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We present an in-depth analysis of dyslipidemia management strategies for patients with diabetes mellitus in Taiwan. It critically examines the disparity between established guideline recommendations and actual clinical practices, particularly in the context of evolving policies affecting statin prescriptions. The focus is on synthesizing the most recent findings concerning lipid management in patients with diabetes mellitus, with a special emphasis on establishing consensus regarding low-density lipoprotein cholesterol treatment targets. The article culminates in providing comprehensive, evidence-based recommendations tailored to the unique needs of those living with diabetes mellitus in Taiwan. It underscores the criticality of personalized care approaches, which incorporate multifaceted factors, and the integration of novel therapeutic options to enhance cardiovascular health outcomes.
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Consenso , Dislipidemias , Humanos , Taiwán/epidemiología , Dislipidemias/tratamiento farmacológico , Dislipidemias/terapia , Diabetes Mellitus/terapia , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Guías de Práctica Clínica como Asunto/normas , LDL-Colesterol/sangreRESUMEN
Post-traumatic soft tissue damage could persist for an extended period, and the non-traumatic side could be affected by indirect consequences. Hyperspectral imaging soft abundance scorer can identify these concealed and asymptomatic lesions.
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Diagnóstico por Imagen , Imágenes Hiperespectrales , Diagnóstico por Imagen/métodos , Ondas de RadioRESUMEN
PURPOSE: Inpatient glycemic management has become a common issue because of the increasing number of hospitalized patients with hyperglycemia. Point-of-care devices can enable timely inpatient glucose monitoring, which may lead to better outcomes. The accuracy of point-of-care testing in various clinical scenarios has been questioned, particularly in neonates and critically ill patients. This study aimed to evaluate the accuracy of the CONTOUR PLUS and CONTOUR PLUS ONE glucometers (new wireless systems that link to a smart mobile device) when used as point-of-care devices for blood glucose monitoring in neonates and critically ill adults in inpatient settings. METHODS: This cross-sectional study was conducted at a medical center in central Taiwan and enrolled patients admitted to the neonatal intensive care unit, sick child room, or respiratory intensive care unit between November 2020 and April 2021. Neonates with suspected infection or abnormal blood coagulation and adults who had abnormal blood coagulation, were pregnant, had received organ transplants, or had undergone massive blood transfusions were excluded. The accuracy of the glucometers was determined based on the following criteria of the International Organization for Standardization (ISO) standard: 15197:2013. FINDINGS: Overall, 114 neonates (mean age, 4.2 days [range, 0-28 days]; 65 boys [57.0%]) and 106 hospitalized critically ill adults (mean age, 68.2 years [range, 27-94 years]; 72 men [67.9%]) were enrolled in this study. The glucose values obtained with each glucometer had good precision, and all findings met the reference criteria of the within-lot results. All measurements of the neonates' venous blood by each glucometer met the accuracy criteria specified by ISO standard 15197:2013. Furthermore, 98.1% and 97.2% of the arterial blood glucose measurements for critically ill adults obtained with CONTOUR PLUS and CONTOUR PLUS ONE met the accuracy criteria, respectively. IMPLICATIONS: Both glucose management systems met the accuracy criteria for venous blood from neonates and arterial blood from critically ill adults. Thus, the use of these 2 point-of-care devices in inpatient settings, including for neonates and critically ill adults, can be recommended to minimize limitations associated with the clinical application of point-of-care testing in glucose management. The wireless connection may play a role in the subsequent development of institution-wide virtual glycemic management under the supervision of a team of endocrinologists.
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Automonitorización de la Glucosa Sanguínea , Glucemia , Masculino , Niño , Recién Nacido , Humanos , Adulto , Anciano , Sistemas de Atención de Punto , Enfermedad Crítica , Estudios Transversales , Glucosa , Unidades de Cuidado Intensivo NeonatalRESUMEN
BACKGROUND: SSIs (surgical site infections) are associated with increased rates of morbidity and mortality. The traditional quality improvement strategies focusing on individual performance did not achieve sustainable improvement. This study aimed to implement the Six Sigma DMAIC method to reduce SSIs and to sustain improvements in surgical quality. The surgical procedures, clinical data, and surgical site infections were collected among 42,233 hospitalized surgical patients from 1 January 2019 to 31 December 2020. Following strengthening leadership and empowering a multidisciplinary SSI prevention team, DMAIC (Define, Measure, Analyze, Improve, and Control) was used as the performance improvement model. An evidence-based prevention bundle for reduction of SSI was adopted as performance measures. Environmental monitoring and antimicrobial stewardship programs were strengthened to prevent the transmission of multi-drug resistant microorganisms. Process change was integrated into a clinical pathway information system. Improvement cycles by corrective actions for the risk events of SSIs were implemented to ensure sustaining improvements. We have reached the targets of the prevention bundle elements in the post-intervention period in 2020. The carbapenem resistance rates of Enterobacteriaceae and P. aeruginosa were lower than 10%. A significant 22.2% decline in SSI rates has been achieved, from 0.9% for the pre-intervention period in 2019 to 0.7% for the post-intervention period in 2020 (p = 0.004). Application of the Six Sigma DMAIC approach could significantly reduce the SSI rates. It also could help hospital administrators and quality management personnel to create a culture of patient safety.
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Diabetic foot ulcers (DFUs) are considered the most challenging forms of chronic ulcerations to handle their multifactorial nature. It is necessary to establish a comprehensive treatment plan, accurate, and systematic evaluation of a patient with a DFU. This paper proposed an image recognition of diabetic foot wounds to support the effective execution of the treatment plan. In the severity of a diabetic foot ulcer, we refer to the current qualitative evaluation method commonly used in clinical practice, developed by the International Working Group on the Diabetic Foot: PEDIS index, and the evaluation made by physicians. The deep neural network, convolutional neural network, object recognition, and other technologies are applied to analyze the classification, location, and size of wounds by image analysis technology. The image features are labeled with the help of the physician. The Object Detection Fast R-CNN method is applied to these wound images to build and train machine learning modules and evaluate their effectiveness. In the assessment accuracy, it can be indicated that the wound image detection data can be as high as 90%.
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Diabetes Mellitus , Pie Diabético , Pie Diabético/diagnóstico , Pie Diabético/terapia , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Aprendizaje Automático , Redes Neurales de la ComputaciónRESUMEN
To investigate the impact of chronic hepatitis on cardiovascular events in patients with type 2 diabetes mellitus (T2DM). This nationwide retrospective cohort study included 152,709 adult patients (> 20 years) with T2DM enrolled in the National Health Insurance Diabetes Pay-for-Performance Program from 2008 to 2010 and followed up until the end of 2017. Patients were categorized into groups with hepatitis B, hepatitis C, fatty liver disease, and patients without chronic hepatitis. The incidence of cardiovascular events in patients with T2DM and hepatitis C (79.9/1000 person-years) was higher than that in patients with diabetes combined with other chronic hepatitis, or without chronic hepatitis. After adjusting for confounding factors, T2DM with fatty liver (adjusted hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.07-1.13) and hepatitis C (adjusted HR: 1.09; 95% CI: 1.03-1.12) demonstrated a significantly higher risk of cardiovascular events. The adjusted visit-to-visit coefficient of variation of HbA1c and fasting blood glucose were associated with a high risk of cardiovascular events (HRs of the highest quartile were 1.05 and 1.12, respectively). Chronic hepatitis affects cardiovascular events in adult patients with T2DM. Glucose variability could be an independent risk factor for cardiovascular events in such patients.
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Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Hepatitis Crónica , Adulto , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Hepatitis C/complicaciones , Hepatitis Crónica/complicaciones , Humanos , Incidencia , Reembolso de Incentivo , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiologíaRESUMEN
Among patients with type 2 diabetes mellitus (T2DM), the association between hyperspectral imaging (HSI) examination and diabetic neuropathy (DN) is ascertained using HSI of the feet using four types of spectral difference measurements. DN was evaluated by traditional Michigan Neuropathy Screening Instrument (MNSI), evaluation of painful neuropathy (ID-Pain, DN4) and sudomotor function by measuring electrochemical skin conductance (ESC). Of the 120 T2DM patients and 20 healthy adults enrolled, T2DM patients are categorized into normal sudomotor (ESC >60 µS) and sudomotor dysfunction (ESC ≤ 60 µS) groups. Spectral difference analyses reveal significant intergroup differences, whereas traditional examinations cannot distinguish between the two groups. HSI waveform reflectance gradually increases with disease severity, at 1400 to 1600 nm. The area under the curve (AUC) of receiver operating characteristic (ROC) analysis for abnormal ESC is ≥0.8 for all four HSI methods. HSI could be an objective, sensitive, rapid, noninvasive and remote approach to identify early small-fiber DN.
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Diabetes Mellitus Tipo 2 , Neuropatías Diabéticas , Adulto , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Neuropatías Diabéticas/diagnóstico por imagen , Pie , Respuesta Galvánica de la Piel , Humanos , Imágenes HiperespectralesRESUMEN
AIMS/INTRODUCTION: Currently, the impact of hospital-wide glycemic control interventions on length of hospital stay (LOS) and readmission rates are largely unknown. We investigated the impact of a 4-year hospital-wide remote glycemic management program on LOS and 30-day readmission rates among hospitalized adults who received glucose monitoring. MATERIALS AND METHODS: In this retrospective study, hospitalized patients who received glucose monitoring were classified into groups 1 (high glucose variability), 2 (hypoglycemia), 3 (hyperglycemia) and 4 (relatively stable). The monthly percentage changes, and average monthly percentage changes of hyperglycemia, hypoglycemia and treat to target were determined using joinpoint regression analysis. RESULTS: A total of 106,528 hospitalized patients (mean age 60.9 ± 18.5 years, 57% men) were enrolled. We observed a significant reduction in the percentage of inpatients in poor glycemic control groups (groups 1, 2 and 3, all P < 0.001), and a reciprocal increase in the relatively stable group (group 4) from 2016 to 2019. We found a significant reduction in LOS by 11.4% (10.5-9.3 days, P = 0.002, after adjustment for age, sex, and admission department). The 30-day readmission rate decreased from 29.9% to 29.3%, mainly among those in group 4 in 2019 (P < 0.001 after adjustment of sex, age, admission department and LOS). CONCLUSIONS: Improved glycemic control through a hospital-wide electronic remote glycemic management system reduced LOS and 30-day readmission rates. Findings observed in this study might be associated with the reduction in cost of avoidable hospitalizations.
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Automonitorización de la Glucosa Sanguínea/métodos , Diabetes Mellitus/tratamiento farmacológico , Control Glucémico/normas , Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Consulta Remota/métodos , Glucemia/análisis , Diabetes Mellitus/metabolismo , Diabetes Mellitus/patología , Electrónica , Femenino , Estudios de Seguimiento , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Masculino , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
INTRODUCTION: Renal injury is a common complication of liver cirrhosis and type 2 diabetes mellitus (T2DM). The aim of this study was to analyze the association between cirrhosis and dialysis in patients with T2DM. METHODS: This was a retrospective study of specific patient populations using data collected from the National Health Insurance Research Database, National Health Research Institutes, Taiwan on patients treated between 1999 and 2007. The study population comprised 1271,759 patients with T2DM without cirrhosis, 38,860 patients with cirrhosis without T2DM, 11,487 patients with T2DM and cirrhosis, and 579,173 patients without T2DM and cirrhosis (non-cirrhotic control group). RESULTS: The average incidence of dialysis in patients with T2DM and liver cirrhosis (2.466%) was 10.6-, 2.3-, and 102.7-fold higher than that in patients with T2DM without cirrhosis (0.232%), with cirrhosis without T2DM (1.071%), and patients without both T2DM and cirrhosis (0.024%), respectively. Adjusted odds ratio (OR) for dialysis risk was 3.19 in patients with T2DM and cirrhosis, 2.16 in patients with T2DM without cirrhosis, and 1.98 in patients with cirrhosis without T2DM, compared to that in patients without T2DM and cirrhosis. Male sex (adjusted hazard ratio [HR] 1.15), age (45-49 vs. 20-34 years [reference]; adjusted HR 1.34), low-income households (adjusted HR 1.46), cirrhosis (adjusted HR 3.42), and diabetic complications severity index (adjusted HR 1.71) were predictors of dialysis in T2DM patients. In addition, those with T2DM participating in the pay-for-performance (P4P) program had a significantly lower relative risk for requiring dialysis (HR 0.64). CONCLUSION: Liver cirrhosis is an independent risk factor for dialysis in patients with T2DM. Participating in the P4P program for diabetes care may reduce the risk of requiring dialysis in patients with T2DM.
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Objective: Better glycemic control for hospitalized diabetic patients significantly reduces health expenditures and improves disease outcomes. We developed a dynamic dashboard with a remote management system and evaluated its impact on inpatient glycemic control. Methods: This was an observational institution-wide study; study participants were enrolled from a 1,500-bed public medical center from 2016 to 2018. We evaluated the impact of a dynamic dashboard system, which analyzed and monitored all glucose data with virtual glycemic management recommendation by a team of endocrinologists, over 3 × 1-year periods: 2016 (pre-implementation), 2017 (development), and 2018 (implementation). Results: A total of 51,641 discharges with 878,159 blood glucose measurements were obtained during the 3-year period. After implementation of the dashboard system, the proportion of patients with poor glycemic control (hyperglycemia or hypoglycemia) was reduced by 31% (from 10.2 to 7.0 per day per 100 patients with glucose monitoring; P<.001); hyperglycemia decreased by 25% (from 6.1 to 4.6 per day per 100 patients with glucose monitoring; P<.001), and hypoglycemia decreased by 45% (from 4.2 to 2.3 per day per 100 patients with glucose monitoring; P<.001). Furthermore, the trend in the proportion of patients within the treat-to-target range showed significant improvement (P<.001) during the development period, with effectiveness maintained throughout the implementation period. Conclusion: We successfully installed a dynamic, electronic medical records-based dashboard monitoring system to improve inpatient glycemic control. The system, supported by a team of endocrinologists via remote recommendations, could efficiently fill an important need for improved glycemic management among hospitalized adults. Abbreviations: CDE = certified diabetes educator; DM = diabetes mellitus; EMR = electronic medical record; POC = point-of-care; TCVGH = Taichung Veterans General Hospital; UCSF = University of California, San Francisco; U.S. = United States; vGMS = virtual glucose management service.
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Automonitorización de la Glucosa Sanguínea , Adulto , Glucemia , Humanos , Hiperglucemia , Hipoglucemia , San FranciscoRESUMEN
BACKGROUND/PURPOSE: Diabetes mellitus (DM) and DM-related complications place a high socioeconomic burden on individuals and society. Updating nationwide information periodically is thus pivotal to preventing DM and improving its management in Taiwan. METHODS: We used the National Health Insurance Research Database; disease diagnosis codes were assigned according to the International Classification of Diseases, 9th Revision, Clinical Modification. DM was defined as ≥3 outpatient visits or 1 hospitalization within a year. We excluded individuals with gestational DM, those with missing data, and those aged >100 years. Type 1 DM (T1DM) was defined based on information from the catastrophic illness registry. RESULTS: From 2005 to 2014, total population with DM increased by 66% and age-standardized prevalence in patients aged 20-79 years increased by 41%. The DM prevalence was generally higher in men; however, the prevalence was higher in women aged ≥65 years. The prevalence of DM was approximately 50% in those aged >80 years. DM incidence increased by 19%; the increase was most obvious in patients aged 20-39 years (p < 0.001). The standardized incidence of T1DM slightly decreased by 11% (p = 0.118) and standardized prevalence of T1DM increased from 0.04% to 0.05%. Number of T1DM accounted for 0.51-0.59% of the entire diabetic population during the observation period. CONCLUSION: DM prevalence is continually increasing, but the incidence only marginally increased from 2005 to 2014. Moreover, DM is a major problem in elderly people. The higher incidence of DM in men is consistent with the pandemic of overweight and obesity in men in Taiwan.
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Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus/epidemiología , Programas Nacionales de Salud/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Lineales , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Distribución por Sexo , Tasa de Supervivencia/tendencias , Taiwán/epidemiología , Adulto JovenRESUMEN
Both diabetic peripheral neuropathy and peripheral arterial disease (PAD) cause foot ulcers and often result in non-traumatic amputations in patients with type 2 diabetes. This study aimed to evaluate the association between clinical variables, PAD, and subclinical diabetic small fiber peripheral neuropathy detected by abnormal thermal thresholds of the lower extremities in patients with type 2 diabetes.We investigated 725 consecutive patients with type 2 diabetes (male/female: 372/353; mean age, 67â±â11 years) who did not have apparent cardiovascular disease (including coronary artery disease, arrhythmia, and stroke) and who underwent the quantitative sensory test for thermal (warm and cold) thresholds of the lower limbs and ankle-brachial index (ABI)/toe-brachial index (TBI) examinations in 2015. The analyses included glycated hemoglobin, estimated glomerular filtration rate, and other characteristics.In total, 539 (74.3%) patients showed an abnormality of at least 1 thermal threshold in their feet. All patients with an abnormal ABI (<0.9) had concurrent impaired thermal thresholds, and 93% (87/94) of patients with an abnormal TBI experienced abnormal thermal thresholds in the lower limbs. Age- and sex-adjusted TBI and estimated glomerular filtration rate were significantly correlated to abnormal thermal thresholds. In the multivariate analysis, fasting plasma glucose, and glycated hemoglobin were independently associated with abnormal thermal thresholds in the lower extremities.Subclinical thermal threshold abnormalities of the feet are significantly associated with PAD and nephropathy in patients who have type 2 diabetes without cardiovascular disease.
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Diabetes Mellitus Tipo 2/fisiopatología , Pie Diabético/fisiopatología , Enfermedad Arterial Periférica/fisiopatología , Umbral Sensorial/fisiología , Temperatura , Anciano , Índice Tobillo Braquial , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/complicaciones , Femenino , Tasa de Filtración Glomerular , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/complicaciones , Estudios Retrospectivos , Distribución por Sexo , Encuestas y CuestionariosRESUMEN
Patients with diabetes are at a high risk of lower extremity amputations and may have a reduced life expectancy. Taiwan has implemented a diabetes pay-for-performance (P4P) program providing team care to improve the control of disease and avoid subsequent complications. Few studies investigated the effects of adopting a nationalized policy to decrease amputation risk in diabetes previously. Our study aimed to analyze the impact of the P4P programs on the incidence of lower extremity amputations in Taiwanese patients with diabetes.This was a population-based cohort study using the Taiwan National Health Insurance Research Database (which provided coverage for 98% of the total population in Taiwan) from 1998 to 2007. Patients with diabetes were identified based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes. We linked procedure codes to inpatient claims to identify patients hospitalized for nontraumatic lower extremity amputations.A total of 9738 patients with diabetes with amputations were enrolled (mean age ± standard deviation: 64.4â±â14.5 years; men: 63.9%). The incidence of nontraumatic diabetic lower extremity amputations decreased over the time period studied (3.79-2.27 per 1000 persons with diabetes). Based on the Cox proportional hazard regression model, male sex (hazard ratio: 1.83, 95% confidence interval [CI] 1.76-1.92), older age, and low socioeconomic status significantly interact with diabetes with respect to the risks of amputation. Patients who did not join the P4P program for diabetes care had a 3.46-fold higher risk of amputation compared with those who joined (95% CI 3.19-3.76).The amputation rate in Taiwanese diabetic patients decreased over the time period observed. Diabetes in patients with low socioeconomic status is associated with an increased risk of amputations. Our findings suggested that in addition to medical interventions and self-management educations, formulate and implement of medical policies, such as P4P program, might have a significant effect on decreasing the diabetes-related amputation rate.
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Amputación Quirúrgica/economía , Pie Diabético/cirugía , Programas Nacionales de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Reembolso de Incentivo/estadística & datos numéricos , Anciano , Amputación Quirúrgica/estadística & datos numéricos , Estudios de Cohortes , Pie Diabético/epidemiología , Femenino , Humanos , Incidencia , Extremidad Inferior/cirugía , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Clase Social , Taiwán/epidemiologíaRESUMEN
In addition to increased risks of macrovascular and microvascular complications, patients with type 2 diabetes mellitus (T2DM) usually also are at increased risk for cognitive impairment and dementia. Hypoglycemia, a common consequence of diabetes treatment, is considered an independent risk factor for dementia in patients with T2DM. Hypoglycemia and dementia are clinically underestimated and are related to poor outcomes; thus, they may compromise the life expectancy of patients with T2DM. Epidemiological evidence of hypoglycemia-associated cognitive decline and dementia is highly varied. Acute, severe hypoglycemic episodes induce chronic subclinical brain damage, cognitive decline, and subsequent dementia. However, the effects of recurrent moderate hypoglycemia on cognitive decline and dementia remain largely uninvestigated. Poor glycemic control (including fluctuation of hemoglobin A1C [HbA1c] and glucose values) and the viscous circle of bidirectional associations between dementia and hypoglycemia may be clinically relevant. The possible pathophysiological hypotheses include post-hypoglycemic neuronal damage, inflammatory processes, coagulation defects, endothelial abnormalities, and synaptic dysfunction of hippocampal neurons during hypoglycemia episodes. This article reviews previous findings, provides insight into the detection of groups at high risk of hypoglycemia-associated dementia, and proposes specific strategies to minimize the potential burdens associated with hypoglycemia-related neurocognitive disorders in patients with T2DM.
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Demencia/etiología , Diabetes Mellitus Tipo 2/complicaciones , Hipoglucemia/complicaciones , Glucemia/análisis , Trastornos del Conocimiento/sangre , Trastornos del Conocimiento/etiología , Demencia/sangre , Demencia/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Hemoglobina Glucada/análisis , Humanos , Hipoglucemia/sangre , Hipoglucemiantes/uso terapéutico , Factores de RiesgoRESUMEN
OBJECTIVES: To examine factors that influenced continuing care participation in patients with diabetes and factors contributing to interrupted participation for patients with diabetes enrolled in a diabetes pay-for-performance (P4P) program in Taiwan. STUDY DESIGN: Retrospective cohort analysis. METHODS: Data were obtained from Taiwan's National Health Insurance Research Database on patients with a new confirmed diagnosis of type 2 diabetes during 2001 to 2008, selected as 1:1 propensity score-matched P4P program enrollees and nonenrollees (totaling 396,830). Logistic regression was performed to analyze factors associated with continuing care participation and with interrupted P4P program participation after enrollment. RESULTS: Among the patients with diabetes, P4P program enrollees were 4.27 times (95% CI, 4.19-4.36) more likely to participate in continuing care than nonenrollees. Factors affecting the participation of patients with diabetes in continuing care included P4P program enrollment status, personal characteristics, health status, characteristics of the main physician, and characteristics of the main healthcare organization. Interruption of P4P program participation occurred in 78,759 (44.33%) of the enrolled patients with diabetes and was correlated with male gender, younger age (< 35 years), residence in areas of highest urbanization, greater severity of diabetes complications, presence of catastrophic illness/injury, high service volume at the site of the main physician, older age (≥55 years) of the main physician, having a regional or private hospital as the main healthcare organization, and change of physician. CONCLUSIONS: Taiwan's diabetes P4P program increased continuing care participation in patients with diabetes. The rate of interruption of P4P program participation among enrolled patients with diabetes, at 44.33%, should be a focus of improvement for Taiwan's health authorities.
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Continuidad de la Atención al Paciente , Diabetes Mellitus Tipo 2/terapia , Participación del Paciente , Reembolso de Incentivo , Adulto , Anciano , Estudios de Cohortes , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos , Taiwán/epidemiologíaRESUMEN
Progressive rising population of diabetes and related nephropathy, namely, diabetic kidney disease and associated end stage renal disease has become a major global public health issue. Results of observational studies indicate that most diabetic kidney disease progresses over decades; however, certain diabetes patients display a rapid decline in renal function, which may lead to renal failure within months. Although the definition of rapid renal function decline remained speculative, in general, it is defined by the decrease of estimated glomerular filtration rate (eGFR) in absolute rate of loss or percent change. Based on the Kidney Disease: Improving Global Outcomes 2012 clinical practice guidelines, a rapid decline in renal function is defined as a sustained decline in eGFR of > 5 mL/min per 1.73 m(2) per year. It has been reported that potential factors contributing to a rapid decline in renal function include ethnic/genetic and demographic causes, smoking habits, increased glycated hemoglobin levels, obesity, albuminuria, anemia, low serum magnesium levels, high serum phosphate levels, vitamin D deficiency, elevated systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity values, retinopathy, and cardiac autonomic neuropathy. This article reviews current literatures in this area and provides insight on the early detection of diabetic subjects who are at risk of a rapid decline in renal function in order to develop a more aggressive approach to renal and cardiovascular protection.
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AIMS: Albuminuria and a reduced estimated glomerular filtration rate (eGFR) are known risk factors of poor cardiovascular outcomes in diabetic patients. We here aimed to investigate the determinants of incident albuminuria and rapid progression of renal dysfunction in patients with type 2 diabetes. METHODS: Type 2 diabetic outpatients (n=215) with a mean baseline eGFR of 87±20 mLmin(-1)1.73 m(-2) were followed for 12 months. Urinary albuminuria was defined according to the urine albumin-to-creatinine ratio (UACR). RESULTS: Among 132 patients with normoalbuminuria at baseline, 20 (15.2%) progressed to a more advanced stage of albuminuria within 1 year, and 20.5% of the 215 patients experienced a rapid decline in eGFR (eGFR reduction >5 mLmin(-1)1.73 m(-2)year(-1)). After adjusting for potential confounders, both baseline UACR and systolic blood pressure (SBP) were found to be significant independent factors for incident albuminuria and a rapid decline of eGFR in separate models. Using receiver operating characteristic curves, systolic blood pressures of 132 and 138 mmHg were found to predict incident albuminuria and a rapid decline of eGFR, respectively. CONCLUSIONS: In addition to baseline UACR, SBP is one of the most powerful modifiable independent risk factors for incident albuminuria and a rapid renal function decline in type 2 diabetic patients without symptomatic cardiovascular disease.
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Albuminuria/diagnóstico , Presión Sanguínea , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Nefropatías Diabéticas/diagnóstico , Riñón/fisiopatología , Anciano , Albuminuria/epidemiología , Albuminuria/fisiopatología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/fisiopatología , Progresión de la Enfermedad , Femenino , Tasa de Filtración Glomerular , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
Various epidemiological studies have shown that type 2 diabetes and metabolic syndrome are highly correlated with Alzheimer's disease (AD). Here, we sought to assess the impact of metabolic syndrome characteristics on the progression of AD. Five-week-old male, spontaneously hypertensive (n = 32) and Wistar Kyoto (abbreviated WKY; n = 8) rats were divided into 5 groups (each n = 8): WKY, hypertension (HTN), streptozotocin-induced diabetes (STZ), high-fat diet (HFD), and STZ + high-fat diet-induced diabetes mellitus (DM). All animals were sacrificed and samples of the blood, liver, and brain were collected for further biological analysis. During the 15-week period of induction, the STZ and DM groups (animals injected with low-dose STZ) had significantly higher fasting glucose levels; the HFD group had elevated insulin levels, but normal blood glucose levels. The HFD and DM groups had hypercholesterolemia and higher hepatic levels of triglycerides and cholesterol. Additionally, correlations between HFD and elevated brain amyloid-beta 42 (Aß-42), hyperglycemia and down-regulation of brain insulin receptor, and serum Aß-42 and hepatic triglyceride concentrations (r(2) = 0.41, p < 0.05) were observed. Serum C-reactive protein and malondialdehyde did not appear to have a significant influence on the association with biomarkers of AD. Thus, our study demonstrated that rats with characteristics of metabolic syndrome had a large number of biomarkers predicting AD; however, no relationship between traditional inflammatory and oxidative markers and AD was found. Further studies are necessary to prove that these findings in rats are relevant to AD processes in humans.