Search

Although recent evidence has revealed that a body shape index (ABSI) is correlated with the incidence of death among different ethnicities, there remains a paucity of studies investigating the impact of ABSI on mortality within the Chinese elderly. Our objective was to ascertain the link between ABSI, as well as its alterations over time, and all-cause mortality among Chinese aged 65 y and above. A total of 3789 participants were enrolled from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cox regressions and restricted cubic splines were employed to assess the association of ABSI and relative changes with all-cause mortality. When nonlinearity was detected, a restricted cubic spline regression was subsequently conducted to compute hazard ratios and 95% confidence intervals. The median survival time was 46 months, and 1342 individuals (35.4%) were reported to have died. ABSI contributed independently to rising death rates among Chinese old populations according to univariate and multivariate Cox regressions. Statistically significant associations were also found stratified by age, sex, and lifestyle. A U-shaped association of ABSI changes with all-cause mortality (p = 0.027) was observed, indicating that old adults with stable ABSI during the follow-up period experienced the lowest risk of mortality. After multivariable adjustment, participants with a 10% reduction in ABSI changes had an increased 9.4% risk of death, while participants with a 10% rise in ABSI changes had an increased 1.9% risk. ABSI and its changes are predictors for all-cause mortality among the elderly Chinese population, which emphasizes the clinical importance of monitoring ABSI and keeping it stable over time.

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.

Introduction Recent studies suggested that growth differentiation factor 15 (GDF-15) may indicate heart failure and a constellation of cardiovascular co-morbidities in diabetic patients. Whereas N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) is a cardiac-specific biomarker, GDF-15 is non-tissue-specific and may be a useful marker of global cardiovascular disease (CVD) burden, particularly in diabetes. In this systematic review and meta-analysis, we summarized the effects of elevated GDF-15 on the composite outcome of cardiovascular disease, events, and/or death in diabetic patients. Methods MEDLINE, EMBASE, CINAHL and Cochrane Library were queried for articles published from inception until February 2020. Longitudinal studies that reported data about the relationship between GDF-15 levels and CVD outcomes in diabetic patients were included. Pooled hazard ratios (HRs) for mortality were calculated and presented with 95% confidence intervals (CIs). Prespecified I2 threshold values of 25%, 50%, and 75% were used to indicate low, moderate, and high levels of heterogeneity, respectively. The risk of bias in the included studies was evaluated according to the criteria established by the Cochrane collaboration. Publication bias was assessed using funnel plot analysis. Results Seven studies with a total 15,805 diabetic patients were included (Fig. 1). The median follow-up ranged from 1.5 to 7.9 years. Pooled effect estimate suggested that elevated GDF-15 levels at baseline was associated with an increased risk for composite CVD-related outcome(s) (per standard deviation (SD) increase in log(GDF-15): HR 1.26, 95% CI 1.12-1.42, P = 0.0001, I2 for heterogeneity 85%, n = 15,651 patients) (Fig. 2a). When an unadjusted study was excluded, the pooled effect estimate remained statistically significant, with improvement in heterogeneity (per SD increase in log(GDF-15): HR 1.16, 95% CI 1.11-1.20, P Conclusion Findings from this systematic review and meta-analysis suggest that elevated GDF-15 levels are associated with increased risk for incident cardiovascular endpoint(s) including acute cardiovascular events, heart failure and/or all-cause death in diabetic patients.