scholarly journals Innovations in personalised diabetes care and risk management

2019 ◽  
Vol 26 (2_suppl) ◽  
pp. 125-132 ◽  
Author(s):  
Giel Nijpels ◽  
Joline WJ Beulens ◽  
Amber AWA van der Heijden ◽  
Petra J Elders
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Care ◽  
Microvascular Complications ◽  
Personalised Medicine ◽  
Innovative Methods ◽  
Increased Risk ◽  
Recent Developments ◽  
Substantial Heterogeneity ◽  
Made In

Type 2 diabetes is associated with an increased risk of developing macro and microvascular complications. Nevertheless, there is substantial heterogeneity between people with type 2 diabetes in their risk of developing such complications. Personalised medicine for people with type 2 diabetes may aid in efficient and tailored diabetes care for those at increased risk of developing such complications. Recently, progress has been made in the development of personalised diabetes care in several areas. Particularly for the risk prediction of cardiovascular disease, retinopathy and nephropathy, innovative methods have been developed for prediction and tailored monitoring or treatment to prevent such complications. For other complications or subpopulations of people with type 2 diabetes, such as the frail elderly, efforts are currently ongoing to develop such methods. In this review, we discuss the recent developments in innovations of personalised diabetes care for different complications and subpopulations of people with type 2 diabetes, their performance and modes of application in clinical practice.

scholarly journals Declining trends of diabetic nephropathy, retinopathy and neuropathy with improving diabetes care indicators in Japanese patients with type 2 and type 1 diabetes (JDDM 46)

2018 ◽  
Vol 6 (1) ◽  
pp. e000521 ◽  
Author(s):  
Hiroki Yokoyama ◽  
Shin-ichi Araki ◽  
Koichi Kawai ◽  
Katsuya Yamazaki ◽  
Osamu Tomonaga ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Diabetes Care ◽  
Microvascular Complications ◽  
Treatment Target ◽  
Younger Patients

ObjectiveWe examined changes in prevalence of diabetic microvascular/macrovascular complications and diabetes care indicators for adults in Japan with type 2 and type 1 diabetes over one decade.Research design and methodsTwo independent cohorts were recruited with the same inclusion criteria in 2004 (cohort 1: 3319 with type 2 and 286 with type 1 diabetes) and in 2014 (cohort 2: 3932 with type 2 and 308 with type 1 diabetes). Prevalence of complications and care indicators including achieving treatment targets for glycemia, blood pressure, lipid control, body mass index (BMI), and smoking were compared. In addition, patients in cohort 1 were re-examined in 2014 and their data were compared with the baseline data of each cohort.ResultsIn type 2 diabetes, the prevalence of nephropathy, retinopathy, neuropathy, chronic kidney disease, current smoking and stroke significantly decreased, with improvements in achieving treatment target rates in cohort 2 two as compared with cohort 1. In type 1 diabetes, the prevalence of nephropathy, retinopathy, chronic kidney disease, and hemoglobin A1Cvalues significantly decreased. Decreases in prevalence of microvascular complications in type 2 diabetes were similarly found in each age-matched and sex-matched group, whereas younger patients exhibited marked increase in BMI and lower treatment target achieving rates compared with elderly patients. Regarding normoalbuminuric renal impairment, only a slight increase in the prevalence was observed both in type 2 and type 1 diabetes. In cohort 1, re-examined in 2014, care indicators were significantly improved from 2004, while complications increased with getting 10 years older.ConclusionsWe observed declining trends of diabetic microvascular complications with improvement in diabetes care indicators in type 2 and type 1 diabetes. Younger patients with type 2 diabetes exhibited marked increase in BMI and lower rates of achieving treatment targets compared with elderly patients, which remains a concern.

Epidemiology of type 2 diabetes mellitus

2011 ◽  
pp. 1748-1754
Author(s):  
Sarah Wild ◽  
Jackie Price
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Social Impact ◽  
Microvascular Complications ◽  
Macrovascular Disease ◽  
Organ Damage ◽  
Increased Risk ◽  
Prevalence Of Obesity ◽  
Obesity Hypertension

Diabetes mellitus represents a group of metabolic disorders characterized by hyperglycaemia, which may or may not be associated with symptoms. The chronic hyperglycaemia of diabetes results from defects in insulin secretion, insulin action, or both, and is associated with long-term organ damage, particularly in the eyes, kidneys, nerves, heart, and blood vessels. Patients with type 2 diabetes have a higher prevalence of obesity (particularly abdominal obesity), hypertension, and lipid disorders, as well as an increased risk of macrovascular disease in coronary, peripheral, and cerebral arterial circulations, than people without diabetes. Microvascular complications of diabetes include retinopathy, which can lead to loss of vision, nephropathy (leading to renal failure), neuropathy (with an increased risk of foot ulcers, amputations, and foot deformations), and autonomic neuropathy, causing cardiovascular, gastrointestinal, genitourinary, and sexual dysfunction. Diabetes may have a serious emotional and social impact on affected individuals and their families, and has major economic implications for society as a whole in both developed and developing countries.

scholarly journals The effect of guideline revisions on vascular complications of type 2 diabetes

2019 ◽  
Vol 10 ◽  
pp. 204201881987540 ◽  
Author(s):  
Ralph Heijmans ◽  
Sunny S. Singh ◽  
Aloysius G. Lieverse ◽  
Eric J.G. Sijbrands ◽  
Mandy van Hoek
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Care ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Continuous Variable ◽  
Diabetes Mellitus Type Ii ◽  
Logistic Regression Models ◽  
Artery Disease ◽  
The Impact

Background: The aim of this study was to investigate the impact of implementation and revision of the ‘Diabetes Mellitus type II’ guideline by the Dutch College of General Practitioners (DCGP) on the prevalence and incidence of macrovascular and microvascular complications. Methods: The DiaGene study is a case-control study ( n = 1886 patients of type 2 diabetes) with extensive, retrospectively collected complication data, as well as prospective follow up of complications. The study incorporates all lines of diabetes care. Cases were divided into categories according to the date of onset of diabetes and publication dates of the DCGP. Logistic regression models were used to investigate the associations between guideline version and complications. To investigate a possible trend between guideline version and complications, the ‘guideline category’ was also used as a continuous variable. All models were adjusted for clinical covariables. Results: The 1999 and 2006 guidelines versions were associated with significantly lower risk of retinopathy than the group that started without a guideline [OR 0.32 (95% CI 0.14–0.72, p = 0.006) and 0.31 (95% CI 0.11–0.91, p = 0.034), respectively]. A significant trend in reduction of peripheral artery disease (PAD) over the guideline versions was found, adjusted for age, sex and diabetes duration (odds ratio (OR) 0.70, 95% CI 0.51-0.97, p trend = 0.029) and for retinopathy in all models (OR = 0.52, 95% CI 0.37-0.73, p trend < 0.001). Conclusions: The introduction of the first diabetes guideline and subsequent revisions have reduced the risk of macrovascular and microvascular complications of type 2 diabetes, most strongly in diabetic retinopathy. This indicates that real-time diabetes care has improved over time.

scholarly journals Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

2020 ◽  
Author(s):  
Nicola J Adderley ◽  
Anuradhaa Subramanian ◽  
Konstantinos Toulis ◽  
Krishna Gokhale ◽  
Thomas Taverner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Microvascular Complications ◽  
High Risk Population ◽  
Diabetes Diagnosis ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Ckd Stage ◽  
All Cause Mortality

<div><b>Objective</b>: To determine risk of cardiovascular diseases (CVD), microvascular complications and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnoea(OSA) compared to patients with type 2 diabetes without a diagnosis of OSA.</div><div><b>Research Design and Methods</b>: An age-, sex-, body mass index- and diabetes duration-matched cohort study using data from a UK primary care database from 01/01/2005 to 17/01/2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischaemic heart disease(IHD), stroke/transient ischaemic attack(TIA), heart failure(HF)); peripheral vascular disease(PVD); atrial fibrillation(AF); peripheral neuropathy(PN); diabetes-related foot disease(DFD); referable retinopathy; chronic kidney disease(CKD); all-cause mortality. The same outcomes were explored in patients with pre-existing OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.</div><div><b>Results</b>: 3,667 exposed participants and 10,450 matched controls were included. Adjusted hazard ratios for the outcomes were: composite CVD 1.54(95%CI 1.32,1.79); IHD 1.55(1.26,1.90); HF 1.67(1.35,2.06); stroke/TIA 1.57(1.27,1.94); PVD 1.10(0.91,1.32); AF 1.53(1.28,1.83); PN 1.32(1.14,1.51); DFD 1.42(1.16,1.74); retinopathy 0.99(0.82,1.21); CKD (stage 3-5) 1.18(1.02,1.36); albuminuria 1.11(1.01,1.22); all-cause mortality 1.24(1.10,1.40). In the prevalent OSA cohort the results were similar but some associations not observed.<br></div><div><b>Conclusions</b>: Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared to patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.</div>

scholarly journals Levels of ankle–brachial index and the risk of diabetes mellitus complications

2020 ◽  
Vol 8 (1) ◽  
pp. e000977
Author(s):  
Lia Alves-Cabratosa ◽  
Marc Comas-Cufí ◽  
Anna Ponjoan ◽  
Maria Garcia-Gil ◽  
Ruth Martí-Lluch ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Proportional Hazards ◽  
Microvascular Complications ◽  
Ankle Brachial Index ◽  
Cardiovascular Prevention ◽  
Cox Proportional Hazards ◽  
Cox Models ◽  
Complications Of Diabetes ◽  
Increased Risk

ObjectiveWe sought to compare the association of categorized ankle–brachial index (ABI) with mortality and complications of diabetes in persons with no symptoms of peripheral arterial disease (PAD) and in primary cardiovascular disease prevention.Research design and methodsThis is a retrospective cohort study of persons with type 2 diabetes aged 35–85 years, from 2006 to 2011. Data were obtained from the Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAPQ). Participants had an ABI measurement that was classified into six categories. For each category of ABI, we assessed the incidence of mortality; macrovascular complications of diabetes: acute myocardial infarction (AMI), ischemic stroke, and a composite of these two; and microvascular complications of this metabolic condition: nephropathy, retinopathy, and neuropathy. We also estimated the HRs for these outcomes by ABI category using Cox proportional hazards models.ResultsData from 34 689 persons with type 2 diabetes were included. The mean age was 66.2; 51.5% were men; and the median follow-up was 6.0 years. The outcome with the highest incidence was nephropathy, with 24.4 cases per 1000 person-years in the reference category of 1.1≤ABI≤1.3. The incidences in this category for mortality and AMI were 15.4 and 4.1, respectively. In the Cox models, low ABI was associated with increased risk and was significant from ABI lower than 0.9; below this level, the risk kept increasing steeply. High ABI (over 1.3) was also associated with significant increased risk for most outcomes.ConclusionsThe studied categories of ABI were associated with different risks of type 2 diabetes complications in persons asymptomatic for PAD, who were in primary cardiovascular prevention. These findings could be useful to optimize preventive interventions according to the ABI category in this population.

scholarly journals PREVALENCE OF THYROID DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Manoj Kumar Mali
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Thyroid Dysfunction ◽  
Microvascular Complications ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Increased Risk ◽  
Status Assessment

Background: Patients with type 2 diabetes mellitus are more prone to thyroid disorders. Hypothyroidism in them leads to an aggravation of microvascular complications. Diabetic patients with hypothyroidism also are at an increased risk of cardiovascular disease. Screening for thyroid dysfunction in diabetic patients will allow early treatment of hypothyroidism. Methods: All patients were evaluated for thyroid status; assessment of T3, T4 and TSH levels and Blood glucose levels and HbA1c. Results: 22.00% patients were present with subclinical hypothyroidism, 18.00% patients were present with hypothyroidism and 4.00% patients present with hyperthyroidism Conclusion: Screening for thyroid disease disease among patients with diabetes mellitus should be routinely performed for early detection and treatment of thyroid dysfunction to delay the complications of diabetes Keywords: Thyroid, Type-2DM, Complication

Long-Term Glycemic Variability and Vascular Complications in Type 2 Diabetes: Post Hoc Analysis of the FIELD Study

2020 ◽  
Vol 105 (10) ◽  
pp. e3638-e3649 ◽  
Author(s):  
Emma S Scott ◽  
Andrzej S Januszewski ◽  
Rachel O’Connell ◽  
Gregory Fulcher ◽  
Russell Scott ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fasting Glucose ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Total Mortality ◽  
Glycemic Variability ◽  
Increased Risk ◽  
Post Hoc

Abstract Aims To investigate whether long-term glycemic variability (GV) is associated with vascular complication development in type 2 diabetes. Methods In a post hoc FIELD trial analysis, GV was calculated as the standard deviation and coefficient of variation (CV) of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose. Baseline variables were compared across quartiles of on-study variability by chi square and ANOVA. Prospective associations between baseline to 2-year GV and subsequent vascular and mortality outcomes were analyzed using landmark logistic and Cox proportional hazards regression. Results Baseline factors associated with higher on-study GV included younger age, male gender, longer diabetes duration, and higher pharmacological therapies usage. Both HbA1c and fasting glucose CV were associated with increased risk of microvascular complications (HR 1.02 [95% CI, 1.01-1.03] P &lt; 0.01; and HR 1.01 [95% CI, 1.00-1.01] P &lt; 0.001, respectively). HbA1c and fasting glucose CV were associated with increased cardiovascular disease (HR 1.02 [95% CI, 1.00-1.04]; and HR 1.01 [95% CI, 1.00-1.02], both P &lt; 0.05). HbA1c CV associated with increased stroke (HR 1.03 [95% CI, 1.01-1.06) P &lt; 0.01). Glucose CV associated with increased coronary events (HR 1.01 [95% CI, 1.00-1.02] P &lt; 0.05). Both HbA1c and glucose CV associated with increased total mortality (HR 1.04 [95% CI, 1.02-1.06]; and HR 1.01 [95% CI, 1.01-1.02], both P &lt; 0.001) and noncardiovascular mortality (HR 1.05 [95% CI, (1.03-1.07]; and HR 1.02 [95% CI, 1.01-1.03], both P &lt; 0.001). HbA1c CV associated with coronary mortality (HR 1.04 [95% CI, 1.01-1.07] P &lt; 0.05). Conclusions Long-term GV was associated with increased risk of vascular outcomes in type 2 diabetes.

scholarly journals Risk Factors for Macro- and Microvascular Complications among Older Adults with Diagnosed Type 2 Diabetes: Findings from The Irish Longitudinal Study on Ageing

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Marsha L. Tracey ◽  
Sheena M. McHugh ◽  
Anthony P. Fitzgerald ◽  
Claire M. Buckley ◽  
Ronan J. Canavan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Longitudinal Study ◽  
Microvascular Complications ◽  
Older Age ◽  
Diabetes Diagnosis ◽  
Increased Risk ◽  
History Of

Objective. To explore risk factors for macro- and microvascular complications in a nationally representative sample of adults aged 50 years and over with type 2 diabetes in Ireland.Methods. Data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) (2009–2011) was used in cross-sectional analysis. The presence of doctor diagnosis of diabetes, risk factors, and macro- and microvascular complications were determined by self-report. Gender-specific differences in risk factor prevalence were assessed with the chi-squared test. Binomial regression analysis was conducted to explore independent associations between established risk factors and diabetes-related complications.Results. Among 8175 respondents, 655 were classified as having type 2 diabetes. Older age, being male, a history of smoking, a lower level of physical activity, and a diagnosis of high cholesterol were independent predictors of macrovascular complications. Diabetes diagnosis of 10 or more years, a history of smoking, and a diagnosis of hypertension were associated with an increased risk of microvascular complications. Older age, third-level education, and a high level of physical activity were protective factors (p<0.05).Conclusions. Early intervention to target modifiable risk factors is urgently needed to reduce diabetes-related morbidity in the older population in Ireland.

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