scholarly journals Choice of HbA1c threshold for identifying individuals at high risk of type 2 diabetes and implications for diabetes prevention programmes: a cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lauren R. Rodgers ◽  
Anita V. Hill ◽  
John M. Dennis ◽  
Zoe Craig ◽  
Benedict May ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Predictive Value ◽  
Absolute Risk ◽  
Parametric Survival Model ◽  
Prevention Programmes ◽  
Parametric Survival ◽  
The Impact ◽  
The Relationship

Abstract Background Type 2 diabetes (T2D) is common and increasing in prevalence. It is possible to prevent or delay T2D using lifestyle intervention programmes. Entry to these programmes is usually determined by a measure of glycaemia in the ‘intermediate’ range. This paper investigated the relationship between HbA1c and future diabetes risk and determined the impact of varying thresholds to identify those at high risk of developing T2D. Methods We studied 4227 participants without diabetes aged ≥ 40 years recruited to the Exeter 10,000 population cohort in South West England. HbA1c was measured at study recruitment with repeat HbA1c available as part of usual care. Absolute risk of developing diabetes within 5 years, defined by HbA1c ≥ 48 mmol/mol (6.5%), according to baseline HbA1c, was assessed by a flexible parametric survival model. Results The overall absolute 5-year risk (95% CI) of developing T2D in the cohort was 4.2% (3.6, 4.8%). This rose to 7.1% (6.1, 8.2%) in the 56% (n = 2358/4224) of participants classified ‘high-risk’ with HbA1c ≥ 39 mmol/mol (5.7%; ADA criteria). Under IEC criteria, HbA1c ≥ 42 mmol/mol (6.0%), 22% (n = 929/4277) of the cohort was classified high-risk with 5-year risk 14.9% (12.6, 17.2%). Those with the highest HbA1c values (44–47 mmol/mol [6.2–6.4%]) had much higher 5-year risk, 26.4% (22.0, 30.5%) compared with 2.1% (1.5, 2.6%) for 39–41 mmol/mol (5.7–5.9%) and 7.0% (5.4, 8.6%) for 42–43 mmol/mol (6.0–6.1%). Changing the entry criterion to prevention programmes from 39 to 42 mmol/mol (5.7–6.0%) reduced the proportion classified high-risk by 61%, and increased the positive predictive value (PPV) from 5.8 to 12.4% with negligible impact on the negative predictive value (NPV), 99.6% to 99.1%. Increasing the threshold further, to 44 mmol/mol (6.2%), reduced those classified high-risk by 59%, and markedly increased the PPV from 12.4 to 23.2% and had little impact on the NPV (99.1% to 98.5%). Conclusions A large proportion of people are identified as high-risk using current thresholds. Increasing the risk threshold markedly reduces the number of people that would be classified as high-risk and entered into prevention programmes, although this must be balanced against cases missed. Raising the entry threshold would allow limited intervention opportunities to be focused on those most likely to develop T2D.

scholarly journals Meta-Analysis of the Relationship Between Ethnicity, Obesity, and Type 2 Diabetes of Adults in Urban Populations of Central America

2016 ◽  
Vol 5 (3) ◽  
pp. 274
Author(s):  
William G Wuenstel ◽  
James A. Johnson ◽  
James Humphries ◽  
Cheryl Samuel
Keyword(s):  
Type 2 Diabetes ◽  
Relative Risk ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Central American ◽  
Significance Level ◽  
Study Participants ◽  
The Impact ◽  
The Relationship

<table width="593" border="1" cellspacing="0" cellpadding="0"><tbody><tr><td rowspan="2" valign="top" width="387">The purpose of this meta-analysis was to examine the impact of ethnicity and obesity as it relates to Type-2 Diabetes (T2D) in specific Central American countries. A meta-analysis was conducted to determine the association of ethnicity, obesity, and T2D.  Four studies that qualified for inclusion were identified by searching MEDLINE and PubMed databases. The studies on the association of ethnicity and T2D had a combined population resulted in 265,858 study participants. Two studies on the association of obesity and T2D had 197,899 participants. An analysis of the data was conducted utilizing the relative risk ration, odds ratio, and forest plots. The comparison of the relative risk of T2D across ethnic categories by studies range for Blacks was 1.59 to 2.74, Asians was 1.43 to 2.08, and Hispanics .92 to 2.91.  The ethnic difference in the prevalence of diabetes was almost two-fold higher in all ethnic groups than among the Caucasians with a significance level of 95%. A comparison of relative risk of T2D across weight categories was significantly higher among those with a diagnosed of diabetes in all reported areas. The odds ratio was very close to the risk ratio in both ethnicity and obesity to the development of T2D. The meta-analysis findings documented that an association does exist between ethnicity and obesity to the development of type 2 diabetes.</td><td width="0" height="85"> </td></tr><tr><td width="0" height="82"> </td></tr></tbody></table>

Abstract P209: Effects of Blood Pressure Lowering on Vascular Outcomes in Different Cardiovascular Risk Groups Among Patients With Type 2 Diabetes: New Results From Advance

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Susan van Dieren ◽  
Andre Pascal Kengne ◽  
John Chalmers ◽  
Joline Beulens ◽  
Yvonne van der Schouw ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Treatment Effects ◽  
Disease Risk ◽  
Risk Group ◽  
Absolute Risk ◽  
Risk Groups ◽  
High Risk Group

Background/Aim: Although patients with type 2 diabetes constitute a high risk group there is a gradation in cardiovascular risk which may lead to differences in outcomes and effects of treatment. The objective of this study was to assess for differences in treatment effects of the fixed combination of perindopril-indapamide across subgroups of cardiovascular risk. Methods: 11,140 patients with type 2 diabetes, participating in the ADVANCE trial, were randomized to perindopril-indapamide or matching placebo. The UKPDS risk engine was used to calculate baseline 5-year coronary heart disease risk and to stratify patients into three risk groups (0-10%; 10–15%; >15%). Endpoints were composites of major macrovascular and microvascular events. Homogeneity of treatment effects across risk subgroups were tested by adding interaction terms to the Cox models. Results: The median estimated 5-year coronary heart disease risk at baseline was 10% (IQR 7%−16%). 1000 macrovascular and 916 microvascular events were recorded during a median follow-up of 4.3 years. The relative treatment effects were similar across all risk groups for all endpoints, with no heterogeneity (all P -values for heterogeneity ≥ 0.38). The hazard ratios for combined macro- and microvascular events were 0.89 (95% confidence interval: 0.77–1.03) for the moderate-high risk group and 0.92 (0.81–1.03) for the very high risk group. The absolute risk reductions were greater in the highest risk groups, with numbers needed to treat ranging from 38 to 244. Conclusions: Reductions in relative risk achieved with the fixed combination of perindopril-indapamide among patients with type 2 diabetes were consistent across subgroups defined by baseline cardiovascular risk, but reductions in absolute risk were greatest in those with the highest initial risk. Acknowledgements: This research was supported by a program grant from the National Health and Medical Research Council of Australia, the Center for Translational Molecular Medicine (CTMM) and the Netherlands Heart Foundation, Dutch Diabetes Research Foundation and Dutch Kidney Foundation (PREDICCt).

scholarly journals Sex Differences in Glutathione Peroxidase Activity and Central Obesity in Patients with Type 2 Diabetes at High Risk of Cardio-Renal Disease

Antioxidants ◽  
2019 ◽  
Vol 8 (12) ◽  
pp. 629 ◽  
Author(s):  
Mia Steyn ◽  
Karima Zitouni ◽  
Frank J Kelly ◽  
Paul Cook ◽  
Kenneth A Earle
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Waist Circumference ◽  
Glutathione Peroxidase ◽  
Renal Disease ◽  
Selenium Concentration ◽  
Fat Deposits ◽  
Central Fat ◽  
The Relationship

Women with type 2 diabetes (T2DM) have an increased susceptibility of developing cardio-renal disease compared to men, the reasons and the mechanisms of this vulnerability are unclear. Since oxidative stress plays a key role in the development of cardio-renal disease, we investigated the relationship between sex, plasma antioxidants status (glutathione peroxidase (GPx-3 activity), vitamin E and selenium), and adiposity in patients with T2DM at high risk of cardio-renal disease. Women compared to men had higher GPx-3 activity (p = 0.02), bio-impedance (p ≤ 0.0001), and an increase in waist circumference in relation to recommended cut off-points (p = 0.0001). Waist circumference and BMI were negatively correlated with GPx-3 activity (p ≤ 0.05 and p ≤ 0.01, respectively) and selenium concentration (p ≤ 0.01 and p ≤ 0.02, respectively). In multiple regression analysis, waist circumference and sex were independent predictors of GPx-3 activity (p ≤ 0.05 and p ≤ 0.05, respectively). The data suggest that increased central fat deposits are associated with reduced plasma antioxidants which could contribute to the future risk of cardio-renal disease. The increased GPx-3 activity in women could represent a preserved response to the disproportionate increase in visceral fat. Future studies should be aimed at evaluating if the modulation of GPx-3 activity reduces cardio-renal risk in men and women with T2DM.

scholarly journals The impact of structured physical activity on glycaemic control in diabetes prevention programmes: A systematic review

2017 ◽  
Vol 27 (3) ◽  
pp. 193-204 ◽  
Author(s):  
Joseph Edwards ◽  
Hassan Hosseinzadeh
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glucose Tolerance ◽  
Diabetes Prevention ◽  
Prevention Programmes ◽  
The Impact

Background: Seven landmark randomised controlled trials, with some that began as early as the 1990s, observed the prediabetic state, namely, impaired glucose tolerance and impaired fasting glucose conditions, against the impact of lifestyle interventions such as physical activity, to prevent or delay the onset of type 2 diabetes mellitus. In addition to the landmark trials, this systematic review examines 14 studies that retained a focus on prediabetic individuals and measured the efficacy of physical activity on improving glucose tolerance. Results: Type, duration and intensity of structured physical activity can have unique benefits to prediabetic individuals. It is posited that diabetes prevention programmes must target prediabetic individuals as belonging to a high-risk group, separate and distinct from those identified with overall risk factors. While the transition from prediabetes to type 2 diabetes mellitus is not completely deterministic, the conversion rate is phenomenally higher among those with impaired glucose tolerance than those with normal glucose levels. Conclusion: Tenets of health behaviour models do support inferences that prediabetic individuals are potentially more inclined to weighing the risks and benefits of progressive illnesses and would therefore be more receptive to active participation in interventions. More research is required to develop evidence-based diabetes prevention programmes linked to structured physical activity intervention.

scholarly journals The Impact of Liraglutide on Diabetes-Related Foot Ulceration and Associated Complications in Patients With Type 2 Diabetes at High Risk for Cardiovascular Events: Results From the LEADER Trial

Diabetes Care ◽  
2018 ◽  
Vol 41 (10) ◽  
pp. 2229-2235 ◽  
Author(s):  
Ketan Dhatariya ◽  
Stephen C. Bain ◽  
John B. Buse ◽  
Richard Simpson ◽  
Lise Tarnow ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Cardiovascular Events ◽  
Foot Ulceration ◽  
The Impact

scholarly journals Strongyloides stercoralis, Eosinophilia, and Type 2 Diabetes Mellitus: The Predictive Value of Eosinophilia in the Diagnosis of S stercoralis Infection in an Endemic Community

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Russell Hays ◽  
Fintan Thompson ◽  
Adrian Esterman ◽  
Robyn McDermott
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Strongyloides Stercoralis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Elisa Testing ◽  
The Relationship

Abstract Background.  This study examines the predictive value of eosinophilia for Strongyloides stercoralis infection, as measured by enzyme-linked immunosorbent assay (ELISA) testing, in an endemic community. In remote communities, eosinophilia is frequently used as a proxy test for the presence of helminth infections. Past studies of eosinophilia and Strongyloides infection have been conducted in specific groups such as immigrants and refugees, or in subpopulations of nonendemic communities, rather than in endemic communities. Methods.  We conducted a cross-sectional study of the relationship between eosinophilia and Strongyloides ELISA serology, as part of a study into the relationship between S stercoralis infection and type 2 diabetes mellitus (T2DM) in an Indigenous community in northern Australia. Results.  Two hundred thirty-nine adults had their eosinophil count and S stercoralis ELISA serology measured in 2012 and 2013, along with other biometric and metabolic data. Eosinophilia was found to have a relatively poor sensitivity (60.9%), specificity (71.1%), positive predictive value (54.6%), and negative predictive value (76.1%) for S stercoralis ELISA positivity in this group. However, there was a more constant relationship between eosinophilia and S Stercoralis ELISA positivity in patients with T2DM (negative predictive value 87.5%). Conclusion.  This study suggests that the presence or absence of eosinophilia is not an adequate proxy test for S stercoralis infection in a community where the infection is prevalent, and that the association between eosinophilia and S stercoralis ELISA positivity is more constant in patients with T2DM.

scholarly journals Meta-Analysis of the Relationship Between Ethnicity, Obesity, and Type 2 Diabetes of Adults in Urban Populations of Central America

2016 ◽  
Vol 5 (3) ◽  
pp. 274
Author(s):  
William G Wuenstel ◽  
James A. Johnson ◽  
James Humphries ◽  
Cheryl Samuel
Keyword(s):  
Type 2 Diabetes ◽  
Relative Risk ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Central American ◽  
Significance Level ◽  
Study Participants ◽  
The Impact ◽  
The Relationship

The purpose of this meta-analysis was to examine the impact of ethnicity and obesity as it relates to Type-2 Diabetes (T2D) in specific Central American countries. A meta-analysis was conducted to determine the association of ethnicity, obesity, and T2D.  Four studies that qualified for inclusion were identified by searching MEDLINE and PubMed databases. The studies on the association of ethnicity and T2D had a combined population resulted in 265,858 study participants. Two studies on the association of obesity and T2D had 197,899 participants. An analysis of the data was conducted utilizing the relative risk ration, odds ratio, and forest plots. The comparison of the relative risk of T2D across ethnic categories by studies range for Blacks was 1.59 to 2.74, Asians was 1.43 to 2.08, and Hispanics .92 to 2.91.  The ethnic difference in the prevalence of diabetes was almost two-fold higher in all ethnic groups than among the Caucasians with a significance level of 95%. A comparison of relative risk of T2D across weight categories was significantly higher among those with a diagnosed of diabetes in all reported areas. The odds ratio was very close to the risk ratio in both ethnicity and obesity to the development of T2D. The meta-analysis findings documented that an association does exist between ethnicity and obesity to the development of type 2 diabetes.

scholarly journals The Associations between Blood and Urinary Concentrations of Metal Metabolites, Obesity, Hypertension, Type 2 Diabetes, and Dyslipidemia among US Adults: NHANES 1999–2016

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Sarah Swayze ◽  
Michael Rotondi ◽  
Jennifer L. Kuk
Keyword(s):  
Heavy Metals ◽  
Type 2 Diabetes ◽  
Metabolic Diseases ◽  
Smoking Status ◽  
Blood Lead ◽  
Curvilinear Relationship ◽  
Obesity Hypertension ◽  
The Impact ◽  
The Relationship

Background. Heavy metals are well known to be associated with cancer outcomes, but its association with obesity and cardiometabolic risk outcomes requires further study. Methods. Adult data from the National Health and Examination Survey (NHANES Continuous 1999–2016, n = 12,636 to 32,012) with data for blood or urinary metals concentrations and body mass index were used. The study aim was twofold: (1) to determine the association between heavy metals and obesity and (2) to examine the influence of heavy metals on the relationship between obesity and hypertension, type 2 diabetes, and dyslipidemia. Logistic regression was used to examine the main effects and interaction effects of metals and obesity for the odds of prevalent hypertension, type 2 diabetes, and dyslipidemia. Models were adjusted for age, gender, ethnicity, smoking status, physical active status, and poverty-income ratio, with additional adjustment for creatinine in models with the urinary measures of heavy metals. High-low concentration categories were defined by grouping metal quintiles with the most similar associations with obesity. Results. Blood lead had a negative linear association with obesity (odds ratio (OR)  = 0.42, 95% confidence interval (CI) = 0.37–0.47). In those with obesity, high blood lead was associated with lower risk of prevalent dyslipidemia, while no association was found in those without obesity. The study observed a curvilinear relationship between urinary antimony and obesity with the moderate group having the highest odds of obesity (OR = 1.36, 1.16–1.59). However, the relationship between urinary antimony and prevalent hypertension and dyslipidemia risk was linear, positive, and independent of obesity. While not associated with prevalent obesity risk, high urinary uranium was associated with 30% ( P = 0.01 ) higher odds for prevalent type 2 diabetes. Conclusions. The impact of environmental factors on obesity and health may be complex, and this study reinforces the heterogeneous relationship between various metals, obesity, and obesity-related metabolic diseases even at levels observed in the general population.

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