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Monday 4 November 2013

Clinical and genetic determinants of progression of type 2 diabetes: A DIRECT Study

Abstract

Objective The rate at which diabetes progresses following diagnosis of type 2 diabetes is highly variable between individuals.
Research Design and Methods We studied 5250 patients with type 2 diabetes using comprehensive electronic medical records on all patients in Tayside, Scotland from 1992 onwards. We investigated the association of clinical, biochemical and genetic factors with the risk of progression of type 2 diabetes from diagnosis to requirement for insulin treatment (defined as insulin treatment or HbA1c ≥8.5%/69 mmol/mol treated with two or more non-insulin diabetes therapies).
Results Risk of progression was associated with both low and high BMI. In an analysis stratified by BMI and HbA1c at diagnosis, faster progression was independently associated with younger age at diagnosis, higher log triacylglyceride concentrations (Hazard Ratio (HR) 1.28 per mmol/L (95% CI 1.15-1.42)) and lower HDL concentrations (HR 0.70 per mmol/L (95% CI 0.55-0.87)). A high genetic risk score derived from 61 diabetes risk variants was associated with a younger age of diagnosis, a younger age at starting insulin, but was not associated with the progression rate from diabetes to requirement for insulin treatment.
Conclusions Increased triacylglyceride and low HDL are independently associated with increased rate of progression of diabetes. The genetic factors that predispose to diabetes are different from those that cause rapid progression of diabetes suggesting a difference in biological process that needs further investigation.
Graham

4 comments:

Lowcarb team member said...

Interesting thanks Graham. Makes a pleasant change from all the studies which just seem to confuse obesity and T2.

Kath

Lowcarb team member said...

So true Kath! and this study also is another plus for LowCarb were high HDL and low trigs are the norm for most of us.

Graham

Anonymous said...

Interesting to see this study. The number of patients studied seems to be quite a fair number to achieve a fair analysis.
James

Anonymous said...

I did read this through twice. But if correct this study is not good for the younger age group and as more and more young people are being diagnosed the long term prognosis does not look good.