Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study

Objective: To investigate the relationship between social deprivation and incident diabetes-related foot disease (DFD), in newly-diagnosed patients with type 2 diabetes. Research design and methods: A population-based, open retrospective cohort study, using The Health Improvement Network (01/01/2005-31/12/2019). Patients with type 2 diabetes, free of DFD at baseline, were stratified by Townsend deprivation index and the risk of developing DFD was calculated. DFD was defined as a composite of foot ulcer (FU), Charcot arthropathy, lower limb amputation (LLA), peripheral neuropathy (PN), peripheral vascular disease (PVD) and gangrene. Results: 176,359 patients were eligible (56% men; aged 62.9±13.1years). After excluding 26,094 patients with DFD before/within 15 months of type 2 diabetes diagnosis, DFD was incidentally developed in 12.1% of study population during 3.27years (IQR:1.41-5.96). Patients in the most deprived Townsend quintile had increased risk of DFD compared to those in the least deprived (aHR:1.22, 95%CI:1.16-1.29) after adjusting for sex, age at type 2 diabetes diagnosis, ethnicity, smoking, BMI, HbA1c, cardiovascular disease, hypertension, retinopathy, eGFR, insulin, glucose/lipid-lowering medications and baseline foot risk. Patients in the most deprived Townsend quintile had higher risk of PN (aHR:1.18, 95%CI:1.11-1.25), FU (aHR:1.44, 95%CI:1.17-1.77), PVD (aHR:1.40, 95%CI:1.28-1.53) LLA (aHR:1.75, 95%CI:1.08-2.83) and gangrene (aHR:8.49, 95% CI:1.01-71.58) compared to those in the least. Conclusion: Social deprivation is an independent risk factor for the development of DFD, PN, FU, PVD, LLA and gangrene in newly-diagnosed patients with type 2 diabetes. Considering the high individual and economic burden of DFD, strategies targeting patients in socially deprived areas are needed to reduce health inequalities.

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Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study

Diabetes Care ◽

10.2337/dc20-1027 ◽

2021 ◽

Vol 44 (3) ◽

pp. 731-739

Author(s):

Jenny Riley ◽

Christina Antza ◽

Punith Kempegowda ◽

Anuradhaa Subramanian ◽

Joht Singh Chandan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Social Deprivation ◽

Population Based ◽

Incident Diabetes ◽

Foot Disease

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The impact of bariatric surgery on incident microvascular complications in patients with type 2 diabetes: A matched controlled population-based retrospective cohort study

10.2337/figshare.13075748.v1 ◽

2020 ◽

Author(s):

Pushpa Singh ◽

Nicola Adderley ◽

Anuradhaa Subramanian ◽

Krishna Gokhale ◽

Rishi Singhal ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Cohort Study ◽

Microvascular Complications ◽

Population Based ◽

Type2 Diabetes ◽

Foot Disease ◽

The Impact ◽

Surgical Group

Aim: To assess the impact of bariatric surgery (BS) on incident microvascular complications [diabetes-related foot disease (DFD), sight threatening diabetic retinopathy (STDR), chronic kidney disease (CKD)] in patients with type 2 diabetes and obesity. Methods: <a>A retrospective matched, controlled population-based cohort study of adults with type 2 diabetes between 1/1/1990 and 31/1/2018 using </a><a>IQVIA Medical Research Data (IMRD), </a>a database of primary care electronic records. <a>Each patient with type2 diabetes who subsequently had BS (surgical) was matched on index date with up to 2 patients with type 2 diabetes did not have BS (non-surgical) within the same general practice by age, sex, pre-index body mass index and diabetes duration</a>. Results: 1126 surgical and 2219 non-surgical participants were included. In the study population, 2261 (68%) were women; Mean (SD) age was 49.87 (9.3) vs 50.12 (9.3) years and BMI was 46.76 (7.96) kg/m2 vs 46.14 (7.49) kg/m2 in surgical vs non-surgical group respectively. In surgical group, 22.1%, 22.7%, 52.2% and 1.1% patients had gastric band, sleeve gastrectomy, gastric bypass & duodenal switch respectively. Over median (IQR) follow-up was 3.9 years (1.8-6.4), BS was associated with reduction in incident combined microvascular complications (adjusted HR 0.63, 95% CI 0.51 to 0.78, p<0.001), DFD (0.61, 0.50 to 0.75, p<0.001), STDR (0.66, 0.44 to 1.00, p<0.001), CKD (0.63, 0.51 to 0.78, p<0.001). Analysis based on the type of surgery showed that all types of surgery were associated with favourable impact on the incident of composite microvascular complications, greatest reduction RYGB. Conclusions: BS was associated with a significant reduction in incident diabetes-related microvascular complications.

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The Association between Parental Type 1 and Type 2 Diabetes Diagnosis and Major Osteoporotic Fracture Risk in Adult Offspring: A Population-based Cohort Study

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2021.04.005 ◽

2021 ◽

Author(s):

Amani F. Hamad ◽

Lin Yan ◽

William D. Leslie ◽

Suzanne N. Morin ◽

Randy Walld ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Fracture Risk ◽

Osteoporotic Fracture ◽

Population Based ◽

Adult Offspring ◽

Diabetes Diagnosis ◽

Major Osteoporotic Fracture

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Ethnic disparities in mortality among overweight or obese adults with newly diagnosed type 2 diabetes: a population-based cohort study

Journal of Endocrinological Investigation ◽

10.1007/s40618-021-01736-9 ◽

2022 ◽

Author(s):

B. Iyen ◽

Y. Vinogradova ◽

R. K. Akyea ◽

S. Weng ◽

N. Qureshi ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Cardiovascular Mortality ◽

Population Based ◽

Diabetes Risk ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Newly Diagnosed ◽

Obese Adults

Abstract Purpose Ethnic variation in risk of type 2 diabetes is well established, but its impact on mortality is less well understood. This study investigated the risk of all-cause and cardiovascular mortality associated with newly diagnosed type 2 diabetes in White, Asian and Black adults who were overweight or obese. Methods This population-based cohort study used primary care records from the UK Clinical Practice Research Datalink, linked with secondary care and death registry records. A total of 193,528 obese or overweight adults (BMI of 25 or greater), with ethnicity records and no pre-existing type 2 diabetes were identified between 01 January 1995 and 20 April 2018. Multivariable Cox proportional hazards regression estimated hazards ratios (HR) for incident type 2 diabetes in different ethnic groups. Adjusted hazards ratios for all-cause and cardiovascular mortality were determined in individuals with newly diagnosed type 2 diabetes. Results During follow-up (median 9.8 years), the overall incidence rate of type 2 diabetes (per 1,000 person-years) was 20.10 (95% CI 19.90–20.30). Compared to Whites, type 2 diabetes risk was 2.2-fold higher in Asians (HR 2.19 (2.07–2.32)) and 30% higher in Blacks (HR 1.34 (1.23–1.46)). In individuals with newly diagnosed type 2 diabetes, the rates (per 1,000 person-years) of all-cause mortality and cardiovascular mortality were 24.34 (23.73–24.92) and 4.78 (4.51–5.06), respectively. Adjusted hazards ratios for mortality were significantly lower in Asians (HR 0.70 (0.55–0.90)) and Blacks (HR 0.71 (0.51–0.98)) compared to Whites, and these differences in mortality risk were not explained by differences in severity of hyperglycaemia. Conclusions/Interpretation Type 2 diabetes risk in overweight and obese adults is greater in Asian and Black compared to White ethnic populations, but mortality is significantly higher in the latter. Greater attention to optimising screening, disease and risk management appropriate to all communities with type 2 diabetes is needed.

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The impact of bariatric surgery on incident microvascular complications in patients with type 2 diabetes: A matched controlled population-based retrospective cohort study

10.2337/figshare.13075748 ◽

2020 ◽

Author(s):

Pushpa Singh ◽

Nicola Adderley ◽

Anuradhaa Subramanian ◽

Krishna Gokhale ◽

Rishi Singhal ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Cohort Study ◽

Microvascular Complications ◽

Population Based ◽

Type2 Diabetes ◽

Foot Disease ◽

The Impact ◽

Surgical Group

Aim: To assess the impact of bariatric surgery (BS) on incident microvascular complications [diabetes-related foot disease (DFD), sight threatening diabetic retinopathy (STDR), chronic kidney disease (CKD)] in patients with type 2 diabetes and obesity. Methods: <a>A retrospective matched, controlled population-based cohort study of adults with type 2 diabetes between 1/1/1990 and 31/1/2018 using </a><a>IQVIA Medical Research Data (IMRD), </a>a database of primary care electronic records. <a>Each patient with type2 diabetes who subsequently had BS (surgical) was matched on index date with up to 2 patients with type 2 diabetes did not have BS (non-surgical) within the same general practice by age, sex, pre-index body mass index and diabetes duration</a>. Results: 1126 surgical and 2219 non-surgical participants were included. In the study population, 2261 (68%) were women; Mean (SD) age was 49.87 (9.3) vs 50.12 (9.3) years and BMI was 46.76 (7.96) kg/m2 vs 46.14 (7.49) kg/m2 in surgical vs non-surgical group respectively. In surgical group, 22.1%, 22.7%, 52.2% and 1.1% patients had gastric band, sleeve gastrectomy, gastric bypass & duodenal switch respectively. Over median (IQR) follow-up was 3.9 years (1.8-6.4), BS was associated with reduction in incident combined microvascular complications (adjusted HR 0.63, 95% CI 0.51 to 0.78, p<0.001), DFD (0.61, 0.50 to 0.75, p<0.001), STDR (0.66, 0.44 to 1.00, p<0.001), CKD (0.63, 0.51 to 0.78, p<0.001). Analysis based on the type of surgery showed that all types of surgery were associated with favourable impact on the incident of composite microvascular complications, greatest reduction RYGB. Conclusions: BS was associated with a significant reduction in incident diabetes-related microvascular complications.

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