Educational level as a cause of type 2 diabetes mellitus: Caution from triangulation of observational and genetic evidence

Introduction: Insulin is one of the suggested treatments to prevent and reduce long-term diabetes complications. However, due to many factors such as socio-demographic factors, many Type 2 diabetes mellitus patients refuse this treatment. This study aimed to determine perception towards insulin among naive Type 2 diabetes mellitus patients, to calculate the prevalence of rejecting insulin therapy, and to find out factors related to the refusal. Materials and methods: This cross-sectional study involved 188 insulin naive Type 2 diabetes mellitus patients attending five primary health clinics in Lipis district, Pahang from October to November 2017. A five-point Likert Scale was used to determine perception towards insulin therapy and the Chi-square test was used to assess the proportion of acceptance of the therapy. Simple and multiple logistic regressions were utilised to study the associated factor(s). Results: Mean score of 60.5 ± 8.2 pointed towards a negative appraisal of insulin therapy. Embarrassment to inject in public (69.1%) and concern of frequent hypoglycaemia (52.7%) were the most common perception. Nearly half of the respondents (46.3%) refused insulin therapy upon suggestion. After adjusting the variables using multiple logistic regressions, only gender (Adjusted OR=0.20, 95% CI=0.10-0.40, p<0.001), educational level (Adjusted OR=0.17, 95% CI=0.06-0.50, p=0.001), age (Adjusted OR=1.04, 95% CI=1.01-1.08, p=0.012) and glycated haemoglobin level (Adjusted OR=1.33, 95% CI=1.07-1.67, p=0.013) remained significant. Conclusion: In conclusion, insulin refusal among insulin naive patients was common in Lipis with an overall negative perception towards therapy. By tailoring strategies according to the patient’s factors such as gender, educational level, age, and glycated haemoglobin level, the insulin refusal rate might decrease in the future.

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Risk Factors for Sarcopenia in the Elderly with Type 2 Diabetes Mellitus and the Effect of Metformin

Journal of Diabetes Research ◽

10.1155/2020/3950404 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Fenqin Chen ◽

Shuai Xu ◽

Yingfang Wang ◽

Feng Chen ◽

Lu Cao ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Educational Level ◽

The Elderly ◽

Protective Agent ◽

Older Individuals ◽

Cross Sectional

Aims. Sarcopenia is a common condition in older individuals, especially in the elderly with type 2 diabetes mellitus (T2DM). The aim of the present study was to examine the risk factors for sarcopenia in elderly individuals with T2DM and the effects of metformin. Methods. A total of 1732 elderly with T2DM were recruited to this cross-sectional observational study, and we analyzed the data using logistic regression analyses. Skeletal muscle mass, grip strength, and usual gait speed were measured to diagnose sarcopenia according to the criteria of the Asian Working Group for Sarcopenia, combined with expert consensus on sarcopenia in China. Results. The overall prevalence of sarcopenia was 10.37% of the participants. In the multivariate analysis, sex, age, educational level, and BMI were risk factors for sarcopenia, with women more likely to develop sarcopenia relative to men ( OR = 2.539 , 95% CI = 1.475 –4.371; P < 0.05 ). We observed that sarcopenia increased with age and decreased with increasing BMI and educational level ( P < 0.05 ). Participants who took metformin alone or combined with other drugs exhibited a lower risk for sarcopenia than those who took no medication ( OR = 0.510 , 95% CI = 0.288 –0.904 and OR = 0.398 , 95% CI = 0.225 –0.702, respectively; P < 0.05 ). Conclusions. We showed that being female and at an older age, lower educational level, and lower BMI were risk factors for sarcopenia in elderly T2DM and that metformin acted as a protective agent against sarcopenia in these patients.

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Educational level as a cause of type 2 diabetes mellitus: Caution from triangulation of observational and genetic evidence

10.1101/2021.07.17.21260688 ◽

2021 ◽

Author(s):

Nat Na-Ek ◽

Juthamanee Srithong ◽

Authakorn Aonkham ◽

Suthida Boonsom ◽

Pimphen Chareon ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Community Dwelling ◽

Genetic Evidence ◽

Mendelian Randomisation ◽

Diabetes Diagnosis ◽

Nucleotide Polymorphisms ◽

Low Education

Background: Education might be causal to type 2 diabetes mellitus (T2DM). We triangulated cohort and genetic evidence to consolidate the causality between education and T2DM. Methods: We obtained observational evidence from the English Longitudinal Study of Ageing (ELSA). Self-reporting educational attainment was categorised as high (post-secondary and higher), middle (secondary), and low (below secondary or no academic qualifications) in 6,787 community-dwelling individuals aged ≥50 years without diabetes at ELSA wave 2, who were followed until wave 8 for the first diabetes diagnosis. Additionally, we performed two-sample Mendelian randomisation (MR) using an inverse-variance weighted (IVW), MR-Egger, weighted median (WM), and weighted mode-based estimate (WMBE) method. Steiger filtering was further applied to exclude single-nucleotide polymorphisms (SNPs) that were correlated with an outcome (T2DM) stronger than exposure (education attainment). Results: We observed 598 new diabetes cases after 10.4 years of follow-up. The adjusted hazard ratios (95%CI) of T2DM were 1.20 (0.97-1.49) and 1.58 (1.28-1.96) in the middle- and low-education groups, respectively, compared to the high-education group. Low education was also associated with increased glycated haemoglobin levels. Psychosocial resources, occupation, and health behaviours fully explained these inverse associations. In the MR analysis of 210 SNPs (R2=0.0161), the odds ratio of having T2DM per standard deviation-decreasing years (4.2 years) of schooling was 1.33 (1.01-1.75; IVW), 1.23 (0.37-4.17; MR-Egger), 1.56 (1.09-2.27; WM), and 2.94 (0.98-9.09; WMBE). However, applying Steiger filtering attenuated most MR results toward the null. Conclusions: Our inconsistent findings between cohort and genetic evidence did not support the causality between education and T2DM.

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