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1.
Eur J Endocrinol ; 181(5): 461-472, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31480014

RESUMO

Objective: Patients with Cushing's syndrome (CS) have increased mortality. The aim of this study was to evaluate the causes and time of death in a large cohort of patients with CS and to establish factors associated with increased mortality. Methods: In this cohort study, we analyzed 1564 patients included in the European Registry on CS (ERCUSYN); 1045 (67%) had pituitary-dependent CS, 385 (25%) adrenal-dependent CS, 89 (5%) had an ectopic source and 45 (3%) other causes. The median (IQR) overall follow-up time in ERCUSYN was 2.7 (1.2-5.5) years. Results: Forty-nine patients had died at the time of the analysis; 23 (47%) with pituitary-dependent CS, 6 (12%) with adrenal-dependent CS, 18 (37%) with ectopic CS and two (4%) with CS due to other causes. Of 42 patients whose cause of death was known, 15 (36%) died due to progression of the underlying disease, 13 (31%) due to infections, 7 (17%) due to cardiovascular or cerebrovascular disease and 2 due to pulmonary embolism. The commonest cause of death in patients with pituitary-dependent CS and adrenal-dependent CS were infectious diseases (n = 8) and progression of the underlying tumor (n = 10) in patients with ectopic CS. Patients who had died were older and more often males, and had more frequently muscle weakness, diabetes mellitus and ectopic CS, compared to survivors. Of 49 deceased patients, 22 (45%) died within 90 days from start of treatment and 5 (10%) before any treatment was given. The commonest cause of deaths in these 27 patients were infections (n = 10; 37%). In a regression analysis, age, ectopic CS and active disease were independently associated with overall death before and within 90 days from the start of treatment. Conclusion: Mortality rate was highest in patients with ectopic CS. Infectious diseases were the commonest cause of death soon after diagnosis, emphasizing the need for careful clinical vigilance at that time, especially in patients presenting with concomitant diabetes mellitus.


Assuntos
Síndrome de Cushing/mortalidade , Doenças das Glândulas Suprarrenais/etiologia , Doenças das Glândulas Suprarrenais/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Comorbidade , Síndrome de Cushing/complicações , Complicações do Diabetes/mortalidade , Europa (Continente)/epidemiologia , Feminino , França/epidemiologia , Humanos , /mortalidade , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/etiologia , Doenças da Hipófise/mortalidade , Sistema de Registros , Fatores Sexuais , Adulto Jovem
2.
J Microbiol Immunol Infect ; 52(4): 654-662, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31446929

RESUMO

BACKGROUND/PURPOSE: Diabetes is associated with increased mortality in Acinetobacter baumannii (AB) complex infection. This study investigated the risk factors and relationship of diabetic status and glycemic indices to mortality in patients with carbapenem-resistant (CR) AB complex bacteremia. METHODS: Relationship of glycemic indices to mortality were compared in adult diabetes (DM) and nondiabetes (non-DM) patients with CRAB complex bacteremia hospitalized from January 2010 to December 2015 in MacKay Memorial Hospital, Taiwan. RESULTS: Of 317 patients with CRAB complex bacteremia, 146 (46.06%) had diabetes. DM patients were elderly (mean age of 69.23 years) and the mortality rate was higher (64.38% vs. 52.05%, p = 0.036) than in non-DM patients. By multivariate analysis, septic shock was associated with increased mortality in DM patients. Hypoglycemia was associated with increased mortality in non-DM patients only (100% vs. 50.33%, p = 0.006). The lowest mortality was for the blood glucose range 70-100 mg/dL in non-DM patients (43.24%) and 100-140 mg/dL for DM patients (56.52%). Increased glycemic variability (coefficient of variation (CV) > 40% compared to < 20%) was associated with increased mortality in non-DM patients (86.36% vs. 47.12%, p = 0.003). CONCLUSION: Effects of dysglycemia on mortality due to CRAB complex bacteremia differ according to diabetic status. Mortality was higher in DM patients. In non-DM patients, hypoglycemia and increased CV were associated with increased mortality. The lowest mortality was for the blood glucose range 70-100 mg/dL in non-DM patients and 100-140 mg/dL for DM patients.


Assuntos
Infecções por Acinetobacter/mortalidade , Bacteriemia/mortalidade , Glicemia/análise , Carbapenêmicos/farmacologia , Complicações do Diabetes/microbiologia , Complicações do Diabetes/mortalidade , Farmacorresistência Bacteriana , Infecções por Acinetobacter/sangue , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Bacteriemia/sangue , Bacteriemia/microbiologia , Complicações do Diabetes/sangue , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
3.
Saudi J Kidney Dis Transpl ; 30(3): 706-709, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249237

RESUMO

Diabetes mellitus (DM) is a common disease in Oman as in rest of Gulf Cooperation Council where metabolic syndrome is of high prevalence. DM is a foremost risk factor for urinary tract infections (UTIs). It is also linked to more complicated infections such as emphysematous pyelonephritis (EPN), emphysematous pyelitis (EP), renal/perirenal abscess, emphysematous cystitis, xanthogranulomatous pyelonephritis, and renal papillary necrosis. The diagnosis of these cases is frequently delayed because the clinical manifestations are generic and not different from the typical triad of upper UTI, which include fever, flank pain, and pyuria. A middle-aged female with DM and chronic kidney disease stage IV was admitted with recurrent UTI with extended-spectrum beta-lactamase-producing Escherichia coli. At presentation, she was afebrile, clinically stable, had no flank pain and there was no leukocytosis. Laboratory test for C- reactive protein done twice and was only mildly elevated at 7 and 11 mg/dL. A computed tomography scan of kidney-ureter-bladder (CT-KUB) was recommended and reported as "no KUB stone but small atrophic left kidney with dilatation of the pelvicalycial system and ureter and the presence of air in the collecting system suggestive of EP." Thus, commonly associated with DM, especially in females, debilitated immune-deficient individuals, and patients harboring obstructed urinary system with infective nidus. Air in the kidney is not always due to EPN. UTI with a gas-producing organism can ascend to the kidney in the presence of vesicoureteral reflux.


Assuntos
Complicações do Diabetes/mortalidade , Enfisema/microbiologia , Infecções por Escherichia coli/microbiologia , Pielite/microbiologia , Infecções Urinárias/microbiologia , Refluxo Vesicoureteral/complicações , Doenças Assintomáticas , Complicações do Diabetes/diagnóstico , Enfisema/diagnóstico por imagem , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Pielite/diagnóstico por imagem , Recidiva , Fatores de Risco , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Refluxo Vesicoureteral/diagnóstico
4.
Stroke ; 50(6): 1497-1503, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31035901

RESUMO

Background and Purpose- Acute ischemic stroke patients with history of prior ischemic stroke plus concomitant diabetes mellitus (DM) were excluded from the ECASS III trial (European Cooperative Acute Stroke Study) because of safety concerns. However, there are few data on use of intravenous tissue-type plasminogen activator and symptomatic intracerebral hemorrhage or outcomes in this population. Methods- Using data from the Get With The Guidelines-Stroke Registry between February 2009 and September 2017 (n=1619 hospitals), we examined characteristics and outcomes among patients with acute ischemic stroke treated with tissue-type plasminogen activator within the 3- to 4.5-hour window who had a history of stroke plus diabetes mellitus (HxS+DM) (n=2129) versus those without either history (n=16 690). Results- Compared with patients without either history, those with both prior stroke and DM treated with tissue-type plasminogen activator after an acute ischemic stroke had a higher prevalence of cardiovascular risk factors in addition to history of stroke, DM, and more severe stroke (National Institutes of Health Stroke Scale: median, 8 [interquartile range, 5-15] versus 7 [4-13]). The unadjusted rates of symptomatic intracerebral hemorrhage and in-hospital mortality were 4.3% (HxS+DM) versus 3.8% (without either history; P=0.31) and 6.2% versus 5.5% ( P=0.20), respectively. These differences were not statistically significant after risk adjustment (symptomatic intracerebral hemorrhage: adjusted odds ratio, 0.79 [95% CI, 0.51-1.21]; P=0.28; in-hospital mortality: odds ratio, 0.77 [95% CI, 0.52-1.14]; P=0.19). Unadjusted rate of functional independence (modified Rankin Scale score, 0-2) at discharge was lower in those with HxS+DM (30.9% HxS+DM versus 44.8% without either history; P≤0.0001), and this difference persisted after adjusting for baseline clinical factors (adjusted odds ratio, 0.76 [95% CI, 0.59-0.99]; P=0.04). Conclusions- Among patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator within the 3- to 4.5-hour window, HxS+DM was not associated with statistically significant increased symptomatic intracerebral hemorrhage or mortality risk.


Assuntos
Isquemia Encefálica , Complicações do Diabetes , Mortalidade Hospitalar , Acidente Vascular Cerebral , Ativador de Plasminogênio Tecidual/administração & dosagem , Doença Aguda , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/mortalidade , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/mortalidade , Intervalo Livre de Doença , Humanos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/mortalidade , Taxa de Sobrevida , Fatores de Tempo , Ativador de Plasminogênio Tecidual/efeitos adversos
5.
PLoS One ; 14(4): e0215392, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30995272

RESUMO

BACKGROUND: Although most countries face increasing population levels of obesity and diabetes their effect on coronary heart disease (CHD) mortality has not been often studied in small island developing states (SIDs) where obesity rates are among the highest in the world. We estimated the relative contributions of treatments and cardiovascular risk factors to the decline in CHD mortality from 1990 to 2012 in the Caribbean island, Barbados. METHODS: We used the IMPACT CHD mortality model to estimate the effect of increased coverage of effective medical/surgical treatments and changes in major CHD risk factors on mortality trends in 2012 compared with 1990. We calculated deaths prevented or postponed (DPPs) for each model risk factor and treatment group. We obtained data from WHO Mortality database, population denominators from the Barbados Statistical Service stratified by 10-year age group (ages 25-34 up to 85 plus), population-based risk factor surveys, Global Burden of Disease and Barbados' national myocardial infarction registry. Monte Carlo probabilistic sensitivity analysis was performed. RESULTS: In 1990 the age-standardized CHD mortality rate was 109.5 per 100,000 falling to 55.3 in 2012. Implementation of effective treatment accounted for 56% DPPs (95% (Uncertainty Interval (UI) 46%, 68%), mostly due to the introduction of treatments immediately after acute myocardial infarction (AMI) (14%) and unstable angina (14%). Overall, risk factors contributed 19% DPPs (95% UI 6% to 34%) mostly attributed to decline in cholesterol (18% DPPs, 95% UI 12%, 26%). Adverse trends in diabetes: 14% additional deaths(ADs) 95% UI 8% to 21% ADs) and BMI (2% ADs 95%UI 0 to 5% ADs) limited potential for risk factor gains. CONCLUSIONS: Given the significant negative impact of obesity/diabetes on mortality in this analysis, research that explores factors affecting implementation of evidenced-based preventive strategies is needed. The fact that most of the decline in CHD mortality in Barbados was due to treatment provides an example for SIDs about the advantages of universal access to care and treatment.


Assuntos
Doença das Coronárias/mortalidade , Complicações do Diabetes/mortalidade , Modelos Cardiovasculares , Obesidade/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Barbados/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
7.
Acta Diabetol ; 56(7): 767-776, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30945048

RESUMO

AIMS: To investigate risk factors for, and the influence of premature mortality on, dementia complicating type 2 diabetes. METHODS: Participants with type 2 diabetes in the community-based observational Fremantle Diabetes Study Phase 1 (n = 1291, mean age 64.0 years) were followed from 1993 to 1996 to end-June 2012. Incident dementia was identified from validated health databases. Dementia risk was assessed using Cox proportional hazards modelling supplemented by competing risk regression modelling in the total cohort and sub-groups defined by age of diabetes onset as mid-life (< 65 years) or late-life (≥ 65 years). RESULTS: During mean ± SD follow-up of 12.7 ± 5.9 years, 717 participants (55.5%) died and 180 (13.9%) developed dementia. Overall, few risk factors predicted incident dementia and most predicted time to death. In mid-life diabetes, incident dementia was predicted by diabetes duration, cerebrovascular disease, schizophrenia, antipsychotic medication and the APOE ε4 allele. In late-life diabetes, risk factors were peripheral neuropathy, lack of exercise, lower fasting serum glucose, no antihypertensive therapy and the APOE ε4 allele. Competing risk analysis showed age to be a positive predictor compared with the inverse association in Cox models that suggested survivor bias in an older community-based cohort. CONCLUSIONS: Dementia in type 2 diabetes is multifactorial. An association with diabetes duration, independent of most possible confounders, suggests that one or more unmeasured processes specific to diabetes may be implicated in the pathogenesis. The risk factors for dementia were also associated with an increased risk of death. This suggests that recently reported improvements in mortality in type 2 diabetes may be accompanied by reductions in dementia incidence.


Assuntos
Demência/complicações , Demência/mortalidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Demência/epidemiologia , Complicações do Diabetes/mortalidade , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mortalidade , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/mortalidade , Fatores de Risco , Austrália Ocidental/epidemiologia
8.
Medicine (Baltimore) ; 98(13): e15095, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921244

RESUMO

BACKGROUND: The role of pre-existing diabetes in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is still controversial. This systematic review and meta-analysis of observational studies aimed to evaluate the effect of diabetes on the risk and mortality of ALI/ARDS. METHODS: A comprehensive literature search was performed in PubMed, Scopus, Cochrane Central Register of Controlled Trails and Web of Science for their inception to September 2018. Summary risk estimates were calculated with a DerSimonian and Laird random-effects model. Heterogeneity was evaluated using Cochran chi-square test and the I statistic. RESULTS: Ultimately, 14 studies with a total of 6613 ALI/ARDS cases were included. The risk of ALI/ARDS was not significantly reduced in diabetes patients (OR 0.82, 95% CI 0.57-1.18, P = .283), with obvious heterogeneity across studies (I = 72.5%, P < .001). Further analyses in the meta-analysis also showed no statistically significant associations between pre-existing diabetes and in-hospital mortality (OR 0.79, 95% CI 0.51-1.21, P = .282) or 60-day mortality of ALI/ARDS (OR 0.91, 95% CI 0.75-1.11, P = .352). CONCLUSION: This systematic review and meta-analysis of observational studies indicates that pre-existing diabetes have no effect on the risk and mortality of ALI/ARDS.


Assuntos
Lesão Pulmonar Aguda/mortalidade , Complicações do Diabetes/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Lesão Pulmonar Aguda/etiologia , Complicações do Diabetes/etiologia , Mortalidade Hospitalar , Humanos , Estudos Observacionais como Assunto , Síndrome do Desconforto Respiratório do Adulto/etiologia , Fatores de Risco
9.
PLoS One ; 14(1): e0211070, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703129

RESUMO

People who develop type 2 diabetes (T2D) are known to have a higher mortality risk. We estimated all-cause, cardiovascular, and cancer mortality-risks in our patient cohort according to categories of impaired glucose metabolism. This 18-year retrospective analysis included a region-wide, representative sample of a population aged 30-75 years. Age- and sex-stratified hazard ratios (HRs) were calculated for 48 participants with diagnosed T2D, 83 with undiagnosed T2D (HbA1c ≥6.5%, fasting glycemia ≥126 mg/dL, or glycemia after 75 g glucose load ≥200 mg/dL); 296 with prediabetes (HbA1c 5.7%-6.4%, fasting glycemia 100-125 mg/dL, or glycemia after 75 g glucose load 140-199 mg/dL), and 607 with normoglycemia. Over 18,612 person-years, 32 individuals with undiagnosed T2D, 30 with diagnosed T2D, 62 with prediabetes, and 80 with normoglycemia died. Total sample crude mortality rate (MR) was 10.96 deaths per 1,000 person-years of follow-up. MR of the diagnosed T2D group was more than 3-times higher and that of newly diagnosed T2D was 2-times higher (34.72 and 21.42, respectively) than total sample MR. Adjusted HR for all-cause mortality was 2.02 (95% confidence interval 1.29-3.16) and 1.57 (95% CI 1.00-2.28) in the diagnosed T2D group and the newly diagnosed T2D group, respectively. Adjusted HR for cardiovascular mortality in the T2D group was 2.79 (95% CI 1.35-5.75); this risk was greatly increased in women with T2D: 6.72 (95% CI 2.50-18.07). In Asturias, age- and sex-standardized all-cause mortality is more than 2-times higher for adults with T2D than for adults without T2D. The HR for cardiovascular mortality is considerably higher in T2D women than in normoglycemic women.


Assuntos
Doenças Cardiovasculares/mortalidade , Complicações do Diabetes/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Estado Pré-Diabético/mortalidade , Adulto , Fatores Etários , Idoso , Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Complicações do Diabetes/sangue , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida
10.
Rev Assoc Med Bras (1992) ; 65(1): 56-60, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30758421

RESUMO

Diabetes is one of the most common chronic pathologies around the world, involving treatment with general clinicians, endocrinologists, cardiologists, ophthalmologists, nephrologists and a multidisciplinary team. Patients with type 2 Diabetes Mellitus (T2DM) can be affected by cardiac autonomic neuropathy, leading to increased mortality and morbidity. In this review, we will present current concepts, clinical features, diagnosis, prognosis, and possible treatment. New drugs recently developed to reduce glycemic level presented a pleiotropic effect of reducing sudden death, suggesting a potential use in patients at risk.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Neuropatias Diabéticas/diagnóstico , Cardiopatias/diagnóstico , Doenças do Sistema Nervoso Autônomo/mortalidade , Doenças do Sistema Nervoso Autônomo/terapia , Morte Súbita , Complicações do Diabetes/mortalidade , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/terapia , Neuropatias Diabéticas/mortalidade , Neuropatias Diabéticas/terapia , Cardiopatias/mortalidade , Cardiopatias/terapia , Humanos , Prognóstico , Fatores de Risco
11.
Circ Res ; 124(6): 920-929, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30776978

RESUMO

RATIONALE: The evidence regarding the potential health benefits of nut consumption among individuals with type 2 diabetes mellitus is limited. OBJECTIVE: To examine intake of total and specific types of nuts, including tree nuts and peanuts, in relation to subsequent risk of cardiovascular disease (CVD), including coronary heart disease and stroke, and all-cause and cause-specific mortality among individuals with diabetes mellitus. METHODS AND RESULTS: This prospective analysis included 16 217 men and women with diabetes mellitus at baseline or diagnosed during follow-up (Nurses' Health Study: 1980-2014, Health Professionals Follow-Up Study: 1986-2014). Nut consumption was assessed using a validated food frequency questionnaire and updated every 2 to 4 years. During 223 682 and 254 923 person-years of follow-up, there were 3336 incident CVD cases and 5682 deaths, respectively. Higher total nut consumption was associated with a lower risk of CVD incidence and mortality. The multivariate-adjusted hazard ratios (95% CIs) for participants who consumed 5 or more servings of total nuts per week (1 serving=28 g), compared with those who consumed <1 serving per month, were 0.83 (0.71-0.98; P trend=0.01) for total CVD incidence, 0.80 (0.67-0.96; P trend=0.005) for coronary heart disease incidence, 0.66 (0.52-0.84; P trend <0.001) for CVD mortality, and 0.69 (0.61-0.77; P trend <0.001) for all-cause mortality. Total nut consumption was not significantly associated with risk of stroke incidence or cancer mortality. For specific types of nuts, higher tree nut consumption was associated with lower risk of total CVD, coronary heart disease incidence, and mortality because of CVD, cancer, and all causes, whereas peanut consumption was associated with lower all-cause mortality only (all P trend <0.001). In addition, compared with participants who did not change the consumption of total nuts from pre- to post-diabetes mellitus diagnosis, participants who increased consumption of total nuts after diabetes mellitus diagnosis had an 11% lower risk of CVD, a 15% lower coronary heart disease risk, a 25% lower CVD mortality, and a 27% lower all-cause mortality. The associations persisted in subgroup analyses stratified by sex/cohort, body mass index at diabetes mellitus diagnosis, smoking status, diabetes mellitus duration, nut consumption before diabetes mellitus diagnosis, or diet quality. CONCLUSIONS: Higher consumption of nuts, especially tree nuts, is associated with lower CVD incidence and mortality among participants with diabetes mellitus. These data provide novel evidence that supports the recommendation of incorporating nuts into healthy dietary patterns for the prevention of CVD complications and premature deaths among individuals with diabetes mellitus.


Assuntos
Doenças Cardiovasculares/epidemiologia , Complicações do Diabetes/epidemiologia , Nozes , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Doença das Coronárias/epidemiologia , Doença das Coronárias/mortalidade , Complicações do Diabetes/mortalidade , Dieta , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/mortalidade , Estudos Prospectivos
12.
Diabetes Res Clin Pract ; 148: 200-211, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30664892

RESUMO

Diabetes is one of the most frequent diseases throughout the world and its incidence is predicted to exponentially progress in the future. This metabolic disorder is associated with major complications such as neuropathy, retinopathy, atherosclerosis, and diabetic nephropathy, the severity of which correlates with hyperglycemia, suggesting that they are triggered by high glucose condition. Reducing sugars and reactive carbonyl species such as methylglyoxal (MGO) lead to glycation of proteins, lipids and DNA and the gradual accumulation of advanced glycation end products (AGEs) in cells and tissues. While AGEs are clearly implicated in the pathogenesis of diabetes complications, their potential involvement during malignant tumor development, progression and resistance to therapy is an emerging concept. Meta-analysis studies established that patients with diabetes are at higher risk of developing cancer and show a higher mortality rate than cancer patients free of diabetes. In this review, we highlight the potential connection between hyperglycemia-associated AGEs formation on the one hand and the recent evidence of pro-tumoral effects of MGO stress on the other hand. We also discuss the marked interest in anti-glycation compounds in view of their strategic use to treat diabetic complications but also to protect against augmented cancer risk in patients with diabetes.


Assuntos
Complicações do Diabetes/metabolismo , Produtos Finais de Glicação Avançada/metabolismo , Neoplasias/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Aldeído Pirúvico/farmacologia , Animais , Complicações do Diabetes/complicações , Complicações do Diabetes/mortalidade , Complicações do Diabetes/patologia , Humanos , Hiperglicemia/complicações , Hiperglicemia/metabolismo , Hiperglicemia/mortalidade , Hiperglicemia/patologia , Metanálise como Assunto , Neoplasias/complicações , Neoplasias/mortalidade , Neoplasias/patologia , Aldeído Pirúvico/metabolismo , Regulação para Cima/efeitos dos fármacos
13.
Diabetes Metab Syndr ; 13(1): 149-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641688

RESUMO

AIM: To investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients. METHODS: A observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality. RESULTS: Data from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29-98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3-436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1-66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r2-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05). CONCLUSION: This study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.


Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Complicações do Diabetes/mortalidade , Diabetes Mellitus/fisiopatologia , Hiperglicemia/complicações , Hipoglicemia/complicações , Tempo de Internação/estatística & dados numéricos , Pneumonia/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Glicemia/análise , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/patologia , Complicações do Diabetes/etiologia , Complicações do Diabetes/patologia , Diabetes Mellitus/tratamento farmacológico , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Hospitalização , Humanos , Hiperglicemia/patologia , Hipoglicemia/patologia , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Pneumonia/patologia , Prognóstico , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/patologia , Estudos Retrospectivos
14.
J Surg Oncol ; 119(4): 472-478, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30637737

RESUMO

BACKGROUND: Hepatobiliary surgeons continue to expand the pool of patients undergoing liver resection using combinations of surgical and interventional procedures with chemotherapy. Improved perioperative care allows for operation on higher risk surgical patients. Postoperative outcomes, including 90-day mortality that improved over the past decade but still varies across cohorts. This study developed a preoperative risk score, on the basis significant clinical and laboratory variables, to predict 90-day mortality after hepatectomy. METHODS: All patients who underwent hepatectomy between 2011 and 2016 were included. Univariable and multivariable analyses were performed to identify the predictors of postoperative mortality and a risk score was derived and validated. RESULTS: The overall 90-day mortality rate in the derivation cohort (n = 1269 patients) was 4.0% (N = 51). Increasing patient age (P < 0.001), extent of resection (P = 0.001), diabetes mellitus (P = 0.006), and low preoperative sodium (P = 0.012) were predictors of the increased 90-day mortality in the multivariable analysis. The risk model developed based on these factors had an AUROC of 0.778 (P < 0.001) and remained significant in a validation cohort of 788 patients (AUROC: 0.703, P < 0.001). CONCLUSION: The proposed preoperative risk score to predict 90-day mortality after liver resection could be useful for appropriate counseling, optimization, and risk-adjusted assessment of surgical outcomes.


Assuntos
Hepatectomia/mortalidade , Fatores Etários , Idoso , Complicações do Diabetes/mortalidade , Feminino , Humanos , Hiponatremia/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco
15.
BMC Infect Dis ; 19(1): 10, 2019 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611208

RESUMO

BACKGROUND: Making an accurate prognosis for mortality during tuberculosis (TB) treatment in TB-diabetes (TB-DM) comorbid patients remains a challenge for health professionals, especially in low TB prevalent populations, due to the lack of a standardized prognostic model. METHODS: Using de-identified data from TB-DM patients from Texas, who received TB treatment had a treatment outcome of completed treatment or died before completion, reported to the National TB Surveillance System from January 2010-December 2016, we developed and internally validated a mortality scoring system, based on the regression coefficients. RESULTS: Of 1227 included TB-DM patients, 112 (9.1%) died during treatment. The score used nine characteristics routinely collected by most TB programs. Patients were divided into three groups based on their score: low-risk (< 12 points), medium-risk (12-21 points) and high-risk (≥22 points). The model had good performance (with an area under the receiver operating characteristic (ROC) curve of 0.83 in development and 0.82 in validation), and good calibration. A practical mobile calculator app was also created ( https://oaa.app.link/Isqia5rN6K ). CONCLUSION: Using demographic and clinical characteristics which are available from most TB programs at the patient's initial visits, our simple scoring system had good performance and may be a practical clinical tool for TB health professionals in identifying TB-DM comorbid patients with a high mortality risk.


Assuntos
Antituberculosos/uso terapêutico , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/mortalidade , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Projetos de Pesquisa , Estudos Retrospectivos , Fatores de Risco , Texas/epidemiologia , Resultado do Tratamento , Tuberculose/complicações
16.
Asian J Surg ; 42(1): 244-250, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29631874

RESUMO

BACKGROUND: Strong evidence has shown that metabolic surgery is more effective than medical treatment in the treatment of type 2 diabetic patients. However, no study demonstrated a survival benefit and reduction of diabetes-related end-organ damage. Here, we describe the study design of a large prospective cohort study, the Taiwan Diabesity Study (TDS) which would compare the long-term survival rate and end-organ damage between overweight/obese type 2 diabetic patients receiving metabolic surgery and medical treatment. METHODS: Eligibility criteria include type 2 diabetic patients with duration > 6 months, body mass index (BMI) over 25 kg/m2 and age between 20 and 67 years. Exclusion criteria are serum creatinine over 2.0 mg/dL, C-peptide below 1.0 ng/ml, recent history of cancer, and major diabetic complications. Eligible participants were recruited from six medical centers in Taiwan. The survival rate and diabetes-related end organ damage will be compared between the metabolic surgery group and medical group after follow-up for 10 years. RESULTS: In 3 years, 1016 participants were identified from 38,751 patients. The average BMI of patients was 30.6 (±2.6) kg/m2 and the average hemoglobin A1c was 8.2% (±1.5%) with 18% of them receiving insulin treatment. Among them, 126 patients received metabolic surgery and 890 patients received conventional medical treatment. The metabolic surgery group are younger, have a higher proportion of females, higher BMI and blood lipids as compared to the medical group. CONCLUSION: The TDS recruited 1016 overweight/obese type 2 diabetic patients including 126 patients receiving metabolic surgery and 890 patients receiving medical treatment.


Assuntos
Cirurgia Bariátrica , Complicações do Diabetes/etiologia , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/cirurgia , Obesidade/tratamento farmacológico , Obesidade/cirurgia , Adulto , Idoso , Estudos de Coortes , Complicações do Diabetes/mortalidade , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Taxa de Sobrevida , Taiwan , Fatores de Tempo , Adulto Jovem
17.
Blood Purif ; 47(1-3): 52-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30223256

RESUMO

AIMS: This study aimed to compare the short-term complications and long-term prognosis between urgent-start peritoneal dialysis (PD) and hemodialysis (HD), and explore the safety and feasibility of PD in end-stage renal disease (ESRD) patients with diabetes. METHODS: This retrospective study enrolled ESRD patients with diabetes who required urgent-start dialysis at a single center from January 2011 to December 2014. Short-term (30-day) dialysis-related complications and patient survival trends were compared between patients receiving PD and HD. RESULTS: Eighty patients were included in the study, including 50 (62.5%) who underwent PD. The incidence of dialysis-related complications and complications requiring reinsertion during the first 30 days was significantly lower in PD patients. Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD. The patient survival rate was higher in the PD compared to that in the HD group. CONCLUSIONS: PD may be acceptable, safe, and feasible for urgent-start dialysis in ESRD patients with diabetes.


Assuntos
Complicações do Diabetes , Diálise Peritoneal/efeitos adversos , Idoso , Complicações do Diabetes/mortalidade , Complicações do Diabetes/terapia , Intervalo Livre de Doença , Feminino , Humanos , Incidência , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
18.
Pediatr Diabetes ; 20(1): 93-98, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30471084

RESUMO

Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High-income countries can usually provide this, but the cost of this care is generally prohibitive for lower-income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower-income countries work toward establishing guidelines-based care, it is helpful to describe the levels of care that are potentially affordable, cost-effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: "minimal care," "intermediate care," and "comprehensive (guidelines-based) care." Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra-clinic mean HbA1c levels range from 12.0% to 14.0% (108-130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64-80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52-69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.


Assuntos
Serviços de Saúde do Adolescente , Cuidado da Criança , Diabetes Mellitus Tipo 1/economia , Diabetes Mellitus Tipo 1/terapia , Recursos em Saúde/estatística & dados numéricos , Adolescente , Serviços de Saúde do Adolescente/economia , Serviços de Saúde do Adolescente/estatística & dados numéricos , Criança , Cuidado da Criança/economia , Cuidado da Criança/métodos , Assistência Integral à Saúde/economia , Assistência Integral à Saúde/estatística & dados numéricos , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Complicações do Diabetes/economia , Complicações do Diabetes/mortalidade , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Humanos , Instituições para Cuidados Intermediários/economia , Instituições para Cuidados Intermediários/estatística & dados numéricos , Mortalidade , Pobreza/economia , Pobreza/estatística & dados numéricos , Unidades de Autocuidado/economia , Unidades de Autocuidado/estatística & dados numéricos
19.
Am J Cardiol ; 123(4): 618-626, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30553509

RESUMO

Glycated hemoglobin (HbA1C) is a risk factor for new onset heart failure (HF). There is however a paucity of data evaluating its association with outcomes in patients with established HF. We assessed the relation of HbA1C with outcomes among hospitalized HF patients. Among 41,776 HF patients from 263 hospitals participating to the Get with the Guidelines-HF registry between January 2009 and March 2016, we related HbA1C to outcomes (in-hospital mortality, length of hospital stay, discharge to home, 30-day mortality, 30-day readmission, and 1-year mortality), using generalized estimating equation to account for within-hospital clustering and potential confounders. There were 68% of HF patients with diabetes and median HbA1C was 7.1%. Each percent change in HbA1C was associated with higher odds of discharge to home for HbA1C levels <6.5% (covariate-adjusted odds ratio [OR] 1.13 [95% confidence interval 1.04 to 1.12]) or ≥6.5% (OR 1.05 [1.02 to 1.07]). After stratification by diabetes status, this association remained significant only among patients with diabetes (ORs for HbA1C levels <6.5%: 1.17 [1.07 to 1.27]; and ≥6.5%: 1.06 [1.03 to 1.09]). Compared with the lowest HbA1C tertile (HbA1C ≤6.1%), patients in the highest HbA1C tertile (HbA1C 7.3% to 19%) were more likely to have a length of hospital stay >4 days (OR 1.10 [1.02 to 1.18]) and to be discharged home (OR 1.23 [1.14 to 1.33]). There were no significant association between HbA1C and the following outcomes: in-hospital mortality, 30-day mortality, 30-day readmission, and 1-year mortality. In conclusion, among hospitalized HF patients, HbA1C was associated with prolonged hospital stay and home discharge, but not with readmission, short-term, or intermediate-term mortality.


Assuntos
Complicações do Diabetes/complicações , Hemoglobina A Glicada/metabolismo , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Complicações do Diabetes/mortalidade , Feminino , Insuficiência Cardíaca/complicações , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Taxa de Sobrevida
20.
J Gerontol A Biol Sci Med Sci ; 74(3): 366-372, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-29562321

RESUMO

BACKGROUND: The number of older people living with cancer and cardiometabolic conditions is increasing, but little is known about how specific combinations of these conditions impact mortality. METHODS: A total of 22,692 participants aged 65 years and older from four international cohorts were followed-up for mortality for an average of 10 years (8,596 deaths). Data were harmonized across cohorts and mutually exclusive groups of disease combinations were created for cancer, myocardial infarction (MI), stroke, and diabetes at baseline. Cox proportional hazards models for all-cause mortality were used to estimate the age- and sex-adjusted hazard ratio and rate advancement period (RAP) (in years). RESULTS: At baseline, 23.6% (n = 5,116) of participants reported having one condition and 4.2% (n = 955) had two or more conditions. Data from all studies combined showed that the RAP increased with each additional condition. Diabetes advanced the rate of dying by the most years (5.26 years; 95% confidence interval [CI], 4.53-6.00), but the effect of any single condition was smaller than the effect of disease combinations. Some combinations had a significantly greater impact on the period by which the rate of death was advanced than others with the same number of conditions, for example, 10.9 years (95% CI, 9.4-12.6) for MI and diabetes versus 6.4 years (95% CI, 4.3-8.5) for cancer and diabetes. CONCLUSIONS: Combinations of cancer and cardiometabolic conditions accelerate mortality rates in older adults differently. Although most studies investigating mortality associated with multimorbidity used disease counts, these provide little guidance for managing complex patients as they age.


Assuntos
Complicações do Diabetes/mortalidade , Infarto do Miocárdio/mortalidade , Neoplasias/mortalidade , Acidente Vascular Cerebral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Complicações do Diabetes/complicações , Feminino , Humanos , Masculino , Multimorbidade , Infarto do Miocárdio/complicações , Neoplasias/complicações , Modelos de Riscos Proporcionais , Fatores de Risco , Acidente Vascular Cerebral/complicações , Taxa de Sobrevida
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