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  • CHOW, ELAINE  (22)
  • 1
    Online-Ressource
    Online-Ressource
    1071-P: Long-Term Renin-Angiotensin System Inhibitor Use and Risk of Pneumonia and Pneumonia-Related Death in Type 2 Diabetes
    American Diabetes Association ; 2021
    In:  Diabetes Vol. 70, No. Supplement_1 ( 2021-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 70, No. Supplement_1 ( 2021-06-01)
    Kurzfassung: Introduction: Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are renin angiotensin system inhibitors (RASi) which can reduce the proinflammatory-vasoconstricting activity of ACE/angiotensin II and enhance the anti-inflammatory-vasodilatory activity of ACE2/angiotensin 1-7. These drugs may be protective across a range of respiratory infections including bacterial and viral pneumonias. We examined long-term use of ACEi/ARBs on the risk of first pneumonia hospitalization and pneumonia-related death in Chinese patients with type 2 diabetes (T2D). Methods: Prospective analysis of 16,285 Chinese T2D patients with new RASi use observed between 2001 and 2019. Overlap weighting was performed to balance baseline characteristics. We used time-dependent Cox model to estimate the hazard ratio (HR) of outcomes while adjusting for the time-varying covariates. Results: There were 6,379 (39.2%) ACEi-users only, 4,065 (25.0%) ARBs-users and 5,841 (35.9%) non RASi-users. During a median observation of 7.6 years, 6.1% had first pneumonia hospitalization, 1.3% died during or within one month of pneumonia hospitalization and 17.6% died from other causes. No association was observed between RASi use and first pneumonia hospitalization. However, RASi-users had lower risk for pneumonia-related death (HR 0.51, 95% CI 0.35-0.76) than non-users [ACEi-users only: HR 0.53 (0.34-0.81); ARBs-users: HR 0.58 (0.32-1.04)]. We also noted reduced risk for all-cause death in RASi-users (HR 0.60, 95% CI 0.54-0.67) [ACEi-users only: HR 0.61 (0.54-0.69); ARBs-users: HR 0.67 (0.57-0.79)] . Conclusions: Long-term use of RASi was associated with reduced risk of pneumonia-related death and all-cause death, but not first pneumonia hospitalization, in Chinese patients with T2D. Relevance to other respiratory infections such as coronavirus-disease 2019 (COVID-19) merits further investigation. Disclosure M. Shi: None. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. A. Yang: None. E. S. H. Lau: None. H. Wu: None. B. Fan: None. A. P. Kong: Advisory Panel; Self; Lilly Diabetes, Speaker’s Bureau; Self; Abbott, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Lilly Diabetes, Sanofi, Stock/Shareholder; Self; Aptorum. A. Luk: None. R. C. Ma: Other Relationship; Self; AstraZeneca, Medtronic, Research Support; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Tricida, Inc. J. C. Chan: Consultant; Self; Bayer AG, Boehringer Ingelheim International GmbH, MSD Corporation, Sanofi, Other Relationship; Self; Asia Diabetes Foundation, GemVCare, Research Support; Self; Applied Therapeutics, AstraZeneca, Hua Medicine, Lilly Diabetes, Merck KGaA.
    Materialart: Online-Ressource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db21-1071-P
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2021
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 2
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    Online-Ressource
    18-OR: Discontinuation of Renin Angiotensin System Inhibitor and Cardiovascular-Renal Events in Advanced Diabetic Kidney Disease
    American Diabetes Association ; 2022
    In:  Diabetes Vol. 71, No. Supplement_1 ( 2022-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 71, No. Supplement_1 ( 2022-06-01)
    Kurzfassung: Introduction: Whether angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) should be discontinued in advanced diabetic kidney disease (DKD) remains controversial. We examined the association of discontinuation of ACEi/ARBs when estimated glomerular filtration rate (eGFR) reached & lt;30 ml/min/1.73m2 with risk of death, major adverse cardiovascular events (MACE) , and end-stage-kidney-disease (ESKD) defined as dialysis and/or eGFR & lt;15/ml/min/1.73m2 in Chinese patients with type 2 diabetes (T2D) . Methods: We performed a prospective analysis of a register including 11,323 patients stratified by continuation of ACEi/ARBs within 6 months of reaching eGFR & lt;30 ml/min/1.73m2 in 2002-2018 followed up until 2019. We used Cox model with time-dependent exposure and covariates to estimate the hazard ratio (HR) of outcomes in the overlap propensity score weighted cohort. Results: Of 11,323 ACEi/ARBs users with new-onset eGFR & lt;30 ml/min/1.73m2, 2,055 (18.5%) discontinued ACEi/ARBs within 6 months whereas 9,268 (81.5%) had continuation of ACEi/ARBs. During a mean follow-up of 4.3 years, 13.5% and 28.4% had incident MACE and ESKD respectively, and 36.2% died. Compared to ACEi/ARBs continuation, discontinuation of ACEi/ARBs was associated with higher risk of MACE (HR=1.26, 95% CI: 1.15-1.39) and ESKD (HR=1.26, 95% CI: 1.14-1.40) , and neutral risk of death (HR=0.96, 95% CI: 0.89-1.04) . Results were consistent when modeling ACEi/ARBs as a time-dependent exposure using a marginal structural model. Conclusions: Discontinuation of ACEi/ARBs was associated with increased risk of cardiovascular-renal events in support of their continued use in patients with advanced DKD. Disclosure M.Shi: None. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer AG, Boehringer Ingelheim International GmbH, Celltrion, Merck Sharp & Dohme Corp., Roche Diabetes Care, Viatris Inc., Research Support; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Hua Medicine, Servier Laboratories, Stock/Shareholder; GemVCare Ltd. E.Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc., Speaker's Bureau; Novartis AG, Sanofi. A.Yang: None. E.S.H.Lau: None. H.Wu: None. X.Zhang: None. B.Fan: None. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Other Relationship; AstraZeneca, Novo Nordisk, Research Support; Boehringer Ingelheim, Speaker's Bureau; AstraZeneca, Bayer, Eli Lilly and Company, Sanofi, Stock/Shareholder; Aptorum Group Limited. A.Luk: None. R.C.Ma: Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc.
    Materialart: Online-Ressource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-18-OR
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2022
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    Online-Ressource
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    1414-P: Stalling of Trends in Glycemic and Risk Factors Control in People with Type 2 Diabetes in Hong Kong in 2000–2019
    American Diabetes Association ; 2023
    In:  Diabetes Vol. 72, No. Supplement_1 ( 2023-06-20)
    Details
    In: Diabetes, American Diabetes Association, Vol. 72, No. Supplement_1 ( 2023-06-20)
    Kurzfassung: Background: We aimed to examine trends in diabetes control in Hong Kong between 2000 and 2019. Methods: We conducted a retrospective analysis of data from 360,202 people aged 20 years or older with type 2 diabetes who underwent a territory-wide Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) in primary and secondary settings in Hong Kong between 2000 and 2019. We examined trends in proportion of people with type 2 diabetes achieving target of glycemic control (hemoglobin A1c [HbA1c] & lt;7.0%), blood-pressure control (systolic/diastolic blood pressures [SBP/DBP] & lt;140/90 mm Hg), and lipid control (low-density lipoprotein cholesterol [LDL-C] & lt;130 mg/dl). Results: The proportion of people with type 2 diabetes who achieved HbA1c & lt;7.0% increased from 40.3% (95% CI: 35.6%, 50.0%) in 2000 to 55.2% (54.4%, 56.0%) in 2014 and then leveled off thereafter. After improvements in blood-pressure control from 2000 to 2014, the proportion of people in whom blood pressure was achieved to below 140/90 mm Hg declined from 71.0% (70.4%, 71.6%) in 2014 to 63.5% (62.8%, 64.2%) in 2019. From 2000 to 2019, the proportion of people with LDL-C & lt;130 mg/dl continued to increase from 32.6% (27.6%, 37.6%) to 59.9% (59.2%, 60.6%). The proportion of people in whom all three targets were simultaneously achieved increased from 9.5% (3.8%, 15.3%) in 2000 to 23.1% (22.1%, 24.1%) in 2014 and plateaued from 2014 to 2019. Conclusions: After major improvements from 2000 to 2014, glycemic control stalled and blood-pressure control declined in people with type 2 diabetes in Hong Kong, while there was a continued encouraging trend in lipid control. Disclosure H.Wu: None. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company. E.S.H.Lau: None. A.Yang: None. X.Zhang: None. B.Fan: None. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd.
    Materialart: Online-Ressource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-1414-P
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2023
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    1317-P: The Use of NT-proBNP for Risk Stratification of Incident Cardiorenal Complications in Type 2 Diabetes—The Hong Kong Diabetes Biobank
    American Diabetes Association ; 2023
    In:  Diabetes Vol. 72, No. Supplement_1 ( 2023-06-20)
    Details
    In: Diabetes, American Diabetes Association, Vol. 72, No. Supplement_1 ( 2023-06-20)
    Kurzfassung: NT-proBNP has emerged as a potential biomarker for cardiovascular complications. We examined the association between NT-proBNP with prevalent and incident diabetes complications, and compared it against prediction based on established risk equations. NT-proBNP was measured using an electrochemiluminescent immunoassay on a Roche cobas e411 analyzer in a subset of baseline samples from the Hong Kong Diabetes Biobank, a multi-centre prospective cohort of individuals with diabetes. All subjects underwent comprehensive assessment for diabetes complications, and were prospectively followed up. Among 1983 subjects with type 2 diabetes (60% male), mean age at recruitment was 61.1±11 years. At baseline, 24.7% of participants had NT-proBNP ≥125pg/ml. Those with NT-proBNP ≥125pg/ml had significantly higher SBP, lower eGFR, and a higher proportion had CHD, PVD and CHF at baseline (all p & lt;0.001). In multivariate logistic regression adjusting for baseline age, sex, DM duration, smoking, BMI, waist, SBP, DBP, HbA1c, lipid traits, lnACR, eGFR and use of DM medications, NT-proBNP was associated with CVD and CKD at baseline. During median follow-up of 5.2 (5.0-5.4) years, baseline NT-proBNP (≥125 vs & lt;125) was associated with increased risk of incident CVD with HR (95%CI) 2.34 (1.41, 3.89), CHF HR 2.60 (1.26, 5.37) and renal complications HR 1.88 (1.20, 2.96)(p & lt;0.01). The cut-off of 125pg/ml showed good performance in differentiating between those with or without incident complications with C-index (95%CI) 0.82 (0.74, 0.89) for CHD, 0.87 (0.80, 0.94) for hospitalization with CHF and 0.86 (0.82, 0.90) for ESRD. Incorporating NT-proBNP improved prediction of CHD, CHF or ESRD compared to using the JADE risk equations alone. Our study highlights the utility of NT-proBNP for risk stratification of cardio-renal complications in T2DM. Disclosure R.C.W.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. C.K.P.Lim: Stock/Shareholder; GemVCare Ltd. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. The hong kong diabetes biobank study group: n/a. C.H.Tam: None. Y.Hou: None. Q.Jin: None. E.S.H.Lau: None. R.Ozaki: None. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company. Funding Roche Diagnostics (Hong Kong) Limited (to R.C.W.M.); Hong Kong Diabetes Biobank (CUR4012-18); Research Grants Council; (T12-402/13N); Croucher Foundation (to R.C.W.M.)
    Materialart: Online-Ressource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-1317-P
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2023
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 5
    Online-Ressource
    Online-Ressource
    1106-P: Glycemic Burden and Obesity Independently Increased Risk of Liver Cancer in Type 2 Diabetes: Hong Kong Diabetes Register (1995-2019)
    American Diabetes Association ; 2021
    In:  Diabetes Vol. 70, No. Supplement_1 ( 2021-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 70, No. Supplement_1 ( 2021-06-01)
    Kurzfassung: The incidence of liver cancer and related mortality is increasing globally. Liver is a major site for glucose metabolism. People with type 2 diabetes (T2D) had increased risk of liver cancer. However, the association of glycemic burden (GB) with liver cancer in T2D remains unclear. We calculated GB using area under the curve above 5.7% of HbA1c (AUC_A1c) in patients with T2D enrolled in the prospective Hong Kong Diabetes Register established since 1995. Structured baseline data were linked to laboratory and hospitalization records in a territory-wide electronic medical record system with data censored in 2019. We performed Cox regression analysis to investigate the association of GB with incident liver cancer defined as first hospitalization with ICD9 code (155). We included 18,173 patients (50.93% male, age: 58.43±12.48 years, HbA1c: 7.58±1.66%, BMI: 25.51±4.06 kg/m2, disease duration: 20.68 ±7.63 years), who had ≥ 10 years of disease duration, & gt; 3 years of observation, and ≥ 5 HbA1c measurements (21.98±12.33). During a median (IQR) follow up period of 10.62 (8.09, 15.88) years (218,381patient-years), 160 patients developed liver cancer with an incidence of 7.33 per 10,000 patient-years. We excluded 3 years of HbA1c values prior to incident liver cancer to avoid reverse causality. After adjusting for confounders, every 1 unit increase in AUC_A1c increased the hazard ratio (HR) of liver cancer by 1.22 (95% CI: 1.01-1.47), while AUC_A1c top quantile group had a HR of 1.78 (1.01-3.13) versus the lowest quantile group. In subgroup analysis, obese patients (BMI & gt;25 kg/m2) had a HR of 1.34 (1.05-1.70) for liver cancer versus non-obese subjects. Amongst patients who developed liver cancer (n=1420) within 3 years of enrolment, one unit increase of AUC_A1c was associated with a HR of 1.49 (1.07-2.07) for liver cancer. GB and obesity independently increased the risk of liver cancer in T2D, emphasizing the importance of metabolic control for cancer risk reduction. Disclosure D. Mao: None. J. C. Chan: Consultant; Self; Bayer AG, Boehringer Ingelheim International GmbH, MSD Corporation, Sanofi, Other Relationship; Self; Asia Diabetes Foundation, GemVCare, Research Support; Self; Applied Therapeutics, AstraZeneca, Hua Medicine, Lilly Diabetes, Merck KGaA. E. S. H. Lau: None. A. Yang: None. H. Wu: None. M. Shi: None. A. P. Kong: Advisory Panel; Self; Lilly Diabetes, Speaker’s Bureau; Self; Abbott, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Lilly Diabetes, Sanofi, Stock/Shareholder; Self; Aptorum. R. C. Ma: Other Relationship; Self; AstraZeneca, Medtronic, Research Support; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Tricida, Inc. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. A. Luk: None.
    Materialart: Online-Ressource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db21-1106-P
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2021
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
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    Online-Ressource
    1208-P: Age-Specific Association between Risk Factors and All-Cause and Cause-Specific Mortality in People with Type 2 Diabetes
    American Diabetes Association ; 2022
    In:  Diabetes Vol. 71, No. Supplement_1 ( 2022-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 71, No. Supplement_1 ( 2022-06-01)
    Kurzfassung: Background: We aimed to examine age-specific association and population attributable fraction (PAF) of risk factors for all-cause and cause-specific mortality in people with type 2 diabetes. Methods: We used data from 360,202 people with type 2 diabetes who underwent metabolic assessment in 2000-20in Hong Kong. We included eight risk factors, including three baseline comorbidities: cardiovascular disease (CVD) , chronic kidney disease (CKD) and cancer; and five modifiable risk factors: suboptimal HbA1c (≥7.0%) , suboptimal blood pressure (SBP/DBP ≥140/90 mmHg) , suboptimal LDL-C (≥2.6 mmol/L) , smoking and suboptimal weight (BMI & lt;24.0 or ≥28.0 kg/m2) . We used Cox regression models to compare the hazard ratios and PAFs of the risk factors for mortality risk across age groups (18-54, 55-64, 65-74, and ≥75 years) . Findings: During a median 6.0 years of follow-up, 44,396 deaths were documented, with cancer, pneumonia, and CVD being the most common causes of death. When stratified by age group, the strength of the associations between most risk factors and all-cause and cause-specific mortality was strongest in the youngest age group and diminished with increasing age. The eight risk factors explained more population burden of mortality in the youngest (PAF: 51.6%) than the oldest (PAF: 35.3%) age group. In the youngest age group, the strongest population attributable risk factor for all-cause mortality was suboptimal control of blood pressure, followed by CKD. In the oldest age group, CKD and CVD were the largest contributors. CKD contributed most to mortality from CVD and pneumonia in the overall population, while cancer had the greatest PAF for cancer mortality across all age groups. Conclusions: The contribution of each risk factor to mortality in people with type 2 diabetes showed a different pattern across age groups. Age-stratified prevention strategies targeting the major risk factors may have the potential to reduce premature mortality. Disclosure H.Wu: None. A.Luk: None. E.S.H.Lau: None. A.Yang: None. X.Zhang: None. B.Fan: None. R.C.Ma: Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Other Relationship; AstraZeneca, Novo Nordisk, Research Support; Boehringer Ingelheim, Speaker's Bureau; AstraZeneca, Bayer, Eli Lilly and Company, Sanofi, Stock/Shareholder; Aptorum Group Limited. E.Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc., Speaker's Bureau; Novartis AG, Sanofi. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer AG, Boehringer Ingelheim International GmbH, Celltrion, Merck Sharp & Dohme Corp., Roche Diabetes Care, Viatris Inc., Research Support; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Hua Medicine, Servier Laboratories, Stock/Shareholder; GemVCare Ltd.
    Materialart: Online-Ressource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-1208-P
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2022
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
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    126-OR: Metformin Discontinuation and Clinical Outcomes in Patients with Diabetes and Advanced Chronic Kidney Disease—A Prospective Cohort Study
    American Diabetes Association ; 2023
    In:  Diabetes Vol. 72, No. Supplement_1 ( 2023-06-20)
    Details
    In: Diabetes, American Diabetes Association, Vol. 72, No. Supplement_1 ( 2023-06-20)
    Kurzfassung: Introduction: Metformin can now be used in patients with chronic kidney disease (CKD) up to estimated glomerular filtration rate [eGFR] ≥30 ml/min/1.73m2. However, surveys suggested its continuing use in some patients with eGFR & lt;30 ml/min/1.73m2 in real world practice although the risk-benefit ratios remain uncertain. Methods: This was a prospective, population-based cohort of 36,940 patients with diabetes in Hong Kong stratified by continuation of metformin within 6 months after reaching eGFR & lt;30 ml/min/1.73m2 in 2002-2018, followed up until 2019. We used Cox model with time-dependent exposure and covariates to estimate the hazard ratio (HR) of death, major-adverse cardiovascular events (MACE), and end-stage kidney disease (ESKD) in a propensity-score overlap-weighted cohort of continued versus discontinued-metformin users. Results: Of 36,940 metformin users with new-onset eGFR & lt;30 ml/min/1.73m2, 8400 (22.7%) discontinued metformin within 6 months whereas 28,540 (77.3%) continued with metformin. The median metformin daily dose was 1000 [interquartile range, IQR: 1000, 1000] mg in continued-metformin users. During a median follow-up of 3.5 (IQR:1.8-5.8) years, 15.3%, 16.6%, and 28.1% had incident MACE, heart failure, and ESKD respectively, and 41.5% died. Compared to continued-metformin use, discontinuation was associated with higher risk of MACE (weighted and adjusted HR=1.42, 95% CI: 1.31-1.54), heart failure (HR=1.70, 1.58-1.83), ESKD (HR=1.73, 1.63-1.83), and death (HR=1.24, 1.19-1.29). Results were consistent in patients with and without established cardiovascular diseases (CVD). Conclusions: Discontinuation of metformin was associated with increased risk of cardiovascular-renal events, regardless CVD status. Continuation of metformin below eGFR 30ml/min/1.73m2 may be associated with cardio-renal and mortality benefits that needs to be weighed against the risks of lactic acidosis. Disclosure A.Yang: None. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. M.Shi: None. H.Wu: None. E.S.H.Lau: None. J.T.K.Cheung: None. X.Zhang: None. B.Fan: None. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company. Funding Chinese University of Hong Kong
    Materialart: Online-Ressource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-126-OR
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2023
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
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    1473-P: A Data-Driven Cluster Analysis of Renal Complications in Patients with Type 2 Diabetes—From Phenotypic Observation to Genetic Discovery
    American Diabetes Association ; 2023
    In:  Diabetes Vol. 72, No. Supplement_1 ( 2023-06-20)
    Details
    In: Diabetes, American Diabetes Association, Vol. 72, No. Supplement_1 ( 2023-06-20)
    Kurzfassung: Diabetic kidney disease (DKD) has a strong genetic component. The marked phenotypic heterogeneity in type 2 diabetes (T2D) limits the power of cross-sectional genome-wide association studies (GWAS) on DKD. We performed a data-driven cluster analysis using the longitudinal electronic health records (EHR) of a prospective cohort to identify subgroups of patients with different patterns of progression of kidney functions. These included 29,416 Chinese patients with T2D recruited in 1995-2018 observed until 2019 (median [IQR] follow-up: 9 [5-12] years). We curated 211 variables including baseline data collected during structured assessment and follow-up EHR data. We applied generalized low rank models (GLRM) to resolve the inter-correlations among variables and reduce the high dimension of the raw dataset. We identified 6 clusters featured by distinct combinations of the 211 variables: 1) DKD-free characterized by stable estimated glomerular filtration rate (eGFR decline & lt;1 ml/min per 1.73 m2 per year) and absence of macroalbuminuria (19.4%); 2) eGFR decline without macroalbuminuria and good glycemic and BP control (26.0%); 3) eGFR decline with albuminuria and high BP (20.1%); 4) eGFR decline with albuminuria and poor glycemic control (14.2%); 5) rapid eGFR decline, albuminuria, high BP and low glucose burden (10.5%); and 6) rapid eGFR decline, macroalbuminuria, high BP and high glucose burden (9.8%). We performed cluster-wise GWAS in 12,358 patients with available genotype data. We found diverse patterns of genetic associations for the 6 DKD clusters reaching genome-wide significance (P GWAS & lt;5×10−8) for cluster 3 and 6. Polygenic risk scores (PRS) using top GWAS loci discriminated risk of end-stage kidney disease with AUC of 0.62 (PRS only) and 0.93 (PRS plus baseline clinical variables). Our novel cluster-GWAS using more precise phenotyping combining baseline and follow-up clinical variables had led to novel genetic discoveries. Disclosure M.Shi: None. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. C.H.Tam: None. E.S.H.Lau: None. A.Yang: None. H.Wu: None. B.Fan: None. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. Funding Research Grants Council of the Hong Kong Special Administrative Region (R4012-18); Theme-Based Research Scheme (T12–402/13N)
    Materialart: Online-Ressource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-1473-P
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2023
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
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    High Serum Branched-Chain Amino Acids Level Independently Predicts Incident Heart Failure—The Hong Kong Diabetes Register
    American Diabetes Association ; 2018
    In:  Diabetes Vol. 67, No. Supplement_1 ( 2018-07-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 67, No. Supplement_1 ( 2018-07-01)
    Kurzfassung: Background: Obesity predicts cardiovascular(CV)-renal disease. Contrary to claims that branched-chain amino acids (BCAA)-rich diet/supplements may improve weight and insulin resistance, recent data suggest impaired oxidation of BCAA (leucine, isoleucine and valine) may contribute to CV-renal disease. We examined the associations of serum BCAA, obesity and CV-renal events in a prospective Chinese T2D cohort (1994-2007). Method: We measured serum total BCAA in 579 and 566 patients (top and lowest BMI quintiles respectively) using the colorimetric ELISA kit. Patients were monitored for clinical outcomes with data censored on May 2015. We analysed the effect of serum BCAA on incident CV-renal events using multivariate Cox regression. Results: At baseline, obese group had shorter T2D duration, worse clinical profile and higher serum BCAA than lean group. After 11 years of follow-up, obese group had higher incidence of heart failure (HF), chronic kidney and any CV disease than the lean group. In all patients, every unit increase in Ln (BCAA) elevated the risk of incident HF by 64% (hazard ratio [HR] 1.64, 95% CI 1.01-2.66). Conclusions: Serum BCAA independently predicted incident HF in T2D population even after adjustment for obesity. The associations of this biomarker with dietary patterns and clinical outcomes will provide new insights regarding the health impacts of nutrition. Model 1Model 2EventHR (95% CI)P-valueEventHR (95% CI)P-valueAny CV disease181 (21.5%)1.37 (1.01-1.85)0.044167 (21.0%)1.26 (0.88-1.79)0.206Heart failure91 (9.4%)1.59 (1.06-2.39)0.02585 (9.3%)1.64 (1.01-2.66)0.045Coronary heart disease103 (11.4%)1.19 (0.78-1.81)0.42897 (11.4%)1.05 (0.65-1.71)0.836Stroke100 (10.2%)1.42 (0.96-2.10)0.08390 (9.8%)1.35 (0.86-2.10)0.191Chronic kidney disease401 (52.0%)1.15 (0.89-1.49)0.271379 (51.6%)0.89 (0.65-1.22)0.463Model 1: adjusted for age, sex, T2D duration Model 2: Model 1 + A1c, systolic BP, LDL-cholesterol, log(triglyceride), BMI top and lowest quintiles (0,1), log(ACR), baseline eGFR, use of insulin, RAS inhibitors, oral blood glucose/lipid lowering agents, smoking status Disclosure L. Lim: Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Sanofi-Aventis. E.S.H. Lau: None. A. Luk: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Sanofi. E. Chow: Research Support; Self; Sanofi. H. Lee: None. R.C. Ma: Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp., Pfizer Inc.. Advisory Panel; Self; Boehringer Ingelheim GmbH, Nippon Boehringer Ingelheim Co. Ltd. J.C. Chan: Consultant; Self; Bayer AG. Other Relationship; Self; Bayer AG. Consultant; Self; Sanofi. Other Relationship; Self; Sanofi, Eli Lilly and Company, Amgen Inc.. Consultant; Self; AstraZeneca, Merck & Co., Inc., Pfizer Inc.. Other Relationship; Self; Pfizer Inc.. Board Member; Self; Asia Diabetes Foundation. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; Merck Sharp & Dohme Corp.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novartis AG, Eli Lilly and Company. A.P. Kong: Research Support; Self; AstraZeneca.
    Materialart: Online-Ressource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db18-455-P
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2018
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
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    1251-P: Glycaemic Trajectory before Diabetes Diagnosis in People with Young-Onset and Usual-Onset Type 2 Diabetes—A Population-Based Retrospective Study in Hong Kong
    American Diabetes Association ; 2023
    In:  Diabetes Vol. 72, No. Supplement_1 ( 2023-06-20)
    Details
    In: Diabetes, American Diabetes Association, Vol. 72, No. Supplement_1 ( 2023-06-20)
    Kurzfassung: Objectives: To identify distinct glycaemic trajectories before diabetes diagnosis in people with young-onset ( & lt;40 years) and usual-onset type 2 diabetes (≥40 years). Methods: Adult patients with incident type 2 diabetes diagnosed between 2002 and 2019 who had at least three HbA1c measurements before diabetes diagnosis in Hong Kong Hospital Authority electronic medical record system were included in this study. Latent class trajectory modelling was applied to identify distinct HbA1c trajectories before diabetes diagnosis, adjusted for sex and age. The shape and number of trajectory classes (one to five) were selected based on a combination of Bayesian Inclusion Criteria, model adequacy and proportion of people in each trajectory class (no less than 2% required). Results: A total of 2,252 people with young-onset type 2 diabetes (age [mean ± SD]: 34.1 ± 4.9 years; 40.0% male) and 77,892 people with usual-onset type 2 diabetes (age [mean ± SD] : 64.9 ± 11.0 years; 51.4% male) were included in this analysis. The 2-class solution and 1-class solution were chosen as the most appropriate models for young-onset and usual-onset type 2 diabetes respectively. A stable-increase trajectory with HbA1c rising gradually before diabetes diagnosis was identified in 96% of people with young-onset type 2 diabetes, while the other 4% had an accelerated-increase trajectory with HbA1c increasing rapidly within one year before diagnosis. People with usual-onset type 2 diabetes had HbA1c value increasing gradually before diabetes diagnosis. Conclusion: Blood glucose climbed gradually at a steady rate before diabetes diagnosis in most people with type 2 diabetes, while a small proportion of people with young-onset type 2 diabetes showed a rapid deterioration within a short period before disease onset. Disclosure Y.Fan: None. H.Wu: None. E.S.H.Lau: None. A.Yang: None. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Speaker's Bureau; Abbott, AstraZeneca, Lilly, Bayer Inc., Boehringer Ingelheim Inc. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd. A.Luk: Research Support; Novo Nordisk, Boehringer-Ingelheim, Bayer Inc., Speaker's Bureau; Eli Lilly and Company.
    Materialart: Online-Ressource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-1251-P
    Sprache: Englisch
    Verlag: American Diabetes Association
    Publikationsdatum: 2023
    ZDB Id: 1501252-9
    Standort Signatur Einschränkungen Verfügbarkeit
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