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1.
Diabetes Care ; 47(4): 589-593, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38252886

RESUMO

OBJECTIVE: We report mortality outcomes in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) among people with type 2 diabetes diagnosed within 10 years and no recent history of cardiovascular events or cancer. RESEARCH DESIGN AND METHODS: Overall mortality rates and major causes of death were assessed over an average of 5 years of follow-up. Cause of death was adjudicated centrally by a committee masked to treatment assignment. We examined baseline covariates and the 10-year Framingham Risk Score for associations. RESULTS: Mortality rate was low (0.59 per 100 participant-years). Participants who died during follow-up were likely to be older, be male, have a history of hypertension, have a history of smoking, and have moderate albuminuria. The two most common underlying causes of death were "cardiovascular-cause" (a composite of underlying causes) (38.6%) and cancer (26.8%). There were no differences by treatment group. CONCLUSIONS: Among people with diabetes of relatively short duration, cause of death was varied. Attention to health risks beyond cardiovascular diseases is warranted.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Hipertensão , Neoplasias , Humanos , Masculino , Fatores de Risco
2.
N Engl J Med ; 381(6): 520-530, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31173679

RESUMO

BACKGROUND: Observational studies support an association between a low blood 25-hydroxyvitamin D level and the risk of type 2 diabetes. However, whether vitamin D supplementation lowers the risk of diabetes is unknown. METHODS: We randomly assigned adults who met at least two of three glycemic criteria for prediabetes (fasting plasma glucose level, 100 to 125 mg per deciliter; plasma glucose level 2 hours after a 75-g oral glucose load, 140 to 199 mg per deciliter; and glycated hemoglobin level, 5.7 to 6.4%) and no diagnostic criteria for diabetes to receive 4000 IU per day of vitamin D3 or placebo, regardless of the baseline serum 25-hydroxyvitamin D level. The primary outcome in this time-to-event analysis was new-onset diabetes, and the trial design was event-driven, with a target number of diabetes events of 508. RESULTS: A total of 2423 participants underwent randomization (1211 to the vitamin D group and 1212 to the placebo group). By month 24, the mean serum 25-hydroxyvitamin D level in the vitamin D group was 54.3 ng per milliliter (from 27.7 ng per milliliter at baseline), as compared with 28.8 ng per milliliter in the placebo group (from 28.2 ng per milliliter at baseline). After a median follow-up of 2.5 years, the primary outcome of diabetes occurred in 293 participants in the vitamin D group and 323 in the placebo group (9.39 and 10.66 events per 100 person-years, respectively). The hazard ratio for vitamin D as compared with placebo was 0.88 (95% confidence interval, 0.75 to 1.04; P = 0.12). The incidence of adverse events did not differ significantly between the two groups. CONCLUSIONS: Among persons at high risk for type 2 diabetes not selected for vitamin D insufficiency, vitamin D3 supplementation at a dose of 4000 IU per day did not result in a significantly lower risk of diabetes than placebo. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; D2d ClinicalTrials.gov number, NCT01942694.).


Assuntos
Colecalciferol/uso terapêutico , Diabetes Mellitus Tipo 2/prevenção & controle , Suplementos Nutricionais , Estado Pré-Diabético/tratamento farmacológico , Vitaminas/uso terapêutico , Administração Oral , Idoso , Colecalciferol/administração & dosagem , Intervalo Livre de Doença , Método Duplo-Cego , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Fatores de Risco , Falha de Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitaminas/administração & dosagem
3.
Curr Cardiol Rep ; 19(3): 25, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28251513

RESUMO

PURPOSE OF REVIEW: Guidelines for a standard second diabetes medication for the treatment of type 2 diabetes (T2DM) have yet to be established. The rapid increase in the number of newer therapies available makes the choice more difficult. Thus, we reviewed clinical trial evidence evaluating newer therapies available for treatment intensification beyond monotherapy. RECENT FINDINGS: Head-to-head studies comparing newer therapies versus traditional (i.e., sulfonylurea) approaches consistently find lower incidence of hypoglycemia and weight gain with newer therapies. Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter 2 (SGLT2) inhibitors demonstrate high glycemic efficacy, while merits of dipeptidyl peptidase-4 (DPP-4) inhibitors include their tolerability. Secondary effects (weight loss, cardiovascular outcomes, renal function) are of growing interest with newer therapies. Choices for treatment intensification in T2DM diabetes are numerous. Understanding the comparative evidence of newer treatment choices, as provided in this review, may help guide clinical decision making.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Peptídeo 1 Semelhante ao Glucagon , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Humanos , Hipoglicemiantes/efeitos adversos , Transportador 2 de Glucose-Sódio , Inibidores do Transportador 2 de Sódio-Glicose , Compostos de Sulfonilureia
4.
Case Rep Endocrinol ; 2013: 970396, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23533839

RESUMO

Pseudoacromegaly is characterized by an acromegalic appearance without any abnormality of growth hormone function. It may be caused by several congenital and acquired conditions. One such condition is the acromegaloid facial appearance (AFA) syndrome. This condition has been described in approximately eight cases/families. It encompasses a spectrum of acromegaloid physical findings, normal growth hormone (GH) and insulin-like growth factor one (IGF-1) levels, and variable mode of inheritance. The most common physical findings are coarse facies, bulbous nose, and thickened lips. We present a case and a review of the literature on this illness. The patient is a 57-year-old woman who was referred to the endocrinology division for evaluation of suspected acromegaly. She had an acromegaloid appearance since birth as well as a terminal hypertrichosis. Her endocrine laboratory evaluation and chromosomal analyses were normal. AFA needs to be considered when evaluating any patient with pseudoacromegaly. Additional cases/families need to be identified in order to better understand the clinical spectrum, clinical implications, and mode of inheritance of AFA.

5.
J Am Med Dir Assoc ; 13(2): 180-6, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21683662

RESUMO

Minimal trauma fractures are an unfortunate, yet not uncommon, event for frail elderly individuals in long term care facilities. These fractures result in significant morbidity including pain and loss of function along with significantly increased mortality. Further concern exists for the medico-legal issues raised after a minimal trauma fracture is discovered. The controversy at hand is whether such fractures are primarily the result of inadequate, careless, or abusive care practices. We build a case to the contrary. Although the data regarding this condition are limited, there exists a reasonable evidence base to identify an at-risk patient population. We present a representative case and subsequent literature review of minimal trauma fractures to illustrate the condition, including risk factors, mode of presentation, and patient outcomes. No direct research has been conducted on the pathophysiology of these fractures. Extrapolating from other similar conditions and likely associated comorbid illnesses, we explore possible physiologic explanations for their occurrence. Again, no direct investigation into prevention or treatment of minimal trauma fractures has been published. Instead, we consider a variety of pharmacologic and nonpharmacologic interventions that may modify the risk for minimal trauma fractures considering the previously identified risk factors and probable pathophysiologic changes leading to fracture development. We propose that reducing minimal trauma fractures in the frail elderly nursing home population will require careful staff education, close attention to identify at-risk patients, and implementation of select interventions aimed at preventing such fractures.


Assuntos
Acidentes por Quedas/prevenção & controle , Demência/diagnóstico , Fixação Interna de Fraturas/métodos , Prevenção Primária/métodos , Gestão da Qualidade Total , Idoso de 80 Anos ou mais , Demência/complicações , Feminino , Seguimentos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/prevenção & controle , Fraturas do Quadril/cirurgia , Instituição de Longa Permanência para Idosos , Humanos , Escala de Gravidade do Ferimento , Radiografia , Medição de Risco , Instituições de Cuidados Especializados de Enfermagem , Texas , Resultado do Tratamento
6.
Int J Eat Disord ; 39(1): 80-3, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16231340

RESUMO

OBJECTIVE: The objectives of the current study were to investigate risky weight control measures (vomiting or pills) among university students in Lebanon and to assess their relation to demographic, scholastic, and health risk behavioral characteristics. METHOD: The study used a cross-sectional design. A proportionate random sample of 2,013 students was selected from public and private universities in Greater Beirut. Each participant completed a self-administered anonymous questionnaire. RESULTS: Among participating students, 123 (6.1%) reported practicing risky weight control measures. Multivariate analysis indicated that younger females, cigarette smokers, engaged/married students, and those with a higher body mass index (BMI) were at increased odds of performing risky weight control measures. CONCLUSION: Health awareness measures need to be proposed and, if possible, implemented to better define the motives and methods of weight reduction among Lebanese youth.


Assuntos
Peso Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Assunção de Riscos , Estudantes/estatística & dados numéricos , Universidades , Feminino , Humanos , Masculino , Inquéritos e Questionários , Redução de Peso
7.
Addiction ; 98(7): 933-9, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12814499

RESUMO

AIMS: The objective was to determine the prevalence of smoking [cigarettes and/or narghile (i.e. water-pipe)] among university students and to examine multiple correlates. DESIGN: Cross-sectional. SETTING: Beirut, Lebanon. PARTICIPANTS: A proportionate random sample of 1964 students from public and private universities in Beirut, Lebanon. MEASUREMENTS: Participants completed a self-administered anonymous questionnaire that included demographic and scholastic items and health behavioral aspects, including smoking, alcohol, physical activity, weight control measures and seat belt use. FINDINGS: The overall prevalence of smoking was 40% (21.1%, 7.6% and 11.3% of the students were smoking only narghile, only cigarettes and both cigarettes and narghile, respectively). Regression analyses showed that males, those of non-Lebanese origin, pursuing undergraduate degrees, performing risky weight control measures and drinking excessive amounts of alcohol had increased odds of smoking cigarettes. Also, age, high level of paternal education and field of study were significant predictors. Narghile smoking was significantly higher among males who drank excessive alcohol. CONCLUSIONS: The authors advocate a collaborative effort to alleviate the consequences of smoking among university students.


Assuntos
Fumar/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Líbano/epidemiologia , Modelos Logísticos , Masculino , Prevalência , Fatores de Risco , Assunção de Riscos , Distribuição por Sexo , Estudantes , Inquéritos e Questionários , Universidades
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