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Huang CT, Muo CH, Sung FC, Chen PC. Risk of chronic kidney disease in patients with a hyperglycemic crisis as the initial presentation of type 2 diabetes. Sci Rep 2024; 14:16746. [PMID: 39033190 PMCID: PMC11271453 DOI: 10.1038/s41598-024-67678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
Limited data exist on long-term renal outcomes in patients with hyperglycemic crisis (HC) as initial type 2 diabetes presentation. We evaluated the risk of chronic kidney disease (CKD) development in those with concurrent HC at diagnosis. Utilizing Taiwan's insurance claims from adults newly diagnosed with type 2 diabetes during 2006-2015, we created HC and matched non-HC cohorts. We assessed incident CKD/diabetic kidney disease (DKD) by 2018's end, calculating the hazard ratio (HR) with the Cox model. Each cohort comprised 13,242 patients. The combined CKD and DKD incidence was two-fold higher in the HC cohort than in the non-HC cohort (56.47 versus 28.49 per 1000 person-years) with an adjusted HR (aHR) of 2.00 (95% confidence interval [CI] 1.91-2.10]). Risk increased from diabetic ketoacidosis (DKA) (aHR:1.69 [95% CI 1.59-1.79]) to hyperglycemic hyperosmolar state (HHS) (aHR:2.47 [95% CI 2.33-2.63]) and further to combined DKA-HHS (aHR:2.60 [95% CI 2.29-2.95]). Subgroup analysis in individuals aged ≥ 40 years revealed a similar trend with slightly reduced incidences and HRs. Patients with HC as their initial type 2 diabetes presentation face a higher CKD risk than do those without HC. Enhanced medical attention and customized interventions are crucial to reduce this risk.
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Affiliation(s)
- Chun-Ta Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei City, 104217, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, 252005, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung City, 404328, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung City, 404328, Taiwan.
- Department of Health Services Administration, China Medical University College of Public Health, 100 Jingmao Road Section 1, Beitun Dist., Taichung, 406040, Taiwan.
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, 413305, Taiwan.
| | - Pei-Chun Chen
- International Master Program for Public Health, China Medical University, Taichung, 406040, Taiwan
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2
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Tassew WC, Bayeh GM, Ferede YA, Zeleke AM. Poor treatment outcome and associated factors of hyperglycemic emergencies among diabetic patients in Ethiopia: A systematic review and meta-analysis. Metabol Open 2024; 21:100275. [PMID: 38455228 PMCID: PMC10918420 DOI: 10.1016/j.metop.2024.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
Background Despite the fact that hyperglycemic crisis poses a significant threat to the health care systems of developing countries like Ethiopia, there is a dearth of reliable data regarding the poor treatment outcome and associated factors among hyperglycemic emergencies in Ethiopia. Therefore, this review aimed to assess poor treatment outcome and associated factors of hyperglycemic emergencies among diabetic patients in Ethiopia. Methods Published articles regarding poor treatment outcome and associated factors of hyperglycemic emergencies among diabetic patients in Ethiopia were extensively searched from PubMed, Google Scholar, Cochrane library, and African journal online. After extraction, data were exported to Stata software version 11 (Stata Corp LLC, TX, USA) for analysis. Statistically, the Cochrane Q-test and I2 statistics were used to determine the presence or absence of heterogeneity. Results 3650 duplicates were eliminated from the 4291 papers (PubMed [18], Google scholar (1170), African journal online [21], and Cochrane library (3082)). The pooled estimate of poor treatment outcome among hyperglycemic emergencies in Ethiopia is found to be 16.21% (95% CI: 11.01, 21.41, P < 0.001). Creatinine level >1.2 mg/dl, stroke, sepsis and comorbidity were associated factors of poor treatment outcome. Conclusion Poor treatment outcome from hyperglycemic emergencies among diabetic patients was found to be high. Poor treatment outcome was predicted for those patients who had creatinine level >1.2 mg/dl, stroke, sepsis and comorbidity. As a result, we recommend healthcare providers to monitor thoroughly and have close follow-ups for patients with the identified predictors to improve poor treatment outcome from hyperglycemic crises.
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Affiliation(s)
- Worku Chekol Tassew
- Department of Medical Nursing, Teda Health Science College, Gondar, Ethiopia
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3
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Wang L, Wang M, Du J, Gong ZC. Intensive insulin therapy in sepsis patients: Better data enables better intervention. Heliyon 2023; 9:e14063. [PMID: 36915524 PMCID: PMC10006498 DOI: 10.1016/j.heliyon.2023.e14063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
In clinics, sepsis is a critical disease that often develops into shock and multiple organ dysfunction, leading to a serious threat of death. Patients with sepsis are often accompanied by stress hyperglycemia which is an independent risk factor for poor prognosis in sepsis. Thus, the treatment for stress hyperglycemia has attracted more and more attention, among which intensive insulin therapy is widely concerned. However, the benefits and harms of intensive insulin therapy for sepsis patients remain controversial. What the existing literature discusses mostly are the clinical benefit and hypoglycemia risk of intensive insulin therapy, but there is no conclusion on the target range of blood glucose control, the applicable patients, the timing of treatment initiation, and how to avoid the risk. In this study, we have analyzed and summarized the existing literature, hoping to determine the adverse and clinical benefit of intensive insulin therapy in sepsis. And we attempt to assemble better evidence to propose a better recommendation on hyperglycemia intervention for sepsis patients.
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Affiliation(s)
- Ling Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Min Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Du
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Cheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Liston K, Manecksha RP, Woods CP. Hyperglycaemic crisis secondary to emphysematous pyelonephritis. BMJ Case Rep 2021; 14:e242617. [PMID: 34380678 PMCID: PMC8359521 DOI: 10.1136/bcr-2021-242617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old woman presented to the emergency department acutely unwell. Initial investigations revealed hyperglycaemia, ketosis and an acute kidney injury precipitated by urosepsis. She was found to have a new diagnosis of diabetes mellitus (type 2) with a glycated haemoglobin (HbA1c) of 156 mmol/mol. CT imaging of the abdomen and pelvis revealed unilateral emphysematous pyelonephritis (EPN), radiologically classified as stage 3 severity with gas extending beyond the renal collecting system. Escherichia coli was grown on blood and urine cultures. This was sensitive to second-generation cephalosporin cefuroxime. The patient was managed with fluid resuscitation, intravenous antibiotics and renal system decompression with urinary catheter insertion. She was commenced on an intravenous insulin infusion for hyperglycaemic crisis. This case illustrates a rare presentation of hyperglycaemic crisis precipitated by EPN in a patient without a previously known diagnosis of diabetes, successfully treated with medical management alone. Close clinical and radiological follow-up was arranged to monitor the need for future nephrectomy.
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Affiliation(s)
- Katie Liston
- Endocrinology, HSE Library East, Naas, Ireland
- Endocrinology, Naas General Hospital, Naas, Kildare, Ireland
- Tallaght University Hospital, Dublin, Dublin, Ireland
| | - Rustom P Manecksha
- Urology, Tallaght University Hospital, Dublin, Dublin, Ireland
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Conor P Woods
- Endocrinology, Naas General Hospital, Naas, Kildare, Ireland
- Tallaght University Hospital, Dublin, Dublin, Ireland
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Gebremedhin G, Enqueselassie F, Yifter H, Deyessa N. Hyperglycemic Crisis Characteristics and Outcome of Care in Adult Patients without and with a History of Diabetes in Tigrai, Ethiopia: Comparative Study. Diabetes Metab Syndr Obes 2021; 14:547-556. [PMID: 33603420 PMCID: PMC7881788 DOI: 10.2147/dmso.s275552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare hyperglycemic crisis characteristics and outcomes of care in adult patients without and with a history of diabetes in Tigrai, Ethiopia. METHODS A retrospective record review of diabetes patients, 196 without and 393 with a history of diabetes who had been treated in the medical wards from September 1/2017 to August 31/2018, aged 18 years and above was included. An independent-samples t-test/Mann-Whitney tests, χ2-test, and logistic regression analysis were used to analyze the data using SPSS version 25.0. RESULTS Patients without history of diabetes were younger [43.9±12.6 vs 48.4±14.9], more rural residents [53.1% vs 30.3%], lower proportion of type 2 diabetes [38.3% vs 53.7%], hyperosmolar hyperglycemic state [15.8% vs 31.8%], with lower mortality rate [8.7% vs 15.5%] compared to with a history of diabetes. A higher mortality reported in rural residents [13.5% vs 3.3%; without vs 21.8% vs 12.8%; with history], and lower urine ketones [1.9± 1.3 vs 2.8± 1.1; without vs 1.6± 1.2 vs 2.2± 1.0; with a history] compared to their counterparts in both patients, respectively. Rural residents [AOR (95% CI); 3.1 (1.8, 5.4)]; medical history of stroke [AOR (95% CI); 2.7 (1.3, 5.6)]; type 2 diabetes [AOR (95% CI); 2.3 (1.1, 4.7)], hyperglycemic hyperosmolar state [AOR (95% CI); 2.4 (1.1, 5.4)]; and with a history of diabetes [AOR (95% CI); 2.0 (1.04, 3.8)] were significantly associated with mortality, but polydipsia [AOR (95% CI); 0.47 (0.27, 0.81)] was preventive. CONCLUSION This finding suggests that rural residents, medical history of stroke, type 2 diabetes, hyperglycemic hyperosmolar state, and with a history of diabetes were independent predictors of mortality while polydipsia was preventive. Therefore, the need for more public health awareness campaigns, screening for people having known risk factors, and expansion of diabetes care services to the primary health care units is a fundamental measure.
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Affiliation(s)
- Getachew Gebremedhin
- Department of Community Health and Preventive Medicines, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Getachew Gebremedhin Email
| | - Fikre Enqueselassie
- Department of Community Health and Preventive Medicines, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helen Yifter
- Department of Endocrinology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Community Health and Preventive Medicines, Addis Ababa University, Addis Ababa, Ethiopia
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Chou CH, Feng IJ, Chen YC, Chen JH, Lin HJ, Wang JJ, Hsu CC, Huang CC. Risk of Dementia in Diabetic Patients with Hyperglycemic Crisis: A Nationwide Taiwanese Population-Based Cohort Study. Neuroepidemiology 2020; 54:419-426. [PMID: 32841952 DOI: 10.1159/000509754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A hyperglycemic crisis episode (HCE) signifies poor control of diabetes and may increase the risk of dementia via microvascular and macrovascular injuries. OBJECTIVES We conducted this study to clarify this issue, which remains unclear. METHODS Using the Taiwan National Health Insurance Database, we identified 9,466 diabetic patients with HCE and the identical number of diabetic patients without HCE who were matched by age and sex for this nationwide population-based cohort study. The risk of dementia was compared between the 2 cohorts by following up until 2014. Investigation of independent predictors of dementia was also done. RESULTS In the overall analysis, the risk of dementia between the 2 cohorts was not different. However, stratified analyses showed that patients with HCE had a higher risk of subsequent dementia in the age subgroup of 45-54 and 55-64 years (adjusted odds ratio [AOR]: 2.4, 95% confidence interval [CI]: 1.6-3.6, and AOR: 1.2, 95% CI: 1.0-1.5, respectively). In the overall analysis, older age, female sex, ≥3 HCEs, hypertension, hyperlipidemia, depression, cerebrovascular disease, Parkinson's disease, and head injury were independent predictors. CONCLUSIONS HCE increased the risk of dementia in diabetic patients aged 45-64 years. Dementia was predicted by ≥3 HCEs. Prevention of recurrent HCE, control of comorbidities, and close follow-up of cognitive decline and dementia are suggested in patients with HCE.
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Affiliation(s)
- Chih-Ho Chou
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - I-Jung Feng
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.,Fu Jen Catholic University School of Medicine, Taipei, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan, .,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan, .,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,
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Siddiqi L, VanAarsen K, Iansavichene A, Yan J. Risk Factors for Adverse Outcomes in Adult and Pediatric Patients With Hyperglycemia Presenting to the Emergency Department: A Systematic Review. Can J Diabetes 2019; 43:361-369.e2. [PMID: 30846250 DOI: 10.1016/j.jcjd.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/29/2022]
Abstract
Hyperglycemia is a significant cause of morbidity and mortality, often resulting in adverse outcomes. This review aimed to identify predictors of adverse outcomes, such as repeated hospital visits, hospitalization or death, in patients presenting to the emergency department (ED) with hyperglycemia. Electronic searches of Medline and EMBASE were conducted for studies in English of patients presenting to the ED with hyperglycemia. Both adult and pediatric populations were included, with and without diabetes. Two reviewers independently screened all titles and abstracts for relevance. If consensus was not reached, full-length manuscripts were reviewed. For discrepancies, a third reviewer was consulted. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Study- and patient-specific data were extracted and presented descriptively. Eight observational studies were reviewed; they included a total of 96,970 patients. Predictors of adverse outcomes included age, lowest income quintile, urban dwellers, presence of comorbidities, coexisting hyperlactatemia, having a family physician, elevated serum creatinine level, diabetes managed with insulin, sentinel visit for hyperglycemia in the past month, and high blood glucose level measured in the ED. Conflicting evidence was found for whether known history of diabetes was associated with risk. Factors associated with favourable outcomes included systolic blood pressure of 90 to 150 mmHg and tachycardia. This systematic review found 12 factors associated with adverse outcomes, and 2 factors associated with more favourable outcomes in patients presenting to the ED with hyperglycemia. These factors should be considered for easier identification of patients at higher risk for adverse outcomes to guide management and follow up.
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Affiliation(s)
- Lubna Siddiqi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Kristine VanAarsen
- London Health Sciences Centre, Division of Emergency Medicine, London, Ontario, Canada
| | | | - Justin Yan
- Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; St. Joseph's Healthcare London, London, Ontario, Canada
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8
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Kao Y, Feng IJ, Hsu CC, Wang JJ, Lin HJ, Huang CC. Association of hyperglycemic crisis with an increased risk of end-stage renal disease: A nationwide population-based cohort study. Diabetes Res Clin Pract 2018; 138:106-112. [PMID: 29409767 DOI: 10.1016/j.diabres.2018.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/23/2017] [Accepted: 01/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND A hyperglycemic crisis episode (HCE) is associated with poor management of diabetes, which is a risk factor for end-stage renal disease (ESRD); however, the association between an HCE and ESRD has not been clarified. We conducted a nationwide population-based cohort study with the purpose of delineating this issue. METHODS We identified 9208 diabetic patients with an HCE and an identical number of diabetic patients with matched age, sex, and index date without an HCE between 2000 and 2002. A comparison of the risk of ESRD between the diabetic patients with and without an HCE was achieved by a follow-up until 2014. RESULTS A Cox proportional hazard regression analysis showed that the diabetic patients with an HCE were at a higher risk of ESRD than those without an HCE (the adjusted hazard ratio [AHR]: 1.47; 95% confidence interval [CI]: 1.34-1.62) by adjusting for renal disease, hypertension, hyperlipidemia, coronary artery disease, hyperuricemia, anemia, chronic obstructive pulmonary disease, liver disease, malignancy, connective tissue disease, non-steroid anti-inflammatory drug use, and monthly income. The increased risk of ESRD was more prominent in the age subgroup of 15-25 years (AHR: 4.91; 95% CI: 1.92-12.56); 25-35 years (AHR: 2.42; 95% CI: 1.51-3.86); 35-45 years (AHR: 3.01; 95% CI: 2.21-4.09); and 45-55 years (AHR: 1.75; 95% CI: 1.41-2.19). CONCLUSIONS An HCE was associated with an increased risk of ESRD, especially in the younger diabetic patients (15-55 years). A close follow-up for the control of diabetes and for monitoring renal function is proposed.
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Affiliation(s)
- Yuan Kao
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - I-Jung Feng
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
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Choi SI, Lee HA, Han JS. Gynura procumbens extract improves insulin sensitivity and suppresses hepatic gluconeogenesis in C57BL/KsJ- db/db mice. Nutr Res Pract 2016; 10:507-515. [PMID: 27698958 PMCID: PMC5037068 DOI: 10.4162/nrp.2016.10.5.507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/29/2016] [Accepted: 05/10/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study was designed to investigate whether Gynura procumbens extract (GPE) can improve insulin sensitivity and suppress hepatic glucose production in an animal model of type 2 diabetes. MATERIALS/METHODS C57BL/Ksj-db/db mice were divided into 3 groups, a regular diet (control), GPE, and rosiglitazone groups (0.005 g/100 g diet) and fed for 6 weeks. RESULTS Mice supplemented with GPE showed significantly lower blood levels of glucose and glycosylated hemoglobin than diabetic control mice. Glucose and insulin tolerance test also showed the positive effect of GPE on increasing insulin sensitivity. The homeostatic index of insulin resistance was significantly lower in mice supplemented with GPE than in the diabetic control mice. In the skeletal muscle, the expression of phosphorylated AMP-activated protein kinase, pAkt substrate of 160 kDa, and PM-glucose transporter type 4 increased in mice supplemented with GPE when compared to that of the diabetic control mice. GPE also decreased the expression of glucose-6-phosphatase and phosphoenolpyruvate carboxykinase in the liver. CONCLUSIONS These findings demonstrate that GPE might improve insulin sensitivity and inhibit gluconeogenesis in the liver.
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Affiliation(s)
- Sung-In Choi
- Department of Food Science and Nutrition, Pusan National University, Jangjeon 2-dong, Geumjeong-gu, Busan 46241, Korea
| | - Hyun-Ah Lee
- Department of Food Science and Nutrition, Pusan National University, Jangjeon 2-dong, Geumjeong-gu, Busan 46241, Korea
| | - Ji-Sook Han
- Department of Food Science and Nutrition, Pusan National University, Jangjeon 2-dong, Geumjeong-gu, Busan 46241, Korea.; Research Institute of Ecology for the Elderly, Pusan National University, Busan 46241, Korea
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10
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Cheng PC, Hsu SR, Cheng YC. Association between Serum Albumin Concentration and Ketosis Risk in Hospitalized Individuals with Type 2 Diabetes Mellitus. J Diabetes Res 2016; 2016:1269706. [PMID: 27504458 PMCID: PMC4967705 DOI: 10.1155/2016/1269706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 06/26/2016] [Indexed: 12/24/2022] Open
Abstract
Objective. This study examined the association between serum albumin concentration and ketosis risk in hospitalized individuals with type 2 diabetes mellitus (T2DM). Methods. A retrospective cross-sectional study was conducted at a medical center in Taiwan. Inclusion criteria were endocrinology ward inpatients exceeding 21 years of age, with preexisting diagnosis of T2DM, and blood glucose above 13.9 millimoles per liter (mmol/L) at admission. Individuals without measurement of serum albumin, urine ketone, or hemoglobin A1C, or harboring active infection, myocardial infarction, cerebrovascular event, cirrhosis, malignancy, or overt proteinuria were excluded. Using serum albumin concentration below 3.0 grams per deciliter to define hypoalbuminemia, 151 hypoalbuminemic cases and 104 normoalbuminemic controls were enrolled. The presence of ketones in urine established ketosis. Results. The prevalence of ketonuria was 48% in hypoalbuminemic subjects compared to 30% in normoalbuminemic controls (odds ratio (OR): 2.15; 95% confidence interval (CI): 1.26-3.57; P = 0.004). Moreover, among the 156 subjects with serum beta-hydroxybutyrate measurement in addition to urine ketone, 33% of the hypoalbuminemic individuals had ketonemia exceeding 3 mmol/L compared to 19% of those with normoalbuminemia (OR: 2.12, 95% CI: 0.99-4.48, P = 0.051). Conclusions. Serum albumin concentration is inversely associated with ketosis risk in hospitalized individuals with T2DM.
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Affiliation(s)
- Po-Chung Cheng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua City, Changhua County 500, Taiwan
| | - Shang-Ren Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua City, Changhua County 500, Taiwan
- *Shang-Ren Hsu:
| | - Yun-Chung Cheng
- Department of Radiology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sector 4, Taichung 40705, Taiwan
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11
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Kao Y, Hsu CC, Weng SF, Lin HJ, Wang JJ, Su SB, Huang CC, Guo HR. Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study. Endocrine 2016; 51:72-82. [PMID: 26115971 DOI: 10.1007/s12020-015-0669-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/16/2015] [Indexed: 01/14/2023]
Abstract
Hyperglycemic crisis episodes (HCEs)-diabetic ketoacidosis and the hyperosmolar hyperglycemic state-are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan's National Health Insurance Research Database, data from 23,079 non-elder patients (≤65 years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Both groups were compared, and follow-up prognoses were done until 2011. One thousand eighty-five (14.1%) patients with HCE and 725 (4.71%) patients without HCE died (P < 0.0001) during follow-up. Incidence rate ratios (IRR) of mortality were 3.24 times higher in patients with HCE than in patients without HCE (P < 0.0001). Individual analysis of diabetic ketoacidosis and hyperosmolar hyperglycemic state also showed the similar result with combination of both. After stratification by age, mortality was significant higher in the middle age (40-64 years) [IRR 3.29; 95% confidence interval (CI) 2.98-3.64] and young adult (18-39 years) (IRR 3.91; 95% CI 3.28-4.66), but not in the pediatric subgroup (<18 years) (IRR 1.28; 95% CI 0.21-7.64). The mortality risk was highest in the first month (IRR 54.43; 95% CI 27.98-105.89), and still high after 8 years (IRR 2.05; 95% CI 1.55-2.71). After adjusting for age, gender, and selected comorbidities, the mortality hazard ratio for patients with HCE was still four times higher than for patients without HCE. Moreover, older age, male gender, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease were independent mortality predictors. HCE significantly increases the subsequent mortality risk in the non-elderly with diabetes. Strategies for prevention and control of comorbidities are needed as soon as possible.
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Affiliation(s)
- Yuan Kao
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan City, 701, Taiwan.
- Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan City, 701, Taiwan.
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
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Park CJ, Lee HA, Han JS. Jicama (Pachyrhizus erosus) extract increases insulin sensitivity and regulates hepatic glucose in C57BL/Ksj-db/db mice. J Clin Biochem Nutr 2015; 58:56-63. [PMID: 26798198 PMCID: PMC4706093 DOI: 10.3164/jcbn.15-59] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/21/2015] [Indexed: 01/16/2023] Open
Abstract
This study investigated the effect of jicama extract on hyperglycemia and insulin sensitivity in an animal model of type 2 diabetes. Male C57BL/Ksj-db/db mice were divided into groups subsequently fed a regular diet (controls), or diet supplemented with jicama extract, and rosiglitazone. After 6 weeks, blood levels of glucose and glycosylated hemoglobin were significantly lower in animals administered the jicama extract than the control group. Additionally, glucose and insulin tolerance tests showed that jicama extract increased insulin sensitivity. The homeostatic index of insulin resistance was lower in the jicama extract-treated group than in the diabetic control group. Administration of jicama extract significantly enhanced the expressions of the phosphorylated AMP-activated protein kinase and Akt substrate of 160 kDa, and plasma membrane glucose transporter type 4 in skeletal muscle. Jicama extract administration also decreased the expressions of glucose 6-phosphatase and phosphoenol pyruvate carboxykinase in the liver. Jicama extract may increases insulin sensitivity and inhibites the gluconeogenesis in the liver.
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Affiliation(s)
- Chan Joo Park
- Department of Food Science and Nutrition & Research Institute of Ecology for the Elderly, Pusan National University, Busan 609-735, Korea
| | - Hyun-Ah Lee
- Department of Food Science and Nutrition & Research Institute of Ecology for the Elderly, Pusan National University, Busan 609-735, Korea
| | - Ji-Sook Han
- Department of Food Science and Nutrition & Research Institute of Ecology for the Elderly, Pusan National University, Busan 609-735, Korea
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13
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Huang CC, Weng SF, Tsai KT, Chen PJ, Lin HJ, Wang JJ, Su SB, Chou W, Guo HR, Hsu CC. Long-term Mortality Risk After Hyperglycemic Crisis Episodes in Geriatric Patients With Diabetes: A National Population-Based Cohort Study. Diabetes Care 2015; 38:746-51. [PMID: 25665811 DOI: 10.2337/dc14-1840] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/05/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hyperglycemic crisis is one of the most serious diabetes-related complications. The increase in the prevalence of diabetes in the geriatric population leads to a large disease burden, but previous studies of geriatric hyperglycemic crisis were focused on acute hyperglycemic crisis episode (HCE). This study aimed to delineate the long-term mortality risk after HCE. RESEARCH DESIGN AND METHODS This retrospective national population-based cohort study reviewed, in Taiwan's National Health Insurance Research Database, data from 13,551 geriatric patients with new-onset diabetes between 2000 and 2002, including 4,517 with HCE (case subjects) (ICD-9 code 250.1 or 250.2) and 9,034 without HCE (control subjects). The groups were compared and followed until 2011. RESULTS One thousand six hundred thirty-four (36.17%) case and 1,692 (18.73%) control subjects died (P < 0.0001) during follow-up. Incidence rate ratios (IRRs) of death were 2.82 times higher in case subjects (P < 0.0001). The mortality risk was highest in the first month (IRR 26.56; 95% CI 17.97-39.27) and remained higher until 4-6 years after the HCE (IRR 1.49; 95% CI 1.23-1.81). After adjustment for age, sex, selected comorbidities, and monthly income, the mortality hazard ratio was still 2.848 and 4.525 times higher in case subjects with one episode and two or more episodes of hyperglycemic crisis, respectively. Older age, male sex, renal disease, stroke, cancer, chronic obstructive pulmonary disease, and congestive heart failure were independent mortality predictors. CONCLUSIONS Patients with diabetes had a higher mortality risk after HCE during the first 6 years of follow-up. Referral for proper education, better access to medical care, effective communication with a health care provider, and control of comorbidities should be done immediately after HCE.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Emergency Medicine, Kuo General Hospital, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kang-Ting Tsai
- Department of Geriatrics and Gerontology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ping-Jen Chen
- Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan Department of Geriatrics and Gerontology, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Shih-Bin Su
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan Department of Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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