All-cause mortality in patients with diabetes under glucagon-like peptide-1 agonists: A population-based, open cohort study

Toulis, Konstantinos; Hanif, Wasim; Saravanan, Ponnusamy; Willis, Brian H; Marshall, Tom; Kumarendran, Balachandran; Gokhale, Krishna; Ghosh, Sandip; Cheng, Kar Keung; Narendran, Parth; Thomas, G. Neil; Nirantharakumar, Krishnarajah

doi:10.1016/j.diabet.2017.02.003

Cited by 27 publications

(45 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Townsend index, ranging from 1 to 5, is a measure of material deprivation, calculated using social indices such as income, education and employment specific to each participant's neighbourhood [22,23]. Socioeconomic status has been convincingly related to glycaemic control [24] and the Townsend index has been used extensively as a covariate in diabetes studies using THIN database [25][26][27]. In the adjusted model, the group with the longest duration of type 1 diabetes (≥10 years) was preferred as the reference category; this is because if individuals were to track, i.e., if the proposed hypothesis was true, then we would expect to see no significant difference between this group and groups with a lower duration of type 1 diabetes.…”

Section: Methodsmentioning

confidence: 99%

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

et al. 2018

View full text Add to dashboard Cite

Aims/hypothesis Our objectives were to explore whether the phenomenon of HbA 1c 'tracking' occurs in individuals with type 1 diabetes, how long after diagnosis does tracking take to stabilise, and whether there is an effect of sex and age at diagnosis on tracking. Methods A total of 4525 individuals diagnosed with type 1 diabetes between 1 January 1995 and 1 May 2015 were identified from The Health Improvement Network (THIN) database. Mixed models were applied to assess the variability of HbA 1c levels over time with random effects on general practices (primary care units) and individuals within practices. Results 4525 individuals diagnosed with type 1 diabetes were identified in THIN over the study period. The greatest difference in mean HbA 1c measurement (−7.0 [95% CI −8.0, −6.1] mmol/mol [0.6%]) was seen when comparing measurements made immediately after diagnosis (0-1 year since diagnosis) with those at 10 or more years (the reference category). The mean difference in HbA 1c for the successive periods compared with 10 or more years after diagnosis declined and was no longer statistically significant after 5 years. In the stratified analysis using sex and age group there was considerable heterogeneity with adult onset type 1 diabetes appearing to track earlier and at a lower mean HbA 1c . Conclusions/interpretation In individuals with type 1 diabetes, glycaemic control measured by HbA 1c settles onto a long-term 'track' and this occurs on average by 5 years following diagnosis. Age at diagnosis modifies both the rate at which individuals settle into their track and the absolute HbA 1c tracking level for the next 10 years.

show abstract

Section: Methodsmentioning

confidence: 99%

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

et al. 2018

View full text Add to dashboard Cite

show abstract

“…More than 675 practices, scattered representatively around the UK, contribute data to THIN covering 3.7 million active patients (6%‐7% of the UK population) . THIN data are generalizable for the UK for major health conditions and used for investigating circulatory disease outcomes and mortality …”

Section: Methodsmentioning

confidence: 99%

“…18 THIN data are generalizable for the UK for major health conditions 19 and used for investigating circulatory disease outcomes and mortality. 20,21 The study period extended from 1 January 1996 (study start or earliest index date) to 1 May 2016 (study end or latest index date).…”

Section: Materials S and Me Thodsmentioning

confidence: 99%

Risk of incident circulatory disease in patients treated for differentiated thyroid carcinoma with no history of cardiovascular disease

Toulis

Viola

Gkoutos

et al. 2019

Clinical Endocrinology

View full text Add to dashboard Cite

Context The incidence of differentiated thyroid cancer (DTC) is increasing, yet the prognosis is favourable and long‐term survival is expected. Exogenous TSH suppression has been used for many years to prevent DTC recurrence and may be associated with increased risks of circulatory diseases. Design Risks of circulatory disease in patients treated for DTC were compared to randomly matched patients without DTC (controls) up to a 1:5 ratio using age, sex, body mass index (BMI) and smoking as the matching parameters in a population‐based, open cohort study using The Health Improvement Network. Patients A total of 3009 patients treated for DTC with no pre‐existing cardiovascular disease were identified and matched to 11 303 controls, followed up to median of 5 years. Results A total of 1259 incident circulatory events were recorded during the observation period. No difference in the risk of ischaemic heart disease (IHD) (adjusted hazards ratio [aHR]: 1.04, 95% CI: 0.80‐1.36) or heart failure (HF) (aHR: 1.27, 95% CI: 0.89‐1.81) was detected. The risk of atrial fibrillation (AF) and stroke was significantly higher in patients with DTC (aHR: 1.71, 95% CI: 1.36‐2.15 and aHR: 1.34, 95% CI: 1.05‐1.72, respectively). In a sensitivity analysis limited to newly diagnosed patients with DTC, only the risk of AF was consistently elevated (aHR: 1.86, 95% CI: 1.33‐2.60). Conclusions The increased risk of AF in patients who have undergone treatment for DTC but without pre‐existing CVD may warrant periodic screening for this arrhythmia. Whereas no evidence of increased risk of IHD or HF was observed, the increased risk of stroke/TIA warrants further investigation.

show abstract

“…In the UK, the Quality Outcome Framework (QOF) in general practices ensures high-quality data on important K E Y W O R D S androgens, diabetes, hypogonadism, metabolic diseases, population health, sex hormonebinding globulin, testosterone comorbidities such as cardiovascular disease, hypertension and T2DM. 19 These included age, body mass index (BMI), Townsend deprivation score and smoking status. 3 Covariates that are independent predictors of T2DM other than the exposure of interest were selected on the basis of biological plausibility and previous literature.…”

Section: Outcome and Covariatesmentioning

confidence: 99%

“…3 Covariates that are independent predictors of T2DM other than the exposure of interest were selected on the basis of biological plausibility and previous literature. 19 These included age, body mass index (BMI), Townsend deprivation score and smoking status.…”

Section: Outcome and Covariatesmentioning

confidence: 99%

Serum testosterone, sex hormone‐binding globulin and sex‐specific risk of incident type 2 diabetes in a retrospective primary care cohort

O’Reilly

Glišić

Kumarendran

et al. 2018

Clinical Endocrinology

View full text Add to dashboard Cite

SummaryObjectivePrevious studies suggest that androgens have a sexually dimorphic impact on metabolic dysfunction. However, the sex‐specific link between circulating androgens and risk of type 2 diabetes mellitus (T2DM) has not been examined in a large scale, longitudinal cohort, a task we undertook in this study.DesignA retrospective cohort study in a UK primary care database.PatientsWe included men and women with available serum testosterone and sex hormone‐binding globulin (SHBG) results.MeasurementsWe categorized serum concentrations according to clinically relevant cut‐off points and calculated crude and adjusted T2DM Incidence Rate Ratios (IRRs and aIRRs).ResultsSerum testosterone concentrations were available in 70 541 men and 81 889 women; serum SHBG was available in 15 907 men and 42 034 women. In comparison to a reference cohort with serum testosterone ≥20 nmol/L, men with lower serum testosterone had a significantly increased risk of T2DM, with the highest risk in those with serum testosterone <7 nmol/L (aIRR 2.71, 95% CI 2.34‐3.14, P < 0.001). In women, the risk of T2DM started to increase significantly when serum testosterone concentrations exceeded 1.5 nmol/L, with the highest risk in women with serum testosterone ≥3.5 nmol/L (aIRR 1.98, 95% CI 1.55‐2.52, P < 0.001). These observations were verified in a continuous rather than categorized analysis. The risk of T2DM increased in men and women with serum SHBG <40 and <50 nmol/L, respectively.Conclusions/InterpretationIn this longitudinal study, we found sexually dimorphic associations between serum testosterone and risk of incident T2DM. Androgen deficiency and excess should be considered important risk factors for diabetes in men and women, respectively.

show abstract

All-cause mortality in patients with diabetes under glucagon-like peptide-1 agonists: A population-based, open cohort study

Cited by 27 publications

References 9 publications

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

Risk of incident circulatory disease in patients treated for differentiated thyroid carcinoma with no history of cardiovascular disease

Serum testosterone, sex hormone‐binding globulin and sex‐specific risk of incident type 2 diabetes in a retrospective primary care cohort

Contact Info

Product

Resources

About