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  • 1
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    Burden of Hospitalization in Young-Onset Type 2 Diabetes—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)
    Abstract: Objective: Young-onset type 2 diabetes (YOD, defined as age & lt;40 years) is associated with early β-cell failure and poor risk factor control. While YOD incidence is increasing rapidly, its disease burden is poorly understood, resulting in clinical inertia and poor treatment adherence. We examined the burden of hospitalization among Chinese adults with YOD. Methods: We conducted a prospective cohort study measuring all-cause hospitalization in YOD and usual-onset type 2 diabetes (T2D) among adults aged 20-75 years using the Hong Kong Diabetes Register (2000-2015, n=21,779). We estimated the impacts of YOD and risk factor control on hospitalization rate after T2D diagnosis using negative binomial regression. Results: YOD hospitalization had a bimodal distribution, with a disproportionate burden of mental illness & lt; age 40 years (35.9% of bed-days; Figure. 1). YOD was associated with a 3-fold increase in hospitalization rate vs. usual-onset T2D (adjusted rate ratio 2.8, 95% confidence interval 2.5-3.2). Intensified risk factor control (A1C & lt;6.2%, blood pressure & lt;120/75, LDL cholesterol & lt;2.0 mmol/L) was associated with a 39.5% reduction in cumulative hospital days. Conclusions: YOD is associated with substantial excess hospitalization across the adult lifespan. Urgent efforts are required to develop aggressive management strategies, and to address the unrecognized burden of mental illness in YOD. Disclosure C. Ke: None. E.S.H. Lau: None. A. Luk: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Sanofi. 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. A.P. Kong: Research Support; Self; AstraZeneca. E. Chow: Research Support; Self; Sanofi. P.M. Clarke: None. 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.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db18-1649-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2018
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  • 2
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    1001-P: HOMA2 IR and HOMA2 Beta on Onset and Progression of Diabetes in Young to Middle-Aged Subjects
    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)
    Abstract: Background: The roles of insulin deficiency (ID) and resistance (IR) in young patients with type 2 diabetes (T2D) are uncertain. We explored the associations of HOMA2 IR and HOMA2 %B using fasting C peptide and plasma glucose (FPG) with incident T2D and insulin use in Chinese aged 18-50 years. Methods: Cohort 1 included subjects without T2D in 1998-2002 with glycemic status ascertained in 2012-2013. Cohort 2 included patients with T2D (1995-2014) with documentation of glycemic deterioration (continuous insulin use or failure of 2 oral drugs). Results: In cohort 1, 62 subjects developed (T2D-progressors) and 285 did not develop T2D (T2D-non-progressors) during 10-year follow-up. In cohort 2 (n=737), 293 (39.8%) required insulin after a median follow-up period of 8.6 years. At baseline, T2D-non-progressors had lower HOMA2 IR [median (IQR) 0.77 (0.60, 1.06)] vs. 1.06 (0.81, 1.38)] and similar HOMA2 %B [84.3 (72, 111.5) vs. 85.1 (75.6, 100.7)] compared with T2D-progressors. Non-insulin-requiring T2D patients had lower HOMA2 IR [1.47 (1.02, 2.11) vs. 1.76 (1.19, 2.42)] and higher HOMA2 %B [62.4 (39.4, 87.4) vs. 45.4 (25.8, 71.8)] than insulin-requiring patients. When stratified by median values and using low HOMA2 %B plus low HOMA2 IR as referent, subjects with high HOMA2 %B plus high HOMA2 IR had age and sex-adjusted odds ratio (95% CI) of 2.47 (1.28, 4.93) and those with low HOMA2% B plus high HOMA2 IR had 5.27 (2.27, 12.84) of incident T2D. In the T2D cohort, using high HOMA2 %B plus low HOMA2 IR as referent, the hazard ratio (95% CI) for insulin use increased with low HOMA2 %B [2.18 (1.47, 3.23)] , high HOMA2 IR [2.45 (1.64, 3.64)] and low HOMA2 %B plus high HOMA2 IR [4.25 (2.82, 6.41)] adjusted for age, sex and disease duration. These associations were attenuated after adjusting for obesity, FPG, HbA1c and TG/HDL-C. Conclusions: In young to middle-aged Chinese, progressive worsening in IR and ID contribute to onset of T2D and insulin requirement, which can be attenuated by early control of metabolic factors. Disclosure B. Fan: None. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. R. C. Ma: Other Relationship; Self; AstraZeneca, Medtronic, Research Support; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Tricida, Inc. A. Luk: 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. H. Wu: None. M. Shi: None. A. Yang: None. C. H. Tam: None. E. S. H. Lau: None. D. Mao: None. C. K. P. Lim: Stock/Shareholder; Self; GemVCare Ltd. 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.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db21-1001-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
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  • 3
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    1186-P: The Effect of Age on the Risk Relationship between Prediabetes and Mortality and Major Adverse Clinical Events
    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)
    Abstract: Background: Prediabetes is associated with increased risk of cardiovascular disease (CVD) , kidney disease and death but the extent to which the risk associations between prediabetes and clinical events are modified by age is not known. Methods: We conducted a retrospective analysis of a territory-wide diabetes surveillance dataset from the Hong Kong Hospital Authority including 2,692,880 individuals with at least one glycaemic measurement between 2000 and 2019. Prediabetes was defined according to the American Diabetes Association criteria. Proportional Cox regression was used to derive hazard ratios (HR) and 95% CI of prediabetes vs. normoglycaemic for incident CVD, end-stage kidney disease (ESKD) , all-site infection and all-cause death, stratified by baseline age categories (20-39, 40-59, 60-79 and ≥80 years) . Results: Compared with people with normoglycaemia, people with prediabetes had greater hazards for clinical events in all age groups but the effect size attenuated with ascending age. In the youngest and in the oldest age categories, the respective HRs (95% CI) of prediabetes vs. normoglycaemia were 1.93 (1.71-2.17) and 1. (1.01-1.12) for CVD, 1.72 (1.42-2.08) and 1. (1.03-1.17) for ESKD, 1.48 (1.36-1.62) and 1. (1.00-1.08) for all-site infection, and, 1.52 (1.33-1.73) and 1. (1.04-1.10) for all-cause death. The associations remained after excluding people who later developed diabetes and after adjusting for metabolic factors. Conclusion: Prediabetes increases the risk of major clinical events and death independent of subsequent development of diabetes and metabolic factors. The risk relationships between prediabetes and clinical events are stronger in young than older people. Disclosure X.Zhang: 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.Luk: None. H.Wu: None. E.S.H.Lau: None. M.Shi: None. B.Fan: None. A.Yang: None. E.Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc., Speaker's Bureau; Novartis AG, Sanofi. 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. 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.
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-1186-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
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  • 4
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    984-P: Incidence of Cardiovascular Disease, Kidney Disease, and Death in Youth-Onset Type 2 Diabetes Before the Age of 20 Years: Eight-Year Follow-Up of Territory-Wide Surveillance in Hong Kong
    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)
    Abstract: Background: Few studies reported incidence rates of late-stage complications in people with youth-onset type 2 diabetes. We compared the clinical characteristics and incidence of cardiovascular disease (CVD) , end-stage kidney disease (ESKD) and death in a cohort of Chinese youth with type 2 and type 1 diabetes. Method: We performed a retrospective analysis of 1221 people with type 2 diabetes and 641 with type 1 diabetes diagnosed at age & lt;20 years who underwent metabolic and complication assessment in Hong Kong Hospital Authority between 2000-2019, followed for incident CVD, ESKD and all-cause death until 2019. Cox regression models were used to determine the hazards of complications in type 2 versus type 1 diabetes. Result: At baseline, people with youth-onset type 2 diabetes were older at diagnosis (16 [14-18] vs. [8-15] years, p & lt;0.01) but had similar diabetes duration (6 [2-15] vs. 6 [2-13] years, p=0.32) to those with type 1 diabetes. People with type 2 diabetes had higher frequency of obesity (71.3% vs. 14.6%) , hypertension (48.3% vs. 21.0%) , dyslipidemia (58.8% vs 24.1%) and albuminuria (29.8% vs. 11.2%) (p & lt;0.01) . Over a median follow-up of 6.7-7.8 years, incidence rates (per 1000 person-year [95% CI]) , were 5.3 (3.9-7.0) vs. 1.4 (0.6-2.9) for CVD, 8.1 (6.4-10.1) vs. 2.4 (1.3-4.2) for ESKD, and 6.9 (5.4-8.7) vs. 2.6 (1.4-4.4) for death in people with type 2 and type 1 diabetes, respectively (p & lt;0.01) . With reference to type 1 diabetes, the risks of CVD (HR [95% CI] 2.6 [1.1-6.2] ) and ESKD (HR 2.4 [1.2-4.5]) but not death (HR 1.6 [0.8-2.9] ) were higher in type 2 diabetes, adjusted for age at diagnosis, diabetes duration and sex. The increased hazard for ESKD but not CVD remained after further adjustment for smoking, glycaemic and metabolic control. Conclusion: People with youth-onset type 2 diabetes had 2-fold increased risk of CVD and ESKD, in part driven by greater burden of obesity and other metabolic risk factors in this group. Disclosure Y.Fan: None. E.S.H.Lau: None. H.Wu: None. A.Yang: None. E.Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc., Speaker's Bureau; Novartis AG, Sanofi. 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. R.C.Ma: Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc. 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. A.Luk: None.
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-984-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
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  • 5
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    1211-P: Associations of C-peptide, HOMA2, and GADA with Insulin Initiation and Risk of Hypoglycemia in 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)
    Abstract: Background: In patients with type 2 diabetes (T2D) and non-ketotic presentation, low C-peptide (CP) and positivity for glutamic acid decarboxylase antibodies (GADA+) indicate early insulin requirement. In GADA- patients, the associations of CP with insulin use, glycemic response and severe hypoglycemia event (SHE) are unknown. Methods: We measured fasting CP and GADA in 4590 Chinese patients with T2D enrolled in the Hong Kong Diabetes Register in 1995-2012 followed up till 2019. The updated homeostasis model assessment (HOMA2) was derived from fasting CP and plasma glucose. We defined incident insulin use as the first insulin prescription of at least 28 days, glycemic response as HbA1c reduction at one year after insulin initiation, and SHE using ICD-9 codes. Linear and Cox regression models were applied for association analyses. Results: At enrolment, 32% had low CP ( & lt;250 pmol/L) and 5% were GADA+. In the low CP group, 7% were GADA+. In the GADA+ group, 50% had low CP. During a mean follow-up of 10.8 years, 58.6% were started on insulin after a median of 6.5 years. The GADA+ group was more likely to initiate insulin [adjusted HR (95% CI) 1.55 (1.26-1.91) ] and experienced SHE [HR 1.45 (1.08-1.95) ] than the GADA- group. In the GADA- group, low CP had lower hazards of insulin use [HR 0.86 (0.77-0.97) ] than high CP especially in patients with HOMA2-IR (insulin resistance) above median. The low CP group had higher HR of 1.34 (1.13-1.59) of SHE than the high CP group. In the GADA+ group, low CP was associated with increased risk of SHE [HR 1.81 (1.25, 2.62) ] but not in patients with high CP (P interaction= 0.01) . Both CP and GADA did not predict glycemia response after controlling for baseline HbA1c. Conclusions: In patients with T2D, CP interacted with GADA to influence disease progressions including early insulin therapy and SHE. C-peptide might be correlated with IR in patients with GADA-. These subphenotypes allowed more precise classification of beta cell function to guide personalized treatment. Disclosure B.Fan: None. A.Luk: 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.S.H.Lau: None. H.Wu: None. M.Shi: None. A.Yang: None. C.K.P.Lim: 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. E.Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc., Speaker's Bureau; Novartis AG, Sanofi. R.C.Ma: Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc. Funding The HKG Health Medical and Research Fund and RGC Research Impact Fund
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-1211-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
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  • 6
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    1133-P: Monogenic Diabetes in Chinese with Young-Onset 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)
    Abstract: Background: The clinical course of monogenic diabetes in Chinese is not well established. We determined the prevalence of mutation and variants of uncertain significance (VUS) in a panel of monogenic diabetes genes in a prospective cohort of Chinese with young-onset diabetes, and examined clinical characteristics and outcome of the affected individuals. Methods: From patients enrolled in Hong Kong Diabetes Register between 1995-2012, DNA samples of 316 Chinese with non-type 1 diabetes diagnosed age & lt;40 years were sequenced. A targeted panel of 34 genes related to monogenic diabetes was designed with AmpliSeq (Illumina). Variants were interpreted based on American College of Medical Genetics and Genomics Standards and Guidelines. Incident complications including cardiovascular disease (CVD) and death were captured until 2019. Baseline characteristics and complications were compared between patients with and without pathogenic/ likely pathogenic variants or VUS. Results: 24 (7.6%) patients had pathogenic/likely pathogenic variants and 39 (12.3%) had VUS in one or more monogenic diabetes genes. At baseline, patients with pathogenic/likely pathogenic variants had lower HbA1c (6.9 ± 1.0 vs. 7.9 ± 2.1%, p=0.02) and urine ACR (0.74 [0.44 - 2.03] vs. 1.71 [0.68 - 9.90] mg/mmol, p=0.01), and lower frequency of hypertension (20.8 vs. 46.9%, p=0.02) than those without mutation. Patients with and without VUS were similar for all characteristics. Over a median follow-up of 15.3 years, 4.3% of patients with pathogenic/likely pathogenic variants vs. 14.7% without mutation developed CVD (p=0.22), and 2.3% vs. 9.2% died (p=0.49). For patients with and without VUS, the frequencies were 14.7% vs. 14.7% (p=1.00) for incident CVD and 5.1% vs. 9.9% (p=0.55) for death. Conclusion: One in five Chinese with young-onset diabetes had either mutation or VUS in monogenic diabetes genes. Patients with monogenic diabetes gene mutation had more favorable metabolic profile but did not differ in incident complication compared with those with no mutation. Disclosure S. Tsoi: None. C. K. P. Lim: Stock/Shareholder; Self; GemVCare Ltd. 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. S. H. Lau: None. B. Fan: None. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. 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. 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. A. Luk: None. Funding Research Grants Council of Hong Kong (14114918); Research Impact Fund (R4012-18)
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db21-1133-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
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  • 7
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    1406-P: Trends in All-Cause and Cause-Specific Mortality in Older Adults With and Without Diabetes—A Territory-Wide Analysis in One Million Older Adults 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)
    Abstract: Objective: Nationwide data on trends in mortality in older adults with and without diabetes in Asia are lacking. We described the recent trends of all-cause and cause-specific (pneumonia, cardiovascular [CV], and cancer) mortality in adults aged ≥65 years in Hong Kong in 2014-2018. Methods: We performed a territory-wide analysis in 1,152,418 elderlies who had at least one in- or out-patient attendance in the Hospital Authority. We used the Joinpoint regression to assess patterns of mortality rate. Results: In 2014-2018, 354,357 (31.7%) and 763,488 (68.3%) old adults with and without diabetes were included respectively. All-cause death rate has declined in older adults with (458.7 vs. 431.2 events/10,000 person-years, average annual percent change [AAPC]: -3.1% [95% CI -4.2%, -2.1%] ) and without (337.0 vs. 294.6 events/10,000 person-years, AAPC: -1.6% [-2.7, -0.4%]) diabetes. In 2018, compared with adults without diabetes, those with diabetes had higher all-cause mortality (1.4-fold), CV- (1.9-fold), and pneumonia-cause (1.3-fold) mortality. Pneumonia was the leading cause of death. CV death has declined significantly in old adults with with (AAPC: -5.5% [-6.8, -4.1%] ) and without (AAPC: -5.8% [-8.6, -2.9%]) diabetes. There were no declines in cancer death in older adults with (AAPC: -1.6% [-2.7, 0.4%] ) and without (AAPC: -1.6% [-2.7, 3.9%]) diabetes, while cancer death has surpassed CV death in old adults with diabetes. Cancer death has increased markedly in men with diabetes versus those without diabetes (AAPC: 2.9% [1.1, 4.6%] vs. 1.8% [-5.0, 1.4%]), particularly in the youngest-older adults (65-74 years) with diabetes. Conclusions: One in 3 elderlies had diabetes. Overall, cardiovascular-death had declined in these elderlies. Although elderly people with diabetes had a greater decline in all-cause death, they had substantially higher risk of cancer-death than those without diabetes, especially in younger men. Disclosure A.Yang: None. M.Shi: None. E.S.H.Lau: None. 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.
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-1406-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2023
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  • 8
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    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)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db21-1071-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
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  • 9
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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)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-1414-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2023
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  • 10
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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)
    Abstract: 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.)
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-1317-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2023
    detail.hit.zdb_id: 1501252-9
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