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Currie C.J.,University of Cardiff | Peyrot M.,Loyola University Maryland | Peyrot M.,Johns Hopkins University | Morgan C.L.L.,Global Epidemiology | And 5 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - To assess the association of compliance with treatment (medication and clinic appointments) and all-cause mortality in people with insulin-treated type 2 diabetes. RESEARCH DESIGN AND METHODS - Data were extracted from U.K. general practice records and included patients (N = 15,984) who had diagnostic codes indicative of type 2 diabetes or who had received a prescription for an oral antidiabetic agent and were treated with insulin. Records in the 30months before the index date were inspected for clinical codes (recorded at consultation) indicating medication noncompliance or medical appointment nonattendance. Noncompliance was defined as missing more than one scheduled visit or having at least one provider code for not taking medications as prescribed. Relative survival postindex date was compared by determining progression to all-cause mortality using Cox proportional hazards models. RESULTS - Those identified as clinic nonattenders were more likely to be smokers, younger, have higher HbA 1c, and have more prior primary care contacts and greater morbidity (P < 0.001). Those identified as medication noncompliers were more likely to be women (P = 0.001), smokers (P = 0.014), and have higher HbA 1c, more prior primary care contacts, and greater morbidity (all P < 0.001). After adjustment for confounding factors, medication noncompliance (hazard ratio 1.579 [95% CI 1.167-2.135]), clinic nonattendance of one or two missed appointments (1.163 [1.042-1.299]), and clinic nonattendance of greater than two missed appointments (1.605 [1.356-1.900]) were independent risk factors for all-cause mortality. CONCLUSIONS - Medication noncompliance and clinic nonattendance, assessed during routine care by primary care physicians or their staff, were independently associated with increased all-cause mortality in patients with type 2 diabetes receiving insulin. © 2012 by the American Diabetes Association. Source

Currie C.J.,University of Cardiff | Poole C.D.,Global Epidemiology | Jenkins-Jones S.,Global Epidemiology | Gale E.A.M.,University of Bristol | And 2 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - Type 2 diabetes is associated with an increased risk of several types of cancer and with reduced survival after cancer diagnosis. We examined the hypotheses that survival after a diagnosis of solid-tumor cancer is reduced in those with diabetes when compared with those without diabetes, and that treatment with metformin influences survival after cancer diagnosis. RESEARCH DESIGN ANDMETHODS - Data were obtained from >350 U.K. primary care practices in a retrospective cohort study. All individuals with or without diabetes who developed a first tumor after January 1990 were identified and records were followed to December 2009. Diabetes was further stratified by treatment regimen. Cox proportional hazards models were used to compare all-cause mortality from all cancers and from specific cancers. RESULTS - Of 112,408 eligible individuals, 8,392 (7.5%) had type 2 diabetes. Cancer mortality was increased in those with diabetes, compared with those without (hazard ratio 1.09 [95% CI 1.06-1.13]). Mortality was increased in those with breast (1.32 [1.17-1.49]) and prostate cancer (1.19 [1.08-1.31]) but decreased in lung cancer (0.84 [0.77-0.92]). When analyzed by diabetes therapy, mortality was increased relative to nondiabetes in those on monotherapy with sulfonylureas (1.13 [1.05-1.21]) or insulin (1.13 [1.01-1.27]) but reduced in those on metformin monotherapy (0.85 [0.78-0.93]). CONCLUSIONS - This study confirmed that type 2 diabetes was associated with poorer prognosis after incident cancer, but that the association varied according to diabetes therapy and cancer site. Metformin was associated with survival benefit both in comparison with other treatments for diabetes and in comparison with a nondiabetic population. © 2012 by the American Diabetes Association. Source

Holden S.E.,University of Cardiff | Gale E.A.M.,University of Bristol | Jenkins-Jones S.,Global Epidemiology | Currie C.J.,University of Cardiff
Diabetes, Obesity and Metabolism | Year: 2014

Aims: We set out to estimate the prevalence rate of insulin use in the UK population, the total number of people in the UK who use insulin, the proportion of users with type 1 and type 2 diabetes and changes between 1991 and 2010. Methods: Patients receiving prescriptions for insulin were identified in the Clinical Practice Research Datalink and attributed a diagnosis of type 1 or type 2 diabetes. The annual prevalence of insulin use was calculated and applied to population data. Results: The crude prevalence rate of insulin use increased from 2.43 (95% CI 2.38-2.49) per 1000 population in 1991 to 6.71 (6.64-6.77) per 1000 in 2010. The largest change was an increase in the prevalence of insulin users with a diagnosis of type 2 diabetes from 0.67 (0.64-0.70) to 4.34 (4.29-4.39) per 1000 population. The absolute number using insulin increased from 137000 people (121000-155000) in 1991 to 421000 (400000-444000) in 2010. The proportion taking insulin alone (as against combination with oral agents) decreased from 97% in the first decade to 37% in the second. Conclusion: The number of people using insulin trebled between 1991 and 2010, largely due to a considerable increase in the number of people with type 2 diabetes using insulin. © 2014 John Wiley & Sons Ltd. Source

Bannister C.A.,University of Cardiff | Poole C.D.,University of Cardiff | Jenkins-Jones S.,Global Epidemiology | Ll. Morgan C.,University of Cardiff | And 3 more authors.
Diabetes Care | Year: 2014

OBJECTIVE To evaluate the performance of the UK Prospective Diabetes Study Risk Engine (UKPDS-RE) for predicting the 10-year risk of cardiovascular disease end points in an independent cohort of U.K. patients newly diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS This was a retrospective cohort study using routine health care data collected between April 1998 and October 2011 from ~350 U.K. primary care practicescontributing to the Clinical Practice Research Datalink (CPRD). Participants comprised 79,966 patients aged between 35 and 85 years (388,269 person-years) with 4,984 cardiovascular events. Four outcomes were evaluated: first diagnosis of coronary heart disease (CHD), stroke, fatal CHD, and fatal stroke. RESULTS Accounting for censoring, the observed versus predicted 10-year event rates were as follows: CHD 6.1 vs. 16.5%, fatal CHD 1.9 vs. 10.1%, stroke 7.0 vs. 10.1%, and fatal stroke 1.7 vs. 1.6%, respectively. The UKPDS-RE showed moderate discrimination for all four outcomes, with the concordance index values ranging from 0.65 to 0.78. CONCLUSIONS The UKPDS stroke equations showed calibration ranging from poor to moderate; however, the CHD equations showed poor calibration and considerably overestimated CHD risk. There is a need for revised risk equations in type 2 diabetes. © 2014 by the American Diabetes Association. Source

Holden S.H.,University of Cardiff | Barnett A.H.,NHS England | Peters J.R.,University of Wales | Jenkins-Jones S.,Global Epidemiology | And 3 more authors.
Diabetes, Obesity and Metabolism | Year: 2013

Aims: To characterize the incidence of type 2 diabetes in the UK over the previous 20years; and determine if there has been an increase in people aged 40years or less at diagnosis. Methods: For this retrospective cohort study, patients newly diagnosed with type 2 diabetes between 1991 and 2010 were identified from the UK Clinical Practice Research Datalink (CPRD). Patient data were grouped into 5-year intervals by year of diagnosis and age at diagnosis. A standardized incidence ratio (SIR) was determined (1991-1995=100). The percentage of newly diagnosed patients for each age group and aged ≤40 years was calculated for each 5-year calendar period. The incidence rate by age and 5-year calendar period was also determined. Results: In 2010, the crude incidence rate of type 2 diabetes was 515 per 100,000 population. The overall SIR increased to 158 (95% CI 157-160, p<0.001), 237 (235-238, p<0.001) and 275 (273-276, p<0.001) for 1996-2000, 2001-2005 and 2006-2010, respectively. For those ≤40, the respective values were 217 (209-226, p<0.001), 327 (320-335, p<0.001) and 598 (589-608, p<0.001). An increase in incidence occurred with increasing 5-year calendar period. The incidence of type 2 diabetes was higher for males after the age of 40 and higher for females aged ≤40. The percentage of patients aged ≤40 years at diagnosis increased with each increasing 5-year calendar period (5.9, 8.4, 8.5 and 12.4%, respectively). Conclusions: There was a significant increase in the incidence of diagnosed type 2 diabetes between 1991 and 2010 and the proportion of people diagnosed at a relatively early age has increased markedly. © 2013 Blackwell Publishing Ltd. Source

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