Incidence Rate Of Diabetes Research Articles

571-P: Motivation, Self-Efficacy, Social Support, and Patient Activation among Racially/Ethnically Diverse Adults with Prediabetes

Background: Black, Latino, and Asian Americans experience higher diabetes incidence rates compared to White adults. According to self-determination theory, psychosocial factors such as autonomous motivation, self-efficacy, perceived social support and patient activation influence the likelihood of initiating and engaging in health behaviors that prevent diabetes. Whether these psychosocial factors differ by race/ethnicity among adults with prediabetes and if these may contribute to observed racial/ethnic disparities in diabetes incidence is unknown. Methods: Using baseline survey data from a diabetes prevention intervention study at Kaiser Permanente Northern California and Michigan Medicine, we measured autonomous motivation and self-efficacy on a 1-7 scale, perceived social support on a 12-72 scale, and activation on a 0-100 scale. Multivariable linear regression models estimated mean racial/ethnic differences, adjusting for age, sex and clinic. Results: Of 296 prediabetic adults, 40% were White, 37% Black, 10% Latino, and 6% Asian American. Mean autonomous motivation was high (6.6/7) and did not differ by race/ethnicity (all p-values >0.05). Self-efficacy was higher for Black vs. White adults (6.1 vs. 5.7; p-value < 0.05). Black and Latino adults had higher values of perceived social support compared to White adults, and Asian American adults had the lowest (all p-values < 0.05). Mean activation was higher in Asian American and Latino compared to White adults, but lower in Black adults (p-values < 0.05). Conclusion: Autonomous motivation was high in adults with prediabetes, underscoring the opportunity to address diabetes prevention efforts at the population level. However, Asian American adults reporter lower social support and Black adults reported lower patient activation than other groups. Differences in these psychosocial factors should be considered when tailoring diabetes prevention efforts and outreach. Disclosure L. A. Rodriguez: None. T. Thomas: None. H. Finertie: None. C. D. Turner: None. M. Heisler: None. J. Schmittdiel: None. Funding Permanente Medical Group; National Institute of Diabetes and Digestive and Kidney Diseases (T32DK11668401)

Estimates of drug treated diabetes incidence and prevalence using Australian administrative pharmaceutical data.

IntroductionThe incidence and prevalence of diabetes within a population are important public health metrics. Pharmaceutical administrative data may offer a resource that can contribute to quantifying these measures using the recorded signals derived from the drugs used to treat people with diabetes.ObjectiveTo estimate the longitudinal incidence and prevalence of drug treated (DT) diabetes in Australia utilising an Australian Pharmaceutical Benefits Scheme (PBS) dataset and compare estimates with community survey data for all diabetes reported in the Australian National Health Survey (NHS).MethodsPersons with DT diabetes were identified within the PBS dataset using assigned Anatomic Therapeutic Chemical codes for ‘Drugs used in diabetes’. Prevalent persons with DT diabetes were determined by a single annual treatment, and incident cases from the earliest treatment with diabetes medications. Counts were aggregated by age group and utilised Australian national census data as a denominator to calculate diabetes disease frequencies for the period 2004–14. Comparison of PBS prevalence data was made with NHS surveys over equivalent years.ResultsThe age adjusted incidence of DT diabetes was 3.4/1000 in 2006 and increased to 3.8/1000 in 2011 and 5.1/1000 in 2014. Age adjusted prevalence of DT diabetes in Australia also rose from 26.7/1000 in 2006 to 32.1/1000 in 2011 and 42.1/1000 in 2014. DT diabetes prevalence estimates correlated with NHS estimates of self-reported diabetes prevalence across age groups and in 2014 was r = 0.987. However, PBS estimates of DT diabetes prevalence generally underestimated NHS values of self-reported diabetes in older age groups with mean percentage differences of –22% to –3%. In contrast, PBS data captured more younger persons with diabetes in comparison to NHS data. These differences were then used to adjust DT diabetes incidence rates to provide age specific estimates that could potentially reflect diabetes incidence estimates acquired by community survey.ConclusionsPBS data representing dispensed medications prescribed to persons with diabetes offers a perspective for the assessment of diabetes incidence and prevalence. PBS derived DT diabetes prevalence estimates correlate well with community survey estimates of self-reported diabetes, but underestimate NHS data in older age groups. Calibrated DT incidence estimates may potentially reflect community survey derived diabetes incidence estimates and may offer a method for longitudinal monitoring.

Modeling the diabetic population in Malaysia using a functional rate of unhealthy lifestyle influence

Social influence poses great challenges to human behavior. The increasing prevalence of diabetics is due to the diabetes incidence that keeps on elevated every year. In this work, we proposed a functional rate of diabetes incidence with the factor of unhealthy social influence. A diabetic population dynamics is governed by using the ordinary differential equation with a nonlinearity of diabetes incidence. In the first, a complete stability property of the diabetic equilibrium is discussed. Parameter estimation problem for given data from the Malaysian National Health and Morbidity Survey, using optimization, is studied. We then carried out the index sensitivity analysis that completely determines the system behavior to a single parameter perturbation. Next, to lower the diabetes incidence rate and minimize the cost of prevention strategies, an optimal control problem is introduced in our model. By numerical simulations, the intervention reduces diabetic individuals in few years of diabetes control and prevention.

Future risk of diabetes among Indians with metabolic and phenotypic obesity: Results from the 10-year follow-up of the Chennai Urban Rural Epidemiology Study (CURES-158).

To investigate the risk of type 2 diabetes (T2DM) among the combinations of BMI categories and metabolic syndrome in Asian Indians. Individuals from the Chennai Urban Rural Epidemiology Study cohort (n = 1,368), free of diabetes at baseline were stratified by BMI and metabolic health as metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically obese non-obese (MONO) and metabolically obese obese (MOO). Phenotypic obesity was defined as BMI ≥ 25kg/m2 and metabolic obesity as presence of any two of the metabolic abnormalities: hyperglycemia, high blood pressure, high triglyceridemia or low HDL cholesterol. Hazard ratios for progression to diabetes were estimated using Cox proportional hazard regression. During median 9.1years of follow-up, incident cases of diabetes were highest among MOO-45.1%, followed by MONO-41.3%, MHO-27.1% and MHNO-15.9%. Incidence rates of diabetes among MOO, MONO, MHO and MHNO were 57.8, 50.9, 30.4 and 18.1 per 1000 person years, respectively. Hazard ratio for diabetes development were 1.71 in MHO, 2.87 in MONO, and 3.39 in MOO compared with MHNO. Increased BMI and metabolic risk factor clustering independently contribute to the increased risk of T2DM in obese individuals. Screening for metabolic abnormalities should be performed routinely in clinic to identify high-risk individuals and institute appropriate preventive measures.

Normal weight obesity and the risk of diabetes in Chinese people: a 9-year population-based cohort study

We evaluated the risk of developing diabetes in Chinese individuals with normal weight obesity (NWO). This 9-year population-based cohort study was based on the China National Diabetes and Metabolic Disorders Survey. A total of 1128 subjects without diabetes were included. Body fat percentage (BF%) was assessed by electrical bioimpedance. NWO was defined as subjects with a normal BMI (< 24 kg/m2) and an excess BF% (≥ 24% in men; ≥ 33% in women). Of 1128 individuals, 528 individuals were normal weight non-obese (NWNO), 118 (10.5%) were normal weight obese (NWO), 63 were overweight non-obese (OWNO), and 419 were overweight obese (OWO). During a follow-up of 9.0 years (interquartile range: 8.9–9.3), 113 (10.0%) individuals developed diabetes. The incidence rates of diabetes in NWNO, NWO, OWNO and OWO people were 5.69 (27 cases), 11.30 (12 cases), 3.53 (2 cases) and 19.09 (72 cases) per 1000 person-years, respectively. Cox regression analyses indicated multivariate-adjusted hazard ratios of diabetes in NWO, OWNO and OWO people were 2.110 (95% CI 1.026–4.337, p = 0.025), 0.441 (95% CI 0.101–1.928, p = 0.232) and 3.465 (95% CI 2.163–5.551, p < 0.001), respectively, relative to NWNO people. Chinese people with NWO are at increased risk of developing diabetes. We strongly suggest the incorporation of BF% measurement into the regular physical examination in Chinese medical practice.

Expanding the Finnish Diabetes Risk Score for Predicting Diabetes Incidence in People Living with HIV.

This study investigated whether the predictive ability of the Finnish Diabetes Risk Score (FINDRISC) can be improved among people with HIV by adding a marker of insulin resistance. In this longitudinal analysis of the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study, HIV-positive and HIV-negative participants without prevalent diabetes were included. FINDRISC score and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) were calculated at baseline. Cox proportional hazards models were used to examine associations between baseline risk scores and time to incident diabetes (first self-report of diabetes medication use). Model discrimination (Uno's c-statistic) and calibration (observed vs. cumulative probability of diabetes) were assessed for FINDRISC, HOMA-IR, and combined FINDRISC and HOMA-IR. Overall, 2,527 men (1,299 HIV-positive and 1,228 HIV-negative, median age = 44) and 2,446 women (1,841 HIV-positive and 605 HIV-negative, median age = 41) were included. Over 47,040 person-years of follow-up, diabetes incidence rates per 1,000 person-years were 9.5 in HIV-positive men, 7.1 in HIV-negative men, 14.5 in HIV-positive women, and 15.1 in HIV-negative women. FINDRISC discrimination (HIV-positive men c = 0.64 [0.55, 0.74], HIV-negative men c = 0.74 [0.68, 0.79], HIV-positive women c = 0.68 [0.64, 0.71], and HIV-negative women c = 0.73 [0.66, 0.79]) was significantly better than that of HOMA-IR. FINDRISC was better calibrated than HOMA-IR in each of the four groups. Adding HOMA-IR did not improve FINDRISC discrimination/calibration. Diabetes risk prediction with FINDRISC was suboptimal in men and women with HIV, and its performance was not improved with addition of HOMA-IR. The optimal method for identifying people living with HIV at-risk for diabetes is yet to be identified.

The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

BackgroundMyocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS.MethodsIn this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%).ResultsIn group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG.ConclusionImpaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

Early Diagnosis of Type 2 Diabetes Based on Near-Infrared Spectroscopy Combined With Machine Learning and Aquaphotomics.

Early diagnosis is important to reduce the incidence and mortality rate of diabetes. The feasibility of early diagnosis of diabetes was studied via near-infrared spectra (NIRS) combined with a support vector machine (SVM) and aquaphotomics. Firstly, the NIRS of entire blood samples from the population of healthy, pre-diabetic, and diabetic patients were obtained. The spectral data of the entire spectra in the visible and near-infrared region (400–2,500 nm) were used as the research object of the qualitative analysis. Secondly, several preprocessing steps including multiple scattering correction, variable standardization, and first derivative and second derivative steps were performed and the best pretreatment method was selected. Finally, for the early diagnosis of diabetes, models were established using SVM. The first overtone of water (1,300–1,600 nm) was used as the research object for an aquaphotomics model, and the aquagram of the healthy group, pre-diabetes, and diabetes groups were drawn using 12 water absorption patterns for the early diagnosis of diabetes. The results of SVM showed that the highest accuracy was 97.22% and the specificity and sensitivity were 95.65 and 100%, respectively when the pretreatment method of the first derivative was used, and the best model parameters were c = 18.76 and g = 0.008583.The results of the aquaphotomics model showed clear differences in the 1,400–1,500 nm region, and the number of hydrogen bonds in water species (1,408, 1,416, 1,462, and 1,522 nm) was evidently correlated with the occurrence and development of diabetes. The number of hydrogen bonds was the smallest in the healthy group and the largest in the diabetes group. The suggested reason is that the water matrix of blood changes with the worsening of blood glucose metabolic dysfunction. The number of hydrogen bonds could be used as biomarkers for the early diagnosis of diabetes. The result show that it is effective and feasible to establish an accurate and rapid early diagnosis model of diabetes via NIRS combined with SVM and aquaphotomics.

Insulin use and new diabetes after acceptance for bariatric surgery: comparison of outcomes after completion of surgery or withdrawal from the program

IntroductionIn people accepted onto a bariatric surgery program we compared diabetes-related outcomes in those who completed surgery with those who withdrew before having surgery—examining rates of insulin use in people...

Smartphone-powered iontophoresis-microneedle array patch for controlled transdermal delivery

The incidence rate of diabetes has been increasing every year in nearly all nations and regions. The traditional control of diabetes using transdermal insulin delivery by metal needles is generally associated with pain and potential infections. While microneedle arrays (MAs) have emerged as painless delivery techniques, the integration of MA systems with electronic devices to precisely control drug delivery has rarely been realized. In this study, we developed an iontophoresis-microneedle array patch (IMAP) powered by a portable smartphone for the active and controllable transdermal delivery of insulin. The IMAP in situ integrates iontophoresis and charged nanovesicles into one patch, achieving a one-step drug administration strategy of “penetration, diffusion and iontophoresis”. The MA of the IMAP is first pressed on the skin to create microholes and then is retracted, followed by the iontophoresis delivery of insulin-loaded nanovesicles through these microholes in an electrically controlled manner. This method has synergistically and remarkably enhanced controlled insulin delivery. The amount of insulin can be effectively regulated by the IMAP by applying different current intensities. This in vivo study has demonstrated that the IMAP effectively delivers insulin and produces robust hypoglycemic effects in a type-1 diabetic rat model, with more advanced controllability and efficiency than delivery by a pristine microneedle or iontophoresis. The IMAP system shows high potential for diabetes therapy and the capacity to provide active as well as long-term glycemic regulation without medical staff care.

Lifetime risk of diabetes in metropolitan cities in India

Aims/hypothesisWe aimed to estimate the lifetime risk of diabetes and diabetes-free life expectancy in metropolitan cities in India among the population aged 20 years or more, and their variation by sex, age and BMI.MethodsA Markov simulation model was adopted to estimate age-, sex- and BMI-specific lifetime risk of developing diabetes and diabetes-free life expectancy. The main data inputs used were as follows: age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010–2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research INdia DIABetes study (2008–2015).ResultsLifetime risk (95% CI) of diabetes in 20-year-old men and women was 55.5 (51.6, 59.7)% and 64.6 (60.0, 69.5)%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk (95% CI) declined with age to 37.7 (30.1, 46.7)% at age 60 years among women and 27.5 (23.1, 32.4)% in men. Lifetime risk (95% CI) was highest among obese Indians: 86.0 (76.6, 91.5)% among 20-year-old women and 86.9 (75.4, 93.8)% among men. We identified considerably higher diabetes-free life expectancy at lower levels of BMI.Conclusions/interpretationLifetime risk of diabetes in metropolitan cities in India is alarming across the spectrum of weight and rises dramatically with higher BMI. Prevention of diabetes among metropolitan Indians of all ages is an urgent national priority, particularly given the rapid increase in urban obesogenic environments across the country.Graphical abstract

Regular consumption of soft drinks is associated with type 2 diabetes incidence in Mexican adults: findings from a prospective cohort study

BackgroundAlthough high consumption of soft drinks has been associated with excess of type 2 diabetes risk, the strength of this association in the Mexican population, where a type 2 diabetes genetic susceptibility has been well established, has been scarcely studied. This study aimed to estimate the risk of type 2 diabetes due to soft drinks consumption in a cohort of Mexicans.MethodsWe used data on 1445 participants from the Health Workers Cohort Study, a prospective cohort conducted in Cuernavaca, Mexico. Soft drinks consumption was assessed with a semi-quantitative 116-item food frequency questionnaire. Incident type 2 diabetes was defined as self-report of physician-diagnosed type 2 diabetes, fasting glucose > 126 mg/dl, or hypoglycemic medication at any examination. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models.ResultsWith a total of 9526.2 person-years of follow-up, 109 incident cases of type 2 diabetes were observed. Type 2 diabetes incidence rate was 7.6, 11.0, and 17.1 per 1000 person-years across levels of soft drinks consumption of < 1, 1–4, and ≥ 5 servings/week, respectively (p < 0.001 for trend). The intake of ≥5 soft drinks/week was significantly associated with an increased risk of type 2 diabetes (HR 1.9 95% CI:1.0–3.5) compared with consumption of < 1/week (p-trend = 0.040). The HR was attenuated by further adjustment for body mass index (HR 1.5 95%CI:0.8–2.8) and abdominal obesity (HR 1.6 95%CI:0.8–3.0).ConclusionsThe consumption of soft drinks was associated with a higher risk of type 2 diabetes in a cohort of Mexican adults. Our results further support recommendations to limit soft drinks intake to address the growing diabetes epidemic in Mexico.

NOVEL-1st: A Non-Interventional, Multi-Center Observational Study to Assess the Safety and Efficacy of Nilotinib in Newly Diagnosed Patients with Philadelphia Chromosome Positive (Ph+) Chronic Myelogenous Leukemia in Chronic Phase (CML-CP) in Taiwan

Background Nilotinib, a second-generation tyrosine kinase inhibitor (TKI), has been approved for the treatment of patients with newly diagnosed Philadelphia chromosome positive chronic myeloid leukemia in chronic phase (Ph+ CML-CP) globally, including Taiwan. However, the real-world evidence regarding the long-term safety (primary) and effectiveness (secondary) of nilotinib in newly diagnosed untreated Ph+ CML-CP is limited in Taiwan. Methods The NOVEL-1st study was a non-interventional, multi-center study. A total of 129 patients with newly diagnosed and previously untreated Ph+ CML-CP were enrolled from 11 centers. The objective was to collect the long-term safety (primary) and effectiveness (secondary) data in patients treated with nilotinib under the real clinical practice for up to three years. Results Of the 129 enrolled patients, 32 patients (24.8%) discontinued the study, predominately due to AEs (n = 8; 6.2%), discontinuing nilotinib or switching to other treatments (n = 7; 5.4%), and death (n = 5; 3.9%). The median age of the study population was 49 years (range, 20 - 53 years), of whom 77 were male (59.7%). At enrollment, the median time from initial CML diagnosis was 22 days (range, 0.0 - 602 days), and three of them had their CML diagnosed for more than one year. Across the 3-year observational period, a total of 1,466 AEs were reported in 127 (98.4%) patients, of which 151 AEs in 44 (34.6%) patients were serious adverse events (SAEs) and 524 AEs in 37 (29.1%) patients were nilotinib-related. The most commonly reported non-hematological AEs (regardless of relationship to nilotinib, incidence ≥ 20 %) were rash (24.8%); while that for hematological AEs were thrombocytopenia (31.0%; Grade 3 or above: 13.2%) (Table 1). Nilotinib discontinuation, and dose reduction or interruptions were only reported in 9 (7.1%) and 11 (8.7%) patients, respectively. Five (3.9%) patients expired, of whom 2 were due to CML progression. Favorable efficacy outcomes were observed in this real-world study. From 3 to 36 months, the rates of clinical response increased over time, from 72.5% to 98.3% for complete hematological response (CHR), from 48.3% to 92.5% for complete cytogenetic response (CCyR), from 16.7% to 85.8% for major molecular response (MMR), from 4.2% to 65.0% for MR4.0 (BCR-ABL ≥ 4 log reduction), and from 3.3% to 45.0% for MR4.5 (BCR-ABL ≥ 4.5 log reduction) (Figure 1). The median time to CHR, CCyR, MMR, and MR4.0 were 4, 5, 9, and 25 months, respectively (not reached for MR4.5). Early molecular response (EMR), defined as BCR-ABL ≤ 10% at Month 3, was seen in 87.6% of patients. Non-hematological and hematological AEs were comparable with previous studies, with no new safety signal detected. This NOVEL-1st study demonstrated a lower percentage of patients withdrawing nilotinib owing to AEs (NOVEL-1st vs. prior: 7.1% vs. 10.0%) and an extremely lower incidence of AEs leading to dose reduction or interruption (8.7% vs. 37 - 55%). It was inferred that the high tolerability and patient adherence further contributed to high treatment response in terms of complete molecular response (CMR [i.e., MR4.5], 45% vs. 32%), molecular response 4.0 (MR4.0, 65% vs. 50%), and major molecular response (MMR, 85.5% vs. 73%) at 3 years. Over the 3 years of follow-up, there was no newly onset of hepatitis or hepatitis B flare. This NOVEL-1st study also reported lower incidence rates of CV events (NOVEL-1st vs. prior: 2.3% vs. 3.5 - 6.0%), diabetes (2.3% vs. 20.2%), and hyperglycemia (3.1% vs. 42.1%) than prior studies. None of them was judged as related to nilotinib treatment (Table 1). Conclusions Across the 3-year observational period, nilotinib demonstrated comparable efficacy and had lower risk of hepatitis flare, CV event, diabetes and hyperglycemia among Ph+CML-CP patients in a real world setting in Taiwan. Long-term good patient adherence and holistic care could contribute to good treatment outcome in this chronic disease under the first-line treatment with nilotinib. Disclosures Chen: Novartis: Current Employment. Lee:Novartis: Current Employment. Ku:Novartis: Current Employment.

Sex-Specific Associations of Circulating Uric Acid with Risk of Diabetes Incidence: A Population-Based Cohort Study from Sweden.

ObjectiveTo explore the longitudinal, as well as sex-specific, associations between circulating uric acid (UA) and diabetes incidence.MethodsA cohort study of the Malmö Diet Cancer-cardiovascular Cohort (Malmö, Sweden) consisting of 3140 individuals without diabetes at baseline, was followed up until the end of 2018. Incident diabetes cases were identified by linking to local and national diabetes registers. Cox proportional hazard regression was used to assess plasma UA levels in relation to diabetes incidence with adjustment for established confounders.ResultsAt baseline, with increasing levels of UA, subjects were more likely to be older and have significantly higher body mass index, waist circumference, triglycerides, C-reactive protein, fasting glucose and 2-h plasma glucose postoral glucose tolerance test, and lower levels of high-density lipoprotein. During a mean follow-up period of 8.09±2.24 years, 315 (10.0%) participants developed diabetes, and diabetes incidence rates were 7.89, 9.48 and 18.11 per 1000 person-years for subjects in the 1st, 2nd, and 3rd tertiles of UA, respectively (log-rank test: p<0.001). With adjustment for potential confounders, elevated UA levels were significantly associated with increased risks of diabetes incidence, with the adjusted hazard ratio (HR) (95% confidence interval) for per standard deviation increment of UA of 1.22 (1.08–1.39, p=0.002). Compared with the 1st tertile of UA, the 3rd tertile showed significantly increased risk of diabetes incidence with the adjusted HR of 1.74 (1.24–2.45, p=0.002), and there was a significant trend between increasing tertiles of UA and diabetes incidence (trend test: p<0.001). Stratified analyses showed that elevated circulating UA levels were independently associated with increased risks of diabetes incidence in men but not in women, although the interaction between sex and UA was not statistically significant.ConclusionElevated circulating UA was independently associated with increased risk of diabetes incidence, especially for men.

A Multipollutant Longitudinal Study of the Association between Urinary Tungsten and Incident Diabetes in a Rural Population

Background/Aim: Tungsten (W) is a transitional metal found in soil, water, food, and air. Cross-sectional analyses indicate that W is associated with fasting glucose (FG) levels. We conducted the first longitudinal analysis assessing the association between W and incident diabetes, accounting for arsenic (As), lead (Pb), and cadmium (Cd) coexposure. Methods: We analyzed data from 1684 individuals residing in rural Colorado (USA) and participating in the San Luis Valley Diabetes Study. Participants’ diabetes status, FG (mg/dL), and urinary concentrations of W, As, Pb, Cd, and creatinine were assessed between one and seven times over 14 years. Metal concentrations (μg/L) and FG were natural log-transformed. We assessed longitudinal associations between lnW exposure and lnFG using linear mixed effect models with a random intercept for each participant. We assessed the association between baseline lnW exposure and incidence rate of diabetes using Fine and Gray competing risk regression (competing event=all-cause mortality). An evidenced-based directed acyclic graph (DAG) was used to determine covariates (age, ethnicity (Hispanic/not), sex, education (&lt;12/12/&gt;12 years), smoker status (current/former/never), alcohol intake (g/week), carbohydrates (g/day), body mass index, urine creatine (μg/g), lnAs, lnPb, and lnCd). Results: At the first examination, 48% of participants were Hispanic, 53% were female, the mean age was 54 years (standard deviation=12), the median W concentration was 0.22 μg/L (25th =0.20; 75th=0.59), and the median FG level was 99 mg/DL (25th=92; 75th =115). Of 1387 participants without diabetes at baseline (mean time at-risk=9.2 years), 398 individuals developed diabetes (incidence=3 cases/100 person-years) and 301 died before developing diabetes. LnW exposure was not associated with lnFG (0.1% decrease in lnFG for a doubling in lnW; 95%CI= 0.2% decrease-0.0% increase) or the incidence rate of diabetes (subdistribution hazard ratio=1.02, 95%CI=0.90,1.15). Conclusion: Accounting for metal coexposures, competing risks, and DAG-determined covariates, we observed no association between W and diabetes.

Low methyl-esterified pectin protects pancreatic β-cells against diabetes-induced oxidative and inflammatory stress via galectin-3

Insufficient intake of dietary fibers in Western societies is considered a major contributing factor in the high incidence rates of diabetes. The dietary fiber pectin has been suggested to be beneficial for management of both Diabetes Type 1 and Type 2, but mechanisms and effects of pectin on insulin producing pancreatic β-cells are unknown. Our study aimed to determine the effects of lemon pectins with different degree of methyl-esterification (DM) on β-cells under oxidative (streptozotocin) and inflammatory (cytokine) stress and to elucidate the underlying rescuing mechanisms, including effects on galectin-3. We found that specific pectins had rescuing effects on toxin and cytokine induced stress on β-cells but effects depended on the pectin concentration and DM-value. Protection was more pronounced with low DM5 pectin and was enhanced with higher pectin-concentrations. Our findings show that specific pectins might prevent diabetes by making insulin producing β-cells less susceptible for stress.

Components of diabetes prevalence in Denmark 1996–2016 and future trends until 2030

IntroductionIncidence rates of diabetes have been increasing and mortality rates have been decreasing. Our aim is the quantification of the effects of these on the prevalence and prediction of the...

Relationship Between Arterial Stiffness and New-Onset Diabetes Mellitus in Hypertensive Population

Abstract Background To investigate the relationship between arterial stiffness and new-onset diabetes mellitus in hypertensive population. Methods A total of 8,061 hypertensive and nondiabetic employees who participated in the yearly physical examination (2010–2015) of the Kailuan study were enrolled into the present study. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). Baseline was set at the first baPWV measurement, while follow-up ended at the first incident of diabetes mellitus or until the last examination (2016–2017). According to baPWV quartile, the effect of baPWV on new-onset diabetes mellitus was analyzed by Cox proportional hazard model, and a sensitivity test was analyzed by body mass index stratification. Results The mean follow-up time was (4.2 ± 2.1) years. During the follow-up period, 874 (10.8%) participants developed diabetes, with an average incidence rate of 25.7 per 1,000 person-years. The incidence rate (per 1,000 person-years) of new-onset diabetes in the first to fourth quartile of baPWV was 14.6, 23.8, 27.2, and 37.7, respectively (P &amp;lt; 0.001). Compared with the first quartile of baPWV, after adjustment for age, gender, mean arterial pressure, baseline fasting glucose, hypersensitive C-reactive protein, and other confounding factors, the HR and 95% confidence interval for new-onset diabetes of the second, third, and fourth quartile were 1.57 (1.24–1.98), 1.74 (1.37–2.20), and 2.38 (1.87–3.03), respectively. For each standard deviation increase of baPWV, the HR and 95% confidence interval were 1.32 (1.24–1.42). Conclusions Arterial stiffness is associated with new-onset diabetes mellitus in the hypertensive population.

LONGITUDINAL STUDY ON THE RELATIVE RISK OF TYPE 2 DIABETES MELLITUS ACCORDING TO OBESITY AND PHYSICAL ACTIVITY

Background and Purpose Diabetes mellitus is a major cause of death and can lead to complications of cardiovascular disease. High physical activity (HPA) and normal weight play a role in reducing the risk of diabetes. This study analyzed the relative risk (RR) of diabetes according to obesity and physical activity using national health census data. Methods Nationwide health screening was performed for all adults every 2 years. Data from 5,590,120 men and 4,102,523 women, who were followed up for 10 years, were analyzed. Physical activity questionnaires about weekly exercise frequency were used to define low physical activity (LPA, 0&ndash;2 days), moderate physical activity (MPA, 3&ndash;5 days), and high physical activity (HPA, 6&ndash;7 days). Body mass index (BMI) &le;24.9 kg/m2 was defined as normal, BMI 25.0&ndash;29.9 kg/m2 was overweight, and BMI &ge;30.0 kg/m2 was obese. The RR was calculated using Cox analysis. Results Diabetes incidence rates were 14.8% in overweight men, 20.0% in men with obesity, 17.9% in over-weight women, and 22.7% in women with obesity. The RR increased by 2.5 times in men with obesity and 3.4 times in women with obesity as compared with that of individuals with a normal BMI. Among overweight and obese individuals, those with HPA had decreased risks of developing diabetes compared with those with LPA (adjusted relative risk [ARR] for overweight individuals: 0.976 for men and 0.966 for women; ARR for individuals with obesity: 0.936 for men and 0.931 for women). Conclusion A high BMI increases the risk of diabetes; however, as physical activity increases, the risk of diabetes decreases. In the overweight and obese groups, those with higher physical activity had a lower risk of developing diabetes.

Effect of dietary myo-inositol supplementation on the insulin resistance and the prevention of gestational diabetes mellitus: study protocol for a randomized controlled trial

BackgroundGestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset or first recognition during pregnancy, which is characterized by an increased insulin resistance. Gestational diabetes mellitus is associated with pregnancy-related maternal and fetal morbidity (both antenatal and perinatal).Myo-inositol has been suggested to improve insulin resistance in women with polycystic ovary syndrome.The aim of this study is to examine the impact of myo-inositol supplementation during pregnancy on the incidence of gestational diabetes mellitus.MethodsWe will conduct a single-center, open-label, randomized controlled trial. A total of 160 healthy pregnant women with singleton pregnancy at 11–13+6 weeks of gestation will be randomly allocated in two groups: intervention group (N = 80) and control group (N = 80). The intervention group will receive myo-inositol and folic acid (4000 mg myo-inositol and 400 mcg folic acid daily) from 11 to 13+6 weeks of gestation until 26–28 weeks of gestation, while the control group will receive folic acid alone (400 mcg folic acid daily) for the same period of time as intervention group. The primary outcome will be gestational diabetes incidence rate at 26–28 weeks of gestation, according to the results of a 75 g oral glucose tolerance test held at 26–28 weeks of gestation. The secondary outcomes will include fasting blood glucose levels, glycated hemoglobin levels, insulin resistance level (evaluated by homeostasis model assessment of insulin resistance and Matsuda Index), and incidence rate of diet-treated gestational diabetes and diabetes requiring insulin therapy at 26–28 weeks of gestation.DiscussionThis trial will provide evidence for the effectiveness of myo-inositol supplementation during pregnancy in reducing the incidence of gestational diabetes mellitus.Trial registrationISRCTN registry: ISRCTN16142533. Registered on 9 March 2017.