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1.
Saudi Med J ; 42(1): 44-48, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33399170

RESUMEN

OBJECTIVES: To identify how children and adolescents with type 1 diabetes were coping with their condition during the COVID-19 lockdown, by detecting differences in blood glucose control and in lifestyle, including diet, physical activity, and mood deterioration, before and during the lockdown. METHODS: This descriptive, cross-sectional study was conducted between April and June 2020 at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Data were collected from interviews, using various forms of telecommunication. RESULTS: The total sample size was 150 patients, 48 (28%) of whom were males and 102 (72%) females. The mean age of the patients was 12.45 years. The lockdown was associated with a significant increase in patients' weight (p=0.001), body mass index (p=0.001), and blood glucose readings (p=0.007) compared to their values before the lockdown. Conclusion: A negative impact of the COVID-19 lockdown was found on blood glucose values and BMI, which may correlate with a lack of physical activity, increased consumption of carbohydrates and fast food, and mood deterioration.


Asunto(s)
Adaptación Psicológica , Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 1/terapia , Adolescente , Afecto , Índice de Masa Corporal , Niño , Estudios Transversales , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Dieta , Ejercicio Físico , Estilo de Vida Saludable , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Pandemias/prevención & control , Arabia Saudita , Aumento de Peso
2.
Rev Med Liege ; 76(1): 64-68, 2021 Jan.
Artículo en Francés | MEDLINE | ID: mdl-33443332

RESUMEN

Development of new insulins aims to mimic in a better way the natural physiology of this hormone secreted by the pancreas. Rapid insulin analogues have proven a better capacity to reduce postprandial glycaemic peaks after eating. Nevertheless, these molecules are still quite inaccurate to limit glycaemic excursions after the meals. This reality is often described by patients using continuous glucose monitoring systems. So, there is undeniably a place for even more rapid insulins. The ones named «ultra-rapid insulin¼ tend to better control hyperglycaemia after meals thanks to more favourable profiles regarding pharmacodynamics and pharmacokinetics. Ultra-rapid lispro (URLi) Lyumjev®, is the new ultra-rapid insulin available in Belgium. This review aims to describe its advantages compared to some other rapid insulins thanks to data obtained from trials in type 1 and type 2 diabetes.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Bélgica , Glucemia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemiantes/uso terapéutico , Insulina , Insulina Lispro
3.
Medicine (Baltimore) ; 100(1): e23954, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429755

RESUMEN

BACKGROUND: The incidence of gestational diabetes is increasing, which not only cause adverse pregnancy outcomes, but also increases the risk of diabetes for pregnant women and their children. Insulin is the gold standard for the treatment of gestational diabetes, but there are some disadvantages, such as poor patient compliance. Metformin has been used in the treatment of gestational diabetes, but the evaluation of its efficacy and safety is lack of reliable evidence-based medicine evidence. The purpose of this study was to systematically investigate the efficacy and safety of metformin in the treatment of diabetic gestational diabetes. METHODS: Computer searches China National Knowledge Infrastructure, Wanfang, Vipu Information Chinese Journal Service Platform and China Biomedical Database, PubMed, Embase, Web of Science, the Cochrane Library from the establishment of the database to November 2020, randomized controlled clinical trials of metformin in the treatment of gestational diabetes mellitus were conducted in English and Chinese. Two researchers independently carried out data extraction and literature quality evaluation on the quality of the included study, and the included literature was analyzed by Meta using RevMan5.3 software. RESULTS: In this study, the efficacy and safety of metformin in the treatment of diabetic gestational diabetes were investigated by evaluating the outcome indicators of pregnant women and newborn babies respectively. CONCLUSION: This study will provide reliable evidence for the clinical application of metformin in the treatment of diabetic gestational diabetes. ETHICS AND DISSEMINATION: The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/ OSF.IO / 7RB95.


Asunto(s)
Protocolos Clínicos , Diabetes Gestacional/tratamiento farmacológico , Metformina/normas , Adulto , Femenino , Humanos , Hipoglucemiantes/normas , Hipoglucemiantes/uso terapéutico , Metaanálisis como Asunto , Metformina/uso terapéutico , Embarazo , Revisiones Sistemáticas como Asunto
4.
Ann Vasc Surg ; 70: 425-433, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32619497

RESUMEN

BACKGROUND: Recent reports suggest that the negative association between diabetes mellitus and abdominal aortic aneurysm (AAA) may be driven by metformin, the world's most common antidiabetic drug rather than diabetes per se. We sought to investigate the association among AAA growth rate, chemokine profile, and metformin prescription in a contemporary Swedish cohort. METHODS: Patients under surveillance for small AAA were identified at 4 Swedish vascular centers with active AAA screening programs. Annual AAA growth rate, medical history, and prescribed medications were recorded for linear regression analysis. In a subset of patients with AAA and control subjects without AAA or diabetes, plasma samples were available and analyzed for 40 inflammatory chemokines. RESULTS: A total of 526 patients were included for AAA growth analysis: 428 without type 2 diabetes mellitus (T2DM), 65 with T2DM and metformin prescription, and 33 with T2DM but without metformin prescription. Patients were included from 2005 to 2017 with mean follow-up of 3.2 (1.7) years and median annual AAA growth rate 1.6 mm, range -4.8 to 15.4 mm. Mean (standard deviation) annual AAA growth rates were 2.3 (2.2) mm in non-T2DM patients versus 1.1 (1.1) mm in patients with T2DM with metformin prescription and 1.6 (1.4) mm among those with T2DM without metformin prescription. With non-T2DM patients as reference in an unadjusted and 2 adjusted models, metformin prescription was significantly associated with reduced AAA growth rate (P < 0.001, P = 0.005, and P = 0.024, respectively), but not T2DM without metformin prescription (P = 0.137, P = 0.331, and P = 0.479, respectively). Among 240 patients with AAA (152 without T2DM, 51 with T2DM and metformin, and 37 with T2DM without metformin) and 59 without AAA or T2DM, metformin prescription was associated with reduced expression of chemokines representing all classes of leukocytes. CONCLUSIONS: Metformin prescription is associated with reduced AAA growth rate, possibly mediated by broad anti-inflammatory effects. A randomized controlled trial is needed to determine what role metformin may play in AAA disease, particularly in the absence of T2DM.


Asunto(s)
Aneurisma de la Aorta Abdominal/prevención & control , Quimiocinas/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Anciano , Aneurisma de la Aorta Abdominal/sangre , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Biomarcadores/sangre , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Regulación hacia Abajo , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Protectores , Factores de Riesgo , Suecia/epidemiología
5.
Life Sci ; 265: 118779, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33217441

RESUMEN

AIM: The present study was designed to check the effect of daidzein in the management of diabetic retinopathy. MAIN METHODS: Streptozotocin at dose 55 mg/kg was used for inducing diabetes in rats. After 28 days of diabetic induction, animals were treated with daidzein at dose 25, 50, and 100 mg/kg for the next 28 days. Electroretinography, estimation of plasma glucose, lactate dehydrogenase, aldose reductase, sorbitol dehydrogenase and oxidative stress parameters were performed at the end of the study. Histopathology of retina was carried out at the end of the study. KEY FINDINGS: Diabetic control animals showed a significant increase in levels of plasma glucose and plasma lactate dehydrogenase (p < 0.001). Treatment with daidzein at a dose of 50 and 100 mg/kg significantly reduced the elevated level of blood glucose (p < 0.01 and p < 0.01). Whereas, treatment with daidzein at a dose 100 mg/kg significantly reduced the elevated level of lactate dehydrogenase in plasma after 28 days of treatment (p < 0.01). Treatment with daidzein at a dose of 100 mg/kg significantly reduced the level of aldose reductase and sorbitol dehydrogenase (p < 0.01 and p < 0.001 respectively). Electroretinography revealed that daidzein treatment at a dose of 100 mg/kg significantly prevented the change in 'a' and 'b' wave amplitude and latency. Oxidative stress was also found to be significantly reduced after 28 days of daidzein treatment. Histopathological findings showed a reduction in retinal thickness after daidzein treatment. SIGNIFICANCE: Daidzein treatment protected retina from damage in hyperglycaemic conditions. Thus, Daidzein can be considered as an effective treatment option for diabetic retinopathy.


Asunto(s)
Retinopatía Diabética/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Isoflavonas/uso terapéutico , Aldehído Reductasa/metabolismo , Animales , Glucemia/análisis , Diabetes Mellitus Experimental/complicaciones , Retinopatía Diabética/patología , Relación Dosis-Respuesta a Droga , Electrorretinografía , Hipoglucemiantes/administración & dosificación , Isoflavonas/administración & dosificación , L-Iditol 2-Deshidrogenasa/metabolismo , L-Lactato Deshidrogenasa/sangre , Cristalino/enzimología , Cristalino/metabolismo , Masculino , Ratas , Ratas Sprague-Dawley , Retina/patología
6.
Expert Opin Pharmacother ; 22(1): 45-54, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32892663

RESUMEN

INTRODUCTION: 'Prediabetes' is a condition of elevated glucose not attaining the established criteria for a diagnosis of diabetes. The United States Diabetes Prevention Program (DPP) began in 1996 and was the iconic study of prediabetes. In that study, after 3 years, the risk of reaching the numerical criteria of diabetes was reduced by 58% by intensive emphasis on diet and exercise whereas treatment with metformin achieved a lesser reduction of 31%. The DPP was widely heralded as suggesting that lifestyle change was superior to pharmacologic therapy in the prediabetes population. This conclusion may be overreaching in terms of the long-term results of that study. AREAS COVERED: The author reviews the subsequent pharmacologic efforts to prevent diabetes in this population. He reviews the existing literature for pharmacologic treatment of prediabetes using Pubmed.gov using the keywords of prediabetes, impaired fasting glucose and impaired glucose tolerance. EXPERT OPINION: Prediabetes is primarily related to being overweight. Obesity has health consequences going beyond glucose elevation. The approach to prediabetes should be primarily by pursuing weight loss with therapeutic agents such as GLP-1 receptor agonists and SGLT2 inhibitors.


Asunto(s)
Hipoglucemiantes/uso terapéutico , Obesidad/complicaciones , Estado Prediabético/tratamiento farmacológico , Diabetes Mellitus Tipo 2/prevención & control , Intolerancia a la Glucosa/tratamiento farmacológico , Humanos , Estilo de Vida , Metformina/uso terapéutico , Obesidad/tratamiento farmacológico , Sobrepeso/tratamiento farmacológico , Estados Unidos , Pérdida de Peso
7.
Cochrane Database Syst Rev ; 12: CD006105, 2020 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-33347618

RESUMEN

BACKGROUND: The use of insulin-sensitising agents, such as metformin, in women with polycystic ovary syndrome (PCOS) who are undergoing ovulation induction or in vitro fertilisation (IVF) cycles has been widely studied. Metformin reduces hyperinsulinaemia and suppresses the excessive ovarian production of androgens. It is suggested that as a consequence metformin could improve assisted reproductive techniques (ART) outcomes, such as ovarian hyperstimulation syndrome (OHSS), pregnancy, and live birth rates. OBJECTIVES: To determine the effectiveness and safety of metformin as a co-treatment during IVF or intracytoplasmic sperm injection (ICSI) in achieving pregnancy or live birth in women with PCOS. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL via the Cochrane Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO, LILACS, the trial registries for ongoing trials, and reference lists of articles (from inception to 13 February 2020). SELECTION CRITERIA: Types of studies: randomised controlled trials (RCTs) comparing metformin treatment with placebo or no treatment in women with PCOS who underwent IVF or ICSI treatment. TYPES OF PARTICIPANTS: women of reproductive age with anovulation due to PCOS with or without co-existing infertility factors. Types of interventions: metformin administered before and during IVF or ICSI treatment. PRIMARY OUTCOME MEASURES: live birth rate, incidence of ovarian hyperstimulation syndrome. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the studies, extracted the data according to the protocol, and assessed study quality. We assessed the overall quality of the evidence using the GRADE approach. MAIN RESULTS: This updated review includes 13 RCTs involving a total of 1132 women with PCOS undergoing IVF/ICSI treatments. We stratified the analysis by type of ovarian stimulation protocol used (long gonadotrophin-releasing hormone agonist (GnRH-agonist) or short gonadotrophin-releasing hormone antagonist (GnRH-antagonist)) to determine whether the type of stimulation used influenced the outcomes. We did not perform meta-analysis on the overall (both ovarian stimulation protocols combined) data for the outcomes of live birth and clinical pregnancy rates per woman because of substantial heterogeneity. In the long protocol GnRH-agonist subgroup, the pooled evidence showed that we are uncertain of the effect of metformin on live birth rate per woman when compared with placebo/no treatment (risk ratio (RR) 1.30, 95% confidence interval (CI) 0.94 to 1.79; 6 RCTs; 651 women; I2 = 47%; low-quality evidence). This suggests that if the chance for live birth following placebo/no treatment is 28%, the chance following metformin would be between 27% and 51%. Only one study used short protocol GnRH-antagonist and reported live birth rate. Metformin may reduce live birth rate compared with placebo/no treatment (RR 0.48, 95% CI 0.29 to 0.79; 1 RCT; 153 women; low-quality evidence). This suggests that if the chance for live birth following placebo/no treatment is 43%, the chance following metformin would be between 13% and 34% (short GnRH-antagonist protocol). We found that metformin may reduce the incidence of OHSS (RR 0.46, 95% CI 0.29 to 0.72; 11 RCTs; 1091 women; I2 = 38%; low-quality evidence). This suggests that for a woman with a 20% risk of OHSS without metformin, the corresponding risk using metformin would be between 6% and 14%. Using long protocol GnRH-agonist stimulation, metformin may increase clinical pregnancy rate per woman compared with placebo/no treatment (RR 1.32, 95% CI 1.08 to 1.63; 10 RCTs; 915 women; I2 = 13%; low-quality evidence). Using short protocol GnRH-antagonist, we are uncertain of the effect of metformin on clinical pregnancy rate per woman compared with placebo/no treatment (RR 1.38, 95% CI 0.21 to 9.14; 2 RCTs; 177 women; I2 = 87%; very low-quality evidence). We are uncertain of the effect of metformin on miscarriage rate per woman when compared with placebo/no treatment (RR 0.86, 95% CI 0.56 to 1.32; 8 RCTs; 821 women; I2 = 0%; low-quality evidence). Metformin may result in an increase in side effects compared with placebo/no treatment (RR 3.35, 95% CI 2.34 to 4.79; 8 RCTs; 748 women; I2 = 0%; low-quality evidence). The overall quality of evidence ranged from very low to low. The main limitations were inconsistency, risk of bias, and imprecision. AUTHORS' CONCLUSIONS: This updated review on metformin versus placebo/no treatment before or during IVF/ICSI treatment in women with PCOS found no conclusive evidence that metformin improves live birth rates. In a long GnRH-agonist protocol, we are uncertain whether metformin improves live birth rates, but metformin may increase the clinical pregnancy rate. In a short GnRH-antagonist protocol, metformin may reduce live birth rates, although we are uncertain about the effect of metformin on clinical pregnancy rate. Metformin may reduce the incidence of OHSS but may result in a higher incidence of side effects. We are uncertain of the effect of metformin on miscarriage rate per woman.


Asunto(s)
Fertilización In Vitro , Hiperandrogenismo/tratamiento farmacológico , Hiperinsulinismo/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Nacimiento Vivo/epidemiología , Metformina/uso terapéutico , Síndrome del Ovario Poliquístico/complicaciones , Aborto Espontáneo/epidemiología , Aborto Espontáneo/prevención & control , Sesgo , Intervalos de Confianza , Femenino , Humanos , Hipoglucemiantes/efectos adversos , Metformina/efectos adversos , Síndrome de Hiperestimulación Ovárica/epidemiología , Síndrome de Hiperestimulación Ovárica/prevención & control , Inducción de la Ovulación/métodos , Placebos/uso terapéutico , Embarazo , Índice de Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Inyecciones de Esperma Intracitoplasmáticas
8.
Medicine (Baltimore) ; 99(49): e23489, 2020 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-33285754

RESUMEN

BACKGROUND: The effects of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists on major adverse cardiovascular events (MACE) in type 2 diabetic subgroups defined by race, ethnicity, and region are unestablished. METHODS: We searched PubMed and Embase for related randomized controlled trials. We conducted random-effects meta-analysis, stratified by drug class, on MACE in various subgroups defined by 3 factors of interest (ie, race, ethnicity, and region) to estimate pooled hazard ratio (HR) and 95% confidence interval. Random-effects meta-regression was conducted to evaluate the differences between 2 drug classes. RESULTS: We included 11 randomized controlled trials for pooled analysis. Compared with placebo, SGLT2is and GLP-1 RAs significantly reduced the risk of MACE (HR ranged from 0.76 to 0.93) in most diabetic subgroups defined by 3 factors of interest. The 2 drug classes did not significantly reduced this risk in the Black race group (HR 0.92, 95% confidence interval 0.70-1.20). The effect of the 2 drug classes on MACE was not significantly different in all diabetic subgroups of interest (P-value for subgroup differences ranged from .101 to .971). CONCLUSIONS: SGLT2is and glucagon-like peptide 1 receptor agonists can significantly reduce the risk of MACE in most type 2 diabetic subgroups defined by race, ethnicity, and region, whereas they fail to do it in Black individuals.


Asunto(s)
Enfermedades Cardiovasculares/etnología , Grupos de Población Continentales/estadística & datos numéricos , Diabetes Mellitus Tipo 2/etnología , Grupos Étnicos/estadística & datos numéricos , Receptor del Péptido 1 Similar al Glucagón/agonistas , Hipoglucemiantes/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Adulto , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Asia Sudoriental/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Sistema Cardiovascular/efectos de los fármacos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , Modelos de Riesgos Proporcionales , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , América del Sur/epidemiología
9.
Medicine (Baltimore) ; 99(50): e23622, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327337

RESUMEN

BACKGROUND: Senile diabetes with depression is a common and frequently-occurring disease, and it is also a difficult and hot point in domestic and international research. However, the efficiency of combination hypoglycemic agents and antidepressants in the treatment of senile diabetes with depression is poor, and new intervention methods are urgently needed. Research shows the 5-element therapy, as a Chinese traditional non-drug intervention, has definite curative effect on the prevention and treatment of various physical and mental diseases. The purpose of this systematic review and meta-analysis is to evaluate the efficacy of 5-element therapy on senile diabetes with depression. METHODS: The electronic databases including Pubmed, Embase, Cochrane Library, Web of science, Chinese National Knowledge Infrastructure, Wanfang Database, Sino Med,China Biomedical Literature Database will be searched. The time limit for retrieving studies is from establishment to October 2020 for each database. Randomized controlled clinical trials related to 5-element therapy intervention on senile diabetes with depression will be included. Stata V.13.0 and Review manager 5.3 software will be implemented for data synthesis, sensitivity analysis, subgroup analysis, and the assessment of bias risk. We will use the grading of recommendations assessment, development, and evaluation system to assess the quality of evidence. RESULTS: This study will provide a quantitative and standardized evaluation for the efficacy of 5-element therapy on senile diabetes with depression. CONCLUSION: This systematic review and meta-analysis will provide the high-quality evidence to assess whether the 5-element therapy has a positive treatment effect for senile diabetes with depression. REGISTRATION NUMBER: INPLASY2020100081.


Asunto(s)
Trastorno Depresivo/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Antidepresivos/uso terapéutico , Trastorno Depresivo/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Servicios de Salud para Ancianos , Humanos , Hipoglucemiantes/uso terapéutico
10.
Int J Nanomedicine ; 15: 10215-10240, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33364755

RESUMEN

In view of the worldwide serious health threat of type 2 diabetes mellitus (T2DM), natural sources of chemotherapies have been corroborated as the promising alternatives, with the excellent antidiabetic activities, bio-safety, and more cost-effective properties. However, their clinical application is somewhat limited, because of the poor solubility, instability in the gastrointestinal tract (GIT), low bioavailability, and so on. Nowadays, to develop nanoscaled systems has become a prominent strategy to improve the drug delivery of phytochemicals. In this review, we primarily summarized the intervention mechanisms of phytocompounds against T2DM and presented the recent advances in various nanosystems of antidiabetic phytocompounds. Selected nanosystems were grouped depending on their classification and structures, including polymeric NPs, lipid-based nanosystems, vesicular systems, inorganic nanocarriers, and so on. Based on this review, the state-of-the-art nanosystems for phytocompounds in T2DM treatment have been presented, suggesting the preponderance and potential of nanotechnologies.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Portadores de Fármacos/química , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/farmacología , Nanopartículas/química , Fitoquímicos/administración & dosificación , Fitoquímicos/farmacología , Administración Oral , Humanos , Hipoglucemiantes/uso terapéutico , Fitoquímicos/uso terapéutico
11.
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
12.
Artículo en Inglés | MEDLINE | ID: mdl-33167380

RESUMEN

Type 2 diabetes is increasingly recognized as a spectrum of metabolic disorders sharing chronic hyperglycaemia. In Europe, the continually growing number of migrants from developing countries could affect diabetes phenotypes. We evaluated a population of 426 Italians and 412 undocumented migrants. Using 17 variables (with the exclusion of ethnic origin) we performed a multiple component analysis to detect potential clusters, independently from ethnicity. We also compared the two groups to evaluate potential ethnicity associated differences. We found five clusters of patients with different disease phenotypes. Comparing Italians with undocumented migrants, we noted that the first had more often cardiovascular risk factors and neurologic involvement, while the latter had a higher frequency of diabetic ulcers and renal involvement. Metformin was used in a comparable percentage of patients in all clusters, but other antidiabetic treatments showed some differences. Italians were more often on insulin, due to a larger use of long acting insulin, and received a larger number of oral antidiabetics in combination. Pharmacological treatment of comorbidities showed some differences too. We suggest that type 2 diabetes should be considered as a spectrum of diseases with different phenotypes also in heterogeneous populations, and that this is not due only to ethnic differences.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Migrantes , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Europa (Continente) , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Italia/epidemiología , Masculino , Fenotipo
13.
PLoS One ; 15(11): e0241909, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33157549

RESUMEN

Medication non-adherence remains a significant barrier in achieving better health outcomes for patients with chronic diseases. Previous self-reported medication adherence tools were not developed in the context of the Malaysia population. The most commonly used tool, MMAS-8, is no longer economical because it requires a license and currently every form used is charged. Hence, there is a need to develop and validate a new medication adherence tool. The Malaysia Medication Adherence Assessment Tool (MyMAAT) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. The face and content validities of the MyMAAT was established by a panel of experts. A total of 495 patients with type 2 diabetes were recruited from the Ministry of Health facilities consisting of five hospitals and five primary health clinics. A test-retest was conducted on 42 of the patients one week following their first data collection. Exploratory factor analysis was performed to evaluate the validity of the MyMAAT. The final item for MyMAAT was compared with SEAMS, HbA1c%, Medication Possession ratio (MPR) score, and pharmacist's subjective assessment for its hypothesis testing validity. The MyMAAT-12 achieved acceptable internal consistency (Cronbach's alpha = 0.910) and stable reliability as the test-retest score showed good to excellent correlation (Spearman's rho = 0.96, p = 0.001). The MyMAAT has significant moderate association with SEAMS (Spearman's rho = 0.44, p = < 0.001) and significant relationship with HbA1c (< 8% and ≥ 8%) (χ2(1) = 13.4, p < 0.001), MPR (χ2(1) = 13.6, p < 0.001) and pharmacist's subjective assessment categories (χ2(1) = 31, p < 0.001). The sensitivity of MyMAAT-12, tested against HbA1c% was 72.9% while its specificity was 43%. This study demonstrates that the MyMAAT-12 together with other methods of assessment may make a better screening tool to identify patients who were non-adherence to their medications.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Psicometría/métodos , Anciano , Análisis Costo-Beneficio , Análisis Factorial , Femenino , Humanos , Malasia , Masculino , Persona de Mediana Edad , Psicometría/economía , Reproducibilidad de los Resultados , Autoinforme , Encuestas y Cuestionarios
14.
Medicine (Baltimore) ; 99(45): e22303, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157911

RESUMEN

RATIONALE: Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor originated from neural crest cells with the potential for recurrence and metastasis. The peak age for the disease is during the first year after birth. The current therapy is primarily surgery. The patient reported here is the first case of MNTI treated with metformin. PATIENT CONCERNS: A case of a 4-month-old infant with a history of swelling in the mouth for 1 month. DIAGNOSIS: The tumor was diagnosed using radiology, pathology, and immunohistochemistry, and it was performed with complete surgical resection. Unfortunately, the tumor recurred 3 months after surgery. INTERVENTIONS: We prescribed metformin for the infant. OUTCOMES: Currently, after 9 months of treatment, the tumor is well controlled without apparent side effects. LESSONS: The case presented suggested that metformin may be an underlying therapy for MNTI.


Asunto(s)
Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Neoplasias de la Boca/diagnóstico por imagen , Recurrencia Local de Neoplasia/tratamiento farmacológico , Tumor Neuroectodérmico Melanótico/tratamiento farmacológico , Terapia Combinada , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Neoplasias de la Boca/cirugía , Tumor Neuroectodérmico Melanótico/diagnóstico por imagen , Tumor Neuroectodérmico Melanótico/cirugía
15.
Rev Col Bras Cir ; 47: e20202655, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33237184

RESUMEN

INTRODUCTION: obesity has become a public health problem in Brazil and worldwide, due to its high prevalence. It is considered a risk factor for systemic arterial hypertension (SAH) and type 2 diabetes mellitus T2DM. Although lifestyle changes can control and even achieve complete T2DM remission, most patients have difficulty controlling blood glucose. Recent studies show that the Roux-en-Y gastric bypass (RYGB) is efficient for weight loss and control of T2DM and SAH in obese individuals. OBJECTIVE: to analyze the effect of the RYGB technique on the control and treatment of comorbidities related to obesity. METHOD: this is a retrospective cohort study, with information obtained from the review of medical records, with data collection in the pre and postoperative period of patients undergoing bariatric surgery. We selected those with T2DM and SAH for the study. RESULTS: 252 patients underwent RYGB in the service. Seventy-nine (31.3%) had T2DM and 64 had SAH associated with T2DM. Regarding T2DM and SAH, 37.9% and 43,7%, respectively, showed total remission of the disease after surgery. There was a reduction in the postoperative use of Metformin, insulin / Gliclazide, Propranolol, Losartan and Hydrochlorothiazide in 62%, 10.1%, 100%, 26.5% and 22.8% of patients, respectively. CONCLUSION: the RYGB technique is effective in the remission of T2DM and SAH. Even in cases where there was no total remission of the diseases, there was a significant drop in the use of medicines used for their treatment.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Derivación Gástrica/métodos , Hipertensión/epidemiología , Obesidad Mórbida/cirugía , Adulto , Antihipertensivos/uso terapéutico , Brasil/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Derivación Gástrica/efectos adversos , Humanos , Hipertensión/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Pérdida de Peso
17.
PLoS One ; 15(11): e0242259, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33227006

RESUMEN

BACKGROUND: Recently, anthropometric indices in children with type 1 diabetes mellitus (T1DM) have begun to change. OBJECTIVE: To examine secular trends in patients' anthropometric indices. SUBJECTS: Japanese children with T1DM from the 1995, 2000, 2008 and 2013 cohorts of The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes. METHODS: We analysed serum haemoglobin A1c (HbA1c) levels, the incidence of severe hypoglycaemic events, the types and doses of insulin, height standard deviation scores (SDS), body mass index (BMI) percentiles compared with healthy Japanese children and obesity prevalence over time. We also stratified the patients according to glycaemic control levels of <58 mmol/mol (optimal), 58-75 mmol/mol (suboptimal) and ≥75 mmol/mol (high-risk). RESULTS: Data for 513-978 patients from each of the cohorts were analysed. The incidence of severe hypoglycaemic events decreased over time (from 21 to 4.8/100 patient-years), while the proportion of insulin analogue doses increased (14.6% to 98.6%). In addition, patient height SDS (-0.22 to +0.17), BMI percentile (52.1 to 58.7) and obesity prevalence (2.1% to 5.1%) increased. Height SDS increased in all of the glycaemic control subgroups, while BMI percentile and obesity prevalence increased in the suboptimal and high-risk groups. CONCLUSIONS: Since 1995, the average height of children with T1DM has increased in parallel with increasing insulin doses. Clinicians should be aware of increased BMI in these patients and the associated risk of developing cardiovascular disease in the future.


Asunto(s)
Diabetes Mellitus Tipo 1/diagnóstico , Obesidad Pediátrica/diagnóstico , Adolescente , Glucemia/análisis , Estatura , Índice de Masa Corporal , Niño , Estudios de Cohortes , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Japón/epidemiología , Masculino , Obesidad Pediátrica/complicaciones , Obesidad Pediátrica/epidemiología , Prevalencia
18.
PLoS One ; 15(11): e0242051, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33175871

RESUMEN

To date, several medication adherence instruments have been developed and validated worldwide. However, most instruments have only assessed medication adherence from the patient's perspective. The aim was to develop and validate the PATIENT-Medication Adherence Instrument (P-MAI) and the HEALTHCARE PROFESSIONAL-Medication Adherence Instrument (H-MAI) to assess medication adherence from the patient's and healthcare professional (HCP)'s perspectives. The P-MAI-12 and H-MAI-12 were developed using the nominal group technique. The face and content validity was determined by an expert panel and piloted. The initial version of these instruments consisted of 12 items were validated from October-December 2018 at a primary care clinic in Malaysia. Included were patients aged ≥21 years, diagnosed with diabetes mellitus, taking at least one oral hypoglycaemic agent and who could understand English. The HCPs recruited were family medicine specialists or trainees. To assess validity, exploratory factor analysis (EFA) and concurrent validity were performed; internal consistency and test-retest were performed to assess its reliability. A total of 120/158 patients (response rate = 75.9%) and 30/33 HCPs (response rate = 90.9%) agreed to participate. EFA found three problematic items in both instruments, which was then removed. The final version of the P-MAI-9 and the HMAI-9 had 9 items each with two domains (adherence = 2 items and knowledge/belief = 7 items). For concurrent validity, the total score of the P-MAI-9 and the H-MAI-9 were not significantly different (p = 0.091), indicating that medication adherence assessed from both the patient's and HCP's perspectives were similar. Both instruments achieved acceptable internal consistency (Cronbach's α: P-MAI-9 = 0.722; H-MAI-9 = 0.895). For the P-MAI-9, 7/9 items showed no significant difference between test and retest whereas 8/9 items in the H-MAI-9 showed significant difference at test and retest (p>0.05). In conclusion, the P-MAI-9 and H-MAI-9 had low sensitivity and high specificity suggesting that both instruments can be used for identifying patients more likely to be non-adherent to their medications.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Anciano , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Humanos , Malasia , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
19.
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
20.
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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