More Patients Get Good Diabetes Control, but Only a Minority Meet All Goals

Mitka M. — Wed, 03 Apr 2013 00:00:00 GMT

The percentage of patients with diabetes who are managing to control their condition has been growing since the late 1980s, according to findings from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). But although the increase—from about 2% in 1988 to just under 20% in 2010—is substantial, the fact remains that a large majority of patients have yet to achieve tight control of their diabetes.

Melatonin Secretion and the Incidence of Type 2 Diabetes Melatonin Secretion and Type 2 Diabetes

McMullan CJ, Schernhammer ES, Rimm EB, et al. — Wed, 03 Apr 2013 00:00:00 GMT

Importance

Loss-of-function mutations in the melatonin receptor are associated with insulin resistance and type 2 diabetes. Additionally, in a cross-sectional analysis of persons without diabetes, lower nocturnal melatonin secretion was associated with increased insulin resistance.

Objective

To study the association between melatonin secretion and the risk of developing type 2 diabetes.

Design, Setting, and Participants

Case-control study nested within the Nurses' Health Study cohort. Among participants without diabetes who provided urine and blood samples at baseline in 2000, we identified 370 women who developed type 2 diabetes from 2000-2012 and matched 370 controls using risk-set sampling.

Main Outcome Measures

Associations between melatonin secretion at baseline and incidence of type 2 diabetes were evaluated with multivariable conditional logistic regression controlling for demographic characteristics, lifestyle habits, measures of sleep quality, and biomarkers of inflammation and endothelial dysfunction.

Results

The median urinary ratios of 6-sulfatoxymelatonin to creatinine were 28.2 ng/mg (5%-95% range, 5.5-84.2 ng/mg) among cases and 36.3 ng/mg (5%-95% range, 6.9-110.8 ng/mg) among controls. Women with lower ratios of 6-sulfatoxymelatonin to creatinine had increased risk of diabetes (multivariable odds ratio, 1.48 [95% CI, 1.11-1.98] per unit decrease in the estimated log ratio of 6-sulfatoxymelatonin to creatinine). Compared with women in the highest ratio category of 6-sulfatoxymelatonin to creatinine, those in the lowest category had a multivariable odds ratio of 2.17 (95% CI, 1.18-3.98) of developing type 2 diabetes. Women in the highest category of melatonin secretion had an estimated diabetes incidence rate of 4.27 cases/1000 person-years compared with 9.27 cases/1000 person-years in the lowest category.

Conclusions and Relevance

Lower melatonin secretion was independently associated with a higher risk of developing type 2 diabetes. Further research is warranted to assess if melatonin secretion is a modifiable risk factor for diabetes within the general population.

JAMA: Diabetes Mellitus Type 2 Topic Collection

More Patients Get Good Diabetes Control, but Only a Minority Meet All Goals

Melatonin Secretion and the Incidence of Type 2 Diabetes Melatonin Secretion and Type 2 Diabetes