scholarly journals A review of mortality in type 2 diabetes mellitus

2015 ◽  
Vol 18 (4) ◽  
pp. 12-21 ◽  
Author(s):  
Nailya Sayfullaevna Asfandiyarova
Keyword(s):  
Type 2 Diabetes ◽  
Causes Of Death ◽  
Severe Hypoglycaemia ◽  
Microvascular Complications ◽  
Antiplatelet Agents ◽  
Diabetic Coma ◽  
Intensive Glucose Control ◽  
Risk Of Death ◽  
Increased Risk

The morbidity and mortality associated with type 2 diabetes have increased over recent years. The causes of death include cardiovascular disease, cancer, infection, kidney disease and diabetic coma. Risk factors for death are a sedentary lifestyle, obesity, smoking, sex, age, duration and severity of diabetes, macro- and microvascular complications and hyper- and hypoglycaemic states. Adequate glycemic control and moderate exercise along with the use of antiplatelet agents (e.g. aspirin), statins, antihypertensives and metformin can reduce mortality. Intensive glucose control was associated with an increased risk of severe hypoglycaemia and death, and surgical intervention increased the risk of death.

scholarly journals Severe hypoglycaemia and absolute risk of cause-specific mortality in individuals with type 2 diabetes: a UK primary care observational study

Diabetologia ◽  
2020 ◽  
Vol 63 (10) ◽  
pp. 2129-2139
Author(s):  
Francesco Zaccardi ◽  
Suping Ling ◽  
Claire Lawson ◽  
Melanie J. Davies ◽  
Kamlesh Khunti
Keyword(s):  
Type 2 Diabetes ◽  
Index Date ◽  
Causes Of Death ◽  
Severe Hypoglycaemia ◽  
Absolute Risk ◽  
Cardiovascular Death ◽  
Hypoglycaemic Episode ◽  
Risk Of Death ◽  
Increased Risk

Abstract Aims/hypothesis Several pathophysiological mechanisms would suggest a causal link between hypoglycaemia and cardiovascular death; conversely, current knowledge would not support a causal relationship with other causes of death. To clarify the nature and the magnitude of the association between hypoglycaemia and death, we investigated the 5 year mortality risks for cardiovascular disease, cancer and other causes in individuals with type 2 diabetes admitted to hospital for a severe hypoglycaemic episode. Methods We defined in the UK Clinical Practice Research Datalink database a prevalent cohort of adults with type 2 diabetes diagnosed between 1 January 1998 and 1 January 2011 (index date), with available linkage to the Office for National Statistics (ONS) and the Hospital Episode Statistics (HES). A hospital admission reporting hypoglycaemia as the underlying cause was identified before the index date in the HES; date and underlying cause of death were obtained from the ONS. We quantified the 5 year risk of cause-specific death in people with and without admission to hospital for severe hypoglycaemia, adjusting for potential confounders and accounting for competing risk. Results Of the 74,610 subjects included in the cohort, 388 (0.5%) were admitted at least once for a severe hypoglycaemic episode; subjects admitted were older, with higher HbA1c and a greater prevalence of multimorbidity. During a median follow-up of 7.1 years, 236 (60.8%) and 18,539 (25.0%) deaths occurred in subjects with and without a previous severe hypoglycaemia, respectively. Non-cardiovascular causes accounted for 71% of all deaths in both subjects with and without hypoglycaemia. In a 60-year-old person with severe hypoglycaemia, the 5 year absolute risk of death, adjusted for age, sex, ethnicity, systolic blood pressure, total cholesterol, HbA1c, BMI, eGFR, smoking status, alcohol consumption and deprivation (Townsend score), was 6.6%, 1.1% and 13.1% for cardiovascular, cancer and other causes, respectively, while the 5 year absolute risk difference compared with a subject without severe hypoglycaemia was 4.7% (95% CI 1.0, 8.3) for cardiovascular, −1.4% (−4.1, 1.4) for cancer and 11.1% (6.1, 16.1) for other causes of death. Results were consistent in models further adjusted for medications and comorbidities (myocardial infarction, stroke, peripheral artery disease, heart failure, atrial fibrillation, cancer), with sulfonylurea and insulin associated with increased mortality rates (from cause-specific hazard ratio of 1.06 [95% CI 0.99, 1.14] for cancer death with use of sulfonylurea to 1.42 [1.29, 1.56] for cardiovascular death with use of insulin). Results were robust to missing data. Conclusions/interpretation The results of this study indicate severe hypoglycaemia as a marker of, rather than causally linked to, an increased risk of long-term mortality. Regardless of the nature of the association, a severe hypoglycaemic episode represents a strong negative prognostic factor in patients with type 2 diabetes.

scholarly journals A higher non-severe hypoglycaemia rate is associated with an increased risk of subsequent severe hypoglycaemia and major adverse cardiovascular events in individuals with type 2 diabetes in the LEADER study

Diabetologia ◽  
2021 ◽  
Author(s):  
Simon R. Heller ◽  
Milan S. Geybels ◽  
Ahmed Iqbal ◽  
Lei Liu ◽  
Lily Wagner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Severe Hypoglycaemia ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Post Hoc Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Post Hoc

Abstract Aims/hypothesis Hypoglycaemia is a common side effect of insulin and some other antihyperglycaemic agents used to treat diabetes. Severe hypoglycaemia has been associated with adverse cardiovascular events in trials of intensive glycaemic control in type 2 diabetes. The relationship between non-severe hypoglycaemic episodes (NSHEs) and severe hypoglycaemia in type 2 diabetes has been documented. However, an association between more frequent NSHEs and cardiovascular events has not been verified. This post hoc analysis of the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial aimed to confirm whether there is an association between NSHEs and severe hypoglycaemic episodes in individuals with type 2 diabetes. In addition, the possible association between NSHEs and major adverse cardiac events (MACE), cardiovascular death and all-cause mortality was investigated. Methods LEADER was a double-blind, multicentre, placebo-controlled trial that found that liraglutide significantly reduced the risk of MACE compared with the placebo. In this post hoc analysis, we explored, in all LEADER participants, whether the annual rate of NSHEs (defined as self-measured plasma glucose <3.1 mmol/l [56 mg/dl]) was associated with time to first severe hypoglycaemic episode (defined as an episode requiring the assistance of another person), time to first MACE, time to cardiovascular death and time to all-cause mortality. Participants with <2 NSHEs per year were used as reference for HR estimates. Cox regression with a time-varying covariate was used. Results We demonstrate that there is an association between NSHEs (2–11 NSHEs per year and ≥12 NSHEs per year) and severe hypoglycaemic episodes (unadjusted HRs 1.98 [95% CI 1.43, 2.75] and 5.01 [95% CI 2.84, 8.84], respectively), which was consistent when baseline characteristics were accounted for. Additionally, while no association was found between participants with 2–11 NSHEs per year and adverse cardiovascular outcomes, higher rates of NSHEs (≥12 episodes per year) were associated with higher risk of MACE (HR 1.50 [95% CI 1.01, 2.23]), cardiovascular death (HR 2.08 [95% CI 1.17, 3.70]) and overall death (HR 1.80 [95% CI 1.11, 2.92]). Conclusions/interpretation The analysis of data from the LEADER trial demonstrated that higher rates of NSHEs were associated with both a higher risk of severe hypoglycaemia and adverse cardiovascular outcomes in individuals with type 2 diabetes. Therefore, irrespective of the cause of this association, it is important that individuals with high rates of hypoglycaemia are identified so that the potentially increased risk of cardiovascular events can be managed and steps can be taken to reduce NSHEs. Trial registration ClinicalTrials.gov (NCT01179048). Graphical abstract

scholarly journals Estimated glucose disposal rate and risk of stroke and mortality in type 2 diabetes: a nationwide cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexander Zabala ◽  
Vladimer Darsalia ◽  
Marcus Lind ◽  
Ann-Marie Svensson ◽  
Stefan Franzén ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Cox Regression ◽  
Glucose Disposal ◽  
Risk Of Death ◽  
Increased Risk ◽  
Estimated Glucose Disposal Rate ◽  
Glucose Disposal Rate

Abstract Background and aims Insulin resistance contributes to the development of type 2 diabetes (T2D) and is also a cardiovascular risk factor. The aim of this study was to investigate the potential association between insulin resistance measured by estimated glucose disposal rate (eGDR) and risk of stroke and mortality thereof in people with T2D. Materials and methods Nationwide population based observational cohort study that included all T2D patients from the Swedish national diabetes registry between 2004 and 2016 with full data on eGDR and categorised as following: < 4, 4–6, 6–8, and ≥ 8 mg/kg/min. We calculated crude incidence rates and 95% confidence intervals (CIs) and used multiple Cox regression to estimate hazard ratios (HRs) to assess the association between the risk of stroke and death, according to the eGDR categories in which the lowest category < 4 (i.e., highest grade of insulin resistance), served as a reference. The relative importance attributed of each factor in the eGDR formula was measured by the R2 (± SE) values calculating the explainable log-likelihoods in the Cox regression. Results A total of 104 697 T2D individuals, 44.5% women, mean age of 63 years, were included. During a median follow up-time of 5.6 years, 4201 strokes occurred (4.0%). After multivariate adjustment the HRs (95% CI) for stroke in patients with eGDR categories between 4–6, 6–8 and > 8 were: 0.77 (0.69–0.87), 0.68 (0.58–0.80) and 0.60 (0.48–0.76), compared to the reference < 4. Corresponding numbers for the risk of death were: 0.82 (0.70–0.94), 0.75 (0.64–0.88) and 0.68 (0.53–0.89). The attributed relative risk R2 (± SE) for each variable in the eGDR formula and stroke was for: hypertension (0.045 ± 0.0024), HbA1c (0.013 ± 0.0014), and waist (0.006 ± 0.0009), respectively. Conclusion A low eGDR (a measure of insulin resistance) is associated with an increased risk of stroke and death in individuals with T2D. The relative attributed risk was most important for hypertension.

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.

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 Fasting C-Peptide Levels and Death Resulting From All Causes and Breast Cancer: The Health, Eating, Activity, and Lifestyle Study

2011 ◽  
Vol 29 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Melinda L. Irwin ◽  
Catherine Duggan ◽  
Ching-Yun Wang ◽  
Ashley Wilder Smith ◽  
Anne McTiernan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Type 2 Diabetes ◽  
Cox Regression ◽  
Treatment Strategies ◽  
Breast Cancer Diagnosis ◽  
C Peptide ◽  
Risk Of Death ◽  
Increased Risk ◽  
Health Eating

Purpose To examine the association between serum C-peptide, a marker of insulin secretion, measured 3 years after a breast cancer diagnosis, and death resulting from all causes and breast cancer. Patients and Methods This was a prospective, observational study of 604 women enrolled onto the Health, Eating, Activity, and Lifestyle (HEAL) Study who were diagnosed with local or regional breast cancer between 1995 and 1998 and observed until death or December 31, 2006, whichever came first. The hazard ratio (HR) for all deaths and deaths owing to breast cancer and 95% CIs for the HR were estimated using multivariable stratified Cox regression analyses. Results Among women without type 2 diabetes, fasting C-peptide levels were associated with an increased risk of death resulting from all causes and from breast cancer. A 1-ng/mL increase in C-peptide was associated with a 31% increased risk of any death (HR = 1.31; 95% CI, 1.06 to 1.63; P = .013) and a 35% increased risk of death as a result of breast cancer (HR = 1.35; 95% CI, 1.02 to 1.87, P = .048). Associations between C-peptide levels and death as a result of breast cancer were stronger in certain subgroups, including women with type 2 diabetes, women with a body mass index less than 25 kg/m2, women diagnosed with a higher stage of disease, and women whose tumors were estrogen receptor positive. Conclusion Treatment strategies to reduce C-peptide levels in patients with breast cancer, including dietary-induced weight loss, physical activity, and/or use of insulin-lowering medications, should be explored.

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>

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