Risk Of Diabetes-related Complications Research Articles

Evaluation of carbohydrate and lipid metabolism dynamics in chronic HCV diabetic patients treated with direct antiviral agents

Although Hepatitis C virus (HCV) infection has become a curable disease, the aftermath of the infection remains an important aspect to be evaluated. HCV infection is well known for its extrahepatic manifestations, mostly the tight relationship between HCV, type 2 diabetes mellitus (T2DM) and dyslipidemia. Not only HCV increases the risk of T2DM, but it also affects its control in diabetic patients, increasing the risk of diabetes related complications. Furthermore, HCV hijacks the lipid metabolism resulting in abnormalities in circulating lipids which can lead to multiple complications, such as increased atherosclerotic risk and hepatic steatosis. Objectives. The aim of this study was to evaluate the dynamics of the parameters of carbohydrate and lipid metabolism in HCV-infected diabetic patients compared to non-diabetic patients after viral eradication. Material and methods. This is a prospective study conducted on 100 patients with chronic HVC infection who obtained viral clearance after interferon-free treatment. 58 patients had type 2 diabetes mellitus and 42 were non-diabetic. We evaluated serum total cholesterol, triglycerides, blood glucose and glycosylated hemoglobin in both groups at treatment initiation and 1 year after. Continuous variables were expressed as mean values ± standard deviation or median, categorical variables were represented as relative or absolute frequencies. Characteristics were compared using the Mann-Whitney method or the two-sample Student's T-test method for continuous variables, Chi-square and Fischer's test for categorical variables. A p value < 0.05 was considered statistically significant. Outcomes. The study analyzed and compared lipid and glycemic profiles of diabetic and non-diabetic HVC patients before and after viral cure. Conclusions. 1 year after treatment initiation the changes in lipid metabolism seem to persist, carbohydrate metabolism seems to remain unchanged, with no differences between diabetic and non-diabetic patients.

31-LB: The Relationship between Improvements in Glycemic Control following a Digital Health Intervention and the Food Environment in a Medicare Advantage Population

Diabetes is a complex disease that is influenced by social determinants of health (SDOH). An inadequate food environment, as a function of socioeconomic status and proximity to food retailers, has been associated with both increased prevalence of diabetes and barriers to diabetes self-management. This work examined the relationship between improvements in glycemic control as a result of a digital health intervention and the food environment in Medicare Advantage members at risk for diabetes-related complications (hemoglobin A1c [A1c] ≥ 8%). Participants enrolled in the Vida Health Diabetes Management program as part of their medical insurance benefit and utilized remote sessions with Registered Dietitians and Certified Diabetes Care and Education Specialists as well as content related to goal-setting to account for SDOH factors. The 2010 USDA Food Access Research Atlas was used to identify areas of low income and the absence of a food retailer within 0.5 or 1 urban and 10 rural miles (LILA). Participants were included if they had a laboratory A1c between -365 to -1 and 60 to 365-days of enrollment. Participants with baseline A1c ≥ 8.0 (n=430, 229 F, 68.9 y) demonstrated a decrease of -0.90 points (SD 1.71, p<0.001). Thirty-five percent resided in LILA areas at the 0.5, and twenty percent at 1 mile distance. Participants who resided in LILA areas had higher baseline A1c (0.5 difference: 0.37 (p=0.02), 1 difference: 0.51 (p=0.005)). Those with baseline A1c ≥ 9.0 (n=216, 120 F, 67.8 y) demonstrated a decrease of -1.38 points (SD 1.96, p<0.001). Thirty-nine percent resided in LILA areas at the 0.5, and twenty-three percent at 1 mile distance. Baseline A1c differences were not observed. Differences in improvements in A1c based on LILA were not observed (p’s > 0.05). Irrespective of LILA residence, the Vida Health program demonstrated significant improvements in glycemic control within 1 year in a high-risk Medicare Advantage population. Disclosure C. Edwards: Employee; Vida Health. L. Voelker: Employee; Vida Health. G. Zimmermann: Employee; Vida Health. K. Rawlings: Employee; Vida Health. A. Venkatesan: Employee; Vida Health. Funding Vida Health

Knowledge of Complications of Diabetes Mellitus among Patients with Type 2 Diabetes in Saudi Arabia: A Descriptive Study.

The objective of this study was to assess the knowledge of diabetes- related complications among patients with type 2 diabetes (T2D) in Saudi Arabia. In this study, 237 patients with T2D, who visited the diabetic clinic at Prince Sultan Military Medical City, Saudi Arabia, from December 2021 to March 2022, were recruited by adopting the non-probability sampling technique. A structured questionnaire was used to collect data on the sociodemographic features of the group in this study and their knowledge regarding T2D-related complications. From the 237 patients with T2D in this study, a higher percentage had hypertension (64.1%), heart disease (67.1%), retinopathy (79.7%), nephropathy (69.7%), diabetic foot (75.9%), and neuropathy (68.4%). Overall, a high number of these patients (122 or 51.5%) expressed inadequate knowledge of complications related to diabetes. Only 40 (16.9%) revealed adequate knowledge of diabetes-related complications, while 75 (31.6%) mentioned genuine ignorance regarding their complications. Patients educational status (p = 0.045), occupation (p = 0.026), and duration of diabetes (p = 0.037) were significantly associated with knowledge of diabetic complications. From the multinomial regression, substantial differences were evident concerning the duration and occupation of the population under study. The knowledge patients with T2D possess concerning diabetes-related complications was generally poor. This study indicates that through improved knowledge of diabetes, the risks of diabetes-related complications among T2D patients can be minimized.

Metabolic syndrome in patients with type 1 diabetes mellitus at a tertiary centre in North India: A five year follow up study

Background and aimsMetabolic syndrome (MS) is prevalent in the Indian population and has been traditionally linked to Type 2 diabetes mellitus (T2DM). Its presence is now being increasingly recognized in patients with Type 1 diabetes mellitus (T1DM). Presence of MS may increase the risk of diabetes related complications. This study was designed to determine the prevalence of MS in a cohort of patients with T1DM at baseline and at 5 years of follow up. MethodsLongitudinal cohort study in a tertiary care center in North India. Patients with T1DM attending the Diabetes of the Young (DOY) Clinic from January 2015 to March 2016 included. Microvascular and macrovascular complications assessed. The cohort was followed after a period of 5 years. ResultsWe included 161 patients (males, 49.4%) with a median (IQR) age of 23 (18–34) years and median (IQR) diabetes duration of 12 (7, 17) years. At baseline, 31 (19.2%) patients had MS. Patients with MS were more likely to have microvascular complications: retinopathy (p = 0.003), neuropathy (p = 0.02) and nephropathy (p = 0.04). Independent predictors of MS: insulin sensitivity (IS) (adjusted OR (aOR) 0.02 [95% CI, 0.003–0.118]), body weight (aOR 1.05 [95% CI, 1.007–1.108]), diastolic blood pressure (aOR 1.08 [95% CI, 1.01–1.15]) and duration of diabetes (aOR 1.09 [95% CI, 1.02–1.16]). On follow-up (n = 100), 13 (13%) had MS. ConclusionsOne in 5 patients with T1DM suffers from MS, and is therefore predisposed to its attendant risks, calling for early identification and targeted interventions.

Clinical Characteristicsof Inpatients With New-Onset Diabetes Mellitus in Eastern China: Based on Novel Clustering Analysis.

IntroductionThis study aimed to explore the novel classification of inpatients with new-onset diabetes in Eastern China by the cluster-based classification method and compare the clinical characteristics among the different subgroups.MethodsA total of 1017 Inpatients with new-onset diabetes of five hospitals in Eastern China were included in the study. Clustering analysis was used to cluster the data into five subgroups according to six basic variables. The differences in clinical characteristics, treatments, and the prevalence of diabetes-related diseases among the five subgroups were analyzed by multiple groups comparisons and pairwise comparisons. The risk of diabetes-related diseases in the five subgroups was compared by calculating odd ratio (OR). P value < 0.05 was considered significant.ResultsFive subgroups were obtained by clustering analysis with the highest proportion of patients with severe insulin-deficient diabetes (SIDD) 451 (44.35%), followed by patients with mild age-related diabetes (MARD) 236 (23.21%), patients with mild obesity-related diabetes (MOD) 207 (20.35%), patients with severe insulin-resistant diabetes (SIRD) 81 (7.96%), and patients with severe autoimmune diabetes (SAID) 42 (4.13%). Five subtypes had their own unique characteristics and treatments. The prevalence and risk of diabetes-related complications and comorbidities were also significantly different among the five subtypes. Diabetic kidney disease (DKD) was the most common in SIRD group. Patients in SIDD, SIRD, and MARD groups were more likely to develop cardiovascular disease (CVD) and/or stroke, diabetic peripheral vascular disease (DPVD), and diabetic distal symmetric polyneuropathy (DSPN). The prevalence and risk of metabolic syndrome (MS) were the highest in MOD and SIRD groups. Patients in SAID group had the highest prevalence and risk of diabetic ketoacidosis (DKA). Patients with MOD were more likely to develop non-alcoholic fatty liver disease (NAFLD).ConclusionsThe inpatients with new-onset diabetes in Eastern China had the unique clustering distribution. The clinical characteristics, treatments, and diabetes-related complications and comorbidities of the five subgroups were different, which may provide the basis for precise treatments of diabetes.

P.102: Long Term Outcomes After Fetal Pancreatic Stem Cell Transplantation in Diabetes Mellitus: Data From Unified National Electronic Health System 2014–2019

Introduction: Fetal pancreatic stem cell transplantations (FPCT) from the aborted fetuses of 16–20 weeks gestation have been approved for the treatment of diabetes mellitus (DM) in a single tertiary research and training hospital in Kazakhstan. Although the immediate short-term beneficial effect was observed, there was a lack of long-term mortality assessment and the risk of diabetes-related complications among patients receiving FPCT compared to patients receiving conventional treatment (CT). We aimed to study long-term all-cause mortality and diabetes-related complications in DM patients who underwent EPCT versus CT using large-scale administrative health data from Unified National Electronic Health System (UNEHS). Methods: The initial cohort of 102,611 patients who were admitted to the hospital with DM were identified using ICD-10 codes through UNEHS between 2014–2019. Out of them, 504 patients who underwent FPCT were defined using ICD-9 procedure codes. Mortality data and patient-related demographics were linked from the National Population Registry. Identified datasets were cross-checked with the whole UNEHS dataset (n=1,565,093 observations) to ascertain the following complications/comorbidities: coronary heart disease (CHD), stroke, retinopathy, nephropathy, neuropathy, diabetic foot, neoplasms. Based on patients’ baseline characteristics (age, sex, duration of DM, residency, ethnicity, number of hospitalizations, and type of diabetes), the cohort of FPCT patients (n=504) matched with a cohort of CT patients (n=102,611) with a 1:5 ratio by propensity score matching (PSM). The final cohort of 2847 patients (504 with EPCT vs 2,343 with CT) was further evaluated. Results: After PS matching, baseline characteristics for FPCT and CT groups did not differ. Median (IQR) age was 50.6 (41.5–57.4) years old and the median duration of diabetes accounted for 6.3 (4.7–10.7) years. The cohort consisted of 55.4% females, 75.2% Kazakhs, 85.3% of type 2 DM, and 72.2% of urban residents. The median number of hospitalizations in 2014–2019 was 3 (1–6). The results of diabetes-related events and all-cause mortality presented in table 1.In logistic regression analysis, FPCT group had 48% lower risk of all-cause death compared to CT group (Odds Ratio 0.52; 95%CI: 0.37–0.72; p-value <0.001). Also, those DM patients receiving FPCT compared to the CT group were less likely to experience CHD, diabetic retinopathy, neuropathy, and diabetic foot, however, they were more likely to have diabetic nephropathy. There was no difference between the groups in terms of stroke and cancer incidences. Survival analysis depicted in figure 1.Conclusion: Findings suggest that patients receiving FPCT had a 48% lower risk of all-cause death. We also reveal better outcomes for the FPCT group regarding CHD, retinopathy, nephropathy, neuropathy, and diabetic foot, however, the EPCT group had a higher risk of nephropathy. Further investigations involving clinical and laboratory data are warranted. This study was supported by grants from the Nazarbayev University Faculty Development Research Grant Program FDCRGP 2020–2022 (Funder Project Reference: 240919FD3913).

Undiagnosed Hyperglycemia Is a Potential Long-term Risk in Metabolic Surgery Patients: 7 Years Follow-up Study.

Diabetes is considered to be a surgically correctable illness. As glycemic control begins soon after surgery, the cessation of anti-diabetic medications is early. Patients believe that their diabetes has been "cured" and the need for blood sugar monitoring is forgotten, leading to undiagnosed hyperglycemia and risk of diabetes-related complications. To study the effect of bariatric surgery on long-term glycemic control and identify the patients with undiagnosed hyperglycemia. All patients with type 2 diabetes who underwent bariatric surgery at our center from January 2012 to December 2013 were included in the study. For each patient, demographic, preoperative, and postoperative data were retrospectively reviewed. Out of the total 119 patients with diabetes, 91 patients underwent sleeve gastrectomy and 28 underwent Roux-en-Y gastric bypass. Diabetes status at 7 years of follow-up was possible in 53 (44.5%) patients: 44 (48.4%) in SG and 9 (32.2%) in RYGB groups. Overall, complete remission at 7 years was seen in 17 (32.1%) patients and partial remission in 12 (22.6%) patients. Amongst non-remitters (n = 24, 45.3%), 7 (13.2%) patients were on medications with good glycemic control (A1C < 6.5) while 8 (15.1%) patients had poor control (A1C > 6.5) despite ongoing medications. Additionally, 9 (17%) patients had poor glycemic control (A1C > 6.5) and were not receiving any anti-diabetic medications. Patients in whom follow-up A1C was unavailable and their diabetes status remain unknown were 66 (55.5%) at 7 years. Our study clearly demonstrates high risk of undiagnosed hyperglycemia. Regular long-term follow-up in diabetic patients is even more desirable than amongst patients undergoing bariatric surgery for weight loss alone. Graphical abstract.

Abstract 15777: Induction Immunosuppression is Associated With a Lower Incidence of Post-transplant Diabetes Mellitus in Heart Transplant Recipients: A Propensity-adjusted Analysis

Introduction: Post-transplant diabetes mellitus (PTDM) is a common complication among heart transplant recipients resulting in heightened risk of diabetes-related complications and death. While there is evidence that certain maintenance immunosuppression drugs like tacrolimus increase the risk of PTDM, it is not known whether induction immunosuppression does the same. We therefore evaluated whether induction immunosuppression in the early post-transplant period with IL-2 inhibitors, alemtuzumab or anti-thymocyte globulin is associated with PTDM after accounting for potential confounding by indication. Methods: Using data from the Scientific Registry of Transplant Recipients, we conducted a cohort study of 23,946 US adults who received a heart transplant in January 2008-December 2018. PTDM was defined as new diagnosis of diabetes at any time 6 months after transplant. We excluded patients with prior organ transplants and diabetes. We used logistic regression to construct propensity scores for predictors of induction immunosuppression and risk factors for PTDM including demographic, clinical and immunologic factors, pre-transplant therapies, steroids, functional status, and transplant year. We estimated the effect of induction immunosuppression in propensity-adjusted Cox proportional hazards models and produced fully adjusted Kaplan-Meier curves using inverse probability of treatment weights. Results: The average age was 54 (SD=12.5) years, 26% were female and 12,303 (51%) received induction immunosuppression. Over 84,969 person-years, 2,678 (11%) developed PTDM (32 cases/1,000 person-years). In the propensity-adjusted analysis, induction immunosuppression was associated with a 20% lower rate of PTDM (Figure 1; hazard ratio=0.80, 95% confidence interval 0.74-0.87). Conclusions: Adult heart transplant recipients who received induction immunosuppression had a 20% lower rate of PTDM compared to those who did not receive it.

Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications.

OBJECTIVECirculating N-terminal pro B-type natriuretic peptide (NT-proBNP) is a classic diagnostic and prognostic marker for heart failure. However, it is inversely associated with diabetes risk. We aimed to investigate relationships of NT-proBNP with risk of diabetes-related complications in initially healthy individuals.RESEARCH DESIGN AND METHODSWe performed a case-cohort study within the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Potsdam cohort including a random subcohort (n = 1,294) and incident cases of type 2 diabetes (n = 649) and cardiovascular diseases (n = 478). Incident cases of type 2 diabetes (n = 545) were followed up for microvascular (n = 133) and macrovascular (n = 50) complications. Plasma NT-proBNP was measured at baseline in initially healthy participants.RESULTSIn multivariable models, NT-proBNP was linearly inversely associated with incident type 2 diabetes with a hazard ratio (HR) (95% CI) per doubling in NT-proBNP of 0.91 (0.86, 0.98). The association was only observable in women (0.80 [0.72, 0.90]) compared with men (0.98 [0.91, 1.07]). Among people with incident diabetes, NT-proBNP was positively associated with diabetes complications: overall, 1.31 (1.13, 1.53); microvascular complications, 1.20 (1.01, 1.43); and macrovascular complications, 1.37 (1.03, 1.83).CONCLUSIONSAlthough higher NT-proBNP levels are associated with lower diabetes risk, NT-proBNP is a biomarker for vascular complications in people who develop diabetes independent of potential confounders. Thus, NT-proBNP might be informative to monitor risk for diabetes-related microvascular and macrovascular complications, which should be further explored in future prospective studies.

Prospective study of factors affecting medication adherence in diabetes mellitus patients

Background: Treatment interruption is an obstacle in therapeutic control of diabetes mellitus. Treatment interruption leads to uncontrolled hyperglycemia which increases the risk of diabetes related complications. Aim of study the factors responsible for the treatment interruptions among the diabetes patients.Methods: Four hundred and ninety-one diabetes patients were studied at Diabetes, obesity and Thyroid center, Gwalior between September 2018 to December 2018. Responses were recorded using a detailed questionnaire consisting of 25 questions. Responses were recorded in terms of Yes or No along with the basic demographic details. Results: Male preponderance was reported (68.4%). Majority were off the diabetes treatment for last 1-5 months (78.8%). Most common response for the treatment interruption was long life medication period (73.7%) followed by the fact that majority were not aware of the consequences of missing the doses (68%), 66.6% due to the side effect of the medication and 57.8% had financial problem.Conclusions: Large number of diabetes patients had poor adherence. There are many modifiable factors which can be improved on individual basis to improve the glycemic outcomes.

Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type 2 Diabetes

The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21-44 years) and mid-age onset (45-64 years) of type 2 diabetes. Using data from a large, integrated health care system, we identified 32,137 adults (aged 21-64 years) with incident diabetes (first HbA1c ≥6.5% [≥48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year. Of identified individuals, 26.4% had younger-onset and 73.6% had mid-age-onset type 2 diabetes. Adults with younger onset had higher initial mean HbA1c values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) (P < 0.0001) and lower odds of achieving an HbA1c <7% (<53 mmol/mol) 1 year after the diagnosis (adjusted odds ratio [aOR] 0.70 [95% CI 0.66-0.74]), even after accounting for HbA1c at diagnosis. Adults with younger onset had lower odds of in-person primary care contact (aOR 0.82 [95% CI 0.76-0.89]) than those with onset during mid-age, but they did not differ in telephone contact (1.05 [0.99-1.10]). Adults with younger onset had higher odds of starting metformin (aOR 1.20 [95% CI 1.12-1.29]) but lower odds of adhering to that medication (0.74 [0.69-0.80]). Adults with onset of type 2 diabetes at a younger age were less likely to achieve glycemic control at 1 year following diagnosis, suggesting the need for tailored care approaches to improve outcomes for this high-risk patient population.

Distinct trajectories in HbA1c are associated with different all-cause mortality and morbidity in newly diagnosed patients with type 2 diabetes

AimsTo identify trajectories of long-term HbA1c levels and examine associations with subsequent risk for morbidity and mortality. MethodsWe conducted a longitudinal follow-up among 27,724 patients, newly diagnosed with type 2 diabetes, in a large healthcare organization. We identified trajectories of long-term HbA1c levels during the first 5 years post diabetes onset to examine associations with subsequent risk for morbidity and all-cause mortality. ResultsWe identified two HbA1c trajectories; the “Steady-plateau HbA1c trajectory” in 93% of patients and a “Sharp-incline HbA1c trajectory” in 7% of patients. When compared to the steady-plateau group, patients in the sharp-incline group were younger, male, from a lower socio-economic background, and higher levels of HbA1c at baseline. Patients in the sharp-incline trajectory had a HR = 1.83 (95%CI: 1.58–2.12) for all-cause mortality, HR = 1.99 (95%CI: 1.74–2.27) for cardiovascular disease, and HR = 1.68 (95%CI: 1.51–1.86) for renal disease, compared to patients in the steady-plateau trajectory. ConclusionsPatients in the sharp-incline trajectory had a higher risk for all-cause mortality, cardiovascular disease, and renal disease, compared to patients in the steady-plateau trajectory. Estimation of HbA1c variability in the first years of diagnosis may be a useful indicator of those patients at high risk for diabetes related complications.

Age at diagnosis of Type 2 diabetes in Germany: a nationwide analysis based on claims data from 69 million people.

For many European countries, including Germany, no valid estimates are available on age at diagnosis of Type 2 diabetes. Thus, we aimed to estimate the age at diagnosis in Germany. Age at diagnosis of Type 2 diabetes in Germany was estimated based on Type 2 diabetes prevalence and incidence and the age distribution of the German population. Age- and sex-specific incidence and prevalence in 2014/2015, based on claims data from statutory health insurance (n= 69 000 000, ~85% of the German population), and the age pyramid for Germany in 2015 were used for the calculation. Age at Type 2 diabetes diagnosis was stratified by sex. CIs were estimated using bootstrap methods. In addition, the age range in which 50% of the population received a diagnosis of Type 2 diabetes was calculated (the interquartile range). The mean ± sd age at Type 2 diabetes diagnosis in 2015 was 61.0 ± 13.4 years (95% CI 60.9-61.0) in men. Women were diagnosed ~2 years later than men (mean age 63.4 ± 14.9 years; 95% CI 63.4-63.5). The age range in which 50% of the population was diagnosed with diabetes was 53-72 years for men and 54-76 years for women. The sex differences are mainly attributable to a higher incidence of Type 2 diabetes in men than women during middle age and the higher absolute number of women in the older ages. The early age at diabetes diagnosis compared to average life expectancy means that the risk of diabetes-related complications is increased.

174-LB: Impact of Quality Improvement (QI) Program on 5-Year Risk of Diabetes-Related Complications

We have successfully implemented the ADA’s Diabetes INSIDE® QI program at a University hospital and safety-net health system (Tulane and Parkland), focused on system-wide improvement in poorly controlled type 2 diabetes (A1c&amp;gt;8.0%). We extrapolated clinical outcomes of the QI program on a 5-year risk of complications, utilizing a validated risk prediction model: Building, Relating, Assessing, Validating of Outcomes (BRAVO) simulation model. We measured the differences between the baseline and post-intervention values of risk factors in 2,429 individuals with A1c &amp;gt;8% at baseline and used the BRAVO model to project the 5-year risk reduction of diabetes-related complications under the assumption that intervention benefits diminished with time. The intervention period was defined as one year and the post-intervention period as the subsequent six months. The QI program was associated with reductions in A1c (-0.84%) and LDL-C (-5.94 mg/dl) among individuals with A1c level &amp;gt;8.0%, with greater reduction in A1c (-1.67%) and LDL-C (-6.81 mg/dl) among those with A1c level &amp;gt; 9.5% at baseline (all p&amp;lt;0.05). The potential outcome of the QI program on 5-year risk of complications are presented in Fig 1. Our outcomes model suggests that the observed risk factor reduction is projected to lead to clinically significant 5-year risk of events - benefiting patients and population health as it relates to future complications burden." Disclosure H. Shao: None. L. Shi: None. R.E. Furman: None. L. Meneghini: Advisory Panel; Self; AstraZeneca, Novo Nordisk Inc., Sanofi-Aventis. Consultant; Self; Sanofi-Aventis. Other Relationship; Self; American Diabetes Association. T.S. Harlan: None. V. Fonseca: Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Abbott, Asahi Kasei Corporation, Novo Nordisk Inc., Sanofi US, Takeda Pharmaceutical Company Limited. Research Support; Self; Bayer US. Stock/Shareholder; Self; Amgen Inc., Bravo4health, Mellitus Health. Funding Lilly USA, LLC; Novo Nordisk; Sanofi

PDB45 EVALUATING THE SHORT-TERM COST-UTILITY OF INSULIN DEGLUDEC VERSUS INSULIN GLARGINE U100 IN BASAL-BOLUS REGIMENS FOR TYPE 2 DIABETES IN CHINA

Insulin degludec (degludec) is an insulin analog with an ultra-long duration of action, low risk of hypoglycaemia and confirmed cardiovascular safety demonstrated in DEVOTE trial (NCT01959529). The study aimed to evaluate the short-term cost-utility of degludec versus insulin glargine 100 units/mL (glargine) for the treatment of type 2 diabetes (T2DM) receiving basal–bolus insulin therapy in China based on data from subgroup results of the DEVOTE trial. A short-term health economic model programmed in Microsoft Excel was conducted to compare costs in patients receiving once daily degludec or glargine over a 2-year time horizon. Clinical inputs and patient characteristics were taken exclusively from DEVOTE trial, whilst China-specific costs (the most current drug provincial biding price in china) were obtained from the literature. Both costs and health effects had not been discounted annually for such a short time horizon. Sensitivity analyses were conducted to assess the robustness of the results. Degludec was associated with a mean improvement of 0.00649 quality-adjusted life-years (QALYs) compared with glargine, with improvements driven predominantly by lower rates of severe hypoglycaemia with degludec versus glargine. degludec was associated with mean cost savings of 289.35 CNY per patient relative to glargine in patients with type 2 diabetes. Cost savings were primarily driven by the reduction in risk of diabetes-related complications with degludec, which offset the higher treatment costs relative to glargine. Insulin relative cost of degludec was 1040.36 CNY (16.98%) more than glargine. However, the costs of Non-fatal myocardial infarction, Non-fatal stroke, severe hypoglycaemia, and self-monitoring of blood glucose were reduced by 764.56 CNY (28.51%), 119.71 CNY (19.47%), 195.06 CNY (21.35%), and 210.13 CNY (36.94%), respectively. Sensitivity analyses demonstrated that the results were stable to variations in biding price. Among T2DM receiving basal–bolus insulin therapy in China, degludec is a cost saving treatment option compared with glargine.

Dealing with complexity in type 2 diabetes

The management of people with type 2 diabetes (or type 2 diabetes mellitus) can be complex and sits largely within the portfolio of primary care. Unfortunately, despite an ever-increasing therapeutic armoury, many people with type 2 diabetes fail to achieve optimal control of their blood glucose and other metabolic indices, putting them at higher risk of diabetes-related complications. The situation has sadly changed little over recent years. People with type 2 diabetes often have other long-term health concerns that need to be recognised and addressed alongside more traditional parameters such as blood glucose and blood pressure. In this article, we will consider the recognition and management of two of the more common conditions that co-exist in people with type 2 diabetes: Diabetes distress and renal disease. Although there is undoubtedly some overlap with type 1 diabetes, the discussion in this article solely relates to the management of type 2 diabetes.

People with type 2 diabetes and screen-detected cognitive impairment use acute health care services more often: observations from the COG-ID study

BackgroundPatients with type 2 diabetes have an increased risk of cognitive impairment which can lead to impaired diabetes self-management and an increased risk of diabetes-related complications. Routine screening for cognitive impairment in elderly patients with type 2 diabetes is therefore increasingly advocated. The aim of this study is to investigate whether people with type 2 diabetes and screen-detected cognitive impairment use acute health care services more often than patients not suspected of cognitive impairment.MethodsPeople with type 2 diabetes ≥ 70 years were screened for cognitive impairment in primary care. Diagnoses in screen positives were established at a memory clinic. Information about acute health care use was collected for 2 years prior to and 2 years after screening and compared to screen negatives.Results154 participants (38% female, mean age 76.7 ± 5.2 years, diabetes duration 8.7 ± 8.2 years) were included, 37 patients with cognitive impairment, 117 screen negatives. A higher percentage of participants with cognitive impairment compared to screen negative patients used acute health care services; this difference was significant for general practitioner’s out of hours services (56% versus 34% used this service over 4 years, p = 0.02). The mean number of acute health care visits was also higher in those with cognitive impairment than in screen negatives (2.2 ± 2.8 versus 1.4 ± 2.2 visits in 4 years, p < 0.05; 1.4 ± 2.2 versus 0.7 ± 1.5 visits in 2 years after screening, p = 0.03). Factors that could have played a role in this increased risk of acute health care services use were a low educational level, the presence of depressive symptoms (CES-D score ≥ 16), self-reported problems in self-care and self-reported problems in usual activities.ConclusionsPeople with type 2 diabetes and screen-detected cognitive impairment use acute health care services more often.

The Association of Depressive Symptoms With Brain Volume Is Stronger Among Diabetic Elderly Carriers of the Haptoglobin 1-1 Genotype Compared to Non-carriers.

Aim: Depression is highly prevalent in type 2 diabetes and is associated with lower adherence to medical treatments, worse glycemic control, and increased risk for diabetes-related complications. The mechanisms underlying depression in type 2 diabetes are unclear. The haptoglobin (Hp) genotype is associated with type 2 diabetes related complications including increased risk for cerebrovascular pathology and worse cognitive performance. Its relationship with depression is unknown. We investigated the role of Hp genotype on the association of depression with brain and white matter hyperintensities (WMH) volumes.Methods: Depressive symptoms (measured with the 15-item Geriatric Depression Scale), brain MRI, and Hp genotypes, were examined in elderly subjects with type 2 diabetes [29 (13.8%) Hp 1–1 carriers and 181 (86.2%) non-carriers]. The interaction of Hp genotype with number of depressive symptoms on regional brain measures was assessed using regression analyses.Results: The significant interactions were such that in Hp 1–1 carriers but not in non-carriers, number of depressive symptoms was associated with overall frontal cortex (p = 0.01) and WMH (p = 0.04) volumes but not with middle temporal gyrus volume (p = 0.43).Conclusions: These results suggest that subjects with type 2 diabetes carrying the Hp 1–1 genotype may have higher susceptibility to depression in the context of white matter damage and frontal lobe atrophy. The mechanisms underlying depression in diabetes may differ by Hp genotype.

Prediabetes and Diabetes Screening in Dental Care Settings: NHANES 2013 to 2016.

Introduction:Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted.Objectives:The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes.Methods:Data from 10,472 adults in the National Health and Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression.Results:A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test (Centers for Disease Control and Prevention), and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old.Conclusion:Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications.Knowledge Transfer Statement:Screening for prediabetes and diabetes during dental visits has the potential to raise patients’ awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being.

AdDIT Editorial comment—challenges in medication treatment of renal and cardiovascular diseases and risk factors in adolescents with type 1 diabetes

A large body of evidence revealed that compared with children and adolescents in the general population, those with type 1 diabetes mellitus (T1DM) are at excessive risk of diabetes related complications (1,2). Presence and long-term diabetes complications are known to increase cardiovascular (CV) morbidity and mortality in population with T1DM in which 26.1% of all deaths are associated with diabetes complications (3).