Dataset Information

Determinants of Long-Term Durable Glycemic Control in New-Onset Type 2 Diabetes Mellitus.

ABSTRACT:

Background

Long-term durable glycemic control is a difficult goal in the management of type 2 diabetes mellitus (T2DM). We evaluated the factors associated with durable glycemic control in a real clinical setting.

Methods

We retrospectively reviewed the medical records of 194 new-onset, drug-naïve patients with T2DM who were diagnosed between January 2011 and March 2013, and were followed up for >2 years. Glycemic durability was defined as the maintenance of optimal glycemic control (glycosylated hemoglobin [HbA1c] <7.0%) for 2 years without substitution or adding other glucose-lowering agents. Clinical factors and glycemic markers associated with glycemic durability were compared between two groups: a durability group and a non-durability group.

Results

Patients in the durability group had a higher baseline body mass index (26.1 kg/m² vs. 24.9 kg/m²) and lower HbA1c (8.6% vs. 9.7%) than the non-durability group. The initial choice of glucose-lowering agents was similar in both groups, except for insulin and sulfonylureas, which were more frequently prescribed in the non-durability group. In multiple logistic regression analyses, higher levels of education, physical activity, and homeostasis model assessment of β-cell function (HOMA-β) were associated with glycemic durability. Notably, lower HbA1c (<7.0%) at baseline and first follow-up were significantly associated with glycemic durability (adjusted odds ratio [OR], 7.48; 95% confidence interval [CI], 2.51 to 22.3) (adjusted OR, 9.27; 95% CI, 1.62 to 53.1, respectively), after adjusting for confounding variables including the types of glucose-lowering agents.

Conclusion

Early achievement of HbA1c level within the glycemic target was a determinant of long-term glycemic durability in new-onset T2DM, as were higher levels of education, physical activity, and HOMA-β.

SUBMITTER: Kim KJ

PROVIDER: S-EPMC5583406 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Determinants of Long-Term Durable Glycemic Control in New-Onset Type 2 Diabetes Mellitus.

Kim Kyoung Jin KJ Choi Ju Hee JH Kim Kyeong Jin KJ An Jee Hyun JH Kim Hee Young HY Kim Sin Gon SG Kim Nam Hoon NH

Diabetes & metabolism journal 20170801 4

<h4>Background</h4>Long-term durable glycemic control is a difficult goal in the management of type 2 diabetes mellitus (T2DM). We evaluated the factors associated with durable glycemic control in a real clinical setting.<h4>Methods</h4>We retrospectively reviewed the medical records of 194 new-onset, drug-naïve patients with T2DM who were diagnosed between January 2011 and March 2013, and were followed up for >2 years. Glycemic durability was defined as the maintenance of optimal glycemic contr ...[more]

PMID: 28868826

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Project description:BackgroundPoor glycemic control is associated with increased risk of cardiovascular disease (CVD) in type 1 diabetes mellitus (T1DM); however, little is known about mechanisms specific to T1DM. In T1DM, myocardial injury can induce persistent cardiac autoimmunity. Chronic hyperglycemia causes myocardial injury, raising the possibility that hyperglycemia-induced cardiac autoimmunity could contribute to long-term CVD complications in T1DM.MethodsWe measured the prevalence and profiles of cardiac autoantibodies (AAbs) in longitudinal samples from the DCCT (Diabetes Control and Complications Trial) in participants with mean hemoglobin A1c (HbA1c) ≥9.0% (n=83) and ≤7.0% (n=83) during DCCT. We assessed subsequent coronary artery calcification (measured once during years 7-9 in the post-DCCT EDIC [Epidemiology of Diabetes Interventions and Complications] observational study), high-sensitivity C-reactive protein (measured during EDIC years 4-6), and CVD events (defined as nonfatal myocardial infarction, stroke, death resulting from CVD, heart failure, or coronary artery bypass graft) over a 26-year median follow-up. Cardiac AAbs were also measured in matched patients with type 2 diabetes mellitus with HbA1c ≥9.0% (n=70) and ≤7.0% (n=140) and, as a control for cardiac autoimmunity, patients with Chagas cardiomyopathy (n=51).ResultsApart from HbA1c levels, the DCCT groups shared similar CVD risk factors at the beginning and end of DCCT. The DCCT HbA1c ≥9.0% group showed markedly higher cardiac AAb levels than the HbA1c ≤7.0% group during DCCT, with a progressive increase and decrease in AAb levels over time in the 2 groups, respectively ( P<0.001). In the HbA1c ≥9.0% group, 46%, 22%, and 11% tested positive for ≥1, ≥2, and ≥3 different cardiac AAb types, respectively, similar to patients with Chagas cardiomyopathy, compared with 2%, 1%, and 0% in the HbA1c ≤7.0% group. Glycemic control was not associated with AAb prevalence in type 2 diabetes mellitus. Positivity for ≥2 AAbs during DCCT was associated with increased risk of CVD events (4 of 6; hazard ratio, 16.1; 95% CI, 3.0-88.2) and, in multivariable analyses, with detectable coronary artery calcification (13 of 31; odds ratio, 60.1; 95% CI, 8.4-410.0). Patients with ≥2 AAbs subsequently also showed elevated high-sensitivity C-reactive protein levels (6.0 mg/L versus 1.4 mg/L in patients with ≤1 AAbs; P=0.003).ConclusionsPoor glycemic control is associated with cardiac autoimmunity in T1DM. Furthermore, cardiac AAb positivity is associated with an increased risk of CVD decades later, suggesting a role for autoimmune mechanisms in the development of CVD in T1DM, possibly through inflammatory pathways.

Project description:Background:Over the past two decades, the prevalence of diabetes has increased faster in low- and middle-income countries than in high-income countries. Regardless of the instant growth in the prevalence of diabetes in Ethiopia, up-to-date data regarding glycemic control and related complications of diabetes is inadequate. This study aimed to identify glycemic control and chronic complications and their determinants among ambulatory diabetic patients at Mizan-Tepi University Teaching Hospital (MTUTH). Methods:We conducted facility-based cross-sectional study from February 25 to March 25, 2019, at Mizan-Tepi University Teaching Hospital. Patients' demographic data, diabetes complications, and treatments were collected using pretested questionnaire and data abstraction format. Data was entered by using Epidata manager 4.0.2.101, and statistical analysis was done by SPSS version 21. Bivariate logistic regression was done to see the association between independent variables and glycemic control and complication. Multivariable logistic regression analyses using backward selection were done to identify the predictors of poor glycemic control and complication at a P-value of <0.05. Results:One hundred ambulatory diabetic patients were included in this study. The mean duration of diabetes and the mean age of the participants were 3.95±5.85 and 46.66±15.53 years, respectively. About 71 (71%) of the studied diabetic patients had uncontrolled fasting blood glucose (FBG) level. More than half of the diabetic patients (59%) developed chronic complications of diabetes. Low medication adherence (adjusted odds ratio (AOR)=11.78, 95%CI: 1.09-17.17) and inappropriate doses in the first, second, and third clinic visits (AOR=7.70, 95%CI: 1.79-33.01; AOR=8.09, 95%CI: 1.90-34.33; AOR=4.34, 95%CI: 1.09-17.17), respectively, were independent predictors of uncontrolled FBG. No variable was found to be an independent predictor of chronic diabetic complication on multivariable logistic regression analyses. Conclusion:Poor glycemic control and diabetes complications among ambulatory diabetic patients were high. Low medication adherence and inappropriate doses in the first, second, and third clinic visits were independent predictors of poor glycemic control.

Project description:ImportanceEvidence suggests that trauma-related mortality and morbidities may follow a multiphasic pattern, with outcomes extending beyond hospital discharge.ObjectivesTo determine the incidence of having new mental health conditions after the first (or index) trauma admission and their association with long-term health outcomes.Design, setting, and participantsThis population-based, linked-data cohort study was conducted between January 1994 and September 2020, with data analyzed in April 2024. Participants were adult patients with trauma admitted to 1 of the 5 adult trauma hospitals in Western Australia. All patients with major trauma with an Injury Severity Score (ISS) greater than 15 were included. For each patient with major trauma, 2 patients with trauma with a lower ISS (<16) were randomly selected.ExposureA new mental health condition recorded in either subsequent public or private hospitalizations after trauma admission.Main outcomes and measuresThe primary outcomes were the associations between new mental health conditions after trauma and subsequent risks of trauma readmission, suicide, and all-cause mortality, as determined by Cox proportional hazards regression. Logistic regression was used to determine which factors were associated with developing a new mental health condition after trauma.ResultsOf 29 191 patients (median [IQR] age, 42 [27-65] years; 19 383 male [66.4%]; median [IQR] ISS, 9 [5-16]; 9405 with ISS >15 and 19 786 with ISS <16) considered, 2233 (7.6%) had a mental health condition before their trauma admissions. The median (IQR) follow-up time after the index trauma admission was 99.8 (61.2-148.5) months. Of 26 958 patients without a prior mental health condition, 3299 (11.3%) developed a mental health condition subsequently, including drug dependence (2391 patients [8.2%], with 419 patients [1.4%] experiencing opioid dependence) and neurotic disorders (1574 patients [5.4%]), including posttraumatic stress disorder. Developing a new mental health condition after trauma was associated with subsequent trauma readmissions (adjusted hazard ratio [aHR], 1.30; 95% CI, 1.23-1.37; P < .001), suicides (aHR, 3.14; 95% CI, 2.00-4.91; P < .001), and all-cause mortality (aHR, 1.24; 95% CI, 1.12-1.38; P < .001). Younger age, unemployment, being single or divorced (vs married), Indigenous ethnicity, and a lower socioeconomic status were all associated with developing a new mental health condition after the first trauma admission.Conclusions and relevanceThis cohort study of 29 191 patients with trauma found that mental health conditions after trauma were common and associated with an increased risk of adverse long-term outcomes, indicating that mental health follow-up of patients with trauma, particularly those from vulnerable subgroups, may be warranted.

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Dataset Information

Determinants of Long-Term Durable Glycemic Control in New-Onset Type 2 Diabetes Mellitus.

Background

Methods

Results

Conclusion

Publications

Determinants of Long-Term Durable Glycemic Control in New-Onset Type 2 Diabetes Mellitus.

Similar Datasets

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