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Lei X, Zhou Q, Wang Y, Fu S, Li Z, Chen Q. Serum and supplemental vitamin D levels and insulin resistance in T2DM populations: a meta-analysis and systematic review. Sci Rep 2023; 13:12343. [PMID: 37524765 PMCID: PMC10390579 DOI: 10.1038/s41598-023-39469-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
Observational studies have shown a negative correlation between Vitamin D level and the likelihood of developing insulin resistance (IR) and/or diabetes over time, yet evidence remains inconsistent. In this meta-analysis and systematic review, we strive to define the potential association between serum or supplemental Vitamin D Levels and insulin resistance respectively, as well as the contribution of Vitamin D to type 2 diabetes, and to summarize the biologic plausibility of Vitamin D. Four databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched for this Systematic Literature Review (SLR) to find appropriate observational studies and clinical trials published in English through to July 2022. EndNote (version X9) is used to manage the literature search results. We calculated Standard Mean Differences (SMDs) and Risk Ratios (RRs) with their 95% Confidence Intervals (CIs), separately, for continuous and dichotomous outcomes. The correlation coefficients were normalized to z values through Fisher's z-transformation to calculate the relevant statistics. Meta-analyses were carried out for all comparisons, based on a random-effects pooling model. Data analysis was performed using RevMan (version 5.3) and STATA (version 15.1). All statistical tests were two-sided, with P < 0.05 were regarded as significant. In our current meta-analysis, there are 18 RCTs and 20 observational studies including 1243 and 11,063 participants respectively. In the overall analysis, the diabetic with Vitamin D supplement treatment group showed significantly improve serum insulin (SMD = - 0.265, 95% CI - 0.394 to - 0.136, P < 0.05), glucose (SMD = - 0.17, 95% CI - 0.301to - 0.039, P < 0.05) and HOMA-IR (SMD = - 0.441, 95% CI - 0.582 to - 0.3, P < 0.05) compared with the routine treatment group. Correlation analysis results showed that all three outcomes were significantly correlated in a negative manner with raised Vitamin D (insulin: r = - 0.08 95% = - 0.12 to - 0.04; glucose: r = - 0.06 95% = - 0.11 to - 0.01; HOMA-IR: r = - 0.08 95% = - 0.09 to - 0.06). Results of overall analysis proved that vitamin D has shown significant effect on regulates insulin resistance, and there is a significant inverse association between serum Vitamin D level and IR. Vitamin D supplementation is expected to be integrated into conventional medical approaches to prevent type 2 diabetes and to mitigate the burden of diabetes for individuals and society.PROSPERO registration number: CRD42022348295.
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Affiliation(s)
- Xingxing Lei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China
| | - Qian Zhou
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China
| | - Yanmei Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China
| | - Shunlian Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China
| | - Zinan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China
| | - Qiu Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Province, No. 39, Shi-er-Qiao Road, Chengdu, 610072, People's Republic of China.
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Williams V, Onwuchekwa C, Vos AG, Grobbee DE, Otwombe K, Klipstein-Grobusch K. Tuberculosis treatment and resulting abnormal blood glucose: a scoping review of studies from 1981 - 2021. Glob Health Action 2022; 15:2114146. [PMID: 36178364 PMCID: PMC9543146 DOI: 10.1080/16549716.2022.2114146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hyperglycaemia is a risk factor for tuberculosis. Evidence of changes in blood glucose levels during and after tuberculosis treatment is unclear. OBJECTIVE To compile evidence of changes in blood glucose during and after tuberculosis treatment and the effects of elevated blood glucose changes on treatment outcomes in previously normoglycaemic patients. METHODS Original research studies (1980 to 2021) were identified in PubMed, Web of Science, CINAHL and Embase databases. RESULTS Of the 1,277 articles extracted, 14 were included in the final review. All the studies were observational and 50% were prospective. Fasting blood sugar was the most common clinical test (64%), followed by the glycated haemoglobin test and the oral glucose tolerance test (each 50%). Most tests were conducted at baseline and in the third month of treatment. Twelve studies showed that the prevalence of hyperglycaemia in previously normoglycaemic patients decreased from baseline to follow-up and end of treatment. Three studies showed successful treatment outcomes of 64%, 75% and 95%. Patients with hyperglycaemia at baseline were more likely to develop cavitary lung lesions and poor treatment outcomes and had higher post-treatment mortality. There was no difference in outcomes by human immunodeficiency virus (HIV) status. CONCLUSION Elevated blood glucose in normoglycaemic patients receiving treatment for tuberculosis decreased by the end of treatment. Positive HIV status did not affect glucose changes during treatment. Further research is needed to investigate post-treatment morbidity in patients with baseline hyperglycaemia and the effects of HIV on the association between blood glucose and tuberculosis.
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Affiliation(s)
- Victor Williams
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Monitoring and Evaluation Unit, National Tuberculosis Control Programme, Manzini, Eswatini.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alinda G Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kennedy Otwombe
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Raymond J, Long H, Darsaut T. Pragmatic trials can address diagnostic controversies: recent lessons from gestational diabetes. Trials 2022; 23:246. [PMID: 35365186 PMCID: PMC8973943 DOI: 10.1186/s13063-022-06169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022] Open
Abstract
Objective The aim of the paper is to discuss how a pragmatic definition could change our conception of diagnosis, using gestational diabetes mellitus (GDM) as an example. Study design We review the diagnostic controversy that followed an observational study showing a linear relationship between maternal glycaemia and adverse pregnancy outcomes and the resolution proposed 15 years later by a recent pragmatic trial comparing two screening approaches (one- vs two-step) with different diagnostic thresholds. Results The pragmatic trial involved approximately 24,000 women. The one-step screening strategy using lower GDM thresholds diagnosed twice as many women with GDM, but pregnancy outcomes were not different. We examine how the pragmatic approach integrates research into practice and defines the meaning of a diagnosis according to patient outcomes. The approach is ethically and scientifically sound as compared to the previous methodology, where observational research separated from care gave a theoretical definition of GDM that may have misled medical practice for two decades. Conclusion Pragmatic research integrated into practice can revolutionize our conception of medical diagnosis in the best medical interest of patients.
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Affiliation(s)
- Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, H2X 0C1, Canada.
| | - Hélène Long
- Department of Medicine, Division of Endocrinology and Metabolism, Laval Health and Social Services Centres, Laval, Canada
| | - Tim Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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Herring RA, Shojaee-Moradie F, Garesse R, Stevenage M, Jackson N, Fielding BA, Mendis A, Johnsen S, Umpleby AM, Davies M, Russell-Jones DL. Metabolic Effects of an SGLT2 Inhibitor (Dapagliflozin) During a Period of Acute Insulin Withdrawal and Development of Ketoacidosis in People With Type 1 Diabetes. Diabetes Care 2020; 43:2128-2136. [PMID: 32641376 DOI: 10.2337/dc19-2579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/30/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin on glucose flux, lipolysis, and ketone body concentrations during insulin withdrawal in people with type 1 diabetes. RESEARCH DESIGN AND METHODS A double-blind, placebo-controlled crossover study with a 4-week washout period was performed in 12 people with type 1 diabetes using insulin pump therapy. Participants received dapagliflozin or placebo in random order for 7 days. Stable isotopes were infused to measure the glucose Ra, Rd, and lipolysis. At isotopic steady state, insulin was withdrawn, and the study was terminated after 600 min or earlier if blood glucose reached 18 mmol/L, bicarbonate <15 mmol/L, venous pH <7.35, or capillary ketones >5.0 mmol/L. RESULTS At baseline, glucose Ra was significantly higher for the dapagliflozin group than the placebo group. Following insulin withdrawal, plasma glucose concentrations at the end point were significantly lower with dapagliflozin than placebo and glucose Rd area under the curve (AUC)0-180 min and β-hydroxybutyrate (BOHB) AUC0-180 min were significantly higher. There was a small but significantly higher glycerol Ra (measure of lipolysis) AUC0-180 min with dapagliflozin. Nonesterified fatty acid concentrations were not different between treatments. When divided by BMI >27 and <27 kg/m2, basal glucose Ra, BOHB, and glycerol Ra AUC0-180 min were significantly higher in the low-BMI group with dapagliflozin treatment versus the low-BMI group with placebo. CONCLUSIONS During insulin withdrawal, the increase in BOHB with dapagliflozin may be partially due to increased lipolysis. However, reduced renal excretion, reduced BOHB uptake by peripheral tissues, or a metabolic switch to increased ketogenesis within the liver may also play a role.
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Affiliation(s)
- Roselle A Herring
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K.
| | - Fariba Shojaee-Moradie
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Robert Garesse
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Mary Stevenage
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
| | - Nicola Jackson
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Barbara A Fielding
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Agampodi Mendis
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Sigurd Johnsen
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - A Margot Umpleby
- Department of Nutritional Sciences, University of Surrey, Guildford, U.K
| | - Melanie Davies
- Diabetes Research Centre, Department of Health Sciences, University of Leicester, Leicester, U.K
| | - David L Russell-Jones
- Centre for Endocrinology, Diabetes and Research, Royal Surrey County Hospital, Guildford, U.K
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Aziz F, AlHazmi A, Aljameil N, Mahmood I, Tabassum H, Mushfiq S, Hijazy S. Serum Selenium and Lead Levels: a Possible Link with Diabetes and Associated Proteinuria. Biol Trace Elem Res 2020; 193:342-347. [PMID: 31004272 DOI: 10.1007/s12011-019-01721-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
Abstract
The study assessed trace element selenium (Se) and a heavy metal lead (Pb) in patients with type II diabetes mellitus (T2DM) and its associated proteinuria. Total 275 subjects aged between 30 and 90 years were studied: 93 T2DM, 98 T2DM with proteinuria, and 84 as controls. Serum Se and Pb were analyzed by inductively coupled plasma optical emission spectrometer (ICP-OES) and other biochemical indices by ROCHE module COBAS 6000 analyzer. Statistical analysis was done by one-way analysis of variance (ANOVA) at P < 0.0001 followed by Tukey's honest test. Pearson's correlation coefficient was applied to observe the effects of Se and Pb on FPG and ACR. Decreased Se levels were observed in T2DM and T2DM with proteinuria with no significant difference and serum Pb was found within reference range in both groups. Se showed no significant association with FBG and ACR while mid-upper tertile of Pb was significantly associated with ACR of T2DM with the proteinuria group (P < 0.01). Se is known to have a U-shaped relationship with T2DM. Low Se levels in both groups may be due to the effect of disease and its related inflammation. Detected levels of Pb suggest that studied population had lower exposure to it. Association of Pb with ACR showed consistency with the classical studies that even low levels of Pb may cause the renal deterioration.
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Affiliation(s)
- Farah Aziz
- King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Amani AlHazmi
- King Khalid University, Abha, Kingdom of Saudi Arabia
| | | | - Iram Mahmood
- King Khalid University, Abha, Kingdom of Saudi Arabia
| | | | | | - Serene Hijazy
- King Abdul Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia
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Studying the effect of parenterally administered l-alanyl l-glutamine dipeptide in diabetes and new onset diabetes in liver transplantation. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Thewjitcharoen Y, Plianpan P, Chotjirat A, Nakasatien S, Chotwanvirat P, Wanothayaroj E, Krittiyawong S, Himathongkam T. Clinical characteristics and outcomes of care in adult patients with diabetic ketoacidosis: A retrospective study from a tertiary diabetes center in Thailand. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2019; 16:100188. [PMID: 31011538 PMCID: PMC6462756 DOI: 10.1016/j.jcte.2019.100188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/29/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
Abstract
Background Diabetic ketoacidosis (DKA) is a metabolic catastrophe which could occur in any type of diabetes. Even when fundamental key points of DKA treatment had been followed, some differences exist in treatment protocols in each physician, highlighting the need to assess adherence to DKA guideline. Aim This study aimed to examine trend of hospitalized DKA patients and outcomes of treatment over a decade at Theptarin Hospital, a multi-discipline based diabetes center in Thailand. Method A retrospective study of DKA episodes admitted over a 14-year period (2005–2018) was done. Clinical characteristics, laboratory data, type of diabetes, severity of DKA were collected and analyzed. Results A total of 94 DKA episodes occurred in 81 diabetic patients (females 61.5%, mean age 47.4 ± 20.4 years, T1DM 41.5%, T2DM 50.0%, Ketosis-prone diabetes 8.5%, baseline A1C 10.8 ± 3.0%). While infection was the common precipitating factor in T2DM, omission of insulin was the usual precipitating factor in T1DM. During ongoing management, 26.6% of patients developed hypokalemia and supplementation was not prescribed as per protocol in this group of patients. Almost 13% of patients experienced hypoglycemia in the first 24 h. Median time to resolution of DKA was 8.5 h. Four T2DM patients expired from the precipitating cause of DKA which accounted for mortality rate at 4.3% in our study. Conclusions Inadequate metabolic monitoring and iatrogenic hypoglycemia remain areas of concern for DKA management. Occurrence of hypokalemia was related to poor adherence to protocol guidance on potassium supplementation. A strengthened educational program for nursing and medical staffs should be emphasized.
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Azami G, Soh KL, Sazlina SG, Salmiah MS, Aazami S. Behavioral interventions to improve self-management in Iranian adults with type 2 diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord 2018; 17:365-380. [PMID: 30918872 PMCID: PMC6405389 DOI: 10.1007/s40200-018-0376-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/16/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to systematically-review published experimental studies to determine the effectiveness of behavioral interventions on self-management in Iranian adults with type 2 diabetes. METHOD Pub Med, Web of Science, Science Direct, Ovid Medline, EBSCO, ProQuest, Google Scholar, and the Scientific Information Database (SID) were searched for English and Persian language studies published between 2009 and 2017. The primary outcome of this review was to assess the effects of behavioral interventions on glycosylated hemoglobin. Changes in the blood pressure, Lipid profiles, BMI, Self-efficacy, knowledge, attitude, practice, Self-care behaviors, social support, anxiety, and depression were the secondary outcomes. RESULTS Comprehensive search procedures resulted in twenty-three experimental studies with 2208 participants. Eleven studies were included in the Meta-analysis. Compared with the control group, behavioral interventions significantly lower glycosylated hemoglobin -0.61% (95% CI -0.80, -0.41). To explore the effects of the study intervention (regarding what aspects of the intervention are most effective), we then conducted a stratified analysis for HbA1c. Larger effects were found in interventions with a longer duration and higher intensity, delivered in the group format, interventions offered to individuals with higher baseline HbA1c, and interventions delivered by a multidisciplinary team. Moreover, behavioral interventions were effective in improving blood glucose, lipid profiles, knowledge, attitude, practice, self-efficacy, quality of life, and self-care. CONCLUSION In line with other behavioral studies, our study shows that behavioral interventions improve self-management in Iranian adults with type 2 diabetes.
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Affiliation(s)
- Golnaz Azami
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, University Putra Malaysia (UPM), 43400 Serdang, Selangor Malaysia
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Science, Ilam, IR 693917714 Iran
| | - Kim Lam Soh
- Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, University Putra Malaysia (UPM), 43400 Serdang, Selangor Malaysia
| | - Shariff-Ghazali Sazlina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, University Putra Malaysia (UPM), 43400 Serdang, Selangor Malaysia
| | - Mohd Said Salmiah
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia (UPM), 43400 Serdang, Selangor Malaysia
| | - Sanaz Aazami
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Science, Ilam, IR 693917714 Iran
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Affiliation(s)
- Priyathama Vellanki
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Guillermo E Umpierrez
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
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Elangovan A, Cattamanchi S, Farook AR, Trichur RV. Validation of Predicting Hyperglycemic Crisis Death Score: A Risk Stratification Tool for Appropriate Disposition of Hyperglycemic Crisis Patients from the Emergency Department. J Emerg Trauma Shock 2018; 11:104-110. [PMID: 29937639 PMCID: PMC5994862 DOI: 10.4103/jets.jets_2_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Predicting hyperglycemic crisis death (PHD) score is a simple, rapid tool with six independent mortality predictors to calculate 30-day mortality and appropriately dispose patients to Intensive Care Unit (ICU) or ward. AIMS This study aimed at validating the efficiency of PHD score as a decision rule for prognosticating 30-day mortality and classifying hyperglycemic crisis patients for appropriate disposition from the emergency department (ED). MATERIALS AND METHODS This is a prospective, observational study done in the ED of a teaching hospital over 14 months. All patients aged >18 years and who met the criteria of hyperglycemic crisis were enrolled. Thirty-day mortality of six independent predictors was the primary end point. Using PHD, risk scores were calculated and patients were disposed as per physician's clinical judgment. Finally, the treating physician's decision and PHD score disposition were compared and the efficiency of PHD in predicting 30-day mortality was analyzed. Multiple logistic regression models were used for analysis. Receiver operating characteristic curve was drawn, and area under the curve along with sensitivity, specificity, positive predictive value, and negative predictive value was analyzed. P < 0.05 was considered statistically significant. RESULTS A total of 133 patients were included. On applying PHD score, 69, 39, and 25 patients were in the low-, intermediate-, and high-risk groups, respectively, with a mortality rate of 5.8%, 20.5%, and 56%, respectively. On comparing physician disposition with PHD score, an increasing mortality was noticed in ICU, and PHD showed equal weight in risk stratification and appropriate disposition of patients. CONCLUSION In adult patients with hyperglycemic crisis, PHD score is validated as a straightforward, prompt tool for predicting 30-day mortality and aids in disposition. The mortality rate in the PHD score Model II was similar to the physician's clinical decision.
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Affiliation(s)
- Akilan Elangovan
- Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Srihari Cattamanchi
- Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Abdul Razack Farook
- Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Correlates and pattern of physical activity among urban and suburban Iranian adults: a population-based study. SPORT SCIENCES FOR HEALTH 2017. [DOI: 10.1007/s11332-017-0390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
We present the case of a 16-year-old boy who presented with fatigue, polyuria, and polydipsia while on chemotherapy for his relapsed acute lymphoblastic leukemia (ALL). Blood gas examination confirmed the diagnosis of hyperosmolar hyperglycemic state. The etiology for his hyperglycemia was most likely a result of oral glucocorticoid therapy combined with asparaginase therapy-both are a cornerstone of induction chemotherapy for ALL. The patient was aggressively rehydrated with saline, and medications were administered to correct his hyperkalemia. He was then slowly brought to euglycemia with a continuous infusion of insulin. Although hyperosmolar hyperglycemic state is rare during the treatment of ALL, frontline providers should be aware of this diagnosis because of the significant risk of hypovolemic shock and death if correction of hyperglycemia occurs prior to complete fluid resuscitation.
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Morris SM, You H, Gao T, Vacher J, Cooper TK, Awad AS. Distinct roles of arginases 1 and 2 in diabetic nephropathy. Am J Physiol Renal Physiol 2017; 313:F899-F905. [PMID: 28446459 PMCID: PMC5668588 DOI: 10.1152/ajprenal.00158.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 11/22/2022] Open
Abstract
Diabetes is the leading cause of end-stage renal disease, resulting in a significant health care burden and loss of economic productivity by affected individuals. Because current therapies for progression of diabetic nephropathy (DN) are only moderately successful, identification of underlying mechanisms of disease is essential to develop more effective therapies. We showed previously that inhibition of arginase using S-(2-boronoethyl)-l-cysteine (BEC) or genetic deficiency of the arginase-2 isozyme was protective against key features of nephropathy in diabetic mouse models. However, those studies did not determine whether all markers of DN were dependent only on arginase-2 expression. The objective of this study was to identify features of DN that are associated specifically with expression of arginase-1 or -2. Elevated urinary albumin excretion rate and plasma urea levels, increases in renal fibronectin mRNA levels, and decreased renal medullary blood flow were associated almost completely and specifically with arginase-2 expression, indicating that arginase-2 selectively mediates major aspects of diabetic renal injury. However, increases in renal macrophage infiltration and renal TNF-α mRNA levels occurred independent of arginase-2 expression but were almost entirely abolished by treatment with BEC, indicating a distinct role for arginase-1. We therefore generated mice with a macrophage-specific deletion of arginase-1 (CD11bCre /Arg1fl/fl ). CD11bCre /Arg1fl/fl mice had significantly reduced macrophage infiltration but had no effect on albuminuria compared with Arg1fl/fl mice after 12 wk of streptozotocin-induced diabetes. These results indicate that selective inhibition of arginase-2 would be effective in preventing or ameliorating major features of diabetic renal injury.
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Affiliation(s)
- Sidney M Morris
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hanning You
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Ting Gao
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jean Vacher
- Clinical Research Institute of Montreal, Départment de Médecine, Université de Montréal, Montréal, Canada; and
| | - Timothy K Cooper
- Department of Comparative Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Alaa S Awad
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania;
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Lee MK, Han KD, Lee JH, Sohn SY, Hong OK, Jeong JS, Kim MK, Baek KH, Song KH, Kwon HS. Normal-to-mildly increased albuminuria predicts the risk for diabetic retinopathy in patients with type 2 diabetes. Sci Rep 2017; 7:11757. [PMID: 28924157 PMCID: PMC5603609 DOI: 10.1038/s41598-017-11906-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/29/2017] [Indexed: 02/06/2023] Open
Abstract
Albuminuria is closely associated with diabetic retinopathy (DR), but the precise role of the albumin-to-creatinine ratio (ACR) in screening for DR remains to be determined. This study aimed to investigate an ACR threshold for predicting DR in patients with type 2 diabetes. A cross-sectional study was conducted on 1,102 type 2 diabetes patients, aged ≥30 years and recruited from the Korea National Health and Nutrition Examination Survey, 2010–2011. Participants were grouped by stage of DR: mild-to-moderate nonproliferative DR (NPDR), severe NPDR, and proliferative diabetic retinopathy (PDR). An early morning spot urine sample was obtained for ACR measurement. ROC curve analysis revealed that the optimal cut-off value of ACR for predicting DR was 2.26 mg/mmol (20 μg/mg). The prevalence of ACR ≥ 2.26 mg/mmol tended to increase with severity of DR. The risk for DR in patients with ACR ≥ 2.26 mg/mmol was higher than in those with ACR < 2.26 mg/mmol. The risk for severe NPDR and PDR also increased at ACR ≥ 2.26 mg/mmol. Normal-to-mildly increased albuminuria (an ACR of 2.26 mg/mmol) may predict the risk for DR development and progression in patients with type 2 diabetes.
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Affiliation(s)
- Min-Kyung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Kyung-Do Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Hyuk Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Seo-Young Sohn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Oak-Kee Hong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee-Sun Jeong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee-Kyoung Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Hyun Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Ho Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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15
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Perreault L, Færch K, Gregg EW. Can Cardiovascular Epidemiology and Clinical Trials Close the Risk Management Gap Between Diabetes and Prediabetes? Curr Diab Rep 2017; 17:77. [PMID: 28766246 DOI: 10.1007/s11892-017-0899-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW We reviewed published literature to determine the relationship between A1c and cardiovascular disease (CVD) and summarize the need and implications for CVD risk reduction with interventions, focusing in the prediabetic A1c range (<6.5%). RECENT FINDINGS Strong evidence supports a continuous relationship between A1c and CVD-even below the current levels of A1c-defined prediabetes and after adjustment for known risk factors for CVD. Clinical trials have demonstrated a reduction in CV morbidity and/or mortality when interventions are invoked in the prediabetic A1c range. Guidelines advocating CV risk factor management in prediabetes have not been widely adopted, subsequently leading to comparable coronary heart disease risk between people with prediabetes (HR = 1.9, 95% CI 1.7-2.1 vs normoglycemia) and diabetes itself (HR=2.0, 95% CI 1.8-2.2 vs no diabetes). This review highlights the missed opportunity to utilize multiple risk factor interventions to reduce CVD in high-risk people with prediabetes.
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Affiliation(s)
- Leigh Perreault
- University of Colorado Anschutz Medical Campus, mailstop F8106, P.O. Box 6511, Aurora, CO, 80045, USA.
| | | | - Edward W Gregg
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Temperature and pH sensors based on graphenic materials. Biosens Bioelectron 2017; 91:870-877. [DOI: 10.1016/j.bios.2017.01.062] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
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17
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Tanash MI, Fitzsimons D, Coates V, Deaton C. An evaluation of the effectiveness of self-management interventions for people with type 2 diabetes after an acute coronary syndrome: a systematic review. J Clin Nurs 2017; 26:1458-1472. [PMID: 27486677 DOI: 10.1111/jocn.13487] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Type 2 diabetes is highly prevalent in patients with acute coronary syndrome and impacts negatively on health outcomes and self-management. Both conditions share similar risk factors. However, there is insufficient evidence on the effectiveness of combined interventions to promote self-management behaviour for people with diabetes and cardiac problems. Identifying critical features of successful interventions will inform future integrated self-management programmes for patients with both conditions. OBJECTIVES To assess the evidence on the effectiveness of existing interventions to promote self-management behaviour for patients presenting with acute coronary syndrome and type 2 diabetes in secondary care settings and postdischarge. DESIGN We searched MEDLINE, PubMed, CINAHL Plus, PsycInfo, Cochrane Library and AMED for randomised controlled trials published between January 2005-December 2014. The search was performed using the following search terms of 'acute coronary syndrome', 'type 2 diabetes' and 'self-management intervention' and their substitutes combined. RESULTS Of 4275 articles that were retrieved, only four trials met all the inclusion criteria (population, intervention, comparison and outcome) and were analysed. Overall, the results show that providing combined interventions for patients with both conditions including educational sessions supported by multimedia or telecommunication technologies was partially successful in promoting self-management behaviours. Implementation of these combined interventions during patient's hospitalisation and postdischarge was feasible. Intervention group subjects reported a significant improvement in self-efficacy, level of knowledge, glycated haemoglobin, blood pressure and fasting glucose test. However, there are many threats have been noticed around internal validity of included studies that could compromise the conclusions drawn. CONCLUSION With limited research in this area, there was no final evidence to support effectiveness of combined interventions to promote self-management behaviour for patients with type 2 diabetes and acute coronary syndrome. Sufficiently powered, good quality, well-conducted and reported randomised controlled trials are required.
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Affiliation(s)
| | | | - Vivien Coates
- School of Nursing, University of Ulster, Coleraine, Londonderry, UK
| | - Christi Deaton
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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18
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19
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Jones PM, Clark LL. Developing Educational Materials for Teaching Diabetes Standards of Care to Home Care Nurses. DIABETES EDUCATOR 2016; 28:712-5, 718-20, 723-4 passim. [PMID: 14625957 DOI: 10.1177/014572170202800512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Phyllis M Jones
- Visiting Nurses Association, Western Pennsylvania, Butler, Pennsylvania, USA.
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20
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21
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Feher MD, Langley-Hawthorne CE, Byrne CD. Cost-outcome benefits of fibrate therapy in type 2 diabetes. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514030030020801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To date there have been few studies focusing on economic assessments of fibrate therapy in the management of coronary heart disease (CHD), particularly in patients with type 2 diabetes. A cost-effectiveness model for an economic analysis was established by an assessment of `cost per CHD event avoided' for fibrate therapy. This model was derived from: i) data on CHD events in patients with and without diabetes from randomised controlled trials of lipid-lowering agents, ii) comparisons of fibrate and HMG CoA reductase inhibitor (statin) treatment compared to no treatment and iii) current UK-based drug and clinical event costs. Treatment benefits over a five-year period were calculated, and the sensitivity of the model to the individual variables tested. Fibrate therapy was substantially more cost-effective than statin therapy in patients with diabetes. Economic costings for fenofibrate, as the index fibrate commonly used in the UK, confirmed an annual cost of £2,642— £3,700 per CHD event avoided over a five-year assessment period. Cost-effectiveness ratios derived in the economic model demonstrated that fibrate therapy was equally effective as statin therapy, but at a 54% reduction in annual cost. Current and future CHD treatment guidelines should incorporate pharmacoeconomic data for fibrate as well as statin therapy.
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Affiliation(s)
- Michael D Feher
- Beta Cell Diabetes Centre, Chelsea & Westminster Hospital, London SW10, UK,
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Affiliation(s)
| | | | - Richard Katz
- Department of Medicine, Division of Cardiology, The George Washington University Medical Center, 2150 Pennsylvania Ave NW, Washington, DC 20037, USA,
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23
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Dailey AD, Lutomski DM. Effectiveness of Sliding-Scale Insulin in Inpatients with Diabetes Mellitus. J Pharm Technol 2016. [DOI: 10.1177/875512250301900301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To compare the incidence of hypoglycemia and hyperglycemia among sliding-scale insulin (SSI) regimens and determine patient characteristics that influence glycemic control in inpatients with diabetes mellitus. Methods: Main outcome measures for this retrospective chart review were rates of hyperglycemic (≥200 mg/dL) and hypoglycemic (≤60 mg/dL or symptomatic) episodes. Patients were excluded if a diabetic complication led to hospitalization. SSI regimens as well as patient demographics and clinical characteristics were evaluated for influence on glycemic control. Results: Seventy-four patients with 1020 capillary glucose measurements were analyzed. Regarding overall glycemic control, 80% of patients had ≥2 hyperglycemic events and 4% had ≥2 hypoglycemic events. Factors that significantly increased the risk of hyperglycemia were insulin use prior to admission (p ≤ 0.0001), corticosteroid use (p ≤ 0.0001), antibiotic use (p = 0.009), and dextrose-containing intravenous fluids (p = 0.004). Implementation of an SSI order form (which was associated with selection of more aggressive SSI regimens) significantly decreased the incidence of hyperglycemia (p ≤ 0.0001) without increasing the incidence of hypoglycemia. When analyzed for interactions among variables, insulin use prior to admission and concurrent corticosteroid use remained as independent predictors of hyperglycemia. Conclusions: Suboptimal glycemic control is common in hospitalized patients with diabetes. Patients receiving insulin prior to admission, corticosteroid therapy, dextrose-containing intravenous fluids, or treatment for an active infection are at increased risk. An aggressive SSI regimen does not appear to increase the incidence of hypoglycemia and may lead to better glycemic control. Whether initiating treatment at blood glucose concentrations <150 mg/dL would improve control remains unknown.
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Affiliation(s)
- Amanda D Dailey
- AMANDA D DAILEY PharmD, Clinical Manager, Pharmacy Systems, Inc., Dublin, OH
| | - Dave M Lutomski
- DAVE M LUTOMSKI RPh MS, Clinical Pharmacy Specialist, The University Hospital, and Assistant Professor, College of Pharmacy, University of Cincinnati
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24
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Derosa G, Gaddi AV, Ciccarelli L, Fogari E, Ghelfi M, Ferrari I, Cicero AFG. Long-term Effect of Glimepiride and Rosiglitazone on Non-conventional Cardiovascular Risk Factors in Metformin-treated Patients Affected by Metabolic Syndrome: A Randomized, Double-blind Clinical Trial. J Int Med Res 2016; 33:284-94. [PMID: 15938589 DOI: 10.1177/147323000503300303] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We evaluated the effect of glimepiride plus metformin and rosiglitazone plus metformin on glucose, and on cardiovascular risk parameters such as lipoprotein(a) (Lp[a]) and homocysteine (HCT) in patients with type 2 diabetes and metabolic syndrome. Ninety-nine patients in the multicentre, randomized, double-blind study took metformin (1500 mg/day) plus glimepiride (2 mg/day) or rosiglitazone (4 mg/day) for 12 months. Changes in body mass index, glycosylated haemoglobin (HbA1c), Lp(a) and HCT were primary efficacy variables. Fasting plasma glucose (FPG), post-prandial plasma glucose (PPG) and homeostasis model assessment index were also used to assess efficacy. On average, HbA1c decreased by 9.1% and 8.1%, FPG decreased by 7.3% and 10.9%, and PPG decreased by 7.6% and 10.5%, respectively, in the glimepiride and rosiglitazone groups after 12 months. Patients receiving rosiglitazone experienced more rapid improvement in glycaemic control than those on glimepiride, and showed a significant improvement in insulin resistance-related parameters. There was a statistically significant decrease in basal homocysteinaemia in glimepiride-treated patients (−27.3%), but not in rosiglitazone-treated patients. Rosiglitazone plus metformin significantly improved long-term control of insulin resistance-related parameters compared with glimepiride plus metformin, although glimepiride treatment was associated with a slight improvement in cholesterolaemia, not observed in the rosiglitazone-treated patients, and with significant improvements in non-traditional risk factors for cardiovascular disease, such as basal homocysteinaemia and plasma Lp(a) levels.
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Affiliation(s)
- G Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
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25
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Derosa G, Dangelo A, Ragonesi PD, Ciccarelli L, Piccinni MN, Pricolo F, Salvadeo S, Montagna L, Gravina A, Ferrari I, Galli S, Paniga S, Cicero AFG. Effects of Rosiglitazone and Pioglitazone Combined with Metformin on the Prothrombotic State of Patients with Type 2 Diabetes Mellitus and Metabolic Syndrome. J Int Med Res 2016; 34:545-55. [PMID: 17133785 DOI: 10.1177/147323000603400513] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this multicentre, randomized, double-blind, controlled, parallel-group trial, 103 patients with type 2 diabetes mellitus and metabolic syndrome were randomized to receive one of two thiazolidinediones – pioglitazone or rosiglitazone – in combination with 1500 mg/day of metformin, increasing up to 3000 mg/day, for 12 months. Anthropometric, metabolic, coagulation and fibrinolysis parameters were assessed at baseline and after 3, 6, 9 and 12 months. Significant decreases in glycosylated haemoglobin, fasting plasma glucose and post-prandial plasma glucose levels were seen after 9 and 12 months in both groups, and significant decreases in fasting plasma insulin and post-prandial plasma insulin levels were seen after 12 months in both groups. In both groups, improvement in the homeostasis model assessment index compared with baseline was obtained only after 12 months. Plasminogen activator inhibitor-1 levels were significantly lower in both groups after 12 months compared with baseline values. In patients with type 2 diabetes mellitus and metabolic syndrome, the combination of metformin plus thiazolidinediones improved glycaemic control and produced a slight but significant reduction in plasminogen activator inhibitor-1 levels.
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Affiliation(s)
- G Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
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26
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Khan FA, Al Jameil N, Arjumand S, Khan MF, Tabassum H, Alenzi N, Hijazy S, Alenzi S, Subaie S, Fatima S. Comparative Study of Serum Copper, Iron, Magnesium, and Zinc in Type 2 Diabetes-Associated Proteinuria. Biol Trace Elem Res 2015; 168:321-9. [PMID: 26024734 DOI: 10.1007/s12011-015-0379-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/20/2015] [Indexed: 01/03/2023]
Abstract
Trace element (TE) disturbances are well noted in type 2 diabetes mellitus (T2DM) and its associated complications. In present study, the effect of proteinuria on serum copper (Cu), iron (Fe), magnesium (Mg), and zinc (Zn) in T2DM patients with and without proteinuria was seen. Total subjects were aged between 30 and 90 years; 73 had proteinuria, 76 had T2DM with proteinuria, 76 had T2DM, and 75 were controls. Serum Cu(II), Fe(III), Mg(II), and Zn(II) were assayed by inductively coupled plasma optical emission spectrometer (ICP-OES). Urinary albumin estimation was performed by turbidimetric method. Other biochemical parameters were analyzed by ROCHE Module COBAS 6000 analyzer. Statistical analysis was performed using analysis of variance (ANOVA) at P<0.0001 followed by t test. Pearson correlation was applied to estimate the effect of proteinuria on TE. Serum Cu(II) level was increased in T2DM patients with proteinuria while Fe(III) was found elevated in T2DM (P<0.0001) compared to control groups. Zn(II) and Mg(II) were significantly low in proteinuria, T2DM with proteinuria, and T2DM (P<0.0001) compare to controls. Serum Cu(II) showed strong positive association with albumin creatinine ratio (ACR) in T2DM with proteinuria group and T2DM group (P<0.01). Fe(III) was positively and Zn(II) was negatively associated with ACR at P<0.10, in T2DM with proteinuria group. Mg(II) was negatively linked with ACR P<0.01 in proteinuria, T2DM with proteinuria, and T2DM group. TE were observed more disturbed in T2DM with proteinuria group, thus considered to be the part of T2DM routine checkup and restricts the disease towards its progression.
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Affiliation(s)
- Farah Aziz Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Noura Al Jameil
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Sadia Arjumand
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Fareed Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hajera Tabassum
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Naif Alenzi
- Department of Research and Seized, Saudi Food and Drug Authority, Element Analysis Unit, Riyadh, Kingdom of Saudi Arabia
| | - Sereen Hijazy
- Department of Research and Seized, Saudi Food and Drug Authority, Element Analysis Unit, Riyadh, Kingdom of Saudi Arabia
| | - Samyah Alenzi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sahar Subaie
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sabiha Fatima
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
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27
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Assessment of estimated GFR and clinical predictors of contrast induced nephropathy among diabetic patients undergoing cardiac catheterization. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
The gateways to advancements in medical fields have always been accessed through the coalition between various specialties. It is almost impossible for any specialty to make rapid strides of its own. However, the understanding of deeper perspectives of each specialty or super specialty is essential to take initiatives for the progress of the other specialty. Endocrinology and anesthesiology are two such examples which have made rapid progress in the last three decades. Somehow the interaction and relationship among these medical streams have been only scarcely studied. Diabetes and thyroid pathophysiologies have been the most researched endocrine disorders so far in anesthesia practice but even their management strategies have undergone significant metamorphosis over the last three decades. As such, anesthesia practice has been influenced vastly by these advancements in endocrinology. However, a comprehensive understanding of the relationship between these two partially related specialties is considered to be an essential cornerstone for further progress in anesthesia and surgical sciences. The current review is an attempt to imbibe the current and the changing perspectives so as to make the understanding of the relationship between these two medical streams a little simple and clearer.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Gurpreet Kaur
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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Gómez Rivera N, García Zárate MG, Fonseca Chon I, Gómez Figueroa CO, Gómez Jiménez IA, Villalobos García L. [Diabetic ketoacidosis in children: hospital experience. A 15-year retrospective study]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:313-317. [PMID: 29421529 DOI: 10.1016/j.bmhimx.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/11/2015] [Accepted: 09/13/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the major complications of diabetes mellitus (DM). The objective of this report was to highlight the clinical and laboratory importance in the treatment of patients with DKA during a 15-year period treated at the Hospital Infantil del Estado de Sonora (HIES). METHODS We retrospectively reviewed 140 patients with episodes of DKA to report clinical and laboratory features, mortality, and treatment with HIES protocol. RESULTS Mortality was 0%. Using descriptive statistics we observed minimal complications without neurologic sequelae in three patients with cerebral edema. CONCLUSIONS The HIES protocol is a practical and effective electrolyte and acid-base treatment for DKA.
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Akinlade AT, Ogbera AO, Fasanmade OA, Olamoyegun MA. Serum C-peptide assay of patients with hyperglycemic emergencies at the Lagos State University Teaching Hospital (LASUTH), Ikeja. Int Arch Med 2014; 7:50. [PMID: 25945127 PMCID: PMC4413546 DOI: 10.1186/1755-7682-7-50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 11/11/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION HE are common acute complications of diabetes mellitus (DM) and include diabetic ketoacidosis (DKA), normo-osmolar hyperglycemic state (NHS) and hyperosmolar hyperglycemic state (HHS). They contribute a lot to the mortality and morbidity of DM. The clinical features include dehydration, hyperglycemia, altered mental status and ketosis. The basic mechanism of HE is a reduction in the net effective action of circulating insulin, resulting in hyperglycemia and ketonemia (in DKA) causing osmotic diuresis and electrolytes loss. Infection is a common precipitating factor. Measurement of serum C-peptide provides an accurate assessment of residual β-cell function and is a marker of insulin secretion in DM patients. AIM AND OBJECTIVES To assess the level of pancreatic beta cell function in HE patients, using the serum C-peptide. METHODOLOGY The biodata and clinical characteristics of the 99 subjects were collated using a questionnaire. All subjects had their serum C-peptide, glucose, electrolytes, urea, creatinine levels, urine ketones determined at admission. Results of statistical analysis were expressed as mean ± standard deviation (SD). A p value <0.05 was regarded statistically significant. Correlation between levels of serum C-peptide and admission blood glucose levels and the duration of DM respectively was done. RESULTS The mean age of the subjects was 51 (SD ± 16) years and comparable in both sexes. Mean duration of DM was 6.3 (SD ± 7.1) years, with 35% newly diagnosed at admission. The types of HE in this study are: DKA (24.7%), NHS (36.1%), and HHS (39.2%). Mean blood glucose in this study was 685 mg/dL, significantly highest in HHS and lowest in NHS. Mean serum C-peptide level was 1.6 ng/dL. It was 0.9 ng/dL in subjects with DKA and NHS while 2.7 ng/dL in HHS (p>0.05). Main precipitating factors were poor drug compliance, new-onset of DM and infection. CONCLUSION Most (70%) of subjects had poor pancreatic beta cell function, this may be a contributory factor to developing HE. Most subjects with high C-peptide levels had HHS.
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Balaji V, Balaji MS, Datta M, Rajendran R, Nielsen KK, Radhakrishnan R, Kapur A, Seshiah V. A cohort study of gestational diabetes mellitus and complimentary qualitative research: background, aims and design. BMC Pregnancy Childbirth 2014; 14:378. [PMID: 25421525 PMCID: PMC4248438 DOI: 10.1186/s12884-014-0378-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 10/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) and their offsprings are at increased risk of future type 2 diabetes and metabolic abnormalities. Early diagnosis and proper management of GDM, as well as, postpartum follow-up and preventive care is expected to reduce this risk. However, no large scale prospective studies have been done particularly from the developing world on this aspect. The objective of this study is to identify and follow a cohort of pregnant women with and without GDM and their offspring to identify determinants and risk factors for GDM, for various pregnancy outcomes, as well as, for the development of future diabetes and metabolic abnormalities. METHODS This is a prospective cohort study involving pregnant women attending prenatal clinics from urban, semi-urban and rural areas in the greater Chennai region in South India. Around 9850 pregnant women will be screened for GDM. Socio-economic status, demographic data, obstetric history, delivery and birth outcomes, perinatal and postnatal complications, neonatal morbidity, maternal postpartum and offsprings follow-up data will be collected. Those diagnosed with GDM will initially be advised routine care. Those unable to reach glycaemic control with diet alone will be advised to take insulin. Postpartum screening for glucose abnormalities will be performed at months 3 and 6 and then every year for 10 years. The offsprings will be followed up every year for anthropometric measurements and growth velocity, as well as, plasma glucose, insulin and lipid profile. In addition, qualitative research will be carried out to identify barriers and facilitators for early GDM screening, treatment compliance and postpartum follow-up and testing, as well as, for continued adherence to lifestyle modifications. DISCUSSION The study will demonstrate whether measures to improve diagnosis and care of GDM mothers followed by preventive postpartum care are possible in the routine care setting. It will also map out the barriers and facilitators for such initiatives and provide new evidence on the determinants and risk factors for both GDM development and occurrence of adverse pregnancy outcomes and development of future diabetes and metabolic abnormalities in the GDM mother and her offspring.
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Affiliation(s)
- Vijayam Balaji
- Dr. V. Balaji Diabetes Care Centre - Dr. V. Seshiah Diabetes Research Institutes, # 729, P. H. Road, Aminjikarai, Chennai, 600 029, Tamil Nadu, India.
| | - Madhuri S Balaji
- Dr. V. Balaji Diabetes Care Centre - Dr. V. Seshiah Diabetes Research Institutes, # 729, P. H. Road, Aminjikarai, Chennai, 600 029, Tamil Nadu, India.
| | - Manjula Datta
- Madras Diabetes Research Foundation, Chennai, India.
| | - Rekha Rajendran
- Dr. V. Balaji Diabetes Care Centre - Dr. V. Seshiah Diabetes Research Institutes, # 729, P. H. Road, Aminjikarai, Chennai, 600 029, Tamil Nadu, India.
| | - Karoline Kragelund Nielsen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
- World Diabetes Foundation, Gentofte, Denmark.
| | - Rohini Radhakrishnan
- Dr. V. Balaji Diabetes Care Centre - Dr. V. Seshiah Diabetes Research Institutes, # 729, P. H. Road, Aminjikarai, Chennai, 600 029, Tamil Nadu, India.
| | - Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
| | - Veerasamy Seshiah
- Dr. V. Balaji Diabetes Care Centre - Dr. V. Seshiah Diabetes Research Institutes, # 729, P. H. Road, Aminjikarai, Chennai, 600 029, Tamil Nadu, India.
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Beato-Víbora PI, Tormo-García MÁ. Glycemic control and insulin requirements in type 1 diabetic patients depending on the clinical characteristics at diabetes onset. Endocr Res 2014; 39:86-90. [PMID: 24152206 DOI: 10.3109/07435800.2013.840651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The long-term prognosis of type 1 diabetes (T1DM) was evaluated in relation to the clinical characteristics at the time of diabetes onset. PATIENTS AND METHODS We examined retrospectively the clinical and laboratory characteristics present at the time of diagnosis in 301 adult patients (187 men) consecutively admitted to hospital with T1DM onset and evaluated the clinical outcome of T1DM during 6 ± 4.8 years following diagnosis. RESULTS Women needed a greater insulin dose per kg of body weight over the first 2 years following diagnosis. Younger patients at diagnosis had greater insulin requirements during follow-up. Patients with at least one positive pancreatic antibody needed a greater insulin dose 2 years after diagnosis and developed poorer glycemic control during follow-up than patients with no detectable pancreatic antibodies at onset. Diabetic ketoacidosis at onset was associated with greater insulin requirements over the first 2 years of follow-up and with poorer glycemic control during the course of the illness. C-peptide levels at diagnosis correlated with insulin requirements during the first 2 years of follow-up. Patients with higher HbA1c levels at diagnosis had greater insulin requirements in the first year of follow-up. A correlation was found between the HbA1c levels at the consecutive years of follow-up. CONCLUSIONS Female sex, younger age, humoral pancreatic autoimmunity, diabetic ketoacidosis, lower pancreatic reserve and higher HbA1c levels at onset could predict a poor long-term clinical outcome of T1DM in terms of insulin requirements and glycemic control.
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Brown SA, Kouzekanani K, García AA, Orlander PR, Hanis CL. Diabetes self-management and leptin in Mexican Americans with type 2 diabetes: the Starr County border health initiative. THE DIABETES EDUCATOR 2013; 39:820-7. [PMID: 24047926 PMCID: PMC8359772 DOI: 10.1177/0145721713505153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to (1) characterize leptin in Mexican Americans with poorly controlled type 2 diabetes, (2) examine relationships among leptin and indicators of diabetes status (body mass index and A1C), and (3) explore the effects of a culturally tailored diabetes self-management education intervention on leptin. METHODS In Starr County, an impoverished Texas-Mexico border community, 252 Mexican Americans with type 2 diabetes were recruited to test a diabetes self-management education intervention culturally tailored in terms of language, dietary recommendations, social emphasis, family participation, and incorporation of cultural health beliefs. Groups of 8 participants were randomized to experimental or wait-listed control conditions. Outcomes were measured at 3, 6, and 12 months; by 12 months, 109 had complete leptin data. RESULTS Most participants were women and, on average, 55 years of age, diagnosed with diabetes for 8 years, obese, and in poor glycemic control. Three variables-body mass index, sex, A1C-explained 36% of the variance in baseline leptin; there were no intervention effects on leptin. Sex, time, and gender × time interaction effects on leptin were statistically significant; greater increases in leptin over time occurred in women compared to men. In women, fasting blood glucose changes from baseline to 12 months significantly predicted leptin changes from baseline to 12 months; in men, body mass index changes predicted leptin change. CONCLUSIONS With increasing obesity rates, further research is warranted to determine if leptin is a useful intervention target in type 2 diabetes.
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Affiliation(s)
- Sharon A Brown
- School of Nursing, The University of Texas at Austin, TX, USA (Dr Brown, Prof García)
| | | | - Alexandra A García
- School of Nursing, The University of Texas at Austin, TX, USA (Dr Brown, Prof García)
| | - Philip R Orlander
- The University of Texas Medical School at Houston, TX, USA (Dr Orlander)
| | - Craig L Hanis
- The University of Texas Health Science Center at Houston, TX, USA (Prof Hanis)
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Murunga AN, Owira PMO. Diabetic ketoacidosis: an overlooked child killer in sub-Saharan Africa? Trop Med Int Health 2013; 18:1357-64. [PMID: 24112393 DOI: 10.1111/tmi.12195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The true incidence of diabetic ketoacidosis (DKA) in sub-Saharan Africa is unknown but unlike in the Western countries, DKA is also uniquely frequent among type 2 diabetes patients of African origin. Increased hyperglycaemia and hepatic ketogenesis lead to osmotic diuresis, dehydration and tissue hypoxia. Acute complications of DKA include cerebral oedema, which may be compounded by malnutrition, parasitic and microbial infections with rampant tuberculosis and HIV. Overlapping symptoms of these conditions and misdiagnosis of DKA contribute to increased morbidity and mortality. Inability of the patients to afford insulin treatment leads to poor glycemic control as some patients seek alternative treatment from traditional healers or use herbal remedies further complicating the disease process. Standard treatment guidelines for DKA currently used may not be ideal as they are adapted from those of the developed world. Children presenting with suspected DKA should be screened for comorbidities which may complicate fluid and electrolyte replacement therapy protocol. Patient rehabilitation should take into account concurrent treatment for infectious conditions to avoid possible life-threatening drug interactions. We recommend that health systems in sub-Saharan Africa leverage the Expanded Immunization Programme or TB/HIV/AIDS programmes, which are fairly well entrenched to support diabetes services.
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Affiliation(s)
- A N Murunga
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Abstract
Success in treatment of endocrine emergencies is contingent on early recognition and treatment. Many endocrine diseases presenting emergently have nonspecific signs and symptoms. In addition, these endocrine crises are often precipitated by concurrent disease, further making early identification difficult. This article concentrates on recognition and emergency management of the most common endocrine crises in dogs and cats.
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Affiliation(s)
- Amie Koenig
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
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Day RT, Cavaglieri RC, Feliers D. Apelin retards the progression of diabetic nephropathy. Am J Physiol Renal Physiol 2013; 304:F788-800. [PMID: 23303408 PMCID: PMC3602700 DOI: 10.1152/ajprenal.00306.2012] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 01/04/2013] [Indexed: 12/14/2022] Open
Abstract
Apelin and its receptor APJ have pleiotropic effects in mice and humans and play a protective role in cardiovascular diseases at least partially by inhibiting oxidative stress. Our objective was to study the effect of apelin on the progression of kidney disease in mice with established type 1 diabetes. Ove26 mice with type 1 diabetes received daily subcutaneous injections of apelin for 2 or 14 wk. APJ localizes in the glomeruli and blood vessels of kidneys. Renal APJ expression was reduced in diabetic mice but increased after treatment with apelin. Apelin treatment did not affect glycemia, body weight, or blood pressure in diabetic mice. Whole kidney and glomerular hypertrophy, as well as renal inflammation, including monocyte chemoattractant protein 1 and vascular cell adhesion molecule 1 expression, NF-κB activation, and monocyte infiltration, was inhibited after short and long treatment with apelin. Apelin administration significantly reduced albuminuria at 6 mo. Short treatment with apelin was sufficient to reverse the downregulation of the antioxidant enzyme catalase. Expression of angiotensin II and angiotensin type 1 receptor (AT1) in kidneys from diabetic mice treated was not affected by apelin. These findings show for the first time that apelin exerts a protective effect on the diabetic kidney. Short administration is sufficient to reduce kidney and glomerular hypertrophy as well as renal inflammation, but prolonged treatment is required to improve albuminuria. This effect was independent of the activation of the renin angiotensin system but correlated with upregulation of the antioxidant catalase. Apelin may represent a novel tool to treat diabetic nephropathy.
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Affiliation(s)
- Robert T Day
- Department of Medicine/Renal Diseases, University of Texas Health Science Center, San Antonio, TX 78229, USA
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Derosa G, Fogari E, D’Angelo A, Bianchi L, Bonaventura A, Romano D, Maffioli P. Adipocytokine Levels in Obese and Non-obese Subjects: an Observational Study. Inflammation 2013; 36:914-20. [DOI: 10.1007/s10753-013-9620-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Eren MA, Vural M, Cece H, Camuzcuoglu H, Yildiz S, Toy H, Aksoy N. Association of serum amyloid A with subclinical atherosclerosis in women with gestational diabetes. Gynecol Endocrinol 2012; 28:1010-3. [PMID: 22827403 DOI: 10.3109/09513590.2012.705371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of our study was to evaluate serum amyloid A (SAA), an acute phase reactant, and carotid intima-media thickness (CIMT) as a valid predictor of atherosclerosis in women with gestational diabetes mellitus (GDM). Serum samples from 39 pregnant women with GDM and 25 healthy pregnant women were collected for the analysis of SAA. CIMT was measured in both groups to evaluate future atherosclerotic heart disease risk. The SAA level was measured with ELISA. The mean arterial blood pressure (MABP), CIMT and SAA levels were significantly higher in women with GDM compared with healthy pregnant controls (p = 0.033, p = 0.001 and p = 0.004, respectively). There were significant correlations between SAA and age, BMI, MABP, 50-g oral glucose tolerance test (OGTT), and A1c (p = 0.048, p = 0.037, p = 0.035, p = 0.042 and p = 0.048, respectively) and between CIMT and BMI, MABP, and 50-g OGTT, (p = 0.001, p = 0.004 and p < 0.001, respectively) in correlation analysis. Furthermore, there was a correlation between SAA and CIMT (p = 0.048). Increased SAA and CIMT values in GDM compared with healthy controls might indicate an increased risk of subclinical atherosclerosis and future atherosclerotic heart disease and the importance of inflammation in this process. These changes were associated with obesity, hypertension and glucose intolerance-related factors (BMI, MABP, and 50-g OGTT), which may be relevant to GDM pathophysiology.
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Affiliation(s)
- Mehmet Ali Eren
- Department of Endocrinology, School of Medicine, Harran University, Sanliurfa, Turkey.
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Affiliation(s)
- K D Barnard
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, UK
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Bajwa SJS, Jindal R. Endocrine emergencies in critically ill patients: Challenges in diagnosis and management. Indian J Endocrinol Metab 2012; 16:722-727. [PMID: 23087855 PMCID: PMC3475895 DOI: 10.4103/2230-8210.100661] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Endocrine emergencies pose unique challenges for the attending intensivist while managing critically ill patients. Besides taking care of primary disease state, one has to divert an equal attention to the possible associated endocrinopathies also. One of the common reasons for inability to timely diagnose an endocrinal failure in critically ill patients being the dominance of other severe systemic diseases and their clinical presentation. The timely diagnosis and administration of therapeutic interventions for these endocrine disorders can improve the outcome in critically ill patients. The timely diagnosis and administration of timely therapeutics in common endocrine disorders like severe thyroid disease, acute adrenal insufficiency and diabetic ketoacidosis significantly influence the outcome and prognosis. Careful evaluation of clinical history and a high degree of suspicion are the corner stone to diagnose such problems. Aggressive management of the patient is equally important as the complications are devastating and can prove highly fatal. The present article is an attempt to review some of the common endocrine emergencies in intensive care unit and the challenges associated with their diagnosis and management.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Ravi Jindal
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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Nielsen KK, de Courten M, Kapur A. The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus--lessons from projects funded by the World Diabetes Foundation. Glob Health Action 2012; 5:GHA-5-17277. [PMID: 22855644 PMCID: PMC3409336 DOI: 10.3402/gha.v5i0.17277] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 12/13/2022] Open
Abstract
Background To address the risks of adverse pregnancy outcomes and future type 2 diabetes associated with gestational diabetes mellitus (GDM), its early detection and timely treatment is essential. In the absence of an international consensus, multiple different guidelines on screening and diagnosis of GDM have existed for a long time. This may be changing with the publication of the recommendations by the International Association of Diabetes and Pregnancy Study Groups. However, none of these guidelines take into account evidence from or ground realities of resource-poor settings. Objective This study aimed to investigate whether GDM projects supported by the World Diabetes Foundation in developing countries utilize any of the internationally recommended guidelines for screening and diagnosis of GDM, explore experiences on applicability and usefulness of the guidelines and barriers if any, in implementing the guidelines. These projects have reached out to thousands of pregnant women through capacity building and improvement of access to GDM screening and diagnosis in the developing world and therefore provide a rich field experience on the applicability of the guidelines in resource-poor settings. Design A mixed methods approach using questionnaires and interviews was utilised to review 11 GDM projects. Two projects were conducted by the same partner; interviews were conducted in person or via phone by the first author with nine project partners and one responded via email. The interviews were analysed using content analysis. Results The projects use seven different screening procedures and diagnostic criteria and many do not completely adhere to one guideline alone. Various challenges in adhering to the recommendations emerged in the interviews, including problems with screening women during the recommended time period, applicability of some of the listed risk factors used for (pre-)screening, difficulties with reaching women for testing in the fasting state, time consuming nature of the tests, intolerance to high glucose load due to nausea, need for repeat tests, issues with scarcity of test consumables and lack of equipment making some procedures impossible to follow. Conclusion Though an international consensus on screening and diagnosis for GDM is welcome, it should ensure that the recommendations take into account feasibility and applicability in low resource settings to ensure wider usage. We need to move away from purely academic discussions focusing on sensitivity and specificity to also include what can actually be done at the basic care level.
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Edo AE. Clinical profile and outcomes of adult patients with hyperglycemic emergencies managed at a tertiary care hospital in Nigeria. Niger Med J 2012; 53:121-5. [PMID: 23293409 PMCID: PMC3531028 DOI: 10.4103/0300-1652.104378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To document the clinical profile and treatment outcomes of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) managed in a tertiary care hospital. MATERIALS AND METHODS This was a retrospective review of hospital records of patients with DKA and HHS admitted to a tertiary care hospital over a 24-month period. Data on demographics, precipitating factors, clinical features, serum electrolytes, duration of hospital admission, and mortality were extracted. RESULTS Eighty-four patients were included in the study. Fifty (59.5%) were females. Ten (11.9%) persons had type 1 diabetes mellitus (T1DM) and 74 (88.1%) had type 2 diabetes mellitus (T2DM). There were 35 cases of DKA and 49 cases of HHS. Nine patients with T1DM presented in DKA and one in HHS. Forty-eight (55.2%) subjects were previously not diagnosed of diabetes mellitus (DM). The mean±SEM age, casual blood glucose, calculated serum osmolality, and duration of hospital stay of the study subjects were 50.59±1.63 years, 517.98±11.69 mg/dL, 313.59±1.62 mOsmol/L, and 18.85±1.78 days, respectively. Patients with T2DM were significantly older than those with T1DM (54.32±1.34 vs. 23.40±1.38 years, P<0.001).The precipitating factors were poor drug compliance 23 (27.4%), malaria 12 (14.3), urinary tract infection 10 (11.9%), lobar pneumonia 4 (4.8%), and unidentifiable in 29 (34.5%). Common electrolyte derangements were hyponatremia, 31 (36.9%) and hypokalemia 21 (25%). Mortality rate was 3.6%. CONCLUSION DKA is common in patients with T2DM.Over 50% of the patients presenting with DKA or HHS have no previous diagnosis of DM. Non-compliance, malaria, and infections are important precipitants. Mortality rate is low.
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Affiliation(s)
- Andrew E. Edo
- Department of Medicine, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria
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Abstract
A quarter century has passed since the first publication of the evolutionary discordance hypothesis, according to which departures from the nutrition and activity patterns of our hunter-gatherer ancestors have contributed greatly and in specifically definable ways to the endemic chronic diseases of modern civilization. Refinements of the model have changed it in some respects, but anthropological evidence continues to indicate that ancestral human diets prevalent during our evolution were characterized by much lower levels of refined carbohydrates and sodium, much higher levels of fiber and protein, and comparable levels of fat (primarily unsaturated fat) and cholesterol. Physical activity levels were also much higher than current levels, resulting in higher energy throughput. We said at the outset that such evidence could only suggest testable hypotheses and that recommendations must ultimately rest on more conventional epidemiological, clinical, and laboratory studies. Such studies have multiplied and have supported many aspects of our model, to the extent that in some respects, official recommendations today have targets closer to those prevalent among hunter-gatherers than did comparable recommendations 25 years ago. Furthermore, doubts have been raised about the necessity for very low levels of protein, fat, and cholesterol intake common in official recommendations. Most impressively, randomized controlled trials have begun to confirm the value of hunter-gatherer diets in some high-risk groups, even as compared with routinely recommended diets. Much more research needs to be done, but the past quarter century has proven the interest and heuristic value, if not yet the ultimate validity, of the model.
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Affiliation(s)
- Melvin Konner
- Department of Anthropology, Emory University, Atlanta, GA 30306, USA.
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Fischer DJ, Koerber A. Assessment of Willingness to Provide Diabetes Education and Counseling in a Dental School Clinic. J Dent Educ 2011. [DOI: 10.1002/j.0022-0337.2011.75.5.tb05085.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dena J. Fischer
- Department of Oral Medicine and Diagnostic Sciences; College of Dentistry; University of Illinois at Chicago
| | - Anne Koerber
- Department of Pediatric Dentistry; College of Dentistry; University of Illinois at Chicago
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Klein K, Mailath-Pokorny M, Leipold H, Krampl-Bettelheim E, Worda C. Influence of gestational diabetes mellitus on weight discrepancy in twin pregnancies. Twin Res Hum Genet 2011; 13:393-7. [PMID: 20707711 DOI: 10.1375/twin.13.4.393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the influence of gestational diabetes mellitus on weight discrepancy in twin pregnancies. METHODS 200 twin pregnancies were included in the study. 157 nondiabetic pregnant women with twin gestations and 43 twin pregnancies with gestational diabetes mellitus (GDM) with viable fetuses born after 24 weeks of gestation were enrolled. Influence of maternal age, body-mass-index at the time of the oral glucose tolerance test, parity, smoking, chorionicity, gestational age at delivery and diagnosis of GDM on weight discrepancy of the twins was evaluated. RESULTS Mean weight discrepancy of all analyzed twin pregnancies was 285 grams (+/- 231), relative weight discrepancy was 11.3% (+/- 8.6). Univariate regression analyses showed that GDM, chorionicity and gestational age at delivery were significantly associated with weight discrepancy. In the multivariate model only diagnosis of GDM was significantly associated with weight discrepancy. CONCLUSION Twin pregnancies with insulin requiring gestational diabetes seem to have less birth weight discrepancy than twin pregnancies with normal glucose tolerance.
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Affiliation(s)
- Katharina Klein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria.
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Kim DK, Lee SR, Kim MS, Bae SH, Hwang JY, Kim JM, Suh SH, Lee HJ, Park MK, Kim DK. A retrospective study on the efficacy of a ten-milligram dosage of atorvastatin for treatment of hypercholesterolemia in type 2 diabetes mellitus patients. KOREAN DIABETES JOURNAL 2010; 34:359-67. [PMID: 21246009 PMCID: PMC3021112 DOI: 10.4093/kdj.2010.34.6.359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 09/17/2010] [Indexed: 11/08/2022]
Abstract
Background There have been few clinical studies on 10 mg atorvastatin as a starting dosage for treatment of hypercholesterolemia in type 2 diabetes mellitus (T2DM) patients. This retrospective study aims to evaluate the efficacy of 10 mg dosage of atorvastatin in clinical setting. Methods One hundred five enrolled patients with high levels of low density lipoprotein cholesterol (LDL-C, > 100 mg/dL) took 10 mg atorvastatin. After 6 months, they were divided into 'Responder group' (LDL-C < 100 mg/dL) and 'Non-responder group' (LDL-C ≥ 100 mg/dL), and the response rate was calculated. Thereafter, we subdivided the 'Responder group' into Maintenance (10 mg), Reduced dosage (5 mg), and Discontinuance group (0 mg). The 'Non-Responder group' was subdivided into Maintenance (10 mg) and Double dosage group (20 mg). After consecutive 6 months, the response rates of each 10 mg Maintenance groups were compared to those of the other groups, respectively. Results Following the first 6 months, the response rate of 10 mg fixed dosage was 74.3%. In the 'Responder group', response rates of 10 mg, 5 mg and Discontinuance groups following 6 months were 52.6%, 53.1%, and 12.5%, respectively. In the 'Non-responder group', response rates of 10 mg and 20 mg groups were 28.6% and 50.0%. Baseline LDL-C levels and body mass index (BMI) of 'Responder group' were significantly lower than those of 'Non-responder group' (P = 0.004, respectively). Conclusion Hypercholesterolemia treatment with 10 mg, fixed dosage of atorvastatin was effective in three quarters of the subjects during the first 6-month treatment; however, a significant number of patients with high LDL-C levels and/or BMI require higher starting and maintenance dosage.
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Affiliation(s)
- Dong Kyun Kim
- Department of Internal Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
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Abstract
The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%-70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1-2 hours; an initial bolus of 10-20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%-10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort.
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Affiliation(s)
- Arlan L Rosenbloom
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA,
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A case of successful treatment of a patient with hyperglycemia of 2700 mg/dL. Am J Emerg Med 2010; 30:254.e1-2. [PMID: 21084169 DOI: 10.1016/j.ajem.2010.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 10/08/2010] [Indexed: 11/20/2022] Open
Abstract
A 34-year-old man with obesity who was an avid consumer of soft drinks was found in a coma after complaining of a poor physical condition for a few days. On arrival, he had hyperglycemia of 2700 mg/dL, coma, shock, sepsis, aspiration pneumonia, acute renal failure, acute pancreatitis, liver dysfunction, and systemic mycosis. The rapid infusion of a large volume of isotonic saline, insulin, antibiotics, and ulinastatin was performed, and mechanical ventilation was applied. The treatment was complicated by transient hypernatremia resulting from osmostasis, which gradually decreased. He demonstrated transient decerebrate posturing upon stimulation; however, he became conscious within a week of admission, and his associated diseases also improved. After correcting his hyperglycemia, the patient was discharged on foot. We report our case of a patient with hyperglycemia of 2700 mg/dL, which was the highest value reported in the English literature. During the correction of the hyperglycemia, transient hypernatremia occurred to prevent abrupt decrease in osmolality, which thus resulted in cell swelling.
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Zisser HC, Biersmith MA, Jovanovič LB, Yogev Y, Hod M, Kovatchev BP. Fetal risk assessment in pregnancies complicated by diabetes mellitus. J Diabetes Sci Technol 2010; 4:1368-73. [PMID: 21129331 PMCID: PMC3005046 DOI: 10.1177/193229681000400610] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypoglycemia and hyperglycemia can pose a number of serious risks to pregnant mothers with diabetes, but these risks are not always related to glucose concentrations directly. Previous studies have shown the utility of using mathematical transformation functions to create patient risk profiles that can then be used to analyze and predict adverse outcomes in individuals with diabetes. We propose a novel use of these functions to analyze the risks posed to the fetus in pregnancies complicated by diabetes. METHODS We retrospectively analyzed 71 h continuous glucose monitoring system (CGMS Gold, Medtronic Northridge, CA) third trimester tracings obtained during a normal pregnancy and in those complicated by gestational diabetes mellitus (GDM), type 2 diabetes mellitus (T2DM), and type 1 diabetes mellitus (T1DM). We then used a transformation function to calculate fetal and maternal risk in each case. RESULTS In the normal pregnancy (0.93), the risk was at a minimum. Along with mean glucose values, the risk increased in those cases where gestation was complicated by GDM (3.12), T2DM (7.85), and T1DM (16.94). In contrast, the original patient risk profile yielded a minimal value for the GDM tracings. CONCLUSIONS Total fetal risk increases from normal to GDM to T2DM to T1DM pregnancies. This new risk assignment better distinguishes the stages of fetal risk than the original method and therefore may be useful in future clinical trials and applications to predict risk for adverse outcomes in pregnancies complicated by diabetes.
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Affiliation(s)
- Howard C Zisser
- Sansum Diabetes Research Institute, Santa Barbara, California 93105, USA.
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Taj Eldin IM, Ahmed EM, Elwahab H.M A. Preliminary Study of the Clinical Hypoglycemic Effects of Allium cepa (Red Onion) in Type 1 and Type 2 Diabetic Patients. ENVIRONMENTAL HEALTH INSIGHTS 2010; 4:71-7. [PMID: 21079693 PMCID: PMC2978938 DOI: 10.4137/ehi.s5540] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Diabetes mellitus is a heterogeneous group of disorders characterized by abnormalities of carbohydrate, protein and lipid metabolism. Type 1 diabetes mellitus is an autoimmune disease caused by destruction of pancreatic beta cells and characterized by defect in insulin secretion while type 2 diabetes mellitus results from abnormalities in insulin secretion and/or insulin action or both. OBJECTIVES The present study was conducted to investigate the clinical hypoglycemic effects of Allium cepa in type 1 and type 2 diabetic patients. RESULTS In assessment of hypoglycaemic activity of Allium cepa in type 1 and type 2 diabetic patients, ingestion of crude Allium cepa (100 g) caused a considerable reduction in fasting blood glucose levels by about 89 mg/dl in relation to insulin (145 mg/dl) in type 1 diabetic patients and it reduced fasting blood glucose levels by 40 mg/dl, compared to glibenclamide (81 mg/dl) in type 2 diabetic patients, 4 hours later. The same dose of crude Allium cepa produced a significant reduction in the induced hyperglycemia (GTT) by about 120 mg/dl compared to water (77 mg/dl) and insulin (153 mg/dl) in type 1 diabetic patients and considerably reduced GTT by 159 mg/dl in relation to water (55 mg/dl) and glibenclamide (114 mg/dl) in type 2 diabetic patients, after 4 hours. CONCLUSION It was evident that, crude Allium cepa produced hypoglycemic effects, thus it could be used as a dietary supplement in management of type 1 and/or type 2 diabetes mellitus.
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Affiliation(s)
- Imad M. Taj Eldin
- Department of Pharmacology, Faculty of Pharmacy, University of Gezira, Sudan
| | - Elhadi M. Ahmed
- Department of Chemistry and Pharmacognosy, Faculty of Pharmacy, University of Gezira, Sudan
| | - Abd Elwahab H.M
- Department of Pharmacology and Toxicology, Medicinal and Aromatic Plant Research Institute, National Center for Research, Sudan
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