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Zhou XH, Liu SY, Yang B, Li YF, Hou BH. Urinary orosomucoid and retinol binding protein levels as early diagnostic markers for diabetic kidney Disease. BMC Nephrol 2023; 24:357. [PMID: 38049745 PMCID: PMC10696675 DOI: 10.1186/s12882-023-03363-3] [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: 06/02/2023] [Accepted: 10/08/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is the most common microvascular complication of diabetes, which has been a major cause of end-stage renal failure. Diagnosing diabetic kidney disease is important to prevent long-term kidney damage and determine the prognosis of patients with diabetes. In this study, we investigated the clinical significance of combined detection of urine orosomucoid and retinol-binding protein for early diagnosis of diabetic kidney disease. METHODS We recruited 72 newly diagnosed patients with type 2 diabetes and 34 healthy persons from August 2016 to July 2018 at the First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital). Using the Mogensen grading criteria, participants were classified as having diabetes or diabetic kidney disease, and healthy persons constituted the control group. Urine orosomucoid and retinol-binding protein levels were measured and correlated with other variables. RESULTS With the aggravation of renal damage, the level of urinary mucoid protein gradually increased. Urinary retinol-binding protein and microalbumin levels were significantly higher in the diabetes group than in control and nephropathy groups. Orosomucoid and retinol-binding protein might be independent risk factors for diabetes and diabetic kidney disease. Urinary orosomucoid significantly correlated with retinol-binding protein and microalbumin levels in the diabetic kidney disease group. CONCLUSION Elevated urine orosomucoid and retinol-binding protein levels can be detected in the early stages of type 2 diabetic kidney disease. Both of these markers are important for diabetic kidney disease detection and early treatment.
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Affiliation(s)
- Xue-Hong Zhou
- Department of Endocrinology, The First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital), Jiaozuo, China.
| | - Shu-Yan Liu
- Department of Endocrinology, The First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital), Jiaozuo, China
| | - Bo Yang
- Department of Neurology, The First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital), Jiaozuo, China
| | - Yong-Feng Li
- Department of Endocrinology, The First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital), Jiaozuo, China
| | - Bao-Hua Hou
- College of Medicine, Henan Polytechnic University, Jiaozuo, China.
- Central Laboratory, The First Affiliated Hospital of Henan Polytechnic University (Jiaozuo Second People's Hospital), Jiaozuo, China.
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Ferdinand KC, Norris KC, Rodbard HW, Trujillo JM. Humanistic and Economic Burden of Patients with Cardiorenal Metabolic Conditions: A Systematic Review. Diabetes Ther 2023; 14:1979-1996. [PMID: 37751142 PMCID: PMC10597898 DOI: 10.1007/s13300-023-01464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Diabetes is associated with significant economic burden. Moreover, cardiovascular disease (CVD), including heart failure, and chronic kidney disease (CKD) are common comorbidities, leading to premature mortality. We conducted a systematic review to assess the humanistic and economic burden of cardio-renal-metabolic (CRM) conditions in individuals ≥ 18 years with CVD, CKD, and type 2 diabetes mellitus. METHODS We searched Embase® and Medline® databases from 2011 to January 10, 2022 for English publications reporting humanistic and economic burden outcomes from observational studies, real-world evidence, and economic model studies. Intervention and validation studies were excluded. Study quality was assessed using the Newcastle-Ottawa Scale. Abstracts/posters were identified from four conferences (2020-2022). RESULTS Of 1804 studies identified, 22 (including four conference publications) were selected involving 351,296,930 participants (one modeled the US population); eight reported healthcare resource utilization (HCRU), seven only cost data, six HCRU and cost data, one reported quality-of-life data (11/18 and 7/18 had estimated low and medium risk of bias, respectively). Participants were predominantly ≥ 65 years and identified as having White ethnicity. Higher costs and HCRU were observed in patients with all three conditions compared to those with two or none. Urban/metropolitan and insured patients had higher healthcare expenditure and service utilization compared to uninsured and racial/ethnic minority populations. Comorbidities were associated with increased hospitalizations, higher costs, and more emergency department visits. In general, patients identified as having Black ethnicity had low odds of using healthcare services, possibly due to disparities in healthcare access and distrust in the system. Limitations included no adjustment for inflation and a predominance of retrospective studies. CONCLUSIONS This review showed a greater economic burden for patients with CRM conditions, with a clear trend between increasing numbers of comorbidities and increasing healthcare costs/resource use. Comparisons between countries are complicated and the scarcity of evidence from minority racial and ethnic groups and lack of data from non-US geographies warrant further investigation.
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Affiliation(s)
- Keith C Ferdinand
- Cardiology Section, Gerald S. Berenson Endowed Chair in Preventive Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, #8548, New Orleans, LA, 70112, USA.
| | - Keith C Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | | | - Jennifer M Trujillo
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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Xie D, Ma T, Cui H, Li J, Zhang A, Sheng Z, Xie Y. Global burden and influencing factors of chronic kidney disease due to type 2 diabetes in adults aged 20-59 years, 1990-2019. Sci Rep 2023; 13:20234. [PMID: 37981642 PMCID: PMC10658077 DOI: 10.1038/s41598-023-47091-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023] Open
Abstract
Population structure and lifestyles may have contributed to the epidemiological status of Chronic Kidney Disease due to Type 2 Diabetes (CKD-T2D). This study is a secondary data analysis. Using data from the Global Burden of Disease Study, we describe the changes in CKD-T2D burden and its influencing factors in the population aged 20-59 years from 1990 to 2019. Globally, the incidence, death, and Disability Adjusted Life Years (DALYs) rate of CKD-T2D showed an upward trend and increased with age, and the burden in males was higher than that in females. Population growth and aging were important driving factors for the increase of CKD-T2D DALY burden, while high systolic blood pressure and high body-mass index were the primary attributable risk factors. High body-mass index exhibited higher contributions to high Socioeconomic Development Index (SDI) countries, whereas low SDI countries were more impacted by high systolic blood pressure. The population attributable fraction of CKD-T2D DALY caused by high body-mass index was positively correlated with SDI, while high temperature and lead exposure were negatively correlated. Therefore, strengthening disease screening for people aged 20-59 years and formulating early intervention measures based on the level of socioeconomic development may effectively alleviate the burden of CKD-T2D.
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Affiliation(s)
- Dandan Xie
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Haikou, 570102, Hainan, China
| | - Tianpeng Ma
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China
| | - Haoliang Cui
- School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jing Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China
| | - Aihua Zhang
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China.
| | - Zhifeng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Health Management Center and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Road, Changsha, 410011, Hunan, China.
| | - Yiqiang Xie
- College of Traditional Chinese Medicine, International Advanced Functional Omics Platform, Scientific Experiment Center, Hainan Medical University, No. 3, Xueyuan Road, Haikou, 571199, Hainan, China.
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Diwan V, Hoy WE, Wang Z, Zhang J, Cameron A, Venuthurupalli SK, Fassett RG, Chan S, Healy HG, Tan KS, Baer R, Mallett AJ, Gray N, Mantha M, Cherian R, Mutatiri C, Madhan K, Kan G, Mitchell G, Hossain S, Wu D, Han T, Kark A, Titus T, Ranganathan D, Bonner A, Govindarajulu S. Hospitalizations Among Adults With CKD in Public Renal Specialty Practices: A Retrospective Study From Queensland, Australia. Kidney Med 2023; 5:100700. [PMID: 37649728 PMCID: PMC10462882 DOI: 10.1016/j.xkme.2023.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Rationale & Objective Little is known about hospital admissions in nondialysis patients with chronic kidney disease (CKD) before death or starting kidney replacement therapy (KRT). Study Design Retrospective observational cohort study. Setting & Participants Hospitalizations among 7,201 patients with CKD from 10 public renal clinics in Queensland (QLD), enrolled in the CKD.QLD registry starting in May 2011, were followed for 25,496.34 person-years until they started receiving KRT or died, or until June 30, 2018. Predictors Demographic and clinical characteristics of patients with CKD. Outcomes Hospital admissions. Analytical Approach We evaluated the association of demographic and clinical features with hospitalizations, length of hospital stay, and cost. Results Approximately 81.5% of the patients were admitted at least once, with 42,283 admissions, costing Australian dollars (AUD) 231 million. The average number of admissions per person-year was 1.7, and the cost was AUD 9,060, 10 times and 2 times their Australian averages, respectively. Single (1-day) admissions constituted 59.2% of all the hospital episodes, led by neoplasms (largely chemotherapy), anemia, CKD-related conditions and eye conditions (largely cataract extractions), but only 14.8% of the total costs. Approximately 41% of admissions were >1-day admissions, constituting 85.2% of the total costs, with cardiovascular conditions, respiratory conditions, CKD-related conditions, and injuries, fractures, or poisoning being the dominant causes. Readmission within 30 days of discharge constituted >42% of the admissions and 46.8% costs. Admissions not directly related to CKD constituted 90% of the admissions and costs. More than 40% of the admissions and costs were through the emergency department. Approximately 19% of the hospitalized patients and 27% of the admissions did not have kidney disease mentioned as either principal or associate causes. Limitations Variable follow-up times because of different dates of consent. Conclusions The hospital burden of patients with CKD is mainly driven by complex multiday admissions and readmissions involving comorbid conditions, which may not be directly related to their CKD. Strategies to prevent these complex admissions and readmissions should minimize hospital costs and outcomes. Plain-Language Summary We analyzed primary causes, types, and costs of hospitalizations among 7,201 patients with chronic kidney disease (CKD) from renal speciality clinics across Queensland, Australia, over an average follow-up of 3.54 years. The average annual cost per person was $9,060, and was the highest in those with more advanced CKD, higher age, and with diabetes. More than 85% of costs were driven by more complex hospitalizations with longer length of stay. Cardiovascular disease was the single largest contributor for hospitalizations, length of hospital stay, and total costs. Readmission within 30 days of discharge, particularly for the same disorder, and multiday admissions should be the main targets for mitigation of hospital costs in this population.
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Affiliation(s)
- Vishal Diwan
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Wendy E. Hoy
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Zaimin Wang
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jianzhen Zhang
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne Cameron
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sree K. Venuthurupalli
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Brisbane, Renal Service, Ipswich Hospital, West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Robert G. Fassett
- Tasmanian Health Service Northwest, Hobart, Tasmania, Australia
- School of Human Movement and Nutrition Studies, the University of Queensland, Brisbane, Queensland, Australia
| | - Samuel Chan
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen G. Healy
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ken-Soon Tan
- Department of Nephrology, Logan Hospital, Logan, Queensland, Australia
| | - Richard Baer
- Department of Nephrology, Logan Hospital, Logan, Queensland, Australia
- Nephrology, Cairns Private Hospital, Cairns, Queensland, Australia
| | - Andrew J. Mallett
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
- Renal Unit, The Townsville Hospital, Townsville, Queensland, Australia
| | - Nicholas Gray
- Renal Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Murty Mantha
- Nephrology, Cairns Private Hospital, Cairns, Queensland, Australia
| | - Roy Cherian
- Nephrology Service, North Mackay, Mackay, Queensland, Australia
| | - Clyson Mutatiri
- Renal Unit, Bundaberg Hospital, Wide Bay Hospital and Health Service, Bundaberg, Queensland, Australia
| | - Krishan Madhan
- Renal Medicine, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
- Hervey Bay Clinical School, University of Queensland, Hervey Bay, Queensland, Australia
| | - George Kan
- Renal Unit, The Townsville Hospital, Townsville, Queensland, Australia
| | - Geoffrey Mitchell
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Danielle Wu
- Mackay Base Hospital, Mackay HHS, Mackay, Queensland, Australia
| | - Thin Han
- Rockhampton Hospital, Central Queensland HHS, Rockhampton, Queensland, Australia
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
| | - Adrian Kark
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Thomas Titus
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | | | - Ann Bonner
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University Gold Coast, Queensland, Australia
| | | | - NHMRC CKD.CRE and the CKD.QLD Collaborative
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Brisbane, Renal Service, Ipswich Hospital, West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Department of Nephrology, Logan Hospital, Logan, Queensland, Australia
- Nephrology, Cairns Private Hospital, Cairns, Queensland, Australia
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
- Renal Unit, The Townsville Hospital, Townsville, Queensland, Australia
- Renal Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- Nephrology Service, North Mackay, Mackay, Queensland, Australia
- Renal Unit, Bundaberg Hospital, Wide Bay Hospital and Health Service, Bundaberg, Queensland, Australia
- Renal Medicine, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
- Hervey Bay Clinical School, University of Queensland, Hervey Bay, Queensland, Australia
- Bundaberg Hospital, Bundaberg Central, Queensland, Australia
- Mackay Base Hospital, Mackay HHS, Mackay, Queensland, Australia
- Rockhampton Hospital, Central Queensland HHS, Rockhampton, Queensland, Australia
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University Gold Coast, Queensland, Australia
- St Andrew’s Hospital, Toowoomba, Queensland, Australia
- Tasmanian Health Service Northwest, Hobart, Tasmania, Australia
- School of Human Movement and Nutrition Studies, the University of Queensland, Brisbane, Queensland, Australia
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Ghobrial EE, Said AM, Abd El Shaheed GF, Shaalan YM. Urinary N-Acetyl-β-D glucosaminidase (uNAG) levels as an early marker for diabetic nephropathy in children with type 1 diabetes. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-022-00126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Diabetic nephropathy is considered a major complication among patients with type 1 diabetes. In the present study, we aimed to evaluate urinary N-acetyl-beta-D-glucosaminidase levels (uNAG) in patients with type 1 diabetes mellitus (DM).
Methods
This cross-sectional study of 60 patients with type 1 DM, was categorized into two groups (normoalbuminuria and microalbuminuria) and 30 healthy controls. uNAG was measured in all cases and controls.
Results
Patients with type 1 DM showed increased mean uNAG values compared to controls. Interestingly, increased NAG levels were found in diabetic patients without early signs of glomerular damage (normoalbuminuric). The severity of renal disease, poor glycemic control, and duration of diabetes were all proportional to uNAG increased levels.
Conclusions
NAG measurement is a useful, noninvasive tool for assessing renal involvement in children with diabetes and for early diagnosis of developing nephropathy.
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6
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Corwin TR, Ozieh MN, Garacci E, Palatnik A, Egede LE. The relationship between financial hardship and incident diabetic kidney disease in older US adults - a longitudinal study. BMC Nephrol 2021; 22:167. [PMID: 33952186 PMCID: PMC8101204 DOI: 10.1186/s12882-021-02373-3] [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] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/19/2021] [Indexed: 01/09/2023] Open
Abstract
Background Financial hardship is associated with poor health, however the association of financial hardship and incident diabetic kidney disease (DKD) is unknown. This study aimed to examine the longitudinal relationship between financial hardship and incident DKD among older adults with diabetes. Methods Analyses were conducted in 2735 adults age 50 or older with diabetes and no DKD using four waves of data (2006–2012) from the Health and Retirement Study, a national longitudinal cohort. The primary outcome was incident DKD. Financial hardship was based on three measures: 1) difficulty paying bills; 2) food insecurity; and 3) cost-related medication non-adherence using validated surveys. A dichotomous financial hardship variable (0 vs 1 or more) was constructed based on all three measures. Cox regression models were used to estimate the association between financial hardship, change in financial hardship experience and incident DKD adjusting for demographics, socioeconomic status, and comorbidities. Results During the median follow-up period of 4.1 years, incident DKD rate was higher in individuals with versus without financial hardship (41.2 versus 27/1000 person years). After adjustment, individuals with financial hardship (HR 1.32, 95% CI 1.04–1.68) had significantly increased likelihood of developing DKD compared to individuals without financial hardship. Persistent financial hardship (adjusted HR 1.52 95% CI 1.06–2.18) and negative financial hardship (adjusted HR 1.54 95% CI 1.02–2.33) were associated with incident DKD compared with no financial hardship experience. However, positive financial hardship was not statistically significant in unadjusted and adjusted (adjusted HR 0.89 95% CI 0.55–1.46) models. Cost-related medication non-adherence (adjusted HR 1.43 95% CI 1.07–1.93) was associated with incident DKD independent of other financial hardship measures. Conclusions Financial hardship experience is associated with a higher likelihood of incident DKD in older adults with diabetes. Future studies investigating factors that explain the relationship between financial hardship and incident DKD are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02373-3.
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Affiliation(s)
- Timothy R Corwin
- Medical College of Wisconsin School of Medicine, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Mukoso N Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA. .,Department of Medicine, Division of Nephrology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA. .,Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Anna Palatnik
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.,Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.,Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
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Diagnostic Accuracy of Serum Cystatin C for Early Recognition of Nephropathy in Type 2 Diabetes Mellitus. Int J Nephrol 2021; 2021:8884126. [PMID: 33996155 PMCID: PMC8096588 DOI: 10.1155/2021/8884126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/23/2021] [Accepted: 04/20/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives Diabetic nephropathy is one of the major complications that develop over time in type 2 diabetes mellitus (T2DM). This prospective study was conducted to assess the diagnostic accuracy of serum cystatin C in detecting diabetic nephropathy at earlier stages. Materials and Methods This study was undertaken on 50 cases of T2DM and 50 healthy subjects as controls. Demographic and anthropometric data and blood and urine samples were collected. The concentration of serum cystatin C (index test) and traditional markers of diabetic nephropathy, serum creatinine, and urinary microalbumin (the reference standard) were estimated. Similarly, blood glucose, glycated haemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, and urinary creatine were measured. Results The mean ± SD serum cystatin C was significantly higher in T2DM as compared to control (1.07 ± 0.38 and 0.86 ± 0.12 mg/dl, respectively, p < 0.001). The mean ± SD bodyweight, BMI, W : H ratio, pulse, SBP, and DBP were 66.4 ± 12.6 kg, 26.2 ± 5.6 kg/m2, 1.03 ± 0.09, 78 ± 7, 125 ± 16 mm of Hg, and 77 ± 9 mm of Hg, respectively, in cases. A significant difference in HDL cholesterol (p=0.018) and serum cystatin C (p < 0.001) was observed among different grades of nephropathy. Cystatin C had a significant positive correlation with age (r = 0.323, p=0.022), duration of T2DM (r = 0.326, p=0.021), and UACR (r = 0.528, p < 0.001) and a significant negative correlation with eGFR CKD-EPI cystatin C (r = −0.925, p < 0.001). The area under ROC curve for serum cystatin C (0.611, 95% CI: 0.450–0.772) was greater than for serum creatinine (0.429, 95% CI: 0.265–0.593) though nonsignificant. Conclusion Serum cystatin C concentration increases with the progression of nephropathy and duration of diabetes in Nepalese T2DM patients suggesting cystatin C as a potential marker of renal impairment in T2DM patients.
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Julian GS, Accetturi Pititto LM, Miresashvili N, Broe Honoré J, Lopes Assis Coelho RC, Campos D. Cost of microvascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil. J Med Econ 2021; 24:1002-1010. [PMID: 34344240 DOI: 10.1080/13696998.2021.1963572] [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] [Indexed: 10/20/2022]
Abstract
AIM To evaluate direct medical costs incurred by patients with diabetes in the periods before and after experiencing a microvascular complication from a Brazilian public healthcare system perspective. MATERIALS AND METHODS This was a retrospective, observational study using the Brazilian Unified Health System (DATASUS) database. Direct medical costs (hospitalization and outpatient) were extracted for patients with evidence of diabetes and a microvascular complication (January 2012-December 2018) and converted to 2019 US Dollars (USD). Length of hospital stays was also extracted. Mixed-effects logistic regression explored associations between demographic/clinical characteristics and incurrence of high direct medical costs (defined as the highest tertile of the annual costs ranked by median cost in the total population). RESULTS In total, 2,096 patients with diabetes experienced a microvascular complication and met study inclusion/exclusion criteria. Median [interquartile range] annual costs (USD/patient) were 176.3 [91.0; 481.2] at baseline, increasing to 1,678.5 [287.0; 6,908.4] and 5,172.4 [274.8; 7,395.9] in the first and second year after the complication, respectively. Median hospital stay was 2.0 and 3.0 days at baseline and in the first year, respectively. The odds of incurring high costs were substantially elevated in the first and second years (odds ratios of 69.9 and 84.7, respectively, vs. baseline, both p < .001). LIMITATIONS The DATASUS database covers secondary and tertiary care (not primary), adding selection bias to our sample. Additionally, our findings may not apply to the entire Brazilian population, as around 25% have some access to private healthcare. CONCLUSIONS This study demonstrates a large increase in costs, from the perspective of the Brazilian public healthcare system, in patients with diabetes after experiencing a microvascular complication compared with pre-complication costs. In addition to providing up-to-date cost estimates, our findings highlight the need to appraise the cost-effectiveness of evidence-based strategies that reduce the risk of diabetes-related microvascular complications in Brazilian patients.
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Lim GJ, Liu YL, Low S, Ang K, Tavintharan S, Sum CF, Lim SC. Medical Costs Associated with Severity of Chronic Kidney Disease in Type 2
Diabetes Mellitus in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.202032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: This was a retrospective cross-sectional study to assess the impact of
chronic kidney disease (CKD) and its severity in Type 2 diabetes mellitus (T2DM) on
direct medical costs, and the effects of economic burden on CKD related complications in
T2DM in Singapore.
Methods: A total of 1,275 T2DM patients were recruited by the diabetes centre at
Khoo Teck Puat Hospital from 2011–2014. CKD stages were classified based on improving
global outcome (KDIGO) categories, namely the estimated glomerular filtration rate
(eGFR) and albuminuria kidney disease. Medical costs were extracted from the hospital
administrative database.
Results: CKD occurred in 57.3% of patients. The total mean cost ratio for CKD relative
to non-CKD was 2.2 (P<0.001). Mean (median) baseline annual unadjusted costs were
significantly higher with increasing CKD severity—S$1,523 (S$949), S$2,065 (S$1,198),
S$3,502 (S$1,613), and S$5,328 (S$2,556) for low, moderate, high, and very high risk
respectively (P<0.001). CKD (P<0.001), age at study entry (P=0.001), Malay ethnicity
(P=0.035), duration of diabetes mellitus (DM; P<0.001), use of statins/fibrates (P=0.021),
and modified Diabetes Complications Severity Index (DCSI) (P<0.001) were positively
associated with mean annual direct medical costs in the univariate analysis. In the fully
adjusted model, association with mean annual total costs persisted for CKD, CKD
severity and modified DCSI.
Conclusion: The presence and increased severity of CKD is significantly associated
with higher direct medical costs in T2DM patients. Actively preventing the occurrence
and progression in DM-induced CKD may significantly reduce healthcare resource
consumption and healthcare costs.
Keywords: Chronic kidney disease, costs, endocrinology, nephrology
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10
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Zhang Y, Li W, Zhou Y. Identification of hub genes in diabetic kidney disease via multiple-microarray analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:997. [PMID: 32953797 PMCID: PMC7475500 DOI: 10.21037/atm-20-5171] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease; however, the underlying molecular mechanisms remain unclear. Recently, bioinformatics analysis has provided a comprehensive insight toward the molecular mechanisms of DKD. Here, we re-analyzed three mRNA microarray datasets including a single-cell RNA sequencing (scRNA-seq) dataset, with the aim of identifying crucial genes correlated with DKD and contribute to a better understanding of DKD pathogenesis. Methods Three datasets including GSE131882, GSE30122, and GSE30529 were utilized to find differentially expressed genes (DEGs). The potential functions of DEGs were analyzed by the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. A protein-protein interaction (PPI) network was constructed, and hub genes were selected with the top three molecular complex detection (MCODE) score. A correlation analysis between hub genes and clinical indicators was also performed. Results In total, 84 upregulated DEGs and 49 downregulated DEGs were identified. Enriched pathways of the upregulated DEGs included extracellular matrix (ECM) receptor interaction, focal adhesion, human papillomavirus infection, malaria, and cell adhesion molecules. The downregulated DEGs were mainly enriched in ascorbate and aldarate metabolism, arginine and proline metabolism, endocrine- and other factor-regulated calcium reabsorption, mineral absorption and longevity regulating pathway, and multiple species signaling pathway. Seventeen hub genes were identified, and correlation analysis between unexplored hub genes and clinical features of DKD suggested that EGF, KNG1, GADD45B, and CDH2 might have reno-protective roles in DKD. Meanwhile, ATF3, B2M, VCAM1, CLDN4, SPP1, SOX9, JAG1, C3, and CD24 might promote the progression of DKD. Finally, most hub genes were found present in the immune cells of diabetic kidneys, which suggest the important role of inflammation infiltration in DKD pathogenesis. Conclusions In this study, we found seventeen hub genes using a scRNA-seq contained multiple-microarray analysis, which enriched the present understanding of molecular mechanisms underlying the pathogenesis of DKD in cells' level and provided candidate targets for diagnosis and treatment of DKD.
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Affiliation(s)
- Yumin Zhang
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China.,Institute of Diabetes, Medical School, Southeast University, Nanjing, China
| | - Wei Li
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China.,Institute of Diabetes, Medical School, Southeast University, Nanjing, China.,Suzhou Hospital Affiliated To Anhui Medical University, Suzhou, China
| | - Yunting Zhou
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China.,Institute of Diabetes, Medical School, Southeast University, Nanjing, China.,Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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11
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Zheng L, Chen X, Luo T, Ran X, Hu J, Cheng Q, Yang S, Wu J, Li Q, Wang Z. Early-Onset Type 2 Diabetes as a Risk Factor for End-Stage Renal Disease in Patients With Diabetic Kidney Disease. Prev Chronic Dis 2020; 17:E50. [PMID: 32614772 PMCID: PMC7367068 DOI: 10.5888/pcd17.200076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Compared with the typical onset of type 2 diabetes in middle age or older, type 2 diabetes with early age of onset has a higher risk of diabetes-related complications. It is unclear whether the early age of diabetes diagnosis would affect the development of end-stage renal disease (ESRD) in patients with diabetic kidney disease (DKD) who are at higher risk of ESRD. Methods We enrolled 1,111 type 2 diabetes patients with DKD in this study. We used the age at diabetes diagnosis of younger than 40 years to define early-onset diabetes and 40 years or older to define late-onset diabetes. Medical history, anthropometry, and laboratory indicators were documented. ESRD was defined by estimated glomerular filtration rate (eGFR) of less than 15 mL/min/1.73 m2 or dialysis. Logistic regression analysis was used to explore the association between early-onset diabetes and ESRD. Results Early-onset diabetes patients had a longer diabetes duration, higher body mass index, and worse blood lipid metabolism profile. Compared with late-onset diabetes patients, patients with early-onset diabetes had a prevalence of ESRD that was twofold higher (9.2% vs 4.3%; P = .009). Univariate analysis showed that early-onset diabetes was a risk factor for ESRD in patients with DKD (P < .05). In multivariate logistic regression analysis, even after adjusting for sex, traditional metabolic factors, drug factors, and diabetes duration, the risk of ESRD in patients with early-onset diabetes was still 3.58-fold higher than in subjects with late-onset (95% CI, 1.47–8.74; P = .005). Conclusions In patients with DKD, early-onset type 2 diabetes is an independent risk factor of ESRD.
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Affiliation(s)
- Li Zheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangjun Chen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Luo
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Ran
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingfeng Cheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinshan Wu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhihong Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China. E-mail:
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12
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Islam J, Lee HJ, Yang SH, Kim DK, Joo KW, Kim YS, Seo SU, Seong SY, Lee DS, Youn JI, Han SS. Expansion of Myeloid-Derived Suppressor Cells Correlates with Renal Progression in Type 2 Diabetic Nephropathy. Immune Netw 2020; 20:e18. [PMID: 32395370 PMCID: PMC7192828 DOI: 10.4110/in.2020.20.e18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 01/04/2023] Open
Abstract
Type 2 diabetic nephropathy (T2DN) progresses with an increasingly inflammatory milieu, wherein various immune cells are relevant. Herein, we investigated the levels of myeloid-derived suppressor cells (MDSCs) and their clinical implication in patients with T2DN. A total of 91 subjects (T2DN, n=80; healthy, n=11) were recruited and their PBMCs were used for flow cytometric analysis of polymorphonuclear (PMN-) and monocytic (M-) MDSCs, in addition to other immune cell subsets. The risk of renal progression was evaluated according to the quartiles of MDSC levels using the Cox model. The proportion of MDSCs in T2DN patients was higher than in healthy individuals (median, 6.7% vs. 2.5%). PMN-MDSCs accounted for 96% of MDSCs, and 78% of PMN-MDSCs expressed Lox-1. The expansion of PMN-MDSCs was not related to the stage of T2DN or other kidney disease parameters such as glomerular filtration rate and proteinuria. The production of ROS in PMN-MDSCs of patients was higher than in neutrophils of patients or in immune cells of healthy individuals, and this production was augmented under hyperglycemic conditions. The 4th quartile group of PMN-MDSCs had a higher risk of renal progression than the 1st quartile group, irrespective of adjusting for multiple clinical and laboratory variables. In conclusion, PMN-MDSCs are expanded in patients with T2DN, and may represent as an immunological biomarker of renal progression.
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Affiliation(s)
- Jahirul Islam
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hack June Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang-Uk Seo
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon 25159, Korea
| | - Seung-Yong Seong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon 25159, Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Dong-Sup Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Je-In Youn
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon 25159, Korea.,Research Institute, ProGen Inc., Seongnam 13488, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
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13
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Low S, Lim SC, Zhang X, Wang J, Yeo SJD, Yeoh LY, Liu YL, Subramaniam T, Sum CF. Medical costs associated with chronic kidney disease progression in an Asian population with type 2 diabetes mellitus. Nephrology (Carlton) 2019; 24:534-541. [PMID: 30141833 DOI: 10.1111/nep.13478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 01/03/2023]
Abstract
AIM We aim to examine difference in incremental direct medical costs between non-progressive and progressive chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) in Singapore. METHODS This was a prospective study on 676 patients with T2DM attending a diabetes centre in a regional hospital. Annual direct medical costs were extracted from the administrative database. Ordinary least squares regression was used to estimate contribution of CKD progression to annual costs, adjusting for demographics and baseline clinical covariates. RESULTS Over mean follow-up period of 2.8 ± 0.4 years, 266 (39.3%) had CKD progression. The excess total follow-up medical costs from baseline was S$4243 higher in progressors compared to non-progressors (P = 0.002). The mean cost differential between the two groups increased from S$2799 in Stages G1-G2 to S$11180 in Stage G4. Inpatient cost accounted for 63.4% of total cost of progression. When stratified by glomerular filtration rate stages, the respective total mean annual costs at stages glomerular filtration rate Stages G3a-G3b and G4 were S$3290 (132%; P = 0.001) and S$4416 (135%; P = 0.011) higher post-progression. CONCLUSION Chronic kidney disease progression in T2DM is associated with high medical costs. The cost of progression is higher with higher severity of CKD stage at baseline and could be largely driven by inpatient admission.
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Affiliation(s)
- Serena Low
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Su C Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.,Diabetes Centre, Khoo Teck Puat Hospital, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xiao Zhang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Jiexun Wang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Su J D Yeo
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Lee Y Yeoh
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Yan L Liu
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | | | - Chee F Sum
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
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14
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Wetmore JB, Li S, Ton TGN, Peng Y, Hansen MK, Neslusan C, Riley R, Liu J, Gilbertson DT. Association of diabetes-related kidney disease with cardiovascular and non-cardiovascular outcomes: a retrospective cohort study. BMC Endocr Disord 2019; 19:89. [PMID: 31455289 PMCID: PMC6712860 DOI: 10.1186/s12902-019-0417-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/11/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diabetes-related kidney disease is associated with end-stage renal disease and mortality, but opportunities remain to quantify its association with cardiovascular and non-cardiovascular morbidity outcomes. METHODS We used the Truven Health MarketScan Commercial Claims and Encounters Database, 2010-2014, which includes specific health services records for employees and their dependents from a selection of large employers, health plans, and government and public organizations. We used administrative claims data to quantify the association between diabetes-related kidney disease and end-stage renal disease, myocardial infarction, congestive heart failure, stroke, and infections. Cox proportional hazard regression models were used to estimate adjusted hazard ratios of developing complications. RESULTS Among 2.2 million patients with diabetes, 7.1% had diabetes-related kidney disease: 13.5%, stage 1-2; 33.8%, stage 3; 13.2% stages 4-5; 39.5%, unknown stage. In multivariable Cox proportional hazard models adjusted for demographic characteristics, baseline comorbid conditions, and total hospital days during the baseline period, hazard ratios for each outcome increased with greater diabetes-related kidney disease severity (stage 1-2 vs. stage 4-5) compared with no diabetes-related kidney disease: myocardial infarction, 1.2 (95% confidence interval 1.1-1.4) and 3.1 (2.9-3.4); congestive heart failure, 1.7 (1.6-1.9) and 5.6 (5.3-5.8); stroke, 1.3 (1.2-1.5) and 2.3 (2.1-2.5); infection, 1.4 (1.3-1.5) and 2.9 (2.8-3.0). Among patients with stage 4-5 disease, 36-month cumulative incidence was nearly 22.8% for congestive heart failure, and 25.8% for infections. CONCLUSIONS Diabetes-related kidney disease appears to be formally diagnosed at a more advanced stage than might be expected, given clinical practice guidelines. Risks of cardiovascular and non-cardiovascular outcomes are high.
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Affiliation(s)
- James B. Wetmore
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Avenue, Suite S4.100, Minneapolis, MN 55415 USA
- Division of Nephrology, Hennepin Healthcare, Minneapolis, MN USA
| | - Suying Li
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Avenue, Suite S4.100, Minneapolis, MN 55415 USA
| | | | - Yi Peng
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Avenue, Suite S4.100, Minneapolis, MN 55415 USA
| | | | | | - Ralph Riley
- Janssen Global Services, LLC, Raritan, NJ USA
| | - Jiannong Liu
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Avenue, Suite S4.100, Minneapolis, MN 55415 USA
| | - David T. Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Avenue, Suite S4.100, Minneapolis, MN 55415 USA
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15
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Serum uromodulin and Roux-en-Y gastric bypass: improvement of a marker reflecting nephron mass. Surg Obes Relat Dis 2019; 15:1319-1325. [DOI: 10.1016/j.soard.2019.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/11/2019] [Accepted: 05/04/2019] [Indexed: 12/20/2022]
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16
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Scheurlen KM, Probst P, Kopf S, Nawroth PP, Billeter AT, Müller-Stich BP. Metabolic surgery improves renal injury independent of weight loss: a meta-analysis. Surg Obes Relat Dis 2019; 15:1006-1020. [DOI: 10.1016/j.soard.2019.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/10/2019] [Accepted: 03/03/2019] [Indexed: 02/05/2023]
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17
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Manns B, Hemmelgarn B, Tonelli M, Au F, So H, Weaver R, Quinn AE, Klarenbach S. The Cost of Care for People With Chronic Kidney Disease. Can J Kidney Health Dis 2019; 6:2054358119835521. [PMID: 31057803 PMCID: PMC6452586 DOI: 10.1177/2054358119835521] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/30/2019] [Indexed: 12/05/2022] Open
Abstract
Background: As the adverse clinical outcomes common in patients with chronic kidney disease (CKD) can be prevented or delayed, information on the cost of care across the spectrum of CKD can inform investments in CKD care. Objectives: To determine the cost of caring for patients with CKD who are not on dialysis or transplant at baseline. Design: Population-based cohort study using administrative health data. Setting: Alberta, Canada. Patients: Cohort of 219 641 adults with CKD categorized by estimated glomerular filtration rate (eGFR) between April 1, 2012, and March 31, 2014, into Kidney Disease: Improving Global Outcomes (KDIGO) CKD categories, excluding patients on dialysis or transplant at baseline. Measurements: The primary outcome was 1-year cumulative unadjusted health care costs, including the cost of drugs, physician visits, emergency department visits, outpatient procedures (including dialysis and other day medicine and surgery procedures), and hospitalizations for the year following each patient’s index date. Methods: Mean 1-year direct medical costs were estimated for the cohort as a whole and for patients in the different KDIGO CKD categories as defined at baseline. Costs were further categorized according to baseline demographic and clinical characteristics, and by type of care (ie, kidney care and cardiovascular care). Results: In 219 641 adults with CKD, the mean unadjusted cumulative 1-year cost of care was Can$14 634 per patient (median = Can$3672; Q1 = Can$1496, Q3 = Can$10 221). Costs were higher for those with more comorbidity, those with lower eGFR, and those with more severe albuminuria. The cost of kidney and cardiovascular care was Can$230 (1.6% of total costs) and Can$720 (4.9% of total costs), respectively, for the cohort overall. These costs increased substantially for patients with lower eGFR, averaging Can$14 169 (32.3% of total costs) and Can$2395 (5.5% of total costs) for kidney and cardiovascular care, respectively, for people with eGFR<15 mL/min/1.73 m2 at baseline. Limitations: We only have estimates of the cost of health care for people with CKD, and not the costs borne by patients or their families. As we have not included costs for people without CKD in this analysis, we are unable to assess the incremental costs associated with CKD. Conclusions: We identified that patients with CKD, even when not on dialysis at baseline, had high health care costs (more than twice the cost per person in Canada in 2015), with a graded association between severity of CKD and costs. Our findings can inform current and future cost estimates across the spectrum of CKD, including an estimate of potential savings that might result from interventions that slow or prevent kidney disease.
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Affiliation(s)
- Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, AB, Canada.,Foothills Medical Centre, Calgary, AB, Canada
| | - Brenda Hemmelgarn
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Marcello Tonelli
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Flora Au
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Helen So
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Rob Weaver
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Amity E Quinn
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, AB, Canada
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18
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Chapman D, Foxcroft R, Dale-Harris L, Ronte H, Bidgoli F, Bellary S. Insights for Care: The Healthcare Utilisation and Cost Impact of Managing Type 2 Diabetes-Associated Microvascular Complications. Diabetes Ther 2019; 10:575-585. [PMID: 30737674 PMCID: PMC6437252 DOI: 10.1007/s13300-018-0548-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The increasing prevalence of type 2 diabetes (T2DM) in the UK imposes a significant burden on the National Health Service (NHS). Despite the availability of effective treatments, the loss of glycaemic control over time results in significant comorbidities, including nephropathy, neuropathy and retinopathy. The cost of treating these microvascular complications has not been well documented, and this study aimed to provide an accurate assessment of the healthcare resource utilisation (HCRU) associated with managing T2DM and its complications. METHODS This retrospective cohort study utilised electronic medical records from patients with T2DM from the Heart of England Foundation Trust (HEFT), which captures data from patients using secondary care services. Patients were diagnosed with microvascular complications based on ICD-10 or OPCS codes. HCRU over a 2-year period was based on NHS Tariffs for healthcare services for inpatient, accident and emergency, and dialysis clinic usage. RESULTS The study cohort comprised 26,629 patients with T2DM who used HEFT services during the study period, 22.6%, 20.8% and 3.1% of whom had comorbid nephropathy, retinopathy or neuropathy, respectively. While the prevalence of diabetes in the overall HEFT population was reported to be 7% in 2012, diabetes and its associated complications accounted for more than 30% of secondary care costs. Furthermore, while patients with diabetes represent only 17% of HEFT inpatients, they account for more than 20% of service usage. The economic burden of microvascular complications increased substantially with the severity of the condition, with the overall cost exceeding £70 million over the 2-year period. CONCLUSION This study of patients with T2DM in a typical secondary care provider in the UK showed that avoiding the progression of microvascular complications could provide substantial cost savings through targeted interventions that improve outcomes and lower resource use. FUNDING Merck Sharp & Dohme Limited.
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Affiliation(s)
| | | | | | | | | | - Srikanth Bellary
- Heart of England NHS Foundation Trust, Birmingham, UK.
- School of Life and Health Sciences, Aston University, Birmingham, UK.
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19
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Siddiqui K, George TP, Nawaz SS, Yaslam M, Almogbel E, Al-Rubeaan K. Significance of glycated LDL in different stages of diabetic nephropathy. Diabetes Metab Syndr 2019; 13:548-552. [PMID: 30641763 DOI: 10.1016/j.dsx.2018.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
AIM The aim of this study was to investigate the role of elevated glycated LDL (low-density lipoprotein) in the progression of diabetic kidney disease among type 2 diabetes (T2D) subjects. MATERIALS AND METHODS This case-control observational study is a part of Saudi Diabetes Kidney Disease (SAUDI-DKD) study conducted during the period from April 2014 to June 2015. This study cohort is divided into two groups; the first group was T2D patients without diabetic nephropathy (DN) (n = 24) and the second group was T2D with DN (n = 45). Serum glycated LDL levels were determined by ELISA. Pearson's correlation analysis was performed, and the diagnostic accuracy was assessed using the area under the ROC curve. RESULTS There was a threefold increase of serum glycated LDL level among diabetic subjects when compared with non-diabetic subjects and this level progressively increased with the progression of DN. The glycated LDL was found to have a significant diagnostic accuracy with AUC of 0.685 and 0.775 for cases with microalbuminuria and macroalbuminuria respectively. CONCLUSION The glycated LDL could play a significant role in predicting diabetic patients who are susceptible to develop DN among T2D patients.
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Affiliation(s)
- Khalid Siddiqui
- Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Teena P George
- Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Shaik Sarfaraz Nawaz
- Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia
| | - Maram Yaslam
- University Diabetes Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Khalid Al-Rubeaan
- Strategic Center for Diabetes Research, King Saud University, Riyadh, Saudi Arabia; University Diabetes Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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20
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Herman WH, Braffett BH, Kuo S, Lee JM, Brandle M, Jacobson AM, Prosser LA, Lachin JM. What are the clinical, quality-of-life, and cost consequences of 30 years of excellent vs. poor glycemic control in type 1 diabetes? J Diabetes Complications 2018; 32:911-915. [PMID: 30082172 PMCID: PMC6459401 DOI: 10.1016/j.jdiacomp.2018.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy for type 1 diabetes delayed the development of microvascular and neuropathic complications compared to conventional therapy. At the end of DCCT, all participants were trained in intensive therapy, care was transferred to community providers, and the difference in HbA1c between treatment groups narrowed and disappeared. Our objective was to describe the outcomes and the quality-of-life and costs associated with those outcomes in participants who maintained excellent vs. poor glycemic control over 30 years. RESEARCH DESIGN AND METHODS We assessed the incidence of retinopathy, nephropathy, neuropathy, cardiovascular disease, acute metabolic complications, death, quality-of-life, and costs in the tertile of DCCT intensive therapy participants who achieved a mean updated HbA1c of <7.2% (55 mmol/mol) and the tertile of DCCT conventional therapy participants (n = 240) who achieved a mean updated HbA1c of >8.8% (73 mmol/mol) over 30 years. RESULTS Thirty years of excellent vs. poor glycemic control substantially reduced the incidence of retinopathy requiring laser therapy (5% vs. 45%), end-stage renal disease (0% vs. 5%), clinical neuropathy (15% vs. 50%), myocardial infarction (3% vs. 5%), stroke (0.4% vs. 2%), and death (6% vs. 20%). It also resulted in a gain of ~1.62 quality-adjusted life-years and averted ~$90,900 in costs of complications per participant. CONCLUSIONS Thirty years of excellent vs. poor glycemic control for T1DM can substantially reduce the incidence of complications, comorbidities, and death, improve quality-of-life, and reduce costs. These estimates represent the benefits that may be achieved with excellent glycemic control.
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Affiliation(s)
- William H Herman
- Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, United States of America.
| | - Barbara H Braffett
- The Biostatistics Center, George Washington University, Washington, DC, United States of America
| | - Shihchen Kuo
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Joyce M Lee
- Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI, United States of America
| | - Michael Brandle
- Division of Endocrinology and Diabetes, Kantonsspital St. Gallen, Sankt Gallen, SG, Switzerland
| | - Alan M Jacobson
- Winthrop-University Hospital, Mineola, NY, United States of America
| | - Lisa A Prosser
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - John M Lachin
- The Biostatistics Center, George Washington University, Washington, DC, United States of America
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Ashrafi Jigheh Z, Ghorbani Haghjo A, Argani H, Roshangar L, Rashtchizadeh N, Sanajou D, Nazari Soltan Ahmad S, Rashedi J, Dastmalchi S, Mesgari Abbasi M. Empagliflozin Attenuates Renal and Urinary Markers of Tubular Epithelial Cell Injury in Streptozotocin-induced Diabetic Rats. Indian J Clin Biochem 2018; 35:109-114. [PMID: 32071503 DOI: 10.1007/s12291-018-0790-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022]
Abstract
Empagliflozin, a SGLT-2 inhibitor, improves diabetic nephropathy through its pleiotropic anti-inflammatory effects. The present study aims to evaluate empagliflozin effects on renal and urinary levels of tubular epithelial cell injury markers in streptozotocin-induced diabetic rats. Empagliflozin at 10 mg/kg (p.o.) was administered for 4 weeks, beginning 8 weeks after induction of diabetes. Renal function as well as markers of renal tubular epithelial cell injury were assessed in kidney tissue homogenates and urine. Empagliflozin was able to ameliorate diabetes induced elevations in serum cystatin C levels. It also alleviated renal KIM-1/NGAL levels and urinary albumin, α-GST, and RBP excretions. In addition to decreasing urinary levels of cell cycle arrest indices i.e. TIMP-2 and IGFBP7, empagliflozin mitigated acetylated NF-κB levels in renal tissues of diabetic rats. As a whole, these findings reveal empagliflozin capability in improving diabetic nephropathy via ameliorating indices of renal inflammation, injury, and cell cycle arrest on streptozotocin-induced diabetic rats.
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Affiliation(s)
- Zahra Ashrafi Jigheh
- 1Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,2Student Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Ghorbani Haghjo
- 3Biotechnology Research Center, Tabriz University of Medical Sciences, Goshgasht Avenue, PO BOX: 14711, Tabriz, 5166614711 Iran
| | - Hassan Argani
- 4Urology and Nephrology Research Center, Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Roshangar
- 5Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nadereh Rashtchizadeh
- 3Biotechnology Research Center, Tabriz University of Medical Sciences, Goshgasht Avenue, PO BOX: 14711, Tabriz, 5166614711 Iran
| | - Davoud Sanajou
- 1Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Nazari Soltan Ahmad
- 1Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalil Rashedi
- 1Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Siavoush Dastmalchi
- 3Biotechnology Research Center, Tabriz University of Medical Sciences, Goshgasht Avenue, PO BOX: 14711, Tabriz, 5166614711 Iran
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Apelin: A potential novel serum biomarker for early detection of diabetic nephropathy in patients with type 2 diabetes. North Clin Istanb 2018; 6:151-155. [PMID: 31297482 PMCID: PMC6593907 DOI: 10.14744/nci.2018.62134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 02/19/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE: Diabetic nephropathy (DN) is the major cause of chronic renal failure, and proteinuria is an independent risk factor for the end stage renal disease. The random urine protein: creatinine ratio (P:C ratio) can accurately predict the amount of 24-hour urinary protein excretion. Apelin is thought to be associated with endothelial dysfunction, angiogenesis, and inflammation. This study investigated the apelin concentration and its association with the urine P:C ratio, and metabolic parameters in subjects with and without type 2 diabetes mellitus (T2D). METHODS: This study involved 86 subjects: 56 with newly diagnosed and untreated T2D and 30 non-diabetic controls. All subjects underwent a complete clinical examination that included anthropometric and laboratory measurements. RESULTS: Twenty-four males and sixty-two females participated in this study, and their mean age was 52.27±11.34 years. There were no differences in age, thyrotropin-stimulating hormone (TSH), creatinine clearance, and apelin levels between groups. As expected, fasting plasma glucose, weight, body mass index, and HbA1C were higher in T2D subjects (p=0.001, p=0.02, p=0.03, and p=0.001, respectively). Although apelin levels were higher in the control group, the differences were not statistically significant (p=0.93). The P:C ratio levels were lower in the control group, and the differences were statistically significant (p=0.006). A Spearman correlation analysis revealed that serum apelin levels were not correlated with the urine P:C ratio. CONCLUSION: Our study demonstrates that T2D is associated with decreased serum apelin levels and increased urine P:C ratios compared to those in non-diabetic subjects. This association may depend on impaired glucose homeostasis. Our results show that the serum apelin levels were not correlated with the urine protein: creatinine ratio and provide further evidence regarding the relationship between apelin and DN.
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Billeter AT, de la Garza Herrera JR, Scheurlen KM, Nickel F, Billmann F, Müller-Stich BP. MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass. Eur J Endocrinol 2018; 179:R77-R93. [PMID: 29764908 DOI: 10.1530/eje-18-0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
Abstract
Obesity and its associated comorbidities have become one of the largest challenges for health care in the near future. Conservative therapy for obesity and related comorbidities has a very high failure rate and poor long-term results. Similarly, the conservative and medical management of the majority of metabolic diseases such as type 2 diabetes mellitus are only able to slow down disease progression but have no causal effect on the disease process. Obesity surgery has evolved as a highly effective therapy for severe obesity achieving long-lasting weight loss. Furthermore, several studies have demonstrated the beneficial effects of obesity surgery on reduction of overall mortality, reduction of cardiovascular events and superior control of obesity-related diseases such as type 2 diabetes mellitus, dyslipidemia and also the non-alcoholic steatohepatitis compared to medical therapy. Based on these findings, the term 'metabolic surgery' with the focus on treating metabolic diseases independent of body weight has been coined. Of great interest are recent studies that show that even existing complications of metabolic diseases such as diabetic nephropathy or the non-alcoholic steatohepatitis can be reversed by metabolic surgery. Although metabolic surgery has proven to be a safe and effective treatment for obesity, resolution of comorbidities and enhancing quality of life, it is still uncertain and unclear, which surgical procedure is the most effective to achieve these metabolic effects. The aim of this review is to compare the effects of the two currently most widely used metabolic operations, the Roux-en-Y gastric bypass and the sleeve gastrectomy in the treatment of obesity and its related comorbidities.
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Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Katharina M Scheurlen
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Franck Billmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Billeter AT, Kopf S, Zeier M, Scheurlen K, Fischer L, Schulte TM, Kenngott HG, Israel B, Knefeli P, Büchler MW, Nawroth PP, Müller-Stich BP. Renal Function in Type 2 Diabetes Following Gastric Bypass. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:827-833. [PMID: 28098067 DOI: 10.3238/arztebl.2016.0827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 05/01/2016] [Accepted: 09/21/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Metabolic surgery for obese patients with type 2 diabetes (T2D) yields short- and long-term remission rates of 60-90%. Its effects on diabetesassociated complications such as neuropathy and nephropathy have not been well studied to date. Hardly any data are available on this subject with respect to moderately obese patients (body mass index [BMI] 25-35 kg/m2) with insulin-dependent T2D. Our previous studies suggest that, in such patients, treatment with a Roux-en-Y gastric bypass (RYGB) improves diabetic neuropathy. In this pilot study, we investigate the course of diabetic nephropathy after RYGB surgery. METHODS 20 insulin-dependent patients whose T2D was inadequately controlled with medication, and whose BMI was in the range 25-35 kg/m2, were prospectively included in a pilot study. All patients underwent a standardized RYGB operation. Blood and urine tests for renal function were performed before surgery and 12 and 24 months afterward. RESULTS The serum creatinine level fell from 0.82 ± 0.23 to 0.69 ± 0.13 mg/dL (p = 0.0025) in the first 12 months after surgery and was unchanged a further 12 months later. The glomerular filtration rate (eGFR) rose in the first 24 months after surgery from 96.4 ± 28.7 to 111.7 ± 23.3 mL/min/1.73 m2 (p = 0.0093). The urinary albumin/creatinine and high-molecular-weight adiponectin/creatinine ratios fell markedly in the first 24 months after surgery (2.89 ± 3.14 versus 1.00 ± 0.24 mg/mmol [p = 0.0491] and 0.18 ± 0.06 versus 0.04 ± 0.01 μg/g [p = 0.0392]). CONCLUSION RYGB has positive effects on renal function and may therefore be a good treatment option for moderately obese, insulin-dependent patients whose T2D cannot be adequately controlled with medication. These results still need to be confirmed in randomized, controlled trials with longer periods of followup.
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Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital; Department of Endocrinology, Metabolism and Clinical Chemistry at Heidelberg University Hospital, Heidelberg
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Brugnara L, Novials A, Ortega R, De Rivas B. Clinical characteristics, complications and management of patients with type 2 diabetes with and without diabetic kidney disease (DKD): A comparison of data from a clinical database. ACTA ACUST UNITED AC 2017; 65:30-38. [PMID: 29233515 DOI: 10.1016/j.endinu.2017.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The main objective of this study was to assess the percentage of co-morbid nephropathy in type 2 diabetes patients using the CKD-EPI equation and to compare the clinical characteristics and treatments of patients with type 2 diabetes with nephropathy with those of patients without nephropathy PATIENTS AND METHODS: This was a cross-sectional analysis of the demographic and clinical data registered in the IDIBAPS Biobank database. Patients were considered to have nephropathy if the diagnosis was reported in their clinical history, albuminuria (>30 mg/g) was indicated as present in the last urine test available, or an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2 was calculated using the CKD-EPI equation. RESULTS Clinical data were obtained from 1,397 patients with a diagnosis of type 2 diabetes. The percentage of patients with nephropathy was 29.3% (N= 369) (95% confidence interval, 26.8% to 31.9%); however, only 109 (7.8%) patients had a nephropathy diagnosis reported in their clinical history. Compared with patients without nephropathy, patients with nephropathy have a higher mean age, higher frequency of diabetes complications and received insulin more frequently. CONCLUSION Our results show that the percentage of type 2 diabetes patients with nephropathy was high and that this comorbidity was associated with a significantly higher frequency of diabetes macro- and microvascular complications (compared to diabetes patients without DKD).
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Affiliation(s)
- Laura Brugnara
- CIBERDEM - Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain; IDIBAPS - August Pi i Sunyer Biomedical Research Institute/Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Novials
- CIBERDEM - Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain; IDIBAPS - August Pi i Sunyer Biomedical Research Institute/Hospital Clínic de Barcelona, Barcelona, Spain.
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Abstract
OBJECTIVE To estimate real-world healthcare utilization and expenditures across the spectrum of chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) categories in patients with diabetes. METHODS This study employed a retrospective cohort study design using the Truven Healthcare and Claims Dataset from 2009-2012. Index date was defined as the first eGFR value during a continuous enrollment period of 24 months. Cohorts of patients were stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90 mL/min/1.73 m2; 2: 60-89; 3A: 45-59; 3B: 30-44; 4: 15-29; 5: <15). Healthcare expenditures (total patient and payer paid claims) and utilization (number of claims or visits) were estimated 12-months post-index date using generalized linear modeling and negative binomial modeling, respectively, after adjusting for baseline characteristics. RESULTS Of 130,098 patients with an index eGFR value and 24-months continuous enrolment, 64,521 (49.59%) were in stage 1 CKD, 47,816 (36.75%) were in stage 2, 13,377 (10.28%) were in stage 3A, 3,217 (2.47%) were in stage 3B, 898 (0.69%) were in stage 4, and 269 (0.21%) were in stage 5. Patients in stages 3A, 3B, and 4 CKD had 1.32 (95% CI = 1.22-1.43), 1.59 (95% CI = 1.41-1.80), and 2.65 (95% CI = 2.23-3.14) times higher rates of diabetes-associated inpatient visits, respectively, compared with stage 1 CKD patients. Patients in stages 3A, 3B, and 4 CKD had increased incremental total annual healthcare expenditures of $1,732 (95% CI = $1,109-$2,356), $2,632 (95% CI = $1,647-$3,619), and $6,949 (95% CI = $5,466-$8,432), respectively, compared with stage 1 CKD patients. LIMITATIONS The claims data were generated for billing and reimbursement, not for research purposes. CONCLUSIONS These real-world data suggest an incremental and significant increase in economic burden in diabetes as kidney function declines, starting with moderate (stage 3A) CKD.
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Affiliation(s)
- R Brett McQueen
- a Department of Clinical Pharmacy , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | | | - Kelly F Bell
- b Employee of AstraZeneca , Wilmington , DE , USA
| | - Kavita V Nair
- a Department of Clinical Pharmacy , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Joseph J Saseen
- a Department of Clinical Pharmacy , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
- c Department of Family Medicine , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
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Zhou Z, Chaudhari P, Yang H, Fang AP, Zhao J, Law EH, Wu EQ, Jiang R, Seifeldin R. Healthcare Resource Use, Costs, and Disease Progression Associated with Diabetic Nephropathy in Adults with Type 2 Diabetes: A Retrospective Observational Study. Diabetes Ther 2017; 8:555-571. [PMID: 28361464 PMCID: PMC5446382 DOI: 10.1007/s13300-017-0256-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Diabetic nephropathy (DN) is a progressive kidney disease resulting as a complication of diabetes mellitus. This study evaluated the disease progression and economic burden of DN among commercially insured patients with type 2 diabetes in the USA. METHODS The research design was a retrospective observational study based on healthcare claims data. The Truven MarketScan Databases (2004-2014) were queried for adults with type 2 diabetes with at least one urine albumin test (index, randomly selected) after diagnosis and at least one test after the index. On the basis of the index test, patients were classified into normoalbuminuria, microalbuminuria, or macroalbuminuria groups. Nephropathy-related treatment use was measured in the 6 months after the index, disease progression was assessed from the index to the end of data availability, and annual all-cause and nephropathy-related costs and healthcare resource use (HRU) were assessed up to 2 years from the index. Outcomes were compared between any two groups, controlling for baseline demographics. RESULTS A total of 23,235 patients were identified and classified into normoalbuminuria (N = 18,409), microalbuminuria (N = 3863), or macroalbuminuria (N = 963) groups. Patients with albuminuria were more likely to be older, male, and have a higher burden of baseline comorbidities and HRU. Within 6 months following the index, 12-20% of patients with albuminuria were not treated with any relevant recommended treatment. Compared to the normoalbuminuria group, patients with macroalbuminuria had a significantly greater risk of disease progression (hazard ratio [HR] = 1.44), and both albuminuria groups were more likely to require dialysis (HR = 4.23 and 40.14 for micro- and macroalbuminuria, respectively; all p < 0.05). Annual all-cause (2016 US dollars, $3580 and $12,830 higher for micro- and macroalbuminuria vs. normoalbuminuria, respectively) and nephropathy-related ($362 and $3716) costs increased significantly with increasing nephropathy severity, consistent with the trend in increased HRU. CONCLUSIONS Diabetic nephropathy may be undertreated or inappropriately treated. It was also associated with significantly higher costs, HRU, and risk of disease progression among commercially insured patients with type 2 diabetes in the USA. FUNDING Takeda Development Center Americas, Inc.
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Affiliation(s)
- Zhou Zhou
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, USA.
| | - Paresh Chaudhari
- Formerly of Takeda Pharmaceuticals, Inc., One Takeda Parkway, Deerfield, IL, USA
| | - Hongbo Yang
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, USA
| | - Anna P Fang
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, USA
| | - Jing Zhao
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, USA
| | - Ernest H Law
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Eric Q Wu
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, USA
| | - Ruixuan Jiang
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Raafat Seifeldin
- Takeda Pharmaceuticals, Inc., One Takeda Parkway, Deerfield, IL, USA
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Schirr-Bonnans S, Costa N, Derumeaux-Burel H, Bos J, Lepage B, Garnault V, Martini J, Hanaire H, Turnin MC, Molinier L. Cost of diabetic eye, renal and foot complications: a methodological review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:293-312. [PMID: 26975444 DOI: 10.1007/s10198-016-0773-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Diabetic retinopathy (DR), diabetic kidney disease (DKD) and diabetic foot ulcer (DFU) represent a public health and economic concern that may be assessed with cost-of-illness (COI) studies. OBJECTIVES (1) To review COI studies published between 2000 and 2015, about DR, DKD and DFU; (2) to analyse methods used. METHODS Disease definition, epidemiological approach, perspective, type of costs, activity data sources, cost valuation, sensitivity analysis, cost discounting and presentation of costs may be described in COI studies. Each reviewed study was assessed with a methodological grid including these nine items. RESULTS The five following items have been detailed in the reviewed studies: epidemiological approach (59 % of studies described it), perspective (75 %), type of costs (98 %), activity data sources (91 %) and cost valuation (59 %). The disease definition and the presentation of results were detailed in fewer studies (respectively 50 and 46 %). In contrast, sensitivity analysis was only performed in 14 % of studies and cost discounting in 7 %. Considering the studies showing an average cost per patient and per year with a societal perspective, DR cost estimates were US $2297 (range 5-67,486), DKD cost ranged from US $1095 to US $16,384, and DFU cost was US $10,604 (range 1444-85,718). DISCUSSION This review reinforces the need to adequately describe the method to facilitate literature comparisons and projections. It also recalls that COI studies represent complementary tools to cost-effectiveness studies to help decision makers in the allocation of economic resources for the management of DR, DKD and DFU.
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Affiliation(s)
- Solène Schirr-Bonnans
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France.
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France.
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.
| | - Nadège Costa
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Hélène Derumeaux-Burel
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Jérémy Bos
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Benoît Lepage
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Methodological Support Unit, Faculté de Médecine, University Hospital of Toulouse, USMR, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Valérie Garnault
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Jacques Martini
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Hélène Hanaire
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Marie-Christine Turnin
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Laurent Molinier
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
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Papadopoulou-Marketou N, Margeli A, Papassotiriou I, Chrousos GP, Kanaka-Gantenbein C, Wahlberg J. NGAL as an Early Predictive Marker of Diabetic Nephropathy in Children and Young Adults with Type 1 Diabetes Mellitus. J Diabetes Res 2017; 2017:7526919. [PMID: 28620620 PMCID: PMC5460379 DOI: 10.1155/2017/7526919] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 04/03/2017] [Indexed: 12/14/2022] Open
Abstract
AIMS Type 1 diabetes (T1D) is often associated with early microvascular complications. Previous studies demonstrated that increased systolic (SAP) and diastolic arterial blood pressures (DAP) are linked to microvascular morbidity in T1D. The aim of the study was to investigate the predictive role of neutrophil gelatinase-associated lipocalin (NGAL) in unravelling early cardio-renal dysfunction in T1D. METHODS Two T1D patient groups participating in two-centre prospective cohorts were studied. Group A consisted of 57 participants aged 13.9 years (SD: 3.1) and group B consisted of 59 patients aged 28.0 years (SD: 4.4). Forty-nine healthy children [age: 10.5 years (SD: 6.6)] and 18 healthy adults [age 27.7 years (SD: 4.2)] served as controls. Serum concentrations of NGAL (ELISA) were determined, and SAP and DAP were examined (SAP and DAP also expressed as z-scores in the younger group). RESULTS NGAL correlated positively with SAP in both patient groups (P = 0.020 and P = 0.031, resp.) and SAP z-score (P = 0.009) (group A) and negatively with eGFR in both groups (P < 0.001 and P < 0.001, resp.). CONCLUSIONS NGAL may be proposed as a biomarker of early renal dysfunction even in nonalbuminuric T1D patients, since it was strongly associated with renal function decline and increasing systolic arterial pressure even at prehypertensive range in people with T1D, in a broad age range.
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Affiliation(s)
- Nektaria Papadopoulou-Marketou
- Department of Endocrinology, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
- Diabetes Centre, Department of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Thivon, 115 27 Athens, Greece
- *Nektaria Papadopoulou-Marketou:
| | - Alexandra Margeli
- Department of Clinical Biochemistry, Aghia Sophia Children's Hospital, Thivon, 115 27 Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, Aghia Sophia Children's Hospital, Thivon, 115 27 Athens, Greece
| | - George P. Chrousos
- Diabetes Centre, Department of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Thivon, 115 27 Athens, Greece
| | - Christina Kanaka-Gantenbein
- Diabetes Centre, Department of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Thivon, 115 27 Athens, Greece
| | - Jeanette Wahlberg
- Department of Endocrinology, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
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Mahfouz MH, Assiri AM, Mukhtar MH. Assessment of Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Retinol-Binding Protein 4 (RBP4) in Type 2 Diabetic Patients with Nephropathy. Biomark Insights 2016; 11:31-40. [PMID: 26917947 PMCID: PMC4756860 DOI: 10.4137/bmi.s33191] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/25/2015] [Accepted: 11/27/2015] [Indexed: 12/15/2022] Open
Abstract
Diabetic nephropathy (DN) is one of the most serious microvascular complications of diabetes. The study aims to evaluate the diagnostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) and retinol-binding protein 4 (RBP4) as biomarkers for early detection of nephropathy in type 2 diabetic patients. The current study was performed on 150 type 2 diabetic patients. These patients were classified into three equal groups according to their albumin/creatinine ratio (ACR), including patients with normoalbuminuria (ACR <30 mg/g creatinine), patients with microalbuminuria (ACR = 30-300 mg/g creatinine), and patients with macroalbuminuria (ACR >300 mg/g creatinine). Fifty apparently healthy subjects matching the same age and socioeconomic status with diabetic subjects were selected as a control group. The plasma glucose, insulin, glycosylated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), lipid profile, urea, creatinine, cystatin C, glomerular filtration rate (GFR), NGAL, and RBP4 were measured in the studied groups. Significantly elevated NGAL and RBP4 levels were observed in micro- and macroalbuminuric diabetic groups when compared to the control and normoalbuminuric diabetic groups. NGAL and RBP4 were found to correlate positively with duration of diabetes, systolic and diastolic blood pressure, glucose, HbA1c, HOMA-IR, triacylglycerol, and ACR, but correlate inversely with GFR in DN groups. Receiver operating characteristic curves revealed that for early detection of DN, the best cutoff values to discriminate DN and diabetic without nephropathy groups were 91.5 ng/mL for NGAL with 87% sensitivity, 74% specificity, and area under the curve (AUC) = 0.881; 24.5 ng/mL for RBP4 with 84% sensitivity, 90% specificity, and AUC = 0.912; and 37.5 mg/g creatinine for ACR with 89% sensitivity, 72% specificity, and AUC = 0.819. RBP4 is more specific (90% specificity) than NGAL (74% specificity) and ACR (72% specificity). Therefore, RBP4 marker may serve as a tool to follow-up clinical monitoring of the development and progression of DN.
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Affiliation(s)
- Mohamed H. Mahfouz
- Biochemistry Unit, Research Centre for Medicine and Medical Sciences, Deanship of Scientific Research (DSR), Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia (KSA)
| | - Adel M. Assiri
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia (KSA)
| | - Mohammed H. Mukhtar
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia (KSA)
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Friedman AN, Wolfe B. Is Bariatric Surgery an Effective Treatment for Type II Diabetic Kidney Disease? Clin J Am Soc Nephrol 2015; 11:528-35. [PMID: 26450931 DOI: 10.2215/cjn.07670715] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Type II diabetic kidney disease is devastating to patients and society alike. This review will evaluate bariatric surgery as a treatment for diabetic kidney disease primarily through its ability to induce and maintain regression of type II diabetes. The review begins by outlining the global challenge of diabetic kidney disease, its link to obesity, and the comparative benefits of bariatric surgery on weight and type II diabetes. It then surveys comprehensively the relevant literature, which reports that although bariatric surgery is associated with reductions in albuminuria, its effect on harder clinical end points like progression of diabetic kidney disease is not known. The review also includes a critical assessment of the risks and costs of bariatric surgery and concludes by acknowledging the major knowledge gaps in the field and providing research strategies to overcome them. Until these knowledge gaps are filled, clinicians will be forced to rely on their own subjective judgment in determining the benefit-risk ratio of bariatric surgery for patients with diabetic kidney disease.
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Affiliation(s)
- Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Bruce Wolfe
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
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Okumura LM, Antunes VD, Aguiar KS, Farias T, Andrzejevski VM, Funke VM. Tyrosine kinase inhibitors in patients with chronic myelogeneous leukemia: defining the role of social risk factors and non-adherence to treatment. Pharm Pract (Granada) 2015; 13:559. [PMID: 26131044 PMCID: PMC4482844 DOI: 10.18549/pharmpract.2015.02.559] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/24/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the role of social risk factors on adherence to tyrosine kinase inhibitors (TKI) therapy in chronic myeloid leukemia (CML) patients. METHODS This is a retrospective study and eligible patients were adults with CML on TKI treatment. Cases of no adherence to treatment were confirmed during pharmacists' consultation (patient-reported adherence). Baseline characteristics between groups were compared between cases and controls groups. Risk factors identified in bivariate analysis (p<0.2) were included in multivariate model. A qualitative investigation assessed whether such predictors of non-adherence had causal relationship. RESULTS Of 151 patients with CML consulted by pharmacists, 21% had adherence problems. Despite patients with secondary school (p=0.03), most of investigated social risk factors did not differ between groups. However, by using a qualitative approach, patients' level of education could not explain low adherence rates behavior. CONCLUSIONS Social determinants of health, herein investigated, were unlikely to predict adherence to treatment. Regression techniques may lead to untrue statements, so future researches should consider investigating the causes, not only the statistical estimates.
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Affiliation(s)
- Lucas M Okumura
- Pharmacy Department, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ).
| | - Valquíria D Antunes
- Pharmacy Department, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ).
| | - Karina S Aguiar
- Pharmacy Department, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ).
| | - Tatiane Farias
- Pharmacy Department, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ).
| | - Vânia M Andrzejevski
- Pharmacy Department, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ).
| | - Vaneuza M Funke
- Hematopoietic Stem Cell Transplantation Division, Clinical Hospital, Federal University of Paraná . Curitiba, PR ( Brazil ).
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Vaidya V, Gangan N, Sheehan J. Impact of cardiovascular complications among patients with Type 2 diabetes mellitus: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2015; 15:487-97. [PMID: 25824591 DOI: 10.1586/14737167.2015.1024661] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Macrovascular and microvascular complications that accompany Type 2 diabetes mellitus (T2DM) add to the burden among patients. The purpose of this systematic review is to conduct a comprehensive search of the medical literature investigating the prevalence of cardiovascular (CV) complications and assess their impact on healthcare costs, quality of life and mortality among patients with T2DM in the context of microvascular complications. A total of 76 studies and reports were used in this systematic review. Hypertension was the most prevalent complication among patients with T2DM. The additional cost burden due to CV complications was higher than any other complication except end-stage renal disease. Quality of life was much lower among patients with CV complications and T2DM, and mortality was higher than either illness alone.
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Affiliation(s)
- Varun Vaidya
- Department of Pharmacy Practice, Pharmacy Health Care Administration, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Health Science Campus 3000 Arlington Ave., Toledo, OH 43614, USA
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Noone D, Licht C. Chronic kidney disease: a new look at pathogenetic mechanisms and treatment options. Pediatr Nephrol 2014; 29:779-92. [PMID: 23471475 DOI: 10.1007/s00467-013-2436-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 01/31/2013] [Accepted: 02/06/2013] [Indexed: 12/16/2022]
Abstract
The concept of renoprotection has evolved significantly, driven by improved understanding of the pathophysiology of chronic kidney disease (CKD) and the advent of novel treatment options. Glomerular hyperfiltration, hypertension and proteinuria represent key mediators of CKD progression. It is increasingly recognized that proteinuria may actually be pathological and etiological in CKD progression and not just symptomatic. It initiates a sequence of events involving activation of proinflammatory and profibrotic signaling pathways in proximal tubular epithelial cells with transmission of the disease to the tubulointerstitium and progression to end-stage kidney disease (ESKD). Although the etiology and epidemiology of pediatric CKD differs to that in adults, studies in the various animal models of kidney disease, from obstructive uropathy to glomerulonephritis, have revealed that many common proinflammatory and profibrotic pathways are induced in progressive proteinuric CKD, irrespective of the primary disease. This pathomechanistic overlap therefore translates into the potential for common treatment targets for a wide spectrum of kidney diseases. In this review we therefore discuss the experimental and clinical evidence for an array of prospective future drug treatments of CKD progression. While conceptually promising, clear definitive evidence beyond preclinical data does not exist for many of these treatments, and others are limited by serious adverse effects. More studies are needed before general recommendations can be given.
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Affiliation(s)
- Damien Noone
- Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, ON, Canada
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Zhang H, Cai X, Yi B, Huang J, Wang J, Sun J. Correlation of CTGF gene promoter methylation with CTGF expression in type 2 diabetes mellitus with or without nephropathy. Mol Med Rep 2014; 9:2138-44. [PMID: 24676352 PMCID: PMC4055476 DOI: 10.3892/mmr.2014.2067] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 02/25/2014] [Indexed: 01/07/2023] Open
Abstract
Increasing evidence shows that DNA methylation is involved in the development and progression of diabetes mellitus (DM) and its complications. Previous studies conducted by our group have indicated that high glucose levels may induce the demethylation process of the connective tissue growth factor (CTGF) gene promoter and increase the expression of CTGF in human glomerular mesangial cells. Based on these findings, the aim of the present study was to investigate the methylation level of genomic DNA and the CTGF promoter in patients with type 2 DM and to analyze its possible correlation with CTGF expression. Methylation levels of the whole genomic DNA were detected by high-performance liquid chromatography in a non-diabetes control (NDM) group (n=29), a diabetes without nephropathy (NDN) group (n=37) and a diabetes with nephropathy (DN) group (n=38). CTGF promoter methylation levels were detected by methylation-specific polymerase chain reaction and bisulfite sequencing. The levels of serum CTGF were assessed using the enzyme-linked immunosorbent assay. The methylation levels of the whole genomic DNA were not significantly different among the three groups. However, the CTGF methylation levels in the two diabetes groups were significantly lower than those in the NDM group (P<0.05), with the lowest methylation level in the DN group (P<0.05). The CTGF protein levels in the DN group were significantly higher than those in the NDM and NDN groups (P<0.05). Levels of CTGF were negatively correlated with the estimated glomerular filtration rate (eGFR) and the methylation level of the promoter, while they were positively correlated with age, urinary albumin-to-creatinine ratio (UACR), blood urea nitrogen, creatinine, fasting blood sugar and postprandial blood glucose. Multiple stepwise regression analysis showed that CTGF expression was associated with the UACR, CTGF methylation level and eGFR. DNA methylation is a regulatory mechanism of CTGF expression, which is decreased in patients with DM, particularly in those with DN, and may contribute to the pathogenesis of nephropathy.
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Affiliation(s)
- Hao Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Xu Cai
- Department of Nephrology, The Second People's Hospital of Guangdong Province, Guangzhou, Guangdong 510317, P.R. China
| | - Bin Yi
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Jing Huang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Jianwen Wang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Jian Sun
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
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Vupputuri S, Kimes TM, Calloway MO, Christian JB, Bruhn D, Martin AA, Nichols GA. The economic burden of progressive chronic kidney disease among patients with type 2 diabetes. J Diabetes Complications 2014; 28:10-6. [PMID: 24211091 DOI: 10.1016/j.jdiacomp.2013.09.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/20/2013] [Accepted: 09/29/2013] [Indexed: 12/13/2022]
Abstract
AIMS To estimate the rate of progression of chronic kidney disease (CKD) among patients with type 2 diabetes (T2D) and calculate medical costs associated with progression. METHODS We conducted a retrospective cohort study of 25,576 members at Kaiser Permanente who had T2D and at least one serum creatinine measurement in 2005. Using estimated glomerular filtration rate (eGFR), we assigned patients to baseline stages of kidney function (stage 0-2, >60ml/min/1.73m(2), n=21,008; stage 3, 30-59, n=3,885; stage 4, 15-29, n=683). We examined all subsequent eGFRs through 2010 to assess progression of kidney disease. Medical costs at baseline and incremental costs during follow-up were assessed. RESULTS Mean age of patients was 60.6years, 51% were men, and mean diabetes duration was 5.3years. At baseline, 17.9% of patients with T2D also had stage 3 or 4 CKD. Incremental adjusted costs that occurred over follow-up (from baseline) was on average $4569, $12,617, and $33,162 per patient per year higher among patients who progressed from baseline stage 0-2, stage 3, and stage 4 CKD, respectively, compared to those who did not progress. Across all stages of CKD, those who progressed to a higher stage of CKD from baseline had follow-up costs that ranged from 2 to 4 times higher than those who did not progress. CONCLUSIONS Progression of CKD in T2D drives substantial medical care costs. Interventions designed to minimize decline in progressive kidney function, particularly among patients with stage 3 or 4 CKD, may reduce the economic burden of CKD in T2D.
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Affiliation(s)
- Suma Vupputuri
- The Center for Health Research, Kaiser Permanente Georgia, Atlanta, GA.
| | - Teresa M Kimes
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | | | - David Bruhn
- GlaxoSmithKline, US Health Outcomes, Research Triangle Park, NC
| | - Alan A Martin
- GlaxoSmithKline, US Health Outcomes, Research Triangle Park, NC
| | - Gregory A Nichols
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: A cohort study. J Allergy Clin Immunol 2013; 133:790-6. [PMID: 24188976 DOI: 10.1016/j.jaci.2013.09.021] [Citation(s) in RCA: 550] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/15/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Penicillin is the most common drug "allergy" noted at hospital admission, although it is often inaccurate. OBJECTIVE We sought to determine total hospital days, antibiotic exposures, and the prevalence rates of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) in patients with and without penicillin "allergy" at hospital admission. METHODS We performed a retrospective, matched cohort study of subjects admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012. RESULTS It was possible to match 51,582 (99.6% of all possible cases) unique hospitalized subjects with penicillin "allergy" to 2 unique discharge diagnosis category-matched, sex-matched, age-matched, and date of admission-matched control subjects each. Cases with penicillin "allergy" averaged 0.59 (9.9%; 95% CI, 0.47-0.71) more total hospital days during 20.1 ± 10.5 months of follow-up compared with control subjects. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin (P < .0001) for each antibiotic compared with control subjects. Cases had 23.4% (95% CI, 15.6% to 31.7%) more C difficile, 14.1% (95% CI, 7.1% to 21.6%) more MRSA, and 30.1% (95% CI, 12.5% to 50.4%) more VRE infections than expected compared with control subjects. CONCLUSIONS A penicillin "allergy" history, although often inaccurate, is not a benign finding at hospital admission. Subjects with a penicillin "allergy" history spend significantly more time in the hospital. Subjects with a penicillin "allergy" history are exposed to significantly more antibiotics previously associated with C difficile and VRE. Drug "allergies" in general, but most those notably to penicillin, are associated with increased hospital use and increased C difficile, MRSA, and VRE prevalence.
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Affiliation(s)
- Eric Macy
- Southern California Permanente Medical Group, Department of Allergy, San Diego Medical Center, San Diego, Calif.
| | - Richard Contreras
- Kaiser Permanente Health Care Program, Department of Research and Evaluation, Pasadena, Calif
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Abstract
Care of patients with diabetes and chronic kidney disease (CKD) in the UK is divided between primary care, diabetologists and nephrology. In a retrospective analysis, we examined the distribution of care provision for patients with diabetes and CKD. Nephrology services see a minority of diabetic patients with CKD, but they see the majority of those with an estimated glomerular filtration rate (eGFR) of <30 ml/min. Of those followed in nephrology, 70% showed no evidence of progressive renal dysfunction. The nephrology cohort were significantly younger that those seen by primary care physicians or diabetologists. Half of the patients with diabetes and CKD seen in either the primary care and diabetology cohorts, with no nephrology input, had a rate of fall of eGFR of >5 ml/min/yr. This suggests that older age might deter referral to nephrology, which is based predominantly on CKD stage. This results in a significant proportion of patients with stable renal function being seen by nephrology, and in the under-referral of a large cohort of patients with progressive CKD.
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Affiliation(s)
- Ruth K Jones
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - David Hampton
- Deparmtent of Clinical Biochemistry, Royal Gwent Hospital, Newport, UK
| | | | - Aled O Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
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Chen WZ, Hung CC, Wen YW, Ning HC, Gau BR, Huang YY. Effect of glycemic control on microalbuminuria development among type 2 diabetes with high-normal albuminuria. Ren Fail 2013; 36:171-5. [DOI: 10.3109/0886022x.2013.832312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zhuo X, Zhang P, Hoerger TJ. Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. Am J Prev Med 2013; 45:253-61. [PMID: 23953350 DOI: 10.1016/j.amepre.2013.04.017] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/03/2012] [Accepted: 04/23/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lifetime direct medical cost of treating type 2 diabetes and diabetic complications in the U.S. is unknown. PURPOSE This study provides nationally representative estimates of lifetime direct medical costs of treating type 2 diabetes and diabetic complications in people newly diagnosed with type 2 diabetes, by gender and by age at diagnosis. METHODS A type 2 diabetes simulation model was used to simulate the disease progression and direct medical costs among a cohort of newly diagnosed type 2 diabetes patients. The study sample used for the simulation was based on data from the 2009-2010 National Health and Nutritional Examination Survey. The costs of treating type 2 diabetes and diabetic complications were derived from published literature. Annual medical costs were accumulated over the life span of type 2 diabetes to determine the lifetime medical costs. All costs were calculated from a healthcare system perspective, and expressed in 2012 dollars. RESULTS In men diagnosed with type 2 diabetes at ages 25-44 years, 45-54 years, 55-64 years, and ≥ 65 years, the lifetime direct medical costs of treating type 2 diabetes and diabetic complications were $124,700, $106,200, $84,000, and $54,700, respectively. In women, the costs were $130,800, $110,400, $85,500, and $56,600, respectively. The age-gender weighted average of the lifetime medical costs was $85,200, of which 53% was due to treating diabetic complications. The cost of managing macrovascular complications accounted for 57% of the total complication cost. CONCLUSIONS Over the lifetime, type 2 diabetes imposes a substantial economic burden on healthcare systems. Effective interventions that prevent or delay type 2 diabetes and diabetic complications might result in substantial long-term savings in healthcare costs.
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Affiliation(s)
- Xiaohui Zhuo
- National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA.
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Abstract
The increasing prevalence of diabetes has led to DKD becoming the leading cause of ESRD in many regions. The economic cost of DKD will grow to prohibitive amounts unless strategies to prevent its onset or progression are urgently implemented. In type 1 and type 2 diabetes, the presence of microalbuminuria and macroalbuminuria confers increased risk of developing ESRD and of death. Comparison of recent studies with earlier historical studies shows that the incidence of ESRD and death has decreased in DKD. Increased risk of albuminuria has been identified in certain non-European ethnic groups. However, the initial concept of progression of DKD as an albuminuric phenotype involving development of microalbuminuria, macroalbuminuria, and then ESRD has had to be modified. Albumin excretion frequently regresses, and GFR can decline without abnormality in albumin excretion. There is emerging evidence that changes in renal function occurring early in the course of diabetes predict future outcomes. The major challenges are to prevent DKD onset, to detect it early, and to improve DKD outcomes globally.
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MESH Headings
- Albuminuria/epidemiology
- Albuminuria/etiology
- Albuminuria/physiopathology
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/etiology
- Cost of Illness
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/physiopathology
- Diabetic Nephropathies/epidemiology
- Diabetic Nephropathies/etiology
- Diabetic Nephropathies/physiopathology
- Diabetic Nephropathies/prevention & control
- Diabetic Nephropathies/urine
- Disease Progression
- Early Diagnosis
- Early Medical Intervention
- Epidemiologic Studies
- Ethnicity
- Glomerular Filtration Rate
- Humans
- Incidence
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/physiopathology
- Kidney Failure, Chronic/urine
- Outcome Assessment, Health Care
- Risk Factors
- Survival Analysis
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Affiliation(s)
- Anne T Reutens
- Department of Epidemiology and Preventive Medicine, Alfred Centre, Monash University, Melbourne, Victoria 3004, Australia.
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Comas J, Arcos E, Castell C, Cases A, Martinez-Castelao A, Donate T, Esmatjes E. Evolution of the incidence of chronic kidney disease Stage 5 requiring renal replacement therapy in the diabetic population of Catalonia. Nephrol Dial Transplant 2012; 28:1191-8. [DOI: 10.1093/ndt/gfs507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chang TJ, Jiang YD, Chang CH, Chung CH, Yu NC, Chuang LM. Accountability, utilization and providers for diabetes management in Taiwan, 2000–2009: An analysis of the National Health Insurance database. J Formos Med Assoc 2012; 111:605-16. [DOI: 10.1016/j.jfma.2012.09.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/05/2012] [Accepted: 09/06/2012] [Indexed: 11/17/2022] Open
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Martínez-García C, Izquierdo A, Velagapudi V, Vivas Y, Velasco I, Campbell M, Burling K, Cava F, Ros M, Orešič M, Vidal-Puig A, Medina-Gomez G. Accelerated renal disease is associated with the development of metabolic syndrome in a glucolipotoxic mouse model. Dis Model Mech 2012; 5:636-48. [PMID: 22773754 PMCID: PMC3424461 DOI: 10.1242/dmm.009266] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 06/10/2012] [Indexed: 12/23/2022] Open
Abstract
Individuals with metabolic syndrome are at high risk of developing chronic kidney disease (CKD) through unclear pathogenic mechanisms. Obesity and diabetes are known to induce glucolipotoxic effects in metabolically relevant organs. However, the pathogenic role of glucolipotoxicity in the aetiology of diabetic nephropathy is debated. We generated a murine model, the POKO mouse, obtained by crossing the peroxisome proliferator-activated receptor gamma 2 (PPARγ2) knockout (KO) mouse into a genetically obese ob/ob background. We have previously shown that the POKO mice showed: hyperphagia, insulin resistance, hyperglycaemia and dyslipidaemia as early as 4 weeks of age, and developed a complete loss of normal β-cell function by 16 weeks of age. Metabolic phenotyping of the POKO model has led to investigation of the structural and functional changes in the kidney and changes in blood pressure in these mice. Here we demonstrate that the POKO mouse is a model of renal disease that is accelerated by high levels of glucose and lipid accumulation. Similar to ob/ob mice, at 4 weeks of age these animals exhibited an increased urinary albumin:creatinine ratio and significantly increased blood pressure, but in contrast showed a significant increase in the renal hypertrophy index and an associated increase in p27(Kip1) expression compared with their obese littermates. Moreover, at 4 weeks of age POKO mice showed insulin resistance, an alteration of lipid metabolism and glomeruli damage associated with increased transforming growth factor beta (TGFβ) and parathyroid hormone-related protein (PTHrP) expression. At this age, levels of proinflammatory molecules, such as monocyte chemoattractant protein-1 (MCP-1), and fibrotic factors were also increased at the glomerular level compared with levels in ob/ob mice. At 12 weeks of age, renal damage was fully established. These data suggest an accelerated lesion through glucolipotoxic effects in the renal pathogenesis in POKO mice.
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Affiliation(s)
- Cristina Martínez-García
- Universidad Rey Juan Carlos, Dpto. de Bioquímica, Fisiología y Genética Molecular, Avda. de Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Adriana Izquierdo
- Universidad Rey Juan Carlos, Dpto. de Bioquímica, Fisiología y Genética Molecular, Avda. de Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Vidya Velagapudi
- VTT Technical Research Centre of Finland, Tietotie 2, Espoo, PO Box 1500, FIN-02044 VTT, Finland
| | - Yurena Vivas
- Universidad Rey Juan Carlos, Dpto. de Bioquímica, Fisiología y Genética Molecular, Avda. de Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Ismael Velasco
- Universidad Rey Juan Carlos, Dpto. de Bioquímica, Fisiología y Genética Molecular, Avda. de Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Mark Campbell
- University of Cambridge Metabolic Research Laboratories, Institute of Metabolic Science, Level 4, Box 289, Addenbrookes Hospital, Hills Road, Cambridge, CB2 OQQ, UK
| | - Keith Burling
- University of Cambridge Metabolic Research Laboratories, Institute of Metabolic Science, Level 4, Box 289, Addenbrookes Hospital, Hills Road, Cambridge, CB2 OQQ, UK
| | - Fernando Cava
- Área de Laboratorio – Hospital Universitario Fundación Alcorcón, C/Budapest 1. 28922, Alcorcón, Madrid, Spain
| | - Manuel Ros
- Universidad Rey Juan Carlos, Dpto. de Bioquímica, Fisiología y Genética Molecular, Avda. de Atenas s/n. 28922, Alcorcón, Madrid, Spain
| | - Matej Orešič
- VTT Technical Research Centre of Finland, Tietotie 2, Espoo, PO Box 1500, FIN-02044 VTT, Finland
| | - Antonio Vidal-Puig
- University of Cambridge Metabolic Research Laboratories, Institute of Metabolic Science, Level 4, Box 289, Addenbrookes Hospital, Hills Road, Cambridge, CB2 OQQ, UK
| | - Gema Medina-Gomez
- Universidad Rey Juan Carlos, Dpto. de Bioquímica, Fisiología y Genética Molecular, Avda. de Atenas s/n. 28922, Alcorcón, Madrid, Spain
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Bollepalli S, Smith LB, Vasquez A, Rodriguez H, Vehik K. Addressing the burdens of Type 1 diabetes in youth. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/cpr.12.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nichols GA, Kimes TM, Harp JB, Kou TD, Brodovicz KG. Glycemic response and attainment of A1C goals following newly initiated insulin therapy for type 2 diabetes. Diabetes Care 2012; 35:495-7. [PMID: 22279033 PMCID: PMC3322680 DOI: 10.2337/dc11-1171] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify the characteristics associated with glycemic response to newly initiated insulin therapy. RESEARCH DESIGN AND METHODS We identified 1,139 type 2 diabetic patients who initiated insulin therapy between 1 January 2009 and 30 June 2010. Outcomes of interest were the proportion of patients achieving A1C <7% and mean change in A1C within 3-9 months. RESULTS Mean A1C at insulin initiation was 8.2 vs. 9.2% among those who did and did not attain A1C <7% (P < 0.001). Within a mean of 5 months, 464 (40.7%) patients attained A1C <7%. In multivariable analyses controlling for insulin regimen, dose, and oral agent use, preinsulin A1C was responsible for nearly all the explained variance in A1C change. Each one percentage point of preinsulin A1C reduced the probability of attaining <7% by 26% (odds ratio 0.74 [95% CI 0.68-0.80]). CONCLUSIONS Insulin initiation at lower levels of A1C improves goal attainment and independently increases glycemic response.
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Affiliation(s)
- Gregory A Nichols
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA.
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Gilmer TP, O'Connor PJ. Strategies to reduce the cost of renal complications in patients with type 2 diabetes. Diabetes Care 2011; 34:2486-7. [PMID: 22025786 PMCID: PMC3198293 DOI: 10.2337/dc11-1335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Todd P. Gilmer
- From the Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California; and the
| | - Patrick J. O'Connor
- HealthPartners Research Foundation and HealthPartners Medical Group, Minneapolis, Minnesota
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