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1.
Medicine (Baltimore) ; 99(15): e19657, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282717

RESUMEN

Timely diagnosis of type 2 diabetes and early intervention and treatment of it are important for controlling metabolic disorders, delaying and reducing complications, reducing mortality, and improving quality of life. Type 2 diabetes was diagnosed by Fourier transform mid-infrared (FTIR) attenuated total reflection (ATR) spectroscopy in combination with extreme gradient boosting (XGBoost). Whole blood FTIR-ATR spectra of 51 clinically diagnosed type 2 diabetes and 55 healthy volunteers were collected. For the complex composition of whole blood and much spectral noise, Savitzky-Golay smoothing was first applied to the FTIR-ATR spectrum. Then PCA was used to eliminate redundant data and got the best number of principle components. Finally, the XGBoost algorithm was used to discriminate the type 2 diabetes from healthy volunteers and the grid search algorithm was used to optimize the relevant parameters of the XGBoost model to improve the robustness and generalization ability of the model. The sensitivity of the optimal XGBoost model was 95.23% (20/21), the specificity was 96.00% (24/25), and the accuracy was 95.65% (44/46). The experimental results show that FTIR-ATR spectroscopy combined with XGBoost algorithm can diagnose type 2 diabetes quickly and accurately without reagents.


Asunto(s)
Análisis Químico de la Sangre/instrumentación , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Adulto , Algoritmos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/psicología , Femenino , Trastornos del Metabolismo de la Glucosa/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Sensibilidad y Especificidad
3.
Am J Nurs ; 120(4): 61-63, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32218054

RESUMEN

Type 2 diabetes mellitus is an increasingly urgent public health issue in the United States. Prevention through early detection and education can help decrease the prevalence and complications of the disease. A nursing faculty member and a postgraduate year one pharmacy resident collaborated to provide diabetes screening and education at a local festival in rural Alabama. The prevalence of diabetes in Alabama is approximately 1.6 times higher than the national average. A glycated hemoglobin (HbA1c) test is the gold standard for diabetes diagnosis and is relatively quick and inexpensive. At the event, 38 participants received point of care HbA1c testing, results, and counseling. Seven participants had an HbA1c level of 5.7% to 6.4%, which indicates prediabetes, and one participant had an HbA1c level of 6.5% or higher, which indicates possible diabetes mellitus. Many patients were surprised by their results and by the simplicity of the test. The purpose of this article is to describe a cost-effective interdisciplinary educational event to increase diabetes awareness in a rural community.


Asunto(s)
Diabetes Mellitus Tipo 2 , Educación en Salud , Tamizaje Masivo , Estado Prediabético/diagnóstico , Adulto , Alabama/epidemiología , Glucemia/análisis , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hemoglobina A Glucada/análisis , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Salud Pública , Población Rural
4.
West Afr J Med ; 37(2): 91-99, 2020.
Artículo en Inglés, Francés | MEDLINE | ID: mdl-32150625

RESUMEN

BACKGROUND: There is a global rise in the prevalence of diabetes mellitus and pre-diabetes is a fore-runner to type-2 diabetes. Pre-diabetes is reversible, therefore, measures should be taken to halt or slow down its progression to frank diabetes. AIM: The study aimed to evaluate the prevalence of pre-diabetes and diabetes amongst staff of ABUTH, Zaria and identify some cardiovascular risks associated with them. METHODS: A cross-sectional analytical study carried out on 377 healthcare workers who presented at the Medical out-patient department of ABUTH, Zaria in response to an invitation for the 2017 World Diabetes Day free medical screening. HbA1c was assessed via Immunofluorescence method. The difference in HbA1c amongst healthcare workers was determined by One-way Analysis of Variance with Post-hoc Bonferroni test. Cardiovascular risk associations were assessed via Multiple Binary Logistic Regression. RESULTS: Pre-diabetes and diabetes prevalence were 19.4% and 6.5% respectively. There were 28.6% undiagnosed diabetic healthcare workers. There was no significant (p=0.35) difference in HbA1c between different categories of healthcare workers, however, random blood glucose was significantly (p=0.042) higher in other healthcare workers than doctors. There was a significant (p<0.01) association between systolic hypertension and risk of developing pre-diabetes and diabetes (OR, 4.11, CI 0.98-17.30). CONCLUSION: There is a high prevalence of pre-diabetes and diabetes amongst healthcare workers in Zaria. The odds of hypertensive healthcare workers developing pre-diabetes and diabetes is high. Efforts should be geared at intensifying health education, increased work physical activity and proper diet.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Hemoglobina A Glucada/análisis , Personal de Salud/estadística & datos numéricos , Estado Prediabético/epidemiología , Glucemia , Enfermedades Cardiovasculares/complicaciones , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Hospitales de Enseñanza , Humanos , Nigeria , Estado Prediabético/diagnóstico , Prevalencia , Factores de Riesgo , Universidades
7.
PLoS One ; 15(1): e0225300, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31917793

RESUMEN

Dilated eye exams are the standard of care to detect advancing, vision threatening, but often asymptomatic retinopathy in a timely fashion, allowing for vision preserving treatments. Annual exam rates are suboptimal, especially in underserved populations. Although teleophthalmology programs tremendously improve annual exam rates in low income/under resourced settings, widespread adoption is limited. Using a mixed methods approach, three focus groups and individual interviews were conducted for patients with type 2 diabetes (N = 23) who had a teleophthalmology exam or a dilated eye exam. A survey and discussion assessed patients' perspectives and value of teleophthalmology, including willingness to pay (WTP). Financial, transportation, and motivational barriers to obtaining an annual dilated eye exam were identified. Patients greatly valued having primary care (PC) based teleophthalmology for its convenience and ability to detect disease to allow for timely treatment and would recommend such a service. Although their WTP was at least the amount of their usual copay, cost was universally cited as a concern. Having a conveniently offered PC based teleophthalmology exam was valued. Educating patients on the value and costs of having such exams may be helpful to encourage informed discussions on eye care, especially in low income, underserved populations. Our study is among the few to provide insight on the value and perceptions of teleophthalmology in US low income, urban minority populations needed to help increase uptake of this innovation. Using surveys followed by facilitated discussion allowed for richer and more varied responses.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Retinopatía Diabética/diagnóstico , Oftalmología/métodos , Telemedicina , Adulto , Anciano , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Diabetes Mellitus Tipo 2/epidemiología , Retinopatía Diabética/diagnóstico por imagen , Retinopatía Diabética/epidemiología , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Examen Físico , Pobreza , Atención Primaria de Salud , Población Urbana
8.
Rev Med Suisse ; 16(676-7): 31-33, 2020 Jan 15.
Artículo en Francés | MEDLINE | ID: mdl-31961079

RESUMEN

Diabetes is a rapidly evolving discipline, numerous new molecules and recommendations are available. This allows for a better follow up of our patients. Moreover, every new molecule devoted to treat type 2 diabetes must undergo a cardiovascular safety study. In recent years, some of these studies revealed beneficial cardiovascular and/or renal effects, which represents a benefit for our patients. Nevertheless, this pharmacological plethora is paradoxically associated with clinical inertia as general practitioners may be in trouble finding the right medication. This article will highlight novelties in the field of diabetes during the year 2019.


Asunto(s)
Diabetes Mellitus Tipo 2 , Médicos Generales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos
9.
Mymensingh Med J ; 29(1): 162-168, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915353

RESUMEN

Hypertension and diabetes co-exist frequently. Therefore, salt intake behavior, a risk factor of hypertension, in diabetic patients plays an important role in determining their cardiovascular outcome. The purpose of this study was to assess the knowledge and behaviors of health risks associated with a salt intake in adults with type 2 diabetes. This cross-sectional study was conducted among the type 2 diabetic in-patients of Bangladesh Institute of Health Sciences General Hospital, Dhaka, Bangladesh from October to December 2016. Data were collected from 131 respondents through interview using WHO STEPS module of salt with adaptation to local context like on amount of added salt while taking meal. Information on blood pressure, body mass index and relevant co-morbidities were also collected. About half of the respondents were women (56.5%). Mean age of the respondents was 54.3±14.4 years. More than six in 10 of them (62.6%) took added salt while taking meal; and 40.5% took processed foods with high salt. The mean amount of added salt intake among the users was 4.4±1.6gm per day having no significant difference between men and women. Though 47.3% of the respondents believed that lowering salt in meal is very important and 77.9% of them believed that excess salt or salty sauce can cause health problems. Salt intake behavior is poor in patients with type 2 diabetes even having regular contacts with doctors and other health professionals. Appropriate measures can be taken to increase awareness, change their attitude and behavior regarding salt consumption.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud/etnología , Cloruro de Sodio Dietético/efectos adversos , Adulto , Anciano , Bangladesh/epidemiología , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Conducta Alimentaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cloruro de Sodio Dietético/administración & dosificación
10.
Diabetes Res Clin Pract ; 160: 108009, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31926844

RESUMEN

AIMS: To evaluate the predictive ability of 2-h post-load glucose level in addition to fasting and 1-h glucose levels in predicting the risk of type 2 diabetes. METHODS: We examined a prospective population-based cohort study of 654 subjects without type 2 diabetes at baseline. All subjects underwent an oral glucose tolerance test (OGTT), with measurement of glucose at 0, 60, and 120 min at baseline, and after 12 years in a follow-up survey. We evaluated the predictive properties of fasting, 1- and 2-h post-load glucose levels by comparing the areas under the receiver-operating characteristic (ROC) curve. RESULTS: We found that 2-h glucose concentration in the prediction model with fasting and 1-h glucose levels did not significantly increase the predictability of type 2 diabetes compared to a model only including fasting and 1-h glucose levels (AUC 0.83 vs. AUC 0.82, respectively; p = 0.23). The area under the ROC curve was the largest for 1-h glucose level (AUC 0.81), compared to fasting (AUC 0.71; p < 0.01) and 2-h glucose levels (AUC 0.72; p = 0.01). CONCLUSIONS: Adding 2-h glucose to the model with fasting and 1-h glucose levels did not improve the predictability of new onset type 2 diabetes.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo
11.
PLoS Med ; 17(1): e1003017, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31905226

RESUMEN

BACKGROUND: Emerging studies have investigated the association between puberty timing, particularly age at menarche (AAM), and type 2 diabetes. However, whether this association is independent of adiposity is unclear. We aimed to systematically review published evidence on the association between puberty timing and type 2 diabetes (T2D) or impaired glucose tolerance (IGT), with and without adjustment for adiposity, and to estimate the potential contribution of puberty timing to the burden of T2D in the United Kingdom (UK). METHODS AND FINDINGS: We searched PubMed, Medline, and Embase databases for publications until February 2019 on the timing of any secondary sexual characteristic in boys or girls in relation to T2D/IGT. Inverse-variance-weighted random-effects meta-analysis was used to pool reported estimates, and meta-regression was used to explore sources of heterogeneity. Twenty-eight observational studies were identified. All assessed AAM in women (combined N = 1,228,306); only 1 study additionally included men. In models without adjustment for adult adiposity, T2D/IGT risk was lower per year later AAM (relative risk [RR] = 0.91, 95% CI 0.89-0.93, p < 0.001, 11 estimates, n = 833,529, I2 = 85.4%) and higher for early versus later menarche (RR = 1.39, 95% CI 1.25-1.55, p < 0.001, 23 estimates, n = 1,185,444, I2 = 87.8%). Associations were weaker but still evident in models adjusted for adiposity (AAM: RR = 0.97 per year, 95% CI 0.95-0.98, p < 0.001, 12 estimates, n = 852,268, I2 = 51.8%; early menarche: RR = 1.19, 95% CI 1.11-1.28, p < 0.001, 21 estimates, n = 890,583, I2 = 68.1%). Associations were stronger among white than Asian women, and in populations with earlier average AAM. The estimated population attributable risk of T2D in white UK women due to early menarche unadjusted and adjusted for adiposity was 12.6% (95% CI 11.0-14.3) and 5.1% (95% CI 3.6-6.7), respectively. Findings in this study are limited by residual and unmeasured confounding, and self-reported AAM. CONCLUSIONS: Earlier AAM is consistently associated with higher T2D/IGT risk, independent of adiposity. More importantly, this research has identified that a substantial proportion of T2D in women is related to early menarche, which would be expected to increase in light of global secular trends towards earlier puberty timing. These findings highlight the need to identify the underlying mechanisms linking early menarche to T2D/IGT risk.


Asunto(s)
Adiposidad/fisiología , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/metabolismo , Pubertad/metabolismo , Factores de Edad , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Humanos , Masculino , Menarquia/metabolismo , Estudios Observacionales como Asunto/métodos
12.
J Agric Food Chem ; 68(5): 1266-1275, 2020 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-31937103

RESUMEN

Diabetes (T2DM) is a major global health issue, and developing new approaches to its prevention is of paramount importance. We hypothesized that abnormalities in lipid metabolism are involved in alpha-cell deregulation. We therefore studied the metabolic factors underlying alpha-cell dysfunction in T2DM progression after a dietary intervention (Mediterranean and low-fat). Additionally, we evaluated whether postprandial glucagon levels may be considered as a predictive factor of T2DM in cardiovascular patients. Non-T2DM participants from the CORDIOPREV study were categorized by tertiles of the area under the curve (AUC) for triacylglycerols and also by tertiles of AUC for glucagon. Our results showed that patients with higher triacylglycerols levels presented elevated postprandial glucagon (P = 0.009). Moreover, we observed higher risk of T2DM (hazard ratio: 2.65; 95% confidence interval: 1.56-4.53) in subjects with elevated glucagon. In conclusion, high postprandial lipemia may induce alpha-cell dysfunction in cardiovascular patients. Our results also showed that postprandial glucagon levels could be used to predict T2DM development.


Asunto(s)
Diabetes Mellitus Tipo 2/metabolismo , Células Secretoras de Glucagón/metabolismo , Hiperlipidemias/metabolismo , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/metabolismo , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Progresión de la Enfermedad , Femenino , Glucagón/metabolismo , Humanos , Hiperlipidemias/complicaciones , Metabolismo de los Lípidos , Masculino , Persona de Mediana Edad , Periodo Posprandial , Estudios Prospectivos , Triglicéridos/metabolismo
13.
Int J Cardiovasc Imaging ; 36(1): 15-22, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31367802

RESUMEN

We sought to investigate the relationship between phasic left atrial function (LA) and functional capacity in the patients with type 2 diabetes (DM). This cross-sectional investigation included 72 controls and 64 uncomplicated DM subjects. All participants underwent echocardiographic examination and cardiopulmonary exercise testing. Total and passive LA emptying fractions (EF), demonstrating LA reservoir and conduit function, were significantly lower in DM patients than in controls. Active LA EF, the parameter of LA booster pump function, was similar between DM and controls. Total and positive LA strains, corresponding with reservoir and conduit function, were also significantly reduced in DM subjects comparing with controls. However, negative LA strain-parameter of LA booster pump function, was significantly increased in DM patients in comparison with controls. Peak oxygen consumption was significantly reduced and ventilation/carbon dioxide slope was elevated in DM patients. In the whole study population LA global longitudinal strain was associated with heart rate recovery in the first minute, peak oxygen consumption and ventilation/carbon dioxide slope independently of other clinical parameters and LV hypertrophy and LV diastolic function. In conclusion, LA phasic function and functional capacity were significantly impaired in the patients with DM. LA longitudinal strain, but not LA volume index, was independently related with functional capacity in the whole study population. Our results suggest that evaluation of LA function and functional capacity could detect subclinical target organ damage and prevent development of further complications in uncomplicated DM patients.


Asunto(s)
Función del Atrio Izquierdo , Diabetes Mellitus Tipo 2/complicaciones , Cardiomiopatías Diabéticas/etiología , Atrios Cardíacos/fisiopatología , Adulto , Estudios de Casos y Controles , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Cardiomiopatías Diabéticas/diagnóstico por imagen , Cardiomiopatías Diabéticas/fisiopatología , Femenino , Atrios Cardíacos/diagnóstico por imagen , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Función Ventricular Izquierda
14.
Eur J Ophthalmol ; 30(1): 19-25, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30409042

RESUMEN

PURPOSE: To investigate the effect of microalbuminuria on macular thickness in patients with type-2 diabetes mellitus with no or mild diabetic retinopathy and to investigate the relationship between macular thickness and metabolic parameters. MATERIALS AND METHODS: Fifty eight eyes of 58 patients without diabetic retinopathy (group 1) in microalbuminuria stage, 42 eyes of 42 patients with mild diabetic retinopathy (group 2) in microalbuminuria stage, and 50 eyes of 50 patients without diabetic retinopathy and microalbuminuria (group 3) were included in this study. After detailed ophthalmologic examination, all patients underwent spectral domain-optical coherence tomography measurements. Macular thickness was noted from nine different areas (fovea, four parafoveal, and four perifoveal areas) and compared between groups. The correlations between macular thickness and age, duration of diabetes mellitus, microalbuminuria, serum urea, creatinine, glycosylated hemoglobin (HbAIc), albumin, sodium (Na), and urinary Na were evaluated. RESULTS: The mean age was 53.29 ± 6.49 in group 1, 55.86 ± 6.97 in group 2, and 52.98 ± 5.66 years in group 3 (p = 0.06). The macular thickness values of superior, inferior, and nasal parafoveal areas were significantly different between groups (p = 0.001, p = 0.006, and p = 0.03, respectively). Bonferroni post test revealed that this difference originated from the difference between group 2 and 3 (p < 0.05 for all values). There were significant negative correlations between the macular thickness values of parafoveal areas and serum urea, HbA1c, albumin, microalbuminuria levels (p < 0.05 for all values). CONCLUSION: In this study, a significantly decreased parafoveal macular thickness was measured in patients with mild diabetic retinopathy and microalbuminuria compared to patients without diabetic retinopathy and microalbuminuria.


Asunto(s)
Albuminuria/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Retinopatía Diabética/diagnóstico , Retina/patología , Adulto , Anciano , Albuminuria/sangre , Albuminuria/orina , Creatinina/orina , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/orina , Retinopatía Diabética/sangre , Retinopatía Diabética/orina , Femenino , Fóvea Central , Hemoglobina A Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Sodio/orina , Tomografía de Coherencia Óptica/métodos , Urea/sangre
15.
Revista Digital de Postgrado ; 9(1): e189, 2020. tab
Artículo en Español | LILACS, LIVECS | ID: biblio-1095033

RESUMEN

Evaluar el impacto educativo en pacientes con Diabetes Mellitus tipo 2 (DMT2) e Hipertensión arterial (HTA), y su efecto en la calidad de vida. Métodos: Se realizó un estudio intervención en comunidad, en pacientes con diagnóstico de DMT2 e HTA, en la consulta de Medicina Interna. Resultados: Participaron 314 pacientes, distribuidos en un grupo estudio (n = 160) y grupo control (n = 154). Sin diferencias en edad (p = 0,491) y sexo (p = 0,747). En la calidad de vida de pacientes DM entre pre y post charla, en cada grupo, sin diferencias entre grupos en pre-charla (p = 0,869), pero sí en post-charla (p = 0,001), siendo calidad de vida más alta en el grupo estudio (98,2%) que en grupo control (76,9%). Al evaluar los cambios entre pre y post charla, se observó que pre charla en el grupo estudio tuvo 86% de alta calidad de vida, posterior aumentó a 98,2%, cambio estadístico (p = 0,008), en grupo control en cambio, la calidad de vida pre charla fue 87% pasó a 76,9% posterior a ésta, aun así, fue un cambio significativo (p = 0,025) La calidad de vida en HTA, sin diferencias en pre y post charla. La comparación entre pre charla y post charla, en el grupo estudio, no tuvo cambios (p = 0,157) como igualmente en el grupo control (p = 0,317). Conclusiones: Se demostró el impacto positivo de un plan educativo en calidad de vida de los pacientes con diabetes, mas no en pacientes hipertensos(AU)


To evaluate the educational impact in patients with Type 2 Diabetes Mellitus (T2DM) and arterial hypertension (AHT), and its effect on quality of life. Methods: A community intervention study was carried out in patients diagnosed with T2DM and HBP in the Internal Medicine department. Results: 314 patients participated, distributed in a study group (n = 160) and control group (n = 154). No differences in age (p = 0.491) and sex (p = 0.747). In the quality of life of DM patients between pre and post talk, in each group, without differences between groups in pre-talk (p = 0.869), but in post-talk (p = 0.001), with higher quality of life in the study group (98.2%) than in the control group (76.9%). When evaluating the changes between pre and post talk, it was observed that pre-talk in the study group had 86% of high quality of life, later it increased to 98.2%, statistical change (p = 0.008), in control group instead, Pre-chat quality of life was 87%, after 76.9%, it was still a significant change (p = 0.025) Quality of life in HTA, without differences in pre and post talk. The comparison between pre-talk and post-talk, in the study group, did not change (p = 0.157) as well as in the control group (p = 0.317). Conclusions: The positive impact of an educational plan on the quality of life of diabetic patients was demonstrated, but not in hypertensive patients(AU)


Asunto(s)
Calidad de Vida , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/prevención & control , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/prevención & control , Planes y Programas de Salud , Educación del Paciente como Asunto , Grupos Control , Encuestas y Cuestionarios/estadística & datos numéricos , Progresión de la Enfermedad
16.
J Matern Fetal Neonatal Med ; 33(1): 120-126, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30032681

RESUMEN

Objective: Women with gestational diabetes (GDM) have a 7-12-fold increased risk for developing type 2 diabetes later in life. Postpartum weight retention is highly predictive for future obesity, and further increases risk for type 2 diabetes. We sought to identify predictors of losing at least 75% of gestational weight gain by very early postpartum in women with recent GDM.Methods: We recruited women with GDM during pregnancy or just after delivery. Prepregnancy weight was self-reported at recruitment; gestational weight gain, mode of delivery, and insulin use were extracted from medical records. At a mean of 7.2 (±2.1) weeks postpartum we measured weight and height and administered questionnaires, including demographics, breastfeeding, Edinburgh Postnatal Depression Scale, sleep, Harvard Food Frequency, and the International Physical Activity Questionnaire. We modeled the odds of 75% loss of gestational weight gain at the study visit using multivariable logistic regression models and selected the model with the lowest Akaike information criterion (AIC) as our final model. Analyses were conducted using JMP 10-13 Pro (SAS Institute Inc.)Results: Seventy-five women with recent GDM were included in the study. The mean age of study participants was 33 (SD ±5) years old, of whom 57% were white, 30% were African American, and 20% of the women identified as Hispanic. The mean prepregnancy BMI was 31.4 kg/m2 (SD ±5.6) and the mean pregnancy weight gain was 12.5 kg (SD ±7.8). Fifty-two percent of participants lost at least 75% of their pregnancy weight gain by the early postpartum study visit. Thirty-seven women (49%) exceeded Institute of Medicine (IOM) guidelines for gestational weight gain. In a multivariate model adjusting for weeks postpartum at the time of the study visit, less gestational weight gain (OR 0.56; 95% CI 0.39-0.73), increased age (OR 1.48; 95% CI 1.13-2.20), and lack of insulin use during pregnancy (OR 0.08 for use of insulin; 95% CI 0.00-0.73) were associated with at least 75% postpartum weight loss. Prepregnancy BMI and sleep were not retained in the model. Race/ethnicity, education, breastfeeding, nulliparity, cesarean section, depressive symptoms, dietary composition, glycemic index, and physical activity did not meet criteria for inclusion in the model.Conclusions: A substantial proportion of women with recent GDM lost at least 75% of their gestational weight gain by early postpartum. Older women, those who did not use insulin during pregnancy and those who gained less weight during pregnancy were significantly more likely to have lost 75% of gestational weight by very early postpartum.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Gestacional , Periodo Posparto/fisiología , Pérdida de Peso/fisiología , Adolescente , Adulto , Diabetes Mellitus Tipo 2/etiología , Diabetes Gestacional/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/diagnóstico , Sobrepeso/complicaciones , Sobrepeso/diagnóstico , Embarazo , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Aumento de Peso , Adulto Joven
17.
Am J Ophthalmol ; 209: 197-205, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31542341

RESUMEN

PURPOSE: To determine the extent of retinal and corneal neurodegeneration and investigate the association with intraepidermal neuronal loss and diabetic peripheral neuropathy (DPN) in type 2 diabetes. DESIGN: Prospective, cross-sectional study. METHODS: Single-center study of 94 patients with type 2 diabetes patients (157 eyes), divided into groups: the groups without diabetic retinopathy (DR) (n = 68); the nonproliferative DR (NPDR) group (n = 48); and the proliferative DR (PDR) group (n = 41). Patients were imaged with optical coherence tomography and confocal microscopy for macular and peripapillary neuroretinal layer thicknesses and corneal nerve length/density, respectively. Distal leg skin punch biopsies and 2 neurological scores were used to depict intraepidermal nerve fiber density (IENFD) and clinical DPN. RESULTS: Among neuroretinal layers, solely the peripapillary retinal nerve fiber layer was decreased in PDR (96 µm; 95% confidence interval [CI], 92-100 µm) versus no DR (103 µm; 95% CI, 100-106 µm) eyes and only after exclusion of outliers (P = .01). Corneal nerve fiber length and density were statistically significantly reduced in the NPDR group (23.0 mm/mm2; 95% CI, 20.0-26.00 mm/mm2 and 14.3 mm; 95% CI, 14.5-16.63 mm, respectively) and the PDR group (18.6 mm/mm2; 95% CI, 14.9-22.30 mm/mm2 and 11.7 mm; 95% CI, 10.2-13-3 mm, respectively) versus the no DR group (25.5 mm/mm2; 95% CI, 23.3-27.70 mm/mm2 and 15.6 mm; 95% CI, 14.5-16.6 mm, respectively), and in the PDR versus the NPDR group. IENFD was statistically significantly reduced in the NPDR (2.0/mm; 95% CI, 1.4-2.7/mm) and PDR stage (1.4/mm; 95% CI, 0.9-2.1/mm) versus in eyes without DR (3.6/mm; 95% CI, 2.9-4.6/mm). A low correlation between intraepidermal and corneal fiber loss was found with both neurological scores (P < .05). CONCLUSIONS: Retinal neurodegenerative changes may develop independently of the microvascular alterations defining DR. Corneal and intraepidermal neuronal loss is more pronounced in advanced stages of DR, indicating a positive severity correlation between DR and DPN.


Asunto(s)
Córnea/inervación , Distrofias Hereditarias de la Córnea/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Neuropatías Diabéticas/diagnóstico , Retinopatía Diabética/diagnóstico , Degeneración Retiniana/diagnóstico , Nervio Trigémino/patología , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Microscopía Confocal , Persona de Mediana Edad , Fibras Nerviosas/patología , Estudios Prospectivos , Células Ganglionares de la Retina/patología , Tomografía de Coherencia Óptica
18.
Orv Hetil ; 160(50): 1976-1983, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31814420

RESUMEN

Introduction and aim: The aim of this study was to implement a two-stage diabetes screening programme in a severely disadvantaged municipality. In the first stage, diabetes risk assessment was carried out in the 18 to 75 age group, followed by screening of the high risk population for potential carbohydrate metabolism disorders using laboratory tests. Method: Stage 1: assessment of diabetes risk with the FINDRISC questionnaire; Stage 2: identification of carbohydrate metabolism status by oral glucose tolerance test and glycated haemoglobin test in patients with elevated or high risk of diabetes. Results: 406 individuals completed the FINDRISC questionnaire. Elevated or high risk for diabetes was confirmed in 129 individuals (31.77%). There was significant correlation between increased risk and age (p<0.001) and between increased risk and body mass index (p<0.001). Based on the oral glucose tolerance test, 28.3% and 9.43% of the patients were diagnosed with pre-diabetes and diabetes mellitus, respectively. According to the glycated haemoglobin test, the incidences of prediabetes and diabetes were 50.94% and 11.32%, respectively. The strongest predictors of prediabetes/diabetes mellitus was the age (p = 0.047). The correlation between prediabetes/diabetes mellitus and smoking (p = 0.635) and physical activity (p = 0.975) was the weakest. The results showed that the glycated hemoglobin value increased by mean 0.2% by metabolic syndromes patients. Conclusions: Our results highlight the necessity for improving preventative care. Based on the risks of significant mortality and disability due to diabetes, prevention and early diagnosis must be prioritised in primary care. In addition to the oral glucose tolerance test, measurement of glycated haemoglobin is also indicated, while keeping in mind the limitations of its diagnostic value. Evaluating for glycated hemoglobin results, it is also worth looking for the presence of metabolic syndrome. Orv Hetil. 2019; 160(50): 1976-1983.


Asunto(s)
Diabetes Mellitus Tipo 2 , Medicina General , Prueba de Tolerancia a la Glucosa , Hemoglobina A Glucada , Estado Prediabético , Glucemia , Diabetes Mellitus Tipo 2/diagnóstico , Hemoglobina A Glucada/análisis , Humanos , Tamizaje Masivo , Estado Prediabético/diagnóstico
19.
Ther Adv Cardiovasc Dis ; 13: 1753944719894509, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31854243

RESUMEN

BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. METHODS: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). RESULTS: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) (p = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group (n = 8, 67%) was significantly lower than that in the conventional treatment group (n = 19, 100%) (p = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day (p = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group (n = 11, 58%) than in the SGLT2 inhibitor group (n = 2, 16%) (p = 0.031). CONCLUSIONS: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.


Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/administración & dosificación , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Enfermedad Aguda , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/prevención & control , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Glucemia/metabolismo , Comorbilidad , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hemoglobina A Glucada/metabolismo , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente , Supervivencia sin Progresión , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/efectos adversos , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Factores de Tiempo
20.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 596-610, dic. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-184787

RESUMEN

Introducción: El número de enfermos de diabetes tipo 2 está creciendo de forma alarmante. Este aumento está causando problemas personales, familiares, sociales, económicos y políticos. El objetivo de este artículo es revisar los efectos secundarios de los tratamientos, complicaciones que experimentan los pacientes y prácticas para mejorar la gestión de esta enfermedad desde el punto de vista de la vivencia del individuo y de la gestión de la atención sanitaria. Material y métodos: Se realizó una revisión narrativa de los estudios sobre la diabetes tipo 2 publicados en inglés y en español indexados en PubMed, Science Direct, Cinahl, MedLine, Psychology and Behavioral Sciences Collection y Google Académico. Se identificaron 1.118 artículos, de los cuales 42 se referían a los objetivos de la revisión y cumplían los criterios de inclusión. Resultados: Los efectos secundarios y complicaciones que experimentan los pacientes y la percepción de recibir escasa información repercuten en una falta de adherencia al tratamiento. Esto implica una disminución de la salud de los pacientes y un aumento de los costes sanitarios. Las propuestas de los estudios revisados encaminan las acciones para mejorar la adherencia al tratamiento y así mejorar la calidad de vida del paciente, disminuir los efectos secundarios, la mortalidad y, por tanto, los costes asociados a esta enfermedad a través de: 1) tener un acceso a la atención médica rápido y fácil, 2) una educación de calidad y 3) permitir que el paciente participe en las decisiones de su tratamiento y autogestione su enfermedad para realizar los mínimos cambios en su estilo de vida


Introduction: There is an alarming increase in the number of patients with type 2 diabetes mellitus. This increase is causing personal, family, social, economic, and political problems. The aim of this article is to review the side effects of treatments, the complications suffered by patients, and the practices to improve management of this disease from the viewpoint of the experience of patients and health care management. Material and methods: A narrative review was conducted of studies on type 2 diabetes mellitus published in English and Spanish indexed in PubMed, Science Direct, Cinahl, MedLine, Psychology and Behavioral Sciences Collection, and Google academic. A total of 1,118 articles were found, 42 of which referred to the objectives of the review and met the inclusion criteria. Results: The side effects and complications experienced by patients and their perception that they do not receive adequate information, together with poor satisfaction, lead to non-adherence to treatment, which impairs patient health and increases health care costs. The proposals in the reviewed studies guide the actions to improve treatment adherence and, thus, quality of life of patients, to decrease side effects and mortality and, therefore, the costs associated to type 2 diabetes mellitus through: 1) quick and easy access to medical care, 2) quality health education, and 3) participation of patients in the decisions about their treatment and in self-management of their disease to make minimum changes in their lifestyles


Asunto(s)
Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Prestación de Atención de Salud/organización & administración , Calidad de Vida/psicología , Cumplimiento y Adherencia al Tratamiento , 25783 , Satisfacción del Paciente , Diabetes Mellitus Tipo 2/complicaciones , Relaciones Médico-Paciente
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