Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

Abstract Background To examine the incidence of atrial fibrillation in individuals with type 2 diabetes compared with age- and sex-matched controls from the general population and its variation in relation to glycaemic control and renal function. Methods A total of 421,855 patients with type 2 diabetes from the Swedish National Diabetes Registry and 2,131,223 controls from the Swedish Population Registry, matched for age, sex and county, were included and followed from January 1, 2001 to December 31, 2013. Results Overall, 8.9% of individuals with type 2 diabetes and 7.0% of controls were diagnosed with atrial fibrillation during follow-up, unadjusted incidence risk ratio (IRR) 1.35 (95% 1.33–1.36). Women < 55 years old with type 2 diabetes had an IRR of 2.36 (95% CI 2.10–2.66), in relation to controls, whereas the corresponding value for men < 55 years old with type 2 diabetes was IRR 1.78 (95% CI 1.67–1.90). In the fully adjusted Cox regression, the risk of type 2 diabetes on incident atrial fibrillation was 28% greater vs controls, hazard ratio (HR) 1.28 (95% CI 1.26–1.30), p < 0.0001. The excess risk of atrial fibrillation in individuals with type 2 diabetes increased with worsening glycaemic control and renal complications. For individuals with HbA1c ≤ 6.9% (≤ 52 mmol/mol) and normoalbuminuria the excess risk vs controls was still increased, adjusted HR 1.16 (95% CI 1.14–1.19); p < 0.0001. Conclusions Individuals with type 2 diabetes had an overall 35% higher risk of atrial fibrillation compared to age- and sex-matched controls from the general population. The excess risk for atrial fibrillation increased with renal complications or with poor glycaemic control. Individuals with type 2 diabetes with good glycaemic control and normoalbuminuria had slightly increased risk.

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Glycaemic control and excess risk of major coronary events in patients with type 2 diabetes: a population-based study

Open Heart ◽

10.1136/openhrt-2018-000967 ◽

2019 ◽

Vol 6 (2) ◽

pp. e000967 ◽

Cited By ~ 1

Author(s):

Mauro Tancredi ◽

Annika Rosengren ◽

Ann-Marie Svensson ◽

Aldina Pivodic ◽

Soffia Gudbjörnsdottir ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

General Population ◽

Cox Regression ◽

Incidence Rates ◽

Excess Risk ◽

Control Group ◽

Diabetes Group ◽

Renal Complications

ObjectiveThe purpose of the study was to investigate the excess risk of acute myocardial infarction (AMI) and death from coronary artery disease (coronary heart disease, CHD) in relation to age, level of glycaemic control and renal complications in patients with type 2 diabetes.MethodsA total of 431 579 patients with type 2 diabetes mellitus registered in the Swedish National Diabetes Register from 1 January 1998 to 31 December 2012, and 2 173 620 controls from the general population were included. Cox regression was used to study the excess risk of AMI and CHD.ResultsDuring follow-up of 5.1 years in the diabetes group and 5.4 years in the control group, 36 124 (8.4%) and 115 712 (5.3%) CHD events were registered, with corresponding incidence rates/1000 person-years of 14.64 (95% CI 14.49 to 14.79) and 8.73 (95% CI 8.68 to 8.78), respectively. The HR after adjustment for sex and age was 1.67 (1.65–1.69) which was reduced to 1.42 (1.41–1.44) with further adjustment for level of education, country of birth, diabetes duration and comorbidities. The multivariable-adjusted HR for AMI and CHD death with a time-updated glycated haemoglobin level of 6.9% or lower (≤52 mmol/mol) together with normoalbuminuria and estimated glomerular filtration rate ≥60 mL/min for patients with diabetes compared with controls was 0.95 (95% CI 0.92 to 0.98, p<0.001).ConclusionsIn this study, the excess risk of AMI and CHD death was higher for patients with type 2 diabetes compared with controls but converged to that in the general population in patients with on-target HbA1c levels and without renal complications.

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Patients with type 2 diabetes have an increased demand for pacemaker treatment - a comparison with age- and sex matched controls from the general population.

10.2337/figshare.12818687 ◽

2020 ◽

Author(s):

Elina Rautio ◽

Fredrik Gadler ◽

Soffia Gudbjörnsdottir ◽

Stefan Franzén ◽

Lars Rydén ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

General Population ◽

Diabetes Duration ◽

Lipid Lowering ◽

Increased Risk ◽

Age And Sex

Objective: Patients with type 2 diabetes mellitus have an increased risk for cardiovascular disease including arrhythmias. The prevalence of bradyarrhythmia and the subsequent need for treatment with pacemakers (PM) is less well explored in a contemporary patient population. The present study explores 1) whether patients with type 2 diabetes mellitus have an increased demand for PM implantation compared with an age- and sex-matched control population without diabetes mellitus; 2) Patient characteristics associated with increased demand of receiving a PM. Methods: In this population-matched registry study a total of 416 247 patients with type 2 diabetes mellitus from the Swedish National Diabetes Registry (NDR) and 2 081 235 age and sex-matched controls selected from the general population were included between 1 January 1998 and 31 December 2012 and followed until 31 December 2013. Mean follow-up time was 7 years. Cox’s proportional hazard regression analyses were performed to estimate the demand of PM-treatment and factors identifying patients with such demand. Results: Type 2 diabetes mellitus was associated with increased need of PM-treatment (Hazard ratio (HR) 1.65, 95% CI 1.60-1.69; p<0.0001) which remained (HR 1.56, 95% CI 1.51-1.60; p<0.0001) after adjustments for age, sex, educational level, marital status, country of birth and coronary heart disease. Risk factors for receiving a PM included increasing age, HbA1c, BMI, diabetes duration, blood pressure- and lipid lowering medication. Conclusion: The need for PM treatment is higher in patients with type 2 diabetes than in matched population-based controls. Age, diabetes duration and HbA1c seem to be risk factors for PM treatment.

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Patients with type 2 diabetes have an increased demand for pacemaker treatment - a comparison with age- and sex matched controls from the general population.

10.2337/figshare.12818687.v1 ◽

2020 ◽

Author(s):

Elina Rautio ◽

Fredrik Gadler ◽

Soffia Gudbjörnsdottir ◽

Stefan Franzén ◽

Lars Rydén ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

General Population ◽

Diabetes Duration ◽

Lipid Lowering ◽

Increased Risk ◽

Age And Sex

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Ethnic differences in participation in diabetes education programmes

European Journal of Public Health ◽

10.1093/eurpub/ckz186.063 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Juul ◽

C Glümer ◽

S S Jervelund ◽

N F Hempler

Keyword(s):

Type 2 Diabetes ◽

General Population ◽

Social Relations ◽

Diabetes Education ◽

Household Composition ◽

Participation Rates ◽

Increased Risk ◽

Depth Analysis ◽

Study Population

Abstract Background Immigrants from non-Western countries have a higher prevalence of type 2 diabetes. In addition, immigrants have an increased risk of developing diabetes complications, compared with the general population. Diabetes education programmes facilitate essential knowledge and skills that enable people to manage their condition in daily life. However, fewer immigrants attend and complete diabetes education compared with the general population. The aim of this study is to explore what characterises those who decline and accept participation in diabetes education in relation to ethnicity, household composition and diabetes burden in the family. Methods The study population consisted of adults with type 2 diabetes referred to a municipal diabetes centre (n = 1819). Individual medical record data was linked to national registry data. Descriptive statistics and logistic regression models were applied. Results Preliminary results showed that 23% of individuals from the study population participated in diabetes education. We found no overall differences in participation rates between the general population and non-Western immigrants (24% vs. 18%, P = 0.12). However, when examining the immigrant groups by language (Arabic, Urdu and Turkish), the results indicated a non-significant tendency: Urdu speaking groups’ participation was similar to the general population (24%), whereas Arabic and Turkish speaking groups had lower participation rates (17% and 11%, P = 0.25/0.40). Conclusions The results suggest that there are differences in participation between some immigrant groups and the general population. Increased knowledge about which mechanisms affecting participation in diabetes education programme is required to ensure equal access. Further studies and analyses will explore how immigrants’ social relations enable and/or hamper participation in diabetes education and investigate which factors can be changed to improve participation rates. Key messages There are differences in participation in diabetes education programmes across different ethnic groups, which suggests a need for in-depth analysis into which mechanisms that affect participation. The results will be used to give input for future practices that can increase immigrant’s participation and retention in diabetes education programmes.

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Early impairment in left ventricular longitudinal systolic function is associated with an increased risk of incident atrial fibrillation in patients with type 2 diabetes

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2016.10.032 ◽

2017 ◽

Vol 31 (2) ◽

pp. 413-418 ◽

Cited By ~ 14

Author(s):

Stefano Bonapace ◽

Filippo Valbusa ◽

Lorenzo Bertolini ◽

Luciano Zenari ◽

Guido Canali ◽

...

Keyword(s):

Atrial Fibrillation ◽

Type 2 Diabetes ◽

Systolic Function ◽

Left Ventricular ◽

Increased Risk

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Type 2 diabetes risk in sarcoidosis patients untreated and treated with corticosteroids

ERJ Open Research ◽

10.1183/23120541.00028-2021 ◽

2021 ◽

pp. 00028-2021

Author(s):

Joshua P. Entrop ◽

Susanna Kullberg ◽

Johan Grunewald ◽

Anders Eklund ◽

Kerstin Brismar ◽

...

Keyword(s):

Type 2 Diabetes ◽

General Population ◽

Sex Education ◽

Cox Regression ◽

Parametric Models ◽

Family History Of Diabetes ◽

Drug Register ◽

Increased Risk ◽

Icd Codes

BackgroundThe rate of type 2 diabetes mellitus (T2D) is increased in sarcoidosis patients but it is unknown if corticosteroid treatment plays a role. We investigated whether the T2D risk is higher in untreated and corticosteroid-treated sarcoidosis patients compared to the general population.MethodsIn this cohort study individuals with ≥2 ICD codes for sarcoidosis were identified from the Swedish National Patient Register (NPR; n=5754). Corticosteroid dispensations ±3 months from first sarcoidosis diagnosis were identified from the Prescribed Drug Register (PDR). General population comparators without sarcoidosis were matched to cases 10:1 on age, sex and region of residence (n=61 297). Incident T2D was identified using ICD codes (NPR) and antidiabetic drug dispensations (PDR). Follow-up was from second sarcoidosis diagnosis/matching date until T2D, emigration, death or study end (Dec 2013). Cox regression models adjusted for age, sex, education, country of birth, healthcare regions and family history of diabetes estimated hazard ratios (HR 95%CI). We used flexible parametric models to examine the T2D risk over time.Results40% of sarcoidosis patients were corticosteroid-treated at diagnosis. The T2D rate was 7.7/1000 person-years in untreated sarcoidosis, 12.7 in corticosteroid-treated sarcoidosis and 5.5 in comparators. The HR for T2D was 1.4 (95%CI 1.2–1.8) associated with untreated sarcoidosis and 2.3 (95%CI 2.0–3.0) associated with corticosteroid-treated sarcoidosis. The T2D risk was highest for corticosteroid-treated sarcoidosis in the first 2 years after diagnosis.ConclusionSarcoidosis is associated with an increased risk of T2D especially in older, male, corticosteroid-treated patients at diagnosis. Screening for T2D for these patients is advisable.

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BMI and Mortality in Patients With New-Onset Type 2 Diabetes: A Comparison With Age- and Sex-Matched Control Subjects From the General Population

Diabetes Care ◽

10.2337/dc17-1309 ◽

2018 ◽

Vol 41 (3) ◽

pp. 485-493 ◽

Cited By ~ 17

Author(s):

Jon Edqvist ◽

Araz Rawshani ◽

Martin Adiels ◽

Lena Björck ◽

Marcus Lind ◽

...

Keyword(s):

Type 2 Diabetes ◽

General Population ◽

Matched Control ◽

Onset Type ◽

Control Subjects ◽

Age And Sex ◽

New Onset

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A case of severe relapsing sulphonylurea-induced hypoglycaemia

BMJ Case Reports ◽

10.1136/bcr-2019-231368 ◽

2019 ◽

Vol 12 (12) ◽

pp. e231368 ◽

Cited By ~ 1

Author(s):

Simon Mifsud ◽

Emma Louise Schembri ◽

Stephen Fava

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Renal Function ◽

Impaired Renal Function ◽

Hypoglycaemic Event ◽

Increased Risk ◽

Prolonged Effect ◽

Prolonged Observation

The authors report a case of a 64-year-old woman who was diagnosed with severe relapsing sulphonylurea-induced hypoglycaemia. Sulphonylureas are frequently used in patients with type 2 diabetes mellitus. They promote insulin secretion independent of the prevailing glucose level and thus are associated with an increased risk of hypoglycaemia. In patients with adequate renal function, gliclazide’s effect lasts 10–24 hours and it is usually completely eliminated within 144 hours postdose. Since our patient suffered from chronic kidney disease, gliclazide’s effect was prolonged and she was experiencing spontaneous hypoglycaemic episodes up to 21 days postomission of gliclazide. This case highlights two important aspects. Primarily, the prolonged effect of sulphonylureas in patients with impaired renal function, hence highlighting the need to be cautious prior to prescribing sulphonylureas in such patients. Secondly, the importance of prolonged observation of patients on sulphonylureas even after the initial hypoglycaemic event is corrected, due to the extended effects of such drugs.

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Serum Soluble CD163 Predicts Risk of Type 2 Diabetes in the General Population

Clinical Chemistry ◽

10.1373/clinchem.2010.154724 ◽

2011 ◽

Vol 57 (2) ◽

pp. 291-297 ◽

Cited By ~ 62

Author(s):

Holger J Møller ◽

Ruth Frikke-Schmidt ◽

Søren K Moestrup ◽

Børge G Nordestgaard ◽

Anne Tybjærg-Hansen

Keyword(s):

Type 2 Diabetes ◽

General Population ◽

Low Grade ◽

Reactive Protein ◽

Soluble Cd163 ◽

Hazard Ratios ◽

Heart Study ◽

Increased Risk ◽

Study Participants

BACKGROUND Activation of adipose tissue macrophages with concomitant low-grade inflammation is believed to play a central role in the development of type 2 diabetes. We tested whether a new macrophage-derived biomarker, soluble CD163 (sCD163), identifies at-risk individuals before overt disease has developed. METHODS A prospective cohort study of 8849 study participants from the general population, the Copenhagen City Heart Study, was followed for 18 years for incidence of type 2 diabetes. Risk of disease was calculated according to age- and sex-adjusted percentile categories of serum sCD163 concentrations: 0%–33%, 34%–66%, 67%–90%, 91%–95%, and 96%–100%. RESULTS A total of 568 participants developed type 2 diabetes. The cumulative incidence increased with increasing baseline sCD163 (trend P < 0.001), and sCD163 was strongly associated with known risk factors such as physical inactivity, body mass index, C-reactive protein, and triglycerides (all P < 0.001). Multifactorially adjusted hazard ratios for type 2 diabetes were 1.4 (95% CI, 1.0–1.9), 2.4 (1.8–3.2), 3.8 (2.6–5.5), and 5.2 (3.6–7.6) for categories 34%–66%, 67%–90%, 91%–95%, and 96%–100%, respectively, vs the 0%–33% category. In overweight men 50–70 and >70 years of age, serum sCD163 concentrations in the top 5% group predicted an absolute 10-year risk of type 2 diabetes of 29% and 36% vs 7% and 8% in the lowest percentile group. Equivalent values in women were 19% and 24% vs 4% and 5%. CONCLUSIONS Increased concentrations of sCD163 predict increased risk of type 2 diabetes in the general population and may be useful for identification of high-risk overweight individuals.

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Low 25-Hydroxyvitamin D and Risk of Type 2 Diabetes: A Prospective Cohort Study and Metaanalysis

Clinical Chemistry ◽

10.1373/clinchem.2012.193003 ◽

2013 ◽

Vol 59 (2) ◽

pp. 381-391 ◽

Cited By ~ 138

Author(s):

Shoaib Afzal ◽

Stig E Bojesen ◽

Børge G Nordestgaard

Keyword(s):

Type 2 Diabetes ◽

General Population ◽

Smoking Status ◽

Hdl Cholesterol ◽

Hazard Ratio ◽

Blood Draw ◽

Hydroxyvitamin D ◽

Increased Risk ◽

25 Hydroxyvitamin D

BACKGROUND Vitamin D deficiency has been implicated in decreased insulin secretion and increased insulin resistance, hallmarks of type 2 diabetes mellitus. We tested the hypothesis that low plasma 25-hydroxyvitamin D [25(OH)D] is associated with increased risk of type 2 diabetes in the general population. METHODS We measured 25(OH)D in 9841 participants from the general population, of whom 810 developed type 2 diabetes during 29 years of follow-up. Analyses were adjusted for sex, age, smoking status, body mass index, income, physical activity, HDL cholesterol, and calendar month of blood draw. RESULTS Lower 25(OH)D concentrations, by clinical categories or seasonally adjusted quartiles, were associated with higher cumulative incidence of type 2 diabetes (trend, P = 2×10−7 and P = 4×10−10). Multivariable adjusted hazard ratios of type 2 diabetes were 1.22 (95% CI 0.85–1.74) for 25(OH)D <5 vs ≥20 μg/L and 1.35 (1.09–1.66) for lowest vs highest quartile. Also, the multivariable adjusted hazard ratio of type 2 diabetes for a 50% lower concentration of 25(OH)D was 1.12 (1.03–1.21); the corresponding hazard ratio for those ≤58 years old was 1.26 (1.15–1.41). Finally, in a metaanalysis of 16 studies, the odds ratio for type 2 diabetes was 1.50 (1.33–1.70) for the bottom vs top quartile of 25(OH)D. CONCLUSIONS We observed an association of low plasma 25(OH)D with increased risk of type 2 diabetes. This finding was substantiated in a metaanalysis.

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