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Spanakis EK, Cook CB, Kulasa K, Aloi JA, Bally L, Davis G, Dungan KM, Galindo RJ, Mendez CE, Pasquel FJ, Shah VN, Umpierrez GE, Aaron RE, Tian T, Yeung AM, Huang J, Klonoff DC. A Consensus Statement for Continuous Glucose Monitoring Metrics for Inpatient Clinical Trials. J Diabetes Sci Technol 2023; 17:1527-1552. [PMID: 37592726 PMCID: PMC10658683 DOI: 10.1177/19322968231191104] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Diabetes Technology Society organized an expert consensus panel to develop metrics for research in the use of continuous glucose monitors (CGMs) in a hospital setting. The experts met virtually in small groups both before and after an April 13, 2023 virtual meeting of the entire panel. The goal of the panel was to develop consensus definitions in anticipation of greater use of CGMs in hospital settings in the future. Establishment of consensus definitions of inpatient analytical metrics will be easier to compare outcomes between studies. Panelists defined terms related to 10 dimensions of measurements related to the use of CGMs including (1) hospital hypoglycemia, (2) hospital hyperglycemia, (3) hospital time in range, (4) hospital glycemic variability, (5) hospital glycemia risk index, (6) accuracy of CGM devices and reference methods for CGMs in the hospital, (7) meaningful time blocks for hospital glycemic goals, (8) hospital CGM data sufficiency, (9) using CGM data for insulin dosing, and (10) miscellaneous factors. The panelists voted on 51 proposed recommendations. Based on the panel vote, 51 recommendations were classified as either strong (43) or mild (8). Additional research is needed on CGM performance in the hospital. This consensus report is intended to support that type of research intended to improve outcomes for hospitalized people with diabetes.
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Affiliation(s)
- Elias K. Spanakis
- Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Curtiss B. Cook
- Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Kristen Kulasa
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Joseph A. Aloi
- Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Georgia Davis
- Emory University School of Medicine, Atlanta, GA, USA
| | - Kathleen M. Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, USA
| | | | | | | | - Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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Ebekozien O, Mungmode A, Sanchez J, Rompicherla S, Demeterco-Berggren C, Weinstock RS, Jacobsen LM, Davis G, McKee A, Akturk HK, Maahs DM, Kamboj MK. Longitudinal Trends in Glycemic Outcomes and Technology Use for Over 48,000 People with Type 1 Diabetes (2016-2022) from the T1D Exchange Quality Improvement Collaborative. Diabetes Technol Ther 2023; 25:765-773. [PMID: 37768677 DOI: 10.1089/dia.2023.0320] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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] [Indexed: 09/29/2023]
Abstract
Objective: Previous studies revealed that hemoglobin A1c (HbA1c) increased overall in the United States in the past decade. In addition, health inequities in type 1 diabetes (T1D) outcomes by race/ethnicity and insurance type persist. This study examines the trends in HbA1c from 2016 to 2022 stratified by race/ethnicity and insurance in a large multicenter national database. Research Design and Methods: We analyzed glycemic outcomes and diabetes device use trends for >48,000 people living with type 1 diabetes (PwT1D) from 3 adult and 12 pediatric centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI), comparing data from 2016 to 2017 with data from 2021 to 2022. Results: The mean HbA1c in 2021-2022 was lower at 8.4% compared with the mean HbA1c in 2016-2017 of 8.7% (0.3% improvement; P < 0.01). Over the same period, the percentage of PwT1D using a continuous glucose monitor (CGM), insulin pump, or hybrid closed-loop system increased (45%, 12%, and 33%, respectively). However, these improvements were not equitably demonstrated across racial/ethnic groups or insurance types. Racial/ethnic and insurance-based inequities persisted over all 7 years across all outcomes; comparing non-Hispanic White and non-Hispanic Black PwT1D, disparate gaps in HbA1c (1.2%-1.6%), CGM (30%), pump (25%-35%), and hybrid-closed loop system (up to 20%) are illuminated. Conclusion: Population-level data on outcomes, including HbA1c, can provide trends and insights into strategies to improve health for PwT1D. The T1DX-QI cohort showed a significant improvement in HbA1c from 2016 to 2022. Improvements in diabetes device use are also demonstrated. However, these increases were inconsistent across all racial/ethnic groups or insurance types, an important focus for future T1D population health improvement work.
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Affiliation(s)
- Osagie Ebekozien
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
- School of Population Health, University of Mississippi, Jackson, Mississippi, USA
| | - Ann Mungmode
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
| | - Janine Sanchez
- Department of Endocrinology, Miller School of Medicine, University of Miami, Maimi, Florida, USA
| | - Saketh Rompicherla
- Office of Chief Medical Officer, T1D Exchange, Boston, Massachusetts, USA
| | - Carla Demeterco-Berggren
- Department of Endocrinology, Rady Children's Hospital, San Diego, California, USA
- Department of Endocrinology, University of California, San Francisco, California, USA
| | - Ruth S Weinstock
- Department of Endocrinology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Laura M Jacobsen
- Department of Endocrinology, University of Florida, Gainsville, Florida, USA
| | | | - Alexis McKee
- Department of Endocrinology, Washington University at St Louis, St Louis, USA
| | - Halis K Akturk
- Department of Endocrinology, Barbara Davis Center, Aurora, Colorado, USA
| | - David M Maahs
- Department of Pediatric Endocrinology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, California, USA
| | - Manmohan K Kamboj
- Department of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Spanakis EK, Urrutia A, Galindo RJ, Vellanki P, Migdal AL, Davis G, Fayfman M, Idrees T, Pasquel FJ, Coronado WZ, Albury B, Moreno E, Singh LG, Marcano I, Lizama S, Gothong C, Munir K, Chesney C, Maguire R, Scott WH, Perez-Guzman MC, Cardona S, Peng L, Umpierrez GE. Continuous Glucose Monitoring-Guided Insulin Administration in Hospitalized Patients With Diabetes: A Randomized Clinical Trial. Diabetes Care 2022; 45:2369-2375. [PMID: 35984478 PMCID: PMC9643134 DOI: 10.2337/dc22-0716] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/02/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The efficacy and safety of continuous glucose monitoring (CGM) in adjusting inpatient insulin therapy have not been evaluated. RESEARCH DESIGN AND METHODS This randomized trial included 185 general medicine and surgery patients with type 1 and type 2 diabetes treated with a basal-bolus insulin regimen. All subjects underwent point-of-care (POC) capillary glucose testing before meals and bedtime. Patients in the standard of care (POC group) wore a blinded Dexcom G6 CGM with insulin dose adjusted based on POC results, while in the CGM group, insulin adjustment was based on daily CGM profile. Primary end points were differences in time in range (TIR; 70-180 mg/dL) and hypoglycemia (<70 mg/dL and <54 mg/dL). RESULTS There were no significant differences in TIR (54.51% ± 27.72 vs. 48.64% ± 24.25; P = 0.14), mean daily glucose (183.2 ± 40 vs. 186.8 ± 39 mg/dL; P = 0.36), or percent of patients with CGM values <70 mg/dL (36% vs. 39%; P = 0.68) or <54 mg/dL (14 vs. 24%; P = 0.12) between the CGM-guided and POC groups. Among patients with one or more hypoglycemic events, compared with POC, the CGM group experienced a significant reduction in hypoglycemia reoccurrence (1.80 ± 1.54 vs. 2.94 ± 2.76 events/patient; P = 0.03), lower percentage of time below range <70 mg/dL (1.89% ± 3.27 vs. 5.47% ± 8.49; P = 0.02), and lower incidence rate ratio <70 mg/dL (0.53 [95% CI 0.31-0.92]) and <54 mg/dL (0.37 [95% CI 0.17-0.83]). CONCLUSIONS The inpatient use of real-time Dexcom G6 CGM is safe and effective in guiding insulin therapy, resulting in a similar improvement in glycemic control and a significant reduction of recurrent hypoglycemic events compared with POC-guided insulin adjustment.
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Affiliation(s)
- Elias K. Spanakis
- University of Maryland Medical Center, Baltimore, MD
- Baltimore VA Medical Center, Baltimore, MD
| | | | | | | | | | | | - Maya Fayfman
- Emory University School of Medicine, Atlanta, GA
| | - Thaer Idrees
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | | | - Sergio Lizama
- University of Maryland Medical Center, Baltimore, MD
| | | | - Kashif Munir
- University of Maryland Medical Center, Baltimore, MD
| | | | | | | | | | | | - Limin Peng
- Emory University Rollins School of Public Health, Atlanta, GA
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Davis G, Bailey R, Calhoun P, Price D, Beck RW. Magnitude of Glycemic Improvement in Patients with Type 2 Diabetes Treated with Basal Insulin: Subgroup Analyses from the MOBILE Study. Diabetes Technol Ther 2022; 24:324-331. [PMID: 34962151 PMCID: PMC9127836 DOI: 10.1089/dia.2021.0489] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective: To determine if type 2 diabetes patients using basal insulin without prandial insulin with worse glycemic control at baseline would have the greatest benefit from using real-time continuous glucose monitoring (CGM). Methods: We conducted a post hoc analysis of the MOBILE Study, a multicenter trial examining the impact of CGM versus self-monitoring with a blood glucose meter (BGM) in patients with type 2 diabetes treated with basal insulin without prandial insulin. Participants were divided into subgroups based on baseline hemoglobin A1c (HbA1c) and baseline time-in-range 70-180 mg/dL (TIR). Change in TIR from baseline was calculated within each subgroup. Results: In subgroups based on baseline HbA1c, compared with the BGM group, the CGM group had 14% greater increase in TIR for participants with baseline HbA1c ≥8.5%, 14% greater increase for baseline HbA1c ≥9.0%, 22% greater increase for baseline HbA1c ≥9.5%, and 32% greater increase for baseline HbA1c ≥10.0% (P-value for interaction = 0.27). The time spent with glucose >250 mg/dL was significantly lower with CGM compared with BGM among participants with higher HbA1c values (P for interaction = 0.004). Results in subgroups based on baseline TIR paralleled the results in subgroups based on baseline HbA1c. Conclusion: While the benefit of CGM on TIR among patients with type 2 diabetes treated with basal insulin is apparent across the range of baseline glycemic control, the greatest impact of CGM is in those with the worst baseline glycemic control, particularly among those with HbA1c ≥10%. Clinical Trial Registration number: NCT03566693.
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Affiliation(s)
- Georgia Davis
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, GA
| | - Ryan Bailey
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
- Address correspondence to: Peter Calhoun, PhD, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647, USA
| | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida, USA
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Narasimhan D, Davis G, Sadhasivam M, Atiku F. Virtual pulmonary rehabilitation programme – A new era of working. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aleppo G, Beck RW, Bailey R, Ruedy KJ, Calhoun P, Peters AL, Pop-Busui R, Philis-Tsimikas A, Bao S, Umpierrez G, Davis G, Kruger D, Bhargava A, Young L, Buse JB, McGill JB, Martens T, Nguyen QT, Orozco I, Biggs W, Lucas KJ, Polonsky WH, Price D, Bergenstal RM. The Effect of Discontinuing Continuous Glucose Monitoring in Adults With Type 2 Diabetes Treated With Basal Insulin. Diabetes Care 2021; 44:2729-2737. [PMID: 34588210 PMCID: PMC8669539 DOI: 10.2337/dc21-1304] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the effect of discontinuing continuous glucose monitoring (CGM) after 8 months of CGM use in adults with type 2 diabetes treated with basal without bolus insulin. RESEARCH DESIGN AND METHODS This multicenter trial had an initial randomization to either real-time CGM or blood glucose monitoring (BGM) for 8 months followed by 6 months in which the BGM group continued to use BGM (n = 57) and the CGM group was randomly reassigned either to continue CGM (n = 53) or discontinue CGM with resumption of BGM for glucose monitoring (n = 53). RESULTS In the group that discontinued CGM, mean time in range (TIR) 70-180 mg/dL, which improved from 38% before initiating CGM to 62% after 8 months of CGM, decreased after discontinuing CGM to 50% at 14 months (mean change from 8 to 14 months -12% [95% CI -21% to -3%], P = 0.01). In the group that continued CGM use, little change was found in TIR from 8 to 14 months (baseline 44%, 8 months 56%, 14 months 57%, mean change from 8 to 14 months 1% [95% CI -11% to 12%], P = 0.89). Comparing the two groups at 14 months, the adjusted treatment group difference in mean TIR was -6% (95% CI -16% to 4%, P = 0.20). CONCLUSIONS In adults with type 2 diabetes treated with basal insulin who had been using real-time CGM for 8 months, discontinuing CGM resulted in a loss of about one-half of the initial gain in TIR that had been achieved during CGM use.
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Affiliation(s)
- Grazia Aleppo
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | | | | | | | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | | | - Shichun Bao
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | - Laura Young
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Thomas Martens
- International Diabetes Center, Park Nicollet Internal Medicine, Minneapolis, MN
| | | | - Ian Orozco
- Carteret Medical Group, Morehead City, NC
| | | | - K Jean Lucas
- Diabetes and Endocrinology Consultants, PC, Morehead City, NC
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Kennedy R, Roberts L, Davis G, Mangos G, Pettit F, Brown MA, O'Sullivan AJ, Henry A. The P4 study: Subsequent pregnancy maternal physiology after hypertensive and normotensive pregnancies. Pregnancy Hypertens 2021; 27:29-34. [PMID: 34864294 DOI: 10.1016/j.preghy.2021.10.004] [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: 06/08/2021] [Revised: 09/09/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hypertensive disorders of pregnancy are associated with subsequent increased risk of cardiometabolic disease. Adverse cardiometabolic measures are noted soon after hypertensive versus normotensive pregnancy (NP); to what degree these persist into a subsequent pregnancy (SP) is unknown. This study aimed to assess women's physiology early in SP after hypertensive pregnancy (HP: preeclampsia or gestational hypertension) or NP and compare SP to 6 months postpartum findings from the index pregnancy. STUDY DESIGN Prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatric) observational cohort. Measurements six months after NP versus HP, and the SP at 11-13 weeks gestation. MAIN OUTCOME MEASURES Blood pressure (BP), blood and urine tests (urine ACR, HOMA-IR, LDL cholesterol), body composition, and contribution of maternal characteristics and inter-pregnancy factors to BP and body fat (FM%) in SP. RESULTS 49 women (34 NP, 15 HP). In the SP, post-HP women had higher BP (112/70 mmHg HP vs 102/64 mmHg NP; p < .001), with no significant drop from six months postpartum to early SP. On regression analysis, systolic and diastolic BP at 6-months were the major predictors for SP systolic (p < 0.001) and diastolic (p = 0.009) BP respectively in the SP. Longer interpregnancy interval and increased FM% 6-months postpartum were associated with higher SP FM% (p < 0.001). CONCLUSIONS BP and body fat six months postpartum were similar early in the SP for HP group, and postpartum BP and FM% were major predictors of their corresponding SP measurements. Postpartum/inter-pregnancy intervention programs to improve these cardiometabolic risk markers might help improve women's long-term health and require investigation.
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Affiliation(s)
- R Kennedy
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia.
| | - L Roberts
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia
| | - G Davis
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia
| | - G Mangos
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - F Pettit
- Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - M A Brown
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - A J O'Sullivan
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Endocrinology, St George Hospital, Sydney, Australia
| | - A Henry
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, Sydney, Australia.
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Deppen S, Rieger-Christ K, Guo Y, Bian J, Frankenberger E, Woodard J, Dorn C, Robbins S, Gawel S, Davis G. P09.02 A Clinical Evaluation Algorithm to Define Clinical Utility of Lung Nodule Diagnosis in a Multi-Collaborator Setting Using Real World Data. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Martens T, Beck RW, Bailey R, Ruedy KJ, Calhoun P, Peters AL, Pop-Busui R, Philis-Tsimikas A, Bao S, Umpierrez G, Davis G, Kruger D, Bhargava A, Young L, McGill JB, Aleppo G, Nguyen QT, Orozco I, Biggs W, Lucas KJ, Polonsky WH, Buse JB, Price D, Bergenstal RM. Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial. JAMA 2021; 325:2262-2272. [PMID: 34077499 PMCID: PMC8173473 DOI: 10.1001/jama.2021.7444] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Continuous glucose monitoring (CGM) has been shown to be beneficial for adults with type 2 diabetes using intensive insulin therapy, but its use in type 2 diabetes treated with basal insulin without prandial insulin has not been well studied. OBJECTIVE To determine the effectiveness of CGM in adults with type 2 diabetes treated with basal insulin without prandial insulin in primary care practices. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted at 15 centers in the US (enrollment from July 30, 2018, to October 30, 2019; follow-up completed July 7, 2020) and included adults with type 2 diabetes receiving their diabetes care from a primary care clinician and treated with 1 or 2 daily injections of long- or intermediate-acting basal insulin without prandial insulin, with or without noninsulin glucose-lowering medications. INTERVENTIONS Random assignment 2:1 to CGM (n = 116) or traditional blood glucose meter (BGM) monitoring (n = 59). MAIN OUTCOMES AND MEASURES The primary outcome was hemoglobin A1c (HbA1c) level at 8 months. Key secondary outcomes were CGM-measured time in target glucose range of 70 to 180 mg/dL, time with glucose level at greater than 250 mg/dL, and mean glucose level at 8 months. RESULTS Among 175 randomized participants (mean [SD] age, 57 [9] years; 88 women [50%]; 92 racial/ethnic minority individuals [53%]; mean [SD] baseline HbA1c level, 9.1% [0.9%]), 165 (94%) completed the trial. Mean HbA1c level decreased from 9.1% at baseline to 8.0% at 8 months in the CGM group and from 9.0% to 8.4% in the BGM group (adjusted difference, -0.4% [95% CI, -0.8% to -0.1%]; P = .02). In the CGM group, compared with the BGM group, the mean percentage of CGM-measured time in the target glucose range of 70 to 180 mg/dL was 59% vs 43% (adjusted difference, 15% [95% CI, 8% to 23%]; P < .001), the mean percentage of time at greater than 250 mg/dL was 11% vs 27% (adjusted difference, -16% [95% CI, -21% to -11%]; P < .001), and the means of the mean glucose values were 179 mg/dL vs 206 mg/dL (adjusted difference, -26 mg/dL [95% CI, -41 to -12]; P < .001). Severe hypoglycemic events occurred in 1 participant (1%) in the CGM group and in 1 (2%) in the BGM group. CONCLUSIONS AND RELEVANCE Among adults with poorly controlled type 2 diabetes treated with basal insulin without prandial insulin, continuous glucose monitoring, as compared with blood glucose meter monitoring, resulted in significantly lower HbA1c levels at 8 months. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03566693.
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Affiliation(s)
- Thomas Martens
- International Diabetes Center, Park Nicollet Internal Medicine, Minneapolis, Minnesota
| | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida
| | - Ryan Bailey
- Jaeb Center for Health Research, Tampa, Florida
| | | | | | - Anne L. Peters
- Keck School of Medicine of the University of Southern California, Los Angeles
| | | | | | - Shichun Bao
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Georgia Davis
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Laura Young
- University of North Carolina School of Medicine, Chapel Hill
| | - Janet B. McGill
- Washington University School of Medicine, St Louis, Missouri
| | - Grazia Aleppo
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Ian Orozco
- Carteret Medical Group, Morehead City, North Carolina
| | | | - K. Jean Lucas
- Diabetes & Endocrinology Consultants PC, Morehead City, North Carolina
| | | | - John B. Buse
- University of North Carolina School of Medicine, Chapel Hill
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Sukkari MA, Cotten L, Alam M, Temponi E, John PD, Davis G, Vellanki P. Ketogenic Diet in a Patient With Type 1 Diabetes Mellitus With Hypoglycemia Unawareness. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: The high fat, low carbohydrate ketogenic diet has become increasingly popular in recent years for weight loss and glycemic control in patients with type 2 diabetes. Although prior studies have suggested this diet can improve glycemic control and decrease glucose variability, the impact of a ketogenic diet on rates of hypoglycemia in patients with hypoglycemia unawareness is not well described. Case Description: Our patient is a 37 year-old woman with Type 1 diabetes for 13 years complicated by hypoglycemia unawareness with HbA1c of 7.7%. Her insulin treatment regimen included insulin glargine 22 units daily, insulin aspart using a 1:15 carbohydrate ratio for prandial insulin dosing with a correction factor of 90. She had 5 episodes of severe hypoglycemia within the previous 3 months. The patient decided to resume a ketogenic diet given her previous improvement in glycemic control. Ketosis was confirmed using urine ketone strips performed by the patient. After 2 weeks on the ketogenic diet, a professional blinded continuous glucose monitor (CGM) was used for 4 weeks to monitor glycemic control.
CGM data for weeks 1 and 2 showed overall stability of time in target glucose range [TIR, 60% and 69%, respectively], with a slight increase in time spent below range [TBR, 13% and 17%, respectively]. During week 3, the patient experienced a significant decline in TIR to 31%, and associated increase in hypoglycemia (TBR, 13% to 28%). In addition, glycemic variability increased during this time [CV (coefficient of variation), 40.6% during week 1 to 58.1% during week 3]. Patient did not experience symptoms concerning for DKA, and continued to have asymptomatic hypoglycemia despite reductions in her insulin doses during week 3. Following these dose adjustments, CGM data during week 4 were similar to week 1 (TIR 65%, TBR 10%, CV 35%). Patient stopped following the ketogenic diet after 6 weeks due to social factors.
Conclusion: A ketogenic diet was associated with increased frequency of hypoglycemic events. In a patient with Type 1 diabetes and hypoglycemia unawareness, use of ketogenic diet may further increase the risk of severe hypoglycemia.
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Affiliation(s)
| | | | - Murtaza Alam
- Emory University Endocrine Fellowship Program, Atlanta, GA, USA
| | - Emily Temponi
- Emory University Endocrine Fellowship Program, Atlanta, GA, USA
| | | | - Georgia Davis
- Emory University School of Med/Grady Memorial Hospital, Atlanta, GA, USA
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Ryan TG, Juniat V, Stewart C, Malhotra R, Hardy TG, McNab AA, Davis G, Selva D. Clinico-radiological findings of neuroendocrine tumour metastases to the orbit. Orbit 2021; 41:44-52. [PMID: 33729098 DOI: 10.1080/01676830.2021.1895845] [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] [Indexed: 10/21/2022]
Abstract
Purpose: We present the clinico-radiological findings of neuroendocrine tumour metastases to the orbit.Methods: This was a multicentre, retrospective study of patients with neuroendocrine tumour metastases to the orbit. Data was collected from medical records across five different sites within Australia and the United Kingdom.Results: Nine patients (eleven lesions) were identified. The most common presenting complaint was diplopia (5/9, 56%). Disease occurred bilaterally in two patients. Seven patients (78%) had extraocular muscle involvement. The lateral recti (4/9, 44%) and superior recti (2/9, 22%) were the most commonly affected. Ocular presentation preceded primary tumour diagnosis in three patients (33%). On orbital imaging, metastases were most commonly reported as well circumscribed, ovoid or round, heterogeneous, contrast-enhancing masses. Features of intralesional haemorrhage and bony invasion are uncommonly reported.Conclusions: Neuroendocrine tumour metastasis to the orbit is uncommon. Metastases have a propensity for the extraocular muscles, commonly presenting as heterogeneous, well circumscribed, contrast-enhancing lesions on neuroimaging. New ocular symptoms, a history of neuroendocrine tumours, and these radiological findings, should lead to high clinical suspicion of metastatic disease. Atypical findings warrant biopsy to exclude other causes of orbital lesions.
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Affiliation(s)
- T G Ryan
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - V Juniat
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - C Stewart
- Department of Ophthalmology, Gold Coast University Hospital, Gold Coast, Australia
| | - R Malhotra
- Oculoplastics Unit, East Grinstead Hospital, East Sussex, UK
| | - T G Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - A A McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Centre for Eye Research Australia Ltd, University of Melbourne, East Melbourne, Australia
| | - G Davis
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - D Selva
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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12
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Albarède F, Blichert‐Toft J, de Callataÿ F, Davis G, Debernardi P, Gentelli L, Gitler H, Kemmers F, Klein S, Malod‐Dognin C, Milot J, Télouk P, Vaxevanopoulos M, Westner K. From commodity to money: The rise of silver coinage around the Ancient Mediterranean (sixth-first centuries bce). Archaeometry 2021; 63:142-155. [PMID: 33510540 PMCID: PMC7821003 DOI: 10.1111/arcm.12615] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 06/12/2023]
Abstract
The reasons why the Western Mediterranean, especially Carthage and Rome, resisted monetization relative to the Eastern Mediterranean are still unclear. We address this question by combining lead (Pb) and silver (Ag) isotope abundances in silver coinage from the Aegean, Magna Graecia, Carthage and Roman Republic. The clear relationships observed between 109Ag/107Ag and 208Pb/206Pb reflect the mixing of silver ores or silver objects with Pb metal used for cupellation. The combined analysis of Ag and Pb isotopes reveals important information about the technology of smelting. The Greek world extracted Ag and Pb from associated ores, whereas, on the Iberian Peninsula, Carthaginians and Republican-era Romans applied Phoenician cupellation techniques and added exotic Pb to Pb-poor Ag ores. Massive Ag recupellation is observed in Rome during the Second Punic War. After defeating the Carthaginians and the Macedonians in the late second century bce, the Romans brought together the efficient, millennium-old techniques of silver extraction of the Phoenicians, who considered this metal a simple commodity, with the monetization of the economy introduced by the Greeks.
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Affiliation(s)
| | - J. Blichert‐Toft
- Ecole Normale Supérieure de Lyon, CNRSUniversité de LyonLyonFrance
| | - F. de Callataÿ
- Royal Library of BelgiumBrusselsBelgium
- Ecole Pratique des Hautes EtudesParisFrance
| | - G. Davis
- Department of Ancient HistoryMacquarie UniversitySydneyNSWAustralia
| | | | - L. Gentelli
- Ecole Normale Supérieure de Lyon, CNRSUniversité de LyonLyonFrance
| | | | - F. Kemmers
- Institut für Archäologische WissenschaftenGoethe Universität Frankfurt am MainFrankfurt am MainGermany
| | - S. Klein
- Deutsches Bergbau‐MuseumBochumGermany
| | - C. Malod‐Dognin
- Ecole Normale Supérieure de Lyon, CNRSUniversité de LyonLyonFrance
| | - J. Milot
- Ecole Normale Supérieure de Lyon, CNRSUniversité de LyonLyonFrance
| | - P. Télouk
- Ecole Normale Supérieure de Lyon, CNRSUniversité de LyonLyonFrance
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13
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Migdal AL, Spanakis EK, Galindo RJ, Davis G, Singh LG, Satyarengga M, Scott WH, Fayfman M, Pasquel FJ, Albury B, Urrutia M, Zamudio Coronado KW, Cardona S, Peng L, Umpierrez GE. Accuracy and Precision of Continuous Glucose Monitoring in Hospitalized Patients Undergoing Radiology Procedures. J Diabetes Sci Technol 2020; 14:1135-1136. [PMID: 32476459 PMCID: PMC7645137 DOI: 10.1177/1932296820930038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
| | - Elias K. Spanakis
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, MD, USA
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, USA
| | | | - Georgia Davis
- Division of Endocrinology, Emory University, Atlanta, GA, USA
| | - Lakshmi G. Singh
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, MD, USA
| | - Medha Satyarengga
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, MD, USA
| | - William H. Scott
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, MD, USA
| | - Maya Fayfman
- Division of Endocrinology, Emory University, Atlanta, GA, USA
| | | | - Bonnie Albury
- Division of Endocrinology, Emory University, Atlanta, GA, USA
| | - Maria Urrutia
- Division of Endocrinology, Emory University, Atlanta, GA, USA
| | | | - Saumeth Cardona
- Division of Endocrinology, Emory University, Atlanta, GA, USA
| | - Limin Peng
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Guillermo E. Umpierrez
- Division of Endocrinology, Emory University, Atlanta, GA, USA
- Guillermo E. Umpierrez, MD, Division of Endocrinology, Emory University, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, USA.
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14
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Davis G, Schladweiler K, Chung Y, Emmanuel B, Kreindler J, Katial R, Burton T, Blauer-Peterson C, Seare J, Peters A. P504 HEALTH CARE RESOURCE USE AND COST FOR PATIENTS WITH CHRONIC RHINOSINUSITIS WITH NASAL POLYPOSIS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Peters A, Schladweiler K, Chung Y, Emmanuel B, Kreindler J, Katial R, Burton T, Blauer-Peterson C, Seare J, Davis G. P510 CHRONIC RHINOSINUSITIS WITH NASAL POLYPOSIS: DEMOGRAPHICS AND CLINICAL CHARACTERISTICS OF PATIENTS BASED ON SURGERY STATUS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Pasquel FJ, Lansang MC, Khowaja A, Urrutia MA, Cardona S, Albury B, Galindo RJ, Fayfman M, Davis G, Migdal A, Vellanki P, Peng L, Umpierrez GE. A Randomized Controlled Trial Comparing Glargine U300 and Glargine U100 for the Inpatient Management of Medicine and Surgery Patients With Type 2 Diabetes: Glargine U300 Hospital Trial. Diabetes Care 2020; 43:1242-1248. [PMID: 32273271 PMCID: PMC7411278 DOI: 10.2337/dc19-1940] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The role of U300 glargine insulin for the inpatient management of type 2 diabetes (T2D) has not been determined. We compared the safety and efficacy of glargine U300 versus glargine U100 in noncritically ill patients with T2D. RESEARCH DESIGN AND METHODS This prospective, open-label, randomized clinical trial included 176 patients with poorly controlled T2D (admission blood glucose [BG] 228 ± 82 mg/dL and HbA1c 9.5 ± 2.2%), treated with oral agents or insulin before admission. Patients were treated with a basal-bolus regimen with glargine U300 (n = 92) or glargine U100 (n = 84) and glulisine before meals. We adjusted insulin daily to a target BG of 70-180 mg/dL. The primary end point was noninferiority in the mean difference in daily BG between groups. The major safety outcome was the occurrence of hypoglycemia. RESULTS There were no differences between glargine U300 and U100 in mean daily BG (186 ± 40 vs. 184 ± 46 mg/dL, P = 0.62), percentage of readings within target BG of 70-180 mg/dL (50 ± 27% vs. 55 ± 29%, P = 0.3), length of stay (median [IQR] 6.0 [4.0, 8.0] vs. 4.0 [3.0, 7.0] days, P = 0.06), hospital complications (6.5% vs. 11%, P = 0.42), or insulin total daily dose (0.43 ± 0.21 vs. 0.42 ± 0.20 units/kg/day, P = 0.74). There were no differences in the proportion of patients with BG <70 mg/dL (8.7% vs. 9.5%, P > 0.99), but glargine U300 resulted in significantly lower rates of clinically significant hypoglycemia (<54 mg/dL) compared with glargine U100 (0% vs. 6.0%, P = 0.023). CONCLUSIONS Hospital treatment with glargine U300 resulted in similar glycemic control compared with glargine U100 and may be associated with a lower incidence of clinically significant hypoglycemia.
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Affiliation(s)
| | | | - Ameer Khowaja
- Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | | | | | | | | | - Maya Fayfman
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Limin Peng
- Rollins School of Public Health, Emory University, Atlanta, GA
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17
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Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, Davis G, Vellanki P, Migdal A, Gujral U, Narayan KMV, Umpierrez GE. Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study. Diabetes Care 2020; 43:349-357. [PMID: 31704689 PMCID: PMC6971788 DOI: 10.2337/dc19-1168] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/24/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Many patients with hyperglycemic crises present with combined features of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The implications of concomitant acidosis and hyperosmolality are not well known. We investigated hospital outcomes in patients with isolated or combined hyperglycemic crises. RESEARCH DESIGN AND METHODS We analyzed admissions data listing DKA or HHS at two academic hospitals. We determined 1) the frequency distributions of HHS, DKA, and combined DKA-HHS (DKA criteria plus elevated effective osmolality); 2) the relationship of markers of severity of illness and clinical comorbidities with 30-day all-cause mortality; and 3) the relationship of hospital complications associated with insulin therapy (hypoglycemia and hypokalemia) with mortality. RESULTS There were 1,211 patients who had a first admission with confirmed hyperglycemic crises criteria, 465 (38%) who had isolated DKA, 421 (35%) who had isolated HHS, and 325 (27%) who had combined features of DKA-HHS. After adjustment for age, sex, BMI, race, and Charlson Comorbidity Index score, subjects with combined DKA-HHS had higher in-hospital mortality compared with subjects with isolated hyperglycemic crises (adjusted odds ratio [aOR] 2.7; 95% CI 1.4, 4.9; P = 0.0019). In all groups, hypoglycemia (<40 mg/dL) during treatment was associated with a 4.8-fold increase in mortality (aOR 4.8; 95% CI 1.4, 16.8). Hypokalemia ≤3.5 mEq/L was frequent (55%). Severe hypokalemia (≤2.5 mEq/L) was associated with increased inpatient mortality (aOR 4.9; 95% CI 1.3, 18.8; P = 0.02). CONCLUSIONS Combined DKA-HHS is associated with higher mortality compared with isolated DKA or HHS. Severe hypokalemia and severe hypoglycemia are associated with higher hospital mortality in patients with hyperglycemic crises.
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Affiliation(s)
| | - Katerina Tsegka
- Department of Medicine/Endocrinology, Emory University, Atlanta, GA
| | - Heqiong Wang
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Saumeth Cardona
- Department of Medicine/Endocrinology, Emory University, Atlanta, GA
| | | | - Maya Fayfman
- Department of Medicine/Endocrinology, Emory University, Atlanta, GA
| | - Georgia Davis
- Department of Medicine/Endocrinology, Emory University, Atlanta, GA
| | | | - Alexandra Migdal
- Department of Medicine/Endocrinology, Emory University, Atlanta, GA
| | - Unjali Gujral
- Rollins School of Public Health, Emory University, Atlanta, GA
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18
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Tran D, Rodrigues C, du Plessis K, Zannino D, Davis G, Celermajer D, d'Udekem Y, Cordina R. 673 Not an Inevitable Decline: Exercise Capacity Trajectory of the Australian and New Zealand Fontan Population. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Davis G, Baboolal N, McRae A, Stewart R. Dementia: is it time for targeted national screening? J Public Health (Oxf) 2019; 41:e217. [PMID: 29982556 DOI: 10.1093/pubmed/fdy109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Davis
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad, W.I
| | - N Baboolal
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad, W.I
| | - A McRae
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad, W.I
| | - R Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
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20
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Fayfman M, Davis G, Duggan EW, Urrutia M, Chachkhiani D, Schindler J, Pasquel FJ, Galindo RJ, Vellanki P, Reyes-Umpierrez D, Wang H, Umpierrez GE. Sitagliptin for prevention of stress hyperglycemia in patients without diabetes undergoing general surgery: A pilot randomized study. J Diabetes Complications 2018; 32:1091-1096. [PMID: 30253968 PMCID: PMC6668912 DOI: 10.1016/j.jdiacomp.2018.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 01/04/2023]
Abstract
AIM We investigated if a dipeptidyl peptidase-4 inhibitor, sitagliptin, can prevent perioperative stress hyperglycemia in patients without prior history of diabetes mellitus undergoing general surgery. METHODS This double-blind pilot trial randomized general surgery patients to receive sitagliptin (n = 44) or placebo (n = 36) once daily, starting one day prior to surgery and continued during the hospital stay. The primary outcome was occurrence of stress hyperglycemia, defined by blood glucose (BG) >140 mg/dL and >180 mg/dL after surgery. Secondary outcomes included: length-of-stay, ICU transfers, hypoglycemia, and hospital complications. RESULTS BG >140 mg/dL was present in 44 (55%) of subjects following surgery. There were no differences in hyperglycemia between placebo and sitagliptin (56% vs. 55%, p = 0.93). BG >180 mg/dL was observed in 19% and 11% of patients treated with placebo and sitagliptin, respectively, p = 0.36. Both treatment groups had resulted in similar postoperative BG (148.9 ± 29.4 mg/dL vs. 146.9 ± 35.2 mg/dL, p = 0.73). There were no differences in length-of-stay (4 vs. 3 days, p = 0.84), ICU transfer (3% vs. 5%, p = 1.00), hypoglycemia <70 mg/dL (6% vs. 11%, p = 0.45), and complications (14% vs. 18%, p = 0.76). CONCLUSION Preoperative treatment with sitagliptin did not prevent stress hyperglycemia or complications in individuals without diabetes undergoing surgery.
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Affiliation(s)
- Maya Fayfman
- Emory University, Department of Medicine, Atlanta, GA, United States of America.
| | - Georgia Davis
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - Elizabeth W Duggan
- Emory University, Department of Anesthesiology, United States of America
| | - Maria Urrutia
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - David Chachkhiani
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - Joanna Schindler
- Emory University, Department of Anesthesiology, United States of America
| | - Francisco J Pasquel
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - Rodolfo J Galindo
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - Priyathama Vellanki
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | | | - Heqiong Wang
- Emory Rollins School of Public Health, United States of America
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21
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Susic D, Roberts L, Henry A, Davis G, Gia A, El-Omar E. 196. The P4 study: Postpartum maternal and infant faecal microbiome 6 months after hypertensive versus normotensive pregnancy. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.08.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Galea M, Dunlop S, Geraghty T, Davis G, Nunn A, Olenko L. Intensive exercise program after spinal cord injury (SCIPA full-on): A randomized controlled trial. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Advances in neuroscience offer the exciting prospect of understanding 'free' choices - the subject of the free will debate in philosophy. However, while physiological techniques and analysis have progressed rapidly to meet this challenge, task design has not. The challenge is now to develop laboratory tasks that adequately capture 'free' picking or choosing. To isolate 'internally' generated intentions from those impelled by external stimulus, observers are asked to 'choose freely' or to wait for a felt 'urge'. However, no previous work has explicitly distinguished between instructions that refer to 'urges' versus to 'choosing'. The philosopher Alfred Mele (e.g., 2009; 2014) has argued that the distinction is of crucial conceptual importance, but the two have not yet been empirically distinguished. Here, we show that conscious and unconscious, task-irrelevant primes, bias observers' binary choices when they are instructed to 'choose freely', not when they 'wait for an urge', underscoring the practical importance of Mele's conceptual distinction. Neuroscience must incorporate this distinction if we are to understand processes underpinning free choice.
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Affiliation(s)
| | - G Davis
- University of Cambridge, United Kingdom
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24
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Davis G, Fayfman M, Reyes-Umpierrez D, Hafeez S, Pasquel FJ, Vellanki P, Haw JS, Peng L, Jacobs S, Umpierrez GE. Stress hyperglycemia in general surgery: Why should we care? J Diabetes Complications 2018; 32:305-309. [PMID: 29273446 PMCID: PMC5975368 DOI: 10.1016/j.jdiacomp.2017.11.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 01/04/2023]
Abstract
AIMS To determine the frequency of increasing levels of stress hyperglycemia and its associated complications in surgery patients without a history of diabetes. METHODS We reviewed hospital outcomes in 1971 general surgery patients with documented preoperative normoglycemia [blood glucose (BG) <140mg/dL] who developed stress hyperglycemia (BG >140mg/dL or >180mg/dL) within 48h after surgery between 1/1/2010 and 10/31/2015. RESULTS A total of 415 patients (21%) had ≥1 episode of BG between 140 and 180mg/dL and 206 patients (10.5%) had BG>180mg/dL. The median length of hospital stay (LOS) was 9days [interquartile range (IQR) 5,15] for BG between 140 and 180mg/dL and 12days (IQR 6,18) for BG>180mg/dL compared to normoglycemia at 6days (IQR 4,11), both p<0.001. Patients with BG 140-180mg/dL had higher rates of complications with an odds ratio (OR) of 1.68 [95% confidence interval (95% CI) 1.15-2.44], and those with BG>180mg/dL had more complications [OR 3.46 (95% CI 2.24-5.36)] and higher mortality [OR 6.56 (95% CI 2.12-20.27)] compared to normoglycemia. CONCLUSION Increasing levels of stress hyperglycemia are associated with higher rates of perioperative complications and hospital mortality in surgical patients without diabetes.
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Affiliation(s)
- Georgia Davis
- Department of Medicine, Emory University, Atlanta, GA, United States
| | - Maya Fayfman
- Department of Medicine, Emory University, Atlanta, GA, United States
| | | | - Shahzeena Hafeez
- Department of Medicine, Emory University, Atlanta, GA, United States
| | | | | | - J Sonya Haw
- Department of Medicine, Emory University, Atlanta, GA, United States
| | - Limin Peng
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sol Jacobs
- Department of Medicine, Emory University, Atlanta, GA, United States
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25
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Limawararut V, Hoyama E, Selva D, Davis G. Squamous Cell Carcinoma Presenting as an Orbital Cyst with Radiologic Evidence of Perineural Invasion. Eur J Ophthalmol 2018; 17:970-2. [DOI: 10.1177/112067210701700616] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To report clinical and radiologic findings of cystic squamous cell carcinoma (SCC) of the orbit with evidence of perineural involvement. Methods Analysis of clinical findings and radiology with a literature review. Results A 66-year-old man with SCC of the forehead 8 years prior presented with paresthesias, diplopia, and proptosis. Magnetic resonance imaging showed a well-defined, cystic mass of the orbit with a single, linear structure running through its center. Lateral orbitotomy revealed a cyst adherent to adjacent periorbita containing viscous, clear, yellow substance and a nerve coursing through the center. Histopathology confirmed poorly differentiated spindle cell carcinoma with positive staining for cytokeratin markers, consistent with SCC. Conclusions Orbital cysts associated with altered sensation are suggestive of SCC with perineural spread, requiring prompt investigation and treatment to minimize morbidity and mortality. The involved nerve may be seen as a single, linear structure within the mass on imaging.
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Affiliation(s)
- V. Limawararut
- Oculoplastic and Orbital Division, Department of Ophthalmology & Visual Sciences, University of Adelaide
| | - E. Hoyama
- Oculoplastic Division, Londrina Eye Hospital, Londrina - PR Brazil
| | - D. Selva
- Oculoplastic and Orbital Division, Department of Ophthalmology & Visual Sciences, University of Adelaide
- South Australian Institute of Ophthalmology, Adelaide - Australia
| | - G. Davis
- Oculoplastic and Orbital Division, Department of Ophthalmology & Visual Sciences, University of Adelaide
- South Australian Institute of Ophthalmology, Adelaide - Australia
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Abstract
OBJECTIVE Examine the frequency with which the most accepted indicators for delivery in pre-eclampsia are used in a population with predominantly late-onset (birth > 32 weeks) pre-eclampsia (PE). METHODS Retrospective cohort study using the St George Public Hospital (SGH) Hypertension in Pregnancy database. Demographic, pregnancy, and outcome details were extracted and verified by comparison with data collection sheets. RESULTS From 2001 to 2013, 908 women (970 babies) with PE were included, of which a subgroup of 303 women (33%) had clearly delineated delivery triggers available. This subgroup of women had similar demographic and outcome characteristics to the total PE population. In this group, the most common maternal trigger for delivery apart from gestational age 37+ weeks was difficult to control/severe hypertension (114 cases, 38%) and the most common fetal trigger intrauterine growth restriction (IUGR: 14 cases, 4%). 78 (35%) of term women had no specific delivery trigger other than gestation. A primary maternal trigger and/or associated complication was slightly more common in those delivering <37 weeks vs 37+ weeks (52 vs 38%, p = .03), while a fetal or combined maternal/fetal complication was over four times more common in preterm women (25 vs 6%, p < .001). CONCLUSION In our population of predominantly late-onset PE, maternal triggers for delivery (predominantly severe hypertension) far outweigh fetal triggers (predominantly IUGR). Fetal and mixed indicators for delivery were relatively more common in women delivering preterm, possibly reflecting the severity of placental dysfunction in this subgroup.
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Affiliation(s)
- N Varnier
- Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia.
| | - M A Brown
- Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
| | - M Reynolds
- School of Women's and Children's Health, UNSW Medicine, Sydney, Australia
| | - F Pettit
- Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
| | - G Davis
- Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
| | - G Mangos
- Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
| | - A Henry
- Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney, Australia
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Lui A, Parvathaneni U, Laramore G, Rodriguez C, Rostomily R, Silbergeld D, Ferreira M, Futran N, Moe K, Davis G, Humphreys I, Houlton J, Schaub S, Liao J. Management and Long Term Outcomes of Esthesioneuroblastoma at a Single Institution. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chen D, Youssef G, Mangos G, Roberts L, Henry A, Davis G, Homer C, Pettit F, Brown M. P3258Echocardiographic assessment of left ventricular structure and function in hypertensive disorders of pregnancy at six months post partum. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D. Chen
- St George Hospital, Sydney, Australia
| | | | - G. Mangos
- St George Hospital, Sydney, Australia
| | | | - A. Henry
- St George Hospital, Sydney, Australia
| | - G. Davis
- St George Hospital, Sydney, Australia
| | - C. Homer
- St George Hospital, Sydney, Australia
| | - F. Pettit
- St George Hospital, Sydney, Australia
| | - M. Brown
- St George Hospital, Sydney, Australia
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Allenson K, Castillo J, San Lucas FA, Scelo G, Kim DU, Bernard V, Davis G, Kumar T, Katz M, Overman MJ, Foretova L, Fabianova E, Holcatova I, Janout V, Meric-Bernstam F, Gascoyne P, Wistuba I, Varadhachary G, Brennan P, Hanash S, Li D, Maitra A, Alvarez H. High prevalence of mutant KRAS in circulating exosome-derived DNA from early-stage pancreatic cancer patients. Ann Oncol 2017; 28:741-747. [PMID: 28104621 PMCID: PMC5834026 DOI: 10.1093/annonc/mdx004] [Citation(s) in RCA: 324] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Indexed: 02/03/2023] Open
Abstract
Background Exosomes arise from viable cancer cells and may reflect a different biology than circulating cell-free DNA (cfDNA) shed from dying tissues. We compare exosome-derived DNA (exoDNA) to cfDNA in liquid biopsies of patients with pancreatic ductal adenocarcinoma (PDAC). Patients and methods Patient samples were obtained between 2003 and 2010, with clinically annotated follow up to 2015. Droplet digital PCR was performed on exoDNA and cfDNA for sensitive detection of KRAS mutants at codons 12/13. A cumulative series of 263 individuals were studied, including a discovery cohort of 142 individuals: 68 PDAC patients of all stages; 20 PDAC patients initially staged with localized disease, with blood drawn after resection for curative intent; and 54 age-matched healthy controls. A validation cohort of 121 individuals (39 cancer patients and 82 healthy controls) was studied to validate KRAS detection rates in early-stage PDAC patients. Primary outcome was circulating KRAS status as detected by droplet digital PCR. Secondary outcomes were disease-free and overall survival. Results KRAS mutations in exoDNA, were identified in 7.4%, 66.7%, 80%, and 85% of age-matched controls, localized, locally advanced, and metastatic PDAC patients, respectively. Comparatively, mutant KRAS cfDNA was detected in 14.8%, 45.5%, 30.8%, and 57.9% of these individuals. Higher exoKRAS MAFs were associated with decreased disease-free survival in patients with localized disease. In the validation cohort, mutant KRAS exoDNA was detected in 43.6% of early-stage PDAC patients and 20% of healthy controls. Conclusions Exosomes are a distinct source of tumor DNA that may be complementary to other liquid biopsy DNA sources. A higher percentage of patients with localized PDAC exhibited detectable KRAS mutations in exoDNA than previously reported for cfDNA. A substantial minority of healthy samples demonstrated mutant KRAS in circulation, dictating careful consideration and application of liquid biopsy findings, which may limit its utility as a broad cancer-screening method.
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Affiliation(s)
| | | | - F. A. San Lucas
- Translational Molecular Pathology
- Sheikh Ahmed Pancreatic Cancer Research Center, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G. Scelo
- Genetic Epidemiology Group International Agency for Research on Cancer, Lyon, France
| | | | | | | | | | - M. Katz
- Departments of Surgical Oncology
| | - M. J. Overman
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L. Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - E. Fabianova
- Regional Authority of Public Health in Banska Bystrica, Banska Bystrica, Slovakia
| | - I. Holcatova
- Institute of Public Health and Preventive Medicine, 2nd Faculty of Medicine, Charles University, Prague
| | - V. Janout
- Department of Preventive Medicine, Palacky University of Medicine, Olomouc
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - F. Meric-Bernstam
- Department of Investigational Cancer Therapeutics and the Institute for Personalized Cancer Therapy, Houston
| | | | | | - G. Varadhachary
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P. Brennan
- Genetic Epidemiology Group International Agency for Research on Cancer, Lyon, France
| | - S. Hanash
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - D. Li
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A. Maitra
- Pathology
- Sheikh Ahmed Pancreatic Cancer Research Center, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H. Alvarez
- Pathology
- Sheikh Ahmed Pancreatic Cancer Research Center, The University of Texas MD Anderson Cancer Center, Houston, USA
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Beigi RH, Davis G, Hodges J, Akers A. Preparedness planning for pandemic influenza among large US maternity hospitals. Emerging Health Threats Journal 2017. [DOI: 10.3402/ehtj.v2i0.7079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- RH Beigi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA; and
| | - G Davis
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Hodges
- Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - A Akers
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA; and
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Reyes-Umpierrez D, Davis G, Cardona S, Pasquel FJ, Peng L, Jacobs S, Vellanki P, Fayfman M, Haw S, Halkos M, Guyton RA, Thourani VH, Umpierrez GE. Inflammation and Oxidative Stress in Cardiac Surgery Patients Treated to Intensive Versus Conservative Glucose Targets. J Clin Endocrinol Metab 2017; 102:309-315. [PMID: 27841946 PMCID: PMC5413099 DOI: 10.1210/jc.2016-3197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/07/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to determine (a) longitudinal changes of inflammatory and oxidative stress markers and (b) the association between markers of inflammation and perioperative complications in coronary artery bypass surgery (CABG) patients treated with intensive vs conservative blood glucose (BG) control. METHODS Patients with diabetes (n = 152) and without diabetes with hyperglycemia (n = 150) were randomized to intensive (n = 151; BG: 100-140 mg/dL) or to conservative (n = 151; BG: 141-180 mg/dL) glycemic targets. Plasma cortisol, high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α, interleukin-6 (IL-6), thiobarbituric acid-reactive substances, and 2'-7'-dichlorofluorescein were measured prior to and at days 3, 5, and 30 after surgery. RESULTS Intensive glycemic control resulted in lower mean BG (132 ± 14 mg/dL vs 154 ± 17 mg/dL, P < 0.001) in the intensive care unit. Plasma cortisol and inflammatory markers increased significantly from baseline after the third and fifth day of surgery (P < 0.001), and returned to baseline levels at 1 month of follow-up. Patients with perioperative complications had higher levels of cortisol, hsCRP, IL-6, and oxidative stress markers compared with those without complications. There were no significant differences in inflammatory and oxidative stress markers between patients, with or without diabetes or complications, treated with intensive or conventional glucose targets. CONCLUSION We report no significant differences in circulating markers of acute inflammatory and oxidative stress response in cardiac surgery patients, with or without diabetes, treated with intensive (100-140 mg/dL) or conservative (141-180 mg/dL) insulin regimens.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Michael Halkos
- Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia 30303
| | - Robert A. Guyton
- Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia 30303
| | - Vinod H. Thourani
- Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia 30303
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Jeanblanc N, Hemken P, Rae T, Brophy S, Manetz S, Vainshtein I, Liang M, Choudhury P, Chang C, Streicher K, Greenlees L, Xiao X, Ranade K, Davis G. P114 Research use only (RUO) DPP-4 immunoassay. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Davies K, Davis G, Barbut F, Eckert C, Petrosillo N, Wilcox MH. Variability in testing policies and impact on reported Clostridium difficile infection rates: results from the pilot Longitudinal European Clostridium difficile Infection Diagnosis surveillance study (LuCID). Eur J Clin Microbiol Infect Dis 2016; 35:1949-1956. [PMID: 27590621 PMCID: PMC5138271 DOI: 10.1007/s10096-016-2746-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/02/2016] [Indexed: 01/05/2023]
Abstract
Lack of standardised Clostridium difficile testing is a potential confounder when comparing infection rates. We used an observational, systematic, prospective large-scale sampling approach to investigate variability in C. difficile sampling to understand C. difficile infection (CDI) incidence rates. In-patient and institutional data were gathered from 60 European hospitals (across three countries). Testing methodology, testing/CDI rates and case profiles were compared between countries and institution types. The mean annual CDI rate per hospital was lowest in the UK and highest in Italy (1.5 vs. 4.7 cases/10,000 patient bed days [pbds], p < 0.001). The testing rate was highest in the UK compared with Italy and France (50.7/10,000 pbds vs. 31.5 and 30.3, respectively, p < 0.001). Only 58.4 % of diarrhoeal samples were tested for CDI across all countries. Overall, only 64 % of hospitals used recommended testing algorithms for laboratory testing. Small hospitals were significantly more likely to use standalone toxin tests (SATTs). There was an inverse correlation between hospital size and CDI testing rate. Hospitals using SATT or assays not detecting toxin reported significantly higher CDI rates than those using recommended methods, despite testing similar testing frequencies. These data are consistent with higher false-positive rates in such (non-recommended) testing scenarios. Cases in Italy and those diagnosed by SATT or methods NOT detecting toxin were significantly older. Testing occurred significantly earlier in the UK. Assessment of testing practice is paramount to the accurate interpretation and comparison of CDI rates.
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Affiliation(s)
- K Davies
- Healthcare Associated Infections Research Group, University of Leeds, Leeds, UK.
- Microbiology, Old Medical School, Leeds General Infirmary, Leeds, LS1 3EX, W. Yorks, UK.
| | - G Davis
- Healthcare Associated Infections Research Group, University of Leeds, Leeds, UK
| | - F Barbut
- National Reference Laboratory for Clostridium difficile, Saint-Antoine Hospital, Paris, France
| | - C Eckert
- National Reference Laboratory for Clostridium difficile, Saint-Antoine Hospital, Paris, France
| | - N Petrosillo
- National Institute for Infectious Diseases, Rome, Italy
| | - M H Wilcox
- Healthcare Associated Infections Research Group, University of Leeds, Leeds, UK
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Matheson E, Luo M, Davis G, Baggs G, Nelson J, Pereira S, Hagazi R, Ahmed N, Steele C, Deutz N. MON-P090: Effect of a Specialized Ons on Serum Markers of Nutrition and Inflammation in Hospitalized Malnourished Older Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Although results of iliac artery balloon angioplasty have been shown to be good, there are much less data regarding initial success and durability of superficial femoral artery (SFA) dilation. The authors retrospectively reviewed the results of 22 patients treated for 27 SFA lesions between 1981 and 1986. Mean age was 64.5 years (fifty-five to seventy-six). Results were analyzed with respect to initial, early ( < twelve months), and late ( > twelve months) angiographic and clinical success. Indications were claudication (22), nonhealing ulcer (3), and rest pain (2). Mean follow-up was 30.9 months; 100% at one year and 92% at two years. Initial failure occurred in 9 (33%) lesions. There were 2 early and 2 late failures for a cumulative patency rate of 90.3% and 78% at one and two years, respectively. Predictors of clinical failure were: (1) initial—age, SFA occlusion, and angio plasty rating; (2) early—age, SFA occlusion, degree of atherosclerosis, and angioplasty rating; (3) late—angioplasty rating. There were 3 complications (11%). The authors conclude that: (1) 33% of attempted SFA angioplasties were initially unsuccessful and that the cumulative patency rate was 78% at two years. (2) Age is predictive of initial and early failure; SFA occlusion, of initial and early failure; degree of atherosclerosis, of early failure; and angioplasty appearance, of initial, early, and late failures. (3) Complications did not result in limb loss or require surgery.
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Affiliation(s)
- H. El-Bayar
- Departments of Surgery and Radiology, VA Medical Center, San Diego, VA Medical Center, West Los Angeles, California
| | - A. Roberts
- Departments of Surgery and Radiology, VA Medical Center, San Diego, VA Medical Center, West Los Angeles, California
| | - R. Hye
- Departments of Surgery and Radiology, VA Medical Center, San Diego, VA Medical Center, West Los Angeles, California
| | - G. Davis
- Departments of Surgery and Radiology, VA Medical Center, San Diego, VA Medical Center, West Los Angeles, California
| | - J. Freischlag
- Departments of Surgery and Radiology, VA Medical Center, San Diego, VA Medical Center, West Los Angeles, California
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Urschel H, Finney J, Dyll L, Boland G, Race G, Jay B, Davis G, Balla G, Urschel HC. Treatment of Arteriosclerotic Obstructive Cerebrovascular Disease With Hydrogen Peroxide. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857446700100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - L.M. Dyll
- 3810 Swiss Avenue Dallas, Texas 75204
| | | | - G.J. Race
- 3810 Swiss Avenue Dallas, Texas 75204
| | - B.E. Jay
- 3810 Swiss Avenue Dallas, Texas 75204
| | - G. Davis
- 3810 Swiss Avenue Dallas, Texas 75204
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Davis G, Patel RP, Tan TL, Alijanipour P, Naik TU, Parvizi J. Ethnic differences in heterotopic ossification following total hip arthroplasty. Bone Joint J 2016; 98-B:761-6. [DOI: 10.1302/0301-620x.98b6.36050] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 11/10/2015] [Indexed: 11/05/2022]
Abstract
Aims We aimed to assess the influence of ethnicity on the incidence of heterotopic ossification (HO) after total hip arthroplasty (THA). Patients and Methods We studied the six-month post-operative anteroposterior radiographs of 1449 consecutive primary THAs (1324 patients) and retrospectively graded them for the presence of HO, using the Brooker Classification. Results Based on multivariate analysis, African-American ethnicity was an independent risk factor for HO formation following THA with an adjusted odds ratio (OR) of 2.6 (95% confidence interval (CI) 1.3 to 5.2, p = 0.007) for severe HO and 1.9 (95% CI 1.3 to 2.7, p < 0.001) for any grade of HO. Conclusion Given the increased risk of HO formation, particularly high grade HO, and the potentially poorer outcomes associated with HO, it is important to consider using prophylaxis against HO in patients of African-American ethnicity undergoing THA. Take home message: African Americans are at an increased risk for developing heterotopic ossification and thus may benefit from HO prophylaxis. Cite this article: Bone Joint J 2016;98-B:761–6.
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Affiliation(s)
- G. Davis
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - R. P. Patel
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - T. L. Tan
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - P. Alijanipour
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - T. U. Naik
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - J. Parvizi
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
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38
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Davis G, Cooles S, Diesel G, Blenkinsop J. Summary of suspected adverse events, 2014. Vet Rec 2016; 178:187-9. [DOI: 10.1136/vr.i895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- G. Davis
- Pharmacovigilance Unit; Veterinary Medicines Directorate; Woodham Lane New Haw Surrey KT15 3LS
| | - S. Cooles
- Pharmacovigilance Unit; Veterinary Medicines Directorate; Woodham Lane New Haw Surrey KT15 3LS
| | - G. Diesel
- Pharmacovigilance Unit; Veterinary Medicines Directorate; Woodham Lane New Haw Surrey KT15 3LS
| | - J. Blenkinsop
- Pharmacovigilance Unit; Veterinary Medicines Directorate; Woodham Lane New Haw Surrey KT15 3LS
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Jin H, Snyder R, Li M, Zhou J, Li X, Davis G, Kishawi I, Liu L. Validation of Short Turnaround Time Preimplantation Genetic Screen (PGS) Assay with Agilent CHG Array (PGS-Quick). Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2014.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Liu L, Hou S, Lin M, Song M, Chen L, Li M, Jin H, Zhou J, Li X, Davis G, Ding H, Tseng H. A Pilot Study of NIPS-24 Using Circulating Fetal Nucleated Cells (CFNCs) Isolated with Nanovelcro Microchips. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2014.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Increase in the number of reports of suspected adverse events in animals, Fewer reports of human adverse events to veterinary medicines, Notable increase in reports relating to products used for treating canine epilepsy. These are some of the results from the surveillance work carried out by the pharmacovigilance unit at the Veterinary Medicines Directorate (VMD), as discussed by Giles Davis and colleagues from the VMD.
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Affiliation(s)
- G Davis
- Suspected Adverse Reaction Surveillance Scheme, Veterinary Medicines Directorate, Woodham Lane, New Haw, Surrey KT15 3LS
| | - S Cooles
- Suspected Adverse Reaction Surveillance Scheme, Veterinary Medicines Directorate, Woodham Lane, New Haw, Surrey KT15 3LS
| | - N Vasan
- Suspected Adverse Reaction Surveillance Scheme, Veterinary Medicines Directorate, Woodham Lane, New Haw, Surrey KT15 3LS
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Cáceres CE, Davis G, Duple S, Hall SR, Koss A, Lee P, Rapti Z. Complex Daphnia interactions with parasites and competitors. Math Biosci 2014; 258:148-61. [PMID: 25445737 DOI: 10.1016/j.mbs.2014.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 11/08/2013] [Revised: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
Species interactions can strongly influence the size and dynamics of epidemics in populations of focal hosts. The "dilution effect" provides a particularly interesting type of interaction from a biological standpoint. Diluters - other host species which resist infection but remove environmentally-distributed propagules of parasites (spores) - should reduce disease prevalence in focal hosts. However, diluters and focal hosts may compete for shared resources. This combination of positive (dilution) and negative (competition) effects could greatly complicate, even undermine, the benefits of dilution and diluter species from the perspective of the focal host. Motivated by an example from the plankton (i.e., zooplankton hosts, a fungal parasite, and algal resources), we study a model of dilution and competition. Our model reveals a suite of five results: • A diluter that is a superior competitor wipes out the host, regardless of parasitism. Although expected, this outcome is an ever-present danger in strategies that might use diluters to control disease. • If the diluter is an inferior competitor, it can reduce disease prevalence, despite the competition, as parameterized in our model. However, competition may also reduce density of susceptible hosts to levels below that seen in focal host-parasite systems alone. • As they decrease disease prevalence, diluters destabilize dynamics of the focal host and their resources. Thus, diluters undermine the stabilizing effects of disease. • The four species combination can generate very complex dynamics, including period-doubling bifurcations and torus (Neimark-Sacker) bifurcations. • At lower resource carrying capacity, the diluter’s dilution of spores is 'helpful' to the focal host, i.e., dilution can elevate host density by reducing disease. But, as the resource carrying capacity increases further, the equilibrium density of the diluter increases while the density of the focal host decreases, despite competition. Namely, the negative effects of competition start to outweigh the positive effects of dilution from the perspective of equilibrium density of the focal host.
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Affiliation(s)
- C E Cáceres
- School of Integrative Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States
| | - G Davis
- Department of Mathematics, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States
| | - S Duple
- School of Integrative Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States
| | - S R Hall
- Department of Biology, Indiana University, Bloomington, IN 47405, United States
| | - A Koss
- Department of Mathematics, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States
| | - P Lee
- School of Integrative Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States
| | - Z Rapti
- Department of Mathematics, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States.
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Hammad FT, Wheatley AM, Davis G. Bosentan normalizes the GFR response to renal nerve stimulation following reversible unilateral ureteric obstruction in the rat. Physiol Res 2014; 63:713-22. [PMID: 25157662 DOI: 10.33549/physiolres.932667] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We investigated the renal response to direct renal nerve stimulation, 2 weeks following reversal of 24-h unilateral (left) ureteric obstruction. Renal nerve stimulation caused a 13-15 % fall in renal blood flow, in 4 groups of anesthetized rats following ureteric obstruction (n=9) or a sham operation (n=7) both with (n=9) and without (n=7) treatment with the mixed ET(A/B) receptor antagonist, bosentan. In the sham-operated rats, renal nerve stimulation did not change glomerular filtration rate but reduced urine flow rate (37+/-3 %, P<0.001), and absolute (38+/-4 %, P<0.001) and fractional (35+/-5 %, P<0.01) sodium excretion. Following unilateral ureteric obstruction, renal nerve stimulation increased glomerular filtration rate by 22+/-3 % (P<0.01), but reduced urine flow rate (14+/-2 %, P<0.001) and fractional sodium excretion (23+/-5 %, P<0.01). Bosentan treatment had no effect on baseline or renal responses to renal nerve stimulation in the sham group but normalized the renal response to renal nerve stimulation in the unilateral ureteric obstruction group. We conclude that 14 days after a 24-h period of unilateral ureteric obstruction there is an increase in GFR in response to direct renal nerve stimulation, which is due, in part, to the actions of endothelin at the time of obstruction.
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Affiliation(s)
- F T Hammad
- Department of Physiology, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand.
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Ade PAR, Aikin RW, Amiri M, Barkats D, Benton SJ, Bischoff CA, Bock JJ, Brevik JA, Buder I, Bullock E, Davis G, Day PK, Dowell CD, Duband L, Filippini JP, Fliescher S, Golwala SR, Halpern M, Hasselfield M, Hildebrandt SR, Hilton GC, Irwin KD, Karkare KS, Kaufman JP, Keating BG, Kernasovskiy SA, Kovac JM, Kuo CL, Leitch EM, Llombart N, Lueker M, Netterfield CB, Nguyen HT, O'Brient R, Ogburn RW, Orlando A, Pryke C, Reintsema CD, Richter S, Schwarz R, Sheehy CD, Staniszewski ZK, Story KT, Sudiwala RV, Teply GP, Tolan JE, Turner AD, Vieregg AG, Wilson P, Wong CL, Yoon KW. BICEP2. II. EXPERIMENT AND THREE-YEAR DATA SET. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/792/1/62] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Increase in serious adverse events; Increase in reports involving products marketed under the Small Animal Exemption Scheme; Decrease in injection site reactions. These are some of the results from the surveillance work carried out by the pharmacovigilance unit at the Veterinary Medicines Directorate (VMD), as discussed by Giles Davis and colleagues.
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Affiliation(s)
- G Davis
- Suspected Adverse Reaction Surveillance Scheme, Veterinary Medicines Directorate, Woodham Lane, New Haw, Surrey KT15 3LS
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Nayak BS, Pinto Pereira LM, Seemungal T, Davis G, Teelucksingh S, Jagessar A, Legall G. Relationship of fasting total homocysteine, high sensitivity C-reactive protein and features of the metabolic syndrome in Trinidadian subjects. Arch Physiol Biochem 2013; 119:22-6. [PMID: 23137347 DOI: 10.3109/13813455.2012.735245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the relationship of homocysteine, hs-CRP, with known cardiovascular risk factors of the metabolic syndrome. METHOD Cross sectional study comprised 182 diabetic outpatients (70 males and 112 females), attending endocrinology clinics in Trinidad. RESULTS Both male and females showed significant linear relationships between high sensitive C-reactive protein (hs-CRP), blood pressure and diabetes (r = -0.2 < R or R > 0.2). In females hs-CRP showed significant linear relationship with HDL, triglyceride, blood pressure and diabetes mellitus (p < 0.0001). The inverse relationship of hs-CRP with HDL implies the strong association of hs-CRP with metabolic syndrome. The multivariate logistic regression analysis showed significant relation of hs-CRP, metabolic syndrome and diabetes mellitus. There was no significant relationship of tHCY to any of the features studied. CONCLUSION Serum C-reactive protein is significantly related to features of the metabolic syndrome. Total plasma homocysteine, appears to be independent of both hs-CRP and features of the metabolic syndrome.
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Affiliation(s)
- B S Nayak
- Department of Preclinical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago.
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Yee J, Abell B, Davis G, Ward L, Black D, Kilbreath S. Relationship amongst three activity monitors commonly used to quantify physical activity. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stancliffe R, Davis G, Bauman A, Jan S, van der Ploeg H, Lante K. Randomised controlled trial protocol: Physical activity and exercise in adults with intellectual disability. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Phizacklea J, Koecher S, Kobialka K, Davis G, Cossburn M. STUDENT LED DEVELOPMENT AND EVALUATION OF UNDERGRADUATE NEUROLOGY VIRTUAL PATIENT E-LEARNING MODULES. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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