fitness 19 rates
Diabetes Care Journal publish ahead of print articles
Diabetes Care Journal publish ahead of print articles
- Heterogeneity of patients with LADA: linkage to autoimmunity is apparent only in those with perceived need for insulin treatment. Results from the Nord-Trondelag Health study (HUNT).
Aim:Subjects diagnosed as Latent Autoimmune Diabetes in the Adult (LADA) are more prone to need insulin treatment than type 2 diabetes (T2D). However, not all LADA patients develop need for insulin treatment, indicating heterogeneity of LADA. We investigated heterogeneity by comparing phenotypes of LADA with and without perceived need for insulin treatment (data obtained at times when diagnosis of LADA was not investigated) and also compared LADA and T2D phenotypes
Methods:We used data from the all-population-based Nord-Trøndelag Health Study (n=64931), performed 1995-97. Data were assembled for LADA (n= 106) and type 2 diabetes (n=943).
Results: Comparing LADA with and without insulin:Insulin-treated subjects had higher titres of anti-GAD (p<0.001) and lower fasting C-peptide (p<0.001). Anti-GAD and C-peptide correlated negatively (r=-0.40; p=0.009). Comparing LADA and T2D, both without insulin: Markers of metabolic syndrome were equally prevalent and pronounced. Also age, C-peptide and glucose levels were similar. Comparing insulin-treated LADA and insulin-treated T2D: More LADA patients received insulin (40% vs. 22%, p<0.001) and C-peptide levels were lower (p<0.001). LADA patients were leaner, but still overweight (mean BMI 28.7 vs. vs. 30.9 in T2D (p<0.001). Comparing T2D with and without insulin: Insulin treated subjects were more obese, had higher HbA1c and lower C-peptide (p<0.001).
Conclusions:1) Need for insulin treatment in LADA is linked to the degree of autoimmunity and beta cell failure. 2) LADA and T2D subjects without need for insulin treatment are phenotypically similar 3) Insulin treatment in T2D is associated with both insulin resistance and beta cell insufficiency.
- Incidence of Lower Limb Amputation in the Diabetic and Nondiabetic General Population: A 10-year Population-based Cohort Study of Initial Unilateral, Contralateral and Re-amputations
Objective:To compare the incidence of vascular lower limb amputation (LLA) in the diabetic and nondiabetic general population.
Research design & methods:A population-based cohort study was conducted in a representative Swedish region. All vascular LLA (at or proximal to transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation or re-amputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged 45 years or older.
Results:During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years (95% CI) was for diabetic women 192 (145–241) and for diabetic men 197 (152–244) and for nondiabetic women 22 (17–26) and for nondiabetic men 24 (19–29). The incidence increased from the age of 75 years. 74% of all amputations were transtibial. The incidence of contralateral amputation and of re-amputation per 100 amputee-years (95% CI) in diabetic women amputees was 15 (7–27) and 16 (8–28) and in diabetic men 18 (10–29) and 21 (12–32), respectively, and in nondiabetic women amputees were 14 (7–24) and 18 (10–28) and in men 13 (6–22) and 24 (15–35), respectively.
Conclusions:In the general population aged 45 years or older the incidence of vascular lower limb amputation at or proximal to transmetatarsal level is 8 times higher in diabetic than in nondiabetic persons. One in four amputees may require contralateral amputation and/or re-amputation.
- Leptin predicts diabetes but not CVD: results from a large prospective study in the elderly
Objective:To clarify the association of circulating levels of leptin with risk for CVD events and new onset diabetes in men and women.
Research Design and Methods:We related baseline leptin levels to CVD events (n=864) and incident diabetes (n=289) in the elderly (n=5672) over 3.2 years follow-up.
Results:In treatment, age, and country adjusted models, leptin was not associated with risk of CVD in men (HR 1.02 [95%CI 0.90–1.16] per unit log-leptin increase) or women (HR 1.05 [0.91–1.20]), but did associate with risk for diabetes in men (HR 2.75 [2.14–3.52]) and women (HR 1.54 [1.22–1.94]). After adjusting for classical risk factors, BMI, CRP and glucose, the diabetes association in men retained significance (HR 1.85 [1.30–2.63]), but not in women (HR 0.89 [0.64–1.26]).
Conclusions:Leptin, like other markers of adiposity in general, is more strongly related to risk of diabetes than CVD in the elderly.
- The effects of fenofibrate treatment on cardiovascular disease risk in 9795 people with type 2 diabetes and various components of the metabolic syndrome: the FIELD study
Objective:We explored whether cardiovascular disease (CVD) risk and the effects of fenofibrate differed in subjects with and without metabolic syndrome (MS) and according to various features of MS defined by ATP III in subjects with type 2 diabetes in the FIELD study.
Research design and methods:The prevalence of MS and its features were calculated. Cox proportional models adjusted for age, gender, CVD status and baseline HbA1c levels were used to determine the independent contributions of MS features to total CVD event rates and the effects of fenofibrate.
Results:Over 80% of FIELD participants met the ATPIII criteria for MS. Each ATPIII feature of MS, apart from increased waist circumference, increased the absolute risk of CVD events over 5 years by at least 3%. Those with marked dyslipidemia (elevated triglycerides ≥2.3 mmol/L and low HDLc) were at the highest risk of CVD (17.8% over 5 years). Fenofibrate significantly reduced CVD events in those with low HDLc or hypertension. The largest effect of fenofibrate to reduce CVD risk was observed in subjects with marked dyslipidaemia where a 27% relative risk reduction (95%CI 9-42, p=0.005; number needed to treat [NNT]=23) was observed. Subjects with no prior CVD had greater risk reductions than the entire group.
Conclusions:MS components identify higher CVD risk in people with type 2 diabetes, so the absolute benefits of fenofibrate is likely to be greater when MS features are present. The highest risk and greatest benefits of fenofibrate are seen among those with marked hypertriglyceridemia.
- All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study
ObjectiveTo determine the mortality rate after diabetes-related lower extremity amputation (LEA) in an African-descent Caribbean population.
Research design and methodsA prospective case-control study. We recruited cases (diabetes and LEA), and age-matched controls (diabetes no LEA) in 1999–2001. We followed these groups for five-years to assess mortality risk and causes.
ResultsThere were 205 amputations (123 minor, 82 major). One and five-year survival rates were 69% and 44% among cases, and 97% and 82% among controls (case-control difference, p<0.001). Mortality rates (per 1000 person years) were 273.9 (95% confidence interval 207.1 – 362.3) after a major amputation, 113.4 (85.2–150.9) after a minor amputation, and 36.4 (25.6–51.8) among controls. Sepsis and cardiac disease were the most common causes of death.
ConclusionsThese mortality rates are the highest reported worldwide. Interventions to limit sepsis and complications from cardiac disease offer a huge potential for improving post-LEA survival in this vulnerable group.
- Associations of Cardiorespiratory Fitness and Obesity on Risks of Impaired Fasting Glucose and Type 2 Diabetes in Men
ObjectiveTo examine the associations of cardiorespiratory fitness (hereafter fitness) and various obesity measures with risks of incident impaired fasting glucose (IFG) and type 2 diabetes.
Research design and methodsProspective cohort study of 14,006 men (7,795 for the analyses of IFG) free of an abnormal electrocardiogram, heart attack, stroke, cancer, and diabetes.
Results3,612 (39,610 man-years) and 477 (101,419 man-year