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Ansari HUH, Qazi SU, Sajid F, Altaf Z, Ghazanfar S, Naveed N, Ashfaq AS, Siddiqui AH, Iqbal H, Qazi S. Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists on Body Weight and Cardiometabolic Parameters in Individuals With Obesity and Without Diabetes: A Systematic Review and Meta-Analysis. Endocr Pract 2024; 30:160-171. [PMID: 38029929 DOI: 10.1016/j.eprac.2023.11.007] [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: 08/25/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially for type 2 diabetes mellitus, show promise in promoting weight loss and improving heart health in obese individuals without diabetes. Our goal was to examine existing research for conclusive evidence on various types of GLP-1 RAs for weight loss and cardiometabolic benefits in obesity without diabetes. METHODS We conducted an electronic search on PubMed, Scopus, and Cochrane Central using keywords, such as "GLP-1 RA," "obesity," and "weight loss." We considered all available global GLP-1 RAs for inclusion. Our analysis focused on weight loss, blood pressure (BP) changes (systolic and diastolic BPs), and lipid profile effects (high-density lipoprotein, low-density lipoprotein, total cholesterol, and triacylglycerol). We used a random-effects meta-analysis with the standardized mean difference (SMD), mean difference (MD), odds ratio, and relative risk to present the results. RESULTS Our search yielded a total of 7535 articles. We included 15 trials in our study. GLP-1 RAs led to significant weight loss (MD, -8.77 kg; P <.01) in obese individuals. GLP-1 RAs also improved the systolic BP (MD, -4.13 mm Hg; P <.01), diastolic BP (MD, -1.39 mm Hg; P <.01), and lipid profiles, including improved levels of triacylglycerol (SMD, -0.99 mg/dL; P <.01), total cholesterol (SMD, -0.73 mg/dL; P <.01), very low-density lipoprotein (SMD, -1.11 mg/dL; P <.01), and low-density lipoprotein (SMD, -0.27 mg/dL; P <.01), and significantly increased high-density lipoprotein levels (SMD, 0.11 mg/dL; P <.01). However, GLP-1 RAs were associated with an increased risk of gastrointestinal adverse events. CONCLUSION GLP-1 RAs were found to be beneficial for not only weight loss but also reduction in risk factors for cardiovascular disease such as BP and lipid profile. Consistent beneficial results were observed across the various subtypes of GLP-1 RAs.
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Affiliation(s)
| | - Shurjeel Uddin Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Faiza Sajid
- Department of Medicine, Liaquat National Hospital and Medical College, Pakistan
| | - Zahabia Altaf
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Shamas Ghazanfar
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Naveen Naveed
- Department of Medicine, Jinnah Sindh Medical University, Pakistan
| | - Amna Shakil Ashfaq
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | | | - Hamza Iqbal
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
| | - Sana Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Pakistan
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Bloch O, Kobi P, Ben Shimol A, Rotmensh A, Kagansky D, Zelnik-Yovel D, Yehudah GB, Cantrell D, Rapoport MJ. Severe and fatal COVID-19 is characterised by increased circulating glucagon like peptide 1 and procalcitonin modulated by type 2 diabetes. Diabetes Metab Res Rev 2023; 39:e3635. [PMID: 36960549 DOI: 10.1002/dmrr.3635] [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: 11/20/2022] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023]
Abstract
AIMS Endotoxemia commonly occurs in severe and fatal COVID-19, suggesting that concomitant bacterial stimuli may amplify the innate immune response induced by SARS-CoV-2. We previously demonstrated that the endogenous glucagon like peptide 1 (GLP-1) system in conjunction with increased procalcitonin (PCT) is hyperactivated in patients with severe Gram-negative sepsis and modulated by type 2 diabetes (T2D). We aimed to determine the association of COVID-19 severity with endogenous GLP-1 activation upregulated by increased specific pro-inflammatory innate immune response in patients with and without T2D. MATERIALS AND METHODS Plasma levels of total GLP-1, IL-6, and PCT were estimated on admission and during hospitalisation in 61 patients (17 with T2D) with non-severe and severe COVID-19. RESULTS COVID-19 patients demonstrated ten-fold increase of IL-6 levels regardless of disease severity. Increased admission GLP-1 levels (p = 0.03) accompanied by two-fold increased PCT were found in severe as compared with non-severe patients. Moreover, GLP-1 and PCT levels were significantly increased in non-survived as compared with survived patients at admission (p = 0.01 and p = 0.001, respectively) and at 5 to 6 days of hospitalisation (p = 0.05). Both non-diabetic and T2D patients demonstrated a positive correlation between GLP-1 and PCT response (r = 0.33, p = 0.03, and r = 0.54, p = 0.03, respectively), but the intensity of this joint pro-inflammatory/GLP-1 response was modulated by T2D. In addition, hypoxaemia down-regulated GLP-1 response only in T2D patients with bilateral lung damage. CONCLUSIONS The persistent joint increase of endogenous GLP-1 and PCT in severe and fatal COVID-19 suggests a role of concomitant bacterial infection in disease exacerbation. Early elevation of endogenous GLP-1 may serve as a new biomarker of COVID-19 severity and fatal outcome.
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Affiliation(s)
- Olga Bloch
- Diabetes & Autoimmunity Research Laboratory, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
| | - Perl Kobi
- Department "C" of Internal Medicine, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
| | - Ariel Ben Shimol
- Department "A" of Internal Medicine, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
| | - Assaf Rotmensh
- Department "C" of Internal Medicine, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
| | - Dana Kagansky
- Department "A" of Internal Medicine, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
| | - Dana Zelnik-Yovel
- Department "C" of Internal Medicine, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
| | - Gilad Ben Yehudah
- Laboratory of Microbiology, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
| | - Dror Cantrell
- Department "C" of Internal Medicine, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
| | - Micha J Rapoport
- Diabetes & Autoimmunity Research Laboratory, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
- Department "C" of Internal Medicine, Yitzhak Shamir Medical Center, Sackler Medical School Tel Aviv University, Zerifin, Israel
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Shu L, Zhang J, Jia L, Wang J, Han Z. Effect of lipid accumulation product on the development of hypertension among nondiabetic individuals in eastern China: A cross-sectional study. J Clin Hypertens (Greenwich) 2023; 25:784-793. [PMID: 37433158 PMCID: PMC10423760 DOI: 10.1111/jch.14696] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/13/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023]
Abstract
This study was aimed at assessing the risk factors for hypertension (HTN) and prehypertension (PHT) in order to clarify the role of lipid accumulation product (LAP) in the development of HTN among nondiabetic individuals. A large cross-sectional study was conducted in community health service centers in urban Bengbu, Anhui Province, China. All participants completed an interview questionnaire and procedures to obtain physical measurements and biochemical indicators. Multivariate logistic regression was used to test for the prevalence of HTN and PHT in relation to each quartile increase in LAP level and family history of HTN. The resulting interaction effects were evaluated by relative excess risk of interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI). A total of 7733 subjects were enrolled in the study. The overall prevalence rates of PHT and HTN were 37.1% and 24.8%, respectively. After adjusting for confounding factors, multinomial logistic regression analysis showed that compared with subjects in LAP quartile 1, those in quartile 3 (OR, 1.257; 95% CI, 1.062-1.494) and quartile 4 (OR, 1.323; 95% CI, 1.101-1.592) had a significantly higher risk for HTN (p for trend < .001). A significant interaction was observed between LAP and family history of HTN in men (AP, 0.1661; 95% CI, 0.0024-0.3296; SI, 1.4037; 95% CI, 1.0599-1.8593) and in women (RERI, 1.4111; 95% CI, 0.1458-2.9678; AP, 0.1662; 95% CI, 0.0085-0.3237; SI, 1.3886; 95% CI, 1.0568-1.8247). The results demonstrated that the interactive effects of LAP with family history of HTN may influence the development of HTN synergistically.
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Affiliation(s)
- Li Shu
- School of public healthBengbu medical collegeBengbuAnhuiChina
| | - Jiaye Zhang
- School of public healthBengbu medical collegeBengbuAnhuiChina
| | - Linlin Jia
- School of public healthBengbu medical collegeBengbuAnhuiChina
| | - Jinchen Wang
- School of public healthBengbu medical collegeBengbuAnhuiChina
| | - Ziyan Han
- School of public healthBengbu medical collegeBengbuAnhuiChina
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Seong JM, Gi MY, Cha JA, Sung HH, Park SY, Park CH, Yoon H. Gender Difference in the Association of Hyperuricemia with Insulin Resistance and beta-cell Function in Nondiabetic Korean Adults: The 2019 Korea National Health and Nutrition Examination Survey. Endocr Res 2023; 48:1-8. [PMID: 36322048 DOI: 10.1080/07435800.2022.2142239] [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] [Indexed: 02/21/2023]
Abstract
AIMS This study was conducted to assess the association of uric acid (UA) with the homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) by gender in nondiabetic Korean adults. MATERIALS AND METHODS The study was carried out using data from the 2019 Korean National Health and Nutrition Examination Survey and included nondiabetic Korean men, premenopausal women, and postmenopausal women aged 20 years or older. RESULTS First, after adjusted for the related variables (excluding obesity), the prevalence of hyperuricemia (UA ≥ 7.0 mg/dL in men or UA ≥ 6.0 mg/dL in women) was positively associated with the quartiles of HOMA-IR and HOMA-B in men, premenopausal women, and postmenopausal women. Second, when further adjusted for obesity, hyperuricemia was positively associated with the quartiles of HOMA-IR and HOMA-B in men and postmenopausal women but not in premenopausal women. Third, after adjusted for the related variables (including obesity), UA level was positively associated with the quartiles of HOMA-IR and HOMA-B in men and postmenopausal women but not in premenopausal women. CONCLUSIONS hyperuricemia is positively associated with insulin resistance and beta-cell function in nondiabetic Korean men and postmenopausal women but not in premenopausal women.
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Affiliation(s)
- Jeong Min Seong
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok-si, 25949, South Korea
| | - Mi Young Gi
- Department of Nursing, Christian College of Nursing, 61662, South Korea
| | - Ju Ae Cha
- Department of Nursing, Chunnam Technouniversity, Gokseong-gun, 57500, South Korea
| | - Hyun Ho Sung
- Department of Clinical Laboratory Science, Dongnam Health University, Suwonsi, 16328, South Korea
| | - So Young Park
- Department of Dental Hygiene, Wonkwang Health Science University, Iksan-si, 54538, South Korea
| | - Cho Hee Park
- Department of Global Medical Beauty, Konyang University, 121, Daehak-ro, Nonsan-si, 32992, South Korea
| | - Hyun Yoon
- Department of Clinical Laboratory Science, Wonkwang Health Science University, 514, Iksan-daero, Iksan-si, 54538, South Korea
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Cui K, Fu R, Yang J, Xu H, Yin D, Song W, Wang H, Zhu C, Feng L, Wang Z, Wang Q, Lu Y, Dou K, Yang Y. Stress hyperglycemia ratio and long-term mortality after acute myocardial infarction in patients with and without diabetes: A prospective, nationwide, and multicentre registry. Diabetes Metab Res Rev 2022; 38:e3562. [PMID: 35772392 DOI: 10.1002/dmrr.3562] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/23/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022]
Abstract
AIMS To assess the predictive value of stress hyperglycemia ratio (SHR) for long-term mortality after acute myocardial infarction (AMI) in patients with and without diabetes. MATERIALS AND METHODS We evaluated 6892 patients with AMI from the prospective, nationwide, multicentre China Acute Myocardial Infarction registry, of which 2820 had diabetes, and the remaining 4072 were nondiabetic patients. Patients were divided into high SHR and low SHR groups according to the optimal cutoff values of SHR to predict long-term mortality for diabetic and nondiabetic patients, respectively. The primary endpoint was all-cause mortality at 2 years. RESULTS The optimal cutoff values of SHR for predicting 2-year mortality were 1.20 and 1.08 for the diabetic and nondiabetic population, respectively. Overall, patients with high SHR were significantly associated with higher all-cause mortality compared with those with low SHR, in both diabetic patients (18.5% vs. 9.7%; hazard ratio [HR] 2.01, 95% confidence interval 1.63-2.49) and nondiabetic patients (12.0% vs. 6.4%; HR 1.95, 95%CI 1.57-2.41). After the potential confounders were adjusted, high SHR was significantly associated with higher risks of long-term mortality in both diabetic (adjusted HR 1.73, 95%CI 1.39-2.15) and nondiabetic (adjusted HR 1.63, 95%CI 1.30-2.03) patients. Moreover, adding SHR to the original model led to a slight albeit significant improvement in C-statistic, net reclassification, and integrated discrimination regardless of diabetic status. CONCLUSIONS This study demonstrated a strong positive association between SHR and long-term mortality in patients with AMI with and without diabetes, suggesting that SHR should be considered a useful marker for risk stratification in these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT01874691.
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Affiliation(s)
- Kongyong Cui
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Beijing, China
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Fu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Beijing, China
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingang Yang
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Beijing, China
| | - Haiyan Xu
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Beijing, China
| | - Dong Yin
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Beijing, China
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihua Song
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Beijing, China
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongjian Wang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Beijing, China
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenggang Zhu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Beijing, China
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Feng
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Beijing, China
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhifang Wang
- Department of Cardiology, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Henan Province, China
| | - Qingsheng Wang
- Department of Cardiology, Qinhuangdao First Hospital, Hebei Province, China
| | - Ye Lu
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Medical Research & Biometrics Center, Fuwai Hospital, Beijing, China
| | - Kefei Dou
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Beijing, China
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Beijing, China
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Fawwad A, Waris N, Basit KA, Tahir B, Gregg EW, Basit A. NDSP-10: The Cardiometabolic Risk Profile with Various Degrees of Dysglycemia in Younger and Older Adults: Findings from the Second National Diabetes Survey of Pakistan 2016-2017. Metab Syndr Relat Disord 2022; 20:351-359. [PMID: 35617703 DOI: 10.1089/met.2021.0154] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: To assess and compare the cardiometabolic risk profile of the Pakistani population between younger (<45 years) and older adults (≥45 years). Methods: This is a substudy of a nationally representative community-based epidemiological second National Diabetes Survey of Pakistan (NDSP) 2016-2017. Out of 12,486 individuals approached, 10,834 participants agreed to be included (response rate 87%). Cardiovascular risk factors assessed were obesity, central obesity, hypertension, diabetes, hyperlipidemia, and tobacco use. Participants were stratified into young adults (<45 years) and older adults (≥45 years) and was subcategorized into four groups that is, diagnosed diabetes mellitus (DM), undiagnosed DM, prediabetes, and without diabetes. Results: Around 14.3% were prediabetes, 8.8% were undiagnosed DM, and 24% were diagnosed diabetes. Most participants in dysglycemic (prediabetes, undiagnosed DM, and diagnosed DM) groups were females and were from rural regions. Cardiovascular disease (CVD) risk factors were more noted in dysglycemic states, compared with without diabetes. Overall CVD risk profile was worse in males in both age categories, although the accumulation of four or five CVD risk factors at one point was more predominant in females in either age group. Conclusion: Overall, the preponderance of CVD risk factors, such as overweight, obesity, central obesity, tobacco use, ex-tobacco uses, and dyslipidemia, were substantially more prevalent in dysglycemia groups of young adults (<45 years) compared with older adults (≥45 years). Early and targeted intervention in young may prevent poor CVD outcomes as they age.
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Affiliation(s)
- Asher Fawwad
- Department of Biochemistry, Baqai Medical University, Karachi, Pakistan.,Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Nazish Waris
- Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.,Clinical Biochemistry and Psychopharmacology Research Unit Department of Biochemistry, University of Karachi, Karachi, Pakistan
| | - Khalid Abdul Basit
- Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.,Acute Medicine and Ambulatory Care Whipps Cross University Hospital, Barts Health NHS Trust, London
| | - Bilal Tahir
- Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health Imperial College London, London
| | - Abdul Basit
- Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
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Foucan L, Afassinou Y, Chingan-Martino V, Ancedy Y, Bassien-Capsa V, Galantine O, Nicolas L, Tabue Teguo M, Martino F, Larifla L. Metabolic Syndrome Components in a Nondiabetic Afro-Caribbean Population: Influence of Gender and Age. Metab Syndr Relat Disord 2022; 20:243-249. [PMID: 35167367 DOI: 10.1089/met.2021.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/12/2022] Open
Abstract
Background: Our aim was to describe the prevalence of metabolic syndrome (MetS) and its components among Afro-Caribbean adults without diabetes and cardiovascular complications. Methods: Participants were recruited from a Health Center in Guadeloupe, French West Indies. MetS was defined according to the NCEP ATP III. Prevalence of MetS and MetS components were compared across age groups and sex. The odds ratios (ORs) and 95% confidence intervals were obtained using logistic regression. Results: There were 1011 participants (68.8% women, mean age 47.8 ± 11.8 years). Prevalence of MetS was 17.9% (21.1% women, 10.8% men) and increased by age in women. High blood pressure had the highest prevalence among men and among women ≥60 years. Prevalence of abdominal obesity (AbO) was higher in women than in men. High triglyceride levels were uncommon at all ages and, men and women <40 years, compared with the other groups had higher prevalence of low high-density lipoprotein cholesterol (HDL-C) levels. With multiple logistic regression, compared with adults <40 years, those ≥60 years had the highest OR for prevalent hypertension 7.8 (4.8-12.8); P < 0.001, AbO 2.1 (1.3-3.3); P = 0.002 and high fasting blood glucose levels 5.5 (3.1-9.8); P < 0.001. They also had lower odds for having low HDL-C than the younger ones (G1: age <40 years). Among persons ≥60 years, OR for MetS was 1.9 (1.1-3.6); P = 0.013 compared with the referent group. Compared with men, women had higher odds of MetS 2.2 (1.5-3.3); P < 0.001. Conclusion: Women were more likely to have MetS than men and persons ≥60 years were significantly more likely to have MetS than persons <40 years. Preventive measures are required to reduce the prevalence of MetS.
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Affiliation(s)
- Lydia Foucan
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,LAMIA, EA4540. University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Yaovi Afassinou
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,Cardiology Unit, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Vaneva Chingan-Martino
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Yann Ancedy
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,Cardiology Unit, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Valerie Bassien-Capsa
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Olivier Galantine
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Livy Nicolas
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | | | - Frederic Martino
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Laurent Larifla
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,LAMIA, EA4540. University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,Cardiology Unit, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
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8
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Yu P, Huang L, Wang Z, Meng X, Yu X. The Association of Serum Uric Acid with Beta-Cell Function and Insulin Resistance in Nondiabetic Individuals: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:2673-2682. [PMID: 34163195 PMCID: PMC8214016 DOI: 10.2147/dmso.s312489] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Higher serum levels of uric acid (SUA) are associated with an increased risk of developing type 2 diabetes. Meanwhile, insulin resistance and beta-cell dysfunction are critical factors that mediate the progression from normal glucose tolerance to impaired fasting glucose (IFG) and type 2 diabetes. We aimed to investigate the association between SUA levels and insulin resistance and beta-cell dysfunction in individuals without diabetes, thus explicating the role of uric acid in the early stage of the natural history of type 2 diabetes. PATIENTS AND METHODS We used cross-sectional data from the China Health and Nutrition Survey to examine the association. Insulin resistance and beta-cell dysfunction were estimated using the homeostasis model assessment of insulin resistance (HOMA-IR) index and homeostasis model assessment of beta-cell function (HOMA-beta) index, respectively. The associations were analyzed by using partial correlation analysis and multivariate logistic regressionl analysis. RESULTS SUA levels were positively associated with fasting glucose, fasting insulin, HOMA-IR in the total population. After adjustment for age, drinking, smoking, living area, daily dietary nutrient intake, body mass index (BMI), estimated glomerular filtration rate (eGFR), hypertension, and dyslipidemia, compared with participants in the lowest quartile of SUA, the adjusted odds ratios for the fourth quartiles were 1.56(1.09-2.24) for IFG, 1.51(1.27-1.78) for insulin resistance, and 1.06(0.88-1.27) for beta-cell dysfunction. In the subgroup analysis, no interactions were found between serum uric acid and age, drinking status, smoking status, BMI, hypertension, or dyslipidemia (all p for interaction>0.05). CONCLUSION In nondiabetic individuals, SUA levels are independently associated with IFG and insulin resistance, while no significant association exists between SUA and beta-cell dysfunction.
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Affiliation(s)
- Peng Yu
- Department of Internal Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Li Huang
- Department of Internal Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Zhihan Wang
- Department of Internal Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Xiaoyu Meng
- Department of Internal Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Xuefeng Yu
- Department of Internal Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
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9
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DuBose SN, Li Z, Sherr JL, Beck RW, Tamborlane WV, Shah VN. Effect of Exercise and Meals on Continuous Glucose Monitor Data in Healthy Individuals Without Diabetes. J Diabetes Sci Technol 2021; 15:593-599. [PMID: 32064911 PMCID: PMC8120054 DOI: 10.1177/1932296820905904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of these analyses was to characterize the effect of exercise and meals on glucose concentrations in healthy individuals without diabetes. METHODS Healthy individuals without diabetes (age ≥6 years) with nonobese body mass index were enrolled at 12 centers within the T1D Exchange Clinic Network. Participants wore a blinded Dexcom G6 for up to ten days. Throughout this sensor wear, participants completed a daily log indicating times and type of any exercise and start times of meals and snacks. RESULTS A total of 153 participants (age 7-80 years) were included in the analyses. Exercise induced a mean change of -15 ± 18 mg/dL from baseline to nadir sensor glucose level. Mean nadir glucose concentration during nights following exercise days was 82 ± 11 mg/dL compared with 85 ± 11 mg/dL during nights following nonexercise days (P = .05). Mean change from baseline to nadir sensor glucose level during aerobic exercise was -15 ± 18 and -9 ± 12 mg/dL for resistance exercise (P = .25). Overnight nadir glucose during nights following aerobic and resistance exercise was 83 ± 12 and 76 ± 14 mg/dL, respectively (P = .25). Overall mean peak postprandial glucose per participant increased from 93 ± 10 mg/dL premeal to 130 ± 13 mg/dL with an average time to peak glucose per participant of 97 ± 31 minutes. Consumption of alcohol on the day prior did not impact overnight mean or nadir glucose. CONCLUSION The present analysis provides important data characterizing the effect of exercise and meals on glucose in healthy individuals without diabetes. These data provide a repository to which future therapies, whether pharmacologic or technologic, can be compared.
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Affiliation(s)
- Stephanie N. DuBose
- Jaeb Center for Health Research, Tampa,
FL, USA
- Stephanie N. DuBose, MPH, Jaeb Center for
Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647, USA.
| | - Zoey Li
- Jaeb Center for Health Research, Tampa,
FL, USA
| | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa,
FL, USA
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10
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Elhefnawy ME, Sheikh Ghadzi SM, Tangiisuran B, Zainal H, Looi I, Ibrahim KA, Sidek NN, Loo KW, Yee Lee K, Abdul Aziz Z, Harun SN. Population-based Study Comparing Predictors of Ischemic Stroke Recurrence After Index Ischemic Stroke in Non-elderly Adults with or without Diabetes. Int J Gen Med 2021; 14:1205-1212. [PMID: 33854362 PMCID: PMC8039196 DOI: 10.2147/ijgm.s303641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/08/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Factors associated with ischemic stroke (IS) recurrence and the contribution of pharmacological treatment as secondary preventions among nondiabetics especially in the non-elderly population are unclear and not widely investigated. This was a population-based study that aimed to identify recurrent IS predictors and to determine the possible impact of secondary preventive medications on the IS recurrence in non-elderly adults with or without diabetes. METHODS Data of 3386 patients <60 years old who had a history of index IS were extracted from the Malaysian National Neurology Registry (NNEUR) from 2009 to 2016. Recurrent IS was defined as any IS event recorded after the index IS in the NNEUR database. Multivariate logistic regression analysis was performed by using SPSS version 22. RESULTS Ischemic heart disease (IHD) was the significant predictor of IS recurrence in non-elderly adults both with or without diabetes (adjusted odds ratio (AOR) of 3.210; 95%CI: 1.909-5.398 and 2.989; 95%CI: 1.515-5.894) respectively). Receiving antiplatelet as secondary stroke prevention (AOR: 0.194; 95%CI: 0.046-0.817) and continuation of antidiabetic medication after the index IS event (AOR: 0.510; 95%CI: 0.298-0.872) reduced the odds of IS recurrence only in non-elderly diabetic adults. Among non-elderly adults without diabetes, hyperlipidemia and every increased in 1 mmHg of systolic blood pressure significantly increased the odds of IS recurrence following the indexing event (AOR: 1.796; 95%CI: 1.058-3.051 and 1.009; 95%CI: 1.002-1.016 respectively). CONCLUSION IHD was found as the main predictor of IS recurrence regardless of diabetes status in non-elderly adults after the index IS event. Receiving antidiabetic and antiplatelet medications upon discharge after index IS were significant predictors of recurrent IS in non-elderly diabetic adults. A proper randomized clinical trial may be required to determine the impact of secondary preventive medication on IS recurrence, especially in non-elderly adults.
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Affiliation(s)
| | | | | | - Hadzliana Zainal
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia
| | - Irene Looi
- Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia
| | | | | | - Keat Wei Loo
- Department of Biological Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR) Kampar Campus, Perak, Malaysia
| | - Keng Yee Lee
- National Clinical Research Centre, Kuala Lumpur, Malaysia
| | - Zariah Abdul Aziz
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | - Sabariah Noor Harun
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia
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11
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Esmeralda CAC, David PE, Maldonado IC, Ibrahim SNA, David AS, Escorza MAQ, Dealmy DG. Deranged Fractional Excretion of Magnesium and Serum Magnesium Levels in Relation to Retrograde Glycaemic Regulation in Patients with Type 2 Diabetes Mellitus. Curr Diabetes Rev 2021; 17:91-100. [PMID: 32664840 DOI: 10.2174/1573399816666200714150434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/12/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Type 2 diabetes (T2DM) has been associated with deficiencies in serum magnesium level, decreasing insulin sensitivity and glucose metabolism. Glycosylated hemoglobin (Hb1Ac) is a biomarker of glucose values within the half-life of the erythrocyte, that is, 3 months. Low circulating and intracellular magnesium levels can modify glucose metabolism and insulin sensitivity. Renal solute management is a parameter little used to estimate circulating and excreted concentrations of elements such as magnesium. OBJECTIVE The purpose of this study was to assess and associated fractional excretion of magnesium (FEMg) and serum magnesium with metabolic parameters, especially Hb1Ac percent, in a group of well characterized subjects with T2DM and non-diabetics subjects (ND). METHODS According to Hb1Ac, two groups were compared and associated with existing biochemical parameters, included Hb1Ac, fasting glucose, lipid profile, serum creatinine, serum magnesium and urinary creatinine for FEMg. RESULTS HbA1c levels were explained by serum magnesium in 25%. Serum magnesium levels in the ND group were higher than in the T2DM group and this was a statistically significant difference. Serum magnesium ≤1.8 is a risk factor (OD 16.1; P=0.021) for an HbA1c ≥ 6.5%. CONCLUSION In this study, hypomagnesemia was a parameter strongly associated with the diagnosis and progression of T2DM, while FEMg showed no significant association.
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Affiliation(s)
- Corvera A C Esmeralda
- Departamento de Farmacologia, Facultad de Medicina U.T., Universidad Autonoma de Coahuila. Torreon, Coah., Mexico
| | - Pedroza E David
- CA de Bioquimica y Salud, Facultad de Medicina y Nutricion, Universidad Juarez del Estado de Durango. Durango, Dgo., Mexico
| | - Irais C Maldonado
- CA de Bioquimica y Salud, Facultad de Medicina y Nutricion, Universidad Juarez del Estado de Durango. Durango, Dgo., Mexico
| | - Sharara Núñez A Ibrahim
- Departamento de Farmacologia, Facultad de Medicina U.T., Universidad Autonoma de Coahuila. Torreon, Coah., Mexico
| | - Alcántar S David
- Departamento de Farmacologia, Facultad de Medicina U.T., Universidad Autonoma de Coahuila. Torreon, Coah., Mexico
| | - Martha A Q Escorza
- Departamento de Bioquimica Centro de Investigacion Biomedica., Universidad Autonoma de Coahuila. Torreon, Coah., Mexico
| | - Delgadillo G Dealmy
- Departamento de Farmacologia, Facultad de Medicina U.T., Universidad Autonoma de Coahuila. Torreon, Coah., Mexico
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12
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Isnard S, Lin J, Fombuena B, Ouyang J, Varin TV, Richard C, Marette A, Ramendra R, Planas D, Raymond Marchand L, Messaoudene M, Van der Ley CP, Kema IP, Sohail Ahmed D, Zhang Y, Finkelman M, Routy B, Angel J, Ancuta P, Routy JP. Repurposing Metformin in Nondiabetic People With HIV: Influence on Weight and Gut Microbiota. Open Forum Infect Dis 2020; 7:ofaa338. [PMID: 32964062 PMCID: PMC7489545 DOI: 10.1093/ofid/ofaa338] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background People with HIV (PWH) taking antiretroviral therapy (ART) may experience weight gain, dyslipidemia, increased risk of non-AIDS comorbidities, and long-term alteration of the gut microbiota. Both low CD4/CD8 ratio and chronic inflammation have been associated with changes in the gut microbiota of PWH. The antidiabetic drug metformin has been shown to improve gut microbiota composition while decreasing weight and inflammation in diabetes and polycystic ovary syndrome. Nevertheless, it remains unknown whether metformin may benefit PWH receiving ART, especially those with a low CD4/CD8 ratio. Methods In the Lilac pilot trial, we recruited 23 nondiabetic PWH receiving ART for more than 2 years with a low CD4/CD8 ratio (<0.7). Blood and stool samples were collected during study visits at baseline, after a 12-week metformin treatment, and 12 weeks after discontinuation. Microbiota composition was analyzed by 16S rDNA gene sequencing, and markers of inflammation were assessed in plasma. Results Metformin decreased weight in PWH, and weight loss was inversely correlated with plasma levels of the satiety factor GDF-15. Furthermore, metformin changed the gut microbiota composition by increasing the abundance of anti-inflammatory bacteria such as butyrate-producing species and the protective Akkermansia muciniphila. Conclusions Our study provides the first evidence that a 12-week metformin treatment decreased weight and favored anti-inflammatory bacteria abundance in the microbiota of nondiabetic ART-treated PWH. Larger randomized placebo-controlled clinical trials with longer metformin treatment will be needed to further investigate the role of metformin in reducing inflammation and the risk of non-AIDS comorbidities in ART-treated PWH.
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Affiliation(s)
- Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Québec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada.,CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - John Lin
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Québec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada
| | - Brandon Fombuena
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Québec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada
| | - Jing Ouyang
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Québec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada.,Chongqing Public Health Medical Center, Chongqing, China
| | - Thibault V Varin
- Institute of Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
| | - Corentin Richard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - André Marette
- Institute of Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada.,Department of Medicine, Faculty of Medicine, Cardiology Axis of the Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Rayoun Ramendra
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Québec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Delphine Planas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | | | - Meriem Messaoudene
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Claude P Van der Ley
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Darakhshan Sohail Ahmed
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Québec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada
| | - Yonglong Zhang
- Associates of Cape Cod Inc., Falmouth, Massachusetts, USA
| | | | - Bertrand Routy
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Division of Medicine, Department of Hemato-Oncology, University of Montreal Healthcare Center, Montreal, Quebec, Canada
| | - Jonathan Angel
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Petronela Ancuta
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Québec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada.,Division of Hematology, McGill University Health Centre, Montreal, Québec, Canada
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13
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Koseler A, Arslan I, Sabirli R, Zeytunluoglu A, Kılıç O, Kilic ID. Molecular and Biochemical Parameters Related to Plasma Mannose Levels in Coronary Artery Disease Among Nondiabetic Patients. Genet Test Mol Biomarkers 2020; 24:562-568. [PMID: 32762555 DOI: 10.1089/gtmb.2020.0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/11/2023] Open
Abstract
Aims: Nondiabetic patients were studied to determine whether modest elevations in plasma mannose may be associated with a greater incidence of coronary artery disease (CAD). Materials and Methods: Plasma insulin, mannose, glucose, hexokinase 1-2, GLUT1-GLUT4 levels, and serum mannose phosphate isomerase enzyme levels were evaluated with respect to subsequent CAD using records from 120 nondiabetic CAD patients and 120 healthy volunteers. CAD was identified from myocardial infarction and new diagnoses of angina. Results: Of 120 nondiabetic CAD patients studied, their plasma GLUT4 and HK1 levels were significantly lower than those of the control group. In addition, a significant increase in plasma mannose levels was found in the patient group compared to the control group. Conclusion: Our findings showed that elevated baseline mannose levels in plasma are associated with an increased risk of CAD over time.
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Affiliation(s)
- Aylin Koseler
- Department of Biophysics, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Idris Arslan
- Department of Biomedical Engineering, Bülent Ecevit University, Zonguldak, Turkey
| | - Ramazan Sabirli
- Department of Emergency Medicine, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Ali Zeytunluoglu
- Department of Electronics and Automation, Vocational School of Technical Sciences, Pamukkale University, Denizli, Turkey
| | - Oğuz Kılıç
- Department of Cardiology, Doc. Dr. Ismail Karakuyu State Hospital, Kütahya, Turkey
| | - Ismail Dogu Kilic
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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14
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Khan JM, Michalski J, Basques BA, Louie PK, Chen O, Hayani Z, Kalish C, Elboghdady I, Colman M, An H. Do Clinical Outcomes and Sagittal Parameters Differ Between Diabetics and Nondiabetics for Degenerative Spondylolisthesis Undergoing Lumbar Fusion? Global Spine J 2020; 10:286-293. [PMID: 32313794 PMCID: PMC7160811 DOI: 10.1177/2192568219850090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess the effect of diabetes mellitus (DM) on clinical and radiographic outcomes in patient with degenerative spondylolisthesis undergoing posterior lumbar spinal fusion. METHODS Analysis of patients who underwent open posterior lumbar spinal fusion from 2011 to 2018. Patients being medically treated for DM were identified and separated from nondiabetic patients. Visual analogue scale Back/Leg pain and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were also collected. RESULTS A total of 850 patients were included; 78 (9.20%) diabetic patients and 772 (90.80%) nondiabetic patients. Final PI-LL difference was significantly larger (P = .032) for patients with diabetes compared to no diabetes, but there were no other significant differences between radiographic measurements, operative time, or postoperative length of stay. There were no differences in clinical outcomes between the 2 groups. Diabetic patients were found to have a higher rate of discharge to a facility following surgery (P = .018). No differences were observed in reoperation or postoperative complication. CONCLUSIONS While diabetic patients had more associated comorbidities compared with nondiabetic patients, they had similar patient-reported and radiographic outcomes. Similarly, there are no differences in rates of reoperation or postoperative complications. This study indicates that diabetic patients who have undergone thorough preoperative screening of related comorbidities and appropriate selection should be considered for lumbar spinal fusion.
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Affiliation(s)
| | | | - Bryce A. Basques
- Rush University Medical Center, Chicago, IL, USA,Bryce A. Basques, Department of Orthopaedic Surgery,
Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612,
USA.
| | | | - Oscar Chen
- Rush University Medical Center, Chicago, IL, USA
| | - Zayd Hayani
- Rush University Medical Center, Chicago, IL, USA
| | - Chaim Kalish
- Rush University Medical Center, Chicago, IL, USA
| | | | | | - Howard An
- Rush University Medical Center, Chicago, IL, USA
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15
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Truong DH, Johnson MJ, Crisologo PA, Wukich DK, Bhavan K, La Fontaine J, Lavery LA. Outcomes of Foot Infections Secondary to Puncture Injuries in Patients With and Without Diabetes. J Foot Ankle Surg 2019; 58:1064-1066. [PMID: 31679659 DOI: 10.1053/j.jfas.2019.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 02/03/2023]
Abstract
It is difficult to compare foot infections in patients with diabetes to those without diabetes because foot infections are uncommon in people without diabetes. The aim of this study is to compare clinical outcomes in people with and without diabetes admitted to the hospital for an infected puncture wound. We evaluated 114 consecutive patients from June 2011 to March 2019 with foot infection resulting from a puncture injury; 83 had diabetes and 31 did not have diabetes. We evaluated peripheral arterial disease (PAD), sensory neuropathy, the need for surgery and amputation, length of hospitalization, and presence of osteomyelitis. Patients with diabetes were 31 times more likely to have neuropathy (91.6% versus 25.8%, p < .001, confidence interval [CI] 10.2 to 95.3), 8 times more likely to have PAD (34.9% versus 6.5%, p = .002, CI 1.7 to 35), and 7 times more likely to have kidney disease (19.3% versus 3.2%, p < .05, CI 0.9 to 56.5). They also took longer before presenting to the hospital (mean 20.1 ± 36.3 versus 18.8 ± 34.8 days, p = .09, CI 13 to 26.5); however, this result was not statistically significant. Patients with diabetes were 9 times more likely to have osteomyelitis (37.3% versus 6.5%, p = .001, CI 1.9 to 38.8). In addition, they were more likely to require surgery (95% versus 77%, p < .001, CI 1.6 to 21.4), required more surgeries (2.7 ± 1.3 versus 1.3 ± 0.8, p < .00001, CI 2.1 to 2.5), were 14 times more likely to have amputations (48.2% versus 6.5%, p < .0001, CI 3.0 to 60.2), and had 2 times longer hospital stays (16.2 ± 10.6 versus 7.5 ± 9 days, p = .0001, CI 11.9 to 15.9. Infected puncture wounds in patients with diabetes often fair much worse with more detrimental outcomes than those in patients without diabetes.
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Affiliation(s)
- David H Truong
- Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew J Johnson
- Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Peter A Crisologo
- Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Professor & Chair, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kavitha Bhavan
- Associate Professor, Department of Internal Medicine, Division of Infectious Disease, University of Texas Southwestern Medical Center, Dallas, TX
| | - Javier La Fontaine
- Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lawrence A Lavery
- Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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16
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Bhatt VR, Khese VB, Jadhav SL, Kakrani AL. Urinary Albumin Excretion, Estimated Glomerular Filtration Rate, and Prevalence of Microalbuminuria in Obese Nondiabetic and Nonhypertensive Adults: A Cross-Sectional Study. Indian J Nephrol 2019; 29:166-171. [PMID: 31142962 PMCID: PMC6521762 DOI: 10.4103/ijn.ijn_116_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Context: Obesity even in absence of diabetes and hypertension increases the risk for microalbuminuria (MAU), glomerular hyperfiltration, and therefore nephropathy. Aims: This study aims to assess the urinary albumin excretion (UAE), prevalence of MAU, and values of estimated glomerular filtration rate (eGFR) in obese nondiabetic and nonhypertensive patients, vis a vis thin healthy subjects, and attempts to correlate anthropometric measurements with UAE and eGFR. Setting and Design: Cross-sectional analytical study on 60 cases who were obese according to Asia Pacific guidelines and 60 nonobese controls. Patients with diabetes, hypertension, ischemic heart disease, and established renal disease were excluded. Methods and Material: Albuminuria was assessed in each patient by quantitative immunoturbidimetry method on a spot urine sample. eGFR was calculated by Cockcroft–Gault formula. Statistical Analysis: Data was analyzed using SPSS (2015 version). Mann–Whitney U-test, Fisher Exact test, and Spearman's correlation coefficient was used for various variables. Results: The mean age of cases was 31.90 ± 6.32 years. About 78.33% were in class 1 and 21.66% in class 2 obese groups. The mean UAE at 21.20 ± 26.82 mg/g creatinine was higher in the case group. The prevalence of MAU was 11.66% and 3.33% in case and control groups, respectively. The cases had a significantly higher mean eGFR of 123.29 ± 20.49 mL/min/kg as compared with controls who had a mean eGFR of 106.59 ± 10.15 mL/min/kg. There was moderate correlation between anthropometric measurements and eGFR. Conclusion: Younger, class 1 obese patients had a higher UAE, eGFR, and three times higher MAU prevalence, even in absence of diabetes and hypertension, with a correlation between anthropometry and eGFR as compared with nonobese individuals.
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Affiliation(s)
- V R Bhatt
- Department of Medicine, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - V B Khese
- Department of Medicine, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - S L Jadhav
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - A L Kakrani
- Department of Medicine, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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17
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Das S, Ghosh K, Hazra A, Sen C, Goswami A. Is elevated blood glucose a marker of occult tissue hypoperfusion in off-pump coronary artery bypass grafting? Ann Card Anaesth 2018; 21:393-401. [PMID: 30333333 PMCID: PMC6206810 DOI: 10.4103/aca.aca_202_17] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Hyperglycemia has been found to occur during myocardial infarction and cardiac surgery even in nondiabetic patients. These being essentially stressful processes associated with hypoperfusion, we decided to find a possible relationship between the occurrence of global tissue hypoperfusion (GTH) and elevated blood glucose level in adult nondiabetic patients undergoing elective off-pump coronary artery bypass grafting (CABG). Aims This study aims to observe for the occurrence of global tissue hypoperfusion and its effect on blood glucose level and whether raised blood glucose level can be used as a marker for GTH. Design Prospective, observational study. Settings Cardiothoracic operation theater and intensive care unit of a tertiary care teaching hospital. Materials and Methods The occurrence of global tissue hypoperfusion were detected with the help of combined markers of mixed venous oxygen saturation and arterial lactate level at various perioperative study points together with arterial blood glucose level. Blood glucose level compared between the patients with and without GTH. Statistical Analysis Used Numerical variables were compared between groups by Student's t-test and categorical variables by Fisher's exact test. Two-tailed P ≤ 0.05 was considered for statistically significant. Results The incidence of GTH was 67%. Blood glucose level was raised in patients with GTH at some study time points but with poor sensitivity and specificity values. Conclusions Global tissue hypoperfusion is a common occurrence in even nondiabetic patients undergoing elective off-pump CABG. A relationship exists between rise in blood glucose level and global tissue hypoperfusion in such patients, although it cannot be viewed as marker of the same.
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Affiliation(s)
- Soumi Das
- Department of Cardiac Anaesthesiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Kakali Ghosh
- Department of Cardiac Anaesthesiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Avijit Hazra
- Department of Cardiac Anaesthesiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Chaitali Sen
- Department of Cardiac Anaesthesiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Anupam Goswami
- Department of Cardiac Anaesthesiology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Wei ZN, Kuang JG. Vitamin D deficiency in relation to the poor functional outcomes in nondiabetic patients with ischemic stroke. Biosci Rep 2018; 38:BSR20171509. [PMID: 29437901 DOI: 10.1042/BSR20171509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 12/25/2022] Open
Abstract
To assess the hypothesis that vitamin D, reflected by 25-hydroxyvitamin D (25(OH) D) would be associated with higher risk of poor functional outcomes amongst nondiabetic stroke patients. The present study was conducted in Nanchang, China. Serum concentration of 25(OH) D and National Institutes of Health Stroke Scale (NIHSS) were measured at the time of admission. Functional outcome was measured by modified Rankin scale (mRS) at 1 year after admission. Multivariate analyses were performed using logistic regression models. The cut point of 25(OH) D level for vitamin D deficiency was 20 ng/ml. In the present study, 266 nondiabetic subjects with stroke were included; 149 out of the 266 patients were defined as vitamin D deficiency (56%). The poor outcome distribution across the 25(OH) D quartiles ranged between 64% (first quartile) and 13% (fourth quartile). In those 149 patients with vitamin D deficiency, 75 patients were defined as poor functional outcomes, giving a prevalence rate of 50% (95% confidence interval (CI): 42–58%). In multivariate analysis models, for vitamin D deficiency, the adjusted risk of poor functional outcomes and mortality increased by 220% (odds ratio (OR): 3.2; 95% CI: 1.7–4.2, P<0.001) and 290% (OR: 3.9; 95% CI: 2.1–5.8, P<0.001), respectively. Vitamin D deficiency is associated with an increased risk of poor functional outcome events in Chinese nondiabetic stroke individuals.
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Yoganathan S, Bagga A, Gulati S, Toteja GS, Hari P, Sinha A, Pandey RM, Irshad M. Prevalence and predictors of peripheral neuropathy in nondiabetic children with chronic kidney disease. Muscle Nerve 2018; 57:792-798. [PMID: 29193154 DOI: 10.1002/mus.26027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study sought to determine the prevalence and predictors of peripheral neuropathy in nondiabetic children with chronic kidney disease (CKD). METHODS Fifty-one consecutive normally nourished children, 3-18 years of age, with CKD stages IV and V of nondiabetic etiology were enrolled from May to December 2012. Nerve conduction studies were performed in 50 children. Blood samples were analyzed for the biochemical parameters, trace elements, and micronutrients. RESULTS The prevalence of peripheral neuropathy in our cohort was 52% (95% confidence interval 37.65, 66.34). The majority (80.8%) of the children had axonal neuropathy, and 11.5% had demyelinating neuropathy. Isolated motor neuropathy was identified in 92.3% of the children, and sensorimotor neuropathy was identified in 7.6%. The significant risk factors associated with peripheral neuropathy were older age, low serum copper, and dialysis therapy. DISCUSSION Electrodiagnostic studies should be performed in children with CKD to assess for peripheral neuropathy for the purpose of optimizing medical care. Muscle Nerve 57: 792-798, 2018.
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Affiliation(s)
- Sangeetha Yoganathan
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Arvind Bagga
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - G S Toteja
- Division of Nutrition, Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India, New Delhi, 110001, India
| | - Pankaj Hari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aditi Sinha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammad Irshad
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
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Nayak SB, Mohammed SB, Nayak AS. Controlling Lipids AIDS in the Prevention of Type 2 Diabetes, Hypertension, and Cardiovascular Diseases. Int J Prev Med 2017; 8:39. [PMID: 28656095 PMCID: PMC5474908 DOI: 10.4103/ijpvm.ijpvm_184_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 03/18/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Abnormal lipid profiles are a characteristic feature of persons with chronic conditions in which the diabetic populations are recognized as the dominant group, regardless of gender and ethnicity worldwide. This study was conducted to identify and evaluate the abnormalities of serum lipid profiles in both nondiabetic and diabetic persons. METHODS This study was a case-control investigation conducted between 2013 and 2015. The study enrolled 266 patients from the North Central and South West Regional Health Authorities of Trinidad. Of the 266 patients recruited, 126 were diabetic and 140 were nondiabetic. RESULTS Our study observed that dyslipidemia was present among the nondiabetic populations as the nondiabetics had 55 women and 20 men with high cholesterol, 22 women and 14 men with high triglyceride (TG), 30 women and 25 men with low high-density lipoprotein cholesterol (HDL-C), 42 women and 21 men with high low-density level-cholesterol (LDL-C), 13 women and 8 men with high very low-density lipoprotein (VLDL), and also 30 women and 11 men with body mass index (BMI) over 30 kg/m2. We also observed that diabetic women had significantly lower TGs (P = 0.019) and higher HDL-C (P = 0.001) and LDL (P = 0.003) when compared with the diabetic men. In addition, the nondiabetic females also had higher HDL-C (P = 0.045) when compared to their male counterparts. Both diabetic and nondiabetic women exhibited significantly higher BMI of P = 0.000. A negative correlation was obtained among TGs and HDL (r = -0.356, n = 83, P = 0.001) and a positive correlation was observed among LDL and HDL (r = 0.230, n = 86, P = 0.035). CONCLUSIONS This study observed the incidences in the abnormalities of serum lipid profiles in both nondiabetic and diabetic persons. It also presents the high occurrence of nondiabetic women with dyslipidemia as they presented with high cholesterol, high TG, low HDL-C, and high VLD-L with BMI over 30 kg/m2.
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Affiliation(s)
- Shivananda B Nayak
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Stephanie B Mohammed
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Chen CL, Yen DHT, Lin CS, Tsai SH, Chen SJ, Sheu WHH, Hsu CW. Glycated hemoglobin level is an independent predictor of major adverse cardiac events after nonfatal acute myocardial infarction in nondiabetic patients: A retrospective observational study. Medicine (Baltimore) 2017; 96:e6743. [PMID: 28471967 PMCID: PMC5419913 DOI: 10.1097/md.0000000000006743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The effect of glycemic control on the prognosis of nondiabetic patients after acute myocardial infarction (AMI) remains uncertain. We investigated whether glycated hemoglobin (HbA1c) is associated with adverse outcomes after AMI in nondiabetic patients. In this observational study, we enrolled nondiabetic patients with AMI in the emergency department of 2 medical centers from January 2011 to September 2014. All patients received primary percutaneous coronary intervention and were divided into 4 groups according to the interquartile range of average HbA1c level (Group I, ≤5.6%; Group II, 5.6%-5.8%; Group III, 5.8%-6.0%; and Group IV, >6.0%). Multivariate logistic analysis was performed to estimate the correlation of HbA1c with major adverse cardiac events (MACEs) after AMI. In total, 267 eligible patients were enrolled; 48 patients (18%) developed MACEs within a median follow-up of 178 days. Univariate analysis showed HbA1c > 6.0%, with a higher risk of MACEs in Group IV than in Group I (odds ratio [OR]: 2.733; 95% confidence interval [CI]: 1.123-6.651 vs OR: 1.511; 95% CI: 0.595-3.835). Multivariate analysis revealed an approximately 3.8 times higher risk of MACEs in Group IV than in Group I (OR: 3.769; 95% CI: 1.30-10.86). The HbA1 level is a significant predictor of MACEs after AMI in nondiabetic patients.
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Affiliation(s)
- Chin-Lan Chen
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University
| | - David H.-T. Yen
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University
- Department of Emergency Medicine, Taipei Veterans General Hospital
| | | | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei
| | - Wayne H.-H. Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Chin-Wang Hsu
- Department of Emergency and Critical Medicine, Wan Fang Hospital
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Kok VC, Lee PH. Management of Hypoglycemia in Nondiabetic Palliative Care Patients: A Prognosis-Based Approach. Palliat Care 2016; 10:1-5. [PMID: 27920549 PMCID: PMC5123827 DOI: 10.4137/pcrt.s38956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023] Open
Abstract
Hypoglycemia due to underlying terminal illness in nondiabetic end-of-life patients receiving palliative care has not been fully studied. For example, we do not have adequate information on the frequency of spontaneous hypoglycemia in patients as occurs during the different stages of palliative care. Depending on the case-mix nature of the palliative care ward, at least 2% of palliative care patients may develop hypoglycemia near the end of life when the remaining life expectancy counts down in days. As many as 25%-60% of these patients will neither have autonomic response nor have neuroglycopenic symptoms during a hypoglycemic episode. Although it is not difficult to diagnose and confirm a true hypoglycemia when it is suspected clinically, an episode of hypoglycemic attack may go unnoticed in some patients in a hospice setting. Current trends in palliative care focus on providing treatments based on a prognosis-based framework, involving shared decision-making between the patient and caregivers, after considering the prognosis, professional recommendations, patient's autonomy, family expectations, and the current methods for treating the patient's physical symptoms and existential suffering. This paper provides professional care teams with both moral and literature support for providing care to nondiabetic patients presenting with hypoglycemia.
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Affiliation(s)
- Victor C. Kok
- Division of Palliative Medicine, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- CORRESPONDENCE:
| | - Ping-Hsueh Lee
- Division of Palliative Medicine, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
- Division of Geriatric Medicine, Department of Family Medicine, Kuang Tien General Hospital, Taichung, Taiwan
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Mahmoodi MR, Baneshi MR, Rastegari A. Comparison of conventional risk factors in middle-aged versus elderly diabetic and nondiabetic patients with myocardial infarction: prediction with decision-analytic model. Ther Adv Endocrinol Metab 2015; 6:258-66. [PMID: 26623003 PMCID: PMC4647132 DOI: 10.1177/2042018815600641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We sought to predict occurrence of myocardial infarction (MI) by means of a classification and regression tree (CART) model by conventional risk factors in middle-aged versus elderly (age ⩾65years) diabetic and nondiabetic patients from the Modares Heart Study. METHOD A total of 469 patients were randomly selected and categorized into two groups according to clinical diabetes status. Group I consisted of 238 diabetic patients and group II consisted of 231 nondiabetic patients. Our population was MI positive. The outcome investigated was diabetes mellitus. We used a decision-analytic model to predict the diagnosis of patients with suspected MI. RESULTS We constructed 4 predictive patterns using 12 input variables and 1 output variable in terms of their sensitivity, specificity and risk. The differences among patterns were due to inclusion of predictor variables. The CART model suggested different variables of hypertension, mean cell volume, fasting blood sugar, cholesterol, triglyceride and uric acid concentration based on middle-aged and elderly patients at high risk for MI. Levels of biochemical measurements identified as best risk cutoff points. In evaluating the precision of different patterns, sensitivity and specificity were 47.9-84.0% and 56.3-93.0%, respectively. CONCLUSIONS The CART model is capable of symbolizing interpretable clinical data for confirming and better prediction of MI occurrence in clinic or in hospital. Therefore, predictor variables in pattern could affect the outcome based on age group variable. Hyperglycemia, hypertension, hyperlipidemia and hyperuricemia were serious predictors for occurrence of MI in diabetics.
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Affiliation(s)
| | - Mohammad Reza Baneshi
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Azam Rastegari
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Shankar SS, Shankar RR, Railkar RA, Beals CR, Steinberg HO, Kelley DE. Early Clinical Detection of Pharmacologic Response in Insulin Action in a Nondiabetic Insulin-Resistant Population. Curr Ther Res Clin Exp 2015; 77:83-9. [PMID: 26543510 PMCID: PMC4589823 DOI: 10.1016/j.curtheres.2015.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 11/16/2022] Open
Abstract
Background Insulin resistance heightens the risk for type 2 diabetes mellitus and cardiovascular disease. Amelioration of insulin resistance may reduce this risk. The thiazolidinedone class of insulin sensitizers improves insulin action in individuals with insulin-resistant diabetes and nondiabetic individuals. However, there are few reports on the time of onset of such effects independent of reversal of glucotoxicity. Objective The goal of our study was to test whether the thiazolidinedione pioglitazone has prominent early metabolic effects that can be detected in an obese, nondiabetic, insulin-resistant population. Methods We conducted a randomized, double-blind, placebo-controlled, parallel-group trial in men with nondiabetic insulin resistance using a hyperinsulinemic euglycemic clamp technique (at low and high doses of insulin at 10 and 40 mU/m2/min, respectively). The patients were given 30 mg daily oral pioglitazone or placebo for 28 days. Patients underwent a baseline clamp before initiation of treatment, and again at 14 and 28 days of treatment. Results Compared with placebo, under high-dose hyperinsulinemia, pioglitazone led to significant increases in glucose disposal rates (GDR) of 1.29 mg/kg/min (90% CI, 0.43–2.15; 39%; P=0.008) that were detectable at 2 weeks of treatment and persisted at 4 weeks of treatment. Under low-dose hyperinsulinemia, significant increases in GDR of 0.40 mg/kg/min (90% CI, 0.17–0.62; 95%; P=0.003) were observed at 4 weeks of treatment. These responses were accompanied by robust suppression of free fatty acids under hyperinsulinemic conditions, and by significant increases in circulating basal total adiponectin at 2 and 4 weeks of treatment. Conclusions Significant changes in insulin action across multiple insulin-sensitive tissues can be detected within 2 weeks of initiation of insulin-sensitizing therapy with pioglitazone in obese patients with nondiabetic insulin resistance. ClinicalTrials.gov identifier: NCT01115712.
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Affiliation(s)
- Sudha S Shankar
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - R Ravi Shankar
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Radha A Railkar
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Chan R Beals
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | | | - David E Kelley
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
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Affiliation(s)
- Nisha Bansal
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington; and
| | - Michael G Shlipak
- General Internal Medicine Division, San Francisco VA Medical Center, San Francisco, California
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Abstract
BACKGROUND Helicobacter pylori (HP) infection plays a significant role in the development of gastrointestinal complications and has a significant role in systemic inflammation. It has some extragastrointestinal manifestations like endocrine diseases. In this study, we aimed to compare the prevalence of HP infection in diabetic and nondiabetic individuals. MATERIALS AND METHODS In this cross-sectional study, 218 nondiabetic and 211 diabetic patients referring to Shahid Beheshti Hospital of Qom between March 2013 and 2014 were studied. The patients were divided into two HP(+) and HP(-) groups based on serological immunoglobulin G antibody against HP and the association between diabetes, and HP infection was evaluated. Data were analyzed using independent t-tests, Chi-square, Fisher's exact and Mann-Whitney tests. RESULTS The prevalence of HP seropositive was 65.9% versus 50.5% in diabetic and nondiabetics, respectively, and the difference was statistically significant (P = 0.001). CONCLUSIONS This study showed a higher prevalence of HP infection in diabetic patients.
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Affiliation(s)
- Jamshid Vafaeimanesh
- Department of Internal Medicine, Clinical Research Development Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Shahid Beheshti Boulevard, Qom, Iran
| | - Mahmoud Parham
- Department of Internal Medicine, Clinical Research Development Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Shahid Beheshti Boulevard, Qom, Iran
| | - Mohammad Bagherzadeh
- Department of Internal Medicine, Clinical Research Development Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Shahid Beheshti Boulevard, Qom, Iran
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Hu Y, Niu Y, Wang D, Wang Y, Holden BA, He M. The association of longitudinal trend of fasting plasma glucose with retinal microvasculature in people without established diabetes. Invest Ophthalmol Vis Sci 2015; 56:842-8. [PMID: 25613941 DOI: 10.1167/iovs.14-15943] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 11/24/2022] Open
Abstract
PURPOSE Structural changes of retinal vasculature, such as altered retinal vascular calibers, are considered as early signs of systemic vascular damage. We examined the associations of 5-year mean level, longitudinal trend, and fluctuation in fasting plasma glucose (FPG) with retinal vascular caliber in people without established diabetes. METHODS A prospective study was conducted in a cohort of Chinese people age ≥40 years in Guangzhou, southern China. The FPG was measured at baseline in 2008 and annually until 2012. In 2012, retinal vascular caliber was assessed using standard fundus photographs and validated software. A total of 3645 baseline nondiabetic participants with baseline and follow-up data on FPG for 3 or more visits was included for statistical analysis. The associations of retinal vascular caliber with 5-year mean FPG level, longitudinal FPG trend (slope of linear regression-FPG), and fluctuation (standard deviation and root mean square error of FPG) were analyzed using multivariable linear regression analyses. RESULTS Multivariate regression models adjusted for baseline FPG and other potential confounders showed that a 10% annual increase in FPG was associated independently with a 2.65-μm narrowing in retinal arterioles (P = 0.008) and a 3.47-μm widening in venules (P = 0. 0.004). Associations with mean FPG level and fluctuation were not statistically significant. CONCLUSIONS Annual rising trend in FPG, but not its mean level or fluctuation, is associated with altered retinal vasculature in nondiabetic people.
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Affiliation(s)
- Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yong Niu
- Guangzhou No.11 People's Hospital, Guangzhou, China
| | - Dandan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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Bahijri SM, Alissa EM. Increased insulin resistance is associated with increased urinary excretion of chromium in non-diabetic, normotensive Saudi adults. J Clin Biochem Nutr 2011; 49:164-8. [PMID: 22128214 PMCID: PMC3208011 DOI: 10.3164/jcbn.10-148] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 02/06/2011] [Indexed: 11/22/2022] Open
Abstract
The role of trivalent chromium in improving glucose tolerance is well documented. Increased urinary chromium has been reported in type 2 diabetes mellitus, but it was not clear whether this had preceded diabetes mellitus, or was caused by it. Aim was to investigate the relationship between urinary chromium and the degree of insulin resistance in non-diabetic normotensive Saudi adults. 357 healthy adults aged 18–50 years were recruited randomly in a cross-sectional study design. Anthropometric and demographic information were taken. Insulin, glucose and free fatty acids were measured in fasting blood samples. Fasting urinary chromium and creatinine were also determined. Using modified QUICKI, subjects were labeled as high insulin resistant, or low insulin resistant. High insulin resistant subjects were matched for age and sex to low insulin resistant subjects. High insulin resistant subjects had higher mean BMI (p<0.001), mean waist circumference (p<0.01), and median urinary chromium (p<0.001) compared to low insulin resistant subgroup. Higher urinary chromium in high insulin resistant subgroup indicates a renal lesion leading to chromium deficiency and possibly diabetes mellitus eventually. Chromium supplementation might help to protect against the development of diabetes mellitus in this group of high insulin resistant non-diabetic Saudi individuals.
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Affiliation(s)
- Suhad M Bahijri
- Clinical Biochemistry, Faculty of Medicine, Nutrition Research Unit-King Fahd Medical Research Centre, King Abdulaziz University, PO Box 12713, Jeddah 21483, Kingdom of Saudi Arabia
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Aramwit P, Bunmee P, Supasyndh O. Effectiveness and tolerability of rosiglitazone on insulin resistance and body composition in nondiabetic Thai patients undergoing continuous ambulatory peritoneal dialysis: A 12-week pilot study. Curr Ther Res Clin Exp 2009; 70:377-89. [PMID: 24683246 PMCID: PMC3967294 DOI: 10.1016/j.curtheres.2009.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with chronic renal insufficiency, especially those undergoing continuous ambulatory peritoneal dialysis (CAPD), normally have insulin resistance due to deficiencies in insulin secretion and degradation, as well as tissue resistance to insulin at both receptor and postreceptor levels. OBJECTIVE The aim of this study was to investigate the effectiveness and tolerability of rosiglitazone on insulin resistance and body composition in patients without diabetes mellitus (DM) undergoing CAPD. METHODS This pilot study included a pretest and posttest with a repeated-measure design in a small number of patients. CAPD patients without DM received rosiglitazone 2-mg tablets BID for 12 weeks. Homeostasis Model Assessment Index of Insulin Resistance (HOMA-IR) and bioelectrical impedance analysis (BIA) were used to assess insulin resistance and body composition, respectively. Tolerability was assessed using laboratory analyses as well as physical examination findings to evaluate peripheral edema. Peripheral edema was assessed by the study investigators. RESULTS Thirteen Thai patients (mean [SD] age, 54.17 [11.42] years [range, 35-85 years]; body mass index [BMI], >20 to <30 kg/m(2); fasting blood glucose [FBG] concentration, <5.39 mmol/L) were included in the study. One patient was withdrawn due to illness unrelated to the study. No significant difference was found in FBG concentration between baseline and posttreatment (after 12 weeks of treatment) (5.45 [0.59] vs 5.24 [0.51] mmol/L), but fasting plasma insulin concentrations (28.50 [23.70] vs 10.15 [4.22] μIU/mL; P = 0.005) and HOMA-IR score (6.70 [5.23] vs 2.40 [1.15]; P = 0.011) were significantly lower. There were no significant changes in weight or BMI from baseline to posttreatment. Seven subjects (58.3%) experienced weight gain at week 4, while 2 patients (16.7%) still had weight gain after 12 weeks of treatment. A significant increase was found between baseline and posttreatment in total body water (38.03 [4.55] vs 42.44 [5.99] L; P = 0.018), extracellular fluid (20.24 [3.75] vs 26.22 [8.69] L; P = 0.005), plasma fluid (4.29 [0.80] vs 5.20 [0.93] L; P = 0.005), and interstitial fluid (14.99 [2.78] vs 17.68 [3.07] L; P = 0.040). Using BIA, no significant changes were observed in intracellular fluid, fat mass, or liver function. After 12 weeks of rosiglitazone administration, 2 patients (16.7%) had mild edema. CONCLUSIONS Rosiglitazone 2 mg BID for 12 weeks was associated with significantly improved insulin resistance in this small group of nondiabetic Thai patients undergoing CAPD. There was a significant increase in total body water and extracellular fluid after administration of rosiglitazone for 12 weeks. There were no significant changes in FBG, weight, or BMI.
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Affiliation(s)
- Pornanong Aramwit
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Panipat Bunmee
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ouppatham Supasyndh
- Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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