Threshold dose-response association between smoking pack-years and the risk of gallbladder cancer: A nationwide cohort study.

BACKGROUND AND AIMS: The association between smoking and gallbladder cancer (GBC) risk is unclear. We investigated the association between smoking (including pack-years) and GBC risk. We also examined the combined effects of smoking and diabetes or prediabetes on GBC risk. METHODS: This Korean nationwide cohort study included 9,520,629 adults without cancer who underwent national health screening in 2009 and were followed-up until 2018. Multivariable Cox proportional hazards models were used to determine risk estimates after adjusting for potential confounders. RESULTS: During 78.4 million person-years (mean 8.2 ± 0.9 years) of follow-up, we identified 6066 patients with newly diagnosed GBC. Current and former smokers were associated with increased GBC risk (hazard ratio [HR], 95% confidence interval [CI]: 1.117, 1.029-1.212 and 1.105, 1.016-1.202, respectively). Smoking of 20 to <30 and ≥30 pack-years was independently associated with increased GBC risk compared with never smoking (HR, 95% CI; 1.241, 1.100-1.400 and 1.231, 1.107-1.370, respectively). However, smoking of <10 and 10 to <20 pack-years was not. This threshold dose-response association between smoking pack-years and GBC risk was observed regardless of the glycaemic status (all P < 0.01). Furthermore, smoking of ≥20 pack-years and hyperglycaemia had a synergistic effect on the GBC risk (all P < 0.01). Smokers with ≥20 pack-years with diabetes had the highest risk of GBC compared to never smokers with normoglycaemia (HR, 1.658; 95% CI, 1.437-1.914). CONCLUSIONS: Smoking was associated with increased GBC risk with a threshold dose-response effect for smoking pack-years. The risk of GBC increases synergistically when smoking and hyperglycaemia coexist. More individualised cancer prevention education is required to reduce GBC risk.

Clinical significance of prediabetes, undiagnosed diabetes and diagnosed diabetes on critical outcomes in COVID-19: Integrative analysis from the Japan COVID-19 task force.

AIM: Diabetes mellitus (DM) is a known risk factor for severe coronavirus disease 2019 (COVID-19), but the clinical impact of undiagnosed diabetes and prediabetes in COVID-19 are unclear particularly in Japan. We clarify the difference in clinical characteristics, including age, sex, body mass index and co-morbidities, laboratory findings and critical outcomes, in a large Japanese COVID-19 cohort without diabetes, with prediabetes, undiagnosed diabetes and diagnosed diabetes, and to identify associated risk factors. MATERIALS AND METHODS: This multicentre, retrospective cohort study used the Japan COVID-19 Task Force database, which included data on 2430 hospitalized COVID-19 patients from over 70 hospitals from February 2020 to October 2021. The prevalence of prediabetes, undiagnosed diabetes and diagnosed diabetes were estimated based on HbA1c levels or a clinical diabetes history. Critical outcomes were defined as the use of high-flow oxygen, invasive positive-pressure ventilation or extracorporeal membrane oxygenation, or death during hospitalization. RESULTS: Prediabetes, undiagnosed diabetes and diagnosed diabetes were observed in 40.9%, 10.0% and 23.0%, respectively. Similar to diagnosed diabetes, prediabetes and undiagnosed diabetes were risk factors for critical COVID-19 outcomes (adjusted odds ratio [aOR] [95% CI]: 2.13 [1.31-3.48] and 4.00 [2.19-7.28], respectively). HbA1c was associated with COVID-19 severity in prediabetes patients (aOR [95% CI]: 11.2 [3.49-36.3]), but not other groups. CONCLUSIONS: We documented the clinical characteristics and outcomes of Japanese COVID-19 patients according to HbA1c levels or diabetes co-morbidity. As well as undiagnosed and diagnosed diabetes, physicians should be aware of prediabetes related to COVID-19 severity.

Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study.

BACKGROUND: Globally, the incidence of diabetes is increasing and strategies to reach a comprehensive approach of care are needed, including education in self-management. This is particularly true in low and middle-income countries where the number of people living with diabetes is higher than in the high-income ones. This article describes the development of a structured patient education program for Brazilians living with diabetes or prediabetes. METHODS: These steps were undertaken: 1) a 4-phase needs assessment (literature search of local diabetes guidelines, environmental scan, evaluation of information needs of patients identified by diabetes experts, and patient focus groups); and, 2) the translation and cultural adaptation of the patient guide (preparation, translation, back-translation, back-translation review, harmonization, and proofreading). RESULTS: Four of the seven guidelines identified include educational aspects of diabetes management. No structured education program was reported from the environmental scan. Regarding the information needs, 15 diabetes experts identified their patients' needs, who referred that they have high information needs for topics related to their health condition. Finally, results from six patient focus groups were clustered into six themes (self-management, physical activity, eating habits, diabetes medication, psychosocial being, and sleep), all embedded into the new education program. Constructive theory, adult learning principles, and the Health Action Process Approach model were used in program development and will be used in delivery. The developed program consists of 18 educational sessions strategically mapped and sequenced to support the program learning outcomes and a patient guide with 17 chapters organized into five sections, matched with weekly lectures. CONCLUSIONS: This program is a sequential and theoretical strategic intervention that can reach programs in Brazil to support diabetes and prediabetes patient education.

Combined Use of Job Stress Models and the Incidence of Glycemic Alterations (Prediabetes and Diabetes): Results from ELSA-Brasil Study.

Evidence of psychosocial stress at work as a risk factor for diabetes and prediabetes is restricted. OBJECTIVES: Analyze the independent and combined association of the models, demand-control and social support (DC-SS) and the effort-reward imbalance and overcommitment (ERI-OC), and the incidence of glycemic alterations (prediabetes and diabetes). METHODS: A prospective study was carried out with data from 7503 active workers from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study in the period 2008-2014. Work stress was measured by two stress models. Glycemic levels were evaluated by glycated hemoglobin (HbA1c) in two moments and classified in four groups: normal, maintenance of prediabetes, incident prediabetes, and incident diabetes. Multinomial logistic regression was analyzed with 5% significance levels stratified by sex, and multiplicative interactions were investigated. RESULTS: Work stress and glycemic alterations were more frequent in women. Psychosocial stress at work was shown to be associated to the risk of prediabetes and diabetes only among women. For women, the combination of models enlarged the magnitude of the association: prediabetes (DC-ERI = OR 1.51, 95% CI 1.15-1.99) and diabetes (DC-ERI = OR 2.10, 95% CI 1.20-3.65). Highly-educated women exposed to ERI-OC were four times more likely to have diabetes. CONCLUSION: Both models may contribute to explaining the psychosocial stress load according to each pattern of glycemic alteration among women.

Matrix metalloproteinase-8 analysis in patients with periodontal disease with prediabetes or type 2 diabetes mellitus: A systematic review.

OBJECTIVES: The objective of this systematic review was to evaluate information on the levels of MMP-8 in patients diagnosed with prediabetes or type 2 diabetes mellitus with periodontal disease, analyzing its validity as a possible biomarker for the diagnosis and progression of periodontal disease (PD). METHODS: A systematic search of the following databases was performed: PubMed/Medline, CENTRAL (The Cochrane Library), EMBASE and Web of Science. Studies involving the evaluation of MMP-8 in patients with prediabetes or patients presenting type 2 diabetes mellitus concomitantly with PD were selected. The evaluation of the methodological quality of the selected studies was based on the methodological bias risk analysis (QUADAS-2). RESULTS: Eight of the initially identified 2683 articles were selected. In all the selected studies, evaluator calibration and the use of clear methods for patient diagnosis with periodontal disease were present. Studies have demonstrated significantly higher MMP-8 concentrations in PD patients compared to controls, as well as in patients presenting more advanced stages of PD. However, controversies regarding MMP-8 levels in prediabetes/diabetes type 2 patients with PD. CONCLUSIONS: Higher MMP-8 levels in patients with PD compared to controls imply the potential use of MMP-8 in the diagnosis of PD. The influence of patient glycemic state, as well as medications these patients make use of, are factors that possibly contribute to the modulation of MMP-8 concentrations in patients with diabetes and should be analyzed, aiming at a better understanding of the relationship between glycemic state and MMP-8 levels in patients with PD.

Correlation between the uncertainty in illnessand social support in elderly patients with prediabetes / 中华老年医学杂志

Objective To investigate the level of uncertainty of illness and social support state in patients with prediabetes,and to discuss the correlation between the two.Methods 243 cases with prediabetes were analyzed by Uncertainty in Illness Scale and Social Support Rating Scale.Results There was a middle uncertainty in the elderly patients with prediabetes.The objective support,sabjective support,social support utilization degree and social support score were negatively related to the complexity of uncertainty(r--0.419,-0.433,-0.390 and-0.421,respectively,all P＜ 0.05).Conclusions Medical staff should evaluate the uncertainty in illness in elderly patients with prediabetes and conduct nursing intervention accordingly,in order to reduce the uncertainty,increase social support,and ultimately improve the quality of life.

Effects of various health management on pre-diabetics / 中华健康管理学杂志

ObjectiveTo explore the effects of different health management on adults with prediabetes.MethodsA total of 1182 pre-diabetics were enrolled in this prospective observation study and assigned to one-by-one interview group,in situ education group,communicative interview group and control group.Three intervention groups received life style intervention ( including health education and risk factor control) for 2 years.Analysis ofvariance,x2 test or q test were used for data analysis.ResultsAfteryear intervention,fasting plasma glucose (FPG)and 2 h plasma glucose of the intervention groups were significantly decreased ( P ＜ 0.05 ).FPG of the one-by-one interview group and the in situ education group was significantly lower than that of the communicative interview group at 6 months ( P ＜ 0.05 ). At 24months,FPG of the one-by-one interview group was lower than that of the in situ education group (P ＜0.05).The percentage of participants who showed appropriate blood glucose control was increased in the intervention groups. In addition,blood pressure,triglyceride,cholesterol,creatinine and body weight of those in the intervened groups were significantly improved compared with the control group ( all P ＜ 0.05 ),although electrocardiogram results and arteriosclerosisshowed nosignificant changes(P ＞ 0.05 ).Conclusion Health management may contribute to life style change and hypertension control of prediabetics.Furthermore,in situ education may be the most effective life style interventions.

Evidence-based management and treatment of high-risk individuals with pre-diabetes

The prevalence of type 2 diabetes (T2DM) has increased dramatically during the last decade, especially in Asian population. The control of hyperglycemia is very important for diabetes patients. Prevention of T2DM should be a major public health goal because of its substantial effect on heath. Treatment of high-risk individuals with impaired fasting glucose and impaired glucose tolerance to prevent T2DM has important medical, economic, social, and human implications. Identifying risk factors affecting transition diabetes is thus very important. Having defined a patient population at high-risk for developing diabetes, the intensive intervention of diet, physical activity, lifestyle modification, and drug therapy (metformin) can substantially affect the delay and prevention of T2DM. Tight glucose control has the potential to reduce the incidence and prevalence of T2DM.

The changes in early phase insulin secretion in newly diagnosed, drug naive korean prediabetes subjects.

BACKGROUND: There have been no systematic observations regarding changes in early phase insulin secretion among Korean prediabetes and early stage type 2 diabetes mellitus (T2DM) patients. METHODS: We conducted 75-g oral glucose tolerance tests (OGTT) in 873 subjects with suspected abnormal glucose tolerance. All subjects were diagnosed as having normal glucose tolerance (NGT), prediabetes (preDM), or T2DM according to the OGTT results and the insulin secretory and insulin resistance indices of each subject were calculated. Additionally, we analyzed the changes in early phase insulin secretion according to changes in fasting (Glc(0)), post-prandial (Glc(120)) glucose and HbA1c (A1c) levels. RESULTS: As compared to subjects with NGT, the insulin secretory indices of the preDM and T2DM subjects progressively declined, and the insulin resistance indices were progressively aggravated. Early phase insulin secretion decreased rapidly according to the increments of Glc(0), Glc(120) and A1c, and these changes were most prominent in the NGT stage. Compared to the control group, the early phase insulin secretion levels of the preDM or T2DM subjects were less than 50% when Glc(0) was over 100 mg/dL, Glc(120) was over 145 mg/dL, and A1c was over 5.8%. CONCLUSION: This study suggests that progressive beta cell dysfunction in Koreans may be initiated and rapidly aggravated during the period generally designated as 'normal.'

Epidemiological study on present situation and influencing factors for abnormal glycometabolism in elderly Han population in Urumqi / 中华老年医学杂志

Objective To investigate the prevalence and distribution of pre-diabetes and diabetes mellitus in Han population aged over 60 years in Urumqi. Methods The physical examination and 75 g oral glucose tolerance test (OGTT) were performed in 2210 people, including 1231 elderly people aged over 60 years (old age group) and 951 people aged 40-59 years (middle age group). The diagnosis of diabetes mellitus was established according to WHO criteria in 1999. Results In Han ethnic people, the prevalence rates of diabetes mellitus and pre-diabetes were 32.2% and 29.0% respectively in old age group, and were significantly higher than in middle age group ( 12.3% and 20.9%,x2= 192.62, P＜0.05). The prevalence rates of impaired glucose tolerance (IGT) were higher in old age group than in middle age people (21.6% vs. 13.9%, x2 = 20.97, P＜0.05), but there was no significant difference in the prevalence rate of impaired fasting glucose (IFG) between the two groups. The prevalence rate of metabolism syndrome (MS) was higher in old age group than in middle age group (52.2% vs. 33.7%, x2 =73.77, P＜0.05). The multivariable analysis showed that hypertriglyceridemia, hypertension, family history of diabetes mellitus were risk factors for development of diabetes mellitus in elderly Han population (x2 =44.34, P＜0.05). Conclusions The prevalence rates of diabetes and pre-diabetes are considerably high in the current state. It should be strengthened to prevent and treat diabetes mellitus and pre-diabetes in Urumqi Han population,especially in residents aged over 60 years.

Results of different interventions applied to 118 cases with impaired fasting glucose for 3 years / 中华内分泌代谢杂志

The results of different interventions administered in 118 cases with impaired fasting glucose (IFG) for 3 years were investigated. The rates of transformation of IFG to diabetes mellitus in metformin treatment groups and rosiglitazone treatment groups were significantly lower than that in life style intervention group. This study suggested that metformin or rosiglitazone treatment could effectively reduce transformation of IFG to diabetes as compared with life style intervention.

The Changes in Early Phase Insulin Secretion in Newly Diagnosed, Drug Naive Korean Prediabetes Subjects / 당뇨병

BACKGROUND: There have been no systematic observations regarding changes in early phase insulin secretion among Korean prediabetes and early stage type 2 diabetes mellitus (T2DM) patients. METHODS: We conducted 75-g oral glucose tolerance tests (OGTT) in 873 subjects with suspected abnormal glucose tolerance. All subjects were diagnosed as having normal glucose tolerance (NGT), prediabetes (preDM), or T2DM according to the OGTT results and the insulin secretory and insulin resistance indices of each subject were calculated. Additionally, we analyzed the changes in early phase insulin secretion according to changes in fasting (Glc(0)), post-prandial (Glc(120)) glucose and HbA1c (A1c) levels. RESULTS: As compared to subjects with NGT, the insulin secretory indices of the preDM and T2DM subjects progressively declined, and the insulin resistance indices were progressively aggravated. Early phase insulin secretion decreased rapidly according to the increments of Glc(0), Glc(120) and A1c, and these changes were most prominent in the NGT stage. Compared to the control group, the early phase insulin secretion levels of the preDM or T2DM subjects were less than 50% when Glc(0) was over 100 mg/dL, Glc(120) was over 145 mg/dL, and A1c was over 5.8%. CONCLUSION: This study suggests that progressive beta cell dysfunction in Koreans may be initiated and rapidly aggravated during the period generally designated as 'normal.'