Risk factors in V‐shaped risk associations with all‐cause mortality in type 2 diabetes—The Hong Kong Diabetes Registry

So, Wing Yee; Yang, Xilin; Ma, Rong; Kong, Alice P.S.; Lam, Christopher Wai‐Kei; Ho, Chung Shun; Cockram, Clive S.; Ko, Gary T.C.; Chow, Chun‐Chung; Wong, Vivian; Tong, Peter C.Y.; Chan, Juliana C.N.

doi:10.1002/dmrr.792

Cited by 52 publications

(57 citation statements)

References 36 publications

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“…1). Following detailed assessments, and after the inclusion of three articles identified from manual searches, 21 articles were included in the quantitative analysis (21 studies and 24 unique cohorts; Table 1) [7,8,11,15,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Study characteristics and the NOS scores are provided in ESM Tables 1-3.…”

Section: Resultsmentioning

confidence: 99%

“…However, evidence on the association between obesity and mortality in patients with diabetes remains inconclusive with some studies reporting an inverse association between obesity (estimated using the conventional Electronic supplementary material The online version of this article (doi:10.1007/s00125-016-4162-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. measure of BMI) and mortality [4][5][6], some reporting U-shaped associations [7,8], some reporting linear positive associations [9,10], and some reporting no association [11].…”

Section: Introductionmentioning

confidence: 99%

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Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

et al. 2016

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Aims/hypothesis The relationship between BMI and mortality has been extensively investigated in the general population; however, it is less clear in people with type 2 diabetes. We aimed to assess the association of BMI with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Methods We searched electronic databases up to 1 March 2016 for prospective studies reporting associations for three or more BMI groups with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Study-specific associations between BMI and the most-adjusted RR were estimated using restricted cubic splines and a generalised least squares method before pooling study estimates with a multivariate random-effects meta-analysis. Results We included 21 studies including 24 cohorts, 414,587 participants, 61,889 all-cause and 4470 cardiovascular incident deaths; follow-up ranged from 2.7 to 15.9 years. There was a strong nonlinear relationship between BMI and all-cause mortality in both men and women, with the lowest estimated risk from 31-35 kg/m 2 and 28-31 kg/m 2 (p value for nonlinearity <0.001) respectively. The risk of mortality at higher BMI values increased significantly only in women, whilst lower values were associated with higher mortality in both sexes. Limited data for cardiovascular mortality were available, with a possible inverse linear association with BMI (higher risk for BMI <27 kg/m 2 ). Conclusions/interpretation In type 2 diabetes, BMI is nonlinearly associated with all-cause mortality with lowest risk in the overweight group in both men and women. Further research is needed to clarify the relationship with cardiovascular mortality and assess causality and sex differences.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

et al. 2016

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“…We have developed an HR curve method to examine full-range associations between risk factors and allcause death (14) and interrelationships of risk factors for the risk of coronary heart disease (CHD) (13). In this analysis, we used the same method to examine fullrange association between A1C, ACR, and ischemic stroke and to choose cutoff points if indicated and their interrelationship for ischemic stroke risk (13,14,17). Use of the selected cutoff points, A1C and ACR, was initially stratified into two levels.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, we have developed a hazard ratio (HR) curve method to examine full-range relationships between risk factors and outcomes (13,14). In this analysis, we hypothesize that hyperglycemia interacts with albuminuria, both being potent risk factors, to increase stroke risk in type 2 diabetes.…”

mentioning

confidence: 99%

“…In this analysis, we hypothesize that hyperglycemia interacts with albuminuria, both being potent risk factors, to increase stroke risk in type 2 diabetes. We tested this hypothesis by applying the HR curve (13,14) and biological interaction (8,9) to ascertain the optimal target of glycemia and its interaction with albuminuria on ischemic stroke risk. ment area of 1.2 million residents, in 1995.…”

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confidence: 99%

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Additive Interaction of Hyperglycemia and Albuminuria on Risk of Ischemic Stroke in Type 2 Diabetes

Yang

et al. 2008

Diabetes Care

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OBJECTIVE -The study aims to test whether biological interaction between hyperglycemia and albuminuria can explain the inconsistent findings from epidemiological studies and clinical trials about effects of hyperglycemia on stroke in type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 6,445 Hong Kong Chinese patients with type 2 diabetes and free of stroke at enrollment were followed up for a median of 5.37 years. Spline Cox proportional hazard regression was used to obtain hazard ratio curves, which were used to identify cutoff points of A1C and spot urinary albumin-to-creatinine ratio for increased ischemic stroke risk. The identified cutoff point of A1C was used to check biological interaction between A1C and albuminuria (micro-and macroalbuminuria). The biological interaction was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index.RESULTS -During the follow-up period, 4.45% (n ϭ 287) of patients developed ischemic stroke. A1C was associated with increased hazard ratios of ischemic stroke in a near-linear manner except for two points-6.2 and 8.0%-where the slope between these two points accelerated. For A1C values Ͻ6.2%, the presence of micro/macroalbuminuria did not confer additional risk, while significant biological interaction between A1C and micro/ macroalbuminuria for values Ն6.2% was observed (RERI 0.92, 95% CI 0.16 -1.68, and AP 0.40, 0.01-0.78).CONCLUSIONS -A1C Ն6.2% and micro/macroalbuminuria interact to markedly increase the ischemic stroke risk, which explains a large proportion of risk in patients with type 2 diabetes harboring both risk factors.

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Body mass index and mortality in patients with and without diabetes mellitus

Akirov

Shochat

Masri-Iraqi

et al. 2018

Diabetes Metabolism Res

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Risk factors in V‐shaped risk associations with all‐cause mortality in type 2 diabetes—The Hong Kong Diabetes Registry

Abstract: Background Body mass index (BMI) is associated with death in a V-shaped manner in general populations but it is unknown whether BMI or other risk factors also exhibit V-shaped relationships with death in type 2 diabetic patients.

Cited by 52 publications

References 36 publications

Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

Additive Interaction of Hyperglycemia and Albuminuria on Risk of Ischemic Stroke in Type 2 Diabetes

Body mass index and mortality in patients with and without diabetes mellitus

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