Outcomes and Management of Type 2 Diabetes in India and China

Nearly half of all the adults with diabetes worldwide live in India and China. This thesis examines various aspects of the management and outcomes of type 2 diabetes mellitus in these populations. In India, the objective was to examine the associations between diabetes and cardiovascular mortality (due to ischemic heart disease and stroke), and between self-reported medication use and cardiovascular mortality among adults with diabetes (with or without comorbid hypertension), in a nationally representative population of India. In Hong Kong, China, the objectives were to determine how age at diagnosis and modifiable risk factors affect hospitalization rates, glycemic exposure, glycemic deterioration, and responses to oral glucose-lowering drugs. In India, diabetes was associated with double the odds of ischemic heart disease mortality and increased odds of stroke mortality. Medication use was associated with lower odds of ischemic heart disease mortality and stroke mortality in high-burden states among people with diabetes and hypertension, with no significant association among people with diabetes alone. In Hong Kong, people with young-onset type 2 diabetes had the highest hospitalization rates, and that 36.8% of bed-days before age 40 years were attributable to mental illness. The adjusted rate ratio of hospitalization was increased in young- versus usual-onset type 2 diabetes for hospitalizations due to any cause, renal causes, diabetes-related causes, cardiovascular causes, or infection. Based on model estimates, intensified risk factor control in young-onset type 2 diabetes was associated with a one-third reduction in cumulative bed-days from diagnosis until age 75 years. people with young-onset type 2 diabetes had a higher mean A1C throughout the lifespan. The cumulative glycemic exposure was >3 times higher for young-onset versus usual-onset type 2 diabetes. Younger age at diagnosis was associated with faster glycemic deterioration, while age at diagnosis ≥60 years was associated with glycemic improvement. Responses to oral glucose-lowering drugs differed by age at diagnosis. Those with young-onset type 2 diabetes had smaller A1C decrements for metformin-based combinations versus usual-onset type 2 diabetes, but greater responses to other combinations containing sulfonylureas. These findings call for better strategies and further research to improve diabetes management and outcomes in India and China.

Department dc:contributor.department

Health Policy, Management and Evaluation

Year dc:date.issued

2021

Author dc:creator

• Ke, Calvin

Advisor dc:contributor.advisor

• Shah, Baiju R

• cardiovascular disease
• China
• hospitalization
• India
• prognosis
• type 2 diabetes

Handle dc:identifier.uri

http://hdl.handle.net/1807/110519

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/110519