Trends and Disparities in Cardiovascular Mortality Among U.S. Adults With and Without Self-Reported Diabetes, 1988–2015

Cheng, Yiling J.; Imperatore, Giuseppina; Geiss, Linda S.; Saydah, Sharon; Albright, Ann; Ali, Mohammed K.; Gregg, Edward W.

doi:10.2337/dc18-0831

Cited by 93 publications

(63 citation statements)

References 28 publications

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“…Deaths from hyperglycemic crisis declined by a relative magnitude similar to that of AMI but are much less common in absolute terms. More recent analyses of NHIS data also reveal similar magnitudes of reduction in all-cause mortality and specific causes of cardiovascular disease (CVD) death among the population with diagnosed diabetes (27)(28)(29) (Fig. 2).…”

Section: Trends In Complications For Adults With Diabetesmentioning

confidence: 63%

The Changing Tides of the Type 2 Diabetes Epidemic—Smooth Sailing or Troubled Waters Ahead? Kelly West Award Lecture 2016

Gregg

2017

Diabetes Care

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Chronic disease epidemics have been described as tsunamis for the forceful way that societal and behavioral instigators carry disease and morbidity in a single direction before receding, only after decades of counter efforts by clinical medicine and public health (1). Type 2 diabetes is considered a classic chronic disease, as long-term cultural and behavioral changes have interacted with diverse susceptible genes to increase prevalence and extensive morbidity in the U.S. and the rest of world (2,3). While chronic disease epidemics can indeed be vast, multifaceted, and difficult to reverse, they can also be dynamic and full of paradoxes and contradictory trends that vary based on the specific population of concern, the time horizon, and the health metrics under consideration. The type 2 diabetes epidemic in the U.S. has encountered numerous phases and transitions in recent decades, including periods of rapid growth in prevalence and incidence, a peak and decline in the incidence of complications, the alarming growth among youth, and, most recently, a peak and apparent decrease in incidence of diagnosed cases in some populations. The most defining characteristics of the recent era of the global diabetes epidemic have been the success in reducing the rate of complications among adults with diagnosed diabetes in high-income countries, the large increases in overall prevalence, and the explosion of prevalence in lower-and middle-income countries (4). However, there are many currents under the surface, variations in the trends, and emerging concerns that are changing the character of the diabetes epidemic in ways that will affect the direction of public health efforts. This synthesis reviews the recent major trends and transitions in the diabetes epidemic in the U.S., describes their impact on the character of diabetes complications, and discusses the challenges and implications for prevention and epidemiology. RESEARCH DESIGN AND METHODS AND SOURCES

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Section: Trends In Complications For Adults With Diabetesmentioning

confidence: 63%

The Changing Tides of the Type 2 Diabetes Epidemic—Smooth Sailing or Troubled Waters Ahead? Kelly West Award Lecture 2016

Gregg

2017

Diabetes Care

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“…19 Death as the result of major cardiovascular disease has significantly and clinically relevantly decreased (−40.3% for ischemic heart disease and −29.2% for stroke) in adults with and without diabetes from 1988 to 2015 in the USA. 20 However, there was no significant change in rates of HF during the same period, and demonstrating a paradoxical increase (+11%) in young adults. These US data are coherent with Swedish data, 21 indicating that patients with T2D who succeeded in controlling five variables to optimal values (A1C <7%, LDL cholesterol <97 mg/dL, BP <140/90 mmHg, absence of albuminuria and abstiance from smoking) were at the same risk of death, stroke and myocardial infarction (MI) as the general population, but were at substantially higher risk (+45%) of hospitalization for HF.…”

Section: Advance (Action In Diabetes and Vascular Disease: Preterax Andmentioning

confidence: 83%

“…Death as the result of major cardiovascular disease has significantly and clinically relevantly decreased (−40.3% for ischemic heart disease and −29.2% for stroke) in adults with and without diabetes from 1988 to 2015 in the USA . However, there was no significant change in rates of HF during the same period, and demonstrating a paradoxical increase (+11%) in young adults.…”

Section: Hf Risk Has Not Changed Despite Improvement In CV Outlookmentioning

confidence: 99%

Heart failure and type 2 diabetes: From cardiovascular outcome trials, with hope

Giugliano

Meier

Esposito

2019

Diabetes Obesity Metabolism

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An excess risk of heart failure (HF) persists in patients with type 2 diabetes (T2D) despite optimal control of an array of conventional risk factors, including hyperglycaemia. Twelve cardiovascular outcome trials (CVOTs) have been published to date, although none, with the exception of the DECLARE trial with dapagliflozin, has included HF as a primary endpoint. The four trials with dipeptidyl‐peptidase inhibitors (DPP‐4i) (SAVOR‐TIMI 53 with saxagliptin, EXAMINE with alogliptin, TECOS with sitagliptin and CARMELINA with linagliptin) failed to show any significant effect on HF risk in patients with T2D, with the notable exception of saxagliptin which was associated with a 27% increased risk. Five completed CVOTs with the GLP‐1 RAs lixisenatide (ELIXA), liraglutide (LEADER), semaglutide (SUSTAIN‐6), exenatide once weekly (EXSCEL) and albiglutide (HARMONY) also failed to reveal any significant effect on HF risk. The three trials with sodium glucose co‐transporter‐2 inhibitors (SGLT‐2i) (EMPA‐REG OUTCOME with empagliflozin, CANVAS with canagliflozin and DECLARE with dapagliflozin) all revealed a robust and significant reduction in the hazard ratios of hospitalization for HF, from 27% to 35%, which remained consistent, significant and of similar magnitude regardless of the presence of a history of HF or established atherosclerotic cardiovascular disease. There is no association between reductions in HF risk and haemoglobin A1c (A1C) levels, while there is a significant association between reductions in HR for MACE and A1C levels (Spearman's correlation, r = 0.695; P = 0.013). All of the 12 CVOTs completed to date have provided reassurance of the overall cardiovascular safety of the newer anti‐hyperglycaemic drugs. At present, the robust, consistent and reproducible reduction of approximately 30% in the risk of HF with SGLT‐2i may be considered a class effect. The beneficial effect on MACE outcome observed with the use of some GLP‐1RAs and SGLT‐2i must be interpreted within the frame of the single trial.

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“…Mortality and morbidity rates in patients with T2DM have fallen considerably over recent decades. [4][5][6] These improvements in diabetes care may be attributed to improvements in several factors, including level of patient (e.g., literacy, patient education, motivation), level of healthcare professional (e.g., knowledge, awareness), and level of healthcare system (e.g., broader list of drugs, increased budgets). For the healthcare professional, the Thai Clinical Practice Guideline for Diabetes was developed and it is revised approximately every 3 years.…”

Section: Introductionmentioning

confidence: 99%

Achievement of Metabolic Goals among Different Health Insurance Schemes in Thai Patients with Type 2 Diabetes Mellitus: a Nationwide Study

Kunavisarut

2020

Smj

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Objective: Thailand has three healthcare insurance schemes, including: Universal Health Coverage (UHC), Social Health Insurance (SHI), and Civil Servant Medical Benefit (CSMB). UHC has the narrowest drug coverage, SHI uses its own list, and CSMB offers the greatest drug coverage. The aim of this study was to investigate metabolic goal achievement in patients with type 2 diabetes mellitus (T2DM) compared among the three healthcare schemes in Thailand. Methods: Data were obtained from a nationwide survey administered by MedResNet during 2011 to 2012. A crosssectional survey was conducted in patients with T2DM aged >35 years who were treated for at least 12 months. The data were retrospectively collected from medical records. Results: Of 49,303 T2DM patients that were recruited, 69.8% were female. CSMB patients were the oldest and had the longest diabetes duration. Achievement of BP, HbA1c, and LDL goals was 32.8%, 33.3%, and 42.5%, respectively. UHC patients had the highest percentage of BP control achievement (<130/80 mmHg; 33.1%), while CSMB patients had the highest percentage of HbA 1c (<7%; 40.4%) and LDL (<100 mg/dL; 49%) achievement. CSMB patients had the highest prevalence of 2-goal (16.8% for T2DM without HT) and 3-goal achievement (8.2% for T2DM with HT). Multivariate analysis revealed the CSMB scheme to be significantly associated with 3-goal achievement compared to the UHC scheme (odds ratio: 1.48, 95% confidence interval: 1.30-1.67; p<0.01). Conclusion: The prevalence of metabolic goal achievement in patients with T2DM in Thailand is low. CSMB patients have the highest prevalence of 2-goal and 3-goal achievement.

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Trends and Disparities in Cardiovascular Mortality Among U.S. Adults With and Without Self-Reported Diabetes, 1988–2015

Cited by 93 publications

References 28 publications

The Changing Tides of the Type 2 Diabetes Epidemic—Smooth Sailing or Troubled Waters Ahead? Kelly West Award Lecture 2016

The Changing Tides of the Type 2 Diabetes Epidemic—Smooth Sailing or Troubled Waters Ahead? Kelly West Award Lecture 2016

Heart failure and type 2 diabetes: From cardiovascular outcome trials, with hope

Achievement of Metabolic Goals among Different Health Insurance Schemes in Thai Patients with Type 2 Diabetes Mellitus: a Nationwide Study

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