98 results on '"Fu Shun Yen"'
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2. Effects of glucagon-like peptide-1 receptor agonists on liver-related and cardiovascular mortality in patients with type 2 diabetes
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Fu-Shun Yen, Ming-Chih Hou, James Cheng-Chung Wei, Ying-Hsiu Shih, Chii-Min Hwu, and Chih-Cheng Hsu
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All-cause mortality ,Liver-related mortality ,Cardiovascular mortality ,Liver cirrhosis ,Hepatic failure ,Medicine - Abstract
Abstract Background Patients with type 2 diabetes (T2D) tend to have nonalcoholic fatty liver disease (NAFLD) with poorer prognosis. We performed this research to compare the risks of cardiovascular diseases, cirrhosis, liver-related mortality, and cardiovascular mortality between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use and no-use in patients with T2D without viral hepatitis. Methods From January 1, 2008, to December 31, 2018, we used propensity-score matching to identify 31,183 pairs of GLP-1 RA users and nonusers from Taiwan’s National Health Insurance Research Database. Multivariable-adjusted Cox proportional hazards models were used to examine the outcomes between the study and control groups. Results The median (Q1, Q3) follow-up time for GLP-1 RA users and nonusers were 2.19 (1.35, 3.52) and 2.14 (1.19, 3.68) years, respectively. The all-cause mortality incidence rate was 5.67 and 13.06 per 1000 person-years for GLP-1 RA users and nonusers, respectively. Multivariable-adjusted analysis showed that GLP-1 RA use had significantly lower risks of all-cause mortality (aHR 0.48, 95%CI 0.43–0.53), cardiovascular events (aHR 0.92, 95%CI 0.86–0.99), cardiovascular death (aHR 0.57, 95%CI 0.45–0.72), and liver-related death (aHR 0.32, 95%CI 0.13–0.75). However, there was no significant difference in the risk of liver cirrhosis development, hepatic failure, and hepatocellular carcinoma compared to GLP-1 RA no-use. Conclusions This nationwide cohort study showed that GLP-1 RA use was associated with a significantly lower risk of all-cause mortality, cardiovascular events, and cardiovascular death in patients with T2D among Taiwan population. More prospective studies are warranted to verify our results.
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- 2024
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3. Diet and exercise are a fundamental part of comprehensive care for type 2 diabetes
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Yun Kai Yeh, Fu‐Shun Yen, and Chii‐Min Hwu
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2023
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4. Impact of individual microvascular disease on the risks of macrovascular complications in type 2 diabetes: a nationwide population-based cohort study
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Fu-Shun Yen, James Cheng-Chung Wei, Ying-Hsiu Shih, Chih-Cheng Hsu, and Chii-Min Hwu
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Diabetic kidney disease ,Diabetic retinopathy ,Diabetic neuropathy ,Coronary artery disease ,Stroke ,Heart failure ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background This study compared the risks of cardiovascular morbidity and mortality between patients with type 2 diabetes (T2D) with and without microvascular diseases, and between matched patients with microvascular diseases. Methods We identified newly diagnosed type 2 diabetes patients from National Health Insurance Research Database in Taiwan from January 1, 2008, to December 31, 2019. Propensity score matching was applied to construct matched pairs of patients with diabetic kidney disease, retinopathy, or neuropathy. Multivariable Cox proportional-hazard models were adopted to compare the risks of cardiovascular morbidity and mortality. Results Patients with microvascular disease had a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. Among the matched cohorts, patients with diabetic retinopathy had a significantly higher risk of stroke development than those with diabetic kidney disease (aHR 1.11, 95%CI 1.03–1.2). Diabetic neuropathy showed a significantly higher risk of stroke development than diabetic kidney disease (aHR 1.17, 95%CI 1.1–1.25) and diabetic retinopathy (aHR 1.12, 95%CI 1.03–1.21). Diabetic retinopathy had a significantly higher risk of incident heart failure than diabetic kidney disease (aHR 1.43, 95%CI 1.3–1.57), and diabetic neuropathy had a significantly lower risk of incident heart failure than diabetic retinopathy (aHR 0.79, 95%CI 0.71–0.87). Conclusions T2D patients with microvascular disease have a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. In the matched cohorts, diabetic neuropathy was significantly associated with stroke development, and diabetic retinopathy had a significant association with heart failure compared to other microvascular diseases.
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- 2023
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5. Is a low‐carbohydrate, high‐fat diet feasible for people with type 2 diabetes and nonalcoholic fatty liver disease?
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Fu‐Shun Yen, Pei‐Chuan Lee, and Chii‐Min Hwu
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2023
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6. Clinical course of adolescents with type 2 diabetes mellitus: A nationwide cohort study in Taiwan
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Fu‐Shun Yen, James Cheng‐Chung Wei, Jia‐Sin Liu, Chih‐Cheng Hsu, and Chii‐Min Hwu
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Adolescent ,Hospitalization ,Type 2 diabetes mellitus ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Aims/Introduction The global incidence of adolescents with type 2 diabetes mellitus is increasing. This cohort study was conducted aiming to describe the characteristics, drug‐use condition, and long‐term outcomes of adolescents with type 2 diabetes mellitus. Materials and Methods Two thousand seven hundred fifty‐five newly diagnosed adolescents with type 2 diabetes mellitus (using ICD‐9‐CM: 250.x and having ≥3 clinic visits) were identified from the national health insurance dataset during 2000–2014. Treatments were classified into four groups: metformin, sulfonylurea (SU), metformin plus SU, and insulin with or without oral antidiabetic drugs. The multiple Cox regression model was used to compare the risks of mortality and hospitalization among these four groups. Results The mean follow‐up period was 5.4 years. After 1 year of antidiabetic treatment, they gradually needed intensified therapy, and at 3 years, half of them showed treatment failure. The mortality rate was 2.08 per 1,000 person‐years. Respiratory diseases (36.2%) and dysglycemia (16.4%) were the most common causes of hospitalization among these adolescents. Compared with persons taking metformin plus SU, metformin users were associated with a lower risk of all‐cause hospitalization [0.82 (0.67–0.99)]; insulin users were associated with a higher risk of dysglycemia [4.38 (2.14–8.96)], cancer [3.76 (1.39–10.1)], and respiratory hospitalization [1.66 (1.14–2.41)]; and SU users were associated with a higher risk of hospitalization for respiratory diseases [1.91 (1.13–3.23)]. Conclusions This nationwide cohort study demonstrated that adolescents with type 2 diabetes mellitus were prone to treatment failure. Furthermore, respiratory diseases and dysglycemia were the most common causes of hospitalization.
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- 2022
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7. Thiazolidinediones lower the risk of pneumonia in patients with type 2 diabetes
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Fu-Shun Yen, James Cheng-Chung Wei, Yu-Tung Hung, Chung Y. Hsu, Chii-Min Hwu, and Chih-Cheng Hsu
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all-cause pneumonia ,bacterial pneumonia ,death ,invasive mechanical ventilation ,pioglitazone ,Microbiology ,QR1-502 - Abstract
IntroductionWe conducted this study to compare the risk of pneumonia between thiazolidinedione (TZD) use and nonuse in persons with type 2 diabetes (T2D).MethodsWe identified 46,763 propensity-score matched TZD users and nonusers from Taiwan’s National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risk of morbidity and mortality associated with pneumonias.ResultsCompared with the nonuse of TZDs, the adjusted hazard ratios (95% CI) for TZD use in hospitalization for all-cause pneumonia, bacterial pneumonia, invasive mechanical ventilation, and death due to pneumonia were 0.92 (0.88–0.95), 0.95 (0.91–0.99), 0.80 (0.77–0.83), and 0.73 (0.64–0.82), respectively. The subgroup analysis revealed that pioglitazone, not rosiglitazone, was associated with a significantly lower risk of hospitalization for all-cause pneumonia [0.85 (0.82–0.89)]. Longer cumulative duration and higher cumulative dose of pioglitazone were associated with further lower adjusted hazard ratios in these outcomes compared to no-use of TZDs.DiscussionThis cohort study demonstrated that TZD use was associated with significantly lower risks of hospitalization for pneumonia, invasive mechanical ventilation, and death due to pneumonia in patients with T2D. Higher cumulative duration and dose of pioglitazone were associated with a further lower risk of outcomes.
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- 2023
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8. The impact of heavy alcohol consumption on cognitive impairment in young old and middle old persons
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Fu-Shun Yen, Shiow-Ing Wang, Shih-Yi Lin, Yung-Hsiang Chao, and James Cheng-Chung Wei
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Dementia ,Cognitive impairment ,Young old ,Middle old ,Older adults ,Alcohol drinking ,Medicine - Abstract
Abstract Background Dementia indicates a significant disease burden worldwide with increased population aging. This study aimed to investigate the impact of alcohol consumption on the risk of cognitive impairment in older adults. Methods Participants ≥ 60 years were administered the Digit Symbol Substitution Test (DSST) to evaluate cognitive function in National Health and Nutrition Examination Survey (NHANES) cycles from 1999 to 2002 and 2011 to 2014 for enrollment in the present study. Participants were categorized into non-drinker, drinker, and heavy drinker groups. Logistic regression analyses were performed to explore associations between cognitive impairment and alcohol consumption. Results Multivariate analysis showed that older adults, men, people from minority races, persons with lower education or income levels, social difficulties, hypertension, or chronic kidney disease were significantly associated with a higher risk of cognitive impairment (all p
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- 2022
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9. Metformin use and the risk of bacterial pneumonia in patients with type 2 diabetes
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Fu-Shun Yen, James Cheng-Chung Wei, Ying-Hsiu Shih, Chih-Cheng Hsu, and Chii-Min Hwu
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Medicine ,Science - Abstract
Abstract Persons with type 2 diabetes (T2D) have neutrophil dysfunction with a higher risk of infection than those without diabetes. We conducted this study aiming to compare the risk of pneumonia between metformin use and nonuse in persons with T2D. We identified 49,012 propensity score-matched metformin users and nonusers from Taiwan’s National Health Insurance Research Database between January 1, 2000, and December 31, 2017. We used the Cox proportional hazards model to compare the risks of pneumonia and respiratory death. The mean (SD) age of the participants was 57.46 (12.88) years, and the mean follow-up time for metformin users and nonusers was 5.47 (3.71) years and 5.15 (3.87) years, respectively. Compared with the nonuse of metformin, the adjusted hazard ratios (95% CI) for metformin use in bacterial pneumonia, invasive mechanical ventilation, and respiratory cause of death were 0.89 (0.84–0.94), 0.77 (0.73–0.82), and 0.64 (0.56–0.74), respectively. A longer cumulative duration of metformin use had further lower adjusted hazard ratios in these risks compared with nonuse. In patients with T2D, metformin use was associated with significantly lower risks of bacterial pneumonia, invasive mechanical ventilation, and respiratory cause of death; moreover, longer metformin use duration was associated with lower hazard ratios of these risks.
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- 2022
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10. Diabetes, hypertension, and cardiovascular disease development
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Fu-Shun Yen, James Cheng-Chung Wei, Lu-Ting Chiu, Chih-Cheng Hsu, and Chii-Min Hwu
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Diabetes mellitus ,Hypertension ,Coronary artery disease ,Stroke ,Heart failure ,Medicine - Abstract
Abstract Background We aimed to compare cardiovascular risks among participants with T2DM with and without subsequent HTN and participants with HTN with and without subsequent T2DM. Methods From January 1, 2000, to December 31, 2018, we identified 16,236 matched pairs of T2DM participants with and without HTN (T2DM cohorts), 53,509 pairs of HTN participants with and without T2DM (HTN cohorts), and 21,158 pairs of comorbid HTN and T2DM participants with T2DM history or HTN history (comorbid cohorts) from Taiwan’s National Health Insurance Research Database. Cox proportional-hazard models were used to calculate the risk of cardiovascular disease. Results The mean follow-up time of this study was 6.75 years. Mean incident rates of coronary artery disease for T2DM cohorts, HTN cohorts, and comorbid cohorts were 16.80, 23.18, and 31.53 per 1000 person-years, respectively. The adjusted hazard ratios (HRs) (95% confidence intervals [95% CIs]) for incident coronary artery disease, stroke, and heart failure in T2DM participants with versus without HTN were 2.22 (2.07–2.37), 1.19 (1.16–1.23), and 0.92 (0.82–1.02), respectively; the adjusted HRs for HTN participants with versus without T2DM were 1.69 (1.55–1.84), 1.25 (1.21–1.30), and 0.98 (0.93–1.05), respectively; the adjusted HRs for comorbid T2DM and HTN participants with previous T2DM versus previous HTN were 2.78 (2.37–3.27), 1.20 (1.13–1.28), and 0.95 (0.88–1.03), respectively. Conclusions This nationwide cohort study demonstrated that both T2DM with subsequent HTN and HTN with subsequent diabetes were associated with higher cardiovascular disease risks.
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- 2022
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11. Severe hypoglycemia in patients with liver cirrhosis and type 2 diabetes
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Fu-Shun Yen, Ming-Chih Hou, Jia-Sin Liu, Chih-Cheng Hsu, and Chii-Min Hwu
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liver cirrhosis ,all-cause mortality ,chronic kidney disease ,hypoglycemic agents ,sulfonylurea ,Medicine (General) ,R5-920 - Abstract
IntroductionAdvanced liver disease with massive liver damage may affect the metabolism of hypoglycemic agents and increase the risk of hypoglycemia. We conduct this research to compare the risk of severe hypoglycemia between patients with type 2 diabetes, with and without compensated liver cirrhosis.MethodsFrom Taiwan’s National Health Insurance Research Database, we identified persons with type 2 diabetes with cirrhosis (n = 18,209) and without cirrhosis (n = 538,510) from January 1, 2000, to December 31, 2010. Cox proportional hazards models were adopted to assess risks of all-cause mortality and severe hypoglycemia.ResultsThe mean follow-up period of this study was 3.7 years. The incidence rates of death during follow-up were 26.54 and 2.75 per 1,000 patient-years [aHR 7.63 (6.70–8.70)] for patients with cirrhosis and without cirrhosis, respectively. The incidence rates of severe hypoglycemia during follow-up were 0.53 and 0.14 per 1,000 patient-years [aHR 2.74 (1.52–4.92)] for patients with and without cirrhosis, respectively. The subgroup analysis of hypoglycemia risks in patients with and without cirrhosis disclosed no significant interaction for variables such as age, sex, chronic kidney disease, sulfonylurea use, number of oral antidiabetic drugs, insulin, b-blocker, and fibrate.ConclusionThis cohort study demonstrated that patients with type 2 diabetes and compensated cirrhosis showed a higher risk of mortality and severe hypoglycemia than those without liver cirrhosis.
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- 2023
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12. Epidemiological characteristics of diabetic kidney disease in Taiwan
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Jun‐Sing Wang, Fu‐Shun Yen, Kun‐Der Lin, Shyi‐Jang Shin, Yueh‐Han Hsu, Chih‐Cheng Hsu, and Diabetes Kidney Disease Research Committee of the Diabetes Association of the Republic of China (Taiwan)
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Diabetic kidney disease ,Prognostic factors ,Risk factors ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
ABSTRACT Diabetic kidney disease (DKD) is a critical microvascular complication of diabetes. With the continuous increase in the prevalence of diabetes since 2000, the prevalence of DKD has also been increasing in past years. The prevalence of DKD among individuals with type 2 diabetes in Taiwan increased from 13.32% in 2000 to 17.92% in 2014. The cumulative incidence of DKD among individuals with type 1 diabetes in Taiwan was higher than 30% during 1999–2012. DKD is the leading cause of end‐stage renal disease (ESRD), with a prevalence of approximately 45% in a population on chronic dialysis in Taiwan. Among individuals with type 2 diabetes, the prevalence of ESRD in the receipt of dialysis also increased from 1.32% in 2005 to 1.47% in 2014. Risk factors for DKD development are age, race, family history, hyperglycemia, hypertension, dyslipidemia, dietary patterns, and lifestyles. Prognostic factors that aggravate DKD progression include age, family history, sex, glycemic control, blood pressure (BP), microvascular complications, and atherosclerosis. This review summarizes updated information on the onset and progression of DKD, particularly in the Taiwanese population. Translating these epidemiological features is essential to optimizing the kidney care and improving the prognosis of DKD in Asian populations.
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- 2021
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13. Liver-related long-term outcomes of alpha-glucosidase inhibitors in patients with diabetes and liver cirrhosis
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Fu-Shun Yen, Ming-Chih Hou, James Cheng-Chung Wei, Ying-Hsiu Shih, Chung Y. Hsu, Chih-Cheng Hsu, and Chii-Min Hwu
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all-cause mortality ,decompensated cirrhosis ,hepatic encephalopathy ,hepatic failure ,hepatocellular carcinoma ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Background: Adequate management of diabetes in patients with liver cirrhosis can be challenging. We conducted this study to investigate the liver-related long term outcomes of alpha-glucosidase inhibitors (AGIs) in patients with diabetes and cirrhosis.Methods: From National Health Insurance Research Database (NHIRD) in Taiwan, we recruited propensity-score matched alpha-glucosidase inhibitor users and non-users from a cohort of type 2 diabetes mellitus (T2DM) with compensated liver cirrhosis between 1 January 2000, and 31 December 2017, and followed them until 31 December 2018. Cox proportional hazards models with robust sandwich standard error estimates were used to assess the risk of main outcomes for alpha-glucosidase inhibitor users versus non-users.Results: The incidence rates of mortality during follow-up were 65.56 vs. 96.06 per 1,000 patient-years for alpha-glucosidase inhibitor users and non-users, respectively. The multivariable-adjusted model shows that alpha-glucosidase inhibitor users had significantly lower risks of all-cause mortality (aHR 0.63, 95% CI 0.56–0.71), hepatocellular carcinoma (aHR 0.55, 95% CI 0.46–0.67), decompensated cirrhosis (aHR 0.74 95% CI 0.63–0.87), hepatic encephalopathy (aHR 0.72, 95% CI 0.60–0.87), and hepatic failure (aHR 0.74, 95% CI 0.62–0.88) than alpha-glucosidase inhibitor non-users. Patients who received alpha-glucosidase inhibitors for a cumulative duration of more than 364 days had significantly lower risks of these outcomes than non-users.Conclusion: Alpha-glucosidase inhibitor use was associated with a lower risk of mortality, hepatocellular carcinoma, decompensated cirrhosis, and hepatic failure in patients with diabetes and compensated cirrhosis. alpha-glucosidase inhibitors may be useful for the management of diabetes in patients with compensated liver cirrhosis. Large-scale prospective studies are required to verify our results.
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- 2022
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14. Similarities and differences in the natural history of youth‐onset type 2 diabetes between the West and Asia
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Fu‐Shun Yen and Chii‐Min Hwu
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2022
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15. Corrigendum: The impact of alcohol consumption on cognitive impairment in patients with diabetes, hypertension, or chronic kidney disease
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Fu-Shun Yen, Shiow-Ing Wang, Shih-Yi Lin, Yung-Hsiang Chao, and James Cheng-Chung Wei
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cognitive impairment ,alcohol drinking ,diabetes ,hypertension ,chronic kidney disease ,Medicine (General) ,R5-920 - Published
- 2022
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16. Cardiovascular outcomes of metformin use in patients with type 2 diabetes and chronic obstructive pulmonary disease
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Fu-Shun Yen, James Cheng-Chung Wei, Lu-Ting Chiu, Chih-Cheng Hsu, and Chii-Min Hwu
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coronary artery disease ,heart failure ,metformin ,stroke ,cardiovascular events ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Aim: To know whether metformin use has different influence on cardiovascular risks in patients with type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD) as compared with metformin no-use.Methods: This study employed a retrospective cohort study design. Using propensity score matching, we recruited 55 ,224 pairs of metformin users and nonusers from Taiwan’s National Health Insurance Research Database between 1 January 2000, and 31 December 2017. Cox proportional-hazards models with robust standard error estimates were used to compare the risks of cardiovascular outcomes.Results: The mean study period of metformin users and nonusers was 11.04 (5.46) and 12.30 (4.85) years, respectively. Compared with the nonuse of metformin, the adjusted hazard ratios (95% CI) of metformin use for composited cardiovascular events, stroke, coronary artery disease, and heart failure were 0.51 (0.48–0.53), 0.62 (0.59–0.64), 0.48 (0.46–0.50), and 0.61 (0.57–0.65), respectively. The longer cumulative duration of metformin use had even lower adjusted hazard ratios compared with metformin nonuse.Conclusion: In patients with coexisting T2DM and COPD, metformin use was associated with significantly lower risks of CVD; moreover, longer duration of metformin use was associated with a lower risk of CVD. A well-designed prospective study is required to verify the results.
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- 2022
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17. Is insulin the preferred treatment in persons with type 2 diabetes and liver cirrhosis?
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Fu-Shun Yen, Jung-Nien Lai, James Cheng-Chung Wei, Lu-Ting Chiu, Chih-Cheng Hsu, Ming-Chih Hou, and Chii-Min Hwu
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All-cause mortality ,Hepatocellular carcinoma ,Hepatic failure ,Decompensated cirrhosis ,Hypoglycemia ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background Insulin is highly recommended for diabetes management in persons with liver cirrhosis. However, few studies have evaluated its long-term effects in these persons. We conducted this study to compare the risks of mortality, liver-related complications, and cardiovascular events in persons with type 2 diabetes mellitus (T2DM) and compensated liver cirrhosis. Methods From January 1, 2000, to December 31, 2012, we selected 2047 insulin users and 4094 propensity score-matched nonusers from Taiwan’s National Health Insurance Research Database. Cox proportional hazard models were used to assess the risks of outcomes. Results The mean follow-up time was 5.84 years. The death rate during the follow-up period was 5.28 and 4.07 per 100 person-years for insulin users and nonusers, respectively. In insulin users, the hazard ratios and 95% confidence intervals (CIs) of all-cause mortality, hepatocellular carcinoma, decompensated cirrhosis, hepatic failure, major cardiovascular events, and hypoglycemia were 1.31 (1.18–1.45), 1.18 (1.05–1.34), 1.53 (1.35–1.72), 1.26 (1.42–1.86), 1.41 (1.23–1.62), and 3.33 (2.45–4.53), respectively. Conclusions This retrospective cohort study indicated that among persons with T2DM and compensated liver cirrhosis, insulin users were associated with higher risks of death, liver-related complications, cardiovascular events, and hypoglycemia compared with insulin nonusers.
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- 2021
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18. The Impact of Alcohol Consumption on Cognitive Impairment in Patients With Diabetes, Hypertension, or Chronic Kidney Disease
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Fu-Shun Yen, Shiow-Ing Wang, Shih-Yi Lin, Yung-Hsiang Chao, and James Cheng-Chung Wei
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cognitive impairment ,alcohol drinking ,diabetes ,hypertension ,chronic kidney disease ,Medicine (General) ,R5-920 - Abstract
To investigate the impact of alcohol use on the risk of cognitive impairment in older adults with chronic illness, we used the Digit Symbol Substitution Test (DSST) to evaluate cognitive function in older adults (≥ 60 years) in the National Health and Nutrition Examination Survey. Participants were categorized as light drinkers, moderate and heavy drinkers. Logistic regression analyses were used to explore associations between cognitive impairment and alcohol drinking in patients with or without diabetes, hypertension, and chronic kidney disease (CKD). Multivariate analysis showed that alcohol heavy drinkers was significantly associated with a higher risk of cognitive impairment in patients with hypertension (aOR 6.089, 95% CI 1.318–28.13) and CKD (aOR 6.324, 95% CI 1.158–34.52) compared with light drinkers. The dose-response analyses revealed that moderate to heavy alcohol use was associated with a higher risk of cognitive decline in patients with diabetes and CKD, heavy drinking increased the risk of cognitive impairment in patients with hypertension. The impacts of alcohol drinking on cognitive impairment are significantly different in patients with different comorbidities.
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- 2022
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19. Association Between Endometriosis and Subsequent Risk of Sjögren’s Syndrome: A Nationwide Population-Based Cohort Study
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Yung-Hsiang Chao, Chin-Hsiu Liu, Yu-An Pan, Fu-Shun Yen, Jeng-Yuan Chiou, and James Cheng-Chung Wei
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Sjogren’s syndrome ,autoimmune disease ,endometriosis ,epidemiology ,cohort ,Immunologic diseases. Allergy ,RC581-607 - Abstract
ObjectiveThe relationship between endometriosis and the ensuing risk of Sjögren’s syndrome has remained unclear. This study aims to present epidemiological evidence for this connection.MethodsThis is a retrospective cohort study of endometriosis patients (ICD-9-CM 617.0-617.9 and 621.3) and matched comparison group between 2000 and 2012 in the National Taiwan Insurance Research Database. After age matching, we analyzed the association between endometriosis and Sjögren’s syndrome (ICD-9-CM 710.2). We used the Cox proportional hazard model to examine the hazard ratio of incidental Sjögren’s syndrome. Subgroup analyses on age, comorbidities, and disease duration were also performed.ResultsA total of 73,665 individuals were included in this study. We identified 14733 newly diagnosed endometriosis patients and 58,932 non-endometriosis comparison group. The adjusted hazard ratio (HR) for incidental Sjögren’s syndrome was 1.45 (95% confidence interval CI=1.27-1.65) in the endometriosis group, compared to the non-endometriosis comparison group. In subgroup analysis, the adjusted HR was 1.53 (95% CI=1.25-1.88) in the age group of 20-39 and 1.41 (95% CI =1.18-1.68) in the age of 40-64. Time-vary analysis showed that endometriosis who have a follow-up time of fewer than five years (adjusted HR=1.57, 95% CI=1.32-1.87) have a significantly highest risk of having subsequent Sjögren’s syndrome.ConclusionThis population-based cohort study indicated that having a history of endometriosis puts patients at an increased risk of getting Sjögren’s syndrome afterward, especially in the age group of 20-39 and within the first five years after the diagnosis of endometriosis. Clinicians should recognize this possible association in managing endometriosis or Sjögren’s syndrome patients.
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- 2022
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20. Serum uric acid and blood pressure among adolescents: data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2010–2011
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Kuan-Hung Lin, Fu-Shun Yen, Harn-Shen Chen, Chii-Min Hwu, and Chen-Chang Yang
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blood pressure ,uric acid ,adolescents ,nahsit ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Purpose Elevated serum uric acid (UA) is frequently observed in adults with high blood pressure (BP); however, data from adolescents are limited. We examined the association between serum UA and BP in a nationally representative sample of Taiwan adolescents. Material and methods Some 1384 participants, aged 14–19 years, from the Nutrition and Health Survey in Taiwan 2010–2011 were included for the study. Elevated BP was defined as systolic or diastolic BP ≥120/80 mmHg. The analyses examined the relationship between serum UA and BP using linear regression and odds ratios of having an elevated BP using logistic regression. Results In this study population, the mean age was 16.0 years, mean serum UA was 5.8 mg/dL, 22.5% were obese (body mass index ≥24 kg/m2) and 9.8% had an elevated BP. Compared to girls, boys are more likely to be obese and to have higher serum UA and BP. After full adjustments, systolic BP, diastolic BP and mean arterial pressure increased 0.45, 0.48 and 0.47 mmHg, respectively, for each 1-mg/dL increase in UA (p = 0.07, 0.03 and 0.02, respectively). The odds of having an elevated BP were 3.4 times higher in subjects of the upper tertile of serum UA than those of the lower tertile (p = 0.02). Conclusion Adolescents with factors as male, obesity, and UA ≥5.5 mg/dL were prone to have an elevated BP, regardless of age and family history of hypertension. The present study found that serum UA levels are significantly correlated to BP in Taiwanese adolescents.
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- 2021
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21. Long-term outcomes of adding alpha-glucosidase inhibitors in insulin-treated patients with type 2 diabetes
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Fu-Shun Yen, James Cheng-Chung Wei, Mei-Chen Lin, Chih-Cheng Hsu, and Chii-Min Hwu
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Insulin ,Alpha-glucosidase inhibitors ,All-cause mortality ,Cardiovascular death ,Coronary artery disease ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Background In insulin-treated patients with type 2 diabetes mellitus (T2DM), glycemic control is usually suboptimal. Methods This study compared the risks of mortality and cardiovascular events in insulin-treated patients adding or not adding alpha-glucosidase inhibitors (AGIs). Results This cohort study included data from the Taiwan National Health Insurance Research Database. In total, 17,417 patients newly diagnosed as having T2DM and undergoing insulin therapy during 2000–2012 were enrolled. Overall incidence rates of all-cause mortality, hospitalized coronary artery disease (CAD), stroke, and heart failure were compared between 4165 AGI users and 4165 matched nonusers. The incidence rates of all-cause mortality were 17.10 and 19.61 per 1000 person-years in AGI nonusers and users, respectively. Compared with nonusers, AGI users had a higher mortality risk [adjusted hazard ratio (aHR) = 1.21, 95% confidence interval (CI) = 1.05–1.40; p = 0.01]. Regarding AGI use, aHRs (95% CI) for cardiovascular death, non-cardiovascular death, hospitalized CAD, stroke, and heart failure were 1.20 (0.83–1.74), 1.27 (1.07–1.50), 1.12 (0.95–1.31), 0.98 (0.85–1.14), and 1.03 (0.87–1.22) respectively. Conclusion AGI use was associated with higher risks of all-cause mortality and non-cardiovascular death in insulin-treated patients with T2DM. Therefore, adding AGIs in insulin-treated patients may not be appropriate.
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- 2021
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22. Persons with type 2 diabetes and high insulin persistence were associated with a lower risk of mortality: A nationwide retrospective cohort study
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Fu‐Shun Yen, James Cheng‐Chung Wei, Jia‐Sin Liu, Chih‐Cheng Hsu, and Chii‐Min Hwu
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All‐cause mortality ,Cardiovascular disease ,Insulin persistence ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Aims/Introduction Studies assessing the long‐term outcomes of insulin persistence are scant. We compared the risk of all‐cause mortality among patients with different degrees of insulin persistence. Materials and Methods In total, 293,210 patients with type 2 diabetes mellitus undergoing insulin therapy were enrolled during 2002–2014. Insulin persistence was defined as continual insulin treatment without a 90‐day gap of discontinuation in the 2‐year observation period. Mortality rates were compared between 111,220 patients with ≥90% insulin persistence and 111,220 matched patients with
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- 2021
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23. Respiratory Outcomes of Insulin Use in Patients with COPD: A Nationwide Population-Based Cohort Study
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Fu-Shun Yen, Shu-Hao Chang, James Cheng-Chung Wei, Ying-Hsiu Shih, and Chii-Min Hwu
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mortality ,bacterial pneumonia ,non-invasive positive pressure ventilation ,invasive mechanical ventilation ,hypoglycemia ,Medicine ,Pharmacy and materia medica ,RS1-441 - Abstract
Acute exacerbations of chronic obstructive pulmonary disease (COPD) with severe hyperglycemia may require insulin to lower glucose levels in people with coexisting type 2 diabetes (T2D) and COPD. We conducted this study to examine the risk of hospitalization for COPD, pneumonia, ventilator use, lung cancer, hypoglycemia, and mortality with and without insulin use in people with T2D and COPD. We adopted propensity-score-matching to identify 2370 paired insulin users and non-users from Taiwan’s National Health Insurance Research Database between 1 January 2000 and 31 December 2018. Cox proportional hazards models and the Kaplan–Meier method were utilized to compare the risk of outcomes between study and control groups. The mean follow-up for insulin users and non-users was 6.65 and 6.37 years. Compared with no insulin use, insulin use was associated with a significantly increased risk of hospitalization for COPD (aHR 1.7), bacterial pneumonia (aHR 2.42), non-invasive positive pressure ventilation (aHR 5.05), invasive mechanical ventilation (aHR 2.72), and severe hypoglycemia (aHR 4.71), but with no significant difference in the risk of death. This nationwide cohort study showed that patients with T2D and COPD requiring insulin therapy may have an increased risk of acute COPD exacerbations, pneumonia, ventilator use, and severe hypoglycemia without a significant increase in the risk of death.
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- 2023
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24. Challenges of optimizing insulin therapy for patients with type 2 diabetes mellitus
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Fu‐Shun Yen and Chii‐Min Hwu
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2021
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25. Selection and Warning of Evidence-Based Antidiabetic Medications for Patients With Chronic Liver Disease
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Fu-Shun Yen, Chih-Cheng Hsu, James Cheng-Chung Wei, Ming-Chih Hou, and Chii-Min Hwu
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diabetes mellitus ,chronic liver disease ,antidiabetic medication ,compensated liver cirrhosis ,decompensated liver cirrhosis ,Medicine (General) ,R5-920 - Abstract
The global prevalence of chronic liver disease and diabetes mellitus (DM) has gradually increased potentially due to changes in diet and lifestyle. The choice of antidiabetic medications for patients with coexisting DM and chronic liver disease is complicated. Severe liver injury may decrease the metabolism of antidiabetic medications, resulting in elevated drug concentrations and adverse effects. The choice of antidiabetic medications in patients with chronic liver disease has not been well studied. The long-term outcomes of antidiabetic medications in patients with chronic liver disease have gained attention recently. Herein, we reviewed relevant articles to extend our understanding on the selection and warning of antidiabetic medications for patients with chronic liver disease.
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- 2022
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26. Thiazolidinedione Use in Individuals With Type 2 Diabetes and Chronic Obstructive Pulmonary Disease
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Fu-Shun Yen, James Cheng-Chung Wei, Yu-Cih Yang, Chih-Cheng Hsu, and Chii-Min Hwu
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mortality ,stroke ,coronary artery disease ,heart failure ,non-invasive positive pressure ventilation ,invasive mechanical ventilation ,Medicine (General) ,R5-920 - Abstract
Few studies have investigated the effects of various antidiabetic agents on individuals with both type 2 diabetes mellitus (T2DM) and Chronic obstructive pulmonary disease (COPD). This study compared mortality, cardiovascular events and respiratory outcomes in individuals with both T2DM and COPD taking TZD vs. those not taking TZD. From Taiwan's National Health Insurance Research Database, 12 856 propensity-score-matched TZD users and non-users were selected between January 1, 2000, and December 31, 2012. Cox proportional hazards models were used to calculate the risks of investigated outcomes. Compared with non-use of TZD, the adjusted hazard ratios (95% CI) of TZD use were stroke 1.63 (1.21–2.18), coronary artery disease 1.55 (1.15–2.10), heart failure 1.61 (1.06–2.46), non-invasive positive pressure ventilation 1.82 (1.46–2.27), invasive mechanical ventilation 1.23 (1.09–1.37), bacterial pneumonia 1.55 (1.42–1.70), and lung cancer 1.71 (1.32–2.22), respectively. The stratified analysis disclosed that rosiglitazone, not pioglitazone, was associated with significantly higher risk of major cardiovascular events than TZD non-users. In patients with concomitant T2DM and COPD, TZD use was associated with higher risks of cardiovascular events, ventilation use, pneumonia, and lung cancer. Use of TZD in these patients should be supported by monitoring for cardiovascular and respiratory complications.
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- 2021
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27. The Risk of Nephropathy, Retinopathy, and Leg Amputation in Patients With Diabetes and Hypertension: A Nationwide, Population-Based Retrospective Cohort Study
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Fu-Shun Yen, James Cheng-Chung Wei, Ying-Hsiu Shih, Chih-Cheng Hsu, and Chii-Min Hwu
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chronic kidney disease ,end-stage renal disease ,sight-threatening retinopathy ,leg amputation ,diabetes and hypertension ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
PurposeTo compare the risks of chronic kidney disease (CKD), end-stage renal disease (ESRD), sight-threatening retinopathy, and leg amputation between patients with diabetes or hypertension.MethodsFrom January 1, 2000, to December 31, 2015, we identified 28943 matched pairs of patients with diabetes with and without subsequent hypertension, 89102 pairs of patients with hypertension with and without subsequent diabetes, and 145294 pairs of patients with coexisting diabetes and hypertension with a previous history of diabetes or hypertension from Taiwan’s National Health Insurance Research Database. Cox proportional-hazard models were used for calculating the risks of CKD, sight-threatening retinopathy, and leg amputation.ResultsThe mean follow-up time of this study in different cohorts was between 3.59 and 4.28 years. In diabetes patients with vs. without subsequent hypertension, hypertension patients with vs. without subsequent diabetes, and comorbid diabetes and hypertension patients with previous diabetes vs. with previous hypertension, the adjusted HRs (95% CIs) for CKD were 2.77 (2.61-2.94), 1.73 (1.68-1.77), and 1.04 (1.02-1.07); for ESRD were 42.38 (22.62-79.4), 2.76 (2.43-3.13), and 0.72 (0.66-0.79); for sight-threatening retinopathy were 2.07 (1.85-2.3), 3.41 (3.14-3.71), and for leg amputation were 1.51 (1.43-1.58); and 4.74 (3.02-7.43), 6.27(4.72-8.31), and 1.19(1.03-1.38).ConclusionsThis study demonstrated that both diabetes and hypertension are risk factors for the development of CKD, retinopathy, and amputation. Tracing subsequent diabetes for patients with hypertension, and hypertension for patients with diabetes are important in clinical settings.
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- 2021
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28. Metformin Use before Influenza Vaccination May Lower the Risks of Influenza and Related Complications
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Fu-Shun Yen, James Cheng-Chung Wei, Ying-Hsiu Shih, Chung Y. Hsu, Chih-Cheng Hsu, and Chii-Min Hwu
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influenza ,vaccination ,pneumonia ,mortality ,Medicine - Abstract
Older adults are more likely to have influenza and respond less well to the flu vaccine. We conducted this study to investigate whether pre-influenza vaccination metformin use had an effect on influenza and relevant complications in older adults with type 2 diabetes mellitus. Propensity score matching was used to identify 28,169 pairs of metformin users and nonusers from Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2018. We used Cox proportional hazards models to calculate the risks of hospitalization for influenza, pneumonia, cardiovascular disease, ventilation, and mortality between metformin users and nonusers. Compared with metformin nonusers, the aHRs (95% CI) for metformin users at risk of hospitalization for influenza, pneumonia, cardiovascular disease, invasive mechanical ventilation, death due to cardiovascular disease, and all-cause mortality were 0.60 (0.34, 1.060), 0.63 (0.53, 0.76), 0.41 (0.36, 0.47), 0.56 (0.45, 0.71), 0.49 (0.33, 0.73), and 0.44 (0.39, 0.51), respectively. Higher cumulative duration of metformin use was associated with lower risks of these outcomes than no use of metformin. This cohort study demonstrated that pre-influenza vaccination metformin use was associated with lower risks of hospitalizations for influenza, pneumonia, cardiovascular disease, mechanical ventilation, and mortality compared to metformin nonusers.
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- 2022
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29. All-cause mortality of insulin plus dipeptidyl peptidase-4 inhibitors in persons with type 2 diabetes
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Fu-Shun Yen, Jen-Huai Chiang, Chii-Min Hwu, Yu-Hsin Yen, Boniface J. Lin, James Cheng-Chung Wei, and Chih-Cheng Hsu
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All-cause mortality ,Cohort study ,Match ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Background Dipeptidyl peptidase-4 (DPP-4) inhibitors could effectively reduce HbA1C and postprandial hyperglycemia and could incur only minimal danger of hypoglycemia. Patients with uncontrolled diabetes might be treated by the complementary action of insulin plus DPP-4 inhibitors. Here, we compared the all-cause mortality risk between DPP-4 inhibitor users and nonusers with underlying insulin therapy. Methods Using the population-based National Health Insurance Research Database of Taiwan, we conducted an 11-year retrospective cohort study. A total of 3120 patients undergoing insulin therapy for type 2 diabetes mellitus (T2DM) during 2000–2010 were enrolled. The overall incidence rates for all-cause mortality of 1560 DPP-4 inhibitor users and 1560 matched DPP-4 inhibitor nonusers were compared. Results No significant difference was found in the baseline demographic and clinical variables of the two groups of patients. Median follow-up period for the matched cohort was 1.67 years. All-cause mortality was observed in 93 (6.0%) of 1560 DPP-4 inhibitor nonusers and 36 (2.3%) of 1560 DPP-4 users. The incidence rate of mortality was 11.72 for DPP-4 inhibitor users and 38.16 per 1000 person-years for DPP-4 inhibitor nonusers. After multivariate adjustment, DPP-4 inhibitor users ran a reduced mortality risk (adjusted hazard ratio 0.32, 95% CI 0.22–0.47; p
- Published
- 2019
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30. Urate-Lowering Therapy May Prevent the Development of Coronary Artery Disease in Patients With Gout
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Fu-Shun Yen, Chih-Cheng Hsu, Hsin-Lun Li, James Cheng-Chung Wei, and Chii-Min Hwu
- Subjects
urate-lowering therapy ,coronary artery disease ,stroke ,heart failure ,gout ,Medicine (General) ,R5-920 - Abstract
Substantial evidence has demonstrated a close relationship between hyperuricemia and cardiovascular (CV) diseases, but few studies have explored the possibility of using urate-lowering therapy (ULT) to attenuate the development of CV diseases. To compare the risks of incident coronary artery disease (CAD), stroke, and heart failure (HF) between ULT users and non-users in patients with gout, we conducted a retrospective cohort study from the population-based National Health Insurance Research Database in Taiwan. In total, 4,072 patients with gout were included between 2000 and 2012. The overall incident rates of CAD, stroke, and HF were compared between 2,036 ULT users and 2,036 matched non-users. The incident rates of incident CAD were 1.3 and 1.7 per 100 person-years for ULT users and non-users. ULT users had a lower adjusted hazard ratio (aHR) for CAD [aHR: 0.7, 95% confidence interval (CI): 0.55–0.89] compared with non-users. ULT users also had a lower aHR for incident stroke (aHR: 0.68, 95% CI: 0.5–0.92) compared with non-users. ULT had a neutral effect on the risk of incident HF (aHR: 0.92, 95% CI: 0.58–1.45). Among the urate-lowering therapy, subgroup analyses indicated that uricosuric agents had a significant effect on the prevention of CAD and stroke development; and the protection against the development of CAD by uricosuric agents appeared to have a dose-response trend. Our study demonstrated that ULT associated with lower risks of incident CAD and stroke. We recommend that patients with gout receive ULT to lower the burden of CV diseases.
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- 2020
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31. Urate-lowering therapy may mitigate the risks of hospitalized stroke and mortality in patients with gout.
- Author
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Fu-Shun Yen, Chih-Cheng Hsu, Hsin-Lun Li, James Cheng-Chung Wei, and Chii-Min Hwu
- Subjects
Medicine ,Science - Abstract
ObjectivesAlthough studies have demonstrated the association of hyperuricemia with cardiovascular (CV) diseases, few have explored the effect of urate-lowering therapy (ULT) on the incidence of CV diseases. Therefore, we compared the risks of hospitalized coronary artery disease (CAD), stroke, heart failure (HF), and all-cause mortality between ULT users and nonusers among patients with gout.MethodsWe performed this retrospective cohort study using Taiwan's population-based National Health Insurance Research Database. In total, 5218 patients with gout were included from 2000 to 2012. We compared the incidence rates (IRs) of hospitalized CAD, stroke, HF, and all-cause mortality between ULT users and matched nonusers.ResultsThe IRs of hospitalized stroke were 0.6 and 1.0 per 100 person-years for ULT users and nonusers, respectively, after adjusting for age, sex, residence, comorbidities, and medications. ULT users showed lower adjusted hazard ratios (aHR) for hospitalized stroke (aHR: 0.52, p < 0.001) and all-cause mortality (aHR: 0.6, p = 0.02) than nonusers. Subgroup analyses revealed that uricosuric agents and xanthine oxidase inhibitors were significantly associated with lower risks of hospitalized stroke and all-cause mortality, respectively. The effect of uricosuric agents on the decrease in hospitalized stroke risk indicated a dose-response relationship.ConclusionsOur study showed lower risks of hospitalized stroke and all-cause mortality in ULT users than in nonusers among patients with gout. Therefore, patients with gout may receive ULT to mitigate the risks of hospitalized stroke and mortality.
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- 2020
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32. Sulfonylureas may be useful for glycemic management in patients with diabetes and liver cirrhosis.
- Author
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Fu-Shun Yen, Jung-Nien Lai, James Cheng-Chung Wei, Lu-Ting Chiu, Chii-Min Hwu, Ming-Chih Hou, and Chih-Cheng Hsu
- Subjects
Medicine ,Science - Abstract
This study aimed to investigate the long-term outcomes of sulfonylurea (SU) use in patients with T2DM and compensated liver cirrhosis. From January 1, 2000, to December 31, 2012, we selected the data of 3781 propensity-score-matched SU users and nonusers from Taiwan's National Health Insurance Research Database. The mean follow-up time for this study was 5.74 years. Cox proportional hazards models with robust sandwich standard error estimates were used to compare the risks of main outcomes between SU users and nonusers. The incidence of mortality during follow-up was 3.24 and 4.09 per 100 person-years for SU users and nonusers, respectively. The adjusted hazard ratios and 95% confidence intervals for all-cause mortality, major cardiovascular events, and decompensated cirrhosis in SU users relative to SU nonusers were 0.79 (0.71-0.88), 0.69 (0.61-0.80), and 0.82 (0.66-1.03), respectively. The SU-associated lower risks of death and cardiovascular events seemed to have a dose-response trend. This population-based cohort study demonstrated that SU use was associated with lower risks of death and major cardiovascular events compared with SU non-use in patients with T2DM and compensated liver cirrhosis. SUs may be useful for glycemic management for patients with liver cirrhosis.
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- 2020
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33. Diabetes, Hypertension, and the Risk of Dementia
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Fu-Shun, Yen, James Cheng-Chung, Wei, Hei-Tung, Yip, Chii-Min, Hwu, and Chih-Cheng, Hsu
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Male ,Dementia, Vascular ,General Neuroscience ,Taiwan ,General Medicine ,Cohort Studies ,Psychiatry and Mental health ,Clinical Psychology ,Diabetes Mellitus, Type 2 ,Risk Factors ,Hypertension ,Humans ,Female ,Geriatrics and Gerontology ,Retrospective Studies - Abstract
Background: Type 2 diabetes (T2D) and hypertension (HTN) are well-known modifiable risk factors for dementia, but their intricate attributes accounting for dementia development has not been clearly delineated. Objective: We conducted this study to investigate and compare the effects of T2D and HTN on dementia risk. Methods: We screened data of matched pairs of patients with T2D or HTN between January 1, 2000 and December 31, 2017 from Taiwan’s National Health Insurance Research Database. Fine and Gray’s subdistribution hazard models were used for calculating the risk of dementia. Results: Patients with T2D and subsequent HTN were associated with significantly higher risks of all-cause dementia (aHR 1.51, 95% CI 1.25–1.83) and vascular dementia (aHR 2.30, 95% CI 1.71–3.13) compared with those without subsequent HTN. Patients with HTN and subsequent T2D were associated with significantly higher risks of all-cause dementia (aHR 1.15, 95% CI 1.08–1.21), vascular dementia (aHR 1.25, 95% CI 1.62–1.34), and other dementia (aHR 1.31, 95% CI 1.03–1.66) compared with those without subsequent HTN. The subgroups of male and female patients, age of 50–69 and 70–90 years with subsequent comorbidity were associated with significantly higher risks of all-cause dementia and vascular dementia than those without subsequent comorbidity. Conclusion: This nationwide cohort study demonstrated that patients with T2D and subsequent HTN had association with higher risks of all-cause dementia and vascular dementia, and those with HTN and subsequent T2D were associated with higher risks of all-cause dementia, vascular dementia, and other dementia.
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- 2022
34. Comment on Yang et al. GLP-1RAs for Ischemic Stroke Prevention in Patients With Type 2 Diabetes Without Established Atherosclerotic Cardiovascular Disease. Diabetes Care 2022;45:1184-1192
- Author
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Cheng-Hsien Hung, Fu-Shun Yen, and James Cheng-Chung Wei
- Subjects
Advanced and Specialized Nursing ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Ischemia ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,Humans ,Atherosclerosis ,Ischemic Stroke - Published
- 2022
35. Sulfonylurea Use in Patients with Type 2 Diabetes and COPD: A Nationwide Population-Based Cohort Study
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Fu-Shun Yen, James Cheng-Chung Wei, Teng-Shun Yu, Chung Y. Hsu, Chih-Cheng Hsu, and Chii-Min Hwu
- Subjects
Cohort Studies ,Pulmonary Disease, Chronic Obstructive ,Sulfonylurea Compounds ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,Humans ,all-cause mortality ,major adverse cardiovascular events ,non-invasive positive pressure ventilation ,invasive mechanical ventilation ,bacterial pneumonia ,lung cancer ,Retrospective Studies - Abstract
We conducted this study to investigate the long-term outcomes of sulfonylurea (SU) use in patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D). We used propensity-score matching to identify 6008 pairs of SU users and nonusers from Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2017. Cox proportional hazard models were used to compare the risks of mortality, cardiovascular events, non-invasive positive pressure ventilation, invasive mechanical ventilation, bacterial pneumonia, lung cancer, and hypoglycemia between SU users and nonusers. In the matched cohorts, the mean follow-up time for SU users and nonusers was 6.57 and 5.48 years, respectively. Compared with nonusers, SU users showed significantly lower risks of mortality [aHR 0.53(0.48–0.58)], cardiovascular events [aHR 0.88(0.81–0.96)], non-invasive positive pressure ventilation [aHR 0.74(0.6–0.92)], invasive mechanical ventilation [aHR 0.57(0.5–0.66)], and bacterial pneumonia [aHR 0.78(0.7–0.87)]. A longer cumulative duration of SU use was associated with a lower risk of these outcomes. This nationwide cohort study demonstrated that SU use was associated with significantly lower risks of cardiovascular events, ventilation use, bacterial pneumonia, and mortality in patients with COPD and T2D. SU may be a suitable option for diabetes management in these patients.
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- 2022
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36. The Risk of Severe Hypoglycemia and Mortality in Patients with Type 2 Diabetes and Discharged with Acute Liver Injury
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Fu-Shun Yen, Ming-Chih Hou, Chun-Wei Pan, Jia-Sin Liu, Chih-Cheng Hsu, and Chii-Min Hwu
- Subjects
Advanced and Specialized Nursing ,Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
OBJECTIVE To compare the risks of severe hypoglycemia and mortality between patients with type 2 diabetes (T2D) and discharged with and without acute liver injury. RESEARCH DESIGN AND METHODS From 1 January 2000 to 31 December 2010, we identified patients with T2D and hospitalization for acute liver injury and hospitalization for other causes from the National Health Insurance Research Database of Taiwan. Multivariable-adjusted Cox proportional hazards models were used to compare the risks of severe hypoglycemia and mortality between the study and control groups. RESULTS The incidence rates and adjusted hazard ratios (aHRs) for severe hypoglycemia within 90 days and 365 days after discharge were 12.28 and 5.59/1,000 person-years (aHR 1.92 [1.30–2.85]) and 7.35 and 2.9/1,000 person-years (aHR 1.98 [1.52–2.58]) for patients discharged with and without acute liver injury, respectively. The incidence rates and aHRs for mortality within 90 days and 365 days after discharge were 82.4 and 27.54/1,000 person-years (aHR 1.73 [1.46–2.05]) and 36.8 and 9.3/1,000 person-years (aHR 1.94 [1.69–2.24]) for patients discharged with and without acute liver injury, respectively. The subgroup analysis of hypoglycemia risk in patients discharged with acute liver injury revealed no significant interaction in risk factors of age, chronic kidney disease, and medications, except for sex difference, which has significant interaction. CONCLUSIONS This cohort study demonstrated that patients with T2D and discharged with acute liver injury showed significantly higher risks of severe hypoglycemia and mortality within 90 days and 365 days after discharge than patients discharged with other causes.
- Published
- 2022
37. Effects of metformin use on total mortality in patients with type 2 diabetes and chronic obstructive pulmonary disease: A matched-subject design.
- Author
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Fu-Shun Yen, Weishan Chen, James Cheng-Chung Wei, Chih-Cheng Hsu, and Chii-Min Hwu
- Subjects
Medicine ,Science - Abstract
BACKGROUNDS:Few studies have investigated the therapeutic effects of metformin in patients with type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD). We compared the risk of all-cause mortality between metformin users and nonusers. METHODS:We conducted a retrospective cohort study for patients with T2DM and COPD who were enrolled between January 1, 2000 and June 30, 2012. Individuals with exacerbated symptoms who were hospitalized or sent to the emergency department (ED) were identified as having exacerbated COPD; outpatient claims were identified as having stable COPD. A total of 40,597 metformin users and 39,529 nonusers comprised the cohort of stable COPD; 14,001 metformin users and 21,613 nonusers comprised the cohort of exacerbated COPD. Users and nonusers were matched using propensity score (1:1). Our primary outcome was all-cause mortality. RESULTS:A total of 19,505 metformin users were matched to 19,505 nonusers in the cohort of diabetes with stable COPD. The mean follow-up time was 3.91 years. All-cause mortality was reported in 1326 and 1609 metformin users and nonusers, respectively. After multivariate adjustment, metformin users had lower risk of mortality (adjusted hazard ratio [aHR] = 0.84, p < 0.0001). Metformin users had significantly lower risk of noncardiovascular death (aHR = 0.86, p = 0.0008). A total of 7721 metformin users were matched to 7721 nonusers in the cohort of diabetes with exacerbated COPD. The mean follow-up time was 3.18 years. All-cause mortality was reported in 1567 and 1865 metformin users and nonusers, respectively. After multivariate adjustment, metformin users had significantly lower risk of mortality (aHR = 0.89, p = 0.002) and cardiovascular death (aHR = 0.70, p = 0.01). CONCLUSION:This large-series, nationwide cohort study demonstrated that metformin use could significantly lower the risk of all-cause mortality in patients with T2DM and either stable or exacerbated COPD.
- Published
- 2018
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38. Epidemiological characteristics of diabetic kidney disease in Taiwan
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Kun-Der Lin, Jun-Sing Wang, Chih-Cheng Hsu, Yueh-Han Hsu, Fu-Shun Yen, and Shyi-Jang Shin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Population ,Taiwan ,Review Article ,Type 2 diabetes ,Prognostic factors ,Diseases of the endocrine glands. Clinical endocrinology ,End stage renal disease ,Young Adult ,Renal Dialysis ,Internal medicine ,Diabetes mellitus ,Prevalence ,Internal Medicine ,medicine ,Humans ,Diabetic Nephropathies ,Diabetic kidney disease ,Family history ,education ,Dialysis ,Aged ,Type 1 diabetes ,education.field_of_study ,business.industry ,Incidence ,General Medicine ,Middle Aged ,RC648-665 ,medicine.disease ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Risk factors ,Kidney Failure, Chronic ,Female ,business ,Dyslipidemia - Abstract
Diabetic kidney disease (DKD) is a critical microvascular complication of diabetes. With the continuous increase in the prevalence of diabetes since 2000, the prevalence of DKD has also been increasing in past years. The prevalence of DKD among individuals with type 2 diabetes in Taiwan increased from 13.32% in 2000 to 17.92% in 2014. The cumulative incidence of DKD among individuals with type 1 diabetes in Taiwan was higher than 30% during 1999–2012. DKD is the leading cause of end‐stage renal disease (ESRD), with a prevalence of approximately 45% in a population on chronic dialysis in Taiwan. Among individuals with type 2 diabetes, the prevalence of ESRD in the receipt of dialysis also increased from 1.32% in 2005 to 1.47% in 2014. Risk factors for DKD development are age, race, family history, hyperglycemia, hypertension, dyslipidemia, dietary patterns, and lifestyles. Prognostic factors that aggravate DKD progression include age, family history, sex, glycemic control, blood pressure (BP), microvascular complications, and atherosclerosis. This review summarizes updated information on the onset and progression of DKD, particularly in the Taiwanese population. Translating these epidemiological features is essential to optimizing the kidney care and improving the prognosis of DKD in Asian populations., This review summarizes updated information on the onset and progression of DKD, particularly in Taiwan. Translating these epidemiological features is essential to optimizing kidney care and improving the prognosis of DKD in Asian populations.
- Published
- 2021
39. Metformin use and the risks of herpes zoster and postherpetic neuralgia in patients with type 2 diabetes
- Author
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Fu‐Shun Yen, James Cheng‐Chung Wei, Hei‐Tung Yip, Chih‐Cheng Hsu, and Chii‐Min Hwu
- Subjects
Infectious Diseases ,Virology - Abstract
Herpes zoster and postherpetic neuralgia cause substantial pain in patients. Persons with type 2 diabetes (T2D) are prone to zoster infection and postherpetic neuralgia due to compromised immunity. We conducted this study to evaluate the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers. Propensity score matching was utilized to select 47 472 pairs of metformin users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers in patients with T2D. Compared with no-use of metformin, the adjusted hazard ratios (95% confidence interval) for metformin use in herpes zoster and postherpetic neuralgia were 0.70 (0.66, 0.75) and 0.510 (0.39, 0.68), respectively. A higher cumulative dose of metformin had further lower risks of herpes zoster and postherpetic neuralgia than metformin no-use. This nationwide cohort study demonstrated that metformin use was associated with a significantly lower risk of herpes zoster and postherpetic neuralgia than metformin no-use. Moreover, a higher cumulative dose of metformin was associated with further lower risks of these outcomes.
- Published
- 2022
40. Metformin use before COVID-19 vaccination and the risks of COVID-19 incidence, medical utilization, and all-cause mortality in patients with type 2 diabetes mellitus
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Fu-Shun Yen, Shiow-Ing Wang, Shih-Yi Lin, and James Cheng-Chung Wei
- Subjects
Endocrinology ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,General Medicine - Published
- 2023
41. Maternal autoimmune disease associated with a higher risk of offspring with type 1 diabetes: A nationwide mother-child cohort study in Taiwan
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Fu-Shun Yen, Jing-Yang Huang, Shih-Yi Lin, Pei-Lun Liao, and James Cheng-Chung Wei
- Subjects
Endocrinology ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,General Medicine - Published
- 2023
42. Metformin and the Development of Asthma in Patients with Type 2 Diabetes
- Author
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Fu-Shun Yen, Chih-Cheng Hsu, Ying-Hsiu Shih, Wei-Lin Pan, James Cheng-Chung Wei, and Chii-Min Hwu
- Subjects
Hospitalization ,Diabetes Mellitus, Type 2 ,Health, Toxicology and Mutagenesis ,Incidence ,Public Health, Environmental and Occupational Health ,Taiwan ,type 2 diabetes ,metformin ,asthma ,exacerbation ,hospitalization ,Humans ,Hypoglycemic Agents ,Asthma ,Metformin ,Proportional Hazards Models ,Retrospective Studies - Abstract
We conducted this study to compare the risks of asthma development and exacerbation between metformin users and nonusers. Overall, 57,743 propensity score-matched metformin users and nonusers were identified from Taiwan’s National Health Insurance Research Database between 1 January 2000, and 31 December 2017. We used the Cox proportional hazards model with robust standard error estimates to compare the risks of asthma onset, exacerbation, and hospitalization for asthma in participants with type 2 diabetes (T2D). Compared with metformin nonuse, the aHRs (95% CI) for metformin use in asthma development, exacerbation, and hospitalization for asthma were 1.13 (1.06–1.2), 1.62 (1.35–1.95), and 1.5 (1.22–1.85), respectively. The cumulative incidences of asthma development, exacerbation, and hospitalization for asthma were significantly higher in metformin users than nonusers (p < 0.001). A longer cumulative duration of metformin use for more than 728 days was associated with significantly higher risks of outcomes than metformin nonuse. Our study demonstrated that metformin users showed significantly higher risks of asthma development, exacerbation, and hospitalization for asthma than metformin nonusers. Moreover, metformin use for more than 728 days was associated with higher risks of outcomes. A randomized control study is warranted to verify our results.
- Published
- 2022
43. Urate-lowering Therapy and Chronic Kidney Disease Development in Patients with Gout
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Fu Shun Yen, Chih Cheng Hsu, James Cheng-Chung Wei, Chii Min Hwu, Chia Ling Chang, and Chen Chang Yang
- Subjects
Adult ,Male ,medicine.medical_specialty ,hypertension ,Population ,Comorbidity ,Lower risk ,urologic and male genital diseases ,Gout Suppressants ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,gout ,Risk Factors ,Internal medicine ,medicine ,Humans ,Hyperuricemia ,Renal Insufficiency, Chronic ,education ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Incidence ,urate-lowering therapy ,Hazard ratio ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Gout ,diabetes mellitus ,Female ,030211 gastroenterology & hepatology ,business ,chronic kidney disease ,Follow-Up Studies ,Cohort study ,Kidney disease ,Research Paper - Abstract
Objectives: Chronic kidney disease (CKD) has emerged as a global health concern. Many studies have identified an association between hyperuricemia and CKD, and some studies have revealed that urate-lowering therapy (ULT) can attenuate CKD progression. However, only a few studies have explored the role of ULT in the prevention of new onset CKD. Methods: To compare the risk of incident CKD between users and nonusers of ULT in patients with gout, we conducted a 13-year population-based retrospective cohort study. Overall incidence of CKD was compared between 7126 ULT users and 7126 matched ULT nonusers. Results: The CKD incidence rate for both the users and nonusers of ULT was 1.7 per 100 person-years, after adjusting for sex, age, region of residence, comorbidities, and medications used. No significant difference in CKD risk (adjusted hazard ratio [aHR]: 0.97; 95% confidence interval [CI]: 0.88-1.07) was noted between the ULT users and nonusers. In the subgroup of patients with diabetes mellitus (DM) and without hypertension (HT), ULT tended to be associated with lower risk of incident CKD (aHR: 0.52; 0.95% CI: 0.28-0.97). Compared with the risk of new onset CKD in patients receiving xanthine oxidase inhibitors, those receiving uricosuric agents seemed to have a lower risk of developing CKD (aHR: 0.81, 95% CI: 0.67-0.99). Conclusion: This population-based cohort study indicated that ULT is not associated with lower risk of CKD development. However, in the subgroup of patients with DM and without HT, ULT is associated with significantly lower risk of incident CKD.
- Published
- 2021
44. Dipeptidyl peptidase-4 inhibitors may accelerate cirrhosis decompensation in patients with diabetes and liver cirrhosis: a nationwide population-based cohort study in Taiwan
- Author
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James Cheng-Chung Wei, Chih-Cheng Hsu, Fu-Shun Yen, Chii-Min Hwu, Hei-Tung Yip, and Ming-Chih Hou
- Subjects
medicine.medical_specialty ,Cirrhosis ,Hepatology ,business.industry ,Proportional hazards model ,Hazard ratio ,Type 2 Diabetes Mellitus ,medicine.disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Diabetes mellitus ,Cohort ,medicine ,030211 gastroenterology & hepatology ,Decompensation ,business - Abstract
Management of type 2 diabetes mellitus (T2DM) in patients with liver cirrhosis is complex and suboptimal, but no clinical trial has adequately investigated antidiabetic drug use for such patients. We evaluate the risk of mortality, cardiovascular events, and hepatic outcomes between dipeptidyl peptidase-4 (DPP-4) inhibitor users and nonusers in patients with type 2 diabetes mellitus (T2DM) and cirrhosis. We selected 2828 paired propensity score matched DPP-4 inhibitor users and nonusers from a cohort of T2DM with compensated liver cirrhosis between January 1, 2007, and December 31, 2012. Cox proportional hazards models were used to assess the risk of main outcomes for DPP-4 inhibitor users. The incidence rate of decompensated cirrhosis during follow-up was 2.20 and 1.53 per 100 patient-years (adjusted hazard ratio [aHR] 1.35, 95% confidence interval [CI] 1.03–1.77) for DPP-4 inhibitor users and nonusers, respectively. The aHRs (95% CI) of variceal bleeding and hepatic failure were 1.67 (1.11–2.52) and 1.35 (1.02–1.79), respectively, for DPP-4 inhibitor users over nonusers. The risk of all-cause mortality, hepatocellular carcinoma, and major cardiovascular events between DPP-4 inhibitor users and nonusers were not statistically different. This study found that DPP-4 inhibitor users were associated with higher risks of decompensated cirrhosis and hepatic failure than did nonusers among patients with T2DM and compensated liver cirrhosis. We must continue to search for appropriate antidiabetic drugs for patients with liver cirrhosis.
- Published
- 2021
45. Liver‐related long‐term outcomes of thiazolidinedione use in persons with type 2 diabetes
- Author
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Yu-Cih Yang, Ming‐Chih Hou, Chih-Cheng Hsu, Fu-Shun Yen, James Cheng-Chung Wei, Chii-Min Hwu, and Yi Hsiang Huang
- Subjects
nonalcoholic fatty liver disease ,medicine.medical_specialty ,Cirrhosis ,Type 2 diabetes ,liver‐related death ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,hepatic decompensation ,Nonalcoholic fatty liver disease ,medicine ,Humans ,Hypoglycemic Agents ,Cumulative incidence ,Metabolic & Toxic Liver Diseases ,Retrospective Studies ,Hepatology ,business.industry ,cirrhosis ,Hazard ratio ,Retrospective cohort study ,medicine.disease ,Confidence interval ,hepatic failure ,all‐cause mortality ,Diabetes Mellitus, Type 2 ,Liver ,030220 oncology & carcinogenesis ,Propensity score matching ,030211 gastroenterology & hepatology ,Original Article ,Thiazolidinediones ,business - Abstract
Background & Aims Studies have described prominent histologic improvement in patients with nonalcoholic steatohepatitis (NASH) using thiazolidinedione (TZD); however, these were all short term with moderate sample size, no liver‐related long‐term outcomes could be noted. Methods This retrospective cohort study enrolled patients with newly diagnosed type 2 diabetes mellitus (T2DM) from Taiwan's National Health Insurance Research Database between 1 January 2000 and 31 December 2013. We matched TZD users and nonusers at a 1:1 ratio through propensity score matching. This study included 5095 paired TZD users and nonusers. Cox proportional hazard models were used to compare the risks of cirrhosis, hepatic decompensation, hepatic failure and all‐cause mortality between TZD users and nonusers. The Kaplan‐Meier method was used to compare the cumulative incidence of these main outcomes. Results The incidence rates of cirrhosis, hepatic decompensation, hepatic failure and all‐cause mortality during follow‐up were 0.77 vs 1.95, 1.43 vs 1.75, 0.36 vs 0.70, and 4.89 vs 3.78 per 1000 person‐years between TZD users and nonusers. The adjusted hazard ratios of cirrhosis, hepatic decompensation, hepatic failure and all‐cause mortality were 0.39 (95% confidence interval [CI]: 0.21‐0.72), 0.86 (95% CI: 0.52‐1.44), 0.46 (95% CI: 0.18‐1.17) and 1.18 (95% CI: 0.87‐1.61) respectively. Conclusions Our study demonstrated that TZD use could significantly lower the risk of cirrhosis. In clinical settings, TZD use might be able to improve liver‐related long‐term outcomes.
- Published
- 2020
46. Comment on Shih et al. Increased Incidence of Pediatric Type 1 Diabetes With Novel Association With Coxsackievirus A Species in Young Children but Declined Incidence in Adolescents in Taiwan. Diabetes Care 2021;44:1579-1585
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Fu-Shun Yen and James Cheng-Chung Wei
- Subjects
Advanced and Specialized Nursing ,Diabetes Mellitus, Type 1 ,e-Letters – Comments and Responses ,Adolescent ,Diabetes Mellitus, Type 2 ,Endocrinology, Diabetes and Metabolism ,Child, Preschool ,Incidence ,Internal Medicine ,Taiwan ,Humans ,Child - Published
- 2022
47. Maternal Autoimmune Disease Associated with a Higher Risk of Children with Type 1 Diabetes: A Nationwide Maternal and Child Cohort Study in Taiwan
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Fu-Shun Yen, Jing Yang Huang, Shih-Yi Lin, Pei-Lun Liao, and James Cheng-Chung Wei
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- 2022
48. Long-term outcomes of the pay-for-performance program for patients with young-onset (20–40 years of age) type 2 diabetes
- Author
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Fu-Shun, Yen, James, Cheng-Chung Wei, Yu-Tung, Hung, Chih-Cheng, Hsu, and Chii-Min, Hwu
- Subjects
Cohort Studies ,Endocrinology ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Endocrinology, Diabetes and Metabolism ,Taiwan ,Internal Medicine ,Humans ,General Medicine ,Reimbursement, Incentive ,Proportional Hazards Models - Abstract
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.
- Published
- 2022
49. Metformin use and the risk of bacterial pneumonia in patients with type 2 diabetes
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Fu-Shun Yen, James Cheng-Chung Wei, Ying-Hsiu Shih, Chih-Cheng Hsu, and Chii-Min Hwu
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Multidisciplinary ,endocrine system diseases ,Incidence ,Taiwan ,nutritional and metabolic diseases ,Middle Aged ,Metformin ,Diabetes Mellitus, Type 2 ,Risk Factors ,Pneumonia, Bacterial ,Humans ,Hypoglycemic Agents ,Proportional Hazards Models ,Retrospective Studies - Abstract
Persons with type 2 diabetes (T2D) have neutrophil dysfunction with a higher risk of infection than those without diabetes. We conducted this study aiming to compare the risk of pneumonia between metformin use and nonuse in persons with T2D. We identified 49,012 propensity score-matched metformin users and nonusers from Taiwan’s National Health Insurance Research Database between January 1, 2000, and December 31, 2017. We used the Cox proportional hazards model to compare the risks of pneumonia and respiratory death. The mean (SD) age of the participants was 57.46 (12.88) years, and the mean follow-up time for metformin users and nonusers was 5.47 (3.71) years and 5.15 (3.87) years, respectively. Compared with the nonuse of metformin, the adjusted hazard ratios (95% CI) for metformin use in bacterial pneumonia, invasive mechanical ventilation, and respiratory cause of death were 0.89 (0.84–0.94), 0.77 (0.73–0.82), and 0.64 (0.56–0.74), respectively. A longer cumulative duration of metformin use had further lower adjusted hazard ratios in these risks compared with nonuse. In patients with T2D, metformin use was associated with significantly lower risks of bacterial pneumonia, invasive mechanical ventilation, and respiratory cause of death; moreover, longer metformin use duration was associated with lower hazard ratios of these risks.
- Published
- 2021
50. Metformin and the Risk of Chronic Urticaria in Patients with Type 2 Diabetes
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Fu-Shun Yen, Chih-Cheng Hsu, Kai-Chieh Hu, Yu-Tung Hung, Chung Y. Hsu, James Cheng-Chung Wei, and Chii-Min Hwu
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Incidence ,Health, Toxicology and Mutagenesis ,type 2 diabetes ,metformin ,chronic urticaria ,development ,hospitalization ,Taiwan ,Public Health, Environmental and Occupational Health ,Metformin ,Cohort Studies ,Diabetes Mellitus, Type 2 ,Risk Factors ,Humans ,Hypoglycemic Agents ,Chronic Urticaria ,Proportional Hazards Models ,Retrospective Studies - Abstract
We conducted this study to determine the effect of metformin use on the risk of new-onset chronic urticaria in patients with type 2 diabetes (T2D). In total, 24,987 pairs of metformin users and nonusers were identified with propensity score-matching from Taiwan’s National Health Insurance Research Database from 1 January 2000, to 31 December 2017. Multivariable Cox proportional hazards models were used to compare the risks of chronic urticaria development, severe chronic urticaria, and hospitalization for chronic urticaria between metformin users and nonusers. Compared with metformin nonuse, the aHRs (95% CI) for metformin use in chronic urticaria development, severe chronic urticaria, and hospitalization for chronic urticaria were 1.56 (1.39–1.74), 0.40 (0.12–1.30), and 1.45 (0.82–2.56), respectively. The cumulative incidence of chronic urticaria development was significantly higher in metformin users than in nonusers (p < 0.0001). A longer average cumulative duration of metformin use was associated with higher risks of new-onset and hospitalization for chronic urticaria than metformin nonuse. This nationwide cohort study showed that metformin use was associated with a significantly higher risk of chronic urticaria development. A longer average cumulative duration of metformin use was associated with a higher risk of outcomes. More prospective studies are needed to verify our results.
- Published
- 2022
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