scholarly journals “The obesity paradox” in patients with atrial fibrillation according to the results of the REKUR-AF study

2021 ◽  
Vol 7 (4) ◽  
pp. 63-69
Author(s):  
Inna L. Polshakova ◽  
Sergey V. Povetkin ◽  
Alexey Y. Gaponov
Keyword(s):  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Survival Rate ◽  
Cox Regression ◽  
Excess Body Weight ◽  
Normal Body Mass Index ◽  
Obese Patients ◽  
Cox Regression Analysis ◽  
Lower Survival Rate

Introduction: to evaluate the effect of excess body weight (EBW) and obesity on the survival of patients with atrial fibrillation (AF) in the REKUR-AF study. Materials and methods: A subanalysis of patients with AF included in the REKUR-AF (382 people) study was performed. Survival rates were analyzed in three patient groups: patients with normal body mass index (BMI), EBW and obesity. Then the nature and significance of the influence of the studied factor on the prognosis in patients with AF were assessed. Results and discussion: Patients with AF and normal BMI were significantly older than those with obesity and EBW (p<0.001 and p=0.021, respectively). Among obese patients, hypertension was significantly (p=0.0015) more common (93.9%) compared to the group of patients with a normal BMI level (80.5%). The frequency of type 2 diabetes in obese patients prevailed over the same indicator in the groups of people with normal BMI and EBW (p=0.007 and p=0.020, respectively). The analysis of the survival rate of patients with AF depending on the BMI level showed that this factor had a significant impact (p=0.013) on the prognosis. The group of individuals with a normal BMI level had a significantly lower survival rate than the cohort of patients with EBW (p=0.011) and OB (p=0.025). The final model for Cox regression analysis (χ2=53.06, p<0.001) included the following factors: age, form of AF, BMI, presence/absence of type 2 diabetes, presence/absence of previous hospitalizations, presence/absence of hypertension, and presence/absence of oral anticoagulant (OAC) intake. Conclusion: The obtained results do not make it possible to unambiguously interpret obesity as a predictor of a positive outcome in this category of individuals.

scholarly journals Correlation between markers of renal function and sight-threatening diabetic retinopathy in type 2 diabetes: a longitudinal study in an Indian clinic population

2020 ◽  
Vol 8 (1) ◽  
pp. e001325 ◽  
Author(s):  
Ramachandran Rajalakshmi ◽  
Coimbatore Subramanian Shanthi Rani ◽  
Ulagamathesan Venkatesan ◽  
Ranjit Unnikrishnan ◽  
Ranjit Mohan Anjana ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Serum Creatinine ◽  
Cox Regression ◽  
Tertiary Care ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
New Onset

IntroductionPrevious epidemiological studies have reported on the prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) from India. The aim of this study is to evaluate the effect of DKD on the development of new-onset DR and sight-threatening diabetic retinopathy (STDR) in Asian Indians with type 2 diabetes (T2D).Research design and methodsThe study was done on anonymized electronic medical record data of people with T2D who had undergone screening for DR and renal work-up as part of routine follow-up at a tertiary care diabetes center in Chennai, South India. The baseline data retrieved included clinical and biochemical parameters including renal profiles (serum creatinine, estimated glomerular filtration rate (eGFR) and albuminuria). Grading of DR was performed using the modified Early Treatment Diabetic Retinopathy Study grading system. STDR was defined as the presence of proliferative diabetic retinopathy (PDR) and/or diabetic macular edema. DKD was defined by the presence of albuminuria (≥30 µg/mg) and/or reduction in eGFR (<60 mL/min/1.73 m2). Cox regression analysis was used to evaluate the hazard ratio (HR) for DR and STDR.ResultsData of 19 909 individuals with T2D (mean age 59.6±10.2 years, mean duration of diabetes 11.1±12.1 years, 66.1% male) were analyzed. At baseline, DR was present in 7818 individuals (39.3%), of whom 2249 (11.3%) had STDR. During the mean follow-up period of 3.9±1.9 years, 2140 (17.7%) developed new-onset DR and 980 individuals with non-proliferative DR (NPDR) at baseline progressed to STDR. Higher serum creatinine (HR 1.5, 95% CI 1.3 to 1.7; p<0.0001), eGFR <30 mL/min/1.73 m2 (HR 4.9, 95% CI 2.9 to 8.2; p<0.0001) and presence of macroalbuminuria >300 µg/mg (HR 3.0, 95% CI 2.4 to 3.8; p<0.0001) at baseline were associated with increased risk of progression to STDR.ConclusionsDKD at baseline is a risk factor for progression to STDR. Physicians should promptly refer their patients with DKD to ophthalmologists for timely detection and management of STDR.

scholarly journals Association between uric acid level and incidence of macroalbuminuria in people with type 2 diabetes mellitus: A 4.5-year cohort study

2019 ◽  
Author(s):  
Yun-Ju Lai ◽  
Yu-Yen Chen ◽  
Li-Jung Chen ◽  
Po-Wen Ku ◽  
Kuo-Chuan Hung ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Cox Regression Analysis ◽  
Increased Risk

Abstract Background: Using animal models and molecular biology researches, hyperuricemia has been shown to instruct renal arteriolopathy, arterial hypertension, and microvascular injury involving the renin-angiotensin system and resulting in renal function impairment. Nevertheless, the association between uric acid levels and the development of macroalbuminuria has been under-investigated in people with type 2 diabetes mellitus. Methods: Patients with type 2 diabetes and regular outpatient visits were recruited from a community hospital in Taiwan since January 2014. Demographics, lifestyle features, and medical history were gathered by well-trained interviewers. All participants underwent comprehensive physical examinations, including a biochemical assay of venous blood specimens and urine samples after an 8-hour overnight fast. Participants were followed until June 2018. The primary outcome was the macroalbuminuria incidence. Univariable and multivariable Cox regression analysis were employed to explore the relation between uric acid and incident macroalbuminuria. Uric acid cutoffs for incident macroalbuminuria were determined with the receiver operator characteristic curve. Results: We included 247 qualified subjects (mean age: 64.78 years old [standard deviation=11.29 years]; 138 [55.87%] men). During a 4.5-year follow-up duration, 20 subjects with incident macroalbuminuria were recognized. Serum uric acid was significantly associated with an increased risk of incident macroalbuminuria (adjusted hazard ratio=2.39; 95% confidence interval: 1.53-3.75; p<0.001) with potential confounders adjustment. The uric acid cutoff point was 6.9 mg/dL (area under the curve 0.708, sensitivity 60.0%, specificity 84.58%) for incident macroalbuminuria. Conclusions: Serum uric acid was associated with incident macroalbuminuria among people with type 2 diabetes.

scholarly journals Underweight is a major risk factor for atrial fibrillation in Asian people with type 2 diabetes mellitus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jung-Chi Hsu ◽  
Yen-Yun Yang ◽  
Shu-Lin Chuang ◽  
Yi-Wei Chung ◽  
Chih-Hsien Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cox Regression ◽  
Reference Group ◽  
University Hospital ◽  
Rank Test ◽  
Obesity Class

Abstract Background Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Obesity commonly accompanies T2DM, and increases the risk of AF. However, the dose-relationship between body mass index (BMI) and AF risk has seldom been studied in patients with diabetes. Methods This cohort study utilized a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, 64,339 adult patients with T2DM were enrolled for analysis. BMI was measured and categorized as underweight (BMI < 18.5), normal (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), obesity class 1 (27 ≤ BMI < 30), obesity class 2 (30 ≤ BMI < 35), or obesity class 3 (BMI ≥ 35). Multivariate Cox regression and spline regression models were employed to estimate the relationship between BMI and the risk of AF in patients with T2DM. Results The incidence of AF was 1.97 per 1000 person-years (median follow-up, 70.7 months). In multivariate Cox regression, using normal BMI as the reference group, underweight (HR 1.52, 95% CI 1.25–1.87, p < 0.001) was associated with a significantly higher risk of AF, while overweight was associated with significantly reduced risk of AF (HR 0.82, 95% CI 0.73–0.89, p < 0.001). Kaplan–Meier analysis showed AF risk was highest in the underweight group, followed by obesity class 3, while the overweight group had the lowest incidence of AF (log-rank test, p < 0.001). The cubic restrictive spline model revealed a “J-shaped” or “L-shaped” relationship between BMI and AF risk. Conclusions Underweight status confers the highest AF risk in Asian patients with T2DM.

scholarly journals Complex laboratory-instrumental and prognostic assessment in hypertensive patients with type 2 diabetes mellitus and atrial fibrillation

2012 ◽  
Vol 18 (1) ◽  
pp. 32-36
Author(s):  
T. S. Sveklina ◽  
A. V. Barsukov ◽  
M. S. Talantseva ◽  
S. B. Shustov
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Survival Rate ◽  
Arterial Hypertension ◽  
High Density Lipoproteins ◽  
Hypertensive Patients ◽  
Prognostic Assessment

Objective. To perform a complex laboratory and instrumental and prognostic assessment of hypertensive subjects with type 2 diabetes mellitus (DM) and atrial fibrillation (AF). Design and methods. Based on the retrospective analysis out of 3150 case records we selected 443 clinical cases of arterial hypertension combined with type 2 diabetes mellitus (DM 2) and with or without atrial fibrillation (AF). They were divided into groups: 1st group included hypertensive patients with DM 2 and AF; 2nd — hypertensives with DM 2, and third — hypertensives with AF. We analyzed haemodynamic, electro-and echocardiography, routine biochemical (blood sugar, glycated hemoglobin, uric acid, potassium, microalbuminuria, cholesterol, low and high density lipoproteins, triglyceride, prothrombin and international normalized ratio, C-reactive protein) parameters, as well as adipokine levels (tumor necrosis factor alpha, adiponectine, leptine, resistine). Kaplan-Meyer’s analysis was performed to assess survival rate. Results. Patients from the 1st group showed subclinical target organ damage, dysregulation of metabolism and hormonal and regulatory activity. Compared to other groups these patients demonstrated a lower survival rate. Conclusion. The association of arterial hypertension, DM 2 and AF can be considered as a mutual burdening phenomenon, increasing the cardiovascular risk.

scholarly journals Causal Associations in Type 2 Diabetes Development

2018 ◽  
Vol 104 (4) ◽  
pp. 1313-1324 ◽  
Author(s):  
Sarah C W Marott ◽  
Børge G Nordestgaard ◽  
Anne Tybjærg-Hansen ◽  
Marianne Benn
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Regression Analysis ◽  
Glucose Level ◽  
Cox Regression ◽  
Model Assessment ◽  
Genetic Contribution ◽  
General Population Study ◽  
Cox Regression Analysis

Abstract Context Obesity, glucose, insulin resistance [homeostatic model assessment, version 2, for insulin resistance (HOMA2-IR)], and insulin secretion (HOMA2-β) have been associated with type 2 diabetes (T2D) observationally. However, the causal, genetic contribution of each parameter to this risk is largely unknown and important to study because observational data are prone to confounding but genetic, causal data are free of confounding and reverse causation. Objective We examined the causal, genetic contribution of body mass index (BMI), glucose level, C-peptide level, HOMA2-IR, and HOMA2-β to the risk of T2D in 95,540 individuals from the Copenhagen General Population Study and estimated the absolute 10-year risks. Methods Cox regression analysis, instrumental variable analysis, and Poisson regression analysis were performed to estimate the observational hazard ratios, causal, genetic ORs, and absolute 10-year risks of T2D. Results For 1-SD greater level, BMI was associated with an observational 66% (95% CI, 62% to 72%) and causal, genetic 121% (95% CI, 25% to 291%) greater risk of T2D; glucose with an observational 44% (95% CI, 41% to 46%) and causal, genetic 183% (95% CI, 56% to 416%) greater risk of T2D; and HOMA2-IR with an observational 30% (95% CI, 18% to 44%) and causal, genetic 12% (95% CI, 2% to 22%) greater risk of T2D. In contrast, for 1-SD greater level, HOMA2-β was associated with an observational 14% (95% CI, 11% to 16%) and causal, genetic 21% (95% CI, 8% to 32%) lower risk of T2D. The upper tertiles of HOMA2-IR were associated with absolute 10-year diabetes risks of 31% and 37% in obese women and men, age &gt;60 years, and a glucose level of 6.1 to 11.0 mmol/L. Conclusions BMI, glucose level, HOMA2-IR, and HOMA2-β are causally associated with T2D.

4-Year Trajectory of Visceral Adiposity Index in the Development of Type 2 Diabetes: A Prospective Cohort Study

2016 ◽  
Vol 69 (2) ◽  
pp. 142-149 ◽  
Author(s):  
Meilin Zhang ◽  
Li Zheng ◽  
Ping Li ◽  
Yufeng Zhu ◽  
Hong Chang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Predictive Ability ◽  
Visceral Adiposity ◽  
Visceral Adiposity Index ◽  
Prediction Ability ◽  
Cox Regression Analysis ◽  
Adiposity Index

Background/Aims: Our aim was to evaluate whether visceral adiposity index (VAI) could predict the risk of type 2 diabetes (T2D) in different genders and to compare the predictive ability between VAI and other fatness indices. Methods: Four thousand seventy-eight participants including 1,817 men and 2,261 women, aged 18 and older and free of T2D at baseline were enrolled in 2010 and followed up for 4 years. New cases of T2D were identified via the annual medical examination. Cox regression analysis was used to assess the association between VAI and incidence of T2D. Receiver operating characteristic curve and area under the curves (AUC) were applied to compare the prediction ability of T2D between VAI and other fatness indices. Results: During the 4-year follow-up, 153 (8.42%) of 1,817 men and 88 (3.89%) of 2,261 women developed T2D. The multivariable-adjusted hazards ratios for developing T2D in the highest tertile of VAI scores were 2.854 (95% CI 1.815-4.487) in men and 3.551 (95% CI 1.586-7.955) in women. The AUC of VAI was not higher than that of other fatness indices. Conclusions: VAI could predict the risk of T2D among Chinese adults, especially in women. However, the prediction ability of T2D risk for VAI was not higher than that of the other fatness indices.

Non-obese patients with type 2 diabetes and prediabetic subjects: distinct phenotypes requiring special diabetes treatment and (or) prevention?

2007 ◽  
Vol 32 (5) ◽  
pp. 912-920 ◽  
Author(s):  
Allan Vaag ◽  
Søren S. Lund
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Insulin Secretion ◽  
Autoimmune Diabetes ◽  
Normal Body Mass Index ◽  
Obese Patients ◽  
Increased Risk ◽  
Obese Subjects

A major reason for the increased incidence of type 2 diabetes mellitus (T2DM) across the world is the so-called obesity epidemic, which occurs both in developed and developing countries. However, a large proportion of patients with T2DM in European and, in particular, Asian countries are non-obese. The non-obese T2DM phenotype is characterized by disproportionally reduced insulin secretion and less insulin resistance, as compared with obese patients with T2DM. Importantly, non-obese patients with T2DM have a similar increased risk of cardiovascular disease as obese T2DM patients. The risk of T2DM in non-obese patients is influenced by genetics as well as factors operating in utero indicated by low birth weight. Furthermore, this phenotype is slightly more prevalent among patients with latent autoimmune diabetes in adults, characterized by positive anti-GAD antibodies. The recently identified TCF7L2 gene polymorphism resulting in low insulin secretion influences the risk of T2DM in both obese and non-obese subjects, but is relatively more prevalent among non-obese patients with T2DM. Furthermore, the Pro12Ala polymorphism of the PPARγ gene influencing insulin action increases the risk of T2DM in non-obese subjects. Despite a “normal” body mass index, non-obese patients with T2DM are generally characterized by a higher degree of both abdominal and total fat masses (adiposity). Prevention of T2DM with lifestyle intervention is at least as effective in non-obese as in obese prediabetic subjects, and recent data suggest that metformin treatment targeting insulin resistance and non-glycemic cardiovascular disease risk factors is as beneficial in non-obese as in obese patients with T2DM. Nevertheless, non-obese patients with T2DM may progress to insulin treatment more rapidly as compared with obese patients with T2DM.

scholarly journals Skin autofluorescence predicts cancer in subjects with type 2 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e001312
Author(s):  
Ninon Foussard ◽  
Alice Larroumet ◽  
Marine Rigo ◽  
Kamel Mohammedi ◽  
Laurence Baillet-Blanco ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cox Regression ◽  
Skin Autofluorescence ◽  
Cox Regression Analysis ◽  
Screening Programs ◽  
Biological Studies ◽  
History Of ◽  
Risk Of Cancer

IntroductionSubjects with type 2 diabetes have an excess risk of cancer. The potential role of advanced glycation end products (AGEs) accumulated during long-term hyperglycemia in cancer development has been suggested by biological studies but clinical data are missing. AGEs can be estimated by measuring the skin autofluorescence. We searched whether the skin autofluorescence could predict new cancers in persons with type 2 diabetes.Research design and methodsFrom 2009 to 2015, we measured the skin autofluorescence of 413 subjects hospitalized for uncontrolled or complicated type 2 diabetes, without any history of cancer. The participants were followed for at least 1 year and the occurrences of new cancers were compared according to their initial skin autofluorescences.ResultsThe participants were mainly men (57.9%), with poorly controlled (HbA1c 72±14 mmol/mol or 8.7%±1.8%) and/or complicated type 2 diabetes. Their median skin autofluorescence was 2.6 (2.2–3.0) arbitrary units. Forty-five new cancer cases (10.9%) were registered during 4.8±2.3 years of follow-up: 75.6% of these subjects had skin autofluorescence higher than the median (χ2: p=0.001). By Cox regression analysis adjusted for age, gender, body mass index, history of smoking and renal parameters, skin autofluorescence >2.6 predicted a 2.57-fold higher risk of cancer (95% CI 1.28 to 5.19, p=0.008). This association remained significant after excluding the eight cancers that occurred in the 4 years after inclusion (OR 2.95, 95% CI 1.36 to 6.38, p=0.006). As a continuous variable, skin autofluorescence was also related to new cancers (OR 1.05, 95% CI 1.01 to 1.10, p=0.045).ConclusionsSkin autofluorescence, a potential marker of glycemic memory, predicts the occurrence of cancer in subjects with type 2 diabetes. This relation provides a new clinical argument for the role of AGEs in cancer. Their estimation by measuring the skin autofluorescence may help select subjects with diabetes in cancer screening programs.

scholarly journals Glycemic Control and Risk of Sepsis and Subsequent Mortality in Type 2 Diabetes

2021 ◽  
Author(s):  
Anca Balintescu ◽  
Marcus Lind ◽  
Mikael Andersson Franko ◽  
Anders Oldner ◽  
Maria Cronhjort ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Regression Analysis ◽  
Cox Regression ◽  
Cubic Spline ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk

<b>Objective</b> <p>To investigate the nature of<b> </b>the relationship between HbA1c and sepsis among individuals with type 2 diabetes and to assess the association of sepsis and all-cause mortality in such patients.<b></b></p> <p><b>Research design and methods</b></p> <p>We included 502,871 individuals with type 2 diabetes recorded in the Swedish National Diabetes Register and used multivariable Cox regression and restricted cubic spline analyses to assess the association between time-updated HbA1c values and sepsis occurrence between January 1, 2005 and December 31, 2015. The association between sepsis and death was examined using multivariable Cox regression analysis.</p> <p><b>Result</b></p> <p>Overall, 14,534 (2.9%) patients developed sepsis during the study period. On multivariable Cox regression analysis, compared with an HbA1c of 48-52 mmol/mol (6.5-6.9%), the adjusted hazard ratio for sepsis was 1.15 (95% CI 1.07-1.24) for HbA1c <43 mmol/mol (6.1%); 0.93 (0.87-0.99) for HbA1c 53-62 mmol/mol (7.0-7.8%); 1.05 (0.97-1.13) for HbA1c 63-72 mmol/mol (7.9-8.7%); 1.14 (1.04-1.25) for HbA1c 73-82 mmol/mol (8.8-9.7%); and 1.52 (1.37-1.68) for HbA1c >82 mmol/mol (9.7%). In the cubic spline model, a reduction of the adjusted risk was observed within the lower HbA1c range until 53 mmol/mol (7.0%), with a hazard ratio of 0.78 (0.73-0.82) per standard deviation, and increased thereafter (P for non-linearity <0.001). As compared to patients without sepsis, the adjusted hazard ratio for death among patients with sepsis was 4.16 (4.03-4.30).</p> <p><b>Conclusions</b></p> <p>In a nationwide cohort of individuals with type 2 diabetes, we found a U-shaped association between HbA1c and sepsis and a four-fold increased risk of death among those developing sepsis. </p>

scholarly journals Underweight Is A Major Risk Factor of Atrial Fibrillation In Asian People With Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Jung-Chi Hsu ◽  
Yen-Yun Yang ◽  
Shu-Lin Chuang ◽  
Yi-Wei Chung ◽  
Lian-Yu Lin
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Regression Model ◽  
Cox Regression ◽  
Rank Test ◽  
Obesity Class ◽  
Increased Risk

Abstract Background: Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Obesity commonly accompanies with T2DM and increases AF incidence. However, the dose-relationship of body mass index (BMI) and the risk of AF has seldom been studied in diabetes patients.Methods: This cohort study was conducted utilizing a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, a total of 64339 adult patients with T2DM were enrolled for analysis. The BMI was measured and categorized into several groups including underweight (BMI <18.5), normal range (18.5≤BMI <24), overweight (24≤BMI <27), obesity class 1 (27≤BMI <30), obesity class 2 (30≤BMI <35), and obesity class 3 (BMI≥35). Multivariate Cox regression models and spline regression model were employed to estimate the relationship between BMI and the risk of AF in patients with T2DM.Results: The incidence rate of AF was 1.97 per 1000 person-year during a median follow-up period of 70.7 months. In multivariate Cox regression model, by using normal BMI as reference group, individuals with underweight (HR 1.47, 95%CI 1.19-1.81, p<0.001) was significantly associated with increased risk of AF while overweight was significantly associated with reduced risk of AF (HR 0.83, 95%CI 0.76-0.91, p<0.001). The Kaplan-Meier analysis showed that the risk of AF was highest in the underweight group, followed by obesity class 3, while the overweight group had the least incidence of AF (log-rank test, p<0.001). Cubic restrictive spline model showed a “J-shaped” or “L-shape” relationship between BMI and the risk AF.Conclusions: We found that underweight carries the highest risk of AF in Asian patients with T2DM.

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