Diabetes Registry Research Articles

Relative poverty is associated with increased risk of diabetic ketoacidosis at onset of type 1 diabetes in children. A Swedish national population-based study in 2014-2019.

The aim of the study was to estimate the effect of household relative poverty on the risk of diabetic ketoacidosis at diagnosis of children with type 1 diabetes using an international standard measurement of relative poverty. A national population-based retrospective study was conducted. The Swedish National Diabetes Register (NDR) was linked with data from Sweden's public statistical agency (Statistics Sweden). Children who were diagnosed with new-onset type 1 diabetes in the period of 2014-2019 were common identifiers. The definition of diabetic ketoacidosis was venous pH <7.30 or a serum bicarbonate level <18 mmol/L. The exposure variable was defined according to the standard definition of the persistent at-risk-of-poverty rate used by the statistical office of the European Union (Eurostat) and several other European public statistical agencies. Univariate and multi-variable analyses were used to calculate the effect of relative poverty on the risk of diabetic ketoacidosis. Children from households with relative poverty had a 41% higher risk of diabetic ketoacidosis (1.41, CI 1.12-1.77, p = 0.004) and more than double the risk of severe diabetic ketoacidosis (pH <7.10) (RR 2.10, CI 1.35-3.25, p = 0.001), as compared to children from households without relative poverty. Relative poverty significantly increases the risk of diabetic ketoacidosis at onset of type 1 diabetes in children, even in a high-income country with publicly reimbursed health care.

Implantable cardioverter defibrillator and cardiac resynchronization treatment in people with type 2 diabetes: a comparison with age- and sex matched controls from the general population

BackgroundIncreased risk of severe tachyarrhythmias is reported in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to explore if treatment with cardiac implantable electronic device (CIED) such as implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy- pacemaker and -defibrillator (CRT-P/CRT-D) differed in patients with vs. without T2DM. A secondary aim was to identify patient characteristics indicating an increased CIED treatment.Method416 162 adult patients with T2DM from the Swedish National Diabetes Registry and 2 081 087 controls from the Swedish population, matched for age, sex and living area, were included between 1/1/1998 and 31/12/2012 and followed until 31/12/2013. They were compared regarding prevalence of ventricular tachycardia (VT) at baseline and the risk of receiving a CIED during follow-up. Multivariable Cox regression analysis was performed to estimate the risk of CIED-treatment and factors identifying patients with such risk.ResultsVentricular fibrillation (VF) (0.1% vs 0.0004%) and (VT) (0.2% vs. 0.1%) were more frequent among patients with T2DM compared to controls. CIED-treatment was significantly increased in patients with T2DM both in unadjusted and adjusted analyses. HR and 95% CI, after adjustment for sex, age, marital status, income, education, country of birth, coronary artery disease and congestive heart failure, were 1.32 [1.21–1.45] for ICD, 1.74 [1.55–1.95] for CRT-P and 1.69 [1.43–1.99] for CRT-D. Blood-pressure and lipid lowering therapies were independent risk factors associated to receiving CIED, while female sex was protective.ConclusionsAlthough the proportion of VT/VF was low, patients with T2DM had a higher prevalence of these conditions and increased risk for treatment with CIED compared to controls. This underlines the importance of recognizing that T2DM patients have an increased need of CIED.

Kidney function trajectories, associated factors, and outcomes in multiethnic Asian patients with type 2 diabetes.

We examined the trajectory of estimated glomerular filtrate rate (eGFR), associated risk factors, and its relationship with end-stage kidney disease (ESKD) among a multiethnic patient population with type 2 diabetes in Singapore. A follow-up study included 62 080 individuals with type 2 diabetes aged ≥18 years in a multi-institutional SingHealth Diabetes Registry between 2013 and 2019. eGFR trajectories were analyzed using latent class linear mixed models. Factors associated with eGFR trajectories were evaluated using multinomial logistic regression. The association of eGFR trajectories with ESKD was assessed via competing risk models. Trajectory of kidney function, determined by eGFR, was nonlinear. The trajectory pattern was classified as stable initially then gradual decline (75%), progressive decline (21.9%), and rapid decline (3.1%). Younger age, female sex, Malay ethnicity, lower-income housing type, current smoking, higher glycated hemoglobin, lower low-density lipoprotein, higher triglyceride, uncontrolled blood pressure, albuminuria, cardiovascular disease, hypertension, and higher eGFR levels each were associated with progressive or rapid decline. Compared with the trajectory of stable initially then gradual eGFR decline, progressive decline increased the hazard of ESKD by 6.14-fold (95% confidence interval [CI]: 4.96-7.61)) and rapid decline by 82.55 folds (95% CI: 55.90-121.89). Three nonlinear trajectory classes of kidney function were identified among multiethnic individuals with type 2 diabetes in Singapore. About one in four individuals had a progressive or rapid decline in eGFR. Our results suggest that eGFR trajectories are correlated with multiple social and modifiable risk factors and inform the risk of ESKD.

Establishing the Saudi pediatric and youth diabetes registry: initial data and challenges.

The Saudi National Diabetes Registry focuses mainly on adult patients. In 2020, the National Guard Health Authority (NGHA) launched the Saudi Pediatric and Youth Diabetes Registry (SPYDR), for children and adolescents with diabetes. This report is about the first data and the challenges we faced during SPYDR initiation. Patients were identified from the electronic medical records of the Saudi NGHA hospitals using the International Classification of Disease (ICD-10). A trained coordinator verified the diagnosis and entered patients' details into the registry and a random sample was validated by experienced endocrinologists. The data were analyzed according to patients' demography, diabetes subtypes, duration, control, and complications. The challenges faced by the team were identified and addressed. At the time of manuscript submission, 2,344 individuals were enrolled. Their mean age at diagnosis was 9.08 (±4.27) years and 1,136 (48.46%) were females. Of these, 91.3% have type 1 (T1D), and 6.4% have type 2 diabetes (T2D). The mean HbA1c was 10.45% (±2.36) and duration of diabetes was 5.31 (±3.05) years. The main challenges included the COVID-19 pandemic, data validation, and centers' participation. However, within 12 months of initiation enrolled subjects matched the expected number. Despite the challenges, the first step of SPYDR was achieved. The initial data confirmed that T1D is the most common form of childhood diabetes, and the frequency of T2D is comparable to regional and international data. SPYDR provides the infrastructure for data sharing and collaborative research with the enrollment of patients from other Saudi healthcare institutes.

Machine learning based predictive model of Type 2 diabetes complications using Malaysian National Diabetes Registry: A study protocol.

The prevalence of diabetes in Malaysia is increasing, and identifying patients with higher risk of complications is crucial for effective management. The use of machine learning (ML) to develop prediction models has been shown to outperform non-ML models. This study aims to develop predictive models for Type 2 Diabetes (T2D) complications in Malaysia using ML techniques. This 10-year retrospective cohort study uses clinical audit datasets from Malaysian National Diabetes Registry from 2011 to 2021. T2D patients who received treatment in public health clinics in the southern region of Malaysia with at least two data points in 10 years are included. Patients with diabetes complications at baseline are excluded to ensure temporality between predictors and the target variable. Appropriate methods are used to address issues related to data cleaning, missing data imputation, data splitting, feature selection, and class imbalance. The study uses 7 ML algorithms, including logistic regression, support vector machine, k-nearest neighbours, decision tree, random forest, extreme gradient boosting, and light gradient boosting machine, to develop predictive models for four target variables: nephropathy, retinopathy, ischaemic heart disease, and stroke. Hyperparameter tuning is performed for each algorithm. The model training is performed using a stratified k-fold cross-validation technique. The best model for each algorithm is evaluated on a hold-out dataset using multiple metrics. The prediction model may be a valuable tool for diabetes management and secondary prevention by enabling earlier interventions and optimal resource allocation, leading to better health outcomes.

Sleep duration and its association with constipation in patients with diabetes: The fukuoka diabetes registry.

Shorter and longer sleep durations are associated with adverse health consequences. However, available evidence on the association of sleep duration with constipation is limited, especially in patients with diabetes, who are at a high risk of both conditions. This study aimed to examine the association between sleep duration and constipation in patients with type 2 diabetes. A total of 4,826 patients with type 2 diabetes were classified into six groups according to sleep duration: <4.5, 4.5-5.4, 5.5-6.4, 6.5-7.4, 7.5-8.4, and ≥8.5 hours/day. The odds ratios for the presence of constipation, defined as a defecation frequency <3 times/week and/or laxative use, were calculated using a logistic regression model. Shorter and longer sleep durations were associated with a higher likelihood of constipation than an intermediate duration (6.5-7.4 hours/day). This U-shaped association persisted after adjusting for confounding factors, including lifestyle behavior, measures of obesity and glycemic control, and comorbidities. Broadly identical findings were observed when decreased defecation frequency and laxative use were individually assessed. This study shows a U-shaped association between sleep duration and constipation in patients with type 2 diabetes, and highlights the importance of assessing sleep duration in daily clinical practice.

Уровень глюкозы, ассоциированный с возникновением новых случаев сахарного диабета 2 типа у мужчин и женщин 45–69 лет в Новосибирске

Aim. What glucose level is associated with the occurrence of new cases of diabetes mellitus 2 type (T2DM). Design. Prospective cohort study. Materials and methods. A survey of a representative sample of Novosibirsk residents was carried out in 2003–2005 as part of the international project Health, Alcohol and Psychosocial factors in Eastern Europe. The presented work included indicators of 3146 people aged 45–69 years without a previous history of carbohydrate metabolism disorders (all individuals with established T2DM at the time of the initial examination were excluded from the analysis). The study included people without a history of diabetes, examined in 2003–2005 and again in 2015–2018. New cases of T2DM were diagnosed in 2003–2021. According to epidemiological criteria, diabetes was established when the fasting blood glucose level was ≥ 7.0 mmol/l, according to the anamnesis and the City Diabetes Registry. Results. Initially, elevated fasting glucose concentrations (5.6–6.9 mmol/l) were detected in 45.3% of participants (28.5% — 5.6–6.0 mmol/l, hyperglycemia 6.1–6.9 mmol/l — 16.8%). According to dynamic observation data, by 2021, 316 (10.1%) people will be diagnosed with T2DM. The threshold blood glucose value that determines the risk of developing T2DM over time is 5.7 mmol/l, Se = 64.2%, Sp = 61.4%, AUC = 0.67. Conclusion. According to our data, among residents of Novosibirsk aged 45–69 years without diabetes, the prevalence of fasting hyperglycemia is high (5.6 mmol/l or more). Glucose level 5.7 mmol/L is the threshold value associated with new cases of T2DM in people 45–69 years of age. Keywords: new cases of type 2 diabetes mellitus, fasting glucose levels, fasting hyperglycemia.

Interactive visualization tool to understand and monitor health disparities in diabetes care and outcomes.

Type 2 diabetes (T2DM) poses a significant public health challenge, with pronounced disparities in control and outcomes. Social determinants of health (SDoH) significantly contribute to these disparities, affecting healthcare access, neighborhood environments, and social context. We discuss the design, development, and use of an innovative web-based application integrating real-world data (electronic health record and geospatial files), to enhance comprehension of the impact of SDoH on T2 DM health disparities. We identified a patient cohort with diabetes from the institutional Diabetes Registry (N = 67,699) within the Duke University Health System. Patient-level information (demographics, comorbidities, service utilization, laboratory results, and medications) was extracted to Tableau. Neighborhood-level socioeconomic status was assessed via the Area Deprivation Index (ADI), and geospatial files incorporated additional data related to points of interest (i.e., parks/green space). Interactive Tableau dashboards were developed to understand risk and contextual factors affecting diabetes management at the individual, group, neighborhood, and population levels. The Tableau-powered digital health tool offers dynamic visualizations, identifying T2DM-related disparities. The dashboard allows for the exploration of contextual factors affecting diabetes management (e.g., food insecurity, built environment) and possesses capabilities to generate targeted patient lists for personalized diabetes care planning. As part of a broader health equity initiative, this application meets the needs of a diverse range of users. The interactive dashboard, incorporating clinical, sociodemographic, and environmental factors, enhances understanding at various levels and facilitates targeted interventions to address disparities in diabetes care and outcomes. Ultimately, this transformative approach aims to manage SDoH and improve patient care.

Heterogeneity in glycaemic control in children and adolescents with type 1 diabetes: A latent class trajectory analysis of Danish nationwide data.

Suboptimal glycaemic control in children and adolescents with type 1 diabetes is prevalent and associated with increased risk of diabetes-related complications and mortality later in life. First, we aimed to identify distinct glycated haemoglobin (HbA1c) trajectories in children and adolescents (2-19 years) with type 1 diabetes. Second, we examined their associations with clinical and socio-demographic factors. Data were obtained from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) comprising all Danish children and adolescents diagnosed with type 1 diabetes from 1996 to 2019. Subgroups of distinct mean trajectories of HbA1c were identified using data-driven latent class trajectory modelling. A total of 5889 children (47% female) had HbA1c measured a median of 6 times (interquartile range 3-8) and contributing to 36,504 measurements. We identified four mean HbA1c trajectories, referred to as 'Stable but elevated HbA1c' (83%), 'Increasing HbA1c' (5%), 'Late HbA1c peak' (7%), and 'Early HbA1c peak' (5%). Compared to the 'Stable but elevated HbA1c' group, the three other groups presented rapidly deteriorating glycaemic control during late childhood or adolescence, had higher HbA1c at study entry, and included fewer pump users, higher frequency of inadequate blood glucose monitoring, more severe hypoglycaemic events, lower proportions with Danish origin, and worse educational status of parents. The groups also represented significant differences by healthcare region. Children and adolescents with type 1 diabetes experience heterogenous trajectories with different timings and magnitudes of the deterioration of HbA1c levels, although the majority follow on average a stable, yet elevated HbA1c trajectory. The causes and long-term health implications of these heterogenous trajectories need to be addressed.

COX2 Inhibitor Use and Type 2 Diabetes Treatment Intensification: a Registry-based Cohort Study

AimThis study examined the association between cyclooxygenase-2 inhibitor (COX2i) use and diabetes progression in people with type 2 diabetes. MethodsWe conducted a nation-wide cohort study using an Australian diabetes registry linked to medication dispensing data. We assessed time to diabetes treatment intensification among new users of COX2i compared to mild opioids. Inverse probability of treatment-weighted Cox regression models were used to adjust for age, sex, time since diabetes diagnosis, comorbidities, and socio-economic disadvantage. We conducted several sensitivity analyses, including per-protocol analyses and comparing use of any NSAID to mild opioids. ResultsThere were 8,071 new users of COX2i and 7,623 of mild opioid with 4,168 diabetes treatment intensifications over a median follow-up of 1.6 years. Use of COX2i was associated with decreased risk of treatment intensification when compared to mild opioid (HR 0.91, 95%CI 0.85-0.96). The results were not significant in the per-protocol analyses. Use of any NSAID was associated with a lower risk of treatment intensification compared to mild opioid (HR 0.90, 95%CI 0.85-0.96). ConclusionsTreatment with COX2i may be associated with a modest decreased risk of diabetes treatment intensification compared to mild opioids. Future clinical studies are required to confirm whether COX2 inhibition has clinically significant benefits for glycaemic control.

The Tyrolean Federal Institute for Integrated Care (LIV Tyrol)

A constantly increasing life expectancy of society leads to an increase in severe chronic diseases, which are accompanied by negative effects on the quality of life for patients and an increasing number of hospital admissions as well as long hospital stays. This poses major challenges for the healthcare system and requires innovative and integrated approaches in order to provide high quality healthcare.&#x0D; Therefore, the Tyrolean Federal Institute for Integrated Care (LIV Tyrol) was founded from a joint initiative of the federal state government of the Province of Tyrol and the social insurance institutions to target the above mentioned challenges and reduce burdens for the health care system by developing and implementing integrated care approaches and programs for different chronic diseases. Integrated care is understood to be patient-oriented, continuous, cross-sectoral, interdisciplinary and/or multiprofessional care based on standardized care concepts.&#x0D; LIV Tyrol aims for optimal care for patients – especially patients suffering from chronic diseases – at their homes in order to increase their quality of life on the one hand and, on the other hand, to relieve the healthcare system through innovative approaches. As a result, different disease management programs are developed, implemented, coordinated, operated and evaluated.&#x0D; They include disease management programs for patients with heart failure (HerzMobil Tirol), dementia (Demenz Tirol), patients who suffered a stroke (Schlaganfallpfad Tirol) or in need of palliative care (Hospiz- und Palliativversorgung). LIV Tyrol also coordinates the care management for the Province of Tyrol, Austria and the post-Covid care. Some of these programs are supported by telemedical solutions including telemonitoring systems to provide a secure framework for patient care outside the hospital and to allow for immediate measures when needed. Furthermore, different registries, such as the Austrian birth registry, the Tyrolean cancer registry, the Tyrolean arthroplasty registry, or the Tyrolean diabetes registry are located and operated at the Institute of Clinical Epidemiology, which is part of LIV Tyrol. LIV Tyrol also supports data management and analytics for (clinical) problems but also provides an important contribution to quality assurance within the Tyrolean healthcare system.&#x0D; In order to implement such disease management programs, a close collaboration of different stakeholders is needed. Stakeholders of LIV Tyrol include but are not limited to health-policy makers, social insurance institutions, healthcare providers (hospitals, resident practitioners, other health-related professions), research institutions, and patients. &#x0D; An institution like LIV Tyrol is unique in the Austrian health care system and contributes to optimal care security for patients in Tyrol and poses hub for new, innovative and flexible integrated care models.&#x0D; To make the health care system fit for the future, the federal and state governments have agreed to expand integrated care. The federal government of Tyrol has therefore commissioned the Tyrolean Federal Institute for Integrated Care to implement these targets and to design, organize and coordinate integrated care initiatives throughout the province of Tyrol.&#x0D;

Real-World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes-Results From a Large Registry Cohort in Asia.

Elevated blood pressure (BP) is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD), especially in patients with type 2 diabetes (T2D). We investigated the association of BP with risk of CVD mortality in patients with T2D. We used data on 83 721 patients with T2D from a multi-institutional diabetes registry in Singapore from 2013 to 2019. BP was analyzed as categories and restricted cubic splines using Cox multivariable regression analysis stratified by preexisting CVD and age (<65 years versus ≥65 years). The primary outcome was CVD mortality, determined via linkage with the national registry. Among 83 721 patients with T2D (mean age 65.3 years, 50.6% women, 78.9% taking antihypertensive medications), 7.6 per 1000 person-years experienced the primary outcome. Systolic BP had a graded relationship with a significant increase in CVD mortality at levels >120 to 129 mm Hg. Diastolic BP levels >90 mm Hg were significantly associated with CVD mortality in those aged ≥65 years. In addition, diastolic BP <70 mm Hg was associated with a significantly higher risk of CVD mortality in all patients. In patients with T2D, clinic systolic BP levels ≥130 mm Hg or diastolic BP levels ≥90 mm Hg are associated with higher risk of CVD mortality. Diastolic BP <70 mm Hg is also associated with the risk of adverse CVD outcomes, although reverse causality cannot be ruled out.

Health poverty among people with type 2 diabetes mellitus (T2DM) in Malaysia

In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40–75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation.

Incident cardiovascular disease in women with type 1 or type 2 diabetes by history of hypertensive disorders of pregnancy

Abstract Background Whereas a history of a hypertensive disorder of pregnancy is associated with incident cardiovascular disease, the extent to which this is relevant for women with diagnosed diabetes is unknown. Purpose To analyse the risk of incident cardiovascular disease by a history of hypertensive disorders of pregnancy in women with diagnosed type 1 or type 2 diabetes and to examine the extent to which any associated risk was contingent on the level of clinical risk factor control. Methods By using nationwide register data (The Swedish Medical Birth Registry and The Swedish Diabetes Registry) between 1998 to 2021, we retrieved information on pregnancy history and cardiovascular disease (myocardial infarction, stroke, and heart failure), in all women with diabetes aged 18 to 69 years who had their first delivery registered. Risk of incident cardiovascular disease was estimated using Cox regression models. In further analyses, we categorized patients by number of risk factors (glycated hemoglobin and low-density lipoprotein cholesterol levels, albuminuria, smoking, and blood pressure) within target ranges. Results In total, 1804 (19.7%) of 9179 women with type 1 diabetes, and 5311 (10.6%) of 50,244 of women with type 2 diabetes, had their first delivery complicated by a hypertensive disorder of pregnancy. The risk for any cardiovascular disease event was higher in women with a previous hypertensive disorder of pregnancy in both diabetes groups: for type 1 diabetes the adjusted hazard ratio was 1.25 (95% confidence interval [CI]: 1.03 – 1.52) and for type 2 diabetes 1.20 (95% CI: 1.07 – 1.35). The risk decreased stepwise by improved risk factor profile: from a 7-fold and 4-fold higher risk in type 1 and type 2 diabetes patients, respectively, compared to women with diabetes but without a hypertensive disorder of pregnancy, to negligible risk differences (both groups) with adequate risk factor control. Conclusions A history of hypertensive disorder of pregnancy was associated with increased risk of incident cardiovascular disease in women with diabetes, but not in those with adequate risk factor control. Our findings emphasise the importance of preventive care in these patients, as well as a health care provider with access to information about reproductive history.

Abstract 15019: Graded Relationships Between Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes: Results From a Large Registry Cohort in Asia

Introduction: Elevated BP is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). This study was undertaken to understand the association of BP with risk of CVD mortality in patients with T2DM. Method: This was a cohort study on 83,721 patients with T2DM age 40 years or older using data from a multi-institutional diabetes registry in Singapore from 2013 to 2019. The relationships between BP and CVD mortality were analyzed using Cox multivariable regression model, adjusting for covariates including gender, use of anti-hypertensive medications and presence of co-existing CVD. Results: Overall, the mean age was 65.3 years with 50.6% women, 78.9% on antihypertensive medications, 21.3% with pre-existing CVD and 7.6 per 1000 person-years experienced the outcome over 7 years. Compared to SBP 120-129 mm Hg, the risk of CVD mortality was higher in SBP 140 mm Hg in patients with and without pre-existing CVD, the elderly and non-elderly. The hazard ratios (HR) were 1.27 (95% CI: 1.12-1.45), 1.87 (1.65-2.12), 1.49 (1.35-1.64) and 1.87 (1.55-2.25), respectively. Using DBP 70-79 mm Hg as reference, DBP &lt; 70 mm Hg was also associated with higher risk of CVD mortality in all patient groups, with corresponding HR 1.25 (1.12-1.39), 1.23 (1.11-1.36), 1.19 (1.10-1.29) and 1.54 (1.32-1.80), respectively. DBP 90 mm Hg was also associated with higher risk of CVD mortality in the elderly and those without pre-existing CVD. Conclusion: In patients with T2DM, higher SBP is associated with raised CVD mortality risk. Elevated DBP is independently associated with higher risk of CVD mortality albeit only in those without pre-existing CVD and the elderly. DBP &lt; 70 mm Hg is also associated with risk of CVD outcome although reverse causality cannot be ruled out.

Increased Frequency of the HLA-DRB1*04:04-DQA1*03-DQB1*03:02 Haplotype Among HLA-DQB1*06:02-Positive Children With Type 1 Diabetes.

HLA DR-DQ haplotypes largely define genetic susceptibility to type 1 diabetes (T1D). The DQB1*06:02 positive haplotype (DR15-DQ602) common in subjects of European ancestry is very rare among children with T1D. Among 4490 children with T1D in the Finnish Pediatric Diabetes Register 57 (1.3%) cases with DQB1*06:02 were identified in comparison to 26.1% of affected family-based association controls. There was no difference between DQB1*06:02 positive and negative children with T1D regarding sex, age, islet autoantibody distribution or autoantibody levels, but significant differences were seen in the frequency of the second class II HLA haplotypes. The most prevalent haplotype present with DQB1*06:02 was DRB1*04:04-DQA1*03-DQB1*03:02 which was found in 27 of 57 (47.4%) children compared to only 797/4433 (18.0%) among DQB1*06:02 negative cases (P<0.001, Chi-square test). The other common risk associated haplotypes, the DRB1*04:01-DQA1*03-DQB1*03:02 and (DR3)-DQA1*05-DQB1*02 were less prevalent in DQB1*06:02 positive than DQB1*06:02 negative children (P<0.001). HLA-B allele frequencies did not differ between DQB1*06:02 haplotypes in children with T1D and controls and neither in DRB1*04:04-DQA1*03-DQB1*03:02 haplotypes of DQB1*06:02 positive and negative T1D children. The increased frequency of DRB1*04:04 allele among DQB1*06:02 positive cases may indicate preferential ability of the DR404 molecule to present islet antigen epitopes despite of the competition by DQ602.

Risk Factors for and Risk of Peripheral Artery Disease in Swedish Individuals With Type 2 Diabetes: A Nationwide Register-Based Study.

To investigate to what extent having control of peripheral artery disease (PAD) risk factors is associated with the risk of incident PAD in individuals with type 2 diabetes. A total of 148,096 individuals with type 2 diabetes in the Swedish National Diabetes Register between 2005 and 2009 were included and matched with 320,066 control subjects on the basis of age, sex, and county. A few control subjects who developed type 2 diabetes after recruitment, during wash-in (<0.2%), were not censored but instead matched with two new control subjects. Individuals with type 2 diabetes were evaluated according to the number of PAD risk factors beyond recommended guideline levels at baseline, including LDL cholesterol, blood pressure, smoking, glycated hemoglobin, and estimated glomerular filtration rate. Incident PAD events were ascertained from 2006 to 2019. A graded association was observed between the number of PAD risk factors not at target and incident PAD in individuals with type 2 diabetes. The adjusted hazard ratio for PAD was 1.41 (95% CI 1.23-1.63) for those with type 2 diabetes with all PAD risk factors within target compared with control subjects matched for sex, age, and county but not risk factor status, in contrast with 9.28 (95% CI 3.62-23.79) for those with all five PAD risk factors not at target. A graded association was observed between increasing number of PAD risk factors not at target and incident PAD in individuals with type 2 diabetes.

Relationships between personality, emotional well-being, self-efficacy and weight management among adults with type 2 diabetes: Results from a cross-sectional survey.

The objective of this study was to examine the associations between personality, general and diabetes-specific well-being and self-efficacy, and weight management indicators, among adults with type 2 diabetes. In addition, to examine whether personality provides incremental explanation of variance in weight management indicators. Australian adults with type 2 diabetes (N = 270; 56% women; age: 61±12 years) were recruited via the national diabetes registry. An online survey included measures of: personality (HEXACO-PI-R), weight management indicators (physical activity, healthy diet, body mass index [BMI]), general well-being (WHO-5), general self-efficacy (GSE), diabetes distress (DDS) and diabetes self-efficacy (DMSES). Analyses included bivariate correlations and linear regression, adjusted for demographic, clinical, and psychological variables. All six personality domains showed significant correlation with at least one weight management indicator: physical activity with extraversion (r = .28), conscientiousness (r = .18) and openness (r = .19); healthy diet with honesty-humility (r = .19), extraversion (r = .24), and agreeableness (r = .14); and BMI with emotionality (r = .20) and extraversion (r = -.20). The strongest associations with general and diabetes-specific well-being and self-efficacy were apparent for extraversion, emotionality and conscientiousness (range: r = -.47-.66). Beyond covariates, personality domains explained additional variance for physical activity (Adjusted R2 = .31, R2 difference = .03, p = .03; openness: β = .16, p = .02, emotionality: β = .15, p = .04) and healthy diet (Adjusted R2 = .19, R2 difference = .03, p = .02; honesty-humility: β = .20, p = .002, extraversion: β = .19, p = .04) but not BMI. This study shows that personality is associated with weight management indicators and psychological factors among adults with type 2 diabetes. Further research is needed, including objective measurement of weight management indictors, to examine how personality influences the experience of type 2 diabetes.

Trends of hospitalisation for cardiovascular diseases among people with diabetes in Australia

ObjectiveTo describe trends in hospitalisation for subtypes of cardiovascular diseases among people with diabetes. MethodsThe data sources included the Australian diabetes registry, admitted hospitalisation datasets, and death registry from 2011 to 2019. The outcomes comprised hospital admissions for: all CVD; all cerebrovascular diseases, ischaemic and haemorrhagic stroke; angina and ischaemic heart disease (AIHD); non-ST elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI); atrial fibrillation and flutter (AFF). Data were analysed using Stata and Joinpoint regression software.Rates were standardised for age and sex. Annual percentage change (APC) was reported. ResultsIn type 1 diabetes, there were increases in hospitalisation for all cerebrovascular diseases (APC 4.5, 95 % CI: 1.2, 7.9) and ischaemic stroke (2.3, 95 % CI: 1.6, 3.0). There were declines in STEMI (-2.6, 95 % CI: −5.0, −0.1) and AIHD (-3.1, 95 % CI: −5.5, −0.7). In type 2 diabetes, hospitalisation for all CVD declined (-0.9, 95 % CI: −1.4, −0.3). Hospitalisation rates for ischaemic stroke increased (4.1, 95 % CI: 3.1, 5.1). There were declines in NSTEMI (-2.5, 95 % CI: −3.2, −1.8) and AIHD (-4.2, 95 % CI: −4.8, −3.5). ConclusionIn type 1 and 2 diabetes, hospitalisation for ischaemic stroke increased while coronary diagnoses declined.

Organic food consumption and the incidence of type 2 diabetes mellitus in the Danish Diet, Cancer and Health cohort

AimTo investigate the association between organic food consumption and the incidence of type 2 diabetes mellitus. MethodsAmong 41,286 cohort participants, aged 50–65 years, organic food consumption of vegetables, fruits, dairy products, eggs, meat, and cereal products, was summarized into an organic food score evaluated as never, low, medium and high consumption and as continuous intake. During follow-up, 4,843 cases were identified in the National Diabetes Register. Organic food consumption was associated to the disease incidence in Cox regression models. ResultsOrganic food consumption was linearly associated with a lower incidence of type 2 diabetes mellitus (Women, HR: 0.94, 95% CI: 0.89–1.00, Men, HR: 0.95, 95% CI: 0.90–1.00). Organic food consumption frequency, compared to never consumption, showed HRs below 1.00 for both women (medium intake HR: 0.96, 95% CI: 0.84–1.10, high intake HR: 0.88, 95% CI: 0.74–1.05) and men (low intake, HR: 0.95, 95% CI: 0.85–1.05, medium intake, HR: 0.92, 95% CI: 0.83–1.03, high intake, HR: 0.89, 95% CI: 0.75–1.05) but were not statistically significant. Similar patterns were observed with consumption of the specific organic food groups for women, but not for men. ConclusionsOrganic food consumption was associated with a suggested lower incidence of type 2 diabetes mellitus.