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2022 ◽  
Author(s):  
Natalie D Jenkins ◽  
Emiel O Hoogendijk ◽  
Joshua J Armstrong ◽  
Nathan A Lewis ◽  
Janice M Ranson ◽  
...  

Abstract Background and Objectives There is an urgent need to better understand frailty and it’s predisposing factors. Although numerous cross-sectional studies have identified various risk and protective factors of frailty, there is a limited understanding of longitudinal frailty progression. Furthermore, discrepancies in the methodologies of these studies hamper comparability of results. Here, we use a coordinated analytical approach in five independent cohorts to evaluate longitudinal trajectories of frailty and the effect of three previously identified critical risk factors: sex, age, and education. Research Design and Methods We derived a frailty index (FI) for five cohorts based on the accumulation of deficits approach. Four linear and quadratic growth curve models were fit in each cohort independently. Models were adjusted for sex/gender, age, years of education, and a sex/gender-by-age interaction term. Results Models describing linear progression of frailty best fit the data. Annual increases in FI ranged from 0.002 in the InCHIANTI cohort to 0.009 in the LASA. Women had consistently higher levels of frailty than men in all cohorts, ranging from an increase in the mean FI in women from 0.014 in the HRS cohort to 0.046 in the LASA cohort. However, the associations between sex/gender and rate of frailty progression were mixed. There was significant heterogeneity in within-person trajectories of frailty about the mean curves. Discussion and Implications Our findings of linear longitudinal increases in frailty highlight important avenues for future research. Specifically, we encourage further research to identify potential effect modifiers or groups that would benefit from targeted or personalized interventions.


2022 ◽  
Vol 12 ◽  
Author(s):  
Daniel Kevin Llanera ◽  
Rebekah Wilmington ◽  
Haika Shoo ◽  
Paulo Lisboa ◽  
Ian Jarman ◽  
...  

ObjectiveTo identify clinical and biochemical characteristics associated with 7- & 30-day mortality and intensive care admission amongst diabetes patients admitted with COVID-19.Research Design and MethodsWe conducted a cohort study collecting data from medical notes of hospitalised people with diabetes and COVID-19 in 7 hospitals within the Mersey-Cheshire region from 1 January to 30 June 2020. We also explored the impact on inpatient diabetes team resources. Univariate and multivariate logistic regression analyses were performed and optimised by splitting the dataset into a training, test, and validation sets, developing a robust predictive model for the primary outcome.ResultsWe analyzed data from 1004 diabetes patients (mean age 74.1 (± 12.6) years, predominantly men 60.7%). 45% belonged to the most deprived population quintile in the UK. Median BMI was 27.6 (IQR 23.9-32.4) kg/m2. The primary outcome (7-day mortality) occurred in 24%, increasing to 33% by day 30. Approximately one in ten patients required insulin infusion (9.8%). In univariate analyses, patients with type 2 diabetes had a higher risk of 7-day mortality [p < 0.05, OR 2.52 (1.06, 5.98)]. Patients requiring insulin infusion had a lower risk of death [p = 0.02, OR 0.5 (0.28, 0.9)]. CKD in younger patients (<70 years) had a greater risk of death [OR 2.74 (1.31-5.76)]. BMI, microvascular and macrovascular complications, HbA1c, and random non-fasting blood glucose on admission were not associated with mortality. On multivariate analysis, CRP and age remained associated with the primary outcome [OR 3.44 (2.17, 5.44)] allowing for a validated predictive model for death by day 7.ConclusionsHigher CRP and advanced age were associated with and predictive of death by day 7. However, BMI, presence of diabetes complications, and glycaemic control were not. A high proportion of these patients required insulin infusion warranting increased input from the inpatient diabetes teams.


2022 ◽  
Author(s):  
Anagha Champakanath ◽  
Halis Kaan Akturk ◽  
G. Todd Alonso ◽  
Janet K Snell-Bergeon ◽  
Viral N Shah

Objective: To evaluate long-term glycemic outcomes of CGM initiation within the first year of type 1 diabetes. <p>Research Design and Methods: 396 patients with type 1 diabetes were divided into three groups; 1) CGM [CGM use within one year of diabetes and continued through the study], 2) no-CGM [no CGM use throughout the study], 3) new-CGM [CGM use after 3 years of diabetes] and were followed up to 7-years. </p> <p>Results: A1c was significantly lower in CGM compared to no-CGM group throughout 7 years of follow-up [LS mean A1cs (%): 6-month 7.3 vs 8.1, 1-year 7.4 vs 8.6, 2-year 7.7 vs 9.1, 3-year 7.6 vs 9.3, 4-year 7.4 vs 9.6, 5-year 7.6 vs 9.7, 6-year 7.5 vs 10.0 and 7-year 7.6 vs 9.8, all p<0.001] adjusting for age at diagnosis, sex, and insulin delivery method. </p> <p>Conclusion: CGM initiation within first year of type 1 diabetes results in long-term improvement in A1c. </p>


2022 ◽  
Author(s):  
Tinashe Chikowore ◽  
Kenneth Ekoru ◽  
Marijana Vujkovic ◽  
Dipender Gill ◽  
Fraser Pirie ◽  
...  

<b>Objective. </b>Polygenic prediction of type 2 diabetes in<b> </b>continental Africans is adversely affected by the limited number of genome-wide association studies (GWAS) of type 2 diabetes from Africa and the poor transferability of European derived polygenic risk scores (PRS) in diverse ethnicities. We set out to evaluate if African American, European or multi-ethnic derived PRSs would improve polygenic prediction in continental Africans. <p><b>Research Design and Methods</b>. Using the PRSice software, ethnic-specific PRSs were computed with weights from the type 2 diabetes GWAS multi-ancestry meta-analysis of 228,499 cases and 1,178,783 controls. The South African Zulu study (1602 cases and 981 controls) was used as the target data set. Validation and assessment of the best predictive PRS association with age at diagnosis was done in the Africa America Diabetes Mellitus (AADM) study (2148 cases and 2161 controls).</p> <p> <b>Results. </b>The discriminatory ability of the African American and Multi-ethnic PRS were similar. However<b>, </b>the African American derived PRS was more transferable in all the countries represented in the AADM cohort, and predictive of type 2 diabetes in the country combined analysis compared to the European and multi-ethnic derived scores. Notably, participants in the 10<sup>th</sup> decile of this PRS had a 3.63-fold greater risk (OR 3.63; 95%CI (2.19 - 4.03), p = 2.79 x 10<sup>-17</sup>) per risk allele of developing diabetes and were diagnosed 2.6 years earlier compared to those in the first decile. </p> <p><b>Conclusions </b>African American derived PRS enhances polygenic prediction of type 2 diabetes in continental Africans. Improved representation of non-European populations (including Africans) in GWAS promises to provide better tools for precision medicine interventions in type 2 diabetes.</p>


2022 ◽  
Author(s):  
Anagha Champakanath ◽  
Halis Kaan Akturk ◽  
G. Todd Alonso ◽  
Janet K Snell-Bergeon ◽  
Viral N Shah

Objective: To evaluate long-term glycemic outcomes of CGM initiation within the first year of type 1 diabetes. <p>Research Design and Methods: 396 patients with type 1 diabetes were divided into three groups; 1) CGM [CGM use within one year of diabetes and continued through the study], 2) no-CGM [no CGM use throughout the study], 3) new-CGM [CGM use after 3 years of diabetes] and were followed up to 7-years. </p> <p>Results: A1c was significantly lower in CGM compared to no-CGM group throughout 7 years of follow-up [LS mean A1cs (%): 6-month 7.3 vs 8.1, 1-year 7.4 vs 8.6, 2-year 7.7 vs 9.1, 3-year 7.6 vs 9.3, 4-year 7.4 vs 9.6, 5-year 7.6 vs 9.7, 6-year 7.5 vs 10.0 and 7-year 7.6 vs 9.8, all p<0.001] adjusting for age at diagnosis, sex, and insulin delivery method. </p> <p>Conclusion: CGM initiation within first year of type 1 diabetes results in long-term improvement in A1c. </p>


2022 ◽  
Author(s):  
Tinashe Chikowore ◽  
Kenneth Ekoru ◽  
Marijana Vujkovic ◽  
Dipender Gill ◽  
Fraser Pirie ◽  
...  

<b>Objective. </b>Polygenic prediction of type 2 diabetes in<b> </b>continental Africans is adversely affected by the limited number of genome-wide association studies (GWAS) of type 2 diabetes from Africa and the poor transferability of European derived polygenic risk scores (PRS) in diverse ethnicities. We set out to evaluate if African American, European or multi-ethnic derived PRSs would improve polygenic prediction in continental Africans. <p><b>Research Design and Methods</b>. Using the PRSice software, ethnic-specific PRSs were computed with weights from the type 2 diabetes GWAS multi-ancestry meta-analysis of 228,499 cases and 1,178,783 controls. The South African Zulu study (1602 cases and 981 controls) was used as the target data set. Validation and assessment of the best predictive PRS association with age at diagnosis was done in the Africa America Diabetes Mellitus (AADM) study (2148 cases and 2161 controls).</p> <p> <b>Results. </b>The discriminatory ability of the African American and Multi-ethnic PRS were similar. However<b>, </b>the African American derived PRS was more transferable in all the countries represented in the AADM cohort, and predictive of type 2 diabetes in the country combined analysis compared to the European and multi-ethnic derived scores. Notably, participants in the 10<sup>th</sup> decile of this PRS had a 3.63-fold greater risk (OR 3.63; 95%CI (2.19 - 4.03), p = 2.79 x 10<sup>-17</sup>) per risk allele of developing diabetes and were diagnosed 2.6 years earlier compared to those in the first decile. </p> <p><b>Conclusions </b>African American derived PRS enhances polygenic prediction of type 2 diabetes in continental Africans. Improved representation of non-European populations (including Africans) in GWAS promises to provide better tools for precision medicine interventions in type 2 diabetes.</p>


2022 ◽  
Author(s):  
Anagha Champakanath ◽  
Halis Kaan Akturk ◽  
G. Todd Alonso ◽  
Janet K Snell-Bergeon ◽  
Viral N Shah

Objective: To evaluate long-term glycemic outcomes of CGM initiation within the first year of type 1 diabetes. <p>Research Design and Methods: 396 patients with type 1 diabetes were divided into three groups; 1) CGM [CGM use within one year of diabetes and continued through the study], 2) no-CGM [no CGM use throughout the study], 3) new-CGM [CGM use after 3 years of diabetes] and were followed up to 7-years. </p> <p>Results: A1c was significantly lower in CGM compared to no-CGM group throughout 7 years of follow-up [LS mean A1cs (%): 6-month 7.3 vs 8.1, 1-year 7.4 vs 8.6, 2-year 7.7 vs 9.1, 3-year 7.6 vs 9.3, 4-year 7.4 vs 9.6, 5-year 7.6 vs 9.7, 6-year 7.5 vs 10.0 and 7-year 7.6 vs 9.8, all p<0.001] adjusting for age at diagnosis, sex, and insulin delivery method. </p> <p>Conclusion: CGM initiation within first year of type 1 diabetes results in long-term improvement in A1c. </p>


Diabetes Care ◽  
2022 ◽  
Author(s):  
Anagha Champakanath ◽  
Halis Kaan Akturk ◽  
G. Todd Alonso ◽  
Janet K. Snell-Bergeon ◽  
Viral N. Shah

OBJECTIVE To evaluate long-term glycemic outcomes of continuous glucose monitoring (CGM) initiation within the first year of type 1 diabetes diagnosis. RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (N = 396) were divided into three groups: 1) CGM (CGM use within 1 year of diabetes diagnosis and continued through the study); 2) no-CGM (no CGM use throughout the study); and 3) new-CGM (CGM use after 3 years since diabetes diagnosis). Patients were followed up to 7 years. RESULTS A1c was significantly lower in the CGM compared with the no-CGM group throughout 7 years of follow-up (least squares mean A1c values: 6 months, 7.3% vs. 8.1%; 1 year, 7.4% vs. 8.6%; 2 years, 7.7% vs. 9.1%; 3 years, 7.6% vs. 9.3%; 4 years, 7.4% vs. 9.6%; 5 years, 7.6% vs. 9.7%; 6 years, 7.5% vs. 10.0%; and 7 years, 7.6% vs. 9.8%; for all, P &lt; 0.001) adjusting for age at diagnosis, sex, and insulin delivery method. CONCLUSION CGM initiation within first year of type 1 diabetes diagnosis results in long-term improvement in A1c.


2022 ◽  
Author(s):  
Maria Overvad ◽  
Lars Jorge Diaz ◽  
Peter Bjerregaard ◽  
Michael Lynge Pedersen ◽  
Christina Viskum Lytken Larsen ◽  
...  

Abstract ObjectiveDiabetes prevalence in Greenland is high and increasing. The aim of this study was to examine the effect of diabetes and the diabetogenic TBC1D4 variant on kidney function in Greenland in a population-based setting.Research Design and MethodsHealth survey data and TBC1D4 genotypes from 5,336 Greenlanders was used to estimate odds ratios (ORs) of albuminuria (>30 mg/g creatinine) and chronic kidney disease (CKD, eGFR<60 ml/min/1.73m2), comparing individuals with and without diabetes. Using baseline and follow-up data from individuals who participated in two surveys we examined the effect of diabetes on eGFR and urinary albumin creatinine ratio (UACR) at follow-up, stepwise adjusting for baseline confounders including the TBC1D4 variant.ResultsA total of 9.3% had diabetes of the 3,909 participants with complete data. Albuminuria and CKD was found in 27.6% and 9.5% among those with and without diabetes respectively. Diabetes was associated with increased risk of albuminuria (OR(95% CI) = 2.37 (1.69,3.33) p<0.001) and the TBC1D4 variant protected against albuminuria (OR(95% CI) = 0.44 (0.22,0.90) p=0.02) in a multivariable model. Neither diabetes nor the TBC1D4 variant significantly associated with CKD. Diabetes was not associated with changes in eGFR or UACR over a median of 11.3 years.ConclusionDiabetes conferred increased risk of albuminuria and the TBC1D4 variant was associated with decreased risk of albuminuria, but neither were associated with CKD. The presence/absence of diabetes did not predict changes in eGFR and UACR in longitudinal analyses. The potential renoprotective association of the TBC1D4 variant on albuminuria calls for further studies.


Diabetes Care ◽  
2022 ◽  
Author(s):  
Tinashe Chikowore ◽  
Kenneth Ekoru ◽  
Marijana Vujkovi ◽  
Dipender Gill ◽  
Fraser Pirie ◽  
...  

OBJECTIVE Polygenic prediction of type 2 diabetes (T2D) in continental Africans is adversely affected by the limited number of genome-wide association studies (GWAS) of T2D from Africa and the poor transferability of European-derived polygenic risk scores (PRSs) in diverse ethnicities. We set out to evaluate if African American–, European-, or multiethnic-derived PRSs would improve polygenic prediction in continental Africans. RESEARCH DESIGN AND METHODS Using the PRSice software, ethnic-specific PRSs were computed with weights from the T2D GWAS multiancestry meta-analysis of 228,499 case and 1,178,783 control subjects. The South African Zulu study (n = 1,602 case and 981 control subjects) was used as the target data set. Validation and assessment of the best predictive PRS association with age at diagnosis were conducted in the Africa America Diabetes Mellitus (AADM) study (n = 2,148 case and 2,161 control subjects). RESULTS The discriminatory ability of the African American and multiethnic PRSs was similar. However, the African American–derived PRS was more transferable in all the countries represented in the AADM cohort and predictive of T2D in the country combined analysis compared with the European- and multiethnic-derived scores. Notably, participants in the 10th decile of this PRS had a 3.63-fold greater risk (odds ratio 3.63; 95% CI 2.19–4.03; P = 2.79 × 10−17) per risk allele of developing diabetes and were diagnosed 2.6 years earlier than those in the first decile. CONCLUSIONS African American–derived PRS enhances polygenic prediction of T2D in continental Africans. Improved representation of non-European populations (including Africans) in GWAS promises to provide better tools for precision medicine interventions in T2D.


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