Prevalence and Incidence Trends for Diagnosed Diabetes Among Adults Aged 20 to 79 Years, United States, 1980-2012

Geiss, Linda S.; Wang, Jing; Cheng, Yiling J.; Thompson, Theodore; Barker, Lawrence; Li, Yanfeng; Albright, Ann; Gregg, Edward W.

doi:10.1001/jama.2014.11494

Cited by 581 publications

(453 citation statements)

References 31 publications

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“…3,4 In the USA, the prevalence of diabetes was 8.3% in 2012, which is a sharp increase (more than doubling) compared with the prevalence in 1990, which was 3.5%. 5 Estimates from the USA predict that Americans born in 2000 will have a one in three lifetime risk of developing type 2 diabetes. 6 In the UK, the prevalence of diabetes is 6.0% (3.2 million people), 7 and Diabetes UK estimates that there are around 630,000 people with diabetes who have not yet been diagnosed.…”

Section: Diabetes: Prevalence and Complicationsmentioning

confidence: 99%

Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Nelson

Wright-Hughes

Brown

et al. 2016

Health Technol Assess

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BackgroundThere is inadequate evidence to advise clinicians on the relative merits of swabbing versus tissue sampling of infected diabetic foot ulcers (DFUs).ObjectivesTo determine (1) concordance between culture results from wound swabs and tissue samples from the same ulcer; (2) whether or not differences in bacterial profiles from swabs and tissue samples are clinically relevant; (3) concordance between results from conventional culture versus polymerase chain reaction (PCR); and (4) prognosis for patients with an infected DFU at 12 months’ follow-up.MethodsThis was a cross-sectional, multicentre study involving patients with diabetes and a foot ulcer that was deemed to be infected by their clinician. Microbiology specimens for culture were taken contemporaneously by swab and by tissue sampling from the same wound. In a substudy, specimens were also processed by PCR. A virtual ‘blinded’ clinical review compared the appropriateness of patients’ initial antibiotic regimens based on the results of swab and tissue specimens. Patients’ case notes were reviewed at 12 months to assess prognosis.ResultsThe main study recruited 400 patients, with 247 patients in the clinical review. There were 12 patients in the PCR study and 299 patients in the prognosis study. Patients’ median age was 63 years (range 26–99 years), their diabetes duration was 15 years (range 2 weeks–57 years), and their index ulcer duration was 1.8 months (range 3 days–12 years). Half of the ulcers were neuropathic and the remainder were ischaemic/neuroischaemic. Tissue results reported more than one pathogen in significantly more specimens than swabs {86.1% vs. 70.1% of patients, 15.9% difference [95% confidence interval (CI) 11.8% to 20.1%], McNemar’sp-value < 0.0001}. The two sampling techniques reported a difference in the identity of pathogens for 58% of patients. The number of pathogens differed in 50.4% of patients. In the clinical review study, clinicians agreed on the need for a change in therapy for 73.3% of patients (considering swab and tissue results separately), but significantly more tissue than swab samples required a change in therapy. Compared with traditional culture, the PCR technique reported additional pathogens for both swab and tissue samples in six (50%) patients and reported the same pathogens in four (33.3%) patients and different pathogens in two (16.7%) patients. The estimated healing rate was 44.5% (95% CI 38.9% to 50.1%). At 12 months post sampling, 45 (15.1%) patients had died, 52 (17.4%) patients had a lower-extremity ipsilateral amputation and 18 (6.0%) patients had revascularisation surgery.LimitationsWe did not investigate the potential impact of microbiological information on care. We cannot determine if the improved information yield from tissue sampling is attributable to sample collection, sample handling, processing or reporting.ConclusionsTissue sampling reported both more pathogens and more organisms overall than swabbing. Both techniques missed some organisms, with tissue sampling missing fewer than swabbing. Results from tissue sampling more frequently led to a (virtual) recommended change in therapy. Long-term prognosis for patients with an infected foot ulcer was poor.Future workResearch is needed to determine the effect of sampling/processing techniques on clinical outcomes and antibiotic stewardship.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Diabetes: Prevalence and Complicationsmentioning

confidence: 99%

Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Nelson

Wright-Hughes

Brown

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

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“…Type 2 diabetes mellitus incidence has plateaued among non‐Hispanic whites (NHWs) but continues to rise among US racial/ethnic minorities 1. Thus, novel preventive intervention targets are of paramount importance, one potential target is the renin‐angiotensin‐aldosterone (RAAS).…”

Section: Introductionmentioning

confidence: 99%

Renin‐Angiotensin‐Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA

Joseph

Tcheugui

Effoe

et al. 2018

JAHA

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BackgroundMechanistic studies suggest that aldosterone impairs glucose metabolism. We investigated the cross‐sectional associations of aldosterone and plasma renin activity with fasting plasma glucose, insulin resistance (IR), β‐cell function, and longitudinal association with incident diabetes mellitus among adults in MESA (the multiethnic study of atherosclerosis) prospective cohort study.Methods and ResultsHomeostatic model assessment of IR (HOMA2‐IR) and HOMA2‐β were used to estimate IR and β‐cell function, respectively. Incident diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dL or anti‐diabetic medication use at follow‐up. Linear regression was used to examine cross‐sectional associations of aldosterone with fasting plasma glucose, HOMA2‐IR and HOMA2‐β; Cox regression was used to estimate hazard ratios (HR) for incident diabetes mellitus with multivariable adjustment. There were 116 cases of incident diabetes mellitus over 10.5 years among 1570 adults (44% non‐Hispanic white, 13% Chinese American, 19% Black, 24% Hispanic American, mean age 64±10 years, 51% female). A 100% increase in log‐aldosterone was associated with a 2.6 mg/dL higher fasting plasma glucose, 15% higher HOMA2‐IR and 6% higher HOMA2‐β (P<0.01). A 1‐SD increase in log‐aldosterone was associated with a 44% higher risk of incident diabetes mellitus (P<0.01) with the greatest increase of 142% (P<0.01) observed in Chinese Americans (P for interaction=0.09 versus other ethnicities). Similar cross‐sectional findings for log‐plasma renin activity existed, but log‐plasma renin activity was not associated with incident diabetes mellitus after full adjustment.ConclusionsAldosterone is associated with glucose homeostasis and diabetes mellitus risk with graded associations among Chinese Americans and blacks, suggesting that pleiotropic effects of aldosterone may represent a modifiable mechanism in diabetes mellitus pathogenesis with potential racial/ethnic variation.

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“…2 Considering the increased prevalence of diabetes mellitus (DM) in the general population, more allo-HSCT recipients will have DM as comorbidity in the future. 3,4 In addition, HSCT survivors have a higher risk of developing hyperglycemia/PTDM owing to pretransplant and post-transplant exposures. Prospective interventions to prevent and treat PTDM are widely tested in the field of kidney transplantation.…”

Section: Introductionmentioning

confidence: 99%

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Fuji

Rovó

Ohashi

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients frequently develop glucose intolerance and post-transplant diabetes mellitus (PTDM). The clinical importance of PTDM and its detrimental impact on HSCT outcomes are underrecognized. After allo-HSCT, various mechanisms can contribute to the development of PTDM. Here we review information about hyperglycemia and PTDM after allo-HSCT as well as PTDM after solid organ transplantation and describe ways to manage hyperglycemia/PTDM after allogeneic HSCT. Taking into consideration a lack of well-established evidence in the field of allo-HSCT, more studies should be conducted in the future, which will require closer multidisciplinary collaboration between hematologists, endocrinologists and nutritionists.

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Prevalence and Incidence Trends for Diagnosed Diabetes Among Adults Aged 20 to 79 Years, United States, 1980-2012

Cited by 581 publications

References 31 publications

Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Renin‐Angiotensin‐Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

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