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Abdlshikure SA, Mamo AG, Fikadu B, Seid A. Prevalence and determinants of erectile dysfunction among type 2 diabetes mellitus patients at selected government hospitals in gurage zone: A cross-sectional study. PLoS One 2025; 20:e0318908. [PMID: 40258018 PMCID: PMC12011261 DOI: 10.1371/journal.pone.0318908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Accepted: 01/23/2025] [Indexed: 04/23/2025] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is often not recognized in men with type 2 diabetes mellitus (T2DM), despite the prevalence of the disease. Early diagnosis of ED in T2DM is very important for effective treatment and prevention of serious complications such as cardiovascular events.This study investigates the prevalence and determinants of ED among T2DM patients at selected government hospitals in the Gurage Zone. METHODS We conducted a study in three public hospitals from September 1 to December 30, 2020. 204 diabetic men were selected using consecutive sampling. ED was evaluated utilizing the International Index of ED-5. Glycated hemoglobin (HbA1c) and lipid levels were analyzed utilizing a Cobas 600 clinical chemistry analyzer. The data was analyzed using the Statistical Package for Social Sciences-20. RESULTS ED was observed in 156 (76.5%) diabetic males. Independent predictors of ED included age above 40 years, alcohol consumption, khat chewing, overweight [Body mass index (BMI) ≥ 25 kg/m2], obesity (BMI ≥ 30 kg/m2), a diabetes duration of more than 5 years, uncontrolled diabetes (HbA1c > 7%), elevated low-density lipoprotein (LDL), and high total cholesterol levels (P < 0.05). CONCLUSION The study confirmed a high prevalence of ED among males with T2DM in the study settings. Consequently, clinicians should adopt preventive measures and focus on identifying the factors associated with ED in these patients.
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Affiliation(s)
- Seid Abrar Abdlshikure
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Aklilu Getachew Mamo
- School of Medical Laboratory Science, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Bisrat Fikadu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Abdulber Seid
- Department of Educational Planning & Management, College of Education & Behavioral Sciences, Wolkite University, Wolkite, Ethiopia
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Ramharack L, Hawkes CP, Coughlin P, Juste L, Ojukwu S, Willi SM, Singh A. Interpreting positive celiac serology in children with new-onset type 1 diabetes. J Pediatr Endocrinol Metab 2025; 38:224-230. [PMID: 39815158 DOI: 10.1515/jpem-2024-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 12/27/2024] [Indexed: 01/18/2025]
Abstract
OBJECTIVES The association of celiac disease (CD) in type 1 diabetes mellitus (T1DM) is well-established, yet variation exists in screening practices. This study measures the accuracy of early screening with tissue transglutaminase immunoglobulin A (TTG-IgA) and endomysial antibody (EMA) in newly diagnosed T1DM. METHODS This is a retrospective study of children with T1DM between 2013 and 2019 with early CD screening and follow-up. Data elements included anthropometrics, serologies, blood pH, bicarbonate, and Hemoglobin A1c. Celiac serologies were analyzed using chi-square and receiver operating characteristic curves to calculate optimal levels for predicting CD. RESULTS A total of 1,292 children met inclusion criteria with 142 having positive celiac serologies; 47 (33.1 %) of whom were subsequently diagnosed with CD - an incidence of 3.6 %. All subjects with positive EMA and TTG-IgA ≥8 times upper limit of normal were diagnosed with CD. Gastrointestinal symptoms, BMI, and thyroid disease were not statistically significant variables in this cohort, although there was a trend toward CD in lower BMI patients and higher TTG IgA in those with markedly elevated HgbA1c. CONCLUSIONS Early celiac screening in T1DM is reliable and promotes timely CD diagnosis and treatment. Although transient positive celiac serologies were noted, the degree of TTG-IgA elevation and EMA positivity are strong predictors of coexisting CD. Larger prospective studies using these assays will further define the risk stratification algorithm that is needed for our T1DM community.
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Affiliation(s)
- Lydia Ramharack
- Division of Gastroenterology, Hepatology, & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Paige Coughlin
- Division of Gastroenterology, Hepatology, & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lionola Juste
- Division of Gastroenterology, Hepatology, & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sando Ojukwu
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Joslin Diabetes Center, Section on Clinical, Behavioral and Outcomes Research, Boston, Massachusetts, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven M Willi
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arunjot Singh
- Division of Gastroenterology, Hepatology, & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Saeed ZI, Ostrominski JW, Aroda VR. Polypharmacy in Type 2 Diabetes: Appropriate or Cause for Concern? Diabetes Care 2024; 47:2104-2106. [PMID: 39602592 DOI: 10.2337/dci24-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 08/31/2024] [Indexed: 11/29/2024]
Affiliation(s)
- Zeb I Saeed
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - John W Ostrominski
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Hu L, Lin NF, Shi Y, Cao J, Sevick MA, Li H, Beasley JM, Levy N, Tamura K, Xu X, Jiang Y, Ong I, Yang X, Bai Y, Su L, Chan SW, Yi SS. The Integrating Cultural Aspects Into Diabetes Education (INCLUDE) Study to Prevent Diabetes in Chinese Immigrants: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e65455. [PMID: 39560984 PMCID: PMC11615548 DOI: 10.2196/65455] [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: 08/16/2024] [Revised: 09/20/2024] [Accepted: 09/28/2024] [Indexed: 11/20/2024] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) contributes to significant morbidity and mortality for Chinese immigrants in the United States, exacerbated by social determinants of health (SDOH) barriers such as language barriers, limited access to healthy foods, and low health literacy. OBJECTIVE The goal of the Integrating Cultural Aspects into Diabetes Education (INCLUDE) study is to test a social media-based intervention adapting the Diabetes Prevention Program (DPP) for Chinese immigrants alongside a culturally adapted, community-supported agriculture program. Here, we report the protocol for the INCLUDE study. METHODS INCLUDE is a 3-year randomized controlled trial (n=150). Participants with prediabetes or at risk for T2D are enrolled and randomized into either the control or intervention group (n=75 each). Participants from the intervention group receive 2-3 culturally tailored, in-language DPP videos weekly for 12 weeks, as well as biweekly phone calls from bilingual study staff to review video content, support goal setting, and assess and address SDOH-related barriers such as food insecurity. Intervention participants will also be given produce for 10 weeks as part of the community-supported agriculture program. Weight (primary outcome), self-efficacy, diet, physical activity, and food insecurity (secondary outcomes) are measured at baseline, 3-month, and 6-month intervals. Splined linear mixed models will be used to examine group differences in longitudinal weight and other secondary outcomes. The INCLUDE study was approved by the Institutional Review Board at the NYU Grossman School of Medicine. RESULTS Recruitment started in May 2023, with the first cohort of 75 participants enrolled and randomized into 2 groups in July 2023. The 3-month and 6-month assessment of the first-year cohort has been completed. We have recruited 75 participants for the second cohort as of July 2024. CONCLUSIONS The INCLUDE study will serve as an innovative model for culturally adapted, multilevel interventions for underserved communities previously unable to access evidence-based diabetes prevention initiatives. Aligning with several national calls for multilevel interventions, the INCLUDE intervention will provide critical data that will inform how researchers and public health professionals address SDOH barriers faced by underserved populations and prevent diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT05492916; https://clinicaltrials.gov/study/NCT05492916. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/65455.
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Affiliation(s)
- Lu Hu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
| | - Nelson F Lin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
- UC Berkeley-UCSF Joint Medical Program, Berkeley, CA, United States
| | - Yun Shi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
| | - Jiepin Cao
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Jeannette M Beasley
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, United States
| | - Natalie Levy
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Xinyi Xu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
| | - Yulin Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
| | - Iris Ong
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
| | - Ximin Yang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
| | - Yujie Bai
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, United States
| | - Liwen Su
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, United States
| | - Sze Wan Chan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Stella S Yi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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Murugiah V, Pal P, Sahoo J, Nanda N, Shamanna SB. Association of Low Vitamin D Status With Adiponectin and Fibroblast Growth Factor-21 in Newly Diagnosed Type 2 Diabetes Mellitus Patients. Cureus 2024; 16:e71448. [PMID: 39544568 PMCID: PMC11560389 DOI: 10.7759/cureus.71448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2024] [Indexed: 11/17/2024] Open
Abstract
INTRODUCTION Adiponectin and fibroblast growth factor-21 (FGF-21) have important roles in metabolic regulation and insulin sensitivity. Vitamin D is linked to metabolic dysregulation, inflammation, and oxidative stress in chronic type 2 diabetes mellitus (T2DM). The present study aimed to assess the relationship of vitamin D levels with adiponectin and FGF-21 in newly diagnosed T2DM. METHODS A descriptive study was conducted on 47 patients with newly diagnosed T2DM recruited based on the American Diabetes Association criteria. Fasting plasma glucose and insulin were measured, and the homeostatic model assessment for insulin resistance was calculated. The serum levels of metabolic regulators such as vitamin D, adiponectin, and FGF-21; inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor-α, and high-sensitivity C-reactive protein; and oxidative stress markers such as malondialdehyde (MDA) and total antioxidant status were measured. RESULTS The mean serum vitamin D concentration was 17.49±7.10 ng/ml, and all patients had low vitamin D levels (<30 ng/ml). Vitamin D was positively correlated with adiponectin (r=0.331, p=0.023), and it was negatively correlated with FGF-21 (r=-0.356, p=0.014), IL-6 (r=-0.411, p=0.004), and MDA (r=-0.515, p<0.001). CONCLUSION There was a reduction in vitamin D concentration in all subjects. Vitamin D showed a positive association with adiponectin and a negative association with FGF-21 and inflammatory and oxidative stress markers. Vitamin D deficiency might increase the risk of progression of T2DM in these subjects.
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Affiliation(s)
- Visakamutharasi Murugiah
- Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Pravati Pal
- Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Jayaprakash Sahoo
- Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Nivedita Nanda
- Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Suryanarayana B Shamanna
- General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Gray J, Thynne TR, Eaton V, Larcombe R, Tantiongco M, Karnon J. Using Expert Elicitation to Adjust Published Intervention Effects to Reflect the Local Context. MDM Policy Pract 2024; 9:23814683231226335. [PMID: 38283395 PMCID: PMC10812103 DOI: 10.1177/23814683231226335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Abstract
Background. Local health services make limited use of economic evaluation to inform decisions to fund new health service interventions. One barrier is the relevance of published intervention effects to the local setting, given these effects can strongly reflect the original evaluation context. Expert elicitation methods provide a structured approach to explicitly and transparently adjust published effect estimates, which can then be used in local-level economic evaluations to increase their local relevance. Expert elicitation was used to adjust published effect estimates for 2 interventions targeting the prevention of inpatient hypoglycemia. Methods. Elicitation was undertaken with 6 clinical experts. They were systematically presented with information regarding potential differences in patient characteristics and quality of care between the published study and local contexts, and regarding the design and application of the published study. The experts then assessed the intervention effects and provided estimates of the most realistic, most pessimistic, and most optimistic intervention effect sizes in the local context. Results. The experts estimated both interventions would be less effective in the local setting compared with the published effect estimates. For one intervention, the experts expected the lower complexity of admitted patients in the local setting would reduce the intervention's effectiveness. For the other intervention, the reduced effect was largely driven by differences in the scope of implementation (hospital-wide in the local setting compared with targeted implementation in the evaluation). Conclusions. The pragmatic elicitation methods reported in this article provide a feasible and acceptable approach to assess and adjust published intervention effects to better reflect expected effects in the local context. Further development and application of these methods is proposed to facilitate the use of local-level economic evaluation. Highlights Local health services make limited use of economic evaluation to inform their decisions on the funding of new health service interventions. One barrier to use is the relevance of published intervention evaluations to the local setting.Expert elicitation methods provide a structured way to consider differences between the evaluation and local settings and to explicitly and transparently adjust published effect estimates for use in local economic evaluations.The pragmatic elicitation methods reported in this article offer a feasible and acceptable approach to adjusting published intervention effects to better reflect the effects expected in the local context. This increases the relevance of economic evaluations for local decision makers.
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Affiliation(s)
- Jodi Gray
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Tilenka R. Thynne
- Flinders Medical Centre, Southern Adelaide Local Health Network (SALHN), Bedford Park, SA, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Vaughn Eaton
- SA Pharmacy Southern Adelaide Local Health Network (SALHN), Department of Health and Wellbeing, SA Health, Government of South Australia, Bedford Park, SA, Australia
| | - Rebecca Larcombe
- SA Pharmacy Southern Adelaide Local Health Network (SALHN), Department of Health and Wellbeing, SA Health, Government of South Australia, Bedford Park, SA, Australia
| | - Mahsa Tantiongco
- SA Pharmacy Southern Adelaide Local Health Network (SALHN), Department of Health and Wellbeing, SA Health, Government of South Australia, Bedford Park, SA, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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En Li Cho E, Ang CZ, Quek J, Fu CE, Lim LKE, Heng ZEQ, Tan DJH, Lim WH, Yong JN, Zeng R, Chee D, Nah B, Lesmana CRA, Bwa AH, Win KM, Faulkner C, Aboona MB, Lim MC, Syn N, Kulkarni AV, Suzuki H, Takahashi H, Tamaki N, Wijarnpreecha K, Huang DQ, Muthiah M, Ng CH, Loomba R. Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis. Gut 2023; 72:2138-2148. [PMID: 37491159 DOI: 10.1136/gutjnl-2023-330110] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM. METHODS MEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies. RESULTS 156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I2=99.90%) and 31.55% (95% CI 17.12% to 50.70%, I2=97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I2=100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2-F4), while 14.95% (95% CI 11.03% to 19.95%, I2=99.00%) had advanced fibrosis (F3-F4). CONCLUSION This study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD. PROSPERO REGISTRATION NUMBER CRD42022360251.
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Affiliation(s)
- Elina En Li Cho
- Department of Medicine, National University Hospital, Singapore
| | - Chong Zhe Ang
- Department of Medicine, National University Hospital, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lincoln Kai En Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zane En Qi Heng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rebecca Zeng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Douglas Chee
- Department of Medicine, National University Hospital, Singapore
| | - Benjamin Nah
- Department of Medicine, National University Hospital, Singapore
| | | | - Aung Hlaing Bwa
- Department of Medical Research, Union of Myanmar, Naypyidaw, Myanmar
| | - Khin Maung Win
- Department of Medical Research, Union of Myanmar, Naypyidaw, Myanmar
| | - Claire Faulkner
- Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Majd B Aboona
- Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Mei Chin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anand V Kulkarni
- Hepatology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Hiroyuki Suzuki
- Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | - Nobuharu Tamaki
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Musashino Red Cross Hospital, Musashino, Japan
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, University of Michigan, Michigan, Michigan, USA
| | - Daniel Q Huang
- Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Mark Muthiah
- Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rohit Loomba
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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Li PI, Guo HR. Long-term quality-of-care score for predicting the occurrence of acute myocardial infarction in patients with type 2 diabetes mellitus. World J Diabetes 2023; 14:1091-1102. [PMID: 37547581 PMCID: PMC10401448 DOI: 10.4239/wjd.v14.i7.1091] [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: 01/10/2023] [Revised: 02/20/2023] [Accepted: 05/17/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death globally, and diabetes mellitus (DM) is a well-established risk factor. Among the risk factors for CVD, DM is a major modifiable factor. In the fatal CVD outcomes, acute myocardial infarction (AMI) is the most common cause of death. AIM To develop a long-term quality-of-care score for predicting the occurrence of AMI among patients with type 2 DM on the basis of the hypothesis that good quality of care can reduce the risk of AMI in patients with DM. METHODS Using Taiwan's Longitudinal Cohort of Diabetes Patient Database and the medical charts of a medical center, we identified incident patients diagnosed with type 2 DM from 1999 to 2003 and followed them until 2011. We constructed a summary quality-of-care score (with values ranging from 0 to 8) with process indicators (frequencies of HbA1c and lipid profile testing and urine, foot and retinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure and HbA1c), and co-morbidity of hypertension. The associations between the score and the incidence of AMI were evaluated using Cox regression models. RESULTS A total of 7351 patients who had sufficient information to calculate the score were enrolled. In comparison with participants who had scores ≤ 1, those with scores between 2 and 4 had a lower risk of developing AMI [adjusted hazard ratio (AHR) = 0.71; 95% confidence interval (95%CI): 0.55-0.90], and those with scores ≥ 5 had an even lower risk (AHR = 0.37; 95%CI: 0.21-0.66). CONCLUSION Good quality of care can reduce the risk of AMI in patients with type 2 DM. The quality-of-care score developed in this study had a significant association with the risk of AMI and thus can be applied to guiding the care for these patients.
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Affiliation(s)
- Pi-I Li
- Department of Family Medicine, Chi Mei Medical Center, Tainan 710, Taiwan
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
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Bétry C, Lablanche S, Carvalho M, Amougay H, Du-Boullay H, Crand A, Lamy C, Borges L, Gorain S, Borel JC, Borel AL. Effect of a lifestyle intervention to prevent weight gain at initiation of insulin pump therapy in type 2 diabetes: a randomized, controlled, multicentre trial. Diabetes Res Clin Pract 2023; 200:110698. [PMID: 37169309 DOI: 10.1016/j.diabres.2023.110698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
Insulin pump therapy improves glycaemic control in individuals with type 2 diabetes. However, it may be associated with weight gain. AIM To test the effectiveness of a six-month dietary and physical activity intervention, compared to usual care, on weight gain prevention after initiation of insulin pump. METHODS Multicentre randomized, controlled trial of 54 individuals. Primary endpoint was between group difference in weight gain at six-months. RESULTS Weight gain after 6 months of insulin pump treatment did not differ between groups: mean 3.2 (3.9) kg in the control group and 3.9 (3.8) kg in the intervention group, (p=0.56). HbA1c improved without difference between groups. Post-hoc multivariate analysis of all participants found that weight gain was independently associated with younger age, active smoking, and the magnitude of HbA1c reduction. A 1% decrease in HbA1c was associated with an increase of 0.94kg [95% Confidence Interval 0.47; 1.41], p<0.001. CONCLUSIONS Treatment intensification by insulin pump therapy in patients with type 2 diabetes is effective to improve glycaemic control. A gain of about 1 kg per 1% drop in HbA1c can be expected after insulin treatment intensification. This weight gain was not prevented by a home-base, individualized, 6-months lifestyle intervention program.
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Affiliation(s)
- Cécile Bétry
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Department of Endocrinology, Diabetology and Nutrition, 38000 Grenoble, France.
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, INSERM U1055, CHU Grenoble Alpes, Department of Endocrinology, Diabetology and Nutrition, 38000 Grenoble, France.
| | - Martin Carvalho
- Hôpital Européen Marseille, Service Diabétologie-Endocrinologie, 13003 Marseille, France.
| | - Hafid Amougay
- Centre Hospitalier Annecy Genevois, Department of Endocrinology, Diabetology, 74000 Annecy, France.
| | - Hélène Du-Boullay
- Centre Hospitalier Métropole Savoie, Department of Endocrinology, Diabetology, 73000 Chambéry, France.
| | - Alexandra Crand
- Centre -Hospitalier Pierre -Oudot, Department of Endocrinology, Diabetology, 38300 Bourgoin Jailleu, France.
| | - Chloé Lamy
- Univ. Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, Department of Endocrinology, Diabetology and Nutrition, 38000 Grenoble, France.
| | | | | | | | - Anne-Laure Borel
- Univ. Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, Department of Endocrinology, Diabetology and Nutrition, 38000 Grenoble, France.
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10
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Lohr AM, Vickery KD, Hernandez V, Ford BR, Gonzalez C, Kavistan S, Patten CA, Njeru JW, Novotny PJ, Larkey LK, Singh D, Wieland ML, Sia IG. Stories for change protocol: A randomized controlled trial of a digital storytelling intervention for Hispanic/Latino individuals with type 2 diabetes. Contemp Clin Trials 2023; 126:107093. [PMID: 36682492 PMCID: PMC9998363 DOI: 10.1016/j.cct.2023.107093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hispanic/Latino adults are disproportionately impacted by type 2 diabetes mellitus (T2D). The Stories for Change (S4C) Diabetes digital storytelling intervention promotes T2D self-management among Hispanic/Latino people. We describe the S4C protocol and participant baseline characteristics. METHODS Study eligibility criteria: Hispanic or Latino, age 18-70 years, ≥1 office visit within a year at a participating clinic, T2D diagnosis for ≥6 months, HbA1c ≥ 8%, and intention to continue care at the recruitment clinic. We used a two-group, parallel randomized controlled trial design and an intervention derived through a community-based participatory research approach. All participants received usual diabetes care and two cards describing how to engage healthcare teams and access diabetes-related resources. At baseline, the intervention group additionally viewed the 12-min, intervention video (four stories about diabetes self-management). To encourage subsequent video viewing, participants received five monthly text messages. The messages prompted them to self-rate their motivation and self-efficacy for T2D management. The control group received no additional intervention. Bilingual (English/Spanish) staff collected data at baseline, six weeks, three months, and six months including biometric measurements and a survey on diabetes self-management outcomes, theory-based measures, and the number of video views. We reviewed the number of diabetes-related appointments attended using electronic medical record data. RESULTS Participants (n = 451; 70% women, mean age = 53 years) had an average HbA1C ≥9%. Intervention participants reported identifying with the storytellers and engaging with the stories. CONCLUSION We present a digital storytelling intervention protocol that provides a template for future health promotion interventions prioritizing health disparity populations. CLINICALTRIAL gov#NCT03766438.
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Affiliation(s)
- Abby M Lohr
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
| | - Katherine Diaz Vickery
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | | | - Becky R Ford
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | - Crystal Gonzalez
- Mountain Park Health Center, 635 E Baseline Rd, Phoenix, AZ 85042, USA
| | - Silvio Kavistan
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | - Christi A Patten
- Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Paul J Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Linda K Larkey
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street Ac, Phoenix, AZ 85004, USA
| | - Davinder Singh
- Mountain Park Health Center, 635 E Baseline Rd, Phoenix, AZ 85042, USA
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Irene G Sia
- Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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11
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Wharam JF, Wallace J, Argetsinger S, Zhang F, Lu CY, Stryjewski TP, Ross-Degnan D, Newhouse JP. Diabetes Microvascular Disease Diagnosis and Treatment After High-Deductible Health Plan Enrollment. Diabetes Care 2022; 45:1754-1761. [PMID: 34588211 PMCID: PMC9346988 DOI: 10.2337/dc21-0407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Affordable Care Act mandates that primary preventive services have no out-of-pocket costs but does not exempt secondary prevention from out-of-pocket costs. Most commercially insured patients with diabetes have high-deductible health plans (HDHPs) that subject key microvascular disease-related services to high out-of-pocket costs. Brief treatment delays can significantly worsen microvascular disease outcomes. RESEARCH DESIGN AND METHODS This cohort study used a large national commercial (and Medicare Advantage) health insurance claims data set to examine matched groups before and after an insurance design change. The study group included 50,790 patients with diabetes who were continuously enrolled in low-deductible (≤$500) health plans during a baseline year, followed by up to 4 years in high-deductible (≥$1,000) plans after an employer-mandated switch. HDHPs had low out-of-pocket costs for nephropathy screening but not retinopathy screening. A matched control group included 335,178 patients with diabetes who were contemporaneously enrolled in low-deductible plans. Measures included time to first detected microvascular disease screening, severe microvascular disease diagnosis, vision loss diagnosis/treatment, and renal function loss diagnosis/treatment. RESULTS HDHP enrollment was associated with relative delays in retinopathy screening (0.7 months [95% CI 0.4, 1.0]), severe retinopathy diagnosis (2.9 months [0.5, 5.3]), and vision loss diagnosis/treatment (3.8 months [1.2, 6.3]). Nephropathy-associated measures did not change to a statistically significant degree among HDHP members relative to control subjects at follow-up. CONCLUSIONS People with diabetes in HDHPs experienced delayed retinopathy diagnosis and vision loss diagnosis/treatment of up to 3.8 months compared with low-deductible plan enrollees. Findings raise concerns about visual health among HDHP members and call attention to discrepancies in Affordable Care Act cost sharing exemptions.
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Affiliation(s)
- J. Frank Wharam
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- Department of Medicine, Duke-Margolis Center for Health Policy, Duke University, Durham, NC
| | | | - Stephanie Argetsinger
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Christine Y. Lu
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - Dennis Ross-Degnan
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Joseph P. Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, MA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Kennedy School, Cambridge, MA
- National Bureau of Economic Research, Cambridge, MA
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12
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Essigmann HT, Hanis CL, DeSantis SM, Perkison WB, Aguilar DA, Jun G, Robinson DA, Brown EL. Worsening Glycemia Increases the Odds of Intermittent but Not Persistent Staphylococcus aureus Nasal Carriage in Two Cohorts of Mexican American Adults. Microbiol Spectr 2022; 10:e0000922. [PMID: 35583495 PMCID: PMC9241628 DOI: 10.1128/spectrum.00009-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022] Open
Abstract
Numerous host and environmental factors contribute to persistent and intermittent nasal Staphylococcus aureus carriage in humans. The effects of worsening glycemia on the odds of S. aureus intermittent and persistent nasal carriage was established in two cohorts from an adult Mexican American population living in Starr County, Texas. The anterior nares were sampled at two time points and the presence of S. aureus determined by laboratory culture and spa-typing. Persistent carriers were defined by the presence of S. aureus of the same spa-type at both time points, intermittent carriers were S. aureus-positive for 1 of 2 swabs, and noncarriers were negative for S. aureus at both time points. Diabetes status was obtained through personal interview and physical examination that included a blood draw for the determination of percent glycated hemoglobin A1c (%HbA1c), fasting plasma glucose, and other blood chemistry values. Using logistic regression and general estimating equations, the odds of persistent and intermittent nasal carriage compared to noncarriers across the glycemic spectrum was determined controlling for covariates. Increasing fasting plasma glucose and %HbA1c in the primary and replication cohort, respectively, were significantly associated with increasing odds of S. aureus intermittent, but not persistent nasal carriage. These data suggest that increasing dysglycemia is a risk factor for intermittent S. aureus nasal carriage potentially placing those with poorly controlled diabetes at an increased risk of acquiring an S. aureus infection. IMPORTANCE Factors affecting nasal S. aureus colonization have been studied primarily in the context of persistent carriage. In contrast, few studies have examined factors affecting intermittent nasal carriage with this pathogen. This study demonstrates that the odds of intermittent but not persistent nasal carriage of S. aureus significantly increases with worsening measures of dysglycemia. This is important in the context of poorly controlled diabetes since the risk of becoming colonized with one of the primary organisms associated with diabetic foot infections can lead to increased morbidity and mortality.
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Affiliation(s)
- Heather T. Essigmann
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - Craig L. Hanis
- Human Genetics Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - Stacia M. DeSantis
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center, Houston, Texas, USA
| | - William B. Perkison
- Human Genetics Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - David A. Aguilar
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Goo Jun
- Human Genetics Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - D. Ashley Robinson
- Department of Microbiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Eric L. Brown
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
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13
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Roberto G, Girardi A, Barone-Adesi F, Pecere A, Ientile V, Bartolini C, Da Cas R, Spila-Alegiani S, Ferrajolo C, Francesconi P, Trifirò G, Poluzzi E, Baccetti F, Gini R. Time to Treatment Intensification in Patients Receiving DPP4 Inhibitors Versus Sulfonylureas as the First Add-On to Metformin Monotherapy: A Retrospective Cohort Study. Front Pharmacol 2022; 13:871052. [PMID: 35707398 PMCID: PMC9189773 DOI: 10.3389/fphar.2022.871052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: To verify whether, in patients on metformin (MET) monotherapy for type 2 diabetes (T2D), the add-on of a dipeptidyl peptidase inhibitor (DPP4i) compared to a sulfonylurea (SU) can delay the time to the subsequent treatment intensification (TI). Methods: Population-based administrative data banks from four Italian geographic areas were used. Patients aged ≥18 years on MET monotherapy receiving first DPP4i or SU dispensing between 2008 and 2015 (cohort entry) were followed up to the occurrence of TI (insulin dispensing or add-on of a third non-insulin hypoglicemic >180 days after cohort entry), treatment discontinuation, switch, cancer, death, TI occurrence within, end of data availability, end of study period (31 December 2016), whichever came first. Patients on MET + DPP4i were matched 1:1 with those on MET + SU by sex, age, year of cohort entry, and data bank. Hazard Ratio (HR) and 95% confidence intervals (95%CI) were estimated using multivariable Cox regression model including matching variables and potential confounders measured at baseline. Different sensitivity analyses were performed: i) matching at 180 days after cohort entry, ii) intent to treat (ITT) analysis, iii) matching by duration of MET monotherapy, iv) matching by propensity score. Results: The matched study cohort included 10,600 patients. Overall, 763 TI were observed (4.5/100 person-years; mean follow-up = 1.6 years). The primary analysis showed no difference in time to TI between the two groups (HR = 1.02; 95% CI = 0.88–1.19). Sensitivity analyses confirmed this result, except from the ITT analysis (HR = 1.27; 1.13–1.43). Conclusion: The use of a DPP4i rather than a SU as add-on to MET monotherapy was not associated with a delay in treatment intensification.
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Affiliation(s)
- Giuseppe Roberto
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
- *Correspondence: Giuseppe Roberto,
| | - Anna Girardi
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Francesco Barone-Adesi
- Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
| | - Alessandro Pecere
- Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
| | - Valentina Ientile
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, Messina, Italy
| | - Claudia Bartolini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Roberto Da Cas
- Centro Nazionale per la Ricerca e la Valutazione Preclinica e Clinica Dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Stefania Spila-Alegiani
- Centro Nazionale per la Ricerca e la Valutazione Preclinica e Clinica Dei Farmaci, Istituto Superiore di Sanità, Roma, Italy
| | - Carmen Ferrajolo
- Dipartimento di Medicina Sperimentale, Università Degli Studi Della Campania “L. Vanvitelli” e Centro Regionale di Farmacovigilanza, Regione Campania, Napoli, Italy
| | - Paolo Francesconi
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
| | - Gianluca Trifirò
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università Degli Studi di Messina, Messina, Italy
| | - Elisabetta Poluzzi
- Unità di Farmacologia, Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Fabio Baccetti
- Unità Operativa di Diabetologia Massa-Carrara, USL Toscana Nordovest, Massa, Italy
| | - Rosa Gini
- Osservatorio di Epidemiologia, Agenzia Regionale di Sanità Della Toscana, Firenze, Italy
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14
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Ng CH, Chan KE, Chin YH, Zeng RW, Tsai PC, Lim WH, Tan DJH, Khoo CM, Goh LH, Ling ZJ, Kulkarni A, Mak LYL, Huang DQ, Chan M, Chew NW, Siddiqui MS, Sanyal AJ, Muthiah M. The Effect of Diabetes and Prediabetes on the Prevalence, Complications and Mortality in Non-alcoholic Fatty Liver Disease. Clin Mol Hepatol 2022; 28:565-574. [PMID: 35585687 PMCID: PMC9293620 DOI: 10.3350/cmh.2022.0096] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background/Aims Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. Methods Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. Results Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. Conclusions Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Pei Chen Tsai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Department of Family Medicine, National University Health System, Singapore
| | - Zheng Jye Ling
- Department of Family Medicine, National University Health System, Singapore.,Medical Informatics, Regional Health System, National University Health System, Singapore
| | - Anand Kulkarni
- Department of Hepatology, AIG Hospitals,Hyderabad, India
| | - Lung-Yi Loey Mak
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mark Chan
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Nicholas Ws Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Mohammad Shadab Siddiqui
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Centre, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
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15
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Berezin AA, Lichtenauer M, Boxhammer E, Fushtey IM, Berezin AE. Serum Levels of Irisin Predict Cumulative Clinical Outcomes in Heart Failure Patients With Type 2 Diabetes Mellitus. Front Physiol 2022; 13:922775. [PMID: 35651870 PMCID: PMC9149086 DOI: 10.3389/fphys.2022.922775] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 01/15/2023] Open
Abstract
Background: The aim of this study was to investigate the role of serum irisin level in predicting clinical outcome in heart failure (HF) patients with type 2 diabetes mellitus (T2DM). Methods: 153 T2DM patients with HF aged 41-62 years were prospectively recruited for the study. Serum levels of irisin and NT-proBNP were measured by ELISA. Laboratory tests including HbA1c, fasting glucose, blood creatinine, insulin, lipids and creatinine with estimation of GFR were performed along with echocardiography at baseline. The observation period was 56 weeks. Results: We identified 76 composite cardiovascular (CV) outcomes, which included CV death and death from all causes, resuscitated cardiac death, non-fatal/fatal acute myocardial infarction or stroke, and HF hospitalization. Therefore, the entire patient cohort was divided into 2 groups with (n = 76) and without (n = 77) composite CV outcomes. We found that the concentrations of NT-proBNP were higher in HF patients with T2DM who had a CV composite outcome than in patients without CV composite outcome (p = 0.001). In contrast, the relationship was exactly reversed for irisin, as HF and T2DM patients with CV composite outcome had significantly lower irisin levels (p = 0.001). Unadjusted multivariate Cox regression analyses showed that LVEF < 40%, LAVI > 39 ml/m2, NT-proBNP > 2,250 pmol/ml, and irisin < 6.50 ng/ml were the strongest predictors of CV outcomes in HF patients with T2DM. After adjustment for LVEF, serum levels of NT-proBNP and irisin remained independent predictors of end points. Furthermore, divergence of Kaplan-Meier curves pointed out that patients with NT-proBNP > 2,250 pmol/ml and irisin < 6.50 ng/ml had worse prognosis than those with any other compartment of the bomarkers' levels. Conclusion: Adding irisin to NT-proBNP significantly improved discriminative value of the whole model. HF patients with T2DM had significantly worse clinical outcomes when showing the constellation NT-proBNP > 2,250 pmol/ml and irisin < 6.50 ng/ml, respectively, in comparison to patients with opposite trends for both biomarkers.
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Affiliation(s)
| | - Michael Lichtenauer
- Department of Internal Medicine IIDivision of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Elke Boxhammer
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ivan M. Fushtey
- Department of Therapy and Endocrinology, Zaporozhye Medical Academy of Postgraduate Education, Zaporozhye, Ukraine
| | - Alexander E. Berezin
- Internal Medicine Department, State Medical University of Zaporozhye, Zaporozhye, Ukraine
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16
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Sehn AP, Brand C, Silveira JFDC, Marshall R, Pollo Renner JD, Reuter CP. Integrated role of lifestyle habits in cardiometabolic risk factors according to sex in adolescents. Ann Hum Biol 2022; 49:18-26. [PMID: 35254182 DOI: 10.1080/03014460.2022.2049873] [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: 11/01/2022]
Abstract
Background: A healthy lifestyle should be adopted by young people to maintain cardiometabolic health. Aim: To verify the prevalence and the integrated role of lifestyle habits in cardiometabolic risk factors according to sex in adolescents. Subjects and methods: Cross-sectional study developed with 1,502 adolescents, aged 10 to 17 years. Lifestyle habits included physical activity, screen time and sleep duration evaluated through a questionnaire. Cardiometabolic risk score (CMRS) was calculated by summing z-scores, divided by six. For statistical analyses, multivariable binary and multinomial logistic regression models were used. Results: 80.7% of the boys classified with adverse CMRS presented physical inactivity, compared to normal CMRS. In girls, 42.6% showed inadequate sleep compared to normal CMRS. Boys classified as inactive showed higher odds for obesity, as well as altered triglycerides, and systolic blood pressure, risk for cardiorespiratory fitness (CRF), high waist circumference, and CMRS, compared to the active. A prolonged screen time increased the odds for altered glucose and decreased the odds for altered triglycerides. In girls, inadequate sleep duration presented higher odds for overweight, obesity, risk for CRF, and high CMRS, compared to adequate sleep. Conclusions: Physical activity for boys and sleep duration for girls are important to maintain healthy metabolic health among youth.
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Affiliation(s)
- Ana Paula Sehn
- Graduate Program in Health Promotion. University of Santa Cruz do Sul (UNISC). Santa Cruz do Sul, RS, Brasil
| | - Caroline Brand
- Graduate Program in Health Promotion. University of Santa Cruz do Sul (UNISC). Santa Cruz do Sul, RS, Brasil
| | | | | | - Jane Dagmar Pollo Renner
- Graduate Program in Health Promotion. Life Sciences Department. University of Santa Cruz do Sul (UNISC). Santa Cruz do Sul, RS, Brazil
| | - Cézane Priscila Reuter
- Graduate Program in Health Promotion. Health Sciences Department. University of Santa Cruz do Sul (UNISC). Santa Cruz do Sul, RS, Brazil
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17
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Davern R, Balan G, Kilcoyne C, Coveney C, Devine H, Walsh JM, Higgins M, Hatunic M. Cystic Fibrosis-Related Diabetes Mellitus and Pregnancy: A Retrospective Study. Diabetes Ther 2022; 13:481-487. [PMID: 35190969 PMCID: PMC8934781 DOI: 10.1007/s13300-022-01223-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/02/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Cystic fibrosis-related diabetes mellitus (CFRDM) is becoming a more common issue in pregnancy care as the life expectancy of females living with cystic fibrosis has improved, with an increasing number of pregnancies in this population. Despite the Republic of Ireland having the highest incidence of cystic fibrosis globally, there is limited Irish data on pregnancy outcomes for those with CFRDM. This study aimed to retrospectively review maternal and foetal outcomes of pregnancies affected by maternal CFRDM. METHODS The patient records of all women with CFRDM who attended the National Maternity Hospital Dublin for obstetric care between 2015 and 2019 were retrospectively reviewed. RESULTS A search of patient records identified 15 pregnancies in 12 women with CFRDM during the study period. CFRDM was diagnosed pre-conception in ten of the 15 pregnancies. Median neonatal weight at birth was lower in women with CFRDM diagnosed pre-conception compared to women diagnosed during pregnancy (2.8 vs. 3.02 kg). The median weight gain in women with CFRDM diagnosed pre-conception was 10.9 kg compared to 11.9 kg for those diagnosed during pregnancy. The majority of women (62.5%) with CFRDM diagnosed pre-conception delivered via caesarean section. Admission for CF exacerbations during pregnancy in women with CFRDM diagnosed pre-conception was very common (87.5%) compared with 75% of those diagnosed during their pregnancy. CONCLUSION Women diagnosed with CFRDM were likely to require caesarean section, to be treated with insulin, and to be frequently admitted to hospital for CF exacerbations. Our review highlights the importance of good glucose control, stable cystic fibrosis before pregnancy and a multidisciplinary team approach.
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Affiliation(s)
- Recie Davern
- Endocrinology Department, Mater Misericordiae University Hospital, 30 Eccles Street, Dublin 7, D07XA09, Ireland
- The National Maternity Hospital, Holles Street, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Gabriela Balan
- Endocrinology Department, Mater Misericordiae University Hospital, 30 Eccles Street, Dublin 7, D07XA09, Ireland
- The National Maternity Hospital, Holles Street, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Ciara Kilcoyne
- Endocrinology Department, Mater Misericordiae University Hospital, 30 Eccles Street, Dublin 7, D07XA09, Ireland
| | - Ciara Coveney
- The National Maternity Hospital, Holles Street, Dublin, Ireland
| | - Hilary Devine
- The National Maternity Hospital, Holles Street, Dublin, Ireland
| | - Jennifer M Walsh
- The National Maternity Hospital, Holles Street, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Mary Higgins
- The National Maternity Hospital, Holles Street, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Mensud Hatunic
- Endocrinology Department, Mater Misericordiae University Hospital, 30 Eccles Street, Dublin 7, D07XA09, Ireland.
- The National Maternity Hospital, Holles Street, Dublin, Ireland.
- University College Dublin, Dublin, Ireland.
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18
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Cui M, Li X, Yang C, Wang L, Lu L, Zhao S, Guo Q, Liu P. Effect of Carbohydrate-Restricted Dietary Pattern on Insulin Treatment Rate, Lipid Metabolism and Nutritional Status in Pregnant Women with Gestational Diabetes in Beijing, China. Nutrients 2022; 14:359. [PMID: 35057540 PMCID: PMC8778860 DOI: 10.3390/nu14020359] [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] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Carbohydrates play an important role in blood glucose control in pregnant women with GDM. Carbohydrate-restricted dietary (CRD) pattern for gestational diabetes mellitus (GDM) has been widely used in clinics, but the change in insulin utilization rate beyond CRD intervention in GDM remains unclear. The aim of the present study was to explore the application of insulin in pregnancy with GDM, as well as the influence of CRD pattern on lipid metabolism and nutritional state. A retrospective study of 265 women with GDM who delivered in Peking University People's Hospital from July 2018 to January 2020 was conducted using a questionnaire survey. Women were divided into a CRD group or a control group according to whether they had received CRD intervention during pregnancy. There was no statistically significant difference in the rate of insulin therapy between the two groups (p > 0.05), the initial gestational week of the CRD group combined with insulin treatment was significantly higher than that of the control group (p < 0.05), and the risk of insulin therapy was positively correlated with fasting plasma glucose (FPG) in early pregnancy (p < 0.05). The incidence of abnormal low-density lipoprotein cholesterol levels in the CRD group was significantly lower than that in the control group (p < 0.05). There were no significant differences in nutritional indexes between the two groups. The results indicate that CRD intervention may be effective in delaying the use of insulin and improving the blood lipids metabolism during GDM pregnancy, while nutritional status may not be significantly affected under CRD intervention, and a high FPG in early pregnancy with GDM may be a risk factor for combined insulin therapy with CRD intervention.
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Affiliation(s)
- Mingxuan Cui
- Department of Clinical Nutrition, Peking University People’s Hospital, Beijing 100044, China; (M.C.); (X.L.); (L.L.); (S.Z.)
| | - Xuening Li
- Department of Clinical Nutrition, Peking University People’s Hospital, Beijing 100044, China; (M.C.); (X.L.); (L.L.); (S.Z.)
| | - Chen Yang
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing 100191, China; (C.Y.); (L.W.)
| | - Linlin Wang
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing 100191, China; (C.Y.); (L.W.)
| | - Lulu Lu
- Department of Clinical Nutrition, Peking University People’s Hospital, Beijing 100044, China; (M.C.); (X.L.); (L.L.); (S.Z.)
| | - Shilong Zhao
- Department of Clinical Nutrition, Peking University People’s Hospital, Beijing 100044, China; (M.C.); (X.L.); (L.L.); (S.Z.)
| | - Qianying Guo
- Department of Clinical Nutrition, Peking University People’s Hospital, Beijing 100044, China; (M.C.); (X.L.); (L.L.); (S.Z.)
| | - Peng Liu
- Department of Clinical Nutrition, Peking University People’s Hospital, Beijing 100044, China; (M.C.); (X.L.); (L.L.); (S.Z.)
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Banerjee D, Winocour P, Chowdhury TA, De P, Wahba M, Montero R, Fogarty D, Frankel AH, Karalliedde J, Mark PB, Patel DC, Pokrajac A, Sharif A, Zac-Varghese S, Bain S, Dasgupta I. Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021. BMC Nephrol 2022; 23:9. [PMID: 34979961 PMCID: PMC8722287 DOI: 10.1186/s12882-021-02587-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/28/2021] [Indexed: 12/31/2022] Open
Abstract
People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.
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Affiliation(s)
- D Banerjee
- St George's Hospitals NHS Foundation Trust, London, UK
| | - P Winocour
- ENHIDE, East and North Herts NHS Trust, Stevenage, UK
| | | | - P De
- City Hospital, Birmingham, UK
| | - M Wahba
- St Helier Hospital, Carshalton, UK
| | | | - D Fogarty
- Belfast Health and Social Care Trust, Belfast, UK
| | - A H Frankel
- Imperial College Healthcare NHS Trust, London, UK
| | | | - P B Mark
- University of Glasgow, Glasgow, UK
| | - D C Patel
- Royal Free London NHS Foundation Trust, London, UK
| | - A Pokrajac
- West Hertfordshire Hospitals, London, UK
| | - A Sharif
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - S Bain
- Swansea University, Swansea, UK
| | - I Dasgupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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20
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Kim RG, Kramer-Feldman J, Bacchetti P, Grimes B, Burchard E, Eng C, Hu D, Hellerstein M, Khalili M. Disentangling the impact of alcohol use and hepatitis C on insulin action in Latino individuals. Alcohol Clin Exp Res 2022; 46:87-99. [PMID: 34773280 PMCID: PMC8799492 DOI: 10.1111/acer.14743] [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: 05/24/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Alcohol, insulin resistance (IR), and hepatitis C (HCV) are all significant contributors to adverse outcomes of chronic liver disease. Latinos are disproportionately affected by these risk factors. We investigated the relationship between alcohol use and insulin action in a prospective cohort of Latino individuals with and without HCV. METHODS One hundred fifty-three nondiabetic Latino individuals (60 HCV+, 93 HCV-) underwent clinical evaluation and metabolic testing; 56 had repeat testing over a median follow-up of 1.5 years. Peripheral IR and hepatic IR were measured via steady-state plasma glucose (SSPG) and endogenous glucose production during a two-step, 240-min insulin suppression test. Insulin secretion (IS) was measured using the graded glucose infusion test. Alcohol use was categorized as none, moderate (≤1 drink/day for women and ≤2 drinks/day for men), and heavy (>moderate). Multivariable models including HCV status assessed associations of alcohol use with baseline SSPG, hepatic IR and IS, and changes in these parameters over time. RESULTS Overall, the median age was 44 years, 63.4% were male, 66.7% overweight/ obese, and 31.9% had heavy lifetime alcohol use while 60.4% had moderate lifetime alcohol use. SSPG and IS were similar by levels of alcohol use at baseline and alcohol use was not statistically significantly associated with change in these measures over time. However, lifetime daily heavy alcohol use (vs. not heavy, coef 2.4 μU-mg/kg-min-ml, p = 0.04) and HCV status (coef 4.4 μU-mg/kg-min-ml, p = 0.0003) were independently associated with higher baseline hepatic IR, and current heavy alcohol use was associated with greater change in hepatic IR in follow-up (coef 5.8 μU-mg/kg-min-ml, p = 0.03). CONCLUSIONS In this cohort of Latino individuals, lifetime and current heavy alcohol use influenced hepatic IR and its change over time. Strategies to decrease rates of heavy alcohol use or increase abstinence along with lifestyle modification and anti-HCV therapy to reduce metabolic risk are critical to prevent adverse liver and metabolic outcomes in Latino individuals.
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Affiliation(s)
- Rebecca G Kim
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA
| | - Jonathan Kramer-Feldman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Esteban Burchard
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA
| | - Mandana Khalili
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA,Liver Center, University of California San Francisco, San Francisco, CA
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21
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Safiah M, Hyassat D, Khader Y, Farahid O, Batieha A, El-Khateeb M, Ajlouni K. Effect of Metformin on Anthropometric Measurements and Hormonal and Biochemical Profile in Patients with Prediabetes. J Diabetes Res 2021; 2021:8275303. [PMID: 34950736 PMCID: PMC8692055 DOI: 10.1155/2021/8275303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Metformin is the most widely preferred first-line oral antidiabetic agent that results in clear benefits in blood sugar regulation and diabetes-related complications. This study is aimed at assessing the effect of metformin on anthropometric, hormonal, and biochemical parameters in patients with prediabetes or insulin resistance. METHODS A prepoststudy was conducted among 52 patients with prediabetes or insulin resistance who met the inclusion criteria. Weight, body mass index (BMI), and waist circumference were measured before and 12 months after metformin treatment. Serum concentrations of sex steroids, gonadotropins, and lipids were also assessed. Homeostasis model assessment (HOMA) index and quantitative sensitivity check (QUICKI) index scores were calculated before metformin treatment and after 12 months of use. RESULTS After 12 months of metformin treatment, female patients had significant reduction in weight, BMI, and waist circumference after adjusting for age. Metformin use for 12 months resulted in significant reduction in mean fasting blood glucose and HbA1c in females only. Total cholesterol decreased significantly among men only and serum HDL-C showed a significant rise among females only. Serum LDL-C and triglycerides did not change significantly in females and males. Our study did now significant changes in ACTH and cortisol levels in both females and males after metformin treatment. Metformin use resulted in significant increase in luteinizing hormone (LH) and progesterone levels in males, while it was associated with significant increase in prolactin, follicular stimulating hormone (FSH), and dehydroepiandrostenedione-sulphate (DHEA-S) levels and significant decrease in total testosterone level in females. CONCLUSION Metformin treatment in females with prediabetes reduces BMI, waist circumference, fasting blood glucose, and HbA1c. The changes in the studied parameters differed significantly according to sex.
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Affiliation(s)
- Mustafa Safiah
- Department of Endocrinology, The National Center for Diabetes, Endocrinology, and Genetics, The University of Jordan, Amman, Jordan
| | - Dana Hyassat
- Department of Endocrinology, The National Center for Diabetes, Endocrinology, and Genetics, The University of Jordan, Amman, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Oraib Farahid
- Department of Endocrinology, The National Center for Diabetes, Endocrinology, and Genetics, The University of Jordan, Amman, Jordan
| | - Anwar Batieha
- Department of Public Health, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Mohammed El-Khateeb
- Department of Endocrinology, The National Center for Diabetes, Endocrinology, and Genetics, The University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- Department of Endocrinology, The National Center for Diabetes, Endocrinology, and Genetics, The University of Jordan, Amman, Jordan
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22
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Ferreira RGDS, Guilhon-Simplicio F, Acho LDR, Batista NY, Guedes-Junior FDC, Ferreira MSL, Barcellos JFM, Veiga-Junior VF, Lima ES. Anti-hyperglycemic, lipid-lowering, and anti-obesity effects of the triterpenes α and β-amyrenones in vivo. AVICENNA JOURNAL OF PHYTOMEDICINE 2021; 11:451-463. [PMID: 34745917 PMCID: PMC8554285 DOI: 10.22038/ajp.2021.18076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/04/2020] [Accepted: 12/12/2020] [Indexed: 01/10/2023]
Abstract
Objective: Diabetes, obesity, and their associated metabolic disorders are public health problems that require prevention and new efficient drugs for treatment. We evaluated the anti-hyperglycemic, lipid-lowering, and anti-obesity effects of semisynthetic α, β-amyrenones (ABA). Materials and Methods: BALB/c mice were used for performing an acute model of oral carbohydrate and triglyceride tolerance, and in a streptozotocin-induced diabetes model, where glycemia and body weight changes were measured during ten days. C57BL/6 strain mice were used in the diet-induced obesity model, where lipidemia and body weight were measured during four weeks, and biochemical and histological parameters were analyzed after euthanasia. The doses considered in this study were 25, 50, and 100 mg/kg of ABA, used following some criteria for each experiment. Results: ABA 25 mg/kg reduced the postprandial glycemia peak higher than acarbose 50 mg/kg (p<0.05). ABA 50 mg/kg significantly reduced glycemia in diabetic mice compared to acarbose 50 mg/kg (p<0.05). There was a reduction in the weight of the obese animals treated with ABA 25 and 50 mg/kg (p<0.05). ABA 50 mg/kg also significantly reduced lipidemia in these animals compared to orlistat 50 mg/kg. Conclusion: This study presents evidence of ABA's action in reducing postprandial glycemia and obesity in mice.
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Affiliation(s)
| | - Fernanda Guilhon-Simplicio
- Faculty of Pharmaceutical Sciences, Federal University of Amazonas, General Rodrigo Otávio 6200, Coroado 1, 69080-900, Manaus, AM, Brazil
| | - Leonard Domingo Rosales Acho
- Faculty of Pharmaceutical Sciences, Federal University of Amazonas, General Rodrigo Otávio 6200, Coroado 1, 69080-900, Manaus, AM, Brazil
| | - Nayana Yared Batista
- Institute of Biological Sciences, Federal University of Amazonas, General Rodrigo Otávio 6200, Coroado 1, 69080-900, Manaus, AM, Brazil
| | - Frank do Carmo Guedes-Junior
- Faculty of Pharmaceutical Sciences, Federal University of Amazonas, General Rodrigo Otávio 6200, Coroado 1, 69080-900, Manaus, AM, Brazil
| | - Mayla Silva Leão Ferreira
- Institute of Biological Sciences, Federal University of Amazonas, General Rodrigo Otávio 6200, Coroado 1, 69080-900, Manaus, AM, Brazil
| | - José Fernando Marques Barcellos
- Institute of Biological Sciences, Federal University of Amazonas, General Rodrigo Otávio 6200, Coroado 1, 69080-900, Manaus, AM, Brazil
| | - Valdir Florêncio Veiga-Junior
- Department of Chemistry, Military Institute of Engineering, Praça General Tibúrcio 80, Urca, 22290-270, Rio de Janeiro, RJ, Brazil
| | - Emerson Silva Lima
- Faculty of Pharmaceutical Sciences, Federal University of Amazonas, General Rodrigo Otávio 6200, Coroado 1, 69080-900, Manaus, AM, Brazil
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23
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The impact of the Th17:Treg axis on the IgA-Biome across the glycemic spectrum. PLoS One 2021; 16:e0258812. [PMID: 34669745 PMCID: PMC8528330 DOI: 10.1371/journal.pone.0258812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Secretory IgA (SIgA) is released into mucosal surfaces where its function extends beyond that of host defense to include the shaping of resident microbial communities by mediating exclusion/inclusion of respective microbes and regulating bacterial gene expression. In this capacity, SIgA acts as the fulcrum on which host immunity and the health of the microbiota are balanced. We recently completed an analysis of the gut and salivary IgA-Biomes (16S rDNA sequencing of SIgA-coated/uncoated bacteria) in Mexican-American adults that identified IgA-Biome differences across the glycemic spectrum. As Th17:Treg ratio imbalances are associated with gut microbiome dysbiosis and chronic inflammatory conditions such as type 2 diabetes, the present study extends our prior work by examining the impact of Th17:Treg ratios (pro-inflammatory:anti-inflammatory T-cell ratios) and the SIgA response (Th17:Treg-SIgA axis) in shaping microbial communities. Examining the impact of Th17:Treg ratios (determined by epigenetic qPCR lymphocyte subset quantification) on the IgA-Biome across diabetes phenotypes identified a proportional relationship between Th17:Treg ratios and alpha diversity in the stool IgA-Biome of those with dysglycemia, significant changes in community composition of the stool and salivary microbiomes across glycemic profiles, and genera preferentially abundant by T-cell inflammatory phenotype. This is the first study to associate epigenetically quantified Th17:Treg ratios with both the larger and SIgA-fractionated microbiome, assess these associations in the context of a chronic inflammatory disease, and offers a novel frame through which to evaluate mucosal microbiomes in the context of host responses and inflammation.
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Russo C, Caponnetto P, Cibella F, Maglia M, Alamo A, Campagna D, Frittitta L, Di Mauro M, Leotta C, Mondati E, Krysiński A, Franek E, Polosa R. A double blind randomized controlled trial investigating efficacy and safety of varenicline for smoking cessation in patients with type 2 diabetes: study protocol. Intern Emerg Med 2021; 16:1823-1839. [PMID: 33735416 PMCID: PMC8502165 DOI: 10.1007/s11739-021-02684-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/22/2021] [Indexed: 12/23/2022]
Abstract
Reducing exposure to cigarette smoke is an imperative for public health and for diabetic patients. Patients with diabetes who continue to smoke face challenges at quitting and the delivery of effective smoking cessation interventions is a major unmet need. The high-affinity α4β2 nicotinic acetylcholine receptor partial agonist varenicline in combination with counseling is effective for smoking cessation, but evidence in patients with diabetes is limited. A clinical trial of varenicline targeted specifically at smokers with T2DM is warranted. This randomized, double blind, placebo-controlled trial will be the first study to test efficacy and safety of varenicline in smokers with type 2 diabetes mellitus (T2DM) over the course of 52 weeks. We hypothesize that varenicline treatment (1 mg BID, administered for 12 weeks) would increase quit rates, maintain smoking abstinence up to 1 year after treatment, and be well-tolerated in T2DM smokers intending to quit. Efficacy end points will include carbon monoxide-confirmed continuous abstinence rate (CAR) and 7-day point prevalence of abstinence. The results of this RCT will help inform medical/health authorities and physicians worldwide whether an optimally varenicline-treated cohort of T2DM patients who smoke will experience significant success rates, without significant side effects.Trial registration NCT01387425 ( https://clinicaltrials.gov/ct2/show/NCT01387425 ).
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Affiliation(s)
- C Russo
- Ambulatorio Di Diabetologia, UOC Medicina Interna E D'Urgenza, Policlinico Universitario, AOU "Policlinico-V. Emanuele", Catania, Italy
| | - P Caponnetto
- Centro Per La Prevenzione E Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V.Emanuele" Dell'Università Di Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - F Cibella
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - M Maglia
- Centro Per La Prevenzione E Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V.Emanuele" Dell'Università Di Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - A Alamo
- Centro Diabetologico - UOC Andrologia Ed Endocrinologia, Policlinico Universitario, AOU "Policlinico-V. Emanuele", Catania, Italy
| | - D Campagna
- Ambulatorio Di Diabetologia, UOC Medicina Interna E D'Urgenza, Policlinico Universitario, AOU "Policlinico-V. Emanuele", Catania, Italy
- UOC MCAU, University Teaching Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - L Frittitta
- Centro Per Il Diabete E L'Obesità - UOC Endocrinologia, Ospedale Garibaldi Nesima, ARNAS Garibaldi, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), Dipartimento Di Medicina Clinica E Sperimentale, Università Di Catania, Catania, Italy
| | - M Di Mauro
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), Dipartimento Di Medicina Clinica E Sperimentale, Università Di Catania, Catania, Italy
- Ambulatorio Di Diabetologia, Ospedale V. Emanuele, AOU "Policlinico-V. Emanuele", Catania, Italy
| | - C Leotta
- Ambulatorio Di Diabetologia - UOC Geriatria, Ospedale Cannizzaro, Catania, Italy
| | - E Mondati
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), Dipartimento Di Medicina Clinica E Sperimentale, Università Di Catania, Catania, Italy
- UOS Sorveglianza Delle Complicanze Delle Malattie Metaboliche, Ospedale S. Marta, AOU "Policlinico-V. Emanuele", Catania, Italy
| | - A Krysiński
- Mossakowski Clinical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital MSWiA, Warsaw, Poland
| | - E Franek
- Mossakowski Clinical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital MSWiA, Warsaw, Poland
| | - R Polosa
- Ambulatorio Di Diabetologia, UOC Medicina Interna E D'Urgenza, Policlinico Universitario, AOU "Policlinico-V. Emanuele", Catania, Italy.
- Centro Per La Prevenzione E Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V.Emanuele" Dell'Università Di Catania, Via S. Sofia 78, 95123, Catania, Italy.
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), Dipartimento Di Medicina Clinica E Sperimentale, Università Di Catania, Catania, Italy.
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Garabedian LF, Zhang F, LeCates R, Wallace J, Ross-Degnan D, Wharam JF. Trends in high deductible health plan enrolment and spending among commercially insured members with and without chronic conditions: a Natural Experiment for Translation in Diabetes (NEXT-D2) Study. BMJ Open 2021; 11:e044198. [PMID: 34518242 PMCID: PMC8438755 DOI: 10.1136/bmjopen-2020-044198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To examine trends in high deductible health plan (HDHP) enrolment among members with diabetes and cardiovascular disease (CVD) compared with healthy members and compare out-of-pocket (OOP) and total spending for members with chronic conditions in HDHPs versus low deductible plans. DESIGN Descriptive study with time trends. SETTING A large national commercial insurance database. PARTICIPANTS 1.2 million members with diabetes, 4.5 million members with CVD (without diabetes) and 18 million healthy members (defined by a low comorbidity score) under the age of 65 years and insured between 2005 and 2013. OUTCOME MEASURES Percentage of members in an HDHP (ie, annual deductible ≥$1000) by year, annual mean OOP and total spending, adjusted for member sociodemographic and employer characteristics. RESULTS Enrolment in HDHPs among members in all disease categories increased by 5 percentage points a year and was over 50% by 2013. On average, over the study period, HDHP enrolment among members with diabetes and CVD was 2.84 (95% CI: 2.78 to 2.90) and 2.02 (95% CI: 1.98 to 2.05) percentage points lower, respectively, than among healthy members. HDHP members with diabetes, CVD and low morbidity had higher annual OOP costs ($636 (95% CI: 630 to 642), $539 (95% CI: 537 to 542) and $113 (95% CI: 112 to 113)) and lower total costs (-$529 (95% CI: -597 to -461), -$364 (95% CI: -385 to -342) and -$79 (95% CI: -81 to -76)), respectively, than corresponding low deductible members when averaged over the study period. Members with chronic diseases had yearly OOP expenditures that were five to seven times higher than healthier members. CONCLUSION High HDHP enrolment coupled with the high OOP costs associated with HDHPs may be particularly detrimental to the financial well-being of people with diabetes and CVD, who have more healthcare needs than healthier populations.
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Affiliation(s)
- Laura F Garabedian
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Robert LeCates
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jamie Wallace
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Dennis Ross-Degnan
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - James F Wharam
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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Bąk E, Młynarska A, Marcisz C, Bobiński R, Sternal D, Młynarski R. The influence of frailty syndrome on quality of life in elderly patients with type 2 diabetes. Qual Life Res 2021; 30:2487-2495. [PMID: 33834352 PMCID: PMC8405487 DOI: 10.1007/s11136-021-02829-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There have been no comprehensive studies that assess the impact of frailty syndrome on quality of life (QoL) of patients with diagnosed type 2 diabetes. The purpose of the study was to assess the impact of frailty syndrome on QoL and depression symptoms of patients with type 2 diabetes. METHODS The study included 148 consecutive patients (aged ≥ 60y). The patients were divided into two groups according to the prevalence of the frailty syndrome: robust and frailty. For all of the patients that were included in the study, we used the Polish version of validated instruments: ADDQoL, TFI and BDI. RESULTS In the study group, 43.2% had been diagnosed with frailty syndrome. An analysis of QoL assessment depending on the prevalence of the frailty syndrome showed that patients who were robust (without recognized frailty syndrome) assessed QoL significantly better than patients with coexisting frailty syndrome. Robust patients did not have any severe depressive symptoms, whereas in the group of patients with the frailty syndrome 43.8% of the patients had a depression. 70.2% of the patients without any depressive symptoms were robust patients, meanwhile only 14% of the patients had frailty syndrome recognized. CONCLUSIONS Frailty syndrome occurred in 43 percent of the patients with type 2 diabetes. This has a negative impact on QoL of patients. Depression is more common in patients with the frailty syndrome and diabetes.
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Affiliation(s)
- E. Bąk
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - A. Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - C. Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - R. Bobiński
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - D. Sternal
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - R. Młynarski
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
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Contreras-Duarte S, Claudette C, Farias M, Leiva A. High total cholesterol and triglycerides levels increase arginases metabolism, impairing nitric oxide signaling and worsening fetoplacental endothelial dysfunction in gestational diabetes mellitus pregnancies. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166216. [PMID: 34314821 DOI: 10.1016/j.bbadis.2021.166216] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 12/23/2022]
Abstract
During human pregnancy, maternal physiological dyslipidemia (MPD) supports fetal development. However, some women develop maternal supraphysiological dyslipidemia (MSPD: increased total cholesterol (TC) and triglycerides (TG) levels). MSPD is present in normal and pregnancies with gestational diabetes mellitus (GDM). Both pathologies associate with fetoplacental endothelial dysfunction, producing alterations in nitric oxide (NO)-L-arginine/arginase metabolism. Nevertheless, the effect of MSPD on GDM, and how this synergy alters fetoplacental endothelial function is unknown, which is the aim of this study. 123 women at term of pregnancy were classified as MPD (n=40), MSPD (n=35), GDM with normal lipids (GDM- MPD, n=23) and with increased lipids (GDM-MSPD, n=25). TC ≥291 mg/dL and TG ≥275 mg/dL were considered as MSPD. Endothelial NO synthase (eNOS), human cationic amino acid transporter 1 (hCat1), and arginase II protein abundance and activity, were assayed in umbilical vein endothelial cells. In MSPD and MSPD-GDM, TC and TG increased respect to MPD and MPD-GDM. eNOS activity was reduced in MSPD and MSPD-GDM, but increased in MPD-GDM compared with MPD. No changes were observed in eNOS protein. However, decreased tetrahydrobiopterin levels were observed in all groups compared with MPD. Increased hCat1 protein and L-arginine transport were observed in both GDM groups compared with MPD. However, the transport was higher in GDM-MSPD compared to GDM-MPD. Higher Arginase II protein and activity were observed in MSPD-GDM compared with MPD. Thus, MSPD in GDM pregnancies alters fetal endothelial function associated with NO metabolism.
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Affiliation(s)
- S Contreras-Duarte
- School of Medical Technology, Health Sciences Faculty, Universidad San Sebastian, Santiago 7510156, Chile.
| | - C Claudette
- School of Medical Technology, Health Sciences Faculty, Universidad San Sebastian, Santiago 7510156, Chile
| | - M Farias
- School of Medical Technology, Health Sciences Faculty, Universidad San Sebastian, Santiago 7510156, Chile
| | - A Leiva
- Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
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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: 10] [Impact Index Per Article: 2.5] [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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Krysinski A, Russo C, John S, Belsey JD, Campagna D, Caponnetto P, Vudu L, Lim CW, Purrello F, Di Mauro M, Iqbal F, Fluck D, Franek E, Polosa R, Sharma P. International randomised controlled trial evaluating metabolic syndrome in type 2 diabetic cigarette smokers following switching to combustion-free nicotine delivery systems: the DIASMOKE protocol. BMJ Open 2021; 11:e045396. [PMID: 33906842 PMCID: PMC8088261 DOI: 10.1136/bmjopen-2020-045396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Reducing exposure to cigarette smoke is an imperative for public health and for patients with diabetes. Increasingly, combustion-free nicotine delivery systems (C-F NDS) such as e-cigarettes and heated tobacco products are substituting conventional cigarettes and accelerating the downward trends in smoking prevalence. However, there is limited information about the long-term health impact in patients with diabetes who use C-F NDS. This randomised trial of type 2 diabetic cigarette smokers will test the hypothesis that following a switch from conventional cigarettes to C-F NDS a measurable improvement in metabolic syndrome (MetS) factors will be shown over the course of 2 years. METHODS AND ANALYSIS The study is multicentre and thus will take place in five locations in four countries in an ambulatory setting. A total of 576 patients with diabetes will be randomised (1:2 ratio) to either a control arm (Study Arm A), in which they will be offered referral to smoking cessation programmes or to an intervention arm (Study Arm B) assigned to C-F NDS use. Participants will be at least 23 years old and of any gender. Patient recruitment will start in February 2021 and is expected to be completed by December 2021. Primary outcome measures include fasting plasma glucose, blood pressure, triglycerides, high-density lipoprotein and waist circumference, while secondary feature absolute change in the sum of the individual factors of MetS and change in each individual factor of MetS measured at each study time point. ETHICS AND DISSEMINATION The approval of research ethics committee (REC) regarding the trial protocol, informed consent forms and other relevant documents is required to commence the study. Substantial amendments to the study protocol cannot be implemented until the REC grants a favourable opinion. The results of the study are intended to be published as articles in high quality peer-reviewed journals and disseminated through conference papers. TRIAL REGISTRATION NUMBER NCT04231838. Pre-results stage.
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Affiliation(s)
- Arkadiusz Krysinski
- Polish Academy of Sciences, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
- Department of Internal Diseases, Endocrinology and Diabetology, CK MSW, Warszawa, Poland
| | - Cristina Russo
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, Surrey, UK
| | - Sarah John
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Davide Campagna
- U O C. MCAU, University Teaching Hospital 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
| | - Pasquale Caponnetto
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Universita degli Studi di Catania Scuola di Facolta di Medicina, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Sicilia, Italy
| | - Lorina Vudu
- Endocrinology, Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, The Republic of Moldova
| | - Chong Wei Lim
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, Surrey, UK
| | - Francesco Purrello
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Sicilia, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Sicilia, Italy
| | - Maurizio Di Mauro
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Sicilia, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Sicilia, Italy
| | - Farrukh Iqbal
- The University of Lahore University College of Medicine and Dentistry, Lahore, Pakistan
| | - David Fluck
- Cardiology, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, Surrey, UK
| | - Edward Franek
- Department of Internal Diseases, Endocrinology and Diabetology, CK MSW, Warszawa, Poland
- Mossakowski Medical Research Centre, Polska Akademia Nauk, Warszawa, Poland
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Sicilia, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Sicilia, Italy
| | - Pankaj Sharma
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, Surrey, UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, Surrey, UK
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Mishra R, Krishan S, Siddiqui AN, Kapur P, Khayyam KU, Rai PK, Sharma M. Impact of metformin therapy on health-related quality of life outcomes in tuberculosis patients with diabetes mellitus in India: A prospective study. Int J Clin Pract 2021; 75:e13864. [PMID: 33236505 DOI: 10.1111/ijcp.13864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/02/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the impact of metformin use on health-related quality of life (HRQoL) in tuberculosis (TB) patients who are presented with type 2 diabetes mellitus (T2DM). METHODOLOGY In this community-based prospective study, TB patients attending Hakeem Abdul Hameed Centenary Hospital, New Delhi (India) and had comorbidity of T2DM between April 2018 and July 2019 were enrolled. Patients were divided into metformin users and metformin non-users on the basis of the presence of metformin in their routine as antidiabetic drug(s). HRQoL was determined using a validated TB-specific tool (Dhingra and Rajpal-12 scale ie, DR-12) consists of symptom and socio-psychological and exercise adaptation domains. The HRQoL scores were compared at pretreatment (1st visit), end of intensive phase (2nd visit) and end of treatment (3rd visit) between the two groups. RESULTS A total of 120 patients were enrolled, of which 24 were excluded as they did not respond at follow-up visits. Among the metformin users (n = 48) the mean age of patients was 47.56 years and 62.50% was males. Among the metformin non-users (n = 48), the mean age of patients was 49.02 years and 54.10% was males. The baseline characteristics were similar in both groups except for the substance used history (P = .025), literacy level (P = .048) and BMI (P = .028). Metformin users demonstrated significant improvement in symptom scores (2nd visit: P < .001; 3rd visit: P = .001) and socio-psychological and exercise adaptation scores (2nd visit: P < .0001; 3rd visit: P < .0001) as compared with metformin non-users at 2nd visit and 3rd visit. Overall, scores were also found to be significantly improved in metformin users (2nd visit: P < .001; 3rd visit: P = .001). CONCLUSION Metformin therapy exerted favourable effects on HRQoL in patients with TB and T2DM and can be recommended as an adjuvant antitubercular drug in TB patients with co-morbidity of T2DM, unless contraindicated.
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Affiliation(s)
- Ritu Mishra
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Shri Krishan
- Department of Drug Safety and Pharmacovigilance, Syneos Health, Gurgaon, India
| | - Ali Nasir Siddiqui
- Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Prem Kapur
- Department of Medicine, Hamdard Institute of Medical Sciences and Research & Hakeem Abdul Hameed Centenary Hospital, Jamia Hamdard, New Delhi, India
| | - Khalid Umer Khayyam
- Department of Epidemiology & Public Health, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | | | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
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Di Iorio AB, Orozco Beltrán D, Quesada Rico JA, Carratalá Munuera MC. The Adaptation of the Carbohydrate Counting Method Affects HbA1c and Improves Anthropometric Indicators in Patients With Diabetes Mellitus 2. Front Nutr 2021; 7:577797. [PMID: 33575268 PMCID: PMC7870683 DOI: 10.3389/fnut.2020.577797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Adriana Beatriz Di Iorio
- Food Agroindustry, Zamorano University, Yaguare Valley, Tegucigalpa, Honduras
- Clinical Medicine, Miguel Hernández University, Alicante-Valencia, Spain
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Gupta P, Lamoureux EL, Sabanayagam C, Tham YC, Tan G, Cheng CY, Wong TY, Cheung N. Six-year incidence and systemic associations of retinopathy in a multi-ethnic Asian population without diabetes. Br J Ophthalmol 2021; 106:845-851. [PMID: 33468492 DOI: 10.1136/bjophthalmol-2020-318126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/12/2020] [Accepted: 01/04/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE We described the 6-year incidence and changes of retinopathy, and their associated risk factors in a multi-ethnic Asian population without diabetes. METHODS We included 4374 participants with non-diabetes from a population-based cohort, the Singapore Epidemiology of Eye Disease Study, with gradable retinal photographs at baseline and 6-year follow-up visit. Retinopathy was assessed according to the modified Airlie House classification system. RESULTS Over the 6-year period, the cumulative rates were 2.5% (106/4279) for retinopathy incidence, 1.0% (1/95) for retinopathy progression and 68.4% (65/95) for retinopathy regression. In multivariable analysis, higher diastolic blood pressure (DBP) (risk ratio (RR)=1.02; 95% CI: 1.00 to 1.04; per 10 mm Hg increase in DBP) and wider retinal arteriolar calibre (RR=1.36; 95% CI: 1.13 to 1.63; per SD increase in central retinal artery equivalent) were associated with higher risk of incident retinopathy, while higher level of high-density lipoprotein (HDL) was associated with lower risk of incident retinopathy (RR=0.56; 95% CI: 0.32 to 0.99; per mmol/L increase in HDL). Compared with Chinese, Malays were more likely to have retinopathy regression (RR=1.63; 95% CI: 1.20 to 2.22), while overweight (RR=0.47; 95% CI: 0.26 to 0.84) and higher glycosylated haemoglobin (HbA1c) level (RR=0.58; 95% CI: 0.37 to 0.93; per per cent increase in HbA1c) were associated with lower likelihood of retinopathy regression. CONCLUSION Risk of developing retinopathy in Asians without diabetes is generally low. However, regression of retinopathy over time is common, suggesting that these retinopathy signs may reflect subclinical reversible microvascular dysfunction. Several metabolic risk factors are associated with incidence or regression of retinopathy, suggesting that good metabolic control may still be important in the management of non-diabetic retinopathy.
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Affiliation(s)
- Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ecosse Luc Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology, University of Melbourne VCCC, Parkville, Victoria, Australia.,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.,Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Yih-Chung Tham
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Gavin Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ching-Yu Cheng
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.,Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Tien Yin Wong
- Academic Medicine Research Institute, Singapore National Eye Centre, Singapore
| | - Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Chen X, Pei Z, Zhang M, Xu Z, Zhao Z, Lu W, Chen L, Luo F, Chen T, Sun C. Glycated Hemoglobin (HbA1c) Concentrations Among Children and Adolescents With Diabetes in Middle- and Low-Income Countries, 2010-2019: A Retrospective Chart Review and Systematic Review of Literature. Front Endocrinol (Lausanne) 2021; 12:651589. [PMID: 33912137 PMCID: PMC8072468 DOI: 10.3389/fendo.2021.651589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/12/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To explore the glycemic control [represented by glycated hemoglobin (HbA1c) concentrations] in children with diabetes mellitus (DM) in east China and middle- and low-income countries, from 2010 to 2019. METHODS Retrospective data of children with DM from two hospital-based health records were reviewed. Data on HbA1c concentrations, hospitalization due to diabetic ketoacidosis, and patient demographics were collected and analyzed. A systematic review was subsequently performed to analyze publications that report HbA1c concentrations in patients aged <18 years. Patients' characteristics extracted from each publication were used to generate simulated individual data for pooled analysis. HbA1c estimates were derived from steady-state iterations. RESULTS Data of 843 diabetic children (aged 11.2 ± 3.9 years) with 2,658 HbA1c measures were retrieved from the two hospitals during the period 2010-2020. The duration of diabetes in the patients was 4.4 ± 2.8 years, and their HbA1c was 8.1 ± 2.2%. Patients who were internal migrants had significantly higher HbA1c concentration than resident patients (8.4 vs. 7.9%). The literature review yielded 1,164 publications, and the majority (74.1%) of patient data were published in high-income countries. The patient data extracted from these publications generated 486,416 HbA1c concentration estimates between 2005 and 2019. The average HbA1c concentration during the 15 years was 9.07 ± 2.15%. The mean HbA1c concentrations among children were 8.23, 8.73, 9.20, and 10.11% in high-income country (HIC), upper-middle income country (UMIC), lower-middle income country (LMIC), and low-income country (LIC) respectively. The mean rate of optimized glycemic control (HbA1c <7.5%) among children was 32.4, 27.5, 21.7, and 12.7% in HIC, UMIC, LMIC, and LIC, respectively. CONCLUSIONS The current study indicated that there is substantial room for improvement in glycemic control in children with DM worldwide, especially in middle- and low-income countries.
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Affiliation(s)
- Xiuli Chen
- Department of Endocrinology, Genetics and Metabolism, Children’s Hospital of Soochow University, Suzhou, China
| | - Zhou Pei
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Miaoying Zhang
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Zhenran Xu
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Zhuhui Zhao
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Wei Lu
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Linqi Chen
- Department of Endocrinology, Genetics and Metabolism, Children’s Hospital of Soochow University, Suzhou, China
| | - Feihong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Ting Chen
- Department of Endocrinology, Genetics and Metabolism, Children’s Hospital of Soochow University, Suzhou, China
| | - Chengjun Sun
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children’s Hospital of Fudan University, Shanghai, China
- *Correspondence: Chengjun Sun,
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Pivonello R, Bancos I, Feelders RA, Kargi AY, Kerr JM, Gordon MB, Mariash CN, Terzolo M, Ellison N, Moraitis AG. Relacorilant, a Selective Glucocorticoid Receptor Modulator, Induces Clinical Improvements in Patients With Cushing Syndrome: Results From A Prospective, Open-Label Phase 2 Study. Front Endocrinol (Lausanne) 2021; 12:662865. [PMID: 34335465 PMCID: PMC8317576 DOI: 10.3389/fendo.2021.662865] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION/PURPOSE Relacorilant is a selective glucocorticoid receptor modulator (SGRM) with no progesterone receptor activity. We evaluated the efficacy and safety of relacorilant in patients with endogenous Cushing syndrome (CS). MATERIALS AND METHODS A single-arm, open-label, phase 2, dose-finding study with 2 dose groups (NCT02804750, https://clinicaltrials.gov/ct2/show/NCT02804750) was conducted at 19 sites in the U.S. and Europe. Low-dose relacorilant (100-200 mg/d; n = 17) was administered for 12 weeks or high-dose relacorilant (250-400 mg/d; n = 18) for 16 weeks; doses were up-titrated by 50 mg every 4 weeks. Outcome measures included proportion of patients with clinically meaningful changes in hypertension and/or hyperglycemia from baseline to last observed visit. For patients with hypertension, clinical response was defined as a ≥5-mmHg decrease in mean systolic or diastolic blood pressure, measured by a standardized and validated 24-h ABPM. For patients with hyperglycemia, clinical response was defined ad-hoc as ≥0.5% decrease in HbA1c, normalization or ≥50-mg/dL decrease in 2-h plasma glucose value on oral glucose tolerance test, or decrease in daily insulin (≥25%) or sulfonylurea dose (≥50%). RESULTS 35 adults with CS and hypertension and/or hyperglycemia (impaired glucose tolerance or type 2 diabetes mellitus) were enrolled, of which 34 (24 women/10 men) received treatment and had postbaseline data. In the low-dose group, 5/12 patients (41.7%) with hypertension and 2/13 patients (15.4%) with hyperglycemia achieved response. In the high-dose group, 7/11 patients (63.6%) with hypertension and 6/12 patients (50%) with hyperglycemia achieved response. Common (≥20%) adverse events included back pain, headache, peripheral edema, nausea, pain at extremities, diarrhea, and dizziness. No drug-induced vaginal bleeding or hypokalemia occurred. CONCLUSIONS The SGRM relacorilant provided clinical benefit to patients with CS without undesirable antiprogesterone effects or drug-induced hypokalemia.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Irina Bancos
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States
| | - Richard A. Feelders
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Atil Y. Kargi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Miami, Miami, FL, United States
| | - Janice M. Kerr
- Department of Endocrinology, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Denver, Aurora, CO, United States
| | - Murray B. Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Cary N. Mariash
- Methodist Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, Internal Medicine 1 – San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Noel Ellison
- Biostatistics, Trialwise, Inc, Houston, TX, United States
| | - Andreas G. Moraitis
- Drug Research and Development, Corcept Therapeutics, Menlo Park, CA, United States
- *Correspondence: Andreas G. Moraitis,
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Yang X, Liu Q, Fan Y, Ding L, Wang R, Hu G, Liu M. Cardiovascular Risk Factor Status in Hospitalized Patients With Type 2 Diabetes in China. Front Endocrinol (Lausanne) 2021; 12:664183. [PMID: 34367063 PMCID: PMC8339370 DOI: 10.3389/fendo.2021.664183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/28/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Controlling blood glucose, blood pressure, and blood lipid is of great importance for patients with type 2 diabetes, not only for cardiovascular disease, but also for other complications. Previous studies mainly focused on the control rate of outpatients, and the results were suboptimal, but few studies aimed at the inpatients. METHOD The present study involved 3,245 hospitalized patients with type 2 diabetes from 2013 to 2017 in the Department of Endocrinology and Metabolism of Tianjin Medical University General Hospital. The percentages of inpatients who attained the goals of the China Diabetes Society and the American Diabetes Association were calculated for major cardiovascular risk factors (HbA1c, blood pressure, and blood lipid). The prevalence of microvascular and macrovascular complications was also assessed. RESULT The percentages of patients who met the Chinese Diabetes Society goals-HbA1c <7%, blood pressure <130/80 mmHg, normal lipids, and all three goals-were 26.7, 14.8, 10.4, and 0.2% in 2013 and 30.5, 16.2, 8.0, and 0.9% in 2017, respectively. The percentage of patients who met all three American Diabetes Association goals (HbA1c<7%, blood pressure <140/90 mmHg, low-density lipoprotein cholesterol <2.6 mmol/L) increased from 4.3% in 2013 to 9.0% in 2017. The prevalence of major diabetes complications including coronary heart disease (31.7 vs. 31.9%), stroke (16.7 vs. 14.8%), diabetic kidney disease (37.9 vs. 35.8%), diabetic retinopathy (48.0 vs. 46.5%), neuropathy (63.1 vs. 61.9%), and diabetic foot (0.8 vs. 1.2%) were stable from 2013 to 2017. CONCLUSION During 2013 to 2017, control rates of major cardiovascular risk factors including HbA1c, blood pressure, and low-density lipoprotein cholesterol were improved among hospitalized patients in Tianjin, China.
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Affiliation(s)
- Xiaoyun Yang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Qian Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Ruodan Wang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Ming Liu,
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Copur S, Siriopol D, Afsar B, Comert MC, Uzunkopru G, Sag AA, Ortiz A, Covic A, van Raalte DH, Cherney DZ, Rossing P, Kanbay M. Serum glycated albumin predicts all-cause mortality in dialysis patients with diabetes mellitus: meta-analysis and systematic review of a predictive biomarker. Acta Diabetol 2021; 58:81-91. [PMID: 32862262 DOI: 10.1007/s00592-020-01581-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM HbA1c, the traditional and current gold standard biomarker guiding diabetic management, has been scrutinized for low predictive value for patients with chronic kidney disease due to variables affecting erythrocyte number and turnover. Glycated albumin, the precursor to advanced glycation end products, reflects glycemic status over the preceding 2-3 week period and already outperforms HbA1c for glycemic monitoring. Our aim was to establish whether serum GA can be further used to predict mortality risk in dialysis patients with diabetes mellitus (DM) METHODS: We did systematic review of the literature in PubMed/Medline, Web of Science, Embase (Elsevier) and the Cochrane Central Register of Controlled Trials (Wiley) up to and including February 2020. RESULTS This meta-analysis included 25,932 dialysis patients across 12 studies with maximum follow-up of 11 years. Higher GA levels were associated with the risk of all-cause mortality in dialysis patients with DM (HR 1.02, 95% CI 1.01 to 1.03, P < 0.001) irrespective of the type of dialysis, whereas higher GA was not associated with cardiovascular mortality (HR 1.03, 95% CI 0.99 to 1.06, P = 0.15) and cardiovascular events (both fatal and non-fatal) (HR 1.03, 95% CI 0.97 to 1.09, P = 0.31) in dialysis patients with DM. CONCLUSION Serum glycated albumin predicts all-cause mortality risk in dialysis patients with DM. The endpoints of cardiovascular mortality and cardiovascular events trended similarly, but did not reach significance at the current sample size.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Dimitrie Siriopol
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Melis C Comert
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Gizem Uzunkopru
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alan A Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Avd. Reyes Católicos 2, 28040, Madrid, Spain
| | - Adrian Covic
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Daniel H van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, Loaction VUMC, Amsterdam, The Netherlands
| | - David Z Cherney
- Toronto General Hospital Research Institute, UHN, Toronto, Canada
- Departments of Physiology and Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, 34010, Istanbul, Turkey.
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Berkley-Patton J, Bowe Thompson C, Bauer AG, Berman M, Bradley-Ewing A, Goggin K, Catley D, Allsworth JE. A Multilevel Diabetes and CVD Risk Reduction Intervention in African American Churches: Project Faith Influencing Transformation (FIT) Feasibility and Outcomes. J Racial Ethn Health Disparities 2020; 7:1160-1171. [PMID: 32329033 PMCID: PMC7581562 DOI: 10.1007/s40615-020-00740-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/30/2022]
Abstract
Wide-reaching health promotion interventions are needed in influential, accessible community settings to address African American (AA) diabetes and CVD disparities. Most AAs are overweight/obese, which is a primary clinical risk factor for diabetes/CVD. Using a faith-community-engaged approach, this study examined feasibility and outcomes of Project Faith Influencing Transformation (FIT), a diabetes/CVD screening, prevention, and linkage to care pilot intervention to increase weight loss in AA church-populations at 8 months. Six churches were matched and randomized to multilevel FIT intervention or standard education control arms. Key multilevel religiously tailored FIT intervention components included: (a) individual self-help materials (e.g., risk checklists, pledge cards); (b) YMCA-facilitated weekly group Diabetes Prevention Program (DPP) weight loss classes; (c) church service activities (e.g., sermons, responsive readings); and (d) church-community text/voice messages to promote healthy eating and physical activity. Health screenings (e.g., weight, blood pressure, blood glucose) were held during church services to identify participants with diabetes/CVD risks and refer them to their church's DPP class and linkage to care services. Participants (N = 352 church members and community members using churches' outreach ministries) were primarily female (67%) and overweight/obese (87%). Overall, FIT intervention participants were significantly more likely to achieve a > 5 lb weight loss (OR = 1.6; CI = 1.24, 2.01) than controls. Odds of intervention FIT-DPP participants achieving a > 5 lb weight loss were 3.6 times more than controls (p < .07). Exposure to sermons, text/email messages, brochures, commitment cards, and posters was significantly related to > 5 lb. weight loss. AA churches can feasibly assist in increasing reach and impact of diabetes/CVD risk reduction interventions with intensive weight loss components among at risk AA church-populations.
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Affiliation(s)
- Jannette Berkley-Patton
- Department of Biomedical and Health Informatics, School of Medicine, and Psychology Department, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO, 64108, USA.
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Alexandria G Bauer
- Department of Biomedical and Health Informatics, School of Medicine, and Psychology Department, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO, 64108, USA
| | - Marcie Berman
- The Institute for Community Research, Hartford, CT, USA
| | - Andrea Bradley-Ewing
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City; Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City; Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jenifer E Allsworth
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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Alqahtani AM, AlMalki ZS, Alalweet RM, Almazrou SH, Alanazi AS, Alanazi MA, AlShehri AA, AlGhamdi S. Assessing the Severity of Illness in Patients With Coronavirus Disease in Saudi Arabia: A Retrospective Descriptive Cross-Sectional Study. Front Public Health 2020; 8:593256. [PMID: 33330336 PMCID: PMC7710861 DOI: 10.3389/fpubh.2020.593256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives: We aimed to describe the epidemiological and clinical characteristics of patients with COVID-19 in Saudi Arabia in various severity groups. Methods: Data for 485 patients were extracted from the medical records from the infectious disease center of Prince Mohammed bin Abdul Aziz Hospital in Riyadh. Patients' basic information, laboratory test results, signs and symptoms, medication prescribed, other comorbidities, and outcome data were collected and analyzed. Descriptive data were reported to examine the distribution of study variables between the severe and not severe groups. Results: Of 458 included patients, 411 (89.7%) were classified as not severe, 47 (10.3%) as severe. Most (59.1%) patients were aged between 20 and 39 years. Patients with severe conditions were non-Saudi, with a chronic condition history, and tended to have more chronic conditions compared with those without severe disease. Diabetes, hypertension, and thyroid disease were significantly higher in patients with severe disease. Death was reported in only 4.26% of severe patients. Only 16 (34.04%) patients remained in the hospital in the severe group. Conclusions: Severe cases were more likely to have more comorbidities, diabetes, hypertension, and thyroid disorders were most common compared with non-severe cases.
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Affiliation(s)
- Abdulhadi M Alqahtani
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ziyad S AlMalki
- Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Randah M Alalweet
- Preventive Health - General Department of Infectious Diseases, Ministry of Health, Riyadh, Saudi Arabia
| | - Saja H Almazrou
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Mona A Alanazi
- Medical Research Unit, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | | | - Saleh AlGhamdi
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Silva MAVD, São-João TM, Cornelio ME, Mialhe FL. Effect of implementation intention on walking in people with diabetes: an experimental approach. Rev Saude Publica 2020; 54:103. [PMID: 33146324 PMCID: PMC7584411 DOI: 10.11606/s1518-8787.2020054002024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effect of implementation intentions as an intervention strategy to promote walking in adults with type 2 diabetes mellitus (T2DM). METHODS We conducted a controlled and randomized trial, with 12 months of follow-up, involving 65 people with T2DM recruited from primary health care units and allocated them in the control group (CG, n = 32) and intervention group (IG, n = 33). The IG received the implementation intention strategy to promote walking and the CG remained in follow-up for conventional treatment in primary health care. The researchers were blinded by anthropometric measurements and the filling of the instruments. RESULTS After twelve months of follow up, the IG presented a statistically significant increase in the leisure time physical activity when compared with the CG (p = 0.0413) and showed a significant decrease in waist circumference (p = 0.0061). No significant difference was observed regarding body mass index and glycated hemoglobin among groups. CONCLUSIONS Implementation intention was effective in promoting walking and improving clinical indicators in adults with T2DM.
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Affiliation(s)
| | | | | | - Fábio Luiz Mialhe
- Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Piracicaba, SP, Brasil
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40
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Almalki ZS, Khan MF, Almazrou S, Alanazi AS, Iqbal MS, Alqahtani A, Alghamdi S, Alahmari AK. Clinical Characteristics and Outcomes Among COVID-19 Hospitalized Patients with Chronic Conditions: A Retrospective Single-Center Study. J Multidiscip Healthc 2020; 13:1089-1097. [PMID: 33116555 PMCID: PMC7547771 DOI: 10.2147/jmdh.s273918] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose Evidence to date suggests that having chronic conditions increases the probability of severe illness from severe coronavirus disease 2019 (COVID-19). Thus, it is essential to identify the features of those patients. The purpose of this research was to identify the clinical characteristics and outcomes of COVID-19 patients with chronic conditions. Patients and Methods A retrospective cross-sectional single-center study was conducted using electronic medical records of hospitalized COVID-19 patients between March 1, 2020, and May 20, 2020. Patients’ basic information, laboratory test, clinical data, medications, and outcome data have been extracted and compared among three groups: patients without chronic conditions, patients with one chronic condition, and patients with two or more chronic conditions. Chi-square, Fisher’s exact test, Student’s t-test, and the Mann–Whitney U-test were used. Results The study population was 458 patients, with an average age of 38.8 years (standard deviation (SD) 12.8). There were 398 (86.9%) males in the study population, most of them with one chronic condition. There were 14 (14.3%) smokers, and the majority of them were among patients with two or more chronic conditions. Longer hospital stay and time in the intensive care unit (ICU), a higher probability of ICU admission, and the need for mechanical ventilation were identified among patients with two or more chronic conditions. Dyspnea, an increased level of platelet counts, and a reduction in hemoglobin levels were discovered among patients with two or more chronic conditions. Conclusion Patients with more chronic conditions were at higher risk of yielding poor clinical outcomes. Prevention and treatment of infections in these patients merit more attention.
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Affiliation(s)
- Ziyad Saeed Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Mohd Faiyaz Khan
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Saja Almazrou
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Salah Alanazi
- Clinical Pharmacy Department, College of Pharmacy, Jouf University, Sakaka, Aljouf, Saudi Arabia
| | - Mohammed Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Abdulhadi Alqahtani
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saleh Alghamdi
- Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah K Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
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Nuamchit T, Siriwittayawan D, Thitiwuthikiat P. The Relationship Between Glycemic Control and Concomitant Hypertension on Arterial Stiffness in Type II Diabetes. Vasc Health Risk Manag 2020; 16:343-352. [PMID: 32943869 PMCID: PMC7459141 DOI: 10.2147/vhrm.s265157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose The impact of glycemic control on macrovascular complications and arterial stiffness in type II diabetes (T2D), as well as the extent of additive effect of hypertension, is unclear. The aims of this study were to investigate the impact of glycemic control on the cardio-ankle vascular index (CAVI), an indicator of arterial stiffness, and to determine the relative risk of concomitant diabetes and hypertension with arterial stiffness. Methods One hundred and nine participants were enrolled and classified as non-diabetes (n= 37) and diabetes (n=72); the diabetic group was further identified as controllable and uncontrollable T2D depending on their hemoglobin A1c (HbA1c) levels. Univariate and multiple regression analyses were used to assess the association between CAVI and glycemic control status and hypertension. Relative risk analysis for abnormal CAVI with exposure to diabetes and hypertension was investigated. Results In all participants, age, systolic blood pressure, body mass index, and fasting blood sugar were independent predictors of CAVI. In diabetic participants, glycemic control status or HbA1c levels did not significantly correlate with CAVI. Systolic blood pressure was an independent predictor for CAVI with β = 0.26. In addition, the coexistence of diabetes together with hypertension was significantly associated with a 2.4-fold increase in the risk of abnormal CAVI (95% CI, 1.410-4.184; p <0.001). Conclusion This study demonstrates that HbA1c as well as fasting blood sugar levels in diabetic participants do not correlate with arterial stiffness. Concomitant diabetes and hypertension significantly increase the risk of arterial stiffness.
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Affiliation(s)
- Teonchit Nuamchit
- Department of Cardiothoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Duangduan Siriwittayawan
- Department of Cardiothoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Piyanuch Thitiwuthikiat
- Department of Cardiothoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
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Lim S, Islam NS. Small Practices, Big (QI) Dreams: Customizing QI Efforts for Under-resourced Primary Care Practices to Improve Diabetes Disparities (Preprint). JMIR Diabetes 2020; 7:e23844. [PMID: 35302500 PMCID: PMC8976251 DOI: 10.2196/23844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/02/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Electronic health record quality improvement (QI) initiatives hold great promise in improving adoption of clinical practice guidelines, including those related to diabetes. QI initiatives implemented in under-resourced primary care settings that primarily serve racial/ethnic minority populations have potential to improve quality of care and ultimately improve diabetes disparities. The “Screen at 23” campaign was launched in 2011 to increase screening for prediabetes and diabetes at lower BMI thresholds (ie, 23 kg/m2) for Asian Americans, in line with the new guidelines put forth by the American Diabetes Association. Here, we describe the implementation of a customized electronic health record QI initiative in under-resourced practices that primarily serve low-income South Asian populations in New York City, designed to increase diabetes screening using updated BMI guidelines and in alignment with the “Screen at 23” campaign. The customization involved the implementation of an innovative, semi-manual alternate solution to automated clinical decision support system (CDSS) alerts in order to address the restrictions on customizing CDSS alerts in electronic health record platforms used in small practice settings. We also discuss challenges and strategies with this customized QI effort. Our experience suggests that multisector partnership engagement, user-centered approaches, and informal strategies for relationship building are even more critical in under-resourced, small practice settings. Relatively simple technological solutions can be greatly beneficial in enhancing small practice capacity to engage in larger-scale QI initiatives. Tailored, context-driven approaches for implementation of equity-focused QI initiatives such as the one we describe can increase adoption of clinical practice guidelines, improve diabetes-related outcomes, and improve health disparities among underserved populations.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, United States
| | - Nadia S Islam
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, United States
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Wackström N, Koponen AM, Suominen S, Tarkka IM, Simonsen N. Does chronic pain hinder physical activity among older adults with type 2 diabetes? Health Psychol Behav Med 2020; 8:362-382. [PMID: 34040877 PMCID: PMC8114375 DOI: 10.1080/21642850.2020.1807350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 08/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Physical activity (PA) is a key component in management of type 2 diabetes (T2D). Pain might be a barrier to PA especially among older adults with T2D, but surprisingly few studies have investigated the association between chronic pain and PA. Our aim was to evaluate the prevalence of chronic pain among older adults with T2D and to examine the association between chronic pain and PA while taking important life-contextual factors into account. Methods: Data of this register-based, cross-sectional study were collected in a survey among adults with T2D (n=2866). In the current study, only respondents aged 65-75 years were included (response rate 63%, n=1386). Data were analysed by means of descriptive statistics and multivariate logistic regression analysis. Results: In total, 64% reported chronic pain. In specific groups, e.g. women and those who were obese, the prevalence was even higher. Among respondents experiencing chronic pain, frequent pain among women and severe pain among both genders were independently associated with decreased likelihood of being physically active. Moreover, the likelihood of being physically active decreased with higher age and BMI, whereas it increased with higher autonomous motivation and feelings of energy. Among physically active respondents suffering from chronic pain, neither intensity nor frequency of pain explained engagement in exercise (as compared with incidental PA). Instead, men were more likely to exercise regularly as were those with good perceived health and higher autonomous motivation. Conclusions: The prevalence of chronic pain is high among older adults with T2D. This study shows that among those suffering from chronic pain, severe pain is independently and inversely associated with being physically active, as is frequent pain, but only among women. Moreover, the findings show the importance of autonomous motivation and health variables for both incidental PA and exercise among older adults with T2D experiencing chronic pain.
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Affiliation(s)
- Nanna Wackström
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anne M. Koponen
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Ina M. Tarkka
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Nina Simonsen
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Gupta P, Majithia S, Fenwick EK, Gan ATL, Tham YC, Poh S, Thakur S, Sabanayagam C, Wong TY, Cheng CY, Lamoureux EL. Rates and Determinants of Eyecare Utilization and Eyeglass Affordability Among Individuals With Visual Impairment in a Multi-Ethnic Population-Based Study in Singapore. Transl Vis Sci Technol 2020; 9:11. [PMID: 32821483 PMCID: PMC7401894 DOI: 10.1167/tvst.9.5.11] [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: 10/08/2019] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The purpose of this study was to determine the rates of, and factors associated with, eyecare utilization and spectacle affordability among Singaporeans with vision impairment (VI). Methods We included adults with VI from their second visit of the Singapore Epidemiology of Eye Disease Study. Data on eyecare utilization and spectacle affordability were collected. Low eyecare utilization was defined as no eye check ever or eye checks not even once per year in reference to at least once per year. Difficulty affording glasses was defined as glasses being rated as expensive in reference to not expensive. Results There were 985 adults (14.5%; 415 Malays, 260 Indian, and 310 Chinese; mean age [SD]: 69.5 [10.2] years; 55.4% women) with VI who answered the above questions, were included. Of these, 624 (63.4%) wore glasses. The rates of low eyecare utilization and difficulty affording eyeglasses were 31% and 63%, respectively. Compared to Chinese (23.8%) and Indians (18.8%), Malays (57.4%) had the highest rates of low eyecare utilization (P < 0.001), and most difficulty affording eyeglasses (47.2% vs. 26.1% and 26.6% in Chinese and Indians, respectively; P < 0.001). Younger age, low socioeconomic status, absence of diabetes, absence of self-reported eye conditions, and poor vision were independently associated with low eyecare utilization, whereas older age and female sex was associated with difficulty affording glasses. Conclusions In this multi-ethnic population with VI, almost one-third had low eyecare utilization and nearly two-thirds reported difficulty affording eyeglasses. Translational Relevance This will inform strategies, such as tailored eyecare utilization awareness campaigns and awareness of available subsidy schemes for at-risk Singaporeans, such as Malays.
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Affiliation(s)
- Preeti Gupta
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Alfred T L Gan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Stanley Poh
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Sahil Thakur
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore.,National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore.,National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore.,National University of Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
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45
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Baranwal JK, Maskey R, Chaudhari RK, Sherchand O. Assessment of Achievement of American Diabetes Association (ADA) Targets in Patients with Type 2 Diabetes Mellitus at a Tertiary Care Centre in Eastern Nepal. Diabetes Metab Syndr Obes 2020; 13:2959-2964. [PMID: 32943892 PMCID: PMC7468501 DOI: 10.2147/dmso.s262643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Management of type 2 diabetes is not limited to blood glucose control, it also addresses blood pressure and lipid levels in order to prevent associated vascular complications and improve the chances of survival and quality-of-life. Although the American Diabetes Association (ADA) has lain specific target levels for glycated hemoglobin, blood pressure and serum low density cholesterol to be achieved by non-pregnant patients with type 2 diabetes mellitus, these are not being achieved in practice. We took on this study to describe the extent of ADA target achievement at our center. METHODS We analyzed data of type 2 diabetes patients who attended the endocrinology clinic at our hospital within the past 1 year from the start of the study. Data of the pregnant women and patients with mentions of conditions that might interfere with measurement of HbA1c were excluded. RESULTS We analyzed 336 records, 45.8% (n=154) males and 54.16% (n=182) females. The mean age of patients was 52.28±11.9 years. The percentages of patients who had HbA1c <7%, blood pressure <140/90 mm of Hg, and LDL-c <100 mg/dL were 56.5%, 72%, and 56.3%, respectively. Only 37.8% of patients were found to have achieved all three ADA targets. Our findings show that a higher percentage of patients who were ≥50 years of age met LDL-c goals as compared to those <50 years of age, 61.9% vs 49% (P<0.05) and that blood pressure control was better among younger age group, 78.9% vs 66.7% (P<0.05). CONCLUSION Our study highlights that a significant proportion of patients missed on achieving the ADA targets. This is worrisome and further studies should be done to find out possible reasons behind this.
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Affiliation(s)
- Jouslin K Baranwal
- Department of Biochemistry, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Robin Maskey
- Department of Internal Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajendra K Chaudhari
- Department of Biochemistry, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ojaswee Sherchand
- Department of Biochemistry, B.P Koirala Institute of Health Sciences, Dharan, Nepal
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Hu J, Amirehsani KA, McCoy TP, Wallace DC, Coley SL, Zhan F. Reliability and Validity of the Spoken Knowledge in Low Literacy in Diabetes in Measuring Diabetes Knowledge Among Hispanics With Type 2 Diabetes. DIABETES EDUCATOR 2020; 46:465-474. [PMID: 32674717 DOI: 10.1177/0145721720941409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of the study was to examine the reliability and validity of the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) scale in measuring diabetes knowledge among Hispanics with type 2 diabetes (T2DM). METHODS A total of 111 Hispanic participants with T2DM were recruited from clinics and churches in the Southeastern US. The Spanish version of the SKILLD was used. Internal consistency reliability and exploratory factor analysis (EFA) were examined for the Spanish SKILLD. Spearman rank correlations of SKILLD scores with the Summary of Diabetes Self-Care Activities (SDSCA) scores were inspected for evidence of convergent validity along with A1C level and duration of diabetes. RESULTS The average SKILLD score was 35.1% (SD = 23.4%). The correct response for each SKILLD item ranged from 4.5% to 56.8%. The estimated reliability via internal consistency was adequate (Kuder-Richardson 20 = 0.706). EFA of the SKILLD items modestly indicated 1 factor could be retained. Spearman rank correlations of SKILLD scores with diabetes self-care activities were significant and positive for foot self-care. Higher SKILLD scores were significantly correlated with duration of diabetes, using insulin, having a high education level, ever attending a diabetes class, or having a parent with diabetes. CONCLUSION The Spanish SKILLD showed acceptable reliability and adequate validity in this sample of Hispanics with T2DM. SKILLD scores indicated low diabetes knowledge in this sample. Patient-centered diabetes education tailored to low literacy needs of Hispanics is needed.
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Affiliation(s)
- Jie Hu
- The Ohio State University, Columbus, Ohio
| | - Karen A Amirehsani
- The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Thomas P McCoy
- The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Debra C Wallace
- The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Sheryl L Coley
- The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Fei Zhan
- The University of North Carolina at Greensboro, Greensboro, North Carolina
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47
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Lowenstern A, Li S, Virani SS, Navar AM, Li Z, Robinson JG, Roger VL, Goldberg AC, Koren A, Louie MJ, Peterson ED, Wang TY. Beliefs, risk perceptions, and lipid management among patients with and without diabetes: Results from the PALM registry. Am Heart J 2020; 225:88-96. [PMID: 32485329 PMCID: PMC7539544 DOI: 10.1016/j.ahj.2020.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022]
Abstract
Intensive lipid management is critical to reduce cardiovascular (CV) risk for patients with diabetes mellitus (DM). METHODS We performed an observational study of 7628 patients with (n = 2943) and without DM (n = 4685), enrolled in the Provider Assessment of Lipid Management (PALM) registry and treated at 140 outpatient clinics across the United States in 2015. Patient self-estimated CV risk, patient-perceived statin benefit and risk, observed statin therapy use and dosing were assessed. RESULTS Patients with DM were more likely to believe that their CV risk was elevated compared with patients without DM (39.1% vs 29.3%, P < .001). Patients with DM were more likely to receive a statin (74.2% vs 63.5%, P < .001) but less likely to be treated with guideline-recommended statin intensity (36.5% vs 46.9%, P < .001), driven by the low proportion (16.5%) of high risk (ASCVD risk ≥7.5%) primary prevention DM patients treated with a high intensity statin. Patients with DM treated with guideline-recommended statin intensity were more likely to believe they were at high CV risk (44.9% vs 38.4%, P = .005) and that statins can reduce this risk (41.1% vs 35.6%, P = .02), compared with patients treated with lower than guideline-recommended statin intensity. Compared with patients with an elevated HgbA1c, patients with well-controlled DM were no more likely to be on a statin (77.9% vs 79.3%, P = .43). CONCLUSIONS In this nationwide study, the majority of patients with DM were treated with lower than guideline-recommended statin intensity. Patient education and engagement may help providers improve lipid therapy for these high-risk patients.
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Affiliation(s)
- Angela Lowenstern
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC.
| | - Shuang Li
- Duke Clinical Research Institute, Durham, NC
| | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ann Marie Navar
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Zhuokai Li
- Duke Clinical Research Institute, Durham, NC
| | | | - Veronique L Roger
- Department of Health Sciences Research and Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Andrew Koren
- Sanofi Pharmaceutical Company, Bridgewater, NJ Washington University, St. Louis, MO
| | | | - Eric D Peterson
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Tracy Y Wang
- Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
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Zghebi SS, Steinke DT, Rutter MK, Ashcroft DM. Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data. BMJ Open 2020; 10:e033866. [PMID: 32611677 PMCID: PMC7358107 DOI: 10.1136/bmjopen-2019-033866] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To compare the patterns of 18 physical and mental health comorbidities between people with recently diagnosed type 2 diabetes (T2D) and people without diabetes and how these change by age, gender and deprivation over time between 2004 and 2014. Also, to develop a metric to identify most prevalent comorbidities in people with T2D. DESIGN Population-based cohort study. SETTING Primary and secondary care, England, UK. PARTICIPANTS 108 588 people with T2D and 528 667 comparators registered in 391 English general practices. Each patient with T2D aged ≥16 years between January 2004 and December 2014 registered in Clinical Practice Research Datalink GOLD practices was matched to up to five comparators without diabetes on age, gender and general practice. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of 18 physical and mental health comorbidities in people with T2D and comparators categorised by age, gender and deprivation. Odds for association between T2D diagnosis and comorbidities versus comparators. A metric for comorbidities with prevalence of ≥5% and/or odds ≥2 in patients with T2D. RESULTS Overall, 77% of patients with T2D had ≥1 comorbidity and all comorbidities were more prevalent in patients with T2D than in comparators. Across both groups, prevalence rates were higher in older people, women and those most socially deprived. Conditional logistic regression models fitted to estimate (OR, 95% CI) for association between T2D diagnosis and comorbidities showed that T2D diagnosis was significantly associated with higher odds for all conditions including myocardial infarction (OR 2.13, 95% CI 1.85 to 2.46); heart failure (OR 2.12, 1.84 to 2.43); depression (OR 1.75, 1.62 to 1.89), but non-significant for cancer (OR 1.12, 0.98 to 1.28). In addition to cardiovascular disease, the metric identified osteoarthritis, hypothyroidism, anxiety, schizophrenia and respiratory conditions as highly prevalent comorbidities in people with T2D. CONCLUSIONS T2D diagnosis is associated with higher likelihood of experiencing other physical and mental illnesses. People with T2D are twice as likely to have cardiovascular disease as the general population. The findings highlight highly prevalent and under-reported comorbidities in people with T2D. These findings can inform future research and clinical guidelines and can have important implications on healthcare resource allocation and highlight the need for more holistic clinical care for people with recently diagnosed T2D.
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Affiliation(s)
- Salwa S Zghebi
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
- Department of Pharmaceutics, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
| | - Douglas T Steinke
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
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Bains V, Kaur H, Badaruddoza B. Association analysis of polymorphisms in LEP (rs7799039 and rs2167270) and LEPR (rs1137101) gene towards the development of type 2 diabetes in North Indian Punjabi population. Gene 2020; 754:144846. [PMID: 32512158 DOI: 10.1016/j.gene.2020.144846] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Obesity is a major risk factor in aetiology of type 2 diabetes mellitus (T2DM). Leptin (LEP) is an anti-obesity hormone which regulates food intake, energy expenditure and glucose metabolism. The genetic variants in leptin and leptin receptor gene (LEPR) may play major role in the pathogenesis of T2DM and obesity. The current study aimed to investigate the association of polymorphisms in LEP (rs7799039, -2548G/A and rs2167270, 19G/A) and LEPR (rs1137101, 668A/G) gene with type 2 diabetes in North Indian Punjabi population. METHODS A total of 817 subjects were included for the present case-control study, consisting of 417 T2DM patients and 400 healthy controls. The anthropometric, physiometric and biochemical measurements were taken from all the subjects. The genotyping of LEP and LEPR gene variants were carried out by polymerase chain reaction based restriction fragment length polymorphism method (PCR-RFLP), followed by genotyping of 10% of the samples for each polymorphism by Sanger sequencing method for quality control measurement. RESULTS The risk genotype frequencies were found to be significantly higher in T2DM cases than control subjects (rs7799039, p = 0.001; rs2167270, p = 0.019 and rs1137101, p = 0.003). Under recessive genetic model LEPrs7799039 and LEPRrs1137101 polymorphism conferred 3.4 and 2.1 fold risk towards the development of T2DM after adjustment of various covariates (OR = 3.44, 95%CI: 1.768-6.681, p = 0.001 and OR: 2.12, 95%CI: 1.256-3.569, p = 0.005, respectively). In the stratified analysis of LEP variant rs7799039 by age, gender, BMI and alcohol use, a significantly increased risk of T2DM was found in female, BMI ≥ 23 and never drinking subgroups. However, in the LEPR variant rs1137101, significantly increased risk of T2DM was observed in age <50, male, BMI ≥ 23 and never drinking subgroup. The A-G haplotype combination of rs7799039A and rs2167270G conferred significant 2 fold risk towards T2DM (OR = 2.35, 95%CI: 1.34-4.12, p = 0.002). In control group, the genetic variants rs7799039 and rs1137101 were significantly associated with levels of random blood sugar and low density lipoprotein cholesterol levels. CONCLUSION The present study revealed the association of LEP rs7799039 and LEPR rs1137101 with type 2 diabetes mellitus, which suggest its predominant role in the estimation of type 2 diabetes mellitus in North Indian Punjabi population.
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Affiliation(s)
- Veena Bains
- Department of Human Genetics, Guru Nanak Dev University (GNDU), Amritsar 143 005, Punjab, India
| | - Harjit Kaur
- Department of Human Genetics, Guru Nanak Dev University (GNDU), Amritsar 143 005, Punjab, India
| | - Badaruddoza Badaruddoza
- Department of Human Genetics, Guru Nanak Dev University (GNDU), Amritsar 143 005, Punjab, India.
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50
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Cheng KJ, Hsieh CM, Nepali K, Liou JP. Ocular Disease Therapeutics: Design and Delivery of Drugs for Diseases of the Eye. J Med Chem 2020; 63:10533-10593. [PMID: 32482069 DOI: 10.1021/acs.jmedchem.9b01033] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The ocular drug discovery field has evidenced significant advancement in the past decade. The FDA approvals of Rhopressa, Vyzulta, and Roclatan for glaucoma, Brolucizumab for wet age-related macular degeneration (wet AMD), Luxturna for retinitis pigmentosa, Dextenza (0.4 mg dexamethasone intracanalicular insert) for ocular inflammation, ReSure sealant to seal corneal incisions, and Lifitegrast for dry eye represent some of the major developments in the field of ocular therapeutics. A literature survey also indicates that gene therapy, stem cell therapy, and target discovery through genomic research represent significant promise as potential strategies to achieve tissue repair or regeneration and to attain therapeutic benefits in ocular diseases. Overall, the emergence of new technologies coupled with first-in-class entries in ophthalmology are highly anticipated to restructure and boost the future trends in the field of ophthalmic drug discovery. This perspective focuses on various aspects of ocular drug discovery and the recent advances therein. Recent medicinal chemistry campaigns along with a brief overview of the structure-activity relationships of the diverse chemical classes and developments in ocular drug delivery (ODD) are presented.
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Affiliation(s)
- Kuei-Ju Cheng
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan.,Department of Pharmacy, Taipei Municipal Wanfang Hospital, Taipei Medical University, No. 111, Section 3, Xing-Long Road, Taipei 11696, Taiwan
| | - Chien-Ming Hsieh
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
| | - Kunal Nepali
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
| | - Jing-Ping Liou
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
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