Long-term glycemic variability and risk of stroke in patients with diabetes: a meta-analysis

Abstract Objectives Long-term glycemic variability has been related to increased risk of vascular complication in patients with diabetes. However, the association between parameters of long-term glycemic variability and risk of stroke remains not fully determined. We performed a meta-analysis to systematically evaluate the above association. Methods Medline, Embase, and Web of Science databases were searched for longitudinal follow-up studies comparing the incidence of stroke in diabetic patients with higher or lower long-term glycemic variability. A random-effect model incorporating the potential heterogeneity among the included studies were used to pool the results. Results Seven follow-up studies with 725,784 diabetic patients were included, and 98% of them were with type 2 diabetes mellitus (T2DM). The mean follow-up duration was 7.7 years. Pooled results showed that compared to those with lowest category of glycemic variability, diabetic patients with the highest patients had significantly increased risk of stroke, as evidenced by glycemic variability analyzed by fasting plasma glucose coefficient of variation (FPG-CV: risk ratio [RR] = 1.24, 95% confidence interval [CI] 1.11 to 1.39, P < 0.001; I2 = 53%), standard deviation of FPG (FPG-SD: RR = 1.16, 95% CI 1.02 to 1.31, P = 0.02; I2 = 74%), HbA1c coefficient of variation (HbA1c-CV: RR = 1.88, 95% CI 1.61 to 2.19 P < 0.001; I2 = 0%), and standard deviation of HbA1c (HbA1c-SD: RR = 1.73, 95% CI 1.49 to 2.00, P < 0.001; I2 = 0%). Conclusions Long-term glycemic variability is associated with higher risk of stroke in T2DM patients.

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176-LB: Long-Term Glycemic Variability in Diabetic Patients According to Their Glycemic Control in Follow-Up

Diabetes ◽

10.2337/db19-176-lb ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 176-LB

Author(s):

HECTOR GARCIA-ALCALA

Keyword(s):

Glycemic Control ◽

Glycemic Variability ◽

Diabetic Patients

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Abstract 13315: Long-term Risk of Cardiovascular Events Following Hospitalization for Sepsis: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.13315 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Leah B Kosyakovsky ◽

Federico Angriman ◽

Emma Katz ◽

Neill Adhikari ◽

Lucas C Godoy ◽

...

Keyword(s):

Systematic Review ◽

Cumulative Incidence ◽

Meta Analysis ◽

Hazard Ratios ◽

Increased Risk ◽

Significant Difference ◽

Sepsis Survivors ◽

Risk Ratios

Introduction: Sepsis results in dysregulated inflammation, coagulation, and metabolism, which may contribute to increased cardiovascular disease (CVD) risk. We conducted a systematic review and meta-analysis to determine the association between sepsis and subsequent long-term CVD events. Methods: MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception to May 2020 to identify observational studies of adult sepsis survivors (defined by diagnostic codes or consensus definitions) measuring long-term CV outcomes. The primary outcome was a composite of myocardial infarction, CV death, and stroke. Random-effects models estimated the pooled cumulative incidence and adjusted hazard ratios of CV events relative to hospital or population controls. Odds ratios were included as risk ratios assuming <10% incidence in non-septic controls, and risk ratios were taken as hazard ratios (HR) assuming no censoring. Outcomes were analyzed at maximum follow-up (primary analysis) and stratified by time (<1 year, 1-2 years, and >2 years) since sepsis. Results: Of 11,235 abstracts screened, 25 studies (22 cohort studies, 2 case-crossover studies, and 1 case-control) involving 1,949,793 sepsis survivors were included. The pooled cumulative incidence of CVD events was 9% (95% CI; 5-14%). Sepsis was associated with an increased risk (HR 1.59, 95% CI 1.37-1.86) of CVD events at maximum follow-up ( Figure ); between-study heterogeneity was substantial (I 2 =97.3%). There was no significant difference when comparing studies using population and hospital controls. Significantly elevated risk was observed up to 5 years following sepsis. Conclusions: Sepsis survivors experience an approximately 50% increased risk of CVD events, which may persist for years following the index episode. These results highlight a potential unmet need for early cardiac risk stratification and optimization in sepsis survivors.

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Association of Long-Term Change and Variability in Glycemia with Risk of Incident Heart Failure among Patients with Type 2 Diabetes Mellitus – A Secondary Analysis of the ACCORD Trial

10.2337/figshare.12273155.v2 ◽

2020 ◽

Author(s):

Matthew W. Segar ◽

Kershaw V. Patel ◽

Muthiah Vaduganathan ◽

Melissa C. Caughey ◽

Javed Butler ◽

...

Keyword(s):

Standard Deviation ◽

Secondary Analysis ◽

Glycemic Variability ◽

Baseline Risk ◽

Absolute Difference ◽

Cox Models ◽

Term Change ◽

Alternative Measures

Objective: Evaluate the associations between long-term change and variability in glycemia with risk of HF among patients with T2DM. Research Design and Methods: Among participants with T2DM enrolled in the ACCORD trial, variability in HbA1c was assessed from stabilization of HbA1c following enrollment (8 months) to 3 years of follow-up as follows: average successive variability (ASV=average absolute difference between successive values), coefficient of variation (CV=standard deviation/mean), and standard deviation. Participants with HF at baseline or within 3 years of enrollment were excluded. Adjusted Cox models were used to evaluate the association of % change (from baseline to 3 years of follow-up) and variability in HbA1c over the first 3 years of enrollment and subsequent risk of HF. Results: The study included 8,576 patients. Over a median follow-up of 6.4 years from the end of variability measurements at year 3, 388 patients had an incident HF hospitalization. Substantial changes in HbA1c were significantly associated with higher risk of HF [HR (95% CI) for ≥10% decrease = 1.32 (1.08-1.75), ≥10% increase = 1.55 (1.19-2.04), ref: <10% change in HbA1c]. Higher long-term variability in HbA1c was significantly associated with higher risk of HF [HR (95% CI) per 1 SD of ASV = 1.34 (1.17-1.54)] independent of baseline risk factors and interval changes in cardiometabolic parameters. Consistent patterns of association were observed using alternative measures of glycemic variability. Conclusions: Substantial long-term changes and variability in HbA1c were independently associated with risk of HF among patients with T2DM.

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Impact of postoperative complications on long-term outcomes of patients following surgery for gastric cancer: A systematic review and meta-analysis of 64 follow-up studies

Asian Journal of Surgery ◽

10.1016/j.asjsur.2019.10.007 ◽

2020 ◽

Vol 43 (7) ◽

pp. 719-729

Author(s):

Jian Li ◽

Yao Zhang ◽

Deng-Min Hu ◽

Tu-Ping Gong ◽

Run Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Postoperative Complications ◽

Meta Analysis ◽

Long Term Outcomes ◽

Follow Up Studies

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Long-term outcomes after coronary artery bypass surgery in patients with diabetes

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa009 ◽

2020 ◽

Vol 30 (5) ◽

pp. 685-690

Author(s):

Tomas Andri Axelsson ◽

Jonas A Adalsteinsson ◽

Linda O Arnadottir ◽

Dadi Helgason ◽

Hera Johannesdottir ◽

...

Keyword(s):

Overall Survival ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Long Term Outcomes ◽

Cerebrovascular Events ◽

Increased Risk ◽

Patients With Diabetes

Abstract OBJECTIVES Our aim was to investigate the outcome of patients with diabetes undergoing coronary artery bypass grafting (CABG) surgery in a whole population with main focus on long-term mortality and complications. METHODS This was a nationwide retrospective analysis of all patients who underwent isolated primary CABG in Iceland between 2001 and 2016. Overall survival together with the composite end point of major adverse cardiac and cerebrovascular events was compared between patients with diabetes and patients without diabetes during a median follow-up of 8.5 years. Multivariable regression analyses were used to evaluate the impact of diabetes on both short- and long-term outcomes. RESULTS Of a total of 2060 patients, 356 (17%) patients had diabetes. Patients with diabetes had a higher body mass index (29.9 vs 27.9 kg/m2) and more often had hypertension (83% vs 62%) and chronic kidney disease (estimated glomerular filtration rate ≤60 ml/min/1.73 m2, 21% vs 14%). Patients with diabetes had an increased risk of operative mortality [odds ratio 2.52, 95% confidence interval (CI) 1.27–4.80] when adjusted for confounders. 5-Year overall survival (85% vs 91%, P < 0.001) and 5-year freedom from major adverse cardiac and cerebrovascular events were also inferior for patients with diabetes (77% vs 82%, P < 0.001). Cox regression analysis adjusting for potential confounders showed that the diagnosis of diabetes significantly predicted all-cause mortality [hazard ratio (HR) 1.87, 95% CI 1.53–2.29] and increased risk of major adverse cardiac and cerebrovascular events (HR 1.47, 95% CI 1.23–1.75). CONCLUSIONS Patients with diabetes have significantly lower survival after CABG, both within 30 days and during long-term follow-up.

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Long-Term Effects of Oral Antidiabetic Drugs During Pregnancy on Offspring: A Systematic Review and Meta-analysis of Follow-up Studies of RCTs

Diabetes Therapy ◽

10.1007/s13300-018-0479-0 ◽

2018 ◽

Vol 9 (5) ◽

pp. 1811-1829 ◽

Cited By ~ 16

Author(s):

Wenneke van Weelden ◽

Vincent Wekker ◽

Leon de Wit ◽

Jacqueline Limpens ◽

Hilkka Ijäs ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Antidiabetic Drugs ◽

Long Term Effects ◽

Oral Antidiabetic Drugs ◽

Oral Antidiabetic ◽

Follow Up Studies

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The Challenge of Lipid Management in Patients with Diabetes or Other Endocrine Disorders

European Endocrinology ◽

10.17925/ee.2011.07.02.92 ◽

2010 ◽

Vol 7 (2) ◽

pp. 92

Author(s):

Alberico L Catapano ◽

Liliana Grigore ◽

Angela Pirillo ◽

◽

...

Keyword(s):

Statin Therapy ◽

Meta Analysis ◽

Diabetic Patients ◽

Endocrine Disorders ◽

Lipid Management ◽

Increased Risk ◽

Patients With Diabetes ◽

Associated Risk Factors

Diabetes increases the risk of developing cardiovascular disease (CVD), and several guidelines suggest that subjects with diabetes are at high risk of developing CVD. The increased risk can be attributed, at least in part, to associated risk factors, including hypertension and dyslipidaemia. The role of statins in primary and secondary prevention of CVD is well established, and the positive effect has been clearly demonstrated also in patients with type 2 diabetes. A number of studies have evaluated the effect of statin therapy on incident CVD and shown that statin therapy produces a great reduction in cardiovascular risk, but a recent meta-analysis revealed a slight increase in the risk of developing diabetes. Such risk is, however, low, especially when compared with the reduction in cardiovascular events and should not interfere with the choice of treating diabetic patients with a cholesterol-lowering therapy.

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Association of Myocardial Fibrosis Detected by Late Gadolinium-Enhanced MRI with Clinical Outcomes of Patients with Diabetes: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-30053/v1 ◽

2020 ◽

Author(s):

Zhi Yang ◽

Rong Xu ◽

Jia-rong Wang ◽

Hua-yan Xu ◽

Hang Fu ◽

...

Keyword(s):

Myocardial Fibrosis ◽

Random Effects ◽

Data Extraction ◽

Meta Analysis ◽

Imaging Biomarker ◽

Diabetic Patients ◽

Significant Heterogeneity ◽

Cardiac Events ◽

Increased Risk ◽

Patients With Diabetes

Abstract Background Prior studies demonstrated that myocardial fibrosis assessed by late gadolinium-enhanced (LGE) MRI is associated with an increased risk for major adverse cardiac and cerebrovascular events (MACCE) or major adverse cardiac events (MACE) in patients with diabetes. However, the results of these studies were controversial and limited. Therefore, we performed this meta-analysis assessing the associations of myocardial fibrosis detected by LGE with the risk of MACCE and MACE in patients with diabetes. Methods We selected studies using MEDLINE, EMBASE and Cochrane by Ovid on December 2019. Prospective and retrospective studies that assessed the associations of myocardial fibrosis detected by LGE with the risk of MACCE or MACE in patients with diabetes with a disease duration of at least 12 months. Two independent reviewers performed the data extraction using a standardized form. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were evaluated by a random-effects model. Results Eight studies with 1121 patients were included in this meta-analysis, and follow-up of patients ranged from 17 to 70 months. The prevalence of LGE in the total sample was high, occurring in 38.09%. The annualized event rates (AERs) for MACCE was 11.94% in patients with diabetes and LGE. The presence of myocardial fibrosis detected by LGE was associated with an increased risk for MACCE (HR: 2.58; 95%CI 1.42-4.71; P=0.002) and MACE (HR: 5.28; 95%CI 3.20-8.70; P=0.000) in patients with diabetes. In a subgroup meta-analysis, ischemic fibrosis detected by LGE was associated with MACCE/MACE (HR 3.75, 95%CI 2.11-6.69; P=0.000) in patients with diabetes. In diabetic patients with preserved ejection fraction, the association between myocardial fibrosis detected by LGE and MACCE/MACE remained significant (HR: 4.02; 95%CI 2.22-7.25; P=0.000). All of the meta-analyses showed no significant heterogeneity from random effects. Conclusion This study demonstrated that myocardial fibrosis detected by LGE conferred an increase in the risk of MACCE/MACE in patients with diabetes and may be an imaging biomarker for risk stratification.

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Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-034135 ◽

2020 ◽

Vol 10 (7) ◽

pp. e034135 ◽

Cited By ~ 1

Author(s):

Jie Li ◽

Feng Ji ◽

Junxian Song ◽

Xiangyang Gao ◽

Deguo Jiang ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Outcomes ◽

Mortality Risk ◽

Meta Analysis ◽

Secondary Outcome ◽

Coronary Syndrome ◽

Increased Risk ◽

Follow Up Studies ◽

Poor Outcomes

ObjectivesAnxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association.DesignA meta-analysis of prospective follow-up studies.SettingHospitals.ParticipantsPatients with ACS.InterventionsWe included related prospective follow-up studies up through 20 July 2019 that were identified by searching PubMed and Embase databases. A random-effect model was used for the meta-analysis. Anxiety was evaluated by validated instruments at baseline.Primary and secondary outcome measuresWe determined the association between anxiety and risks of mortality and adverse cardiovascular events (MACEs) in patients with ACS.ResultsOur analysis included 17 studies involving 39 038 patients wqith ACS. Anxiety was independently associated with increased mortality risk (adjusted risk ratio (RR) 1.21, 95% CI 1.07 to 1.37, p=0.002) and MACEs (adjusted RR 1.47, 95% CI 1.24 to 1.74, p<0.001) in patients with ACS. Subgroup analyses showed that depression may at least partly confound the association between anxiety and poor outcomes in patients with ACS. Adjustment of depression significantly attenuated the association between anxiety and MACEs (adjusted RR 1.25, 95% CI 1.04 to 1.52, p=0.02). Moreover, anxiety was not significantly associated with mortality risk after adjusting for depression (adjusted RR 0.88, 95% CI 0.66 to 1.17, p=0.37).ConclusionsAnxiety is associated with increased risk of mortality and MACEs in patients with ACS. However, at least part of the association may be confounded by concurrent depressive symptoms in these patients.

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