Diabetes Complications Severity Index Research Articles

Risk of mortality and complications in people with depressive disorder and diabetes mellitus: A 20-year population-based propensity score-matched cohort study

People with depression have increased premature mortality and elevated prevalence of diabetes-mellitus compared to general population. However, risk of mortality and diabetes-related complications among patients with depression and co-occurring diabetes is under-studied. This population-based propensity score-matched (1:10) cohort study identified 12,175 patients with pre-existing depression and incident-diabetes (depression-diabetes group) and 117,958 patients with incident-diabetes only (diabetes-only group) between 2002 and 2021 in Hong-Kong, using territory-wide medical-record database of public-healthcare services, to investigate whether depression increased the risk of overall mortality, complications and post-complication mortality in people with diabetes. Associations of depression with all-cause mortality, complication and post-complication all-cause mortality rates were examined by Cox proportional-hazards model. Complications were assessed by Diabetes-Complications-Severity-Index (DCSI). Associations of complications, in terms of DCSI scores (complication burden), specific types and two-way combinations of complications (complication patterns) with all-cause mortality rate in depression were also examined. Our results showed that depression-diabetes group exhibited increased all-cause mortality risk (adjusted hazards-ratio: 1.06 [95 %CI: 1.02–1.10]) relative to diabetes-only group, particularly among men and older age group, with significantly higher rate of experiencing neuropathy (1.44 [1.27–1.62]) and metabolic complications (1.30 [1.09–1.56]) and lower likelihood of peripheral-vascular complications, retinopathy and nephropathy, albeit comparable macrovascular and microvascular complication rates. The mortality-rate-ratio for patients with depression and diabetes was significantly higher than patients with diabetes-only at a low level of complication burden. In conclusion, depression patients with co-occurring diabetes are at increased risk of excess mortality. Further research is warranted to improve diabetes-related outcomes and reduce mortality gap in this vulnerable population.

Insulin Resistance-Nutritional Index: A Simple Index and Potential Predictor of Mortality Risk in Patients with Chronic Heart Failure and Type 2 Diabetes.

Patients with chronic heart failure (CHF) and type 2 diabetes mellitus (DM) are prone to insulin resistance and malnutrition, both of which are significant prognostic factors for CHF. However, the combined effect of the triglyceride-glucose index (TyG index) and prognostic nutritional index (PNI) on the mortality risk in patients with CHF and type 2 DM has not yet been studied. We enrolled 3,315 patients with CHF and type 2 DM. We used a multivariate Cox regression model to assess hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk based on TyG index and PNI levels. Furthermore, we constructed a novel index, the insulin resistance-nutritional index (IRNI), defined as TyG index/Ln (PNI), and evaluated its prognostic significance. During follow-up, 1,214 deaths occurred. Participants with a high TyG index and non-high PNI had a significantly higher mortality risk compared to those with a non-high TyG index and high PNI, with an adjusted HR of 1.91 (95% CI, 1.57-2.32). The multivariate Cox regression analysis revealed HRs for all-cause and cardiovascular deaths of 1.93 (95% CI, 1.66-2.26; P < 0.001) and 2.50 (95% CI, 2.05-3.06; P < 0.001), respectively, when comparing the highest and lowest IRNI tertiles. IRNI's predictive power was stronger in groups with higher adapted Diabetes Complications Severity Index scores (P for interaction < 0.05). Additionally, adding IRNI to the baseline risk model significantly improved predictive performance, showing a greater effect compared to the TyG index or PNI. IRNI, a novel and composite index reflecting insulin resistance and nutritional status, emerges as a potentially valuable prognostic marker for patients with CHF and type 2 DM.

Acarbose might be associated with reduced risk of gastric cancer in patients with diabetes mellitus: A nationwide population-based cohort study.

Several epidemiologic studies have revealed a higher risk of cancer in patients with diabetes mellitus (DM) relative to the general population. To investigate whether the use of acarbose was associated with higher/lower risk of new-onset cancers. We conducted a retrospective cohort study, using a population-based National Health Insurance Research Database of Taiwan. Both inpatients and outpatients with newly onset DM diagnosed between 2000 and 2012 were collected. The Adapted Diabetes Complications Severity Index (aDCSI) was used to adjust the severity of DM. The Cox proportional hazards regression model was used to estimate the hazard ratio (HR) of disease. A total of 22 502 patients with newly diagnosed DM were enrolled. The Cox proportional hazards regression model indicating acarbose was neutral for risk for gastroenterological malignancies, when compared to the acarbose non-acarbose users group. However, when gastric cancer was focused, acarbose-user group had significantly lowered HR than non-acarbose users group (p = 0.003). After adjusted for age, sex, cancer-related comorbidity, severity of DM, and co-administered drugs, the HR of gastric cancer risk was 0.43 (95% CI = 0.25-0.74) for acarbose-user patients. This long-term population-based study demonstrated that acarbose might be associated with lowered risk of new-onset gastric cancer in diabetic patients after adjusting the severity of DM.

Association between dipeptidyl peptidase-4 inhibitor use and risk of Parkinson's disease among patients with diabetes mellitus: a retrospective cohort study.

How a person's Parkinson disease (PD) risk is affected by dipeptidyl peptidase-4 (DPP-4) inhibitors remains unclear. We evaluated the association of PD risk with use of these inhibitors in individuals diagnosed as having diabetes mellitus (DM). Individuals diagnosed as having new-onset DM were enrolled into the case group and comparison group, comprising patients who received a DPP-4 inhibitor and a sulfonylurea, respectively. These groups were matched through propensity score matching on the basis of income level, gender, urbanization level, enrollment year, age, and diabetes complications severity index score. The case group was divided into subgroups on the basis of whether they had a cumulative defined daily dose (cDDD) of <75, 75-150, or >150. The DPP-4 inhibitor-PD risk association was evaluated through a Cox proportional hazards model. The Bonferroni adjustment test was employed to adjust P-values and reduce the false positive rate. Compared with those in the comparison group (treatment with a sulfonylurea), patients with a DPP-4 inhibitor cDDD of >150 had a hazard ratio (HR) of 1.30 for PD development (95% confidence interval [CI]: 0.97-1.73; adjusted P = .263); the HRs for patients with a cDDD of <75 or 75-150 were 0.95 (95% CI: 0.71-1.27; adjusted P = .886) and 1.06 (95% CI: 0.75-1.50; adjusted P = .886), respectively. We noted nonsignificant differences regarding the associations between the use of the various DPP-4 inhibitors (linagliptin, saxagliptin, sitagliptin, and vildagliptin) and PD risk after adjustment for any individual inhibitor (adjusted P > .05). DPP-4 inhibitors were discovered in this study to not be associated with increased PD risk. This result was confirmed when the analysis was conducted individually for the 4 investigated DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin, and vildagliptin).

Severity of Complications and Duration of Type 2 Diabetes and the Risk of Cancer: A Population-Based Study.

The literature on the association between diabetes severity and cancer risk is limited and inconclusive. The study aimed to evaluate the association between the adapted Diabetes Complications Severity Index (aDCSI) and the duration of type 2 diabetes and cancer risk. Patients ages 20 years or older with newly diagnosed type 2 diabetes between January 1, 2007, and December 31, 2011, were identified from Taiwan National Health Insurance claims data. Standardized incidence ratios (SIR) were calculated to compare cancer incidence in people with diabetes with that in the general population. Poisson regression was used to examine whether SIRs differed by age, sex, aDSCI, and duration of diabetes. A total of 756,547 patients were included, with a median follow-up of 8.8 years. Excluding the first year after diagnosis, the SIR for overall cancer was 1.18 [95% confidence interval (CI) 1.17-1.19]. Higher aDCSI was associated with increased SIRs for overall [SIR ratio 1.03 (1.02-1.03) per point increase], head and neck (1.03; 1.01-1.04), liver (1.04; 1.03-1.05), pancreas (1.03; 1.00-1.05), kidney (1.13; 1.10-1.15), and leukemia (1.09; 1.06-1.13). There was no association between aDCSI and colorectal, extrahepatic biliary tract, uterus and thyroid cancer, and a negative association with breast cancer (0.97; 0.95-0.98). Type 2 diabetes duration was associated with increased SIRs for overall [1.01 (1.00-1.02) per year increase], head and neck (1.03; 1.01-1.05), and liver cancer (1.04; 1.02-1.05). The heterogeneity in the association between diabetes severity and diabetes-related cancers suggests diverse underlying connections. Adopting distinct approaches in further research and prevention strategies for different kinds of diabetes-related cancers is important.

Adapted diabetes complications severity index predicts dementia risk in ageing type 2 diabetes mellitus patients.

This study investigated the link between the adapted diabetes complication severity index at the time of type 2 diabetes mellitus diagnosis and diabetes-induced dementia risk in elderly patients. Elderly type 2 diabetes mellitus patients (age ≥ 60) were matched using propensity score matching. Cox regression was used to determine dementia hazard ratios; Kaplan-Meier method to assess cumulative incidence. The cohort included 256 214 elderly type 2 diabetes mellitus patients. Adapted diabetes complication severity index ≥ 1 showed higher dementia risk (adjusted hazard ratio: 1.30; 95% confidence interval: 1.27-1.34), increasing by 1.17-fold per adapted diabetes complication severity index point. Dementia risk rose progressively across adapted diabetes complication severity index scores (P < 0.0001). Higher adapted diabetes complication severity index scores at the time of type 2 diabetes mellitus diagnosis elevated dementia risk in elderly patients. Adapted diabetes complication severity index ≥ 1 is linked to increased dementia risk. Adapted diabetes complication severity index evaluation at the time of type 2 diabetes mellitus diagnosis could predict risk, aiding early interventions. Effective diabetes management is crucial for reducing dementia risk in this population.

Type 2 Diabetes Status, Diabetes Complication Severity Index Scores, and Their Relationship With COVID-19 Severity: A Retrospective Cohort Study of Hospitalized Patients in a Southwest Virginia Health System.

Background Studies have shown that patients with type 2 diabetes mellitus (T2DM) tend to have poorer outcomes associated with COVID-19, including increased rates of hospitalization, ICU admission, need for ventilatory support, and mortality. Methods We performed a retrospective cohort study that included all non-pregnant adult patients who were hospitalized as a result of COVID-19 in a Southwest Virginia health system between March 18, 2020, and August 31, 2022. T2DM status was treated as a binary variable. T2DM severity was assessed using the Diabetes Complications Severity Index (DCSI). Multivariate logistic regression was used to assess the relationship between T2DM status and COVID-19 severity outcomes. Multivariate logistic regression was also used to assess the relationship between DCSI score and COVID-19 severity outcomes among patients with an established diagnosis of T2DM at the time of COVID-19 hospital admission. Results Patients with T2DM had 1.27 times the odds of experiencing a poor COVID-19 clinical outcome (95% CI: 1.13, 1.43) and 1.35 times the odds of in-hospital mortality (95% CI: 1.14, 1.59) compared to patients without diabetes. Among patients with T2DM, increasing DCSI score was significantly associated with increased odds of experiencing a poor COVID-19 clinical outcome and in-hospital mortality. Conclusions Diabetic patients in our sample were at increased odds of experiencing poor COVID-19 clinical outcomes and in-hospital mortality compared to individuals without diabetes. Amongst patients with T2DM, increasing DCSI score was associated with worse COVID-19 outcomes. Clinical decision support tools may be able to utilize DCSI scores as an indicator of COVID-19 severity risk to facilitate decisions regarding treatment aggressiveness and resource allocation.

Sarcopenia and diabetes-induced dementia risk.

This study aimed to investigate whether sarcopenia independently increases the risk of diabetes-induced dementia in elderly individuals diagnosed with type 2 diabetes mellitus. The study cohort consisted of a large sample of elderly individuals aged 60 years and above, who were diagnosed with type 2 diabetes mellitus between 2008 and 2018. To minimize potential bias and achieve covariate balance between the sarcopenia and non-sarcopenia groups, we employed propensity score matching. Various statistical analyses, including Cox regression models to assess dementia risk and associations, competing risk analysis to account for mortality and Poisson regression analysis for incidence rates, were used. Before propensity score matching, the study included 406 573 elderly type 2 diabetes mellitus patients, with 20 674 in the sarcopenia group. Following propensity score matching, the analysis included a total of 41 294 individuals, with 20 647 in the sarcopenia group and 20 647 in the non-sarcopenia group. Prior to propensity score matching, elderly type 2 diabetes mellitus patients with sarcopenia exhibited a significantly higher risk of dementia (adjusted hazard ratio: 1.12, 95% confidence interval: 1.07-1.17). After propensity score matching, the risk remained significant (adjusted hazard ratio: 1.14, 95% confidence interval: 1.07-1.21). Incidence rates of dementia were notably higher in the sarcopenia group both before and after propensity score matching, underscoring the importance of sarcopenia as an independent risk factor. Our study highlights sarcopenia as an independent risk factor for diabetes-induced dementia in elderly type 2 diabetes mellitus patients. Advanced age, female gender, lower income levels, rural residency, higher adapted diabetes complication severity index and Charlson Comorbidity Index scores and various comorbidities were associated with increased dementia risk. Notably, the use of statins was linked to a reduced risk of dementia. This research underscores the need to identify and address modifiable risk factors for dementia in elderly type 2 diabetes mellitus patients, offering valuable insights for targeted interventions and healthcare policies.

Investigation of predictors of severity of diabetes complications among hospitalized patients with diabetes in Florida, 2016–2019

BackgroundSevere diabetes complications impact the quality of life of patients and may lead to premature deaths. However, these complications are preventable through proper glycemic control and management of risk factors. Understanding the risk factors of complications is important in guiding efforts to manage diabetes and reduce risks of its complications. Therefore, the objective of this study was to identify risk factors of severe diabetes complications among adult hospitalized patients with diabetes in Florida.MethodsHospital discharge data from 2016 to 2019 were obtained from the Florida Agency for Health Care Administration through a Data Use Agreement with the Florida Department of Health. Adapted Diabetes Complications Severity Index (aDCSI) scores were computed for 1,061,140 unique adult patients with a diagnosis of diabetes. Severe complications were defined as those with an aDCSI ≥ 4. Population average models, estimated using generalized estimating equations, were used to identify individual- and area-level predictors of severe diabetes complications.ResultsNon-Hispanic Black patients had the highest odds of severe diabetes complications compared to non-Hispanic White patients among both males (Odds Ratio [OR] = 1.20, 95% Confidence Interval [CI]: 1.17, 1.23) and females (OR = 1.27, 95% CI: 1.23, 1.31). Comorbidities associated with higher odds of severe complications included hypertension (OR = 2.30, 95% CI: 2.23, 2.37), hyperlipidemia (OR = 1.29, 95% CI: 1.27, 1.31), obesity (OR = 1.24, 95% CI: 1.21, 1.26) and depression (OR = 1.09, 95% CI: 1.07, 1.11), while the odds were lower for patients with a diagnosis of arthritis (OR = 0.81, 95% CI: 0.79, 0.82). Type of health insurance coverage was associated with the severity of diabetes complications, with significantly higher odds of severe complications among Medicare (OR = 1.85, 95% CI: 1.80, 1.90) and Medicaid (OR = 1.83, 95% CI: 1.77, 1.90) patients compared to those with private insurance. Residing within the least socioeconomically deprived ZIP code tabulation areas (ZCTAs) in the state had a protective effect compared to residing outside of these areas.ConclusionsRacial, ethnic, and socioeconomic disparities in the severity of diabetes complications exist among hospitalized patients in Florida. The observed disparities likely reflect challenges to maintaining glycemic control and managing cardiovascular risk factors, particularly for patients with multiple chronic conditions. Interventions to improve diabetes management should focus on populations with disproportionately high burdens of severe complications to improve quality of life and decrease premature mortality among adult patients with diabetes in Florida.

Sodium-glucose co-transporter 2 inhibitor add-on therapy for metformin delays diabetic retinopathy progression in diabetes patients: a population-based cohort study

To investigate how sodium-glucose co-transporter 2 inhibitors (SGLT2is) add-on therapy for metformin affects diabetic retinopathy (DR) progression in patients with type 2 diabetes mellitus (T2DM). This nationwide population-based study conducted from January 1, 2016, to December 31, 2018 involved 3,432,911 adults with T2DM in Taiwan. To adjust for potential confounders, data on sex, age, income, comorbidities, diabetes complication severity index score, staging of kidney disease, anti-diabetic medications, and index year were included. The outcome was DR progression, determined by procedure codes or the addition of ICD-9-CM or ICD-10-CM codes to the medical records of the patients during the study. Sensitivity analyses were performed to validate the findings. The adjusted hazard ratio (aHR) of DR progression was 0.89 for the SGLT2is add-on group, relative to the control group [95% confidence interval (CI) 0.81–0.99, P = 0.026]. The Kaplan–Meier curve of the cumulative incidence rate showed that the cumulative incidence of DR progression was considerably decreased in the SGLT2is cohort (log-rank P = 0.0261). The use of SGLT2is for less than 1 year and 1–2 years were associated with a significant increase in the risk of DR progression (aHR 1.56 and 1.88, respectively); however, the risk markedly reduced if the SGLT2is regimen was used for more than 2 years (aHR 0.41, 95% Cl 0.35–0.48; P < 0.001). The serial sensitivity analysis showed consistent findings. The aHR of DR progression was 0.82 for the SGLT2is cohort relative to the non-SGLT2is cohort based on the fundoscopy or indirect ophthalmoscopy findings within 1 year before the outcome date (95% Cl 0.71–0.95; P = 0.009). Co-administration of metformin and SGLT2is may reduce the risk of DR progression. Short-term use of SGLT2is may markedly increase the risk of DR, whereas prolonged use SGLT2is may significantly decrease it.

Risk of rapid progression to dialysis in patients with type 2 diabetes mellitus with and without diabetes-related complications at diagnosis

Many adults with diabetes mellitus are unaware worldwide. The study objectives aimed to evaluate the risk of dialysis within 5 years of diagnosis between patients with newly diagnosed diabetes with and without diabetes-related complications. A retrospective longitudinal nationwide cohort study was conducted. Patients diagnosed with diabetes between 2005 and 2013 were followed up until 2018. They were categorized based on the presence or absence of complications, the number of complications, and the diabetes complications severity index (DCSI) scores. Dialysis outcomes were determined through the Registry of Catastrophic Illness from the National Health Insurance Research Database. Among the analyzed patients, 25.38% had complications at diagnosis. Patients with complications at diagnosis had a significantly higher risk of dialysis within 5 years (adjusted hazard ratio: 9.55, 95% confidence interval CI 9.02–10.11). Increasing DCSI scores and the number of complications were associated with higher dialysis risks. Patients with one complication had a 7.26-times higher risk (95% CI 6.83–7.71), while those with ≥ 3 complications had a 36.12-times higher risk (95% CI 32.28–40.41). In conclusion, newly diagnosed diabetes patients with complications face an increased risk of dialysis within 5 years. The severity and number of complications are directly linked to the risk of dialysis within this timeframe.

Quantifying association and disparities between diabetes complications and COVID-19 outcomes: A retrospective study using electronic health records.

Despite established relationships between diabetic status and an increased risk for COVID-19 severe outcomes, there is a limited number of studies examining the relationships between diabetes complications and COVID-19-related risks. We use the Adapted Diabetes Complications Severity Index to define seven diabetes complications. We aim to understand the risk for COVID-19 infection, hospitalization, mortality, and longer length of stay of diabetes patients with complications. We perform a retrospective case-control study using Electronic Health Records (EHRs) to measure differences in the risks for COVID-19 severe outcomes amongst those with diabetes complications. Using multiple logistic regression, we calculate adjusted odds ratios (OR) for COVID-19 infection, hospitalization, and in-hospital mortality of the case group (patients with diabetes complications) compared to a control group (patients without diabetes). We also calculate adjusted mean difference in length of stay between the case and control groups using multiple linear regression. Adjusting demographics and comorbidities, diabetes patients with renal complications have the highest odds for COVID-19 infection (OR = 1.85, 95% CI = [1.71, 1.99]) while those with metabolic complications have the highest odds for COVID-19 hospitalization (OR = 5.58, 95% CI = [3.54, 8.77]) and in-hospital mortality (OR = 2.41, 95% CI = [1.35, 4.31]). The adjusted mean difference (MD) of hospital length-of-stay for diabetes patients, especially those with cardiovascular (MD = 0.94, 95% CI = [0.17, 1.71]) or peripheral vascular (MD = 1.72, 95% CI = [0.84, 2.60]) complications, is significantly higher than non-diabetes patients. African American patients have higher odds for COVID-19 infection (OR = 1.79, 95% CI = [1.66, 1.92]) and hospitalization (OR = 1.62, 95% CI = [1.39, 1.90]) than White patients in the general diabetes population. However, White diabetes patients have higher odds for COVID-19 in-hospital mortality. Hispanic patients have higher odds for COVID-19 infection (OR = 2.86, 95% CI = [2.42, 3.38]) and shorter mean length of hospital stay than non-Hispanic patients in the general diabetes population. Although there is no significant difference in the odds for COVID-19 hospitalization and in-hospital mortality between Hispanic and non-Hispanic patients in the general diabetes population, Hispanic patients have higher odds for COVID-19 hospitalization (OR = 1.83, 95% CI = [1.16, 2.89]) and in-hospital mortality (OR = 3.69, 95% CI = [1.18, 11.50]) in the diabetes population with no complications. The presence of diabetes complications increases the risks of COVID-19 infection, hospitalization, and worse health outcomes with respect to in-hospital mortality and longer hospital length of stay. We show the presence of health disparities in COVID-19 outcomes across demographic groups in our diabetes population. One such disparity is that African American and Hispanic diabetes patients have higher odds of COVID-19 infection than White and Non-Hispanic diabetes patients, respectively. Furthermore, Hispanic patients might have less access to the hospital care compared to non-Hispanic patients when longer hospitalizations are needed due to their diabetes complications. Finally, diabetes complications, which are generally associated with worse COVID-19 outcomes, might be predominantly determining the COVID-19 severity in those infected patients resulting in less demographic differences in COVID-19 hospitalization and in-hospital mortality.

Sodium-glucose cotransporter-2 inhibitor in risk of sepsis/septic shock among patients with type 2 diabetes mellitus-a retrospective analysis of nationwide medical claims data.

This research is an attempt to investigate the benefit of sodium-glucose cotransporter-2 inhibitor (SGLT2I) use in patients with diabetes mellitus (DM) for outcomes of sepsis/septic shock. We used Taiwan's national data set to identify patients and patients' characteristics to investigate sepsis/septic shock among diabetes patients who use SGLT2I compared to those who do not. We have compared the two groups for several relevant categories of potential risk factors for sepsis/septic shock and adjusted the Cox regression models accordingly. The adapted diabetes complications severity index (DCSI) was used for stratifying the advancing disease of DM. Compared to patients with DCSI = 0, patients with DCSI ≥ 2 had a significantly higher risk of sepsis/septic shock (adjusted HR = 1.52, 95% CI = 1.37-1.68). A significantly lower risk of sepsis/septic shock events was observed in the SGLT2I cohort than in the non-SGLT2I cohort with the DCSI groups [adjusted HR = 0.6 (DCSI group = 0), adjusted HR = 0.61 (DCSI group = 1), adjusted HR = 0.55 (DCSI group ≥ 2)]. Patients who received SGLT2I for a cumulative duration of ≥ 90days had a significantly lower risk of sepsis/septic shock than patients with a duration of < 90days (adjusted HR = 0.36, 95% CI = 0.34-0.39). We described a decreased risk of sepsis/septic shock among diabetic patients who took SGLT2I.

Risk and dose-response relationship of diabetes mellitus for endophthalmitis after cataract surgery in a nationwide cohort study in Taiwan.

To investigate the risk of endophthalmitis after cataract surgery in patients with diabetes mellitus (DM) and evaluate the dose-response relationship. This retrospective cohort study enrolled patients who underwent bilateral cataract surgeries from 2000 to 2017 in Taiwan National Health Insurance Research Database. The endophthalmitis rates within 3 months after cataract surgery were compared between DM and non-DM cohorts using a generalised estimating equation. The diabetes complications severity index (DSCI) score was adopted to assess the dose-response effect on the endophthalmitis rate. A total of 883 398 patients (1 766 796 eyes) were included. Patients with DM had an increased risk of endophthalmitis after cataract surgery than patients without DM (0.261% vs. 0.242%, adjusted odds ratio = 1.09, 95% confidence interval = 1.03-1.16). The higher endophthalmitis rate in the DM group than in the non-DM group remains after excluding those with prior vitrectomy or intravitreal injection (IVI), and took IVI between the cataract surgery and endophthalmitis (p = 0.0156, 0.0048, and 0.0139). There was a significant dose-response relationship on the likelihood of endophthalmitis in DM patients when DCSI score >10. The endophthalmitis rate is highest among DM complications in patients with metabolic disorders (0.342%). DM was a risk factor for endophthalmitis after cataract surgery after adjusting for age, sex, common systemic disorders, and excluding those with prior vitrectomy or IVI and having IVI between cataract surgery and endophthalmitis. A dose-response relationship was noted in DM patients with a DCSI score >10.

The impact of the incidence of diabetic complications on mortality in colorectal cancer patients with diabetes: A nationwide study.

The prevalence of diabetes is higher in patients with colorectal cancer, which is important because diabetes is recognized as a risk factor for increased mortality. This study investigated the impact of incident diabetes-related complications on all-cause five-year mortality in older aged colorectal cancer patients with diabetes. The 2008 to 2019 National Health Insurance Service data on the elderly were used to identify patients with colorectal cancer aged 60years or above diagnosed with type 2 diabetes mellitus. The outcome measure was all-cause five-year mortality. The main independent variable was incident status of diabetes-related complications using the Diabetes Complications Severity Index (DCSI). Survival analyses were performed using the Cox proportional hazards model, in addition to the calculation of risk differences. Subgroup analysis was conducted based on the type of complication and DCSI scores. Among 1,312 individuals, 319 (24.3%) died within five years after one year of a cancer diagnosis. The risk of mortality was higher in patients with diabetes and cancer having incident diabetes-related complications (Hazard Ratio 1.29, 95% Confidence Interval 1.03-1.63). These tendencies were generally maintained regardless of the type of complication and DCSI scores. The incidence of diabetes-related complications after cancer diagnosis was associated with an increased risk of all-cause five-year mortality in older patients with colorectal cancer and preexisting diabetes.

Psychiatric disorders in patients with type 2 diabetes mellitus on sodium-glucose cotransporter-2 inhibitors-a nationwide retrospective cohort study.

To compare the potential role of sodium-glucose cotransporter-2 inhibitors (SGLT2I) in the development of psychiatric disease among patients with type 2 diabetes mellitus (DM). Using a large population-based database, SGLT2I users and non-SGLT2I users were 1:1 matched according to the covariates of sex, age, comorbidities, adapted diabetes complications severity index (DCSI), medications, and index year using propensity score matching and a logistic regression model. We calculated the incidence of major psychiatric disorders and adjusted hazard ratios (HR) with 95% confidence interval (CI) for SGLT2I users and the non- SGLT2I users using a Cox proportional hazards model. SGLT2I were associated with a lower risk for psychiatric disorders than those not treated with SGLT2I (HR 0.80 and 95% CI 0.72-0.88). Among patients with DM, SGLT2I were associated with a lower risk of psychiatric disease.

Diabetes type 2 in the Berlin Aging Study II: Cross-sectional and longitudinal data on prevalence, incidence and severity over on average seven years of follow-up.

Aim of the current study was to describe the prevalence, incidence, and severity of diabetes mellitus type 2 (T2D) in a cohort of older men and women aged 60 years and above over the course of on average 7 years, since longitudinal data on this topic are scarce for this age group in Germany. Baseline data of 1671 participants of the Berlin Aging Study II (BASE-II; 68.8 ± 3.7 years) and follow-up data assessed 7.4 ± 1.5 years later were analysed. The BASE-II is an exploratory, observational study on cross-sectional and longitudinal data of an older population. T2D was diagnosed based on self-report, antidiabetic medication use and laboratory parameters. T2D severity was determined by the diabetes complications severity index (DCSI). Prognostic capacity of laboratory parameters was evaluated. The proportion of participants with T2D increased from 12.9% (37.3% women) at baseline to 17.1% (41.1% women) with 74 incident cases and 22.2% not being aware of the disease at follow-up. The incidence rate is 10.7 new T2D diagnoses per 1000 person-years. More than half of the 41 newly identified incident T2D cases were diagnosed solely by the 2 h-plasma glucose test (OGTT) and diagnosis based on OGTT as the only criterion among incident cases was found more frequently in women (p = 0.028). T2D severity expressed by the DCSI significantly increased from baseline to follow-up (mean DCSI 1.1 ± 1.2 vs. 2.0 ± 1.8; range 0-5 vs. 0-6). Cardiovascular complications had the highest impact (43.2% at baseline and 67.6% at follow-up). A comprehensive picture of T2D with respect to prevalence, incidence, and severity in older people of the Berlin Aging Study II is provided.

Adapted Diabetes Complications Severity Index and Charlson Comorbidity Index in predicting all-cause and cause-specific mortality among patients with type 2 diabetes

IntroductionAdapted Diabetes Complications Severity Index (aDCSI) is a commonly used severity measure based on the number and severity of diabetes complications using diagnosis codes. The validity of aDCSI in predicting...

DNA methylation age acceleration is associated with risk of diabetes complications

BackgroundPatients with Type 2 diabetes mellitus (T2D) are at risk for micro- and macrovascular complications. Implementable risk scores are needed to improve targeted prevention for patients that are particularly susceptible to complications. The epigenetic clock estimates an individual’s biological age using DNA methylation profiles.MethodsIn this study, we examined older adults of the Berlin Aging Study II that were reexamined on average 7.4 years after baseline assessment as part of the GendAge study. DNA methylation age (DNAmA) and its deviation from chronological age DNAmA acceleration (DNAmAA) were calculated with the 7-CpG clock (available at both timepoints, n = 1,071), Horvath’s clock, Hannum’s clock, PhenoAge and GrimAge (available at follow-up only, n = 1,067). T2D associated complications were assessed with the Diabetes Complications Severity Index (DCSI).ResultsWe report on a statistically significant association between oral glucose tolerance test results and Hannum and PhenoAge DNAmAA. PhenoAge was also associated with fasting glucose. In contrast, we found no cross-sectional association after covariate adjustment between DNAmAA and a diagnosis of T2D. However, longitudinal analyses showed that every additional year of 7-CpG DNAmAA at baseline increased the odds for developing one or more additional complications or worsening of an already existing complication during the follow-up period by 11% in male participants with T2D. This association persisted after covariate adjustment (OR = 1.11, p = 0.045, n = 56).ConclusionAlthough our results remain to be independently validated, this study shows promising evidence of utility of the 7-CpG clock in identifying patients with diabetes who are at high risk for developing complications.

Role of sodium-glucose cotransporter-2 inhibitors in risk of chronic kidney disease among patients with type 2 diabetes mellitus.

This retrospective analysis aims to explore the risk of chronic kidney disease (CKD) among type 2 diabetes mellitus (DM) patients with different scores of adapted diabetes complications severity index (DCSI) who received sodium-glucose cotransporter-2 inhibitors (SGLT2Is). This study includes 113,449 DM patients from the Taiwan National Health Insurance Research Database (NHIRD). We analyzed the data collected from 107,440 patients showing a DCSI score change of < 1 per year, 3720 patients with a score change of 1 to 2 per year and 2289 patients with a score change of > 2 per year. Cox proportional hazard models were used to evaluate the CKD risk throughout the overall follow-up period, and were adjusted for sex, age, comorbidities and medications of a-glucosidase inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, biguanides, dipeptidyl peptidase-4inhibitors, glucagon like peptide-1 receptor agonists, insulin, meglitinides, sulphonylurea and thiazolidinedione. The incidence of CKD increased from 18.30 per 1000 person-years in patients with a score change of<1 per year to 137.55 per 1000 person-years for those with a score change of > 2 per year. Patients with a higher score change (> 2 per year) and receiving SGLT2Is had a lower risk of developing CKD than patients who did not receive SGLT2Is. The use of SGLT2Is was significantly associated with the reduction in CKD incidence in diabetic patients with a higher DCSI.