Antidiabetic drugs use and new-onset atrial fibrillation in patients with diabetes mellitus

Abstract Background Diabetes is one of the most common chronic disorders worldwide and is an important cause of cardiovascular disease. Large studies investigating the risk of atrial fibrillation (AF) in diabetic patients taking different diabetes medications are still missing. Methods The analysis was based on the EGB (“Echantillon Généraliste des Bénéficiaires”) database, a 1/97 representative sample of the French nationwide claims and hospitalisation database. A cohort comprising 25,117 adult patients with diabetes and no previous AF seen between 2010 and 2018 was created and followed until December 2018 for incidence of new-onset AF. Among these diabetic patients, 36.0% were treated with metformin, 32.0% were treated with Sulfonylureas, 7.0% were treated with DPP4-inhibitors, 1.6% were treated with GLP1- analogues and 19.6% were treated with insulin. A Cox proportional hazards model was used to determine factors and different oral diabetes medications independently associated with the risk of AF during follow-up. Results During a follow-up of 4.8±3.5 years, there were 3,300 patients with new onset AF (yearly rate 2.7%). In multivariable analysis, among baseline characteristics, we found that older age, male sex, hypertension, heart failure, aortic stenosis, chronic kidney disease, anemia and diuretic use were independently associated with a higher risk of new AF. Among diabetes medications included in the multivariable model, use of sulfonylureas was independently associated with a lower risk of AF (HR 0.86, 95% CI 0.80–0.92, p<0.0001 vs no use). By contrast, use of GLP1-analogues (HR 2.27, 95% CI 1.49–3.46, p=0.0001 vs no use), DPP4-inhibitors (HR 1.88, 95% CI 1.59–2.22, p<0.0001 vs no use), metformin (HR 1.09, 95% CI 1.01–1.18, p=0.03 vs no use) and of insulin (HR 1.15, 95% CI 1.05–1.26, p=0.004 vs no use) were independently associated with a higher risk of AF. Conclusions Patients with different diabetes medications have significantly different long-term risk of AF. Specifically, sulfonylureas use was associated with a lower risk of incident AF whilst other antidiabetic drugs were associated with a higher risk of AF during follow-up. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text

Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10132927 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2927

Author(s):

Amaar Obaid Hassan ◽

Gregory Y. H. Lip ◽

Arnaud Bisson ◽

Julien Herbert ◽

Alexandre Bodin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Multivariable Analysis ◽

National Database ◽

Increased Risk ◽

Periapical Abscess ◽

The Relationship ◽

Onset Atrial Fibrillation ◽

New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

Download Full-text

3269Impact of type 2 diabetes on incidence and phenotype of heart failure in patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0054 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Polovina ◽

I Milinkovic ◽

G Krljanac ◽

I Veljic ◽

I Petrovic-Djordjevic ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Type 2 Diabetes ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Diabetic Patients ◽

History Of ◽

New Onset

Abstract Background Type 2 diabetes (T2DM) portends adverse prognosis in patients with atrial fibrillation (AF). Whether T2DM independently increases the risk of incident heart failure (HF) in AF is uncertain. Also, HF phenotype developing in patients with vs. those without T2DM has not been characterised. Purpose In AF patients without a history of prior HF, we aimed to assess: 1) the impact of T2DM on the risk of new-onset HF; and 2) the association between T2DM and HF phenotype developing during the prospective follow-up. Methods We included diabetic and non-diabetic AF patients, without a history of HF. Baseline T2DM status was inferred from medical history, haemoglobin A1c levels and oral glucose tolerance test. Study outcome was the first hospital admission or emergency department treatment for new-onset HF during the prospective follow-up. The phenotype of new-onset HF was determined by echocardiographic exam performed following clinical stabilisation (at hospital discharge, or within a month after HF diagnosis). HF phenotype was defined as HFrEF (left ventricular ejection fraction [LVEF] <40%), HFmrEF (LVEF 40–49%) or HFpEF (LVEF≥50%). Cox regression analyses adjusted for age, sex, baseline LVEF, comorbidities, smoking status, alcohol intake, AF type (paroxysmal vs. non-paroxysmal) and T2DM treatment was used to analyse the association between T2DM and incident HF. Results Among 1,288 AF patients without prior HF (mean age: 62.1±12.7 years; 61% male), T2DM was present in 16.5%. Diabetic patients had higher mean baseline LVEF compared with nondiabetic patients (50.0±6.2% vs. 57.6±9.0%; P<0.001). During the median 5.5-year follow-up, new-onset HF occurred in 12.4% of patients (incidence rate, 2.9; 95% confidence interval [CI], 2.5–3.3 per 100 patient-years). Compared with non-diabetic patients, those with T2DM had a hazard ratio of 2.1 (95% CI, 1.6–2.8; P<0.001) for new-onset HF, independent of baseline LVEF or other factors. In addition, diabetic patients had a significantly greater decline in covariate-adjusted mean LVEF (−10.4%; 95% CI, −9.8% to −10.8%) at follow-up, compared with nondiabetic patients (−4.0%; 95% CI, −3.8% to −4.2%), P<0.001. The distribution of HF phenotypes at follow-up is presented in Figure. Among patients with T2DM, HFrEF (56.9%) was the most common phenotype of HF, whereas in patients without T2DM, HF mostly took the phenotype of HFpEF (75.0%). Conclusions T2DM is associated with an independent risk of new-onset HF in patients with AF and confers a greater decline in LVEF compared to individuals without T2DM. HFrEF was the most prevalent presenting phenotype of HF in AF patients with T2DM.

Download Full-text

Liu Wei Di Huang Wan and the Delay of Insulin Use in Patients with Type 2 Diabetes in Taiwan: A Nationwide Study

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/1298487 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Hsin-Hung Chen ◽

Chien-Tung Wu ◽

Yueh-Ting Tsai ◽

Chun-Wei Ho ◽

Ming-Chia Hsieh ◽

...

Keyword(s):

Type 2 Diabetes ◽

Lower Risk ◽

Cox Proportional Hazards Model ◽

Antidiabetic Drugs ◽

Diabetic Patients ◽

Research Database ◽

Oral Antidiabetic Drugs ◽

Oral Antidiabetic ◽

Insulin Use

Introduction. Patients with type 2 diabetes are widely prescribed metformin for controlling blood glucose levels to avoid related comorbidities. In Taiwan, traditional Chinese medicine (TCM) is also commonly used, especially Liu Wei Di Huang Wan (LWDHW), which has been reported to delay the occurrence of kidney failure. However, the effect of combinational therapy of TCM and oral antidiabetic drugs is still unclear. This study aims to estimate their efficacy in delaying insulin use. Materials and Methods. This case-control study was conducted using one million randomized samples from the National Health Insurance Research Database in Taiwan. The effects of TCM and LWDHW were estimated using the Cox proportional hazards model. Results. In this study, 70,036 diabetic patients were enrolled; of them, 17,451 (24.9%) used insulin, while the rest (52,585, 75.1%) did not. TCM users had a lower risk for insulin use (HR: 0.58, 95% CI: 0.56–0.60). LWDHW users had a lower risk compared with patients who used other TCM (HR: 0.86, 95% CI: 0.82–0.90) and presented a dose-dependent effect. Conclusion. The use of LWDHW and oral antidiabetic drugs is highly associated with the delay in the use of insulin. Clinical practitioners may take them into consideration when treating patients with type 2 diabetes.

Download Full-text

P6560Delayed ablation of atrioventricular nodal reentry tachycardia as a risk factor for future atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz746.1150 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Ferreira Fonseca ◽

L Parreira ◽

J Farinha ◽

R Marinheiro ◽

A Esteves ◽

...

Keyword(s):

Atrial Fibrillation ◽

Regression Analysis ◽

Cox Regression ◽

Multivariable Analysis ◽

Cox Regression Analysis ◽

Functional Changes ◽

Atrioventricular Nodal Reentry Tachycardia ◽

Reentry Tachycardia ◽

New Onset

Abstract Introduction Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of supraventricular tachycardia. Most of the patients experience recurrent symptoms for years before electrocardiographic documentation and AVNRT ablation. The effects of these ongoing episodes of AVNRT on atrial structure and function, and their influence on new-onset atrial fibrillation (AF) in patients with delayed AVNRT ablation are unknown. Purpose To assess if delayed ablation of AVNRT was associated with the development of AF. Methods We retrospectively evaluated patients subjected to AVNRT ablation between 2009 and 2016. Patients with history of AF previous to ablation were excluded. We evaluated age at the time of AVNRT ablation, the presence of cardiovascular risk factors, left atrial (LA) dilatation and the presence of frequent premature atrial contractions (PACs) (by 24-hour holter monitoring, defined as >30/h). During follow-up we assessed the occurrence of sustained AF episodes and age at the time of the first AF episode. Results We studied 130 patients that underwent AVNRT ablation. Mean follow-up time was 75±27 months and seventeen patients (13%) had new-onset AF during follow-up. Patients who developed AF were more often males (35% vs. 22%, p=0,015), older at the time of AVNRT ablation (60±16 vs. 50±15, p=0,01), had a higher prevalence of hypertension (64% vs. 35%, p=0,03), diabetes mellitus (35% vs. 6%, p=0,02), LA dilation (41% vs. 7%, p=0,01) and frequent PACs (24% vs. 2%, p=0,03). In Univariable Cox regression analysis all these available variables were associated with AF occurrence during follow-up. However, in Multivariable Cox regression analysis, only age at the time of the ablation procedure was independently associated with AF occurrence (Table 1). Multivariable Analysis HR 95% CI P value Age at ablation 8.762 3.308–23.20 <0.001 Age at the time of the first AF episode 0.113 0.043–0.302 <0.001 LA dilation 0.408 0.113–1.472 0.171 Frequent PACs 1.016 0.156–6.611 0.987 Conclusion In this group of patients the occurrence of new-onset AF during follow-up was independently associated with delayed AVNRT ablation. These findings suggest that longer atrial exposure to AVNRT episodes before ablation may be associated with LA structural and functional changes leading to higher occurrence of AF.

Download Full-text

Antithrombotic therapy and the risk of new-onset dementia in elderly patients with atrial fibrillation

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-137916 ◽

2020 ◽

pp. postgradmedj-2020-137916

Author(s):

Chun Ka Wong ◽

Duo Huang ◽

Mi Zhou ◽

JoJo Hai ◽

Wen Sheng Yue ◽

...

Keyword(s):

Atrial Fibrillation ◽

Antithrombotic Therapy ◽

Lower Risk ◽

Female Gender ◽

Increased Risk ◽

The Mean ◽

Relationship Of ◽

The Relationship ◽

New Onset

BackgroundAtrial fibrillation (AF) is associated with an increased risk of dementia. Little is known about the relationship of antithrombotic therapy and the risk of dementia in patients with AF without clinical stroke.MethodThis was an observational study based on a hospital AF registry. Patients aged 65–85 years at the time of AF diagnosis were identified via the computerised database of the clinical management system. Patients with prior stroke or known cognitive dysfunction were excluded. The primary outcome was newly diagnosed dementia during the follow-up period.Results3284 patients (mean age 76.4±5.3 years, 51.6% male) were included for analysis. The mean CHA2DS2-VASc score was 3.94±1.44. 18.5% patients were prescribed warfarin, 39.8% were prescribed aspirin and 41.7% were prescribed no antithrombotic therapy. After a mean follow-up of 3.6 years, 71 patients (2.2%) developed dementia, giving rise to an incidence of 0.61%/year. The incidence of dementia were 1.04%/year, 0.69%/year and 0.14%/year for patients on no therapy, aspirin and warfarin, respectively. Both univariate and multivariate analyses showed that age ≥75 years, female gender and high CHA2DS2-VASc score were associated with significantly higher risk of dementia; warfarin use was associated with significantly lower risk of dementia (HR: 0.14%, 95% CI 0.05 to 0.36, p<0.001). Patients on warfarin with time in therapeutic range (TTR) ≥65% had a non-significant trend towards a lower risk of dementia compared with those with TTR <65%.ConclusionIn elderly AF patients, warfarin therapy was associated with a significantly lower risk of new-onset dementia compared those with no therapy or aspirin.

Download Full-text

Acute dental periapical abscess and new-onset atrial fibrillation: A nationwide, population-based cohort study

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.168 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

A Hassan ◽

G Lip ◽

A Bisson ◽

J Herbert ◽

A Bodin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Univariate Analysis ◽

Multivariable Analysis ◽

National Database ◽

Increased Risk ◽

Periapical Abscess ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Background There are limited data on whether there is an association between hospitalisation with dental periapical abscess and new-onset atrial fibrillation (AF) which is independent of main cardiovascular risk factors. Purpose To investigate whether there is an association between hospitalisation with dental periapical abscess and new-onset AF. Methods A retrospective cohort study from a national database of patients hospitalised in 2013 (3.4 million patients) with at least five years of follow up, unless deceased. International Classification of Diseases (ICD) codes were used to compare the risk of developing new-onset AF for adults with and without dental periapical abscesses using univariate and multivariable analysis and hazard ratios (HR). Results In total, 4,693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). Conclusions An increased risk of new onset AF was identified for individuals hospitalised with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections are needed for incident AF, as well as investigations of possible mechanisms linking these conditions. Predictors of new-onset AF during FU Univariate analysis Multivariate analysis HR, 95%CI P HR, 95%CI P Age, years 1.077 (1.076-1.077) <0.0001 1.076 (1.075-1.076) <0.0001 Gender (male) 1.640 (1.629-1.651) <0.0001 1.0498 (1.487-1.509) <0.0001 Hypertension 2.849 (2.829-2.869) <0.0001 1.114 (1.487-1.509) <0.0001 Diabetes mellitus 1.951 (1.935-1.968) <0.0001 1.106 (1.096-1.116) <0.0001 Heart failure 3.893 (3.857-3.930) <0.0001 1.434 (1.416-1.452) <0.0001 Ischaemic stroke 2.289 (2.23902.340) <0.0001 1.140 (1.114-1.165) <0.0001 smoker 0.903 (0.891-0.917) <0.0001 1.052 (1.036-1.069) <0.0001 Liver disease 1.141 (1.119-1.164) <0.0001 1.082 (1.059-1.105) <0.0001 Previous myocardial infarction 2.128 (2.082-2.176) <0.0001 0.903 (0.880-0.926) <0.0001 Inflammatory disease 1.036 (1.020-1.052) <0.0001 0.978 (0.964-0.994) 0.005 Cognitive impairment 2.368 (2.326-2.410) <0.0001 0.821 (0.807-0.836) <0.0001 Illicit drug use 0.288 (0.263-0.317) <0.0001 0.940 (0.855-1032) 0.19 Dental periapical abscess 0.855 (0.778- 0.939) 0.001 1.107 (1.008-1.216) 0.03 At least 5 years of follow-up (mean follow-up 4.8 ± 1.7 years). Abstract Figure. Flow Chart of the study patients

Download Full-text

Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation

BMJ Open Quality ◽

10.1136/bmjoq-2020-001270 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001270

Author(s):

Jonathan James Hyett Bray ◽

Elin Fflur Lloyd ◽

Firdaus Adenwalla ◽

Sarah Kelly ◽

Kathie Wareham ◽

...

Keyword(s):

Atrial Fibrillation ◽

Community Setting ◽

Cost Effective ◽

Ventricular Rate ◽

Service Improvement ◽

Community Monitoring ◽

Ventricular Response ◽

Community Diagnosis ◽

New Onset

BackgroundCommunity management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting.MethodsDuring the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician.ResultsSeventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF.ConclusionsWe have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.

Download Full-text

Exercise and the Risk of Dementia in Patients with Newly Diagnosed Atrial Fibrillation: A Nationwide Population-Based Study

Journal of Clinical Medicine ◽

10.3390/jcm10143126 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3126

Author(s):

Jaehyun Lim ◽

So-Ryoung Lee ◽

Eue-Keun Choi ◽

Kyung-Do Han ◽

Jin-Hyung Jung ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Reduction ◽

Lower Risk ◽

Population Based ◽

Newly Diagnosed ◽

Incident Dementia ◽

Before And After ◽

Korean National Health Insurance ◽

New Diagnosis ◽

New Onset

Background: It is unclear whether exercise would reduce dementia in patients with a new diagnosis of atrial fibrillation (AF). Therefore, we aimed to evaluate the association between the change in physical activity (PA) before and after new-onset AF and the risk of incident dementia. Methods: Using the Korean National Health Insurance Service database, we enrolled a total of 126,555 patients with newly diagnosed AF between 2010 and 2016, who underwent health examinations within two years before and after their diagnosis of AF. The patients were divided into four groups: persistent non-exercisers, exercise starters, exercise quitters, and exercise maintainers. Results: Based on a total of 396,503 person-years of follow-up, 5943 patients were diagnosed with dementia. Compared to persistent non-exercisers, exercise starters (adjusted hazard ratio (aHR) 0.87; 95% confidence interval (CI) 0.81–0.94), and exercise maintainers (aHR 0.66; 95% CI 0.61–0.72) showed a lower risk of incident dementia; however, the risk was similar in exercise quitters (aHR 0.98; 95% CI 0.92–1.05) (p-trend < 0.001). There was a J-shaped relationship between the dose of exercise and the risk of dementia, with the risk reduction maximized at 5–6 times per week of moderate-to-vigorous PA among exercise starters. Conclusion: Patients who initiated or continued regular exercise after diagnosis of AF were associated with a lower risk of dementia than persistent non-exercisers, with no risk reduction associated with exercise cessation. Our findings may provide evidence for the benefit of exercise prescription to patients with new-onset AF to prevent incident dementia regardless of their current exercise status.

Download Full-text

Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1750 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S.L Xu ◽

J Luo ◽

H.Q Li ◽

Z.Q Li ◽

B.X Liu ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Natural Science ◽

Funding Source ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization. Methods This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics. Results A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p<0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p<0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p<0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008). Conclusion NOAF complicating AMI is strongly associated with an increased long-term risk of heart. Cumulative incidence of outcome Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai

Download Full-text

Screening Strategy of Pancreatic Cancer in Patients with Diabetes Mellitus

Diagnostics ◽

10.3390/diagnostics10080572 ◽

2020 ◽

Vol 10 (8) ◽

pp. 572

Author(s):

Suguru Mizuno ◽

Yousuke Nakai ◽

Kazunaga Ishigaki ◽

Kei Saito ◽

Hiroki Oyama ◽

...

Keyword(s):

Diabetes Mellitus ◽

Pancreatic Cancer ◽

Epidemiological Studies ◽

Screening Strategy ◽

Diabetic Patients ◽

Reverse Causality ◽

Pilot Studies ◽

Patients With Diabetes ◽

High Risk Populations ◽

New Onset

The incidence of pancreatic cancer (PCa) is increasing worldwide and has become one of the leading causes of cancer-related death. Screening for high risk populations is fundamental to overcome this intractable malignancy. Diabetes mellitus (DM) is classically known as a risk factor for PCa. Recently the reverse causality is in the spotlight, that is to say, DM is considered to be a manifestation of PCa. Numbers of epidemiological studies clarified that new-onset DM (≤2-year duration) was predominant in PCa patients and the relative risk for PCa inversely correlated with duration of DM. Among patients with new-onset DM, elder onset, weight loss, and rapid exacerbation of glycemic control were reported to be promising risk factors and signs, and the model was developed by combining these factors. Several pilot studies disclosed the possible utility of biomarkers to discriminate PCa-associated DM from type 2 DM. However, there is no reliable biomarkers to be used in the practice. We previously reported the application of a multivariate index for PCa based on the profile of plasma free amino acids (PFAAs) among diabetic patients. We are further investigating on the PFAA profile of PCa-associated DM, and it can be useful for developing the novel biomarker in the near future.

Download Full-text