Patient disposition flow diagram.

<p>Patient disposition flow diagram showing patients included, excluded or lost-to-follow-up within the study cohort. MS: Multiple Sclerosis; RRMS: Relapsing-Remitting Multiple Sclerosis.</p

Healthcare costs for MS treatment and the rate of relapse occurrence, of 1-point EDSS progression, of reaching of EDSS 4.0, of reaching of EDSS 6.0, and of SP conversion.

<p>Healthcare costs for DMT administration and management before the specific endpoint was reached (considered as continuous variables), have been associated with the rate of relapse occurrence, of 1-point disability progression, of reaching of EDSS 4.0, of reaching of EDSS 6.0, and of SP conversion during the follow-up period. P-values, hazard ratios (HR), and 95% confidence intervals (95%CI) are shown from time varying Cox regression models, subsequently adjusted for age, gender, disease duration, and baseline EDSS.</p

Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes

OBJECTIVE: The associated risk of vascular disease following diagnosis of type 2 diabetes in people previously identified as having pre-diabetes in real-world settings is unknown. We examined the presence of microvascular and macrovascular disease in individuals with newly diagnosed type 2 diabetes by glycemic status within 3 years before diagnosis. RESEARCH DESIGN AND METHODS: We identified 159 736 individuals with newly diagnosed type 2 diabetes from the UK Clinical Practice Research Datalink database in England between 2004 and 2017. We used logistic regression models to compare presence of microvascular (retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular and peripheral arterial disease) disease at the time of type 2 diabetes diagnosis by prior glycemic status. RESULTS: Half of the study population (49.9%) had at least one vascular disease, over one-third (37.4%) had microvascular disease, and almost a quarter (23.5%) had a diagnosed macrovascular disease at the time of type 2 diabetes diagnosis.Compared with individuals with glycemic values within the normal range, those detected with pre-diabetes before the diagnosis had 76% and 14% increased odds of retinopathy and nephropathy (retinopathy: adjusted OR (AOR) 1.76, 95% CI 1.69 to 1.85; nephropathy: AOR 1.14, 95% CI 1.10 to 1.19), and 7% higher odds of the diagnosis of acute coronary syndrome (OR 1.07, 95% CI 1.03 to 1.12) in fully adjusted models at time of diabetes diagnosis. CONCLUSIONS: Microvascular and macrovascular diseases are detected in 37%-24% of people with newly diagnosed type 2 diabetes. Pre-diabetes before diagnosis of type 2 diabetes is associated with increased odds of microvascular disease and acute coronary syndrome. Detection of pre-diabetes might represent an opportunity for reducing the burden of microvascular and macrovascular disease through heightened attention to screening for vascular complications

Kaplan-Meier curves for the probability of relapse occurrence, of 1-point EDSS progression, of reaching of EDSS 4.0, of reaching of EDSS 6.0, and of SP conversion, in relation to annual healthcare costs before the specific study endpoint was reached.

<p>Kaplan-Meier plots estimating the probability of relapse occurrence (<b>A</b>), of experiencing 1-point EDSS progression (<b>B</b>), of reaching of EDSS 4.0 (<b>C</b>), of reaching of EDSS 6.0 (<b>D</b>), and of SP conversion (<b>E</b>), in relation to the annual healthcare costs before the specific study endpoint was reached. P-values and hazard ratios (HR) are shown from time varying Cox regression models. For graphical purposes, healthcare costs have been categorized on the median value (the red line represents costs lower than the median value, whereas the blue line represents costs higher than the median value). EDSS: Expanded Disability Status Scale; HR: Hazard Ratio.</p

Scatter plot for overall annual healthcare costs and relapses.

<p>Scatter plot showing the relationship between overall annual healthcare costs and the ARR. P-value and coefficient from Poisson regression analysis are shown; 95% confidence intervals are represented in grey shadow. ARR: Annualised Relapse Rate; Coef: Coefficient.</p

Demographic features, clinical findings and healthcare costs.

<p>Demographic features, clinical findings and annual healthcare costs for DMT administration and management.</p

Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Background: Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings: In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation: Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation