New data from a team of investigators in Taiwan is underlining the importance of physical activity and exercise for long-term survival in patients with type 2 diabetes.

Presented at the European Association for the Study of Diabetes (EASD) 2020 Annual Meeting, the analysis of more than 4500 patients over a 15-year period suggests greater levels of exercise was linked to a 25-32% reduction in risk of all-cause mortality among patients with type 2 diabetes.

"Among people with type 2 diabetes, those with increased exercise capacity had a significantly decreased risk of all-cause mortality. Further studies should investigate the type and dose of exercise that is most helpful to promote health and prolong life expectancy,” wrote study investigators.

While many studies have examined the effects of exercise in diabetics, investigators noted few had examined associations between exercise capacity and all-cause mortality. To provide further information on this subject, investigators from the Taichung Veterans General Hospital in Taiwan designed their study as an analysis of data from the National Health Interview Survey (NHIS) and the National Health Insurance research databases.

As part of NHIS, patients underwent standardized face-to-face interviews in 2001, 2005, 2009, and 2013. Through a search of the National Health Insurance research database from 2000-2016, investigators were able to confirm comorbidities for each patient and, from the National Registration of Death, investigators were able to ascertain instances of mortality.

Investigators identified a total of 4859 adult participants with type 2 diabetes for their study. Of these, 49.15% (n=2389) were men and the cohort had a mean age of 59.5 (12.63) years. Using Kaplan-Meier curves, of all-cause mortality stratified by exercise capacity, investigators unveiled significant findings. In univariate Cox regression analysis, investigators found those with higher exercise capacity had a significantly decreased risk of all-cause mortality compared to those with no exercise habits (moderate exercise with 0-800 kcal/week HR, 0.83; 95% CI, 0.71-0.97, high exercise with more than 800 kcal/week HR, 0.77; 95% CI, 0.67-0.89).

After adjustment for potential confounders, a multivariate Cox regression analysis indicated those with a higher exercise capacity was associated with a significantly decreased risk of all-cause mortality compared to those with no exercise habits (moderate exercise with 0-800 kcal/week: HR, 0.75, 95% CI: 0.62-0.91, high exercise with more than 800 kcal/week: HR, 0.68, 95% CI, 0.57-0.81). Additionally, investigators noted a significant trend (

In a sensitivity analysis excluding mortality in the first and second year in the study period, results suggest those with increased exercise capacity had a significantly decreased risk of all-cause mortality.

Association between exercise capacity and all-cause mortality in people with type 2 diabetes

Articles

A study presented at EASD 2020 examines the impact of increased exercise capacity on risk of all-cause mortality among more than 4k patients with type 2 diabetes.

Study Finds Increased Exercise Lowers Mortality Risk 25-32% Among Diabetics

New research from an Australian aging study suggests a first-line diabetes treatment could also be slowing cognitive decline in older patients.

The study, which was conducted over a 6-year period, suggests those taking metformin experienced a slower cognitive decline and lower rates of dementia than those who did not use metformin.

"This study has provided promising initial evidence that metformin may protect against cognitive decline,” said study investigator Katherine Samaras, MBBS, PhD, Leader of the Healthy Ageing Research Theme at the Garvan Institute and endocrinologist at St Vincent's Hospital Sydney, 

. “While type 2 diabetes is thought to increase dementia risk by promoting degenerative pathways in the brain and nerves, these pathways also occur in others at risk of dementia and it is possible insulin resistance may be the mediator.”

 at a greater risk for a slew of other conditions and comorbidities, including dementia and cognitive decline, investigators sought to determine whether use of metformin would reduce the incidence of dementia and cognitive decline over an extended period of time. Part of the Sydney Memory and Ageing Study, the current study was designed as a prospective observational study of 1037 community-dwelling participants aged 70-90 without dementia at baseline.

Of note, patients were excluded from the study if they had dementia, a major neurological or psychiatric disease, or progressive malignancy. For the purpose of analysis, neuropsychological testing measuring cognitive function were performed every 2 years. Additionally, participants underwent a slew of tests designed to assess executive function, memory, attention-speed, language, and visuospatial function as individual components to determine global function. For the purpose of the study, investigators determined incident dementia through a multidisciplinary panel.

Investigators were also able to obtain total brain, hippocampal, and parahippocampal volumes through MRI measurements at baseline and 2 years for 526 patients. For the purpose of analysis, investigators used linear mixed models to examine potential associations between metformin use and cognitive decline. Investigators noted these models were adjusted for age, sex, education, BMI, heart disease, hypertension, stroke, smoking, and apolipoprotein Ee4 carriage.

Upon analysis, investigators identified 123 patients in the cohort of 1037 that were classified as having diabetes. Of these, 67 reported metformin use—investigators pointed out those receiving metformin were demographically similar to those who were not receiving metformin and those without diabetes. Results of the analysis suggest diabetics using metformin had significantly slower global cognition and executive function decline compared to diabetes not receiving metformin. Additionally, incident dementia was significantly higher in those with diabetes not receiving metformin compared to those with diabetes receiving metformin (OR, 5.29; 95% CI, 1.17-23.88; 

"While an observational study does not provide conclusive 'proof' that metformin is protective against dementia, it does encourage us to study this and other anti-diabetic treatments for dementia prevention,” said lead investigator Perminder Sachdev, MD, PhD, co-director of the Centre for Health Brain Aging at UNSW Sydney, in the aforementioned statement.

Metformin Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes: The Sydney Memory and Ageing Study

Analysis of information from more than 1000 patients in Australia sheds light on the potential association between metformin use and slower cognitive decline in older individuals.

Metformin Could Slow Cognitive Decline, Reduce Dementia Incidence in Diabetics

While most studies related to coronavirus disease 2019 (COVID-19) and diabetes focused on increased risk of mortality, new data suggest stay-at-home orders and spending time in lockdown may have improved diabetes management for those with 

European Association for the Study of Diabetes (EASD) 2020 Annual Meeting

, results of the Italian study indicate patients with type 1 diabetes who stopped working achieved greater glycemic control during the lockdown than they had before the lockdown began.

“Despite the psychological stress and very limited opportunities for exercise, the study found that glucose control was significantly improved in patients with T1D who stayed at home during the first week of the COVID-19-induced lockdown in Italy. This observation suggests that slowing down routine activities can have beneficial effects on T1D control in the short term,” wrote investigators.

With the COVID-19 pandemic presenting clinicians and patients with a slew of new hurdles in disease management, a team from University Hospital of Padova wanted to develop a greater understanding of how changes as a result of the pandemic impacted glycemic control. With this in mind, they designed their study to as a retrospective analysis of patients with type 1 diabetes using a flash glucose monitoring device.

For inclusion in the study, patients had to meet the following criteria: attend the diabetes clinic at the University Hospital of Padova, live in the nearby area, use the FreeStyle Libre FGM system for at least 3 months, share sensor data with the outpatient clinic, and have greater than 90% coverage of sensor data. From the sensor data, investigators hoped to obtain data related to average glucose, standard deviation, and percentage time in hypoglycemia, glucose range, and hyperglycemia.

For the purpose of analysis, hypoglycemia was defined as less than 70 mg/dl, glucose range was defined as 70-180 mg/dl, and hyperglycemia was defined as greater than 180 mg/dl. In total, 33 individuals were identified for inclusion, of which 20 had stopped working and were included in the final analysis. In comparison, those who stopped working were more likely to be younger, male, and have a greater length of diabetes duration.

Upon analysis, investigators found the average glucose declined from 177±45 mg/dl during the week before the lockdown to 160±40 mg/dl during the lockdown (

=.005). Additionally, results indicated time in range increased from 54.5% before the lockdown to 65.2% during the lockdown while time in hyperglycemia decreased from 42.3% before the lockdown to 31.6% during the lockdown (

Investigators also pointed out none of the measurements of glycemic control changed during the lockdown for the 13 patients who continued working during the lockdown. While investigators were unable to determine the exact reasons for glycemic control, but suggested it may have something to do with increased concern over disease management in the face of the pandemic.

"In addition, the knowledge that diabetes worsens the outcomes of COVID-19 may have improved patients' awareness and compliance to diabetes management,” wrote investigators.

Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy

,” was presented at EASD 2020 and published in 

Data from a group of type 1 diabetics from a diabetes center in Italy suggests time off work and in lockdown could have been helped some patients improve glycemic control.  

COVID-19 Lockdown May Have Improved Glycemic Control for Some Diabetics

New research from the University of Manchester offers an updated overview of the reduction in life expectancy associated with type 1 and type 2 diabetes compared against the general population.

European Association for the Study of Diabetes (EASD) 2020

 annual meeting, results of the study suggest the average person with type 1 diabetes will live nearly 8 years less and those with type 2 diabetes will live almost 2 years less than their counterparts in the general population.

"Knowledge of this may act as an incentive for clinicians to ensure that all people are on the best therapy to keep their blood sugar in the target range, and for those people to engage more strongly with their therapy and lifestyle recommendations,” noted study authors.

With many previous analyses of lost life years relying on older data, a team led by Adrian Heald, MD, sought to quantify the average reduction in life expectancy associated with type 1 and type diabetes, respectively, among patients using more recent data. With this in mind, investigators identified the UK National Diabetes Audit (NDA) and the Office for National Statistics (ONS) as data sources for their analysis.

Using the ONS, investigators performed a search of data from 2015-2017 and extracted actual mortality rates and projected life expectancy of the general population for each age year and sex. Through a search of the UK NDA from 2015-2016, investigators obtained information related to mortality rates for people with type 1 diabetes and type 2 diabetes in 5 different age groups and each sex as a ratio to the general population.

In total, investigators obtained data from more than 6000 general practices providing care to 41.3 million patients. Of these 41.3 million, 217k had type 1 diabetes and 2.5 million had type 2 diabetes.

Upon analysis, investigators found the average person with type 1 diabetes was 42.8 years of age and had a life expectancy from now of 32.6 years. In comparison, people the same age without diabetes were expected to live 40.2 years from now. For type 2 diabetes, the average patient was 65.4 years old and had a life expectancy from now of 18.6 years. In comparison, patients the same age without diabetes were expected to live 20.3 years from now.

Results of the investigators’ analysis also suggested each year with an HbA1c greater than 58 mmol/mol equated to a loss of around 100 life days for both type 1 and type 2 diabetes. Additionally, investigators noted their hope that further research into associations of glycemic control with mortality could improve care and management efforts.

“Linking poor glycemic control to expected mortality in such a quantitative way may incentivize clinicians and people with diabetes and poor blood sugar control to increase their efforts to achieve targets,” investigators added. Communication of life years lost from now to patients at the time of consultation with healthcare professionals and through messages publicized by advocacy groups such as Diabetes UK and other national/international patient facing organizations will be of great help in terms of dissemination of the conclusions of this study.”

Estimating life years lost to diabetes: outcomes from analysis of National Diabetes Audit and Office of National Statistics data

Cardiovascular Endocrinology and Metabolism.

Research presented at EASD 2020 provides an updated estimate of the life years lost as a result of type 1 and type 2 diabetes, respectively, among patients in the UK.

Study Estimates Average Life Years Lost from Type 1, Type 2 Diabetes

Results from a recent study of patients in a national registry is offering greater insight into the risk of falls and fall-related injuries in patients with 

The study, which examined risks associated with type 1 and type 2 diabetes separately, found patients with type 1 diabetes were at a 33% greater risk while patients with type 2 diabetes were at a 19% greater risk of falls than the general population.

"While of course we cannot do anything about getting older or our gender, diabetes—especially type 2 diabetes—use of medications and alcohol abuse could be potentially modifiable risk factors for falls,” concluded investigators. “Gaining further information on risk factors for falls could guide the management of diabetes treatment such as the choice of medication, which enables us to improve treatment particularly in people with a high risk of falls and fractures associated with high mortality."

Led by Nicklas Rasmussen, of the Steno Diabetes Center, the study was designed to tackle a pair of pressing questions through analysis of data within the Danish National Patient Register. The specific goals of the study were to estimate risk of falls and identify factors associated with increased falls and also to estimate differences in fall-related injuries and where they occur in those with type 1 and type 2 diabetes versus the general population. The study, which was presented at the 

 annual meeting, examined all data the within the registry from 1996-2017.

Through their search, investigators identified cohorts of 12,975 type 1 diabetics and 407,099 type 2 diabetes. From these populations, investigators created sex- and age-matched control groups from the general population. Of note, adjusted analyses performed in the study accounted for age, sex, diabetic complications, a history of alcohol abuse, and a history of medication.

Results of the investigators' query revealed the cumulative incidence rate of falls requiring hospitalization was 13.% among patients with type 1 diabetes and 11.9% in patients with type 2 diabetes. Upon analysis, results suggest type 1 diabetes was associate with a 33% greater risk of falls (HR, 1.33; 95% CI, 1.25-1.43) and type 2 diabetes Wass associated with a 19% greater risk of falls (HR, 1.19; 95% CI, 1.16-1.22).

The investigators' analysis also identified multiple other risk factors significantly associated with falls among patients in both groups. Among patients with type 1 diabetes, other risk factors included being female (T1: HR, 1.21; 95% CI, 1.13-1.29; T2: HR, 1.61; 95% CI, 1.58-1.64), older than 65 years of age (T1: HR, 1.52; 95% CI, 1.39-1.61; T2: HR, 1.32; 95% CI, 1.58-1.64), use not SSRI (HR, 1.35; 95% CI, 1.30-1.40; T2: HR, 1.32; 95% CI, 1.27-1.38), use of opioids (T1: HR, 1.15; 95% CI, 1.12-1.19; T2: HR, 1.09; 95% CI, 1.05-1.12), and a history of alcohol abuse (T1: HR, 1.77; 95% CI, 1.17-2.15; T2: HR, 1.88; 95% CI, 1.69-2.15).

Additionally, investigators found the incidence rate ratio(IRR) of fall-related injuries such as hip (IRR, 1.02; 95% CI, 1.01-1.04), radius (IRR, 1.39; 95% CI, 1.18-1.61), humerus (IRR, 1.24; 95% CI, 1.12-1.37), and skull/facial fractures (IRR, 1.15; 95% CI, 1.07-1.24) were greater among patients with type 2 diabetes. Among patients with type 1 diabetes, an increased IRR was only noted with hip fractures (IRR, 1.11; 95% CI, 1.11-1.23).

Increased risk of falls, fall-related injuries and fractures in people with type 1 and type 2 diabetes compared with the general population: a nationwide cohort study

A study from EASD 2020 found type 1 diabetes was associated with a 33% increase in risk of falls while type 2 diabetes was associated with a 19% increase in risk. 

Diabetics, Both Type 1 and Type 2, at Increased Risk of Falls, Fall-Related Injuries

 annual meeting suggests patients with rheumatoid arthritis were at a nearly 25% increased risk of developing diabetes compared to the general population.

The study, which was conducted by researchers from the University of Manchester, sheds further light on the potential impact of systemic inflammation associated with the common rheumatic disease.

"This finding supports the notion that inflammatory pathways are involved in the pathogenesis of diabetes,” said study investigators.

Led by Adrian Heald, MD, an honorary research fellow, the team of investigators from the University of Manchester sought to evaluate potential associations between inflammatory diseases and the onset of type 2 diabetes. With this in mind, they designed their study as a comprehensive search of the Medline, Embase, and Web of Science databases from inception through March 10, 2020.

Searching for studies comparing the risk of diabetes mellitus incidence in people with rheumatoid arthritis versus those in the general population, investigators identified a total of 3669 articles for potential inclusion in their analysis. After the application of inclusion criteria and abstracting screening, investigators identified 5 journal articles and 2 conference abstracts to be included in their final analysis.

From these studies, investigators obtained data related to 1,639,854 participants. Investigators noted most studies were population-based but 1 of the studies included was hospital-based. Additionally, investigators noted heterogeneity was observed in an I2 test (I2=96%; 

Upon analysis of these studies, investigators found rheumatoid arthritis was associated with a 23% increase in risk of diabetes mellitus incidence (pooled RR, 1.23; 95% CI, 1.07-1.40). In a sensitivity analysis, investigators found exclusion of the hospital-based study did not materially change the result (pooled RR, 1.23; 95% CI, 1.06-1.42).

“We suggest that more intensive screening and management of diabetes risk factors should be considered in people with rheumatoid arthritis. Agents that reduce systemic inflammatory marker levels may have a role in preventing type 2 diabetes. This may involve focusing on more than one pathway at a time,” investigators added.

The relation between rheumatoid arthritis and diabetes incidence: a systematic review and meta-analysis

A study from EASD 2020 suggests patients with RA could be at a nearly 25% increase in risk of developing type 2 diabetes later in life. 

Rheumatoid Arthritis Tied to 23% Increase in Risk of New Diabetes

New research from a team at Kaiser Permanente Colorado suggests concern over impact of synthetic medication versus desiccated thyroid products on thyroid-stimulating hormone (TSH) stability when choosing 

A retrospective matched cohort study with more than 800 patients, investigators found no difference in longitudinal TSH stability over a 3-year period between desiccated thyroid products and synthetic levothyroxine.

While hypothyroidism is among the most common thyroid disorders and synthetic levothyroxine is the most popular treatment for this, some clinicians prefer to treat with desiccated thyroid products. In an effort to evaluate how treatment choice could influence TSH in patients, investigators designed their study using data from electronic medical, pharmacy, and laboratory records within Kaiser Permanente Colorado.

For their study, investigators included patients aged 18 years and older receiving levothyroxine for hypothyroidism from 2005-2015. After identifying these patients, investigators matched them in a 1:1 ratio based on age, sex, and race/ethnicity to patients prescribed desiccated thyroid products.

Of note, patients were excluded if they had panhypopituitarism, were post-radioiodine therapy, had a history of thyroid cancer, were pregnant, diagnosed with Graves’ disease, or had Hashimoto’s thyroiditis. Additionally, patients were excluded if they were prescribed more than 1 agent for treatment of hypothyroidism.

For the purpose of the study, investigators chose the percent of euthyroid (0.320-5.500 uIU/mL) TSH values. Investigators also included visit-to-visit TSH variability, the percentage of patients with TSH values in-range during the follow-up period, and number of TSH values as secondary outcomes.

In total, 870 patients were included in the study. Compared to those prescribed levothyroxine, patients prescribed desiccated thyroid products had lower body mass index (

=.001) compared with those prescribed levothyroxine. Upon analysis, investigators found no difference in TSH values time in-range between the study arms, with rates of 79.3% for levothyroxine and 79.1% for desiccated thyroid products (

Results suggest those receiving levothyroxine had significantly less visit-to-visit TSH variability than those prescribed desiccated thyroid (1.25 vs 1.44; 

=.015), but investigators noted 60% of the patients in both groups had all of their TSH values measured during the study period considered in-range (

=.951). Investigators also pointed out the median number of TSH laboratory values obtained during the study period was 4 among patients receiving levothyroxine compared to 3 for patterns prescribed desiccated thyroid products (

, Jill Schneiderhan, MD and Suzanna Zick, MD, both of the University of Michigan Medical School, urge clinicians to use a patient-centered approach instead of relying primarily on laboratory results when determining the effective management strategy for patients with hypothyroidism.

“Keeping desiccated thyroid medications as an option in our tool kit will allow for improved shared decision making, while allowing for patient preference, and offer an option for those patients who remain symptomatic on levothyroxine monotherapy,” wrote the pair of University of Michigan physicians.

Thyroid Stimulating Hormone Stability in Patients Prescribed Synthetic or Desiccated Thyroid Products: A Retrospective Study

Results of the study offer clinicians greater insight and could improve decision-making in regards to treatment choices for hypothyroidism. 

Synthetic Medication, Desiccated Thyroid Similar in Effectiveness for Hypothyroidism

New research suggests patients with thyroid inflammation could be at a greater risk of developing anxiety disorders.

The study, which was presented at the European Society of Endocrinology 2020 annual meeting, suggests thyroid function could play a pivotal role in the development of anxiety disorders and call for further research into whether thyroid inflammation should be considered an underlying factor for psychiatric disorders.

"These findings indicate that the endocrine system may play an important role in anxiety. Doctors should also consider the thyroid gland and the rest of the endocrine system, as well as the nervous system, when examining patients with anxiety," said lead investigator Juliya Onofriichuk, of Kyiv City Clinical Hospital

With nations across the world placing a greater emphasis on treatment and identification of anxiety disorders in recent years, Onofriichuk and a team of colleagues from Kyiv City Clinical Hospital sought to contribute to physicians’ understanding of the role of the endocrine system in anxiety disorders. WItht this in mind, investigators designed their study as an examination of 76 patients with anxiety disorders, including 29 men and 47 women.

All patients included in the study initially consulted a neurologist or psychotherapist with panic attacks. These patients underwent ultrasounds of their thyroid glands that assessed thyroid function and levels of thyroid hormones were also measured. Of note, thyroid hormone levels of interest included thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4).

Upon analysis, investigators found total thyroid gland in 55% of patients was within normal range and 28% exceeded the norm by no more than 20%. In 71 patients, investigators observed an increase in the intensity of blood flow in the gland.

Patients with increased blood flow to their thyroid gland but normal TSH were prescribed a nonsteroidal anti-inflammatory drug (NSAID) twice a day for 14 days and and those with increased blood flow in the gland and increased TSH (42%) received an NSAID and thyroxine for 8 weeks. These patients underwent an additional ultrasound of their thyroid gland. Investigators noted patients treated for 14 days saw reductions in thyroid inflammation, normalized thyroid hormone levels, and anxiety scores.

“All patients with anxiety disorders need to check the function of the thyroid gland, since its disorders can lead to psycho-emotional disorders,” wrote investigators in their conclusion.

The aforementioned statement noted Onofriichuk has plans to conduct further research examining levels of thyroid, sex, and adrenal hormones, such as cortisol, progesterone, prolactin, estrogen, and testosterone, in patients with dysfunctional thyroid glands and anxiety disorders.

This study, “Anxiety Disorders in Patients with Autoimmune Thyroiditis,” was presented at e-ECE 2020.

A study from e-ECE 2020 suggests thyroid inflammation could put patients at greater risk for developing an anxiety disorder. 

Study Finds Thyroid Inflammation Tied to Anxiety Disorders

A new study from a Rutgers University-led team suggests children taking oral steroids may be at an increased risk for a multitude of health issues later in life, including 

While investigators note the absolute risk for most children is low, results from the retrospective cohort analysis of more than 900k children indicate children receiving oral glucocorticoids to treat asthma or autoimmune diseases were at increased risk of cardiometabolic complications later in life.

“This study allowed us to put numbers on the association between oral steroids and rare, but potentially serious, complications in children,” said study investigator Daniel Horton, MD, MSCE, an assistant professor of pediatrics and epidemiology at Rutgers Robert Wood Johnson Medical School, 

. “While children receiving high-dose steroids were at substantially higher risk for developing diabetes, high blood pressure or blood clots relative to children not taking these medicines, the absolute risks of these complications were still small. The vast majority of children taking brief courses of steroids for conditions such as asthma, for instance, will not experience these complications.”

While incidence of cardiometabolic complications with oral steroids in older adults has been thoroughly researched, Horton and a team of colleagues sought to close the clinical knowledge gap related to this relationship in children—who investigators point out require different treatment regimens with oral steroids and have lower levels of baseline risk compared to their older counterparts. With this in mind, investigators designed their study as a retrospective cohort analysis using Medicaid Analytic eXtract (MAX) files from 2000-2010.

From MAX files, investigators identified a cohort of 932,517 eligible individuals for inclusion in their study. For inclusion in the study, participants needed to be between the ages of 1-18 years of age with 9 months or more of observable time, and 1 of 4 of the following disease diagnoses: inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), psoriasis, or attention-deficit/hyperactivity disorder (ADHD). ADHD was chosen to serve as a common non-immune reference condition for the purpose of comparison.

Children were excluded from the study if they had prior malignancies, chemotherapy, organ or hematopoietic transplantation, human immunodeficiency virus, or a non-JIA rheumatic disease. Investigators noted children diagnosed before age 1 were excluded due to questions about diagnostic validity.

For the purpose of analysis, glucocorticoid exposure, which was determined through pharmacy claims, was categorized as low (less than 0.25 mg/kg/day), medium (0.25-0.99 mg/kg/day), or high (1 mg/kg/day or more). Of the 932,517 children eligible for inclusion, 198,885 (21.3%) were considered glucocorticoid-exposed. The primary outcomes chosen for the study were incident treatment of diabetes mellitus, hypertension, or venous thromboembolism (VTE).

Results of the investigators’ analyses indicated crude rates were lowest for VTE with rates of 0.5 per million person-days (95% CI, 0.4-0.6) among unexposed patients versus 15.6 per million person-days (95% CI, 11.8-20.1) among exposed patients and highest for hypertension with rates of 6.7 per million person-days (95% CI, 6.5-7.0) among unexposed patients and 74.4 per million person-days (95% CI, 65.7-83.9) among exposed patients. The corresponding rates for diabetes mellitus were 5.3 per million person-days (95% CI, 5.1-5.5) among unexposed patients and 24.5 per million person-days (95% CI, 19.7-30.0) among exposed patients.

Investigates pointed out the absolute rates for all outcomes were higher in unexposed and exposed children with autoimmune diseases compared to those with ADHD.

Further analysis indicated strong dose-dependent relationships existed between current glucocorticoid exposure and all of the study outcomes. Specifically, the adjusted hazard ratios for high-dose glucocorticoids and incidence of outcomes were 5.93 (95% CI, 3.94-8.91) for diabetes mellitus, 19.13 (95% CI, 15.43-23.73) for hypertension, and 16.16 (95% CI, 8.94-29.22) for VTE. Investigators purport these results suggest strong relative risks but low absolute risks of new VTE, diabetes, and hypertension among children taking high-dose oral glucocorticoids.

Oral Glucocorticoids and Incident Treatment of Diabetes Mellitus, Hypertension, and Venous Thromboembolism in Children

New research suggests children treated with high-doses of oral glucocorticoids could be at a greater risk of diabetes, hypertension, and venous thromboembolism. 

Pediatric Asthma Treatment Could Increase Risk of Diabetes, Other Conditions

An analysis of data from a major women’s health study is detailing associations between adverse pregnancy outcomes and risk of atherosclerotic cardiovascular disease (ASCVD) in 

Results of the study, which included information from more than 45k women, suggest adverse pregnancy outcomes were a sex-specific risk factor for ASCVD in women.

With a renewed emphasis on identifying sex-specific risk factors for ASCVD in women, a team of investigators from the University of California San Francisco (UCSF) School of Medicine sought to determine whether adverse pregnancy outcomes could serve as a predictor for ASCVD in these patients. To do so, they designed their study in hopes of using data from the Women’s Health Initiative (WHI) in a retrospective analysis.

From the WHI, investigators obtained data related to a cohort of 48,113 participants. Of note, all women included in WHI were between the ages of 50-79 years when enrolled, were [postmenopausal, and represented ethnically diverse populations. All women included in the current analysis participated in a 2017 questionnaire that surveyed dental health, memory, mental function, and asked specific questions related to history of adverse pregnancy outcomes.

The adverse pregnancy outcomes of interest for the study included gestational diabetes, hypertensive disorders of pregnancy, low birth weight, high birth weight, and preterm delivery by 3 weeks or more. For the purpose of the analysis, the primary outcome was ASCVD, which was defined as myocardial infarction, stroke, peripheral artery disease, or coronary revascularization. Of note, these outcomes were prospectively ascertained and adjudicated using standard criteria.

The median age at time of enrollment for the current study cohort was 60 (55-64.0) years, 28.8% of participants reported 1 or more adverse pregnancy outcome, and about a third of these patients experienced 2 or more adverse pregnancy outcomes.

Upon analysis, investigators found ASCVD was more common in women who reported an adverse pregnancy outcome compared to those without adverse pregnancy outcome (7.6% vs 5.8%). When analyzed separately, investigators determined each of the 5 adverse pregnancy outcomes of interest were significantly associated with ASCVD. When adjusting for ASCVD risk factors, including hyperlipidemia, diabetes, and smoking status, results indicated associations between ASCVD and gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and preterm delivery remained significant.

In analyses examining all 5 adverse pregnancy outcomes of interest jointly for their associations with ASCVD, results indicated only hypertensive disorders of pregnancy (OR, 1.34; 95% CI, 1.15-1.54) and low birth weight (OR, 1.18; 95% CI, 1.03-1.35) were independently associated with ASCVD.

, a trio of physicians from Barbra Streisand Women's Heart Center at Cedars-Sinai Smidt Heart Institute in Los Angeles discuss how the role of women’s health knowledge needs to transition from the duty of specialists in obstetrics and gynecology to a responsibility for specialists in other fields.

“This new study appears to be the largest that adjusts not only for known ASCVD risk factors but also other APOs and finds independent associations between hypertensive disorders of pregnancy and low birth weight with late ASCVD. Other strengths include the use of a large and multiethnic cohort. Furthermore, the new study includes the adjudication of APOs, while many large cohort studies are limited by the use of self-report APO adjudication, which has low to moderate sensitivity in older women,” wrote the commentary authors.

Association of Adverse Pregnancy Outcomes With Risk of Atherosclerotic Cardiovascular Disease in Postmenopausal Women

Data from the WHI indicates adverse pregnancy outcomes were associated with increased risk of ASCVD later in life. 