Impact of diabetes mellitus on risk of cardiovascular disease and all-cause mortality: Evidence on health outcomes and antidiabetic treatment in United States adults

AIMTo examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Fileson prescribed medicines for patients with DM were used to test the research questions. χ 2, Poisson and Cox’s regression models were applied in data analysis.RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD= 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI:1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM,respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without DM. Antidiabetic mediations,specifically for metformin use, show a protective effect against all-cause and CVD mortalities.

Collembola communities and soil conditions in forest plantations established in an intensively managed agricultural area

The challenges of a changing climate have directed greater attention to afforestation,but the effects of afforestation on soil fertility and soil biota have not been fully clarified.To explore changes in the soil conditions in two 20-year-old forest plantations established in formerly intensively fertilized plots of agricultural land,we focused on the current developmental state of the sites that received the most fertilizer and evaluated soil properties and Collembola(springtails)communities.Sessile oak(Quercus petraea)and black locust(Robinia pseudoacacia)that had been planted in the afforestation sites were assessed for differences between plantations of native and invasive species.Five adjacent reference associations,including forests and open habitats,were also analyzed and compared.Results showed that the soils in the two afforested sites were similar in their properties and Collembola communities to those of the control cultivated forests,but differed from each other in pH,calcium,phosphorus,and ammonium content.The available potassium and phosphorus contents in the soil of the sessile oak plantation were still high,while the soil organic matter content was adequate(SOM>2.0%)in both plantations.Species richness of Collembola ranged from 18 in the cultivated arable land to 43 in the relict forest.Only a few species typical for forests(e.g.,Neanura muscorum,Isotomiella minor,Entomobrya muscorum)were detected in the young plantations,while species characteristic of open habitats(e.g.,Protaphorura campata,Lepidocyrtus cyaneus)occurred as well.Although more individuals and species of Collembola were present in the soil of young plantations than in arable fields,their community diversities were significantly lower compared to the control forest stands.Collembola community diversity differed significantly also between the two plantation types(with native and non-native tree species).Mean abundance in the afforested sites was about 2.5 times higher than in the cultivated arable land,yet far lower than the mean abundance in the control forests.