A prospective study of depression and mortality in patients with type 2 diabetes: the Fremantle Diabetes Study

Aims/hypothesis Depression is associated with excess mortality in patients with type 2 diabetes. We investigated the impact, and possible causal mechanisms, of depression on all-cause and cardiac mortality in patients with type 2 diabetes. Methods We recruited 1,273 patients with type 2 diabetes from a postcode-defined community (average age 64.1±11.2 years, 48.7% males, median duration of diabetes 4 years [range 1.0–9.0]) and followed them for 7.8±2.4 years. Depression was assessed using data obtained using a quality-of-life questionnaire, and cause and date of death were obtained from the state registry. Results Depression was present in 31.5% of subjects at recruitment. Depressed subjects had a longer duration of diabetes, more cardiovascular risk factors, CHD, cerebrovascular disease and diabetic microvascular complications at baseline, and higher all-cause and cardiac mortality rates during follow-up. In Cox proportional hazards models and after adjustment for demographic and diabetes-related variables and cardiovascular risk factors, depression was significantly associated with excess all-cause and cardiac mortality. When diabetic microvascular and macrovascular complications were added to the Cox models, depression was not significantly associated with excess all-cause or cardiac mortality. Conclusions/interpretation Depression in patients with type 2 diabetes is associated with a greater prevalence of complications but is not an independent predictor of all-cause or cardiac mortality. Depression may contribute to the progression of important prognostic variables in diabetes, particularly macrovascular and microvascular disease.     

Coffee consumption and risk of total and cardiovascular mortality among patients with type 2 diabetes

AIMS/HYPOTHESIS: Higher habitual coffee drinking has been associated with a lower risk of developing type 2 diabetes. The relation between coffee consumption and risk of cardiovascular disease (CVD) has been examined in many studies, but the issue remains controversial. This study was designed to assess the association between coffee consumption and CVD mortality among patients with type 2 diabetes. METHODS: We prospectively followed 3,837 randomly ascertained Finnish patients with type 2 diabetes aged 25 to 74 years. Coffee consumption and other study parameters were determined at baseline. The International Classification of Diseases was used to identify CHD, CVD and stroke cases using computerised record linkage to the national Death Registry. The associations between coffee consumption at baseline and risk of total, CVD, CHD, and stroke mortality were analysed by using Cox proportional hazards models. RESULTS: During the average follow-up of 20.8 years, 1,471 deaths were recorded, of which 909 were coded as CVD, 598 as CHD and 210 as stroke. The respective multivariate-adjusted hazard ratios in participants who drank 0-2, 3-4, 5-6, and > or =7 cups of coffee daily were 1.00, 0.77, 0.68 and 0.70 for total mortality (P<0.001 for trend), 1.00, 0.79, 0.70 and 0.71 for CVD mortality (P=0.006 for trend), 1.00, 0.78, 0.70 and 0.63 for CHD mortality (p=0.01 for trend), and 1.00, 0.77, 0.64 and 0.90 for stroke mortality (p=0.12 for trend). CONCLUSIONS/INTERPRETATION: In this large prospective study we found that in type 2 diabetic patients coffee drinking is associated with reduced total, CVD and CHD mortality.     

Leisure time physical activity and the risk of type 2 diabetes in men and women from the general population

Aims/hypothesis The aim of this study was to examine sex-specific associations between leisure time physical activity and incident type 2 diabetes in a representative population sample in Germany.Methods The study was based on 4,069 men and 4,034 women (aged 25 to 74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995. Subjects were free of diabetes at baseline. Incident cases of type 2 diabetes were assessed in 1998 using a follow-up questionnaire. Sex-specific hazard ratios (HRs) were estimated from Cox proportional hazard models.Results A total of 145 cases of incident type 2 diabetes among men and 82 among women were registered during the mean follow-up period of 7.4 years. In both sexes, a high leisure time physical activity level was associated with a reduced risk of incident type 2 diabetes. After adjustment for confounding factors, the HR in highly active men (more than 2 h physical activity per week in summer and winter) was 0.83 (95% CI: 0.50–1.36). In contrast, highly active women had the lowest risk of type 2 diabetes even after multivariable adjustment (HR 0.24; 95% CI: 0.06–0.98). In subgroup analyses, after multivariable adjustment, the protective effect of moderate to high physical activity was significant in women with a BMI below 30 kg/m² (HR 0.24; 95% CI: 0.09–0.65) but not in women with a BMI of 30 kg/m² or higher (HR 0.97; 95% CI: 0.44–2.11).Conclusions/interpretation Leisure time physical activity is effective in preventing type 2 diabetes, especially in nonobese women, in the general population.     

基因、体力活动及其交互作用与2型糖尿病

2型糖尿病是目前威胁人类健康,发病率迅速增长的疾病之一.2007年以来,全基因组关联分析研究发现一系列包括SLC30A8、LOC387761、IDE-KIF11-HHEX和EXT2-ALX4等新的糖尿病基因.基因及体力活动不足与2型糖尿病患病风险相关,且两个因素可能有交互影响,本文就基因、体力活动及其交互作用与2型糖尿病间的关系作一综述.     

Leisure time physical activity is associated with better metabolic control in adults with type 1 and type 2 diabetes mellitus: A cross-sectional study from two public hospitals in Chile

AimTo examine the association between leisure time physical activity (LTPA) and metabolic control, in adults with diabetes mellitus (DM).MethodsA cross-sectional study was conducted in two hospitals (Santiago, Chile) with 101 type 1 (mean 34.4 ± 12.3 years) and 100 type 2 DM (mean 57.8 ± 5.2 years) adults. Glycated hemoglobin level (A1C) was obtained, and LTPA levels were estimated through the Global Physical Activity Questionnaire.Multiple linear regression models were fitted evaluating the independent effect of LTPA, sociodemographic, cardiovascular risk factors and other types of physical activity (PA) on metabolic control.ResultsDM participants which reported no LTPA had higher levels of A1C (type 1 mean A1C: 8.8 ± 1.5% and type 2 mean A1C: 9.2 ± 1.4%) compared to those who fulfilled PA recommendations of ≥150 min/week (type 1 mean A1C: 8.0 ± 1.6% and type 2 mean A1C: 8.1 ± 1.4%).Regression analysis showed that A1C levels were negatively associated with ≥150 min/week on LTPA in type 1 (b = ?0.25; 95%CI ?0.16 to ?0.01) and type 2 DM (b = ?0.24; 95%CI ?0.29 to ?0.02) participants.ConclusionLeisure time physical activity may be considered as an efficient and inexpensive non-pharmacological tool for DM treatment. Hence, healthcare professionals should educate and promote PA since primary-care diagnosis in addition to prevent disease-related complications.     

Assessment of energy expenditure using doubly labeled water,physical activity by accelerometer and reported dietary intake in Japanese men with type 2 diabetes: A preliminary study

The aim of the present study was to determine the total energy expenditure, physical activity and dietary intake of men with type 2 diabetes mellitus and control participants without type 2 diabetes mellitus who were matched for age and body mass index. The participants in the present study were 12 well‐controlled type 2 diabetes mellitus patients and 10 controls, aged 40–75 years, with a body mass index <30 kg/m². Total energy expenditure under free‐living conditions was assessed using the doubly labeled water method, and physical activity was measured using a triaxial accelerometer. Dietary intake was assessed using a self‐recorded food intake diary during the measurement period. Participants were instructed to record their dietary intake over 3 days, including 2 weekdays. Total energy expenditure was not significantly different between the groups (P = 0.153), nor were energy (P = 0.969) or macronutrient intakes. In conclusion, when age and body mass index are matched, total energy expenditure and self‐reported energy intake are not significantly different between type 2 diabetes mellitus patients and healthy controls.     

Joint effect of physical activity and blood lipid levels on all-cause and cardiovascular disease mortality: The Rural Chinese Cohort Study

Background and aimsWe aimed to evaluate the joint effect of physical activity (PA) and blood lipid levels on all-cause and cardiovascular disease (CVD) mortality.Methods and resultsWe analyzed 17,236 participants from the Rural Chinese Cohort Study. Cox's proportional-hazards regression models were used to assess the hazard ratios (HRs) and 95% confidence intervals (CIs) between the joint effect of PA and blood lipid levels and risk of all-cause and CVD mortality. Restricted cubic splines were used to estimate the dose–response relationship of PA with risk of all-cause and CVD mortality. During a median follow-up of 6.01 years there were 1106 deaths (484 from CVD) among participants. For all-cause mortality, compared with the group with dyslipidemia and extremely light PA (ELPA), the HRs with dyslipidemia and light PA (LPA), moderate PA (MPA), and heavy PA (HPA) were 0.56 (95% CI 0.45–0.70), 0.59 (0.46–0.75), and 0.59 (0.45–0.78), respectively, while the HRs of groups with normal lipid levels and ELPA, LPA, MPA, and HPA were 0.88 (0.72–1.04), 0.59 (0.48–0.73), 0.53 (0.41–0.67), and 0.38 (0.29–0.50), respectively. We observed similar effects on CVD mortality. Restricted cubic splines showed a curvilinear relationship between PA and risk of all-cause and CVD mortality with normal lipid levels and with dyslipidemia.ConclusionHigher PA reduces the risk of all-cause and CVD mortality. Higher levels of PA are needed in the population.     

Long-term risk of stroke in type 2 diabetes patients with diabetic ketoacidosis: A population-based,propensity score-matched,longitudinal follow-up study

AimTo investigate the long-term risk of stroke in type 2 diabetes (T2D) patients with previous episodes of diabetic ketoacidosis (DKA).MethodsThis retrospective nationwide population-based cohort study was conducted using Taiwan's National Health Insurance database. Claims data from 2000 to 2002 were extracted for 3572 T2D patients with DKA and 7144 controls matched for age, gender, diabetes complications severity index, frequency of clinical visits and baseline comorbidities. Patients with type 1 diabetes (T1D), identified by glucagon C-peptide stimulation or glutamic acid decarboxylase (GAD) antibody blood tests and possession of a catastrophic illness certificate were excluded. All patients were tracked until a new stroke diagnosis, death or the end of 2011.ResultsOf the 3572 selected patients, 270 with DKA and 404 of the 7144 controls were diagnosed with a new stroke, giving an incidence rate ratio (IRR) of 1.56 (95% CI: 1.34–1.82; P < 0.0001). DKA patients had a higher risk of ischaemic stroke than those without DKA (IRR: 1.62, 95% CI: 1.34–1.96; P < 0.0001), and DKA patients with hypertension and hyperlipidaemia were at even greater risk of stroke. Also, DKA patients were at particular risk for stroke during the first half-year following DKA diagnosis. After adjusting for patient characteristics and comorbidities, these patients were 1.55 times more likely to have a stroke than those without DKA (95% CI: 1.332–1.813, P < 0.0001).ConclusionT2D patients with previous DKA have a higher risk of stroke, especially ischaemic strokes.     

Development of diabetic retinopathy and its associated risk factors in type 2 diabetic patients in Osaka district, Japan: a long-term prospective study

Incidence rates of diabetic retinopathy and its associated risk factors were studied in a long-term prospective study involving 976 type 2 (non-insulin dependent) diabetic patients that showed no retinopathy at entry to the study. 322 of the patients (one-third of the subjects studied) developed diabetic retinopathy during the observation period (average length 8.3 years). The incidence rate per 1000 person-years was 39.8. The rate was significantly related to age at onset of diabetes, to fasting plasma glucose (FPG) level at entry, and to type of treatment. The incidence rate was also related to the duration of the disease. Glycemic control clearly played a role in the occurrence of retinopathy. Patients with FPG ≥ 200 mg/dl had the highest incidence rate, while patients with FPG < 140 mg/dl showed the lowest incidence rate throughout the observation period. Furthermore, a longer period between onset of diabetes and development of retinopathy was observed in patients with FPG < 140 mg/dl compared to patients with FPG ≥ 200 mg/dl. The findings suggest that strict glycemic control may be of particular value to reduce the incidence of retinopathy and to delay its appearance in type 2 diabetic patients.     

The Association between time spent in performing physical activity and physical function in outpatients with type 2 diabetes who may have diabetic neuropathy

AimsTo determine the relationship between physical activity time and physical function according to the Japanese Clinical Practice Guideline for Diabetes, which recommended 150 min of activity for outpatients with type 2 diabetes who may have diabetic neuropathy.MethodsWe examined a cross-sectional study with 79 outpatients with Type 2 diabetes participated. A short version, Japanese language edition of the International Physical Activity Questionnaire (IPAQ) was used to evaluate physical activity. Isometric knee extensor strength, grip strength, maximum 10-m walking speed, the Michigan Neuropathy Screening Instrument score, and the Short Physical Performance Battery (SPPB). Each evaluation item was compared between time spent performing physical activity ≥150 min group and <150 min group, and multiple regression analysis was performed to determine the factors associated with time spent performing physical activity. Further, the correlation between time spent performing physical activity and isometric knee extensor strength was examined.ResultsThe ≥150 min group had significantly higher isometric knee extensor strength than the <150 min group. In addition, the ≥150 min group had significantly faster maximum 10-m walking speed and sit-to-stand time than the <150 min group. Isometric knee extensor strength was determined to be an independent factor associated with the IPAQ score. A positive correlation was found between the IPAQ score and isometric knee extensor strength.ConclusionsAmong the patients with type 2 diabetes who may have diabetic neuropathy, those who performed physical activity for ≥150 min per week were suggested to have higher physical function than those with <150 min of activity.     

Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: A cohort study

Background and aimsLow-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis.Methods and resultsDietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50–55) and 2013 (aged 62–67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15).ConclusionCarbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.     

Coffee consumption and incidence of impaired fasting glucose,impaired glucose tolerance,and type 2 diabetes: the Hoorn Study

Aims/hypothesis Coffee contains several substances that may affect glucose metabolism. The aim of this study was to evaluate the relationship between habitual coffee consumption and the incidence of IFG, IGT and type 2 diabetes.Methods We used cross-sectional and prospective data from the population-based Hoorn Study, which included Dutch men and women aged 50–74 years. An OGTT was performed at baseline and after a mean follow-up period of 6.4 years. Associations were adjusted for potential confounders including BMI, cigarette smoking, physical activity, alcohol consumption and dietary factors.Results At baseline, a 5 cup per day higher coffee consumption was significantly associated with lower fasting insulin concentrations (–5.6%, 95% CI –9.3 to –1.6%) and 2-h glucose concentrations (–8.8%, 95% CI –11.8 to –5.6%), but was not associated with lower fasting glucose concentrations (–0.8%, 95% CI –2.1 to 0.6%). In the prospective analyses, the odds ratio (OR) for IGT was 0.59 (95% CI 0.36–0.97) for 3–4 cups per day, 0.46 (95% CI 0.26–0.81) for 5–6 cups per day, and 0.37 (95% CI 0.16–0.84) for 7 or more cups per day, as compared with the corresponding values for the consumption of 2 or fewer cups of coffee per day (p=0.001 for trend). Higher coffee consumption also tended to be associated with a lower incidence of type 2 diabetes (OR 0.69, CI 0.31–1.51 for 7 vs 2 cups per day, p=0.09 for trend), but was not associated with the incidence of IFG (OR 1.35, CI 0.80–2.27 for 7 vs 2 cups per day, p=0.49 for trend).Conclusions/interpretation Our findings indicate that habitual coffee consumption can reduce the risk of IGT, and affects post-load rather than fasting glucose metabolism.     

Coffee consumption and risk of cardiovascular events and all-cause mortality among women with type 2 diabetes

Aims/hypothesis  Coffee has been linked to both beneficial and harmful health effects, but data on its relationship with cardiovascular disease and mortality in patients with type 2 diabetes are sparse. Methods  This was a prospective cohort study including 7,170 women with diagnosed type 2 diabetes but free of cardiovascular disease or cancer at baseline. Coffee consumption was assessed in 1980 and then every 2–4 years using validated questionnaires. A total of 658 incident cardiovascular events (434 coronary heart disease and 224 stroke) and 734 deaths from all causes were documented between 1980 and 2004. Results  After adjustment for age, smoking and other cardiovascular risk factors, the relative risks were 0.76 (95% CI 0.50–1.14) for cardiovascular diseases (p trend = 0.09) and 0.80 (95% CI 0.55–1.14) for all-cause mortality (p trend = 0.05) for the consumption of ≥4 cups/day of caffeinated coffee compared with non-drinkers. Similarly, multivariable RRs were 0.96 (95% CI 0.66–1.38) for cardiovascular diseases (p trend = 0.84) and 0.76 (95% CI 0.54–1.07) for all-cause mortality (p trend = 0.08) for the consumption of ≥2 cups/day of decaffeinated coffee compared with non-drinkers. Higher decaffeinated coffee consumption was associated with lower concentrations of HbA_1c (6.2% for ≥2 cups/day versus 6.7% for <1 cup/month; p trend = 0.02). Conclusions  These data provide evidence that habitual coffee consumption is not associated with increased risk of cardiovascular diseases or premature mortality among diabetic women. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorised users.     

Effects of alcohol consumption on mortality in patients with Type 2 diabetes mellitus

Aims/hypothesis Moderate alcohol intake has been associated with increased life expectancy due to reduced mortality from cardiovascular disease. We prospectively examined the effects of alcohol consumption on mortality in Type 2 diabetic patients in Switzerland.Methods A total of 287 patients with Type 2 diabetes mellitus (125 women, 162 men), recruited in Switzerland for the WHO Multinational Study of Vascular Disease in Diabetes, were included in this study. After a follow-up period of 12.6±0.6 years (means ± SD), mortality from CHD and from all causes was assessed.Results During the follow-up, 70 deaths occurred (21 from CHD, 49 from other causes). Compared with non-drinkers, alcohol consumers who drank alcohol 1 to 15 g, 16 to 30 g and 30 g or more per day had the following risk rates of death from CHD: 0.87 (95% CI: 0.25 to 2.51, NS), 0.00 (95% CI: 0.00 to 0.92, p less than 0.05) and 0.37 (95% CI, 0.01 to 2.42, NS), respectively. The corresponding risk rates of death from all causes were 1.27 (95% CI: 0.68 to 2.28, NS), 0.36 (95% CI: 0.09 to 0.99, p less than 0.05) and 1.66 (95% CI: 0.76 to 3.33, NS).Conclusions/interpretation In Swiss Type 2 diabetic patients moderate alcohol consumption of 16 to 30 g per day was associated with reduced mortality from CHD and from all causes. Alcohol intake above 30 g per day was associated with a tendency towards increased all-cause mortality.Abbreviations HR Hazard ratio - ICD-9 International Classification of Disease 9 - RR risk rate     

Serum uric acid levels and the risk of type 2 diabetes: a prospective study

Purpose

To evaluate the impact of serum uric acid levels on the future risk of developing type 2 diabetes independent of other factors.

Methods

We used prospective data from the Framingham Heart Study original (n = 4883) and offspring (n = 4292) cohorts to examine the association between serum uric acid levels and the incidence of diabetes. We used Cox proportional hazards models to estimate the relative risk of incident diabetes adjusting for age, sex, physical activity, alcohol consumption, smoking, hypertension, body mass index, and blood levels of glucose, cholesterol, creatinine, and triglycerides.

Results

We identified 641 incident cases of diabetes in the original cohort and 497 cases in the offspring cohort. The incidence rates of diabetes per 1000 person-years for serum uric acid levels <5.0, 5.0-5.9, 6.0-6.9, 7.0-7.9 and ≥8.0 mg/dL were 3.3, 6.1, 8.7, 11.5, and 15.9, respectively, in the original cohort; and 2.9, 5.0, 6.6, 8.7, and 10.9, respectively, in the offspring cohort (P-values for trends <.001). Multivariable relative risks per mg/dL increase in serum uric acid levels were 1.20 (95% confidence interval; 1.11-1.28) for the original cohort and 1.15 (95% confidence interval; 1.06-1.23) for the offspring cohort.

Conclusions

These prospective data from 2 generations of the Framingham Heart Study provide evidence that individuals with higher serum uric acid; including younger adults, are at a higher future risk of type 2 diabetes independent of other known risk factors. These data expand on cross-sectional associations between hyperuricemia and the metabolic syndrome, and extend the link to the future risk of type 2 diabetes.     

Coffee consumption,genetic susceptibility and risk of latent autoimmune diabetes in adults: A population-based case-control study

Aim

Coffee consumption is inversely related to risk of type 2 diabetes (T2D). In contrast, an increased risk of latent autoimmune diabetes in adults (LADA) has been reported in heavy coffee consumers, primarily in a subgroup with stronger autoimmune characteristics. Our study aimed to investigate whether coffee consumption interacts with HLA genotypes in relation to risk of LADA.

Lower objectively measured physical activity is linked with perceived risk of hypoglycemia in type 1 diabetes

Aims

Compare physical activity (PA) levels in adults with and without type 1 diabetes and identify diabetes-specific barriers to PA.

A case risk study of lactic acidosis risk by metformin use in type 2 diabetes mellitus tuberculosis coinfection patients

Metformin (MET) has possibilities to be utilized as an adjunct of tuberculosis (TB) therapy for controlling the growth of Mycobacterium tuberculosis (M. tuberculosis). MET enhances the production of mitochondrial reactive oxygen species and facilitates phagosome–lysosome fusion; those mechanism are important in M. tuberculosis elimination. Moreover, MET-associated lactic acidosis (MALA) needs to be considered and the incidence of MALA in patients with type 2 DM–TB coinfection remains unknown. This result contributes much to our understanding about the clinical effect of MET use in type 2 DM–TB coinfection.For the purpose of understanding the MET effect as an adjuvant therapy in TB therapy and insulin simultaneous therapy, an observational clinical study was done in type 2 DM newly TB coinfection outpatients at Surabaya Paru Hospital. Patients were divided into two groups. First group was MET group, in which the patients were given MET accompanying insulin and TB treatment regimens, the golden standard therapy of DM–TB coinfection. MET therapy was given for at least 2 months. Second group was non-MET group, in which the patients were given insulin and TB treatment regimens. The lactate levels in both groups were measured after 2 months.Among 42 participants, there was no case of lactic acidosis during this study period. Data were normally distributed; thus, we continued analysis of the difference using paired T-test with 95% confidence. There was no difference in lactate levels (p = 0.396) after MET therapy compared to non-MET group.In this study involving patients with TB pulmonary diseases, there is neither evidence that MET therapy induced lactic acidosis event nor that it increased lactate blood level. Thus, we concluded that MET use in type 2 DM–TB coinfection did not induce lactic acidosis.