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Jairoun AA, Al-Hemyari SS, Shahwan M, Jairoun SA, Alorfi NM, Zyoud SH, Suliman AA, Shahwan MK, Alnuaimi G, Shahwan M, Al-Qirim T, El-Dahiyat F. Current Perspectives, Practices, and Barriers Faced by Community Pharmacists Regarding Pharmaceutical Care Services for Diabetes Mellitus in the United Arab Emirates. J Multidiscip Healthc 2024; 17:2563-2576. [PMID: 38803617 PMCID: PMC11129742 DOI: 10.2147/jmdh.s447450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/04/2024] [Indexed: 05/29/2024] Open
Abstract
Background Providing accurate and sufficient information is a crucial requirement for delivering effective diabetes care, making it essential for community pharmacists to possess adequate knowledge of diabetes mellitus (DM) and its management. Objective To investigate community pharmacists' level of expertise and engagement in providing counseling and health promotion services for individuals with DM in the United Arab Emirates (UAE). Methods A cross-sectional study design was used. The community Pharmacies were chosen via random sampling and researchers then conducted face-to-face interviews with them using the structured questionnaire. The questionnaire included demographic data, 14 questions on the knowledge and 9 questions about the practice concerning pharmaceutical care for Diabetes Mellitus. Results The average age ± SD was 31 ± 6.3. Of the total 516 community pharmacists recruited in the study, 37.2% (n=192) were male and 62.8% (n=324) were female. The average knowledge score about DM prevention and management was 9.7 with a 95% confidence interval (CI) [9.5, 9.9] and the average practice score about DM prevention and management was 7.1 with a 95% confidence interval (CI) [6.9, 7.2]. Better knowledge scores were observed in chief pharmacists (OR 1.29; 95% CI 1.08-1.56), pharmacists with 6-10 Years of experience (OR 6.92; 95% CI 3.43-8.86), pharmacist with > 10 years of experience (OR 1.99; 95% CI 1.67-2.36), when the number of patients the pharmacist serve is 5-10 (OR 1.27; 95% CI 1.06-1.53) and being trained on DM prevention and management (OR 2.18; 95% CI 1.92-2.47). Similarly, better practice scores were observed in older participants (OR1.02; 95% CI 1.001-1.03), chain pharmacies (OR 1.42; 95% CI 1.20-1.68), chief pharmacists (OR 1.56; 95% CI 1.18-2.06), when the number of patients the pharmacists serve was 5-10 (OR 12.26; 95% CI 7.26-16.19), when the number of patients the pharmacists serve was 11-20 (OR 4.23; 95% CI 3.54-5.06) and being trained on DM prevention and management (OR 1.33; 95% CI 1.11-1.59). The most commonly reported barriers to providing counseling and health promotion services for diabetes mellitus (DM) in community pharmacies include a lack of coordination with other healthcare professionals (77%) and insufficient knowledge or clinical skills (68.7%). Conclusion Our study revealed that community pharmacy staff members displayed a noteworthy level of involvement in providing pharmaceutical care services for patients with diabetes mellitus. Based on these findings, it is recommended to enhance pharmacy education by incorporating more advanced, evidence-based training and curricula focusing on disease management and appropriate therapies, particularly for diabetes.
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Affiliation(s)
- Ammar Abdulrahman Jairoun
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, 11500, Malaysia
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
| | - Sabaa Saleh Al-Hemyari
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, 11500, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, United Arab Emirates
| | - Moyad Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, 346, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Sumaya Abdulrahman Jairoun
- Department of Clinical Pharmacy & Pharmacotherapeutics, Dubai Pharmacy College for Girls, Al Mizhar Dubai, United Arab Emirates
| | - Nasser M Alorfi
- Pharmacology and Toxicology Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sa’ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Abdulhaq A Suliman
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Manar Khalil Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, 346, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Ghala Alnuaimi
- College of Pharmacy and Health Sciences, Ajman University, Ajman, 346, United Arab Emirates
| | - Monzer Shahwan
- Diabetes Clinic, AL-Swity Center for Dermatology and Chronic Diseases, Ramallah, 972, Palestine
| | - Tariq Al-Qirim
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, 11733, Jordan
| | - Faris El-Dahiyat
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, 64141, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, 112612, United Arab Emirates
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Horinouchi S, Deguchi T, Mukai M, Ijuin A, Kawamoto Y, Nishio Y. Assessment of the severity of diabetic polyneuropathy aids in predicting the risk of developing diabetic complications in patients with untreated diabetes. Front Endocrinol (Lausanne) 2024; 15:1380970. [PMID: 38559690 PMCID: PMC10978669 DOI: 10.3389/fendo.2024.1380970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
This study aimed to determine the efficacy of assessing the severity of diabetic polyneuropathy (DPN) in patients with untreated diabetes. Seventy-two patients with untreated type 2 diabetes who were hospitalized for glycemic control were enrolled and divided into the following two groups: patients who had no prior diagnosis and patients who were unattended or had discontinued treatment. Electrophysiological criteria consistent with Baba's classification were used to diagnose and assess the severity of DPN. The patients were divided into three subgroups: no DPN (stage 0), mild DPN (stage 1), and moderate or more-severe DPN (stages 2-4). Intergroup comparisons were performed for the clinical characteristics and the results of the nerve conduction studies. Twenty-two (30%), 25 (35%), and 25 (35%) patients were categorized into the no DPN, mild DPN, and moderate or more-severe DPN subgroups, respectively. The number of patients who were unattended or had discontinued treatment in the moderate or more-severe DPN subgroup was significantly higher than that in the no DPN subgroup. The patients in the moderate or more-severe DPN subgroup had an increased risk of developing diabetic retinopathy and nephropathy, with odds ratios of 19.5 and 11.0 for advanced stages of retinopathy and nephropathy, respectively. Thus, the assessment of the severity of DPN could aid in the prediction of the risk of developing diabetic complications in patients with untreated diabetes.
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Affiliation(s)
- Shuji Horinouchi
- Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Takahisa Deguchi
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Miki Mukai
- Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Ayako Ijuin
- Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Yudai Kawamoto
- Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Hong D, Stoecker C, Shao Y, Nauman E, Fonseca V, Hu G, Bazzano AN, Kabagambe EK, Shi L. Effects of Non-Face-to-Face Chronic Care Management on Service Utilization and Outcomes Among US Medicare Beneficiaries with Diabetes. J Gen Intern Med 2024:10.1007/s11606-024-08667-0. [PMID: 38381242 DOI: 10.1007/s11606-024-08667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/26/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) results in heavy economic and disease burdens in Louisiana. The Centers for Medicare and Medicaid Services has reimbursed non-face-to-face chronic care management (NFFCCM) for patients with two or more chronic conditions since 2015. OBJECTIVE To assess the impacts of NFFCCM on healthcare utilization and health outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included Medicare fee-for-service beneficiaries with T2DM and at least one additional chronic disease between 2014 and 2018. EXPOSURES At least one record of NFFCCM Current Procedural Terminology codes. MAIN MEASURES The health outcomes in the study included major adverse cardiovascular events (MACE), all-cause mortality, and heart failure. The monthly service utilization and continuity of care index for primary care were also included. The propensity score method was used to balance the baseline differences between the two groups. Weighted multivariate regression models were developed using propensity score weights to assess the impacts of NFFCCM on outcomes. KEY RESULTS During the 5 years of study period, 8415 patients among the 118,643 Medicare beneficiaries received at least one NFFCCM. Patients receiving any NFFCCM had reduced healthcare utilization compared with patients not receiving NFFCCM, including 0.012 (95% CI - 0.014 to - 0.011; p < 0.001) fewer monthly hospital admissions, 0.017 (95% CI - 0.019 to - 0.016; p < 0.001) fewer monthly ED visits, and 0.399 (95% CI 0.375 to 0.423; p < 0.001) more monthly outpatient encounters. Patients receiving NFFCCM services had lower MACE event rates of 7.4% (95% CI 7.1 to 7.8%; p < 0.001), all-cause mortality rate of 7.8% (95% CI 7.4 to 8.1%; p < 0.001), and heart failure rate of 0.3% (95% CI 0.2 to 0.5%; p < 0.001), respectively. CONCLUSIONS AND RELEVANCE These findings suggest that reimbursement for NFFCCM was associated with the shifting high-cost utilization to lower-cost primary health care settings among patients with diabetes in Louisiana.
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Affiliation(s)
- Dongzhe Hong
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Program On Regulation, Therapeutics, and LAW (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Charles Stoecker
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yixue Shao
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Vivian Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Alessandra N Bazzano
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Edmond K Kabagambe
- Division of Academics, Ochsner Center for Outcomes Research, Ochsner Health, New Orleans, LA, USA
- Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
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Rony M, Quintero-Arias C, Osorio M, Ararso Y, Norman EM, Ravenell JE, Wall SP, Lee DC. Perceptions of the Healthcare System Among Black Men with Previously Undiagnosed Diabetes and Prediabetes. J Racial Ethn Health Disparities 2023; 10:3150-3158. [PMID: 36520369 PMCID: PMC10267290 DOI: 10.1007/s40615-022-01488-z] [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: 09/27/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Given the significant disparities in diabetes burden and access to care, this study uses qualitative interviews of Black men having HbA1c levels consistent with previously undiagnosed diabetes or prediabetes to understand their perceptions of the healthcare system. RESEARCH DESIGN AND METHODS We recruited Black men from Black-owned barbershops in Brooklyn, NY, who were screened using point-of-care HbA1c tests. Among those with HbA1c levels within prediabetes or diabetes thresholds, qualitative interviews were conducted to uncover prevalent themes related to their overall health status, health behaviors, utilization of healthcare services, and experiences with the healthcare system. We used a theoretical framework from the William and Mohammed medical mistrust model to guide our qualitative analysis. RESULTS Fifty-two Black men without a prior history of diabetes and an HbA1c reading at or above 5.7% were interviewed. Many participants stated that their health was in good condition. Some participants expressed being surprised by their abnormal HbA1c reading because it was not previously mentioned by their healthcare providers. Furthermore, many of our participants shared recent examples of negative interactions with physicians when describing their experiences with the healthcare system. Finally, several participants cited a preference for incorporating non-pharmaceutical options in their diabetes management plans. CONCLUSION To help alleviate the disparity in diabetes burden among Black men, healthcare providers should take a more active role in recognizing and addressing their own implicit biases, engage in understanding the specific healthcare needs and expectations of each patient, and consider emphasizing non-medication approaches to improve glycemic control.
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Affiliation(s)
- Melissa Rony
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | | | - Marcela Osorio
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Yonathan Ararso
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Elizabeth M Norman
- Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, 10003, USA
| | - Joseph E Ravenell
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - Stephen P Wall
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - David C Lee
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA.
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA.
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5
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 2023; 46:e151-e199. [PMID: 37471273 PMCID: PMC10516260 DOI: 10.2337/dci23-0036] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association for Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (HbA1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA
| | - George L. Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IL
| | - David E. Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA
| | - Andrea R. Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E. Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL
| | - David M. Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA
| | - M. Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC
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Liao PJ, Ting MK, Kuo CF, Ding YH, Lin CM, Hsu KH. Kinship analysis of type 2 diabetes mellitus familial aggregation in Taiwan. Biomed J 2023; 46:100549. [PMID: 35863666 PMCID: PMC10345230 DOI: 10.1016/j.bj.2022.07.003] [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: 07/27/2021] [Revised: 05/11/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Family disease history plays a vital role in type 2 diabetes mellitus (T2DM) risk. However, the familial aggregation of T2DM among different kinship relatives warrants further investigation. METHODS This nationwide kinship relationship study collected 2000-2016 data of two to five generations of the Taiwanese population from the National Health Insurance Research Database. Approximately 4 million family trees were constructed from the records of 20, 890, 264 Taiwanese residents during the study period. T2DM was diagnosed on the basis of ICD-9-CM codes 250.x0 or 250.x2, with three consecutive related prescriptions. The Cox proportional hazard model was used for statistical analysis. RESULTS Compared with their counterparts, individuals who had first-degree relatives with T2DM were more likely to develop T2DM during the follow-up period (hazard ratio [HR], 2.37-27.75), followed by individuals who had second-degree relatives with T2DM (HR, 1.29-1.88). T2DM relative risk was higher in those with an affected mother than in those with affected father. The HR for T2DM was 20.32 (95%CI = 15.64-26.42) among male individuals with an affected twin brother, whereas among female individuals with an affected twin sister, it was 60.07 (95%CI = 40.83-88.36). The HRs presented a dose-response relationship with the number of affected family members. CONCLUSION The study suggests a significant familial aggregation of T2DM occurrence; these findings could aid in identifying the high-risk group for T2DM and designing early intervention strategies and treatment plans.
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Affiliation(s)
- Pei-Ju Liao
- International Program of Health Informatics and Management, and Master Degree Program in Health and Long-term Care Industry, Chang Gung University, Taoyuan, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Ming-Kuo Ting
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
| | - Yu-Hao Ding
- Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ciao-Ming Lin
- Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, Department of Urology, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan; Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei, Taiwan.
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7
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem 2023:hvad080. [PMID: 37473453 DOI: 10.1093/clinchem/hvad080] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association of Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (Hb A1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA, United States
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, ILUnited States
| | - David E Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA, United States
| | - Andrea R Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL, United States
| | - David M Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA, United States
| | - M Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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Horinouchi S, Harada M, Ikeda S, Horinouchi R, Kubo M, Tashiro Y, Ijuin A, Mukai M, Nishio Y. Relationship between diabetic complications and the nutritional index in untreated diabetes. Diabetol Int 2022; 14:58-64. [PMID: 36636155 PMCID: PMC9829937 DOI: 10.1007/s13340-022-00595-w] [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: 03/30/2022] [Accepted: 06/24/2022] [Indexed: 01/16/2023]
Abstract
This study aimed to determine the association between diabetic complications and the nutritional index at the first hospital visit in untreated patients with diabetes. Two hundred and four patients with untreated type 2 diabetes were enrolled in the present study. Nutrition-related risks were assessed using the Geriatric Nutritional Risk Index (GNRI). The patients were divided into the following three subgroups: major/moderate risk, low risk, and no risk. Intergroup comparisons of clinical characteristics were carried out. The risk of complications related to diabetes was associated with the GNRI. The major/moderate-risk group (GNRI < 92) had a high risk for diabetic retinopathy, diabetic nephropathy, and diabetic foot, while the low-risk group (GNRI of 92 to ≤ 98) had a high risk for diabetic nephropathy only. The odds ratio of diabetic retinopathy for a major/moderate risk was 17.6. The odds ratio of diabetic nephropathy for a major/moderate risk was 16.7. Nutritional assessment at the first hospital visit using the GNRI could be a simple and useful tool for predicting the risk of diabetic complications in untreated patients with diabetes.
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Affiliation(s)
- Shuji Horinouchi
- grid.410788.20000 0004 1774 4188Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760 Japan
| | - Mihoko Harada
- grid.410788.20000 0004 1774 4188Department of Outpatient Nursing, Kagoshima City Hospital, Kagoshima, Japan
| | - Sakiko Ikeda
- grid.410788.20000 0004 1774 4188Department of Nutrition Management, Kagoshima City Hospital, Kagoshima, Japan
| | - Remi Horinouchi
- grid.410788.20000 0004 1774 4188Department of Nutrition Management, Kagoshima City Hospital, Kagoshima, Japan
| | - Misako Kubo
- grid.410788.20000 0004 1774 4188Department of Nutrition Management, Kagoshima City Hospital, Kagoshima, Japan
| | - Yuma Tashiro
- grid.410788.20000 0004 1774 4188Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760 Japan
| | - Ayako Ijuin
- grid.410788.20000 0004 1774 4188Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760 Japan
| | - Miki Mukai
- grid.410788.20000 0004 1774 4188Department of Diabetes and Endocrine Medicine, Kagoshima City Hospital, 37-1 Uearata, Kagoshima, 890-8760 Japan
| | - Yoshihiko Nishio
- grid.258333.c0000 0001 1167 1801Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Mahmoud MF, Abdelaal S, Mohammed HO, El-Shazly AM, Daoud R, Abdelfattah MAO, Sobeh M. Syzygium aqueum (Burm.f.) Alston Prevents Streptozotocin-Induced Pancreatic Beta Cells Damage via the TLR-4 Signaling Pathway. Front Pharmacol 2021; 12:769244. [PMID: 34912223 PMCID: PMC8667316 DOI: 10.3389/fphar.2021.769244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
Although several treatments are available for the treatment of type 2 diabetes mellitus, adverse effects and cost burden impose the search for safe, efficient, and cost-effective alternative herbal remedies. Syzygium aqueum (Burm.f.) Alston, a natural anti-inflammatory, antioxidant herb, may suppress diabetes-associated inflammation and pancreatic beta-cell death. Here, we tested the ability of the bioactive leaf extract (SA) to prevent streptozotocin (STZ)-induced oxidative stress and inflammation in pancreatic beta cells in rats and the involvement of the TLR-4 signaling pathway. Non-fasted rats pretreated with 100 or 200 mg kg-1 SA 2 days prior to the STZ challenge and for 14 days later had up to 52 and 39% reduction in the glucose levels, respectively, while glibenclamide, the reference standard drug (0.5 mg kg-1), results in 70% reduction. Treatment with SA extract was accompanied by increased insulin secretion, restoration of Langerhans islets morphology, and decreased collagen deposition as demonstrated from ELISA measurement, H and E, and Mallory staining. Both glibenclamide and SA extract significantly decreased levels of TLR-4, MYD88, pro-inflammatory cytokines TNF-α, and TRAF-6 in pancreatic tissue homogenates, which correlated well with minimal pancreatic inflammatory cell infiltration. Pre-treatment with SA or glibenclamide decreased malondialdehyde, a sensitive biomarker of ROS-induced lipid peroxidation, and restored depleted reduced glutathione in the pancreas. Altogether, these data indicate that S. aqueum is effective in improving STZ-induced pancreatic damage, which could be beneficial in treating type 2 diabetes mellitus.
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Affiliation(s)
- Mona F. Mahmoud
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Shimaa Abdelaal
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Heba Osama Mohammed
- Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Assem M. El-Shazly
- Department of Pharmacognosy, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Rachid Daoud
- African Genome Center, Mohammed VI Polytechnic University, Ben Guerir, Morocco
| | | | - Mansour Sobeh
- AgroBioSciences, Mohammed VI Polytechnic University, Ben Guerir, Morocco
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Hong D, Fort D, Shi L, Price-Haywood EG. Electronic Medical Record Risk Modeling of Cardiovascular Outcomes Among Patients with Type 2 Diabetes. Diabetes Ther 2021; 12:2007-2017. [PMID: 34143415 PMCID: PMC8266923 DOI: 10.1007/s13300-021-01096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Increased utilization of electronic health records (EHR) has enriched databases for creating risk models. We used machine learning techniques to develop an EHR-based risk model locally fitted to patients with type 2 diabetes mellitus (T2DM) for predicting cardiovascular disease. METHODS This retrospective observational study was conducted within Ochsner Health, Louisiana, USA, between 2013-2017. Data analysis included 6245 patients who had two outpatient diagnoses of T2DM recorded on separate days or a diagnosis recorded during an inpatient encounter. Baseline clinical data were limited to 180 days before the index diagnosis. Cardiovascular outcomes were coronary heart disease (CHD), heart failure and stroke. Machine learning approaches were used to select predictor variables into Cox proportional hazards models for each outcome. Locally fit equations were compared to "generalized" risk equations (RECODe, AS-CVD, QRISK3) using model discrimination and calibration. RESULTS Among factors identified in the Ochsner (n = 11), RECODe (n = 14), AS-CVD (n = 15) and QRISK3 (n = 23), only age was common to all four risk equations. The Ochsner model had high internal discrimination for CHD (C-statistics 0.85) and better discrimination than RECODe (C-statistics 0.45), the QRISK3 (C-statistics 0.72) and AS-CVD (C-statistics 0.54). CONCLUSIONS The Ochsner model overestimated 5-year CHD risk, but had relatively higher calibration than the other models in CHD. Risk equations fitted for local populations improved cardiovascular risk stratification for patients with T2DM. Application of machine learning simplified the models compared to "generalized" risk equations.
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Affiliation(s)
- Dongzhe Hong
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Daniel Fort
- Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, LA, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Eboni G Price-Haywood
- Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, LA, USA.
- University of Queensland Ochsner Clinical School, New Orleans, LA, USA.
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Fründt T, Schröder N, Hölzemer A, Pinnschmidt H, de Heer J, Behrends BC, Renne T, Lautenbach A, Lohse AW, Schrader J. Prevalence and risk factors of undiagnosed diabetes mellitus among gastroenterological patients: a HbA1c-based single center experience. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1306-1313. [PMID: 34157754 DOI: 10.1055/a-1482-8840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diabetes mellitus is a major risk factor for microvascular disease, leading to chronic kidney injury or cardiovascular disease, but there is a tremendous proportion of patients worldwide who suffer from undiagnosed diabetes. Until now, little is known about the prevalence of undiagnosed diabetes in gastroenterology inpatients. OBJECTIVE To improve detection of undiagnosed diabetes, a routine screening procedure for gastroenterology inpatients, based on hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) measurement, was established. METHODS We conducted a retrospective analysis of the implemented diabetes screening. Diabetes mellitus was diagnosed according to the guideline of the German Diabetes Association in patients with an HbA1c of ≥6.5% anld/or fasting plasma glucose (FPG) ≥126 mg/dL. Univariate and multivariate analyses were performed to identify independent risk factors for undiagnosed diabetes. RESULTS Within a 3-month period, 606 patients were eligible for a diabetes screening. Pre-existing diabetes was documented in 120 patients (19.8 %), undiagnosed diabetes was found in 24 (3.9%), and 162 patients (26.7%) met the definition for prediabetes. Steroid medication use, age, and liver cirrhosis due to primary sclerosing cholangitis (PSC) were identified as risk factors for undiagnosed diabetes. CONCLUSION The prevalence of undiagnosed diabetes in gastroenterology inpatients is markedly elevated in comparison to the general population, and a substantial number of inpatients are in a prediabetic status, underlining the need for diabetes screening. In addition to previously described risk factors of patient age and steroid medication use, we identified PSC-related liver cirrhosis (but not liver cirrhosis due to another etiology) as an independent risk factor for undiagnosed diabetes.
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Affiliation(s)
- Thorben Fründt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niko Schröder
- Department of Internal Medicine, Gastroenterology, Hepatology, Endoscopy and Diabetology, Osnabrück, Germany
| | - Angelique Hölzemer
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jocelyn de Heer
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Berit C Behrends
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Renne
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Lautenbach
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Schrader
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Bonora E, Dauriz M, Rinaldi E, Mantovani A, Boscari F, Mazzuccato M, Vedovato M, Gallo A, Toffanin E, Lapolla A, Fadini GP, Avogaro A. Assessment of simple strategies for identifying undiagnosed diabetes and prediabetes in the general population. J Endocrinol Invest 2021; 44:75-81. [PMID: 32342446 DOI: 10.1007/s40618-020-01270-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The rising tide of diabetes mellitus (DM) and prediabetes (PDM) is urgently calling for strategies easily applicable to anticipate diagnosis. We assessed the effectiveness of random capillary blood glucose (RCBG), administration of a validated DM risk questionnaire, or the combination of both. MATERIALS AND METHODS RCBG measurement and/or questionnaire administration were offered to all individuals presenting at gazebos organized during the World Diabetes Day or similar public initiatives on diabetes awareness. Subjects with suspicious DM or PDM were invited to the Diabetes Center (DC) for laboratory confirmation (fasting plasma glucose and HbA1c). RESULTS Among 8563 individuals without known diabetes undergoing RCBG measurement, 341 (4%) had suspicious values. Diagnosis of DM was confirmed in 36 (41.9%) of the 86 subjects who came to the DC and PDM was found in 40 (46.5%). Among 3351 subjects to whom the questionnaire was administered, 480 (14.3%) had suspicious scores. Diagnosis of DM was confirmed in 40 (10.1%) of the 397 who came to the DC and PDM was found in 214 (53.9%). These 3351 subjects also had RCBG measurement and 30 out of them had both tests positive. Among them, 27 subjects came to DC and DM was diagnosed in 17 (63.0%) and PDM was found in 9 (33.3%). CONCLUSIONS These data suggest that RCBG definitely outperforms the questionnaire to identify unknown DM and PDM. RCBG measurement, with questionnaire as an adjunctive tool, appears to be a simple, fast, and feasible opportunistic strategy in detecting undiagnosed DM and PDM.
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Affiliation(s)
- E Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - M Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
- Department of Internal Medicine, Section of Endocrinology and Diabetes, Bolzano General Hospital, Bolzano, Italy
| | - E Rinaldi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - A Mantovani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - F Boscari
- Department of Medicine, University of Padua, Padua, Italy
| | - M Mazzuccato
- Department of Medicine, University of Padua, Padua, Italy
| | - M Vedovato
- Department of Medicine, University of Padua, Padua, Italy
| | - A Gallo
- Department of Medicine, University of Padua, Padua, Italy
| | - E Toffanin
- Department of Medicine, University of Padua, Padua, Italy
| | - A Lapolla
- Department of Medicine, University of Padua, Padua, Italy
| | - G P Fadini
- Department of Medicine, University of Padua, Padua, Italy
| | - A Avogaro
- Department of Medicine, University of Padua, Padua, Italy
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Al Awadi F, Hassanein M, Hussain HY, Mohammed H, Ibrahim G, Khater A, Suliman E. Prevalence of Diabetes and Associated Health Risk Factors among Adults in Dubai, United Arab Emirates: Results from Dubai Household Survey 2019. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2020. [DOI: 10.1159/000512428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> The health and social burdens of diabetes mellitus (DM) are steadily increasing worldwide, reflecting the impact of urbanization, industrial transitions, and shifting to nonhealthy, sedentary life patterns’, as well as the high sugar, low-fiber food consumptions. All these factors have contributed to the global increase in the prevalence of DM and metabolic disorders. <b><i>Objectives:</i></b> The objective is to study the prevalence of DM among adult cohorts in Dubai and the extent of behavioral health risk factors associations. <b><i>Methodology:</i></b> A cross-sectional household health survey with multistage, stratified cluster random sample of 9,630 participants including 2,496 households was carried out in Dubai 2019. About 5,371 non-United Arab Emirates (UAE) national, 2,245 UAE-nationals, of different age-groups, gender, education, nationality, smoking, and marital status were included in the survey. The survey questionnaire was adapted from the one used in the World Bank’s Living Standards Measurement Surveys (LSMSs) and the WHO’s World Health Surveys (WHSs). Self-reported diabetes was considered as well as newly diagnosed diabetes based on HbA1C results. About 75 well-trained surveyors, 25 well-trained nurses, and other laboratory technicians conducted the survey. SPSS 21 and Stata 12 software was used for data management. <b><i>Results:</i></b> The data indicate that the prevalence of diabetes among Dubai Emiratis is much higher than Dubai expats (19.3 vs. 12.4% <i>p</i> = 0.000). The association between diabetes and age was evident regardless of nationality. Rates of diabetes were higher in males (15.4%) compared to females (11.8%) (<i>p</i> < 0.001). About 11.2% of those considered overweight have DM, while the prevalence is 21.5% in obese people (<i>p</i> = 0.000). Physical inactivity, smoking, and hypertension (HTN) were strongly associated with higher rates of DM. Regardless of nationality, lower levels of education were statistically significantly associated with the prevalence of DM (<i>p</i> = 0.000), while single marital status was associated with the lowest rate of DM. <b><i>Conclusions:</i></b> Dubai household health survey 2019 indicated that the prevalence of DM among Dubai adults was still high as an overall estimation. Higher rates of diabetes were significantly associated with Emirati nationality, older age-groups, male gender, physical inactivity, high BMI, HTN, smoking<b>,</b> marital status of divorced, separated or divorced as well as low educational level groups.
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Bonora E, Trombetta M, Dauriz M, Travia D, Cacciatori V, Brangani C, Negri C, Perrone F, Pichiri I, Stoico V, Zoppini G, Rinaldi E, Da Prato G, Boselli ML, Santi L, Moschetta F, Zardini M, Bonadonna RC. Chronic complications in patients with newly diagnosed type 2 diabetes: prevalence and related metabolic and clinical features: the Verona Newly Diagnosed Type 2 Diabetes Study (VNDS) 9. BMJ Open Diabetes Res Care 2020; 8:8/1/e001549. [PMID: 32819978 PMCID: PMC7443259 DOI: 10.1136/bmjdrc-2020-001549] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION We explored the presence of chronic complications in subjects with newly diagnosed type 2 diabetes referred to the Verona Diabetes Clinic. Metabolic (insulin secretion and sensitivity) and clinical features associated with complications were also investigated. RESEARCH DESIGN AND METHODS The comprehensive assessment of microvascular and macrovascular complications included detailed medical history, resting ECG, ultrasonography of carotid and lower limb arteries, quantitative neurological evaluation, cardiovascular autonomic tests, ophthalmoscopy, kidney function tests. Insulin sensitivity and beta-cell function were assessed by state-of-the-art techniques (insulin clamp and mathematical modeling of glucose/C-peptide curves during oral glucose tolerance test). RESULTS We examined 806 patients (median age years, two-thirds males), of whom prior clinical cardiovascular disease (CVD) was revealed in 11.2% and preclinical CVD in 7.7%. Somatic neuropathy was found in 21.2% and cardiovascular autonomic neuropathy in 18.6%. Retinopathy was observed in 4.9% (background 4.2%, proliferative 0.7%). Chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2) was found in 8.8% and excessive albuminuria in 13.2% (microalbuminuria 11.9%, macroalbuminuria 1.3%).Isolated microvascular disease occurred in 30.8%, isolated macrovascular disease in 9.3%, a combination of both in 9.1%, any complication in 49.2% and no complications in 50.8%.Gender, age, body mass index, smoking, hemoglobin A1c and/or hypertension were independently associated with one or more complications. Insulin resistance and beta-cell dysfunction were associated with macrovascular but not microvascular disease. CONCLUSIONS Despite a generally earlier diagnosis for an increased awareness of the disease, as many as ~50% of patients with newly diagnosed type 2 diabetes had clinical or preclinical manifestations of microvascular and/or macrovascular disease. Insulin resistance might play an independent role in macrovascular disease. TRIAL REGISTRATION NUMBER NCT01526720.
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Affiliation(s)
- Enzo Bonora
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Maddalena Trombetta
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Marco Dauriz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Daniela Travia
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Vittorio Cacciatori
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Corinna Brangani
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Carlo Negri
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fabrizia Perrone
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Isabella Pichiri
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Vincenzo Stoico
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giacomo Zoppini
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Elisabetta Rinaldi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Giuliana Da Prato
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Maria Linda Boselli
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Lorenza Santi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Federica Moschetta
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Monica Zardini
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
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Alawadi F, Hassanein M, Suliman E, Hussain H, Mamdouh H, Ibrahim G, Al Faisal W, Monsef N, Farghaly M. The Prevalence of Diabetes and Pre-Diabetes among the Dubai Population: Findings from Dubai Household Health Surveys, 2014 and 2017. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2020. [DOI: 10.1159/000508833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
<b><i>Background:</i></b> Diabetes mellitus is a leading cause of morbidity and mortality worldwide, imposing a considerable burden on health systems and societies as it affects both individuals and their families and has a large impact on the economic and social development of a country. <b><i>Objectives:</i></b> The purpose of this study was to study the prevalence of diabetes and pre-diabetes among the Dubai population and associations with diabetes risk factors. <b><i>Methodology:</i></b> A cross-sectional Diabetes Household Survey was carried out in the Emirates of Dubai during 2017 as a complementary stage of the Dubai Household Survey, 2014, which was a randomly selected, multistage, stratified, cluster survey. The sampling technique was selected to assess the rates of undiagnosed diabetes as well as the rates of pre-diabetes through screening with HbA1c. The size of the 2017 survey sample was estimated at 300 individuals for Emirati and 300 for non-Emirati. An additional 200 individuals were added to address non-response cases. These were added to those who were identified as diabetics in the 2014 Household Health Survey and then weighted to give a representative sample for the Dubai population. <b><i>Results:</i></b> The study revealed that the prevalence of diabetes in Dubai among UAE nationals was 19%, and it was 14.7% for expats. Consequently, the overall prevalence of diabetes in Dubai is 15.2%. Undiagnosed diabetes was 10% in UAE nationals and 10.9% in expats. Pre-diabetes in UAE national males was lower than in females, although this pattern was not observed among expats. Younger age, normal weight, and exercise were associated with lower rates of diabetes and pre-diabetes in UAE nationals and expats. Hypertension was associated with higher rates of diabetes regardless of nationality. <b><i>Conclusions:</i></b> The study concluded that the prevalence of diabetes among the Dubai population is alarmingly high and that a large proportion of the population are not aware of their diagnosis. A higher prevalence of diabetes is associated with multiple factors, such as age, male gender, hypertension, higher BMI, lack of exercise, and lower level or no education, as well as a family history of diabetes mellitus. Many of these factors can be easily modified, which could lead to a decrease in the burden of the disease.
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Li Y, Huang C, Fu W, Zhang H, Lao Y, Zhou H, Tan H, Xu H. Screening of the active fractions from the Coreopsis tinctoria Nutt. Flower on diabetic endothelial protection and determination of the underlying mechanism. JOURNAL OF ETHNOPHARMACOLOGY 2020; 253:112645. [PMID: 32045684 DOI: 10.1016/j.jep.2020.112645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/06/2020] [Accepted: 02/01/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Coreopsis tinctoria Nutt. flower (CTF) has been used traditionally in China for treating hypertension and diabetes as well as reducing body weight and blood fat. However, the vascular protection effect of the CTF has not been studied to date. AIM OF THE STUDY This study aimed to screen and identify bioactive fractions from the CTF with a diabetic endothelial protection effect and to clarify the underlying mechanism. MATERIALS AND METHODS The vascular protection effect of Fraction A was studied in high-fat diet and streptozocin-induced diabetic models. The endothelial protection effect of Fraction A-2 was further studied in an in vitro vascular endothelial dysfunction model induced by high glucose. In a high glucose-induced human umbilical vein endothelial cell (HUVEC) model, Fractions A-2-2 and A-2-3 were screened, and their detailed mechanisms of endothelial protection were studied. Liquid chromatography mass spectrometry (LC-MS) was used to identify the main components in Fractions A-2-2 and A-2-3. RESULTS Fraction A treatment significantly improved the endothelium-dependent vasodilation of the mesenteric artery induced by acetylcholine in diabetic rats. The maximum relaxation was 79.82 ± 2.45% in the control group, 64.36 ± 9.81% in the model group, and 91.87 ± 7.38% in the Fraction A treatment group (P < 0.01). Fraction A treatment also decreased rat tail pressure compared with the model group at the 12th week. The systolic blood pressure was 152.7 5 ± 16.99 mmHg in the control group, 188.50 ± 5.94 mmHg in the model group, and 172.60 ± 14.31 mmHg in the Fraction A treatment group (P < 0.05). The mean blood pressure was 128.50 ± 13.79 mmHg in the control group, 157.00 ± 6.06 mmHg in the model group, and 144.80 ± 11.97 mmHg in the Fraction A treatment group (P < 0.05). In an in vitro vascular endothelium-dependent vasodilation dysfunction model induced by high glucose, Fraction A-2 improved the vasodilation of the mesenteric artery. The maximum relaxation was 82.15 ± 16.24% in the control group, 73.29 ± 14.25% in the model group, and 79.62 ± 13.89% in the Fraction A-2 treatment group (P < 0.05). In a high glucose-induced HUVEC model, Fraction A-2-2 and Fraction A-2-3 upregulated the expression of IRS-1, Akt, and eNOS and increased the levels of p-IRS-1Ser307, p-Akt Ser473, and p-eNOSSer1177 and also decreased the expression of NOX4, TNF-α, IL-6, sVCAM, sICAM, and NF-κB (P < 0.01). With the intervention of AG490 and LY294002, the above effects of Fraction A-2-2 and Fraction A-2-3 were inhibited (P < 0.01). LC-MS data showed that in Fraction A-2-2 and Fraction A-2-3, there were 10 main components: flavanocorepsin; polyphenolic; flavanomarein; isochlorogenic acid A; dicaffeoylquinic acid; coreopsin; marein; coreopsin; luteolin-7-O-glucoside; and 3',5,5',7-tetrahydroxyflavanone-O-hexoside. CONCLUSION The protective effect of the CTF on diabetic endothelial dysfunction may be due to its effect on the JAK2/IRS-1/PI3K/Akt/eNOS pathway and the related oxidative stress and inflammation. The results strongly suggested that Fraction A-2-2 and Fraction A-2-3 were the active fractions from the CTF, and the CTF might be a potential option for the prevention of vascular complications in diabetes.
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Affiliation(s)
- Yajuan Li
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, PR China
| | - Chaoran Huang
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, PR China
| | - Wenwei Fu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, PR China
| | - Hong Zhang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, PR China
| | - Yuanzhi Lao
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, PR China
| | - Hua Zhou
- Institute of Cardiovascular Disease of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, PR China
| | - Hongsheng Tan
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, PR China.
| | - Hongxi Xu
- Institute of Cardiovascular Disease of Integrated Traditional Chinese and Western Medicine, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, PR China.
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Abstract
Long-term safety of living kidney donation (LKD), especially for young donors, has become a real matter of concern in the transplant community and may contribute to creating resistance to LKD. In this context, the criteria that govern living donor donations must live up to very demanding standards as well as adjust to this novel reality. In the first part, we review the existing guidelines published after 2010 and critically examine their recommendations to see how they do not necessarily lead to consistent and universal practices in the choice of specific thresholds for a parameter used to accept or reject a living donor candidate. In the second part, we present the emergence of a new paradigm for LKD developed in the 2017 Kidney Disease: Improving Global Outcomes guidelines with the introduction of an integrative risk-based approach. Finally, we focus on predonation renal function evaluation, a criteria that remain central in the selection process, and discuss several issues surrounding the donor candidate's glomerular filtration rate assessment.
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Nangia R, Thakur JS, Bhalla A, Duseja A. Development and validation of composite risk score to assess risks of major noncommunicable diseases in Northern Indian populations: A research protocol. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_23_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rahmani B, Gandhi J, Joshi G, Smith NL, Reid I, Khan SA. The Role of Diabetes Mellitus in Diseases of the Gallbladder and Biliary Tract. Curr Diabetes Rev 2020; 16:931-948. [PMID: 32133965 DOI: 10.2174/1573399816666200305094727] [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: 08/25/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increasing prevalence of diabetes mellitus worldwide continues to pose a heavy burden. Though its gastrointestinal impact is appropriately recognized, the lesser known associations may be overlooked. OBJECTIVE We aim to review the negative implications of diabetes on the gallbladder and the biliary tract. METHODS A MEDLINE® database search of literature was conducted with emphasis on the previous five years, combining keywords such as "diabetes," "gallbladder," and "biliary". RESULTS The association of diabetes to the formation of gallstones, gallbladder cancer, and cancer of the biliary tract are discussed along with diagnosis and treatment. CONCLUSION Though we uncover the role of diabetic neuropathy in gallbladder and biliary complications, the specific individual diabetic risk factors behind these developments is unclear. Also, in addition to diabetes control and surgical gallbladder management, the treatment approach also requires further focus.
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Affiliation(s)
- Benjamin Rahmani
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
- Medical Student Research Institute, St. George’s University School of Medicine, Grenada, West Indies
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | | | - Inefta Reid
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Um T, Seo EJ, Kim YJ, Yoon YH. Optical coherence tomography angiography findings of type 1 diabetic patients with diabetic retinopathy, in comparison with type 2 patients. Graefes Arch Clin Exp Ophthalmol 2019; 258:281-288. [PMID: 31832768 DOI: 10.1007/s00417-019-04517-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To compare optical coherence tomography angiography (OCT-A) parameters between type 1 and type 2 diabetic patients with diabetic retinopathy (DR). METHODS A total of 70 patients with type 1 diabetes and 70 with type 2 diabetes were retrospectively analyzed. DR was graded as no DR, mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). Using OCT-A, the foveal avascular zone (FAZ) area (mm2) and vascular density (VD) (%) were calculated in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). RESULTS In both type 1 and 2 diabetes patients, the FAZ area (mm2) in both capillary plexuses (CP) increased with DR progression, whereas the VD (%) progressively decreased. The changes in the FAZ area and the VD were significantly greater in the DCP than in the SCP in both types of diabetes patients(p < 0.001). In the analysis of decreasing slope of the VD in the DCP, attenuation was not significant until severe NPDR stage but then abruptly decreased when it progressed to PDR stage in type 1 diabetes. In type 2 diabetes, the DCP VD decreased gradually as DR stage progressed. CONCLUSIONS As DR progression, the increasing in FAZ area and the decreasing in VD are more severe in the DCP than in the SCP in both types of diabetes. In type 1 diabetes eyes, they were remained in relatively healthy until it gets to the advanced stage of DR, while the gradual deterioration of FAZ area and VD was found from the early stage to the advanced stage of DR in type 2 diabetes.
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Affiliation(s)
- Taewoong Um
- Department of Ophthalmology, Pureun Eye Center, Jeonju, South Korea
| | - Eoi Jong Seo
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Yoon Jeon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, #88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, #88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
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Liu Y, Guo H, Wang Q, Lian D, Yang M, Huang K, Chen J, Xuan Y, Zhang J, Wei Q, Fang S, Xu J, Liu Y, Sun K, Sun Z, Wang B. Use of capillary glucose combined with other non-laboratory examinations to screen for diabetes and prediabetes. Diabet Med 2019; 36:1671-1678. [PMID: 31392737 DOI: 10.1111/dme.14101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/19/2023]
Abstract
AIM To evaluate the value and feasibility of capillary glucose assessment, combined with other non-laboratory measures, in screening for diabetes and prediabetes in the community. METHODS In this cross-sectional study, we assessed fasting capillary glucose, fasting plasma glucose, and both capillary glucose and plasma glucose values after 2-h oral glucose tolerance tests in a total of 3736 samples. We determined the optimal threshold of capillary glucose using receiver-operating characteristic curve analysis. The effect of screening methods using capillary glucose combined with other variables, such as age, BMI and waist circumference, was assessed according to area under the receiver-operating characteristic curve. RESULTS There was a strong positive correlation between capillary glucose and venous plasma glucose. The area under the curve for the model using fasting capillary glucose to screen for impaired fasting glucose was 0.722, while that for the model using capillary glucose after a 2-h oral glucose tolerance test to screen for impaired glucose tolerance was 0.916. The area under the curve for the model using fasting capillary glucose to screen for diabetes was 0.835, while that for the model using 2-h oral glucose tolerance test capillary glucose was 0.912. The area under the curve for the model using fasting capillary glucose + 2-h oral glucose tolerance test capillary glucose to screen for diabetes was 0.945. The discriminatory capability of models using capillary glucose was somewhat improved by adding non-laboratory variables. CONCLUSIONS Capillary glucose could be an alternative for screening for diabetes and prediabetes, especially in low-resource areas.
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Affiliation(s)
- Yuxiang Liu
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Haijian Guo
- Integrated Business Management Office, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Qing Wang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Dashuai Lian
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Man Yang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Kaiping Huang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Jianshuang Chen
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Yan Xuan
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Jiarong Zhang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Qiankun Wei
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | | | - Jinshui Xu
- Integrated Business Management Office, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yu Liu
- Centre for Disease Control and Prevention, Jurong, Jiangsu, China
| | - Kaicheng Sun
- Centre for Disease Control and Prevention, Yandu, Jiangsu, China
| | - Zilin Sun
- Department of Endocrinology, Institute of Diabetes, Medical School, Southeast University, Nanjing, Jiangsu, China
| | - Bei Wang
- Department of Epidemiology and Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
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Topal M. The inhibition profile of sesamol against α-glycosidase and acetylcholinesterase enzymes. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2019. [DOI: 10.1080/10942912.2019.1656234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Meryem Topal
- Vocational School of Health Services, Gumushane University, Gumushane University, Gumushane, Turkey
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Lee S, Park H, Lee Y, Choi O, Kim J, Gray HL, Song K. Relationships between the diabetes awareness and clinical indices/nutrient intakes in Korean adults: Based on the 2012-2013 Korea National Health and Nutrition Examination Survey Data. Nutr Res Pract 2019; 13:240-246. [PMID: 31214292 PMCID: PMC6548712 DOI: 10.4162/nrp.2019.13.3.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/18/2019] [Accepted: 05/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Diabetes is diagnosed after an average of 10-12 years of diabetic development. Strict glycemic control in diabetic patients promotes the normalization of blood glucose and reduces cardiovascular diseases (CVDs) and diabetic complications. Therefore, early diagnosis in non-aware individuals is very important. SUBJECTS/METHODS Clinical indices and nutrient intakes in Korean diabetic adults aged 19-64 years were examined according to the awareness of diabetes, using 2012 and 2013 Korea National Health and Nutrition Examination Survey (KNHANES) data. The aware group was defined as individuals who were aware of having diabetes from diagnosis by physician before the survey and the non-aware group as individuals who were not aware of having diabetes. RESULTS The average age was higher in the aware group compared to the non-aware group in both men (P = 0.002) and women (P = 0.004). The prevalences of hypertension and dyslipidemia were not different between the two groups, but the diagnosis rate was significantly lower in the non-aware group. In the non-aware group, total and LDL-cholesterol were significantly higher (P < 0.001), the risk for total cholesterol over 240 mg/dL was 3.4 times (95% CI: 1.58-7.52) higher (P = 0.002) and the risk for LDL-cholesterol over 160 mg/dL was 4.59 times (95% CI: 2.07-10.17) higher (P < 0.001). The calorie intake of the female non-aware group was significantly higher compared to the female aware group (P = 0.033). CONCLUSION The results suggested that the recommendation of screening test is necessary even for young adults. Studies on the methodology for early diagnosis of diabetes are also needed.
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Affiliation(s)
- Seul Lee
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Haeryun Park
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Youngmi Lee
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Onjeong Choi
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Jiwon Kim
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
| | - Heewon L Gray
- Department of Community and Family Health, University of South Florida 13201, Florida, USA
| | - Kyunghee Song
- Department of Food and Nutrition, Myongji University, Yongin, Gyeonggi 17058, Korea
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Wu J, Hou X, Chen L, Chen P, Wei L, Jiang F, Bao Y, Jia W. Development and validation of a non-invasive assessment tool for screening prevalent undiagnosed diabetes in middle-aged and elderly Chinese. Prev Med 2019; 119:145-152. [PMID: 30594538 DOI: 10.1016/j.ypmed.2018.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
To develop a non-invasive assessment tool and compare it to other assessment tools among middle-aged and elderly Shanghainese, 15,309 individuals, who were 45-70 years old, not previously diagnosed with diabetes, and from a cross-sectional survey conducted between April 2013 and August 2014 in Shanghai, were selected into this study. The participants were randomly assigned to either the exploratory group or the validation group. Undiagnosed diabetes was defined according to the American Diabetes Association diagnostic criteria, and score points were generated according to the logistic regression coefficients. Age, family history of diabetes, hypertension, overweight/obesity, and central obesity all contributed to the constructed model, the Shanghai Nicheng diabetes screening score, with the area under the receiver-operating characteristic curve (AUC) being 0.654 (95% CI 0.637-0.670) in the exploratory group and 0.669 (95% CI 0.653-0.686) in the validation group. The score value of 6 was the optimal cut-point with the largest Youden's index. When applied to the validation group, our model had a similar discriminative ability to the New Chinese Diabetes Risk Score (AUC: 0.669 vs. 0.662, p = 0.187), and performed better than other screening scores for Chinese. However, our model was inferior to fasting plasma glucose, 2-hour plasma glucose, and glycosylated hemoglobin in detecting prevalent undiagnosed diabetes (AUC: 0.669 (0.653-0.686) vs. 0.881 (0.868-0.894), 0.934 (0.923-0.944), and 0.834 (0.819-0.848), all p < 0.001). Although non-invasive models, based on demographic and clinical information, are advisable in resource-scarce developing areas, regular blood glucose screening is still necessary among those aged 45 or older.
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Affiliation(s)
- Jingzhu Wu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Shanghai Diabetes Institute, 600 Yishan Road, Shanghai 200233, China; Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Xuhong Hou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Shanghai Diabetes Institute, 600 Yishan Road, Shanghai 200233, China; Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Lei Chen
- Department of Clinical Diabetes and Epidemiology, Baker Heart & Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Peizhu Chen
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Shanghai Diabetes Institute, 600 Yishan Road, Shanghai 200233, China; Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Li Wei
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Shanghai Diabetes Institute, 600 Yishan Road, Shanghai 200233, China; Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Fusong Jiang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Shanghai Diabetes Institute, 600 Yishan Road, Shanghai 200233, China; Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Shanghai Diabetes Institute, 600 Yishan Road, Shanghai 200233, China; Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Shanghai Diabetes Institute, 600 Yishan Road, Shanghai 200233, China; Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai 200233, China; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
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25
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Townsend DK, McGregor K, Wu E, Cialkowski K, Haub MD, Barstow TJ. Insulin resistance and metabolic syndrome criteria in lean, normoglycemic college-age subjects. Diabetes Metab Syndr 2018; 12:609-616. [PMID: 29655623 DOI: 10.1016/j.dsx.2018.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/26/2018] [Indexed: 11/21/2022]
Abstract
AIMS The goal of this study was to determine insulin sensitivity in a fasted state and during an oral glucose tolerance test (OGTT), in normoglycemic (NGT), lean (L) (n = 35) and, for comparison, overweight/obese (OW/O) (n = 9) college-aged subjects. MATERIALS AND METHODS Insulin sensitivity for 44 NGT, normotensive subjects, age 18-26 yrs., was determined by homeostasis model assessment (HOMA-IR) and from Matsuda index (ISI Matsuda). RESULTS Subjects were normoglycemic fasted (4.59 + 0.35 mmol/L) and at two hours post OGTT (4.52 + 1.35 mmol/L). Besides anthropometric measures, there were significant differences between OW/O and L for fasting insulin (P < 0.001) and both measures of insulin sensitivity (P < 0.05). All subjects exhibited a 9-fold range in HOMA-IR (0.88 + 0.51, range 0.3-2.7) and an 8-fold range in ISI Matsuda (11.9 + 4.7, range 3.0-24.2). The latter was inversely correlated with systolic blood pressure (r = 0.35, P = 0.04) even though subjects were normotensive. In lean subjects, 2.3% were IR by HOMA-IR > 2.1, 5.7% by ISI Matsuda < 5.9, and 22.9% had >one criteria for metabolic syndrome (MetS); 28.6% had some negative metabolic biomarker. CONCLUSIONS Insulin resistance is present in lean, NGT college-age subjects even without MetS criteria and is discernable with an easily applicable OGTT-derived index.
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Affiliation(s)
- Dana K Townsend
- Applied Health Science, Wheaton College, Wheaton, Il, United States.
| | - Katheryn McGregor
- Kansas University School of Medicine, Kansas City, KS, United States
| | - Esther Wu
- Washington University in St. Louis School of Occupational Therapy, St. Louis., MO, United States
| | | | - Mark D Haub
- Rush University College of Nursing, Chicago, Il, United States
| | - Thomas J Barstow
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
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Khan A, Uddin S, Srinivasan U. Comorbidity network for chronic disease: A novel approach to understand type 2 diabetes progression. Int J Med Inform 2018; 115:1-9. [PMID: 29779710 DOI: 10.1016/j.ijmedinf.2018.04.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 04/01/2018] [Accepted: 04/07/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic diseases management outside expensive hospital settings has become a major target for governments, funders and healthcare service providers. It is well known that chronic diseases such as Type 2 Diabetes (T2D) do not occur in isolation, and has a shared aetiology common to many other diseases and disorders. Diabetes Australia reports that it is associated with a myriad of complications, which affect the feet, eyes, kidneys, and cardiovascular health. For instance, nerve damage in the lower limbs affects around 13% of Australians with diabetes, diabetic retinopathy occurs in over 15% of Australians with diabetes, and diabetes is now the leading cause of end-stage kidney disease. Our research focus is therefore to understand the comorbidity pattern, which in turn can enhance our understanding of the multifactorial risk factors of chronic diseases like Type 2 Diabetes. Our research approach is based on utilising valuable indicators present in pre-existing administrative healthcare data, which are routinely collected but often neglected in health research. One such administrative healthcare data is the hospital admission and discharge data that carries information about diagnoses, which are represented in the form of ICD-10 diagnosis codes. Analysis of diagnoses codes and their relationships helps us construct comorbidity networks which can provide insights that can be used to understand chronic disease progression pattern and comorbidity network at a population level. This understanding can subsequently enable healthcare providers to formulate appropriate preventive health policies targeted to address high-risk chronic conditions. METHODS AND FINDINGS The research utilises network theory principles applied to administrative healthcare data. Given the high rate of prevalence, we selected Type 2 Diabetes as the exemplar chronic disease. We have developed a research framework to understand and represent the progression of Type 2 diabetes, utilising graph theory and social network analysis techniques. We propose the concept of a 'comorbidity network' that can effectively model chronic disease comorbidities and their transition patterns, thereby representing the chronic disease progression. We further take the attribution effect of the comorbidities into account while generating the network; that is, we not only look at the pattern of disease in chronic disease patients, but also compare the disease pattern with that of non-chronic patients, to understand which comorbidities have a higher influence on the chronic disease pathway. The research framework enables us to construct a baseline comorbidity network for each of the two cohorts. It then compares and merges these two networks into single comorbidity network to discover the comorbidities that are exclusive to diabetic patients. This framework was applied on administrative data drawn from the Australian healthcare context. The overall dataset contained approximately 1.4 million admission records from 0.75 million patients, from which we filtered and sampled the records of 2300 diabetics and 2300 non-diabetic patients. We found significant difference in the health trajectory of diabetic and non-diabetic cohorts. The diabetic cohort exhibited more comorbidity prevalence and denser network properties. For example, in the diabetic cohort, heart and liver-related disorders, cataract etc. were more prevalent. Over time, the prevalence of diseases in the health trajectory of diabetic cohorts were almost double of the prevalence in the non-diabetic cohort, indicating entirely different ways of disease progression. CONCLUSIONS The paper presents a research framework based on network theory to understand chronic disease progression along with associated comorbidities that manifest over time. The analysis methods provide insights that can enable healthcare providers to develop targeted preventive health management programs to reduce hospital admissions and associated high costs. The baseline comorbidity network has the potential to be used as the basis to develop a chronic disease risk prediction model.
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Affiliation(s)
- Arif Khan
- Complex Systems Research Group, Project Management Program, The University of Sydney, Sydney, NSW, Australia; Health Market Quality Research Stream, Capital Markets CRC, Level 3, 55 Harrington Street, Sydney, NSW, Australia.
| | - Shahadat Uddin
- Complex Systems Research Group, Project Management Program, The University of Sydney, Sydney, NSW, Australia
| | - Uma Srinivasan
- Health Market Quality Research Stream, Capital Markets CRC, Level 3, 55 Harrington Street, Sydney, NSW, Australia
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Joung KH, Ju SH, Kim JM, Choung S, Lee JM, Park KS, Kim HJ, Ku BJ. Clinical Implications of Using Post-Challenge Plasma Glucose Levels for Early Diagnosis of Type 2 Diabetes Mellitus in Older Individuals. Diabetes Metab J 2018; 42:147-154. [PMID: 29676544 PMCID: PMC5911518 DOI: 10.4093/dmj.2018.42.2.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/15/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to explore the differences in the clinical characteristics and diagnostic rates of diabetes mellitus (DM) according to various criteria in different age groups and to evaluate the efficacy of each criterion for screening older patients. METHODS We studied 515 patients and measured the fasting plasma glucose level (FPG), 2-hour plasma glucose level after the 75 g oral glucose tolerance test (2-hour postload glucose [2-h PG]), and glycosylated hemoglobin (HbA1c) for re-evaluation of hyperglycemia without a history of diabetes. Patients with newly diagnosed DM were grouped by age as younger (<65 years) or older (≥65 years). RESULTS Older patients had significantly lower HbA1c, FPG, and 2-h PG levels and a higher homeostatic level of pancreatic β-cell function compared with younger patients (P<0.001). The older group had the lowest diagnostic rate when using the FPG level (45.5%) and the highest diagnostic rate when using the 2-h PG level (84.6%). These results were mostly due to the higher frequency of isolated post-challenge hyperglycemia in the older patients than in the younger group (28.8% vs. 9.2%). The use of both the FPG and HbA1c levels significantly enhanced the low diagnostic power when employing only the FPG levels in the older group (71.2% vs. 45.5%). CONCLUSION In the older patients, the 2-h PG level was the most accurate diagnostic criterion. When we consider the costs and convenience, a combination of the FPG and HbA1c criteria may be recommended as a screening test for DM in older people.
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Affiliation(s)
- Kyong Hye Joung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang Hyun Ju
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ji Min Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sorim Choung
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Kang Seo Park
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Bon Jeong Ku
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.
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28
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Abstract
BackgroundA number of studies have examined the prevalence of diabetes mellitus and impaired glucose tolerance in general populations and in those with schizophrenia and other forms of serious mental illness.AimsTo establish whether it is possible to describe accurately comparative rates of diabetes mellitus and impaired glucose tolerance in populations of people with schizophrenia and those without mental illness.MethodReview of current literature.ResultsResearch published in the pre-neuroleptic era suggested that people with severe mental illness were at increased risk of developing glycaemic abnormalities. Recent studies appear to confirm that the prevalence of diabetes and impaired glucose tolerance may be higher in people with schizophrenia than in the general population, and suggest that patients with schizophrenia have impaired glucose tolerance even before they begin treatment.ConclusionsSchizophrenia may be a significant and independent risk factor for both diabetes and impaired glucose tolerance. Current data preclude precise estimates of the prevalence of these conditions among people with schizophrenia.
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Affiliation(s)
- Chris Bushe
- Eli Lilly & Co. Ltd, Basingstoke, University of Southampton, UK.
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Veritti D, Sarao V, Francescutti L, Rota N, Loewenstein A, Borrelli E, Sadda SR, Lanzetta P. Optical coherence tomography angiography findings in diabetic retinopathy. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1395698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
| | | | - Nestore Rota
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Anat Loewenstein
- Ophthalmology Department, Tel Aviv Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Enrico Borrelli
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D’Annunzio Chieti-Pescara, Chieti, Italy
| | - Srinivas R. Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
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Baradan R, Hollander JM, Das S. Mitochondrial miRNAs in diabetes: just the tip of the iceberg. Can J Physiol Pharmacol 2017; 95:1156-1162. [PMID: 28467860 DOI: 10.1139/cjpp-2016-0580] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Over the last 2 decades, mi(cro)RNAs have emerged as one of the key regulators of metabolic homeostasis. Most of the studies have highlighted that, in the cytoplasm, miRNAs directly bind to the 3'-UTR (untranslated region) of a mRNA. Conventional RNA-induced silencing complex (RISC) formation results in the post-transcriptional inhibition. This process is known to contribute to the development of metabolic diseases, including diabetes mellitus. Recent advancements with small RNA detection technologies have enabled us to identify miRNAs in the mitochondrial compartment of the cells. We have termed these miRNAs, which translocate into the mitochondria as mitochondrial miRNA, MitomiR. It has been demonstrated that MitomiRs can regulate gene expression, with some evidence even suggesting that, after translocation, MitomiRs can bind to the 3'-end of a mitochondrial gene, altering its regulation. Our main focus in this review is to highlight the potential role of MitomiR in the pathogenesis of metabolic disorders such as diabetes mellitus.
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Affiliation(s)
- Rohini Baradan
- a Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA.,b School of Life Sciences, B.S. Abdur Rahman University, Tamilnadu, India
| | - John M Hollander
- c Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Samarjit Das
- a Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
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Park SJ, Gavrilova O, Brown AL, Soto JE, Bremner S, Kim J, Xu X, Yang S, Um JH, Koch LG, Britton SL, Lieber RL, Philp A, Baar K, Kohama SG, Abel ED, Kim MK, Chung JH. DNA-PK Promotes the Mitochondrial, Metabolic, and Physical Decline that Occurs During Aging. Cell Metab 2017; 25:1135-1146.e7. [PMID: 28467930 PMCID: PMC5485859 DOI: 10.1016/j.cmet.2017.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/25/2017] [Accepted: 04/11/2017] [Indexed: 12/21/2022]
Abstract
Hallmarks of aging that negatively impact health include weight gain and reduced physical fitness, which can increase insulin resistance and risk for many diseases, including type 2 diabetes. The underlying mechanism(s) for these phenomena is poorly understood. Here we report that aging increases DNA breaks and activates DNA-dependent protein kinase (DNA-PK) in skeletal muscle, which suppresses mitochondrial function, energy metabolism, and physical fitness. DNA-PK phosphorylates threonines 5 and 7 of HSP90α, decreasing its chaperone function for clients such as AMP-activated protein kinase (AMPK), which is critical for mitochondrial biogenesis and energy metabolism. Decreasing DNA-PK activity increases AMPK activity and prevents weight gain, decline of mitochondrial function, and decline of physical fitness in middle-aged mice and protects against type 2 diabetes. In conclusion, DNA-PK is one of the drivers of the metabolic and fitness decline during aging, and therefore DNA-PK inhibitors may have therapeutic potential in obesity and low exercise capacity.
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Affiliation(s)
- Sung-Jun Park
- Laboratory of Obesity and Aging Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Oksana Gavrilova
- Mouse Metabolism Core, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alexandra L Brown
- Laboratory of Obesity and Aging Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jamie E Soto
- Program in Molecular Medicine and Division of Endocrinology, Metabolism and Diabetes, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; Fraternal Order of Eagles Diabetes Research Center and Division of Endocrinology and Metabolism, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Shannon Bremner
- Department of Orthopedic Surgery, University of California and V.A. Medical Centers, San Diego, La Jolla, CA 92093, USA
| | - Jeonghan Kim
- Laboratory of Obesity and Aging Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xihui Xu
- Laboratory of Obesity and Aging Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shutong Yang
- Laboratory of Obesity and Aging Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jee-Hyun Um
- Laboratory of Obesity and Aging Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lauren G Koch
- Department of Anesthesiology, The University of Michigan, Ann Arbor, MI 48109, USA
| | - Steven L Britton
- Department of Anesthesiology, The University of Michigan, Ann Arbor, MI 48109, USA; Department of Molecular & Integrative Physiology, The University of Michigan, Ann Arbor, MI 48109, USA
| | - Richard L Lieber
- Department of Orthopedic Surgery, University of California and V.A. Medical Centers, San Diego, La Jolla, CA 92093, USA
| | - Andrew Philp
- Department of Physiology and Membrane Biology, University of California Davis, Davis, CA USA 95616
| | - Keith Baar
- Department of Physiology and Membrane Biology, University of California Davis, Davis, CA USA 95616
| | - Steven G Kohama
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Sciences University, Portland, OR 97239, USA
| | - E Dale Abel
- Program in Molecular Medicine and Division of Endocrinology, Metabolism and Diabetes, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; Fraternal Order of Eagles Diabetes Research Center and Division of Endocrinology and Metabolism, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Myung K Kim
- Laboratory of Obesity and Aging Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jay H Chung
- Laboratory of Obesity and Aging Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Abstract
Diabetic retinopathy is a progressive microvascular disease that leads to increased vessel permeability, retinal ischemia, and retinal neovascularization. Optical coherence tomography angiography (OCTA) is a novel angiography technique that has the capability to advance our understanding of diabetic eye disease by providing high-resolution images of retinal and choroidal microvasculature blood flow and structure. Using OCTA, the vascular changes of diabetic retinopathy including microaneurysms, retinal non-perfusion, intraretinal microvascular abnormalities, and neovascularization can be clearly visualized. OCTA offers several advantages over fluorescein angiography (FA) in that it is faster, safer, and non-invasive, allows better visualization of retinal vessels in both the superficial and deep capillary layers, and can provide quantitative measurements of areas of non-perfusion of the macula and nerve. OCTA capillary perfusion density maps and average perfusion density values provide an easy way to grade progressive vascular change. Despite these advantages, imaging with OCTA can only provide a limited view of the peripheral retina and is unable to demonstrate leakage, staining, or pooling. OCTA requires patients to maintain good fixation to obtain high-resolution images which can be a challenge for those with severe macular disease. In patients who cannot safely undergo FA, OCTA may serve as an alternative form of angiography that can be safely and more frequently performed for the management of diabetic retinopathy.
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Affiliation(s)
- Jessica Lee
- The New York Eye & Ear Infirmary of Mount Sinai, 310 E 14th Street, New York, NY, 10003, USA
| | - Richard Rosen
- The New York Eye & Ear Infirmary of Mount Sinai, 310 E 14th Street, New York, NY, 10003, USA.
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Sharma Y, Saxena S, Mishra A, Saxena A, Natu SM. Apolipoprotein A-I and B and Subjective Global Assessment relationship can reflect lipid defects in diabetic retinopathy. Nutrition 2016; 33:70-75. [PMID: 27908554 DOI: 10.1016/j.nut.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/01/2016] [Accepted: 08/27/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Elevated lipid levels increase complications of diabetic retinopathy (DR). Uncontrolled diabetes increases these complications and causes unintentional weight loss, indicating an apparently normal body mass index (BMI). Thus, it is easy to assume that patients with DR and a normal BMI have optimal lipid status. Apolipoprotein (Apo) A-I and Apo B levels differentially indicate serum lipid status in DR. Subjective Global Assessment (SGA) scores are associated with DR status. If SGA scores and serum Apo A-I and B levels are found to be interrelated, their relationship can reflect lipid defects in patients with DR despite apparently normal BMI. The aim of the present study was to investigate the possible relationship between serum Apo A-I and B levels and SGA scores of patients with DR. METHOD This was a case-control study conducted from November 2011 to April 2014. Serum Apo A-I and B levels and SGA scores were calculated for 40 healthy controls, 48 individuals without DR, 49 nonproliferative DR cases, and 48 proliferative DR cases. Pearson's correlation analysis was applied between Apo A-I, Apo B, Apo B/Apo A-I ratio, and SGA scores. RESULTS Negative correlation was observed between serum Apo A-I level (r = -0.567, P < 0.001) and positive correlation between serum Apo B level (r = 0.451, P < 0.001) and Apo B/Apo A-I ratio (r = 0.597, P < 0.001) with escalating SGA scores. CONCLUSION To our knowledge, this is the first study to report a novel correlation between serum Apo A-I, Apo B and Apo B/Apo A-I ratio and SGA scores. SGA scores can help predict lipid abnormalities in patients with DR even when they have an apparently normal BMI.
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Affiliation(s)
- Yashodhara Sharma
- Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Sandeep Saxena
- Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India.
| | - Arvind Mishra
- Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Anita Saxena
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shankar Madhav Natu
- Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
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Phan K, Mitchell P, Liew G, Plant AJ, Wang SB, Xu J, Chiha J, Thiagalingam A, Burlutsky G, Gopinath B. Severity of coronary artery disease and retinal microvascular signs in patients with diagnosed versus undiagnosed diabetes: cross-sectional study. J Thorac Dis 2016; 8:1532-9. [PMID: 27499940 DOI: 10.21037/jtd.2016.05.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is increasing evidence that a considerable proportion of patients with diabetes remain undiagnosed and untreated, however, it is unclear whether this is associated with more severe coronary artery disease (CAD) and microvasculature changes compared with diagnosed patients. We assessed CAD extent and severity, along with changes to the retinal microvascular structure in participants with undiagnosed versus diagnosed type 2 diabetes. METHODS Participants of the Australian Heart Eye Study were stratified into participants with previously diagnosed diabetes (n=489), undiagnosed diabetes (n=76) and no diabetes (n=1,112). Retinal vessel caliber was measured from digital retinal images. Extent and severity of CAD was assessed using Extent and Gensini scores from angiography findings, respectively. RESULTS Participants with undiagnosed and diagnosed diabetes versus those with no diabetes (reference group) had increased odds of being in the highest quartile of Gensini scores, multivariate adjusted odds ratios (OR) =7.02 [95% confidence interval (CI), 2.04-24.1] and OR =2.76 (95% CI, 1.67-4.55), respectively. Participants with undiagnosed and diagnosed diabetes versus those with no diabetes also had increased odds of being in the highest quartile of Extent scores, multivariate adjusted OR =7.63 (95% CI, 2.15-27.10) and OR =3.72 (95% CI, 2.22-6.27), respectively. No significant differences were observed in retinal vessel caliber between participants with undiagnosed versus diagnosed diabetes. CONCLUSIONS The present study demonstrated that participants with undiagnosed diabetes compared to those with previously diagnosed diabetes, had a stronger likelihood of having more severe and extensive CAD. However, retinal microvascular signs did not differ by diabetes status.
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Affiliation(s)
- Kevin Phan
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Adam J Plant
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Sarah B Wang
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Joshua Xu
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Joseph Chiha
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
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Barengo NC, Tuomilehto JO. How can we identify candidates at highest risk – to screen or not to screen? Herz 2016; 41:175-83. [DOI: 10.1007/s00059-016-4417-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Proteomics of Skeletal Muscle: Focus on Insulin Resistance and Exercise Biology. Proteomes 2016; 4:proteomes4010006. [PMID: 28248217 PMCID: PMC5217365 DOI: 10.3390/proteomes4010006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 12/21/2022] Open
Abstract
Skeletal muscle is the largest tissue in the human body and plays an important role in locomotion and whole body metabolism. It accounts for ~80% of insulin stimulated glucose disposal. Skeletal muscle insulin resistance, a primary feature of Type 2 diabetes, is caused by a decreased ability of muscle to respond to circulating insulin. Physical exercise improves insulin sensitivity and whole body metabolism and remains one of the most promising interventions for the prevention of Type 2 diabetes. Insulin resistance and exercise adaptations in skeletal muscle might be a cause, or consequence, of altered protein expressions profiles and/or their posttranslational modifications (PTMs). Mass spectrometry (MS)-based proteomics offer enormous promise for investigating the molecular mechanisms underlying skeletal muscle insulin resistance and exercise-induced adaptation; however, skeletal muscle proteomics are challenging. This review describes the technical limitations of skeletal muscle proteomics as well as emerging developments in proteomics workflow with respect to samples preparation, liquid chromatography (LC), MS and computational analysis. These technologies have not yet been fully exploited in the field of skeletal muscle proteomics. Future studies that involve state-of-the-art proteomics technology will broaden our understanding of exercise-induced adaptations as well as molecular pathogenesis of insulin resistance. This could lead to the identification of new therapeutic targets.
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Coton SJ, Nazareth I, Petersen I. A cohort study of trends in the prevalence of pregestational diabetes in pregnancy recorded in UK general practice between 1995 and 2012. BMJ Open 2016; 6:e009494. [PMID: 26810997 PMCID: PMC4735208 DOI: 10.1136/bmjopen-2015-009494] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the characteristics of pregnant women with and without pregestational diabetes and to estimate the prevalence of pregestational diabetes in pregnant women recorded in a UK primary care database. METHODS The data source for this study is The Health Improvement Network (THIN) primary care database. Pregnant women with and without diabetes aged 16 years and over were identified using diagnostic Read codes and prescriptions for antidiabetics from medical records. Data were examined on: age, body mass index (BMI), social deprivation, smoking, ethnicity and glycaemic control. The prevalence of pregestational diabetes was calculated by diabetes type and calendar year between 1995 and 2012. RESULTS Data from 400,434 pregnancies suggests that women with pregestational diabetes were: older (median 29, 32 vs 29 years for type 1, type 2 and without diabetes, respectively), had higher BMI (median 25.0, 30.4 vs 23.9 k/m(2) for type 1, type 2 and without diabetes, respectively) and were registered with a general practice for longer than pregnant women without diabetes. The prevalence of type 1 diabetes in pregnancy increased from 1.56 to 4.09 per 1000 pregnancies between 1995 and 2015. For type 2 diabetes the increase was from 2.34 to 5.09 per 1000 pregnancies between 1995 and 2008 followed by a more rapid increase to 10.62 per 1000 pregnancies by 2012. CONCLUSIONS Pregnant women with pregestational diabetes were older, had higher BMI and were registered for longer than women without diabetes. The prevalence of type 1 and type 2 diabetes increased in pregnancy. The prevalence of type 2 diabetes rose more rapidly with a marked increase after 2008.
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Affiliation(s)
- Sonia J Coton
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, UK
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Gupta N, Kishore J, Ray PC, Kohli C, Kumar N. Determination of Prevalence of Type 2 Diabetes Mellitus by Screening Tests using a Mathematical Formula in Place of Invasive Blood Tests. J Clin Diagn Res 2016; 10:LC05-9. [PMID: 26894093 DOI: 10.7860/jcdr/2016/14812.7039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION True prevalence rate of diabetes mellitus in a population can be obtained by using invasive tests but it is practically difficult on large scale. AIM To find out the feasibility of mass non-invasive screening test to detect the prevalence of diabetes mellitus in rural population of India with the help of a mathematical formula. MATERIALS AND METHODS From population of 18800 residing in two adjacent rural areas of Delhi, a systematic random sample of 1005 adult subjects was screened for diabetes by using urine benedicts test, Canrisk questionnaire, Madras Diabetes Research Foundation-Indian Diabetic Risk Score (MDRF-IDRS) and determined prevalence of diabetes (pA) gauzed by each of these screening tests. Simultaneously, each subject's glycaemic status was confirmed by standard fasting Plasma glucose (FPG) and postprandial plasma glucose (PPPG) levels. The blood test was also used to determine true prevalence which was cross-checked with the prevalence estimated (Pe) by the above stated screening tests using a mathematical formula. RESULTS The true prevalence of T2DM in more than 18 years of population by Fasting Plasma Sugar (FPS) was 4.5% while that by using mathematical formulae that estimated by urine test, Canrisk test and MDRF-IDRS was 4.4%, 4.4 and 4.3% respectively. When more than 35 years age-group was selected, true prevalence was 7.4% and estimated prevalence by Canrisk test was 7.1% (as against gold standard of Fasting) and 6.9% (as against PP). By fasting urine test it came out to be 7.2% and by PP urine test it was 7.4%. In population l8-35 years, the prevalence of diabetes was 1.1% by plasma glucose test. By using Canrisk, it came out to be 1.04%. CONCLUSION Individual screening tests such as urine, Canrisk and MDRF-IDRS can be used to estimate prevalence rates of diabetes in rural areas by means of mathematical formula which would be close to true estimates.
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Affiliation(s)
- Neeru Gupta
- Scientist F, Div. of Reproductive Biology and Maternal Health, Indian Council of Medical Research , India
| | - Jugal Kishore
- Professor, Department of Community Medicine, Vardhman Mahavir Medical College , New Delhi, India
| | - Prakash Chandra Ray
- Director Professor, Department of Biochemistry, Maulana Azad Medical College , New Delhi, India
| | - Charu Kohli
- Senior Resident, Maulana Azad Medical College , New Delhi, India
| | - Neeta Kumar
- Scientist D, Div. of Child Health, Indian Council of Medical Research, India
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Anderson AE, Kerr WT, Thames A, Li T, Xiao J, Cohen MS. Electronic health record phenotyping improves detection and screening of type 2 diabetes in the general United States population: A cross-sectional, unselected, retrospective study. J Biomed Inform 2015; 60:162-8. [PMID: 26707455 DOI: 10.1016/j.jbi.2015.12.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/15/2015] [Accepted: 12/12/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES An estimated 25% of type two diabetes mellitus (DM2) patients in the United States are undiagnosed due to inadequate screening, because it is prohibitive to administer laboratory tests to everyone. We assess whether electronic health record (EHR) phenotyping could improve DM2 screening compared to conventional models, even when records are incomplete and not recorded systematically across patients and practice locations, as is typically seen in practice. METHODS In this cross-sectional, retrospective study, EHR data from 9948 US patients were used to develop a pre-screening tool to predict current DM2, using multivariate logistic regression and a random-forests probabilistic model for out-of-sample validation. We compared (1) a full EHR model containing commonly prescribed medications, diagnoses (as ICD9 categories), and conventional predictors, (2) a restricted EHR DX model which excluded medications, and (3) a conventional model containing basic predictors and their interactions (BMI, age, sex, smoking status, hypertension). RESULTS Using a patient's full EHR or restricted EHR was superior to using basic covariates alone for detecting individuals with diabetes (hierarchical X(2) test, p<0.001). Migraines, depot medroxyprogesterone acetate, and cardiac dysrhythmias were associated negatively with DM2, while sexual and gender identity disorder diagnosis, viral and chlamydial infections, and herpes zoster were associated positively. Adding EHR phenotypes improved classification; the AUC for the full EHR Model, EHR DX model, and conventional model using logistic regression, were 84.9%, 83.2%, and 75.0% respectively. For random forest machine learning out-of-sample prediction, accuracy also was improved when using EHR phenotypes; the AUC values were 81.3%, 79.6%, and 74.8%, respectively. Improved AUCs reflect better performance for most thresholds that balance sensitivity and specificity. CONCLUSIONS EHR phenotyping resulted in markedly superior detection of DM2, even in the face of missing and unsystematically recorded data, based on the ROC curves. EHR phenotypes could more efficiently identify which patients do require, and don't require, further laboratory screening. When applied to the current number of undiagnosed individuals in the United States, we predict that incorporating EHR phenotype screening would identify an additional 400,000 patients with active, untreated diabetes compared to the conventional pre-screening models.
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Affiliation(s)
- Ariana E Anderson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States
| | - Wesley T Kerr
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States; Department of Biomathematics, David Geffen School of Medicine at UCLA, United States.
| | - April Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States
| | - Tong Li
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States
| | - Jiayang Xiao
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States
| | - Mark S Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States; Departments of Psychology, Neurology, Radiology, Biomedical Engineering, Biomedical Physics, University of California, Los Angeles, United States; California NanoSystems Institute, University of California, Los Angeles, United States
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Zendjabil M. Biological diagnosis of diabetes mellitus. Curr Res Transl Med 2015; 64:S0369-8114(15)00100-5. [PMID: 26552327 DOI: 10.1016/j.patbio.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
Diabetes mellitus is a common disease whose complications are severe. For decades, the diagnosis of diabetes and prediabetes was using only fasting glucose or glucose two hours during an oral glucose tolerance test. Recently, it is possible to use HbA1c. Each of these tests has advantages and limitations that must be well known by clinicians for better care for patients. So they could use one, two or three of this tests to reach to a proper diagnosis. The aim of this article is about the strong and weak points of these tests.
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Affiliation(s)
- M Zendjabil
- Laboratoire de biochimie, Établissement Hospitalier Universitaire d'Oran 1er Novembre 1954, BP No. 4166, Ibn Rochd, Oran, Algeria.
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Strauss SM, Vega M, Clayton-Jeter HD, Deren S, Rosedale M, Rindskopf DM. Latinas with elevated fasting plasma glucose: an analysis using NHANES 2009-2010 data. HISPANIC HEALTH CARE INTERNATIONAL 2015; 12:16-23. [PMID: 24865436 DOI: 10.1891/1540-4153.12.1.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
For Latinas with fasting plasma glucose (FPG) levels in the prediabetes and diabetes ranges, early detection can support steps to optimize their health. Data collected in 2009-2010 indicate that 36.7% of Latinas in the United States had elevated FPG levels. Latinas with elevated FPG who were unaware of their diabetes status were significantly less likely than non-Hispanic White and non-Hispanic Black women to have seen a health care provider in the past year (75.8%, 92.9%, and 90.2%, respectively; p = .018). With almost 1 million Latinas in the United States with elevated FPG unaware of their diabetes risk, and less likely than other at-risk women to see health care providers, there is an urgent need to establish alternate sites of opportunity for their diabetes screening.
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Dugee O, Janchiv O, Jousilahti P, Sakhiya A, Palam E, Nuorti JP, Peltonen M. Adapting existing diabetes risk scores for an Asian population: a risk score for detecting undiagnosed diabetes in the Mongolian population. BMC Public Health 2015; 15:938. [PMID: 26395572 PMCID: PMC4578253 DOI: 10.1186/s12889-015-2298-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 09/17/2015] [Indexed: 12/28/2022] Open
Abstract
Background Most of the commonly used diabetes mellitus screening tools and risk scores have been developed with American or European populations in mind. Their applicability, therefore, to low and middle-income countries remains unquantified. Simultaneously, low and middle-income countries including Mongolia are currently witnessing rising diabetes prevalence. This research aims to develop and validate a diabetes risk score for the screening of undiagnosed type 2 diabetes mellitus in the Mongolian adult population. Methods Blood glucose measurements from 1018 Mongolians, as well as information on demography and risk factors prevalence was drawn from 2009 STEPS data. Existing risk scores were applied, measuring sensitivity using area under ROC-curves. Logistic regression models were used to identify additional independent predictors for undiagnosed diabetes. Finally, a new risk score was developed and Hosmer-Lemeshow tests were used to evaluate the agreement between the observed and predicted prevalence. Results The performance of existing risk scores to identify undiagnosed diabetes was moderate; with the area under ROC curves between 61–64 %. In addition to well-established risk factors, three new independent predictors for undiagnosed diabetes were identified. Incorporating these into a new risk score, the area under ROC curves increased to 77 % (95 % CI 71 %–82 %). Conclusions Existing European or American diabetes risk tools cannot be adopted in Asian countries without prior validation in the specific population. With this in mind, a low-cost, reliable screening tool for undiagnosed diabetes was developed and internally validated for Mongolians. The potential for cost and morbidity savings could be significant.
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Affiliation(s)
- Otgontuya Dugee
- Public Health Institute, Ministry of Health, Ulaanbaatar, Mongolia.
| | | | - Pekka Jousilahti
- Department of Health, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | | | - Enkhtuya Palam
- Public Health Institute, Ministry of Health, Ulaanbaatar, Mongolia.
| | - J Pekka Nuorti
- Department of Epidemiology, School of Health Sciences, University of Tampere, Tampere, Finland.
| | - Markku Peltonen
- Department of Health, National Institute for Health and Welfare (THL), Helsinki, Finland.
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Development and validation of a simple risk score for prevalent undiagnosed type 2 diabetes in Southern Chinese population. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0285-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Previous studies have implicated age-associated reductions in mitochondrial oxidative phosphorylation activity in skeletal muscle as a predisposing factor for intramyocellular lipid (IMCL) accumulation and muscle insulin resistance (IR) in the elderly. To further investigate potential alterations in muscle mitochondrial function associated with aging, we assessed basal and insulin-stimulated rates of muscle pyruvate dehydrogenase (VPDH) flux relative to citrate synthase flux (VCS) in healthy lean, elderly subjects and healthy young body mass index- and activity-matched subjects. VPDH/VCS flux was assessed from the (13)C incorporation from of infused [1-13C] glucose into glutamate [4-13C] relative to alanine [3-13C] assessed by LC-tandem MS in muscle biopsies. Insulin-stimulated rates of muscle glucose uptake were reduced by 25% (P<0.01) in the elderly subjects and were associated with ∼70% (P<0.04) increase in IMCL, assessed by 1H magnetic resonance spectroscopy. Basal VPDH/VCS fluxes were similar between the groups (young: 0.20±0.03; elderly: 0.14±0.03) and increased approximately threefold in the young subjects following insulin stimulation. However, this increase was severely blunted in the elderly subjects (young: 0.55±0.04; elderly: 0.18±0.02, P=0.0002) and was associated with an ∼40% (P=0.004) reduction in insulin activation of Akt. These results provide new insights into acquired mitochondrial abnormalities associated with aging and demonstrate that age-associated reductions in muscle mitochondrial function and increased IMCL are associated with a marked inability of mitochondria to switch from lipid to glucose oxidation during insulin stimulation.
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Zhang Y, Hu G, Zhang L, Mayo R, Chen L. A novel testing model for opportunistic screening of pre-diabetes and diabetes among U.S. adults. PLoS One 2015; 10:e0120382. [PMID: 25790106 PMCID: PMC4366186 DOI: 10.1371/journal.pone.0120382] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/21/2015] [Indexed: 12/25/2022] Open
Abstract
Objective The study aim was to evaluate the performance of a novel simultaneous testing model, based on the Finnish Diabetes Risk Score (FINDRISC) and HbA1c, in detecting undiagnosed diabetes and pre-diabetes in Americans. Research Design and Methods This cross-sectional analysis included 3,886 men and women (≥ 20 years) without known diabetes from the U.S. National Health and Nutrition Examination Survey (NHANES) 2005-2010. The FINDRISC was developed based on eight variables (age, BMI, waist circumference, use of antihypertensive drug, history of high blood glucose, family history of diabetes, daily physical activity and fruit & vegetable intake). The sensitivity, specificity, and the receiver operating characteristic (ROC) curve of the testing model were calculated for undiagnosed diabetes and pre-diabetes, determined by oral glucose tolerance test (OGTT). Results The prevalence of undiagnosed diabetes was 7.0% and 43.1% for pre-diabetes (27.7% for isolated impaired fasting glucose (IFG), 5.1% for impaired glucose tolerance (IGT), and 10.3% for having both IFG and IGT). The sensitivity and specificity of using the HbA1c alone was 24.2% and 99.6% for diabetes (cutoff of ≥6.5%), and 35.2% and 86.4% for pre-diabetes (cutoff of ≥5.7%). The sensitivity and specificity of using the FINDRISC alone (cutoff of ≥9) was 79.1% and 48.6% for diabetes and 60.2% and 61.4% for pre-diabetes. Using the simultaneous testing model with a combination of FINDRISC and HbA1c improved the sensitivity to 84.2% for diabetes and 74.2% for pre-diabetes. The specificity for the simultaneous testing model was 48.4% of diabetes and 53.0% for pre-diabetes. Conclusions This simultaneous testing model is a practical and valid tool in diabetes screening in the general U.S. population.
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Affiliation(s)
- Yurong Zhang
- The First Affiliated Hospital of Medical School, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, United States of America
| | - Lu Zhang
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Rachel Mayo
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America
| | - Liwei Chen
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America
- * E-mail:
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Sharma Y, Saxena S, Saxena A, Mishra A, Natu SM. Interrelationship of elevated serum Advanced Glycation End-product levels and malnutrition (Subjective Global Assessment) scores with the severity of retinopathy in type II diabetes. Clin Nutr ESPEN 2015; 10:e42-e48. [PMID: 28531446 DOI: 10.1016/j.clnesp.2014.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/03/2014] [Accepted: 12/16/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Hyperglycemia in diabetes causes endogenous formation of Advanced Glycation End-products (AGEs) which accumulate in various body parts including retina causing diabetic retinopathy. AGEs also originate from exogenous dietary sources contributing to the body's AGE pool. Currently, curing of diabetic retinopathy is mainly focused on medication, surgical or laser interventions and not much emphasis is given on preventing or halting its occurrence or advancement to more severe stages, nutritionally. Planning a 'low glycemic index-low AGE' diet therapy for diabetic subjects can reduce endogenous and exogenous origin AGEs in the body and help in controlling retinopathy. Sound and accurate assessment of nutritional status is a crucial step for planning a therapeutic diet for this condition. As this aspect has not gained sufficient attention till now we are assessing the association of serum Advanced Glycation End-product (AGE) levels with the severity of diabetic retinopathy and for the first time estimating the nutritional status of subjects with this eye disorder for long term patient care. METHODS This was a tertiary care centre-based, case-control study involving sixty three consecutive cases with diabetes divided as 21 cases with diabetes but no retinopathy, 21 cases with non proliferative diabetic retinopathy (NPDR), 21 cases with proliferative diabetic retinopathy (PDR) along with 21 healthy controls. Serum AGE levels of all the cases and controls were evaluated by Enzyme Linked Immuno Sorbent Assay (ELISA) and nutritional status was assessed by anthropometric measurements and SGA scores. RESULTS Serum AGE levels were found significantly elevated in PDR group when compared with no retinopathy (p < 0.05) and control (p < 0.001) group. Control group was also significantly different from (p < 0.05) from NPDR group. Increase in SGA scores was statistically significant amongst the four study groups though other indices of nutritional status showed no definite trend with the increasing severity of retinopathy. CONCLUSION Our study shows that serum AGE levels are potential risk markers of diabetic retinopathy and SGA can be used as a regular tool for the assessment of nutritional status of diabetic retinopathy subjects which will help planning a 'low glycemic index-low AGE' therapeutic diet for halting this morbidity.
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Affiliation(s)
- Yashodhara Sharma
- Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India.
| | - Sandeep Saxena
- Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Anita Saxena
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arvind Mishra
- Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Shankar Madhav Natu
- Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
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Julka S, Goyal R, Sharma R. Screening for diabetes in high risk a passé. Indian J Endocrinol Metab 2014; 18:872. [PMID: 25364688 PMCID: PMC4192999 DOI: 10.4103/2230-8210.141393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sandeep Julka
- Department of Endocrinology, Synergy Hospital, Indore, Madya Pradesh, India
| | - Raksha Goyal
- Department of Dietetics, Synergy Hospital, Indore, Madya Pradesh, India
| | - Rituraj Sharma
- Department of Endocrinology, Synergy Hospital, Indore, Madya Pradesh, India
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Schellini SA, Carvalho GMD, Rendeiro FS, Padovani CR, Hirai FE. Prevalence of diabetes and diabetic retinopathy in a Brazilian population. Ophthalmic Epidemiol 2014; 21:33-8. [PMID: 24467560 DOI: 10.3109/09286586.2013.868004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the prevalence of type 2 diabetes mellitus and diabetic retinopathy (DR) in a Brazilian population. METHODS Population-based, cross-sectional study conducted in 9 cities located in the Midwest region of the state of São Paulo, Brazil, between 2006 and 2007, including 4690 individuals aged ≥30 years. Diabetes was self-reported and DR was assessed by indirect ophthalmoscopy. RESULTS The prevalence of type 2 diabetes was 8.68% (95% confidence interval, CI, 7.87-9.48%), and DR was present in 7.62% (95% CI 5.02-10.20%) of participants with self-reported type 2 diabetes. Approximately 35.4% of individuals diagnosed with DR did not know they had diabetes prior to DR diagnosis. Prevalences of low vision and blindness were higher among those with diabetes and DR. Cataract was still a major cause of blindness in this population. CONCLUSION This is the first large population-based study on DR in Brazil. High rates of visual impairment were found in persons with type 2 diabetes, but cataract is still one of the main causes of blindness. Large surveys are necessary for public health policy advocacy in developing countries.
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50
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Glycemic Variability and Acute Ischemic Stroke: The Missing Link? Transl Stroke Res 2014; 5:638-46. [DOI: 10.1007/s12975-014-0365-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/19/2014] [Accepted: 07/28/2014] [Indexed: 12/20/2022]
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