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1.
Am J Physiol Endocrinol Metab ; 318(5): E736-E741, 2020 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-32228322

RESUMEN

The pandemic of coronavirus disease (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is causing substantial morbidity and mortality. Older age and presence of diabetes mellitus, hypertension, and obesity significantly increases the risk for hospitalization and death in COVID-19 patients. In this Perspective, informed by the studies on SARS-CoV-2, Middle East respiratory syndrome (MERS-CoV), and the current literature on SARS-CoV-2, we discuss potential mechanisms by which diabetes modulates the host-viral interactions and host-immune responses. We hope to highlight gaps in knowledge that require further studies pertinent to COVID-19 in patients with diabetes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Diabetes Mellitus , Interacciones Microbiota-Huesped , Pandemias , Neumonía Viral , Animales , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/virología , Diabetes Mellitus/inmunología , Diabetes Mellitus/mortalidad , Interacciones Microbiota-Huesped/inmunología , Humanos , Neumonía Viral/inmunología , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Neumonía Viral/virología , Medición de Riesgo , Incertidumbre , Estados Unidos/epidemiología
2.
J Glob Health ; 10(1): 010401, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257151

RESUMEN

Background: Data on mortality burden and excess deaths attributable to diabetes are sparse and frequently unreliable, particularly in low and middle-income countries. Estimates in Brazil to date have relied on death certificate data, which do not consider the multicausal nature of deaths. Our aim was to combine cohort data with national prevalence and mortality statistics to estimate the absolute number of deaths that could have been prevented if the mortality rates of people with diabetes were the same as for those without. In addition, we aimed to estimate the increase in burden when considering undiagnosed diabetes. Methods: We estimated self-reported diabetes prevalence from the National Health Survey (PNS) and overall mortality from the national mortality information system (SIM). We estimated the diabetes mortality rate ratio (rates of those with vs without diabetes) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), an ongoing cohort study. Joining estimates from these three sources, we calculated for the population the absolute number and the fraction of deaths attributable to diabetes. We repeated our analyses considering both self-reported and unknown diabetes, the latter estimated based on single point-in-time glycemic determinations in ELSA-Brasil. Finally, we compared results with diabetes-related mortality information from death certificates. Results: In 2013, 65 581 deaths, 9.1% of all deaths between the ages of 35-80, were attributable to known diabetes. If cases of unknown diabetes were considered, this figure would rise to 14.3%. In contrast, based on death certificates only, 5.3% of all death had diabetes as the underlying cause and 10.4% as any mentioned cause. Conclusions: In this first report of diabetes mortality burden in Brazil using cohort data to estimate diabetes mortality rate ratios and the prevalence of unknown diabetes, we showed marked underestimation of the current burden, especially when unknown cases of diabetes are also considered.


Asunto(s)
Certificado de Defunción , Diabetes Mellitus/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/análisis , Brasil/epidemiología , Causas de Muerte , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos
3.
J Frailty Aging ; 9(2): 94-100, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32259183

RESUMEN

BACKGROUND: Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. OBJECTIVES: Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. DESIGN: Retrospective cohort. SETTING: Outpatient. PARTICIPANTS: Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. MEASUREMENTS: The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. RESULTS: We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. CONCLUSIONS: Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.


Asunto(s)
Diabetes Mellitus/mortalidad , Diabetes Mellitus/terapia , Fragilidad/epidemiología , Hospitalización/estadística & datos numéricos , Vida Independiente , Anciano , Anciano Frágil/estadística & datos numéricos , Humanos , Estudios Retrospectivos , Veteranos/estadística & datos numéricos
4.
Sci Total Environ ; 711: 135098, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32000339

RESUMEN

Diabetes is a major public health problem globally, and heat exposure may be a potential risk factor for death among diabetes. This study examines the association between heat and diabetes mortality in different regions of Thailand and investigates whether heat effects are modified by regional greenness. Daily temperature and daily diabetes deaths data were obtained for 60 provinces of Thailand during 2000-2008. A case-crossover analysis was conducted to quantify the odds of heat-related death among diabetes. Meta-regression was then used to examine potential modification effects of regional greenness (as represented by the Normalized Difference Vegetation Index) on heat-related mortality. A strong association between heat and diabetes mortality was found in Thailand, with important regional variations. Nationally, the pooled odds ratio of diabetes mortality was 1.10 (95% confidence interval (CI): 1.06-1.14) for heat (90th percentile of temperature) and 1.20 (95% CI: 1.10-1.30) for extreme heat (99th percentile of temperature) compared with the minimum mortality temperature, across lag 0-1 days. Central and northeast Thailand were the most vulnerable regions. Regional greenness modified the effects of heat, with lower mortality impacts in areas of higher levels of greenness. In conclusion, heat exposure increases mortality risk in diabetes, with large geographical variations in risk suggesting the need for region-specific public health strategies. Increasing greenness levels may help to reduce the burden of heat on diabetes in Thailand against the backdrop of a warming climate.


Asunto(s)
Diabetes Mellitus , Diabetes Mellitus/mortalidad , Calor , Humanos , Temperatura , Tailandia/epidemiología
5.
PLoS One ; 15(1): e0225207, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940349

RESUMEN

BACKGROUND: Hypertension-related mortality has been increasing in recent years; however, limited information exists concerning rate, temporal, secular, and geographic trends in the United States. METHODS AND RESULTS: Using CDC death certificate data spanning 1999-2016, we sought to delineate trends in deaths attributable to an underlying cause of hypertension using joinpoint regression and proportion testing. From 1999-2016, the hypertension-related mortality rate increased by 36.4% with an average annual percent change (AAPC) of 1.8% for individuals ≥ 35 years of age. Interestingly, there was a notable acceleration in the AAPC of hypertension mortality between 2011 and 2016 (2.7% per year). This increase was due to a significant uptick in mortality for individuals ≥ 55 years of age with the greatest AAPC occurring in individuals 55-64 (4.5%) and 65-74 (5.1%) years of age. Increased mortality and AAPC were pervasive throughout sex, ethnicity, and White and American Indian or Alaska Native race, but not Black or African American race. From 2011-2016, there were significant increases in AAPC for hypertension-related mortality with contributing causes of atrial fibrillation, heart failure, diabetes, obesity, and vascular dementia. Elevated mortality was observed for conditions with a contributing cause of hypertension that included chronic obstructive pulmonary disease, diabetes, Alzheimer's, Parkinson's, and all types of falls. Geographically, increases in AAPCs and mortality rates were observed for 25/51 States between 2011 and 2016. CONCLUSIONS: Our results indicate hypertension-related mortality may have accelerated since 2011 for middle-aged and older Americans, which may create new challenges in care and healthcare planning.


Asunto(s)
Diabetes Mellitus/mortalidad , Insuficiencia Cardíaca/mortalidad , Hipertensión/mortalidad , Adulto , Afroamericanos , Distribución por Edad , Anciano , Causas de Muerte , Certificado de Defunción , Diabetes Mellitus/fisiopatología , Grupo de Ascendencia Continental Europea , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/fisiopatología , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología
6.
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
7.
S Afr Med J ; 109(12): 957-962, 2019 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-31865959

RESUMEN

BACKGROUND: The International Diabetes Federation (IDF) recently reported that there are 1.8 million South Africans with diabetes, and estimates an additional undiagnosed population of 69% of the total number of diabetics. The African continent is expected to see the highest increase in diabetes globally by 2045. Healthcare measures to manage this surge in diabetes and its related complications should be tailored to Africa's unique challenges; however, the epidemiolocal data essential for policy development are lacking. Bridging the data gap will guide funding distribution and the creation of evidence-based initiatives for diabetes. OBJECTIVES: To investigate the frequency, age proportion and distribution of new patients diagnosed with diabetes in the public healthcare sector of Eastern Cape (EC) Province, South Africa (SA). METHODS: All data collected to date were obtained from the EC District Health Information System. According to the information collected from the Department of Health, diabetes-related data collection fields were implemented in 2013, which resulted in this 4-year study. Additional open-source data on population estimates, mortality and medical aid coverage were provided by Statistics SA. RESULTS: Of the eight districts in the province, O R Tambo was recorded as having the highest average proportion of new patients diagnosed with diabetes. A positive correlation was found between the calculated incidence of disease and the diabetes mortality rate. CONCLUSIONS: The study showed an annual growth in the incidence of diabetes in the EC since 2014, and highlights the issue of an increasing burden of diabetes in the rural population. This increase is consonant with predictions by authoritative bodies on the growing burden of diabetes in Africa. The pattern of distribution highlights the deprived district of O R Tambo contradicting the well-known link between diabetes and urbanisation.


Asunto(s)
Áreas de Influencia de Salud/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Sector Público/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Diabetes Mellitus/mortalidad , Política de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Incidencia , Persona de Mediana Edad , Áreas de Pobreza , Prevalencia , Sudáfrica/epidemiología , Adulto Joven
8.
Artículo en Ruso | MEDLINE | ID: mdl-31884765

RESUMEN

The statistics of causes of death is the informational basis for identifying public health problems. That is why the accurately accounting for mortality from diabetes mellitus, which is a global medical and social problem for society, is important. The study was carried out to analyze the correctness of coding death causes of diabetes mellitus and the frequency of alleged death. MATERIALS AND METHODS: The Moscow deceased population database of July 2018 - July 2019 was analyzed. Using the decision tables on codes linkages from ICD-10, incorrect codes for underline cause were established for 342 death cases from diabetes mellitus. Among 43044 cases of cardiovascular death the cases of presumed death from diabetes were detected. The analysis was carried out in the Microsoft Access 2007 software. THE RESULTS: In 18.4% of cases, the cause of death from diabetes was encoded incorrectly. If a modification of the underline death cause is assumed due to the mention of certain diseases in any line of the Death Certificate, cases of coding for death from diabetes with wrong fourth character are more often detected when mentioning kidney diseases. If modification of the underline cause is provided for cases when information in the Death Certificate indicates that diabetes has caused the development of some diseases then the largest number of cases with incorrect coding was detected when mentioning circulatory diseases. Only in one medical organization the frequency of incorrect coding is 3.4%, in the rest it varies from 15.4% to 52.2%. Among all death causes, diabetes was only 0.41%. If to add cases of presumptive death from diabetes mellitus, then the proportion of diabetes in the structure of death causes will almost triple and reach up to 1.2%. CONCLUSIONS: The quality of diagnosis and coding of death causes from diabetes has not improved in recent years. To increase it, it is advisable to organize and establish the institution of coders. It is advisable to indicate the presence of diabetes mellitus in the Death Certificate without fail and use the information from the diabetes register. It is proposed to encode the death cause from diabetes mellitus with multiple complications use line D in the Death Certificate to indicate damage to various organs and systems if it is necessary.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Diabetes Mellitus/mortalidad , Humanos , Clasificación Internacional de Enfermedades , Moscú/epidemiología
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.
Nursing (Säo Paulo) ; 22(257): 3226-3233, out.2019.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1026097

RESUMEN

Objetivo: analisar a taxa de internação por Diabetes mellitus no Pará. Método: Estudo analítico, de abordagem quantitativo. Os dados das internações hospitalares do período de 2008 a 2017 foram extraídos do Sistema de Informação Hospitalar do Sistema Único de Saúde, por meio do programa Tabwin. Para análise foram utilizados os programas Bioestat, Tabwin e Excel. Resultados: Foram registradas 53.954 internações e 1.950 óbitos ocorridos durante a internação pela doença. O maior risco de óbito na internação pela doença foi associado aos homens, pessoas com idade acima de 70 anos, e nas complicações agudas e de longo prazo. A taxa de internação ao longo de todo o período foi crescente nas Regiões de Saúde do Marajó I, II e Araguaia. Conclusão: Houve um crescimento das taxas de internação e mortalidade durante a internação por Diabetes Mellitus até o ano de 2015 no Pará e variação entre as regiões de saúde.(AU)


Objective: analyze the hospitalization rate for Diabetes mellitus in Pará. Method: Analytical study, with a quantitative approach. Data from hospital admissions from 2008 to 2017 were extracted from the Hospital Information System of the Unified Health System, through the Tabwin program. For the analysis, the programs Bioestat, Tabwin and Excel were used. Results: There were 53,954 hospitalizations and 1,950 deaths during hospitalization. The highest risk of death in hospitalization for the disease was associated with men, people over 70 years of age, and in acute and long-term complications. The hospitalization rate throughout the period was increasing in the Health Regions of Marajó I, II and Araguaia. Conclusion: There was an increase in hospitalization rates and mortality during hospitalization for Diabetes mellitus up to 2015 in Pará and variation among health regions.(AU)


Objetivo: analizar la tasa de internación por Diabetes mellitus en Pará. Método: Estudio analítico, de abordaje cuantitativo. Los datos de las internaciones hospitalarias del período de 2008 a 2017 fueron extraídos del Sistema de Información Hospitalaria del Sistema Único de Salud, a través del programa Tabwin. Para el análisis se utilizaron los programas Bioestat, Tabwin y Excel. Resultados: Se registraron 53.954 internaciones y 1.950 muertes ocurridas durante la internación por la enfermedad. El mayor riesgo de muerte en la internación por la enfermedad fue asociado a los hombres, personas mayores de 70 años, y en las complicaciones agudas ya largo plazo. La tasa de internación a lo largo de todo el período fue creciente en las Regiones de Salud del Marajó I, II y Araguaia. Conclusión: Hubo un crecimiento de las tasas de internación y mortalidad durante la internación por Diabetes Mellitus hasta el año 2015 en Pará y variación entre las regiones de salud.(AU)


Asunto(s)
Humanos , Factores de Riesgo , Complicaciones de la Diabetes , Diabetes Mellitus/mortalidad , Hospitalización
11.
Transplant Proc ; 51(7): 2434-2438, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474298

RESUMEN

Owing to impaired immune function, surgical procedures, and multiple hospitalizations, patients with end-stage liver disease are at risk for numerous infectious complications while waiting for transplantation. Infection in transplant recipients remains the main cause of mortality and morbidity, despite advances in surgical techniques and the development of new repressive agents. The purpose of this study is to examine the infections that develop during the pretransplantion period in live donor liver transplant recipients and their effect on post-transplant clinical outcomes. The retrospective analysis of adult live donor liver transplant recipients in the last 4 years was conducted at Ankara University Hospital, a 1900-bed tertiary-care university hospital, in Ankara, Turkey. Demographic characteristics, preoperative infections, and clinical outcomes were analyzed. Patients were divided into 2 groups according to whether they had developed an infection before transplantation. The diagnoses were based on clinical, laboratory, and microbiological findings. Statistical analyses were performed using Stata version 9.0 (StataCorp, College Station, Tex., United States), and P < .05 were considered statistically significant. In univariate analyses, having diabetes mellitus or a pretransplant infection, the number of pretransplant infection attacks, the need for a reoperation, and developing a post-transplant infection were the statistically significant factors associated with 1-year mortality (P < .001, χ2 test). In multivariate analyses, diabetes mellitus (Odds ratio [OR] = 7.44, 95% confidence interval [CI], .03-45.79; P = .013), reoperation (OR = .33, 95% CI, .25-2.20; P < .001), having a pretransplantation infection (OR = 12.47, 95% CI, .011-87.67; P = .013), and the number of pretransplantation infection attacks (OR = .028, 95% CI, .013-.47; P < .001) were found to be statistically significant risk factors for 1-year mortality. Our study showed the effect of pretransplantation infections on post-transplant morbidity but not on rejection or mortality. According to the situation of patients, manageable pretransplantation infection is not an absolute contraindication for liver transplantation. Awareness of the increased risk for post-transplant infections and fast-acting antimicrobial coverage are the most important facts for patient survival.


Asunto(s)
Enfermedad Hepática en Estado Terminal/complicaciones , Trasplante de Hígado/mortalidad , Donadores Vivos , Complicaciones Posoperatorias/mortalidad , Adulto , Contraindicaciones de los Procedimientos , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etiología , Diabetes Mellitus/mortalidad , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/cirugía , Femenino , Hospitalización , Humanos , Trasplante de Hígado/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Turquia , Adulto Joven
12.
Diab Vasc Dis Res ; 16(6): 582-584, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31476896

RESUMEN

OBJECTIVE: To investigate the association between admission plasma glucose and cardiovascular events in patients with acute myocardial infarction treated with modern therapies including early percutaneous coronary intervention and modern stents. METHODS: Patients (n = 5309) with established diabetes and patients without previously known diabetes with a reported admission plasma glucose, included in the VALIDATE trial 2014-2016, were followed for cardiovascular events (first of mortality, myocardial infarction, stroke, heart failure) within 180 days. Event rates were analysed by four glucose categories according to the World Health Organization criteria for hyperglycaemia and definition of diabetes. Odds ratios were calculated in a multivariate logistic regression model. RESULTS: Mean age was 67 ± 11 years. Previously known diabetes was present in 21.2% (n = 1124). Cardiovascular events occurred in 3.7%, 3.8%, 6.6% and 15.7% in the four glucose level groups and 9.9% in those with known diabetes (p < 0.001), while bleeding complications did not differ significantly (9.1%, 8.5%, 8.4%, 12.2% and 8.5%, respectively). After adjustment, odds ratio (95% confidence interval) was 1.00 (0.65-1.53) for group II, 1.62 (1.14-2.29) for group III and 3.59 (1.99-6.50) for group IV compared to the lowest admission plasma glucose group (group I). The corresponding number for known diabetes was 2.42 (1.71-3.42). CONCLUSION: In a well-treated contemporary population of acute myocardial infarction patients, 42% of those without diabetes had elevated admission plasma glucose levels with a greater risk for clinical events already within 180 days. Event rate increased with increasing admission plasma glucose levels. These findings highlight the importance of searching for undetected diabetes in the setting of acute myocardial infarction and that new treatment options are needed to improve outcome.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus/sangre , Hiperglucemia/sangre , Infarto del Miocardio/terapia , Admisión del Paciente , Intervención Coronaria Percutánea/efectos adversos , Anciano , Anticoagulantes/uso terapéutico , Antitrombinas/uso terapéutico , Biomarcadores/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Femenino , Insuficiencia Cardíaca/mortalidad , Humanos , Hiperglucemia/diagnóstico , Hiperglucemia/mortalidad , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/mortalidad , Recurrencia , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Stents , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia Arriba
13.
Medicine (Baltimore) ; 98(34): e16927, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31441878

RESUMEN

Coronary artery disease (CAD) is a life-threatening medical emergency which needs urgent medical attention. Percutaneous coronary intervention (PCI) is common and necessary for patients with CAD. The effect of hypercholesterolemia and diabetes on long-term outcomes in patients with stable CAD receiving PCI is unclear.In this study, patients with stable CAD who underwent PCI were prospectively divided into 4 groups according to the presence or absence of diabetes or hypercholesterolemia. Clinical characteristics, risk factors, medications, angiographic findings, and outcome predictors were analyzed and long-term outcomes compared between groups.Of the 1676 patients studied, those with hypercholesterolemia and diabetes had the highest all-cause mortality rate after PCI (P < .01); those with diabetes only had the highest cardiovascular (CV) mortality (P < .01). However, the 4 groups did not differ in rates of myocardial infarction (MI) or repeated PCI. In Kaplan-Meier survival analysis, patients with diabetes only had the highest rates of all-cause mortality and CV mortality (both P < .001). In the Cox proportional hazard model, patients with both hypercholesterolemia and diabetes had the highest risk of all-cause mortality (hazard ratio: 1.70), but groups did not differ in rates of MI, CV mortality, and repeated PCI.With or without hypercholesterolemia, diabetes adversely impacts long-term outcomes in patients receiving PCI. Diabetes mellitus seemed to be a more hazardous outcome predictor than hypercholesterolemia. Hypercholesterolemia and diabetes seemed to have an additive effect on all-cause mortality in patients after receiving PCI.


Asunto(s)
Enfermedad de la Arteria Coronaria/mortalidad , Diabetes Mellitus/mortalidad , Hipercolesterolemia/mortalidad , Intervención Coronaria Percutánea/efectos adversos , Estudios de Casos y Controles , Comorbilidad , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Resultado del Tratamiento
14.
Eur J Epidemiol ; 34(10): 939-949, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31372866

RESUMEN

To investigate the major causes and predictive factors of death in a middle-aged and elderly Chinese population. A total of 6591 residents aged ≥ 45 years from Shanghai Changfeng community were followed up for an average of 5.4 years. The causes of death were coded according to the 10th Revision of International Classification of Diseases. The mortality rate was calculated by person-years of follow up and age-standardized according to the 2010 Chinese census data. Multivariable-adjusted Cox proportional hazards model was performed to investigate the predictors of all-cause and cause-specific mortality. During the total follow-up of 35,739 person-years, 370 deaths were documented (157 from malignant neoplasms, 70 from heart diseases, 68 from cerebrovascular diseases, 75 from other causes). The age-standardized all-cause mortality rate was 798.2 per 100,000 person-years (927.9 among men and 716.7 among women). Results from multivariable analyses showed that aging, diabetes, and osteoporosis at baseline were independent predictors of all-cause mortality, with hazard ratios (HR) of 1.11 (95% CI 1.10-1.13), 1.91 (1.51-2.42), and 1.71 (1.24-2.35), respectively. The population attributable risk percent of diabetes and osteoporosis was 19.7% and 11.7%, respectively. Cigarette smoking was associated with a higher risk of all-cause mortality in men (HR and 95%CI 1.44, 1.01-2.06). In women, diabetes and osteoporosis were related to a higher risk of cardiovascular mortality (3.27, 1.82-5.88 and 1.89, 1.04-3.46, respectively). While in men, osteoporosis was related to a higher risk of malignant neoplasms mortality (2.39, 1.07-5.33). Malignant neoplasms, heart diseases, and cerebrovascular diseases are the leading causes of death. Aging, smoking, underweight, diabetes, and osteoporosis are independent predictors of premature death among middle-aged and elderly Chinese community population. Moreover, there may have been some differences in the causes and predictors of premature death between men and women.


Asunto(s)
Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Neoplasias/mortalidad , Fumar/efectos adversos , Anciano , Anciano de 80 o más Años , China/epidemiología , Diabetes Mellitus/mortalidad , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Osteoporosis/mortalidad , Vigilancia de la Población , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Delgadez/complicaciones
16.
J Stroke Cerebrovasc Dis ; 28(10): 104281, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31351827

RESUMEN

INTRODUCTION: The highest mortality rates associated with ischemic stroke occur in patients of advanced age. However, studies of factors that establish the increase in hospital mortality are scanty in this population. MATERIAL AND METHODS: Epidemiologic, clinical and laboratory data, etiology and ischemic stroke subtype and complications during hospitalization were analyzed in 195 patients aged 80 years or older. In attempt to associate prognostic factor with the in-hospital mortality during first 28 days from admission, the death and survivor groups were compared. RESULTS: Among the 195 patients evaluated, the age was 85.3 ± 4.6 years with a mortality of 26.1%. Following the multivariate model, the factors associated with in-hospital mortality were: age (OR = 1.07, 95% CI = 1.00-1.20), the score less than or equal to 8 on Glasgow coma scale (OR = 22.87, 95% CI = 3.55-148.76), diabetes mellitus (OR = 3.40, 95% CI = 1.30-8.87), total anterior clinical subtype (OR = 5.15, 95% CI = 1.82-14.52) and infectious complications (OR = 8.38, 95% CI = 3.28-21.43). CONCLUSIONS: The following risk factors were associated with a higher in-hospital mortality rate in patients over 79 years of age with ischemic stroke: older age, Glasgow coma score less than or equal to 8, total anterior circulation infarction, infection, and diabetes mellitus.


Asunto(s)
Isquemia Encefálica/mortalidad , Mortalidad Hospitalaria , Pacientes Internos , Accidente Cerebrovascular/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Brasil/epidemiología , Enfermedades Transmisibles/mortalidad , Diabetes Mellitus/mortalidad , Femenino , Escala de Coma de Glasgow , Humanos , Masculino , Admisión del Paciente , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Factores de Tiempo
17.
Diabetes Metab Syndr ; 13(2): 1035-1040, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31336440

RESUMEN

AIMS: The study intended to investigate the impact of controlled glycemia on morbidity and estimated 10-year survival (ES-10Y). METHODS: A cross-sectional investigation was conducted at General Penang Hospital, Malaysia. Demographic criteria and laboratory tests of patients were investigated. Controlled glycemia (CG) was recognized as glycated hemoglobin (HbA1c) ≤7% depending on American Diabetes Association guidelines 2018. Charlson Comorbidity Index (CCI) was used to estimate the confounding influence of co-morbidities and predict ES-10Y. Data was managed by IBM-SPSS 23.0. RESULTS: A total of 400 cases categorized to (44.25%) patients with CG, and (55.75%) cases had uncontrolled glycemia (UCG). HbA1c mean in CG and UCG group was (6.8 ±â€¯0.9 vs 9.5 ±â€¯1.6, P-value: 0.001). Fasting blood glucose was (7 ±â€¯2.3 vs. 9.9 ±â€¯4.3, P-value: 0.001) in CG and UCG group. CCI was (3.38 ±â€¯2.38 vs. 4.42 ±â€¯2.70, P-value: 0.001) and, ES-10Y was (62% vs 46.2%, p-value: 0.001) in CG vs. UCG respectively. Spearman test indicates a negative correlation between CG and CCI (r: 0.19, p-value: 0.001). Logistic regression confirmed HbA1c as a significant predictor of CCI (r2: 0.036, P-value: 0.001). CG has a positive correlation with survival (r: 0.16, P-value: 0.001) and logistic regression of survival (r2: 0.26, P-value: 0.001). CONCLUSIONS: More than one-half of the investigated persons had UCG. Controlled HbA1c was associated with lower co-morbidities and higher ES-10Y.


Asunto(s)
Biomarcadores/análisis , Diabetes Mellitus/mortalidad , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Hipoglucemiantes/uso terapéutico , Glucemia/análisis , Estudios Transversales , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/fisiopatología , Femenino , Estudios de Seguimiento , Hemoglobina A Glucada/análisis , Humanos , Hiperglucemia/metabolismo , Hipoglucemia/metabolismo , Masculino , Persona de Mediana Edad , Morbilidad , Pronóstico , Tasa de Supervivencia
18.
Arthritis Rheumatol ; 71(11): 1935-1942, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31169353

RESUMEN

OBJECTIVE: To examine cause-specific mortality beyond cardiovascular diseases (CVDs) in patients with gout compared to the general population. METHODS: We included all residents of Skåne (Sweden) age ≥18 years in the year 2002. Using the Skåne Healthcare Register, we identified subjects with a new diagnosis of gout (2003-2013) and matched each person with gout with 10 comparators free of gout, by age and sex. We used information on the underlying cause of death from the Swedish Cause of Death Register (through December 31, 2014) to estimate hazard ratios (HRs, with 95% confidence intervals [95% CIs]) of mortality for specific causes of death in a multi-state Cox model, with adjustment for potential confounders. RESULTS: Among 832,258 persons, 19,497 had a new diagnosis of gout (32% women) and were matched with 194,947 comparators. Subjects with gout had higher prevalence of chronic kidney disease, metabolic disease, and CVD. Gout was associated with 17% increased hazard of all-cause mortality overall (HR 1.17 [95% CI 1.14-1.21]), 23% in women (HR 1.23 [95% CI 1.17-1.30]), and 15% in men (HR 1.15 [95% CI 1.10-1.19]). In terms of cause-specific mortality, the strongest associations were seen in the relationship of gout to the risk of death due to renal disease (HR 1.78 [95% CI 1.34-2.35]), diseases of the digestive system (HR 1.56 [95% 1.34-1.83]), CVD (HR 1.27 [95% CI 1.22-1.33]), infections (HR 1.20 [95% CI 1.06-1.35]), and dementia (HR 0.83 [95% CI 0.72-0.97]). CONCLUSION: Several non-CV causes of mortality are increased in persons with gout, emphasizing the need for improved management of comorbidities.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Demencia/mortalidad , Diabetes Mellitus/mortalidad , Enfermedades del Sistema Digestivo/mortalidad , Gota/epidemiología , Insuficiencia Renal Crónica/mortalidad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , Causas de Muerte , Demencia/epidemiología , Diabetes Mellitus/epidemiología , Enfermedades del Sistema Digestivo/epidemiología , Femenino , Humanos , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Mortalidad , Neoplasias/epidemiología , Neoplasias/mortalidad , Modelos de Riesgos Proporcionales , Insuficiencia Renal Crónica/epidemiología , Suecia/epidemiología
19.
BMC Public Health ; 19(1): 719, 2019 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-31182076

RESUMEN

BACKGROUND: The incidence and associated risk factors for premature death were investigated in a population-based cohort study in Iran. METHODS: A total of 7245 participants (3216 men), aged 30-70 years, were included. We conducted Cox proportional hazards models to identify the risk factors for premature death. For each risk factor, hazard ratio (HR), 95% confidence intervals (95% CI) and population attributable fraction (PAF) were calculated. RESULTS: After a median follow-up of 13.8 years, 262 premature deaths (153 in men) occurred. Underlying causes of premature deaths were cardiovascular disease (CVD) (n = 126), cancer (n = 51), road injuries (n = 15), sepsis and pneumonia (n = 9) and miscellaneous reasons (n = 61). The age-standardized incident rate of premature death was 2.35 per 1000 person years based on WHO standard population. Hypertension [HR 1.40, 95% CI (1.07-1.83)], diabetes (2.53, 1.94-3.29) and current smoking (1.58, 1.16-2.17) were significant risk factors for premature mortality; corresponding PAFs were 12.3, 22.4 and 9.2%, respectively. Overweight (body mass index (BMI): 25-29.9 kg/m2) (0.65, 0.49-0.87) and obesity (BMI ≥30 kg/m2) (0.67, 0.48-0.94) were associated with decreased premature mortality. After replacing general adiposity with central adiposity, we found no significant risk for the latter (0.92, 0.71-1.18). Moreover, when we excluded current smokers, those with prevalent cancer/cardiovascular disease and those with survival of less than 3 years, the inverse association between overweight (0.59, 0.39-0.88) and obesity (0.67, 0.43-1.04), generally remained unchanged; although, diabetes still showed a significant risk (2.62, 1.84-3.72). CONCLUSIONS: Controlling three modifiable risk factors including diabetes, hypertension and smoking might potentially reduce mortality events by over 40%, and among these, prevention of diabetes should be prioritized to decrease burden of events. We didn't confirm a negative impact of overweight and obesity status on premature mortality events.


Asunto(s)
Mortalidad Prematura/tendencias , Adulto , Anciano , Índice de Masa Corporal , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Estudios de Cohortes , Diabetes Mellitus/mortalidad , Femenino , Humanos , Hipertensión/mortalidad , Incidencia , Irán/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Sobrepeso/mortalidad , Neumonía/mortalidad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Sepsis/mortalidad , Fumar/mortalidad , Heridas y Traumatismos/mortalidad
20.
Cardiovasc Diabetol ; 18(1): 79, 2019 06 12.
Artículo en Inglés | MEDLINE | ID: mdl-31189473

RESUMEN

BACKGROUND: Prevalent diabetes at the time of heart failure (HF) diagnosis is associated with a higher risk of death, but the incidence and prognostic importance of new-onset diabetes in patients with established HF remains unknown. METHODS: Patients with a first hospitalization for HF in the period 2003-2014 were included and stratified according to history of diabetes. Annual incidence rates of new-onset diabetes were calculated and time-dependent multivariable Cox regression models were used to compare the risk of death in patients with prevalent and new-onset diabetes with patients without diabetes as reference. The model was adjusted for age, sex, duration of HF, educational level and comorbidity. Covariates were continuously updated throughout follow-up. RESULTS: A total of 104,522 HF patients were included in the study, of which 21,216 (19%) patients had diabetes at baseline, and 8164 (10%) developed new-onset diabetes during a mean follow-up of 3.9 years. Patients with new-onset diabetes and prevalent diabetes were slightly younger than patients without diabetes (70 vs. 74 and 77, respectively), more likely to be men (62% vs. 60% and 54%), and had more comorbidities expect for ischemic heart disease, hypertension and chronic kidney disease which were more prevalent among patients with prevalent diabetes. Incidence rates of new-onset diabetes increased from around 2 per 100 person-years in the first years following HF hospitalization up to 3 per 100 person-years after 5 years of follow-up. A total of 61,424 (59%) patients died during the study period with event rates per 100 person-years of 21.5 for new-onset diabetes, 17.9 for prevalent diabetes and 13.9 for patients without diabetes. Compared to patients without diabetes, new-onset diabetes was associated with a higher risk of death (adjusted HR 1.47; 95% CI 1.42-1.52) and prevalent diabetes was associated with an intermediate risk (HR 1.19; 95% CI, 1.16-1.21). CONCLUSION: Following the first HF hospitalization, the incidence of new-onset diabetes was around 2% per year, rising to 3% after 5 years of follow-up. New-onset diabetes was associated with an increased risk of death, compared to HF patients with prevalent diabetes (intermediate risk) and HF patients without diabetes.


Asunto(s)
Diabetes Mellitus/epidemiología , Insuficiencia Cardíaca/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Dinamarca/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Diabetes Mellitus/terapia , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Adulto Joven
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