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1.
Diabetes Res Clin Pract ; 152: 103-110, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31108137

RESUMO

AIMS: Several insulin secretagogues are widely used to treat diabetes; however, few outcome-based comparative studies have clarified which one of these should be used when indicated. We investigated mortality and cardiovascular event risk associated with optimal forms of insulin secretagogues. METHODS: In this cohort study using real-world data from the diabetes database of Taiwan's National Health Insurance program, patients with diabetes were enrolled if their initial treatment was glimepiride, gliclazide, glipizide, glyburide, or repaglinide from 1999 to 2013. Each group was propensity score-matched to the glimepiride group before comparison. Primary outcomes were all-cause mortality and the combined cardiovascular event risk of acute myocardial infarction and ischemic stroke. Hazard ratios were calculated by Cox proportional hazard regression models. RESULTS: There were 66,790, 97,426, 38,806, 92,970, and 11,468 participants in the glimepiride, gliclazide, glipizide, glyburide, and repaglinide groups, respectively. The median follow-up time was 8 years. Glimepiride was associated with the best clinical outcome, showing the lowest mortality and lowest cardiovascular event risk of the five insulin secretagogues. Using patients on glimepiride as the reference group, the adjusted hazard ratios of all-cause mortality and cardiovascular event risk were 1.52 (p < 0.001) and 1.22 (p = 0.005) for gliclazide, 1.42 (p < 0.001) and 1.19 (p = 0.073) for glipizide, 1.43 (p < 0.001) and 1.32 (p < 0.001) for glyburide, and 1.88 (p < 0.001) and 1.69 (p = 0.001) for repaglinide. CONCLUSIONS: For patients with diabetes taking an insulin secretagogue, glimepiride was associated with the best clinical outcome, showing the lowest mortality and cardiovascular event risk.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/mortalidade , Hipoglicemiantes/uso terapêutico , Secreção de Insulina/efeitos dos fármacos , Secretagogos/uso terapêutico , Idoso , Carbamatos/uso terapêutico , Doenças Cardiovasculares/induzido quimicamente , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/induzido quimicamente , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/mortalidade , Feminino , Seguimentos , Gliclazida/uso terapêutico , Glipizida/uso terapêutico , Glibureto/uso terapêutico , Humanos , Hipoglicemiantes/farmacologia , Insulina/metabolismo , Masculino , Pessoa de Meia-Idade , Mortalidade , Piperidinas/uso terapêutico , Secretagogos/farmacologia , Compostos de Sulfonilureia/uso terapêutico , Taiwan/epidemiologia
2.
Acta Diabetol ; 56(9): 1051-1060, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30993527

RESUMO

AIMS: Patients with type 2 diabetes (T2D) have an increased risk of cardiovascular disease. Recent cardiovascular outcome trials (CVOTs) with liraglutide, semaglutide, and albiglutide have shown significant reduction in major adverse cardiovascular events. Conversely, the CVOT with exenatide long-acting release (ELAR) confirmed cardiovascular safety of the drug, but did not reached superiority versus placebo. Herein, we systematically evaluated the effect of ELAR versus placebo or active comparators on cardiovascular events and mortality in patients with T2D. METHODS: We screened the literature for randomized controlled trials reporting cardiovascular events and deaths in patients receiving ELAR versus those receiving placebo or any other glucose-lowering medications. Event rates were pooled and compared using the random-effects model. RESULT: We retrieved 16 trials comparing the occurrence of cardiovascular events and mortality in patients treated with ELAR versus placebo or active comparators. The pooled rate ratio for cardiovascular events was similar in the two groups (0.99; 95% CI 0.92-1.06). The rate ratio for all-cause mortality was significantly lower in exenatide group than in comparators (0.87; 95% CI 0.77-0.97). When results of the EXSCEL trial were omitted, the pooled rate ratio for cardiovascular events and mortality was 0.80 (95% CI 0.40-1.63) and 0.75 (95% CI 0.30-1.84), respectively. CONCLUSIONS: Treatment with ELAR does not increase the risk of cardiovascular events and may reduce all-cause mortality.


Assuntos
Preparações de Ação Retardada/farmacologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Exenatida/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Sistema Cardiovascular/efeitos dos fármacos , Causas de Morte , Preparações de Ação Retardada/administração & dosagem , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/tratamento farmacológico , Angiopatias Diabéticas/mortalidade , Exenatida/administração & dosagem , Feminino , Peptídeos Semelhantes ao Glucagon/uso terapêutico , Humanos , Incidência , Liraglutida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mortalidade
3.
Biomed Res Int ; 2019: 2941861, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931324

RESUMO

Objective: The purpose of the meta-analysis was to evaluate the relationship between serum asymmetric dimethylarginine (ADMA) level and microvascular complications in diabetes mellitus (DM) including diabetic retinopathy (DR), diabetic neuropathy (DN), and diabetic nephropathy. Methods: Studies were comprehensively identified by searching Web of Science, Embase, and PubMed databases up to August 30, 2018. The meta-analysis was carried out to compare the difference of serum ADMA concentrations of DR, DN, and diabetic nephropathy patients with healthy controls. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality were applied to assess the methodological quality. Chi-squared Q test and I2 statistics were applied to evaluate statistical heterogeneity. Subgroup analyses were conducted and publication bias was assessed by Egger's test. Result: Ten studies were finally entered in the meta-analysis. Statistically significant heterogeneity was observed across these studies (I 2 = 77.0%, p < 0.001). Compared with DM without microvascular complications, circulating level of ADMA was significantly higher in DM with microvascular complications (all p < 0.05). Sensitivity analysis suggested that the results of this meta-analysis were shown to be stable. There was no significant publication bias (P=0.823). Conclusion: Elevated ADMA levels correlate with diabetic microangiopathies such as DR and diabetic nephropathy. ADMA may play an important role in the pathobiology of microvascular complications of diabetes.


Assuntos
Arginina/análogos & derivados , Diabetes Mellitus/sangue , Angiopatias Diabéticas/sangue , Nefropatias Diabéticas/sangue , Arginina/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/patologia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/patologia , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/patologia , Retinopatia Diabética/sangue , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/patologia , Feminino , Humanos , Masculino , Fatores de Risco
4.
Cardiovasc Diabetol ; 18(1): 26, 2019 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-30851727

RESUMO

AIMS: The prevalence of asymptomatic coronary artery disease (CAD) in type 2 diabetes (T2D) is unclear. We investigated the extent and prevalence of asymptomatic CAD in T2D patients by utilizing invasive coronary angiography (ICA) and intravascular ultrasound (IVUS), and whether CAD progression, evaluated by ICA, could be modulated with a multi-intervention to reduce cardiovascular (CV) risk. METHODS: Fifty-six T2D patients with ≥ 1 additional CV risk factor participated in a 2 year randomized controlled study comparing hospital-based multi-intervention (multi, n = 30) versus standard care (stand, n = 26), with a pre-planned follow-up at year seven. They underwent ICA at baseline and both ICA and IVUS at year seven. ICA was described by conventional CAD severity and extent scores. IVUS was described by maximal intimal thickness (MIT), percent and total atheroma volume and compared with individuals without T2D and CAD (heart transplant donors who had IVUS performed 7-11 weeks post-transplant, n = 147). RESULTS: Despite CV risk reduction in multi after 2 years intervention, there was no between-group difference in the progression of CAD at year seven. Overall, the prevalence of CAD defined by MIT ≥ 0.5 mm in the T2DM subjects was 84%, and as compared to the non-T2DM controls there was a significantly higher atheroma burden (mean MIT, PAV and TAV in the T2D population were 0.75 ± 0.27 mm, 33.8 ± 9.8% and 277.0 ± 137.3 mm3 as compared to 0.41 ± 0.19 mm, 17.8 ± 7.3% and 134.9 ± 100.6 mm3 in the reference population). CONCLUSION: We demonstrated that a 2 year multi-intervention, despite improvement in CV risk factors, did not influence angiographic progression of CAD. Further, IVUS revealed that the prevalence of asymptomatic CAD in T2D patients is high, suggesting a need for a broader residual CV risk management using alternative approaches. Trial registration Clinical trials.gov id: NCT00133718 ( https://clinicaltrials.gov/ct2/show/NCT00133718 ).


Assuntos
Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/prevenção & controle , Diabetes Mellitus Tipo 2/terapia , Angiopatias Diabéticas/diagnóstico por imagem , Angiopatias Diabéticas/prevenção & controle , Ultrassonografia de Intervenção , Idoso , Doenças Assintomáticas , Terapia Combinada , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Diabetes Care ; 42(3): 457-465, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30617142

RESUMO

OBJECTIVE: To estimate the long-term absolute risk for cardiovascular disease (CVD) according to fasting glucose (FG) levels below the threshold of diabetes. RESEARCH DESIGN AND METHODS: We pooled data from seven observational cohorts of U.S. black and white men and women followed from 1960 to 2015. We categorized FG as follows: <5.0, 5.0-5.5, 5.6-6.2, 6.3-6.9 mmol/L, and diabetes (FG ≥7.0 mmol/L or use of diabetes medications). CVD was defined as fatal/nonfatal coronary heart disease and fatal/nonfatal stroke. We estimated the risk of CVD by FG category at index age 55 years using a modified Kaplan-Meier survival analysis, adjusted for the competing risk of non-CVD death. We also assessed risk for incident CVD according to change in FG before 50 years of age, specifically among the categories <5.6 mmol/L, 5.6-6.9 mmol/L, and diabetes. RESULTS: Our sample included 19,630 individuals (6,197 blacks and 11,015 women) without a prior CVD event. Risk for CVD through 85 years of age ranged from 15.3% (<5.0 mmol/L) to 38.6% (diabetes levels) among women and from 21.5% (5.0-5.5 mmol/L) to 47.7% (diabetes levels) among men. An FG of 6.3-6.9 mmol/L was associated with higher long-term CVD risk compared with the lowest FG among men but not women. Increases in glucose during midlife with conversion to diabetes were associated with higher cardiovascular risk (1.3- to 3.6-fold) than increases in glucose below the diabetes threshold. CONCLUSIONS: Middle-age individuals with diabetes have high long-term absolute risk for CVD. These data strongly support the importance of blood glucose monitoring in midlife for CVD prevention.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Diabetes Mellitus/sangue , Angiopatias Diabéticas/sangue , Adulto , Idoso , Glicemia/análise , Automonitorização da Glicemia , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/epidemiologia , Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Diabetes Mellitus/epidemiologia , Angiopatias Diabéticas/classificação , Angiopatias Diabéticas/epidemiologia , Jejum , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia
6.
Diabetes Metab Syndr ; 13(1): 716-720, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641794

RESUMO

AIMS: Non-Caucasian migrants require dedicated approaches in diabetes management due to specific genetic; socio-cultural; demographic and anthropological determinants. Documenting such phenotypes allows for better understanding unmet needs and management priorities. METHODS: This age- and sex-adjusted case-control (1:6 ratio) study compared 56 T2DM Turkish migrants (70% males) resident in Belgium [Tu] with 336 T2DM Caucasians [Ca], all benefiting from state-funded healthcare. RESULTS: The 2 groups did not differ regarding BMI; waist circumference; fat mass; visceral fat; muscle mass; insulin sensitivity; insulinemia; metabolic syndrome; hypertension; lipid-modifying drugs; and macroangiopathy. They also had similar renal function and (micro)albuminuria. Education (low/high) and ethanol consumption were lower among [Tu]: 83/17% and 2.0 U/wk vs 43/57% and 13.6 U/wk in [Ca] (p < 0.0001). ß-cell function loss (BCF) was higher in [Tu]: 1.58(0.45) vs 1.35(0.54)%/yr (p 0.0027), as was HbA1c: 8.39(1.91) vs 7.48(1.35)% in [Ca] (p < 0.0001). Diabetes duration and insulin use were increased in [Tu]: 19(9)yr and 70% vs 16(8)yr and 48% in [Ca] (p 0.0111 and 0.0024). Atherogenic dyslipidemia (AD) was more prevalent in [Tu]: 64% vs 49% (p 0.0309), who had higher non-HDL-C; apolipoprotein B100; LDL-C; and triglycerides; and lower HDL-C and apolipoprotein A-I levels (all p < 0.05). Overall microangiopathy; retinopathy; and neuropathy were more prevalent in [Tu]: 55-35-37% vs 40-18-20% in [Ca] (all p < 0.05). CONCLUSIONS: These results should raise concerns about poor glycaemic control; rapid BCF loss; severe AD; and microangiopathy among Turkish migrants with T2DM. Targeting AD could improve the cardiometabolic profile of this minority given the relationship between AD and residual vascular risk.


Assuntos
Angiopatias Diabéticas/epidemiologia , Dislipidemias/epidemiologia , Células Secretoras de Insulina/fisiologia , Idoso , Glicemia , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Fatores Socioeconômicos , Migrantes , Turquia/epidemiologia , Circunferência da Cintura
7.
Cardiovasc Diabetol ; 18(1): 2, 2019 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-30630491

RESUMO

BACKGROUND: The prognostic importance of carotid atherosclerosis in individuals with diabetes is unsettled. We aimed to evaluate the relationships between parameters of carotid atherosclerosis and the future occurrence of micro- and cardiovascular complications in individuals with type 2 diabetes. METHODS: Ultrasonographic parameters of carotid atherosclerosis, intima-media thickness (CIMT) and plaques, were measured at baseline in 478 participants who were followed-up for a median of 10.8 years. Multivariate Cox analysis was used to examine the associations between carotid parameters and the occurrence of microvascular (retinopathy, renal, and peripheral neuropathy) and cardiovascular complications (total cardiovascular events [CVEs] and cardiovascular mortality), and all-cause mortality. The improvement in risk stratification was assessed by using the C-statistic and the integrated discrimination improvement (IDI) index. RESULTS: During follow-up, 116 individuals had a CVE and 115 individuals died (56 from cardiovascular diseases); 131 newly-developed or worsened diabetic retinopathy, 156 achieved the renal composite outcome (94 newly developed microalbuminuria and 78 deteriorated renal function), and 83 newly-developed or worsened peripheral neuropathy. CIMT, either analysed as a continuous or as a categorical variable, and presence of plaques predicted CVEs occurrence and renal outcomes, but not mortality or other microvascular complications. Individuals with an increased CIMT and plaques had a 1.5- to 1.8-fold increased risk of CVEs and a 1.6-fold higher risk of renal outcome. CIMT and plaques modestly improved cardiovascular risk discrimination over classic risk factors, with IDIs ranging from 7.8 to 8.4%; but more markedly improved renal risk discrimination, with IDIs from 14.8 to 18.5%. CONCLUSIONS: Carotid atherosclerosis parameters predicted cardiovascular and renal outcomes, and improved renal risk stratification. Ultrasonographic carotid imaging may be useful in type 2 diabetes management.


Assuntos
Artérias Carótidas , Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Placa Aterosclerótica , Idoso , Brasil/epidemiologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/mortalidade , Doenças das Artérias Carótidas/patologia , Causas de Morte , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Angiopatias Diabéticas/diagnóstico , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
8.
Diab Vasc Dis Res ; 16(3): 227-235, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30599757

RESUMO

Diabetes mellitus, besides disrupting the carbohydrate metabolism process, also induces vascular disease and impacts nearly all the types and sizes of blood vessels. In fact, vascular complications cause majority of the morbidity, hospitalizations and mortality of patients with diabetes mellitus. Retinopathy, nephropathy and neuropathy (microvascular complications) impact hundreds of millions of diabetics and normally target those having long-term or uncontrolled forms of the disease; however, these disorders can also exist at the time of diagnosis or in those yet to be diagnosed. The Kingdom of Saudi Arabia is the biggest country in the Middle East that occupies around four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people. The prevalence of diabetes mellitus is increasing at an alarming rate in Saudi Arabia. Over 25% of the adult population is suffering and that figure is projected to more than double by 2030. In fact, diabetes mellitus has approximately registered a 10-fold upsurge in the past three decades in Saudi Arabia. However, the prevalence and risk factors of microvascular complications in diabetes mellitus patients have not yet been clearly documented in Saudi Arabia. Hence, in this review, we aim to provide an overview of the microvascular complications among patients with diabetes in Saudi Arabia, utilizing data from the currently available published literature. This is an attempt to facilitate the government and healthcare systems aware of the enormous worth of prevention, early detection and appropriate management of such microvascular complications.


Assuntos
Angiopatias Diabéticas/epidemiologia , Microcirculação , Microvasos/fisiopatologia , Adulto , Idoso , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/fisiopatologia , Angiopatias Diabéticas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores de Risco , Arábia Saudita/epidemiologia
9.
Diabetes Care ; 42(2): 327-330, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30552131

RESUMO

OBJECTIVE: To assess the prevalence of cerebral small-vessel disease (SVD) in subjects with type 1 diabetes compared with healthy control subjects and to characterize the diabetes-related factors associated with SVD. RESEARCH DESIGN AND METHODS: This substudy was cross-sectional in design and included 191 participants with type 1 diabetes and median age 40.0 years (interquartile range 33.0-45.1) and 30 healthy age- and sex-matched control subjects. All participants underwent clinical investigation and brain MRIs, assessed for cerebral SVD. RESULTS: Cerebral SVD was more common in participants with type 1 diabetes than in healthy control subjects: any marker 35% vs. 10% (P = 0.005), cerebral microbleeds (CMBs) 24% vs. 3.3% (P = 0.008), white matter hyperintensities 17% vs. 6.7% (P = 0.182), and lacunes 2.1% vs. 0% (P = 1.000). Presence of CMBs was independently associated with systolic blood pressure (odds ratio 1.03 [95% CI 1.00-1.05], P = 0.035). CONCLUSIONS: Cerebral SVD, CMBs in particular, is more common in young people with type 1 diabetes compared with healthy control subjects.


Assuntos
Doenças de Pequenos Vasos Cerebrais/diagnóstico , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/epidemiologia , Adulto , Pressão Sanguínea , Estudos de Casos e Controles , Doenças de Pequenos Vasos Cerebrais/patologia , Estudos Transversais , Diabetes Mellitus Tipo 1/diagnóstico , Angiopatias Diabéticas/patologia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência
10.
Acta Diabetol ; 55(11): 1143-1150, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30105469

RESUMO

AIMS: Urinary levels of kidney injury molecule 1 (u-KIM-1) and neutrophil gelatinase-associated lipocalin (u-NGAL) reflect proximal tubular pathophysiology and have been proposed as risk markers for development of complications in patients with type 2 diabetes (T2D). We clarify the predictive value of u-KIM-1 and u-NGAL for decline in eGFR, cardiovascular events (CVE) and all-cause mortality in patients with T2D and persistent microalbuminuria without clinical cardiovascular disease. METHODS: This is a prospective study that included 200 patients. u-KIM-1 and u-NGAL were measured at baseline and were available in 192 patients. Endpoints comprised: decline in eGFR > 30%, a composite of fatal and nonfatal CVE consisting of: cardiovascular mortality, myocardial infarction, stroke, ischemic heart disease and heart failure based on national hospital discharge registries, and all-cause mortality. Adjusted Cox models included traditional risk factors, including eGFR. Hazard ratios (HR) are provided per 1 standard deviation (SD) increment of log2-transformed values. Relative integrated discrimination improvement (rIDI) was calculated. RESULTS: During the 6.1 years' follow-up, higher u-KIM-1 was a predictor of eGFR decline (n = 29), CVE (n = 34) and all-cause mortality (n = 29) in adjusted models: HR (95% CI) 1.68 (1.04-2.71), p = 0.034; 2.26 (1.24-4.15), p = 0.008; and 1.52 (1.00-2.31), p = 0.049. u-KIM-1 contributed significantly to risk prediction for all-cause mortality evaluated by rIDI (63.1%, p = 0.001). u-NGAL was not a predictor of any of the outcomes after adjustment. CONCLUSIONS: In patients with T2D and persistent microalbuminuria, u-KIM-1, but not u-NGAL, was an independent risk factor for decline in eGFR, CVE and all-cause mortality, and contributed significant discrimination for all-cause mortality, beyond traditional risk factors.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/urina , Nefropatias Diabéticas/urina , Idoso , Albuminúria/urina , Biomarcadores/sangue , Biomarcadores/urina , Colesterol/sangue , Creatinina/sangue , Creatinina/urina , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/epidemiologia , Feminino , Taxa de Filtração Glomerular , Receptor Celular 1 do Vírus da Hepatite A/análise , Humanos , Lipocalina-2/urina , Masculino , Pessoa de Meia-Idade , Mortalidade
11.
BMC Endocr Disord ; 18(1): 52, 2018 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-30064436

RESUMO

BACKGROUND: Type 2 Diabetes Mellitus is a serious metabolic disease that is often associated with vascular complications. There are 1.9 million people living with Diabetes in Ethiopia; diabetes mellitus is found to be the ninth leading cause of death related to its complications. Although the rate of vascular complications continues to rise, there is limited information about the problem. This study aimed to estimate the incidence and predictors of vascular complications among type 2 diabetes mellitus patients at University of Gondar Referral Hospital. METHODS: Institution based retrospective follow-up study was conducted at University of Gondar Referral Hospital with 341 newly diagnosed type 2 DM patients from September 2005 to March 2017 and the data were collected by reviewing their records. Schoenfeld residuals test and interaction of each covariate with time were used to check proportional hazard assumption. The best model was selected by using Akaike Information Criteria (AIC). Hazards ratio (HR) with its respective 95% confidence interval were reported to show strength of association. RESULT: The selected patients were followed retrospectively for a median follow up time of 81.50 months (Inter quartile range (IQR) = 67.2-103.3). The mean age (± Standard deviation (SD)) of patients at baseline was 51.7(SD: ±11.5 years) and 57.48% were females. The incidence rate of vascular complications was 40.6 cases/ 1000 person years of observation. The significant predictors for vascular complications where found to be male sex (Adjusted hazard ratio (AHR) = 0.50, 95% CI: 0.27, 0.94), having hypertension at baseline(AHR = 3.99, 95% CI: 1.87, 8.56), positive protein urea at base line (AHR = 1.69, 95% CI: 1.03, 2.78), high density lipoprotein cholesterol(HDL-C) level ≥ 40 mg per deciliter (mg/dl) (AHR = 0.43, 95% CI: 0.24, 0.77), low density lipoprotein cholesterol(LDL-C) level > 100 mg/dl (AHR = 3.05, 95% CI: 1.47, 6.35) and triglyceride > 150 mg/dl (AHR = 2.74, 95% CI: 1.28, 5.84). CONCLUSION: The incidence of vascular complications among type 2 diabetes patients remains a significant public health problem. Hypertension at baseline, LDL-C > 100 mg/dl, triglyceride > 150 mg/dl, HDL-C ≥ 40 mg/dl and male sex were significant predictors of vascular complication. In the light of these findings targeted interventions should be given to diabetes patients with hypertension comorbidity and dyslipidemia at follow up clinics.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/etiologia , Etiópia/epidemiologia , Feminino , Seguimentos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária
12.
BMC Endocr Disord ; 18(1): 45, 2018 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-29973163

RESUMO

BACKGROUND: Incidence of dementia is growing rapidly and affects many people worldwide. Type 2 diabetes mellitus (DM) might link cognitive decline and dementia, but the reasons for this association remain unclear. Our study explored the factors associated with type 2 DM in patients with dementia. METHODS: Patients (n = 40,404) with vascular dementia were identified in Taiwan's 1997 to 2008 National Health Insurance Research Database and divided into a DM group and non-DM group. Eleven comorbidities were identified and categorized into four groups: cardiovascular and cerebrovascular diseases, digestive system diseases, renal and metabolic system diseases, and cancer. The associations of these factors with type 2 DM were explored through multivaraible logistic regression. RESULTS: Of the patients with dementia, 22.5% had DM. Associated with a higher likelihood of DM in this population were female sex (adjusted odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.36-1.52), young age (range of adjusted OR: 0.55-1.13), low income (range of adjusted OR: 1.09-1.18), and renal and metabolic system diseases (OR: 2.81, 95% CI: 2.64-2.98). CONCLUSIONS: The findings of this study suggest that clinicians should encourage patients with dementia to receive regular glucose impairment screening if they are female, have low socioeconomic status, or have renal or metabolic diseases.


Assuntos
Demência Vascular/complicações , Demência Vascular/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologia
13.
Diabetes Care ; 41(9): 2010-2018, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30002197

RESUMO

OBJECTIVE: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2. RESEARCH DESIGN AND METHODS: A cohort of people diagnosed with type 2 diabetes between 2004 and 2016 was identified from the Scottish national diabetes register. CVD events were identified using linked hospital and death records. Five-year risk of CVD was estimated using each of QRISK2, ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation), Cardiovascular Health Study (CHS), New Zealand Diabetes Cohort Study (NZ DCS), Fremantle Diabetes Study, and Swedish National Diabetes Register (NDR) risk scores. Discrimination and calibration were assessed using the Harrell C statistic and calibration plots, respectively. RESULTS: The external validation cohort consisted of 181,399 people with type 2 diabetes and no history of CVD. There were 14,081 incident CVD events within 5 years of follow-up. The 5-year observed risk of CVD was 9.7% (95% CI 9.6, 9.9). C statistics varied between 0.66 and 0.67 for all risk scores. QRISK2 overestimated risk, classifying 87% to be at high risk for developing CVD within 5 years; ADVANCE underestimated risk, and the Swedish NDR risk score calibrated well to observed risk. CONCLUSIONS: None of the risk scores performed well among people with newly diagnosed type 2 diabetes. Using these risk scores to predict 5-year CVD risk in this population may not be appropriate.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatias Diabéticas/etiologia , Técnicas de Diagnóstico Endócrino , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Projetos de Pesquisa , Medição de Risco/métodos , Fatores de Risco , Escócia/epidemiologia
14.
Enferm. glob ; 17(51): 238-247, jul. 2018. graf
Artigo em Espanhol | IBECS | ID: ibc-173967

RESUMO

Objetivo: Analizar la asociación entre el número de personas hospitalizadas por la diabetes y el número de personas con amputación de extremidades. Método: Se realizó un estudio ecológico utilizando el sistema de información hospitalaria del Sistema Único de Salud (SIH / SUS) en el periodo 2010-2015 en el estado de Ceará, Brasil. Los datos fueron analizados utilizando el paquete estadístico para Sciences(R) Sociales (SPSS). Se ha aplicado el coeficiente de correlación lineal de Pearson para medir la intensidad de la asociación lineal existente entre las variables. Resultados: Se registraron 27.054 hospitalizaciones por diabetes. Hubo correlación inversa entre el número de admisiones para el tratamiento de la diabetes y la correlación proporcional del número de ingresos para el tratamiento del pie complicado y hospitalización por amputaciones de miembros. Conclusión: Los datos revelan una línea muy fina cuando se trata del cuidado de la salud de las personas con pie diabético


Objetivo: Analisar a associação entre o número de pessoas internadas por diabetes e número de pessoas com amputação de membro. Método: Trata-se de um estudo ecológico utilizando o Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) no período de 2010 a 2015 no estado do Ceará, Brasil. Os dados foram analisados pelo Statistical Package for the Social Sciences(R) (SPSS). Aplicou-se o coeficiente de correlação linear de Pearson para medir a intensidade da associação linear existente entre as variáveis. Resultados: Foram registradas 27.054 internações hospitalares por diabetes. Observou-se correlação inversa entre o número de internações para tratamento do diabetes e correlação proporcional do número internações para tratamento de pé complicado e hospitalização por amputações de membros. Conclusão: Os dados revelam uma linha ténue no que concerne a atenção à saúde da pessoa com pé diabético


Objective: To analyze the association between the number of people hospitalized for diabetes and the number of people with limb amputation. Method: This is an ecological study using the Hospital Information System of the Unified Health System (SIH / SUS) from 2010 to 2015 in the state of Ceará, Brazil. The data were analyzed by the Statistical Package for the Social Sciences (SPSS). Pearson's linear correlation coefficient was applied to measure the intensity of the linear association between the variables. Results: There were 27,054 hospital admissions for diabetes. There was an inverse correlation between the number of admissions for treatment of diabetes and proportional correlation of the number of hospitalizations for complicated foot treatment and hospitalization for limb amputations


Assuntos
Humanos , Diabetes Mellitus/cirurgia , Amputação/estatística & dados numéricos , Pé Diabético/cirurgia , Hospitalização/estatística & dados numéricos , Complicações do Diabetes/epidemiologia , Angiopatias Diabéticas/epidemiologia , Fatores de Risco , Cuidados de Enfermagem/métodos , Estudos Ecológicos
15.
Diabetes Care ; 41(8): 1792-1800, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29903845

RESUMO

OBJECTIVE: In observational cohorts, adiponectin is inversely associated and free fatty acids (FFAs) are directly associated with incident coronary heart disease (CHD). Adiponectin tends to be reduced and FFAs elevated in type 2 diabetes. We investigated relationships of adiponectin and FFA and major adverse cardiovascular events (MACEs) and death in patients with acute coronary syndrome (ACS) and type 2 diabetes using data from the AleCardio (Effect of Aleglitazar on Cardiovascular Outcomes After Acute Coronary Syndrome in Patients With Type 2 Diabetes Mellitus) trial, which compared the PPAR-α/γ agonist aleglitazar with placebo. RESEARCH DESIGN AND METHODS: Using Cox regression adjusted for demographic, laboratory, and treatment variables, we determined associations of baseline adiponectin and FFAs, or the change in adiponectin and FFAs from baseline, with MACEs (cardiovascular death, myocardial infarction, or stroke) and death. RESULTS: A twofold higher baseline adiponectin (n = 6,998) was directly associated with risk of MACEs (hazard ratio [HR] 1.17 [95% CI 1.08-1.27]) and death (HR 1.53 [95% CI 1.35-1.73]). A doubling of adiponectin from baseline to month 3 (n = 6,325) was also associated with risk of death (HR 1.20 [95% CI 1.03-1.41]). Baseline FFAs (n = 7,038), but not change in FFAs from baseline (n = 6,365), were directly associated with greater risk of MACEs and death. There were no interactions with study treatment. CONCLUSIONS: In contrast to prior observational data for incident CHD, adiponectin is prospectively associated with MACEs and death in patients with type 2 diabetes and ACS, and an increase in adiponectin from baseline is directly related to death. These findings raise the possibility that adiponectin has different effects in patients with type 2 diabetes and ACS than in populations without prevalent cardiovascular disease. Consistent with prior data, FFAs are directly associated with adverse outcomes.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Adiponectina/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/tratamento farmacológico , Ácidos Graxos não Esterificados/sangue , Oxazóis/uso terapêutico , Tiofenos/uso terapêutico , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/epidemiologia , Idoso , Doença das Coronárias/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
16.
Diabetes Care ; 41(8): 1783-1791, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29903847

RESUMO

OBJECTIVE: In the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) cardiovascular (CV) outcomes trial (NCT01179048), liraglutide significantly reduced the risk of CV events (by 13%) and hypoglycemia versus placebo. This post hoc analysis examines the associations between hypoglycemia and CV outcomes and death. RESEARCH DESIGN AND METHODS: Patients with type 2 diabetes and high risk for CV disease (n = 9,340) were randomized 1:1 to liraglutide or placebo, both in addition to standard treatment, and followed for 3.5-5 years. The primary end point was time to first major adverse cardiovascular event (MACE) (1,302 first events recorded), and secondary end points included incidence of hypoglycemia. We used Cox regression to analyze time to first MACE, CV death, non-CV death, or all-cause death with hypoglycemia as a factor or time-dependent covariate. RESULTS: A total of 267 patients experienced severe hypoglycemia (liraglutide n = 114, placebo n = 153; rate ratio 0.69; 95% CI 0.51, 0.93). These patients had longer diabetes duration, higher incidence of heart failure and kidney disease, and used insulin more frequently at baseline than those without severe hypoglycemia. In combined analysis (liraglutide and placebo), patients with severe hypoglycemia were more likely to experience MACE, CV death, and all-cause death, with higher risk shortly after hypoglycemia. The impact of liraglutide on risk of MACE was similar in patients with and without severe hypoglycemia (P-interaction = 0.90). CONCLUSIONS: Patients experiencing severe hypoglycemia were at greater risk of CV events and death, particularly shortly after the hypoglycemic episode. While causality remains unclear, reducing hypoglycemia remains an important goal in diabetes management.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/prevenção & controle , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Liraglutida/uso terapêutico , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Hipoglicemia/epidemiologia , Incidência , Nefropatias/complicações , Nefropatias/epidemiologia , Liraglutida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Resultado do Tratamento
17.
Diab Vasc Dis Res ; 15(5): 424-432, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29911415

RESUMO

AIMS: In type 2 diabetes, we aimed at clarifying the role of glycated haemoglobin variability and other risk factors in the development of the main micro-vascular complications: peripheral neuropathy, nephropathy and retinopathy. METHODS: In a single-centre cohort of 900 patients, glycated haemoglobin variability was evaluated as intra-individual standard deviation, adjusted standard deviation and coefficient of variation of serially measured glycated haemoglobin in the 2-year period before a randomly selected index visit. We devised four models considering different aspects of glycated haemoglobin evolution. Multivariate stepwise logistic regression analysis was performed including the following covariates at the index visit: age, disease duration, body mass index, total cholesterol, high-density lipoprotein cholesterol, triglycerides, sex, smoking habit, hypertension, dyslipidemia, treatment with anti-diabetic drugs, occurrence of macro-vascular events and the presence of another micro-vascular complication. RESULTS: Males with high mean glycated haemoglobin, long duration of diabetes, presence of macro-vascular events and retinopathy emerged at higher risk for peripheral neuropathy. Development of nephropathy was independently associated with higher glycated haemoglobin variability, older age, male sex, current smoking status, presence of retinopathy, of peripheral neuropathy and of hypertension. Higher mean glycated haemoglobin, younger age, longer duration of diabetes, reduced estimated glomerular filtration rate and the presence of peripheral neuropathy were significantly associated with increased incidence of retinopathy. CONCLUSION: Glycated haemoglobin variability was associated with increased incidence of nephropathy, while mean glycated haemoglobin emerged as independent risk factor for the development of retinopathy and peripheral neuropathy. The presence of macro-vascular events was positively correlated with peripheral neuropathy. Finally, the occurrence of another micro-vascular complication was found to be a stronger risk factor for developing another micro-vascular complication than the mean or variability of glycated haemoglobin.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/epidemiologia , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/diagnóstico , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/diagnóstico , Retinopatia Diabética/epidemiologia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Incidência , Itália/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
18.
Diabetes Care ; 41(9): 1854-1861, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29945936

RESUMO

OBJECTIVE: Diabetes distress among patients from ethnic minorities is still poorly understood. We investigated the association between ethnicity and diabetes distress among ethnic minority groups of people with type 2 diabetes in the Netherlands, focusing on the possible effects of glycemic control, lifestyle factors, cardiovascular risk factors, and diabetes complications. RESEARCH DESIGN AND METHODS: Cross-sectional data from the Dutch Diabetes Pearl cohort included people with type 2 diabetes from primary, secondary, and tertiary diabetes care programs. We used the 20-item Problem Areas in Diabetes Survey (PAID) scale to assess diabetes distress; a score ≥40 is considered to represent high distress. Ethnicity was estimated on the basis of country of birth. Sociodemographic and lifestyle data were self-reported; cardiovascular and metabolic data were retrieved from medical charts. Logistic regression analysis determined the association between ethnicity and diabetes distress, with Caucasians as the reference group. RESULTS: Diabetes distress scores and ethnicity were available for 4,191 people with type 2 diabetes: 3,684 were Caucasian, 83 were Asian, 51 were Moroccan, 92 were African, 134 were Latin American, 46 were Turkish, and 101 were Hindustani-Surinamese. Overall, participants in minority groups had worse health outcomes than those of Caucasian descent, and diabetes distress was more prevalent (ranging from 9.6 to 31.7%, compared with 5.8% among Caucasians), even after adjusting for age, sex, education level, alcohol use, smoking, BMI, lipid profile, HbA1c, medication use, and the presence of diabetes complications. CONCLUSIONS: Among people with type 2 diabetes in the Netherlands, ethnicity is independently associated with high diabetes distress. Further research is warranted to explain the higher prevalence of diabetes distress in minority groups and to develop effective interventions.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/psicologia , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/psicologia , Estilo de Vida , Grupos Minoritários/estatística & dados numéricos , Estresse Psicológico/etnologia , Adulto , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/etnologia , Angiopatias Diabéticas/psicologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Estresse Psicológico/epidemiologia , Inquéritos e Questionários
19.
Diabetes Care ; 41(8): 1749-1756, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29871904

RESUMO

OBJECTIVE: Patients with type 1 diabetes now live long enough to experience cognitive decline. During middle age, they show mild cognitive deficits, but it is unknown whether severity increases with aging or whether cognitive profiles are similar to those of age-matched peers with and without diabetes. RESEARCH DESIGN AND METHODS: We tested and compared cognition in 82 individuals with 50 or more years of type 1 diabetes (Medalists), 31 age-matched individuals with type 2 diabetes, and 30 age-matched control subjects without diabetes. Medical histories and biospecimens were collected. We also evaluated the association of complications with cognition in Medalists only. RESULTS: Compared with control subjects, both individuals with type 1 diabetes and individuals with type 2 diabetes performed worse on immediate and delayed recall (P ≤ 0.002) and psychomotor speed in both hands (P ≤ 0.01) and showed a trend toward worse executive function (P = 0.05). In Medalists, cardiovascular disease was associated with decreased executive function and proliferative diabetic retinopathy with slower psychomotor speed. CONCLUSIONS: Both patients with type 1 and patients with type 2 diabetes showed overall worse cognition than control subjects. Further, in Medalists, a relationship between complications and cognition was seen. Although both groups with diabetes showed similar deficit patterns, the underlying mechanisms may be different. Now that patients with type 1 diabetes are living longer, efforts should be made to evaluate cognition and to identify modifying behaviors to slow decline.


Assuntos
Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/psicologia , Estudos de Casos e Controles , Criança , Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/psicologia , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
20.
Acta Diabetol ; 55(9): 975-979, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29808390

RESUMO

AIM: Cardio-metabolic disease and physical activity are closely related but large-scale objective studies which measure physical activity are lacking. Using the largest accelerometer cohort to date, we aimed to investigate whether there is an association between disease status and accelerometer variables after a 5-year follow-up. METHODS: 106,053 UK Biobank participants wore a wrist-worn GENEactiv monitor. Those with acceptable wear time (> 3 days) were split into 4 cardio-metabolic disease groups based on self-report disease status which was collected 5 ± 1 years prior. Multiple linear regression models were used to investigate associations, controlling for confounders and stratified for gender. RESULTS: Average daily acceleration was lower in men ('healthy'-42 ± 15 mg v 'Type 2 diabetes + cardiovascular disease (CVD)'-31 ± 12 mg) and women ('healthy'-44 ± 13 mg v 'Type 2 diabetes + CVD'-31 ± 11 mg) with cardio-metabolic disease and this was consistent across both week and weekend days. Men and women with the worst cardio-metabolic disease perform around half of moderate to vigorous physical activity on a daily basis compared to healthy individuals, and spend almost 7 h per day in 30 min inactivity bouts. Significant associations were seen between cardio-metabolic disease and accelerometer variables 5 years on when controlling for confounders. CONCLUSION: In the largest accelerometer cohort to date, there are significant associations between cardio-metabolic disease and physical activity variables after 5 years of follow-up. Triaxial accelerometers provide enhanced measurement opportunities for measuring lifestyle behaviours in chronic disease.


Assuntos
Acelerometria , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Exercício/fisiologia , Acelerometria/métodos , Adulto , Idoso , Bancos de Espécimes Biológicos , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Autorrelato , Reino Unido/epidemiologia
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