bluuebunny/crossref_metadata_2025 huggingface dataset:
Comorbidity of Diabetes and Chronic Sleep Disturbances and Consumption of a Mediterranean-Style Diet
Authors: GUYER HEIDI
Published: June 2018

Objective: This study assessed whether comorbidity of diabetes and chronic sleep disturbances was associated with less healthy dietary consumption, defined as a Mediterranean-style Diet, compared to adults with only one or neither of the conditions.

Research Design and Methods: Participants were selected from the Health and Retirement Study (HRS). Diabetes status and chronic sleep disturbances were assessed during the 2010 interview. Participants were categorized into one of four groups: no sleep disturbances or diabetes, sleep disturbances, diabetes, or sleep disturbances and diabetes. 7,423 participants completed a food frequency questionnaire by mail from which the alternative Mediterranean Diet (aMedDiet) score was assessed. Logistic regression was used to determine the odds of consuming an aMedDiet based on comorbidity of diabetes and chronic sleep disturbances. Models were stratified by gender.

Results: After adjusting for age and caloric intake, men with diabetes were more likely to consume an aMedDiet in the highest quartile (OR 1.45; 95% CI 1.11-1.91) than men with neither chronic sleep disturbances nor diabetes. The magnitude of the association increased after adjustment for additional demographic and health variables (OR 1.70, 95% CI 1.25-2.29). Women with sleep disturbances were less likely to consume an aMedDiet than those without sleep disturbances. The reduction in the odds of consuming an aMedDiet was greatest among women with comorbidity of the two conditions (OR 0.53, 95% CI 0.37-0.77) yet was also significant among those with chronic sleep disturbances alone (OR sleep disturbances 0.71, 95% CI 0.56-0.90). The results in women were attenuated after multivariate adjustment.

Conclusion: Chronic sleep disturbances reduce healthy dietary intake in adults with diabetes.

Disclosure

H. Guyer: None.
No Increased Risk of Breast Cancer in Patients Exposed to Insulin Glargine Compared with Human NPH Insulin
Authors: BOYLE PETER , WU CHUNTAO , SHARMA KRISTEN , LIN STEPHEN L. , JUHAERI JUHAERI
Published: June 2018

The objective of this study was to compare the risks of breast cancer in women treated with insulin glargine and NPH using claims data. The MarketScan and Clinformatics databases were used to identify patients prescribed glargine or NPH in the study periods of January 2007 to March 2016 and July 20to June 2016, respectively. The risks of breast cancer in patients prescribed glargine relative to NPH were compared using three approaches: (1) on-treatment, (2) intent-to-treat and (3) time-dependent analysis. The overall and follow-up period stratified adjusted hazard ratios (aHRs) for breast cancer for glargine compared to NPH were obtained using Cox proportional hazards modelling controlling for potential confounders.In the MarketScan database, 75,422 glargine and 21,491 NPH patients were identified, of which 42,491 glargine and 7,826 NPH patients were new users. Using the Clinformatics database, 65,648 glargine and 16,194 NPH patients were identified, including 47,118 and 10,560 new users, respectively. The overall aHRs for breast cancer for glargine compared to NPH ranged from 0.90 (95% CI: 0.76-1.07) in the time-dependent analysis for all users in the Clinformatics database to 1.30 (95% CI: 0.76-2.25) in the on-treatment analysis for new users in the MarketScan database. In the MarketScan database, the aHRs stratified by the follow-up period (< 1, 1 - < 3, 3 - < 5 and ≥ 5 Years) ranged from 0.67 to 1.63. In the Clinformatics database the corresponding aHRs ranged from 0.85 to 1.40. All 95% confidence intervals (CIs) included the null value of 1. These findings suggest that the risk of breast cancer in patients prescribed glargine was not different from that in NPH patients.

In conclusion, the risks of breast cancer were not different between patients prescribed glargine and NPH. Additionally, no association between glargine and breast cancer was observed with follow-up longer than 5 years.

Disclosure

P. Boyle: Other Relationship; Self; Sanofi. C. Wu: Employee; Self; Sanofi. K. Sharma: Employee; Spouse/Partner; Sanofi US. S.L. Lin: Employee; Self; Sanofi. Employee; Spouse/Partner; Bristol-Myers Squibb Company. J. Juhaeri: Employee; Self; Sanofi. Other Relationship; Spouse/Partner; Sanofi.
Metformin and Risk of Hepatocellular Carcinoma in Taiwanese Patients with Type 2 Diabetes
Authors: TSENG CHIN-HSIAO
Published: June 2018

Background: Whether metformin may reduce hepatocellular carcinoma (HCC) risk requires confirmation.

Methods: Newly diagnosed type 2 diabetes patients during 1999-20with 2 or more prescriptions of antidiabetic drugs were enrolled from the Taiwan’s National Health Insurance. A total of 173917 ever users and 21900 never users of metformin were identified (unmatched cohort). A 1:1 matched-pairs cohort of 21900 ever users and 21900 never users based on propensity score was created. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using PS. Additionally, the interactions with aspirin and statin were evaluated.

Results: In the unmatched cohort, 619 never users and 2642 ever users developed HCC, with respective incidence of 668.0 and 330.7 per 100,000 person-years and overall hazard ratio of 0.49 (95% confidence interval: 0.45-0.54). The hazard ratio for the first (<25.7 months), second (25.7-56.9 months) and third (>56.9 months) tertile of cumulative duration of metformin therapy was 0.89 (0.81-0.98), 0.50 (0.46-0.56) and 0.23 (0.21-0.26), respectively. Analyses in the matched cohort showed an overall hazard ratio of 0.69 (0.62-0.78) and the hazard ratio for the respective tertile was 1.28 (1.10-1.50), 0.68 (0.57-0.82) and 0.35 (0.29-0.44). A significant interaction with metformin was observed for aspirin and statin.

Conclusions: Metformin is associated with a reduced risk of HCC in a dose-response pattern. Users of both metformin and aspirin or statin have the lowest risk.

Disclosure

C. Tseng: None.
Effect of Vitamin D Supplementation on Glucose Metabolism Biomarkers—A Meta-analysis of Randomized Controlled Trials
Authors: PIZOT CECILE , MULLIE PATRICK , MACACU ALINA , DRAGOMIR MIRUNA , BOYLE PETER , AUTIER PHILIPPE
Published: June 2018

Observational studies have linked higher serum concentrations of 25(OH)D with a reduced risk of diabetes. In order to assess the effect of vitaminD supplementation (VDS) on glucose metabolism biomarkers, a systematic review with meta-analysis of randomized-controlled trials (RCTs) was undertaken. RCTs published until February 2017 conducted in adults were selected if they examined the effect of VDS on glycosylated haemoglobin (HbA1c), fasting glucose (FG), fasting insulin (FI), or HOMA-IR. For each biomarker, summary mean differences (MDs) between intervention and placebo groups were computed using a random-effect model. A total of 48 (n=5,100 subjects), 80 (n=9,565), 58 (n=7,841), and 57 (n=7,763) RCTs were selected for the analyses on HbA1c, FG, FI and HOMA-IR, respectively, with a majority of studies conducted in Europe and the Middle-East. The summary MDs (95% confidence intervals) were: -0.06% (−0.12, 0.00) for HbA1c, -0.12 mmol/L (-0.20, -0.05) for FG, -8.53 pmol/L (-13.17, -3.90) for FI, and −0.35 (-0.54, -0.15) for HOMA-IR. High heterogeneity between studies was observed for all biomarkers (I² > 70%) and no evidence for publication bias was noted. Important differences appeared between countries. In the Middle-East, the results were -0.25 (−0.42, -0.08) for FG, -17.74 (-26.36, -9.11) for FI and -0.71 (-1.09, -0.32) for HOMA-IR, with high heterogeneity (I²=76%, 79%, 79% respectively). In Europe, the results were 0.01 (-0.06, 0.07) for FG, −0.59 (-6.86, 5.68) for FI and -0.04 (-0.19, 0.10) for HOMA-IR, with lower heterogeneity (I²=21%, 48%, 0% respectively). In studies with high dose of vitamin D (≥ 100 µg/d) and subjects with baseline 25(OH)D ≤ 20 ng/mL, the summary MDs for HB1Ac and FG were -0.09% (-0.24, 0.07) and -0.mmol/l (-0.16, 0.06). The influence of VDS on glucose metabolism biomarkers seems to be marginal. The reasons underlying the heterogeneity of results across countries is unknown but differences in the conduct of RCTs cannot be excluded.

Disclosure

C. Pizot: None. P. Mullie: None. A. Macacu: None. M. Dragomir: None. P. Boyle: Other Relationship; Self; Sanofi. P. Autier: Other Relationship; Self; Sanofi.
Both Diabetes Duration and Cumulative Hyperglycemic Exposure Promote Myocardial Fibrosis and Increase Coronary Microvascular Resistance Evaluated by Comprehensive Myocardial CT Perfusion
Authors: CHOU SHENGPU , HARAGUCHI MIKIKO , FUJINO YUSUKE , TOMIZAWA NOBUO , NOJO TAKESHI , NAKAMURA SUNAO
Published: June 2018

Background: Diabetes cardiomyopathy is raising attention recently, however, there is few clinical study to evaluate changes in the early stage before clinical signs appear. The present study investigated the risk of diabetes duration and cumulative hyperglycemic exposure (CHE) to myocardial extracellular volume (ECV), a marker of myocardial fibrosis, and coronary microvascular resistance (CMVR) assessed by dynamic myocardial CT perfusion (DMCTP).

Material and Methods: We assessed 192 patients who had undergone DMCTP from April 2016 to October 2017. Patients with significant coronary stenosis and previous stent intervention were excluded. ECV of myocardium was calculated from CT delay enhancement subtraction image. CMVR was derived from the diastolic pressure gradient divided by myocardial blood flow. We defined HbA1c debt as sum of elevated HbA1c in recent 10 years as the indicator of CHE. The impacts of diabetes duration and HbA1c debt to ECV and CMVR were analyzed by multivariable analysis.

Results: Diabetic patients showed significant increase of ECV (30.4±4.4% vs. 25.9±3.8%, p <0.05) and CMVR (32.2±22.6 vs. 18.6±7.0, p <0.01) compared with those without diabetes. Diabetes duration was positively related to ECV (r=0.313) and CMVR (r=0.411) respectively. A positive correlation also existed between HbA1c debt and ECV (r=0.373), and CMVR (r=0.442) respectively. Grouping patients in relation to diabetes duration presented that longer duration elevated ECV and CMVR significantly (p<0.01). Elevation of HbA1c debt was also related to increase of ECV and CMVR (p<0.01).

Conclusion: Diabetes induces myocardial fibrosis and increases microvascular resistance since the very early stage. Both longer diabetes duration and CHE are risk factors to the progression of microcirculatory disorders, suggesting that good glycemic control is warranted to reduce risk of diabetes cardiomyopathy.

Disclosure

S. Chou: None. M. Haraguchi: None. Y. Fujino: None. N. Tomizawa: None. T. Nojo: None. S. Nakamura: None.
Impacts of the Kumamoto Earthquake 2016 on Glycemic Control in Diabetic Patients
Authors: KONDO TATSUYA , MIYAKAWA NOBUKAZU , MOTOSHIMA HIROYUKI , ISHII NORIO , IGATA MOTOYUKI , YOSHINAGA KAYO , KUKIDOME DAISUKE , SENOKUCHI TAKAFUMI , KAWASHIMA JUNJI , MATSUMURA TAKESHI , ARAKI EIICHI
Published: June 2018

In April 14th and 16th, 2016, Kumamoto area was severely damaged by massive M7 class earthquakes. To examine the effects of these earthquakes on glycemic control and stress factors in diabetic outpatients regularly cared in diabetic clinic of Kumamoto University Hospital, sequential HbA1c, glycated albumin, other biochemical parameters, life style associated questionnaire and Impact of Event Scale-Revised (IES-R) scores were analyzed. A total of 557 patients were enrolled and data were collected from 13 months before to 13 months after the earthquakes. In patients with type 1 diabetes (T1D) or specific types of diabetes due to other causes, glycemic control was not altered during the observational period. This glycemic stability in T1D may result from self-management of insulin doses (increase in 7% and decrease in 20% of patients). In patients with type 2 diabetes (T2D), HbA1c was decreased by 0.11% (from 7.33% to 7.22%) at 1-2 months after the earthquakes compared to that before the earthquakes, and increased at 3-4, 6-7 and 12-13 months after the earthquakes. The reduction of HbA1c at after 1-2 months in T2D was associated with “quick restoration of life-lines” and “sufficiency of sleep.” The glycemic deterioration at after 3-4 months was related to “shortage of antidiabetic agents” and “insufficient amount of food”, and at after 12-13 months that was connected to “large-scale partial destruction of houses” and “changes in working environments.” IES-R, representing disaster associated stress levels were positively correlated with “age”, “delayed restoration of life-lines”, “self-managements of antidiabetic agents” and “increased amount of activity”, and negatively associated with “early restoration of life-lines” and “sufficiency of sleep.” Thus, the glycemic control, associated factors and stress levels are altered in chronological order. Post-disaster diabetic medical care must consider these corresponding points in accordance with the time period.

Disclosure

T. Kondo: None. N. Miyakawa: None. H. Motoshima: None. N. Ishii: None. M. Igata: None. K. Yoshinaga: None. D. Kukidome: None. T. Senokuchi: None. J. Kawashima: None. T. Matsumura: None. E. Araki: Speaker's Bureau; Self; Astellas Pharma US, Inc., MSD K.K., Kowa Pharmaceuticals America, Inc., Sanofi, Novo Nordisk Inc.. Research Support; Self; Astellas Pharma US, Inc., MSD K.K., Ono Pharmaceutical Co., Ltd., Shionogi & Co., Ltd., Takeda Pharmaceuticals U.S.A., Inc., Daiichi Sankyo Company, Limited, Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Novo Nordisk Inc., Sanofi, Mitsubishi Tanabe Pharma Corporation, Sumitomo Dainippon Pharma Co., Ltd., Taisho Toyama Pharmaceutical Co..
Impact of Early Intensification with Sitagliptin on Glycemic Goal Attainment among Patients with Metformin Monotherapy Failure
Authors: EJZYKOWICZ FLAVIA , LIU JINAN , ENGEL SAMUEL S. , RAJPATHAK SWAPNIL
Published: June 2018

Background: Delay in the intensification of type 2 diabetes (T2DM) treatment after metformin monotherapy failure, or clinical inertia, is often observed among patients with poor glycemic control. Sitagliptin is used frequently as an add-on to metformin monotherapy among patients with T2DM. The objective of the study is to evaluate the association between early treatment intensification with sitagliptin and glycemic goal attainment among patients failing metformin monotherapy.

Methods: This retrospective database study of adult T2DM patients was conducted using the Quintiles Electronic Medical Record (EMR) database. The study population consisted of patients diagnosed with T2DM who failed to achieve A1c level of <7% on metformin monotherapy between January 20and June 2015. The study included two groups (1) those who did not receive treatment intensification within 3 months after metformin failure (non-early group), but were intensified with any oral anti-hyperglycemic agent between 4 and 12 months and (2) those who were intensified with sitagliptin within 3 months (early sitagliptin group). A Cox regression analysis was conducted to evaluate the association between sitagliptin use and A1c goal attainment within 12 months.

Results: We identified 2,852 patients aged ≥18 years with T2DM who failed metformin monotherapy, of which 362 patients were intensified with sitagliptin within 3 months and 2,490 patients were included in the non-early group. A multivariate Cox regression model adjusted for age, gender, BMI, smoking status, baseline A1c, comorbidities, and other nondiabetic medications showed that early sitagliptin therapy resulted in doubling the likelihood of achieving A1c goal attainment (HR 2.12; 95% CI 1.80-2.50) within 12 months compared to non-early group.

Conclusion: Early intensification with sitagliptin results in higher goal achievement levels among patients failing metformin monotherapy failure.

Disclosure

F. Ejzykowicz: Employee; Self; Merck Sharp & Dohme Corp. J. Liu: Employee; Self; Merck & Co., Inc.. Employee; Spouse/Partner; Anthem, Inc.. Employee; Self; Janssen Scientific Affairs, LLC. S.S. Engel: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc. S. Rajpathak: Employee; Self; Merck & Co., Inc..
Treatment Patterns in Patients with Newly Diagnosed Type 2 Diabetes in 2015
Authors: WU JIANMIN , XIE JIN , WONG-JACOBOSN SIEW HOONG , HAYNES VIRGINIA S. , ZHAO ZHENXIANG
Published: June 2018

This study explored the treatment pattern of newly diagnosed type 2 diabetes (T2D) patients in 2015 using the Commercial and Medicare MarketScan databases. Therapy lines were defined in Table 1. A total of 115,091 adult patients with newly diagnosed (Dx) T2D were identified. Of patients who had antidiabetic drug (ADD) claims within a year after first T2D Dx (n = 53,041), about 20% progressed to second line. The average time from initial Dx to first line and from first to second line were 53 and 117 days respectively. The proportion of combination therapy (≥ 2 ADDs) was increased from 12% in first line to 63% in second line. Table 1 captured the top 20 therapies in each line. About 76% of patients started with metformin (MET) as monotherapy or in combination with sulfonylurea (SU). Substantial variation exists in second line therapies with SU leading the top monotherapy (8.7%). A very small number of patients received newer drugs such as dapagliflozin, dulaglutide and empagliflozin. In line with ADA recommendations, the majority of patients initiated MET-based regimens in first line. SUs were widely used in second line. Despite ongoing research and drug development, little has changed in prescribing of ADD, suggesting a need for better understanding of the gaps in diabetes management and/or education on use and benefits of newer drugs. This study most likely underestimated ADD therapy due to lack of prescriptions filled without pharmacy benefits.

Disclosure

J. Wu: None. J. Xie: None. S. Wong-Jacobosn: None. V.S. Haynes: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. Z. Zhao: None.
Burden of Hospitalization in Young-Onset Type 2 Diabetes—The Hong Kong Diabetes Register
Authors: KE CALVIN , LAU ERIC S.H. , LUK ANDREA , MA RONALD C. , KONG ALICE P. , CHOW ELAINE , CLARKE PHILIP M. , CHAN JULIANA C.
Published: June 2018

Objective: Young-onset type 2 diabetes (YOD, defined as age <40 years) is associated with early β-cell failure and poor risk factor control. While YOD incidence is increasing rapidly, its disease burden is poorly understood, resulting in clinical inertia and poor treatment adherence. We examined the burden of hospitalization among Chinese adults with YOD.

Methods: We conducted a prospective cohort study measuring all-cause hospitalization in YOD and usual-onset type 2 diabetes (T2D) among adults aged 20-75 years using the Hong Kong Diabetes Register (2000-2015, n=21,779). We estimated the impacts of YOD and risk factor control on hospitalization rate after T2D diagnosis using negative binomial regression.

Results: YOD hospitalization had a bimodal distribution, with a disproportionate burden of mental illness < age 40 years (35.9% of bed-days; Figure. 1). YOD was associated with a 3-fold increase in hospitalization rate vs. usual-onset T2D (adjusted rate ratio 2.8, 95% confidence interval 2.5-3.2). Intensified risk factor control (A1C<6.2%, blood pressure<120/75, LDL cholesterol<2.0 mmol/L) was associated with a 39.5% reduction in cumulative hospital days.

Conclusions: YOD is associated with substantial excess hospitalization across the adult lifespan. Urgent efforts are required to develop aggressive management strategies, and to address the unrecognized burden of mental illness in YOD.

Disclosure

C. Ke: None. E.S.H. Lau: None. A. Luk: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Sanofi. R.C. Ma: Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp., Pfizer Inc.. Advisory Panel; Self; Boehringer Ingelheim GmbH, Nippon Boehringer Ingelheim Co. Ltd. A.P. Kong: Research Support; Self; AstraZeneca. E. Chow: Research Support; Self; Sanofi. P.M. Clarke: None. J.C. Chan: Consultant; Self; Bayer AG. Other Relationship; Self; Bayer AG. Consultant; Self; Sanofi. Other Relationship; Self; Sanofi, Eli Lilly and Company, Amgen Inc.. Consultant; Self; AstraZeneca, Merck & Co., Inc., Pfizer Inc.. Other Relationship; Self; Pfizer Inc.. Board Member; Self; Asia Diabetes Foundation. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; Merck Sharp & Dohme Corp.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novartis AG, Eli Lilly and Company.
Prevalence of Prediabetes and Undiagnosed Diabetes among Adults Aged 18 to 70 Years in France—The CONSTANCES Cohort
Authors: FUENTES SONSOLES , FOSSE-EDORH SANDRINE , REGNAULT NOLWENN , GOLDBERG MARCEL , COSSON EMMANUEL
Published: June 2018

Introduction: This study aimed to update the prevalence of different diabetes stages in France among adults aged 18 to 70 years according to gender, age and socioeconomic status.

Methods: The CONSTANCES cohort is a randomly selected representative sample of French adults. In 2013, 16,340 participants were recruited. Based on data from self-administered questionnaires, medical examination (including fasting plasma glucose (FPG) measurement) and data from the French National Insurance System (antidiabetic drugs consumption and hospitalization), three stages were defined: prediabetes (WHO definition), diagnosed and undiagnosed (FPG ≥ 126 mg/dL) diabetes. Weighted prevalence of each stage was estimated for all population and by gender, age and education. Confidence intervals were calculated using logit transformation.

Results: In 2013, the prevalence of prediabetes, undiagnosed diabetes and diagnosed diabetes was 7.4%, 1.9% and 3.9%, respectively. All these rates were higher in males, increased steadily with age while decreasing with education (Figure).

Discussion: Our results show that the prevalence of prediabetes and unknown diabetes are still very high in developed countries, like France. They highlight the need to increase primary prevention, and to reinforce secondary prevention of diabetes, especially through promotion of screening in population at risk.

Disclosure

S. Fuentes: None. S. Fosse-Edorh: None. N. Regnault: None. M. Goldberg: None. E. Cosson: Consultant; Self; Lilly France. Board Member; Self; Novartis France. Consultant; Self; Roche Diagnostics France. Board Member; Self; Ascensia Diabetes Care. Consultant; Self; Bezins France. Board Member; Self; MSD France.
Impact of Diabetes on Colorectal Cancer Screening Rates in U.S. Adults
Authors: CAMPBELL JENNIFER A. , WALKER REBEKAH J. , EILER CHRISTIAN , EGEDE LEONARD E.
Published: June 2018

Background: Individuals with diabetes have an increased risk for colorectal cancer, however routine diabetes care visits may increase colorectal screening rates. The aim of this study is to examine whether diabetes diagnosis influences screening completion in U.S. adults.

Methods: This study used data from 464,664 adults completing the 2014 BRFSS national survey. Logistic regression models tested the likelihood of colorectal screening by diabetes status, and whether diabetes quality of care indicators predicted colorectal screening among diabetes patients. A stratified analysis examined predictors of screening by demographic status for diabetes/nondiabetes patients.

Result: Of the population, 13.1% reported having diabetes and of these, 67% reported completing colorectal screening. Diabetes status, accounting for demographic variables, predicted blood stool screening in the last year (OR 1.09), colonoscopy (OR 1.17), and any colorectal screening technique (OR 1.08). For diabetes patients, non-Hispanic black patients were significantly more likely to receive any type of screening (OR 1.18), as well as women (OR 1.15). Diabetes patients reporting an HbA1c check (OR 1.49), having their eyes checked (OR 1.52), and receiving diabetes education (OR 1.37) were significantly more likely to have completed any screening technique, whereas primary care visits did not predict screening.

Conclusions: Patients with diabetes are more likely to complete colorectal screening compared to patients without diabetes. Non-Hispanic blacks and women with diabetes were significantly more likely to complete any screening, whereas this was not the case in patients with no diabetes. Quality of care indicators and receiving diabetes education significantly predicted screening completion compared to having a physician visit alone. Colorectal screening interventions incorporating patient engagement may be warranted for both the diabetes and general population.

Disclosure

J.A. Campbell: None. R.J. Walker: None. C. Eiler: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..
Antiplatelet Therapy as a Primary Prevention Strategy for Cardiovascular Disease in Type 2 Diabetes Mellitus in Taiwan—A Population-Based Study
Authors: YEH YI-CHUN , CHEN PEI-YIN , CHEN YEN-YU
Published: June 2018

Purpose: The American diabetes association (ADA) standards of medical care in diabetes 2017 recommends considering aspirin therapy as a primary prevention strategy for patients with type 2 diabetes who are at increased cardiovascular risk. The aim of this study was to investigate the prescription rate of antiplatelet as a primary prevention treatment in diabetes patients in Taiwan.

Methods: We conducted a new user cohort from the Taiwan longitudinal cohort of diabetes patients (LCDP) between 1999 and 2013 in diabetes patients aged over 20. We stratified these patients into three risk group (low, intermediate, and high risk) according to the standards of medical care in diabetes 2017 to explore the utilization of antiplatelet agent as a primary prevention strategy in each risk stratification.

Results: We assembled a diabetic cohort (n=513,012) who were potentially eligible for primary prevention therapy. We then stratified them into low (n= 27,572), intermediate (n=190,038) and high (n= 295,402) cardiovascular risk. Around 1% of patients in the low-risk group were dispensed antiplatelet agents, 8% in the intermediate-risk group, and about 16% in the high-risk groups. The median dispensing days for total follow-up period in those with low risk was 189 days, equally 12% of the period from initiating antiplatelet agents to study end. The median dispensing days for those with high risk was 392 days, about one-fourth of the period from starting antiplatelet agents to study end.

Conclusions: Aspirin or alternative effective antiplatelet agents as a primary prevention treatment for type 2 diabetes patients with increased cardiovascular risks were underutilized in Taiwan.

Disclosure

Y. Yeh: None. P. Chen: None. Y. Chen: None.
Type 2 Diabetes Remission—Analysis of Three Population-Level Historical Cohorts
Authors: TANGELLOJU SRIKANTH , VU GIANG , CHAVIS-BLAKELY HUNTER , LITTLE BERT B.
Published: June 2018

Objective: To analyze the characteristics of individuals who went into remission for type 2 diabetes mellitus (T2DM) in the absence of bariatric surgery in three large population level datasets.

Methods: Data from three large T2DM cohorts were used in this analysis: a) 10,059 subjects from a longitudinal Medicare cohort (n=2.4 Million); b) 4,997 subjects, Continuous NHANES (n=82,091); and c) 562 subjects, NHANES III (n=33,994). A Medicare T2DM individual with no T2DM related claims continuously for more than 12 months was considered to be in remission. In the NHANES data T2DM remission was defined as an HbA1c ≤ 5.7 without T2DM related medications. Cox proportional hazards was used to identify significant variables associated with T2DM “remission” in the Medicare data. NHANES data were analyzed with multiple logistic regression with T2DM remission as the dependent variable.

Results: In the Medicare dataset 4.97% met the criteria for T2DM remission in a five-year longitudinal study, while 2.76% and 1.97% of the continuous NHANES and the NHANES III subjects, respectively, achieved remission in the cross-sectional cohorts. The factors associated with T2DM remission were no statin use; no insulin use; no hypertension; no hyperlipidemia; no neuropathy; no retinopathy; female gender; non-African American ethnicity; decreased waist circumference and lower systolic blood pressure (Bonferroni adjusted p≤0.05). The rate of T2DM remission appears to be approximately 1.97 to 4.97%.

Conclusions: T2DM remission triggers exist (Lancet, Dec 2017). Of the factors associated with T2DM remission, only ethnicity and gender are non-modifiable risk factors. Therefore, diabetes prevention and management programs should concentrate on lowering body weight, lipids, and blood pressure. Management of these factors is associated with T2DM remission. Identification of other factors associated with T2DM may lead to more efficacious programmatic management of the disease and attenuation of serious co-morbidities.

Disclosure

S. Tangelloju: Employee; Self; Humana Inc.. G. Vu: None. H. Chavis-Blakely: None. B.B. Little: None.
The Number of Metabolic Syndrome Components and Incidence Rates of Type 2 Diabetes—A Korean National Sample Cohort Study
Authors: LEE MIN-KYUNG , KWON HYUK-SANG
Published: June 2018

Background: Metabolic syndrome (MetS) is associated with an increased risk of diabetes. In this study, we aimed to investigate the incidence rate of type 2 diabetes according to the number of MetS components using data from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC).

Methods: A total of 24,582,108, aged 20 years or older, with no history of diabetes were recruited between 2009 and 2012. MetS components were defined using the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Type 2 diabetes was defined as a current medication history of antidiabetic drugs and the presence of International Classification of Diseases (ICD)-10 codes (E11-E14) as diagnosis.

Results: The number of MetS components gradually increased with increasing age. Over a total of 118,311,497.11 person-years of follow-up, 658,934 subjects were diagnosed with type 2 diabetes. The multivariable-adjusted hazard ratios for incident diabetes for the number of MetS components were 2.54, 4.83, 7.92, 11.78 and 20.94 for one, two, three, four or five components, respectively, compared with the absence of components. The risk of diabetes with regard to each component of MetS was 1.76 for high fasting plasma glucose, 1.44 for high blood pressure, 1.19 for central obesity, 1.17 for high triglycerides, and 1.15 for low HDL cholesterol. The combinations that included high fasting plasma glucose level appeared to be more strongly associated with the risk of diabetes than other combinations with the same number of MetS components.

Conclusions: The risk of diabetes gradually increased with the increasing number of MetS components. Among the components, hyperglycemia was the most powerful predictor of diabetes. Our findings indicate that the risk stratification of individuals by the number of MetS components and hyperglycemia status can detect individuals with a high risk of diabetes.

Disclosure

M. Lee: None. H. Kwon: None.
Prospective Association between Gestational Diabetes and Subsequent Abnormal Liver Function Scores 9 to 16 Years after Pregnancy
Authors: DONNELLY SARAH , HINKLE STEFANIE , RAWAL SHRISTI , GRUNNET LOUISE , CHAVARRO JORGE E. , VAAG ALLAN A. , WU JING , DAMM PETER , MILLS JAMES , LI MENGYING , BJERREGAARD ANNE A. , BAUN THUESEN ANNE CATHRINE , GORE-LANGTON ROBERT E. , FRANCIS ELLEN C. , LEY SYLVIA , HU FRANK , TSAI MICHAEL Y. , OLSEN SJURDUR F. , ZHANG CUILIN
Published: June 2018

Chronic hyperglycemia is a risk factor for liver dysfunction. Women with gestational diabetes mellitus (GDM), glucose intolerance first recognized in pregnancy, may identify a population of individuals at an increased risk for liver complications. However, large prospective studies examining liver function following a GDM pregnancy are lacking. The Diabetes & Women’s Health (DWH) Study (2012-2014) followed women with and without GDM in the Danish National Birth Cohort (DNBC). DNBC was a population-based cohort study of pregnant Danish women (1996-2002). At 9-16 years postpartum, the DWH Study conducted a clinical exam and collected bio-specimens on 607 of 1,274 women with GDM and 619 of a random sample of 1,457 women without GDM during the index DNBC pregnancy. Markers of liver function measured at follow-up included: alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). Liver function scoring indices were used to assess liver capacity including: nonalcoholic fatty liver disease liver fat score (NAFLD-LFS), fatty liver index (FLI), hepatic steatosis index (HSI), and liver fat percentage. The mean (standard deviation) age (years) at follow-up for women without and with prior GDM was 43.4 (4.5) and 43.8 (4.6), respectively. Women with prior GDM had an increased risk at follow-up of elevated NAFLD-LFS (Adjusted Relative risk [RR], 2.34; 95% CI, 1.68-3.27), FLI (RR, 1.59; 95% CI, 1.27-1.99), and HSI (RR, 1.44; 95% CI, 1.21-1.71) adjusted for pre-pregnancy BMI and other relevant risk factors compared to women without prior GDM. Women with prior GDM also had a significantly higher fatty liver percentage (Adjusted difference (%), 1.93; 95% CI, 1.10-2.77). Women with GDM during pregnancy were at an increased risk for subsequent abnormal liver function 9-16 years postpartum. GDM may serve as another risk indicator for the early identification and prevention of liver dysfunction.

Disclosure

S. Donnelly: None. S. Hinkle: None. S. Rawal: None. L. Grunnet: None. J.E. Chavarro: None. A.A. Vaag: Employee; Self; AstraZeneca. J. Wu: None. P. Damm: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S. M. Li: None. A.A. Bjerregaard: None. A. Thuesen: None. R.E. Gore-Langton: None. E.C. Francis: None. F. Hu: None. M.Y. Tsai: None. S.F. Olsen: None. C. Zhang: None.
Subjective Sleep Debt Is Correlated with Body Fat Percentage Independent of Sleep Duration
Authors: TAN XIAO , BENEDICT CHRISTIAN
Published: June 2018

No study has investigated whether subjective sleep debt (i.e., the gap between self estimations of sleep duration and sleep requirement) is linked to body fat mass. We studied 20,531 Swedish adults aged between 36 and 78 years (mean age: 60.9 ± 8.5 years, 56.6% women). Self-reported sleep duration and sleep needed for feeling fully rested (both in hours/day) were obtained by questionnaire. Subjective sleep debt per day was calculated by subtracting the value of sleep requirement with sleep duration. Fat mass was estimated by bioelectrical impedance analysis. Body fat percentage was calculated based on fat mass (kg) per total body mass (kg). Analysis of covariance (adjusting for age, gender, and self-reported sleep duration) was utilized to test the body fat percentage differences between hours of sleep debt, followed with Bonferroni corrections for multiple comparisons. Compared to those without subjective sleep debt, adults reporting a sleep debt of 2 hours and 3 hours or more were respectively associated with a 0.9 (95% CI: 0.5, 1.3) and 2.2 (95% CI: 1.4, 3.1) higher percentage of body fat mass (both p < 0.001). The corresponding differences when comparing these two groups to those reporting 1-hour sleep debt were 1.4 (95% CI: 1.0, 1.8) and 2.7 (95% CI: 1.9, 3.5), (both p < 0.001). The results suggest that subjective sleep debt of greater than one hour per day is associated with significantly higher body fat percentage.

Subjective sleep debtBody fat percentageTotalWomenMenMean (95% CI)Mean (95% CI)Mean (95% CI)0 hour30.0 (29.9, 30.1)35.2 (35.0, 35.4)24.8 (24.7, 25.0)1 hour29.5 (29.4, 29.7)34.9 (34.7, 35.1)24.2 (24.0, 24.4)2 hours30.9 (30.7, 31.2)36.2 (35.8, 36.5)25.7 (25.3, 26.1)3 hours or more32.3 (31.7, 32.8)37.2 (36.5, 37.8)27.3 (26.5, 28.2)

Disclosure

X. Tan: None. C. Benedict: None.
Seasonal Trends in HbA1c Level in Adult Patients with Type 1 Diabetes Treated with Personal Insulin Pumps
Authors: MATEJKO BARTłOMIEJ , KIEC-WILK BEATA , MROZINSKA SANDRA , KLUPA TOMASZ , MALECKI MACIEJ
Published: June 2018

Introduction/Aim: The DCCT and other studies showed that the variability in HbA1c added to mean HbA1c increases the risk of the development of complications of diabetes. There were some earlier reports showing a seasonal variability in the HbA1c level in a pediatric population.

Methods: We evaluated seasonal HbA1c changes over a period of 9 years (2009-2017) in 453 adults with type 1 diabetes (T1DM) treated with personal insulin pumps. HbA1c was measured at a tertiary care university hospital on the Bio-Rad D10 hemoglobin testing system. Differences between groups (12 groups for 12 months and 6 for every consecutive two months) were assessed using the Kruskal-Wallis and post-hoc tests.

Results: Patients median age was 24 years [range 18-80 years], median BMI 22.9 kg/m2 [15.6-43.7 kg/m2], median diabetes duration 12 years [1-40 years] and median duration on personal insulin pump 6 years [0-18 years]. A total of 1, 438 HbA1c measurements were analyzed. Median HbA(1c) level for the whole study period was 7.25% [55.7 mmol/mol] (range 4.8-12.8% [29-116.4 mmol/mol]). There were seasonal differences in HbA1c over 12 months (p=0.02): The lowest HbA1c was observed in summer (July, 6.8% [50.8 mmol/mol) and the highest in winter months (from 7.1% [54.1 mmol/mol] in January to 7.3% [56.3 mmol/mol] in February). HbA1c was lower in July than in February (p=0.03). After combining two consecutive months in one group seasonality of HbA1c values was still observed (p=0.008). Median HbA1c in July/August (6.9% [51.9 mmol/mol]) was lower than in January/February (7.2% [55.2 mmol/mol], p=0.01) and in November/December groups (7.3% [56.3 mmol/mol], p=0.02).

Conclusion: To our knowledge this is the first report concerning HbA1c seasonal fluctuations in well controlled cohort of adult T1DM patients treated with insulin pumps. Seasonal changes of HbA1c levels (peak in summer months, drop in winter months) in such a group of patients should be considered in patient education and diabetes management.

Disclosure

B. Matejko: None. B. Kiec-Wilk: None. S. Mrozinska: None. T. Klupa: None. M. Malecki: Consultant; Self; Abbott, Bioton, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi-Aventis, AstraZeneca, Servier, MSD K.K..
Shared Decision-Making for Diabetes Prevention—One-Year Results from the Prediabetes Informed Decision and Education (PRIDE) Study
Authors: MOIN TANNAZ , TURK NORMAN , MANGIONE CAROL , CASTELLON-LOPEZ YELBA , SKRINE JEFFERS KIA , NORRIS KEITH C. , TSENG CHIHONG , KENRIK DURU O.
Published: June 2018

Lifestyle change (e.g., the DPP) and metformin can reduce diabetes risk. Real-world uptake of both strategies remains low. In a pragmatic, cluster-randomized controlled trial, we tested the effectiveness of a shared decision-making (SDM) intervention. After an in-person SDM visit with a pharmacist, overweight patients with prediabetes (A1c 5.7-6.4%) chose to start DPP, metformin, both strategies, or continue usual care. We randomized 20 primary care clinics to intervention vs. usual care, and enrolled 364 study patients with prediabetes from the 10 intervention clinics. We used propensity score matching to identify 1,086 comparison patients within the 10 usual care clinics. The primary outcome was uptake of any diabetes prevention strategy (DPP +/- metformin) within 8 months of the SDM visit. A secondary outcome was change in weight at 1 year after the SDM visit. We used data from the electronic health record (EHR) together with data from 2 local DPP vendors to assess DPP attendance. We used data from the EHR to track metformin uptake and weight change, and ran generalized estimating equation models that controlled for clustering by clinic. Among 364 intervention patients, 57% chose DPP, 17% chose DPP + metformin, 9% chose metformin, and 17% chose to continue usual care. Intervention patients were more likely to join the DPP and/or take metformin than matched controls, 43% (n=155) vs. 3% (n=36; p<.001). In a complete-case analysis among patients with follow-up weight available in the EHR, weight loss was greater for all intervention patients who had an SDM visit (n=312) vs. control patients (n=841) at 12 months (-5.2 lbs vs. -0.29 lbs, p<.001). A prediabetes SDM intervention can enhance patient engagement in evidence-based therapies to prevent diabetes and can promote weight loss at 12 months. Shared decision making in prediabetes may be a promising approach to enhance prevention efforts among patients at highest risk.

Disclosure

T. Moin: None. N. Turk: None. C. Mangione: None. Y. Castellon-Lopez: None. K. Skrine Jeffers: None. K.C. Norris: Other Relationship; Self; AbbVie Inc.. C. Tseng: None. O. Duru: None.
Serum Levels of Soluble LR11 Are Associated with Insulin Resistance in the Patients with Type 2 Diabetes Mellitus
Authors: UNOKI-KUBOTA HIROYUKI , JIANG MEIZI , KAJIO HIROSHI , YAMAMOTO-HONDA RITSUKO , TOBE KAZUYUKI , NODA MITSUHIKO , BUJO HIDEAKI , KABURAGI YASUSHI
Published: June 2018

Obesity is now a worldwide epidemic, with overweight, obesity, and morbid obesity all increasing. Recently, there is increasing support that obesity is a major risk factor for developing insulin resistance and type 2 diabetes mellitus (T2D). Plasma soluble low-density lipoprotein receptor-relative with 11 ligand-binding repeats (sLR11) plays a role in the development of atherosclerosis, and has also been linked to the metabolism of triglyceride-rich lipoproteins and adiposity. To assess the relationship between sLR11 levels and T2D, we analyzed the sLR11 levels in T2D patients. Serum sLR11 levels were measured in 70 patients with T2D (mean age 60.8 ± 7.0, 68.6% males, and BMI 24.7 ± 3.2) and 76 healthy control subjects (mean age 58.5 ± 6.5, 65.8% males, and BMI 24.1 ± 2.5) by ELISA. Circulating sLR11 levels were significantly increased in T2D patients compared with healthy control subjects (10.2 ± 4.2 vs. 8.3 ± 2.1, P = 1.4 × 10-3). Stepwise multivariate regression analysis showed that serum sLR11 levels were significantly associated with HOMA-IR (β = 0.26, P = 4.8 × 10-3), BMI (β = 0.24, P = 1.0 × 10-2) and age (β = 0.20, P = 2.7 × 10-2). Logistic regression analyses indicated that sLR11 was independently associated with HOMA-IR (odds ratio [OR], sLR11 tertile increment: 6.81; 95% confidence interval [CI]: 1.71—27.13) and BMI (OR, sLR11 tertile increment: 1.86; 95% CI: 1.03—3.35). We then analyzed a gene-dosage effect that links LR11 expression to insulin resistance and obesity using db/db mice with genetic loss of LR11 (LR11-KO db/db). LR11-KO db/db mice displayed significantly lower fasting plasma glucose and insulin levels, and improved glucose tolerance compared with age-matched db/db mice, although there was no significant difference in body weight between them. Our findings imply that LR11 may be mechanistically involved in the prevalence and development of insulin resistance and T2D.

Disclosure

H. Unoki-Kubota: None. M. Jiang: None. H. Kajio: None. R. Yamamoto-Honda: None. K. Tobe: Research Support; Self; Bristol-Myers Squibb Company, Takeda Pharmaceutical Company, Teijin Pharma Limited, Japan Diabetes Society, Eli Lilly and Company, MSD K.K., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Pfizer Inc., Astellas Parma Inc, Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Company, Limited, Novo Nordisk Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Tsumura & Co., Ono Pharmaceutical Co., Ltd., Novartis Pharma K.K., Sumitomo Dainippon Pharma Co. M. Noda: None. H. Bujo: None. Y. Kaburagi: None.
Association between Polycystic Ovarian Syndrome and Bone Mineral Density—A Systematic Review and Meta-analysis
Authors: UPALA SIKARIN , EHRMANN DAVID A.
Published: June 2018

Background: Polycystic ovarian syndrome (PCOS) affects at least 17-20% of female population. Little information is available about whether PCOS is related to low bone mineral density (BMD). In this meta-analysis, we try to explore and compare PCOS patient and normal female population to determine the relation between PCOS patients and osteoporosis as an outcome.

Methods: Two investigators searched published studies indexed in MEDLINE and EMBASE. This review included published observational studies evaluating the association between PCOS and bone mass, BMD, or osteoporosis. PCOS is diagnosed base on clinical, biochemical, radiological findings per Rotterdam criteria. The primary outcome of this study were differences in the total BMD (g/cm2) or BMD at different anatomical sites including lumbar spine, pelvis, femur and total body as measured by dual-energy X-ray absorptiometry between patients with PCOS and participants without PCOS (controls).

Results: Five cross sectional studies involving 1276 participants were included. Meta-analysis using the random-effects model to examine the difference in outcomes between PCOS and controls are performed. The pooled mean difference of total BMD in patients who have PCOS vs. controls in the five studies was -0.22 (95% confidence interval, -0.66 to 0.23; P = 0.35). The statistical between-study heterogeneity may represent substantial heterogeneity with an I2 of 99% (p<0.01). For femoral neck BMD, the difference was not statistically significant, which was 0.00 (95% confidence interval, -0.03 to 0.02; P = 0.81). For lumbar spine BMD, the difference was also not statistically significant, which was -0.02 (95% confidence interval, -0.to 0.02; P = 0.25).

Conclusion: Women with PCOS have seemed to increase a chance of having osteoporosis more than the normal population. The real mechanism of PCOS and osteoporosis and a larger PCOS population need to be clarified and study more in the future.

Disclosure

S. Upala: None. D.A. Ehrmann: None.
Differential Effect of Nativity on Type 2 Diabetes Diagnosis Post-Gestational Diabetes, by Race/Ethnicity
Authors: BUTLER BRITTNEY , SALSBERRY PAMELA , BOWER JULIE K.
Published: June 2018

Background: Women with GDM have seven times higher risk of T2D compared to women with normoglycaemic pregnancies, with black women having the highest risk. Immigrants are a growing share of the U.S. population, with approximately 9% of the black population and 34% of Hispanic population being foreign-born. Due to differences in acculturation and assimilation, foreign-born U.S. women experience different pregnancy-related outcomes and subsequent chronic disease development, depending on their race/ethnicity.

Objective: To examine the association between nativity and T2D diagnosis following a prior GDM pregnancy and whether this association differs by racial/ethnic group.

Methods: We conducted a cross-sectional analysis of data from the 2007-2014 National Health and Nutrition Examination Survey, a nationally representative survey of non-institutionalized Americans. The analytic population included women with at least one prior GDM pregnancy. Logistic regression (OR, 95% CI) was used to examine the association.

Results: Our final sample included 433 women. The population was predominantly non-Hispanic white (62%), followed by Hispanic (18%) and black (12%). T2D was found in 29% of the population. After controlling for confounders, foreign-born black women had 0.14 (0.02-0.82) times the odds of developing T2D post GDM compared to black U.S. born women. Nativity was not significantly associated with cumulative incidence of T2D among Hispanics (1.45, 0.48-4.41) or non-Hispanic whites (1.53, 0.04,-6.07).

Conclusion: We found differential effects of nativity across racial/ethnic groups consistent with prior literature. Among black women, being foreign-born significantly decreases the odds of developing T2D following a GDM pregnancy but not among other groups. This observed effect may be due to U.S. born black women experiencing higher levels of racialized and gendered stress, both associated with higher levels of inflammation that can lead to higher risk of T2D.

Disclosure

B. Butler: None. P. Salsberry: None. J.K. Bower: None.