The Impact of Cardiovascular Disease on Medical Care Costs in Subjects With and Without Type 2 Diabetes

IntroductionDiabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Research design and methodsThis was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.ResultsA total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).ConclusionDiabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.

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Impact of a 2-year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-020-01178-2 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Shaminie J. Athinarayanan ◽

Sarah J. Hallberg ◽

Amy L. McKenzie ◽

Katharina Lechner ◽

Sarah King ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Principal Component ◽

Carbohydrate Diet ◽

Low Carbohydrate Diet ◽

Ldl Particles ◽

Low Carbohydrate ◽

Lipoprotein Subfraction ◽

The Impact

Abstract Background We have previously reported that in patients with type 2 diabetes (T2D) consumption of a very low carbohydrate diet capable of inducing nutritional ketosis over 2 years (continuous care intervention, CCI) resulted in improved body weight, glycemic control, and multiple risk factors for cardiovascular disease (CVD) with the exception of an increase in low density lipoprotein cholesterol (LDL-C). In the present study, we report the impact of this intervention on markers of risk for atherosclerotic cardiovascular disease (CVD), with a focus on lipoprotein subfraction particle concentrations as well as carotid-artery intima-media thickness (CIMT). Methods Analyses were performed in patients with T2D who completed 2 years of this study (CCI; n = 194; usual care (UC): n = 68). Lipoprotein subfraction particle concentrations were measured by ion mobility at baseline, 1, and 2 years and CIMT was measured at baseline and 2 years. Principal component analysis (PCA) was used to assess changes in independent clusters of lipoprotein particles. Results At 2 years, CCI resulted in a 23% decrease of small LDL IIIb and a 29% increase of large LDL I with no change in total LDL particle concentration or ApoB. The change in proportion of smaller and larger LDL was reflected by reversal of the small LDL subclass phenotype B in a high proportion of CCI participants (48.1%) and a shift in the principal component (PC) representing the atherogenic lipoprotein phenotype characteristic of T2D from a major to a secondary component of the total variance. The increase in LDL-C in the CCI group was mainly attributed to larger cholesterol-enriched LDL particles. CIMT showed no change in either the CCI or UC group. Conclusion Consumption of a very low carbohydrate diet with nutritional ketosis for 2 years in patients with type 2 diabetes lowered levels of small LDL particles that are commonly increased in diabetic dyslipidemia and are a marker for heightened CVD risk. A corresponding increase in concentrations of larger LDL particles was responsible for higher levels of plasma LDL-C. The lack of increase in total LDL particles, ApoB, and in progression of CIMT, provide supporting evidence that this dietary intervention did not adversely affect risk of CVD.

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The Impact Of Cardiovascular Disease And Type 2 Diabetes Mellitus On Social Cost In Chronic Kidney Disease Patients In Italy

Value in Health ◽

10.1016/j.jval.2014.08.1318 ◽

2014 ◽

Vol 17 (7) ◽

pp. A468

Author(s):

S. Bellelli ◽

G. Turchetti

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Type 2 Diabetes Mellitus ◽

Kidney Disease ◽

Social Cost ◽

The Impact

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The Impact of Training Modalities on the Clinical Benefits of Exercise Intervention in Patients with Cardiovascular Disease Risk or Type 2 Diabetes Mellitus

Sports Medicine ◽

10.2165/11535930-000000000-00000 ◽

2010 ◽

Vol 40 (11) ◽

pp. 921-940 ◽

Cited By ~ 70

Author(s):

Dominique Hansen ◽

Paul Dendale ◽

Luc J.C. van Loon ◽

Romain Meeusen

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Exercise Intervention ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Clinical Benefits ◽

Training Modalities ◽

The Impact

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Cost–effectiveness of empagliflozin versus weekly semaglutide as add-on therapy for Type 2 diabetes

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2021-0016 ◽

2021 ◽

Vol 10 (15) ◽

pp. 1133-1141

Author(s):

Margaret F Zupa ◽

Ronald A Codario ◽

Kenneth J Smith

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Cost Effectiveness ◽

Quality Adjusted Life Year ◽

Complication Rates ◽

Usual Treatment ◽

Markov Decision Model ◽

The Impact ◽

Quality Adjusted Life

Aim: Perform a cost–effectiveness analysis of addition of subcutaneous semaglutide versus empagliflozin to usual treatment for patients with Type 2 diabetes and cardiovascular disease in US setting. Materials & methods: A Markov decision model estimated the impact of each strategy using cardiovascular complication rates based on EMPA-REG and SUSTAIN-6 trials. Modeled cohorts were followed for 3 years at 1-month intervals beginning at age 66. Results: Compared with empagliflozin, semaglutide resulted in cost of US$19,964 per quality-adjusted life-year gained. In one-way sensitivity analysis, only semaglutide cost >US$36.25/day (base case US$18.04) resulted in empagliflozin being preferred at a willingness-to-pay threshold of US$50,000/quality-adjusted life-year gained. Conclusion: For patients with Type 2 diabetes and cardiovascular disease, semaglutide is likely more cost-effective than empagliflozin added to usual treatment.

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