10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

Holman, Rury R.; Paul, Sanjoy K.; Bethel, M. Angelyn; Matthews, David R.; Neil, H. A. W.

doi:10.1056/nejmoa0806470

Cited by 6,753 publications

(5,093 citation statements)

References 31 publications

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“…These findings are consistent with previous results that have identified these factors as being integral to the development of diabetic foot [41,42]. The role of poor glycaemic control in the causation of microvascular complications such as diabetic peripheral neuropathy, for instance, was well established in both Diabetes Complication and Clinical Trial for type 1 diabetic patients and the UK Prospective Diabetes Study for type 2 patients [43,44]. Similarly, the influence of nephropathy and hypertension on the development and advancement of atherosclerotic lesions, especially macrovascular complications such as PVD/gangrene has been well studied [45].…”

Section: Discussionsupporting

confidence: 91%

Diabetes-related foot disorders among adult Ghanaians

Sarfo‐Kantanka

Kyei

Mbanya

et al. 2018

Diabetic Foot & Ankle

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Background: Diabetic foot remains a challenge in most low-middle-income countries (LMICs). A severe deficit in data exists on them in sub-Saharan Africa (SSA). Up-to-date data on the longitudinal trajectories and determinants can provide a benchmark for reducing diabetic foot complications in SSA. Objective: The primary objective of this study was to estimate trends in the incidence of diabetic foot and determine predictors in an adult Ghanaian diabetes cohort. Design: The study is a retrospective longitudinal study over a 12 year period. Methods: We applied Poisson regression analysis and Cox proportional hazard models to demographic and clinical information obtained from patients who enrolled in a diabetes specialist clinic in Ghana from 2005 to 2016 to identify longitudinal trends in incidence and predictors of diabetic foot. Results: The study comprised 7383 patients (63.8% female, mean follow-up duration: 8.6 years). The mean incidence of foot disorders was 8.39% (5.27% males and 3.12% females). An increase in the incidence of diabetic foot ranging from 3.25% in 2005 to 12.57% in 2016, p < 0.001, was determined. Diabetic foot, with adjusted hazard ratio (HR; 95% confidence interval (CI)), was predicted by disease duration, that is, for every 5-year increase in diabetes duration: 2.56 (1.41–3.06); male gender: 3.51 (1.41–3.06); increased body mass index (BMI), that is, for every 5 kg/m2: 3.20 (2.51–7.52); poor glycaemic control, that is, for every percentage increase in HbA1c: 1.11 (1.05–2.25), hypertension: 1.14 (1.12–3.21); nephropathy: 1.15 (1.12–3.21); and previous foot disorders: 3.24 (2.12–7.21). Conclusions: We have found a trend towards an increased incidence of diabetic foot in an outpatient tertiary diabetes setting in Ghana. Systemic and individual-level factors aimed at preventive foot screening as well as vascular risk factor control should be intensified in diabetic patients in Ghana and other LMICs. Abbreviations: BMI: Body Mass Index, BP: Blood Pressure, CI: Confidence Interval, HR: Hazard Ratio, HbA1c: Glycated Hemoglobin, PAD: Peripheral Arterial Disease, NCDs: Non Communicable Disease, SSA: Sub Saharan Africa.

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Section: Discussionsupporting

confidence: 91%

Diabetes-related foot disorders among adult Ghanaians

Sarfo‐Kantanka

Kyei

Mbanya

et al. 2018

Diabetic Foot & Ankle

View full text Add to dashboard Cite

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“…In a 10‐year posttrial follow‐up study of the United Kingdom Prospective Diabetes Study, intensive glycemic treatment reduced MI and all‐cause mortality among patients with DM in the general population 28. In the ADVANCE and Veterans Affairs Diabetes Trial, however, tight glycemic control did not lead to an improvement in cardiovascular outcomes, whereas in the ACCORD trial, in which patients had underlying cardiovascular disease, intensive treatment was associated with higher cardiovascular mortality risk 29, 30, 31.…”

Section: Discussionmentioning

confidence: 99%

“…However, higher HbA 1c was a strong risk factor for sudden death, whereas no association was found between baseline HbA 1c and risks of fatal or nonfatal MI and heart failure death 33. Although the effect of tight glycemic control on microvascular complications has been well established,5, 28, 31, 34 its effect on macrovascular complications remains controversial, and more research is warranted to further study these relationships in patients on hemodialysis with DM. In this study we observed only moderate associations between higher HbA 1c and increased rates of cardiovascular mortality and MI.…”

Section: Discussionmentioning

confidence: 99%

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Rhee

Zheng

Montez‐Rath

et al. 2017

JAHA

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BackgroundThere is a lack of data on the relationship between glycemic control and cardiovascular end points in hemodialysis patients with diabetes mellitus.Methods and ResultsWe included adult Medicare‐insured patients with diabetes mellitus who initiated in‐center hemodialysis treatment from 2006 to 2008 and survived for >90 days. Quarterly mean time‐averaged glycated hemoglobin (HbA1c) values were categorized into <48 mmol/mol (<6.5%) (reference), 48 to <58 mmol/mol (6.5% to <7.5%), 58 to <69 mmol/mol (7.5% to <8.5%), and ≥69 mmol/mol (≥8.5%). Medicare claims were used to identify outcomes of cardiovascular mortality, nonfatal myocardial infarction (MI), fatal or nonfatal MI, stroke, and peripheral arterial disease. We used Cox models as a function of time‐varying exposure to estimate multivariable adjusted hazard ratios and 95%CI for the associations between HbA1c and time to study outcomes in a cohort of 16 387 eligible patients. Patients with HbA1c 58 to <69 mmol/mol (7.5% to <8.5%) and ≥69 mmol/mol (≥8.5%) had 16% (CI, 2%, 32%) and 18% (CI, 1%, 37%) higher rates of cardiovascular mortality (P‐trend=0.01) and 16% (CI, 1%, 33%) and 15% (CI, 1%, 32%) higher rates of nonfatal MI (P‐trend=0.05), respectively, compared with those in the reference group. Patients with HbA1c ≥69 mmol/mol (≥8.5%) had a 20% (CI, 2%, 41%) higher rate of fatal or nonfatal MI (P‐trend=0.02), compared with those in the reference group. HbA1c was not associated with stroke, peripheral arterial disease, or all‐cause mortality.ConclusionsHigher HbA1c levels were significantly associated with higher rates of cardiovascular mortality and MI but not with stroke, peripheral arterial disease, or all‐cause mortality in this large cohort of hemodialysis patients with diabetes mellitus.

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“…These findings allied to the risk of hypoglycemia 34 and suggestions that insulin might promote cardiovascular disease or cancers 35, 36, 37 have raised concerns regarding the safety of insulin for type 2 diabetes. However, conflicting evidence from an extended follow‐up of the trial with the biggest between‐group difference in insulin use revealed a 15% reduction in myocardial infarction and a 13% reduction in death among people with new‐onset type 2 diabetes 38. The Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial 39 looked at the role of additional insulin to normalize fasting blood glucose in patients with diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Noman

Balasubramaniam

Alhous

et al. 2016

Cathet Cardio Intervent

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ObjectivesTo assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency).BackgroundDM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI.MethodsRetrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011.ResultsAbout 7,652 patients were nondiabetics (non‐DM), 1,116 had non‐insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi‐vessel coronary artery disease, renal impairment and non‐coronary vascular disease were more prevalent in DM patients. Overall 30‐day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30‐day mortality were 1.28 (0.81–2.03, P = 0.34) in NITDM and 2.82 (1.61–4.94, P < 0.001) in ITDM compared with non‐DM. During a median follow‐up period of 641 days, longer‐term post‐30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer‐term mortality were 1.15 (0.88–1.49, P = 0.31) in NITDM and 1.88 (1.38–2.55, P < 0.001) in ITDM compared with non‐DM group. Similar result was observed in all three different PCI settings.ConclusionIn the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin‐treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non‐diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

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10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

Cited by 6,753 publications

References 31 publications

Diabetes-related foot disorders among adult Ghanaians

Diabetes-related foot disorders among adult Ghanaians

Associations of Glycemic Control With Cardiovascular Outcomes Among US Hemodialysis Patients With Diabetes Mellitus

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

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