scholarly journals Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes

2020 ◽  
Vol 22 (1) ◽  
pp. 87-98 ◽  
Author(s):  
Yun Shen ◽  
Lizheng Shi ◽  
Elizabeth Nauman ◽  
Peter Katzmarzyk ◽  
Eboni Price-Haywood ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Hemorrhagic Stroke ◽  
Hemoglobin A1c ◽  
Stroke Risk ◽  
Diabetes Management ◽  
Reference Group ◽  
Research Network ◽  
Lipid Lowering ◽  
Common Data Model

Background and Purpose The association between hemoglobin A1c (HbA1c) and stroke risk along with its subtypes is rarely reported. We aimed to investigate the association between HbA1c and the risk of incident stroke in patients with type 2 diabetes based on real world data from three healthcare systems.Methods We performed a retrospective cohort study of 27,113 African Americans and 40,431 whites with type 2 diabetes. Demographic, anthropometric, laboratory, and medication information were abstracted from the National Patient-Centered Clinical Research Network common data model. Incident stroke events including both ischemic and hemorrhagic stroke were defined.Results During a mean follow-up period of 3.79±1.68 years, 7,735 patients developed stroke (6,862 ischemic and 873 hemorrhagic). Multivariable-adjusted hazard ratios across levels of HbA1c at baseline (<6.0%, 6.0% to 6.9% [reference group], 7.0% to 7.9%, 8.0% to 8.9%, 9.0% to 9.9%, and ≥10%) were 1.07, 1.00, 1.13, 1.23, 1.27, and 1.37 (<i>P</i><sub>trend</sub> <0.001) for total stroke, 1.02, 1.00, 1.13, 1.20, 1.24, and 1.35 (<i>P</i><sub>trend</sub> <0.001) for ischemic stroke, and 1.40, 1.00, 1.14, 1.47, 1.47, and 1.51 (<i>P</i><sub>trend</sub>=0.002) for hemorrhagic stroke. When we used an updated mean value of HbA1c, the U-shaped association of HbA1c with stroke risk did not change. This U-shaped association was consistent among patients of different subgroups. The U-shaped association was more pronounced among patients taking antidiabetic, lipid-lowering, and antihypertensive medications compared with those without these medications.Conclusions These data suggest that diabetes management may have to be individualized according to the guideline recommendations rather than intensively attempting to lower HbA1c.

scholarly journals Association between Body Mass Index and Stroke Risk Among Patients with Type 2 Diabetes

2019 ◽  
Vol 105 (1) ◽  
pp. 96-105 ◽  
Author(s):  
Yun Shen ◽  
Lizheng Shi ◽  
Elizabeth Nauman ◽  
Peter T Katzmarzyk ◽  
Eboni G Price-Haywood ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Body Mass ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Reference Group ◽  
Research Network ◽  
Common Data Model ◽  
Inverse Association

Abstract Context Very few studies focused on the association between body mass index (BMI) and stroke risk among patients with diabetes. Objective We aimed to investigate the association between BMI and stroke risk in patients with type 2 diabetes. Design Demographic, anthropometric, laboratory, and medication information were extracted from the National Patient-Centered Clinical Research Network common data model. Participants We performed a retrospective cohort study of 67 086 patients with type 2 diabetes. Main Outcome Measures Incident stroke including both ischemic and hemorrhagic stroke were defined. Results During a mean follow up of 3.74 years. 8918 incident stroke events occurred. Multivariable-adjusted hazard ratios across different categories of BMI at baseline (18.5–24.9 [reference group], 25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40 kg/m2) were 1.00, 0.92, 0.85, 0.74, and 0.63 (Ptrend &lt;0.001) for total stroke; 1.00, 0.93, 0.88, 0.77, and 0.65 (Ptrend &lt;0.001) for ischemic stroke; and 1.00, 0.79, 0.50, 0.50, and 0.41 (Ptrend &lt;0.001) for hemorrhagic stroke, respectively. When we used an updated mean value of BMI, the graded inverse association of body mass index with stroke risk did not change. This linear association was consistent among patients of different subgroups. Further sensitivity analysis excluding patients who were diagnosed stroke within 6 months after first diagnosis of type 2 diabetes or including non-smokers only also confirmed our findings. Conclusion The present study found an inverse association between BMI and the risk of total, ischemic, and hemorrhagic stroke among patients with type 2 diabetes. More clinical and molecular insights are still needed in explaining these findings.

Abstract P224: Sex Differences in the Risk of Stroke and HbA1c among Diabetic Patients

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Gang Hu ◽  
Peter Katzmarzyk ◽  
Ronald Horswell ◽  
Yujie Wang ◽  
Jolene Johnson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Stroke Risk ◽  
Reference Group ◽  
Epidemiological Studies ◽  
Diabetic Patients ◽  
Hospital System ◽  
Incident Cases ◽  
Different Levels

Background: Epidemiological studies have reported that type 2 diabetes is an independent risk factor for stroke, but how much its effect varies by sex is uncertain. Aim: To better understand the relationship between glycemic control and stroke risk in men and women, we studied a large sample of patients with type 2 diabetes with long-term follow up. Methods: We prospectively investigated the sex-specific association of different levels of HbA1c with incident stroke risk among 10,876 male and 19,278 female diabetic patients within the Louisiana State University (LSU) Hospital System. Results: During a mean follow up of 6.7 years, 2,949 incident cases of stroke were identified. The multivariable-adjusted hazard ratios (HRs) of stroke associated with different levels of HbA1c at baseline (<6.0%, 6.0-6.9% [reference group], 7.0-7.9%, 8.0-8.9%, 9.0-9.9%, and ≥10.0%,) were 0.96 (95% confidence interval [CI] 0.80-1.14), 1.00, 1.04 (0.85-1.28), 1.11 (0.89-1.39), 1.10 (0.86-1.41), and 1.22 (0.92-1.35) (P trend =0.66) for males, and 1.03 (0.90-1.18), 1.00, 1.09 (0.94-1.26), 1.19 (1.00-1.42), 1.32 (1.09-1.59), and 1.42 (1.23-1.65) (P trend <0.001) for females, respectively. The graded association of HbA1c during follow-up with stroke risk was observed among female diabetic patients (P trend=0.066). When stratified by race, with glucose-lowering agents or not, this graded association of HbA1c with stroke was still present. When stratified by age, the adjusted HRs were significantly higher in women older than 55 years compared to younger women. Conclusions: The current study suggests a graded association between HbA1c and the risk of stroke among female patients with type 2 diabetes and poor control of blood sugar has a stronger effect in women older than 55 years.

Factors Associated with Poor Hemoglobin A1c Control in Patients with Type 2 Diabetes

2019 ◽  
Vol 15 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Salam Alqudah ◽  
Anan S. Jarab ◽  
Eman A. Alefishat ◽  
Fadia Mayyas ◽  
Maher Khdour ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Glycemic Control ◽  
Hemoglobin A1c ◽  
Diabetes Management ◽  
Blood Glucose Control ◽  
Clinical Pharmacy Service ◽  
Diabetes Clinic ◽  
Factors Associated

Background: The limited implementation of clinical pharmacy service programs and the lack of studies identifying barriers to achieve blood glucose control have all attributed to the increased proportion of type 2 diabetes patients who have poor glycemic control in Jordan. Objective: To explore factors associated with higher HbA1c in patients with type 2 diabetes in Jordan. Methods: Variables including socio-demographics, disease and treatment factors were collected from171 patients with type2 diabetes at an outpatient diabetes clinic in Amman. Validated questionnaires were used to assess medication adherence, self-care activities, diabetes knowledge and healthrelated quality of life in addition to data collected from medical records. After the single-predictor analysis, stepwise linear regression was performed to develop a model with variables that best predicted hemoglobin A1c. Results: Medication adherence was inversely associated with HbA1c values (β = -0.275; t = 2.666; P < 0.01), indicating better glycemic control. Receiving insulin therapy was also associated with less HbA1c values and better glycemic control (β = - 0.184; t = 2.080; P < 0.05). Patients who had one or more comorbid conditions (β = 0.215; t = 2.264; P < 0.05) and those with longer diabetes duration (β = 0.092; t = 1.339; P < 0.05) were found to have significantly higher HbA1c values. Conclusion: Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes.

scholarly journals Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study)

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Fahri Bayram ◽  
◽  
Alper Sonmez ◽  
Cem Haymana ◽  
Tevfik Sabuncu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Media Coverage ◽  
Ldl Cholesterol ◽  
Diabetes Management ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Target Attainment ◽  
Significant Independent Predictor ◽  
Cross Sectional

Abstract Background Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians’ attitudes on the treatment of diabetic dyslipidemia were also examined. Methods A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported. Results A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59–0.83). Conclusions Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.

239-OR: Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 239-OR
Author(s):  
YUN SHEN ◽  
LIZHENG SHI ◽  
ELIZABETH NAUMAN ◽  
PETER KATZMARZYK ◽  
EBONI G. PRICE-HAYWOOD ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Hemoglobin A1c ◽  
Stroke Risk

A Practice-Based Research Network Focused on Comparative Effectiveness Research in Type 2 Diabetes Management

2013 ◽  
Vol 125 (3) ◽  
pp. 172-179 ◽  
Author(s):  
John E. Anderson ◽  
Andrew S. Rhinehart ◽  
Timothy S. Reid ◽  
Robert M. Cuddihy ◽  
Aleksandra Vlajnic ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Diabetes Management ◽  
Research Network ◽  
Effectiveness Research ◽  
Practice Based Research

Frequency of Diabetes-Related Complications in Type 1 and Type 2 Diabetes—Results from the International Diabetes Management Practices Study (IDMPS)

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1584-P
Author(s):  
JUAN J. GAGLIARDINO ◽  
PABLO ASCHNER ◽  
HASAN M. ILKOVA ◽  
FERNANDO J. LAVALLE-GONZALEZ ◽  
AMBADY RAMACHANDRAN ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Management Practices ◽  
Diabetes Management

1311-P: Machine Learning (ML) Application to Predict Patient Risk of Nonadherence in Type 2 Diabetes Management Using U.S. Claims Databases

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1311-P
Author(s):  
XIN CHEN ◽  
GAIL FERNANDES ◽  
JIE CHEN ◽  
ZHIWEN LIU ◽  
RICHARD BAUMGARTNER
Keyword(s):  
Machine Learning ◽  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Patient Risk
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