Sedentary Behavior and Diabetes Risk Among Women Over the Age of 65 Years: The OPACH Study

Objective: Evaluate whether <a></a><a>sedentary </a>time (ST) and/or sedentary behavior patterns are related to incident diabetes in America's oldest age groups. Research Design and Methods: Women without physician-diagnosed diabetes (n=4839, age=79±7) wore accelerometers for ≥4 days and were followed up-to six years for self-reported newly-diagnosed diabetes requiring treatment with medications. Hazard ratios (HRs) for incident diabetes were estimated across quartiles (Q) of accelerometer-measured ST and mean bout duration using Cox proportional hazard models. Isotemporal substitution analyses using Cox regression tested associations with risk for diabetes after statistically replacing ST with light physical activity (PA) or moderate-to-vigorous PA (MVPA) and after replacing light PA with MVPA. Results: During 20949 person-years, 342 diabetes cases were identified. Women in ST Q2, Q3, and Q4 (vs. Q1) had incident diabetes HR(95% confidence interval) of 1.20(0.87-1.65), 1.33(0.97-1.82), and 1.21(0.86-1.70); p-trend=0.04. Respective HR(95%CI) following additional adjustment for body mass index and MVPA were 1.04(0.74-1.47), 1.04(0.72-1.50), and 0.85(0.56-1.29); p-trend=0.90. Fully adjusted isotemporal substitution results indicated that each 30 minutes of ST replaced with MVPA (but not light PA) was associated with 15% lower risk for diabetes [HR=0.85(0.75-0.96); p=0.01]; the HR(95%CI) for replacing 30 minutes of light PA with MVPA was 0.85(0.73-0.98); p=0.03. Mean bout duration was not associated with incident diabetes. Conclusions: Statistically replacing ST or light PA with MVPA was associated with lower diabetes risk in older women. While reducing ST is important for several health outcomes, results indicate that to reduce diabetes risk among older adults, the primary public health focus should be on increasing MVPA.

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Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000794 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000794 ◽

Cited By ~ 3

Author(s):

Crystal Man Ying Lee ◽

Stephen Colagiuri ◽

Mark Woodward ◽

Edward W Gregg ◽

Robert Adams ◽

...

Keyword(s):

Cox Regression ◽

Meta Analysis ◽

Characteristic Curve ◽

Diabetes Risk ◽

Incident Diabetes ◽

Cut Points ◽

Risk Of Progression ◽

Individual Participant ◽

Definition Of ◽

Design And Methods

ObjectiveThere are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful.Research design and methodsWe conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell’s C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points.ResultsSixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79–0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol).ConclusionsIn terms of identifying individuals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying individuals at risk of diabetes.

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HAS FRAILTY SCORE AND FRAILTY LETHALITY CHANGED OVER TIME? HARMONIZATION OF NHANES COHORTS FROM 1999 TO 2016

Innovation in Aging ◽

10.1093/geroni/igz038.2518 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S682-S682

Author(s):

Joanna M Blodgett ◽

Kenneth Rockwood ◽

Olga Theou

Keyword(s):

Multilevel Models ◽

Healthcare Access ◽

Frailty Index ◽

Age Groups ◽

Proportional Hazard ◽

Health And Nutrition ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Cox Proportional Hazard Models ◽

Over Time

Abstract Positive advances in life expectancy, healthcare access and medical technology have been accompanied by an increased prevalence of chronic diseases and substantial population ageing. How this impacts changes in both frailty level and subsequent mortality in recent decades are not well understood. We aimed to investigate how these factors changed over an 18-year period. Nine waves of the National Health and Nutrition Examination Survey (1999-2016) were harmonized to create a 46-item frailty index (FI) using self-reported and laboratory-based health deficits. Individuals aged 20+ were included in analyses (n=44086). Mortality was ascertained in December 2015. Weighted multilevel models estimated the effect of cohort on FI score in 10-year age-stratified groups. Cox proportional hazard models estimated if two or four-year mortality risk of frailty changed across the 1999-2012 cohorts. Mean FI score was 0.11±0.10. In the five older age groups (>40 years), later cohorts had higher frailty levels than did earlier cohorts. For example, in people aged 80+, each subsequent cohort had an estimated 0.007 (95%CI: 0.005, 0.009) higher FI score. However, in those aged 20-29, later cohorts had lower frailty [β=-0.0009 (-0.0013, -0.0005)]. Hazard ratios and cohort-frailty interactions indicated that there was no change in two or four-year lethality of FI score over time (i.e. two-year mortality: HR of 1.069 (1.055, 1.084) in 1999-2000 vs 1.061 (1.044, 1.077) in 2011-2012). Higher frailty levels in the most recent years in middle and older aged adults combined with unchanged frailty lethality suggests that the degree of frailty may continue to increase.

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Fluctuations in waist circumference increase diabetes risk: a 4-year cohort study in 61,587 older adults

Nutrition & Metabolism ◽

10.1186/s12986-021-00627-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Linna Wu ◽

Hongyan Liu ◽

Zhuang Cui ◽

Fang Hou ◽

Xiaowen Gong ◽

...

Keyword(s):

Older Adults ◽

Weight Gain ◽

Waist Circumference ◽

Abdominal Obesity ◽

Cox Regression ◽

Weight Maintenance ◽

Diabetes Risk ◽

Healthy Weight ◽

Diabetes Onset ◽

Hazard Ratios

Abstract Purpose To evaluate the effect of fluctuations in waist circumference (WC), weight, and body mass index (BMI) on the incidence of diabetes in older adults. Patients and methods A prospective cohort of 61,587 older adults (age, 60–96 years) who did not have diabetes at study initiation was examined. Data on weight, BMI, and WC were collected, and participants were followed up until 31 December 2018. The main end point was new-onset diabetes. A Cox regression model was used to estimate the risk of diabetes (hazard ratios [HRs] and confidence intervals [CI]) in these participants. Results During a mean follow-up of 3.6 years, being overweight (HR [95% CI] 1.87 [1.62–2.17]), obesity (1.41 [1.26–1.59]), abdominal obesity (1.42 [1.28–1.58]), and obesity plus abdominal obesity at baseline (1.93 [1.66–2.25]) increased the risk of diabetes onset. Compared with older adults who “maintained normal WC”, those who “remained abdominally obese” (HR = 1.66), “became abdominally obese” (HR = 1.58), or “achieved normal WC” (HR = 1.36) were at a higher risk of diabetes onset, as well as those with an increase in WC > 3 cm or > 5% compared with the baseline level. Weight gain or loss > 6 kg or weight gain > 5%, increase or decrease in BMI > 2 kg/m2, or an increase in BMI > 10% were associated with a higher diabetes risk. The diabetes risk was reduced by 19% in overweight older adults who exercised daily. Conclusion For older adults, WC, BMI, and healthy weight maintenance reduce the diabetes risk. The findings may provide evidence for developing guidelines of proper weight and WC control for older adults.

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Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial

10.2337/figshare.13528037.v1 ◽

2021 ◽

Author(s):

Frederik Persson ◽

Stephen C Bain ◽

Ofri Mosenzon ◽

Hiddo J.L. Heerspink ◽

Johannes F. E. Mann ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cox Regression ◽

Major Adverse Cardiovascular Events ◽

First Year ◽

Treatment Groups ◽

Renal Outcomes ◽

Hazard Ratios ◽

Post Hoc ◽

Design And Methods

OBJECTIVE A post hoc analysis to investigate the association between 1-year changes in albuminuria and subsequent risk of cardiovascular and renal events. RESEARCH DESIGN AND METHODS LEADER was a randomized trial of liraglutide up to 1.8 mg/day versus placebo added to standard care for 3.5–5 years, in 9,340 participants with type 2 diabetes and high cardiovascular risk. We calculated change in urinary albumin-to-creatinine ratio (UACR) from baseline to 1 year in participants with >30% reduction (N=2,928), 30–0% reduction N=1,218) or any increase in UACR (N=4,124) irrespective of treatment. Using Cox regression, risks of major adverse cardiovascular events (MACE) and a composite nephropathy outcome (from 1 year to end of trial in subgroups by baseline UACR [<30 mg/g, 30–300 mg/g or ≥300 mg/g]) were assessed. The analysis was adjusted for treatment allocation alone as a fixed factor and for baseline variables associated with cardiovascular and renal outcomes. RESULTS For MACE, hazard ratios (HRs) for those with >30% and 30%–0% UACR reduction were 0.82 (95% CI 0.71–0.94; P=0.006) and 0.99 (0.82–1.19; P=0.912), respectively, compared with any increase in UACR (reference). For the composite nephropathy outcome, respective HRs (95% CI) were 0.67 (0.49–0.93; P=0.02) and 0.97 (0.66–1.43; P=0.881). Results were independent of baseline UACR and consistent in both treatment groups. After adjustment, HRs were significant and consistent in >30% reduction subgroups with baseline micro- or macroalbuminuria. CONCLUSIONS A reduction in albuminuria during the first year was associated with fewer cardiovascular and renal outcomes, independent of treatment. Albuminuria monitoring remains an important part of diabetes care, with great unused potential.

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Changes in Albuminuria Predict Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Post Hoc Analysis of the LEADER Trial

10.2337/figshare.13528037 ◽

2021 ◽

Author(s):

Frederik Persson ◽

Stephen C Bain ◽

Ofri Mosenzon ◽

Hiddo J.L. Heerspink ◽

Johannes F. E. Mann ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cox Regression ◽

Major Adverse Cardiovascular Events ◽

First Year ◽

Treatment Groups ◽

Renal Outcomes ◽

Hazard Ratios ◽

Post Hoc ◽

Design And Methods

OBJECTIVE A post hoc analysis to investigate the association between 1-year changes in albuminuria and subsequent risk of cardiovascular and renal events. RESEARCH DESIGN AND METHODS LEADER was a randomized trial of liraglutide up to 1.8 mg/day versus placebo added to standard care for 3.5–5 years, in 9,340 participants with type 2 diabetes and high cardiovascular risk. We calculated change in urinary albumin-to-creatinine ratio (UACR) from baseline to 1 year in participants with >30% reduction (N=2,928), 30–0% reduction N=1,218) or any increase in UACR (N=4,124) irrespective of treatment. Using Cox regression, risks of major adverse cardiovascular events (MACE) and a composite nephropathy outcome (from 1 year to end of trial in subgroups by baseline UACR [<30 mg/g, 30–300 mg/g or ≥300 mg/g]) were assessed. The analysis was adjusted for treatment allocation alone as a fixed factor and for baseline variables associated with cardiovascular and renal outcomes. RESULTS For MACE, hazard ratios (HRs) for those with >30% and 30%–0% UACR reduction were 0.82 (95% CI 0.71–0.94; P=0.006) and 0.99 (0.82–1.19; P=0.912), respectively, compared with any increase in UACR (reference). For the composite nephropathy outcome, respective HRs (95% CI) were 0.67 (0.49–0.93; P=0.02) and 0.97 (0.66–1.43; P=0.881). Results were independent of baseline UACR and consistent in both treatment groups. After adjustment, HRs were significant and consistent in >30% reduction subgroups with baseline micro- or macroalbuminuria. CONCLUSIONS A reduction in albuminuria during the first year was associated with fewer cardiovascular and renal outcomes, independent of treatment. Albuminuria monitoring remains an important part of diabetes care, with great unused potential.

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Lack of Association between Past Helicobacter pylori Infection and Diabetes: A Two-Cohort Study

Nutrients ◽

10.3390/nu11081874 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1874

Author(s):

Jeung Hui Pyo ◽

Hyuk Lee ◽

Sung Chul Choi ◽

Soo Jin Cho ◽

Yoon-Ho Choi ◽

...

Keyword(s):

Helicobacter Pylori ◽

Diabetic Nephropathy ◽

Glycemic Control ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Poor Glycemic Control ◽

Hazard Ratios ◽

Cox Proportional Hazard Models ◽

H Pylori ◽

Diagnosed Diabetes

Helicobacter pylori (H. pylori) may be involved in diabetes and other insulin-related processes. This study aimed to investigate the associations between H. pylori infection and the risks of type 2 diabetes, impaired glucose tolerance (IGT), diabetic nephropathy, and poor glycemic control. We retrospectively evaluated 16,091 subjects without diabetes at baseline who underwent repeated health examinations. Subjects were categorized according to whether they were seropositive and seronegative for H. pylori infection. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models. The serological results were validated using an independent cohort (n = 42,351) based on a histological diagnosis of H. pylori infection. During 108,614 person-years of follow-up, 1338 subjects (8.3%) developed newly diagnosed diabetes, although the cumulative incidence of diabetes was not significantly related to serological H. pylori status. The multivariate Cox proportional-hazards regression models revealed that H. pylori seropositivity was not significantly associated with diabetes (HR: 1.01, 95% CI: 0.88–1.16; p = 0.854), IGT (HR: 0.98, 95% CI: 0.93–1.04; p = 0.566), diabetic nephropathy (HR: 0.99, 95% CI: 0.82–1.21; p = 0.952), or poor glycemic control (HR: 1.05, 95% CI: 0.90–1.22; p = 0.535). Similarly, histopathological findings of H. pylori infection were not significantly associated with diabetes (p = 0.311), diabetic nephropathy (p = 0.888), or poor glycemic control (p = 0.989). The findings from these large Korean cohorts indicate that there does not appear to be a role for past H. pylori infection in the development of diabetes, IGT, diabetic nephropathy, or poor glycemic control.

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Self-reported visual impairment, physical activity and all-cause mortality: The HUNT Study

Scandinavian Journal of Public Health ◽

10.1177/1403494816680795 ◽

2016 ◽

Vol 45 (1) ◽

pp. 33-41 ◽

Cited By ~ 4

Author(s):

Audun Brunes ◽

W. Dana Flanders ◽

Liv Berit Augestad

Keyword(s):

Physical Activity ◽

Visual Impairment ◽

Mortality Risk ◽

Cox Regression ◽

Age Groups ◽

Health Study ◽

Cox Models ◽

Hazard Ratios ◽

All Cause Mortality ◽

Hunt Study

Aims: To examine the associations of self-reported visual impairment and physical activity (PA) with all-cause mortality. Methods: This prospective cohort study included 65,236 Norwegians aged ⩾20 years who had participated in the Nord-Trøndelag Health Study (HUNT2, 1995−1997). Of these participants, 11,074 (17.0%) had self-reported visual impairment (SRVI). The participants’ data were linked to Norway’s Cause of Death Registry and followed throughout 2012. Hazard ratios and 95% confidence intervals (CI) were assessed using Cox regression analyses with age as the time-scale. The Cox models were fitted for restricted age groups (<60, 60−84, ⩾85 years). Results: After a mean follow-up of 14.5 years, 13,549 deaths were identified. Compared with adults with self-reported no visual impairment, the multivariable hazard ratios among adults with SRVI were 2.47 (95% CI 1.94–3.13) in those aged <60 years, 1.22 (95% CI 1.13–1.33) in those aged 60–84 years and 1.05 (95% CI 0.96–1.15) in those aged ⩾85 years. The strength of the associations remained similar or stronger after additionally controlling for PA. When examining the joint associations, the all-cause mortality risk of SRVI was higher for those who reported no PA than for those who reported weekly hours of PA. We found a large, positive departure from additivity in adults aged <60 years, whereas the departure from additivity was small for the other age groups. Conclusions: Adults with SRVI reporting no PA were associated with an increased all-cause mortality risk. The associations attenuated with age.

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Metformin Reduces the Risk of Diverticula of Intestine in Taiwanese Patients with Type 2 Diabetes Mellitus

Frontiers in Pharmacology ◽

10.3389/fphar.2021.739141 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chin-Hsiao Tseng

Keyword(s):

Incidence Rate ◽

Lower Risk ◽

Cox Regression ◽

Age Groups ◽

Confounding By Indication ◽

Hazard Ratios ◽

Cumulative Duration ◽

Insurance Database

Aim: To investigate the risk of diverticula of intestine associated with metformin use.Methods: This retrospective cohort study used the Taiwan’s National Health Insurance database to enroll 307,548 ever users and 18,839 never users of metformin. The patients were followed up starting on January 1, 2006 and ending on a date up to December 31, 2011. To address confounding by indication, hazard ratios were derived from Cox regression based on the inverse probability of treatment weighting using propensity score.Results: During follow-up, newly diagnosed cases of diverticula were identified in 1,828 ever users (incidence rate: 125.59 per 100,000 person-years) and 223 never users (incidence rate: 268.17 per 100,000 person-years). Ever users had an approximately 54% lower risk, as shown by the overall hazard ratio of 0.464 (95% confidence interval 0.404–0.534). While patients categorized in each tertile of cumulative duration of metformin therapy were compared to never users, a dose-response pattern was observed with hazard ratios of 0.847 (0.730–0.983), 0.455 (0.391–0.531) and 0.216 (0.183–0.255) for the first (<27.37 months), second (27.37–59.70 months) and third (>59.70 months) tertiles, respectively. The findings were similar when the diagnosis of diverticula was restricted to the small intestine or to the colon. Subgroup analyses suggested that the lower risk of diverticula of intestine associated with metformin use was significant in all age groups of <50, 50–64 and ≥65 years, but the magnitude of risk reduction attenuated with increasing age.Conclusion: Metformin treatment is associated with a significantly reduced risk of diverticula of intestine.

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Abstract P143: Circulating Level of Hepatocyte Growth Factor and Incidence of Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.131.suppl_1.p143 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Michael P Bancks ◽

Suzette J Bielinski ◽

Paul A Decker ◽

Naomi Q Hanson ◽

Nicholas B Larson ◽

...

Keyword(s):

Growth Factor ◽

Hepatocyte Growth Factor ◽

Cox Regression ◽

Fasting Glucose ◽

Smoking Status ◽

Incident Diabetes ◽

Hazard Ratios ◽

Increased Risk ◽

Race Ethnicity ◽

Hepatocyte Growth

Introduction: Increased levels of hepatocyte growth factor (HGF), active in cell growth, motility, and morphogenesis, are associated with the presence of obesity, poor metabolic health, and cardiovascular disease. Hypothesis: We assessed the hypothesis that higher baseline levels of HGF will be associated with increased risk of diabetes. Methods: We examined the association between HGF and incident diabetes in MESA, including 5395 men and women 45-84 years of age at enrollment (2000-02). Fasting serum HGF was measured at baseline and on a subsample of participants at exam 2 (n = 1915). From 2000-11, incidence of diabetes was ascertained over 4 follow-up examinations, determined by new use of insulin or oral hypoglycemic medication or fasting glucose ≥ 126 mg/dL. Cox regression was used to estimate hazard ratios (HR) for incident diabetes according to 1 standard deviation unit (SDU) of HGF (1 SDU =256 pg/mL), before and after adjustment for age, sex, race/ethnicity, education, study center, smoking status, alcohol consumption, BMI, WC, fasting glucose and insulin, CRP, and IL-6 levels. Similarly, hazard ratios for incident diabetes were estimated according to change in HGF levels from exam 1 to exam 2 in the subsample. Results: At baseline, older age, male sex, current smoking, and higher body mass index (BMI), waist circumference (WC), fasting glucose and insulin, C-reactive protein (CRP) and interleukin-6 (IL-6) levels were all associated with higher levels of HGF, while greater education and physical activity were associated with lower serum HGF. Incidence of diabetes in this analytic sample was 12% (n cases = 670). Per 1 SDU increase in baseline HGF level, unadjusted risk for diabetes increased 1.46 fold (95% CI=1.37, 1.56). After adjustment, diabetes risk per 1 SDU increase in HGF was attenuated but remained significantly increased (HR=1.22; 95% CI=1.12, 1.32). No association was found between change in HGF level between exam 1 and exam 2 and incidence of diabetes. There was no evidence of effect modification by race/ethnicity for either analysis. Conclusion: In conclusion, in this ethnically diverse U.S. adult population, higher levels of serum HGF were independently associated with increased incidence of diabetes.

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