scholarly journals Association of Low Fasting C-Peptide Levels With Cardiovascular Risk, Visit-To-Visit Glucose Variation and Severe Hypoglycemia in The Veterans Affairs Diabetes Trial (VADT)

2021 ◽  
Author(s):  
Juraj Koska ◽  
Daniel S. Nuyujukian ◽  
Gideon Bahn ◽  
Jin J. Zhou ◽  
Peter D. Reaven
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Decision Making ◽  
Severe Hypoglycemia ◽  
Clinical Decision ◽  
Veterans Affairs ◽  
Cvd Risk ◽  
C Peptide ◽  
Increased Risk ◽  
Control Patterns

Abstract Aims Low C-peptide levels, indicating beta-cell dysfunction, are associated with increased within-day glucose variation and hypoglycemia. In advanced type 2 diabetes, severe hypoglycemia and increased glucose variation predict cardiovascular (CVD) risk. The present study examined the association between C-peptide levels and CVD risk and whether it can be explained by visit-to-visit glucose variation and severe hypoglycemia. Materials and Methods Fasting C-peptide levels at baseline, composite CVD outcome, severe hypoglycemia, and visit-to-visit fasting glucose coefficient of variation (CV) and average real variability (ARV) were assessed in 1565 Veterans Affairs Diabetes Trial participants. Results There was a U-shaped relationship between C-peptide and CVD risk with increased risk with declining levels in the low range (<0.50 nmol/l, HR 1.30 [95%CI 1.05-1.60], p=0.02) and with rising levels in the high range (>1.23 nmol/l, 1.27 [1.00-1.63], p=0.05). C-peptide levels were inversely associated with the risk of severe hypoglycemia (OR 0.68 [0.60-0.77]) and visit-to-visit glucose variation (CV, standardized beta-estimate -0.12 [SE 0.01]; ARV, -0.10 [0.01]) (p<0.0001 all). The association of low C-peptide levels with CVD risk was independent of cardiometabolic risk factors (1.48 [1.17-1.87, p=0.001) and remained associated with CVD when tested in the same model with severe hypoglycemia and glucose CV. Conclusions Low C-peptide levels were associated with increased CVD risk in advanced type 2 diabetes. The association was independent of increases in glucose variation or severe hypoglycemia. C-peptide levels may predict future glucose control patterns and CVD risk, and identify phenotypes influencing clinical decision making in advanced type 2 diabetes.

scholarly journals Association of low fasting C-peptide levels with cardiovascular risk, visit-to-visit glucose variation and severe hypoglycemia in the Veterans Affairs Diabetes Trial (VADT)

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Juraj Koska ◽  
Daniel S. Nuyujukian ◽  
Gideon D. Bahn ◽  
Jin J. Zhou ◽  
Peter D. Reaven
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Decision Making ◽  
Severe Hypoglycemia ◽  
Clinical Decision ◽  
Veterans Affairs ◽  
Cvd Risk ◽  
C Peptide ◽  
Increased Risk ◽  
Control Patterns

Abstract Aims Low C-peptide levels, indicating beta-cell dysfunction, are associated with increased within-day glucose variation and hypoglycemia. In advanced type 2 diabetes, severe hypoglycemia and increased glucose variation predict cardiovascular (CVD) risk. The present study examined the association between C-peptide levels and CVD risk and whether it can be explained by visit-to-visit glucose variation and severe hypoglycemia. Materials and methods Fasting C-peptide levels at baseline, composite CVD outcome, severe hypoglycemia, and visit-to-visit fasting glucose coefficient of variation (CV) and average real variability (ARV) were assessed in 1565 Veterans Affairs Diabetes Trial participants. Results There was a U-shaped relationship between C-peptide and CVD risk with increased risk with declining levels in the low range (< 0.50 nmol/l, HR 1.30 [95%CI 1.05–1.60], p = 0.02) and with rising levels in the high range (> 1.23 nmol/l, 1.27 [1.00–1.63], p = 0.05). C-peptide levels were inversely associated with the risk of severe hypoglycemia (OR 0.68 [0.60–0.77]) and visit-to-visit glucose variation (CV, standardized beta-estimate − 0.12 [SE 0.01]; ARV, − 0.10 [0.01]) (p < 0.0001 all). The association of low C-peptide levels with CVD risk was independent of cardiometabolic risk factors (1.48 [1.17–1.87, p = 0.001) and remained associated with CVD when tested in the same model with severe hypoglycemia and glucose CV. Conclusions Low C-peptide levels were associated with increased CVD risk in advanced type 2 diabetes. The association was independent of increases in glucose variation or severe hypoglycemia. C-peptide levels may predict future glucose control patterns and CVD risk, and identify phenotypes influencing clinical decision making in advanced type 2 diabetes.

Glucagon-like peptide-1 (GLP-1) Biological Role in Patients of Type 2 Diabetes and Metabolic Syndrome

2019 ◽  
Vol 56 (2) ◽  
pp. 227
Author(s):  
Mohammedziyad Abu Awad
Keyword(s):  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Glucagon Secretion ◽  
Diabetic Patients ◽  
Metabolic Disturbances ◽  
Cvd Risk ◽  
First Line Therapy ◽  
Increased Risk ◽  
Glucagon Like Peptide 1

<p style="margin: 0in 0in 10pt; text-align: justify; line-height: 200%;">Type2 diabetes is estimated to affect 380 million people worldwide in 2025. Patients of this disease are at increased risk of cardiovascular diseases (CVD).The CVD risk is greater when diabetic patients have metabolic syndrome. Thus, the management of metabolic syndrome and CVD is crucial for diabetic patient’s life progress. GLP-1 has positive biological influences on glucose metabolism control by inhibiting glucagon secretion, enhancing insulin secretion and protecting the effects of cells. GLP-1 was also found to have other positive influences including weight loss, appetite sensation and food intake. These are important factors in metabolic disturbances control and CVD management. The paper reviewed several studies regarding the GLP-1 positive concerns. In conclusion, the paper supports the modern proposal of GLP-1 RAs as a first line therapy in initially diagnosed type 2 diabetes patients.</p>

Virtual Simulation Improves Clinical Decision-Making in Managing Type 2 Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 688-P ◽  
Author(s):  
AMY LARKIN ◽  
KELLY L. HANLEY ◽  
MARTIN WARTERS ◽  
GWEN S. LITTMAN
Keyword(s):  
Type 2 Diabetes ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Virtual Simulation

Pharmacogenetics of sulfonylurea-induced hypoglycemia in Type 2 diabetes patients: the SUCLINGEN study

2021 ◽  
Author(s):  
Navin Kumar Loganadan ◽  
Hasniza Zaman Huri ◽  
Shireene Ratna Vethakkan ◽  
Zanariah Hussein
Keyword(s):  
Type 2 Diabetes ◽  
Odds Ratio ◽  
Gene Polymorphisms ◽  
Prospective Observational Study ◽  
Severe Hypoglycemia ◽  
Prior History ◽  
Increased Risk ◽  
History Of

Aim: This study investigated the incidence of sulfonylurea-induced hypoglycemia and its predictors in Type 2 diabetes (T2D) patients. Patients & methods: In this prospective, observational study, T2D patients on maximal sulfonylurea-metformin therapy >1 year were enrolled. Hypoglycemia was defined as having symptoms or a blood glucose level <3.9 mmol/l. Results: Of the 401 patients, 120 (29.9%) developed sulfonylurea-induced hypoglycemia during the 12-month follow-up. The ABCC8 rs757110, KCNJ11 rs5219, CDKAL1 rs7756992 and KCNQ1 rs2237892 gene polymorphisms were not associated with sulfonylurea-induced hypoglycemia (p > 0.05). Prior history of hypoglycemia admission (odds ratio = 16.44; 95% CI: 1.74–154.33, p = 0.014) independently predicted its risk. Conclusion: Sulfonylurea-treated T2D patients who experienced severe hypoglycemia are at increased risk of future hypoglycemia episodes.

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 Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism and Severe Hypoglycemia Complicating Type 2 Diabetes: The Fremantle Diabetes Study

2011 ◽  
Vol 96 (4) ◽  
pp. E696-E700 ◽  
Author(s):  
Wendy A. Davis ◽  
Simon G. A. Brown ◽  
Ian G. Jacobs ◽  
Max Bulsara ◽  
John Beilby ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitor ◽  
Severe Hypoglycemia ◽  
Inhibitor Therapy ◽  
First Episode ◽  
Converting Enzyme ◽  
Increased Risk

Abstract Aims/hypotheses: The aim of this study was to determine whether the angiotensin-converting enzyme (ACE) gene I/D polymorphisms independently predict severe hypoglycemia in community-dwelling type 2 patients. Methods: Six hundred and two patients who were ACE genotyped at baseline and assessed in 1998 were followed up to the end of June 2006. Severe hypoglycemia was defined as that requiring documented health service use as the primary diagnosis. Cox proportional hazards modeling was used to determine the predictors of first episode and zero-inflated negative binomial regression modeling identified predictors of frequency. Results: Forty-nine patients (8.1%) experienced 63 episodes of severe hypoglycemia. After adjusting for previously identified significant independent predictors of time to first episode, both ACE DD genotype and ACE inhibitor therapy, but not their interaction, added to the model [hazard ratio (95% confidence interval): 2.34 (1.29–4.26), P = 0.006, and 1.77 (0.99–3.13), P = 0.052, respectively]. Similarly, after adjusting for previously identified risk factors for multiple episodes of severe hypoglycemia, ACE DD genotype was independently associated with increased risk [incidence relative risk (95% confidence interval): 1.80 (1.00–3.24), P = 0.050]. Conclusions/interpretation: ACE DD genotype was associated with an approximately 2-fold increased risk of the first episode of severe hypoglycemia and its subsequent frequency in well-characterized patients with type 2 diabetes. Consistent with previous case-control studies, ACE inhibitor therapy was a weak predictor of severe hypoglycemia. ACE I/D genotyping might provide useful adjunctive prognostic information when intensive glycemic control measures are contemplated.

scholarly journals Gestational diabetes mellitus and the role of intercurrent type 2 diabetes on long-term risk of cardiovascular events

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jiyu Sun ◽  
Gyu Ri Kim ◽  
Su Jin Lee ◽  
Hyeon Chang Kim
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cardiovascular Events ◽  
Cvd Risk ◽  
Increased Risk ◽  
Incident Cases

AbstractRecent studies have shown that gestational diabetes mellitus (GDM) is associated with an increased risk for cardiovascular disease. GDM has also been shown to be a risk factor for type 2 diabetes (T2DM) after pregnancy. However, there is limited evidence regarding the role of intercurrent T2DM on the relationship between GDM and future CVD. Thus, we investigated the risks of incident cardiovascular events among women with GDM during pregnancy compared to women without GDM and whether the increased CVD risk is dependent on intercurrent development of T2DM. We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service claims database. Outcomes were the first occurrence of any CVD (myocardial infarction, treatment with coronary revascularization, heart failure, and cerebrovascular disease). Cox proportional hazard models were used to assess the association between GDM and incident CVD events, using landmark analysis at 4 years. A total of 1,500,168 parous women were included in the analysis, of which 159,066 (10.60%) had GDM. At a median follow-up of 12.8 years, 13,222 incident cases of total CVD were observed. Multivariable-adjusted hazard ratio for total CVD among women with prior GDM, compared with those without GDM, was 1.08 (95% CI 1.02–1.14). Further classifying GDM by progression to T2DM in relation to total CVD risk indicated a positive association for GDM with progression to T2DM vs no GDM or T2DM (HR 1.74; 95% CI 1.40–2.15), and no statistically significant association for GDM only (HR 1.06; 95% CI 1.00–1.12). GDM with subsequent progression to T2DM were linked with an increased risk of cardiovascular diseases. These findings highlight the need for more vigilant postpartum screening for diabetes and the implementation of diabetes interventions in women with a history of GDM to reduce future CVD risk.

scholarly journals Natural Language Processing Improves Detection of Non-Severe Hypoglycemia in Medical Records versus Coding Alone in Patients with Type 2 Diabetes but does not Improve Prediction of Severe Hypoglycemia Events: An Analysis Using the Electronic Medical Record in a Large Health System

2020 ◽  
Author(s):  
Anita D. Misra-Hebert ◽  
Alex Milinovich ◽  
Alex Zajichek ◽  
Xinge Ji ◽  
Todd D. Hobbs ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Natural Language Processing ◽  
Natural Language ◽  
Prediction Model ◽  
Language Processing ◽  
Severe Hypoglycemia ◽  
C Statistic ◽  
Diagnosis Codes ◽  
Increased Risk

Objective: To determine if natural language processing (NLP) improves detection of non-severe hypoglycemia (NSH) in patients with type 2 diabetes and no NSH documentation by diagnosis codes, and to measure if NLP detection improves the prediction of future severe hypoglycemia (SH). <p>Research Design and Methods: From 2005-2017, we identified NSH events by diagnosis codes and NLP. We then built an SH prediction model. </p> <p>Results: There were 204,517 patients with type 2 diabetes and no diagnosis codes for NSH. Evidence of of NSH was found in 7035 (3.4%) using NLP. We reviewed 1200 of the NLP-detected NSH notes and confirmed 93% to have NSH. The SH prediction model (C-statistic 0.806) showed increased risk with NSH (Hazard Ratio=4.44, p<0.001). However the model with NLP did not improve SH prediction compared to diagnosis code-only NSH. </p> <p>Conclusions: Detection of NSH improved with NLP in patients with type 2 diabetes without improving SH prediction. </p>

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