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Mohammedi K, Fauchier L, Quignot N, Khachatryan A, Banon T, Kapnang R, Kikuchi K, Ren H, Massien C, Vigié L, Larsen S, Sibon I. Incidence of stroke, subsequent clinical outcomes and health care resource utilization in people with type 2 diabetes: a real-world database study in France: "INSIST" study. Cardiovasc Diabetol 2024; 23:183. [PMID: 38812009 DOI: 10.1186/s12933-024-02257-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND People with type 2 diabetes (T2D) are at elevated risk of cardiovascular disease (CVD) including stroke, yet existing real-world evidence (RWE) on the clinical and economic burden of stroke in this population is limited. The aim of this cohort study was to evaluate the clinical and economic burden of stroke among people with T2D in France. METHODS We conducted a retrospective RWE study using data from the nationally representative subset of the French Système National des Données de Santé (SNDS) database. We assessed the incidence of stroke requiring hospitalization between 2012 and 2018 among T2D patients. Subsequent clinical outcomes including CVD, stroke recurrence, and mortality were estimated overall and according to stroke subtype (ischemic versus hemorrhagic). We also examined the treatment patterns for glucose-lowering agents and CVD agents, health care resource utilization and medical costs. RESULTS Among 45,331 people with T2D without baseline history of stroke, 2090 (4.6%) had an incident stroke requiring hospitalization. The incidence of ischemic stroke per 1000 person-years was 4.9-times higher than hemorrhagic stroke (6.80 [95% confidence interval (CI) 6.47-7.15] versus 1.38 [1.24-1.54]). During a median follow-up of 2.4 years (interquartile range 0.6; 4.4) from date of index stroke, the rate of CVD, stroke recurrence and mortality per 1000 person-years was higher among hemorrhagic stroke patients than ischemic stroke patients (CVD 130.9 [107.7-159.0] versus 126.4 [117.2-136.4]; stroke recurrence: 86.7 [66.4-113.4] versus 66.5 [59.2-74.6]; mortality 291.5 [259.1-327.9] versus 144.1 [134.3-154.6]). These differences were not statistically significant, except for mortality (adjusted hazard ratio 1.95 [95% CI 1.66-2.92]). The proportion of patients prescribed glucagon-like peptide-1 receptor agonists increased from 4.2% at baseline to 6.6% during follow-up. The proportion of patients prescribed antihypertensives and statins only increased slightly following incident stroke (antihypertensives: 70.9% pre-stroke versus 76.7% post-stroke; statins: 24.1% pre-stroke versus 30.0% post-stroke). Overall, 68.8% of patients had a subsequent hospitalization. Median total medical costs were €12,199 (6846; 22,378). CONCLUSIONS The high burden of stroke among people with T2D, along with the low proportion of patients receiving recommended treatments as per clinical guidelines, necessitates a strengthened and multidisciplinary approach to the CVD prevention and management in people with T2D.
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Affiliation(s)
- Kamel Mohammedi
- INSERM Unit 1034, Biology of Cardiovascular Diseases, Bordeaux University Hospital, 33000, Bordeaux, France.
- Department of Endocrinology, Diabetes, and Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, PESSAC CEDEX, France.
| | - Laurent Fauchier
- Cardiology Department, Trousseau University Hospital, Tours, University of Tours, Tours, France
| | | | | | - Tamar Banon
- Evidence & Access, Certara Canada, Montreal, QC, Canada
| | | | | | - Hongye Ren
- Novo Nordisk Denmark A/S, Copenhagen, Denmark
| | | | | | - Sara Larsen
- Novo Nordisk Denmark A/S, Copenhagen, Denmark
| | - Igor Sibon
- Stroke Unit, Bordeaux University Hospital, Bordeaux, France
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Hurwitz SJ, De R, LeCher JC, Downs-Bowen JA, Goh SL, Zandi K, McBrayer T, Amblard F, Patel D, Kohler JJ, Bhasin M, Dobosh BS, Sukhatme V, Tirouvanziam RM, Schinazi RF. Why Certain Repurposed Drugs Are Unlikely to Be Effective Antivirals to Treat SARS-CoV-2 Infections. Viruses 2024; 16:651. [PMID: 38675992 PMCID: PMC11053489 DOI: 10.3390/v16040651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Most repurposed drugs have proved ineffective for treating COVID-19. We evaluated median effective and toxic concentrations (EC50, CC50) of 49 drugs, mostly from previous clinical trials, in Vero cells. Ratios of reported unbound peak plasma concentrations, (Cmax)/EC50, were used to predict the potential in vivo efficacy. The 20 drugs with the highest ratios were retested in human Calu-3 and Caco-2 cells, and their CC50 was determined in an expanded panel of cell lines. Many of the 20 drugs with the highest ratios were inactive in human Calu-3 and Caco-2 cells. Antivirals effective in controlled clinical trials had unbound Cmax/EC50 ≥ 6.8 in Calu-3 or Caco-2 cells. EC50 of nucleoside analogs were cell dependent. This approach and earlier availability of more relevant cultures could have reduced the number of unwarranted clinical trials.
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Affiliation(s)
- Selwyn J. Hurwitz
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Ramyani De
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Julia C. LeCher
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Jessica A. Downs-Bowen
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Shu Ling Goh
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Keivan Zandi
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Tamara McBrayer
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Franck Amblard
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Dharmeshkumar Patel
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - James J. Kohler
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Manoj Bhasin
- Center for Cystic Fibrosis & Airways Disease Research, Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis and Sleep, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA; (M.B.); (B.S.D.); (R.M.T.)
| | - Brian S. Dobosh
- Center for Cystic Fibrosis & Airways Disease Research, Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis and Sleep, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA; (M.B.); (B.S.D.); (R.M.T.)
| | - Vikas Sukhatme
- Morningside Center for Innovative and Affordable Medicine, Departments of Medicine and Hematology and Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Rabindra M. Tirouvanziam
- Center for Cystic Fibrosis & Airways Disease Research, Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis and Sleep, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA; (M.B.); (B.S.D.); (R.M.T.)
| | - Raymond F. Schinazi
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
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Susanti I, Pratiwi R, Rosandi Y, Hasanah AN. Separation Methods of Phenolic Compounds from Plant Extract as Antioxidant Agents Candidate. PLANTS (BASEL, SWITZERLAND) 2024; 13:965. [PMID: 38611494 PMCID: PMC11013868 DOI: 10.3390/plants13070965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024]
Abstract
In recent years, discovering new drug candidates has become a top priority in research. Natural products have proven to be a promising source for such discoveries as many researchers have successfully isolated bioactive compounds with various activities that show potential as drug candidates. Among these compounds, phenolic compounds have been frequently isolated due to their many biological activities, including their role as antioxidants, making them candidates for treating diseases related to oxidative stress. The isolation method is essential, and researchers have sought to find effective procedures that maximize the purity and yield of bioactive compounds. This review aims to provide information on the isolation or separation methods for phenolic compounds with antioxidant activities using column chromatography, medium-pressure liquid chromatography, high-performance liquid chromatography, counter-current chromatography, hydrophilic interaction chromatography, supercritical fluid chromatography, molecularly imprinted technologies, and high-performance thin layer chromatography. For isolation or purification, the molecularly imprinted technologies represent a more accessible and more efficient procedure because they can be applied directly to the extract to reduce the complicated isolation process. However, it still requires further development and refinement.
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Affiliation(s)
- Ike Susanti
- Pharmaceutical Analysis and Medicinal Chemistry Department, Faculty of Pharmacy, Universitas Padjadjaran, Jl Raya Bandung Sumedang KM 21 r, Sumedang 45363, Indonesia
| | - Rimadani Pratiwi
- Pharmaceutical Analysis and Medicinal Chemistry Department, Faculty of Pharmacy, Universitas Padjadjaran, Jl Raya Bandung Sumedang KM 21 r, Sumedang 45363, Indonesia
| | - Yudi Rosandi
- Faculty of Mathematics and Natural Sciences, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Sumedang 45363, Indonesia
| | - Aliya Nur Hasanah
- Pharmaceutical Analysis and Medicinal Chemistry Department, Faculty of Pharmacy, Universitas Padjadjaran, Jl Raya Bandung Sumedang KM 21 r, Sumedang 45363, Indonesia
- Drug Development Study Center, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Sumedang 45363, Indonesia
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Wu X, Qiu W, Yang H, Chen YJ, Liu J, Zhao G. Associations of the triglyceride-glucose index and atherogenic index of plasma with the severity of new-onset coronary artery disease in different glucose metabolic states. Cardiovasc Diabetol 2024; 23:76. [PMID: 38378553 PMCID: PMC10880297 DOI: 10.1186/s12933-024-02163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index is considered a dependable biomarker for gauging insulin resistance. The atherogenic index of plasma (AIP) represents a marker reflecting atherosclerosis. However, there is currently no study specifically exploring the associations of these two biomarkers with the severity of new-onset coronary artery disease (CAD) under different glucose metabolic states. Therefore, this study aims to evaluate the correlations of these two biomarkers with CAD severity in patients newly diagnosed with CAD under various glucose metabolism conditions. METHOD Totally 570 subjects first administered coronary angiography were enrolled, including 431 first diagnosed CAD patients and 139 non-CAD patients. CAD severity was gauged by the quantity of narrowed arteries (single-vessel and multi-vessel CAD). According to WHO diabetes guidelines, glucose metabolic states were divided into normal glucose regulation (NGR), pre-diabetes mellitus (Pre-DM), and diabetes mellitus (DM). The relationships of the TyG index and AIP with CAD severity were validated by logistic regression analysis, including adjustment for traditional cardiovascular risk elements and medical treatments. Their predictive efficacy for CAD was evaluated by receiver operating characteristic (ROC) curves. RESULT The TyG index and AIP were independently correlated with CAD in accordance with logistic regression analysis (both P < 0.05). Regardless of the glucose metabolic states, there was no statistical correlation between the TyG index and CAD severity. However, AIP in NGR patients was significantly related to CAD severity (P < 0.05). The areas under the curve of the TyG index and AIP for predicting CAD were 0.682 and 0.642 (both P < 0.001), respectively, and their optimal cut-off values were 3.210 (Youden index: 0.305) and 0.095 (Youden index:0.246), respectively. CONCLUSION The TyG index and AIP have significant associations with CAD. The TyG index had no association with CAD severity, regardless of glucose metabolic states. AIP exhibited a discernible link with CAD severity in NGR patients, but not in the pre-DM or DM populations. The TyG index and AIP have similar predictive values for new-onset CAD.
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Affiliation(s)
- Xiaosheng Wu
- Affiliated Qingyuan Hospital, Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, Guangdong, China
- Guangzhou Medical University, Guangzhou, China
| | - Weiping Qiu
- Affiliated Qingyuan Hospital, Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, Guangdong, China
| | - Huancheng Yang
- Department of Radiology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen, 518000, China
- Shantou University Medical College, Shantou University, Shantou, 515000, China
| | - Yan-Jun Chen
- Department of Pathology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Jianling Liu
- Affiliated Qingyuan Hospital, Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, Guangdong, China.
| | - Guojun Zhao
- Affiliated Qingyuan Hospital, Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, Guangdong, China.
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Stampouloglou PK, Anastasiou A, Bletsa E, Lygkoni S, Chouzouri F, Xenou M, Katsarou O, Theofilis P, Zisimos K, Tousoulis D, Vavuranakis M, Siasos G, Oikonomou E. Diabetes Mellitus in Acute Coronary Syndrome. Life (Basel) 2023; 13:2226. [PMID: 38004366 PMCID: PMC10671950 DOI: 10.3390/life13112226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The global prevalence of diabetes mellitus (DM) has led to a pandemic, with significant microvascular and macrovascular complications including coronary artery disease (CAD), which worsen clinical outcomes and cardiovascular prognosis. Patients with both acute coronary syndrome (ACS) and DM have worse prognosis and several pathophysiologic mechanisms have been implicated including, insulin resistance, hyperglycemia, endothelial dysfunction, platelet activation and aggregations as well as plaque characteristics and extent of coronary lesions. Therefore, regarding reperfusion strategies in the more complex anatomies coronary artery bypass surgery may be the preferred therapeutic strategy over percutaneous coronary intervention while both hyperglycemia and hypoglycemia should be avoided with closed monitoring of glycemic status during the acute phase of myocardial infraction. However, the best treatment strategy remains undefined. Non-insulin therapies, due to the low risk of hypoglycemia concurrently with the multifactorial CV protective effects, may be proved to be the best treatment option in the future. Nevertheless, evidence for the beneficial effects of glucagon like peptide-1 receptor agonists, dipeptidyl-peptidase 4 inhibitors and sodium glycose cotransporter 2 inhibitors, despite accumulating, is not robust and future randomized control trials may provide more definitive data.
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Affiliation(s)
- Panagiota K. Stampouloglou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Artemis Anastasiou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Evanthia Bletsa
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Stavroula Lygkoni
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Flora Chouzouri
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Maria Xenou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Ourania Katsarou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Panagiotis Theofilis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (D.T.)
| | - Konstantinos Zisimos
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Dimitris Tousoulis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (D.T.)
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.K.S.); (A.A.); (E.B.); (S.L.); (F.C.); (M.X.); (K.Z.); (M.V.); (G.S.)
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Maun A, Björkelund C, Arvidsson E. Primary care utilisation, adherence to guideline-based pharmacotherapy and continuity of care in primary care patients with chronic diseases and multimorbidity - a cross-sectional study. BMC PRIMARY CARE 2023; 24:237. [PMID: 37957554 PMCID: PMC10644564 DOI: 10.1186/s12875-023-02191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND To understand how to improve care for patients with chronic diseases and multimorbidity we wanted to describe the prevalence of different chronic diseases and the pattern of multimorbidity and to analyse the associations between occurrence of diseases and primary care utilization, adherence to guideline-based pharmacotherapy, and continuity of care. METHODS Retrospective cross-sectional study of routine care data of the general population in region Jönköping in Sweden (345 916 inhabitants using primary care services) covering 4.3 years. PARTICIPANTS Patients fulfilling the inclusion criteria of having ≥ 1 of 10 common chronic diseases and ≥ 3 visits to primary care between 2011 and 2015. PRIMARY OUTCOME MEASURES In order to determine diseases and multimorbidity, primary care utilisation, adherence to guideline-based pharmacotherapy, frequencies and percentages, interval and ratio scaled variables were described using means, standard deviations, and various percentiles in the population. Two continuity indices were used (MMCI, COC) to describe continuity. RESULTS Of the general population, 25 829 patients fulfilled the inclusion criteria (7.5% of the population). Number of diseases increased with increasing age, and multimorbidity was much more common than single diseases (mean 2.0 per patient). There was a slight positive correlation (0.29) between number of diseases and visits, but visits did not increase proportionally to the number of diseases. Patients with physical diseases combined with anxiety and/or depression made more visits than others. The number of diseases per patient was negatively associated with the adherence to pharmacotherapy guidelines. There was no association between continuity and healthcare utilisation or adherence to pharmacotherapy guidelines. CONCLUSIONS Multimorbid patients are common in primary care and for many chronic diseases it is more common to have other simultaneous diseases than having only one disease. This can make adherence to pharmacotherapy guidelines a questionable measure for aged multimorbid patients. Existing continuity indices also revealed limitations. Holistic and patient-centred measures should be used for quality assessment of care for multimorbid patients in primary care.
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Affiliation(s)
- Andy Maun
- Institute of General Practice / Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Str 2m, Freiburg, DE-79110, Germany.
| | - Cecilia Björkelund
- Primary Health Care, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, Göteborg, SE-405 30, Sweden
| | - Eva Arvidsson
- Research and Development Unit for Primary Care, Futurum, Hus B4, Länssjukhuset Ryhov, Jönköping, SE-551 85, Sweden
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Cohen Rodrigues TR, Breeman LD, Kinik A, Reijnders T, Dusseldorp E, Janssen VR, Kraaijenhagen RA, Atsma DE, Evers AW. Effectiveness of Human-Supported and Self-Help eHealth Lifestyle Interventions for Patients With Cardiometabolic Risk Factors: A Meta-Analysis. Psychosom Med 2023; 85:795-804. [PMID: 37549197 PMCID: PMC10662612 DOI: 10.1097/psy.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/02/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE eHealth is a useful tool to deliver lifestyle interventions for patients with cardiometabolic diseases. However, there are inconsistent findings about whether these eHealth interventions should be supported by a human professional, or whether self-help interventions are equally effective. METHODS Databases were searched between January 1995 and October 2021 for randomized controlled trials on cardiometabolic diseases (cardiovascular disease, chronic kidney disease, type 1 and 2 diabetes mellitus) and eHealth lifestyle interventions. A multilevel meta-analysis was used to pool clinical and behavioral health outcomes. Moderator analyses assessed the effect of intervention type (self-help versus human-supported), dose of human support (minor versus major part of intervention), and delivery mode of human support (remote versus blended). One hundred seven articles fulfilled eligibility criteria and 102 unique ( N = 20,781) studies were included. RESULTS The analysis showed a positive effect of eHealth lifestyle interventions on clinical and behavioral health outcomes ( p < .001). However, these effects were not moderated by intervention type ( p = .169), dose ( p = .698), or delivery mode of human support ( p = .557). CONCLUSIONS This shows that self-help eHealth interventions are equally effective as human-supported ones in improving health outcomes among patients with cardiometabolic disease. Future studies could investigate whether higher-quality eHealth interventions compensate for a lack of human support.Meta-analysis registration: PROSPERO CRD42021269263 .
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Chen S, Guan S, Yan Z, Ouyang F, Li S, Liu L, Zhong J. Role of RIPK3‑CaMKII‑mPTP signaling pathway‑mediated necroptosis in cardiovascular diseases (Review). Int J Mol Med 2023; 52:98. [PMID: 37654208 PMCID: PMC10495754 DOI: 10.3892/ijmm.2023.5301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Necroptosis, which is distinct from apoptosis and necrosis, serves a crucial role in ontogeny and the maintenance of homeostasis. In the last decade, it has been demonstrated that the pathogenesis of cardiovascular diseases is also linked to necroptosis. Receptor interaction protein kinase (RIPK) 1, RIPK3 and mixed lineage kinase domain‑like protein serve vital roles in necroptosis. In addition to the aforementioned necroptosis‑related components, calcium/calmodulin‑dependent protein kinase II (CaMKII) has been identified as a novel substrate for RIPK3 that promotes the opening of the mitochondrial permeability transition pore (mPTP), and thus, mediates necroptosis of myocardial cells through the RIPK3‑CaMKII‑mPTP signaling pathway. The present review provides an overview of the current knowledge of the RIPK3‑CaMKII‑mPTP‑mediated necroptosis signaling pathway in cardiovascular diseases, focusing on the role of the RIPK3‑CaMKII‑mPTP signaling pathway in acute myocardial infarction, ischemia‑reperfusion injury, heart failure, abdominal aortic aneurysm, atherosclerosis, diabetic cardiomyopathy, hypertrophic cardiomyopathy, atrial fibrillation, and the cardiotoxicity associated with antitumor drugs and other chemicals. Finally, the present review discusses the research status of drugs targeting the RIPK3‑CaMKII‑mPTP signaling pathway.
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Affiliation(s)
- Sheng Chen
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Senhong Guan
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Zhaohan Yan
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Fengshan Ouyang
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Shuhuan Li
- Department of Pediatrics, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Lanyuan Liu
- Department of Ultrasound Medicine, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
| | - Jiankai Zhong
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong 528308, P.R. China
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Altabtabaei R, Alhuwail D. Exploring the Challenges and Opportunities of Adopting and Using Telemedicine for Diabetes Care and Management: Qualitative Semistructured Interview Study Among Health Care Providers and Patients With Diabetes. JMIR Hum Factors 2023; 10:e46324. [PMID: 37676711 PMCID: PMC10514770 DOI: 10.2196/46324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Around the world, over half of the global population experiences noncommunicable diseases, resulting in premature death. Health care providers (HCPs) can deliver medical treatment from a distance by using digital advancements such as telemedicine. However, there is a limited understanding of the difficulties and opportunities of implementing telemedicine solutions in different socioeconomic and cultural environments, including Kuwait. OBJECTIVE The purpose of this study is to (1) examine the obstacles and benefits of telemedicine in the context of diabetes treatment and management, as perceived by both HCPs and patients with diabetes; (2) investigate the nonfunctional requirements for telemedicine applications used in diabetes care and management; and (3) provide suggestions to enhance the integration and adoption of telemedicine in Kuwait's health care system for diabetes care and management. METHODS The research used a qualitative and exploratory design, with semistructured interviews as the main data collection method. Participants were recruited on the internet through social media platforms due to the COVID-19 pandemic. The results were analyzed using thematic analysis and the Framework Method. The "diffusion of innovation" model was used as a perspective to interpret the findings. RESULTS A total of 20 participants were included in this study-10 HCPs and 10 patients with diabetes-all of whom supported telemedicine. The HCPs reported that many diabetes cases could be managed through telemedicine, with only a few requiring in-person visits. Patients with diabetes noted the convenience and time-saving aspect of telemedicine. Both groups recommended the creation of a secure and user-friendly telemedicine system similar to popular social media platforms. Additionally, participants emphasized the importance of telemedicine during the pandemic as a way to prioritize patient safety. CONCLUSIONS The results of this study provide valuable insights into the needs and preferences of both HCPs and patients with diabetes in a resource-rich country like Kuwait to embrace telemedicine. The COVID-19 pandemic has changed the way medical care is provided and has pushed both groups to consider digital solutions for ongoing diabetes management and treatment.
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Affiliation(s)
- Rabab Altabtabaei
- Information Science Department, Kuwait University, Kuwait City, Kuwait
| | - Dari Alhuwail
- Information Science Department, Kuwait University, Kuwait City, Kuwait
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
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10
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Li Y, Guan L, Ning C, Zhang P, Zhao Y, Liu Q, Ping P, Fu S. Machine learning-based models to predict one-year mortality among Chinese older patients with coronary artery disease combined with impaired glucose tolerance or diabetes mellitus. Cardiovasc Diabetol 2023; 22:139. [PMID: 37316853 DOI: 10.1186/s12933-023-01854-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE An accurate prediction of survival prognosis is beneficial to guide clinical decision-making. This prospective study aimed to develop a model to predict one-year mortality among older patients with coronary artery disease (CAD) combined with impaired glucose tolerance (IGT) or diabetes mellitus (DM) using machine learning techniques. METHODS A total of 451 patients with CAD combined with IGT and DM were finally enrolled, and those patients randomly split 70:30 into training cohort (n = 308) and validation cohort (n = 143). RESULTS The one-year mortality was 26.83%. The least absolute shrinkage and selection operator (LASSO) method and ten-fold cross-validation identified that seven characteristics were significantly associated with one-year mortality with creatine, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and chronic heart failure being risk factors and hemoglobin, high density lipoprotein cholesterol, albumin, and statins being protective factors. The gradient boosting machine model outperformed other models in terms of Brier score (0.114) and area under the curve (0.836). The gradient boosting machine model also showed favorable calibration and clinical usefulness based on calibration curve and clinical decision curve. The Shapley Additive exPlanations (SHAP) found that the top three features associated with one-year mortality were NT-proBNP, albumin, and statins. The web-based application could be available at https://starxueshu-online-application1-year-mortality-main-49cye8.streamlitapp.com/ . CONCLUSIONS This study proposes an accurate model to stratify patients with a high risk of one-year mortality. The gradient boosting machine model demonstrates promising prediction performance. Some interventions to affect NT-proBNP and albumin levels, and statins, are beneficial to improve survival outcome among patients with CAD combined with IGT or DM.
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Affiliation(s)
- Yan Li
- Department of Endocrinology, People's Hospital of Macheng City, Hubei, China
| | - Lixun Guan
- Hematology Department, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Chaoxue Ning
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Pei Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Qiong Liu
- Medical Care Center, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Ping Ping
- General Station for Drug and Instrument Supervision and Control, Joint Logistic Support Force of Chinese People's Liberation Army, Beijing, China.
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.
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11
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Winter J. Embedding guidelines into clinical practice. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Judy Winter
- Advanced Nurse Practitioner & Diabetes Specialist Nurse, Park Medical Practice Greater Preston Clinical Commissioning Group Preston UK
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12
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Manoharan P, Nadarajah R, Suganthan N. Assessment of Additional Risk Factors for Cardiovascular Disease and Awareness Among Adult Patients With Diabetes Mellitus: A Cross-Sectional Study From Northern Sri Lanka. Cureus 2022; 14:e30047. [DOI: 10.7759/cureus.30047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
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13
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The Impact of Hypoglycemic Therapy on the Prognosis for Acute Coronary Syndrome in Patients with Type 2 Diabetes. J Pers Med 2022; 12:jpm12050845. [PMID: 35629267 PMCID: PMC9143707 DOI: 10.3390/jpm12050845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
The article discusses particular circumstances of acute coronary syndrome (ACS) in patients with type 2 diabetes (T2D). In addition, the available literature data and clinical guidelines reflecting the role of hypoglycemic therapy as a cardioprotection factor in ACS are analyzed. The article considers possible protective molecular mechanisms of various groups of drugs in ischemic cardiomyocytes.
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14
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The ceRNA Crosstalk between mRNAs and lncRNAs in Diabetes Myocardial Infarction. DISEASE MARKERS 2022; 2022:4283534. [PMID: 35592708 PMCID: PMC9112177 DOI: 10.1155/2022/4283534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
Competitive endogenous RNA regulation suggests an intricate network of all transcriptional RNAs that have the function of repressing miRNA function and regulating mRNA expression. Today, the specific ceRNA regulatory mechanisms of lncRNA–miRNA–mRNA in patients who have diabetes mellitus (DM) and myocardial infarction (MI) are still unknown. Two data sets, GSE34198 and GSE112690, were rooted in the Gene Expression Omnibus database to search for changes of lncRNA, miRNA, and mRNA in MI patients with diabetes. Weighted gene correlation network analysis (WGCNA) was used to identify the modules related to the development of diabetes in patients with MI. Target genes of miRNAs were predicted using miRWalk, TargetScan, mirDB, RNA22, and miRanda. Then, functional and enrichment analyses were performed to build the lncRNA–miRNA–mRNA interaction network. We built ceRNA regulatory networks with three lncRNAs, two miRNAs, and nine mRNAs. Differentially expressed genes enriched in biological process, including neutrophil activation, refer to immune response and positive system of defense feedback. Besides, there is significant enrichment in molecular function of calcium toll−like receptor binding, icosanoid binding, RAGE receptor binding, and arachidonic acid binding. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis enriched differentially expressed genes (DEGs) in pathways that were well known in MI, indicating inflammation and immune response. Pathways associated with diabetes were also significantly enriched. We confirmed significantly altered lncRNA, miRNA, and mRNA in MI patients with diabetes, which might serve as biomarkers for the progress and development of diabetic cardiovascular diseases. We constructed a ceRNA regulatory network of lncRNA–miRNA–mRNA, which will enable us to understand the novel molecular mechanisms included in the initiation, progression, and interaction between DM and MI, laying the foundation for clinical diagnosis and treatment.
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15
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Bhatti JS, Sehrawat A, Mishra J, Sidhu IS, Navik U, Khullar N, Kumar S, Bhatti GK, Reddy PH. Oxidative stress in the pathophysiology of type 2 diabetes and related complications: Current therapeutics strategies and future perspectives. Free Radic Biol Med 2022; 184:114-134. [PMID: 35398495 DOI: 10.1016/j.freeradbiomed.2022.03.019] [Citation(s) in RCA: 121] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes (T2DM) is a persistent metabolic disorder rising rapidly worldwide. It is characterized by pancreatic insulin resistance and β-cell dysfunction. Hyperglycemia induced reactive oxygen species (ROS) production and oxidative stress are correlated with the pathogenesis and progression of this metabolic disease. To counteract the harmful effects of ROS, endogenous antioxidants of the body or exogenous antioxidants neutralise it and maintain bodily homeostasis. Under hyperglycemic conditions, the imbalance between the cellular antioxidant system and ROS production results in oxidative stress, which subsequently results in the development of diabetes. These ROS are produced in the endoplasmic reticulum, phagocytic cells and peroxisomes, with the mitochondrial electron transport chain (ETC) playing a pivotal role. The exacerbated ROS production can directly cause structural and functional modifications in proteins, lipids and nucleic acids. It also modulates several intracellular signaling pathways that lead to insulin resistance and impairment of β-cell function. In addition, the hyperglycemia-induced ROS production contributes to micro- and macro-vascular diabetic complications. Various in-vivo and in-vitro studies have demonstrated the anti-oxidative effects of natural products and their derived bioactive compounds. However, there is conflicting clinical evidence on the beneficial effects of these antioxidant therapies in diabetes prevention. This review article focused on the multifaceted role of oxidative stress caused by ROS overproduction in diabetes and related complications and possible antioxidative therapeutic strategies targeting ROS in this disease.
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Affiliation(s)
- Jasvinder Singh Bhatti
- Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, India.
| | - Abhishek Sehrawat
- Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, India.
| | - Jayapriya Mishra
- Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, India.
| | - Inderpal Singh Sidhu
- Department of Zoology, Sri Guru Gobind Singh College, Sector 26, Chandigarh, India.
| | - Umashanker Navik
- Department of Pharmacology, Central University of Punjab, Bathinda, India.
| | - Naina Khullar
- Department of Zoology, Mata Gujri College, Fatehgarh Sahib, Punjab, India.
| | - Shashank Kumar
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India.
| | - Gurjit Kaur Bhatti
- Department of Medical Lab Technology, University Institute of Applied Health Sciences, Chandigarh University, Mohali, India.
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA; Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA; Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA; Department of Speech, Language, and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA.
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16
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Haemoglobin A1c and serum glucose levels and risk of gastric cancer: a systematic review and meta-analysis. Br J Cancer 2022; 126:1100-1107. [PMID: 35027671 PMCID: PMC8979989 DOI: 10.1038/s41416-021-01693-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/27/2021] [Accepted: 12/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background This systematic review and meta-analysis examined associations between serum levels of haemoglobin A1c (HbA1c) and glucose and the risk of gastric cancer. Methods MEDLINE, Embase, and Cochrane Library were searched for studies examining associations between serum levels of HbA1c or glucose and the risk of gastric cancer. Inclusion of studies, quality assessment, and data extraction were conducted independently by two authors. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were synthesised using random-effects models. Cochran’s Q test and I2 statistic were used to assess heterogeneity. Results Among 3473 identified studies, 12 were included. Of these, 5 studies examined HbA1c levels and 7 studies examined serum glucose levels. Serum HbA1c levels >6% were associated with an increased risk of gastric cancer (HR 1.36, 95% CI 1.06–1.74). When compared with the lowest glucose categories, the highest glucose categories were associated with a borderline increased risk of gastric cancer (HR 1.11, 95% CI 0.98–1.26). In subgroup analyses, studies that adjusted for Helicobacter pylori infection indicated stronger associations between elevated HbA1c levels and gastric cancer (HR 2.08, 95% CI 1.46–2.98) than those without such adjustment (HR 1.10, 95% CI 0.91–1.32). Conclusions Long-standing poor glycaemic control may increase the risk of gastric cancer. Registration number PROSPERO CRD42020157453.
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Giblin S, Scully P, Evers J, Dalton N, Hayes G, Donnelly A, Orla Neylon O, O'Gorman C. Physical Activity Surveillance in Adolescents with Type 1 Diabetes: A Pilot Mixed-Methods Investigation. J Diabetes Res 2022; 2022:4202561. [PMID: 35342770 PMCID: PMC8941581 DOI: 10.1155/2022/4202561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/08/2021] [Accepted: 02/26/2022] [Indexed: 12/23/2022] Open
Abstract
Type 1 diabetes (T1D) affects over 2,500 children in Ireland. Insulin replacement is the mainstay of treatment for T1D, and physical activity (PA) is an important, modifiable lifestyle factor for sustaining health. Surveillance of PA for both research and clinical purposes in paediatric T1D has been limited. This study deployed both quantitative (accelerometry) and qualitative (self-report) measures to assess habitual PA patterns in children with T1D. Twenty-one participants (9 females, 12 males) between 10 and 17 years (mean 13.7 ± 1.94 years) were recruited from an Outpatients Paediatric Diabetes Clinic. Total steps, standing time (minutes (mins)) and sitting time (mins) were recorded using the activPAL 3 microactivity monitor. Clinical parameters (HbA1c, insulin regimen, and weight centiles) were measured. A self-report diary was used to measure perceived activity levels. The findings of this study show that participant children with T1D are not achieving the required steps per day to sustain physical health (recommended minimum 11,500). Females (mean = 7,306 steps ± 5,468) achieved significantly less (p = 0.001) steps per day compared to males (10,806 steps ± 5,904). No significant differences were found between genders for sitting time or standing time. Overweight or obesity was identified in 44% of female participants and 15% of male participants. Mean HbA1c for both females 8.25% (67 mmol/mol) and males 7.97% (64 mmol/mol) was above the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommended <7.0% (53 mmol/mol) for children. Further research is warranted to investigate PA promotion strategies in populations of children with paediatric T1D.
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Affiliation(s)
- Susan Giblin
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
| | - Paul Scully
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
| | - Julie Evers
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
| | - Niall Dalton
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
- Department of Paediatrics, University Hospital Limerick, Ireland
| | - Grainne Hayes
- Department of Physical Education and Sports Science, Physical Activity for Health Research Cluster & Health Research Institute, University of Limerick, Ireland
| | - Alan Donnelly
- Department of Physical Education and Sports Science, Physical Activity for Health Research Cluster & Health Research Institute, University of Limerick, Ireland
| | - O. Orla Neylon
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
- Department of Paediatrics, University Hospital Limerick, Ireland
| | - Clodagh O'Gorman
- Department of Paediatrics, School of Medicine, University of Limerick, Ireland
- Department of Paediatrics, University Hospital Limerick, Ireland
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Meyers J, Hoog M, Mody R, Yu M, Davis K. The Health Care Resource Utilization and Costs Among Patients With Type 2 Diabetes and Either Cardiovascular Disease or Cardiovascular Risk Factors An Analysis of a US Health Insurance Database. Clin Ther 2021; 43:1827-1842. [PMID: 34625283 DOI: 10.1016/j.clinthera.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/09/2021] [Accepted: 09/01/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE Health care costs and cardiovascular (CV) outcomes were evaluated among US patients with type 2 diabetes (T2D) and cardiovascular disease (CVD) or CV risk factors. METHODS Patients with ≥24 months of continuous enrollment were selected from the MarketScan Commercial and Medicare databases from January 1, 2014, to September 30, 2018. For the first qualifying 24-month period, months 1 to 12 defined the baseline period and months 13 to 24 defined the follow-up period. All patients had ≥2 T2D diagnoses during baseline. Two cohorts were created: (1) patients with ≥1 CVD diagnosis during baseline ("CVD cohort"); and (2) patients with ≥1 CV risk factor ("CV risk cohort") and no diagnosed CVD during baseline. The percentage of patients with subsequent CVD diagnoses and annual all-cause, T2D-related, and CV-related costs in baseline and follow-up periods were reported. FINDINGS In total, 1,106,716 patients met inclusion criteria: CVD cohort, 224,018 patients; CV risk cohort, 812,144 patients; and no diagnosed CVD or CV risk factors, 70,554. During baseline, 40.2% of the CVD cohort had 2 or more CVD diagnoses. During follow-up, 10.5% of the CV risk cohort had evidence of CVD (ie, emergent CVD). During baseline, the CVD cohort had mean (SD) all-cause costs of $38,985 ($69,936); T2D-related costs, $16,208 ($34,104); and CV-related annual costs, $18,842 ($44,457). The CV risk cohort had mean all-cause costs of $13,207 ($27,057); T2D-related costs, $5226 ($12,268); and CV-related costs, $2754 ($10,586). During follow-up, the CV risk cohort with emergent CVD had higher mean all-cause, T2D-related, and CV-related annual costs than costs among patients without CVD (all-cause, $39,365 [$67,731] vs $13,401 [$27,530]; T2D related, $18,520 [$37,256] vs $5732 [$12,540]; and CV related, $18,893 [$43,584] vs $2650 [$10,501], respectively). IMPLICATIONS Costs for patients with T2D and either CVD or CV risk are substantial. In this analysis, ∼10% of patients with CV risk were diagnosed with emergent CVD. All-cause costs among patients with emergent CVD were nearly 3 times higher than those among patients with CV risk only. Because costs associated with CVD in the T2D population are high, preventing CVD events in patients with T2D has the potential to decrease overall health care costs and avoid additional disease burden for these patients.
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Affiliation(s)
| | | | - Reema Mody
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Maria Yu
- Eli Lilly and Company, Eli Lilly Canada Inc, Toronto, Ontario, Canada
| | - Keith Davis
- RTI Health Solutions, Research Triangle Park, NC, USA
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Kruger S, Deacon E, van Rensburg E, Segal DG. Young adult women's meaning-making of living with type 1 diabetes: towards growth and optimism. Psychol Health 2021; 38:573-590. [PMID: 34510968 DOI: 10.1080/08870446.2021.1977303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Type 1 diabetes is primarily researched as a medical condition; an examination of the subjective experience of it appears to be neglected. This study explored young women's meaning-making of living with type 1 diabetes in an attempt to uncover possible positive outcomes of growth and optimism.Design: Interpretative phenomenological analysis (IPA) enabled the in-depth exploration of the journeys of a group of young female adults living with type 1 diabetes from distress to positive outcomes. Six participants between the ages of 18 and 25 were recruited from a Centre for Diabetes and Endocrinology, in Parktown, South Africa, to participate in semi-structured interviews about their meaning-making process.Results: Three superordinate themes emerged: (1) the process of reappraising a life with diabetes; (2) the development of diabetes as a lifestyle; and (3) positive outcomes of living with diabetes.Conclusion: Findings in this study demonstrate how the meaning-making process has a significant impact on positive adjustment to living with diabetes. While participants experienced distress, they reframed living with diabetes as an opportunity for empowerment and personal growth. Actively seeking and promoting of the positive outcomes of meaning-making could assist young adults to improve their quality of life while living with diabetes.
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Affiliation(s)
- Sylvia Kruger
- Department of Psychosocial Health, North-West University, Potchefstroom, South Africa and Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
| | - Elmari Deacon
- Department of Psychosocial Health, North-West University, Potchefstroom, South Africa and Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
| | - Esmé van Rensburg
- Department of Psychosocial Health, North-West University, Potchefstroom, South Africa
| | - David Grant Segal
- Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
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Ahmadizar F, Wang K, Aribas E, Fani L, Heshmatollah A, Ikram MK, Kavousi M. Impaired fasting glucose, type 2 diabetes mellitus, and lifetime risk of cardiovascular disease among women and men: the Rotterdam Study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002406. [PMID: 34433547 PMCID: PMC8388277 DOI: 10.1136/bmjdrc-2021-002406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/15/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Data on sex-specific lifetime risk of cardiovascular disease (CVD) across the glycemic spectrum, in particular in impaired fasting glucose (IFG) state, are scarce. Whether overweight/obesity modifies the CVD burden also remains unclear. RESEARCH DESIGN AND METHODS Using a prospective population-based Rotterdam Study, normoglycemia, IFG, and type 2 diabetes mellitus (T2D) were defined. First incident cases of coronary heart disease, heart failure, and stroke during a follow-up time until January 1, 2015 were identified and formed the composite CVD end point. The remaining lifetime risks of CVD were estimated in each glucose category at 55, 65, 75, and 85 years of age, using a modified version of survival analysis adjusted for the competing risk of death. RESULTS Among 5698 women and 3803 men free of CVD at baseline, the mean age was 64.5 years (SD 9.6) and 60.0% of participants were women. At age 55 years, the remaining lifetime risk of any CVD event among women was 55.1% (95% CI 48.3 to 61.9) for IFG, compared with 52.7% (95% CI 49.5 to 55.9) for normoglycemia and 61.5% (95% CI 54.7 to 68.3) for T2D. For men, the remaining lifetime risk of any CVD event was 62.1% (95% CI 55.2 to 69.1) for IFG, compared with 59.1% (95% CI 55.5 to 62.7) for normoglycemia and 60.3% (95% CI 53.1 to 67.5) for T2D. At age 55 years, the lifetime risk for incident CVD was higher, although not statistically significant, among women and men with IFG who were overweight or had obesity compared with normal-weight women and men. CONCLUSION IFG carried a large lifetime risk for incident CVD among both women and men compared with normoglycemia. In particular among men, the risk was comparable to that of T2D. Overweight/Obesity modifies the risk and conferred a larger burden of lifetime CVD risk among women and men with IFG.
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Affiliation(s)
- Fariba Ahmadizar
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kan Wang
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lana Fani
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alis Heshmatollah
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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21
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Strong and Bitter Vegetables from Traditional Cultivars and Cropping Methods Improve the Health Status of Type 2 Diabetics: A Randomized Control Trial. Nutrients 2021; 13:nu13061813. [PMID: 34073610 PMCID: PMC8227621 DOI: 10.3390/nu13061813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
Vegetables rich in bitter-tasting phytochemicals may exert enhanced beneficial effects against key factors associated with type two diabetes (T2D). This study investigates whether selected cultivars of bitter and strong-tasting (BST) Brassica and root vegetables exert greater health benefits on T2D patients compared to equivalent modern mild and sweet tasting (MST) vegetables. A 12-week randomized, controlled, parallel intervention study involved 92 T2D patients, who were allocated three different diets: (1) 500 g daily of bitter and strong-tasting (BST) vegetables; (2) 500 g daily of mild and sweet-tasting (MST) vegetables; (3) 120 g daily MST normal diet (control). Both vegetable diets contained root vegetables and cabbages selected based on sensory differences and content of phytochemicals. Prior to and after the study, all participants underwent an oral glucose tolerance test (OGTT), 24 h blood pressure measurements, DEXA scans, and fasted blood samples. Both diets high in vegetables significantly reduced the participants' BMI, total body fat mass, and HbA1c levels compared to control, but in the BST group, significant differences were also found regarding incremental area under the curve glucose 240 min (OGTT) and fasting glucose levels. A high daily intake of root vegetables and cabbages showed significant health improvements in both vegetable groups. BST vegetables had the greatest impact on insulin sensitivity, body fat mass, and blood pressure compared to control; moreover, they further improved glycemic control compared to MST vegetables.
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22
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Elamragy A, Yakoub S, AbdelGhany M, Ammar W. Coronary tortuosity relation with carotid intima-media thickness, coronary artery disease risk factors, and diastolic dysfunction: is it a marker of early atherosclerosis? Egypt Heart J 2021; 73:34. [PMID: 33788058 PMCID: PMC8012427 DOI: 10.1186/s43044-021-00157-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
Background Coronary tortuosity (C-Tor) is a common finding in coronary angiography (CAG). There are conflicting data about its link to atherosclerosis: one study found a negative relationship with coronary artery disease (CAD), although it had been linked to age and hypertension (HTN), which are CAD risk factors. Carotid intima-media thickness (C-IMT) is a measure of early atherosclerosis and a surrogate for CAD, diastolic dysfunction is also associated with CAD risk factors. In this retrospective case-control study, we investigated the relationship between C-Tor, C-IMT, diastolic dysfunction, and the other risk factors in patients undergoing CAG in a tertiary hospital between July 2017 and June 2018, after excluding patients with significant CAD. C-Tor was defined as the presence of ≥ 3 bends (≥ 45°) along the trunk of at least one main coronary artery in CAG. Results After excluding 663 patients due to exclusion criteria, 30 patients with C-Tor were compared with age and gender-matched controls. HTN was significantly more common in the C-Tor group (86.7% vs. 30%, p < 0.002); other clinical characteristics were similar. The C-IMT was abnormal in the C-Tor group only (p: 0.007). The diastolic dysfunction parameters differed between the two groups: the E/A ratio was < 1 in the C-Tor group and > 1 in the normal group (p: < 0.001); the E velocity and deceleration time were significantly lower in the C-Tor group (p: 0.001 and < 0.001 respectively); the E/E′ ratio, A, and A′ velocities were significantly higher (p: 0.005, < 0.001, < 0.001 respectively); while the S′ velocity was similar in the 2 groups (p: 0.078). The C-Tor group had higher total cholesterol and LDL (p: 0.003 and 0.006 respectively). All C-Tor patients undergoing stress tests had positive results. The only independent C-Tor predictors in a regression analysis were HTN, total cholesterol, A-wave velocity, and deceleration time (DT) (odds ratio: 14.7, 1.03, 1.15, and 0.95, all p: < 0.05). A-wave velocity had the best area under the curve, sensitivity, and specificity for C-Tor prediction (0.88, 73.3%, and 96.7% respectively) followed by DT (0.86, 66.67%, and 96.6% respectively). Conclusion C-Tor is associated with increased C-IMT, HTN, hyperlipidemia, and left ventricular diastolic dysfunction; all contributing to an ongoing atherosclerotic process. A-wave velocity and DT were independent predictors of C-Tor. C-Tor may cause microvascular ischemia that merits further investigation.
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Affiliation(s)
- Ahmed Elamragy
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
| | - Samuel Yakoub
- Department of Cardiology, 6th Of October Health Insurance Hospital, Giza, 12573, Egypt
| | - Mohamed AbdelGhany
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Waleed Ammar
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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23
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Palmer BF, Carrero JJ, Clegg DJ, Colbert GB, Emmett M, Fishbane S, Hain DJ, Lerma E, Onuigbo M, Rastogi A, Roger SD, Spinowitz BS, Weir MR. Clinical Management of Hyperkalemia. Mayo Clin Proc 2021; 96:744-762. [PMID: 33160639 DOI: 10.1016/j.mayocp.2020.06.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/18/2020] [Accepted: 06/10/2020] [Indexed: 12/26/2022]
Abstract
Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K+) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting. There is a need to improve effective management of hyperkalemia, including classification and K+ monitoring, when to reinitiate previously discontinued renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and when to use oral K+-binding agents. Monitoring serum K+ should be individualized; however, increased frequency of monitoring should be considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia and for those receiving RAASi therapy. Recent clinical studies suggest that the newer K+ binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Enhancing the knowledge of primary care physicians and internists with respect to the safety profiles of these newer K+ binders may increase confidence in managing patients with hyperkalemia. Lastly, the availability of newer K+-binding agents requires further study to establish whether stringent dietary K+ restrictions are needed in patients receiving K+-binder therapy. Individualized monitoring of serum K+ among patients with an increased risk of hyperkalemia and the use of newer K+-binding agents may allow for optimization of RAASi therapy and more effective management of hyperkalemia.
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Affiliation(s)
- Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Deborah J Clegg
- Drexel University College of Nursing and Health Professions, Philadelphia, PA
| | | | | | - Steven Fishbane
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Debra J Hain
- Christine E. Lynn College of Nursing, Florida Atlantic University, and Cleveland Clinic Florida, Weston, FL
| | - Edgar Lerma
- Department of Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn
| | - Macaulay Onuigbo
- Robert Larner College of Medicine, University of Vermont Medical Center, Burlington
| | - Anjay Rastogi
- David Geffen School of Medicine, University of California, Los Angeles
| | - Simon D Roger
- Renal Research, Gosford Hospital, Gosford, Australia
| | | | - Matthew R Weir
- Department of Medicine, University of Maryland School of Medicine, Baltimore
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24
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Wierzba W, Karnafel W, Śliwczyński A, Pinkas J, Gujski M. Diabetes mellitus and congestive heart failure: the prevalence of congestive heart failure in patients with and without diabetes in Poland. Arch Med Sci 2021; 17:646-651. [PMID: 34025834 PMCID: PMC8130468 DOI: 10.5114/aoms.2018.74261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is a systemic disease and has a negative effect on the cardiovascular system. This paper aimed to present a retrospective analysis of morbidity associated with heart failure in subgroups of patients with and without diabetes in Poland in 2012. MATERIAL AND METHODS Data from the National Health Fund were used for the study. In general, 656,937 patients with heart failure, including 281,538 males and 375,354 females, were studied. In this population, additionally, 201,043 patients with heart failure (main diagnosis) and diabetes were studied, including 82,117 males and 118,926 females. RESULTS The mean index of morbidity associated with heart failure in the whole subpopulation of diabetes patients was 9.03%; 8.42% for males and 9.50% for females. Morbidity associated with heart failure in the population of patients diagnosed with diabetes in Poland in 2012 was seven times higher compared to morbidity associated with heart failure in non-diabetes patients. Morbidity associated with heart failure in females was significantly higher compared to morbidity in males in the whole population, in both the subpopulations of patients with and without diabetes. CONCLUSIONS Diabetes mellitus significantly increases risk of heart failure in both women and men. The risk is significantly high after the age of 60 years and higher in females.
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Affiliation(s)
- Waldemar Wierzba
- Department of Public Health, University of Humanities and Economics, Lodz, Poland
| | - Waldemar Karnafel
- Department of Public Health, University of Humanities and Economics, Lodz, Poland
| | - Andrzej Śliwczyński
- Department of Public Health, University of Humanities and Economics, Lodz, Poland
- National Health Fund, Central Office, Warsaw, Poland
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mariusz Gujski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
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25
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Perez GS, Cordeiro GDS, Santos LS, Espírito-Santo DDA, Boaventura GT, Barreto-Medeiros JM. Does a high-fat diet-induced obesity model brown adipose tissue thermogenesis? A systematic review. Arch Med Sci 2021; 17:596-602. [PMID: 34025828 PMCID: PMC8130461 DOI: 10.5114/aoms.2019.86781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/20/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In this systematic review, we analysed studies that assessed the brown adipose tissue (BAT) activity in the high-fat/cafeteria diet model of obesity in rats. MATERIAL AND METHODS Scopus, PubMed, Embase, and ScienceDirect databases were searched from January 2017 to November 2017. Using specific combinations of medical subject heading (MeSH) descriptors, seven papers remained after the inclusion and exclusion criteria. RESULTS Most papers showed an increase in BAT thermogenesis in rodents fed high-fat/cafeteria diet. Some studies did not mention the diet composition or housing temperature, and the most of them investigated the thermogenesis superficially, being limited to the analysis of the UCP 1 expression. CONCLUSIONS Despite the consolidated use of high-fat/cafeteria diets as a model to induce obesity, the identification of the energy expenditure arm has been slow, especially the direct quantitative assessment of the contribution of BAT to the increase in metabolic rate in rats fed a cafeteria/high-fat diet.
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Affiliation(s)
- Gabriela S Perez
- Graduate Program of Food Nutrition and Health, Department of Nutrition Science, Federal University of Bahia, Brazil
| | - Gabriele D S Cordeiro
- Graduate Program of Food Nutrition and Health, Department of Nutrition Science, Federal University of Bahia, Brazil
| | - Lucimeire S Santos
- Graduate Program of Food Nutrition and Health, Department of Nutrition Science, Federal University of Bahia, Brazil
| | - Djane D A Espírito-Santo
- Graduate Program of Food Nutrition and Health, Department of Nutrition Science, Federal University of Bahia, Brazil
| | - Gilson T Boaventura
- Graduate Program of Food Nutrition and Health, Department of Nutrition Science, Federal University of Bahia, Brazil
| | - Jairza M Barreto-Medeiros
- Graduate Program of Food Nutrition and Health, Department of Nutrition Science, Federal University of Bahia, Brazil
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26
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Zharkikh E, Dremin V, Zherebtsov E, Dunaev A, Meglinski I. Biophotonics methods for functional monitoring of complications of diabetes mellitus. JOURNAL OF BIOPHOTONICS 2020; 13:e202000203. [PMID: 32654427 DOI: 10.1002/jbio.202000203] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 06/11/2023]
Abstract
The prevalence of diabetes complications is a significant public health problem with a considerable economic cost. Thus, the timely diagnosis of complications and prevention of their development will contribute to increasing the length and quality of patient life, and reducing the economic costs of their treatment. This article aims to review the current state-of-the-art biophotonics technologies used to identify the complications of diabetes mellitus and assess the quality of their treatment. Additionally, these technologies assess the structural and functional properties of biological tissues, and they include capillaroscopy, laser Doppler flowmetry and hyperspectral imaging, laser speckle contrast imaging, diffuse reflectance spectroscopy and imaging, fluorescence spectroscopy and imaging, optical coherence tomography, optoacoustic imaging and confocal microscopy. Recent advances in the field of optical noninvasive diagnosis suggest a wider introduction of biophotonics technologies into clinical practice and, in particular, in diabetes care units.
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Affiliation(s)
- Elena Zharkikh
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
| | - Viktor Dremin
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- School of Engineering and Applied Science, Aston University, Birmingham, UK
| | - Evgeny Zherebtsov
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
- Optoelectronics and Measurement Techniques unit, University of Oulu, Oulu, Finland
| | - Andrey Dunaev
- Research & Development Center of Biomedical Photonics, Orel State University, Orel, Russia
| | - Igor Meglinski
- School of Engineering and Applied Science, Aston University, Birmingham, UK
- Optoelectronics and Measurement Techniques unit, University of Oulu, Oulu, Finland
- Interdisciplinary Laboratory of Biophotonics, National Research Tomsk State University, Tomsk, Russia
- Institute of Engineering Physics for Biomedicine (PhysBio), National Research Nuclear University-MEPhI, Moscow, Russia
- School of Life and Health Sciences, Aston University, Birmingham, UK
- Department of Histology, Cytology and Embryology, Institute of Clinical Medicine N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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27
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Kahraman S, Agus HZ, Avci Y, Serbest NG, Guner A, Erturk M. The Neutrophil to Lymphocyte Ratio (NLR) Is Associated With Residual Syntax Score in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2020; 72:166-173. [PMID: 32945176 DOI: 10.1177/0003319720958556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The neutrophil to lymphocyte ratio (NLR) predicts adverse clinical outcomes in several cardiovascular diseases. Our aim was to investigate the association of residual SYNTAX score (rSS) with the NLR in patients (n = 613) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients were divided into 2 groups: group 1 with low NLR (<2.59) and group 2 with high NLR (>2.59). Coronary artery disease severity was calculated for both groups besides baseline clinical and demographic variables. Receiver operating characteristic curve analysis demonstrated that NLR with a cutoff value of 2.59 had good predictive value for increased rSS (area under the curve = 0.707, 95% CI: 0.661-0.752, P < .001). The median rSS value of group 2 was higher (2.0 [0-6.0]; 4.0 [0-10.0], P < .001) compared with group 1; the number of patients with high rSS was also higher in group 2 (26 [9.7%]; 107 [31.0%], P < .001). In multivariate logistic regression analysis, the NLR (odds ratio = 3.933; 95% CI: 2.419-6.393; P < .001) was an independent predictor of high rSS. Additionally, there was a positive correlation between NLR and rSS (r = 0.216, P < .001). In conclusion, higher NLR was an independent predictor of increased rSS in patients with STEMI.
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Affiliation(s)
- Serkan Kahraman
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Hicaz Zencirkiran Agus
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Yalcin Avci
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Nail Guven Serbest
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Guner
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
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Abstract
PURPOSE OF REVIEW Persons with diabetes mellitus (DM) have increased morbidity and mortality rates compared with persons without DM. Sudden cardiac death (SCD) is a leading cause of death, and multiple studies have found an increased risk of SCD among individuals with DM. This review sought to collect the latest knowledge of the epidemiological and pathophysiological interplay between DM and SCD. RECENT FINDINGS Persons with DM have a two- to tenfold increased risk of SCD compared with persons without DM. The underlying mechanisms for the increased risk of SCD are complex and multifactorial. The main pathophysiological contributors are DM-induced cardiac autonomic neuropathy (CAN), metabolic changes, silent ischemia, and polypharmacy. Persons with DM have an increased risk of SCD. Future studies should focus on CAN and the combined risk of QT prolongation from the interplay between CAN, hypoglycemia, and polypharmacy. Genes and pathways involved in control of the autonomic nervous system and cardiac ion channels could be a future focal point.
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29
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Becchetti C, Dirchwolf M, Banz V, Dufour JF. Medical management of metabolic and cardiovascular complications after liver transplantation. World J Gastroenterol 2020; 26:2138-2154. [PMID: 32476781 PMCID: PMC7235200 DOI: 10.3748/wjg.v26.i18.2138] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/26/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation represents the only curative option for patients with end-stage liver disease, fulminant hepatitis and advanced hepatocellular carcinoma. Even though major advances in transplantation in the last decades have achieved excellent survival rates in the early post-transplantation period, long-term survival is hampered by the lack of improvement in survival in the late post transplantation period (over 5 years after transplantation). The main etiologies for late mortality are malignancies and cardiovascular complications. The latter are increasingly prevalent in liver transplant recipients due to the development or worsening of metabolic syndrome and all its components (arterial hypertension, dyslipidemia, obesity, renal injury, etc.). These comorbidities result from a combination of pre-liver transplant features, immunosuppressive agent side-effects, changes in metabolism and hemodynamics after liver transplantation and the adoption of a sedentary lifestyle. In this review we describe the most prevalent metabolic and cardiovascular complications present after liver transplantation, as well as proposing management strategies.
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Affiliation(s)
- Chiara Becchetti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern CH-3008, Switzerland
- Department of Biomedical Research, University of Bern, Bern CH-3008, Switzerland
| | - Melisa Dirchwolf
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern CH-3008, Switzerland
- Department of Biomedical Research, University of Bern, Bern CH-3008, Switzerland
- Hepatology, Hepatobiliary Surgery and Liver Transplant Unit, Hospital Privado de Rosario, Rosario S2000GAP, Santa Fe, Argentina
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern CH-3008, Switzerland
- Department of Clinical Research, University of Bern, Bern CH-3008, Switzerland
| | - Jean-François Dufour
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern CH-3008, Switzerland
- Department of Biomedical Research, University of Bern, Bern CH-3008, Switzerland
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30
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Mendes Lúcio MC, Reis JS, Moreira AD, Horta Murta TG, Rosário PW. Factors associated to type 2 diabetes among employees of a public hospital in Belo Horizonte, Brazil. Rev Bras Med Trab 2020; 17:292-299. [PMID: 32368663 DOI: 10.5327/z1679443520190395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/02/2019] [Indexed: 11/05/2022] Open
Abstract
Background Occupational aspects have been described as additional risk factors for type 2 diabetes mellitus (DM2). Workers whose job interferes with healthy eating and physical activity might be more susceptible to disease. Objective To investigate sociodemographic, clinical, occupational and lifestyle factors associated with DM2 among employees of a public hospital in Belo Horizonte, Minas Gerais, Brazil. Methodology Cross-sectional study with 443 employees of a public hospital in Belo Horizonte. We administered a sociodemographic and occupational questionnaire and the Finnish Diabetes Risk Score (FINDRISC) and collected biochemical data. We performed multivariate logistic regression analysis to investigate factors associated with diabetes. The significance level was set to 5%. Results 6.3% of the participants had a diagnosis of DM2 and 13% were found to be at high or very high risk to develop disease within 10 years. Participants aged above 54, with abnormal waist circumference, who took antihypertensive drugs or had family history of diabetes exhibited higher odds of developing disease. Conclusion Older age, abdominal obesity, hypertension and family history of diabetes were associated with diagnosis of DM2.
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Affiliation(s)
- Marcelo Cássio Mendes Lúcio
- Holy House of Mercy of Belo Horizonte, Learning and Research Institute of Belo Horizonte - Belo Horizonte (MG), Brazil
| | - Janice Sepúlveda Reis
- Holy House of Mercy of Belo Horizonte, Learning and Research Institute of Belo Horizonte - Belo Horizonte (MG), Brazil
| | - Alexandra Dias Moreira
- Mother-Child Care and Public Health Department, Nursing School, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Tatiane Géa Horta Murta
- Holy House of Mercy of Belo Horizonte, Learning and Research Institute of Belo Horizonte - Belo Horizonte (MG), Brazil
| | - Pedro Wesley Rosário
- Holy House of Mercy of Belo Horizonte, Learning and Research Institute of Belo Horizonte - Belo Horizonte (MG), Brazil
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31
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Wang H, Song Y, Tang X, Xu J, Jiang P, Jiang L, Gao Z, Chen J, Song L, Zhang Y, Zhao X, Qiao S, Yang Y, Gao R, Xu B, Yuan J, Gao L. Impact of unknown diabetes and prediabetes on clinical outcomes in "nondiabetic" Chinese patients after a primary coronary intervention. Nutr Metab Cardiovasc Dis 2020; 30:644-651. [PMID: 32143897 DOI: 10.1016/j.numecd.2019.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIM To explore the prevalence of unknown diabetes (DM) or prediabetes (pre-DM) in "nondiabetic" patients and its association with 2-year clinical outcomes after primary percutaneous coronary intervention (PCI). METHODS AND RESULTS 5202 consecutive "nondiabetic" patients who underwent primary PCI at Fuwai Hospital from January to December 2013 were prospectively enrolled. The patients were grouped according to their glycemia status: unknown DM (HbA1c ≥ 47 mmol/L; FPG≥ 7.0 mmol/L), pre-DM (HbA1c 39-47 mmol/L; FPG: 5.6-6.9 mmol/L) and normoglycemia (NG, HbA1c < 39 mmol/L; FPG < 5.6 mmol/L). The main endpoint was 2-year major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, and target vessel revascularization. A total of 905 patients had unknown DM, and 3407 patients had pre-DM. Unknown DM and pre-DM were associated with aging (p < 0.001); a greater proportion of hypertension (p < 0.001), previous myocardial infarction (p < 0.001), and chronic kidney disease (p = 0.004). During the 2-year follow-up, the rate of MACE was significantly higher in the unknown DM and pre-DM groups than in the NG group (8.1% vs. 5.8% vs. 4.1%, respectively, p = 0.001). Multivariate analyses demonstrated that unknown DM was associated with a 1.9-fold higher event risk compared to NG (95% CI: 1.2-2.8). CONCLUSIONS The prevalence of abnormal glucose metabolism was high in "nondiabetic" Chinese PCI patients. Patients with unknown DM and pre-DM had higher event risks than those with NG. In "nondiabetes" patients requiring PCI, routine assessment of HbA1c and FPG appears to be of value to identify patients with an increased event risk.
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Affiliation(s)
- Huanhuan Wang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaofang Tang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingjing Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ping Jiang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Jiang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhan Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jue Chen
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yin Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xueyan Zhao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuejin Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Runlin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinqing Yuan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
| | - Lijian Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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Nishioka Y, Okada S, Noda T, Myojin T, Kubo S, Ohtera S, Kato G, Kuroda T, Ishii H, Imamura T. Absolute risk of acute coronary syndrome after severe hypoglycemia: A population-based 2-year cohort study using the National Database in Japan. J Diabetes Investig 2020; 11:426-434. [PMID: 31581351 PMCID: PMC7078084 DOI: 10.1111/jdi.13153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS/INTRODUCTION Although the epidemiological relationship between hypoglycemia and increased risk of acute coronary syndrome (ACS) has been well established, the time period for increased risk of ACS after a severe hypoglycemic episode remains unknown. The present study aimed to determine the ACS risk after a severe hypoglycemic episode. MATERIALS AND METHODS We carried out a retrospective population-based cohort study based on national claims data in Japan. We retrieved data of diabetes patients aged ≥35 years collected from April 2014 to March 2016. The absolute risk of ACS was defined as the occurrence of an emergency percutaneous coronary intervention after a severe hypoglycemic episode. RESULTS In total, data of 7,909,626 patients were included in the analysis. The absolute risk of ACS was 2.9 out of 1,000 person-years in all patients. ACS risk in patients with severe hypoglycemic episodes was 3.0 out of 1,000 person-years. Severe hypoglycemic episodes increased the absolute risk of ACS in patients aged ≥70 years, but not in patients aged <70 years. The absolute risk of ACS was 10.6 out of 1,000 person-years within 10 days of a severe hypoglycemic episode. There was a significant trend between shorter duration after an episode and higher ACS risk. CONCLUSIONS Severe hypoglycemia was associated with an increased risk of ACS in elderly diabetes patients. ACS risk increased with a shorter period after a severe hypoglycemic episode, suggesting that severe hypoglycemia leads to an increased risk of ACS in diabetes patients. These findings show that it is important to avoid severe hypoglycemia while treating diabetes, particularly in elderly patients.
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Affiliation(s)
- Yuichi Nishioka
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
- Department of DiabetologyNara Medical UniversityNaraJapan
| | - Sadanori Okada
- Department of DiabetologyNara Medical UniversityNaraJapan
| | - Tatsuya Noda
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
| | - Tomoya Myojin
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
| | - Shosuke Ohtera
- Division of Medical Information Technology and Administration PlanningKyoto University HospitalKyotoJapan
| | - Genta Kato
- Solutions Center for Health Insurance ClaimsKyoto University HospitalKyotoJapan
| | - Tomohiro Kuroda
- Division of Medical Information Technology and Administration PlanningKyoto University HospitalKyotoJapan
| | - Hitoshi Ishii
- Department of DiabetologyNara Medical UniversityNaraJapan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and PolicyNara Medical UniversityNaraJapan
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German recommendations for physical activity and physical activity promotion in adults with noncommunicable diseases. Int J Behav Nutr Phys Act 2020; 17:12. [PMID: 32024526 PMCID: PMC7003325 DOI: 10.1186/s12966-020-0919-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Existing physical activity guidelines predominantly focus on healthy age-stratified target groups. The objective of this study was to develop evidence-based recommendations for physical activity (PA) and PA promotion for German adults (18–65 years) with noncommunicable diseases (NCDs). Methods The PA recommendations were developed based on existing PA recommendations. In phase 1, systematic literature searches were conducted for current PA recommendations for seven chronic conditions (osteoarthrosis of the hip and knee, chronic obstructive pulmonary disease, stable ischemic heart disease, stroke, clinical depression, and chronic non-specific back pain). In phase 2, the PA recommendations were evaluated on the basis of 28 quality criteria, and high-quality recommendations were analysed. In phase 3, PA recommendations for seven chronic conditions were deducted and then synthesised to generate generic German PA recommendations for adults with NCDs. In relation to the recommendations for PA promotion, a systematic literature review was conducted on papers that reviewed the efficacy/effectiveness of interventions for PA promotion in adults with NCDs. Results The German recommendations for physical activity state that adults with NCDs should, over the course of a week, do at least 150 min of moderate-intensity aerobic PA, or 75 min of vigorous-intensity aerobic PA, or a combination of both. Furthermore, muscle-strengthening activities should be performed at least twice a week. The promotion of PA among adults with NCDs should be theory-based, specifically target PA behaviour, and be tailored to the respective target group. In this context, and as an intervention method, exercise referral schemes are one of the more promising methods of promoting PA in adults with NCDs. Conclusion The development of evidence-based recommendations for PA and PA promotion is an important step in terms of the initiation and implementation of actions for PA-related health promotion in Germany. The German recommendations for PA and PA promotion inform adults affected by NCDs and health professionals on how much PA would be optimal for adults with NCDs. Additionally, the recommendations provide professionals entrusted in PA promotion the best strategies and interventions to raise low PA levels in adults with NCDs. The formulation of specific PA recommendations for adults with NCDs and their combination with recommendations on PA promotion is a unique characteristic of the German recommendations.
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Nasi M, Patrizi G, Pizzi C, Landolfo M, Boriani G, Dei Cas A, Cicero AFG, Fogacci F, Rapezzi C, Sisca G, Capucci A, Vitolo M, Galiè N, Borghi C, Berrettini U, Piepoli M, Mattioli AV. The role of physical activity in individuals with cardiovascular risk factors: an opinion paper from Italian Society of Cardiology-Emilia Romagna-Marche and SIC-Sport. J Cardiovasc Med (Hagerstown) 2020; 20:631-639. [PMID: 31436678 DOI: 10.2459/jcm.0000000000000855] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
: Regular physical activity is a cornerstone in the prevention and treatment of atherosclerotic cardiovascular disease (CVD) due to its positive effects in reducing several cardiovascular risk factors. Current guidelines on CVD suggest for healthy adults to perform at least 150 min/week of moderate intensity or 75 min/week of vigorous intensity aerobic physical activity. The current review explores the effects of physical activity on some risk factors, specifically: diabetes, dyslipidemia, hypertension and hyperuricemia. Physical activity induces an improvement in insulin sensitivity and in glucose control independently of weight loss, which may further contribute to ameliorate both diabetes-associated defects. The benefits of adherence to physical activity have recently proven to extend beyond surrogate markers of metabolic syndrome and diabetes by reducing hard endpoints such as mortality. In recent years, obesity has greatly increased in all countries. Weight losses in these patients have been associated with improvements in many cardiometabolic risk factors. Strategies against obesity included caloric restriction, however greater results have been obtained with association of diet and physical activity. Similarly, the beneficial effect of training on blood pressure via its action on sympathetic activity and on other factors such as improvement of endothelial function and reduction of oxidative stress can have played a role in preventing hypertension development in active subjects. The main international guidelines on prevention of CVD suggest to encourage and to increase physical activity to improve lipid pattern, hypertension and others cardiovascular risk factor. An active action is required to the National Society of Cardiology together with the Italian Society of Sports Cardiology to improve the prescription of organized physical activity in patients with CVD and/or cardiovascular risk factors.
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Affiliation(s)
- Milena Nasi
- Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena
| | | | - Carmine Pizzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum
| | - Matteo Landolfo
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena
| | - Alessandra Dei Cas
- Endocrinology and Metabolism, Department of Clinical and Experimental Medicine, University of Parma, Parma
| | - Arrigo F G Cicero
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna
| | - Federica Fogacci
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna
| | - Claudio Rapezzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum
| | - Giovanbattista Sisca
- Bologna F.C.,FIFA Medical Centre of Excellence, Isokinetic Medical Group, Bologna
| | | | - Marco Vitolo
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum
| | - Claudio Borghi
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna
| | | | - Massimo Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Anna V Mattioli
- Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena
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Frank U, Nikol S, Belch J, Boc V, Brodmann M, Carpentier PH, Chraim A, Canning C, Dimakakos E, Gottsäter A, Heiss C, Mazzolai L, Madaric J, Olinic DM, Pécsvárady Z, Poredoš P, Quéré I, Roztocil K, Stanek A, Vasic D, Visonà A, Wautrecht JC, Bulvas M, Colgan MP, Dorigo W, Houston G, Kahan T, Lawall H, Lindstedt I, Mahe G, Martini R, Pernod G, Przywara S, Righini M, Schlager O, Terlecki P. ESVM Guideline on peripheral arterial disease. VASA 2019; 48:1-79. [DOI: 10.1024/0301-1526/a000834] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Pomero F, Dentali F, Mumoli N, Salomone P, Tangianu F, Desideri G, Mastroiacovo D. The continuous challenge of antithrombotic strategies in diabetes: focus on direct oral anticoagulants. Acta Diabetol 2019; 56:1247-1258. [PMID: 31552542 DOI: 10.1007/s00592-019-01426-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/17/2019] [Indexed: 12/16/2022]
Abstract
Direct oral anticoagulants (DOACs) include dabigatran, which inhibits thrombin, and apixaban, edoxaban, and rivaroxaban, which inhibit factor Xa. They have been extensively studied in large trials involving patients affected by the most common cardiovascular diseases. As the presence of diabetes leads to peculiar changes in primary and secondary hemostasis, in this review we highlight the current evidence regarding DOAC use in diabetic patients included in the majority of recently conducted studies. Overall, in trials involving patients with atrial fibrillation, data seem to confirm at least a similar efficacy and safety of DOACs compared to warfarin in patients with or without diabetes. Furthermore, in diabetic patients, treatment with DOACs is associated with a significant relative reduction in vascular death compared to warfarin. In trials enrolling patients undergoing percutaneous coronary intervention, results concerning bleeding events are consistent in patients with or without diabetes. With regards to the COMPASS study, in patients with diabetes (n = 10,241), addition of rivaroxaban 2.5 mg to aspirin resulted in a significantly lower incidence of major adverse cardiovascular events (HR 0.74, 95% CI 0.61-0.90; interaction p = 0.68) with higher rates of major bleeding expected (HR 1.70, 95% CI 1.25-2.31). The 3287 patients with peripheral artery disease and diabetes receiving rivaroxaban plus aspirin had a twofold higher absolute reduction in the composite endpoint (cardiovascular death, myocardial infarction, and stroke) than patients without diabetes. Finally, we report the involvement of cytochromes or P-glycoprotein on the metabolism of the most commonly prescribed glucose-lowering drugs. No clinically relevant interactions are expected during the concomitant use of DOACs and anti-diabetic agents.
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Affiliation(s)
- Fulvio Pomero
- Department of Internal Medicine, S. Lazzaro Hospital, Alba, CN, Italy.
| | - Francesco Dentali
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Nicola Mumoli
- Department of Internal Medicine, Ospedale Fornaroli, Magenta, Italy
| | - Pietro Salomone
- Specialty Training in Internal Medicine, University of Turin, Turin, Italy
| | - Flavio Tangianu
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Science, San Salvatore Hospital, University of L'Aquila, Building Delta 6, L'Aquila, Italy
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Effect of Exercise on Risk Factors of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2019; 98:103-116. [PMID: 30020090 DOI: 10.1097/phm.0000000000001002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objectives of this study were to examine the effectiveness of different types of exercise on risk factors of diabetic foot ulcers, including glycated hemoglobin, peripheral arterial disease, and diabetic peripheral neuropathy, in people with type 2 diabetes mellitus. PubMed, Web of Science, Cochrane Library, Scopus, and CINAHL were searched from inception to January 2018 for relevant articles. Eligible studies were randomized controlled trials that examined effects of exercise on the selected risk factors. Twenty randomized controlled trials with 1357 participants were included in the meta-analyses. The differences in postintervention values of glycated hemoglobin and ankle brachial index between exercise and control groups were synthesized, yielding mean differences of -0.45% (P < 0.00001) and 0.03 (P = 0.002), respectively; the differences in within-group changes in glycated hemoglobin were synthesized, yielding mean differences of -0.19% (P = 0.1), -0.25% (P = 0.0006), and -0.64% (P = 0.006) for aerobic versus resistance, combined versus aerobic, and combined versus resistance exercise, respectively. Exercise has a significant effect on reducing glycated hemoglobin, whereas combined exercise is more effective compared with aerobic or resistance exercise alone. Exercise also improves ankle brachial index. However, evidence regarding the association between exercise and peripheral neuropathy and risks of diabetic foot ulcers in people with type 2 diabetes mellitus remains insufficient.
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Johansen M, Schou M, Rasmussen J, Rossignol P, Holm M, Chabanova E, Dela F, Faber J, Kistorp C. Low N-terminal pro-brain natriuretic peptide levels are associated with non-alcoholic fatty liver disease in patients with type 2 diabetes. DIABETES & METABOLISM 2019; 45:429-435. [DOI: 10.1016/j.diabet.2018.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 12/24/2022]
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Olesen KKW, Gyldenkerne C, Madsen M, Thim T, Jensen LO, Raungaard B, Sørensen HT, Bøtker HE, Maeng M. Extent of coronary artery disease is associated with myocardial infarction and mortality in patients with diabetes mellitus [Response to Letter]. Clin Epidemiol 2019; 11:721-722. [PMID: 31496826 PMCID: PMC6698142 DOI: 10.2147/clep.s222994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kevin Kris Warnakula Olesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Georges A, Galbiati L, Clair C. Smoking in men and women with type 2 diabetes: A qualitative gender-sensitive exploration of barriers to smoking cessation among people with type 2 diabetes. PLoS One 2019; 14:e0221783. [PMID: 31461485 PMCID: PMC6713328 DOI: 10.1371/journal.pone.0221783] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives Despite growing evidence of the impact of smoking on diabetes complications, people with type 2 diabetes still smoke at high rates and little is known about the specific barriers to quit smoking in this group. The purpose of this article is to explore the perception of smoking, and motivation and barriers to quit among smokers with type 2 diabetes. This exploratory study will help designing a smoking cessation intervention tailored to the needs of people with type 2 diabetes. We hypothesize both that living with diabetes and gender may raise additional difficulties to quit smoking. Setting The qualitative exploratory research included ten in-depth semi-structured individual interviews and five focus groups conducted in an Ambulatory Care University Hospital in Switzerland. The thematic analysis was conducted with a gender-sensitive focus. Participants Both current and former smokers recruited from the ambulatory clinic and the community took part in the qualitative interviews. We restricted the analysis to 21 current smokers only. Results The sample included 12 men and 9 women with type 2 diabetes, having a mean age of 59.4 years, who had diabetes for an average of 9 years with a mean HbA1c of 7.4%. We found that harmful effects of tobacco were superficially understood, and participants used several patterns of thinking to minimize the risks. The relation between tobacco and diabetes was poorly known. Readiness to change was related to personal self-image and meaningful engagement in life and social relationships. Barriers could be organized into three groups: dependence, psychological habits and social barriers. Barriers were markedly shaped by gender and living with diabetes. Conclusions Results suggest that “one -fits-all” smoking cessation interventions do not satisfy the needs of type 2 diabetic smokers. Personalized smoking cessation interventions should be preferred and should pursue positive psychological outcomes addressing contextual factors.
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Affiliation(s)
- Aurélien Georges
- Programme cantonal Diabète (PcD), Department of Ambulatory care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Laura Galbiati
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
- * E-mail:
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Bozdemir Ozel C, Arikan H, Demirtas RN, Saglam M, Calik-Kutukcu E, Vardar-Yagli N, Inal-Ince D, Akalin A, Celer O, Sonbahar-Ulu H, Cakmak A. Evaluation of exercise capacity using two field tests in patients with metabolic syndrome. Disabil Rehabil 2019; 43:1015-1021. [PMID: 31393177 DOI: 10.1080/09638288.2019.1648569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Field tests are popular for assessing exercise capacity because they are practical and have established validity. The objective of this study was to compare physiological responses and exercise performance of patients with metabolic syndrome in two field tests of exercise capacity. MATERIAL AND METHODS Forty-seven patients diagnosed with metabolic syndrome participated in this cross-sectional study. Exercise capacity was assessed using incremental shuttle walk test and six-minute walk test. Factors determining exercise capacity and agreement between the two tests were also investigated. RESULTS Metabolic syndrome patients achieved a significantly greater percentage of predicted maximal heart rate, blood pressure, and longer distance in the incremental shuttle walk test than in the six-minute walk test (p < 0.001). Gender and body mass index explained 48.5% of the variance in six-minute walk test distance (R = 0.697, R2 = 0.485, F(2-46) = 20.737, p < 0.001). Body mass index and fat-free mass explained 55% of the variance in incremental shuttle walk test distance (R = 0.746, R2= 0.557, F(2-46) = 27.623, p < 0.001). CONCLUSIONS Despite the agreement in the percentages of predicted maximal heart rate during these two field tests, the incremental shuttle walk test may be a better assessment tool than the six-minute walk test because it elicits more pronounced and definitive physiological responses to exercise tolerance in patients with metabolic syndrome.IMPLICATIONS FOR REHABILITATIONThe incremental shuttle walk test can be used to evaluate exercise capacity in metabolic syndrome.The incremental shuttle walk test elicits greater physiological responses than the six-minute walk test.The incremental shuttle walk test may be preferable over the six-minute walk test in investigating exercise capacity.Both tests can guide and assist in the evaluation of this patient population in clinical practice.Body mass index affected distance in both exercise tests.
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Affiliation(s)
- Cemile Bozdemir Ozel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Hulya Arikan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Raziye Nesrin Demirtas
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Melda Saglam
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Aysen Akalin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ozgen Celer
- Department of Endocrinology and Metabolism, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Hazal Sonbahar-Ulu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Aslihan Cakmak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Rosticci M, Pervjakova N, Kaakinen M, Cicero AF, Feufer AP, Marullo L, Mägi R, Fischer K, Jiang L, D'Addato S, Rizzoli E, Massimo G, Giovannini M, Angelini S, Hrelia P, Scapoli C, Borghi C, Prokopenko I. A meta-analysis of Italian and Estonian individuals shows an effect of common variants in HMGCR on blood apoB levels. Biomark Med 2019; 13:931-940. [PMID: 30191727 DOI: 10.2217/bmm-2017-0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of the study was to explore the effects of variants at HMGCR-KIF6loci on a range of cardio-metabolic phenotypes. Methods: We analyzed the range of variants within Genetics in Brisighella Health Study and KIF6 genes using an additive genetic model on 18 cardiometabolic phenotypes in a sample of 1645 individuals from the Genetics in Brisighella Health Study and replicated in 10,662 individuals from the Estonian Genome Center University of Tartu. Results: We defined directly the effects of rs3846662:C>A at HMGCR on apoB levels. The analysis also confirmed effects of on low-density lipoprotein-cholesterol and total cholesterol levels. Variants in KIF6 gene did not reveal any associations with cardiometabolic phenotypes. Conclusion: This study highlights effect of HMGCR locus on assay-determined apoB levels, an infrequent measure of blood lipids in large studies.
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Affiliation(s)
- Martina Rosticci
- Medicine & Surgery Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Natalia Pervjakova
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia.,Department of Biotechnology, Institute of Molecular & Cell Biology, University of Tartu, Tartu, Estonia.,Genomics of Common Disease, Division of Diabetes, Endocrinology & Metabolism, Department of Medicine, Imperial College London, London, UK
| | - Marika Kaakinen
- Genomics of Common Disease, Division of Diabetes, Endocrinology & Metabolism, Department of Medicine, Imperial College London, London, UK.,Pharmacology & Therapeutics, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - Arrigo F Cicero
- Medicine & Surgery Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Arne P Feufer
- Institute of Bioinformatics & Systems Biology, Helmholtz Zentrum München, München, Germany
| | - Letizia Marullo
- Department of Life Sciences & Biotechnology, University of Ferrara, Ferrara, Italy
| | - Reedik Mägi
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Krista Fischer
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Longda Jiang
- Genomics of Common Disease, Division of Diabetes, Endocrinology & Metabolism, Department of Medicine, Imperial College London, London, UK
| | - Sergio D'Addato
- Medicine & Surgery Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elisabetta Rizzoli
- Medicine & Surgery Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gianmichele Massimo
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum University of Bologna, Italy
| | - Marina Giovannini
- Medicine & Surgery Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Sabrina Angelini
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum University of Bologna, Italy
| | - Patrizia Hrelia
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum University of Bologna, Italy
| | - Chiara Scapoli
- Department of Life Sciences & Biotechnology, University of Ferrara, Ferrara, Italy
| | - Claudio Borghi
- Medicine & Surgery Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Inga Prokopenko
- Genomics of Common Disease, Division of Diabetes, Endocrinology & Metabolism, Department of Medicine, Imperial College London, London, UK
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Colaiori I, Izzo R, Barbato E, Franco D, Di Gioia G, Rapacciuolo A, Bartunek J, Mancusi C, Losi MA, Strisciuglio T, Manzi MV, de Simone G, Trimarco B, Morisco C. Severity of Coronary Atherosclerosis and Risk of Diabetes Mellitus. J Clin Med 2019; 8:jcm8071069. [PMID: 31330868 PMCID: PMC6678313 DOI: 10.3390/jcm8071069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Cardio-vascular target organ damage predicts the onset of type 2 diabetes mellitus (DM) in hypertensive patients. Whether an increased incidence of DM is also in relation to the severity of coronary atherosclerosis is unknown. Objective: We evaluated the onset of DM in relation to the extent and severity of coronary atherosclerosis, using the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score (SS), in patients with stable angina or acute coronary syndromes, referred for coronary angiography (CA). Methods: Non-diabetic patients that underwent CA for the first time were included, and the SS was computed. Predictors of DM onset in low, medium, and high SSs were investigated. Results: Five hundred and seventy patients were included, and the mean SS was 6.3 ± 7.6. During a median follow-up of 79 months (interquartile range (IQR): 67–94), 74 patients (13%) developed DM. The risk of DM onset was significantly higher in the patients with a medium or high SS (hazard ratio (HR)—95% confidence interval (CI): 16 (4–61), p < 0.0001; and 30 (9–105), p < 0.0001, vs low SS, respectively), even after adjustment for obesity, history of hypertension, impaired fasting glucose, and cardiovascular therapy. Conclusions: The severity and extent of the coronary atherosclerosis, evaluated by the SS, is a strong and independent predictor of the development of DM in patients, referred to CA.
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Affiliation(s)
- Iginio Colaiori
- Cardiovascular Research Center Aalst OLV Hospital, 9300 Aalst, Belgium
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy.
| | - Danilo Franco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Giuseppe Di Gioia
- Cardiovascular Research Center Aalst OLV Hospital, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Jozef Bartunek
- Cardiovascular Research Center Aalst OLV Hospital, 9300 Aalst, Belgium
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Teresa Strisciuglio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy
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44
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Cloete L, Mitchell BG, Morton D. Protocol: investigating the effectiveness and cost benefit of a lifestyle intervention targeting type 2 diabetes in Australia. BMC Endocr Disord 2019; 19:74. [PMID: 31307434 PMCID: PMC6631877 DOI: 10.1186/s12902-019-0396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/12/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) has become an endemic disease. A number of interrelated factors increase the risk of the onset of T2DM, however much of the pathogenesis of the disease is associated with lifestyle. A number of studies have indicated that adopting positive lifestyle changes can successfully prevent or delay the onset of T2DM in a number of different population groups. The CHIP intervention is a lifestyle program that has been shown in over more than 30 published papers have indicated that the CHIP intervention leads to dramatic improvement in the indicators of T2DM these diseases of lifestyle. METHODS A randomized control trial will be conducted involving 150 individuals with an established diagnosis of T2DM. All participants will continue to receive usual ongoing diabetes care, however, the intervention group (75 individuals) will in addition participate in a 12-week CHIP lifestyle intervention programme followed by a further 9 months of monthly follow-up appointments. Approval for funding was obtained on 30 June 2017. DISCUSSION The outcomes of this study have the potential to inform decisions about patient treatment and potentially provide incentive for the provision of funded lifestyle-based preventive and restorative programs for patients diagnosed with T2DM. TRIAL REGISTRATION This trial is registered as an initial version with the Australia New Zealand Clinical Trials Registry ( http://www.anzctr.org.au/ ), registration number ACTRN12617001233314. Registered on 23/08/2017. No enrollments in the study to date.
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Affiliation(s)
- Linda Cloete
- Faculty of Arts Nursing and Theology, Avondale College of Higher Education, 185 Fox Valley Road, Wahroonga, Sydney, NSW, 2076, Australia.
| | - Brett G Mitchell
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Q-10 Loop Road & The Boulevarde, Ourimbah, NSW, Australia
| | - Darren Morton
- Faculty of Education and Business, Avondale College of Higher Education, 582 Freemans Drive, Cooranbong, NSW, Australia
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45
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Papadimitriou-Olivgeris M, Psychogiou R, Garessus J, Camaret AD, Fourre N, Kanagaratnam S, Jecker V, Nusbaumer C, Monnerat LB, Kocher A, Portillo V, Duplain H. Predictors of mortality of bloodstream infections among internal medicine patients in a Swiss Hospital: Role of quick Sequential Organ Failure Assessment. Eur J Intern Med 2019; 65:86-92. [PMID: 31128976 DOI: 10.1016/j.ejim.2019.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sepsis has been associated with high morbidity and mortality. The aims were to determine predictors of mortality among patients with bloodstream infections (BSIs) and to ascertain the role of quick Sequential Organ Failure Assessment (qSOFA) in predicting poor outcomes. METHODS All internal medicine patients with BSIs at the Hospital of Jura, Switzerland during a three year period (July 2014 to June 2017) were included. RESULTS Among 404 BSIs, Escherichia coli represented the most common species isolated (156 episodes; 38.6%), followed by Staphylococcus aureus (68; 16.8%). The most common site of infection was urinary tract accounting for 39.6% of BSIs (160 episodes). Thirty-day mortality was 18.1%. Multivariate analysis revealed BSI due to staphylococci, malignancy (haematologic or solid organ), qSOFA≥2 points, Pitt bacteraemia score as independent predictors of mortality, while appropriate empiric antibiotic therapy and administration of antibiotic therapy within three hours from infection's recognition were identified as a predictor of good prognosis. qSOFA showed the highest sensitivity (87.7%), negative predictive value (96.6%) and accuracy (0.83) as compared to other scores. Mortality among 141 septic patients was 45.4%. Malignancy (haematologic or solid organ), primary BSI, Pitt bacteraemia score, were independently associated with mortality, while appropriate empiric antibiotic therapy and administration of antibiotic therapy within the first hour from infection's recognition were associated with better prognosis. CONCLUSION qSOFA as compared to other severity scores showed an excellent negative predictive value. Better prognosis was associated with administration of appropriate empiric antibiotic therapy and its timely initiation.
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Affiliation(s)
| | - Roxanni Psychogiou
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Jonathan Garessus
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Adeline De Camaret
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Nicolas Fourre
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | | | - Virginie Jecker
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | | | | | - Alain Kocher
- Intensive Care Unit, Hospital of Jura, Delémont, Switzerland
| | - Vera Portillo
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Hervé Duplain
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
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46
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Saponara S, Fusi F, Spiga O, Trezza A, Hopkins B, Brimble MA, Rennison D, Bova S. The Selective Rat Toxicant Norbormide Blocks K ATP Channels in Smooth Muscle Cells But Not in Insulin-Secreting Cells. Front Pharmacol 2019; 10:598. [PMID: 31191321 PMCID: PMC6540933 DOI: 10.3389/fphar.2019.00598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/09/2019] [Indexed: 12/02/2022] Open
Abstract
Norbormide is a toxicant selective for rats to which it induces a widespread vasoconstriction. In a recent paper, we hypothesized a role of ATP-sensitive potassium (KATP) channels in norbormide-induced vasoconstriction. The current study was undertaken to verify this hypothesis by comparing the effects of norbormide with those of glibenclamide, a known KATP channel blocker. The whole-cell patch-clamp method was used to record KATP currents in myocytes freshly isolated from the rat and mouse caudal artery and from the rat gastric fundus, as well as in insulin-secreting pancreatic beta cells (INS-1 cells). Smooth muscle contractile function was assessed on either rat caudal artery rings or gastric fundus strips. Molecular modeling and docking simulation to KATP channel proteins were investigated in silico. Both norbormide (a racemic mixture of endo and exo isomers) and glibenclamide inhibited KATP currents in rat and mouse caudal artery myocytes, as well as in gastric fundus smooth muscle cells. In rat INS-1 cells, only glibenclamide blocked KATP channels, whereas norbormide was ineffective. The inhibitory effect of norbormide in rat caudal artery myocytes was not stereo-specific as both the endo isomers (active as vasoconstrictor) and the exo isomers (inactive as vasoconstrictor) had similar inhibitory activity. In rat caudal artery rings, norbormide-induced contraction was partially reverted by the KATP channel opener pinacidil. Computational approaches indicated the SUR subunit of KATP channels as the binding site for norbormide. KATP channel inhibition may play a role in norbormide-induced vasoconstriction, but does not explain the species selectivity, tissue selectivity, and stereoselectivity of its constricting activity. The lack of effect in INS-1 cells suggests a potential selectivity of norbormide for smooth muscle KATP channels.
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Affiliation(s)
- Simona Saponara
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Fabio Fusi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Ottavia Spiga
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Alfonso Trezza
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Brian Hopkins
- Landcare Research, Lincoln, New Zealand.,School of Chemical Sciences, University of Auckland, Auckland, New Zealand
| | - Margaret A Brimble
- School of Chemical Sciences, University of Auckland, Auckland, New Zealand
| | - David Rennison
- School of Chemical Sciences, University of Auckland, Auckland, New Zealand
| | - Sergio Bova
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
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47
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Buzurtanova MB, Didigova RT, Ugurchieva ZO, Mardanov BU, Mamedov MN. Clinical and anatomical myocardium features according to invasive and non-invasive examination methods in patients with coronary artery disease in combination with diabetes mellitus. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-3-18-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim.To study the clinical and anatomical myocardium features according to invasive and non-invasive examination methods in men and women with coronary artery disease (CAD) in combination with diabetes mellitus (DM).Material and methods.A single-step clinical study included 77 men and 68 women with angina of the II-III functional classes, observed in the Republican clinical hospital in Nazran. Depending on the presence of type 2 DM and gender, patients were divided into 4 groups: Group I — men with CAD+DM (n=34), Group II — women with CAD+DM (n=36), Group III — men with CAD without DM (n=43), group IV — women with CAD without DM (n=32). All patients underwent electrocardiography (ECG), echocardiography (EchoCG) and coronary angiography.Results.Hypertrophy of the left ventricle on ECG was most often diagnosed in men with CAD+DM (38%). Similar, but less pronounced tendency is observed in men without DM (23%). Among women, these parameters were <20%. Left ventricular hypertrophy on EchoCG was determined two times more than the ECG results. Defect of local contractility and myocardial hypokinesis according to EchoCG data was found in both men and women with DM — 29% and 22%, respectively. Among patients without DM, these parameters were 40% less. In general, the frequency of cicatricial ECG changes in all groups had a similar trend. According to coronary angiography, anterior interventricular stenosis was the most frequent vascular lesion. Among men with CAD+DM, it was noted in 62% of cases, in men without DM — in 30%. Among women with CAD+DM, anterior interventricular branch stenosis is detected in 28% of cases, without ~20%. Stenosis of the circumflex branch is detected in no more than 20% of cases in men and women with CAD+DM, and in the groups without DM — in 10%. Stenosis of the right coronary artery is detected in every fourth patient, regardless of the glycemic status. The majority of patients (60%) have constriction of the coronary vessels, the absolute number of such constrictions in the groups of men with CAD and with or without DM was ~70 cases. Among women, this figure was less than 50 cases. Constriction of one or more coronary arteries >80% more often occurred among men with CAD without DM, among men and women with CAD+DM, the absolute number of such constrictions was 21-25 cases. The greatest number of stenoses ≥2 coronary arteries was observed in men with CAD+DM (~30 cases), in the group of men with CAD without DM constriction >2 vessels are found in ~20 cases. Among women, stenosis ≥2 vessels are detected twice as less as compared with men. At the same time, in the group of women with CAD+DM, the frequency of multiple stenoses was 15% higher than those of women with CAD without DM.Conclusion.Thus, using non-invasive and invasive examination methods in CAD patients, a number of complementary changes in the myocardium and coronary arteries were found. The presence of DM worsens these changes, both among men and women.
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Affiliation(s)
| | | | | | | | - M. N. Mamedov
- National Medical Research Center for Preventive Medicine
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48
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Kim GS, Park JH, Won JC. The Role of Glucagon-Like Peptide 1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors in Reducing Cardiovascular Events in Patients with Type 2 Diabetes. Endocrinol Metab (Seoul) 2019; 34:106-116. [PMID: 31099200 PMCID: PMC6599901 DOI: 10.3803/enm.2019.34.2.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 12/18/2022] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM), which is associated with cardiovascular morbidity and mortality, is increasing worldwide. Although there have been advances in diabetes treatments that reduce microvascular complications (nephropathy, neuropathy, retinopathy), many clinical studies have found that conventional oral hypoglycemic agents and glucose control alone failed to reduce cardiovascular disease. Thus, incretin-based therapies including glucagon-like peptide 1 (GLP-1) receptor agonists (RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT-2Is) represent a new area of research, and may serve as novel therapeutics for treating hyperglycemia and modifying other cardiovascular risk factors. Recently, it has been confirmed that several drugs in these classes, including canagliflozin, empagliflozin, semaglutide, and liraglutide, are safe and possess cardioprotective effects. We review the most recent cardiovascular outcome trials on GLP-1RAs and SGLT-2Is, and discuss their implications for treating patients with T2DM in terms of protective effects against cardiovascular disease.
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Affiliation(s)
- Gwang Sil Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- Cardiovascular and Metabolic Disease Center (CMDC), Inje University, Busan, Korea
| | - Joong Hyun Park
- Department of Neurology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jong Chul Won
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- Cardiovascular and Metabolic Disease Center (CMDC), Inje University, Busan, Korea.
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49
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Pararajasingam G, Løgstrup BB, Høfsten DE, Christophersen TB, Auscher S, Hangaard J, Egstrup K. Dysglycemia and increased left ventricle mass in normotensive patients admitted with a first myocardial infarction: prognostic implications of dysglycemia during 14 years of follow-up. BMC Cardiovasc Disord 2019; 19:103. [PMID: 31046690 PMCID: PMC6498536 DOI: 10.1186/s12872-019-1084-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/18/2019] [Indexed: 01/20/2023] Open
Abstract
Background Left ventricle mass (LVM) can be influenced by various conditions including hypertension and/or inherent cardiomyopathies. Dysglycemia is also thought to exert an anabolic effect on heart tissue by hyperinsulinemia and thereby promoting increased LVM. The primary aim of this study was to assess the influence of dysglycemia on LVM evaluated by an oral glucose tolerance test (OGTT) in patients admitted with a first myocardial infarction (MI) without hypertension. The secondary aim was to assess the impact of dysglycemia on major adverse cardiovascular events (MACE) and all-cause mortality during long-term follow-up. Methods Patients admitted with a first MI without known history of hypertension were included. All patients without previously known type 2 diabetes mellitus (T2DM) had a standardized 2-hour OGTT performed and were categorized as: normal glucose tolerance (NGT), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) and newly detected T2DM (new T2DM). LVM was measured by echocardiography using Devereaux formula and indexed by body surface area. Multivariate linear regression analysis was used to assess the impact of confounders (dysglycemia by OGTT, known T2DM, age, sex and type of MI) on LVM. Cox proportional hazard model was used to assess the impact of dysglycemia on all-cause mortality and a composite endpoint of MACE (all-cause mortality, MI, revascularisation due to stable angina, coronary artery bypass graft, ischemic stroke or hemorrhagic stroke). Results Two-hundred-and-five patients were included and followed up to 14 years. In multivariate regression analysis, LVM was only significantly increased in patients categorized as new T2DM (β = 25.3; 95% CI [7.5–43.0]) and known T2DM (β = 37.3; 95% CI [10.0-64.5]) compared to patients with NGT. Patients with new T2DM showed higher rates of MACE and all-cause mortality compared to patients with IFG/IGT and NGT; however no significantly increased hazard ratio was detected. Conclusions Dysglycemia is associated with increasing LVM in normotensive patients with a first acute myocardial infarction and the strongest association was observed in patients with new T2DM and patients with known T2DM. Dysglycemia in normotensive patients with a first MI is not an independent predictor of neither MACE nor all-cause mortality during long-term follow-up compared to normotensive patients without dysglycemia. Electronic supplementary material The online version of this article (10.1186/s12872-019-1084-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gokulan Pararajasingam
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark.
| | - Brian Bridal Løgstrup
- Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Dan Eik Høfsten
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | - Søren Auscher
- Department of Internal Medicine, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Jørgen Hangaard
- Department of Internal Medicine, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
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50
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Holte KB, Svanteson M, Hanssen KF, Haig Y, Solheim S, Berg TJ. Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study. J Diabetes Complications 2019; 33:383-389. [PMID: 30846232 DOI: 10.1016/j.jdiacomp.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/21/2019] [Accepted: 01/26/2019] [Indexed: 02/07/2023]
Abstract
AIMS We studied the total prevalence of obstructive coronary artery disease (CAD), undiagnosed CAD and absent CAD in persons with ≥45-year duration of type 1 diabetes (T1D) versus controls, and associations with mean HbA1c, LDL-cholesterol and blood pressure over 2-3 decades. METHODS We included 76% (n = 103) of all persons with T1D diagnosed ≤1970 attending a diabetes center and 63 controls without diabetes. We collected 20-30 years of HbA1c, LDL-cholesterol and blood pressure measurements. Participants without previously diagnosed coronary heart disease (CHD) underwent Computed Tomography Coronary Angiography (CTCA). Undiagnosed obstructive CAD was defined as any coronary stenosis >50% on CTCA, absent CAD as no detected plaque, and total obstructive CAD as either obstructive CAD on CTCA or previous CHD diagnosis. RESULTS The prevalence of undiagnosed, absent and obstructive CAD was 24% (21/88), 16% (14/88) and 35% (36/103) in T1D versus 10% (6/60), 50% (30/60) and 14% (9/63) in controls (all p < 0.05). Mean HbA1c was associated with undiagnosed obstructive CAD (OR 2.30 95% C.I. 1.13-4.69), while mean LDL-cholesterol was inversely associated with absent CAD (0.12, 0.04-0.43). CONCLUSIONS The prevalence of undiagnosed obstructive CAD was high (24%) in this cohort of long-term survivors with T1D. Mean LDL-cholesterol and HbA1c were associated with CAD.
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Affiliation(s)
- Kristine Bech Holte
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Mona Svanteson
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristian Folkvord Hanssen
- The Norwegian Diabetics' Center, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ylva Haig
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Svein Solheim
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Tore Julsrud Berg
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; The Norwegian Diabetics' Center, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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