This study determined trends in hospital admission for diabetic ketoacidosis (DKA) in adults with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) from 1998 to 2013 in England.
The ...study population included 23,246 adults with T1DM and 241,441 adults with T2DM from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). All hospital admissions for DKA as the primary diagnosis from 1998 to 2013 were identified. Trends in hospital admission for DKA in incidence, length of hospital stay, 30-day all-cause readmission rate, and 30-day and 1-year all-cause mortality rates were determined using joinpoint regression, negative binomial regression, and logistic regression models.
For T1DM, the incidence of hospital admission for DKA increased between 1998 and 2007 and remained static until 2013. The incidence in 2013 was higher than that in 1998 (incidence rate ratio 1.53 95% CI 1.09-2.16). For T2DM, the incidence increased 4.24% (2.82-5.69) annually between 1998 and 2013. The length of hospital stay decreased over time for both diabetes types (
≤ 0.0004). Adults with T1DM were more likely to be discharged within 2 days compared with adults with T2DM (odds ratio OR 1.28 1.07-1.53). The 30-day readmission rate was higher in T1DM than in T2DM (OR 1.61 1.04-2.50) but remained unchanged for both diabetes types over time. Trends in 30-day and 1-year all-cause mortality rates were also stable, with no difference by diabetes type.
In the previous two decades in England, hospitalization for DKA increased in adults with T1DM and in those with T2DM, and associated health care performance did not improve except decreased length of hospital stay.
IMPORTANCE: Understanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. OBJECTIVE: To ...determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. DESIGN, SETTING, AND PARTICIPANTS: Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. EXPOSURES: Survey cycle. MAIN OUTCOMES AND MEASURES: Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A1c (HbA1c) level of 6.5% or more. Three risk factor control goals were individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. RESULTS: Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend < .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend < .001) increased significantly, but not individualized HbA1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults ≥65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 95% CI, 0.16-0.63), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 95% CI, 0.40-0.90), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 95% CI, 0.31-0.77). CONCLUSIONS AND RELEVANCE: Based on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.
Abstract
Except for drinking water, most beverages taste bitter or sweet. Taste perception and preferences are heritable and determinants of beverage choice and consumption. Consumption of several ...bitter- and sweet-tasting beverages has been implicated in development of major chronic diseases. We performed a genome-wide association study (GWAS) of self-reported bitter and sweet beverage consumption among ~370 000 participants of European ancestry, using a two-staged analysis design. Bitter beverages included coffee, tea, grapefruit juice, red wine, liquor and beer. Sweet beverages included artificially and sugar sweetened beverages (SSBs) and non-grapefruit juices. Five loci associated with total bitter beverage consumption were replicated (in/near GCKR, ABCG2, AHR, POR and CYP1A1/2). No locus was replicated for total sweet beverage consumption. Sub-phenotype analyses targeting the alcohol, caffeine and sweetener components of beverages yielded additional loci: (i) four loci for bitter alcoholic beverages (GCKR, KLB, ADH1B and AGBL2); (ii) five loci for bitter non-alcoholic beverages (ANXA9, AHR, POR, CYP1A1/2 and CSDC2); (iii) 10 loci for coffee; six novel loci (SEC16B, TMEM18, OR8U8, AKAP6, MC4R and SPECC1L-ADORA2A); (iv) FTO for SSBs. Of these 17 replicated loci, 12 have been associated with total alcohol consumption, coffee consumption, plasma caffeine metabolites or BMI in previous GWAS; none was involved in known sweet and bitter taste transduction pathways. Our study suggests that genetic variants related to alcohol consumption, coffee consumption and obesity were primary genetic determinants of bitter and sweet beverage consumption. Whether genetic variants related to taste perception are associated with beverage consumption remains to be determined.
Identifying when an incident diabetes (DM) diagnosis was made is complicated using retrospective, structured electronic health record (EHR) data alone. Unstructured clinical notes have been underused ...but contain valuable information that could complement traditional methods. However, manually reviewing clinical notes is time-consuming. We developed and validated a simple rule-based Natural Language Processing (NLP) method to extract incident DM timing from clinical notes.
In a single center we used structured EHR data to identify a cohort (age <45 as of 12/31/19) with likely type 1 (T1D) or type 2 (T2D) DM based on 2016-2019 records: (≥1 T1D ICD-10 code and insulin and no other DM medication) or (≥2 T2D and no T1D codes or ≥1 T2D code and a DM medication besides insulin or metformin).
This cohort had 2,654 patients (548,316 clinical notes, 2003-present). We randomly selected 58,450 clinical notes (1,465 patients) as a training set to look for relevant text patterns. We handcrafted the rules into our NLP tool. We required 3 distinct concepts at the sentence level to determine an incident DM diagnosis: DM (not, e.g., epilepsy), an onset attribute (e.g., “diagnosed in”), and a temporal component (e.g., 8/2008). We pre-defined all related keywords and date formats for these concepts in our training notes. We then tested the NLP algorithm against manual review in an independent set of 100 randomly selected patients from the cohort. Analysis was at the patient level (true+: ≥1 true+ note per patient).
NLP in the training set found 1,268 patients with at least 1 of the 3 concepts and 826 patients with all 3. In the test set, we excluded 4 patients without substantive notes. NLP correctly detected incident DM timing in 73 of 96 patients. The NLP had recall 88%, specificity 77%, precision (PPV) 96%, and NPV 50%.
NLP was helpful in finding incident DM timing and may complement structured EHR queries for identifying incident DM. Refinement of our NLP algorithm is ongoing.
Disclosure
A.Wong: None. V.W.Zhong: None. M.Rosenman: None.
Funding
Centers for Disease Control and Prevention (1U18DP006693-01-00)
Objective: To estimate trends in prevalence, awareness and treatment of diabetes and prediabetes among young adults in the US.
Methods: Adults aged 20-44 years except pregnant women were included ...from the National Health and Nutrition Examination Survey between 1988-1994 and 2017-2020. Primary outcomes were diabetes and prediabetes defined according to self-reported diagnosis, fasting plasma glucose, or hemoglobin A1c. Secondary outcomes were awareness and treatment of diabetes and awareness of prediabetes. The prevalence trends of outcomes were assessed, and grouping variables (e.g., age, sex, race/ethnicity) were selected for subgroup analysis.
Results: Among young adults included, the estimated prevalence of diabetes increased from 3.1% 95% CI, 2.5%-3.7% in 1988-1994 to 4.9% 95% CI, 4.0%-5.8% in 2017-2020 (P=0.002). The estimated prevalence of prediabetes rose from 21.8% 95% CI, 19.7%-23.9% in 1988-1994 to 28.7% 95% CI, 24.6%-32.8% in 2017-2020 (P=0.001). The estimated prevalence of diabetes awareness decreased from 70.8% 95% CI, 60.4%-81.2% in 1988-1994 to 64.9% 95% CI, 59.0%-70.8% in 2010-2020 with no significance (P=0.25), and the estimated prevalence of diabetes treatment plateaued (P=0.64). In 2011-2020, among young adults with prediabetes, only 8.8% 95% CI, 6.5%-11.2% reported being aware of their condition. During the study period, young adults aged 20-29 years had significant decrease in the prevalence of diabetes awareness and diabetes treatment, significant increase in the prevalence of prediabetes, and the lowest prevalence of prediabetes awareness.
Conclusions: Among young US adults, the estimated prevalence of diabetes and prediabetes increased significantly from 1988 to 2020, and their awareness of diabetes and prediabetes was insufficient, especially among adults aged 20-29 years. Comprehensive actions are needed to address the continuously rising burden of glycemic control among young adults in the US.
Disclosure
Y.Huang: None. H.Wang: None. V.W.Zhong: None.
Funding
Shanghai Municipal Education Commission (QD2020027, GWV-10.1-XK15)
IMPORTANCE: Although the associations between processed meat intake and cardiovascular disease (CVD) and all-cause mortality have been established, the associations of unprocessed red meat, poultry, ...or fish consumption with CVD and all-cause mortality are still uncertain. OBJECTIVE: To identify the associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed individual-level data of adult participants in 6 prospective cohort studies in the United States. Baseline diet data from 1985 to 2002 were collected. Participants were followed up until August 31, 2016. Data analyses were performed from March 25, 2019, to November 17, 2019. EXPOSURES: Processed meat, unprocessed red meat, poultry, or fish intake as continuous variables. MAIN OUTCOMES AND MEASURES: Hazard ratio (HR) and 30-year absolute risk difference (ARD) for incident CVD (composite end point of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality, based on each additional intake of 2 servings per week for monotonic associations or 2 vs 0 servings per week for nonmonotonic associations. RESULTS: Among the 29 682 participants (mean SD age at baseline, 53.7 15.7 years; 13 168 44.4% men; and 9101 30.7% self-identified as non-white), 6963 incident CVD events and 8875 all-cause deaths were adjudicated during a median (interquartile range) follow-up of 19.0 (14.1-23.7) years. The associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality were monotonic (P for nonlinearity ≥ .25), except for the nonmonotonic association between processed meat intake and incident CVD (P for nonlinearity = .006). Intake of processed meat (adjusted HR, 1.07 95% CI, 1.04-1.11; adjusted ARD, 1.74% 95% CI, 0.85%-2.63%), unprocessed red meat (adjusted HR, 1.03 95% CI, 1.01-1.06; adjusted ARD, 0.62% 95% CI, 0.07%-1.16%), or poultry (adjusted HR, 1.04 95% CI, 1.01-1.06; adjusted ARD, 1.03% 95% CI, 0.36%-1.70%) was significantly associated with incident CVD. Fish intake was not significantly associated with incident CVD (adjusted HR, 1.00 95% CI, 0.98-1.02; adjusted ARD, 0.12% 95% CI, −0.40% to 0.65%). Intake of processed meat (adjusted HR, 1.03 95% CI, 1.02-1.05; adjusted ARD, 0.90% 95% CI, 0.43%-1.38%) or unprocessed red meat (adjusted HR, 1.03 95% CI, 1.01-1.05; adjusted ARD, 0.76% 95% CI, 0.19%-1.33%) was significantly associated with all-cause mortality. Intake of poultry (adjusted HR, 0.99 95% CI, 0.97-1.02; adjusted ARD, −0.28% 95% CI, −1.00% to 0.44%) or fish (adjusted HR, 0.99 95% CI, 0.97-1.01; adjusted ARD, −0.34% 95% CI, −0.88% to 0.20%) was not significantly associated with all-cause mortality. CONCLUSIONS AND RELEVANCE: These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality. These findings have important public health implications and should warrant further investigations.
IMPORTANCE: Cholesterol is a common nutrient in the human diet and eggs are a major source of dietary cholesterol. Whether dietary cholesterol or egg consumption is associated with cardiovascular ...disease (CVD) and mortality remains controversial. OBJECTIVE: To determine the associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: Individual participant data were pooled from 6 prospective US cohorts using data collected between March 25, 1985, and August 31, 2016. Self-reported diet data were harmonized using a standardized protocol. EXPOSURES: Dietary cholesterol (mg/day) or egg consumption (number/day). MAIN OUTCOMES AND MEASURES: Hazard ratio (HR) and absolute risk difference (ARD) over the entire follow-up for incident CVD (composite of fatal and nonfatal coronary heart disease, stroke, heart failure, and other CVD deaths) and all-cause mortality, adjusting for demographic, socioeconomic, and behavioral factors. RESULTS: This analysis included 29 615 participants (mean SD age, 51.6 13.5 years at baseline) of whom 13 299 (44.9%) were men and 9204 (31.1%) were black. During a median follow-up of 17.5 years (interquartile range, 13.0-21.7; maximum, 31.3), there were 5400 incident CVD events and 6132 all-cause deaths. The associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality were monotonic (all P values for nonlinear terms, .19-.83). Each additional 300 mg of dietary cholesterol consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.17 95% CI, 1.09-1.26; adjusted ARD, 3.24% 95% CI, 1.39%-5.08%) and all-cause mortality (adjusted HR, 1.18 95% CI, 1.10-1.26; adjusted ARD, 4.43% 95% CI, 2.51%-6.36%). Each additional half an egg consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.06 95% CI, 1.03-1.10; adjusted ARD, 1.11% 95% CI, 0.32%-1.89%) and all-cause mortality (adjusted HR, 1.08 95% CI, 1.04-1.11; adjusted ARD, 1.93% 95% CI, 1.10%-2.76%). The associations between egg consumption and incident CVD (adjusted HR, 0.99 95% CI, 0.93-1.05; adjusted ARD, −0.47% 95% CI, −1.83% to 0.88%) and all-cause mortality (adjusted HR, 1.03 95% CI, 0.97-1.09; adjusted ARD, 0.71% 95% CI, −0.85% to 2.28%) were no longer significant after adjusting for dietary cholesterol consumption. CONCLUSIONS AND RELEVANCE: Among US adults, higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD and all-cause mortality in a dose-response manner. These results should be considered in the development of dietary guidelines and updates.
Abstract
Background
longitudinal evidence concerning frailty phenotype and the risk of cardiovascular disease (CVD) remained insufficient, and whether CVD preventive strategies exert low CVD risk on ...frail adults is unclear.
Objectives
we aimed to prospectively evaluate the association of frailty phenotype, adherence to ideal cardiovascular health (CVH) and their joint associations with the risk of CVD.
Methods
a total of 314,093 participants from the UK Biobank were included. Frailty phenotype was assessed according to the five criteria of Fried et al.: weight loss, exhaustion, low physical activity, slow gait speed and low grip strength. CVH included four core health behaviours (smoking, physical activity and diet) and three health factors (weight, cholesterol, blood pressure and glycaemic control). The outcome of interest was incident CVD, including coronary heart disease, heart failure and stroke.
Results
compared with the non-frail people whose incident rate of overall CVD was 6.54 per 1,000 person-years, the absolute rate difference per 1,000 person-years was 1.67 (95% confidence interval, CI: 1.33, 2.02) for pre-frail and 5.00 (95% CI: 4.03, 5.97) for frail. The ideal CVH was significantly associated with a lower risk of all CVD outcomes. For the joint association of frailty and CVH level with incident CVD, the highest risk was observed among frailty accompanied by poor CVH with an HR of 2.92 (95% CI: 2.68, 3.18).
Conclusions
our findings indicate that physical frailty is associated with CVD incidence. Improving CVH was significantly associated with a considerable decrease in CVD risk, and such cardiovascular benefits remain for the frailty population.
Graphical abstract
Adding salt at the table is a prevalent eating habit, but its long-term relationship with cardiovascular disease (CVD) and all-cause mortality remains unclear. We evaluated the associations of adding ...salt at the table with the risk of incident CVD and all-cause mortality.
Among 413,109 middle- and old-aged adults without cancer or CVD, all participants reported the frequency of adding salt at the table at baseline. The associations between adding salt at the table and incident CVD (the composite endpoint of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality were investigated using Cox proportional hazards models.
Of the study population, the mean age was 55.8 years and 45.5% were men; 44.4% reported adding salt at the table; 4.8% reported always adding salt at the table. During a median follow-up of 12 years, there were 37,091 incident CVD cases and 21,293 all-cause deaths. After adjustment for demographic, lifestyle, and cardiometabolic risk factors, the multivariable-adjusted hazard ratios (HRs) for participants who always added salt at the table versus never/rarely added salt at the table were 1.21 (95% confidence interval CI: 1.16-1.26) for CVD, 1.19 (95%CI: 1.05-1.35) for CVD mortality, and 1.22 (95%CI: 1.16-1.29) for all-cause mortality, respectively.
In this prospective cohort study, a higher frequency of adding salt at the table was associated with a greater risk of incident CVD and mortality. Our findings support the benefits of restricting the habit of adding salt at the table in promoting cardiovascular health.
Full text
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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