Type 2 diabetes mellitus (T2DM) onset and "remission".

diabetes;onset;remission;lifestyle

Srikanth Tangelloju

University:University of Louisville

Department:Health Management and Systems Sciences

关键词: diabetes;    onset;    remission;    lifestyle;   

Others  :  https://ir.library.louisville.edu/cgi/viewcontent.cgi?article=3593&context=etd

美国|英语

来源: The Universite of Louisville's Institutional Repository

【 摘 要 】

Background: Type 2 diabetes mellitus (T2DM) is a progressive disease condition. As the disease progresses the function of beta (β) cells (cells which regulate insulin) decline, thereby increasing the circulating blood glucose levels. If left unmanaged the disease progresses from onset to development of T2DM related complications and eventually death. When managed, in certain individuals, T2DM onset can be prevented and/or slowed down and in certain T2DM individuals, remission is observed. There are some known modifiable risk factors such as diet and physical activities that are associated with the speed and direction of progression, but much is still unknown. In order to develop effective intervention and management programs, it is first important to understand the factors that predict speed and direction of T2DM progression. Purpose: This dissertation evaluated T2DM disease progression with three key objectives: a) evaluate factors that predict T2DM onset; b) evaluate rate of T2DM “remission” and, c) evaluate factors that predict T2DM “remission” in Medicare patients 65 years and older who did not undergo bariatric surgery. Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if they had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association definition of remission which includes HbA1c values and hence is represented in quotation (as “remission”). 89,390 individuals were evaluated for T2DM onset and 10,059 T2DM individuals were evaluated for T2DM “remission” over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM onset and “remission.” Results: The factors that were significantly associated with T2DM onset were: male gender; non-white ethnicity (African American, Hispanics); statin use; hypertension; hyperlipidemia; heart failure; ulcer of lower limbs; atherosclerosis; other retinopathy; angina pectoris; blindness and low vision; absence of other chronic ischemic heart disease (IHD) (pConclusions:In line with previously published studies, the study presented here also found that hyperlipidemia, hypertension, gender and race are significantly associated with T2DM onset. In addition to these known factors, this study identified additional factors associated with T2DM onset such as: statin use;