Risk Of New-onset Diabetes Mellitus Research Articles

New-Onset Diabetes Mellitus (NODM) After Liver Transplantation (LT): The Ultimate Non-diabetogenic Immunosuppressive Therapy.

New-onset diabetes mellitus (NODM) is a common long-term complication after liver transplantation (LT). It is thought to be drug-induced in most cases, no matter the underlying disease that cause liver failure and indicated transplantation. Standard post-transplantation (PT) immunosuppressive regimens include prolonged use of calcineurin inhibitors (CNIs), namely tacrolimus (TAC), alongside corticosteroids to avoid acute and chronic graft rejection. This combination is well known for its diabetogenicity. Significant differences between the applied regimens stand out concerning the duration and dosages to prevent the metabolic side effects of these drugs in the long run without compromising the graft's survival. Studies were collected after an extensive research of PubMed database for this very specific topic using the following MeSH keywords in multiple combinations: "Liver Transplantation," "Diabetes Mellitus," "NODM," "Tacrolimus," "Cyclosporine A," and "Steroids." In addition, we used the same keywords for regular searches in Google Scholar. Only the relevant English human studies between 2010 and 2020 were collected except for review articles. Duplicates were eliminated using Mendeley software. Twelve relevant studies directly related to the targeted topic were collected and discussed, including five retrospective cohorts, four prospective cohorts, one clinical trial, one prospective pilot, and one case report. Their topics included primarily the factors increasing the risk of new-onset diabetes mellitus after liver transplantation (NODALT), TAC-based immunosuppression and its relative blood levels affecting the possible development of NODALT, the role of cyclosporine in substituting TAC regimen, and the effect of different steroids-avoiding protocols on the prevention of NODALT. The reviewed studies suggested that lowering the serum concentration of tacrolimus (cTAC) throughout the PT period and eliminating the corticosteroids regimen as early as possible, among other measures, can significantly impact the rate of emergence of NODM. This traditional review tackles the most recent studies about NODALT to establish a comprehensive view on this issue and guide clinicians and researchers for the safest immunosuppressive regimen to date, while maintaining a balanced metabolic profile.

Moderate-intensity statin use for primary prevention for more than 5 years is associated with decreased all-cause mortality in 75 years and older

ObjectiveEvidence regarding the primary preventive effects of statin in the elderly is inadequate. This study aimed to determine the duration and intensity of statins beneficial in adults aged ≥75 years for primary prevention. MethodsThis is a retrospective longitudinal study, using the National Health Insurance Corporation-Senior Cohort data from 2002 to 2015. Exact block matching was used to select comparable subjects from statin users and non-users. ResultThe study subjects consisted of 685 pairs of statin non-users and users (total number of 1,370). During the follow-up (mean 8.7 years) period, the adjusted HR for mortality compared to non-user was 0.95 (p = 0.71) in low intensity statin users and 0.80 (p = 0.002) in the moderate intensity statin groups. The adjusted HR for MACE (Major Adverse Cardiovascular Events) compared to non-users was 1.10 (p = 0.39) in the low intensity statin group and 1.29 (p = 0.001) in the moderate intensity statin group. The risk of MACE disappeared five years after in moderate intensity statin users. Moderate intensity statin use was significantly associated with an increased risk of NODM (New Onset Diabetes Mellitus) (HR 1.50, p < 0.001) for up to three years, but the risk faded away after five years (HR 0.90, p = 0.52). ConclusionModerate intensity statins taken for five or more years for primary prevention would be associated with low risk of all-cause mortality in the 75+ years old. This result may support the evidence that initiation of statin for primary prevention in patients aged over 75 years is beneficial and tolerable.

Assessing the Incidence of New-onset Diabetes Mellitus with Statin Use: A Systematic Review of the Systematic Reviews and Meta-analyses.

Statin use has been linked with new-onset diabetes mellitus (NODM). In the present systematic review, we aimed to determine the incidence of NODM with statin use by assessing and summarizing the data generated by different systematic reviews and metaanalyses published on this topic. We conducted a systematic review of systematic reviews and meta-analyses using a pre-defined study protocol. Two authors independently performed a literature search using PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies reporting data on statin use and NODM incidence and screened and extracted data for the outcomes of interest. The Assessing the Methodological Auality of Systematic Reviews 2 (AMSTAR 2) checklist was used to evaluate the quality of the included systematic reviews and meta-analyses. The initial search yielded 621 potential records, and 16 relevant systematic reviews and meta-analyses were included in the present systematic review. The included studies showed an increase in the risk of NODM with statin use. In particular, rosuvastatin and atorvastatin were associated with NODM in many systematic reviews or meta-analyses; however, pravastatin and pitavastatin were found to be associated with lower or no risk. We observed a positive trend of development of NODM with statin use became more evident with advancing years as more number of studies were added. Intensive doses of statins and use in older subjects were found to be important risk factors for NODM. Finally, the quality assessment revealed that the included systematic reviews and metaanalyses were of critically low or low quality. We concluded that statin use carries a risk of causing NODM. Statins should not be discouraged in anticipation of NODM. However, glycaemic monitoring should be encouraged with the on-going statin therapy. Furthermore, clinical studies addressing the use of statins and the incidence of NODM as their primary objective should be planned.

Pharmacogenetics Based Dose Prediction Model for Initial Tacrolimus Dosing in Renal Transplant Recipients.

Tacrolimus, an immunosuppressant used in solid organ transplantation, has a narrow therapeutic index and exhibits inter-individual pharmacokinetic variability. Achieving and maintaining a therapeutic level of the drug by giving appropriate doses is crucial for successful immunosuppression, especially during the initial post-transplant period. We studied the effect of CYP3A5, CYP3A4, and ABCB1 gene polymorphisms on tacrolimus trough concentrations in South Indian renal transplant recipients from Kerala to formulate a genotype-based dosing equation to calculate the required starting daily dose of tacrolimus to be given to each patient to attain optimal initial post-transplant period drug level. We also investigated the effect of these genes on drug-induced adverse effects and rejection episodes and looked into the global distribution of allele frequencies of these polymorphisms. One hundred forty-five renal transplant recipients on a triple immunosuppressive regimen of tacrolimus, mycophenolate mofetil, and steroid were included in this study. Clinical data including tacrolimus daily doses, trough levels (C0) and dose-adjusted tacrolimus trough concentration (C0/D) in blood at three time points (day 6, 6 months, and 1-year post-transplantation), adverse drug effects, rejection episodes, serum creatinine levels, etc., were recorded. The patients were genotyped for CYP3A5*3, CYP3A4*1B, CYP3A4*1G, ABCB1 G2677T, and ABCB1 C3435T polymorphisms by the PCR-RFLP method. We found that CYP3A5*3 polymorphism was the single most strongly associated factor determining the tacrolimus C0/D in blood at all three time points (p < 0.001). Using multiple linear regression, we formulated a simple and easy to compute equation that will help the clinician calculate the starting tacrolimus dose per kg body weight to be administered to a patient to attain optimal initial post-transplant period tacrolimus level. CYP3A5 expressors had an increased chance of rejection than non-expressors (p = 0.028), while non-expressors had an increased risk for new-onset diabetes mellitus after transplantation (NODAT) than expressors (p = 0.018). Genotype-guided initial tacrolimus dosing would help transplant recipients achieve optimal initial post-transplant period tacrolimus levels and thus prevent the adverse effects due to overdose and rejection due to inadequate dose. We observed inter-population differences in allele frequencies of drug metabolizer and transporter genes, emphasizing the importance of formulating population-specific dose prediction models to draw results of clinical relevance.

Risk of Incident Diabetes and Dysregulated Pre-Existing Diabetes Mellitus in Newly Diagnosed Lymphoma Patients Treated with Steroid-Containing Immunochemotherapy: A Danish Population-Based Study

IntroductionPrednisolone has important potential side-effects, one of which is steroid-induced diabetes mellitus (DM). Due to the exposure to a high cumulative dosage of steroids during first-line treatment, patients with non-Hodgkin lymphoma (NHL) could face increased risk of new onset steroid-induced DM or dysregulation of a pre-existing DM. This nationwide observational cohort study evaluated the risk of new onset DM in lymphoma patients and the impact on pre-existing DM in lymphoma survivors following treatment with steroid-containing regimens.MethodsAdult NHL patients (≥18 years) treated with ≥3 cycles of steroid-containing immunochemotherapy, such as R-CHOP(-like) and R-CVP, between 2002 and 2015 were identified in the Danish Lymphoma Register and matched to five random individuals from the general population on birth year, sex, Charlson Comorbidity Index score, baseline DM status (DM or not), and DM duration. NHL patients and matched comparators were followed from start of treatment for the patients until the event of interest (DM, insulin prescription), death, relapse, NHL diagnosis (for matched comparators), or censoring (emigration, missing, or end of study on 31 December 2018), whichever came first.DM was captured by either a diagnosis of any DM (ICD-10 codes: E10-E14) in the Danish National Patient Register or any redeemed anti-diabetic prescription registered in the National Prescription Register (insulin or oral anti-diabetic medicine; ATC A10A or A10B). In the analysis of insulin prescriptions following lymphoma treatment initiation, patients with any redeemed prescription of insulin prior to start of lymphoma treatment were excluded.Time-varying incidence rates (IRs) per 1,000 person years and incidence rate ratios (IRRs) with 95% confidence intervals were estimated using a spline-based Poisson regression approach with two-month time splits and five knots. The Aalen-Johansen estimator was used to compute the cumulative risk of an event treating death, relapse, and NHL diagnosis (in comparators) as competing events. Risk differences at specific time points were calculated using pseudo-observations. Crude and adjusted cause-specific hazard ratios (HR) were obtained using Cox regression.ResultsA total of 4,703 NHL patients were included in the present study. Median age was 66 years and median follow-up was 8.5 years.Among the NHL patients, 4,325 patients did not have pre-existing DM and were matched to 21,625 comparators without DM. The time-varying IR of DM among comparators was 8-10 cases/1000 person years. The IRR of DM for patients vs comparators was higher for patients in the first year following treatment initiation (maximum IRR: 2.40), lower from 1 to 5 years (minimum IRR: 0.52), and higher from 5 to 10 years (maximum IRR: 1.18) (Fig. 1).The cumulative incidence of DM was higher for NHL patients at six months (0.58 percentage units (%U), p <0.01), but lower at 5 years (-1.17%U, p <0.01) and 10 years (-2.09%U, p <0.01) compared to the matched comparators (p <0.01 for the whole period, Fig. 2).Among the NHL patients, 378 had pre-existing non-insulin dependent DM and were matched to 1,890 comparators. The cumulative incidence difference of any insulin use was higher for patients at 6 months (14.29%U, p <0.01), 5 years (9.95%U, p <0.01), and 10 years (4.61%U, p =0.15) (p <0.01 for the whole period, Fig. 3). However, when events were limited ≥5 prescriptions of insulin, no difference was found (p =0.84 for the whole period). The crude HR for ≥5 prescriptions of insulin was 1.42 [1.10;183] for patients compared to the matched comparators and the HR adjusted for sex, age, and comorbidities was 1.39 [1.08;1.79].ConclusionIn conclusion, patients treated with steroid-containing immunochemotherapy did not experience a higher risk of diabetes mellitus compared to matched comparators beyond the first year. Matched comparators had a higher cumulative incidence of diabetes mellitus after 2 years, which was partly explained by the high competing risk of death in the patient group.NHL patients with pre-existing non-insulin dependent diabetes mellitus had an increased cumulative incidence of any insulin prescriptions; however, the difference was diminished when assessing the risk of at least five insulin prescriptions, suggesting that the impact of steroids on diabetes regulation is limited in time when taking competing risks into account. [Display omitted] DisclosuresØvlisen: Abbvie: Other: Travel expenses. Frederiksen: Abbvie: Research Funding; Gilead: Research Funding; Alexion: Research Funding; Novartis: Research Funding; Janssen Pharmaceuticals: Research Funding. Vestergaard: Novo Nordisk Foundation: Other: Head of Research at Steno Diabetes Center North Jutland funded by the Novo Nordisk Foundation, Research Funding. Jørgensen: Gilead: Consultancy; Novartis: Consultancy; Roche: Consultancy; Celgene: Consultancy. Clausen: Gilead: Consultancy, Other: Travel expences 15th ICML ; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel expences ASH 2019; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Poulsen: Janssen: Consultancy; Abbvie: Consultancy. Ekstroem Smedby: Janssen Cilag: Research Funding; Takeda: Consultancy. Eloranta: Janssen Pharmaceutical NV: Other: NV. El-Galaly: ROCHE Ltd: Ended employment in the past 24 months; Abbvie: Other: Speakers fee.

Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers: New-onset diabetes mellitus stratified by statin use.

Regardless of statin use, which is known to induce hyperglycaemia, comparative studies on the risk of new-onset diabetes mellitus (NODM) with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are needed. This study evaluated the effects of ACEIs and ARBs on NODM in the clinical setting. This retrospective cohort study utilized electronic medical record data from Seoul St. Mary's Hospital and Seoul National University Hospital from 2009 to 2012. Patients who were prescribed ACEIs or ARBs for the first time (irrespective of concomitant statin use) were followed up for 5years. A total of 11,703 patients were included, 24.9% (n=2916) were taking ACEIs and 75.1% (n=9189) were taking ARBs. Patients on ACEIs had a significantly lower incidence of NODM both with statin use (HR=0.13, p<0.001) and without (HR=0.15, p=0.009) than patients on ARBs. Age ≥60years (HR=1.49, p=0.010), BMI ≥25 (HR=1.96, p<0.010), use of calcium channel blockers (HR=1.47, p=0.010), and diuretics (HR=1.48, p=0.010) were risk factors for NODM with statin use. Patients taking ACEIs are less likely to develop NODM than patients taking ARBs, irrespective of statin use. Patients' conditions, including the risk of NODM, should be considered before prescribing ACEIs or ARBs. Future randomized clinical trials are needed to clarify further the relationship between ACEIs and ARBs and their effect on NODM.

Less statin associated adverse events after initiation of pitavastatin compared with atorvastatin and rosuvastatin

Abstract Background Statin associated adverse events (SAAEs), including hepatitis, myopathy and new onset diabetes mellitus (NODM), are major reasons that prevent the use of statins. We compared the risk of SAAEs among the commonly used statins to see if SAAEs were similar among the statins. Methods We retrieved data from the Taiwan National Health Insurance Research Database. From January 2013 to December 2017, all statin-treated patients without diabetes at baseline were enrolled. We classified eligible patients into pitavastatin (2–4mg/day), moderate-intensity statin (MIS [atorvastatin 10–20 mg/day or rosuvastatin 5–10 mg/day]), and high-intensity statin group (HIS [atorvastatin ≥40 mg/day and rosuvastatin ≥20mg/day]). The study endpoint is a composite of safety events, including hepatitis, myopathy, and NODM. All patients were followed-up for at least one year until December 2018. We used propensity score to balance the baseline differences between the 3 statin groups (N=50935 in each group). Results After a mean follow up time of 3.08 years, the safety events occurred in 5014 patients in pitavastatin group (9.84%), 5542 in MIS group (10.88%), and 5343 in HIS group (10.49%). Multivariate Cox proportional hazards model showed that MIS and HIS statins were associated with a higher risk of safety events compared with pitavastatin (adjusted hazard ratio [aHR] 1.122, 95% confidence interval [CI] 1.08–1.17 for MIS and aHR 1.056, 95% CI 1.02–1.10 for HIS). Most events were NODM, with 4818 events in pitavastatin (9.46%), 5284 in MIS (10.37%), and 5113 in HIS group (10.04%). Multivariate Cox proportional hazard analysis showed higher risk of NODM in MIS (adjusted HR 1.111, 95% CI 1.07–1.16) and HIS (aHR 1.050, 95% CI 1.01–1.10) compared with pitavastatin. Time-varying HR analysis showed increased risk of NODM with use of all these statins for more than 1 year compared with non-statin users. Conclusions Pitavastatin was associated with a lower risk of SAAEs, especially NODM, compared with atorvastatin and rosuvastatin. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Orient EuroPharma Co., Ltd.

The association of new-onset diabetes mellitus and medical therapy for benign prostatic hyperplasia: A population-based study.

Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms are highly prevalent in the aging male. Similarly, the prevalence of metabolic syndrome is increasing worldwide, with mounting evidence that these two common conditions share more than age as a predisposing factor. The objective of this study was to determine if medical management of BPH is associated with an increased risk of new-onset diabetes mellitus (DM) in routine care. This population-based, retrospective cohort study expands on a parent study of linked administrative databases identifying patients diagnosed and treated for BPH between 2005 and 2015. The primary outcome of this secondary analysis was a new diagnosis of DM after the index date of BPH diagnosis. Covariates included age, dyslipidemia, hypertension, and vascular diseases. A Cox proportional hazards regression model was used for inferential statistical analysis. A total 129 223 men were identified with a BPH diagnosis and no prior history of DM. Of those men, 6390 (5%) were exposed to 5-alpha-reductase inhibitor (5-ARI), 39 592 (31%) exposed to alpha-blocker (AB), and 30 545 (24%) exposed to combination therapy. Compared to those men with no BPH medication use, those exposed to drugs had an increased risk of new DM. Men treated with combination therapy of 5-ARI and AB (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.25-1.35), 5-ARI monotherapy (HR 1.25, 95% CI 1.17-1.34), or AB monotherapy (HR 1.17, 95% CI 1.13-1.22) all were at higher risk of new DM diagnosis after adjusting for important covariates. When calculating the risk of a new diabetes diagnosis measured from the start of drug exposure, men treated with 5-ARIs had an increased risk of DM compared to AB monotherapy as the reference, with HR 1.12 (95% CI 1.03-1.21) for 5-ARI monotherapy and HR 1.20 (95% CI 1.14-1.25) for combination therapy. In this large, long-term, retrospective study of men with a BPH diagnosis in routine practice, the risk of a new diagnosis of DM was greater in patients receiving medical management compared to controls. This modest but significant increased risk was highest in men treated with any 5-ARIs, in combination as well as monotherapy, compared to the ABs.

Long-term effects of statins on hemoglobin A1c and fasting blood sugar levels

Background and Aims: Statins increase the risk of new-onset diabetes mellitus (DM). Clinical characteristics of this phenomenon are poorly understood. This study investigated long-term effects of statins using hemoglobin A1c (HbA1c) and fasting blood sugar (FBS) levels.

An Analysis of the Risk Factors for New-Onset Diabetes Mellitus After Liver Transplantation.

ObjectiveTo investigate the risk factors related to new-onset diabetes mellitus (NODM) and the significance of IL-6.MethodsA retrospective analysis was conducted on clinical data from 64 patients who received either a living donor liver transplantation or a donation after circulatory death from September 2013 to October 2020 and attended regular follow-up visits for six or more months. During follow-up, patients were randomized into groups and followed up until the completion of the study or the death of the patient.ResultsThe incidence of NODM was 31.25% (n = 20). The median age in the NODM group was 52.15 years (p < 0.01). Age (OR = 1.089; 95% CI: 0.0211–0.1495, p = 0.003) and elevated preoperative IL-6 (OR = 1.122; 95% CI: 0.0619–0.1677, p = 0.029) were found to be independent risk factors for NODM. HBV-induced liver cirrhosis, warm ischemia time (WIT), body mass index (BMI), and high preoperative fasting blood glucose (FBG) were also found to be risk factors for NODM. The recipient had a higher risk of NODM if the donor had a high BMI and poor hepatic function. The concentrations of IL-6, procalcitonin (PCT), FBG, and tacrolimus (TAC) in the first month postoperatively were significantly higher in the NODM group than in the NO-NODM group. The survival rate of the patients was not affected by NODM.ConclusionHBV-induced liver cirrhosis, WIT, BMI, and high preoperative FBG levels are risk factors for NODM, and age and preoperative IL-6 levels are independent risk factors. To a certain extent, higher BMI and poor hepatic function had reference significance for the incidence of NODM. Patients with a high concentration of FBG, IL-6, and TAC in the first month postoperatively had an increased risk of suffering from NODM.

The risk factors of new onset diabetes mellitus following distal pancreatectomy: The ideal candidate for active surveillance

In pancreatic resection, the focus has been mainly on the oncologic safety, however, the endocrine function of the remnant pancreas also should be considered due to relatively longer life expectancy of the patients with benign or borderline malignant pancreatic tumor. We investigated risk factors for occurring new onset diabetes mellitus (NODM) after distal pancreatectomy (DP). Total 205 patients were diagnosed with benign or borderline malignant tumor of the pancreas and underwent DP from 2005 to 2019 in Severance hospital, Seoul, Korea. The patients diagnosed with NODM postoperatively under American Diabetes Association guidelines were included to DM group (n = 51), and other patients were included in non-DM group (n = 154). Preoperative characteristics and surgical outcomes were compared between two groups. We investigated risk factors for occurring NODM by univariate and multivariate analysis and analyzed cumulative NODM ratio by time sequence. Age (DM: 55.3 ± 12.3 vs. non-DM: 47.6 ± 15.2, p < 0.001) and BMI (DM: 24.1 ± 3.4 vs. non-DM: 23.0 ± 3.1, p = 0.026) were significantly higher in DM group than non-DM group. DM group showed more operation time (p = 0.033), more blood loss (p = 0.024), and more extended range of pancreatectomy (neck level resection. DM 51.0% vs. non-DM 26.6%, p = 0.002). Pathologic and postoperative outcomes did not differ between the two groups. Age over 50 (p = 0.001), pancreatectomy on neck level (p = 0.003), underline chronic pancreatitis (p = 0.039) and blood loss (p = 0.019) remained significant risk factors for NODM in multivariate analysis. About half of the NODM patients were diagnosed within 1 year postoperatively. The patients who underwent distal pancreatectomy with high risk of NODM should be actively under surveillance for at least 1 year postoperatively.

Individual and combined contributions of age-specific and sex-specific pulse pressure and brachial-ankle pulse wave velocity to the risk of new-onset diabetes mellitus

IntroductionWe aimed to investigate the individual and combined effects of age-specific and sex-specific pulse pressure (PP) and brachial-ankle pulse wave velocity (baPWV) on the incidence of new-onset diabetes mellitus.Research design...

Postoperative serum triglyceride levels in predicting risk of new-onset diabetes mellitus in patients following liver transplantation.

To investigate the postoperative serum triglyceride (TG) levels in predicting the risk of new-onset diabetes mellitus (NODM) in patients following allogeneic liver transplantation. One hundred and forty three patients undergoing allogeneic liver transplantation in Shanghai General Hospital from July 2007 to July 2014 were enrolled in this study. The NODM developed in 33 patients after liver transplantation. The curve of dynamic TG levels in the early period after liver transplantation was generated. Independent risk factors of NODM were determined by univariate and multivariant logistic regression analyses. The clinical value of TG in predicting NODM was analyzed by area under the ROC curve (AUC). Serum TG levels were gradually rising in the first week and then reached the plateau phase (stable TG, sTG) in patients after surgery. The sTG in NODM group were significantly higher than that in non-NODM group (=-2.31, <0.05). Glucocorticoid therapy (=4.054, <0.01), FK506 drug concentration in the first week after operation (=3.482, <0.05) and sTG (=3.156, <0.05) were independent risk factors of NODM. ROC curve analysis showed that the AUC of sTG in predicting NODM was 0.72. TG shows a gradual recovery process in the early period after liver transplantation, and the higher TG level in stable phase may significantly increase the risk of NODM in patients.

Relationship Between Remnant Pancreatic Volume and Endocrine Function After Pancreaticoduodenectomy.

Decreased pancreatic volume (PV) is a predictive factor for diabetes mellitus (DM) after surgery. There are few reports on PV and endocrine function pre- and post-surgery. We investigated the correlation between PV and insulin secretion. Seventeen patients underwent pancreaticoduodenectomy (PD) Pre- and post-surgery PV and C-peptide index (CPI) measurements were performed. Additionally, the correlation between PV and CPI was analyzed. The mean preoperative PV (PPV) was 55.1 ± 31.6mL, postoperative remnant PV (RPV) was 25.3±17.3mL, and PV reduction was 53%. The mean preoperative C-peptide immunoreactivity (CPR) was 1.39 ± .51 and postoperative CPR was .85±.51. The mean preoperative CPI was 1.29±.72 and postoperative CPI was .73 ± .48. Significant correlations were observed between RPV and post CPR (ρ = .507, P = .03) and post CPI (ρ = .619, P = .008). There was a significant correlation between RPV and CPI after PD. A smaller RPV resulted in lower insulin secretion ability, increasing the potential risk of new-onset DM after PD.

Incidence and Risk Factors for New Onset Diabetes Mellitus Following Surgical Resection of Pancreatic Cystic Lesions

Background: Compared with patients who undergo pancreatic surgery for chronic pancreatitis and malignancy, patients with pancreatic cystic lesions (PCLs) generally have normal adjacent pancreatic parenchyma. There is a paucity of literature evaluating new-onset diabetes mellitus (NODM) following PCL resection. We sought to characterize the incidence and risk factors associated with NODM following partial pancreatectomy for PCLs. Methods: We utilized the IBM MarketScan Database (2012-2018) to identify all non-diabetic adult patients who underwent elective partial pancreatectomy for PCLs. Rigorous stepwise exclusion criteria were applied to identify patients without other pancreatic disease. We performed time-to-event analyses using Kaplan-Meier curves and multivariable Cox proportional hazards regression to define the incidence and risk factors associated with postoperative NODM. Findings: Among 311 patients with PCLs who underwent partial pancreatectomy, the overall risk of NODM was 9.1% (95% CI 6.3-12.9%), 15.1% (95% CI 11.3-20.2%), and 20.2% (95% CI 15.3-26.4%) at six, 12 and 24 months, respectively. Multivariable analysis revealed that older age (55-64 years, adjusted Hazard Ratio (aHR) 1.97, 95% CI 1.04-3.72 vs. 18-54 years), obesity (aHR 2.63, 95% CI 1.35-5.12), hypertension (aHR 1.79, 95% CI 1.01-3.17), and cardiovascular disease (aHR 2.54, 95% CI 1.02-6.28) were independent predictors of postoperative NODM. Rates of NODM were similar following distal pancreatectomy versus pancreaticoduodenectomy. Interpretation: Within two years, approximately one in five patients will develop NODM following partial pancreatectomy for PCLs. Those with advanced age, metabolic syndrome features, and/or cardiovascular disease may benefit from preoperative counselling for risk-reduction and intensive postoperative monitoring, education, and treatment strategies for DM. Funding: National Center for Advancing Translational Sciences, award number UL1TR002733. Declaration of Interests: None of the authors have any conflicts of interest or financial ties to disclose related to the current study. Ethics Approval Statement: This database is a publicly available population-based dataset. As such, the study was exempt from approval by the Ohio State University Institutional Review Board.

Statin use and the risk of new-onset diabetes mellitus: a retrospective cohort study

Statin use and the risk of new-onset diabetes mellitus: a retrospective cohort study

Long-term effects of statins on blood sugar levels

Background and Aims: Statins have increased the risk of new-onset diabetes mellitus (DM). However, the reports observing changes in fasting blood sugar (FBS) levels are rare. In addition, influences of long-term therapy were not known. This study investigated long-term effects of statins on FBS.

Statin Therapy for Primary Prevention in the Elderly and Its Association with New-Onset Diabetes, Cardiovascular Events, and All-Cause Mortality

PurposeThis study assessed associations of the use of statins for primary prevention with cardiovascular outcomes among adults ages ≥70 years. MethodsIn a retrospective population-based cohort study, new users of statins without cardiovascular disease or diabetes mellitus were stratified by ages ≥70 years and <70 years. Using a time-dependent approach, adherence to statins was evaluated according to the proportion of days covered: <25%, 25%-50%, 50%-75%, and ≥75%. We assessed associations of statin therapy with increased risk of new-onset diabetes mellitus and with decreased risks of major adverse cardiovascular events and all-cause mortality. ResultsOf 42,767 new users of statins, 5970 (14%) were ages ≥70 years. The incident rates of major adverse cardiovascular events, all-cause mortality, and new-onset diabetes mellitus in the highest to lowest proportion of days covered categories were 16.9%, 16.7%, and 9.4% and 6.3%, 1.7%, and 9.4%, respectively. For the older group, the adjusted hazard ratios of major adverse cardiovascular events and mortality were significantly decreased for the highest adherence group (proportion of days covered ≥75%): 0.71 (0.57-0.88) and 0.68 (0.54-0.84), respectively. The respective hazard ratios were less favorable for the younger group: 0.80 (0.68-0.93) and 0.74 (0.58-1.03). The risk of new-onset diabetes mellitus was increased for the younger but not the older group. ConclusionsStatin use for primary prevention was associated with cardiovascular benefit in adults ages ≥70 years without a significant risk for the development of diabetes. These data may support the use of statin therapy for primary prevention in the elderly.

Abstract 15098: New-Onset Diabetes Mellitus Risk in Statin Users Depends on Baseline HemoglobinA1c Value - Results of VA Database Analysis

Introduction: Statin use in non-diabetic patients is associated with an increased risk of development of new-onset diabetes mellitus (NODM). However, little is known if baseline hemoglobin A1c (HbA1c) can affect diabetogenic risks and mortality benefits of statin therapy. Methods: In a retrospective cohort study between 01/2011 and 12/2018 we collected the data of 152358 non-diabetic US veterans on statin and not on statin therapy who had available baseline HbA1c value and full demographic and clinical information prior to DM diagnosis. The risk of statin-induced DM and all-cause mortality rate were assessed in the whole cohort and based on baseline HbA1c categories: ≤5.6%, 5.7-5.9% and 6.0-6.4%. DM rate and mortality rate were calculated by Cox proportional hazards model adjusted for case-mix. Results: After mean follow up of 6.89 (SD 2.26) years in non-statin users and 3.85 (SD 2.29) years in statin users and adjustments for multiple covariates such as age, gender, ethnicity, obesity, hypertension (HTN), cardiovascular disease, and metformin use, we found that the rate of statin-induced DM depends on baseline HbA1c (Table 1). Analysis by HbA1c categories showed that NODM rate is inversely related to HbA1c level, while statin use in patients with HbA1c 6.0-6.4% was not associated with increased rate of NODM. We did not observe increase in all-cause mortality in statin users and statin users with HTN across HbA1c categories. Atorvastatin use was associated with decrease in all-cause mortality in HTN patients (Table 1). Conclusions: The results of this largest to date analysis of non-diabetic US veterans closely matched for baseline characteristics suggest that the rate of statin-induced DM depends on baseline HbA1c. The significant increase in NODM rate is only observed in patients with baseline HbA1c &lt;6.0% regardless of statin type prescribed. The increased NODM risk is not associated with all-cause mortality in statin users in general including patients with HTN.

Effects of Pitavastatin, Atorvastatin, and Rosuvastatin on the Risk of New-Onset Diabetes Mellitus: A Single-Center Cohort Study.

Statins constitute the mainstay treatment for atherosclerotic cardiovascular disease, which is associated with the risk of new-onset diabetes mellitus (NODM). However, the effects of individual statins on the risk of NODM remain unclear. We recruited 48,941 patients taking one of the three interested statins in a tertiary hospital between 2006 and 2018. Among them, 8337 non-diabetic patients taking moderate-intensity statins (2 mg/day pitavastatin, 10 mg/day atorvastatin, and 10 mg/day rosuvastatin) were included. The pitavastatin group had a higher probability of being NODM-free than the atorvastatin and rosuvastatin groups during the 4-year follow-up (log-rank test: p = 0.038). A subgroup analysis revealed that rosuvastatin had a significantly higher risk of NODM than pitavastatin among patients with coronary artery disease (CAD) (adjusted HR [aHR], 1.47, 95% confidence interval [CI], 1.05–2.05, p = 0.025), hypertension (aHR, 1.26, 95% CI, 1.00–1.59, p = 0.047), or chronic obstructive pulmonary disease (COPD) (aHR, 1.74, 95% CI, 1.02–2.94, p = 0.04). We concluded that compared with rosuvastatin, reduced diabetogenic effects of pitavastatin were observed among patients treated with moderate-intensity statin who had hypertension, COPD, or CAD. Additional studies are required to prove the effects of different statins on the risk of NODM.