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1.
Am J Hum Genet ; 108(2): 219-239, 2021 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-33440170

RESUMEN

We present a full-likelihood method to infer polygenic adaptation from DNA sequence variation and GWAS summary statistics to quantify recent transient directional selection acting on a complex trait. Through simulations of polygenic trait architecture evolution and GWASs, we show the method substantially improves power over current methods. We examine the robustness of the method under stratification, uncertainty and bias in marginal effects, uncertainty in the causal SNPs, allelic heterogeneity, negative selection, and low GWAS sample size. The method can quantify selection acting on correlated traits, controlling for pleiotropy even among traits with strong genetic correlation (|rg|=80%) while retaining high power to attribute selection to the causal trait. When the causal trait is excluded from analysis, selection is attributed to its closest proxy. We discuss limitations of the method, cautioning against strongly causal interpretations of the results, and the possibility of undetectable gene-by-environment (GxE) interactions. We apply the method to 56 human polygenic traits, revealing signals of directional selection on pigmentation, life history, glycated hemoglobin (HbA1c), and other traits. We also conduct joint testing of 137 pairs of genetically correlated traits, revealing widespread correlated response acting on these traits (2.6-fold enrichment, p = 1.5 × 10-7). Signs of selection on some traits previously reported as adaptive (e.g., educational attainment and hair color) are largely attributable to correlated response (p = 2.9 × 10-6 and 1.7 × 10-4, respectively). Lastly, our joint test shows antagonistic selection has increased type 2 diabetes risk and decrease HbA1c (p = 1.5 × 10-5).


Asunto(s)
Genoma Humano , Herencia Multifactorial , Selección Genética , Simulación por Computador , Diabetes Mellitus Tipo 2/genética , Evolución Molecular , Interacción Gen-Ambiente , Heterogeneidad Genética , Pleiotropía Genética , Estudio de Asociación del Genoma Completo , Hemoglobina A Glucada/genética , Humanos , Modelos Genéticos , Fenotipo , Polimorfismo de Nucleótido Simple , Tamaño de la Muestra
2.
J Surg Res ; 257: 153-160, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32828999

RESUMEN

BACKGROUND: The effect of an enhanced recovery protocol including preoperative carbohydrate loading on patients with diabetes is unclear. This study investigated the effect of both on perioperative glucose management and postoperative outcomes in patients with diabetes undergoing colorectal surgery. MATERIALS AND METHODS: A retrospective study was conducted on patients undergoing elective colorectal surgery before and after implementation of an enhanced recovery protocol. Ninety-nine patients with type 2 diabetes (DM, 41 control versus 58 enhanced recovery) and 366 patients without diabetes (NDM, 158 control versus 158 enhanced recovery) were included. Multivariate analyses were run to compare mean peak perioperative serum glucose and postoperative outcomes in enhanced recovery and control cohorts with (DM) and without diabetes (NDM). RESULTS: Mean peak preoperative glucose was elevated in DM enhanced recovery compared with DM control patients (192.2 [72.2] versus 139.8 [41.4]; P < 0.001). Mean peak intraoperative (162.3 [43.1] versus 163.8 [39.6]; P = 0.869) and postoperative glucose (207.7 [75.8] versus 217.8 [78.5]; P = 0.523) were similar in DM enhanced recovery compared with DM control group. Enhanced recovery led to decreased LOS in DM (P = 0.001) and NDM enhanced recovery patients (P < 0.000) compared with their control groups. CONCLUSIONS: An enhanced recovery protocol may lead to increased peak preoperative glucose levels and 30-d readmissions in patients with type 2 diabetes undergoing colorectal surgery. However, the ultimate clinical significance of transiently elevated preoperative glucose in DM patients is uncertain. Our results suggest that an enhanced recovery protocol and preoperative carbohydrate loading does not lead to poorer postoperative glycemic control overall in patients with diabetes undergoing colorectal surgery.


Asunto(s)
Cirugía Colorrectal/métodos , Diabetes Mellitus Tipo 2/complicaciones , Recuperación Mejorada Después de la Cirugía , Anciano , Glucemia/análisis , Estudios de Cohortes , Dieta de Carga de Carbohidratos/métodos , Procedimientos Quirúrgicos Electivos , Femenino , Hemoglobina A Glucada/análisis , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Resultado del Tratamiento
3.
Angiology ; 72(1): 86-92, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32840113

RESUMEN

We investigated the role of vitamin D on glycemic regulation and cardiac complications in patients with type 2 diabetes mellitus (T2DM). A total of 1139 patients (49.3% males vs 50.7% females) were included. Information on sociodemographic lifestyle, family history, blood pressure (BP), and coronary heart disease (CHD) complications was collected. Significant differences were found between males and females regarding age-groups (P = .002), body mass index (BMI; P = .008), physical activity (P = .010), sheesha smoking (P = .016), cigarette smoking (P = .002), hypertension (P = .050), metabolic syndrome (P = .026), and CHD (P = .020). There were significant differences between vitamin D deficiency, insufficiency, and sufficiency in relation to age-group (P = .002), income (P = .002), waist circumference (P = .002), hip circumference (P = .028), waist-hip ratio (P = .002), and BMI (P = .002). Further, mean values of hemoglobin, magnesium, creatinine, hemoglobin A1c (HbA1c), total cholesterol, uric acid, and diastolic BP were significantly higher among patients with vitamin D deficiency compared with those with insufficiency and sufficiency. Multiple logistic regression analysis revealed that 25-hydroxy vitamin D, 25(OH)D, HbA1c, waist circumference, uric acid, duration of T2DM, total cholesterol, systolic and diastolic BP, and BMI were strong predictor risk factors for CHD among patients with T2DM. The present study supports that 25(OH)D may have a direct effect on CHD and on its risk factors.


Asunto(s)
Enfermedad Coronaria/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Vitamina D/análogos & derivados , Adulto , Presión Sanguínea , Índice de Masa Corporal , Colesterol/sangre , Estudios de Cohortes , Femenino , Hemoglobina A Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Turquia/epidemiología , Ácido Úrico/sangre , Vitamina D/sangre , Circunferencia de la Cintura
4.
Med Care ; 59(1): 67-76, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33017341

RESUMEN

BACKGROUND: Health care delivery systems are increasingly integrating physical and mental health services to address patients' complex needs, contain costs, and improve satisfaction. Therefore, it is critical to understand whether adoption of integrated care models is effective in diverse settings. OBJECTIVE: This study examined the effect of integrated care on physical and mental health outcomes among low-income Latino participants on the US-Mexico border. RESEARCH DESIGN: In this quasi-experimental multisite study, individual-level data were pooled from 8 studies of locally adapted integrated care models. SUBJECTS: Participants were 18 years or older and had 1 or more chronic conditions: diabetes, depression, hypertension, or obesity. The study enrolled 4226 participants with 2254 participants in the intervention group and 1972 in the comparison group. MEASURES: Primary outcomes were depressive symptoms as measured by the Patient Health Questionnaire-9 score and blood glucose measured by hemoglobin A1c (HbA1c). Blood pressure, body mass index, and quality of life were secondary outcomes. RESULTS: Multivariable linear regression analyses indicated intervention participants had significantly lower Patient Health Questionnaire-9 scores (ß=-0.39, P=0.03) and HbA1c (ß=-0.14, P=0.02) at 12 months compared with comparison group participants. Stratified analyses showed improvements in HbA1c were even greater among intervention participants who had diabetes, depression, severe and persistent mental illness, were older or female compared with their counterparts in the comparison group. CONCLUSIONS: Health care is constantly transforming, making it critical to study these changes across populations and settings. Findings from this study indicate that integrated care can significantly improve mental and physical health in an underserved Latino population.


Asunto(s)
Enfermedad Crónica , Prestación Integrada de Atención de Salud , Depresión/terapia , Diabetes Mellitus/terapia , Hispanoamericanos/estadística & datos numéricos , Servicios de Salud Mental , Atención Primaria de Salud , Adulto , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hipertensión , Masculino , México , Persona de Mediana Edad , Pobreza , Encuestas y Cuestionarios , Estados Unidos
5.
Nefrología (Madrid) ; 40(6): 664-671, nov.-dic. 2020. tab, graf
Artículo en Inglés | IBECS | ID: ibc-197203

RESUMEN

BACKGROUND: Linagliptin does not require dose adjustment in diabetes mellitus patients with chronic kidney disease (CKD). But, renal effects of linagliptin are not clear. Our aim was to examine the effect of linagliptin on renal disease progression in only insulin dependent type 2 diabetes mellitus (DM) patients with CKD. METHODS: Stage 3-4 CKD patients were randomized into 2 groups in this prospective randomized controlled study. In the first group, linagliptin 5mg was added in addition to the background insulin therapy. In the second group, patients continued their insulin therapy. Patients were followed up at 3-month intervals for one year. RESULTS: The study population consisted of 164 patients (90 patients in linagliptin group, 74 patients in other group) with a mean age of 67.5 ± 8.8 years. eGFR significantly increased in linagliptin group (p = 0.033), but decreased in other group (p = 0.003). No significant change was observed in total insulin dose in linagliptin group (p = 0.111), but in other group, total insulin dose significantly increased (p < 0.001). Proteinuria levels decreased in both groups, but there was no significant change. In the multiple logistic regression analysis, male gender and proteinuria emerged as variables that showed significant association with increased risk and the use of linagliptin emerged as variable that showed significant association with decreased risk for CKD progression. CONCLUSION: Linagliptin in DM patients with CKD was able to improve renal progression without significant effect on proteinuria and glucose control. With regard to treating diabetic nephropathy, linagliptin may offer a new therapeutic approach


ANTECEDENTES: La linagliptina no precisa un ajuste de la dosis en pacientes con diabetes mellitus y enfermedad renal crónica (ERC). No obstante, los efectos renales de la linagliptina no están claros. Nuestro objetivo fue examinar el efecto de la linagliptina en la evolución de la enfermedad renal únicamente en pacientes con diabetes mellitus de tipo 2 insulinodependientes con ERC. MÉTODOS: En este estudio prospectivo, aleatorizado y controlado, se asignaron de forma aleatoria pacientes con ERC en estadios 3-4 en 2 grupos. En el primer grupo se añadió linagliptina 5 mg además de la insulinoterapia de base. En el segundo grupo, los pacientes siguieron con su insulinoterapia. Los pacientes fueron objeto de seguimiento a intervalos de 3 meses durante un año. RESULTADOS: La población del estudio estuvo compuesta por 164 pacientes (90 pacientes en el grupo de linagliptina, 74 pacientes en el otro grupo) con una edad media de 67,5 ± 8,8 años. La TFGe aumentó significativamente en el grupo de linagliptina (p = 0,033), pero disminuyó en el otro grupo (p = 0,003). No se observó ningún cambio significativo en la dosis total de insulina en el grupo de la linagliptina (p = 0,111), pero, en el otro grupo, la dosis total de insulina aumentó significativamente (p < 0,001). Los niveles de proteinuria disminuyeron en ambos grupos, pero no hubo cambios significativos. En el análisis de regresión logística múltiple, el género masculino y la proteinuria destacaron como variables que mostraban una asociación significativa con el aumento del riesgo y el uso de la linagliptina destacó como variable con una asociación significativa con la disminución del riesgo de progresión de la enfermedad renal crónica. CONCLUSIÓN: La linagliptina en pacientes con DM y ERC consiguió mejorar la evolución renal sin un efecto significativo sobre la proteinuria y el control glucémico. En lo que respecta al tratamiento de la nefropatía diabética, la linagliptina puede ofrecer un nuevo enfoque terapéutico


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Linagliptina/uso terapéutico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Renal Crónica/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Insuficiencia Renal Crónica/fisiopatología , Progresión de la Enfermedad , Estudios Prospectivos , Proteinuria/orina , Estadísticas no Paramétricas , Hemoglobina A Glucada , Modelos Logísticos , Resultado del Tratamiento
6.
Ter Arkh ; 92(10): 54-62, 2020 Nov 24.
Artículo en Ruso | MEDLINE | ID: mdl-33346480

RESUMEN

AIM: To investigate the link between the hypoglycemia (registrated accurately by the professional Continuous Glucose Monitoring CGM; severe hypoglycemia at home) and the hetero-/homozygote carriage of single nucleotide polymorphisms (SNP) of cytochrome systems geneCYP2C9(rs1799853CYP2C9*2 иrs1057910CYP2C9*3) at the patients with Type 2 Diabetes Mellitus (T2DM) used sulphonylurea (SU). MATERIALS AND METHODS: In Study Case-Control 120 T2DM-SU-patients genotyped by SNPs of geneCYP2C9(using PCR-RT) had been done the professional CGM (System iPro2, Medtronic) recorded Time in Range of Hypoglycemia (TIR-HYPO), level of Minimal CGM-hypoglycemia (MinGl) and standard CGM-parameters of Glycemic Variability. Severe hypoglycemia at home was recorded from visit to visit. The odds ratio (OR) of metabolic disturbances had been assessed for carriage SNPs in comparison with wide alleles. RESULTS: The Study established that carriage of SNPsrs1799853andrs1057910geneCYP2C9at T2DM-SU-patients associated with rising of Glycemic Variability and frequency of CGM-hypoglycemia (MinGl decreasing, increasing of TIR-HYPO and number of Glycemia Excursion 4 mmol/L/h), as well as increasing severe hypoglycemia at home (p0.05). Thus, OR at the carriage ofrs1799853andrs1057910respectively equaled: for CGM-hypoglycemia 7.78 (3.0220.01) and 5.80 (0.23145.87); number of Glycemia Excursion 4 mmol/L/h 5.76 (2.2914.43) and 4.44 (1.4313.76); MinGl3.9 mmol/L 4.39 (1.7910.75) and 6.26 (1.8421.30); CV40% (vs30%) 3.63 (1.0412.62) and 15.22 (0.59393.94);p0.05. CONCLUSION: At the real clinical practice the assessment of carriage of SNPs of geneCYP2C9before inclusion of SU to glucose-lowering scheme of T2DM-therapy it necessary to carry out for the detecting patients with a higher risk of hypoglycemia and rising of Glycemic Variability.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemia , Hipoglucemiantes/efectos adversos , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/genética , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/genética , Hipoglucemiantes/uso terapéutico , Farmacogenética
7.
Vnitr Lek ; 66(7): 20-25, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33380130

RESUMEN

Diabetes is an established risk factor of cardiovascular disease including the coronary heart disease (CHD) and elevates the risk of cardiovascular death 2 times. Based on current evidence the risk of acquiring the CHD increases accordingly to the level of fasting blood glucose even in the prediabetic range. In the range of 5.6-6.0mmol/l the risk is 1.11, in the range of 6.1-6.9mmol/l the risk is 1.17. In the range of HbA1c of 42-47mmol/l the risk of the CHD is 1.28. The probability of the CHD occurrence therefore does indeed increase in conjunction with the fasting blood glucose levels but the dependence is not linear.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus , Estado Prediabético , Glucemia , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Ayuno , Hemoglobina A Glucada/análisis , Humanos , Estado Prediabético/complicaciones , Estado Prediabético/epidemiología , Factores de Riesgo
8.
Vnitr Lek ; 66(6): 28-34, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33380150

RESUMEN

Patients with less severe glycated haemoglobin (HbA1c) targets may find it difficult to achieve the target values of lipid parameters treatment at high cardiovascular risk. We have been monitoring the correlation between levels of triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) with glycosylated haemoglobin (HbA1c) by IFCC method (method of testing according to the International Federation of Clinical Chemistry and Laboratory Medicine) and by DCCT method (Diabetes Control and Complication Trial) as well as body mass index (BMI) at the time of diagnosis of the disease, that could help identify patients with an increased risk of cardiovascular disease. In the cohort study we were monitoring outpatients with newly diagnosed type 2 diabetes mellitus during a 5 year period. Patients (117 men, 83 women), aged from 30 to 92 years were conducted sampling blood glucose, HbA1c (IFCC/DCCT), HDL, LDL, TG. At baseline, the patients height, weight, waist circumference, calculated BMI and blood pressure were measured. Waist circumference was measured in the horizontal plane in the middle of the distance between the upper edge of the iliac crest and the lower edge of the last rib in the breath. Our study did not exclude patients taking statin or fibrate. The high HbA1c values increased the risk of elevating LDL-cholesterol levels and TAG levels in the whole group (p = 0.012) and (p = 0.017), and the high BMI values increased the risk of lowering HDL-cholesterol levels in the female population (p = 0.010). The results of our study stratify the increased risk of atherogenicity in these groups. HbA1c is a direct marker of elevated LDL and TAG, and indirect marker for coronary artery disease risk assessment.


Asunto(s)
Diabetes Mellitus Tipo 2 , Adulto , Anciano , Anciano de 80 o más Años , Glucemia , HDL-Colesterol , Estudios de Cohortes , Femenino , Hemoglobina A Glucada , Humanos , Masculino , Persona de Mediana Edad , Triglicéridos
9.
Medicine (Baltimore) ; 99(50): e23427, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327270

RESUMEN

Differences in the mechanism of action and potential pleiotropic effects between statins and fibrates would potentially drive a different effect on various laboratory parameters, but this remains controversial because of a paucity of reports comparing them. Therefore, the aim of this study was to compare the effects of statins and fibrates on laboratory parameters in Japanese patients in routine clinical practice.This retrospective cohort study included patients with dyslipidemia who had been newly treated with statin or fibrate monotherapy between January 2005 and December 2017. Patients were randomly matched into two sets of pairs by sex, age, and baseline triglyceride (TG) or low-density lipoprotein (LDL) cholesterol level. The 830 patients in TG-matched pairs (415 fibrate users and 415 matched statin users) and 1172 patients in LDL cholesterol-matched pairs (586 fibrate users and 586 matched statin users) were included in this study. Generalized estimating equations were used to estimate the effects of the drugs on serum creatinine level, estimated glomerular filtration rate (eGFR), urea nitrogen, hemoglobin A1c, aspartate aminotransferase, and alanine aminotransferase (ALT), in addition to LDL cholesterol and TG levels, and red blood cell (RBC) and platelet (PLT) counts, up to 12 months after the start of study drug administration.In TG-matched pairs, the increases in creatinine and urea nitrogen levels (P = .010 and P < .001, respectively) and the decreases in eGFR, ALT level and RBC count (P < .001, P = .003, and P = .014, respectively) were greater in fibrate users than in statin users. The decrease in PLT count was greater in statin users than in fibrate users (P < .001). The mean changes in aspartate aminotransferase and hemoglobin A1c levels were not significantly different between statin users and fibrate users. In LDL cholesterol-matched pairs, the differences in changes of all laboratory parameter levels between statin users and fibrate users were similar to those in TG-matched pairs.We demonstrate here that fibrates have a greater effect of increasing creatinine and urea nitrogen levels and of reducing eGFR, ALT level, and RBC count than statins, and that the lowering effect on PLT count is greater with statins than with fibrates.


Asunto(s)
Dislipidemias/sangre , Dislipidemias/tratamiento farmacológico , Ácidos Fíbricos/farmacología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Hipolipemiantes/farmacología , Adulto , Anciano , LDL-Colesterol/sangre , Femenino , Hemoglobina A Glucada/efectos de los fármacos , Humanos , Japón , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Triglicéridos/sangre , Adulto Joven
10.
Pan Afr Med J ; 35(Suppl 2): 139, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33193954

RESUMEN

Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.


Asunto(s)
Anemia Megaloblástica/sangre , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/sangre , Pérdida Auditiva Sensorineural/sangre , Pandemias , Neumonía Viral/epidemiología , Deficiencia de Tiamina/congénito , Trombocitopenia/etiología , Síndrome Coronario Agudo/diagnóstico , Anemia Megaloblástica/tratamiento farmacológico , Anemia Megaloblástica/fisiopatología , Dolor en el Pecho/etiología , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/fisiopatología , Diagnóstico Diferencial , Hemoglobina A Glucada/análisis , Accesibilidad a los Servicios de Salud , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Pérdida Auditiva Sensorineural/fisiopatología , Hemoglobinas/análisis , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Recurrencia , Tiamina/provisión & distribución , Tiamina/uso terapéutico , Deficiencia de Tiamina/sangre , Deficiencia de Tiamina/tratamiento farmacológico , Deficiencia de Tiamina/fisiopatología , Túnez , Adulto Joven
11.
Medicine (Baltimore) ; 99(47): e23392, 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33217883

RESUMEN

BACKGROUND: The impact of glycosylated hemoglobin on mortality in patients with coronavirus disease 2019 (COVID-19) and type 2 diabetes (T2D) remains uncertain. In this study, we aim to assess the effect of pre-hospital blood glucose regulation on patients with COVID-19 and pre-existing T2D. METHODS: All randomized controlled trials (RCTs) and cohort studies of association of glycosylated hemoglobin and outcomes in patients with COVID-19 and T2D will be included in this review. PubMed, Embase, and CNKI will be searched for relevant literature, up to August 20, 2020 in English and Chinese language. Two reviewers will select trials independently for inclusion and assess trial quality. Two pairs of authors will independently extract information for each included trials. Primary outcomes are death and composite adverse outcomes: the number of participants who died or remained severely disabled. Revman 5.3 will be used for heterogeneity assessment, data synthesis, subgroup analysis, sensitivity analysisa and generating funnel-plots. RESULTS: We will provide practical results about the association of glycosylated hemoglobin and outcomes in patients with COVID-19 and T2D. CONCLUSION: The stronger evidence about the association of glycosylated hemoglobin and outcomes in patients with COVID-19 and T2D will be provided for clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020200574. ETHICS AND DISSEMINATION: There is no need for ethical approval, and the review will be reported in a peer-reviewed journal.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/sangre , Diabetes Mellitus Tipo 2/sangre , Hemoglobina A Glucada/análisis , Neumonía Viral/sangre , Índice de Severidad de la Enfermedad , Adulto , Anciano , Estudios de Cohortes , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/virología , Femenino , Humanos , Masculino , Metaanálisis como Asunto , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto
12.
Rev Saude Publica ; 54: 103, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33146324

RESUMEN

OBJECTIVE: To evaluate the effect of implementation intentions as an intervention strategy to promote walking in adults with type 2 diabetes mellitus (T2DM). METHODS: We conducted a controlled and randomized trial, with 12 months of follow-up, involving 65 people with T2DM recruited from primary health care units and allocated them in the control group (CG, n = 32) and intervention group (IG, n = 33). The IG received the implementation intention strategy to promote walking and the CG remained in follow-up for conventional treatment in primary health care. The researchers were blinded by anthropometric measurements and the filling of the instruments. RESULTS: After twelve months of follow up, the IG presented a statistically significant increase in the leisure time physical activity when compared with the CG (p = 0.0413) and showed a significant decrease in waist circumference (p = 0.0061). No significant difference was observed regarding body mass index and glycated hemoglobin among groups. CONCLUSIONS: Implementation intention was effective in promoting walking and improving clinical indicators in adults with T2DM.


Asunto(s)
Diabetes Mellitus Tipo 2 , Promoción de la Salud , Intención , Caminata , Anciano , Diabetes Mellitus Tipo 2/terapia , Femenino , Hemoglobina A Glucada/análisis , Promoción de la Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Caminata/psicología
13.
J Assoc Physicians India ; 68(12[Special]): 18-24, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247659

RESUMEN

The progressive nature of type 2 diabetes mellitus (T2DM) renders the shifting of patients from oral drugs to insulin therapy an inevitability in most patients especially in those with long duration of diabetes. At the turn of the last millennium, neutral protamine Hagedorn (NPH) insulin was still the only long-acting insulin available for people with diabetes. The advent of the first truly long-acting basal insulin, i.e. insulin glargine 100 U/mL (Gla-100) brought to the table a remarkably long duration of action and a very minimal risk of hypoglycemia by due to less pronounced peaks in their action profile. Further, in trying to achieve fasting normoglycemia, Gla-100 has demonstrated remarkably more holistic glucose-lowering efficacy in several pivotal trials compared to other insulin formulations, such as premixed insulin and coformulations-apart from NPH insulin. This article delineates clinical data on the effectiveness of Gla-100 vs. other insulin formulations in the context of T2DM.


Asunto(s)
Diabetes Mellitus Tipo 2 , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Insulina Glargina , Insulina de Acción Prolongada
14.
J Assoc Physicians India ; 68(12[Special]): 25-30, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247660

RESUMEN

Fueled by perceptions regarding Indian dietary patterns and premixed insulin's claim to fame of providing dual fasting and post-prandial control, there was a greater inclination towards using premixed insulins in clinical practice until the last decade. However, the advent of insulin glargine 100 U/mL (Gla-100) opened up a new dimension in insulin therapy landscape in India. The data from the last 5 years reveal that Gla-100 has gained more traction among Indian clinical practitioners. Basis evidences that have emerged from various clinical studies, this present review elaborates on certain key issues which have helped Gla-100 carve its own niche and effected a progressive shift in insulin prescription pattern in India.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemia , Insulinas , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes , India , Insulina , Insulina Glargina
15.
J Assoc Physicians India ; 68(12[Special]): 31-37, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247661

RESUMEN

Early insulin initiation benefits people with diabetes by inducing a rapid and sustained glycemic control along with preventing the onset of adverse legacy effects early in the disease course. This has an over-arching effect as it could possibly modify the disease course and prevent the development of vascular complications, as has been attested to in landmark studies like the UKPDS and GRACE. Insulin glargine 100 U/mL (Gla-100) has been extensively studied under various scenarios as the initial insulin administered early in T2DM disease course, registering significant glycemic and vascular benefits over the standard of care. By virtue of its ease of use and better safety profile, basal insulin like Gla-100 has been recommended by various international and Indian guidelines as the go-to initial insulin in people with diabetes. Further, the ability to personalize the initiating dose basis one's HbA1c and weight is an additional feature that contributes to the scientific merit of initiating with basal insulin like Gla-100. However, early insulin initiation is mostly delayed owing to 'clinical inertia,' thereby causing an evitable glycemic burden. Therefore, physicians managing diabetes must aim to increase acceptance, persistence, and adherence to insulin therapy by focusing on the safety, simplicity, and convenience of therapies.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemia , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Insulina Glargina
16.
J Assoc Physicians India ; 68(12[Special]): 38-42, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247662

RESUMEN

Owing to the progressive nature of the disease, patients with type 2 diabetes mellitus (T2DM) eventually require adjustment or titration of insulin doses to achieve the desired glycemic control. Titration inertia, or the inability to dose-titrate, is one of the key barriers to optimized insulin therapy and is common in Asian countries such as India. Simple and effective titration algorithms involving the use of basal insulin, which has the lowest hypoglycemia risk, that can be individualized by physicians and easily followed by patients aid in tackling titration inertia. In this context, insulin glargine 100 U/mL (Gla-100) appears to be the ideal insulin to overcome titration inertia, owing to its low risk of hypoglycemia and effective glycemic control. Different guidelines recommend the use of basal insulin, such as Gla-100, and encourage a patient-centric approach for dose titration. Although the effective implementation of the patient-centric approach in India is challenging, it is nevertheless achievable.


Asunto(s)
Diabetes Mellitus Tipo 2 , Asia , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes , India , Insulina Glargina
17.
J Assoc Physicians India ; 68(12[Special]): 43-48, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247663

RESUMEN

The inadequate control of postprandial glucose (PPG) excursions, are linked in some studies with cardiovascular disease. Even though basal insulins, such as insulin glargine 100 U/mL (Gla-100), maintain overall glycemic control, effective PPG control eventually requires intensification of therapy by adding prandial insulins. Compared to conventional basal-bolus or premixed approaches, a stepwise basal-plus or basal-prandial intensification regimen involving the addition of one, two, or three prandial insulins to basal therapy such as Gla-100, has received much attention in recent times. This intensification approach is comparable to other conventional approaches in terms of glycemic control, and offers the additional advantages of fewer hypoglycemic events, personalization of therapy, and a simple self-management algorithm for titration. Owing to such benefits, recent guidelines recommend its use over other approaches for initiating intensification. It is preferred by both physicians and patients and is a better alternative to immediately embarking on a full basal-bolus regimen or introducing premixed insulin preparations for intensification of therapy.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemia , Insulinas , Glucemia , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes , Insulina , Insulina Glargina
18.
J Assoc Physicians India ; 68(12[Special]): 49-54, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247664

RESUMEN

Cardiovascular diseases (CVD) risk in people with type 2 diabetes mellitus (T2DM) is two to four folds higher than in individuals without T2DM. Insulin therapy was speculated to be atherogenic- thereby aggravating CVD risk years ago. However, cardiovascular outcome trials (CVOTs) such as the Outcome Reduction with Initial Glargine Intervention (ORIGIN), and its extended follow-up study - ORIGIN and Legacy Effects (ORIGINALE) conclusively established the long-term cardiovascular (CV) safety of basal insulin, such as insulin glargine 100 U/mL (Gla-100). Moreover, these studies hinted at the possible benefits of early insulin therapy-including stalling the progression of diabetes with minimal weight gain and hypoglycemia risk. This review highlights the background developments which led to the ORIGIN trial. Additionally, it also dwells on the critical insights to emerge from this trial pertaining to the CV safety of basal insulin Gla-100 in high CV risk individuals with T2DM.


Asunto(s)
Diabetes Mellitus Tipo 2 , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Estudios de Seguimiento , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/efectos adversos , Insulina Glargina/efectos adversos
19.
J Assoc Physicians India ; 68(12[Special]): 60-66, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247666

RESUMEN

Insulin therapy is the cornerstone of diabetes management in people with type 2 diabetes mellitus (T2DM). Therefore, its use is recommended even in special populations and situations such as the elderly, pregnant women, obese individuals, people observing religious fasting, and in the presence of comorbidities such as renal insufficiency, and cancer. Since these special situations predispose to complications such as a high risk of hypoglycemia, patients need constant glucose monitoring and insulin dose adjustments, wherever applicable. This review discusses the various considerations that might guide the decision-making process in the special situations alluded to here. It also throws light on how insulin glargine 100 U/mL has emerged as a preferred choice of insulin therapy in most of these situations, on the strength of its inherently low hypoglycemia and weight gain potential, which has found traction even in the recent diabetes guidelines.


Asunto(s)
Diabetes Mellitus Tipo 2 , Anciano , Glucemia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Embarazo
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