作者: Zhu, Qiuli ; Yao, Ye ; Lin, Ruilang ; Li, Guochen ; Tang, Jianguo ; Liu, Yahang ; Huang, Yifang ; Yu, Yongfu ; Peng, Yuwei ; Pan, Lulu ; Huang, Chen

OBJECTIVESDiabetes was associated with increased serum urate levels and a higher risk of dementia. However, current evidence regarding the association between serum urate and dementia is controversial.The research gap on how to effectively control urate levels in the population with diabetes still remains. We aim to examine the association of diabetes status and serum urate with dementia incidence, and the differences in this association among participants with different diabetes statuses.METHODSA total of 321,896 participants was recruited from the UK Biobank and followed up until 2022. Diabetes status was classified into diabetes, prediabetes and normoglycaemia according to the American Diabetes Association 2023 guideline. Serum urate levels were stratified using gender-specific quartiles of concentrations. All-cause dementia, Alzheimer's disease and vascular dementia were ascertained using the International Classification of Diseases-10th revision (ICD-10). Cox proportional hazards regression models were used to examine the association between serum urate, diabetes status, and dementia incidence.RESULTSOf the 321,896 participants (mean age, 57 years old; 43.5% males), 7,087 (2.20%) individuals were diagnosed with dementia during the follow-up period. Diabetes was associated with a 70% 58%, and 134% increased risk for all-cause dementia, Alzheimer's disease, and vascular dementia respectively. Elevated serum urate levels were associated with a lower risk of all-cause and cause-specific dementia regardless of the status of diabetes. Each standard deviation increase in urate concentration was related to a 11% reduced risk for all-cause dementia (HR, 0.89; 95% CI, 0.86 to 0.91), 7% for Alzheimer's disease (HR, 0.93; 95% CI, 0.88 to 0.98), and 12% for vascular dementia (HR, 0.88; 95% CI, 0.81 to 0.95).CONCLUSIONAppropriately higher urate levels within the threshold of hyperuricemia can reduce the adverse health effects of excessively high urate levels and better protect the cognitive health of people with varying diabetes status.

2024-11-01·Diabetes Research and Clinical Practice

Analysis of the global burden of CKD-T2DM in young and middle-aged adults in 204 countries and territories from 2000 to 2019: A systematic study of the global burden of disease in 2019

Article

作者: Li, Lin ; Cui, Huanxi ; Liu, Beiyan ; Zhao, Qingbin ; Chen, Sufang

BACKGROUNDDiabetes stands as a principal risk factor for severe complications including renal and cardiovascular diseases. The gradual rise in type 2 diabetes cases globally, coupled with a trend towards younger demographics, has led to an escalating prevalence of chronic kidney disease. However, its etiology is multifaceted, necessitating individualized treatment and refinement, particularly crucial in screening and managing the burden of CKD-T2DM. A comprehensive analysis of CKD-T2DM burden at global, regional, and national levels from 2000 to 2019, based on the latest data, can inform screening, early diagnostics, and treatment strategies, thereby optimizing healthcare resource allocation.METHODSUtilizing data sourced from the Global Burden of Disease (GBD) database, we delineated the incidence, mortality, and DALYs rates of CKD-T2DM from 2000 to 2019 across global, regional, and national scales. We summarized the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized death rate (ASDR) of CKD-T2DM globally, regionally, and nationally, presenting them visually. Moreover, we calculated and visually depicted the estimated annual percentage change (EAPC) of various CKD-T2DM indicators at these levels. Additionally, CKD-T2DM patients were stratified by age to compare the age distribution of patient deaths and the age burden between 2000 and 2019.FINDINGSThe disease burden of CKD-T2DM among young and middle-aged individuals globally has shown a sustained increase from 2000 to 2019. Incidence, mortality, and DALYs rates have exhibited an overall upward trend, with males showing higher rates compared to females. Significant disparities exist among different countries and regions, with India, China, and Mexico emerging as the countries with the highest number of new cases. Nicaragua, Mexico, and the United Arab Emirates have the highest age-standardized incidence rates, whereas Uganda, Ethiopia, and Burundi have the lowest. At the age level, the burden of CKD-T2DM exhibits varying trends among different age groups but generally shows an upward trajectory, particularly in the 45-49 age bracket. High systolic blood pressure and high BMI stand as the primary contributing factors to mortality and DALYs, with variations in their influence observed across different regions and levels of development.INTERPRETATIONver the past 20 years, the burden of CKD-T2DM among young and middle-aged individuals globally has continued to increase, with disparities existing among different countries, regions, and age groups, but overall showing an upward trend. The reasons for this trend are multifaceted, including global lifestyle changes such as dietary shifts, sedentary lifestyles, obesity, as well as population aging and inadequate preventive measures in certain regions. Addressing these challenges necessitates optimizing screening methods, adjusting lifestyles, enhancing management strategies, improving medical care and awareness levels, particularly intensifying awareness and screening efforts among males, reinforcing prevention and control measures for the 45-49 age group, enhancing infrastructure and healthcare resources in developing countries, fostering international collaboration, and implementing context-specific measures.

2024-10-18·BMJ open

Treatments, medical expenses and complications of hospital outpatient healthcare associated with stroke in patients with diabetes in China: a retrospective analysis of the Beijing Municipal Medical Insurance Database.

Article

作者: Luo, Ying ; Zeng, Yi ; Wang, Weihao ; Zhang, Zhen ; Liang, SiTing ; Wang, Hanming ; Qiao, JingTao ; Guo, Lixin ; Fan, Jingwen ; Zeng, JiaDong

OBJECTIVESDiabetes is closely associated with risk of stroke and its adverse sequelae. Approximately 20%-33% of patients with stroke have diabetes. In China, however, it is unclear how stroke affects healthcare utilisation, medications and complications among people with diabetes. This study aimed to analyse the clinical characteristics, treatment options, medical expenses and complications of hospital outpatient healthcare associated with stroke in patients with diabetes in China.DESIGNA retrospective, multicentre, observational study.SETTINGBeijing Municipal Medical Insurance Database, with data from 2016 to 2018.PARTICIPANTSThe study included patients with diabetes whose data included 2016-2018 outpatient medication records and who had Beijing medical insurance. Patients who did not have continuous prescription records for more than 2 months were excluded from the analysis. In total, 2 853 036 people with diabetes were included, and patients who had and did not have a stroke were compared.RESULTSIn our study, 19.75%-22.30% of patients with diabetes suffered from stroke between 2016 and 2018. The average annual medical cost for a patient diagnosed with diabetes is ¥9606.65, and the cost increases to ¥13 428.39 when diabetes was combined with stroke; thus, stroke increases the medical cost for patients with diabetes by 39.78% (p<0.0001). Among patients with diabetes who had a stroke, 4.76 medications were used (1.8 hypoglycaemic drugs and 2.97 non-hypoglycaemic drugs); these numbers were significantly greater than for patients with diabetes who did not have a stroke receiving both hypoglycaemic drugs and non-hypoglycaemic drugs (p<0.0001). Among patients with diabetes who did not have a stroke, 3.58 medications were used (1.66 hypoglycaemic drugs and 1.92 non-hypoglycaemic drugs). Patients with diabetes who had a stroke also had significantly greater incidences of diabetic peripheral neuropathy, diabetic kidney disease, diabetic retinopathy and diabetic angiopathy than those who did not have a stroke (p<0.0001). These drugs and costs increased with the number of complications (p<0.0001). The increased medical costs for each specific complication are also listed. We also analysed the medical costs and medication regimens stratified by sex, age group and complications.CONCLUSIONSStroke is associated with a significant increase in complications and medications for patients with diabetes and greatly adds to the economic burden of these patients. Early identification of stroke risk factors in patients with diabetes, as well as targeted poststroke diabetes management, is crucial from a socioeconomic perspective for a comprehensive management and treatment of stroke in patients with diabetes.

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