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Lund LC, Jensen PH, Pottegård A, Andersen M, Pratt N, Hallas J. Identifying diabetogenic drugs using real world health care databases: A Danish and Australian symmetry analysis. Diabetes Obes Metab 2023; 25:1311-1320. [PMID: 36683229 DOI: 10.1111/dom.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
AIMS Drug-induced diabetes is underreported in conventional drug safety monitoring and may contribute to the increasing incidence of type 2 diabetes. Therefore, we used routinely collected prescription data to screen all commonly used drugs for diabetogenic effects. METHODS Leveraging the Danish nationwide health registries, we used a case-only symmetry analysis design to evaluate all possible associations between drug initiation and subsequent diabetes. The study was conducted among individuals aged ≥40 years with a first-ever prescription for any antidiabetic drug 1996-2018 (n = 348 996). Sequence ratios (SRs) and 95% confidence intervals (CIs) were obtained for all possible drug class-diabetes combinations. A lower bound of the 95% CI >1.00 was considered a signal. Signals generated in Denmark were replicated using the Services Australia, Pharmaceutical Benefits Scheme 10% data extract. RESULTS Overall, 386 drug classes were investigated, of which 70 generated a signal. In total, 43 were classified as previously known based on the SIDER database or a literature review, for example, glucocorticoids (SR 1.67, 95% CI 1.62-1.72) and β-blockers (SR 1.20, 95% CI 1.16-1.23). Of 27 new signals, three drug classes yielded a signal in both the Danish and Australian data source: digitalis glycosides (SR 2.15, 95% CI 2.04-2.27, and SR 1.76, 95% CI 1.50-2.08), macrolides (SR 1.20, 95% CI 1.16-1.24, and SR 1.11, 95% CI 1.06-1.16) and inhaled β2-agonists combined with glucocorticoids (SR 1.35, 95% CI 1.28-1.42, and SR 1.14, 95% CI 1.06-1.22). CONCLUSION We identified 70 drug-diabetes associations, of which 27 were classified as hitherto unknown. Further studies evaluating the hypotheses generated by this work are needed, particularly for the signal for digitalis glycosides.
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Affiliation(s)
- Lars Christian Lund
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
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Practical Applicability of the ISARIC-4C Score on Severity and Mortality due to SARS-CoV-2 Infection in Patients with Type 2 Diabetes. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070848. [PMID: 35888567 PMCID: PMC9318227 DOI: 10.3390/medicina58070848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
Background and objectives. There is a bidirectional relationship between SARS-CoV-2 infection and diabetes mellitus (DM), as people with DM are more vulnerable, and SARS-CoV-2 infections worsen the prognosis in these patients. The main purpose of the study was to evaluate the application validity of the ISARIC-4C score in patients confirmed with SARS-CoV-2 infection. Materials and Methods. The study included 159 patients previously known to have type 2 DM and confirmed positive for SARS-CoV-2 infection. We analyzed the concordance between the clinical evaluation of the patients and the ISARIC-4C score. Results. The mortality rate in hospitalized patients was 25.15%. The mortality risk was higher for ISARIC-4C values >14 than in the opposite group (63.93% vs. 31.24%; p < 0.001). The area under the curve (AUC) of the mortality score was 0.875 (95% CI: 0.820−0.930; p < 0.001), correctly classifying 77.36% of the cohort. A cut-off value of >14 had a sensitivity of 87.80% (95% CI: 87.66−87.93), specificity 73.72% (95% CI: 73.48−73.96), positive predictive value 53.73% (95% CI: 53.41−54.04), and negative predictive value 94.56% (95% CI: 94.5−94.62). The Cox regression model showed that the length of hospitalization (LH) was significantly influenced by body mass index, lung impairment, and aspartate aminotransferase, increasing the hazards, while lower HbA1c and lower SatO2 significantly decreased the hazards. Conclusions. ISARIC-4C score estimates the likelihood of clinical deterioration and the mortality risk in patients hospitalized with type 2 DM and positive for SARS-CoV-2, being useful in assessing the prognosis from the onset, as well as in developing therapeutic strategies.
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Zacay G, Hershkowitz Sikron F, Heymann AD. Glycemic Control and Risk of Cellulitis. Diabetes Care 2021; 44:367-372. [PMID: 33262125 DOI: 10.2337/dc19-1393] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We know that diabetes predisposes to common infections, such as cellulitis and pneumonia. However, the correlation between the level of glycemic control and the rate of infection is unknown. RESEARCH DESIGN AND METHODS We examined the association between glycemic control in patients with diabetes and the incidence of infection in the entire population of patients with diabetes in a large HMO. During the study period, we first selected an HbA1c test for each patient and then searched for an infection diagnosis in the 60 days that followed the test. A multivariate logistic regression analysis was performed to determine the independent effect of HbA1c on the likelihood of being diagnosed with an infection. We were able to control for many confounders, such as other chronic illness, time since the diagnosis of diabetes, and use of steroids before the infection. RESULTS We identified 407 cases of cellulitis. Multivariate logistic regressions for cellulitis showed a 1.4-fold increased risk among patients with HbA1c >7.5% (58 mmol/mol). Factors such as obesity, Parkinson's disease, peripheral vascular disease, and prior treatment with prednisone predisposed to cellulitis. There was an increase of 12% in the odds of cellulitis for every 1% (11 mmol/mol) elevation in HbA1c (odds ratio [OR] 1.12; CI 1.05-1.19). A similar analysis showed a trend toward an increased risk of pneumonia in patients with HbA1c >7.5% (58 mmol/mol) (OR 1.1; CI 0.9-1.4). CONCLUSIONS Poor glycemic control was associated in this study with the development of cellulitis. The study also suggests that exposure to oral prednisolone increases the risk of cellulitis, pneumonia, and upper respiratory infection.
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Affiliation(s)
- Galia Zacay
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel .,Department of Family Medicine, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | | | - Anthony D Heymann
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel.,Department of Family Medicine, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
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Yin P, Li J, Wen Q, Qiu Y, Liang W, Wang J, Yu J, Zhong Z, Yang X, Yu X, Ye Q, Huang F. Infection-related hospitalization after intensive immunosuppressive therapy among lupus nephritis and ANCA glomerulonephritis patients. Ren Fail 2021; 42:474-482. [PMID: 32406300 PMCID: PMC7269069 DOI: 10.1080/0886022x.2020.1763400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: This study aimed to investigate the clinical characteristics, risk factors, and outcomes of infection-related hospitalization (IRH) in patients with lupus nephritis (LN) and ANCA glomerulonephritis after intensive immunosuppressive therapy.Methods: Patients diagnosed with LN or ANCA glomerulonephritis who received intensive immunosuppressive therapy at the First Affiliated Hospital of Sun Yat-sen University from 2005 to 2014 were enrolled. Demographics, laboratory parameters, immunosuppressive agents, and IRH details were collected. Multivariable Cox regression was used, and hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.Results: Totally, 872 patients with 806 LN and 66 ANCA glomerulonephritis were enrolled, and 304 (34.9%) patients with 433 episodes of IRH were recorded. ANCA glomerulonephritis patients were more vulnerable to IRH than LN patients (53.0% vs. 33.4%, p = .001). Multivariable Cox regression analysis showed that ANCA glomerulonephritis (HR = 1.62, 95% CI: 1.06-2.49, p = .027), diabetes (HR = 1.82, 95% CI: 1.03-3.22, p = .039) and a higher initial dose of prednisone (HR = 1.01, 95% CI: 1.00-1.02, p = .013) were associated with a higher likelihood of IRH. Higher albumin (HR = 0.96, 95% CI: 0.94-0.98, p < .001), globulin (HR = 0.98, 95% CI: 0.96-0.99, p = .008), and eGFR (HR = 0.99, 95% CI: 0.99-1.00, p < .001), were associated with a lower likelihood of IRH. The rates of transfer to ICU and mortality for ANCA glomerulonephritis patients were higher than those for LN patients (22.9% vs. 1.9%, p < .001, and 20.0% vs. 0.7%, p < .001, respectively).Conclusions: ANCA glomerulonephritis patients had a higher risk of IRH and poorer outcome once infected after intensive immunosuppressive therapy than LN patients. More strict control for infection risks is required for ANCA glomerulonephritis patients who undergo intensive immunosuppressive therapy.
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Affiliation(s)
- Peihong Yin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Nephrology, Zhongshan City People's Hospital, Zhongshan, China
| | - Jianbo Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yagui Qiu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenyi Liang
- Department of Nephrology, Zhongshan City People's Hospital, Zhongshan, China
| | - Junxian Wang
- Department of Nephrology, Zhongshan City People's Hospital, Zhongshan, China
| | - Jing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhong Zhong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qing Ye
- Department of Nephrology, Zhongshan City People's Hospital, Zhongshan, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Hasan SS, Kow CS, Bain A, Kavanagh S, Merchant HA, Hadi MA. Pharmacotherapeutic considerations for the management of diabetes mellitus among hospitalized COVID-19 patients. Expert Opin Pharmacother 2020; 22:229-240. [PMID: 33054481 DOI: 10.1080/14656566.2020.1837114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Diabetes mellitus is one of the most prevalent comorbidities identified in patients with coronavirus disease 2019 (COVID-19). This article aims to discuss the pharmacotherapeutic considerations for the management of diabetes in hospitalized patients with COVID-19. AREAS COVERED We discussed various aspects of pharmacotherapeutic management in hospitalized patients with COVID-19: (i) susceptibility and severity of COVID-19 among individuals with diabetes, (ii) glycemic goals for hospitalized patients with COVID-19 and concurrent diabetes, (iii) pharmacological treatment considerations for hospitalized patients with COVID-19 and concurrent diabetes. EXPERT OPINION The glycemic goals in patients with COVID-19 and concurrent type 1 (T1DM) or type 2 diabetes (T2DM) are to avoid disruption of stable metabolic state, maintain optimal glycemic control, and prevent adverse glycemic events. Patients with T1DM require insulin therapy at all times to prevent ketosis. The management strategies for patients with T2DM include temporary discontinuation of certain oral antidiabetic agents and consideration for insulin therapy. Patients with T2DM who are relatively stable and able to eat regularly may continue with oral antidiabetic agents if glycemic control is satisfactory. Hyperglycemia may develop in patients with systemic corticosteroid treatment and should be managed upon accordingly.
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Affiliation(s)
| | - Chia Siang Kow
- School of Postgraduate Studies, International Medical University , Kuala Lumpur, Malaysia
| | - Amie Bain
- Department of Pharmacy, University of Huddersfield , Huddersfield, UK.,Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK
| | - Sallianne Kavanagh
- Department of Pharmacy, University of Huddersfield , Huddersfield, UK.,Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK
| | - Hamid A Merchant
- Department of Pharmacy, University of Huddersfield , Huddersfield, UK
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Abstract
Objectives: Poor glycemic control is associated with mortality in critical patients with diabetes. The aim of the study was to assess the predicting value of stress hyperglycemia in patients with diabetes following hospital admission for sepsis. Design: Retrospective observational study. Setting: Adult, emergency department, and critical care in a district hospital. Patients: In a 10-year retrospective analysis of sepsis-related hospitalizations in the emergency department, we carried out a secondary analysis of 915 patients with diabetes (males, 54.0%) in whom both fasting glucose at entry and glycosylated hemoglobin were available. Interventions: None. Measurements and Main Results: Patients’ mean age was 79.0 (sd 11.0), glucose at admission was 174.0 mg/dL (74.3 mg/dL), and glycosylated hemoglobin was 7.7% (1.7%). Stress hyperglycemia was defined by the stress hyperglycemia ratio, that is, fasting glucose concentration at admission divided by the estimated average glucose derived from glycosylated hemoglobin. A total of 305 patients died (33.3%) in hospital. Factors associated with in-hospital case fatality rate were tested by multivariable logistic model. Ten variables predicting outcomes in the general population were confirmed in the presence of diabetes (male sex, older age, number of organ dysfunction diagnoses, in particular cardiovascular dysfunction, infection/parasitic, circulatory, respiratory, digestive diseases diagnosis, and Charlson Comorbidity Index). In addition, also glycemic control (glycosylated hemoglobin: odds ratio, 1.17; 95% CI, 1.15–1.40) and stress hyperglycemia (stress hyperglycemia ratio: 5.25; 3.62–7.63) were significant case fatality rate predictors. High stress hyperglycemia ratio (≥ 1.14) significantly increased the discriminant capacity (area under the receiver operating characteristic curve, 0.864; se, 0.013; p < 0.001). Conclusions: Stress hyperglycemia, even in the presence of diabetes, is predictive of mortality following admission for sepsis. Stress hyperglycemia ratio may be used to refine prediction of an unfavorable outcome.
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Mazucanti CH, Egan JM. SARS-CoV-2 disease severity and diabetes: why the connection and what is to be done? IMMUNITY & AGEING 2020; 17:21. [PMID: 32612666 PMCID: PMC7325192 DOI: 10.1186/s12979-020-00192-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/17/2020] [Indexed: 01/20/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus responsible for the current coronavirus disease 2019 (COVID-19) pandemic, has infected over 3.5 million people all over the world since the first case was reported from Wuhan, China 5 months ago. As more epidemiological data regarding COVID-19 patients is acquired, factors that increase the severity of the infection are being identified and reported. One of the most consistent co-morbidities associated with worse outcome in COVID-19 patients is diabetes, along with age and cardiovascular disease. Studies on the association of diabetes with other acute respiratory infections, namely SARS, MERS, and Influenza, outline what seems to be an underlying factor in diabetic patients that makes them more susceptible to complications. In this review we summarize what we think may be the factors driving this pattern between diabetes, aging and poor outcomes in respiratory infections. We also review therapeutic considerations and strategies for treatment of COVID-19 in diabetic patients, and how the additional challenge of this co-morbidity requires attention to glucose homeostasis so as to achieve the best outcomes possible for patients.
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Affiliation(s)
- Caio Henrique Mazucanti
- National Institute on Aging, Intramural Research Program, 251 Bayview Boulevard, Baltimore, MD 21224 USA
| | - Josephine Mary Egan
- National Institute on Aging, Intramural Research Program, 251 Bayview Boulevard, Baltimore, MD 21224 USA
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Rhee JJ, Zheng Y, Liu S, Montez-Rath ME, Hamill RJ, Ishida JH, Winkelmayer WC. Glycemic Control and Infections Among US Hemodialysis Patients With Diabetes Mellitus. Kidney Int Rep 2020; 5:1014-1025. [PMID: 32647759 PMCID: PMC7335954 DOI: 10.1016/j.ekir.2020.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/24/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Patients with diabetes mellitus (DM) on hemodialysis (HD) may be particularly vulnerable to infections. Methods We used merged data from the United States Renal Data System and electronic health records data from a large US dialysis provider to retrospectively examine the association between glycemic control and infections in these patients. Adult patients with DM aged ≥18 years who initiated in-center maintenance HD treatment from 2006 to 2011 and survived >90 days were included. Quarterly mean time-averaged hemoglobin A1c (HbA1c) values were categorized into <5.5%, 5.5 to <6.5%, 6.5 to <7.5%, 7.5 to <8.5%, and ≥8.5%. We used Medicare claims to ascertain infection-related outcomes and the ESRD Death Notification to identify death from infectious cause. We used Cox proportional hazards models to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for the associations between time-averaged HbA1c categories and infectious events. Results In a cohort of 33,753 eligible patients, those with higher HbA1c levels had higher rates of diabetic foot infections and skin and soft tissue infections, with patients with HbA1c ≥8.5% having 23% (95% CI, 5%, 45%) and 22% (95% CI, 5%, 42%) higher rates, respectively, compared with HbA1c 5.5 to <6.5%. Patients in the lower HbA1c categories had higher rates of infection-related and all-cause mortality (P-for-trend <0.001). Conclusion This study highlights the need for greater attention to foot evaluation and skin and soft tissue infections among patients on HD with less than optimal diabetes control.
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Affiliation(s)
- Jinnie J Rhee
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Yuanchao Zheng
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sai Liu
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Maria E Montez-Rath
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Richard J Hamill
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Julie H Ishida
- Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Chang CH, Wang JL, Wu LC, Chuang LM, Lin HH. Diabetes, Glycemic Control, and Risk of Infection Morbidity and Mortality: A Cohort Study. Open Forum Infect Dis 2019; 6:ofz358. [PMID: 31660337 PMCID: PMC6765350 DOI: 10.1093/ofid/ofz358] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/02/2019] [Indexed: 12/14/2022] Open
Abstract
Objective Diabetic patients have an elevated risk of infection, but the optimal level of glycemic control with the lowest infection risk remains unclear, especially among the elderly. We aimed to investigate the relation between fasting plasma glucose (FPG) level and risk of infection-related morbidity and mortality. Method The participants were from a community-based health screening program in northern Taiwan during 2005–2008 (n = 118 645) and were followed up until 2014. Incidence of hospitalization for infection and infection-related death was ascertained from the National Health Insurance Database and National Death Registry. Cox proportional hazards regression modelling was used to estimate the hazard ratio (HR) between FPG and risk of infection. Results During a median follow-up of 8.1 years, the incidence rate of hospitalization for any infection was 36.33 and 14.26 per 1000 person-years among diabetics and nondiabetics, respectively, in the total study population, but increased to 70.02 and 45.21 per 1000 person-years, respectively, in the elderly. In the Cox regression analysis, the adjusted HR comparing diabetics to nondiabetics was 1.59 (95% confidence interval [CI], 1.52–1.67) for any hospitalization for infection and 1.71 (95% CI, 1.36–2.16) for infection-related mortality. The hazard for infection morbidity and mortality was higher at both extremes (<90 and >200 mg/dl) of FPG. The excess risk associated with FPG ≤ 90 mg/dl was attenuated after controlling for multiple comorbidities. Conclusions Poor glycemic control (FPG > 200 mg/dl) was associated with a higher risk of infection-related morbidity and mortality, especially in the elderly population where the baseline infection risk was high.
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Affiliation(s)
- Chia-Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, and, Tainan, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chiu Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
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Low level of hemoglobin A1c and the increased incidence of herpes zoster: longitudinal study. Eur J Clin Microbiol Infect Dis 2019; 38:1539-1545. [DOI: 10.1007/s10096-019-03584-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/07/2019] [Indexed: 12/27/2022]
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López-Simarro F, Redondo Margüello E, Mediavilla Bravo JJ, Soriano Llora T, Iturralde Iriso J, Hormigo Pozo A. [Prevention and treatment of infectious diseases in diabetic patients]. Semergen 2018; 45:117-127. [PMID: 30580897 DOI: 10.1016/j.semerg.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 01/13/2023]
Abstract
The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations.
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Affiliation(s)
- F López-Simarro
- Área Básica de Salud Martorell Urbano, Institut Català de la Salut, Martorell, Barcelona, España; Grupo de Trabajo Diabetes de SEMERGEN, España.
| | - E Redondo Margüello
- Centro de Salud Internacional Madrid Salud, Ayuntamiento de Madrid, Madrid, España; Grupo de Actividades Preventivas y Salud Pública de SEMERGEN, España
| | - J J Mediavilla Bravo
- Grupo de Trabajo Diabetes de SEMERGEN, España; Centro de Salud Burgos Rural, Burgos, España
| | - T Soriano Llora
- Grupo de Trabajo Diabetes de SEMERGEN, España; Centro de Salud Canal de Panamá, Madrid, España
| | - J Iturralde Iriso
- Grupo de Trabajo Diabetes de SEMERGEN, España; Centro de Salud La Habana, Vitoria-Gasteiz, España
| | - A Hormigo Pozo
- Grupo de Trabajo Diabetes de SEMERGEN, España; Unidad de Gestión Clínica Puerta Blanca, Málaga, España
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Critchley JA, Carey IM, Harris T, DeWilde S, Hosking FJ, Cook DG. Glycemic Control and Risk of Infections Among People With Type 1 or Type 2 Diabetes in a Large Primary Care Cohort Study. Diabetes Care 2018; 41:2127-2135. [PMID: 30104296 DOI: 10.2337/dc18-0287] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes mellitus (DM) increases the risk of infections, but the effect of better control has not been thoroughly investigated. RESEARCH DESIGN AND METHODS With the use of English primary care data, average glycated hemoglobin (HbA1c) during 2008-2009 was estimated for 85,312 patients with DM ages 40-89 years. Infection rates during 2010-2015 compiled from primary care, linked hospital, and mortality records were estimated across 18 infection categories and further summarized as any requiring a prescription or hospitalization or as cause of death. Poisson regression was used to estimate adjusted incidence rate ratios (IRRs) by HbA1c categories across all DM, and type 1 and type 2 DM separately. IRRs also were compared with 153,341 age-sex-practice-matched controls without DM. Attributable fractions (AF%) among patients with DM were estimated for an optimal control scenario (HbA1c 6-7% [42-53 mmol/mol]). RESULTS Long-term infection risk rose with increasing HbA1c for most outcomes. Compared with patients without DM, those with DM and optimal control (HbA1c 6-7% [42-53 mmol/mol], IRR 1.41 [95% CI 1.36-1.47]) and poor control (≥11% [97 mmol/mol], 4.70 [4.24-5.21]) had elevated hospitalization risks for infection. In patients with type 1 DM and poor control, this risk was even greater (IRR 8.47 [5.86-12.24]). Comparisons within patients with DM confirmed the risk of hospitalization with poor control (2.70 [2.43-3.00]) after adjustment for duration and other confounders. AF% of poor control were high for serious infections, particularly bone and joint (46%), endocarditis (26%), tuberculosis (24%), sepsis (21%), infection-related hospitalization (17%), and mortality (16%). CONCLUSIONS Poor glycemic control is powerfully associated with serious infections and should be a high priority.
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Affiliation(s)
- Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, U.K.
| | - Iain M Carey
- Population Health Research Institute, St George's, University of London, London, U.K
| | - Tess Harris
- Population Health Research Institute, St George's, University of London, London, U.K
| | - Stephen DeWilde
- Population Health Research Institute, St George's, University of London, London, U.K
| | - Fay J Hosking
- Population Health Research Institute, St George's, University of London, London, U.K
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, U.K
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Luk AOY, Lau ESH, Cheung KKT, Kong APS, Ma RCW, Ozaki R, Chow FCC, So WY, Chan JCN. Glycaemia control and the risk of hospitalisation for infection in patients with type 2 diabetes: Hong Kong Diabetes Registry. Diabetes Metab Res Rev 2017; 33. [PMID: 28731281 DOI: 10.1002/dmrr.2923] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/20/2017] [Accepted: 07/16/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Infection occurs more commonly in diabetic patients compared with the general population and is an under-recognised but important morbidity in patients with diabetes. We examined the impact of glycaemic control on hospitalisation for infection in a large prospective cohort of Chinese adults with type 2 diabetes. METHODS Between July 1994 and June 2014, 22 846 patients with type 2 diabetes underwent detailed assessment of metabolic control and diabetes complications. Patients were followed for occurrence of infection requiring hospitalisation as identified using discharge diagnosis codes. RESULTS Over a median follow-up of 4.8 years, 20.3% of patients were hospitalised for any infection type, with respiratory tract, genitourinary tract, and skin being the most commonly affected sites. In multivariate Cox regression, time-dependent HbA1c was associated with all-site infection (hazard ratio [HR] 1.07 [95% confidence interval {CI}:1.05-1.09, P < 0.001]), genitourinary tract infection (HR 1.09 [95% CI: 1.04-1.14], P < 0.001), and skin infection (HR 1.16 [95% CI 1.12-1.21]. P < 0.001), but not infection of respiratory tract, and was independent of age, gender, disease duration, smoking, body mass index, glomerular filtration rate, haemoglobin, history of stroke, congestive heart failure, coronary heart disease, peripheral artery disease, diabetic neuropathy and cancer, and baseline drug use. Against an arbitrary HbA1c interval of >7.0-8.0% (53-64 mmol/mol), patients with HbA1c ≤6.0% (42 mmol/mol) and >8.0% (64 mmol/mol) had excess risks of infection-related hospitalisation adjusted for other factors. CONCLUSIONS In patients with type 2 diabetes, burden of serious infection is high. In the diabetic population, a U-shape relationship between glycaemia and infection-related hospitalisation was detected.
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Affiliation(s)
- Andrea O Y Luk
- Department of Medicine and Therapeutics, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, Hong Kong
- Li Ka Shing Institute of Health Sciences, Hong Kong
- Prince of Wales Hospital, Hong Kong, SAR, China
- The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, Hong Kong
- The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Kitty K T Cheung
- Department of Medicine and Therapeutics, Hong Kong
- Prince of Wales Hospital, Hong Kong, SAR, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, Hong Kong
- Li Ka Shing Institute of Health Sciences, Hong Kong
- The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, Hong Kong
- Li Ka Shing Institute of Health Sciences, Hong Kong
- The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, Hong Kong
- Prince of Wales Hospital, Hong Kong, SAR, China
| | - Francis C C Chow
- Department of Medicine and Therapeutics, Hong Kong
- Prince of Wales Hospital, Hong Kong, SAR, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Hong Kong
- Prince of Wales Hospital, Hong Kong, SAR, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, Hong Kong
- Li Ka Shing Institute of Health Sciences, Hong Kong
- The Chinese University of Hong Kong, Hong Kong, SAR, China
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14
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Ansari AS, de Lusignan S, Hinton W, Munro N, McGovern A. The association between diabetes, level of glycaemic control and eye infection: Cohort database study. Prim Care Diabetes 2017; 11:421-429. [PMID: 28648963 DOI: 10.1016/j.pcd.2017.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 02/07/2023]
Abstract
AIM To examine whether diabetes and the degree of glycaemic control is associated with an increased risk of acute eye infection, and prescribing of ocular antimicrobial agents. DESIGN AND SETTING A retrospective cohort study was carried out using the Royal College of General Practitioners Research and Surveillance Centre database (RCGP RSC), a large primary care database in the United Kingdom. We compared ocular infection rates in people aged ≥15 years without diabetes to those with diabetes, both type 1 and type 2. We developed logistic regression models to assess the excess risk in diabetes of: conjunctivitis, blepharitis, stye/chalzion, periorbital cellulitis, keratitis/keratoconjunctivitis, lacrimal gland infection, endopthalmitis, and ocular antimicrobial prescriptions over a six-year period (2010-2015). We also analysed the impact of glycaemic control on infection rates in those with diabetes. All models were adjusted for potential confounders. RESULTS We analysed infection risk in 889,856 people without diabetes and 48,584 people with diabetes (3273 type 1, and 45,311 type 2). After adjustment for confounders both type 1 and type 2 were associated with increased incidence of conjunctivitis (OR 1.61; 95% CI 1.38-1.88; p<0.0001 and OR 1.11; 95% CI 1.06-1.16; p<0.0001 respectively). No association was found with blepharitis, stye/chalzion, periorbital cellulitis, keratitis/keratoconjunctivitis, lacrimal gland infection, and endopthalmitis in the whole population. In subgroup analyses blepharitis was more common in those with type 1 diabetes under 50 years old and endopthalmitis in those under 50 with type 2 diabetes. Glycaemic control was not found to be associated with any infection. Diabetes was also associated with an increased incidence of antimicrobial prescriptions (Type 1 OR 1.69; 95% CI 1.51-1.88; p<0.0001 and type 2 OR 1.17; 95% CI 1.13-1.20; p<0.0001). CONCLUSIONS Conjunctivitis is recorded more frequently in people with diabetes. However, no substantial increase in recording of other ocular infections was noted. Infection risk was not found to be associated with the degree of glycaemic control.
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MESH Headings
- Administration, Ophthalmic
- Adolescent
- Adult
- Aged
- Anti-Infective Agents/administration & dosage
- Biomarkers/blood
- Blood Glucose/drug effects
- Blood Glucose/metabolism
- Databases, Factual
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/epidemiology
- Drug Prescriptions
- Eye Infections/diagnosis
- Eye Infections/drug therapy
- Eye Infections/epidemiology
- Female
- Glycated Hemoglobin/metabolism
- Humans
- Hypoglycemic Agents/therapeutic use
- Incidence
- Logistic Models
- Male
- Middle Aged
- Odds Ratio
- Retrospective Studies
- Risk Factors
- Time Factors
- Treatment Outcome
- United Kingdom/epidemiology
- Young Adult
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Affiliation(s)
- Abdus Samad Ansari
- Section of Clinical Medicine and Ageing, Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7PX, UK.
| | - Simon de Lusignan
- Section of Clinical Medicine and Ageing, Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7PX, UK
| | - William Hinton
- Section of Clinical Medicine and Ageing, Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7PX, UK
| | - Neil Munro
- Section of Clinical Medicine and Ageing, Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7PX, UK
| | - Andrew McGovern
- Section of Clinical Medicine and Ageing, Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7PX, UK
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15
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Mor A, Dekkers OM, Nielsen JS, Beck-Nielsen H, Sørensen HT, Thomsen RW. Impact of Glycemic Control on Risk of Infections in Patients With Type 2 Diabetes: A Population-Based Cohort Study. Am J Epidemiol 2017; 186:227-236. [PMID: 28459981 DOI: 10.1093/aje/kwx049] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 08/25/2016] [Indexed: 01/04/2023] Open
Abstract
Infections are a major clinical challenge for type 2 diabetes patients, but little is known about the impact of glycemic control. We used Cox regression analyses to examine the association between baseline and time-varying hemoglobin A1c (HbA1c) values and development of community antiinfective-agent-treated and hospital-treated infections in 69,318 patients with type 2 diabetes diagnosed between 2000 and 2012 in Northern Denmark. Incidence rates were 394/1,000 patient-years for community-treated infections and 63/1,000 patient-years for hospital-treated infections. The adjusted hazard ratios for community-treated infection at an HbA1c level of ≥10.50%, as compared with 5.50%-<6.49%, were 0.97 (95% confidence interval (CI): 0.94, 1.00) for HbA1c measured at early baseline, 1.09 (95% CI: 1.03, 1.14) for updated mean HbA1c, 1.13 (95% CI: 1.08, 1.19) for updated time-weighted mean HbA1c, and 1.19 (95% CI: 1.14, 1.26) for the latest updated HbA1c. Corresponding estimates for hospital-treated infections were 1.08 (95% CI: 1.02, 1.14) for early baseline HbA1c, 1.55 (95% CI: 1.42, 1.71) for updated mean HbA1c, 1.58 (95% CI: 1.44, 1.72) for updated time-weighted mean HbA1c, and 1.64 (95% CI: 1.51, 1.79) for the latest updated HbA1c. Our findings provide evidence for an association between current hyperglycemia and infection risk in type 2 diabetes patients.
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16
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Pearson-Stuttard J, Blundell S, Harris T, Cook DG, Critchley J. Diabetes and infection: assessing the association with glycaemic control in population-based studies. Lancet Diabetes Endocrinol 2016; 4:148-58. [PMID: 26656292 DOI: 10.1016/s2213-8587(15)00379-4] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 02/08/2023]
Abstract
Diabetes is a leading cause of morbidity and mortality. The global burden of diabetes is rising because of increased obesity and population ageing. Although preventive and treatment measures are well documented for macrovascular and microvascular complications, little such guidance exists for infections in people with diabetes, despite evidence suggesting greater susceptibility to infections, and worse outcomes. In particular, few studies have characterised the relation between glycaemic control and infectious disease, which we discuss in this Review. Some large population-based observational studies have reported strong associations between higher HbA1c and infection risks for both type 1 and type 2 diabetes. However, studies are contradictory, underpowered, or do not control for confounders. Evidence suggests that better glycaemic control might reduce infection risk, but further longitudinal studies with more frequent measures of HbA1c are needed. Older people (aged 70 years or older) with diabetes are at increased risk of complications, including infectious diseases. There is more uncertainty about appropriate glycaemic control targets in this age group, and evidence suggests that glycaemic control is often neglected. Robust evidence from cohorts with sufficient numbers of older people would help to develop clinically relevant guidelines and targets to reduce mortality, morbidity, and antibiotic use, and to improve quality of life.
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Affiliation(s)
| | | | - Tess Harris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Julia Critchley
- Population Health Research Institute, St George's, University of London, London, UK
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17
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Cummings PL, Kuo T, Javanbakht M, Sorvillo F. Trends, productivity losses, and associated medical conditions among toxoplasmosis deaths in the United States, 2000-2010. Am J Trop Med Hyg 2014; 91:959-64. [PMID: 25200264 PMCID: PMC4228893 DOI: 10.4269/ajtmh.14-0287] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/25/2014] [Indexed: 11/07/2022] Open
Abstract
Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000-2010. A matched case-control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups.
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Affiliation(s)
- Patricia L Cummings
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California; Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California; Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California
| | - Marjan Javanbakht
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California; Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California
| | - Frank Sorvillo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California; Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California
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18
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Mandal SM, Mahata D, Migliolo L, Parekh A, Addy PS, Mandal M, Basak A. Glucose directly promotes antifungal resistance in the fungal pathogen, Candida spp. J Biol Chem 2014; 289:25468-73. [PMID: 25053418 PMCID: PMC4162151 DOI: 10.1074/jbc.c114.571778] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/20/2014] [Indexed: 11/06/2022] Open
Abstract
Effects of glucose on the susceptibility of antifungal agents were investigated against Candida spp. Increasing the concentration of glucose decreased the activity of antifungal agents; voriconazole was the most affected drugs followed by amphotericin B. No significant change has been observed for anidulafungin. Biophysical interactions between antifungal agents with glucose molecules were investigated using isothermal titration calorimetry, Fourier transform infrared, and (1)H NMR. Glucose has a higher affinity to bind with voriconazole by hydrogen bonding and decrease the susceptibility of antifungal agents during chemotherapy. In addition to confirming the results observed in vitro, theoretical docking studies demonstrated that voriconazole presented three important hydrogen bonds and amphotericin B presented two hydrogen bonds that stabilized the glucose. In vivo results also suggest that the physiologically relevant higher glucose level in the bloodstream of diabetes mellitus mice might interact with the available selective agents during antifungal therapy, thus decreasing glucose activity by complex formation. Thus, proper selection of drugs for diabetes mellitus patients is important to control infectious diseases.
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Affiliation(s)
- Santi M Mandal
- From the Department of Chemistry, Central Research Facility, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India, the Department of Microbiology, Vidyasagar University, Midnapore 721102, West Bengal, India
| | - Denial Mahata
- From the Department of Chemistry, Central Research Facility, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Ludovico Migliolo
- the Programa de Pós-Graduação em Biotecnologia, Centro de Pesquisas Bioquímicas e Biofísicas, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil, and
| | - Aditya Parekh
- From the Department of Chemistry, Central Research Facility, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Partha S Addy
- From the Department of Chemistry, Central Research Facility, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Mahitosh Mandal
- From the Department of Chemistry, Central Research Facility, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Amit Basak
- From the Department of Chemistry, Central Research Facility, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India,
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19
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Yeoh LY, Tan FLG, Willis GC, Ooi ST. Methicillin-resistantStaphylococcus aureuscarriage in hospitalized chronic hemodialysis patients and its predisposing factors. Hemodial Int 2013; 18:142-7. [DOI: 10.1111/hdi.12061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lee Ying Yeoh
- Department of Medicine; Khoo Teck Puat Hospital; Singapore
| | | | | | - Say Tat Ooi
- Department of Medicine; Khoo Teck Puat Hospital; Singapore
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20
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Nishio N, Teranishi M, Uchida Y, Sugiura S, Ando F, Shimokata H, Sone M, Otake H, Kato K, Yoshida T, Tagaya M, Hibi T, Nakashima T. Contribution of complement factor H Y402H polymorphism to sudden sensorineural hearing loss risk and possible interaction with diabetes. Gene 2012; 499:226-30. [PMID: 22426290 DOI: 10.1016/j.gene.2012.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 01/14/2012] [Accepted: 02/16/2012] [Indexed: 11/19/2022]
Abstract
Sudden sensorineural hearing loss (SSNHL) is one of the most common diseases encountered by otolaryngologists; however, the etiology is unclear. The aim of this study was to assess the association between SSNHL and polymorphism of complement factor H (CFH) Y402H, which is implicated in age-related macular degeneration. We conducted a case-control study, in which the cases were 72 SSNHL patients and the controls were 2161 residents selected randomly from the resident register. The odds ratio (OR) for SSNHL risk was determined using the additive-genetic model of CFH Y402H polymorphism. The OR for SSNHL risk was 1.788 (95% confidence interval [CI]: 1.008-3.172) with no adjustments and 1.820 (CI: 1.025-3.232) after adjusting for age and sex. Of the three lifestyle-related diseases hypertension, dyslipidemia, and diabetes, only diabetes was significantly associated with SSNHL risk. We classified both the controls and SSNHL patients into those with or without diabetes, and the OR for SSNHL risk was 6.326 (CI: 1.885-21.225) in diabetic subjects and 1.214 (CI: 0.581-2.538) in nondiabetic subjects. We conclude that CFH Y402H polymorphism and SSNHL risk are significantly related, and that diabetic CFH Y402H minor allele carriers may be susceptible to SSNHL.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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21
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Gyurus E, Kaposztas Z, Kahan BD. Sirolimus therapy predisposes to new-onset diabetes mellitus after renal transplantation: a long-term analysis of various treatment regimens. Transplant Proc 2011; 43:1583-92. [PMID: 21693238 DOI: 10.1016/j.transproceed.2011.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE This retrospective analysis evaluated the impacts of sirolimus (SRL), cyclosporine (CsA), and steroids (S) on the occurrence, treatment, and complications of new-onset diabetes after transplantation (NODAT). METHODS We compared 4 groups: group 1, SRL plus full-exposure CsA/S (n = 118); group 2, full-exposure CsA/S/no SRL ± antiproliferative drug (n = 141); group 3, SRL plus reduced CsA exposure/S (n = 212); and group 4, no SRL/full-exposure CsA/S ± antiproliferative drug (n = 43). RESULTS NODAT rates reflected the level of CsA exposure; at 10 years 54% versus 30% for groups 1 versus 2 (P = .0001); at 5 years 30% versus 21% for Groups 3 versus 4 (P = .3); 81% of cases were detected within 1 year. The lower NODAT rate in group 3 reflected a benefit of reduced CsA exposure (P = .02; hazard ratio (HR), 1.006). Group 1 showed higher CsA (P = .0001) and lower SRL concentrations (P = .016) versus group 3. CsA exposure closely correlating with NODAT among group 1 (P = .0001) was the major difference between groups 1 and 3 (P = .04; HR, 0.97). Differences in steroid treatment did not play a significant role in NODAT. Comparing groups 1 and 2, SRL was an independent risk factor for NODAT (P = .004; HR, 3.5). CONCLUSIONS Our 10-year experience revealed SRL to be an etiologic agent for NODAT, displaying interactive, possibly pharmacokinetic, and pharmacodynamic effects with concomitant CsA in combination treatment.
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Affiliation(s)
- E Gyurus
- Division of Immunology and Organ Transplantation, University of Texas Medical School, Houston, Texas 77030, USA
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22
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Hakim GD, Kızıltaş S, Ciftçi H, Göktaş S, Tuncer I. The prevalence of giardia intestinalis in dyspeptic and diabetic patients. ISRN GASTROENTEROLOGY 2011; 2011:580793. [PMID: 21991517 PMCID: PMC3168463 DOI: 10.5402/2011/580793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 06/09/2011] [Indexed: 12/02/2022]
Abstract
Background and Aims. We aimed to investigate the prevalence of Giardiasis in patients with dyspepsia and patients with diabetes mellitus. Methods. 400 patients and 100 healthy persons were included in this clinical prospective study. The number of patients in each group was equal, 200 dyspeptic and 200 diabetic, respectively. The antigen of G. lntestinalis was determined in the stool specimens by ELISA method. Results. The frequency of Giardiasis was 7% in dyspeptic and 15% in diabetic patients. There was no positive results in any of the healthy persons. There was a significant difference in prevalence rate of Giardiasis between patients with dyspepsia and diabetes mellitus (P < 0.05). Conclusions. These results revealed that the prevalence of Giardiasis in dyspepsia and with diabetes mellitus was high in our country. This is the first study investigating the prevalence of Giardiasis in diabetic patients. To investigate Giardiasis in diabetic patients, who have dyspepsia or not, may be a good approach for public health.
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Affiliation(s)
- Gözde Derviş Hakim
- Department of Internal Medicine, Göztepe Training and Research Hospital, Health Ministry, 34862 Istanbul, Turkey
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23
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Hutchinson MS, Figenschau Y, Njølstad I, Schirmer H, Jorde R. Serum 25-hydroxyvitamin D levels are inversely associated with glycated haemoglobin (HbA1c). The Tromsø Study. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 71:399-406. [DOI: 10.3109/00365513.2011.575235] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Yngve Figenschau
- Department of Medical Biochemistry, University Hospital of North Norway, Tromsø and Institute of Medical Biology, University of Tromsø
| | | | - Henrik Schirmer
- Institute of Clinical Medicine, University of Tromsø
- Department of Cardiology, University Hospital of North Norway,
Tromsø
| | - Rolf Jorde
- Institute of Clinical Medicine, University of Tromsø
- Medical Clinic, University Hospital of North Norway,
Tromsø, Norway
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24
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Incidence and predictors of 30-day readmission among patients hospitalized for advanced liver disease. Clin Gastroenterol Hepatol 2011; 9:254-9. [PMID: 21092762 PMCID: PMC3156473 DOI: 10.1016/j.cgh.2010.10.035] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 10/20/2010] [Accepted: 10/23/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The rate of readmission to the hospital 30 days after discharge (30-day readmission rate) is used as a quality measure for hospitalized patients, but it has not been studied adequately for patients with advanced liver disease. We investigated the incidence and factors that predict this rate and its relationship with mortality at 90 days. METHODS We analyzed data from patients with advanced liver disease who were hospitalized to an inpatient hepatology service at 2 large academic medical centers in 2008. Patients with elective admission and recipients of liver transplants were not included. During the study period, there were 447 patients and a total of 554 eligible admissions. Multivariate analyses were performed to identify variables associated with 30-day readmission and to examine its relationship with mortality at 90 days. RESULTS The 30-day readmission rate was 20%. After adjusting for multiple covariates, readmission within 30 days was associated independently with model for end-stage liver disease scores at discharge (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.09; P = .002), the presence of diabetes (OR, 1.78; 95% CI, 1.07-2.95; P = .027), and male sex (OR, 1.73; 95% CI, 1.03-2.89; P = .038). After adjusting for age, sex, and model for end-stage liver disease score at discharge, the 90-day mortality rate was significantly higher among patients who were readmitted to the hospital within 30 days than those who were not (26.8% vs 9.8%; OR, 2.6; 95% CI, 1.36-5.02; P = .004). CONCLUSIONS Patients with advanced liver disease frequently are readmitted to the hospital within 30 days after discharge; these patients have a higher 90-day mortality rate than those who are not readmitted in 30 days. These data might be used to develop strategies to reduce early readmission of hospitalized patients with cirrhosis.
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25
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Alexander M, Krishnan B, Shenoy N. Diabetes mellitus and odontogenic infections--an exaggerated risk? Oral Maxillofac Surg 2008; 12:129-130. [PMID: 18575903 DOI: 10.1007/s10006-008-0118-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The diabetic host is considered to be at an increased risk for the development of odontogenic infections due to his medically compromised state. This perceived risk of higher infections often results in dentists delaying much-needed surgical treatment in this patient population. DISCUSSION A critical examination of literature does not seem to support the role of diabetes mellitus as a definitive risk factor for odontogenic infections. A simplistic extrapolation of infection rates observed in other sites may not be justified in the orofacial region.
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Affiliation(s)
- Mohan Alexander
- 41, Hutchins Road, 2nd Cross, Cooke Town, Bangalore, 560084, Karnataka, India.
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26
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Venmans LMAJ, Sloof M, Hak E, Gorter KJ, Rutten GEHM. Prediction of complicated urinary tract infections in patients with type 2 diabetes: a questionnaire study in primary care. Eur J Epidemiol 2007; 22:49-54. [PMID: 17203360 DOI: 10.1007/s10654-006-9077-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 11/03/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Relatively few data are available to predict a complicated course of community-acquired complicated urinary tract infections (UTIs) in patients with diabetes type 2 (DM2). The aim of this study was to assess predictors for a complicated course of UTIs in DM2 patients in primary care. METHOD We conducted a cross-sectional questionnaire study among DM2 patients aged over 45 years as part of an educational trial. The combined outcome measure was a complicated course of UTI, defined as a self-reported episode of acute pyelonephritis, prostatitis or recurrent cystitis in the 12 months before the trial. Patients with an outcome were all verified by review of medical records. A prediction model was derived with multivariable logistic regression analysis. RESULTS Of the 1151 trial participants, 94 (8%) had a self-reported community-acquired complicated course of UTIs and 62 (66%) of these were medically-attended. Independent predictors for a complicated course were age above 60 years (adjusted odds ratio (OR): 1.74; 95% confidence interval (CI): 0.99-3.03), chronic use of antibiotics (adjusted OR: 5.50; 95% CI: 2.31-13.08), more than 6 physician contacts in previous year (adjusted OR: 3.60; 95% CI: 2.00-6.49), hospitalization in previous year (adjusted OR: 1.36; 95% CI: 1.00-1.85), renal disease (adjusted OR: 4.92; 95% CI: 1.59-15.18) and incontinence of urine (adjusted OR: 3.78; 95% CI: 1.93-7.38). Area under the receiver-operating curve was 0.72 (95% CI: 0.66-0.78). Analysis according to medically attended complicated UTIs did not change our findings. CONCLUSION Easily obtainable predictors from medical history can be used to accurately predict a complicated course of UTIs in DM2 patients.
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Affiliation(s)
- Leonie M A J Venmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. 85500, 3508 6A Utrecht, The Netherlands.
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Wu JT, Wu LL. Linking inflammation and atherogenesis: Soluble markers identified for the detection of risk factors and for early risk assessment. Clin Chim Acta 2006; 366:74-80. [PMID: 16343470 DOI: 10.1016/j.cca.2005.10.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 10/14/2005] [Indexed: 01/22/2023]
Abstract
Increasing evidence has shown that atherogenesis is not only caused by hypercholesterolemia. Several risk factors including abdominal obesity, dyslipidemia, hyperglycemia, bacterial and viral infection, hyperhomocysteinemia have been identified recently, all mediated through inflammation, which can lead to atherosclerosis. Several events have also been identified to be involved in the overall inflammation reaction in the blood vessel which include endothelium dysfunction, expression of adhesion molecules, recruitment of leukocytes to the injured endothelium, migration of monocytes to the arterial intima, and transformation of monocytes to macrophages. In order to facilitate the assessment of early risk for atherogenesis we have made an effort in this review to identify soluble markers that will allow the detection of these risk factors and the identification of associated inflammation events. Since early risks for atherogenesis are largely preventable with dietary modification and lifestyle changes, capable of detecting early risks by monitoring soluble risk markers is conceivably important for asymptomatic individuals to avoid serious or fatal consequences of atherosclerosis. These soluble markers should also be useful for monitoring the effectiveness of intervention and for the identification of therapeutic targets.
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Affiliation(s)
- James T Wu
- ARUP Laboratories and Cardiovascular Genetics, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah 84108, USA.
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Yumuk Z, Küçükbasmaci O, Büyükbaba Boral O, Küçüker Anğ M, Dundar V. The effects of streptozotocin-induced diabetes on brucellosis of rats. ACTA ACUST UNITED AC 2003; 39:275-8. [PMID: 14642313 DOI: 10.1016/s0928-8244(03)00257-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It is believed that an infection is more common and runs a more protracted course in people with diabetes. In clinical practice, it is important to be aware of these associations, as the prognosis is often dependent upon prompt recognition and appropriate treatment. To show the course of brucellosis in the diabetic state, a model of Brucella melitensis infection was used in the setting of streptozotocin-induced diabetes in rat. B. melitensis infection proceeded more severely in diabetic rats and the severity of diabetes affected the prognosis. However, no association was found between B. melitensis and insulin using in vitro and in vivo experiments. Our study illustrates that B. melitensis infection in diabetes should be taken seriously.
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Affiliation(s)
- Zeki Yumuk
- Department of Microbiology and Clinical Microbiology, Kocaeli University, Faculty of Medicine, 41900 Kocaeli, Turkey.
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Wu HC, Chang CH, Lai MM, Lin CC, Lee CC, Kao A. Using Tc-99m DMSA renal cortex scan to detect renal damage in women with type 2 diabetes. J Diabetes Complications 2003; 17:297-300. [PMID: 12954160 DOI: 10.1016/s1056-8727(02)00222-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Women with diabetes mellitus (DM) have urinary tract infection (UTI) more often than women without DM. It is unknown, however, what the prevalence and type of renal damage due to UTI is in these women. Therefore, in this study, we compared type 2 DM women with or without UTI history for the prevalence and type of renal damage by technetium-99m dimercapto-succinic acid (Tc-99m DMSA) renal scan. A total of 128 type 2 DM women with or without UTI history received Tc-99m DMSA renal scan were included in this study. The patients were separated into three groups: (1) 43 patients without UTI history, (2) 42 patients with only lower UTI (cystitis) history and (3) 43 patients with upper UTI (pyelonephritis) history. The renal scan findings were separated into three types: (A) normal, (B) inflammation and (C) scar. The 31.9% (50/128) of type 2 DM patients had renal damages. Group 1 patients had a significantly lower prevalence of renal damages including inflammation and scar as compared to Groups 2 and 3 patients. In addition, the prevalence of renal damage was significantly higher in Group 3 than in Group 2 patients. Renal scars only were visualized in Group 3 patients. However, other clinical data were not statistically different among the three group patients. Type 2 DM women with UTI history, especially if they had upper UTI have a significantly higher prevalence of renal damage than in those without UTI.
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Affiliation(s)
- Hsi-Chin Wu
- Department of Urology, China Medical College Hospital, Taichung, Taiwan.
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Chang CH, Shiau YC, Lin CC, Kao CH, Hsu CH. Using Tc-99m DMSA renal scan to detect renal damage in Taiwanese women with Type 2 diabetes--a preliminary report. Endocr Res 2003; 29:1-7. [PMID: 12665313 DOI: 10.1081/erc-120018671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED In this preliminary study, we compared control women and Type 2 diabetes mellitus (DM) women for the prevalence and type of renal damage as revealed by technetium-99m dimercapto-succinic acid (Tc-99m DMSA) renal scan. METHODS A total of 20 control women and 60 women with Type 2 DM received Tc-99m DMSA renal scan were included in this study. The 60 women with Type 2 DM were separated into three groups: 20 women without UTI history, 20 patients with cystitis histories only, and 20 with pyelonephritis histories. RESULTS All of the control women had normal Tc-99m DMSA renal scan findings. However, 38.3% of Type 2 DM wonmen had abnormal Tc-99m DMSA renal scan findings. Type 2 DM women without UTI history had no abnormal scan findings. The prevalence of abnormal renal scan findings was significantly higher in Type 2 DM women with pyelonephritis (90.0%) than with cystitis alone (25.0%). Renal scar findings were found only in Type 2 DM women with pyelonephritis (40.0%). CONCLUSIONS Compared with control women, women with Type 2 DM, especially if they had UTI and pyelonephritis histories, have a significantly higher prevalence of abnormal Tc-99m DMSA renal scan findings.
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Affiliation(s)
- Chao-Hsiang Chang
- Department of Urology, China Medical College Hospital, Taichung, Taiwan
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Wu HC, Huang WS, Lin CC, Lee CC, Kao A, Huang WS. Objective evidence of a high prevalence of renal damage in women with type 2 diabetes by technetium-99m DMSA renal cortex scan findings. Urology 2003; 61:50-4. [PMID: 12559263 DOI: 10.1016/s0090-4295(02)02111-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To compare control women with men and women with type 2 diabetes mellitus (DM) for the prevalence and type of renal damage due to urinary tract infections (UTIs) using technetium-99m dimercapto-succinic acid (99mTc DMSA) renal scanning. Women with DM have UTIs more often than do women without DM. It is unknown, however, what the prevalence and type of renal damage due to UTI are in these women. METHODS Three groups of patients: 28 control women without type 2 DM and a history of UTIs, 25 male patients with type 2 DM but without a history of UTIs, and 103 female patients with type 2 DM underwent 99mTc DMSA renal scan. The 103 women with type 2 DM were separated into three groups: 36 women without a history of UTIs, 34 patients with a history of cystitis only, and 33 with a history of pyelonephritis. RESULTS All the control women and male patients with type 2 DM without a history of UTIs had normal 99mTc DMSA renal scan findings. However, 39.8% of women with type 2 DM had abnormal 99mTc DMSA renal scan findings. Women with type 2 DM without a history of UTI had a significantly lower prevalence of abnormal renal scan findings than did those with a history of cystitis only or pyelonephritis. In addition, the prevalence of abnormal renal scan findings was significantly higher in women with type 2 DM with pyelonephritis than in those with a history of cystitis only. Renal scars on 99mTc DMSA renal scans were found in women with type 2 DM and a history of pyelonephritis. CONCLUSIONS Compared with control women and men with type 2 DM, women with type 2 DM, especially if they had a history of UTIs, had a significantly higher prevalence of abnormal 99mTc DMSA renal scan findings.
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Affiliation(s)
- Hsi-Chin Wu
- Department of Urology, China Medical College Hospital, Taichung, Taiwan
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Goswami R, Bal CS, Tejaswi S, Punjabi GV, Kapil A, Kochupillai N. Prevalence of urinary tract infection and renal scars in patients with diabetes mellitus. Diabetes Res Clin Pract 2001; 53:181-6. [PMID: 11483234 DOI: 10.1016/s0168-8227(01)00255-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In a case control study, we assessed the prevalence of bacterial urinary tract infections (UTI) and renal scarring in 155 consecutive type 1 (n=102) and type 2 (n=53) diabetic individuals and 128 healthy controls. Subjects who received antibiotics during the past 6 months, pregnant women and those with overt renal failure were excluded. In all subjects, urine culture and 99m Technetium (Tc) dimercapto-succinic acid renal scan was performed. UTI was diagnosed if two consecutive urine cultures grew the same organism with at least 10(5) colony forming unit (cfu)/ml in asymptomatic and at least 10(4) cfu/ml in symptomatic subjects, respectively. Renal scan was considered abnormal if focal or multiple tracer uptake defects and/or break in cortical outline were observed. The prevalence of UTI in diabetes mellitus was higher, when compared to that in controls (9% vs. 0.78%, P=0.005). Escherichia coli was the most commonly grown organism (64.3%), followed by Staphyloccocus aureus (21.4%) and Klebsiella pneumoniae (14.3%). Prevalence of renal scarring was higher in patients with diabetes (28/155, 18.0%), when compared to that of controls (7/128, 5.4%, P=0.002). Fifty percent of patients with diabetes and UTI had renal scarring. The prevalence in diabetics with no UTI was also higher, when compared to controls (14.8 vs. 5.5%, P<0.01). The prevalence of UTI as well as renal scarring was significantly higher in females, when compared to male diabetics. No significant difference in vascular events, hypertension, proteinuria, renal function tests and HbA1 was observed in patients with and without renal scar. Thus, patients with diabetes mellitus have 10- and 3-folds increased risk of UTI and renal scarring, respectively. The results could help prioritize protocols for management of UTI among patients with diabetes mellitus.
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Affiliation(s)
- R Goswami
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110 029, India
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