Self-reported Type 2 Diabetes Mellitus Research Articles

Prospective associations of hemoglobin A1c and c-peptide with risk of diabetes-related cancers in the Cancer Prevention Study-II Nutrition Cohort.

Self-reported type 2 diabetes mellitus (T2DM) is a risk factor for many cancers, suggesting its pathology relates to carcinogenesis. We conducted a case-cohort study to examine associations of hemoglobin A1c (HbA1c) and c-peptide with cancers associated with self-reported T2DM. This study was drawn from a prospective cohort of 32,383 women and men who provided blood specimens at baseline: c-peptide and HbA1c were assessed in 3,000 randomly selected participants who were cancer-free-at-baseline and an additional 2,281 participants who were cancer-free-at-baseline and subsequently diagnosed with incident colorectal, liver, pancreatic, female breast, endometrial, ovarian, bladder, or kidney cancers. Weighted-Cox regression models estimated hazards ratios (HRs) and 95% confidence intervals (CI), adjusted for covariates. C-peptide was associated with higher risk of liver cancer (per standard deviation (SD) HR: 1.80; 95%CI: 1.32-2.46). HbA1c was associated with higher risk of pancreatic cancer (per SD HR: 1.21 95%CI 1.05-1.40) and with some suggestion of higher risks for all-cancers-of-interest (per SD HR: 1.05; 95%CI: 0.99-1.11) and colorectal (per SD HR: 1.09; 95%CI: 0.98-1.20), ovarian (per SD HR: 1.18; 95%CI 0.96-1.45) and bladder (per SD HR: 1.08; 95%CI 0.96-1.21) cancers. Compared to no self-reported T2DM and HbA1c <6.5% (reference group), self-reported T2DM and HbA1c <6.5% (i.e., T2DM in good glycemic control) was not associated with risk of colorectal cancer, whereas it was associated with higher risks of all-cancers-of-interest combined (HR: 1.28; 95%CI: 1.01-1.62), especially for breast and endometrial cancers. Additional large, prospective studies are needed to further explore the roles of hyperglycemia, hyperinsulinemia, and related metabolic traits with T2DM-associated cancers to better understand the mechanisms underlying the self-reported T2DM-cancer association and to identify persons at higher cancer risk.

Type 2 diabetes mellitus and anxiety symptoms: a cross-sectional study in Peru.

Information about the effect of type 2 diabetes mellitus (T2DM) awareness in the prevalence of anxiety disorders is scarce. Moreover, reports from resource-constrained and semiurban settings are usually focused on hospital-based data, instead of population-based surveys. We aimed to evaluate the association between T2DM and anxiety symptoms, with emphasis on T2DM awareness. A secondary data analysis was conducted using information from a population-based study. The outcome of interest was the presence of anxiety symptoms assessed by the Goldberg anxiety test, while the exposure variable was T2DM, defined using the oral glucose tolerance test. In addition, another definition was used based on self-reported T2DM awareness of previous diagnosis. Prevalence ratios (PR) and 95% confidence intervals (CI) were reported using Poisson regression models. Data from 1,607 participants, of mean age 48.2 (SD: 10.6) years, and 809 (50.3%) females, were analyzed. Of all participants, 176 (11.0%; 95% CI: 9.5%-12.6%) had T2DM, 105 (59.7%) were aware of previous diagnosis, and 674 (41.9%; 95% CI: 39.5%-44.4%) had anxiety symptoms. In multivariable model, T2DM was not associated with anxiety symptoms (PR = 1.16; 95% CI: 0.99-1.36); however, individuals aware of T2DM diagnosis had a 36% (95% CI: 14%-64%) greater prevalence of anxiety symptoms compared to those without T2DM. Additionally, those aware of T2DM diagnosis had a 56% (95% CI: 13%-116%) higher probability to have anxiety symptoms compared to those not aware of T2DM diagnosis. Conclusions: The association between T2DM and anxiety symptoms was present among those participants who self-reported T2DM diagnosis, as opposed to those with T2DM but not aware and to those without T2DM. Evaluation of anxiety symptoms may be relevant among those with previous T2DM diagnosis.

Type 2 diabetes mellitus and anxiety symptoms: a cross-sectional study in Peru

Background: Information about the effect of type 2 diabetes mellitus (T2DM) awareness in the prevalence of anxiety disorders is scarce. Moreover, reports from resource-constrained and semiurban settings are usually focused on hospital-based data, instead of population-based surveys. We aimed to evaluate the association between T2DM and anxiety symptoms, with emphasis on T2DM awareness. Methods: A secondary data analysis was conducted using information from a population-based study. The outcome of interest was the presence of anxiety symptoms assessed by the Goldberg anxiety test, while the exposure variable was T2DM, defined using the oral glucose tolerance test. In addition, another definition was used based on self-reported T2DM awareness of previous diagnosis. Prevalence ratios (PR) and 95% confidence intervals (CI) were reported using Poisson regression models. Results: Data from 1,607 participants, of mean age 48.2 (SD: 10.6) years, and 809 (50.3%) females, were analyzed. Of all participants, 176 (11.0%; 95% CI: 9.5%–12.6%) had T2DM, 105 (59.7%) were aware of previous diagnosis, and 674 (41.9%; 95% CI: 39.5%–44.4%) had anxiety symptoms. In multivariable model, T2DM was not associated with anxiety symptoms (PR = 1.16; 95% CI: 0.99–1.36); however, individuals aware of T2DM diagnosis had a 36% (95% CI: 14%–64%) greater prevalence of anxiety symptoms compared to those without T2DM. Additionally, those aware of T2DM diagnosis had a 56% (95% CI: 13%-116%) higher probability to have anxiety symptoms compared to those not aware of T2DM diagnosis.   Conclusions: The association between T2DM and anxiety symptoms was present among those participants who self-reported T2DM diagnosis, as opposed to those with T2DM but not aware and to those without T2DM. Evaluation of anxiety symptoms may be relevant among those with previous T2DM diagnosis.

Association Between Triglyceride-Glucose Index and the Risk of Type 2 Diabetes Mellitus in an Older Chinese Population Aged Over 75 Years.

BackgroundThe association between the triglyceride–glucose (TyG) index and type 2 diabetes mellitus (T2DM) in older adults has not been fully understood. This research aims to explore the association between the TyG index and the incidence of T2DM in an older Chinese population aged over 75 years.MethodsThis longitudinal analysis study was performed based on a database from a health check screening program in China. The participants were stratified based on the quintile ranges of the TyG index (Q1 to Q5 groups). T2DM was defined as fasting plasma glucose (FPG) ≥ 7.00 mmol/L and/or self-reported T2DM. The cumulative incidences of T2DM in various quintile groups were estimated by the Kaplan–Meier method. The Cox proportional hazard model was used to examine the independent impact of the TyG index on the risk of T2DM during the follow-up period. Subgroup analysis was performed by gender and BMI to further validate the credibility of the results.ResultsDuring the follow-up period, a total of 231 new-onset T2DM cases were recorded among the 2,571 individuals aged over 75 years. After adjusting confounding factors, elevated TyG index independently indicated a higher risk of T2DM (HR = 1.89; 95% CI, 1.47–2.44; p < 0.01). Higher TyG index quintile groups (Q3 to Q5) also presented with a higher risk of T2DM (hazard ratio (HR) = 1.36, 1.44, and 2.12, respectively) as compared with the lowest quintile group (Q1). Subgroup analysis showed that increased TyG index led to a higher risk of T2DM with HR = 2.35 (95% CI, 1.73–3.19), 1.90 (95% CI, 1.27–2.83), 2.95 (95% CI, 1.94–4.50), and 1.72 (95% CI, 1.25–2.35) in male subgroup, female subgroup, BMI < 24 kg/m2 subgroup, and BMI ≥ 24 kg/m2 subgroup, respectively.ConclusionsTriglyceride–glucose index independently correlated with the risk of incident T2DM in Chinese adults aged over 75 years. The TyG index might be useful in monitoring T2DM in the older populations.

Type 2 diabetes mellitus and anxiety symptoms: a cross-sectional study in Peru

Background: Information about the effect of type 2 diabetes mellitus (T2DM) awareness in the prevalence of anxiety disorders is scarce. Moreover, reports from resource-constrained and semiurban settings are usually focused on hospital-based data, instead of population-based surveys. We aimed to evaluate the association between T2DM and anxiety symptoms, with emphasis on T2DM awareness. Methods: A secondary data analysis was conducted using information from a population-based study. The outcome of interest was the presence of anxiety symptoms assessed by the Goldberg anxiety test, while the exposure variable was T2DM, defined using the oral glucose tolerance test. In addition, another definition was used based on self-reported T2DM awareness of previous diagnosis. Prevalence ratios (PR) and 95% confidence intervals (CI) were reported using Poisson regression models. Results: Data from 1,607 participants, of mean age 48.2 (SD: 10.6) years, and 809 (50.3%) females, were analyzed. Of all participants, 176 (11.0%; 95% CI: 9.5%–12.6%) had T2DM, 105 (59.7%) were aware of previous diagnosis, and 674 (41.9%; 95% CI: 39.5%–44.4%) had anxiety symptoms. In multivariable model, T2DM was not associated with anxiety symptoms (PR = 1.16; 95% CI: 0.99–1.36); however, individuals aware of T2DM diagnosis had a 36% (95% CI: 14%–64%) greater prevalence of anxiety symptoms compared to those without T2DM. Additionally, those aware of T2DM diagnosis had a 56% (95% CI: 13%-116%) higher probability to have anxiety symptoms compared to those not aware of T2DM diagnosis.   Conclusions: The association between T2DM and anxiety symptoms was present among those participants who self-reported T2DM diagnosis, as opposed to those with T2DM but not aware and to those without T2DM. Evaluation of anxiety symptoms may be relevant among those with previous T2DM diagnosis.

Time Trends in Comorbidity and Management of Hypertension and Self-reported Diabetes: A 15-Year Nationwide Longitudinal Study in China.

To examine time trends in comorbidity of hypertension and self-reported type 2 diabetes mellitus (T2DM) and their diagnosis, treatment, and management in China during 2000-2015 and study factors associated with these outcomes. Longitudinal data collected from the China Health and Nutrition Survey (CHNS) during 2000-2015 were analyzed. 143, 351, and 338 had both hypertension and self-reported T2DM were selected in 2000, 2011, and 2015, respectively. Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) and hypertension prevalence among T2DM participants, and treatment and control of hypertension and self-reported T2DM among participants with both conditions were examined for all and by sex and weight status. Poisson regression model assessed the associations. From 2000 to 2015, among participants with self-reported T2DM, hypertension prevalence dropped from 88.4% to 83.0% and blood pressures decreased (P < 0.05). Men and overweight/obese participants had greater decreases in hypertension prevalence and DBP, while women had a larger decrease in SBP than men. Over time, among participants with both hypertension and self-reported T2DM, rates of hypertension treatment (45.3%-57.7%), hypertension control (3.0%-10.9%), and self-reported T2DM treatment (90.0%-95.6%) increased (all P < 0.001). Older, women, ever-smoking, heavier drinking, better income level, higher education level, and obesity had higher rates of prevalence, treatment, and control of hypertension, and self-reported T2DM treatment among participants with both hypertension and self-reported T2DM. Rates of hypertension treatment and control among participants with both hypertension and self-reported T2DM have improved in recent years, but were still low.

Does undiagnosed diabetes mitigate the association between diabetes and cognitive impairment? Findings from the ELSI-Brazil study.

Type 2 diabetes mellitus (T2DM) is associated with cognitive impairment. However, most of the evidence has been based on self-reported T2DM, and undiagnosed diabetes has not been considered as a separate category. We aimed to examine the extent to which undiagnosed diabetes modifies the association between diabetes and cognitive impairment in a representative sample of Brazilian adults aged 50 years and older. We analyzed baseline data from 1944 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) conducted from 2015 to 2016. Diabetes was evaluated based on self-reported doctor diagnosis and glycosylated hemoglobin levels. Participants were classified as diabetics (D), undiagnosed diabetics (UDD), or nondiabetics (ND). Cognitive function was assessed by word list learning and verbal fluency tests. Three multiple logistic regression models were used to evaluate the changes in the strength of the associations. Participants with diabetes had 49% greater odds of exhibiting impaired memory than nondiabetics (odds ratio [OR] = 1.49; 95% CI: 1.01-2.20). By combining UDD and ND, the association between diabetes and impaired memory was attenuated by 2.0%, losing its statistical significance (OR = 1.46; 95% CI: 0.98-2.17). By combining UDD and D, the association was attenuated by 7.4% (OR = 1.38; 95% CI: 1.01-1.90). No significant association was found between T2DM and impaired verbal fluency. This study found an association between T2DM and impaired memory but not with impaired verbal fluency. When UDD individuals are considered diabetics, this association is attenuated; when UDD individuals are considered as ND, this association is attenuated to the extent that it loses its statistical significance, affecting thus the clinical interpretation.

Total Fermented Dairy Food Intake Is Inversely Associated with Cardiovascular Disease Risk in Women

The relation between fermented dairy consumption and type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) in an Australian population remains to be established. The aim of this study was to investigate the association between fermented dairy consumption and T2DM and CVD risk. The Australian Longitudinal Study on Women's Health included Australian women (aged 45-50 y) at baseline in 2001, who were followed up through 5 surveys until 2016. Dietary intake was assessed through the use of a validated 101-item FFQ at baseline. Main study outcomes were self-reported physician-diagnosed T2DM and CVD. Logistic regression models adjusted for sociodemographic and lifestyle factors were used to estimate the association between dairy intake and T2DM and CVD risk. Of 7633 women free of diabetes at baseline, 701 (9.2%) developed T2DM during a maximum 15-y follow-up period. Women in the highest tertile of yogurt intake had lower adjusted odds of T2DM than those in the lowest tertile (OR: 0.81; 95% CI: 0.67, 0.99; P = 0.041). This relation became nonsignificant after adjustment for dietary variables and total energy intake (OR: 0.88; 95% CI: 0.71, 1.08; P = 0.21). Of 7679 women free of CVD at baseline, 835 (10.9%) cases of CVD were reported during follow-up. High intake of yogurt and total fermented dairy was associated with lower CVD risk (OR: 0.84; 95% CI: 0.70, 1.00; P = 0.05, 0.80; 0.67, 0.96; 0.017, respectively) than observed in the lowest tertile of dairy product intake. Additional adjustment attenuated the relation (OR: 0.87; 95% CI: 0.72, 1.04; P = 0.13, 0.83; 0.69, 1.00; 0.048, for yogurt and total fermented dairy, respectively). No associations were found with other dairy groups. The findings from this population-based study of Australian women suggest an inverse association between total fermented dairy intake and CVD risk, which may partly be accounted for by other dietary components.

Type 2 diabetes mellitus, blood cholesterol, triglyceride and colorectal cancer risk in Lynch syndrome

BackgroundType 2 diabetes mellitus and high total cholesterol and triglycerides are known to be associated with increased colorectal cancer risk for the general population. These associations are unknown for people with a germline DNA mismatch repair gene mutation (Lynch syndrome), who are at high risk of colorectal cancer.MethodsThis study included 2023 (56.4% female) carriers with a mismatch repair gene mutation (737 in MLH1, 928 in MSH2, 230 in MSH6, 106 in PMS2, 22 in EPCAM) recruited by the Colon Cancer Family Registry between 1998 and 2012. Weighted Cox regression was used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for the associations between self-reported type 2 diabetes, high cholesterol, triglyceride and colorectal cancer risk.Results Overall, 802 carriers were diagnosed with colorectal cancer at a median age of 42 years. A higher risk of colorectal cancer was observed in those with self-reported type-2 diabetes (HR 1.92; 95% CI, 1.03–3.58) and high cholesterol (HR 1.76; CI 1.23–2.52) compared with those without these conditions. There was no evidence of high triglyceride being associated with colorectal cancer risk.ConclusionFor people with Lynch syndrome, self-reported type-2 diabetes mellitus and high cholesterol were associated with increased colorectal cancer risk.

An Evaluation of Digital Health Tools for Diabetes Self-Management in Hispanic Adults: Exploratory Study

BackgroundAlthough multiple self-monitoring technologies for type 2 diabetes mellitus (T2DM) show promise for improving T2DM self-care behaviors and clinical outcomes, they have been understudied in Hispanic adult populations who suffer disproportionately from T2DM.ObjectiveThe objective of this study was to evaluate the acceptability, feasibility, and potential integration of wearable sensors for diabetes self-monitoring among Hispanic adults with self-reported T2DM.MethodsWe conducted a pilot study of T2DM self-monitoring technologies among Hispanic adults with self-reported T2DM. Participants (n=21) received a real-time continuous glucose monitor (RT-CGM), a wrist-worn physical activity (PA) tracker, and a tablet-based digital food diary to self-monitor blood glucose, PA, and food intake, respectively, for 1 week. The RT-CGM captured viewable blood glucose concentration (mg/dL) and PA trackers collected accelerometer-based data, viewable on the device or an associated tablet app. After 1 week of use, we conducted a semistructured interview with each participant to understand experiences and thoughts on integration of the data from the devices into a technology-facilitated T2DM self-management intervention. We also conducted a brief written questionnaire to understand participants’ self-reported T2DM history and past experience using digital health tools for T2DM self-management. Feasibility was measured by device utilization and objective RT-CGM, PA tracker, and diet logging data. Acceptability and potential integration were evaluated through thematic analysis of verbatim interview transcripts.ResultsParticipants (n=21, 76% female, 50.4 [SD 11] years) had a mean self-reported hemoglobin A1c of 7.4 [SD 1.8] mg/dL and had been diagnosed with T2DM for 7.4 [SD 5.2] years (range: 1-16 years). Most (89%) were treated with oral medications, whereas the others self-managed through diet and exercise. Nearly all participants (n=20) used both the RT-CGM and PA tracker, and 52% (11/21) logged at least one meal, with 33% (7/21) logging meals for 4 or more days. Of the 8 possible days, PA data were recorded for 7.1 [SD 1.8] days (range: 2-8), and participants averaged 7822 [SD 3984] steps per day. Interview transcripts revealed that participants felt most positive about the RT-CGM as it unveiled previously unknown relationships between lifestyle and health and contributed to changes in T2DM-related thoughts and behaviors. Participants felt generally positive about incorporating the wearable sensors and mobile apps into a future intervention if support were provided by a health coach or health care provider, device training were provided, apps were tailored to their language and culture, and content were both actionable and delivered on a single platform.ConclusionsSensor-based tools for facilitating T2DM self-monitoring appear to be a feasible and acceptable technology among low-income Hispanic adults. We identified barriers to acceptability and highlighted preferences for wearable sensor integration in a community-based intervention. These findings have implications for the design of T2DM interventions targeting Hispanic adults.

Abstract 594: Associations of hemoglobin A1c with risk of diabetes-related cancers in the Cancer Prevention Study-II Nutrition Cohort (CPS-II NC)

Abstract Self-reported type 2 diabetes mellitus (T2DM) is convincingly associated with higher risks of liver, pancreatic, colon, rectal, female breast, and endometrial cancers, and may also be associated with higher risks of ovarian, bladder and kidney cancers. This evidence largely relies on self-reported T2DM, which does not properly classify the many individuals with pre-diabetes or with undiagnosed T2DM or adequately reflect glucose control among people with T2DM. To clarify these associations, we conducted a case-cohort analysis of hemoglobin A1c (HbA1c), an indicator of circulating glucose over the past 2-to-3 months used to diagnose and monitor T2DM. Participants were identified from the CPS-II NC. From an initial cohort of 32,328 participants who were cancer-free and provided a blood sample at baseline in 1998-2001, we selected a random sub-cohort of 3,000 participants. Further, we selected all participants diagnosed between baseline and June, 2013 with a verified, incident cancer of the colorectum (n=479), liver (n=35), pancreas (n=176), female breast (n=889), endometrium (n=155), ovary (n=93), bladder (n=344), or kidney (n=110). Weighted Cox proportional hazards regression models estimated hazards ratios (HRs) and 95% confidence intervals (CI) for associations of HbA1c with cancer risks combined and stratified by organ site. HRs were adjusted for age, gender, smoking, physical activity, alcohol, and hormone-use (women only). HbA1c levels reflective of clinically-defined T2DM (&amp;gt;=6.5%), compared to HbA1c levels in the non-diabetes range (&amp;lt;5.7%), were associated with statistically significantly higher risks of all 9-T2DM-associated cancers combined (HR: 1.30; 95% CI: 1.05-1.60) and colorectal cancer (HR: 1.58; 95% CI: 1.14-2.19), and associations, although not statistically significant, were in the same, hypothesized directions for risks of liver (HR: 2.30), pancreas (HR: 1.60), endometrial (HR: 1.61), ovarian (HR: 1.85), bladder (HR: 1.23), and kidney (HR: 1.23) cancers. There was no suggestion of association between HbA1c and breast cancer risk (HR: 0.95). Further analyses of colorectal cancer risk combined self-reported T2DM and measured HbA1c levels. Compared to participants who had non-diabetes levels of HbA1c (&amp;lt;=6.5%) and did not report T2DM, participants with high HbA1c levels (&amp;gt;=6.5%) were at higher risk of CRC whether they self-reported T2DM (HR: 1.54), or not (HR:1.56), whereas participants who self-reported T2DM but had good glycemic control (HbA1c =&amp;lt;6.5%) were not at higher risk (HR: 0.96). Results for c-peptide and CRP are forthcoming. This study suggests that HbA1c, a clinically meaningful marker of circulating glucose, is related to the etiology of some cancers. Citation Format: Peter T. Campbell, Christina Newton, Eric J. Jacobs, Michael Pollak, Susan M. Gapstur. Associations of hemoglobin A1c with risk of diabetes-related cancers in the Cancer Prevention Study-II Nutrition Cohort (CPS-II NC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 594.

The risk of mortality among people with type 2 diabetes in Latin America: A systematic review and meta-analysis of population-based cohort studies.

Type 2 diabetes mellitus (T2DM) is associated with a high mortality risk, although the magnitude of this association remains unknown in Latin America (LA). We aimed to assess the strength of the association between T2DM and all-cause and cause-specific mortality in population-based cohort studies in LA. Systematic review and meta-analysis: inclusion criteria were (1) men and women 18years old and above with T2DM; (2) study outcomes all-cause and/or cause-specific mortality; and (3) using people without T2DM as comparison group. Five databases (Scopus, Medline, Embase, Global Health, and LILACS) were searched. Risk of bias was evaluated with the ROBINS-I criteria. Initially, there were 979 identified studies, of which 17 were selected for qualitative synthesis; 14 were included in the meta-analysis (N=416821). Self-reported T2DM showed a pooled relative risk (RR) of 2.49 for all-causes mortality (I-squared [I2 ]=85.7%, p<0.001; 95% confidence interval [CI], 1.96-3.15). T2DM based on a composite definition was associated with a 2.26-fold higher all-cause mortality (I2 =93.9%, p<0.001; 95% CI, 1.36-3.74). The pooled risk estimates were similar between men and women, although higher at younger ages. The pooled RR for cardiovascular mortality was 2.76 (I2 =59.2%; p<0.061; 95% CI, 1.99-3.82) and for renal mortality 15.85 (I2 =0.00%; p<0.645; 95% CI, 9.82-25.57). Using available population-based cohort studies, this work has identified and estimated the strength of the association between T2DM and mortality in LA. The higher mortality risk compared with high-income countries deserves close attention from health policies makers and clinicians to improve diabetes care and control hence preventing complications and delaying death.

Alzheimer's disease and type 2 diabetes mellitus are distinct diseases with potential overlapping metabolic dysfunction upstream of observed cognitive decline.

Alzheimer's disease (AD) and type 2 diabetes mellitus (T2DM) are highly prevalent aging-related diseases associated with significant morbidity and mortality. Some findings in human and animal models have linked T2DM to AD-type dementia. Despite epidemiological associations between the T2DM and cognitive impairment, the interrelational mechanisms are unclear. The preponderance of evidence in longitudinal studies with autopsy confirmation have indicated that vascular mechanisms, rather than classic AD-type pathologies, underlie the cognitive decline often seen in self-reported T2DM. T2DM is associated with cardiovascular and cerebrovascular disease (CVD), and is associated with increased risk of infarcts and small vessel disease in the brain and other organs. Neuropathological examinations of post-mortem brains demonstrated evidence of cerebrovascular disease and little to no correlation between T2DM and β-amyloid deposits or neurofibrillary tangles. Nevertheless, the mechanisms upstream of early AD-specific pathology remain obscure. In this regard, there may indeed be overlap between the pathologic mechanisms of T2DM/"metabolic syndrome," and AD. More specifically, cerebral insulin processing, glucose metabolism, mitochondrial function, and/or lipid metabolism could be altered in patients in early AD and directly influence symptomatology and/or neuropathology.

Prevalence of pre-diabetes and type 2 diabetes mellitus among Sami and non-Sami men and women in Northern Norway – The SAMINOR 2 Clinical Survey

ABSTRACTThe aim of this study was to determine and compare the prevalence of pre-diabetes and type 2 diabetes mellitus (T2DM) among Sami and non-Sami men and women of rural districts in Northern Norway. The SAMINOR 2 Clinical Survey is a cross-sectional population-based study performed in 2012–2014 in 10 municipalities of Northern Norway. A total of 12,455 Sami and non-Sami inhabitants aged 40–79 years were invited to participate and 5878 were included in the analyses. Participants with self-reported T2DM and/or a glycated haemoglobin (HbA1c) result ≥6.5% were categorised as having T2DM. Those with 5.7%≤HbA1c<6.5% were categorised as pre-diabetics. In men, the total age-standardised prevalence of pre-diabetes (37.9% vs 31.4%) and T2DM (10.8% vs 9.5%) were higher in Sami compared with non-Sami; the ethnic difference was statistically significant for both pre-diabetes (OR 1.42, p < 0.001) and T2DM (OR 1.31, p = 0.042). In women, pre-diabetes (36.4% vs 33.5%) and T2DM (8.6% vs 7.0%) were also more common in Sami than non-Sami; the differences in both pre-diabetes (OR 1.20, p = 0.025) and T2DM (OR 1.38, p = 0.021) were also statistically significant. The observed ethnic difference in the waist-to-height ratio (WHtR) was a plausible explanation for the ethnic difference in the prevalence of pre-diabetes and T2DM.

Patient Preferences for Attributes of Type 2 Diabetes Mellitus Medications in Germany and Spain: An Online Discrete-Choice Experiment Survey.

IntroductionUnderstanding patient preferences for attributes of type 2 diabetes mellitus (T2DM) medications may help explain how the attributes differentially affect patient perceptions and behaviors. In this survey, we quantified the relative preferences among patients in Germany and Spain in separate analyses.MethodsA stated-preference, discrete-choice experiment (DCE) survey was designed to elicit preferences for T2DM treatment attributes among patients with self-reported T2DM and who reported being prescribed T2DM medication for > 2 years. Patients recruited from an online national consumer panel completed an online survey. The survey presented choices between eight pairs of hypothetical T2DM treatments defined by seven attributes: chance of reaching target hemoglobin A1c (HbA1c) level; reduced risk of serious heart attack or stroke; frequency of hypoglycemia; risk of gastrointestinal (GI) problems; weight change; mode of administration (oral or injectable); dosing frequency. Data were analyzed using random-parameters logit. Minimum acceptable benefit (MAB) was defined as the minimum increase in the probability of reaching target HbA1c for which respondents would accept less desirable levels of other attributes.ResultsIn Germany and Spain, 474 and 401 respondents completed the survey, respectively. DCE analysis showed that risk of GI problems was most important to German respondents. MAB analysis found that respondents would require a 56 percentage point increase in the probability of reaching their HbA1c target to offset a change from 0% to 30% risk of GI problems. For Spanish respondents, mode of administration was the most important attribute. These respondents would require a 59 percentage point increase in the probability of reaching their HbA1c target to offset moving from oral to injectable medications.ConclusionsRespondents in Germany and Spain were willing to trade efficacy for improvements in side effects and mode of administration. Given the variety of T2DM medications currently available, the results suggest that careful discussion about patient preferences could help improve patient satisfaction with T2DM treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0326-8) contains supplementary material, which is available to authorized users.

PDB18 - real-World Data (RWD) On The Attainment Of Composite Quality Measures (Cqm) In A Brazilian Population With Self-Reported Type-2 Diabetes Mellitus (T2DM)

PDB18 - real-World Data (RWD) On The Attainment Of Composite Quality Measures (Cqm) In A Brazilian Population With Self-Reported Type-2 Diabetes Mellitus (T2DM)

Abstract 24: Childhood Risk Factor Patterns Predict Adult Type 2 Diabetes Better Than Single Childhood Risk Factor Measures: The International Childhood Cardiovascular Cohort (i3C) Consortium

Background: Childhood risk factors predict adult onset type 2 diabetes mellitus (T2DM). We developed a novel statistical approach using risk factor patterns to improve prediction. Methods: The cohort included 5269 individuals from the Bogalusa Heart Study, Cardiovascular Risk in Young Finns Study, Childhood Determinants of Adult Health Study, Childhood Cohort Studies in Minneapolis and Cincinnati, and the Muscatine Study. All had 2+ childhood measures of risk factors between ages 3 and 20 in 1970s-90s and reported whether they had T2DM between ages 21 and 63 in 2011-16. We established sex-specific polynomial age patterns to represent standard growth curves for each risk factor and computed the residual from this standard for each observation within ages 3-20. Residuals were regressed on age within each person to get a personal intercept and slope, and then 9 patterns were formed as intercept tertiles crossed with slope tertiles within each intercept tertile. T2DM associations with risk factors were assessed by using either the first childhood measurement or childhood patterns of body mass index (BMI), systolic blood pressure (SBP), and height (HT), with covariates age at first visit, sex, race, and study. Results: Mean age at first measure was 9.2 (SD 3.3) y, 41% male, 85% white, 12% black, with 2-19 repeats of childhood risk factor measures. Risk factor patterns tended to diverge from each other by mid-childhood and measured adult risk factor values were well predicted, diverging widely across the childhood patterns (not shown). After mean follow-up of 29.0 (SD 8.1) y, 282 (5.4%) participants self-reported T2DM. T2DM was predicted by the model including first measures of BMI (positive), SBP (positive), and HT (inverse), but the corresponding pattern model improved prediction probability by 55% (Table). Conclusion: These findings show the value of using multiple risk factor measurements during childhood and the potential for developing risk factor pattern charts to be used as clinical standards for predicting adult T2DM risk.

Evaluating preferences for profiles of glucagon-like peptide-1 receptor agonists among injection-naive type 2 diabetes patients in Japan.

ObjectiveThe objective of this study was to use a discrete choice experiment (DCE) to estimate patients’ preferences for the treatment features, safety, and efficacy of two specific glucagon-like peptide-1 receptor agonists, dulaglutide and liraglutide, among patients with type 2 diabetes mellitus (T2DM) in Japan.MethodsIn Japan, patients with self-reported T2DM and naive to treatment with self-injectable medications were administered a DCE through an in-person interview. The DCE examined the following six attributes of T2DM treatment, each described by two levels: “dosing frequency”, “hemoglobin A1c change”, “weight change”, “type of delivery system”, “frequency of nausea”, and “frequency of hypoglycemia”. Part-worth utilities were estimated using logit models and were used to calculate the relative importance (RI) of each attribute. A chi-square test was used to determine the differences in preferences for the dulaglutide versus liraglutide profiles.ResultsThe final evaluable sample consisted of 182 participants (mean age: 58.9 [standard deviation =10.0] years; 64.3% male; mean body mass index: 26.1 [standard deviation =5.0] kg/m2). The RI values for the attributes in rank order were dosing frequency (44.1%), type of delivery system (26.3%), frequency of nausea (15.1%), frequency of hypoglycemia (7.4%), weight change (6.2%), and hemoglobin A1c change (1.0%). Significantly more participants preferred the dulaglutide profile (94.5%) compared to the liraglutide profile (5.5%; P<0.0001).ConclusionThis study elicited the preferences of Japanese T2DM patients for attributes and levels representing the actual characteristics of two existing glucagon-like peptide-1 receptor agonists. In this comparison, dosing frequency and type of delivery system were the two most important characteristics, accounting for >70% of the RI. These findings are similar to those of a previous UK study, providing information about patients’ preferences that may be informative for patient–clinician treatment discussions.

Exposures to road traffic, noise, and air pollution as risk factors for type 2 diabetes: A feasibility study in Bulgaria

Type 2 diabetes mellitus (T2DM) is a growing public health problem in Bulgaria. While individual and lifestyle determinants have been researched; till date there has been no study on environmental risks such as road traffic, noise, and air pollution. As a first step toward designing a large-scale population-based survey, we aimed at exploring the overall associations of prevalent T2DM with exposures to road traffic, noise, and air pollution. A total of 513 residents of Plovdiv city, Bulgaria were recruited. Individual data on self-reported doctor-diagnosed T2DM and confounding factors were linked to objective and self-rated exposure indicators. Logistic and log-link Poisson regressions were conducted. In the fully adjusted logistic models, T2DM was positively associated with exposures to Lden 71-80 dB (odds ratio (OR) = 4.49, 95% confidence interval (CI): 1.38, 14.68), fine particulate matter (PM)2.5 25.0-66.8 μg/m3 (OR = 1.32, 95% CI: 0.28, 6.24), benzo alpha pyrene 6.0-14.02 ng/m3 (OR = 1.76, 95% CI: 0.52, 5.98) and high road traffic (OR = 1.40, 95% CI: 0.48, 4.07). Lden remained a significant risk factor in the: Poisson regression model. Other covariates with consistently high multivariate effects were age, gender, body mass index, family history of T2DM, subjective sleep disturbance, and especially bedroom location. We concluded that residential noise exposure might be associated with elevated risk of prevalent T2DM. The inferences made by this research and the lessons learned from its limitations could guide the designing of a longitudinal epidemiological survey in Bulgaria.

Evaluating preferences for profiles of GLP-1 receptor agonists among injection-naïve type 2 diabetes patients in the UK.

ObjectiveTo use a discrete choice experiment (DCE) to evaluate preferences for the actual treatment features and overall profiles of two injectable glucagon-like peptide-1 receptor agonists (dulaglutide and liraglutide) among patients with type 2 diabetes mellitus (T2DM) in the UK.MethodsIn-person interviews were conducted in the UK to administer a DCE to patients with self-reported T2DM, naïve to treatment with injectable medications. The DCE examined six attributes of T2DM treatment each described by two levels: “dosing frequency,” “hemoglobin A1c change,” “weight change,” “type of delivery system,” “frequency of nausea,” and “frequency of hypoglycemia.” Part-worth utilities were estimated using random effects logit models and were used to calculate relative importance (RI) values for each attribute. A chi-square test was used to determine differences in preferences for dulaglutide versus liraglutide profiles.ResultsA total of 243 participants [mean age: 60.5 (standard deviation 10.9) years; 76.1% male; mean body mass index: 29.8 (standard deviation 5.4) kg/m2] completed the study. RI values for the attributes in rank order were: “dosing frequency” (41.6%), “type of delivery system” (35.5%), “frequency of nausea” (10.4%), “weight change” (5.9%), “hemoglobin A1c change” (3.6%), and “frequency of hypoglycemia” (3.0%). Significantly more participants preferred the dulaglutide profile (83.1%) compared with the liraglutide profile (16.9%; P<0.0001).ConclusionThis study elicited patients’ preferences for attributes and levels representing the actual characteristics of two specific glucagon-like peptide-1 medications. In this context, dosing frequency and type of delivery system were most important, accounting for over 75% of the RI. While previous studies have identified efficacy as highly important in T2DM medication decisions, this study suggests that when differences in efficacy between medications are small, other treatment features (eg, dosing frequency and delivery system) are of much greater importance to patients.