Difference In Incidence Of Diabetes Research Articles

1553-P: Estimated Beta-Cell Function and BMI Do Not Explain Racial/Ethnic Differences in Diabetes Incidence in People with Prediabetes

1553-P: Estimated Beta-Cell Function and BMI Do Not Explain Racial/Ethnic Differences in Diabetes Incidence in People with Prediabetes

Profiles of Glucose Metabolism in Different Prediabetes Phenotypes, Classified by Fasting Glycemia, 2-Hour OGTT, Glycated Hemoglobin, and 1-Hour OGTT: An IMI DIRECT Study.

Differences in glucose metabolism among categories of prediabetes have not been systematically investigated. In this longitudinal study, participants (N = 2,111) underwent a 2-h 75-g oral glucose tolerance test (OGTT) at baseline and 48 months. HbA1c was also measured. We classified participants as having isolated prediabetes defect (impaired fasting glucose [IFG], impaired glucose tolerance [IGT], or HbA1c indicative of prediabetes [IA1c]), two defects (IFG+IGT, IFG+IA1c, or IGT+IA1c), or all defects (IFG+IGT+IA1c). β-Cell function (BCF) and insulin sensitivity were assessed from OGTT. At baseline, in pooling of participants with isolated defects, they showed impairment in both BCF and insulin sensitivity compared with healthy control subjects. Pooled groups with two or three defects showed progressive further deterioration. Among groups with isolated defect, those with IGT showed lower insulin sensitivity, insulin secretion at reference glucose (ISRr), and insulin secretion potentiation (P < 0.002). Conversely, those with IA1c showed higher insulin sensitivity and ISRr (P < 0.0001). Among groups with two defects, we similarly found differences in both BCF and insulin sensitivity. At 48 months, we found higher type 2 diabetes incidence for progressively increasing number of prediabetes defects (odds ratio >2, P < 0.008). In conclusion, the prediabetes groups showed differences in type/degree of glucometabolic impairment. Compared with the pooled group with isolated defects, those with double or triple defect showed progressive differences in diabetes incidence.

Regional differences in diabetes across Europe – regression and causal forest analyses

We examine regional differences in diabetes within Europe, and relate them to variations in socio-economic conditions, comorbidities, health behaviour and diabetes management. We use the SHARE (Survey of Health, Ageing and Retirement in Europe) data of 15 European countries and 28,454 individuals, who participated both in the 4th and 7th (year 2011 and 2017) waves of the survey. First, we estimate multivariate regressions, where the outcome variables are diabetes prevalence, diabetes incidence, and weight loss due to diet as an indicator of management. Second, we study the heterogeneous impact of demographic, socio-economic, health and lifestyle indicators on the regional differences in diabetes incidence with causal random forests.Compared to Western Europe, the odds of a new diabetes diagnosis over a six-year horizon is 2.2-fold higher in Southern and 2.6-fold higher in Eastern Europe. Adjusting for individual characteristics, the odds ratio decreases to 1.8 in the South-West and to 2.0 in the East-West dimension. These remaining differences are mostly explained by country-specific healthcare indicators. Based on the causal forest approach, the adjusted East-West difference is essentially zero for the lowest risk groups (tertiary education, employment, no hypertension, no overweight) and increases substantially with these risk factors, but the South-West difference is much less heterogeneous. The prevalence of diet-related weight loss around the time of diagnosis also exhibits regional variation. The results suggest that the regional differences in diabetes incidence could be reduced by putting more emphasis on diabetes prevention among high-risk individuals in Eastern and Southern Europe.

The effectiveness of intensive and traditional cardiac rehabilitation programs for improving cardiometabolic outcomes in patients with cardiovascular disease

Abstract Background Cardiac rehabilitation (CR) is integral to the optimal medical management of patients with cardiovascular disease (CVD). Purpose This study aims at evaluating the effectiveness of traditional (TCR) and intensive (ICR) CR programs for improving cardiometabolic outcomes of patients with CVD. Methods The study is based on retro-prospective review of hospital medical data of patients enrolled in TCR or ICR programs. TCR involved 36 supervised exercise and educational sessions (1 hr) 3 days/week over 12 weeks. ICR included a structured class model (4 hrs) twice a week over 9 weeks (a total of 18 sessions, 72 hrs). The ICR sessions were provided by a multidisciplinary team and consisted of supervised exercise, plant-based diet, nutrition education, stress management, and social support. The comparative analyses of numerous biomarkers and hemodynamic parameters before and after CR program for both groups were performed. The occurrence of major cardiac adverse events (MACE) in the long-term follow-up was assessed. Results In total, 314 patients (213 in TCR and 101 in ICR) were enrolled. Mean treatment adherence was 78% (97% in ICR vs 68% in TCR, p=0.000). Mean follow-up for MACE was 12.6 months (13.2 in ICR vs 12 in TCR, p=0.038). No differences were observed between TCR and ICR in patient age (66 years on average) and gender (68–73% of males). Coronary heart disease, hypertension, and heart failure (HF) were the most frequent CVDs in both TCR and ICR groups (88% vs 95%, p=0.044, 75% vs 66%, p=0.104, 48% vs 25%, p=0.000, respectively). There was no significant difference in incidence of diabetes and chronic kidney disease, and pharmacotherapy between groups. TCR program resulted in significant improvements in body and visceral fat, waist circumference, and exercise capacity whereas no significant changes were observed in weight, body mass index (BMI), blood pressure (BP), heart rate (HR), and lipids levels. ICR resulted in significant improvements in most metabolic biomarkers (weight, BMI, body and visceral fat, waist circumference), hemodynamic parameters (exercise capacity, BP) and lipid biomarkers levels (total cholesterol, low-density and non-high-density-lipoprotein cholesterol). Compared with TCR, ICR resulted in more significant improvements of metabolic biomarkers such as weight (p&amp;lt;0.001), BMI (p&amp;lt;0.001), body fat (p&amp;lt;0.05) and waist circumference (p=0.002), and hemodynamic parameters such as diastolic BP (p&amp;lt;001) and HR (p=0.05). A trend towards lower incidence of MACE (all-cause death, non-fatal myocardial infarction, unstable angina, and revascularisation) with significantly lower rates of hospitalisation for HF (2 vs 24, p=0.005) in the long-term follow-up was observed in ICR compared with TCR group. Conclusion Intense and more comprehensive lifestyle modification provided by the ICR program had greater impact on improving cardiometabolic outcomes including long-term MACE compared to the TCR program. Funding Acknowledgement Type of funding source: None

Allopurinol use and type 2 diabetes incidence among patients with gout: A VA retrospective cohort study.

To assess the impact of allopurinol on diabetes in a retrospective cohort of Veterans' Affairs patients with gout.The New York Harbor VA computerized patient record system was searched to identify patients with an ICD-9 code for gout meeting at least 4 modified 1977 American Rheumatology Association gout diagnostic criteria. Patients were divided into subgroups based on >30 continuous days of allopurinol, versus no allopurinol. New diagnoses of diabetes, defined according to American Diabetes Association diagnostic criteria or clinical documentation explicitly stating a new diagnosis of diabetes, were identified during an observation period from January 1, 2000 through December 31, 2015.Six hundred six gout patients used allopurinol >30 continuous days, and 478 patients never used allopurinol. Over an average 7.9 ± 4.8 years of follow-up, there was no significant difference in diabetes incidence between the allopurinol and non-allopurinol groups (11.7/1000 person-years vs 10.0/1000 person-years, P = .27). A lower diabetes incidence in the longest versus shortest quartiles of allopurinol use (6.3 per 1000 person-years vs 19.4 per 1000 person-years, P<.0001) was attributable to longer duration of medical follow-up.In this study, allopurinol use was not associated with decreased diabetes incidence. Prospective studies may further elucidate the relationship between hyperuricemia, gout, xanthine oxidase activity, and diabetes, and the potential impact of gout treatments on diabetes incidence.

Agreement between Type 2 Diabetes Risk Scales in a Caucasian Population: A Systematic Review and Report.

Early detection of people with undiagnosed type 2 diabetes (T2D) is an important public health concern. Several predictive equations for T2D have been proposed but most of them have not been externally validated and their performance could be compromised when clinical data is used. Clinical practice guidelines increasingly incorporate T2D risk prediction models as they support clinical decision making. The aims of this study were to systematically review prediction scores for T2D and to analyze the agreement between these risk scores in a large cross-sectional study of white western European workers. A systematic review of the PubMed, CINAHL, and EMBASE databases and a cross-sectional study in 59,042 Spanish workers was performed. Agreement between scores classifying participants as high risk was evaluated using the kappa statistic. The systematic review of 26 predictive models highlights a great heterogeneity in the risk predictors; there is a poor level of reporting, and most of them have not been externally validated. Regarding the agreement between risk scores, the DETECT-2 risk score scale classified 14.1% of subjects as high-risk, FINDRISC score 20.8%, Cambridge score 19.8%, the AUSDRISK score 26.4%, the EGAD study 30.3%, the Hisayama study 30.9%, the ARIC score 6.3%, and the ITD score 3.1%. The lowest agreement was observed between the ITD and the NUDS study derived score (κ = 0.067). Differences in diabetes incidence, prevalence, and weight of risk factors seem to account for the agreement differences between scores. A better agreement between the multi-ethnic derivate score (DETECT-2) and European derivate scores was observed. Risk models should be designed using more easily identifiable and reproducible health data in clinical practice.

Abstract P300: C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: Reasons for Geographic and Racial Differences in Stroke (REGARDS)

Introduction: Black Americans have a higher incidence of diabetes and have elevated inflammatory biomarkers compared to white Americans. Elevated inflammation is a risk factor for diabetes but the impact of inflammation on the racial disparity in diabetes is unknown. Hypothesis: Elevated C-reactive protein (CRP) attenuates the observed black-white difference in incident diabetes. Methods: REGARDS enrolled 30,239 black and white adults aged ≥45 years from the contiguous US in 2003-07. This analysis included REGARDS participants without baseline diabetes who were assessed for diabetes 9 years later. RRs for incident diabetes by race were calculated using modified Poisson regression adjusting for risk factors known to contribute to the racial difference in diabetes incidence. The attenuation by CRP of the black-white RR of incident diabetes was calculated as the percent difference in the race RR in models with and without CRP adjustment; 95% CI for the difference was estimated using bootstrapping. Results: Of 11,073 participants without baseline diabetes (33% black, 67% white), black participants had higher CRP than white participants, and 12.5% developed incident diabetes. The black-white RR for incident diabetes in the base model was 1.74 (95% CI: 1.52, 1.99) for women and 1.44 (1.25, 1.66) for men. Baseline CRP mediated 21% (14, 29%) of this association in women and 20% (12, 34%) in men. These percent attenuations were similar in models adjusting for other diabetes risk factors but were diminished in a fully adjusted model; 5% (-4, 25%) in women and 7% (-43, 50%) in men (Figure). Conclusion: Adjustment for CRP in base models accounted for 20% and 21% of the excess risk of incident diabetes observed in black men and women, respectively, in this study. This substantial mediation persisted after adjusting for other risk factors but was diminished in the fully adjusted model. This suggests a role of inflammation in the diabetogenic effects of risk factors contributing to the observed racial difference in diabetes incidence.

Incidence of Type 2 Diabetes in People With a History of Hospitalization for Major Mental Illness in Scotland, 2001-2015: A Retrospective Cohort Study.

To determine the incidence of type 2 diabetes in people with a history of hospitalization for major mental illness versus no mental illness in Scotland by time period and sociodemographics. We used national Scottish population-based records to create cohorts with a hospital record of schizophrenia, bipolar disorder, or depression or no mental illness and to ascertain diabetes incidence. We used quasi-Poisson regression models including age, sex, time period, and area-based deprivation to estimate incidence and relative risks (RRs) of diabetes by mental illness status. Estimates are illustrated for people aged 60 years and in the middle deprivation quintile in 2015. We identified 254,136 diabetes cases during 2001-2015. Diabetes incidence in 2015 was 1.5- to 2.5-fold higher in people with versus without a major mental disorder, with the gap having slightly increased over time. RRs of diabetes incidence were greater among women than men for schizophrenia (RR 2.40 [95% CI 2.01, 2.85] and 1.63 [1.38, 1.94]), respectively) and depression (RR 2.10 [1.86, 2.36] and 1.62 [1.43, 1.82]) but similar for bipolar disorder (RR 1.65 [1.35, 2.02] and 1.50 [1.22, 1.84]). Absolute and relative differences in diabetes incidence associated with mental illness increased with increasing deprivation. Disparities in diabetes incidence between people with and without major mental illness appear to be widening. Major mental illness has a greater effect on diabetes risk in women and people living in more deprived areas, which has implications for intervention strategies to reduce diabetes risk in this vulnerable population.

Extracorporeal membrane oxygenation in treating elderly patients with acute myocardial infarction complicated with cardiogenic shock: analysis of prognosis and risk factors

Objective To investigate the short-term clinical effect of extracorporeal membrane oxygenation(ECMO)for elderly patients with acute myocardial infarction(AMI)complicated with cardiogenic shock and to analyze its risk factors. Methods Clinical data of 55 elderly patients with AMI complicated with cardiogenic shock admitted into Henan Provincial Chest Hospital from January 2011 to July 2018 were retrospectively analyzed.According to the prognosis, patients were divided into the survival group(n=41)and the death group(n=14). Baseline characteristics were compared between the two groups.The short-term prognosis during hospitalization including use of temporary pacemaker, continuous renal replacement therapy and ventilation treatment and complications were compared.Univariate and multivariate logistic regression analysis were used to assess the risk factors for mortality. Results Of the 55 patients, 30 patients were male(54.5%), with a mean ±SD age of(67.2±5.3)years.The time from admission to ECMO insertion was(8.6±6.3)h, and the support time was(143.2±61.7)h.There were significant differences in diabetes incidence, hemodynamic indexes, renal function, troponin, B-type natriuretic peptide, lactate levels and the Acute Physiology and Chronic Health Enquiry(APACHE-Ⅱ)score between the two groups(P<0.05). The dosage of norepinephrine, dobutamine and other vasoactive agents, and the application frequency of continuous renal replacement therapy, invasive ventilation treatment and intra-aortic balloon counterpulsation during hospitalization were increased in the death group compared with the survival group(P<0.05). Incidence rates of complications including acute kidney injury, infection and multiple organ dysfunction syndrome were higher in death group than in survival group(P<0.05). Multiple logistic regression analysis showed that advanced age, low left ventricular ejection fraction(LVEF), acute kidney injury, infection and multiple organ dysfunction syndrome were risk factors for the short-term mortality(P<0.05). Conclusions The prognosis of elderly patients with AMI complicated with cardiogenic shock are poor.ECMO can significantly improve the hemodynamic indexes, but has no effect on the survival time in elderly patients with AMI complicated with cardiogenic shock.The advanced age, low LVEF, acute kidney injury, infection and multiple organ dysfunction syndrome are risk factors for the short-term mortality. Key words: Shock, cardiogenic; Extracorporeal membrane oxygenation; Risk factor

Effect of stress on cardiometabolic health 12 years after the Indian Ocean tsunami: a quasi-experimental longitudinal study

BackgroundStress is associated with elevated cardiometabolic health risks, but establishing a causal mechanism is challenging, and evidence of the longer-term effects of large-scale stressors on health is limited. To fill these gaps, we investigated the effect of elevated stress from direct exposure to the 2004 Indian Ocean tsunami on diabetes risk 12 years later. The Indian Ocean tsunami destroyed the built and natural environment along coastal Aceh, Indonesia, killed 5% of the population, and caused very high levels of post-traumatic stress among those who were exposed. MethodsIn a quasi-experimental research design, we focused on respondents who were living, at the time of the tsunami, in districts that had a vulnerable coastline in Aceh, Indonesia. Using unique, population-representative, longitudinal survey data collected before and after the tsunami (the Study of the Tsunami Aftermath and Recovery), we compared diabetes incidence in adults directly exposed to the trauma of the tsunami with diabetes incidence in adults not directly exposed. Specifically, adults who were living, at the time of the tsunami, in communities that were heavily damaged were compared with those living in other communities in the same districts that were not damaged. We collected biomarker data 12 years after the tsunami, including levels of glycated haemoglobin (HbA1c), from respondents who were still living in a randomly selected sample of baseline communities, as well as from baseline respondents who had moved elsewhere. FindingsOf 4538 respondents aged 20–65 years for whom biomarker data were collected, 6·7% were diabetic (HbA1c ≥6·5%) and, of the 1882 respondents aged 40–65 years, 12·2% were diabetic. Among men in this older age group, when controlling for age, those who were living in heavily damaged communities at the time of the tsunami were 6 percentage points more likely to be diabetic than those who were living in communities that were not damaged (p=0·008). There was no evidence of elevated diabetes incidence among younger men or among women living in heavily damaged communities: the difference between the exposed and unexposed groups was small (–0·3 percentage points) and not significant (p=0·77) for these respondents InterpretationExposure to mortality and destruction at the community level is unlikely to explain these differences in diabetes incidence among the exposed and unexposed by age group and sex. It is likely that the loss of livelihood took a greater toll on the cardiometabolic health of older men, who faced greater difficulty rebuilding their wealth later in the life course than did younger men and women of all ages. The results suggest an important economic pathway by which stress-related exposures can affect cardiometabolic health. FundingWellcome Trust (OPOH 106853/A/15/Z), the National Institute on Aging (R01 AG031266), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD052762), the National Science Foundation (CMS-0527763), and the World Bank.

Long-term Sustainability of Diabetes Prevention Approaches

Diabetes prevention is imperative to slow worldwide growth of diabetes-related morbidity and mortality. Yet the long-term efficacy of prevention strategies remains unknown. To estimate aggregate long-term effects of different diabetes prevention strategies on diabetes incidence. Systematic searches of MEDLINE, EMBASE, Cochrane Library, and Web of Science databases. The initial search was conducted on January 14, 2014, and was updated on February 20, 2015. Search terms included prediabetes, primary prevention, and risk reduction. Eligible randomized clinical trials evaluated lifestyle modification (LSM) and medication interventions (>6 months) for diabetes prevention in adults (age ≥18 years) at risk for diabetes, reporting between-group differences in diabetes incidence, published between January 1, 1990, and January 1, 2015. Studies testing alternative therapies and bariatric surgery, as well as those involving participants with gestational diabetes, type 1 or 2 diabetes, and metabolic syndrome, were excluded. Reviewers extracted the number of diabetes cases at the end of active intervention in treatment and control groups. Random-effects meta-analyses were used to obtain pooled relative risks (RRs), and reported incidence rates were used to compute pooled risk differences (RDs). The main outcome was aggregate RRs of diabetes in treatment vs control participants. Treatment subtypes (ie, LSM components, medication classes) were stratified. To estimate sustainability, post-washout and follow-up RRs for medications and LSM interventions, respectively, were examined. Forty-three studies were included and pooled in meta-analysis (49 029 participants; mean [SD] age, 57.3 [8.7] years; 48.0% [n = 23 549] men): 19 tested medications; 19 evaluated LSM, and 5 tested combined medications and LSM. At the end of the active intervention (range, 0.5-6.3 years), LSM was associated with an RR reduction of 39% (RR, 0.61; 95% CI, 0.54-0.68), and medications were associated with an RR reduction of 36% (RR, 0.64; 95% CI, 0.54-0.76). The observed RD for LSM and medication studies was 4.0 (95% CI, 1.8-6.3) cases per 100 person-years or a number-needed-to-treat of 25. At the end of the washout or follow-up periods, LSM studies (mean follow-up, 7.2 years; range, 5.7-9.4 years) achieved an RR reduction of 28% (RR, 0.72; 95% CI, 0.60-0.86); medication studies (mean follow-up, 17 weeks; range, 2-52 weeks) showed no sustained RR reduction (RR, 0.95; 95% CI, 0.79-1.14). In adults at risk for diabetes, LSM and medications (weight loss and insulin-sensitizing agents) successfully reduced diabetes incidence. Medication effects were short lived. The LSM interventions were sustained for several years; however, their effects declined with time, suggesting that interventions to preserve effects are needed.

PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin.

Although the Diabetes Prevention Program and other clinical trials demonstrated the efficacy of intensive lifestyle interventions (ILI) and metformin to prevent type 2 diabetes, no studies have tested their comparative effects in pragmatic settings. This study was designed to compare the real-world effectiveness of ILI, metformin, and standard care among Hispanic women (Latinas) with prediabetes. RCT. Ninety-two Latinas, who had a mean hemoglobin A1c of 5.9%, BMI of 33.3 kg/m2, and waist circumference of 97.4 cm (38.3 inches), were recruited from an urban community and randomly assigned to ILI, metformin, or standard care using 1:1:1 allocation. Data were collected from 2013-2015 and analyzed in 2016. The 12-month ILI was adapted from the Diabetes Prevention Program's ILI and delivered by community health workers (promotoras) over 24 sessions. Metformin participants received 850 mg twice daily. Those randomized to standard care continued their regular medical care. Weight and secondary outcomes (waist circumference, blood pressure, hemoglobin A1c, fasting plasma glucose, insulin, and lipids) were assessed at baseline and 12 months. ILI participants demonstrated significantly greater mean weight loss (-4.0 kg, 5.0%) than metformin (-0.9 kg, 1.1%) and standard care participants (+0.8 kg, 0.9%) (p<0.001). The difference in weight loss between metformin and standard care was not significant. The ILI group experienced a greater reduction in waist circumference than standard care (p=0.001), and a marginal improvement in hemoglobin A1c compared with metformin and standard care (p=0.063). In the first comparative effectiveness trial of diabetes prevention treatments, a 12-month ILI produced significantly greater weight loss than metformin and standard care among Latinas with prediabetes. These data suggest that ILI delivered by promotoras is an effective strategy for preventing diabetes in this high-risk group, which may be superior to metformin. Future pragmatic trials involving larger samples should examine differences in diabetes incidence associated with these treatments.

Effect of general health screening and lifestyle counselling on incidence of diabetes in general population: Inter99 randomised trial

We aimed to examine the effect of a large population-based multifactorial screening and lifestyle intervention programme on 10-year incidence of diabetes. In a randomised trial of the general Danish population initiated in 1999–2001 59,616 men and women aged 30–60years were assigned to a five year screening and lifestyle counselling programme (n=11,629) or control group (n=47,987) and followed for ten years in nationwide registers. Intention to treat was applied and risk of diabetes was modeled by Cox regression and expressed as hazard ratios (HRs). We found that 1692 individuals had diabetes at baseline. Among 57,924 individuals without diabetes at baseline, 1267 emigrated, 2593 died and 3369 (Intervention group=684, Control group=2685) developed diabetes. We saw no significant difference in diabetes incidence between the groups after 10-year follow-up (Grey's test: p=0.22). In the first year of follow-up, incidence of diabetes was significantly higher in the intervention group than the control group (HR=1.68, 95%CI 1.29 to 2.29). We observed no difference in incidence of diabetes between the groups in the follow-up intervals from 1 to 6years or after 6–10years (HR=0.94, 0.83 to 1.06; HR=1.03, 0.91 to 1.17). Inviting the general population to participate in a repeated screening and lifestyle counselling programme over five years did not result in lower incidence of diabetes after 10years of follow-up. As expected, significantly more individuals were diagnosed with diabetes in the intervention group during the first year, but this was not followed by a decrease in the following years.Trials registration: Clinical trials NCT00289237

Activation of Innate Immunity Modulates Insulin Sensitivity, Glucose Effectiveness and Pancreatic β-Cell Function in Both African Ancestry and European Ancestry Healthy Humans

ObjectiveInsulin resistance is a risk factor for type 2 diabetes, and is associated with inflammatory cardiometabolic disease. Given differences between African ancestry (AA) and European ancestry (EA) in the epidemiology of type 2 diabetes as well as in response to inflammatory stress, we investigated potential race differences in glucose homeostasis responses during experimental endotoxemia in humans. MethodsHealthy volunteers (age 18–45years, BMI 18–30kg/m2, 47% female, African-ancestry (AA, n=42) and European-ancestry (EA, n=106)) were recruited as part of the Genetics of Evoked Responses to Niacin and Endotoxemia (GENE) Study. Subjects underwent an inpatient endotoxin challenge (1ng/kg LPS) and two frequently-sampled intravenous glucose tolerance tests (FSIGTT). Insulin and glucose values obtained during FSIGTT pre- and 24-hours post-LPS were analyzed using the minimal model. ResultsFSIGTT derived insulin sensitivity index (SI), disposition index (DI) and glucose effectiveness (SG) decreased significantly following LPS (p<0.0001) while the acute insulin response to glucose (AIRg) increased (p<0.0001). Although expected race differences were observed in glucose homeostasis parameters at baseline prior to LPS e.g., lower SI (2.5 vs. 4.1μU/L/min, p<0.0001) but higher AIRg (median 848 vs. 290μU/L/min, p<0.0001) in AA vs. EA, the changes in glucose homeostasis responses to LPS were directionally and proportionally consistent across race e.g., SI median −35% in EA and −29% in AA and AIRg median +17% in EA and +26% in AA. ConclusionBoth EA and AA samples modulated glucose and insulin homeostasis similarly during endotoxemia. ImplicationsRace differences in response to environmental inflammatory stress are unlikely to be a substantial contributor to the observed difference in diabetes incidence and complications between EA and AA.

Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance.

To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence. We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2 years. In an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3-2.3), 1.7 (1.2-2.3) and 2.0 (1.3-3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk. MetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.

Insulin Resistance and Truncal Obesity as Important Determinants of the Greater Incidence of Diabetes in Indian Asians and African Caribbeans Compared With Europeans

OBJECTIVETo determine the extent of, and reasons for, ethnic differences in type 2 diabetes incidence in the U.K.RESEARCH DESIGN AND METHODSPopulation-based triethnic cohort. Participants were without diabetes, aged 40–69 at baseline (1989–1991), and followed-up for 20 years. Baseline measurements included fasting and postglucose bloods, anthropometry, and lifestyle questionnaire. Incident diabetes was identified from medical records and participant recall. Ethnic differences in diabetes incidence were examined using competing risks regression.RESULTSIncident diabetes was identified in 196 of 1,354 (14%) Europeans, 282 of 839 (34%) Indian Asians, and 100 of 335 (30%) African Caribbeans. All Indian Asians and African Caribbeans were first-generation migrants. Compared with Europeans, age-adjusted subhazard ratios (SHRs [95% CI]) for men and women, respectively, were 2.88 (95%, 2.36–3.53; P < 0.001) and 1.91 (1.18–3.10; P = 0.008) in Indian Asians, and 2.23 (1.64–3.03; P < 0.001) and 2.51 (1.63–3.87; P < 0.001) in African Caribbeans. Differences in baseline insulin resistance and truncal obesity largely attenuated the ethnic minority excess in women (adjusted SHRs: Indian Asians 0.77 [0.49–1.42]; P = 0.3; African Caribbeans 1.48 [0.89–2.45]; P = 0.13), but not in men (adjusted SHRs: Indian Asians 1.98 [1.52–2.58]; P < 0.001 and African Caribbeans, 2.05 [1.46–2.89; P < 0.001]).CONCLUSIONSInsulin resistance and truncal obesity account for the twofold excess incidence of diabetes in Indian Asian and African Caribbean women, but not men. Explanations for the excess diabetes risk in ethnic minority men remains unclear. Further study requires more precise measures of conventional risk factors and identification of novel risk factors.

Determinants of Racial/Ethnic Disparities in Incidence of Diabetes in Postmenopausal Women in the U.S.

OBJECTIVETo examine determinants of racial/ethnic differences in diabetes incidence among postmenopausal women participating in the Women’s Health Initiative.RESEARCH DESIGN AND METHODSData on race/ethnicity, baseline diabetes prevalence, and incident diabetes were obtained from 158,833 women recruited from 1993–1998 and followed through August 2009. The relationship between race/ethnicity, other potential risk factors, and the risk of incident diabetes was estimated using Cox proportional hazards models from which hazard ratios (HRs) and 95% CIs were computed.RESULTSParticipants were aged 63 years on average at baseline. The racial/ethnic distribution was 84.1% non-Hispanic white, 9.2% non-Hispanic black, 4.1% Hispanic, and 2.6% Asian. After an average of 10.4 years of follow-up, compared with whites and adjusting for potential confounders, the HRs for incident diabetes were 1.55 for blacks (95% CI 1.47–1.63), 1.67 for Hispanics (1.54–1.81), and 1.86 for Asians (1.68–2.06). Whites, blacks, and Hispanics with all factors (i.e., weight, physical activity, dietary quality, and smoking) in the low-risk category had 60, 69, and 63% lower risk for incident diabetes. Although contributions of different risk factors varied slightly by race/ethnicity, most findings were similar across groups, and women who had both a healthy weight and were in the highest tertile of physical activity had less than one-third the risk of diabetes compared with obese and inactive women.CONCLUSIONSDespite large racial/ethnic differences in diabetes incidence, most variability could be attributed to lifestyle factors. Our findings show that the majority of diabetes cases are preventable, and risk reduction strategies can be effectively applied to all racial/ethnic groups.

Prediction models for risk of developing type 2 diabetes: systematic literature search and independent external validation study

Objective To identify existing prediction models for the risk of development of type 2 diabetes and to externally validate them in a large independent cohort.Data sources Systematic search of English,...

Selected Risk Factors' Contribution to State-Level Incidence of Diagnosed Diabetes, 2005-2007

Introduction: Differences in incidence of diabetes and prevalence of risk factors for diabetes exist among states. It is unknown how much of this variability in incidence of diagnosed diabetes is due to variability in risk factor prevalence. We investigate the contribution of selected risk factors to state level incidence of diagnosed diabetes. Materials and Methods: Using 2005-2007 data from the Behavioral Risk Factor Surveillance System, we conducted two logistic regressions, both with incident case status as dependent variable. One model considered only state of residence as an independent variable. The other added: age; sex; race/ethnicity; education; inactive lifestyle; and obesity. We compared adjusted and unadjusted odds of incident diabetes among states, and calculated excess risk. Results: Adjusted and unadjusted odds of incident diabetes were similar. Sensitivity analyses showed that this differed little if we used data from earlier years or if we included income or insurance as a risk factor. In most states, the excess risk associated with risk factors was less than 30%. Discussion: Factors other than age, sex, race/ethnicity, education, inactivity, and obesity (i.e., established risk factors for diabetes) might substantially influence the differences in state incidence rates. These factors' identities are unknown. If these factors are identified and modifiable, states might use them to reduce between-state disparities in diabetes incidence.

P2-103 Is the socioeconomic patterning of type II diabetes mediated by sleeping problems? Evidence from the west of Scotland

IntroductionSleep deprivation produces physiological changes similar to those that occur in the development of diabetes. Sleeping patterns may therefore act as a mediator between socioeconomic status and diabetes.MethodsData are from...