Relationship between heavy metal exposure and type 2 diabetes: a large-scale retrospective cohort study using occupational health examinations

ObjectivesTo investigate the associations between heavy metal exposure and serum ferritin levels, physical measurements and type 2 diabetes mellitus (DM).DesignA retrospective cohort study.SettingChangwon, the location of this study, is a Korean representative industrial city. Data were obtained from medical check-ups between 2002 and 2018.ParticipantsA total of 34 814 male subjects were included. Of them, 1035 subjects with lead exposure, 200 subjects with cadmium exposure and the 33 579 remaining were assigned to cohort A, cohort B and the control cohort, respectively. Data including personal history of alcohol and smoking, age, height, weight, the follow-up duration, haemoglobin A1c (HbA1c), fasting blood sugar (FBS), ferritin levels, and lead and cadmium levels within 1 year after exposure were collected.Primary outcome measureIn subjects without diabetes, changes in FBS and HbA1c were analysed through repeated tests at intervals of 1 year or longer after the occupational exposure to heavy metals.ResultsIn Cohort A, DM was diagnosed in 33 subjects. There was a significant difference in lead concentrations between the subjects diagnosed with DM and those without DM during the follow-up period (3.94±2.92 mg/dL vs 2.81±2.03 mg/dL, p=0.002). Simple exposure to heavy metals (lead and cadmium) was not associated with DM in Cox regression models (lead exposure (HR) 1.01, 95% CI: 0.58 to 1.77, p 0.971; cadmium exposure HR 1.48, 95% CI: 0.61 to 3.55, p=0.385). Annual changes in FBS according to lead concentration at the beginning of exposure showed a positive correlation (r=0.072, p=0.032).ConclusionOur findings demonstrated that simple occupational exposure to heavy metals lead and cadmium was not associated with the incidence of DM. However, lead concentrations at the beginning of the exposure might be an indicator of DM and glucose elevations.

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FRAILTY AND THE COMPARATIVE EFFECTIVENESS AND SAFETY OF SGLT2I AND SULFONYLUREA IN OLDER ADULTS WITH TYPE 2 DIABETES

Innovation in Aging ◽

10.1093/geroni/igz038.2156 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S581-S581

Author(s):

Ajinkya Pawar ◽

elisabetta Patorno ◽

Dae Kim

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Cohort Study ◽

Comparative Effectiveness ◽

Retrospective Cohort ◽

Severe Hypoglycemia ◽

Medicare Data ◽

Cardiovascular Endpoint

Abstract We conducted a 1:1 propensity score-matched retrospective cohort study of 70,826 patients with type 2 diabetes (mean age, 71.4 years [standard deviation, 5.0]) initiating a SGLT2i or a second-generation sulfonylurea in Medicare data. We estimated HRs (95% CIs) for a composite cardiovascular endpoint and severe hypoglycemia comparing the two treatments in the entire population and by the CFI-based frailty subgroups. Compared with sulfonylureas, SGLT2is were associated with lower rates of the composite cardiovascular endpoint (HR, 0.68 [95% CI, 0.62-0.75]) and severe hypoglycemia (0.43 [0.35-0.53]) over a mean follow-up of 9.5 months. The lower rate of composite cardiovascular endpoint for SGLT2i vs sulfonylureas was observed in pre-frail (0.68 [0.61-0.77]) and frail (0.64 [0.53-0.77]) subgroups, but not in non-frail subgroup (0.95 [0.59-1.54]). The rate of severe hypoglycemia was consistently lower for SGLT2i vs sulfonylureas across frailty subgroups (non-frail, 0.37 [0.12-1.16]; pre-frail, 0.45 [0.35-0.59]; frail, 0.40 [0.28-0.58]).

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Effect of Exercise Habit on Skeletal Muscle Mass Varies with Protein Intake in Elderly Patients with Type 2 Diabetes: A Retrospective Cohort Study

Nutrients ◽

10.3390/nu12103220 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3220 ◽

Cited By ~ 1

Author(s):

Yoshitaka Hashimoto ◽

Ayumi Kaji ◽

Ryosuke Sakai ◽

Fuyuko Takahashi ◽

Rena Kawano ◽

...

Keyword(s):

Type 2 Diabetes ◽

Skeletal Muscle ◽

Cohort Study ◽

Muscle Mass ◽

Protein Intake ◽

Retrospective Cohort ◽

Skeletal Muscle Mass ◽

Exercise Habit

Exercise has been reported to be effective in maintaining and recovering muscle; however, the effect of exercise combined with adequate or inadequate protein intake on muscle mass is not clear. Therefore, this study investigates the effect of exercise habit on changes in muscle mass, with adequate or inadequate protein intake. This retrospective cohort study included 214 elderly patients with type 2 diabetes. The rate of skeletal muscle mass index (SMI) change (%) was defined as ((SMI at follow-up minus SMI at baseline)/(follow-up years [kg/m2/year] × SMI at baseline [kg/m2])) × 100. Adequate protein intake was defined as protein intake ≥1.2 g/kg ideal body weight/day. During a mean follow-up duration of 18.0 (7.1) months, the rate of SMI change was −1.14 (4.10)% in the whole sample. The rate of SMI change of non-habitual exercisers with inadequate protein intake, habitual exercisers with inadequate protein intake, non-habitual exercisers with adequate protein intake, and habitual exercisers with adequate protein intake was −1.22 (3.71), −2.31 (3.30), −1.88 (4.62), and 0.36 (4.29)%, respectively. Compared with patients with exercise habit and adequate protein intake, the odds ratio for decreasing SMI was 2.50 (0.90–6.90, p = 0.078) in patients with no exercise habit and inadequate protein intake, 3.58 (1.24–10.4, p = 0.019) in those with exercise habit and inadequate protein intake, and 3.03 (1.27–7.22, p = 0.012) in those with no exercise habit and adequate protein intake, after adjusting for covariates. Therefore, exercise habit without adequate protein intake was associated with an increased risk of decreasing SMI compared with exercise habit with adequate protein intake.

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Metformin Is Associated with a Lower Incidence of Benign Brain Tumors: A Retrospective Cohort Study in Patients with Type 2 Diabetes Mellitus

Biomolecules ◽

10.3390/biom11101405 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1405

Author(s):

Chin-Hsiao Tseng

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cohort Study ◽

Brain Tumors ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hazard Ratios

Background: The risk of benign brain tumors (BBT) associated with metformin use has not received much attention. Therefore, a retrospective cohort study was designed to investigate such an association in patients with type 2 diabetes mellitus (T2DM). Methods: We used the database of Taiwan’s National Health Insurance to enroll 152,176 ever users and 16,120 never users of metformin for the follow-up of incidence of BBT and a more specific outcome of cerebral meningioma. The patients were newly diagnosed with T2DM between 1999 and 2005; and they were followed up from 1 January 2006 until 31 December 2011. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using propensity score. Results: During follow-up, 111 never users and 557 ever users were diagnosed with BBT. For BBT, the respective incidence rates for never users and ever users were 153.95 per 100,000 person-years and 77.61 per 100,000 person-years. While ever users were compared to never users, the hazard ratio was 0.502 (95% confidence interval: 0.409–0.615). A dose-response pattern was seen when ever users were categorized into tertiles of cumulative duration of metformin therapy (cutoffs: <27.10 months, 27.10–58.27 months and >58.27 months) with respective hazard ratios of 0.910 (0.728–1.138), 0.475 (0.375–0.602) and 0.243 (0.187–0.315). For cerebral meningioma, the overall hazard ratio was 0.506 (0.317–0.808); and the hazard ratios comparing the respective tertiles to never users were 0.895 (0.531–1.508), 0.585 (0.346–0.988) and 0.196 (0.104–0.369). Conclusions: A reduced risk of BBT and cerebral meningioma is observed in metformin users in patients with T2DM.

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Effect of COVID-19 Pandemic on the Change in Skeletal Muscle Mass in Older Patients with Type 2 Diabetes: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084188 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4188

Author(s):

Yuka Hasegawa ◽

Fuyuko Takahashi ◽

Yoshitaka Hashimoto ◽

Chihiro Munekawa ◽

Yukako Hosomi ◽

...

Keyword(s):

Type 2 Diabetes ◽

Skeletal Muscle ◽

Cohort Study ◽

Muscle Mass ◽

Retrospective Cohort Study ◽

Older Patients ◽

Retrospective Cohort ◽

Skeletal Muscle Mass

Background: The aim of this study was to investigate the effect of the coronavirus disease (COVID-19) pandemic restrictions on the change in muscle mass in older patients with type 2 diabetes (T2D), who were not infected with COVID-19. Methods: In this retrospective cohort study, data were obtained from outpatients who underwent bioelectrical impedance analysis at least twice before April 2020 and at least once thereafter. Skeletal muscle mass index (SMI, kg/m2) was calculated as appendicular muscle mass (kg) divided by height squared (m2). Change in SMI (kg/m2/year) was calculated as (follow-up SMI—baseline SMI/follow-up period). The differences between the changes in SMI before and after the start of the COVID-19 pandemic were evaluated using paired t test. Results: This study recruited 56 patients, with a mean (SD) age of 75.2 (7.1) years. SMI changed from 6.7 (0.9) to 6.8 (0.9) kg/m2 before the COVID-19 pandemic, whereas SMI changed from 6.8 (0.9) to 6.6 (0.9) kg/m2 after the start of the COVID-19 pandemic. SMI decreased after the start of the COVID-19 pandemic compared with before the pandemic (−0.117 (0.240) vs. 0.005 (0.289) kg/m2/year, p = 0.049). This decrease was observed in men (−0.159 (0.257) vs. 0.031 (0.325) kg/m2/year, p = 0.038), patients with poor glycemic control (−0.170 (0.264) vs. 0.031 (0.285) kg/m2/year, p = 0.042), and those with a long diabetes duration (−0.153 (0.229) vs. 0.082 (0.291) kg/m2, p = 0.049). Conclusions: The COVID-19 pandemic restrictions caused muscle mass loss in older patents with T2D. Actions, including recommendation of exercise and adequate diet intake, are needed to prevent loss of muscle mass.

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Type 2 Diabetes Mellitus Development in Low-Income Mother-Infant Pairs of Brazilian Women with Previous Gestational Diabetes Mellitus: A 5-11 Years of Follow-up Retrospective Cohort Study

Placenta ◽

10.1016/j.placenta.2019.06.143 ◽

2019 ◽

Vol 83 ◽

pp. e44

Author(s):

Marilza Vieira Cunha Rudge ◽

Mariana Alvarez Arantes ◽

Lucas Pontes de Camargo ◽

Carlos Antonio Negrato ◽

Grasiela Bossolan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cohort Study ◽

Low Income ◽

Retrospective Cohort ◽

Previous Gestational Diabetes Mellitus ◽

Previous Gestational Diabetes

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Trigger finger is associated with risk of incident cardiovascular disease in individuals with type 2 diabetes: a retrospective cohort study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002070 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002070

Author(s):

Yusuke Mineoka ◽

Michiyo Ishii ◽

Yoshitaka Hashimoto ◽

Hiroki Yuge ◽

Machiko Toyoda ◽

...

Keyword(s):

Type 2 Diabetes ◽

Regression Analysis ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Trigger Finger ◽

Cox Regression Analysis

IntroductionTrigger finger is one of the complications affecting the upper extremity in patients with diabetes. Diabetes is also a well-known risk factor that predisposes individuals to cardiovascular diseases (CVDs). This retrospective cohort study aimed to establish the association between trigger finger and the patients with incident CVD with type 2 diabetes.Materials and methodsTrigger finger was diagnosed by palpating a thickened tendon during ﬂexion or on the manifestation of a locking phenomenon during extension or ﬂexion of either ﬁnger. The relationship between trigger finger and other clinical parameters or complications of diabetes was examined by a comparative analysis. Cox regression analysis was used to evaluate the association between trigger finger and incidence of CVD. We calculated the propensity scores using sex, body mass index, age, smoking status, duration of diabetes, estimated glomerular filtration rate, hypertension, dyslipidemia, and hemoglobin A1c as the number of patients with incident CVD during the follow-up period was low.ResultsAmong the 399 patients with type 2 diabetes, 54 patients had trigger finger. Patients with trigger finger were significantly older in age and had been suffering from diabetes for a longer duration. They also displayed worse renal function and glycemic control, along with a higher incidence of hypertension, neuropathy and nephropathy. During the average 5.66±1.12 years of follow-up, a total of 18 incidents occurred. According to the Cox regression analysis, trigger finger was shown to be associated with enhanced risk of the incidence of CVD after adjustment for the covariates (adjusted HR=3.33 (95% CI 1.25 to 8.66), p=0.017).ConclusionsTrigger finger is associated with the risk of incident CVD in patients with type 2 diabetes. Thus, clinicians must consider these factors at the time of diagnosis of such patients.

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