Type 2 diabetes, socioeconomic status and risk of cancer in Scotland 2001–2007

Aims/hypothesis

The objective of this study was to use Scottish national data to assess the influence of type 2 diabetes on the risk of cancer at 16 different sites, while specifically investigating the role of confounding by socioeconomic status in the diabetes–cancer relationship.

Methods

All people in Scotland aged 55–79 years diagnosed with any of the cancers of interest during the period 2001–2007 were identified and classified by the presence/absence of co-morbid type 2 diabetes. The influence of diabetes on cancer risk for each site was assessed via Poisson regression, initially with adjustment for age only, then adjusted for both age and socioeconomic status.

Results

There were 4,285 incident cancers in people with type 2 diabetes. RR for any cancers (adjusted for age only) was 1.11 (95% CI 1.05, 1.17) for men and 1.33 (1.28, 1.40) for women. Corresponding values after additional adjustment for socioeconomic status were 1.10 (1.04, 1.15) and 1.31 (1.25, 1.38), respectively. RRs for individual cancer sites varied markedly.

Conclusions/interpretation

Socioeconomic status was found to have little influence on the association between type 2 diabetes and cancer.     

Prior inpatient admission increases the risk of post‐operative infection in hepatobiliary and pancreatic surgery

BackgroundHepatobiliary and pancreatic (HPB) operations have a high incidence of post‐operative nosocomial infections. The aim of the present study was to determine whether hospitalization up to 1 year before HPB surgery is associated with an increased risk of post‐operative infection, surgical‐site infection (SSI) and infection resistant to surgical chemoprophylaxis.MethodsA retrospective cohort study of patients undergoing HPB surgeries between January 2008 and June 2013 was conducted. A multivariable logistic regression model was used for controlling for potential confounders to determine the association between pre‐operative admission and post‐operative infection.ResultsOf the 1384 patients who met eligibility criteria, 127 (9.18%) experienced a post‐operative infection. Pre‐operative hospitalization was independently associated with an increased risk of a post‐operative infection [adjusted odds ratio (aOR): 1.61, 95% confidence interval [CI]: 1.06–2.46] and SSI (aOR: 1.79, 95% CI: 1.07–2.97). Pre‐operative hospitalization was also associated with an increased risk of post‐operative infections resistant to standard pre‐operative antibiotics (OR: 2.64, 95% CI: 1.06–6.59) and an increased risk of resistant SSIs (OR: 3.99, 95% CI: 1.25–12.73).DiscussionPre‐operative hospitalization is associated with an increased incidence of post‐operative infections, often with organisms that are resistant to surgical chemoprophylaxis. Patients hospitalized up to 1 year before HPB surgery may benefit from extended spectrum chemoprophylaxis.     

Physical activity reduces the risk of incident type 2 diabetes in general and in abdominally lean and obese men and women: the EPIC–InterAct Study

Aims/hypothesis  

We examined the independent and combined associations of physical activity and obesity with incident type 2 diabetes in men and women.     

Incidence of first heart failure hospitalisation and mortality in Aboriginal and non-Aboriginal patients in Western Australia, 2000–2009

Objectives

To compare the incidence of first heart failure (HF) hospitalisation, antecedent risk factors and 1-year mortality between Aboriginal and non-Aboriginal populations in Western Australia (2000–2009).

Methods

A population-based cohort aged 20–84 years comprising Aboriginal (n = 1013; mean 54 ± 14 years) and non-Aboriginal patients (n = 16,366; mean 71 ± 11 years) with first HF hospitalisation was evaluated. Age and sex-specific incidence rates and HF antecedents were compared between subpopulations. Regression models were used to examine 30-day and 1-year (in 30-day survivors) mortality.

Results

Aboriginal patients were younger, more likely to reside in rural/remote areas (76% vs 23%) and to be women (50.6% vs 41.7%, all p < 0.001). Aboriginal (versus non-Aboriginal) HF incidence rates were 11-fold higher in men and 23-fold in women aged 20–39 years, declining to about 2-fold in patients aged 70–84 years.Ischaemic and rheumatic heart diseases were more common antecedents of HF in younger (< 55 years) Aboriginal versus non-Aboriginal patients (p < 0.001). Hypertension, diabetes, chronic kidney disease, renal failure, chronic obstructive pulmonary disease, and a high Charlson comorbidity index (>= 3) were also more prevalent in younger and older Aboriginal patients (p < 0.001). Although 30-day mortality was similar in both subpopulations, Aboriginal patients aged < 55 years had a 1.9 risk-adjusted hazard ratio (HR) for 1-year mortality (p = 0.015).

Conclusions

Aboriginal people had substantially higher age and sex-specific HF incidence rate and prevalence of HF antecedents than their non-Aboriginal counterparts. HR for 1-year mortality was also significantly worse at younger ages, highlighting the urgent need for enhanced primary and secondary prevention of HF in this population.     

Reduced risk of heart failure with intensified multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: 21 years of follow-up in the randomised Steno-2 study

Aims/hypothesis

In type 2 diabetes mellitus, heart failure is a frequent, potentially fatal and often forgotten complication. Glucose-lowering agents and adjuvant therapies modify the risk of heart failure. We recently reported that 7.8 years of intensified compared with conventional multifactorial intervention in individuals with type 2 diabetes and microalbuminuria in the Steno-2 study reduced the risk of cardiovascular disease and prolonged life over 21.2 years of follow-up. In this post hoc analysis, we examine the impact of intensified multifactorial intervention on the risk of hospitalisation for heart failure.

Methods

One hundred and sixty individuals were randomised to conventional or intensified multifactorial intervention, using sealed envelopes. The trial was conducted using the Prospective, Randomised, Open, Blinded Endpoints (PROBE) design. After 7.8 years, all individuals were offered intensified therapy and the study continued as an observational follow-up study for an additional 13.4 years. Heart-failure hospitalisations were adjudicated from patient records by an external expert committee blinded for treatment allocation. Event rates were compared using a Cox regression model adjusted for age and sex.

Results

Eighty patients were assigned to each treatment group. Ten patients undergoing intensive therapy vs 24 undergoing conventional therapy were hospitalised for heart failure during follow-up. The HR (95% CI) was 0.30 (0.14, 0.64), p?=?0.002 in the intensive-therapy group compared with the conventional-therapy group. Including death in the endpoint did not lead to an alternate overall outcome; HR 0.51 (0.34, 0.76), p?=?0.001. In a pooled cohort analysis, an increase in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) during the first two years of the trial was associated with incident heart failure.

Conclusions/interpretation

Intensified, multifactorial intervention for 7.8 years in type 2 diabetic individuals with microalbuminuria reduced the risk of hospitalisation for heart failure by 70% during a total of 21.2 years of observation.

Trial registration:

ClinicalTrials.gov NCT00320008.

     

Sodium–glucose cotransporter 2 inhibitors represent a paradigm shift in the prevention of heart failure in type 2 diabetes patients

Recent major clinical trials of the use of sodium–glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes have shown that they reduce three-point major adverse cardiovascular events, cardiovascular death, hospitalization for heart failure (HF) and a composite renal outcome. These beneficial effects of SGLT2 inhibitors are also evident in type 2 diabetes patients with a previous history of atherosclerotic cardiovascular disease or advanced renal disease. HF is a major determinant of the prognosis of diabetes patients. Although HF with low ejection fraction can be effectively treated with antihypertensive drugs, these treatments do not reduce mortality in HF patients with preserved ejection fraction (HFpEF). HFpEF is clinically characterized by left ventricular diastolic dysfunction, perivascular fibrosis and stiffness of cardiomyocytes, defined as “cardiomyopathy”. Therefore, HFpEF is considered to be an entirely separate entity to HF with low ejection fraction. Recent studies have suggested that HFpEF might be treatable using SGLT2 inhibitors, which ameliorate visceral adiposity, insulin resistance, hyperglycemia, hyperlipidemia, volume overload, hypertension and cardiac inflammation. In the final part of the present review, we discuss the biochemical and molecular mechanisms of the effects of SGLT2 inhibitors in type 2 diabetes patients with HFpEF. These involve amelioration of the low nitric oxide production and oxidative stress, a reduction in cardiac inflammatory cytokine signaling, inhibition of Ca²⁺ overload, and an improvement in cardiac energy metabolism as a result of ketone body production. Investigations of the beneficial effects of SGLT2 inhibitors on cardiorenal outcomes, including hospitalization for HF, are now being carried out in preclinical and clinical studies.     

An acute hospital admission greatly increases one year mortality – Getting sick and ending up in hospital is bad for you: A multicentre retrospective cohort study

BackgroundFor most of the population a serious acute illness that require an emergency admission to hospital is a rare “once in a life time” event. This paper reports the one year mortality of patients admitted to hospital as acute emergencies compared to the general population.MethodThis is a post-hoc retrospective multicentre cohort study of acutely admitted patients from October 2008 to December 2013 aged 40 or higher. It compares the observed one-year mortality of both acute medical and surgical patients with the overall mortality in the general population at comparable age bands.ResultsWe included 18,375 patients and 4037 (22.0%) died within one year. For all age groups the one year mortality of those admitted to hospital for acute illness was markedly greater than for the general population. Although the odds ratio of death was highest in younger patients (e.g. odds ratio > 20 for 40 year olds), the absolute risk of death was greatest in the elderly (e.g. 20% mortality rate for men admitted to hospital over 65 years of age, compared to 1.7% for the general population).DiscussionAdmission to hospital for an acute illness is associated with a greatly increased risk of death within a year and for many elderly patients may be a seminal event.