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1.
Biochem Med (Zagreb) ; 30(1): 010704, 2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-31839724

RESUMEN

Introduction: Diabetes mellitus (DM) is one of the most prevalent diseases worldwide. The objective of this study was to find out under what preanalytical conditions routine and diagnostic glucose tests are performed across Spanish laboratories; and also what criteria are used for DM diagnosis. Materials and methods: An online survey was performed by the Commission on Quality Assurance in the Extra-Analytical Phase of the Spanish Society of Laboratory Medicine (SEQC-ML). Access to the questionnaire was available on the home page of the SEQC-ML website during the period April-July 2018. Data analysis was conducted with the IBM SPSS© Statistics (version 20.0) program. Results: A total of 96 valid surveys were obtained. Most laboratories were in public ownership, serving hospital and primary care patients, with high and medium workloads, and a predominance of mixed routine-urgent glucose testing. Serum tubes were the most used for routine glucose analysis (92%) and DM diagnosis (54%); followed by lithium-heparin plasma tubes (62%), intended primarily for urgent glucose testing; point-of-care testing devices were used by 37%; and plasma tubes with a glycolysis inhibitor, mainly sodium fluoride, by 19%. Laboratories used the cut-off values and criteria recognized worldwide for DM diagnosis in adults and glucose-impaired tolerance, but diverged in terms of fasting plasma glucose and gestational DM criteria. Conclusion: Preanalytical processing of routine and DM diagnostic glucose testing in Spain does not allow a significant, non-quantified influence of glycolysis on the results to be ruled out. Possible adverse consequences include a delay in diagnosis and possible under-treatment.


Asunto(s)
Glucemia/análisis , Recolección de Muestras de Sangre/métodos , Recolección de Muestras de Sangre/instrumentación , Diabetes Mellitus/diagnóstico , Humanos , Laboratorios de Hospital/normas , Fase Preanalítica , España , Encuestas y Cuestionarios
2.
J Assoc Physicians India ; 67(11): 22-24, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31793264

RESUMEN

Statement of the Problem: It is important to note, liver and pancreas are majorly responsible for normal glucose metabolism, these organs are located centrally hence central obesity/abdominal distension will affect glycaemic control more than generalise obesity. Scientific literature highlights a strong and consistent relation between abdominal girth and diabetes risk. Haemoglobin A1c (HbA1c) is recognized as a diagnostic test for DM as well as for its monitoring. Aim: The purpose of this study is to assess association of anthropometric markers viz. Body mass index (BMI) and abdominal girth (AG) for prediction of glycaemic control in Indian population. Methods: This single centre observational study was carried out from Feb 2015 to Oct 2015 at Khopoli, Maharashtra. Participants of both gender, andgt;20 yrs and willing to screen for HbA1c and anthropometry were included. Findings: Out of the 2640 participants who visited the centre, 1870 (N=860 non-DM, age median (range): 57 (48/65) and N=1010 DM, age: 60 (53/65)) were enrolled in this study. HbA1c levels were statistically significantly elevated in DM vs. non-DM group (median (range): 7.5 (6.5/8.9) vs. 5.7 (5.2/6.3); p=0.000). Interestingly, abdominal girth showed significant difference between DM and non-DM groups (median (range): 95 (88/102) vs. 93 (86/100); p=0.022). Whereas BMI did not differ across the groups (median (range): 25.5 (23.2/28.6) vs. 25.7 (23.1/28.8); p=0.486). Conclusion and Significance: Among the anthropometric markers namely BMI and AG, AG is a better predictor of DM risk. Therefore AG should also be considered along with HbA1c for predicting DM risk.


Asunto(s)
Glucemia , Diabetes Mellitus , Obesidad , Biomarcadores , Índice de Masa Corporal , Diabetes Mellitus/diagnóstico , Hemoglobina A Glucada , Humanos , India , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/diagnóstico
3.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1445-1449, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838819

RESUMEN

Objective: To explore the association of the glycosylated hemoglobin (HbA1c) level at admission with 90 days functional outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods: Patients admitted to the Department of Neurology, Tongji Hospital from January to December 2017 were prospectively and continuously enrolled in this study. Clinical data were collected at admission and functional outcomes 90 days after ICH were assessed by using the modified RANKIN scale. Univariate and multivariate conditional logistic regression models were constructed. Patients were divided into four groups according to the quartile of HbA1c values. The median value of HbA1c in each group was taken as the substitute value and P for trend was calculated. The logistic regression model was fitted by restricted cubic splines to investigate the association between HbA1c level and outcome of ICH. Results: A total of 345 patients with ICH were enrolled, including 214 with favorable outcomes and 131 with poor outcomes (99 severe disability cases and 32 deaths). The risk of poor 90 days outcomes was significantly associated with HbA1c level at admission indicated by multivariate logistic regression analysis, and the P for trend test was <0.001 (middle-level group vs. low-level group: OR=2.33, 95%CI: 1.07-5.07; high-level group vs. low-level group: OR=2.52, 95%CI: 1.12-5.64; extremely high-level group vs. low-level group: OR=6.80, 95%CI: 3.01-15.34). Results from the restricted cubic spline showed that there was a linear correlation between HbA1c level at admission and poor 90 days outcomes of ICH (χ(2)=14.81, P<0.001; non- linear test: P=0.118). Compared with patients with HbA1c level of 6.5%, the risk of poor outcomes in patients with HbA1c level of <6.5% decreased linearly with the decrease in HbA1c level at admission, and the risk in patients with HbA1c level >6.5% was higher but not significantly. Conclusion: There was correlation between high HbA1c level at admission and 90 days poor outcome of ICH. High HbA1c level is an independent prediction indicator for ICH.


Asunto(s)
Hemorragia Cerebral/diagnóstico , Diabetes Mellitus/sangre , Hemoglobina A Glucada/metabolismo , Hospitalización/estadística & datos numéricos , Biomarcadores/sangre , Glucemia/metabolismo , Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/fisiopatología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Hemoglobina A Glucada/análisis , Humanos , Modelos Logísticos , Resultado del Tratamiento
4.
Medicine (Baltimore) ; 98(50): e18100, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852069

RESUMEN

INTRODUCTION: Pulse wave analysis is an emerging approach that analyzes parameters comprising strong predictors of cardiovascular (CV) events and all-cause mortality, especially in patients with high CV risk based on established risk factors. This study used the oscillometric method, provided by the Mobil-o-Graph (PWA-EMI GmbH, Stolberg, Germany) device, to compare data regarding the pulse wave analysis parameters in hypertensive nondiabetic and diabetic patients. MATERIAL AND METHODS: In this cross-sectional study, 276 individuals were examined in the academic hypertension outpatient care unit of the Federal University of the Triângulo, in Mineiro, Brazil, from January to December 2016. The pulse wave analysis was performed by oscillometry, and its parameters were acquired from all patients. RESULTS: Of the 276 patients, 99 were diabetic and 177 nondiabetic. The mean systolic and pulse central blood pressure were significantly higher in diabetic patients than in nondiabetic patients (P = .008 and.0003, respectively). The mean peripheral systolic blood pressure and pulse pressure were also significantly higher in the diabetic group (P = .001 and P < .0001, respectively). The average pulse wave velocity (PWV, m/s) was 9.4 ±â€Š1.6 and 8.8 ±â€Š1.6 in the diabetic and nondiabetic groups, respectively (P = .003). CONCLUSION: The group of hypertensive diabetic patients had significantly higher central blood pressure, peripheral blood pressure, and PWV than the hypertensive nondiabetic patients. The patients with overlapping established CV risk factors presented values of the pulse wave analysis parameters consistent with higher central pressure and greater arterial stiffness.


Asunto(s)
Atención Ambulatoria , Presión Sanguínea/fisiología , Diabetes Mellitus/fisiopatología , Hipertensión/fisiopatología , Oscilometría/métodos , Análisis de la Onda del Pulso/métodos , Rigidez Vascular/fisiología , Brasil/epidemiología , Estudios Transversales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Factores de Riesgo , Sístole
6.
Sheng Li Xue Bao ; 71(6): 917-934, 2019 Dec 25.
Artículo en Chino | MEDLINE | ID: mdl-31879747

RESUMEN

Exosome is a kind of nanoscale-size extracellular vesicles secreted by the means of cell active stimulation with outer membrane structure of vacuoles corpuscle. It can carry and transfer a lot of biological molecules, such as DNA fragments, circular RNA (circRNA), messenger RNA (mRNA), microRNA (miRNA), functional proteins, transcription factors, etc., so as to achieve the goal of information transmission between cells. The relationship between exosomes and diabetes has received extensive attention in recent years. The exosomes play an important role in insulin sensitivity, glucose homeostasis and vascular endothelial function. This paper reviews the role of exosomes in the occurrence and development of diabetes and its complications, and discusses the role and prospect of exosomes as a target for diabetes treatment and its role in the diagnosis and treatment of diabetes.


Asunto(s)
Diabetes Mellitus , Exosomas , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatología , Diabetes Mellitus/terapia , Exosomas/metabolismo , Humanos , Resistencia a la Insulina/fisiología , MicroARNs/metabolismo , ARN Mensajero/metabolismo
7.
Anal Bioanal Chem ; 411(30): 7967-7979, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31754770

RESUMEN

Naturally occurring fructosamines are of high clinical significance due to their potential use in diabetes mellitus monitoring (quantification of fructosylated hemoglobin, HbA1c) or for the investigation of their reactivity in consecutive reactions and harmfulness towards the organism. Here we report the specific synthesis of the fructosylated dipeptide L-valyl-L-histidine (Fru-Val-His) and fructosylated L-valine (Fru-Val). Both are basic tools for the development and validation of enzymatic HbA1c assays. The two fructosamine derivatives were synthesized via a protected glucosone intermediate which was coupled to the primary amine of Val or Val-His, performing a reductive amination reaction. Overall yields starting from fructose were 36% and 34% for Fru-Val and Fru-Val-His, respectively. Both compounds were achieved in purities > 90%. A HILIC-ESI-MS/MS method was developed for routine analysis of the synthesized fructosamines, including starting materials and intermediates. The presented method provides a well-defined and efficient synthesis protocol with purification steps and characterization of the desired products. The functionality of the fructosylated dipeptide has been thoroughly tested in an enzymatic HbA1c assay, showing its concentration-dependent oxidative degradation by fructosyl-peptide oxidases (FPOX). Graphical abstract.


Asunto(s)
Diabetes Mellitus/diagnóstico , Fructosa/química , Hemoglobina A Glucada/análisis , Histidina/química , Cetosas/química , Espectrometría de Masa por Ionización de Electrospray/métodos , Espectrometría de Masas en Tándem/métodos , Valina/química , Pruebas de Enzimas , Humanos
8.
Pan Afr Med J ; 34: 10, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762879

RESUMEN

Introduction: There is an increasing commitment in the African Region towards diabetes care, following acknowledgement that it is an important public health issue which needs to be addressed in order to improve population health. We conducted a situational analysis of diabetes care in Guinea Bissau in order to identify the main issues faced in the management of the disease in this country. Methods: The study design was qualitative and data collection was done using semi directive interviews and focus groups with participants involved in primary diabetes care and management in Guinea Bissau (health care professionals, non-governmental organization staff, traditional healers) and patients. The data was analyzed using the five-phase approach of the thematic analysis framework. Results: The major themes identified included: the lack of specialists and properly trained healthcare personnel; no standardized care protocol for diagnosis, treatment, follow up and proper management for diabetic patients; resources poor primary health care settings; no validated epidemiological dataset on prevalence and the lack of awareness about diabetes (in general population and also in medical staff). Conclusion: This first situational analysis can serve as a baseline to develop an action plan to address the main issues identified.


Asunto(s)
Diabetes Mellitus/terapia , Personal de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Adulto , Niño , Diabetes Mellitus/diagnóstico , Grupos Focales , Guinea Bissau , Humanos , Entrevistas como Asunto
9.
Scand Cardiovasc J ; 53(6): 379-384, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31675271

RESUMEN

Objective. Patients with diabetes have higher mortality rate than patients without diabetes after ST-segment elevated myocardial infarction (STEMI). Prognosis of patients with new onset diabetes (NOD) after STEMI remains unclear. The aim of this study was to evaluate the prognosis of patients with NOD compared to that of patients without NOD after STEMI. Design. This study was a retrospective observational study. We enrolled 901 STEMI patients. Patients were divided into diabetic and non-diabetic groups at index admission. Non-diabetic group was divided into NOD and non-NOD groups. Kaplan-Meier analysis and Cox's proportional hazard regression models were used to compare major adverse cardiac events (MACE) free survival rate and hazard ratio for MACE between NOD and non-NOD groups. Results. Mean follow-up period was 59 ± 28 months. Diabetes group had higher MACE than non-diabetes group (p = .038). However, MACE was not different between NOD and non-NOD groups (p = 1.000). After 1:2 propensity score matching, incidence of MACE was not different between the two groups. In Kaplan-Meier survival curves, MACE-free survival rates were not statistically different between NOD and non-NOD groups either (p = .244). Adjusted hazard ratios of NOD for MACE, all-cause of death, recurrent myocardial infarction, and target vessel revascularization were 0.697 (95% confidence interval [CI]: 0.362-1.345, p = .282), 0.625 (95% CI: 0.179-2.183, p = .461), 0.794 (95% CI: 0.223-2.835, p = .723), and 0.506 (95% CI: 0.196-1.303, p = .158), respectively. Conclusion. This retrospective observational study with a limited statistical power did not show a different prognosis in patients with and without NOD.


Asunto(s)
Diabetes Mellitus/terapia , Infarto del Miocardio con Elevación del ST/terapia , Adulto , Anciano , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Supervivencia sin Progresión , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Factores de Tiempo
10.
BMC Infect Dis ; 19(1): 799, 2019 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-31510930

RESUMEN

BACKGROUND: The accuracy of different laboratory tests for diagnosis of diabetes mellitus (DM) and prediabetes (preDM) in populations exposed to tuberculosis (TB) remains poorly understood. Here, we examined the prevalence of DM and preDM in TB affected people in Lima, Peru. METHODS: A prospective cohort study of patients affected TB and their household contacts (HHC), was conducted between February and November 2017 in Lima, Peru. Fasting plasma glucose (FPG), HbA1c and oral glucose tolerance test (OGTT) were used to detect DM and preDM in a prospective cohort of TB patients (n = 136) and household contacts (n = 138). Diagnostic performance of the laboratory tests was analyzed. Potential effects of sociodemographic and clinical factors on detection of dysglycemia were analyzed. RESULTS: In TB patients, prevalence of DM and preDM was 13.97 and 30.88% respectively. Lower prevalence of both DM (6.52%) and preDM (28.99%) were observed in contacts. FPG, HbA1c and OGTT had poor agreement in detection of preDM in either TB cases or contacts. TB-DM patients had substantially lower hemoglobin levels, which resulted in low accuracy of HbA1c-based diagnosis. Classic sociodemographic and clinical characteristics were not different between TB patients with or without dysglycemia. CONCLUSION: High prevalence of DM and preDM was found in both TB patients and contacts in Lima. Anemia was strongly associated with TB-DM, which directly affected the diagnostic performance of HbA1c in such population.


Asunto(s)
Diabetes Mellitus/diagnóstico , Estado Prediabético/diagnóstico , Tuberculosis/patología , Adulto , Glucemia/análisis , Complicaciones de la Diabetes/patología , Diabetes Mellitus/epidemiología , Femenino , Prueba de Tolerancia a la Glucosa , Hemoglobina A Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Perú , Estado Prediabético/complicaciones , Estado Prediabético/epidemiología , Prevalencia , Estudios Prospectivos , Tuberculosis/complicaciones
11.
Klin Lab Diagn ; 64(8): 453-458, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31479598

RESUMEN

The article contains the literature review on laboratory criteria of detection and monitoring of the progression of the disease in patients with the diagnosis of diabetes mellitus. It also covers the issues of methodical approaches to the identification of glycated hemoglobin (HbA1c). The findings of author's researches of glycated hemoglobin in 149 patients have been given within the framework of comparison of two methodical approaches and comparison of the results with the subsequent classification of the received data. A random laboratory finding of qualitative hemoglobinopathy has been demonstrated, and the results recognized as unqualifiable and the approach to classification of such values have been discussed.Comparison of the results of glycated hemoglobin identification performed by different methods. 149 patients underwent a one-stage identification of glycated hemoglobin from plasma stabilized with K2-EDTA on Bio-Rad D10 and Sebia Capillarys Flex Piercing 2. Comparative study of the results of glycated hemoglobin identification has shown a difference in absolute values. However, a statistically reliable (p < 0.05) correlation between the values of glycated hemoglobin, expressed as a percentage obtained by different methods, has been revealed. In this case, the choice of a method for identifying glycated hemoglobin is not a matter of principal but it is important to adhere to the same method in treatment and long-term monitoring.


Asunto(s)
Diabetes Mellitus/diagnóstico , Hemoglobina A Glucada/análisis , Electroforesis Capilar , Humanos
12.
Acta Diabetol ; 56(12): 1275-1282, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31401734

RESUMEN

AIMS: To investigate the association between progressive macular ganglion cell/inner plexiform layer (mGCIPL) thinning and change of optical coherence tomography angiography (OCTA)-derived microvascular parameters in early-stage diabetic retinopathy (DR). METHODS: A retrospective cohort study involved 40 eyes presenting with no DR or mild non-proliferative DR at baseline, and 30 healthy controls were included. All participants underwent spectral-domain OCT and OCTA at baseline and at 6, 12, 18, and 24 months. Change of mGCIPL thickness and OCTA metrics including foveal avascular zone (FAZ) area and FAZ circularity, vessel density (VD), and perfusion index (PI) was measured. Correlations between mGCIPL thickness and OCTA metrics were explored using regression models. RESULTS: Average progressive mGCIPL loss was 0.45 µm per year. Three microvascular parameters were significantly impaired at 24 months compared to baseline (FAZ area: 0.34-0.36 mm2, VD: 18.9-18.5/mm, PI: 0.35-0.34). A strong positive correlation was found between loss of mGCIPL and VD from baseline to 24 months (r = 0.817, p < 0.001). Multivariable regression analysis showed that thinner baseline mGCIPL and greater loss of mGCIPL thickness (B = 0.658, p < 0.001) were significantly associated with change of VD. CONCLUSIONS: In the early stage of DR, progressive structural retinal neurodegeneration and parafoveal microvascular change seem to be highly linked. Advanced mGCIPL thinning might precede microvascular impairment in early DR.


Asunto(s)
Angiopatías Diabéticas/patología , Neuropatías Diabéticas/patología , Retinopatía Diabética/patología , Degeneración Nerviosa/patología , Neuronas Retinianas/patología , Vasos Retinianos/diagnóstico por imagen , Anciano , Estudios de Casos y Controles , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/patología , Angiopatías Diabéticas/diagnóstico , Neuropatías Diabéticas/diagnóstico , Retinopatía Diabética/complicaciones , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/fisiopatología , Progresión de la Enfermedad , Femenino , Angiografía con Fluoresceína , Humanos , Estudios Longitudinales , Mácula Lútea/diagnóstico por imagen , Mácula Lútea/patología , Masculino , Persona de Mediana Edad , Degeneración Nerviosa/diagnóstico , Degeneración Nerviosa/etiología , Retina/diagnóstico por imagen , Retina/patología , Neuronas Retinianas/ultraestructura , Vasos Retinianos/patología , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos
13.
Mayo Clin Proc ; 94(9): 1670-1680, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31405751

RESUMEN

OBJECTIVE: To retrospectively investigate the real-world impact of elevated triglyceride (TG) levels on cardiovascular (CV) outcomes, medical resource utilization, and medical costs using observational administrative claims data from the Optum Research Database. METHODS: Patients with one or more claims for statin therapy between January 1, 2010, and December 31, 2010, and 6 months or more of baseline data prior to the index date were eligible for inclusion in the study. Patients aged 45 years or older with diabetes and/or atherosclerotic CV disease were included and analyzed in an elevated TG cohort (≥150 mg/dL) vs a comparator cohort with TG levels less than 150 mg/dL and high-density lipoprotein cholesterol (HDL-C) levels greater than 40 mg/dL. RESULTS: In the elevated TG vs propensity-matched comparator cohorts (both N=23,181 patients), the mean age was 62.2 vs 62.6 years, mean follow-up was 41.4 vs 42.5 months, 49.7% (11,518) vs 49.5% (11,467) were female, 83.7% (19,392) vs 84.0% (19,478) had diabetes, and 29.8% (6915) vs 29.3% (6800) had atherosclerotic CV disease. In the elevated TG (N=27,471 patients) vs comparator (N=32,506 patients) cohorts, multivariate analysis revealed significantly greater risk of composite major CV events (hazard ratio [HR], 1.26; 95% CI, 1.19-1.34; P<.001), nonfatal myocardial infarction (HR, 1.32; 95% CI, 1.20-1.45; P<.001), nonfatal stroke (HR, 1.14; 95% CI, 1.04-1.24; P=.004), and need for coronary revascularization (HR, 1.46; 95% CI, 1.33-1.61; P<.001) but not unstable angina (P=.53) or CV death (P=.23). Increased CV risk was maintained with the addition of non-HDL-C to the multivariate model and with high and low HDL-C subgroup analysis. Total direct health care costs (cost ratio, 1.12; 95% CI, 1.08-1.16; P<.001) and inpatient hospital stays (HR, 1.13; 95% CI, 1.10-1.17; P<.001) were significantly higher in the elevated TG cohort vs the comparator cohort. CONCLUSION: Statin-treated patients with TG levels of 150 mg/dL or greater had worse CV and health economic outcomes than those with well-managed TG (<150 mg/dL) and HDL-C (>40 mg/dL) levels.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Costos de los Medicamentos/estadística & datos numéricos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/economía , Hipertrigliceridemia/tratamiento farmacológico , Hipertrigliceridemia/epidemiología , Anciano , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/terapia , Estudios de Casos y Controles , Causas de Muerte , Comorbilidad , Análisis Costo-Beneficio , Bases de Datos Factuales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamiento farmacológico , Femenino , Costos de la Atención en Salud , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertrigliceridemia/diagnóstico , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Análisis de Supervivencia , Resultado del Tratamiento , Triglicéridos/sangre
14.
Rev Med Suisse ; 15(659): 1444-1447, 2019 Aug 21.
Artículo en Francés | MEDLINE | ID: mdl-31436059

RESUMEN

Continuous glucose monitoring is a technique that allows near-continuous measurement of interstitial glucose concentration. Much progress has been made in this area. The management of certain diabetic patients, in particular type 1, has been considerably improved thanks to the use of this technique. Many pitfalls have been crossed to allow its commercialization. There is still a lot of progress to be made. A good knowledge of these new devices is necessary to understand their strengths and weaknesses. This article briefly discusses the state of the art in this area and the expected perspectives of this attractive but expensive technology that must meet the ever-increasing but legitimate expectations of diabetic patients.


Asunto(s)
Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea/economía , Automonitorización de la Glucosa Sanguínea/instrumentación , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Pruebas Hematológicas/instrumentación , Humanos
15.
Acta Diabetol ; 56(12): 1293-1303, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31468199

RESUMEN

AIMS: To evaluate superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) perfusion in macular and near/mid periphery regions in diabetic patients using widefield swept-source optical coherence tomography angiography (WSS-OCTA). METHODS: Ninety-four diabetic patients (94 eyes) classified as diabetics without diabetic retinopathy (no DR) (25 eyes), mild DR (23 eyes), moderate/severe DR (26 eyes), proliferative DR (20 eyes) and a control group of 25 healthy subjects (25 eyes) were imaged with the WSS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). Quantitative analysis was performed in the macular and peripheral regions. The main outcome measures were perfusion density (PD) and vessel length density of SCP, DCP and CC. RESULTS: Peripheral retina (all sectors) showed lower SCP and DCP PD compared to the macular region (p < 0.001). In diabetics without DR and DR in different stages, SCP and DCP PD significantly decreased at advancing stages of DR (p < 0.001). At DCP level, central PD was significantly directly related to peripheral PD (superior, R = 0.682 and 0.479; temporal, R = 0.918 and 0.554; inferior, R = 0.711). A good sensitivity and an excellent specificity were found in terms of prediction of disease worsening, especially for central and temporal sectors in all plexuses and for all sectors both central and peripheral of DCP. CONCLUSIONS: The widefield OCTA is useful for the study of central and peripheral retina in diabetic patients with or without diabetic retinopathy, assessing good correlation between central and peripheral retina.


Asunto(s)
Retinopatía Diabética/diagnóstico , Angiografía con Fluoresceína/métodos , Tomografía de Coherencia Óptica/métodos , Adulto , Anciano , Capilares/diagnóstico por imagen , Capilares/patología , Estudios de Casos y Controles , Recuento de Células , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/patología , Retinopatía Diabética/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Retina/diagnóstico por imagen , Retina/patología , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología
16.
Int J Med Inform ; 129: 107-113, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31445244

RESUMEN

OBJECTIVE: Use symptoms to stratify temporal disease trajectories. MATERIALS AND METHODS: We use data from the Danish National Patient Registry to stratify temporal disease pairs by the symptom distributions they associate to. The underlying data comprise of 6.6 million patients collectively assigned with 7.5 million symptoms from chapter XVIII in the WHO International Classification of Disease version 10 terminology. RESULTS: We stratify 33 disease pairs into 67 temporal disease-symptom-disease trajectories from three main diagnoses (two diabetes subtypes and COPD), where the symptom significantly changes the risk of developing the subsequent diseases. We combine these trajectories into three temporal disease networks, one for each main diagnosis. We confirm apparent relations between diseases and symptoms and discovered that multiple symptoms decrease the risk for diabetes progression. CONCLUSION: Symptoms can be used to stratify disease trajectories, and we suggest that this approach can be applied to temporal disease trajectories systematically using structured claims data. The method can be extended to also use text-mined symptoms from unstructured data in health records.


Asunto(s)
Diabetes Mellitus/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Diabetes Mellitus/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adulto Joven
18.
Cornea ; 38(10): 1203-1208, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31299666

RESUMEN

PURPOSE: To determine whether donor diabetes mellitus (DM) severity is associated with differences in endothelial cell density (ECD) and surgically unsuitable tissue. METHODS: Raw data were obtained from Saving Sight Eye Bank (Kansas City, MO) including 10,454 donated eyes from 5346 eligible donors from July 2014 through May 2017. Donors were grouped into 5 categories by their insulin use and the presence of microvascular end-organ complications. The categories were non-DM (NDM), noninsulin-dependent DM without complications (NIDDMnc), noninsulin-dependent DM with complication (NIDDMc), insulin-dependent DM without complications, and insulin-dependent DM with complication. Outcome variables included ECD and tissue transplant suitability. Mixed effects models were used to adjust for the random effect of repeated measures and fixed effects of donor age, race, lens status, and death to refrigeration and death to preservation times. Interaction effects of DM severity group and donor age and DM severity group and lens status were included in the models. RESULTS: One thousand six hundred eighty-four (32.1%) donors had a diagnosis of DM. Six hundred fifty-eight donors were in the NIDDMnc group, 225 in the NIDDMc group, 404 in the insulin-dependent DM without complication group, and 397 in the insulin-dependent DM with complication group. Compared with non-DM, donors with DM were older (P < 0.001) and more likely to be pseudophakic (P < 0.001). DM severity groups did not affect adjusted ECD at mean donor age. There was no statistically significant ECD interaction between DM severity group and lens status. There was a statistically significant ECD crossover interaction with NIDDMnc and donor age (P < 0.001). In phakic eyes, NIDDMc was associated with a statistically significantly lower odds of transplant suitability (odds ratio 0.62, P = 0.006). CONCLUSIONS: DM severity does not affect lowering adjusted ECD at mean donor age. DM severity and pseudophakia were not associated with lower adjusted ECD. NIDDMnc was associated with an attenuation of the age-dependent decrease in ECD. NIDDMc was associated with decreased transplant suitability in phakic eyes. Future studies should include age, lens status, and interaction effects in their models of ECD and transplant suitability.


Asunto(s)
Enfermedades de la Córnea/cirugía , Trasplante de Córnea/métodos , Diabetes Mellitus/diagnóstico , Epitelio Posterior/patología , Bancos de Ojos/estadística & datos numéricos , Donantes de Tejidos , Anciano , Enfermedades de la Córnea/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
19.
Prog Cardiovasc Dis ; 62(4): 306-314, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31301314

RESUMEN

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality for patients with diabetes mellitus (DM). Although the burden of atherosclerotic CVD (ASCVD) is well documented, heart failure (HF) has been an under-appreciated CVD complication of DM. However, as more patients with DM live longer and survive acute ASCVD events, the distribution of CVD complications has evolved. This review summarizes the epidemiology of DM, the relative risk and prognosis of both ASCVD and HF following a diagnosis of DM, and the likelihood of cause-specific CVD mortality in patients with DM.


Asunto(s)
Aterosclerosis/epidemiología , Enfermedades Cardiovasculares/epidemiología , Causas de Muerte , Diabetes Mellitus/epidemiología , Insuficiencia Cardíaca/epidemiología , Adulto , Anciano , Aterosclerosis/diagnóstico , Enfermedades Cardiovasculares/diagnóstico , Comorbilidad , Diabetes Mellitus/diagnóstico , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Estados Unidos/epidemiología
20.
Med Care ; 57(9): 710-717, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31295167

RESUMEN

BACKGROUND: The State Innovation Models (SIM) Initiative invested $254 million in 6 states in Round 1 to accelerate delivery system and payment reforms. OBJECTIVE: The objective of this study was to examine the association of early SIM implementation and diagnosed diabetes prevalence among adults and hospitalization rates among diagnosed adults. RESEARCH DESIGN: Quasi-experimental design compares diagnosed diabetes prevalence and hospitalization rates before SIM (2010-2013) and during early implementation (2014) in 6 SIM states versus 6 comparison states. County-level, difference-in-differences regression models were estimated. SUBJECTS: The annual average of 4.5 million adults aged 20+ diagnosed with diabetes with 1.4 million hospitalizations in 583 counties across 12 states. MEASURES: Diagnosed diabetes prevalence among adults and hospitalization rates per 1000 diagnosed adults. RESULTS: Compared with the pre-SIM period, diagnosed diabetes prevalence increased in SIM counties by 0.65 percentage points (from 10.22% to 10.87%) versus only 0.10 percentage points (from 9.64% to 9.74%) in comparison counties, a difference-in-differences of 0.55 percentage points. The difference-in-differences regression estimates ranged from 0.49 to 0.53 percentage points (P<0.01). Regression results for ambulatory care-sensitive condition and all-cause hospitalization rates were inconsistent across models with difference-in-differences estimates ranging from -5.34 to -0.37 and from -13.16 to 0.92, respectively. CONCLUSIONS: SIM Round 1 was associated with higher diagnosed diabetes prevalence among adults after a year of implementation, likely because of SIM's emphasis on detection and care management. SIM was not associated with lower hospitalization rates among adults diagnosed with diabetes, but the SIM's long-term impact on hospitalizations should be assessed.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Diabetes Mellitus/diagnóstico , Reforma de la Atención de Salud/legislación & jurisprudencia , Implementación de Plan de Salud/estadística & datos numéricos , Adulto , Anciano , Prestación de Atención de Salud/legislación & jurisprudencia , Diabetes Mellitus/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados no Aleatorios como Asunto , Innovación Organizacional , Prevalencia , Gobierno Estatal , Estados Unidos/epidemiología , Adulto Joven
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