scholarly journals Cancer risk in Chinese diabetes patients: a retrospective cohort study based on management data

2018 ◽  
Vol 7 (12) ◽  
pp. 1415-1423 ◽  
Author(s):  
Yuan Fang ◽  
Xuehong Zhang ◽  
Huilin Xu ◽  
Stephanie A Smith-Warner ◽  
Dongli Xu ◽  
...  
Keyword(s):  
Vital Statistics ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Cancer Risks ◽  
Upward Trend ◽  
Detection Bias ◽  
Thyroid Cancers ◽  
Risk Of Cancer

The excess risk of cancer observed in patients with type 2 diabetes (T2DM) may have been influenced by detection bias. The aim of this study was to examine the real association by evaluating time-varying site-specific cancer risks in newly diagnosed T2DM patients. A total of 51,324 registered cancer-free individuals newly diagnosed with T2DM between 2004 and 2014 were linked with the Shanghai Cancer Registry and the Vital Statistics through September 2015. A total of 2920 primary, invasive cancer cases were identified during 325,354 person-years period. Within 1 year following diabetes onset, participants with T2DM had higher risks of total, lung and rectal cancer in men and total, liver, pancreas, thyroid, breast and uteri cancer in women. Thereafter the incidence for overall cancer decreased and then increased along with follow-up time, with the upward trend varying by cancer, suggesting potential detection bias. After the initial 1-year period, standardized incidence ratios (SIR) and 95% CIs for overall cancer were 0.80 (95% CI 0.76–0.85) in men and 0.93 (95% CI 0.88–0.99) in women, but a higher risk of breast and thyroid cancers were observed in women, with SIR and 95% CI being 1.13 (1.01, 1.28) and 1.37 (1.11, 1.63), respectively. Our results suggest that T2DM patients are at higher risk of certain cancers; this risk particularly increases shortly after diabetes diagnosis, which is likely to be due to detection bias caused by increased ascertainment. Prevention of female breast and thyroid cancers should be paid attention in Chinese individuals with T2DM.

scholarly journals Metformin use and risk of cancer in patients with type 2 diabetes: a cohort study of primary care records using inverse probability weighting of marginal structural models

2019 ◽  
Vol 48 (2) ◽  
pp. 527-537 ◽  
Author(s):  
Ruth E Farmer ◽  
Deborah Ford ◽  
Rohini Mathur ◽  
Nish Chaturvedi ◽  
Rick Kaplan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cancer Risk ◽  
Structural Models ◽  
Marginal Structural Models ◽  
Diabetes Diagnosis ◽  
Inverse Probability ◽  
Risk Of Cancer

Abstract Background Previous studies provide conflicting evidence on whether metformin is protective against cancer. When studying time-varying exposure to metformin, covariates such as body mass index (BMI) and glycated haemoglobin (HbA1c) may act as both confounders and causal pathway variables, and so cannot be handled adequately by standard regression methods. Marginal structural models (MSMs) with inverse probability of treatment weights (IPTW) can correctly adjust for such confounders. Using this approach, the main objective of this study was to estimate the effect of metformin on cancer risk compared with risk in patients with T2DM taking no medication. Methods Patients with incident type 2 diabetes (T2DM) were identified in the Clinical Practice Research Datalink (CPRD), a database of electronic health records derived from primary care in the UK. Patients entered the study at diabetes diagnosis or the first point after this when they had valid HbA1c and BMI measurements, and follow-up was split into 1-month intervals. Logistic regression was used to calculate IPTW; then the effect of metformin on all cancers (including and excluding non-melanoma skin cancer) and breast, prostate, lung, colorectal and pancreatic cancers was estimated in the weighted population. Results A total of 55 629 T2DM patients were alive and cancer-free at their study entry; 2530 people had incident cancer during a median follow-up time of 2.9 years [interquartile range (IQR) 1.3–5.4 years]. Using the MSM approach, the hazard ratio (HR) for all cancers, comparing treatment with metformin with no glucose-lowering treatment, was 1.02 (0.88–1.18). Results were robust to a range of sensitivity analyses and remained consistent when estimating the treatment effect by length of exposure. We also found no evidence of a protective effect of metformin on individual cancer outcomes. Conclusions We find no evidence that metformin has a causal association with cancer risk.

scholarly journals Patients characteristics associated with better glycemic response to teneligliptin and metformin therapy in type 2 diabetes: a retrospective study

2018 ◽  
Vol 5 (2) ◽  
pp. 424
Author(s):  
Pradeep V. Gadge ◽  
Roshani P. Gadge ◽  
Nikita D. Paralkar
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Retrospective Study ◽  
Blood Sugar ◽  
Therapeutic Effectiveness ◽  
Glycemic Response ◽  
Newly Diagnosed ◽  
Long Duration

Background: Teneligliptin was recently approved for type 2 diabetes (T2D) management in India and is used as monotherapy or in combination with different antidiabetic drugs. The aim of this study was to identify patients’ characteristics associated with better glycemic response to teneligliptin and metformin.Methods: A retrospective analysis of data was performed in patients of T2D with HbA1c above 7% who were treated with teneligliptin 20 mg/d as add on to metformin (500-100 mg/d) and whose follow-up data at 12-weeks was available. Fasting blood sugar (FBS) and post-prandial blood sugar (PPBS) changes were analysed.  Results: Among 66 patients included in analysis, mean age was 61.0±9.8 years and 53% were females. Median duration of diabetes was 2 years. At 12-weeks, a significant reduction PPBS was observed (mean change: -14.3 mg/dL, p=0.009) but not in FBS (mean change: -2.4 mg/dL, p=0.353). Among different patients’ characteristics, age ≤60 years (p=0.006), duration of ≤1 year (p=0.023), body-mass index ≥25 kg/m2 (p=0.009), presence of dyslipidemia (p=0.05) and absence of complications (p=0.012) were associated with significant reduction in PPBS but not in FBS.Conclusions: A younger, newly-diagnosed, obese T2D patients with dyslipidemia without any complications of diabetes can derive better therapeutic effectiveness from teneligliptin added to metformin. These findings need to be confirmed in large, prospective, long duration study.  

scholarly journals Health Care Utilization Following Newly-Diagnosed Type-2 Diabetes in Sweden: A Follow-Up of 38,956 Patients in a Real Clinical Setting

2013 ◽  
Vol 16 (7) ◽  
pp. A451
Author(s):  
U. Sabale ◽  
J. Bodegård ◽  
J. Sundström ◽  
B. Svennblad ◽  
C.J. Östgren ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care Utilization ◽  
Clinical Setting ◽  
Care Utilization ◽  
Newly Diagnosed

scholarly journals Phenotyping Individuals With Newly-Diagnosed Type 2 Diabetes at Risk for All-Cause Mortality: A Single Centre Observational, Prospective Study

2020 ◽  
Author(s):  
Edoardo Biancalana ◽  
Federico Parolini ◽  
Alessandro Mengozzi ◽  
Anna Solini
Keyword(s):  
Type 2 Diabetes ◽  
Mortality Rate ◽  
Disease Duration ◽  
Previous History ◽  
Newly Diagnosed ◽  
Time Data ◽  
Short Disease Duration ◽  
All Cause Mortality

Abstract Background Type 2 diabetes (T2D) shows a high mortality rate, dependent on disease duration, comorbidities and glucose control over time. Data on patients with short disease duration are scanty.Methods We prospectively followed a cohort of newly-diagnosed T2D patients referring to a single diabetes centre, treated according to the international guidelines and checked every 6-12 months. All-cause mortality and major cardiovascular (CV) events were registered.Results 289 patients out of 3019 consecutive first attendances matched inclusion criteria and were included in the observation. Mean follow-up was 51.2 months. At 31 December 2018, 253 patients were alive and 36 deceased. At baseline, deceased individuals were older, with lower eGFR and lower uric acid, higher prevalence of atrial fibrillation. During the follow-up, 18 non-fatal CV events were adjudicated; patients with incident CV disease (CVD) differed at baseline for sex, previous history of CVD and retinopathy, higher use of secretagogues and lower use of metformin. At multivariate analysis, age and previous CVD were the only independent determinants of all-cause mortality and incident CVD, respectively. In deceased individuals, eGFR slope was markedly unstable and ΔeGFR at the end of the follow-up was higher (p<0.001), and predicted mortality. Conclusion Newly-diagnosed T2D patients followed according to the best clinical practice show a mortality rate similar to that reported in more complicated patients with longer disease duration; none of the clinical and biochemical variables commonly measured at baseline can predict mortality or incident CVD; early metformin use seems to be associated with no risk of prevalent or incident retinopathy.

scholarly journals Phenotyping Individuals With Newly-Diagnosed Type 2 Diabetes at Risk for All-Cause Mortality: A Single Centre Observational, Prospective Study

2020 ◽  
Author(s):  
Edoardo Biancalana ◽  
Federico Parolini ◽  
Alessandro Mengozzi ◽  
Anna Solini
Keyword(s):  
Type 2 Diabetes ◽  
Mortality Rate ◽  
Disease Duration ◽  
Previous History ◽  
Newly Diagnosed ◽  
Time Data ◽  
Short Disease Duration ◽  
All Cause Mortality

Abstract Background Type 2 diabetes (T2D) shows a high mortality rate, dependent on disease duration, comorbidities and glucose control over time. Data on patients with short disease duration are scanty. Methods We prospectively followed a cohort of newly-diagnosed T2D patients referring to a single diabetes centre, treated according to the international guidelines and checked every 6-12 months. All-cause mortality and major cardiovascular (CV) events were registered. Results 289 patients out of 3019 consecutive first attendances matched inclusion criteria and were included in the observation. Mean follow-up was 51.2 months. At 31 December 2018, 253 patients were alive and 36 deceased. At baseline, deceased individuals were older, with lower eGFR and lower uric acid, higher prevalence of atrial fibrillation. During the follow-up, 18 non-fatal CV events were adjudicated; patients with incident CV disease (CVD) differed at baseline for sex, previous history of CVD and retinopathy, higher use of secretagogues and lower use of metformin. At multivariate analysis, age and previous CVD were the only independent determinants of all-cause mortality and incident CVD, respectively. In deceased individuals, eGFR slope was markedly unstable and ΔeGFR at the end of the follow-up was higher (p<0.001), and predicted mortality. Conclusion Newly-diagnosed T2D patients followed according to the best clinical practice show a mortality rate similar to that reported in more complicated patients with longer disease duration; none of the clinical and biochemical variables commonly measured at baseline can predict mortality or incident CVD; early metformin use seems to be associated with no risk of prevalent or incident retinopathy.

scholarly journals Temporal Trends in Incident Hospitalization for Diabetes-Related Foot Ulcer in Type 2 Diabetes: The Fremantle Diabetes Study

2021 ◽  
Author(s):  
Emma J Hamilton ◽  
Wendy A Davis ◽  
Ranita Siru ◽  
Mendel Baba ◽  
Paul E Norman ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Proportional Hazards ◽  
Temporal Trends ◽  
Age Groups ◽  
Foot Ulcer ◽  
Cox Proportional Hazards ◽  
Diabetes Diagnosis ◽  
Incident Rate

Objective:<b> </b>To determine whether, reflecting trends in other chronic complications, incident hospitalization for diabetes-related foot ulcer (DFU) has declined over recent decades in type 2 diabetes. <p>Research design and methods:<b> </b>Participants with type 2 diabetes from the community-based Fremantle Diabetes Study Phases I (FDS1; 1,296 participants, mean age 64.0 years, 48.6% males, recruited 1993-1996) and II (FDS2; 1,509 participants, mean age 65.4 years, 51.8% males, recruited 2008-2011) were followed from entry to first hospitalization for/with DFU, death or 5 years (whichever came first). Incident rate ratios (IRRs) and incident rate differences (IRDs) were calculated for FDS2 versus FDS1 overall and in 10-year age-groups. Cox proportional hazards modelling determined independent predictors of first DFU hospitalization in the combined cohort.</p> <p>Results:<b> </b>Incident DFU hospitalization (95% CI) was 1.9 (0.9-3.3) /1,000 person-years in FDS1 during 5,879 person-years of follow-up, and 4.5 (3.0-6.4) /1,000 person-years in FDS2 during 6,915 person-years of follow-up. The crude IRR (95% CI) was 2.40 (1.17-5.28), <i>P</i>=0.013) and IRD 2.6 (0.7-4.5) /1,000 person-years (<i>P</i>=0.010). The highest incidence rate (IR) for any age-group was 23.6/1,000 person-years in FDS2 participants aged 31-40 years. Age at diabetes diagnosis (inverse), HbA<sub>1c</sub>, insulin use, height, ln(urinary albumin:creatinine), absence of any foot pulse, previous peripheral revascularization and peripheral sensory neuropathy (PSN) were independent predictors of incident hospitalization for/with DFU.</p> <p>Conclusions:<b> </b>Incident DFU hospitalizations complicating type 2 diabetes increased between FDS Phases, especially in younger participants, and were more likely in those with PSN, peripheral arterial disease and suboptimal glycemic control at baseline.</p>

scholarly journals Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study

2021 ◽  
Author(s):  
Jenny Riley ◽  
Christina Antza ◽  
Punith Kempegowda ◽  
Anuradhaa Subramanian ◽  
Joht Singh Chandan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Social Deprivation ◽  
Population Based ◽  
Incident Diabetes ◽  
Lipid Lowering ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Foot Disease

<b>Objective: </b>To investigate the relationship between social deprivation and incident diabetes-related foot disease (DFD), in newly-diagnosed patients with type 2 diabetes. <p><b>Research design and methods:</b> A population-based, open retrospective cohort study, using The Health Improvement Network (01/01/2005-31/12/2019). Patients with type 2 diabetes, free of DFD at baseline, were stratified by Townsend deprivation index and the risk of developing DFD was calculated. DFD was defined as a composite of foot ulcer (FU), Charcot arthropathy, lower limb amputation (LLA), peripheral neuropathy (PN), peripheral vascular disease (PVD) and gangrene.</p> <p><b>Results:</b> 176,359 patients were eligible (56% men; aged 62.9±13.1years). After excluding 26,094 patients with DFD before/within 15 months of type 2 diabetes diagnosis, DFD was incidentally developed in 12.1% of study population during 3.27years (IQR:1.41-5.96). Patients in the most deprived Townsend quintile had increased risk of DFD compared to those in the least deprived (aHR:1.22, 95%CI:1.16-1.29) after adjusting for sex, age at type 2 diabetes diagnosis, ethnicity, smoking, BMI, HbA1c, cardiovascular disease, hypertension, retinopathy, eGFR, insulin, glucose/lipid-lowering medications and baseline foot risk. Patients in the most deprived Townsend quintile had higher risk of PN (aHR:1.18, 95%CI:1.11-1.25), FU (aHR:1.44, 95%CI:1.17-1.77), PVD (aHR:1.40, 95%CI:1.28-1.53) LLA (aHR:1.75, 95%CI:1.08-2.83) and gangrene (aHR:8.49, 95% CI:1.01-71.58) compared to those in the least.</p> <p><b>Conclusion: </b>Social deprivation is an independent risk factor for the development of DFD, PN, FU, PVD, LLA and gangrene in newly-diagnosed patients with type 2 diabetes. Considering the high individual and economic burden of DFD, strategies targeting patients in socially deprived areas are needed to reduce health inequalities.</p> <p><b> </b></p>

Dispensation Patterns of Glucose-Lowering Drugs in Newly Diagnosed Type 2 Diabetes: Routine Data Analysis of Insurance Claims in Germany

2021 ◽  
Author(s):  
Brenda Bongaerts ◽  
Bianca Kollhorst ◽  
Oliver Kuss ◽  
Iris Pigeot ◽  
Wolfgang Rathmann
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Diagnosis ◽  
Research Database ◽  
Second Line ◽  
Newly Diagnosed ◽  
First Line ◽  
Glucose Lowering ◽  
Receptor Agonists ◽  
Metformin Monotherapy

Abstract Aims To describe dispensation patterns of glucose-lowering drugs in newly diagnosed type 2 diabetes in Germany. Materials and methods Based on claims data from four statutory health insurances (German Pharmacoepidemiological Research Database,>25 million insurants), all individuals with newly diagnosed type 2 diabetes were identified. Eligible patients had a first diagnosis for type 2 diabetes between January 2012 and December 2016. We analyzed the dispensation patterns of first-line glucose-lowering therapies initiated in the year after diabetes diagnosis and patterns of second-line therapies dispensed one year after first-line treatment. Results A total of 356,647 individuals with newly diagnosed type 2 diabetes were included (average age [SD]: 63.5 [13.4] years; 49.3% males). Of the 31.6% of individuals who were pharmacologically treated in the year after diagnosis, metformin monotherapy was most frequently dispensed (73.1%), followed by dual therapy of metformin and dipeptidyl peptidase-4 inhibitors (DPP-4is) (6.4%), and monotherapy with DPP-4is (2.9%). From 2012 through 2016, sulfonylurea dispensations were reduced by more than 50%. Dispensations for combination therapies with DPP-4is increased up to 10.6%. Glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors contributed to 2% of all treatments. After a median of 5 months, 20.0% of individuals on pharmacological therapy initiated second-line glucose-lowering treatment. Conclusions Data from German statutory health insurances (2012 to 2016) showed that most individuals with newly diagnosed type 2 diabetes were dispensed metformin monotherapy in line with diabetes care guidelines. A substantial decrease in the use of sulfonylureas was observed after the introduction of DPP-4i and GLP-1 receptor agonists.

Sign in / Sign up

Export Citation Format

Share Document