Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study

Abstract

BackgroundUnderstanding the determinants associated with prediabetes and type 2 diabetes in coronary patients may help to individualize treatment and modelling interventions. We sought to identify sociodemographic, medical and psychosocial factors associated with normal blood glucose (HbA1c < 5.7%), prediabetes (HbA1c 5.7–6.4%), and type 2 diabetes.MethodsA cross-sectional explorative study applied regression analyses to investigate the factors associated with glycaemic status and control (HbA1c level) in 1083 patients with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records at the index event and from a self-report questionnaire and clinical examination with blood samples at 2–36 months follow-up.ResultsIn all, 23% had type 2 diabetes, 44% had prediabetes, and 33% had normal blood glucose at follow-up. In adjusted analyses, type 2 diabetes was associated with larger waist circumference (Odds Ratio 1.03 per 1.0 cm, p = 0.001), hypertension (Odds Ratio 2.7, p < 0.001), lower high-density lipoprotein cholesterol (Odds Ratio 0.3 per1.0 mmol/L, p = 0.002) and insomnia (Odds Ratio 2.0, p = 0.002). In adjusted analyses, prediabetes was associated with smoking (Odds Ratio 3.3, p = 0.001), hypertension (Odds Ratio 1.5, p = 0.03), and non-participation in cardiac rehabilitation (Odds Ratio 1.7, p = 0.003). In patients with type 2 diabetes, a higher HbA1c level was associated with ethnic minority background (standardized beta [β] 0.19, p = 0.005) and low drug adherence (β 0.17, p = 0.01). In patients with prediabetes or normal blood glucose, a higher HbA1c was associated with larger waist circumference (β 0.13, p < 0.001), smoking (β 0.18, p < 0.001), hypertension (β 0.08, p = 0.04), older age (β 0.16, p < 0.001), and non-participation in cardiac rehabilitation (β 0.11, p = 0.005).ConclusionsAlong with obesity and hypertension, insomnia and low drug adherence were the major modifiable factors associated with type 2 diabetes, whereas smoking and non-participation in cardiac rehabilitation were the factors associated with prediabetes. Further research on the effect of individual tailoring, addressing the reported significant predictors of failure, is needed to improve glycaemic control.Trial registrationRetrospectively registered at ClinicalTrials.gov: NCT02309255, December 5th 2014.

The Prevalence of Diabetes, Prediabetes and Associated Risk Factors in Hangzhou, Zhejiang Province: A Community-Based Cross-Sectional Study

“…Secondly, statistical methods matched to the study design were used to accurately derive factors associated with diabetes or prediabetes. Finally, the study reached conclusions about the relationship between smoking and prediabetes that are inconsistent with other studies, 45 , 46 and these may provide us with some ideas for future research. Nonetheless, there are several limitations in our study.…”

The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus

“…Sleep deprivation and sleep disorders contribute to pathophysiological changes associated with the development of T2DM, and, among diabetes, sleep deprivation contributes to elevations of HbA1c [85]. A recently published Norwegian study concluded that, along with obesity and hypertension, insomnia was the major modifiable factor associated with T2DM [86]. Aurora et al reported the bidirectional link between OSA and T2DM and concluded that early identification of obstructive sleep apnea in patients with metabolic dysfunction—including type 2 diabetes—and assessment for metabolic abnormalities in those with obstructive sleep apnea could reduce cardiovascular disease risk and improve the quality of life of patients [87].…”

Medication Adherence in Type 2 Diabetes Mellitus Patients With Coronary Heart Disease

“…MDAM and MTR-7 summary scores were significantly correlated with a p-value <0.001. The study by Munkhaugen, et al, (2018) had results with low Morisky scores (Score: >2 on the 8-item Morisky medication adherence questionnaire, indicating low adherence) of 9.6%, or 22 people out of 243 patients, for a p-value of 0.01.…”