Dianna J Magliano

Baker Heart and Diabetes Institute · Diabetes and Population Health

Aims We investigated the association of fasting triglycerides with cardiovascular disease (CVD) mortality. Methods and results This cohort study included US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014. CVD mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional ha...

OBJECTIVE Differentiation of risk for major adverse cardiovascular events (MACE) from heart failure hospitalization (HHF) or kidney disease is important when selecting glucose-lowering therapy. We investigated the ability of separate MACE and HHF risk scores to 1) differentiate MACE from HHF risk; and 2) identify individuals more likely to benefit...

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT-2Is) reduce heart failure (HF) hospitalizations and major adverse cardiovascular events (MACE) in general type 2 diabetes populations. The objective of this study was to determine whether SGLT-2Is vs. dipeptidyl peptidase-4 inhibitors (DPP-4Is) are associated with reductions in MACE, HF...

Dyslipidemia associates with and usually precedes the onset of chronic kidney disease (CKD), but a comprehensive assessment of molecular lipid species associated with risk of CKD is lacking. Here, we sought to identify fasting plasma lipids associated with risk of CKD among American Indians in the Strong Heart Family Study, a large-scale community-...

Aim We evaluated the associations of age and duration of type 2 diabetes with major diabetes-related complications. Methods We included 1.1 million people with type 2 diabetes from the Australian diabetes registry, followed from 2010-2019. We estimated the incidence of hospitalization or death from myocardial infarction (MI), stroke, and heart fai...

Objectives Prolonged exposure to stress is a risk factor for mental and physical health problems (i.e., depression, cardiovascular disease). Although higher consumption of fruit and vegetables (FV) has been associated with lower perceived stress (PS), the relationship between specific FV types and PS remains uncertain. The aim of this cross-section...

Background Although insulin pump therapy is an important treatment modality for patients with type 1 diabetes, rates of pump use appear to vary broadly internationally. This study aimed to investigate the application of insulin pump therapy among patients with type 1 diabetes in China. Methods Data were collected from the Type 1 Diabetes Mellitus...

Aims/hypothesis Mortality has declined in people with type 1 diabetes in recent decades. We examined how the pattern of decline differs by country, age and sex, and how mortality trends in type 1 diabetes relate to trends in general population mortality. Methods We assembled aggregate data on all-cause mortality during the period 2000–2016 in peop...

To estimate the age-standardized prevalence of diabetes and prediabetes and identify factors associated with these conditions at individual, household, and community levels. Data from 11952 Bangladeshi adults aged 18-95 years available from the most recent Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and f...

The traditional complications of diabetes mellitus are well known and continue to pose a considerable burden on millions of people living with diabetes mellitus. However, advances in the management of diabetes mellitus and, consequently, longer life expectancies, have resulted in the emergence of evidence of the existence of a different set of less...

Background: It is unknown how use of newer glucose-lowering drugs (GLDs) has changed in Australia following the publication of clinical trials demonstrating definitive clinical advantages for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter 2 inhibitors (SGLT2is), and whether this varies by socioeconomic disa...

Traffic-related air pollution (TRAP) is associated with lower cognitive function and diabetes in older adults, but little is known about whether diabetes status moderates the impact of TRAP on older adult cognitive function. We analysed cross-sectional data from 4141 adults who participated in the Australian Diabetes, Obesity and Lifestyle (AusDiab...

Background and Aims Higher total fruit and vegetable (FV) intakes have been associated with lower perceived stress. However, the relationship of FV intake with domains of perceived stress is unclear. The aim of this cross-sectional study was to explore the relationship between consumption of FV and four perceived stress domains (worries, tension, l...

Aims: We evaluated variation in treatment for, and outcomes following, myocardial infarction (MI) by diabetes status, sex and socioeconomic disadvantage. Methods: We included all people aged ≥30 years who were discharged alive from hospital following MI between 1 July 2012 and 30 June 2017 in Victoria, Australia (n=43 272). We assessed receipt o...

This study provides evidence that consuming flavonoid-rich food may be protective against type 2 diabetes (T2DM) through mechanisms related to better glucose tolerance and insulin sensitivity.

BACKGROUND The epidemiology of adult-onset type 1 diabetes (T1D) incidence is not well-characterized due to the historic focus on T1D as a childhood-onset disease. PURPOSE We assess the incidence of adult-onset (≥20 years) T1D, by country, from available data. DATA SOURCES A systematic review of MEDLINE, Embase, and the gray literature, through 1...

Background Studies have shown that among people with diabetes, those with non-albuminuric chronic kidney disease (CKD) have a slower rate of reduction in renal function than do those with normal renal function. This suggests the presence of protective factors, the identification of which may open up targets for intervention. The aim of this study w...

Purpose Higher total fruit and vegetable (FV) intakes have been associated with lower perceived stress. The relationship between specific types of FV and perceived stress remains uncertain. The aims of this cross-sectional study were to explore the relationship between consumption of specific types of FV with perceived stress in a population-based...

Background Adequate dietary protein intake is recommended for older adults to optimise muscle health and function, and support recovery from illness, however, its effect on health-related quality of life (HRQoL) is unclear. The aim of this study was to examine the association between total protein intake and different sources of dietary protein and...

Aims It is unknown whether low serum uric acid (hypouricemia) is associated with diabetes diagnosis. This study aimed to investigate this association in Chinese adults. Methods This cross-sectional study included 22,546 Chinese adults. The reference interval for serum uric acid was determined in a sub-group of healthy individuals. The association...

Metabolic Associated Fatty Liver Disease (MAFLD) is the most common cause of liver disease in Australia, but prevalence data are limited. We aimed to describe the frequency of alanine aminotransferase (ALT) elevation, and MAFLD within a large prospective Australian cohort. Cross-sectional analysis of the 2012 survey of the Australian Diabetes, Obes...

Aim: To estimate the prevalence of undiagnosed diabetes, and to identify the relative importance of risk factors for undiagnosed diabetes among Bangladeshi adults. Method: Data from 11, 421 Bangladeshi adults aged 18 years and older available from the most recent nationally representative Bangladesh Demographic and Health Survey 2017-18 were used....

Aims We aimed to conduct a systematic review of published studies on the incidence of type 2 diabetes in children and adolescents aged under 20 years and provide worldwide incidence estimates for 2021. Methods We used MEDLINE and EMBASE to identify studies reporting type 2 diabetes incidence in children and adolescents published between Jan 2000 a...

OBJECTIVE To determine trends in the incidence of major diabetes-related complications in Australia. RESEARCH DESIGN AND METHODS This study included 70,885 people with type 1 and 1,089,270 people with type 2 diabetes registered on the Australian diabetes registry followed from July 2010 to June 2019. Outcomes (hospitalization for myocardial infarc...

Objective We estimated the 1-year incidence of readmission to hospital and 1-year all-cause mortality following ischaemic stroke (IS), by diabetes status, sex, and socioeconomic disadvantage. Methods This study included all individuals aged ≥30 years who were discharged from hospital following an IS between July 2012 and June 2017 in Victoria, Aus...

Background Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes. Methods In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdiction...

In this paper, we assess the cost-effectiveness of 1 g daily of carnosine (an over the counter supplement) in addition to standard care for the management of type 2 diabetes and compare it to standard care alone. Dynamic multistate life table models were constructed in order to estimate both clinical outcomes and costs of Australians aged 18 years...

Aims Excess mortality is high in the setting of diabetes and end-stage kidney disease (ESKD), but the effects of ESKD beyond diabetes itself remains incompletely understood. We examined excess mortality in people with diabetes with vs. without ESKD, and variation by age, sex, and diabetes type. Methods This study included 63,599 people with type 1...

Aim: To investigate the incidence of, and factors associated with addition and switching of glucose-lowering medications within 12-months of initiating metformin or a sulfonylurea for type 2 diabetes (T2D). Methods: We identified 109,573 individuals aged 18–99 years who initiated metformin or a sulfonylurea between July 2013 and April 2015 using Au...

Aims To provide up-to-date estimates of undiagnosed diabetes mellitus (UDM) prevalence - both globally, and by region/country, for the year 2021. Methods: Data sources reporting diabetes prevalence were identified through a systematic search in the peer-reviewed and grey literature. The prevalence of undiagnosed diabetes was estimated from the data...

Aims To provide global, regional, and country-level estimates of diabetes prevalence and health expenditures for 2021 and projections for 2045. Methods A total of 219 data sources meeting pre-established quality criteria reporting research conducted between 2005 and 2020 and representing 215 countries and territories were identified. For countries...

Objectives High dietary phosphate intake may lead to adverse outcomes including cardiovascular disease (CVD). Urinary phosphate excretion, a marker of intestinal phosphate absorption, may be a more reliable marker of phosphate homeostasis in steady state than serum phosphate. Studies report good agreement between urine phosphate-to-creatinine ratio...

Thyroid cancer incidence and the prevalence of overweight and obesity are increasing, but the future thyroid cancer burden attributable to contemporary levels of overweight and obesity has not been evaluated before. We quantified this burden in Australia, and assessed whether the overweight/obesity-attributable burden differed by sex or other popul...

Background Examining a variety of diet quality methodologies will inform best practice use of diet quality indices for assessing all-cause and CVD mortality. Objective To examine the association between three diet quality indices (Australian Dietary Guideline Index, DGI; Dietary Inflammatory Index, DII; Mediterranean-DASH Intervention for Neurodeg...

Background and objectives The number of people with diabetes-related end-stage kidney disease (ESKD-DM) has doubled in the last two decades. We examined changes in excess mortality for people with ESKD-DM in the US and Australia. Design, setting, participants, and measurements In this retrospective cohort study, we included adults (ages 20–84) rec...

Objective: Diabetes increases the risk of premature mortality and considerably impacts on work productivity. We sought to examine the impact of diabetes in India, in terms of excess premature mortality, years of life lost (YLL), productivity-adjusted life years (PALYs) lost, and its associated economic impact. Research design and methods: A life...

PurposeTo investigate the relationship of habitual FV intake, different types of FV, and vegetable diversity with depressive symptoms.Methods Australian men and women (n = 4105) aged > 25 years from the Australian Diabetes, Obesity and Lifestyle Study were included. Dietary intake was assessed using a Food Frequency Questionnaire at baseline, 5 and...

Background and aims: Clinical and public health implications of the recent re-defining of non-alcoholic fatty liver (NAFLD) to metabolic associated fatty liver (MAFLD) remain unclear. We sought to determine the prevalence and compare MAFLD to NAFLD in a well-defined cohort. Methods: A cross-sectional study was conducted in regional Victoria with...

Lipid metabolism is tightly linked to adiposity. Comprehensive lipidomic profiling offers new insights into the dysregulation of lipid metabolism in relation to weight gain. Here, we investigated the relationship of the human plasma lipidome and changes in waist circumference (WC) and body mass index (BMI). Adults (2653 men and 3196 women), 25–95 y...

Background Estimates of the future burden of invasive cancer attributable to current modifiable causal exposures can guide cancer prevention. Methods We linked pooled data from seven Australian cohort studies (N = 367,058) to national cancer and death registries, and estimated exposure-cancer and exposure-death associations using adjusted proporti...

Background Intensive therapy is often required to reach glycated haemoglobin targets in people with Type 2 Diabetes (T2D), however, aggressive treatment in people >80 years, frail individuals and people with dementia may be harmful. We aimed to determine whether these factors predict the intensity of anti-hyperglycaemic therapies prescribed for old...

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30...

Background: Randomized, controlled cardiovascular outcome trials may not be fully representative of the management of patients with type 2 diabetes across different geographic regions. We conducted analyses of data from the multinational CVD-REAL consortium to determine the association between initiation of sodium-glucose cotransporter-2 inhibitor...

The association between rate of kidney function decline and age-of-onset or duration of diabetes has not been well investigated. We aimed to examine whether rates of estimated glomerular filtration rate (eGFR) decline differ by age-of-onset or duration in people with type 2 diabetes. Using the Action to Control Cardiovascular Risk in Diabetes study...

Background Fruit, but not fruit juice, intake is inversely associated with type 2 diabetes mellitus (T2DM). However, questions remain about the mechanisms by which fruits may confer protection. Aims were to examine associations between intake of fruit types and 1) measures of glucose tolerance and insulin sensitivity and 2) diabetes at follow-up....

Objectives To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) and its risk factors in regional Victoria. Design Prospective cross-sectional observational study (sub-study to CrossRoads II health study in Shepparton and Mooroopna). Setting Four towns (populations, 6300‒49 800) in the Goulburn Valley of Victoria. Participan...

Objective: This study sought to examine the effects of two diabetes prevention approaches and of widespread use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) among people with diabetes on the future incidence of diabetes-related end-stage kidney disease (ESKD-D). Research design and methods: We developed a life table model to project th...

Background: Estimates of future burden of cancer attributable to current modifiable causal exposures can guide cancer prevention. We quantified future head and neck cancer burden in Australia attributable to individual and joint causal exposures, and assessed whether these burdens differ between population subgroups. Methods: We estimated the st...

Aim To examine psychosocial and behavioural impacts of the COVID-19 pandemic and lockdown restrictions among adults with type 2 diabetes. Methods Participants enrolled in the Progression of Diabetic Complications (PREDICT) cohort study in Melbourne, Australia (n=489 with a baseline assessment pre-2020) were invited to complete a phone/online follo...

Increasing prevalence of mental health disorders within the Australian population is a serious public health issue. Adequate intake of fruits and vegetables (FV), dietary fibre (DF) and resistant starch (RS) is associated with better mental and physical health. Few longitudinal studies exist exploring the temporal relationship. Using a validated fo...

The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pa...

Background & aims Poor nutritional habits are linked to higher perceived stress, but the relationship between fruit and vegetable (FV) intake and stress is uncertain. The primary aim of this cross-sectional study was to explore the relationship between FV intake and perceived stress in a population-based cohort of men and women aged ≥25 years from...

Background Nitrate supplements can improve vascular and muscle function. Whether higher habitual dietary nitrate is associated with better muscle function remains underexplored. Objective The aim was to examine whether habitual dietary nitrate intake is associated with better muscle function in a prospective cohort of men and women, and whether th...

Effective cardiovascular disease (CVD) prevention relies on timely identification and intervention for individuals at risk. Conventional formula-based techniques have been demonstrated to over- or under-predict the risk of CVD in the Australian population. This study assessed the ability of machine learning models to predict CVD mortality risk in t...

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in di...

Background The consumption of legumes is promoted as part of a healthy diet in many countries but associations of total and types of legume consumption with type 2 diabetes (T2D) are not well established. Analyses across diverse populations are lacking despite the availability of unpublished legume consumption data in prospective cohort studies. O...

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in di...

The association between rate of kidney function decline and age-of-onset or duration of type 2 diabetes has not been well investigated. We aimed to examine whether rates of estimated glomerular filtration rate (eGFR) decline differ by age-of-onset or duration in people with type 2 diabetes. Using the Action to Control Cardiovascular Risk in Diabete...

Aim We examined whether chronic kidney disease (CKD) modifies the frequency of heart failure hospitalisation (HHF) relative to atherosclerotic major adverse cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction [MI], or stroke) in people with type 2 diabetes. Methods Of 16 cardiovascular outcomes trials in type 2 di...

Aims/hypothesis In recent years, several new medications for the treatment of type 2 diabetes have been released and some evidence indicates sociodemographic disparity in their utilisation. We sought to investigate sociodemographic disparities in receipt of diabetes medications across Australia. Methods This study included 1,203,317 people with ty...

Aims/hypothesis Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. Methods Data were sourced from MEDLINE and All EBM (Evid...

Background Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of cli...

Aims To explore exposure to 22 persistent organic pollutants (POPs) and incident type 2 diabetes in a population-based, prospective cohort. Methods This case-cohort study on 753 participants without type 2 diabetes at baseline, was followed-up over nine years, as part of the French D.E.S.I.R. cohort. We measured 22 POPs in fasting serum at baselin...

Background Excess mortality in people with vs without type 2 diabetes (T2DM) has fallen, but it is unclear whether men/women at all ages have benefited and which causes of death have driven these trends. Methods All-cause and cause-specific mortality rates and excess mortality [by mortality rate ratios (MRRs) relative to the non-diabetic general p...

OBJECTIVE Diabetes imposes a heavy burden on both health and productivity. In this study, we sought to estimate the potential productivity gains associated with the prevention of type 2 diabetes over the next 10 years in Australia. RESEARCH DESIGN AND METHODS Dynamic life table models were constructed to estimate years of life lived and productivi...

Background: The risks of intensive blood glucose lowering may outweigh the benefits in vulnerable older people. Objectives: Our primary aim was to determine whether age, frailty, or dementia predict discharge treatment types for patients with type 2 diabetes (T2D) and related complications. Secondly, we aimed to determine the association between...

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