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Mittal M, Jethwani P, Naik D, Garg MK. Non-medicalization of medical science: Rationalization for future. World J Methodol 2022; 12:402-413. [PMID: 36186743 PMCID: PMC9516546 DOI: 10.5662/wjm.v12.i5.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
As we delve into the intricacies of human disease, millions of people continue to be diagnosed as having what are labelled as pre-conditions or sub-clinical entities and may receive treatments designed to prevent further progression to clinical disease, but with debatable impact and consequences. Endocrinology is no different, with almost every organ system and associated diseases having subclinical entities. Although the expansion of these “grey” pre-conditions and their treatments come with a better understanding of pathophysiologic processes, they also entail financial costs and drug adverse-effects, and lack true prevention, thus refuting the very foundation of Medicine laid by Hippocrates “Primum non nocere” (Latin), i.e., do no harm. Subclinical hypothyroidism, prediabetes, osteopenia, and minimal autonomous cortisol excess are some of the endocrine pre-clinical conditions which do not require active pharmacological management in the vast majority. In fact, progression to clinical disease is seen in only a small minority with reversal to normality in most. Giving drugs also does not lead to true prevention by changing the course of future disease. The goal of the medical fraternity thus as a whole should be to bring this large chunk of humanity out of the hospitals towards leading a healthy lifestyle and away from the label of a medical disease condition.
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Affiliation(s)
- Madhukar Mittal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
| | - Parth Jethwani
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
| | - Dukhabandhu Naik
- Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - MK Garg
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
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McGill JB, Haller H, Roy-Chaudhury P, Cherrington A, Wada T, Wanner C, Ji L, Rossing P. Making an impact on kidney disease in people with type 2 diabetes: the importance of screening for albuminuria. BMJ Open Diabetes Res Care 2022; 10:e002806. [PMID: 35790319 PMCID: PMC9258490 DOI: 10.1136/bmjdrc-2022-002806] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022] Open
Abstract
Albuminuria is useful for early screening and diagnosis of kidney impairment, especially in people with pre-diabetes or type 2 diabetes (T2D), which is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), associated with increased mortality, poor cardiovascular outcomes, and high economic burden. Identifying patients with CKD who are most likely to progress to ESKD permits timely implementation of appropriate interventions. The early stages of CKD are asymptomatic, which means identification of CKD relies on routine assessment of kidney damage and function. Both albuminuria and estimated glomerular filtration rate are measures of kidney function. This review discusses albuminuria as a marker of kidney damage and cardiorenal risk, highlights the importance of early screening and routine testing for albuminuria in people with T2D, and provides new insights on the optimum management of CKD in T2D using albuminuria as a target in a proposed algorithm. Elevated urine albumin can be used to detect CKD in people with T2D and monitor its progression; however, obstacles preventing early detection exist, including lack of awareness of CKD in the general population, poor adherence to clinical guidelines, and country-level variations in screening and treatment incentives. With albuminuria being used as an entry criterion and a surrogate endpoint for kidney failure in clinical trials, and with novel treatment interventions available to prevent CKD progression, there is an urgent need for early screening and diagnosis of kidney function decline in people with T2D or pre-diabetes.
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Affiliation(s)
- Janet B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Prabir Roy-Chaudhury
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Department of Medicine, WG Hefner VA Medical Center, Salisbury, North Carolina, USA
| | - Andrea Cherrington
- Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Christoph Wanner
- Division of Nephrology and Hypertension, University Hospital of Würzburg, Würzburg, Germany
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Manouchehri M, Cea-Soriano L, Franch-Nadal J, Ruiz A, Goday A, Villanueva R, Diez-Espino J, Mata-Cases M, Giraldez-García C, Regidor E. Heterogeneity in the association between prediabetes categories and reduction on glomerular filtration rate in a 5-year follow-up. Sci Rep 2022; 12:7373. [PMID: 35513560 PMCID: PMC9072306 DOI: 10.1038/s41598-022-11392-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/04/2022] [Indexed: 11/09/2022] Open
Abstract
Prediabetes and not just diabetes can cause kidney damage. This study assess the association of prediabetes with development of impaired renal function (IRF). We used data from PREDAPS prospective study a cohort of 1072 subjects with prediabetes and another cohort of 772 subjects without prediabetes were follow-up from 2012 to 2017. Prediabetes was defined according to American Association of Diabetes criteria. IRF was defined as having a glomerular filtration rate < 60 mL/min/1.73 m2. Incidence rates of IRF in both cohorts and in different categories of prediabetes, based on impaired glycosylated hemoglobin (HbA1c) and/or fasting plasma glucose (FPG), were calculated. Hazard ratios (HR) for the association of the prediabetes with IRF, adjusting for potential confounders, were estimated by Cox regression models. Incidence rates of IRF per 100 person-years were 1.72 (95% confidence interval [CI]: 1.34-2.21) and 1.79 (95%CI: 1.45-2.20) for those without and with prediabetes, respectively .The HR of IRF in subjects with prediabetes with respect to subjects without prediabetes was 0.76 (95% CI: 0. 54-1.07). Corresponding HRs for type of prediabetes was 0.68 (95%CI: 0.40-1.15) for those with both altered parameters, 0.68 (95%CI: 00.40-1.15) for those with only impaired HbA1c and 1.12 (95%CI: 0.68-1.85) for those with only impaired FPG. The present study reflects an overall trend towards a slightly decreased risk of IRF onset associated to prediabetes except for individuals with only isolated impaired FPG. Further studies are warranted to fully assess the renal progression of each group.
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Affiliation(s)
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Pza. Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain.
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
- redGDPS Foundation, Madrid, Spain.
| | - Josep Franch-Nadal
- redGDPS Foundation, Madrid, Spain
- Barcelona City Research Support Unit, University Institute for Research in Primary Care Jordi Gol, Barcelona, Spain
- CIBER Diabetes Y Enfermedades Metabólicas Asociadas, Madrid, Spain
- Department of Medicine, Universidad de Barcelona, Barcelona, Spain
| | - Antonio Ruiz
- redGDPS Foundation, Madrid, Spain
- Centro de Salud Universitario Pinto, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Albert Goday
- Servicio de Endocrinología, Hospital del Mar, IMIM, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Fisiopatología de La Obesidad Y Nutrición, Madrid, Spain
| | - Rosa Villanueva
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Pza. Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain
| | - Javier Diez-Espino
- redGDPS Foundation, Madrid, Spain
- CIBER Fisiopatología de La Obesidad Y Nutrición, Madrid, Spain
- Tafalla Health Center, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IDiSNA), Pamplona, Spain
| | - Manel Mata-Cases
- redGDPS Foundation, Madrid, Spain
- Barcelona City Research Support Unit, University Institute for Research in Primary Care Jordi Gol, Barcelona, Spain
| | | | - Enrique Regidor
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Pza. Ramón y Cajal, s/n. Ciudad Universitaria, 28040, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- redGDPS Foundation, Madrid, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
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Yadav R, Jain N, Raizada N, Jhamb R, Rohatgi J, Madhu SV. Prevalence of diabetes related vascular complications in subjects with normal glucose tolerance, prediabetes, newly detected diabetes and known diabetes. Diabetes Metab Syndr 2021; 15:102226. [PMID: 34303917 DOI: 10.1016/j.dsx.2021.102226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/06/2023]
Abstract
AIMS Varying prevalence of individual diabetes related vascular complications in prediabetes has been reported. However, very few studies have looked at both macrovascular and microvascular complications in prediabetes. METHODS Study subjects without any history of diabetes underwent oral glucose tolerance test (OGTT) and were classified as either normal glucose tolerance (NGT), prediabetes (PD), newly detected diabetes mellitus (NDDM) on the basis of American Diabetes Association (ADA) criteria. Age and sex matched known diabetes mellitus (KDM) patients were also recruited. All the participants were subsequently screened for both macrovascular (CAD, CVA,PVD) and microvascular (retinopathy, nephropathy and neuropathy)complications of diabetes. RESULTS Prevalence of vascular complications among prediabetes subjects was 11.1% as compared to 1.4% among NGT subjects, 13.9% among NDDM subjects and 23.8% among KDM subjects. There was no significant between complication rates in prediabetes and NDDM group (p = 0.060). The prevalence of macrovascular and microvascular complications among prediabetes subjects was 4.2% and 6.9% while the same in NDDM was 4.2% and 9.7%. CONCLUSIONS The proportion of subjects with prediabetes and vascular complications was about half of those with known diabetes and almost similar to those with newly detected diabetes mellitus.
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Affiliation(s)
- Rini Yadav
- Department of Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India
| | - Nishesh Jain
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India
| | - Nishant Raizada
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India
| | - Rajat Jhamb
- Department of Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India
| | - Jolly Rohatgi
- Department of Ophthalmology, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India
| | - S V Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India.
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Nishi T, Saito Y, Kitahara H, Nishi T, Fujimoto Y, Kobayashi Y. Coronary Flow Reserve and Glycemic Variability in Patients with Coronary Artery Disease. Intern Med 2021; 60:1151-1158. [PMID: 33132339 PMCID: PMC8112971 DOI: 10.2169/internalmedicine.6158-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Glycemic variability is being increasingly recognized as an early indicator of glucose metabolic disorder and may contribute to the development of diabetic vascular complications, such as coronary microvascular dysfunction. The present study sought to investigate the relationship between coronary microvascular function assessed by intracoronary thermodilution method and glycemic variability on a continuous glucose monitoring system (CGMS). Methods We prospectively enrolled 40 patients with or without known diabetes mellitus who had epicardial coronary artery disease referred for coronary angiography and were not treated with diabetic medications. Of these, two had a significant stenosis in the left main coronary artery and were therefore excluded from the analyses. In the end, 38 patients were equipped with a CGMS and underwent intracoronary physiological assessments in the unobstructed left anterior descending artery. The mean amplitude of glycemic excursion (MAGE) and standard deviation were calculated from the obtained CGMS data as indicators of glucose variability. Results Coronary flow reserve (CFR) was negatively correlated with MAGE (r=-0.328, p=0.044) and standard deviation (r=-0.339, p=0.037) on CGMS, while the index of microcirculatory resistance showed no such correlation. Multivariable linear regression analyses showed that MAGE on CGMS was significantly associated with CFR after adjusting for age, sex, fractional flow reserve and hemoglobin A1c. Conclusion Higher MAGE on CGMS was associated with reduced CFR in stable patients with coronary artery disease, suggesting a potential effect of glycemic variability on coronary microvascular flow regulation. A further study with a larger sample size needs to be conducted to confirm our findings.
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Affiliation(s)
- Takeshi Nishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Tomoko Nishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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Abstract
Evidence increasingly demonstrates that prediabetes is a toxic state, as well as a risk factor for diabetes, and is associated with pathophysiological changes in several tissues and organs. Unfortunately, use of available evidence-based treatments for prediabetes is low. This review seeks to explain why prediabetes must be viewed and treated as a serious pathological entity in its own right. It offers an overview of the pathophysiology and complications of prediabetes and describes how this condition can be reversed if all treatment avenues are deployed early in its course.
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Affiliation(s)
| | - Fatima Bello
- Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria
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Nyenwe E, James D, Wan J, Dagogo-Jack S. Glycemic Response to Oral Dexamethasone Predicts Incident Prediabetes in Normoglycemic Subjects With Parental Diabetes. J Endocr Soc 2020; 4:bvaa137. [PMID: 33134765 PMCID: PMC7585402 DOI: 10.1210/jendso/bvaa137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/16/2020] [Indexed: 12/22/2022] Open
Abstract
Background Prediabetes, an often unrecognized precursor of type 2 diabetes (T2DM), is associated with cardiometabolic complications. Here, we investigated the utility of dexamethasone challenge in predicting incident prediabetes among normoglycemic subjects with parental T2DM enrolled in the prospective Pathobiology of Prediabetes in a Biracial Cohort study. Design and Methods After documenting normoglycemic status with an oral glucose tolerance test (OGTT), participants ingested dexamethasone (2 mg) at 10:00 pm, and fasting plasma glucose (FPG-Dex) and cortisol were measured at 8:00 am the next day. Subjects were followed quarterly for 5 years, the primary outcome being incident prediabetes. Serial assessments included body composition, blood chemistry, OGTT, insulin sensitivity, and secretion. Results We analyzed data from 190 participants (107 Black, 83 white; mean age 44.7 ± 10.0 years; body mass index [BMI] 29.8 ± 6.8 kg/m2; fasting plasma glucose [FPG] 90.9 ± 5.7 mg/dL). Following dexamethasone ingestion, plasma cortisol was < 5 µg/dL; FPG-Dex levels displayed marked variability (81-145 mg/dL) as did delta FPG (–7 to +48 mg/dL). During 5 years of follow-up, 58 of 190 subjects (30.5%) progressed to prediabetes. FPG-Dex (116.8 ± 10.9 vs 106.9 ± 10.8 mg/dL, P < 0.0001) and delta FPG (23.4 ± 10.1 vs 17.0 ± 10.2 mg/dL, P < 0.0001) were higher in progressors than nonprogressors. FPG-Dex (P = 0.007) was an independent predictor of incident prediabetes in a multivariate model that included age, race, gender, BMI, waist circumference, FPG, insulin sensitivity, and secretion. In further analyses, an FPG-Dex level ≥ 107 mg/dL predicted incident prediabetes with 88% sensitivity and 49% specificity. Conclusions The glycemic response to dexamethasone significantly predicted incident prediabetes among offspring of parents with T2DM, and may be a tool for uncovering latent risk of dysglycemia.
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Affiliation(s)
- Ebenezer Nyenwe
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism
| | - Deirdre James
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism
| | - Jim Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sam Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism
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Xie Q, Xu C, Wan Q. Association between microalbuminuria and outcome of non-diabetic population aged 40 years and over: The reaction study. Prim Care Diabetes 2020; 14:376-380. [PMID: 31874822 DOI: 10.1016/j.pcd.2019.12.003] [Citation(s) in RCA: 2] [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: 04/08/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 01/06/2023]
Abstract
AIMS The goal of this study was to analyze the association between microalbuminuria (MAU) and the outcome of non-diabetic populations among Chinese people. METHODS A cohort of 2042 Chinese individuals without diabetes, aged 40 years or older were included. We identified people with impaired fasting glucose and/or impaired glucose tolerance by conducting an oral glucose tolerance test, and then followed them up after 3years. We defined MAU as a urinary albumin-to-creatinine ratio (ACR) exceeding the normal range of 2.5-25mg/mmol (males) or 3.5-35mg/mmol (females). RESULTS Among 2042 adults aged 40 years or older in an urban fringe area of Luzhou city (1984 cases were followed up), 262 (12.8%) developed diabetes over 3years. MAU was significantly associated with age, fasting plasma glucose, 2-h glucose, hemoglobin A1c, and triglycerides (P<0.05). Follow-up FBG, 2hPG, TG, and HbA1c levels in the IGR+MAU group were higher than those in other groups (P<0.05). If the relative risk of the isolated normal glucose tolerance (NGT) group progressing to diabetes was set to 1, the risk of progression to diabetes in the NGT+MAU, isolated impaired glucose regulation (IGR), and IGR+MAU groups increased 1.1, 3.9, and 7.5 times, respectively. CONCLUSIONS Our study found that MAU is associated with increased risk of diabetes in NGT and IGR populations, especially in the IGR populations, MAU may predict adulthood at very high risk for diabetes.
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Affiliation(s)
- Qian Xie
- Department of Gerontology, The People's Hospital of LeShan, 614000 LeShan, China.
| | - Chaoran Xu
- Department of Gerontology, The People's Hospital of LeShan, 614000 LeShan, China
| | - Qin Wan
- Department of Endocrinology, The Affiliated Hospital of XiNan Medical University, 641400 Luzhou, China
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Sumbul HE, Koc AS, Gülümsek E. Renal cortical stiffness is markedly increased in pre-diabetes mellitus and associated with albuminuria. Singapore Med J 2020; 61:435-442. [PMID: 31197376 PMCID: PMC7926591 DOI: 10.11622/smedj.2019052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We aimed to investigate changes in renal cortical stiffness (CS) in Type 2 diabetes mellitus (DM) and pre-DM patients compared to subjects with normal glucose metabolism (NGM), as well as the usefulness of renal CS to determine the presence of nephropathy. METHODS This study included 125 individuals with NGM, pre-DM and Type 2 DM. Routine laboratory data was obtained, and micro- and macrovascular involvement were investigated. Urinary albumin-creatinine ratio (UACR) was measured for urinary albuminuria detection. In addition to routine renal ultrasonography, CS was measured using renal elastography. RESULTS Among the included patients, 42, 40 and 43 patients had NGM, pre-DM and Type 2 DM, respectively, with prevalence of nephropathy of 5%, 15% and 33%, respectively. Carotid and aortic intima-media thickness (IMT), renal width, and CS were found to be higher in the pre-DM and Type 2 DM groups than the NGM group. Aortic IMT, renal width and UACR levels were independently associated with CS. Patients with nephropathy were found to have a higher CS value than those without nephropathy (8.72 ± 1.67 kPa vs. 10.60 ± 1.74 kPa, p = 0.001). In receiver operating characteristic curve analysis, when the cut-off value for CS was taken as 9.2 kPa, renal CS predicted the possibility of nephropathy with 78.9% sensitivity and 71.4% specificity. CONCLUSION CS values are significantly higher in patients with impaired glucose metabolism. We recommend CS measurement as part of routine screening of nephropathy in patients with pre-DM and newly diagnosed Type 2 DM.
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Affiliation(s)
- Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
| | - Ayse Selcan Koc
- Department of Radiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
| | - Erdinç Gülümsek
- Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
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Muhammed A, Zaki MT, Elserafy AS, Amin SA. Correlation between prediabetes and coronary artery disease severity in patients undergoing elective coronary angiography. Egypt Heart J 2019; 71:34. [PMID: 31883041 PMCID: PMC6934639 DOI: 10.1186/s43044-019-0034-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/21/2019] [Indexed: 01/06/2023] Open
Abstract
Background Diabetes is a chronic disease that is responsible for a high rate of morbidity and mortality which can be attributed to atherosclerosis and cardiovascular disease. Diabetes is heralded by prediabetes which not only indicates a higher risk of developing diabetes but also increases the burden of cardiovascular disease. The objective was to observe the effect of prediabetes on the severity of coronary artery disease in patients undergoing elective coronary angiography. Seven hundred and thirty-one patients were admitted for elective coronary angiography and/or PCI starting from September 2017 to August 2018. Patients were divided into group A (normoglycemic group, N = 228), group B (prediabetes group, N = 177), and group C (diabetic group, N = 326). Coronary artery disease (CAD) severity including number of vessels affected and atherosclerotic burden by Gensini score were compared among different groups. Results The number of vessels affected as well as left main (LM) disease was higher in the prediabetes group when compared to the normoglycemic group (P,=0.001, P = 0.009, respectively) and was comparable to the diabetes group (P = 0.4, P = 0.6, respectively). Prediabetes showed a Gensini score higher than the normoglycemic group (P = 0.0001) with no significant difference when compared to the diabetic group (P = 0.9). Conclusion Prediabetes is associated with high atherosclerotic burden and coronary artery disease complexity that is similar to diabetic than normoglycemic individuals.
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Affiliation(s)
- Ahmed Muhammed
- Department of Cardiology, Ain Shams University, Cairo, Egypt
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Živković M, Tönjes A, Baber R, Wirkner K, Loeffler M, Engel C. Prevalence of moderately increased albuminuria among individuals with normal HbA1c level but impaired glucose tolerance: Results from the LIFE-Adult-Study. Endocrinol Diabetes Metab 2018; 1:e00030. [PMID: 30815561 PMCID: PMC6354744 DOI: 10.1002/edm2.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 12/20/2022] Open
Abstract
AIMS Diabetes screening strategies using glycated haemoglobin (HbA1c) as first-instance diagnostic parameter may cause failure to detect individuals with abnormal glucose regulation and possible signs of microvascular complications despite "rule-out" HbA1c levels. This cross-sectional study examined the diagnostic performance of HbA1c in relation to fasting and two-hour postload plasma glucose (FPG/2 h-PG), and investigated whether individuals with normal HbA1c but abnormal FPG/2 h-PG have a higher prevalence of moderately increased albuminuria as possible sign of early stage kidney damage. METHODS A total of 2695 individuals (age 40-79 years, 48% men) without prior diagnosis of diabetes and complete measurement of HbA1c, FPG, 2 h-PG and urine albumin-creatinine ratio (UACR) were taken from a large population-based epidemiological study in the City of Leipzig, Germany. RESULTS A total of 2439 individuals (90.5%, 95% CI: 89.4-91.6) had normal HbA1c levels, <39 mmol/mol (<5.7%), while 234 (8.7%, 95% CI: 7.7-9.8) had prediabetes, HbA1c ≥39 and <48 mmol/mol (≥5.7 and <6.5%), and 22 (0.8%, 95% CI: 0.5-1.2) had diabetes, HbA1c ≥48 mmol/mol (≥6.5%), according to HbA1c. Among individuals with normal HbA1c, 35.6% (95% CI: 33.7-37.5) had impaired fasting glucose or impaired glucose tolerance and 1.8% (95% CI: 1.4-2.4) had diabetes according to FPG/2 h-PG. Individuals with normal HbA1c but prediabetic or diabetic FPG/2 h-PG had a significantly higher prevalence of moderately increased albuminuria (9.4%, 95% CI: 7.6-11.5 and 13.3%, 95% CI: 5.8-25.4, respectively) than individuals with normal HbA1c and normal FPG/2 h-PG (3.9%, 95% CI: 3.0-5.0). CONCLUSIONS The prevalence of prediabetes according to FPG/2 h-PG among individuals with normal HbA1c is considerably high, and the prevalence of moderately increased albuminuria in this group is significantly elevated. Risk factors for diabetes such as age, gender and BMI may help to better identify this at-risk group.
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Affiliation(s)
- Mila Živković
- LIFE – Leipzig Research Centre for Civilization DiseasesUniversity of LeipzigLeipzigGermany
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Anke Tönjes
- Department of MedicineUniversity of LeipzigLeipzigGermany
| | - Ronny Baber
- LIFE – Leipzig Research Centre for Civilization DiseasesUniversity of LeipzigLeipzigGermany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular DiagnosticsUniversity of LeipzigLeipzigGermany
| | - Kerstin Wirkner
- LIFE – Leipzig Research Centre for Civilization DiseasesUniversity of LeipzigLeipzigGermany
| | - Markus Loeffler
- LIFE – Leipzig Research Centre for Civilization DiseasesUniversity of LeipzigLeipzigGermany
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
| | - Christoph Engel
- LIFE – Leipzig Research Centre for Civilization DiseasesUniversity of LeipzigLeipzigGermany
- Institute for Medical Informatics, Statistics and EpidemiologyUniversity of LeipzigLeipzigGermany
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Habartová L, Logerová H, Tomaník L, Marešová A, Setnička V. Electronic circular dichroism for the detection of microalbuminuria. Chirality 2018; 30:576-580. [PMID: 29443429 DOI: 10.1002/chir.22832] [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: 11/03/2017] [Revised: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 12/15/2022]
Abstract
Over the past decades, chiroptical spectroscopy has proved its incomparable ability to elucidate the structure and spatial arrangement of chiral molecules. Systematic analysis of biomolecules in the natural environment of biofluids, however, remains challenging. In this study, we used chiroptical spectroscopy to monitor urinary levels of human serum albumin. Not only severe proteinuria but even just a slightly increased urinary excretion of albumin (microalbuminuria) may indicate serious health complications, especially for diabetic individuals. Given the chiral nature of albumin and its typical spectral pattern, it may be easily observable by chiroptical spectroscopy, particularly electronic circular dichroism. The performed chiroptical analysis of urine not only allowed the detection of clinically confirmed microalbuminuria but was also able to reveal this pathological condition in cases beyond the diagnostic capability of common clinical procedures. Thus, our approach suggests that electronic circular dichroism is a useful tool for the fast and reliable qualitative monitoring of microalbuminuria with the potential for a quantitative analysis in the future.
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Affiliation(s)
- Lucie Habartová
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic
| | - Hana Logerová
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic.,Department of Biochemistry, Cell and Molecular Biology, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Lukáš Tomaník
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic
| | - Aneta Marešová
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic
| | - Vladimír Setnička
- Department of Analytical Chemistry, University of Chemistry and Technology Prague, Prague 6, Czech Republic
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Mou Y, Zhang Y, Guo C, Zhao J, Zhang Z, Zhou X, Dong J, Liao L. Integrated Treatment of Prostaglandin E1 and Angiotensin-Converting Enzyme Inhibitor in Diabetic Kidney Disease Rats: Possible Role of Antiapoptosis in Renal Tubular Epithelial Cells. DNA Cell Biol 2017; 37:133-141. [PMID: 29185789 DOI: 10.1089/dna.2017.3690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To investigate the therapeutic mechanisms underlying prostaglandin E1 (PGE1) and angiotensin-converting enzyme inhibitor (ACEI) on reducing urinary protein in diabetic kidney disease (DKD). DKD rats were established and randomly divided into four groups: PGE1 (10 μg/kg/day) (P group), ACEI (10 mg/kg/day) (A group), combination of PGE1 with ACEI treatment (P + A group), and saline treatment group (DKD group). Untreated rats were used as normal control (N group). Urinary albumin, endothelin-1 (ET-1), angiotensin II (AngII), TUNEL assay, Masson's trichrome staining, and immunohistochemistry staining for CD68 were evaluated in all groups. Ten days after treatment, urinary albumin was significantly decreased in the P and P + A groups (p < 0.01 vs. the DKD group). At the end of 8 weeks, the albumin was still significantly reduced in the P + A group (p < 0.05 vs. the A group). ET-1 and AngII were also significantly decreased in three treatment groups (p < 0.01 vs. the DKD group), especially in the P + A group. Few cells underwent apoptosis in glomerular regions in DKD rats, while amounts of apoptotic cells were seen in tubules regions. Further, apoptosis and the areas of fibrosis in tubulointerstitial were both decreased most in the P + A group compared with the DKD group. Apoptosis of renal tubular epithelial cells may participate in the development and progression of DKD in rats. Combination of PGE1 with AGEI remarkably protects renal function compared with PGE1 or ACEI monotherapy. The potential therapeutic mechanisms of PGE1 and AGEI might be via multiple targets and, at least in part, through inhibiting the apoptosis of renal tubular epithelial cells.
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Affiliation(s)
- Yaru Mou
- 1 Division of Cardiology, Department of Internal Medicine, Shandong Provincial Hospital Affiliated to Shandong University , Jinan, China
| | - Yaqin Zhang
- 2 Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan, China
| | - Congcong Guo
- 2 Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan, China .,3 First Clinical Medical College, Shandong University of Traditional Chinese Medicine , Jinan, China
| | - Junyu Zhao
- 2 Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan, China
| | - Zhongwen Zhang
- 2 Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan, China
| | - Xiaojun Zhou
- 2 Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan, China
| | - Jianjun Dong
- 4 Division of Endocrinology, Department of Internal Medicine, Qilu Hospital of Shandong University , Jinan, China
| | - Lin Liao
- 2 Division of Endocrinology, Department of Internal Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan, China
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Choi JW, Oh IH, Lee CH, Park JS. Effect of synergistic interaction between abnormal adiposity-related metabolism and prediabetes on microalbuminuria in the general population. PLoS One 2017; 12:e0180924. [PMID: 28715448 PMCID: PMC5513435 DOI: 10.1371/journal.pone.0180924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/23/2017] [Indexed: 12/27/2022] Open
Abstract
Central obesity and related metabolic components are important risks for microalbuminuria. To describe the effects of interactions between central obesity and related metabolic components on microalbuminuria, we conducted a nation-wide, population-based interaction analysis using cardio-metabolic index (CMI) as a candidate indicator of central obesity and related abnormal lipid metabolism. We recruited native Koreans aged 20 years or older with no medical illness. A total of 5398 participants were divided into quintiles according to CMI with sex as a covariate factor. Participants in the highest CMI quintile had elevated blood pressure (BP), increased glycemic exposure, poor lipid profile, and increased urine albumin-to-creatinine ratio compared to other lower quintiles. Multiple logistic regression models adjusted for age, sex, systolic BP, and diastolic BP showed that CMI had an independent association with increased glycemic exposure and increased urine albumin-to-creatinine ratio. Our interaction analysis revealed a significant interaction between the highest CMI quintile and prediabetes with an increased risk of microalbuminuria (adjusted RERI = 0.473, 95% CI = 0.464–0.482; adjusted AP = 0.276, 95% CI = 0.156–0.395; adjusted SI = 2.952, 95% CI = 1.234–4.670). Our findings suggest a significant association between central obesity-related abnormal lipid metabolism and prediabetes, and their interaction may exert a synergistic effect on renal vascular endothelial dysfunction even before the appearance of full-blown diabetes mellitus. To confirm these findings, large population-based prospective studies are needed.
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Affiliation(s)
- Jong Wook Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Il Hwan Oh
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Hwa Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail: (JSP); (CHL)
| | - Joon-Sung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail: (JSP); (CHL)
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Brannick B, Wynn A, Dagogo-Jack S. Prediabetes as a toxic environment for the initiation of microvascular and macrovascular complications. Exp Biol Med (Maywood) 2017; 241:1323-31. [PMID: 27302176 DOI: 10.1177/1535370216654227] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Prediabetes is a state characterized by impaired fasting glucose or impaired glucose tolerance. Evidence is increasingly demonstrating that prediabetes is a toxic state, in addition to being a harbinger of future development of diabetes mellitus. This minireview discusses the pathophysiology and clinical significance of prediabetes, and approach to its management, in the context of the worldwide diabetes epidemic. The pathophysiologic defects underlying prediabetes include insulin resistance, β cell dysfunction, increased lipolysis, inflammation, suboptimal incretin effect, and possibly hepatic glucose overproduction. Recent studies have revealed that the long-term complications of diabetes may manifest in some people with prediabetes; these complications include classical microvascular and macrovascular disorders, and our discussion explores the role of glycemia in their development. Finally, landmark intervention studies in prediabetes, including lifestyle modification and pharmacologic treatment, are reviewed.
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Affiliation(s)
- Ben Brannick
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, TN 38163, USA
| | - Anne Wynn
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, TN 38163, USA
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, TN 38163, USA
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Agarwal A, Hegde A, Yadav C, Ahmad A, Manjrekar PA, Srikantiah RM. Assessment of oxidative stress and inflammation in prediabetes-A hospital based cross-sectional study. Diabetes Metab Syndr 2016; 10:S123-S126. [PMID: 27016886 DOI: 10.1016/j.dsx.2016.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/05/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Prediabetes is associated with dysglycemia, obesity, inflammation and endothelial dysfunction, contributing towards the pathogenesis of cardiovascular diseases rendering them vulnerable for the same. The current study intended to explore the risk of cardiovascular disease (CVD) related with prediabetes by assessing oxidative stress and inflammation using serum interleukin-6 (IL-6), myeloperoxidase (MPO) and urine microalbumin (MA) and their correlation with fasting plasma glucose (FPG) and physical measurements. MATERIALS AND METHODS Based on FPG values, 80 subjects were grouped into prediabetes and healthy controls. IL-6 and MPO were estimated in serum sample whereas MA was estimated in random urine sample. RESULTS Prediabetes group had significantly increased (p<0.05) mean anthropometric measurements and IL-6, MPO and MA as compared to healthy controls. MPO had significant correlation with FPG (r-0.388) in the prediabetes group. IL-6 and MPO showed a positive correlation with body mass index (BMI (r-0.339, r-0.327)), waist circumference (WC (r-484, r-0.493)) and waist-to-hip ratio (WHR (r-0.430, r-0.493)) while MA did not correlate with FPG and anthropometric measurements. CONCLUSION This study suggests that prediabetes is associated with central adiposity, inflammation and oxidative stress predisposing them to an increased risk for CVD.
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Affiliation(s)
- Ashish Agarwal
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
| | - Anupama Hegde
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India.
| | - Charu Yadav
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
| | - Afzal Ahmad
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
| | - Poornima A Manjrekar
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
| | - Rukmini M Srikantiah
- Department of Biochemistry, Kasturba Medical College, Manipal University, ,Mangalore 575004, Karnataka, India
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Kim CH, Kim KJ, Kim BY, Jung CH, Mok JO, Kang SK, Kim HK. Prediabetes is not independently associated with microalbuminuria in Korean general population: the Korea National Health and Nutrition Examination Survey 2011-2012 (KNHANES V-2,3). Diabetes Res Clin Pract 2014; 106:e18-21. [PMID: 25271114 DOI: 10.1016/j.diabres.2014.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/12/2014] [Indexed: 12/22/2022]
Abstract
We investigated the association between microalbuminuria and prediabetes in Korean population using data from the KNHANES 2011-2012. Prevalence of microalbuminuria was significantly increased in prediabetes group. However, the odds ratio became insignificant after adjustment for blood pressure, and the prevalence of microalbuminuria was not increased in prediabetic subjects without hypertension.
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Affiliation(s)
- Chul-Hee Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea.
| | - Kyu-Jin Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Bo-Yeon Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Chan-Hee Jung
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Ji-Oh Mok
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Sung-Koo Kang
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Hong-Kyu Kim
- Health Screening & Promotion Center, Asan Medical Center, Seoul, South Korea
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Lamster IB, Cheng B, Burkett S, Lalla E. Periodontal findings in individuals with newly identified pre-diabetes or diabetes mellitus. J Clin Periodontol 2014; 41:1055-60. [DOI: 10.1111/jcpe.12307] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Ira B. Lamster
- Department of Health Policy and Management; Columbia University Mailman School of Public Health; New York NY USA
- Section of Oral and Diagnostic Sciences; Division of Periodontics; Columbia University College of Dental Medicine; New York NY USA
| | - Bin Cheng
- Department of Biostatistics; Columbia University Mailman School of Public Health; New York NY USA
| | - Sandra Burkett
- Section of Oral and Diagnostic Sciences; Division of Periodontics; Columbia University College of Dental Medicine; New York NY USA
| | - Evanthia Lalla
- Section of Oral and Diagnostic Sciences; Division of Periodontics; Columbia University College of Dental Medicine; New York NY USA
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