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Howse PM, Chibrikova LN, Twells LK, Barrett BJ, Gamble JM. Safety and Efficacy of Incretin-Based Therapies in Patients With Type 2 Diabetes Mellitus and CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis 2016; 68:733-742. [DOI: 10.1053/j.ajkd.2016.06.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/07/2016] [Indexed: 12/16/2022]
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Guo M, Niu JY, Li SR, Ye XW, Fang H, Zhao YP, Gu Y. Gender differences in the association between hyperuricemia and diabetic kidney disease in community elderly patients. J Diabetes Complications 2015; 29:1042-9. [PMID: 26387809 DOI: 10.1016/j.jdiacomp.2015.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 01/23/2023]
Abstract
AIMS To investigate gender differences of the associations between hyperuricemia and diabetic kidney disease (DKD) in elderly patients with type 2 diabetes mellitus (T2DM) based on electronic health records (EHR). METHODS A total of 20,207 older diabetic patients (mean age 71±7years) were investigated based on the EHR from 2012 to 2013 in the Minhang District of Shanghai-China. The status of hyperuricemia, albuminuric DKD and the odds ratios of DKD relative to hyperuricemia were analyzed among 8541 men and 11,666 women. RESULTS The overall rate of hyperuricemia was 20.5% (males: 17.2%, females: 23.0%) and that of albuminuric DKD was 36.2% (males: 32.2%, female: 39.1%) in these diabetic patients. Hyperuricemia was independently associated with increased risk of reduced renal function and albuminuria (p<0.001) in both genders. After adjustment of traditional DKD risk factors, hyperuricemia had a stronger association with albuminuric DKD in males (OR 1.67, 95% CI: 1.48-1.88) than in females (OR 1.23, 95% CI: 1.12-1.35). CONCLUSIONS This study showed an independent association of hyperuricemia with albuminuric DKD that was stronger in elderly males for the first time in China based on EHR. The level of uric acid should be monitored and managed in older diabetic patients.
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Affiliation(s)
- Mei Guo
- Fifth People's Hospital, Fudan University, No. 128 Ruili Road,Minhang District, Shanghai 200240, China
| | - Jian-Ying Niu
- Fifth People's Hospital, Fudan University, No. 128 Ruili Road,Minhang District, Shanghai 200240, China
| | - She-Ran Li
- Fifth People's Hospital, Fudan University, No. 128 Ruili Road,Minhang District, Shanghai 200240, China
| | - Xian-Wu Ye
- Fifth People's Hospital, Fudan University, No. 128 Ruili Road,Minhang District, Shanghai 200240, China
| | - Hong Fang
- Center for Disease Prevention and Control of Minhang District, No. 965 Zhongyi Road, Shanghai 201101, China
| | - Yan-Ping Zhao
- Fifth People's Hospital, Fudan University, No. 128 Ruili Road,Minhang District, Shanghai 200240, China
| | - Yong Gu
- Fifth People's Hospital, Fudan University, No. 128 Ruili Road,Minhang District, Shanghai 200240, China; Department of Nephrology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road, Shanghai 200040, China.
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Abstract
IN BRIEF Diabetic kidney disease carries a heavy burden, both economically and in terms of quality of life, largely because of its very high risk for vascular disease. Coordinated, multidisciplinary care with attention to appropriate, timely screening and preventive management is crucial to reducing the morbidity and mortality of this devastating disease.
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Affiliation(s)
- Koyal Jain
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Amy K Mottl
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, NC
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Van Casteren VFA, Bossuyt NHE, Moreels SJS, Goderis G, Vanthomme K, Wens J, De Clercq EW. Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients? Arch Public Health 2015; 73:31. [PMID: 26171143 PMCID: PMC4499949 DOI: 10.1186/s13690-015-0080-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model. The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care. METHODS This observational study took place in the period 2006-2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011. Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively. Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders. RESULTS By the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion. CONCLUSIONS According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive.
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Affiliation(s)
- Viviane F. A. Van Casteren
- />Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium
| | - Nathalie H. E. Bossuyt
- />Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium
| | - Sarah J. S. Moreels
- />Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium
| | - Geert Goderis
- />Katholieke Universiteit Leuven - Academisch Centrum voor Huisartsgeneeskunde, Kapucijnevoer 33 Blok J Bus 7001, 3000 Leuven, Belgium
- />UZ Leuven - MIR (Management Informatie Rapportering, Herestraat 49, 3000 Leuven, Belgium
| | - Katrien Vanthomme
- />Vrije Universiteit Brussel, Demografie, Pleinlaan 2, 1050 Brussel, Belgium
| | - Johan Wens
- />Universiteit Antwerpen, Academisch Centrum voor Huisartsgeneeskunde, Campus 3 Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Etienne W De Clercq
- />Université Catholique de Louvain, Institut de Recherche Santé et Société, Clos Chapelle aux Champs 30, 1200 Brussels, Belgium
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Bailey RA, Wang Y, Zhu V, Rupnow MFT. Chronic kidney disease in US adults with type 2 diabetes: an updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging. BMC Res Notes 2014; 7:415. [PMID: 24990184 PMCID: PMC4091951 DOI: 10.1186/1756-0500-7-415] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/27/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Kidney Disease Improving Global Outcomes (KDIGO) 2013 updated the classification and risk stratification of chronic kidney disease (CKD) to include both the level of renal function and urinary albumin excretion (UAE). The update subclassifies the previous category of moderate renal impairment. There is currently limited information on the prevalence of CKD based on this new classification in United States (US) adults with type 2 diabetes mellitus (T2DM). The objective of this study was to provide such estimates, for T2DM both overall and in those ≥ 65 years of age. We used the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2012 to identify participants with T2DM. Estimated glomerular filtration rate (eGFR) and UAE were calculated using laboratory results and data collected from the surveys, and categorized based on the KDIGO classification. Projections for the US T2DM population were based on NHANES sampling weights. RESULTS A total of 2915 adults diagnosed with T2DM were identified from NHANES, with 1466 being age ≥ 65 years. Prevalence of CKD based on either eGFR or UAE was 43.5% in the T2DM population overall, and 61.0% in those age ≥ 65 years. The prevalence of mildly decreased renal function or worse (eGFR < 60/ml/min/1.73 m2) was 22.0% overall and 43.1% in those age ≥ 65 years. Prevalence of more severe renal impairment (eGFR < 45 ml/min/1.73 m2) was 9.0% overall and 18.6% in those age ≥ 65 years. The prevalence of elevated UAE (> 30 mg/g) was 32.2% overall and 39.1% in those age ≥ 65 years. The most common comorbidities were hypertension, retinopathy, coronary heart disease, myocardial infarction, and congestive heart failure. CONCLUSIONS This study confirms the high prevalence of CKD in T2DM, impacting 43.5% of this population. Additionally, this study is among the first to report US prevalence estimates of CKD based on the new KDIGO CKD staging system.
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Affiliation(s)
- Robert A Bailey
- Janssen Scientific Affairs, LLC, 1000 Route 202 South, Raritan, NJ 08869, USA.
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Ishtiaque I, Shafique K, Ul-Haq Z, Shaikh AR, Khan NA, Memon AR, Mirza SS, Ishtiaque A. Water-pipe smoking and albuminuria: new dog with old tricks. PLoS One 2014; 9:e85652. [PMID: 24465635 PMCID: PMC3894981 DOI: 10.1371/journal.pone.0085652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/28/2013] [Indexed: 11/18/2022] Open
Abstract
Water-pipe (WP) smoking is on rise worldwide for the past few years, particularly among younger individuals. Growing evidence indicates that WP smoking is as harmful as cigarette smoking. To date, most of the research has focused on acute health effects of WP smoking, and evidence remains limited when it comes to chronic health effects in relation to long-term WP smoking. Therefore, the aim of this study was to examine the association between WP smoking and albuminuria in apparently healthy individuals. This analysis was conducted on data of a population-based cross-sectional study—the Urban Rural Chronic Diseases Study (URCDS). The study sample was recruited from three sites in Pakistan. Trained nurses carried out individual interviews and obtained the information on demographics, lifestyle factors, and past and current medical history. Measurements of complete blood count, lipid profile, fasting glucose level, and 24-hour albuminuria were also made by using blood and urine samples. Albumin excretion was classified into three categories using standard cut-offs: normal excretion, high-normal excretion and microalbuminuria. Multiple logistic regression models were used to examine the relationship between WP smoking and albuminuria. The final analysis included data from 1,626 health individuals, of which 829 (51.0%) were males and 797 (49.0%) females. Of 1,626 individuals, 267 (16.4%) were current WP smokers and 1,359 (83.6%) were non-WP smokers. WP smoking was significantly associated with high-normal albuminuria (OR = 2.33, 95% CI 1.68-3.22, p-value <0.001) and microalbuminuria (OR = 1.75, 95% CI 1.18-2.58, p-value 0.005) after adjustment for age, sex, BMI, social class, hypertension, and diabetes mellitus. WP smoking was significantly associated with high-normal albuminuria and microalbuminuria when analysis was stratified on hypertension and diabetes mellitus categories. WP smoking has a strong association with albuminuria in apparently healthy individuals. More research is warranted to evaluate the temporality of this association between WP smoking and albuminuria.
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Affiliation(s)
- Iqra Ishtiaque
- University Medical and Dental College, Faisalabad, Pakistan
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
- Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Zia Ul-Haq
- Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, United Kingdom
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, KPK, Pakistan
| | - Abdul Rauf Shaikh
- Department of Community Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Naveed Ali Khan
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Abdul Rauf Memon
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Saira Saeed Mirza
- Department of Epidemiology, University of Rotterdam, Rotterdam, The Netherlands
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Watt KD. Extrahepatic implications of metabolic syndrome. Liver Transpl 2013; 19 Suppl 2:S56-61. [PMID: 23960041 DOI: 10.1002/lt.23726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/08/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Kymberly D Watt
- Division of Gastroenterology and Hepatology, William J. von Liebig Transplant Center, Mayo Clinic and Foundation, Rochester, MN
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