Diabetes Mellitus Medication Research Articles

The Impact of New Onset Post-Transplant Diabetes on Outcomes after Heart Transplantation

Purpose Diabetes mellitus (DM) is common amongst heart transplant (HT) recipients and may occur either pre-HT or as new onset DM post-HT. We sought to define the incidence of pre-HT and post-HT DM in the contemporary era, evaluate predictors of post-HT DM, and assess the impact of post-HT DM on major clinical outcomes. Methods This is an ISHLT Transplant Registry study of adult primary HT-alone recipients between Jan 1995 and June 2012 without missing pre- or post-HT DM status, who survived to 1 year post-HT. DM status was characterized as (1) No DM pre- or post-HT; (2) Pre-HT DM; or (3) Post-HT DM (onset within 5 years of HT). Kaplan-Meier curves were constructed for post-HT DM onset. Multivariable Cox proportional hazards models were constructed to assess risk factors for post-HT DM onset, as well as risk factors for development of subsequent severe renal dysfunction and death/re-transplantation. Results Of 26,263 eligible subjects, 57% had no DM pre- or post-HT, 22% had pre-HT DM, and 21% had new onset post-HT DM. Most cases of new-onset DM occurred during the first year post-HT, with equivalent incidence between eras in the unadjusted analysis (Figure). In adjusted analyses, onset of post-HT DM was associated with tacrolimus (vs cyclosporine), as well as with female sex, ischemic cardiomyopathy, pre-HT dialysis and steroids; subjects with pre-HT MCS had a lower hazard of post-HT DM. In patients without pre-HT DM, post-HT DM within 5 years was associated with an increased risk of subsequent severe renal dysfunction and death/re-transplantation, compared to patients without post-HT DM (HR 1.89; 1.77- 2.01 and HR 1.39; 1.32-1.45, respectively). Conclusion Pre- and post-HT DM are both common in the contemporary era. Post-HT DM is associated with increased risk of severe renal dysfunction and death or re-transplantation. Sodium-glucose cotransporter (SGLT)-2 inhibitors, a DM medication class that reduces renal dysfunction and cardiovascular events, should be tested as a novel strategy to improve survival in HT recipients.

Abstract MP46: Fasting Glucose Variability in Young Adulthood and Incident Diabetes, Cardiovascular Disease, and Mortality: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Whether long-term variability in fasting glucose (FG) independent of incident diabetes mellitus (DM) is associated with incident cardiovascular disease (CVD) and mortality is unclear. Hypothesis: Higher variability of FG would be associated with higher risk for incident CVD and mortality as compared with lower FG variability, independent of increases in FG over time and the development of DM. Methods: We studied 4210 black and white CARDIA participants, ages 18 to 30 years (1985-1986) at baseline and calculated 2 measures of long-term glucose variability, the coefficient of variation about the mean (CV-FG) and the absolute difference between successive FG measurements (average real variability; ARV-FG) before the onset of DM. We estimated hazard ratios (HR) for incident CVD and mortality over 30 years of follow-up with adjustment for time-varying CVD risk factors. Results: There were 417 incident cases of DM, 195 incident CVD events (122,279 person-years) and 237 deaths (123,505 person-years). The HR for incident CVD per 1-standard deviation (1-SD) higher CV-FG was 1.24 (95% confidence interval [CI]: 1.08, 1.42) and for ARV-FG was 1.14 (95% CI: 1.01, 1.28) after adjustment for demographics, baseline FG, change in FG, and time-varying education, smoking, alcohol consumption, body mass index, physical activity, systolic blood pressure (BP), BP medications, low-density lipoprotein cholesterol, cholesterol medications, incident DM, and DM medications (Figure 1A and 1B). HRs for mortality were similar in magnitude for 1-SD ARV-FG (HR: 1.22, 95% CI: 1.10, 1.35) and slightly weaker for CV-FG (HR: 1.12, 95% CI:0.98, 1.27) after adjustment for time-varying CVD risk factors. The majority of mortality and the variability-mortality association was due to non-CVD mortality. Associations were similar in magnitude when restricted to individuals without incident DM. Conclusion: Higher intra-individual FG variability during young adulthood before the onset of DM was associated with incident CVD and mortality.

Diabetes-Related Health Care Utilization and Dietary Intake Among Food Pantry Clients.

Purpose: Consuming a diet appropriate for management of diabetes mellitus (DM) is challenging, particularly for adults with food insecurity (FI). DM-related health care services are thought to support better dietary intake. In this study, we explored associations between DM-related health care utilization and dietary intake among FI adults with DM.Methods: We used cross-sectional, baseline data (collected 2015–2016) from a trial designed to improve glycemic control among adult food pantry clients with DM. We examined intake of vegetables, fruit, sugar-sweetened beverages (SSBs), and desserts using the California Health Interview Survey dietary screener. We then examined adjusted associations between dietary intake and two components of DM-related health care utilization (<12 months vs. ≥12 months ago): self-reported visit to a health care provider for DM management and DM self-management education.Results: Among 523 participants (mean hemoglobin A1c 9.8%; body mass index 34.6 kg/m2; 17.0% uninsured), vegetable intake was more frequent in those reporting recent utilization of health care providers for DM management and DSME-related services (p<0.01), compared with those with less recent use. There was no association between intake frequency of fruit or SSBs and utilization of either DM-related service. Participants more recently utilizing DSME-related services consumed desserts more frequently (p=0.02). Relationships persisted after controlling for DM duration, race/ethnicity, education, health insurance, location, medication adherence, and depression.Conclusions: Among FI patients, DM-related services offered in clinical settings may more effectively increase vegetable consumption than decrease consumption of food and beverage items that can worsen glycemic control. Food pantry settings may provide an opportunity to reinforce dietary messaging.

The prevalence of diabetes mellitus among Sami and non-Sami inhabitants of Northern Norway - the SAMINOR 1 Survey (2003-2004) and the SAMINOR 2 Clinical Survey (2012-2014).

This study aimed to compare the prevalence of diabetes mellitus (DM) between Sami and non-Sami inhabitants of Northern Norway participating in the SAMINOR 1 Survey and the SAMINOR 2 Clinical Survey, and to track DM prevalence over time. SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014) are cross-sectional, population-based studies that each recruited Sami and non-Sami inhabitants. The data used in this article were restricted to participants aged 40-79 years in 10 municipalities in Northern Norway. Participants completed self-administered questionnaires and underwent clinical examination and blood sampling. Both questionnaire information and non-fasting/random plasma glucose levels were used to ascertain DM. The study included 6288 and 5765 participants with complete data on DM and outcomes, ie 54.6% and 46.3% of the invited samples, respectively. No difference in the prevalence of DM between Sami and non-Sami participants was observed, in either survey. Women had a statistically significantly lower DM prevalence than men in SAMINOR 2. Mean waist-to-height ratio and waist circumference increased substantially in both sexes; mean body mass index increased only slightly in men and remained unchanged in women. The total, age-standardized DM prevalence in SAMINOR 1 and 2 was 10.0% (95% confidence interval (CI) 9.2-10.7) and 11.2% (95%CI 10.4-12.0), respectively, and the proportion of self-reported (ie known) DM increased from 49.2% to 73.0%. In almost the same time span (2004-2015), the use of oral glucose-lowering agents increased. Overall, no ethnic difference was observed in DM prevalence. Overall DM prevalence was high, but did not change significantly from SAMINOR 1 to SAMINOR 2. The percentage of known versus unknown cases of DM increased, as did the prescription of medication for DM between 2004 and 2015.

Effects of the Relative Distribution of Body Mass Index on the Incidence of Hypertension and Diabetes Mellitus, Using the Korean Obesity Index.

The Korean Obesity Index, which contains standard reference data (SRD) of obesity, was established in 2016 and revised in 2017 based on national health screening data to provide the distribution of the body mass index (BMI) of the whole population of Korea as a reference. This study aimed to investigate the effect of the SRD of obesity on the incidence of hypertension (HTN) and diabetes mellitus (DM). The percentile of BMI was calculated for each of the 864 subgroups by defined by gender, region, and age group according to the groupings in the SRD. Incident cases were defined as the presence of HTN and DM and medication prescription in the health care utilization database for a given individual in 2017, but not in 2015-2016. Logistic regression for the incidence of HTN and DM according to the relative distribution of BMI was performed. Gender, age, insurance type, insurance contribution, smoking, drinking, physical activity, blood pressure, waist circumference, fasting glucose, triglycerides, high-density lipoprotein cholesterol, the Charlson comorbidity index (2012-2014), and diagnosis and medication for HTN and DM (2015-2017) were adjusted in the analysis. The C-statistics of the fully adjusted model for HTN and DM were 0.799 and 0.852, respectively. The risks of HTN and DM increased by 1.007 and 1.011 times, respectively, for each 1-percentile increase in BMI. The results showed that BMI was associated with the incidence of HTN and DM according to the SRD. The relative distribution of BMI can be used to motivate self-care through providing more detailed information to individuals.

Chronic Kidney Disease (CKD) in the U.S. Hemophilia Population: A Cohort Study

Chronic Kidney Disease (CKD) in the U.S. Hemophilia Population: A Cohort Study

NORMAL FASTING BLOOD SUGAR LEVELS AND MEDICATION ADHERENCE IMPROVE THE QUALITY OF LIFE OF TYPE 2 DIABETES MELLITUS PATIENTS IN PRIMARY HEALTH FACILITIES

Objective: The aim of the overall study was to determine the quality of life (QOL) and the factors that influence it in patients with diabetes mellitus (DM) in primary health care (PHC) Jetis 1, Bantul.Methods: This cross-sectional study was conducted on 153 DM patients in PHC Jetis I, Bantul. Respondents were recruited by inclusion and exclusion criteria. Primary data on exposure to cigarette smoke, adherence with physical activity, perception of disease, and QOL are collected through interviews. Data were analyzed by a mean test for ratio scale data and Chi-square test.Results: The results showed that the QOL and the level of adherence of DM patients in Puskesmas Jetis I were classified as very good. Male patients, elementary school graduates, normal body mass index (BMI), normal fasting blood sugar levels, adherent DM medication, and positive disease perception have a greater chance of having a better QOL. The mean of the random blood sugar and the fasting blood sugar levels exceeded the normal values, with 261.70 ± 121.15 mg/dl and 167.43 ± 10.23, respectively.Conclusion: The QOL of DM patients in I Jetis PHC is very good. Men, normal BMI, adherent with medication therapy, and normal fasting sugar levels are associated with an increase in QOL.

The Progression of Hyperglycemia and Diabetes Before and After Lung Transplant

Diabetes mellitus (DM) is a frequent complication of organ transplantion . The aim of the study was to determine the incidence and prevalence of DM after Lung Transplant (LTx). Methods: Chart review of patients undergoing LTx at the University of Florida, Gainesville between 2013 and 2015. Variables such as diabetes status before and after LTx, glucose level (G) during first seven days after LTx, insulin therapy and other relevant factors were included. Results: There were 81 LTx surgeries corresponding to 78 patients (3 had repeat LTX). Prior to LTx 14 patients had DM (5 CF), only 2 them were taking insulin, both had CF. G &amp;gt;200 mg/dl and &amp;lt;70mg/dl were observed in 71% (58/81) and 19% (16/81) patients during the first 7 days after LTx respectively. At LTx surgery discharge, 35% (29/81) were on insulin, 51% of them (15/29) on basal insulin alone or in combination. After 12m from LTx, 26 were on insulin, 69% of them (18/26) on basal insulin alone or in combination. Among those who had G&amp;gt;200mg/dl within the first 7 days, only 19% (11/58) had been diagnosed of DM before LTX, and 45% of them (26/58) were taking DM medications 12 months after LTx, and 65% (17/26) were using basal insulin alone or in combination. Conclusion: Inpatient hyperglycemia is very common after LTx. Use of insulin at discharge is a strong predictor for use of insulin 12m after LTX, indicating the need for close monitoring. Characteristic1 month BEFORE LTx12 months AFTER LTxAge (SD)50.7 (16.8)xFemale41% (34/81)xBMI23.9 (4.0)25.2 (4.2)Diabetes Mellitus18 (14/78) Dx per PMH36% (28/78) Dx per medication listAny type of Insulin14% (2/14)32% (26/81)G &amp;gt;200 mg/d first 7 d after LTx71% (58/81)xG &amp;lt;70 mg/dl first 7 d after LTx19% (16/81)x Disclosure D. Akshintala: None. E. Valenzuela Scheker: None. A. Pelaez: None. S. Chandrashekaran: None. T. Machuca: None. J.A. Leey: None.

Composite Cardiovascular Risk Factor Target Achievement and Its Indicators in U.S. Adults with Diabetes—The Diabetes Collaborative Registry

Background and Objective: Patients with diabetes mellitus (DM) who are at multiple atherosclerotic cardiovascular disease (ASCVD) risk factor (RF) targets have &amp;gt;50% lower ASCVD risks. Limited “real world” data exists on how often such targets are reached. We studied multiple RF target attainment for ASCVD prevention and its indicators in a contemporary DM registry. Methods: We determined in the U.S. Diabetes Collaborative Registry those at target for HbA1c (&amp;lt;7.0% or &amp;lt;8.0% if with ASCVD), LDL-C (&amp;lt;100 or &amp;lt;70 mg/dl if ASCVD), blood pressure (&amp;lt;130/80 and &amp;lt;140/90 mmHg), and nonsmoking status by sex, race, and prior history of ASCVD. Multiple logistic regression examined indicators of target attainment. Results: In 45,134 persons with DM (mean age 68.7 years, 41% female) the Table shows achievement of RF targets. Age (&amp;gt;65 [odds ratio, OR=2.3] or 55-64 [OR=1.5] vs. &amp;lt;55), male sex (OR=1.3), white race (OR=1.4), moderate/high intensity statin use (OR=1.2), middle or high income (OR’s 1.2 and 1.4), and (inversely) private insurance (OR=0.9), depression (OR=0.8), and multiple DM medications (OR= 0.9) (all p&amp;lt;0.to p&amp;lt;0.001) were independently associated with being at all 4 targets (including BP&amp;lt;130/80 mmHg). Conclusions: Less than 1 in 6 U.S. adults with DM are achieving comprehensive RF control. Multifactorial interventions will be necessary to optimize the prevention of ASCVD. Disclosure N.D. Wong: Research Support; Self; Amarin Corporation, Amgen Inc.. Speaker's Bureau; Self; Sanofi. Consultant; Self; Pfizer Inc.. Research Support; Self; Pfizer Inc.. Y. Song: None. S.V. Arnold: None. L. Sperling: None. C.P. Cannon: Research Support; Self; Amgen Inc., Arisaph Pharmaceuticals, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Daiichi Sankyo Company, Limited, Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Takeda Pharmaceuticals U.S.A., Inc.. Consultant; Self; Alnylam, Amarin Corporation, Amgen Inc., Arisaph Pharmaceuticals, Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Regeneron Pharmaceuticals, Inc., Sanofi, Eisai Inc., GlaxoSmithKline plc., Kowa Pharmaceuticals America, Inc., Lipimedix, Merck &amp; Co., Inc., Pfizer Inc., Takeda Pharmaceuticals U.S.A., Inc. S. Inzucchi: Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca, Novo Nordisk Inc., Sanofi, Lexicon Pharmaceuticals, Inc.. Consultant; Self; VTV Therapeutics. Other Relationship; Self; Intarcia Therapeutics, Inc.. Consultant; Self; Janssen Pharmaceuticals, Inc., Alere Inc. M. Kosiborod: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Amgen Inc., Sanofi, Boehringer Ingelheim GmbH, GlaxoSmithKline plc., Glytec Systems, Merck &amp; Co., Inc., Novo Nordisk A/S, Janssen Pharmaceuticals, Inc., ZS Pharma, Inc., Intarcia Therapeutics, Inc., Novartis AG. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH.

Protocol for the CHORD project (community health outreach to reduce diabetes): a cluster-randomized community health worker trial to prevent diabetes

BackgroundType 2 diabetes mellitus (DM) affects 9.4% of US adults and children, while another 33.9% of Americans are at risk of DM. Health care institutions face many barriers to systematically delivering the preventive care needed to decrease DM incidence. Community health workers (CHWs) may, as frontline public health workers bridging clinic and community, help overcome these challenges. This paper presents the protocol for a pragmatic, cluster-randomized trial integrating CHWs into two primary care clinics to support DM prevention for at-risk patients.MethodsThe trial will randomize 15 care teams, stratified by practice site (Bellevue Hospital and Manhattan VA), totaling 56 primary care physicians. The study cohort will consist of ~ 2000 patients who are 18–75 years of age, actively enrolled in a primary care team, able to speak English or Spanish, and have at least one glycosylated hemoglobin (HbA1c) result in the prediabetic range (5.7–6.4%) since 2012. Those with a current DM diagnosis or DM medication prescription (other than metformin) are ineligible. The intervention consists of four core activities – setting health goals, health education, activation for doctor’s appointments, and referrals to DM prevention programs – adjustable according to the patient’s needs and readiness. The primary outcome is DM incidence. Secondary outcomes include weight loss, HbA1C, and self-reported health behaviors. Clinical variables and health behaviors will be obtained through electronic medical records and surveys, respectively. Implementation outcomes, namely implementation fidelity and physicians’ perspectives about CHW integration into the clinic, will be assessed using interviews and CHW activity logs and analyzed for the influence of moderating organizational factors.DiscussionThis is the first rigorous, pragmatic trial to test the effectiveness of integrating CHWs into primary care for DM prevention reaching a population-based sample. Our study’s limitations include language-based eligibility and the use of HbA1c as a measure of DM risk. It will measure both clinical and implementation outcomes and potentially broaden the evidence base for CHWs and patient-centered medical home implementation. Further, the intervention’s unique features, notably patient-level personalization and referral to existing programs, may offer a scalable model to benefit patients at-risk of DM.Trial Registration.Clinicaltrials.gov NCT03006666 (Received 12/27/2016).

Awareness of Risk Factors of DKA among Diabetic Adults in KSA

Background: Diabetic ketoacidosis (DKA) is a complication of Diabetes mellitus (DM) that lingers to have high rates of morbidity and mortality regardless of advances in the management of DM. DKA mainly results from insulin deficiency from new-onset diabetes, insulin noncompliance and increased insulin need because of infection. Most persons with DKA have type 1 diabetes however, a subgroup of type 2 diabetes patients might as well have ketosis-prone diabetes. Aim of the work: To assess the level of awareness of the risk factors of DKA as well as the adherence of DM patients with drugs. Methods: This is a questionnaire-based cross-sectional study enrolling a total of 100 randomly selected diabetic Saudi adults ensuring diversity in age range and educational stages. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS) 23. Awareness levels for DKA were calculated as absolute frequencies and were reported as overall percentages. Results: a total of 100 randomly selected diabetic Saudi adults (81 females and 19 males), 56% were diagnosed with DM-1 while 44% had DM-2 and only 11% were active sport practitioners. Moreover, only 62% reported a robust adherence to DM medications. The majority of the respondent scored low knowledge on DKA (54%). Regarding awareness of predisposing risk factors: 9% and 29% of the participants have related DKA to infection and febrile illness respectively. While, 50% of them suggested that there was an association between physical stress and DKA. Conclusion: Our results revealed a compelling need to bridge the disparity in awareness of DKA among Saudi adults with both types. The current knowledge gap doesn’t only incur a significant cost burden on the patients and their sponsors because of the high cost treatment and rehabilitation but also and more severely the complications that can be life-threatening if not spotted and treated quickly. Accordingly, we recommend the launch of education and awareness programs for the public at large, in the hope that this will lead to improved quality of life particularity for DM patients and their caregivers as well as establishing nutrition and sports programs at schools and universities that can teach children and young adults the preventive measures and appropriate management of DKA early on in life. Other public Awareness raising campaign through TV & Radio spots, culture and art activities and informational events would add a great value.

Correlation between glycemic control and peripapillary retinal nerve fiber layer thickness in Saudi type II diabetics.

ObjectiveTo evaluate the effect of diabetes mellitus (DM), diabetic retinopathy, and degree of glycemic control (glycosylated hemoglobin [HbA1c]) on peripapillary retinal nerve fiber layer thickness (RNFLT) using optical coherence tomography.MethodsThe study included 126 eyes of healthy controls (n=32) and diabetics patients (n=31), whose ages ranged from 40 to 70 years. The diabetic group was divided into: Subgroup 1: with HbA1c <7% and Subgroup 2: with HbA1c ≥7%. All patients underwent full ophthalmic examination. HbA1c level was obtained with the A1cNow+ system and the peripapillary RNFLT was measured using 3D-OCT 2000 Topcon (360-degree circular scan with 3.4 mm diameter centered on optic disc).ResultsThe obtained data demonstrates significant decrease in peripapillary RNFLT in superior and inferior quadrants of the right eye (p=0.000 and p=0.039, respectively), and in superior quadrant of the left eye (p=0.002) with impairment of glycemic control. Pearson’s correlation test showed significant negative correlation of RNFLT with HbA1c in the superior quadrant in both eyes.ConclusionImpairment of glycemic control affects the peripapillary RNFLT mainly in the superior quadrant. This thickness also tends to decrease with long-standing DM, use of DM medications, and development of diabetic retinopathy. The measurement of peripapillary RNFLT may become a useful method to monitor early retinal changes in diabetic patients.

Diabetes Is Associated With Reduced Stress Hyperlactatemia in Cardiac Surgery.

Hyperglycemia and hyperlactatemia are associated with increased morbidity and mortality in critical illness. We evaluated the relationship among hyperlactatemia, glycemic control, and diabetes mellitus (DM) after cardiac surgery. This was a retrospective cohort study of 4,098 cardiac surgery patients treated between 2011 and 2015. Patients were stratified by DM and glucose-lowering medication history. Hyperglycemia (glucose >180 mg/dL), hypoglycemia (<70 mg/dL), and the hyperglycemic index were assessed postoperatively (48 h). The relationship between lactate and glucose levels was modeled using generalized linear regression. Mortality was analyzed using an extended Cox regression model. Hyperglycemia occurred in 26.0% of patients without DM (NODM), 46.5% with DM without prior drug treatment (DMNT), 62.8% on oral medication (DMOM), and 73.8% on insulin therapy (DMIT) (P < 0.0001). Hypoglycemia occurred in 6.3%, 9.1%, 8.8%, and 10.8% of NODM, DMNT, DMOM, and DMIT, respectively (P = 0.0012). The lactate levels of all patients were temporarily increased with surgery. This increase was greater in patients who also had hyperglycemia or hypoglycemia and was markedly attenuated in patients with DM. Peak lactate was 5.8 mmol/L (95% CI 5.6, 6.0) in NODM with hyperglycemia vs. 3.3 (95% CI 3.2, 3.4) without hyperglycemia; in DMNT: 4.8 (95% CI 4.4, 5.2) vs. 3.4 (95% CI 3.1, 3.6); in DMOM: 3.8 (95% CI 3.5, 4.1) vs. 2.9 (95% CI 2.7, 3.1); and in DMIT: 3.3 (95% CI 3.0, 3.5) vs. 2.7 (95% CI 2.3, 3.0). Increasing lactate levels were associated with increasing mortality; increasing glucose reduced this effect in DM but not in NODM (P = 0.0069 for three-way interaction). Stress hyperlactatemia is markedly attenuated in patients with DM. There is a three-way interaction among DM, stress hyperlactatemia, and stress hyperglycemia associated with mortality after cardiac surgery.

The preoperative HbA1c level is an independent prognostic factor for the postoperative survival after resection of non-small cell lung cancer in elderly patients.

The aim of this study was to investigate the influence of a history of diabetes mellitus (DM) and the glycated hemoglobin (HbA1c) level on the survival in patients who underwent complete resection for non-small cell lung cancer (NSCLC). Of the patients who underwent complete resection for NSCLC between 2007 and 2015, 468 were classified into DM (who were currently taking medication for DM) and no DM groups as well as into high HbA1c (≥ 6.5) and normal HbA1c (< 6.5) groups. The overall survival (OS) did not differ significantly between either pair of groups. Among the elderly patients, the OS did not differ significantly between the DM and no DM groups, but was significantly higher in the normal-HbA1c group than in the high-HbA1c group (5-year survival rate: 84.7 versus 37.2%, respectively, p < 0.01). In the elderly patients, non-adenocarcinoma histology, advanced stage, a high Charlson comorbidity index, and a high preoperative HbA1c level were found to be independent risk factors for the OS. We revealed that a high preoperative HbA1c level was associated with a poor OS in elderly patients who underwent complete resection for NSCLC. This suggests that it is necessary to achieve diabetic control prior to complete resection in NSCLC patients.

Prevalence, awareness, treatment and control of diabetes and impaired fasting glucose in the Southern Cone of Latin America.

AimsTo determine the prevalence, treatment and control of diabetes mellitus (DM) and impaired fasting glucose (IFG) as well as associated factors in the adult population of four cities of the Southern Cone of Latin America (SCLA).MethodsThis is a cross-sectional population-based study that included 7407 adults between 35 and 74 years old in four cities of the SCLA: Temuco (Chile), Marcos Paz and Bariloche (Argentina), and Pando-Barros Blancos (Uruguay). DM was defined as fasting plasma glucose ≥126 mg/dL or self-reported history of diabetes. Awareness, treatment, and control of DM were defined as subjects self-reporting a DM previous diagnosis, the use of a prescription medication or nonpharmacological intervention for DM, and fasting plasma glucose <126 mg/dl, respectively.ResultsPrevalence of DM varied among cities, between 8.4% in Bariloche and 14.3% in Temuco. Prevalence of IFG varied at different sites, from 3.5% in Barros Blancos to 6.8% in Marcos Paz. Of the total number of people with diabetes, 20% were newly diagnosed at the time of the study. Overall, 79.8% of patients with diabetes were aware of their condition. The treatment and control rate were 58.8% and 46.2%, respectively. Older age, family history of diabetes, lower educational attainment, overweight, obesity, central obesity, low physical activity, hypertension, hypercholesterolemia and hypertriglyceridemia were all significantly associated with an increased risk of diabetes.ConclusionsThe prevalence of DM and IFG in the adult population of the SCLA is high and varies among cities. These conditions represent a public health challenge since the rates of awareness, treatment, and control are still low.

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

BackgroundExpenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world’s two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India.MethodsUsing national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents’ socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007–2010).ResultsPrevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33).ConclusionsThe country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.

Risk of diabetes mellitus associated with disease-modifying antirheumatic drugs and statins in rheumatoid arthritis

ObjectiveTo investigate the rate of incident diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and the impact of disease-modifying antirheumatic drug (DMARD) and statin treatments.MethodsWe studied patients with RA...

Diabetes mellitus and the incidence of hearing loss: a cohort study.

To evaluate the association between diabetes mellitus (DM) and the development of incident hearing loss. Prospective cohort study was performed in 253301 adults with normal hearing tests who participated in a regular health-screening exam between 2002 and 2014. The main exposure was the presence of DM at baseline, defined as a fasting serum glucose ≥ 126 mg/dL, a self-reported history of DM or current use of anti-diabetic medications. Pre-diabetes was defined as a fasting glucose 100-125 mg/dL and no history of DM or anti-diabetic medication use. Incident hearing loss was defined as a pure-tone average of thresholds at 0.5, 1.0 and 2.0 kHz > 25 dB in both right and left ears. During 1285704 person-years of follow-up (median follow-up of four years), 2817 participants developed incident hearing loss. The rate of hearing loss in participants with normal glucose levels, pre-diabetes and DM were 1.8, 3.1 and 9.2 per 1000 person-years, respectively ( P < 0.001). The multivariable-adjusted hazard ratios for incident hearing loss for participants with pre-diabetes and DM compared with those with normal glucose levels were 1.04 (95% confidence interval 0.95-1.14) and 1.36 (1.19-1.56), respectively. In spline regression analyses, the risk of incident hearing loss increased progressively with HbA1c levels above 5%. In this large cohort study of young and middle-aged men and women, DM was associated with the development of bilateral hearing loss. DM patients have a moderately increased risk of future hearing loss.

Effectiveness of Pharmacist and Physician Collaboration in the Treatment of Type 2 Diabetes Mellitus With Severe Insulin Resistance Using U-500 Insulin.

To evaluate the effectiveness of pharmacist-physician collaboration in the treatment of type 2 diabetes mellitus (DM) with severe insulin resistance, using 500 U/mL concentrated regular insulin (U-500) in a primary care clinic that is not staffed by an endocrinologist. A retrospective chart review was conducted searching for patients who were prescribed U-500 insulin from January 1, 2008 through December 31, 2014. Subjects were included in the analysis if the pharmacist initiated U-500 insulin therapy, received treatment for at least 6 months, and who attended at least one follow-up visit with the pharmacist. Anyone who received U-500 insulin before the initial pharmacist consultation, managed by an endocrinologist, or who was missing follow-up hemoglobin A1c (HbA1c) laboratory values during the follow-up period was excluded. The primary endpoint was the change in HbA1c from U-500 initiation to 6 months later. Secondary endpoints included changes in weight, confirmed hypoglycemia events, changes in other anti-DM medications and the number of pharmacist and primary care physician visits during the follow-up period. Eighty-one patients were identified and screened, and 44 patients were included in the analysis. Baseline HbA1c (mean ± standard deviation) was 9.7% ± 1.6% and decreased to 8.6% ± 1.6% after 6 months of follow-up, representing a reduction of 1.1% (95% confidence interval -1.6 to -0.6, P < 0.001). Body weight increased (mean ± standard deviation) by 6.7 ± 15.1 lb from baseline (P = 0.005). The frequency of confirmed hypoglycemia events was low (0.8 events per patient). Treatment with metformin was preserved, whereas most other DM medications were discontinued. A similar number of pharmacist and physician follow-up visits were completed by the end of the study period (2.0 and 2.7 visits, respectively; P = 0.805). Initiation of U-500 insulin by clinical pharmacists collaborating with primary care physicians results in improved DM control in patients with severe insulin resistance. Our findings suggest this interprofessional partnership provides an alternative referral approach for primary care physicians when endocrinology services are absent or limited.

Management of newly treated diabetes in Medicare beneficiaries with and without heart failure.

Several diabetes mellitus (DM) therapies are associated with worse heart failure (HF) outcomes, yet limited data exist characterizing routine DM management based on HF status. DM medications prescribed for patients with HF will differ in meaningful ways from patients without HF, and co-morbidities will impact the choice of medications prescribed. Using Medicare fee-for-service claims data, we identified patients with newly treated DM between 2008 and 2011 and used multivariable logistic regression to assess associations between baseline HF status and DM medication use. We used the cumulative incidence function to describe outcomes at 1 year by HF status and DM medication use. Of 35 603 patients with newly treated DM, 8965 (25.2%) had HF at baseline. Patients with HF had greater comorbidity, including renal dysfunction. After adjustment for baseline covariates, patients with HF had higher odds of initiation on insulin monotherapy (odds ratio: 1.72, 95% confidence interval: 1.59-1.87, P < 0.001) and lower odds of initiation on metformin (odds ratio: 0.66, 95% confidence interval: 0.62-0.71, P < 0.001) compared with patients without HF. Cumulative incidence of 1-year mortality was higher among patients with HF than among those without (22.4% vs 6.4%) and highest among those prescribed insulin. Patients with HF were more likely to be initiated on insulin monotherapy than were patients without HF, who were more likely to be initiated on metformin. Studies of comparative effectiveness and safety are needed for DM treatment options in patients with comorbid HF.