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1.
Angiol Sosud Khir ; 27(3): 125-130, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528596

RESUMO

AIM: To study the effect of type 2 diabetes mellitus on changes of intracardiac haemodynamics and myocardial morphology in patients with ischaemic heart disease and a postinfarction aneurysm of the left ventricle before and after corrective operations on the heart. PATIENTS AND METHODS: The study included 79 patients with ischaemic heart disease and a chronic aneurysm of the left ventricle (Group I - patients with type 2 diabetes mellitus (n=27), mean age 57.5±3.9 years, average number of shunts 2.9±0.6; Group II - patients without diabetes mellitus (n=52), mean age 55,3 ±7.1 years, average number of shunts - 2.7±0.3). In the preoperative period all patients were examined taking into account the functional class of angina pectoris, with the assessment of the left ventricular ejection fraction, end-diastolic index, end-systolic index, sphericity index. All patients underwent coronary artery bypass grafting and surgical restoration of the normal geometry of the left ventricle according to the Menicanty technique with the target end-systolic index of 60 ml/m2, during which 39 patients from both groups were subjected to intraoperative biopsy of the left ventricular myocardium and right atrial auricle. RESULTS: The intergroup analysis revealed no statistically significant differences in age, angina pectoris class, level of arterial pressure between the groups. Neither were there statistically significant differences in the echocardiographic parameters at the preoperative stage. In the postoperative period, we detected a significant decrease in the end-systolic and end-diastolic volumes of the left ventricle in both groups, with a statistically significant increase of the left ventricular ejection fraction observed only in non-diabetic patients. One year after the operation, such patients still continued to demonstrate more favourable parameters of the systolic and diastolic functions of the left ventricle. A detailed analysis with determining the delta of the alterations in the parameters revealed more significant positive dynamics in the postoperative period in patients with ischaemic heart disease not associated with type 2 diabetes mellitus. CONCLUSION: The obtained findings are indicative of negative dynamics of the course of chronic ischaemic heart disease aggravated by type 2 diabetes mellitus after reconstruction of the left ventricle. Macro- and microangiopathy in type 2 diabetes mellitus significantly deteriorated the myocardial trophism. Subsequent bleedings draw phagocytic cells into the myocardial stroma, thus adversely affecting the further prognosis and course of the disease, since we demonstrated that the presence of inflammatory infiltrate in the myocardial stroma is a key factor of unfavourable outcomes of surgical treatment of patients with ischaemic cardiomyopathy.


Assuntos
Doença da Artéria Coronariana , Diabetes Mellitus Tipo 2 , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Pessoa de Meia-Idade , Volume Sistólico , Função Ventricular Esquerda
2.
Ann Palliat Med ; 10(8): 8787-8796, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488367

RESUMO

BACKGROUND: Ultrasound is a promising imaging examination for type 2 diabetic peripheral neuropathy (DPN). This study aimed to explore the risk factors of ultrasound diagnostic characteristics in the tibial nerves of patients with type 2 DPN. METHODS: The Michigan Neuropathy Screening Instrument (MNSI) was used for neuropathy evaluation, and 520 patients with type 2 diabetes were divided into a DPN group and non-DPN (NDPN) group with 2 points as the cut-off value. The two groups were matched at a ratio of 1:1 according to age, BMI, calf circumference, and gender, resulting in 44 matched pairs. The dependent variable was type 2 DPN and the concomitant variables were the width, thickness, cross-sectional area, and unclear honeycomb-like structure of the tibial nerve. A 1:1 matched conditional logistic regression model was established to analyze which ultrasound diagnostic characteristics of the tibial nerve were risk factors for type 2 DPN. RESULTS: The thickness (OR =5.176, P=0.043) and cross-sectional area (OR =1.659, P=0.030) of the tibial nerve were risk factors for the diagnosis of DPN, while the width and unclear honeycomb-like structure of the nerve were not (P>0.05). In the diagnosis of DPN, the area under the receiver operating characteristic (ROC) curve of the cross-sectional area of the tibial nerve was 0.747, and the sensitivity, specificity, positive predictive value, and negative predictive value were 61.36%, 95.45%, 93.10%, and 71.20%, respectively. The area under the ROC curve of tibial nerve thickness was 0.867, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.82%, 90.91%, 90.00%, and 83.30%, respectively. The area under the ROC curve of thickness was larger than that of cross-sectional area of the tibial nerve (z statistic =1.800, P=0.07). CONCLUSIONS: The thickness and cross-sectional area of the tibial nerve measured by ultrasound are risk factors for type 2 DPN. The diagnostic sensitivity of the thickness is higher than the cross-sectional area, while the diagnostic specificity of the cross-sectional area is higher than the thickness.


Assuntos
Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Nervo Tibial/diagnóstico por imagem , Ultrassonografia
3.
Trials ; 22(1): 595, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488845

RESUMO

BACKGROUND: Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. METHODS: A multicenter, randomized double-blind, placebo-controlled trial has been designed. Ninety eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: control group (n = 30), low-cell dose treatment group (n = 30), and high-cell dose treatment group (n = 30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical, and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. DISCUSSION: Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future. TRIAL REGISTRATION: ClinicalTrials.gov NCT04466007 . Registered on January 07, 2020. All items from the World Health Organization Trial Registration Data Set are included within the body of the protocol.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Mesenquimais , Noma , Tecido Adiposo , Animais , Ensaios Clínicos Fase II como Assunto , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Método Duplo-Cego , Humanos , Isquemia/diagnóstico , Isquemia/terapia , Estudos Multicêntricos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(35): e27104, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477149

RESUMO

ABSTRACT: To evaluate the diagnostic values of shear wave elastography (SWE) alone and in combination with the Toronto clinical scoring system (TCSS) on diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM).The study included 41 DPN patients, 42 non-DPN patients, and 21 healthy volunteers. Conventional ultrasonography and SWE were performed on the 2 sides of the tibial nerves, and cross-sectional area (CSA) and nerve stiffness were measured. TCSS was applied to all patients. A receiver operating characteristic curve analysis was performed.The stiffness of the tibial nerve, as measured as mean, minimum or maximum elasticity, was significantly higher in patients in the DPN group than the other groups (P < .05). The tibial nerve of subjects in the non-DPN group was significantly stiffer compared to the control group (P < .05). There was no significant difference of the tibial nerve CSA among the 3 groups (P > .05). Mean elasticity of the tibial nerve with a cutoff of 71.3 kPa was the most sensitive (68.3%) and had a higher area under the curve (0.712; 0.602-0.806) among the 3 shear elasticity indices for diagnosing DPN when used alone. When combining SWE with TCSS in diagnosing DPN, the most effective parameter was the EMax, which yielded a sensitivity of 100.00% and a specificity of 95.24%.SWE is a better diagnostic tool for DPN than the conventional ultrasonic parameter CSA, and a higher diagnostic value is attained when combining SWE with TCSS.


Assuntos
Nefropatias Diabéticas/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/normas , Projetos de Pesquisa , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/complicações , Técnicas de Imagem por Elasticidade/métodos , Técnicas de Imagem por Elasticidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/classificação , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Curva ROC , Reprodutibilidade dos Testes
5.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 33(4): 414-416, 2021 Jan 04.
Artigo em Chinês | MEDLINE | ID: mdl-34505451

RESUMO

OBJECTIVE: To investigate the seroprevalence of Toxoplasma gondii infections among patients with diabetes mellitus in Hangzhou City. METHODS: A total of 337 patients with type 1 diabetes mellitus, 624 patients with type 2 diabetes mellitus and 384 patients with gestational diabetes mellitus living in Hangzhou City during the period from March 2017 through May 2020 were recruited as the study subjects, while age- and gender-matched healthy volunteers and pregnant women without gestational diabetes mellitus served as controls. Enzyme-linked immunosorbent assay (ELISA) was employed to detect serum IgG and IgM antibodies against T. gondii in patients with diabetes mellitus and controls, and the seroprevalence of anti-T. gondii antibody was compared between diabetes mellitus patients and controls. RESULTS: The overall seroprevalence of anti-T. gondii antibody (18.10% vs. 4.45%, χ2 = 31.38, P < 0.01) and the seroprevalence of anti-T. gondii IgG antibody (14.54% vs. 2.97%, χ2 = 28.28, P < 0.01) were both significantly higher in patients with type 1 diabetes mellitus than in healthy controls, while no significant difference was seen in the seroprevalence of anti-T. gondii IgM antibody between patients and controls (3.56% vs. 1.48%, χ2 = 2.96, P > 0.05). The seroprevalence rates of serum anti-T. gondii (23.56% vs. 6.57%, χ2 = 70.37, P < 0.01) and anti-T. gondii IgG antibodies (21.15% vs. 5.45%, χ2 = 66.73, P < 0.01) were significantly higher in patients with type 2 diabetes mellitus than in healthy controls, while no significant difference was seen in the seroprevalence of anti-T. gondii IgM antibody between patients and controls (2.40% vs. 1.12%, χ2 = 2.96, P > 0.05). In addition, the overall seroprevalence of serum anti-T. gondii antibody (26.30% vs. 19.53%, χ2 = 4.98, P < 0.05) and the seroprevalence of anti-T. gondii IgG antibody (23.70% vs. 17.71%, χ2 = 4.20, P < 0.05) were both significantly higher in patients with gestational diabetes mellitus than in pregnant women without gestational diabetes mellitus, while no significant difference was seen in the seroprevalence of anti-T. gondii IgM antibody between pregnant women with and without gestational diabetes mellitus (2.60% vs. 1.82%, χ2 = 0.54, P > 0.05). CONCLUSIONS: The patients with diabetes mellitus present a higher seroprevalence rate of anti-T. gondii antibody than controls in Hangzhou City. Screening of T. gondii infections and health education pertaining to toxoplasmosis prevention and control knowledge should be reinforced in patients with diabetes mellitus.


Assuntos
Diabetes Mellitus Tipo 2 , Toxoplasma , Toxoplasmose , Anticorpos Antiprotozoários , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Imunoglobulina G , Imunoglobulina M , Gravidez , Fatores de Risco , Estudos Soroepidemiológicos , Toxoplasmose/complicações , Toxoplasmose/epidemiologia
6.
JNMA J Nepal Med Assoc ; 59(236): 305-309, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508529

RESUMO

INTRODUCTION: Dyslipidemia is highly prevalent among type 2 diabetic patients. It increases the risk of atherosclerosis and consequent mortality in diabetic patients. The aim of this study was to find out the prevalence of dyslipidemia among type 2 diabetic patients. METHODS: This was a descriptive cross-sectional study in 355 type 2 diabetic patients at tertiary care hospital from 15th May, 2020 to 15th November, 2020 after taking ethical clearence from Institutional Review Committee (Reference no. IRC-PA-052/2077-78). Convenience sampling was done. Demographic and lipid profile variables were recorded based on the structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Out of total 355 cases of type 2 Diabetes mellitus, prevalence of dyslipidemia was 224 (63.1%). It was more prevalent in male 145 (69.4%) than female 79 (54.1%). Increased Low density Lipoprotein (94.2%) was the most prevalent type followed by mixed dyslipidemia (91.1%). CONCLUSIONS: Dyslipidemia was common among type 2 diabetic patients and was higher in male gender, older age, obesity and longer duration of diabetes. Hence type 2 diabetic patient should undergo the routine monitoring of blood sugar and lipid profile so that any abnormalities can be identified and preventive measures along with interventions can be initiated at the earliest.


Assuntos
Diabetes Mellitus Tipo 2 , Dislipidemias , Idoso , Glicemia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Masculino , Centros de Atenção Terciária
7.
BMJ Case Rep ; 14(9)2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511416

RESUMO

Primary lung abscess as a complication of necrotising community-acquired pneumonia due to multidrug-resistant (MDR) Klebsiella pneumoniae is rare. A 63-year-old man with a medical history of type 2 diabetes mellitus and chronic kidney disease was diagnosed with lung abscess due to MDR Klebsiella pneumoniae, a rare organism as a causative agent for community-acquired pneumonia. This unusual case revealed therapeutic challenges faced owing to factors such as drug-resistant pathogen, longer duration of antibiotics required for lung abscess and the chronic kidney status of the patient limiting the dosage of antibiotics. The clinical nuggets discussed in this case might pave the way in the future for management guidelines to be formulated in optimising the selection and duration of therapy for lung abscesses with MDR aetiology and in early recognition of this rare but dreaded entity.


Assuntos
Infecções Comunitárias Adquiridas , Diabetes Mellitus Tipo 2 , Infecções por Klebsiella , Abscesso Pulmonar , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
8.
J Assoc Physicians India ; 69(6): 11-12, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34472785

RESUMO

BACKGROUND: The development of diabetic nephropathy demands an early detection aiming to decrease the incidence of end stage renal incidence. Podocyte injury is an essential element in the diabetic renal disease occurrence and progression. We attempted to identify podocyte markers in the urine of patients with and without overt diabetic nephropathy, in comparison with controls to diagnose early podocyte injury. METHODS: The study included Type 2 Diabetic individuals with 45 of them having normoalbuminuria, 40 patients with microalbuminuria and 40 of them with macroalbuminuria (based on the albumin-creatinine ratio - ACR) and 45 non diabetic healthy controls from a medical college hospital from South India. Urinary podocin quantification was done among all these patients and compared among the different groups of study, along with other parameters. RESULTS: The fasting blood sugar, post prandial sugar, glycosylated haemoglobin, triglyceride levels and the duration of diabetes along with systolic and diastolic blood pressure, body mass index, all seemed to be strong risk factors for the diabetic kidney disease progression showing a significant correlation with microalbumin, glomerular filtration rate and urine albumin-creatinine ratio. Podocin was excreted in the urine at higher concentrations among patients with ACR less than 30, ACR 30-299 and ACR more than 300 compared to healthy controls respectively (p < 0.001). The glomerular filtration rate showed significant negative correlation with the levels of podocin excreted in urine whereas urinary podocin positively correlated with the fasting blood sugar, post prandial sugar, glycosylated haemoglobin, triglyceride levels and the duration of diabetes along with systolic and diastolic blood pressure, body mass index, microalbumin and urine albumin-creatinine ratio. CONCLUSION: The urinary podocin can serve as an early marker for diabetic nephropathy as well as a marker of disease progression and severity among the patients with Type 2 Diabetes. The standard risk factors have to be identified early and controlled inorder to slow down the progression of diabetic kidney disease.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Proteínas de Membrana , Albuminúria/etiologia , Biomarcadores , Creatinina , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Rim , Proteínas de Membrana/urina , Prognóstico , Fatores de Risco
9.
Medicine (Baltimore) ; 100(35): e27126, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477156

RESUMO

ABSTRACT: Currently no research is available on muscle and functional performance of chronic obstructive pulmonary disease (COPD) patients with type 2 diabetes (T2DM) in China, even though both diseases have been reported to damage motor function.This single-center prospective study involves 55 males with COPD and T2DM and 46 males with COPD. Lung function, muscle strength and endurance of the upper limbs, and quadriceps strength of both legs were assessed using instruments. The 6-min walk (6MW) test was performed to evaluate physical performance.Between the two groups, respiratory function of COPD patients with T2DM was worse than in those without (P < .05). Mean handgrip strength and muscle endurance of upper limbs and mean quadriceps strength at both 60°/s and 120°/s in COPD males with T2DM was also significantly less (P < .05). Mean 6MW distances of COPD patients with T2DM were significantly worse (P < .05), and mean pulse rate (PR) increments of COPD patients with T2DM in 6MW test were significantly higher (P < .05).The combination of COPD and T2DM not only brings one more chronic disease to elderly patients but also significantly affects muscle strength and endurance as well as physical performance. Accordingly, in the management of chronic diseases, we recommend that clinicians as well as patients themselves actively control blood sugar and review them regularly with a view to reducing adverse effects on physical performance.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Desempenho Físico Funcional , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Músculo Quadríceps/fisiopatologia
10.
Medicine (Baltimore) ; 100(35): e27141, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477167

RESUMO

ABSTRACT: The aim of this study is to compare the endothelial cell density (ECD) and morphology between diabetic mellitus (DM) and nondiabetic patients at 1 year after phacoemulsification in operated eyes and nonoperated eyes.Evaluation was performed in 28 patients (56 eyes) with type 2 diabetes and 37 patients (74 eyes) without diabetes who underwent 1-year interval cataract surgery. Using a noncontact specular microscope and Scheimpflug rotating camera, corneal parameters were analyzed before and 1 year after surgery. Subgroups analysis was performed based on a disease duration 10 years and HbA1c concentration 7% and Pearson correlation analysis was performed.The mean change in ECD at 1 year after surgery was 13.28% in the DM group and 11.40% in the control group. In the fellow nonoperated eyes, the mean change was 4.47% and 3.63% in the DM and control groups, respectively. There was no significant difference in postoperative ECD, coefficient of variance, hexagonality, and central corneal thickness between 2 groups. In the subgroup analysis, the long disease duration DM group (≥10 years) had a significantly greater ECD loss than the control and short disease duration DM groups (<10 years). Blood urea nitrogen (BUN) showed a significant correlation with postoperative ECD change (r = -0.474, P = .011).The diabetic group with a longer disease duration showed significantly greater ECD decrease compared to the nondiabetic group and BUN correlated with ECD changes after phacoemulsification. Postoperative ECD loss may be high if the disease duration is long or if the BUN level is high.


Assuntos
Córnea/patologia , Diabetes Mellitus Tipo 2/patologia , Células Endoteliais , Facoemulsificação/efeitos adversos , Idoso , Catarata/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
J Am Podiatr Med Assoc ; 111(4)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478528

RESUMO

BACKGROUND: Ankle position sense may be reduced before the appearance of the clinical manifestation of diabetic peripheral neuropathy. This is known to impair gait and cause falls and foot ulcers. Early detection of impaired ankle proprioception is important because it allows physicians to prescribe an exercise program to patients to prevent foot complications. METHODS: Forty-six patients diagnosed as having type 2 diabetes mellitus and 22 control patients were included in the study. Presence of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Level of foot care awareness was determined using the Nottingham Assessment of Functional Footcare (NAFF). Joint position sense was measured using a dynamometer. RESULTS: Mean absolute angular error (MAAE) values were significantly higher in the neuropathy group compared with the control group (P < .05). Right plantarflexion MAAE values were significantly lower in the group without neuropathy compared with the group with neuropathy (P < .05). No correlation was found between MAAE values (indicating joint position sense) and age, educational level, disease duration, glycemic control, NAFF score, and MNSI history and examination scores in the groups with and without neuropathy (P > .05). Educational level and disease duration were found to be correlated with NAFF scores. CONCLUSIONS: Increased MNSI history scores and increased deficits in ankle proprioception demonstrate that diabetic foot complications associated with reduced joint position sense may be seen at an increased rate in symptomatic patients.


Assuntos
Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Tornozelo , Articulação do Tornozelo , Diabetes Mellitus Tipo 2/complicações , Humanos , Propriocepção
12.
Bone Joint J ; 103-B(9): 1497-1504, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465153

RESUMO

AIMS: Type 2 diabetes mellitus (T2DM) impairs bone strength and is a significant risk factor for hip fracture, yet currently there is no reliable tool to assess this risk. Most risk stratification methods rely on bone mineral density, which is not impaired by diabetes, rendering current tests ineffective. CT-based finite element analysis (CTFEA) calculates the mechanical response of bone to load and uses the yield strain, which is reduced in T2DM patients, to measure bone strength. The purpose of this feasibility study was to examine whether CTFEA could be used to assess the hip fracture risk for T2DM patients. METHODS: A retrospective cohort study was undertaken using autonomous CTFEA performed on existing abdominal or pelvic CT data comparing two groups of T2DM patients: a study group of 27 patients who had sustained a hip fracture within the year following the CT scan and a control group of 24 patients who did not have a hip fracture within one year. The main outcome of the CTFEA is a novel measure of hip bone strength termed the Hip Strength Score (HSS). RESULTS: The HSS was significantly lower in the study group (1.76 (SD 0.46)) than in the control group (2.31 (SD 0.74); p = 0.002). A multivariate model showed the odds of having a hip fracture were 17 times greater in patients who had an HSS ≤ 2.2. The CTFEA has a sensitivity of 89%, a specificity of 76%, and an area under the curve of 0.90. CONCLUSION: This preliminary study demonstrates the feasibility of using a CTFEA-based bone strength parameter to assess hip fracture risk in a population of T2DM patients. Cite this article: Bone Joint J 2021;103-B(9):1497-1504.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/etiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Casos e Controles , Estudos de Viabilidade , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
13.
Chem Biol Interact ; 347: 109617, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34391751

RESUMO

PURPOSE: This study was designed to investigate the mechanism of Dapagliflozin (Dapa) cardioprotection against diabetic cardiomyopathy (DCM). Structural and functional changes in the heart as well as decrease of erythropoietin (EPO) levels were reported in DCM. EPO simultaneously activates three pathways: the Janus-activated kinase-signal transducer and activator of transcription (JAK2/STAT5), phosphatidylinositol-3-kinase-Akt (PI3K/Akt), and extracellular signal-related kinase (ERK/MAPK) cascades, that result in proliferation and differentiation of cardiac cells. METHODS AND RESULTS: DCM was induced by a high fat diet for 10 weeks followed by administration of streptozotocin. After confirmation of diabetes, rats were divided randomly to 5 groups: Group 1; normal control group, Group 2; untreated diabetic group and Groups (3-5); diabetic groups received Dapa daily (0.75 mg, 1.5 or 3 mg/Kg, p.o) respectively for a month. At the end of the experiment, full anaesthesia was induced in all rats using ether inhalation and ECG was recorded. Blood samples were collected then rats were sacrificed and their heart were dissected out and processed for biochemical and histopathological studies. Untreated diabetic rats showed abnormal ECG pattern, elevation of serum cardiac enzymes, decrease EPO levels, downregulation of P-Akt, P-JAK2 and pMAPK pathways, abnormal histological structure of the heart and increase immunostaining intensity of P53 and TNF α in the cardiomyocytes. Dapa in a dose dependent manner attenuated the alterations in the previously mentioned parameters. CONCLUSION: The cardioprotective effect of Dapa could be mediated by increasing EPO levels and activation of P-Akt, P-JAK2 and pMAPK signalling cascades which in turn decrease apoptosis.


Assuntos
Compostos Benzidrílicos/uso terapêutico , Cardiotônicos/uso terapêutico , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Cardiomiopatias Diabéticas/tratamento farmacológico , Glucosídeos/uso terapêutico , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Animais , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Tipo 2/induzido quimicamente , Diabetes Mellitus Tipo 2/complicações , Cardiomiopatias Diabéticas/etiologia , Cardiomiopatias Diabéticas/metabolismo , Cardiomiopatias Diabéticas/patologia , Eletrocardiografia/efeitos dos fármacos , Eritropoetina/sangue , Eritropoetina/metabolismo , Masculino , Miocárdio/metabolismo , Miocárdio/patologia , Ratos Wistar , Estreptozocina
14.
J Transl Med ; 19(1): 355, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404433

RESUMO

BACKGROUND: Diabetic nephropathy (DN) is a leading cause of renal failure, whereas the effective and early diagnostic biomarkers are still lacking. METHODS: Fourteen cytokines and chemokines mRNA were detected in urinary extracellular vesicles (EVs) from the screening cohort including 4 healthy controls (HC), 4 diabetes mellitus (DM) and 4 biopsy-proven DN patients, and was validated in another 16 HC and 15 DM and 28 DN patients. Correlation analysis was performed between the candidate biomarkers and clinic parameters as well as kidney histological changes. The findings were also confirmed in DN rat model with single injection of STZ. RESULTS: The number of small EVs secreted in urine was increased in DN patients compared to DM patients and healthy controls, with expression of AQP1 (a marker of proximal tubules) and AQP2 (a marker of distal/collecting tubules). Small EVs derived CCL21 mRNA increased significantly in DN patients and correlated with level of proteinuria and eGFR. Interestingly, elevated CCL21 mRNA from urine small EVs was observed in DN patients with normal renal function and could discriminate early DN patients from DM more efficiently compared to eGFR and proteinuria. CCL21 also showed an accurate diagnostic ability in distinguishing incipient from overt DN. Histologically, CCL21 mRNA expression increased progressively with the deterioration of tubulointerstitial inflammation and showed the highest level in nodular sclerosis group (class III) in DN patients. Remarkable infiltration of CD3 positive T cells including both CD4 and CD8 positive T cell population were observed in DN patients with high-CCL21 expression. Besides, accumulation of CD3 positive T cells correlated with level of urinary small EVs derived CCL21 and co-localized with CCL21 in the tubulointerstitium in DN patients. Finally, the correlation of CCL21 expression in renal cortex and urinary small EVs was confirmed in STZ-induced DN rat model. CONCLUSIONS: Urinary small EVs derived CCL21 mRNA may serve as early biomarker for identifying DN linked with pathogenesis. CCL21 mRNA mediated T cell infiltration may constitute the key mechanism of chronic inflammation in DN.


Assuntos
Quimiocina CCL21 , Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Vesículas Extracelulares , Animais , Aquaporina 2 , Biomarcadores , Quimiocina CCL21/genética , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/genética , Humanos , RNA Mensageiro/genética , Ratos
15.
Nutrients ; 13(8)2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34444742

RESUMO

Type 2 diabetes is associated with an increased risk for sarcopenia. Moreover, sarcopenia correlates with increased risk for falls, fractures, and mortality. This study aimed to explore relationships among nutrient intakes, diet quality, and functional limitations in a sample of adults across levels of glycemic control. Data were examined from 23,487 non-institutionalized adults, 31 years and older, from the 2005-2016 National Health and Nutrition Examination Survey. Hemoglobin A1c (%) was used to classify level of glycemic control: non-diabetes (<5.7%); pre-diabetes (5.7-6.4%); diabetes (≥6.5%). Dietary data were collected from a single 24-h dietary recall. Participants were categorized as meeting or below the protein recommendation of 0.8 g/kg of body weight. Physical functioning was assessed across 19-discrete physical tasks. Adults below the protein recommendation consumed significantly more carbohydrate and had lower diet quality across all glycemic groups compared to those who met the protein recommendation (p < 0.001). Adults with diabetes who did not meet protein recommendations had significantly poorer diet quality and significantly higher mean number of functional limitations. A greater percent of adults with diabetes who did not meet the protein recommendation reported being physically limited for most activities, with more than half (52%) reporting limitations for stooping, crouching, and kneeling. This study underscores the potential for physical limitations associated with low protein intakes, especially in adults with diabetes. In the longer term, low protein intakes may result in increased risk of muscle loss, as protein intake is a critical nutritional factor for prevention of sarcopenia, functional limitations, and falls.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Dieta , Proteínas na Dieta , Valor Nutritivo , Desempenho Físico Funcional , Atividades Cotidianas , Diabetes Mellitus Tipo 2/complicações , Ingestão de Alimentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Necessidades Nutricionais , Sarcopenia/etiologia
16.
Lancet Diabetes Endocrinol ; 9(9): 595-605, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34358471

RESUMO

BACKGROUND: Visceral and ectopic fat are key drivers of adverse cardiometabolic outcomes in obesity. We aimed to evaluate the effects of injectable liraglutide 3·0 mg daily on body fat distribution in adults with overweight or obesity without type 2 diabetes at high cardiovascular disease risk. METHODS: In this randomised, double-blind, placebo-controlled, phase 4, single centre trial, we enrolled community-dwelling adults, recruited from the University of Texas Southwestern Medical Center, with BMI of at least 30 kg/m2 or BMI of at least 27 kg/m2 with metabolic syndrome but without diabetes and randomly assigned them, in a 1:1 ratio, to 40 weeks of treatment with once-daily subcutaneous liraglutide 3·0 mg or placebo, in addition to a 500 kcal deficient diet and guideline-recommended physical activity counselling. The primary endpoint was percentage reduction in visceral adipose tissue (VAT) measured with MRI. All randomly assigned participants with a follow-up imaging assessment were included in efficacy analyses and all participants who received at least one dose of study drug were included in the safety analyses. The trial is registered on ClinicalTrials.gov: NCT03038620. FINDINGS: Between July 20, 2017 and Feb 21, 2020 from 235 participants assessed for eligibility, 185 participants were randomly assigned (n=92 liraglutide, n=93 placebo) and 128 (n=73 liraglutide, n=55 placebo) were included in the final analysis (92% female participants, 37% Black participants, 24% Hispanic participants, mean age 50·2 years (SD 9·4), mean BMI 37·7 kg/m2). Mean change in VAT over median 36·2 weeks was -12·49% (SD 9·3%) with liraglutide compared with -1·63% (SD 12·3%) with placebo, estimated treatment difference -10·86% (95% CI -6·97 to -14·75, p<0·0001). Effects seemed consistent across subgroups of age, sex, race-ethnicity, BMI, and baseline prediabetes. The most frequently reported adverse events were gastrointestinal-related (43 [47%] of 92 with liraglutide and 12 [13%] of 93 with placebo) and upper respiratory tract infections (10 [11%] of 92 with liraglutide and 14 [15%] of 93 with placebo). INTERPRETATION: In adults with overweight or obesity at high cardiovascular disease risk, once-daily liraglutide 3·0 mg plus lifestyle intervention significantly lowered visceral adipose tissue over 40 weeks of treatment. Visceral fat reduction may be one mechanism to explain the benefits seen on cardiovascular outcomes in previous trials with liraglutide among patients with type 2 diabetes. FUNDING: NovoNordisk.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Gordura Intra-Abdominal/efeitos dos fármacos , Liraglutida/administração & dosagem , Obesidade/complicações , Sobrepeso/complicações , Adulto , Composição Corporal , Doenças Cardiovasculares , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
17.
BMC Psychiatry ; 21(1): 402, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389017

RESUMO

BACKGROUND: Patients with diabetes mellitus type 2 (DM2) and/or coronary heart disease (CHD) are at high risk to develop major depression. Preventing incident major depression may be an important tool in reducing the personal and societal burden of depression. The aim of the current study was to assess the cost-effectiveness of a stepped care program to prevent major depression (Step-Dep) in diabetes mellitus type 2 and/or coronary heart disease patients with subthreshold depression in comparison with usual care. METHODS: An economic evaluation with 12 months follow-up was conducted alongside a pragmatic cluster-randomized controlled trial from a societal perspective. Participants received care as usual (n = 140) or Step-Dep (n = 96) which consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to a general practitioner. Primary outcomes were quality-adjusted life years (QALYs) and cumulative incidence of major depression. Costs were measured every 3 months. Missing data was imputed using multiple imputation. Uncertainty around cost-effectiveness outcomes was estimated using bootstrapping and presented in cost-effectiveness planes and acceptability curves. RESULTS: There were no significant differences in QALYs or depression incidence between treatment groups. Secondary care costs (mean difference €1644, 95% CI €344; €3370) and informal care costs (mean difference €1930, 95% CI €528; €4089) were significantly higher in the Step-Dep group than in the usual care group. The difference in total societal costs (€1001, 95% CI €-3975; €6409) was not statistically significant. The probability of the Step-Dep intervention being cost-effective was low, with a maximum of 0.41 at a ceiling ratio of €30,000 per QALY gained and 0.32 at a ceiling ratio of €0 per prevented case of major depression. CONCLUSIONS: The Step-Dep intervention is not cost-effective compared to usual care in a population of patients with DM2/CHD and subthreshold depression. Therefore, widespread implementation cannot be recommended. TRIAL REGISTRATION: The trial was registered in the Netherlands Trial Register ( NTR3715 ).


Assuntos
Doença das Coronárias , Transtorno Depressivo Maior , Diabetes Mellitus Tipo 2 , Doença das Coronárias/complicações , Doença das Coronárias/prevenção & controle , Análise Custo-Benefício , Depressão/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Humanos , Atenção Primária à Saúde , Anos de Vida Ajustados por Qualidade de Vida
18.
Neuroscience ; 472: 25-34, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34333062

RESUMO

Studying the nonlinear synchronization of electroencephalogram (EEG) in type 2 diabetic mellitus (T2DM) to find the EEG characteristics related to cognitive impairment is beneficial to the early prevention and diagnosis of mild cognitive impairment. Correlation between probabilities of recurrence (CPR) is a nonlinear phase synchronization method based on recurrence and recurrence probability, which had shown its superiority in detecting epilepsy. In this study, CPR method was used for the first time to analyze the synchronization of eye-closed resting EEG signals with T2DM. The 27 participants were divided into amnesic mild cognitive impairment (aMCI) group (17 case) and control group (10 cases with age and education matched). The CPR values in two groups were statistically analyzed by Mann-Whitney U test, and the correlation between EEG synchronization and cognitive function was studied by Spearman's correlation. The results showed that aMCI group had lower CPR values at each electrode pair than control group, and two groups had decreased CPR values with the increase of the spatial distance of the electrode pair in inter hemispheric. The CPR values were significantly different in frontal, parietal and temporal regions in intra hemispheric between two groups. The CPR values of C3-F7, F4-C4 and FP2-T6 were significantly positively correlated with the MOCA values. This study showed that the synchronization values of EEG signals obtained by the CPR method were significantly different between aMCI and control group, and they were the EEG characteristics associated with cognitive impairment in T2DM.


Assuntos
Disfunção Cognitiva , Diabetes Mellitus Tipo 2 , Epilepsia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Diabetes Mellitus Tipo 2/complicações , Eletroencefalografia , Humanos , Descanso
20.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404640

RESUMO

Following non-elective orthopaedic surgery, a 61-year-old man with poorly controlled type 2 diabetes mellitus on empagliflozin developed high anion gap metabolic acidosis in the high-dependency unit. Metabolic acidosis persisted despite intravenous sodium bicarbonate, contributing to tachycardia and a run of non-sustained ventricular tachycardia. He was euglycaemic throughout hospital admission. Investigations revealed elevated urine and capillary ketones, and a diagnosis of sodium-glucose cotransporter-2 inhibitor-associated euglycaemic diabetic ketoacidosis was made. He was treated with an intravenous sliding scale insulin infusion and concurrent dextrose 5% with potassium chloride. Within 24 hours of treatment, his arterial pH, anion gap and serum bicarbonate levels normalised. After a further 12 hours, the intravenous insulin infusion was converted to a basal/bolus regimen of subcutaneous insulin, and he was transferred to the general ward. He was discharged well on subcutaneous insulin 6 days postoperatively.


Assuntos
Diabetes Mellitus Tipo 2 , Cetoacidose Diabética , Inibidores do Transportador 2 de Sódio-Glicose , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Cetoacidose Diabética/induzido quimicamente , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/tratamento farmacológico , Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Sódio , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos
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