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Nagy DK, Bresee LC, Eurich DT, Simpson SH. Are Guideline-concordant Processes of Care Consistent Across the Rural-Urban Continuum? A Retrospective Cohort Study of Adults Newly Treated for Type 2 Diabetes. Can J Diabetes 2024:S1499-2671(24)00065-0. [PMID: 38583767 DOI: 10.1016/j.jcjd.2024.03.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Our aim in this study was to identify the association between place of residence (metropolitan, urban, rural) and guideline-concordant processes of care in the first year of type 2 diabetes management. METHODS We conducted a retrospective cohort study of new metformin users between April 2015 and March 2020 in Alberta, Canada. Outcomes were identified as guideline-concordant processes of care through the review of clinical practice guidelines and published literature. Using multivariable logistic regression, the following outcomes were examined by place of residence: dispensation of a statin, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), eye examination, glycated hemoglobin (A1C), cholesterol, and kidney function testing. RESULTS Of 60,222 new metformin users, 67% resided in a metropolitan area, 10% in an urban area, and 23% in a rural area. After confounder adjustment, rural residents were less likely to have a statin dispensed (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.79 to 0.87) or undergo cholesterol testing (aOR 0.86, 95% CI 0.83 to 0.90) when compared with metropolitan residents. In contrast, rural residents were more likely to receive A1C and kidney function testing (aOR 1.14, 95% CI 1.08 to 1.21 and aOR 1.17, 95% CI 1.11 to 1.24, respectively). ACEi/ARB use and eye examinations were similar across place of residence. CONCLUSIONS Processes of care varied by place of residence. Limited cholesterol management in rural areas is concerning because this may lead to increased cardiovascular outcomes.
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Affiliation(s)
- Danielle K Nagy
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren C Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, Li Ka Shing Centre for Research, University of Alberta, Edmonton, Alberta, Canada
| | - Scot H Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Fougère E, Delavaud JM, Filloux C, Danigo A, Fagnère C, Jost J, Teissier MP, Demiot C. [Interest of a short educational intervention coordinated by community pharmacists for elderly type 2 diabetes patients in a rural area]. Therapie 2024:S0040-5957(24)00006-4. [PMID: 38341320 DOI: 10.1016/j.therap.2024.01.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
The number of elderly people with type 2 diabetes (T2D) is increasing worldwide. Community pharmacies, thanks to their proximity, provide more easy access to therapeutic education for rural patients. Populations living in isolated areas require specific educational resources related to their condition. The aim of this project was to perform a short (FLASH) educational intervention, coordinated by community pharmacists, and then evaluate the impact of this intervention on patient knowledge of their disease. The study was performed in Issoudun, a rural French town of approximately 10,000 inhabitants. Educational priorities were defined and the project was presented to health authorities and local health professionals. Pharmacies in Issoudun recruited patients, either alone or accompanied by their caregivers. The educational intervention lasted 2h and focused on 4 teaching objectives: knowledge concerning diabetes, diabetic complications and how to monitor them; how to react to hypoglycemia; understanding treatments; and understanding glycated hemoglobin. The impact of this educational intervention was assessed using a questionnaire delivered before the intervention, immediately after, and after 6months. Forty-five patients aged 71±6years with T2D duration of 14±6years were recruited over 6months. Some false beliefs were identified before the intervention. The educational session led to a significant improvement in the percentage of correct answers (before: 60.3%±7.5, after: 99%±0.4, P=0.0002) and at 6months (99.5%±0.3, P=0.0002) compared with the patients' initial knowledge. Almost all false beliefs were corrected by the intervention and patients were able to recall the mechanism of action of their drugs, with the help of a "key and lock" schematic. This short FLASH educational intervention, coordinated by community pharmacists, showed that the model was both interesting to patients and effective. This method could be expanded to other rural communities and medical deserts.
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Affiliation(s)
- Edouard Fougère
- Service de chimie thérapeutique, faculté de pharmacie, université de Limoges, 87025 Limoges, France
| | - Jean-Michel Delavaud
- Unité transversale territoriale d'éducation du patient de Haute-Vienne, centre hospitalier universitaire, 87042 Limoges, France
| | - Claire Filloux
- Service de pharmacologie, toxicologie et pharmacovigilance, centre hospitalier universitaire, 87042 Limoges, France
| | - Aurore Danigo
- UR 20218-NeurIT, facultés de médecine et pharmacie, université de Limoges, 87025 Limoges, France
| | - Catherine Fagnère
- Service de chimie thérapeutique, faculté de pharmacie, université de Limoges, 87025 Limoges, France
| | - Jérémy Jost
- Service de chimie thérapeutique, faculté de pharmacie, université de Limoges, 87025 Limoges, France; Service pharmacie, centre hospitalier universitaire, 87042 Limoges, France
| | - Marie-Pierre Teissier
- Service d'endocrinologie, diabète et maladies métaboliques, centre hospitalier universitaire, 87042 Limoges, France
| | - Claire Demiot
- UR 20218-NeurIT, facultés de médecine et pharmacie, université de Limoges, 87025 Limoges, France; Service pharmacie, centre hospitalier universitaire, 87042 Limoges, France.
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Vatier C, Bourcigaux N. [Evolution of the non-insulin therapeutic strategy in type 2 diabetes]. Rev Med Interne 2023; 44:561-566. [PMID: 37059602 DOI: 10.1016/j.revmed.2023.03.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
While the prevalence of diabetes continues to rise worldwide, with 537 million adults aged 20-79-years-old having diabetes in 2021, the development of new therapeutic classes improving not only glycemic control but also kidney function and cardiovascular prevention has revolutionized patient care. Today, the treatment of diabetes is no longer just the treatment of blood sugar level. In this context, the individualized therapeutic strategy has been completely reviewed, with in particular sulfamides indicated much later in the therapeutic strategy, while SGLT2 inhibitors are indicated very early in patients with kidney disease and/or with ischemic heart disease or chronic heart failure, and GLP-1 analogues in obese patients and/or in primary or secondary cardiovascular prevention. As for lifestyle rules and metformin, they remain the cornerstone of treatment. Knowledge of antidiabetic effects in terms of efficacy and hypoglycemic risk, of cardiovascular, nephroprotective and weight effects is essential to optimize the management of diabetic patients today.
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Affiliation(s)
- C Vatier
- Service d'endocrinologie, diabétologie et endocrinologie de la reproduction, centre national de référence des pathologies rares de l'insulinosécrétion et de l'insulinosensibilité (PRISIS), hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm UMR_S 938, centre de recherche Saint-Antoine, Institut hospitalo-universitaire de cardiométabolisme et nutrition (ICAN), Sorbonne université, Paris, France.
| | - N Bourcigaux
- Service d'endocrinologie, diabétologie et endocrinologie de la reproduction, centre national de référence des pathologies rares de l'insulinosécrétion et de l'insulinosensibilité (PRISIS), hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, Paris, France
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Abstract
OBJECTIVE We sought to evaluate ginger's cardiovascular and metabolic effects (Zingiberofficinale) add-on therapy in type 2 diabetes patients over six weeks. METHODS We performed a single-arm clinical trial. In well-to-moderately controlled Type 2 diabetic patients with unchanged treatment for at least three months, the intervention consisted of 6-week add-on oral supplementation of powdered ginger extracts in capsules at a dose of 399 mg three times per day. Transthoracic Doppler echocardiography, ambulatory blood pressure monitoring (ABPM), glycatedhaemoglobin (HbA1c), lipid profile, kidney and liver function analysis were performed at initial and final visits, with a follow-up visit on day 21. Adherence to treatment, palatability and safety were also assessed. RESULTS Overall, 21 participants (16 females) were included in the analysis. We found a non-significant decrease of E' wave from 0.05[0.04-0.09] to 0.06[0.05-0.7]cm/s, A-wave from 0.8[0.6-0.8] to 0.7[0.6-0.8] cm/s, and E-wave from 0.6[0.5-0.7] to 0.5[0.425-0.6]cm/s. There was a significant reduction of HbA1c from 49.7[47.0-57.4] to 44.3[38.8-53.0] mmol/mol and triglycerides from 1.6[1.4-1.9] to 1.2[0.9-1.8] mmol/l. A 5% decrease or more was observed for diurnal DBP, diurnal MAP and 24-hour DBP. CONCLUSION Zingiberofficinale used as add-on therapy tend to improve diastolic function, blood pressure and lipid profile of type 2 diabetes patients. Further studies are needed to define the dosage and duration of this supplementary treatment accurately. TRIAL REGISTRATION NUMBER NCT04222738.
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Affiliation(s)
- Chris Nadège Nganou-Gnindjio
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; Cardiology Department, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Denetria Ngati Nyonga
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Guy Sadeu Wafeu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Emmanuel Nnanga Nga
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; Galenical Pharmacy and pharmaceutical legislation department, Faculty of Medicine and Biological Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Eugène Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
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Jaffiol C, Thomas F, Spira A, Pannier B, Danchin N. Prediabetes and deprivation: A couple at high risk of diabetes. Rev Epidemiol Sante Publique 2021; 69:361-365. [PMID: 34053795 DOI: 10.1016/j.respe.2021.04.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/04/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022] Open
Abstract
AIM The higher prevalence of diabetes in deprived populations is well documented but little is known about the risk of diabetes associated with deprivation among pre-diabetic subjects. The aim of the study was to evaluate the risk of diabetes in a population of deprived pre-diabetic patients. METHODS 2743 pre-diabetic subjects identified using the American Diabetes Association (ADA) criteria, 16 to 85 years old, 1656 non-deprived and 1087 deprived, had at least two health check-ups at an interval of 4.95 (2.04) vs 3.20 (1.71) years, P<0.0001, respectively. At the first visit, socioeconomic status was assessed using the EPICES score to differentiate deprived and non-deprived subjects. RESULTS At the second visit, the prevalence of overt diabetes was 9.5% among deprived vs 5.1% in the non-deprived group (P<0.001). After adjustment on confounding factors, deprivation was found independently associated with occurrence of diabetes [1.70 (1.15-2.51), P=0.01]. Beyond social deprivation, Fasting Plasma Glucose and waist circumference were the main independent predictors of new-onset diabetes. CONCLUSION After 4 years of follow-up, among subjects with prediabetes, prevalence of diabetes was twice as high among deprived compared with non-deprived subjects. Deprived populations with pre-diabetes may require specific public health approaches to avoid the occurrence of overt diabetes.
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Affiliation(s)
- C Jaffiol
- National Academy of Medicine, Paris, France
| | - F Thomas
- Research department, The Investigations Préventives et Cliniques (IPC) Center, 6, rue La Perouse, 75116 Paris, France.
| | - A Spira
- National Academy of Medicine, Paris, France
| | - B Pannier
- Research department, The Investigations Préventives et Cliniques (IPC) Center, 6, rue La Perouse, 75116 Paris, France
| | - N Danchin
- Research department, The Investigations Préventives et Cliniques (IPC) Center, 6, rue La Perouse, 75116 Paris, France; University, Paris Descartes, Faculty of Medicine, Paris, France
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Koskinas K, Melmer A, Steiner N, Gübeli A, Wilhelm M, Laimer M. [Diagnosis, Prevention and Treatment of Cardiovascular Disease in People with Diabetes and Prediabetes]. Praxis (Bern 1994) 2021; 110:37-47. [PMID: 33406932 DOI: 10.1024/1661-8157/a003589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Diagnosis, Prevention and Treatment of Cardiovascular Disease in People with Diabetes and Prediabetes Abstract. Diabetes is associated with an increased cardiovascular risk. In addition to optimizing glycemia, timely diagnosis and stringent control of cardiovascular risk factors is essential for individuals with diabetes. Therapeutic options include lifestyle-optimization, individualized drug therapy and targeted treatment of concomitant or secondary cardiovascular disease. Cardiovascular disease occurs more often in individuals with diabetes and includes heart failure, atrial fibrillation, coronary heart disease and sudden cardiac death. The correct choice of antidiabetic drugs and interventions can control cardiovascular risk factors, reduce cardiovascular risk and treat concomitant or secondary diseases in a targeted manner. This review is intended to provide guidance on diagnosis, treatment and choice of therapy for individuals with type 2 diabetes without and with concomitant or secondary cardiovascular disease.
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Affiliation(s)
- Konstantinos Koskinas
- Zentrum für Präventive Kardiologie, Universitätsklinik für Kardiologie, Interdisziplinäres Zentrum für Sport- & Bewegungsmedizin, Inselspital, Universitätsspital und Universität Bern
| | - Andreas Melmer
- Universitätsklinik für Diabetologie, Endokrinologie, klinische Ernährung und Metabolismus (UDEM), Inselspital, Universitätsspital und Universität Bern
| | - Nicole Steiner
- Universitätsklinik für Diabetologie, Endokrinologie, klinische Ernährung und Metabolismus (UDEM), Inselspital, Universitätsspital und Universität Bern
| | - Andreas Gübeli
- Universitätsklinik für Diabetologie, Endokrinologie, klinische Ernährung und Metabolismus (UDEM), Inselspital, Universitätsspital und Universität Bern
| | - Matthias Wilhelm
- Zentrum für Präventive Kardiologie, Universitätsklinik für Kardiologie, Interdisziplinäres Zentrum für Sport- & Bewegungsmedizin, Inselspital, Universitätsspital und Universität Bern
| | - Markus Laimer
- Universitätsklinik für Diabetologie, Endokrinologie, klinische Ernährung und Metabolismus (UDEM), Inselspital, Universitätsspital und Universität Bern
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Feng X, Gu Q, Gao G, Yuan L, Li Q, Zhang Y. The plasma levels of atrial natriuretic peptide and brain natriuretic peptide in type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor. Ann Endocrinol (Paris) 2020; 81:476-481. [PMID: 32822653 DOI: 10.1016/j.ando.2020.07.1113] [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] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/07/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to determine the levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) after treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitor or dipeptidyl peptidase-4 (DPP4) inhibitor in patients with type-2 diabetes inadequately controlled by insulin, and to determine whether variation in ANP levels can explain favorable cardiovascular outcome. METHODS We enrolled 56 patients, aged 18-80years, with type-2 diabetes inadequately controlled by insulin: i.e., HbA1c level 7.5-10.5% despite at least 8weeks' injectable insulin at a stable mean dose of 20-150IU daily, with or without no more than two oral antidiabetic agents. FINDINGS The 56 patients were randomized between 3 treatment groups: SGLT2 inhibitor (n=18), DPP4 inhibitor (n=19) and placebo (n=19). Patients who received SGLT2 inhibitor or DPP4 inhibitor treatment all showed significantly lower HbA1c levels, fasting blood glucose (FBG) levels and systolic blood pressure at 24weeks than controls. SGLT2 inhibitor treatment decreased ANP levels, BNP levels, systolic blood pressure and weight compared with placebo. Compared to those receiving DPP4 inhibitor, patients receiving SGLT2 inhibitor showed lower HbA1c levels (7.01 vs. 7.58%; P=0.03), ANP levels (28.41 vs. 43.03 pg/mL; P=0.00) and weight (66.14 vs. 71.76 kg; P=0.04) at 24weeks after adjusting for baseline values. The SGLT2 inhibitor group showed higher sodium concentrations than the placebo and DPP4 inhibitor groups (145.89 vs. 143.89 and 144.79 mmol/L, respectively; P=0.00 and P=0.04) at 24 weeks. ANP and BNP levels did not significantly correlate with HbA1c and blood glucose levels. IMPLICATIONS These results indicated that SGLT2 inhibitors may be superior to DPP4 inhibitors in reducing risk of cardiovascular disease in diabetic patients. The major study limitation was the small number of patients per group, which should be enlarged in further research.
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Affiliation(s)
- Xiu Feng
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68, Changle Road, Qinhuai District, Nanjing, Jiangsu Province, China.
| | - Qingwei Gu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68, Changle Road, Qinhuai District, Nanjing, Jiangsu Province, China.
| | - Gu Gao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68, Changle Road, Qinhuai District, Nanjing, Jiangsu Province, China.
| | - Lu Yuan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68, Changle Road, Qinhuai District, Nanjing, Jiangsu Province, China.
| | - Qian Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68, Changle Road, Qinhuai District, Nanjing, Jiangsu Province, China.
| | - Ying Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68, Changle Road, Qinhuai District, Nanjing, Jiangsu Province, China.
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Chemouny JM, Sannier A, Hanouna G, Raimbourg Q, Daugas É, Vigneau C, Vrtovnsik F. [Criteria to indicate kidney biopsy in type 2 diabetic patients with proteinuria: Survey among French nephrologists]. Nephrol Ther 2019; 15:524-531. [PMID: 31718993 DOI: 10.1016/j.nephro.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/11/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022]
Abstract
Diabetic nephropathy is usually a presumptive diagnosis based on clinical and biological evidence. Renal biopsies are performed in diabetic patients with atypical findings evoking non-diabetic renal disease who could benefit from specific therapies. French speaking nephrologists were asked which criteria they retain to indicate renal biopsy in patients with type 2 diabetes and albuminuria>0.5g/day or equivalent through an online anonymous questionnaire. Among the suggested criteria were absence of diabetic retinopathy, hematuria, rapid decrease in GFR, short diabetes duration or rapid raise of proteinuria. 188 people answered the poll among whom interns (12%), fellows (13%), university hospital practitioners (26%), general hospital practitioners (24%), practitioners in a non-profit organization (13%), practitioners on private activity (10%), multi-modal practitioners (3%) and people without clinical activity (2%). Increasing proteinuria was retained as an indication criterion for renal biopsy by 51% of respondents, nephrotic syndrome by 56% of respondents, absence of diabetic retinopathy by 57% of respondents, short diabetes duration by 65% of respondents, rapid GFR decline by 75% of respondents and hematuria by 78% of respondents. These data highlight the high diversity of opinions on this topic and their discrepancies with guidelines and current literature regarding the association between non-diabetic renal disease and clinical and biological features. The lack of adhesion of nephrologists to guidelines was especially noteworthy regarding the absence of diabetic retinopathy. These results emphasize the need for studies focusing on biopsy indication criteria in patients with type 2 diabetes.
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Affiliation(s)
- Jonathan Maurice Chemouny
- Service de néphrologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; Faculté de médecine, université Rennes 1, 2, avenue du professeur Léon-Bernard, CS 34317, 35043 Rennes cedex, France; Institut Micalis, Inra, AgroParisTech, university Paris-Saclay, domaine de Vilvert, 78352 Jouy-en-Josas cedex, France.
| | - Aurélie Sannier
- Laboratoire d'anatomopathologie et de cytologie, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris-Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard, 75018 Paris, France
| | - Guillaume Hanouna
- Université Paris-Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard, 75018 Paris, France; Service de néphrologie, hôpital Bichat-Claude-Bernard, DHU Fire, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - Quentin Raimbourg
- Service de néphrologie, hôpital Bichat-Claude-Bernard, DHU Fire, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - Éric Daugas
- Université Paris-Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard, 75018 Paris, France; Service de néphrologie, hôpital Bichat-Claude-Bernard, DHU Fire, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Inserm 1149, Center for research on inflammation (CRI), 16, rue Henri-Huchard, 75018 Paris, France
| | - Cécile Vigneau
- Service de néphrologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; Faculté de médecine, université Rennes 1, 2, avenue du professeur Léon-Bernard, CS 34317, 35043 Rennes cedex, France; IRSET-UMR 1085, 9, avenue du professeur Léon-Bernard, 35000 Rennes, France
| | - François Vrtovnsik
- Université Paris-Diderot, Sorbonne Paris Cité, 16, rue Henri-Huchard, 75018 Paris, France; Service de néphrologie, hôpital Bichat-Claude-Bernard, DHU Fire, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Inserm 1149, Center for research on inflammation (CRI), 16, rue Henri-Huchard, 75018 Paris, France
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Achouri MY, Mammeri M, Sehanine Y, Selka MA, Ghomari WI, Lahmer A, Hadj Habib M. [Factors associated with medication non-adherence in patients with type 2 diabetes mellitus: The first Algerian survey]. Ann Pharm Fr 2019; 77:506-515. [PMID: 31564421 DOI: 10.1016/j.pharma.2019.08.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/21/2019] [Accepted: 08/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Non-adherence in patients with type 2 diabetes is a frequent phenomenon with important impact in terms of management of this disease. The aim of this study was to assess the level of medication adherence and to identify the factors associated with non-adherence in type 2 diabetic patients. METHODS A cross-sectional study was conducted in type 2 diabetic patients at the endocrinology and diabetology department of University Medical Center of Sidi Bel Abbes (Algeria) in 2017. Medication adherence was determined using a morisky 8-Item medication adherence questionnaire. A logistic regression was used to identify factors associated with non-adherence. RESULTS The study enrolled 403 type 2 diabetic patients. The mean age was 60 years and sex-ratio was 0.8. Medication non-adherence rate was 31.3% (95% CI: 26.8-35.8%). The factors significantly associated with non-adherence in multivariate analysis were: health insurance status, self-monitoring of blood glucose, disease duration, education level and need for information on diabetes. CONCLUSION Our study had demonstrated a low adherence in patients with type 2 diabetes. The results suggest that implementation of a therapeutic education program could be important in management of diabetes.
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Affiliation(s)
- M Y Achouri
- Département de pharmacie, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, boulevard Colonel Othmane, 22000 Sidi Bel Abbès, Algérie.
| | - M Mammeri
- Département de pharmacie, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, boulevard Colonel Othmane, 22000 Sidi Bel Abbès, Algérie
| | - Y Sehanine
- Département de pharmacie, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, boulevard Colonel Othmane, 22000 Sidi Bel Abbès, Algérie
| | - M A Selka
- Département de pharmacie, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, boulevard Colonel Othmane, 22000 Sidi Bel Abbès, Algérie
| | - W I Ghomari
- Département de médecine, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, 22000, Algérie
| | - A Lahmer
- Département de médecine, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, 22000, Algérie
| | - M Hadj Habib
- Département de médecine, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, 22000, Algérie
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Benharrats SS, Bencharif MA. [Comorbidity schizophrenia and diabetes mellitus in Algeria - A study of risk factors]. Rev Epidemiol Sante Publique 2019; 67:189-197. [PMID: 31005354 DOI: 10.1016/j.respe.2019.02.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The combination of schizophrenia and diabetes mellitus presents a public health problem in the world. Several studies have been carried out for the analysis of this comorbidity, including prognostic factors. OBJECTIVE The objective of our study is to determine the risk factors associated with the comorbidity schizophrenia and diabetes mellitus. METHODS From a sample of 200 cases of schizophrenic patients hospitalized at the Sidi Chami psychiatric hospital of Oran in Algeria, we carried out a descriptive transversal and analytical study during the period of one year. RESULTS Our results are consistent with those of the different studies carried out in neighboring countries. Among the risk factors recorded in our study, we mention the age of 40 and over, divorce, dyslipidemia, high blood pressure, overweight and severe and moderate obesity, the age of schizophrenia of 30 to 40 years, the first-generation neuroleptic treatment and family history related to diabetes. While the male sex, celibacy and second-generation neuroleptics were found in the study as protective factors against the onset of diabetes mellitus in schizophrenic patients. CONCLUSION The factors associated with comorbidity schizophrenia and type 2 diabetes are manifold. These factors must be taken into account when introducing preventive behaviors that must be multidisciplinary in order to ensure better patient care.
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Affiliation(s)
- S S Benharrats
- Faculté de médecine d'Oran, établissement hospitalier spécialisé en psychiatrie de Sidi-Chami, Oran, Algérie.
| | - M A Bencharif
- Faculté de médecine de Blida, établissement hospitalier spécialisé en psychiatrie Frantz-Fanon, Blida, Algérie
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Mondal P, Prasad A, Girdhar K. Interventions to improve β-cell mass and function. Ann Endocrinol (Paris) 2017; 78:469-477. [PMID: 28870707 DOI: 10.1016/j.ando.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/18/2016] [Accepted: 11/09/2016] [Indexed: 01/09/2023]
Abstract
Diabetes mellitus (T2DM) has become an epidemiologically important disease worldwide and is also becoming a great matter of concern due to the effects associated with it like: high morbidity, elevated health care cost and shortened life span. T2DM is a chronic metabolic disease characterized by insulin resistance as well as β-cell dysfunction. It is widely accepted that in the face of insulin resistance, euglycemia can be maintained by increase in pancreatic β-cell mass and insulin secretion. This compensation is largely due to enhanced secretion of insulin by the β-cell mass, which is present initially, and thereby subsequent increases in β-cell mass provide additional insulin secretion. However, the mechanism by which β-cell anatomical plasticity and functional plasticity for insulin secretion is coordinated and executed in different physiological and pathophysiological states is complex and has been poorly understood. As the incidence of T2DM continues to increase at an alarming rate, it is becoming imperative to shift the research focus towards the β-cell physiology where identification of novel pathways that influence the β-cell proliferation and/or contribute to increase insulin secretion has the potential to lead to new therapies for preventing or delaying onset of disease.
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Affiliation(s)
- Prosenjit Mondal
- School of Basic Sciences, BioX, Indian Institute of Technology, Mandi, HP 175005, India.
| | - Amit Prasad
- School of Basic Sciences, BioX, Indian Institute of Technology, Mandi, HP 175005, India
| | - Khyati Girdhar
- School of Basic Sciences, BioX, Indian Institute of Technology, Mandi, HP 175005, India
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Nibouche-Hattab WN, Lanasri N, Zeraoulia F, Chibane A, Biad A. Orthostatic hypertension in normotensive type 2 diabetics: What characteristics? Ann Cardiol Angeiol (Paris) 2017; 66:159-164. [PMID: 28554697 DOI: 10.1016/j.ancard.2017.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/20/2017] [Accepted: 04/27/2017] [Indexed: 06/07/2023]
Abstract
AIM OF THE STUDY We aimed to determine the prevalence of orthostatic hypertension (OHT) in normotensive, newly diagnosed type 2 diabetics, to assess clinical, biological characteristics of those patients and evaluate the evolution of their blood pressure, after one year of follow-up. MATERIALS AND METHODS It is an observational, prospective, cohort study, on 108 normotensive, newly diagnosed diabetics, 40 men and 68 women aged from 40 to 70 ans. OHT was defined as an increase of systolic blood pressure (SBP) ≥20mmHg and/or diastolic blood pressure (DBP) ≥10mmHg, after 1 and 2min of standing from supine position. Arterial hypertension and metabolic syndrome were respectively defined according to WHO and AHA 2009 guidelines. Clinical and biological data were collected for all patients. They had a screening for diabetic complications and a follow-up during one year. Statistical analysis was performed with Epi-Info 6.04. RESULTS We found OHT in 22 patients (20.4%). Patients with OHT had a higher SBP at lying position (P=0.029), a higher waist circumference (P=0.022) and LDL (P=0.041). They had more frequently obesity (P=0.036) left ventricular hypertrophy (P=0.024), metabolic syndrome (P=0.042) and cerebrovascular events (P=0.050) when compared with those with normal blood pressure response to orthostasis. One year after follow-up, the prevalence of permanent hypertension was significantly higher in the OHT group (P=0.0008). CONCLUSION Our study suggests that OHT is associated with insulin resistance syndrome and onset of sustained arterial hypertension in normotensive, newly diagnosed diabetics.
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Affiliation(s)
- W N Nibouche-Hattab
- Department of internal medecine, Ain-Taya's hospital, University of Algiers, Algiers, Algeria.
| | - N Lanasri
- Department of internal medecine, Ain-Taya's hospital, University of Algiers, Algiers, Algeria
| | - F Zeraoulia
- Department of internal medecine, Ain-Taya's hospital, University of Algiers, Algiers, Algeria
| | - A Chibane
- Department of internal medecine, Ain-Taya's hospital, University of Algiers, Algiers, Algeria
| | - A Biad
- Department of internal medecine, Ain-Taya's hospital, University of Algiers, Algiers, Algeria
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Torabi R, Ghourchian H, Amanlou M, Pasalar P. Aptamer-Conjugated Calcium Phosphate Nanoparticles for Reducing Diabetes Risk via Retinol Binding Protein 4 Inhibition. Can J Diabetes 2017; 41:305-311. [PMID: 28279618 DOI: 10.1016/j.jcjd.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/11/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Inhibition of the binding of retinol to its carrier, retinol binding protein 4, is a new strategy for treating type 2 diabetes; for this purpose, we have provided an aptamer-functionalized multishell calcium phosphate nanoparticle. METHODS First, calcium phosphate nanoparticles were synthesized and conjugated to the aptamer. The cytotoxicity of nanoparticles releases the process of aptamer from nanoparticles and their inhibition function of binding retinol to retinol binding protein 4. RESULTS After synthesizing and characterizing the multishell calcium phosphate nanoparticles and observing the noncytotoxicity of conjugate, the optimum time (48 hours) and the pH (7.4) for releasing the aptamer from the nanoparticles was determined. The half-maximum inhibitory concentration (IC50) value for inhibition of retinol binding to retinol binding protein 4 was 210 femtomolar (fmol). CONCLUSIONS The results revealed that the aptamer could prevent connection between retinol and retinol binding protein 4 at a very low IC50 value (210 fmol) compared to other reported inhibitors. It seems that this aptamer could be used as an efficient candidate not only for decreasing the insulin resistance in type 2 diabetes, but also for inhibiting the other retinol binding protein 4-related diseases.
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Affiliation(s)
- Raheleh Torabi
- Laboratory of Microanalysis, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Hedayatollah Ghourchian
- Laboratory of Microanalysis, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; Nanobiomedicine Center of Excellence, Nanoscience and Nanotechnology Research Center, University of Tehran, Tehran, Iran.
| | - Massoud Amanlou
- Department of Medicinal Chemistry, Faculty of Pharmacy and Medicinal Plants Research Center, Tehran University of Medical Sciences, Tehran, Iran; Nanobiomedicine Center of Excellence, Nanoscience and Nanotechnology Research Center, University of Tehran, Tehran, Iran
| | - Parvin Pasalar
- Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Bernard L, Reix N, Benabu JC, Gabriele V, Mathelin C. [Breast cancer and diabetes mellitus: Complex interactions]. ACTA ACUST UNITED AC 2016; 44:701-711. [PMID: 27836525 DOI: 10.1016/j.gyobfe.2016.09.004] [Citation(s) in RCA: 4] [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: 06/29/2016] [Accepted: 09/09/2016] [Indexed: 02/03/2023]
Abstract
The aim of this literature review was to quantify the incidence and mortality of breast cancer for women treated for a diabetes mellitus and to analyze the complex relationship between these two common diseases. METHODS The articles analyzed were extracted from the PubMed database from 2000 to 2015. A total of 22 case/control studies or cohorts were retained, allowing the realization of a meta-analysis. RESULTS The incidence of breast cancer for women with diabetes is significantly increased for cohorts (RR=1.32; 95% CI: 1.06 to 1.65) and not significantly for case/control studies (RR=1.46; 95% CI: 0.99 to 2.26). Overall, mortality of women with breast cancer is significantly increased for diabetic patients compared with non-diabetic patients (RR=1.53; 95% CI: 1.23 to 1.90). The links between diabetes and breast cancer are explained by common risk factors (overweight/obesity, qualitative and quantitative dietary errors, physical inactivity), biological changes and the impact of some anti-diabetic treatments or hormonotherapy. CONCLUSION Physicians facing a diabetic patient treated for breast cancer have a role in choosing the best anti-diabetic treatment and implementing lifestyle modifications. Diabetic women without breast cancer should participate in organized breast screening programs and have an annual breast clinical examination.
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Affiliation(s)
- L Bernard
- Unité de sénologie, hôpital Haute-pierre, hôpitaux universitaires de Strasbourg, CHRU, 1, avenue Molière, 67200 Strasbourg, France.
| | - N Reix
- Laboratoire de biochimie et biologie moléculaire, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; ICube UMR 7357, université de Strasbourg/CNRS, fédération de médecine translationnelle de Strasbourg (FMTS), 67412 Illirch-graffenstaden, France
| | - J-C Benabu
- Unité de sénologie, hôpital Haute-pierre, hôpitaux universitaires de Strasbourg, CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - V Gabriele
- Unité de sénologie, hôpital Haute-pierre, hôpitaux universitaires de Strasbourg, CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - C Mathelin
- Unité de sénologie, hôpital Haute-pierre, hôpitaux universitaires de Strasbourg, CHRU, 1, avenue Molière, 67200 Strasbourg, France; IGBMC, institut de génétique et de biologie moléculaire et cellulaire, biologie du cancer, CNRS UMR 7104, Inserm U964, université de Strasbourg, 67400 Illkirch-graffenstaden, France
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Balkau B, Halimi S, Blickle JF, Vergès B, Avignon A, Attali C, Chartier I, Amelineau E. Reasons for non-intensification of treatment in people with type 2 diabetes receiving oral monotherapy: Outcomes from the prospective DIAttitude study. Ann Endocrinol (Paris) 2016; 77:649-657. [PMID: 27646493 DOI: 10.1016/j.ando.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/17/2016] [Accepted: 03/23/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To describe the management of glucose-lowering agents in people with type 2 diabetes initially on oral monotherapy, cared for by French general practitioners, and to identify reasons underlying treatment non-intensification. METHODS People with type 2 diabetes on oral monotherapy were recruited by general practitioners and followed-up over 12 months. Patient characteristics, HbA1c, and glucose-lowering treatments were recorded electronically. Management objectives and reasons for treatment non-intensification were solicited from the general practitioners. RESULTS A total of 1212 patients were enrolled by 198 general practitioners; 937 patients (mean age 68 years) were treated with oral monotherapy, and 916 patients had at least two successive HbA1c values recorded. Of these, 390 patients (43%) had HbA1c≥6.5% on both occasions, and 164/390 (42%) had their treatment intensified. The 226 patients whose treatment was not intensified were older (69±11 years vs. 66±12 years, P=0.02) and had better glycaemic control at study inclusion (6.9%±0.6 vs. 7.3%±0.8, P<0.0001) than treatment intensified patients. Among uncontrolled patients, there were no differences in general practitioner treatment objectives at inclusion for treatment intensified and non-intensified patients; the main reason given by general practitioners for non-intensification was that the patient had an adequate HbA1c (66%). HbA1c did exceed the 6.5% target, but was less than 7.0% in 69% of cases. CONCLUSIONS General practitioners showed a patient-centred approach to treatment, but clinical inertia was apparent for 31% of the uncontrolled patients.
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Affiliation(s)
- Beverley Balkau
- Inserm U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ-UPS, 94807 Villejuif, France.
| | - Serge Halimi
- Université Grenoble Alpes (UJF), 38043 Grenoble, France
| | | | | | | | - Claude Attali
- Université Paris Est, Faculté de Médecine, 94010 Créteil, France
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Nibouche WN, Biad A. [Arterial hypertension at the time of diagnosis of type 2 diabetes in adults]. Ann Cardiol Angeiol (Paris) 2016; 65:152-8. [PMID: 27234335 DOI: 10.1016/j.ancard.2016.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
Abstract
AIM OF STUDY Our aim was to determine the prevalence of arterial hypertension and evaluate its association with vascular chronic complications in newly diagnosed type 2 diabetes patients, in an observational, prospective study. MATERIAL AND METHODS We have recruited 327 newly diagnosed type 2 diabetics aged from 40 to 70 years, in general practice units. Arterial blood pressure has been measured according to WHO guidelines. All data on clinical examination, diabetes's chronic complications were collected during 6 months and statistically analyzed with Epi-Info 6.04 database program. RESULTS Among the patients, 66.7% had arterial hypertension at diagnosis of diabetes, 28% were known as hypertensive. They were 54.3±8.4years old and have metabolic syndrome in 88.4%. Men have more frequently a higher cardiovascular risk, higher glycaemia and albuminuria; women were more likely to have a metabolic syndrome and a higher BMI. Blood pressure increases with cardiovascular risk and metabolic syndrome components. Microangiopathy is present in 65.7%, atherosclerosis in 59.4 and 71.2% of hypertensive patients who have atherosclerosis have also microvascular complications. CONCLUSION The prevalence of arterial hypertension in newly diagnosed type 2 diabetes is high. This association is linked with an alarming level of vascular morbidity. Early detection and treatment of these two diseases need a better implication and motivation of patients and health care providers. Clinicaltrials.gov ID: NCT02002091.
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Affiliation(s)
- W N Nibouche
- Service de médecine interne, hôpital universitaire d'Ain-Taya, 16019 Alger Est, Algérie.
| | - A Biad
- Service de médecine interne, hôpital universitaire d'Ain-Taya, 16019 Alger Est, Algérie.
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Tan X, Hu J. Empagliflozin/Linagliptin: Combination therapy in patients with type 2 diabetes. Ann Endocrinol (Paris) 2016; 77:557-562. [PMID: 27062036 DOI: 10.1016/j.ando.2015.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/13/2015] [Accepted: 11/23/2015] [Indexed: 01/20/2023]
Abstract
Glyxambi® (empagliflozin/linagliptin) is a fixed-dose, once-daily tablet combining a sodium glucose co-transporter-2 (SGLT2) inhibitor with a dipeptidyl peptidase-4 (DPP-4) inhibitor. Glyxambi® is served as an adjuvant to diet and exercise to improve glycemic control in adults with type 2 diabetes when both empagliflozin and linagliptin are appropriate treatments. Glyxambi® combines 10mg or 25mg empagliflozin with 5mg linagliptin, with different, complementary mechanisms of action to improve glycemic control in patients with type 2 diabetes. Empagliflozin removes glucose through the urine by blocking blood glucose re-absorption in the kidney, and linagliptin exerts glucose-lowering activity by increasing hormones that stimulate the pancreas to produce more insulin and decreasing the levels of glucagon in the circulation. In addition, this combination therapy modestly reduces body weight and blood pressure without significant safety issues.
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Affiliation(s)
- Xueying Tan
- Department of endocrinology, Ningbo University Affiliated Yuyao Yangming Hospital, 315400 Yuyao, China.
| | - Jingbo Hu
- College of Pharmaceutical Science, Zhejiang University, 866 Yuhangtang Road, 310058 Hangzhou, China.
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Kotbi S, Mjabber A, Chadli A, El Hammiri A, El Aziz S, Oukkache B, Mifdal H, Nourichafi N, Kamal N, Habbal R, Ghalim N, Farouqi A, Kabine M. Correlation between the plasma fibrinogen concentration and coronary heart disease severity in Moroccan patients with type 2 diabetes. Prospective study. Ann Endocrinol (Paris) 2016; 77:606-614. [PMID: 26903037 DOI: 10.1016/j.ando.2015.02.004] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/10/2015] [Accepted: 02/04/2015] [Indexed: 11/17/2022]
Abstract
AIM The present study aims at determining the relationship between the plasma fibrinogen concentration and the severity of coronary heart disease in type 2 diabetic patients. METHODS Prospective analytical survey, based on a sample of 120 subjects divided in four groups: 30 non diabetic coronary patients (G1), 30 coronary diabetic patients (G2), 30 non-coronary diabetic patients (G3), and 30 healthy subjects (G4). RESULTS The average age was 59.58±7.88 years; female gender predominated by 52.5%. The plasma fibrinogen concentration corresponded to 3.46g/L±0.86 in G1; 3.73g/L±1.11 in G2; 3.06g/L±0.98 in G3 and 2.46g/L±0.51 in G4; with a significant difference between the four groups (P=0.001). The plasma fibrinogen concentration increased in parallel with the cardiovascular risk (P=0.0001); there was also a significant correlation between the plasma fibrinogen concentration and the clinical and para-clinical coronary disease severity (respectively P=0.005 and P=0.0001). A positive correlation between the plasma fibrinogen concentration and hyperglycemia (P=0.035) was found in G4. But no correlation with the lipids parameters, except for the low density-lipoproteins in G3 (P=0.035). CONCLUSION In the Moroccan population, the plasma fibrinogen concentration was positively and significantly correlated with the coronary heart disease severity.
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Affiliation(s)
- Souad Kotbi
- Department of Biology, Laboratory of Biochemistry and Molecular Biology, Ain chock Faculty of Science, Km 9, El Jadida road, Box 5366 Maarif, Casablanca, Morocco
| | - Amal Mjabber
- Endocrinology and Metabolic Diseases department, Ibn Rochd, University Hospital Center 1, Hospitals part, Casablanca, Morocco
| | - Asma Chadli
- Endocrinology and Metabolic Diseases department, Ibn Rochd, University Hospital Center 1, Hospitals part, Casablanca, Morocco.
| | - Ayoub El Hammiri
- Cardiology department, Ibn Rochd university, Hospital Center, 1, Hospitals part, Casablanca, Morocco
| | - Siham El Aziz
- Endocrinology and Metabolic Diseases department, Ibn Rochd, University Hospital Center 1, Hospitals part, Casablanca, Morocco
| | - Bouchra Oukkache
- Regional blood transfusion centre, 1, Mohamed El Fidouzi-ex Jenner street, Casablanca, Morocco
| | - Hassan Mifdal
- Hematology laboratory, Ibn Rochd university, Hospital Center, Hospitals part, Casablanca, Morocco
| | - Nadia Nourichafi
- Hematology laboratory, Ibn Rochd university, Hospital Center, Hospitals part, Casablanca, Morocco
| | - Nabiha Kamal
- Laboratory of biochemistry, Ibn Rochd university, Hospital Center, 1, Hospitals part, Casablanca, Morocco
| | - Rachida Habbal
- Cardiology department, Ibn Rochd university, Hospital Center, 1, Hospitals part, Casablanca, Morocco
| | - Norredine Ghalim
- Department of medical biology, Pasteur Institute of Morocco, 1, place Louis-Pasteur, 20360 Casablanca, Morocco
| | - Ahmed Farouqi
- Endocrinology and Metabolic Diseases department, Ibn Rochd, University Hospital Center 1, Hospitals part, Casablanca, Morocco
| | - Mostafa Kabine
- Department of Biology, Laboratory of Biochemistry and Molecular Biology, Ain chock Faculty of Science, Km 9, El Jadida road, Box 5366 Maarif, Casablanca, Morocco
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Cui Y, Chen W, Chi J, Wang L. Differential expression network analysis for diabetes mellitus type 2 based on expressed level of islet cells. Ann Endocrinol (Paris) 2016; 77:22-9. [PMID: 26874994 DOI: 10.1016/j.ando.2015.11.002] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Diabetes mellitus type 2 (T2DM) is a metabolic disease that has become a pressing issue, with potential adverse impact on mental health. We aimed to explore the potential molecular mechanism of T2DM. MATERIAL AND METHODS GSE38642 microarray data downloaded from gene expression omnibus was used to identify the differentially expressed genes (DEGs). Profiling of complex functionality (ProfCom) was used to analyze the complex function and mine T2DM signature genes. Finally, the differential expression network (DEN) was constructed. RESULTS We identified 147 DEGs including 59 up- and 88 down-regulated genes. With increasing of degree, the specificity of functional description of DEGs was higher. GO term of "integral to membrane and immune response (not receptor activity) not regulation of immune response" in degree 4 was enriched by 6 DEGs, while the GO term of "immune response" in degree 1 was enriched by 12 DEGs. Two complex functions of integral to membrane an immune response and response to glucose stimulus were enriched by 11 T2DM signature genes including ARG2, GLP1R, PFKFB2, PTPRN, ACSL5, CCR7, IL2RA, IL7R, IL1R2, IL1RL1 and CHST4. Finally, DEN including 11 signature genes and 491 edges was obtained. CONCLUSION The identified DEGs especially 11 signature genes such as PTPRN, GLP1R, CCR7 and IL2RA may play important roles in the pathogenesis of T2DM.
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Affiliation(s)
- Ying Cui
- Department of Endocrinology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013 Shandong Province, China
| | - Wen Chen
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013 Shandong Province, China
| | - Jinfeng Chi
- Department of Endocrinology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013 Shandong Province, China
| | - Lei Wang
- Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, No. 105, Jiefang Road, Jinan City, 250013 Shandong Province, China.
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Esteghamati A, Aflatoonian M, Rad MV, Mazaheri T, Mousavizadeh M, Nakhjavani M, Noshad S. Association of osteoprotegerin with peripheral artery disease in patients with type 2 diabetes. Arch Cardiovasc Dis 2015; 108:412-9. [PMID: 26184866 DOI: 10.1016/j.acvd.2015.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 05/27/2014] [Revised: 11/30/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Osteoprotegerin plays a critical role in the pathogenesis of atherosclerosis. Elevated osteoprotegerin concentrations have been reported in microvascular complications of diabetes. Patients with diabetes are at increased risk of macrovascular complications, particularly peripheral artery disease (PAD). AIM To investigate the association between osteoprotegerin concentration and PAD in diabetes. METHODS In a cross-sectional setting, patients with type 2 diabetes for>5 years and no apparent diabetic foot ulcer were recruited. Patients underwent colour Doppler ultrasonography of lower limbs and were designated PAD+ if arterial narrowing was detected. Ankle-brachial index (ABI) was measured. Serum osteoprotegerin concentrations were determined. RESULTS Ninety-eight patients (47 PAD+, 51 PAD-) were recruited. Osteoprotegerin concentrations (median [interquartile range]) were significantly higher in PAD+ versus PAD- patients (0.80 [0.50-1.95] ng/mL vs 0.30 [0.25-0.40] ng/mL; P<0.001). In logistic regression, log-osteoprotegerin was a predictor of PAD in univariate and multivariable analyses. In the final multivariable model, adjusting for age, sex, body mass index, smoking, hypertension, glycaemic control, lipid profile, renal function and C-reactive protein, one standard deviation increase in log-osteoprotegerin was associated with a more than twofold increase in the risk of having PAD (odds ratio 2.26, 95% confidence interval 1.50-3.40). In PAD+ patients, osteoprotegerin was a significant predictor of disease severity, determined by ABI and percentage of vessel occlusion in univariate and multivariable models. CONCLUSIONS Osteoprotegerin concentrations are increased in patients with diabetes and PAD. Osteoprotegerin is an independent predictor of the presence and severity of PAD in diabetic patients.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.
| | - Maryam Aflatoonian
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Mona Vahidi Rad
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Tina Mazaheri
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Mostafa Mousavizadeh
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Sina Noshad
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
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Callec R, Perdriolle-Galet E, Sery GA, Lamy C, Floriot M, Fresson J, Morel O. [Type 2 diabetes and pregnancy: epidemiology and obstetrical consequences. A 97 women continuous series]. J Gynecol Obstet Hum Reprod 2015; 44:41-46. [PMID: 24315525 DOI: 10.1016/j.jgyn.2013.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/26/2013] [Revised: 10/21/2013] [Accepted: 10/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To update the epidemiologic data of pregnant women with type 2 diabetes and to assess obstetrical outcomes. PATIENTS AND METHODS The pregnant women with type 2 diabetes who delivered between 2002 and 2010 were systematically involved in an observational study. Maternal and fetal outcomes were reviewed, as well as the potential impact of preconceptional management. The presented data were compared with those from the 2010 French perinatal study. RESULTS A rise in the incidence of type 2 diabetes was observed during the study period (from 0.19% to 0.35% between 2002 and 2010). Women with diabetes (n=97) were older and had a higher BMI than the general population (>35years: 49% vs 19%, P<0.00001, BMI>25: 86% vs 27.2, P<0.00001). The delivery mode was, for half of these women with diabetes, a C-section. Pregnancy was scheduled in only 4% of cases. Compared to the general population, prematurity rate was multiplied by 6 (28.7% vs 4.7%, P<0.0001) and the malformation rate by 3.2 (7.22% vs 2.2%, P<0.00001). CONCLUSION Obstetrical complications were more frequent than in the general population. Preconception care was almost inexistent, despite its potential benefits for the mother and child.
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Affiliation(s)
- R Callec
- Unité d'obstétrique et de médecine fœtale, pôle de la femme, maternité régionale universitaire de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Unité Inserm 947, IADI, 54000 Nancy, France; Université de Lorraine, 54000 Nancy, France.
| | - E Perdriolle-Galet
- Unité d'obstétrique et de médecine fœtale, pôle de la femme, maternité régionale universitaire de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Unité Inserm 947, IADI, 54000 Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - G-A Sery
- Unité d'obstétrique et de médecine fœtale, pôle de la femme, maternité régionale universitaire de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France
| | - C Lamy
- Unité d'obstétrique et de médecine fœtale, pôle de la femme, maternité régionale universitaire de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France
| | - M Floriot
- Unité d'obstétrique et de médecine fœtale, pôle de la femme, maternité régionale universitaire de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France
| | - J Fresson
- Département d'informatique médicale, maternité régionale universitaire de Nancy, 54000 Nancy, France
| | - O Morel
- Unité d'obstétrique et de médecine fœtale, pôle de la femme, maternité régionale universitaire de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Unité Inserm 947, IADI, 54000 Nancy, France; Université de Lorraine, 54000 Nancy, France
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Chen RH, Jiang XZ, Jiang Q, Gu Z, Gu PL, Zhou B, Zhu ZH, Xu LY, Zou YF. Correlations between serum levels of 25-hydroxyvitamin D and carotid atherosclerosis in patients with type 2 diabetes in Shanghai. Ann Endocrinol (Paris) 2014; 75:206-12. [PMID: 25168108 DOI: 10.1016/j.ando.2014.07.113] [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] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 03/16/2014] [Accepted: 07/04/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To explore the potential association between the serum levels of 25-hydroxyvitamin D [25(OH)D] and carotid atherosclerosis in patients with type 2 diabetes. MATERIAL AND METHODS Three hundred and fifty patients with type 2 diabetes were enrolled in this study in Shanghai, China. B-mode ultrasound was used to detect carotid plaques as indicators of atherosclerosis and measure carotid artery intima-media wall thickness (C-IMT) at two sites of carotid artery. Subjects were divided into group A (patients with carotid plaques) and group B (patients without carotid plaques) and be assessed clinically. Serum levels of 25(OH)D and other clinical parameters were measured. Multivariate logistic regression was performed to find predictors of carotid atherosclerosis in the entire group. RESULTS The levels of serum 25(OH)D were lower in group A than in group B[19.60 (13.30-25.73) vs 23.19 (18.10-30.06)ng/ml, P<0.001]. The C-IMT levels [(1.00±0.17 vs 0.88±0.20)mm, Ptrend<0.001] and proportion of people with carotid plaques(44/88 vs 20/87, Ptrend<0.001) in the lowest quartile of 25(OH)D were higher than in the highest quartile. Vitamin D concentrations were inversely associated with HbA1c in women(r=-0.194, P=0.006), and C-IMT in men(r=-0.409, P<0.001). Logistic regression analysis showed age, male sex, current smoke, history of hypertension, SBP, LDL-C and lg[25(OH)D] (OR: 0.924, 95%CI: 0.893-0.955, P<0.001) were independently associated with the presence of carotid plaques in T2DM. CONCLUSIONS Serum vitamin D level is significantly and independently associated with carotid atherosclerosis in patients with T2DM in Shanghai, China.
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Affiliation(s)
- Rui-hua Chen
- Department of endocrinology, Pudong New Area People's Hospital, 490, South Chuan Huan Road, Shanghai, China
| | - Xiao-zhen Jiang
- Department of endocrinology, Pudong New Area People's Hospital, 490, South Chuan Huan Road, Shanghai, China.
| | - Quan Jiang
- Department of ultrasonography, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Zhe Gu
- Department of endocrinology, Pudong New Area People's Hospital, 490, South Chuan Huan Road, Shanghai, China
| | - Pei-li Gu
- Department of endocrinology, Pudong New Area People's Hospital, 490, South Chuan Huan Road, Shanghai, China
| | - Bin Zhou
- Department of endocrinology, Pudong New Area People's Hospital, 490, South Chuan Huan Road, Shanghai, China
| | - Zhen-hong Zhu
- Department of endocrinology, Pudong New Area People's Hospital, 490, South Chuan Huan Road, Shanghai, China
| | - Lin-yan Xu
- Department of endocrinology, Pudong New Area People's Hospital, 490, South Chuan Huan Road, Shanghai, China
| | - Yu-feng Zou
- Department of endocrinology, Pudong New Area People's Hospital, 490, South Chuan Huan Road, Shanghai, China
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Coulibaly B, Delage-Corre M, Durand-Fontanier S, Mathonnet M, Paraf F, Labrousse F. [Two cases reports of pancreatic endocrine microadenoma incidentally found]. Ann Pathol 2013; 33:406-9. [PMID: 24331723 DOI: 10.1016/j.annpat.2013.10.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/08/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
A 59-year-old male, was admitted to our hospital for a tumor of the pancreatic tail. Serum CEA and CA 19-9 levels were normal. Splenopancreasectomy found a desmoid tumour. A 69-year-old male was referred to our institution for chronic anemia and inflammatory syndrome with splenomegaly. Splenectomy showed an important splenic congestion and siderosis. Both patients had a type 2 diabetes mellitus. Furthermore, histological examination revealed pancreatic endocrine microadenomas. The two patients' postoperative course was unremarkable. Eleven and 24 months respectively after the diagnosis, the patients are alive and well, with no tumor recurrence.
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Affiliation(s)
- Béma Coulibaly
- Service d'anatomie pathologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| | - Manuela Delage-Corre
- Service d'anatomie pathologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Sylvaine Durand-Fontanier
- Service de chirurgie digestive et endocrinienne, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Muriel Mathonnet
- Service de chirurgie digestive et endocrinienne, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - François Paraf
- Service d'anatomie pathologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - François Labrousse
- Service d'anatomie pathologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
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Paquier-Valette C, Cante V, Brassat S, Camus M, Bolac C, Guillet G. [Endogenous endophthalmitis as a complication in erysipelas]. Ann Dermatol Venereol 2013; 140:718-21. [PMID: 24206809 DOI: 10.1016/j.annder.2013.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/12/2013] [Revised: 04/21/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endogenous endophthalmitis is a devastating infection of the eye that leads to blindness in about two-thirds of patients. It results from the haematogenous spread of a microorganism from a focus of sepsis, mainly gastro-intestinal, genitourinary or cardiac. PATIENTS AND METHODS We describe the case of a diabetic subject presenting endogenous endophthalmitis following erysipelas of the leg due to Streptococcus agalactiae. The outcome was favourable thanks to prompt initiation of appropriate antibiotic treatment. DISCUSSION Endogenous endophthalmitis as a complication of a skin infection is a rare entity, with only about 30 reported cases in the literature. Awareness of this condition among dermatologists would allow prompt intervention, which is essential for sparing of the patient's eyesight.
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Affiliation(s)
- C Paquier-Valette
- Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
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Bodegard J, Sundström J, Svennblad B, Östgren CJ, Nilsson PM, Johansson G. Changes in body mass index following newly diagnosed type 2 diabetes and risk of cardiovascular mortality: a cohort study of 8486 primary-care patients. Diabetes Metab 2013; 39:306-13. [PMID: 23871502 DOI: 10.1016/j.diabet.2013.05.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/25/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
AIMS Elevated body mass index (BMI) is associated with an increased risk of type 2 diabetes and cardiovascular disease (CVD). This study explored the association between BMI changes in the first 18 months of newly diagnosed type 2 diabetes and the risk of long-term CVD mortality. METHODS A total of 8486 patients with newly diagnosed type 2 diabetes and no previous history of CVD or cancer were identified from 84 primary-care centres in Sweden. During the first year after diagnosis, patients were grouped according to BMI change: 'Increase', or ≥+1 BMI unit; 'unchanged', or between +1 and-1 BMI unit; and 'decrease', or ≤-1 BMI unit. Associations between BMI change and CVD mortality, defined as death from stroke, myocardial infarction or sudden death, were estimated using adjusted Cox proportional hazards models (NCT 01121315). RESULTS Baseline mean age was 60.0 years and mean BMI was 30.2kg/m(2). Patients were followed for up to 9 years (median: 4.6 years). During the first 18 months, 53.4% had no change in their BMI, while 32.2% decreased and 14.4% increased. Compared with patients with unchanged BMI, those with an increased BMI had higher risks of CVD mortality (hazard ratio: 1.63, 95% CI: 1.11-2.39) and all-cause mortality (1.33, 1.01-1.76). BMI decreases had no association with these risks compared with unchanged BMI: 1.06 (0.76-1.48) and 1.06 (0.85-1.33), respectively. CONCLUSION Increased BMI within the first 18 months of type 2 diabetes diagnosis was associated with an increased long-term risk of CVD mortality. However, BMI decrease did not lower the long-term risk of mortality.
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Affiliation(s)
- J Bodegard
- Department of Medicine, AstraZeneca AB, Karlebyhus, 151 85 Södertälje, Sweden.
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