Abstract 190: Use of Intensive Glycemic Management in Older Adults With Diabetes. An Analysis From the Diabetes Collaborative Registry

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Suzanne V Arnold ◽  
Kasia J Lipska ◽  
Jingyan Wang ◽  
Leo Seman ◽  
Sanjeev N Mehta ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
High Risk ◽  
Glucose Control ◽  
Low Risk ◽  
Minimal Risk ◽  
Tight Control ◽  
Poor Control ◽  
Intensively Managed

Background: Older adults with diabetes are less likely to benefit and more likely to be harmed by intensive glucose control. Prior research has shown that many older adults continue to be intensively managed despite guidelines that recommend that treatment targets should be relaxed in these patients. As many new agents have been introduced with minimal risk of hypoglycemia, we examined contemporary data to understand to what extent older patients with diabetes are still intensively managed with agents that can cause hypoglycemia. Methods: We examined A1c and treatment data in adults ≥75 years with type 2 diabetes from 151 US outpatient sites in DCR. Patients were categorized as poor control (A1c >9%), moderate control (A1c >8-9%), conservative control (A1c 7-8%), tight control/low-risk agents (A1c <7% on meds with low risk for hypoglycemia), and tight control/high-risk agents (A1c <7% on insulin, sulfonylureas, or meglitinides). Adults with A1c <7% on no glucose-lowering medications were excluded. We used hierarchical logistic regression to examine patient and site factors associated with tight control/high-risk agents vs. conservative control or tight control/low-risk agents. Results: Among 30,696 older adults with diabetes, 5,596 (18%) had moderate or poor control, 9,227 (30%) conservative control, 7,893 (26%) tight control/low-risk agents, and 7,980 (26%) tight control/high-risk agents (Fig. A). Older age, male sex, heart failure, chronic kidney disease, and coronary artery disease were each independently associated with a greater odds of tight control/high-risk agents (Fig. B). After adjusting for patient factors, there were no differences among practice specialties (endocrinology, primary care, cardiology) in how aggressively patients were managed. Conclusion: Despite greater availability of agents that do not cause hypoglycemia, a quarter of older adults with type 2 diabetes are tightly controlled with high-risk medications. These results suggest potential overtreatment of a substantial proportion of patients. Efforts are needed to provide more specific guidance on how to safely treat older adults with diabetes (both through targeting treatment with low-risk agents and through de-escalation of glucose control) and then to efficiently translate that guidance into busy clinical practice.

scholarly journals Polygenic risk scores predict diabetes complications and their response to intensive blood pressure and glucose control

Diabetologia ◽  
2021 ◽  
Author(s):  
Johanne Tremblay ◽  
Mounsif Haloui ◽  
Redha Attaoua ◽  
Ramzan Tahir ◽  
Camil Hishmih ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
High Risk ◽  
Glucose Control ◽  
Risk Group ◽  
Cardiovascular Death ◽  
Polygenic Risk ◽  
Renal Complications ◽  
Intensive Blood Pressure

Abstract Aims/hypothesis Type 2 diabetes increases the risk of cardiovascular and renal complications, but early risk prediction could lead to timely intervention and better outcomes. Genetic information can be used to enable early detection of risk. Methods We developed a multi-polygenic risk score (multiPRS) that combines ten weighted PRSs (10 wPRS) composed of 598 SNPs associated with main risk factors and outcomes of type 2 diabetes, derived from summary statistics data of genome-wide association studies. The 10 wPRS, first principal component of ethnicity, sex, age at onset and diabetes duration were included into one logistic regression model to predict micro- and macrovascular outcomes in 4098 participants in the ADVANCE study and 17,604 individuals with type 2 diabetes in the UK Biobank study. Results The model showed a similar predictive performance for cardiovascular and renal complications in different cohorts. It identified the top 30% of ADVANCE participants with a mean of 3.1-fold increased risk of major micro- and macrovascular events (p = 6.3 × 10−21 and p = 9.6 × 10−31, respectively) and a 4.4-fold (p = 6.8 × 10−33) higher risk of cardiovascular death. While in ADVANCE overall, combined intensive blood pressure and glucose control decreased cardiovascular death by 24%, the model identified a high-risk group in whom it decreased the mortality rate by 47%, and a low-risk group in whom it had no discernible effect. High-risk individuals had the greatest absolute risk reduction with a number needed to treat of 12 to prevent one cardiovascular death over 5 years. Conclusions/interpretation This novel multiPRS model stratified individuals with type 2 diabetes according to risk of complications and helped to target earlier those who would receive greater benefit from intensive therapy. Graphical abstract

scholarly journals Temporal Trend in Young-Onset Type 2 Diabetes - the Macrovascular and Mortality Risk: Study of UK Primary Care Electronic Medical Records

2020 ◽  
Author(s):  
Digsu N. Koye ◽  
Joanna Ling ◽  
John Dibato ◽  
Kamlesh Khunti ◽  
Olga Montvida ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Risk Factor ◽  
High Risk ◽  
Mortality Risk ◽  
Cardiometabolic Risk ◽  
Low Risk ◽  
Young Onset ◽  
Onset Type

<b>Objectives: </b>To evaluate temporal prevalence trend, cardiometabolic risk factors, and the risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality (ACM) in incident young- and usual-onset type 2 diabetes. <p><b>Research Design and Methods: </b>From the UK primary care database, 370,854 people with new diagnosis of type 2 diabetes from 2000 to 2017 were identified. Analyses were conducted by age groups (18-39, 40-49, 50-59, 60-69, 70-79 years) and high/low risk status without history of ASCVD at diagnosis - ≥ two of current smoking, high SBP, high LDL-C or chronic kidney disease were classified as high-risk. </p> <p><b>Results:</b> Proportion of people aged <50 years at diagnosis increased during 2000-2010 and then stabilised. The incidence rates of ASCVD and ACM declined in people aged ≥50 years, but did not decrease in people <50 years. Compared to people aged ≥50 years, those aged 18-39 years at diagnosis had higher obesity (71% obese), higher HbA1c (8.6%), 71% had high LDL-C, while only 18% were on cardio-protective therapy. Although 2% in this age group had ASCVD at diagnosis, 23% were identified as high-risk. In the 18-39 years group, the adjusted average years to ASCVD /ACM in high-risk individuals (years (95% CI): 9.1 (8.2–10.0) /9.3 (8.1–10.4)) were similar to those with low-risk (years (95% CI): 10.0 (9.5 – 10.5) /10.5 (9.7–11.2)). However, individuals ≥50 years with high-risk were likely to experience an ASCVD event 1.5 - 2 years earlier and death 1.1 – 1.5 years earlier compared to low-risk groups (p<0.01). </p> <p><b>Conclusions: </b>Unlike usual-onset,<b> </b>young-onset type 2 diabetes have similar cardiovascular and mortality risk irrespective of their cardiometabolic risk factor status at diagnosis. The guidelines on the management of young-onset type 2 diabetes for intensive risk-factor management and cardioprotective therapies need to be urgently re-evaluated through prospective studies.<b> </b></p>

scholarly journals MO048MULTICENTRE PROSPECTIVE VALIDATION OF THE URINARY PEPTIDOME-BASED CLASSIFIER CKD273 AS A PREDICTOR OF RENAL FUNCTION DECLINE IN SUBJECTS WITH TYPE 2 DIABETES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Morten Lindhardt ◽  
Nete Tofte ◽  
Gemma Currie ◽  
Marie Frimodt-Moeller ◽  
Heiko Von der Leyen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
High Risk ◽  
Risk Group ◽  
Cox Model ◽  
Risk Groups ◽  
High Risk Group ◽  
Low Risk ◽  
Renal Function Decline

Abstract Background and Aims In the PRIORITY study, it was recently demonstrated that the urinary peptidome-based classifier CKD273 was associated with increased risk for progression to microalbuminuria. As a prespecified secondary outcome, we aim to evaluate the classifier CKD273 as a determinant of relative reductions in eGFR (CKD-EPI) of 30% and 40% from baseline, at one timepoint without requirements of confirmation. Method The ‘Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria trial’ (PRIORITY) is the first prospective observational study to evaluate the early detection of diabetic kidney disease in subjects with type 2 diabetes (T2D) and normoalbuminuria using the CKD273 classifier. Setting 1775 subjects from 15 European sites with a mean follow-up time of 2.6 years (minimum of 7 days and a maximum of 4.3 years). Patients Subjects with T2D, normoalbuminuria and estimated glomerular filtration rate (eGFR) ≥ 45 ml/min/1.73m2. Participants were stratified into high- or low-risk groups based on their CKD273 score in a urine sample at screening (high-risk defined as score &gt; 0.154). Results In total, 12 % (n = 216) of the subjects had a high-risk proteomic pattern. Mean (SD) baseline eGFR was 88 (15) ml/min/1.73m2 in the low-risk group and 81 (17) ml/min/1.73m2 in the high-risk group (p &lt; 0.01). Baseline median (interquartile range) urinary albumin to creatinine ratio (UACR) was 5 (3-8) mg/g and 7 (4-12) mg/g in the low-risk and high-risk groups, respectively (p &lt; 0.01). A 30 % reduction in eGFR from baseline was seen in 42 (19.4 %) subjects in the high-risk group as compared to 62 (3.9 %) in the low-risk group (p &lt; 0.0001). In an unadjusted Cox-model the hazard ratio (HR) for the high-risk group was 5.7, 95 % confidence interval (CI) (3.9 to 8.5; p&lt;0.0001). After adjustment for baseline eGFR and UACR, the HR was 5.2, 95 % CI (3.4 to 7.8; p&lt;0.0001). A 40 % reduction in eGFR was seen in 15 (6.9 %) subjects in the high-risk group whereas 22 (1.4 %) in the low-risk group developed this endpoint (p&lt;0.0001). In an unadjusted Cox-model the HR for the high-risk group was 5.0, 95 % CI (2.6 to 9.6; p&lt;0.0001). After adjustment for baseline eGFR and UACR, the HR was 4.8, 95 % CI (2.4 to 9.7; p&lt;0.0001). Conclusion In normoalbuminuric subjects with T2D, the urinary proteomic classifier CKD273 predicts renal function decline of 30 % and 40 %, independent of baseline eGFR and albuminuria.

scholarly journals Psychological Distress and Incidence of Type 2 Diabetes in High-Risk and Low-Risk Populations: The Whitehall II Cohort Study

Diabetes Care ◽  
2014 ◽  
Vol 37 (8) ◽  
pp. 2091-2097 ◽  
Author(s):  
Marianna Virtanen ◽  
Jane E. Ferrie ◽  
Adam G. Tabak ◽  
Tasnime N. Akbaraly ◽  
Jussi Vahtera ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Psychological Distress ◽  
High Risk ◽  
Low Risk

scholarly journals Evaluation of the HbA1c Reduction Cut Point for a Nonglycemic Effect on Cardiovascular Benefit of Hypoglycemic Agents in Patients with Type 2 Diabetes Based on Endpoint Events

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yuchao Wu ◽  
Lizhi Tang ◽  
Fang Zhang ◽  
Zhe Yan ◽  
Jing Li ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Prevention ◽  
High Risk ◽  
Secondary Prevention ◽  
Glucose Control ◽  
Hypoglycemic Agents ◽  
Intensive Glucose Control ◽  
Very High ◽  
Cardiovascular Benefit

Background. Atherosclerotic cardiovascular disease (ASCVD) is a major cause of death among patients with diabetes but can be improved by certain hypoglycemic agents. However, adjudicating criteria on whether improvements are a glycemic or nonglycemic effect of these agents remain unclear. Methods. Hypoglycemic agents that produce a cardiovascular benefit in nondiabetic patients are considered to do so via a nonglycemic effect. We performed a subgroup analysis for primary and secondary prevention or very high risk of ASCVD in patients with type 2 diabetes (T2DM). Where glycosylated hemoglobin (HbA1c) was reduced to the same extent in a head-to-head comparison, cardiovascular benefits were judged as a nonglycemic effect. Furthermore, by analyzing the endpoints of four important randomized controlled intensive glucose control studies, UKPDS33, ADVANCE, ACCORD, and VADT, we calculated the cut point of HbA1c reduction for a nonglycemic effect on cardiovascular benefit by hypoglycemic agents in ASCVD groups of different severities. Results. For the ASCVD primary prevention group of T2DM, UKPDS33 indicated a reduction in HbA1c < 0.9%, and a cardiovascular benefit within 10 years was considered a nonglycemic effect. For ASCVD secondary prevention or in the very high-risk group, pioglitazone exerted a nonglycemic effect on cardiovascular benefit in nondiabetic patients with insulin resistance; metformin may exert a similar effect in T2DM patients in a head-to-head study. Analysis of T2DM intensive glucose control studies showed a reduction in HbA1c of <1.0%, and a cardiovascular benefit after approximately 5 years was deemed a nonglycemic effect. Conclusions. For ASCVD primary prevention in T2DM, a reduction in HbA1c < 0.9% and a cardiovascular benefit within 10 years were considered a nonglycemic effect. For ASCVD secondary prevention or in a very high-risk population, a reduction in HbA1c < 1.0% and a cardiovascular benefit within about 5 years were also considered a nonglycemic effect.

scholarly journals The Relationship between the Risks of Developing Type 2 Diabetes Mellitus and Cardiovascular Diseases

2020 ◽  
Vol 14 (1) ◽  
pp. 13-17
Author(s):  
Carlos Sotomayor-Beltran ◽  
Rosa Perez-Siguas ◽  
Eduardo Matta-Solis ◽  
Hernan Matta-Solis
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Healthcare Facility ◽  
Low Risk ◽  
Exact Test ◽  
Significant Difference

Background: Type 2 Diabetes Mellitus (T2DM) has significantly increased in the past decades due to changes in lifestyles. This chronic disease is expected to be ranked in the seventh position by the year 2030 among the 15 leading causes of death. Poorly treated T2DM can be an important risk factor for cardiovascular diseases as well (CVD). Objective: We have sought to determine a relationship between the risks of developing T2DM and CVD in a healthcare facility in the district of Breña (Lima, Peru). Methods: The Finnish Diabetes Risk Score survey and the Pan American Health Organization risk calculator were used on a sample of 150 patients. The inclusion criteria were: patient age 40-80 years, attended their medical appointment more than once, were overweight or showed cholesterol levels above normal values and lived within the catchment area of the healthcare center where the study was carried out. Results: Only 8.7% of our sample was at a low risk of developing T2DM, whereas the rest was at a slightly elevated, moderate and high risk. Additionally, 79.3% of the patients were at low risk of developing CVD. Using the Fisher’s Exact test, there was a significant difference (p=0.026) between the risk grading of developing T2DM and CVD. Conclusion: The risk of developing CVD in our population is expected to rise in the future due to the already observed high risk of developing T2DM. It is hoped that this work serves Peruvian (and other) health authorities to bolster their prevention programs, especially focusing on lifestyle interventions (e.g. increased physical activity), which have proven to be successful and economical.

scholarly journals Prediction scores to identify older adults at high risk for type 2 diabetes

2009 ◽  
Vol 63 (Suppl 2) ◽  
pp. 61-61
Author(s):  
S. G. Wannamethee ◽  
O. Papacosta ◽  
P. Whincup ◽  
C. Carson ◽  
M. C. Thomas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
High Risk

scholarly journals Risk-stratified lifestyle intervention to prevent type 2 diabetes

2021 ◽  
Author(s):  
Andreas Fritsche ◽  
Robert Wagner ◽  
Martin Heni ◽  
Kostantinos Kantartzis ◽  
Jürgen Machann ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Glucose Tolerance ◽  
Lifestyle Intervention ◽  
Fat Content ◽  
Low Risk ◽  
Liver Fat ◽  
List Type ◽  
Liver Fat Content

AbstractBackgroundLifestyle intervention (LI) can successfully prevent type 2 diabetes, but response to LI strongly varies depending on risk subphenotypes. We tested if individuals with prediabetes and a high-risk phenotype benefit from an intensification of LI.Methods and findingsWe conducted a risk stratified multicenter randomized controlled intervention study over 12 months with additional 2 year follow up. In eight University Hospitals in Germany, 1105 individuals (female 59%, age 58±11 years, BMI 31.1±6.0 kg/m2 (mean±SD)) with impaired fasting glucose and/or impaired glucose tolerance were included between May 2012 and May 2016 in the study. Participants were stratified into 2 groups; a high- and low-risk phenotype, based on insulin secretion, insulin sensitivity and liver fat content. Low-risk individuals were randomly assigned to conventional LI or control (1:1), high-risk individuals to conventional or intensified LI (1:1), each over one year. Intensified LI included doubling of physical exercise and time of counselling. The primary endpoint was change in post-challenge glucose levels, assessed by frequently sampled oral glucose tolerance tests. Secondary endpoints included changes in liver fat content, assessed by magnetic resonance spectroscopy. A total of 908 (82%) participants completed the study after 12 months of LI. In high-risk individuals, the mean difference estimate between conventional and intensified LI in change in post-challenge glucose levels from baseline was −0.290 mmol/l [CI: −0.544;−0.036], p=0.025. Liver fat content was more reduced by intensified LI than by conventional LI (mean difference estimate: −1.34 percentage points [CI: −2.17;−0.50], p=0.002), and cardiovascular risk decreased stronger with intensified LI than with conventional LI (mean difference estimate −1.82 [CI: −3.13−0.50], p=0.007). In low-risk individuals, conventional LI was not superior to control in reducing postprandial glucose, liver fat or cardiovascular risk. During the total observation period of 3 years, high-risk participants with intensified LI had a higher probability to normalize glucose tolerance compared to conventional LI (p=0.003). The limitations of this study include a relative short duration of LI, a non-completer rate of 18% and an underrepresentation of low risk individuals.ConclusionsIn high-risk individuals with prediabetes it is possible to improve glycemic and cardiometabolic outcomes by intensification of the commonly recommended conventional LI. Our results show that individualized, risk-phenotype-based LI can be implemented for the prevention of diabetes.RegistrationNCT01947595Author summaryWhy Was This Study Done?Clinical trials in individuals with prediabetes have shown that the onset of type 2 diabetes can be delayed or prevented with lifestyle intervention.Among individuals with prediabetes, there is a large variability in the response to lifestyle intervention.It is unknown whether an intensification of intervention is able to improve the beneficial response.What Did the Researchers Do and Find?The present multicenter, risk stratified randomized and controlled intervention trial in 1105 German individuals with prediabetes prospectively confirms the existence of a high-risk prediabetes phenotypeThe intensification of lifestyle intervention in high-risk individuals improves the glycemic outcome after 1 year of lifestyle intervention, and additionally results in a higher frequency of regression to normal glucose tolerance after 3 years of follow up..Intensification of lifestyle intervention results in a larger reduction of liver fat content and stronger improves cardiometabolic outcomes in high-risk individuals.What Do These Findings Mean?Strategies for the prevention of type 2 diabetes should include risk stratification and individualised interventions.Our results highlight a dose-effect relationship for lifestyle intervention and suggest that “one size fits NOT all” in the field of diabetes prevention.It remains to be clarified whether low risk individuals benefit from lifestyle intervention, as there was a low number of individuals in this risk group in the current study.

scholarly journals PromarkerD Predicts Renal Function Decline in Type 2 Diabetes in the Canagliflozin Cardiovascular Assessment Study (CANVAS)

2020 ◽  
Vol 9 (10) ◽  
pp. 3212
Author(s):  
Kirsten E. Peters ◽  
Jialin Xu ◽  
Scott D. Bringans ◽  
Wendy A. Davis ◽  
Timothy M.E. Davis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
High Risk ◽  
Low Risk ◽  
Moderate Risk ◽  
Renal Function Decline ◽  
Assessment Study ◽  
Cardiovascular Assessment ◽  
Egfr Decline

The ability of current tests to predict chronic kidney disease (CKD) complicating diabetes is limited. This study investigated the prognostic utility of a novel blood test, PromarkerD, for predicting future renal function decline in individuals with type 2 diabetes from the CANagliflozin CardioVascular Assessment Study (CANVAS). PromarkerD scores were measured at baseline in 3568 CANVAS participants (n = 1195 placebo arm, n = 2373 canagliflozin arm) and used to predict incident CKD (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 during follow-up in those above this threshold at baseline) and eGFR decline ≥30% during the 4 years from randomization. Biomarker concentrations (apolipoprotein A-IV (apoA4), CD5 antigen-like (CD5L/AIM) and insulin-like growth factor-binding protein 3 (IGFBP3) measured by mass spectrometry were combined with clinical data (age, serum high-density lipoprotein (HDL)-cholesterol, eGFR) using a previously defined algorithm to provide PromarkerD scores categorized as low-, moderate- or high-risk. The participants (mean age 63 years, 33% females) had a median PromarkerD score of 2.9%, with 70.5% categorized as low-risk, 13.6% as moderate-risk and 15.9% as high-risk for developing incident CKD. After adjusting for treatment, baseline PromarkerD moderate-risk and high-risk scores were increasingly prognostic for incident CKD (odds ratio 5.29 and 13.52 versus low-risk, respectively; both p < 0.001). Analysis of the PromarkerD test system in CANVAS shows the test can predict clinically significant incident CKD in this multi-center clinical study but had limited utility for predicting eGFR decline ≥30%.

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