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1.
Georgian Med News ; (312): 71-74, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33964830

RESUMEN

The clinical picture and course of lichen planus (LP) on the mucous membrane of the oral cavity have significant differences from its manifestations on the skin. In particular, greater resistance to treatment, which is due to the structural features of the mucous membrane, as well as the specificity of biological and physicochemical processes in the oral cavity. There are 6 clinical forms of LP of the red border of the lips and oral mucosa - typical, hyperkeratotic, exudative-hyperemic, erosive - ulcerative, bullous and atypical. The variety of clinical manifestations and low effectiveness of treatment present certain difficulties and interest not only for dentists, but also for dermatologists in terms of diagnostics and treatment of LP with localization on the oral mucosa. A clinical case of a rare triad of symptoms of erosive lichen planus (LP) of the oral cavity, hypertension and diabetes mellitus - Grinshpan-Potekaev syndrome is presented. In the described clinical case, a 65-year-old female patient took antihypertensive drugs for a long time for arterial hypertension. Type 2 diabetes mellitus was latent and was diagnosed after contacting our clinic. Complex therapy with Delagil, tetracycline, application of corticosteroid preparations and protopic cream (on the oral mucosa) along with effective antihypertensive and antidiabetic treatment led to a rapid regression of the manifestations of LP with complete epithelialization of erosions.


Asunto(s)
Diabetes Mellitus Tipo 2 , Liquen Plano Oral , Liquen Plano , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Humanos , Liquen Plano/diagnóstico , Liquen Plano/tratamiento farmacológico , Liquen Plano Oral/diagnóstico , Liquen Plano Oral/tratamiento farmacológico , Mucosa Bucal , Piel
2.
Rev Bras Epidemiol ; 24(suppl 1): e210010, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33886883

RESUMEN

OBJECTIVE: To analyze the contextual factors associated with type II diabetes mellitus in Belo Horizonte City. METHODS: Cross-sectional study with 5,779 adults living in Belo Horizonte City, participating in the Risk and Protection Factors Surveillance System for Chronic Diseases through Telephone Survey (Vigitel), in 2008, 2009, and 2010. Multilevel regression models were used to test the association between contextual indicators of physical and social environments, and self-reported diagnosis of diabetes, adjusted for individual sociodemographic and lifestyle factors. Descriptive analyzes and multilevel logistic regression models were used, considering a 5% significance level. RESULTS: The prevalence of diabetes was 6.2% (95%CI 5.54 - 6.92), and 3.1% of the variability of chance of presenting diabetes were explained by contextual characteristics. Living in areas with high density of private places for physical activity and high income was associated with a lower chance of having diabetes. The areas with high level of social vulnerability were strongly associated with the chance of presenting diabetes, adjusted for individual characteristics. CONCLUSION: Characteristics of physical and social environments were associated with the chance of diabetes occurrence. Urban centers with opportunities to adopt healthy behaviors can help to reduce the occurrence of diabetes and its complications.


Asunto(s)
Diabetes Mellitus Tipo 2 , Adulto , Brasil , Ciudades , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Humanos , Análisis Multinivel , Autoinforme , Factores Socioeconómicos
3.
Mymensingh Med J ; 30(2): 447-452, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33830127

RESUMEN

Type 2 diabetic mellitus (T2DM) patients with sub-clinical cardiac autonomic neuropathy (CAN), which precedes clinically apparent CAN, may have reduced heart rate variability (HRV); yet may remain undetected by conventional autonomic test. The objective of this study was to explore the short-term HRV by power spectral analysis as a tool to detect sub-clinical diabetic cardiac autonomic neuropathy (CAN). This cross -sectional study included 30 recently diagnosed and 54 long-term T2DM male patients (aged 45 to 55 years and without any symptoms of CAN) and 30 age and body mass index (BMI) matched healthy male subjects as controls. This study was done from January 2015 to January 2016 in Endocrinology OPD, BSMMU, who were previously or then diagnosed by the physician at this very OPD following the diagnostic criteria set by the American Diabetes Association Ewing battery of cardiovascular reflex tests (CARTs) was performed to rule out signs of autonomic neuropathy in enrolled patients. Power spectral analysis of frequency domain signals of short term HRV were done by digital data acquisition device RMS Polyrite-D. For statistical analysis, One way ANOVA and independent sample 't' test were used. LF power, HF power and HF normalized units (nu) were significantly lower, and LF nu and LF/HF were significantly higher in long-term T2DM compared to recently diagnosed T2DM (p<0.05) and control (p<0.001). LF power (p<0.01) and HF power (p<0.001) were significantly lower in recently diagnosed T2DM compared to control. Results from this study demonstrate the presence of autonomic dysfunction in CAN asymptomatic long-term T2DM patients. Short-term HRV, thus, seems to be an invaluable tool to detect sub-clinical diabetic CAN.


Asunto(s)
Diabetes Mellitus Tipo 2 , Neuropatías Diabéticas , Sistema Nervioso Autónomo , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Neuropatías Diabéticas/diagnóstico , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad
4.
Vasc Health Risk Manag ; 17: 69-76, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33692625

RESUMEN

Purpose: To determine if further endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization improves the clinical outcomes regarding major amputation rate, rate of secondary interventions, and mortality in diabetic type-II patients presented with critical lower limb ischemia (CLI). Patients and Methods: This is a retrospective study in which all type-II diabetic patients with CLI at King Abdullah University Hospital between October 2015 and September 2019 were identified. Patients with concomitant femoropopliteal and infrapopliteal vessels atherosclerotic lesions (total occlusion or more than 50% stenosis) who received successful endovascular treatment were included. Patients were divided into 2 groups. Group-I included patients treated for femoropopliteal segment alone, while Group-II included patients treated for both femoropopliteal and infrapopliteal segments. The outcomes of the two groups were compared regarding major amputation rate, rate of secondary interventions, and mortality. In addition, demographic data, atherosclerotic lesions distributions and cardiovascular risk factors were also collected and analyzed. Results: In all, 90 patients (65 males and 25 females) with a mean age of 67.5±12 years were included. In Group-I; 44 patients (48.9%) were included (36 males and 8 females) with a mean age of 67±12 years. In group-II; 46 patients (51.1%) were included (29 males and 17 females) with a mean age of 68±13 years. The major amputation rate was higher and statistically significant in Group-I (38.6% vs 17.4%, p-value = 0.034). However, the secondary interventions and the mortality rates showed no statistically significant differences (56.8% vs 39.1%, p-value = 0.139) and (22.7% vs 28.3%, p-value = 0.632), respectively. Conclusion: Endovascular infrapopliteal angioplasty in combination with femoropopliteal revascularization in diabetic type-II patients with CLI improves the clinical outcome regarding major amputation rate. However, there were no significant differences regarding the rate of secondary interventions and the mortality rate.


Asunto(s)
Diabetes Mellitus Tipo 2 , Angiopatías Diabéticas/terapia , Procedimientos Endovasculares , Arteria Femoral , Isquemia/terapia , Arteria Poplítea , Anciano , Anciano de 80 o más Años , Amputación , Enfermedad Crítica , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Angiopatías Diabéticas/diagnóstico por imagen , Angiopatías Diabéticas/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Femenino , Arteria Femoral/diagnóstico por imagen , Humanos , Isquemia/diagnóstico por imagen , Isquemia/mortalidad , Jordania/epidemiología , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Arteria Poplítea/diagnóstico por imagen , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
5.
Ter Arkh ; 93(1): 87-93, 2021 Jan 10.
Artículo en Ruso | MEDLINE | ID: mdl-33720632

RESUMEN

Assesment of arterial stiffness the substantional prognostic factor for evaluating complications of cardiovascular diseases (CVD) in patients with atherosclerosis, hypertension and type 2 diabetes, may be performed using different parameters, including cardio-ankle vascular index (CAVI). The main purpose of this review is to analyze data from studies where CAVI is used to test the arterial wall stiffness in magistral vessels. CAVI measurement is non-invasive and performed by portable devices which makes it comfortable for ambulatory use in patients who come for a check-up and also in those who already are hospitalized. It does not require any special knowledge from investigator and the test lasts a couple of minutes long. CAVI does not depend on blood pressure changes and is more specific in structural changes of arterial wall assessment than brachial-ankle pulse wave velocity (baPWV). CAVI shows considerable correlation with markers of CVD like atherosclerotic plaques in vessels, diastolic disfunction of left ventricle and angina pectoris. CAVI may be used for early monitoring and assessing the lesions of target organs in patients with atherosclerosis, chronic hypertension and type 2 diabetes. Establishing CAVI as a standart parameter in assessing patients who are at risk of CVD can help to improve complications prevention, reduce mortality and prolong their lifespan.


Asunto(s)
Diabetes Mellitus Tipo 2 , Rigidez Vascular , Tobillo , Índice Tobillo Braquial , Presión Sanguínea , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Humanos , Análisis de la Onda del Pulso
6.
Aten Primaria ; 53(4): 101983, 2021 04.
Artículo en Español | MEDLINE | ID: mdl-33743202

RESUMEN

The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.


Asunto(s)
Algoritmos , Lista de Verificación , Diabetes Mellitus Tipo 2/terapia , Consulta Remota/métodos , Terapia Combinada , Diabetes Mellitus Tipo 2/diagnóstico , Dietoterapia/métodos , Terapia por Ejercicio , Humanos , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación , Consulta Remota/normas
7.
Medicine (Baltimore) ; 100(10): e25100, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725905

RESUMEN

BACKGROUND: Mitochondrial diabetes mellitus (MDM) is characterized by maternal inheritance, progressive neurosensory deafness, insulin secretory disorder, and progressive microvascular complications. Mitochondria are critical organelles that provide energy in the form of adenosine triphosphate (ATP). An impairment of ATP production in pancreatic ß cells is regarded as the main cause of the insulin secretory disorder in patients with MDM, and these patients require insulin replacement therapy early after the diagnosis. The amino acid 5-aminolevulinic acid (5-ALA), a precursor of heme metabolites, is a non-proteinogenic δ amino acid synthesized in mitochondria. An addition of ferrous iron to 5-ALA enhances heme biosynthesis and increases ATP production through an upregulation of the respiratory complex. Several studies have reported that the administration of 5-ALA and ferrous iron to existing treatment improved the glycemic control in both patients with prediabetes and those with type 2 diabetes mellitus. The additional administration of 5-ALA and ferrous iron to MDM patients on insulin therapy may improve their insulin secretory capacity and glycemic control by improving their mitochondrial function. The findings of this study are expected to provide new treatment options for MDM and improve the patients' glycemic control and prognosis. METHODS/DESIGN: This study is a single-arm, open-label pilot intervention study using clinical endpoints to investigate the effects of treatment with 5-ALA plus sodium ferrous citrate (SFC) to patients with MDM on their glucose tolerance. A total of 5 patients with MDM will be administered 5-ALA/SFC (200 mg/d) for 24 weeks. We will perform a 75-g oral glucose tolerance test before and at 24 weeks after the start of this 5-ALA/SFC treatment to evaluate glucose-dependent insulin responses. DISCUSSION: To the best of our knowledge, this study will be the first assessment of the effects of 5-ALA/SFC in patients with MDM. This study will obtain an evidence regarding the effectiveness and safety of 5-ALA/SFC for patients with MDM. TRIAL REGISTRATION: This study was registered with the University Hospital Medical Information Network (UMIN000040581) on July 1, 2020 and with the Japan Registry of Clinical Trials (jRCTs071200025) on August 3, 2020.


Asunto(s)
Sordera/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Compuestos Ferrosos/administración & dosificación , Intolerancia a la Glucosa/tratamiento farmacológico , Insulina/administración & dosificación , Ácidos Levulínicos/administración & dosificación , Enfermedades Mitocondriales/tratamiento farmacológico , Adenosina Trifosfato/metabolismo , Adulto , Glucemia/análisis , Sordera/sangre , Sordera/diagnóstico , Sordera/patología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/patología , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/métodos , Femenino , Compuestos Ferrosos/efectos adversos , Intolerancia a la Glucosa/sangre , Intolerancia a la Glucosa/diagnóstico , Intolerancia a la Glucosa/patología , Prueba de Tolerancia a la Glucosa , Humanos , Japón , Ácidos Levulínicos/efectos adversos , Masculino , Mitocondrias/efectos de los fármacos , Mitocondrias/patología , Enfermedades Mitocondriales/sangre , Enfermedades Mitocondriales/diagnóstico , Enfermedades Mitocondriales/patología , Proyectos Piloto , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 100(11): e25081, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725985

RESUMEN

ABSTRACT: This work aims to explore risk factors for ischemic stroke in young adults and analyze the Traditional Vascular Risk Factors Model based on age, hypertension, diabetes, smoking history, and drinking history. Further, the Lipid Metabolism Model was analyzed based on lipoprotein a [LP (a)], high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein AI (apo AI), apolipoprotein B (apo B), and the Early Renal Injury Model based on urinary microalbuminuria/creatinine ratio (UACR). Besides, we estimated glomerular filtration rate (eGFR), cystatin C (Cys-C), homocysteine (Hcy), ß2 microglobulin (ß2m), and validated their predictive efficacy and clinical value for the development of ischemic stroke in young adults.We selected and retrospectively analyzed the clinical data of 565 young inpatients admitted to Zhejiang Provincial Hospital of Chinese Medicine between 2010 and 2020, 187 of whom were young stroke patients. A single-factor analysis was used to analyze the risk factors for stroke in young people and developed a traditional vascular risk factors model, a lipid metabolism model, and an early kidney injury model based on backpropagation (BP) neural networks technology to predict early stroke occurrence. Moreover, the prediction performance by the area under the receiver operating characteristics (ROC) curve (AUC) was assessed to further understand the risk factors for stroke in young people and apply their predictive role in the clinical setting.Single-factor analysis showed that ischemic stroke in young adults was associated with hypertension, diabetes, smoking history, drinking history, LP(a), HDL, LDL, apo AI, apo B, eGFR, Cys-C, and ß2m (P < .05). The BP neural networks technique was used to plot the ROC curves for the Traditional Vascular Risk Factors Model, the Lipid Metabolism Model, and the Early Kidney Injury Model in enrolled patients, and calculated AUC values of 0.7915, 0.8387, and 0.9803, respectively.The early kidney injury model precisely predicted the risk of ischemic stroke in young adults and exhibited a certain clinical value as a reference for morbidity assessment. Whereas the prediction performance of the Traditional Vascular Risk Factors Model and the Lipid Metabolism Model were inferior to that of the early kidney injury model.


Asunto(s)
Reglas de Decisión Clínica , Pruebas de Función Renal/estadística & datos numéricos , Redes Neurales de la Computación , Medición de Riesgo/estadística & datos numéricos , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/diagnóstico , Adolescente , Adulto , Factores de Edad , Consumo de Bebidas Alcohólicas/efectos adversos , Área Bajo la Curva , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Análisis Factorial , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Pruebas de Función Renal/métodos , Lipoproteínas/sangre , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Medición de Riesgo/métodos , Factores de Riesgo , Fumar/efectos adversos , Adulto Joven
9.
Ther Adv Cardiovasc Dis ; 15: 17539447211002678, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33779401

RESUMEN

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors are a relatively new class of antihyperglycemic drug with salutary effects on glucose control, body weight, and blood pressure. Emerging evidence now indicates that these drugs may have a beneficial effect on outcomes in heart failure with reduced ejection fraction (HFrEF). Post-approval cardiovascular outcomes data for three of these agents (canagliflozin, empagliflozin, and dapagliflozin) showed an unexpected improvement in cardiovascular endpoints, including heart failure hospitalization and mortality, among patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease or risk factors. These studies were followed by a placebo controlled trial of dapagliflozin in patients with HFrEF both with and without T2DM, showing a reduction in all-cause mortality comparable to current guideline-directed HFrEF medical therapies such as angiotensin-converting enzyme inhibitors and beta-blockers. In this review, we discuss the current landscape of evidence, safety and adverse effects, and proposed mechanisms of action for use of these agents for patients with HFrEF. The United States (US) and European guidelines are reviewed, as are the current US federally approved indications for each SGLT2 inhibitor. Use of these agents in clinical practice may be limited by an uncertain insurance environment, especially in patients without T2DM. Finally, we discuss practical considerations for the cardiovascular clinician, including within-class differences of the SGLT2 inhibitors currently available on the US market (217/300).


Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , Biomarcadores/sangre , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Progresión de la Enfermedad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Hospitalización , Humanos , Recuperación de la Función , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Resultado del Tratamiento
10.
Circ Heart Fail ; 14(3): e007048, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33663235

RESUMEN

BACKGROUND: Empagliflozin reduces the risk of hospitalization for heart failure in patients with type 2 diabetes and cardiovascular disease. We sought to elucidate the effect of empagliflozin as an add-on therapy on decongestion and renal function in patients with type 2 diabetes admitted for acute decompensated heart failure. METHODS: The study was terminated early due to COVID-19 pandemic. We enrolled 59 consecutive patients with type 2 diabetes admitted for acute decompensated heart failure. Patients were randomly assigned to receive either empagliflozin add-on (n=30) or conventional glucose-lowering therapy (n=29). We performed laboratory tests at baseline and 1, 2, 3, and 7 days after randomization. Percent change in plasma volume between admission and subsequent time points was calculated using the Strauss formula. RESULTS: There were no significant baseline differences in left ventricular ejection fraction and serum NT-proBNP (N-terminal pro-B-type natriuretic peptide), hematocrit, or serum creatinine levels between the 2 groups. Seven days after randomization, NT-proBNP level was significantly lower in the empagliflozin group than in the conventional group (P=0.040), and hemoconcentration (≥3% absolute increase in hematocrit) was more frequently observed in the empagliflozin group than in the conventional group (P=0.020). The decrease in percent change in plasma volume between baseline and subsequent time points was significantly larger in the empagliflozin group than in the conventional group 7 days after randomization (P=0.017). The incidence of worsening renal function (an increase in serum creatinine ≥0.3 mg/dL) did not significantly differ between the 2 groups. CONCLUSIONS: In this exploratory analysis, empagliflozin achieved effective decongestion without an increased risk of worsening renal function as an add-on therapy in patients with type 2 diabetes with acute decompensated heart failure. Registration: URL: https://www.umin.ac.jp/ctr/index.htm; Unique identifier: UMIN000026315.


Asunto(s)
Compuestos de Bencidrilo/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Hospitalización , Riñón/efectos de los fármacos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Compuestos de Bencidrilo/efectos adversos , Biomarcadores/sangre , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Creatinina/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Terminación Anticipada de los Ensayos Clínicos , Femenino , Glucósidos/efectos adversos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Japón , Riñón/fisiopatología , Masculino , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Estudios Prospectivos , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
11.
Medicine (Baltimore) ; 100(12): e25326, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761736

RESUMEN

ABSTRACT: Single-nucleotide polymorphisms (SNPs) in the transcription factor 7-like 2 (TCF7L2) gene have been identified to be associated with the susceptibility to type 2 diabetes mellitus (T2DM) in various populations worldwide, but the results in Chinese are conflicting, and no data are available about the Liannan Yao population. Therefore, this study aimed to investigate the association of the TCF7L2 gene polymorphisms (rs12255372, rs7903146, rs7901695, rs11196205, and rs7895340) with T2DM in the Yao population living in the rural areas in the Liannan Yao Autonomous County.This was a case-control study of 28 subjects with T2DM or prediabetes and 52 non-T2DM controls, all from the Chinese Yao population and recruited between January 2019 and June 2020. Patients with T2DM and prediabetes were grouped as the case group. The five SNPs (rs12255372, rs7903146, rs7901695, rs11196205, and rs7895340) were examined by polymerase chain reaction and direct genomic DNA sequencing in case and control groups.The subjects in case group were older than the controls (55±14 vs 48 ±â€Š15 years, P = .047), had higher FBG levels (9.31 ±â€Š5.43 vs 4.09 ±â€Š0.81, P < .001), higher TC (5.79 ±â€Š1.29 vs 5.13 ±â€Š1.18 mmol/L, P = .025), and higher triglycerides (2.94 ±â€Š2.04 vs 1.86 ±â€Š1.39 mmol/L, P = .003). The genotypic distribution for each of the SNPs was in agreement with the Hardy-Weinberg equilibrium. There were no statistically significant differences in the distributions of genotypes or alleles at all five SNPs of the TCF7L2 gene between the case and control groups (all P > .05).TCF7L2 SNPs were not associated with T2DM in the Liannan Yao population.


Asunto(s)
Diabetes Mellitus Tipo 2 , Proteína 2 Similar al Factor de Transcripción 7/genética , Glucemia/análisis , Estudios de Casos y Controles , China/epidemiología , Colesterol/sangre , Correlación de Datos , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/genética , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Triglicéridos/sangre
12.
Diabetes Metab Syndr ; 15(2): 569-571, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33706188

RESUMEN

BACKGROUND AND AIMS: We aimed to study newly diagnosed diabetes in patients with mild to moderate COVID-19. METHODS: This was a retrospective cohort study of COVID-19 patients who were admitted to a tertiary care hospital in India from May to October 2020. RESULTS: Of 102 patients, 21 (20.6%) had newly diagnosed diabetes on admission. Of which, four (19.0%) had marked hyperglycemia with no ketosis or ketoacidosis. CONCLUSION: In this study of patients with mild to moderate COVID-19, newly diagnosed diabetes and marked hyperglycemia in those with newly diagnosed diabetes were common.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Hemoglobina A Glucada/metabolismo , Adulto , Anticoagulantes/uso terapéutico , /terapia , Estudios de Cohortes , Dexametasona/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Glucocorticoides/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , India , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
13.
Clin Exp Rheumatol ; 39(2): 403-406, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33666156

RESUMEN

OBJECTIVES: Interleukin (IL)-1ß is considered a shared pathogenic mediator between rheumatoid arthritis (RA) and type 2 diabetes (T2D). In the TRACK study, participants with both diseases were randomised to an IL-1 inhibitor, anakinra, or a TNF inhibitor (TNFi). After 6 months, anakinra induced a such of improvement on metabolic and inflammatory parameters, leading to a premature stoppage of the study. Thus, we aimed to assess how long IL-1 inhibition benefits lasted. METHODS: Since the TRACK was prematurely discontinued for "early benefit", we furtherly followed-up the enrolled participants to assess how long persisted the improvement of glycated haemoglobin (HbA1c%) and of RA disease activity. RESULTS: After a mean follow-up of 18 months (15 participants in anakinra-group and 14 in TNFi-group), RA clinical response was retained in both groups (DAS28: 2.59±1.01 vs. 2.88±0.91; p=0.109). Concomitant glucocorticoids were reduced in both groups (2.01±0.71 vs. 3.01±0.87 mg/die; p=0.124), but a larger percentage of anakinra-treated participants discontinued such drugs (53.3% vs. 28.6%; p=0.004). There was no difference between anakinra and TNFi for HbA1c% (6.60±0.52 vs. 6.79±0.43; p=0.291), but a reduction of anti-diabetic drugs was observed in anakinra-treated participants (53.3% vs. 7.1%; p=0.008) whereas an increase of anti-diabetic therapies was needed in TNFi-treated ones. Significant correlations were also observed among HbA1c% with DAS28 and with C-reactive protein. Analysing the safety profile, only minor side effects were recorded. CONCLUSIONS: Data deriving from the long-term extension of participants with RA and T2D, enrolled in the TRACK study, could suggest that the benefits of IL-1 inhibition on metabolic and inflammatory parameters could last longer than first 6 months of follow-up, but further studies are needed to confirm these findings.


Asunto(s)
Antirreumáticos , Artritis Reumatoide , Diabetes Mellitus Tipo 2 , Antirreumáticos/efectos adversos , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Proteína Antagonista del Receptor de Interleucina 1/efectos adversos , Inhibidores del factor de Necrosis Tumorales
14.
J Stroke Cerebrovasc Dis ; 30(5): 105708, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33714073

RESUMEN

BACKGROUND: Recent evidence indicates that treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i) may favorably affect the risk of stroke in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease. OBJECTIVES: This meta-analysis considered data from cardiovascular outcome trials (CVOTs) regarding the effect of SGLT2i treatment on stroke risk in T2DM patients with an emphasis on patients with impaired renal function. SELECTION CRITERIA: Double-blind randomized trials (RCTs) representing CVOTs were included if they compared SGLT2i add-on therapy with placebo, and reported stroke among primary or secondary endpoints. RESULTS: Six eligible multicenter RCTs were included. The pooled analysis of 5 RCTs (n = 40,393) showed a neutral effect on the risk of total stroke from treatment with SGLT2i vs. placebo (hazard ratio, HR 0.90, 95% CI: 0.74-1.09, p = 0.29, I2 = 58%). Subgroup analysis (4 RCTs) involving patients with impaired renal function (n = 17,072) demonstrated a significant benefit in favor of SGLT2i (HR: 0.66, 95% CI: 0.54-0.82, p<0.0001, I2 = 8%). The pooled analysis of 2 RCTs (n = 14,543) showed a significant reduction in the risk of hemorrhagic stroke in T2DM patients (HR: 0.46, 95% CI: 0.25-0.83, p = 0.01; I2 = 0). No differences were noticed regarding the risk of ischemic stroke (HR: 0.97, 95% CI: 0.85-1.12, p = 0.69; I2 = 0), non-fatal stroke (HR: 0.98, 95% CI: 0.83-1.16, p = 0.79, I2 = 28%), and fatal stroke (HR: 0.77, 95% CI: 0.50-1.17, p = 0.22, I2 = 0). CONCLUSIONS: Available data suggest that SGLT2i reduce the risk of total stroke in patients with T2DM and impaired renal function. Based on the findings of two RCTs, these drugs may offer a protection against hemorrhagic stroke.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/fisiopatología , Riñón/fisiopatología , Insuficiencia Renal Crónica/fisiopatología , Anciano , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/mortalidad , Femenino , /mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Factores Protectores , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/mortalidad , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
15.
Nutr Metab Cardiovasc Dis ; 31(3): 699-704, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33549430

RESUMEN

AIMS: The Italian Society of Diabetology and the Italian Association of Clinical Diabetologists are developing new guidelines for drug treatment of type 2 diabetes. The effects of anti-hyperglycaemic drugs on all-cause mortality and major adverse cardiovascular events (MACEs) were included among the critical clinical outcomes. We have therefore carried out an updated meta-analysis on the effects of metformin on these outcomes. DATA SYNTHESIS: A MEDLINE and EMBASE search was performed to identify all randomized controlled trials (RCTs) with duration ≥52 weeks (published up to August 2020), in which metformin was compared with either placebo/no therapy or active comparators. MACEs (restricted for RCT reporting MACEs within their study endpoints) and all-cause mortality (irrespective of the inclusion of MACEs among the pre-specified endpoints) were considered as the primary endpoints. Mantel-Haenszel odds ratio (MH-OR) with 95% confidence interval was calculated for all endpoints considered. Metformin was associated with a nonsignificant reduction of all-cause mortality (n = 13 RCTs; MH-OR 0.80 [95% CI 0.60, 1.07]). However, this association became statistically significant after excluding RCTs comparing metformin with sulfonylureas, SGLT-2 inhibitors or GLP-1 analogues (MH-OR 0.71 [0.51, 0.99]). Metformin was associated with a lower risk of MACEs compared with comparator treatments (n = 2 RCTs; MH-OR 0.52 [0.37, 0.73]), p < 0.001. Similar results were obtained in a post-hoc analysis including all RCTs fulfilling criteria for inclusion in the analysis (MH-OR: 0.57 [0.42, 0.76]). CONCLUSIONS: This updated meta-analysis suggests that metfomin is significantly associated with lower risk of MACEs and tendentially lower all-cause mortality compared to placebo or other anti-hyperglycaemic drugs.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Humanos , Hipoglucemiantes/efectos adversos , Metformina/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
16.
Nutr Metab Cardiovasc Dis ; 31(3): 921-929, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33549453

RESUMEN

BACKGROUND AND AIMS: There is debate over the independent and combined effects of caloric restriction (CR) and physical activity (PA) on reduction in fat mass and in epicardial fat thickness. We compared the impact of a similar energy deficit prescription by CR or by CR combined with PA on total fat mass, epicardial fat thickness, and cardiometabolic profile in individuals with type 2 diabetes. METHODS AND RESULTS: In this 16-week randomized controlled study, 73 individuals were randomly enrolled to receive: 1) a monthly motivational phone call (Control), 2) a caloric deficit of -700 kilocalories/day (CR), or 3) a caloric deficit of -500 kilocalories/day combined with a PA program of -200 kilocalories/day (CR&PA). Total fat mass, epicardial fat, and cardiometabolic profile were measured at baseline and after 16 weeks. While comparable weight loss occurred in both intervention groups (-3.9 ± 3.5 kg [CR], -5.1 ± 4.7 kg [CR&PA], -0.2 ± 2.9 kg [Control]), changes in total fat mass were significantly different between all groups (-2.4 ± 2.9 kg [CR], -4.5 ± 3.4 kg [CR&PA], +0.1 ± 2.1 kg [Control]; p < 0.05) as well as epicardial fat thickness (-0.4 ± 1.6 mm [CR], -1.4 ± 1.4 mm [CR&PA], +1.1 ± 1.3 mm [Control]; p < 0.05). There were no significant differences in trends for cardiometabolic parameters improvement between groups. CONCLUSIONS: For a similar energy deficit prescription and comparable weight loss, the combination of CR&PA provides a greater reduction in fat mass and epicardial fat thickness than CR alone in individuals with comparable weight loss and with a similar energy deficit prescription. These results, however, do not translate into significant improvements in cardiometabolic profiles. CLINICALTRIALS. GOV IDENTIFIER: NCT01186952.


Asunto(s)
Composición Corporal , Restricción Calórica , Diabetes Mellitus Tipo 2/dietoterapia , Terapia por Ejercicio , Adiposidad , Adulto , Anciano , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pericardio , Proyectos Piloto , Quebec , Factores de Tiempo , Resultado del Tratamiento
17.
Nutr Metab Cardiovasc Dis ; 31(3): 827-833, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33549458

RESUMEN

BACKGROUND AND AIM: Frailty has emerged as a third category of complication in patients with type 2 diabetes mellitus (T2DM). It has been suggested that adequate protein intake is an important dietary strategy for counteracting frailty. Therefore, we explored the association between protein intake and functional biomarkers of frailty in older adults with T2DM. METHODS AND RESULTS: Frailty was operationalized as the presence of three of the following: exhaustion, low muscle strength, low physical activity, slow gait speed, and weight loss. Functional biomarkers included handgrip strength (HGS), chair stands, the short physical performance battery and gait speed. Eighty-seven older adults (71.2 ± 8.2 years; 66.7% males) were included. A total of n = 6 (~7%) and n = 32 (~37%) participants were identified as frail and pre-frail respectively. No significant difference was observed for protein intake across staging of frailty (pre-frail/frail: 1.3 ± 0.4 g/kg BW; non-frail: 1.4 ± 0.4 g/kg BW; P = 0.320). A significant association was observed for total protein intake and HGS (ß = 0.44; 95% CI: 0.23-1.8; P = 0.01). However, this was no longer significant after adjusting for age, gender, physical activity, energy intake and total appendicular lean muscle (ß = 0.03; 95% CI: -0.45-0.60; P = 0.78). Nil other associations were observed between total protein intake and functional biomarkers of frailty. CONCLUSION: Adequate protein intake was not associated with functional biomarkers in older adults with T2DM. Future research should focus on the efficacy of protein on attenuating functional decline in vulnerable older adults with low protein intake.


Asunto(s)
Diabetes Mellitus Tipo 2 , Proteínas en la Dieta/administración & dosificación , Anciano Frágil , Fragilidad/diagnóstico , Vida Independiente , Factores de Edad , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Ejercicio Físico , Femenino , Fragilidad/epidemiología , Fragilidad/fisiopatología , Evaluación Geriátrica , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular , Evaluación Nutricional , Estado Nutricional , Queensland/epidemiología , Ingesta Diaria Recomendada , Velocidad al Caminar , Pérdida de Peso
19.
BMC Infect Dis ; 21(1): 224, 2021 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-33639846

RESUMEN

BACKGROUND: The clinical profiles and outcomes of cryptococcal meningitis have been shown to vary depending on the underlying condition. The aim of this study was to investigate clinical characteristics and outcomes in patients with and without type II diabetes mellitus. METHODS: A retrospective study was performed. Clinical data of HIV-negative cryptococcal meningitis patients with type II diabetes mellitus (n = 26) and without type II diabetes mellitus (n = 52) referring to the Jiangxi Chest Hospital between January 2012 to December 2018 were analyzed. The data were analyzed using chi square, none-parametric tests, and logistic regression. P-values < 0.05 were considered significant. RESULTS: In this study, cryptococcal meningitis patients suffering from type II diabetes mellitus had a higher mortality (23.08% vs. 7.69%; P = 0.055), and required longer hospitalization (59.58 vs. 42.88 days; P = 0.132). Moreover, cerebrospinal fluid examinations revealed that cryptococcal meningitis patients with type II diabetes mellitus had higher opening pressure (271.54 vs. 234.23 mmH2O; P = 0.125).The results of multivariate regression analysis revealed that cryptococcal meningitis patients with type II diabetes were more often presented with visual disorders (28.54% vs. 11.54%; [95% CI 0.056-0.705]; p = 0.012), and had higher cerebrospinal fluid protein levels (1027.62 ± 594.16 vs. 705.72 ± 373.88 mg/l; [95% CI 1.000-1.002]; p = 0.016). Among patients with type II diabetes mellitus, nausea and vomiting was more frequent at the initial visit in those died (100% vs. 50%; p = 0.027), and 66% of died type II diabetes mellitus patients were poorly controlled blood glucose level, compared with 30% in survival type II diabetes mellitus patients. CONCLUSION: This study suggests that cryptococcal meningitis patients with type II diabetes mellitus differ significantly from cryptococcal meningitis patients without type II diabetes mellitus with respect to clinical symptoms such as visual disorders and cerebrospinal fluid examination. The presence of nausea and vomiting among type II diabetes mellitus patients could have implication in mortality.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Meningitis Criptocócica/diagnóstico , Meningitis Criptocócica/epidemiología , Adulto , Anciano , China/epidemiología , Comorbilidad , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Femenino , Seronegatividad para VIH/fisiología , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Meningitis Criptocócica/complicaciones , Meningitis Criptocócica/terapia , Persona de Mediana Edad , Mortalidad , Pronóstico , Estudios Retrospectivos
20.
Nutr Metab Cardiovasc Dis ; 31(4): 1267-1275, 2021 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-33612381

RESUMEN

BACKGROUND AND AIMS: Blinded retrospective continuous glucose monitoring (rCGM) provides detailed information about real-life glycaemic profile. In persons with type 2 diabetes without adequate glycaemic control, the structured introduction of rCGM may be beneficial to sustain improvements in diabetes management. METHODS AND RESULTS: 102 individuals with insulin-treated type 2 diabetes, age less than 66 years old and HbA1c >7.5%, were recruited. Participants performed a 7-day blinded rCGM (iPro2) every four months for one year. Biochemical, anthropometric, and rCGM data was collected. Participants' and healthcare professionals' perceptions were assessed. 90 participants completed the protocol. HbA1c was 9.1 ± 0.1% one year prior to enrolment and 9.4 ± 0.1% at enrolment (p < 0.01). With the rCGM-based intervention, a decrease in HbA1c was achieved at 4 months (8.4 ± 0.1%, p < 0.0001), and 12 months (8.1 ± 0.1%, p < 0.0001). A significant increase in time-in-range was observed (50.8 ± 2.4 at baseline vs 61.5 ± 2.2% at 12 months, for 70-180 mg/dL, p < 0.001), with no difference in exposure time to hypoglycaemia. After 12 months, there was an increase in self-reported diabetes treatment satisfaction (p < 0.05). CONCLUSION: In persons with type 2 diabetes and poor metabolic control, specific data from blinded rCGM informed therapeutic changes and referral to targeted education consultations on nutrition and insulin administration technique. Therapeutic changes were made more frequently and targeted to changes in medication dose, timing, and/or type, as well as to lifestyle. Together, these brought significant improvements in clinical outcomes, effective shared decision-making, and satisfaction with treatment. REGISTRATION NUMBER: NCT04141111.


Asunto(s)
Automonitorización de la Glucosa Sanguínea , Glucemia/efectos de los fármacos , Toma de Decisiones Clínicas , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Glucemia/metabolismo , Toma de Decisiones Conjunta , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Hipoglucemia/sangre , Hipoglucemia/etiología , Hipoglucemia/prevención & control , Hipoglucemiantes/efectos adversos , Insulina/efectos adversos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estudios Retrospectivos , Conducta de Reducción del Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
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