scholarly journals Association between detection of non-diabetic hyperglycaemia and vascular complications

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Palladino ◽  
A G Tabak ◽  
K Khunti ◽  
J Valabhji ◽  
A Majeed ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Microvascular Disease ◽  
Diabetes Diagnosis ◽  
Research Database ◽  
Newly Diagnosed ◽  
Coronary Events ◽  
Events Detection

Abstract Background The benefit of screening for non-diabetic hyperglycaemia (NDH) is still debated. Furthermore, the associated risk of vascular complications following a diagnosis of Type 2 diabetes (T2D) in people previously detected as NDH in real-world settings is not known. We examined the presence of vascular disease in newly diagnosed T2D individuals by glycaemic status within 3 years of diagnosis. Methods We identified 159,736 individuals diagnosed with T2D from the Clinical Practice Research Database in England between 2004 and 2017. We used logistic regression models to compare presence of microvascular (retinopathy and nephropathy) and macrovascular (coronary artery events, cerebrovascular and peripheral arterial disease) disease at the time of T2D diagnosis by prior glycaemic status. Models were adjusted for age, sex, ethnicity, deprivation, smoking status, blood pressure, cholesterol, and number of primary care visits. Results There was a strong association between baseline glycaemic status and presence of microvascular complications at diabetes diagnosis (normoglycaemia 30.7%, no glycaemic test 36.7%, NDH 42.4%). Similarly, prevalence of macrovascular disease was lower for those with normoglycaemia(26.9%) compared with NDH(29.8%). Compared with individuals with normoglycaemia, those detected with NDH before the diagnosis of T2D had 76% and 53% increased odds of retinopathy and any microvascular complications (AOR 1.76, 95%CI 1.69-1.85; AOR 1.53, 95%CI 1.41-1.65), and 7% higher odds of diagnosis of acute coronary events (OR 1.07, 95%CI 1.03-1.12) at time of diagnosis of T2D. Conclusions Microvascular and macrovascular diseases are detected in 40 and 20% of newly diagnosed T2D. NDH before the diagnosis of T2D was more likely associated with microvascular complications and acute coronary events. Detection of NDH might represent opportunities for reducing the burden of microvascular disease through heightened attention to screening for microvascular complications. Key messages Detection of non-diabetic hyperglycaemia before the diagnosis of Type 2 diabetes was more likely associated with microvascular complications and acute coronary events. Detection of non-diabetic hyperglycaemia might represent opportunities for reducing the burden of microvascular disease through heightened attention to screening for microvascular complications.

Dispensation Patterns of Glucose-Lowering Drugs in Newly Diagnosed Type 2 Diabetes: Routine Data Analysis of Insurance Claims in Germany

2021 ◽  
Author(s):  
Brenda Bongaerts ◽  
Bianca Kollhorst ◽  
Oliver Kuss ◽  
Iris Pigeot ◽  
Wolfgang Rathmann
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Diagnosis ◽  
Research Database ◽  
Second Line ◽  
Newly Diagnosed ◽  
First Line ◽  
Glucose Lowering ◽  
Receptor Agonists ◽  
Metformin Monotherapy

Abstract Aims To describe dispensation patterns of glucose-lowering drugs in newly diagnosed type 2 diabetes in Germany. Materials and methods Based on claims data from four statutory health insurances (German Pharmacoepidemiological Research Database,>25 million insurants), all individuals with newly diagnosed type 2 diabetes were identified. Eligible patients had a first diagnosis for type 2 diabetes between January 2012 and December 2016. We analyzed the dispensation patterns of first-line glucose-lowering therapies initiated in the year after diabetes diagnosis and patterns of second-line therapies dispensed one year after first-line treatment. Results A total of 356,647 individuals with newly diagnosed type 2 diabetes were included (average age [SD]: 63.5 [13.4] years; 49.3% males). Of the 31.6% of individuals who were pharmacologically treated in the year after diagnosis, metformin monotherapy was most frequently dispensed (73.1%), followed by dual therapy of metformin and dipeptidyl peptidase-4 inhibitors (DPP-4is) (6.4%), and monotherapy with DPP-4is (2.9%). From 2012 through 2016, sulfonylurea dispensations were reduced by more than 50%. Dispensations for combination therapies with DPP-4is increased up to 10.6%. Glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors contributed to 2% of all treatments. After a median of 5 months, 20.0% of individuals on pharmacological therapy initiated second-line glucose-lowering treatment. Conclusions Data from German statutory health insurances (2012 to 2016) showed that most individuals with newly diagnosed type 2 diabetes were dispensed metformin monotherapy in line with diabetes care guidelines. A substantial decrease in the use of sulfonylureas was observed after the introduction of DPP-4i and GLP-1 receptor agonists.

scholarly journals Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes

2020 ◽  
Vol 8 (1) ◽  
pp. e001061 ◽  
Author(s):  
Raffaele Palladino ◽  
Adam G Tabak ◽  
Kamlesh Khunti ◽  
Jonathan Valabhji ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Acute Coronary Syndrome ◽  
Vascular Disease ◽  
Microvascular Disease ◽  
Macrovascular Disease ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Glycemic Status ◽  
Coronary Syndrome

ObjectiveThe associated risk of vascular disease following diagnosis of type 2 diabetes in people previously identified as having pre-diabetes in real-world settings is unknown. We examined the presence of microvascular and macrovascular disease in individuals with newly diagnosed type 2 diabetes by glycemic status within 3 years before diagnosis.Research design and methodsWe identified 159 736 individuals with newly diagnosed type 2 diabetes from the UK Clinical Practice Research Datalink database in England between 2004 and 2017. We used logistic regression models to compare presence of microvascular (retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular and peripheral arterial disease) disease at the time of type 2 diabetes diagnosis by prior glycemic status.ResultsHalf of the study population (49.9%) had at least one vascular disease, over one-third (37.4%) had microvascular disease, and almost a quarter (23.5%) had a diagnosed macrovascular disease at the time of type 2 diabetes diagnosis.Compared with individuals with glycemic values within the normal range, those detected with pre-diabetes before the diagnosis had 76% and 14% increased odds of retinopathy and nephropathy (retinopathy: adjusted OR (AOR) 1.76, 95% CI 1.69 to 1.85; nephropathy: AOR 1.14, 95% CI 1.10 to 1.19), and 7% higher odds of the diagnosis of acute coronary syndrome (OR 1.07, 95% CI 1.03 to 1.12) in fully adjusted models at time of diabetes diagnosis.ConclusionsMicrovascular and macrovascular diseases are detected in 37%–24% of people with newly diagnosed type 2 diabetes. Pre-diabetes before diagnosis of type 2 diabetes is associated with increased odds of microvascular disease and acute coronary syndrome. Detection of pre-diabetes might represent an opportunity for reducing the burden of microvascular and macrovascular disease through heightened attention to screening for vascular complications.

scholarly journals Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses

Diabetologia ◽  
2020 ◽  
Author(s):  
Natalie Nanayakkara ◽  
Andrea J. Curtis ◽  
Stephane Heritier ◽  
Adelle M. Gadowski ◽  
Meda E. Pavkov ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Observational Studies ◽  
Microvascular Complications ◽  
Microvascular Disease ◽  
Age At Diagnosis ◽  
Diabetes Diagnosis ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Meta Analyses

Abstract Aims/hypothesis Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. Methods Data were sourced from MEDLINE and All EBM (Evidence Based Medicine) databases from inception to July 2018. Observational studies, investigating the effect of age at diabetes diagnosis on macrovascular and microvascular diabetes complications in adults with type 2 diabetes were selected according to pre-specified criteria. Two investigators independently extracted data and evaluated all studies. If data were not reported in a comparable format, data were obtained from authors, presented as minimally adjusted ORs (and 95% CIs) per 1 year increase in age at diabetes diagnosis, adjusted for current age for each outcome of interest. The study protocol was recorded with PROSPERO International Prospective Register of Systematic Reviews (CRD42016043593). Results Data from 26 observational studies comprising 1,325,493 individuals from 30 countries were included. Random-effects meta-analyses with inverse variance weighting were used to obtain the pooled ORs. Age at diabetes diagnosis was inversely associated with risk of all-cause mortality and macrovascular and microvascular disease (all p < 0.001). Each 1 year increase in age at diabetes diagnosis was associated with a 4%, 3% and 5% decreased risk of all-cause mortality, macrovascular disease and microvascular disease, respectively, adjusted for current age. The effects were consistent for the individual components of the composite outcomes (all p < 0.001). Conclusions/interpretation Younger, rather than older, age at diabetes diagnosis was associated with higher risk of mortality and vascular disease. Early and sustained interventions to delay type 2 diabetes onset and improve blood glucose levels and cardiovascular risk profiles of those already diagnosed are essential to reduce morbidity and mortality.

Mean Platelet Volume and Platelet Distribution Width Correlate with Microvascular Complications in Egyptian People with Type 2 Diabetes Mellitus

2021 ◽  
Vol 17 ◽  
Author(s):  
Mohammed I. Abd El-Ghany ◽  
Nahed Abdallah ◽  
Waleed Eldars
Keyword(s):  
Type 2 Diabetes ◽  
Mean Platelet Volume ◽  
Microvascular Complications ◽  
Fasting Blood Glucose ◽  
Vascular Complications ◽  
Platelet Distribution Width ◽  
Platelet Volume ◽  
Distribution Width ◽  
Diabetic Microvascular Complications

Background: Type 2 diabetes is a part of metabolic syndrome associated with a higher risk of vascular complications. Diabetes is characterized by changes in platelet morphology, function, and platelet hyperactivity so, it's considered a prothrombotic condition. Morbidity and mortality in people with type 2 diabetes-related to micro and macrovascular complications. Novel biomarkers are needed to identify and treat people at higher risk. Objective: The main objective of this controlled cross-sectional study was to evaluate Platelet volume indices (PVI) in subjects with type 2 diabetes with and without complications in comparison to subjects without diabetes. Methods: Hundred and thirty-five subjects aged from 35 to 60 years were subdivided into 3 groups. Group A includes 55 subjects with type 2 diabetes with complications. Group B includes 45 subjects with type 2 diabetes without complications. Group C includes 35 normal healthy subjects. Detailed clinical history was taken. Also, PVI, fasting blood glucose (FBG), hemoglobin A1c, and creatinine were obtained. Results: Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet large cell ratio (P-LCR) were significantly higher among subjects with retinopathy, nephropathy, and neuropathy than other subjects with diabetes who didn't develop complications (P<0.001). At cutoff value > 11.9 fL, MPV have diagnostic sensitivity 80% and specificity 97.8%. Whereas PDW >16.9fL has a sensitivity of 74.5% and specificity of 100% for diabetic microvascular complications (retinopathy, nephropathy, and neuropathy). Conclusion: MPV and PDW may be considered as possible biomarkers for the early detection of diabetic microvascular complications.

scholarly journals THE FAMILY DOCTOR’S ROLE IN ACHIEVING TARGET LEVELS OF TREATMENT IN PATIENTS WITH TYPE 2 DIABETES

2020 ◽  
Vol 72 (2) ◽  
pp. 51-58
Author(s):  
О. Korzh ◽  
A. Titkova ◽  
M. Kochuieva ◽  
Yu. Vinnyk ◽  
L. A. Ruban ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Lifestyle Changes ◽  
Treatment Goal ◽  
Treatment Goals ◽  
Factors Associated ◽  
Triple Treatment

The aim of the study was to identify the proportion of patients with type 2 diabetes who were unable toachieve the triple treatment goal for concomitant control of blood glucose level, blood pressure, LDL and modifying factors associated with achieving triple therapy goals. The study included 675 patients with type 2 diabetes,dyslipidemia and hypertension. The analysis was performed using concurrent triple treatment goals with specific levels of HbA1c, LDL and blood pressure as the main result. The questionnaire for patients with dyslipidemiaincluded self-assessment of compliance with prescribed drugs and perceptions related to their understandingand attitude towards lifestyle changes and pharmacological treatment. The results of the analysis of the logistic regression of factors associated with the achievement of triple treatment goals showed that patients whoreceived moderate doses of statins with high intensity were less likely to achieve concurrent treatment of thegoal compared to low intensity. Younger patients were less likely to achieve the triple treatment goal than thoseover 60 years of age. Based on life expectancy, they will be more susceptible to vascular complications due to anearlier onset of the disease and a longer period of time during which these adverse events can develop. Fewerdrugs and a shorter duration of type 2 diabetes were significant factors in the triple control. It was proved thatsimultaneous control of glycemia, hypertension and lipids was achieved in 22.4% of patients, who were affectedby the intensity of statin treatment, the number of diabetic drugs and the presence of concomitant pathology.Thus, the simultaneous achievement of the triple goal is a more comprehensive mitigation measure to reduce therisk of both macro- and microvascular complications

scholarly journals Prevalence of microvascular complications in newly diagnosed patients with Type 2 diabetes

2013 ◽  
Vol 29 (4) ◽  
Author(s):  
Alia Ali ◽  
Farrukh Iqbal ◽  
Azeem Taj ◽  
Zafar Iqbal ◽  
Muhammad Joher Amin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Microvascular Complications ◽  
Newly Diagnosed

scholarly journals Obstructive sleep apnoea, a risk factor for cardiovascular and microvascular disease in patients with type 2 diabetes mellitus: findings from a population-based cohort study

2020 ◽  
Author(s):  
Nicola J Adderley ◽  
Anuradhaa Subramanian ◽  
Konstantinos Toulis ◽  
Krishna Gokhale ◽  
Thomas Taverner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Obstructive Sleep Apnoea ◽  
Microvascular Complications ◽  
Sleep Apnoea ◽  
Diabetes Diagnosis ◽  
Obstructive Sleep ◽  
Ckd Stage ◽  
All Cause Mortality

<div><b>Objective</b>: To determine risk of cardiovascular diseases (CVD), microvascular complications and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnoea(OSA) compared to patients with type 2 diabetes without a diagnosis of OSA.</div><div><b>Research Design and Methods</b>: An age-, sex-, body mass index- and diabetes duration-matched cohort study using data from a UK primary care database from 01/01/2005 to 17/01/2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischaemic heart disease(IHD), stroke/transient ischaemic attack(TIA), heart failure(HF)); peripheral vascular disease(PVD); atrial fibrillation(AF); peripheral neuropathy(PN); diabetes-related foot disease(DFD); referable retinopathy; chronic kidney disease(CKD); all-cause mortality. The same outcomes were explored in patients with pre-existing OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.</div><div><b>Results</b>: 3,667 exposed participants and 10,450 matched controls were included. Adjusted hazard ratios for the outcomes were: composite CVD 1.54(95%CI 1.32,1.79); IHD 1.55(1.26,1.90); HF 1.67(1.35,2.06); stroke/TIA 1.57(1.27,1.94); PVD 1.10(0.91,1.32); AF 1.53(1.28,1.83); PN 1.32(1.14,1.51); DFD 1.42(1.16,1.74); retinopathy 0.99(0.82,1.21); CKD (stage 3-5) 1.18(1.02,1.36); albuminuria 1.11(1.01,1.22); all-cause mortality 1.24(1.10,1.40). In the prevalent OSA cohort the results were similar but some associations not observed.<br></div><div><b>Conclusions</b>: Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared to patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.</div>

scholarly journals Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study

2021 ◽  
Author(s):  
Jenny Riley ◽  
Christina Antza ◽  
Punith Kempegowda ◽  
Anuradhaa Subramanian ◽  
Joht Singh Chandan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Social Deprivation ◽  
Population Based ◽  
Incident Diabetes ◽  
Lipid Lowering ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Foot Disease

<b>Objective: </b>To investigate the relationship between social deprivation and incident diabetes-related foot disease (DFD), in newly-diagnosed patients with type 2 diabetes. <p><b>Research design and methods:</b> A population-based, open retrospective cohort study, using The Health Improvement Network (01/01/2005-31/12/2019). Patients with type 2 diabetes, free of DFD at baseline, were stratified by Townsend deprivation index and the risk of developing DFD was calculated. DFD was defined as a composite of foot ulcer (FU), Charcot arthropathy, lower limb amputation (LLA), peripheral neuropathy (PN), peripheral vascular disease (PVD) and gangrene.</p> <p><b>Results:</b> 176,359 patients were eligible (56% men; aged 62.9±13.1years). After excluding 26,094 patients with DFD before/within 15 months of type 2 diabetes diagnosis, DFD was incidentally developed in 12.1% of study population during 3.27years (IQR:1.41-5.96). Patients in the most deprived Townsend quintile had increased risk of DFD compared to those in the least deprived (aHR:1.22, 95%CI:1.16-1.29) after adjusting for sex, age at type 2 diabetes diagnosis, ethnicity, smoking, BMI, HbA1c, cardiovascular disease, hypertension, retinopathy, eGFR, insulin, glucose/lipid-lowering medications and baseline foot risk. Patients in the most deprived Townsend quintile had higher risk of PN (aHR:1.18, 95%CI:1.11-1.25), FU (aHR:1.44, 95%CI:1.17-1.77), PVD (aHR:1.40, 95%CI:1.28-1.53) LLA (aHR:1.75, 95%CI:1.08-2.83) and gangrene (aHR:8.49, 95% CI:1.01-71.58) compared to those in the least.</p> <p><b>Conclusion: </b>Social deprivation is an independent risk factor for the development of DFD, PN, FU, PVD, LLA and gangrene in newly-diagnosed patients with type 2 diabetes. Considering the high individual and economic burden of DFD, strategies targeting patients in socially deprived areas are needed to reduce health inequalities.</p> <p><b> </b></p>

scholarly journals ASSOCIATION OF HYPOTHYROIDISM WITH MICROVASCULAR COMPLICATIONS AMONG PATIENTS OF TYPE-2 DIABETES MELLITUS

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Krishan Kumar Meena ◽  
Praveen Sharma ◽  
Swati Srivastava ◽  
Uma Kumari Meena
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Vascular Complication ◽  
Cross Sectional ◽  
Type 2 Dm ◽  
Hypothyroid Patients

Introduction: Diabetes mellitus (DM) is common metabolic disorder leading to various complications including micro-vascular complication. Diabetes and thyroid dysfunction can result in abnormalities of one another, as both are strongly implicated in cellular metabolism.  Aim of study was to establish any association between hypothyroidism and micro-vascular complications in patients of type 2 DM. Material and Methods: This Hospital based Cross sectional analytical Study was included 80 Euthyroid and 80 hypothyroid patients of type 2 DM. These patients were subjected to fundus examination (for retinopathy), urine for spot albumin and creatinine ratio and routine microscopy (for nephropathy), clinical examination and NCV (for neuropathy). Results: Age of patients ranged from 30 – 80 years. Most patients had duration of Diabetes > 5 years. Diabetic retinopathy was found in 15% Euthyroid and 37.5% Hypothyroid diabetics (p=0.002). Neuropathy was more in Hypothyroid (35%) as compared to Euthyroid (12.5%) patients (p=0.003). Prevalence of Nephropathy was also significantly more (p=0.011) in Hypothyroids (60%) as compared to Euthyroid (38.75%). Conclusion: Significant association was found between hypothyroidism and micro vascular complications in type 2 Diabetes mellitus. Screening of diabetics for thyroid functions is essential to reduce morbidity. Keywords: Diabetes, thyroid, retinopathy, neuropathy, nephropathy

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