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1.
Nat Commun ; 11(1): 3865, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737319

RESUMO

Polygenic scores (PGS) have been widely used to predict disease risk using variants identified from genome-wide association studies (GWAS). To date, most GWAS have been conducted in populations of European ancestry, which limits the use of GWAS-derived PGS in non-European ancestry populations. Here, we derive a theoretical model of the relative accuracy (RA) of PGS across ancestries. We show through extensive simulations that the RA of PGS based on genome-wide significant SNPs can be predicted accurately from modelling linkage disequilibrium (LD), minor allele frequencies (MAF), cross-population correlations of causal SNP effects and heritability. We find that LD and MAF differences between ancestries can explain between 70 and 80% of the loss of RA of European-based PGS in African ancestry for traits like body mass index and type 2 diabetes. Our results suggest that causal variants underlying common genetic variation identified in European ancestry GWAS are mostly shared across continents.


Assuntos
Asma/genética , Diabetes Mellitus Tipo 2/genética , Hipertensão/genética , Modelos Genéticos , Herança Multifatorial , Polimorfismo de Nucleotídeo Único , Adulto , África/epidemiologia , Idoso , Alelos , Ásia/epidemiologia , Asma/diagnóstico , Asma/epidemiologia , Asma/etnologia , Índice de Massa Corporal , Colesterol/sangue , Simulação por Computador , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Europa (Continente)/epidemiologia , Feminino , Frequência do Gene , Estudo de Associação Genômica Ampla , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/etnologia , Desequilíbrio de Ligação , Masculino , Pessoa de Meia-Idade , Prognóstico , Característica Quantitativa Herdável , Risco
2.
J Natl Black Nurses Assoc ; 31(1): 32-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853494

RESUMO

The prevalence of type 2 diabetes mellitus (T2DM) is 19.7% in Haiti (DeGennaro et al., 2018). Haitian American women (HAW) experience difficulties with adherence to T2DM treatment and management (Bivins, 2016; Magny-Normilus et al., 2019; Vimalananda et al., 2011; Huffman et al., 2013); however, no previous study was found that focused exclusively on Haitian American women with T2DM. Van Manen's six research activities guided this phenomenological qualitative inquiry. Recruitment included 25 Haitian American women (N = 25) with T2DM from three South Florida counties. Data were collected using a vignette and audio-recorded semi-structured interviews with open-ended questions. Recordings were then transcribed and analyzed to identify thematic concepts and patterns. Themes of spiritualizing and shifting cultural norms with the subtheme of dietary restrictions were found. In conclusion, to promote health outcomes nurses must incorporate these salient factors in the care of Haitian American women with T2DM.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Assistência à Saúde Culturalmente Competente/organização & administração , Diabetes Mellitus Tipo 2/enfermagem , Feminino , Haiti/etnologia , Humanos , Pesquisa Qualitativa , Estados Unidos
3.
Am J Med Sci ; 359(5): 266-270, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32359533

RESUMO

BACKGROUND: Cross-sectional surveys report a higher prevalence of diagnosed type 2 diabetes mellitus (T2DM) in African Americans (AA) than European Americans (EA). We studied 5-year glycemic excursions among AA and EA in the Pathobiology of Prediabetes in A Biracial Cohort study, to assess ethnic disparities. MATERIALS AND METHODS: Pathobiology of Prediabetes in A Biracial Cohort followed normoglycemic offspring of parents with T2DM for 5 years, with serial assessments of oral glucose tolerance test , anthropometry, body fat, insulin sensitivity and beta-cell function. The primary outcome was progression to prediabetes (impaired fasting glucose and/or impaired glucose tolerance). We further analyzed 5-year changes in fasting (FPG) and 2-hour plasma glucose (2hrPG). RESULTS: One hundred and one (52 AA, 49 EA) out of 343 subjects developed prediabetes during follow-up. The change in FPG ranged from -24 mg/dl to +38 mg/dl. The FPG remained stable (± 5 mg/dl from baseline) in 50% of EA and 46.8% of AA and the 2hrPG remained stable (± 25 mg/dl from baseline) in 73.7% of EA and 71.0 % of AA during follow-up. The proportions with change in FPG of 5mg/dl to >25 mg/dl and 2hrPG of 25 mg/dl to >50 mg/dl were similar in EA and AA offspring, as were the 10th - 90th percentiles of the distribution of 5-year changes in FPG and 2hrPG. CONCLUSIONS: During 5 years of follow-up, black and white offspring of parents with T2DM exhibited remarkable phenotypic concordance of glycemic trajectories. Thus, parental history of T2DM may be a stronger factor than race/ethnicity in the prediction of longitudinal glycemic trends.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Estado Pré-Diabético/etnologia , Adulto , Afro-Americanos , Antropometria , Glicemia/análise , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Grupo com Ancestrais do Continente Europeu , Saúde da Família , Feminino , Seguimentos , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Disparidades em Assistência à Saúde , Humanos , Hiperglicemia/sangue , Insulina/sangue , Resistência à Insulina , Células Secretoras de Insulina/citologia , Masculino , Pessoa de Meia-Idade , Pais , Fenótipo , Estado Pré-Diabético/sangue , Prevalência , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
PLoS One ; 15(5): e0230815, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379818

RESUMO

Smoking is a potentially causal behavioral risk factor for type 2 diabetes (T2D), but not all smokers develop T2D. It is unknown whether genetic factors partially explain this variation. We performed genome-environment-wide interaction studies to identify loci exhibiting potential interaction with baseline smoking status (ever vs. never) on incident T2D and fasting glucose (FG). Analyses were performed in participants of European (EA) and African ancestry (AA) separately. Discovery analyses were conducted using genotype data from the 50,000-single-nucleotide polymorphism (SNP) ITMAT-Broad-CARe (IBC) array in 5 cohorts from from the Candidate Gene Association Resource Consortium (n = 23,189). Replication was performed in up to 16 studies from the Cohorts for Heart Aging Research in Genomic Epidemiology Consortium (n = 74,584). In meta-analysis of discovery and replication estimates, 5 SNPs met at least one criterion for potential interaction with smoking on incident T2D at p<1x10-7 (adjusted for multiple hypothesis-testing with the IBC array). Two SNPs had significant joint effects in the overall model and significant main effects only in one smoking stratum: rs140637 (FBN1) in AA individuals had a significant main effect only among smokers, and rs1444261 (closest gene C2orf63) in EA individuals had a significant main effect only among nonsmokers. Three additional SNPs were identified as having potential interaction by exhibiting a significant main effects only in smokers: rs1801232 (CUBN) in AA individuals, rs12243326 (TCF7L2) in EA individuals, and rs4132670 (TCF7L2) in EA individuals. No SNP met significance for potential interaction with smoking on baseline FG. The identification of these loci provides evidence for genetic interactions with smoking exposure that may explain some of the heterogeneity in the association between smoking and T2D.


Assuntos
Glicemia/análise , Fumar Cigarros/genética , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Jejum/sangue , Genótipo , Adulto , Grupo com Ancestrais do Continente Africano/genética , Idoso , Fumar Cigarros/etnologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Grupo com Ancestrais do Continente Europeu/genética , Estudos de Viabilidade , Feminino , Loci Gênicos , Estudo de Associação Genômica Ampla , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Risco
5.
BMC Med Genet ; 21(1): 65, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228543

RESUMO

BACKGROUND: Several obesity susceptibility loci in genes, including GNPDA2, SH2B1, TMEM18, MTCH2, CDKAL1, FAIM2, and MC4R, have been identified by genome-wide association studies. The purpose of this study was to investigate whether these loci are associated with the concurrence of obesity and type 2 diabetes in Chinese Han patients. METHODS: Using the SNaPshot technique, we genotyped seven single nucleotide polymorphisms (SNPs) in 439 Chinese patients living in Northeast China who presented at The Second Hospital of Jilin University. We analyzed the associations between these seven alleles and clinical characteristics. RESULTS: Risk alleles near TMEM18 (rs6548238) were associated with increased waist circumference, waist/hip ratio, body mass index (BMI), fasting plasma glucose, hemoglobin A1c, diastolic blood pressure, triglycerides, total cholesterol, and low-density lipoprotein-cholesterol; risk alleles of CDKAL1 (rs7754840) were associated with increased waist circumference and waist/hip ratio; and FAIM2 (rs7138803) risk alleles were linked to increased BMI, diastolic blood pressure, and triglycerides (all P < 0.05). After adjusting for sex and age, loci near TMEM18 (rs6548238) and FAIM2 (rs7138803), but not SH2B1 (rs7498665), near GNPDA2 (rs10938397), MTCH2 (rs10838738) and near MC4R (rs12970134), were associated with increased risk for type 2 diabetes in obese individuals. CONCLUSION: We found that loci near TMEM18 (rs6548238), CDKAL1 (rs7754840), and FAIM2 (rs7138803) may be associated with obesity-related indicators, and loci near TMEM18 (rs6548238) and FAIM2 (rs7138803) may increase susceptibility of concurrent type 2 diabetes associated with obesity.


Assuntos
Proteínas Reguladoras de Apoptose/genética , Diabetes Mellitus Tipo 2/genética , Loci Gênicos , Proteínas de Membrana/genética , Obesidade/genética , tRNA Metiltransferases/genética , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/etnologia , Polimorfismo de Nucleotídeo Único , Adulto Jovem
6.
Diabetes Res Clin Pract ; 163: 108148, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32302665

RESUMO

AIMS: Hypoglycemia is one of the most important complications associated with Ramadan fasting in people with type 2 diabetes. LixiRam (NCT02941367) was the first randomized trial comparing safety and efficacy of lixisenatide + basal insulin (BI) vs. sulphonylurea + BI in people with type 2 diabetes who fast during Ramadan. This post hoc analysis focuses on the LixiRam study population from India. METHODS: Adults with type 2 diabetes insufficiently controlled with sulphonylurea + BI ± another oral anti-hyperglycemic drug were randomized 1:1 to receive lixisenatide + BI or to continue sulphonylurea + BI treatment. RESULTS: In total, 150 participants were randomized in India. One participant (1.3%) with lixisenatide + BI vs. 5 participants (6.8%) with sulphonylurea + BI experienced ≥1 documented symptomatic hypoglycemic event during the Ramadan fast (odds ratio [OR]: 0.22; 95% confidence interval [CI]: 0.02-1.93). Incidence of any hypoglycemia was numerically lower with lixisenatide + BI vs. sulphonylurea + BI during Ramadan fasting (1.3% [1/75] vs. 14.7% [11/75], respectively; OR: 0.09; 95% CI: 0.01-0.69). No new safety signals were identified. CONCLUSIONS: A combination of lixisenatide prandial GLP1-RA + BI may be a suitable treatment option for people with type 2 diabetes who elect to fast during Ramadan. Clinical Trial Registry: clinicaltrials.gov (NCT02941367).


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/epidemiologia , Hipoglicemiantes/uso terapêutico , Insulinas/uso terapêutico , Peptídeos/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Hipoglicemiantes/farmacologia , Incidência , Índia , Insulinas/farmacologia , Islamismo , Masculino , Pessoa de Meia-Idade , Peptídeos/farmacologia
7.
Womens Health Issues ; 30(3): 191-199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32340896

RESUMO

BACKGROUND: Diabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined. METHODS: This retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures-glycemic testing, glycemic control, and medication adherence-among women ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use. RESULTS: In this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar. CONCLUSIONS: Our findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Glicemia , Estudos de Coortes , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hemoglobina A Glicada , Hispano-Americanos/estatística & dados numéricos , Humanos , Adesão à Medicação/etnologia , Prevalência , Estudos Retrospectivos , Risco , Estados Unidos , Adulto Jovem
8.
Am J Cardiol ; 125(10): 1492-1499, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32245632

RESUMO

Rural residence and ethnic-minority status are individually associated with increased cardiovascular (CV) mortality. Statin therapy is known to reduce the risk of cardiovascular mortality. Although ethnic disparities in statin treatment exist, the joint impact of urban/rural residence and race/ethnicity on statin prescribing is unclear. Veterans Health Administration (VHA) and Centers for Medicare and Medicaid data were used to perform a longitudinal study of Veterans with Type 2 diabetes mellitus from 2007 to 2016. Mixed effects logistic regression with a random intercept was used to model the longitudinal association between the primary exposure (race/ethnicity and residence) and statin prescribing. After adjusting for covariates, non-Hispanic White (NHW)-Rural Veterans were 7% (odds ratio [OR] = 1.07; confidence interval [CI] 1.05 to 1.08), non-Hispanic Black (NHB)-Rural Veterans were 4% (OR 1.04; CI 1.00 to 1.08), and Hispanic-Urban Veterans were 20% (OR 1.20; CI 1.17 to 1.23) more likely to be prescribed statins versus NHW-Urban Veterans; whereas, NHB-Urban Veterans were 14% (OR 0.86; CI 0.85 to 0.55) and Hispanic-Rural Veterans were 10% (OR 0.90; CI 0.85 to 0.96) less likely. When disability and dual use were removed from the full model, compared with NHW-Urban, the odds of statin prescribing in NHW-Rural Veterans remained unchanged (OR 1.06; CI 1.04 to 1.07) whereas the odds of statin prescribing in all other groups were higher. In conclusion, NHB-Urban and Hispanic-Rural Veterans had lower odds of statin prescribing versus NHW-Urban Veterans; whereas NHW-Rural, NHB-Rural and Hispanic-Urban Veterans had higher odds. The findings in ethnic-minorities changed when we accounted for markers of VHA care (i.e., disability, dual use) showing that these individuals are more likely to receive statins when they receive more VHA care.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/etnologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Características de Residência , Veteranos , Idoso , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Medicare , Estudos Retrospectivos , Estados Unidos
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(3): 278-282, 2020 Mar 06.
Artigo em Chinês | MEDLINE | ID: mdl-32187932

RESUMO

Objective: To explore the association of dietary pattern and type 2 diabetes mellitus (T2DM) risk. Methods: In 2013, 3 747 participants from 87 coalmine branches of a large coal mine group in Datong City, Shanxi Province were selected by using a two-stage cluster stratified sampling method. Data on demographic characteristics, smoking, drinking, and family history of diabetes were collected by using a self-made questionnaire, and the International Physical Activity Questionnaire was used to assess the level of physical activity. Physical, glucose and lipid metabolism indicators were measured and subjects were divided into high-risk groups and low-risk groups of T2DM according to the T2DM risk score. Dietary data were collected by using Semi-quantitative Food Frequency Questionnaire, and dietary patterns were derived by using the exploratory factor analysis and cluster analysis. The unconditional logistic regression model was used to assess the association of dietary patterns and T2DM risk. Results: The age of the subjects was(41.48±8.62) years old, and 2 843 of them were males (84.31%). A total of 1 819 subjects were in the high-risk group and 1 553 in the low-risk group. Four dietary patterns, healthy diet, high-salt diet, meats diet, and carbohydrate-rich diet, were identified in this study. The unconditional logistic regression analysis showed that compared with the healthy diet pattern, after the adjustment of demographic characteristics, smoking, and drinking, the OR (95%CI) of T2DM risk in high-salt diet, carbohydrate-rich diet and meats diet patterns was 1.54 (1.26-1.88), 1.80 (1.43-2.28) and 1.20 (0.99-1.46), respectively. Conclusion: High-salt diet and carbohydrate-rich diet were positively associated with T2DM risk, whereas there was no association of meats diet and T2DM risk.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Dieta/efeitos adversos , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/etnologia , Inquéritos sobre Dietas , Carboidratos da Dieta , Açúcares da Dieta , Feminino , Humanos , Modelos Logísticos , Masculino , Carne , Pessoa de Meia-Idade , Fatores de Risco , Cloreto de Sódio na Dieta
10.
Angiology ; 71(6): 520-535, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32180436

RESUMO

We evaluated the association between automatically measured carotid total plaque area (TPA) and the estimated glomerular filtration rate (eGFR), a biomarker of chronic kidney disease (CKD). Automated average carotid intima-media thickness (cIMTave) and TPA measurements in carotid ultrasound (CUS) were performed using AtheroEdge (AtheroPoint). Pearson correlation coefficient (CC) was then computed between the TPA and eGFR for (1) males versus females, (2) diabetic versus nondiabetic patients, and (3) between the left and right carotid artery. Overall, 339 South Asian Indian patients with either type 2 diabetes mellitus (T2DM) or CKD, or hypertension (stage 1 or stage 2) were retrospectively analyzed by acquiring cIMTave and TPA measurements of their left and right common carotid arteries (CCA; total CUS: 678, mean age: 54.2 ± 9.8 years; 75.2% males; 93.5% with T2DM). The CC between TPA and eGFR for different scenarios were (1) for males and females -0.25 (P < .001) and -0.35 (P < .001), respectively; (2) for T2DM and non-T2DM -0.26 (P < .001) and -0.49 (P = .02), respectively, and (3) for left and right CCA -0.25 (P < .001) and -0.23 (P < .001), respectively. Automated TPA is an equally reliable biomarker compared with cIMTave for patients with CKD (with or without T2DM) with subclinical atherosclerosis.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2 , Taxa de Filtração Glomerular , Rim/fisiopatologia , Placa Aterosclerótica , Insuficiência Renal Crônica/fisiopatologia , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Pressão Sanguínea , Doenças das Artérias Carótidas/etnologia , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etnologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
11.
MMWR Morb Mortal Wkly Rep ; 69(6): 161-165, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32053581

RESUMO

Diabetes is one of the most common chronic diseases among persons aged <20 years (1). Onset of diabetes in childhood and adolescence is associated with numerous complications, including diabetic kidney disease, retinopathy, and peripheral neuropathy, and has a substantial impact on public health resources (2,3). From 2002 to 2012, type 1 and type 2 diabetes incidence increased 1.4% and 7.1%, respectively, among U.S. youths (4). To assess recent trends in incidence of diabetes in youths (defined for this report as persons aged <20 years), researchers analyzed 2002-2015 data from the SEARCH for Diabetes in Youth Study (SEARCH), a U.S. population-based registry study with clinical sites located in five states. The incidence of both type 1 and type 2 diabetes in U.S. youths continued to rise at constant rates throughout this period. Among all youths, the incidence of type 1 diabetes increased from 19.5 per 100,000 in 2002-2003 to 22.3 in 2014-2015 (annual percent change [APC] = 1.9%). Among persons aged 10-19 years, type 2 diabetes incidence increased from 9.0 per 100,000 in 2002-2003 to 13.8 in 2014-2015 (APC = 4.8%). For both type 1 and type 2 diabetes, the rates of increase were generally higher among racial/ethnic minority populations than those among whites. These findings highlight the need for continued surveillance for diabetes among youths to monitor overall and group-specific trends, identify factors driving these trends, and inform health care planning.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Incidência , Índios Norte-Americanos/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , Estados Unidos/epidemiologia , Adulto Jovem
12.
Am J Med Sci ; 359(4): 218-225, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32087942

RESUMO

BACKGROUND: This study aimed to describe the prevalence of type 2 diabetes and combinations of multiple chronic conditions (MCCs) that are leading causes of death (LCD) and confirm that disparities exist between groups based on race and sex. MATERIALS AND METHODS: We conducted a retrospective cohort study using 2012 Medicare claims data from beneficiaries with type 2 diabetes over the age of 65 in the state of Michigan. RESULTS: Female beneficiaries have type 2 diabetes and 1 or more MCCs that are LCD more often than males. Most type 2 diabetes patients have diabetes alone without MCCs, while a large proportion have at least 1 additional chronic condition that is a LCD. One in 3 patients have 3 or more chronic conditions. The most prevalent type 2 diabetes coexisting MCCs are congestive heart failure (CHF), chronic obstructive pulmonary disease and chronic kidney disease. Asian/Pacific Islanders have the highest prevalence of type 2 diabetes without MCCs, and the highest prevalence of diabetes plus CHF. While fewer black beneficiaries have diabetes alone or 1 additional MCC, the prevalence of 3 or more MCCs in blacks generally exceeds the prevalence in other races. In beneficiaries with newly diagnosed type 2 diabetes, chronic obstructive pulmonary disease and CHF are the first new chronic conditions to be diagnosed after an initial type 2 diabetes diagnosis. CONCLUSIONS: Race and sex disparities occur in the prevalence of type 2 diabetes and MCCs that are LCD in Medicare beneficiaries in the state of Michigan.


Assuntos
Doença Crônica/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/etnologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/etnologia , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Medicare/estatística & dados numéricos , Michigan/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos
13.
Arterioscler Thromb Vasc Biol ; 40(4): 1009-1015, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078369

RESUMO

OBJECTIVE: Type 2 diabetes mellitus (T2DM) is known to be related to increased arterial stiffness. However, little is known about the risk of T2DM due to accelerated arterial stiffness and the underlying mechanism involved. We aimed to examine arterial stiffness, as determined by brachial-ankle pulse wave velocity (baPWV), in relation to T2DM among a community-based population and whether the association was mediated by white blood cell (WBC) counts. Approach and results: A total of 1036 Chinese adults aged 64.3 years with complete data were qualified in the present study. The dose-response association between baPWV levels, WBC counts, and risk of T2DM were explored using generalized linear models or multivariate logistic regression models. A mediation analysis was conducted to investigate the role of WBC counts on the association between baPWV and T2DM. After multivariate adjustments, we observed a dose-responsive relationship between increased baPWV and elevated risk of T2DM: comparing extreme tertiles of baPWV, the adjusted odds ratio for T2DM risk was 2.29 (95% CI, 1.32-3.98; P for trend =0.005). In addition, significant dose-dependent relationships were found across baPWV tertiles with increasing total or differential WBC counts, which in turn, were positively related to higher risk of T2DM (all P for trend <0.05). Mediation analyses indicated that total WBC count mediated 4.5% of the association between increased baPWV and elevated T2DM risk. CONCLUSIONS: Increased arterial stiffness might increase T2DM risk among middle-aged and older Chinese adults, which was partially mediated by total WBC count.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Contagem de Leucócitos , Rigidez Vascular , Índice Tornozelo-Braço , Grupo com Ancestrais do Continente Asiático , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Análise de Onda de Pulso , Fatores de Risco
14.
Diabetes Res Clin Pract ; 161: 108037, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32004696

RESUMO

AIMS: Obesity measurement is a vital component of most type 2 diabetes screening tests; while studies had shown that waist circumference (WC) is a better predictor in South Asians, there is evidence that BMI is also effective. Our objective was to evaluate the efficacy of BMIWC, a composite measure, against BMI and WC. METHODS: Using data from a nationwide randomized cluster sample survey (NMB-2017), we analyzed 7496 adults at high risk for type 2 diabetes. WC, BMI, and BMIWC were evaluated using Odds Ratio (OR), and Classification scores (Sensitivity, Specificity, and Accuracy). These were validated using Indian Diabetes Risk Score (IDRS) by replacing WC with BMI and BMIWC, and calculating Sensitivity, Specificity, and Accuracy. RESULTS: BMIWC had higher OR (2·300) compared to WC (1·87) and BMI (2·26). WC, BMI, and BMIWC were all highly Sensitive (0·75, 0·81, 0·70 resp.). But BMIWC had significantly higher Specificity (0.36) when compared to WC and BMI (0.27 each). IDRSWC, IDRSBMI, and IDRSBMIWC were all highly Sensitive (0·87, 0·88, 0·82 resp.). But IDRSBMIWC had significantly higher Specificity (0·39) compared to IDRSWC and IDRSBMI (0·30, 0·31 resp.). CONCLUSIONS: Both WC and BMI are good predictors of risk for T2DM, but BMIWC is a better predictor, with higher Specificity; this may indicate that Indians with high values of both central (high WC) and general (BMI > 23) obesity carry higher risk for type 2 diabetes than either one in isolation. Using BMIWC in IDRS improves its performance on Accuracy and Specificity.


Assuntos
Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/etiologia , Obesidade/diagnóstico , Estado Pré-Diabético/diagnóstico , Circunferência da Cintura , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/etnologia , Estado Pré-Diabético/complicações , Estado Pré-Diabético/etnologia , Prognóstico , Fatores de Risco , Sensibilidade e Especificidade , Adulto Jovem
15.
Acta Diabetol ; 57(6): 733-741, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32025861

RESUMO

AIMS: The milk fat globule-epidermal growth factor 8 (MFGE8), also called lactadherin, is an integrin ligand and a known mediator of inflammation and atherosclerosis in T2DM in studies using animal models. However, its role in the pathophysiology of human T2DM, obesity, and cardiovascular disease has been poorly explored. Aim of this study  was to investigate the role of a missense variant (rs371227978 C/T: Arg148His) in the MFGE8 gene identified through exome sequencing for its association with T2DM and cardiometabolic traits. METHODS: Exome-wide sequencing was performed using DNA samples from 68 Sikh individuals from multi-generation pedigrees affected with diabetes on Illumina's GAIIx using "SureSelect Human All Exon" panels. We further replicated this variant by de novo genotyping in a total of 4242 individuals of the Asian Indian Diabetic Heart Study/Sikh Diabetes Study using custom TaqMan genotyping assay. We also measured circulating concentrations of Mfge8 using frozen serum aliquots by enzyme-linked immunosorbent assay. RESULTS: Overall, only 1.78% of 4242 individuals were carriers of this variant with MAF being 0.009. Except for the significant correlation of this variant with T2DM and triglycerides, no other quantitative risk phenotype was significant. The minor per allele-associated increased risk for T2DM showed odds ratio of 1.95 (95% CI 1.18-3.23; p = 0.008) in unadjusted model and was 1.73 (95% CI 1.02-2.93; p = 0.043) after adjusting for the age, gender, and BMI. However, there was a strong correlation between serum Mfge8 concentrations with T2DM, (r2 = 0.38; p = 0.001), fasting glucose (r2= 0.36; p = 0.002), and triglycerides (r2 = 0.33; p = 0.005). Our data revealed a significant dose-related increase in MFGE8 genotypes for affecting serum Mfge8 (p = 2.1 × 10-3) and triglyceride concentrations (p = 3.2 × 10-3). For a per risk allele-associated increase of 4.74 ng/ml ± SD of 1.62 ng/ml of the Mfge8 concentration was found to increase T2DM risk to 1.7 fold (95% CI from 1 to 3 fold). CONCLUSIONS: Here, we report for the first time a novel population-specific rare variant in the MFGE8 gene linked with the increased Mfge8 concentrations and the risk for developing T2DM and cardiovascular risk factors in a population of Punjabi Sikhs from India. In view of a strong evidence from animal studies supporting the role of Mfge8 in obesity, insulin resistance, and the development of atherosclerosis in T2DM, our findings are important and timely. If validated in a large independent dataset, early screening of Mfge8 in blood levels may especially benefit those patients with genetically elevated Mfge8 levels to preventing or reducing the risk of T2DM and cardiovascular disease.


Assuntos
Antígenos de Superfície/genética , Doenças Cardiovasculares/genética , Diabetes Mellitus Tipo 2/genética , Angiopatias Diabéticas/genética , Grupos Étnicos/genética , Proteínas do Leite/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Asiático/genética , Doenças Cardiovasculares/etnologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/etnologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Frequência do Gene , Estudos de Associação Genética/métodos , Predisposição Genética para Doença/etnologia , Genética Populacional , Genótipo , Humanos , Índia/epidemiologia , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Linhagem , Sequenciamento Completo do Exoma , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-32033032

RESUMO

The aim of this study was to determine whether racial differences in HbA1c persist in older adults (≥65 years) living with type 2 diabetes. Data from The National Health and Nutrition Examination Survey (NHANES) 2003-2014 were used to examine the association between HbA1c and older adults (≥65 years) over time. Compared to non-Hispanic Whites, Mexican Americans had the greatest difference in average HbA1c among minority groups, followed by those with unspecified/mixed ethnicities and non-Hispanic Blacks. In the adjusted linear model, racial minorities had a statistically significant relationship with HbA1c. There was no relationship between HbA1c and older age and insulin use. Trends in mean HbA1c over time increased for non-Hispanic Blacks and Mexican Americans and decreased for non-Hispanic Whites. The findings suggest that racial differences in HbA1c persist into older age and compared to non-Hispanic Whites, non-Hispanic Blacks and Mexican Americans are at an increased risk of morbidity, mortality, and disability due to high HbA1c. Furthermore, alternate measures of glycemic control may be needed to screen and manage T2DM in racial minorities.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Hemoglobina A Glicada/metabolismo , Idoso , Idoso de 80 Anos ou mais , Glicemia , Grupos de Populações Continentais , Diabetes Mellitus Tipo 2/sangue , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Grupos Minoritários , Inquéritos Nutricionais , Estados Unidos/epidemiologia
17.
Curr Diab Rep ; 20(1): 4, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32002674

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to summarize our current knowledge of factors that influence clinical decision making and management of type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) among South Asians (SA). RECENT FINDINGS: ASCVD and T2DM in SAs have been examined in recent times. Pathophysiologic and genetic factors including the role of adiponectin, visceral adiposity, lower beta cell function, and psycho-social factors like sedentary lifestyle, poor adherence to medications, and carbohydrate dense meals play a role in early development and the high-risk presentation of both ASCVD and T2DM in SA. Recently, large population-based cohort studies have attempted to compare outcomes and interventions that can be translated to timely detection and targeted interventions in this high-risk group. SAs in the USA are more likely to be diagnosed with T2DM and ASCVD when compared to non-Hispanic whites, non-Hispanic Blacks, and Hispanic populations. The development of personalized ethnic risk assessment tools and better representation of SAs in prospective studies are essential to increasing our understanding and management of cardio-metabolic disease in SA living in the USA.


Assuntos
Americanos Asiáticos , Aterosclerose/etnologia , Diabetes Mellitus Tipo 2/etnologia , Ásia Ocidental/etnologia , Aterosclerose/epidemiologia , Aterosclerose/etiologia , Aterosclerose/terapia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/terapia , Tomada de Decisão Clínica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Humanos , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia
18.
Diabetes Res Clin Pract ; 160: 108006, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923438

RESUMO

AIMS: To characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis. METHODS: An observational cohort study of 179,886 people with incident type 2 diabetes between 2004 and 2017 in the Clinical Practice Research Datalink was undertaken; 63.4% of the cohort were of white ethnicity, 3.9% south Asian, and 1.6% black. Ethnic differences in clinical profile at diagnosis, consultation rates, and risk factor recording were derived from linear and logistic regression. Cox-proportional hazards regression was used to determine ethnic differences in time to initiation of therapeutic and non-therapeutic management following diagnosis. All analyses adjusted for age, sex, deprivation, and clustering by practice. RESULTS: In the 12 months prior to diagnosis, non-white groups had fewer consultations compared to white groups, but risk factor recording was better than or equivalent to white groups for 9/10 risk factors for south Asian groups and 8/10 risk factors for black groups (p < 0.002). Blood pressure, BMI, cholesterol, eGFR, and CVD risk levels were more favourable in non-white groups, and prevalence of macrovascular disease was significantly lower (p < 0.003). Time to initiation of antidiabetic treatment and first risk assessment was faster in non-white groups relative to white groups, while time to risk factor measurement and diabetes review was slower. CONCLUSIONS: We find limited evidence of systematic ethnic inequalities around the time of type 2 diabetes diagnosis. Ethnic disparities in downstream consequences may relate to genetic risk factors, or manifest later in the care pathway, potentially in relation to long-term risk factor control.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Grupos Étnicos/estatística & dados numéricos , Hipoglicemiantes/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Estudos de Coortes , Feminino , Humanos , Hipoglicemiantes/farmacologia , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Reino Unido
19.
Nurs Res ; 69(3): 210-218, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31972848

RESUMO

BACKGROUND: Although scientific reports increasingly document the negative impact of inadequate health literacy on health-seeking behaviors, health literacy's effect on health outcomes in patients with diabetes is not entirely clear, owing to insufficient empirical studies, mixed findings, and insufficient longitudinal research. OBJECTIVE: The aim of this study was to empirically examine underlying mechanisms of health literacy's role in diabetes management among a group of Korean Americans with Type 2 diabetes mellitus. METHODS: Data from a randomized clinical trial of a health literacy-focused Type 2 diabetes self-management intervention conducted during 2012-2016 in the Korean American community were collected at baseline and at 3, 6, 9, and 12 months. A total of 250 Korean Americans with Type 2 diabetes participated (intervention, 120; control, 130). Participants were first-generation Korean American immigrants. Health literacy knowledge was measured with the original Rapid Estimate of Adult Literacy in Medicine and the diabetes mellitus-specific Rapid Estimate of Adult Literacy in Medicine. Functional health literacy was measured with the numeracy subscale of the Test of Functional Health Literacy in Adults and the Newest Vital Sign screening instrument, which also uses numeracy. Primary outcomes included glucose control and diabetes quality of life. Multivariate analyses included latent variable modeling. RESULTS: A series of path analyses identified self-efficacy and self-care skills as significant mediators between health literacy and glucose control and quality of life. Education and acculturation were the most significant correlates of health literacy. DISCUSSION: Despite inconsistent findings in the literature, this study indicates that health literacy may indirectly influence health outcomes through mediators such as self-care skills and self-efficacy. The study highlights the importance of health literacy, as well as underlying mechanisms with which health literacy influences processes and outcomes of diabetes self-management.


Assuntos
Americanos Asiáticos , Serviços de Saúde Comunitária , Diabetes Mellitus Tipo 2/etnologia , Letramento em Saúde/estatística & dados numéricos , Autocuidado , Idoso , Americanos Asiáticos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
Med Care ; 58(1): 59-64, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31688551

RESUMO

INTRODUCTION: Hypertension, hypercholesterolemia, and type II diabetes are leading cardiovascular risk factors in the United States, and Latinos are disproportionately burdened by these chronic health conditions. The extent to which Latinos overall and by language spoken at home report health behavior modification following diagnosis is poorly understood. METHODS: Our inclusion criteria included participants sampled in the 2011-2016 waves of the National Health and Nutrition Examination Survey who self-identified as Latinos, were 20 years of age or above, and reported a diagnosis of hypertension, hypercholesterolemia or diabetes (N=2027). We examined associations between the language spoken at home and report of adoption of 3 recommended health behaviors in the past year: weight loss, leisure-time physical activity (LTPA) and smoking cessation. Separate log-binomial models were fit to estimate prevalence ratios (PRs) for each health behavior. RESULTS: Approximately one third (28%) of study participants had been diagnosed with diabetes and more than half reported a diagnosis of hypercholesterolemia (65%) or hypertension (60%). Most Latinos met the highest levels of smoking cessation criteria (82%), whereas less than a third met LTPA recommendations (29%) or attempted weight loss (24%) in the past year. Fully adjusted outcome specific models showed that exclusively speaking English at home was associated with a higher probability of reporting weight loss attempt and LTPA compared with Spanish only speakers, although only LTPA was statistically significant [weight loss PR: 1.23, 95% confidence interval (CI): 0.92, 1.65; LTPA PR: 1.74; 95% CI: 1.37, 2.20; smoking cessation PR: 0.93, 95% CI: 0.86, 1.01]. CONCLUSIONS: Our findings provide new evidence on patterns of behavioral modification in a population-based sample of Latinos diagnosed with chronic health conditions. Findings suggest the need to promote language and culturally relevant initiatives to increase the adoption of health-enhancing behaviors and improve chronic disease management among Spanish-speaking Latinos.


Assuntos
Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/psicologia , Comportamentos Relacionados com a Saúde , Hispano-Americanos/psicologia , Comportamento de Redução do Risco , Adulto , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/etnologia , Hipercolesterolemia/psicologia , Hipertensão/complicações , Hipertensão/etnologia , Hipertensão/psicologia , Masculino , Inquéritos Nutricionais , Fatores de Risco , Estados Unidos , Adulto Jovem
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