Impact of continued high blood pressure on the progression of diabetic nephropathy after 10 years: KAMOGAWA-HBP study

Poor Glycemic Control and Its Predictors Among Type 2 Diabetes Patients: Insights From a Single-Centre Retrospective Study in Ghana

Background and Aims

The primary objective of glycemic control in individuals with diabetes mellitus is to avert or postpone complications, which ultimately leads to an improved quality of life. Nonetheless, achieving the recommended targets for glycemic control in clinical settings often proves challenging. Consequently, it is crucial to ascertain factors that affect glycemic outcomes to enhance the management of diabetes mellitus. This study sought to evaluate the levels of glycemic control and the associated factors among patients with type 2 diabetes receiving care at the Methodist Hospital, Wenchi, Ghana.

Methods

A retrospective study was conducted using an existing database. Glycemic control was evaluated by HbA1c measurements with a target of < 7% indicating good control, as per the guidelines established by the American Diabetes Association for nonpregnant adults. HbA1c levels ≥ 7% were classified as poor control. Data analysis was conducted using SPSS version 25 and multivariate logistic regression analysis was employed to determine the factors affecting glycemic control.

Results

The median HbA1c level among the participants was 7.9% (IQR: 5.8-9.9). Majority (59.3%) demonstrated poor glycemic control with HbA1c ≥ 7%. Factors associated with poor glycemic control included advanced age (AOR: 4.32, 95% CI: 0.61-11.21, p = 0.012), duration of diabetes mellitus > 10 years (AOR: 3.60, 95% CI: 1.05-9.82, p = 0.019), insulin therapy (AOR: 3.13, 95% CI: 0.55-11.01, p = 0.009) and hypertension diagnosis (AOR: 2.88, 95% CI: 0.75-5.45, p = 0.030).

Conclusions

The study indicated that a considerable proportion of individuals with diabetes exhibited inadequate glycemic control. Older age, longer duration of diabetes mellitus, insulin therapy and comorbid hypertension were significantly associated with poor glycemic control among the study population. Multidisciplinary interventions as well as customized management strategies are required to ensure effective glycemic control to prevent long-term complications of diabetes mellitus.

The role of advanced glycation end products between thyroid function and diabetic nephropathy and metabolic disorders

purpose of this study was to investigate the relationship between AGEs, TSH, metabolic metrics and DN, and to provide evidence for future intervention.

METHOD

This study selected community health service centers which had signed medical alliance agreement with the First Affiliated Hospital of Anhui Medical University and outpatints and inpatients in Anhui province. From March 2018 to July 2022, the multi-stage cluster sampling. method was used to screen residents aged 18-90 years in the above areas. Participants' blood was collected on an empty stomach to detect TSH, blood lipids, liver and kidney function and blood glucose, in addition, AGEs levels were detected by skin autofluorescence (SAF), and urine was retained to measure the ratio of urinary microalbumin to creatinine concentration by ACR. One-way ANOVA was used to compare the differences between general data, biochemical markers, and urinary ACR, association between variables.

RESULT

A total of 7000 patients who participated in community health examination and inpatients and also had no history of serious mental disorders were selected. After excluding data with missing value of more than 5%, 6921 samples were finally included, and the effective rate was 94.4%. Following health risk factors (HRFs), such as body mass index (BMI), TSH, low-density lipoprotein (LDL), TyG (triglyceride glucose index), systolic blood pressure (SBP), cholesterol (TC), and uric acid (UA) were associated with a higher incidence of urine ACR. In moderation analysis, there is an significant effect among TSH, AGEs and DN, HRFs moderate also these effect.

CONCLUSION

The findings suggest that HRFs such as HDL, TyG and TC should be prioritized when evaluating indicators related to DN to effectively reduce DN in Chinese patients with high health risk levels. Comprehensive indicators may be an effective and practical. method to evaluate the metabolic progression of DN. Optimizing thyroid function management may be a new strategy to prevent and treat DN and may help reduce the risk of AGE-related complications in people with diabetes. This study highlights the important role of AGEs in the relationship between TSH and DN. In addition, future studies should further explore how to improve the management and prevention of DN by regulating TSH.Among the leading causes of disability and death in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes (T2DM), chronic kidney disease (CKD) occupies a certain position. Multi-factor intervention targeting advanced glycation end products (AGEs), blood glucose, blood pressure and lipids can reduce the morbidity and mortality of diabetic nephropathy (DN) in T2DM patients through thyroid stimulating hormone (TSH), which plays an important role in the pathological process of metabolic diseases such as DN. AGEs, as a key factor in metabolic regulation, may affect the formation and function of the thyroid gland; However, in DN, the correlation between AGEs and TSH has not been clarified. We hypothesized that AGEs aggravated the negative effect of TSH on DN. The.

Visit-to-visit variability of blood pressure and risk of diabetic retinopathy: a systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM), a worldwide disease affecting more than 400 million people, is associated with high blood pressure (BP). In addition to macrovascular complications, high BP in DM patients is potentially linked to microvascular complications. More than 70% of DM patients have retinopathy. To our knowledge, no systematic review and meta-analysis has been conducted on the relationship between visit-to-visit variability in blood pressure and diabetic retinopathy risk.

METHODS

This systematic review and meta-analysis study was performed on the related articles. The search strategy, screening, and data selection were all checklist-based. A comprehensive search was done in three databases, including PubMed, Google Scholar, and Scopus. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed. English clinical studies published up to January 2023 contained diabetic patients as the population, retinopathy as the outcome, and visit-to-visit blood pressure as the intervention. Using the QUIPS technique, two authors independently quantify the risk of bias in included publications. The meta-analysis was conducted using R version 4.4.1. We calculated relative risk (RR) as the effect size, applying the random effect model. Standard deviation (SD) and coefficient of variation (CV), were used as measures of BP variability.

RESULTS

A total number of 8 studies with 743,315 participants were covered in this systematic review. After meta-analysis, we concluded that the group with higher SD of BP variability had 2 percent higher risk than the control group (RR = 1.02, 95% CI = 1.01-1.03, I-squared = 41%); however, results of our analysis for CV of BP variability showed no significant contrast with control group thus no increased risk was reported (RR = 1.04, 95% CI = 0.94-1.15, I-squared = 32%, P-value = 0.23).

CONCLUSION

In conclusion, an increased SD of BP variability significantly increased the relative risk for the development of retinopathy.

Factors influencing the efficacy and safety of esaxerenone in hypertensive patients: a pooled analysis of five clinical studies on different comorbidities

This study aimed to identify factors associated with a strong home blood pressure (BP)-lowering effect of esaxerenone and the incidence of elevated serum potassium levels in hypertensive patients treated with esaxerenone. A pooled analysis of five multicenter, prospective, open-label single-arm studies was conducted, including 479 patients in the full analysis set (FAS) and 492 patients in the safety analysis set. Multivariate linear regression analysis of morning home systolic BP (SBP) and diastolic BP (DBP) changes from baseline to Week 12 in the FAS (primary endpoint) showed that male sex (estimated change 4.37 mmHg), office pulse rate ≥100 beats/min (25.10 mmHg), and calcium channel blocker (CCB) use as a basal antihypertensive agent (4.53 mmHg) were significantly associated with a positive estimated change (weaker BP-lowering effect) in morning home SBP. CCB use (3.70 mmHg) was associated with a positive estimated change in morning home DBP. Urine albumin-to-creatinine ratio 30 to <300 mg/gCr (-4.13 mmHg) was significantly associated with a negative estimated change (stronger BP-lowering effect) in morning home SBP. Based on multivariate logistic regression analysis, elevated baseline serum potassium level (≥4.5 vs < 4.5 mEq/L, odds ratio 13.502) was significantly associated with a high incidence of serum potassium level ≥5.5 mEq/L after esaxerenone treatment. In conclusion, factors associated with a strong BP-lowering effect of esaxerenone were female sex and use of renin-angiotensin system inhibitors as a basal antihypertensive drug. Patients with baseline serum potassium levels ≥4.5 mEq/L had an increased risk of developing elevated serum potassium levels (≥5.5 mEq/L) after esaxerenone treatment.

Evaluation of health factors on artificial intelligence and the internet of things-based older adults healthcare programmes

Objective

This study evaluates Artificial intelligence and the Internet of Things-based older adults' healthcare programmes (AI·IoT-OAHPs), which offer non-face-to-face and face-to-face health management to older adults for health promotion.

Methods

The study involved 146 participants, adults over 60 who had registered in AI·IoT-OAHPs. This study assessed the health factors as the outcome of pre- and post-health screening and health management through AI·IoT-OAHPs for six months.

Results

Preand post-health screening and management through AI·IoT-OAHPs were evaluated as significant outcomes in 14 health factors. Notably, the benefits of post-cognitive function showed a twofold increase in older female adults through AI·IoT-OAHPs. Adults over 70 showed a fourfold increase in post-walking days, a threefold in post-dietary practice, and a twofold in post-cognitive function in the post-effects compared with pre via AI·IoT-OAHPs.

Conclusions

AI·IoT-OAHPs seem to be an effective program in the realm of face-to-face and non-face-to-face AI·IoT-based older adults' healthcare initiatives in the era of COVID-19. Consequently, the study suggests that AI·IoT-OAHPs contribute to the upgrade in health promotion of older adults. In future studies, the effectiveness of AI·IoT-OAHPs can be evaluated as a continuous project every year in the short term and every two years in the long term.