Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register

Background: Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. Aims: To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. Patients and methods: A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. Results: A time-updated systolic blood pressure < 130 mmHg was associated with a higher risk of all-cause mortality in patients both with and without a history of chronic heart failure (hazard ratio: 1.25, 95% confidence interval: 1.13–1.40 and hazard ratio: 1.26, 1.17–1.36, respectively). A time-updated decrease in systolic blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (−10 to −25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17–1.32). Conclusion: Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.

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Shortened Relative Leukocyte Telomere Length is Associated with Prevalent and Incident Cardiovascular Complications in Type 2 Diabetes- Analysis from the Hong Kong Diabetes Register

10.2337/figshare.12498335 ◽

2020 ◽

Author(s):

Feifei Cheng ◽

Andrea O Luk ◽

Claudia HT Tam ◽

Baoqi Fan ◽

Hongjiang Wu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Hong Kong ◽

Telomere Length ◽

Cox Regression ◽

Quantitative Polymerase Chain Reaction ◽

Hazard Ratio ◽

Chinese Patients ◽

Diabetes Register

Objective: Several studies support potential links between leukocyte relative telomere length (rLTL), a biomarker of biological aging and type 2 diabetes. This study investigates relationships between rLTL and subsequent cardiovascular disease (CVD) in patients with type 2 diabetes. Research design and methods: Consecutive Chinese patients with type 2 diabetes (N=5349) from the Hong Kong Diabetes Register with stored baseline DNA and available follow-up data were studied. rLTL was measured using quantitative polymerase chain reaction. CVD was diagnosed based on ICD-9 code. Results: Mean (SD) follow-up was 13.4(5.5) years. rLTL was correlated inversely with age, diabetes duration, blood pressure, HbA1c, urine ACR and positively with eGFR (all P<0.001). Subjects with versus without CVD at baseline had shorter rLTL (4.3±1.2 vs. 4.6±1.2, P<0.001). Of the 4541 CVD-free subjects at baseline, the 1140 who developed CVD during follow-up had shorter rLTL than those remaining CVD-free after adjusting for age, sex, smoking and albuminuria status (4.3±1.2 vs. 4.7±1.2, P<0.001). In Cox regression models, shorter rLTL was associated with higher risk of incident CVD (hazard ratio (95% CI) for each unit decrease: 1.252 (1.195-1.311), P<0.001), which remained significant after adjusting for age, sex, BMI, SBP, LDL-C, HbA1c, eGFR and ACR (hazard ratio (95% CI): 1.141 (1.084-1.200), P<0.001). Conclusions: rLTL is significantly shorter in type 2 diabetes patients with CVD, is associated with cardiometabolic risk factors, and is independently associated with incident CVD. Telomere length may be a useful biomarker for CVD risk in type 2 diabetes.

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Abstract 11267: LX4211, a Dual Inhibitor of Sodium-Glucose Cotransporters 1 and 2, Reduces Systolic Blood Pressure in Patients With Type 2 Diabetes Mellitus and Moderate to Severe Renal Impairment

Circulation ◽

10.1161/circ.130.suppl_2.11267 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Pablo Lapuerta ◽

Paul Strumph ◽

Philip Banks ◽

Ikenna Ogbaa ◽

Brian Zambrowicz ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Renal Impairment ◽

Systolic Blood Pressure ◽

Severe Renal Impairment ◽

Postprandial Glucose ◽

Dual Inhibitor

Introduction: Selective sodium-glucose cotransporter 2 (SGLT2) inhibitors target only the kidney, and they have reduced efficacy when patients with type 2 diabetes mellitus (T2DM) have renal impairment (RI). LX4211 blocks sodium and glucose absorption in the gastrointestinal tract by inhibition of SGLT1, and it enhances urinary sodium and glucose excretion in the urine through inhibition of SGLT2. The dual SGLT1/2 action of LX4211 was anticipated to reduce systolic blood pressure (SBP) in addition to improving glucose control in the setting of RI. Methods: This analysis explored the effect of LX4211 on SBP in a clinical trial of patients with T2DM and moderate to severe RI. Patients (N=31) were randomly assigned to be treated with LX4211 (400 mg, N=16) or placebo (N=15) qd for 7 consecutive days. Postprandial glucose levels after a standard high glucose meal served as the primary measure of pharmacodynamic activity. Baseline and Day 8 trough SBP measures were each an average of 3 seated assessments. Results: Mean baseline characteristics included age 66.4 years, estimated glomerular filtration rate (eGFR) 43.4 mL/min/1.73 m 2 , and SBP 130.9 mmHg. Postprandial glucose area under the curve (sampled from pre-dose to 4 hours post meal) was reduced from Baseline to Day 7 by 169.3 mg*hr/dL on LX4211 compared to placebo (p=0.003). Day 8 SBP reductions were 11.4 mmHg on LX4211 and 0.0 mmHg on placebo (p=0.045 for difference between groups). Patients with greater RI (eGFR <45 mL/min/1.73 m2) treated with LX4211 (N=6) had a 10.5 mmHg SBP reduction compared to 0.3 mmHg on placebo (N=9). The difference between seated and standing SBP did not change with LX4211 (0.0 mmHg change, Day 8 vs. Baseline). There were no reports of hypotension, hypovolemia, no serious adverse events, and no patient discontinued due to an adverse event. Mild hypoglycemia was reported in 1 LX4211 patient compared to 2 placebo patients. Conclusions: LX4211 may reduce SBP and enhance glycemic control in T2DM patients with moderate to severe RI.

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UPSTROKE TIME PER CARDIAC CYCLE IS ASSOCIATED WITH CARDIOVASCULAR PROGNOSIS IN TYPE 2 DIABETES

Endocrine Practice ◽

10.4158/ep-2019-0078 ◽

2019 ◽

Vol 25 (11) ◽

pp. 1109-1116 ◽

Cited By ~ 2

Author(s):

Li-Hsin Chang ◽

Chii-Min Hwu ◽

Chia-Huei Chu ◽

Justin G.S. Won ◽

Harn-Shen Chen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Confidence Interval ◽

Cardiac Cycle ◽

Hazard Ratio ◽

All Cause Mortality ◽

Composite Events ◽

Artery Disease

Objective: Upstroke time per cardiac cycle (UTCC) in the lower extremities has been found to be predictive of cardiovascular mortality in the general population. Therefore, the purpose of the study was to test the associations between increasing UTCC and outcomes in patients with type 2 diabetes. Methods: A total of 452 patients with type 2 diabetes (age, 67.5 ± 8.6 years; male, 54%) registered in a share-care program participated in the study at an outpatient clinic in Taipei Veterans General Hospital across a mean of 5.8 years. Primary outcomes were all-cause mortality hospitalization for coronary artery disease, stroke, revascularization, amputation, and diabetic foot syndrome. Secondary end-point outcome was all-cause mortality. Results: Increment of UTCC associations with primary and secondary outcomes were undertaken prior to baseline characteristic adjustments. A UTCC of 20.1% exhibited the greatest area under curve (AUC), sensitivity, and specificity balance to predict composite events in receiver operating curves (AUC, 0.63 [ P = .001]; sensitivity, 67.7%; specificity, 54.9%). Sixty-four composite events and 17 deaths were identified from medical records. UTCC ≥20.1% was associated with the occurrence of composite events and an increased risk of mortality. For composite events, an adjusted hazard ratio (HR) of 2.45 and 95% confidence interval (CI) of 1.38 to 4.35 ( P = .002) were calculated. For all-cause mortality, an adjusted HR of 1.91 and 95% CI of 0.33 to 10.99 ( P = .467) were calculated. Conclusion: Increasing UTCC was associated with cardiovascular outcomes in patients with type 2 diabetes. Therefore, UTCC is advocated as a noninvasive screening tool for ambulatory patients with type 2 diabetes. Abbreviations: CAD = coronary artery disease; CI = confidence interval; eGFR = estimated glomerular filtration rate; HR = hazard ratio; PAD = peripheral artery disease; UTCC = upstroke time per cardiac cycle

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SP459BOTH LOW AND HIGH SYSTOLIC BLOOD PRESSURE INCREASES THE RISK OF CARDIOVASCULAR EVENTS AND ALL-CAUSE OF MORTALITY IN PATIENTS WITH TYPE 2-DIABETES AND RENAL IMPAIRMENT WITHOUT PREVIOUS CARDIOVASCULAR DISEASE OR CONGESTIVE HEART FAILURE- THE SWEDISH NATIONAL DIABETES REGISTER (NDR)

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfv195.03 ◽

2015 ◽

Vol 30 (suppl_3) ◽

pp. iii531-iii532

Author(s):

Maria Svensson ◽

Mervete Miftaraj ◽

Ann-Marie Svensson ◽

Bjorn Eliasson ◽

Hanri Afghahi

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Congestive Heart Failure ◽

Renal Impairment ◽

Cardiovascular Events ◽

High Systolic Blood Pressure ◽

Diabetes Register

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Predictors of Glycemic Control Among Patients With Type 2 Diabetes in North West Ethiopia: A Longitudinal Study

10.21203/rs.3.rs-288389/v1 ◽

2021 ◽

Author(s):

Nigusie Gashaye Shita ◽

Ashagrie Sharew Iyasu

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycemic Control ◽

Systolic Blood Pressure ◽

Good Glycemic Control ◽

Type 2 Dm

Abstract Background Type 2 diabetes mellitus patients with hyperglycemia for a long period of time are significant causes of mortality and morbidity worldwide. Studying the predictors of glycemic control help to minimize deaths and the development of acute and chronic diabetes complication. Hence, the aim of this study is to asses’ predictors of glycemic control among patients with Type 2 diabetes in Ethiopia. Methods A retrospective cohort study was conducted among Type 2 Diabetes mellitus (T2DM) patients enrolled between December 2011 and December 2012 at Debre Markos and Felege Hiwot Referral Hospital. A total of 191 T2DM patients was included in the study who meets the eligibility criteria. Generalized linear mixed model was employed. Results The prevalence of good glycemic control among type 2 diabetes patients was 58.4% where as 23.25% of variation was explained in the fitted model due to adding the random effects. The significance predictors of glycemic control among patients with Type 2 diabetes at 95% confidence level were reside in rural(0.454, 0.614)), patients age 38–50, 51–59 and 60–66 years(1.267,1.776), (1.057,1.476) and (1.004, 1.403), respectively, Proteinuria positive(1.211,1.546), diastolic blood pressure ≥ 90 (1.101, 1.522), systolic blood pressure ≥ 140 (1.352, 1.895), creatinine (0.415, 0.660), duration per visit (0.913, 0.987), duration since diagnosis (0.985, 0.998), weight 78–88(0.603, 0.881). Conclusion Level of glycemic control among type 2 diabetes patients was poor. Resident, age, weight, duration of T2DM since diagnosis, duration of type 2 DM per visit, follow up time, protein urea, diastolic blood pressure, systolic blood pressure and creatinine were significant predictors of glycemic control among type 2 DM patients. During diabetic patients follow up, clinicians should give appropriate attention to these significant variables for good glycemic control since it is the main goal of diabetes management.

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Shortened Relative Leukocyte Telomere Length is Associated with Prevalent and Incident Cardiovascular Complications in Type 2 Diabetes- Analysis from the Hong Kong Diabetes Register

10.2337/figshare.12498335.v1 ◽

2020 ◽

Author(s):

Feifei Cheng ◽

Andrea O Luk ◽

Claudia HT Tam ◽

Baoqi Fan ◽

Hongjiang Wu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Hong Kong ◽

Telomere Length ◽

Cox Regression ◽

Quantitative Polymerase Chain Reaction ◽

Hazard Ratio ◽

Chinese Patients ◽

Diabetes Register

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Exploring potential mediators of the cardiovascular benefit of dulaglutide in type 2 diabetes patients in REWIND

Cardiovascular Diabetology ◽

10.1186/s12933-021-01386-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Manige Konig ◽

Matthew C. Riddle ◽

Helen M. Colhoun ◽

Kelley R. Branch ◽

Charles M. Atisso ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Systolic Blood Pressure ◽

Repeated Measures ◽

Cox Regression ◽

Cox Model ◽

Hazard Ratio ◽

Major Adverse Cardiovascular Events

Abstract Background The REWIND trial demonstrated cardiovascular (CV) benefits to patients with type 2 diabetes and multiple CV risk factors or established CV disease. This exploratory analysis evaluated the degree to which the effect of dulaglutide on CV risk factors could statistically account for its effects on major adverse cardiovascular events (MACE) in the REWIND trial. Methods Potential mediators of established CV risk factors that were significantly reduced by dulaglutide were assessed in a post hoc analysis using repeated measures mixed models and included glycated hemoglobin (HbA1c), body weight, waist-to-hip ratio, systolic blood pressure, low-density lipoprotein (LDL), and urine albumin/creatinine ratio (UACR). These factors, for which the change in level during follow-up was significantly associated with incident MACE, were identified using Cox regression modeling. Each identified variable was then included as a covariate in the Cox model assessing the effect of dulaglutide on MACE to estimate the degree to which the hazard ratio of dulaglutide vs placebo was attenuated. The combined effect of the variables associated with attenuation was assessed by including all variables in an additional Cox model. Results Although all evaluated variables were significantly improved by treatment, only changes in HbA1c and UACR were associated with MACE and a reduction in the effect of dulaglutide on this outcome was observed. The observed hazard ratio for MACE for dulaglutide vs placebo reduced by 36.1% by the updated mean HbA1c, and by 28.5% by the updated mean UACR. A similar pattern was observed for change from baseline in HbA1c and UACR and a reduction of 16.7% and 25.4%, respectively in the hazard ratio for MACE with dulaglutide vs placebo was observed. When HbA1c and UACR were both included, the observed hazard ratio reduced by 65.4% for the updated mean and 41.7% for the change from baseline with no HbA1c-UACR interaction (P interaction = 0.75 and 0.15, respectively). Conclusions Treatment-induced improvement in HbA1c and UACR, but not changes in weight, systolic blood pressure, or LDL cholesterol, appear to partly mediate the beneficial effects of dulaglutide on MACE outcomes. These observations suggest that the proven effects of dulaglutide on cardiovascular disease benefit are partially related to changes in glycemic control and albuminuria, with residual unexplained benefit. Clinicaltrials.gov; Trial registration number: NCT01394952. URL: https://clinicaltrials.gov/ct2/show/NCT01394952

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Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes: an observational study from the Swedish national diabetes register

Journal of Hypertension ◽

10.1097/hjh.0b013e32833c8b75 ◽

2010 ◽

Vol 28 (10) ◽

pp. 2026-2035 ◽

Cited By ~ 35

Author(s):

Jan Cederholm ◽

Soffia Gudbjörnsdottir ◽

Björn Eliasson ◽

Björn Zethelius ◽

Katarina Eeg-Olofsson ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Diseases ◽

Observational Study ◽

Systolic Blood Pressure ◽

Diabetes Register

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Long-term predictors of stroke in healthy middle-aged men

International Journal of Stroke ◽

10.1177/1747493017730760 ◽

2017 ◽

Vol 13 (3) ◽

pp. 292-300 ◽

Cited By ~ 4

Author(s):

Erik Prestgaard ◽

Christian Hodnesdal ◽

Kristian Engeseth ◽

Jan Erikssen ◽

Johan Bodegård ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Hazard Ratio ◽

Conduction Time ◽

Middle Aged ◽

Hemodynamic Variables

Background There are few data on risk factors for stroke during long-term follow-up of healthy individuals. Aims We aimed to investigate the long-term predictive impact on stroke risk of baseline variables including hemodynamic variables measured at rest and during exercise in middle-aged, healthy men. Methods We performed a prospective cohort study of 2014 healthy Norwegian men aged 40–59 years, recruited during the period 1972–1975 and followed until 2007. Participants underwent a comprehensive clinical assessment at baseline, including a bicycle exercise test. Data on stroke, transient ischemic attack, and death were collected on all participants from follow-up visits, medical records, and the National Cause of Death Registry. We used Cox regression for analysis and estimated hazard ratios with 95% confidence intervals, adjusting for traditional risk factors and hemodynamic variables measured at rest and during exercise. Results During 35 years’ follow-up, 316 participants (16%) had stroke, of which 287 (91%) were ischemic and 29 (9%) were hemorrhagic. Age (hazard ratio 2.70 per increase in one standard deviation, 95% confidence interval 2.13–3.43), resting systolic blood pressure (hazard ratio 1.24, 95% confidence interval 1.11–1.39), body mass index (hazard ratio 1.14, 95% confidence interval 1.02–1.29), and atrioventricular conduction time (hazard ratio 1.11, 95% confidence interval 1.03–1.19) were significantly associated with long-term risk of stroke, as were maximal systolic blood pressure and heart rate during exercise (hazard ratio 1.28, 95% confidence interval 1.13–1.46, and hazard ratio 0.86, 95% confidence interval 0.74–0.99, respectively). Conclusions Hemodynamic variables at rest and during exercise testing add to the predictive value of clinical variables in healthy, middle-aged men, and should be included in the assessment of long-term risk of stroke, when available.

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