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4. Characterising frailty, metrics of continuous glucose monitoring, and mortality hazards in older adults with type 2 diabetes on insulin therapy (HARE):a prospective, observational cohort study

Author

Fung, E. (Erik), Lui, L.-T. (Leong-Ting), Huang, L. (Lei), Cheng, K. F. (King Fai), Lau, G. H. (Gloria H. W.), Chung, Y. T. (Yi Ting), Ahmadabadi, B. N. (Behzad Nasiri), Xie, S. (Suyi), Lee, J. S. (Jenny S. W.), Hui, E. (Elsie), So, W. Y. (Wing Yee), Sung, J. J. (Joseph J. Y.), King, I. (Irwin), Goggins, W. B. (William B.), Chan, Q. (Queenie), Järvelin, M.-R. (Marjo-Riitta), Ma, R. C. (Ronald C. W.), Chow, E. (Elaine), and Kwok, T. (Timothy)

Abstract

Summary Background: To our knowledge, no previous study has examined the inter-relationship between frailty, dysglycaemia, and mortality in frail older adults with type 2 diabetes who are on insulin therapy. We used continuous glucose monitors (CGMs) to profile this patient population and determine the prognostic value of CGM metrics. We hypothesised that incremental frailty was associated with increased hypoglycaemia or time below range (TBR). Methods: HARE was a multicentre, prospective, observational cohort study with mortality hazard analysis carried out in four hospitals in Hong Kong. Eligible participants were community-living adults aged 70 years and older; had had type 2 diabetes for 5 years or more; were on insulin therapy; were frail; and were not hospitalised at the time of frailty assessment and CGM recording. Glucose control was characterised according to the Advanced Technologies and Treatments for Diabetes 2019 international consensus clinical targets. Frailty index was computed, and comprehensive frailty assessments and targeted serum metabolic profiling were performed. The Jonckheere-Terpstra test for trend was used to analyse frailty index tertiles and variables. Inter-relationships between CGM metrics and frailty, glycated haemoglobin A1c (HbA1c), and serum albumin were characterised using adjusted regression models. Survival analysis and Cox proportional hazard modelling were performed. Findings: Between July 25, 2018, and Sept 27, 2019, 225 participants were recruited, 222 of whom had CGMs fitted and 215 of whom had analysable CGM data (190 were frail, 25 were not frail). Incremental frailty was associated with older age, greater HbA1c, worse renal function, and history of stroke. Eight of 11 CGM metrics were significantly associated with frailty. Decreased time in range (TIR; glucose concentration 3·9–10·0 mmol/L) and increased time above range (TAR) metrics were strongly correlated with increased frailty and hyperglycaemia, whereas TBR metrics were marginally or not different between frailty levels. Glucose-lowering agents did not significantly affect regression estimates. In patients with HbA1c of 7·5% or more, reduced serum albumin was associated with level 2 TAR (glucose concentration >13·9 mmol/L) and dysglycaemia. During a median follow-up of 28·0 months (IQR 25·3–30·4), increased level 2 TAR was predictive of mortality explainable by frailty in the absence of detectable interaction. Each 1% increment of level 2 TAR was associated with 1·9% increase in mortality hazard. Interpretation: In older adults with type 2 diabetes who are on insulin therapy, incremental frailty was associated with increased dysglycaemia and hyperglycaemia rather than hypoglycaemia. Mortality hazard was increased with severe hyperglycaemia. Future clinical studies and trials targeting actionable CGM metrics highlighted in this study could translate into improved care and outcomes. Funding: Health and Medical Research Fund, Food and Health Bureau, The Government of the Hong Kong Special Administrative Region of China.

Published
2021

9. Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis

Author

Acharya, S, Lim, L-L, Lau, ESH, Ozaki, R, Chung, H, Fu, AWC, Chan, W, Kong, APS, Ma, RCW, So, W-Y, Chow, E, Cheung, KKT, Yau, T, Chow, CC, Lau, V, Yue, R, Ng, S, Zee, B, Goggins, W, Oldenburg, B, Clarke, PM, Lau, M, Wong, R, Tsang, CC, Gregg, EW, Wu, H, Tong, PCY, Ko, GTC, Luk, AOY, Chan, JCN, Acharya, S, Lim, L-L, Lau, ESH, Ozaki, R, Chung, H, Fu, AWC, Chan, W, Kong, APS, Ma, RCW, So, W-Y, Chow, E, Cheung, KKT, Yau, T, Chow, CC, Lau, V, Yue, R, Ng, S, Zee, B, Goggins, W, Oldenburg, B, Clarke, PM, Lau, M, Wong, R, Tsang, CC, Gregg, EW, Wu, H, Tong, PCY, Ko, GTC, Luk, AOY, and Chan, JCN

Abstract

BACKGROUND: Diabetes outcomes are influenced by host factors, settings, and care processes. We examined the association of data-driven integrated care assisted by information and communications technology (ICT) with clinical outcomes in type 2 diabetes in public and private healthcare settings. METHODS AND FINDINGS: The web-based Joint Asia Diabetes Evaluation (JADE) platform provides a protocol to guide data collection for issuing a personalized JADE report including risk categories (1-4, low-high), 5-year probabilities of cardiovascular-renal events, and trends and targets of 4 risk factors with tailored decision support. The JADE program is a prospective cohort study implemented in a naturalistic environment where patients underwent nurse-led structured evaluation (blood/urine/eye/feet) in public and private outpatient clinics and diabetes centers in Hong Kong. We retrospectively analyzed the data of 16,624 Han Chinese patients with type 2 diabetes who were enrolled in 2007-2015. In the public setting, the non-JADE group (n = 3,587) underwent structured evaluation for risk factors and complications only, while the JADE (n = 9,601) group received a JADE report with group empowerment by nurses. In a community-based, nurse-led, university-affiliated diabetes center (UDC), the JADE-Personalized (JADE-P) group (n = 3,436) received a JADE report, personalized empowerment, and annual telephone reminder for reevaluation and engagement. The primary composite outcome was time to the first occurrence of cardiovascular-renal diseases, all-site cancer, and/or death, based on hospitalization data censored on 30 June 2017. During 94,311 person-years of follow-up in 2007-2017, 7,779 primary events occurred. Compared with the JADE group (136.22 cases per 1,000 patient-years [95% CI 132.35-140.18]), the non-JADE group had higher (145.32 [95% CI 138.68-152.20]; P = 0.020) while the JADE-P group had lower event rates (70.94 [95% CI 67.12-74.91]; P < 0.001). The adjusted hazard ratio

Published
2020

19. Determinants of hospitalization in Chinese patients with type 2 diabetes receiving a peer support intervention and JADE integrated care: the PEARL randomised controlled trial.

Author

Yeung, RO, Cai, J-H, Zhang, Y, Luk, AO, Pan, J-H, Yin, J, Ozaki, R, Kong, APS, Ma, R, So, W-Y, Tsang, CC, Lau, KP, Fisher, E, Goggins, W, Oldenburg, B, Chan, J, Yeung, RO, Cai, J-H, Zhang, Y, Luk, AO, Pan, J-H, Yin, J, Ozaki, R, Kong, APS, Ma, R, So, W-Y, Tsang, CC, Lau, KP, Fisher, E, Goggins, W, Oldenburg, B, and Chan, J

Abstract

BACKGROUND: In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores. METHODS: We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization. RESULTS: Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer support reduced the frequency of hospitalizations by 48% with a relative risk of 0.52 (95% CI 0·35-0·79;p = 0·0018). Using SEM, improvement of negative emotions reduced treatment nonadherence (Est = 0.240, p = 0.034) and hospitalizations (Est=-0.218, p = 0.001). The latter was also reduced by an interactive term of peer support and chronic kidney disease (Est = 0.833, p = < 0.001) and that of peer support and heart disease (Est = 0.455, p = 0.001). CONCLUSIONS: In type 2 diabetes, improvement of negative emotions and peer support reduced hospitalizations, especially in those with comorbidities, in part mediated through improving treatment nonadherence. Integrating peer support is feasible and adds value to multidisciplinary care, augmented by information technology, especially in patients with comorbidities. TRIAL REGISTRATION: NCT00950716 Registered July 31, 2009.

Published
2018

20. A study of the short-term associations between hospital admissions and mortality from heart failure and meteorological variables in Hong Kong: Weather and heart failure in Hong Kong

Author

Goggins, W and Chan, E

Abstract

Background Previous research has shown winter peaks for both hospitalizations and mortality from HF, but few studies have examined the association between meteorological parameters and HF. Methods Daily HF admissions to Hong Kong public hospitals, which cover about 83% of total admissions, and daily HF deaths, were obtained for 2002–2011. Generalized additive (Poisson) regression models were used with daily HF admissions/mortality as outcomes and dailymean temperature, humidity, and wind speed as predictors, while controlling for pollutant levels, time trend, season, day of theweek, and holiday. Non-linear distributed lag functions were used for predictors to allow for non-linear and delayed associations. Results Lower mean daily temperatures were strongly associated with increased HF admissions and mortality with a cumulative (to 23 days) relative risk (RR) (95% confidence interval (CI)) for HF admissions of 2.63 (2.43, 2.84) for an 11 °C. vs. a 25 °C day, and cumulative (42 days) RR (95% CI)=3.13 (1.90, 5.16) for HF mortality. The association with cold weather was stronger among older age groups and for new hospitalizations compared to recurrent ones, while presence of co-morbidities did not modify the association. Both high and low relative humidity were modestly associated with more admissions. Conclusions Both HF admissions and mortality in Hong Kong were very strongly associated with cold temperatures. Reducing exposure to cold temperatures among those at risk for HF has the potential to reduce hospitalizations and mortality.

Published
2016

40. Lifetime risk of mole transforming to melanoma is very low. (Poem *)

Author

Tsao, H, Bevona, C, Goggins, W, and Quinn, T

Subjects
Mole (Dermatology) -- Physiological aspects -- Research -- Development and progression -- Risk factors, Disease susceptibility -- Research -- Development and progression -- Risk factors -- Physiological aspects, Melanoma -- Development and progression -- Risk factors -- Research -- Physiological aspects, Health, Physiological aspects, Development and progression, Research, Risk factors
Abstract

Question What is the risk that any given mole will become a melanoma? Synopsis This is an interesting question, and may be helpful as we talk to our patients about [...]

Published
2003

41. Are current or future mesothelioma epidemics in Hong Kong the tragic legacy of uncontrolled use of asbestos in the past? [corrected] [published erratum appears in DIABETES HEALTH 2010 Aug-Sep;19(4):A240].

Author

Tse LA, Yu IT, Goggins W, Clements M, Wang XR, Au JS, and Yu KS

Abstract

Background: Because of the long latent period of asbestos-related mesothelioma, investigators suggest that the high incidence of this disease will continue in the coming decades. Objectives: We describe the time trends of mesothelioma incidence and its relationship to historical consumption of asbestos in Hong Kong and project future trends of mesothelioma incidence. Methods: We obtained local annual consumption of total asbestos for 1960-2006 (converted to kilograms per person per year). Age-standardized incidence rates (ASIRs) of mesothelioma were computed and depicted on graphs using the centered moving average method. Indirectly standardized rates were regressed on a transformation of consumption data that assumed that the latency between asbestos exposure and mesothelioma diagnosis followed a normal distribution with a mean +/- SD of 42 +/- 10.5 years. Results: ASIRs for males started to increase substantially in 1994 and were highest in 2004; for females, ASIRs climbed in the 1980s and in the early 1990s but have fluctuated without obvious trends in recent years. The highest asbestos consumption level in Hong Kong was in 1960-1963 and then decreased sharply afterward. Using past asbestos consumption patterns, we predict that the mesothelioma incidence rate for males will peak in 2009, with the number of cases peaking in 2014, and then slowly decline in the coming decades. Conclusions: Hong Kong experienced an epidemic of mesothelioma from 2000 to 2006 that corresponded with the peak of local asbestos consumption in the early 1960s assuming an average latent period of 42 years. The incidence is anticipated to decline in the coming decades but may not decrease back to the background risk level (the risk unrelated to asbestos exposure). [ABSTRACT FROM AUTHOR]

Published
2010
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43. Lifetime environmental exposure to tobacco smoke and primary lung cancer of non-smoking Taiwanese women.

Author

Lee, C-H, Ko, Y-C, Goggins, W, Huang, J-J, Huang, M-S, Kao, E-L, and Wang, H-Z

Abstract

Background: For a female population with a high lung cancer mortality rate, such as Taiwanese women, who smoke relatively rarely, but live in an environment with high male smoking prevalence, the risk and population burden of lung cancer due to environmental tobacco smoke (ETS) are relatively important.Methods: An age-matched case-control study was designed to investigate the effects of cumulative environmental exposure to tobacco smoke during childhood and adult life on lung cancer risk among non-smoking women in Taiwan. Information on passive smoking from all possible sources and life periods were obtained from interviews with 268 and 445 lifetime non-smoking cases and controls. Conditional logistic regression and synergism 'S' index were applied to the data to assess the independent and joint effects of passive smoking in different life stages while controlling for possible confounding variables.Results: Risks of contracting lung cancer among women near-distantly exposed to the highest level of ETS in childhood (>20 smoker-years) and in adult life (>40 smoker-years) were 1.8-fold (95% CI: 1.2-2.9) and 2.2-fold (95% CI: 1.4-3.7) higher than that among women being never exposed to ETS, and the two variables accounted for about 37% of tumours in this non-smoking female population. Children were found to be more susceptible to ETS than adults and such early exposure was found to modify the effect of subsequent tobacco smoke exposure in adult life based on an additive interaction model.Conclusions: Environmental tobacco smoke exposure occurring in childhood potentiates the effect of high doses of exposure in adult life in determining the development of lung cancer. Smoking prohibition would be expected to protect about 37% of non-smoking Taiwanese women against lung cancer. [ABSTRACT FROM AUTHOR]

Published
2000
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44. 91Is rainfall associated with paediatric acute gastroenteritis in an affluent setting? A 21-Year Retrospective Investigation.

Author

Chong, Ka Chun, Chan, Emily, Lee, TC, Kwok, KL, Lau, SYF, Wang, P, Lam, HCY, Goggins, W, Mohammad, K, Leung, SY, and Chan, PKS

Subjects
GASTROENTERITIS, ENTEROVIRUSES, WATER pollution, HUMIDITY, LOW temperatures, NOROVIRUS diseases
Abstract

Background Although many literatures demonstrated heavy rainfall was associated with an increased risk of acute gastroenteritis via contaminated food and water, we hypothesized there is no association between rainfall and paediatric acute gastroenteritis in a setting with high-standard food and water hygiene. Methods Intestinal infection-related hospital admissions data during 1998-2018 for children under 5 years of age in Hong Kong were collected. Meteorological data were collected from the Hong Kong Observatory. A distributed lag nonlinear model was employed to examine the associations between meteorological factors and the risk of hospital admissions due to acute gastroenteritis. Results Rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to acute gastroenteritis but low temperature, low and high relative humidity did. The risk was 6.3% higher (95% confidence interval: 0.3% to 12.6%) when temperature was at 15.1oC (i.e. the 5th percentile). The adjusted relative risk was statistically significantly higher when relative humidity was ≤73.0% or ≥ 84.0%. Conclusions Text: We suggest rainfall playing a minor role in disease transmission via contaminated food and water in affluent societies like Hong Kong. Instead, we speculate low temperature and humidity extremes have greater impact on transmission through increased stability and infectivity of enteric viruses. Key messages Weather plays a minor role in food and water contamination in affluent societies. Low temperature and humidity extremes might improve survival of enteric viruses. [ABSTRACT FROM AUTHOR]

Published
2021
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49. RADAR SIGNATURE ANALYSIS BASED ON MEASURED DIFFERENTIAL PHASE SHIFTS OF TARGET SCATTERING AT TWO HARMONIC FREQUENCIES.

Author

AIR FORCE CAMBRIDGE RESEARCH LABS L G HANSCOM FIELD MASS, Goggins,W. B. , Jr., Blacksmith,P., Sletten,C. J., AIR FORCE CAMBRIDGE RESEARCH LABS L G HANSCOM FIELD MASS, Goggins,W. B. , Jr., Blacksmith,P., and Sletten,C. J.

Abstract

The identification and classification of radar targets is facilitated by a newly developed technique based on measurements of the differential phase shift of the target scattering obtained at two harmonic phase-locked frequencies. These phase differences are independent of target range and relative motion. The differential phase shift between two harmonic frequencies has been measured for various types of targets. The experimental results indicate that the differential phase shift can be used as a parameter in the classification or identification of targets. (Author)

Published
1967

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