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1.
Anticancer Res ; 39(10): 5639-5643, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570461

RESUMO

BACKGROUND/AIM: Diabetes mellitus (DM) is known as an important risk factor for hepatocellular carcinoma (HCC). However, surgical outcomes in patients with DM and HCC have not been evaluated in detail. PATIENTS AND METHODS: We retrospectively studied 177 patients with type 2 DM who underwent curative hepatectomy for HCC. Surgical outcomes after curative hepatectomy and prognostic factors were evaluated among 75 patients with DM and/or nonalcoholic steatohepatitis (NASH)-related HCC and 102 patients with DM and viral or alcoholic hepatitis (VAH)-related HCC. RESULTS: The 5-year survival rate and 5-year recurrence-free survival rate were significantly higher in the DM and/or NASH-related HCC group (87% and 51%) than in the DM and VAH-related HCC group (68%: p=0.0001 and 26%: p=0.0002). Multivariate analysis showed DM and/or NASH-related HCC to be significant independent prognostic factors for overall survival and recurrence-free survival. CONCLUSION: Patients with DM and/or NASH-related HCC showed more favorable surgical outcomes after hepatectomy in patients with DM and HCC.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/mortalidade , Hepatopatia Gordurosa não Alcoólica/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/cirurgia , Intervalo Livre de Doença , Feminino , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/patologia , Hepatopatia Gordurosa não Alcoólica/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
2.
J Agric Food Chem ; 67(38): 10614-10623, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31483658

RESUMO

Type 2 diabetes (T2D) is a pandemic disease chiefly characterized by hyperglycemia. In this study, the combination of serum lipidomic and metabolomic approach was employed to investigate the effect of arabinoxylan on type 2 diabetic rats and identify the critical biomarkers of T2D. Metabolomics analysis revealed that branched-chain amino acids, 12α-hydroxylated bile acids, ketone bodies, and several short- and long-chain acylcarnitines were significantly increased in T2D, whereas lysophosphatidylcholines (LPCs) were significantly decreased. Lipidomics analysis indicated T2D-related dyslipidemia was mainly associated with the increased levels of acetylcarnitine, free fatty acids (FFA), diacylglycerols, triacylglycerols, and cholesteryl esters and the decreased levels of some unsaturated phosphatidylcholines (less than 22 carbons). These variations indicated the disturbed amino acid and lipid metabolism in T2D, and the accumulation of incompletely oxidized lipid species might eventually contribute to impaired insulin action and glucose homeostasis. Arabinoxylan treatment decreased the concentrations of 12α-hydroxylated bile acids, carnitines, and FFAs and increased the levels of LPCs. The improved bile acid and lipid metabolism by arabinoxylan might be involved in the alleviation of hypercholesterolemia and hyperlipidemia in T2D.


Assuntos
Anticolesterolemiantes/administração & dosagem , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipercolesterolemia/tratamento farmacológico , Hiperlipidemias/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Hipolipemiantes/administração & dosagem , Xilanos/administração & dosagem , Aminoácidos de Cadeia Ramificada/metabolismo , Animais , Ácidos e Sais Biliares/metabolismo , Carnitina/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Ácidos Graxos não Esterificados/metabolismo , Glucose/metabolismo , Humanos , Hipercolesterolemia/etiologia , Hipercolesterolemia/metabolismo , Hiperlipidemias/etiologia , Hiperlipidemias/metabolismo , Metabolismo dos Lipídeos , Lipídeos/química , Metabolômica , Ratos
3.
Medicine (Baltimore) ; 98(36): e17081, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490412

RESUMO

OBJECTIVE: The purpose of this study was to assess the efficacy and hypoglycemic risk of sitagliptin versus that of GLP-1 receptor agonists in the management of obese/overweight patients with T2DM. METHODS: EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov were searched; randomized controlled trials comparing the efficacy of sitagliptin versus that of GLP-1 receptor agonists in obese/overweight patients with T2DM were included. The mean BMI of participants for each study was ≥30 kg/m. We conducted a meta-analysis according to the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions. RevMan 5.1 software was used to perform the meta-analysis. The Cochrane Q test and I statistics were used to estimate the heterogeneity among studies. The results are expressed as the mean difference (MD) or risk ratio (RR) with 95% confidence intervals. RESULTS: A total of 8 eligible studies were included in our meta-analysis. Compared with GLP-1 receptor agonists, sitagliptin was less effective at reducing HbA1c (0.42 [0.27, 0.56]), FPG (0.78 [0.36, 1.19]), PPG (2.61 [1.35, 3.87]), and body weight (1.42 [0.71, 2.14]). Conversely, there were no significant differences in SBP reduction (0.38 [-1.14, 1.89]), DBP reduction (-0.30 [-1.00, 0.39]), and hypoglycemic risk (1.09 [0.50, 2.35]). CONCLUSION: For obese/overweight patients, sitagliptin may exert a less potent effect on HbA1C, FPG, PPG, and weight reduction than GLP-1 receptor agonists, but these drugs had a similar efficacy in reducing blood pressure; furthermore, there was no significant difference in hypoglycemic risk.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Obesidade/complicações , Fosfato de Sitagliptina/uso terapêutico , Glicemia/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Diabetes Mellitus Tipo 2/complicações , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/farmacologia , Fosfato de Sitagliptina/farmacologia
4.
Bratisl Lek Listy ; 120(9): 676-679, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31475553

RESUMO

OBJECTIVES: Medial arterial calcification (MAC) is a nonobstructive condition leading to reduced arterial compliance. The disease most commonly occurs in diabetes mellitus. Decreased ankle-brachial pressure index (ABI) is a well-known marker of increased cardiovascular mortality. However, also the values of ABI above 1.3, typical in MAC, are associated with increased mortality. METHODS: By means of Holter ECG monitoring, we investigated 41 patients (25 men, 16 women) with mean age of 59±8 years, suffering of type 2 diabetes mellitus and identified as having MAC, and Holter ECG monitoring with an average duration of recording 22.36 hours, was carried out by GE-Marquette MARS ECG Holter system. RESULTS: We found frequent incidence of cardiac arrhythmias and myocardial ischemia in 22 patients (53.7 %). Only 19 patients (46.3 %) had normal Holter ECG recordings. ABI values were significantly higher in patients with abnormal ECG Holter recordings. CONCLUSION: Our results confirm the importance of ABI estimation in clinical practice. As the central goal of therapy for patients with myocardial ischemia and/or complex forms of cardiac arrhythmias is the reduction or elimination of these episodes. Ambulatory Holter ECG monitoring plays an important role in the management of these patients (Tab. 7, Ref. 16).


Assuntos
Arritmias Cardíacas/diagnóstico , Calcinose/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Eletrocardiografia Ambulatorial , Isquemia Miocárdica/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Pan Afr Med J ; 33: 103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489081

RESUMO

Introduction: Foot deformities and amputations are parameters that have been studied as risk factors for diabetic foot ulceration (DFU). However, inclusion of "foot deformities" and "amputations" in a single, broad variable and with reference to the severity of these deformities, may better characterize subjects who are prone to develop DFU. Methods: The objective of the study was the examination of amputative and non-amputative foot deformities severity as risk factor for DFU in relation with the other established risk factors. A cross-sectional and case-control study was conducted from October 2005 to November 2016. One hundred and thirty-four subjects with type 1 and 2 diabetes, with and without active foot ulcers, participated. A structured quantitative interview guide was used. Univariate logistic regression analysis for the literature's established risk factors was performed, as well as for two versions of the "amputative and non-amputative foot deformities severity" variable. Subsequently, multivariate logistic regression analysis (MLRA) for three models and receiver operating characteristic (ROC) curve analysis were carried out. Results: From the MLRA, only PAD (peripheral arterial disease) was significant (OR 3.56, 95% CI 1.17-10.82, P=0.025 and OR 3.33, 95% CI 1.02-10.08, P=0.033). Concerning the ROC curve analysis of the models, the one with the three categories amputative and non-amputative foot deformities severity variable, had the greatest area under the ROC curve (0.763, P<0.001). Conclusion: A united variable for lower extremity amputations and other foot deformities with reference to their severity, could be more helpful to the clinicians in identifying patients with diabetes at risk for foot ulceration.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/epidemiologia , Deformidades do Pé/epidemiologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Pé Diabético/etiologia , Feminino , Humanos , Modelos Logísticos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos Piloto , Curva ROC , Fatores de Risco , Índice de Gravidade de Doença
6.
Rev Col Bras Cir ; 46(4): e2252, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508737

RESUMO

OBJECTIVE: to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. METHODS: a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. RESULTS: among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. CONCLUSION: the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Pacotes de Assistência ao Paciente , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Assistência Perioperatória/métodos , Estudos Prospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
7.
Ther Umsch ; 76(3): 133-137, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31498050

RESUMO

Metabolic surgery in patients with poorly controlled type 2 diabetes and low BMI Abstract. Bariatric surgery has been established as an efficient therapy for morbid obesity. Metabolic surgery represents the operative treatment of type 2 diabetes and other metabolic disorders. Metabolic surgery does not focus on weight loss, as many mechanisms, which are responsible for the improvement of the glycemic control are independent from weight loss. There are many studies, which show the efficient effect of metabolic surgery in diabetic patients with class II obesity. Furthermore, there is growing evidence, that metabolic surgery does also work in patients with a BMI below 35 kg / m2. Multiple surgical and endocrinological associations have endorsed these facts and adopted their guidelines. In obese type 2 diabetics with a BMI below 35 kg / m2 and a poor glycemic control metabolic surgery should be considered as a therapeutic option.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Obesidade Mórbida , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Humanos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Perda de Peso
8.
Ann Agric Environ Med ; 26(3): 429-438, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559799

RESUMO

INTRODUCTION: Quality of Life (QoL) of Polish women and men with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) was analyzed, taking into consideration acceptance of the illness, the occurrence of depression, complications of diabetes, concentration of glycated haemoglobin, and demographic factors. MATERIAL AND METHODS: The study was conducted among 115 patients with T1DM and 215 patients with T2DM aged 18-60. The patients were divided into women and men. The tool applied for studying QoL was the Polish language version of the Audit of diabetes-dependent QoL questionnaire(ADDQoL) comprising 2 questions related to the general QoL and 19 domains related to aspects of life. Each domain included 2 components: Impact and Importance, and their product determined the value of the weighted impact score. The Acceptance of Illness Scale, Beck Depression Inventory and studied demographic and clinical parameters were also applied. RESULTS: Patients with both types of diabetes demonstrated a negative influence of the disease in all domains of ADDQoL. Values of the average weighted impact of ADDQoL showed significant associations with diabetic complications in T1DM and gender and depressive symptoms in T2DM. Diabetes negatively affects the QoL of diabetic patients in Poland, especially regarding freedom to eat and to drink and sex life in both genders in T1DM, and freedom to eat and drink, and feelings about the future in both genders, and working life and sex life in T2DM men. CONCLUSIONS: Risk factors for worse QoL are: the occurrence of diabetes complications in T1DM patients and male gender and depression in T2DM patients.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Qualidade de Vida , Adolescente , Adulto , Depressão , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Humanos , Pessoa de Meia-Idade , Polônia , Inquéritos e Questionários , Adulto Jovem
10.
BMC Ophthalmol ; 19(1): 186, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419954

RESUMO

BACKGROUND: This study aims to investigate the choroidal thickness and choroidal vascular density parameters and their correlation with severity of diabetic retinopathy (DR) in diabetes mellitus (DM) patients. METHODS: An observational cross-sectional study was conducted of 104 eyes, which were divided into 4 groups: Healthy controls (n = 38), DM with no DR eyes (n = 22), panretinal photocoagulation-untreated non-proliferative DR eyes (PRP-untreated NPDR eyes) (n = 24), PRP-untreated proliferative DR eyes (PRP-untreated PDR eyes) (n = 20). Optical coherence tomography (OCT) was performed. The total choroidal area (TCA), stromal area (SA), the luminal areas (LA) and the ratio of the luminal to choroidal area (L/C ratio) were compared. The choroidal parameters were also compared between PRP untreated and PRP-treated DR eyes. RESULTS: The L/C ratio values were 0.68 ± 0.06 in controls and 0.63 ± 0.04 in DM eyes (P < 0.001). But there were no statistically significant differences in retinal nerve fiber layer (RNFL) thickness, retinal thickness and subfoveal choroidal thickness (SCT) measurements between the two groups (P = 0.407, P = 0.654 and P = 0.849; respectively). The vessel density values were significantly different in DM with no DR eyes, PRP-untreated NPDR eyes and PRP-untreated PDR eyes (P < 0.001 for SCT, TCA and SA). The L/C ratio values in the three groups were significant different (P = 0.019). There was no significant difference in SCT, TCA, LA, SA and the L/C ratio between PRP-untreated and PRP-treated DR eyes. CONCLUSION: Eyes of patients with DM showed the L/C ratio decreased compared with normal controls. The SCT increased, but L/C ratio significantly decreased with severity of DR eyes compared with DM and normal eyes. Changes in the L/C ratio may predict DR development before they are otherwise evident clinically. Choroidal blood flow deficit can be an early pathologic change in DR.


Assuntos
Corioide/patologia , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Capilares/patologia , Corioide/irrigação sanguínea , Estudos Transversais , Retinopatia Diabética/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Índice de Gravidade de Doença
11.
J Natl Black Nurses Assoc ; 30(1): 21-28, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31465681

RESUMO

African-Americans have the highest rates of chronic kidney disease due to type 2 diabetes (T2DM-CKD) and of progression to end-stage renal disease. The purpose of this study was to describe African-American's perceptions of T2DM-CKD: specifically, perceptions of cause, risk, severity, self-management of T2DM-CKD before and after diagnosis, and overall effect on their lives. Informed by the Common Sense Model of Illness, a cross-sectional qualitative study using purposive sampling was conducted. Findings were that participants did not take T2DM seriously until they had CKD and they also had misperceptions about the cause of T2DM. Participants believed that a family history of diabetes meant nothing could prevent a T2DM onset. In addition, participants viewed primary care providers as not explicitly informing them of their status/risks regarding CKD. The study results identified factors among African-Americans that contribute to the T2DM-CKD progression. This may enhance primary care providers' ability to educate African-Americans, which may lead to more accurate perceptions.


Assuntos
Afro-Americanos/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Insuficiência Renal Crônica/etnologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Humanos , Pesquisa Qualitativa , Insuficiência Renal Crônica/psicologia
12.
Life Sci ; 233: 116686, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31348946

RESUMO

Epilepsy is a neurological disorder characterized by an enduring predisposition to generate and aggravate epileptic seizures affecting around 1% of global population making it a serious health concern. Despite the recent advances in epilepsy research, no disease-modifying treatment able to terminate epileptogenesis have been reported yet reflecting the complexity in understanding the disease pathogenesis. To overcome the current treatment gap against epilepsy, one effective approach is to explore anti-epileptic effects from a drug that are approved to treat non-epileptic diseases. In this regard, Metformin emerged as an ideal candidate which is a first line treatment option for type 2 diabetes mellitus (T2DM), has conferred neuroprotection in several in vivo neurological disorders such as Alzheimer's diseases (AD), Parkinson's disease (PD), Stroke, Huntington's diseases (HD) including epilepsy. In addition, Metformin has ameliorated cognitive alteration, learning and memory induced by epilepsy as well as in animal model of AD. Herein, we review the promising findings demonstrated upon Metformin treatment against animal model of epilepsy however, the precise underlying mechanism of anti-epileptic potential of Metformin is not well understood. However, there is a growing understanding that Metformin demonstrates its anti-epileptic effect mainly via ameliorating brain oxidative damage, activation of AMPK, inhibition of mTOR pathway, downregulation of α-synuclein, reducing apoptosis, downregulation of BDNF and TrkB level. These reflects that Metformin being non-anti-epileptic drug (AED) has a potential to ameliorate the cellular pathways that were impaired in epilepsy reflecting its therapeutical potential against epileptic seizure that might plausibly overcome the limitations of today epilepsy treatment.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Modelos Animais de Doenças , Epilepsia/tratamento farmacológico , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Fármacos Neuroprotetores/farmacologia , Animais , Diabetes Mellitus Tipo 2/complicações , Epilepsia/etiologia
13.
Medicine (Baltimore) ; 98(29): e15404, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335666

RESUMO

This study retrospectively evaluated the effect of lutein supplement (LS) on patients with non-proliferative diabetic retinopathy (NPDR).A total of 72 patients with NPDR were included in this study. All patients received Zeaxanthin during the study period. In addition, 36 patients also received LS and were assigned to the treatment group, while the other 36 patients did not receive LS and were assigned to the control group. All patients were treated for a total of 4 months. The endpoints included visual acuity (VA), contrast sensitivity (CS), and glare sensitivity (GS). In addition, any adverse events were also assessed. All endpoints were measured before and after 4-month treatment.Before treatment, there were no significant differences in VA (P = .75), CS (P = .71), and GS (P = .73) between two groups. After 4-month treatment, there were still no significant differences in all endpoints of VA (P = .66), CS (P = .58), and GS (P = .61) between two groups. No adverse events were recorded in either group.The results of this retrospective study showed that LS may not benefit for patients with NPDR after 4-month treatment. More high quality randomized controlled trials should still be needed to warrant the results of this study.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/metabolismo , Luteína , Antioxidantes/administração & dosagem , Antioxidantes/efeitos adversos , Sensibilidades de Contraste , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/fisiopatologia , Suplementos Nutricionais , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Luteína/administração & dosagem , Luteína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/efeitos dos fármacos , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
14.
Medicine (Baltimore) ; 98(29): e16510, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335726

RESUMO

BACKGROUND: Screening and diagnosis of diabetic retinopathy (DR) mainly depends on fundus examination, which is not an intuitive and simple screening or diagnostic method. Recently, the relationship between platelet parameters and DR has become a hot topic. Whether platelet parameters have clinical value in DR is controversial. METHODS: Literature was retrieved by formal search of electronic databases (PubMed, Embase, Cochrane library, Scopus, and CNKI) and by hand searching of reference lists of related articles from the beginning of building database to December 2017. Review manager 5.3 was utilized to deal with statistical data. This study was registered at International Prospective Register of Systematic Reviews (number: CRD42018093773). RESULTS: This study included 1720 DR patients, 1477 type 2 diabetic mellitus (T2DM) without DR patients and 1456 health controls in 21 eligible studies. We found there was significant increase of platelet distribution width (PDW) level in the comparison of DR versus Control group (standard mean difference [SMD] [95% confidence interval [CI]] = 1.04 [0.68, 1.40]) and DR versus T2DM without DR group (SMD [95% CI] = 0.68 [0.40, 0.95]). For platelet count (PLT), it showed obvious decrease in the comparison of DR versus T2DM without DR group (SMD [95% CI] = -0.26 [-0.49, -0.03]) and no difference in comparison of DR versus Control (SMD [95% CI] = -0.26 [-0.51, -0.00]). Subgroup analysis showed that significant result of PDW level appeared in China and Turkey in all comparisons, while similar results of PLT only in China. In addition, PDW level was different in various DR-subtypes, obvious high level in proliferation DR. CONCLUSIONS: We concluded that the guiding significance of PDW and PLT in diagnosis and monitor of DR, and especially, application of PDW to PDR management may have potential sense.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Volume Plaquetário Médio , Contagem de Plaquetas , Testes de Função Plaquetária , China , Humanos , Guias de Prática Clínica como Assunto , Turquia
15.
Medicine (Baltimore) ; 98(30): e16573, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348288

RESUMO

RATIONALE: Previous studies have suggested that increased levels of advanced glycation end products (AGEs) and soluble receptor for AGE (sRAGE) are associated with diabetes-related complications. However, there is little evidence on the association between long-term levels of AGEs and sRAGE and progression of diabetes-related complications. PATIENT CONCERNS: A 64-year-old man had poorly controlled type 2 diabetes, obesity, smoking, hypertension, and dyslipidemia. He had many risk factors for diabetes-related complications. DIAGNOSIS: Despite poor glycemic control over 15 years, the patient did not exhibit diabetes-related complications. INTERVENTIONS: We examined serum AGEs (CEL and MG-H1) and sRAGE levels in this patient over the past 10 years. OUTCOMES: The patient maintained low serum AGEs and sRAGE levels. LESSONS: AGEs and sRAGE levels may be associated with long-term development of diabetes-related complications.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Produtos Finais de Glicação Avançada/sangue , Receptor para Produtos Finais de Glicação Avançada/sangue , Glicemia , Progressão da Doença , Dislipidemias/complicações , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Fumar/epidemiologia
16.
Bone Joint J ; 101-B(7_Supple_C): 3-9, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256656

RESUMO

AIMS: The best marker for assessing glycaemic control prior to total knee arthroplasty (TKA) remains unknown. The purpose of this study was to assess the utility of fructosamine compared with glycated haemoglobin (HbA1c) in predicting early complications following TKA, and to determine the threshold above which the risk of complications increased markedly. PATIENTS AND METHODS: This prospective multi-institutional study evaluated primary TKA patients from four academic institutions. Patients (both diabetics and non-diabetics) were assessed using fructosamine and HbA1c levels within 30 days of surgery. Complications were assessed for 12 weeks from surgery and included prosthetic joint infection (PJI), wound complication, re-admission, re-operation, and death. The Youden's index was used to determine the cut-off for fructosamine and HbA1c associated with complications. Two additional cut-offs for HbA1c were examined: 7% and 7.5% and compared with fructosamine as a predictor for complications. RESULTS: Overall, 1119 patients (441 men, 678 women) were included in the study. Fructosamine level of 293 µmol/l was identified as the optimal cut-off associated with complications. Patients with high fructosamine (> 293 µmol/l) were 11.2 times more likely to develop PJI compared with patients with low fructosamine (p = 0.001). Re-admission and re-operation rates were 4.2 and 4.5 times higher in patients with fructosamine above the threshold (p = 0.005 and p = 0.019, respectively). One patient (1.7%) from the elevated fructosamine group died compared with one patient (0.1%) in the normal fructosamine group (p = 0.10). These complications remained statistically significant in multiple regression analysis. Unlike fructosamine, all three cut-offs for HbA1c failed to show a significant association with complications. CONCLUSION: Fructosamine is a valid and an excellent predictor of complications following TKA. It better reflects the glycaemic control, has greater predictive power for adverse events, and responds quicker to treatment compared with HbA1c. These findings support the screening of all patients undergoing TKA using fructosamine and in those with a level above 293 µmol/l, the risk of surgery should be carefully weighed against its benefit. Cite this article: Bone Joint J 2019;101-B(7 Supple C):3-9.


Assuntos
Artroplastia do Joelho/efeitos adversos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Frutosamina/sangue , Hemoglobina A Glicada/metabolismo , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/sangue , Idoso , Biomarcadores/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Humanos , Incidência , Masculino , Osteoartrite do Joelho/complicações , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Prospectivos , Estados Unidos/epidemiologia
17.
Rev Bras Enferm ; 72(3): 780-787, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269146

RESUMO

OBJECTIVE: to describe the validation of the booklet on self-care with the feet of people with diabetes. METHOD: methodological study, focusing on the validation of a printed booklet. The content and appearance of the booklet was validated by 23 judges divided into three groups: 11 content and appearance, seven technicians and five of the area of design and marketing. The appearance was validated by 30 people with type 2 Diabetes Mellitus. RESULTS: the judges in the nursing area allowed the validation of material with a Content Validity Index (CVI) of 0.99, judges in the area of design and marketing with Suitability Assessment of Materials (SAM) of 99.2% and the target audience with concordance index of 99.4%. CONCLUSION: the educational booklet proved to be valid and reliable educational material to be used in order to promote compliance with self-care with the feet of people with Diabetes Mellitus.


Assuntos
Pé Diabético/terapia , Folhetos , Educação de Pacientes como Assunto/normas , Autocuidado/instrumentação , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/psicologia , Humanos , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Autocuidado/normas , Inquéritos e Questionários , Estudos de Validação como Assunto
18.
Ophthalmic Res ; 62(2): 68-79, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256153

RESUMO

AIMS: To conduct an evidence-based evaluation of diabetic retinopathy (DR) for the diagnosis of diabetic nephropathy (DN) in type 2 diabetics with kidney disease. METHODS: We systematically searched PubMed, EMBASE, and the Cochrane Library from inception to June 27, 2018, including the reference lists of identified primary studies. A study was included if it (1) used DR as a diagnostic test for DN; and (2) used histological evaluation of renal tissues as the reference standard. RESULTS: The analysis included 45 studies (4,561 patients). A bivariate analysis yielded a sensitivity of 0.67 (95% CI 0.61-0.74) and a specificity of 0.78 (95% CI 0.73-0.82). The summary receiver operating characteristic curve analysis provided an area under the curve (AUC) of 0.79 (95% CI 0.76-0.83). In a setting of 41% prevalence of DN, the probability of DN would be 68% if the test of DR was positive, and the probability of DN would be 23% if it was negative. In addition, although the mean specificity of proliferative DR for the detection of DN was 0.99 (95% CI 0.45-1.00), the mean sensitivity was 0.34 (95% CI 0.24-0.44), and the AUC was 0.58 (95% CI 0.53-0.62). CONCLUSIONS: DR is helpful in diagnosing DN in persons with type 2 diabetes and kidney disease, but the severity of DR may not parallel the presence of DN.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/diagnóstico , Retinopatia Diabética/diagnóstico , Área Sob a Curva , Humanos , Curva ROC , Sensibilidade e Especificidade
19.
Pan Afr Med J ; 32: 209, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312321

RESUMO

Introduction: This study aims to determine the clinical and evolutionary profile of skin and soft tissue lesions in diabetics followed up at the dressing room. Methods: We conducted an observational descriptive and analytical study in the dressing room of the Marc Sankalé Diabetes Center, Dakar from 1 January to 31 December 2017. Our study focused on diabetics who were examined in the dressing room. Results: A total of 37.173 procedures were recorded at the Marc Sankalé Diabetes Center; 16.418 patients were treated in the dressing room, representing a prevalence of 14.16%. The average age of patients was 56,6 ±12 years, the sex ratio (M/F) was 0,88. Type 2 diabetes predominated (78,97%) and the average disease duration was 8.06 ± 7.9 years. The mean capillary blood glucose concentration was 2.4±1 g/l. Diabetic neuropathy was found in 72.33% of patients. Limb lesions were found in 93,98% of patients(1185 cases). The most common lesions included: ulcer (46,76%), abscess (13.46%), phlegmon (13.20%), gangrene (8.41%), erysipelas (3.78%), perforating ulcer (3.53%), intertrigo (3.95%). The lesions were be divided into infectious lesions (61,41), non-infectious lesions(33,50%), pure vascular lesions (1.57%) and mixed lesions (3.70%). Out of 1189 patients 7.57% had had osteitis. The germs found were Gram-positive bacteria (12.70%), Gram-negative bacteria (23.80%). Amputation was performed according to the topographical features of the lesion (p=0.00), the type of lesion (p=0.000), the seniority of diabetes (p=0.02), the type of diabetes (p=0.008), the presence of osteitis (p=0.006). Minor amputation was performed in 43,33% of cases, major amputation in 37.43% of cases; 70 deaths were recorded (5.89%). Conclusion: Skin and soft tissue lesions were dominated by diabetic foot. Mortality is not negligible and the risk of amputation was statistically related to the topographical features of the lesion, the type of lesion, the seniority and the type of diabetes and the presence of osteitis.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Dermatopatias/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Amputação/estatística & dados numéricos , Glicemia/análise , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/epidemiologia , Neuropatias Diabéticas/epidemiologia , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Senegal/epidemiologia , Dermatopatias/patologia , Infecções dos Tecidos Moles/patologia , Adulto Jovem
20.
Pan Afr Med J ; 33: 14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312330

RESUMO

Introduction: dry eye is a fairly common ocular surface disorder which significantly affects the quality of life of patients. This study aimed to determine the prevalence, and relationship between dry eye and glycosylated haemoglobin (HbA1c) among patients with diabetes mellitus. Methods: this was a descriptive hospital-based study conducted among patients diagnosed with diabetes mellitus and attending the Diabetic Clinic at a tertiary health facility in Ibadan, south-western Nigeria. Dry eye was assessed using the standardized Ocular Surface Disease Index Questionnaire administered to the eligible respondents on dry eye symptoms. Detailed ocular examination including the tear break-up time (TBUT) and Schirmer I test were carried out and a recent glycosylated haemoglobin value was also obtained. Results: one hundred and eighty-nine Type 2 diabetic patients were studied, with 68.8% female and a mean age of 60.2 ± 10.3 years. The frequency of dry eye among patients was 21.7% (95% CI, 15.8-27.6). The most commonly reported symptoms of dry eye were "feeling of gritty sensation" (78%, 95% CI, 65.4-90.7) and "blurred vision" (73.2%, 95% CI, 59.6-86.7) while "discomfort in windy areas" (61%, 95% CI, 46.0-75.9) was the most common environmental trigger. No statistically significant correlation was noted between dry eye and HbA1c (r = 0.086, p= 0.239), and age (r = 0.096, p = 0.1). Conclusion: dry eye is fairly common among patients with diabetes mellitus with most frequent symptoms being gritty sensation and blurred vision. No significant correlation was noted between dry eye and glycosylated haemoglobin (HbA1c).


Assuntos
Diabetes Mellitus Tipo 2/complicações , Síndromes do Olho Seco/epidemiologia , Hemoglobina A Glicada/metabolismo , Lágrimas/metabolismo , Idoso , Síndromes do Olho Seco/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Prevalência , Qualidade de Vida , Inquéritos e Questionários
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