Differences In Diabetes Risk Research Articles

Personal light exposure patterns and incidence of type 2 diabetes: analysis of 13 million hours of light sensor data and 670,000 person-years of prospective observation

Light at night disrupts circadian rhythms, and circadian disruption is a risk factor for type 2 diabetes. Whether personal light exposure predicts diabetes risk has not been demonstrated in a large prospective cohort. We therefore assessed whether personal light exposure patterns predicted risk of incident type 2 diabetes in UK Biobank participants, using ∼13 million hours of light sensor data. Participants (N=84,790, age (M ± SD)=62.3±7.9 years, 58% female) wore light sensors for one week, recording day and night light exposure. Circadian amplitude and phase were modeled from weekly light data. Incident type 2 diabetes was recorded (1997 cases; 7.9±1.2 years follow-up; excluding diabetes cases prior to light-tracking). Risk of incident type 2 diabetes was assessed as a function of day and night light, circadian phase, and circadian amplitude, adjusting for age, sex, ethnicity, socioeconomic and lifestyle factors, and polygenic risk. Compared to people with dark nights (0-50th percentiles), diabetes risk was incrementally higher across brighter night light exposure percentiles (50-70th: multivariable-adjusted HR=1.29 [1.14-1.46]; 70-90th: 1.39 [1.24-1.57]; and 90-100th: 1.53 [1.32-1.77]). Diabetes risk was higher in people with lower modeled circadian amplitude (aHR=1.07 [1.03-1.10] per SD), and with early or late circadian phase (aHR range: 1.06-1.26). Nightlight and polygenic risk independently predicted higher diabetes risk. The difference in diabetes risk between people with bright and dark nights was similar to the difference between people with low and moderate genetic risk. Type 2 diabetes risk was higher in people exposed to brighter night light, and in people exposed to light patterns that may disrupt circadian rhythms. Avoidance of light at night could be a simple and cost-effective recommendation that mitigates risk of diabetes, even in those with high genetic risk. Australian Government Research Training Program.

Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey

BackgroundDifferences in type 2 diabetes risk have been reported for several sociodemographic determinants including sex/gender or socioeconomic status. From an intersectional perspective, it is important to not only consider the role of social dimensions individually, but also their intersections. This allows for a deeper understanding of diabetes risk and preventive needs among diverse population groups.MethodsAs an intersectionality-informed approach, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was used in a population-based sample of adults without known diabetes in Germany from the cross-sectional survey “Disease knowledge and information needs– Diabetes mellitus (2017)”. Diabetes risk was assessed by the German Diabetes Risk Score (GDRS, range 0-122 points), estimating the individual risk of developing type 2 diabetes within the next 5 years based on established self-reported risk factors. Nesting individuals in 12 intersectional strata defined by combining sex/gender, educational level, and history of migration, we calculated measures to quantify the extent to which individual differences in diabetes risk were explained at strata level, and how much this was due to additive or multiplicative intersectional effects of social determinants.ResultsDrawing on data of 2,253 participants, we found good discriminatory accuracy of intersectional strata (variance partition coefficient = 14.00% in the simple intersectional model). Model-predicted GDRS means varied between 29.97 (corresponding to a “low risk” of < 2%) in women with high educational level and a history of migration, and 52.73 (“still low risk” of 2–5%) in men with low educational level without a history of migration. Variance in GDRS between strata was mainly explained by additive effects of social determinants (proportional change in variance to intersectional interaction model = 77.95%) with being male and having low educational level being associated with higher GDRS. There was no evidence of multiplicative effects in individual strata.ConclusionsType 2 diabetes risk differed between intersectional strata and can to some extent be explained at strata level. The role of intersectional effects was minor and needs to be further investigated. Findings suggest a need for specific preventive measures targeted at large groups with increased diabetes risk, such as men and persons with low educational level.

Influence of Gestational Diabetes Mellitus on Diabetes Risk and Glycemic Control in a Retrospective Population-Based Cohort.

Racial/ethnic-specific estimates of the influence of gestational diabetes mellitus (GDM) on type 2 diabetes remain underexplored in large population-based cohorts. We estimated racial/ethnic differences in the influence of GDM on diabetes risk and glycemic control in a multiethnic, population-based cohort of postpartum women. Hospital discharge and vital registry data for New York City (NYC) births between 2009 and 2011 were linked with NYC A1C Registry data between 2009 and 2017. Women with baseline diabetes (n = 2,810) were excluded for a final birth cohort of 336,276. GDM on time to diabetes onset (two A1C tests of ≥6.5% from 12 weeks postpartum onward) or glucose control (first test of A1C <7.0% following diagnosis) was assessed using Cox regression with a time-varying exposure. Models were adjusted for sociodemographic and clinical factors and stratified by race/ethnicity. The cumulative incidence for diabetes was 11.8% and 0.6% among women with and without GDM, respectively. The adjusted hazard ratio (aHR) of GDM status on diabetes risk was 11.5 (95% CI 10.8, 12.3) overall, with slight differences by race/ethnicity. GDM was associated with a lower likelihood of glycemic control (aHR 0.85; 95% CI 0.79, 0.92), with the largest negative influence among Black (aHR 0.77; 95% CI 0.68, 0.88) and Hispanic (aHR 0.84; 95% CI 0.74, 0.95) women. Adjustment for screening bias and loss to follow-up modestly attenuated racial/ethnic differences in diabetes risk but had little influence on glycemic control. Understanding racial/ethnic differences in the influence of GDM on diabetes progression is critical to disrupt life course cardiometabolic disparities.

31-OR: Sex-Specific Differences in Subcutaneous Adipose Tissue in Persons with HIV May Contribute to Diabetes Risk

Background: Men with HIV have greater visceral adipose tissue (VAT) accumulation compared to women, which contributes to insulin resistance and derives, in part, from a failure to sequester lipids in subcutaneous adipose tissue (SAT). We assessed whether sex-specific differences in SAT composition are associated with measures of VAT volume and insulin resistance. Methods: Adults with HIV and consistent viral suppression on antiretroviral therapy had SAT and VAT measured by CT imaging, HOMA2-IR using fasting plasma glucose and insulin, and a subset had abdominal SAT lipoaspirates for single-cell RNA-sequencing to define proportions of CD4 and CD8 T effector memory cells (TEM), perivascular (PVM) and intermediate (IM) macrophages, and fibroblasts. Adjusted ordinal regression models and partial Spearman’s assessed the interaction between sex and cell proportions. Results: We enrolled 111 participants (24% female) with a median age of 48 years, BMI of 31.5 kg/m2, and HOMA2-IR of 3.0. VAT volume was significantly associated with HOMA2-IR. Women had lower VAT volumes and higher proportions of SAT PVMs and lower IMs, as well as fewer cytotoxic CD4 and CD8 T cells compared with men (p ≤ 0.05 for all). The proportions of SAT CD4 TEM, CD8 TEM, myofibroblasts, MYOC fibroblasts, and IMs were associated with VAT volume (p ≤ 0.05 for all), but an interaction by sex was not observed. The proportions of CD4 and CD8 TEM cells were significantly associated with HOMA2-IR and there was evidence of an interaction by sex status (interaction term p = 0.09 &amp; p = 0.06, respectively). Conclusions: Women with HIV have a greater adjusted proportion of PVMs and lower cytotoxic CD4 and CD8 T cells in SAT. While the relationship between immune cell proportions and HOMA-IR only appeared to differ for CD4 and CD8 TEM cells, lower ectopic fat deposition in the context of reduced SAT inflammatory cells in women suggests the sex difference in diabetes risk among persons with HIV may relate to adipose tissue cellular composition. Disclosure S.Bailin: None. M.Mashayekhi: None. C.L.Gabriel: None. L.Hannah: None. S.Kalams: None. S.A.Mallal: None. J.A.Kropski: Advisory Panel; APIE Therapeutics, Research Support; Boehringer Ingelheim Inc., Bristol-Myers Squibb Company, Genentech, Inc. C.N.Wanjalla: None. J.Koethe: Advisory Panel; Merck Sharp &amp; Dohme Corp., Janssen Pharmaceuticals, Inc., Gilead Sciences, Inc., Theratechnologies, Research Support; Merck Sharp &amp; Dohme Corp. Funding National Institutes of Health (R01DK112262, UL1RR024975, T32AI007474, P30AI110527)

Predictors of incident diabetes in two populations: framingham heart study and hispanic community health study / study of latinos

BackgroundNon-genetic factors contribute to differences in diabetes risk across race/ethnic and socioeconomic groups, which raises the question of whether effects of predictors of diabetes are similar across populations. We studied diabetes incidence in the primarily non-Hispanic White Framingham Heart Study (FHS, N = 4066) and the urban, largely immigrant Hispanic Community Health Study/Study of Latinos (HCHS/SOL, N = 6891) Please check if the affiliations are captured and presented correctly.MethodsClinical, behavioral, and socioeconomic characteristics were collected at in-person examinations followed by seven-day accelerometry. Among individuals without diabetes, Cox proportional hazards regression models (both age- and sex-adjusted, and then multivariable-adjusted for all candidate predictors) identified predictors of incident diabetes over a decade of follow-up, defined using clinical history or laboratory assessments.ResultsFour independent predictors were shared between FHS and HCHS/SOL. In each cohort, the multivariable-adjusted hazard of diabetes increased by approximately 50% for every ten-year increment of age and every five-unit increment of body mass index (BMI), and was 50–70% higher among hypertensive than among non-hypertensive individuals (all P < 0.01). Compared with full-time employment status, the multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for part-time employment was 0.61 (0.37,1.00) in FHS and 0.62 (0.41,0.95) in HCHS/SOL. Moderate-to-vigorous physical activity (MVPA) was an additional predictor in common observed in age- and sex-adjusted models, which did not persist after adjustment for other covariates (compared with MVPA ≤ 5 min/day, HR for MVPA level ≥ 30 min/day was 0.48 [0.31,0.74] in FHS and 0.74 [0.56,0.97] in HCHS/SOL). Additional predictors found in sex- and age-adjusted analyses among the FHS participants included male gender and lower education, but these predictors were not found to be independent of others in multivariable adjusted models, nor were they associated with diabetes risk among HCHS/SOL adults.ConclusionsThe same four independent predictors – age, body mass index, hypertension and employment status – were associated with diabetes risk across two disparate US populations. While the reason for elevated diabetes risk in full-time workers is unclear, the findings suggest that diabetes may be part of the work-related burden of disease. Our findings also support prior evidence that differences by gender and socioeconomic position in diabetes risk are not universally present across populations.

Association of antibiotics exposure within the first 2 years after birth with subsequent childhood type 1 diabetes.

Antibiotics prescription in early life can cause dysbiosis, an imbalance of gut microbiota. We aimed to reveal the relationship between antibiotics exposure during the first 2 years after birth and type 1 diabetes risk in children under 8 years of age using a nationally representative data from South Korea. The final study population consisted of 63,434 children from the National Health Insurance Service (NHIS) database from 2008 to 2015. The primary exposure of interest was antibiotics prescription in first 2 years after birth. The analysis was conducted with cumulative defined daily dose (cDDD; 0-29, 30-59, ≥ 60 cDDD), the number of antibiotics classes (0-3, 4, ≥5 classes), and age at first antibiotics prescription (0-119, 120-239, ≥ 240 days). Age, sex, household income, and overweight were considered as potential confounding covariates. Compared to those within the less than 30 cDDD, other groups that were prescribed more antibiotics did not have a significant difference in diabetes risk (aHR 0.86, 95% CI 0.37-2.02 in ≥ 60 cDDD). The number of antibiotics classes and age at first antibiotics prescriptions were also not associated with the risk of type 1 diabetes. The development of diabetes was not related to the cDDD, the number of antibiotics classes, and age at first antibiotics prescription according to subgroup analysis which was stratified by overweight. Antibiotics exposure within the first 2 years of life was not associated with subsequent diabetes risk. Future studies using a larger number of long-term follow-up data are needed.

Inclusion of Biological Sex as a Variable in Diabetes Research

Men and women differ in the risk of developing type 1 and type 2 diabetes, in diabetes-associated complications, and in the efficacy of drugs used to manage diabetes. Lifestyle and cultural factors contribute to these differences; however, male-female differences in glucose homeostasis also exist in animal models. This suggests biological sex is a variable that contributes to the differences between men and women in diabetes risk and progression. To determine whether this important variable has been integrated into diabetes research, we systematically examined all studies published in the journal Diabetes in 1999, 2009, and 2019. We assigned scores between 0 and 6 for each paper based on the degree to which biological sex was included as a variable. A score of 0 indicates no mention of biological sex; a score of 6 reflected proper consideration of biological sex. Over 20 years, we noticed a decrease in papers scored as 0, and an increase in manuscripts scored as 6. Despite these and other statistically significant changes, overall improvements in the inclusion of biological sex as a variable were relatively modest. These trends were observed across clinical and biomedical streams, sub-fields of diabetes research, and in studies with and without National Institutes of Health funds, which mandates inclusion of both sexes. Together, our data indicate a need for better integration of sex as a biological variable in diabetes research. In doing so, we will gain a deeper understanding of the differences in diabetes risk and progression between men and women.

Abstract P063: Afro Caribbeans With Type 2 Diabetes Have Lower Body Mass Index And Lower Waist Circumference Than African Americans: New York City Health And Nutrition Examination Survey 2013/14

African descent populations are experiencing a disproportionate burden of type 2 diabetes. In New York City, almost one third of the Black population are foreign-born Afro-Caribbeans and two thirds are African American. We compared type 2 diabetes risk profiles and disease burden among foreign-born Afro-Caribbean and US-born African American New Yorkers by estimating: a) Prevalence of type 2 diabetes; b) Type 2 diabetes risk profile by ethnicity and c) Odds of type 2 diabetes. Using the 2013/14 New York City Health and Nutrition Examination Survey probability sample weighted to the New York City population, we analyzed data for Afro-Caribbean (n=81) and African American (n=118) participants. Type 2 diabetes was defined as prior diagnosis; or HbA1c≥6.5%; or fasting glucose ≥126mg/dL. Logistic regression estimated odds of type 2 diabetes by BMI category, waist circumference (cm), and physical activity; adjusting for age, sex, education, income, and marital status. Among Afro-Caribbeans (Age (Mean ±SE) 49±2years, BMI 29.2 ±0.7kg/m 2 ) and African Americans (Age 46±2years, BMI 30.3 ±0.9kg/m 2 ) type 2 diabetes prevalence was 31% (25 of 81) and 21% (25 of 118) respectively. Compared to African Americans with type 2 diabetes, Afro-Caribbeans with type 2 diabetes had lower mean BMI (29.9 ±0.8kg/m 2 vs. 34.6 ±1.78kg/m 2 , P =0.01), and lower waist circumference (102 ±2cm vs. 114 ±3cm, P =0.0015). Afro-Caribbeans with type 2 diabetes were more likely to be overweight (57.2% vs. 13.5%) rather than obese (33.2% vs. 74.7%), yet less likely to meet HP2010 physical activity goals (23.6% vs 35.3%). Overall type 2 diabetes odds were no different between groups. In the total population odds were 5% higher for each cm waist circumference [aOR=1.05 (95% CI 1.01-1.10), P =0.0194]. Compared to the youngest age group, ages 20-49y, type 2 diabetes odds were higher among ages 50-59y [aOR=7.12 (95% CI 2.29-22.14)], and ages 60+ [aOR=5.04 (95% CI 1.65-15.39), P =0.0482]. In stratified logistic regression analyses among Afro-Caribbean New Yorkers, odds were 18% greater per cm waist circumference [aOR=1.18 (95% CI 1.03-1.35), P =0.0194]. For Afro-Caribbeans, low physical activity was associated with seven times greater odds of type 2 diabetes [aOR=7.03 (95% CI 1.19-41.53), P =0.0314]. Compared to African Americans, Afro-Caribbeans with type 2 diabetes are more likely to have lower waist circumference and be overweight rather than obese despite reporting less physical activity. Further examination of the relationship between BMI, waist circumference and visceral vs. subcutaneous adipose tissue may elucidate important intraethnic differences in diabetes risk. To enhance detection of diabetes among Afro-Caribbeans and African Americans in New York City, screening criteria should consider unique diabetes phenotypes.

NUMBER OF FRIENDS AND THE RISK OF DEVELOPING DIABETES: A REPLICATION USING NSHAP AND HRS

The epidemic increase in diabetes prevalence (primarily type 2) is a public health crisis. We hypothesized that the rates of movement among diabetic states depend in part on one’s social relationships and environment. Using population-based samples from both NSHAP and HRS, collected in 2005–15, we found that having more friends was associated with a lower risk for acquiring diabetes over the next 4-5 years. As an independent replication, separate logistic models for NSHAP and HRS data yielded similar odds-ratios for the protective effect of having friends (OR = 0.82 and 0.92 respectively), adjusting for gender, age, race/ethnicity, and BMI. This effect was concentrated entirely between 0–4 friends; differences in the number of friends above 4 were not associated with differences in diabetes risk.

Anthropometric changes and risk of diabetes: are there sex differences? A longitudinal study of Alberta’s Tomorrow Project

ObjectivesTo characterise the sex-specific difference in the association between anthropometric changes and risk of diabetes in the general population in Canada.Setting and participantsFrom 2000 to 2008, Alberta’s Tomorrow Project (ATP)...

Food Insecurity and Type 2 Diabetes Risk of Adults with School Children

After the presentation, participants will be able to state differences in diabetes risk by food security status in adults, as well as the association of food security to diabetes risk.

Good Questions 3

&#x0D; Scientific publications can be misinterpreted in newsletters and the popular press. Some&#x0D; misinterpretations could lead to inappropriate choices related to health, and thus create serious&#x0D; risks. Who should correct misinterpretations? This editorial raises the question with an example&#x0D; related to infant feeding practices and the risk of type 1diabetes. A major study found no&#x0D; difference in diabetes risk with using two different types of infant formula. Many people&#x0D; mistakenly interpreted that study as meaning that all infant formula has no impact on diabetes&#x0D; risk. That is not what the study showed

Tobacco Use, Insulin Resistance, and Risk of Type 2 Diabetes: Results from the Multi-Ethnic Study of Atherosclerosis.

IntroductionTobacco use is associated with insulin resistance and incident diabetes. Given the racial/ethnic differences in smoking patterns and incident type 2 diabetes our objective was to evaluate the association between tobacco use and insulin resistance (IR) as well as incident type 2 diabetes mellitus in a contemporary multiethnic cohort.Methods and ResultsWe studied 5,931 Multi- Ethnic Study of Atherosclerosis (MESA) participants who at baseline were free of type 2 diabetes (fasting glucose ≥7.0 mmol/l (126 mg/dl) and/or use of insulin or oral hypoglycemic medications) categorized by self-reported tobacco status and reclassified by urinary cotinine (available in 58% of participants) as never, current or former tobacco users. The association between tobacco use, IR (fasting plasma glucose, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR)) and incident diabetes over 10 years was evaluated using multivariable linear regression and Cox proportional hazards models, respectively. Mean age of the participants was 62 (±10) years, 46% were male, 41% Caucasian, 12% Chinese, 26% African American and 21% Hispanic/Latino. IR biomarkers did not significantly differ between current, former, and never cigarette users (P >0.10) but showed limited unadjusted differences for users of cigar, pipe and smokeless tobacco (All P <0.05). Fully adjusted models showed no association between dose or intensity of tobacco exposure and any index of IR. When stratified into participants that quit smoking vs. those who continued smoking during the 10-year study there was no difference in serum glucose levels or frequency of diabetes. In fully adjusted models, there was no significant difference in diabetes risk between former or current cigarette smokers compared to never smokers [HR (95% CI) 1.02 (0.77,1.37) and 0.81 (0.52,1.26) respectively].ConclusionIn a contemporary multi-ethnic cohort, there was no independent association between tobacco use and IR or incident type 2 diabetes. The role smoking plays in causing diabetes may be more complicated than originally thought and warrants more in-depth large contemporary multi-ethnic studies.

Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus.

The steep rise of type 2 diabetes mellitus (T2DM) and associated complications go along with mounting evidence of clinically important sex and gender differences. T2DM is more frequently diagnosed at lower age and body mass index in men; however, the most prominent risk factor, which is obesity, is more common in women. Generally, large sex-ratio differences across countries are observed. Diversities in biology, culture, lifestyle, environment, and socioeconomic status impact differences between males and females in predisposition, development, and clinical presentation. Genetic effects and epigenetic mechanisms, nutritional factors and sedentary lifestyle affect risk and complications differently in both sexes. Furthermore, sex hormones have a great impact on energy metabolism, body composition, vascular function, and inflammatory responses. Thus, endocrine imbalances relate to unfavorable cardiometabolic traits, observable in women with androgen excess or men with hypogonadism. Both biological and psychosocial factors are responsible for sex and gender differences in diabetes risk and outcome. Overall, psychosocial stress appears to have greater impact on women rather than on men. In addition, women have greater increases of cardiovascular risk, myocardial infarction, and stroke mortality than men, compared with nondiabetic subjects. However, when dialysis therapy is initiated, mortality is comparable in both males and females. Diabetes appears to attenuate the protective effect of the female sex in the development of cardiac diseases and nephropathy. Endocrine and behavioral factors are involved in gender inequalities and affect the outcome. More research regarding sex-dimorphic pathophysiological mechanisms of T2DM and its complications could contribute to more personalized diabetes care in the future and would thus promote more awareness in terms of sex- and gender-specific risk factors.

Linking data on work, health and lifestyle to explain socio-occupational inequality in Danish register-based incidence of diabetes

This study aimed to combine three consecutive cohorts representative of the general working population to estimate the lifestyle, work and health of the entire Danish working population and to explore the influence of these factors on socio-occupational inequality in relation to incident diabetes over ten years. This study linked the National Danish Diabetes Register with (a) three questionnaire rounds (1995, 2000, 2005) on work, health and lifestyle from the Danish Work Environment Cohort Study (DWECS) among 6823 representative Danish workers aged 30-59 years and (b) the different socio-occupational groups of the entire Danish population aged 30-59 years (n=1,833,756). The relative risk (RR) was calculated using a Poisson regression. In DWECS, none of the investigated job factors was associated with incident diabetes. Lifestyle factors in terms of smoking (RR = 1.35; 95% confidence interval (CI) 1.07-1.70), high body mass index (overweight RR = 2.81; 95% CI 2.11-3.74 and obesity RR = 7.49; 95% CI 5.46-10.28) were risk factors for incident diabetes. When adjusted for health and lifestyle, there was no difference in diabetes risk among socio-occupational groups in DWECS. In the entire working population, there was a negative socio-occupational gradient for the risk of diabetes. Compared with professionals, workers in elementary occupations had the highest ten-year risk (RR = 2.06; 95% CI 2.01-2.12). CONCLUSIONS WE FOUND A SIGNIFICANT NEGATIVE SOCIO-OCCUPATIONAL GRADIENT IN THE RISK OF INCIDENT DIABETES HOWEVER, LIFESTYLE RATHER THAN WORK ENVIRONMENT APPEARS TO BE THE MOST IMPORTANT FACTOR AND ADJUSTING FOR THIS ALMOST ELIMINATED THE SOCIO-OCCUPATIONAL INEQUALITY FOR THE DEVELOPMENT OF DIABETES.

Ethnic differences in diabetes prevalence and ICT use.

Uptake of information and communication technology (ICT) by individuals with diabetes can assist nursing care delivery, and improve patient outcomes. However, it is unclear how such uptake relates to ethnic differences in diabetes risk. To assess the moderating effects of ICT uptake on South Asian excess diabetes prevalence over a specific elapsed timeframe, accounting for selected environmental, socio-economic, and behavioural risk factors. Archived data from a UK Office for National Statistics household survey 2006-2011 (120 621 partly non-orthogonal participant records) were analysed using hierarchical binary logistic regression analyses. ICT uptake qualified ethnic differences in diabetes prevalence. Non-smoking diabetes cases living in terraced housing with a home computer were more likely to be South Asian than Caucasian. By contrast, such cases were more likely to be Caucasian if a computer was unavailable (OR: 0.61; CI: 0.43-0.86; P=0.005). Furthermore, diabetes cases from low-income, mobile-dependent homes were probably South Asian (OR: 0.05; CI: 0.00-0.50; P=0.012). Home computing was linked to better tobacco control among South Asians with diabetes living in terraced properties. Mobile phone dependence was pronounced in those that received income support. Implications for nursing care are considered.

Different angiotensin receptor blockers and incidence of diabetes: a nationwide population-based cohort study.

BackgroundAngiotensin receptor blockers (ARBs) have been shown to exert various peroxisome proliferator-activated receptor gamma (PPARγ) binding activities and insulin-sensitizing effects. The objective of this study was to investigate the association of different ARBs with new-onset diabetes mellitus.MethodsIn the respective cohort, a total of 492,530 subjects who initiated ARB treatment between January 2004 and December 2009 were identified from Taiwan National Health Insurance Database. The primary outcome was newly diagnosed diabetes, defined as at least one hospital admission or two or more outpatient visits within a year with an ICD-9-CM code 250. Cox proportional regression was used to estimate the risk of diabetes associated with each ARB, using losartan as the reference.ResultsA total of 65,358 incident diabetes cases were identified out of 1,771,173 person-years. Olmesartan initiators had a small but significantly increased risk of developing diabetes after adjusting for baseline characteristics and mean daily dose (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.12). After excluding those followed for less than one year, the increase in diabetes risk are more pronounced (HR, 1.09; 95% CI, 1.05-1.14). This association was consistent across all subgroup analyses. Similar results were observed when a more strict definition of diabetes combining both diabetes diagnosis and anti-diabetic treatment was used. On the other hand, there was no difference in diabetes risk between telmisartan and losartan.ConclusionsAmong all ARBs, olmesartan might be associated with a slightly increased risk of diabetes mellitus. Our data suggest differential diabetes risks associated with ARBs beyond a class effect.

Splenectomy in trauma patients is associated with an increased risk of postoperative type II diabetes: a nationwide population-based study

BackgroundAnimal studies indicate that splenocytes may act as precursors of β-islet secretory cells in the pancreas. This study aimed to assess the risk of postoperative type II diabetes after splenectomy in trauma patients. MethodsWe used data from the Taiwan National Health Insurance hospitalized claims. Study 1 included 3,723 patients receiving splenectomy and 3,723 matched patients receiving other types of abdominal surgery. Study 2 included 5,996 patients with spleen injury and 5,996 matched patients with other types of abdominal injury. The hazard ratio for diabetes was estimated using the matched Cox proportional hazard regression model. ResultsIn trauma patients after surgery, those who received splenectomy had a 2-fold higher risk of diabetes compared with patients without splenectomy after a 3-year follow-up period. In the nonoperative group, there was no difference in diabetes risk between patients with splenic injury and those with other types of injury. ConclusionsSplenectomy was associated with an increased risk of postoperative type II diabetes in trauma patients. Thus, there may be a role for the spleen in the development of diabetes.

Gender and racial/ethnic differences in the associations of urinary phthalate metabolites with markers of diabetes risk: national health and nutrition examination survey 2001–2008

BackgroundPhthalates are ubiquitous endocrine disrupting chemicals associated with diabetes. Although women and minorities are more likely to be exposed to phthalates, no prior studies have examined phthalate exposure and markers of diabetes risk evaluating effect modification by gender and race/ethnicity.MethodsWe analyzed CDC data for 8 urinary phthalate metabolites from 3,083 non-diabetic, non-pregnant participants aged 12- < 80 years in the National Health and Nutrition Examination Survey (NHANES) 2001–2008. We used median regression to assess the associations between urinary phthalate metabolites and fasting blood glucose (FBG), fasting insulin and Homeostatic Model Assessment of insulin resistance (HOMA-IR), controlling for urinary creatinine as well as several sociodemographic and behavioral factors. Stratified analyses were conducted to compare the gender- and race/ethnicity-specific patterns for the associations.ResultsUrinary levels of several phthalate metabolites, including MBzP, MnBP, MiBP, MCPP and ∑DEHP showed significant positive associations with FBG, fasting insulin and HOMA-IR. No clear difference was noted between men and women. Mexican-Americans and non-Hispanic blacks had stronger dose–response relationships for MnBP, MiBP, MCPP and ∑DEHP compared to non-Hispanic whites. For example, the highest quartile of MiBP relative to its lowest quartile showed a median FBG increase of 5.82 mg/dL (95% CI: 3.77, 7.87) in Mexican-Americans, 3.63 mg/dL (95% CI: 1.23, 6.03) in blacks and 1.79 mg/dL (95% CI: -0.29, 3.87) in whites.ConclusionsThe findings suggest that certain populations may be more vulnerable to phthalates with respect to disturbances in glucose homeostasis. Whether endocrine disrupting chemicals contribute to gender and racial/ethnic differences in diabetes risk will be an important area for further study.

Metabolic Basis of Ethnic Differences in Diabetes Risk in Overweight and Obese Youth

The global pandemic of childhood obesity has led to increased risk for prediabetes and type 2 diabetes mellitus (T2DM). Studies have shown decreased insulin sensitivity and/or secretion with increasing adiposity and consistently observed greater risk for T2DM in obese, non-Caucasian youth. In the current review we describe recent advances in understanding how obesity and metabolic status in children and adolescents confers various risk profiles for T2DM among Latinos, African Americans, Caucasians, Asians, and Native Americans. These possible determinants include ectopic fat distribution, adipose tissue inflammation and fibrosis, and elevated plasma levels of nonesterified free fatty acids. Future work should aim to elucidate the ethnic-specific pathophysiology of T2DM in order to develop and implement appropriate prevention and treatment strategies based on different ethnic profiles of diabetes risk.