Risk Of Diabetes-related Mortality Research Articles

The Physical Activity Guidelines and Diabetes-Related Mortality: National Health and Nutrition Examination Survey 1999-2006.

Background: Previous studies have indicated an inverse relationship between aerobic physical activity (PA) and risk of diabetes-related mortality (DRM). However, the contribution of aerobic PA across multiple domains, while also considering the contribution of muscle-strengthening activity (MSA), in reduction of risk for DRM has yet to be examined. Purpose: The aim of this study is to examine the individual and combined associations of aerobic PA and MSA with DRM. Methods: The study sample (n = 13,350) included adult (20-79 years of age) participants from the 1999 to 2006 National Health and Nutrition Examination Survey. PA was categorized into 6 categories based around the 2018 PA guidelines: category 1 (inactive), category 2 (insufficient aerobic PA and no MSA), category 3 [active (aerobic) and no MSA], category 4 (no aerobic PA and sufficient MSA), category 5 (insufficient aerobic PA and sufficient MSA), and category 6 (meeting both recommendations). The dependent variable in this study was DRM, which includes those who had diabetes as the primary cause of death as well as those with diabetes listed as an underlying cause of death. Cox proportional hazards models were used for all analyses. Results: Following adjustment for covariates, significant risk reductions for DRM were found only in category 3 (HR = 0.57; 95% confidence interval: 0.37-0.88). Conclusions: Results suggest that meeting the aerobic PA guidelines significantly reduces the risk for DRM. Those meeting versus not meeting the MSA guidelines seem to have no difference in risk for DRM independent of aerobic PA.

The Physical Activity Guidelines And Diabetes-related Mortality: Nhanes 1999-2006

Previous studies have indicated an inverse relationship between aerobic physical activity (PA) and risk of diabetes-related mortality (DRM). Limitations of these previous studies include lack of a measure of PA duration, lack of a representative sample of the U.S. population, only consideration of leisure-time PA measures (LTPA), and no examination of the potential contribution of muscular strengthening activity (MSA) to risk reduction of DRM. The continuous National Health and Nutrition Examination Survey (NHANES) remedies these limitations as the PA questionnaires include data on a PA across different domains, MSA, and duration of all PA measures. PURPOSE: To examine the relationship between meeting the 2018 PA guidelines, for both total aerobic activity and MSA, and DRM. METHODS: The study sample (n=13,739), included adult (20-79 years of age) participants from the 1999-2006 NHANES. Using the 2018 aerobic and MSA guidelines, PA was categorized into 6 categories: category 1 (no aerobic PA and no MSA), category 2 (insufficient aerobic PA and no MSA), category 3 (meet aerobic PA and no MSA), category 4 (no aerobic PA and meet MSA), category 5 (insufficient aerobic PA and meet MSA), and category 6 (meeting both recommendations). The dependent variable in this study was DRM, which includes those who had diabetes as the primary cause of death as well as those with diabetes listed as an underlying cause of death. Cox-proportional hazard models were used for all analyses, adjusting for age, gender, race-ethnicity, education, self-reported smoking, self-reported physician diagnosed diabetes, HbA1c, and body mass index. Category 1 served as the reference group. RESULTS: Significant risk reductions for DRM were found in PA category 2 (HR = 0.62; 95% CI, 0.45-0.85), category 3 (HR = 0.48; 95% CI, 0.31-0.74) and category 6 (HR = 0.32; 95% CI, 0.15-0.69). CONCLUSIONS: Results suggest that aerobic PA has a significant, pronounced effect on reducing risk for DRM. MSA alone showed no effect on reducing DRM risk. However, meeting both recommendations led to greater risk reduction for DRM.

Prevalence of hypertension among individuals with diabetes and its determinants: evidences from the National Family Health Survey 2015–16, India

Background The incidence of diabetes mellitus (DM) has escalated in recent decades, and the risk of diabetes-related mortality has increased dramatically due to the co-existence of hypertension (HTN). DM and HTN, having similar aetiology and disease mechanisms, are influenced by lifestyle factors and greatly contribute to critical health complications. Aim This study attempted to explore the co-existence of DM–HTN and the potential determinants considering the rapid upsurge of both these diseases. Subjects and methods National Family Health Survey data were used, which included 7092 adult diabetic individuals, to find out the prevalence rate of HTN in diabetic persons in India. Appropriate statistical analyses were performed to accomplish the study objectives. Results Prevalence rate of HTN in diabetic individuals was approximately 37%. Higher body mass index (BMI) was associated with DM–HTN co-existence. In males, increased age, higher BMI, alcohol consumption, poorest wealth index, and non-smoking (tobacco) were the significant determinants of the co-existence of DM-HTN, while in females, they were increased age, higher BMI, and geographical region. Conclusions This study unveiled the significance of healthy lifestyle maintenance and equitable health care services to prevent HTN among diabetics, along with promotion of the awareness and management of DM and HTN through appropriate pharmacological treatments.

Leisure-time aerobic physical activity and the risk of diabetes-related mortality: An analysis of effect modification by race-ethnicity

To examine the relationship between aerobic moderate-to-vigorous intensity leisure-time physical activity (LTPA) and the risk of diabetes-related mortality in the NHANES III (1988-1994) while considering potential effect modification by race-ethnicity. The study sample (n = 14,006) included adults, 20-79 years of age, with Mobile Examination Center (MEC) data. An age-standardized physical activity score (PAS) was calculated from the self-reported frequency and intensity of 12 leisure-time aerobic activities. Three categories of PA were examined: inactive (PAS = 0), insufficiently active (PAS >0-<10), and active (PAS ≥10). Diabetes-related mortality was defined as death from diabetes mellitus. Cox Proportional Hazard models were used all analyses. A statistically significant reduction in risk was found for insufficiently active (HR 0.59, 95% CI 0.40-0.90) and active non-Hispanic black (NHB) (HR 0.54, 95% CI 0.34-0.88). Among active non-Hispanic white (NHW), a similar pattern of risk reduction was found, however, this relationship was borderline significance (HR 0.59, 95% CI 0.35-1.02, p = 0.06). Any volume of aerobic LTPA is beneficial in terms of reducing the risk of diabetes-related mortality. However, these benefits may differ by racial-ethnic group, with further research on health disparities in the area of PA being warranted.

1609-P: Diabetes and Risk of All-Cause and Cancer-Specific Mortality in Breast, Prostate, and Colorectal Cancer Survivors

Aims: To determine whether diabetes is associated with all-cause, cancer-related and cardiovascular disease (CVD) mortality and examine the effect of duration of diabetes on mortality in breast, prostate and colorectal cancer survivors. Methods: National Health Interview Survey (NHIS) was used to select 37,993 adults cancer survivors from 1997 to 2013 linked data retrieved from the National Death Index through December 31, 2015. Cox proportional-hazards models were used to assess associations between diabetes and all-cause and cause-specific mortality. Results: Over a median follow-up period of 13 years, 2,346 all-cause, 698 cancer and 506 CVD deaths occurred. Among all cancer survivors, patients with diabetes had hazard ratios (HR) of 1.36 (95% CI=1.28-1.44) for all-cause mortality, 1.14 for cancer-specific mortality (95% CI=1.03-1.27), 1.36 for CVD mortality (95% CI=1.18-1.55), 17.18 for diabetes related mortality (95% CI=11.51-25.64) and 2.51 for kidney disease mortality (95% CI=1.65-3.82). For specific cancer sites, the HRs for all-cause mortality among survivors with diabetes diagnosed with breast cancer, prostate cancer and colorectal cancer. Diabetes increased the risk of cancer-specific mortality among colorectal cancer survivors compared to nondiabetic survivors. However, there is no the increasing risk in breast or prostate cancer survivors with diabetes. Diabetes was associated with higher risk of diabetes related mortality when compared to nondiabetic breast, prostate and colorectal cancer survivors. Cancer survivors with diabetes had similar risk of all-cause and CVD mortality during the second 5 years of diabetes and above 10 years of diabetes as compared to nondiabetic patients. Conclusions: Diabetes increased the risk of all-cause mortality among breast, prostate, and colorectal cancer survivors. Greater attention on diabetes management is warranted in cancer survivors with diabetes. Disclosure X. Chen: None. J. Xiao: None. Y. Wang: None. F. Shen: None. Funding Natural Science Foundation of Zhejiang Province (LWY20H020001); China Scholarship Council (201908330235); Science and Technology Project of Wenzhou Science and Technology Bureau (Y20190125); First Affiliated Hospital of Wenzhou Medical University (FHY2019015)

Abstract P321: Leisure-Time Aerobic Physical Activity Reduces the Risk of Diabetes-Related Mortality: NHANES III

Background: Evidence exists to suggest physical activity (PA) reduces risk for diabetes-related mortality (DRM). However, these studies were limited to examining specific modes of PA with only walking, running, and sports participation being consistently related to a reduced risk for DRM. Given the spectrum of leisure-time PA is inclusive of many different modes, it is important to examine this relationship using a more robust measure of PA. Purpose: To examine the relationship between leisure-time moderate-to-vigorous intensity physical activity (MVPA) and the risk of DRM in the Third National Health and Nutrition Examination Survey (1988-1994). Methods: The study sample (n=11,017) included adults, 20-79 years of age, with Mobile Examination Center (MEC) data. An age-standardized physical activity score (PAS) was calculated from the self-reported frequency and intensity of 12 leisure-time aerobic activities. PASs were then used to categorize participants into no activity (PAS = 0) versus any MVPA (PAS &gt; 0). DRM was defined as death from diabetes mellitus, either as the primary cause or as a contributing cause in the National Death Index database. Cox Proportional Hazard models were adjusted for age, sex, race-ethnicity, education, smoking, alcohol consumption, healthy eating index, family history of diabetes, body mass index and diabetes status at the time of the MEC. Race-ethnicity specific models (i.e., non-Hispanic white, non-Hispanic black, and Mexican Americans) were also examined. Results: There was a 68% [HR=0.32 (95% CI 0.23-0.47)] reduction in the risk of DRM, adjusted for age. Following further adjustment for age, race-ethnicity, gender, education, family history of diabetes, body mass index, glycemic status, healthy eating index, smoking status, and alcohol consumption risk estimates were attenuated, but remained statistically significant [HR 0.63 (95% CI 0.43-0.93)]. No interaction between race-ethnicity and MVPA was found. Conclusions: The results of this large, nationally representative prospective study suggest that the accumulation of any volume of MVPA, across a plethora of activities, reduces the risk of DRM.

Socioeconomic Status and Risk of Diabetes-Related Mortality in the U.S.

We examined disparities in diabetes-related mortality for socioeconomic status (SES) groups in nationally representative U.S. samples. We analyzed National Health Interview Survey respondents linked to their death records and included those eligible for mortality follow-up who were aged 25 years and older at the time of interview and not missing information on covariates (n=527,426). We measured SES by education and family income. There were 5,613 diabetes-related deaths. Having less than a high school education was associated with a twofold higher mortality from diabetes, after controlling for age, gender, race/ethnicity, marital status, and body mass index, compared with adults with a college degree or higher education level (relative hazard [RH] = 2.05, 95% confidence interval [CI] 1.78, 2.35). Having a family income below poverty level was associated with a twofold higher mortality after adjustments compared with adults with the highest family incomes (RH=2.41, 95% CI 2.05, 2.84). Approximately one-quarter of the excess risk among those in the lowest SES categories was explained by adjusting for potential confounders. Findings from this nationally representative cohort demonstrate a socioeconomic gradient in diabetes-related mortality, with both education and income being important determinants of the risk of death.

Contribution of diabetes duration before puberty to development of microvascular complications in IDDM subjects.

The contribution of diabetes duration, both pre- and postpuberty, to the development of microvascular complications and mortality in diabetic subjects was investigated in three study populations from the Children's Hospital of Pittsburgh Insulin-Dependent Diabetes Mellitus (IDDM) Registry. Life-table analyses by total and postpubertal IDDM duration were used to evaluate differences in the prevalence of microvascular complications and diabetes-related mortality in subjects diagnosed before and during puberty, as defined by an age at IDDM onset marker of 11 yr for girls and 12 yr for boys. The prevalence of retinopathy and overt nephropathy in 552 White adult diabetic subjects (population 1, mean IDDM duration 20.8 yr was significantly greater in subjects diagnosed during puberty compared with those diagnosed before puberty. However, similar analyses by postpubertal duration showed no difference in microvascular complication prevalence between the two groups. These findings did not appear to be due to a confounding effect of age. Additional analyses of 239 adolescent diabetic subjects (population 2, mean duration 8.3 yr) revealed the same trend for the prevalence of retinopathy. Finally, results concerning the risk of diabetes-related mortality in a cohort of 1582 subjects (population 3, mean duration 12.9 yr) indicated that postpubertal duration of IDDM may be a more accurate determinant of the development of microvascular complications and diabetes-related mortality than total duration, and it is suggested that the contribution of the prepubertal years of diabetes to long-term prognosis may be minimal.