Abstract
Aim
To quantify the impact of foot complications on mortality outcomes in people with type 2 diabetes (T2D), and how routinely measured factors might modulate that risk.
Materials and ...Methods
Data for individuals with T2D for 2010‐2020, from the Salford Integrated Care Record (Salford, UK), were extracted for laboratory and clinical data, and deaths. Annual expected deaths were taken from Office of National Statistics mortality data. An index of multiple deprivation (IMD) adjusted the standardized mortality ratio (SMR_IMD). Life years lost per death (LYLD) was estimated from the difference between expected and actual deaths.
Results
A total of 11 806 T2D patients were included, with 5583 new diagnoses and 3921 deaths during 2010‐2020. The number of expected deaths was 2135; after IMD adjustment, there were 2595 expected deaths. Therefore, excess deaths numbered 1326 (SMR_IMD 1.51). No foot complications were evident in
n
= 9857. This group had an SMR_IMD of 1.13 and 2.74 LYLD. In total, 2979 patients had any foot complication recorded. In this group, the SMD_IMR was 2.29; of these, 2555 (75%) had only one foot complication. Patients with a foot complication showed little difference in percentage HbA1c more than 58 mmol/mol. In multivariate analysis, for those with a foot complication and an albumin‐to‐creatinine ratio of more than 3 mg/mmol, the odds ratio (OR) for death was 1.93, and for an estimated glomerular filtration rate of less than 60 mL/min/1.73m
2
, the OR for death was 1.92.
Conclusions
Patients with T2D but without a foot complication have an SMR_IMD that is only slightly higher than that of the general population. Those diagnosed with a foot complication have a mortality risk that is double that of those without T2D.
Faecal immunochemical testing for haemoglobin (FIT) is used to triage patients for colonic investigations. Point-of-care (POC) FIT devices on the market have limited data for their diagnostic ...accuracy for colorectal cancer (CRC). Here, a POC FIT device is compared with a laboratory-based FIT system using patient collected samples from the urgent referral pathway for suspected CRC.
A prospective, observational cohort study. Patients collected two samples from the same stool. These were measured by POC QuikRead go
(Aidian Oy, Espoo, Finland) and laboratory-based FOB Gold Wide
(Sentinel Diagnostics, Italy). Faecal haemoglobin <10 μg haemoglobin/g of faeces was considered as negative. At this threshold, comparisons between the two systems were made by calculating percentage agreement and Cohen's kappa coefficient. Proportion of negative results were compared with Chi squared testing. Sensitivities for CRC were calculated.
A total of 629 included patients provided paired samples for FIT to compare the QuikRead go
and FOB Gold Wide
. The agreement around the negative threshold was 83.0% and Cohen's kappa coefficient was 0.54. The QuikRead go
reported 440/629 (70.0% of samples) as negative compared to 523/629 (83.1%) for the FOB Gold Wide
, this difference was significant (p-value<0.001). Sensitivities for CRC detection by the QuikRead go
and FOB Gold Wide
were 92.9% (95% confidence interval (CI): 68.5-98.7%) and 100% (CI: 78.5-100%) respectively.
Both systems were accurate in their ability to detect CRC. Whilst good agreement around the negative threshold was identified, more patients would be triaged to further colonic investigation if using the QuikRead go
.
Increasing evidence points to endothelial cell dysfunction as a key pathophysiological factor in severe coronavirus disease-19 (COVID-19), manifested by platelet aggregation, microthrombi and altered ...vasomotor tone. This may be driven by direct endothelial cell entry by the virus, or indirectly by activated inflammatory cascade. Major risk groups identified for adverse outcomes in COVID-19 are diabetes, and those from the Black, Asian and ethnic minority (BAME) populations. Hyperglycaemia (expressed as glycated haemoglobin or mean hospital glucose) correlates with worse outcomes in COVID-19. It is not known whether hyperglycaemia is causative or is a surrogate marker - persistent hyperglycaemia is well known as an aetiological agent in microangiopathy. In this article, we propose that pre-existing endothelial dysfunction of microangiopathy, more commonly evident in diabetes and BAME groups, makes an individual vulnerable to the subsequent 'endothelitis' of COVID-19 infection.
Aim
To determine the absolute risk reduction (ARR) of heart failure events in people treated with sodium‐glucose co‐transporter‐2 (SGLT2) inhibitors.
Materials and Methods
We searched PubMed, EMBASE, ...CINAHL and ISI Web of Science for observational studies published to 9 May 2022 that explored the association between SGLT2 inhibitors and any indication for heart failure (including new diagnosis or hospitalization for heart failure) in type 2 diabetes. Identified studies were independently screened by two reviewers and assessed for bias using the Newcastle‐Ottawa scale. Eligible studies with comparable outcome data were pooled for meta‐analysis using random‐effects models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs). The ARR per 100 person‐years was determined overall, and in subgroups with and without baseline cardiovascular disease (CVD).
Results
From 43 eligible studies, with a total of 4 818 242 participants from 17 countries, 21 were included for meta‐analysis. SGLT2 inhibitors were associated with a reduced risk of hospitalization for heart failure (HR 0.65, 95% CI 0.59‐0.72) overall and both in those with CVD (HR 0.78, 95% CI 0.68‐0.89) and without CVD (HR 0.53, 95% CI 0.39‐0.71). Risk reduction for hospitalization for heart failure in people with a history of CVD (ARR 1.17, 95% CI 0.78‐1.55) was significantly greater than for those without CVD (ARR 0.39, 95% CI 0.32‐0.47). The number‐needed‐to‐treat to prevent one event of hospitalization for heart failure was 86 (95% CI 65‐128) person‐years of treatment for the CVD group and 256 (95% CI 215‐316) person‐years for those without CVD.
Conclusions
Real‐world SGLT2 inhibitor use supports randomized trial data for the size effect of reduced hospitalization for heart failure in type 2 diabetes, although with a much lower ARR in people without CVD.
•Retinopathy prevalence at Type 2 diabetes mellitus diagnosis has reduced compared to earlier studies.•Higher HbA1c at Type 2 diabetes mellitus diagnosis is associated with greater development and ...progression of retinopathy.•Obesity may be associated with lower risk of retinopathy development.
To determine, inreal-world primary care settings, the prevalence of, and risk factors for, retinopathy atType 2 diabetes mellitus diagnosis and report cumulative incidence and progression of retinopathy seven years after diabetes diagnosis.
Retrospective cohort analysis of people with newly diagnosed Type 2 diabetesrecorded bythe Royal College of General Practitioners Research and Surveillance Centre(between 2005 and 2009, n=11,399).Outcomes included; retinopathy prevalence atdiabetesdiagnosis (baseline) and cumulative incidence or progression of retinopathy at seven years. Retinopathy prevalence was compared with the United Kingdom Prospective Diabetes Study (UKPDS-1998). Factors influencing retinopathy incidence and progression were analysed using logistic regression.
Baseline retinopathy prevalencewas 18% (n=2,048) versus 37% in UKPDS. At seven years, 11.6% (n=237) of those with baseline retinopathyhad progression of retinopathy. In those without baseline retinopathy, 46.4% (n=4,337/9,351) developed retinopathy by seven years. Retinopathy development (OR: 1.05 95%CI: 1.02–1.07 per mmol/mol increase) and progression (OR: 1.05 1.04–1.06) at seven years was associated with higher HbA1catdiabetesdiagnosis. Obesity (OR: 0.88 0.79–0.98) and high socioeconomic status (OR: 0.63 0.53–0.74) were negatively associated with retinopathy development at seven years.
Baseline retinopathy prevalence has declined since UKPDS. Additionally, HbA1c at diabetes diagnosis remains important for retinopathy development and progression.
Introduction
Glycaemic control associates with better outcomes for hospitalised patients. Whether GLP‐1 receptor agonists (GLP‐1 RA) are suitable and effective drugs for inpatients is unclear.
...Methods
A retrospective, single centre, observational study using data from the electronic health record. Patients admitted using GLP‐1 RA as outpatients, from 2016 to 2019, were identified. Outcomes were compared to those admitted using twice‐daily (BD) mixed insulin. Capillary glucose, medication use, creatinine, and demographic data were collected. As drugs may be discontinued/not administered in hospital, days when GLP‐1 RA was administered were ‘GLP‐1 RA active’ and, for insulin, ‘insulin active’. The primary comparison was rate of hypoglycaemia (<4 mmol/L) and severe hypoglycaemia (<3 mmol/L). A logistic regression model examined variables for hypoglycaemia.
Results
GLP‐1 RA comprised n = 262 admissions and BD insulin n = 166. The ‘insulin active’ cohort (n = 957 patient days) had higher risk of hypoglycaemia than ‘GLP‐1 RA active’ (n = 806 days); occurring on 14.7% of days; 95% confidence interval CI 12.6–17.1 versus 9.9% days; 95% CI 8.0–12.2; p = 0.002, and severe hypoglycaemia 4.0% of days (95% CI 2.8–5.4) versus 2.0% (95% CI 1.1%–3.2%; p = 0.005). Daily glucose (mean ± standard deviation) was 10.8 ± 5.2 mmol/L in insulin active versus 9.6 ± 4.7 mmol/L in GLP‐1 RA active; p < 0.001. Insulin use, age, and acute admissions predicted hypoglycaemia. The odds ratio for hypoglycaemia was 2.15 times greater (95% CI, 1.14–4.08; p = 0.019) with insulin than with GLP‐1 RA.
Conclusions
GLP‐1 RA provided better glycaemic control than BD mixed insulin and should be continued during hospitalisation unless there is a clear indication for cessation.
Aim
To determine whether achieving early glycaemic control, and any subsequent glycaemic variability, was associated with any change in the risk of major adverse cardiovascular events (MACE).
...Materials and Methods
A retrospective cohort analysis from the Oxford‐Royal College of General Practitioners Research and Surveillance Centre database—a large, English primary care network—was conducted. We followed newly diagnosed patients with type 2 diabetes, on or after 1 January 2005, aged 25 years or older at diagnosis, with HbA1c measurements at both diagnosis and after 1 year, plus five or more measurements of HbA1c thereafter. Three glycaemic bands were created: groups A (HbA1c < 58 mmol/mol <7.5%), B (HbA1c ≥ 58 to 75 mmol/mol 7.5%‐9.0%) and C (HbA1c ≥ 75 mmol/mol ≥9.0%). Movement between bands was determined from diagnosis to 1 year. Additionally, for data after the first 12 months, a glycaemic variability score was calculated from the number of successive HbA1c readings differing by 0.5% or higher (≥5.5 mmol/mol). Risk of MACE from 1 year postdiagnosis was assessed using time‐varying Cox proportional hazards models, which included the first‐year transition and the glycaemic variability score.
Results
From 26 180 patients, there were 2300 MACE. Compared with group A‐>A transition over 1 year, those with C‐>A transition had a reduced risk of MACE (HR 0.75; 95% CI 0.60‐0.94; P = .014), whereas group C‐>C had HR 1.21 (0.81‐1.81; P = .34). Compared with the lowest glycaemic variability score, the greatest variability increased the risk of MACE (HR 1.51; 1.11‐2.06; P = .0096).
Conclusion
Early control of HbA1c improved cardiovascular outcomes in type 2 diabetes, although subsequent glycaemic variability had a negative effect on an individual's risk.
Abstract
Introduction
The standardised mortality rate (SMR) for people with diabetes in England is 1.5–1.7, with differences in outcomes between sexes. There has been little work examining the ...factors that could have an impact on this or on what may determine sex differences in outcome.
Methods
Data were extracted for patients with type 2 diabetes (T2D) in Salford (England) in 2010 for the years up to 2020, including any deaths recorded. Expected deaths were calculated from annual Office of National Statistics mortality rate and life expectancy by age and gender, adjusted for the local Index of Multiple Deprivation (IMD). This provided the SMR deprivation (SMRd), and life expectancy years lost per death (LEYLD). The effects of treatment type, and clinical features on SMRd relative to sex were examined by univariable and multivariable analysis.
Results
Data from
n
= 11,806 (
F
= 5184;
M
= 6622) patients were included. Of these,
n
= 5540 were newly diagnosed and
n
= 3921 died (
F
= 1841;
M
= 2080). In total,
n
= 78,930 patient years. The expected deaths numbered
n
= 2596 (adjusted for age, sex, and IMD). Excess deaths were
n
= 1325 (
F
= 689;
M
= 636). Life expectancy years lost (LEYL) 18,989 (
F
= 9714;
M
= 9275). SMRd 1.51 (
F
= 1.60;
M
= 1.44) and LEYLD 4.84 years (
F
= 5.28;
M
= 4.46). The impact of risk factors was not different by sex. However, women had higher prevalence of % diagnosed >65 years of age; % last eGFR <60 mLs/min/1.73 m
2
, and lower prevalence of % prescribed ACE‐inhibitor/ARB, DPP4‐inhibitor and SGLT2‐inhibitor. Applying the male prevalence rate to the female population and expected mortality suggested
n
= 437 (55%) of excess T2D female deaths were attributed to sex difference in the prevalence of these risk and protective factors.
Conclusions
Outcomes in women with T2DM are worse than in men, contributed to by greater prevalence of adverse factors and less prescribing of cardioprotective medication.
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