Short-term societal economic burden of first-incident type 2 diabetes-related complications - a nationwide cohort study.

BACKGROUND: People with type 2 diabetes are at increased risk of developing diabetes-related complications and the augmented societal costs increase with the severity of complications. The objective was to estimate the short-term attributable societal costs of the first event of specific diabetes-related complications amongst people with type 2 diabetes. METHODS: The study was based on national registry data covering all patients with type 2 diabetes in Denmark. Attributable costs of each event were calculated as the difference between costs of patients with the specific event and costs incurred by their controls. Results were reported for the incidence year and the following two years. RESULTS: On average, 13,054 patients were identified annually from 2007 to 2013 with one or more of 17 specific first-incident diabetes-related complications. The attributable healthcare costs amounted to 114 million EUR annually in the incidence year alone. Costs were highest in the incidence year but were significantly higher also in the 2nd and 3rd year, driven particularly by increased indirect costs. CONCLUSIONS: Short-term excess costs of treating specific first-incident diabetes-related complications are massive for society. Our study highlights the importance of strengthening primary prevention within type 2 diabetes to minimize the risk of developing costly diabetes-related complications.

Projected diabetes prevalence and related costs in three North American urban centres (2015-2040).

OBJECTIVES: To explore the future implications of diabetes for urban centres, we projected the prevalence and cost of diabetes from 2015 to 2040 in three very different North American cities: Houston, Mexico City and Vancouver. STUDY DESIGN: We use a simple demographic transition model using existing sources to project future prevalence and financial burden of diabetes. METHODS: Based on data from each individual city, projections of the diabetes prevalence and financial burden were created through a three-stage transition model where the likelihood of moving across stages is based on incidence rates for age and gender groups. RESULTS: According to our projections from 2015 to 2040, diabetes prevalence will approximately double in Houston to 1,051,900 people and in Vancouver to 379,778 people and increase by >1 million to 3,080,013 people in Mexico City. Prevalence rates will increase from 8.5% to 11.7% in Houston, from 9.1% to 11.9% in Mexico City and from 7.2% to 11.3% in Vancouver. Associated costs will rise 1.9-fold to $11.5 billion (in US dollars) in Houston, 1.6-fold to $2.8 billion in Mexico City and 2.1-fold to $2.6 billion in Vancouver. CONCLUSIONS: Unless actions are taken to decrease its incidence, diabetes is expected to increasingly contribute to the societal and financial burden, particularly for urban areas. Resources and policy actions are needed immediately to promote healthy lifestyles and to implement secondary prevention of diabetes complications.

Study protocol for the Cities Changing Diabetes programme: a global mixed-methods approach.

INTRODUCTION: Urban living has been shown to affect health in various ways. As the world is becoming more urbanised and almost two-thirds of people with diabetes now live in cities, research into the relationship between urban living, health and diabetes is key to improving the lives of many. The majority of people with diabetes have type 2 diabetes, a subset linked to overweight and obesity, decreased physical activity and unhealthy diets. Diabetes has significant consequences for those living with the condition as well as their families, relationships and wider society. Although care and management are improving, complications remain common, and diabetes is among the leading causes of vision loss, amputation, neuropathy and renal and cardiovascular disease worldwide. We present a research protocol for exploring the drivers of type 2 diabetes and its complications in urban settings through the Cities Changing Diabetes (CCD) partnership programme. METHODS AND ANALYSIS: A global study protocol is implemented in eight collaborating CCD partner cities. In each city, academic institutions, municipal representatives and local stakeholders collaborate to set research priorities and plan implementation of findings. Local academic teams execute the study following the global study protocol presented here. A quantitative Rule of Halves analysis obtains measures of the magnitude of the diabetes burden, the diagnosis rates in each city and the outcomes of care. A qualitative Diabetes Vulnerability Assessment explores the urban context in vulnerability to type 2 diabetes and identifies social factors and cultural determinants relevant to health, well-being and diabetes. ETHICS AND DISSEMINATION: The protocol steers the collection of primary and secondary data across the study sites. Research ethics board approval has been sought and obtained in each site. Findings from each of the local studies as well as the result from combined multisite (global) analyses will be reported in a series of core scientific journal papers.

Individual and societal consequences of hypoglycemia: A cross-sectional survey.

BACKGROUND: Hypoglycemia and fear of hypoglycemia threaten individuals' ability to work and drive. We studied the effect of hypoglycemia on the individual and society, with a focus on possible implications of new European union legislation on patients' continued ability to drive. METHODS: A cross-sectional survey of Danish Diabetes Association members was conducted to investigate individual and societal consequences of hypoglycemia. RESULTS: A total of 3117/9951 individuals with type 1 diabetes (T1DM) (32.2%) or type 2 diabetes (T2DM) (67.8%) completed the survey. The calculated incidence rates of self-reported severe and mild hypoglycemia were 2.9, 0.6 and 0.1 events per patient year (ppy) in patients with T1DM, insulin using T2DM and non-insulin using T2DM, respectively; and incidence rates of self-reported mild hypoglycemia were 99.0, 23.2 and 10.9 events ppy, respectively. Self-care strategies to avoid hypoglycemia include maintaining higher blood glucose levels (45.7%) and reducing physical activity (15.7%). Few people take sick leave as a result of hypoglycemia, but prolonged mental recovery ≥4 h following an episode of mild or severe hypoglycemia was reported by 8.7 and 31.0%, respectively. 26.5% of patients holding a valid driving license reported having ever had at least one episode of severe hypoglycemia. Patients considering underreporting of hypoglycemia to maintain their driving license were more likely to have experienced severe hypoglycemia (odds ratio [OR]: 3.03; 95% CI: 2.42-3.79; p < 0.0001). CONCLUSION: A high proportion of insulin-treated patients experience hypoglycemia resulting in fear of hypoglycemia and changes in self-care behavior that may compromise glycemic control. Many patients with a history of severe hypoglycemia consider underreporting hypoglycemic events through concern over retaining their driving license.

Effects of vibration and resistance training on neuromuscular and hormonal measures.

The aim was to study whether whole body vibration (WBV) combined with conventional resistance training (CRT) induces a higher increase in neuromuscular and hormonal measures compared with CRT or WBV, respectively. Twenty-eight young men were randomized in three groups; squat only (S), combination of WBV and squat (S+V) and WBV only (V). S+V performed six sets with eight repetitions with corresponding eight repetition maximum (RM) loads on the vibrating platform, whereas S and V performed the same protocol without WBV and resistance, respectively. Maximal isometric voluntary contraction (MVC) with electromyography (EMG) measurements during leg press, counter movement jump (CMJ) measures (mechanical performance) including jump height, mean power (Pmean), peak power (Ppeak) and velocity at Ppeak (Vppeak) and acute hormonal responses to training sessions were measured before and after a 9-week training period. ANOVA showed no significant changes between the three groups after training in any neuromuscular variable measured [except Pmean, S higher than V (P<0.05)]. However, applying t tests within each group revealed that MVC increased in S and S+V after training (P<0.05). Jump height, Pmean and Ppeak increased only in S, concomitantly with increased Vppeak in all groups (P<0.05). Testosterone increased during training sessions in S and S+V (P<0.05). Growth hormone (GH) increased in all groups but S+V showed higher responses than S and V (P<0.05). Cortisol increased only in S+V (P<0.05). We conclude that combined WBV and CRT did not additionally increase MVC and mechanical performance compared with CRT alone. Furthermore, WBV alone did not increase MVC and mechanical performance in spite of increased GH.