The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

Lee, Ji Hyun; Han, Kyungdo; Huh, Ji Hye

doi:10.1186/s12933-020-01021-8

Cited by 29 publications

(17 citation statements)

References 31 publications

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“…Our data indicate a primary role of diabetes and hypertension in the development of disability in a frail cohort of older adults. Furthermore, consistent with previous investigations [64,65], in our population we observed a robust impact of age (p < 0.001) and admission glycemia (p < 0.001), strongly suggesting that glycemic control is a goal to achieve for avoiding adverse outcomes in this class of patients. Indeed, hyperglycemia worsens a delicate balance in patients with multimorbidity such as frail elders [66][67][68].…”

Section: Discussionsupporting

confidence: 92%

Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults

Mone

Gambardella

Lombardi

et al. 2022

Cardiovasc Diabetol

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Background Diabetes and hypertension are common in older adults and represent established risk factors for frailty. Frailty is a multidimensional condition due to reserve loss and susceptibility to stressors with a high risk of death, hospitalizations, functional and cognitive impairment. Comorbidities such as diabetes and hypertension play a key role in increasing the risk of mortality, hospitalization, and disability. Moreover, frail patients with diabetes and hypertension are known to have an increased risk of cognitive and physical impairment. Nevertheless, no study assessed the correlation between physical and cognitive impairment in frail older adults with diabetes and hypertension. Methods We evaluated consecutive frail older patients with diabetes and hypertension who presented at ASL (local health unit of the Italian Ministry of Health) Avellino, Italy, from March 2021 to October 2021. The inclusion criteria were: a previous diagnosis of diabetes and hypertension with no evidence of secondary causes; age > 65 years; a frailty status; Montreal Cognitive Assessment (MoCA) score < 26. Results 179 patients successfully completed the study. We found a strong and significant correlation between MoCA score and 5-m gait speed test (r: 0.877; p < 0.001). To further verify our results, we performed a linear multivariate analysis adjusting for potential confounding factors, with MoCA score as dependent variable, which confirmed the significant association with glycemia (p < 0.001). Conclusions This is the first study showing a significant correlation between 5-m gait speed test and MoCA score in frail diabetic and hypertensive older adults.

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Section: Discussionsupporting

confidence: 92%

Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults

Mone

Gambardella

Lombardi

et al. 2022

Cardiovasc Diabetol

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“…Our study showed a J-shaped association between FBG and the risk of MI. There are several studies showing the J-shaped relationship between FBG and CVD or mortality, independent of diabetes status [33,34]. A Chinese population-based prospective cohort study demonstrated that this association was evident in participants including untreated diabetes [34].…”

Section: Discussionmentioning

confidence: 99%

Predicting the Development of Myocardial Infarction in Middle-Aged Adults with Type 2 Diabetes: A Risk Model Generated from a Nationwide Population-Based Cohort Study in Korea

Lee¹,

Kim²,

Cho³

et al. 2020

Endocrinol Metab

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Background: Most of the widely used prediction models for cardiovascular disease are known to overestimate the risk of this disease in Asians. We aimed to generate a risk model for predicting myocardial infarction (MI) in middle-aged Korean subjects with type 2 diabetes. Methods: A total of 1,272,992 subjects with type 2 diabetes aged 40 to 64 who received health examinations from 2009 to 2012 were recruited from the Korean National Health Insurance database. Seventy percent of the subjects (n=891,095) were sampled to develop the risk prediction model, and the remaining 30% (n=381,897) were used for internal validation. A Cox proportional hazards regression model and Cox coefficients were used to derive a risk scoring system. Twelve risk variables were selected, and a risk nomogram was created to estimate the 5-year risk of MI. Results: During 7.1 years of follow-up, 24,809 cases of MI (1.9%) were observed. Age, sex, smoking status, regular exercise, body mass index, chronic kidney disease, duration of diabetes, number of anti-diabetic medications, fasting blood glucose, systolic blood pressure, total cholesterol, and atrial fibrillation were significant risk factors for the development of MI and were incorporated into the risk model. The concordance index for MI prediction was 0.682 (95% confidence interval [CI], 0.678 to 0.686) in the development cohort and 0.669 (95% CI, 0.663 to 0.675) in the validation cohort. Conclusion: A novel risk engine was generated for predicting the development of MI among middle-aged Korean adults with type 2 diabetes. This model may provide useful information for identifying high-risk patients and improving quality of care.

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“…While the association between MI or stroke with FBG levels was J-shaped, it did not show statistical significance, especially after adjustment for hypertension and dyslipidemia. An increased risk of cardiovascular events has been reported in older patients with diabetes and particularly high comorbidities among those with low FBG levels (<95 mg/dL) [ 18 ]. In the general Korean population, the HR of all-cause mortality was significantly higher in the low (<70 mg/dL) and high FBG ranges (≥126 mg/dL) than in the reference range (80 to 99 mg/dL) [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Frequency of Exposure to Impaired Fasting Glucose and Risk of Mortality and Cardiovascular Outcomes

et al. 2021

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Background: Metabolic abnormalities, such as impaired fasting glucose (IFG), are dynamic phenomena; however, it is unclear whether the timing of IFG exposure and cumulative exposure to IFG are related to cardiovascular disease (CVD) and mortality risk. Methods: Data were extracted from a nationwide population-based cohort in South Korea for adults (n=2,206,679) who were free of diabetes and had 4 years of consecutive health examination data. Fasting blood glucose levels of 100 to 125 mg/dL were defined as IFG, and the number of IFG diagnoses for each adult in the 4-year period was tabulated as the IFG exposure score (range, 0 to 4). Adults with persistent IFG for the 4-year period received a score of 4. Results:The median follow-up was 8.2 years. There were 24,820 deaths, 13,502 cases of stroke, and 13,057 cases of myocardial infarction (MI). IFG exposure scores of 1, 2, 3, and 4 were associated with all-cause mortality (multivariable-adjusted hazard ratio [

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The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

Cited by 29 publications

References 31 publications

Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults

Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults

Predicting the Development of Myocardial Infarction in Middle-Aged Adults with Type 2 Diabetes: A Risk Model Generated from a Nationwide Population-Based Cohort Study in Korea

Frequency of Exposure to Impaired Fasting Glucose and Risk of Mortality and Cardiovascular Outcomes

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