PMID- 37389516
OWN - NLM
STAT- MEDLINE
DCOM- 20240205
LR  - 20240205
IS  - 1942-5546 (Electronic)
IS  - 0025-6196 (Linking)
VI  - 99
IP  - 2
DP  - 2024 Feb
TI  - Progression to Insulin Therapy in Patients With Type 2 Diabetes According to 
      Cardiorespiratory Fitness, Body Mass Index, and Statin Therapy.
PG  - 249-259
LID - S0025-6196(23)00201-X [pii]
LID - 10.1016/j.mayocp.2023.05.005 [doi]
AB  - OBJECTIVE: To evaluate the association between statin therapy, cardiorespiratory 
      fitness (CRF), body mass index (BMI), and progression to insulin therapy in type 
      2 diabetes mellitus (T2DM). METHODS: Participants were patients with T2DM (mean 
      age, 62.7+/-8.4 years; men, 178,992; women, 8360) not treated with insulin, with no 
      evidence of uncontrolled cardiovascular disease, who completed an exercise 
      treadmill test between October 1, 1999, and September 3, 2020. Of these, 158,578 
      were treated with statins and 28,774 were not. We established 5 age-specific CRF 
      categories according to peak metabolic equivalents of task achieved during an 
      exercise treadmill test. RESULTS: During a median follow-up period of 9.0 years, 
      51,182 patients progressed to insulin therapy with an average annual incidence 
      rate of 28.4 events/1000 person-years. The adjusted progression rate was 27% 
      higher in statin-treated patients (hazard ratio [HR], 1.27; 95% CI, 1.24 to 
      1.31), related directly to BMI and inversely related to CRF. A progressively 
      higher rate was noted in statin-treated vs non-statin-treated patients within all 
      BMI categories, ranging from 23% for normal weight to 90% for those with BMI of 
      35 kg/m(2) and higher. The statin-CRF interaction revealed 43% higher rate in the 
      least-fit statin-treated patients (HR, 1.43; 95% CI, 1.35 to 1.51) and a 
      progressive decline with increased CRF to 30% lower risk in highly fit 
      statin-treated patients (HR, 0.70; 95% CI, 0.66 to 0.75). CONCLUSION: In patients 
      with T2DM, the statin-related progression to insulin therapy was associated with 
      relatively low CRF and high BMI levels. The progression rate was mitigated by 
      increased CRF regardless of BMI. Clinicians should foster regular exercise for 
      patients with T2DM to enhance CRF and to lessen the rate of progression to 
      insulin therapy.
CI  - Copyright (c) 2023. Published by Elsevier Inc.
FAU - Kokkinos, Peter
AU  - Kokkinos P
AD  - Veterans Affairs Medical Center, Washington, DC; Department of Kinesiology and 
      Health, Rutgers University, New Brunswick, NJ; George Washington University 
      School of Medicine and Health Sciences, Washington, DC. Electronic address: 
      peter.kokkinos@va.gov.
FAU - Nylen, Eric
AU  - Nylen E
AD  - Veterans Affairs Medical Center, Washington, DC; George Washington University 
      School of Medicine and Health Sciences, Washington, DC.
FAU - Faselis, Charles
AU  - Faselis C
AD  - Veterans Affairs Medical Center, Washington, DC; George Washington University 
      School of Medicine and Health Sciences, Washington, DC.
FAU - Pittaras, Andreas
AU  - Pittaras A
AD  - Veterans Affairs Medical Center, Washington, DC; George Washington University 
      School of Medicine and Health Sciences, Washington, DC.
FAU - Samuel, Immanuel Babu Henry
AU  - Samuel IBH
AD  - Veterans Affairs Medical Center, Washington, DC; Henry M. Jackson Foundation for 
      the Advancement of Military Medicine, Bethesda, MD.
FAU - Lavie, Carl
AU  - Lavie C
AD  - John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University 
      of Queensland School of Medicine, New Orleans, LA.
FAU - Doumas, Michael
AU  - Doumas M
AD  - Veterans Affairs Medical Center, Washington, DC; Aristotle University of 
      Thessaloniki, Thessaloniki, Greece.
FAU - Heimall, Michael S
AU  - Heimall MS
AD  - Veterans Affairs Medical Center, Washington, DC.
FAU - Murphy, Rayelynn
AU  - Murphy R
AD  - Veterans Affairs Medical Center, Washington, DC.
FAU - Myers, Jonathan
AU  - Myers J
AD  - Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, 
      CA; Department of Cardiology, Stanford University, Stanford, CA.
LA  - eng
PT  - Journal Article
DEP - 20230629
PL  - England
TA  - Mayo Clin Proc
JT  - Mayo Clinic proceedings
JID - 0405543
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Insulin)
SB  - IM
MH  - Male
MH  - Humans
MH  - Female
MH  - Middle Aged
MH  - Aged
MH  - *Diabetes Mellitus, Type 2/drug therapy/epidemiology
MH  - *Cardiorespiratory Fitness
MH  - *Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
MH  - Body Mass Index
MH  - Physical Fitness
MH  - Insulin/therapeutic use
MH  - Exercise Test
MH  - Risk Factors
EDAT- 2023/06/30 13:11
MHDA- 2024/02/05 06:42
CRDT- 2023/06/30 10:30
PHST- 2022/12/30 00:00 [received]
PHST- 2023/03/17 00:00 [revised]
PHST- 2023/05/01 00:00 [accepted]
PHST- 2024/02/05 06:42 [medline]
PHST- 2023/06/30 13:11 [pubmed]
PHST- 2023/06/30 10:30 [entrez]
AID - S0025-6196(23)00201-X [pii]
AID - 10.1016/j.mayocp.2023.05.005 [doi]
PST - ppublish
SO  - Mayo Clin Proc. 2024 Feb;99(2):249-259. doi: 10.1016/j.mayocp.2023.05.005. Epub 
      2023 Jun 29.