Body Weight Fluctuation as a Risk Factor for Type 2 Diabetes: Results from a Nationwide Cohort Study

We aimed to investigate how body weight fluctuation affects the risk of developing type 2 diabetes by conducting a nationwide cohort study. A total of 3,855,884 participants from the National Health Insurance System health check-up data from 2012 were included in this study, and follow-up continued until 2016. Body weight was measured at least thrice between 2009 and 2012. Body weight variability (BWV) was estimated using average successive variability (ASV) indices. Cox proportional hazards regression models were used to evaluate the association of BWV with the risk of type 2 diabetes using hazard ratios (HRs) and 95% confidence intervals (CIs). Body weight fluctuation was associated with a higher risk of incident diabetes after adjustment for confounders (HR 1.10, 95% CI 1.07, 1.12 in the highest BWV quartile compared to the lowest). Regardless of the weight change status, the highest ASV quartile of BWV increased the risk for diabetes. Even subjects with a normal glucose tolerance status and those aged under 65 years had a higher risk of diabetes if their body weight highly fluctuated during the follow-up years. Our results suggest that body weight variability is an independent risk factor for diabetes. It is important to pay attention to frequent body weight fluctuations.

Download Full-text

Diabetes is associated with decreased migraine risk: A nationwide cohort study

Cephalalgia ◽

10.1177/0333102417748573 ◽

2017 ◽

Vol 38 (11) ◽

pp. 1759-1764 ◽

Cited By ~ 5

Author(s):

Ippazio Cosimo Antonazzo ◽

Trond Riise ◽

Marianna Cortese ◽

Line Iden Berge ◽

Anders Engeland ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Cohort Study ◽

Educational Level ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Prescription Database

Background Results from studies on diabetes and migraine risk are conflicting, which may be due to methodological limitations. Prospective studies with long follow-up could increase our understanding of the relationship between the two diseases. Method We performed a cohort study including the whole Norwegian population alive on 01.01.2004, using prescriptions registered in the Norwegian prescription database to identify individuals developing type 1 diabetes, type 2 diabetes and migraine during follow-up (10 years). We used Cox proportional hazards regression to estimate rate ratios with corresponding 95% confidence intervals for the effect of diabetes on migraine risk, adjusting for age, sex, and educational level. Result We identified 7,883 type 1 diabetes patients and 93,600 type 2 patients during the study period. Type 1 diabetes was significantly associated with a subsequent decreased migraine risk during follow-up in the age- and sex-adjusted analyses (0.74; 0.61–0.89). Type 2 diabetes was also associated with a significantly lower migraine risk (0.89; 0.83–0.95). Further adjustment for educational level yielded similar results for both diabetes. Conclusion Both type 1 and type 2 diabetes were significantly associated with a decreased risk of migraine. This suggests that diabetes or diabetes treatment may have a protective effect on the development of migraine.

Download Full-text

Changes in Plant Based Diets and Subsequent Risk of Type 2 Diabetes: Results from 3 Large US Cohorts

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_015 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1387-1387

Author(s):

Zhangling Cheng ◽

Jean-Philippe Drouin-Chartier ◽

Yanping Li ◽

Megu Baden ◽

JoAnn Manson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Body Weight ◽

Proportional Hazards ◽

Meta Analysis ◽

Cox Proportional Hazards ◽

Health Study ◽

Weight Changes ◽

Cox Proportional Hazards Models

Abstract Objectives Plant-based diets may lower type 2 diabetes (T2D) risk. Whether changes in adherence to plant-based diets are associated with subsequent T2D risk remains unknown. We aimed to evaluate the associations between 4 year changes in plant based diets and subsequent 4 year risk of T2D. Methods We prospectively followed 76,530 women in the Nurses’ Health Study (NHS, 1986–2012), 81,586 women in NHS II (1991–2017), and 34,468 men in the Health Professionals’ Follow-up Study (1986–2016). Diet was assessed every 4 years using validated food-frequency questionnaires. Adherence to plant-based diets was assessed using previously developed indices – the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Self reported T2D cases were validated by supplementary questionnaires. We used multivariable time dependent Cox proportional hazards models to estimate hazard ratios (HR) and 95% CIs for T2D associated with 4 year changes in adherence to plant based diets. Results of the three cohorts were pooled using an inverse variance-weighted meta-analysis. Results We documented 12,016 cases of T2D during 2818,485 person-years of follow-up. After adjustment for initial BMI, initial and 4-year changes in lifestyle and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest 4-year decrease (>10%) in PDI and hPDI had a 12%-23% higher T2D risk in the subsequent 4 years (HR for PDI, 1.12 (95% CI 1.05, 1.20), HR for hPDI, 1.23 (1.16, 1.31)). Conversely, each 10% incremental increase in PDI and hPDI over 4 years was associated with a 7%–9% lower T2D risk in subsequent 4 years (HR for PDI, 0.93 (0.90, 0.95), HR for hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not associated with T2D risk. Further adjustment for concurrent changes in body weight, a potential mediator, modestly attenuated the associations but results remained significant. We estimated that body weight changes explained 6.0%–36% of the associations between 4 year changes in PDI and hPDI and subsequent T2D risk. Conclusions Improving adherence to overall and healthful plant based diets over a 4 year period was associated with a lower T2D risk, whereas decreased adherence to overall and healthful plant based diets was associated with a higher T2D risk. Funding Sources Nutricia Research Foundation/NIH.

Download Full-text

Body Weight Variability and the Risk of Cardiovascular Outcomes and Mortality in Patients with Type 2 Diabetes: a Nationwide Cohort Study

10.2337/figshare.12465983 ◽

2020 ◽

Author(s):

Ga Eun Nam ◽

Wonsock Kim ◽

Kyungdo Han ◽

Chung-woo Lee ◽

Yeongkeun Kwon ◽

...

Keyword(s):

Type 2 Diabetes ◽

Body Weight ◽

Large Scale ◽

Cox Proportional Hazards ◽

Cardiovascular Outcomes ◽

National Health Insurance System ◽

All Cause Mortality ◽

Quartile Group ◽

Diabetes Patients

Objective: Obesity and type 2 diabetes are risk factors for cardiovascular diseases and mortality, and that commonly result in weight variabilities. We aimed to investigate the association between body weight variability and risk of major cardiovascular outcomes and mortality in individuals with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. <div>Research Design and Methods: We enrolled 624,237 individuals with type 2 diabetes who underwent health examinations provided by the Korean National Health Insurance System between 2009 and 2010, with ≥3 body weight measurements within 5 years since enrollment and followed up until the end of 2017. We assessed body weight variability using four indices, including variability independent of the mean (VIM). Multivariable-adjusted Cox proportional hazards regression analysis was performed. Results: During the follow-up, 15,832, 25,038, and 44,716 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively, were recorded. Body weight variability was associated with increased risks of major cardiovascular outcomes after adjusting for confounding variables. Compared with the hazard ratios (HRs) of the lowest quartile group, the HRs (95% CIs) of the highest quartile group of VIM for body weight were 1.15 (1.10–1.20), 1.22 (1.18–1.26), and 1.58 (1.53–1.62) for MI, stroke, and all-cause mortality, respectively. Conclusions: Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in type 2 diabetes patients and may be a predictor of cardiovascular outcomes in such patients. Appropriate interventions to maintain stable weight could positively influence health outcomes in type 2 diabetes patients. </div>

Download Full-text

Temporal Trends in Incident Hospitalization for Diabetes-Related Foot Ulcer in Type 2 Diabetes: The Fremantle Diabetes Study

10.2337/figshare.13377134 ◽

2021 ◽

Author(s):

Emma J Hamilton ◽

Wendy A Davis ◽

Ranita Siru ◽

Mendel Baba ◽

Paul E Norman ◽

...

Keyword(s):

Type 2 Diabetes ◽

Proportional Hazards ◽

Temporal Trends ◽

Age Groups ◽

Foot Ulcer ◽

Cox Proportional Hazards ◽

Diabetes Diagnosis ◽

Incident Rate

Objective: To determine whether, reflecting trends in other chronic complications, incident hospitalization for diabetes-related foot ulcer (DFU) has declined over recent decades in type 2 diabetes. Research design and methods: Participants with type 2 diabetes from the community-based Fremantle Diabetes Study Phases I (FDS1; 1,296 participants, mean age 64.0 years, 48.6% males, recruited 1993-1996) and II (FDS2; 1,509 participants, mean age 65.4 years, 51.8% males, recruited 2008-2011) were followed from entry to first hospitalization for/with DFU, death or 5 years (whichever came first). Incident rate ratios (IRRs) and incident rate differences (IRDs) were calculated for FDS2 versus FDS1 overall and in 10-year age-groups. Cox proportional hazards modelling determined independent predictors of first DFU hospitalization in the combined cohort. Results: Incident DFU hospitalization (95% CI) was 1.9 (0.9-3.3) /1,000 person-years in FDS1 during 5,879 person-years of follow-up, and 4.5 (3.0-6.4) /1,000 person-years in FDS2 during 6,915 person-years of follow-up. The crude IRR (95% CI) was 2.40 (1.17-5.28), P=0.013) and IRD 2.6 (0.7-4.5) /1,000 person-years (P=0.010). The highest incidence rate (IR) for any age-group was 23.6/1,000 person-years in FDS2 participants aged 31-40 years. Age at diabetes diagnosis (inverse), HbA1c, insulin use, height, ln(urinary albumin:creatinine), absence of any foot pulse, previous peripheral revascularization and peripheral sensory neuropathy (PSN) were independent predictors of incident hospitalization for/with DFU. Conclusions: Incident DFU hospitalizations complicating type 2 diabetes increased between FDS Phases, especially in younger participants, and were more likely in those with PSN, peripheral arterial disease and suboptimal glycemic control at baseline.

Download Full-text

Association of triglyceride to HDL cholesterol ratio with cardiometabolic outcomes

Journal of Investigative Medicine ◽

10.1136/jim-2018-000869 ◽

2018 ◽

Vol 67 (3) ◽

pp. 663-668

Author(s):

May Yang ◽

Joseph Rigdon ◽

Sandra A Tsai

Keyword(s):

Type 2 Diabetes ◽

Proportional Hazards ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Cox Proportional Hazards ◽

Cholesterol Ratio ◽

Cox Proportional Hazards Models ◽

Potential Opportunity

Electronic medical records (EMRs) offer a potential opportunity to identify patients at high risk for cardiometabolic disease, which encompasses type 2 diabetes and cardiovascular disease (CVD). The objective of this retrospective cohort study is to use information gathered from EMR to investigate the association between triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) and cardiometabolic outcomes in a general population of subjects over 50 years of age during a follow-up period of 8–9 years. TG/HDL-C was recorded for each of 1428 subjects in 2008, and diagnoses of type 2 diabetes and CVD were recorded through chart review until 2017. Cox proportional hazards models controlling for demographic characteristics and other risk factors demonstrated that high TG/HDL-C (>2.5 in women or >3.5 in men) was significantly associated with increased incidence of type 2 diabetes (HR 1.66; 95% CI 1.07 to 2.57; p=0.0230). There was also a suggested association between high TG/HDL-C and incidence of CVD (HR 1.51; 95% CI 0.98 to 2.35; p=0.0628). These findings suggest that using TG/HDL-C, which can be easily calculated from data in an EMR, should be another tool used in identifying patients at high cardiometabolic risk.

Download Full-text

Decreased risk of colorectal cancer among patients with type 2 diabetes receiving Chinese herbal medicine: a population-based cohort study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000732 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000732

Author(s):

Jing-Siang Jhang ◽

Hanoch Livneh ◽

Shu-Yi Yang ◽

Hui-Ju Huang ◽

Michael W Y Chan ◽

...

Keyword(s):

Colorectal Cancer ◽

Type 2 Diabetes ◽

Cohort Study ◽

Proportional Hazards ◽

Herbal Medicines ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Research Database ◽

Chinese Herbal

ObjectivesPatients with type 2 diabetes have a higher risk of colorectal cancer (CRC), but whether Chinese herbal medicines (CHMs) can reduce this risk is unknown. This study investigated the effect that CHMs have on CRC risk in patients with type 2 diabetes.Research design and methodsThis cohort study used the Taiwanese National Health Insurance Research Database to identify 54 744 patients, newly diagnosed with type 2 diabetes, aged 20–70 years, who were receiving treatment between 1998 and 2007. From this sample, we randomly selected 14 940 CHMs users and 14 940 non-CHMs users, using propensity scores matching. All were followed through 2012 to record CRC incidence. Cox proportional hazards regression was used to compute the hazard ratio (HR) of CRC by CHMs use.ResultsDuring follow-up, 235 CHMs users and 375 non-CHMs users developed CRC, incidence rates of 1.73% and 2.47% per 1000 person-years, respectively. CHM users had a significantly reduced risk of CRC compared with non-CHM users (adjusted HR=0.71; 95% CI 0.60 to 0.84). The greatest effect was in those receiving CHMs for more than 1 year. Huang-Qin, Xue-Fu-Zhu-Yu-Tang, Shu-Jing-Huo-Xue-Tang, Liu-Wei-Di-Huang-Wan, Ji-Sheng-Shen-Qi-Wan, Gan-Lu-Yin, Shao-Yao-Gan-Cao-Tang and Ban-Xia-Xie-Xin-Tang were significantly associated with lower risk of CRC.ConclusionIntegrating CHMs into the clinical management of patients with type 2 diabetes may be beneficial in reducing the risk of CRC.

Download Full-text

Substitutions between dairy product subgroups and risk of type 2 diabetes: the Danish Diet, Cancer and Health cohort

British Journal Of Nutrition ◽

10.1017/s0007114517002896 ◽

2017 ◽

Vol 118 (11) ◽

pp. 989-997 ◽

Cited By ~ 10

Author(s):

Daniel B. Ibsen ◽

Anne Sofie D. Laursen ◽

Lotte Lauritzen ◽

Anne Tjønneland ◽

Kim Overvad ◽

...

Keyword(s):

Type 2 Diabetes ◽

Dairy Products ◽

Proportional Hazards ◽

Dairy Product ◽

Cox Proportional Hazards ◽

Low Fat ◽

Baseline Information ◽

Diabetes Register

AbstractThe aim of this study was to investigate the associations for specified substitutions between different subgroups of dairy products and the risk of type 2 diabetes. We used data from the Danish Diet, Cancer and Health cohort including 54 277 men and women aged 50–64 years at baseline. Information regarding intake of dairy products was obtained from a validated FFQ, and cases of type 2 diabetes were identified through the Danish National Diabetes Register. Cox proportional hazards regressions were used to estimate associations. During a median follow-up of 15·3 years, 7137 cases were identified. Low-fat yogurt products in place of whole-fat yogurt products were associated with a higher rate of type 2 diabetes (hazard ratio (HR) 1·17; 95 % CI 1·06, 1·29) per serving/d substituted. Whole-fat yogurt products in place of low-fat milk, whole-fat milk or buttermilk were associated with a lower rate of type 2 diabetes (HR 0·89; 95 % CI 0·83, 0·96; HR 0·89; 95 % CI 0·82, 0·96; HR 0·89; 95 % CI 0·81, 0·97; per serving/d substituted, respectively). The pattern of associations was similar when intake was expressed as kJ/d (kcal/d). These findings suggest that intake of whole-fat yogurt products in place of low-fat yogurt products, low-fat milk, whole-fat milk and buttermilk are associated with a lower rate of type 2 diabetes.

Download Full-text

Association between living alone and incident type 2 diabetes among middle-aged individuals in Korea: a nationwide cohort study

Scientific Reports ◽

10.1038/s41598-021-82868-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ga Eun Nam ◽

Wonsock Kim ◽

Kyungdo Han ◽

Jin-Hyung Jung ◽

Byoungduck Han ◽

...

Keyword(s):

Type 2 Diabetes ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Living Alone ◽

Older Individuals ◽

Middle Aged ◽

National Health Insurance System ◽

Incident Type ◽

Incident Type 2 Diabetes

AbstractWe studied the association between living alone and the risk of incident type 2 diabetes in middle-aged individuals using nationwide cohort data from the Korean population. 11,686, 677 middle-aged individuals aged 40–64 years who underwent health examinations by the Korean National Health Insurance System between 2009 and 2012 were followed up until December 31, 2015. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards regression analysis. During the median follow-up duration of 5.6 years, 393,438 individuals developed type 2 diabetes. Living alone was significantly associated with incident type 2 diabetes in all adjusted models (HR 1.08; 95% CI 1.07–1.09 in model 4). Individuals who lived alone for < 1 year and 1–7 years were associated with increased HRs of 1.07 (1.04–1.09) and 1.08 (1.07–1.09). Living alone was associated with incident type 2 diabetes in all subgroups. The association was stronger in men than in women and younger individuals than in older individuals. Living alone, even for a short duration, may be an important factor in type 2 diabetes development. Better household conditions and appropriate support to one-person households may be needed to prevent type 2 diabetes.

Download Full-text

Restricted AccessChanges in Plant-Based Diet Indices and Subsequent Risk of Type 2 Diabetes in Women and Men: Three U.S. Prospective Cohorts

10.2337/figshare.13312577.v1 ◽

2021 ◽

Author(s):

Zhangling Chen ◽

Jean-Philippe Drouin-Chartier ◽

Yanping Li ◽

Megu Y. Baden ◽

JoAnn E. Manson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Diabetes Risk ◽

Health Study ◽

Weight Changes ◽

Subsequent Risk

Objective We evaluated the associations between changes in plant-based diets and subsequent risk of type 2 diabetes. Methods We prospectively followed 76,530 women in the Nurses’ Health Study (NHS, 1986-2012), 81,569 women in NHS II (1991-2017), and 34,468 men in the Health Professionals’ Follow-up Study (1986-2016). Adherence to plant-based diets was assessed every 4 years using the overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs). Results of the three cohorts were pooled using meta-analysis. Results We documented 12,627 cases of type 2 diabetes during 2,955,350 person-years of follow-up. <a>After adjustment for initial BMI, initial and 4-year changes in alcohol intake, smoking, physical activity, and other factors, </a><a>compared with participants whose indices remained relatively stable (±3%), </a><a>participants with the largest decrease (>10%) in PDI and hPDI over 4 years had a 12%-23% higher diabetes risk in the subsequent 4 years (pooled HR: PDI, 1.12 (95% CI 1.05, 1.20), hPDI, 1.23 (1.16, 1.31)). </a>Each 10% increment in PDI and hPDI over 4 years was associated with a 7%-9% lower risk (PDI, 0.93 (0.91, 0.95), hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not associated with diabetes risk. Weight changes accounted for 6.0%-35.6% of the associations between changes in PDI and hPDI and diabetes risk. Conclusions Improving adherence to overall and healthful plant-based diets was associated with a lower risk of type 2 diabetes, whereas decreased adherence to such diets was associated with a higher risk.

Download Full-text

Abstract P025: Perceived Stress and Incidence of Type 2 Diabetes: a 35-Year Follow-up Study of Middle Aged Swedish Men

Circulation ◽

10.1161/circ.125.suppl_10.ap025 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Masuma Novak

Keyword(s):

Type 2 Diabetes ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Prior History ◽

Diabetes Incidence ◽

Middle Aged ◽

Cox Regression Analysis

OBJECTIVE_ To explore the incidence cases of diabetes over 35 years of follow-up in middle-aged Swedish men in relation to their severity of stress at baseline. RESEARCH DESIGHN AND METHODS_ This was a population-based random sample of 7 495 men derived from the Primary Prevention cohort study (Gothenburg) aged 47-55 years and without prior history of diabetes at baseline (1970-1973). Self-perceived psychological stress during the previous years was assessed with a single-item in the questionnaire. Incident diabetes from hospital discharge and death registries was collected during the 35 years follow-up. Cox proportional hazards regression was used to evaluate association of stress with incidence of diabetes. RESULTS_ During the follow up of 35 years, 884 men developed diabetes. The crude incidence rate was 46.32 per 1000 persons-years. At baseline, 15.5% men reported to experience permanent stress. The age-adjusted cumulative incidence of type diabetes in men who had permanent stress was 16%, compared with 12% for those with no or periodic stress. In age-adjusted Cox regression analysis, men with permanent stress had a higher risk of diabetes incident (hazard ratio 1.52 [95% CI 1.26-1.82]) compared with men with periodic or no stress (referent). The excess risk of diabetes incident associated with permanent stress remained significant after adjusting for age, socioeconomic status (SES), smoking, physical inactivity, alcohol abuse, height, BMI, serum-cholesterol, hypertension, systolic and diastolic blood pressure. CONCLUSIONS_ Perceived permanent stress in middle aged Swedish men was an important long-term predictor of diabetes incidence. The association of stress was independent of SES, lifestyle and other conventional type 2 diabetes risk factors. The significant impact of stress on diabetes, as demonstrated in this study, emphasizes need for prevention strategies including intervention programmes for people with permanent stress.

Download Full-text