Effect of medication adherence on long-term all-cause-mortality and hospitalization for cardiovascular disease in 65,067 newly diagnosed type 2 diabetes patients

Introduction: Obesity is an increasingly prevalent global health issue and has a considerable disease burden, including numerous co-morbidities. Atherosclerotic cardiovascular disease (ASCVD) is one such co-morbidity associated with a high mortality rate and prevalence, especially in patients with obesity and concomitant Type 2 diabetes mellitus (T2DM). Bariatric surgery is an effective intervention for patients with obesity, shown to reduce overall cardiovascular disease risk. However, few studies have quantified the long-term impact of bariatric surgery on ASCVD outcomes in the context of key co-morbidities such as T2DM. Hypothesis: Bariatric surgery will improve long-term ASCVD outcomes in obese patients with T2DM. Methods: A nested, nationwide, propensity-matched cohort study was carried out using the Clinical Practice Research Datalink. The study cohort included 593 patients who underwent bariatric surgery and had no past history of ASCVD. A further 593 patients served as propensity-score matched controls. Patients were followed up for a median time of 47.2 months. The primary composite study endpoint was the incidence of ASCVD defined by a diagnosis of new coronary artery disease (CAD), cerebrovascular disease (CeVD), peripheral arterial disease (PAD), or other miscellaneous atherosclerotic disease. Secondary endpoints included all-cause mortality and the incidence of CAD, CeVD, and PAD individually. Results: Patients who underwent bariatric surgery had significantly lower rates of new ASCVD during follow-up (HR 0.53, CI 0.30-0.95, p=0.032). No significant difference was observed in rates of new CAD (HR 0.69, CI 0.32-1.46, p=0.331), CeVD (HR 0.23, CI 0.00-5.45, p=0.1760) and PAD (HR 0.55, CI 0.21-1.43, p=0.218). The bariatric surgery group also had a lower rate of all-cause mortality (HR 0.36, CI 0.19-0.71, p=0.003) compared to controls. Conclusions: In this study, bariatric surgery was associated with improved ASCVD outcomes, as well as lower all-cause mortality, in patients with obesity and T2DM. These findings support the use of bariatric surgery in treating obesity and reducing the burden of its related comorbidities.

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Abstract WMP59: Association of Glycated Hemoglobin Testing Interval on Stroke and Cardiovascular Disease Among Newly Diagnosed Type 2 Diabetes Patients

Stroke ◽

10.1161/str.50.suppl_1.wmp59 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Seulggie Choi ◽

Jung Jin Cho ◽

Sang Min Park ◽

Kyuwoong Kim ◽

Mi Hee Cho ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Glycated Hemoglobin ◽

Newly Diagnosed ◽

Testing Interval ◽

Diabetes Patients

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Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: nationwide, matched, observational cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023882 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023882 ◽

Cited By ~ 10

Author(s):

Vasileios Liakopoulos ◽

Stefan Franzén ◽

Ann-Marie Svensson ◽

Mervete Miftaraj ◽

Johan Ottosson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Gastric Bypass ◽

Kidney Disease ◽

Secondary Outcome ◽

Control Group ◽

Positive Effects ◽

All Cause Mortality

ObjectivesLong-term effects of gastric bypass (GBP) surgery have been presented in observational and randomised studies, but there are only limited data for persons with obesity and type 2 diabetes mellitus (T2DM) regarding postoperative complications.DesignThis is a nationwide observational study based on two quality registers in Sweden (National Diabetes Register, NDR and Scandinavian Obesity Surgery Register, SOReg) and other national databases.SettingAfter merging the data, we matched individuals with T2DM who had undergone GBP with those not surgically treated for obesity on propensity score, based on sex, age, body mass index (BMI) and calendar time. The risks of postoperative outcomes (rehospitalisations) were assessed using Cox regression models.ParticipantsWe identified 5321 patients with T2DM in the SOReg and 5321 matched controls in the NDR, aged 18–65 years, with BMI >27.5 kg/m² and followed for up to 9 years.Primary and secondary outcome measuresWe assessed risks for all-cause mortality and hospitalisations for cardiovascular disease, severe kidney disease, along with surgical and other medical conditions.ResultsThe results agree with the previously suggested lower risks of all-cause mortality (49%) and cardiovascular disease (34%), and we also found positive effects for severe kidney disease but significantly increased risks (twofold to ninefold) of several short-term complications after GBP, such as abdominal pain and gastrointestinal conditions, frequently requiring surgical procedures, apart from reconstructive plastic surgery. Long-term, the risk of anaemia was 92% higher, malnutrition developed approximately three times as often, psychiatric diagnoses were 33% more frequent and alcohol abuse was three times as great as in the control group.ConclusionsThis nationwide study confirms the benefits and describes the panorama of adverse events after bariatric surgery in persons with obesity and T2DM. Long-term postoperative monitoring and support, as better selection of patients by appropriate specialists in interdisciplinary settings, should be provided to optimise the outcomes.

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External applicability of SGLT2 inhibitor cardiovascular outcome trials to patients with type 2 diabetes and cardiovascular disease

Cardiovascular Diabetology ◽

10.1186/s12933-021-01373-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Lisanne C. A. Smidt ◽

Frank L. J. Visseren ◽

Wendela L. de Ranitz-Greven ◽

Hendrik M. Nathoe ◽

L. Jaap Kappelle ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Clinical Practice ◽

Daily Clinical Practice ◽

Cardiovascular Outcome ◽

Exclusion Criteria ◽

Cardiovascular Outcome Trials ◽

All Cause Mortality ◽

Diabetes Patients

Abstract Background Recent treatment guidelines support the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes and cardiovascular disease based on the results of cardiovascular outcome trials (CVOTs). Applicability of these trials to everyday patients with type 2 diabetes and cardiovascular disease is however unknown. The aim of this study is to assess the external applicability of SGLT2i CVOTs in daily clinical practice type 2 diabetes patients with established cardiovascular disease. Methods Trial in- and exclusion criteria from EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58 and VERTIS-CV were applied to 1389 type 2 diabetes patients with cardiovascular disease in the Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease (UCC-SMART). To evaluate the difference in cardiovascular risk (MACE) and all-cause mortality between trial eligible and ineligible patients, age and sex-adjusted Cox-regression analyses were performed. Results After applying trial in- and exclusion criteria, 48% of UCC-SMART patients with type 2 diabetes and cardiovascular disease would have been eligible for DECLARE-TIMI 58, 35% for CANVAS, 29% for EMPA-REG OUTCOME and 21% for VERTIS-CV. Without the eligibility criteria of HbA1c, eligibility was 58–88%. For all trials the observed risk for cardiovascular events and all-cause mortality was similar in eligible and ineligible patients after adjustment for age and gender. Conclusion A large proportion of patients with type 2 diabetes and cardiovascular disease in daily clinical practice would have been eligible for participation in the SGLT2i CVOTs. Trial eligible and ineligible patients have the same risk for MACE and all-cause mortality.

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Predictors of treatment failure during the first year in newly diagnosed type 2 diabetes patients: a retrospective, observational study

PeerJ ◽

10.7717/peerj.11005 ◽

2021 ◽

Vol 9 ◽

pp. e11005

Author(s):

Hon-Ke Sia ◽

Chew-Teng Kor ◽

Shih-Te Tu ◽

Pei-Yung Liao ◽

Yu-Chia Chang

Keyword(s):

Type 2 Diabetes ◽

Medication Adherence ◽

Glycemic Control ◽

Treatment Failure ◽

First Year ◽

Regular Exercise ◽

Newly Diagnosed ◽

Baseline Hba1c ◽

Diabetes Patients

Background Diabetes patients who fail to achieve early glycemic control may increase the future risk of complications and mortality. The aim of the study was to identify factors that predict treatment failure (TF) during the first year in adults with newly diagnosed type 2 diabetes mellitus (T2DM). Methods This retrospective cohort study conducted at a medical center in Taiwan enrolled 4,282 eligible patients with newly diagnosed T2DM between 2002 and 2017. Data were collected from electronic medical records. TF was defined as the HbA1c value >7% at the end of 1-year observation. A subgroup analysis of 2,392 patients with baseline HbA1c ≥8% was performed. Multivariable logistic regression analysis using backward elimination was applied to establish prediction models. Results Of all study participants, 1,439 (33.6%) were classified as TF during the first year. For every 1% increase in baseline HbA1c, the risk of TF was 1.17 (95% CI 1.15–1.20) times higher. Patients with baseline HbA1c ≥8% had a higher rate of TF than those with HbA1c <8% (42.0 vs 23.0%, p < 0.001). Medication adherence, self-monitoring of blood glucose (SMBG), regular exercise, gender (men), non-insulin treatment, and enrollment during 2010–2017 predicted a significant lower risk of TF in both of the primary and subgroup models. Conclusions Newly diagnosed diabetes patients with baseline HbA1c ≥8% did have a much higher rate of TF during the first year. Subgroup analysis for them highlights the important predictors of TF, including medication adherence, performing SMBG, regular exercise, and gender, in achieving glycemic control.

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