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Original Articles
- Complications
- To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study
- Jinxiao Lian, Ching So, Sarah Morag McGhee, Thuan-quoc Thach, Cindy Lo Kuen Lam, Colman Siu Cheung Fung, Alfred Siu Kei Kwong, Jonathan Cheuk Hung Chan
- Received March 21, 2024 Accepted July 24, 2024 Published online October 31, 2024
- DOI: https://doi.org/10.4093/dmj.2024.0142 [Epub ahead of print]
- 519 View
- 27 Download
-
Abstract
PDF
Supplementary Material
PubReader 
ePub - Background
The optimal screening interval for diabetic retinopathy (DR) remains controversial. This study aimed to develop a risk algorithm to predict the individual risk of referable sight-threatening diabetic retinopathy (STDR) in a mainly Chinese population and to provide evidence for risk-based screening intervals.
Methods
The retrospective cohort data from 117,418 subjects who received systematic DR screening in Hong Kong between 2010 and 2016 were included to develop and validate the risk algorithm using a parametric survival model. The risk algorithm can be used to predict the individual risk of STDR within a specific time interval, or the time to reach a specific risk margin and thus to allocate a screening interval. The calibration performance was assessed by comparing the cumulative STDR events versus predicted risk over 2 years, and discrimination by using receiver operative characteristics (ROC) curve.
Results
Duration of diabetes, glycosylated hemoglobin, systolic blood pressure, presence of chronic kidney disease, diabetes medication, and age were included in the risk algorithm. The validation of prediction performance showed that there was no significant difference between predicted and observed STDR risks in males (5.6% vs. 5.1%, P=0.724) or females (4.8% vs. 4.6%, P=0.099). The area under the receiver operating characteristic curve was 0.80 (95% confidence interval [CI], 0.78 to 0.81) for males and 0.81 (95% CI, 0.79 to 0.83) for females.
Conclusion
The risk algorithm has good prediction performance for referable STDR. Using a risk-based screening interval allows us to allocate screening visits disproportionally more to those at higher risk, while reducing the frequency of screening of lower risk people.
- Cardiovascular Risk/Epidemiology
- Prognostic Value of Plasma Endothelin-1 in Predicting Worse Outcomes in Patients with Prediabetes and Diabetes and Stable Coronary Artery Diseases
- Cheng Yang, Cheng-Gang Zhu, Yuan-Lin Guo, Na-Qiong Wu, Qian Dong, Rui-Xia Xu, Yong-Jian Wu, Jie Qian, Jian-Jun Li
- Diabetes Metab J. 2024;48(5):993-1002. Published online August 21, 2024
- DOI: https://doi.org/10.4093/dmj.2023.0410
- 1,275 View
- 132 Download
-
Abstract
PDFSupplementary MaterialPubReader ePub
- Background
Endothelin-1 (ET-1) is an endogenous vasoconstrictor implicated in coronary artery disease (CAD) and diabetes. This study aimed to determine the prognostic value of ET-1 in the patients with stable CAD under different glucose metabolism states.
Methods
In this prospective, large-cohort study, we consecutively enrolled 7,947 participants with angiography-diagnosed stable CAD from April 2011 to April 2017. Patients were categorized by baseline glycemic status into three groups (normoglycemia, prediabetes, and diabetes) and further divided into nine groups by circulating ET-1 levels. Patients were followed for the occurrence of cardiovascular events (CVEs), including nonfatal myocardial infarction, stroke, and cardiovascular mortality.
Results
Of the 7,947 subjects, 3,352, 1,653, and 2,942 had normoglycemia, prediabetes, and diabetes, respectively. Over a median follow-up of 37.5 months, 381 (5.1%) CVEs occurred. The risk for CVEs was significantly higher in patients with elevated ET-1 levels after adjustment for potential confounders. When patients were categorized by both status of glucose metabolism and plasma ET-1 levels, the high ET-1 levels were associated with higher risk of CVEs in prediabetes (adjusted hazard ratio [HR], 2.089; 95% confidence interval [CI], 1.151 to 3.793) and diabetes (adjusted HR, 2.729; 95% CI, 1.623 to 4.588; both P<0.05).
Conclusion
The present study indicated that baseline plasma ET-1 levels were associated with the prognosis in prediabetic and diabetic patients with stable CAD, suggesting that ET-1 may be a valuable predictor in CAD patients with impaired glucose metabolism.
- COVID-19
-
- Independent Impact of Diabetes on the Severity of Coronavirus Disease 2019 in 5,307 Patients in South Korea: A Nationwide Cohort Study
- Sun Joon Moon, Eun-Jung Rhee, Jin-Hyung Jung, Kyung-Do Han, Sung-Rae Kim, Won-Young Lee, Kun-Ho Yoon
- Diabetes Metab J. 2020;44(5):737-746. Published online October 21, 2020
- DOI: https://doi.org/10.4093/dmj.2020.0141
- 11,877 View
- 209 Download
- 27 Web of Science
- 25 Crossref
-
Abstract
PDFSupplementary MaterialPubReader ePub
- Background
Inconsistent results have been observed regarding the independent effect of diabetes on the severity of coronavirus disease 2019 (COVID-19). We conducted a nationwide population-based cohort study to evaluate the relationship between diabetes and COVID-19 severity in South Korea.
Methods
Patients with laboratory-confirmed COVID-19 aged ≥30 years were enrolled and medical claims data were obtained from the Korean Health Insurance Review and Assessment Service. Hospitalization, oxygen treatment, ventilator application, and mortality were assessed as severity outcomes. Multivariate logistic regression analyses were performed after adjusting for age, sex, and comorbidities.
Results
Of 5,307 COVID-19 patients, the mean age was 56.0±14.4 years, 2,043 (38.5%) were male, and 770 (14.5%) had diabetes. The number of patients who were hospitalized, who received oxygen, who required ventilator support, and who died was 4,986 (94.0%), 884 (16.7%), 121 (2.3%), and 211 (4.0%), respectively. The proportion of patients with diabetes in the abovementioned outcome groups was 14.7%, 28.1%, 41.3%, 44.6%, showing an increasing trend according to outcome severity. In multivariate analyses, diabetes was associated with worse outcomes, with an adjusted odds ratio (aOR) of 1.349 (95% confidence interval [CI], 1.099 to 1.656; P=0.004) for oxygen treatment, an aOR of 1.930 (95% CI, 1.276 to 2.915; P<0.001) for ventilator use, and an aOR of 2.659 (95% CI, 1.896 to 3.729; P<0.001) for mortality.
Conclusion
Diabetes was associated with worse clinical outcomes in Korean patients with COVID-19, independent of other comorbidities. Therefore, patients with diabetes and COVID-19 should be treated with caution. -
Citations
Citations to this article as recorded by
- Reasons for Hospitalization Among Australians With Type 1 or Type 2 Diabetes and COVID-19
Dunya Tomic, Jonathan E. Shaw, Dianna J. Magliano
Canadian Journal of Diabetes.2024; 48(1): 53. CrossRef - Mortality-related risk factors of inpatients with diabetes and COVID-19: A multicenter retrospective study in Belgium
Thomas Servais, France Laurent, Thomas Roland, Camelia Rossi, Elodie De Groote, Valérie Godart, Ernestina Repetto, Michel Ponchon, Pascale Chasseur, Laurent Crenier, Sandrine Van Eeckhoudt, John Yango, Philippe Oriot, Mirela Morisca Gavriliu, Stéphanie Ro
Annales d'Endocrinologie.2024; 85(1): 36. CrossRef - Factors Associated with Length of Hospitalization in Patients with Diabetes and Mild COVID-19: Experiences from a Tertiary University Center in Serbia
Vojislav M. Ciric, Natasa Krsto Rancic, Milica M. Pesic, Danijela B. Radojkovic, Nikola Milenkovic
Medicina.2024; 60(5): 788. CrossRef - Association of ABO genetic Polymorphisms and Type 2 Diabetes Mellitus Susceptibility in the Korean Population
Yu-Na Kim, Sung Won Lee, Sangwook Park
Biomedical Science Letters.2024; 30(2): 65. CrossRef - Impact of COVID-19 on the Microbiome and Inflammatory Status of Type 2 Diabetes Patients
Gratiela Gradisteanu Pircalabioru, Georgiana Alexandra Grigore, Ilda Czobor Barbu, Mariana-Carmen Chifiriuc, Octavian Savu
Biomedicines.2023; 11(1): 179. CrossRef - Bidirectional Relationship between Glycemic Control and COVID-19 and Perspectives of Islet Organoid Models of SARS-CoV-2 Infection
Tongran Zhang, Nannan Wang, Lingqiang Zhu, Lihua Chen, Huisheng Liu
Biomedicines.2023; 11(3): 856. CrossRef - Anti-SARS-CoV-2 antibody levels predict outcome in COVID-19 patients with type 2 diabetes: a prospective cohort study
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Scientific Reports.2023;[Epub] CrossRef - Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations
Dan Ziegler, Solomon Tesfaye, Vincenza Spallone, Irina Gurieva, Juma Al Kaabi, Boris Mankovsky, Emil Martinka, Gabriela Radulian, Khue Thy Nguyen, Alin O Stirban, Tsvetalina Tankova, Tamás Varkonyi, Roy Freeman, Péter Kempler, Andrew JM Boulton
Diabetes Research and Clinical Practice.2022; 186: 109063. CrossRef - The Role of Diabetes and Hyperglycemia on COVID-19 Infection Course—A Narrative Review
Evangelia Tzeravini, Eleftherios Stratigakos, Chris Siafarikas, Anastasios Tentolouris, Nikolaos Tentolouris
Frontiers in Clinical Diabetes and Healthcare.2022;[Epub] CrossRef - The Interrelationship between Diabetes Mellitus and COVID-19
Thekra Abdulaali Abed, Zainab Adil Ghani Chabuck
Medical Journal of Babylon.2022; 19(1): 1. CrossRef - Impact of Type 2 Diabetes Mellitus on the Incidence and Outcomes of COVID-19 Needing Hospital Admission According to Sex: Retrospective Cohort Study Using Hospital Discharge Data in Spain, Year 2020
Jose M. de Miguel-Yanes, Rodrigo Jimenez-Garcia, Javier de Miguel-Diez, Valentin Hernández-Barrera, David Carabantes-Alarcon, Jose J. Zamorano-Leon, Ricardo Omaña-Palanco, Ana Lopez-de-Andres
Journal of Clinical Medicine.2022; 11(9): 2654. CrossRef - Diabetes Fact Sheet in Korea 2021
Jae Hyun Bae, Kyung-Do Han, Seung-Hyun Ko, Ye Seul Yang, Jong Han Choi, Kyung Mook Choi, Hyuk-Sang Kwon, Kyu Chang Won
Diabetes & Metabolism Journal.2022; 46(3): 417. CrossRef - The burden and risks of emerging complications of diabetes mellitus
Dunya Tomic, Jonathan E. Shaw, Dianna J. Magliano
Nature Reviews Endocrinology.2022; 18(9): 525. CrossRef - Clinical Characteristics and Outcomes of Patients Hospitalized with COVID-19 at Case Hospital, Uganda
Mirriam Apiyo, Ronald Olum, Amina Kabuye, Betty Khainza, Anne M. Amate, Vittal Byabashaija, Derrick Nomujuni, Kato Sebbaale, Peter Senfuka, Simon Kazibwe, Gurav Sharma, Lindsay Davidson, Felix Bongomin, Diamantis Kofteridis
Interdisciplinary Perspectives on Infectious Diseases.2022; 2022: 1. CrossRef - Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning
Daniel J. Drucker
Cell Metabolism.2021; 33(3): 479. CrossRef - Effects of a DPP-4 Inhibitor and RAS Blockade on Clinical Outcomes of Patients with Diabetes and COVID-19
Sang Youl Rhee, Jeongwoo Lee, Hyewon Nam, Dae-Sung Kyoung, Dong Wook Shin, Dae Jung Kim
Diabetes & Metabolism Journal.2021; 45(2): 251. CrossRef - COVID-19 vaccine acceptance among high-risk populations in Uganda
Felix Bongomin, Ronald Olum, Irene Andia-Biraro, Frederick Nelson Nakwagala, Khalid Hudow Hassan, Dianah Rhoda Nassozi, Mark Kaddumukasa, Pauline Byakika-Kibwika, Sarah Kiguli, Bruce J. Kirenga
Therapeutic Advances in Infectious Disease.2021;[Epub] CrossRef - Caracterización clínica, según niveles de glucemia, de pacientes hospitalizados por COVID-19: serie de casos
Irene Stulin, Maria Montes de Oca, Gabriela Blanco, Laura Sánchez, Isabel-Carlota Silva, Jennireth Quevedo, Maria Cristina Arvelo, Nathalia Valera, Irene Papa, Hospital Centro Médico de Caracas, Caracas, Venezuela Bacci, Fátima de Abreu, Héctor Villarroel
Investigación Clínica.2021; 62: 27. CrossRef - COVID-19 Vaccination for Endocrine Patients: A Position Statement from the Korean Endocrine Society
Cheol Ryong Ku, Kyong Yeun Jung, Chang Ho Ahn, Jun Sung Moon, Ju Hee Lee, Eun Heui Kim, Hyemi Kwon, Hee Kyung Kim, Sunghwan Suh, Sangmo Hong, Jeonghoon Ha, Eun Roh, Jin Hwa Kim, Mi-kyung Kim
Endocrinology and Metabolism.2021; 36(4): 757. CrossRef - Diabetes Mellitus and COVID-19: Review Article
Mahmoud Nassar, Ahmed Daoud, Nso Nso, Luis Medina, Victoria Ghernautan, Harangad Bhangoo, Andrew Nyein, Mahmoud Mohamed, Ahmed Alqassieh, Karim Soliman, Mostafa Alfishawy, Issac Sachmechi, Anoop Misra
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2021; 15(6): 102268. CrossRef - Dissection of non-pharmaceutical interventions implemented by Iran, South Korea, and Turkey in the fight against COVID-19 pandemic
Mohammad Keykhaei, Sogol Koolaji, Esmaeil Mohammadi, Reyhaneh Kalantar, Sahar Saeedi Moghaddam, Arya Aminorroaya, Shaghayegh Zokaei, Sina Azadnajafabad, Negar Rezaei, Erfan Ghasemi, Nazila Rezaei, Rosa Haghshenas, Yosef Farzi, Sina Rashedi, Bagher Larijan
Journal of Diabetes & Metabolic Disorders.2021; 20(2): 1919. CrossRef - A Systematic Review and Meta-analysis of Diabetes Associated Mortality in Patients with COVID-19
Puneeta Gupta, Meeta Gupta, Neena KAtoch, Ketan Garg, Bhawna Garg
International Journal of Endocrinology and Metabolism.2021;[Epub] CrossRef - Diabetes, Obesity, and COVID-19
Sang Youl Rhee
The Journal of Korean Diabetes.2021; 22(3): 174. CrossRef - Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies
Yahya Mahamat-Saleh, Thibault Fiolet, Mathieu Edouard Rebeaud, Matthieu Mulot, Anthony Guihur, Douae El Fatouhi, Nasser Laouali, Nathan Peiffer-Smadja, Dagfinn Aune, Gianluca Severi
BMJ Open.2021; 11(10): e052777. CrossRef - Independent Impact of Diabetes on the Severity of Coronavirus Disease 2019 in 5,307 Patients in South Korea: A Nationwide-Cohort Study (Diabetes Metab J 2020;44:737-46)
Kyuho Kim, Tae Jung Oh
Diabetes & Metabolism Journal.2020; 44(6): 938. CrossRef
- Reasons for Hospitalization Among Australians With Type 1 or Type 2 Diabetes and COVID-19
- Covid-19
-
- The Clinical Characteristics and Outcomes of Patients with Moderate-to-Severe Coronavirus Disease 2019 Infection and Diabetes in Daegu, South Korea
- Mi Kyung Kim, Jae-Han Jeon, Sung-Woo Kim, Jun Sung Moon, Nan Hee Cho, Eugene Han, Ji Hong You, Ji Yeon Lee, Miri Hyun, Jae Seok Park, Yong Shik Kwon, Yeon-Kyung Choi, Ki Tae Kwon, Shin Yup Lee, Eon Ju Jeon, Jin-Woo Kim, Hyo-Lim Hong, Hyun Hee Kwon, Chi Young Jung, Yin Young Lee, Eunyeoung Ha, Seung Min Chung, Jian Hur, June Hong Ahn, Na-young Kim, Shin-Woo Kim, Hyun Ha Chang, Yong Hoon Lee, Jaehee Lee, Keun-Gyu Park, Hyun Ah Kim, Ji-Hyun Lee
- Diabetes Metab J. 2020;44(4):602-613. Published online August 12, 2020
- DOI: https://doi.org/10.4093/dmj.2020.0146
- 15,035 View
- 219 Download
- 71 Web of Science
- 83 Crossref
-
Abstract
PDFSupplementary MaterialPubReader ePub
Background Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes.
Methods We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group.
Results Compared with the non-DM group (
n =847), patients with DM (n =235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease.Conclusion DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.
-
Citations
Citations to this article as recorded by- Potential use of sodium glucose co-transporter 2 inhibitors during acute illness: a systematic review based on COVID-19
Carmen Tisch, Eleni Xourgia, Aristomenis Exadaktylos, Mairi Ziaka
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Afnan Alshnbari, Iskandar Idris
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Li-Min Zhao, Xie-Hui Chen, Mei Qiu
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Awadhesh Kumar Singh, Kamlesh Khunti
Annual Review of Medicine.2022; 73(1): 129. CrossRef - The enzymes in COVID-19: A review
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Clifford J. Bailey, Mike Gwilt
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Evangelia Tzeravini, Eleftherios Stratigakos, Chris Siafarikas, Anastasios Tentolouris, Nikolaos Tentolouris
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Ah Reum Khang
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Endocrinology, Diabetes & Metabolism.2022;[Epub] CrossRef - The Association Between Antidiabetic Agents and Clinical Outcomes of COVID-19 Patients With Diabetes: A Bayesian Network Meta-Analysis
Yidan Chen, Xingfei Lv, Sang Lin, Mohammad Arshad, Mengjun Dai
Frontiers in Endocrinology.2022;[Epub] CrossRef - Renin‐Angiotensin Aldosterone System Inhibitors and COVID‐19: A Systematic Review and Meta‐Analysis Revealing Critical Bias Across a Body of Observational Research
Jordan Loader, Frances C. Taylor, Erik Lampa, Johan Sundström
Journal of the American Heart Association.2022;[Epub] CrossRef - Diabetes and SARS-CoV-2–Is There a Mutual Connection?
Anna P. Jedrzejak, Edyta K. Urbaniak, Jadwiga A. Wasko, Natalia Ziojla, Malgorzata Borowiak
Frontiers in Cell and Developmental Biology.2022;[Epub] CrossRef - The relationship of age, sex and prothrombin time related to the severity and mortality of COVID-19 patients with diabetes mellitus: a systematic review and meta analysis
Audrey Fabianisa Mirza, Ceria Halim, Mutiara Indah Sari
F1000Research.2022; 11: 729. CrossRef - Are lipid ratios and triglyceride-glucose index associated with critical care outcomes in COVID-19 patients?
Marzieh Rohani-Rasaf, Kosar Mirjalili, Akram Vatannejad, Maryam Teimouri, Xiao-Feng Yang
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- Complications
- The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study
- Seung Min Chung, Yin Young Lee, Eunyeong Ha, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee, Jian Hur, Kyung Soo Hong, Jong Geol Jang, Hyun Jung Jin, Eun Young Choi, Kyeong-Cheol Shin, Jin Hong Chung, Kwan Ho Lee, June Hong Ahn, Jun Sung Moon
- Diabetes Metab J. 2020;44(3):405-413. Published online May 21, 2020
- DOI: https://doi.org/10.4093/dmj.2020.0105
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Abstract
PDFSupplementary MaterialPubReader
Background To determine the role of diabetes mellitus (DM) in the coronavirus disease 2019 (COVID-19), we explored the clinical characteristics of patients with DM and compared risk factors such as age, glycemic control, and medications to those without DM.
Methods This was a retrospective cohort study of 117 confirmed patients with COVID-19 which conducted at a tertiary hospital in Daegu, South Korea. The primary outcome was defined as the severe and critical outcome (SCO), of which the composite outcomes of acute respiratory distress syndrome, septic shock, intensive care unit care, and 28-day mortality. We analyzed what clinical features and glycemic control-related factors affect the prognosis of COVID-19 in the DM group.
Results After exclusion, 110 participants were finally included. DM patients (
n =29) was older, and showed higher blood pressure compared to non-DM patients. DM group showed higher levels of inflammation-related biomarkers and severity score, and highly progressed to SCO. After adjustment with other risk factors, DM increased the risk of SCO (odds ratio [OR], 10.771;P <0.001). Among the DM patients, SCO was more prevalent in elderly patients of ≥70 years old and age was an independent risk factor for SCO in patients with DM (OR, 1.175;P =0.014), while glycemic control was not. The use of medication did not affect the SCO, but the renin-angiotensin system inhibitors showed protective effects against acute cardiac injury (OR, 0.048;P =0.045).Conclusion The COVID-19 patients with DM had higher severity and resulted in SCO. Intensive and aggressive monitoring of COVID-19 clinical outcomes in DM group, especially in elderly patients is warranted.
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Citations
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- Metabolic Risk/Epidemiology
- Multiple Biomarkers Improved Prediction for the Risk of Type 2 Diabetes Mellitus in Singapore Chinese Men and Women
- Yeli Wang, Woon-Puay Koh, Xueling Sim, Jian-Min Yuan, An Pan
- Diabetes Metab J. 2020;44(2):295-306. Published online November 22, 2019
- DOI: https://doi.org/10.4093/dmj.2019.0020
- 6,664 View
- 113 Download
- 9 Web of Science
- 9 Crossref
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Abstract
PDFSupplementary MaterialPubReader
Background Multiple biomarkers have performed well in predicting type 2 diabetes mellitus (T2DM) risk in Western populations. However, evidence is scarce among Asian populations.
Methods Plasma triglyceride-to-high density lipoprotein (TG-to-HDL) ratio, alanine transaminase (ALT), high-sensitivity C-reactive protein (hs-CRP), ferritin, adiponectin, fetuin-A, and retinol-binding protein 4 were measured in 485 T2DM cases and 485 age-and-sex matched controls nested within the prospective Singapore Chinese Health Study cohort. Participants were free of T2DM at blood collection (1999 to 2004), and T2DM cases were identified at the subsequent follow-up interviews (2006 to 2010). A weighted biomarker score was created based on the strengths of associations between these biomarkers and T2DM risks. The predictive utility of the biomarker score was assessed by the area under receiver operating characteristics curve (AUC).
Results The biomarker score that comprised of four biomarkers (TG-to-HDL ratio, ALT, ferritin, and adiponectin) was positively associated with T2DM risk (
P trend <0.001). Compared to the lowest quartile of the score, the odds ratio was 12.0 (95% confidence interval [CI], 5.43 to 26.6) for those in the highest quartile. Adding the biomarker score to a base model that included smoking, history of hypertension, body mass index, and levels of random glucose and insulin improved AUC significantly from 0.81 (95% CI, 0.78 to 0.83) to 0.83 (95% CI, 0.81 to 0.86;P =0.002). When substituting the random glucose levels with glycosylated hemoglobin in the base model, adding the biomarker score improved AUC from 0.85 (95% CI, 0.83 to 0.88) to 0.86 (95% CI, 0.84 to 0.89;P =0.032).Conclusion A composite score of blood biomarkers improved T2DM risk prediction among Chinese.
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Citations
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Review
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- Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet
- Vincenza Spallone
- Diabetes Metab J. 2019;43(1):3-30. Published online November 2, 2018
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Abstract
PDFPubReader
The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to increase due to the diabetes epidemic and its early and widespread appearance. CAN has a definite prognostic role for mortality and cardiovascular morbidity. Putative mechanisms for this are tachycardia, QT interval prolongation, orthostatic hypotension, reverse dipping, and impaired heart rate variability, while emerging mechanisms like inflammation support the pervasiveness of autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: by promoting screening for symptoms and signs; by simplifying cardiovascular reflex tests; and by selecting the candidates for screening. CAN assessment allows for treatment of its manifestations, cardiovascular risk stratification, and tailoring therapeutic targets. Risk factors for CAN are mainly glycaemic control in type 1 diabetes mellitus (T1DM) and, in addition, hypertension, dyslipidaemia, and obesity in type 2 diabetes mellitus (T2DM), while preliminary data regard glycaemic variability, vitamin B12 and D changes, oxidative stress, inflammation, and genetic biomarkers. Glycaemic control prevents CAN in T1DM, whereas multifactorial intervention might be effective in T2DM. Lifestyle intervention improves autonomic function mostly in pre-diabetes. While there is no conclusive evidence for a disease-modifying therapy, treatment of CAN manifestations is available. The modulation of autonomic function by SGLT2i represents a promising research field with possible clinical relevance.
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Original Articles
- Epidemiology
- Depression and Mortality in People with Type 2 Diabetes Mellitus, 2003 to 2013: A Nationwide Population-Based Cohort Study
- Jong-Hyun Jeong, Yoo Hyun Um, Seung-Hyun Ko, Jong-Heon Park, Joong-Yeol Park, Kyungdo Han, Kyung-Soo Ko
- Diabetes Metab J. 2017;41(4):296-302. Published online August 3, 2017
- DOI: https://doi.org/10.4093/dmj.2017.41.4.296
- 5,010 View
- 61 Download
- 24 Web of Science
- 21 Crossref
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Abstract
PDFPubReader
Background Previous reports have demonstrated a bidirectional relationship between depression and diabetes mellitus (DM), accentuating a need for more intensive depression screening in DM patients. There is a relative paucity of data on the mortality of depressed DM patients in Korea.
Methods Retrospective data from January 2003 to December 2013 were collected for adult type 2 diabetes mellitus (T2DM) patients older than 30 years using the National Health Information database maintained by the Korean National Health Insurance Service (NHIS). Demographic characteristics were analyzed with descriptive statistics, and the annual prevalence of depression was estimated. Mortality rates and hazard ratios for each age group (stratified into six age groups) of patients diagnosed with T2DM in 2003 were estimated using a Cox proportional hazard method, with the Kaplan-Meier cumulative survival curve showing the overall survival rates according to the T2DM status until the given year of 2013.
Results The annual prevalence of depression was consistently higher in T2DM group from 2003 to 2013. The mortality hazard ratio was higher in the depressed in all age groups, and the risk was higher in male groups and in younger-aged groups.
Conclusion Depression was significantly associated with a high mortality risk in T2DM patients; hence, a more systematic surveillance of T2DM patients to identify risk factors for depression might contribute significantly to reducing mortality risk in this group of patients.
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Citations
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- Trajectories of depressive symptoms in Korean adults with diabetes: Individual differences and associations with life satisfaction and mortality
- Poor Prognosis Factors and Risk Factors of Amputation in Foot ulcers in Diabetes.
- Mi Jung Eun, Jung Hoon Lee, Jin Ho Kim, Ji Eun Lee, Jae Hong Kim, Kyu Chang Won, In Ho Jo, Hyoung Woo Lee
- Korean Diabetes J. 2004;28(4):304-314. Published online August 1, 2004
- 1,674 View
- 28 Download
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Abstract
PDF
- BACKGROUND
Foot ulcers are a common complication of diabetes mellitus, and their prevalence is increased relative to those without diabetes. Foot ulcers and related complications represent an important cause of morbidity among patients with diabetes mellitus. Most of the poor prognosis factors and amputation risk factors of diabetic foot ulcers have been found to be largely affected by male sex, inadequate blood glucose control, vascular disease, neuropathy, end organ defects, and the depth and size of ulcers, prior ulcer history, infection and ischemia. Currently, the poor prognosis factors and amputation risk factors of diabetic foot ulcers in the Korean diabetic population are unknown. The purpose of this study was to identify and quantify the poor prognosis factors of diabetic foot ulcers and the risk factors of lower extremity amputation. METHODS: This study comprised of involved 37 male and 14 female diabetics with foot ulcers aged 23 to 83 years. According to the results of treatment, the patients were divided into 4 groups; complete healing (CH), partial healing (PH), unhealing (UH), and amputation (AM) groups. The baseline characteristics of the study subjects (gender, age, duration of diabetes, BMI, drinking, smoking, insulin therapy, blood pressure, whole blood count, renal function test and the size and depth of ulcer, prior ulcer history, osteomyelitis, infection, ischemia, neuropathy and retinopathy) were examined. RESULTS: The following characteristics were not significantly related to the poor prognosis factors and amputation risk factors of diabetic foot ulcers: age, duration of diabetes, BMI; drinking, smoking, insulin therapy, blood pressure, whole blood count and renal function test. The following characteristics were significantly related to the poor prognosis factors and amputation risk factors of diabetic foot ulcers: male (p=0.021), ischemia (p<0.05), infection (p<0.01), osteomyelitis (p<0.01), prior ulcer history (p<0.05), retinopathy (p<0.05), size of ulcer (p<0.001) and depth of ulcer (p<0.001). The size and depth of an ulcer, prior ulcer history, ischemia and infection were found to be associated with poor prognosis factors of treatment and risk factors of amputation in diabetic foot ulcer patients by a multiple regression test (P<0.05). CONCLUSION: This study shows that the size and depth of an ulcer, prior ulcer history, ischemia and infection are poor prognosis factors of diabetic foot ulcer and amputation risk factors However, further studies will be required due to the smaill size of our study population.
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