Diabetes incidence in Austria: The role of famines on diabetes and related NCDs.
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ABSTRACT:
SUBMITTER: Kaleta M
PROVIDER: S-EPMC10395033 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
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Diabetes incidence in Austria: The role of famines on diabetes and related NCDs.
Kaleta Michaela M Leutner Michael M Thurner Stefan S Kautzky Alexander A Endel Gottfried G Kiss Noemi N Robausch Martin M Kautzky-Willer Alexandra A Klimek Peter P
Heliyon 20230628 7
Undernutrition in early life associates with increased risk for type 2 diabetes in later life. Whether similar associations hold for other diseases remains unclear. We aim to quantify how perinatal exposure to famines relates to the risk of becoming incident with type 2 diabetes in later life. Using population-wide medical claims data for Austrians aged >50y, yearly diabetes incidence was measured in an epidemiological progression model. We find incidence rates that increase from 2013 to 2017 an ...[more]
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Project description:This study aims to quantify whether age and sex groups in Austrian regions are equally affected by the rise of type 2 diabetes. Population-wide medical claims data was obtained for citizens in Austria aged above 50 year, who received antihyperglycemic treatments or underwent HbA1c monitoring between 2012 and 2017. Diabetes incidence was measured using an epidemiological diabetes progression model accounting for patients who discontinued antihyperglycemic therapy; the erratic group. Out of 746,184 patients, 268,680 (140,960 females) discontinued their treatment and/or monitoring for at least one year. Without adjusting for such erratic patients, incidence rates increase from 2013 to 2017 (females: from 0·5% to 1·1%, males: 0·5% to 1·2%), whereas they decrease in all groups after adjustments (females: - 0·3% to - 0·5%, males: - 0·4% to - 0·5%). Higher mortality was observed in the erratic group compared to patients on continued antihyperglycemic therapy (mean difference 12% and 14% for females and males, respectively). In summary, incidence strongly depends on age, sex and place of residency. One out of three patients with diabetes in Austria discontinued antihyperglycemic treatment or glycemic monitoring for at least one year. This newly identified subgroup raises concern regarding adherence and continuous monitoring of diabetes care and demands further evaluation.
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Project description:European farm households will face increasingly challenging conditions in the coming decades due to climate change, as the frequency and severity of extreme weather events rise. This study assesses the complex interrelations between external framework conditions such as climate change or adjustments in the agricultural price and subsidy schemes with farmers' decision-making. As social aspects remain understudied drivers for agricultural decisions, we also consider value-based characteristics of farmers as internal factors relevant for decision-making. We integrate individual learning as response to extreme weather events into an agent-based model that simulates farmers' decision-making. We applied the model to a region in Eastern Austria that already experiences water scarcity and increasing drought risk from climate change and simulated three future scenarios to compare the effects of changes in socio-economic and climatic conditions. In a cross-comparison, we then investigated how farmers can navigate these changes through individual adaptation. The agricultural trajectories project a decline of active farms between -27 and -37% accompanied by a reduction of agricultural area between -20 and -30% until 2053. The results show that regardless of the scenario conditions, adaptation through learning moderates the decline in the number of active farms and farmland compared to scenarios without adaptive learning. However, adaptation increases the workload of farmers. This highlights the need for labor support for farms.Supplementary informationThe online version contains supplementary material available at 10.1007/s13593-023-00890-z.
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Project description:Aim/introductionAlthough immune checkpoint inhibitor-related type 1 diabetes mellitus (ICI-T1DM) is a rare condition, it is of significant concern globally. We aimed to elucidate the precise incidence, risk factors, and impact of ICI-T1DM on survival outcomes.Materials and methodsThe study is a large retrospective cohort study, performed using the DeSC Japanese administrative claims database comprising 11 million patients. The database population is reportedly similar to the entire population of Japan. Patients administered ICI between 2014 and 2022 were enrolled in the study, including 21,121 patients. The risk factors for ICI-T1DM development and their characteristics were evaluated by logistic regression analysis. Development of a new irAE after the day following the first administration of ICI was set as the study outcome.ResultsICI-T1DM was observed in 102 (0.48%) of the 21,121 patients after ICI initiation. PD-(L)1 and CTLA-4 combination therapy was associated with an increased risk of ICI-T1DM compared with PD-1 monotherapy (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.21-4.58; P = 0.01). Patients with a prior diagnosis of diabetes mellitus (OR, 1.59; 95% CI, 1.03-2.46; P = 0.04) or hypothyroidism (OR, 2.48; 95% CI, 1.39-4.43; P < 0.01) also exhibited an increased risk of ICI-T1DM. The Kaplan-Meier analysis revealed that patients with ICI-T1DM showed higher survival rates than those without (log-lank test, P < 0.01). Multivariable Cox regression analysis demonstrated that ICI-T1DM development was associated with lower mortality (hazard ratio, 0.60; 95% CI, 0.37-0.99; P = 0.04).ConclusionsCollectively, the results of this study demonstrate the precise incidence and risk factors of ICI-T1DM. The development of ICI-T1DM, like other irAEs, is associated with higher survival rates.
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Project description:Melatonin is a circulating hormone that is mainly released from the pineal gland. It is best known as a regulator of seasonal and circadian rhythms, its levels being high during the night and low during the day. Interestingly, insulin levels are also adapted to day/night changes through melatonin-dependent synchronization. This regulation may be explained by the inhibiting action of melatonin on insulin release, which is transmitted through both the pertussis-toxin-sensitive membrane receptors MT(1) and MT(2) and the second messengers 3',5'-cyclic adenosine monophosphate, 3',5'-cyclic guanosine monophosphate and inositol 1,4,5-trisphosphate. Melatonin may influence diabetes and associated metabolic disturbances not only by regulating insulin secretion, but also by providing protection against reactive oxygen species, since pancreatic β-cells are very susceptible to oxidative stress because they possess only low-antioxidative capacity. On the other hand, in several genetic association studies, single nucleotide polymorphysms of the human MT(2) receptor have been described as being causally linked to an elevated risk of developing type 2 diabetes. This suggests that these individuals may be more sensitive to the actions of melatonin, thereby leading to impaired insulin secretion. Therefore, blocking the melatonin-induced inhibition of insulin secretion may be a novel therapeutic avenue for type 2 diabetes.
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