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To investigate the long-term outcomes of Pay-for-Performance (P4P) care in patients with young-onset (20-40 years of age) diabetes (YOD).We recruited 3088 pairs of propensity-score matched patients with and without P4P care from the National Health Insurance Research Database between January 1, 2001, and December 31, 2017. The study used a multivariable Cox regression model to compare the risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes in YOD patients with and without P4P care.The multivariable-adjusted model showed that patients with P4P care had significantly lower risks of mortality (aHR 0.31, 95% CI 0.25-0.38) and hospitalization for cardiovascular events (aHR 0.63, 95% CI 0.5-0.79) but a significantly higher risk of major microvascular outcomes (aHR 1.31, 95% CI 1.07-1.6). Patients with a longer cumulative duration of P4P and complete P4P care showed further lower risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes than those without P4P care.This nationwide cohort study showed that young-onset diabetes patients with P4P care had lower risks of death and cardiovascular events but a higher risk of major microvascular outcomes. However, patients with a longer duration of P4P care showed lower risks of these outcomes.

Aim To compare long-term outcomes among three groups with different ages of diabetes onset. Method 66,520 paired age-, and sex-matched persons with and without type 2 diabetes were selected from the Taiwan National Health Insurance Research Database from 2000 to 2012. Cox proportional hazards models were used to compare the outcomes. Using late-onset diabetes as a reference, adjusted difference in differences analyses were performed to assess excessive odds comparing diabetes versus non-diabetes for young-onset diabetes (YOD) and early-onset diabetes in the risks of mortality and vascular complications. Results Persons with type 2 diabetes, irrespective of the onset age, had higher associated risks of all-cause mortality and vascular complications than their matched counterparts without diabetes. Compared to the odds of complications between those with diabetes and non-diabetes in the late-onset diabetes group, the excess odds in YOD are generally greater than in the early-onset diabetes (for stroke: 1.90 vs. 1.32; heart failure: 2.03 vs. 1.58; myocardial infarction: 3.02 vs. 1.56; and microvascular complications: 3.52 vs. 3.01). Conclusions Diabetes with different ages of onset may imply distinct long-term health outcomes. The persons with young-onset and early-onset diabetes seem to bear excess risk for mortality and vascular complications.

Implementation of insulin therapy among those with diabetes is often suboptimal as a result of non-adherence or non-persistence. Studies regarding factors leading to insulin nonpersistence are limited. Therefore, we conducted this retrospective cohort study to determine the factors affecting insulin nonpersistence.A total of 274,852 persons with type 2 diabetes mellitus under insulin therapy during the period 2000-2014 were enrolled. Persons who stopped insulin therapy for90 days were defined as having insulin nonpersistence. We searched for factors associated with insulin nonpersistence during the long-term follow-up period.According to the multiple Cox regression model with a mean follow-up of 13.9 years, the factors associated with higher risk of insulin nonpersistence were age40 years, men, residing in a rural area, Charlson comorbidity index score = 4, use of two or more oral antidiabetic drugs, and hypoglycemia during follow-up. The Kaplan-Meier graph showed that patients aged40 years had significantly less insulin persistence.This nationwide cohort study indicated that persons with young-onset type 2 diabetes, less medical resources, and more comorbidities are at risk of insulin nonpersistence. Healthcare providers should regularly assess insulin persistence and help patients who are having difficulty with insulin-taking.

Aims To compare the hazard of cardiovascular diseases between DPP-4 inhibitor users and non-users who were on insulin therapy. Methods We conducted a population-based cohort study. 2652 patients with type 2 diabetes mellitus (T2DM) under insulin therapy were enrolled during 1997–2010. The incidence rates per 1000 person-years (PYs) of stroke, coronary heart disease (CAD) and heart failure were compared between 1326 DPP-4 inhibitor users and 1326 propensity score matched non-users. Multivariable Cox proportional hazards model was used to evaluate excess risk of the DPP-4 inhibitor non-users. Results After adjustment of age, gender, comorbidities, drugs used and diabetes duration; the incidence rate per 1000 PYs were 21.70 and 9.88 in DPP-4 inhibitor non-users and users; DPP-4 inhibitor users had lower hazard ratio (HR) of stroke (adjusted HR: 0.59, 95% CI: 0.42–0.83, p value: 0.002) compared with non-users. The incidence rates per 1000 PYs of CAD and heart failure of control versus users were 19.85 versus 13.54 and 5.56 versus 4.78; the adjusted HRs of CAD and heart failure were 0.86 and 1.11. Both were non-significant. Conclusion This nationwide study demonstrated that insulin plus DPP-4 inhibitor users had significantly lower risk of stroke as compared with non-users.

Aim People with young-onset diabetes (YOD) exhibit a higher risk of morbidity and mortality than those with late-onset diabetes. Few studies have explored the preferred management of diabetes in such patients. We compared the risks of hospitalization and mortality among people with YOD to whom second-line oral antidiabetic drugs (OADs) were administered. Methods 7257 people taking second-line OADs after initial metformin therapy were enrolled during 2009–2014. Using add-on sulfonylureas (SUs) as a reference, the multivariable Cox regression model was used to compare the hospitalization and mortality risks among 5 categories of second-line OADs: alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors, SUs, and thiazolidinediones. Results After baseline characteristics, comorbidities, duration of diabetes, and drug use were controlled, the adjusted hazard ratios and 95% confidence interval for all-cause, cardiovascular, and non-infection hospitalization and all-cause mortality for metformin plus DPP-4 inhibitors were 0.62 (0.52–0.73), 0.49 (0.29–0.85), 0.64 (0.54–0.76), and 0.50 (0.27–0.92), respectively, when compared with the data for metformin plus SUs. Conclusions Among people with YOD, taking add-on DPP-4 inhibitors was associated with lower risks of all-cause hospitalization and mortality than taking add-on SUs. DPP-4 inhibitors thus seem to be a suitable second-line OAD for such patients.

Aims Interleukin-6 (IL-6), an inflammatory cytokine, is considered a candidate gene possibly involved in susceptibility to nephropathy in diabetes. This study aimed to examine whether IL-6 polymorphisms predict the progression of nephropathy in a prospective Chinese cohort of patients with type 2 diabetes. Methods A total of 568 type 2 diabetic patients with normoalbuminuria at baseline were followed up for a mean of 5.3 ± 1.5 years. Urinary albumin-to-creatinine ratio (ACR) ⩾30 mg/g in two consecutive urine tests were defined as progression to diabetic nephropathy (n = 143). Five polymorphisms of IL-6 gene, rs1800795, rs1800796, rs1524107, rs2069837, and rs2069840, were genotyped. Cox proportional hazard models were used to estimate hazard ratio (HR) and 95% CI of progression to diabetic nephropathy under different genetic models. Results Almost all patients (99.6%) carried the rs1800795 GG homozygous genotypes. In the Cox proportional models adjusted for multiple covariates, the HR under recessive model was 2.02 for rs1800796 GG (vs. CC + CG, 95% CI: 1.08–3.75, p = 0.027), 2.37 for rs2069837 GG (vs. AA + AG, 95% CI: 1.15–4.87, p = 0.019), and 2.08 for rs1524107 CC (vs. TT + TC, 95% CI: 1.12–3.89, p = 0.021). These associations remained significant for rs1800796 and rs1524107 after correction for multiple testing (α = 0.017). Overall, our results suggest that rs1800796 GG and rs1524107 CC homozygous genotypes may confer a greater risk for development of nephropathy in type 2 diabetes. Conclusions IL-6 gene polymorphisms rs1800796 and rs1524107 may serve as predictors of progression of nephropathy in Chinese patients with type 2 diabetes.

We examined time trends in the prevalence of diabetes using nationally representative samples, with a focus on gender differences. Data were from the Nutrition and Health Survey in Taiwan (NAHSIT), 1993-1996 (n = 2700), and NAHSIT 2004-2008 (n = 2258). Participants aged 19 years or older with adequate fasting glucose data were included. When needed, rates were standardized to the year 2000 WHO 5-year interval population for comparisons. The prevalence increased significantly in men, whose standardized rate increased from 4.6% to 9.3%. In women, the age standardized prevalence decreased slightly from 7.9% to 6.4%. High triglycerides (≥ 150 mg/dL) was associated with diabetes with odds ratios (OR) of 2.14, and 2.69 (all with p

Aims This study aimed to evaluate the long-term effects on glycemic control of a diabetes care program focusing on case management and to discuss challenges in the quality of diabetes care in Taiwan. Methods We randomized 1,060 study subjects recruited from the Diabetes Management through an Integrated Delivery System project in 2003–2005 into intervention (n = 789 from 27 clinics) and control (n = 271 from 7 clinics) groups. The quarterly self-care and nutrition-education program in the intervention group was delivered by case managers, and standard care was provided to the control group. The intervention program was conducted during 2003–2007. A multivariate mixed model analysis was used to assess the 3.5-year intervention effects on glycemic control. Results Glycated hemoglobin (HbA 1c ) level in the intervention group (especially for those with a baseline HbA 1c level of 7–9% and >9%) was significantly lower than that in the control group 6 months after recruitment and remained lower through the subsequent three intervention years. Conclusions The current findings provide evidence that case management provided in the pay-for-performance (P4P) diabetes care program in Taiwan was effective at improving glycemic control for at least 3 years. However, previous research indicated poverty is associated with not only higher diabetes incidence but also inequality of diabetes care in Taiwan despite universal health coverage. Those with a more severe condition were less likely to be enrolled in the P4P diabetes care program. Additional cost-effectiveness studies and more health policy reforms are needed to optimize diabetes care in Taiwan.

Aims Polymorphisms of the ADIPOQ gene were associated with diabetic nephropathy (DN) in case–control studies predominantly among European populations. Gender may modify the ADIPOQ associated risk for DN. We investigated the association of 18 ADIPOQ polymorphisms with DN in a prospective Taiwanese cohort of type 2 diabetes (T2D) and explored whether gender plays a role in this genetic association. Methods Selected single nucleotide polymorphisms (SNPs) of ADIPOQ were genotyped in 566 T2D patients with normoalbuminuria at baseline. DN was defined based on urinary albumin-to-creatinine ratio (ACR). The Cox proportional hazard model was used to explore the association of individual SNP to DN events under different genetic models over a 6-year follow-up period. Analyses were further stratified by gender. Results In male patients, the adjusted hazard ratios under the recessive models were 1.81 for rs2241766 TT (vs. GT + GG, 95% CI = 1.10–2.96, p = 0.019) and 1.89 for rs1063537 CC (vs. CT + TT, 95% CI = 1.15–3.11, p = 0.013). In the Kaplan–Meier survival curve, males carrying rs2241766 TT (vs. GT + GG, p = 0.050) and rs1063537 CC (vs. CT + TT, p = 0.037) recessive homozygotes also had a reduced nephropathy-free survival rate. SNPs rs2241767 and rs2082940, both in strong correlation with tag SNP rs1063537 ( r 2 ≥ 0.96), were also associated with DN progression in males. In females, ADIPOQ polymorphisms were not associated with the progression of DN. Conclusions ADIPOQ genetic polymorphisms rs2241766 (+45T>G), rs1063537, rs2241767 and rs2082940 were correlated with the progression of DN in Taiwanese male patients with T2D. The role of gender in this ADIPOQ genetic association needs to be further investigated in other populations.