An Early-Onset Subgroup of Type 2 Diabetes: A Multigenerational, Prospective Analysis in the Framingham Heart Study

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Abstract

OBJECTIVE To assess the relation of type 2 diabetes occurring earlier (age <55 years) versus later in life to the risk of cardiovascular death and to diabetes in offspring.

RESEARCH DESIGN AND METHODS In the Framingham Heart Study, a community-based prospective cohort study, glycemic status was ascertained at serial examinations over six decades among 5,571 first- and second-generation participants with mortality data and 2,123 second-generation participants who initially did not have diabetes with data on parental diabetes status. We assessed cause of death in a case (cardiovascular death)–control (noncardiovascular death) design and incident diabetes in offspring in relation to parental early-onset diabetes.

RESULTS Among the participants in two generations (N = 5,571), there were 1,822 cardiovascular deaths (including 961 coronary deaths). The odds of cardiovascular versus noncardiovascular death increased with decreasing age of diabetes onset (P < 0.001 trend). Compared with never developing diabetes, early-onset diabetes conferred a 1.81-fold odds (95% CI 1.10–2.97, P = 0.02) of cardiovascular death and 1.75-fold odds (0.96–3.21, P = 0.07) of coronary death, whereas later-onset diabetes was not associated with greater risk for either (P = 0.09 for cardiovascular death; P = 0.51 for coronary death). In second-generation participants, having a parent with early-onset diabetes increased diabetes risk by 3.24-fold (1.73–6.07), whereas having one or both parents with late-onset diabetes increased diabetes risk by 2.19-fold (1.50–3.19).

CONCLUSIONS Our findings provide evidence for a diabetes subgroup with an early onset, a stronger association with cardiovascular death, and higher transgenerational transmission.

Diabetes Care 2020 Dec; 43(12): 3086-3093. https://doi.org/10.2337/dc19-1758

Translation – The earlier you develop diabetes your risk of CVD and coronary death is higher. An if one or both of your parents developed either early onset or late onset diabetes you’re screwed.

Meanwhile in Oklahoma – Follow the Science

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With a mask mandate in place since spring, free drive-through testing, hospitals well-stocked with PPE, and a small army of public health officers fully supported by their chief, the Cherokee Nation has been able to curtail its Covid-19 case and death rates even as those numbers surge in surrounding Oklahoma, where the White House coronavirus task force says spread is unyielding.

The Cherokee Nation, with about 140,000 citizens on its reservation in northeastern Oklahoma, has reported just over 4,000 cases and 33 deaths.

“It’s dire, but what in the world would it look like if we weren’t doing this work?’” said Lisa Pivec, senior director of public health for Cherokee Nation Health Services. Pivec leads a team that jumped into action in late February, holding coronavirus task force meetings twice a day, instituting procedures to screen thousands of employees, stockpiling PPE, protecting elders, ensuring food security, and educating residents in both English and Cherokee language. With no guidance on contact tracing available from the CDC early in the pandemic, Pivec researched the World Health Organization’s Ebola response to set up tracing protocols; after the first case appeared on the reservation March 24, she made many of the contact tracing calls herself.

‘They’ve been following the science’: How the Covid-19 pandemic has been curtailed in Cherokee Nation — https://www.statnews.com/2020/11/17/how-covid19-has-been-curtailed-in-cherokee-nation/

Take a few minutes and read the full article. You will be impressed as I was.

Oxford vaccine found safe and immunogenic in Phase 2 Trial Results— Science Chronicle

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Results of the Phase-2 trial of the Oxford vaccine show that the vaccine is safe across age groups — younger (18-55 years age) and older adults (over 56 years age). In fact, older adults better tolerated the vaccine than younger adults, the results show. The vaccine also induced T cell immune responses and neutralising antibodies […]

Oxford vaccine found safe and immunogenic even in older adults — Science Chronicle

Meanwhile in Oklahoma — First-of-Its-Kind Med School Makes History

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Ashton Glover Gatewood, 31, a member of the Choctaw Nation and descendent of both the Chickasaw and Cherokee Nations, has long lamented the glaring lack of Native American physicians. So she decided to become one.

Gatewood is a student in the inaugural class of the first tribally affiliated medical school in the United States, the Oklahoma State University (OSU) College of Osteopathic Medicine at the Cherokee Nation. The school opened this fall on Cherokee land in Tahlequah, the capital of the Cherokee Nation’s 14-county reservation in the rolling hills of rural Oklahoma, about an hour east of Tulsa.


First-of-Its-Kind Med School Makes History — https://www.medscape.com/viewarticle/941187?src=rss#vp_1

I’ll have to ask Project #1 on my Project List if he will be teaching any classes at the new medical school.

More on Vulvar Melanoma

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Lesions could be angiokeratomas, petechiae, purpura, melanosis, and nevi, for example. Seborrheic keratoses can mimic melanoma. “If it looks odd, don’t be afraid to biopsy it,” said Mauskar, assistant professor of dermatology and obstetrics and gynecology at the University of Texas Southwestern Medical Center in Dallas.

Low Threshold to Biopsy Atypical Lesions May ID Vulvar Melanoma Early, Experts Say — https://www.medscape.com/viewarticle/941157?src=rss

I first became aware of melanoma down there back in June of this year. See Vulvar Melanoma Is Increasing in Older Women

So remember, if it looks odd get it biopsied.

Can 2020 Get Any Worse? (si)

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Until now, there had been only one confirmed case of Chapare virus, an Ebola-like illness that turned up in the rural Bolivian province of Chapare in 2004 and then disappeared. But in 2019, at least five more people caught the bug, according to research now made public. The virus spread from person to person through bodily fluids in a region near Bolivia’s capital city of La Paz, killing three people. There are no active outbreaks of Chapare in 2020, and even in the event of further outbreaks the virus would be unlikely to cause a pandemic, according to virus experts.

There are reasons to be concerned about the news, however. Three of the five confirmed patients from the 2019 outbreak were health care workers, according to a CDC statement; a “young medical resident,” an ambulance medic and a gastroenterologist all contracted Chapare after contact with bodily fluids from infected patients. Two of them died.

Deadly hemorrhagic fever in Bolivia can spread between people — https://www.livescience.com/chapare-virus-human-transmission.htm

In my next life I want to come back as an Infectious Disease specialist.

ATTENTION Anti-Vaxxers — (you probably don’t want this vaccine either)

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The 30,000-person trial included 11,000 volunteers from communities of color, making up 37% of the total study population. It also included more than 7,000 volunteers over the age of 65 and more than 5,000 people under 65 who have high-risk medical conditions that put them at high risk of suffering from a severe infection, should they contract Covid, things like diabetes, severe obesity and heart disease. 

Moderna’s Covid-19 vaccine is strongly effective, early look at data show – https://www.statnews.com/2020/11/16/modernas-covid-19-vaccine-is-strongly-effective-early-look-at-data-show/?utm_campaign=rss

Refrigeration Requirements

The mRNA-1273 vaccine can be shipped and stored for up to 6 months at –20° C (about –4° F), a temperature maintained in most home or medical freezers, according to Moderna. The company expects that after the product thaws, it will remain stable at standard refrigerator temperatures of 2° to 8° C (36° to 46° F) for up to 30 days within the 6-month shelf life.

Because the mRNA-1273 vaccine is stable at these refrigerator temperatures, it can be stored at most physicians’ offices, pharmacies, and hospitals, the company notes. In contrast, the similar Pfizer BTN162b2 vaccine ― early results for which showed a 90% efficacy rate, as reported by Medscape Medical News ― requires shipment and storage at “deep freeze” conditions of –70° C or –80° C, which is more challenging from a logistic point of view.

Moderna’s mRNA-1273 can be kept at room temperature for up to 12 hours after removal from a refrigerator for patient administration. The vaccine will not require dilution prior to use.

Moderna: Interim Data Show 94.5% Efficacy for COVID-19 Vaccine, Will Seek FDA EUA — https://www.medscape.com/viewarticle/941023?src=rss

Game changer!

COVID-19: Study Suggests Durable Immune Response After SARS-CoV-2 Infection

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Immune responses to SARS-CoV-2 might last for years, according to a study posted on the preprint server bioRxiv.

Some 185 adults who recovered from COVID-19 (most had mildly symptomatic disease) provided blood samples for analysis. The majority provided a single sample, but roughly 20% provided multiple samples over several months.

The researchers found that levels of spike-specific memory B cells (which make antibodies as needed) increased with time — and were higher at 4–6 months than at earlier time points in most participants who gave multiple samples. In addition, SARS-CoV-2 spike IgG titers were generally stable, showing only modest declines at 6–8 months.

COVID-19: Study Suggests Durable Immune Response After SARS-CoV-2 Infection — https://www.jwatch.org/fw117245/2020/11/17/covid-19-study-suggests-durable-immune-response-after

I hope these findings are replicated in other studies.

ATTENTION Anti-Vaxxers – Measles Deaths Surge Worldwide

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Deaths due to measles increased 50% from 2016 to 2019, according to recent data from the World Health Organization and CDC that were highlighted in MMWR. In 2019, over 200,000 people died from the disease.

Measles Deaths Surge Worldwide — https://www.jwatch.org/fw117234/2020/11/15/measles-deaths-surge-worldwide

Measles is entirely preventable. And please don’t quote me the U.S. fatality statistics for measles. I am aware the U.S. numbers are very low. Don’t use this as a reason not to vaccinate your children.

How our Brains can be Manipulated to Tribalism

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An earlier article by Prof. Javanbakht.

Tribalism has been an inherent part of human history, and is closely linked with fear. There has always been competition between groups of humans in different ways and with different faces, from brutal wartime nationalism to a strong loyalty to a football team. Evidence from cultural neuroscience shows that our brains even respond differently at an unconscious level simply to the view of faces from other races or cultures.

At a tribal level, people are more emotional and consequently less logical: Fans of both teams pray for their team to win, hoping God will take sides in a game. On the other hand, we regress to tribalism when afraid. This is an evolutionary advantage that would lead to the group cohesion and help us fight the other tribes to survive.

Tribalism is the biological loophole that many politicians have banked on for a long time: tapping into our fears and tribal instincts. Abuse of fear has killed in many faces: extreme nationalism, Nazism, the Ku Klux Klan and religious tribalism have all led to heartless killing of millions.

How our brains can be manipulated to tribalism — https://theconversation.com/trump-the-politics-of-fear-and-racism-how-our-brains-can-be-manipulated-to-tribalism-139811