Diabetes medication use and blood lactate level among participants with type 2 diabetes : the atherosclerosis risk in communities carotid MRI study

Background: The objective of this study is to compare lactate levels between users and non-users of diabetes medications under the hypothesis that the level of lactate is a marker of oxidative capacity. Methods: The cross-sectional data of 493 participants aged 61–84 with type 2 diabetes who participated in the Atherosclerosis Risk in Communities Carotid MRI study were analyzed using survey weighted linear regression. Results: Median plasma lactate level was 8.58 (95% CI: 8.23, 8.87) mg/dl. Comparing users of diabetic medications with nonusers, thiazolidinedione use was significantly associated with lower lactate level (7.57 (6.95–8.25) mg/dL vs. 8.78 (8.43–9.14) mg/dL), metformin use with a slightly higher lactate level (9.02 (8.51–9.58) mg/dL vs. 8.36 (7.96–8.77) mg/dL), and sulfonylurea and insulin use were not associated with lactate level. After adjustment for demographic and lifestyle factors, the plasma lactate level for thiazolidinedione users was 15.78% lower than that for non-users (p,0.001). Considering use of each medication separately and in combination did not change the results. Conclusion: In conclusion, thiazolidinedione use was associated with lower plasma lactate level compared to non-use and metformin use was only marginally associated with a slightly higher lactate level. These results are consistent with the previously demonstrated effects of diabetes medications on oxidative metabolism. Further investigation of the role that diabetes medications play in improvement of oxidative metabolism is warrante

Diabetes Medication Use and Blood Lactate Level among Participants with Type 2 Diabetes: The Atherosclerosis Risk in Communities Carotid MRI Study

BackgroundThe objective of this study is to compare lactate levels between users and non-users of diabetes medications under the hypothesis that the level of lactate is a marker of oxidative capacity.MethodsThe cross-sectional data of 493 participants aged 61–84 with type 2 diabetes who participated in the Atherosclerosis Risk in Communities Carotid MRI study were analyzed using survey weighted linear regression.ResultsMedian plasma lactate level was 8.58 (95% CI: 8.23, 8.87) mg/dl. Comparing users of diabetic medications with non-users, thiazolidinedione use was significantly associated with lower lactate level (7.57 (6.95–8.25) mg/dL vs. 8.78 (8.43–9.14) mg/dL), metformin use with a slightly higher lactate level (9.02 (8.51–9.58) mg/dL vs. 8.36 (7.96–8.77) mg/dL), and sulfonylurea and insulin use were not associated with lactate level. After adjustment for demographic and lifestyle factors, the plasma lactate level for thiazolidinedione users was 15.78% lower than that for non-users (p<0.001). Considering use of each medication separately and in combination did not change the results.ConclusionIn conclusion, thiazolidinedione use was associated with lower plasma lactate level compared to non-use and metformin use was only marginally associated with a slightly higher lactate level. These results are consistent with the previously demonstrated effects of diabetes medications on oxidative metabolism. Further investigation of the role that diabetes medications play in improvement of oxidative metabolism is warranted

Obesity severity and duration are associated with incident metabolic syndrome: Evidence against metabolically healthy obesity from the Multi-Ethnic Study of Atherosclerosis

While the health risks of obesity compared to normal weight have been well studied, the cumulative risk associated with chronic obesity remains unknown. Specifically, debate continues about the importance of recommending weight loss for those with metabolically healthy obesity.We hypothesized that relatively greater severity and longer duration of obesity are associated with greater incident metabolic syndrome.Repeated measures logistic regression with random effects investigated the association of time varying obesity severity and duration with incident metabolic syndrome in 2,748 Multi Ethnic Study of Atherosclerosis participants with obesity (body mass index ≥30kg/m(2)) at any visit. Obesity duration was defined as the cumulative number of visits with measured obesity and obesity severity by the WHO levels I-III based on body mass index. Metabolic syndrome was defined using Adult Treatment Panel III criteria modified to exclude waist circumference.Higher obesity severity (Level II odds ratio [OR]=1.32 (95% confidence interval: 1.09-1.60), Level III OR=1.63 (1.25-2.14) vs. Level I) and duration (by number of visits: 2 visits OR=4.43 (3.54-5.53), 3 visits OR=5.29 (4.21-6.63), 4 visits OR=5.73 (4.52-7.27), 5 visits OR=6.15 (4.19-9.03) vs. 1 visit duration of obesity) were both associated with a higher odds of incident metabolic syndrome.Both duration and severity of obesity are positively associated with incident metabolic syndrome, suggesting that metabolically healthy obesity is a transient state in the pathway to cardiometabolic disease. Weight loss should be recommended to all individuals with obesity, including those who are currently defined as metabolically healthy

Liver steatosis and the risk of albuminuria: the multi-ethnic study of atherosclerosis.

ObjectiveTo measure association between hepatic fat and albuminuria (an early marker of renal injury) in individuals without diabetes or hypertension.Methods2,281 individuals in the Multi-Ethnic Study of Atherosclerosis without diabetes or hypertension, renal disease, or excess alcohol consumption underwent computed tomography (CT) for assessment of liver attenuation (marker of hepatic lipid content) and urinalysis (for albuminuria) at initial study visit, with assessment of incident and prevalent albuminuria by logistic regression in follow-up.ResultsAfter adjustment for age, gender, race, smoking, blood pressure, insulin resistance, and body mass index, individuals with less liver fat (higher liver CT attenuation) had a lower probability of having albuminuria at Exam 1 (OR per 10 unit increase in attenuation 0.77, 95 % CI 0.61-0.97, P = 0.02). At median 9.3 years follow-up, albuminuria was identified in 129 individuals were (5.8 %). In fully adjusted models (with age, smoking, body mass index, blood pressure, diabetes and hypertension as time-dependent covariates), lower liver attenuation (greater liver fat) was associated with higher risk of incident albuminuria (OR 0.79, 95 % CI 0.66-0.94, P = 0.008).ConclusionsHepatic attenuation is associated with prevalent and incident albuminuria, an early, potent risk factor for renal risk in a population not clearly at risk for future renal failure

Diabetes medication use and blood lactate level among participants with type 2 diabetes : the atherosclerosis risk in communities carotid MRI study

Background: The objective of this study is to compare lactate levels between users and non-users of diabetes medications under the hypothesis that the level of lactate is a marker of oxidative capacity. Methods: The cross-sectional data of 493 participants aged 61–84 with type 2 diabetes who participated in the Atherosclerosis Risk in Communities Carotid MRI study were analyzed using survey weighted linear regression. Results: Median plasma lactate level was 8.58 (95% CI: 8.23, 8.87) mg/dl. Comparing users of diabetic medications with nonusers, thiazolidinedione use was significantly associated with lower lactate level (7.57 (6.95–8.25) mg/dL vs. 8.78 (8.43–9.14) mg/dL), metformin use with a slightly higher lactate level (9.02 (8.51–9.58) mg/dL vs. 8.36 (7.96–8.77) mg/dL), and sulfonylurea and insulin use were not associated with lactate level. After adjustment for demographic and lifestyle factors, the plasma lactate level for thiazolidinedione users was 15.78% lower than that for non-users (p,0.001). Considering use of each medication separately and in combination did not change the results. Conclusion: In conclusion, thiazolidinedione use was associated with lower plasma lactate level compared to non-use and metformin use was only marginally associated with a slightly higher lactate level. These results are consistent with the previously demonstrated effects of diabetes medications on oxidative metabolism. Further investigation of the role that diabetes medications play in improvement of oxidative metabolism is warrante

Association of Obesity and Diabetes with SARS-Cov-2 Infection and Symptoms in the COVID-19 Community Research Partnership

OBJECTIVE: Obesity and diabetes are established risk factors for severe SARS-CoV-2 outcomes, but less is known about their impact on susceptibility to COVID-19 infection and general symptom severity. We hypothesized that those with obesity or diabetes would be more likely to self-report a positive SARS-CoV-2 test, and among those with a positive test, have greater symptom severity and duration. METHODS: Among 44,430 COVID-19 Community Research Partnership participants, we evaluated the association of self-reported and electronic health record obesity and diabetes with a self-reported positive COVID-19 test at any time. Among the 2,663 participants with a self-reported positive COVID-19 test during the study, we evaluated the association of obesity and diabetes with self-report of symptom severity, duration, and hospitalization. Logistic regression models were adjusted for age, sex, race/ethnicity, socioeconomic status, and healthcare worker status. RESULTS: We found a positive graded association between Body Mass Index (BMI) category and positive COVID-19 test (Overweight OR = 1.14 [1.05-1.25]; Obesity I OR = 1.29 [1.17-2.42]; Obesity II OR = 1.34 [1.19-1.50]; Obesity III OR = 1.53 [1.35-1.73]), and a similar but weaker association with COVID-19 symptoms and severity among those with a positive test. Diabetes was associated with COVID-19 infection but not symptoms after adjustment, with some evidence of an interaction between obesity and diabetes. CONCLUSIONS: While the limitations of this health system convenience sample include generalizability and selection around test-seeking, the strong graded association of BMI and diabetes with self-reported COVID-19 infection suggests that obesity and diabetes may play a role in risk for symptomatic SARS-CoV-2 beyond co-occurrence with socioeconomic factors

Effect of medication combinations on percent differences and 95% confidence intervals in serum lactate level.

<p>Effect of medication combinations on percent differences and 95% confidence intervals in serum lactate level (mg/dl) among persons with type 2 diabetes in the ARIC Carotid MRI Study. All comparisons based on a model containing age, sex, race, education, sport and leisure activity, and body mass index. Diabetes medication use was constructed as a factor variable with mutually exclusive groups representing each medication separately and in combination. All groups are compared to no diabetes medication use. Not all combinations are shown.</p

Adjusted percent differences in plasma lactate in the ARIC Carotid MRI Study.

<p>Adjusted differences in plasma lactate (vs non-users of diabetes medications) in users of thiazolidinediones, Insulin, Sulfonylureas, and Metformin in those with type 2 diabetes in the ARIC Carotid MRI Study: Percent differences and 95% confidence intervals. Adjusted for age, sex, race, and education, sport and leisure activity, and body mass index.</p

Characteristics of 493 Adults Aged 61–84 With Type 2 Diabetes in the ARIC Carotid MRI Study by Diabetes Medication Use.

<p>Bolded values indicate p-values<0.05 for the t-test of the difference for Yes – No.</p><p>All estimates are survey weighted mean (SE) except where indicated as % (SE). SE = linearized standard error.</p>a<p>. Geometric mean and 95% confidence interval for blood lactate (mg/dl).</p