scholarly journals The importance of addressing multiple risk markers in type 2 diabetes: results from the LEADER and SUSTAIN 6 trials

2021 ◽  
Author(s):  
Emilie H. Zobel ◽  
Bernt Johan von Scholten ◽  
Tine W. Hansen ◽  
Frederik Persson ◽  
Søren Rasmussen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Markers ◽  
Multiple Risk

scholarly journals FC 058THE IMPORTANCE OF ADDRESSING MULTIPLE RISK MARKERS IN TYPE 2 DIABETES: RESULTS FROM THE LEADER AND SUSTAIN 6 TRIALS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Emilie Zobel ◽  
Bernt Johan Von Scholten ◽  
Tine Hansen ◽  
Frederik Persson ◽  
Søren Rasmussen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Death ◽  
Observation Time ◽  
Risk Marker ◽  
Risk Markers ◽  
Multiple Risk ◽  
Reduced Risk ◽  
Parameters Of Interest

Abstract Background and Aims The extent to which improvements in multiple risk markers affect outcomes in type 2 diabetes is unclear. Our aim was to investigate whether clinically relevant improvement in multiple risk markers confers lower risk of micro- and macrovascular disease in a contemporary type 2 diabetes population with cardiovascular disease or high risk for cardiovascular disease, independent of specific treatments. Method Exploratory post-hoc analysis of the two cardiovascular outcome trials in patients with type 2 diabetes LEADER (NCT01179048; n=8638 with baseline and year 1 assessment of at least one of the parameters of interest; patients randomised to the glucagon like peptide-1 receptor agonist [GLP-1 RA] liraglutide or placebo [1:1]; median observation time: 3.8 years) and SUSTAIN 6 (NCT01720446; n=3040 with baseline and year 1 assessment of at least one of the parameters of interest; patients randomised to the GLP-1 RA semaglutide or placebo [1:1]; median observation time: 2.1 years). We pooled all participants, including the active (liraglutide/semaglutide) and placebo-treated groups. We categorised patients according to number of risk markers with a clinically relevant change 1 year after randomisation and investigated subsequent risk of major adverse cardiovascular events (MACE: cardiovascular death, nonfatal myocardial infarction and nonfatal stroke), expanded MACE (MACE plus coronary revascularisation and hospitalisation for heart failure or unstable angina pectoris), cardiovascular death or nephropathy (new onset of macroalbuminuria or doubling of the serum creatinine level and an estimated glomerular filtration rate [eGFR] ≤45 ml/min/1.73 m2, or the need for continuous renal-replacement therapy, or death from renal disease). We defined clinically relevant change as: body weight loss ≥5%, glycated haemoglobin reduction ≥1%, systolic blood pressure reduction ≥5 mmHg, low-density lipoprotein cholesterol reduction ≥0.5 mmol/L, eGFR reduction ≥0 ml/min/1.73m2 and urinary albumin-to-creatinine ratio reduction ≥30% of baseline value. Numbers of risk markers with change were classified as: none (group G0), 1 (G1), 2 (G2), 3 (G3) and ≥4 (G4). Cox regression analysed risk of each outcome and tested for trends; models were adjusted for continuous baseline levels of the risk markers and treatment group (liraglutide/semaglutide and placebo) and stratified by trial. Results The Table contains baseline characteristics of patients in each risk marker group. Compared to patients with no risk-marker improvement, patients with 2, 3 or ≥4 improved risk markers had reduced risk of expanded MACE [hazard ratio (95% CI): 0.80 (0.67-0.96); 0.80 (0.66-0.97); 0.82 (0.66-1.02)], cardiovascular death [0.66 (0.45-0.96); 0.67 (0.45-0.99); 0.60 (0.38-0.94)] and nephropathy [(0.71 (0.52-0.97); 0.48 (0.34-0.68); 0.43 (0.29-0.65)] (Figure). One improved risk marker conferred no risk reduction. The trend of decreased risk for each additional risk marker improvement was significant for expanded MACE (p=0.004), cardiovascular death (p=0.005) and nephropathy (p<0.0001). We observed a stepwise higher number of patients on GLP-1 RA treatment in the groups with 0, 1, 2, 3 or ≥4 risk marker improvements as follows: 30.5% in G0, 38.0% in G1, 48.8% in G2, 61.6% in G3 and 75.3% in G4. We observed similar results in separate analyses of the LEADER and SUSTAIN 6 trials. Conclusion In patients with type 2 diabetes, improvements in two or more risk markers confer reduced risk of cardiovascular disease and nephropathy as compared with none or one improved risk marker, most notably for nephropathy. Our findings stress the importance of multifactorial intervention and underscore the benefit of pleiotropic antidiabetic treatments.

scholarly journals Ocular and Systemic Risk Markers for Development of Macular Edema and Proliferative Retinopathy in Type 2 Diabetes: A 5-Year Longitudinal Study

Diabetes Care ◽  
2020 ◽  
Vol 44 (1) ◽  
pp. e12-e14
Author(s):  
António C.-V. Martinho ◽  
Inês P. Marques ◽  
Ana L. Messias ◽  
Torcato Santos ◽  
Maria H. Madeira ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Longitudinal Study ◽  
Macular Edema ◽  
Systemic Risk ◽  
Proliferative Retinopathy ◽  
Risk Markers

scholarly journals The contribution of physical fitness to individual and ethnic differences in risk markers for type 2 diabetes in children: The Child Heart and Health Study in England (CHASE)

2018 ◽  
Vol 19 (4) ◽  
pp. 603-610 ◽  
Author(s):  
Claire M Nightingale ◽  
Alicja R Rudnicka ◽  
Sarah R Kerry-Barnard ◽  
Angela S Donin ◽  
Soren Brage ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Physical Fitness ◽  
Ethnic Differences ◽  
Health Study ◽  
Risk Markers

The Importance and Role of Multiple Risk Factor Control in Type 2 Diabetes

2019 ◽  
Vol 21 (5) ◽  
Author(s):  
Caroline Holm Nørgaard ◽  
Mitra Mosslemi ◽  
Christina J.-Y. Lee ◽  
Christian Torp-Pedersen ◽  
Nathan D. Wong
Keyword(s):  
Type 2 Diabetes ◽  
Risk Factor ◽  
Multiple Risk Factor ◽  
Risk Factor Control ◽  
Multiple Risk

scholarly journals Sudomotor dysfunction independently predicts incident cardiovascular–renal events and all-cause death in type 2 diabetes: the Joint Asia Diabetes Evaluation register

2018 ◽  
Vol 34 (8) ◽  
pp. 1320-1328 ◽  
Author(s):  
Lee Ling Lim ◽  
Amy W C Fu ◽  
Eric S H Lau ◽  
Risa Ozaki ◽  
Kitty K T Cheung ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Screening Strategy ◽  
Composite Score ◽  
Risk Markers ◽  
Chinese Adults ◽  
Non Invasive ◽  
Hazard Ratios ◽  
Never Smokers

AbstractBackgroundEarly detection and risk factor control prevent chronic kidney disease (CKD) progression. Evaluation of peripheral autonomic dysfunction may detect incident cardiovascular–renal events in type 2 diabetes (T2D).MethodsSUDOSCAN, a non-invasive tool, provides an age-adjusted electrochemical skin conductance (ESC) composite score incorporating hands/feet ESC measurements, with a score ≤53 indicating sudomotor dysfunction. A consecutive cohort of 2833 Chinese adults underwent structured diabetes assessment in 2012–13; 2028 participants without preexisting cardiovascular disease (CVD) and CKD were monitored for incident cardiovascular–renal events until 2015.ResultsIn this prospective cohort {mean age 57.0 [standard deviation (SD) 10.0] years; median T2D duration 7.0 [interquartile range (IQR) 3.0–13.0] years; 56.1% men; 72.5% never-smokers; baseline ESC composite score 60.7 (SD 14.5)}, 163 (8.0%) and 25 (1.2%) participants developed incident CKD and CVD, respectively, after 2.3 years of follow-up. The adjusted hazard ratios (aHRs) per 1-unit decrease in the ESC composite score for incident CKD, CVD and all-cause death were 1.02 [95% confidence interval (CI) 1.01–1.04], 1.04 (1.00–1.07) and 1.04 (1.00–1.08), respectively. Compared with participants with an ESC composite score >53, those with a score ≤53 had an aHR of 1.56 (95% CI 1.09–2.23) for CKD and 3.11 (95% CI 1.27–7.62) for CVD, independent of common risk markers. When added to clinical variables (sex and duration of diabetes), the ESC composite score improved discrimination of all outcomes with appropriate reclassification of CKD risk.ConclusionsA low ESC composite score independently predicts incident cardiovascular–renal events and death in T2D, which may improve the screening strategy for early intervention.

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