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1Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
2Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
3Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
Copyright © 2018 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
(1) Statin non-users who had both LDL-C less than 2.8 mmol/L and albuminuria had 5-fold increased risk of all-site cancer compared with statin users with or without both risk factors [13].
(2) Non-users of metformin with HDL-C less than 1 mmol/L had 5-fold increased risk of all-site cancer compared to metformin users with HDL-C greater than 1 mmol/L [14].
(3) Users of RAS blockers had 64% lower cancer risk than non-users in those with WBC count greater than 8.2×109 count/L [4].
(4) Patients with all three risk factors of HbA1c higher than 7%, non-use of RAS inhibitors and non-use of statins had 4-fold higher adjusted risk of all-site cancer than users of both drugs with HbA1c less than 7% [11].
CONFLICTS OF INTEREST: Juliana C.N. Chan is the Chief Executive Officer, on a probono basis, of the Asia Diabetes Foundation which designs and operates the JADE Programme (www.adf.org.hk). Other authors reported no conflict of interest relevant to this article.
CUHK-PWH Hong Kong Diabetes Register [8] | ||
1995–2007, 1 public hospital, 8,558 patients, median duration of diabetes 5 years | ||
Patients with complications after median follow-up 6.7 years, % | ||
CKD | 32.5 | |
CVD | 15.1 | |
Death | 11.8 (cancer 23.7, circulatory disease 23.3, renal disease 13.4) | |
Territory-wide Hong Kong Diabetes Database [50] | ||
2000–2012, primary and secondary care settings, subgroup with duration of diabetes >15 years | ||
Cohort year | 2000–2003 | 2010–2012 |
No. of patients | 33,143 | 147,819 |
Incidence (per 1,000 person-years [95% CI]) | ||
ESRD | 25.75 (22.35–29.67) | 22.46 (20.86–24.17) |
Stroke | 13.53 (11.06–16.56) | 10.13 (9.04–11.34) |
AMI | 8.68 (6.75–11.18) | 5.76 (4.94–6.71) |
Death | 29.03 (25.46–33.11) | 26.55 (24.84–28.38) |
Risk Assessment Management Program in public primary care setting [53] | ||
2009–2011, territory-wide public primary care clinics in low risk patients | ||
Public-RAMP | Propensity-score matched control | |
No. of patients | 8,570 | 8,570 |
Mean duration of diabetes, yr | 8.67 | 8.54 |
Patients with events after 5 years follow-up period, % | ||
CVD | 12.33 | 23.97 |
Stroke | 5.19 | 8.48 |
Death | 7.96 | 21.35 |
Public vs. PPP-JADE Program [57] | ||
2007–2015, PPP: university-affiliated diabetes centre, private doctors and JADE technology | ||
Public | PPP-JADE | |
No. of patients | 3,570 | 3,424 |
Median duration of diabetes, yr | 9 | 7.4 |
Median follow-up, yr | 3.2 | 5.1 |
Incidence (per 1,000 person-years [95% CI])a | ||
CKD | 86.6 (80.32–93.39) | 39.96 (36.38–43.54) |
ESRD | 15.6 (13.44–18.11) | 7.06 (5.92–8.43) |
CHD | 7.19 (5.71–9.06) | 5.56 (4.5–6.87) |
Stroke | 6.39 (5.03–8.13) | 4.09 (3.22–5.19) |
Death | 15.19 (13.09–17.62) | 8.54 (7.28–10.03) |
CUHK-PWH, The Chinese University of Hong Kong–Prince of Wales Hospital; CKD, chronic kidney disease; CVD, cardiovascular disease; CI, confidence interval; ESRD, end stage renal disease; AMI, acute myocardial infarction; RAMP, Risk Assessment and Management Program; PPP-JADE, Private Public Partnership–Joint Asia Diabetes Evaluation; CHD, coronary heart disease.
aConsistent benefits in favor of PPP in patients with different risk profiles.
Key phenotypes | Drugs associated with reduced cancer risk | Hypothesized pathways |
---|---|---|
LDL-C <2.8 mmol/L+albuminuria [13]±HbA1c >7% [11] | Statins and RAS blockers | RAS+IGF-1+HMGCR crosstalk |
LDL-C <2.8 mmol/L+low TG <1.7 mmol/L [15] | ||
HDL-C <1 mmol/L [14] | Metformin | AMPK |
BMI >27.4 kg/m2 [4] | Not applicable | Not applicable |
WBC >8.2×109 count/L [15] | RAS blockers | RAS |
RASLDL-C, low density lipoprotein cholesterol; HbA1c, glycated hemoglobin; TG, triglycerides; RAS, renin-angiotensin system; IGF-1, insulin-like growth factor; HMGCR, hydroxymethylglutaryl-CoA reductase; HDL-C, high density lipoprotein cholesterol; AMPK, adenosine 5′-monophosphate-activated protein kinase; BMI, body mass index; WBC, white blood cell.
Study | Outcomes | HR (95% CI; P value) vs. usual care |
---|---|---|
Jiao et al. (2016) [52] | Microvascular complications | 0.73 (0.66–0.81; <0.001) |
3 Years propensity matched cohort (RAMP-DM vs. usual care) | STDR/blindness | 0.55 (0.39–0.78; 0.001) |
14,835 Patients/group | ESRD | 0.4 (0.24–0.69; 0.001) |
LL ulcers/amputation | 0.49 (0.30–0.80; 0.005) | |
Wan et al. (2018) [51] | Microvascular complications | 0.881 (0.834–0.93; 0.001) |
5 Years propensity matched cohort (RAMP-DM vs. usual care) | CVD | 0.434 (0.4144–0.0455; 0.001) |
26,718 Patients/group | All cause mortality | 0.339 (0.321–0.357; 0.001) |
Hospitalizations | 0.415 (0.403–0.4428; 0.001) | |
Emergency attendance | 0.588 (0.575–0.602; 0.001) | |
Specialist clinic attendance | 0.65 (0.636–0.664; 0.001) | |
Fung et al. (2015) [49] | Proportions of patients reaching treatment goals (2009 vs. 2013) | |
Longitudinal study (2009 vs. 2013) | LDL-C <2.6 mmol/L | 25.9%→65.6% |
127,977 Patients in primary care | HbA1c <7% | 47.5%→56.5% |
SBP <130 mm Hg | 47.5%→56.5% | |
DBP <80 mm Hg | 65.7%→77.5% | |
Waist hip ratio ≤0.9 male; ≤0.85 female | 22.9%→18.7% | |
Urine ACR ≤2.5 mg/mmol male; ≤3.5 mg/mmol female | 77%→73.7% | |
Drug use pattern (2009 vs. 2013) | ||
Statin | 9%→55% | |
OAD+insulin | 0.5%→3% | |
ACEI/ARB | 59.4%→58.3% | |
CCB | 73.9%→71% |
RAMP, Risk Assessment and Management Program; HR, hazard ratio; CI, confidence interval; DM, diabetes mellitus; STDR, sight threatening diabetic retinopathy; ESRD, end stage renal disease; LL, lower limb; CVD, cardiovascular disease; LDL-C; low density lipoprotein cholesterol; HbA1c, glycated hemoglobin; SBP, systolic blood pressure; DBP, diastolic blood pressure; ACR, albumin-creatinine ratio; OAD, oral anti-diabetic drug; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blockers.