Changes in Diabetes-Related Complications in the United States, 1990–2010

Gregg, Edward W.; Li, Yanfeng; Wang, Jing; Burrows, Nilka Ríos; Ali, Mohammed K.; Rolka, Deborah B.; Williams, Desmond E.; Geiss, Linda S.

doi:10.1056/nejmoa1310799

Cited by 1,457 publications

(1,084 citation statements)

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“…Diabetes, hypertension, chronic obstructive pulmonary disease, and increased operative time, however, were reported not to be independently associated with CVA after elective orthopaedic surgery [24,29].However, this may be attributable to insulin-dependent diabetes mellitus not being separated from noninsulin-dependent diabetes mellitus, there were smaller patient cohorts, and/or the exclusion of postdischarge CVAs with the NIS, which may have contributed to these discrepancies. Insulin-dependent diabetes mellitus has been linked to advanced atherosclerosis and ischemic stroke, whereas uncontrolled hypertension is associated with ischemic and hemorrhagic CVA in the general population [13,35]. Moreover, chronic obstructive pulmonary disease recently was shown to be associated with carotid artery wall thickening, placing patients at greater danger for ischemic events [21].…”

Section: Discussionmentioning

confidence: 99%

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Minhas

Goyal

Patel

2016

Clinical Orthopaedics &Amp; Related Research

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Background Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. Questions/purposes Our goals were to (1) establish the national, baseline proportion of patients experiencing a 30-day CVA and the timing of CVA; and (2) determine independent risk factors for 30-day CVA rates after common elective orthopaedic procedures. Methods Patients undergoing elective TKA, THA, posterior or posterolateral lumbar fusion, anterior cervical discectomy and fusion, and total shoulder arthroplasty, from 2006 to 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program 1 database. A total of 42,150 patients met inclusion criteria. Thirty-day CVA rates were recorded for each procedure, and patients were assessed for characteristics associated with CVA through univariate analysis. Multivariate regression models were created to identify independent risk factors for CVA. Results A total of 55 (0.13%) patients experienced a CVA within 30 days of the procedure, occurring a median of 2 days after surgery (range, 1-30 days) with 0.08% of patients experiencing a CVA after TKA, 0.15% after THA, 0.00% after single-level anterior cervical discectomy and fusion, 0.38% after multilevel anterior cervical discectomy and fusions, 0.20% after single-level posterior or posterolateral lumbar fusion, 0.70% after multilevel posterior or posterolateral lumbar fusion, and 0.22% after total shoulder arthroplasty. Independent risk factors for CVA included age of 75 years or older (odds ratio [OR], 2.50; 95% CI,

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Section: Discussionmentioning

confidence: 99%

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Minhas

Goyal

Patel

2016

Clinical Orthopaedics &Amp; Related Research

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“…Likewise, coronary heart disease (CHD) remains an important macrovascular complication of T2DM,11 which, in turn, has been suggested as a risk equivalent of CHD 12. Over the years, the association of circulating FGF21 with CHD in T2DM has not been clearly defined.…”

Section: Introductionmentioning

confidence: 99%

Role of Circulating Fibroblast Growth Factor 21 Measurement in Primary Prevention of Coronary Heart Disease Among Chinese Patients With Type 2 Diabetes Mellitus

Lee

Woo

Chow

et al. 2017

JAHA

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BackgroundFibroblast growth factor 21 (FGF21) has demonstrated beneficial effects on lipid and carbohydrate metabolism. In cross‐sectional studies, an association of raised circulating FGF21 levels with coronary heart disease (CHD) was found in some but not all studies. Here we investigated prospectively whether baseline serum FGF21 levels could predict incident CHD in subjects with type 2 diabetes mellitus and no known cardiovascular diseases.Methods and ResultsBaseline serum FGF21 levels were measured in 3528 Chinese subjects with type 2 diabetes mellitus recruited from the Hong Kong West Diabetes Registry. The role of baseline serum FGF21 levels in predicting incident CHD over a median follow‐up of 3.8 years was analyzed using Cox regression analysis. Among 3528 recruited subjects without known cardiovascular diseases, 147 (4.2%) developed CHD over a mean follow‐up of 4 years. Baseline serum log‐transformed FGF21 levels were significantly higher in those who had incident CHD than those who did not (222.7 pg/mL [92.8–438.4] versus 151.1 pg/mL [75.6–274.6]; P<0.001). On multivariable Cox regression analysis, baseline serum FGF21 levels, using an optimal cutoff of 206.22 pg/mL derived from our study, independently predicted incident CHD (hazard ratio, 1.55; 95% CI, 1.10–2.19; P=0.013) and significantly improved net reclassification index and integrated discrimination improvement after adjustment for conventional cardiovascular risk factors.ConclusionsWe have demonstrated, for the first time, that serum FGF21 level is an independent predictor of incident CHD and might be usefully utilized as a biomarker for identifying type 2 diabetes mellitus subjects with raised CHD risk, for primary prevention.

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“…Although, contemporary population data demonstrates evidence of reduction in cardiovascular complications with risk factor control in patients with diabetes 5, 6, it is not known whether this translates to improvements following coronary revascularization as recent randomized control trials continue to show worst outcomes in diabetic patients with complex coronary artery disease when treated with PCI compared with coronary artery bypass graft (CABG) 7, 8, 9.…”

Section: Introductionmentioning

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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Changes in Diabetes-Related Complications in the United States, 1990–2010

Abstract: Rates of diabetes-related complications have declined substantially in the past two decades, but a large burden of disease persists because of the continued increase in the prevalence of diabetes. (Funded by the Centers for Disease Control and Prevention.).

Cited by 1,457 publications

References 33 publications

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Role of Circulating Fibroblast Growth Factor 21 Measurement in Primary Prevention of Coronary Heart Disease Among Chinese Patients With Type 2 Diabetes Mellitus

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

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