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.     

Seasonal variation of hemoglobin A1c levels in patients with type 2 diabetes

The purpose of our study was to retrospectively examine the association between hemoglobin A1c (HbA1c) with season variation in patients with type 2 diabetes from the Chinese mainland. Monthly average of HbA1c values of type 2 diabetes patients in Jinan Central Hospital between 2008 and 2011 were respectively reviewed. The effects of sex, age, and season on HbA1c levels were analyzed. Moreover, a multiple linear regression analysis was performed to discuss the correlations between HbA1c levels and sex, age, and season. The HbA1c levels were significantly higher in winter (December, January, and February) and significantly lower in summer (June, July, and August). Significant difference was found for HbA1c between men and women in the elderly group (P < 0.01). The levels of HbA1c were similar in youth and middle groups (P > 0.05), but significantly lower in the elderly group (P < 0.05). Additionally, negative correlations of HbA1c with season, age, and gender were identified (P < 0.01). Our study suggests that cold weather may elevate the levels of HbA1c in type 2 diabetic patients in mainland China. However, more detailed studies are needed to reveal the variation of HbA1c with age and gender.     

V-shaped relationship between HbA1c and all-cause mortality in the elderly with type 2 diabetes

PurposeThe optimal glycemic target for elderly patients with diabetes has not been established. The purpose of this study was to elucidate relationship between HbA1c and mortality in elderly patients with diabetes.SubjectsThree hundred consecutive elderly (≥ 65 yrs) patients with type 2 diabetes mellitus admitted for control of hyperglycemia between 2002 and 2010 were registered. Upon mortality survey at the end of 2012, 201 (70%) of them were traceable (men/women 121/80, mean age 71 yrs, duration of diabetes 11 yrs and HbA1c 9.9%). The analysis took account of the following baseline information: gender, age, duration of diabetes, HbA1c, body mass index, systolic blood pressure, eGFR, urinary albumin excretion, serum lipid levels and use of insulin and oral hypoglycemic agents. The follow-up HbA1c was also recorded.ResultsThe mean follow-up period was 5.7 yrs and 45 of the patients have died. The mortality hazard as a function of the baseline HbA1c quartile was significantly V-shaped with the nadir in quartile 2 (HbA1c 8.5–9.4%) (P = 0.02), and this relationship remained significant after adjustment for the confounders such as estimated glomerular filtration rate and insulin use. The follow-up HbA1c was 7.7 ± 1.6% and not significantly related to mortality.Discussion/ConclusionThere was a V-shaped relationship between baseline HbA1c and all-cause mortality in elderly patients with insufficiently controlled glycemia. The nadir was in Q2 in which the HbA1c value was 8.5–9.4%. No significant relationship was found between the follow-up HbA1c and mortality. Further studies are needed to clarify the relationship between HbA1c and mortality in the elderly.     

2型糖尿病患者糖化血红蛋白衰减动力学研究

目的 研究T2DM患者胰岛素强化治疗后HbA1c衰减动力学. 方法 选取胰岛素强化治疗后血糖达标并可持续控制血糖患者41例,随访3个月血糖和HbA1c水平,建立HbA1c衰减动力学模型. 结果 血糖达标后,HbA1c于1周后开始下降,其后下降基本呈线性,衷减速率0.071（0.062,0.077）％/d,半衰期39.4（31.7,44.6）d,衰减方程y=-0.0706×（x-7）＋治疗前HbA1c. 结论 T2DM患者经胰岛素强化治疗达标后,根据HbA1c衰减方程计算结果,与相应时间点HbA1c检测值比较,可初步判断HbA1c是否能达标,并指导治疗措施调整.     

Distinct trajectories in HbA1c are associated with different all-cause mortality and morbidity in newly diagnosed patients with type 2 diabetes

AimsTo identify trajectories of long-term HbA1c levels and examine associations with subsequent risk for morbidity and mortality.MethodsWe conducted a longitudinal follow-up among 27,724 patients, newly diagnosed with type 2 diabetes, in a large healthcare organization. We identified trajectories of long-term HbA1c levels during the first 5 years post diabetes onset to examine associations with subsequent risk for morbidity and all-cause mortality.ResultsWe identified two HbA1c trajectories; the “Steady-plateau HbA1c trajectory” in 93% of patients and a “Sharp-incline HbA1c trajectory” in 7% of patients. When compared to the steady-plateau group, patients in the sharp-incline group were younger, male, from a lower socio-economic background, and higher levels of HbA1c at baseline. Patients in the sharp-incline trajectory had a HR = 1.83 (95%CI: 1.58–2.12) for all-cause mortality, HR = 1.99 (95%CI: 1.74–2.27) for cardiovascular disease, and HR = 1.68 (95%CI: 1.51–1.86) for renal disease, compared to patients in the steady-plateau trajectory.ConclusionsPatients in the sharp-incline trajectory had a higher risk for all-cause mortality, cardiovascular disease, and renal disease, compared to patients in the steady-plateau trajectory. Estimation of HbA1c variability in the first years of diagnosis may be a useful indicator of those patients at high risk for diabetes related complications.     

Proteinuria predicts 10-year cancer-related mortality in patients with type 2 diabetes

BackgroundWe conducted a cohort study to determine if proteinuria predicts cancer-related mortality in type 2 diabetic subjects.MethodsBetween July 1996 and June 2003, we enrolled 646 type 2 diabetic subjects. Participants were followed-up until December 31, 2008. The vital status was ascertained by linking records with computerized death certificates in Taiwan.ResultsDuring a median follow-up of 10.4 years, 158 subjects had died, including 59 from cancers. Subjects with proteinuria had a hazard ratio (HR) of 2.77 (95% CI 1.82–4.21) for all-cause mortality and 1.99 (95% CI 1.00–3.94) for cancer-related mortality after adjustment for demographic factors and medical conditions. Specifically, proteinuria showed a trend of increased colon cancer death. The presence of proteinuria significantly improved the predictive ability of cancer-related mortality (increase in concordance statistics or area under the ROC curve = 0.03). Patients with both proteinuria and estimated glomerular filtration rate < 60 ml/min per 1.73 m² showed higher HR for all-cause mortality than patients with proteinuria only (adjusted HRs (95% CI), 4.01 (2.42–6.67) vs. 2.69 (1.51–4.79), both p < 0.01).ConclusionsProteinuria can predict 10-year all-cause and cancer-related mortalities independently in type 2 diabetic subjects, over and above the established risk factors associated with type 2 diabetes.     

Nerve function varies with hemoglobin A1c in controls and type 2 diabetes

Aims

To determine the cross-sectional threshold at which hemoglobin A1c (HbA1c) is associated with polyneuropathy in healthy controls, and the values associated with the most pronounced decline in nerve function in patients with diabetes.

Association of anxiety and hemoglobin A_1c in patients with type 2 diabetes mellitus

<正>Objective To investigate the association between anxiety and hemoglobin A1c(Hb A1c)in patients with type 2 diabetes mellitus(T2DM).Methods Cluster sampling was used in this study.The sell-designed questionnaire,self-rating anxiety scale(SAS)and self-rating depression scale(SDS)questionnaire were filled out by all     

Association between HbA1c variability and mortality in patients with type 2 diabetes

AimsWe aimed to evaluate the association between HbA1c variability and mortality due to all causes, cancer, and non-cancer in patients with type 2 diabetes independently of mean HbA1c levels.MethodsWe enrolled 754 patients with type 2 diabetes who first visited our hospital between 1995 and 1996, had been followed for at least 2 years, and had undergone four or more HbA1c determinations. Patients were followed through June 2012. The standard deviation (SD) or coefficient of variation (CV) was used as a measure of HbA1c variability. Risk of death was evaluated by multivariate Cox proportional hazard models.ResultsThrough June 2012, 63 patients died. Hazard ratios (HRs) for all-cause mortality and non-cancer mortality including cardiovascular diseases (CVD) increased across tertiles of both HbA1cSD and HbA1cCV. HRs for cancer mortality did not increase across tertiles of either HbA1cSD or HbA1cCV. Using a stepwise regression method, both HbA1cSD and HbA1cCV predicted all-cause mortality, especially non-cancer mortality. In contrast, mean HbA1c predicted cancer mortality.ConclusionsHbA1c variability is a predictor of all-cause mortality, especially non-cancer mortality including CVD, in patients with type 2 diabetes, independent of mean HbA1c level. In contrast, mean HbA1c, but not HbA1c variability, might predict cancer mortality.     

Relationship between glycated hemoglobin A1c and cognitive function in nondemented elderly patients with type 2 diabetes

Elderly patients with type 2 diabetes are at a greater risk for cognitive decline. The purpose of this study was to assess the relationship between the degree of hyperglycemia and cognitive status in nondemented, elderly diabetics. Between Jan 2013 and Dec 2014, 1174 geriatric patients with type 2 diabetes were enrolled in the study (579 males; age?≥?60 years; from Fuzhou, Fujian, China). Cognitive function was measured with the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). A statistically significant, age-adjusted association was observed between the A1C levels and the scores on two cognitive tests (MMSE and MoCA). Specifically, a 1 % higher A1C value was associated with a 0.21-point lower MMSE score (95 % CI; compare ?0.11to ?0.28; P?<?0.0001), as well as a 0.11-point lower MoCA score (95 % CI; compare ?0.10 to ?0.38; P?<?0.0001). Higher A1C levels were not significantly associated with lower MMSE and MoCA test scores after adjusting for all variables. No significant correlation was found between the two variables in patients older than 80 years of age (n?=?215; OR?=?1.019; 95 % CI?=?0.968???1.099; p?=?0.251). Evidence strongly suggests that chronic hyperglycemia is associated with a decline in cognitive function in nondemented elderly patients with type 2 diabetes. When cognitive assessments are made, comprehensive factors such as advanced age, education level, duration of diabetes, hypertension and other vascular risks should be taken into account. For older geriatric patients (age ≥80 years), there is no significant correlation between A1c levels and cognitive function.     

Duration of type 2 diabetes strongly predicts all-cause and cardiovascular mortality in people referred for coronary angiography

ObjectiveType 2 diabetes represents a major cardiovascular risk factor. However, few studies have addressed the impact of the disease duration on mortality. Thus, we aimed to investigate the predictive value of diabetes duration for all-cause and cardiovascular mortality in subjects undergoing coronary angiography.MethodsWe studied 2455 participants of the LUdwigshafen RIsk and Cardiovascular health study (1768 males/687 females). They had a mean ± standard deviation (SD) age of 63.1 ± 9.0 years (range: 40.0–79.9) and a mean ± SD body mass index of 27.7 ± 4.0 kg/m². 704 subjects were newly diagnosed with type 2 diabetes according to the 2010 criteria of the American Diabetes Association and 446 subjects had a known history of type 2 diabetes. The mean ± SD duration of the follow-up for all-cause and cardiovascular mortality was 7.4 ± 2.3 years.ResultsA total of 543 deaths occurred during the follow-up. Among these, 343 were accounted for by cardiovascular diseases. The duration of type 2 diabetes was strongly and positively correlated with all-cause and cardiovascular mortality (both P < 0.001). The multivariate adjusted hazard ratios (95% confidence intervals) for cardiovascular mortality compared to subjects without diabetes were 1.76 (1.34–2.32), 2.86 (2.00–4.08), 2.96 (1.85–4.74), and 4.55 (3.24–6.39) for subjects with new onset type 2 diabetes and subjects with known type 2 diabetes (duration ≤5, >5 and ≤10, >10 years), respectively.ConclusionsThe data emphasise the need to consider the diabetes duration for the prediction of mortality in subjects at intermediate to high cardiovascular risk.     

Elevated third-trimester haemoglobin A 1c predicts preterm delivery in type 1 diabetes

The prevalence of preterm delivery is considerably elevated in women with type 1 diabetes. The aim of the study was to evaluate haemoglobin A(1c) (HbA(1c)) as a predictor of preterm delivery. Two hundred thirteen consecutive pregnant women with type 1 diabetes and normal urinary albumin excretion were included prospectively. HbA(1c) was analyzed at 10, 20 and 28 weeks of gestation. Seventy-one women (33%) delivered pre term and 142 at term. At 10 weeks of gestation, HbA(1c) was 7.3% (S.D. 1.0) vs. 6.9% (S.D. 0.9) (P<.01), at 20 weeks of gestation 6.6% (S.D. 0.7) vs. 6.1% (S.D. 0.7) (P<.001) and at 28 weeks of gestation 6.7% (S.D. 0.8) vs. 6.1% (S.D. 0.7) (P<.001). When comparing HbA(1c) at 10, 20 and 28 weeks of gestation, HbA(1c) at 28 weeks of gestation (P<.001) was the best predictor of preterm delivery. The adjusted odds ratio per 1% increment in HbA(1c) at 28 weeks of gestation was 2.8 (95% CI 1.7-4.4). HbA(1c) at 28 weeks of gestation was a clinical significant predictor of preterm delivery in type 1 diabetes.