Comment on: Hanssen et al. Associations Between the Ankle-Brachial Index and Cardiovascular and All-Cause Mortality Are Similar in Individuals Without and With Type 2 Diabetes: Nineteen-Year Follow-Up of a Population-Based Cohort Study. Diabetes Care 2012;35:1731-1735

Background: This study investigated the effects of age, gender, socio-economic status, smoking status, hypertension, ischaemic heart disease, Body Mass Index (BMI), Glycaemic control (HbA1c) and dyslipidaemia in type 2 diabetes in a population-based analysis.

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Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2020.108352 ◽

2020 ◽

Vol 167 ◽

pp. 108352

Author(s):

Rebecka Husdal ◽

Eva Thors Adolfsson ◽

Janeth Leksell ◽

Björn Eliasson ◽

Stefan Jansson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Diabetes Care ◽

All Cause Mortality

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Primary care experience and remission of Type 2 diabetes: a population-based prospective cohort study

Family Practice ◽

10.1093/fampra/cmaa086 ◽

2020 ◽

Author(s):

Hajira Dambha-Miller ◽

Alexander Day ◽

Ann Louise Kinmonth ◽

Simon J Griffin

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Weight Loss ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Population Based ◽

Care Experience

Abstract Background Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed. Objective To quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up. Methods A prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes. Results Of 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01–1.05, P = 0.01). Conclusion Primary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.

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Plasma Metabolites Associate with All-Cause Mortality in Individuals with Type 2 Diabetes

Metabolites ◽

10.3390/metabo10080315 ◽

2020 ◽

Vol 10 (8) ◽

pp. 315

Author(s):

Filip Ottosson ◽

Einar Smith ◽

Céline Fernandez ◽

Olle Melander

Keyword(s):

Type 2 Diabetes ◽

Premature Mortality ◽

Population Based ◽

Plasma Metabolites ◽

Increased Risk ◽

All Cause Mortality ◽

Prospective Cohorts ◽

Diet And Cancer

Alterations in the human metabolome occur years before clinical manifestation of type 2 diabetes (T2DM). By contrast, there is little knowledge of how metabolite alterations in individuals with diabetes relate to risk of diabetes complications and premature mortality. Metabolite profiling was performed using liquid chromatography-mass spectrometry in 743 participants with T2DM from the population-based prospective cohorts The Malmö Diet and Cancer-Cardiovascular Cohort (MDC-CC) and The Malmö Preventive Project (MPP). During follow-up, a total of 175 new-onset cases of cardiovascular disease (CVD) and 298 deaths occurred. Cox regressions were used to relate baseline levels of plasma metabolites to incident CVD and all-cause mortality. A total of 11 metabolites were significantly (false discovery rate (fdr) <0.05) associated with all-cause mortality. Acisoga, acylcarnitine C10:3, dimethylguanidino valerate, homocitrulline, N2,N2-dimethylguanosine, 1-methyladenosine and urobilin were associated with an increased risk, while hippurate, lysine, threonine and tryptophan were associated with a decreased risk. Ten out of 11 metabolites remained significantly associated after adjustments for cardiometabolic risk factors. The associations between metabolite levels and incident CVD were not as strong as for all-cause mortality, although 11 metabolites were nominally significant (p < 0.05). Further examination of the mortality-related metabolites may shed more light on the pathophysiology linking diabetes to premature mortality.

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