Metformin use is associated with a lower risk of uterine leiomyoma in female type 2 diabetes patients

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018819895159 ◽

2019 ◽

Vol 10 ◽

pp. 204201881989515 ◽

Cited By ~ 1

Author(s):

Chin-Hsiao Tseng

Keyword(s):

Type 2 Diabetes ◽

Lower Risk ◽

Uterine Leiomyoma ◽

Sensitivity Analyses ◽

Matched Pair ◽

Diagnostic Code ◽

Hazard Ratios ◽

Diabetes Patients

Background: Whether metformin may reduce the risk of uterine leiomyoma in type 2 diabetes patients has not been investigated. This retrospective cohort study compared the risk of uterine leiomyoma in ever versus never users of metformin. Methods: Female patients with new-onset type 2 diabetes during 1999–2005 were enrolled from the reimbursement database of Taiwan’s National Health Insurance and followed up from 1 January 2006 until 31 December 2011. Analyses were conducted in a propensity score (PS) matched-pair cohort of 10,998 ever users and 10,998 never users of metformin. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using the PS. Results: A total of 321 never users and 162 ever users developed uterine leiomyoma during follow up, with respective incidence of 704.65 and 329.82 per 100,000 person-years. The overall hazard ratio was 0.467 (95% confidence interval: 0.387–0.564). The hazard ratios for the first (<23.3 months), second (23.3–53.1 months), and third (>53.1 months) tertiles of cumulative duration were 0.881 (0.685–1.132), 0.485 (0.367–0.642), and 0.198 (0.134–0.291), respectively; and were 0.751 (0.576–0.980), 0.477 (0.360–0.632), and 0.277 (0.198–0.386), respectively, for the first (<655,000 mg), second 655,000–1,725,500 mg), and third (>1,725,500) tertiles of cumulative dose. Sensitivity analyses after excluding users of sulfonylurea, users of estrogen, users of insulin, users of incretin-based therapies during follow up, patients with irregular drug refills, patients who discontinued the use of metformin, patients who received metformin prescription less than four times, or redefining uterine leiomyoma by using ‘diagnostic code’ plus ‘procedure codes’ consistently supported a lower risk of uterine leiomyoma in ever users of metformin. Conclusion: Metformin use is associated with a lower risk of uterine leiomyoma.

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P5006Metformin reduces the risk of hospitalization for heart failure in type 2 diabetes patients: a retrospective cohort analysis

European Heart Journal ◽

10.1093/eurheartj/ehz746.0184 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C H Tseng

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Cohort Analysis ◽

Sensitivity Analyses ◽

Matched Pair ◽

Hazard Ratios ◽

Reimbursement Database ◽

Diabetes Patients

Abstract Background A beneficial effect of metformin on heart failure requires confirmation. Purpose To investigate whether metformin might affect the risk of heart failure hospitalization in type 2 diabetes patients. Methods Patients with new-onset type 2 diabetes during 1999–2005 were enrolled from the reimbursement database of Taiwan's National Health Insurance and followed until December 31, 2011. Analyses were conducted in a propensity score (PS) matched-pair cohort (42,367 ever users and 42,367 never users) and hazard ratios were estimated by Cox's hazard regression analysis incorporated with the inverse probability of treatment weighting using the PS. Results A total of 1,592 never users and 987 ever users were hospitalized for heart failure for the first time during follow-up, with a respective incidence of 843.34 and 499.18 per 100,000 person-years. The overall hazard ratio was 0.588 (95% confidence interval: 0.543–0.637), and the hazard ratios for the first (<29.13 months), second (29.13–61.63 months), and third (>61.63 months) tertiles of cumulative duration were 1.018 (0.914–1.135), 0.575 (0.511–0.647), and 0.340 (0.297–0.390), respectively. Sensitivity analyses conducted in an unmatched cohort before and after excluding patients who received an irregular refill of metformin or who were treated with incretin-based therapies during follow-up consistently supported such a protective effect of metformin on heart failure. Conclusion Metformin use is associated with a lower risk of hospitalization for heart failure. Acknowledgement/Funding The study was partly supported by the Ministry of Science and Technology (MOST 107-2221-E-002-129-MY3) of Taiwan.

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Metformin reduces risk of benign nodular goiter in patients with type 2 diabetes mellitus

Acta Endocrinologica ◽

10.1530/eje-19-0133 ◽

2019 ◽

Vol 180 (6) ◽

pp. 365-372 ◽

Cited By ~ 2

Author(s):

Chin-Hsiao Tseng

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Propensity Score ◽

Lower Risk ◽

Cox Regression ◽

Nodular Goiter ◽

Sensitivity Analyses ◽

Hazard Ratios

BackgroundWhether metformin might affect the risk of benign nodular goiter in patients with type 2 diabetes mellitus has not been investigated.MethodsPatients with new-onset type 2 diabetes mellitus during 1999–2005 were enrolled from Taiwan’s National Health Insurance database. Analyses were conducted in a propensity score matched-pairs of 20,048 ever users and 20,048 never users of metformin. The patients were followed until December 31, 2011, for the incidence of benign nodular goiter. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using the propensity score.ResultsAmong the never users and ever users of metformin, 392 and 221 cases were diagnosed of benign nodular goiter during follow-up, with incidence of 457.88 and 242.45 per 100,000 person-years, respectively. The overall hazard ratio for ever versus never users was 0.527 (95% confidence interval: 0.447–0.621). When cumulative duration of metformin therapy was divided into tertiles, the hazard ratios for the first (<25.3 months), second (25.3–57.3 months) and third (>57.3 months) tertiles were 0.815 (0.643–1.034), 0.648 (0.517–0.812) and 0.255 (0.187–0.348), respectively. Sensitivity analyses estimating the overall hazard ratios for patients enrolled in each specific year from 1999 to 2005 consistently showed a lower risk of benign nodular goiter among users of metformin.ConclusionMetformin use is associated with a lower risk of benign nodular goiter in patients with type 2 diabetes mellitus.

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Metformin use is associated with a lower risk of osteoporosis/vertebral fracture in Taiwanese patients with type 2 diabetes mellitus

Acta Endocrinologica ◽

10.1530/eje-20-0507 ◽

2021 ◽

Vol 184 (2) ◽

pp. 299-310

Author(s):

Chin-Hsiao Tseng

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vertebral Fracture ◽

Lower Risk ◽

Sensitivity Analyses ◽

Incident Cases ◽

New Onset

Objectives To investigate the metformin effect on the risk of osteoporosis (OS) and/or vertebral fracture (VF). Methods We enrolled 14 611 pairs of metformin ever and never users matched on propensity score (PS) from Taiwan’s National Health Insurance database. All patients had new-onset type 2 diabetes mellitus (T2DM) during 1999–2005 and were free from OS and/or any fracture at the start of follow-up on January 1, 2006. They were followed up until December 31, 2011 for the incidence of OS/VF. Cox regression incorporated with the inverse probability of treatment weighting using PS was used in the main analyses. Results New-onset OS/VF was diagnosed in 1757 never users (median follow-up 5.0 years) and 1143 ever users (median follow-up 5.3 years). The respective incidence rates were 2870.97 and 1713.20 per 100 000 person-years. Two-thirds of the incident cases had OS without VF and the other third had VF. In main analyses, the hazard ratio for ever vs never users was 0.592 (95% CI: 0.550–0.638). In either sex, a dose–response pattern was noted and metformin therapy > 2 years was consistently associated with a lower risk. The protective effect attenuated with increasing age but remained significant in patients aged ≥ 80 years. In sensitivity analyses, metformin significantly reduced the risk of both OS and VF (with or without a prior OS) by 30–40%. Additional analyses showed a null association for other antidiabetic drugs, but significant interactions between metformin and insulin, sulfonylurea and pioglitazone, respectively, were noted. Conclusion Metformin use is associated with a lower risk of OS/VF.

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Variability, mean, and baseline values of metabolic parameters in predicting the risk of type 2 diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgac017 ◽

2022 ◽

Author(s):

Duong Duc Pham ◽

Jaekyung Song ◽

Yunwan Jeon ◽

Ibrahimi Hajar ◽

Chae Hun Leem

Keyword(s):

Type 2 Diabetes ◽

Density Lipoprotein ◽

Tolerance Test ◽

Metabolic Parameters ◽

Sensitivity Analyses ◽

Oral Glucose ◽

Average Value ◽

Hazard Ratios

Abstract Context Impact of baseline and alteration of metabolic parameters (MPs), including plasma glucose (PGs) testing, insulin resistance surrogates, and lipid profile and their mutual interactions on the development of type 2 diabetes (T2DM) has not been investigated systematically. Objective To access the association of the past variability (V), past mean (M), and the baseline (B) values of various MPs and their mutual interaction with the risk of T2DM. Design Longitudinal analysis from the Korean Genome and Epidemiology Study. Setting Community-based Participants 3829 non-diabetic participants with completed MPs measurements during three biannually visits were followed up over the next 10 years. Outcomes Incidence of T2DM during the follow up. Results Among predictors, PG concentrations measured during the oral glucose tolerance test were the most prominent T2DM determinants, in which the M of the average value of fasting PG, 1-h, and 2-h PGs had the strongest discriminative power (hazard ratios and 95% CI for an increment of SD: 3.00 (2.5–3.26), AUC: 0.82). The M values of MPs were superior to their B and V values in predicting T2DM, especially among post-load PGs. Various mutual interactions between indices and among MPs were found. The most consistent interactants were the M values of high-density lipoprotein cholesterol and the M and V values of fasting PG. The findings were similar in normal tolerance glucose participants and were confirmed by sensitivity analyses. Conclusion The post-load PGs, past alteration of measurements, and mutual interactions among indices of MPs are important risk factors for T2DM development.

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Assessment of follow-up quality among type 2 diabetes patients in Madinah, Saudi Arabia

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1592926083 ◽

2020 ◽

pp. 1342-1348

Author(s):

Khalid Mohamed ◽

Rami Alharbi ◽

Yazeed Aljoahni ◽

Abdulmajeed Alamri ◽

Mohammed Saeed ◽

...

Keyword(s):

Type 2 Diabetes ◽

Saudi Arabia ◽

Diabetes Patients

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Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

10.21203/rs.3.rs-48852/v2 ◽

2020 ◽

Author(s):

Kai-Cheng Chang ◽

Shih-Chieh Shao ◽

Shihchen Kuo ◽

Chen-Yi Yang ◽

Hui-Yu Chen ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cohort Study ◽

Real World ◽

Comparative Effectiveness ◽

Blood Pressure Reduction ◽

Renal Functions ◽

Diabetes Patients

Abstract Background Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide. Methods We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016-2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every three months in the one-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches. Results A total of 1,512 subjects receiving dulaglutide and 1,513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: -1.06%, p<0.001; liraglutide: -0.83%, p<0.001), with a significant between-group difference (-0.23%, 95% confidence interval: -0.38 to -0.08%, p<0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: -1.14 kg, -3.08 U/L and -2.08 ml/min/1.73 m2, p<0.01; liraglutide: -1.64 kg, -3.65 U/L and -2.33 ml/min/1.73 m2, p<0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (-2.47 mmHg, p<0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant. Conclusions In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions.

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Abstract MP05: Leisure-Time Running and Incident Type 2 Diabetes

Circulation ◽

10.1161/circ.131.suppl_1.mp05 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Duck-chul Lee ◽

Carl J. Lavie ◽

Timothy S. Church ◽

Xuemei Sui ◽

Steven N. Blair

Keyword(s):

Type 2 Diabetes ◽

Lower Risk ◽

Leisure Time ◽

Cox Regression ◽

Smoking Status ◽

Physical Activities ◽

Incident Type ◽

Incident Type 2 Diabetes

Introduction: There is still little evidence on the dose-response relation between leisure-time running and incident type 2 diabetes (T2D). Hypothesis: We examined the hypothesis that running reduces the risk of developing T2D. Methods: Participants were 19,347 adults aged 18 to 100 years (mean age, 44) who received an extensive preventive medical examination during 1974-2006 in the Aerobics Center Longitudinal Study. Participants were free of cardiovascular disease, cancer, and T2D at baseline. Running and other physical activities were assessed on the medical history questionnaire by self-reported leisure-time activities during the past 3 months. We defined T2D as fasting glucose ≥126 mg/dl, insulin use, or physician-diagnosis during follow-up medical examinations. Cox regression was used to quantify the association between running and T2D after adjusting for baseline age, sex, examination year, body mass index, smoking status, heavy alcohol drinking, abnormal electrocardiogram, hypertension, hypercholesterolemia, and levels of other physical activities. Results: During an average follow-up of 6.5 years, 1,015 adults developed T2D. Approximately 30% of adults participated in leisure-time running. Runners had a 29% lower risk of developing T2D compared with non-runners. The hazard ratios (95% confidence intervals) of T2D were 0.97 (0.74-1.27), 0.66 (0.49-0.89), 0.62 (0.45-0.85), 0.78 (0.58-1.03), and 0.57 (0.42-0.79) across quintiles (Q) of running time (minutes/week); 0.99 (0.76-1.30), 0.60 (0.44-0.82), 0.72 (0.55-0.94), 0.65 (0.47-0.90), and 0.63 (0.47-0.86) across Q of running distance (miles/week); 1.08 (0.83-1.40), 0.67 (0.50-0.90), 0.70 (0.53-0.93), 0.61 (0.45-0.83), and 0.53 (0.36-0.76) across Q of running frequency (times/week); 0.95 (0.73-1.24), 0.70 (0.52-0.94), 0.62 (0.45-0.84), 0.73 (0.55-0.97), and 0.58 (0.42-0.80) across Q of total amount of running (MET-minutes/week); and 0.95 (0.71-1.28), 0.76 (0.59-0.99), 0.59 (0.42-0.83), 0.66 (0.51-0.85), and 0.62 (0.43-0.90) across Q of running speed (mph), respectively, compared with no running after adjusting for confounders including levels of other physical activities. Conclusions: Participating in leisure-time running is associated with markedly lower risk of developing T2D in adults. Except for those in the very lowest Q for running doses, even relatively low running doses (starting with Q 2) were associated with marked reductions in T2D risk over time, supporting the prescription of running to reduce T2D.

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Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study

Cardiovascular Diabetology ◽

10.1186/s12933-019-0953-7 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 7

Author(s):

You-Bin Lee ◽

Kyungdo Han ◽

Bongsung Kim ◽

Seung-Eun Lee ◽

Ji Eun Jun ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Cox Regression ◽

Early Mortality ◽

Hazard Ratios ◽

Epidemiological Characteristics

Abstract Background Both type 1 and type 2 diabetes are well-established risk factors for cardiovascular disease and early mortality. However, few studies have directly compared the hazards of cardiovascular outcomes and premature death among people with type 1 diabetes to those among people with type 2 diabetes and subjects without diabetes. Furthermore, information about the hazard of cardiovascular disease and early mortality among Asians with type 1 diabetes is sparse, although the clinical and epidemiological characteristics of Asians with type 1 diabetes are unlike those of Europeans. We estimated the hazard of myocardial infarction (MI), hospitalization for heart failure (HF), atrial fibrillation (AF), and mortality during follow-up in Korean adults with type 1 diabetes compared with those without diabetes and those with type 2 diabetes. Methods We used Korean National Health Insurance Service datasets of preventive health check-ups from 2009 to 2016 in this retrospective longitudinal study. The hazard ratios of MI, HF, AF, and mortality during follow-up were analyzed using the Cox regression analyses according to the presence and type of diabetes in ≥ 20-year-old individuals without baseline cardiovascular disease (N = 20,423,051). The presence and type of diabetes was determined based on the presence of type 1 or type 2 diabetes at baseline. Results During more than 93,300,000 person-years of follow-up, there were 116,649 MIs, 135,532 AF cases, 125,997 hospitalizations for HF, and 344,516 deaths. The fully-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MI, hospitalized HF, AF, and all-cause death within the mean follow-up of 4.6 years were higher in the type 1 diabetes group than the type 2 diabetes [HR (95% CI) 1.679 (1.490–1.893) for MI; 2.105 (1.901–2.330) for HF; 1.608 (1.411–1.833) for AF; 1.884 (1.762–2.013) for death] and non-diabetes groups [HR (95% CI) 2.411 (2.138–2.718) for MI; 3.024 (2.730–3.350) for HF; 1.748 (1.534–1.993) for AF; 2.874 (2.689–3.073) for death]. Conclusions In Korea, the presence of diabetes was associated with a higher hazard of cardiovascular disease and all-cause death. Specifically, people with type 1 diabetes had a higher hazard of cardiovascular disease and all-cause mortality compared to people with type 2 diabetes.

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Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies

BMJ ◽

10.1136/bmj.m2206 ◽

2020 ◽

pp. m2206 ◽

Cited By ~ 3

Author(s):

Yang Hu ◽

Ming Ding ◽

Laura Sampson ◽

Walter C Willett ◽

JoAnn E Manson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Brown Rice ◽

Whole Grains ◽

Health Study ◽

Whole Grain ◽

Breakfast Cereal ◽

Hazard Ratios ◽

Grain Foods

Abstract Objective To examine the associations between the intake of total and individual whole grain foods and the risk of type 2 diabetes. Design Prospective cohort studies. Setting Nurses’ Health Study (1984-2014), Nurses’ Health Study II (1991-2017), and Health Professionals Follow-Up Study (1986-2016), United States. Participants 158 259 women and 36 525 men who did not have type 2 diabetes, cardiovascular disease, or cancer at baseline. Main outcome measures Self-reports of incident type 2 diabetes by participants identified through follow-up questionnaires and confirmed by a validated supplementary questionnaire. Results During 4 618 796 person years of follow-up, 18 629 participants with type 2 diabetes were identified. Total whole grain consumption was categorized into five equal groups of servings a day for the three cohorts. After adjusting for lifestyle and dietary risk factors for diabetes, participants in the highest category for total whole grain consumption had a 29% (95% confidence interval 26% to 33%) lower rate of type 2 diabetes compared with those in the lowest category. For individual whole grain foods, pooled hazard ratios (95% confidence intervals) for type 2 diabetes in participants consuming one or more servings a day compared with those consuming less than one serving a month were 0.81 (0.77 to 0.86) for whole grain cold breakfast cereal, 0.79 (0.75 to 0.83) for dark bread, and 1.08 (1.00 to 1.17) for popcorn. For other individual whole grains with lower average intake levels, comparing consumption of two or more servings a week with less than one serving a month, the pooled hazard ratios (95% confidence intervals) were 0.79 (0.75 to 0.83) for oatmeal, 0.88 (0.82 to 0.94) for brown rice, 0.85 (0.80 to 0.90) for added bran, and 0.88 (0.78 to 0.98) for wheat germ. Spline regression showed a non-linear dose-response association between total whole grain intake and the risk of type 2 diabetes where the rate reduction slightly plateaued at more than two servings a day (P<0.001 for curvature). For whole grain cold breakfast cereal and dark bread, the rate reduction plateaued at about 0.5 servings a day. For consumption of popcorn, a J shaped association was found where the rate of type 2 diabetes was not significantly raised until consumption exceeded about one serving a day. The association between higher total whole grain intake and lower risk of type 2 diabetes was stronger in individuals who were lean than in those who were overweight or obese (P=0.003 for interaction), and the associations did not vary significantly across levels of physical activity, family history of diabetes, or smoking status. Conclusion Higher consumption of total whole grains and several commonly eaten whole grain foods, including whole grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ, was significantly associated with a lower risk of type 2 diabetes. These findings provide further support for the current recommendations of increasing whole grain consumption as part of a healthy diet for the prevention of type 2 diabetes.

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