Favourable changes in mortality in people with diabetes: <scp>US NHANES</scp> 1999–2010

Tsujimoto, Tetsuro; Kajio, Hiroshi; Sugiyama, Masaya

doi:10.1111/dom.13039

Cited by 19 publications

(14 citation statements)

References 31 publications

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“…However, there is limited evidence on the effects of antihyperglycemic therapy in nonobese type 2 diabetic patients. Although obesity is a well-established risk factor for diabetes and common in type 2 diabetic patients, approximately half of diabetic patients in the United States are nonobese [1,2]. In China, the mean BMI levels of diabetic patients are approximately 25 kg/m 2 , indicating that approximately half of diabetic patients have normal weight [3].…”

Section: Discussionmentioning

confidence: 99%

“…Type 2 diabetic patients are commonly obese. However, nonobese patients may also develop type 2 diabetes, with recent studies suggesting that approximately half of diabetic patients are nonobese [1][2][3]. In addition, studies have reported that nonobese diabetic patients are associated with a higher risk of cardiovascular events than obese diabetic patients [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Strategies for glycemic control in nonobese and obese type 2 diabetic patients with coronary artery disease

Tsujimoto

Kajio

2019

International Journal of Cardiology

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Background: This study aimed to assess strategies of insulin-providing (IP) or insulin-sensitizing (IS) therapy for glycemic control in nonobese diabetic patients with coronary artery disease (CAD) with possibly higher cardiovascular risk and lower insulin secretion than obese diabetic patients with CAD. Methods: We used data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial to calculate hazard ratio (HR) with 95% confidence interval (95%CI) for outcome events in patients with type 2 diabetes and CAD using Cox proportional hazard models. The comparison between the IP and IS groups was performed using the randomized design of the BARI 2D trial separately for nonobese (n = 1021) and obese (n = 1319) patients. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, and stroke. Results: During the follow-up, 231 nonobese and 295 obese patients had one confirmed primary outcome event. In nonobese patients, the risk of primary outcome events was significantly higher in the IP group than the IS group (HR: 1.30, 95%CI: 1.00-1.68, P = 0.04), whereas that in obese patients did not differ significantly between the two groups. Moreover, in nonobese patients, the risk of primary outcome events in those without abdominal obesity was significantly higher in the IP group than that in the IS group (HR: 1.51, 95%CI: 1.05-2.19, P = 0.02). There were no significant interactions between the strategy for glycemic control and various subgroups of nonobese patients. Conclusions: In nonobese patients with type 2 diabetes and CAD, the IS treatment strategy may be more beneficial than the IP treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Strategies for glycemic control in nonobese and obese type 2 diabetic patients with coronary artery disease

Tsujimoto

Kajio

2019

International Journal of Cardiology

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“…Between 1990 and 2010 age‐standardized rates of cases of acute myocardial infarction in the USA declined from 141 to 46 per 10 000 and declined from 112 to 53 for stroke, decreases of 68% and 53%, respectively, decreases that were much more marked than estimates for the general population, and resulting in a reduction in relative risk from 3.8 to 1.8 for myocardial infarction and from 3.1 to 1.5 for stroke . Similarly, much improved outcomes for total, cardiovascular and deaths from cardiac causes were observed in people with diabetes during the 2005–2010 NHANES compared to the 1999–2004 NHANES . More improvement in diabetes is not universal, ischaemic stroke, for example, did not decline faster in people with, compared with persons without, diabetes between 2004 and 2013 in Scotland .…”

Section: Secular Trends Of Cardiovascular Disease In Diabetesmentioning

confidence: 98%

“…Whilst earlier studies that compared coronary mortality between the diabetic and nondiabetic population showed substantial reductions in both, excess mortality in persons with diabetes remained twofold [78,79]. However, several studies now have shown substantial declines in rates of macrovascular complications in diabetes [80,81]. Between 1990 and 2010 age-standardized rates of cases of acute myocardial infarction in the USA declined from 141 to 46 per 10 000 and declined from 112 to 53 for stroke, decreases of 68% and 53%, respectively, decreases that were much more marked than estimates for the general population, and resulting in a reduction in relative risk from 3.8 to 1.8 for myocardial infarction and from 3.1 to 1.5 for stroke [80].…”

Section: Secular Trends Of Cardiovascular Disease In Diabetesmentioning

confidence: 99%

Cardiovascular disease in diabetes type 2: current concepts

Rosengren

2018

J Intern Med

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Type 2 diabetes is a major and accelerating public health challenge. Between 1980 and 2014, a period of just 35 years, the number of adults with diabetes globally is estimated to have increased from 108 to 422 million, due not only to sharply rising obesity rates, but also to increasing population size, longer life expectancy, and rising prevalence of diabetes worldwide. Overall, worldwide age-standardized adult diabetes prevalence doubled from 4.3% to 9.0% in men and from 5.0% to 7.9% in women. The largest increases in diabetes type 2 have been demonstrated in low- and middle-income countries, whilst rises in high-income countries have been less marked, or even flat. Diabetes type 2 rates in low- and middle-income countries now in many instances surpass those in high-income countries, in response to changes in lifestyle. One factor of particular concern are the large relative increases in type 2 diabetes amongst young individuals observed in many countries, their higher overall risk factor burden, long exposure to hyperglycaemia and greater risk of complications over the life course. Type 2 diabetes is increasingly found to be a heterogeneous condition, where risk of cardiovascular disease that traditionally has been estimated at 2-4 times that of the nondiabetic population varies substantially with diabetes phenotype and accordingly diabetes does not confer the same increase in relative or absolute risk in all people. New research shows that excess risk varies substantially with type of outcome, age, glycaemic control, the presence of renal complications and other factors. Heart failure, previously less recognized that other cardiovascular conditions, is increasingly coming into focus, because of strong links with poor glycaemic control and obesity. The knowledge about risk of cardiovascular disease in diabetes is almost entirely derived from high-income countries, whereas there is comparatively very little data from low- and middle income countries, where the majority of persons with type 2 diabetes live, and where management in many cases is far from optimal. The reductions in cardiovascular disease incidence and mortality now observed in high-income countries are encouraging, because this reinforces the fact that improvement is possible and that a near-normal, or even normal life-expectancy can be achieved in subtypes of type 2 diabetes.

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“…A prospective cohort study using NHANES data showed that compared to years 1999 to 2004, there were significant declines in all cause death, including death from cardiovascular and cardiac causes, in patients with diabetes in years 2005‐2010 . Furthermore, there was remarkable decrease in cardiac death compared to cancer deaths and cardiac deaths were similar to rates in nondiabetic group in the years 2005‐2010 (Figure ).…”

Section: Population Risk Reduction From Statins‐observational Studiesmentioning

confidence: 99%

The extent to which statins have improved cardiovascular outcomes: Lessons from randomized trials and observational studies of “real world” practice in people with diabetes

Jayanna

Robinson

2019

Diabetes Obesity Metabolism

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Statins are the mainstay of therapy for cardiovascular risk reduction in patients with diabetes mellitus. It is estimated that there are more than half a billion patients with diabetes mellitus worldwide and the numbers of prevalent cases of diabetes are expected to increase in both developed and developing countries in the next decade. Statins reduce risk of mortality and morbidity mainly by reducing blood low density cholesterol. Statins, along with other medical treatments, are responsible for about half of the decrease in cardiovascular mortality over the past several decades. Multiple clinical trials have found evidence for statin use in patients with diabetes, for both primary prevention and secondary prevention. The benefit of statins in patients with coronary heart disease and diabetes in terms of absolute risk reduction is twice as much as compared to the risk in patients with coronary heart disease but no diabetes. The proportion of patients with diabetes treated with statins has increased steadily over the past few decades with concurrent decrease in cardiovascular deaths in this high‐risk population. However, there are significant unmet needs in cardiovascular risk reduction, due to underutilization of statins and due to residual cardiovascular risk despite maximal statin therapy. Future strategies in population risk reduction in diabetics should include maximal statin therapy, additional treatment with nonstatin therapy and new paradigms of prevention with early intervention with shorter, more intensive therapy to potentially “reverse” atherosclerosis with goals of reducing clinical cardiovascular disease later in life.

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Favourable changes in mortality in people with diabetes: US NHANES 1999–2010

Cited by 19 publications

References 31 publications

Strategies for glycemic control in nonobese and obese type 2 diabetic patients with coronary artery disease

Strategies for glycemic control in nonobese and obese type 2 diabetic patients with coronary artery disease

Cardiovascular disease in diabetes type 2: current concepts

The extent to which statins have improved cardiovascular outcomes: Lessons from randomized trials and observational studies of “real world” practice in people with diabetes

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