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1.
Horm Metab Res ; 54(2): 84-93, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35130569

RESUMEN

Long-term glycemic fluctuation has been associated with cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). However, the findings are inconsistent. We performed a meta-analysis to summarize the association between parameters of long-term glycemic variability and risk of cardiovascular events in T2DM patients. Medline, Embase, and Web of Science databases were searched for longitudinal follow-up studies comparing the incidence of cardiovascular events in T2DM patients with higher or lower long-term glycemic variability. A random-effect model incorporating the potential heterogeneity among the included studies was used to pool the results. Twelve follow-up studies with 146 653 T2DM patients were included. The mean follow-up duration was 4.9 years. Pooled results showed that compared to those with the lowest glycemic variability, patients with the highest glycemic variability had significantly increased risk of cardiovascular events, as evidenced by the standard deviation of glycated hemoglobin [HbA1c-SD: relative risk (RR)=1.44, 95% confidence interval (CI): 1.23 to 1.69, p<0.001; I2=70%], HbA1c coefficient of variation (HbA1c-CV: RR=1.46, 95% CI: 1.19 to 1.79. p<0.001; I2=83%), standard deviation of fasting plasma glucose (FPG-SD: RR=1.33, 95% CI: 1.07 to 1.65, p=0.009; I2=0%), and FPG coefficient of variation (FPG-CV: RR=1.29, 95% CI: 1.01 to 1.64, p=0.04; I2=47%). In conclusion, increased long-term glycemic variability may be an independent risk factor for cardiovascular events in T2DM patients.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Glucemia , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/complicaciones , Ayuno , Hemoglobina A Glucada/análisis , Humanos , Factores de Riesgo
2.
Horm Metab Res ; 54(2): 94-103, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35130570

RESUMEN

Glycated hemoglobin (HbA1c) variability is emerging as an indicator of long-term glycemic control, which may play a significant role during vascular complications. We conducted a systematic review and meta-analysis to assess the association between the scope of HbA1c variability and vascular complications in patients with type 2 diabetes mellitus. PubMed and Embase were searched for studies that evaluated the association of HbA1c variability with vascular complications in patients with type 2 diabetes. Two reviewers independently completed data extraction. Random-effects meta-analysis was conducted with stratification according to the type of vascular complications. Nine studies were eligible for inclusion in our systematic review and meta-analysis. Six studies evaluated the impact of the standard deviation of HbA1c (HbA1c-SD) on cardiovascular events and showed an association of HbA1c-SD with cardiovascular events (HR: 1.25, 95% CI 1.18-1.32, 5 studies). Six studies evaluated renal disease associated with HbA1c-SD and showed that HbA1c-SD was correlated with an increased risk of renal disease (HR: 1.19, 95% CI 1.13-1.24). Two studies evaluated HbA1c-SD and the risk of retinopathy and showed that no significant association was found between retinopathy and HbA1c-SD (HR 1.08, 95% CI 0.92-125). For HbA1c-SD ranging from 0.6 to 0.8%, HbA1c-SD was associated with an increased risk of cardiovascular events (HR: 1.25, 95% CI 1.15-1.35) and renal disease (HR: 1.16, 95% CI 1.11-1.22). For individuals with index HbA1c variability greater than or equal to 0.6%, HbA1c variability was significantly associated with vascular complications in patients with type 2 diabetes mellitus.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Glucemia/análisis , Enfermedades Cardiovasculares/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Hemoglobina A Glucada/análisis , Humanos , Estudios Prospectivos
3.
Horm Metab Res ; 54(2): 104-112, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35130571

RESUMEN

Some studies have suggested that diabetes may be a risk factor for osteoarthritis. However, whether prediabetes is also associated with osteoarthritis has not been comprehensively examined. We performed a meta-analysis to evaluate the relationship between prediabetes and osteoarthritis. This meta-analysis included relevant observational studies from Medline, Embase, and Web of Science databases. A random-effect model after incorporation of the intra-study heterogeneity was selected to pool the results. Ten datasets from six observational studies were included, which involved 41 226 general adults and 10 785 (26.2%) of them were prediabetic. Pooled results showed that prediabetes was not independently associated with osteoarthritis [risk ratio (RR): 1.07, 95% confidence interval (CI): 1.00 to 1.14, p=0.06, I2=0%]. Sensitivity limited to studies with adjustment of age and body mass index showed consistent result (RR: 1.06, 95% CI: 0.99 to 1.14, p=0.09, I2=0%). Results of subgroup analyses showed that prediabetes was not associated with osteoarthritis in cross-sectional or cohort studies, in studies including Asian or non-Asian population, or in studies with different quality scores (p for subgroup difference>0.10). Besides, prediabetes was not associated with osteoarthritis in men or in women, in studies with prediabetes defined as impaired fasting glucose, impaired glucose tolerance, or HbA1c (approximately 39-46 mmol/mol). Moreover, prediabetes was not associated with overall osteoarthritis, and knee or hip osteoarthritis. Current evidence does not support that prediabetes is independently associated with osteoarthritis in adult population.


Asunto(s)
Intolerancia a la Glucosa , Osteoartritis , Estado Prediabético , Adulto , Glucemia/metabolismo , Estudios Transversales , Femenino , Hemoglobina A Glucada/análisis , Humanos , Masculino , Estudios Observacionales como Asunto , Osteoartritis/complicaciones , Osteoartritis/epidemiología , Estado Prediabético/complicaciones , Estado Prediabético/epidemiología , Estado Prediabético/metabolismo , Factores de Riesgo
4.
PLoS One ; 17(6): e0267663, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35704644

RESUMEN

OBJECTIVES: To report the prevalence of total diabetes in pregnancy (TDP) and diabetes-related microvascular complications among Indonesian pregnant women. METHODS: We conducted a community-based cross-sectional study with multi-stage, cluster random sampling to select the participating community health centers (CHC) in Jogjakarta, Indonesia between July 2018-November 2019. All pregnant women in any trimester of pregnancy within the designated CHC catchment area were recruited. Capillary fasting blood glucose (FBG) and blood glucose (BG) at 1-hour (1-h), and 2-hour (2-h) post oral glucose tolerance test (OGTT) were measured. TDP was defined as the presence of pre-existing diabetes or diabetes in pregnancy (FBG ≥7.0 mmol/L, or 2-h OGTT ≥11.1 mmol/L, or random BG ≥11.1 mmol/L with diabetes symptoms). Disc and macula-centered retinal photographs were captured to assess diabetic retinopathy (DR). Blood pressure, HbA1c and serum creatinine levels were also measured. RESULTS: A total of 631/664 (95%) eligible pregnant women were included. The median age was 29 (IQR 26-34) years. The prevalence of TDP was 1.1% (95%CI 0.5, 2.3). It was more common in women with chronic hypertension (p = 0.028) and a family history of diabetes (p = 0.015). Among the TDP group, 71% had a high HbA1c, but no DR nor nephropathy were observed. CONCLUSIONS: Although a very low prevalence of TDP and no diabetes-related microvascular complications were documented in this population, there is still a need for a screening program for diabetes in pregnancy. Once diabetes has been identified, appropriate management can then be provided to prevent adverse outcomes.


Asunto(s)
Diabetes Gestacional , Retinopatía Diabética , Embarazo en Diabéticas , Enfermedades de la Retina , Adulto , Glucemia , Estudios Transversales , Proteínas de Unión al ADN , Retinopatía Diabética/epidemiología , Femenino , Hemoglobina A Glucada , Humanos , Indonesia/epidemiología , Embarazo , Embarazo en Diabéticas/epidemiología , Prevalencia
5.
BMJ Open ; 12(6): e055534, 2022 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-35705351

RESUMEN

OBJECTIVE: To assess the levels of blood pressure, cardiovascular biomarkers and their correlations measured within 7 years postpartum in women with previous pre-eclamptic pregnancies compared with women with previous normotensive pregnancies. DESIGN: Cross-sectional study. SETTING: Two tertiary hospitals in the southern region of Thailand. PARTICIPANTS: Women with pre-eclamptic and normotensive pregnancies in the past 7 years were enrolled from 1 October 2019 to 30 April 2021. Eligible women were interviewed, examined for body mass index (BMI) and blood pressure, and donated morning spot urine and blood samples. PRIMARY OUTCOME MEASURES: Serum high-sensitivity C reactive protein, creatinine, fasting blood glucose (FBS), glycated haemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol, urine microalbumin to creatinine ratio (UACR) and sodium were measured. Group differences in biomarkers were tested using unpaired t-test, Wilcoxon rank-sum test or χ2 test. The levels of blood pressure and biomarkers between the two study groups at <2 years, 2-4 years and >4 years were also compared. The correlations between blood pressure and biomarkers were analysed using Pearson's correlation and partial correlation methods. RESULTS: From 206 women included in the analysis, 88 had pre-eclamptic pregnancies and 118 had normotensive pregnancies. Compared with women with previous normotensive pregnancies, women with previous pre-eclamptic pregnancies had significantly increased rates of hypertension (31.8% vs 7.6%, p<0.001) and obesity (55.7% vs 40.7%, p=0.038), as well as higher serum levels of FBS (p<0.001), HbA1c (p<0.001), LDL cholesterol (p=0.03), creatinine (p<0.001) and UACR (p<0.001). Correlation coefficients of BMI, serum creatinine and UACR with blood pressure ranged from 0.27 to 0.31. CONCLUSION: The risk of hypertension after a pre-eclamptic pregnancy increased. Blood pressure measurement combined with BMI, serum creatinine and UACR screening at least once during 7 years postpartum is suggested for early detection of cardiovascular risk.


Asunto(s)
Hipertensión , Preeclampsia , Biomarcadores , Presión Sanguínea/fisiología , Creatinina , Estudios Transversales , Femenino , Hemoglobina A Glucada , Humanos , Periodo Posparto/fisiología , Preeclampsia/diagnóstico , Embarazo , Tailandia/epidemiología
6.
BMC Endocr Disord ; 22(1): 161, 2022 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-35705956

RESUMEN

BACKGROUND: Glycemic control is an important part of diabetes management. Strict glycemic control has been shown to reduce the long-term complications of diabetes. However, achieving good glycemic control is challenging for people with diabetes especially in resource limited settings. The aim of this study was to assess glycemic control and identify its determinants among children and adolescents with diabetes. METHODS: A cross-sectional study among 116 children and adolescents with diabetes was done at a pediatric endocrine clinic in southern Ethiopia. Data on socioeconomic, demographic, nutrition, and diabetes related variables were collected. Glycemic control was assessed based on glycosylated hemoglobin level. Logistic regression analysis was used to identify predictors of glycemic control. RESULTS: The mean glycated hemoglobin (HbA1c) of the participants was 9.6 ± 2.4% (81 ± 3 mmol/mol). Ninety seven (83.6%) of the study participants had poor glycemic control [HbA1c ≥7.5% (58 mmol/mol)]. The presence of lipodystrophic change at injection sites (p =0.028) and being from a family that cannot afford for insulin when there is no free supply (p =0.009) were associated with poor glycemic control. CONCLUSIONS: The majority of children and adolescents with diabetes had poor glycemic control. Stakeholders shall focus on identifying strategies to improve the magnitude of poor glycemic control. More research is warranted to exhaustively list out factors contributing to poor glycemic control.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus , Hiperglucemia , Adolescente , Glucemia/análisis , Niño , Estudios Transversales , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/epidemiología , Etiopía/epidemiología , Hemoglobina A Glucada/análisis , Control Glucémico , Humanos
7.
Front Endocrinol (Lausanne) ; 13: 878585, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35707462

RESUMEN

Background: The role of metformin in the treatment of adolescents with type 1 diabetes mellitus (T1DM) remains controversial. We conducted this updated meta-analysis to generate a comprehensive assessment regarding the effect and safety of metformin in treating adolescents with T1DM. Methods: We systematically searched PubMed, Embase, and the Cochrane Central Registry of Controlled Trials (CENTRAL) from their inception to November 2021 to identify randomized controlled trials evaluating the efficacy of metformin in the treatment of adolescents with T1DM. The primary outcome was the HbA1c level, and secondary outcomes included the body mass index (BMI), total insulin daily dose (TIDD) (unit/kg/d), hypoglycemia events, diabetes ketoacidosis (DKA) events, and gastrointestinal adverse events (GIAEs). Statistical analysis was conducted using RevMan 5.4 and STATA 14.0. Results: Ten studies enrolling 539 T1DM adolescents were included. Results suggested that metformin significantly decreased the HbA1c level at 12 months (mean difference [MD])=-0.50, 95% confidence interval [CI]=-0.61 to -0.39, P < 0.01); BMI (kg/m2) at 3 months (MD=-1.05, 95%CI=-2.05 to -0.05, P=0.04); BMI z-score at 6 months (MD=-0.10, 95%CI=-0.14 to -0.06, P<0.01); and TIDD at 3 (MD=-0.13, 95%CI=-0.20 to -0.06, P<0.01), 6 (MD=-0.18, 95%CI=-0.25 to -0.11, P<0.01), and 12 (MD=-0.42, 95%CI=-0.49 to -0.35, P<0.01) months but significantly increased the risk of hypoglycemia events (risk ratio [RR]=3.13, 95%CI=1.05 to 9.32, P=0.04) and GIAEs (RR=1.64, 95%CI=1.28 to 2.10, P<0.01). For remaining outcomes at other time points, no statistical difference was identified. Sensitivity analysis confirmed the robustness of all pooled results. Conclusions: The use of metformin might result in decreased BMI (kg/m2), BMI z-score, and TIDD and increased risk of hypoglycemia events and GIAEs in adolescents with T1DM. However, future studies are required to further confirm the optimal dose and duration of metformin therapy.


Asunto(s)
Diabetes Mellitus Tipo 1 , Hipoglucemia , Metformina , Adolescente , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Insulina/uso terapéutico , Metformina/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Nutrients ; 14(11)2022 May 26.
Artículo en Inglés | MEDLINE | ID: mdl-35684004

RESUMEN

Our study evaluated the association between the increase in body mass index (BMI) in men and women (menstruating and non-menstruating) (n = 1340) with different dietary groups (omnivores, semi-vegetarians, lacto-ovo-vegetarian, and vegans) and the measurement of the biochemical markers high-sensitive C-reactive protein (hs-CRP), ferritin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), glycated hemoglobin (HbA1C), and insulin resistance index (HOMA-IR). Increasing BMI values in all groups and dietary profiles were related to a significant increase in hs-CRP (p < 0.0001), ALT (p = 0.02), ferritin (p = 0.009), and HbA1C (p < 0.0001), with no difference between dietary groups (p < 0.05). The increase in BMI increases the levels of HOMA-IR (p < 0.0001) and GGT (p < 0.05), with higher values found in men when compared to women (p < 0.0001 for HOMA- IR and p = 0.0048 for GGT). The association between ALT and BMI was different between dietary groups, as it showed a decrease in vegan women who do not menstruate compared to other dietary groups (p = 0.0099). When including only obese individuals (BMI ≥ 30 kg/m2, n = 153) in the analysis, we observed lower concentrations of GGT and ferritin in vegetarians than in omnivores, regardless of gender and menstrual blood loss (p = 0.0395). Our data showed that for both vegetarians and omnivores, the higher the BMI, the worse the metabolic parameters. However, regarding obesity, vegetarians showed better antioxidant status (lower GGT elevation) and lower inflammatory status (lower ferritin elevation), which may provide them with potential protection in the development of morbidities associated with overweight.


Asunto(s)
Dieta Vegetariana , Obesidad/metabolismo , Proteína C-Reactiva/análisis , Femenino , Ferritinas/sangre , Hemoglobina A Glucada/análisis , Humanos , Masculino , Obesidad/sangre , Vegetarianos
9.
BMC Med ; 20(1): 218, 2022 06 13.
Artículo en Inglés | MEDLINE | ID: mdl-35692046

RESUMEN

BACKGROUND: Neurofilament light chain (NfL) is released into the blood during neuronal damage. NfL is linked to mortality in neurological disorders, remaining unexplored in population studies. We investigated whether initial (v1) and annualized change (δ) in plasma NfL can predict all-cause mortality in middle-aged dementia-free urban adults. METHODS: Longitudinal data were from 694 participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span study (HANDLS, mean agev1: 47.8 years, 42% male, 55.8% African American). Plasma NfL was measured prospectively at three visits. Analyses included Cox proportional hazards models for all-cause mortality risk and 4-way decomposition testing for interaction and mediation. RESULTS: Unlike men, women exhibited a direct association between δNfL (above vs. below median) and all-cause mortality risk in both the minimally (HR = 3.91, 95% CI 1.10-13.9, p = 0.036) and fully adjusted models (HR = 4.92, 95% CI 1.26-19.2, p = 0.022), and for δNfL (per unit increase) in the full model (HR = 1.65, 95% CI 1.04-2.61, p = 0.034). In both models, and among women, 1 standard deviation of NfLv1 was associated with an increased all-cause mortality risk (reduced model: HR = 2.01, 95% CI 1.24-3.25, p = 0.005; full model: HR = 1.75, 95% CI 1.02-2.98, p = 0.041). Only few interactions were detected for cardio-metabolic risk factors. Notably, NfLv1 was shown to be a better prognostic indicator at normal hsCRP values among women, while HbA1c and δNfL interacted synergistically to determine mortality risk, overall. CONCLUSIONS: These findings indicate that plasma NfL levels at baseline and over time can predict all-cause mortality in women and interacts with hsCRP and HbA1c to predict that risk.


Asunto(s)
Proteína C-Reactiva , Filamentos Intermedios , Biomarcadores , Femenino , Hemoglobina A Glucada , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales
10.
BMJ Open ; 12(6): e046759, 2022 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-35701054

RESUMEN

OBJECTIVES: Considering health literacy needs is a key component of health services responsiveness to diabetes self-management among vulnerable individuals. The purpose of this qualitative study was to provide a detailed analysis of the health literacy of people with type 2 diabetes in relation to their daily self-care practices. DESIGN: Nested qualitative study in the ERMIES randomised controlled trial testing a 2-year structured care in type 2 diabetes. First round of semidirected interviews at the beginning of the trial with thematic analysis of content. Second round at the completion with directed interviews guided by the first round's themes together with Health Literacy Questionnaire. SETTINGS: Interviews conducted at home. PARTICIPANTS: Forty-four (31 females/13 males, 30-79 years, glycated haemoglobin (HbA1c)≥7.5%) consecutive participants out of 100 recruited in the ERMIES trial from 4 diabetology outpatient settings (Reunion Island). Forty-two respondents to the second round interviews. RESULTS: Three poles structured into eight themes characterised practices in context: health knowledge, disease management, expertise and social support. The relationships of participants in each of the eight themes were differentiated, ranging from functional to interactive and critical. Treatment and follow-up were essentially functional, while diet and exercise remained more interactive. Social support and relationship to health professionals were important determinants of disease management. CONCLUSIONS: Treatment management and disease monitoring remain primarily the job of health professionals, as opposed to diet, physical activity and social support being part of ordinary practice. Decision-making, as a shared social task, as well as resources for participation in health services, should be considered for relevant interventions in type 2 diabetes. TRIAL REGISTRATION NUMBER: NCT01425866.


Asunto(s)
Diabetes Mellitus Tipo 2 , Alfabetización en Salud , Automanejo , Diabetes Mellitus Tipo 2/terapia , Femenino , Hemoglobina A Glucada/análisis , Humanos , Masculino , Investigación Cualitativa
11.
J Assoc Physicians India ; 70(6): 11-12, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35702836

RESUMEN

BACKGROUND: Though the risk factors for nonalcoholic fatty liver disease (NAFLD) are the same in diabetic and nondiabetic patients, their exact interrelation and weightage in the pathogenesis are unclear Methods: A total of 130 nondiabetic and 170 diabetic patients with NAFLD [diagnosed on abdominal ultrasound and severity assessed by NAFLD fibrosis score (NFS)] were recruited from 2009 to 2018 and their baseline risk factors [body mass index (BMI), waist circumference (WC), blood pressure, presence of the metabolic syndrome (MS) and insulin resistance (IR) by Homeostasis Model of Assessment for Insulin Resistance (HOMA-IR), fasting blood glucose (FBG) and lipid levels, and hemoglobin A1c (HbA1c) levels] were noted and their interrelationship studied. The nondiabetic patients were prospectively followed up for alteration of glycemic status. RESULTS: There was presence of high BMI (>23) in 66%, central obesity in 86% (of whom 59% had normal body weight), low high-density lipoprotein cholesterol (HDL) in 51%, high triglyceride (TG) in 68%, high low-density lipoprotein cholesterol (LDL) in 46.7%, IR in 86%, hypertension in 54%, and the MS in 57%. Hemoglobin A1c was high in 42.3% of nondiabetics. The prevalence of the MS was significantly higher in patients having IR and vice versa but only the MS and its components as also increasing age determined advanced fibrosis. After mean follow-up 7.3 years, progression from prediabetes (PD) to diabetes mellitus (DM) occurred in 10%, from normal glucose tolerance (NGT) to PD in 6.25%, and progression of NFS occurred in 16.9%. Advanced age, low HDL and high TG were associated with IR and were involved in glycemic progression as also obesity in progression from NGT to PD and central obesity from PD to DM. CONCLUSION: Though IR and MS go hand in hand in the pathogenesis of NAFLD in both diabetic and nondiabetic patients as well as in the glycemic progression of nondiabetic patients with NAFLD, the MS or its components have more weightage in determining the severity.


Asunto(s)
Diabetes Mellitus , Resistencia a la Insulina , Síndrome Metabólico , Enfermedad del Hígado Graso no Alcohólico , Glucemia , Índice de Masa Corporal , HDL-Colesterol , Diabetes Mellitus/epidemiología , Fibrosis , Estudios de Seguimiento , Hemoglobina A Glucada/metabolismo , Humanos , Resistencia a la Insulina/fisiología , Síndrome Metabólico/complicaciones , Síndrome Metabólico/epidemiología , Síndrome Metabólico/metabolismo , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Obesidad/epidemiología , Obesidad Abdominal , Factores de Riesgo , Triglicéridos
12.
J Assoc Physicians India ; 70(6): 11-12, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35702841

RESUMEN

BACKGROUND: There are a handful of sodium glucose co-transporter 2 (SGLT2) inhibitors available in the global and Indian markets to manage type II diabetes mellitus (T2DM). However, head-to-head comparison between different SGLT2 inhibitors is scarce. Therefore, the present study was aimed to analyze the effect of different SGLT2 inhibitors on glycemic control and body weight in Indian patients with T2DM. METHODS: This was a prospective, interventional, nonrandomized study that included patients (N = 480) of either sex, aged ≥30 years, with inadequately controlled T2DM having HbA1c > 8.5%, and were receiving either Canagliflozin, Empagliflozin, Dapagliflozin or Remogliflozin on the background of triple-drug therapy. In this study, patients were evaluated for HbA1c, fasting blood sugar (FBS), post-prandial blood sugar (PPBS), body weight, and systolic and diastolic blood pressure at baseline, 12 and 24 weeks. RESULTS: A total of 480 patients who received either Canagliflozin (n = 120), Empagliflozin (n = 120), Dapagliflozin (n = 120), or Remogliflozin (n = 120) were included in this study. There was a significant reduction in levels of HbA1c, FBS, PPBS, body weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) at week 12 and 24 in all treatment groups. The difference in mean values of glycemic parameters and body weight was comparable across the treatment groups at week 12 and 24 but was not significant. Out of all 480 patients, 10 patients (2.08%) reported urinary tract infection (UTI), and five (1.04%) reported genital mycotic infection. All the five patients were females and treatment for UTI and mycotic infection was provided as required. Rest of the patients tolerated the therapy well. CONCLUSION: Overall observations indicate that all the four SGLT2 inhibitors are effective in reducing HbA1c, FBS, PPBS, body weight SBP, and DBP. Therefore, gliflozins can be the best choice to start early in patients with inadequately controlled T2DM receiving triple-drug therapy which helps in controlling the parameters of glycemia and significantly reducing the body weight. Hence SGLT2 Inhibitors could be considered as an add-on to all antidiabetic agents currently used for the management of diabetes in Indian setting.


Asunto(s)
Diabetes Mellitus Tipo 2 , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Infecciones Urinarias , Glucemia , Peso Corporal , Canagliflozina/efectos adversos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Hipoglucemiantes/efectos adversos , Masculino , Estudios Prospectivos , Sodio , Transportador 2 de Sodio-Glucosa/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Resultado del Tratamiento , Infecciones Urinarias/tratamiento farmacológico
13.
BMC Endocr Disord ; 22(1): 143, 2022 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-35641973

RESUMEN

AIMS: To describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged > 25 years attending a public outpatient diabetes service. METHODS: Retrospective cohort study of people with T1D aged > 25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. RESULTS: Among the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m2), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of < 53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy. CONCLUSIONS: A high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a "wait for acute event" rather than "complication prevention" model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.


Asunto(s)
Diabetes Mellitus Tipo 1 , Adulto , Australia/epidemiología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/terapia , Femenino , Hemoglobina A Glucada/análisis , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
14.
Clin Chim Acta ; 532: 188-192, 2022 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-35660014

RESUMEN

BACKGROUND: To examine glycaemic status, and the impact of at-admission HbA1c levels on outcome, in a large group of participants hospitalized for COVID-19. METHODS: We inclued 515 participants with confirmed COVID-19 infection, with or without known diabetes, who met the following additional criteria: 1) age > 18 years, 2) HbA1c was determined at admission; 3) fasting plasma glucose was determined in the week of admission, and 4) discharge or death was reached before the end of the study. We examined attributes of participants at admission and 3-6 months post-discharge. To assess the associations of pre-admission attributes with in-hospital mortality, logistic regression analyses were performed. RESULTS: Mean age was 70 years, 98.8% were of white race, 49% were female, 31% had known diabetes (KD), an additional 7% met the HbA1c criterion for diabetes, and 13.6% died. In participants with KD, FPG and HbA1c levels were not associated with mortality in adjusted analyses; however, in participants without KD, whereas FPG showed direct association with mortality, HbA1c showed slight inverse association. CONCLUSIONS: There was a very high prevalence of people without KD with HbA1c levels above normal at-admission. This alteration does not seem to have been related to blood glucose levels.


Asunto(s)
COVID-19 , Diabetes Mellitus Tipo 2 , Adulto , Cuidados Posteriores , Anciano , Glucemia/análisis , Ayuno , Femenino , Hemoglobina A Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente
15.
Artículo en Inglés | MEDLINE | ID: mdl-35682506

RESUMEN

Background: Dietary habits, food intake and oral health are important factors for general health. The aim of these present study was to assess the association between implant-supported fixed oral rehabilitation and glycemia, by monitoring HbA1c values before and after implant-supported prostheses (ISP) delivery to diabetic individuals. Methods: Retrospective, cohort study based on dental records. All treatments were performed by experienced oral and maxillofacial surgeons and experienced prosthodontists. Inclusion criteria: ISP delivery, diagnosis of diabetes in the medical files, consecutive individuals. Variables included-primary outcome-differences (delta) in HbA1c values prior to implant placement and one year after ISP delivery, early implant failure (EIF). Confounding factors included age, gender, physical status, smoking, implant jaw location, implant length, implant width, total implant count per individual. Results: Statistically significant (p < 0.01) decrease in HbA1c from 7.10 ± 1.09% to 6.66 ± 1.02% following ISP delivery was recorded. The mean HbA1c delta was 0.44 ± 0.73%, where 39.0% of the patients had a significant improvement (delta decrease > 0.5%). Univariate and multivariate model using logistic regression at individual level showed that initial high HbA1c levels was the only factor positively predicting improvement (OR = 1.96, CI [1.22, 3.14], p < 0.01). Univariate model at implant level demonstrated that implants placed in the anterior maxilla also contributed to significant improvement in HbA1c values. Multivariate analysis at implant level was similar to individual level. Number of missing teeth did not affect the results significantly. Conclusion: ISP delivery to partially or completely edentulous diabetic individuals may improve HbA1c balance. The mechanism awaits future elucidation.


Asunto(s)
Arcada Edéntula , Estudios de Cohortes , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Hemoglobina A Glucada , Control Glucémico , Humanos , Arcada Edéntula/rehabilitación , Arcada Edéntula/cirugía , Prótesis e Implantes , Estudios Retrospectivos , Resultado del Tratamiento
16.
Eur Rev Med Pharmacol Sci ; 26(11): 4117-4122, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35731084

RESUMEN

OBJECTIVE: Most patients with a severe COVID-19 infection have underlying diseases such as hypertension, cardiovascular disorders, and diabetes, and the mortality rate in these patients is higher than in other patients. Reasonable glycemic control is a practical approach to prevent the progression of COVID-19 in patients with diabetes. In this study, we aimed at demonstrating that glycemic control status can be used as a biomarker in predicting the severity of the disease in the early period in diabetic patients with COVID-19. PATIENTS AND METHODS: Our retrospective study consisted of 122 patients who referred to Sinop Ayancik State Hospital between April 1, 2020, and April 1, 2021. 40 diabetic patients with poor glycemic control (HbA1C above 7), 40 diabetic patients with reasonable glycemic control (HgA1c below 7), and 42 patients without diabetes were included in the study. The patients' data included in the study were obtained by scanning the retrospective files. These patients' demographic characteristics, clinical features, age, gender, length of stay, hemogram, biochemical, hormonal parameters, HgA1c levels, and atherogenic indexes were calculated and recorded. Study groups were compared in terms of disease severity and mortality. RESULTS: A statistically significant difference was found between mild/severe conditions (p-value < 0.001). 72.5% of those with poor glycemic control, 57.5% of those with reasonable glycemic control, and 26.2% without diabetes had severe diseases. Also, a statistically significant difference was found between the distributions of death rate (p = 0.008). 17.5% of those with poor glycemic control, 5% of those with reasonable glycemic control, and 0% of patients without diabetes died. CONCLUSIONS: Our results showed that poor glycemic control was an effective indicator of disease severity and mortality in patients with COVID-19 and could predict disease progression and mortality.


Asunto(s)
COVID-19 , Diabetes Mellitus , Hiperglucemia , Glucemia , Hemoglobina A Glucada/análisis , Control Glucémico , Humanos , Estudios Retrospectivos , Factores de Riesgo
17.
Biomed Res Int ; 2022: 7737626, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35711522

RESUMEN

Objective: To analyze the effect of calisthenics on hypoglycemic in diabetic patients. Method: From September 2019 to May 2020, 210 patients with type 2 diabetes who were newly diagnosed in our hospital were chosen. They were split into two groups: observation (n = 105) and control (n = 105). Only drug therapy and diet management were given to the control group, whereas the observation group was given calisthenics treatment in addition to regular diet control and medicine. The outcomes of the two groups of patient's blood glucose levels, BMI, quality of life, and blood lipid index were compared in this study. Results: Before treatment, there was no significant difference in FPG, 2hPG, and HbA1c levels between the two groups (P > 0.05). Compared with before treatment, FPG, 2hPG, and HbA1c were significantly reduced in both groups (P < 0.05). In addition, FPG, 2hPG, and HbA1c in the observation group were significantly lower than those in the control group (P < 0.05). There was no significant difference in BMI between the two groups before treatment (P > 0.05). After treatment, the BMI of the two groups was significantly reduced (P < 0.05), and the BMI of the observation group was significantly lower than that of the control group (P < 0.05). A comparison of the two groups' SF-36 scale scores before intervention revealed no statistically significant difference (P > 0.05). The observation group's SF-36 scores were substantially higher than the control group's after intervention (P < 0.05). After treatment, the TC and HDL-c levels in the observation group were not significantly different from those in the control group (P > 0.05). Compared with the control group, TG and LDL-C levels were significantly decreased, with statistically significant differences (P < 0.05). Conclusion: Based on routine nursing intervention, using calisthenics to treat blood sugar has a significant effect, it not only made the patient's self-care ability significantly improved, which was worthy of active promotion in clinical practice.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemiantes , Glucemia , Hemoglobina A Glucada/análisis , Gimnasia , Humanos , Calidad de Vida
18.
Diabetes Metab J ; 46(3): 417-426, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35656565

RESUMEN

BACKGROUND: This study aimed to investigate the prevalence and management of diabetes mellitus, risk-factor control, and comorbidities among Korean adults. METHODS: We conducted a cross-sectional analysis of data from the Korea National Health and Nutrition Examination Survey to assess the prevalence, treatment, risk factors, comorbidities, and self-management behaviors of diabetes mellitus from 2019 to 2020. We also analyzed data from the Korean National Health Insurance Service to evaluate the use of antidiabetic medications in people with diabetes mellitus from 2002 through 2018. RESULTS: Among Korean adults aged 30 years or older, the estimated prevalence of diabetes mellitus was 16.7% in 2020. From 2019 through 2020, 65.8% of adults with diabetes mellitus were aware of the disease and treated with antidiabetic medications. The percentage of adults with diabetes mellitus who achieved glycosylated hemoglobin (HbA1c) <6.5% was 24.5% despite the increased use of new antidiabetic medications. We found that adults with diabetes mellitus who achieved all three goals of HbA1c <6.5%, blood pressure (BP) <140/85 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL were 9.7%. The percentage of self-management behaviors was lower in men than women. Excess energy intake was observed in 16.7% of adults with diabetes mellitus. CONCLUSION: The prevalence of diabetes mellitus among Korean adults remained high. Only 9.7% of adults with diabetes mellitus achieved all glycemic, BP, and lipid controls from 2019 to 2020. Continuous evaluation of national diabetes statistics and a national effort to increase awareness of diabetes mellitus and improve comprehensive diabetes care are needed.


Asunto(s)
Diabetes Mellitus , Adulto , Estudios Transversales , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Encuestas Nutricionales , República de Corea/epidemiología
19.
Artículo en Inglés | MEDLINE | ID: mdl-35675951

RESUMEN

INTRODUCTION: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are now recommended in guidelines for persons with type 2 diabetes mellitus (T2DM) and at risk of advanced kidney disease as part of the glucose-lowering regimen. RESEARCH DESIGN AND METHODS: To explore the optimal threshold at which to initiate SGLT2 inhibitor therapy, we conducted an observational study analyzed under a counterfactual framework. This study used the electronic healthcare database in Japan, comprising data from approximately 20 million patients at approximately 160 medical institutions. Persons with T2DM with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 in April 2014 were eligible. The primary end point was the composite of renal deterioration (>40% decline in eGFR) and the development of eGFR<30 mL/min/1.73 m2. We estimated the risk of the composite end point occurring over 77 months in different scenarios, such as early or delayed intervention with SGLT2 inhibitors for uncontrolled diabetes at different hemoglobin A1c (HbA1c) thresholds. The parametric g-formula was used to estimate the risk of the composite end point, adjusting for time-fixed and time-varying confounders. RESULTS: We analyzed data from 36 237 persons (149 346 person-years observation), of whom 4679 started SGLT2 inhibitor therapy (9470 person-years observation). Overall, initiating SGLT2 inhibitor therapy was associated with a 77-month risk reduction in the end point by 1.3-3.7%. The largest risk reduction was observed within 3 months of initiation once the HbA1c level exceeded 6.5% (risk reduction of 3.7% (95% CI 1.6% to 6.7%)) compared with a threshold of 7.0% or higher. CONCLUSIONS: Our analyses favored early intervention with SGLT2 inhibitors to reduce the renal end point, even for persons with moderately controlled HbA1c levels. Our findings also suggest caution against clinical inertia in the care of diabetes.


Asunto(s)
Diabetes Mellitus Tipo 2 , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Tasa de Filtración Glomerular , Glucosa , Hemoglobina A Glucada , Humanos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico
20.
PLoS One ; 17(6): e0269245, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35648780

RESUMEN

BACKGROUND: Treatments should be customized to patients to improve patients' health outcomes and maximize the treatment benefits. We aimed to identify meaningful data-driven trajectories of incident type 2 diabetes patients with similarities in glycated haemoglobin (HbA1c) patterns since diagnosis and to examine their clinical and economic relevance. MATERIALS AND METHODS: A cohort of 1540 patients diagnosed in 2011-2012 was retrieved from electronic health records covering primary and specialized healthcare in the North Karelia region, Finland. EHRs data were compiled with medication purchase data. Average HbA1c levels, use of medications, and incidence of micro- and macrovascular complications and deaths were measured annually for seven years since T2D diagnosis. Trajectories were identified applying latent class growth models. Differences in 4-year cumulative healthcare costs with 95% confidence intervals (CIs) were estimated with non-parametric bootstrapping. RESULTS: Four distinct trajectories of HbA1c development during 7 years after T2D diagnosis were extracted: patients with "Stable, adequate" (66.1%), "Slowly deteriorating" (24.3%), and "Rapidly deteriorating" glycaemic control (6.2%) as well as "Late diagnosed" patients (3.4%). During the same period, 2.2 (95% CI 1.9-2.6) deaths per 100 person-years occurred in the "Stable, adequate" trajectory increasing to 3.2 (2.4-4.0) in the "Slowly deteriorating", 4.7 (3.1-6.9) in the "Rapidly deteriorating" and 5.2 (2.9-8.7) in the "Late diagnosed" trajectory. Similarly, 3.5 (95% CI 3.0-4.0) micro- and macrovascular complications per 100 person-years occurred in the "Stable, adequate" trajectory increasing to 5.1 (4.1-6.2) in the "Slowly deteriorating", 5.5 (3.6-8.1) in the "Rapidly deteriorating" and 7.3 (4.3-11.8) in the "Late diagnosed" trajectory. Patients in the "Stable, adequate" trajectory had lower accumulated 4-year medication costs than other patients. CONCLUSIONS: Data-driven patient trajectories have clinical and economic relevance and could be utilized as a step towards personalized medicine instead of the common "one-fits-for-all" treatment practices.


Asunto(s)
Diabetes Mellitus Tipo 2 , Estudios de Cohortes , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Finlandia/epidemiología , Hemoglobina A Glucada/análisis , Control Glucémico , Humanos
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