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Abstract
Sodium glucose cotransporter 2 (SGLT-2) inhibitors are the latest class of antidiabetic medications. They prevent glucose reabsorption in the proximal convoluted tubule to decrease blood sugar. Several animal studies revealed that SGLT-2 is profoundly involved in the inflammatory response, fibrogenesis, and regulation of numerous intracellular signaling pathways. Likewise, SGLT-2 inhibitors markedly attenuated inflammation and fibrogenesis and improved the function of damaged organ in animal studies, observational studies, and clinical trials. SGLT-2 inhibitors can decrease blood pressure and ameliorate hypertriglyceridemia and obesity. Likewise, they improve the outcome of cardiovascular diseases such as heart failure, arrhythmias, and ischemic heart disease. SGLT-2 inhibitors are associated with lower cardiovascular and all-cause mortality as well. Meanwhile, they protect against nonalcoholic fatty liver disease (NAFLD), chronic kidney disease, acute kidney injury, and improve micro- and macroalbuminuria. SGLT-2 inhibitors can reprogram numerous signaling pathways to improve NAFLD, cardiovascular diseases, and renal diseases. For instance, they enhance lipolysis, ketogenesis, mitochondrial biogenesis, and autophagy while they attenuate the renin-angiotensin-aldosterone system, lipogenesis, endoplasmic reticulum stress, oxidative stress, apoptosis, and fibrogenesis. This review explains the beneficial effects of SGLT-2 inhibitors on NAFLD and cardiovascular and renal diseases and dissects the underlying molecular mechanisms in detail. This narrative review explains the beneficial effects of SGLT-2 inhibitors on NAFLD and cardiovascular and renal diseases using the results of latest observational studies, clinical trials, and meta-analyses. Thereafter, it dissects the underlying molecular mechanisms involved in the clinical effects of SGLT-2 inhibitors on these diseases.
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Affiliation(s)
- Moein Ala
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Kebede SA, Tusa BS, Weldesenbet AB, Tessema ZT, Ayele TA. Time to diabetic neuropathy and its predictors among newly diagnosed type 2 diabetes mellitus patients in Northwest Ethiopia. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Despite the high number of patients suffering from the negative impact of diabetic neuropathy (DN) in Ethiopia, evidence regarding the time to DN and its predictors are not well document in Ethiopia. Therefore, the current study aimed to determine time to DN and its predictors among newly diagnosed type 2 diabetes patients (T2DM) in North West Ethiopia.
Methods
Institutional based retrospective cohort study was conducted among 463 T2DM. Cox proportional hazard model was fitted to identify predictors of time to DN. The adjusted hazard ratio (AHR) with its 95% confidence interval was used to declare the presence and strength of association.
Results
From a total 463 study participants, 77 (16.63%), (95% CI 13.23%, 20.03%) had developed diabetic neuropathy. The median time to develop DN was 233.77 months. About 40 (51.95%) diabetic neuropathy cases occurred within 6 years of diagnosis of diabetic mellitus. The incidence density was 2.01/100 PY with 95% CI of [1.60, 2.53]. In the multivariable Cox proportional hazard analysis; being aged 65–69 [AHR = 2.78; 95% CI 1.20, 6.46], living with diabetes for less than 4 years [AHR = 3.77; 95% CI 1.82, 7.76], having anaemia [AHR = 3.82; 95% CI 1.66, 8.82] and having other complications [AHR = 1.68; 95% CI 1.03, 2.76 were significant predictors of DN.
Conclusion
More than half of diabetic neuropathy cases occurred within a short period of diagnosed with T2DM. Significant predictors for the time to DN were age, duration, having anaemia and other DM complication. Therefore, we recommend that early screening for DM and its complication for risky groups. While doing that due consideration should be assumed for old and anemic patients.
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Chou MY, Huang ST, Liang CK, Peng LN, Lin YT, Hsiao FY, Chen LK. All-cause mortality, cardiovascular mortality, major cardiovascular events and hypoglycaemia of patients with diabetes onset at an older age: results from the 10-year nationwide cohort study. Age Ageing 2021; 50:2094-2104. [PMID: 34628489 DOI: 10.1093/ageing/afab183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Longitudinal adverse outcomes are unclear among adults with diabetes according to the age of onset. OBJECTIVE To investigate the longitudinal diabetes-related outcomes in adults with new-onset diabetes stratified by age. DESIGN Retrospective cohort study. SETTING Taiwan National Health Insurance Research Database claims data from 2000 to 2015. SUBJECTS In total, 115,751 participants aged ≥40 years with new-onset diabetes in 2003 were recruited and stratified by the ages 40-64 (64.3%), 65-74 (21.2%), 75-84 (11.8%) and ≥85 years (2.7%) at the time of diagnosis. METHODS Time-varying multivariate Cox proportional hazards model adjusted for covariates was used to examine the associations between the ages of the patients at diabetes onset and the outcomes of interest [all-cause mortality, cardiovascular (CV) mortality, major cardiovascular events (MACE) and hypoglycaemia] during a 10-year follow-up period. RESULTS The results showed that compared with those patients aged 40-64 at diagnosis, patients with older-onset diabetes had significantly higher comorbidities (P < 0.01) and a higher diabetes severity (P < 0.01). Patients with older-onset diabetes had a higher risk of all-cause mortality [adjusted hazard ratio (aHR) 2.28, 4.48 and 10.07 in 65-74, 75-84 and ≥85 years old, respectively], CV mortality (aHR = 2.82, 6.06 and 15.91), MACE (aHR = 2.19, 3.01 and 4.15) and hypoglycaemia (aHR = 2.41, 3.59 and 4.62) than patients aged 40-64 during a 10-year follow-up period. CONCLUSIONS Patients with diabetes onset at an older age was associated with increased risks of all-cause mortality, CV mortality, MACE and hypoglycaemia after adjusting for the severity of diabetes and anti-diabetic treatment.
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Affiliation(s)
- Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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Frias JP, Bonora E, Nevárez Ruiz L, Hsia SH, Jung H, Raha S, Cox DA, Bethel MA, Konig M. Efficacy and safety of dulaglutide 3.0 and 4.5 mg in patients aged younger than 65 and 65 years or older: Post hoc analysis of the AWARD-11 trial. Diabetes Obes Metab 2021; 23:2279-2288. [PMID: 34159708 PMCID: PMC8518960 DOI: 10.1111/dom.14469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the efficacy and safety of dulaglutide 3.0 and 4.5 mg versus 1.5 mg when used as an add-on to metformin in subgroups defined by age (<65 and ≥65 years). MATERIALS AND METHODS Of 1842 patients included in this post hoc analysis, 438 were aged 65 years or older and 1404 were younger than 65 years. The intent-to-treat (ITT) population, while on treatment without rescue medication, was used for all efficacy analyses; the ITT population without rescue medication was used for hypoglycaemia analyses; all other safety analyses used the ITT population. RESULTS Patients aged 65 years or older and those younger than 65 years had a mean age of 69.5 and 53.2 years, respectively. In each age subgroup, the reduction from baseline in HbA1c and body weight (BW), and the proportion of patients achieving a composite endpoint of HbA1c of less than 7% (<53 mmol/mol) with no weight gain and no documented symptomatic or severe hypoglycaemia, were larger for dulaglutide 3.0 and 4.5 mg compared with dulaglutide 1.5 mg, but the treatment-by-age interactions were not significant. The safety profile for the additional dulaglutide doses was consistent with that of dulaglutide 1.5 mg and was similar between the age subgroups. CONCLUSION Dulaglutide doses of 3.0 or 4.5 mg provided clinically relevant, dose-related improvements in HbA1c and BW with no significant treatment-by-age interactions, and with a similar safety profile across age subgroups.
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Affiliation(s)
| | - Enzo Bonora
- University and University Hospital of VeronaVeronaItaly
| | | | | | - Heike Jung
- Lilly Deutschland GmbHBad HomburgGermany
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Was Sleep a Problem for the Elderly During COVID-19? ACTA ACUST UNITED AC 2021; 5:197-203. [PMID: 34514292 PMCID: PMC8420144 DOI: 10.1007/s41782-021-00164-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022]
Abstract
Over the past few decades, the population of geriatrics has seen an exponential rise and it is well known that the prevalence of chronic diseases and other associated comorbidities is higher among them which in turn, has an established association with sleep disorders. During these unprecedented circumstances, geriatrics are predisposed to be at an increased risk of sleep disorders due to the social isolation and loneliness imposed on them by the lockdowns. The fact that older adults are at a greater risk of contracting the virus due to the presence of comorbidities and the high virulence adds on to the existing risk of sleep disturbances. A lack of sleep in these circumstances has the potential to add on to the vicious cycle of sleep disorders predisposed by chronic disease and vice versa. Mental health, sleep and the presence of comorbidities are closely interlinked and they often tend to overlap. Research in sleep has established insomnia to be the most commonly diagnosed sleep disorder affecting almost 50% of the older adults which can subsequently, elevate their risk of falls. This prevalence of sleep disorders is hypothesized to increase during the second wave of the COVID-19 pandemic and a good sleep routine needs to be advocated for to improve the quality of life of this population. However, scientific evidence concerning this is scarce and this review aims to highlight the significance of sleep and urges its readers to undertake studies that investigate the architecture of sleep amongst older adults during the pandemic.
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Andreasen CR, Andersen A, Knop FK, Vilsbøll T. Understanding the place for GLP-1RA therapy: Translating guidelines for treatment of type 2 diabetes into everyday clinical practice and patient selection. Diabetes Obes Metab 2021; 23 Suppl 3:40-52. [PMID: 34519400 DOI: 10.1111/dom.14500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
Since the first glucagon-like peptide 1 (GLP-1) receptor agonist (GLP-1RA) was approved in 2005 (exenatide twice daily) for type 2 diabetes (T2D), the class has developed with newer compounds having more pronounced effects on glycaemic control and body weight. Also, administration regimes have become more convenient with once weekly injections, and recently an oral administration has become available. Large-scale randomized controlled cardiovascular (CV) outcome trials (CVOTs) have shown that GLP-1RA therapy can reduce the risk of CV disease (CVD) in high-risk individuals with T2D. In addition, GLP-1RAs may have renal benefits driven by new-onset macroalbuminuria, although no effect on hard renal endpoints has been found. Subsequently, the place for GLP-1RA therapy has changed over recent years, with most societies endorsing GLP-1RA therapy in patients with established or high risk of CVD independently of glycaemia. Initiation of GLP-1RA therapy can be complex due to differences in efficacy, side effects and safety profiles as well as administration forms within the class. Implementing guideline recommendations into ideal patient selection may be challenging both in specialty and non-specialty settings. To ensure adequate and proactive use of modern glucose-lowering medications in the treatment of T2D, it is essential to recognize patients with high risk or documented CVD. The present review provides an overview of the efficacy and benefits of the currently available GLP-1RA compounds. Furthermore, we review the results from recent large-scale CVOTs in a clinical context and suggest improving the implementation of GLP-1RA therapy across specialties to improve overall patient selection.
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Affiliation(s)
- Christine Rode Andreasen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Andreas Andersen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip Krag Knop
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Cicek M, Buckley J, Pearson-Stuttard J, Gregg EW. Characterizing Multimorbidity from Type 2 Diabetes: Insights from Clustering Approaches. Endocrinol Metab Clin North Am 2021; 50:531-558. [PMID: 34399960 PMCID: PMC8383848 DOI: 10.1016/j.ecl.2021.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with type 2 diabetes mellitus (T2DM) often live with and develop multiple co-occurring conditions, namely multimorbidity, with diffuse impacts on clinical care and patient quality of life. However, literature characterizing T2DM-related multimorbidity patterns is limited. This review summarizes the findings from the emerging literature characterizing and quantifying the association of T2DM with multimorbidity clusters. The authors' findings reveal 3 dominant cluster types appearing in patients with T2DM-related multimorbidity, such as cardiometabolic precursor conditions, vascular conditions, and mental health conditions. The authors recommend that holistic patient care centers around early detection of other comorbidities and consideration of wider risk factors.
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Affiliation(s)
- Meryem Cicek
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstan's Road, London W6 8RP, UK.
| | - James Buckley
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
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Bonikowska I, Szwamel K, Uchmanowicz I. Analysis of the Impact of Disease Acceptance, Demographic, and Clinical Variables on Adherence to Treatment Recommendations in Elderly Type 2 Diabetes Mellitus Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8658. [PMID: 34444407 PMCID: PMC8391118 DOI: 10.3390/ijerph18168658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 01/13/2023]
Abstract
This project aimed to analyze the impact of disease acceptance and selected demographic and clinical factors on the adherence to treatment recommendations in elderly type 2 diabetes mellitus patients. The observational study was performed using standardized research questionnaires: the Acceptance of Illness Scale (AIS), the Self-Care of Diabetes Inventory (SCODI), and the Adherence in Chronic Diseases Scale (ACDS). Two hundred patients with T2DM were studied (age M = 70.21 years, SD = 6.63 years). The median degree of disease acceptance was 29 (min-max = 8-40) and the median level of adherence was 24 (min-max = 13-28). Disease acceptance was a significant (p = 0.002) independent predictor of the odds of qualifying for non-adherence OR = 0.903, 95% CI = 0.846-0.963. The respondents gave the lowest scores for glycemic control (Mdn = 38.99, min-max = 8.33-150), and health control (Mdn = 55.88, min-max = 11.76-100). A one-way ANOVA showed that the non-adhering patients were significantly older compared to the adherence group and were taking significantly more diabetes pills per day. The level of disease acceptance was average, but it turned out to be an independent predictor of adherence. Therefore, it is justified to use psychological and behavioral interventions that are aimed at increasing the level of diabetes acceptance in elderly people with T2DM. It is important to have a holistic approach to the patient and to take actions that consider the patient's deficits in the entire biopsychosocial sphere. The obtained result confirmed the legitimacy of interventions aimed at increasing the level of disease acceptance in this group of patients.
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Affiliation(s)
- Iwona Bonikowska
- Institute of Health Sciences, Department Nursing, University of Zielona Góra, 2 Energetyków Street, 65-00 Zielona Góra, Poland
| | - Katarzyna Szwamel
- Institute of Health Sciences, University of Opole, Katowicka Street 68, 45-060 Opole, Poland;
| | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wrocław Medical University, K. Bartla 5, 51-618 Wroclaw, Poland;
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The Value of Nerve Biopsy in Transthyretin Amyloidosis with Competing Comorbidities. Can J Neurol Sci 2021; 49:725-727. [PMID: 34275504 DOI: 10.1017/cjn.2021.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mathiyalagen P, Kanagasabapathy S, Kadar Z, Rajagopal A, Vasudevan K. Prevalence and Determinants of Peripheral Neuropathy Among Adult Type II Diabetes Mellitus Patients Attending a Non-communicable Disease Clinic in Rural South India. Cureus 2021; 13:e15493. [PMID: 34268025 PMCID: PMC8261778 DOI: 10.7759/cureus.15493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes. Almost half of the diabetic patients develop foot ulcer as a complication of DPN during their lifetime. The aim was to estimate the prevalence and identify the risk factors of diabetic peripheral neuropathy among adult diabetes mellitus (DM) patients. Methods A cross-sectional study was conducted among 421 type 2 DM patients attending Non-Communicable Disease (NCD) clinic in rural Puducherry through systematic random sampling. The study instruments used for data collection were a pre-tested semi-structured questionnaire, Michigan Neuropathy Screening Instrument (MNSI), Morisky Green Levine Scale (MGLS), physical measurements and recent laboratory results. The data was captured using Epicollect5 and analyzed using SPSS version 20. Results The prevalence of DPN was 31.1% (95% confidence interval (CI): 27.1%-35.1%). The mean age, duration of diabetes, and duration of foot symptoms were 57.91±10.61, 7.00±6.23, 5.56±5.26 years. Smoking (adjusted odds ratio (AOR) 3.14; 95% CI 1.73-5.69), mean duration of diabetes>5years (AOR 2.74; 95% CI 1.71-4.40), hyperglycemic status(>200mg/dl) (AOR 2.24; 95% CI 1.08-4.64) and unemployment (AOR 2.05; 95% CI 1.11-3.76) were found to be statistically significant determinants of DPN on binary logistic regression analysis. Conclusions A considerable proportion of diabetics are at risk of developing DPN among rural DM patients. More diligent screening in a primary health care setting and addressing the modifiable risk factors like smoking, obesity, physical inactivity, and uncontrolled hyperglycemia will delay or hamper DPN development among diabetic patients.
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Affiliation(s)
- Prakash Mathiyalagen
- Epidemiology and Public Health, Indira Gandhi Medical College and Research Institute, Puducherry, IND
| | - Sivagami Kanagasabapathy
- Epidemiology and Public Health, Indira Gandhi Medical College and Research Institute, Puducherry, IND
| | - Zubaidabegum Kadar
- Epidemiology and Public Health, Indira Gandhi Medical College and Research Institute, Puducherry, IND
| | - Anandaraj Rajagopal
- Epidemiology and Public Health, Indira Gandhi Medical College and Research Institute, Puducherry, IND
| | - Kavita Vasudevan
- Epidemiology and Public Health, Indira Gandhi Medical College and Research Institute, Puducherry, IND
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Delbari A, Zanjari N, Momtaz YA, Rahim F, Saeidimehr S. Prevalence of frailty and associated socio-demographic factors among community-dwelling older people in southwestern Iran: a cross-sectional study. J Diabetes Metab Disord 2021; 20:601-610. [PMID: 34222080 PMCID: PMC8212196 DOI: 10.1007/s40200-021-00787-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/20/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This community-based cross-sectional study aimed to identify the frailty prevalence and associated socio-demographic factors among older adults in five cities of the south west of Iran. METHODS We selected a random sample of adults aged 60 years and above from five Southwest cities in Iran. Data for this study were retrospectively collected from 540 community-dwelling older adults. To measure frailty, we utilized the frailty index of cumulative deficit (FICD). Data were collected from medical records and socio-demographic factors, including gender, age, marital status, education level, lifestyle, income, and job status. The chi-square test and Spearman's correlation coefficient test were used to assess the relationship between the demographic variables and frailty status (SPSS version 22). Also, multiple binary logistic regression models were used to estimate the effects of demographic characteristics on the frailty recurrence. RESULTS The overall frailty prevalence was as follows: 77 (14.3%) frail, 139 (25.7%) pre-frail, and 324 (60%) not frail. The findings showed that all variables except education level and marital status are significantly associated with frailty status (P < 0.05). Multiple ridge logistic regression model indicated that age, gender, marital status, job status have significant, and education level, living arrangement, and economic status have no considerable effect on the frailty. CONCLUSIONS This study has shown that age and gender significantly contributed to the frailty process in older adults. The research also has shown the syndrome's occurrence affected by the aging process, and it supports the biological characteristics of frailty.
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Affiliation(s)
- Ahmad Delbari
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nasibeh Zanjari
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Fakher Rahim
- Research Center of Thalassemia & Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeid Saeidimehr
- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Hui T, Shang C, Yang L, Wang M, Li R, Song Z. Metformin improves the outcomes in Chinese invasive breast cancer patients with type 2 diabetes mellitus. Sci Rep 2021; 11:10034. [PMID: 33976288 PMCID: PMC8113316 DOI: 10.1038/s41598-021-89475-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/27/2021] [Indexed: 02/01/2023] Open
Abstract
Early reports indicate that metformin, a clinical drug administered to treat type 2 diabetes mellitus (T2DM), was found to be associated with a better prognosis of cancer. The objective of this study was retrospectively analyzed the effect of metformin on the outcomes of Chinese breast cancer patients with T2DM. A total of 3757 primary invasive breast cancer patients who underwent surgery from January 2010 to December 2013 were enrolled. According to the medication treatment, all the patients were divided as non-diabetes group, metformin group and insulin group. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 3553 patients (median follow up of 85 months) and estimated with the Kaplan–Meier method followed by a log-rank test. Multivariate Cox proportional hazards regression model was applied. The results showed that there was a significant survival difference among non-diabetes group, metformin group and insulin group, 5-year DFS was 85.8%, 96.1%, 73.0%, and 5-year OS was 87.3%, 97.1%, 73.3% respectively (P < 0.05). Prognostic analysis showed metformin was significantly associated with better DFS and OS. Our results suggested that metformin may have a good effect on the survival of invasive breast cancer patients with T2DM.
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Affiliation(s)
- Tianli Hui
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Chao Shang
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Liu Yang
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Meiqi Wang
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Ruoyang Li
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China
| | - Zhenchuan Song
- Breast Center, Hebei Medical University Fourth Affiliated Hospital, No. 169 Tianshan Street, Shijiazhuang, 050035, China.
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Ebrahimzadeh T, Kuprasertkul A, Neugent ML, Lutz KC, Fuentes JL, Gadhvi J, Khan F, Zhang C, Sharon BM, Orth K, Li Q, Zimmern PE, De Nisco NJ. Urinary prostaglandin E2 as a biomarker for recurrent UTI in postmenopausal women. Life Sci Alliance 2021; 4:4/7/e202000948. [PMID: 33958485 PMCID: PMC8200289 DOI: 10.26508/lsa.202000948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023] Open
Abstract
This work uses controlled human cohorts to investigate urinary prostaglandin E2, the product of cyclooxygenase-2, as both a diagnostic and prognostic biomarker of recurrent UTI postmenopausal women. Urinary tract infection (UTI) is one of the most common adult bacterial infections and exhibits high recurrence rates, especially in postmenopausal women. Studies in mouse models suggest that cyclooxygenase-2 (COX-2)–mediated inflammation sensitizes the bladder to recurrent UTI (rUTI). However, COX-2–mediated inflammation has not been robustly studied in human rUTI. We used human cohorts to assess urothelial COX-2 production and evaluate its product, PGE2, as a biomarker for rUTI in postmenopausal women. We found that the percentage of COX-2–positive cells was elevated in inflamed versus uninflamed bladder regions. We analyzed the performance of urinary PGE2 as a biomarker for rUTI in a controlled cohort of 92 postmenopausal women and PGE2 consistently outperformed all other tested clinical variables as a predictor of rUTI status. Furthermore, time-to-relapse analysis indicated that the risk of rUTI relapse was 3.6 times higher in women with above median urinary PGE2 levels than with below median levels. Taken together, these data suggest that urinary PGE2 may be a clinically useful diagnostic and prognostic biomarker for rUTI in postmenopausal women.
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Affiliation(s)
- Tahmineh Ebrahimzadeh
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Amy Kuprasertkul
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael L Neugent
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Kevin C Lutz
- Depatment of Mathematics, University of Texas at Dallas, Richardson, TX, USA
| | - Jorge L Fuentes
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jashkaran Gadhvi
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Fatima Khan
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Cong Zhang
- Depatment of Mathematics, University of Texas at Dallas, Richardson, TX, USA
| | - Belle M Sharon
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Kim Orth
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Qiwei Li
- Depatment of Mathematics, University of Texas at Dallas, Richardson, TX, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicole J De Nisco
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
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64
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Huang YT, Steptoe A, Zaninotto P. Prevalence of Undiagnosed Diabetes in 2004 and 2012: Evidence From the English Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci 2021; 76:922-928. [PMID: 32674123 PMCID: PMC8522434 DOI: 10.1093/gerona/glaa179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND In light of recent publicity campaigns to raise awareness of diabetes, we investigated changes in the prevalence of diabetes and undiagnosed diabetes in adults age 50 and older in England between 2004 and 2012, and explored risk factors for undiagnosed diabetes. METHOD In total, 7666 and 7729 individuals were from Wave 2 (2004-2005, mean age 66.6) and Wave 6 (2012-2013, mean age 67.6) of the English Longitudinal Study of Ageing. Diagnosed diabetes was defined as either self-reported diabetes or taking diabetic medications. Undiagnosed diabetes was defined as not self-reporting diabetes and not taking diabetic medications, but having a glycated hemoglobin measurement ≥48 mmol/mol (6.5%). RESULTS There were increases in both diagnosed diabetes (7.7%-11.5%) and undiagnosed diabetes (2.4%-3.4%) between 2004 and 2012. However, a small decrease in the proportion of people with diabetes who were unaware of this condition (24.5%-23.1%, p < .05) was observed. Only men aged 50-74 showed a stable prevalence of undiagnosed diabetes, with better recognition of diabetes. Age, non-white ethnicity, manual social class, higher diastolic blood pressure, and cholesterol level were factors associated with higher risks of undiagnosed diabetes, whereas greater depressive symptoms were related to lower risks. CONCLUSION This study suggests that the greater awareness of diabetes in the population of England has not resulted in a decline in undiagnosed cases between 2004 and 2012. A greater focus on people from lower socioeconomic groups and those with cardiometabolic risk factors may help early diagnosis of diabetes for older adults.
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Affiliation(s)
- Yun-Ting Huang
- Department of Epidemiology and Public Health, University College
London
| | - Andrew Steptoe
- Department of Behavioral Science and Health, University College
London
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College
London
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Effects of Power Training on Physical Activity, Sitting Time, Disability, and Quality of Life in Older Patients With Type 2 Diabetes During the COVID-19 Confinement. J Phys Act Health 2021; 18:660-668. [PMID: 33883291 DOI: 10.1123/jpah.2020-0489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND To evaluate the effectiveness of a multicomponent supervised and unsupervised training program focused on muscle power to counteract the potential changes in sedentary behavior, disability, physical activity (PA), and health-related quality of life (HRQoL) caused by the COVID-19 pandemic domiciliary confinement in prefrail older adults with type 2 diabetes mellitus. METHODS Thirty-five older adults with type 2 diabetes mellitus were assigned to 2 groups according to their frailty status: exercise training group (prefrail or frail; n = 21; 74.7 [4.5] y; 33.3% male) and control group (robust; n = 14; 73.1 [3.9] y; 42.9% male). The exercise training group followed a multicomponent training program focusing on muscle power: supervised (5 wk) and unsupervised (6 wk). The primary outcomes, including PA and sitting time, perceived disability, and HRQoL, were assessed at the baseline and after 11 weeks. RESULTS At the end of confinement, there were significant decreases in PA in both groups (P < .05). Thus, sitting time increased more in the control group than in the exercise training group (P < .05). The HRQoL measures remained unchanged. CONCLUSIONS Muscle power training before and during mandatory COVID-19 self-isolation in type 2 diabetes mellitus older adults (1) attenuates the COVID-19 domiciliary confinement-related increase in sitting time and (2) slightly decreases the self-reported levels of disability and maintains HRQoL.
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66
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Nie F, He J, Cao H, Hu X. Predictive value of abnormal ankle-brachial index in patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2021; 174:108723. [PMID: 33647330 DOI: 10.1016/j.diabres.2021.108723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
AIMS This meta-analysis aimed to examine the association of abnormal ankle brachial index (ABI) with adverse prognosis in patients with diabetes. METHODS We systematically searched PubMed and Embase databases from inception to October 31, 2020 for observational studies investigating the predictive utility of abnormal ABI in patients with diabetes. The normal ABI is usually defined by 0.9-1.3 or 1.4. RESULTS Data were collected from 9 studies involving 9673 patients. When compared with the reference normal ABI, abnormal ABI was associated with a higher risk of cardiovascular mortality (risk ratio [RR] 1.98; 95% confidence intervals [CI] 1.66-2.37), all-cause mortality (RR 2.12; 95% CI 1.81-2.49), and major adverse cardiovascular events ([MACEs] RR 2.37; 95% CI 1.73-3.26). Subgroup analysis indicated that the pooled RR of cardiovascular mortality was similar in individuals with abnormally low ABI (RR 1.98; 95% CI 1.64-2.39) or high ABI (RR 2.00; 95% CI 1.12-3.59). CONCLUSIONS Abnormal ABI independently predicts subsequent risk of cardiovascular or all-cause mortality and MACEs in patients with diabetes. However, the predictive role of abnormal ABI is largely dominated by the low ABI rather than the high ABI.
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Affiliation(s)
- Fengze Nie
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, PR China
| | - Jiaan He
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, PR China
| | - Hui Cao
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, PR China.
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Du C, Wang H, Chen H, Fan X, Liu D, Du D, Wu M, Wang G, Boey J, Armstrong DG, Ma Y, Deng W. The Feasibility and Effectiveness of Wearable Sensor Technology in the Management of Elderly Diabetics with Foot Ulcer Remission: A Proof-Of-Concept Pilot Study with Six Cases. Gerontology 2021; 67:493-502. [PMID: 33657570 DOI: 10.1159/000513729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS Using specials wearable sensors, we explored changes in gait and balance parameters, over time, in elderly patients at high risk of diabetic foot, wearing different types of footwear. This assessed the relationship between gait and balance changes in elderly diabetic patients and the development of foot ulcers, in a bid to uncover potential benefits of wearable devices in the prognosis and management of the aforementioned complication. METHODS A wearable sensor-based monitoring system was used in middle-elderly patients with diabetes who recently recovered from neuropathic plantar foot ulcers. A total of 6 patients (age range: 55-80 years) were divided into 2 groups: the therapeutic footwear group (n = 3) and the regular footwear (n = 3) group. All subjects were assessed for gait and balance throughout the study period. Walking ability and gait pattern were assessed by allowing participants to walk normally for 1 min at habitual speed. The balance assessment program incorporated the "feet together" standing test and the instrumented modified Clinical Test of Sensory Integration and Balance. Biomechanical information was monitored at least 3 times. RESULTS We found significant differences in stride length (p < 0.0001), stride velocity (p < 0.0001), and double support (p < 0.0001) between the offloading footwear group (OG) and the regular footwear group on a group × time interaction. The balance test embracing eyes-open condition revealed a significant difference in Hip Sway (p = 0.004), COM Range ML (p = 0.008), and COM Position (p = 0.004) between the 2 groups. Longitudinally, the offloading group exhibited slight improvement in the performance of gait parameters over time. The stride length (odds ratio 3.54, 95% CI 1.34-9.34, p = 0.018) and velocity (odds ratio 3.13, 95% CI 1.19-8.19, p = 0.033) of OG patients increased, converse to the double-support period (odds ratio 6.20, 95% CI 1.97-19.55, p = 0.002), which decreased. CONCLUSIONS Special wearable devices can accurately monitor gait and balance parameters in patients in real time. The finding reveals the feasibility and effectiveness of advanced wearable sensors in the prevention and management of diabetic foot ulcer and provides a solid background for future research. In addition, the development of foot ulcers in elderly diabetic patients may be associated with changes in gait parameters and the nature of footwear. Even so, larger follow-up studies are needed to validate our findings.
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Affiliation(s)
- Chenzhen Du
- Bioengineering College and Department of Endocrinology, Chongqing University Central Hospital, Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, China
| | - Hongyan Wang
- Bioengineering College and Department of Endocrinology, Chongqing University Central Hospital, Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, China
| | - Heming Chen
- Department of Endocrinology, Ankang Central Hospital, Ankang, China
| | - Xiaoyun Fan
- Chongqing Prevention and Treatment Hospital for Occupational Diseases, Chongqing, China
| | - Dongliang Liu
- Chongqing Prevention and Treatment Hospital for Occupational Diseases, Chongqing, China
| | - Dingyuan Du
- Bioengineering College and Department of Endocrinology, Chongqing University Central Hospital, Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, China
| | - Mengjun Wu
- Bioengineering College and Department of Endocrinology, Chongqing University Central Hospital, Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, China
| | - Guixue Wang
- Bioengineering College and Department of Endocrinology, Chongqing University Central Hospital, Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, China
| | - Johnson Boey
- Department of Podiatry, National University Hospital, Singapore, Singapore
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Yu Ma
- Bioengineering College and Department of Endocrinology, Chongqing University Central Hospital, Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, China
| | - Wuquan Deng
- Bioengineering College and Department of Endocrinology, Chongqing University Central Hospital, Key Laboratory for Biorheological Science and Technology of Ministry of Education, Chongqing University, Chongqing, China,
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Fismen AS, Igland J, Teigland T, Tell GS, Ostbye T, Haltbakk J, Graue M, Birkeland KI, Peyrot M, Iversen MM. Pharmacologically treated diabetes and hospitalization among older Norwegians receiving homecare services from 2009 to 2014: a nationwide register study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002000. [PMID: 33771766 PMCID: PMC8006844 DOI: 10.1136/bmjdrc-2020-002000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/10/2021] [Accepted: 02/28/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The aim was to assess whether annual hospitalization (admissions, length of stay and total days hospitalized) among persons >65 years receiving home care services in Norway were higher for persons with diabetes than those without diabetes. Given the growing prevalence of diabetes, this issue has great importance for policy makers who must plan for meeting these needs. RESEARCH DESIGN AND METHODS Data were obtained from national Norwegian registries, and the study population varied from 112 487 to 125 593 per calendar year during 2009-2014. Diabetes was defined as having been registered with at least one prescription for blood glucose lowering medication. Overall and cause-specific hospitalization were compared, as well as temporal trends in hospitalization. Hospitalization outcomes for persons with and without diabetes were compared using log-binomial regression or quantile regression, adjusting for age and gender. Results are reported as incidence rate ratios (IRRs). RESULTS Higher total hospitalization rates (IRR 1.17; 95% CI 1.12 to 1.22) were found among persons with, versus without, diabetes, and this difference remained stable throughout the study period. Similar reductions over time in hospital length of stay were observed among persons with and without diabetes, but total annual days hospitalized decreased significantly (p=0.001) more among those with diabetes than among those without diabetes. CONCLUSIONS Among older recipients of home care services in Norway, diabetes was associated with a higher overall risk of hospitalization and increased days in the hospital. Given the growing prevalence of diabetes, it is important for policy makers to plan for meeting these needs.
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Affiliation(s)
- Anne-Siri Fismen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Tonje Teigland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Grethe Seppola Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Truls Ostbye
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Johannes Haltbakk
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kare I Birkeland
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Mark Peyrot
- Department of Sociology, Loyola University Maryland, Baltimore, Maryland, USA
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Chiba I, Lee S, Bae S, Makino K, Shinkai Y, Shimada H. Visceral fat accumulation is associated with risk of diabetes in community-dwelling Japanese older adults. Geriatr Gerontol Int 2021; 21:306-312. [PMID: 33555133 DOI: 10.1111/ggi.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 12/11/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Abstract
AIM The prevalence of diabetes generally increases with age, and older adults with diabetes are at a higher risk of adverse outcomes. Visceral fat accumulation is a well-known risk factor for diabetes in middle-aged adults, and its association with diabetes increases with age. The present study investigated the association between visceral fat and risk of diabetes in older adults that is yet to be completely elucidated. METHODS This cross-sectional study enrolled 2850 community-dwelling older adults. Participants underwent abdominal bioelectrical impedance analysis to estimate the visceral fat area (VFA). The risk of diabetes was assessed using the value of hemoglobin A1c according to the diagnostic criteria of diabetes. We examined the relationship of VFA and risk of diabetes, and explored the optimal cut-off value stratified by sex. RESULTS In total, 47 of 1640 (2.9%) women and 41 of 1210 (3.4%) men had a high risk of diabetes. Higher values of VFA in units of 10 cm2 were significantly associated with a higher risk of diabetes for both women (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [95% CI]: 1.02-1.34) and men (aOR: 1.18; 95% CI: 1.06-1.31) in multivariate logistic regression analysis. The cut-off value to classify 30% of subjects into high VFA (72 cm2 ) had a relatively higher sensitivity of 0.660 and was significantly associated with a higher risk of diabetes for women (aOR: 3.49; 95% CI: 1.54-8.12), whereas all cut-off values we examined had no relation in men. CONCLUSIONS Increases in VFA is associated with a high risk of diabetes in older adults but the optimal cut-off value is inconclusive in men. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Ippei Chiba
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Medical Sciences, Medical Science Division, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Medical Sciences, Medical Science Division, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Japan
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70
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Lorber M, Kmetec S, Mlinar Reljić N, Fekonja Z. Diabetes management of older adults in nursing homes: A retrospective study. J Nurs Manag 2021; 29:1293-1301. [PMID: 33482053 DOI: 10.1111/jonm.13268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 01/21/2023]
Abstract
AIM To examine the diabetes management of older adults in nursing homes. BACKGROUND Diabetes is an increasing problem in nursing homes, and diabetes care is defined as a neglected clinical area. METHODS A retrospective collected data review of 166 older adults with known diabetes from four nursing homes. RESULTS 65% older than 75 years had HbA1c levels lower than 7.5% (58 mmol/mol), 74% older than 85 years had HbA1c levels lower than 8% (64 mmol/mol). The HbA1c levels were 7.3% (56 mmol/mol) for those who had three and more chronic disorders and 6.8% (51 mmol/mol) for those who had less than three chronic disorders. Individuals treated with insulin had higher HbA1c levels (p < .001) and glycaemia (p = .002). Age was associated with a number of chronic disorders (p = .031), a number of regularly prescribed medications (p = .038) and a number of medications as needed (p = .009). CONCLUSIONS More than half to three quarters have diabetes well-managed. Nevertheless, there is still some potential for improving diabetes care, and these findings warrant further research for improving diabetes management of older adults in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT Interventions designed to promote a healthy lifestyle, documenting individuals' target level and regular monitoring of glycaemia and HbA1c levels may help to improve diabetes management, which may result in better well-being and quality of life for older adults with diabetes in nursing homes.
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Affiliation(s)
- Mateja Lorber
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Sergej Kmetec
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | | | - Zvonka Fekonja
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, Neijens AMJ, Topsever P, Khunti K. A disease state approach to the pharmacological management of Type 2 diabetes in primary care: A position statement by Primary Care Diabetes Europe. Prim Care Diabetes 2021; 15:31-51. [PMID: 32532635 DOI: 10.1016/j.pcd.2020.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes and its associated comorbidities are growing more prevalent, and the complexity of optimising glycaemic control is increasing, especially on the frontlines of patient care. In many countries, most patients with type 2 diabetes are managed in a primary care setting. However, primary healthcare professionals face the challenge of the growing plethora of available treatment options for managing hyperglycaemia, leading to difficultly in making treatment decisions and contributing to therapeutic inertia. This position statement offers a simple and patient-centred clinical decision-making model with practical treatment recommendations that can be widely implemented by primary care clinicians worldwide through shared-decision conversations with their patients. It highlights the importance of managing cardiovascular disease and elevated cardiovascular risk in people with type 2 diabetes and aims to provide innovative risk stratification and treatment strategies that connect patients with the most effective care.
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Affiliation(s)
- S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
| | - X Cos
- Sant Marti de Provençals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - S Brunton
- Primary Care Metabolic Group, Los Angeles, CA, USA
| | - S B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - S P O Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - M Mata-Cases
- La Mina Primary Care Centre, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - A M J Neijens
- Praktijk De Diabetist, Nurse-Led Case Management in Diabetes, QOL-consultancy, Deventer, The Netherlands
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, Atasehir 34752, Istanbul, Turkey
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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Association between lipoprotein cholesterol and future cardiovascular disease and mortality in older adults: a Korean nationwide longitudinal study. Lipids Health Dis 2021; 20:3. [PMID: 33407561 PMCID: PMC7789148 DOI: 10.1186/s12944-020-01426-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dyslipidemia is considered an independent health risk factor of cardiovascular disease (CVD), a leading cause of mortality in older adults. Despite its importance, there have been few reports on the association between lipoprotein cholesterol and future CVD and cardiovascular (CV) mortality among elderly Asians aged ≥ 65 years. This study investigated the association between lipoprotein cholesterol and future CVD and CV mortality in an elderly Korean population using a large nationwide sample. METHODS From the cohort database of the Korean National Health Insurance Service, 62,604 adults aged ≥ 65 years (32,584 men and 30,020 women) were included. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were categorized by quartiles. Cox proportional hazard models and linear regression analyses were used to assess the association between the quartiles of lipoprotein cholesterol and future CV events or mortality. RESULTS The mean follow-up period was 3.3 years. The incidence rates of ischemic heart disease and ischemic brain disease were 0.97 and 0.61 per 1,000 person-years, respectively, and the mortality rates from these diseases were 0.22 and 0.34 per 1,000 person-years, respectively. In a completely adjusted model, high HDL-C and LDL-C levels were not associated with total CV events and CVD mortality. However, high LDL-C levels were significantly associated with a lower incidence of ischemic brain disease. Furthermore, diabetic patients with high LDL-C levels were more likely to have higher CV mortality, whereas non-smokers with high LDL-C levels were less likely to be at risk of CV events. CONCLUSIONS Neither high LDL-C nor HDL-C levels were significantly associated with future CV mortality in older adults aged ≥ 65 years. High LDL-C levels do not seem to be a risk factor for CVD in elderly individuals, and further studies are required.
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Jiwani R, Dennis B, Bess C, Monk S, Meyer K, Wang J, Espinoza S. Assessing acceptability and patient experience of a behavioral lifestyle intervention using fitbit technology in older adults to manage type 2 diabetes amid COVID-19 pandemic: A focus group study. Geriatr Nurs 2021; 42:57-64. [PMID: 33248357 PMCID: PMC7933081 DOI: 10.1016/j.gerinurse.2020.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023]
Abstract
Type 2 diabetes (T2D) contributes to reduced quality of life in older adults, especially in those with comorbidities such as being overweight or obese. Personal fitness technology (Fitbit ®) has the potential to improve the management of T2D. Using a semi-structured interview guide, focus groups were conducted to explore participants' acceptability and experiences following a behavioral lifestyle intervention that integrated Fitbit in overweight/obese older adults with T2D amid the COVID-19 pandemic which began during the time of this study. Focus group transcripts were transcribed and analyzed using thematic analysis. Eighteen (18) of the 20 participants completed the program and focus group interviews. Overall, we observed high acceptability of the program, and participants reported favorable experiences such as increased knowledge of health behaviors, improved diabetes management, and improved quality of life following the behavioral lifestyle intervention, even under stressful life circumstances from COVID-19.
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Affiliation(s)
- Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA.
| | - Brittany Dennis
- Graduate School of Biomedical Sciences, University of Texas Health Science Center at San Antonio, San Antonio,Texas, USA; Center on Smart and Connected Health Technologies at University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Chandler Bess
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Siler Monk
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Center on Smart and Connected Health Technologies at University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Sara Espinoza
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA; Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Sam & Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Orozco-Beltrán D, Navarro-Pérez J, Cebrián-Cuenca AM, Álvarez-Guisasola F, Caride-Miana E, Mora G, Quesada JA, López-Pineda A, Cardona-Llorens AF, Redón J, Gil-Guillen VF, Fernández A, Carratalá-Munuera C. The influence of hemoglobin A1c levels on cardiovascular events and all-cause mortality in people with diabetes over 70 years of age. A prospective study. Prim Care Diabetes 2020; 14:678-684. [PMID: 32605878 DOI: 10.1016/j.pcd.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/31/2022]
Abstract
AIM Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years. METHODS Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008-2012. We included men and women aged≥70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-cause mortality and/or hospital admission due to coronary heart disease or stroke. A standard Cox and Cox-Aalen models were adjusted. RESULTS 5016 subjects were included whit a mean age of 75.1 years (46.7% men). During an average follow-up of 49 months (4.1 years), 807 (16.1%) MACE were recorded. The incidence of MACE was 20.6 per 1000-person-years. Variables significantly associated to the incidence of MACE were male gender (HR: 1.61), heart failure (HR: 2.26), antiplatelet therapy (HR: 1.39), oral antidiabetic treatment (HR: 0.74), antithrombotics (HR: 1.79), while age, creatinine, HbA1c and peripheral arterial disease were time-depend associated variables. CONCLUSION These results highlights the importance of HbA1c level in the incidence of cardiovascular events in older diabetic patients.
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Affiliation(s)
| | - Jorge Navarro-Pérez
- Biomedical Research Institute INCLIVA, Hospital Clinico Universitario de Valencia, University of Valencia, Valencia, Spain; Ciber of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
| | | | | | | | | | - José A Quesada
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | | | - Josep Redón
- Biomedical Research Institute INCLIVA, Hospital Clinico Universitario de Valencia, University of Valencia, Valencia, Spain; Ciber of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
| | - Vicente F Gil-Guillen
- Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | - Antonio Fernández
- Biomedical Research Institute INCLIVA, Hospital Clinico Universitario de Valencia, University of Valencia, Valencia, Spain; Ciber of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
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Stouge A, Khan KS, Kristensen AG, Tankisi H, Schlaffke L, Froeling M, Væggemose M, Andersen H. MRI of Skeletal Muscles in Participants with Type 2 Diabetes with or without Diabetic Polyneuropathy. Radiology 2020; 297:608-619. [PMID: 33048033 DOI: 10.1148/radiol.2020192647] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BackgroundDiabetic polyneuropathy (DPN) is associated with loss of muscle strength. MRI including diffusion-tensor imaging (DTI) may enable detection of muscle abnormalities related to type 2 diabetes mellitus (DM2) and DPN.PurposeTo assess skeletal muscle abnormalities in participants with DM2 with or without DPN by using MRI.Materials and MethodsThis prospective cross-sectional study included participants with DM2 and DPN (DPN positive), participants with DM2 without DPN (DPN negative), and healthy control (HC) participants enrolled between August 2017 and June 2018. Muscle strength at the knee and ankle was determined with isokinetic dynamometry. MRI of the lower extremities included the Dixon sequence, multicomponent T2 mapping, and DTI calculated fat fractions (FFs), T2 relaxation of muscle (T2water), fractional anisotropy (FA), and diffusivity (mean, axial, and radial). One-way analysis of variance and Tukey honestly significant difference were applied for comparison between groups, and multivariate regression models were used for association between MRI parameters, nerve conduction, strength, and body mass index (BMI).ResultsTwenty participants with DPN (mean age, 65 years ± 9 [standard deviation]; 70% men; mean BMI, 34 kg/m2 ± 5), 20 participants without DPN (mean age, 64 years ± 9; 55% men; mean BMI, 30 kg/m2 ± 6), and 20 HC participants (mean age, 61 years ± 10; 55% men; mean BMI, 27 kg/m2 ± 5) were enrolled in this study. Muscle strength adjusted for age, sex, and BMI was lower in participants with DPN than in DPN-negative and HC participants in the upper and lower leg (plantar flexors [PF], 62% vs 78% vs 89%; P < .001; knee extensors [KE], 73% vs 95% vs 93%; P < .001). FF was higher in leg muscle groups of participants with DPN than in DPN-negative and HC participants (PF, 20% vs 10% vs 8%; P < .001; KE, 13% vs 8% vs 6%; P < .001). T2water was prolonged in leg muscle groups of participants with DPN when compared with HC participants (PF, 33 msec vs 31 msec; P < .001; KE, 32 msec vs 31 msec; P = .002) and in the lower leg when compared with participants without DPN (PF, 33 msec vs 32 msec; P = .03). In multivariate regression models, strength was associated with FA (b = -0.0004), T2water (b = -0.03 msec), and FF (b = -0.1%) at thigh level (P < .001). Furthermore, FA (b = -0.007), T2water (b = -0.53 msec), and FF (b = -4.0%) were associated with nerve conduction at calf level (P < .001).ConclusionMRI of leg muscle groups revealed fat accumulation, differences in water composition, and structural changes in participants with type 2 diabetes mellitus and neuropathy. Abnormalities were most pronounced in the plantar flexors.© RSNA, 2020Online supplemental material is available for this article.See also the editorial by Sneag and Tan in this issue.
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Affiliation(s)
- Anders Stouge
- From the Departments of Neurology and International Diabetic Neuropathy Consortium (A.S., K.S.K., H.A.), Clinical Neurophysiology and International Diabetic Neuropathy Consortium (A.G.K.), Clinical Neurophysiology (H.T.), and Neurology (M.V.), Neurologisk Afdeling, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Image Division, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (L.S., M.F.); and Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (L.S.)
| | - Karolina S Khan
- From the Departments of Neurology and International Diabetic Neuropathy Consortium (A.S., K.S.K., H.A.), Clinical Neurophysiology and International Diabetic Neuropathy Consortium (A.G.K.), Clinical Neurophysiology (H.T.), and Neurology (M.V.), Neurologisk Afdeling, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Image Division, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (L.S., M.F.); and Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (L.S.)
| | - Alexander G Kristensen
- From the Departments of Neurology and International Diabetic Neuropathy Consortium (A.S., K.S.K., H.A.), Clinical Neurophysiology and International Diabetic Neuropathy Consortium (A.G.K.), Clinical Neurophysiology (H.T.), and Neurology (M.V.), Neurologisk Afdeling, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Image Division, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (L.S., M.F.); and Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (L.S.)
| | - Hatice Tankisi
- From the Departments of Neurology and International Diabetic Neuropathy Consortium (A.S., K.S.K., H.A.), Clinical Neurophysiology and International Diabetic Neuropathy Consortium (A.G.K.), Clinical Neurophysiology (H.T.), and Neurology (M.V.), Neurologisk Afdeling, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Image Division, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (L.S., M.F.); and Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (L.S.)
| | - Lara Schlaffke
- From the Departments of Neurology and International Diabetic Neuropathy Consortium (A.S., K.S.K., H.A.), Clinical Neurophysiology and International Diabetic Neuropathy Consortium (A.G.K.), Clinical Neurophysiology (H.T.), and Neurology (M.V.), Neurologisk Afdeling, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Image Division, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (L.S., M.F.); and Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (L.S.)
| | - Martijn Froeling
- From the Departments of Neurology and International Diabetic Neuropathy Consortium (A.S., K.S.K., H.A.), Clinical Neurophysiology and International Diabetic Neuropathy Consortium (A.G.K.), Clinical Neurophysiology (H.T.), and Neurology (M.V.), Neurologisk Afdeling, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Image Division, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (L.S., M.F.); and Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (L.S.)
| | - Michael Væggemose
- From the Departments of Neurology and International Diabetic Neuropathy Consortium (A.S., K.S.K., H.A.), Clinical Neurophysiology and International Diabetic Neuropathy Consortium (A.G.K.), Clinical Neurophysiology (H.T.), and Neurology (M.V.), Neurologisk Afdeling, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Image Division, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (L.S., M.F.); and Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (L.S.)
| | - Henning Andersen
- From the Departments of Neurology and International Diabetic Neuropathy Consortium (A.S., K.S.K., H.A.), Clinical Neurophysiology and International Diabetic Neuropathy Consortium (A.G.K.), Clinical Neurophysiology (H.T.), and Neurology (M.V.), Neurologisk Afdeling, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark; Image Division, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (L.S., M.F.); and Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (L.S.)
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Perry SB, Billek-Sawhney B, Schreiber J. Stroke Prevention: Education and Barriers for Physical and Occupational Therapists Caring for Older Adults. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2020. [DOI: 10.1080/02703181.2020.1755410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Susan B. Perry
- Physical Therapy Program, Chatham University, Pittsburgh, Pennsylvania, USA
| | | | - Jodi Schreiber
- Occupational Therapy Program, Chatham University, Pittsburgh, Pennsylvania, USA
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Bello-Chavolla OY, Aguilar-Salinas CA, Avila-Funes JA. The type 2 diabetes-specific dementia risk score (DSDRS) is associated with frailty, cognitive and functional status amongst Mexican community-dwelling older adults. BMC Geriatr 2020; 20:363. [PMID: 32962659 PMCID: PMC7510254 DOI: 10.1186/s12877-020-01776-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background The type 2 diabetes (T2D) specific dementia-risk score (DSDRS) was developed to evaluate dementia risk in older adults with T2D. T2D-related factors have been shown increase the risk of age-related conditions, which might also increase dementia risk. Here, we investigate the associations of DSDRS with frailty, disability, quality of life (QoL) and cognition in community-dwelling older adults with T2D. Methods We included 257 community-dwelling older adults with T2D to evaluate the association between DSDRS and Mini-mental state examination (MMSE), Isaac’s set-test (IST), clock drawing test (CDT), quality of life (SF-36), risk of malnutrition (Mini-Nutritional Assessment or MNA), as well as frailty, Katz’ and Lawton-Brody scores. We also assessed the phenotype and correlates of high-estimated dementia risk by assessing individuals with DSDRS >75th age-specific percentiles. Results Mean age of participants was 78.0 ± 6.2 years. DSDRS showed a significant correlation with MMSE test, IST, CDT, SF-36, MNA, Lawton-Brody and Katz scores, and an increasing number of frailty components. DSDRS was higher among frail, pre-frail, and subjects with limited ADL and IADL (p < 0.001). Participants with DSDRS >75th age-specific percentiles had lower education, MMSE, IST, SF-36, MNA, Katz, Lawton-Brody, and higher frailty scores. High-estimated 10-year dementia risk was associated with ADL and IADL disability, frailty and risk of malnutrition. When assessing individual components of DSDRS, T2D-related microvascular complications were associated to all outcome measures. Conclusion The DSDRS is associated with frailty, disability, malnutrition and lower cognitive performance. These findings support that T2D-related factors have significant burden on functional status, QoL, disability and dementia risk.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico. .,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15. CP 14080, Tlalpan, Mexico City, Mexico. .,Department of Physiology, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico.
| | - Carlos Alberto Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15. CP 14080, Tlalpan, Mexico City, Mexico.,Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Instituto Tecnologico y de Estudios Superiores de Monterrey Tec Salud, Nuevo León, Mexico
| | - José Alberto Avila-Funes
- Geriatrics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Centre de recherche INSERM, U1219, F-33076, Bordeaux, France
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Effect of temporary housing on incidence of diabetes mellitus in survivors of a tsunami-stricken area in 2011 Japan disaster: a serial cross-sectional RIAS study. Sci Rep 2020; 10:15400. [PMID: 32958796 PMCID: PMC7505964 DOI: 10.1038/s41598-020-71759-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022] Open
Abstract
The association between incidence of diabetes mellitus (DM) and living conditions has not been studied after natural disasters. We compared the incidence of DM between individuals living in temporary housing (TH) and those living in other types of accommodation (non-TH) five years after the 2011 Great East Japan Earthquake. Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 7,491 residents of coastal communities in Iwate Prefecture directly impacted by the 2011 disaster (mean age, 61.6 years; men, 36.0%). We calculated the odds ratio of new onset of DM in the TH group (n = 2,372) compared with the non-TH group (n = 5,119) using discrete-time logit models stratified by sex and age classes (64 years or younger and older than 65 years). The TH group showed a significantly higher odds ratio (OR) for DM in men aged 64 years or younger (OR [95% confidence interval (CI)], 1.71 [1.03–2.85]; P-value = 0.040). In women, living conditions were not significantly associated DM. Survivors relocated to TH appeared to be at an increased risk of new onset DM.
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Glucose Levels as a Mediator of the Detrimental Effect of Abdominal Obesity on Relative Handgrip Strength in Older Adults. J Clin Med 2020; 9:jcm9082323. [PMID: 32707776 PMCID: PMC7464715 DOI: 10.3390/jcm9082323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Abstract
Excess central adiposity accelerates the decline of muscle strength in older people. Additionally, hyperglycemia, independent of associated comorbidities, is related to the loss of muscle mass and strength, and contributes to functional impairment in older adults. We studied the mediation effect of glucose levels, in the relationship between abdominal obesity and relative handgrip strength (HGS). A total of 1571 participants (60.0% women, mean age 69.1 ± 7.0 years) from 86 municipalities were selected following a multistage area probability sampling design. Measurements included demographic and anthropometric/adiposity markers (weight, height, body mass index, and waist circumference). HGS was measured using a digital dynamometer for three sets and the mean value was recorded. The values were normalized to body weight (relative HGS). Fasting glucose was analyzed by enzymatic colorimetric methods. Mediation analyses were performed to identify associations between the independent variable (abdominal obesity) and outcomes (relative HGS), as well as to determine whether fasting glucose levels mediated the relationship between excess adiposity and relative HGS. A total of 1239 (78.8%) had abdominal obesity. Abdominal obesity had a negative effect on fasting glucose (β = 9.04, 95%CI = 5.87 to 12.21); while fasting glucose to relative HGS was inversely related (β = −0.003, 95%CI = −0.005 to −0.001), p < 0.001. The direct effect of abdominal obesity on relative HGS was statistically significant (β = −0.069, 95%CI = −0.082 to −0.057), p < 0.001. Lastly, fasting glucose levels mediates the detrimental effect of abdominal obesity on relative HGS (indirect effect β = −0.002, 95%CI = −0.004 to −0.001), p < 0.001. Our results suggest that the glucose level could worsen the association between abdominal obesity status and lower HGS. Thus, it is plausible to consider fasting glucose levels when assessing older adults with excess adiposity and/or suspected loss of muscle mass.
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Tuttle KR, McGill JB. Evidence-based treatment of hyperglycaemia with incretin therapies in patients with type 2 diabetes and advanced chronic kidney disease. Diabetes Obes Metab 2020; 22:1014-1023. [PMID: 32009296 PMCID: PMC7317405 DOI: 10.1111/dom.13986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 01/14/2023]
Abstract
Type 2 diabetes is the leading cause of chronic kidney disease (CKD). The prevalence of CKD is growing in parallel with the rising number of patients with type 2 diabetes globally. At present, the optimal approach to glycaemic control in patients with type 2 diabetes and advanced CKD (categories 4 and 5) remains uncertain, as these patients were largely excluded from clinical trials of glucose-lowering therapies. Nonetheless, clinical trial data are available for the use of incretin therapies, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists, for patients with type 2 diabetes and advanced CKD. This review discusses the role of incretin therapies in the management of these patients. Because the presence of advanced CKD in patients with type 2 diabetes is associated with a markedly elevated risk of cardiovascular disease (CVD), treatment strategies must include the reduction of both CKD and CVD risks because death, particularly from cardiovascular causes, is more probable than progression to end-stage kidney disease. The management of hyperglycaemia is essential for good diabetes care even in advanced CKD. Current evidence supports an individualized approach to glycaemic management in patients with type 2 diabetes and advanced CKD, taking account of the needs of each patient, including the presence of co-morbidities and concomitant therapies. Although additional studies are needed to establish optimal strategies for glycaemic control in patients with type 2 diabetes and advanced CKD, treatment regimens with currently available pharmacotherapy can be individually tailored to meet the needs of this growing patient population.
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Affiliation(s)
- Katherine R. Tuttle
- Providence Medical Research CenterProvidence Health CareSpokaneWashington
- Division of Nephrology, Kidney Research Institute, and Institute of Translational Health SciencesUniversity of WashingtonSeattleWashington
| | - Janet B. McGill
- Division of Endocrinology, Metabolism and Lipid ResearchWashington University School of MedicineSt. LouisMissouriUnited States
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Chou MY, Huang ST, Liang CK, Hsiao FY, Chen LK. Clinical characteristics and 10-year outcomes of diabetes in adults with advancing age at onset: A population cohort. Arch Gerontol Geriatr 2020; 88:104039. [DOI: 10.1016/j.archger.2020.104039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 11/26/2022]
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Accelerated cerebral vascular injury in diabetes is associated with vascular smooth muscle cell dysfunction. GeroScience 2020; 42:547-561. [PMID: 32166556 DOI: 10.1007/s11357-020-00179-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/04/2020] [Indexed: 12/20/2022] Open
Abstract
Individuals with diabetes are more susceptible to cerebral vascular aging. However, the underlying mechanisms are not well elucidated. The present study examined whether the myogenic response of the middle cerebral artery (MCA) is impaired in diabetic rats due to high glucose (HG)-induced cerebral vascular smooth muscle cell (CVSMC) dysfunction, and whether this is associated with ATP depletion and changes in mitochondrial dynamics and membrane potential. The diameters of the MCA of diabetic rats increased to 135.3 ± 11.3% when perfusion pressure was increased from 40 to 180 mmHg, while it fell to 85.1 ± 3.1% in non-diabetic controls. The production of ROS and mitochondrial-derived superoxide were enhanced in cerebral arteries of diabetic rats. Levels of mitochondrial superoxide were significantly elevated in HG-treated primary CVSMCs, which was associated with decreased ATP production, mitochondrial respiration, and membrane potential. The expression of OPA1 was reduced, and MFF was elevated in HG-treated CVSMCs in association with fragmented mitochondria. Moreover, HG-treated CVSMCs displayed lower contractile and proliferation capabilities. These results demonstrate that imbalanced mitochondrial dynamics (increased fission and decreased fusion) and membrane depolarization contribute to ATP depletion in HG-treated CVSMCs, which promotes CVSMC dysfunction and may play an essential role in exacerbating the impaired myogenic response in the cerebral circulation in diabetes and accelerating vascular aging.
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An IoT-Based Glucose Monitoring Algorithm to Prevent Diabetes Complications. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10030921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetes mellitus (DM) is a metabolic disorder characterized by blood glucose levels above normal limits. The impact of this disease on the population has increased in recent years. It is already a public health problem worldwide and one of the leading causes of death. Recently, several proposals have been developed for better and regular monitoring of glucose. However, theses proposals do not discard erroneous readings and they are not able to anticipate a critical condition. In this work, we propose an algorithm based on the double moving average supported by an IoT architecture to prevent possible complications in elderly patients. The algorithm uses historical readings to construct a series. Given a number of periods, it is possible to calculate averages of different subsets and trends for the next periods and, in this way, the prognosis is obtained. With the prognosis, it is possible to notify the doctor and relatives in advance about a possible critical condition in the patient. The aim of our work is to validate the architecture and prognosis algorithm used for elderly persons. Tests of the algorithm and the architecture were performed with different readings and it was shown that the system generated corresponding notifications before the glucose values were higher than those defined by the WHO (World Health Organization), thus avoiding unnecessary alarms.
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Dang-Tan T, Kamble PS, Meah Y, Gamble C, Ganguly R, Horter L. Real-world Effectiveness of Liraglutide vs. Sitagliptin Among Older Patients with Type 2 Diabetes Enrolled in a Medicare Advantage Prescription Drug Plan: A Retrospective Observational Study. Diabetes Ther 2020; 11:213-228. [PMID: 31820328 PMCID: PMC6965544 DOI: 10.1007/s13300-019-00739-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Liraglutide and sitagliptin were compared on glycemic control and all-cause healthcare costs over a 1-year period among older adults with type 2 diabetes (65-89 years) enrolled in a national Medicare Advantage Prescription Drug health plan. METHODS This was a retrospective study in which the index date was the first prescription fill for liraglutide or sitagliptin between 25 January 2010 and 31 December 2014. Post-index treatment persistence and glycosylated hemoglobin (HbA1c) at baseline and 1 year (± 90 days) post-index date were required. Patients were excluded if their record included use of insulin during the baseline period. Inverse probability of treatment weighting using stabilized weights was employed with final covariate adjusted regression modeling to estimate the primary outcome (mean change in HbA1c) and secondary outcomes (achieving glycemic goal and costs), each at 1-year post-index date. RESULTS Overall, 3056 patients met the selection criteria, of whom 218 filled prescriptions for liraglutide and 2838 for sitagliptin. Adjusted mean change in HbA1c at 1 year post-index was - 0.42 with liraglutide versus - 0.12 with sitagliptin (P = 0.0012). Adjusted odds of achieving the treatment goals of HbA1c < 7% and achieving an HbA1c reduction of ≥ 1% were higher for those on liraglutide than for those on sitagliptin (1.68, 95% confidence interval [CI] 1.25-2.24 and 1.76, 95% CI 1.31-2.36), respectively. Total healthcare costs in those achieving an HbA1c of < 7% were not significantly different between treatment groups but were higher within the liraglutide group for those achieving an HbA1c < 8%. CONCLUSIONS When compared to sitagliptin, liraglutide was associated with greater achievement of an HbA1c < 7% over a 1-year period in an older population. This finding was not associated with a statistically significant increase in all-cause total healthcare costs, although costs were slightly higher in the liraglutide group than in the sitagliptin group.
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Affiliation(s)
| | | | | | | | | | - Libby Horter
- Humana Healthcare Research, Inc., Louisville, KY, USA
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85
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Yuan K, Jin SH, Fang JL, Jia SS, Lin Y. Extraction, purification, content analysis and hypoglycemic effect of mulberry marc anthocyanin. Pharmacogn Mag 2020. [DOI: 10.4103/pm.pm_169_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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86
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Guo WL, Deng JC, Pan YY, Xu JX, Hong JL, Shi FF, Liu GL, Qian M, Bai WD, Zhang W, Liu B, Zhang YY, Luo PJ, Ni L, Rao PF, Lv XC. Hypoglycemic and hypolipidemic activities of Grifola frondosa polysaccharides and their relationships with the modulation of intestinal microflora in diabetic mice induced by high-fat diet and streptozotocin. Int J Biol Macromol 2019; 153:1231-1240. [PMID: 31759027 DOI: 10.1016/j.ijbiomac.2019.10.253] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023]
Abstract
This study aimed to investigate the hypoglycemic and hypolipidemic activities of polysaccharides from Grifola frondosa (GFP) in diabetic mice induced by high-fat diet (HFD) and streptozotocin (STZ). Results showed that oral administration of GFP markedly reduced the serum levels of fasting blood glucose (FBG), oral glucose tolerance (OGT), cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C), and significantly decreased the hepatic levels of TC, TG and free fatty acids (FFA). Meanwhile, high-dose of GFP supplementation (900 mg/kg day) also showed powerful effects on moderating the composition of intestinal microflora in diabetic mice, especially altering the functionally relevant intestinal microbial phylotypes. Spearman's correlation network analysis revealed that key microbial phylotypes responding to GFP intervention were strongly correlated with the glucose and lipid metabolic disorders associated parameters. Moreover, GFP treatment regulated mRNA expression levels of the genes responsible for hepatic glucose and lipid metabolism. It is noteworthy that GFP treatment markedly increased mRNA expression of cholesterol 7α-hydroxylase (CYP7A1) and bile salt export pump (BSEP), suggesting an enhancement of bile acids (BAs) synthesis and excretion in liver. These findings demonstrated that GFP could prevent hyperglycemia and hyperlipidemia in diabetic mice by altering gut microbiota and regulating hepatic glycolipid metabolism related genes, and therefore could be used as potential functional food ingredients for the prevention or treatment of hyperglycemia and hyperlipidemia.
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Affiliation(s)
- Wei-Ling Guo
- Institute of Food Science and Technology, College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, China; National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou, Fujian 350002, China
| | - Jia-Cong Deng
- School of Ocean Science and Biochemistry Engineering, Fuqing Branch of Fujian Normal University, Fuqing, Fujian 350300, China
| | - Yu-Yang Pan
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou, Fujian 350002, China
| | - Jia-Xin Xu
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou, Fujian 350002, China
| | - Jia-Li Hong
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou, Fujian 350002, China
| | - Fei-Fei Shi
- Institute of Food Science and Technology, College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, China; National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou, Fujian 350002, China
| | - Gong-Liang Liu
- College of Light Industry and Food Science, Zhongkai University of Agriculture and Engineering, Guangzhou 510225, China
| | - Min Qian
- College of Light Industry and Food Science, Zhongkai University of Agriculture and Engineering, Guangzhou 510225, China
| | - Wei-Dong Bai
- College of Light Industry and Food Science, Zhongkai University of Agriculture and Engineering, Guangzhou 510225, China
| | - Wen Zhang
- Institute of Food Science and Technology, College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, China
| | - Bin Liu
- National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou, Fujian 350002, China
| | - Yan-Yan Zhang
- Institute of Food Science and Technology, College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, China; Department of Flavor Chemistry, Institute of Food Science and Biotechnology, University of Hohenheim, Stuttgart 70599, Germany
| | - Peng-Jie Luo
- China National Center for Food Safety Risk Assessment, NHC Key Laboratory of Food Safety Risk Assessment, Beijing 100022, China.
| | - Li Ni
- Institute of Food Science and Technology, College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, China
| | - Ping-Fan Rao
- Institute of Food Science and Technology, College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, China
| | - Xu-Cong Lv
- Institute of Food Science and Technology, College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian 350108, China; National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou, Fujian 350002, China; Department of Flavor Chemistry, Institute of Food Science and Biotechnology, University of Hohenheim, Stuttgart 70599, Germany.
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87
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Chen CM, Shih CK, Su YJ, Cheang KU, Lo SF, Li SC. Evaluation of white sweet potato tube-feeding formula in elderly diabetic patients: a randomized controlled trial. Nutr Metab (Lond) 2019; 16:70. [PMID: 31636690 PMCID: PMC6796455 DOI: 10.1186/s12986-019-0398-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/24/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Elderly people with type 2 diabetes mellitus (T2DM) have an increased risk of diabetes-related microvascular and macrovascular complications, thus diabetic patients with a functioning gastrointestinal tract but without sufficient oral intake require enteral nutrition (EN) formulas to control blood glucose. White sweet potato (WSP) was a kind of sweet potato could provide a healthy carbohydrate source to EN formula. The aim of this study was to examine at risk of malnutrition T2DM patients whether a WSP-EN would attenuate glucose response and elevate nutritional index compared to a standard polymeric formulas. METHODS In this randomized, parallel, placebo-controlled, pilot clinical trial to investigate the effects of EN with WSP on aged residents with T2DM in long-term care institutions. In total, 54 eligible participants were randomly assigned to either the non-WSP-EN or WSP-EN group. For 60 days, the WSP-EN group received a WSP formula through nasogastric tube via a stoma with a large-bore syringe. The participants received EN of standard polymeric formulas without WSP in the non-WSP-EN group. RESULTS The body weight, body mass index, Mini Nutritional Assessment score, and Geriatric Nutritional Risk Index were significantly higher in the WSP-EN group (p < 0.05). Moreover, the WSP-EN intervention reduced glycated hemoglobin levels (6.73% ± 1.47% vs. 6.40% ± 1.16%), but increased transferrin (223.06 ± 38.85 vs. 245.85 ± 46.08 mg/dL), high-density lipoprotein cholesterol (42.13 ± 10.56 vs. 44.25 ± 8.43 mg/dL), and vitamin A (2.45 ± 0.77 vs 2.74 ± 0.93 μM) levels (p < 0.05). In addition, there was no important side effects including gastrointestinal intolerance with prescribed doses in our WSP-EN treated patients when compared with control ones. CONCLUSIONS The results suggest WSP incorporated into enteral formulas can improve nutrition status and glycemic control in elderly diabetic patients. TRIAL REGISTRATION NCT02711839, registered 27 May 2015.
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Affiliation(s)
- Chiao-Ming Chen
- Department of Food Science, Nutrition, and Nutraceutical Biotechnology, Shih-Chien University, No.70, Dazhi St., Zhongshan Dist., Taipei City, 10462 Taiwan
| | - Chun-Kuang Shih
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Yi-Jing Su
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Kuan-Un Cheang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Shu-Fang Lo
- Department of Agronomy, Chiayi Agricultural Experiment Station, Taiwan Agricultural Research Institute, 2 Min-Cheng Road, Chiayi, 60044 Taiwan
| | - Sing-Chung Li
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan
- Department of Agronomy, Chiayi Agricultural Experiment Station, Taiwan Agricultural Research Institute, 2 Min-Cheng Road, Chiayi, 60044 Taiwan
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88
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Schimmer R, Orre C, Öberg U, Danielsson K, Hörnsten Å. Digital Person-Centered Self-Management Support for People With Type 2 Diabetes: Qualitative Study Exploring Design Challenges. JMIR Diabetes 2019; 4:e10702. [PMID: 31538941 PMCID: PMC6754678 DOI: 10.2196/10702] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 04/19/2019] [Accepted: 07/21/2019] [Indexed: 01/20/2023] Open
Abstract
Background Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce. Objective The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D. Methods A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data. Results Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service. Conclusions A total of three overarching challenges—flexible access, reducing administrative tasks, and patient empowerment—each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.
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Affiliation(s)
- Robyn Schimmer
- Department of Informatics, Umeå University, Umeå, Sweden
| | - Carljohan Orre
- Department of Computer Science and Media Technology, Malmö University, Malmö, Sweden
| | - Ulrika Öberg
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Åsa Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden
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89
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Mendes R, Martins S, Fernandes L. Adherence to Medication, Physical Activity and Diet in Older Adults With Diabetes: Its Association With Cognition, Anxiety and Depression. J Clin Med Res 2019; 11:583-592. [PMID: 31413770 PMCID: PMC6681861 DOI: 10.14740/jocmr3894] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 01/13/2023] Open
Abstract
Background Adherence to medication, physical activity (PA) and diet in diabetes mellitus (DM) patients is crucial for its good management, avoiding acute and chronic complications. There are several risk factors associated with non-adherence, including cognitive impairment, depression and anxiety. Nevertheless, studies on therapeutic adherence in older patients with DM are scarce. In this context, the present study aimed to analyze whether adherence to medication, PA and diet are associated with cognitive impairment, anxiety and depression. It also aimed to identity predictors of medication non-adherence. Methods A cross-sectional study of older patients (≥ 65 years old) with DM was carried out in the Outpatient Department of Internal Medicine Service of CHUSJ-Porto, Portugal. Those unable to communicate were excluded. Cognition (mini-mental state examination), anxiety and depression (hospital anxiety and depression scale) were assessed. Adherence to medication, PA and diet was measured, based on self-reporting patient/family, questionnaires, physician clinical opinion, hemoglobin test and pharmacy records. Patient groups were compared, using the Mann-Whitney or the Kruskal-Wallis test for continuous variables and the Chi-square test for paired categorical variables (significance level of 0.05). The odds ratio (OR) was calculated to identify independent predictors of non-adherence to medication. Results The final sample (n = 94) had a mean age of 75.2 years (standard deviation: 6.7) and mostly were female (53.2%), married (63.8%) and with a low education level (61.7%). Also, 22.3% with cognitive impairment, 16% with depression and 23.4% with anxiety were found. Patients non-adherent to medication had higher depression (P = 0.048) and anxiety (P = 0.010), compared to adherents/partial adherents. Patients non-adherent to PA showed higher anxiety (P = 0.035) and depression (P = 0.004), compared to adherents. Non-adherents to PA had more cognitive impairment than adherents (26.3% vs. 0%; P = 0.034). Patients who had insulin prescribed presented a higher risk of non-adherence to medication (OR: 4.041, 95% confidence interval (CI): 1.404 - 11.628; P = 0.010). Also, the risk of non-adherence to medication is higher by an increase of one unit in anxiety (OR: 1.252, 95% CI: 1.046 - 1.499; P = 0.014). Conclusions Higher anxiety and depression were associated with non-adherence to medication and to PA. Insulin prescribed and high anxiety scores were predictors of medication non-adherence. This study appears to contribute to the knowledge about the influence of cognitive and psychological factors in therapeutic adherence in these older diabetic patients.
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Affiliation(s)
- Rosa Mendes
- Department of Internal Medicine, Centro Hospitalar Universitario S. Joao (CHUSJ), Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Sonia Martins
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Lia Fernandes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Portugal.,Clinic of Psychiatry and Mental Health, Centro Hospitalar Universitario S. Joao (CHUSJ), Porto, Portugal
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90
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Lima DLF, Saintrain MVL, Neri JR, Beck O, Malet P, Moizan JAH, Doucet J. Oral health complications in Brazilian and French diabetic older people: A comparative study. Arch Gerontol Geriatr 2019; 84:103905. [PMID: 31319368 DOI: 10.1016/j.archger.2019.103905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Diabetes mellitus (DM) is a risk factor for periodontitis for over 40 years and novel evidence suggests that periodontitis has an impact on glycemic control in patients with diabetes. This study aimed to compare oral health complications in diabetic older patients from Brazil and France. METHODS This cross-sectional study included 120 patients aged 65 and over diagnosed with type 2 diabetes. Sixty patients were admitted to a center for diabetes and hypertension care in Brazil and 60 patients were admitted to the Rouen University hospital. Dental conditions were assessed through the decayed, missing and filled teeth index and periodontal condition was assessed using the Community Periodontal Index. The significance threshold was p < 0.05. RESULTS Decayed teeth differed statistically between the groups (p = 0.001). The French group presented more tooth mobility, gingival recession and furcation involvement (p < 0.001). Tooth brushing frequency differed significantly between the groups (p < 0.030). The main cause of missing teeth was periodontitis in the French group and caries and periodontitis in the Brazilian group (p < 0.001). Statistical significance was found for use of fixed upper (p = 0.013) and lower (p = 0.013) dentures in the French group. The French group needed upper denture rehabilitation (p = 0.010) while the Brazilian group needed lower denture rehabilitation (p = 0.003). CONCLUSION Edentulism was prevalent in diabetic older people in both countries. However, the French participants presented with better oral health.
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Affiliation(s)
- Danilo L F Lima
- School of Dentistry, University of Fortaleza - UNIFOR, Fortaleza, Brazil; School of Dentistry, Christus University Center - UNICHISTUS, Fortaleza, Brazil
| | | | - Jiovanne R Neri
- School of Dentistry, University of Fortaleza - UNIFOR, Fortaleza, Brazil; School of Dentistry, Christus University Center - UNICHISTUS, Fortaleza, Brazil.
| | - Oscar Beck
- Dental Care Department, Rouen University Hospital, Saint Julien Hospital, Rouen, France
| | - Pierre Malet
- Dental Care Department, Rouen University Hospital, Saint Julien Hospital, Rouen, France
| | - Jean A H Moizan
- Dental Care Department, Rouen University Hospital, Saint Julien Hospital, Rouen, France
| | - Jean Doucet
- Department of Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, Rouen, France
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Pratley RE, Emerson SS, Franek E, Gilbert MP, Marso SP, McGuire DK, Pieber TR, Zinman B, Hansen CT, Hansen MV, Mark T, Moses AC, Buse JB. Cardiovascular safety and lower severe hypoglycaemia of insulin degludec versus insulin glargine U100 in patients with type 2 diabetes aged 65 years or older: Results from DEVOTE (DEVOTE 7). Diabetes Obes Metab 2019; 21:1625-1633. [PMID: 30850995 PMCID: PMC6617815 DOI: 10.1111/dom.13699] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/26/2022]
Abstract
AIMS The aim of this study was to describe the risks of cardiovascular (CV) events and severe hypoglycaemia with insulin degludec (degludec) vs insulin glargine 100 units/mL (glargine U100) in patients with type 2 diabetes (T2D) aged 65 years or older. MATERIALS AND METHODS A total of 7637 patients in the DEVOTE trial, a treat-to-target, randomized, double-blind trial evaluating the CV safety of degludec vs glargine U100, were divided into three age groups (50-64 years, n = 3682; 65-74 years, n = 3136; ≥75 years, n = 819). Outcomes by overall age group and randomized treatment differences were analysed for major adverse cardiovascular events (MACE), all-cause mortality, severe hypoglycaemia and serious adverse events (SAEs). RESULTS Patients with increasing age had higher risks of CV death, all-cause mortality and SAEs, and there were non-significant trends towards higher risks of MACE and severe hypoglycaemia. Treatment effects on the risk of MACE, all-cause mortality, severe hypoglycaemia and SAEs were consistent across age groups, based on the non-significant interactions between treatment and age with regard to these outcomes. CONCLUSIONS There were higher risks of CV death, all-cause mortality and SAEs, and trends towards higher risks of MACE and severe hypoglycaemia with increasing age after adjusting for baseline differences. The effects across age groups of degludec vs glargine U100 on MACE, all-cause mortality and severe hypoglycaemia were comparable, suggesting that the risk of MACE, as well as all-cause mortality, is similar and the risk of severe hypoglycaemia is lower with degludec regardless of age. Evidence is conclusive only until 74 years of age.
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Affiliation(s)
- Richard E. Pratley
- AdventHealth Translational Research Institute for Metabolism and DiabetesOrlandoFlorida
| | | | - Edward Franek
- Mossakowski Clinical Research Centre, Polish Academy of SciencesWarsawPoland
| | - Matthew P. Gilbert
- Larner College of Medicine at The University of VermontBurlingtonVermont
| | - Steven P. Marso
- HCA Midwest Health Heart and Vascular InstituteKansas CityMissouri
| | | | | | - Bernard Zinman
- Lunenfeld‐Tanenbaum Research Institute, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | | | | | | | | | - John B. Buse
- University of North Carolina School of MedicineChapel HillNorth Carolina
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92
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Heller SR, DeVries JH, Wysham C, Hansen CT, Hansen MV, Frier BM. Lower rates of hypoglycaemia in older individuals with type 2 diabetes using insulin degludec versus insulin glargine U100: Results from SWITCH 2. Diabetes Obes Metab 2019; 21:1634-1641. [PMID: 30891886 PMCID: PMC6618254 DOI: 10.1111/dom.13708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/06/2019] [Accepted: 03/16/2019] [Indexed: 01/09/2023]
Abstract
AIM This study aimed to investigate the safety of insulin degludec (degludec) in relation to age and risk of hypoglycaemia post hoc in individuals with type 2 diabetes (T2D) (SWITCH 2 trial). METHODS In this crossover study, individuals with T2D who were at risk of hypoglycaemia were randomized to double-blind treatment with degludec or insulin glargine 100 units/mL (glargine U100) ± oral antidiabetic drugs. After 32 weeks, patients crossed over to the other treatment. Primary endpoint was number of overall severe (positively adjudicated) or glucose-confirmed (plasma glucose <56 mg/dL; 3.1 mmol/L) symptomatic hypoglycaemia events during the two 16-week maintenance periods. RESULTS For individuals ≤65 (n = 450) and >65 (n = 270) years, baseline median (range) duration of diabetes was 12 (1-40) vs 15 (1-54) years, mean HbA1c was 7.7% vs 7.4% and mean estimated glomerular filtration rate was 87.0 vs 63.7 mL/min/1.73 m2 , respectively. No significant differences in HbA1c reduction were seen in individuals ≤65 or >65 years. During both maintenance periods, treatment with degludec lowered rates of hypoglycaemia (overall/nocturnal symptomatic) vs those with glargine U100 in individuals ≤65 (31% vs 43%) and >65 (30% vs 41%) years. With degludec and glargine U100, respectively, six vs nine severe hypoglycaemic events occurred in individuals ≤65 years and four vs eight events occurred in those >65 years. Adverse event rates were 3.2 and 3.3 events/patient-year for individuals ≤65 years and were 3.5 and 4.1 events/patient-year for individuals >65 years with degludec and glargine U100, respectively. CONCLUSION Treatment with degludec was safe and effective, with a frequency of hypoglycaemia lower than that with glargine U100 in both younger and older individuals (>65 years) with T2D.
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Affiliation(s)
- Simon R. Heller
- Academic Unit of Diabetes, Endocrinology and MetabolismUniversity of SheffieldSheffieldUK
| | - J. Hans DeVries
- Academic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Carol Wysham
- School of MedicineUniversity of Washington/Multicare Rockwood ClinicSpokaneWashington
| | | | | | - Brian M. Frier
- The Queen's Medical Research CentreUniversity of EdinburghEdinburghUK
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Mao F, Zhu X, Liu S, Qiao X, Zheng H, Lu B, Li Y. Age as an Independent Risk Factor for Diabetic Peripheral Neuropathy in Chinese Patients with Type 2 Diabetes. Aging Dis 2019; 10:592-600. [PMID: 31165003 PMCID: PMC6538210 DOI: 10.14336/ad.2018.0618] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is more prevalent in aging populations. Older adults with diabetes have higher rates of macro and micro vascular complications. Our study assessed whether age is an independent factor for both large and small nerve dysfunctions in Chinese patients with T2DM. This cross-sectional study involved a total of 950 patients with type 2 diabetes (mean age: 60.01±12.30 years). Diabetic peripheral neuropathy (DPN) was assessed according to clinical symptoms and physical examinations by using neuropathy symptom score (NSS), the neuropathy disability score (NDS), Michigan Neuropathy Screening Instrument (MNSI score), vibration perception threshold (VPT) and SUDOSCAN test. By using independent logistic regression model, we showed that age was an independent risk factor of DPN (odds ratio [OR] = 1.036, 95% confidence interval [CI] 1.018-1.054, P< 0.01). T2DM patients over 71 years had a higher risk of DPN determined by using NSS/NDS (OR= 2.087; 95% CI 1.112-3.918; P <0.05), MNSI (OR=1.922; 95% CI 1.136-3.252; P<0.05), VPT (OR=3.452; 95%CI 1.052-11.332; P<0.05) and SUDOSCAN (OR=1.922; 95%CI 1.136-3.252; P<0.05) as diagnostic criteria respectively. The results of spline analysis showed a non-linearly positive association between age and OR of DPN. Individuals with 40, 50, 60, and 70 years old had LnOR of 1.22 (95%CI: 0.44- 2.00), 1.79(95%CI: 0.67- 2.91), 2.29 (95% CI: 0.98- 3.59), and 2.67(95% CI: 1.38-3.96) in DPN risk compared to T2DM patients with 19 years old, respectively. All of the above results in our study suggested age as an independent risk factor for the development of diabetic neuropathy in T2DM patients is significantly associated with the occurrence of both small and large nerve dysfunction, independent of other risk factors.
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Affiliation(s)
- Fei Mao
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Zhu
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Siying Liu
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaona Qiao
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Hangping Zheng
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Lu
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiming Li
- 1Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,2Department of Endocrinology and Metabolism, Jing'an District Center Hospital of Shanghai, China
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94
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Cardiovascular Risks Associated with Gender and Aging. J Cardiovasc Dev Dis 2019; 6:jcdd6020019. [PMID: 31035613 PMCID: PMC6616540 DOI: 10.3390/jcdd6020019] [Citation(s) in RCA: 389] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022] Open
Abstract
The aging and elderly population are particularly susceptible to cardiovascular disease. Age is an independent risk factor for cardiovascular disease (CVD) in adults, but these risks are compounded by additional factors, including frailty, obesity, and diabetes. These factors are known to complicate and enhance cardiac risk factors that are associated with the onset of advanced age. Sex is another potential risk factor in aging adults, given that older females are reported to be at a greater risk for CVD than age-matched men. However, in both men and women, the risks associated with CVD increase with age, and these correspond to an overall decline in sex hormones, primarily of estrogen and testosterone. Despite this, hormone replacement therapies are largely shown to not improve outcomes in older patients and may also increase the risks of cardiac events in older adults. This review discusses current findings regarding the impacts of age and gender on heart disease.
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95
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Ildarabadi EH, Tabei MG, Khosh AM. Effects of Face-To-Face and Online Training on Self-Care of Middle-Aged and Elderly People with Type 2 Diabetes: A Comparative Study. Open Access Maced J Med Sci 2019; 7:1214-1219. [PMID: 31049110 PMCID: PMC6490490 DOI: 10.3889/oamjms.2019.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND: Self-care training is one of the strategies used to control diabetes. There is some ambiguity about the appropriate method for educating middle-aged and older adults about self-care. AIM: This study aimed to compare the effects of face-to-face and online training on self-care levels in middle-aged and older adults with type 2 diabetes. MATERIAL AND METHODS: In a randomised clinical trial, 84 middle-aged and older adults with type 2 diabetes who had been referred to the Diabetes Clinic of Esfarayen in Iran, were evaluated. Patients who meet the inclusion criteria were randomly assigned into two groups. Diabetes self-care education (DSCE) was provided using a face-to-face training method in one group and using online training method in the other group. The summary of diabetes self-care activities (SDSCA) questionnaire was completed at baseline and 1 month after training. RESULTS: The mean and standard deviation of self-care scores before and 1 month after training were 43.16 ± 14.94 and 65.76 ± 10.65 in the face-to-face training group, and 37 ± 10.75 and 56.82 ± 12.06 in the online training group, respectively. The differences in the self-care scores were significant both before and after the intervention in the two groups (p < 0.05). Although the difference was greater in the face-to-face training group than in the online training group, it was not statistically significant (P > 0.05). CONCLUSION: Both face-to-face and online training had a similar effect on the self-care levels in middle-aged and older adults with type 2 diabetes. Therefore, both training methods could be used as effective techniques to meet the needs and educational requirements of middle-aged and older adults with type 2 diabetes.
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Affiliation(s)
- Es-Hagh Ildarabadi
- Department of Nursing, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Mohammad Ghasem Tabei
- Department of Internal Medicine, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Ameneh Mosaferi Khosh
- Department of Postgraduate, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
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96
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Davidson JA. SGLT2 inhibitors in patients with type 2 diabetes and renal disease: overview of current evidence. Postgrad Med 2019; 131:251-260. [PMID: 30929540 DOI: 10.1080/00325481.2019.1601404] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and is associated with poor clinical outcomes, including an increased risk of all-cause and cardiovascular mortality, as well as adverse economic and social effects. Slowing the development and progression of CKD remains an unmet clinical need in patients with T2DM. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are widely used for the management of T2DM and have effects beyond glucose lowering that include cardiovascular benefits and potential renoprotective effects. Although the glucose-lowering efficacy of these agents is dependent on renal function, the cardiovascular and renal benefits of SGLT2 inhibition appear to be maintained to estimated glomerular filtration levels as low as 30 mL/min/1.73 m2. Clinical evidence has indicated that these agents can reduce the risk of development or worsening of albuminuria, a marker of renal damage, through a range of mechanisms. These include blood pressure lowering, reduction of intraglomerular pressure and hyperfiltration, modification of inflammatory processes, reduction of ischemia-related renal injury, and increases in glucagon levels. The blood pressure-lowering effect of SGLT2 inhibitors is maintained in people with CKD and could further contribute to reduced renal burden, as well as potentially offering synergistic effects with antihypertensive therapies in these patients. Several cardiovascular outcomes trials (CVOTs) have included renal endpoints, adding to the growing evidence of the potential renoprotective effects of these agents in patients with T2DM. Several ongoing dedicated renal outcomes trials will provide further guidance on the potential clinical role of SGLT2 inhibitors in slowing the development and progression of renal impairment in individuals with T2DM.
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Affiliation(s)
- Jaime A Davidson
- a The University of Texas Southwestern Medical Center, Touchstone Diabetes Center , Dallas , TX , USA
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97
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Cintra R, Moura FA, Carvalho LSFD, Barreto J, Tambascia M, Pecoits-Filho R, Sposito AC. Inhibition of the sodium-glucose co-transporter 2 in the elderly: clinical and mechanistic insights into safety and efficacy. ACTA ACUST UNITED AC 2019; 65:70-86. [PMID: 30758423 DOI: 10.1590/1806-9282.65.1.70] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/26/2018] [Indexed: 12/16/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) in the elderly grew sharply over the last decade. Reduced insulin sensitivity and secretory capacity, weight gain, sarcopenia, and elevated adiposity are all common metabolic and body changes in the aging population that favor an increased risk of hypoglycemia, frailty syndrome, falls, and cognitive dysfunction. First line antidiabetic therapy is frequently not safe in older individuals because of its high risk of hypoglycemia and prevalent co-morbid diseases, such as chronic kidney disease, osteoporosis, cardiovascular disease, and obesity. Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a new class of antidiabetic therapy that inhibits glucose and sodium reabsorption on renal proximal convoluted tubule. Its effect is well demonstrated in various clinical scenarios in the younger population. This review and metanalysis describe particularities of the SGLT2i on the elderly, with mechanistic insights of the potential benefit and remaining challenges about the use of these drugs in this important age group. Further, we will present a meta-analysis of the main effects of SGLT2i reported in post-hoc studies in which the median age of the subgroups analyzed was over 60 years. Despite the absence of specific clinical trials for this population, our findings suggest that SGLT2i therapy on older individuals is effective to lower glucose and maintain its effect on systolic blood pressure and body weight.
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Affiliation(s)
- Riobaldo Cintra
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Filipe A Moura
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Luis Sergio F de Carvalho
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil.,Cardiology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | - Joaquim Barreto
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil
| | - Marcos Tambascia
- Endocrinology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
| | | | - Andrei C Sposito
- Laboratory of Atherosclerosis and Vascular Biology, Unicamp, Campinas, SP, Brasil.,Cardiology Division, State University of Campinas (Unicamp), Campinas, SP, Brasil
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98
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Yaribeygi H, Simental-Mendía LE, Barreto GE, Sahebkar A. Metabolic effects of antidiabetic drugs on adipocytes and adipokine expression. J Cell Physiol 2019; 234:16987-16997. [PMID: 30825205 DOI: 10.1002/jcp.28420] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/05/2019] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
Several classes of antidiabetic agents have been developed that achieve their hypoglycemic outcomes via various molecular mechanisms. Adipose tissue is a major metabolic and energy-storing tissue and plays an important role in many metabolic pathways, including insulin signaling and insulin sensitivity. Adipose tissue monitors and regulates whole body homeostasis via production and release of potent proteins, such as adipokine and adiponectin, into the circulation. Therefore, any agent that can modulate adipocyte metabolism can, in turn, affect metabolic and glucose homeostatic pathways. Antidiabetic drugs are not only recognized primarily as hypoglycemic agents but may also alter adipose tissue itself, as well as adipocyte-derived adipokine expression and secretion. In the current review, we present the major evidence concerning routinely used antidiabetic agents on adipocyte metabolism and adipokine expression.
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Affiliation(s)
- Habib Yaribeygi
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Luis E Simental-Mendía
- Unidad de Investigación Biomédica, Delegación Durango, Instituto Mexicano del Seguro Social, México, México
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C, Colombia.,Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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99
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Brostow DP, Gunzburger E, Abbate LM, Brenner LA, Thomas KS. Mental Illness, Not Obesity Status, is Associated with Food Insecurity Among the Elderly in the Health and Retirement Study. J Nutr Gerontol Geriatr 2019; 38:149-172. [PMID: 30794096 DOI: 10.1080/21551197.2019.1565901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Food insecurity, limited or uncertain access to adequate nutrition, is an increasingly recognized determinant of health outcomes and is often associated with having obesity. It is unclear, however, if this association persists in elderly populations. METHODS We conducted a cross-sectional study of 2868 participants' aged 65+ years from the Health and Retirement Study. Multivariate logistic regression was used to assess associations between food insecurity and body mass index, demographic characteristics, psychiatric history, and medical history. RESULTS Participants with overweight/obesity had a higher prevalence of food insecurity than leaner counterparts, however, weight status was not a significant predictor of food insecurity after multivariate adjustment. Instead, mental illness, current smoking status, and non-White race were all independently associated with food insecurity. DISCUSSION Beyond financial status, health care providers are encouraged to use these characteristics to identify elderly patients that may be at risk of food insecurity.
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Affiliation(s)
- Diana P Brostow
- a Denver VA Medical Center , Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care , Denver , CO , USA
| | - Elise Gunzburger
- a Denver VA Medical Center , Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care , Denver , CO , USA.,b Department of Biostatistics and Informatics , University of Colorado School of Public Health , Aurora , CO , USA
| | - Lauren M Abbate
- c Geriatric Research, Education, and Clinical Center , Denver VA Medical Center , Denver , CO , USA.,d Department of Emergency Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Lisa A Brenner
- e Denver VA Medical Center , Rocky Mountain Mental Illness Research Education and Clinical Center , Denver , CO , USA.,f Departments of Psychiatry, Physical Medicine and Rehabilitation, and Neurology , University of Colorado, Anschutz School of Medicine , Aurora , CO , USA
| | - Kali S Thomas
- g Providence VA Medical Center , Center of Innovation in Long-Term Services and Supports , Providence , RI , USA.,h Center for Gerontology and Healthcare Research , Brown University , Providence , RI , USA
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100
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Kaewput W, Thongprayoon C, Rangsin R, Ruangkanchanasetr P, Mao MA, Cheungpasitporn W. Associations of renal function with diabetic retinopathy and visual impairment in type 2 diabetes: A multicenter nationwide cross-sectional study. World J Nephrol 2019; 8:33-43. [PMID: 30815379 PMCID: PMC6388308 DOI: 10.5527/wjn.v8.i2.33] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/07/2019] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) separately has been noted as a major public health problem worldwide as well. Currently, many studies have demonstrated an association between diabetic nephropathy and DR in type 1 diabetes mellitus (T1DM) patients, but this association is less strong in T2DM. The evidence for an association between renal function and DR and visual impairment among T2DM patients is limited, particularly in the Asian population.
AIM To assess the association between glomerular filtration rate (GFR) and DR, severe DR, and severe visual impairment among T2DM patients in Thailand.
METHODS We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. GFR was categorized into ≥ 90, 60-89, 30-59 and < 30 mL/min/1.73 m2. The association between GFR and DR, severe DR, and severe visual impairment were assessed using multivariate logistic regression.
RESULTS A total of 13192 T2DM patients with available GFR were included in the analysis. The mean GFR was 66.9 ± 25.8 mL/min/1.73 m2. The prevalence of DR, proliferative DR, diabetic macular edema, and severe visual impairment were 12.4%, 1.8%, 0.2%, and 2.1%, respectively. Patients with GFR of 60-89, 30-59 and < 30 mL/min/1.73 m2 were significantly associated with increased DR and severe DR when compared with patients with GFR of ≥ 90 mL/min/1.73 m2. In addition, increased severe visual impairment was associated with GFR 30-59 and < 30 mL/min/1.73 m2.
CONCLUSION Decreased GFR was independently associated with increased DR, severe DR, and severe visual impairment. GFR should be monitored in diabetic patients for DR awareness and prevention.
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Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Prajej Ruangkanchanasetr
- Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok 10400, Thailand
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
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