ORCID Profile
0000-0002-6664-8630
Current Organisations
Emory University
,
Monash University
,
University of Melbourne
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Publisher: Elsevier BV
Date: 02-2014
Abstract: The aim of this study is to determine the validity of self-reported cancer data by comparing it to the Australian Cancer Database (ACD). Self-reported data were obtained from the Australian Diabetes, Obesity and Lifestyle (AusDiab) study, which were then linked to the ACD up until 31 December 2010. Positive predictive value, negative predictive value, sensitivity and specificity were calculated. Cohen's kappa coefficient (ĸ) was also calculated to assess the agreement between self-reported cancer and the ACD. Logistic regression was used to examine the determinants associated with false negative and false positive reporting. The overall sensitivity of self-report cancer was 71.1%, and sensitivities showed great variation by cancer site. Higher sensitivities were observed for breast (90.7%), bowel (77.8%) and prostate (77.1%) cancers, whereas the lowest sensitivity was observed for melanoma of the skin (36.9%). Similarly, the kappa coefficient analysis showed substantial agreement for self-reported breast cancer (ĸ=0.79) and moderate agreement for melanoma (ĸ=0.45) against the ACD. Years since cancer diagnosis and older age were associated with false negative reporting and older age was associated with false positive reporting. The use of self-reported cancer to collect cancer outcomes has varying reliability, depending on cancer type and population. The findings presented here may assist medical researchers in making informed decisions when conducting research using self-reported cancer data in Australia where the acquisition of registry data is not feasible.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Elsevier BV
Date: 06-2022
Publisher: Springer Science and Business Media LLC
Date: 20-03-2020
DOI: 10.1038/S41574-020-0334-Z
Abstract: Accumulating data suggest that type 2 diabetes mellitus (T2DM) in younger people (aged <40 years), referred to as young-onset T2DM, has a more rapid deterioration of β-cell function than is seen in later-onset T2DM. Furthermore, in iduals with young-onset T2DM seem to have a higher risk of complications than those with type 1 diabetes mellitus. As the number of younger adults with T2DM increases, young-onset T2DM is predicted to become a more frequent feature of the broader diabetes mellitus population in both developing and developed nations, particularly in certain ethnicities. However, the magnitude of excess risk of premature death and incident complications remains incompletely understood likewise, the potential reasons for this excess risk are unclear. Here, we review the evidence pertaining to young-onset T2DM and its current and future burden of disease in terms of incidence and prevalence in both developed and developing nations. In addition, we highlight the associations of young-onset T2DM with premature mortality and morbidity.
Publisher: Elsevier BV
Date: 10-2013
Publisher: Elsevier BV
Date: 08-2015
Publisher: Elsevier BV
Date: 10-2011
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJDRC-2020-001190
Abstract: Little research has been done to systematically evaluate concerns of people living with diabetes through social media, which has been a powerful tool for social change and to better understand perceptions around health-related issues. This study aims to identify key diabetes-related concerns in the USA and primary emotions associated with those concerns using information shared on Twitter. A total of 11.7 million diabetes-related tweets in English were collected between April 2017 and July 2019. Machine learning methods were used to filter tweets with personal content, to geolocate (to the USA) and to identify clusters of tweets with emotional elements. A sentiment analysis was then applied to each cluster. We identified 46 407 tweets with emotional elements in the USA from which 30 clusters were identified 5 clusters (18% of tweets) were related to insulin pricing with both positive emotions ( joy, love ) referring to advocacy for affordable insulin and sadness emotions related to the frustration of insulin prices, 5 clusters (12% of tweets) to solidarity and support with a majority of joy and love emotions expressed. The most negative topics (10% of tweets) were related to diabetes distress (24% sadness, 27% anger , 21% fear elements), to diabetic and insulin shock (45% anger , 46% fear ) and comorbidities (40% sadness ). Using social media data, we have been able to describe key diabetes-related concerns and their associated emotions. More specifically, we were able to highlight the real-world concerns of insulin pricing and its negative impact on mood. Using such data can be a useful addition to current measures that inform public decision making around topics of concern and burden among people with diabetes.
Publisher: Wiley
Date: 06-04-2015
DOI: 10.1002/IJC.29529
Abstract: Obesity is a risk factor for cancer. However, it is not known if general adiposity, as measured by body mass index (BMI) or central adiposity [e.g., waist circumference (WC)] have stronger associations with cancer, or which anthropometric measure best predicts cancer risk. We included 79,458 men and women from the Australian and New Zealand Diabetes and Cancer Collaboration with complete data on anthropometry [BMI, WC, Hip Circumference (HC), WHR, waist to height ratio (WtHR), A Body Shape Index (ABSI)], linked to the Australian Cancer Database. Cox proportional hazards models assessed the association between each anthropometric marker, per standard deviation and the risk of overall, colorectal, post-menopausal (PM) breast, prostate and obesity-related cancers. We assessed the discriminative ability of models using Harrell's c-statistic. All anthropometric markers were associated with overall, colorectal and obesity-related cancers. BMI, WC and HC were associated with PM breast cancer and no significant associations were seen for prostate cancer. Strongest associations were observed for WC across all outcomes, excluding PM breast cancer for which HC was strongest. WC had greater discrimination compared to BMI for overall and colorectal cancer in men and women with c-statistics ranging from 0.70 to 0.71. We show all anthropometric measures are associated with the overall, colorectal, PM breast and obesity-related cancer in men and women, but not prostate cancer. WC discriminated marginally better than BMI. However, all anthropometric measures were similarly moderately predictive of cancer risk. We do not recommend one anthropometric marker over another for assessing an in iduals' risk of cancer.
Publisher: Centers for Disease Control MMWR Office
Date: 16-03-2018
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1053/J.AJKD.2022.01.422
Abstract: Transplant referral and evaluation are critical steps to waitlisting yet remain an elusive part of the transplant process. Despite calls for more data collection on pre-waitlisting steps, there are currently no national surveillance data to aid in understanding the causes and potential solutions for the extreme variation in access to transplantation. As population health scientists, epidemiologists, clinicians, and ethicists we submit that the transplant community has an obligation to better understand disparities in transplant access as a first necessary step to effectively mitigating these inequities. Our position is grounded in a population health approach, consistent with several new overarching national policy and quality initiatives. The purpose of this Perspective is to (1) provide an overview of how a population health approach should inform current multisystem policies impacting kidney transplantation and demonstrate how these efforts could be enhanced with national data collection on pre-waitlisting steps (2) demonstrate the feasibility and concrete next steps for pre-waitlisting data collection and (3) identify potential opportunities to use these data to implement effective population-level interventions, policies, and quality measures to improve equity in access to kidney transplantation.
Publisher: Wiley
Date: 28-03-2012
DOI: 10.1002/IJC.27503
Abstract: There are accumulating data describing the association between diabetes and cancer mortality from Westernised populations. There are no data describing the relationship between diabetes and cancer mortality in African or South Asian populations from developing countries. We explored the relationship of abnormal glucose tolerance and diabetes on cancer mortality risk in a large, multi-ethnic cohort from the developing nation of Mauritius. Population-based surveys were undertaken in 1987, 1992 and 1998. The 9559 participants comprised 66% of South Asian (Indian), 27% of African (Creole), and 7% of Chinese descent. Cox's proportional hazards model with time varying covariates was used to obtain hazard ratios (HRs) and 95% confidence intervals (95% CI) for risk of cancer mortality, after adjustment for confounding factors. In men, but not women, cancer mortality risk increased with rising 2h-PG levels with HR for the top versus bottom quintile of 2.77 (95%CI: 1.28 to 5.98). South Asian men with known diabetes had a significantly greater risk of cancer mortality than those with normal glucose tolerance (NGT) HR: 2.74 (95%CI: 1.00-7.56). Overall, impaired glucose tolerance was associated with an elevated risk of cancer mortality compared to NGT (HR: 1.47, 95% CI: 0.98-2.19), though this was not significant. We have shown that the association between abnormal glucose tolerance and cancer extends to those of African and South Asian descent. These results highlight the importance of understanding this relationship in a global context to direct future health policy given the rapid increase in type 2 diabetes, especially in developing nations.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Oxford University Press (OUP)
Date: 18-01-2021
DOI: 10.1093/IJE/DYAA270
Abstract: Excess mortality in people with vs without type 2 diabetes (T2DM) has fallen, but it is unclear whether men/women at all ages have benefited and which causes of death have driven these trends. All-cause and cause-specific mortality rates and excess mortality [by mortality rate ratios (MRRs) relative to the non-diabetic general population] were examined in 1 268 018 Australians with T2DM registered on the National Diabetes Services Scheme (2002–2014). Age-standardized mortality decreased in men (−2.2%/year Ptrend & 0.001) and women with T2DM (−1.3%/year Ptrend & 0.001) throughout 2002–14, which translated to declines in the MRRs (from 1.51 to 1.45 in men 1.59 to 1.46 in women Ptrend & 0.05 for both). Declining mortality rates in T2DM were observed in men aged 40+ years and women aged 60+ years (Ptrends & .001), but not at younger ages. However, the only age group in which excess mortality declined relative to those without diabetes was 80+ years (Ptrends & 0.05) driven by reductions in excess cancer-related deaths in men and cardiovascular disease (CVD) in women. Among age groups & years, CVD and cancer MRRs remained similar or increased over time, despite falls in both CVD and cancer mortality rates. MRRs for non-CVD/non-cancer-related deaths increased in 60–79 year-olds, but were otherwise unchanged. Declining excess mortality attributable to T2DM from 2002–14 was driven entirely by reductions in those aged 80+ years. Declines in total mortality among those with T2DM were apparent in more age groups, but often to a lesser extent than in the general population, thereby serving to increase the excess risk associated with T2DM.
Publisher: American Diabetes Association
Date: 07-08-2014
DOI: 10.2337/DC14-0096
Abstract: With improvements in cardiovascular disease (CVD) rates among people with diabetes, mortality rates may also be changing. However, these trends may be influenced by coding practices of CVD-related deaths on death certificates. We analyzed trends of mortality over 13 years in people with diabetes and quantified the potential misclassification of CVD mortality according to current coding methods. A total of 1,136,617 Australians with diabetes registered on the National Diabetes Services Scheme between 1997 and 2010 were linked to the National Death Index. Excess mortality relative to the Australian population was reported as standardized mortality ratios (SMRs). Potential misclassification of CVD mortality was determined by coding CVD according to underlying cause of death (COD) and then after consideration of both the underlying and other causes listed in part I of the death certificate. For type 1 diabetes, the SMR decreased in males from 4.20 in 1997 to 3.08 in 2010 (Ptrend & 0.001) and from 3.92 to 3.46 in females (Ptrend & 0.01). For type 2 diabetes, the SMR decreased in males from 1.40 to 1.21 (Ptrend & 0.001) and from 1.56 to 1.22 in females (Ptrend & 0.001). CVD deaths decreased from 35.6 to 31.2% and from 31.5 to 27.2% in males and females with type 1 diabetes, respectively (Ptrend & 0.001 for both sexes). For type 2 diabetes, CVD decreased from 44.5 to 29.2% in males and from 45.5 to 31.6% in females (Ptrend & 0.001 for both sexes). Using traditional coding methods, ∼38 and 26% of CVD deaths are underestimated in type 1 diabetes and type 2 diabetes, respectively. All-cause and CVD mortality has decreased in diabetes. However, the total CVD mortality burden is underestimated when only underlying COD is considered. This has important ramifications for understanding mortality patterns in diabetes.
Publisher: Wiley
Date: 07-2014
DOI: 10.5694/MJA14.00639
Publisher: Wiley
Date: 13-06-2014
DOI: 10.1002/OBY.20423
Abstract: Emerging evidence suggests that psychosocial stress may influence weight gain. The relationship between stress and weight change and whether this was influenced by demographic and behavioral factors was explored. A total of 5,118 participants of AusDiab were prospectively followed from 2000 to 2005. The relationship between stress at baseline and BMI change was assessed using linear regression. Among those who maintained/gained weight, in iduals with high levels of perceived stress at baseline experienced a 0.20 kg/m 2 (95% CI: 0.07‐0.33) greater mean change in BMI compared with those with low stress. Additionally, in iduals who experienced 2 or ≥3 stressful life events had a 0.13 kg/m 2 (0.00‐0.26) and 0.26 kg/m 2 (0.14‐0.38) greater increase in BMI compared with people with none. These relationships differed by age, smoking, and baseline BMI. Further, those with multiple sources of stressors were at the greatest risk of weight gain. Psychosocial stress, including both perceived stress and life events stress, was positively associated with weight gain but not weight loss. These associations varied by age, smoking, obesity, and multiple sources of stressors. Future treatment and interventions for overweight and obese people should consider the psychosocial factors that may influence weight gain.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.AJO.2018.10.019
Abstract: To estimate prevalence and severity of diabetic retinopathy (DR) among U.S. adults with diabetes and with or without chronic kidney disease (CKD), and assess associated risk of mortality. Cross-sectional study with national survey data. The cohort included adults ≥40 years old with diabetes in the National Health and Nutrition Examination Surveys (NHANES) 2005-2008. Vital status was determined through December 31, 2011. We defined diabetes as hemoglobin A1c ≥6.5% or self-report and CKD by urinary albumin/creatinine ≥30 mg/g or glomerular filtration rate <60 mL/min/1.73 m Prevalence of DR was 27.8% (95% CI 24.3-31.7), 36.2% (95%CI 30.1-42.7), and 23.4% (95% CI 19.2-28.1), overall, with and without CKD. Prevalence of vision-threatening DR was 4.2% (95% CI 3.2-5.5), 8.2% (95% CI 5.4-12.2), and 2.0% (95% CI 1.2-3.5), respectively. In a multivariable adjusted model, DR was positively but nonsignificantly associated with CKD (OR = 1.1, 95% CI 0.7-1.7), was 40% higher per 1% increase in hemoglobin A1c (OR = 1.4, 95% CI 1.1-1.6), was 30% higher per 5 years additional diabetes duration (OR = 1.3, 95% CI 1.1-1.5), was 30% higher per 10 mm Hg increase in systolic blood pressure (OR = 1.3, 95% CI 1.1-1.5), and was 6-fold higher with insulin treatment (OR = 6.2, 95% CI 2.6-14.8). Compared with diabetic participants with neither DR nor CKD, those with DR and CKD had a 3.6-fold (95% CI 1.5-9.1) increased adjusted risk for all-cause mortality. Over one third of persons with diabetes and CKD had DR. The risk of death was higher with than without CKD and DR. Many of the studied risk factors associated with DR are modifiable.
Publisher: American Diabetes Association
Date: 12-06-2015
DOI: 10.2337/DC14-2820
Abstract: To investigate infection-related mortality in in iduals with type 1 and type 2 diabetes. A total of 1,108,982 in iduals with diabetes who were registered with the Australian Diabetes register between 2000 and 2010 were linked to the National Death Index. Mortality outcomes were defined as infection-relatedA-B death (ICD codes A99–B99), pneumonia (J12–J189), septicemia (A40 and A41), and osteomyelitis (M86). During a median follow-up of 6.7 years, there were 2,891, 2,158, 1,248, and 147 deaths from infection-relatedA-B causes, pneumonia, septicemia, or osteomyelitis, respectively. Crude mortality rates from infectionsA-B were 0.147 and 0.431 per 1,000 person-years in type 1 and type 2 diabetes, respectively. Standardized mortality ratios (SMRs) were higher in type 1 and type 2 diabetes for all outcomes after adjustment for age and sex. For infection-relatedA-B mortality, SMRs were 4.42 (95% CI 3.68–5.34) and 1.47 (1.42–1.53) for type 1 and type 2 diabetes (P & 0.001), respectively. For pneumonia in type 1 diabetes, SMRs were approximately 5 and 6 in males and females, respectively, while the excess risk was ∼20% for type 2 (both sexes). For septicemia, SMRs were approximately 10 and 2 for type 1 and type 2 diabetes, respectively, and similar by sex. For osteomyelitis in type 1 diabetes, SMRs were 16 and 58 in males and females, respectively, and ∼3 for type 2 diabetes (both sexes). Although death owing to infection is rare, we confirm that patients with diabetes have an increased mortality from a range of infections, compared with the general population, and that the increased risk appears to be greater for type 1 than type 2 diabetes.
Publisher: American Diabetes Association
Date: 06-2019
DOI: 10.2337/DB19-1550-P
Abstract: Cancer-related mortality is higher among people with diabetes (DM) than people without DM. However, it is not known if this excess risk has changed over time. To estimate rates of cancer mortality in people with and without self-reported DM, we used data from adults aged ≥18 years who participated in the 1985-2012 National Health Interview Survey. Participants were linked to the National Death Index to determine vital status through the end of 2015. Cancer deaths were classified according to underlying cause of death. Death rates for five time periods (1988-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2012) were estimated by survival analysis using Poisson regression models adjusted for age, sex and race/ethnicity with p for trend reported. Among people with DM, overall cancer mortality (per 1,000 person-years) declined 34.1% from 4.1 (95% CI: 3.0-5.3) in 1988-1994 to 2.7 (2.3-3.2) in 2010-2015, ptrend& .01. Among people without DM, overall cancer mortality declined 26.7% from 3.0 (2.8-3.2) to 2.2 (2.0-2.3), respectively for the 1988-1994 and 2010-2015 periods, ptrend& .01. The excess rate of cancer mortality in people with vs. without DM did not change over time (from rate ratio 1.4 (1.0-1.8) in 1988-1994, to 1.3 (1.2-1.4) in 2010-2015). In this nationally representative study, cancer mortality rates declined in people with and without DM but cancer mortality rates remain 30% higher in people with DM. Future research could identify risk factors and prevention strategies for this excess risk. J.L. Harding: None. L.J. Andes: None. Y.J. Cheng: None. K.M. Bullard: None. E. Gregg: None. H.K. Weir: None. N. Burrows: None. G. Imperatore: None.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Springer Science and Business Media LLC
Date: 21-01-2016
DOI: 10.1007/S00125-015-3857-4
Abstract: There is limited information about the impact of type 1 diabetes on life expectancy in a contemporary population. We examined the life expectancy of type 1 diabetic patients and explored the contribution of mortality at different ages and of different causes of death to years of life lost (YLL) compared with the general population. We derived mortality rates of Australians with type 1 diabetes listed on the National Diabetes Services Scheme (NDSS) between 1997 and 2010 (n = 85,547) by linking the NDSS to the National Death Index. The Chiang method was used to estimate life expectancy and Arriaga's method was used to estimate the contributions of age-specific and cause-specific mortality to the YLL. A total of 5,981 deaths were identified during the 902,136 person-years of follow up. Type 1 diabetic patients had an estimated life expectancy at birth of 68.6 years (95% CI 68.1, 69.1), which was 12.2 years (95% CI 11.8, 12.7) less than that in the general population. The improvement in life expectancy at birth in 2004-2010 compared with 1997-2003 was similar for both type 1 diabetic patients (men, 1.9 years [95% CI 0.4, 3.3] women, 1.5 years [95% CI 0.0, 3.2]) and the general population (men, 2.2 years women, 1.4 years). Deaths at age <60 years accounted for 60% of the YLL from type 1 diabetes for men and 45% for women. The major contribution to YLL was mortality from endocrine and metabolic disease at age 10-39 years (men, 39-59% women, 35-50%) and from circulatory disease at age ≥40 years (men, 43-75% women, 34-75%). Data from 1997 to 2010 showed that Australian type 1 diabetic patients had an estimated loss in life expectancy at birth of 12.2 years compared with the general population.
Publisher: Springer Science and Business Media LLC
Date: 31-08-2018
DOI: 10.1007/S00125-018-4711-2
Abstract: In recent decades, large increases in diabetes prevalence have been demonstrated in virtually all regions of the world. The increase in the number of people with diabetes or with a longer duration of diabetes is likely to alter the disease profile in many populations around the globe, particularly due to a higher incidence of diabetes-specific complications, such as kidney failure and peripheral arterial disease. The epidemiology of other conditions frequently associated with diabetes, including infections and cardiovascular disease, may also change, with direct effects on quality of life, demands on health services and economic costs. The current understanding of the international burden of and variation in diabetes-related complications is poor. The available data suggest that rates of myocardial infarction, stroke and utation are decreasing among people with diabetes, in parallel with declining mortality. However, these data predominantly come from studies in only a few high-income countries. Trends in other complications of diabetes, such as end-stage renal disease, retinopathy and cancer, are less well explored. In this review, we synthesise data from population-based studies on trends in diabetes complications, with the objectives of: (1) characterising recent and long-term trends in diabetes-related complications (2) describing regional variation in the excess risk of complications, where possible and (3) identifying and prioritising gaps for future surveillance and study.
Publisher: American Diabetes Association
Date: 07-2013
Publisher: JMIR Publications Inc.
Date: 06-10-2022
DOI: 10.2196/38914
Abstract: In the United States, the COVID-19 pandemic has magnified the disproportionate and long-standing health disparities experienced by Black communities. Although it is acknowledged that social determinants of health (SDOH) rather than biological factors likely contribute to this disparity, few studies using rigorous analytic approaches in large, information-rich community-based data sets are dedicated to understanding the underlying drivers of these racial disparities. The overall aim of our study is to elucidate the mechanisms by which racial disparities in severe COVID-19 outcomes arise, using both quantitative and qualitative methods. In this protocol, we outline a convergent parallel mixed methods approach to identifying, quantifying, and contextualizing factors that contribute to the dramatic disparity in COVID-19 severity (ie, hospitalization, mortality) in Black versus white COVID-19 patients within the integrated health care system of Kaiser Permanente Georgia (KPGA). Toward this end, we will generate two quantitative cohorts of KPGA members with a confirmed COVID-19 diagnosis between January 1, 2020, and September 30, 2021: (1) an electronic medical record (EMR) cohort including routinely captured data on diagnoses, medications, and laboratory values, and a subset of patients hospitalized at Emory Healthcare to capture additional in-hospital data and (2) a survey cohort, where participants will answer a range of questions related to demographics (eg, race, education), usual health behaviors (eg, physical activity, smoking), impact of COVID-19 (eg, job loss, caregiving responsibilities), and medical mistrust. Key outcomes of interest for these two cohorts include hospitalization, mortality, intensive care unit admission, hospital readmission, and long COVID-19. Finally, we will conduct qualitative semistructured interviews to capture perceptions of and experiences of being hospitalized with COVID-19 as well as related interactions with KPGA health care providers. We will analyze and interpret the quantitative and qualitative data separately, and then integrate the qualitative and quantitative findings using a triangulation design approach. This study has been funded by a Woodruff Health Sciences grant from December 2020 to December 2022. As of August 31, 2022, 31,500 KPGA members diagnosed with COVID-19 have been included in the EMR cohort, including 3028 who were hospitalized at Emory Healthcare, and 482 KPGA members completed the survey. In addition, 20 KPGA members (10 Black and 10 white) have been interviewed about their experiences navigating care with COVID-19. Quantitative and qualitative data cleaning and coding have been completed. Data analysis is underway with results anticipated to be published in December 2022. Results from this mixed methods pilot study in a erse integrated care setting in the southeastern United States will provide insights into the mechanisms underpinning racial disparities in COVID-19 complications. The quantitative and qualitative data will provide important context to generate hypotheses around the mechanisms for racial disparities in COVID-19, and may help to inform the development of multilevel strategies to reduce the burden of racial disparities in COVID-19 and its ongoing sequelae. Incorporating contextual information, elucidated from qualitative interviews, will increase the efficacy, adoption, and sustainability of such strategies. RR1-10.2196/38914
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-05-2022
Abstract: There is substantial variation in county-level ESKD mortality across the United States, with highest rates seen in the Southeastern United States. County characteristics explain approximately 19% of variation in ESKD mortality. Counties with high ESKD-related mortality may benefit from targeted and multilevel interventions. Geographic and neighborhood-level factors, such as poverty and education, have been associated with an increased risk for incident ESKD, likelihood of receiving pre-ESKD care, and likelihood of receiving a transplant. However, few studies have examined whether these same factors are associated with ESKD mortality. In this study, we examined county-level variation in ESKD mortality and identified county-level characteristics associated with this variation. We identified 1,515,986 in iduals (aged 18–84 years) initiating RRT (dialysis or transplant) between 2010 and 2018 using the United States Renal Data System. Among 2781 counties, we estimated county-level, all-cause, age-standardized mortality rates (ASMR) among patients with ESKD. We then identified county-level demographic ( e.g. , percent female), socioeconomic ( e.g. , percent unemployed), healthcare ( e.g. , percent without health insurance), and health behavior ( e.g. , percent current smokers) characteristics associated with ASMR using multivariable hierarchic linear mixed models and quantified the percentage of ASMR variation explained by county-level characteristics. County-level ESKD ASMR ranged from 45 to 1022 per 1000 person-years (PY) (mean, 119 per 1000 PY). ASMRs were highest in counties located in the Tennessee Valley and Appalachia regions, and lowest in counties located in New England, the Pacific Northwest, and Southern California. In fully adjusted models, county-level characteristics significantly associated with higher ESKD mortality included a lower percentage of Black residents (−4.94 per 1000 PY), lower transplant rate (−4.08 per 1000 PY), and higher healthcare expenditures (5.21 per 1000 PY). Overall, county-level characteristics explained 19% of variation in ESKD mortality. Counties with high ESKD-related mortality may benefit from targeted and multilevel interventions that combine knowledge from a growing evidence base on the interplay between in idual and community-level factors associated with ESKD mortality.
Publisher: Springer Science and Business Media LLC
Date: 21-08-2018
Publisher: Springer Science and Business Media LLC
Date: 22-02-2018
DOI: 10.1007/S00125-018-4544-Z
Abstract: Current evidence suggests that type 2 diabetes may have a greater impact on those with earlier diagnosis (longer duration of disease), but data are limited. We examined the effect of age at diagnosis of type 2 diabetes on the risk of all-cause and cause-specific mortality over 15 years. The data of 743,709 Australians with type 2 diabetes who were registered on the National Diabetes Services Scheme (NDSS) between 1997 and 2011 were examined. Mortality data were derived by linking the NDSS to the National Death Index. All-cause mortality and mortality due to cardiovascular disease (CVD), cancer and all other causes were identified. Poisson regression was used to model mortality rates by sex, current age, age at diagnosis, diabetes duration and calendar time. The median age at registration on the NDSS was 60.2 years (interquartile range [IQR] 50.9-69.5) and the median follow-up was 7.2 years (IQR 3.4-11.3). The median age at diagnosis was 58.6 years (IQR 49.4-67.9). A total of 115,363 deaths occurred during 7.20 million person-years of follow-up. During the first 1.8 years after diabetes diagnosis, rates of all-cause and cancer mortality declined and CVD mortality was constant. All mortality rates increased exponentially with age. An earlier diagnosis of type 2 diabetes (longer duration of disease) was associated with a higher risk of all-cause mortality, primarily driven by CVD mortality. A 10 year earlier diagnosis (equivalent to 10 years' longer duration of diabetes) was associated with a 1.2-1.3 times increased risk of all-cause mortality and about 1.6 times increased risk of CVD mortality. The effects were similar in men and women. For mortality due to cancer (all cancers and colorectal and lung cancers), we found that earlier diagnosis of type 2 diabetes was associated with lower mortality compared with diagnosis at an older age. Our findings suggest that younger-onset type 2 diabetes increases mortality risk, and that this is mainly through earlier CVD mortality. Efforts to delay the onset of type 2 diabetes might, therefore, reduce mortality.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Massachusetts Medical Society
Date: 26-02-2015
DOI: 10.1056/NEJMC1415677
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJDRC-2020-001962
Abstract: Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD). We included 254 188 first-time single kidney transplant recipients aged ≥18 years from the US Renal Data System (2000–2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000–2017), relative to the general US population, were assessed using Joinpoint regression. A total of 72 175 (28.4%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88%, 85% and 77% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively. In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D.
Publisher: Elsevier BV
Date: 10-2010
Publisher: ACM
Date: 24-10-2016
Publisher: Elsevier BV
Date: 12-2013
Publisher: Elsevier BV
Date: 2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-07-2021
Publisher: American Diabetes Association
Date: 29-03-2022
DOI: 10.2337/DC21-1752
Abstract: The epidemiology of adult-onset type 1 diabetes (T1D) incidence is not well-characterized due to the historic focus on T1D as a childhood-onset disease. We assess the incidence of adult-onset (≥20 years) T1D, by country, from available data. A systematic review of MEDLINE, Embase, and the gray literature, through 11 May 2021, was undertaken. We included all population-based studies reporting on adult-onset T1D incidence and published from 1990 onward in English. With the search we identified 1,374 references of which 46 were included for data extraction. Estimates of annual T1D incidence were allocated into broad age categories (20–39, 40–59, ≥60, or ≥20 years) as appropriate. Overall, we observed the following patterns: 1) there is a paucity of data, particularly in low- and middle-income countries 2) the incidence of adult-onset T1D is lowest in Asian and highest in Nordic countries 3) adult-onset T1D is higher in men versus women 4) it is unclear whether adult-onset T1D incidence declines with increasing age and 5) it is unclear whether incidence of adult-onset T1D has changed over time. Results are generalizable to high-income countries, and misclassification of diabetes type cannot be ruled out. From available data, this systematic review suggests that the incidence of T1D in adulthood is substantial and highlights the pressing need to better distinguish T1D from T2D in adults so that we may better assess and respond to the true burden of T1D in adults.
Publisher: Springer Science and Business Media LLC
Date: 29-02-2016
Publisher: American Diabetes Association
Date: 26-04-2016
DOI: 10.2337/DC15-2308
Abstract: To analyze changes by age-group in all-cause and cause-specific mortality rates from 2000–2011 in people with diabetes. A total of 1,189,079 (7.3% with type 1 diabetes) Australians with diabetes registered on the National Diabetes Service Scheme between 2000 and 2011 were linked to the National Death Index. Mortality rates in the total population were age standardized to the 2001 Australian population. Mortality rates were calculated for the following age-groups: 0 to & years, ≥ 40 to & years, and ≥60 to ≤85 years. Annual mortality rates were fitted using a Poisson regression model including calendar year as a covariate and age and sex where appropriate, with Ptrend reported. For type 1 diabetes, all-cause, cardiovascular disease (CVD), and diabetes age-standardized mortality rates (ASMRs) decreased each year by 0.61, 0.35, and 0.14 per 1,000 person-years (PY), respectively, between 2000 and 2011, Ptrend & 0.05, while cancer mortality remained unchanged. By age, significant decreases in all-cause, CVD, and diabetes mortality rates were observed in all age-groups, excluding diabetes mortality in age-group 0–40 years. For type 2 diabetes, all-cause, CVD, and diabetes ASMRs decreased per year by 0.18, 0.15, and 0.03 per 1,000 PY, respectively, Ptrend & 0.001, while cancer remained unchanged. By age, these decreases were observed in all age-groups, excluding 0–40 years, where significant increases in all-cause and cancer mortality were noted and no change was seen for CVD and diabetes mortality. All-cause, CVD, and diabetes ASMRs in type 1 and type 2 diabetes decreased between 2000 and 2011, while cancer ASMRs remained unchanged. However, younger populations are not benefiting from the same improvements as older populations. In addition, the absence of a decline in cancer mortality warrants urgent attention.
Publisher: American Diabetes Association
Date: 07-2018
DOI: 10.2337/DB18-1566-P
Abstract: Non-traumatic lower extremity utation (NLEA) is a complication of end-stage renal disease (ESRD) and diabetes mellitus (DM). Global data suggest hospitalization rates for NLEA among people with DM are declining. Contemporary data from the U.S. and among those with ESRD is lacking. We estimated NLEA hospitalizations during 2000-2014 in adults aged ≥18 years with ESRD and DM (ESRD-DM) and in the broader DM population. We determined NLEA hospitalisations rates (ICD-9 CM procedure codes: 8411-8419, excluding diagnosis codes 895-897) for ESRD-DM using the U.S. Renal Data System and for DM using the U.S. National Health Interview Survey and the National Inpatient S le. We assessed trends over time using Joinpoint regression. In the ESRD-DM population, age-standardised NLEA rates per 1,000 persons decreased from 61.5 (95% CI: 59.8-63.2) in 2000 to 39.7 (38.4-41.0) in 2014 (Figure). In the DM population, NLEA rates decreased from 10.8 (9.2-12.4) in 2000 to 6.1 (5.1-7.0) in 2009, and then increased to 8.7 (7.7-9.6) by 2014. NLEA rates remained 4.6 times (95% CI: 4.5-4.7) higher in ESRD-DM compared with DM only. Rates of NLEA hospitalisations declined during 2000-2014 in ESRD-DM, while they declined then increased in the population with DM. Increased attention to preventive care among ESRD-DM and DM populations is needed. J.L. Harding: None. M.E. Pavkov: None. N. Burrows: None. E.W. Gregg: None. I.A. Hora: None.
Publisher: American Diabetes Association
Date: 06-2020
DOI: 10.2337/DB20-106-OR
Abstract: Diabetes is the leading cause of non-traumatic lower extremity utation (NLEA) in the United States. After a period of decline, some U.S. data show that diabetes-related NLEA has recently increased, particularly among young and middle-aged adults. However, the trend for older adults is less clear. To examine NLEA trends among older adults with diabetes (≥67 years), we used 100% Medicare claims for beneficiaries enrolled in Parts A and B during 2000-2017. NLEA was defined as the highest-level utation per patient per calendar year. NLEA rates were stratified by sex, race and ethnicity, and NLEA level. All rates were age-sex standardized to the 2000 Medicare population. Trends over time were assessed using Joinpoint regression and annual percent change (APC) reported. NLEA rates (per 1,000 persons) halved from 8.5 in 2000 to 4.4 in 2009 (APC -7.9, p value& .001). However, from 2009 to 2017 NLEA rates increased slightly to 4.8 (APC 1.2, p-value& .001). Trends were similar across most sex and race/ethnic groups, however absolute rates were highest in blacks and men (Figure A). By NLEA level, overall increases were driven by increases in rates of toe and foot NLEAs. This study of the U.S. Medicare population shows that recent increases in diabetes-related NLEA are also occurring in the older population but at a less severe rate. J. Harding: None. L.J. Andes: None. D.B. Rolka: None. G. Imperatore: None. Y. Li: None. E. Gregg: None. A.L. Albright: None.
Publisher: American Diabetes Association
Date: 06-2022
DOI: 10.2337/DB22-174-LB
Abstract: Background: Diabetes is a key risk factor for severe COVID-19 (i.e., hospitalization, mortality) . Whether diabetes is also a risk factor for post-acute sequelae of COVID-19 (PASC) , also known as long COVID, is unknown. Methods: We conducted a scoping literature review on January 27, 2022 using the keyword terms ‘long hauler’, ‘long COVID-19’, ‘post-acute sequalae’, and ‘persistent COVID-19’ combined with the operator OR, with AND ‘diabetes’, AND ‘COVID-19 [MeSH Term]’. We included all peer-reviewed full-text observational research studies published in English between January 1, 2020 and January 27, 2022 that reported on the risk of PASC in people with and without diabetes with a minimum of 4-weeks follow-up after COVID-19 diagnosis, and narratively synthesized results. Results: Among 39 studies identified, seven were included in the review and are summarized in Table 1. Overall, we found that 43% of studies identified diabetes as a potent risk factor for PASC (all odds ratios were & ) . However, this conclusion is limited by the heterogeneity of studies with regard to PASC definitions (e.g., ongoing symptoms of fatigue, cough, dyspnea etc.) , populations at risk (hospitalized vs. non-hospitalized populations) , and follow-up times (range 4 weeks to 7 months) . Conclusions: More high-quality studies across multiple populations and settings are needed to determine if diabetes is indeed a risk factor for PASC. In the meantime, careful monitoring of people with diabetes for development of PASC may be advised. J. L. Harding: None. M. K. Ali: Advisory Panel Bayer AG, Research Support Merck & Co., Inc. J. C. Gander: None. R. E. Patzer: None.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1053/J.AJKD.2019.09.012
Abstract: Dialysis-requiring acute kidney injury (AKI-D) has increased substantially in the United States. We examined trends in and comorbid conditions associated with hospitalizations and in-hospital mortality in the setting of AKI-D among people with versus without diabetes. Cross-sectional study. Nationally representative data from the National Inpatient S le and National Health Interview Survey were used to generate 16 cross-sectional s les of US adults (aged ≥18 years) between 2000 and 2015. Diabetes, defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. AKI-D, defined using ICD-9-CM diagnosis and procedure codes. Annual age-standardized rates of AKI-D and AKI-D mortality were calculated for adults with and without diabetes, by age and sex. Data were weighted to be representative of the US noninstitutionalized population. Trends were assessed using join point regression with annual percent change (Δ/y) reported. In adults with diabetes, AKI-D increased between 2000 and 2015 (from 26.4 to 41.1 per 100,000 persons Δ/y, 3.3% P < 0.001), with relative increases greater in younger versus older adults. In adults without diabetes, AKI-D increased between 2000 and 2009 (from 4.8 to 8.7 Δ/y, 6.5% P < 0.001) and then plateaued. AKI-D mortality significantly declined in people with and without diabetes. In adults with and without diabetes, the proportion of AKI-D hospitalizations with liver, rheumatic, and kidney disease comorbid conditions increased between 2000 and 2015, while the proportion of most cardiovascular comorbid conditions decreased. Lack of laboratory data to corroborate AKI diagnosis National Inpatient S le data are hospital-level rather than person-level data no data for type of diabetes residual unmeasured confounding. Hospitalization rates for AKI-D have increased considerably while mortality has decreased in adults with and without diabetes. Hospitalization rates for AKI-D remain substantially higher in adults with diabetes. Greater AKI risk-factor mitigation is needed, especially in young adults with diabetes.
Publisher: Human Kinetics
Date: 05-2013
Abstract: Regular physical activity (PA) is associated with a reduced risk for chronic health conditions and improved health-related quality of life (HRQoL). Efforts to increase PA have included workplace health promotion. Currently, little is known about the effect of these programs on overall HRQoL. To evaluate whether participation in a pedometer-based PA program in the workplace was associated with changes in HRQoL. 487 voluntary employees enrolled in a health program completed the SF-12 Health Survey at baseline and 4 months. Change in Physical and Mental component summary scores (PCS MCS) was assessed with multivariable regression analysis, adjusting for covariates. Participation in the program was associated with an increase of 1.5 MCS units (95% CI: 0.76, −2.09). Greater improvements in MCS were observed in those reporting an increased level of PA during the program [1.9 (CI: 0.78, 2.92) versus 0.9 (CI: −0.12, 2.03)] and a lower baseline MCS score [6.3 (CI: 4.80, 7.62) versus −1.5 (CI: −2.21, −0.80)]. No change in PCS was observed. Participation in this workplace PA program was associated with improvements in the mental component of HRQoL. We recommend the use of a broad perspective of health be used in both the implementation and evaluation of workplace PA programs.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.DIABET.2013.09.006
Abstract: The prevalence of diabetes and obesity has increased rapidly over the last few decades in both developed and developing countries. While it is intuitively appealing to suggest that lifestyle risk factors such as decreased physical activity and adoption of poor diets can explain much of the increase, the evidence to support this is poor. Given this, there has been an impetus to look more widely than traditional lifestyle and biomedical risk factors, especially those risk factors, which arise from the environment. Since the industrial revolution, there has been an introduction of many chemicals into our environment, which have now become environmental pollutants. There has been growing interest in one key class of environmental pollutants known as persistent organic pollutants (POPs) and their potential role in the development of diabetes. This review will summarise and appraise the current epidemiological evidence relating POPs to diabetes and highlight gaps and flaws in this evidence.
Publisher: Springer Science and Business Media LLC
Date: 14-04-2016
DOI: 10.1007/S00125-016-3948-X
Abstract: The aim of this work was to estimate the life expectancy (LE) and disability-free life expectancy (DFLE) for adults with and without diabetes. The Chiang method and the adapted Sullivan method were used to estimate LE and DFLE by age and sex. Mortality data in 2011 were available from the National Diabetes Services Scheme for diabetes and from standard national mortality datasets for the general population. Data on prevalence of disability and severe or profound core activity limitation were derived from the 2012 Australian Survey of Disability, Ageing and Carers (SDAC). The definitions of disability used in the SDAC followed the International Classification of Functioning, Disability and Health. Data on diabetes prevalence were derived from the Australian Diabetes, Obesity and Lifestyle study. The estimated LE and DFLE (with 95% uncertainty interval [UI]) at age 50 years were 30.2 (30.0, 30.4) and 12.7 (11.5, 13.7) years, respectively, for men with diabetes, and the estimates were 33.9 (33.6, 34.1) and 13.1 (12.3, 13.9) years, respectively, for women with diabetes. The estimated loss of LE associated with diabetes at age 50 years was 3.2 (3.0, 3.4) years for men and 3.1 (2.9, 3.4) years for women, as compared with their counterparts without diabetes. The corresponding estimated loss of DFLE was 8.2 (6.7, 9.7) years for men and 9.1 (7.9, 10.4) years for women. Women with diabetes spent a greater number of absolute years and a greater proportion of their life with disability as compared with men with diabetes and women without diabetes. The gains in LE and DFLE across the whole population at age 50 years after hypothetically eliminating diagnosed diabetes were 0.6 (0.5, 0.6) years and 1.8 (1.0, 2.8) years. In adults, diabetes results in a modest reduction in LE and a substantial reduction in DFLE. Efforts to identify the specific causes of disability and effective interventions are needed.
Publisher: BMJ
Date: 11-09-2019
DOI: 10.1136/BMJ.L5003
Abstract: To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes. Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines. Medline, Embase, CINAHL, and reference lists of relevant publications. Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year. Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively. The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different. Prospero CRD42018092287.
Publisher: Springer Science and Business Media LLC
Date: 12-09-2019
DOI: 10.1007/S00125-019-04991-X
Abstract: Cancer-related death is higher among people with vs without diabetes. However, it is not known if this excess risk has changed over time or what types of cancer may be driving these changes. To estimate rates of site-specific cancer mortality in adults with vs without self-reported diagnosed diabetes, we used data from adults aged ≥18 years at the time of the interview who participated in the 1985-2012 National Health Interview Survey. Participants' data were linked to the National Death Index by the National Center for Health Statistics to determine vital status and cause of death through to the end of 2015. Cancer deaths were classified according to underlying cause of death. Death rates for five time periods (1988-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2015) were estimated using discrete Poisson regression models adjusted for age, sex and race/ethnicity with p for linear trend reported (p Among adults with diabetes, age-adjusted cancer mortality rates (per 10,000 person-years) declined 25.5% from 39.1 (95% CI 30.1, 50.8) in 1988-1994 to 29.7 (26.6, 33.1) in 2010-2015, p Declines in cancer mortality rates were observed in adults with and without diabetes. However, adults with diabetes continue to be more likely to die from cancer than people without diabetes. This study highlights the continued need for greater cancer risk-factor mitigation, especially in adults with diabetes.
Publisher: American Diabetes Association
Date: 28-07-2020
DOI: 10.2337/DC20-0586
Abstract: Diabetes is a leading cause of nontraumatic lower-extremity utation (NLEA) in the U.S. After a period of decline, some national U.S. data have shown that diabetes-related NLEAs have recently increased, particularly among young and middle-aged adults. However, the trend for older adults is less clear. To examine NLEA trends among older adults with diabetes (≥67 years), we used 100% Medicare claims for beneficiaries enrolled in Parts A and B, also known as fee for service (FFS). NLEA was defined as the highest-level utation per patient per calendar year. Annual NLEA rates were estimated from 2000 to 2017 and stratified by age-group, sex, race/ethnicity, NLEA level (toe, foot, below-the-knee utation [BKA], or above-the-knee utation [AKA]), and state. All rates were age and sex standardized to the 2000 Medicare population. Trends over time were assessed using Joinpoint regression and annual percent change (APC) reported. NLEA rates (per 1,000 people with diabetes) decreased by half from 8.5 in 2000 to 4.4 in 2009 (APC −7.9, P & 0.001). However, from 2009 onward, NLEA rates increased to 4.8 (APC 1.2, P & 0.01). Trends were similar across most age, sex, and race/ethnic groups, but absolute rates were highest in the oldest age-groups, Blacks, and men. By NLEA type, overall increases were driven by increases in rates of toe and foot NLEAs, while BKA and AKA continued to decline. The majority of U.S. states showed recent increases in NLEA, similar to national estimates. This study of the U.S. Medicare FFS population shows that recent increases in diabetes-related NLEAs are also occurring in older populations but at a less severe rate than among younger adults (& years) in the general population. Preventive foot care has been shown to reduce rates of NLEA among adults with diabetes, and the findings of the study suggest that those with diabetes—across the age spectrum—could benefit from increased attention to this strategy.
Publisher: American Diabetes Association
Date: 08-12-2015
DOI: 10.2337/DC14-1996
Abstract: Evidence indicates an increased risk of certain cancers among people with type 2 diabetes. Evidence for rarer cancers and for type 1 diabetes is limited. We explored the excess risk of site-specific cancer incidence and mortality among people with type 1 and type 2 diabetes, compared with the general Australian population. Registrants of a national diabetes registry (953,382) between 1997 and 2008 were linked to national death and cancer registries. Standardized incidence and mortality ratios (SIRs/SMRs) are reported. For type 1 diabetes, significant elevated SIRs were observed for pancreas, liver, esophagus, colon and rectum (females only [F]), stomach (F), thyroid (F), brain (F), lung (F), endometrium, and ovary, and decreased SIRs were observed for prostate in males. Significantly increased SMRs were observed for pancreas, liver, and kidney (males only), non-Hodgkin’s lymphoma, brain (F), and endometrium. For type 2 diabetes, significant SIRs were observed for almost all site-specific cancers, with highest SIRs observed for liver and pancreas, and decreased risks for prostate and melanoma. Significant SMRs were observed for liver, pancreas, kidney, Hodgkin’s lymphoma, gallbladder (F), stomach (F), and non-Hodgkin’s lymphoma (F). Cancer risk was significantly elevated throughout follow-up time but was higher in the first 3 months postregistration, suggesting the presence of detection bias and/or reverse causation. Type 1 and type 2 diabetes are associated with an excess risk of incidence and mortality for overall and a number of site-specific cancers, and this is only partially explained by bias. We suggest that screening for cancers in diabetic patients is important.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.DIABET.2015.04.006
Abstract: The metabolic syndrome (MetS) is a risk factor for cancer. However, it is not known if the MetS confers a greater cancer risk than the sum of its in idual components, which components drive the association, or if the MetS predicts future cancer risk. We linked 20,648 participants from the Australian and New Zealand Diabetes and Cancer Collaboration with complete data on the MetS to national cancer registries and used Cox proportional hazards models to estimate associations of the MetS, the number of positive MetS components, and each of the five MetS components separately with the risk for overall, colorectal, prostate and breast cancer. Hazard ratios (HR) and 95% confidence intervals (95%CI) are reported. We assessed predictive ability of the MetS using Harrell's c-statistic. The MetS was inversely associated with prostate cancer (HR 0.85 95% CI 0.72-0.99). We found no evidence of an association between the MetS overall, colorectal and breast cancers. For those with five positive MetS components the HR was 1.12 (1.02-1.48) and 2.07 (1.26-3.39) for overall, and colorectal cancer, respectively, compared with those with zero positive MetS components. Greater waist circumference (WC) (1.38 1.13-1.70) and elevated blood pressure (1.29 1.01-1.64) were associated with colorectal cancer. Elevated WC and triglycerides were (inversely) associated with prostate cancer. MetS models were only poor to moderate discriminators for all cancer outcomes. We show that the MetS is (inversely) associated with prostate cancer, but is not associated with overall, colorectal or breast cancer. Although, persons with five positive components of the MetS are at a 1.2 and 2.1 increased risk for overall and colorectal cancer, respectively, and these associations appear to be driven, largely, by elevated WC and BP. We also demonstrate that the MetS is only a moderate discriminator of cancer risk.
Publisher: American Diabetes Association
Date: 06-2019
DOI: 10.2337/DB19-1615-P
Abstract: Several studies have suggested a fall or stabilisation of diabetes incidence rates in the last decade. We therefore conducted a multi-country analysis of trends in diabetes incidence over time. Data from 16 countries comprising 17 administrative sources and one set of annual surveys were analysed according to a standard protocol mainly from the period 1995-2015. We modelled incidence rates using age and calendar time as quantitative variables (scored as the midpoint of each interval), and using restricted cubic splines with 6 knots for age and one knot per 4 years of observation for calendar time. The estimated rates from the models were presented as age- and sex-standardized rates (standardized to the 2010 EU population) for each centre to provide an overview of general trends. To formally assess temporal changes in incidence rates, we also fitted joinpoint models with joinpoints at one of the dates 2009, 2010, 2011, and 2012, estimating the average trend before and after the joinpoint. Among the 18 populations we assembled, 4 of the studies were from predominantly non-Europid populations (Taiwan, Korea, Singapore, Hong Kong) and only 2 of the studies were from middle-income countries (Ukraine and Latvia). In general, from 2000 (or when data were available) until 2010 we saw increasing trends in incidence rates in populations from the U.S., Canada, Australia, Denmark, UK, Spain, Scotland and Latvia, while we saw decreasing incidence rates in Israel, Italy, UK, Hong Kong, Taiwan and Korea. In contrast, after 2010, incidence rates appeared stable or decreasing in 14/18 centres, with U.S. (Kaiser Permanente Healthcare), Ukraine, Singapore, and Taiwan showing increasing trend of diabetes incidence. In conclusion, incidence rates of diabetes have shown a tendency to stabilise or even fall across some high-income populations in Europe, Asia, Canada and Australia. Patterns in low to middle income countries may be different, but little information is currently available from these. D.J. Magliano: None. R.M. Islam: None. L. Chen: None. B. Carstensen: Consultant Self Leo Pharma. Speaker's Bureau Self Novo Nordisk A/S. Stock/Shareholder Self Novo Nordisk Inc. M.E. Pavkov: None. E.W. Gregg: None. M. Tabesh: None. D. Koye: None. J.L. Harding: None. J.E. Shaw: Advisory Panel Self Abbott, Merck Sharp & Dohme Corp. Speaker's Bureau Self AstraZeneca, Mylan, Roche Diabetes Care, Sanofi-Aventis. Centers for Disease Control and Prevention
Publisher: Springer Science and Business Media LLC
Date: 06-07-2020
Publisher: American Diabetes Association
Date: 06-2021
DOI: 10.2337/DB21-1022-P
Publisher: American Diabetes Association
Date: 06-2019
DOI: 10.2337/DB19-1659-P
Abstract: Some studies have reported falling mortality among populations with diabetes, but the consistency of this trend is unclear. We systematically reviewed studies published from 1980-2017 reporting all-cause mortality across 2 time-periods in people with diabetes. A total of 35 studies were found, providing data on 56 sex-specific or total populations with diabetes or type 2 diabetes. All studies were from high-income countries. Mortality declined in 80% of populations with diabetes in the 1980s, 53% in the 1990s, and 85% from 2000 onwards (Table). Falling mortality in diabetes occurred in 87% of Europid populations and in 10% of non-Europid populations. Of 25 populations with age-specific data, mortality declined in 29% of populations aged & years and in & % of populations aged & years. Of 37 populations that reported on those with and without diabetes, greater or similar mortality reduction was observed among those with diabetes than without diabetes in 70% of populations. In conclusion, mortality has declined in the majority of Europid populations with diabetes since 1980. However, most non-Europid and most younger populations show no such declines. L. Chen: None. R.M. Islam: None. J. Wang: None. T.R. Hird: None. M.E. Pavkov: None. E.W. Gregg: None. M. Tabesh: None. D. Koye: None. J.L. Harding: None. J.W. Sacre: None. E.L. Barr: None. D.J. Magliano: None. J.E. Shaw: Advisory Panel Self Abbott, Merck Sharp & Dohme Corp. Speaker's Bureau Self AstraZeneca, Mylan, Roche Diabetes Care, Sanofi-Aventis. Centers for Disease Control and Prevention
Publisher: American Diabetes Association
Date: 29-05-2019
DOI: 10.2337/DC19-0296
Abstract: Nontraumatic lower-extremity utation (NLEA) is a complication of end-stage renal disease (ESRD) and diabetes. Although recent data show that NLEA rates in the U.S. ESRD population are declining overall, trends in diabetes and diabetes subgroups remain unclear. We estimated annual rates of NLEA hospitalizations during 2000-2015 among >2 million adults (≥18 years) with ESRD from the U.S. Renal Data System. Age, sex, and race-adjusted NLEA rates were stratified by diabetes status, age, sex, race, and level of utation (toe, foot, below the knee, and above the knee). Time trends were assessed using Joinpoint regression with annual percent changes (APC) reported. Among adults with diabetes, NLEA rates declined 43.8% between 2000 and 2013 (from 7.5 to 4.2 per 100 person-years APC -4.9, Despite an initial period of decline, this analysis documents a stall in progress in NLEA trends in recent years in a high-risk population with both ESRD and diabetes. Increased attention to preventive foot care in the ESRD population should be considered, particularly for those with diabetes.
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJDRC-2023-003466
Abstract: We investigated the impact of the COVID-19 pandemic on annual adherence to seven diabetes care guidelines and risk factor management among people with diabetes. We included all adults (aged ≥18 years) with prevalent diabetes as of 1 January 2018, who were continuously enrolled at Kaiser Permanente Georgia (KPGA) through 31 December 2021 (n=22 854). Prevalent diabetes was defined as a history of at least one of a diagnosis code for diabetes, use of antihyperglycemic medication, or at least one laboratory value of HbA1c, fasting plasma glucose or random glucose in the diabetic range. We defined pre-COVID (2018–2019) and during COVID (2020–2021) cohorts. Cohort-specific laboratory measurements (ie, blood pressure (BP), HbA1c, cholesterol, creatinine, urine-albumin-creatinine ratio (UACR)) and procedures (ie, eye and foot examinations) were determined from KPGA’s electronic medical record data. We used logistic generalized estimating equations (GEE), adjusted for baseline age, to assess the within-subject change in guideline adherence (ie, at least one measurement per year per period) from pre-COVID to during COVID era overall, and by age, sex, and race. Linear GEE compared mean laboratory measurements pre and during COVID. The proportion of adults meeting each of the seven diabetes care guidelines decreased significantly during (vs pre) COVID (range in absolute reductions: −0.8% to −11.2%) with greatest reductions seen for BP (−11.2%) and cholesterol (−8.8%). Declines were similar across age, sex, and race subgroups. Average HbA1c and systolic BP increased 0.11% and 1.6 mmHg, respectively, while low-density lipoprotein cholesterol declined 8.9 mg/dL. The proportion of adults at high risk of kidney disease (ie, UACR ≥300 mg/g) increased from 6.5% to 9.4%. In an integrated healthcare system, the proportion of people with diabetes meeting guideline-recommended screenings decreased during the pandemic, coinciding with worsening glucose, kidney, and (some) cardiovascular risk profiles. Follow-up is needed to assess the long-term implications of these care gaps.
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJDRC-2021-002377
Abstract: Heart failure (HF) is a major contributor to cardiovascular morbidity and mortality in people with diabetes. In this study, we estimated trends in the incidence of HF inpatient admissions and emergency department (ED) visits by diabetes status. Population-based age-standardized HF rates in adults with and without diabetes were estimated from the 2006–2017 National Inpatient S le, Nationwide ED S le and year-matched National Health Interview Survey, and stratified by age and sex. Trends were assessed using Joinpoint. HF inpatient admissions did not change in adults with diabetes between 2006 and 2013 (from 53.9 to 50.4 per 1000 persons annual percent change (APC): −0.3 (95% CI −2.5 to 1.9) but increased from 50.4 to 62.3 between 2013 and 2017 (APC: 4.8 (95% CI 0.3 to 9.6)). In adults without diabetes, inpatient admissions initially declined (from 14.8 in 2006 to 12.9 in 2014 APC −2.3 (95% CI −3.2 to –1.2)) and then plateaued. Patterns were similar in men and women, but relative increases were greatest in young adults with diabetes. HF-related ED visits increased overall, in men and women, and in all age groups, but increases were greater in adults with (vs without) diabetes. Causes of increased HF rates in hospital settings are unknown, and more detailed data are needed to investigate the aetiology and determine prevention strategies, particularly among adults with diabetes and especially young adults with diabetes.
Publisher: American Diabetes Association
Date: 15-10-2020
DOI: 10.2337/DC19-0653
Abstract: Vascular complications of diabetes have declined substantially over the past 20 years. However, the impact of modern medical treatments on infectious diseases in people with diabetes remains unknown. We estimated rates of infections requiring hospitalizations in adults (≥18 years) with versus without diabetes, using the 2000-2015 National Inpatient S le and the National Health Interview Surveys. Annual age-standardized and age-specific hospitalization rates in groups with and without diabetes were stratified by infection type. Trends were assessed using Joinpoint regression with the annual percentage change (Δ%/year) reported. In 2015, hospitalization rates remained almost four times as high in adults with versus without diabetes (rate ratio 3.8 [95% CI 3.8-3.8]) and as much as 15.7 times as high, depending on infection type. Overall, between 2000 and 2015, rates of hospitalizations increased from 63.1 to 68.7 per 1,000 persons in adults with diabetes and from 15.5 to 16.3 in adults without diabetes. However, from 2008, rates declined 7.9% in adults without diabetes (from 17.7 to 16.3 per 1,000 persons Δ%/year -1.5, Findings from this study highlight the need for greater infectious risk mitigation in adults with diabetes, especially young adults with diabetes.
Publisher: International Journal of Medical Education
Date: 28-06-2016
Publisher: American Medical Association (AMA)
Date: 11-2021
Publisher: Elsevier BV
Date: 10-2022
Publisher: Springer Science and Business Media LLC
Date: 17-10-2012
Publisher: Springer Science and Business Media LLC
Date: 25-08-2020
Location: No location found
Location: Australia
Location: United States of America
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