Visual impairment and mortality in patients with type 2 diabetes

ObjectiveTo evaluate whether visual acuity impairment was an independent predictor of mortality in patients with type 2 diabetes.Research design and methodsThis is a 19-year follow-up of a cohort of 1241 patients newly diagnosed with type 2 diabetes and aged 40 years or over. Visual acuity was assessed by practicing ophthalmologists both at diabetes diagnosis and after 6 years. The logarithmic value of the visual acuity (logMAR) was the exposure. Multivariable Cox regression models were adjusted for multiple potential confounders including cardiovascular disease, and censored for potential mediators, that is, fractures/trauma. Primary outcomes were from national registers: all-cause mortality and diabetes-related mortality.ResultsVisual impairment at diabetes diagnosis was robustly associated with subsequent 6-year all-cause mortality. Per 1 unit reduced logMAR acuity the incidence rate of all-cause mortality increased with 51% (adjusted HR: 1.51; 95% CI 1.12 to 2.03) and of fractures/trauma with 59% (HR: 1.59; 95% CI 1.18 to 2.15), but visual acuity was not associated with diabetes-related mortality. After censoring for fractures/trauma, visual acuity was still an independent risk factor for all-cause mortality (HR: 1.68; 95% CI 1.23 to 2.30). In contrast, visual acuity 6 years after diabetes diagnosis was not associated with the subsequent 13 years’ incidence of any of the outcomes, as an apparent association with all-cause mortality and diabetes-related mortality was explained by confounding from comorbidity.ConclusionsVisual acuity measured by ophthalmologists in patients newly diagnosed with type 2 diabetes was an independent predictor of mortality in the short term.

Download Full-text

Circulating Adipocyte Fatty Acid–Binding Protein Concentrations Predict Multiple Mortality Outcomes among Men and Women with Diabetes

Clinical Chemistry ◽

10.1373/clinchem.2018.289157 ◽

2018 ◽

Vol 64 (10) ◽

pp. 1496-1504 ◽

Cited By ~ 5

Author(s):

Chi Ho Lee ◽

Chloe Y Y Cheung ◽

Yu Cho Woo ◽

David T W Lui ◽

Michele M A Yuen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Fatty Acid ◽

Fatty Acid Binding Protein ◽

Independent Predictor ◽

Fatty Acid Binding ◽

Men And Women ◽

Acid Binding Protein ◽

All Cause Mortality

AbstractINTRODUCTIONRaised circulating adipocyte fatty acid–binding protein (AFABP) concentrations are associated with various adverse health conditions. However, their relationship with mortality remains to be defined, especially in view of the sexual dimorphism of circulating AFABP concentrations. Here we investigated prospectively whether serum AFABP concentrations predict multiple mortality outcomes in men and women alike, using a large clinic-based cohort of individuals with type 2 diabetes, a condition with raised AFABP concentrations.METHODSBaseline serum AFABP concentrations were measured in 5305 research participants with a monoclonal antibody-based sandwich immunoassay. The role of circulating AFABP concentrations in predicting mortality outcomes was evaluated by multivariable Cox regression analysis.RESULTSAmong the 5305 participants (59% men) in this study, over a median follow-up of 5 years, there were 512 deaths (19.3 deaths per 1000 person-years). Circulating AFABP concentrations, with higher levels in women at baseline, predicted all-cause mortality (P < 0.001), cardiovascular mortality (P = 0.037), and infection-related deaths (P < 0.002) among all participants. In sex-specific analyses, circulating AFABP concentration was an independent predictor of all-cause mortality in both men and women and a predictor of cancer-related deaths and infection-related deaths in men only. Furthermore, the addition of serum AFABP concentrations improved the time-dependent c statistics in predicting all-cause mortality in participants with type 2 diabetes (P = 0.008).CONCLUSIONSCirculating AFABP concentration was an independent predictor of various mortality outcomes in type 2 diabetes over and above known risk factors of reduced survival in men and women. The role of AFABP as a prognostic biomarker and therapeutic target warrants further investigation.

Download Full-text

The development of multimorbidity during 16 years after diagnosis of type 2 diabetes

Journal of Comorbidity ◽

10.1177/2235042x18801658 ◽

2018 ◽

Vol 8 (1) ◽

pp. 2235042X1880165 ◽

Cited By ~ 3

Author(s):

Sandra Pouplier ◽

Maria Åhlander Olsen ◽

Tora Grauers Willadsen ◽

Håkon Sandholdt ◽

Volkert Siersma ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Disease ◽

Diabetes Care ◽

Cox Regression ◽

Neurological Diseases ◽

Gastrointestinal Diseases ◽

Diabetes Diagnosis ◽

Prevalent Disease ◽

Diabetes Patients

Objective: The aims of this study were to (1) quantify the development and composition of multimorbidity (MM) during 16 years following the diagnosis of type 2 diabetes and (2) evaluate whether the effectiveness of structured personal diabetes care differed between patients with and without MM. Research design and methods: One thousand three hundred eighty-one patients with newly diagnosed type 2 diabetes were randomized to receive either structured personal diabetes care or routine diabetes care. Patients were followed up for 19 years in Danish nationwide registries for the occurrence of outcomes. We analyzed the prevalence and degree of MM based on 10 well-defined disease groups. The effect of structured personal care in diabetes patients with and without MM was analyzed with Cox regression models. Results: The proportion of patients with MM increased from 31.6% at diabetes diagnosis to 80.4% after 16 years. The proportion of cardiovascular and gastrointestinal diseases in surviving patients decreased, while, for example, musculoskeletal, eye, and neurological diseases increased. The effect of the intervention was not different between type 2 diabetes patients with or without coexisting chronic disease. Conclusions: In general, the proportion of patients with MM increased after diabetes diagnosis, but the composition of chronic disease changed during the 16 years. We found cardiovascular and musculoskeletal disease to be the most prevalent disease groups during all 16 years of follow-up. The post hoc analysis of the intervention showed that its effectiveness was not different among patients who developed MM compared to those who continued to have diabetes alone.

Download Full-text

Mannose-binding Lectin and Risk of Cardiovascular Events and Mortality in Type 2 Diabetes: A Danish Cohort Study

10.2337/figshare.12240836 ◽

2020 ◽

Author(s):

Anne Gedebjerg ◽

Mette Bjerre ◽

Alisa Devedzic Kjaergaard ◽

Rudi Steffensen ◽

Jens Steen Nielsen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Cohort Study ◽

Cardiovascular Events ◽

Cox Regression ◽

Mannose Binding Lectin ◽

Mannose Binding ◽

All Cause Mortality ◽

Binding Lectin

<b>Objective</b>: Mannose-binding lectin (MBL) is linked to risk of cardiovascular disease in diabetes, but the nature of the association is unclear. We investigated the association between MBL and risk of cardiovascular events (CVE) and all-cause mortality in type 2 diabetes. <p><b>Research Design and Methods</b>: In a cohort study of 7588 patients with type 2 diabetes, we measured serum MBL in 7305 and performed MBL expression genotyping in 3043. We grouped serum MBL and MBL expression genotypes into three categories: low, intermediate, and high. Outcomes were CVE (myocardial infarction, stroke, coronary revascularization, unstable angina, and cardiovascular death) and all-cause mortality. The association with outcomes was examined by spline and Cox regression analyses. </p> <p><b>Results</b>: Serum MBL and CVE showed a U-shaped association. Compared to the intermediate serum MBL category, the adjusted hazard ratio (HR) for CVE was 1.82 (95% CI, 1.34 to 2.46) for the low-MBL category and 1.48 (95% CI, 1.14 to 1.92) for the high-MBL category. We found a similar U-shaped association for all-cause mortality, but with lower risk estimates. Compared to the intermediate MBL expression genotype, the adjusted HR for CVE was 1.40 (95% CI, 0.87 to 2.25) for the low-expression genotype and 1.44 (95% CI, 1.01 to 2.06) for the high-expression genotype. MBL expression genotype was not associated with all-cause mortality. </p> <p><b>Conclusions:</b> Both serum MBL and MBL expression genotype showed a U-shaped association with CVE risk in individuals with type 2 diabetes. Our findings suggest that serum MBL is a risk factor for cardiovascular disease in this population.</p>

Download Full-text

Mannose-binding Lectin and Risk of Cardiovascular Events and Mortality in Type 2 Diabetes: A Danish Cohort Study

10.2337/figshare.12240836.v1 ◽

2020 ◽

Author(s):

Anne Gedebjerg ◽

Mette Bjerre ◽

Alisa Devedzic Kjaergaard ◽

Rudi Steffensen ◽

Jens Steen Nielsen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Cohort Study ◽

Cardiovascular Events ◽

Cox Regression ◽

Mannose Binding Lectin ◽

Mannose Binding ◽

All Cause Mortality ◽

Binding Lectin

Download Full-text

The Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz045 ◽

2019 ◽

Vol 105 (1) ◽

pp. 152-162 ◽

Cited By ~ 1

Author(s):

Alexandra K Lee ◽

Mark Woodward ◽

Dan Wang ◽

Toshiaki Ohkuma ◽

Bethany Warren ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Weight Change ◽

Cox Regression ◽

Lifestyle Changes ◽

Baseline Body Mass Index ◽

Diabetes Medication ◽

Increased Risk ◽

All Cause Mortality

Abstract Context Weight loss is strongly recommended for overweight and obese adults with type 2 diabetes. Unintentional weight loss is associated with increased risk of all-cause mortality, but few studies have examined its association with cardiovascular outcomes in patients with diabetes. Objective To evaluate 2-year weight change and subsequent risk of cardiovascular events and mortality in established type 2 diabetes. Design and Setting The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation was an international, multisite 2×2 factorial trial of intensive glucose control and blood pressure control. We examined 5 categories of 2-year weight change: >10% loss, 4% to 10% loss, stable (±<4%), 4% to 10% gain, and >10% gain. We used Cox regression with follow-up time starting at 2 years, adjusting for intervention arm, demographics, cardiovascular risk factors, and diabetes medication use from the 2-year visit. Results Among 10 081 participants with valid weight measurements, average age was 66 years. By the 2-year examination, 4.3% had >10% weight loss, 18.4% had 4% to 10% weight loss, and 5.3% had >10% weight gain. Over the following 3 years of the trial, >10% weight loss was strongly associated with major macrovascular events (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.26-2.44), cardiovascular mortality (HR, 2.76; 95% CI, 1.87-4.09), all-cause mortality (HR, 2.79; 95% CI, 2.10-3.71), but not major microvascular events (HR, 0.91; 95% CI, 0.61-1.36), compared with stable weight. There was no evidence of effect modification by baseline body mass index, age, or type of diabetes medication. Conclusions In the absence of substantial lifestyle changes, weight loss may be a warning sign of poor health meriting further workup in patients with type 2 diabetes.

Download Full-text

Peripheral monocyte count is an independent predictor of all-cause mortality in type 2 diabetes with macro-vascular complications

Medicine ◽

10.1097/md.0000000000018876 ◽

2020 ◽

Vol 99 (4) ◽

pp. e18876

Author(s):

Lina Yang ◽

Jinbo Hu ◽

Zhihong Wang ◽

Xiangjun Chen ◽

Yue Wang ◽

...

Keyword(s):

Type 2 Diabetes ◽

Independent Predictor ◽

Vascular Complications ◽

Monocyte Count ◽

All Cause Mortality ◽

Peripheral Monocyte

Download Full-text

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

Scientific Reports ◽

10.1038/s41598-018-30740-y ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 7

Author(s):

Yeon-Yong Kim ◽

Jin-Seok Lee ◽

Hee-Jin Kang ◽

Sang Min Park

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Medication Adherence ◽

Newly Diagnosed ◽

All Cause Mortality ◽

Diabetes Patients

Download Full-text

Increased orosomucoid in urine is an independent predictor of cardiovascular and all-cause mortality in patients with type 2 diabetes at 10years of follow-up

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2013.05.008 ◽

2013 ◽

Vol 27 (6) ◽

pp. 570-575 ◽

Cited By ~ 5

Author(s):

Mathilde Svendstrup ◽

Merete Skovdal Christiansen ◽

Erik Magid ◽

Eva Hommel ◽

Bo Feldt-Rasmussen

Keyword(s):

Type 2 Diabetes ◽

Independent Predictor ◽

All Cause Mortality

Download Full-text

Ultrafiltration rate and diabetes as useful indicators of cardiovascular-related death in hemodialysis patients below 60 years of age

Postępy Higieny i Medycyny Doświadczalnej ◽

10.5604/01.3001.0010.7010 ◽

2017 ◽

Vol 71 (0) ◽

pp. 0-0

Author(s):

Marcin Krzanowski ◽

Katarzyna Krzanowska ◽

Artur Dziewierz ◽

Małgorzata Banaszkiewicz ◽

Artur Jurczyszyn ◽

...

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Mortality Data ◽

Cox Regression Analysis ◽

Time To Death ◽

All Cause Mortality ◽

Dm Type 2 ◽

Related Mortality

Background: The survival rate of elderly hemodialyzed (HD) patients is commonly thought to be poor. In a prospective, single center, non-interventional, observational study, the cause of all-cause and cardiovascular (CV) and heart failure (HF) mortality in this patient group were examined and compared with a younger cohort (below 60 years). Material/Methods: The study included 223 patients (90 women and 133 men) with age ranging from 34.5 to 75.0 years treated with HD. Median duration of HD was 70.0 months (24.0-120.0). Mortality data was collected over a period of six years. We divided patients into groups: <60 (n=123), ≥60 years (n=100), and with (n=33) and without DM type 2 (n=190). Results: During a six-year follow-up, 100 patients (44.8%) died, including 83 (37.2%) patients who died due to CV reasons. Median follow-up was 2015.0 days (946.0-2463.0) with the median time to death of 1166.0 days (654.5-1631.0). The factors negatively affecting patients’ survival in univariate Cox regression analysis included for all-cause mortality were: inter-dialytic weight gain (IDWG) (hazard ratio [HR]=1.60; p=0.01), ultrafiltration (UF) rate (HR=3.63; p=0.012) for group <60 years; for CV death: UF rate (HR=4.20; p=0.03), DM (HR=5.11; p=0.002) for group <60 years; for HF death: mellitus type 2 (DM) (HR=2.93; p=0.027) for group ≥60 years). In a multivariate Cox regression analysis for patients <60 years, the UF rate was the only independent predictor of all-cause mortality (HR 3.63 (1.34-9.67); p=0.011). Both DM (HR 4.91 (1.71-14.10); p=0.003) and UF rate (HR 3.62 (1.04-12.61); p=0.044) were independent predictors of CV-related mortality in patients <60 years. Conclusions: The UF rate can be a simple, useful indicator of higher long-term all-cause and CV mortality in HD patients <60 years of age. Also, DM may be a predictor of CV–related mortality in younger HD patients.

Download Full-text

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

10.2337/dc20-1234/suppl.12014598 ◽

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>

Download Full-text