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Januszewski AS, Niedzwiecki P, Sachithanandan N, Ward GM, O’Neal DN, Zozulinska‐Ziolkiewicz DA, Uruska AA, Jenkins AJ. Interactive calculator to estimate insulin sensitivity in type 1 diabetes. J Diabetes Investig 2024; 15:594-597. [PMID: 38366869 PMCID: PMC11060155 DOI: 10.1111/jdi.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/18/2024] Open
Abstract
The gold standard for measuring insulin sensitivity (IS) is the hyperinsulinemic-euglycemic clamp, a time, costly, and labor-intensive research tool. A low insulin sensitivity is associated with a complication-risk in type 1 diabetes. Various formulae using clinical data have been developed and correlated with measured IS in type 1 diabetes. We consolidated multiple formulae into an online calculator (bit.ly/estimated-GDR), enabling comparison of IS and its probability of IS <4.45 mg/kg/min (low) or >6.50 mg/kg/min (high), as measured in a validation set of clamps in 104 adults with type 1 diabetes. Insulin sensitivity calculations using different formulae varied significantly, with correlations (R2) ranging 0.005-0.87 with agreement in detecting low and high glucose disposal rates in the range 49-93% and 89-100%, respectively. We demonstrate that although the calculated IS varies between formulae, their interpretation remains consistent. Our free online calculator offers a user-friendly tool for individual IS calculations and also offers efficient batch processing of data for research.
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Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
- Department of MedicineUniversity of MelbourneFitzroyVictoriaAustralia
- Sydney Pharmacy SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Pawel Niedzwiecki
- Department of Internal Medicine and DiabetologyPoznan University of Medical SciencesPoznanPoland
| | | | - Glenn M Ward
- Department of MedicineUniversity of MelbourneFitzroyVictoriaAustralia
| | - David N O’Neal
- Department of MedicineUniversity of MelbourneFitzroyVictoriaAustralia
| | | | - Aleksandra A Uruska
- Department of Internal Medicine and DiabetologyPoznan University of Medical SciencesPoznanPoland
| | - Alicia J Jenkins
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
- Department of MedicineUniversity of MelbourneFitzroyVictoriaAustralia
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
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Januszewski AS, Niedzwiecki P, Sachithanandan N, Ward GM, Karschimkus CS, O'Neal DN, Zozulinska-Ziolkiewicz DA, Uruska AA, Jenkins AJ. Corrigendum to "Independent euglycaemic hyperinsulinaemic clamp studies validate clinically applicable formulae to estimate insulin sensitivity in people with type 1 diabetes" [Diabetes Metabol Syndr Clin Res Rev 17(1) (2023) 102691]. Diabetes Metab Syndr 2023; 17:102700. [PMID: 36586292 DOI: 10.1016/j.dsx.2022.102700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia.
| | - Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
| | | | - Glenn M Ward
- Department of Medicine, University of Melbourne, Australia
| | | | - David N O'Neal
- Department of Medicine, University of Melbourne, Australia
| | | | - Aleksandra A Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia
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Januszewski AS, Niedzwiecki P, Sachithanandan N, Ward GM, Karschimkus CS, O'Neal DN, Zozulinska-Ziolkiewicz DA, Uruska AA, Jenkins AJ. Independent euglycaemic hyperinsulinaemic clamp studies validate clinically applicable formulae to estimate insulin sensitivity in people with type 1 diabetes. Diabetes Metab Syndr 2023; 17:102691. [PMID: 36508938 DOI: 10.1016/j.dsx.2022.102691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/10/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Low insulin sensitivity (IS) increases Type 1 diabetes (T1D) complication risk and can be estimated by simple formulae developed from complex euglycemic hyperinsulinaemic clamp studies. We aimed to validate these formulae using independent clamp data. METHODS Clamps were performed in 104 T1D adults. Measured glucose disposal rate (GDR) was correlated with eGDR and eLog10 M/I calculated by five IS formulae. RESULTS Correlations ranged between 0.23-0.40. Two IS formulae (by the authors), using age, sex, HDL-C, HbA1c, pulse pressure, BMI, and waist-hip-ratio had the highest correlation with measured GDR and the best performance in detecting low IS.
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Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia.
| | - Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
| | | | - Glenn M Ward
- Department of Medicine, University of Melbourne, Australia
| | | | - David N O'Neal
- Department of Medicine, University of Melbourne, Australia
| | | | - Aleksandra A Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Department of Medicine, University of Melbourne, Australia
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Niedzwiecki P, Pilacinski S, Uruska A, Zozulinska-Ziolkiewicz D. Clinical Remission of Type 1 Diabetes Predicts Higher Insulin Sensitivity at 7 Years from Diagnosis of the Disease. Diabetes Technol Ther 2020; 22:577-583. [PMID: 32013564 DOI: 10.1089/dia.2019.0473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Clinical remission of type 1 diabetes is not only associated with regeneration of beta cells and preserved insulin secretion but also with increased insulin sensitivity. The aim of the study was to determine the association between presence of remission in the first year of type 1 diabetes and insulin resistance at 7 years from diagnosis of the disease. Material and Methods: A total of 108 consecutive patients with newly diagnosed type 1 diabetes were followed prospectively. During the follow-up time, the onset and duration of clinical remission were registered. Seventy-four patients were included in the final analysis. Insulin sensitivity was assessed by the glucose disposal rate (GDR), determined using the hyperinsulinemic-euglycemic clamp, performed at 7 years from diagnosis of diabetes. Patients were divided into groups with GDR <4.5 mg/(kg·min) (G1-lower insulin sensitivity group) and GDR ≥4.5 mg/(kg·min) (G2-higher insulin sensitivity group). Results: Higher insulin sensitivity was observed in the remission group [GDR 6.2 interquartile range (IQR) 4.2-7.0 mg/(kg·min) vs. 3.8 (IQR 3.0-4.8) mg/(kg·min); P = 0.01]. Furthermore, in G2 group, the duration of remission was longer than in G1 group: (351 [IQR 206-561] days vs. 70 [IQR 0-289] days; P = 0.002). Also, the GDR value correlated positively with duration of remission (r = 0.42; P = 0.002). In the multivariate logistic regression model, including age, sex, body mass index at diagnosis, and presence of remission, the remission period was independently associated with a higher GDR value (odds ratio 10.88; 95% confidence interval: 1.70-69.50; P = 0.009]. Conclusions: Patients with type 1 diabetes who entered remission at the beginning of the disease, despite its ending, have higher insulin sensitivity at 7 years after diagnosis of diabetes than nonremitters.
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Uruska A, Zozulinska-Ziolkiewicz D, Niedzwiecki P, Pietrzak M, Wierusz-Wysocka B. TG/HDL-C ratio and visceral adiposity index may be useful in assessment of insulin resistance in adults with type 1 diabetes in clinical practice. J Clin Lipidol 2018. [PMID: 29523408 DOI: 10.1016/j.jacl.2018.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insulin resistance (IR) is an important clinical issue in patients with type 1 diabetes due to worse metabolic control and risk of development of chronic complications. OBJECTIVE The aim of the study was to evaluate simple and easily available parameters as indirect markers of IR in adults with type 1 diabetes and correlate it with the results of hyperinsulinemic-euglycemic clamp. METHODS The study included 88 patients (62 men), aged 34.1 ± 6.5 years, with type 1 diabetes with a median disease duration of 8 (7-13) years and mean HbA1c of 7.6 ± 1.5%. Tissue sensitivity to insulin was assessed on the basis of glucose distribution rate (GDR) obtained in the course of hyperinsulinemic-euglycemic clamp. In addition, indirect markers of IR, such as estimated GDR, presence of features of metabolic syndrome, visceral adiposity index (VAI), and the triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio, were evaluated. RESULTS In the study group, IR defined as GDR <4 mg/kg/min was observed in 33 (37.5%) patients. Group with IR had significantly higher postprandial glycemia (9.1 ± 2.0 vs 8.4 ± 1.1 mmol/L, P = .04), serum TG level (1.11 [0.75-1.92] vs 0.85 [0.60-1.08] mmol/L, P = .001), lower HDL-C level (1.59 ± 0.38 vs 1.8 ± 0.5 mmol/L, P = .02), higher TG/HDL-C ratio (1.60 [1.00-3.13] vs 1.05 [0.62-1.53], P = .001), and higher VAI (2.61 [1.31-4.25] vs 1.56 [0.96-2.25], P = .002). Significant relationship between GDR and TG/HDL-C ratio and VAI, adjusted for age, sex, HbA1c, and duration of diabetes was revealed (respectively, odds ratio 1.90 [95% confidence interval 1.15-3.15], P = .01 and odds ratio 1.47 [95% confidence interval 1.06-2.04], P = .01). CONCLUSIONS TG/HDL-C ratio and VAI appear to be clinically useful tools to assess IR in adults with type 1 diabetes.
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Affiliation(s)
- Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland.
| | | | - Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Pietrzak
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bogna Wierusz-Wysocka
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
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Niedzwiecki P, Naskret D, Pilacinski S, Pempera M, Uruska A, Adamska A, Zozulinska-Ziolkiewicz D. The Higher the Insulin Resistance the Lower the Cardiac Output in Men with Type 1 Diabetes During the Maximal Exercise Test. Metab Syndr Relat Disord 2017; 15:252-257. [PMID: 28394194 DOI: 10.1089/met.2017.0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the hemodynamic parameters analyzed in bioimpedance cardiography during maximal exercise in patients with type 1 diabetes differing in insulin resistance. METHODS The study group consisted of 40 men with type 1 diabetes. Tissue sensitivity to insulin was assessed on the basis of the glucose disposal rate (GDR) analyzed during hyperinsulinemic-euglycemic clamp. Patients were divided into groups with GDR <4.5 mg/kg/min (G1 group-lower insulin sensitivity) and GDR ≥4.5 mg/kg/min (G2 group-higher insulin sensitivity). During the exercise test, the heart rate, systolic volume, cardiac output, cardiac index were measured by the impedance meter (PhysioFlow). RESULTS Compared with the G2 group, the G1 group had a lower cardiac output (CO): during exercise 8.6 (IQR 7.7-10.0) versus 12.8 (IQR 10.8-13.7) L/min; P < 0.0001, at the maximal effort 13.1 (IQR 12.2-16.7) versus 18.6 (IQR 16.9-20.2) L/min; P = 0.001, and during observation after exercise 8.4 (IQR 6.3-9.6) versus 11.9 (IQR 10.1-13.1) L/min; P < 0.0001. We noticed a positive correlation of GDR and cardiac output: during the exercise test (r = 0.63, P = 0.0002), at the maximal effort (Rs 0.56, P = 0.001), and during observation after the exercise test (r = 0.72, P < 0.0001). In multivariate logistic regression, cardiac output during exercise and during observation was associated with high GDR, regardless of the age and duration of diabetes [OR: 1.98 (95% CI 1.10-3.56), P = 0.02 and OR: 1.91 (95% CI 1.05-3.48), P = 0.03; respectively]. CONCLUSION In nonobese subjects with type 1 diabetes, with good metabolic control, insulin resistance is associated with cardiac hemodynamic parameters assessed during and after exercise. The higher the insulin resistance the lower the cardiac output during maximal exercise in men with type 1 diabetes.
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Affiliation(s)
- Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Dariusz Naskret
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Stanislaw Pilacinski
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Maciej Pempera
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Anna Adamska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
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Gawrecki A, Naskret D, Niedzwiecki P, Duda-Sobczak A, Araszkiewicz A, Zozulinska-Ziolkiewicz D. High-intensity Exercise in Men with Type 1 Diabetes and Mode of Insulin Therapy. Int J Sports Med 2017; 38:329-335. [PMID: 28255965 DOI: 10.1055/s-0042-123046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate the impact of high intensity exercise on glucose levels and risk of metabolic decompensation in males with type 1 diabetes (T1D), depending on the method of insulin administration. The study comprised 29 males (aged 25.3±5.1 years; duration of diabetes 10.3±3.2 years) treated with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI). Treadmill exercise test was performed twice in each patient until subjective exhaustion as maximum according to the Borg scale. All the patients achieved ≥85% of the maximal heart rate. Distance during the test was 4 500±1 400 m and 4 473±1 559 m in the MDI and CSII groups, respectively, which was achieved in 31±8 min. During the test and in the 6 h after, no clinically significant episodes of hypoglycemia occurred. Mean glucose levels did not exceed 10 mmol/L in most patients. The risk of the composite endpoint (hypoglycemia<3.8 mmol/L, hyperglycemia≥16.6 mmol/L, ketones≥0.6 mmol/L, and lactate>2.2 mmol/L) was higher in patients treated with MDI than CSII (OR3.75, 95%CI:1.22-11.52, p=0.02). In conclusion, planned high intensity physical effort in men with well-controlled T1D is metabolically safe. CSII shows greater metabolic advantage over MDI during and after high intensity exercise in men with T1D.
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Affiliation(s)
- Andrzej Gawrecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Dariusz Naskret
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Duda-Sobczak
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
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Uruska A, Niedzwiecki P, Araszkiewicz A, Zozulinska-Ziolkiewicz D. Brain-derived neurotrophic factor and insulin resistance during hyperinsulinaemic-euglycaemic clamp in type 1 diabetes patients in the PoProStu. Diabetes Metab 2017; 43:472-474. [PMID: 28139435 DOI: 10.1016/j.diabet.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Affiliation(s)
- A Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland.
| | - P Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - A Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - D Zozulinska-Ziolkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
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Niedzwiecki P, Pilacinski S, Uruska A, Adamska A, Naskret D, Zozulinska-Ziolkiewicz D. Influence of remission and its duration on development of early microvascular complications in young adults with type 1 diabetes. J Diabetes Complications 2015; 29:1105-11. [PMID: 26427560 DOI: 10.1016/j.jdiacomp.2015.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/07/2015] [Accepted: 09/02/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Prevalence of partial remission ranges between 20% and 80% in the initial course of type 1 diabetes. In this phase of the disease, a substantial insulin secretion contributes to good metabolic control. The aim of the study was to determine the association between presence of partial remission and occurrence of microangiopathy complications in type 1 diabetes. MATERIAL AND METHODS Ninety-eight consecutive patients with newly diagnosed type 1 diabetes were asked to participate in a cohort study. Partial remission was defined as the time in which all of the following criteria were met: HbA1c below 6.5% (48mmol/mol), daily insulin requirement below 0.3 U/kg body weight and serum Cpeptide concentration above 0.5ng/ml. Patients were divided into those who were in remission at any time during follow-up (remitters) and non-remitters. After 7years of follow-up, the occurrence of microangiopathy complications was analyzed. In statistical analysis, Mann-Whitney test, chi(2) test and Fisher test were used for analysis between groups. We applied a Cox's multivariate regression model and univariate regression method. P<0.05 was considered statistically significant. RESULTS In univariate logistic regression, a significant association was found between absence of remission and occurrence of at least one microvascular complication. In the Cox proportional hazards regression model that included clinically significant parameters at diagnosis (presence of ketoacidosis, cigarette smoking and HbA1c value) as covariates, absence of remission was associated with occurrence of chronic complications of diabetes at 7years [HR: 3.65 (95% CI 1.23-4.56), p=0.04]. In non-remitters, higher incidence of at least one microvascular complication (46.4% vs. 7.6%), higher incidence of retinopathy (42.8% vs. 5.7%), and neuropathy (21.4% vs. 1.9%) was found. CONCLUSIONS Occurrence of partial remission of diabetes is associated with a reduced risk of chronic microvascular complications at 7-year follow-up.
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Affiliation(s)
- Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences.
| | - Stanislaw Pilacinski
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences
| | - Anna Adamska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences
| | - Dariusz Naskret
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences
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Araszkiewicz A, Naskret D, Niedzwiecki P, Samborski P, Wierusz-Wysocka B, Zozulinska-Ziolkiewicz D. Increased accumulation of skin advanced glycation end products is associated with microvascular complications in type 1 diabetes. Diabetes Technol Ther 2011; 13:837-42. [PMID: 21568748 DOI: 10.1089/dia.2011.0043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Skin autofluorescence (AF) measured with an AF reader device is a noninvasive tool to measure the tissue accumulation of advanced glycation end products (AGEs). The aim of the study was to assess the association between AF and microvascular complications in type 1 diabetes mellitus (DM1). METHODS The study population consisted of 140 DM1 patients, 28 years old (interquartile range [IQR], 23-35), 76 of whom were women, with disease duration of 13 years (IQR, 8-19). We used the AGE Reader (DiagnOptics, Groningen, The Netherlands) to measure the AF phenomenon, which occurs because of fluorescent properties of AGEs. The patients were divided according to the presence or absence of diabetes-associated microvascular complications: retinopathy, nephropathy, and neuropathy and any microangiopathy. RESULTS The median AF was 2.0 (IQR, 1.7-2.4). In the univariate logistic regression AF was significantly associated with retinopathy (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.26-4.84, P = 0.008), nephropathy (OR 3.15, 95% CI 1.34-7.39, P = 0.008), neuropathy (OR 3.17, 95% CI 1.46-6.90, P = 0.003), and any microvascular complication (OR 2.94, 95% CI 1.46-5.92, P = 0.002). Multivariate logistic regression showed that skin AF was independently associated only with diabetic neuropathy (OR 2.98, 95% CI 0.99-8.90, P = 0.05). CONCLUSIONS The tissue accumulation of AGE is significantly associated with microvascular complications in DM1.
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Affiliation(s)
- Aleksandra Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland.
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Niedzwiecki P, Priest SL, Pivnicny VC, Ruffino BC. Leveraging HIPAA to support consumer empowerment. J Healthc Inf Manag 2001; 14:95-104. [PMID: 11190266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The consumer empowerment movement needs to provide consumers with more access and control of their healthcare records. The premise of this article is that there is a fundamental market shift towards consumer empowerment--and technology is the driving force. We contend the results will satisfy the intent of the HIPAA mandate. Two restrictions impede the market from moving toward real consumer empowerment. First, managing one's own health history record is difficult because the complete record is segmented in disparate systems that are difficult to integrate. This is because unique identifiers and consistent coding are nonexistent. Second, security and control of patient identifiable health information is still evolving. There is no consensus among providers for Internet security, as we can see by all the legislative privacy bills trying to address the issue. HIPAA is both a legislative mandate and an enabler of the next healthcare paradigm. Providers must comply with the HIPAA mandates for electronic data interchange (EDI) code sets, administrative simplification, and privacy and confidentiality protocols. By recognizing HIPAA as part of a consumer-driven movement, organizations can incorporate empowerment strategies into a planning process that creates consumer options in healthcare and leverages HIPAA compliance to benefit both providers and consumers. This article suggests methods for meeting HIPAA compliance through innovative consumer empowerment methods.
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