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 Chronic complications in patients with newly diagnosed type 2 diabetes: prevalence and related metabolic and clinical features: the Verona Newly Diagnosed Type 2 Diabetes Study (VNDS) 9

2020 ◽  
Vol 8 (1) ◽  
pp. e001549
Author(s):  
Enzo Bonora ◽  
Maddalena Trombetta ◽  
Marco Dauriz ◽  
Daniela Travia ◽  
Vittorio Cacciatori ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Beta Cell ◽  
Clinical Features ◽  
Microvascular Disease ◽  
Macrovascular Disease ◽  
Newly Diagnosed ◽  
Chronic Complications ◽  
Detailed Medical History

IntroductionWe explored the presence of chronic complications in subjects with newly diagnosed type 2 diabetes referred to the Verona Diabetes Clinic. Metabolic (insulin secretion and sensitivity) and clinical features associated with complications were also investigated.Research design and methodsThe comprehensive assessment of microvascular and macrovascular complications included detailed medical history, resting ECG, ultrasonography of carotid and lower limb arteries, quantitative neurological evaluation, cardiovascular autonomic tests, ophthalmoscopy, kidney function tests. Insulin sensitivity and beta-cell function were assessed by state-of-the-art techniques (insulin clamp and mathematical modeling of glucose/C-peptide curves during oral glucose tolerance test).ResultsWe examined 806 patients (median age years, two-thirds males), of whom prior clinical cardiovascular disease (CVD) was revealed in 11.2% and preclinical CVD in 7.7%. Somatic neuropathy was found in 21.2% and cardiovascular autonomic neuropathy in 18.6%. Retinopathy was observed in 4.9% (background 4.2%, proliferative 0.7%). Chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2) was found in 8.8% and excessive albuminuria in 13.2% (microalbuminuria 11.9%, macroalbuminuria 1.3%).Isolated microvascular disease occurred in 30.8%, isolated macrovascular disease in 9.3%, a combination of both in 9.1%, any complication in 49.2% and no complications in 50.8%.Gender, age, body mass index, smoking, hemoglobin A1c and/or hypertension were independently associated with one or more complications. Insulin resistance and beta-cell dysfunction were associated with macrovascular but not microvascular disease.ConclusionsDespite a generally earlier diagnosis for an increased awareness of the disease, as many as ~50% of patients with newly diagnosed type 2 diabetes had clinical or preclinical manifestations of microvascular and/or macrovascular disease. Insulin resistance might play an independent role in macrovascular disease.Trial registration numberNCT01526720.

scholarly journals Knowledge, attitudes, and beliefs about acute coronary syndrome among patients with type 2 diabetes

2021 ◽  
Vol 29 ◽  
Author(s):  
Camille Alardis Hunte Johnson ◽  
Natássia Condilo Pitta ◽  
Carina Aparecida Marosti Dessotte ◽  
Rosana Aparecida Spadoti Dantas ◽  
Lídia Aparecida Rossi
Keyword(s):  
Type 2 Diabetes ◽  
Acute Coronary Syndrome ◽  
Educational Level ◽  
Diabetes Diagnosis ◽  
Attitudes And Beliefs ◽  
Cross Sectional ◽  
Response Index ◽  
Arm Pain ◽  
Coronary Syndrome

Objective: to evaluate the knowledge, attitudes, and beliefs of Guyanese individuals with type 2 diabetes regarding acute coronary syndrome and explore associations between these measures and the population’s sociodemographic and clinical characteristics. Method: cross-sectional study conducted in Linden, Guyana, with sixty type 2 diabetics, interviewed using a sociodemographic and clinical questionnaire and the Acute Coronary Syndrome-Response Index. The Mann-Whitney test was used to assess potential differences between groups according to the ACS-Response Index subscales, and sex, age, time since diabetes diagnosis, and body mass index and the Kruskal-Wallis test to compare the ACS-Response Index subscales according to educational level. Results: only two participants correctly answered more than 70% of the Knowledge subscale. Participants obtained low mean scores in all subscales. Less than half of the participants reported chest pain and arm pain as symptoms of heart attack. Significant differences were found when comparing Knowledge (p=0.008) and Attitudes (p=0.009) according to educational level. Conclusion: individuals with type 2 diabetes showed low level of Knowledge, Attitudes, and Beliefs. Participants who scored the highest in Knowledge and Attitudes presented the highest educational level. The results show a need for health professionals to heed knowledge deficits regarding acute coronary syndrome among type 2 diabetes.

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.

scholarly journals Impact of timing of randomization after an acute coronary syndrome and subsequent events in patients with type 2 diabetes mellitus: an analysis of the EXAMINE trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Elharram ◽  
A Sharma ◽  
W White ◽  
G Bakris ◽  
P Rossignol ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Clinical Trials ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Primary Outcome ◽  
Funding Source ◽  
Coronary Syndrome ◽  
The Impact

Abstract Background The timing of enrolment following an acute coronary syndrome (ACS) may influence cardiovascular (CV) outcomes and potentially treatment effect in clinical trials. Using a large contemporary trial in patients with type 2 diabetes mellitus (T2DM) post-ACS, we examined the impact of timing of enrolment on subsequent CV outcomes. Methods EXAMINE was a randomized trial of alogliptin versus placebo in 5380 patients with T2DM and a recent ACS. The primary outcome was a composite of CV death, non-fatal myocardial infarction [MI], or non-fatal stroke. The median follow-up was 18 months. In this post hoc analysis, we examined the occurrence of subsequent CV events by timing of enrollment divided by tertiles of time from ACS to randomization: 8–34, 35–56, and 57–141 days. Results Patients randomized early (compared to the latest times) had less comorbidities at baseline including a history of heart failure (HF; 24.7% vs. 33.0%), prior coronary artery bypass graft (9.6% vs. 15.9%), or atrial fibrillation (5.9% vs. 9.4%). Despite the reduced comorbidity burden, the risk of the primary outcome was highest in patients randomized early compared to the latest time (adjusted hazard ratio [aHR] 1.47; 95% CI 1.21–1.74) (Figure 1). Similarly, patients randomized early had an increased risk of recurrent MI (aHR 1.51; 95% CI 1.17–1.96) and HF hospitalization (1.49; 95% CI 1.05–2.10). Conclusion In a contemporary cohort of T2DM with a recent ACS, early randomization following the ACS increases the risk of CV events including recurrent MI and HF hospitalization. This should be taken into account when designing future clinical trials. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Takeda Pharmaceutical

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