Older Adults with Lowest Risk of Developing Type 2 Diabetes: Results from a Large and Diverse US Cohort (2003–2016) (OR22-06-19)

Abstract Objectives High rates of early obesity substantially increase lifetime risk of developing diabetes. The objective of this research is to examine the impact of this shift on type-2 diabetes risk and aging in a large and diverse U.S. cohort. Methods A nationally sampled, longitudinal survey, the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (2003–2007), a collection of sociobiological data, were observed through 2013–2016. We included black and white men and women aged ≥45 without diabetes at baseline for whom follow-up data was available. To assess incident diabetes as a function of age, we used the R package Segmented and examined whether this risk was constant over the whole range of age or whether the risk was non-linear with a threshold inflection value. After inspection of the data, age as a continuous variable appeared to have a piecewise relationship with incidence diabetes. A logistic model to see the effect of age on incident diabetes adjusting for sex and race was run. We estimated changes in odds for developing diabetes in ten years by age using restricted cubic spline knots. We estimated the breakpoint statistically using the psi argument in ‘segmented’. Odds ratios for developing diabetes on both sides of the breakpoint were calculated. Results Baseline age appeared to show a non-linear association with future diabetes incidence with a breakpoint at age 55 (P = 0.005). After 55 years, incident diabetes declined (slope at age 45–54.9: 0.06; CI: 0.02, 0.10; slope age ≥55: −0.02; CI −0.04, −0.01). Odds ratio for developing diabetes in ten years for those 45–55 years (OR: 1.18, 95% CI 1.02–1.37, P = 0.024) confirm this relationship – those 45–55 years have 18% higher odds of developing diabetes than those over 55. Conclusions This model estimated an age breakpoint of roughly 55 years of age when younger individuals were observed to have a progressive increase in incident diabetes while those 55 and older had a declining risk. Between 1992 and 2010, mean BMI in the US increased, resulting primarily from accelerated weight gain among persons initially normal and overweight - our findings argue for a careful data driven approach in considering the effects of age on incident diabetes to derive a more accurate prediction for diabetes. Funding Sources Lua Wilkinson is supported in part by NIH grant T32 DK062710. Supporting Tables, Images and/or Graphs

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Abstract P300: C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: Reasons for Geographic and Racial Differences in Stroke (REGARDS)

Circulation ◽

10.1161/circ.141.suppl_1.p300 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Kaitlyn M Peper ◽

Boyi Guo ◽

Leann Long ◽

George Howard ◽

April P Carson ◽

...

Keyword(s):

Risk Factors ◽

Racial Differences ◽

Racial Difference ◽

Incident Diabetes ◽

Diabetes Incidence ◽

C Reactive Protein ◽

Reactive Protein ◽

The Difference ◽

Adjusted Model ◽

The Impact

Introduction: Black Americans have a higher incidence of diabetes and have elevated inflammatory biomarkers compared to white Americans. Elevated inflammation is a risk factor for diabetes but the impact of inflammation on the racial disparity in diabetes is unknown. Hypothesis: Elevated C-reactive protein (CRP) attenuates the observed black-white difference in incident diabetes. Methods: REGARDS enrolled 30,239 black and white adults aged ≥45 years from the contiguous US in 2003-07. This analysis included REGARDS participants without baseline diabetes who were assessed for diabetes 9 years later. RRs for incident diabetes by race were calculated using modified Poisson regression adjusting for risk factors known to contribute to the racial difference in diabetes incidence. The attenuation by CRP of the black-white RR of incident diabetes was calculated as the percent difference in the race RR in models with and without CRP adjustment; 95% CI for the difference was estimated using bootstrapping. Results: Of 11,073 participants without baseline diabetes (33% black, 67% white), black participants had higher CRP than white participants, and 12.5% developed incident diabetes. The black-white RR for incident diabetes in the base model was 1.74 (95% CI: 1.52, 1.99) for women and 1.44 (1.25, 1.66) for men. Baseline CRP mediated 21% (14, 29%) of this association in women and 20% (12, 34%) in men. These percent attenuations were similar in models adjusting for other diabetes risk factors but were diminished in a fully adjusted model; 5% (-4, 25%) in women and 7% (-43, 50%) in men (Figure). Conclusion: Adjustment for CRP in base models accounted for 20% and 21% of the excess risk of incident diabetes observed in black men and women, respectively, in this study. This substantial mediation persisted after adjusting for other risk factors but was diminished in the fully adjusted model. This suggests a role of inflammation in the diabetogenic effects of risk factors contributing to the observed racial difference in diabetes incidence.

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The effect of guideline revisions on vascular complications of type 2 diabetes

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018819875408 ◽

2019 ◽

Vol 10 ◽

pp. 204201881987540 ◽

Cited By ~ 2

Author(s):

Ralph Heijmans ◽

Sunny S. Singh ◽

Aloysius G. Lieverse ◽

Eric J.G. Sijbrands ◽

Mandy van Hoek

Keyword(s):

Type 2 Diabetes ◽

Diabetes Care ◽

Microvascular Complications ◽

Vascular Complications ◽

Continuous Variable ◽

Diabetes Mellitus Type Ii ◽

Logistic Regression Models ◽

Artery Disease ◽

The Impact

Background: The aim of this study was to investigate the impact of implementation and revision of the ‘Diabetes Mellitus type II’ guideline by the Dutch College of General Practitioners (DCGP) on the prevalence and incidence of macrovascular and microvascular complications. Methods: The DiaGene study is a case-control study ( n = 1886 patients of type 2 diabetes) with extensive, retrospectively collected complication data, as well as prospective follow up of complications. The study incorporates all lines of diabetes care. Cases were divided into categories according to the date of onset of diabetes and publication dates of the DCGP. Logistic regression models were used to investigate the associations between guideline version and complications. To investigate a possible trend between guideline version and complications, the ‘guideline category’ was also used as a continuous variable. All models were adjusted for clinical covariables. Results: The 1999 and 2006 guidelines versions were associated with significantly lower risk of retinopathy than the group that started without a guideline [OR 0.32 (95% CI 0.14–0.72, p = 0.006) and 0.31 (95% CI 0.11–0.91, p = 0.034), respectively]. A significant trend in reduction of peripheral artery disease (PAD) over the guideline versions was found, adjusted for age, sex and diabetes duration (odds ratio (OR) 0.70, 95% CI 0.51-0.97, p trend = 0.029) and for retinopathy in all models (OR = 0.52, 95% CI 0.37-0.73, p trend < 0.001). Conclusions: The introduction of the first diabetes guideline and subsequent revisions have reduced the risk of macrovascular and microvascular complications of type 2 diabetes, most strongly in diabetic retinopathy. This indicates that real-time diabetes care has improved over time.

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Association between Hemoglobin Levels and Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes: A Cross-Sectional Study Using Electronic Health Records

Journal of Diabetes Research ◽

10.1155/2017/2835981 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Jun Yang ◽

Pi-jun Yan ◽

Qin Wan ◽

Hua Li

Keyword(s):

Type 2 Diabetes ◽

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Patient Characteristics ◽

Continuous Variable ◽

Perception Threshold ◽

Cross Sectional ◽

Increased Risk ◽

The Impact

Objective. To investigate the relationship between hemoglobin levels and diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM). Methods. 1511 patients with T2DM were included in the study. DPN was diagnosed based on symptoms, signs, and laboratory tests. Hemoglobin was defined as both a continuous variable and a quartile category variable. We compared patient characteristics between the no diabetic peripheral neuropathy (NDPN) and DPN groups. Logistic regression was conducted to investigate the association of DPN with hemoglobin in all T2DM patients. Linear regression was also performed to investigate the impact of hemoglobin on the vibrating perception threshold (VPT). Results. Compared with the NDPN group, hemoglobin level in the DPN group was significantly lower (118.54 ± 16.91 versus 131.62 ± 18.32 g/L, P<0.01). The prevalence of DPN increased by 50.1% (95% CI: 42.2–57.0%; P<0.001) per standard deviation decrease in hemoglobin. Compared to the highest quartile of hemoglobin, the lower quartiles were associated with a significantly increased risk of DPN in the entire T2DM population (all P<0.01). A per unit decrease in hemoglobin leads to a 0.12 (95% CI: 0.07–0.168) unit increase in VPT after adjustment for possible confounders (P<0.001). Conclusions. Lower hemoglobin levels were associated with increased prevalence of DPN and higher VPT.

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Longitudinal study of the relationship between coffee consumption and type 2 diabetes in Chinese adult residents: Data from China Health and Nutrition Survey

PLoS ONE ◽

10.1371/journal.pone.0251377 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251377

Author(s):

Zhenkai Ma ◽

Mo Hao

Keyword(s):

Type 2 Diabetes ◽

Longitudinal Study ◽

Protective Factor ◽

Coffee Consumption ◽

Diabetes Incidence ◽

Chinese Adults ◽

Nutrition Survey ◽

Health And Nutrition ◽

The Impact

Background Increasing coffee intake was inversely associated with risk of type 2 diabetes in Western countries. However, in China where coffee consumption and diabetes population has been growing fast in recent years, studies on the impact of coffee intakes on the onset of type 2 diabetes are lacking. This study attempts to determine the associations between coffee consumption and type 2 diabetes in Chinese adults. Methods This longitudinal study analyzed 10447 adults who had participated in at least two rounds of the China Health and Nutrition Survey (CHNS), which is a survey database of multistage, random cluster process during 1993–2011. Coffee consumption and type 2 diabetes incidence were measured in the survey. Body mass index (BMI), age, sex, place of residence, waves, education level, smoking, drinking alcohol and tea drinking frequency were adjusted as covariate. We used longitudinal fixed effects regression models to assess changes within person. Results After adjusting confounding factors, lower risk of diabetes is observed among Chinese adults who drink coffee occasionally (Adjusted Odds Ratio (AOR) = 0.13, 95% CI = 0.05, 0.34) and drink almost every day (AOR = 0.61, 95% CI = 0.45, 0.83), compared with those who do not or hardly drink. In the subgroup analysis, among women aged 45–59 who drink coffee one to three times a week (AOR = 0.21, 95% CI = 0.08, 0.52) and men over 60 who drink coffee almost every day (AOR = 0.19, 95% CI = 0.07, 0.53), protective effects were found. For young men aged 19–29, drinking coffee almost every day showed a risk effect (AOR = 20.21, 95% CI = 5.96–68.57). Conclusions Coffee drinking habit is an independent protective factor for adult on type 2 diabetes in China. And it varies among people with different ages and genders. The rapid growth of coffee consumption in China in recent years may help reduce the risk of type 2 diabetes, but at the same time, the risk of type 2 diabetes in adolescents needs attention.

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Reducing weight and BMI following gestational diabetes: a systematic review and meta-analysis of digital and telemedicine interventions

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002077 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002077

Author(s):

Julia Halligan ◽

Maxine E Whelan ◽

Nia Roberts ◽

Andrew J Farmer

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

Data Extraction ◽

Meta Analysis ◽

Cochrane Library ◽

Point Estimate ◽

Diabetes Incidence ◽

The Impact ◽

Digital Or

Women with past gestational diabetes mellitus (GDM) are at risk of subsequent type 2 diabetes and adverse cardiovascular events. Digital and telemedicine interventions targeting weight loss and reductions in body mass index (BMI) may help reduce risk for women with GDM. The aim was to compare the effectiveness of digital or telemedicine intervention with usual care. Randomized controlled trials (RCTs) were identified in Embase, Medline, CINAHL, PsycINFO and the Cochrane Library. Included trials recruited women with prior GDM but without pre-existing diabetes, and tested a digital or telemedicine intervention with or without an in-person component. Data extraction was carried out independently by two authors. The search yielded 898 citations. Eighteen articles reporting 15 trials were included, of which 8 tested digital interventions. Reported outcomes included weight, BMI, fasting plasma glucose and waist circumference. None of the included trials reported type 2 diabetes incidence or cardiovascular risk. Data were pooled using a random-effects model. The point estimate favored the intervention but was non-significant for both BMI (−0.90 kg/m2, 95% CI −1.89 to 0.09; p=0.08) and weight (−1.83 kg, 95% CI −4.08 to 0.42, p=0.11). Trials evaluating digital and telemedicine interventions identified clinically relevant, but non-significant improvements in BMI and weight compared with control. No trials assessed type 2 diabetes occurrence as an outcome. More well-designed RCTs with adequate power and long-term follow-up are needed to identify the impact of these interventions on type 2 diabetes occurrence.

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Psychosocial factors and the risk of type 2 diabetes mellitus in women. Population based epidemiological study

Journal of Geriatric Medicine ◽

10.30564/jgm.v2i2.2304 ◽

2020 ◽

Vol 2 (2) ◽

Author(s):

Valery Gafarov ◽

Dmitriy Panov ◽

Elena Gromova ◽

Igor Gagulin ◽

Almira Gafarova

Keyword(s):

Diabetes Mellitus ◽

Social Support ◽

Type 2 Diabetes ◽

Psychosocial Factors ◽

Social Gradient ◽

Diabetes Incidence ◽

Female Population ◽

The Social ◽

The Impact

Our aim was to study the effect of depression and social support on the risk of type 2 diabetes in female population aged 25-64 in Russia / Siberia. Under the screening surveys random representative samples of women aged 25–64 years were examined in 1994 and 2005. Depression assessment was performed using the MONICA- MOPSY test. Social support was measured using the Berkman-Sim test. From 1994 to 2018 in a cohort of women new-onset cases of diabetes mellitus were detected. The risk of T2DM in persons with depression was 1.844 (p<0.01). After adjusting for socio-demographic variables, the risk decreased by 6% but remained significantly significant (p <0.05). The impact of a low level of social relations showed a significant effect on the risk of diabetes mellitus, including the multivariate model adjusted for the social gradient (HR=1.833, p<0.05). The presence of psychosocial factors decreases the protective effect of education in diabetes incidence. The incidence of T2D was higher in the group of manual labor and in executives. Depression and low social support increase the risk of T2DM by 80%. The frequencies of T2DM are determined by the social gradient and are associated with the role conflict “family-work”.

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Estimated effects of white rice consumption and rice variety selection on incidence of type 2 diabetes in Cambodia

Public Health Nutrition ◽

10.1017/s1368980014003280 ◽

2015 ◽

Vol 18 (14) ◽

pp. 2592-2599 ◽

Cited By ~ 4

Author(s):

Seila Sar ◽

Geoffrey C Marks

Keyword(s):

Type 2 Diabetes ◽

Rice Variety ◽

Glycaemic Index ◽

Consumption Patterns ◽

Diabetes Incidence ◽

Rice Varieties ◽

White Rice ◽

Rice Consumption ◽

The Impact

AbstractObjectiveRice consumption patterns are considered an important risk factor for diabetes in many countries. The present study aimed to model the impact of a shift in consumption of white rice from current to appropriately reduced levels and a shift in rice variety from one with a high glycaemic index to one with a low glycaemic index, on the burden of type 2 diabetes in Cambodia.DesignPrevent Plus software was used to model the impact of selected changes to white rice consumption on the burden of type 2 diabetes. Data used for modelling included: demographic projections, relative risk estimates for white rice consumption and diabetes, diabetes incidence, rice type and quantities consumed. The 10-year projections were based on different scenarios of changes in risk factors.ResultsWith no intervention, 10-year projections showed that total new diabetes cases will increase from 11 315 (9·1 per 10 000 person-years) for the year 2011 to 14 852 new cases (12·4 per 10 000 person-years) in 2020. However, this increase will be reduced by 27 % (average across 10 years) with a change in rice variety from Phka Rumdual to IR66 and by 26 % (average across 10 years) with a 25 % reduction in quantity from current consumption levels.ConclusionsChanging rice consumption patterns has potential for an important impact on diabetes risk, with a change of rice variety having a similar impact on the burden of diabetes in communities consuming rice with a high glycaemic index as a 25 % reduction in the quantity of rice consumed. Similar effects are likely for other countries with rice as a staple food, diversity in rice varieties and high incidence of diabetes.

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Abstract 13814: Semaglutide Reduces Mace Consistently Across Baseline Triglyceride Levels in Patients With Type 2 Diabetes: A Post Hoc Analysis of the Sustain 6 and Pioneer 6 Trials

Circulation ◽

10.1161/circ.142.suppl_3.13814 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Subodh Verma ◽

Lawrence A Leiter ◽

Marie M Michelsen ◽

David Orsted ◽

Soren Rasmussen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cox Regression ◽

Density Lipoprotein ◽

Statin Treatment ◽

Continuous Variable ◽

Post Hoc Analysis ◽

Glucagon Like Peptide 1 ◽

Post Hoc ◽

The Impact

Introduction: Elevated triglyceride (TG) levels may predict CV events, although this has not been evaluated in large contemporary trials. The effects of glucagon-like peptide-1 receptor agonists on major adverse CV events (MACE) across TG levels are not fully characterized. SUSTAIN 6 (NCT01720446) and PIONEER 6 (NCT02692716) were randomized, CV outcomes trials investigating once-weekly and oral semaglutide vs placebo, respectively, in patients with type 2 diabetes at high CV risk. We performed a post hoc analysis to assess the effect of semaglutide vs placebo on the primary endpoints, MACE (CV death, nonfatal myocardial infarction, or nonfatal stroke), and its components in these two trials pooled, across baseline TG levels. Methods: The risk of first MACE with semaglutide vs placebo was evaluated across three baseline TG groups (≤151, >151-≤205, and >205 mg/dL). The effect of semaglutide vs placebo on MACE was estimated with Cox regression by TG level categorically, and continuously when adjusting for baseline TG and high-density lipoprotein-cholesterol (HDL-C) levels. The impact of statin treatment was also assessed. Results: In total, 6,417 patients had baseline TG measurements: 3,191 (49.7%) ≤151, 1,459 (22.7%) >151-≤205, and 1,767 (27.5%) >205 mg/dL; mean (±SD) TGs were 107.3 (26.0), 176.6 (15.6), and 326.5 (197.1) mg/dL, respectively. Overall, semaglutide reduced TGs vs placebo by 5% in SUSTAIN 6 and 6% in PIONEER 6 (p<0.01). The incidence of MACE with placebo increased across increasing TG levels (Figure) . Semaglutide generally reduced the risk of MACE and its components vs placebo across TG groups. Results were consistent when evaluating TGs as a continuous variable (adjusting for baseline TG and HDL-C levels), and regardless of statin treatment. Conclusions: In this post hoc analysis of SUSTAIN 6 and PIONEER 6, over half of patients had elevated TG levels (>151 mg/dL). Semaglutide consistently reduced the risk of MACE vs placebo across baseline TG levels.

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Association between Diet Quality Indices and Incidence of Type 2 Diabetes in the Melbourne Collaborative Cohort Study

Nutrients ◽

10.3390/nu13114162 ◽

2021 ◽

Vol 13 (11) ◽

pp. 4162

Author(s):

Allison M. Hodge ◽

Md Nazmul Karim ◽

James R. Hébert ◽

Nitin Shivappa ◽

Barbora de Courten

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Body Size ◽

Diet Quality ◽

Healthy Eating Index ◽

Incident Diabetes ◽

Diabetes Incidence ◽

Family History Of Diabetes ◽

Melbourne Collaborative Cohort Study

Type 2 diabetes mellitus is a common condition whose incidence is increasing worldwide, and for which obesity and diet are important risk factors. The aim of this study was to assess the association of three diet quality scores with diabetes risk and how much of the association was mediated through body size. The Melbourne Collaborative Cohort Study recruited 41,513 men and women aged 40–69 years during 1990–94. At baseline, data were collected on lifestyle and diet, anthropometric measures were performed. Incident diabetes was assessed by self-report at follow-up surveys in 1994–98 and 2003–07. The associations between the dietary inflammatory index (DII®), Mediterranean Diet Score (MDS) and the Alternative Healthy Eating Index—2010 and incident diabetes were assessed using Poisson regression, adjusting for age, sex, physical activity, smoking, alcohol consumption, socio-economic status (area based) and family history of diabetes. Data from 39,185 participants were included in the analysis and 1989 cases of diabetes were identified. Both DII and AHEI-2010 were associated with diabetes incidence, but MDS was not. In the top quintile of DII (most pro-inflammatory) vs. the least inflammatory quintile IRR was 1.49 95% CI (1.30, 1.72), p trend across quintiles <0.001. For AHEI-2010 the IRR was 0.67 (0.58, 0.78), p trend <0.001 for the healthiest vs. the least healthy quintile. Mediation analysis indicated that body size (body mass index/waist to hip ratio) mediated 35–48% of the association with incident diabetes for the AHEI and DII. Healthier diets may reduce risk of diabetes both by reducing weight gain and other mechanisms such as reducing inflammation.

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