scholarly journals Impact of overlapping risks of type 2 diabetes and obesity on coronavirus disease severity in the United States

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wataru Ando ◽  
Takeshi Horii ◽  
Takayuki Uematsu ◽  
Hideaki Hanaki ◽  
Koichiro Atsuda ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Critical Care ◽  
Risk Score ◽  
The United States ◽  
Risk Scores ◽  
Research Database ◽  
Male Sex ◽  
The Impact ◽  
Diabetes And Obesity

AbstractThe impact of overlapping risk factors on coronavirus disease (COVID-19) severity is unclear. To evaluate the impact of type 2 diabetes (T2D) and obesity on COVID-19 severity, we conducted a cohort study with 28,095 anonymized COVID-19 patients using data from the COVID-19 Research Database from January 1, 2020 to November 30, 2020. The mean age was 50.8 ± 17.5 years, and 11,802 (42%) patients were male. Data on age, race, sex, T2D complications, antidiabetic medication prescription, and body mass index ≥ 30 kg/m2 (obesity) were analysed using Cox proportional hazard models, with hospitalization risk and critical care within 30 days of COVID-19 diagnosis as the main outcomes. The risk scores were 0–4 for age ≥ 65 years, male sex, T2D, and obesity. Among the participants, 11,294 (61.9%) had obesity, and 4445 (15.8%) had T2D. T2D, obesity, and male sex were significantly associated with COVID-19 hospitalization risk. Regarding hospitalization risk scores, compared with those for hospitalization risk score 0 and critical care risk score 0, hazard ratios [95% confidence intervals] were 19.034 [10.470–34.600] and 55.803 [12.761–244.015] (P < 0.001) (P < 0.001), respectively, for risk score 4. Complications from diabetes and obesity increased hospitalization and critical care risks for COVID-19 patients.

scholarly journals A novel drug response score more accurately predicts renoprotective drug effects than existing renal risk scores

2021 ◽  
Vol 12 ◽  
pp. 204201882097419
Author(s):  
Nienke M. A. Idzerda ◽  
Sok Cin Tye ◽  
Dick de Zeeuw ◽  
Hiddo J. L. Heerspink
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Risk Score ◽  
Drug Response ◽  
Drug Effects ◽  
Risk Scores ◽  
Renal Outcome ◽  
Response Score

Background: Risk factor-based equations are used to predict risk of kidney disease progression in patients with type 2 diabetes order to guide treatment decisions. It is, however, unknown whether these models can also be used to predict the effects of drugs on clinical outcomes. Methods: The previously developed Parameter Response Efficacy (PRE) score, which integrates multiple short-term drug effects, was first compared with the existing risk scores, Kidney Failure Risk Equation (KFRE) and The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) renal risk score, in its performance to predict end-stage renal disease (ESRD; KFRE) and doubling of serum creatinine or ESRD (ADVANCE). Second, changes in the risk scores were compared after 6 months’ treatment to predict the long-term effects of losartan on these renal outcomes in patients with type 2 diabetes and chronic kidney disease. Results: The KFRE, ADVANCE and PRE scores showed similarly good performance in predicting renal risk. However, for prediction of the effect of losartan, the KFRE risk score predicted a relative risk change in the occurrence of ESRD of 3.1% [95% confidence interval (CI) −5 to 12], whereas the observed risk change was −28.8% (95% CI −42.0 to −11.5). For the composite endpoint of doubling of serum creatinine or ESRD, the ADVANCE score predicted a risk change of −12.4% (95% CI −17 to −7), which underestimated the observed risk change −21.8% (95% CI −34 to −6). The PRE score predicted renal risk changes that were close to the observed risk changes with losartan treatment [−24.0% (95% CI −30 to −17) and −22.6% (95% CI −23 to −16) for ESRD and the composite renal outcome, respectively]. Conclusion: A drug response score such as the PRE score may assist in improving clinical decision making and implement precision medicine strategies.

scholarly journals Type 2 diabetes and tuberculosis in a dynamic bi-national border population

2006 ◽  
Vol 135 (3) ◽  
pp. 483-491 ◽  
Author(s):  
B. I. RESTREPO ◽  
S. P. FISHER-HOCH ◽  
J. G. CRESPO ◽  
E. WHITNEY ◽  
A. PEREZ ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Large Population ◽  
The United States ◽  
South Texas ◽  
Control Programmes ◽  
Mexico Border ◽  
Northeastern Mexico ◽  
The Impact ◽  
Border Population

The epidemic of type 2 diabetes in the United States prompted us to explore the association between diabetes and tuberculosis (TB) on the South Texas–Mexico border, in a large population of mostly non-hospitalized TB patients. We examined 6 years of retrospective data from all TB patients (n=5049) in South Texas and northeastern Mexico and found diabetes self-reported by 27·8% of Texan and 17·8% of Mexican TB patients, significantly exceeding national self-reported diabetes rates for both countries. Diabetes comorbidity substantially exceeded that of HIV/AIDS. Patients with TB and diabetes were older, more likely to have haemoptysis, pulmonary cavitations, be smear positive at diagnosis, and remain positive at the end of the first (Texas) or second (Mexico) month of treatment. The impact of type 2 diabetes on TB is underappreciated, and in the light of its epidemic status in many countries, it should be actively considered by TB control programmes, particularly in older patients.

The Impact of Partnership Status on Diabetes Control and Self-Management Behaviors

2018 ◽  
Vol 45 (5) ◽  
pp. 668-671 ◽  
Author(s):  
Lindsay Haines ◽  
Natalie Coppa ◽  
Yael Harris ◽  
Juan P. Wisnivesky ◽  
Jenny J. Lin
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Monitoring ◽  
The United States ◽  
Diabetes Control ◽  
Self Management ◽  
Partnership Status ◽  
The Impact ◽  
Management Behaviors

According to the Centers for Disease Control and Prevention, diabetes affects 29.1 million people in the United States. Marriage has been suggested to have a protective effect on overall health outcomes, but few studies have evaluated the role of partnership status on patients with type 2 diabetes. This study aimed to assess this role of partnership status on diabetes control and self-management behaviors. Patients with type 2 diabetes taking at least one oral hypoglycemic agent were assessed over a 3-month period to measure hemoglobin A1c (HbA1c) changes and adherence to medication, exercise, diet, and glucose monitoring. Partnered participants were more likely to adhere to their medications, but there was no significant difference in HbA1c changes over 3 months or exercise, diet, or glucose monitoring adherence. This study suggests that being partnered improves medication adherence; further analysis with a larger population is required to fully assess the role of partner support for patients with type 2 diabetes.

scholarly journals Skeletal changes associated with the onset of type 2 diabetes in the ZDF and ZDSD rodent models

2009 ◽  
Vol 296 (4) ◽  
pp. E765-E774 ◽  
Author(s):  
Susan Reinwald ◽  
Richard G. Peterson ◽  
Matt R. Allen ◽  
David B. Burr
Keyword(s):  
Type 2 Diabetes ◽  
The United States ◽  
Diabetic Rats ◽  
Sprague Dawley ◽  
Preclinical Research ◽  
Three Point Bending ◽  
Skeletal Changes ◽  
Adult Onset Diabetes ◽  
The Impact

The incidence and prevalence of type 2 diabetes (T2D) continue to escalate at an unprecedented rate in the United States, particularly among populations with high rates of obesity. The impact of T2D on bone mass, geometry, architecture, strength, and resistance to fracture has yet to be incontrovertibly characterized because of the complex and heterogeneous nature of this disease. This study utilized skeletally mature male diabetic rats of the commonly used Zucker diabetic fatty (ZDF) and Zucker diabetic Sprague-Dawley (ZDSD) strains as surrogate models to assess alterations in bone attributable to T2D-like states. After the animals were euthanized, bone data were collected using dual-energy X-ray absorptiometry, peripheral quantitative tomography, and micro-CT imaging modalities and via three-point bending or compression mechanical testing methods. ZDF and ZDSD diabetic rats exhibited lower bone mineral densities, which coincided with declines in structural strength and increased fragility at the femoral midshaft and the L4 vertebral body in response to monotonic loading. Vertebral trabecular morphology was compromised in both diabetic rodent strains, and ZDSD diabetic rats exhibited additional phenotypic impairments to bone material properties at the spine. Because the metabolic origin of the T2D-like state that develops in the ZDSD rat strain is highly relevant to adult-onset diabetes, it is a particularly attractive novel model for future preclinical research.

scholarly journals Joint Effect of Insulin Signaling Genes on Insulin Secretion and Glucose Homeostasis

2013 ◽  
Vol 98 (6) ◽  
pp. E1143-E1147 ◽  
Author(s):  
Sabrina Prudente ◽  
Eleonora Morini ◽  
Lorella Marselli ◽  
Roberto Baratta ◽  
Massimiliano Copetti ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Secretion ◽  
Glucose Tolerance ◽  
Risk Score ◽  
Glucose Homeostasis ◽  
Insulin Signaling ◽  
The United States ◽  
Joint Effect ◽  
Functional Polymorphisms

Context: Reduced insulin signaling in insulin secreting β-cells causes defective insulin secretion and hyperglycemia in mice. Objective: We investigated whether functional polymorphisms affecting insulin signaling (ie, ENPP1 K121Q, rs1044498; IRS1 G972R, rs1801278; and TRIB3 Q84R, rs2295490) exert a joint effect on insulin secretion and abnormal glucose homeostasis (AGH). Design: Insulin secretion was evaluated by 1) the disposition index (DI) from an oral glucose tolerance test (OGTT) in 829 individuals; 2) insulin secretion stimulation index (SI) in islets from nondiabetic donors after glucose (n = 92) or glibenclamide (n = 89) stimulation. AGH (including impaired fasting glucose and/or impaired glucose tolerance or type 2 diabetes; T2D) was evaluated in case-control studies from the GENetics of Type 2 Diabetes in Italy and the United States (GENIUS T2D) Consortium (n = 6607). Results: Genotype risk score, obtained by totaling individual weighted risk allele effects, was associated with the following: 1) DI (P = .005); 2) glucose and glibenclamide SI (P = .046 and P = .009); or 3) AGH (odds ratio 1.08, 95% confidence interval 1.03–1.13; P = .001). We observed an inverse relationship between genetic effect and age at AGH onset, as indicated by a linear correlation between AGH-genotype risk score odds ratios and age-at-diagnosis cutoffs (R2 = 0.80, P < .001). Conclusions: Functional polymorphisms affecting insulin signaling exert a joint effect on both in vivo and in vitro insulin secretion as well as on early-onset AGH. Our data provide further evidence that abnormal insulin signaling reduces β-cell function and impairs glucose homeostasis.

scholarly journals Driving Type 2 Diabetes Risk Scores into Clinical Practice: Performance Analysis in Hospital Settings

2019 ◽  
Vol 8 (1) ◽  
pp. 107 ◽  
Author(s):  
Antonio Martinez-Millana ◽  
María Argente-Pla ◽  
Bernardo Valdivieso Martinez ◽  
Vicente Traver Salcedo ◽  
Juan Merino-Torres
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Electronic Health Records ◽  
Bayesian Network ◽  
Risk Score ◽  
Diabetes Risk ◽  
Risk Scores ◽  
Health Records ◽  
Electronic Health

Electronic health records and computational modelling have paved the way for the development of Type 2 Diabetes risk scores to identify subjects at high risk. Unfortunately, few risk scores have been externally validated, and their performance can be compromised when routine clinical data is used. The aim of this study was to assess the performance of well-established risk scores for Type 2 Diabetes using routinely collected clinical data and to quantify their impact on the decision making process of endocrinologists. We tested six risk models that have been validated in external cohorts, as opposed to model development, on electronic health records collected from 2008-2015 from a population of 10,730 subjects. Unavailable or missing data in electronic health records was imputed using an existing validated Bayesian Network. Risk scores were assessed on the basis of statistical performance to differentiate between subjects who developed diabetes and those who did not. Eight endocrinologists provided clinical recommendations based on the risk score output. Due to inaccuracies and discrepancies regarding the exact date of Type 2 Diabetes onset, 76 subjects from the initial population were eligible for the study. Risk scores were useful for identifying subjects who developed diabetes (Framingham risk score yielded a c-statistic of 85%), however, our findings suggest that electronic health records are not prepared to massively use this type of risk scores. Use of a Bayesian Network was key for completion of the risk estimation and did not affect the risk score calculation (p > 0.05). Risk score estimation did not have a significant effect on the clinical recommendation except for starting pharmacological treatment (p = 0.004) and dietary counselling (p = 0.039). Despite their potential use, electronic health records should be carefully analyzed before the massive use of Type 2 Diabetes risk scores for the identification of high-risk subjects, and subsequent targeting of preventive actions.

Farming for Life: Pilot assessment of the impact of medical prescriptions for vegetables on health and food security among Latino adults with type 2 diabetes

2020 ◽  
Vol 26 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Benjamin York ◽  
Mary Kujan ◽  
Casey Conneely ◽  
Namino Glantz ◽  
David Kerr
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Food Security ◽  
Waist Circumference ◽  
The United States ◽  
Post Intervention ◽  
Female Age ◽  
Organic Vegetables ◽  
The Impact

Background: In the United States, Latino families have a disproportionate burden of diabetes and associated complications. Aim: This pilot study assessed the feasibility of using medical prescriptions of organic vegetables to improve health outcomes among Latinos with type 2 diabetes (T2D). Methods: Latino participants ( n = 21, 91% female, age 56 ± 11.1 years) with T2D received 12 weeks of medically prescribed organic vegetables. Weight, waist circumference, blood pressure, and HbA1c were measured pre and post-intervention. Food security was also assessed. Results: Over 12 weeks, there was a significant fall in systolic ( p = 0.03) and diastolic ( p = 0.01) blood pressure. A total of 14 participants lost weight (median weight loss among responders was 1.9 pounds), and waist circumference decreased in 9 of 19 responders by a median of 1.5 inches. HbA1c was unchanged (6.7 ± 1.1% at baseline versus 7.0 ± 1.1% post-intervention). Conclusions: Medical prescriptions of organic vegetables may have measurable health benefits for adult Latinos with T2D.

scholarly journals Selecting the optimal risk threshold of diabetes risk scores to identify high-risk individuals for diabetes prevention: a cost-effectiveness analysis

2019 ◽  
Vol 57 (4) ◽  
pp. 447-454 ◽  
Author(s):  
Kristin Mühlenbruch ◽  
Xiaohui Zhuo ◽  
Barbara Bardenheier ◽  
Hui Shao ◽  
Michael Laxy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
High Risk ◽  
Risk Score ◽  
Cost Effectiveness Analysis ◽  
Diabetes Risk ◽  
Population Characteristics ◽  
Risk Scores ◽  
Effectiveness Analysis

Abstract Aims Although risk scores to predict type 2 diabetes exist, cost-effectiveness of risk thresholds to target prevention interventions are unknown. We applied cost-effectiveness analysis to identify optimal thresholds of predicted risk to target a low-cost community-based intervention in the USA. Methods We used a validated Markov-based type 2 diabetes simulation model to evaluate the lifetime cost-effectiveness of alternative thresholds of diabetes risk. Population characteristics for the model were obtained from NHANES 2001–2004 and incidence rates and performance of two noninvasive diabetes risk scores (German diabetes risk score, GDRS, and ARIC 2009 score) were determined in the ARIC and Cardiovascular Health Study (CHS). Incremental cost-effectiveness ratios (ICERs) were calculated for increasing risk score thresholds. Two scenarios were assumed: 1-stage (risk score only) and 2-stage (risk score plus fasting plasma glucose (FPG) test (threshold 100 mg/dl) in the high-risk group). Results In ARIC and CHS combined, the area under the receiver operating characteristic curve for the GDRS and the ARIC 2009 score were 0.691 (0.677–0.704) and 0.720 (0.707–0.732), respectively. The optimal threshold of predicted diabetes risk (ICER < $50,000/QALY gained in case of intervention in those above the threshold) was 7% for the GDRS and 9% for the ARIC 2009 score. In the 2-stage scenario, ICERs for all cutoffs ≥ 5% were below $50,000/QALY gained. Conclusions Intervening in those with ≥ 7% diabetes risk based on the GDRS or ≥ 9% on the ARIC 2009 score would be cost-effective. A risk score threshold ≥ 5% together with elevated FPG would also allow targeting interventions cost-effectively.

scholarly journals The association of elevated maternal genetic risk scores for hypertension, type 2 diabetes and obesity and having a child with a congenital heart defect

PLoS ONE ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. e0216477 ◽  
Author(s):  
Michelle Kaplinski ◽  
Deanne Taylor ◽  
Laura E. Mitchell ◽  
Dorothy A. Hammond ◽  
Elizabeth Goldmuntz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Congenital Heart Defect ◽  
Genetic Risk ◽  
Congenital Heart ◽  
Risk Scores ◽  
Genetic Risk Scores ◽  
Heart Defect ◽  
Diabetes And Obesity
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