RESUMEN
PURPOSE: To determine the utility of estimated glucose disposal rate (eGDR) as a candidate biomarker for thrombotic biomarkers in patients with type 1 diabetes (T1D). METHODS: We reanalysed baseline pretreatment data in a subset of patients with T1D from two previous RCTs, consisting of a panel of thrombotic markers, including fibrinogen, tissue factor (TF) activity, and plasminogen-activator inhibitor (PAI)-1, and TNFα, and clinical factors (age, T1D duration, HbA1c, insulin requirements, BMI, blood pressure, and eGDR). We employed univariate linear regression models to investigate associations between clinical parameters and eGDR with thrombotic biomarkers. RESULTS: Thirty-two patients were included [mean ± SD age 31 ± 7 years, HbA1c of 58 ± 9 mmol/mol (7.5 ± 0.8%), eGDR 7.73 ± 2.61]. eGDR negatively associated with fibrinogen (P < 0.001), PAI-1 concentrations (P = 0.005), and TF activity (P = 0.020), but not TNFα levels (P = 0.881). We identified 2 clusters of patients displaying significantly different characteristics; 56% (n = 18) were categorised as 'higher-risk', eliciting significantly higher fibrinogen (+ 1514 ± 594 µg/mL; P < 0.001), TF activity (+ 59.23 ± 9.42 pmol/mL; P < 0.001), and PAI-1 (+ 8.48 ± 1.58 pmol/dL; P < 0.001), HbA1c concentrations (+ 14.20 ± 1.04 mmol/mol; P < 0.001), age (+ 7 ± 3 years; P < 0.001), duration of diabetes (15 ± 2 years; P < 0.001), BMI (+ 7.66 ± 2.61 kg/m2; P < 0.001), and lower mean eGDR (- 3.98 ± 1.07; P < 0.001). CONCLUSIONS: Compared to BMI and insulin requirements, classical surrogates of insulin resistance, eGDR is a suitable and superior thrombotic risk indicator in T1D. TRIAL REGISTRATION: ISRCTN4081115; registered 27 June 2017.
Asunto(s)
Glucemia , Diabetes Mellitus Tipo 1 , Fibrinógeno/análisis , Hemoglobina Glucada , Insulina/uso terapéutico , Inhibidor 1 de Activador Plasminogénico/sangre , Tromboplastina/análisis , Trombosis , Adulto , Biomarcadores/análisis , Biomarcadores/sangre , Coagulación Sanguínea/fisiología , Glucemia/análisis , Glucemia/metabolismo , Índice de Masa Corporal , Análisis por Conglomerados , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/metabolismo , Femenino , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismo , Humanos , Resistencia a la Insulina , Masculino , Agregación Plaquetaria/fisiología , Medición de Riesgo , Trombosis/sangre , Trombosis/diagnóstico , Trombosis/etiologíaRESUMEN
Problem-based learning should be continued and extended to more topics. However, the steps and details of the process should be modified to each group of students. The students and tutors should have a period for preparing themselves for the process. The learning media should be improved in quality, quantity and variety to serve almost all of the students.