scholarly journals Changes in the Diagnosis and Management of Diabetes in Mexico City Between 1998–2004 and 2015–2019

2021 ◽  
Author(s):  
Diego Aguilar-Ramirez ◽  
Jesus Alegre-Díaz ◽  
Louisa Gnatiuc ◽  
Raúl Ramirez-Reyes ◽  
Rachel Wade ◽  
...  
Keyword(s):  
Prospective Study ◽  
Mexico City ◽  
Diabetes Management ◽  
Medication Use ◽  
Diabetes Prevalence ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Glucose Lowering ◽  
Diagnosis And Management ◽  
Lowering Therapy

<i>Objective: </i>To investigate the trends in diabetes prevalence, diagnosis, and management among Mexican adults who were participants in a long-term prospective study. <p><i> </i></p> <p><i>Research design and methods:</i> In 1998-2004, 159,755 adults from Mexico City were recruited into a prospective study and in 2015-2019 10,144 survivors were resurveyed. Diabetes was defined as self-reported diagnosis, glucose-lowering medication use, or HbA<sub>1c</sub>≥6.5%. Controlled diabetes was defined as HbA<sub>1c</sub><7%. Prevalence estimates were uniformly standardised for age, sex and residential district. Cox models explored the relevance of controlled and inadequately controlled diabetes to cause-specific mortality. </p> <p><i> </i></p> <p><i>Results: </i>99,623 participants in 1998-2004 and 8986 participants in 2015-2019 were aged 45-84 years. Diabetes prevalence increased from 26% in 1998-2004 to 35% by 2015-2019. Of those with diabetes, the proportion previously-diagnosed increased from 76% to 89%, and glucose-lowering medication use among them increased from 80% to 94%. Median HbA<sub>1c</sub> among all with diabetes decreased from 8.2% to 7.3%, and the proportion of them with controlled diabetes increased from 16% to 37%. Use of blood pressure lowering medication among all with previously-diagnosed diabetes increased from 35% to 51% and their use of lipid-lowering therapy increased from 1% to 14%. The excess mortality risk associated with diabetes accounted for 34% of deaths at ages 35-74 years, of which 5% were attributable to controlled and 29% to inadequately controlled diabetes.</p> <p> </p> <i>Conclusions:</i> Inadequately controlled diabetes is a leading cause of premature adult death in Mexico. Improvements in diabetes management have increased diagnosis and control, but substantial opportunities remain to improve treatment, particularly with lipid-lowering therapy.

scholarly journals Changes in the Diagnosis and Management of Diabetes in Mexico City Between 1998–2004 and 2015–2019

2021 ◽  
Author(s):  
Diego Aguilar-Ramirez ◽  
Jesus Alegre-Díaz ◽  
Louisa Gnatiuc ◽  
Raúl Ramirez-Reyes ◽  
Rachel Wade ◽  
...  
Keyword(s):  
Prospective Study ◽  
Mexico City ◽  
Diabetes Management ◽  
Medication Use ◽  
Diabetes Prevalence ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Glucose Lowering ◽  
Diagnosis And Management ◽  
Lowering Therapy

<i>Objective: </i>To investigate the trends in diabetes prevalence, diagnosis, and management among Mexican adults who were participants in a long-term prospective study. <p><i> </i></p> <p><i>Research design and methods:</i> In 1998-2004, 159,755 adults from Mexico City were recruited into a prospective study and in 2015-2019 10,144 survivors were resurveyed. Diabetes was defined as self-reported diagnosis, glucose-lowering medication use, or HbA<sub>1c</sub>≥6.5%. Controlled diabetes was defined as HbA<sub>1c</sub><7%. Prevalence estimates were uniformly standardised for age, sex and residential district. Cox models explored the relevance of controlled and inadequately controlled diabetes to cause-specific mortality. </p> <p><i> </i></p> <p><i>Results: </i>99,623 participants in 1998-2004 and 8986 participants in 2015-2019 were aged 45-84 years. Diabetes prevalence increased from 26% in 1998-2004 to 35% by 2015-2019. Of those with diabetes, the proportion previously-diagnosed increased from 76% to 89%, and glucose-lowering medication use among them increased from 80% to 94%. Median HbA<sub>1c</sub> among all with diabetes decreased from 8.2% to 7.3%, and the proportion of them with controlled diabetes increased from 16% to 37%. Use of blood pressure lowering medication among all with previously-diagnosed diabetes increased from 35% to 51% and their use of lipid-lowering therapy increased from 1% to 14%. The excess mortality risk associated with diabetes accounted for 34% of deaths at ages 35-74 years, of which 5% were attributable to controlled and 29% to inadequately controlled diabetes.</p> <p> </p> <i>Conclusions:</i> Inadequately controlled diabetes is a leading cause of premature adult death in Mexico. Improvements in diabetes management have increased diagnosis and control, but substantial opportunities remain to improve treatment, particularly with lipid-lowering therapy.

scholarly journals Rheumatoid Arthritis and Cardiovascular Risk: Retrospective Matched-Cohort Analysis Based on the RECORD Study of the Italian Society for Rheumatology

2021 ◽  
Vol 8 ◽  
Author(s):  
Lisa Argnani ◽  
Anna Zanetti ◽  
Greta Carrara ◽  
Ettore Silvagni ◽  
Giulio Guerrini ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
General Population ◽  
Cohort Analysis ◽  
Lipid Lowering ◽  
World Population ◽  
Lipid Lowering Therapy ◽  
Matched Cohort ◽  
Glucose Lowering ◽  
Lowering Therapy

Background: Rheumatoid arthritis (RA) is associated with an increase in cardiovascular (CV) risk. This issue maybe not only explained by a genetic component, as well as by the traditional CV risk factors, but also by an underestimation and undertreatment of concomitant CV comorbidities.Method: This was a retrospective matched-cohort analysis in the Italian RA real-world population based on the healthcare-administrative databases to assess the CV risk factors and incidence of CV events in comparison with the general population. Persistence and adherence to the CV therapy were also evaluated in both groups.Results: In a RA cohort (N = 21,201), there was a greater prevalence of hypertension and diabetes with respect to the non-RA subjects (N = 249,156) (36.9 vs. 33.4% and 10.2 vs. 9.6%, respectively), while dyslipidemia was more frequent in the non-RA group (15.4 vs. 16.5%). Compared with a non-RA cohort, the patients with RA had a higher incidence of atrial fibrillation (incidence rate ratio, IRR 1.28), heart failure (IRR 1.53), stroke (IRR 1.19), and myocardial infarction (IRR 1.48). The patients with RA presented a significantly lower persistence rate to glucose-lowering and lipid-lowering therapies than the controls (odds ratio, OR 0.73 [95% CI 0.6–0.8] and OR 0.82 [0.8–0.9], respectively). The difference in the adherence to glucose-lowering therapy was significant (OR 0.7 [0.6–0.8]), conversely no statistically significant differences emerged regarding the adherence to lipid-lowering therapy (OR 0.89 [95% CI 0.8–1.0]) and anti-hypertensive therapy (OR 0.96 [95% CI 0.9–1.0]).Conclusion: The patients with RA have a higher risk of developing CV events compared with the general population, partially explained by the excess and undertreatment of CV risk factors.

A four-year naturalistic prospective study of cardiometabolic disease in antipsychotic-treated patients

2012 ◽  
Vol 27 (1) ◽  
pp. 50-55 ◽  
Author(s):  
P. Mackin ◽  
T. Waton ◽  
H.M. Watkinson ◽  
P. Gallagher
Keyword(s):  
Cardiovascular Risk ◽  
Prospective Study ◽  
Lipid Lowering ◽  
Antipsychotic Treatment ◽  
Oral Glucose ◽  
Lipid Lowering Therapy ◽  
Model Assessment ◽  
The Metabolic Syndrome ◽  
Lowering Therapy ◽  
Cardiovascular Morbidity And Mortality

AbstractThe relationship between antipsychotic use and cardiovascular morbidity and mortality is controversial. There is a lack of long-term prospective studies investigating changes in cardiometabolic risk in patients treated with antipsychotic drugs. We report data from a 4-year prospective study. Patients (89) underwent detailed metabolic and cardiovascular risk assessment at 4-years which included anthropometric assessment, blood pressure, lipid profile, and an oral glucose tolerance test. We used the homeostatic model assessment to determine insulin resistance, and calculated 10-year cardiovascular risk scores. Mean age of subjects was 44.7 (±11.5) years, and 52% were male. The prevalence of type 2 diabetes was 8%, and 38.4% fulfilled diagnostic criteria for the metabolic syndrome. With the exception of increased central adiposity over the 4-year follow-up period (p < 0.001), other cardiometabolic parameters were generally unchanged. There was a high prevalence of dyslipidaemia, but only 16.9% were prescribed lipid-lowering treatment. Commencing lipid-lowering therapy was associated with a reduction in cardiovascular risk score (OR 7.9, 95% CI = 1.3 to 48.7; p = 0.02). Patients established on longer-term antipsychotic treatment show less dramatic metabolic changes than those occurring in the early stages of treatment, but have a high burden of cardiovascular risk. Lipid-lowering therapy is associated with a significant reduction in cardiovascular risk.

scholarly journals Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045482
Author(s):  
Didier Collard ◽  
Nick S Nurmohamed ◽  
Yannick Kaiser ◽  
Laurens F Reeskamp ◽  
Tom Dormans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Icu Admission ◽  
Lowering Therapy ◽  
Secondary Outcomes ◽  
Age And Sex

ObjectivesRecent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.DesignWe analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.SettingPatients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.ParticipantsAdmitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.Primary and secondary outcomes measuresThe primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.ResultsWe included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).ConclusionsThe accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.

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