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18th February 2023
A retrospective analysis of electronic health records by US researchers has revealed that the use of glucagon-like peptide-1 (GLP-1) agonists in overweight patients with type 2 diabetes in routine clinical practice is associated with a modest degree of weight loss.
It has long been recognised that obesity is an independent risk factor for cardiovascular disease. In addition, cardiovascular disease is often present in those with type 2 diabetes and presents a major cause of death among such patients. Despite this elevated risk, lifestyle modification, in particular weight loss, has been shown to be associated with better control of diabetes and and a reduction in cardiovascular risk factors. Clinical trials in overweight, type 2 diabetic patients have demonstrated that drugs such as semaglutide, which is one of the GLP-1 agonists, achieves superior and clinically meaningful reductions in body weight in comparison to placebo. However, most of the weight loss clinical trials have included a lifestyle intervention to support patients but in the absence of such support, GLP-1 agonist associated weight loss is no better than that achieved with other agents such as metformin.
In the current study, US researchers from the University of Pittsburgh, wanted to understand the degree to which GLP-1 agonists induced weight loss when used as a part of routine clinical care, i.e., in the absence of a specific behavioural weight loss intervention. The team retrospectively examined the electronic health records of those prescribed any drugs from the GLP-1 agonist class and the subsequent weight loss after 72 weeks of therapy.
GLP-1 agonists and real-world weight loss
Outcomes were available for 2,405 participants with a mean age of 48 years (47.4% male) and of whom, 92.1% had type 2 diabetes and mean, baseline body mass index of 37.
Only 8 weeks after the first dispensing of a GLP-1 agonist, the mean weight loss was 1.1% and this increased to 2.2% after 72 weeks. However, some patients did even better. For instance, 11.2% had lost at least 5% of their body weight after 8 weeks but after 72 weeks, this proportion increased to just over a third (33.3%). In fact, at the 72 week mark, nearly half of the entire cohort (42.7%) had lost weight with a small proportion of patients (10.5%) managing to lose 10% or more of their body weight.
The authors concluded that the use of GLP-1 agonists prescribed at standard doses led to a modest degree of weight loss in a real-world setting and in the absence of any specific patient support.
White GE et al. Real-world weight-loss effectiveness of glucagon-like peptide-1 agonists among patients with type 2 diabetes: A retrospective cohort study. Obesity (Silver Spring) 2023
15th February 2023
Participants who continued to exercise for up to 10 years following completion of a 12 month randomised trial, had a significantly lower risk of developing incident type 2 diabetes according to the findings of a study by Chinese researchers.
Globally, type 2 diabetes affects around 462 million people or just over 6% of the entire population. Lifestyle modifications such as diet or increased exercise are known to reduce the risk of developing the disease. However, most of the available evidence for effects of lifestyle modification has been derived from high-risk individuals, for instance, those with elevated fasting glucose levels, or those who are both overweight and having impaired glucose tolerance. A further problem is that many of these intervention studies were of a relatively short duration. It is therefore less unclear whether maintenance of lifestyle modifications such as increased physical activity, over the longer term, still reduces the risk of developing T2D.
In the current study, Chinese researchers reported the longer term outcomes of a 12 month randomised trial they had undertaken. In the original trial, participants with non-alcoholic fatty liver disease, were randomised to vigorous to moderate physical activity, moderate exercise (brisk walking) or no exercise for 12 months. The results of the trial showed that both forms of exercise were effective at reducing intrahepatic triglyceride levels compared to those who did not exercise.
Following the trial, the majority of the study participants were followed-up after 2 and 10 years to assess the incidence of T2D, defined as a fasting plasma glucose of 6.9 mmol/L and a HBA1c of > 6.5% and or the use of anti-diabetic treatment.
Continued exercise and incident type 2 diabetes
From an original cohort of 208 participants who completed the year long trial, 195 and 179 remained for subsequent assessment after 2 and 10 years respectively.
The cumulative incidence of T2D was 2.1 per 100 person-years, 1.9 and 4.1 in those who continued with vigorous, moderate or no exercise respectively. In fact, the risk of T2D was reduced by 49% among those performing vigorous exercise (relative risk, RR = 0.51, 95% CI 0.27 – 0.94, p = 0.01) and by 53% among moderate level intensity exercise (RR = 0.47, 95% CI 0.25 – 0.89, p = 0.01) compared to the non-exercising group.
While both exercise groups had significant reductions in HBA1c levels compared to non-exercisers during the follow-up period, fasting plasma glucose levels while numerically lower in the two exercising groups than the non-exercise control group, these differences were non-significant.
The authors suggested that vigorous to moderate aerobic physical activity could be used to prevent T2D, particularly in those with obesity.
Chen Y et al. Effect of Moderate and Vigorous Aerobic Exercise on Incident Diabetes in Adults With Obesity: A 10-Year Follow-up of a Randomized Clinical Trial. JAMA Intern Med 2023
14th February 2023
Vitamin D supplementation may be of value to patients with type 2 diabetes, especially if they have suboptimal levels of the vitamin according to a meta-analysis undertaken by US and Iranian researchers.
It has been estimated that in 2017, a staggering 462 million individuals had type 2 diabetes, corresponding to just over 6% of the global population. While there are several therapies available for the management of type 2 diabetes, new treatments will always be needed, given the high prevalence of the disorder. One such potential treatment is vitamin D supplementation and while this is usually given to regulate calcium and phosphorus levels, in recent years, a purported role has been suggested for several diseases. For example, data from the prospective Nurses’ Health study found that higher vitamin D and calcium intake was associated with a 33% lower risk of type 2 diabetes. Nevertheless, studies that involved actual vitamin D supplementation produced mixed findings. For example, one study 6-month trial found that supplementing with the vitamin in patients with type 2 diabetes, failed to affect either insulin sensitivity or secretion. In contrast, an 8-week intervention study demonstrated significant reductions in fasting plasma glucose, insulin and HOMA-IR.
As a result, in the current study, researchers performed a meta-analysis to examine the effect of using the vitamin on indices of glycaemic control including fasting plasma glucose (FPG), HbA1c and HOMA-IR.
Vitamin D supplementation and glycaemic measures
A total of 46 eligible trials were identified including 4,313 patients with type 2 diabetes and a mean age of 56.5 years and of whom 2,164 received the vitamin intervention. The majority of the studies (42) used an oral supplement, whereas in four trials, it was given via intramuscular injection.
The pooled analysis for HbA1c showed a significant reduction compared to placebo for vitamin D (weighted mean difference, WMD = -0.20, p < 0.001). Similarly, there was a significant reduction in FPG (WMD = -0.28 mmol/L, p < 0.001) and HOMA-IR (WMD = -0.42, p = 0.019) in those given vitamin D.
The authors concluded that although vitamin D supplementation had a positive impact of glycaemic indices, they cautioned that the substantial heterogeneity between the included studies, raised the possibility of publication bias.
Farahmand MA et al. What is the impact of vitamin D supplementation on glycemic control in people with type-2 diabetes: a systematic review and meta-analysis of randomized controlled trails. BMC Endocr Disord 2023
28th September 2022
Semaglutide 2.4 mg given as a weekly subcutaneous injection to patients with obesity but without type 2 diabetes in combination with diet and exercise, led to a significant reduction in their 10-year risk of developing type 2 diabetes compared to placebo according to the findings of a study by US researchers presented at the 58th European Association for the Study of Diabetes (EASD) 2022.
Obesity is a major public health challenge and several lines of evidence from both observational and clinical studies over the past 30 years have clearly demonstrated a strong link between visceral and ectopic fat and the development of a clinical syndrome characterised by atherogenic dyslipidaemia, hyper-insulinaemia/glucose intolerance, hypertension, atherosclerosis and adverse cardiac remodelling and heart failure. Although diet and exercise are recommended as a first step to reduce obesity, some evidence shows that among obese individuals who have lost weight, multiple compensatory mechanisms encouraging weight gain, can persist for at least 12 months after weight loss. Semaglutide is a glucagon-like peptide-1 (GLP-1) analogue that is approved as an adjunct to diet and exercise in adults with insufficiently controlled type 2 diabetes mellitus. However, the STEP 1 trial showed that semaglutide at a dose of 2.4 mg weekly in combination with a lifestyle intervention could also result in sustained, clinically relevant reductions in body weight among patients with a body mass index (BMI) > 30. Moreover, in a further trial (STEP 4), researchers examined the effect of continuing vs withdrawing treatment with semaglutide on weight loss maintenance and showed that after a 20-week run-in period, maintaining treatment with semaglutide 2.4 mg once weekly, compared with switching to placebo resulted in continued weight loss over the following 48 weeks.
With clear evidence that semaglutide could lead to weight loss, whether this also reduced an individual’s risk of developing type 2 diabetes was unclear and was the objective of the study presented at the EASD meeting. Researchers used data from both STEP 1 and 4, to assess an individual’s 10-year risk of developing type 2 diabetes. The team used the cardiometabolic disease staging tool which uses three unmodifiable factors (age, sex, and race) and five modifiable factors (BMI, blood pressure, glucose level, high-density lipoprotein (HDL) cholesterol, and triglycerides) to predict an individual’s percentage risk of developing the disease over the next 10 years.
Semaglutide and 10-year diabetes risk
For the STEP 1 trial, the 10-year risk scores of developing T2D after 68 weeks of treatment decreased from 18.2% to 7.1% with semaglutide 2.4 mg, and 17.8% to 15.6% with placebo (p < 0.01). In STEP 4, most of the risk score reduction with semaglutide 2.4 mg occurred during weeks 0-20, from 20.6% to 11.4% but the risk score decreased further to 7.7% with continued semaglutide 2.4 mg during weeks 20-68 but increased to 15.4% after a switch to placebo (p < 0.01). In addition, data from STEP 4 showed that weight loss was 11% for weeks 0 – 20 and a further 9% with continued semaglutide 2.4 mg vs a 6%
regain with switch to placebo for weeks 20 – 68.
The authors concluded that treatment with semaglutide 2.4 mg reduces the 10-year risk of T2D by
~60% adding that sustained treatment was required to maintain this benefit but suggested that semaglutide 2.4 mg could help prevent type 2 diabetes in people with obesity.
Garvey TW et al. Semaglutide 2.4 mg reduces the 10-year type 2 diabetes risk in people with overweight or obesity Abstract 562. EASD 2022
12th August 2022
Higher serum aldosterone levels in those with chronic kidney disease (CKD) is associated with an increased risk of disease progression and of developing end-stage kidney disease, according to an analysis of data from the Chronic Renal Insufficiency Cohort (CRIC) by US researchers.
Aldosterone is produced by the adrenal glands and is known to play a role in the development of hypertension and kidney disease. Elevated levels of aldosterone (primary aldosteronism) are a factor in the development of hypertension, but while high among hypertensive patients, the condition is often unrecognised. However, the extent to which aldosterone levels impact on the subsequent risk of progression in patients with CKD is uncertain and was the subject of the current retrospective analysis by the US team.
The researchers turned to data collected as part of the Chronic Renal insufficiency Cohort (CRIC) study and which was designed to investigate risk factors for mortality and worsening of disease in patients with CKD. They included individuals with an estimated glomerular filtration rate (eGFR) of between 20 and 70 ml/min/1.73 m2 and for whom aldosterone levels had been recorded and these levels were divided into quartiles The researchers also collected demographic and co-morbidity data which was adjusted for in regression analysis. The primary outcome of interest was CKD progression and defined as the composite of a 50% decline in eGFR or incident end-stage kidney disease (ESKD), whichever came first.
Aldosterone levels and disease progression
A total of 3680 individuals with a mean age of 58.1 years (44.7% female) were included in the analysis, of whom 48.1% were diabetics with the overall mean serum aldosterone being 10 ng/dL, although this was significantly higher in men than women (10.5 vs 9.4, p < 0.001).
After a median follow-up of 9.6 years, 1412 individuals developed CKD disease progression and 1129 developed ESKD. In fully adjusted models, those with the highest quartile serum aldosterone level had a 45% higher risk of CKD progression compared to those in the lowest quartile (hazard ratio, HR = 1.45, 95% CI 1.22 – 1.73). Using aldosterone levels as a continuous variable in the models, indicated that there was an 11% higher risk of CKD progression (HR = 1.11, 95% CI 1.04 – 1.18). Furthermore, those with the highest aldosterone serum levels also had a 46% increased risk of developing ESKD (HR = 1.46). While there was also a 22% increased risk of all-cause mortality for individuals in the highest versus the lowest aldosterone levels, this became non-significant when levels were considered as a continuous variable (HR = 1.05, 95% CI 0.99 – 1.12). There was also no relationship between the adverse outcomes from higher levels of aldosterone and diabetes status.
The authors concluded by suggesting that aldosteronism may play a role in CKD progression.
Verma A et al. Aldosterone in chronic kidney disease and renal outcomes. Eur Heart J 2022
5th August 2022
A time-restricted eating (TRE) pattern which limits intake of food to a 10-hour window can improve glucose homeostasis but not insulin sensitivity according to the results of a randomised, cross-over trial by Dutch researchers.
Any changes to the day–night rhythm due, for example, to shift work and subsequent changes in eating patterns is associated with body weight gain and impaired glucose tolerance. Moreover, some data also indicate that night shift work, especially rotating shift work, is associated with higher risk of type 2 diabetes. Time-restricted eating could have health benefits and some evidence for this arose from a study which found that the daily duration of food intake exceeded 14.75 hour for half of the cohort. As part of this study, when researchers asked overweight individuals with a >14 hr eating duration, to restrict food intake to only 10-11 hours per day for 16 weeks, they reduced body weight and reported higher levels of energy and had improved sleep. Other work has revealed how TRE improves 24-hour glucose levels and among men with pre-diabetes, whereas the use of a 12-hour TRE pattern improved insulin sensitivity, β cell responsiveness, blood pressure, oxidative stress, and appetite. But whether a time-restricted eating regime could benefit those with type 2 diabetes remains unclear, although in one feasibility study, it was found that a TRE regime did not significantly improve measures of glycaemic control or reduce body mass. Despite this, the effect of TRE on other metabolic health parameters is largely unknown and was the subject of the present study.
The Dutch team recruited adults with type 2 diabetes and a HbA1C of 6.4% and asked them to participate in a 10-hour TRE regime for 3 weeks in comparison to a control group whose food intake was spread over a period of > 14 hours/day and then the TRE group crossed-over after a 4 week wash-out period. Since the liver plays an important role in the regulation of blood glucose and that among those with type 2 diabetes, nocturnal glucose levels are elevated, the authors speculated that a TRE regime might reduce nocturnal glucose levels and therefore improve insulin sensitivity.
Time-restricted eating and glucose levels
A total of 14 adults with a mean age of 67.5 years (50% female) were recruited into the trial.
The mean 24-hour glucose levels were lower among the TRE group compared to controls (6.8 vs 7.6mmol/l, TRE vs control, p < 0.01). However, there were no significant differences with insulin sensitivity (19.6 vs 17.7 mcmol/kg/min, TRE vs control, p = 0.1). There were also no changes in 24-hour energy and substrate metabolism between the two groups, although the time-restricted eating group did spend a significantly longer period of time with blood glucose levels within the normal range (15.1 vs 12.2 hours, TRE vs control p = 0.01).
The authors concluded that TRE provides an additional strategy to maintain 24 hour glucose homeostasis in free-living subjects with type 2 diabetes.
Andriessen C et al. Three weeks of time-restricted eating improves glucose homeostasis in adults with type 2 diabetes but does not improve insulin sensitivity: a randomised crossover trial Diabetologia 2022
16th June 2022
Combing pomegranate juice (PJ) and aerobic training led to improvements in anthropomorphic indices and markers of insulin resistance among patients with type 2 diabetes and may therefore represent an important approach to risk modification in these patients. This was the conclusion of a trial by a team from the Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran.
In a 2017 study it was estimated that globally, approximately 462 million individuals had type 2 diabetes, which equates to just over 6% of the world population leading to over 1 million deaths per year. In addition, elevated levels of the liver enzymes, alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) have been found to be significantly associated with an increased risk of diabetes. Lifestyle modification is an important first step in patients with type 2 diabetes with one 2019 systematic review finding that the condition is preventable by changing lifestyle and that the risk reduction is sustained for many years after the active intervention. In patients with type 2 diabetes, the hyperglycaemic state results in the production of free radicals, increasing oxidative stress and use of a dietary invention with pomegranate juice has been shown to exert a favourable effect on this oxidative stress. Pomegranate juice contains a large number of anti-oxidative poly-phenolic compounds which are assumed to have cardioprotective effects. In fact, a 2019 trial found that PJ consumption decreased systolic and diastolic blood pressure in patients with type 2 diabetes.
Since aerobic training improves insulin sensitivity and lowers insulin resistance, for the present study, the Iranian team wondered if there were additional benefits from combing aerobic training with pomegranate juice. They conducted an 8-week trial and randomised middle-aged men with type 2 diabetes into four groups: aerobic training (AT) and pomegranate juice (AT+PJ); AT and PJ alone and a control group. Those assigned to PJ drank 240 ml of pure juice once daily whereas the control group had a water-based, identical drink. Measurements of bodyweight (BW), body mass index (BMI), waist-hip ratio (WHR) and body fat percentage (BFP) were taken at baseline and at the end of trial. Other assessments included ALT, AST and GGT as well as fasting blood sugar (FBS), insulin levels and HOMA-IR – a measure of insulin resistance.
Pomegranate juice and diabetic outcomes
A total of 40 middle-aged men with a mean age of 42.2 years were randomised between the four groups.
At the end of the study there were statistically significant reductions in BW, BMI, BFP and WHR for those in the AT+PJ, AT and PJ groups compared to the control group. However, there were no significant differences between the AT+PJ, AT or PJ groups.
Reductions also occurred in FBS, HOMA-IR and insulin but this time, the reductions were significantly greater for the AT+PJ group compared to either the AT or PJ groups alone. While levels of the three liver enzymes were also significantly reduced compared to the control group, ALT and GGT levels were significantly lower in the AT+PJ compared to AT and GGT was significantly lower in the AT+PJ group compared to PJ alone.
The authors concluded that based on these findings, a combination of aerobic training and pomegranate juice could be recommended to patients with type 2 diabetes to prevent increases in the levels of liver enzymes associated with diabetes and to improve insulin resistance.
Nemati S et al. Pomegranate juice intake enhances the effects of aerobic training on insulin resistance and liver enzymes in type 2 diabetic men: a single-blind controlled trial BMC Nutr 2022
6th June 2022
Eldecalcitol, a vitamin D analogue, could prevent the development of overt type 2 diabetes in patients with impaired glucose tolerance although more data are required. This was the finding from a randomised, placebo-controlled trial by a team of Japanese researchers.
In 2017, it was estimated that globally, there were approximately 462 million individuals with type 2 diabetes ( 6.3% of the world’s population) and over 1 million deaths per year attributed to the disorder. Pre-diabetes is best described as an intermediate metabolic state between normoglycaemia and diabetes that is characterised by impaired glucose tolerance and impaired fasting glucose. Moreover, the presence of impaired glucose tolerance is associated with an increased risk of cardiovascular disease.
The potential role of vitamin D in diabetes has been suggested by the evidence that insulin secreting cells are able to not only produce but respond to the natural hormone 1-alpha, 25-Dihydroxyvitamin D3. In addition, low plasma 25-hydroxyvitamin D levels are associated with increased risk of type 2 diabetes in the general population. Furthermore, a systemic review and meta-analysis has revealed how in people with impaired glucose tolerance, vitamin D supplementation reduces the risk of type 2 diabetes and increases the reversion rate to normoglycaemia. Despite this, other studies have found that supplementation with vitamin D in patients who are not deficient in the vitamin is unlikely to prevent progression from pre-diabetes to diabetes.
With uncertainty over the value of vitamin D supplementation in those with impaired glucose tolerance, the present study undertook a randomised, placebo-controlled trial with eldecalcitol, a vitamin D analogue. The aim was to determine if eldecalcitol (which is used in Japan as a treatment for the prevention of osteoporosis) at a dose of 75mcg/day to patients with impaired glucose tolerance could prevent the development of type 2 diabetes.
Enrolled participants had a fasting glucose level < 126mg/dl and a glycated haemoglobin of < 6.5%. The primary outcome was the development of type 2 diabetes defined by either a glycated haemoglobin > 6.5% and a fasting glucose concentration > 200mg/dl. The main secondary outcome was regression to normoglycaemia.
Eldecalcitol and development of type 2 diabetes
A total of 1256 participants with a mean age of 61.3 years (44.5% female) were randomised to eldecalcitol (630) or placebo and followed for a median of 2.9 years. Among participants, the mean baseline 25-hydroxyvitamin D concentration was 20.9ng/ml.
During the follow-up period, 12.5% of those in the eldecalcitol group and 14.2% of those assigned to placebo developed type 2 diabetes (hazard ratio, HR = 0.87, 95% CI 0.67 – 1.17, p = 0.39), representing a non-significant difference. The proportion of patients regressing to normoglycaemia was also similar and not significantly different (HR = 1.15, 95% CI 0.93 – 1.41, P = 0.21).
Interestingly, when the researchers undertook a regression analysis that adjusted for 11 pre-specified covariates including age, sex, body mass index, glycated haemoglobin, they found that eldecalcitol was effective for the prevention of type 2 diabetes (HR = 0.69, 95% CI 0.51 – 0.95, p = 0.02).
They concluded that while eldecalcitol did not significantly reduce the incidence of type 2 diabetes or the level of regression to normoglycaemia, after adjustment for confounders, the drug was found to be effective at reducing the incidence of diabetes. As a result, it could be possible that eldecalcitol prevents the development of type 2 diabetes and they called for further work to examine their findings in more detail.
Kawahara T el al. Effect of active vitamin D treatment on development of type 2 diabetes: DPVD randomised controlled trial in Japanese population BMJ 2022
20th May 2022
Higher arterial stiffness (AS) rather than the presence of hypertension is a better predictor for the development of diabetes according to the findings of a prospective study by a team of Chinese researchers.
The World Health Organization estimates that there are approximately 422 million people worldwide that have diabetes. The most common form of diabetes is type 2 and in 2017, it was estimated that approximately 462 million individuals were affected by the condition, corresponding to 6.28% of the world’s population. Hypertension is common in those with type 2 diabetes and reportedly affects over two-thirds of patients and a Chinese study has suggested that a higher blood pressure is a risk factor for type 2 diabetes in both middle-aged and elderly patients.
Furthermore, the presence of arterial stiffness, especially in the aorta, has been shown to be an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension. In addition, other work has suggested that the presence of arterial stiffness is associated with an increased incidence of diabetes, independent of other risk factors and may represent an early risk marker for developing diabetes. However, whether arterial stiffness among hypertensive patients is a useful prognostic marker for the development of diabetes compared with hypertension alone is unclear.
For the present study, the Chinese researchers looked at data obtained from the Kailuan study, which is an ongoing prospective study following patients initially free of hypertension and examines factors associated with development of the condition. In a subgroup of patients, brachial-ankle pulse wave velocity measurements, which is a widely used technique to assess arterial stiffness, were taken. The researchers set the primary outcome as the development of diabetes during the follow-up period. Participants blood pressure and arterial stiffness was categorised as ideal vascular function (IVF) and normotensive, normotensive with AS, hypertensive and with normal AS and hypertensive and with elevated AS (HTAS).
Arterial stiffness and the development of type 2 diabetes
A total of 11,166 participants were enrolled in the study and followed for 6.16 years during which time 768 (6.88%) of incident cases of type 2 diabetes were identified.
After adjustment for covariates (e.g., age, gender, co-morbidities), compared to the IVF group, individuals in the HTAS group had the highest risk developing type 2 diabetes (hazard ratio, HR = 2.42, 95% CI 1.93 – 3.03). This was followed by the normotensive, elevated AS group (HR = 2.11, 95% CI 1.64 – 2.61). Interestingly, the lowest risk was associated with those who were hypertensive and with normal AS (HR = 1.48). These results did not change when further adjusted for mean arterial or diastolic pressure.
The researchers then examined whether an elevated AS or hypertension, or both, increased the predictive power of a conventional model, i.e., with age, sex, BMI, smoking status etc, for the development of diabetes The results showed that the C statistic increased from 0.690 to 0.707 (p = 0.0003), i.e., had more predictive power, after addition of AS. However, the predictive power increased to 0.709 when both hypertension and AS were added, in other words, there was little additional benefit to the model by adding hypertension alone.
The authors concluded that an elevated AS performed better than hypertension for the prediction of type 2 diabetes and suggested that future strategies for the prevention of type 2 diabetes should focus on both hypertension and AS.
Tian X et al. Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study Hypertension 2022
11th May 2022
A greater coffee consumption in those with type 2 diabetes is significantly associated with a reduction in the rate of decline in the estimated glomerular filtration rate (eGFR). This was the key finding from a prospective study by researchers from the Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Chronic kidney disease (CKD) is a non-communicable disease and which usually develops as a consequence of diabetes and hypertension. Disease severity in CKD can be assessed by a low serum creatinine-based eGFR, which indicates excretory kidney function and by a raised urinary albumin. Lifestyle management is deemed to be a fundamental aspect of diabetes care and this encompasses self-management education and support, medical nutrition therapy, physical activity, smoking cessation counselling and psychosocial care. Nutritional therapy, however, does not just include what foods to eat but also what should be drunk. One commonly consumed beverage is coffee and a higher coffee consumption, as well as green tea, has been found to be associated with a reduction in all-cause mortality, particularly in patients with type 2 diabetes. Furthermore, some data suggests that a higher coffee consumption is associated with lower risk for incident CKD. Nevertheless, this finding is not consistent, with other work undertaken in men, find that there was no significant association between coffee consumption and CKD.
What remains unclear though, is if a higher level of coffee consumption in patients with type 2 diabetes would reduce the decline in kidney function. For the present study, the Japanese team carried out a prospective study of adult diabetic patients attending diabetic clinics throughout the country. They carried out a dietary survey which asked about coffee consumption but also had access to clinical measurements such as blood pressure and eGFR taken at the clinics. Coffee consumption was recorded as none, less than 1 cup/day, one cup/day or two or more cups/day. The primary outcome was set as a decline in eGFR to <60 mL/min/ 1.73 m2, based on two consecutive measures of eGFR during the follow-up period.
Coffee consumption and decline in eGFR rate
In total, 3,805 patients with type 2 diabetes and a mean age of 64.2 years (44.4% female) and eGFR ≥60ml/min/1.73 m2 were followed-up for a median of 5.3 years.
During the period of follow-up, 840 participants experienced a decline in eGFR of < 60 mL/min/1.73 m2. Using multivariate analysis, the researched found that compared to those who drank no coffee, the adjusted hazard ratio (aHR) for a decline in eGFR associated with drinking less than one cup/day was 0.77 (95% CI 0.63 – 0.97) and this increased slightly to 0.75 (95% CI 0.62 – 0.91) for those drinking two or more cups/day.
The mean eGFR change per year was -2.16ml/min/1.73 m2 with no coffee consumption, and -1.78ml/min/1.73 m2 with two or more cups per day (p for trend 0.03).
There was also no significant effect on coffee drinking and the decline in eGFR based on age, gender, body mass index, smoking status, those who exercised regularly or blood pressure.
The authors concluded that coffee consumption is significantly associated with a lower risk of a decline in eGFR, which suggested a progressive impairment in renal function, in patients with type 2 diabetes.
Komorita Y et al. Relationship of coffee consumption with a decline in kidney function among patients with type 2 diabetes: The Fukuoka Diabetes Registry J Diabetes Investig 2022