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Li H, Wang Q, Ke J, Lin W, Luo Y, Yao J, Zhang W, Zhang L, Duan S, Dong Z, Chen X. Optimal Obesity- and Lipid-Related Indices for Predicting Metabolic Syndrome in Chronic Kidney Disease Patients with and without Type 2 Diabetes Mellitus in China. Nutrients 2022; 14:nu14071334. [PMID: 35405947 PMCID: PMC9002364 DOI: 10.3390/nu14071334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 12/10/2022] Open
Abstract
Existing obesity- and lipid-related indices are inconsistent with metabolic syndrome (MetS) in chronic kidney disease (CKD) patients. We compared seven indicators, including waist circumference (WC), body mass index (BMI), visceral fat area (VFA), subcutaneous fat area (SFA), visceral adiposity index (VAI), Chinese VAI and lipid accumulation product (LAP), to evaluate their ability to predict MetS in CKD patients with and without Type 2 diabetes mellitus (T2DM) under various criteria. Multivariate logistic regression analysis was used to investigate the independent associations between the indices and metabolic syndrome among 547 non-dialysis CKD patients, aged ≥18 years. The predictive power of these indices was assessed using receiver operating characteristic (ROC) curve analysis. After adjusting for potential confounders, the correlation between VAI and MetS was strongest based on the optimal cut-off value of 1.51 (sensitivity 86.84%, specificity 91.18%) and 2.35 (sensitivity 83.54%, specificity 86.08%), with OR values of 40.585 (8.683–189.695) and 5.076 (1.247–20.657) for males and females with CKD and T2DM. In CKD patients without T2DM, based on the optimal cut-off values of 1.806 (sensitivity 98.11%, specificity 72.73%) and 3.11 (sensitivity 84.62%, specificity 83.82%), the OR values were 7.514 (3.757–15.027) and 3.008 (1.789–5.056) for males and females, respectively. The area under ROC curve (AUC) and Youden index of VAI were the highest among the seven indexes, indicating its superiority in predicting MetS in both male and female CKD patients, especially those with T2DM.
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Affiliation(s)
- Hangtian Li
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Qian Wang
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
| | - Jianghua Ke
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Wenwen Lin
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Yayong Luo
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Jin Yao
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Weiguang Zhang
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
| | - Li Zhang
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
| | - Shuwei Duan
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
| | - Zheyi Dong
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
- Correspondence: (Z.D.); (X.C.)
| | - Xiangmei Chen
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing 100853, China; (H.L.); (Q.W.); (J.K.); (W.L.); (Y.L.); (J.Y.); (W.Z.); (L.Z.); (S.D.)
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Correspondence: (Z.D.); (X.C.)
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Gomez-Peralta F, Abreu C, Gomez-Rodriguez S, Barranco RJ, Umpierrez GE. Safety and Efficacy of DPP4 Inhibitor and Basal Insulin in Type 2 Diabetes: An Updated Review and Challenging Clinical Scenarios. Diabetes Ther 2018; 9:1775-1789. [PMID: 30117055 PMCID: PMC6167285 DOI: 10.1007/s13300-018-0488-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 12/18/2022] Open
Abstract
The safety and efficacy of dipeptidyl peptidase-4 (DPP4) inhibitors as monotherapy or in combination with other oral antidiabetic agents or basal insulin are well established. DPP4 inhibitors stimulate glucose-dependent insulin secretion and inhibit glucagon production. As monotherapy, they reduce the hemoglobin A1c level by about 0.6-0.8%. The addition of a DPP4 inhibitor to basal insulin is an attractive option, because they lower both postprandial and fasting plasma glucose concentrations without increasing the risk of hypoglycemia or weight gain. The present review summarizes the extensive evidence on the combination therapy of DPP4 inhibitors and insulin-based regimens in patients with type 2 diabetes. We focus our discussion on challenging clinical scenarios including patients with chronic renal impairment, elderly persons and hospitalized patients. The evidence indicates that these drugs are highly effective and safe in the elderly and in the presence of mild, moderate and severe renal failure improving glycemic control with low risk of hypoglycemia. In addition, several randomized-controlled trials have shown that the use of DPP4 inhibitors in combination with basal insulin represents an alternative to the basal-bolus insulin regimen in hospitalized patients with type 2 diabetes.
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Affiliation(s)
| | - Cristina Abreu
- Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
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Alemán-Vega G, Gómez Cabañas I, Reques Sastre L, Rosado Martín J, Polentinos-Castro E, Rodríguez Barrientos R. Prevalence and risk of progression of chronic kidney disease in diabetics and hypertensive patients followed in primary care in Madrid. Nefrologia 2018. [PMID: 28648211 DOI: 10.1016/j.nefro.2016.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Laura Reques Sastre
- Medicina Preventiva y Salud Pública, Escuela Nacional de Sanidad, Madrid, España
| | | | - Elena Polentinos-Castro
- Unidad Docente de Atención Familiar y Comunitaria Norte, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | - Ricardo Rodríguez Barrientos
- Unidad Docente de Atención Familiar y Comunitaria Norte, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
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Arrieta F, Iglesias P, Pedro-Botet J, Becerra A, Ortega E, Obaya JC, Nubiola A, Maldonado GF, Campos MDM, Petrecca R, Pardo JL, Sánchez-Margalet V, Alemán JJ, Navarro J, Duran S, Tébar FJ, Aguilar M, Escobar F. Diabetes mellitus y riesgo cardiovascular. Actualización de las recomendaciones del Grupo de Trabajo de Diabetes y Riesgo Cardiovascular de la Sociedad Española de Diabetes (SED, 2018). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 30:137-153. [DOI: 10.1016/j.arteri.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/28/2018] [Accepted: 03/09/2018] [Indexed: 12/24/2022]
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Gómez-Huelgas R, Gómez Peralta F, Rodríguez Mañas L, Formiga F, Puig Domingo M, Mediavilla Bravo JJ, Miranda C, Ena J. [Treatment of type 2 diabetes mellitus in elderly patients]. Rev Esp Geriatr Gerontol 2018; 53:89-99. [PMID: 29439834 DOI: 10.1016/j.regg.2017.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 06/08/2023]
Abstract
The prevalence of type 2 diabetes mellitus (DM2) increases markedly with age. Antidiabetic treatment and the objectives of glycaemic control in elderly patients with DM2 should be individualised according to their biopsychosocial characteristics. In elderly patients for whom the benefits of intensive antidiabetic treatment are limited, the basic objectives should be to improve the quality of life, preserve functionality and avoid adverse effects, especially hypoglycaemia. Treatment of DM2 in the elderly was the subject of a consensus document published in 2012 and endorsed by several Spanish scientific societies. Since then, new therapeutic groups and evidence have emerged that warrant an update to this consensus document. The present document focuses on the therapeutic aspects of DM2 in elderly patients, understood as being older than 75 years or frail.
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Affiliation(s)
- R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA); CIBER de Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III; Sociedad Española de Medicina Interna (SEMI).
| | - F Gómez Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España; Sociedad Española de Diabetes (SED)
| | - L Rodríguez Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, España; CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III; Sociedad Española de Medicina Geriátrica (SEMEG)
| | - F Formiga
- Unidad de Geriatría, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Sociedad Española de Geriatría y Gerontología (SEGG)
| | - M Puig Domingo
- Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III; Sociedad Española de Endocrinología y Nutrición (SEEN)
| | - J J Mediavilla Bravo
- Centro de Salud Burgos Rural, Burgos, España; Sociedad Española de Medicina General (SEMERGEN)
| | - C Miranda
- Centro de Salud Buenavista, Toledo, España; Sociedad Española de Médicos Generales y de Familia (SEMG)
| | - J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, La Vila Joiosa, Alicante, España; Sociedad Española de Medicina Interna (SEMI)
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Gómez-Huelgas R, Gómez Peralta F, Rodríguez Mañas L, Formiga F, Puig Domingo M, Mediavilla Bravo JJ, Miranda C, Ena J. Treatment of type 2 diabetes mellitus in elderly patients. Rev Clin Esp 2018; 218:74-88. [PMID: 29366502 DOI: 10.1016/j.rce.2017.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/03/2017] [Indexed: 02/06/2023]
Abstract
The prevalence of type 2 diabetes mellitus (DM2) increases markedly with age. Antidiabetic treatment and the objectives of glycaemic control in elderly patients with DM2 should be individualised according to their biopsychosocial characteristics. In elderly patients for whom the benefits of intensive antidiabetic treatment are limited, the basic objectives should be to improve the quality of life, preserve functionality and avoid adverse effects, especially hypoglycaemia. Treatment of DM2 in the elderly was the subject of a consensus document published in 2012 and endorsed by several Spanish scientific societies. Since then, new therapeutic groups and evidence have emerged that warrant an update to this consensus document. The present document focuses on the therapeutic aspects of DM2 in elderly patients, understood as being older than 75 years or frail.
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Affiliation(s)
- R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA); CIBER de Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III; Sociedad Española de Medicina Interna (SEMI).
| | - F Gómez Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España; Sociedad Española de Diabetes (SED)
| | - L Rodríguez Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, España; CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III; Sociedad Española de Medicina Geriátrica (SEMEG)
| | - F Formiga
- Unidad de Geriatría, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España; Sociedad Española de Geriatría y Gerontología (SEGG)
| | - M Puig Domingo
- Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III; Sociedad Española de Endocrinología y Nutrición (SEEN)
| | - J J Mediavilla Bravo
- Centro de Salud Burgos Rural, Burgos, España; Sociedad Española de Medicina General (SEMERGEN)
| | - C Miranda
- Centro de Salud Buenavista, Toledo, España; Sociedad Española de Médicos Generales y de Familia (SEMG)
| | - J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, La Vila Joiosa, Alicante, España; Sociedad Española de Medicina Interna (SEMI)
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León Jiménez D, Castilla Guerra L, López Chozas JM, Miramontes González JP. Update concept of the dual blocking of the renin-angiotensin-aldosteron system. A new therapeutic option? Med Clin (Barc) 2017; 150:33-38. [PMID: 28668172 DOI: 10.1016/j.medcli.2017.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Affiliation(s)
- David León Jiménez
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Luis Castilla Guerra
- Unidad de Riesgo Vascular, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Manuel López Chozas
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España
| | - José Pablo Miramontes González
- Servicio de Medicina Interna, Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, España
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán M. Cardiopatía isquémica crónica en el anciano. Semergen 2017; 43:109-122. [DOI: 10.1016/j.semerg.2016.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 01/09/2023]
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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: 334] [Impact Index Per Article: 41.8] [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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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. [Chronic ischaemic heart disease in the elderly]. Rev Esp Geriatr Gerontol 2016; 51:170-179. [PMID: 27102136 DOI: 10.1016/j.regg.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
It is the aim of this manuscript to take into account the peculiarities and specific characteristics of elderly patients with chronic ischaemic heart disease from a multidisciplinary perspective, with the participation of the Spanish Society of Cardiology (sections of Geriatric Cardiology and Ischaemic Heart Disease/Acute Cardiovascular Care), the Spanish Society of Internal Medicine, the Spanish Society of Primary Care Physicians and the Spanish Society of Geriatrics and Gerontology. This consensus document shows that in order to adequately address these elderly patients a comprehensive assessment is needed, which includes comorbidity, frailty, functional status, polypharmacy and drug interactions. We conclude that in most patients medical treatment is the best option and that this treatment must take into account the above factors and the biological changes associated with aging.
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Affiliation(s)
- Manuel Martínez-Sellés
- Sociedad Española de Cardiología (SEC), Sección de Cardiología Geriátrica, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea y Universidad Complutense, Madrid, España.
| | - Ricardo Gómez Huelgas
- Sociedad Española de Medicina Interna (SEMI), Departamento de Medicina Interna, Hospital Universitario Regional de Málaga, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Málaga, España
| | - Emad Abu-Assi
- Sociedad Española de Cardiología (SEC), Sección de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares, Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Alberto Calderón
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, España
| | - María Teresa Vidán
- Sociedad Española de Geriatría y Gerontología (SEGG), Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
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Arrieta F, Iglesias P, Pedro-Botet J, Tébar FJ, Ortega E, Nubiola A, Pardo JL, Maldonado GF, Obaya JC, Matute P, Petrecca R, Alonso N, Sarabia E, Sánchez-Margalet V, Alemán JJ, Navarro J, Becerra A, Duran S, Aguilar M, Escobar-Jiménez F. [Diabetes mellitus and cardiovascular risk: Working group recommendations of Diabetes and Cardiovascular Disease of the Spanish Society of Diabetes (SED, 2015)]. Aten Primaria 2016; 48:325-36. [PMID: 26031458 PMCID: PMC6877822 DOI: 10.1016/j.aprim.2015.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/11/2015] [Indexed: 02/07/2023] Open
Abstract
The present paper updates the Clinical Practice Recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. This is a medical consensus agreed by an independent panel of experts from the Spanish Society of Diabetes (SED). Several consensuses have been proposed by scientific and medical Societies to achieve clinical goals. However, the risk score for general population may lack sensitivity for individual assessment or for particular groups at risk, such as diabetics. Traditional risk factors together with non-traditional factors are reviewed throughout this paper. Intervention strategies for managing CVRF in the diabetic patient are reviewed in detail: balanced food intake, weight reduction, physical exercise, smoking cessation, reduction in HbA1c, therapy for high blood pressure, obesity, lipid disorders, and platelet anti-aggregation. It is hoped that these guidelines can help clinicians in the decisions of their clinical activity. This regular update by the SED Cardiovascular Disease Group of the most relevant concepts, and of greater practical and realistic clinical interest, is presented in order to reduce CVR of diabetics.
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Affiliation(s)
- Francisco Arrieta
- Unidad Enfermedades Metabólicas del Adulto (CSUR), Servicio de Endocrinología y Nutrición Hospital Universitario Ramón y Cajal, IRYCIS, CIBEROBN, Madrid, España.
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Parc de Salut Mar, Barcelona, España
| | - Francisco Javier Tébar
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Emilio Ortega
- Servicio de Endocrinología y Nutrición, Hospital Clínic, IDIBAPS, CIBEROBN, Barcelona, España
| | - Andreu Nubiola
- Servicio Endocrinologia, Hospital ĹEsperit Sant, Sta. Coloma Gramenet, Barcelona, España
| | - Jose Luis Pardo
- Centro de Salud Orihuela I, Orihuela (Alicante), Alicante, España
| | | | | | - Pablo Matute
- Instituto Médico del Puerto de Santamaría, Cádiz, España
| | - Romina Petrecca
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Madrid, España
| | - Nuria Alonso
- Servicio de Endocrinología y Nutrición, Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - Elena Sarabia
- Profesora del Grado en Ciencias de la Actividad Física y del Deporte en Cardenal Spínola CEU, Sevilla
| | | | | | - Jorge Navarro
- Dirección Atención Primaria, IIS INCLIVA, CIBERESP, Valencia, España
| | - Antonio Becerra
- Servicio de Endocrinología y Nutrición Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | - Santiago Duran
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Ntra. Sra. de Valme. Sevilla, España
| | - Manuel Aguilar
- Servicio de Endocrinología y Nutrición, Hospital Puerta del Mar, Cádiz, España
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. Cardiopatía isquémica crónica en el anciano. Med Clin (Barc) 2016; 146:372.e1-372.e10. [DOI: 10.1016/j.medcli.2016.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 12/12/2022]
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Salinero-Fort MÁ, San Andrés-Rebollo FJ, de Burgos-Lunar C, Abánades-Herranz JC, Carrillo-de-Santa-Pau E, Chico-Moraleja RM, Jiménez-García R, López-de-Andrés A, Gómez-Campelo P. Cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus in the MADIABETES Cohort Study: Association with chronic kidney disease. J Diabetes Complications 2016; 30:227-36. [PMID: 26627635 DOI: 10.1016/j.jdiacomp.2015.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/30/2015] [Accepted: 10/14/2015] [Indexed: 11/18/2022]
Abstract
AIMS To assess the prevalence of stage 3-5 chronic kidney disease (CKD) at baseline and to identify associated risk factors. To determine the effect of CKD and CKD stage according to estimated glomerular filtration rate (eGFR) and albuminuria categories on all-cause and cardiovascular mortality after a 5-year follow-up. METHODS Prospective cohort study of 3443 outpatients with type 2 diabetes mellitus. RESULTS The prevalence of CKD was 28.32% (95% CI, 26.84-29.86); and variables most strongly associated were: age >74 years (OR, 19.88; 95% CI, 12.89-30.68) and albuminuria (OR, 2.27; 95% CI, 1.72-3.00). During follow-up, 221 CKD patients (22.90%) died compared with 203 non-CKD patients (8.31%) (p<0.01). The adjusted HR of CKD for cardiovascular and all-cause mortality was 1.82 (95% CI, 1.36-2.44) and 2.11 (95% CI, 1.61-2.76) for those with LDL cholesterol =135 mg/dl, respectively. The adjusted HR of very-high-risk CKD for all-cause mortality was 4.44 (95% CI, 2.31-8.53) in aged <75 years and 1.80 (95% CI, 1.19-2.72) in aged ≥75 years. CONCLUSIONS CKD at baseline is an independent risk factor for all-cause and cardiovascular mortality in the overall cohort, men and women, or in primary and secondary prevention of coronary heart disease. Albuminuria is an independent risk factor for all-cause and cardiovascular mortality only in primary prevention.
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Affiliation(s)
- Miguel Ángel Salinero-Fort
- Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Aging and fragility in the elderly Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | | | - Carmen de Burgos-Lunar
- Aging and fragility in the elderly Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Servicio de Medicina Preventiva, Hospital Universitario La Paz, Servicio Madrileño de Salud, Madrid, Spain
| | - Juan Carlos Abánades-Herranz
- Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Aging and fragility in the elderly Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | | | | | | | - Ana López-de-Andrés
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paloma Gómez-Campelo
- Aging and fragility in the elderly Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain; Plataforma de Apoyo al Investigador Novel-PAIN Platform, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
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Arrieta F, Iglesias P, Pedro-Botet J, Tébar FJ, Ortega E, Nubiola A, Pardo JL, Maldonado GF, Obaya JC, Matute P, Petrecca R, Alonso N, Sarabia E, Sánchez-Margalet V, Alemán JJ, Navarro J, Becerra A, Duran S, Aguilar M, Escobar-Jiménez F. Diabetes mellitus y riesgo cardiovascular: recomendaciones del Grupo de Trabajo Diabetes y Enfermedad Cardiovascular de la Sociedad Española de Diabetes (SED, 2015). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2015; 27:181-92. [DOI: 10.1016/j.arteri.2014.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 12/29/2022]
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Xue L, Lou Y, Feng X, Wang C, Ran Z, Zhang X. Prevalence of chronic kidney disease and associated factors among the Chinese population in Taian, China. BMC Nephrol 2014; 15:205. [PMID: 25528680 PMCID: PMC4382930 DOI: 10.1186/1471-2369-15-205] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background This study was designed to assess the prevalence of chronic kidney disease (CKD) and associated risk factors among the Chinese population in Taian, China. Methods A primary care-based cross-sectional study was conducted in Taian, China, from September to December 2012. Participants selected by a multi-stage stratified cluster sampling procedure were interviewed and tested for hematuria, albuminuria, estimated glomerular filtration rate (eGFR) and other clinical indices. Factors associated with CKD were analyzed by univariate and multivariate logistic regression analysis. Results A total of 14,399 subjects were enrolled in this study. The rates of hematuria, albuminuria and reduced eGFR were 4.20%, 5.25% and 1.89%, respectively. Approximately 9.49% (95% CI: 8.93%–10.85%) of the participants had at least one indicator of CKD, with an awareness of 1.4%. Univariate analyses showed that greater age, body mass index, and systolic and diastolic blood pressure; higher levels of serum creatinine, uric acid, fasting blood glucose, triglycerides, total cholesterol and low-density lipoprotein cholesterol; and lower eGFR were associated with CKD (p < 0.05 each). Multivariate analysis showed that age, female gender, educational level, smoking habits, systolic blood pressure, and history of diabetes mellitus, hyperlipidemia, hypercholesterolemia and hyperuricemia were independent risk factors for CKD. Conclusions The prevalence of CKD in the primary care population of Taian, China, is high, although awareness is quite low. Health education and policies to prevent CKD are urgently needed among this population.
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Affiliation(s)
- Lingyu Xue
- Department of Nephrology, the Affiliated Hospital of Taishan Medical University, No. 706 Taishan Street, Taian, 271000, Shandong Province, China.
| | - Yanxia Lou
- Department of Nephrology, Veterans Hospital, Taian, 271000, Shandong Province, China.
| | - Xiaoqing Feng
- Department of Nephrology, the Affiliated Hospital of Taishan Medical University, No. 706 Taishan Street, Taian, 271000, Shandong Province, China.
| | - Chuaihai Wang
- Department of Nephrology, the Affiliated Hospital of Taishan Medical University, No. 706 Taishan Street, Taian, 271000, Shandong Province, China.
| | - Zhangshen Ran
- The Physical Examination Centre of Affiliated Hospital of Taishan Medical University, Taian, 271000, Shandong Province, China.
| | - Xuebin Zhang
- Department of Nephrology, the Affiliated Hospital of Taishan Medical University, No. 706 Taishan Street, Taian, 271000, Shandong Province, China.
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de Miguel-Yanes JM, Inglada-Galiana L, Gómez-Huelgas R. Prioritization of patient-related factors according to renal function in antidiabetic drug selection: the REDIM Project. Diabetes Res Clin Pract 2014; 105:199-205. [PMID: 24890859 DOI: 10.1016/j.diabres.2014.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/25/2014] [Accepted: 04/27/2014] [Indexed: 01/15/2023]
Abstract
AIMS Few studies have evaluated how physicians prioritize renal function among other patient-related factors when stepping-up in antidiabetic treatment. METHODS The REDIM Spanish national online survey included 550 internists. We firstly tested proficiency in chronic kidney disease (Agrawal's Questionnaire) and motivation in diabetes (DAS-3p Questionnaire). We then analyzed how physicians prioritized renal function, age, weight, glycemic control, non-renal co-morbidities and patient perceptions in five varying fictitious clinical scenarios (generic; ambulatory vs. high cardiovascular risk hospitalized patient, for estimated glomerular filtration rates (eGFRs)=50 vs. 25 ml/min/1.73 m(2)). We assigned every item a score (from 5 to 0, highest to lowest relevance) per-physician and compared mean values between clinical scenarios using the t-test for independent means (nominal significance at p<0.05). RESULTS Completion rate was 57.5% (N=316; mean age, 46.3 years; men, 71%). Average scores were 22.6 ± 3.9 (possible range [0-30]) for Agrawal's Questionnaire and 4.1 ± 0.6 (range [1-5]) for DAS-3p Questionnaire. In the generic scenario, renal function had the highest priority (mean=3.36 ± 1.66, range [0-5]). When eGFR was set at 50 ml/min/1.73 m(2), physicians prioritized glycemic control for ambulatory (mean=3.23 ± 1.59) and non-renal co-morbidities for hospitalized patients (mean=3.20 ± 1.68) over renal function (mean=3.18 ± 1.77 for ambulatory, p=0.032; mean=3.11 ± 1.65 for hospitalized patients, p=0.002). When eGFR was subsequently lowered to 25 ml/min/1.73 m(2), renal function again led priorities (mean values=3.73 ± 2.05 for ambulatory and 3.75 ± 1.96 for hospitalized patients; both p<0.001). CONCLUSIONS Knowledge of the degree of renal function impairment induced physicians to prioritize patient-related factors differently when adding a second antidiabetic drug. Renal function led priorities when severely impaired.
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