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1.
World J Gastroenterol ; 27(30): 4939-4962, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34497428

RESUMO

Pancreatic cancer (PC) is often associated with a poor prognosis. Long-standing diabetes mellitus is considered as an important risk factor for its development. This risk can be modified by the use of certain antidiabetic medications. On the other hand, new-onset diabetes can signal towards an underlying PC in the elderly population. Recently, several attempts have been made to develop an effective clinical tool for PC screening using a combination of history of new-onset diabetes and several other clinical and biochemical markers. On the contrary, diabetes affects the survival after treatment for PC. We describe this intimate and complex two-way relationship of diabetes and PC in this review by exploring the underlying pathogenesis.


Assuntos
Diabetes Mellitus , Neoplasias Pancreáticas , Idoso , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Detecção Precoce de Câncer , Humanos , Hipoglicemiantes/uso terapêutico , Neoplasias Pancreáticas/epidemiologia , Fatores de Risco
2.
Ann Palliat Med ; 10(8): 8746-8752, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488364

RESUMO

BACKGROUND: The early diagnosis and treatment of diabetes mellitus has significant clinical benefits. However, the current diagnostic tools available for community-based populations are limited. This study sought to evaluate the clinical benefits of combining serum 1,5-anhydroglucitol (1,5-AG) with fasting plasma glucose (FPG) to detect diabetes in a community-based population with hypertension. METHODS: A total of 359 subjects were enrolled in this diagnostic study, all of whom underwent a 75-g oral glucose tolerance test (OGTT). Venous blood samples were collected to measure FPG, 2 h postprandial plasma glucose (2h-PG), and hemoglobin A1c (HbA1c). Serum 1,5-AG levels were tested using the Glycomark assay, and a receiver operating characteristic (ROC) curve was used to assess the diagnostic value of this tool for diabetes and determine the optimal cut-point value to provide the maximum Youden's index. A Spearman correlation analysis was performed to analyze the relationship between 1,5-AG and other indexes. RESULTS: A total of 102 participants were diagnosed with diabetes, indicating a prevalence of 28.4% in the community-based population. The Spearman correlation analysis showed that 1,5-AG was negatively correlated with FPG and 2h-PG (r=-0.367 and -0.487, respectively; both P<0.05). For the estimation of 2h-PG ≥11.1 mmol/L using 1,5-AG, the area under the curve (AUC) for the ROC analysis was 0.850 (95% confidence interval: 0.809-0.891). The corresponding optimal cut-off for 1,5-AG was 13.23 µg/mL, which yielded a sensitivity of 89.7% and a specificity of 73.5%. Compared with FPG alone, FPG combined with 1,5-AG had a higher sensitivity for detecting diabetes (97.1% vs. 47.1%; P<0.001). CONCLUSIONS: FPG combined with 1,5-AG substantially improved the sensitivity in detecting diabetes relative to FPG alone in a community-based population with hypertension, and may be a simple and efficient tool for screening diabetes.


Assuntos
Diabetes Mellitus , Hipertensão , Glicemia , Desoxiglucose , Diabetes Mellitus/diagnóstico , Jejum , Humanos , Hipertensão/diagnóstico
3.
Front Endocrinol (Lausanne) ; 12: 688071, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34489863

RESUMO

Coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to scale and threaten human health and public safety. It is essential to identify those risk factors that lead to a poor prognosis of the disease. A predisposing host genetic background could be one of these factors that explain the interindividual variability to COVID-19 severity. Thus, we have studied whether the rs4341 and rs4343 polymorphisms of the angiotensin converting enzyme (ACE) gene, key regulator of the renin-aldosterone-angiotensin system (RAAS), could explain the different outcomes of 128 COVID-19 patients with diverse degree of severity (33 asymptomatic or mildly symptomatic, 66 hospitalized in the general ward, and 29 admitted to the ICU). We found that G allele of rs4341 and rs4343 was associated with severe COVID-19 in hypertensive patients, independently of gender (p<0.05). G-carrier genotypes of both polymorphisms were also associated with higher mortality (p< 0.05) and higher severity of COVID-19 in dyslipidemic (p<0.05) and type 2 diabetic patients (p< 0.01). The association of G alleles with disease severity was adjusted for age, sex, BMI and number of comorbidities, suggesting that both the metabolic comorbidities and the G allele act synergistically on COVID-19 outcome. Although we did not find a direct association between serum ACE levels and COVID-19 severity, we found higher levels of ACE in the serum of patients with the GG genotype of rs4341 and rs4343 (p<0.05), what could explain the higher susceptibility to develop severe forms of the disease in patients with the GG genotype, in addition to hypertension and dyslipidemia. In conclusion, our preliminary study suggests that the G-containing genotypes of rs4341 and rs4343 confer an additional risk of adverse COVID-19 prognosis. Thus, rs4341 and rs4343 polymorphisms of ACE could be predictive markers of severity of COVID-19 in those patients with hypertension, dyslipidemia or diabetes. The knowledge of these genetic data could contribute to precision management of SARS-CoV-2 infected patients when admitted to hospital.


Assuntos
COVID-19/genética , Diabetes Mellitus/genética , Dislipidemias/genética , Variação Genética/genética , Hipertensão/genética , Peptidil Dipeptidase A/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-34353880

RESUMO

INTRODUCTION: Early detection and treatment of diabetes as well as its prevention help lessen longer-term complications. We determined the prevalence of pre-diabetes and undiagnosed diabetes in the UK Biobank and standardized the results to the UK general population. RESEARCH DESIGN AND METHODS: This cross-sectional study analyzed baseline UK Biobank data on plasma glycated hemoglobin (HbA1c) to compare the prevalence of pre-diabetes and undiagnosed diabetes mellitus in white, South Asian, black, and Chinese participants. The overall and ethnic-specific results were standardized to the UK general population aged 40-70 years of age. RESULTS: Within the UK Biobank, the overall crude prevalence was 3.6% for pre-diabetes, 0.8% for undiagnosed diabetes, and 4.4% for either. Following standardization to the UK general population, the results were similar at 3.8%, 0.8%, and 4.7%, respectively. Crude prevalence was much higher in South Asian (11.0% pre-diabetes; 3.6% undiagnosed diabetes; 14.6% either) or black (13.8% pre-diabetes; 3.0% undiagnosed diabetes; 16.8% either) participants. Only six middle-aged or old-aged South Asian individuals or seven black would need to be tested to identify an HbA1c result that merits action. CONCLUSIONS: Single-stage population screening for pre-diabetes or undiagnosed diabetes in middle-old or old-aged South Asian and black individuals using HbA1c could be efficient and should be considered.


Assuntos
Bancos de Espécimes Biológicos , Diabetes Mellitus , Grupos Étnicos , Hemoglobina A Glicada , Estado Pré-Diabético , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Hemoglobina A Glicada/análise , Humanos , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/etnologia , Prevalência , Reino Unido/epidemiologia
5.
Ann Clin Lab Sci ; 51(4): 535-539, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34452892

RESUMO

OBJECTIVE: Routine monitoring of hemoglobin A1c (HbA1c) is the standard of care in diabetes mellitus (DM), but adhering to regular laboratory appointments may be challenging when access to care is limited, such as during the initial wave of the COVID-19 pandemic in the United States in 2020. MATERIALS: We evaluated trends in patient encounters and laboratory testing for DM in a pediatric healthcare system from March to September 2019 and during the same period in 2020. RESULTS: Evaluation of 17,367 patient encounters illustrated that the pandemic was associated with significantly fewer in-person office visits and point-of-care HbA1c tests for patients with DM in 2020 relative to 2019. A separate analysis of 7,193 HbA1c results measured by point-of-care testing in the general population found a significant increase in the number of measured HbA1c >14 % in May 2020 relative to 2019, but other measured HbA1c values did not differ. As a means to address lapses in the monitoring of HbA1c due to the pandemic, we evaluated the use of the dried blood spot (DBS) matrix for measurement of HbA1c by the Vitros 5600 chemistry analyzer. DBS HbA1c was well correlated to whole blood (r=0.9889) and exhibited intra- and inter-assay precision from 0.5-3.5%. CONCLUSION: DBS measurement of HbA1c presents a viable alternative to routine in-person laboratory monitoring of DM.


Assuntos
Coleta de Amostras Sanguíneas/métodos , COVID-19/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Teste em Amostras de Sangue Seco/tendências , Hemoglobina A Glicada/análise , Telemedicina/tendências , Adolescente , Adulto , Idoso , COVID-19/prevenção & controle , Criança , Pré-Escolar , Diabetes Mellitus/diagnóstico , Teste em Amostras de Sangue Seco/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Telemedicina/métodos , Estados Unidos/epidemiologia , Adulto Jovem
6.
Artif Intell Med ; 118: 102120, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34412843

RESUMO

BACKGROUND AND AIM: Hypoglycaemia prediction play an important role in diabetes management being able to reduce the number of dangerous situations. Thus, it is relevant to present a systematic review on the currently available prediction algorithms and models for hypoglycaemia (or hypoglycemia in US English) prediction. METHODS: This study aims to systematically review the literature on data-based algorithms and models using diabetics real data for hypoglycaemia prediction. Five electronic databases were screened for studies published from January 2014 to June 2020: ScienceDirect, IEEE Xplore, ACM Digital Library, SCOPUS, and PubMed. RESULTS: Sixty-three eligible studies were retrieved that met the inclusion criteria. The review identifies the current trend in this topic: most of the studies perform short-term predictions (82.5%). Also, the review pinpoints the inputs and shows that information fusion is relevant for hypoglycaemia prediction. Regarding data-based models (80.9%) and hybrid models (19.1%) different predictive techniques are used: Artificial neural network (22.2%), ensemble learning (27.0%), supervised learning (20.6%), statistic/probabilistic (7.9%), autoregressive (7.9%), evolutionary (6.4%), deep learning (4.8%) and adaptative filter (3.2%). Artificial Neural networks and hybrid models show better results. CONCLUSIONS: The data-based models for blood glucose and hypoglycaemia prediction should be able to provide a good balance between the applicability and performance, integrating complementary data from different sources or from different models. This review identifies trends and possible opportunities for research in this topic.


Assuntos
Diabetes Mellitus , Hipoglicemia , Algoritmos , Glicemia , Bases de Dados Factuais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia
7.
Cardiovasc Diabetol ; 20(1): 162, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348706

RESUMO

In a cohort study performed using primary care databases in a General Practitioners Network, Groenewegen et al. report a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably heart failure (Groenewegen et al. in Cardiovasc Diabetol 20:123, 2021). However, no mention is made of body mass index and hypertension in the methods or in the results. Obesity is linked to hypertension and hypertension is a major risk factor for all cardiovascular diseases, and prospective studies have shown that obesity and hypertension contribute significantly to atrial fibrillation in persons with diabetes. The data would be improved by assessing the role of obesity and of hypertension in the incidence of heart diseases in these patients. This would also lead to a better and personalized treatment of patients with diabetes, for instance through weight loss and intensification of treatment of hypertension, to modify the incidence of atrial fibrillation, ischaemic heart disease and heart failure.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Cardíaca , Hipertensão , Isquemia Miocárdica , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Incidência , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Estudos Prospectivos , Fatores de Risco
8.
Endocrinol Metab (Seoul) ; 36(4): 800-809, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34418914

RESUMO

BACKGROUND: Based on recent evidence on the importance of the presence of diabetes mellitus (DM) and fibrosis-4 (FIB-4) index in coronavirus disease 2019 (COVID-19) mortality, we analyzed whether these factors could additively predict such mortality. METHODS: This multicenter observational study included 1,019 adult inpatients admitted to university hospitals in Daegu. The demographic and laboratory findings, mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM and/or a high FIB-4 index. The mortality risk and corresponding hazard ratio (HR) were analyzed using the Kaplan-Meier method and Cox proportional hazard models. RESULTS: The patients with DM (n=217) exhibited significantly higher FIB-4 index and mortality compared to those without DM. Although DM (HR, 2.66; 95% confidence interval [CI], 1.63 to 4.33) and a high FIB-4 index (HR, 4.20; 95% CI, 2.21 to 7.99) were separately identified as risk factors for COVID-19 mortality, the patients with both DM and high FIB-4 index had a significantly higher mortality (HR, 9.54; 95% CI, 4.11 to 22.15). Higher FIB-4 indices were associated with higher mortality regardless of DM. A high FIB-4 index with DM was more significantly associated with a severe clinical course with mortality (odds ratio, 11.24; 95% CI, 5.90 to 21.41) than a low FIB-4 index without DM, followed by a high FIB-4 index alone and DM alone. The duration of quarantine and hospital stay also tended to be longer in those with both DM and high FIB-4 index. CONCLUSION: Both DM and high FIB-4 index are independent and additive risk factors for COVID-19 mortality.


Assuntos
COVID-19/diagnóstico , COVID-19/mortalidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Adulto , Idoso , COVID-19/terapia , Diabetes Mellitus/terapia , Feminino , Humanos , Cirrose Hepática/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
9.
Comput Intell Neurosci ; 2021: 5573179, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34462631

RESUMO

Today, diabetes is one of the most prevalent, chronic, and deadly diseases in the world owing to some complications. If accurate early diagnosis is feasible, the risk factor and incidence of diabetes may be greatly decreased. Diabetes prediction is stable and reliable, since there are only minimal labelling evidence and outliers found in the datasets of diabetes. Numerous works coped with diabetes disease prediction and provided the solution. But the existing methods proffered low accuracy detection and consumed more training time. So, this paper proposed an OWDANN algorithm for diabetes mellitus disease prediction and severity level estimation. The proposed system mainly consists of two phases, namely, disease prediction and severity level estimation phase. In the disease prediction phase, the preprocessing is performed for the Pima dataset. Then, the features are extracted from the preprocessed data, and finally, the classification step is performed by using OWDANN. In the severity level estimation phase, the diabetes positive dataset is preprocessed first. Then, the features are extracted, and lastly, the severity level is predicted using GDHC. The extensive experimental results showed that the proposed system outperforms with 98.97% accuracy, 94.98% sensitivity, 95.62% specificity, 97.02% precision, 93.84% recall, 9404% f-measure, 0.094% FDR, and 0.023% FPR compared with the state-of-the-art methods.


Assuntos
Algoritmos , Diabetes Mellitus , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Humanos
10.
Neurology ; 97(8): e836-e848, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34210821

RESUMO

OBJECTIVE: To assess the role of biomarkers of Alzheimer disease (AD), neurodegeneration, and small vessel disease (SVD) as mediators in the association between diabetes mellitus and cognition. METHODS: The study sample was derived from MEMENTO, a cohort of French adults recruited in memory clinics and screened for either isolated subjective cognitive complaints or mild cognitive impairment. Diabetes was defined based on blood glucose assessment, use of antidiabetic agent, or self-report. We used structural equation modeling to assess whether latent variables of AD pathology (PET mean amyloid uptake, Aß42/Aß40 ratio, and CSF phosphorylated tau), SVD (white matter hyperintensities volume and visual grading), and neurodegeneration (mean cortical thickness, brain parenchymal fraction, hippocampal volume, and mean fluorodeoxyglucose uptake) mediate the association between diabetes and a latent variable of cognition (5 neuropsychological tests), adjusting for potential confounders. RESULTS: There were 254 (11.1%) participants with diabetes among 2,288 participants (median age 71.6 years; 61.8% women). The association between diabetes and lower cognition was significantly mediated by higher neurodegeneration (standardized indirect effect: -0.061, 95% confidence interval: -0.089, -0.032), but not mediated by SVD and AD markers. Results were similar when considering latent variables of memory or executive functioning. CONCLUSION: In a large clinical cohort in the elderly, diabetes is associated with lower cognition through neurodegeneration, independently of SVD and AD biomarkers.


Assuntos
Doença de Alzheimer/diagnóstico , Doenças de Pequenos Vasos Cerebrais/diagnóstico , Disfunção Cognitiva/diagnóstico , Diabetes Mellitus/diagnóstico , Degeneração Neural/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/metabolismo , Doença de Alzheimer/fisiopatologia , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Biomarcadores , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Doenças de Pequenos Vasos Cerebrais/metabolismo , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/metabolismo , Disfunção Cognitiva/fisiopatologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/metabolismo , Diabetes Mellitus/fisiopatologia , Feminino , França/epidemiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Degeneração Neural/epidemiologia , Degeneração Neural/metabolismo , Degeneração Neural/fisiopatologia , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons
11.
Cardiovasc Diabetol ; 20(1): 140, 2021 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246277

RESUMO

BACKGROUND: The pleiotropic effects of statins may reduce the severity of COVID-19 disease. This study aims to determine the association between inpatient statin use and severe disease outcomes among hospitalized COVID-19 patients, especially those with Diabetes Mellitus (DM). RESEARCH DESIGN AND METHODS: A retrospective cohort study on hospitalized patients with confirmed COVID-19 diagnosis. The primary outcome was mortality during hospitalization. Patients were classified into statin and non-statin groups based on the administration of statins during hospitalization. Analysis included multivariable regression analysis adjusting for confounders and propensity score matching to achieve a 1:1 balanced cohort. Subgroup analyses based on presence of DM were conducted. RESULTS: In the cohort of 922 patients, 413 had a history of DM. About 27.1% patients (n = 250) in the total cohort (TC) and 32.9% patients (n = 136) in DM cohort received inpatient statins. Atorvastatin (n = 205, 82%) was the most commonly prescribed statin medication in TC. On multivariable analysis in TC, inpatient statin group had reduced mortality compared to the non-statin group (OR, 0.61; 95% CI, 0.42-0.90; p = 0.01). DM modified this association between inpatient statins and mortality. Patients with DM who received inpatient statins had reduced mortality (OR, 0.35; 95% CI, 0.21-0.61; p < 0.001). However, no such association was noted among patients without DM (OR, 1.21; 95% CI, 0.67-2.17; p = 0.52). These results were further validated using propensity score matching. CONCLUSIONS: Inpatient statin use was associated with significant reduction in mortality among COVID-19 patients especially those with DM. These findings support the pursuit of randomized clinical trials and inpatient statin use appears safe among COVID-19 patients.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/mortalidade , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/mortalidade , Hospitalização/tendências , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , COVID-19/diagnóstico , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
12.
BMC Geriatr ; 21(1): 438, 2021 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-34301190

RESUMO

BACKGROUND: Family-centered care, as a contemporary model of health service delivery, involves a mutually beneficial partnership between healthcare providers, patients and their families. Although evidence on the positive effects of family-centered care on older adults and their families is accumulating, less is known about the providers' beliefs, attitudes and practices related to family-centeredness, especially regarding community-based primary healthcare services for the rapidly-ageing Chinese population. METHODS: This study investigated Chinese primary care providers' perceptions and experiences of family-centered care for older adults, using community-based diabetes management services as an example. Ten focus-group interviews involving 48 community health professionals were conducted. Major themes were identified using thematic analysis. RESULTS: The interviews revealed that the providers acknowledged the importance of the family in older patients' diabetes management, while their current scope of practice with the patients' families was limited and informal. The barriers to implementing family-centered care were attributed to structural and environmental obstacles associated with the patients' families and the community healthcare context and culture. To engage patients' families more effectively, the providers suggested that family-centered values endorsed by their healthcare organizations and reinforced by policies, a trained interdisciplinary team of health professionals and community social workers, and also that the utilization of technology would be beneficial. CONCLUSIONS: Our study extends the evidence of family-centered care for older adults in Chinese community-based healthcare settings, contributing to the design of a tailored healthcare delivery model embodying ageing in place.


Assuntos
Diabetes Mellitus , Vida Independente , Idoso , China/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Pessoal de Saúde , Humanos , Assistência Centrada no Paciente , Percepção , Atenção Primária à Saúde , Pesquisa Qualitativa
13.
BMC Geriatr ; 21(1): 445, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34325672

RESUMO

BACKGROUND: Diabetes is a major concern for the global health burden. This study aimed to investigate the relationship between handgrip strength (HGS) and the risk of new-onset diabetes and to compare the predictive abilities between relative HGS and dominant HGS. METHODS: This longitudinal study used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including 66,100 European participants aged 50 years or older free of diabetes at baseline. The Cox proportional hazard model was used to analyze the relationship between HGS and diabetes, and the Harrell's C index, net reclassification index (NRI), and integrated discrimination improvement (IDI) were calculated to evaluate the predictive abilities of different HGS expressions. RESULTS: There were 5,661 diabetes events occurred during follow-up. Compared with individuals with lowest quartiles, the hazard ratios (95 % confidence intervals) of the 2nd-4th quartiles were 0.88 (0.81-0.94), 0.82 (0.76-0.89) and 0.85 (0.78-0.93) for dominant HGS, and 0.95 (0.88-1.02), 0.82 (0.76-0.89) and 0.60 (0.54-0.67) for relative HGS. After adding dominant HGS to an office-based risk score (including age, gender, body mass index, smoking, and hypertension), the incremental values of the Harrell's C index, NRI, IDI of relative HGS were all slightly higher than those of dominant HGS in both training and validation sets. CONCLUSIONS: Our findings supported that HGS was an independent predictor of new-onset diabetes in the middle-aged and older European population. Moreover, relative HGS exhibited a slightly higher predictive ability than dominant HGS.


Assuntos
Diabetes Mellitus , Aposentadoria , Idoso , Envelhecimento , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Força da Mão , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade
14.
Front Public Health ; 9: 626331, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34268283

RESUMO

Purpose: We aimed to establish and validate a risk assessment system that combines demographic and clinical variables to predict the 3-year risk of incident diabetes in Chinese adults. Methods: A 3-year cohort study was performed on 15,928 Chinese adults without diabetes at baseline. All participants were randomly divided into a training set (n = 7,940) and a validation set (n = 7,988). XGBoost method is an effective machine learning technique used to select the most important variables from candidate variables. And we further established a stepwise model based on the predictors chosen by the XGBoost model. The area under the receiver operating characteristic curve (AUC), decision curve and calibration analysis were used to assess discrimination, clinical use and calibration of the model, respectively. The external validation was performed on a cohort of 11,113 Japanese participants. Result: In the training and validation sets, 148 and 145 incident diabetes cases occurred. XGBoost methods selected the 10 most important variables from 15 candidate variables. Fasting plasma glucose (FPG), body mass index (BMI) and age were the top 3 important variables. And we further established a stepwise model and a prediction nomogram. The AUCs of the stepwise model were 0.933 and 0.910 in the training and validation sets, respectively. The Hosmer-Lemeshow test showed a perfect fit between the predicted diabetes risk and the observed diabetes risk (p = 0.068 for the training set, p = 0.165 for the validation set). Decision curve analysis presented the clinical use of the stepwise model and there was a wide range of alternative threshold probability spectrum. And there were almost no the interactions between these predictors (most P-values for interaction >0.05). Furthermore, the AUC for the external validation set was 0.830, and the Hosmer-Lemeshow test for the external validation set showed no statistically significant difference between the predicted diabetes risk and observed diabetes risk (P = 0.824). Conclusion: We established and validated a risk assessment system for characterizing the 3-year risk of incident diabetes.


Assuntos
Diabetes Mellitus , Aprendizado de Máquina , Adulto , China/epidemiologia , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Humanos , Distribuição Aleatória , Medição de Risco
15.
Front Endocrinol (Lausanne) ; 12: 649525, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34220706

RESUMO

The relationship between COVID-19 and diabetes mellitus is complicated and bidirectional. On the one hand, diabetes mellitus is considered one of the most important risk factors for a severe course of COVID-19. Several factors that are often present in diabetes mellitus are likely to contribute to this risk, such as older age, a proinflammatory and hypercoagulable state, hyperglycemia and underlying comorbidities (hypertension, cardiovascular disease, chronic kidney disease and obesity). On the other hand, a severe COVID-19 infection, and its treatment with steroids, can have a specific negative impact on diabetes itself, leading to worsening of hyperglycemia through increased insulin resistance and reduced ß-cell secretory function. Worsening hyperglycemia can, in turn, adversely affect the course of COVID-19. Although more knowledge gradually surfaces as the pandemic progresses, challenges in understanding the interrelationship between COVID-19 and diabetes remain.


Assuntos
COVID-19/etiologia , COVID-19/patologia , Diabetes Mellitus , COVID-19/diagnóstico , COVID-19/epidemiologia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/patologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Diabetes Mellitus/virologia , Progressão da Doença , Humanos , Pandemias , Prognóstico , Fatores de Risco , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença
16.
Vasc Health Risk Manag ; 17: 389-394, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262283

RESUMO

Background: The World Health Organization (WHO) proposed the integrated care for older people (ICOPE) screening tool to identify functional impairment. We explore the association of geriatric functional impairment and hypertension, diabetes, dyslipidemia in the community-dwelling elderly. Methods: We enrolled individuals aged at least 65 with hypertension, diabetes, or dyslipidemia; or those aged at least 75 from May to July 2019. We applied ICOPE tools to evaluate six function assessments: cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms. Factors were analyzed using stepwise multivariable linear regression for ICOPE scores and logistic regression for geriatric functional impairment. All analyses were adjusted for age and glomerular filtration rate. Results: We enrolled 457 participants including 303 (66.3%) participants with hypertension, 296 (64.8%) diabetes, and 221 (48.4%) dyslipidemia. Seventy-eight (17.1%) participants have at least one geriatric functional impairment, including 41 (25.9%) participants aged ≥ 75 and 37 (12.4%) aged 65-74. The ICOPE score (0.4 ± 0.6) of participants aged at least 75 was higher than that (0.1 ± 0.4) of the participants aged 65-74 (p < 0.001). Dyslipidemia (p = 0.002) was positively associated with ICOPE score. Dyslipidemia (odds ratio: 2.15, 95% confidence interval: 1.27-3.70, p = 0.005), not hypertension (p = 0.3) and diabetes (p = 0.9), was associated with geriatric functional impairment. Visual impairment was the most common function impairment. Female was linked to limited mobility, renal function was associated with mobility (p < 0.001) and nutrition (p = 0.02). Conclusion: Dyslipidemia but not hypertension, diabetes is linked to geriatric functional impairment in community-dwelling elderly. Lower renal function is associated with decreased mobility and nutrition. More studies are needed to determine if treatment of dyslipidemia reduces geriatric functional impairment.


Assuntos
Dislipidemias/diagnóstico , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Vida Independente , Afeto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/psicologia , Dislipidemias/fisiopatologia , Dislipidemias/psicologia , Dislipidemias/terapia , Feminino , Fragilidade/fisiopatologia , Fragilidade/psicologia , Fragilidade/terapia , Estado Funcional , Taxa de Filtração Glomerular , Audição , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/psicologia , Rim/fisiopatologia , Masculino , Saúde Mental , Limitação da Mobilidade , Estado Nutricional , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Visão Ocular
17.
Lancet ; 398(10296): 238-248, 2021 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-34274065

RESUMO

BACKGROUND: The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings. METHODS: In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5-22·9 kg/m2], upper-normal [23·0-24·9 kg/m2], overweight [25·0-29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region. FINDINGS: Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6-27·8), of obesity was 21·0% (19·6-22·5), and of diabetes was 9·3% (8·4-10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5-22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35-44 years and in men aged 25-34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean. INTERPRETATION: The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. FUNDING: Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.


Assuntos
Índice de Massa Corporal , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus , Obesidade/epidemiologia , Adulto , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Saúde Global , Hemoglobina A Glicada/análise , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , Prevalência
18.
Int J Mol Sci ; 22(11)2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34205870

RESUMO

Diabetic patients are predisposed to diabetic cardiomyopathy, a specific form of cardiomyopathy which is characterized by the development of myocardial fibrosis, cardiomyocyte hypertrophy, and apoptosis that develops independently of concomitant macrovascular and microvascular diabetic complications. Its pathophysiology is multifactorial and poorly understood and no specific therapeutic guideline has yet been established. Diabetic cardiomyopathy is a challenging diagnosis, made after excluding other potential entities, treated with different pharmacotherapeutic agents targeting various pathophysiological pathways that need yet to be unraveled. It has great clinical importance as diabetes is a disease with pandemic proportions. This review focuses on the potential mechanisms contributing to this entity, diagnostic options, as well as on potential therapeutic interventions taking in consideration their clinical feasibility and limitations in everyday practice. Besides conventional therapies, we discuss novel therapeutic possibilities that have not yet been translated into clinical practice.


Assuntos
Diabetes Mellitus/fisiopatologia , Cardiomiopatias Diabéticas/fisiopatologia , Fibrose/fisiopatologia , Miocárdio/patologia , Apoptose/genética , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Cardiomiopatias Diabéticas/diagnóstico , Cardiomiopatias Diabéticas/terapia , Fibrose/diagnóstico , Fibrose/terapia , Humanos
19.
Analyst ; 146(16): 5074-5080, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34318784

RESUMO

Diabetes mellitus has received much attention because its complications include liver, kidney, eye, heart and cerebrovascular diseases. Thus, it would be highly significant to develop a rapid and efficient method for glucose detection in biological samples. In this work, a point-of-care testing (POCT) method of glucose detection was proposed using a standard colorimetric card for semi-quantitative determination patterns. In the prepared fluorescence color card for glucose, a good linear relationship was acquired by plotting the ratio of the grayscale value (I/I0) versus the logarithm of glucose concentration within 100.0 to 1000.0 µmol L-1, and the LOD of glucose detection was 1.1 µmol L-1. A large number of actual samples (30 serum and 7 urine) were analyzed and the results demonstrated that this method had good potential to be applied in the primary screening of diabetic patients. In addition, this method is universal and can be applied in the simultaneous detection of multiple small molecules. It provides a new strategy for the primary screening of multiple diseases simultaneously, which presents excellent application potential.


Assuntos
Diabetes Mellitus , Testes Imediatos , Colorimetria , Diabetes Mellitus/diagnóstico , Glucose , Humanos , Sistemas Automatizados de Assistência Junto ao Leito
20.
J Anal Toxicol ; 45(8): 878-884, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34086901

RESUMO

The aim of the study is to evaluate the contribution of ethanol metabolite detection in postmortem cases by showing the connection between the presence of ethanol metabolites, which are indicators of alcohol consumption, and the detection of potential postmortem ethanol formation in decomposed and diabetic cases. Determination of ethanol consumption before death is often one of the most important questions in death investigations. Postmortem ethanol formation or degradation products in the blood make it difficult to distinguish antemortem consumption or postmortem formation of ethanol and eventually may lead to misinterpretation. Decomposed bodies and diabetic cases are vulnerable to postmortem ethanol formation due to putrefaction, fermentation or other degradations. Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are two metabolites of ethanol produced only in the antemortem time interval. In this study, EtG and EtS levels in urine and vitreous humor samples of 27 postmortem cases, including diabetic and degraded bodies were compared to ethanol results of their blood, urine and vitreous humor samples. EtG and EtS in urine and vitreous humor were analyzed by liquid chromatography-tandem mass spectrometry, and ethanol was assayed by routine headspace gas chromatography-flame ionization detector. These cases were devoid of other influences from forensically relevant drugs, so ethanol and/or glucose were among the only positive findings in these cases. The results of this pilot study indicate the postmortem ethanol concentrations do not correlate with the measured EtG and EtS values but are beneficial in rulings of accidental or natural deaths. This preliminary study gives additional data to help distinguish between antemortem ethanol intake and postmortem formation. EtG and EtS were well correlated positively with antemortem ethanol use instead of forming spontaneously in samples from decedents who are decomposing or have a history of diabetic hyperglycemia.


Assuntos
Diabetes Mellitus , Espectrometria de Massas em Tandem , Consumo de Bebidas Alcoólicas , Biomarcadores , Diabetes Mellitus/diagnóstico , Cromatografia Gasosa-Espectrometria de Massas , Glucuronatos/análise , Humanos , Projetos Piloto , Ésteres do Ácido Sulfúrico
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