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Abstract
PURPOSE OF REVIEW Older adults often live with chronic disease including diabetes and its complications. In this review, we examine the complexity and heterogeneity of older adults with diabetes and chronic kidney disease, explore the nuances in their diabetes-related monitoring, and discuss their best diabetes management. RECENT FINDINGS Although there remains an overall lack of studies in older adults with diabetes and chronic kidney disease, recent reports have highlighted their vulnerabilities. These individuals face an increased risk of cognitive impairment and dementia, frailty, dysglycemia, polypharmacy, declining kidney function, and acute kidney injury. Their diabetes management should focus upon safer antihyperglycemic medications, close monitoring, and care individualization. Older adults with diabetes and chronic kidney disease are a complex population who requires careful diabetes management and monitoring. Research efforts might focus on improving the care and outcomes of these patients.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology, Western University, London, Ontario, Canada.
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
- St. Joseph's Health Care London, London, Ontario, Canada.
- Institute for Clinical Evaluative Sciences, Ontario, Canada.
- Lawson Health Research Institute, London, Ontario, Canada.
| | - Niamh O'Regan
- St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Jinnie J Rhee
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
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Adult Nesidioblastosis in Chronic Kidney Disease. Case Rep Endocrinol 2019; 2019:7640384. [PMID: 30895162 PMCID: PMC6393863 DOI: 10.1155/2019/7640384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 02/05/2019] [Indexed: 11/24/2022] Open
Abstract
Context Nesidioblastosis is a rare cause of hyperinsulinemic hypoglycemia in adults. The diagnosis is further complicated in patients with kidney failure, since impaired renal function can cause hypoglycemia by itself and diagnostic criteria for this clinical scenario have not been developed yet. Case Description We present the case report of a 36-year-old patient with end stage chronic kidney disease who presented to the emergency department because of hypoglycemia. However, the patient's hypoglycemia did not respond well to medical treatment; the diagnosis of hyperinsulinemic hypoglycemia was made due to the presence of inappropriately high levels of insulin, proinsulin, and C-peptide during an episode of hypoglycemia. Imaging studies were performed without any conclusive findings; so selective intra-arterial pancreatic stimulation with hepatic venous sampling (SACTS) was done. Based on the results of this study the patient was referred for subtotal pancreatectomy. Classic criteria for the diagnosis of insulinoma with SACTS required a 2-fold increase in insulin levels but newer criteria suggest thresholds that are useful in the differential diagnosis of insulinoma and nesidioblastosis. In our patient, the former criteria were positive; however, the new criteria were not compatible with insulinoma but with nesidioblastosis, which was the final histopathological diagnosis. Conclusion This seems to be the first case report of a patient with end stage chronic kidney disease and nesidioblastosis, as well as the first case of hyperinsulinemic hypoglycemia in the context of kidney failure diagnosed by SACTS. We consider this method to be very useful in patients with renal impairment because peripancreatic insulin levels do not depend on the renal function.
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Al-Ozairi E, El Samad A, Al Kandari J, Aldibbiat AM. Intermittent Fasting Could Be Safely Achieved in People With Type 1 Diabetes Undergoing Structured Education and Advanced Glucose Monitoring. Front Endocrinol (Lausanne) 2019; 10:849. [PMID: 31866948 PMCID: PMC6906269 DOI: 10.3389/fendo.2019.00849] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 11/20/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Fasting during Ramadan is a form of intermittent fasting in which a person abstains from oral intake between the hours of sunrise and sunset. The fasting month of Ramadan is observed by Muslims worldwide. People with type 1 diabetes (T1DM) who choose to fast during Ramadan are at a particularly high risk of acute diabetes complications including hypoglycemia and significant hyperglycemia. We hypothesized that people with uncomplicated T1DM would be able to fast safely during Ramadan following structured education and with daily advanced glucose monitoring. Methods: People with stable and uncomplicated T1DM treated with multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) who chose to fast during Ramadan were recruited for the study. Participants attended Dose Adjustment for Normal Eating (DAFNE) structured education training, and basal insulin was reduced in a controlled fashion. Participants were assigned a sensor-augmented insulin pump or FreeStyle Libre for advanced glucose monitoring. The primary endpoint was the rate of hypoglycemia during Ramadan compared to before Ramadan. Secondary endpoints were percentage time spent <4 mmol/L, >10 mmol/L (range, 4-10 mmol/L), episodes of diabetic ketoacidosis (DKA), and acute kidney injury or hospitalization for any cause. Results: Rates of hypoglycemia were significantly reduced during Ramadan compared with rates before Ramadan (0.53 ± 0. 49 vs. 0.81 ± 0.69 episodes/day, p = 0.0015). No episodes of severe hypoglycemia, DKA, acute kidney injury, or hospitalization occurred during Ramadan period. Percentage time spent >10 mmol/L (46.7 ± 17.7% vs. 42.5 ± 16.4%, p = 0.03) was significantly increased, and percentage time [range, 4-10 mmol/L (48.8 ± 15.9% vs. 50.9 ± 15.9%, p = 0.13)] and percentage time spent <4 mmol/L (4.7 ± 5.4.7% vs. 5.7 ± 6.3%, p = 0.09) were reduced, but these differences were not significant. Conclusions: People with uncomplicated T1DM could safely participate in intermittent fasting similar to Ramadan fasting if equipped with structured education and advanced glucose monitoring systems.
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Affiliation(s)
- Ebaa Al-Ozairi
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
- *Correspondence: Ebaa Al-Ozairi
| | - Abeer El Samad
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jumana Al Kandari
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- Ministry of Health, Kuwait City, Kuwait
| | - Ali M. Aldibbiat
- Department of Diabetes and Endocrinology, James Cook University Hospital, Middlesbrough, United Kingdom
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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Wojszel ZB, Kasiukiewicz A. A Retrospective Time Trend Study Of Diabetes Overtreatment In Geriatric Patients. Diabetes Metab Syndr Obes 2019; 12:2023-2032. [PMID: 31632112 PMCID: PMC6782028 DOI: 10.2147/dmso.s221179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE We assessed changes in diabetes mellitus (DM) overtreatment prevalence in geriatric patients that had taken place after the introduction of the rule of therapy individualization in the Polish diabetes treatment guidelines. PATIENTS AND METHODS This time-trend assessment comprised two retrospective cross-sectional cohort studies of type 2 DM patients admitted to a geriatric ward in 2009-2010 (1st round) and in 2014-2015 (2nd round). A high-risk group was defined as patients on antihyperglycemic medications prior to admission, who were 80+ years old, diagnosed with dementia, end-stage renal disease, or had a history of macrovascular complications. The primary outcome measure was glycosylated A1C hemoglobin (HbA1C) ≤7.0% (53 mmol/mol). RESULTS 213 patients in the 1st round and 83 in the 2nd round were included. Groups did not differ in age, gender, health and functional characteristics. The percentage of dementia (36.1% versus 18.8%, P=0.002) and of the high-risk cases (79.3% versus 67.7%, P=0.05) was higher in the 2nd round of the study. During the study, tight glycemic control prevalence in the high-risk group decreased significantly from 73.1% to 58.5%, P=0.04 (odds ratio 0.68, 95% CI 0.47-0.97), and the median value of HbA1c increased significantly from 6.4%, IQR 5.7-7.3 (46 mmol/mol, IQR 39-56) to 6.7%, IQR 6.1-7.9 (50 mmol/mol, IQR 43-63), P=0.03. CONCLUSION Despite the principle of individualization of DM therapy that was in force, after a five-year observation, the problem of DM overtreatment still concerned a large percentage of geriatric patients, although a positive trend was noted in this respect.
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Affiliation(s)
- Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland
- Correspondence: Zyta Beata Wojszel Department of Geriatrics, Medical University of Bialystok, Fabryczna street 27, Bialystok15-471, PolandTel +48 85 8694 982Fax +48 85 8694974 Email
| | - Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland
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Kadowaki T, Sarai N, Hirakawa T, Taki K, Iwasaki K, Urushihara H. Persistence of oral antidiabetic treatment for type 2 diabetes characterized by drug class, patient characteristics and severity of renal impairment: A Japanese database analysis. Diabetes Obes Metab 2018; 20:2830-2839. [PMID: 29974673 PMCID: PMC6282986 DOI: 10.1111/dom.13463] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the persistence with oral antidiabetic drug (OAD) treatment characterized by drug class, patient characteristics and severity of renal impairment (RI) in patients with type 2 diabetes (T2DM) in Japan. MATERIALS AND METHODS This retrospective, observational study extracted data from a large-scale hospital database (April 2008 to September 2016). Patients with T2DM aged ≥40 years on the day of their first prescription (index date) of any OAD (biguanides [BGs], thiazolidinediones [TZDs], sulphonylureas [SUs], glinides, dipeptidyl peptidase-4 [DPP-4] inhibitors, or α-glucosidase inhibitors [α-GIs]) available between January 1, 2014 and September 30, 2016 were identified. Sodium-glucose co-transporter-2 inhibitors were not available at study initiation. Treatment persistence was assessed by Kaplan-Meier survival curves. Patients were also categorized by RI status using estimated glomerular filtration rate: ≥90 mL/min/1.73 m2 (G1); 60 to <90 mL/min/1.73 m2 (G2); 30 to <60 mL/min/1.73 m2 (G3); and <30 mL/min/1.73 m2 (G4+). RESULTS We identified 206 406 index dates from 162 116 eligible patients. The largest number of index dates (91634) was observed for DPP-4 inhibitors, followed by BGs, SUs, α-GIs, glinides and TZDs. Treatment persistence was longest for DPP-4 inhibitors (median 17.0 months, 95% confidence interval [CI] 16.4-17.5) and BGs (median 17.3 months, 95% CI 16.6-18.2), and shortest for α-GIs (median 5.6 months, 95% CI 5.4-5.9) and SUs (median 4.3 months, 95% CI 4.2-4.6). Persistence was longest with DPP-4 inhibitors at all RI stages (G1-G4+), followed by BGs at stages G1/G2. CONCLUSIONS The longest OAD persistence was observed for BGs and DPP-4 inhibitors at RI stages G1/G2, and for DPP-4 inhibitors at RI stages G3/G4+.
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Affiliation(s)
- Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Nobuaki Sarai
- Clinical Development and Medical AffairsNippon Boehringer Ingelheim Co., LtdTokyoJapan
| | - Takeshi Hirakawa
- Clinical Development and Medical AffairsNippon Boehringer Ingelheim Co., LtdTokyoJapan
| | - Kentaro Taki
- Medicine Development Unit JapanEli Lilly Japan K.K.KobeJapan
| | | | - Hisashi Urushihara
- Division of Drug Development and Regulatory Science, Faculty of PharmacyKeio UniversityTokyoJapan
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Javier Escalada F, Halimi S, Senior PA, Bonnemaire M, Cali AMG, Melas‐Melt L, Karalliedde J, Ritzel RA. Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild-to-moderate renal impairment. Diabetes Obes Metab 2018; 20:2860-2868. [PMID: 30003642 PMCID: PMC6282564 DOI: 10.1111/dom.13470] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
Abstract
AIM To investigate the impact of renal function on the safety and efficacy of insulin glargine 300 U/mL (Gla-300) and insulin glargine 100 U/mL (Gla-100). MATERIALS AND METHODS A meta-analysis was performed using pooled 6-month data from the EDITION 1, 2 and 3 trials (N = 2496). Eligible participants, aged ≥18 years with a diagnosis of type 2 diabetes (T2DM), were randomized to receive once-daily evening injections of Gla-300 or Gla-100. Pooled results were assessed by two renal function subgroups: estimated glomerular filtration rate (eGFR) <60 and ≥60 mL/min/1.73 m2 . RESULTS The decrease in glycated haemoglobin (HbA1c) after 6 months and the proportion of individuals with T2DM achieving HbA1c targets were similar in the Gla-300 and Gla-100 groups, for both renal function subgroups. There was a reduced risk of nocturnal (12:00-5:59 am) confirmed (≤3.9 mmol/L [≤70 mg/dL]) or severe hypoglycaemia with Gla-300 in both renal function subgroups (eGFR <60 mL/min/1.73 m2 : relative risk [RR] 0.76 [95% confidence interval {CI} 0.62-0.94] and eGFR ≥60 mL/min/1.73 m2 : RR 0.75 [95% CI 0.67-0.85]). For confirmed (≤70 mg/dL [≤3.9 mmol/L]) or severe hypoglycaemia at any time of day (24 hours) the hypoglycaemia risk was lower with Gla-300 vs Gla-100 in both the lower (RR 0.94 [95% CI 0.86-1.03]) and higher (RR 0.90 [95% CI 0.85-0.95]) eGFR subgroups. CONCLUSIONS Gla-300 provided similar glycaemic control to Gla-100, while indicating a reduced overall risk of confirmed (≤3.9 and <3.0 mmol/L [≤70 and <54 mg/dL]) or severe hypoglycaemia, with no significant difference between renal function subgroups.
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Affiliation(s)
- F. Javier Escalada
- Department of Endocrinology and NutritionClínic University of NavarraPamplonaSpain
| | - Serge Halimi
- Department of Diabetology, Endocrinology and NutritionGrenoble University Hospital CenterGrenobleFrance
- Department of Diabetology, Endocrinology and NutritionUniversity Grenoble Alpes, Medical and Science UniversityGrenobleFrance
| | - Peter A. Senior
- Division of EndocrinologyUniversity of AlbertaEdmontonCanada
- Diabetic Nephropathy Prevention Clinics, Alberta Health ServicesEdmontonCanada
| | | | | | | | - Janaka Karalliedde
- Cardiovascular Division, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | - Robert A. Ritzel
- Division of Endocrinology and Diabetes Klinikum SchwabingStädtisches Klinikum München GmbHMunichGermany
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Boye KS, Botros FT, Haupt A, Woodward B, Lage MJ. Glucagon-Like Peptide-1 Receptor Agonist Use and Renal Impairment: A Retrospective Analysis of an Electronic Health Records Database in the U.S. Population. Diabetes Ther 2018; 9:637-650. [PMID: 29460259 PMCID: PMC6104268 DOI: 10.1007/s13300-018-0377-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The study characterizes the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D) with and without renal impairment and examines the effects of such use on the clinical outcomes of estimated glomerular filtration rate (eGFR) and glycated hemoglobin (A1c). METHODS Data from the Practice Fusion electronic health records database from 1 January 2012 through 30 April 2015 were used. Adults with T2D who received serum creatinine laboratory tests and initiated therapy with a GLP-1 RA (N = 3225) or other glucose-lowering agent (GLA) (N = 37,074) were included in the analysis. The GLP-1 RA cohort was matched to cohorts initiating therapy any other GLA, and multivariable analyses examined the association between GLP-1 RA use and changes in eGFR or A1c at 1 year after therapy initiation. RESULTS In this study, only 5.7% of patients with an eGFR of < 30 and ≥ 15 mL/min/1.73 m2 and 3.6% of patients with an eGFR of < 15 mL/min/1.73 m2 initiated therapy with a GLP-1 RA. Compared to other GLAs, at 1-year after initiation of therapy the use of a GLP-1 RA was associated with a significantly smaller decline in eGFR (- 0.80 vs. - 1.03 mL/min/1.73 m2; P = 0.0005), a significantly smaller likelihood of having a ≥ 30% reduction in eGFR (2.19 vs. 3.14%; P < 0.0001), and a significantly larger reduction in A1c (- 0.48 vs. - 0.43; P = 0.0064). CONCLUSION In clinical practice, the use of GLP-1 RAs in patients with a higher degree of renal impairment disease was limited. Compared to other GLAs, the use of GLP-1 RAs was associated with a significantly smaller decline in eGFR and a larger reduction in A1c over the 1 year following therapy initiation. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Kristina S Boye
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Fady T Botros
- Diabetes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Axel Haupt
- Early Phase Clinical Research-Diabetes and Complications, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Brad Woodward
- Diabetes, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 27576 River Reach Drive, Bonita Springs, FL, 34134, USA.
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Gardiner FW, Nwose EU, Bwititi PT, Crockett J, Wang L. Blood glucose and pressure controls in diabetic kidney disease: Narrative review of adherence, barriers and evidence of achievement. J Diabetes Complications 2018; 32:104-112. [PMID: 29102249 DOI: 10.1016/j.jdiacomp.2017.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/07/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022]
Abstract
AIMS To review the epidemiology and the clinical evidence regarding achieving blood pressure (BP) and blood glucose control in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), with emphasis on adherence and barriers within the context of Australian clinical guidelines. This article then considers Australian services aimed at BP, DM, and CKD, guideline adherence and control. METHODS Evidence from PubMed-listed articles published between 1994 and 2016 is considered, including original research, focusing on randomised controlled trials and prospective studies, review articles, meta- analyses, expert and professional bodies' guidelines as well as our experience. RESULTS There have been no Australian studies that consider adherence to BP control in DM and CKD patients. This is a major limitation in preventing DM and renal disease progression. It is possible that Australian clinicians are not adhering to DM, hypertension (HT), and glucose recommendations, thus resulting in reduced patient outcomes. CONCLUSIONS It is hoped that future studies ascertain the extent to which the required BP and glucose control in patients is achieved, and the potential barriers to adherence. The significance of this is immense since the impact of failure to control blood glucose levels and BP leads to renal damage.
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Affiliation(s)
- Fergus William Gardiner
- School of Community Health, Charles Sturt University, Australia; Calvary Hospital, ACT, Australia; School of Biomedical Sciences, Charles Sturt University, Australia.
| | | | | | - Judith Crockett
- School of Community Health, Charles Sturt University, Australia
| | - Lexin Wang
- School of Biomedical Sciences, Charles Sturt University, Australia
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Gardiner FW, Nwose EU, Bwititi PT, Crockett J, Wang L. Services aimed at achieving desirable clinical outcomes in patients with chronic kidney disease and diabetes mellitus: A narrative review. SAGE Open Med 2017; 5:2050312117740989. [PMID: 29201367 PMCID: PMC5697580 DOI: 10.1177/2050312117740989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022] Open
Abstract
There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients with CKD and DM, and HT in Australia. Literature pertaining to pathology diagnosis and management of these patients as well as the complexities in management were considered. This involved evidence from PubMed-listed articles published between 1993 and 2016 including original research studies, focusing on randomised controlled trials and prospective studies where possible, systematic and other review articles, meta- analyses, expert consensus documents and specialist society guidelines, such as those from the National Heart Foundation of Australia, American Diabetes Association, the Department of Health, The Royal College of Pathologists of Australasia, and The Australasian College of Emergency Medicine. Based on the literature reviewed, it is yet unknown as to how effective programs, such as diabetes inpatient services, endocrine out-patient services, and cardiac rehabilitation services, are at achieving guideline recommendations. It is also not clear how or whether clinicians are encumbered by complexities in their efforts of adhering to DM, HT, and glucose control recommendations, and the potential reasons for clinical inertia. Future studies are needed to ascertain the extent to which required BP and glucose control in patients is achieved, and whether clinical inertia is a barrier.
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Affiliation(s)
- Fergus William Gardiner
- School of Community Health, Charles Sturt University, Canberra, ACT, Australia
- Calvary Hospital, Canberra, ACT, Australia
- School of Biomedical Sciences, Charles Sturt University, Canberra, ACT, Australia
| | - Ezekiel Uba Nwose
- School of Community Health, Charles Sturt University, Canberra, ACT, Australia
| | | | - Judith Crockett
- School of Community Health, Charles Sturt University, Canberra, ACT, Australia
| | - Lexin Wang
- School of Biomedical Sciences, Charles Sturt University, Canberra, ACT, Australia
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Al-Agha AE, Kafi SE, Zain Aldeen AM, Khadwardi RH. Flash glucose monitoring system may benefit children and adolescents with type 1 diabetes during fasting at Ramadan. Saudi Med J 2017; 38:366-371. [PMID: 28397942 PMCID: PMC5447188 DOI: 10.15537/smj.2017.4.18750] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To assess the benefit of using the flash glucose monitoring system (FGMS) in children and adolescents with type 1 diabetes mellitus (T1DM) during Ramadan fasting. Methods: A prospective pilot study of 51 participants visited the pediatric diabetes clinic at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from between June until and July 2016. The FreeStyle® Libre™ FGMS (Abbott Diabetes Care, Alameda, CA, USA) was used. Hypoglycemia was defined as glucose values of less than 70 mg/dL, while hyperglycemia as glucose values of more than 150 mg/dL for all participants based on our institute’s protocol. Results: Participants were able to fast for 67.0% of the total days eligible for fasting, whereas they did not fast on 33% of the days due to either hypoglycemia (15.4%) or non-diabetes-related reasons (17.6 %). None of the participants developed severe hypoglycemia. The mean number of hyperglycemic episodes during fasting hours was 1.29, per day, which was higher than that of hypoglycemic episodes (0.7). None of the participants developed diabetic ketoacidosis (DKA). Glycemic control with mean of estimated hemoglobin A1C reading during Ramadan (8.16 ± 1.64% [pre study]) to 8.2 ± 1.63% [post study] p=0.932. Conclusions: Children and adolescents with T1DM who use the FGMS could fast without the risk of life-threatening episodes of severe hypoglycemia (namely seizure, coma), or DKA during Ramadan. Adequate education and good glycemic control prior to Ramadan are important strategies in combination with the use of an FGMS to achieve better outcome.
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Affiliation(s)
- Abdulmoein E Al-Agha
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Hanefeld M, Arteaga JM, Leiter LA, Marchesini G, Nikonova E, Shestakova M, Stager W, Gómez‐Huelgas R. Efficacy and safety of lixisenatide in patients with type 2 diabetes and renal impairment. Diabetes Obes Metab 2017; 19:1594-1601. [PMID: 28449324 PMCID: PMC5655920 DOI: 10.1111/dom.12986] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/13/2017] [Accepted: 04/22/2017] [Indexed: 12/27/2022]
Abstract
AIMS This post hoc assessment evaluated the efficacy and safety of once-daily, prandial glucagon-like peptide-1 receptor agonist lixisenatide in patients with type 2 diabetes (T2D) and normal renal function (estimated glomerular filtration rate ≥90 mL/min), or mild (60-89 mL/min) or moderate (30-59 mL/min) renal impairment. METHODS Patients from 9 lixisenatide trials in the GetGoal clinical trial programme were categorized by baseline creatinine clearance: normal renal function (lixisenatide n = 2094, placebo n = 1150); renal impairment (mild: lixisenatide n = 637, placebo n = 414; moderate: lixisenatide n = 122, placebo n = 68). Meta-analyses of placebo-adjusted mean differences between baseline renal categories were performed for efficacy and safety outcomes. RESULTS HbA1c, 2-hour postprandial plasma glucose and fasting plasma glucose were comparably reduced in lixisenatide-treated patients with normal renal function, and mild and moderate renal impairment. The most common adverse events (AEs) in all renal function categories were gastrointestinal (GI), predominantly nausea and vomiting. A 14% higher incidence of GI AEs and a 10% higher incidence of nausea and vomiting were seen with mild impairment vs normal function (P = .003 for both), but no significant differences were observed between the mild and moderate impairment categories (P = .99 and P = .57, respectively), or between the moderate impairment and normal categories (P = .16 and P = .65, respectively). Additionally, the incidence of hypoglycaemia was similar in all categories. CONCLUSIONS This study demonstrates that baseline renal status does not affect efficacy outcomes in lixisenatide- vs placebo-treated patients, and that no lixisenatide dose adjustment is required for patients with T2D with mild or moderate renal impairment.
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Affiliation(s)
- Markolf Hanefeld
- Centre for Clinical StudiesGWT‐Technical University DresdenDresdenGermany
| | - Juan M. Arteaga
- National University of Colombia School of MedicineBogotá D.C.Colombia
| | - Lawrence A. Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's HospitalUniversity of TorontoTorontoCanada
| | - Giulio Marchesini
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | | | - Marina Shestakova
- Endocrinology Research CenterMoscowRussian Federation
- I.M. Sechenov First Moscow State Medical UniversityMoscowRussian Federation
| | | | - Ricardo Gómez‐Huelgas
- Internal Medicine DepartmentUniversity Regional HospitalMalagaSpain
- Malaga Institute of Biomedicine (IBIMA)MalagaSpain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIMadridSpain
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Bae JP, Duan R, Fu H, Hoogwerf BJ. Risk Factors for Nocturnal Hypoglycemia in Insulin-treated Patients With Type 2 Diabetes: A Secondary Analysis of Observational Data Derived From an Integrated Clinical Trial Database. Clin Ther 2017; 39:1790-1798.e7. [PMID: 28781218 DOI: 10.1016/j.clinthera.2017.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE A trade-off exists in most diabetes therapies between the benefits of good glycemic control and the morbidity of hypoglycemia. Balancing these factors to achieve desired outcomes is a key consideration for personalized diabetes therapy. Hypoglycemia at night (nocturnal hypoglycemia [NH]) is a common but often under-reported problem in insulin-treated patients with type 2 diabetes. To better understand the risk for NH, we pooled data from multiple clinical trials of insulin treatment and specifically examined NH risk factors in relation to glycemic goals. METHODS Of 53 randomized trials involving insulin treatment, 18 trials that collected NH data were included. Risk factors associated with NH were identified by using gradient-boosting methods. A proportional hazards model was used to quantify the hazard ratio (HR) for risk factors. By modeling with individual patient data, a patient-level NH risk score distribution was created. Finally, results of the model were used to quantify an adjustment to the glycemic goal that would fully offset each risk factor, all other factors being equal. FINDINGS Data pooling resulted in the inclusion of 7341 patients with type 2 diabetes from 18 randomized clinical trials. In the mean 6-month treatment period, 43% of patients experienced at least 1 episode of NH (mean [SD], 1.1 [1.5] events/month). Reduction of glycosylated hemoglobin (HbA1c) levels during the trial was a risk factor for NH (HR, 1.40 [95% CI, 1.38-1.43] per -1% of HbA1c). Higher baseline HbA1c level was a protective factor against NH (HR, 0.76 [95% CI, 0.74-0.77] per +1% of HbA1c); and the adjustment to HbA1c goal required to offset 1% higher baseline HbA1c was -0.825%. Patient characteristics for risk of NH included older age (HR, 1.02 [95% CI, 1.01-1.02]) per 1-year increase), female sex (HR, 1.18 [95% CI, 1.15-1.22]), black or African-American race (HR, 1.41 [95% CI, 1.33-1.50] vs white race), longer diabetes duration (HR, 1.02 [95% CI, 1.01-1.02] per 1-year increase), diabetic nephropathy (HR, 1.40 [95% CI, 1.27-1.54]), and concomitant sulfonylurea use (HR, 1.10 [95% CI, 1.05-1.15]). Asian race was associated with a lower risk of NH (HR, 0.50 [95% CI, 0.48-0.53] vs white race); this finding could be offset with a 2.03% adjustment to the HbA1c goal. IMPLICATIONS Data on NH are scarce. By pooling multiple clinical trials, this study was able to evaluate patient-level data. A quantitative understanding of the trade-off between individual risk factors for NH and glycemic reduction may help clinicians to personalize patients' glycemic goals, while effectively managing NH risk. Limitations of the study include that patients were selected through inclusion/exclusion criteria and that patient compliance may be better in a trial setting. Validating the findings in the real world will be helpful.
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Affiliation(s)
- Jay P Bae
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana.
| | - Ran Duan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
| | - Haoda Fu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
| | - Byron J Hoogwerf
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
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Mansour AA, Nassan MA, Saleh OM, Soliman MM. PROTECTIVE EFFECT OF CAMEL MILK AS ANTI-DIABETIC SUPPLEMENT: BIOCHEMICAL, MOLECULAR AND IMMUNOHISTOCHEMICAL STUDY. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2017. [PMID: 28638873 PMCID: PMC5471457 DOI: 10.21010/ajtcam.v14i4.13] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Diabetes is a serious disease affects human health. Diabetes in advanced stages is accompanied by general weakness and alteration in fats and carbohydrates metabolism. Recently there are some scientific trends about the usage of camel milk (CM) in the treatment of diabetes and its associated alterations. CM contains vital active particles with insulin like action that cure diabetes and its complications but how these effects occur, still unclear. Materials and Methods: Seventy-five adult male rats of the albino type divided into five equal groups. Group 1 served as a negative control (C). Group 2 was supplemented with camel milk (CM). Diabetes was induced in the remaining groups (3, 4 and 5). Group 3 served as positive diabetic control (D). Group 4 served as diabetic and administered metformin (D+MET). Group 5 served as diabetes and supplemented with camel milk (D+CM). Camel milk was supplemented for two consecutive months. Serum glucose, leptin, insulin, liver, kidney, antioxidants, MDA and lipid profiles were assayed. Tissues from liver and adipose tissues were examined using RT-PCR analysis for the changes in mRNA expression of genes of carbohydrates and lipid metabolism. Pancreas and liver were used for immunohistochemical examination using specific antibodies. Results: Camel milk supplementation ameliorated serum biochemical measurements that altered after diabetes induction. CM supplementation up-regulated mRNA expression of IRS-2, PK, and FASN genes, while down-regulated the expression of CPT-1 to control mRNA expression level. CM did not affect the expression of PEPCK gene. On the other hand, metformin failed to reduce the expression of CPT-1 compared to camel milk administered rats. Immunohistochemical findings revealed that CM administration restored the immunostaining reactivity of insulin and GLUT-4 in the pancreas of diabetic rats. Conclusion: CM administration is of medical importance and helps physicians in the treatment of diabetes mellitus.
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Affiliation(s)
- Ahmed A Mansour
- Medical Biotechnology Department, Faculty of Applied Medical Sciences (Turbah), Taif Univ., KSA.,Genetics Department, Faculty of Agriculture, Ain Shams University, Cairo, Egypt
| | - Mohammed A Nassan
- Pathology Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Osama M Saleh
- Medical Biotechnology Department, Faculty of Applied Medical Sciences (Turbah), Taif Univ., KSA.,National Centre for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Nasr City, Cairo, Egypt
| | - Mohamed M Soliman
- Biochemistry Department, Faculty of Veterinary Medicine, Banha University, Banha, Egypt.,Medical Laboratories Department, Faculty of Applied Medical Sciences (Turbah), Taif University., KSA
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64
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Goh SNS, Yeoh E, Tan KY. Impact of perioperative hypoglycaemia in subjects with diabetes undergoing colorectal surgery. Int J Colorectal Dis 2017; 32:209-214. [PMID: 27864588 DOI: 10.1007/s00384-016-2680-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study explores the association between perioperative hypoglycaemia and surgical outcomes in subjects with diabetes, undergoing colorectal surgery. METHODS A retrospective review of 149 subjects with Type 2 Diabetes Mellitus (DM) who underwent colorectal surgery between 2010 and 2015 was performed. Perioperative glucose levels, glycated haemoglobin (HbA1c) measurements within 3 months of surgery and surgical complications based on Clavien-Dindo classification were analysed. RESULTS The mean age was 67 years (67 ± 11.2). Perioperative hypoglycaemia was found in 7.4% of subjects. The mean HbA1c of subjects with Clavien 2 and above surgical complications were higher than patients with Clavien 1 or no complications, Hba1c 7.6% (7.6 ± 2.5%) and 7.0% (7.0 ± 1.1%, p = 0.008), respectively. Similar findings in subjects with Clavien 3 and above complications, HbA1c of 8.2% (8.2 ± 3.9%) as compared to those with Clavien 2 and below complications, 7.2% (7.2 ± 1.5%, p = 0.001). Adjusted multivariate analysis showed that hypoglycaemia was significantly associated with Clavien 2 and above surgical complications, OR of 19.0 (CI 2.23-162, p = 0.007). Preoperative hypoglycaemia was associated with Clavien 2 and above surgical complications, OR 10.7 (CI 1.22-94.1, p = 0.032). Suboptimal glycaemic control (Hba1c >8.0%) was significantly associated with Clavien 2 and above complications, OR 2.48 (CI 1.04-5.91, p = 0.04), but not with Clavien 3 and above complications, OR 1.50 (CI 0.450-4.98, p = 0.511). CONCLUSION Perioperative hypoglycaemia is associated with adverse surgical outcomes in diabetic patients undergoing colorectal surgery. Prevention of hypoglycaemia may improve surgical outcomes. HbA1c is an independent predictor for adverse surgical outcomes.
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Affiliation(s)
- Si Ning Serene Goh
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
| | - Ester Yeoh
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
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Leyco T, Ryanputra D, Peh R, Ponce A, Khoo CM. Glycaemic Control after Metformin Discontinuation in Diabetic Patients with a Declining Renal Function. J Diabetes Res 2017; 2017:2769819. [PMID: 29230420 PMCID: PMC5694578 DOI: 10.1155/2017/2769819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 12/29/2022] Open
Abstract
Metformin is contraindicated in diabetic patients with declining renal function. This study examined the glycaemic control in diabetic patients with chronic kidney disease when metformin was discontinued. This was a retrospective study. We screened 2032 diabetic patients who attended the Diabetes Clinic at a tertiary hospital between 1 September 2014 and 30 September 2015. We analyzed the data on 69 patients whom metformin was discontinued due to declining renal function and had a complete 6-month follow-up. There was no significant difference in the HbA1c and body weight at 6-month follow-up compared to baseline after metformin discontinuation. The eGFR was significantly lower at 6-month follow-up compared to baseline. Upon metformin discontinuation, the majority of patients had their diabetes medication uptitrated (in particular insulin or sulphonylurea). Patients with an improved glycaemia at 6-month follow-up had further declined in eGFR compared to patients with worsened glycaemia. 17% of the study patients experienced hypoglycaemia. Upon metformin discontinuation, glycaemic control could be optimised with uptitration but should be balanced against the risk of hypoglycaemia. Further improvement in the glycaemic control might indicate further deterioration in the renal function.
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Affiliation(s)
- Theresa Leyco
- Department of Medicine, National University Hospital, Singapore
| | - Davin Ryanputra
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ray Peh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alexphil Ponce
- Higher Education Department, Centre for International Education, Cebu, Philippines
| | - Chin Meng Khoo
- Department of Medicine, National University Hospital, Singapore
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Marín-Peñalver JJ, Martín-Timón I, Sevillano-Collantes C, del Cañizo-Gómez FJ. Update on the treatment of type 2 diabetes mellitus. World J Diabetes 2016; 7:354-95. [PMID: 27660695 PMCID: PMC5027002 DOI: 10.4239/wjd.v7.i17.354] [Citation(s) in RCA: 329] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/02/2016] [Accepted: 07/20/2016] [Indexed: 02/05/2023] Open
Abstract
To achieve good metabolic control in diabetes and keep long term, a combination of changes in lifestyle and pharmacological treatment is necessary. Achieving near-normal glycated hemoglobin significantly, decreases risk of macrovascular and microvascular complications. At present there are different treatments, both oral and injectable, available for the treatment of type 2 diabetes mellitus (T2DM). Treatment algorithms designed to reduce the development or progression of the complications of diabetes emphasizes the need for good glycaemic control. The aim of this review is to perform an update on the benefits and limitations of different drugs, both current and future, for the treatment of T2DM. Initial intervention should focus on lifestyle changes. Moreover, changes in lifestyle have proven to be beneficial, but for many patients is a complication keep long term. Physicians should be familiar with the different types of existing drugs for the treatment of diabetes and select the most effective, safe and better tolerated by patients. Metformin remains the first choice of treatment for most patients. Other alternative or second-line treatment options should be individualized depending on the characteristics of each patient. This article reviews the treatments available for patients with T2DM, with an emphasis on agents introduced within the last decade.
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Wu B, Bell K, Stanford A, Kern DM, Tunceli O, Vupputuri S, Kalsekar I, Willey V. Understanding CKD among patients with T2DM: prevalence, temporal trends, and treatment patterns-NHANES 2007-2012. BMJ Open Diabetes Res Care 2016; 4:e000154. [PMID: 27110365 PMCID: PMC4838667 DOI: 10.1136/bmjdrc-2015-000154] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/12/2016] [Accepted: 02/24/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe the estimated prevalence and temporal trends of chronic kidney disease (CKD) treatment patterns, and the association between CKD and potential factors for type 2 diabetes mellitus (T2DM) in different demographic subgroups. RESEARCH DESIGN AND METHODS This was a cross-sectional analysis of adults with T2DM based on multiple US National Health and Nutrition Examination Survey (NHANES) datasets developed during 2007-2012. CKD severity was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines using the CKD Epidemiology Collaboration (CKD-EPI) equation: mild to moderate=stages 1-3a; moderate to kidney failure=stages 3b-5. Multivariable logistic regression analyses were performed to assess the associations between CKD and potential factors. RESULTS Of the adult individuals with T2DM (n=2006), age-adjusted CKD prevalence was 38.3% during 2007-2012; 77.5% were mild-to-moderate CKD. The overall age-adjusted prevalence of CKD was 40.2% in 2007-2008, 36.9% in 2009-2010, and 37.6% in 2011-2012. The prevalence of CKD in T2DM was 58.7% in patients aged ≥65 years, 25.7% in patients aged <65 years, 43.5% in African-Americans and Mexican-Americans, and 38.7% in non-Hispanic whites. The use of antidiabetes and antihypertensive medications generally followed treatment guideline recommendations. Older age, higher hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and having hypertension were significantly associated with CKD presence but not increasing severity of CKD. CONCLUSIONS CKD continued to be prevalent in the T2DM population; prevalence remained fairly consistent over time, suggesting that current efforts to prevent CKD could be improved overall, especially by monitoring certain populations more closely.
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Affiliation(s)
- Bingcao Wu
- HealthCore Inc., Wilmington, Delaware, USA
| | - Kelly Bell
- AstraZeneca R&D, Fort Washington, Pennsylvania, USA
| | - Amy Stanford
- Bristol-Myers Squibb Company, Plainsboro, New Jersey, USA
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Sourij H, Edlinger R, Prischl F, Auinger M, Kautzky-Willer A, Säemann MD, Prager R, Clodi M, Schernthaner G, Mayer G, Oberbauer R, Rosenkranz AR. Diabetische Nierenerkrankung – Update 2016. Wien Klin Wochenschr 2016; 128 Suppl 2:S85-96. [DOI: 10.1007/s00508-016-0992-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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