RÉSUMÉ
OBJECTIVE: Women with type 2 diabetes experience higher cardiovascular and mortality risk than men possibly because of a sub-optimal cardio-protective treatment. We evaluated whether an intensive multifactorial therapy (MT) produces similar protective effect on development of adverse outcomes in women and men. RESEARCH DESIGN AND METHODS: Nephropathy in Diabetes type 2 study is an open-label cluster randomized trial comparing the effect of Usual Care (UC) or MT of main cardiovascular risk factors (blood pressure < 130/80 mmHg, HbA1c < 7%, LDL < 100 mg/dL, and total cholesterol < 175 mg/dL) on cardiovascular and mortality risk in patients with type 2 diabetes. In this post-hoc analysis, we stratified patients by sex to compare the occurrence of MACEs (primary endpoint) and all-cause death (secondary endpoint) between women (104 MT and 105 UC) and men (103 MT and 83 UC). RESULTS: Achievement of therapeutic goals was similar by sex, with 44% and 47% of women and men in MT achieving at least 3 targets vs. 16% and 20% of women and men in UC. During a median follow-up of 13.0 years, we recorded 262 MACE (48.5% in women) and 189 deaths (53.6% in women). Compared to the UC group, the risk of MACE in the MT group was reduced by 52% in women and by 44% in men (P = 0.11). Conversely, the reduction in mortality risk by MT was greater in women (44% versus 12%, P = 0.019). CONCLUSIONS: MT similarly reduces the risk of MACEs in either sex. This therapeutic approach is associated with a survival advantage in women as compared with men and it may represent an important rationale to motivate physicians in overcoming their therapeutic inertia often encountered in female patients as well as to encourage patients of both sexes at improving their adherence to multidrug therapy.
Sujet(s)
Maladies cardiovasculaires , Diabète de type 2 , Néphropathies diabétiques , Facteurs de risque de maladie cardiaque , Humains , Mâle , Femelle , Maladies cardiovasculaires/mortalité , Maladies cardiovasculaires/diagnostic , Maladies cardiovasculaires/prévention et contrôle , Adulte d'âge moyen , Facteurs sexuels , Sujet âgé , Appréciation des risques , Résultat thérapeutique , Facteurs temps , Diabète de type 2/mortalité , Diabète de type 2/diagnostic , Diabète de type 2/thérapie , Diabète de type 2/sang , Néphropathies diabétiques/mortalité , Néphropathies diabétiques/thérapie , Néphropathies diabétiques/diagnostic , Marqueurs biologiques/sang , Disparités de l'état de santé , Hypoglycémiants/usage thérapeutique , Hémoglobine glyquée/métabolisme , Cause de décès , Pression sanguineRÉSUMÉ
BACKGROUND: We evaluated the prevalence of "heart stress" (HS) based on NT-proBNP cut-points proposed by the 2023 Consensus of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in asymptomatic patients with T2DM and hypertension or high-normal blood pressure (BP) eligible for SGLT2 inhibitors (SGLT2i) and/or GLP-1 receptor agonists (GLP1-RA), drugs with proven benefits on reducing the incidence of HF, hospitalizations, cardiovascular events and mortality. METHODS: A cross-sectional multicentric study was conducted on 192 consecutive outpatients, aged ≥ 55 years, with hypertension or high-normal BP, referred to three diabetology units. NT-proBNP was collected before starting new anti-diabetic therapy. Patients with known HF were excluded, and participants were classified based on the age-adjusted NT-proBNP cut-points. RESULTS: Mean age: 70.3 ± 7.8 years (67.5% males). Patients with obesity (BMI ≥ 30 Kg/m2): 63.8%. Median NT-proBNP: 96.0 (38.8-213.0) pg/mL. Prevalence of chronic kidney disease (CKD, eGFR < 60 mL/min/1.73m2): 32.1%. Mean arterial BP: 138.5/77.0 ± 15.8/9.9 mmHg. The NT-proBNP values, according to the proposed age-adjusted cut-points, classified 28.6% of patients as "HS likely" (organize elective echocardiography and specialist evaluation), 43.2% as "HS not likely" (a grey area, repeat NT-proBNP at six months) and 28.2% as "very unlikely HS" (repeat NT-proBNP at one year). The presence of CKD and the number of anti-hypertensive drugs, but not glycemic parameters, were independently associated with HS. CONCLUSIONS: According to NT-proBNP, over a quarter of T2DM patients with hypertension/high-normal BP, among those eligible for SGLT2i and/or GLP1-RA, were already at risk of cardiac damage, even subclinical. Most would receive an indication to echocardiogram and be referred to a specialist, allowing the early implementation of effective strategies to prevent or delay the progression to advanced stages of cardiac disease and overt HF.
Sujet(s)
Marqueurs biologiques , Pression sanguine , Diabète de type 2 , Hypertension artérielle , Peptide natriurétique cérébral , Fragments peptidiques , Valeur prédictive des tests , Humains , Mâle , Études transversales , Fragments peptidiques/sang , Femelle , Peptide natriurétique cérébral/sang , Sujet âgé , Diabète de type 2/sang , Diabète de type 2/diagnostic , Diabète de type 2/épidémiologie , Diabète de type 2/traitement médicamenteux , Marqueurs biologiques/sang , Adulte d'âge moyen , Hypertension artérielle/diagnostic , Hypertension artérielle/épidémiologie , Hypertension artérielle/traitement médicamenteux , Hypertension artérielle/sang , Hypertension artérielle/physiopathologie , Prévalence , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Inhibiteurs du cotransporteur sodium-glucose de type 2/effets indésirables , Appréciation des risques , Sujet âgé de 80 ans ou plus , Maladies asymptomatiques , PronosticRÉSUMÉ
OBJECTIVE AND BACKGROUND: The early detection of diabetic ketoacidosis (DKA) in patients with type 2 diabetes (T2D) plays a crucial role in enhancing outcomes. We developed a nomogram prediction model for screening DKA in T2D patients. At the same time, the input variables were adjusted to reduce misdiagnosis. METHODS: We obtained data on T2D patients from Mimic-IV V0.4 and Mimic-III V1.4 databases. A nomogram model was developed using the training data set, internally validated, subjected to sensitivity analysis, and further externally validated with data from T2D patients in Aviation General Hospital. RESULTS: Based on the established model, we analyzed 1885 type 2 diabetes patients, among whom 614 with DKA. We further additionally identified risk factors for DKA based on literature reports and multivariate analysis. We identified age, glucose, chloride, calcium, and urea nitrogen as predictors in our model. The logistic regression model demonstrated an area under the curve (AUC) of 0.86 (95%CI: 0.85-0.90]. To validate the model, we collected data from 91 T2D patients, including 15 with DKA, at our hospital. The external validation of the model yielded an AUC of 0.68 (95%CI: 0.67-0.70). The calibration plot confirmed that our model was adequate for predicting patients with DKA. The decision-curve analysis revealed that our model offered net benefits for clinical use. CONCLUSIONS: Our model offers a convenient and accurate tool for predicting whether DKA is present. Excluding input variables that may potentially hinder patient compliance increases the practical application significance of our model.
Sujet(s)
Diabète de type 2 , Acidocétose diabétique , Nomogrammes , Humains , Diabète de type 2/complications , Diabète de type 2/diagnostic , Acidocétose diabétique/diagnostic , Femelle , Mâle , Adulte d'âge moyen , Facteurs de risque , Dépistage de masse/méthodes , Dépistage de masse/normes , Adulte , Sujet âgé , Pronostic , Diagnostic précoceRÉSUMÉ
BACKGROUND: Patients with concomitant type 2 diabetes mellitus (T2DM) and aortic regurgitation (AR) can present with right ventricular (RV) dysfunction. The current study aimed to evaluate the impact of AR on RV impairment and the importance of ventricular interdependence using cardiac magnetic resonance feature tracking (CMRFT) in patients with T2DM. METHODS: This study included 229 patients with T2DM (AR-), 88 patients with T2DM (AR+), and 122 healthy controls. The biventricular global radial strain (GRS), global circumferential strain (GCS), and global longitudinal peak strain (GLS) were calculated with CMRFT and compared among the healthy control, T2DM (AR-), and T2DM (AR+) groups. The RV regional strains at the basal, mid, and apical cavities between the T2DM (AR+) group and subgroups with different AR degrees were compared. Backward stepwise multivariate linear regression analyses were performed to determine the effects of AR and left ventricular (LV) strains on RV strains. RESULTS: The RV GLS, LV GRS, LV GCS, LV GLS, interventricular septal (IVS) GRS and IVS GCS were decreased gradually from the controls through the T2DM (AR-) group to the T2DM (AR+) group. The IVS GLS of the T2DM (AR-) and T2DM (AR+) groups was lower than that of the control group. AR was independently associated with LV GRS, LV GCS, LV GLS, RV GCS, and RV GLS. If AR and LV GLSs were included in the regression analyses, AR and LV GLS were independently associated with RV GLS. CONCLUSION: AR can exacerbate RV dysfunction in patients with T2DM, which may be associated with the superimposed strain injury of the left ventricle and interventricular septum. The RV longitudinal and circumferential strains are important indicators of cardiac injury in T2DM and AR. The unfavorable LV-RV interdependence supports that while focusing on improving LV function, RV dysfunction should be monitored and treated in order to slow the progression of the disease and the onset of adverse outcomes.
Sujet(s)
Insuffisance aortique , Diabète de type 2 , IRM dynamique , Valeur prédictive des tests , Dysfonction ventriculaire droite , Fonction ventriculaire gauche , Fonction ventriculaire droite , Humains , Mâle , Insuffisance aortique/physiopathologie , Insuffisance aortique/imagerie diagnostique , Femelle , Adulte d'âge moyen , Dysfonction ventriculaire droite/physiopathologie , Dysfonction ventriculaire droite/imagerie diagnostique , Dysfonction ventriculaire droite/étiologie , Diabète de type 2/complications , Diabète de type 2/physiopathologie , Diabète de type 2/diagnostic , Sujet âgé , Études rétrospectives , Adulte , Études cas-témoins , Facteurs de risque , Phénomènes biomécaniquesRÉSUMÉ
OBJECTIVE: To explore trends in prognosis and use of glucose-lowering drugs (GLD) in patients with diabetes and coronary artery disease (CAD). RESEARCH DESIGN AND METHODS: All patients with diabetes and CAD undergoing a coronary angiography between 2010 and 2021 according to the Swedish Angiography and Angioplasty Registry were included. Information on GLD (dispended 6 months before or after coronary angiography) was collected from the Swedish Prescribed Drug Registry. Data on major cardiovascular events (MACE; mortality, myocardial infarction, stroke, heart failure) through December 2021 were obtained from national registries. Cox proportional survival analysis was used to assess outcomes where cardioprotective GLD (any of Sodium Glucose Lowering Transport 2 receptor inhibitors [SGLT2i] and Glucagon Like Peptide Receptor Agonists [GLP-1 RA]) served as a reference. RESULTS: Among all patients (n = 38,671), 31% had stable CAD, and 69% suffered an acute myocardial infarction. Mean age was 69 years, 67% were male, and 81% were on GLD. The use of cardioprotective GLD increased rapidly in recent years (2016-2021; 7-47%) and was more common in younger patients (66 vs. 68 years) and men (72.9% vs. 67.1%) than other GLD. Furthermore, compared with other GLD, the use of cardioprotective GLD was more common in patients with a less frequent history of heart failure (5.0% vs. 6.8%), myocardial infarction (7.7% vs. 10.5%) and chronic kidney disease (3.7% vs. 5.2%). The adjusted hazard ratio (HR) (95% CI) for MACE was greater in patients on other GLD than in those on cardioprotective GLD (1.10; 1.03-1.17, p = 0.004). Trend analyses for the years 2010-2019 revealed improved one-year MACE in patients with diabetes and CAD (year 2019 vs. 2010; 0.90; 0.81-1.00, p = 0.045), while 1-year mortality was unchanged. CONCLUSIONS: The prescription pattern of diabetes medication is changing quickly in patients with diabetes and CAD; however, there are worrying signals of inefficient use prioritizing cardioprotective GLD to younger and healthier individuals at lower cardiovascular risk. Despite this, there are improving trends in 1-year morbidity.
Sujet(s)
Maladie des artères coronaires , Récepteur du peptide-1 similaire au glucagon , Enregistrements , Inhibiteurs du cotransporteur sodium-glucose de type 2 , Humains , Mâle , Femelle , Sujet âgé , Suède/épidémiologie , Maladie des artères coronaires/mortalité , Maladie des artères coronaires/diagnostic , Maladie des artères coronaires/épidémiologie , Maladie des artères coronaires/imagerie diagnostique , Maladie des artères coronaires/traitement médicamenteux , Adulte d'âge moyen , Facteurs temps , Récepteur du peptide-1 similaire au glucagon/agonistes , Appréciation des risques , Résultat thérapeutique , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Inhibiteurs du cotransporteur sodium-glucose de type 2/effets indésirables , Facteurs de risque , Incrétines/usage thérapeutique , Incrétines/effets indésirables , Types de pratiques des médecins/tendances , Diabète de type 2/traitement médicamenteux , Diabète de type 2/mortalité , Diabète de type 2/diagnostic , Diabète de type 2/épidémiologie , Coronarographie/tendances , Sujet âgé de 80 ans ou plus , Glycémie/métabolisme , Glycémie/effets des médicaments et des substances chimiquesRÉSUMÉ
INTRODUCTION: Early detection and prevention of type 2 diabetes and its complications are global health priorities. Optimal outcomes depend on individual awareness and proactive self-management of health risks. This study evaluates the effectiveness of a community-based diabetes detection and intervention program in a high-risk area in western Sydney, Australia. RESEARCH DESIGN AND METHODS: We collaborated with the Workers Lifestyle Group, Tamil Association Arts and Culture Association, and the National Aboriginal and Islanders Day Observance Committee to implement our program. Participants underwent HbA1C testing via point-of-care blood spot testing. They received personalized feedback, education on diabetes management, and were offered opportunities to enrol in lifestyle modification programs. Participants identified with pre-diabetes (HbA1C 5.7-6.4%) or diabetes (HbA1C > 6.4%) were advised to consult their General Practitioners (GPs). A follow-up questionnaire was distributed 3-8 months post-intervention to evaluate the programs usefulness and relevance and lifestyle changes implemented by the participants. RESULTS: Over eight months, 510 individuals participated. Of these, 19% had an HbA1C > 6.4%, and 38% had levels between 5.7 and 6.4%. Among those with diabetes, HbA1C levels ranged as follows: 56% <7%; 20% 7-7.9%; 18% 8-8.9%; and 5% >9%. Post intervention survey indicated that the program was well-received, with 62.5% of responses reporting lifestyle changes and 36.3% seeking further advice from their local healthcare providers. CONCLUSION: The study demonstrates a significant prevalence of pre-diabetes and diabetes in the community, similar to findings from larger-scale hospital and general practice studies. Point-of-care testing combined with personalized education effectively motivated participants toward healthier lifestyle choices and medical consultations. The paper discusses the scalability of this approach for broader population.
Sujet(s)
Diabète de type 2 , Humains , Femelle , Mâle , Diabète de type 2/thérapie , Diabète de type 2/diagnostic , Diabète de type 2/prévention et contrôle , Adulte d'âge moyen , Assistance/méthodes , Adulte , Mode de vie , Hémoglobine glyquée/analyse , Sujet âgé , Systèmes automatisés lit malade , Nouvelle-Galles du Sud , Analyse sur le lieu d'intervention , Services de santé communautaires , Australie , Enquêtes et questionnairesRÉSUMÉ
The newfound knowledge in type 2 diabetes (T2D) during the past decade for the sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) is wealthy in favorable results for key patient-important outcomes including morbidity, mortality and health-related quality of life (HRQoL). The SGLT-2i and GLP-1RA offer cardiovascular and renal protection beyond their glucose lowering effect, reduce body weight and hypoglycemia and improve diabetes-related distress, physical function and HRQoL. Along with the fixed-ratio combinations of basal insulin/GLP-1RA, they make feasible a regimen simplification and de-escalation from high dose and multiple injections of insulin reducing treatment burden. Besides cardiorenal risk reduction, the SGLT-2i and GLP-1RA reduce the incidence of depression, cognitive decline, respiratory disease, gout, arrhythmias and other co-occurring conditions of T2D, namely multimorbidity, which frequently complicates T2D and adversely affects HRQoL. The alleviation of multimorbidity by the pleiotropic effects of the SGLT-2i and GLP-1RA, could improve patients' HRQoL. The use of the SGLT-2i and GLP-1RA should be increased within a shared decision-making in which they are reframed as cardiorenal risk-reducing medications with the potential to lower blood glucose. By improving outcomes that patients may highly perceive and value, the SGLT-2i and GLP-1RA may facilitate the contemporary person-centered management of T2D.
Sujet(s)
Glycémie , Diabète de type 2 , Récepteur du peptide-1 similaire au glucagon , Hypoglycémiants , Qualité de vie , Inhibiteurs du cotransporteur sodium-glucose de type 2 , Humains , Diabète de type 2/traitement médicamenteux , Diabète de type 2/diagnostic , Diabète de type 2/sang , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Inhibiteurs du cotransporteur sodium-glucose de type 2/effets indésirables , Récepteur du peptide-1 similaire au glucagon/agonistes , Récepteur du peptide-1 similaire au glucagon/métabolisme , Résultat thérapeutique , Hypoglycémiants/usage thérapeutique , Hypoglycémiants/effets indésirables , Glycémie/métabolisme , Glycémie/effets des médicaments et des substances chimiques , Facteurs de risque , Régulation de la glycémie/effets indésirables , Incrétines/usage thérapeutique , Incrétines/effets indésirables , Marqueurs biologiques/sang , Mesures des résultats rapportés par les patients , Appréciation des risques , État de santé ,RÉSUMÉ
Background: Point-of-care Testing (POCT) glycosylated hemoglobin (HbA1c) is a convenient, cheap, effective and accessible screening method for type 2 diabetes in rural areas and community settings that is widely used in the European region and Japan, but not yet widespread in China. The study is the first to evaluate the cost-effectiveness of POCT HbA1c, fasting capillary glucose (FCG), and venous blood HbA1c to screen for type 2 diabetes in urban and rural areas of China, and to identify the best socio-economically beneficial screening strategy. Methods: Based on urban and rural areas in China, economic models for type 2 diabetes screening were constructed from a social perspective. The subjects of this study were adults aged 18-80 years with undiagnosed type 2 diabetes. Three screening strategies were established for venous blood HbA1c, FCG and POCT HbA1c, and cost-effectiveness analysis was performed by Markov models. One-way sensitivity analysis and probabilistic sensitivity analysis were performed on all parameters of the model to verify the stability of the results. Results: Compared with FCG, POCT HbA1c was cost-effective with an incremental cost-utility ratio (ICUR) of $500.06/quality-adjusted life year (QALY) in urban areas and an ICUR of $185.10/QALY in rural areas, within the willingness-to-pay threshold (WTP = $37,653). POCT HbA1c was cost-effective with lower cost and higher utility compared with venous blood HbA1c in both urban and rural areas. In the comparison of venous blood HbA1c and FCG, venous blood HbA1c was cost-effective (ICUR = $20,833/QALY) in urban areas but not in rural areas (ICUR = $41,858/QALY). Sensitivity analyses showed that the results of the study were stable and credible. Conclusions: POCT HbA1c was cost-effective for type 2 diabetes screening in both urban and rural areas of China, which could be considered for future clinical practice in China. Factors such as geographic location, local financial situation and resident compliance needed to be considered when making the choice of venous blood HbA1c or FCG.
Sujet(s)
Analyse coût-bénéfice , Diabète de type 2 , Hémoglobine glyquée , Analyse sur le lieu d'intervention , Population rurale , Population urbaine , Humains , Diabète de type 2/diagnostic , Diabète de type 2/sang , Chine , Hémoglobine glyquée/analyse , Adulte d'âge moyen , Adulte , Sujet âgé , Analyse sur le lieu d'intervention/économie , Femelle , Mâle , Population rurale/statistiques et données numériques , Sujet âgé de 80 ans ou plus , Dépistage de masse/économie , Adolescent , Jeune adulte , Glycémie/analyse , Évaluation du Coût-EfficacitéRÉSUMÉ
OBJECTIVES: This study aimed to assess the guideline recommended diagnostic tools NT-proBNP and NYHA classification, with a focus on sex-specific differences. BACKGROUND: Patients with Type 2 Diabetes (T2D) face a heart failure (HF) risk up to four times higher than those without T2D, particularly affecting women more than twice as much as men. Despite distinct pathophysiological differences between men and women, there are currently no sex-specific recommendations for the diagnostic algorithm of HF in diabetic patients. METHODS: A total of 2083 patients with T2D were enrolled, and the primary endpoint was heart failure during hospitalization within a 5-year timeframe. The secondary endpoint was all-cause death. RESULTS: In female patients, frequency of HF diagnosis prior to or during hospitalization and mortality did not differ significantly between NYHA II and III, in contrast to male patients. Additionally, there was no notable difference in mean NT-proBNP levels between NYHA stage II and III only in female patients. The multivariable regression analysis highlighted NYHA classification not to be a predictor of NT-proBNP levels in female but solely in male patients. On multivariable Cox regression NYHA score was also no significant risk factor for occurence of HF in female patients. Furthermore, there was no significant disparity in mortality between men with NT-proBNP levels between 125 and 400 pg/ml and those below 125 pg/ml, whereas in women mortality was significantly higher in the group with NT-proBNP levels between 125 and 400 pg/ml than below 125 pg/ml. CONCLUSION: These findings suggest that NYHA classification may not be the most suitable tool for assessing the diagnosis of HF in female patients with T2D. Moreover, the need for consideration of a more symptom-independent screening for HF in female patients with T2D and re-evaluation of current guidelines especially regarding sex-specific aspects is highlighted.
Sujet(s)
Algorithmes , Marqueurs biologiques , Diabète de type 2 , Défaillance cardiaque , Peptide natriurétique cérébral , Fragments peptidiques , Valeur prédictive des tests , Humains , Peptide natriurétique cérébral/sang , Diabète de type 2/diagnostic , Diabète de type 2/sang , Diabète de type 2/mortalité , Diabète de type 2/complications , Femelle , Défaillance cardiaque/diagnostic , Défaillance cardiaque/sang , Défaillance cardiaque/mortalité , Mâle , Fragments peptidiques/sang , Sujet âgé , Marqueurs biologiques/sang , Facteurs sexuels , Adulte d'âge moyen , Facteurs de risque , Appréciation des risques , Pronostic , Facteurs temps , Disparités de l'état de santé , Techniques d'aide à la décision , HospitalisationRÉSUMÉ
ABSTRACT: Recent studies have revealed the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in heart failure patients. However, their effects on acute myocardial infarction (AMI) remain uncertain. Therefore, we conducted this meta-analysis to assess the effectiveness of SGLT2i in patients with AMI with or without diabetes. We conducted a comprehensive search of PubMed, Embase, and Cochrane Library encompassing data from inception until November 30, 2023. Relevant studies comparing SGLT2i with placebo or non-SGLT2i in patients with AMI were included. The mean difference and/or odds ratio (OR) with 95% confidence intervals were pooled using a fixed-effects model when the heterogeneity statistic (I2) was less than 50%; otherwise, a random-effects model was employed. Four randomized controlled trials and 4 observational studies involving 9397 patients with AMI were included in this meta-analysis. Patients treated with SGLT2i exhibited a significantly lower rate of hospitalization for heart failure (OR = 0.50, 95% CI: 0.32-0.80) and all-cause death (OR = 0.65, 95% CI: 0.44-0.95) compared with those treated with placebo or non-SGLT2i. Furthermore, the use of SGLT2i was associated with a significant increase in left ventricular ejection fraction (mean difference = 1.90, 95% CI: 1.62-2.17) and a greater reduction of N-terminal prohormone of brain natriuretic peptide (OR = 0.88, 95% CI 0.82-0.94). Subgroup analysis revealed that in patients with diabetes, SGLT2i exhibited similar effects. The present meta-analysis provided evidence indicating the effectiveness of SGLT2i in patients with AMI; SGLT2i may serve as an additional therapeutic option for patients with AMI, regardless of the presence or absence of diabetes.
Sujet(s)
Diabète de type 2 , Défaillance cardiaque , Infarctus du myocarde , Essais contrôlés randomisés comme sujet , Inhibiteurs du cotransporteur sodium-glucose de type 2 , Humains , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Inhibiteurs du cotransporteur sodium-glucose de type 2/effets indésirables , Diabète de type 2/traitement médicamenteux , Diabète de type 2/diagnostic , Diabète de type 2/complications , Résultat thérapeutique , Infarctus du myocarde/traitement médicamenteux , Infarctus du myocarde/mortalité , Infarctus du myocarde/diagnostic , Mâle , Adulte d'âge moyen , Femelle , Sujet âgé , Défaillance cardiaque/traitement médicamenteux , Défaillance cardiaque/mortalité , Défaillance cardiaque/physiopathologie , Défaillance cardiaque/diagnostic , Études observationnelles comme sujet , Facteurs de risque , Appréciation des risques , Récupération fonctionnelle , Facteurs tempsRÉSUMÉ
BACKGROUND: The atherogenic index of plasma (AIP) is closely associated with the onset of diabetes, with obesity being a significant risk factor for type 2 diabetes mellitus (T2DM). However, the association between the AIP and T2DM in overweight and obese populations has been infrequently studied. Therefore, this study aimed to explore this association in overweight and obese individuals with T2DM. METHODS: This cross-sectional analysis utilized data from 40,633 participants with a body mass index (BMI) ≥ 24 kg/m2 who were screened from January 2018 to December 2023 at Henan Provincial People's Hospital. Participants were categorized into groups of overweight and obese individuals with and without diabetes according to the T2DM criteria. The AIP, our dependent variable, was calculated using the formula log10 [(TG mol/L)/HDL-C (mol/L)]. We investigated the association between the AIP and T2DM in overweight and obese individuals using multivariate logistic regression, subgroup analysis, generalized additive models, smoothed curve fitting, and threshold effect analysis. Additionally, mediation analysis evaluated the role of inflammatory cells in AIP-related T2DM. RESULTS: Overweight and obese patients with T2DM exhibited higher AIP levels than those without diabetes. After adjusting for confounders, our results indicated a significant association between the AIP and the risk of T2DM in overweight and obese individuals (odds ratio (OR) = 5.17, 95% confidence interval (CI) 4.69-5.69). Notably, participants with a high baseline AIP (Q4 group) had a significantly greater risk of T2DM than those in the Q1 group, with an OR of 3.18 (95% CI 2.94-3.45). Subgroup analysis revealed that the association between the AIP and T2DM decreased with increasing age (interaction P < 0.001). In overweight and obese populations, the association between AIP and T2DM risk displayed a J-shaped nonlinear pattern, with AIP > - 0.07 indicating a significant increase in T2DM risk. Various inflammatory cells, including neutrophils, leukocytes, and monocytes, mediated 4.66%, 4.16%, and 1.93% of the associations, respectively. CONCLUSION: In overweight and obese individuals, the AIP was independently associated with T2DM, exhibiting a nonlinear association. Additionally, the association between the AIP and T2DM decreased with advancing age. Multiple types of inflammatory cells mediate this association.
Sujet(s)
Marqueurs biologiques , Diabète de type 2 , Obésité , Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Athérosclérose/épidémiologie , Athérosclérose/sang , Athérosclérose/diagnostic , Marqueurs biologiques/sang , Indice de masse corporelle , Chine/épidémiologie , Cholestérol HDL/sang , Études transversales , Diabète de type 2/diagnostic , Diabète de type 2/sang , Diabète de type 2/épidémiologie , Peuples d'Asie de l'Est , Obésité/diagnostic , Obésité/sang , Obésité/épidémiologie , Surpoids/épidémiologie , Surpoids/sang , Surpoids/diagnostic , Surpoids/complications , Pronostic , Appréciation des risques , Facteurs de risque , Triglycéride/sangRÉSUMÉ
BACKGROUND: The abnormal low-density protein cholesterol (LDL-C) level in the development of atherosclerosis is often comorbid in individuals with type 2 diabetes mellitus(T2DM). This study aimed to investigate the aggravating effect of abnormal LDL-C levels on coronary artery plaques assessed by coronary computed tomography angiography (CCTA) in T2DM. MATERIALS AND METHODS: This study collected 3439 T2DM patients from September 2011 to February 2022. Comparative analysis of differences in coronary plaque characteristics was performed for the patients between the normal LDL-C level group and the abnormal LDL-C level group. Factors with P < 0.1 in the univariable linear regression analyses were included in the multivariable linear stepwise regression. RESULTS: A total of 2820 eligible T2DM patients were included and identified as the normal LDL-C level group (n = 973) and the abnormal LDL-C level group (n = 1847). Compared with the normal LDL-C level group, both on a per-patient basis and per-segment basis, patients with abnormal LDL-C level showed more calcified plaques, partially calcified plaques, low attenuation plaques, positive remodellings, and spotty calcifications. Multivessel obstructive disease (MVD), nonobstructive stenosis (NOS), obstructive stenosis (OS), plaque involvement degree (PID), segment stenosis score (SSS), and segment involvement scores (SIS) were likely higher in the abnormal LDL-C level group than that in the normal LDL-C level group (P < 0.001). In multivariable linear stepwise regression, the abnormal LDL-C level was validated as an independent positive correlation with high-risk coronary plaques and the degree and extent of stenosis caused by plaques (low attenuation plaque: ß = 0.116; positive remodelling: ß = 0.138; spotty calcification: ß = 0.091; NOS: ß = 0.427; OS: ß = 0.659: SIS: ß = 1.114; SSS: ß = 2.987; PID: ß = 2.716, all P value < 0.001). CONCLUSIONS: Abnormal LDL-C levels aggravate atherosclerotic cardiovascular disease (ASCVD) in patients with T2DM. Clinical attention deserves to be caught by the tailored identification of cardiovascular risk categories in T2DM individuals and the achievement of the corresponding LDL-C treatment goal.
Sujet(s)
Marqueurs biologiques , Cholestérol LDL , Angiographie par tomodensitométrie , Coronarographie , Maladie des artères coronaires , Diabète de type 2 , Plaque d'athérosclérose , Valeur prédictive des tests , Calcification vasculaire , Humains , Diabète de type 2/sang , Diabète de type 2/épidémiologie , Diabète de type 2/complications , Diabète de type 2/diagnostic , Mâle , Femelle , Adulte d'âge moyen , Maladie des artères coronaires/imagerie diagnostique , Maladie des artères coronaires/sang , Maladie des artères coronaires/épidémiologie , Sujet âgé , Cholestérol LDL/sang , Marqueurs biologiques/sang , Calcification vasculaire/imagerie diagnostique , Calcification vasculaire/épidémiologie , Calcification vasculaire/sang , Facteurs de risque , Appréciation des risques , Dyslipidémies/sang , Dyslipidémies/épidémiologie , Dyslipidémies/diagnostic , Études rétrospectives , Vaisseaux coronaires/imagerie diagnostique , Indice de gravité de la maladie , Pronostic , Études transversalesRÉSUMÉ
Diabetic nephropathy represents a microvascular complication related to type 2 diabetes mellitus (T2DM) that ultimately causes end-stage renal disease. Our study aimed to evaluate the association of plasma type IV collagen with albuminuria status and to assess the clinical significance of plasma type IV collagen as a potential biomarker in the early stage of diabetic nephropathy. The study comprised 75 participants diagnosed with T2DM allocated equally (n=25) into three groups: (A) normal albuminuria levels, (B) microalbuminuria, and (C) macroalbuminuria, depending on their urine albumin-to-creatinine ratio. A comparative analysis was conducted between these groups and a control group (D, n=15). The enzyme-linked immunosorbent assay (ELISA) method was employed for measuring plasma type IV collagen levels. The results revealed that plasma type IV collagen levels were significantly higher in T2DM groups than in the control group. Moreover, diabetic patients without albuminuria had significantly higher plasma type IV collagen levels than the control group (p < 0.001). Furthermore, albuminuria levels among diabetic patient groups were significantly increased as albuminuria categories increased (p < 0.001). A significant positive correlation existed between plasma type IV collagen and glycated hemoglobin (HbA1c) levels in the macroalbuminuric diabetic group. Our study employed the receiver operating characteristic (ROC) curve analysis to determine plasma type IV collagen diagnostic utility in macroalbuminuria prediction. The ROC curve analysis revealed that type IV collagen can significantly determine macroalbuminuric patients at a cutoff value of 2.25 with sensitivity, specificity, positive predictive value, and negative predictive value of 68%, 100%, 100%, and 75.8%, respectively (p < 0.001). In conclusion, plasma type IV collagen levels might serve as a valuable predictor of albuminuria onset in patients with T2DM.
Sujet(s)
Albuminurie , Marqueurs biologiques , Collagène de type IV , Diabète de type 2 , Néphropathies diabétiques , Diagnostic précoce , Humains , Collagène de type IV/sang , Collagène de type IV/urine , Néphropathies diabétiques/sang , Néphropathies diabétiques/diagnostic , Néphropathies diabétiques/urine , Diabète de type 2/complications , Diabète de type 2/sang , Diabète de type 2/diagnostic , Marqueurs biologiques/sang , Marqueurs biologiques/urine , Mâle , Femelle , Adulte d'âge moyen , Albuminurie/sang , Albuminurie/urine , Albuminurie/diagnostic , Courbe ROC , Hémoglobine glyquée/analyse , Adulte , Test ELISA , Sujet âgéRÉSUMÉ
OBJECTIVE: To adapt risk prediction equations for myocardial infarction (MI), stroke, and heart failure (HF) among patients with type 2 diabetes in real-world settings using cross-institutional electronic health records (EHRs) in Taiwan. METHODS: The EHRs from two medical centers, National Cheng Kung University Hospital (NCKUH; 11,740 patients) and National Taiwan University Hospital (NTUH; 20,313 patients), were analyzed using the common data model approach. Risk equations for MI, stroke, and HF from UKPDS-OM2, RECODe, and CHIME models were adapted for external validation and recalibration. External validation was assessed by (1) discrimination, evaluated by the area under the receiver operating characteristic curve (AUROC) and (2) calibration, evaluated by calibration slopes and intercepts and the Greenwood-Nam-D'Agostino (GND) test. Recalibration was conducted for unsatisfactory calibration (p-value of GND test < 0.05) by adjusting the baseline hazards of original equations to address variations in patients' cardiovascular risks across institutions. RESULTS: The CHIME risk equations had acceptable discrimination (AUROC: 0.71-0.79) and better calibration than that for UKPDS-OM2 and RECODe, although the calibration remained unsatisfactory. After recalibration, the calibration slopes/intercepts of the CHIME-MI, CHIME-stroke, and CHIME-HF risk equations were 0.9848/- 0.0008, 1.1003/- 0.0046, and 0.9436/0.0063 in the NCKUH population and 1.1060/- 0.0011, 0.8714/0.0030, and 1.0476/- 0.0016 in the NTUH population, respectively. All the recalibrated risk equations showed satisfactory calibration (p-values of GND tests ≥ 0.05). CONCLUSIONS: We provide valid risk prediction equations for MI, stroke, and HF outcomes in Taiwanese type 2 diabetes populations. A framework for adapting risk equations across institutions is also proposed.
Sujet(s)
Diabète de type 2 , Dossiers médicaux électroniques , Facteurs de risque de maladie cardiaque , Défaillance cardiaque , Infarctus du myocarde , Valeur prédictive des tests , Accident vasculaire cérébral , Humains , Diabète de type 2/diagnostic , Diabète de type 2/épidémiologie , Appréciation des risques , Mâle , Femelle , Sujet âgé , Adulte d'âge moyen , Infarctus du myocarde/épidémiologie , Infarctus du myocarde/diagnostic , Accident vasculaire cérébral/épidémiologie , Accident vasculaire cérébral/diagnostic , Taïwan/épidémiologie , Reproductibilité des résultats , Pronostic , Défaillance cardiaque/épidémiologie , Défaillance cardiaque/diagnostic , Techniques d'aide à la décision , Facteurs temps , Facteurs de risqueRÉSUMÉ
BACKGROUND: The effect of empagliflozin, a sodium-glucose-co-transporter-2 inhibitor, on risk for myocardial infarction has not been fully characterized. METHODS: This study comprised prespecified and post-hoc analyses of the EMPA-REG OUTCOME trial in which 7020 people with type 2 diabetes (T2D) and cardiovascular disease [mostly atherosclerotic (ASCVD)] were randomized to empagliflozin or placebo and followed for a median 3.1 years. We assessed the effect of empagliflozin on total (first plus recurrent) events of centrally adjudicated fatal and non-fatal myocardial infarction (MI) using a negative binomial model with robust confidence intervals (CI) that preserves randomization and accounts for the within-patient correlation of multiple events. Post hoc, we analyzed types of MI: type 1 (related to plaque-rupture/thrombus), type 2 (myocardial supply-demand imbalance), type 3 (sudden-death related, i.e. fatal MI), type 4 (percutaneous coronary intervention-related), and type 5 (coronary artery bypass graft-related). MIs could be assigned to > 1 type. RESULTS: There were 421 total MIs (including recurrent); 299, 86, 26, 19, and 1 were classified as type 1, 2, 3, 4, and 5 events, respectively. Overall, empagliflozin reduced the risk of total MI events by 21% [rate ratio for empagliflozin vs. placebo, 0.79 (95% CI, 0.620-0.998), P = 0.0486], largely driven by its effect on type 1 [rate ratio, 0.79 (95% CI, 0.61-1.04)] and type 2 MIs [rate ratio, 0.67 (95% CI, 0.41-1.10)]. CONCLUSIONS: In T2D patients with ASCVD, empagliflozin reduced the risk of MIs, with consistent effects across the two most common etiologies, i.e. type 1 and 2. TRAIL REGISTRATION: URL: https://www. CLINICALTRIALS: gov ; Unique identifier: NCT01131676.
Sujet(s)
Composés benzhydryliques , Diabète de type 2 , Glucosides , Infarctus du myocarde , Inhibiteurs du cotransporteur sodium-glucose de type 2 , Humains , Glucosides/usage thérapeutique , Glucosides/effets indésirables , Composés benzhydryliques/usage thérapeutique , Composés benzhydryliques/effets indésirables , Infarctus du myocarde/mortalité , Infarctus du myocarde/prévention et contrôle , Infarctus du myocarde/diagnostic , Infarctus du myocarde/épidémiologie , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Inhibiteurs du cotransporteur sodium-glucose de type 2/effets indésirables , Mâle , Diabète de type 2/traitement médicamenteux , Diabète de type 2/diagnostic , Diabète de type 2/mortalité , Diabète de type 2/complications , Résultat thérapeutique , Femelle , Adulte d'âge moyen , Sujet âgé , Facteurs temps , Appréciation des risques , Facteurs de risque , RécidiveRÉSUMÉ
BACKGROUND: The link between diabetes mellitus and chronic hepatitis C infection remains well established. It is estimated that up to one third of chronic hepatitis C patients have type II diabetes mellitus. Hepatitis C virus infection is one of the main global health burdens. Sofosbuvir and Daclatasvir are used as effective antiviral inhibitors of hepatitis C virus. The cardiovascular effects of those drugs are not well studied. We used electrocardiography and echocardiography with global longitudinal strain assessment by speckle tracking to detect their effect on cardiac function. METHODS AND RESULTS: One hundred diabetic patients with hepatitis C infection were included in the study. Abdominal ultrasound and laboratory work up were carried out for all participants. Left ventricular systolic and diastolic function were assessed by 2D-echocardiography and global longitudinal strain, before and 3 months after treatment. Results showed significant decrease in global longitudinal strain 3 months after therapy (-21 ± 4 vs. -18 ± 7; P < 0.001) but other echocardiographic findings showed no significant changes. CONCLUSIONS: Sofosbuvir and Daclatasvir were associated with early left ventricular systolic dysfunction as assessed by global longitudinal strain in diabetic patients. More deterioration in left ventricular systolic function was detected among those with Child-Pough class B. Further long-term follow-up may be required.
Sujet(s)
Antiviraux , Carbamates , Diabète de type 2 , Hépatite C chronique , Imidazoles , Pyrrolidines , Sofosbuvir , Valine , Dysfonction ventriculaire gauche , Fonction ventriculaire gauche , Humains , Antiviraux/usage thérapeutique , Antiviraux/effets indésirables , Diabète de type 2/traitement médicamenteux , Diabète de type 2/diagnostic , Diabète de type 2/complications , Mâle , Femelle , Adulte d'âge moyen , Sofosbuvir/usage thérapeutique , Sofosbuvir/effets indésirables , Valine/analogues et dérivés , Valine/usage thérapeutique , Pyrrolidines/usage thérapeutique , Imidazoles/usage thérapeutique , Résultat thérapeutique , Hépatite C chronique/traitement médicamenteux , Hépatite C chronique/complications , Hépatite C chronique/diagnostic , Carbamates/usage thérapeutique , Fonction ventriculaire gauche/effets des médicaments et des substances chimiques , Dysfonction ventriculaire gauche/physiopathologie , Dysfonction ventriculaire gauche/imagerie diagnostique , Dysfonction ventriculaire gauche/traitement médicamenteux , Dysfonction ventriculaire gauche/étiologie , Dysfonction ventriculaire gauche/diagnostic , Facteurs temps , Sujet âgé , Électrocardiographie , AdulteRÉSUMÉ
BACKGROUND: Cardiovascular disease remains the primary cause of morbidity and mortality despite advancements in the treatment of patients with type 2 diabetes. Effective diabetes management extends beyond blood glucose control and includes cardiovascular prevention and treatment. However, the conventional healthcare model often emphasizes single-disease-specific management, leading to fragmented care. We aim to establish an affordable Cardio-Metabolic Clinic (CMC) that can provide comprehensive assessment and specialized care with a focus on cardiovascular protection. METHODS: The ProtecT-2-D study is a prospective, randomized control trial at the Cardiovascular Research Unit, Odense University Hospital Svendborg, Denmark. In this study, 1500 participants with type 2 diabetes and cardiovascular disease will be randomly assigned in a 2:1 ratio to receive either the intervention: treatment in the CMC, or the control: standard of care. The Cardio-Metabolic Clinic applies a decision-making algorithm coded with the latest guidelines to evaluate lifestyle factors and manage medical treatment. Health examinations are conducted at baseline and after three years, and clinical events will be assessed through registry and journal audits after five and ten years. The primary outcome is the time to the first occurrence of a composite of cardiovascular deaths, non-fatal acute myocardial infarctions, non-fatal stroke, or hospitalization due to heart failure at a time frame of five years. DISCUSSION: The Cardio-Metabolic Clinic represents a pioneering approach to diabetes management that aims to improve patient outcomes by reducing the cardiovascular disease burden. This study could transform diabetes care and offer a multidisciplinary, cost-effective, and specialized treatment. We need to establish the efficacy and feasibility of a CMC to integrate comparable clinics into broader healthcare systems, and potentially enhance cardiovascular health in patients with type 2 diabetes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT06203860.
Sujet(s)
Maladies cardiovasculaires , Diabète de type 2 , Humains , Diabète de type 2/diagnostic , Diabète de type 2/mortalité , Diabète de type 2/complications , Diabète de type 2/sang , Diabète de type 2/thérapie , Études prospectives , Danemark/épidémiologie , Maladies cardiovasculaires/prévention et contrôle , Maladies cardiovasculaires/diagnostic , Maladies cardiovasculaires/mortalité , Maladies cardiovasculaires/épidémiologie , Facteurs temps , Résultat thérapeutique , Essais contrôlés randomisés comme sujet , Hypoglycémiants/usage thérapeutique , Hypoglycémiants/effets indésirables , Prestation intégrée de soins de santé , Facteurs de risque de maladie cardiaque , Hôpitaux universitaires , Établissements de soins ambulatoires , Coûts des soins de santé , Appréciation des risques , Mâle , Comportement de réduction des risques , Analyse coût-bénéfice , Marqueurs biologiques/sangRÉSUMÉ
BACKGROUND: The association between years of non-diabetes status after diagnosis of impaired glucose tolerance (IGT) and the risk of long-term death and cardiovascular outcomes needed to be clarified. METHODS AND FINDINGS: In this post hoc analysis, we included 540 individuals with IGT who participated in the original Da Qing Diabetes Prevention Study (DQDPS). In the DQDPS, all participants were diagnosed with IGT by a 75 g oral glucose tolerance test and randomized to intervention or control groups with a 6-year lifestyle intervention trial. After the completion of the trial, death, cardiovascular events, and microvascular complications were monitored over a 30-year follow-up. In this post hoc analysis, the Cox analysis assessed the extended risk of these outcomes in individuals who either remained non-diabetes status or progressed to diabetes at the end of 2, 4, and 6 years after diagnosis of IGT. In all participants, the difference in the cumulative incidence rate of the outcomes between the diabetes and non-diabetes group gradually increased over 30 years. Compared with the diabetes group, a significantly lower risk of all-cause death (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.57 to 0.97, p = 0.026), cardiovascular events (HR: 0.63; 95% CI: 0.49 to 0.82, p < 0.001), and microvascular complications (HR: 0.62; 95% CI: 0.45 to 0.86, p = 0.004) first emerged in individuals who remained non-diabetes at the 4 years visit, whereas the significant risk reduction in cardiovascular death was first observed at the end of 6 years (HR: 0.56; 95% CI: 0.39 to 0.81, p = 0.002) after adjustment for age, sex, smoking status, BMI, systolic blood pressure, blood glucose, total cholesterol, intervention, and medications (including insulin plus oral hypoglycaemics, antihypertensives, and lipid-lowering agents). The results in the original intervention group alone were similar to the whole group. The main limitations of our study are the limited number of participants and the sole ethnicity of the Chinese population. CONCLUSIONS: In this study, we observed that maintaining several years of non-diabetes status after IGT diagnosis was associated with a significant reduction in long-term risk of death and vascular complications, and for most of these outcomes, maintaining at least 4 years of non-diabetes status may be needed to achieve a significant risk reduction.
Sujet(s)
Intolérance au glucose , Humains , Mâle , Intolérance au glucose/diagnostic , Intolérance au glucose/complications , Femelle , Adulte d'âge moyen , Hyperglycémie provoquée , Chine/épidémiologie , Sujet âgé , Maladies cardiovasculaires/mortalité , Maladies cardiovasculaires/prévention et contrôle , Maladies cardiovasculaires/diagnostic , Maladies cardiovasculaires/épidémiologie , Facteurs de risque , Glycémie/métabolisme , Diabète de type 2/complications , Diabète de type 2/diagnostic , AdulteRÉSUMÉ
INTRODUCTION: Due to the high cost and complexity, the oral glucose tolerance test is not adopted as the screening method for identifying diabetes patients, which leads to the misdiagnosis of patients with isolated post-challenge hyperglycemia (IPH), that is., patients with normal fasting plasma glucose (<7.0 mmoL/L) and abnormal 2-h postprandial blood glucose (≥11.1 mmoL/L). We aimed to develop a model to differentiate individuals with IPH from the normal population. METHODS: Data from 54301 eligible participants were obtained from the Risk Evaluation of Cancers in Chinese Diabetic Individuals: a longitudinal (REACTION) study in China. Data from 37740 participants were used to develop the diagnostic system. External validation was performed among 16561 participants. Three machine learning algorithms were used to create the predictive models, which were further evaluated by various classification algorithms to establish the best predictive model. RESULTS: Ten features were selected to develop an IPH diagnosis system (IPHDS) based on an artificial neural network. In external validation, the AUC of the IPHDS was 0.823 (95% CI 0.811-0.836), which was significantly higher than the AUC of the Taiwan model [0.799 (0.786-0.813)] and that of the Chinese Diabetes Risk Score model [0.648 (0.635-0.662)]. The IPHDS model had a sensitivity of 75.6% and a specificity of 74.6%. This model outperformed the Taiwan and CDRS models in subgroup analyses. An online site with instant predictions was deployed at https://app-iphds-e1fc405c8a69.herokuapp.com/. CONCLUSIONS: The proposed IPHDS could be a convenient and user-friendly screening tool for diabetes during health examinations in a large general population.