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1.
An Bras Dermatol ; 94(5): 561-566, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777357

RESUMO

BACKGROUND: Rubeosis faciei diabeticorum is a persistent facial erythema in patients with diabetes mellitus. The actual pathogenesis has not been studied. However, it is speculated to be a cutaneous diabetic microangiopathy. OBJECTIVE: Examine the correlation between the severity of facial erythema and the possible causes of microvascular diabetic complications, namely oxidative stress, hyperglycemia, and cutaneous accumulation of advanced glycation end-products . METHODS: Patients diagnosed with Type 2 diabetes mellitus (n=32) were enrolled in the study. The facial erythema index was measured using the Mexameter MX18; cutaneous accumulation of advanced glycation end-products was estimated by measuring skin auto fluorescence with the AGE Reader (DiagnOptics Technologies B.V. - Groningen, Netherlands). Glycated haemoglobin, total antioxidant status, and malondialdehyde were measured in blood by TBARS assay. The correlation between the selected variables was assessed by Spearman's rank test; p≤0.05 was considered statistically significant. RESULTS: There was a statistically significant correlation between total antioxidant status and the facial erythema index (ρ=0.398, p=0.024). Malondialdehyde, skin autofluorescence, glycated haemoglobin, body mass index, duration of diabetes, and age did not demonstrate statistically significant correlation with the facial erythema index. STUDY LIMITATIONS: This is an observational study. Elevation of total antioxidant status could have been caused by several factors that might have also influenced the development of rubeosis faciei, including hyperbilirubinemia and hyperuricemia. CONCLUSIONS: The results contradicted expectations. Total antioxidant status correlated positively with facial erythema index; however, there was no correlation with oxidative stress and skin autofluorescence. Further investigations should be conducted to reveal the cause of total antioxidant status elevation in patients with rubeosis faciei.


Assuntos
Angiopatias Diabéticas/metabolismo , Eritema/metabolismo , Dermatoses Faciais/metabolismo , Estresse Oxidativo , Adulto , Idoso , Antioxidantes/análise , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Angiopatias Diabéticas/complicações , Eritema/etiologia , Dermatoses Faciais/etiologia , Feminino , Fluorescência , Hemoglobina A Glicada/análise , Humanos , Masculino , Malondialdeído/sangue , Pessoa de Meia-Idade , Valores de Referência , Espectrofotometria , Estatísticas não Paramétricas
2.
Eur J Radiol ; 119: 108636, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31493727

RESUMO

PURPOSE: To highlight the importance of quantitative breast arterial calcifications (BAC) assessment for an effective stratification of cardiovascular (CV) risk in women, for whom current preventive strategies are inadequate. BAC, easily detectable on mammograms, are associated with CV disease and represent a potential imaging biomarker for CV disease prevention in women. METHOD: We summarized the available evidence on this topic. RESULTS: Age, parity, diabetes, and hyperlipidemia were found to positively correlate with BAC. Women with BAC have a higher CV risk than those without BAC: the relative risk was reported to be 1.4 for transient ischemic attack/stroke, 1.5 for thrombosis, 1.8 for myocardial infarction; the reported hazard ratio was 1.32 for coronary artery disease (CAD), 1.52 for heart failure, 1.29 for CV death, 1.44 for death from CAD. However, BAC do not alarm radiologists; when reported, they are commonly mentioned as "present", not impacting on CV decision-making. Of 18 published studies, 9 reported only presence/absence of BAC, 4 used a semi-quantitative scale, and 5 a continuous scale (with manual, automatic or semiautomatic segmentation). Various appearance, topological complexity, and vessels overlap make BAC quantification difficult to standardize. Nevertheless, machine learning approaches showed promising results in BAC quantification on mammograms. CONCLUSIONS: There is a strong rationale for mammography to become a dual test for breast cancer screening and CV disease prevention. However, robust and automated quantification methods are needed for a deeper insight on the association between BAC and CV disease, to stratifying CV risk and define personalized preventive actions.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Mama/diagnóstico por imagem , Doenças Mamárias/complicações , Doença da Artéria Coronariana/complicações , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Mamografia/métodos , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Gravidez , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
3.
Acta Med Port ; 32(6): 459-465, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31292028

RESUMO

Diabetes is a serious, chronic disease with a rising prevalence worldwide. Its complications are a major cause of morbidity and mortality and contribute substantially to health care costs. In this article the authors review the most common and sensitive skin manifestations that can be present on patients with diabetes and prediabetes. The prompt recognition of these frequently underestimated entities is extremely important as it may trigger not only an adequate metabolic evaluation but also a timely referral and appropriate treatment, minimizing the secondary effects of long-term diabetes and improving the prognosis of diabetic patients.


Assuntos
Complicações do Diabetes/etiologia , Estado Pré-Diabético/complicações , Dermatopatias/etiologia , Acantose Nigricans/etiologia , Vesícula/etiologia , Angiopatias Diabéticas/complicações , Pé Diabético/etiologia , Granuloma Anular/etiologia , Humanos , Necrobiose Lipoídica/etiologia , Escleredema do Adulto/etiologia , Dermatopatias Infecciosas/etiologia , Dermatopatias Vasculares/etiologia , Xantomatose/etiologia
4.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302625

RESUMO

Toe necrosis has many aetiologies. The most common one is ischaemia. In fact, both direct and indirect toe necrosis, as well as related lower limb gangrene, could be secondary to mechanical trauma, infections, pharmacological sensitivity, cancer, blue toe syndrome and other granulomatous diseases. We report a case of toes necrosis caused by an uncommon aetiology.


Assuntos
Angiopatias Diabéticas/complicações , Doenças do Pé/etiologia , Gangrena/etiologia , Fumar Maconha/efeitos adversos , Amputação , Humanos , Masculino , Dedos do Pé/cirurgia , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-31343130

RESUMO

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterised by a destruction of pancreatic  cells, which leads to absolute insulin deficiency. Persistently high glycaemia causes vascular damage throughout the body. Microvascular complications com-prise the following: nephropathy, retinopathy, and neuropathy. Macrovascular complications include coronary heart disease (CHD), which may result in myocardial infarction, cerebrovascular disease (leading to strokes), and peripheral vascular disease. The pathogene-sis of vascular complications is multifactorial and is probably the combination of direct glucose-mediated endothelial damage, oxidative stress, production of sorbitol, and advanced glycation end-products. Precise understanding of these mechanisms could help clinicians to identify diabetic complications earlier and subsequently implement indispensable therapy on time. It is vital to determine biomarkers of microvascular and macrovascular complications in children affected with T1DM. Advanced glycation end-products and their receptors, adhesive molecules, pro- and anti-inflammatory cytokines, enzymes such as N-acetyl-ß-D-glucosaminidase, and growth factors are the subject of ongoing studies. Numerous biomarkers of diabetic microangiopathy are already known and may constitute therapeutic targets in the future. Unfortunately, despite substantial progress in the understanding of the processes by which microvascular and macrovascu-lar complications develop, much effort still needs to be devoted to the matter, and further investigations are required.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/etiologia , Inflamação , Biomarcadores , Doença das Coronárias/etiologia , Angiopatias Diabéticas/complicações , Nefropatias Diabéticas/etiologia , Neuropatias Diabéticas/etiologia , Retinopatia Diabética/etiologia , Humanos , Acidente Vascular Cerebral/etiologia
6.
Diabetes Res Clin Pract ; 152: 1-8, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31078665

RESUMO

AIMS: It is known that autonomic nerve activity (ANA) affects glucose metabolism by regulating the secretion of insulin and glucagon. Sympathetic nerve stimulation results in increased blood glucose levels. ANA also showed a circadian variation, and sympathetic nerve activity was minimal at night and began to rise at arousal. Therefore, a drastic alteration in ANA around wake-up would be associated with glycemic variability (GV) known risk factor for cardiovascular disease. We investigated the relation between ANA around wake-up and either morning or daily GV. METHODS: We simultaneously performed Holter ECG and continuous glucose monitoring system in 41 patients with type 2 diabetes (T2D). ANA was assessed by heart rate variability (HRV) analysis. Delta (Δ) wake-up was defined as the difference between the maximum and minimum value during 1 h before and after wake-up time, before breakfast. RESULTS: Δ of low frequency/high frequency (LF/HF) around wake-up time (Δ LF/HF wake-up) was positively associated with Δ glucose wake-up, standard deviation (SD) glucose wake-up, the mean amplitude of glucose excursions (MAGE24h), and SD glucose24h after adjustment for age, sex, BMI, the duration of diabetes, and the prevalence of diabetic polyneuropathy (ß = 0.47, p = 0.011, ß = 0.48, p = 0.009, ß = 0.54, p = 0.002 and ß = 0.41, p = 0.0025, respectively). No association was found between Δ LF/HFwake-up and either mean blood glucose for 24 h, or HbA1c as parameters of chronic hyperglycemia. CONCLUSIONS: In T2D, the fluctuation in fasting sympathetic nerve activity around wake-up was positively associated with not only morning but also daily GV.


Assuntos
Nível de Alerta/fisiologia , Glicemia/metabolismo , Ritmo Circadiano/fisiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Frequência Cardíaca/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Idoso , Automonitorização da Glicemia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/metabolismo , Angiopatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/fisiopatologia , Progressão da Doença , Eletrocardiografia , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Insulina/metabolismo , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Fatores de Risco , Sistema Nervoso Simpático/metabolismo
7.
World Neurosurg ; 125: 414-424, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822589

RESUMO

BACKGROUND: Carotid artery restenosis after carotid endarterectomy (CEA) or carotid artery stenting (CAS) will occur in 3%-30% of cases. Restenosis can lead to more frequent clinical and imaging monitoring and the potential for reoperation. We sought to define the demographic, clinical, and radiographic characteristics that influence the restenosis risk after carotid revascularization. METHODS: The present study was performed in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. A random effects model meta-analysis of hazard ratios (HRs) was conducted. RESULTS: Eighteen studies with 17,106 patients were included. Diabetes (HR, 1.68; 95% confidence interval [CI], 1.00-2.83; I2, 76.7%), dyslipidemia (HR, 1.77; 95% CI, 1.08-2.91; I2, 22.5%), female gender (HR, 1.50; 95% CI, 1.14-1.98, I2, 0%), chronic kidney disease (HR, 4.15; 95% CI, 1.69-10.19; I2, 44.5%), hypertension (HR, 1.99; 95% CI, 1.07-3.72; I2, 68%), smoking (HR, 1.65; 95% CI, 1.15-2.37; I2, 54.3%), and pretreatment stenosis >70% (HR, 1.04; 95% CI, 1.0-1.08; I2, 0%) showed a statistically significant increase in restenosis risk after carotid revascularization. Subgroup analyses of CEA and CAS showed that female gender and smoking status were significantly associated with recurrent stenosis after CEA but not after CAS. In contrast, hypertension was associated with restenosis after CAS but not after CEA. Patch endarterectomy (HR, 0.33; 95% CI, 0.22-0.50; I2, 0%) and symptomatic status at presentation in the CAS group (HR, 0.61; 95% CI, 0.41-0.90; I2, 0%) were associated with a decreased risk of restenosis. Antiplatelet use and coronary artery disease were not associated with restenosis risk. CONCLUSIONS: Diabetes, dyslipidemia, female gender, renal failure, hypertension, and smoking were associated with an increased risk of restenosis, and patch endarterectomy and symptomatic status at presentation were associated with a decreased risk of carotid restenosis. Both female gender and current smoking status were only associated with recurrent stenosis after CEA, and hypertension was only associated with restenosis after CAS.


Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Reperfusão/métodos , Angiopatias Diabéticas/complicações , Humanos , Hipertensão/complicações , Recidiva , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Stents
8.
Int J Clin Pharm ; 41(2): 563-573, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30864083

RESUMO

Background Diabetes is a major cause of microvascular complications. Renin-angiotensin-aldosterone blockers have been known to have the benefits of delaying onset and progression of diabetic complications including nephropathy. Objective To evaluate the effect of sarpogrelate, an antiplatelet agent, on the new onset diabetic complications in patients with type 2 diabetes mellitus. Setting A 1108-bed tertiary university hospital in Korea. Methods A retrospective cohort study was conducted using electronic medical records between 2010 and 2015 in Korea. The study cohort of the propensity score matched patients with or without sarpogrelate was evaluated for the diabetic complications identified with the diagnosis codes in T2DM patients on the metformin based antidiabetic therapy. Nephropathy was further evaluated for progression of kidney function. Main outcome measure The incidence of composite microvascular complications included nephropathy, neuropathy, and retinopathy. Results The 1:2 propensity score matched 478 out of 14,440 patients were included in the final analysis with or without sarpogrelate (162 vs. 316 patients). The incidence of nephropathy, neuropathy, and retinopathy was 1.23% versus 5.38% (HR 0.21, 95% CI 0.05-0.92), 1.23% versus 4.43% (HR 0.26, 95% CI 0.06-1.14), and 6.17% versus 6.33% (HR 0.93, 95% CI 0.43-1.97) with sarpogrelate and without sarpogrelate, respectively. Changes in the estimated glomerular filtration rate and urine albumin creatinine ratio were not significantly different between the groups. Conclusion In Korean patients, sarpogrelate, an antiplatelet agent, was associated with reducing the incidence and progression of nephropathyin type 2 diabetes, but not associated with the composite endpoints including neuropathy and retinopathy.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/tratamento farmacológico , Neuropatias Diabéticas/tratamento farmacológico , Retinopatia Diabética/tratamento farmacológico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Succinatos/uso terapêutico , Idoso , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/complicações , Nefropatias Diabéticas/complicações , Neuropatias Diabéticas/complicações , Retinopatia Diabética/complicações , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos
9.
Diabet Med ; 36(2): 237-242, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30499197

RESUMO

AIMS: To assess the association between vascular complications of diabetes and the risk of congenital malformations in pregnant women with Type 1 diabetes. METHODS: We conducted an observational retrospective cohort study in women with Type 1 diabetes who received care consecutively from three tertiary care diabetes-in-pregnancy clinics in Calgary, Alberta, Canada. Multivariable logistic regression was used to assess the association between vascular complications (retinopathy, nephropathy and pre-existing hypertension) and congenital malformations in offspring of women with Type 1 diabetes. RESULTS: Of 232 women with Type 1 diabetes, 49 (21%) had at least one vascular complication and there were 52 babies with congenital malformations. Maternal age (31.8 ± 5.0 vs. 29.4 ± 4.7 years, P < 0.01), diabetes duration (20.9 ± 6.7 vs. 11.2 ± 7.4 years, P < 0.01) and pre-eclampsia rate (12.5% vs. 1.3%, P < 0.01) were higher in mothers with vascular complications than in those without. Multivariable analyses showed that vascular complications were not associated with an increased risk of congenital malformations (odds ratio 1.16, 95% confidence interval 0.46 to 2.88). CONCLUSIONS: Vascular complications are common, occurring in one-fifth of pregnant women with Type 1 diabetes, and in this study do not appear to be associated with an increased risk of congenital malformations in children.


Assuntos
Anormalidades Congênitas/etiologia , Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/complicações , Complicações Cardiovasculares na Gravidez , Gravidez em Diabéticas , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Idade Materna , Gravidez , Estudos Retrospectivos , Fatores de Risco
10.
J Am Coll Cardiol ; 73(6): 629-638, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30428398

RESUMO

BACKGROUND: The FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial demonstrated that for patients with diabetes mellitus (DM) and multivessel coronary disease (MVD), coronary artery bypass grafting (CABG) is superior to percutaneous coronary intervention with drug-eluting stents (PCI-DES) in reducing the rate of major adverse cardiovascular and cerebrovascular events after a median follow-up of 3.8 years. It is not known, however, whether CABG confers a survival benefit after an extended follow-up period. OBJECTIVES: The purpose of this study was to evaluate the long-term survival of DM patients with MVD undergoing coronary revascularization in the FREEDOM trial. METHODS: The FREEDOM trial randomized 1,900 patients with DM and MVD to undergo either PCI with sirolimus-eluting or paclitaxel-eluting stents or CABG on a background of optimal medical therapy. After completion of the trial, enrolling centers and patients were invited to participate in the FREEDOM Follow-On study. Survival was evaluated using Kaplan-Meier analysis, and Cox proportional hazards models were used for subgroup and multivariate analyses. RESULTS: A total of 25 centers (of 140 original centers) agreed to participate in the FREEDOM Follow-On study and contributed a total of 943 patients (49.6% of the original cohort) with a median follow-up of 7.5 years (range 0 to 13.2 years). Of the 1,900 patients, there were 314 deaths during the entire follow-up period (204 deaths in the original trial and 110 deaths in the FREEDOM Follow-On). The all-cause mortality rate was significantly higher in the PCI-DES group than in the CABG group (24.3% [159 deaths] vs. 18.3% [112 deaths]; hazard ratio: 1.36; 95% confidence interval: 1.07 to 1.74; p = 0.01). Of the 943 patients with extended follow-up, the all-cause mortality rate was 23.7% (99 deaths) in the PCI-DES group and 18.7% (72 deaths) in the CABG group (hazard ratio: 1.32; 95% confidence interval: 0.97 to 1.78; p = 0.076). CONCLUSIONS: In patients with DM and MVD, coronary revascularization with CABG leads to lower all-cause mortality than with PCI-DES in long-term follow-up. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/cirurgia , Intervenção Coronária Percutânea , Idoso , Doença da Artéria Coronariana/etiologia , Angiopatias Diabéticas/complicações , Stents Farmacológicos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Resultado do Tratamento
11.
Ann Cardiol Angeiol (Paris) ; 68(2): 80-86, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30293798

RESUMO

AIM: To assess the quality of long-term anticoagulation therapy with antivitamin-K in patients with atrial fibrillation by measuring the TTR and to determine the factors associated with a good TTR. PATIENTS AND METHODS: This is an observational study conducted over a period of three years (from January 2013 until December 2015) in the outpatient clinic of cardiology of Farhat Hached hospital of Sousse, Tunisia. Pre-established individual plugs were used for data collection. The data analysis was performed using the SPSS Software, version 20. RESULTS: Overall, 200 patients were eligible. Half of the patients did not know the risks of AVK and 29.1% were unaware of their interest. The average TTR was 57.3±18.2%. Good control of anticoagulation was obtained in 24.5% of patients. Those with a≥70% were more autonomous, observant, of urban origin, living in Sousse and Kairouan, with good knowledge about AVK and having a small left atrium. The factors associated negatively with TTR were hypertension, diabetes, old AF, hematological diseases, high number of medications taken daily and the presence of mitral insufficiency, mitral valve replacement, a tricuspid insufficiency or a tricuspid plasty. CONCLUSION: The quality of AVK anticoagulation in AF patients is insufficient. Improving this indicator would reduce the morbidity and mortality associated with AVK treatment.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Conhecimentos, Atitudes e Prática em Saúde , Coeficiente Internacional Normatizado/normas , Terapia Trombolítica/normas , Adulto , Idoso , Assistência Ambulatorial , Anticoagulantes/efeitos adversos , Fibrilação Atrial/sangue , Angiopatias Diabéticas/complicações , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças Hematológicas/complicações , Hemorragia/induzido quimicamente , Humanos , Hipertensão/complicações , Coeficiente Internacional Normatizado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Polimedicação , Qualidade da Assistência à Saúde , Fatores de Risco , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Tunísia , Vitamina K/antagonistas & inibidores
12.
BMJ Open ; 8(12): e024004, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30552272

RESUMO

OBJECTIVE: To translate an informed shared decision-making programme (ISDM-P) for patients with type 2 diabetes from a specialised diabetes centre to the primary care setting. DESIGN: Patient-blinded, two-arm multicentre, cluster randomised controlled trial of 6 months follow-up; concealed randomisation of practices after patient recruitment and acquisition of baseline data. SETTING: 22 general practices providing care according to the German Disease Management Programme (DMP) for type 2 diabetes. PARTICIPANTS: 279 of 363 eligible patients without myocardial infarction or stroke. INTERVENTIONS: The ISDM-P comprises a patient decision aid, a corresponding group teaching session provided by medical assistants and a structured patient-physician encounter.Control group received standard DMP care. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary endpoint was patient adherence to antihypertensive or statin drug therapy by comparing prescriptions and patient-reported uptake after 6 months. Secondary endpoints included informed choice, risk knowledge (score 0-11 from 11 questions) and prioritised treatment goals of patients and doctors. RESULTS: ISDM-P: 11 practices with 151 patients; standard care: 11 practices with 128 patients; attrition rate: 3.9%. There was no difference between groups regarding the primary endpoint. Mean drug adherence rates were high for both groups (80% for antihypertensive and 91% for statin treatment). More ISDM-P patients made informed choices regarding statin intake, 34% vs 3%, OR 16.6 (95% CI 4.4 to 63.0), blood pressure control, 39% vs 3%, OR 22.2 (95% CI 5.3 to 93.3) and glycated haemoglobin, 43% vs 3%, OR 26.0 (95% CI 6.5 to 104.8). ISDM-P patients achieved higher levels of risk knowledge, with a mean score of 6.96 vs 2.86, difference 4.06 (95% CI 2.96 to 5.17). In the ISDM-P group, agreement on prioritised treatment goals between patients and doctors was higher, with 88.5% vs 57%. CONCLUSIONS: The ISDM-P was successfully implemented in general practices. Adherence to medication was very high making improvements hardly detectable. TRIAL REGISTRATION NUMBER: ISRCTN77300204; Results.


Assuntos
Tomada de Decisões , Diabetes Mellitus Tipo 2/tratamento farmacológico , Participação do Paciente , Atenção Primária à Saúde/métodos , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/tratamento farmacológico , Seguimentos , Hemoglobina A Glicada/metabolismo , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Adesão à Medicação , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Relações Médico-Paciente , Encaminhamento e Consulta
13.
Rev. cuba. angiol. cir. vasc ; 19(2): 133-149, jul.-dic. 2018. ilus, graf
Artigo em Espanhol | LILACS | ID: biblio-960336

RESUMO

Introducción: Las arterias elásticas se caracterizan por un comportamiento hiperelástico anisotrópico, no lineal y cuasi -incompresible, el cual depende de la contribución y distribución de los principales constituyentes. Su evaluación a través de modelos constitutivos junto con enfoques numéricos apropiados puede contribuir potencialmente al estudio de enfermedades como la aterosclerosis, así como al modelado de las intervenciones quirúrgicas o traumas por accidente. Objetivo: Valorar los modelos constitutivos que caracterizan el comportamiento biomecánico de la pared arterial para la identificación del potencial adecuado que permita la correlación de parámetros bioquímicos y mecánicos, en condiciones de daño. Métodos: Se realizó una revisión bibliográfica entre los años 2010-2016 en las bases de datos: Medline, Cochrane Library, Lilacs, así como en el meta-buscador Google. Se consultaron estudios de cohorte, prospectivos, retrospectivos, clínicos, epidemiológicos, revisiones bibliográficas y ensayos clínicos. Resultados: El modelo constitutivo anisotrópico de dos familias de fibras resulta apropiado para obtener nuevas relaciones constitutivas, que aporten más información sobre las propiedades mecánicas de las arterias bajo la influencia del descontrol metabólico generado por la acción de la diabetes mellitus, en los estadios tempranos de la aterosclerosis. Conclusiones: Los cambios en la estructura, composición y propiedades mecánicas que sufre la pared arterial, debido al descontrol metabólico, permite aseverar que la formulación de un modelo adecuado para representar esta realidad es una etapa crucial en la obtención de nuevas relaciones constitutivas, que contribuyan a una solución satisfactoria en el diagnóstico clínico no invasivo de las enfermedades vasculares(AU)


Introduction: The elastic arteries are characterized by a hyper-elastic, anisotropic, non-linear and quasi-incomprehensible behaviour, which depends on the contribution and distribution of the main constituents. Its evaluation through constitutive models together with appropriate numerical approaches can potentially contribute to the study of pathologies such as atherosclerosis, as well as to the modelling of surgical interventions or traumas by accident. Objective: To assess the constitutive models that characterize the biomechanical behavior of the arterial wall for the identification of the adequate potential that allows the correlation of biochemical and mechanical parameters in damage conditions. Methods: A bibliographic review was conducted from 2010 to 2016 in databases such as: Medline, Cochrane Library, Lilacs, as well as in the metasearch engine Google. There were consulted cohort, prospective, retrospective, clinical, epidemiological studies, bibliographic reviews and clinical trials. Results: The constitutive anisotropic model of two families of fibers is appropriate to obtain new constitutive relations, which provide of more information about the mechanical properties of the arteries under the influence of the metabolic decontrol generated by the action of diabetes mellitus, in the early stages of atherosclerosis. Conclusions: The changes in the structure, composition and mechanical properties of the arterial wall as a consequence of the metabolic decontrol allows to assert that the formulation of a suitable model to represent this reality is a crucial stage in obtaining new constitutive relations that contribute to a satisfactory solution in the non-invasive clinical diagnosis of vascular diseases(AU)


Assuntos
Humanos , Angiopatias Diabéticas/complicações , Epidemiologia Descritiva , Estudos Prospectivos , Estudos Retrospectivos , Estudos de Coortes
14.
BMC Health Serv Res ; 18(1): 900, 2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30486824

RESUMO

BACKGROUND: Management of type 2 diabetes mellitus (T2DM) encompasses intensive glycaemic control, along with treatment of comorbidities and complications to handle the increased risk of cardiovascular disease (CVD). Improved control of LDL-cholesterol (LDL-C) with lipid-lowering medications is associated with reduced CVD risk in T2DM patients. Thus, treatment guidelines recommend lipid-lowering medications for T2DM patients with LDL-C above risk-associated thresholds. This study aimed to assess healthcare provider adherence to guidelines regarding lipid-lowering medication prescription among T2DM patients and to analyse factors associated with lipid-lowering medication prescription. METHODS: Observations in 2007 - 2014 for T2DM patients age ≥ 18 were collected from the Swedish National Diabetes Register. Observations were excluded if they lacked information about LDL-C, lipid-lowering medication prescription or CVD. Observations with established CVD were attributed to secondary prevention; remaining observations were attributed to primary prevention. The analyses included primary and secondary prevention observations with LDL-C above risk-associated thresholds (LDL-C ≥ 2.5 mmol/l and LDL-C ≥ 1.8 mmol/l respectively). Guideline adherence was analysed as the probability of prescribing lipid-lowering medications using mixed-effect model regression adjusted for potential confounders. Factors associated with prescribing lipid-lowering medications were analysed for patient and healthcare provider characteristics using mixed-effect model regression and odds ratio. RESULTS: A total of 1,204,376 observations from 322,046 patients reported by 1352 healthcare providers were included. Primary prevention accounted for 63%; 52% were men, mean age was 64 and mean LDL-C was 3.4 mmol/l. For secondary prevention, 60% were men, mean age was 72 and mean LDL-C was 2.7 mmol/l. During 2007-2014, guideline adherence ranged from 36 to 47% for primary prevention and 59 to 69% for secondary prevention. In general, concomitant prescription of diabetes medications, antiplatelets and antihypertensives along with smoking and specialised care were associated with higher prescription of lipid-lowering medications. Patients age ≥ 80 were associated with lower prescription of lipid-lowering medications. Higher prescription was associated with longer diabetes duration in primary prevention and men in secondary prevention. CONCLUSIONS: Adherence to treatment guidelines levelled off after an initial increase in both prevention groups. Lipid-lowering medication prescription was based on individualised CVD risk.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Angiopatias Diabéticas/prevenção & controle , Hipercolesterolemia/prevenção & controle , Hipolipemiantes/uso terapêutico , Idoso , Anti-Hipertensivos/uso terapêutico , Glicemia/metabolismo , LDL-Colesterol/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/complicações , Feminino , Fidelidade a Diretrizes , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/complicações , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Medicamentos sob Prescrição/uso terapêutico , Prevenção Primária , Sistema de Registros , Fatores de Risco , Prevenção Secundária , Suécia
15.
J Am Heart Assoc ; 7(20): e009770, 2018 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-30371286

RESUMO

Background The CASTLE - AF (Catheter Ablation versus Standard Conventional Therapy in Patients With Left Ventricular Dysfunction and Atrial Fibrillation) trial recently reported that catheter ablation of atrial fibrillation ( AF ) improves survival in heart failure (HF) with reduced ejection fraction ( HF r EF ). However, established AF was not associated with mortality in trials of contemporary HF r EF pharmacotherapies. We investigated whether HF r EF pathogenesis may influence the conclusions of studies evaluating the prognostic impact of AF . Methods and Results Using a prospective cohort study of 791 patients with HFr EF , with AF determined using 24-hour ambulatory ECG monitoring, univariable and multivariable Cox regression analyses were used to define the association between AF and mode-specific mortality (mean follow-up of 5.4 years). One-year HF-related hospitalization was assessed with binary logistic regression analysis. One-year cardiac remodeling was assessed in a subgroup (n=378) using echocardiography. AF was present in 28.2% of patients, with 9.4% of these being paroxysmal. While AF was associated with increased risk of all-cause mortality (hazard ratio, 1.27; 95% confidence interval 1.03-1.57), with diverging survival curves after 1 year of follow-up, this association was lost in age-sex-adjusted analyses. However, AF was associated with increased risk of age-sex-adjusted all-cause mortality in people with ischemic pathogenesis, with a statistically significant interaction between pathogenesis and AF. This was predominantly attributed to progressive HF deaths. After 1 year, HF hospitalization and cardiac remodeling were not associated with AF , even in people with ischemic pathogenesis. Conclusions AF is associated with increased risk of death in HF r EF of ischemic pathogenesis, predominantly due to progressive HF deaths during long-term follow-up. HF r EF pathogenesis should be considered in trial design and interpretation.


Assuntos
Fibrilação Atrial/complicações , Insuficiência Cardíaca/complicações , Isquemia Miocárdica/complicações , Idoso , Fibrilação Atrial/mortalidade , Causas de Morte , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/mortalidade , Angiopatias Diabéticas/fisiopatologia , Progressão da Doença , Eletrocardiografia Ambulatorial , Feminino , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Isquemia Miocárdica/mortalidade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/mortalidade , Remodelação Ventricular/fisiologia
16.
Taiwan J Obstet Gynecol ; 57(5): 659-664, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30342646

RESUMO

OBJECTIVE: Microangiopathy is common after a long duration in type 1 diabetes mellitus (T1DM). Pregnancies with end-age vascular complications are a big challenge to multidisciplinary physicians. The objective of this study was to assess the risk of microangiopathy for adverse pregnancy outcome in T1DM. MATERIALS AND METHODS: PubMed, EMBASE, and Cochrane Library databases were searched for relevant articles appearing in the literature up to October 1, 2017. Analysis of cohort studies were performed with Review Manager 5.3 and Newcastle Ottawa Scale (NOS) was chosen to evaluate the risk of bias. RESULTS: A total of 10 studies involving 3239 pregnancies were retrieved and analyzed. Microangiopathy for diabetic nephropathy (DN), microalbuminuria and diabetic retinopathy (DR) significantly increased the risk of preeclampsia (PE) (OR of 7.19, [95%CI: 5.15, 10.03], 4.19, [95%CI: 2.78, 6.31] and 3.02, [95%CI: 2.24, 4.07], respectively). Significant association of the presence of DN with preterm delivery was demonstrated (OR = 4.14, 95%CI [2.84, 6.02]), with small for gestation age was demonstrated (OR = 6.23, 95%CI [2.75, 14.14]) and with large for gestation age was demonstrated (OR = 0.41, 95%CI [0.27, 0.62]). A mild association of the presence of DR with preterm delivery was demonstrated (OR = 1.57, 95%CI [1.08, 2.29]). CONCLUSION: The presence of microangiopathy before or in early pregnancy increased the risk of adverse pregnancy outcome in T1DM. We highlighted it was important that White's classification and a full assessment of vasculopathy should be carry out before pregnancy to ensure a well-planned pregnancy. Further work should be designed to establish risks model involving microangiopathy and find out whether early intervention with strict blood sugar control or medication such as low-dose aspirin will reduce the incidence of PE in T1DM.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/complicações , Resultado da Gravidez , Gravidez em Diabéticas , Adulto , Estudos de Coortes , Nefropatias Diabéticas/complicações , Retinopatia Diabética/complicações , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Pré-Eclâmpsia/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Fatores de Risco
17.
BMC Infect Dis ; 18(1): 428, 2018 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-30153797

RESUMO

BACKGROUND: Chronic diseases, chiefly cancers and circulatory system diseases (CSDs), have become the leading non-AIDS-related causes of death among HIV-infected people, as in the general population. After our previous report of an excess mortality for several non-AIDS-defining cancers, we now aim to assess whether people with AIDS (PWA) experience also an increased mortality for CSDs and diabetes mellitus (DM), as compared to the non-AIDS general population (non-PWA). METHODS: A nationwide, population-based, retrospective cohort study was conducted including 5285 Italians, aged 15-74 years, who were diagnosed with AIDS between 2006 and 2011. Multiple cause-of-death (MCoD) data, i.e. all conditions reported in death certificates, were retrieved through record-linkage with the National Register of Causes of Death up to 2011. Using MCoD data, sex- and age-standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated by dividing the observed number of PWA reporting a specific disease among MCoD to the expected number, estimated on the basis of mortality rates (based on MCoD) of non-PWA. RESULTS: Among 1229 deceased PWA, CSDs were mentioned in 201 (16.4%) certificates and DM in 46 (3.7%) certificates among the various causes of death. These values corresponded to a 13-fold higher mortality related to CSDs (95% CI 10.8-14.4) and DM (95% CI: 9.5-17.4) as compared to 952,019 deceased non-PWA. Among CSDs, statistically significant excess mortality emerged for hypertension (23 deaths, SMR = 6.3, 95% CI: 4.0-9.4), ischemic heart diseases (39 deaths, SMR = 6.1, 95% CI: 4.4-8.4), other forms of heart diseases (88 deaths, SMR = 13.4, 95% CI: 10.8-16.5), and cerebrovascular diseases (42 deaths, SMR = 13.4, 95% CI: 9.7-18.2). The SMRs were particularly elevated among PWA aged < 50 years and those infected through drug injection. CONCLUSIONS: The use of MCoD data disclosed the fairly high mortality excess related to several CSDs and DM among Italian PWA as compared to non-PWA. Study findings also indicate to start preventive strategies for such diseases at a younger age among AIDS patients than in the general population and with focus on drug users.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/mortalidade , Síndrome de Imunodeficiência Adquirida/complicações , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/complicações , Causas de Morte , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/mortalidade , Estudos de Coortes , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/mortalidade , Feminino , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
18.
Diabetes ; 67(9): 1729-1741, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30135134

RESUMO

Microvascular and metabolic physiology are tightly linked. This Perspective reviews evidence that 1) the relationship between hyperglycemia and microvascular dysfunction (MVD) is bidirectional and constitutes a vicious cycle; 2) MVD in diabetes affects many, if not all, organs, which may play a role in diabetes-associated comorbidities such as depression and cognitive impairment; and 3) MVD precedes, and contributes to, hyperglycemia in type 2 diabetes (T2D) through impairment of insulin-mediated glucose disposal and, possibly, insulin secretion. Obesity and adverse early-life exposures are important drivers of MVD. MVD can be improved through weight loss (in obesity) and through exercise. Pharmacological interventions to improve MVD are an active area of investigation.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/fisiopatologia , Hiperglicemia/fisiopatologia , Microvasos/fisiopatologia , Estado Pré-Diabético/complicações , Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/metabolismo , Animais , Terapia Combinada , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/terapia , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/prevenção & controle , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/prevenção & controle , Retinopatia Diabética/complicações , Retinopatia Diabética/etiologia , Retinopatia Diabética/prevenção & controle , Estilo de Vida Saudável , Humanos , Hiperglicemia/complicações , Hiperglicemia/prevenção & controle , Resistência à Insulina , Obesidade/complicações , Obesidade/metabolismo , Obesidade/fisiopatologia , Obesidade/terapia , Estado Pré-Diabético/sangue , Estado Pré-Diabético/metabolismo , Estado Pré-Diabético/terapia
19.
Diabet Med ; 35(11): 1596-1604, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29999549

RESUMO

AIM: To investigate the association between cardiovascular autonomic neuropathy and bone metabolism in people with Type 1 diabetes. METHODS: We assessed cardiovascular autonomic neuropathy in 329 people with Type 1 diabetes according to heart rate response to deep breathing, to standing and to the Valsalva manoeuvre, and 2-min resting heart rate. More than one pathological non-resting test was defined as cardiovascular autonomic neuropathy. Bone mineral density of the femoral neck (BMDfn) was assessed by dual energy X-ray absorptiometry. Serum parathyroid hormone levels and other bone markers were measured. RESULTS: The mean (sd) age of the participants was 55.6 (9.4) years, 52% were men, and the mean (sd) diabetes duration was 40 (8.9) years, HbA1c 62 (9) mmol/mol and estimated GFR 78 (26) ml/min/1.73m2 . In all, 36% had cardiovascular autonomic neuropathy. Participants with cardiovascular autonomic neuropathy had 4.2% (95% CI -8.0 to -0.2; P=0.038) lower BMDfn and 33.6% (95% CI 14.3 to 53.8; P=0.0002) higher parathyroid hormone levels compared with participants without cardiovascular autonomic neuropathy in adjusted models. Higher resting heart rate remained associated with higher parathyroid hormone level and lower BMDfn after additional adjustment for eGFR (P<0.0001 and P = 0.042, respectively). CONCLUSIONS: The presence of cardiovascular autonomic neuropathy was associated with reduced BMDfn and increased levels of parathyroid hormone. Kidney function may either confound or mediate these findings. Cardiovascular autonomic neuropathy could be associated with increased risk of osteoporosis in Type 1 diabetes. Whether cardiovascular autonomic neuropathy directly affects bone metabolism detrimentally or if this association is mediated via decreased kidney function should be investigated further.


Assuntos
Doenças do Sistema Nervoso Autônomo/epidemiologia , Osso e Ossos/metabolismo , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Angiopatias Diabéticas/epidemiologia , Osteoporose/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Sistema Nervoso Autônomo/complicações , Densidade Óssea , Doenças Cardiovasculares/complicações , Estudos de Casos e Controles , Estudos Transversais , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/metabolismo , Neuropatias Diabéticas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/etiologia , Osteoporose/metabolismo , Fatores de Risco , Adulto Jovem
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