Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

10.2337/figshare.12014598.v2 ◽

2020 ◽

Author(s):

Nicola J Adderley ◽

Anuradhaa Subramanian ◽

Konstantinos Toulis ◽

Krishna Gokhale ◽

Thomas Taverner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Microvascular Complications ◽

High Risk Population ◽

Diabetes Diagnosis ◽

Obstructive Sleep ◽

Increased Risk ◽

Ckd Stage ◽

All Cause Mortality

<div><b>Objective</b>: To determine risk of cardiovascular diseases (CVD), microvascular complications and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnoea(OSA) compared to patients with type 2 diabetes without a diagnosis of OSA.</div><div><b>Research Design and Methods</b>: An age-, sex-, body mass index- and diabetes duration-matched cohort study using data from a UK primary care database from 01/01/2005 to 17/01/2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischaemic heart disease(IHD), stroke/transient ischaemic attack(TIA), heart failure(HF)); peripheral vascular disease(PVD); atrial fibrillation(AF); peripheral neuropathy(PN); diabetes-related foot disease(DFD); referable retinopathy; chronic kidney disease(CKD); all-cause mortality. The same outcomes were explored in patients with pre-existing OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.</div><div><b>Results</b>: 3,667 exposed participants and 10,450 matched controls were included. Adjusted hazard ratios for the outcomes were: composite CVD 1.54(95%CI 1.32,1.79); IHD 1.55(1.26,1.90); HF 1.67(1.35,2.06); stroke/TIA 1.57(1.27,1.94); PVD 1.10(0.91,1.32); AF 1.53(1.28,1.83); PN 1.32(1.14,1.51); DFD 1.42(1.16,1.74); retinopathy 0.99(0.82,1.21); CKD (stage 3-5) 1.18(1.02,1.36); albuminuria 1.11(1.01,1.22); all-cause mortality 1.24(1.10,1.40). In the prevalent OSA cohort the results were similar but some associations not observed.<br></div><div><b>Conclusions</b>: Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared to patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.</div>

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Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

10.2337/figshare.12014598.v3 ◽

2020 ◽

Author(s):

Nicola J Adderley ◽

Anuradhaa Subramanian ◽

Konstantinos Toulis ◽

Krishna Gokhale ◽

Thomas Taverner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Microvascular Complications ◽

High Risk Population ◽

Diabetes Diagnosis ◽

Obstructive Sleep ◽

Increased Risk ◽

Ckd Stage ◽

All Cause Mortality

<div><b>Objective</b>: To determine risk of cardiovascular diseases (CVD), microvascular complications and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnoea(OSA) compared to patients with type 2 diabetes without a diagnosis of OSA.</div><div><b>Research Design and Methods</b>: An age-, sex-, body mass index- and diabetes duration-matched cohort study using data from a UK primary care database from 01/01/2005 to 17/01/2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischaemic heart disease(IHD), stroke/transient ischaemic attack(TIA), heart failure(HF)); peripheral vascular disease(PVD); atrial fibrillation(AF); peripheral neuropathy(PN); diabetes-related foot disease(DFD); referable retinopathy; chronic kidney disease(CKD); all-cause mortality. The same outcomes were explored in patients with pre-existing OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.</div><div><b>Results</b>: 3,667 exposed participants and 10,450 matched controls were included. Adjusted hazard ratios for the outcomes were: composite CVD 1.54(95%CI 1.32,1.79); IHD 1.55(1.26,1.90); HF 1.67(1.35,2.06); stroke/TIA 1.57(1.27,1.94); PVD 1.10(0.91,1.32); AF 1.53(1.28,1.83); PN 1.32(1.14,1.51); DFD 1.42(1.16,1.74); retinopathy 0.99(0.82,1.21); CKD (stage 3-5) 1.18(1.02,1.36); albuminuria 1.11(1.01,1.22); all-cause mortality 1.24(1.10,1.40). In the prevalent OSA cohort the results were similar but some associations not observed.<br></div><div><b>Conclusions</b>: Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared to patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.</div>

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Obstructive sleep apnoea, a risk factor for cardiovascular and microvascular disease in patients with type 2 diabetes mellitus: findings from a population-based cohort study

10.2337/dc20-1234/suppl.12014598 ◽

2020 ◽

Author(s):

Nicola J Adderley ◽

Anuradhaa Subramanian ◽

Konstantinos Toulis ◽

Krishna Gokhale ◽

Thomas Taverner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Obstructive Sleep Apnoea ◽

Microvascular Complications ◽

Sleep Apnoea ◽

Diabetes Diagnosis ◽

Obstructive Sleep ◽

Ckd Stage ◽

All Cause Mortality

<div><b>Objective</b>: To determine risk of cardiovascular diseases (CVD), microvascular complications and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnoea(OSA) compared to patients with type 2 diabetes without a diagnosis of OSA.</div><div><b>Research Design and Methods</b>: An age-, sex-, body mass index- and diabetes duration-matched cohort study using data from a UK primary care database from 01/01/2005 to 17/01/2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischaemic heart disease(IHD), stroke/transient ischaemic attack(TIA), heart failure(HF)); peripheral vascular disease(PVD); atrial fibrillation(AF); peripheral neuropathy(PN); diabetes-related foot disease(DFD); referable retinopathy; chronic kidney disease(CKD); all-cause mortality. The same outcomes were explored in patients with pre-existing OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.</div><div><b>Results</b>: 3,667 exposed participants and 10,450 matched controls were included. Adjusted hazard ratios for the outcomes were: composite CVD 1.54(95%CI 1.32,1.79); IHD 1.55(1.26,1.90); HF 1.67(1.35,2.06); stroke/TIA 1.57(1.27,1.94); PVD 1.10(0.91,1.32); AF 1.53(1.28,1.83); PN 1.32(1.14,1.51); DFD 1.42(1.16,1.74); retinopathy 0.99(0.82,1.21); CKD (stage 3-5) 1.18(1.02,1.36); albuminuria 1.11(1.01,1.22); all-cause mortality 1.24(1.10,1.40). In the prevalent OSA cohort the results were similar but some associations not observed.<br></div><div><b>Conclusions</b>: Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared to patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.</div>

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Obstructive sleep apnoea, a risk factor for cardiovascular and microvascular disease in patients with type 2 diabetes mellitus: findings from a population-based cohort study

10.2337/figshare.12014598.v1 ◽

2020 ◽

Author(s):

Nicola J Adderley ◽

Anuradhaa Subramanian ◽

Konstantinos Toulis ◽

Krishna Gokhale ◽

Thomas Taverner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Obstructive Sleep Apnoea ◽

Microvascular Complications ◽

Sleep Apnoea ◽

Diabetes Diagnosis ◽

Obstructive Sleep ◽

Ckd Stage ◽

All Cause Mortality

<div><b>Objective</b>: To determine risk of cardiovascular diseases (CVD), microvascular complications and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnoea(OSA) compared to patients with type 2 diabetes without a diagnosis of OSA.</div><div><b>Research Design and Methods</b>: An age-, sex-, body mass index- and diabetes duration-matched cohort study using data from a UK primary care database from 01/01/2005 to 17/01/2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischaemic heart disease(IHD), stroke/transient ischaemic attack(TIA), heart failure(HF)); peripheral vascular disease(PVD); atrial fibrillation(AF); peripheral neuropathy(PN); diabetes-related foot disease(DFD); referable retinopathy; chronic kidney disease(CKD); all-cause mortality. The same outcomes were explored in patients with pre-existing OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.</div><div><b>Results</b>: 3,667 exposed participants and 10,450 matched controls were included. Adjusted hazard ratios for the outcomes were: composite CVD 1.54(95%CI 1.32,1.79); IHD 1.55(1.26,1.90); HF 1.67(1.35,2.06); stroke/TIA 1.57(1.27,1.94); PVD 1.10(0.91,1.32); AF 1.53(1.28,1.83); PN 1.32(1.14,1.51); DFD 1.42(1.16,1.74); retinopathy 0.99(0.82,1.21); CKD (stage 3-5) 1.18(1.02,1.36); albuminuria 1.11(1.01,1.22); all-cause mortality 1.24(1.10,1.40). In the prevalent OSA cohort the results were similar but some associations not observed.<br></div><div><b>Conclusions</b>: Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared to patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.</div>

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Obstructive sleep apnoea, a risk factor for cardiovascular and microvascular disease in patients with type 2 diabetes mellitus: findings from a population-based cohort study

10.2337/dc20-1234/suppl.12014598.v1 ◽

2020 ◽

Author(s):

Nicola J Adderley ◽

Anuradhaa Subramanian ◽

Konstantinos Toulis ◽

Krishna Gokhale ◽

Thomas Taverner ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Obstructive Sleep Apnoea ◽

Microvascular Complications ◽

Sleep Apnoea ◽

Diabetes Diagnosis ◽

Obstructive Sleep ◽

Ckd Stage ◽

All Cause Mortality

<div><b>Objective</b>: To determine risk of cardiovascular diseases (CVD), microvascular complications and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnoea(OSA) compared to patients with type 2 diabetes without a diagnosis of OSA.</div><div><b>Research Design and Methods</b>: An age-, sex-, body mass index- and diabetes duration-matched cohort study using data from a UK primary care database from 01/01/2005 to 17/01/2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischaemic heart disease(IHD), stroke/transient ischaemic attack(TIA), heart failure(HF)); peripheral vascular disease(PVD); atrial fibrillation(AF); peripheral neuropathy(PN); diabetes-related foot disease(DFD); referable retinopathy; chronic kidney disease(CKD); all-cause mortality. The same outcomes were explored in patients with pre-existing OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.</div><div><b>Results</b>: 3,667 exposed participants and 10,450 matched controls were included. Adjusted hazard ratios for the outcomes were: composite CVD 1.54(95%CI 1.32,1.79); IHD 1.55(1.26,1.90); HF 1.67(1.35,2.06); stroke/TIA 1.57(1.27,1.94); PVD 1.10(0.91,1.32); AF 1.53(1.28,1.83); PN 1.32(1.14,1.51); DFD 1.42(1.16,1.74); retinopathy 0.99(0.82,1.21); CKD (stage 3-5) 1.18(1.02,1.36); albuminuria 1.11(1.01,1.22); all-cause mortality 1.24(1.10,1.40). In the prevalent OSA cohort the results were similar but some associations not observed.<br></div><div><b>Conclusions</b>: Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared to patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.</div>

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Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses

Diabetologia ◽

10.1007/s00125-020-05319-w ◽

2020 ◽

Author(s):

Natalie Nanayakkara ◽

Andrea J. Curtis ◽

Stephane Heritier ◽

Adelle M. Gadowski ◽

Meda E. Pavkov ◽

...

Keyword(s):

Type 2 Diabetes ◽

Observational Studies ◽

Microvascular Complications ◽

Microvascular Disease ◽

Age At Diagnosis ◽

Diabetes Diagnosis ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Meta Analyses

Abstract Aims/hypothesis Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. Methods Data were sourced from MEDLINE and All EBM (Evidence Based Medicine) databases from inception to July 2018. Observational studies, investigating the effect of age at diabetes diagnosis on macrovascular and microvascular diabetes complications in adults with type 2 diabetes were selected according to pre-specified criteria. Two investigators independently extracted data and evaluated all studies. If data were not reported in a comparable format, data were obtained from authors, presented as minimally adjusted ORs (and 95% CIs) per 1 year increase in age at diabetes diagnosis, adjusted for current age for each outcome of interest. The study protocol was recorded with PROSPERO International Prospective Register of Systematic Reviews (CRD42016043593). Results Data from 26 observational studies comprising 1,325,493 individuals from 30 countries were included. Random-effects meta-analyses with inverse variance weighting were used to obtain the pooled ORs. Age at diabetes diagnosis was inversely associated with risk of all-cause mortality and macrovascular and microvascular disease (all p < 0.001). Each 1 year increase in age at diabetes diagnosis was associated with a 4%, 3% and 5% decreased risk of all-cause mortality, macrovascular disease and microvascular disease, respectively, adjusted for current age. The effects were consistent for the individual components of the composite outcomes (all p < 0.001). Conclusions/interpretation Younger, rather than older, age at diabetes diagnosis was associated with higher risk of mortality and vascular disease. Early and sustained interventions to delay type 2 diabetes onset and improve blood glucose levels and cardiovascular risk profiles of those already diagnosed are essential to reduce morbidity and mortality.

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Type 2 diabetes and COVID-19 related mortality in the critical care setting: A national cohort study in England, March-July 2020

10.2337/figshare.13034210 ◽

2020 ◽

Author(s):

John M. Dennis ◽

Bilal A Mateen ◽

Raphael Sonabend ◽

Nicholas J Thomas ◽

Kashyap A Patel ◽

...

Keyword(s):

Type 2 Diabetes ◽

Critical Care ◽

Cohort Study ◽

Care Setting ◽

Critical Care Setting ◽

Risk Of Death ◽

Risk Increase ◽

Increased Risk ◽

All Cause Mortality

<b>Objective: </b>To describe the relationship between type 2 diabetes and all-cause mortality amongst adults with COVID-19 in the critical care setting. <p><b>Research Design and Methods: </b>Nationwide retrospective cohort study in people admitted to hospital in England with COVID-19 requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between March 1, 2020 and July 27, 2020. Cox proportional hazards models were used to estimate 30 day in-hospital all-cause mortality associated with type 2 diabetes, adjusted for age, sex, ethnicity, obesity, and other major comorbidities (chronic respiratory disease, asthma, chronic heart disease, hypertension, immunosuppression, chronic neurological disease, chronic renal disease, and chronic liver disease).</p> <p><b>Results: </b>19,256 COVID-19 related HDU and ICU admissions were included in the primary analysis, including 13,809 HDU (mean age 70), and 5,447 ICU admissions (mean age 58). 3,524 (18.3%) had type 2 diabetes. 5,077 people (26.4%) died during the study period. People with type 2 diabetes were at increased risk of death (adjusted hazard ratio (aHR) 1.23 [95%CI 1.14;1.32]), results were consistent in HDU and ICU subsets. The relative mortality risk associated with type 2 diabetes decreased with increasing age (age 18-49 aHR 1.50 [95%CI 1.05;2.15]; age 50-64 1.29 [1.10;1.51]; age 65 or greater 1.18 [1.09;1.29], p-value for age:type 2 diabetes interaction 0.002).</p> <b>Conclusions: </b>Type 2 diabetes may be an independent prognostic factor for survival in people with severe COVID-19 requiring critical care treatment, and in this setting the risk increase associated with type 2 diabetes is greatest in younger people.<b><u><br> </u></b>

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Risk Factors for Macro- and Microvascular Complications among Older Adults with Diagnosed Type 2 Diabetes: Findings from The Irish Longitudinal Study on Ageing

Journal of Diabetes Research ◽

10.1155/2016/5975903 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Marsha L. Tracey ◽

Sheena M. McHugh ◽

Anthony P. Fitzgerald ◽

Claire M. Buckley ◽

Ronan J. Canavan ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Type 2 Diabetes ◽

Longitudinal Study ◽

Microvascular Complications ◽

Older Age ◽

Diabetes Diagnosis ◽

Increased Risk ◽

History Of

Objective. To explore risk factors for macro- and microvascular complications in a nationally representative sample of adults aged 50 years and over with type 2 diabetes in Ireland.Methods. Data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) (2009–2011) was used in cross-sectional analysis. The presence of doctor diagnosis of diabetes, risk factors, and macro- and microvascular complications were determined by self-report. Gender-specific differences in risk factor prevalence were assessed with the chi-squared test. Binomial regression analysis was conducted to explore independent associations between established risk factors and diabetes-related complications.Results. Among 8175 respondents, 655 were classified as having type 2 diabetes. Older age, being male, a history of smoking, a lower level of physical activity, and a diagnosis of high cholesterol were independent predictors of macrovascular complications. Diabetes diagnosis of 10 or more years, a history of smoking, and a diagnosis of hypertension were associated with an increased risk of microvascular complications. Older age, third-level education, and a high level of physical activity were protective factors (p<0.05).Conclusions. Early intervention to target modifiable risk factors is urgently needed to reduce diabetes-related morbidity in the older population in Ireland.

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Type 2 diabetes and COVID-19 related mortality in the critical care setting: A national cohort study in England, March-July 2020

10.2337/figshare.13034210.v1 ◽

2020 ◽

Author(s):

John M. Dennis ◽

Bilal A Mateen ◽

Raphael Sonabend ◽

Nicholas J Thomas ◽

Kashyap A Patel ◽

...

Keyword(s):

Type 2 Diabetes ◽

Critical Care ◽

Cohort Study ◽

Care Setting ◽

Critical Care Setting ◽

Risk Of Death ◽

Risk Increase ◽

Increased Risk ◽

All Cause Mortality

<b>Objective: </b>To describe the relationship between type 2 diabetes and all-cause mortality amongst adults with COVID-19 in the critical care setting. <p><b>Research Design and Methods: </b>Nationwide retrospective cohort study in people admitted to hospital in England with COVID-19 requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between March 1, 2020 and July 27, 2020. Cox proportional hazards models were used to estimate 30 day in-hospital all-cause mortality associated with type 2 diabetes, adjusted for age, sex, ethnicity, obesity, and other major comorbidities (chronic respiratory disease, asthma, chronic heart disease, hypertension, immunosuppression, chronic neurological disease, chronic renal disease, and chronic liver disease).</p> <p><b>Results: </b>19,256 COVID-19 related HDU and ICU admissions were included in the primary analysis, including 13,809 HDU (mean age 70), and 5,447 ICU admissions (mean age 58). 3,524 (18.3%) had type 2 diabetes. 5,077 people (26.4%) died during the study period. People with type 2 diabetes were at increased risk of death (adjusted hazard ratio (aHR) 1.23 [95%CI 1.14;1.32]), results were consistent in HDU and ICU subsets. The relative mortality risk associated with type 2 diabetes decreased with increasing age (age 18-49 aHR 1.50 [95%CI 1.05;2.15]; age 50-64 1.29 [1.10;1.51]; age 65 or greater 1.18 [1.09;1.29], p-value for age:type 2 diabetes interaction 0.002).</p> <b>Conclusions: </b>Type 2 diabetes may be an independent prognostic factor for survival in people with severe COVID-19 requiring critical care treatment, and in this setting the risk increase associated with type 2 diabetes is greatest in younger people.<b><u><br> </u></b>

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1418-P: Increased Risk of Incident Heart Failure and All-Cause Mortality in Insulin-Resistant People with Type 2 Diabetes in the United Kingdom Prospective Diabetes Study (UKPDS)

Diabetes ◽

10.2337/db20-1418-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1418-P

Author(s):

MALGORZATA WAMIL ◽

RUTH L. COLEMAN ◽

AMANDA ADLER ◽

JOHN J. MCMURRAY ◽

RURY R. HOLMAN

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

United Kingdom ◽

Insulin Resistant ◽

The United Kingdom ◽

Increased Risk ◽

All Cause Mortality ◽

Incident Heart Failure

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