Effect of dipeptidyl peptidase IV inhibitors, thiazolidinedione, and sulfonylurea on osteoporosis in patients with type 2 diabetes: population-based cohort study.

The population-based cohort study used the Korean National Health Insurance claims database to evaluate the effect of anti-diabetic drugs on osteoporosis. The use of DPP-IV inhibitors does not increase the risk of osteoporosis compared with the use of sulfonylureas in patients with type 2 diabetes mellitus, while a weak association was found between thiazolidinediones and increased risk of osteoporosis. PURPOSE: The current study aimed to evaluate the effect of dipeptidyl peptidase IV inhibitors (DPP-IVi), thiazolidinedione (TZD), and sulfonylurea (SU) on osteoporosis in patients with type 2 diabetes. METHODS: A population-based cohort study was conducted in the Republic of Korea using the Korean National Health Insurance claims database. Data from 2012 to 2017 for patients of 50-99 years of age who were prescribed DPP-IVi, TZD, or SU during 2013-2015 were extracted from the database. Based on pre-defined criteria, a total of 381,404 patients were analyzed after inverse probability of treatment weighting. The association between the study drugs and osteoporosis was estimated using Cox proportional hazards models. Data of 220,166 patients who were prescribed DPP-IVi, 18,630 who were prescribed TZD, and 142,608 patients who were prescribed SU were set. RESULTS: In the multivariate-adjusted analysis, the hazard ratio (HR) of osteoporosis in the DPP-IVi group was not significantly different from that of the SU group (HR: 0.97; 95% confidence interval (CI) 0.94-1.00), whereas the HR of osteoporosis in the TZD group was higher (HR: 1.13; 95% CI 1.06-1.20). In the subgroup analysis, the HRs of osteoporosis were higher with pioglitazone (HR: 1.14; 95% CI 1.06-1.23) in the TZD group and with glibenclamides (HR: 1.39; 95% CI 1.09-1.77) in the SU group, whereas drugs with lower HR in the DPP-IVi group were saxagliptin (HR: 0.93; 95% CI 0.87-0.99) and sitagliptin (HR: 0.93; 95% CI 0.89-0.97). CONCLUSION: DPP-IV inhibitors do not increase the risk of osteoporosis compared with sulfonylureas in patients with type 2 diabetes mellitus, while a weak association was found between thiazolidinediones and increased risk of osteoporosis.

[Characteristics of executive function in children with attention deficit/hyperactivity disorder comorbid with high functioning autism].

Objective: To explore the characteristics of executive function in children with attention-deficit/hyperactivity disorder comorbid with high functioning autism. Methods: A total of 165 children with attention-deficit/hyperactivity disorder (ADHD group), 65 children with attention-deficit/Hyperactivity disorder comorbid with high functioning autism (ADHD-HFA group), and 84 healthy controls (control group) (based on the criteria of DSM-5) were recruited from the Outpatient Clinic of Child Healthcare Department of Shen Zhen Children's Hospital. The Rey complex figure test (RCFT), trail making test (TMT), Stroop color-word test were used to assess working memory, shifting and inhibition. Results: ADHD group (2.1±1.9, 7±5, 2.1±2.0 and 7±5) and ADHD-HFA group (2.0±2.0, 7±6, 2.0±2.1 and 6±5) performed worse than control group (3.4±2.0, 10±5, 3.4±2.0 and 10±6) in Rey complex figure test (all P<0.05). ADHD group ((171±8) s, (27.40±0.82) s and (52.29±1.62) s) and ADHD-HFA group ((197±11) s, (29.7±1.1) s and (58.6±2.1) s) group took longer time on the TMT-2, Stroop2 and Stroop4 test than control group ((135±18) s, (22.4±1.9) s and (38.7±3.8) s) (all P<0.05). In children with low intelligence quotient (IQ), ADHD group ((30±8) s) and ADHD-HFA group ((34±9) s) performed worse on Stroop3 test than control group ((20±4) s) (all P<0.05). In children with average IQ, ADHD group ((19±5) s and (24±8) s) took longer time on the Stroop1 and Stroop3 test than control group ((16±3) s and (19±4) s) (all P<0.05). In children with high IQ, ADHD-HFA group ((20±8) s) spent more time on Stroop1 than control group ((15±4) s) (P<0.05). Inattention symptoms were associated with the time on TMT-2 of ADHD-HFA group (r=0.275 and 0.329, all P<0.05). The score of item 1 in autism spectrum screening questionnaire (ASSQ) was negatively correlated with immediate recall structure and detail scores as well as delay structure scores of Rey complex figure test (r=-0.358, -0.326 and -0.306, all P<0.05). The score of item 4 was positively correlated with errors of Stroop4 (r=0.296, P<0.05). The score of item 22 was positively correlated with time of color interference (r=0.279, P<0.05). Conclusions: Children with ADHD-HFA are likely to demonstrate the spatial working memory, shifting and inhibition deficits associated with ADHD alone. Some domains of executive function impairment in ADHD-HFA group are related with symptoms of inattention/hyperactivity and autism.

Metformin and tuberculosis risk in elderly patients with diabetes mellitus.

SETTING: Tuberculosis (TB) and diabetes mellitus (DM) remain global health concerns. Metformin has recently received attention for its anti-tuberculosis effects.OBJECTIVE: To evaluate the risk of TB development in elderly DM patients treated with metformin compared with sulfonylureas.DESIGN: We performed a retrospective cohort study using the National Health Insurance Service-Senior database. The participants were type-2 DM (T2DM) patients aged ≥60 years between 1 January 2003 and 31 December 2013. We matched each metformin user to a sulfonylurea user using a propensity score. A Cox proportional hazards model was used to compare the risk of TB in metformin and sulfonylurea users.RESULTS: After propensity score matching, 12,582 patients were in each group. The TB incidence was 280.2/100 000 person-years (py) for metformin users and 394.5/100 000 py for sulfonylurea users. Metformin users had a lower risk of TB development than sulfonylurea users (adjusted hazard ratio 0.74, 95%CI 0.58-0.95), and the results were stronger for male participants. A dose-response relationship between metformin use and TB development was found in both sexes.CONCLUSION: Metformin use was associated with a decreased risk of TB development among elderly T2DM patients compared with sulfonylurea use.

Tuberculosis is frequently diagnosed within 12 months of diabetes mellitus.

BACKGROUND: Evidence regarding the effects of tuberculosis (TB) screening among patients with diabetes mellitus (DM) in intermediate TB burden countries is insufficient, and the most appropriate time point for TB screening is unclear. OBJECTIVE: To investigate trends in TB incidence among newly diagnosed DM patients. DESIGN: A retrospective cohort study of the claims database of the Health Insurance Review and Assessment Service in Korea was performed. Participants were newly diagnosed with type 2 DM in 2009. The study outcome was TB incidence between 2009 and 2011 among participants according to duration of type 2 DM. RESULTS: A cohort of 331,601 patients with newly diagnosed type 2 DM in 2009 was identified. During the 3-year follow-up period, 1533 patients were diagnosed with TB. The estimated incidence of TB among newly diagnosed type 2 DM patients was 18/10,000 patient-years (py) (95%CI 17.5-19.4). TB incidence was 33/10,000 py (95%CI 30.0-35.6) in the first 6 months, and 19/10,000 py (95%CI 16.5-20.6) in the following 6-month period. CONCLUSIONS: The risk of developing TB was increased among DM patients, particularly during the first 12 months after DM diagnosis.

Cool and hot executive functions in medication-naive attention deficit hyperactivity disorder children.

BACKGROUND: This study aimed to compare 'cool' [working memory (WM) and response inhibition] and 'hot' (delay aversion) executive functions (EFs) in children with and without attention deficit hyperactivity disorder (ADHD). METHOD: A total of 100 ADHD children (45 with family history of ADHD and 55 with no family history) and 100 healthy controls, all medication free, were tested on tasks related to the 'hot' (i.e. two choice-delay tasks) and 'cool' domains of EF (i.e. Digits backward, Corsi Block Task backward, Go/No-Go Task, Stop-Signal Task, and the Stroop). RESULTS: Compared with the controls, children with ADHD were found to perform significantly worse on one or more measures of response inhibition, WM, and delay aversion after controlling for co-morbidities and estimated IQ. In addition, comparisons between ADHD children with family history of ADHD and those with no family history found significant differences on measures of response inhibition and WM but not delay aversion. These results are largely supported by results of two logistic regressions. CONCLUSIONS: ADHD was found to be associated with deficits on both cool and hot EFs. There is also evidence to suggest that cool EFs impairment is related to a family history of ADHD. Findings of this study have helped to elucidate the nature and extent of EF deficits in children with ADHD.