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Johnson ML, Preston JD, Rashid CS, Pearson KJ, Ham JN. Sex differences in type 2 diabetes: an opportunity for personalized medicine. Biol Sex Differ 2023; 14:88. [PMID: 38093356 PMCID: PMC10716945 DOI: 10.1186/s13293-023-00571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
Over the past several decades, substantial ground has been gained in understanding the biology of sex differences. With new mandates to include sex as a biological variable in NIH-funded research, greater knowledge is forthcoming on how sex chromosomes, sex hormones, and social and societal differences between sexes can affect the pathophysiology of health and disease. A detailed picture of how biological sex impacts disease pathophysiology will directly inform clinicians in their treatment approaches and challenge canonical therapeutic strategies. Thus, a profound opportunity to explore sex as a variable in personalized medicine now presents itself. While many sex differences are apparent in humans and have been described at length, we are only beginning to see how such differences impact disease progression, treatment efficacy, and outcomes in obesity, type 2 diabetes, and cardiovascular disease. Here, we briefly present the most salient and convincing evidence of sex differences in type 2 diabetes detection, diagnostics, disease course, and therapeutics. We then offer commentary on how this evidence can inform clinicians on how to approach the clinical workup and management of different patients with diabetes. Finally, we discuss some gaps that remain in the literature and propose several research questions to guide basic and translational researchers as they continue in this growing area of scientific exploration.
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Affiliation(s)
- Meredith L Johnson
- Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, 40506, USA
| | - Joshua D Preston
- Medical Scientist Training Program, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Cetewayo S Rashid
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - Kevin J Pearson
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - J Nina Ham
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA.
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Hou Q, Song R, Zhao X, Yang C, Feng Y. Lower circulating irisin levels in type 2 diabetes mellitus patients with chronic complications: A meta-analysis. Heliyon 2023; 9:e21859. [PMID: 38027674 PMCID: PMC10658327 DOI: 10.1016/j.heliyon.2023.e21859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of this study was to provide evidence of the differences in circulating irisin levels between type 2 diabetes mellitus (T2DM) patients with and without chronic complications. Methods We performed a meta-analysis to compare circulating irisin levels between different groups. Literature search was conducted in PubMed, Cochrane Library, Embase, WanFang, and China National Knowledge Infrastructure databases from inception through December 2022. Random effects model and standard mean difference (SMD) was used to calculate the pooled outcomes with 95 % confidence intervals (CIs). Results Forty-two studies that matched the inclusion criteria were analyzed. Circulating irisin levels were significantly lower in T2DM patients with chronic complications than those in T2DM patients without chronic complications (SMD: -1.43; 95 % CI: -1.76 to -1.09; p < 0.00001) and healthy control group (SMD: -2.40; 95 % CI: -3.02 to -1.77; p < 0.00001). Moreover, irisin levels further decrease with the aggravation of complications in T2DM patients with diabetic nephropathy or diabetic retinopathy. Conclusion Compared with T2DM patients without chronic complications, T2DM patients with chronic complications had lower circulating irisin levels. In addition, irisin levels were negatively correlated with the severity of chronic complications.
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Affiliation(s)
- Qiaoyu Hou
- Department of Pharmacy, Peking University People's Hospital, Beijing, 100044, China
- Department of Pharmacy, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, 253000, China
| | - Rongjing Song
- Department of Pharmacy, Peking University People's Hospital, Beijing, 100044, China
| | - Xuecheng Zhao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Changqing Yang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China
| | - Yufei Feng
- Department of Pharmacy, Peking University People's Hospital, Beijing, 100044, China
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Sutkowska E, Marciniak D, Koszewicz M, Dziadkowiak E, Budrewicz S, Biernat K, Kuciel N, Mazurek J, Hap K. Validity and reliability of the Polish version of the Michigan Neuropathy Screening Instrument. World J Diabetes 2023; 14:435-446. [PMID: 37122429 PMCID: PMC10130898 DOI: 10.4239/wjd.v14.i4.435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/11/2022] [Accepted: 01/10/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation. Thus, patients with diabetes should be screened for this disorder according to local guidelines. An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.
AIM To validate both sections (A and B) of the Michigan Neuropathy Screening Instrument (MNSI) in Polish (PL) patients with diabetes.
METHODS A cross-sectional study using a test (A1, B1) and re-test (A2, B2) formula was performed in 80 patients with diabetes. The gold standard used for neuropathy detection was a nerve conduction study (NCS) which was performed in all participants. Reliability of the MNSI-PL was assessed using the Cronbach’s alpha, Kuder-Richardson formula 20 (KR-20), split-half reliability, the Gottman split-half tests, and correlation between first and second half was accessed. Stability was assessed using an intraclass correlation coefficient (ICC). For external validation, we used simple linear correlation, binomial regression, and agreement between two different tools using a Bland-Altman plot analysis.
RESULTS The scale was internally consistent (Cronbach’s alpha for the full scale: 0.81 for A and 0.87 for B). MNSI-PL scores in test/retest showed high stability (ICC = 0.73 for A and ICC = 0.97 for B). The statistically important correlations between MNSI-PL and NCS were found for B1, B2, and A1 (P < 0.005). The cut-off points of ≥ 3 for section A (sensitivity of 90%-100%; specificity of 33%-40%) and ≥ 2 for section B (sensitivity of 81%-84%; specificity of 60%-70%) were obtained during neuropathy detection.
CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.
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Affiliation(s)
- Edyta Sutkowska
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Dominik Marciniak
- Department of Drugs Form Technology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | | | - Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Karolina Biernat
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Natalia Kuciel
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Justyna Mazurek
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
| | - Katarzyna Hap
- University Rehabilitation Centre, Wroclaw Medical University, Wroclaw 50-556, Poland
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Ren W, Feng Y, Feng Y, Li J, Zhang C, Feng L, Cui L, Ran J. Relationship of liver fat content with systemic metabolism and chronic complications in patients with type 2 diabetes mellitus. Lipids Health Dis 2023; 22:11. [PMID: 36694216 PMCID: PMC9872378 DOI: 10.1186/s12944-023-01775-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This study investigated the correlation of liver fat content (LFC) with metabolic characteristics and its association with chronic complications in type 2 diabetes mellitus (T2DM) patients. METHODS Eighty-one prospectively enrolled T2DM patients were divided into non-alcoholic fatty liver disease (NAFLD) group and the non-NAFLD group according to the presence of NAFL complications. LFC was determined by MRI IDEAL-IQ Sequence, and patients were divided into 4 groups according to LFC by quartile method. Basic information, metabolic indexes, and occurrence of chronic complications in different groups were analyzed and compared. RESULTS BMI, SBP, DBP, TG, ALT, AST, GGT, UA, HbA1c, FCP, 2 h CP, HOMA-IR, and HOMA-IS in the NAFLD group were significantly higher than the non-NAFLD group (P < 0.05). The incidences of chronic complications in the NAFLD group were higher than in the non-NAFLD group but not statistically significant (P > 0.05). BMI, SBP, DBP, TC, TG, ALT, AST, FCP, 2 h CP, HOMA-IR, and HOMA-IS showed significant differences between the patients with different LFC, and these indexes were significantly higher in patients with higher LFC than those with lower LFC (P < 0.05). Moreover, diabetes duration, TC, HOMA-IR, and LFC were the risk factors for ASCVD complications, while diabetes duration, TG, and LDL-C were risk factors for DN complications. Also, diabetes duration and SBP were risk factors for both DR and DPN complications in T2DM patients (P < 0.05). CONCLUSION LFC is positively correlated with the severity of the systemic metabolic disorder and chronic complications in T2DM patients.
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Affiliation(s)
- Weiwei Ren
- grid.412601.00000 0004 1760 3828Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Huizhou District, Guangzhou, 510630 China
| | - Yunlu Feng
- grid.263785.d0000 0004 0368 7397General Practice Department, South China Normal University Hospital. No.55, West of Zhongshan Avenue, Tianhe District, Guangzhou, 510632 China
| | - Youzhen Feng
- grid.412601.00000 0004 1760 3828Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, 510000 China
| | - Jiaying Li
- grid.412601.00000 0004 1760 3828Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Huizhou District, Guangzhou, 510630 China
| | - Chuangbiao Zhang
- grid.412601.00000 0004 1760 3828Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Huizhou District, Guangzhou, 510630 China
| | - Lie Feng
- grid.412601.00000 0004 1760 3828Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Huizhou District, Guangzhou, 510630 China
| | - Lijuan Cui
- Department of Endocrinology and Metabolism, Guangzhou Baiyun District Maternity and Child Healthcare Hospital, No.1128 Airport Road, Guangzhou, 510000 China
| | - Jianmin Ran
- grid.258164.c0000 0004 1790 3548Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital Affiliated to Jinan University, No. 396, Tongfu Middle Road, Huizhou District, Guangzhou, 510220 China
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Mesa A, Giménez M, Pueyo I, Perea V, Viñals C, Blanco J, Vinagre I, Serés-Noriega T, Boswell L, Esmatjes E, Conget I, Amor AJ. Hyperglycemia and hypoglycemia exposure are differentially associated with micro- and macrovascular complications in adults with Type 1 Diabetes. Diabetes Res Clin Pract 2022; 189:109938. [PMID: 35662616 DOI: 10.1016/j.diabres.2022.109938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/10/2022] [Accepted: 05/30/2022] [Indexed: 11/03/2022]
Abstract
AIMS Evaluate the relationship between high and low exposure continuous glucose monitoring (CGM)-derived glucometrics and micro- and macrovascular complications in type 1 diabetes (T1D). METHODS Cross-sectional study in T1D without cardiovascular disease (CVD) and with ≥ 1 of the following: ≥40 years, diabetic nephropathy, or ≥ 10 years of diabetes duration with CVD risk factors. Glucometrics were obtained over 14 consecutive days: glucose management indicator (GMI) and proportion of time < 54 (TBR < 54), <70, 70-180 (TIR), >180 (TAR). Carotid plaque was evaluated by ultrasonography. Logistic regression models adjusted for age, sex, and other risk factors were constructed to test the independent associations with chronic complications. RESULTS We included 152 patients (54.6% men, 48.7 ± 10.0 years-old). Sixty-seven patients had plaque and n = 71 microvascular complications. TAR (OR 1.28 [1.09-1.51]) and GMI (OR 3.05 [1.46-6.36]) were directly associated with the presence of microvascular complications, while TIR had an inverse relationship (OR 0.79 [0.66-0.93]). TBR < 54 was directly associated with the presence of plaque, even after adjusting for 5-year mean HbA1c (OR 1.51 [1.07-2.13]). CONCLUSIONS High-glucose glucometrics were independently associated with microvascular complications. Only low-glucose exposure glucometrics was significantly associated with preclinical atherosclerosis. Our data support the role of hypoglycemia in the development of CVD in this population.
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Affiliation(s)
- Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain.
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Jesús Blanco
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Laura Boswell
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; Endocrinology and Nutrition Department, Althaia - Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain.
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Arrieta F, Pedro-Botet J, Iglesias P, Obaya JC, Montanez L, Maldonado GF, Becerra A, Navarro J, Perez JC, Petrecca R, Pardo JL, Ribalta J, Sánchez-Margalet V, Duran S, Tébar FJ, Aguilar M. Diabetes mellitus and cardiovascular risk: an update of the recommendations of the Diabetes and Cardiovascular Disease Working Group of the Spanish Society of Diabetes (SED, 2021). Clínica e Investigación en Arteriosclerosis 2022; 34:36-55. [PMID: 34330545 DOI: 10.1016/j.arteri.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. The consensus has been developed by a multidisciplinary team made up of members of the Cardiovascular Risk Group of the Spanish Diabetes Society (SED). The work is a necessary update as, since the last review three years ago, there have been many clinical trials that have studied the cardiovascular outcomes of numerous drugs in the diabetic population. We believe that this guideline update may be of interest to all clinicians treating patients with diabetes.
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Affiliation(s)
- Francisco Arrieta
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España.
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Barcelona, España
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Juan Carlos Obaya
- Centro de Salud CHOPERA, Atención Primaria Alcobendas, Gdt Enfermedades Cardiovasculares Semfyc, Madrid, España
| | - Laura Montanez
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | | | - Antonio Becerra
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | - Jorge Navarro
- Hospital Clínico Universitario de Valencia, Gdt Diabetes Semfyc, Valencia, España
| | - J C Perez
- Centro de Salud Rincón de la Victoria, Atención Primaria, Málaga, España
| | - Romina Petrecca
- Unidad de Nutrición y dietética, Hospital de la Princesa, Madrid, España
| | - José Luis Pardo
- Centro de Salud Orihuela I. Médico de Familia, Atención Primaria Alicante, Alicante, España
| | - Josep Ribalta
- Universidad Rovira i Vigili, IISPV, CIBERDEM, Tarragona, España
| | | | - Santiago Duran
- Servicio de Endocrinología y Nutrición, Hospital Virgen de Valme, Sevilla, España
| | - Francisco Javier Tébar
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Manuel Aguilar
- Servicio de Endocrinología y Nutrición, Hospital Puerta del Mar, Cádiz, España
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Stelmaszyk A, Mikołajczak P, Dworacka M. Sirtuin 1 as the mechanism of action of agents used in the diabetes mellitus pharmacotherapy. Eur J Pharmacol 2021; 907:174289. [PMID: 34214583 DOI: 10.1016/j.ejphar.2021.174289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/23/2021] [Accepted: 06/25/2021] [Indexed: 01/13/2023]
Abstract
SIRT1 (sirtuin 1, a member of histone deacetylase III family) is responsible for deacetylation of lysine in histones and the conservation of DNA in the state of transcriptionally inactive heterochromatin. SIRT1 is also capable of deacetylation of transcription factors, as well as other regulatory proteins. The SIRT1 activity plays a unique role in the prevention of metabolic memory, reducing many pathways leading to chronic diabetic complications or diseases concomitant with diabetes. Factors modifying expression and/or activity of SIRT1 may be especially helpful for patients with diabetes. This article attempts to sum up the current state of knowledge about agents commonly used in the treatment of type 2 diabetes which might have an impact on the SIRT1 expression and activity. It is the review of several studies regarding drug-induced pleiotropic activity and the way in which their interference with cellular pathways gives us better understanding of this activity, as well as the influence of therapy on the course of the disease.
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Affiliation(s)
- Agnieszka Stelmaszyk
- Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Katedra i Zakład Farmakologii, Poznan University of Medical Sciences, Department of Pharmacology, ul. Rokietnicka 5A, 60-806, Poznań, Poland.
| | - Przemysław Mikołajczak
- Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Katedra i Zakład Farmakologii, Poznan University of Medical Sciences, Department of Pharmacology, ul. Rokietnicka 5A, 60-806, Poznań, Poland
| | - Marzena Dworacka
- Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Katedra i Zakład Farmakologii, Poznan University of Medical Sciences, Department of Pharmacology, ul. Rokietnicka 5A, 60-806, Poznań, Poland
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Li W, Peng L, Yang C, Chen G. Diagnostic significance of serum PP4R1 and its predictive value for the development of chronic complications in patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2021; 13:27. [PMID: 33750415 PMCID: PMC7945353 DOI: 10.1186/s13098-021-00642-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Protein phosphatase 4 regulatory subunit 1 (PP4R1) is one of the regulatory subunits of PP4. It has been determined to be involved in the regulation of TNF-α-induced hepatic insulin resistance and gluconeogenesis. Considering the important role of PP4R1 in hepatic insulin resistance, the current study explored the expression and diagnostic value of PP4R1 in type 2 diabetes mellitus (T2DM) patients and further investigated its predictive value for the development of chronic complications. METHOD Hundred and five patients with T2DM and 97 healthy controls were collected. qRT-PCR was used for the measurement of serum PP4R1 mRNA level in both T2DM and control groups. The diagnostic value of PP4R1 in T2DM patients was evaluated using receiver operating characteristic (ROC) curve. Kaplan-Meier methods and Cox regression analysis were used to evaluate the predictive value of PP4R1 for the development of chronic complications in T2DM patients. RESULTS PP4R1 was determined to be elevated in the serum of T2DM patients compared with healthy controls. Serum PP4R1 had the potential to distinguish T2DM patients from healthy controls with a sensitivity of 81.9% and specificity of 82.5%. Patients with high PP4R1 expression experienced more chronic complications events. The multivariate Cox analysis results suggested that serum PP4R1 expression was an independent factor for the occurrence of chronic complications for T2DM patients. CONCLUSION: PP4R1 is elevated in the serum of T2DM patients, had the potential to distinguish T2DM patients from healthy controls. PP4R1 serves as a promising biomarker for predicting the risk of future chronic complications in T2DM patients.
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Affiliation(s)
- Wenjing Li
- Endocrinology Department, The Second People's Hospital of Liaocheng, Liaocheng, Shandong, 252600, China
| | - Lanbo Peng
- Endocrinology Department, Liaocheng People's Hospital, Liaocheng, Shandong, 252000, China
| | - Chao Yang
- Endocrinology Department, The Second People's Hospital of Liaocheng, Liaocheng, Shandong, 252600, China
| | - Guangmin Chen
- Nephrology and Urology Centre, University-Town Hospital of Chongqing Medical University, No. 55, University-Town Middle Road, Chongqing, 401551, China.
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Turégano-Yedro M, Cinza-Sanjurjo S, Cubelos-Fernández N, Segura-Fragoso A, Sánchez-Sánchez B, Sánchez-Rodríguez R, Micó-Pérez RM, Velilla-Zancada S, Núñez-Villén A, Llisterri-Caro JL. [Analysis of the level of compliance to the clinical practice guidelines recommendations for the diagnosis and monitoring of chronic vascular complications in type2 diabetes in Primary Care]. Semergen 2020; 46:175-185. [PMID: 31899151 DOI: 10.1016/j.semerg.2019.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the level of compliance to the clinical practice guidelines (CPG) recommendations for the diagnosis and monitoring of the main chronic vascular complications of patients with type2 diabetes (DM2) in Primary Care (PC). MATERIAL AND METHODS A retrospective cross-sectional descriptive study was conducted on patients aged 18years and over and consecutively selected in PC. Patient data were obtained by direct interview and access to the computerised history, and recording the clinical and analytical variables of interest. The determination and recording of urine microalbumin (MALB), glomerular filtration rate (GFR), foot examination (pulse palpation, monofilament or tuning fork), and electrocardiogram (ECG), if performed annually, and the eye fundus (FO) every two years. RESULTS A total of 1,420 patients were included, of which 55.8% were male. The mean age (SD) was 70.6 (10.8) years and the mean onset of the diabetes was 9.3 (6.2) years. The mean BMI (kg /m2) was 30.1 (5.4) in females and 29.5 (4.7) in males (P=.023), and a mean HbA1c (%) of 6.9 (1.2). Good metabolic control of DM was achieved in 63.0% (95%CI: 60.4-65.5). In the last two years, 976 (68.7%; 95%CI: 66.2-71.1) patients had an eye fundus examination. The urine microalbumin had been performed on 1,228 patients (86.5%; 95%CI: 84.6-88.2). The mean glomerular filtration rate was performed on 1,391 patients (98.0%; 95%CI: 97.1-98.6), the foot pulses examination on 626 (44.1%; 95%CI: 41.5-46.7), and the neurological examination on 473 patients (33.3%; 95%CI: 30.8-35.8). CONCLUSIONS The results of the present study indicate that the presence of retinopathy or neuropathy is not explored in a significant percentage of patients with DM2. Only seven out of ten patients have been screened for retinopathy, one in three had a neurological examination, and only one in four have all the scans recommended by the CPG.
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Affiliation(s)
| | - S Cinza-Sanjurjo
- Centro de Salud de Porto do Son, EOXI Santiago de Compostela, Porto do Son, A Coruña, España
| | | | - A Segura-Fragoso
- Servicio de Investigación, Instituto de Ciencias de la Salud de Castilla-La Mancha, Talavera de la Reina, Toledo, España
| | - B Sánchez-Sánchez
- Fundación de Investigación de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Madrid, España
| | | | - R M Micó-Pérez
- Centro de Salud Fontanars dels Alforins, Fontanars dels Alforins, Valencia, España
| | | | - A Núñez-Villén
- Centro de Salud Ingeniero Joaquín Benlloch, Valencia, España
| | - J L Llisterri-Caro
- Fundación de Investigación de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Madrid, España
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10
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Ballesta S, Güerri-Fernández RC, Chillarón JJ, Güell A, Herrera S, Torres E, Ascoeta NG, Flores Le-Roux JA, Díez A. The use of microindentation for the study of bone properties in type 1 diabetes mellitus patients. Osteoporos Int 2020; 31:175-180. [PMID: 31641800 DOI: 10.1007/s00198-019-05178-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
UNLABELLED Diabetes mellitus is associated with a higher risk of fracture. In this study, we analysed the bone quality of premenopausal women with type 1 diabetes mellitus by microindentation. No differences in bone quality were identified between patients and healthy controls, suggesting that intensive insulin therapy can preserve bone health. PURPOSE To compare the bone quality of women with type 1 diabetes mellitus (T1DM) and healthy controls, and to determine the relationship with bone mineral density (BMD). METHODS This was a cross-sectional study of 45 premenopausal women with T1DM and 21 healthy controls, matched according to age and BMI. Clinical parameters, BMD and bone tissue mechanical properties (assessed using the bone material strength index [BMSi]) were evaluated in each group using microindentation. In T1DM patients, glycosylated haemoglobin (HbA1c), the number of hypoglycaemic events and the status of chronic complications were also analysed. RESULTS No differences in BMSi or BMD between T1DM patients and healthy controls were identified. In the T1DM patients, the mean HbA1c was 7.52% ± 1.00% and the mean time elapsed since diagnosis was 22.6 ± 12.2 years. Eight patients (17.7%) met the criteria for metabolic syndrome (MetS), and microvascular complications were present in 12 patients (26.7%). Neither the number of features of MetS present nor the presence of microangiopathy was found to be associated with BMSi. CONCLUSIONS T1DM premenopausal patients showed bone tissue properties comparable to those shown by controls. Further larger-scale studies should be conducted to confirm these results.
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Affiliation(s)
- S Ballesta
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - R C Güerri-Fernández
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - A Güell
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - S Herrera
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
| | - E Torres
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
| | - N G Ascoeta
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
| | - J A Flores Le-Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, PasseigMarítim, 25-29, 08003, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - A Díez
- Department of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Internal Medicine, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Santos‐Bezerra DP, Admoni SN, Mori RC, Pelaes TS, Perez RV, Machado CG, Monteiro MB, Parisi MC, Pavin EJ, Queiroz MS, Passarelli M, Machado UF, Correa‐Giannella ML. Genetic variants in DNMT1 and the risk of cardiac autonomic neuropathy in women with type 1 diabetes. J Diabetes Investig 2019; 10:985-989. [PMID: 30548403 PMCID: PMC6626951 DOI: 10.1111/jdi.12988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/29/2018] [Accepted: 12/09/2018] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION Epigenetics participate in the pathogenesis of metabolic memory, a situation in which hyperglycemia exerts prolonged deleterious effects even after its normalization. We tested the hypothesis that genetic variants in an epigenetic gene could predispose to diabetes complications. MATERIAL AND METHODS We assessed the frequency of five single-nucleotide polymorphisms in the gene encoding deoxyribonucleic acid methytransferase 1 (DNMT1; rs8112895, rs7254567, rs11085721, rs17291414 and rs10854076), and their associations with diabetic kidney disease, retinopathy, distal polyneuropathy and autonomic cardiovascular neuropathy in 359 individuals with long-term type 1 diabetes. RESULTS None of the single-nucleotide polymorphisms studied was significantly associated with the presence of chronic complications in the overall population. However, after sex stratification, the minor allele C of rs11085721 conferred risk for cardiovascular neuropathy in women after adjustment for confounding variables (odds ratio 2.32; 95% confidence interval 1.26-4.33; P = 0.006). CONCLUSIONS The fact that heterozygous mutations in DNMT1 are associated with hereditary sensory autonomic neuropathy provides plausibility to the present finding. If confirmed in independent samples, it suggests that genetic variants in epigenetic genes might predispose to more or fewer epigenetic changes in the face of similar metabolic derangements triggered by hyperglycemia, constituting the "genetics of epigenetics" for microvascular diabetes complications.
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Affiliation(s)
- Daniele Pereira Santos‐Bezerra
- Laboratory of Carbohydrates and Radioimuneassays (LIM‐18)Clinical HospitalMedical SchoolUniversity of Sao PauloUniversidade de Sao PauloSao PauloBrazil
| | - Sharon Nina Admoni
- Laboratory of Carbohydrates and Radioimuneassays (LIM‐18)Clinical HospitalMedical SchoolUniversity of Sao PauloUniversidade de Sao PauloSao PauloBrazil
- Division of EndocrinologyClinical HospitalMedical SchoolUniversity of Sao PauloUniversidade de Sao PauloSao PauloBrazil
| | - Rosana Cristina Mori
- Department of Physiology and BiophysicsInstitute of Biomedical SciencesUniversity of Sao PauloUniversity of São PauloSão PauloBrazil
| | - Tatiana Souza Pelaes
- Laboratory of Carbohydrates and Radioimuneassays (LIM‐18)Clinical HospitalMedical SchoolUniversity of Sao PauloUniversidade de Sao PauloSao PauloBrazil
| | - Ricardo Vesoni Perez
- Laboratory of Carbohydrates and Radioimuneassays (LIM‐18)Clinical HospitalMedical SchoolUniversity of Sao PauloUniversidade de Sao PauloSao PauloBrazil
| | | | - Maria Beatriz Monteiro
- Laboratory of Carbohydrates and Radioimuneassays (LIM‐18)Clinical HospitalMedical SchoolUniversity of Sao PauloUniversidade de Sao PauloSao PauloBrazil
| | - Maria Candida Parisi
- Department of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSao PauloBrazil
| | - Elizabeth Joao Pavin
- Department of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSao PauloBrazil
| | - Marcia Silva Queiroz
- Division of EndocrinologyClinical HospitalMedical SchoolUniversity of Sao PauloUniversidade de Sao PauloSao PauloBrazil
| | - Marisa Passarelli
- Laboratory of Carbohydrates and Radioimuneassays (LIM‐18)Clinical HospitalMedical SchoolUniversity of Sao PauloSao PauloBrazil
| | - Ubiratan Fabres Machado
- Department of Physiology and BiophysicsInstitute of Biomedical SciencesUniversity of Sao PauloUniversity of São PauloSão PauloBrazil
| | - Maria Lucia Correa‐Giannella
- Laboratory of Carbohydrates and Radioimuneassays (LIM‐18)Clinical HospitalMedical SchoolUniversity of Sao PauloUniversidade de Sao PauloSao PauloBrazil
- Department of Post‐graduation in MedicineNove de Julho University (UNINOVE)Sao PauloBrazil
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Abstract
PURPOSE OF REVIEW In patients with type 1 diabetes with extreme glycemic variability, the restoration of pancreas endocrine function is potentially and completely achieved with islets of Langerhans (tissue derived from whole organ) or pancreas (whole organ) transplantation. The aim of our review is to report on the latest studies and to highlight the benefits and risks of the two procedures, providing clearer, more selective, evidence-based clinical indications that also consider the impact on the degenerative complications of diabetes as a potential benefit. RECENT FINDINGS Clinical experience in this field has been dynamic over the last three decades, and has been characterized by the development of more standardized protocols and a clearer definition of clinical outcome. On the contrary, the recommendations thus far are not well delineated and tend to overlap, and the past ADA position statement for pancreas transplant alone has also been applied to islet transplant alone, without differentiation. Both outcome-driven and non-outcome-driven criteria are considered in the conclusions, in an attempt to streamline indications for islet-alone or pancreas-alone transplantation.
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Affiliation(s)
- Paola Maffi
- Diabetes Research Institute - Internal Medicine and Transplant Unit, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy.
| | - Antonio Secchi
- Internal Medicine and Transplant Unit, Vita-Salute San Raffaele University, Milan, Italy
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13
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Hubacek JA, Dlouha D, Klementova M, Lanska V, Neskudla T, Pelikanova T. The FTO variant is associated with chronic complications of diabetes mellitus in Czech population. Gene 2017; 642:220-224. [PMID: 29154870 DOI: 10.1016/j.gene.2017.11.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Genome-wide association studies have resulted in the identification of the FTO gene as an important genetic determinant of diabetes mellitus. The aim of this study was to confirm the role of this gene in the development of DM in the Czech-Slavonic population and to analyse whether this gene is associated with common DM complications. METHODS Two groups of patients (814 with T1DM and 848 with T2DM) and a group of healthy controls (2339 individuals) - both of Czech origin - were genotyped for the FTO rs17817449 SNP. ANOVA and logistic regression were used for the statistical evaluations. RESULTS The frequency of the GG genotype was significantly higher in T2DM (25.4% vs. 16.7%, P<0.0005) but not in T1DM patients (19.3% vs. 16.7%, P=0.20) than in controls. The increased risk of development of diabetic nephropathy was observed both for T1DM patients (GG vs. TT homozygotes, P<0.01) and T2DM patients (G carriers vs. TT homozygotes, P<0.05). FTO genotype predicted the development of diabetic neuropathy (GG vs. TT comparison; P<0.01) in the T2DM patients only. No association between FTO genotype and development of retinopathy was detected. All presented values are after adjustment for age, sex, BMI and duration of diabetes. CONCLUSIONS We confirm the association between the FTO rs17817449 SNP and susceptibility to T2DM in the Czech-Slavonic population. The same variant is associated with a spectrum of chronic complications in both types of diabetes.
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Affiliation(s)
- Jaroslav A Hubacek
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | - Dana Dlouha
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marta Klementova
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Lanska
- Medical Statistics Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomas Neskudla
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Terezie Pelikanova
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Selim S. Frequency and pattern of chronic complications of diabetes and their association with glycemic control among adults with type 2 diabetes in Bangladesh. Diabetes Metab Syndr 2017; 11 Suppl 1:S329-S332. [PMID: 28314538 DOI: 10.1016/j.dsx.2017.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The study was conducted in diabetes care centers to explore association of chronic complications of diabetes with glycemic status along with their frequency and pattern among adult patients with type 2 diabetes. METHODS A cross-sectional study was conducted at outpatient departments of eight diabetes care centers in Dhaka. Data were collected by face to face interview by trained research physicians. Disease related information was recorded in the checklist from diabetes guide books of the patients. Chronic complications of diabetes were recorded from the records of expert consultation. RESULTS Records of 5215 patients with type diabetes (59.4% males) were analyzed. Mean age of the male and female subjects was 52.7 and 50.6 years, respectively. Hypertriglyceridemia [OR 1.74, 95% CI (1.18-2.57)], increased LDL [OR 1.27, 95% CI (0.78-2.07)] and decreased HDL [OR 0.81, 95% CI (0.43-1.53)] and diabetic foot ulcers [OR 2.32, 95% CI (1.14-4.01)] were significantly associated with poor glycemic control, whereas hypertriglyceridemia [OR 2.39, 95% CI (1.42-4.03)] diabetic foot ulcer [OR 2.32, 95% CI (1.14-4.01)], hypetension [OR 1.65, 95% CI (1.15-2.43)] and coronary artery diasease [OR 1.23, 95% CI (0.77-2.13) were significantly associated with poor glycemic control according to FPG. CONCLUSION The study finds association of chronic complications of diabetes with glycemic control among type 2 diabetes patients in Bangladesh.
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Affiliation(s)
- Shahjada Selim
- Department of Endocrinology & Metabolism, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh.
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Andong AM, Ngouadjeu EDT, Bekolo CE, Verla VS, Nebongo D, Mboue-Djieka Y, Choukem SP. Chronic complications and quality of life of patients living with sickle cell disease and receiving care in three hospitals in Cameroon: a cross-sectional study. BMC Hematol 2017; 17:7. [PMID: 28439419 PMCID: PMC5399423 DOI: 10.1186/s12878-017-0079-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 04/03/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sickle Cell Disease (SCD) is associated with chronic multisystem complications that significantly influence the quality of life (QOL) of patients early in their life. Although sub-Saharan Africa bears 75% of the global burden of SCD, there is a paucity of data on these complications and their effects on the QOL. We aimed to record these chronic complications, to estimate the QOL, and to identify the corresponding risk factors in patients with SCD receiving care in three hospitals in Cameroon. METHODS In this cross-sectional study, a questionnaire was used to collect data from consecutive consenting patients. Information recorded included data on the yearly frequency of painful crisis, the types of SCD, and the occurrence of chronic complications. A 36-Item Short Form (SF-36) standard questionnaire that examines the level of physical and mental well-being, was administered to all eligible participants. Data were analyzed with STATA® software. RESULTS Of 175 participants included, 93 (53.1%) were female and 111 (aged ≥14 years) were eligible for QOL assessment. The median (interquartile range, IQR) age at diagnosis was 4.0 (2.0-8.0) years and the median (IQR) number of yearly painful crisis was 3.0 (1.0-7.0). The most frequent chronic complications reported were: nocturnal enuresis, chronic leg ulcers, osteomyelitis and priapism (30.9%, 24.6%, 19.4%, and 18.3% respectively). The prevalence of stroke and avascular necrosis of the hip were 8.0% and 13.1% respectively. The median (IQR) physical and mental scores were 47.3 (43.9-58.5) and 41.0 (38.8-44.6) respectively. Age and chronic complications such as stroke and avascular necrosis were independently associated with poor QOL. CONCLUSIONS In this population of patients living with SCD, chronic complications are frequent and their QOL is consequently poor. Our results highlight the need for national guidelines for SCD control, which should include new-born screening programs and strategies to prevent chronic complications.
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Affiliation(s)
- Anne M. Andong
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Health and Human Development (2HD) Research Network, P.O. Box 4856, Douala, Cameroon
| | - Eveline D. T. Ngouadjeu
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Department of Internal Medicine, Douala General Hospital, P.O. Box 4856, Douala, Cameroon
| | - Cavin E. Bekolo
- Ministry of Public Health, Centre Medical d’Arrondissement de Bare, Nkongsamba, Cameroon
| | - Vincent S. Verla
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Daniel Nebongo
- Health and Human Development (2HD) Research Network, P.O. Box 4856, Douala, Cameroon
| | - Yannick Mboue-Djieka
- Health and Human Development (2HD) Research Network, P.O. Box 4856, Douala, Cameroon
| | - Simeon-Pierre Choukem
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Health and Human Development (2HD) Research Network, P.O. Box 4856, Douala, Cameroon
- Department of Internal Medicine, Douala General Hospital, P.O. Box 4856, Douala, Cameroon
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Schirr-Bonnans S, Costa N, Derumeaux-Burel H, Bos J, Lepage B, Garnault V, Martini J, Hanaire H, Turnin MC, Molinier L. Cost of diabetic eye, renal and foot complications: a methodological review. Eur J Health Econ 2017; 18:293-312. [PMID: 26975444 DOI: 10.1007/s10198-016-0773-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Diabetic retinopathy (DR), diabetic kidney disease (DKD) and diabetic foot ulcer (DFU) represent a public health and economic concern that may be assessed with cost-of-illness (COI) studies. OBJECTIVES (1) To review COI studies published between 2000 and 2015, about DR, DKD and DFU; (2) to analyse methods used. METHODS Disease definition, epidemiological approach, perspective, type of costs, activity data sources, cost valuation, sensitivity analysis, cost discounting and presentation of costs may be described in COI studies. Each reviewed study was assessed with a methodological grid including these nine items. RESULTS The five following items have been detailed in the reviewed studies: epidemiological approach (59 % of studies described it), perspective (75 %), type of costs (98 %), activity data sources (91 %) and cost valuation (59 %). The disease definition and the presentation of results were detailed in fewer studies (respectively 50 and 46 %). In contrast, sensitivity analysis was only performed in 14 % of studies and cost discounting in 7 %. Considering the studies showing an average cost per patient and per year with a societal perspective, DR cost estimates were US $2297 (range 5-67,486), DKD cost ranged from US $1095 to US $16,384, and DFU cost was US $10,604 (range 1444-85,718). DISCUSSION This review reinforces the need to adequately describe the method to facilitate literature comparisons and projections. It also recalls that COI studies represent complementary tools to cost-effectiveness studies to help decision makers in the allocation of economic resources for the management of DR, DKD and DFU.
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Affiliation(s)
- Solène Schirr-Bonnans
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France.
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France.
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.
| | - Nadège Costa
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Hélène Derumeaux-Burel
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Jérémy Bos
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Benoît Lepage
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Methodological Support Unit, Faculté de Médecine, University Hospital of Toulouse, USMR, 37 allées Jules Guesde, 31073, Toulouse, France
| | - Valérie Garnault
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Jacques Martini
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Hélène Hanaire
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Marie-Christine Turnin
- Diabetology Metabolic Disease and Nutrition Department, Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Rangueil, University Hospital of Toulouse, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
| | - Laurent Molinier
- Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Research Unit 1027, 37 allées Jules Guesde, 31073, Toulouse, France
- University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Bâtiment 1R1, 31062, Toulouse Cedex 9, France
- Medical Information Department, University Hospital of Toulouse, Hôtel-Dieu Saint-Jacques, 2, rue viguerie, 31059, Toulouse Cedex 9, France
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Rodriguez-Morales AJ, Gil-Restrepo AF, Ramírez-Jaramillo V, Montoya-Arias CP, Acevedo-Mendoza WF, Bedoya-Arias JE, Chica-Quintero LA, Murillo-García DR, García-Robledo JE, Castrillón-Spitia JD, Londoño JJ, Bedoya-Rendón HD, Cárdenas-Pérez JDJ, Cardona-Ospina JA, Lagos-Grisales GJ. Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. F1000Res 2016; 5:360. [PMID: 27081477 PMCID: PMC4813633 DOI: 10.12688/f1000research.8235.2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 02/02/2023] Open
Abstract
Objective: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. Methods: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. Results: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). Conclusions: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).
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Affiliation(s)
- Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia; Organización Latinoamericana para el Fomento de la Investigación en Salud (OLFIS), Bucaramanga, Colombia; Committee on Zoonoses and Haemorrhagic Fevers, Asociación Colombiana de Infectología (ACIN), Bogota, Colombia; Working Group on Zoonoses, International Society for Chemotherapy, Aberdeen, UK
| | - Andrés F Gil-Restrepo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Valeria Ramírez-Jaramillo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Cindy P Montoya-Arias
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Wilmer F Acevedo-Mendoza
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan E Bedoya-Arias
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Laura A Chica-Quintero
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - David R Murillo-García
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan E García-Robledo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia; School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | - Jose J Londoño
- School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | | | - Jaime A Cardona-Ospina
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Guillermo J Lagos-Grisales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
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Rodriguez-Morales AJ, Gil-Restrepo AF, Ramírez-Jaramillo V, Montoya-Arias CP, Acevedo-Mendoza WF, Bedoya-Arias JE, Chica-Quintero LA, Murillo-García DR, García-Robledo JE, Castrillón-Spitia JD, Londoño JJ, Bedoya-Rendón HD, Cárdenas-Pérez JDJ, Cardona-Ospina JA, Lagos-Grisales GJ. Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. F1000Res 2016; 5:360. [PMID: 27081477 PMCID: PMC4813633 DOI: 10.12688/f1000research.8235.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVE There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. METHODS We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. RESULTS Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). CONCLUSIONS According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).
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Affiliation(s)
- Alfonso J. Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
- Organización Latinoamericana para el Fomento de la Investigación en Salud (OLFIS), Bucaramanga, Colombia
- Committee on Zoonoses and Haemorrhagic Fevers, Asociación Colombiana de Infectología (ACIN), Bogota, Colombia
- Working Group on Zoonoses, International Society for Chemotherapy, Aberdeen, UK
| | - Andrés F. Gil-Restrepo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Valeria Ramírez-Jaramillo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Cindy P. Montoya-Arias
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Wilmer F. Acevedo-Mendoza
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan E. Bedoya-Arias
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Laura A. Chica-Quintero
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - David R. Murillo-García
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan E. García-Robledo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
- School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | - Jose J. Londoño
- School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | | | - Jaime A. Cardona-Ospina
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Guillermo J. Lagos-Grisales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
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Niedzwiecki P, Pilacinski S, Uruska A, Adamska A, Naskret D, Zozulinska-Ziolkiewicz D. Influence of remission and its duration on development of early microvascular complications in young adults with type 1 diabetes. J Diabetes Complications 2015; 29:1105-11. [PMID: 26427560 DOI: 10.1016/j.jdiacomp.2015.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/07/2015] [Accepted: 09/02/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Prevalence of partial remission ranges between 20% and 80% in the initial course of type 1 diabetes. In this phase of the disease, a substantial insulin secretion contributes to good metabolic control. The aim of the study was to determine the association between presence of partial remission and occurrence of microangiopathy complications in type 1 diabetes. MATERIAL AND METHODS Ninety-eight consecutive patients with newly diagnosed type 1 diabetes were asked to participate in a cohort study. Partial remission was defined as the time in which all of the following criteria were met: HbA1c below 6.5% (48mmol/mol), daily insulin requirement below 0.3 U/kg body weight and serum Cpeptide concentration above 0.5ng/ml. Patients were divided into those who were in remission at any time during follow-up (remitters) and non-remitters. After 7years of follow-up, the occurrence of microangiopathy complications was analyzed. In statistical analysis, Mann-Whitney test, chi(2) test and Fisher test were used for analysis between groups. We applied a Cox's multivariate regression model and univariate regression method. P<0.05 was considered statistically significant. RESULTS In univariate logistic regression, a significant association was found between absence of remission and occurrence of at least one microvascular complication. In the Cox proportional hazards regression model that included clinically significant parameters at diagnosis (presence of ketoacidosis, cigarette smoking and HbA1c value) as covariates, absence of remission was associated with occurrence of chronic complications of diabetes at 7years [HR: 3.65 (95% CI 1.23-4.56), p=0.04]. In non-remitters, higher incidence of at least one microvascular complication (46.4% vs. 7.6%), higher incidence of retinopathy (42.8% vs. 5.7%), and neuropathy (21.4% vs. 1.9%) was found. CONCLUSIONS Occurrence of partial remission of diabetes is associated with a reduced risk of chronic microvascular complications at 7-year follow-up.
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Affiliation(s)
- Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences.
| | - Stanislaw Pilacinski
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences
| | - Anna Adamska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences
| | - Dariusz Naskret
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences
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Downs CA, Faulkner MS. Toxic stress, inflammation and symptomatology of chronic complications in diabetes. World J Diabetes 2015; 6:554-565. [PMID: 25987953 PMCID: PMC4434076 DOI: 10.4239/wjd.v6.i4.554] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/30/2014] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Diabetes affects at least 382 million people worldwide and the incidence is expected to reach 592 million by 2035. The incidence of diabetes in youth is skyrocketing as evidenced by a 21% increase in type 1 diabetes and a 30.5% increase in type 2 diabetes in the United States between 2001 and 2009. The effects of toxic stress, the culmination of biological and environmental interactions, on the development of diabetes complications is gaining attention. Stress impacts the hypothalamus-pituitary-adrenal axis and contributes to inflammation, a key biological contributor to the pathogenesis of diabetes and its associated complications. This review provides an overview of common diabetic complications such as neuropathy, cognitive decline, depression, nephropathy and cardiovascular disease. The review also provides a discussion of the role of inflammation and stress in the development and progression of chronic complications of diabetes, associated symptomatology and importance of early identification of symptoms of depression, fatigue, exercise intolerance and pain.
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Račić M, Kusmuk S, Mašić S, Ristić S, Ivković N, Djukanović L, Božović D. Quality of diabetes care in family medicine practices in eastern Bosnia and Herzegovina. Prim Care Diabetes 2015; 9:112-119. [PMID: 24953555 DOI: 10.1016/j.pcd.2014.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/09/2014] [Accepted: 05/27/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In the present study, the audit of medical files of patients with diabetes, followed in family medicine practices in the eastern region of Bosnia and Herzegovina (BiH), was carried out in order to investigate the frequency of the use of screening tests for early diagnosis of diabetes complications. METHODS The audit was conducted in 32 family medicine practices from 12 primary health care centers in the eastern part of BiH over one-year period (March 2010 to March 2011). A specially established audit team randomly selected medical files of 20 patients with diabetes from the Diabetes Registry administered by each family medicine team database. Screening tests assessed are selected according to the ADA guidelines. RESULTS Frequency of the individual screening test varied between 99%, found for at least one blood pressure measurement, and 3.8% for ABI measurement. When the frequency of optimal use of screening was analyzed, only 1% of patients received all recommended screening tests. CONCLUSION The frequency of the use of screening tests for chronic diabetes complications was found to be low in the eastern part of Bosnia and Herzegovina. Multivariate linear regression analysis showed that longer duration of diabetes and a larger number of diabetics per practice were associated with a smaller number of screening tests, but specialists in family medicine provided a higher number of screening tests compared to other physicians.
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Affiliation(s)
- Maja Račić
- University of East Sarajevo, Faculty of Medicine Foča, Studentska 4, Foča, Bosnia and Herzegovina.
| | - Srebrenka Kusmuk
- University of East Sarajevo, Faculty of Medicine Foča, Studentska 4, Foča, Bosnia and Herzegovina
| | - Srđan Mašić
- University of East Sarajevo, Faculty of Medicine Foča, Studentska 4, Foča, Bosnia and Herzegovina
| | - Siniša Ristić
- University of East Sarajevo, Faculty of Medicine Foča, Studentska 4, Foča, Bosnia and Herzegovina
| | - Nedeljka Ivković
- University of East Sarajevo, Faculty of Medicine Foča, Studentska 4, Foča, Bosnia and Herzegovina
| | - Ljubica Djukanović
- University of Belgrade, Faculty of Medicine, Suboticeva 10, Belgrade, Serbia
| | - Djordje Božović
- University of East Sarajevo, Faculty of Medicine Foča, Studentska 4, Foča, Bosnia and Herzegovina
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Abstract
Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients’ functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI.
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Wegner M, Neddermann D, Piorunska-Stolzmann M, Jagodzinski PP. Role of epigenetic mechanisms in the development of chronic complications of diabetes. Diabetes Res Clin Pract 2014; 105:164-75. [PMID: 24814876 DOI: 10.1016/j.diabres.2014.03.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 03/13/2014] [Accepted: 03/22/2014] [Indexed: 12/24/2022]
Abstract
There is growing evidence that epigenetic regulation of gene expression including post-translational histone modifications (PTHMs), DNA methylation and microRNA (miRNA)-regulation of mRNA translation could play a crucial role in the development of chronic, diabetic complications. Hyperglycemia can induce an abnormal action of PTHMs and DNA methyltransferases as well as alter the levels of numerous miRNAs in endothelial cells, vascular smooth muscle cells, cardiomyocytes, retina, and renal cells. These epigenetic abnormalities result in changes in the expression of numerous genes contributing to effects such as development of chronic inflammation, impaired clearance of reactive oxygen species (ROS), endothelial cell dysfunction and/or the accumulation of extracellular matrix in the kidney, which causing the development of retinopathy, nephropathy or cardiomyopathy. Some epigenetic modifications, for example PTHMs and DNA methylation, become irreversible over time. Therefore, these processes have gained much attention in explaining the long-lasting detrimental consequences of hyperglycaemia causing the development of chronic complications even after improved glycaemic control is achieved. Our review suggests that the treatment of chronic complications should focus on erasing metabolic memory by targeting chromatin modification enzymes and by restoring miRNA levels.
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Affiliation(s)
- Malgorzata Wegner
- Lipid Metabolism Laboratory, Chair of Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland.
| | - Daniel Neddermann
- Novartis Pharma AG, Drug Metabolism and Pharmacokinetics, Postfach, 4002 Basel, Switzerland
| | - Maria Piorunska-Stolzmann
- Department of Clinical Biochemistry and Laboratory Medicine, Chair of Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
| | - Pawel P Jagodzinski
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, 6 Swiecickiego Street, 60-781 Poznan, Poland
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Elgart JF, Caporale JE, Asteazarán S, De La Fuente JL, Camilluci C, Brown JB, González CD, Gagliardino JJ. Association between socioeconomic status, type 2 diabetes and its chronic complications in Argentina. Diabetes Res Clin Pract 2014; 104:241-7. [PMID: 24629409 DOI: 10.1016/j.diabres.2014.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/20/2013] [Accepted: 02/13/2014] [Indexed: 01/18/2023]
Abstract
AIM To compare the socioeconomic status (SES) of people with type 2 diabetes (T2DM) in Argentina (Córdoba) with and without major chronic complications of diabetes, with that recorded in persons without diabetes matched by age and gender. METHODS For this descriptive and analytic case-control study, potential candidates were identified from the electronic records of one institution of the Social Security System of the city of Córdoba. We identified and recruited 387 persons each with T2DM with or without chronic complications and 774 gender- and age-matched persons without T2DM (recruitment rate, 83%). Data were obtained by telephone interviews and supplemented with data from the institution's records. Group comparisons were performed with parametric or non-parametric tests as appropriate. We used ordinary least squares to regress household income and the difference between income and household expenses on diabetes status, age, sex, education and body mass index. RESULTS Persons with T2DM, particularly those with complications, reported fewer years of general education (13.6±4.2 years vs. 12.2±4.4 years), a lower percentage of full time jobs (43.0% vs. 26.9%), lower salaries and monthly household income among those with full-time jobs (> 5000 ARG$: 52.6% vs. 24.5%), and a higher propensity to spend more money than they earned (expenditure/income ratio≥1: 10.2% vs. 16.0%). The percentage of unmarried people was also higher among people with type 2 diabetes (7.0% vs. 10.9%). CONCLUSION T2DM and the development of its complications are each positively associated with lower SES and greater economic distress in Argentina.
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Affiliation(s)
- Jorge F Elgart
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina.
| | - Joaquín E Caporale
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | - Santiago Asteazarán
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | | | | | - Jonathan B Brown
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
| | - Claudio D González
- Department of Pharmacology, University of Buenos Aires School of Medicine, Argentina
| | - Juan J Gagliardino
- CENEXA - Center of Experimental and Applied Endocrinology (National University of La Plata-National Research Council, PAHO/WHO Collaborating Center for Diabetes), National University of La Plata School of Medicine, La Plata, Argentina
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Chillarón JJ, Flores Le-Roux JA, Benaiges D, Pedro-Botet J. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism 2014; 63:181-7. [PMID: 24274980 DOI: 10.1016/j.metabol.2013.10.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 11/24/2022]
Abstract
Patients with type 1 diabetes mellitus (T1DM) traditionally had a low body mass index and microangiopathic complications were common, while macroangiopathy and the metabolic syndrome were exceptional. The Diabetes Control and Complications Trial, published in 1993, demonstrated that therapy aimed at maintaining HbA1c levels as close to normal as feasible reduced the incidence of microangiopathy. Since then, the use of intensive insulin therapy to optimize metabolic control became generalized. Improved glycemic control resulted in a lower incidence of microangiopathy; however, its side effects included a higher rate of severe hypoglycemia and increased weight gain. Approximately 50% of patients with T1DM are currently obese or overweight, and between 8% and 40% meet the metabolic syndrome criteria. The components of the metabolic syndrome and insulin resistance have been linked to chronic T1DM complications, and cardiovascular disease is now the leading cause of death in these patients. Therefore, new therapeutic strategies are required in T1DM subjects, not only to intensively lower glycemia, but to control all associated metabolic syndrome traits.
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Affiliation(s)
- Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona.
| | - Juana A Flores Le-Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
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Gomes MB, Negrato CA, Cobas R, Tannus LRM, Gonçalves PR, da Silva PCB, Carneiro JRI, Matheus ASM, Dib SA, Azevedo MJ, Nery M, Rodacki M, Zajdenverg L, Montenegro Junior RM, Sepulveda J, Calliari LE, Jezini D, Braga N, Luescher JL, Berardo RS, Arruda-Marques MC, Noronha RM, Manna TD, Salvodelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Guedes MDFS, Dualib P, Silva SC, Sampaio E, Rea R, Faria ACR, Tschiedel B, Lavigne S, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Tolentino M, Pedrosa HC, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Matos OS, Palma CC, Azulay R, Forti AC, Façanha C, Montenegro AP, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM. Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil. Diabetol Metab Syndr 2014; 6:67. [PMID: 24920963 PMCID: PMC4052842 DOI: 10.1186/1758-5996-6-67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D). METHODS This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups. RESULTS We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). The majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001). CONCLUSIONS Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.
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Affiliation(s)
- Marilia Brito Gomes
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Roberta Cobas
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Lucianne Righeti Monteiro Tannus
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Paolla Ribeiro Gonçalves
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - Pedro Carlos Barreto da Silva
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | - João Regis Ivar Carneiro
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Sergio Atala Dib
- Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Márcia Nery
- Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Melanie Rodacki
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Neuza Braga
- Hospital Geral de Bonsucesso, Rio de Janeiro, Brazil
| | - Jorge L Luescher
- Hospital Universitário Clementino Fraga Filho – IPPMG, Rio de Janeiro, Brazil
| | | | | | - Renata M Noronha
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Thais D Manna
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Roberta Salvodelli
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda G Penha
- Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Milton C Foss
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, Brazil
| | - Maria C Foss-Freitas
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, Brazil
| | - Antonio C Pires
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | - Fernando C Robles
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | | | - Patricia Dualib
- Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil
| | - Saulo C Silva
- Clínica de Endocrinologia da Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | | | - Rosangela Rea
- Hospital de Clínicas da Universidade Federal do Paraná, Porto Alegre, Brazil
| | | | - Balduino Tschiedel
- Instituto da Criança com Diabetes, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Suzana Lavigne
- Instituto da Criança com Diabete Rio Grande Sul, Rio Grande do Sul, Brazil
| | - Luis Henrique Canani
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | - Alessandra T Zucatti
- Ambulatório da Faculdade Estadual de Medicina de São José do Rio Preto, Ribeirão Preto, Brazil
| | | | | | | | | | | | - Flaviane A Prado
- Centro de Diabetes da Escola Paulista de Medicina, Ribeirão Preto, Brazil
| | | | | | | | - Alexis D Guedes
- Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil
| | - Odelissa S Matos
- Centro de Diabetes e Endocrinologia do Estado da Bahia, Goiânia, Brazil
| | - Catia C Palma
- Unit of Diabetes, Universidade Estadual do Rio de Janeiro, Avenida 28 de Setembro, 77, 3 andar CEP 20.551-030 Rio de Janeiro, Brazil
| | | | - Adriana C Forti
- Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil
| | - Cristina Façanha
- Centro Integrado de Diabetes e Hipertensão do Ceará, Fortaleza, Brazil
| | | | - Naira H Melo
- Universidade Federal de Sergipe, Aracaju, Brazil
| | | | - Alberto Ramos
- Hospital Universitário Alcides Carneiro, Campina Grande, Brazil
| | | | - Flavia M Santos
- Hospital Universitário João de Barros Barreto, Pará, Belém, Brazil
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Uloko AE, Ofoegbu EN, Chinenye S, Fasanmade OA, Fasanmade AA, Ogbera AO, Ogbu OO, Oli JM, Girei BA, Adamu A. Profile of Nigerians with diabetes mellitus - Diabcare Nigeria study group (2008): Results of a multicenter study. Indian J Endocrinol Metab 2012; 16:558-564. [PMID: 22837916 PMCID: PMC3401756 DOI: 10.4103/2230-8210.98011] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes Mellitus is the commonest endocrine-metabolic disorder in Nigeria similar to the experience in other parts of the world. The aim was to assess the clinical and laboratory profile, and evaluate the quality of care of Nigerian diabetics with a view to planning improved diabetes care. MATERIALS AND METHODS In a multicenter study across seven tertiary health centers in Nigeria, the clinical and laboratory parameters of diabetic out-patients were evaluated. Clinical parameters studied include type of diabetes, anthropometry, and blood pressure (BP) status, chronic complications of diabetes, and treatment types. Laboratory data assessed included fasting plasma glucose (FPG), 2-h post-prandial (2-HrPP) glucose, glycated hemoglobin (HbA1c), urinalysis, serum lipids, electrolytes, urea, and creatinine. RESULTS A total of 531 patients, 209 (39.4%) males and 322 (60.6%) females enrolled. The mean age of the patients was 57.1 ± 12.3 years with the mean duration of diabetes of 8.8 ± 6.6 years. Majority (95.4%) had type 2 diabetes mellitus (DM) compared to type 1 DM (4.6%), with P < 0.001. The mean FPG, 2-HrPP glucose, and HbA1c were 8.1 ± 3.9 mmol/L, 10.6 ± 4.6 mmol/L, and 8.3 ± 2.2%, respectively. Only 170 (32.4%) and 100 (20.4%) patients achieved the ADA and IDF glycemic targets, respectively. Most patients (72.8%) did not practice self-monitoring of blood glucose. Hypertension was found in 322 (60.9%), with mean systolic BP 142.0 ± 23.7 mmHg, and mean diastolic BP 80.7 ± 12.7 mmHg. Diabetic complications found were peripheral neuropathy (59.2%), retinopathy (35.5%), cataracts (25.2%), cerebrovascular disease (4.7%), diabetic foot ulcers (16.0%), and nephropathy (3.2%). CONCLUSION Most Nigerian diabetics have suboptimal glycemic control, are hypertensives, and have chronic complications of DM. Improved quality of care and treatment to target is recommended to reduce diabetes-related morbidity and mortality.
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Affiliation(s)
- Andrew E Uloko
- Endocrine and Metabolic Unit, Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria.
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