Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 18.886
Filtrar
1.
BMJ Open ; 11(1): e044526, 2021 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-33518528

RESUMEN

OBJECTIVES: To determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions. DESIGN: Retrospective cohort study. SETTING: Urban tertiary care center in New York City. PARTICIPANTS: 302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone). MEASUREMENTS: Primary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality. RESULTS: Patients with obesity and/or diabetes were more likely to develop ARDS (79 patients vs 57 patients, p<0.0001) and to be intubated (71 patients vs 45 patients, p=0.0031). Patients with obesity and/or diabetes were more likely to require vasopressors (60 patients vs 41 patients, p=0.0284) and to develop lactic acidosis (median 3.15 mmol/L, IQR 1.8 to 5.2 mmol/L, p=0.0432). When comparing patients with diabetes with and without obesity against patients with obesity alone, they were more likely to develop ARDS (87.5%, p=0.0305). Despite these findings, there was no difference in mortality. CONCLUSIONS: In patients hospitalised with COVID-19, those with obesity and/or diabetes were more likely to suffer severe complications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.


Asunto(s)
Diabetes Mellitus , Hemoglobina A Glucada/análisis , Obesidad , /aislamiento & purificación , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Índice de Masa Corporal , /complicaciones , /terapia , Comorbilidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Ciudad de Nueva York/epidemiología , Obesidad/diagnóstico , Obesidad/epidemiología , Evaluación de Procesos y Resultados en Atención de Salud , Distribución Aleatoria , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
2.
Endocr Pract ; 27(2): 118-123, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33616045

RESUMEN

OBJECTIVE: To determine the impact of diabetes-specific recommendations at 1 year after hospital discharge on glycemic control and diabetes care in an outpatient setting. METHODS: A total of 139 patients with type 2 diabetes on a basal-bolus insulin regimen during hospitalization were included in the statistical analysis. We gathered data on treatment regimens after 12 to 16, 26 to 30, and 52 to 56 weeks following discharge as well as glycosylated hemoglobin (HbA1c) levels for all patients. Prescriptions for diabetes therapy were retrieved. All changes in insulin or oral/noninsulin injectable drug regimens were recorded. RESULTS: Half of the patients (n = 69) were discharged on their preadmission regimen (no change), and a change in the home treatment was recommended in the other half (n = 70). In the group of patients whose preadmission therapy was adjusted, HbA1c decreased from 9.6% (80 mmol/mol) to 8.5% (69 mmol/mol) (P = .0004) 1 year after discharge. In the group of patients discharged on their preadmission regimen, no significant changes in HbA1c levels during the study were observed. At follow-ups occurring 12 to 16 weeks after discharge, 52% (95% CI: 37.4%-66.3%) of patients in the change group had their treatment modified, compared with 18.6% (95% CI: 9.7%-30.9%) in the no-change group. In the group of patients discharged on their preadmission regimen, no significant change was observed. At the beginning of the study, patients in the change treatment group had higher HbA1c levels than patients in the no-change group (9.6 ± 2.0 vs 8.6 ± 1.7, P < .001). At the end of the study, no significant changes in terms of HbA1c levels were found between the groups (8.8 ± 1.9 vs 8.5 ± 1.9, P = .2). CONCLUSIONS: Significant improvement in diabetes control occurred 1 year after hospital discharge in patients who underwent modifications in their treatment. This supports the relevance of providing and implementing proper care recommendations at transition.


Asunto(s)
Diabetes Mellitus Tipo 2 , Alta del Paciente , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hemoglobina A Glucada/análisis , Hospitales , Humanos , Hipoglucemiantes , Insulina
3.
Medicine (Baltimore) ; 100(4): e24200, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530212

RESUMEN

BACKGROUND: Diabetic peripheral neuropathy (DPN) is 1 of the most common clinical complications of diabetes, which seriously affects the quality of life of patients and causes a substantial economic burden on diabetes care. The pathogenesis of DPN is complex. There is no targeted treatment method, and mainstream treatment methods have low efficacy and large side effects. Traditional Chinese medicine has rich clinical experience in the prevention and treatment of diabetic peripheral neuropathy, which has dramatically improved the quality of life of patients. It is clinically proven that traditional Chinese medicine fumigants (TCMF) have apparent effects in treating diabetic peripheral neuropathy. Therefore, we aim to systematically review the effectiveness and safety of TCMF for DPN. METHODS: We will search the following databases: PubMed, Embase, Cochrane Library, MEDLINE, the China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Cqvip Database, and Wanfang Data. Besides, we will also search for clinical trial registrations, potential grey literature, relevant conference abstracts, and reference lists of established studies. The studies published from the inception of the database to November 2020 will be retrieved. The randomized controlled trials on TCMF for DPN will be included. Also, we will search for clinical trial registrations, potential grey literature, relevant conference abstracts, and reference lists of established studies. The main result is clinical efficacy and nerve conduction velocity. Fasting blood glucose, 2 hours postprandial blood glucose, blood lipid, glycosylated hemoglobin, and adverse events are secondary results. We will perform the analyses using RevMan V.5.3 software. RESULTS: This study will provide a high-quality comprehensive evaluation of the efficacy and safety of TCMF in the treatment of DPN. CONCLUSIONS: This systematic review will evaluate the effectiveness and safety of TCMF in the treatment of DPN, and provide the latest evidence for clinical application. INPLASY REGISTRATION NUMBER: INPLASY2020110137.


Asunto(s)
Neuropatías Diabéticas/terapia , Fumigación/métodos , Medicina China Tradicional/métodos , Enfermedades del Sistema Nervioso Periférico/terapia , Glucemia/análisis , Diabetes Mellitus/sangre , Diabetes Mellitus/fisiopatología , Neuropatías Diabéticas/sangre , Neuropatías Diabéticas/etiología , Hemoglobina A Glucada/análisis , Humanos , Metaanálisis como Asunto , Conducción Nerviosa , Enfermedades del Sistema Nervioso Periférico/sangre , Enfermedades del Sistema Nervioso Periférico/etiología , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
4.
Biomed Environ Sci ; 34(1): 9-18, 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33531103

RESUMEN

Objective: The relationship between serum uric acid (SUA) levels and glycemic indices, including plasma glucose (FPG), 2-hour postload glucose (2h-PG), and glycated hemoglobin (HbA1c), remains inconclusive. We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population. Methods: The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study. A total of 105,922 community-dwelling adults aged ≥ 40 years underwent the oral glucose tolerance test and uric acid assessment. The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models. Results: A total of 30,941 men and 62,361 women were eligible for the current analysis. Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels, but with different inflection points in men and women. The thresholds for FPG, 2h-PG, and HbA1c for men and women were 6.5/8.0 mmol/L, 11.0/14.0 mmol/L, and 6.1/6.5, respectively (SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices). Conclusion: An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes, while the inflection points were reached earlier in men than in women.


Asunto(s)
Índice Glucémico , Ácido Úrico/sangre , Anciano , Grupo de Ascendencia Continental Asiática , Glucemia/análisis , China/epidemiología , Estudios de Cohortes , Diabetes Mellitus/sangre , Femenino , Prueba de Tolerancia a la Glucosa , Hemoglobina A Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad
5.
Medicine (Baltimore) ; 100(6): e23843, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578512

RESUMEN

BACKGROUND: Diabetes refers to any group of metabolic diseases characterized by high blood sugar and generally thought to be caused by insufficient production of insulin, impaired response to insulin. Globally, patients with type 2 diabetes account for more than 85% of the total diabetic patients, and due to factors, such as obesity, aging, environment and lifestyle, the incidence of diabetes is rising. Salvia miltiorrhiza (SM) is a medicine used to treat diabetes in China. In recent years, it has been reported that SM has the effect of improving type 2 diabetes. However, there is no systematic review of its efficacy and safety yet. Therefore, we propose a systematic review to evaluate the efficacy and safety of SM for T2D. METHODS: Six databases will be searched: China National Knowledge Infrastructure (CNKI), China Biological Medicine (CBM), China Scientific Journals Database (CSJD), Wanfang database, PubMed, and EMBASE. The information is searched from January 2010 to July 2020. Languages are limited to English and Chinese. The primary outcomes include 2 hour plasma glucose, fasting plasma glucose, hemoglobin A1c, homeostasis model assessment of insulin resistance, and fasting plasma insulin. The secondary outcomes include clinical efficacy and adverse events. RESULTS: This systematic review will evaluate the efficacy and safety of Salvia miltiorrhiza in the treatment of type 2 diabetes. CONCLUSION: This systematic review provides evidence as to whether Salvia miltiorrhiza is effective and safe for type 2 diabetes. ETHICS: Ethical approval is not necessary as this protocol is only for systematic review and does not involve in privacy data or an animal experiment. SYSTEMATIC REVIEW REGISTRATION: INPLASY2020110046.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Salvia miltiorrhiza/química , China/epidemiología , Manejo de Datos , Diabetes Mellitus Tipo 2/epidemiología , Ayuno/sangre , Femenino , Glucosa/análisis , Hemoglobina A Glucada/análisis , Homeostasis/efectos de los fármacos , Humanos , Incidencia , Insulina/sangre , Masculino , Medicina China Tradicional/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Seguridad , Resultado del Tratamiento
6.
J Assoc Physicians India ; 69(2): 22-24, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33527806

RESUMEN

Background: Exercise prescription has always been a mandatory yet extremely under rated non-pharmacological approach in management of diabetes mellitus. SMART acronym for S - specific, M - measurable, A - attainable, R - realistic, T - time oriented, is a newly proposed idea for implementing the same with supposedly better results. We tried to analyse the results objectively by SMART prescription of individualized exercise regimes to patients along with medicines. Methods: Single centred, prospective study conducted over a time span of 3 months, on 75 patients, with biweekly follow-up. At the end of three months, we evaluated the results (of 52 patients who remained) by comparing random blood sugar and glycosylated haemoglobin values of the patients at the beginning and end of the trial. Results: A significant reduction in blood sugar (p-0.023) and A1C levels (p-0.105; ns) was noted after a period of three months; with an average reduction of 31mg/ dl and 0.37% noted in each respectively. Additional benefits of better follow up, reduced financial burden, increased compliance to the said regimen were observed. Discussion: Recommending exercise and lifestyle changes is as important as pharmacological management in diabetes. A SMART approach, methodical prescription of the exercise routines and drugs- individualized for patients, will likely have better results and patient satisfaction. A practice of switching to precise written suggestions than verbal ideas and reviewing the progress on every follow up visit may improve the outcome.


Asunto(s)
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Glucemia , Diabetes Mellitus/terapia , Hemoglobina A Glucada/análisis , Humanos , Prescripciones , Estudios Prospectivos
7.
J Diabetes Res ; 2021: 6666086, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33506050

RESUMEN

Background: The risk factors for acute kidney injury (AKI) development in patients with diabetes hospitalized for COVID-19 have not been fully studied yet. In this study, we aimed to estimate the rate of AKI among the hospitalized population with COVID-19 and to identify the risk factors associated with AKI among patients with diabetes. Material and Methods. This retrospective cohort study included 254 patients (127 with diabetes and 127 without diabetes) who were admitted for COVID-19 to a tertiary hospital in Tehran, Iran, between February and May 2020. Clinical characteristics and outcomes, radiological findings, and laboratory data, including data on AKI, hematuria, and proteinuria were recorded and analyzed. Results: Of 254 patients, 142 (55.9%) were male and the mean (± SD) age was 65.7 years (±12.5). In total, 58 patients (22.8%) developed AKI during hospitalization, of whom 36 patients had diabetes (p = 0.04); most patients (74.1%) had stage 1 or 2 AKI. Also, 8 patients (13.8%) required renal replacement therapy (RRT) after developing AKI. Regardless of diabetes status, patients who developed AKI had significantly higher mortality rates compared with patients who did not develop AKI (p = 0.02). Hematuria and proteinuria were observed in 38.1% and 55% of patients, respectively. Multivariate analysis showed that invasive mechanical ventilation, proteinuria, HBA1c level, history of cardiovascular disease, and use of statins were independent risk factors for AKI development in patients with diabetes. Conclusion: Results of this study showed that AKI develops in a considerable percentage of patients with COVID-19, especially in those with diabetes, and is significantly associated with mortality.


Asunto(s)
Lesión Renal Aguda/epidemiología , /epidemiología , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/epidemiología , Anciano , Enfermedades Cardiovasculares/complicaciones , Femenino , Hemoglobina A Glucada/análisis , Hematuria/epidemiología , Mortalidad Hospitalaria , Hospitalización , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Irán/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Proteinuria/epidemiología , Terapia de Reemplazo Renal/efectos adversos , Respiración Artificial , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Riesgo , Resultado del Tratamiento
8.
J Diabetes Res ; 2021: 7830136, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33506052

RESUMEN

Backgrounds: Diabetes mellitus (DM) is one of the most common comorbidities in patients with coronavirus disease (COVID-19). We aim to summarize the clinical features of DM patients with COVID-19 and find out potential factors associated with severe disease. Methods: In this retrospective, single-center study, the medical records of patients with COVID-19 in Changsha, Hunan, China, from January 21, 2020, to February 19, 2020, were reviewed. Epidemiological information, clinical features, and outcomes were compared between DM patients admitted to the intensive care unit (ICU) or not. Results: A total of 241 patients confirmed with COVID-19 were enrolled, including 19 DM patients. There were more patients in DM group admitted to the ICU than non-DM group (36.8% vs. 15.8%, P = 0.045). Compared with non-DM group in the ICU, there were more female patients from DM group in the ICU (85.7% vs. 31.4%, P = 0.024). On admission, the mean level of glycated hemoglobin A1c (HbA1c) was higher in the ICU DM patients than that in the non-ICU DM patients (8.5% vs. 7.1%). There were more DM patients with proteinuria in the ICU group than the non-ICU group (57.1% vs. 33.3%). Twelve DM patients (63.2%) changed diabetic therapy during hospitalization, and all DM patients admitted to the ICU used insulin. As of March 14, all 19 DM patients have been discharged, and no death occurred. Conclusions: DM patients with COVID-19 are vulnerable to severe disease, especially for female patients. High levels of HbA1c and proteinuria could be potential risk factors for severe COVID-19 in DM patients. In addition to timely systemic therapy, the control of blood glucose and proper diabetic therapy is essential to improve the prognosis of severe DM patients with COVID-19.


Asunto(s)
/complicaciones , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/análisis , Niño , Preescolar , China , Cuidados Críticos , Femenino , Hemoglobina A Glucada/análisis , Hospitalización , Humanos , Lactante , Unidades de Cuidados Intensivos , Masculino , Registros Médicos , Persona de Mediana Edad , Proteinuria , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
9.
Endocr Pract ; 27(1): 38-43, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33471730

RESUMEN

OBJECTIVE: To compare glycemic efficacy of Technosphere insulin (TI) versus that of insulin aspart (IA), each added to basal insulin, in type 2 diabetes. METHODS: This randomized, 24-week trial included subjects aged from 18 to 80 years who were treated with subcutaneous insulin for 3 months and had glycated hemoglobin (HbA1C) levels of 7.0% to 11.5%. After receiving stabilized insulin glargine doses during a 4-week lead in, the subjects were randomized to TI or IA. The primary end point was an HbA1C change from baseline, with the differences analyzed by equivalence analyses. RESULTS: In the overall cohort (N = 309; males, 23.3%), mean (SD) age was 58.5 (8.4) years, body mass index was 30.8 (4.7) kg/m2, weight was 82.2 (13.6) kg, and duration of diabetes was 12.2 (7.1) years. An intention-to-treat cohort had 150 subjects randomized to TI (mean [SD] HbA1C: 8.9% [1.1%]) and 154 randomized to IA (mean [SD] HbA1C: 9.0% [1.3%]). At 24 weeks, mean (SD) HbA1C value declined to 7.9% (1.3%) and 7.7% (1.1%) in the TI and IA cohorts, respectively. A treatment difference of 0.26% was not statistically significant, but the predefined equivalency margin was not met. Subjects receiving TI lost 0.78 kg compared to baseline; subjects receiving IA gained 0.23 kg (P =.0007). The incidence of mild/moderate hypoglycemia was lower for the TI cohort, though not statistically significant. CONCLUSION: Both TI and IA resulted in significant and clinically meaningful HbA1C reductions. TI also resulted in significant and clinically meaningful weight reductions. These data support the use of inhaled insulin as a treatment option for individuals with type 2 diabetes.


Asunto(s)
Diabetes Mellitus Tipo 2 , Insulina Aspart , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes , Insulina , Insulina Glargina , Insulina de Acción Prolongada , Masculino , Persona de Mediana Edad , Adulto Joven
10.
Endocr Pract ; 27(1): 44-50, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33475500

RESUMEN

OBJECTIVE: In type 1 diabetes mellitus (T1DM) management, continuous glucose monitoring (CGM)-derived parameters can provide additional insights, with time in range (TIR) and other parameters reflecting glycemic control and variability being put forward. This study aimed to examine the added and interpretative value of the CGM-derived indices TIR and coefficient of variation (CV%) in T1DM patients stratified according to their level of glycemic control by means of HbA1C. METHODS: T1DM patients with a minimum disease duration of 10 years and without known macrovascular disease were enrolled. Patients were equipped with a blinded CGM device for 7 days. TIR and time spent in hypoglycemia and hyperglycemia were determined, and CV% was used as a parameter for glycemic variability. Pearson (r) and Spearman correlations (rs) and a regression analysis were used to examine associations. RESULTS: Ninety-five patients (age: 45 ± 10 years; HbA1C level: 7.7% ± 0.8% [61 ± 7 mmol/mol]) were included (mean blood glucose [MBG]: 159 ± 31 mg/dL; TIR: 55.8% ± 14.9%; CV%: 43.5% ± 7.8%) and labeled as having good (HbA1C level ≤7% [≤53 mmol/mol]; n = 20), moderate (7%-8%; n = 44), or poor (>8% [>64 mmol/mol]; n = 31) glycemic control. HbA1C was significantly associated with MBG (rs = 0.48, P < .001) and time spent in hyperglycemia (total: rs = 0.52; level 2: r = 0.46; P < .001) but not with time spent in hypoglycemia and CV%, even after an analysis of the HbA1C subgroups. Similarly, TIR was negatively associated with HbA1C (r = -0.53; P < .001), MBG (rs = -0.81; P < .001), and time spent in hyperglycemia (total: rs = -0.90; level 2: rs = -0.84; P < .001) but not with time in hypoglycemia. The subgroup analyses, however, showed that TIR was associated with shorter time spent in level-2 hypoglycemia in patients with good (rs = -0.60; P = .007) and moderate (rs = -0.25; P = .047) glycemic control. In contrast, CV% was strongly positively associated with time in hypoglycemia (total: rs = 0.78; level 2: rs = 0.76; P < .001) but not with TIR or time in hyperglycemia in the entire cohort, although the subgroup analyses showed that TIR was negatively associated with CV% in patients with good glycemic control (r = -0.81, P < .001) and positively associated in patients with poor glycemic control (r = +0.47; P < .01). CONCLUSION: The CGM-derived metrics TIR and CV% are related to clinically important situations, TIR being strongly dependent on hyperglycemia and CV% being reflective of hypoglycemic risk. However, the interpretation and applicability of TIR and CV% and their relationship depends on the level of glycemic control of the individual patient, with CV% generally adding less clinically relevant information in those with poor control. This illustrates the need for further research and evaluation of composite measures of glycemic control in T1DM.


Asunto(s)
Diabetes Mellitus Tipo 1 , Adulto , Glucemia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Persona de Mediana Edad
11.
Medicina (Kaunas) ; 57(1)2021 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-33466617

RESUMEN

Background and objectives: Critically and non-critically ill patients with SARS-CoV-2 infection (Covid-19) may present with higher-than-expected glycemia, even in the absence of diabetes. With this study we aimed to assess glucose, glycemic gap (GlyG) and insulin secretion/sensitivity measures in patients with Covid-19. Materials and Methods: We studied, upon admission, 157 patients with Covid-19 (84: in wards and 73: in intensive care units; ICU); 135 had no history of diabetes. We measured blood glucose upon admission as well as glycated hemoglobin (A1c), plasma insulin and C-peptide. We calculated the GlyG and the Homeostasis Model Assessment 2 (HOMA2) estimates of steady state beta cell function (HOMA2%B) and insulin sensitivity (HOMA2%S). Statistical assessment was done with analysis or the Kruskal-Wallis test. Results: Compared to patients in the wards without diabetes, patients with diabetes in the wards, as well as patients in the ICU (without or with diabetes) had higher admission glycemia. The GlyG was significantly higher in patients without diabetes in the ICU compared to patients without diabetes in the wards, while HOMA2%B based on glucose and insulin was significantly higher in the ICU patients compared to patients in the wards. Of all the parameters, HOMA2%S based on C-peptide/glucose was higher in survivors (n = 133). Conclusions: In our series of patients with Covid-19, a substantial number of patients with and without diabetes had admission hyperglycemia and those who were critically ill may have had compromised insulin secretion and lowered sensitivity to insulin. These findings lend credence to reports of association between Covid-19 and hyperglycemia/secondary diabetes.


Asunto(s)
Glucemia/análisis , Péptido C/sangre , Resistencia a la Insulina , Insulina/sangre , Anciano , Enfermedad Crítica , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Femenino , Hemoglobina A Glucada/análisis , Grecia/epidemiología , Hospitalización , Humanos , Hiperglucemia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad
12.
Monaldi Arch Chest Dis ; 91(1)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33501821

RESUMEN

Dear Editor, The Corona virus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the Wuhan province of china in December 2019. COVID-19 spread to the world in a short time and was declared as public health emergency of international concern by World Health Organization...


Asunto(s)
Diabetes Mellitus Tipo 2 , Hemoglobina A Glucada/análisis , Pulmón , Terapia por Inhalación de Oxígeno/métodos , Anciano , /diagnóstico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Resultado Fatal , Fibrosis/diagnóstico , Fibrosis/etiología , Fibrosis/terapia , Servicios de Atención de Salud a Domicilio , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
13.
Medicine (Baltimore) ; 100(2): e23780, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466127

RESUMEN

ABSTRACT: Among Asian countries, South Korea was the first to approve liraglutide as a treatment for obesity. Thus, the clinical effectiveness of liraglutide has not been studied in Asian populations.In this study, we retrospectively analyzed obese patients [body mass index (BMI) >27 kg/m2] who were treated with liraglutide between March 2018 and March 2019 in a single clinic. Weight, BMI, HbA1c, and clinical data were collected before liraglutide treatment. Changes in body weight and composition and their relationships with clinical variables were examined at re-prescription dates within 30, 60, 90, and 180 days.A total of 169 subjects were studied. The average age was 41.5 years, and 42% of the subjects were male. The average weight was 85.2 kg, and the average BMI was 30.8 kg/m2. Weight reduction was significant (-5.5 ±â€Š3.4 kg, 30 days: -3.2 ±â€Š1.8 kg, 60 days: -4.5 ±â€Š2.3 kg, 90 days: -6.3 ±â€Š2.6 kg, 180 days: -7.8 ±â€Š3.5 kg) during the follow-up period and increased with longer treatment time (P < .001). The percentages of subjects that showed ≥ 5% and ≥ 10% body weight reduction were 62.1% and 17.2%, respectively. In the body composition analysis, skeletal muscle weight loss was -3.56 ±â€Š29.7%, which was significantly smaller than fat weight loss of -11.06 ±â€Š10.4% (P = .03). Weight loss was not significantly related to age, sex, baseline BMI, baseline HbA1c, smoking status, alcohol consumption, coffee intake.In conclusion, Liraglutide treatment led to meaningful weight loss in South Korean patients, and fat mass reduction was prominent during treatment. Furthermore, liraglutide showed greater clinical effectiveness with longer treatment time.


Asunto(s)
Péptido 1 Similar al Glucagón/análogos & derivados , Liraglutida/uso terapéutico , Obesidad/tratamiento farmacológico , Pérdida de Peso/efectos de los fármacos , Adulto , Glucemia , Índice de Masa Corporal , Pesos y Medidas Corporales , Relación Dosis-Respuesta a Droga , Femenino , Hemoglobina A Glucada/análisis , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos
14.
Medicine (Baltimore) ; 100(1): e24101, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429775

RESUMEN

BACKGROUND: To evaluate dapagliflozin, canagliflozin, empagliflozin, ertugliflozin, and sotagliflozin according to their effect on the glycated hemoglobin A1c (HbA1c) level in patients with type 2 diabetes mellitus. METHODS: The Web of Science, PubMed, Cochrane Library, EMBASE, and Clinical Trials databases were electronically searched to collect randomized controlled trials of patients with type 2 diabetes mellitus through June 2020. Two researchers independently screened and evaluated the obtained studies and extracted the outcome indexes. RevMan 5.3 software was used to perform the meta-analysis and to create plots. RESULTS: Finally, 27 studies were selected and included in this study. The meta-analysis results showed that sodium-dependent glucose transporter (SGLT) inhibitors significantly reduced the HbA1c level in patients with type 2 diabetes mellitus. However, these results were highly heterogeneous, so we conducted a subgroup analysis. The results of the subgroup analysis suggested that by dividing populations into different subgroups, the heterogeneity of each group could be reduced. CONCLUSIONS: SGLT inhibitors had a good effect on the HbA1c level in patients with type 2 diabetes mellitus, but there might be differences in the efficacy of SGLT inhibitors in different populations. It is hoped that more studies will be conducted to evaluate the efficacy and safety of SGLT inhibitors in different populations. REGISTRATION NUMBER: CRD42020185025.


Asunto(s)
Hemoglobina A Glucada/análisis , Inhibidores del Cotransportador de Sodio-Glucosa 2/normas , Compuestos de Bencidrilo/farmacología , Compuestos de Bencidrilo/normas , Compuestos de Bencidrilo/uso terapéutico , Glucemia/análisis , Compuestos Bicíclicos Heterocíclicos con Puentes/farmacología , Compuestos Bicíclicos Heterocíclicos con Puentes/normas , Compuestos Bicíclicos Heterocíclicos con Puentes/uso terapéutico , Canagliflozina/farmacología , Canagliflozina/normas , Canagliflozina/uso terapéutico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos/farmacología , Glucósidos/normas , Glucósidos/uso terapéutico , Glicósidos/farmacología , Glicósidos/normas , Glicósidos/uso terapéutico , Humanos , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Factores de Tiempo
15.
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
16.
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
17.
Phytomedicine ; 81: 153431, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33352495

RESUMEN

BACKGROUND: Several lines of preclinical studies have shown promising antidiabetic effects of the aqueous leaves extract of Coccinia grandis (Linn.) Voigt (Cucurbitaceae) in vivo and in vitro. PURPOSE: The present study was conducted to evaluate the efficacy and safety of a newly developed herbal formulation of C. grandis in newly diagnosed patients with type 2 diabetes mellitus (T2DM). STUDY DESIGN: A three months long, randomized, double blind, placebo controlled clinical trial in patients with newly diagnosed T2DM. METHOD: Based on fasting plasma glucose (FPG) concentration, a total number of 158 newly diagnosed patients with T2DM (45 ± 15 years age) were recruited for the present trial from the University Medical Clinic, Teaching Hospital, Karapitiya, Galle, Sri Lanka. They were randomly assigned to the test or placebo group to receive 500 mg of herbal drug (n = 79) or placebo drug (n = 79) once daily for three months. Patients and investigators were blinded for the treatment. Percentage of glycated hemoglobin (HbA1C %), insulin and lipid profile parameters were estimated at the base line and at the end of the intervention. Serum concentration of fructosamine was assessed at every other visit of the trial. The homeostatic model assessment for insulin resistance (HOMA-IR), atherogenic index (AI), cardio-protective index (CPI) and coronary risk index (CRI) were calculated. Furthermore, fasting plasma glucose concentration, renal and liver toxicity parameters, hematological parameters, blood pressure (BP) were assessed throughout the study in two weekly intervals till the end of three months. RESULTS: Out of 158, a total number of 145 patients completed the entire clinical trial period successfully. Mean (SD) changes of variables from the baseline to the end of the intervention in test and placebo groups were 0.65 (0.54) and 0.08 (0.66) for HbA1C % (p < 0.001), 1.91 (3.07) and -1.28 (9.77) for insulin (p < 0.001), 0.02 (0.03) and -0.01 (0.04) for frucosamine (p < 0.001), 1.51 (0.49) and 0.05 (0.50) for FPG (p < 0.001), 1.73 (1.36) and -0.37 (3.38) for HOMA-IR (p < 0.001), 0.16 (0.18) and -0.04 (0.42) for TG (p < 0.001), 0.07 (0.08) and -0.02 (0.19) for VLDL-C (p < 0.001), respectively. However, the herbal drug of C. grandis was unable to change other outcome variables significantly when compared to the placebo (p > 0.05). All the renal, liver and toxicity parameters, hematological parameters and BP were within the normal physiological reference ranges at each visit. CONCLUSION: Treatment with herbal drug of C. grandis (500 mg per day) for three months for patients with newly diagnosed T2DM significantly improved their glycemic and selected lipid profile parameters with well tolerated safety.


Asunto(s)
Cucurbitaceae/química , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Adulto , Glucemia/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Diabetes Mellitus Tipo 2/sangre , Método Doble Ciego , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/química , Insulina/sangre , Resistencia a la Insulina , Lípidos/sangre , Masculino , Persona de Mediana Edad , Placebos , Plantas Medicinales/química , Resultado del Tratamiento
18.
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
19.
PLoS One ; 15(12): e0243465, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33332410

RESUMEN

Continuous glucose monitoring (CGM) improves treatment with lower blood glucose levels and less patient effort. In combination with continuous insulin application, glycemic control improves and hypoglycemic episodes should decrease. Direct feedback of CGM to continuous subcutaneous insulin application, using an algorithm is called a closed-loop (CL) artificial pancreas system. Commercial devices stop insulin application by predicting hypoglycemic blood glucose levels through direct interaction between the sensor and pump. The prediction is usually made for about 30 minutes and insulin delivery is restarted at the previous level if a rise in blood glucose is predicted within the next 30 minutes (hybrid closed loop system, HCL this is known as a predictive low glucose suspend system (PLGS)). In a fully CL system, sensor and pump communicate permanently with each other. Hybrid closed-loop (HCL) systems, which require the user to estimate the meal size and provide a meal insulin basis, are commercially available in Germany at the moment. These systems result in fewer hyperglycemic and hypoglycemic episodes with improved glucose control. Open source initiatives have provided support by building do-it-yourself CL (DIYCL) devices for automated insulin application since 2014, and are used by a tech-savvy subgroup of patients. The first commercial hybrid CL system has been available in Germany since September 2019. We surveyed 1054 patients to determine which devices are currently used, which features would be in demand by potential users, and the benefits of DIYCL systems. 9.7% of these used a DIYCL system, while 50% would most likely trust these systems but more than 85% of the patients would use a commercial closed loop system, if available. The DIYCL users had a better glucose control regarding their time in range (TIR) and glycated hemoglobin (HbA1c).


Asunto(s)
Automonitorización de la Glucosa Sanguínea/instrumentación , Diabetes Mellitus/psicología , Adolescente , Adulto , Anciano , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea/métodos , Niño , Preescolar , Diabetes Mellitus/sangre , Diabetes Mellitus/tratamiento farmacológico , Femenino , Alemania , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Lactante , Recién Nacido , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
20.
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
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA