Higher Risk Of Diabetes Mellitus Research Articles

Effect of Behavioral Intervention on Dilated Fundus Examination Rates in Older African American Individuals With Diabetes Mellitus: A Randomized Clinical Trial.

African American individuals are at high risk of diabetes mellitus and diabetic retinopathy but have suboptimal rates of dilated fundus examinations (DFEs). Early intervention is crucial for the prevention of diabetic retinopathy in this high-risk population. To test the efficacy of behavioral activation for diabetic retinopathy prevention on rates of DFEs in older African American individuals with diabetes mellitus. Masked randomized clinical trial at 2 urban medical centers from October 1, 2010, to May 31, 2014. Participants included 206 African American individuals 65 years and older with diabetes mellitus who had not obtained a DFE in the preceding 12 months. Participants were randomized to either behavioral activation for diabetic retinopathy prevention, a behavioral intervention designed to provide education, facilitate identifying and addressing health care barriers, and promote goal setting to improve rates of DFEs, or supportive therapy, a control condition. The primary outcome was medical documentation of a DFE at 6 months' follow-up. Secondary outcomes included the Risk Perceptions and Risk Knowledge Survey of Diabetes Mellitus, Diabetes Self-Care Inventory, Patient Health Questionnaire 9, and National Eye Institute Vision Function Questionnaire 25 scores and hemoglobin A1c levels. More participants in the behavioral activation for diabetic retinopathy prevention group (87.9%) obtained a DFE compared with those in the supportive therapy group (34.1%) by the 6-month follow-up assessment (P < .001). Overall, participants in the behavioral activation for diabetic retinopathy prevention group were 2.5 times more likely to obtain a DFE compared with those in the supportive therapy group (risk ratio = 2.58; 95% CI, 1.91-3.48; P < .001). The intervention had no short-term effect on secondary outcomes of hemoglobin A1c levels, depression, or the Risk Perceptions and Risk Knowledge Survey of Diabetes Mellitus or National Eye Institute Vision Function Questionnaire 25 composite scores; however, both groups had improved adherence to diabetes mellitus self-care behaviors from baseline to 6-month follow-up. Behavioral activation for diabetic retinopathy prevention significantly increased rates of DFEs in older African American individuals with diabetes mellitus. Behavioral interventions may have the potential to positively affect screening for diabetic retinopathy in at-risk populations. clinicaltrials.gov Identifier: NCT01179555.

High-risk drinking is associated with a higher risk of diabetes mellitus in Korean men, based on the 2010–2012 KNHANES

We examined the association between alcohol-drinking pattern and diabetes mellitus (DM) in Korean adults. This cross-sectional study included 12,486 participants (5551 men and 6935 women) who participated in the 2010–2012 Korean National Health and Nutrition Examination Survey. We categorized alcohol-drinking pattern into three groups based on the alcohol-use disorders identification test (AUDIT): low-risk (score: 0–7), intermediate-risk (score: 8–14), and high-risk (score: ≥15). DM was defined as having fasting plasma glucose ≥126 mg/dL or taking glucose-lowering medication, including insulin therapy. In the study population, 25.2% of men and 4.7% of women were high-risk drinkers. DM prevalence was 9.2% in men and 5.4% in women. DM prevalence was 9.0% and 5.7% in the low-risk drinking group, 7.6% and 4.1% in the intermediate-risk drinking group, and 11.2% and 3.5% in the high-risk drinking group in men and women, respectively. Compared to the low-risk drinking group, odds ratios (95% confidence intervals) of men and women in the intermediate-risk drinking group for DM were 1.043 (0.779–1.396) and 1.139 (0.712–1.824), respectively, and 1.480 (1.133–1.933) and 0.827 (0.296–2.311) in the high-risk drinking group, after adjusting for age and other confounding factors. In conclusion, high-risk drinking appears to be associated with a higher risk of DM in men, but not in women.

Risk of diabetes mellitus among patients with myasthenia gravis.

To determine the risk of diabetes mellitus (DM) in patients with myasthenia gravis (MG) in a large cohort representing 99% of the Taiwan population. Data from the Taiwan National Health Insurance Database were used to conduct retrospective cohort analyses. The study cohort comprised 1520 patients with MG who were four-fold frequency matched to those without MG by age and sex, and assigned the same index year. Cox proportional hazard regression analysis was conducted to estimate the risk of DM. The MG cohort had a 1.26-fold increased risk of developing DM compared with the comparison cohort (HR=1.26, 95% CI=1.04-1.53). MG patients without corticosteroids use had no increased risk of developing DM (HR=1.05, 95% CI=0.79-1.40), and MG patients with corticosteroids use had a 1.46-fold increased risk of developing DM (HR=1.46, 95%=1.15-1.86). In addition, patients with MG received aggressive treatment, associated thyroid diseases, and male patients had higher risk of DM. This population-based retrospective cohort study demonstrates that MG is associated with a high risk of DM, which might be related to the adverse effect of corticosteroid and aggressive therapy.

Investigation of glycosylated hemoglobin A1c levels in 10 487 adults in Xiamen city

Objective To study the distribution of glycosylated hemoglobin A1c (HbA1c) levels in Xiamen, and to investigate the relationship among HbA1c level and gender and age. Methods This was a cross-sectional study. 10 487 cases of physical examination individuals in Zhongshan hospital from January 2013 to April 2014 were recruited．HbA1c was measured by ARKRAY HA-8180 automatic glycosylated hemoglobin analyzer (Japan). All data were collected for analyzing the HbA1c levels in different sex and age groups, exploring the rule between HbA1c and age, and comparing the different diagnostic criteria of diabetes mellitus(DM).Differences between the two groups were compared using the Independent Samples T Test. The measurement data of multiple group were compared with single factor analysis of variance (One way ANOVA), and the comparison between two groups was performed with LSD T test. Correlation between different variables was analyzed by Pearson correlation and linear regression. Results Focused on all the 10 487 cases and 9 436 cases with HbA1c < 6.5% physical examination population,the levels of HbA1c were positively correlated with age, the linear regression equations were HbA1c (%) =0.021 2 × age (years) + 4.811 9 (r=0.348 9, P=0.000) and HbA1c (%) =0.010 9 × age (years) + 5.094 4 (r=0.4257, P=0.000)respectively; HbA1c levels in male physical examination population were significantly higher than those in females (P＜0.001),moreover, in different gender groups, HbA1c level had gradually risen with increasing age. Patients at risk for diabetes (prediabetes, 39.60%) diagnosed by the criteria of 2010 American Diabetes Association (ADA) were 2.55 times more than those diagnosed by the criteria of international expert committee (15.55%). Conclusions The HbA1c level is related to age and gender in Xiamen city. It is necessary to establish different reference intervals and DM diagnostic cut-off point. The criteria of 2010 ADA can identify more high-risk DM individuals, with is especially suitable for the physical examination screening. （Chin J Lab Med,2014,37:912-916） Key words: Hemoglobin A, glycosylated; Diabetes mellitus; Sex factors; Age factors

Late-Breaking Clinical Trial Abstracts

### Late-Breaking Clinical Trials: Risk and Benefit of Dual Antiplatelet Therapy #### Increased Risk of Ischemic Events Upon Discontinuation of Prasugrel After 12 or 30 Months of Therapy Following Placement of the Taxus Liberte Paclitaxel-Eluting Coronary Stent Kirk N Garratt1, Ronald D Jenkins2, Thomas K Pow3, W. Douglas Weaver4, Laura Mauri5, De J Kereiakes6, Kenneth J Winters7, Thomas Christen8, Dominic J Allocco8, David P Lee9; 1Cardiac Interventions, Lenox Hill Heart and Vascular Institute, New York, NY; 2Cardiac Interventions, Heart Clinics Northwest, Coeur d'Alene, ID; 3Cardiac Interventions, Great Lakes Heart Institute, St Joseph, MI; 4Cardiology, Henry Ford Hosp, Detroit, MI; 5Div of Cardiovascular Medicine, Brigham and Women's Hosp, Boston, MA; 6Cardiology, The Christ Hosp Heart and Vascular Cntr/The Lindner Rsch Cntr, Cincinnati, OH; 7Lilly Rsch Laboratories, Eli Lily and Company, Indianapolis, IN; 8Clinical Sciences, Boston Scientific, Marlborough, MA; 9Cardiovascular Medicine Clinic, Standford, Stanford, CA Introduction : The TAXUS Liberte Post-approval Study (TL-PAS) studied long-term clinical outcomes for the TL stent in conjunction with the use of prasugrel and aspirin. A portion of patients from TL-PAS contributed to the Dual Anti-Platelet Therapy (DAPT) trial. Methods : Eligible and consecutive patients in the United States treated with TL stents were enrolled into TL-PAS (N=4199). Those meeting inclusion and exclusion criteria were recruited for participation in the DAPT trial (N=3904). Patients received open-label prasugrel plus aspirin for 12 months after stent placement. At 12 months, patients without ischemic or bleeding events continued aspirin therapy and were randomized 1:1 to continued blinded treatment with either prasugrel or placebo for an additional 18 months (N=2202). At 30 months, study drugs were discontinued, and aspirin was continued through at least 33 months after stent placement. Events were adjudicated by a clinical events committee and monitored by the TL-PAS Data Monitoring Committee (DMC). Results : Nearly 3 years following randomization, the DMC noted a significant increase …

Demographic distribution of diabetes–tuberculosis comorbidity in Eastern rural China

ObjectiveChina has the second highest burden of tuberculosis (TB) worldwide, and it is also facing a remarkable increase of Diabetes Mellitus (DM) in the population. DM patients are at high risk of contracting TB and patients with DM–TB comorbidity usually present a relatively poor disease progress. To achieve the goal of TB control on incidence and mortality, it is of great importance to understand the epidemiology of DM–TB comorbidity in the Chinese population. This study aims to understand the prevalence of DM–TB comorbidity in newly diagnosed active TB patients and its demographic distribution in eastern rural China. MethodsA population-based cross-sectional study was carried out in four counties in eastern rural China, two in Jiangsu Province (GDP per capita in 2013: 74699.37 yuan, prevalence of DM: 8.50%) and two in Jiangxi Province (GDP per capita in 2013: 31835.53 yuan, prevalence of DM: 7.63%). All newly diagnosed and registered active TB patients from April 2013 to March 2014 were investigated using a structured questionnaire. Fasting blood glucose levels were tested to screen potential DM patients. Confirmation of diagnosis was made by glycosylated hemoglobin A1c (HbA1C). ResultsIn total, 1406TB patients from four counties were recruited with 447 (33.8%) being smear-positive TB. The average age of patients was 41years, and the male to female ratio was 1019 (76.2%) to 319 (23.8%). Overall, 71 DM–TB comorbidity patients were detected; of them 52 (73.24%) were from Jiangsu and 19 (26.76%) from Jiangxi. The prevalence of DM–TB comorbidity was 5.05% of the 1406TB patients. The prevalence of DM–TB in Jiangsu (9.29%) was 4.13 times higher than Jiangxi Province (2.25%, p<0.01). It was found that ethnicity, family history of diabetes, diet habit and Province were associated with the prevalence of DM in TB patients. Compared to patients from Jiangxi Province and Han ethnicity patients, TB patients from Jiangsu Province (60.2% vs. 39.8%, OR: 24.17, 95% CI: 4.94–118.32) and minority patients (1.4% vs. 98.6%, OR: 24.29, 95% CI: 1.69–349.11) had a higher prevalence of DM–TB comorbidity. It was found that patients with a family history of DM had an increased possibility of DM–TB comorbidity (2.6% vs. 97.4%, OR: 6.46, 95% CI: 1.05–39.70), as well as those having a diet consisting of salty food (25.2% vs. 74.8%, OR: 3.41, 95% CI: 1.25–9.29). ConclusionDM–TB comorbidity is more prevalent in areas with better economic status and higher prevalence of DM. Patients with a DM family history might be at high risk of DM–TB comorbidity. A TB control program should be integrated with DM screening and management program in eastern rural China.

Evaluation of the fatty liver index as a predictor for the development of diabetes among insurance beneficiaries with prediabetes

Aims/IntroductionNon-alcoholic fatty liver disease (NAFLD) is the most common liver disease in developed countries, and it was required to monitor patients with prediabetes. However, there have been few reports establishing the risk for diabetes mellitus (DM) among patients with prediabetes. The purpose of the present study was to evaluate the effect of NAFLD on the progression of DM among insurance beneficiaries with prediabetes, using data from specific health check-ups and the fatty liver index (FLI).Materials and MethodsWe used a retrospective cohort study that enrolled 967 insurance beneficiaries with prediabetes who had rarely drunk or could not drink alcohol, or whose alcohol consumption was <19 g/day from two health insurance societies. We divided insurance beneficiaries into FLI <30, intermediates FLIs and FLI ≥60, and compared the incidence rate of DM among the groups after 3 years' follow up, using multiple logistic regression models.ResultsDuring 3 years' follow up, progression of diabetes was seen in 65 men (11.5%) and 24 women (6.0%). Logistic regression analyses showed that those with NAFLD had significantly higher risks of developing DM; this was the case in both men (odds ratio 2.68, 95% confidential interval 1.29–5.56) and women (odds ratio 10.35, 95% confidential interval 3.22–33.31).ConclusionsAmong insurance beneficiaries with prediabetes, those with NAFLD had a significantly higher risk of DM than those without NAFLD. The FLI might be useful for detecting individuals who have an especially higher risk for DM, and developing more effective guidance for delivering healthcare services in Japan.

Thiazide Diuretic Prophylaxis for Kidney Stones and the Risk of Diabetes Mellitus

Thiazide diuretics used to treat hypertension are associated with a modest risk of diabetes mellitus. It is unknown if there is a similar risk with kidney stone prevention. We identified and validated incident stone formers in Olmsted County, Minnesota from 1984 to 2011 with manual review of medical records using the Rochester Epidemiology Project. The risk of diabetes mellitus after thiazide therapy was evaluated with and without multivariate adjustment for hypertension, age, gender, race, family history of stones, body mass index and number of stone events. Among 2,350 incident stone formers with a median followup of 10 years, 332 (14%) were treated with thiazide diuretics at some point after the first stone event and 84 (3.6%) received the thiazide diuretic only for kidney stone prevention. Stone formers who received thiazide diuretics were more likely to be older, have hypertension, have higher body mass index and have more stone events. The incidence of diabetes mellitus at 10 years after the first stone event was 9.2% in the group that received thiazide diuretics vs 4.2% in those who did not (HR 2.91; 95% CI 2.02, 4.20). After multivariate adjustment the risk of diabetes mellitus was attenuated (HR 1.20; 95% CI 0.78, 1.83). The risk of diabetes mellitus among those receiving thiazide diuretics solely for kidney stones was further attenuated (multivariate adjusted HR 0.80; 95% CI 0.28, 2.23). Thiazide diuretic use for kidney stone prophylaxis was not associated with a high risk of diabetes mellitus. Larger studies are needed to determine if there is a modest risk of diabetes mellitus with thiazide diuretics.

Pancreatic endocrine and exocrine function in children following near-total pancreatectomy for diffuse congenital hyperinsulinism.

ContextCongenital hyperinsulinism (CHI), the commonest cause of persistent hypoglycaemia, has two main histological subtypes: diffuse and focal. Diffuse CHI, if medically unresponsive, is managed with near-total pancreatectomy. Post-pancreatectomy, in addition to persistent hypoglycaemia, there is a very high risk of diabetes mellitus and pancreatic exocrine insufficiency.SettingInternational referral centre for the management of CHI.PatientsMedically unresponsive diffuse CHI patients managed with near-total pancreatectomy between 1994 and 2012.InterventionNear-total pancreatectomy.Main Outcome MeasuresPersistent hypoglycaemia post near-total pancreatectomy, insulin-dependent diabetes mellitus, clinical and biochemical (faecal elastase 1) pancreatic exocrine insufficiency.ResultsOf more than 300 patients with CHI managed during this time period, 45 children had medically unresponsive diffuse disease and were managed with near-total pancreatectomy. After near-total pancreatectomy, 60% of children had persistent hypoglycaemia requiring medical interventions. The incidence of insulin dependent diabetes mellitus was 96% at 11 years after surgery. Thirty-two patients (72%) had biochemical evidence of severe pancreatic exocrine insufficiency (Faecal elastase 1<100 µg/g). Clinical exocrine insufficiency was observed in 22 (49%) patients. No statistically significant difference in weight and height standard deviation score (SDS) was found between untreated subclinical pancreatic exocrine insufficiency patients and treated clinical pancreatic exocrine insufficiency patients.ConclusionsThe outcome of diffuse CHI patients after near-total pancreatectomy is very unsatisfactory. The incidence of persistent hypoglycaemia and insulin-dependent diabetes mellitus is very high. The presence of clinical rather than biochemical pancreatic exocrine insufficiency should inform decisions about pancreatic enzyme supplementation.

Pleiotropic genes for metabolic syndrome and inflammation

Metabolic syndrome (MetS) has become a health and financial burden worldwide. The MetS definition captures clustering of risk factors that predict higher risk for diabetes mellitus and cardiovascular disease. Our study hypothesis is that additional to genes influencing individual MetS risk factors, genetic variants exist that influence MetS and inflammatory markers forming a predisposing MetS genetic network. To test this hypothesis a staged approach was undertaken. (a) We analyzed 17 metabolic and inflammatory traits in more than 85,500 participants from 14 large epidemiological studies within the Cross Consortia Pleiotropy Group. Individuals classified with MetS (NCEP definition), versus those without, showed on average significantly different levels for most inflammatory markers studied. (b) Paired average correlations between 8 metabolic traits and 9 inflammatory markers from the same studies as above, estimated with two methods, and factor analyses on large simulated data, helped in identifying 8 combinations of traits for follow-up in meta-analyses, out of 130,305 possible combinations between metabolic traits and inflammatory markers studied. (c) We performed correlated meta-analyses for 8 metabolic traits and 6 inflammatory markers by using existing GWAS published genetic summary results, with about 2.5 million SNPs from twelve predominantly largest GWAS consortia. These analyses yielded 130 unique SNPs/genes with pleiotropic associations (a SNP/gene associating at least one metabolic trait and one inflammatory marker). Of them twenty-five variants (seven loci newly reported) are proposed as MetS candidates. They map to genes MACF1, KIAA0754, GCKR, GRB14, COBLL1, LOC646736-IRS1, SLC39A8, NELFE, SKIV2L, STK19, TFAP2B, BAZ1B, BCL7B, TBL2, MLXIPL, LPL, TRIB1, ATXN2, HECTD4, PTPN11, ZNF664, PDXDC1, FTO, MC4R and TOMM40. Based on large data evidence, we conclude that inflammation is a feature of MetS and several gene variants show pleiotropic genetic associations across phenotypes and might explain a part of MetS correlated genetic architecture. These findings warrant further functional investigation.

Promising Role of ANGPTL4 Gene in Diabetic Wound Healing

Diabetes mellitus (DM) is one of the severe metabolic disorders of carbohydrate metabolism worldwide. Developing countries are at higher risk of DM, and there is significant evidence that it is epidemic in many economically developing and newly industrialized countries. Among all other complications associated with DM, delayed wound healing is a major concern in diabetic patients. Wound healing is a natural healing process that starts immediately after injury. This involves interaction of a complex cascade of cellular events that generates resurfacing, reconstitution, and restoration of the tensile strength of injured skin. There are multiple factors responsible for delayed wound healing among which the contribution of DM has been well documented. The wound healing process is also delayed by the metabolic, vascular, neurological, and inflammatory alterations, which are well known in both type 1 and type 2 diabetes. Keratinocytes are crucial for wound re-epithelialization, and defects in directed migration of keratinocytes due to DM are associated with the delayed wound healing process. Many factors responsible for re-epithelialization have been identified, characterized, and well described; however, the genes responsible for the healing process have only partially been illustrated. This article will therefore focus on the efficacy of ANGPTL4 (angiopoietin-like 4) gene, which plays a novel role in keratinocyte migration during wound healing.

High prevalence of type 2 diabetes melitus and its risk factors among the rural population of Pondicherry, South India.

We aimed to assess the prevalence of type-2 diabetes in rural Pondicherry and to study the determinants of Diabetes Mellitus (DM) in the rural population of Pondicherry, south Induia. It was a cross-sectional community-based study conducted from November 2010 to January 2012 in two of the field practice villages affiliated to a Medical College in Pondicherry. Sample size was calculated using open source software, Open Epi Version 2.3.10. The sampling frame comprised individuals aged above 25 years and single stage cluster random sampling was carried out. After obtaining the verbal informed consent each of the study participants were interviewed face-to-face using a pre-tested structured questionnaire. Data were analyzed using the SPSS version 16. The age of the study participants ranged from 25 to 98 years with mean of 42.6 (±13.7) and majority of the study participants 339 (32.5%) from the age-group of 30-39 years. The prevalence of diabetes was 19.8% (60-69 years), 17.1% (40-49 years), 16.8% (50-59 years), and 13.6% (>69 years) among study subjects. In univariate analysis, higher age, being educated, unemployed and poor was associated with higher risk of diabetes mellitus (DM). Furthermore, a high triglyceride level was significantly associated with increase in the risk of DM (adjusted odds ratio: 3.01; 95% CI: 1.86, 4.86). Type-2 diabetes mellitus (T2DM) is an important public health problem in the adults of rural Pondicherry. Among non-modifiable factors, higher age, better socio-educational background and positive family history of diabetes was significantly associated with T2DM.

Utility of the triglyceride level for predicting incident diabetes mellitus according to the fasting status and body mass index category: the Ibaraki Prefectural Health Study.

The levels of lipids, especially triglycerides (TG), and obesity are associated with diabetes mellitus (DM). Although typically measured in fasting individuals, non-fasting lipid measurements play an important role in predicting future DM. This study compared the predictive efficacy of lipid variables according to the fasting status and body mass index (BMI) category. Data were collected for 39,196 nondiabetic men and 87,980 nondiabetic women 40-79years of age who underwent health checkups in Ibaraki-Prefecture, Japan in 1993 and were followed through 2007. The hazard ratios (HRs) for DM in relation to sex, the fasting status and BMI were estimated using a Cox proportional hazards model. A total of 8,867 participants, 4,012 men and 4,855 women, developed DM during a mean follow-up of 5.5 years. TG was found to be an independent predictor of incident DM in both fasting and non-fasting men and non-fasting women. The multivariable-adjusted HR for DM according to the TG quartile (Q) 4 vs. Q1 was 1.18 (95% confidence interval (CI): 1.05, 1.34) in the non-fasting men with a normal BMI (18.5-24.9). This trend was also observed in the non-fasting women with a normal BMI. That is, the multivariable-adjusted HRs for DM for TG Q2, Q3 and Q4 compared with Q1 were 1.07 (95% CI: 0.94, 1.23), 1.17 (95%CI: 1.03, 1.34) and 1.48 (95%CI: 1.30, 1.69), respectively. The fasting and non-fasting TG levels in men and non-fasting TG levels in women are predictive of future DM among those with a normal BMI. Clinicians must pay attention to those individuals at high risk for DM.

Antidepressants may lead to higher risk of diabetes mellitus

Antidepressants may lead to higher risk of diabetes mellitus

Hypertriglyceridemic Waist Might Be an Alternative to Metabolic Syndrome for Predicting Future Diabetes Mellitus

BackgroundIn some cross-sectional studies, hypertriglyceridemic waist (HTGW) has been recommended as an alternative to metabolic syndrome (MetS) for screening individuals at high risk for diabetes mellitus (DM). However, little information is about the predictive power of HTGW for future DM. The aims of the study were to assess the DM predictive power of HTGW compared with MetS based on the follow-up data over 15 years collected from a general Chinese population.Methods And Findings: The data were collected in 1992 and then again in 2007 from the same group of 687 individuals without DM in 1992. For the whole population (n =687), multivariate analysis showed presence of HTGW was associated with a 4.1-fold (95%CI: 2.4-7.0, p < 0.001) increased risk and presence of MetS was associated with a 3.7-fold (95%CI: 2.2-6.2, p < 0.001) increased risk for future DM. For the population without elevated fasting plasma glucose (n = 650), multivariate analysis showed presence of HTGW was associated with a 3.9-fold (95%CI: 2.2-7.0, p < 0.001) increased risk and presence of MetS was associated with a 3.7-fold (95%CI: 2.1-6.6, p < 0.001) increased risk for future DM.ConclusionsHTGW could predict future DM independently, and the predictive power was similar to MetS. HTGW might be an alternative to MetS for predicting future DM. For simpler and fewer components, HTGW might be more practical than MetS, and it might be recommended in most clinical practices. This finding might be more useful for the individuals who only have elevated WC and TG. Although these individuals are without MetS, they are still at high risk for future DM, similarly to the individuals with MetS.

GW24-e2937 Hypertriglyceridemic waist might be an alternative to metabolic syndrome for predicting future diabetes mellitus

ObjectivesIn some cross-sectional studies, hypertriglyceridemic waist (HTGW) has been recommended as an alternative to metabolic syndrome (MetS) for screening individuals at high risk for diabetes mellitus (DM). However, little information...

Population-based cohort study on the increase in the risk for type 2 diabetes mellitus development from nonapnea sleep disorders

ObjectivesThe evidence concerning the relationship between nonapnea sleep disorders and the risk for type 2 diabetes mellitus (DM) is scant and elusive. Our study aimed to examine if nonapnea sleep disorders increase the risk for DM using a population-based retrospective cohort study from 1997 to 2010. MethodsIn the Taiwan’s National Health Insurance Research Database (NHIRD), 45,602 patients with nonapnea sleep disorders were identified as the study cohort. The comparison cohort was formed by 91,204 age- and gender-matched controls. Cox proportional hazards regression model was used to estimate the risk for developing DM. ResultsIn 45,602 patients with nonapnea sleep disorders, 7241 new cases of DM were reported during the follow-up period. The mean follow-up time was 9.04 (standard deviation [SD], 3.33) and 8.96 (SD, 3.47) for the nonapnea sleep disorders cohort and the comparison cohort, respectively. The incidence rate of DM was higher in the nonapnea sleep disorder cohort than in the comparison cohort (17.6 vs 13.3 per 1000 individuals-years). Overall, patients with nonapnea sleep disorders had a higher risk for DM compared to patients without nonapnea sleep disorders (adjusted hazard ratio [HR], 1.05 [95% confidence interval {CI}, 1.02–1.08]). Men with nonapnea sleep disorders had a higher risk for DM than the men in the comparison group (adjusted HR, 1.08 [95% CI, 1.03–1.14]). Among subjects aged less than 40years, patients with nonapnea sleep disorders had a higher risk for DM than the comparison group (adjusted HR, 1.42 [95% CI, 1.27–1.59]). Compared with the comparison cohort, patients with sleep disturbance had an 11% higher risk for DM (adjusted HR, 1.11 [95% CI, 1.07–1.16]). ConclusionCompared to patients without nonapnea sleep disorders, patients with nonapnea sleep disorders had a higher risk for developing DM, especially among those who were less than 40years of age and who had sleep disturbances.

Circulation Editors’ Picks

<i>Circulation</i> Editors’ Picks

Association between habitual physical activity and lower cardiovascular risk in premenopausal, perimenopausal, and postmenopausal women

Menopause is associated with an increased risk of cardiovascular disease. Habitual physical activity, defined as any form of body movement with energy expenditure above resting levels, may improve health parameters. We assessed the level of habitual physical activity and its effect on anthropometric measures and cardiovascular risk factors in a cohort of premenopausal, perimenopausal, and postmenopausal women. This cross-sectional study is nested on a longitudinal population-based study that was begun in 1995 in the city of Passo Fundo, Brazil. For the present analysis, 292 women were included. Anthropometric and metabolic profile was evaluated. Habitual physical activity was assessed by a digital pedometer for 7 days, and participants were stratified into active and inactive (≥6,000 and <6,000 steps/day, respectively). The mean (SD) age was 57.1 (5.4) years. The average number of steps per day for the total sample was 5,250.7 (3,372.9): 3,472.4 (1,570.2) in the inactive group (61.8%) and 9,055.9 (3,033.4) in the active group (31.9%). A negative and statistically significant correlation was found between physical activity and smoking (P = -0.019), body mass index (P = -0.006), waist circumference (P = -0.013), and waist-to-hip ratio of 0.85 or higher (P = -0.043). Inactive women presented a higher risk of overweight/obesity (odds ratio [OR], 2.1; 95% CI, 1.233-3.622; P = 0.006) and waist circumference larger than 88 cm (OR, 1.7; 95% CI, 1.054-2.942; P = 0.03), even after adjustment for age, menopause status, smoking, and hormone therapy. Inactive women also had a higher risk of diabetes mellitus (OR, 2.7; 95% CI, 1.233-6.295; P = 0.014) and metabolic syndrome (OR, 2.5, 95% CI, 1.443-4.294; P = 0.001). Habitual physical activity, specifically walking 6,000 or more steps daily, was associated with a decreased risk of cardiovascular disease and diabetes in middle-aged women, independently of menopause status.

Abstract MP92: Processed and Unprocessed Red Meat Consumption and Incident Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-Analysis

Background: Several studies have recently evaluated the relation of processed and unprocessed red meat consumption and type 2 diabetes mellitus (DM). An updated review and quantitative assessment of these studies is crucial for public health recommendations. Methods: We performed a systematic review and meta-analysis of the relation of processed (salted or otherwise preserved), unprocessed, and total red meat consumption with DM. We updated a prior systematic search (to Mar 2009) for additional cohort, case-control, or randomized studies through Oct 2012. Among prior identified studies and 208 newly identified abstracts, 13 studies, all prospective cohorts, met inclusion criteria. These included 4 prior identified studies, 3 updated analyses, and 6 new cohorts. Data were extracted independently in duplicate. Random-effects generalized least squares models for trend were used to derive pooled dose-response estimates. Statistical heterogeneity between studies was tested with goodness of fit (λ2), and publication bias by funnel plots and Begg’s test. Results: The 13 studies provided 34 separate estimates for relations of processed, unprocessed, and total red meat consumption with incident DM. These included 574,212 individuals and 33,482 DM cases. In pooled analyses, per 50-g serving/d of processed meats, DM risk was 35% higher (13 studies; 34,077 cases; RR 1.35; 95% CI, 1.24-1.55; P&lt;0.001). The latter corresponded to 82% higher DM risk (RR 1.82; 95% CI, 1.64-2.02; P&lt;0.001) for each 100-g serving/d of processed meats. Per 100-g serving/d of unprocessed red meats, 13% higher risk of DM was seen (12 studies; 31 591 cases; RR 1.13; 95% CI, 1.08-1.17; P&lt;0.001). Fewer studies evaluated total red meat, with intermediate results (5 studies; 16,747 cases; RR per 100-g serving/d 1.16; 95% CI, 1.11-1.21; P&lt;0.001). Heterogeneity was evident by study location, with stronger risk estimates in US vs European populations. Evidence for publication bias was not seen. Conclusions: Consumption of red meat is associated with high incidence of DM. Per gram, risk is highest for processed meats, highlighting the need for investigation of key responsible constituents and informing policy priorities.