Risk Of Macrovascular Complications Research Articles

Lipids and apolipoproteins and the risk of vascular disease and mortality outcomes in women and men with type 2 diabetes in the ADVANCE study.

Whether apolipoproteins (apolipoprotein A1, apolipoprotein B, apolipoprotein B/apolipoprotein A1 [ApoB/ApoA1] ratio) or very-low-density lipoprotein (VLDL) cholesterol are better risk predictors than established lipid risk markers, and whether there are sex differences, is uncertain, both in general populations and in patients with diabetes. The aim of this study was to assess the association between established risk markers, apolipoproteins and the risk of macro- and microvascular disease and death in a large study of women and men with diabetes and to assess the potential sex differences in the associations. Established lipid risk markers were studied in 11 140 individuals with type 2 diabetes from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial, and apolipoproteins (A1, B, ApoB/ApoA1 ratio) and VLDL cholesterol from nuclear magnetic resonance (NMR) lipid analyses in biobanked samples from 3586 individuals included in the ADVANCE case-cohort study (ADVANCE CC). Primary outcomes were major macro- and microvascular events and death. Cox proportional hazards models adjusted for confounders were used to quantify the associations (hazard ratio [HR] and 95% confidence intervals [CIs]) between established lipid risk markers and apolipoproteins with study outcomes. To address potential effect modification by sex, we investigated the association between the lipid risk markers and outcomes in subgroup analyses by sex. There was a lower risk of macrovascular complications for high-density lipoprotein (HDL) cholesterol (HR [95%CI] 0.88 [0.82-0.95]), a higher risk for total cholesterol (1.10 [1.04-1.17]), low-density lipoprotein (LDL) cholesterol (1.15 [1.08-1.22]), non-HDL cholesterol (1.13 [1.07-1.20]) and the total cholesterol/HDL ratio (1.20 [1.14-1.27]) but no significant associations with triglycerides from ADVANCE. There was a higher risk of macrovascular complications for the ApoB/ApoA1 ratio (1.13 [1.03-1.24]) from the ADVANCE CC. Only the ApoB/ApoA1 ratio (1.19 [1.06-1.34]), but none of the established lipid risk markers, was associated with a higher risk of microvascular complications. There were no statistically significant sex differences for any of the established lipid risk markers or apolipoproteins with any outcome. Using C-statistics and net reclassification improvement (NRI) did not detect significant improvement in predicting all outcomes by adding lipids or apolipoproteins to the models with confounding factors only. All established lipid risk markers, except triglycerides, were predictors of macrovascular complications, but not microvascular complications, in patients with type 2 diabetes. The ApoB/ApoA1 ratio was associated with major macro- and microvascular complications, but there was no evidence that apolipoproteins are better than established lipid risk markers in predicting cardiovascular complications in patients with type 2 diabetes.

Relapse and side effects of steroid therapy beyond 3 years in autoimmune pancreatitis: A multicenter retrospective study

BackgroundThe impact of extended steroid administration on patients with autoimmune pancreatitis after a 3-year maintenance period remains poorly understood. This study analyzed the advantage and disadvantage of continuing steroid therapy beyond 3 years. MethodsIn this retrospective multicenter study across 17 institutions, patients who successfully completed 3 years of maintenance therapy without experiencing relapse were categorized into two groups: the maintenance therapy discontinuation group, who discontinued steroid therapy after the initial 3-year period, and maintenance therapy continuation group, who continued steroid therapy beyond 3 years. The cumulative relapse rate after 3 years of maintenance therapy was the primary outcome. Relapse predictors were compared using the Gray test for cumulative relapse incidence by specific factor. ResultsOf 211 patients, 105 experienced no relapse during the 3-year maintenance therapy and were divided into two groups: 69 in the maintenance therapy discontinuation group and 36 in the maintenance therapy continuation group. The relapse rate was lower in the maintenance therapy continuation group than in the maintenance therapy discontinuation group (P = 0.035). Predictors of relapse after 3 years included cessation of maintenance therapy (hazard ratio [HR] = 3.76; 95 % confidence interval [CI] = 1.07–13.3, P = 0.040) and renal involvement (HR = 2.88; 95 % CI = 1.04–7.99, P = 0.042). The maintenance therapy continuation group showed a significantly higher prevalence of macrovascular complications, compared with the maintenance therapy discontinuation group (P = 0.005). ConclusionsCessation of steroid maintenance therapy and renal involvement were predictors of relapse after 3 years of maintenance therapy. However, the long-term use of steroids may increase the risk of macrovascular complications.

Predictors of macrovascular complications in Al-Madinah Al-Munawara type 2 diabetes mellitus patients, Saudi Arabia: A cross-sectional study

Background/aim Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia, which causes macrovascular complications that account for most of the morbidity, hospitalizations, and deaths. The goal of this study is to evaluate the relationship between macrovascular complications and associated risk factors in Al-Madinah Al-Munawara patients suffering from type 2 diabetes mellitus. Patients and methods This descriptive cross-sectional study involved 275 type 2 diabetes mellitus patients who resided in Al-Madinah Al-Munawara and visited the diabetic clinic at King Fahd Hospital on a regular basis. Participants in the study ranged in age from 20 to 65. Hemoglobin, glycated hemoglobin, serum calcium, fasting blood glucose, and lipid profile were analyzed. Results Out of 275 patients with type 2 diabetes mellitus, 113 have had macrovascular complications. A significant association (P<0.05) has been observed between the age of the patients and different forms of macrovascular complications, which impact 62.7% of the elderly (41–65 years old). The prevalence of macrovascular complications was higher among females. Glycated hemoglobin levels positively correlated with the number of hospitalizations, high blood pressure, hemoglobin, and serum cholesterol levels. Macrovascular complications are positively correlated with age, sex, hypertension, and therapy type (P<0.05), while physical activity has a negative significant effect on the appearance of macrovascular complications by multiple regression analysis. Conclusion In this study, diabetic macrovascular complications were prevalent. The age, sex of participants, and type of treatment were independent predictors of macrovascular complications. Hypertension has a significant positive effect on the appearance of macrovascular complications. Physically inactive patients have a higher risk of macrovascular complications.

Impact of glycated hemoglobin A1c on cardiovascular risk in diabetes patients with and without coronary artery disease

Abstract Background Guidelines recommend a haemoglobin A1c (HbA1c) target <53 mmol/mol (7%) to achieve microvascular risk reduction. However, the impact of HbA1c target levels on macrovascular complications is less certain. Moreover, we have previously shown that the risk of macrovascular complications is dependent on presence of coronary artery disease (CAD). Purpose We tested the hypothesis that HbA1c ≥53 mmol/mol is associated with cardiovascular risk in diabetes patients with and without CAD. Methods We conducted a contemporary cohort study including diabetes patients examined by coronary angiography in Western Denmark from 2011-2021. The association between HbA1c and major adverse cardiovascular events (MACE, a composite outcome of myocardial infarction, ischemic stroke, and cardiovascular death) was modeled using restricted cubic splines. Patients were followed for up to 10 years. We estimated adjusted hazards ratios (aHR) using HbA1c of 52 mmol/mol as reference. We also performed stratified analyses by presence of CAD. Results We included 15,825 patients with diabetes, of whom 12,200 (77%) had CAD. Median HbA1c was 52 mmol/mol in patients with CAD and 51 mmol/mol in patients without CAD. Using restricted cubic splines, we observed significantly increased MACE rates with HbA1c ≥53 mmol in the entire cohort (Figure 1A). MACE rates plateaued with increasing HbA1c above 65 mmol/mol. When stratifying by presence of CAD, this association between HbA1c and MACE was sustained in patients with CAD (Figure 1B). In contrast, we did not observe any relation between HbA1c and MACE rates in patients without CAD (Figure 1C). Conclusions The current study suggest two novel findings. Firstly, a HbA1c <53 mmol/mol target is associated with a reduced risk of macrovascular complications in patients with diabetes. Thus, the impact of glucose control on macrovascular complications corresponds to the HbA1c levels recommended for avoidance of microvascular complications. Secondly, the association between HbA1c and MACE is restricted to diabetes patients with CAD while not observed in those without CAD.Figure 1,A-C

The impact of glycated hemoglobin A1c on cardiovascular risk in patients with and without coronary artery disease

Abstract Background Diabetes is defined according to the level of glycated hemoglobin (HbA1c) based on the risk of microvascular complications. However, HbA1c has been associated with increased risk of macrovascular complications at lower HbA1c levels than the conventional cut-off for "microvascular" diabetes. In patients without known diabetes, it is unsettled when HbA1c becomes a marker of macrovascular complications in non-diabetes patients with and without coronary artery disease (CAD). Purpose We tested the hypothesis that the HbA1c cut-off for macrovascular complications differ for patients with versus without CAD. Methods We included every patient undergoing coronary angiography in Western Denmark from 2011-2021 without known diabetes prior to examination. Follow-up was censored if it exceeded 10 years. We examined the risk of atherosclerotic cardiovascular disease (ASCVD, a composite of myocardial infarction and ischemic stroke) and HbA1c using Cox regression. We modeled the relation between ASCVD and HbA1c using restricted cubic splines with 38 mmol/mol as reference. In a separate analysis, we stratified patients by HbA1c levels (<30 mmol/mol, 31-38 mmol/mol (reference), 39-47 mmol/mol, and ≥48 mmol/mol) and CAD. Results We included 56,927 patients without known diabetes at the time of angiography, of whom 1,225 (2.2%) had undiagnosed, untreated diabetes, i.e. HbA1c ≥48 mmol/mol. Mean HbA1c was 38 mmol/mol. In patients without CAD we did not observe any association between HbA1c and ASCVD (Figure 1). In contrast, we observed a U-shaped relationship between HbA1c and ASCVD in patients with CAD. The lowest risk of ASCVD was observed at HbA1c 35 mmol/mol, which was followed by a steady incline with higher HbA1c levels. When categorizing HbA1c, the adjusted ASCVD risk was significantly increased in patients with CAD and HbA1c 39-47 mmol/mol (aHR 1.09, 95% CI 1.01-1.19), with HbA1c ≥48 mmol/mol (aHR 1.60, 95% CI 1.32-1.94) having the highest ASCVD risk (Figure 2). Conclusions The current study provides two novel findings. Firstly, HbA1c provides no prognostic information concerning risk of ASCVD when CAD is absent. Secondly, a U-shaped relationship between HbA1c and ASCVD was found in patients where CAD is present. The lowest risk of ASCVD was observed at HbA1c 35 mmol/mol and the risk steadily increased with higher (and lower) HbA1c levels. Thus, the risk of ASCVD associated with HbA1c starts much earlier than the conventional 48 mmol/mol HbA1c cut-off for diabetes, but the relationship exists only when CAD is present.Figure 1Figure 2

Association Between Atrial Fibrillation and Diabetes-Related Complications: A Nationwide Cohort Study.

This study aimed to investigate the associations between concurrent atrial fibrillation and diabetes-related complications among patients with diabetes. This nationwide observational cohort study used the health checkup database from the Korean National Health Insurance Service. Patients diagnosed with diabetes who underwent health checkups between 2009 and 2012 were investigated. The patients with atrial fibrillation were matched in a 1:5 ratio with those without atrial fibrillation using propensity scores. Study outcomes included macrovascular, microvascular (diabetic retinopathy and diabetic nephropathy), and diabetic foot complications. The risks of clinical outcomes were measured using hazard ratios (HRs) with 95% CIs. A total of 65,760 patients with diabetes were analyzed (54,800 without atrial fibrillation and 10,960 with atrial fibrillation). After well-balanced propensity score matching, atrial fibrillation was associated with significantly higher risks of macrovascular complications (HR 1.12, 95% CI 1.09-1.16), diabetic nephropathy (HR 1.23, 95% CI 1.16-1.30), and diabetic foot complications (HR 1.13, 95% CI 1.09-1.17) compared with no atrial fibrillation, while the risk of diabetic retinopathy was comparable (HR 0.99, 95% CI 0.96-1.03). Patients with atrial fibrillation had a significantly higher risk of diabetic foot amputation (HR 4.12, 95% CI 1.98-8.56). Among patients with diabetes, concurrent atrial fibrillation was associated with increased risks for diabetes-related macrovascular complications, diabetic nephropathy, and diabetic foot. Such patients require holistic management to reduce the risk of adverse outcomes.

Cardiovascular and microvascular outcomes according to vitamin D level and genetic variants among individuals with prediabetes: a prospective study

BackgroundWhether serum vitamin D mediate vascular diseases in prediabetic populations remains unclear. This study aimed to determine the associations between circulating 25-hydroxyvitamin D [25(OH)D] levels and vitamin D receptor (VDR) polymorphisms with the risk of macrovascular complications, including myocardial infarction and stroke, and microvascular complications such as diabetic nephropathy and retinopathy, among adults with prediabetes.MethodsParticipants with prediabetes in UK Biobank were included (N = 56,387). Multivariable dose–response and Cox proportion models were used to explore the relationship of serum 25(OH)D status and the risks of vascular complications. The interaction of VDR polymorphisms with serum 25(OH)D level on risks of vascular events was also assessed.ResultsDuring a median follow-up of 12 years, higher levels of 25(OH)D were significantly and nonlinearly associated with a lower risk of macrovascular diseases among prediabetic individuals. The adjusted hazard ratios (95% confidential interval) of serum 25(OH)D levels of ≥ 75.0 nmol/L versus < 25 nmol/L were 0.75 (0.63–0.88) for myocardial infarction, 0.74 (0.55–1.00) for stroke, 1.02 (0.60–1.74) for diabetic nephropathy, and 1.30 (0.92–1.84) for diabetic retinopathy, respectively. The rs2228570 (FokI) polymorphisms significantly interacted with 25(OH)D on incident myocardial infarction (P-interaction = 0.042) and stroke (P-interaction = 0.033). The individuals with serum 25(OH)D level of 50.0–74.9 nmol/L and rs2228570 (FokI) homozygotes had the lowest risks of vascular complications.ConclusionsLower serum 25(OH)D levels are significantly and nonlinearly associated with an increased risk of cardiocerebrovascular diseases in prediabetic individuals, with VDR polymorphisms of rs2228570 (FokI) modify such associations. Monitoring a safe 25(OH)D concentration is suggested to prevent the vascular complications for prediabetes.

Glycemia control using remote technologies

Diabetes mellitus is a chronic metabolic disease with a rapidly increasing prevalence. Glycemic control in diabetes mellitus remains the key to improving the effectiveness of therapy, reducing the risk of hypoglycemia, preventing microvascular complications, and reducing the long-term risk of macrovascular complications. However, regular glycemic control is only a part of this process, since an equally important step is the timely and correct interpretation of the data obtained, as well as the decision on further therapeutic tactics. Technological advances are providing tools to help diabetic patients reach their glycemic targets and facilitate ongoing monitoring of blood glucose levels. Currently, there is the possibility of remote monitoring of glycemia, transmission of data to medical professionals and caregivers: blood glucose meters with wireless glucose reporting, continuous glucose monitors, flash glucose monitors, and non-invasive glucose monitoring systems. Large scientific studies have proven the effectiveness and prospects of telemedicine technologies in the treatment of diabetes. Today, the digitalization of healthcare is actively developing from telemedicine and remote interaction with patients to new digital approaches to diagnostics and information exchange. Thus, in the Russian Federation, within the framework of the digital transformation strategy of the Healthcare industry until 2024 and for the planned period until 2030, the Personal Medical Assistants project is being implemented, aimed at creating technologies for dynamic remote monitoring of patients using platforms of centralized diagnostic services based on a unified state information system in the field of healthcare.

Antidiabetic and antioxidant effect of magnetic and noble metal nanoparticles of Clitoria ternatea

Diabetes is a chronic metabolic endocrine disorder associated with diabetic complications that result in microvascular and macrovascular complications due to oxidative stress, neurodegeneration, and peripheral cell damage. Oxidative stress is characterized by the development of reactive oxygen species (ROS) which progresses by hampering antioxidant enzyme activities. Phytomolecules from different plant sources like leaves, flowers, fruits, etc are reported to possess super-antioxidant properties. Hence these phytomolecules can be good leads in the treatment and management of diabetes. Metal nanoparticles have evolved to increase the potency, efficacy, and safety of different drug delivery systems owing to their superior physicochemical properties. This research work is designed for the synthesis of magnetic and noble metal nanoparticles by green synthesis of fresh flower aqueous extract of Clitoria ternatea. A mechanistic evaluation of the magnetic (cobalt oxide) and noble metal (gold) nanoparticles has been designed by in-vitro and in-vivo models of a streptozotocin-induced diabetes model. The cobalt oxide and gold nanoparticles showed a significant (p < 0.05) decrease in the diabetic enzyme levels (α-amylase, α-glucosidase, and xanthine oxidase). In vitro and in vivo studies of the antioxidant activity of both nanoparticles also revealed the increased potential of antioxidant activity. In-vivo studies of both nanoparticles exhibited anti-diabetic properties by significantly enhancing the level of insulin. The cholesterol profiling of both nanoparticles proved the reduction of levels of serum cholesterol, triglycerides, HDL, VLDL, LDL, and creatinine content signifying the decreasing risk of macrovascular complications associated with diabetes. However, gold nanoparticles produced a more protective effect as compared to cobalt oxide nanoparticles. The study concludes that the magnetic and gold nanoparticles conjugated with Clitoria ternatea exhibited potential anti-diabetic and antioxidant activities in a streptozotocin-induced diabetic rat model.

Impact of individual microvascular disease on the risks of macrovascular complications in type 2 diabetes: a nationwide population-based cohort study

BackgroundThis study compared the risks of cardiovascular morbidity and mortality between patients with type 2 diabetes (T2D) with and without microvascular diseases, and between matched patients with microvascular diseases.MethodsWe identified newly diagnosed type 2 diabetes patients from National Health Insurance Research Database in Taiwan from January 1, 2008, to December 31, 2019. Propensity score matching was applied to construct matched pairs of patients with diabetic kidney disease, retinopathy, or neuropathy. Multivariable Cox proportional-hazard models were adopted to compare the risks of cardiovascular morbidity and mortality.ResultsPatients with microvascular disease had a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. Among the matched cohorts, patients with diabetic retinopathy had a significantly higher risk of stroke development than those with diabetic kidney disease (aHR 1.11, 95%CI 1.03–1.2). Diabetic neuropathy showed a significantly higher risk of stroke development than diabetic kidney disease (aHR 1.17, 95%CI 1.1–1.25) and diabetic retinopathy (aHR 1.12, 95%CI 1.03–1.21). Diabetic retinopathy had a significantly higher risk of incident heart failure than diabetic kidney disease (aHR 1.43, 95%CI 1.3–1.57), and diabetic neuropathy had a significantly lower risk of incident heart failure than diabetic retinopathy (aHR 0.79, 95%CI 0.71–0.87).ConclusionsT2D patients with microvascular disease have a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. In the matched cohorts, diabetic neuropathy was significantly associated with stroke development, and diabetic retinopathy had a significant association with heart failure compared to other microvascular diseases.

Evaluation and Identification of Macrovascular Complications in Patients with COVID-19 – Original Study

Background: Coronavirus disease 2019 (COVID-19) is a pandemic that has affected many patients worldwide. Infection with this virus appears to be associated with a high risk of macrovascular complications. Methods: In this descriptive study, we examined the clinical and demographic information of 67 patients in whom COVID-19 was confirmed in terms of vascular complications. Results: The results of this study showed that 65.6% of COVID-19 patients had venous complications and 34.4% had arterial complications. In the patients who had more severe symptoms caused by COVID-19 such as fever, cough, sore throat, nausea and vomiting, diarrhea, anorexia, shortness of breath, joint pain, and fatigue, they had more severe venous complications. Conclusions: Better and more accurate understanding of the pathophysiological mechanisms causing severe disease of COVID-19, as well as identifying the prevalence of macrovascular complications and possible disorders resulting from them in patients with COVID-19 in different ethnicities and populations to develop new treatment, is needed.

Machine Learning for Predicting Micro- and Macrovascular Complications in Individuals With Prediabetes or Diabetes: Retrospective Cohort Study.

Micro- and macrovascular complications are a major burden for individuals with diabetes and can already arise in a prediabetic state. To allocate effective treatments and to possibly prevent these complications, identification of those at risk is essential. This study aimed to build machine learning (ML) models that predict the risk of developing a micro- or macrovascular complication in individuals with prediabetes or diabetes. In this study, we used electronic health records from Israel that contain information about demographics, biomarkers, medications, and disease codes; span from 2003 to 2013; and were queried to identify individuals with prediabetes or diabetes in 2008. Subsequently, we aimed to predict which of these individuals developed a micro- or macrovascular complication within the next 5 years. We included 3 microvascular complications: retinopathy, nephropathy, and neuropathy. In addition, we considered 3 macrovascular complications: peripheral vascular disease (PVD), cerebrovascular disease (CeVD), and cardiovascular disease (CVD). Complications were identified via disease codes, and, for nephropathy, the estimated glomerular filtration rate and albuminuria were considered additionally. Inclusion criteria were complete information on age and sex and on disease codes (or measurements of estimated glomerular filtration rate and albuminuria for nephropathy) until 2013 to account for patient dropout. Exclusion criteria for predicting a complication were diagnosis of this specific complication before or in 2008. In total, 105 predictors from demographics, biomarkers, medications, and disease codes were used to build the ML models. We compared 2 ML models: logistic regression and gradient-boosted decision trees (GBDTs). To explain the predictions of the GBDTs, we calculated Shapley additive explanations values. Overall, 13,904 and 4259 individuals with prediabetes and diabetes, respectively, were identified in our underlying data set. For individuals with prediabetes, the areas under the receiver operating characteristic curve for logistic regression and GBDTs were, respectively, 0.657 and 0.681 (retinopathy), 0.807 and 0.815 (nephropathy), 0.727 and 0.706 (neuropathy), 0.730 and 0.727 (PVD), 0.687 and 0.693 (CeVD), and 0.707 and 0.705 (CVD); for individuals with diabetes, the areas under the receiver operating characteristic curve were, respectively, 0.673 and 0.726 (retinopathy), 0.763 and 0.775 (nephropathy), 0.745 and 0.771 (neuropathy), 0.698 and 0.715 (PVD), 0.651 and 0.646 (CeVD), and 0.686 and 0.680 (CVD). Overall, the prediction performance is comparable for logistic regression and GBDTs. The Shapley additive explanations values showed that increased levels of blood glucose, glycated hemoglobin, and serum creatinine are risk factors for microvascular complications. Age and hypertension were associated with an elevated risk for macrovascular complications. Our ML models allow for an identification of individuals with prediabetes or diabetes who are at increased risk of developing micro- or macrovascular complications. The prediction performance varied across complications and target populations but was in an acceptable range for most prediction tasks.

Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea: A nationwide retrospective cohort

ObjectiveThe main aim of this study is to investigate whether acupuncture could be an effective complementary treatment for reducing the risk of macrovascular complications in diabetic patients currently taking antidiabetic medications using a nationwide population-based database. MethodsWe conducted a retrospective cohort study to assess the efficacy of acupuncture on cardiovascular complications in diabetic patients using data from patients between 40 and 79 years of age, newly diagnosed with diabetes between 2003 and 2006, found in the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea. From the data, we identified 21,232 diabetic patients who were taking antidiabetic medication between 2003 and 2006. The selected patients were divided into two groups—those who received acupuncture at least three times and those who received no acupuncture (non-acupuncture) in the year following their diagnosis of diabetes. After 1:1 propensity score matching (PSM), each group had 3350 patients, and the observation ceased at the occurrence of a major adverse cardiovascular event (MACE), which was defined as either myocardial infarction, stroke, or death due to cardiovascular cause. ResultsAfter PSM, the acupuncture group had a lower incidence of MACE (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.81–0.94; P = 0.0003) and all-cause mortality (HR: 0.77; 95% CI: 0.70–0.84; P < 0.0001) than the non-acupuncture group; the HRs for stroke-related mortality (HR: 0.75; 95% CI: 0.56–1.00; P = 0.0485), ischemic heart disease mortality (HR: 0.53; 95% CI: 0.34–0.84; P = 0.006) and circulatory system disease mortality (HR: 0.67; 95% CI: 0.55–0.82; P < 0.0001) were lower in the acupuncture group than in the non-acupuncture group in the secondary analysis. ConclusionOur results indicate that diabetic patients receiving acupuncture treatment might have a lower risk of MACE, all-cause mortality and cardiovascular mortality. This population-based retrospective study suggests beneficial effects of acupuncture in preventing macrovascular complications associated with diabetes. These findings call for further prospective cohort or experimental studies on acupuncture treatment for cardiovascular complications of diabetes.Please cite this article as: Jung H, Won T, Kim GY, Jang J, Yeo S, Lim S. Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea: A nationwide retrospective cohort. J Integr Med. 2023; 21(2): 176–183.

Combined evaluation of arterial stiffness, glycemic control and hypertension for macrovascular complications in type 2 diabetes

BackgroundArterial stiffness, glycemic control and blood pressure are risk factors of macrovascular complications in type 2 diabetes. This study aimed to investigate the combined association of arterial stiffness, glycemic control and hypertension status with the occurrence of diabetic macrovascular complication.MethodsA total of 1870 patients of diabetes were enrolled from Beijing Health Management Cohort between 2008 and 2018 as baseline, and then followed for macrovascular complication onset. We proposed a composite risk score (0–4) by arterial stiffness severity, pool glycemic control and hypertension status. Cox model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).ResultsThe mean age (SD) of this population was 59.90 (12.29) years. During a median follow-up of 4.0 years, 359 (19.2%) patients developed macrovascular complication. Compared to the normal arterial stiffness and good glycemic control group, patients with severe arterial stiffness and pool glycemic control had the highest risk of macrovascular complications (HR: 2.73; 95% CI: 1.42–5.25). Similarly, those of severe arterial stiffness and hypertension had the highest risk (HR: 2.69; 95% CI: 1.61–4.50). Patients of the composite score > 2 had a significantly increased risk of macrovascular complication.ConclusionThis study suggested the clinical importance of combined evaluation of arterial stiffness, glycemic control and hypertension status for the risk stratification and management of macrovascular complication of type 2 diabetes.

Association Between the Variability of Glycated Hemoglobin and Retinopathy in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis.

Visit-to-visit variability of glycated hemoglobin (HbA1c) is a marker of long-term glycemic fluctuation, which has been related to increased risk of macrovascular complications in patients with type 2 diabetes mellitus (T2DM). The association between HbA1c variability and retinopathy in patients with T2DM, however, has been inconsistent in previous studies. In order to fully evaluate the above association, we conducted a meta-analysis. Observational studies related to the aim of the meta-analysis were identified by search of PubMed, Web of Science, and Embase databases. Studies with HbA1c variability evaluated as the standard deviation (SD) and/or the coefficients of variation (CV) of HbA1c were included. The results were analyzed using a random-effects model that incorporated potential heterogeneity between studies. Twelve observational studies involving 44 662 T2DM patients contributed to the meta-analysis. Overall, 5150 (11.5%) patients developed retinopathy. Pooled results showed that compared to patients with lower HbA1c variability, T2DM patients with higher HbA1c-SD (relative risk [RR]: 1.48, 95% confidence interval [CI]: 1.24 to 1.78, p<0.001, I2=34%) and higher HbA1c-CV (RR: 1.29, 95% CI: 1.05 to 1.59, p=0.02, I2=0%) were both associated with higher risk of DR. For studies with HbA1c-SD, the association was not significantly affected by study characteristics such as country, study design, mean age, disease duration, adjustment of mean HbA1c, or quality scores (p for subgroup difference all>0.05). In conclusion, higher HbA1c variability may be associated with an increased risk of retinopathy in patients with T2DM.

Retinal Artery Occlusion as an Early Indicator of Macrovascular Complications in Diabetes

BackgroundA characteristic of the retinal circulation is that arterial occlusion is embolic or secondary to vasculitis but rarely or never due to in situ atherosclerosis. Therefore, retinal artery occlusion suggests the presence of cardiac or large-vessel disease outside the eye. This cohort study examined the general risk of macrovascular disease in individuals with diabetes, with or without retinal artery occlusion. MethodsWe retrieved data on 992 subjects with incident retinal artery occlusion and preexisting diabetes, registered in Denmark between January 1, 2000, and December 31, 2018. Each retinal artery occlusion subject was matched for age, sex, and diabetes duration, with 5 control subjects with diabetes but without retinal artery occlusion. We performed survival analyses to compare the risk of extraocular macrovascular disease between the 2 groups in a 5-year follow-up. ResultsAfter 1 year, the incidence of macrovascular disease in subjects with retinal artery occlusion was approximately 21 per 100 person-years (95% confidence interval [CI]: 18.11-24.29), compared to 6.25 per 100 patient-years (95% CI: 5.57-7.00) in those without retinal artery occlusion. After 5 years, the cumulative incidences of macrovascular disease were 51.2% (95% CI: 47.9-54.7%) and 29.4% (95% CI: 28.0-30.8%) in patients with diabetes with or without retinal artery occlusion, respectively. Hazard rate ratios were 3.36 (95% CI: 2.79-4.05) after 1 year and 2.27 (95% CI: 2.04-2.53) after 5 years. ConclusionAmong individuals with diabetes, those diagnosed with retinal artery occlusion had a higher general risk of macrovascular complications for at least 5 years after the occlusion event compared with those without retinal artery occlusion.

Impact of prior gestational diabetes on long-term type 2 diabetes complications

AimsWhile women with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes mellitus (T2DM) and at a younger age, it is unknown whether T2DM following GDM is associated with worse clinical outcomes. This study aims to examine the impact of GDM on subsequent development of long-term complications of T2DM. MethodsAll women with T2DM from the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey of US population, between 2007 and 2018 (n = 2494) were stratified into two groups: those with a history of GDM (n = 385) and those without (n = 2109). Rates of macrovascular and microvascular complications of T2DM were compared between the two groups using bivariate and multivariate analyses. ResultsOf 2494 participants with T2DM included in the analysis, 385 (15.4 %) had a history of GDM and 2109 (84.6 %) did not. A history of GDM was independently associated with increased risk of myocardial infarction (aOR 2.53, 95%Cl: 1.18–5.40) and likely coronary artery disease (aOR 2.15, 95 % Cl: 1.00–4.66). ConclusionsIn this cohort, women with T2DM and a history of GDM had higher risk of macrovascular complications of myocardial infarction and coronary artery disease, compared to those with no history of gestational diabetes.

EE287 Economic Model for Trivalent to Quadrivalent Influenza Vaccination Switch for Type 2 Diabetes Mellitus 40-64 Years Old Patients in Colombia

Influenza vaccination has been associated with a decreased risk of macrovascular complications in patients with type 2 diabetes mellitus (T2D). We determined potential savings of reducing these complications, with the synergistic effect of switching from a trivalent to a quadrivalent standard dose influenza vaccine (TIV to QIV-SD) and increasing vaccination coverage rates (VCR) in Colombia from the healthcare system perspective.

MO897: Diabetic Retinopathy and Risk of Macrovascular Complications in Patients Undergoing Hemodialysis: A National Population-Based Cohort Study

Abstract BACKGROUND AND AIMS The association of diabetic retinopathy (DR) with macrovascular complications in patients with end-stage kidney disease undergoing hemodialysis is unclear. METHOD We conducted a nationwide cohort study of 44 514 incident hemodialysis patients who were enrolled in Taiwan's national health insurance research database between 1 January 2010 and 31 December 2014 and had follow-up data until 31 December 2015. Patients with and without DR were matched by propensity score in a 1:1 ratio. The primary outcomes were acute coronary syndrome (ACS), acute ischemic stroke and hospitalizations for peripheral artery disease (PAD). RESULTS Of the 27 286 patients with type 2 diabetes, 10 537 (38.1%) had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) by propensity score to 9164 patients with DR (mean age, 63.5 years; 43.8% women). Over a median follow-up of 2.8 years, 2781 patients (15.2%) experienced ACS. Stroke occurred in 1613 patients (8.8%), and 1938 patients (10.6%) were hospitalized for PAD. In a multivariable Cox model accounting for the competing risk of death, the presence of DR was associated with an increased risk of stroke {subdistribution hazard ratio (sHR) 1.30 [95% confidence interval (95% CI) 1.17–1.44]; P &amp;lt; 0.0001} and PAD (sHR 1.17, 95% CI 1.08–1.29; P = 0.0006) but not ACS (sHR 0.99, 95% CI 0.91–1.07; P = 0.9168). The observations were consistent across patient subgroups. CONCLUSION Our findings support early identification and close monitoring and management of hemodialysis patients with DR to prevent the development of stroke and PAD.

Self-monitoring of blood glucose in patients with type 2 diabetes mellitus from the standpoint of evidence-based medicine

According to clinical guidelines self-monitoring of blood glucose is a part of the treatment of type 2 diabetes mellitus. However, self-monitoring of glycemia is associated with signifi cant costs. Th at’s why the issue if there is a possibility to decrease the use of self-monitoring of blood glucose is actual. Since the United Kingdom Prospective Study (UKPDS) showed that every 1% decrease in glycated hemoglobin leads to a 37% decrease in the risk of microvascular complications and 14% decrease in the risk of macrovascular complications as well as it leads to a decrease in mortality, the article mainly examined the eff ect of selfmonitoring on the level of glycated hemoglobin in various clinical situations.