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Aldafas R, Crabtree T, Vinogradova Y, Gordon JP, Idris I. Efficacy and safety of intensive versus conventional glucose targets in people with type 2 diabetes: a systematic review and meta-analysis. Expert Rev Endocrinol Metab 2023; 18:95-110. [PMID: 36718676 DOI: 10.1080/17446651.2023.2166489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of study is to re-evaluate the risk-benefits of intensive glycemic control in the context of multi-factorial intervention in adults with T2D. METHODS We searched Ovid MEDLINE, Embase, Cochrane, and CINHAL for randomized control trials comparing standard glucose targets to intensive glucose targets with pre-specified HbA1clevels. Subgroup analysis was also performed to account for the inclusion of glucose only versus multi-factorial intervention trials. Results are reported as risk ratio (RR) and 95% confidence interval (CI). RESULTS Fifty-seven publications including 19 trials were included. Compared to conventional glycemic control, intensive glycemic control decreased the risk of non-fatal myocardial infarction (0.8, 0.7-0.91), macroalbuminuria (0.72, 0.5--0.87), microalbuminuria (0.67, 0.52-0.85), major amputation (0.6, 0.38-0.96), retinopathy (0.75 ,0.63-0.9), and nephropathy (0.78, 0.63-0.97). The risk of hypoglycemia increased with intensive glycemic control than conventional treatment (2.04, 1.34-3.1). No reduction in all-cause or cardiovascular mortality was observed. However, in the context of multifactorial intervention, intensive glucose control was associated with a significant reduction in all-cause mortality (0.74, 0.57-0.95). CONCLUSION Targeting HbA1c levels should be individualized based on the clinical status, balancing risks and benefits and potential risk for developing these complications among people with T2D.
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Affiliation(s)
- Rami Aldafas
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Faculty of Public Health, College of Health Science, the Saudi Electronic University, Riyadh, Saudi Arabia
| | - Thomas Crabtree
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Department of Endocrinology and Diabetes, University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
| | - Yana Vinogradova
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Jason P Gordon
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Health Economic Outcomes Research, Birmingham, UK
| | - Iskandar Idris
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Department of Endocrinology and Diabetes, University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, NIHR, Nottingham BRC, University of Nottingham, UK
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Colloidal lithography as a novel approach for the development of Ni-nanocavity insulin sensor. Sci Rep 2022; 12:11020. [PMID: 35773298 PMCID: PMC9246938 DOI: 10.1038/s41598-022-15283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/21/2022] [Indexed: 11/08/2022] Open
Abstract
In this study, a highly sensitive, fast, and selective enzyme-free electrochemical sensor based on the deposition of Ni cavities on conductive glass was proposed for insulin detection. Considering the growing prevalence of diabetes mellitus, an electrochemical sensor for the determination of insulin was proposed for the effective diagnosis of the disease. Colloidal lithography enabled deposition of nanostructured layer (substrate) with homogeneous distribution of Ni cavities on the electrode surface with a large active surface area. The morphology and structure of conductive indium tin oxide glass modified with Ni cavities (Ni-c-ITO) were characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM). The diameter of the resulting cavities was approximately 500 nm, while their depth was calculated at 190 ± 4 nm and 188 ± 18 nm using AFM and SEM, respectively. The insulin assay performance was evaluated by cyclic voltammetry. Ni-c-ITO exhibited excellent analytical characteristics, including high sensitivity (1.032 µA µmol-1 dm3), a low detection limit (156 µmol dm-3), and a wide dynamic range (500 nmol dm-3 to 10 µmol dm-3). Finally, the determination of insulin in buffer with interferents and in real blood serum samples revealed high specificity and demonstrated the practical potential of the method.
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Yang SY, Sencadas V, You SS, Jia NZX, Srinivasan SS, Huang HW, Ahmed AE, Liang JY, Traverso G. Powering Implantable and Ingestible Electronics. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2009289. [PMID: 34720792 PMCID: PMC8553224 DOI: 10.1002/adfm.202009289] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 05/28/2023]
Abstract
Implantable and ingestible biomedical electronic devices can be useful tools for detecting physiological and pathophysiological signals, and providing treatments that cannot be done externally. However, one major challenge in the development of these devices is the limited lifetime of their power sources. The state-of-the-art of powering technologies for implantable and ingestible electronics is reviewed here. The structure and power requirements of implantable and ingestible biomedical electronics are described to guide the development of powering technologies. These powering technologies include novel batteries that can be used as both power sources and for energy storage, devices that can harvest energy from the human body, and devices that can receive and operate with energy transferred from exogenous sources. Furthermore, potential sources of mechanical, chemical, and electromagnetic energy present around common target locations of implantable and ingestible electronics are thoroughly analyzed; energy harvesting and transfer methods befitting each energy source are also discussed. Developing power sources that are safe, compact, and have high volumetric energy densities is essential for realizing long-term in-body biomedical electronics and for enabling a new era of personalized healthcare.
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Affiliation(s)
- So-Yoon Yang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vitor Sencadas
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; School of Mechanical, Materials & Mechatronics Engineering, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Siheng Sean You
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Neil Zi-Xun Jia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Shriya Sruthi Srinivasan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hen-Wei Huang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Abdelsalam Elrefaey Ahmed
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jia Ying Liang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Llisterri-Caro JL, Turégano-Yedro M, Cinza-Sanjurjo S, Segura-Fragoso A, Sánchez-Sánchez B, Cubelos-Fernández N, Velilla-Zancada S, Micó-Pérez RM, Martín-Sánchez V. [Factors associated with the optimum simultaneous control of diabetes, arterial hypertension and hypercholesterolemia in the diabetic population. BPC Diabetes study]. Semergen 2021; 48:225-234. [PMID: 34479796 DOI: 10.1016/j.semerg.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To know the degree of simultaneous optimal control of diabetes (DM), high blood pressure (BP) and hypercholesterolemia and determine the associated factors. MATERIAL AND METHOD Cross-sectional descriptive study in diabetic patients 18 years aged or older selected consecutively in primary care centers (PC). Patient data were obtained through access to electronical clinical history. Clinical and analytical variables of interest were registered. Good metabolic control was considered as HbA1c < 7%, good blood pressure control (PA) as values < 140/80 mmHg and good LDL cholesterol control (c-LDL) as values < 100 mg/dL. Bivariate analysis was performed and odds ratio were calculated in a logistic regression model. The study was approved by the San Carlos Clinical Hospital's Clinical Research Ethics Committee (CREC), in Madrid. RESULTS 1420 patients (55.8% male), with an average (SD) age of 70.6 (10.8) years were included. 75.9% were hypertensive patients, and 69.1% dyslipemic. HbA1c values were 6.9 (1.2) %, sistolic BP 135.0 (16.8) mmHg, diastolic BP 75.9 (10.6) mmHg and LDL-cholesterol 93.7 (32.8) mg/dL. Good metabolic control of DM was achieved at 63.0% (95% CI: 60.4-65.5), good control of HTA at 42.6% (95% CI: 40.0-45.2) and good LDL cholesterol control in 61.1% (95% IC: 58.4-63.7) of patients. Good simultaneous control of the three cardiovascular risk factors (CVRF) was reached at 16.1% (95% CI: 14.2-18.1). A positive and independent association (p<0.05) was observed between good simultaneous control of CVRF with age (OR: 1.017) and with personal history of cardiovascular disease (OR: 1.596). CONCLUSIONS The results of our study indicate that a small proportion, less than two out of 10 patients, meet the good control goals recommended by clinical practice guidelines. We found important differences between patients with and without cardiovascular disease.
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Affiliation(s)
| | | | - S Cinza-Sanjurjo
- Centro de Salud Porto do Son, Área Sanitaria de Santiago de Compostela, A Coruña, España
| | - A Segura-Fragoso
- Universidad de Castilla-La Mancha, Facultad de Ciencias de la Salud, Talavera de la Reina, Toledo, España
| | | | | | | | - R M Micó-Pérez
- Consultorio Fontanars dels Alforins, Departamento de Salud de Xàtiva-Ontinyent, Valencia, España
| | - V Martín-Sánchez
- Instituto de Biomedicina (IBIOMED), Universidad de León, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), León, España
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Zhu Q, Hu S, He Y, Qiu C, Chen T, He Y, Wu Z, Tian L, Shang T, Xiang Y, Zhang H, Li D. Nuclear Factor Kappa-B/Homeobox A9-Mediated Modulation of Leucine-Rich Repeat Flightless-Interacting Protein 1 Is Involved in Advanced Glycation End Product-Induced Endothelial Dysfunction. J Vasc Res 2021; 58:311-320. [PMID: 33882503 DOI: 10.1159/000515177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pathogenesis of cardiovascular diseases begins with endothelial dysfunction. Our previous study has shown that advanced glycation end products (AGE) could inhibit the expression of homeobox A9 (Hoxa9), thereby inducing endothelial dysfunction. Leucine-rich repeat flightless-interacting protein 1 (LRRFIP1) has been found to participate in a variety of pathological processes, but reports of its role in endothelial dysfunction are rare. OBJECTIVES This study aims to investigate whether LRRFIP1 is involved in AGE-induced endothelial dysfunction through Hoxa9-mediated transcriptional activation. METHODS Chromatin immunoprecipitation was used to detect the transcriptional regulation of Hoxa9 on LRRFIP1 promoters. Human umbilical vein endothelial cells were treated with AGE or pyrrolidinedithiocarbamate (nuclear factor kappa-B [NF-κB] inhibitor). Moreover, changes in apoptosis, proliferation, migration, release of nitric oxide, and angiogenesis were detected. RESULTS Hoxa9 promotes LRRFIP1 expression by binding to the -LRRFIP1 promoter. Meanwhile, overexpression of LRRFIP1 inhibited phosphorylation of P65 and elevated expression of Hoxa9. Overexpression of LRRFIP1 or/and Hoxa9 reversed the effects of AGE on HUVEC. AGE-induced inhibition on the expression of LRRFIP1 and Hoxa9 could be reversed by the NF-κB inhibitor. CONCLUSION LRRFIP1 is involved in AGE-induced endothelial dysfunction via being regulated by the NF-κB/Hoxa9 axis.
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Affiliation(s)
- Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Songjie Hu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yunjun He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tianchi Chen
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tao Shang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yilang Xiang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Donglin Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Del Pino-Sedeño T, González de León B, Pérez Martín EF, Martín Gandolfo AM, Estupiñán Ramírez M, Redondo M, Ramallo-Fariña Y, Trujillo-Martín MM. Relationship between glycemic control and chronic obstructive pulmonary disease in patients with type 2 diabetes: A nested case-control study. Prim Care Diabetes 2020; 14:729-735. [PMID: 32535089 DOI: 10.1016/j.pcd.2020.05.007] [Citation(s) in RCA: 1] [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: 12/27/2019] [Revised: 04/17/2020] [Accepted: 05/17/2020] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate the relationship between glycemic control and plasma glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2D) and the risk of chronic obstructive pulmonary disease (COPD). METHODS We conducted a population-based, retrospective, nested, case-control study involving 124,876 patients with DM2 from the Canary Islands, Spain. From the cohort, we selected all COPD cases and, for each case, five control subjects who were COPD free. We analyzed the association between glycemic control, HbA1c level and incident COPD. RESULTS A total of 1320 incidence cases of COPD (1.06%) were identified and matched individually with 6600 controls according to age and sex. After multivariate adjustment, the COPD risk increased among patients with poor glycemic control compared to patients with good glycemic control [HbA1c levels <7% (53 mmol/mol)] (OR 1.18; 95% CI: 1.03-1.36). In comparison with patients exhibiting HbA1c levels <7% (53 mmol/mol), the risk of COPD was higher among people with HbA1c levels of 7-8% (53-64 mmol/mol) (OR 1.24; 95% CI: 1.05-1.47) and 8-9% (64-75 mmol/mol) (OR 1.31; 95% CI: 1.04-1.66). CONCLUSIONS Poor glycemic control reveals a weak association with increased risk of COPD in T2D patients.
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain
| | - Beatriz González de León
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Elías Fernando Pérez Martín
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Anna María Martín Gandolfo
- Unidad Docente de Atención Familiar y Comunitaria "La Laguna-Tenerife Norte", Servicio Canario de Salud, Santa Cruz de Tenerife, Spain
| | - Marcos Estupiñán Ramírez
- Servicio de Atención Primaria, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Las Palmas de Gran Canaria, Spain
| | - Maximino Redondo
- Unidad de Investigación, Hospital Costa del Sol Marbella, Universidad de Málaga, IBIMA (Instituto de Investigación Biomédica de Málaga), Málaga, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - María M Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.
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Summers C, Curtis K. Novel Digital Architecture of a "Low Carb Program" for Initiating and Maintaining Long-Term Sustainable Health-Promoting Behavior Change in Patients with Type 2 Diabetes. JMIR Diabetes 2020; 5:e15030. [PMID: 32130113 PMCID: PMC7081139 DOI: 10.2196/15030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/29/2019] [Accepted: 09/29/2019] [Indexed: 12/11/2022] Open
Abstract
Globally, the burden of noncommunicable diseases such as type 2 diabetes is crippling health care systems. Type 2 diabetes, a disease linked with obesity, affects 1 in every 30 people today and is expected to affect 1 in 10 people by 2030. Current provisions are struggling to manage the trajectory of type 2 diabetes prevalence. Offline, face-to-face education for patients with type 2 diabetes has shown to lack long-term impact or the capacity for widespread democratized adoption. Digitally delivered interventions have been developed for patients with type 2 diabetes, and the evidence shows that some interventions provide the capacity to support hyperpersonalization and real-time continuous support to patients, which can result in significant engagement and health outcomes. However, digital health app engagement is notoriously difficult to achieve. This paper reviews the digital behavior change architecture of the Low Carb Program and the application of health behavioral theory underpinning its development and use in scaling novel methods of engaging the population with type 2 diabetes and supporting long-term behavior change.
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Affiliation(s)
| | - Kristina Curtis
- Faculty Research Centre for Advances in Behavioural Science, University of Coventry, Coventry, United Kingdom
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Glycated Hemoglobin in the Diagnosis of Diabetes Mellitus in a Semi-Urban Brazilian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193598. [PMID: 31561434 PMCID: PMC6801550 DOI: 10.3390/ijerph16193598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 01/10/2023]
Abstract
The study evaluated glycated hemoglobin (HbA1c) as a diagnostic tool for diabetes and pre-diabetes in the Brazilian population. Further, the homeostasis model assessment of insulin resistance (HOMA-IR) was also examined against HbA1c values to identify the most suitable cut-off points for HOMA-IR to predict the risk of diabetes. A cross-sectional study was conducted among 714 randomly selected subjects. HbA1c, fasting, and 2 h plasma glucose values were measured. Insulin resistance estimates were calculated with HOMA-IR. The receiver operating characteristic curve assessed HbA1c performance. The adjusted prevalence rate of diabetes mellitus was 14.7%, and pre-diabetes 14.2%. The optimal HbA1c cut-off value was ≥6.8% for the diagnosis of diabetes, and ≥6.0% for pre-diabetes. The area under the curve using HbA1c was 0.85 (95% CI: 0.80–0.90) for detecting diabetes and 0.61 (95% CI: 0.55–0.67) for pre-diabetes. The optimal HOMA-IR cut-off value was 2.06 for HbA1c at 6.8%. The HbA1c cut-off value of ≥6.8% may be suitable for diagnosing diabetes in the Brazilian population. Our results do not support the use of HbA1c to diagnose pre-diabetes. A HOMA-IR cut-off point of 2.06 was a sensitive marker to assess the risk of diabetes.
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Banarjee R, Sharma A, Bai S, Deshmukh A, Kulkarni M. Proteomic study of endothelial dysfunction induced by AGEs and its possible role in diabetic cardiovascular complications. J Proteomics 2018; 187:69-79. [DOI: 10.1016/j.jprot.2018.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 12/30/2022]
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Abougalambou SSI, Ahmed NO, Abougalambou AS. A study evaluating the postprandial plasma glucose control among type 2 diabetes patients attending a teaching hospital in Malaysia. Diabetes Metab Syndr 2017; 11 Suppl 1:S445-S449. [PMID: 28434857 DOI: 10.1016/j.dsx.2017.03.033] [Citation(s) in RCA: 2] [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: 03/11/2017] [Accepted: 03/31/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Type 2 DM is rapidly rising as a global health care problem that threatens to reach pandemic levels by 2030. Type 2 diabetes mellitus is a disease with no cure and chronic disease that results in major morbidity and mortality. The main objective of this study is to evaluate postprandial plasma glucose level and to determine factors affect on postprandial plasma glucose level among type 2 diabetes outpatients attending endocrinology clinics at Hospital Universiti Sains Malaysia, Teaching Hospital. SUBJECTS AND METHODS The study design was observational prospective longitudinal follow-up study, the study was conducted with sample of 1077 type 2 diabetes mellitus outpatient recruited via attended the diabetes clinics at Hospital Universiti Sains Malaysia (HUSM) in Kelantan. Post prandial plasma glucose (PPG) parameter to measure the glycaemic control. Logistic regression analysis was used to assess the independent variables that affect the PPG control. RESULTS About 426 (39.6%) of the patients did not achieve the optimal postprandial plasma glucose level (<10mmol/l). In this study, the possible factors that affect postprandial plasma glucose levels (PPG) were found to be gender (OR=0.77) and the duration of diabetes (OR=1.12). CONCLUSION It has been found that gender and the duration of diabetes are the factors affecting PPG. New strategy to improve the current status of control of diabetes is needed. The study recommends that health-care providers should pay more attention to type 2 DM male patients and patients who had diabetic for long time.
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Affiliation(s)
| | - Nahid Osman Ahmed
- Discipline of Clinical Pharmacy, Pharmacy School, Qassim University, Buraydah, Saudi Arabia
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11
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Kaneko M, Narukawa M. Meta-analysis of dipeptidyl peptidase-4 inhibitors use and cardiovascular risk in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2016; 116:171-82. [PMID: 27321333 DOI: 10.1016/j.diabres.2016.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/07/2016] [Accepted: 04/15/2016] [Indexed: 11/24/2022]
Abstract
AIMS Some meta-analyses have shown that dipeptidyl peptidase-4 (DPP-4) inhibitors decrease the risk of major adverse cardiovascular events (MACE) compared to placebo. However, this association has not been confirmed in large placebo-controlled clinical trials with cardiovascular events as a primary endpoint. The aim of the present meta-analysis is to assess the association between DPP-4 inhibitors use and cardiovascular risk using uniform definition of MACE. METHODS Relevant studies through 31 December 2014 were searched in the electronic databases, and we identified all eligible trials comparing DPP-4 inhibitors with active drugs or placebo. Summary odds ratio (OR) with 95% confidence interval (CI) for MACE was calculated using random-effects model. RESULTS In 69 trials included in our study, 36,488 patients were treated with DPP-4 inhibitors and 31,290 with other comparators. Treatment with DPP-4 inhibitors was associated with a lower risk of MACE (OR [95% CI]=0.52 [0.36,0.76]) compared to sulfonylureas, while showed a trend toward increased risk (OR [95% CI]=1.89 [0.60,5.93]) compared to sodium-glucose cotransporter 2 (SGLT2) inhibitors. The difference was not statistically significant when compared to placebo (OR [95% CI]=1.04 [0.92,1.18]), and this tendency was similar in both subgroup analyses conducted with a general type 2 diabetes population as well as the population at high cardiovascular risk. CONCLUSIONS There is no significant difference in the risk of MACE between DPP-4 inhibitors and placebo groups. DPP-4 inhibitors show significantly lower risk of MACE when compared to sulfonylureas, while SGLT2 inhibitors might have lower risk compared to DPP-4 inhibitors.
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Affiliation(s)
- Masayuki Kaneko
- Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University Graduate School of Pharmaceutical Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan.
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Kitasato University Graduate School of Pharmaceutical Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan.
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Amur S, LaVange L, Zineh I, Buckman-Garner S, Woodcock J. Biomarker Qualification: Toward a Multiple Stakeholder Framework for Biomarker Development, Regulatory Acceptance, and Utilization. Clin Pharmacol Ther 2015; 98:34-46. [PMID: 25868461 DOI: 10.1002/cpt.136] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/07/2015] [Indexed: 12/16/2022]
Abstract
The discovery, development, and use of biomarkers for a variety of drug development purposes are areas of tremendous interest and need. Biomarkers can become accepted for use through submission of biomarker data during the drug approval process. Another emerging pathway for acceptance of biomarkers is via the biomarker qualification program developed by the Center for Drug Evaluation and Research (CDER, US Food and Drug Administration). Evidentiary standards are needed to develop and evaluate various types of biomarkers for their intended use and multiple stakeholders, including academia, industry, government, and consortia must work together to help develop this evidence. The article describes various types of biomarkers that can be useful in drug development and evidentiary considerations that are important for qualification. A path forward for coordinating efforts to identify and explore needed biomarkers is proposed for consideration.
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Affiliation(s)
- S Amur
- Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - L LaVange
- Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - I Zineh
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - S Buckman-Garner
- Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - J Woodcock
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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Ding C, Hsu SHJ, Wu YJ, Su TC. Additive effects of postchallenge hyperglycemia and low-density lipoprotein particles on the risk of arterial stiffness in healthy adults. Lipids Health Dis 2014; 13:179. [PMID: 25431283 PMCID: PMC4280693 DOI: 10.1186/1476-511x-13-179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 11/21/2014] [Indexed: 11/17/2022] Open
Abstract
Background To determine the effects of post-challenge hyperglycemia potentiate low-density lipoprotein cholesterol (LDL) particles on the risk of arterial stiffness in non-diabetic adults. Methods During 2009–2011, 592 adults without clinical diabetes (fasting glucose <7.0 mmol/L) or known coronary heart disease or stroke were recruited. All subjects underwent standard 75-g oral glucose tolerance test (OGTT) after overnight fasting. The glucose area under curve (GluAUC) after OGTT was defined as the postchallenge glucose load. Levels of LDL-C and small dense LDL-C (sdLDL-C) were measured. Arterial stiffness in terms of brachial–ankle pulse wave velocity (baPWV) was also measured. Results The baPWV in tertile distributions were significantly associated with all conventional cardiovascular risk factors, LDL-C, and sdLDL-C. Multivariate logistic regression analyses revealed that LDL-C (or sdLDL-C) combined with one of the seven glycemic indices (glucose levels at 0, 30, 60, 90, and 120 min; GluAUC; HbA1C) was associated with arterial stiffness after covariates being adjusted. Further interaction analyses showed only concurrent higher levels of both glycemic indices and atherogenic LDL-C or sdLDL-C have significant risk for arterial stiffness. Conclusions Additive effects of both postchallenge hyperglycemia and LDL subclass particles potentiate the risk of arterial stiffness. The adverse joint effects of hyperlipidemia and postchallenge hyperglycemia on subclinical cardiovascular function provide important information in primary prevention of cardiovascular disease in subjects without clinical diabetes.
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Affiliation(s)
| | | | - Yong-Jian Wu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
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Nwaneri C, Cooper H, Bowen-Jones D. Mortality in type 2 diabetes mellitus: magnitude of the evidence from a systematic review and meta-analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1474651413495703] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Type 2 diabetes is associated with an increase in age-related mortality. A systematic review and meta-analysis were performed to define the relative risks (RR) of all-cause or cause-specific mortality in type 2 diabetes and to determine gaps in current research. Methods: A comprehensive literature search was undertaken for studies (published 1990–2010) on mortality in type 2 diabetes. The study reports on the measure of mortality as defined by RR for all-cause and cause-specific mortality, heterogeneity, sensitivity analyses and biases. Results: In total 35 studies (220,689 patients; mean follow-up of 10.7 years) were eligible for inclusion: 33 studies reported increased mortality risks; 24 had full data on 95% confidence intervals (CIs), one study reported no excess mortality in men diagnosed after 65 years whereas three reported increased mortality in similar age groups in both sexes. Meta-analysis showed RR = 1.85 (95% CI 1.79–1.92) for all-cause mortality [men RR=1.57 (95% CI 1.46–1.68); women RR=2.0 (95% CI 1.89–2.12)], RR=1.76 (95% CI 1.66–1.88) for cardiovascular mortality and RR=2.26 (95% CI: 1.7-3.02) for stroke. There was no statistically significant evidence of publication bias. Conclusion: Type 2 diabetes increases mortality approximately two-fold increase and macrovascular disease is the principal cause of death.
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Affiliation(s)
- Chukwuemeka Nwaneri
- Department of Community Health & Wellbeing, Faculty of Health & Social Care, University of Chester, UK
- Department of Medicine, Centre for Diabetes & Endocrinology, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Upton, Wirral, UK
| | - Helen Cooper
- Department of Community Health & Wellbeing, Faculty of Health & Social Care, University of Chester, UK
- Research and Development, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool, UK
| | - David Bowen-Jones
- Department of Medicine, Centre for Diabetes & Endocrinology, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Upton, Wirral, UK
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Fan HQ, Tang W, Wang ZX, Wang SJ, Qin YH, Fu Q, Gao Y, Sun M, Zhang M, Zhou HW, Yang T. Association of serum uric acid with 2-hour postload glucose in Chinese with impaired fasting plasma glucose and/or HbA1c. PLoS One 2013; 8:e67759. [PMID: 23844086 PMCID: PMC3700996 DOI: 10.1371/journal.pone.0067759] [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: 03/02/2013] [Accepted: 05/22/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine whether serum uric acid (SUA) is associated with 2-hour postload glucose (2-h PG) in Chinese with impaired fasting plasma glucose (IFG) and/or HbA1c (IA1C). RESEARCH DESIGN AND METHODS Anthropometric and biochemical examinations, such as SUA concentration, were performed in 3763 individuals from all the villages in Baqiao County, China. A 75-g oral glucose tolerance test (OGTT) was conducted in 1197 Chinese with prediabetes as having IFG (110 ≤ fasting plasma glucose [FPG] <126 mg/dl and HbA1c <6.5%), IA1C (5.7% ≤ HbA1c <6.5% and FPG <126 mg/dl), or both. RESULTS The present study included 1197 participants with IFG and/or IA1C (mean age 56.5 ± 10.3 years; 50.6% men). In multivariate linear regression, after adjustment for gender, age, smoking and drinking, body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), lipid profiles, logarithmic transformed C-reactive protein (log-CRP), estimated glomerular filtration rate (e-GFR), FPG and HbA1c, with a 1-mg/dl increment of SUA, 2-h PG increased by 5.04 ± 0.72 (P<0.001), 3.06 ± 1.08 (P = 0.001), 5.40 ± 1.26 (P<0.001), and 2.34 ± 2.16 mg/dl (P = 0.056) in all participants, in participants with normal glucose tolerance (NGT), with impaired glucose tolerance (IGT), and with 2-h newly diagnosed diabetes (2-h NDM, with 2-h PG ≥ 200 mg/dl), respectively. In both men and women, 2-h PG increased progressively and significantly from the lower to the upper SUA tertiles (P<0.001). Moreover, in multivariate logistic regression, 1-standard deviation (SD; 1.53 mg/dl) increment of SUA was significantly associated with a 36% higher risk for 2-h NDM (Odds ratio [CI 95%]: 1.36 [1.09-1.99]; P = 0.03). CONCLUSIONS SUA is significantly associated with 2-h PG in Chinese with IFG and/or IA1C.
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Affiliation(s)
- Hong-Qi Fan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Tang
- Department of Endocrinology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, Jiangsu, China
| | - Zhi-Xiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Su-Juan Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yue-Hua Qin
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qi Fu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Gao
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Sun
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mei Zhang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hong-Wen Zhou
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- * E-mail:
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Dacks PA, Moreno CL, Kim ES, Marcellino BK, Mobbs CV. Role of the hypothalamus in mediating protective effects of dietary restriction during aging. Front Neuroendocrinol 2013; 34:95-106. [PMID: 23262258 PMCID: PMC3626742 DOI: 10.1016/j.yfrne.2012.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/04/2012] [Accepted: 12/11/2012] [Indexed: 01/09/2023]
Abstract
Dietary restriction (DR) can extend lifespan and reduce disease burden across a wide range of animals and yeast but the mechanisms mediating these remarkably protective effects remain to be elucidated despite extensive efforts. Although it has generally been assumed that protective effects of DR are cell-autonomous, there is considerable evidence that many whole-body responses to nutritional state, including DR, are regulated by nutrient-sensing neurons. In this review, we explore the hypothesis that nutrient sensing neurons in the ventromedial hypothalamus hierarchically regulate the protective responses of dietary restriction. We describe multiple peripheral responses that are hierarchically regulated by the hypothalamus and we present evidence for non-cell autonomous signaling of dietary restriction gathered from a diverse range of models including invertebrates, mammalian cell culture, and rodent studies.
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Affiliation(s)
- Penny A. Dacks
- Department of Neurosciences and Friedman Brain Institute, Mount Sinai School of Medicine, New York, NY 10029
- Alzheimer's Drug Discovery Foundation, New York, NY 10019
| | - Cesar L. Moreno
- Department of Neurosciences and Friedman Brain Institute, Mount Sinai School of Medicine, New York, NY 10029
| | - Esther S. Kim
- Department of Neurosciences and Friedman Brain Institute, Mount Sinai School of Medicine, New York, NY 10029
| | - Bridget K. Marcellino
- Department of Neurosciences and Friedman Brain Institute, Mount Sinai School of Medicine, New York, NY 10029
| | - Charles V. Mobbs
- Department of Neurosciences and Friedman Brain Institute, Mount Sinai School of Medicine, New York, NY 10029
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Tamita K, Katayama M, Takagi T, Yamamuro A, Kaji S, Yoshikawa J, Furukawa Y. Newly diagnosed glucose intolerance and prognosis after acute myocardial infarction: comparison of post-challenge versus fasting glucose concentrations. Heart 2012; 98:848-54. [PMID: 22581733 PMCID: PMC3351853 DOI: 10.1136/heartjnl-2012-301629] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Recent studies have demonstrated that newly diagnosed glucose intolerance is common among patients with acute myocardial infarction (AMI). The purpose of this study was to assess the long-term clinical cardiovascular outcomes in participants with AMI with abnormal fasting glucose compared with normal fasting glucose and an abnormal oral glucose tolerance test (OGTT) compared with a normal OGTT. Methods A prospective study was performed in 275 consecutive patients with AMI, 85 of whom had pre-diagnosed diabetes mellitus (DM). Those without DM were divided into two groups based on the 75 g OGTT at the time of discharge. Abnormal glucose tolerance (AGT) was defined as 2 h glucose ≥140 mg/dl; 78 patients had normal glucose tolerance (NGT) and 112 had AGT. The same patients were also reclassified into the normal fasting glucose group (NFG; n=168) or the impaired fasting glucose group (IFG; n=22). The association between the glucometabolic status and long-term major adverse cardiovascular event rates was evaluated. Results Kaplan–Meier survival curves showed that the AGT group had a worse prognosis than the NGT group and an equivalent prognosis to the DM group (p<0.0005). Cox proportional hazard model analysis showed that the HR of AGT to NGT for major adverse cardiovascular event rates was 2.65 (95% CI 1.37 to 5.15, p=0.004) while the HR of DM to NGT was 3.27 (1.68 to 6.38, p=0.0005). However, Cox HR of IFG to NFG for major adverse cardiovascular event rates was 1.83 (0.86 to 3.87), which was not significant. Conclusion In patients with AMI, an abnormal OGTT is a better risk factor for future adverse cardiovascular events than impaired fasting blood glucose.
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Affiliation(s)
- Koichi Tamita
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Center, 3-25 Ikeda-cho, Nishinomiya City 662-0911, Japan.
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18
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Hypoglycemic effects of intraluminal intestinal electrical stimulation in healthy volunteers. Obes Surg 2011; 21:224-30. [PMID: 21113684 DOI: 10.1007/s11695-010-0326-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intestinal electrical stimulation (IES) has been shown to delay gastric emptying and reduce nutrient absorption in humans. The aim of this study was to investigate the effect of IES using an intraluminal method on postprandial blood glucose. METHODS An oral glucose tolerance test with 150 g of glucose was performed in 10 healthy volunteers with and without IES (13 pulses/min, 300 ms and 5 mA). An intraluminal catheter with a pair of ring electrodes was incubated into the duodenum under endoscopy and used for IES. Gastric emptying was performed simultaneously using an established ultrasonic technique. RESULTS (1) IES significantly decreased the postprandial glucose level from 15 min to 90 min after the glucose load. (2) The serum insulin level at 30 min but not other times after the meal was lower in the IES session than that in the control session (p = 0.06). (3) The half-time of gastric emptying with IES was increased from 27 ± 4.8 min in the control session to 36 ± 8.5 min with IES (p < 0.01). (4) The symptoms score of dyspepsia were almost the same between the two sessions except that IES induced a slightly higher nausea symptom score. CONCLUSIONS IES decreases postprandial blood glucose possibly by delaying gastric emptying and other unknown mechanisms and the intraluminal method of IES may serve as an excellent screening and research tool for various applications of IES. Further clinical studies are needed to explore therapeutic potentials of IES for diabetes.
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Pollock RF, Valentine WJ, Pilgaard T, Nishimura H. The cost effectiveness of rapid-acting insulin aspart compared with human insulin in type 2 diabetes patients: an analysis from the Japanese third-party payer perspective. J Med Econ 2011; 14:36-46. [PMID: 21192769 DOI: 10.3111/13696998.2010.541045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The Nippon Ultra-Rapid Insulin and Diabetic Complication Evaluation Study (NICE Study) (NCT00575172) was a 5-year, open-label, randomised controlled trial which compared cardiovascular outcomes in Japanese type 2 diabetes patients intensively treated with regular human insulin or insulin aspart (NovoRapid; Novo Nordisk A/S, Bagsvaerd, Denmark), a rapid-acting insulin analogue. The aim of the present analysis was to evaluate the cost effectiveness of insulin aspart versus regular human insulin from the perspective of a Japanese third-party healthcare payer. RESEARCH DESIGN AND METHODS A discrete event-simulation model was developed in Microsoft Excel to assess the within-trial cost effectiveness and make longer-term clinical projections in patients treated with regular human insulin or insulin aspart. In addition to severe hypoglycaemia, the model captured myocardial and cerebral infarction events and percutaneous coronary intervention and coronary artery bypass graft procedures. Within-trial mortality, incidence of severe hypoglycaemia and cardiovascular event probabilities were derived from the annual rates observed during the trial period, while post-trial outcomes were calculated using the event rates from the trial, adjusted for increasing patient age. Event costs were accounted from the healthcare payer perspective and expressed in 2008 Japanese yen (JPY), while health-related quality of life (HRQoL) was captured using event and state utilities. Future costs and clinical benefits were discounted at 3% annually. Life expectancy, quality-adjusted life expectancy, cardiovascular event rates and costs were evaluated over 5- and 10-year time horizons and sensitivity analyses were performed to assess variability in model outcomes. RESULTS Over 5 years of treatment, insulin aspart dominated human insulin both in incremental life expectancy and in incremental quality-adjusted life-years (QALYS). Insulin aspart was associated with a small improvement in discounted life expectancy of 0.005 years (4.688 vs. 4.684 years) and an increase of 0.023 quality-adjusted life-years (QALYs) (3.800 vs. 3.776 QALYs) when compared with regular human insulin. Insulin aspart also incurred lower costs (JPY 481,586 vs. 594,717, difference -113,131) which resulted from the decreased incidence of cardiovascular events with insulin aspart (0.013 events per patient year vs. 0.030 on regular human insulin). Breakdown of costs indicated that pharmacy costs were higher with insulin aspart (JPY 346,608 vs. 278,468), but these costs were more than offset by the reduced costs associated with cardiovascular complications and hypoglycaemia over 5 years of treatment (JPY 134,978 vs. 316,249). Sensitivity analysis showed that insulin aspart was still cost-effective in the case where only 18% of the within-trial cardiovascular and mortality benefit over regular human insulin was captured in the model (assuming a willingness-to-pay threshold of JPY 5,000,000). LIMITATIONS The NICE study cohort was relatively small (n = 325), meaning that caution should be exercised when calculating and interpreting the incremental cost-effectiveness ratio. Also, despite the differences in cardiovascular risk profile between the Japanese and UK populations, UKPDS-derived risk equations were used to project MI outcomes and PCI and CABG procedures and UKPDS HRQoL scores were applied to all health states. While these risk formulas and HRQoL utilities may not be directly applicable to the Japanese population, no equivalent Japanese-specific data are currently available. CONCLUSIONS In a Japanese type 2 diabetes population, prescribing rapid-acting insulin aspart significantly reduced cardiovascular complications over 5- and 10-year time horizons, resulting in increased quality of life and decreased costs when compared with human insulin.
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Affiliation(s)
- R F Pollock
- Ossian Health Economics and Communications GmbH, Basel, Switzerland.
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Chun KH. Evidence-based management and treatment of high-risk individuals with pre-diabetes. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.10.1020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ki Hong Chun
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
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21
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de Fine Olivarius N, Siersma V, Nielsen ABS, Hansen LJ, Rosenvinge L, Mogensen CE. Predictors of mortality of patients newly diagnosed with clinical type 2 diabetes: a 5-year follow up study. BMC Endocr Disord 2010; 10:14. [PMID: 20698977 PMCID: PMC2928228 DOI: 10.1186/1472-6823-10-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 08/10/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND At diabetes diagnosis major decisions about life-style changes and treatments are made based on characteristics measured shortly after diagnosis. The predictive value for mortality of these early characteristics is widely unknown. We examined the predictive value of patient characteristics measured shortly after diabetes diagnosis for 5-year all-cause and cardiovascular mortality with special reference to self-rated general health. METHODS Data were from a population-based sample of 1,323 persons newly diagnosed with clinical diabetes and aged 40 years or over. Possible predictors of mortality were investigated in Cox regression models. RESULTS Multivariately patients who rated their health less than excellent experienced increased all-cause and cardiovascular mortality. These end-points also increased with sedentary life-style, relatively young age at diagnosis and presence of cardiovascular disease (CVD) at diagnosis. Further predictors of all-cause mortality were male sex, low body mass index and cancer, while cardiovascular mortality increased with urinary albumin concentration. CONCLUSIONS We found that patients who rated their health as less than excellent had increased 5-year mortality, similar to that of patients with prevalent CVD, even when biochemical, clinical and life-style variables were controlled for. This finding could motivate doctors to discuss perceptions of health with newly diagnosed diabetic patients and be attentive to patients with suboptimal health ratings. Our findings also confirm that life-style changes and optimizing treatment are particularly relevant for relatively young and inactive patients and those who already have CVD or (micro)albuminuria at the time of diabetes diagnosis.
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Affiliation(s)
- Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anni BS Nielsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars J Hansen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Rosenvinge
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Carl Erik Mogensen
- Medical Department M, Århus Kommunehospital, Århus University Hospital, Århus, Denmark
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Simons WR, Hagan MA. An economic evaluation of colesevelam when added to metformin-, insulin- or sulfonylurea-based therapies in patients with uncontrolled type 2 diabetes mellitus. PHARMACOECONOMICS 2010; 28:765-780. [PMID: 20799756 DOI: 10.2165/11539600-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Several early studies demonstrated that bile acid sequestrants were useful for lowering lipid levels in patients with hypercholesterolaemia and may also be useful for lowering glucose levels in patients with type 2 diabetes mellitus (T2DM) uncontrolled on existing treatment (metformin-, insulin- or sulfonylurea-based therapies). OBJECTIVE This study modelled efficacy and safety data from the three clinical trials to evaluate the cost effectiveness to US Managed Care Organizations of add-on treatment with colesevelam for reducing diabetes-related complications. METHODS Three randomized controlled trials in patients with T2DM and one in hyperlipidaemia established that colesevelam lowered both glycaemic and lipid parameters in adult patients participating in the studies. The validated 'diabetic risk equation' (DRE) and the 'LIPID cardiovascular risk equation' (LCRE) were used to translate the observed clinical benefits (surrogate markers related to T2DM [glycosylated haemoglobin {HbA(1c)} and fasting plasma glucose] and cardiovascular disease [low-density lipoprotein cholesterol {LDL-C}]). Performing an appropriate economic evaluation required the use of both the DRE and the LCRE. These equations parameterize the clinical efficacy measures as continuous, facilitating their application to clinical trial results as well as the replication of other well established epidemiological data. Tobit regressions were applied to a large commercially available managed care administrative claims database (2000-6), Integrated Health Care Services (IHCS), to evaluate the incremental costs associated with each type of diabetic complication. Costs were inflated to 2010 values using the Healthcare Consumer Price Index, while second- and third-year cost savings were discounted at 5% to the current year. Bootstrap sampling with 5000 samples of 100 patients per cohort was conducted, varying the number of events avoided as well as their associated cost. RESULTS With established metformin-, insulin- or sulfonylurea-based therapies, the addition of colesevelam significantly reduced HbA(1c) by approximately 0.5% (p < 0.001) in all three studies. In addition, colesevelam reduced placebo-adjusted LDL-C by 12.8-16.7% (p < 0.001). Using the DRE and LCRE equations, the total savings from reductions in diabetes-related and cardiovascular events were $US3543, $US4074 and $US3855 for colesevelam added to metformin-, insulin- and sulfonylurea-based regimens in patients with normal lipid levels. After subtracting the cost of colesevelam, first-year savings were $US1326, $US1852 and $US1629 in the metformin, insulin and sulfonylurea studies, respectively, for patients with raised lipid levels. CONCLUSIONS In adult patients with T2DM, the addition of colesevelam to metformin-, insulin- or sulfonylurea-based therapies significantly improves glycaemic control while also reducing LDL-C, and these improvements could translate into substantial cost reductions due to reductions in the rates of diabetes-related and cardiovascular complications.
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Affiliation(s)
- W Robert Simons
- Global Health Economics & Outcomes Research, Inc., Summit, New Jersey 07901, USA.
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Hu Y, Liu W, Huang R, Zhang X. Postchallenge plasma glucose excursions, carotid intima-media thickness, and risk factors for atherosclerosis in Chinese population with type 2 diabetes. Atherosclerosis 2009; 210:302-6. [PMID: 20005514 DOI: 10.1016/j.atherosclerosis.2009.11.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 11/10/2009] [Accepted: 11/11/2009] [Indexed: 12/01/2022]
Abstract
AIMS Isolated hyperglycemia is associated with atherosclerosis in individuals with type 2 diabetes, but the relationship between postchallenge glucose excursion and atherosclerosis is less clear. This study examines the relationships between postchallenge glucose spikes (PGS), carotid intima-media thickness (IMT), and traditional risk factors for atherosclerosis in individuals with type 2 diabetes. METHODS A total of 474 individuals with type 2 diabetes who were within the highest or lowest IMT distribution quartile were included. The Student's t-test, one-way analysis of variance (ANOVA), single variate and multivariate analyses were implemented to study the data. An additional healthy control group (n=896) was selected during routine health examination. They were Han nationality and unrelated to the diabetic patients. RESULTS (1) Compared with subjects of healthy control group, the subjects with type 2 diabetes had significantly higher levels of body mass index (BMI), waist-to-hip ratio (WHR), systolic blood pressure, triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), 120 min postchallenge glucose (PG120), hemoglobin A1c (HbA1c) and IMT (P < or = 0.01) and relatively lower levels of high density lipoprotein cholesterol (HDL-C) (P < or = 0.05). (2) According to the IMT which was measured by B-mode ultrasonography, the patients of type 2 diabetes could be divided into two subgroups: one was the subgroup of IMT > or = P(75) and another was the subgroup of IMT < or = P(25). Compared with subjects of IMT > or = P(25) subgroup, subjects being in the IMT > or = P(75) subgroup exhibited significantly increased age, WHR, diabetes duration, systolic blood pressure, total cholesterol, triglyceride, LDL-C, and significantly decreased HDL-C levels. And among all the plasma glucose variables, except for FPG and PG30, all the other variables (include PG60, PG120, PG180, PGS, HbA1C, under area curve of glucose) showed a significant increase in the IMT>/=P(75) subgroup. (3) A multivariate logistic regression analysis was performed to establish which were independently related with carotid IMT, and the results showed the PGS was identified as the strongest determinant of IMT from all the atherosclerosis risk factors. (4) PGS is significantly correlated to a variety of atherosclerosis risk factors. CONCLUSIONS This study identified several important associations between PGS and known risk factors for atherosclerosis and suggested that PGS is independently related to carotid IMT. Wide postchallenge glucose excursions may contribute to the development of atherosclerosis in individuals with type 2 diabetes, independent of other risk factors.
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Affiliation(s)
- Yaomin Hu
- Department of Endocrinology, Renji Hospital, Shanghai Jiaotong University, Shanghai 200127, China
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Vieira-Santos ICR, Souza WVD, Carvalho EFD, Medeiros MCWCD, Nóbrega MGDL, Lima PMS. [Prevalence of diabetic foot and associated factors in the family health units of the city of Recife, Pernambuco State, Brazil, in 2005]. CAD SAUDE PUBLICA 2009; 24:2861-70. [PMID: 19082277 DOI: 10.1590/s0102-311x2008001200015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 04/16/2008] [Indexed: 11/22/2022] Open
Abstract
One of the most important chronic complications of diabetes mellitus is diabetic foot. Severe progression of diabetes can lead to lower limb amputations. However, since evolution of the disease is slow, it is possible to implement prevention and control measures. The scope of the Family Health Program (in terms of the possibility of early diagnosis of diabetes mellitus and diabetic foot) favors epidemiological studies to determine the problem's magnitude. This article aimed to identify the proportion of individuals with diabetic foot treated at family health units in the city of Recife, Pernambuco State, Brazil. An epidemiological survey was conducted with a probabilistic sample of medical charts of diabetic patients (N = 1,374) enrolled in six health districts in the city, analyzing relations between socioeconomic variables, health conditions, and the occurrence of amputation. Diabetic foot was observed in 9% of the sample. There was a positive and statistically significant association with the variables alcoholism and amputation (p < 0.001). The prevalence of lower limb amputations was 25.6% among individuals with complications and 2.3% of the total sample.
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Wieczorek A, Rys P, Skrzekowska-Baran I, Malecki M. The role of surrogate endpoints in the evaluation of efficacy and safety of therapeutic interventions in diabetes mellitus. Rev Diabet Stud 2008; 5:128-35. [PMID: 19099084 PMCID: PMC2613271 DOI: 10.1900/rds.2008.5.128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 11/21/2008] [Accepted: 11/23/2008] [Indexed: 11/03/2022] Open
Abstract
In this paper, we examine the concept of surrogate endpoints (i.e. substitute outcome measures) and review their use in clinical trials involving therapies for diabetes mellitus using the example of metformin. Trials such as DCCT and UKPDS, in which patient-important endpoints were evaluated, are relatively rare in diabetology. Clinical decisions, therefore, are often based on evidence obtained using surrogate outcomes, usually fasting or postprandial glycemia or glycated hemoglobin level. In contrast to patient-important endpoints, surrogates do not describe direct clinical benefit to the patient. However, a proven association between a surrogate and patient-important endpoint is essential to draw appropriate therapeutic conclusions. In the process of new drug development, the duration of follow-up, sample size and methodology of the studies initially available are often inadequate to demonstrate the effect of the intervention on patient-important endpoints. Evidence concerning the effect of an intervention on surrogate outcomes usually comes first, followed only later by reports describing its influence on patient-important endpoints. Metformin may serve as an example in several ways. The first publications reported beneficial effects on glycemic control and body weight. Outcomes from the subsequent UKPDS study suggested the patient-important efficacy of metformin measured as a reduction in mortality and a decrease in the incidence of diabetic complications, including myocardial infarction. This reasoning process worked for some but not all strategies. It is particularly questionable whether a change in surrogate endpoint was associated with a potential deterioration in patient-important outcomes. Defining the general relationship between surrogates widely used as measures of metabolic control and patient-important endpoints remains an important challenge in contemporary diabetology.
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Affiliation(s)
| | | | | | - Maciej Malecki
- Department of Metabolic Diseases, Jagiellonian University College of Medicine, Krakow, Poland
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Affiliation(s)
- Saul Genuth
- Division of Clinical and Molecular Endocrinology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio 44106-4951, USA.
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Huang CW, Tsai JJ, Ou HY, Wang ST, Cheng JT, Wu SN, Huang CC. Diabetic hyperglycemia is associated with the severity of epileptic seizures in adults. Epilepsy Res 2008; 79:71-7. [DOI: 10.1016/j.eplepsyres.2007.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Revised: 12/15/2007] [Accepted: 12/29/2007] [Indexed: 10/22/2022]
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Konukoglu D, Firtina S, Serin O. The relationship between plasma asymmetrical dimethyl-L-arginine and inflammation and adhesion molecule levels in subjects with normal, impaired, and diabetic glucose tolerance. Metabolism 2008; 57:110-5. [PMID: 18078867 DOI: 10.1016/j.metabol.2007.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 08/31/2007] [Indexed: 02/08/2023]
Abstract
Increasing evidence suggests that the postprandial state is a contributing factor to the development of atherosclerosis. To evaluate the effects of acute hyperglycemia on endothelial dysfunction and inflammation, plasma asymmetrical dimethyl-l-arginine (ADMA), intercellular adhesion molecule 1 (sICAM-1), vascular cell adhesion molecule 1, and C-reactive protein (CRP) levels and secretory phospholipase A(2) (sPLA(2)) activities were measured in subjects with normal (n = 35), impaired (IGT) (n = 25), and diabetic (DGT) (n = 20) glucose tolerance. At baseline, plasma ADMA, sICAM-1, and CRP concentrations and plasma sPLA(2) activities were higher in both the IGT and DGT groups than in the normal glucose tolerance group (for each comparison, each P < .001). Patients with DGT have higher plasma ADMA and sICAM-1 concentrations than patients with IGT (for each, P < .001).Two hours after glucose loading, plasma ADMA and CRP concentrations and sPLA(2) activities were significantly elevated in the 3 groups when compared with baseline levels (for each comparison, P < .001). Plasma vascular cell adhesion molecule 1 and sICAM-1 concentrations were found to be elevated from baseline levels after glucose loading in the IGT and DGT groups (for each comparison, P < .001). Correlation analysis at baseline suggested that there was a significant relationship between ADMA and inflammation and soluble adhesion markers in the studied groups. In conclusion, plasma concentrations of ADMA and of inflammation and adhesion molecules were elevated in the prediabetic state. A complex interrelation could exist between ADMA and inflammation, and mechanisms involved in endothelial dysfunction are multifactorial at the prediabetic and diabetic state.
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Affiliation(s)
- Dildar Konukoglu
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Biochemistry, Istanbul 34303, Turkey.
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Tamita K, Katayama M, Takagi T, Akasaka T, Yamamuro A, Kaji S, Morioka S, Kihara Y. Impact of Newly Diagnosed Abnormal Glucose Tolerance on Long-Term Prognosis in Patients With Acute Myocardial Infarction. Circ J 2007; 71:834-41. [PMID: 17526977 DOI: 10.1253/circj.71.834] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Newly-diagnosed diabetes mellitus (DM) and impaired glucose tolerance are common among patients with acute myocardial infarction (AMI). However, its significance on long-term clinical outcomes in those patients remains unclear. The present study was designed to determine whether such abnormalities after AMI affect long-term clinical outcomes. METHODS AND RESULTS Two-hundred and seventy-five AMI patients were prospectively enrolled. Eighty-five had diagnosed DM, while the other 190 did not. According to oral glucose tolerance tests at discharge, non-DM patients were divided into 2 groups: 78 patients with normal glucose tolerance and 112 patients with abnormal glucose tolerance. Patients were followed until they reached the primary endpoint: cardiovascular death or unplanned hospitalization due to major adverse cardiovascular events. The median follow-up period was 5.3 years. Kaplan-Meier survival curves for the abnormal glucose tolerance group were poorer than for normal glucose tolerance, and were equivalent to the pre-diagnosed DM group in prognosis (p<0.0005). Glucometabolic status was the strongest predictor for future cardiovascular events (hazard ratio to normal glucose tolerance; 2.65; confidence interval: 1.37-5.15; p=0.004 in abnormal glucose tolerance and 3.27:1.68-6.38; p=0.0005 in DM). CONCLUSIONS Abnormal glucose tolerance in patients with AMI is a major risk factor for future cardiovascular events and may critically distinguish high-risk individuals.
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Affiliation(s)
- Koichi Tamita
- Department of Cardiovascular Medicine, Kobe General Hospital, 4-6 Minatojima-nakamachi, Chuo-ku, Kobe 650-0046, Japan.
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Monnier L, Colette C. Addition of rapid-acting insulin to basal insulin therapy in type 2 diabetes: indications and modalities. DIABETES & METABOLISM 2006; 32:7-13. [PMID: 16523182 DOI: 10.1016/s1262-3636(07)70241-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There are many reasons to believe that in the near future, the treatment of patients with Type 2 diabetes will be characterised by an increased use of insulin therapy. To ensure that insulin regimens are acceptable to patients, and implemented by physicians, they should be as simple and efficient as possible. Simplicity is synonymous with the regimen of once-daily basal insulin glargine given at any time of the day (at the same time each day). With such a strategy, the dose is adjusted by titrating to target fasting blood glucose values of 5.0 - 7.2 mmol/L (90 - 130 mg/dL). When these targets can no longer be achieved with reasonable doses of long-acting insulin, a rapid-acting insulin analogue should be added at meal times. A step-by-step strategy can be used; it is recommended that initially, a single daily prandial bolus of a rapid-acting insulin analogue is administered before the meal that leads to the highest post-meal blood glucose excursions. Further boluses can be added at other meal times as necessary, i.e, when post-meal blood glucose values remain above 10.0 mmol/L (180 mg/dL) and 7.8 mmol/L (140 mg/dL) at mid-morning and 2h-post-lunch or post-dinner times, respectively. This stepwise strategy may eventually lead to a standard basal-bolus regimen with 3 pre-meal injections of rapid-acting insulin analogues, a potentially small trade-off for achieving fairly-well controlled diabetes.
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Affiliation(s)
- L Monnier
- Hôpital Lapeyronie. Service des maladies métaboliques, 34295 Montpellier Cedex 5, France.
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Murray AD, Staff RT, Shenkin SD, Deary IJ, Starr JM, Whalley LJ. Brain white matter hyperintensities: relative importance of vascular risk factors in nondemented elderly people. Radiology 2005; 237:251-7. [PMID: 16126931 DOI: 10.1148/radiol.2371041496] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively determine whether there is an association between brain white matter signal hyperintensities on magnetic resonance (MR) images and potential risk factors for cerebral ischemia in a well-characterized narrow age cohort of nondemented community-dwelling elderly people. MATERIALS AND METHODS The study population consisted of surviving members of the Aberdeen 1921 Birth Cohort, a subsample of participants in the 1932 Scottish Mental Survey who were born in 1921. With the permission of the local ethics committee and with informed written consent, 106 nondemented subjects (62 men, 44 women) aged 78-79 years underwent T2-weighted brain MR imaging. Brain MR images were scored semiquantitatively for deep white matter hyperintensities and periventricular hyperintensities. Vascular risk factors and clinical measures potentially associated with cerebral ischemia included hypertension, diabetes, cerebrovascular disease, smoking, body mass index grade, respiratory function levels (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and peak expiratory flow rate [PEFR]) normalized for subject's height, plasma lipid levels (cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein), glycated hemoglobin level, and mean fasting blood glucose level. Pearson correlation coefficients were calculated for correlations between potential vascular risk factors and scores for deep white matter and periventricular hyperintensities, and stepwise multiple linear regression analysis was performed for factors with a statistically significant correlation. RESULTS Significant Pearson correlations with deep white matter hyperintensities were found for glycated hemoglobin level (r = 0.31), hypertension (r = 0.27), normalized FEV1 (r = -0.27), normalized FVC (r = -0.22), normalized PEFR (r = -0.27), low-density lipoprotein (r = 0.24), and cholesterol (r = 0.20), and with periventricular hyperintensities for glycated hemoglobin level (r = 0.28) and normalized PEFR (r = -0.23). Multiple linear regression analysis showed that glycated hemoglobin level and hypertension were predictive of 16.2% of the variance in deep white matter hyperintensities. When subjects with non-insulin-dependent (type 2) diabetes mellitus (n = 11) were excluded, hypertension and decreased normalized PEFR were predictive of 11.7% of the variance. CONCLUSION White matter hyperintensities are associated with elevated levels of glycated hemoglobin in nondemented community-dwelling elderly subjects. Hypertension and decreased normalized PEFR are the principal predictors of deep white matter hyperintensities in nondiabetic subjects.
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Affiliation(s)
- Alison D Murray
- Department of Radiology, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland.
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Abstract
Patients with diabetes mellitus have a 2- to 4-fold increased risk of atherosclerotic cardiovascular, peripheral vascular, and cerebrovascular disease, which are the leading causes of morbidity and mortality in this population. Several epidemiological studies have shown an association between diabetic dyslipidemia, which is characterized by hypertriglyceridemia, low levels of high density lipoprotein-cholesterol, postprandial lipemia and small, dense low density lipoprotein-cholesterol (LDL-C) particles, and the occurrence of cardiovascular disease. Other studies have established the beneficial effects of lipid lowering on the reduction of major coronary events in diabetic patients. The recent National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines emphasize diabetes as a coronary heart disease risk equivalent. The NCEP ATP III states that elevated LDL-C is a major risk factor for coronary heart disease, and the primary goal of risk-reduction therapy is the reduction of LDL-C levels to 100 mg/dL. This article defines and describes diabetic dyslipidemia and its etiology and pathogenesis, as well as reviewing guidelines and recommendations for treatment of this disorder. Treatment of diabetic dyslipidemia includes 1) lifestyle modifications: physical activity and a diet low in saturated fats and cholesterol and high in complex carbohydrates and fiber; and 2) pharmacological treatment with (i) oral antihyperglycemic agents: metformin and thiazolidinediones; (ii) weight reduction drugs: orlistat and sibutramine and; (iii) lipid-lowering drugs: HMG-CoA reductase inhibitors, fibric acid derivatives, nicotinic acid, and bile acid sequestrants.
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Affiliation(s)
- Elena Izkhakov
- Metabolic Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Vinck EM, Cagnie BJ, Cornelissen MJ, Declercq HA, Cambier DC. Green Light Emitting Diode Irradiation Enhances Fibroblast Growth Impaired by High Glucose Level. Photomed Laser Surg 2005; 23:167-71. [PMID: 15910180 DOI: 10.1089/pho.2005.23.167] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The chronic metabolic disorder diabetes mellitus is an important cause of morbidity and mortality due to a series of common secondary metabolic complications, such as the development of severe, often slow healing skin lesions. In view of promoting the wound-healing process in diabetic patients, this preliminary in vitro study investigated the efficacy of green light emitting diode (LED) irradiation on fibroblast proliferation and viability under hyperglycemic circumstances. MATERIALS AND METHODS To achieve hyperglycemic circumstances, embryonic chicken fibroblasts were cultured in Hanks' culture medium supplemented with 30 g/L glucose. LED irradiation was performed on 3 consecutive days with a probe emitting green light (570 nm) and a power output of 10 mW. Each treatment lasted 3 min, resulting in a radiation exposure of 0.1 J/cm2. RESULTS A Mann-Whitney U test revealed a higher proliferation rate (p = 0.001) in all irradiated cultures in comparison with the controls. CONCLUSION According to these results, the effectiveness of green LED irradiation on fibroblasts in hyperglycemic circumstances is established. Future in vivo investigation would be worthwhile to investigate whether there are equivalent positive results in diabetic patients.
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Affiliation(s)
- Elke M Vinck
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, 9000 Ghent, Belgium.
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Nakagami T. Hyperglycaemia and mortality from all causes and from cardiovascular disease in five populations of Asian origin. Diabetologia 2004; 47:385-394. [PMID: 14985967 DOI: 10.1007/s00125-004-1334-6] [Citation(s) in RCA: 217] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Revised: 09/05/2003] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS The study was done to assess how well fasting and 2-h plasma glucose (FPG, 2-h PG) after a 75-g OGTT predict cardiovascular disease (CVD) and all-cause mortality in Asian subjects. METHODS People ( n=6817) of Japanese and Asian Indian origin from five prospective studies in five countries were monitored for 5 to 10 years. Hazard ratios for death from all causes and CVD were estimated using Cox proportional hazard models, adjusting for FPG, 2-h PG and established risk factors. RESULTS Multivariate Cox regression analysis showed that an increase in FPG from 7.0 to 8.0 mmol/l (increase of 0.76 SD) increased relative risk (95% CI) by 1.14 (1.05-1.25) for all-cause and 1.24 (1.10-1.39) for CVD mortality. An increase in 2-h PG from 9.0 to 11.9 mmol/l (0.76 SD) increased relative risks by 1.29 (1.18-1.41) and 1.35 (1.19-1.54). Inclusion of 2-h PG in the FPG model improved the predictive value ( p<0.001), whereas FPG did not influence the predictive value of 2-h PG ( p>10). In a model containing FPG and 2-h PG, hazards ratios for 2-h PG in subjects with IGT or diabetes were 1.35 (1.03-1.77) or 3.03 (2.18-4.21) for all-cause and 1.27 (0.86-1.88) or 3.39 (2.14-5.37) for CVD mortality, compared with normal subjects. The respective hazards ratio for FPG in subjects with IFG or diabetes were 0.94 (0.68-1.31) or 0.88 (0.59-1.32) for all-cause and 1.05 (0.67-1.65) or 0.88 (0.51-1.51) for CVD mortality, compared with normal subjects. CONCLUSIONS/INTERPRETATION For prediction of premature death, 2-h PG was superior to FPG in several Asian populations.
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Affiliation(s)
- T Nakagami
- Steno Diabetes Centre, Niels Steensense Vej 2, 2820, Gentofte, Denmark.
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Pickup JC, Mattock MB. Activation of the innate immune system as a predictor of cardiovascular mortality in Type 2 diabetes mellitus. Diabet Med 2003; 20:723-6. [PMID: 12925051 DOI: 10.1046/j.1464-5491.2003.00990.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS Activation of innate immunity may play a major role in the development and pathophysiology of Type 2 diabetes; we therefore investigated whether a marker of innate immunity (serum sialic acid) predicts cardiovascular disease (CVD) and all-cause mortality in Type 2 diabetes. METHODS Type 2 diabetic subjects (n=128, age 31-64 years at outset) participating in the Lewisham Diabetes Survey were followed up for a mean of 12.8 years. Baseline measurements were made of serum sialic acid and known or putative risk factors for CVD. Cause of death was coded from death certificates, post mortem examination and hospital records. RESULTS Fifty-six (43%) subjects had died after 12.8 years. The major cause of death was CVD (71.4%), predominantly coronary heart disease (62.5%). Baseline variables significantly associated with CVD mortality were sialic acid and CVD (borderline significance smoking and cholesterol). In multivariate analysis, significant independent predictors of CVD mortality were sialic acid [standardized relative risk (95% confidence interval) 1.53 (1.12, 2.10)], age, male sex and existing CVD. CONCLUSIONS Activated innate immunity (low-grade inflammation) is a risk factor for CVD mortality in Type 2 diabetes, independently of other known risk factors, including existing CVD. Since activation of the innate immune system predicts Type 2 diabetes, it may be a common antecedent of both Type 2 diabetes and CVD.
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Affiliation(s)
- J C Pickup
- Metabolic Unit, Guy's, King's and St Thomas's School of Medicine, Guy's Hospital, London, UK.
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Krentz AJ. Sulfonylureas in the prevention of vascular complications: from UKPDS to the ADVANCE study. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0531-5131(02)01278-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bonds DE, Zaccaro DJ, Karter AJ, Selby JV, Saad M, Goff DC. Ethnic and racial differences in diabetes care: The Insulin Resistance Atherosclerosis Study. Diabetes Care 2003; 26:1040-6. [PMID: 12663570 DOI: 10.2337/diacare.26.4.1040] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes and its complications disproportionately affect African Americans and Hispanics. Complications could be prevented with appropriate medical care. We compared five processes of care and three outcomes of care among African Americans, Hispanics, and non-Hispanic whites. RESEARCH DESIGN AND METHODS We used data from the Insulin Resistance Atherosclerosis Study (1993-1998) of participants with known diabetes. African Americans and Hispanics were compared with non-Hispanic whites from the same region. Five process measures (treatment of diabetes, hypertension, hyperlipidemia, albuminuria, and coronary artery disease) and three outcome measures (control of diabetes, hypertension, and hyperlipidemia) were evaluated. RESULTS Comparison groups were similar in baseline characteristics. African Americans and Hispanics were equally likely as their non-Hispanic white comparison group to receive treatment for diabetes, hypertension, hyperlipidemia, albuminuria, and coronary artery disease, although treatment rates for hyperlipidemia and albuminuria were poor for all groups. African Americans were more likely to have poorly controlled diabetes (HbA(1c) >8.0%: OR 2.23, 95% CI 1.26-3.94). Both African American and Hispanics were significantly more likely to have borderline or poorly controlled hypertension than non-Hispanic whites (blood pressure >130-140/85-90 or >140/90 mmHg: African American/non-Hispanic white OR 3.22, 95% CI 1.57-6.59; Hispanic/non-Hispanic white 3.14, 1.35-7.3). CONCLUSIONS The rates of treatment for diabetes and associated comorbidities are similar across all three ethnic groups. Few individuals in any ethnic group received treatment for hyperlipidemia and albuminuria. Ethnic disparities exist in control of diabetes and hypertension. Programs should be tested to improve overall quality of care and eliminate these disparities.
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Affiliation(s)
- Denise E Bonds
- Section on General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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Gimeno Orna J, Boned Juliani B, Lou Arnal L, Castro Alonso F. Microalbuminuria y proteinuria clínica como principales predictores de morbimortalidad cardiovascular en pacientes con diabetes tipo 2. Rev Clin Esp 2003. [DOI: 10.1016/s0014-2565(03)71346-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gil Extremera B, Maldonado Martín A, Soto Más JA, Gómez Jiménez FJ. [Postprandial hyperglycemia as cardiovascular risk factor]. Rev Clin Esp 2002; 202:399-402. [PMID: 12139826 DOI: 10.1016/s0014-2565(02)71090-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- B Gil Extremera
- Unidad de Hipertensión y Lípidos, Servicio de Medicina Interna A, Hospital Clínico San Cecilio, Granada, Spain
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40
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Abstract
Diabetes mellitus is among the diseases with great impact on health and society, not only for its high prevalence but also for its chronic complications and high mortality. The most precise method to investigate the prevalence of diabetes is by oral glucose tolerance testing. In Spain, the prevalence of diabetes in the 30-65 year-old population is estimated to be 6.5% among 30-to-65- year old, and 10.3% among the 30-to-89 year-old population. The ratio of known to unknown diabetes ranges from 1:3 to 2:3. The incidence of diabetes mellitus type 2 in Spain is 8/1000 persons per year, and the incidence of type 1 is 11 to 12 cases per 100,000 persons per year. The prevalence of chronic complications varies according to type of diabetes, time since onset and degree of metabolic control: neuropathy 25%, retinopathy 32% and nephropathy 23%. Diabetes is one of the most important causes of death in Spain, occupying third place for women and seventh for men.
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Affiliation(s)
- Alberto Goday
- Servicio de Endocrinología, Hospital Universitario del Mar, Barcelona, Spain
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Sampson MJ, Gopaul N, Davies IR, Hughes DA, Carrier MJ. Plasma F2 isoprostanes: direct evidence of increased free radical damage during acute hyperglycemia in type 2 diabetes. Diabetes Care 2002; 25:537-41. [PMID: 11874943 DOI: 10.2337/diacare.25.3.537] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Acute hyperglycemia in type 2 diabetes increases the generation of plasma 8-epi-prostaglandin F2 (8-epi-PGF2alpha) isoprostane, a sensitive direct marker of in vivo free radical oxidative damage to membrane phospholipids. RESEARCH DESIGN AND METHODS A total of 21 patients with type 2 diabetes underwent an oral 75-g glucose tolerance test. Plasma 8-epi-PGF2alpha isoprostane concentrations (by gas chromatography [GC]/mass spectrometry [MS]), intralymphocyte reduced-to-oxidized glutathione ratios, and plasma total antioxidant capacity were measured at baseline and 90 min after glucose loading. RESULTS Plasma 8-epi-PGF2alpha isoprostane concentrations rose significantly (P=0. 010) from 0.241 +/- 0.1 to 0.326 +/- 0.17 ng/l after 90 min. Intracellular oxidative balance and plasma antioxidant capacity did not change in either group. CONCLUSIONS Plasma concentrations of 8-epi-PGF2alpha isoprostane increase during acute hyperglycemia in type 2 diabetes, providing direct evidence of free radical-mediated oxidative damage and demonstrating a pathway for an association between acute rather than fasting hyperglycemia and macrovascular risk in type 2 diabetes.
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Affiliation(s)
- Michael J Sampson
- Bertram Diabetes Research Unit, Norfolk and Norwich University Hospital National Health Service Trust, Norwich, UK.
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Belfort R, Oliveira JEPD. Mortalidade por diabetes mellitus e outras causas no município do Rio de Janeiro: diferenças por sexo e idade. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0004-27302001000500009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objetivo: O diabetes mellitus (DM) é considerado um problema de saúde pública em razão de sua alta prevalência e pelo fato de que a maioria dos seus portadores não está em tratamento adequado e, portanto, exposta ao risco de desenvolver altas taxas de morbidade e mortalidade. A análise dos registros contidos nas declarações de óbito é uma das formas de se avaliar o impacto desta síndrome na sociedade. Este estudo objetiva analisar comparativamente óbitos por DM e outras causas na população geral do Rio de Janeiro (RJ). Materiais, métodos e desenho da pesquisa: Os dados foram obtidos do banco de dados de Mortalidade da Secretaria Municipal de Saúde do RJ. Compararam-se os óbitos por DM como causa básica ocorridos no município do RJ nos anos de 1994, 1995 e 1996 com os óbitos ocorridos na população geral em relação aos critérios de sexo e grupo etário. Resultados: Até os 50 anos as mulheres com DM e aquelas sem DM apresentam mortalidade proporcional semelhante. Após os 50 anos, as mulheres com DM têm valores percentuais mais elevados do que as sem DM. Já entre os homens, os sem DM têm percentuais de mortalidade maiores até os 60 anos, quando então são ultrapassados pelos portadores de DM. Conclusão: No conjunto dos óbitos nos três anos entre os diabéticos, as mulheres apresentam percentual de mortalidade superior ao dos homens. Já entre as demais causas de óbitos nos três anos, o predomínio foi do sexo masculino. Portanto, sugerindo menor sobrevida das mulheres entre os diabéticos e dos homens entre as outras causas de óbitos.
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Affiliation(s)
- Renata Belfort
- Secretaria Municipal de Saúde do Município do Rio de Janeiro; Universidade Fedral do Rio de Janeiro
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Abstract
Diabetes-related cardiovascular disease remains the leading cause of death in patients with type 2 diabetes. Hypertension is common among diabetics and has the same pathogenetic mechanisms as insulin resistance, in which the activated renin-angiotensin system contributes to the emerging high blood pressure and hyperglycemia. Hyperglycemia is one of the triggering factors for vascular dysfunction and clotting abnormalities and, therefore, for accelerated atherosclerosis in diabetes. Glycated hemoglobin levels, as a reflection of the degree of glycemia, are strongly associated with the risk of cardiovascular disease in diabetics and in the general population. Tight glycemic control, the treatment of dyslipidemia and raised blood pressure, in addition to the use of antiplatelet therapy, all powerfully reduce the risks associated with diabetes. Furthermore, angiotensin-converting enzyme inhibitors might offer additional cardioprotection to diabetics above that provided by blood pressure reduction.
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Affiliation(s)
- D Kirpichnikov
- Endocrinology, Diabetes and Hypertension, SUNY Downstate, 11203, Brooklyn, New York, USA
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Abstract
Diabetes is common in the elderly population. By the age of 75, approximately 20% of the population are afflicted with this illness. Diabetes in elderly adults is metabolically distinct from diabetes in younger patient populations, and the approach to therapy needs to be different in this age group. Diabetes is associated with substantial morbidity from macro- and microvascular complications. Several lines of evidence suggest that optimal glycemic control and risk factor modification can substantially reduce the risk of complications in elderly patients. In the past, treatment options were limited. However, recent studies have delineated several new and exciting therapeutic opportunities for elderly patients with diabetes.
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Affiliation(s)
- G S Meneilly
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ (CLINICAL RESEARCH ED.) 2000; 321:405-12. [PMID: 10938048 PMCID: PMC27454 DOI: 10.1136/bmj.321.7258.405] [Citation(s) in RCA: 5718] [Impact Index Per Article: 238.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the relation between exposure to glycaemia over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes. DESIGN Prospective observational study. SETTING 23 hospital based clinics in England, Scotland, and Northern Ireland. PARTICIPANTS 4585 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk. OUTCOME MEASURES Primary predefined aggregate clinical outcomes: any end point or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photo-coagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 1% reduction in updated mean HbA(1c) adjusted for possible confounders at diagnosis of diabetes. RESULTS The incidence of clinical complications was significantly associated with glycaemia. Each 1% reduction in updated mean HbA(1c) was associated with reductions in risk of 21% for any end point related to diabetes (95% confidence interval 17% to 24%, P<0.0001), 21% for deaths related to diabetes (15% to 27%, P<0.0001), 14% for myocardial infarction (8% to 21%, P<0.0001), and 37% for microvascular complications (33% to 41%, P<0.0001). No threshold of risk was observed for any end point. CONCLUSIONS In patients with type 2 diabetes the risk of diabetic complications was strongly associated with previous hyperglycaemia. Any reduction in HbA(1c) is likely to reduce the risk of complications, with the lowest risk being in those with HbA(1c) values in the normal range (<6.0%).
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Affiliation(s)
- I M Stratton
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE.
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Puig-Domingo M. Control of postprandial state abnormalities: meeting the challenge of type 2 diabetes? Eur J Clin Invest 2000; 30 Suppl 2:19-24. [PMID: 10975050 DOI: 10.1046/j.1365-2362.30.s2.4.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M Puig-Domingo
- Hospital de Mataró Research Unit, Carretera de Cirera, Mataró, Spain.
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Affiliation(s)
- P D Home
- Newcastle Diabetes Centre, and Human Diabetes and Metabolism Research Centre, University of Newcastle upon Tyne, UK.
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Affiliation(s)
- N F Wiernsperger
- LiPHA/INSERM U, 352 Diabetic Microangiopathy Research Unit, F-69621 Villeurbanne, France.
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