Prevalence Of Type 2 Diabetes Research Articles

#6054 CLINICAL CHARACTERISTICS AND RENAL RISK OF PATIENTS WITH CHRONIC KIDNEY DISEASE: REAL-WORLD EVIDENCE FROM THE ICAREME GLOBAL REGISTRY

Abstract Background and Aims Chronic kidney disease (CKD) has emerged as a leading global public health concern due to its growing prevalence and associated morbidity and mortality. Throughout the disease progression, CKD is associated with a substantial health and socio-economic burden on patients, families, and healthcare systems worsened by complex interactions with type 2 diabetes (T2D), hypertension (HTN), and heart failure (HF). To help current and future patients get the best possible care, it is of the greatest importance to better understand how they are managed routinely, but real-world data on coexisting cardiovascular, renal, and metabolic diseases are scarce or non-existent in many countries. The iCaReMe Global Registry aims to address these knowledge gaps by providing observational data on patients’ characteristics, risk factors, management patterns, disease progression, and outcomes related to CKD and associated comorbidities namely: T2D, HTN, and HF. Method The iCaReMe Global Registry (NCT03549754) is a prospective, investigator-led, multinational, observational registry relying on voluntary participation by treating physicians to assess the management and quality of care through socio-demographic and clinical characteristics, disease management patterns (including screening, diagnosis, treatment approaches), healthcare resource utilization and clinical outcomes in patients with CKD, T2D, HTN, and/or HF. Eligible and consented patients were enrolled during routine clinical practice based on the physician's discretion and were followed up per routine clinical care. We present the descriptive analysis of baseline clinical and demographic characteristics of the CKD cohort enrolled in the iCaReMe Global Registry from February 2018 to December 2022. Results Overall 2977 patients with CKD have been enrolled from 21 countries (Argentina, Costa Rica, Egypt, Ethiopia, Georgia, Greece, Hong Kong, Indonesia, India, Jordan, Kenya, Lebanon, Malaysia, Mexico, Russia, South Africa, Thailand, The Philippines, Turkey, Ukraine, and the United Arab Emirates). At baseline, the mean ± standard deviation (SD) age was 60.4 ± 13.8 years and 54.6% were males. The mean ± SD systolic and diastolic blood pressures of the cohort were 120.4 ± 43.6 and 70.5 ± 25.6 mmHg and the mean ± SD body mass index was 21.6 ± 12.9 kg/m2. 68.9% had T2D and 68.3% had hypertension. Diabetic kidney disease and hypertensive kidney disease were the most common etiologies in 78.8% of the patients (Figure 2). Serum creatinine was reported in 85.3% of patients and urine albumin-creatinine ratio (UACR) in 30.5% and only 25.9% had both. The prevalence of KDIGO GFR categories G3-5 based on estimated glomerular filtration rate (eGFR) using CKD-EPI was 72.5% and the prevalence of albuminuria A2/A3 was 75.9%. In total, 7.9% patients were undergoing dialysis. In patients with T2D (n = 2051); 69.1% (1250/1808) had G3-5 GFR category and 76.1% (484/636) had albuminuria stage A2 and A3. In patients with HTN (n = 2033); 77.6% (1367/1761) had G3-5 GFR category and 76.6% (485/633) had albuminuria stage A2 and A3. Conclusion At baseline most of iCaReMe Registry CKD cohort fall within the KDIGO high or very high risk of outcomes associated with a high prevalence of T2D and HTN. Our results also indicate an underutilization of albuminuria testing despite its critical role in diagnosis, risk stratification and follow up which raises concerns about CKD early detection, management, and prognosis.

Prevalence of Type 2 Diabetes, Impaired Fasting Glucose, and Diabetes Risk in an Adult and Older North-Eastern Portuguese Population.

The aims of this study were (1) to evaluate the prevalence of type 2 diabetes (T2D) in a middle-aged north-eastern Portuguese population, (2) to analyze the prevalence of impaired fasting glucose (IFG), and (3) to assess the risk of T2D in this community-based sample. An exploratory, retrospective, and cross-sectional study was conducted from a total of 6570 individuals aged 18-102 years, among which 3865 were women (57.4 ± 18.1 years) and 2705 were men (60.0 ± 16.8 years). T2D diagnosis, IFG, and the diabetes risk score (low to very high risk) were assessed. The prevalence of T2D in this adult and an older north-eastern Portuguese population was 17.4%. A higher prevalence of T2D was reported in men (22.2%) than in women (14.0%); however, this was without significant differences (p = 0.086). Otherwise, the prevalence of T2D was significantly different among the age groups and increased with age (p < 0.001). Regarding IFG, a higher percentage of cases was observed in men (14.1%) than in women (8.4%) (p < 0.001). The risk of developing T2D in the next 10 years showed an association with sex and age group (p < 0.001) with a small-to-moderate effect (V = 0.1-0.3). Men and the elderly had the highest percentage of cases in the moderate-to-very high-risk bands. The current research confirmed a higher prevalence of T2D, IFG, and diabetes risk than previous Portuguese epidemiological reports. The results also suggest potential prediabetes cases, which should be carefully monitored. The current research adds evidence to the worldwide trend of the increasing prevalence of T2D and intermediate hyperglycemia (i.e., prediabetes).

Impact of type 2 diabetes on mortality, cause of death, and treatment in chronic lymphocytic leukemia.

Age-related comorbid conditions are exceedingly common in patients with chronic lymphocytic leukemia (CLL). As the prevalence of type 2 diabetes (T2D) is predicted to double during the next two decades, a better understanding of the interplay between CLL and T2D is of increasing importance. In this study, analyses were performed in parallel in two separate cohorts, based on Danish national registers and the Mayo Clinic CLL Resource. The primary outcomes were overall survival (OS) from time of CLL diagnosis, OS from time of treatment, and time to first treatment (TTFT), studied using Cox proportional hazard regression analysis and Fine-Gray regression analysis. In the Danish CLL cohort, the prevalence of T2D was 11%, in the Mayo CLL cohort, it was 12%. Patients with CLL and T2D had shorter OS both from time of diagnosis and from first-line treatment for were less likely to receive treatment for CLL compared with patients with CLL and without T2D. The increased mortality was largely driven by an increased risk of death due to infections, especially in the Danish cohort. The findings of this study emphasize a substantial subgroup of CLL patients with co-occurring T2D with an inferior prognosis and a possible unmet treatment need requiring additional interventions and further research.

Absence of the influence of the APOE gene on the incidence of type 2 diabetes mellitus in a cohort of workers: Effect of diet and shift work

BackgroundAPOE gene encoded a multifunctional protein in lipid metabolism, also associated with inflammatory markers. Type 2 diabetes (T2D) is a complex metabolic disease related to increased blood glucose, triglycerides and VLDL and associated with different dyslipidaemias. The aim of this study was to analyze whether the APOE genotype could determining the risk of developing T2D in a large cohort of workers. Material and methodsData from the Aragon Workers Health Study (AWHS) (n=4895) were used to investigate the relationship between glycemic levels and APOE genotype. All patients in the AWHS cohort had their blood drawn after an overnight fast and laboratory tests were performed on the same day as the blood drawn. Dietary and physical assessment was assessed by face-to-face interview. APOE genotype was determined by the Sanger sequencing method. ResultsThe relationship between APOE genotype and glycemic profile showed that glucose, Hb1Ac, insulin and HOMA levels did not seem to be associated with the APOE genotype (p=0.563, p=0.605, p=0.333 and p=0.276, respectively). In addition, the T2D prevalence did not show an association with the APOE genotype (p=0.354). Along the same lines, blood glucose levels and T2D prevalence did not show association with the APOE allele. Shift work had some effect on the glycaemic profile, showing that night shift workers have significantly lower levels of glucose, insulin and HOMA (p<0.001). However, the APOE genotype did not show difference in the concentration of glycaemic parameters adjusting by sex, age and BMI, work shift and dietary parameters. ConclusionGlycemic profile and T2D prevalence did not show any significant association with the APOE genotype. Besides, individuals, who worked in non-rotating night shift showed significantly lower glycemic levels, while workers in the morning-afternoon-night shift showed significantly higher values.

Triazine herbicides exposure, natural immunoglobulin M antibodies, and fasting plasma glucose changes: Association and mediation analyses in general Chinese urban adults

The effects of triazine herbicides on glucose metabolism remain unclear. In this study, we aimed to assess the associations between serum triazine herbicides and glycemia-related risk indicators in general adults, and to evaluate the mediating role of natural immunoglobulin M antibodies (IgM) in the above associations among uninfected participants. We measured the concentrations of atrazine, cyanazine, and IgM in serum, as well as fasting plasma glucose (FPG), and fasting plasma insulin in 4423 adult participants from the Wuhan-Zhuhai cohort baseline population, enrolled in 2011–2012. Generalized linear models were used to evaluate the associations of serum triazine herbicides with glycemia-related risk indicators, and mediation analyses were performed to evaluate the mediating role of serum IgM in the above associations. The median levels of serum atrazine and cyanazine were 0.0237 μg/L and 0.0786 μg/L, respectively. Our study found significant positive associations of serum atrazine, cyanazine, and Σtriazine with FPG levels, risk of impaired fasting glucose (IFG), abnormal glucose regulation (AGR), and type 2 diabetes (T2D). Additionally, serum cyanazine and Σtriazine were found to be significant positive associated with the homeostatic model assessment of insulin resistance (HOMA-IR) levels. Significant negative linear relationships were observed in associations of serum IgM with serum triazine herbicides, FPG, HOMA-IR levels, the prevalence of T2D, and AGR (P < 0.05). Furthermore, we observed a significant mediating role by IgM in the associations of serum triazine herbicides with FPG, HOMA-IR, and AGR, with the proportions ranging from 2.96% to 7.71%. To ensure the stability of our findings, we conducted sensitivity analyses in normoglycemic participants and found that the association of serum IgM with FPG and the mediating role by IgM remained stable. Our results suggest that triazine herbicides exposure is positively associated with abnormal glucose metabolism, and decreasing serum IgM may partly mediate these associations.

Performance Analysis and Assessment of Type 2 Diabetes Screening Scores in Patients with Non-Alcoholic Fatty Liver Disease

Type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD) are worldwide chronic diseases that have strong relationships with one another and commonly exist together. Type 2 diabetes is considered one of the risk factors for NAFLD, so its occurrence in people with NAFLD is highly likely. As the high and increasing number of T2D and NAFLD, which potentially followed by existing together number, an analysis and assessment of T2D screening scores in people with NAFLD is necessary to be done. To prevent this potential case, an effective early prediction model is also required to be developed, which could help the patients avoid the dangers of both existing diseases. Therefore, in this study, analysis and assessment of T2D screening scores in people with NAFLD and the early prediction model utilizing a forward logistic regression-based feature selection method and multi-layer perceptrons are proposed. Our analysis and assessment results showed that the prevalence of T2D among patients with NAFLD was 8.13% (for prediabetes) and 37.19% (for diabetes) in two population-based NAFLD datasets. The variables related to clinical tests, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and systolic blood pressure (SBP), were found to be statistically significant predictors (p-values &lt; 0.001) that indicate a strong association with T2D among patients with NAFLD in both the prediabetes and diabetes NAFLD datasets. Finally, our proposed model showed the best performance in terms of all performance evaluation metrics compared to existing various machine learning models and also the models using variables recommended by WHO/CDC/ADA, with achieved accuracy as much as 92.11% and 83.05% and its improvement scores after feature selection of 1.35% and 5.35%, for the first and second dataset, respectively.

Interethnic Differences in Bladder Cancer Incidence and the Association between Type 2 Diabetes and Bladder Cancer in the Multiethnic Cohort Study.

Research on the association between type 2 diabetes (T2D) and bladder cancer (BCA) risk among non-European ancestry populations is sparse to nonexistent, and most prior studies rely on a single baseline assessment of T2D status. We estimated the T2D-BCA association using the Multiethnic Cohort Study of 185,059 men and women in California and Hawaii. Participants were African American, European American, Japanese American, Latin American, and Native Hawaiian, ages 45-75 years at enrollment (1993-1996). T2D was assessed by self-report at baseline, follow-up surveys, and Medicare claims. Cases were identified using Surveillance, Epidemiology and End Results Program cancer registries through 2016. Associations were estimated by race/ethnicity using Cox proportional hazards regression. Adjusted attributable fractions (AAF) and cumulative absolute risk of bladder cancer were estimated across groups. Over an average 19.7 years of follow-up 1,890 incident bladder cancer cases were diagnosed. Time-varying T2D was associated with bladder cancer in the multiethnic sample (HR = 1.17; 95% confidence interval, 1.05-1.30); however, the HR did not differ by race/ethnicity (P = 0.85). The AAF was 4.2% in the multiethnic sample and largest among Native Hawaiians (9.8%). Absolute risk of bladder cancer among European Americans without T2D was higher than all other groups with T2D. T2D is significantly associated with bladder cancer risk in a multiethnic sample. Those with T2D have higher incidence of bladder cancer, regardless of racial/ethnic group. Reducing T2D prevalence could substantially lower bladder cancer incidence among Native Hawaiians due to T2D being more common in this group. High absolute risk of bladder cancer among European Americans, regardless of T2D status, indicates that elevated bladder cancer risk in this group may be due to factors other than T2D. Future studies must explore reasons for this difference in incidence.

Does flux through the hexosamine biosynthesis pathway differ between endothelial cells from African American and Caucasian donors?

People with Type 2 Diabetes (T2D) often exhibit endothelial dysfunction (EndoDys), which underlies the initiation of many diseases. African Americans (AA) have a greater prevalence of T2D and EndoDys than their Caucasian (CA) counterparts. To understand these differences, we examined glucose metabolism within the endothelium. Specifically, we sought to determine whether there are differences between AAs and CAs in the Hexosamine Biosynthesis Pathway (HBP), a route of glucose utilization that is upregulated in T2D. We hypothesized that endothelial cells (EC) from AA donors will show a greater flux through the HBP and express higher markers of EndoDys compared to CA donors. Human umbilical vein ECs (HUVECs), n=2-3/group, were incubated for 24hrs with high (HG, 30mM) or normal (5.5mM) glucose. Protein expression was measured via western blot for the: 1) HBP rate-limiting enzyme (Glutamine: fructose-6-phosphate amidotransferase, GFAT); 2) enzyme catalyzing the addition of HBP end-products to various proteins (O-GlcNAc transferase, OGT); and 3) attachment of O-linked N-acetylglucosamine moieties to various proteins (O-GlcNAcylation, O-GlcNAc), in addition to markers of EndoDys. Hyperglycemia did not differentially impact the expression of HBP markers GFAT or OGT between ECs from CA and AA donors (glycemic status [GS], p=0.6723; race, p=0.3807 and GS, p=0.8695; race, p=0.3536, respectively). Although total O-GlcNAc did not significantly increase with HG, there was a trend toward higher O-GlcNAcylation in AA ECs (p=0.0897). Upon further examination of O-GlcNAcylation, there were 3 prominent bands of highly O-GlcNAcylated proteins at &gt;220kDa (band 1), ~150-200kDa (band 2), and ~85kDa (band 3). There was significantly higher O-GlcNAcylation of protein in band 2 for AA donors compared to CA donors (p=0.0362). The apoptotic marker, Caspase-3, did not change with HG (p=0.9219) nor differ in expression between races (p=0.2060). The inflammatory marker, VCAM, was significantly higher in cells from AA donors (p=0.002) but did not differ with GS (p=0.3468). There was no GS by race interaction found. EndoDys links T2D and other pathologies. We examined the HBP pathway of glucose utilization in ECs from CA and AA donors. There was a main effect of race related to inflammation and total O-GlcNAcylation, without differences in the expression of key proteins within the pathway. Our results suggest that the HBP may contribute to the racial differences in EndoDys, however, this relationship is not straightforward and does not seem to be exacerbated in the context of HG. Future research is needed to examine these unexpected discrepancies and interrogate the link between HBP flux within the endothelium, along with its connection to various pathologies This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Achievement of the ABC goal among Canadians with type 2 diabetes and the influence of physical activity: data from the Canadian Health Measures Survey.

Achieving the three therapeutics targets known as ABC (A1c≤7.0%, LDL-C<2.0mmol/L, and resting BP<130/80mmHg), limiting sedentary behaviors as well as accumulating a total of 150 min/week of moderate-to-vigorous aerobic exercise reduce the risk of cardiovascular disease in type 2 diabetes (T2D) individuals. However, more recent data regarding the achievement of ABC over time in Canada is needed and it remains to be determined how sedentary behaviors and physical activity levels can influence its achievement. Analyses were performed using a total of 17582 individuals (18-79 years) from the 2007-2017 Canadian Health Measures Survey. Sedentary behaviors and physical activity levels were estimated using an accelerometer for a total of 7 consecutive days and quartiles of physical activity were used to categorize individuals. The prevalence of T2D has increased from 2007 to 2017 in the Canadian population (from 4.80% to 8.38%) with a considerable number of undiagnosed patients. The achievement of ABC went from 11.53% [11.49%-11.57%] in 2007 to 14.84% [14.80%-14.89%] in 2017 in T2D individuals. Moderate-to-vigorous physical activity (MVPA) levels were positively but weakly correlated to the achievement of the ABC (r=0.044; p=0.001), while sedentary time and light physical activity were not (r < -0.014; p=0.266). Only 8.8% of individuals with the lowest level of MVPA (Q1) reached the ABC while 15.1% of the most active individuals (Q4) reached the triple target. In addition to physical activity, other important factors such as body mass index and medication use should also be considered as modifiable contributing factors.

The impact of forced displacement: trauma, increased levels of inflammation and early presentation of diabetes in women Syrian refugees.

Forced displacement and war trauma cause high rates of post-traumatic stress, anxiety disorders and depression in refugee populations. We investigated the impact of forced displacement on mental health status, gender, presentation of type 2 diabetes (T2D) and associated inflammatory markers among Syrian refugees in Lebanon. Mental health status was assessed using the Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptom Checklist-25 (HSCL-25). Additional metabolic and inflammatory markers were analyzed. Although symptomatic stress scores were observed in both men and women, women consistently displayed higher symptomatic anxiety/depression scores with the HSCL-25 (2.13±0.58 versus 1.95±0.63). With the HTQ, however, only women aged 35-55 years displayed symptomatic post-traumatic stress disorder (PTSD) scores (2.18±0.43). Furthermore, a significantly higher prevalence of obesity, prediabetes and undiagnosed T2D were observed in women participants (23.43, 14.91 and 15.18%, respectively). Significantly high levels of the inflammatory marker serum amyloid A were observed in women (11.90±11.27 versus 9.28±6.93, P=0.036). Symptomatic PTSD, anxiety/depression coupled with higher levels of inflammatory marker and T2D were found in refugee women aged between 35 and 55years favoring the strong need for psychosocial therapeutic interventions in moderating stress-related immune dysfunction and development of diabetes in this subset of female Syrian refugees.

Evaluation of effective coverage for type 2 diabetes in Mexican primary care health information systems: a retrospective registry analysis

BackgroundAs the leading cause of disability and the fourth leading cause of premature death in Mexico, type 2 diabetes (T2D) represents a serious public health concern. The incidence of diabetes has increased dramatically in recent years, and data from the Mexican National Health and Nutrition Survey (ENSANUT) indicate that many people remain undiagnosed. Persistent socioeconomic health care barriers exacerbate this situation, as T2D morbidity and mortality are worsened in vulnerable populations, such as those without social security. We evaluated the performance of public primary health centers (PHCs) in T2D medical attention through the measure of effective coverage (EC, a combined measure of health care need, use, and quality) at national, state, health jurisdiction, and municipality levels.MethodsThis retrospective analysis used blinded data recorded during 2017 in the Non-communicable Diseases National Information System (SIC) and T2D prevalence reported in 2018 ENSANUT to evaluate the EC achieved. We included individuals ≥ 20 years old without social security who did not declare the use of private health care services. Each EC component (need, use, and quality) was estimated based on the Shengelia adapted framework. The Kruskal–Wallis test was applied to evaluate the associations among EC quintiles and demographics.ResultsIn 2017, 26.5 million individuals, aged ≥ 20 years, without social security, and without the use of private health care services, were under the care of 12,086 PHCs. The national prevalence of T2D was 10.3%, equivalent to 2.6 million people living with T2D in need of primary health care. Large contrasts were seen among EC components between and within Mexican states. We found that only 37.1% of the above individuals received health services at PHCs and of them, 25.8% improved their metabolic condition. The national EC was 9.3%, and the range (by health jurisdiction) was 0.2%–38.6%, representing a large geographic disparity in EC. We found an evident disconnect among need, utilization, and quality rates across the country.ConclusionsExpansion and improvement of EC are urgently needed to address the growing number of people living with T2D in Mexico, particularly in states with vulnerable populations.

Effects of residential greenness and genetic predisposition on hemoglobin A1c and type 2 diabetes: Gene-environment interaction analysis from a nationwide study

BackgroundCurrent evidence on the relations of residential greenness with glucose homeostasis and type 2 diabetes (T2D) remained largely uncertain. Most importantly, no prior studies have investigated whether genetic predisposition modifies the above associations. MethodsWe leveraged data from the UK Biobank prospective cohort study, with participants enrolled between 2006 and 2010. Residential greenness was assessed by using the Normalized Difference Vegetation Index, and the weighting T2D-specific genetic risk score (GRS) was constructed based on previously published genome-wide association studies. Linear regression models and logistic regression models were used to investigate associations of residential greenness with glycated hemoglobin (HbA1c) and T2D prevalence, respectively. Interaction models explored whether genetic predisposition modifies greenness-HbA1c/T2D associations. ResultsAmong 315,146 individuals (mean [SD] age, 56.59 [8.09] years), each one-unit increase in residential greenness was associated with reduction in HbA1c (β: −0.87, 95% CI: −1.16 to −0.58) and a 12% decrease in odds of T2D (OR: 0.88, 95% CI: 0.79 to 0.98), respectively. Additionally, interaction analyses further demonstrated that residential greenness and genetic risk had cumulative effects on HbA1c and T2D. Compared with individuals who were exposed to low greenness and had high GRS, participants with low GRS and high greenness had a significant decline in HbA1c (β: −2.96, 95% CI: −3.10 to −2.82, P for interaction = 0.04) and T2D (OR: 0.47, 95% CI: 0.45 to 0.50, P for interaction = 0.09). ConclusionsWe add novel evidence that residential greenness has protective effects on glucose metabolism and T2D, and those beneficial effects can be amplified by low genetic risk. Our findings may facilitate the improvement of the living environment and the development of prevention strategies by considering genetic susceptibility to T2D.

Changes in Prevalence and Incidence at the Population Level of Type 2 Diabetes in First Nations and All Other Adults in Manitoba

ObjectivesThe prevalence of type 2 diabetes (T2D) is increasing and Indigenous populations are at highest risk. Canadian data are crucial for health planning. MethodsPopulation-based, de-identified, linked databases were used to calculate the incidence and prevalence of T2D for registered adult First Nations Manitobans and all other adult Manitobans from 2011–2012 to 2016–2017. ResultsThe crude prevalence of T2D increased over the 6-year study period. The crude incidence of T2D for First Nations Manitobans dropped from 11.02 to 9.74 per 1,000 person-years at risk and the crude incidence for all other Manitobans did not change; in the last 2-year period, it was 6.53 per 1,000 person-years at risk. When incidence was stratified by age, the results differed between the younger and older age groups. For First Nations individuals, the adjusted incidence of T2D for those <30 years old increased over time, with no change in those ≥30 years old. For all other Manitobans, crude incidence increased over time in the young and middle age ranges (i.e. 18 to 29 years and 35 to 44 years, respectively). Both age- and sex-adjusted relative prevalence (adjusted rate ratio [aRR], 3.47; 95% confidence interval [CI], 2.56 to 4.70) and incidence (aRR, 1.97; 95% CI, 1.51 to 2.56) were higher for First Nations Manitobans. ConclusionsThe prevalence of T2D continues to increase and disproportionately affects First Nations populations. Furthermore, the incidence is increasing in the younger age groups. Prevention and screening programs must include younger age groups and partner with First Nations communities.

A polygenic and family risk score are both independently associated with risk of type 2 diabetes in a population-based study

The availability of polygenic scores for type 2 diabetes (T2D) raises the question, whether assessing family history might become redundant. However, family history not only involves shared genetics, but also shared environment. It was the aim of this study to assess the independent and combined effects of one family risk score (FamRS) and a polygenic score (PGS) on prevalent and incident T2D risk in a population-based study from Germany (n = 3071). The study was conducted in 2004/2005 with up to 12 years of follow-up. The FamRS takes into account not only the number of diseased first grade relatives, but also age at onset of the relatives and age of participants. 256 prevalent and additional 163 incident T2D cases were recorded. Prevalence of T2D increased sharply for those within the top quantile of the PGS distribution resulting in an OR of 19.16 (p < 2 × 10–16) for the top 20% compared to the remainder of the population, independent of age, sex, BMI, physical activity and FamRS. On the other hand, having a very strong family risk compared to average was still associated with an OR of 2.78 (p = 0.001), independent of the aforementioned factors and the PGS. The PGS and FamRS were only slightly correlated (r2Spearman = 0.018). The combined contribution of both factors varied with varying age-groups, though, with decreasing influence of the PGS with increasing age. To conclude, both, genetic information and family history are relevant for the prediction of T2D risk and might be used for identification of high risk groups to personalize prevention measures.

Case Study of How China’s Community Healthcare Service Responds to Type 2 Diabetes

Diabetes is one of the world’s most common chronic diseases. From the data shown above, we can see that diabetes is a wide-spread serious illness. Hence, prevalence of diabetes imposes a substantial threat on public health well-being. Therefore, it is important for official organizations to come up with solutions to respond to diabetes. Among different type of diabetes, type 2 diabetes (T2D) is the most common one and usually influenced by postnatal factors. In China, community health service centers play a major role in responding to T2D. Thus, it is important to analyze how the community health service centers are currently responding to diabetes and create guides for future works based on the analyzed results. In this article, background information on present T2D prevalence and strategies used as response solution for diabetes in China are provided. The method, main goal, and significance of the case study are also included. The main focus of this study is evaluating how China’s community health service centers are responding to T2D via SWOT analysis. Thorough evaluation on internal strengths, internal weakness, external opportunities, and external threats are conducted with the aid of health impact pyramid and levels of prevention. At the end of the article, 3 possible ways to improve how China’s community health service responds to T2D based on SWOT analysis are stated. In addition, expectations towards future research on China’s response to T2D are discussed.

Coronary artery calcium, hepatic steatosis, and atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus: Results from the Dallas heart study

IntroductionCardiovascular disease (CVD) risk amongst those with type 2 diabetes (T2D) is heterogenous. The role of imaging-based cardiometabolic biomarkers (e.g., coronary artery calcium [CAC] score, and hepatic triglyceride content [HTC]) in CVD risk stratification in T2D is unclear. To better understand this, we sought to evaluate the individual and joint associations between CAC and hepatic steatosis (HS) with clinical atherosclerotic CVD (ASCVD) in Dallas Heart Study (DHS) participants with and without T2D. MethodsWe examined participants in the DHS, a multi-ethnic cohort study, without self-reported ASCVD. CAC scoring was performed via computed tomography with the mean of two consecutive scores used. HTC was measured using magnetic resonance spectroscopy, and HS was defined as HTC >5.5% The primary outcome was incident ASCVD, defined as coronary heart disease (CHD; myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery), ischemic stroke, transient ischemic attack, or CVD death. Cox regression analyses, and interaction testing was performed to evaluate the individual and joint associations between CAC and HS with ASCVD. The association between HS and coronary heart disease was validated in the UK Biobank (UKB). ResultsA total of 1252 DHS participants were included with mean age 44.8 ± 9.3 years, mean body mass index 28.7 ± 5.9 kg/m2, 55% female, and 59% black with an overall prevalence of T2D of 9.7%. CAC scores were significantly higher (p < 0.01) and HS was significantly more prevalent in those with T2D (p < 0.01). Over a median of 12.3 years, 8.3% of participants experienced ASCVD events. The ASCVD event rate was significantly higher in participants with T2D (20.5% vs 7.0%, p < 0.01). Continuous CAC was associated with ASCVD events in the overall cohort regardless of T2D status with a significant interaction present between CAC and T2D status on ASCVD, Pinteraction = 0.02. HTC was not associated with ASCVD risk in participants without T2D but was inversely associated with risk in participants with T2D (HR 0.91, 95% CI 0.83–0.99 per 1% increase in HTC, p = 0.02), Pinteraction = 0.02. Amongst 37,266 UKB participants, 4.5% had T2D. CHD events occurred in 2.2% of participants, with 10.2% of events occurring amongst those with T2D. An inverse relationship between HTC and CHD was also found amongst those with T2D in UKB with a significant interaction between T2D status and HTC on CHD (HR per 1% increase in HTC 0.95, 95% CI 0.91–0.99, p = 0.01, Pinteraction = 0.02). ConclusionsIn the DHS, we found that CAC was associated with ASCVD risk independent of T2D status. We did not observe an association between HTC and ASCVD in participants without T2D, but there was an inverse association between HTC and ASCVD in those with T2D that was replicated in the UKB cohort. Further investigation is warranted to understand the possible protective association of HS in participants with T2D.

Type 2 diabetes prevalence, awareness, and risk factors in rural Mali: a cross-sectional study

Diabetes is currently a crisis in sub-Saharan West Africa (SSWA) with dramatic implications for public health and national budgets prioritizing infectious diseases. There is limited recent literature about the prevalence, awareness, and risk factors for type 2 diabetes (T2D) in rural parts of SSWA. This study characterized T2D prevalence and risk factors for the rural Malian community of Nièna, which is situated in Mali’s second-largest province of Sikasso. Between December 2020 and July 2021, a cross-sectional study of 412 participants was conducted in the Nièna community using clinical questionnaires and rapid diagnostic tests. Among 412 participants, there were 143 (34.7%) and 269 (65.3%) males and females, respectively. The overall prevalence of T2D in Nièna was 7.5% (31/412), and prevalence rates were 8.6% (23/269) and 5.6% (8/143) for females and males, respectively. Age, family history of diabetes, hypertension, waist circumference, and fetal macrosomia were significantly associated with T2D (p = 0.007, p < 0.001, p = 0.003, p = 0.013, and p < 0.001, respectively). Notably, 61.3% (19/31) of T2D subjects were unaware of their diabetic status before the study. Field surveys have considerable utility in driving T2D awareness in rural African settings.

Critical Overview on Endocrine Disruptors in Diabetes Mellitus.

Diabetes mellitus is a major public health problem in all countries due to its high human and economic burden. Major metabolic alterations are associated with the chronic hyperglycemia that characterizes diabetes and causes devastating complications, including retinopathy, kidney failure, coronary disease and increased cardiovascular mortality. The most common form is type 2 diabetes (T2D) accounting for 90 to 95% of the cases. These chronic metabolic disorders are heterogeneous to which genetic factors contribute, but so do prenatal and postnatal life environmental factors including a sedentary lifestyle, overweight, and obesity. However, these classical risk factors alone cannot explain the rapid evolution of the prevalence of T2D and the high prevalence of type 1 diabetes in particular areas. Among environmental factors, we are in fact exposed to a growing amount of chemical molecules produced by our industries or by our way of life. In this narrative review, we aim to give a critical overview of the role of these pollutants that can interfere with our endocrine system, the so-called endocrine-disrupting chemicals (EDCs), in the pathophysiology of diabetes and metabolic disorders.

Serum 25-Hydroxyvitamin D Levels and Youth-Onset Type 2 Diabetes: A Two-Sample Mendelian Randomization Study.

Observational studies have linked vitamin D insufficiency to pediatric type 2 diabetes (T2D), but evidence from vitamin D supplementation trials is sparse. Given the rising prevalence of pediatric T2D in all ethnicities, determining the protective role of vitamin D has significant public health importance. We tested whether serum 25-hydroxyvitamin D (25OHD) levels are causally linked to youth-onset T2D risk using Mendelian randomization (MR). We selected 54 single-nucleotide polymorphisms (SNPs) associated with 25OHD in a European genome-wide association study (GWAS) on 443,734 individuals and obtained their effects on pediatric T2D from the multi-ethnic PRODIGY GWAS (3006 cases/6061 controls). We applied inverse variance weighted (IVW) MR and a series of MR methods to control for pleiotropy. We undertook sensitivity analyses in ethnic sub-cohorts of PRODIGY, using SNPs in core vitamin D genes or ancestry-informed 25OHD SNPs. Multivariable MR accounted for the mediating effects of body mass index. We found that a standard deviation increase in 25OHD in the logarithmic scale did not affect youth-onset T2D risk (IVW MR odds ratio (OR) = 1.04, 95% CI = 0.96-1.13, p = 0.35) in the multi-ethnic analysis, and sensitivity, ancestry-specific and multivariable MR analyses showed consistent results. Our study had limited power to detect small/moderate effects of 25OHD (OR of pediatric T2D < 1.39 to 2.1). In conclusion, 25OHD levels are unlikely to have significant effects on the risk of youth-onset T2D across different ethnicities.

Association and Interaction of Genetics and Area-Level Socioeconomic Factors on the Prevalence of Type 2 Diabetes and Obesity.

Quantify the impact of genetic and socioeconomic factors on risk of type 2 diabetes (T2D) and obesity. Among participants in the Mass General Brigham Biobank (MGBB) and UK Biobank (UKB), we used logistic regression models to calculate cross-sectional odds of T2D and obesity using 1) polygenic risk scores for T2D and BMI and 2) area-level socioeconomic risk (educational attainment) measures. The primary analysis included 26,737 participants of European genetic ancestry in MGBB with replication in UKB (N = 223,843), as well as in participants of non-European ancestry (MGBB N = 3,468; UKB N = 7,459). The area-level socioeconomic measure most strongly associated with both T2D and obesity was percent without a college degree, and associations with disease prevalence were independent of genetic risk (P < 0.001 for each). Moving from lowest to highest quintiles of combined genetic and socioeconomic burden more than tripled T2D (3.1% to 22.2%) and obesity (20.9% to 69.0%) prevalence. Favorable socioeconomic risk was associated with lower disease prevalence, even in those with highest genetic risk (T2D 13.0% vs. 22.2%, obesity 53.6% vs. 69.0% in lowest vs. highest socioeconomic risk quintiles). Additive effects of genetic and socioeconomic factors accounted for 13.2% and 16.7% of T2D and obesity prevalence, respectively, explained by these models. Findings were replicated in independent European and non-European ancestral populations. Genetic and socioeconomic factors significantly interact to increase risk of T2D and obesity. Favorable area-level socioeconomic status was associated with an almost 50% lower T2D prevalence in those with high genetic risk.