV (11.0% vs. 5.4%, p = 0.002). In the Kaplan–Meier failure curve, subjects with higher A1C_CV demonstrated a trend of higher mortality (p = 0.1). In multivariate Cox's proportional hazards models, A1C_SD and A1C_CV significantly predicted all-cause mortality with an HR of 1.987 (p = 0.02) and 1.062 (p = 0.013), respectively, after adjusting for age, gender, body mass index, duration of diabetes, mean systolic blood pressure, use of antihypertensives and statins, mean LDL-cholesterol, smoking status, chronic kidney disease, and mean A1C values (A1C_MEAN). The ability of A1C_SD and A1C_CV to predict all-cause mortality was more evident in subjects with relatively low A1C_MEAN.ConclusionsA1C variability is an important risk factor for all-cause mortality in type 2 diabetic patients.     

Albuminuria predicts mid-term mortality of elective drug eluting stent implantation in patients with type 2 diabetes mellitus

Background The influence of albuminuria on clinical outcomes in patients with type 2 diabetes mellitus(T2 DM) after elective percutaneous coronary intervention(PCI) with drug-eluting stent(DES) implantation remains unclear. Methods We observed 386 patients with T2 DM after elective PCI. The patients were stratified based on the early morning urinary albumin: negative(n = 309), trace(urine dipstick trace, n = 39), and positive group(urine dipstick ≥1+, n = 38). Kaplan-Meier curve analysis was used to compare the cumulative rates of clinical outcomes(all-cause death, cardiovascular death, MACEs: cardiovascular death, non-fatal myocardial infarction, stroke or revascularization). Cox regression was performed to assess the risk factors for all-cause death and cardiovascular death. Results Median follow-up was 25 months(IQR: 17-37 months). Twenty eight(7.3%,13 in the negative group, 3 in the trace group and 12 in the positive group) patients died during the entire study period, 2 of them(0.7%,1 in the negative group and 1 in the trace group)died during index hospitalization. Positive albuminuria group suffered more contrast-induced acute kidney injury(CI-AKI) and dialysis during hospitalization. The cumulative all-cause death(34.5% vs. 8.9% vs. 4.9%, PNegative vs. Trace= 0.333, PNegative vs. Positive 0.001,PTrace vs. Positive= 0.013, log-rank P 0.001) and cardiovascular death(29.5% vs. 7.4% vs. 3.4%, PNegative vs. Trace= 0.458,PNegative vs. Positive 0.001, PTrace vs. Positive= 0.014, log-rank P 0.001) were highest in the positive group. MACE also tends to increase in positive group. After adjusting for potential confounding risk factors, positive albuminuria was still related to all-cause death(HR = 5.13, 95% CI: 2.21-11.89, P 0.001) and cardiovascular death(HR =5.40, 95% CI: 2.07-14.09, P = 0.001). Conclusion Preprocedural albuminuria predicts poor clinical outcomes,including all-cause death and cardiovascular death, in T2 DM patients after elective PCI with DES implantation.     

Hemoglobin glycation index predicts cardiovascular disease in people with type 2 diabetes mellitus: A 10-year longitudinal cohort study

Background and aims

Previous studies have suggested that the hemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications. We examined the prognostic significance of a high HGI for cardiovascular disease (CVD) in an ongoing hospital-based cohort.

Proteinuria modifies the effects of physical activity on total and cardiovascular disease mortality rates in patients with type 2 diabetes

Aims/hypothesis  

Physical activity reduces cardiovascular disease (CVD) and total mortality rates in patients with type 2 diabetes. However, it is not known whether or not the effects of physical activity on mortality rates depend on the presence of proteinuria in type 2 diabetic patients.     

Social adaptability index predicts overall mortality in patients with diabetes

BackgroundA quantifiable assessment of socioeconomic status and its bearing on clinical outcome in patients with diabetes is lacking. The social adaptability index (SAI) has previously been validated in the general population and in patients with chronic kidney disease, including those on dialysis and with kidney transplant. We hypothesize that SAI could be used in diabetes practice to identify a disadvantaged population at risk for inferior outcomes.MethodsThe NHANES-3 database of patients who have diabetes was analyzed. The association of the SAI (calculated as the linear combination of indicators of education status, employment, income, marital status, and substance abuse) with patient survival was evaluated using Cox model.ResultsThe study population consisted of 1634 subjects with diabetes mellitus with mean age of 61.9±15.3 years; 40.9% males; 38.5% white, 27.7% African American, and 31.3% Mexican American. The highest SAI was in whites (6.9±2.5), followed by Mexican Americans (6.5±2.3), and then African Americans (6.1±2.6) (ANOVA, P<.001). SAI was higher in subjects living in metropolitan areas (6.8±2.6) compared to the rural population (6.3±2.4) (T test, P<.001). Also, SAI was greater in males (7.1±2.4) than in females (6.1±2.4) (T test, P<.001).SAI had significant association with survival (hazard ratio 0.9, P<.001) in the entire study population and in most of the subgroups (divided by race, sex, and urban/rural location). Furthermore, SAI divided into tertiles (≤5, 6 to 8, >8) demonstrated a significant and “dose-dependent” association with survival.ConclusionSocial adaptability index is associated with mortality in the diabetic population and is useful in identifying individuals who are at risk for inferior outcomes.     

Pulse pressure predicts cardiovascular risk in patients with type 2 diabetes mellitus

BACKGROUND: Pulse pressure (PP), a marker of arterial stiffness, is a better predictor of coronary heart disease (CHD) risk than systolic blood pressure (SBP) or diastolic blood pressure (DBP) in older adults. Whether this is also true in subjects with type 2 diabetes, who are at increased risk for cardiovascular disease, is unknown. METHODS: Data on 2911 type 2 diabetic subjects relating to blood pressure (BP), other risk factors, and cardiovascular events were abstracted from The Cardiff Diabetes Database. Logistic regression was used to assess the relationship among BP components and the risk of CHD, cerebrovascular (CVD), and peripheral vascular (PVD) events after correction for age, gender, cholesterol, and smoking status. RESULTS: In the 4-year follow-up period there were 574 CHD, 168 CVD, and 157 PVD events. Both PP and SBP, but not DBP, were positively associated with the risk of all event types. However, PP emerged as the best predictor of CHD events, and SBP as the best predictor of CVD and PVD events. Total and HDL-cholesterol were the most important variables associated with PP after age. CONCLUSIONS: In summary, PP is a better predictor of CHD events than SBP in persons with type 2 diabetes, but the converse is true for CVD and PVD.     

Cystatin C predicts diabetic retinopathy in Chinese patients with type 2 diabetes

This study aims to identify the predictive value of cystatin C for diabetic retinopathy (DR) in Chinese patients with type 2 diabetes. Data from a cross-sectional hospital-based survey of 450 type 2 diabetes patients were analyzed in the study. DR was assessed by fundus fluorescein angiography. Duration of diabetes and other related information were obtained by questionnaire. Body mass index, blood pressure, HbA_1c, cystatin C, glomerular filtration rate, urinary albumin excretion, blood lipids, and uric acid were measured. Binary logistic regression was performed to evaluate potential risk factors for DR. The predictive value of cystatin C for DR was evaluated using ROC curve. Cystatin C (P = 0.039) was a risk factor for DR after GFR, and other possibly related variables were adjusted. Cystatin C had a significant predictive value for any DR (AUC, 0.763, P < 0.001; optimal cutoff value, 1.11 mg/L; sensitivity, 56.00 %; specificity, 83.90 %) or severe DR (AUC, 0.821, P < 0.001; optimal cutoff value, 1.23 mg/L; sensitivity, 73.60 %; specificity, 88.70 %). Cystatin C is a novel risk factor for DR and should be used to screen and forecast the presence of DR (especially severe DR) in Chinese patients with type 2 diabetes. The association between cystiatin C and DR should not depend on the excellent ability of cystatin C for the estimation of GFR.

     

Metabolic syndrome predicts 10-year mortality in non-diabetic patients following coronary artery bypass surgery.

Background Metabolic syndrome (MetS) is a risk factor for cardiovascular disease and mortality, but, the relationship between MetS and survival after coronary artery bypass grafting (CABG) remains unclear. Methods and Results The outcomes of patients with and without MetS were analyzed. Patients who had undergone CABG at Juntendo University Hospital between January 1984 and December 1992 were enrolled. The survival search was performed by the end of 2000. The patients were categorized by the existence of preoperative MetS using the modified American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definition with body mass index instead of waist circumference. MetS was present in 551 (46.6%) patients and absent in 632 (53.4%). Preoperative MetS was associated with long-term poor prognosis in terms of all-cause death (hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.03-1.74; p=0.028) and cardiac death (HR 2.31; 95% CI 1.36-3.92; p=0.002) in non-diabetic patients. These differences in the mortality of the 2 groups were more obvious after 10 years. However, among the patients with diabetes, the presence of MetS was not related to long-term mortality. Conclusions Preoperative MetS predicted increased all-cause and cardiac mortality, especially after 10 years, in non-diabetic patients undergoing CABG. (Circ J 2008; 72: 1481 - 1486).     

Treatment with insulin secretagogues and cancer-related mortality in type 2 diabetic patients a retrospective cohort study

BACKGROUND: Recent evidence suggests that some hypoglycemic treatments could affect the incidence of malignancies. This study was aimed at the assessment of cancer-related mortality in type 2 diabetic patients treated with different hypoglycemic drugs. METHODS: A retrospective observational cohort study was performed on a consecutive series of 3002 type 2 diabetic outpatients. Cancer-related death was identified through the City Registry Office. For patients visited for the first time after January 1 (st), 2000, information on incidence of cancer was also available. RESULTS: During a mean follow-up of 4.3+/-2.5 years, 87 cases of cancer-related death were recorded, with a yearly incidence rate of 0.70%. Patients receiving secretagogues showed a significantly higher mortality than the rest of the sample (unadjusted OR [95%CI] 1.76 [1.15-2.69], p=0.009), which was maintained after adjustment for confounders (HR 2.29 [1.21-4.02], p=0.003). Conversely, no significant association of cancer-related mortality was observed with insulin sensitizers or exogenous insulin. In comparison with patients receiving no hypoglycemic treatment, those on secretagogue or insulin monotherapy showed a higher cancer-related mortality (HR 2.25 [1.10-4.78], p=0.034 and HR 2.11 [1.01-4.50], p=0.048, respectively). The effect of treatments on incidence of malignancies was similar to that observed on cancer-related death. CONCLUSIONS: Insulin secretagogues and, to a lesser extent, exogenous insulin, appear to be associated with increased mortality for cancer, even after adjustment for multiple confounders. This issue deserves further investigation through epidemiological studies on larger samples of patients.     

Low human paraoxonase predicts cardiovascular events in Japanese patients with type 2 diabetes

Human serum paraoxonase (PON1) is associated with HDL and inhibits oxidative modification of LDL. PON1 enzymatic activity has been shown to decrease in diabetic patients; however, the effect of PON1 status on long-term outcome has not been reported. In this study, we examined the association between baseline PON1 status and the development of cardiovascular disease (CVD) during 10 years of follow-up in 88 type 2 diabetic patients whose enzymatic activities, concentrations, and genetic polymorphisms of PON1 had been determined. A total of 20 CVD events were recorded during the follow-up period. Using Kaplan–Meier survival curves, we found a significantly increased incidence of CVD in patients with a lower concentration or paraoxonase activity of PON1 than each median value (log-rank 7.460; P < 0.01, and log-rank 4.187; P < 0.05, respectively). By Cox regression analysis, both concentration and paraoxonase activity were significantly associated with the development of CVD, even after correction for gender, age, and preexisting CVD (P < 0.05). Low concentration and enzymatic activity of PON1 may be an independent predictor of cardiovascular events in diabetic patients.     

Determinants of mortality in patients with type 2 diabetes: a review

We aimed to review and summarize the evidence from accomplished trials analyzing factors influencing mortality in patients with T2DM and to provide some recommendations for targets and treatment in the European region. The following databases were searched for relevant trials: PubMed and the Cochrane Library. Of 3.806 citations, 134 trials met our inclusion criteria. Results: The reduction in lifetime for 65 + ?years-old patients having less than 10 years T2DM amounts to 1.8 years. Having T2DM for more than 10 years lifetime will be reduced by 2.7 years. However, the lifetime shortening factor of T2DM will even be stronger for 40 + ?years-old patients at onset. Males will lose 11.6 years of life and 18.6 QUALYs. T2DM among females will reduce life by 14 QUALYs by 22 years. From a statistical point of view, the highest mortality rate will occur in an over 55-years-old European smoking and non-compliant diabetic woman with alcohol abuse living in a rural area with a low level of education and a low socio-economic status. Furthermore, other co-morbidities such as cardiovascular diseases, gout, and depression affect mortality. Additionally, mortality will increase with a BMI over 35 and also with a BMI under 20–25. This refers to the obesity paradox indicating a higher mortality rate among normal weight patients with T2DM compared to overweight patients with T2DM. HbA1c-levels between 6.5 % and 7 % are associated with the lowest impact on mortality.