The long-term effectiveness of metabolic control on cardiovascular disease in patients with diabetes in a real-world health care setting — A prospective diabetes management study

AimsTo determine the incidence rates of cardiovascular disease (CVD) and assess the effect of metabolic risk factor management on the development of CVD in patients with diabetes.MethodsWe studied 733 patients with diabetes without prior CVD in the Shanghai Taopu community health service center. Success in managing CVD risk factors was evaluated as follows: (1) glucose control (haemoglobin A1c [HbA1c] <7.0% in patients aged <65 years and <8.0% in patients aged ≥65 years), (2) blood pressure control (<140/90 mmHg), and (3) lipid control (high-density lipoprotein cholesterol ≥1.0 mmol/L in men and ≥1.3 mmol/L in women, and triglycerides <1.7 mmol/L).ResultsDuring a median 8.0-year follow-up, 206 CVD incident cases were identified. Each 1% increment in HbA1c, 10 mmHg increment in systolic blood pressure (SBP), and 1 mmol/L increment in triglycerides during follow-up significantly increased the risk of CVD by 17%, 37%, and 14%, respectively. Compared to those who did not, patients who met the blood pressure and glucose control goals during follow-up had a 64% and a 29% decreased risk of CVD, respectively. The multivariable-adjusted hazard ratios of CVD were 1.00, 1.78 (95% confidence interval [CI] 1.10–2.87), and 2.51 (95% CI 1.54–4.07) among patients who attained three, two, and one/none of the CVD factor control goals (HbA1c, blood pressure, and lipid) during follow-up, respectively.ConclusionsAverage levels of HbA1c, SBP, and triglycerides during follow-up were positively associated with the risk of CVD, and treatment targeting multiple factors can significantly reduce CVD risk.     

Elevated depressive symptoms and risk of all-cause and cardiovascular mortality among adults with and without diabetes: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study

AimsTo examine the association of elevated depressive symptoms with all-cause and cardiovascular disease (CVD) mortality and determine whether these associations differ for those with and without diabetes.MethodsWe included 22,807 black and white men and women aged 45–98 years at baseline (2003–2007) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Elevated depressive symptoms were defined as a score ≥ 4 on the 4-item Centers for Epidemiologic Studies of Depression Scale. Participants were classified as having diabetes, prediabetes, or no prediabetes/diabetes based on glucose levels and diabetes medication use. All-cause mortality events were available through 2018 and adjudicated CVD mortality events were available through 2015.ResultsDuring follow-up, there were 5383 all-cause deaths, of which 1585 were adjudicated CVD deaths. The mean survival time was lower for participants with elevated depressive symptoms than those without elevated depressive symptoms for those with diabetes, prediabetes, and no prediabetes/diabetes. In multivariable adjusted models, elevated depressive symptoms increased the risk of all-cause mortality for those with diabetes (HR = 1.15; 95% CI = 1.00–1.32), prediabetes (HR = 1.56; 95% CI = 1.28–1.91), and neither prediabetes/diabetes (HR = 1.34; 95% CI = 1.19–1.50) (p for interaction = 0.0342). Findings were similar for CVD mortality.ConclusionElevated depressive symptoms increased the risk of all-cause and CVD mortality among individuals with and without diabetes, with a stronger magnitude of association observed among those with prediabetes. This underscores the need for assessing depressive symptoms across the glycemic spectrum, including those with prediabetes.     

Overweight and obese children with optimal control in the T1D Exchange Registry: How are they different from lean children with optimal control?

AimsIncreased adiposity is a risk factor for suboptimal diabetes control and cardiovascular disease (CVD) complications.Our goal was to identify modifiable behavioral characteristics of overweight and obese pediatric patients with type 1 diabetes mellitus (T1DM) who achieve optimal glycemic control and to evaluate their CVD risk compared to lean patients. Our hypothesis was that optimally controlled obese and overweight participants require more total daily insulin and are at higher CVD risk compared to optimally controlled lean participants.MethodsWe analyzed a cohort of 9263 participants with T1DM aged <21 years in the T1D Exchange Registry. Optimal diabetes control was defined as HbA1c ≤ 7.5% (58 mmol/mol). We compared factors that influence glycemic control in lean, overweight and obese participants with optimal vs. suboptimal control, using logistic regression.ResultsAge, race, overweight status, continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) use were important variables influencing glycemic control. In the optimally controlled cohort, 27% of participants were overweight or obese versus 30% in the suboptimally controlled cohort (P < 0.001). Overweight and obese participants with optimal control were not significantly different from lean participants in terms of CSII use, total daily insulin dosage per kg of bodyweight, glucose checks per day, boluses with bedtime snack, use of CGM, but had higher LDL cholesterol and triglycerides, and lower HDL cholesterol (P < 0.05).ConclusionsThere were no differences in modifiable behavioral characteristics between the obese, overweight and lean optimally controlled participants. However, predictors of cardiovascular disease were higher in the overweight and obese group.     

Glycemic control in Kuwaiti diabetes patients treated with glucose-lowering medication

BackgroundDiabetes is prevalent in Kuwait. We aimed to assess the level of glycemic control in Kuwaiti adults with diabetes.MethodsThe World Health Organization’s STEPS non-communicable disease risk factor survey was conducted in Kuwait in 2014. Participants’ demographics, medical history, physical measurements and blood biochemistry were assessed. A total of 2561 Kuwaiti men and women aged 18–69 years completed all three survey steps. Glycemic control in 278 individuals with diabetes who were on glucose-lowering medication was determined using the US National Institutes of Health guidelines of fasting plasma glucose (FPG) ≤7.2 mmol/l and the American Diabetes Association guidelines of glycated hemoglobin (HbA1c) <7% (53 mmol/mol).ResultsAdequate glycemic control in people with drug-treated diabetes was 34.5% when determined by HbA1c, 37.8% when determined by FPG level, and 24.5% when both criteria were met. Mean body-mass index and fasting serum triglycerides were significantly higher and serum high-density lipoprotein-cholesterol significantly lower in individuals with an inadequate glycemic control than in those with adequate control. Women with diabetes were almost twice as likely to have inadequate HbA1c levels as men with diabetes (OR, 1.9, [95% CI, 1.03, 3.5]).ConclusionsGlycemic control in Kuwaiti adults with treated diabetes is low. A systemic, multi-disciplinary public health approach is needed to improve diabetes education and adherence to treatment.     

Relationship between glycemic control and chronic obstructive pulmonary disease in patients with type 2 diabetes: A nested case-control study

AimsTo evaluate the relationship between glycemic control and plasma glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2D) and the risk of chronic obstructive pulmonary disease (COPD).MethodsWe conducted a population-based, retrospective, nested, case-control study involving 124,876 patients with DM2 from the Canary Islands, Spain. From the cohort, we selected all COPD cases and, for each case, five control subjects who were COPD free. We analyzed the association between glycemic control, HbA1c level and incident COPD.ResultsA total of 1320 incidence cases of COPD (1.06%) were identified and matched individually with 6600 controls according to age and sex. After multivariate adjustment, the COPD risk increased among patients with poor glycemic control compared to patients with good glycemic control [HbA1c levels <7% (53 mmol/mol)] (OR 1.18; 95% CI: 1.03–1.36). In comparison with patients exhibiting HbA1c levels <7% (53 mmol/mol), the risk of COPD was higher among people with HbA1c levels of 7–8% (53–64 mmol/mol) (OR 1.24; 95% CI: 1.05–1.47) and 8–9% (64–75 mmol/mol) (OR 1.31; 95% CI: 1.04–1.66).ConclusionsPoor glycemic control reveals a weak association with increased risk of COPD in T2D patients.     

Diabetes subgroups and risk for complications: The Multi-Ethnic Study of Atherosclerosis (MESA)

AimsTo characterize diabetes subgroups among a multi-ethnic cohort and assess risk for incident complications.MethodsWe included 1587 participants from the Multi-Ethnic Study of Atherosclerosis with diabetes. We characterized eight diabetes subgroups according to absolute thresholds for disease characteristics: age at diabetes diagnosis (≤45 years), fasting glucose (FG ≥7.7 mmol/L; ≥140 mg/dL), and waist circumference (women ≥105 cm; men ≥110 cm). We estimated risk for mortality, incident cardiovascular disease, chronic kidney disease, heart failure, dementia, and retinopathy, respectively, over 17 years after adjustment for demographics, behavioral, clinical risk factors, and cohort attrition.ResultsThe subgroup with both high FG and early age at onset was associated with higher risk for death, CVD, heart failure, CKD, and retinopathy and the subgroup with both early age at onset and high waist circumference was associated CVD, heart failure, CKD, and retinopathy. The subgroup that met all three high-risk thresholds had greater risk for death, heart failure, CKD, and retinopathy. We did not observe evidence for synergistic or antagonistic joint effects of the high-risk characteristics for any outcome.ConclusionsOur work supports differential risk for various diabetes complications among exclusive subgroups defined by age at diabetes onset, fasting glucose, and central adiposity.     

Impact of comorbid conditions and race/ethnicity on glycemic control among the US population with type 2 diabetes, 1988–1994 to 1999–2004

ObjectiveTo measure trends in glycemic control in type 2 diabetes in the United States from 1988–1994 to 1999–2004 and to identify factors influencing glycemic control, including the presence of comorbid conditions and race/ethnicity.MethodsParticipants in the National Health and Nutrition Examination Surveys (1988–1994 and 1999–2004) aged ≥30 years with diagnosed type 2 diabetes were identified. Outcome measures included glycemic control [glycosylated hemoglobin (A1C) <7%] and pharmacologic treatment rate. Comorbid conditions assessed included obesity, hyperlipidemia, and hypertension.ResultsPrevalence of type 2 diabetes increased from 5.8% in 1988–1994 to 7.1% in 1999–2004. Rates of treatment for type 2 diabetes improved, from 72.3% to 82.2%. The proportion of patients who achieved A1C <7% did not change significantly (44.4% to 50.1%, P=.06); however, blood pressure and cholesterol level both improved. During 1999–2004, only 14% of persons treated for type 2 diabetes did not have an additional comorbid condition; 21% had all three comorbid conditions. During 1999–2004, among treated patients, non-Hispanic blacks were 0.43 times as likely (95% CI 0.29–0.63), and Mexican Americans were 0.47 times as likely (95% CI 0.32–0.68), to have A1C <7% compared to non-Hispanic whites.ConclusionsDespite improved treatment rates, one in two individuals with type 2 diabetes has A1C of ≥7%. Most type 2 diabetic subjects also suffer from hypertension, hyperlipidemia, and/or obesity, and glycemic control rates were lowest for those with all three conditions. Non-Hispanic blacks and Mexican Americans are less likely to achieve glycemic control as compared to non-Hispanic whites.     

Trends in depression by glycemic status: Serial cross-sectional analyses of the National Health and Nutrition Examination Surveys, 2005–2016

AimsWe examined changes in the prevalence of elevated depressive symptoms among US adults with diabetes, prediabetes, and normal glycemic status during 2005–2016.MethodsWe analyzed data from 32,676 adults in the 2005–2016 National Health and Nutrition Examination Surveys. We defined diabetes as self-reporting a physician diagnosis of diabetes or A1C ≥ 6.5% [48 mmol/mol], and prediabetes as A1C 5.7–6.4% [39–46 mmol/mol]. We used the 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10 or antidepressant use to define ‘clinically significant depressive symptoms’ (CSDS) and PHQ-9 score ≥ 12 as ‘Major Depressive Disorder’ (MDD). We calculated prevalence age-standardized to the 2000 US census and used logistic-regression to compute adjusted odds of CSDS and MDD for 2005–2008, 2009–2012, and 2015–2016. We analyzed the prevalence of A1C ≥ 9.0% [75 mmol/mol], systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, non-HDL cholesterol ≥ 130 mg/dL, and current smoking among adults with diagnosed diabetes by depressive status.ResultsThe prevalence of CSDS increased among individuals with normal glycemic status from 15.0% (13.5–16.2) to 17.3% (16.0–18.7) (p = 0.03) over 2005–2016. The prevalence of CSDS and MDD remained stable among adults with prediabetes (~ 16% and 1%, respectively) and diabetes (~ 26% and ~3%). After controlling for glycemic, sociodemographic, economic, and self-rated health variables, we found 2-fold greater odds of CSDS among unemployed individuals and 3-fold greater odds among those with fair/poor self-rated health across all survey periods. Cardiometabolic care targets for adults with diagnosed diabetes were stable from 2005 to 2016 and similar across depressive status.ConclusionsOne-fourth of adults with diabetes have comorbid CSDS; this prevalence remained stable over 2005–2016 with no change in diabetes care. At the population level, depression does not appear to impact diabetes care, but further research could explore subgroups that may be more vulnerable and could benefit from integrated care that addresses both conditions.     

Poor quality of sleep in Mexican patients with type 2 diabetes and its association with lack of glycemic control

AimsTo determine the association between sleep quality and lack of glycemic control in a Mexican population of type 2 diabetes patients.MethodsCross-sectional study. Two hundred two patients between 20 and 60 years old with a previous diagnosis of diabetes were included. Sleep quality was assessed with the Pittsburgh Sleep Quality Index and lack of glycemic control as a glycated hemoglobin A1c level ≥ 7 %. Univariate and multivariate analyses using logistic regression were performed.ResultsThe study population showed poor sleep quality and a lack of glycemic control of 70.3 % and 69.8 %, respectively. The prevalence of patients with both conditions was 52.5 %. In multivariate analysis, poor sleep quality was significantly associated with a lack of glycemic control (OR = 2.3, p = 0.030). Other associated variables were napping (p = 0.015), diabetes duration (p = 0.011), insulin use (p = 0.024), and diastolic blood pressure ≥ 85 mmHg (p = 0.029).ConclusionsThe prevalence of lack of glycemic control in the study population is high. Poor sleep quality significantly doubles the risk of lack of glycemic control, even in the presence of other risk factors.     

Target attainment in insulin-naive patients at high risk for hypoglycemia: Results from ACHIEVE Control

AimsTo better understand outcomes in people with type 2 diabetes at high risk of hypoglycemia, we conducted post hoc analyses in subgroups of participants from the real-world ACHIEVE Control study (NCT02451137) with ≥1 hypoglycemia risk factor.MethodsInsulin-naive adults with type 2 diabetes and A1c ≥8% were randomized 1:1 to insulin glargine 300 U/mL (Gla-300) or standard-of-care basal insulin (SOC-BI). Participants had documented history of ≥1 risk factors for hypoglycemia: chronic kidney disease, cardiovascular disease, dementia or blindness, age ≥65 years, or history of hypoglycemia. Outcomes included individualized A1c target attainment without documented symptomatic hypoglycemia (blood glucose [BG] ≤3.9 mmol/L or <3.0 mmol/L) or severe hypoglycemia, A1c target attainment, and absence of documented symptomatic or severe hypoglycemia at 6 and 12 months.ResultsWithin subgroups, odds ratios generally showed trends favoring Gla-300 versus SOC-BI, particularly for hypoglycemia avoidance in participants ≥65 years of age (BG ≤3.9 mmol/L; odds ratio, 1.52; 95% confidence interval, 1.14–2.03) and those with chronic kidney disease (BG ≤3.9 mmol/L; odds ratio, 2.28; 95% confidence interval, 1.26–4.12). Results were consistent with the overall population.ConclusionsThese data suggest potential benefit of Gla-300 versus SOC-BI for avoiding hypoglycemia in participants with ≥1 hypoglycemia risk factor.     

Mortality differentials by previous diagnosis of diabetes and glycemic status in the United States

AimsThis study examines mortality differences associated with current glycemic status in mortality by current glycemic status among adults with a previously diagnosed diabetes. Using previous clinical diagnosis of diabetes (diagnosed diabetes) and laboratory measures of hemoglobin A1c (HbA1c) measured at baseline, we estimated mortality differentials simultaneously by diagnosed diabetes and baseline glycemic status in the United States.MethodsData were from 39,491 adults aged 30–84 years assessed in the National Health and Nutrition Examination Survey (NHANES) III and continuous NHANES 1999–2014 linked to mortality data. We categorized participants into four mutually exclusive groups based on diagnosed diabetes and glycemic control measured by HbA1c ≥6.5 % at baseline. Relative hazard ratio (HR) of all-cause death among these four groups were estimated using Cox proportional models.ResultsThere was no significant difference in mortality by glycemic control status among adults with diagnosed diabetes. The same finding was observed among adults without diagnosed diabetes. Adults with diagnosed diabetes had higher mortality than adults without diagnosed diabetes independent of their baseline glycemic control.ConclusionsOnce diagnosed with diabetes, US adults with normal- and hyper-glycemia showed no significant difference in all-cause mortality. This finding emphasizes the importance of primary prevention interventions among adults with a sign of early-stage diabetes.     

All-cause and cardiovascular mortality risk in U.S. adults with and without type 2 diabetes: Influence of physical activity,pharmacological treatment and glycemic control

AimsThis study determined the joint association between physical activity, pharmacotherapy, and HbA1c control on all-cause and cardiovascular disease (CVD) mortality risk in adults with and without type 2 diabetes (T2D).Methods12,060 adults from NHANES III and NHANES continuous (1999–2002) surveys were used. Cox proportional hazards analyses were included to estimate mortality risk according to physical activity, pharmacotherapy, and glycemic control (HbA1c < 7.0%) status, with physically active, treated and controlled (goal situation) as the referent.ResultsCompared to the referent, adults with T2D who were uncontrolled, or controlled but physically inactive had a higher all-cause mortality risk (p < 0.05). Compared to the referent, only adults with T2D who were physically inactive had a higher CVD mortality risk, regardless of treatment or control status (p < 0.05). Normoglycemic adults had a similar all-cause and CVD mortality risk as the referent (p > 0.05).ConclusionsPhysical activity and glycemic control are both associated with lower all-cause and CVD mortality risk in adults with T2D. Adults with T2D who are physically active, pharmacologically treated, and obtain glycemic control may attain similar mortality risk as normoglycemic adults.     

Factors associated with poor glycemic control among patients with Type 2 diabetes

ObjectivesDetermine factors associated with poor glycemic control among Jordanian patients with Type 2 diabetes.MethodsA systematic random sample of 917 patients was selected from all patients with Type 2 diabetes over a period of 6 months in 2008. A prestructured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviours, medication adherence, barriers to adherence, and attitude towards diabetes. Weight, height, and waist circumferences were measured. All available last readings of hemoglobin A1c (HbA1c), fasting blood sugar measurements and lipid were abstracted from patients' records. Poor glycemic control was defined as HbA1c ≥7%.ResultsOf the total 917 patients, 65.1% had HbA1c ≥7%. In the multivariate analysis, increased duration of diabetes (>7 years vs. ≤7years) (OR=1.99, P≤.0005), not following eating plan as recommended by dietitians (OR=2.98, P≤.0005), negative attitude towards diabetes, and increased barriers to adherence scale scores were significantly associated with increased odds of poor glycemic control.ConclusionThe proportion of patients with poor glycemic control was high, which was nearly comparable to that reported from many countries. Longer duration of diabetes and not adherent to diabetes self-care management behaviors were associated with poor glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence to treatment regimen would be of great benefit in glycemic control.     

Comparison of demographic factors and cardiovascular risk factor control among U.S. adults with type 2 diabetes by insulin treatment classification

AimsData on glucose and cardiovascular disease (CVD) risk factor control among persons with type 2 diabetes mellitus (DM) according to insulin treatment status are lacking. We examined DM control, risk factors, and comorbidities among U.S. persons according to insulin treatment status.MethodsIn the U.S. National Health and Nutrition Examination Surveys 2003–2006, we examined in 10,637 adults aged ≥ 30 with type 2 DM the extent of control of A1c, LDL-C, HDL-C, triglycerides, and blood pressure (BP) and composite goal attainment by insulin use status.Results6.6% (n = 889, projected to 14.3 million) had type 2 DM; of these, 22.9% were insulin users and 57.2% were treated only by other diabetes medications. Overall, 58.2% had an A1c < 7% (53 mmol/mol) (insulin users 33.1%, non-insulin treated 66.1%, and 77.9% of those not on medication, p < 0.0001). Overall, 44.2% were at a BP goal of < 130/80 mmHg, 43.8% had an LDL-C < 100 mg/dl (2.6 mmol/L), and 13.9% a BMI < 25 kg/m². Only 10.2% were simultaneously at A1c, LDL, and BP goals (5.4% of those on insulin).ConclusionsU.S. adults with type 2 DM, especially those treated with insulin remain inadequately controlled for A1c and CVD risk factors and have a high prevalence of comorbidities.     

Cardiometabolic profile of people screened for high risk of type 2 diabetes in a national diabetes prevention programme (FIN-D2D)

AimsTo study screening of high-risk individuals as part of a national diabetes prevention programme in primary health care settings in Finland between 2003 and 2007, and evaluate the cardiometabolic risk profile of persons identified for intervention.MethodsHigh-risk individuals were identified by the Finnish Diabetes Risk Score (FINDRISC), history of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), cardiovascular disease (CVD), or gestational diabetes. Participants subsequently underwent an oral glucose tolerance test. CVD morbidity risk was estimated by the Framingham Study Risk Equation and CVD mortality risk by the Systematic Coronary Risk Evaluation Formula (SCORE).ResultsA high-risk cohort of 10,149 (of whom 30.3% men) was identified (mean age 54.7 for men, 53.0 for women). Altogether 18.8% of men and 11.5% of women had screen-detected diabetes. In total 68.1% of men and 49.4% of women had abnormal glucose tolerance (IFG, IGT or screen-detected diabetes). Furthermore, 43.2% and 41.5% of men, and 13.3% and 11.3% of women, respectively, had a high predicted risk of CVD morbidity or mortality.ConclusionPrevalence of dysglycemia including undiagnosed diabetes and the predicted risk for CVD was alarmly high in the identified high-risk cohort, particularly in men.     

Sex-influenced association between free triiodothyronine levels and poor glycemic control in euthyroid patients with type 2 diabetes mellitus

ObjectiveThe study investigated the association between free triiodothyronine (FT3) and poor glycemic control with different definitions in euthyroid patients with type 2 diabetes mellitus (T2DM).MethodsThis was a cross-sectional study which included 2172 patients from National Metabolic Management Center in Ruijin Hospital. The association between thyroid function and glycated hemoglobin A1c (HbA1c) was determined by multiple liner regression models. The association between FT3 and poor glycemic control was further determined by binary logistic regression models. Two definitions of poor glycemic control (HbA1c ≥ 7% and HbA1c ≥ 8%) were applied when we analyzed the association.ResultsPrevalence of HbA1c ≥ 7% and HbA1c ≥ 8% were 63.8% and 39.3%, respectively. After adjusting for confounding factors, FT3, rather than free tetraiodothyronine (FT4) or thyroid stimulating hormone (TSH), was independently associated with HbA1c (β = −0.104, P = 0.002). Further analysis after gender stratification showed that the association was only found in males (β = −0.164, P < 0.001). We further analyzed the association between FT3 quartiles and poor glycemic control. FT3 quartiles were not significantly associated with the risk of HbA1c ≥ 7% before and after adjusting for confounding factors in both genders. FT3 quartiles were negatively associated with the risk of HbA1c ≥ 8% only in males, independent of traditional risk factors for poor glycemic control (P for trend = 0.030).ConclusionsFT3 in the reference range was significantly associated with reduced risk of HbA1c ≥ 8% in males, independent of traditional risk factors for poor glycemic control.     

Serum uric acid and its change with the risk of type 2 diabetes: A prospective study in China

ObjectiveTo assess the association of baseline uric acid levels and their changes from baseline to Year 1 with the risk of type 2 diabetes.Research design and methodsThis study cohort included 9471 subjects without a history of diabetes at baseline. The incident diabetes was diagnosed according to the American Diabetes Association standard.ResultsDuring a mean follow-up of 2.9 years, we identified 762 type 2 diabetes cases. Multivariate-adjusted hazard ratios (HRs) of diabetes across baseline tertiles of serum uric acid were 1.00, 1.15, and 1.32 (P for trend = 0.018), respectively. Participants with hyperuricemia compared with those without had a 1.20-fold (95% confidence interval [CI] 1.01−1.44) risk of diabetes. When uric acid was examined as a continuous variable, multivariable-adjusted HR of diabetes for each 1 mg/dL (60 μmol/L) increase in serum uric acid was 1.09 (95% CI 1.03−1.15). Compared with subjects with stable serum uric acid from baseline to Year 1 (±10%), those with uric acid gain ≥30% had a 30% (95% CI 1.01–1.79) increased risk of diabetes and those with uric acid loss ≥10% had a 21% (95% 0.62−0.99) decreased risk of diabetes. This positive association between baseline serum uric acid and diabetes risk was consistent among subjects younger and older than 45 years, non-obese and obese participants, and men.ConclusionsHigh level of baseline serum uric acid and serum uric acid gain from baseline to Year 1 are associated with an increased risk of type 2 diabetes among Chinese adults.     

Improvement of glycemic control in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials

AimDifferent guidelines provide similar, but not identical, therapeutic targets for HbA1c in type 2 diabetes. These targets can also depend from the different pharmacological strategies adopted for intensifying glycemic control.Data synthesisThis meta-analysis includes randomized trials adopting any pharmacological regimen for intensifying glycemic control in T2DM (versus standard of care/placebo), with a trial duration ≥2 years and a between-group HbA1c difference≥0.5%. The primary outcome was to assess the effects of the improvement of glycemic control on major cardiovascular events (MACE), ocular and renal complications, and severe hypoglycemia. Mantel-Haenszel odds ratios (MH–OR) with 95% Confidence Intervals were calculated for all the outcomes considered.We included 13 trials fulfilling the inclusion criteria. The improvement of glycemic control was associated with a lower risk of MACE (MH–OR:0.89 [95%CI 0.85–0.94]) and renal adverse events (MH–OR 0.73 [0.65–0.82]), but not all-cause mortality (MH–OR 0.95 [0.88–1.01]) and ocular adverse complications (MH–OR 0.94 [0.72–1.22]). For glucose-lowering drugs inducing hypoglycemia, a protective effect on the risk of microvascular complications, but not of MACE and all-cause mortality, was observed only for HbA1c ≤ 48 mmol/mol, but with higher risk of severe hypoglycaemia (MH–OR 2.72 [1.79–4.13]). Drugs not inducing hypoglycaemia were associated with a reduction of MACE, renal adverse events, and all-cause mortality, for HbA1c< 7% (no data for lower targets).ConclusionsThe present meta-analysis show that the improvement of glycemic control with drugs not inducing hypoglycemia is associated with a reduction in the risk of long-term chronic vascular and renal complications, and all-cause mortality.     

Marginal association of fasting blood glucose with the risk of cystic fibrosis-related diabetes

ObjectivesCystic fibrosis-related diabetes (CFRD) may be diagnosed by fasting blood glucose ≥ 7.0 mmol/L and/or glucose ≥ 11.1 mmol/L following oral glucose tolerance test (OGTT). We compared the role of fasting and stimulated glucose for diagnosis of CFRD.MethodsWe performed a cross-sectional review of the prevalence of fasting glycemic abnormalities and Kaplan-Meier survival analysis of risk of progression to CFRD according to baseline fasting glucose in the prospective Montreal Cystic Fibrosis Cohort.ResultsIsolated fasting hyperglycemia was detected in only 8% of participants at study onset. Eighty percent of subjects had isolated post-challenge hyperglycemia on their first OGTT meeting criteria for CFRD. Kaplan Meier survival analysis demonstrated that impaired fasting glucose (IFG) alone is not a risk factor for CFRD. Subjects with combined IFG and impaired glucose tolerance at baseline (IGT) had the highest risk of progression to CFRD.ConclusionPost-prandial elevations in blood glucose are more common at diagnosis of CFRD. While IGT is a significant risk factor for CFRD, IFG alone is uncommon and does not increase the risk of CFRD. Patients with both IGT and IFG have the highest risk of CFRD.