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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.
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.
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
27th April 2022
A fish diet appears to be the best way of reducing the risk of developing type 2 diabetes in comparison to either a poultry, meat-based or even a vegetarian diet. This was the conclusion of an analysis of the UK Biobank by researchers from the UK, Thailand and Chile.
Type 2 diabetes is a metabolic disorder that results in hyperglycaemia and is a global health concern. One estimate from 2017 suggested that approximately 462 million individuals were affected (6.28% of the world’s population), leading to 1 million deaths per year. Many cases of type 2 diabetes could potentially be prevented by lifestyle changes, including maintaining a healthy body weight, consuming a healthy diet, staying physically active, not smoking and drinking alcohol in moderation. In fact, a 2017 systemic review identified how the risk of diabetes is reduced by increased consumption of whole grains, fruits and dairy, but that the risk is increased by greater consumption of red meat, processed meat and sugar sweetened beverages. However, there is some uncertainty over whether any specific type of eating pattern e.g., fish diet, poultry or vegetarianism, has a greater impact on the risk of developing diabetes.
For the present analysis, the team turned to the UK Biobank database to explore the associations between different diets and the risk of incident type 2 diabetes. In addition, the researchers examined the extent to which adiposity might impact on these associations. Within the UK Biobank, participants complete food frequency questionnaires and based on responses, individuals were categorised as vegetarian, fish eaters, fish and poultry eaters and finally meat eaters. A number of participants reported eating a varied diet and the effect on this type of diet was analysed separately. The results were analysed using Cox-proportional hazard models which provided a measure of the association between the different diets and the risk of type 2 diabetes and models were adjusted for several factors including age, sex, alcohol intake, smoking status etc.
Fish diet and the risk of type 2 diabetes
A total of 203,790 individuals were included in the analysis with 1.6% who were vegetarian, 2.2% fish diet, 1.1% fish and poultry eaters, 87.3% meat eaters and 7.8% who reported eating a varied diet. The mean age of the groups ranged from 52.8 to 56.5 years and after excluding the first two years, individuals were followed-up for a median of 5.4 years. During the follow-up, 5,067 (2.5%) participants developed type 2 diabetes.
Using meat eaters as the reference, a fish diet had the lowest risk of developing type 2 diabetes (hazard ratio, HR = 0.41, 95% CI 0.31 – 0.55, p < 0.0001), followed by fish and poultry eaters (HR = 0.61, 95% CI 0.44 – 0.86). However, the association with vegetarian and a varied diet were non-significant. However, in the fully adjusted models, a significant association remained only for a fish diet but not for fish and poultry eaters or any of the other diets.
Interestingly, general obesity was a partial mediator for fish diets, accounting for 49.8% of their lower risk of developing type 2 diabetes.
The authors concluded that fish diets produced the greatest reduction in the risk of developing diabetes and that this effect was largely due to the fact that fish eaters had a lower level of adiposity.
Boonpor J et al. Types of Diet, Obesity, and Incident Type 2 Diabetes: Findings from The UK Biobank Prospective Cohort Study Diabetes Obes Metab 2022
22nd April 2022
Early glycaemic control in patients with type 2 diabetes leads to a reduction in the incidence of adverse cardiovascular outcomes according to the findings of a retrospective analysis by a team from the Department of Clinical & Experimental Medicine, University of Surrey, UK.
Patients with diabetes are deemed to be at a higher risk of death and adverse cardiovascular outcomes than those without the condition. Furthermore, poor control of diabetes defined by an increased level of glycated haemoglobin levels (HbA1c) is also a risk factor for myocardial infarction (MI). In fact, one study found that each 1% higher HbA1c was associated with an 18% greater risk of MI. In addition, the HbA1c levels 3 months post-diabetes diagnosis, has been found to be a strong predictor of subsequent mortality.
However, there is some uncertainty over whether tight glycaemic control in patients with a high HbA1c after diagnosis is associated with a subsequent reduction in adverse cardiovascular outcomes. For the present study, the UK researchers examined the effect of changes in HbA1c levels in the first year after a diagnosis of type 2 diabetes and how this impacted on the incidence of cardiovascular events. A further consideration was the effect of glycaemic variability on cardiovascular events as there is some evidence to show that having consistent glycaemic control reduces the risk of vascular events and death in type 2 diabetes.
The team reviewed the records of adults with a diagnosis of type 2 diabetes and an HbA1c level recorded at diagnosis and after 1 year and with an additional five measurements recorded over time. The HbA1c values were categorised into three groups: group A (HbA1c < 7.5%), group B (HbA1c 7.5% – 9.0%) and group C (HbA1c > 9.0%). The team then recorded the individual patient’s group status at the end of the first year, for instance, a status of A to A, meant that the person’s levels remained in group A, a C to A status meant that values transitioned from C to A during the first year and so on. A glycaemic variability score was also calculated, based on the number of times the HbA1c reading differed by more than 0.5% and the results categorised into 5 groups, depending on the level of variability (e.g., 0 – 20, 21 – 40 up to 81 – 100). The primary outcome of interest was the first occurrence of a major adverse cardiovascular event (MACE) which included myocardial infarction, coronary intervention, stroke, amputation/limb revascularisation.
Early glycaemic control and MACE
A total of 26,180 individuals with type 2 diabetes and a mean age of 68.7 years (43.9% female) were identified and included in the analysis.
The proportion of individuals categorised as A to A was 48%, whereas only 1.5% were categorised as C to A. A total of 2,300 MACE events occurred in the 26,180 individuals with type 2 diabetes and the median time to the first MACE was 635 days. Compared to those in the A to A group after the first year, individuals who transitioned from C to A had a significantly reduced risk of MACE (hazard ratio, HR = 0.75, 95% CI 0.60 – 0.94, p = 0.014). In addition, individuals who displayed the greater glycaemic variability (81 – 100) also had the highest risk for MACE (HR = 1.51, 95% CI 1.11 – 2.06, p = 0.0096) compared to those in the lowest (0 – 20) group.
The authors concluded that both transitioning to an HbA1c <7.5% within the first year after a type 2 diabetes diagnosis and lack of substantial glycaemic variability were both associated with reduced MACE events.
Whyte MB et al. Early and ongoing stable glycaemic control is associated with a reduction in major adverse cardiovascular events (MACE) in people with type 2 diabetes: primary care cohort study Diabetes Obes Metab 2022
31st March 2022
The type 2 diabetes risk after an acute infection with COVID-19 is as much as 50% higher in comparison to other acute upper respiratory tract infections. This was the main finding from a retrospective analysis by researchers from the Institute for Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany.
The development of type 2 diabetes after infection with COVID-19 has been recognised and evidenced by impaired glucose homoeostasis due to a viral-associated β-cell destruction. Moreover, other work has found that infection with COVID-19 potentially increases type 2 diabetes risk by induction of insulin resistance, leading to clinically evident hyperglycaemia detectable even in the post-acute phase.
However, there is uncertainty over whether or not these adverse metabolic disturbances are merely transient or if infection with COVID-19 does ultimately increase an individual’s subsequent risk of developing type 2 diabetes. For the present study, the German team retrospectively examined the incidence of type 2 diabetes over a longer time frame, after infection with COVID-19, among patients with mild infections, i.e., those managed in primary care. In order to show that the development of type 2 diabetes was a unique feature of COVID-19 as opposed to a general response to viral infections, the team included a control group of individuals who experienced other acute upper respiratory tract infections (AURIs). Propensity score matching was carried out based on sex, age and co-morbidities and the presence of newly diagnosed type 2 diabetes was extracted from the electronic medical records.
Type 2 diabetes risk and infection with COVID-19
A total of 35,865 individuals with a mean age of 42.6 years (45.6% women) were propensity-matched and followed-up for a median of 119 days (COVID-19) or 161 days (AURI patients). Although disease severity was generally mild, a similar proportion from each cohort were hospitalised due to their infection (3.2% COVID-19 vs AURI 3.1%).
After matching 1:1 COVID-19 and AURI individuals (9823 pairs) the type 2 diabetes incidence after recovery from both infections was 20.5 per 1000 person-years in the COVID-19 group and 13.6 in the AURI group (incidence rate ratio, IIR = 1.51, 95% CI 1.05-2.18). However, the risk of developing all other forms of diabetes were not significantly different between COVID-19 and any other AURI (IIR = 1.25, 95% CI 0.60 – 2.59).
Whether or not the incident cases of type 2 diabetes uncovered in the study would resolve over time could not be determined due to the retrospective nature of the study. However, based on these findings, the authors concluded that if other studies confirmed their own results, active monitoring of glucose dysregulation should be instigated after recovery, even from mild forms of COVID-19 infection.
Rathermann W et al. Incidence of newly diagnosed diabetes after Covid-19 Diabetologia 2022