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1.
Wiad Lek ; 72(9 cz 2): 1723-1726, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622254

RESUMO

OBJECTIVE: Introduction: Chronic hyperglycemia as the main link in DM pathogenesis leads to systemic vessels and nerves lesion with chronic bone complications development consequently. The aim: To evaluate influence of hyperglycemia on reparative osteogenesis after perforated tibial fracture in rats. PATIENTS AND METHODS: Materials and methods: A total of 30 white adult rats were subdivided into two groups: 15 healthy rats in Group 1 (control) and 15 rats with alloxan induced hyperglycemia in Group 2 (investigated) and were carried out of experiment on the 10th, 20th and 30th day after the fracture. Hyperglycemia in rats was verificated as the postprandial glycemic rate ≥ 8,0 mmol/l. Tibia diaphysis fracture was modeled by a cylindrical defect with a diameter of 2 mm with portable frezer. Morphological evaluation. A complex morphological studies included histological, morphometric and immunohistochemical examination. RESULTS: Results: This is confirmed by an increase in MMP-9 expression in connective tissue, a decrease in TGF-ß expression in all phases, an increase in the expression of CD3 and CD20 and a marked decrease in the expression of all vascular markers. During hyperglycemia, incomplete blood supply to the tissues occurs, necrosis of bone and soft tissues develop in the area of the fracture, the reparative reaction slows down considerably and manifests itself in the development of fibrous and, less commonly, cartilage tissue. CONCLUSION: Conclusions: In hyperglycemia rats, there was a delay in the callus formation, a decrease in proliferation and ossification, and a slowdown in the processes of angiogenesis.


Assuntos
Diabetes Mellitus/fisiopatologia , Osteogênese , Fraturas da Tíbia/complicações , Animais , Antígenos CD20/metabolismo , Osso e Ossos , Calo Ósseo , Complexo CD3/metabolismo , Modelos Animais de Doenças , Metaloproteinase 9 da Matriz/metabolismo , Neovascularização Fisiológica , Ratos , Fator de Crescimento Transformador beta/metabolismo
2.
Rev Assoc Med Bras (1992) ; 65(8): 1067-1073, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531603

RESUMO

OBJECTIVE: Diabetes is a risk factor for acute kidney injury (AKI). However, its mechanism of pathogenesis has not been elucidated. The aim of the study was to investigate the role of inflammation and the toll-like receptor 7 (TLR7) in ischemic AKI for diabetes. METHODS: A high glucose hypoxia-reoxygenation model of human renal tubular epithelial (HK-2) cells was used to generate AKI induced by ischemia-reperfusion in diabetes. The activity of cells was measured by CCK-8 assay and LDH activity. Inflammatory cytokines were assessed by ELISA. TLR7, MyD88, and NF-κB expressions were examined by western blotting. Apoptosis was evaluated by flow cytometry. RESULTS: The high glucose group and low glucose group were subjected to hypoxia-reoxygenation. The low glucose group developed only mild cell damage, apoptosis, and inflammatory response. In contrast, an equivalent hypoxia-reoxygenation injury provoked severe cell damage, apoptosis, and inflammatory response in the high glucose group. Expression of TLR7 and its related proteins were measured in the high glucose group before and after hypoxia-reoxygenation. The high glucose group exhibited more significant increases in TLR7 expression following hypoxia-reoxygenation than the low glucose group. In addition, the expression of TLR7 and its related proteins after hypoxia-reoxygenation were higher in the high glucose group than in the low glucose group. Inhibition of TLR7 provides significant protection against ischemic injury in diabetes. CONCLUSION: Our results suggest that diabetes increases the vulnerability to ischemia-induced renal injury. This increased vulnerability originates from a heightened inflammatory response involving the TLR7 signal transduction pathway.


Assuntos
Lesão Renal Aguda/metabolismo , Diabetes Mellitus/metabolismo , Isquemia/metabolismo , Receptor 7 Toll-Like/metabolismo , Lesão Renal Aguda/fisiopatologia , Células Cultivadas , Diabetes Mellitus/fisiopatologia , Citometria de Fluxo , Humanos , Isquemia/fisiopatologia , RNA Interferente Pequeno , Transdução de Sinais , Receptor 7 Toll-Like/fisiologia , Transfecção
3.
Medicine (Baltimore) ; 98(35): e17008, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464958

RESUMO

Urinary kallidinogenase may assist recovery acute ischemic stroke. This study evaluated the effect of urinary kallidinogenase on National Institute of Health Stroke Scale (NIHSS) score, modified Rankin scale (mRS) score, and fasting glucose levels in patients with acute ischemic stroke (AIS) combined with diabetes mellitus and impaired fasting glucose.Patients with AIS and abnormal glucose metabolism were enrolled in this prospective cohort study and divided into 2 groups. The human urinary kallidinogenase (HUK) group were treated with urinary kallidinogenase and standard treatment; the control group received standard treatment. NIHSS scores, mRS scores, and fasting blood glucose were evaluated and compared.A total of 113 patients were included: 58 in the HUK group and 55 in the control group. NIHSS scores decreased with treatment in both groups (time effect P < .05), but were lower in the HUK group (main effect P = .026). The mRS score decreased in both groups from 10 until 90 days after treatment (time effect P < .05); the 2 groups were similar (main effect, P = .130). Blood glucose levels decreased in both groups 10 days after treatment (time effect, P < .05), but there was no significant treatment effect (main effect, P = .635). Multivariate analysis showed blood uric acid >420 µmol/L (odds ratio [OR]: 0.053, 95% confidence interval [CI]: 0.008-0.350; P = .002) and application of HUK (OR: 0.217, 95% CI: 0.049-0.954; P = .043) were associated with 90% NIHSS recovery. Baseline NIHSS score was independently associated with poor curative effect.Urinary kallidinogenase with conventional therapy significantly improved NIHSS scores in patients with AIS. Urinary kallidinogenase also showed a trend toward lower fasting blood glucose levels, although the level did not reach significance.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Calicreínas Teciduais/uso terapêutico , Adulto , Idoso , Glicemia/efeitos dos fármacos , Isquemia Encefálica/etiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Feminino , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
4.
Diabetes Res Clin Pract ; 154: 130-137, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279958

RESUMO

AIMS: We aimed to confirm the hypothesis that dysglycaemia including in the pre-diabetes range affects a majority of patients admitted with acute coronary syndrome (ACS) and is associated with worse outcomes. METHODS: In this prospective observational cohort study, consecutive inpatients aged ≥ 54 years with ACS were uniformly tested and categorised into diabetes (prior diagnosis/ HbA1c ≥ 6.5%, ≥48 mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-47 mmol/mol) and no diabetes (HbA1c ≤ 5.6%, ≤38 mmol/mol) groups. RESULTS: Over two years, 847 consecutive inpatients presented with ACS. 313 (37%) inpatients had diabetes, 312 (37%) had pre-diabetes and 222 (25%) had no diabetes. Diabetes, compared with no diabetes, was associated with higher odds of acute pulmonary oedema (APO, odds ratio, OR 2.60, p < 0.01), longer length of stay (LOS, incidence rate ratio, IRR 1.18, p = 0.02) and, 12-month ACS recurrence (OR 1.86, p = 0.046) after adjustment, while no significant associations were identified for pre-diabetes. Analysed as a continuous variable, every 1% (11 mmol/mol) increase in HbA1c was associated with increased odds of APO (OR 1.28, P = 0.002) and a longer LOS (IRR 1.05, P = 0.03). CONCLUSIONS: The high prevalence of dysglycaemia and association with poorer clinical outcomes justifies routine HbA1c testing to identify individuals who may benefit from cardioprotective anti-hyperglycaemic agents and, lifestyle modification to prevent progression of pre-diabetes.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Diabetes Mellitus/fisiopatologia , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Estado Pré-Diabético/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos
5.
Physiol Rev ; 99(4): 1701-1763, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31339053

RESUMO

Obesity is increasingly prevalent and is associated with substantial cardiovascular risk. Adipose tissue distribution and morphology play a key role in determining the degree of adverse effects, and a key factor in the disease process appears to be the inflammatory cell population in adipose tissue. Healthy adipose tissue secretes a number of vasoactive adipokines and anti-inflammatory cytokines, and changes to this secretory profile will contribute to pathogenesis in obesity. In this review, we discuss the links between adipokine dysregulation and the development of hypertension and diabetes and explore the potential for manipulating adipose tissue morphology and its immune cell population to improve cardiovascular health in obesity.


Assuntos
Tecido Adiposo/fisiopatologia , Pressão Sanguínea , Diabetes Mellitus/fisiopatologia , Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Adipocinas/metabolismo , Tecido Adiposo/imunologia , Tecido Adiposo/metabolismo , Adiposidade , Animais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/imunologia , Diabetes Mellitus/metabolismo , Humanos , Hipertensão/epidemiologia , Hipertensão/imunologia , Hipertensão/metabolismo , Mediadores da Inflamação/metabolismo , Obesidade/epidemiologia , Obesidade/imunologia , Obesidade/metabolismo , Fenótipo , Medição de Risco , Fatores de Risco , Transdução de Sinais , Sistema Nervoso Simpático/metabolismo , Sistema Nervoso Simpático/fisiopatologia
6.
Yonsei Med J ; 60(8): 742-750, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347329

RESUMO

PURPOSE: Muscle mass, strength, and composition determine muscle quantity and quality. However, data on muscle properties in relation to bone mass or insulin resistance are limited in Asian populations. This study aimed to investigate the relative importance of muscle measurements in regards to their relationship with lower bone mass and insulin resistance. MATERIALS AND METHODS: In this study, 192 postmenopausal women (age, 72.39±6.07 years) were enrolled. We measured muscle cross-sectional area (CSA) and attenuation at the gluteus maximus and quadriceps muscles through quantitative computed tomography. Muscle strength and physical performance were evaluated with the hand grip test and Short Physical Performance Battery (SPPB). Pearson correlation analysis and linear regression were performed to evaluate the relationship between muscle properties and homeostatic model assessment-insulin resistance (HOMA-IR) or bone mineral density (BMD). RESULTS: Muscle CSA, hand grip strength, and SPPB score held positive correlations with spine and hip BMDs, but not with insulin resistance. In contrast, muscle attenuation of the gluteus maximus or quadriceps was inversely related to HOMA-IR (r=-0.194, p=0.018 and r=-0.292, p<0.001, respectively), but not BMD. Compared with the control group, muscle CSA was significantly decreased in patients with osteoporosis; however, decreased muscle attenuation, indicating high fat infiltration, was found only in patients with diabetes. CONCLUSION: Muscle mass, strength, and physical performance were associated with low bone mass, and accumulation of intramuscular fat, a histological hallmark of persistently damaged muscles, may play a major role in the development of insulin resistance in Korean postmenopausal women.


Assuntos
Osso e Ossos/anatomia & histologia , Resistência à Insulina , Força Muscular/fisiologia , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/fisiologia , Pós-Menopausa/fisiologia , Idoso , Índice de Massa Corporal , Densidade Óssea/fisiologia , Estudos Transversais , Diabetes Mellitus/fisiopatologia , Feminino , Força da Mão/fisiologia , Humanos , Tamanho do Órgão , Osteoporose/fisiopatologia , República da Coreia
7.
BMC Complement Altern Med ; 19(1): 137, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215420

RESUMO

BACKGROUND: The Cree of Eeyou Istchee (James Bay area of northern Quebec) suffer from a high rate of diabetes and its complications partly due to the introduction of the western lifestyle within their culture. As part of a search for alternative medicine based on traditional practice, this project evaluates the biological activity of Picea mariana (Mill.) Britton, Sterns & Poggenb. needle, bark, and cone, in preventing glucose toxicity to PC12-AC cells in vitro (a diabetic neurophathy model) and whether habitat and growth environment influence this activity. METHODS: Three different organs (needle, bark, and cone) of P. mariana were collected at different geographical locations and ecological conditions and their 80% ethanolic extracts were prepared. Extracts were then tested for their ability to protect PC12-AC cells from hyperglycaemic challenge at physiologically relevant concentrations of 0.25, 0.5, 1.0 and 2.0 µg/mL. Folin-Ciocalteu method was used to determine the total phenolic content of P. mariana extracts. RESULTS: All extracts were well-tolerated in vitro exhibiting LD50 of 25 µg/mL or higher. Extracts from all tested organs showed a cytoprotective concentration-dependent response. Furthermore, the cytoprotective activity was habitat- and growth environment-dependent with plants grown in bog or forest habitats in coastal or inland environments exhibiting different cytoprotective efficacies. These differences in activity correlated with total phenolic content but not with antioxidant activity. In addition, this paper provides the first complete Ultra-Performance Liquid Chromatography-quadrupole time-of-flight (UPLC-QTOF) mass spectrometry analysis of Picea mariana's bark, needles and cones. CONCLUSIONS: Together, these results provide further understanding of the cytoprotective activity of Canadian boreal forest plants identified by the Cree healers of Eeyou Istchee in a cell model of diabetic neuropathy. Their activity is relevant to diabetic peripheral neuropathic complications and shows that their properties can be optimized by harvesting in optimal growth environments.


Assuntos
Diabetes Mellitus/fisiopatologia , Glucose/toxicidade , Hipoglicemiantes/farmacologia , Picea/química , Extratos Vegetais/farmacologia , Substâncias Protetoras/farmacologia , Animais , Sobrevivência Celular/efeitos dos fármacos , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/metabolismo , Glucose/metabolismo , Hipoglicemiantes/análise , Células PC12 , Extratos Vegetais/análise , Substâncias Protetoras/análise , Quebeque , Ratos
8.
BMC Health Serv Res ; 19(1): 375, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196189

RESUMO

BACKGROUND: The levels of knowledge, attitude and practice among primary physicians concerning both diabetic retinopathy screening and treatment of sight threatening diabetic retinopathy have been studied by different groups, such as medical students, pharmacists, Primary Health Care staff and opticians. In some studies, the levels were very high, while in others it was noted to be less than desired. AIM: This study's intent is to estimate and improve level of Knowledge (K), Attitude (A) and Practice (P) among non-ophthalmic health care providers regarding eye management of diabetes and barriers that people with diabetes face in Saudi Arabia. METHODS: This cross-sectional survey targeted medical doctors (except ophthalmologists) working at private sector institutions in Riyadh. They were interviewed using closed-ended questions for knowledge (8), attitude (5), practice (5), and reasons for their current KAP status comprised of 8 questions. The level of Knowledge was assessed as good if its score was (> 50%); positive attitude (> 50%) and excellent practice (> 75%) were estimated and associated to the risk factors. RESULTS: Out of the 355 participants that were interviewed, the percentages of good knowledge, positive attitude and excellent practice concerning diabetic retinopathy (DR)were 193 [54.3% (95% CI 49.2-59.5)], 111 [31.3% (95% CI 26.4-36.1)], and 145 [40.8% (95% CI 35.7-46.0) participants, respectively. Gender, place of work and type of doctor were not significantly associated with the level of KAP. Salient reasons for low KAP status included a busy schedule (54.6%), less resources (75.2%), inadequate periodic training in eye care (69%), and absence of retinal evaluation training (49.6%). CONCLUSIONS: Improving KAP level is urgently needed. Addressing underlying causes of low KAP could enhance eye care of people with diabetes. Additionally, training for primary health care providers for early detection of DR and timely management of sight threatening diabetic retinopathy (STDR) is necessary.


Assuntos
Diabetes Mellitus/fisiopatologia , Retinopatia Diabética/diagnóstico , Pessoal de Saúde/estatística & dados numéricos , Programas de Rastreamento , Setor Privado , Estudos Transversais , Retinopatia Diabética/fisiopatologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Encaminhamento e Consulta , Arábia Saudita
9.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(5): 297-304, mayo 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182804

RESUMO

Introducción: Los pacientes con enfermedad renal crónica (ERC) y diabetes mellitus (DM) tienen un elevado riesgo cardiovascular. Ambas enfermedades se relacionan con el desarrollo de ateroesclerosis sistémica y calcificación vascular. La prevalencia y la severidad de la calcificación arterial coronaria (CaC) es mayor en personas con DM, independientemente de su función renal. Los datos acerca del papel pronóstico a largo plazo de la CaC en pacientes con DM y ERC son escasos. Material y métodos: Se diseñó un estudio prospectivo que incluía a 137 pacientes (85 en hemodiálisis y 52 con ERC avanzada). Se realizó una tomografía computerizada (TC) helicoidal multicorte coronario basal. La CaC se cuantificó mediante el método de Agatston y los pacientes fueron clasificados en CaC leve-moderada (CaC<400UH) y severa (CaC≥400UH). Resultados: El tiempo medio de seguimiento fue de 87,5 meses. El 28% eran pacientes con DM; tenían una CaC más severa, menor nivel de albúmina y una proteína C reactiva más elevada. La albúmina se correlacionó con la CaC severa (r=-0,45; p=0,009). La mortalidad fue del 58%. Los casos con DM mostraban una tendencia lineal de mayor mortalidad en comparación con los sujetos sin DM (Chi cuadrado 3,51, p=0,061). Los pacientes con DM y CaC severa tuvieron, además, una mayor mortalidad en comparación con aquellos con CaC severa sin DM (93% vs.73%; p=0,04). Conclusiones: Los pacientes con ERC avanzada y DM presentan una CaC más severa, datos bioquímicos compatibles con una mayor inflamación-malnutrición y una mayor mortalidad en comparación con aquellos sin DM


Introduction: Patients with chronic kidney disease (CKD) and diabetes mellitus (DM) have high cardiovascular risk. Both conditions are related to systemic atherosclerosis and vascular calcification. The prevalence and severity of coronary artery calcification (CaC) is higher in patients with DM, regardless of their renal function. Data about the long-term prognostic role of CaC in diabetic patients with CKD are scarce. Material and methods: We carried out a prospective longitudinal study enrolling 137 patients with advanced CKD. A non-enhanced multislice coronary computed tomography (CT) was performed at baseline. CaC was assessed using Agatston method. Patients were stratified according to their CaC score: severe calcification group (CaCs≥400HU) and mild-moderate calcification group (CaCs<400HU). Results: The median follow-up time was 87.5 months. DM was found in 28% of subjects. The patients with DM showed more severe CaC, lower albumin and higher C-reactive protein serum levels. Serum albumin was correlated with severe CaC (r=-0.45, P=.009). Overall mortality rate reached 58%. Patients with DM also tended to have higher mortality compared to non-diabetic subjects (X2 3.51, P=.061) especially those with severe CaC showed higher mortality than those with severe CaC without DM (93% vs.73%, P=.04). Conclusions: Patients with advanced CKD and DM have more severe CaC, increased inflammation-malnutrition data and higher mortality compared to those without DM


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Insuficiência Renal Crônica/complicações , Calcificação Vascular/diagnóstico , Diabetes Mellitus/fisiopatologia , Calcinose/diagnóstico , Estudos de Coortes , Vasos Coronários/patologia , Fatores de Risco , Estudos Prospectivos , Diálise Renal/métodos , Calcinose/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Índice de Gravidade de Doença
10.
Adv Exp Med Biol ; 1128: 27-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31062324

RESUMO

Accumulating clinical data indicates that insulin resistance and diabetes mellitus (DM) are major risk factors for Alzheimer's disease (AD); however, the exact mechanisms on how insulin resistance and DM act as risk factors for AD remain unclear. Recent progress in gene expression profiling of AD brains revealed that brain insulin production and insulin signaling are significantly impaired, indicating that AD brain exhibits a feature of brain diabetes with depletion of brain insulin, which causes mitochondrial dysfunction with increased oxidative stress, thereby increasing sensitivity to peripheral diabetes. Such diabetic condition in early stage of AD brain can be exacerbated by peripheral diabetes, namely, through hyperglycemia, hyperinsulinemia, or impaired insulin response. In this chapter, I reviewed mitochondrial dysfunction and oxidative stress in AD brain and discussed how those events are involved in AD pathogenesis.


Assuntos
Doença de Alzheimer/fisiopatologia , Encéfalo/fisiopatologia , Insulina/fisiologia , Mitocôndrias/patologia , Estresse Oxidativo , Diabetes Mellitus/fisiopatologia , Humanos
11.
Diabetes Res Clin Pract ; 153: 1-5, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31145928

RESUMO

AIMS: Diabetes interferes with cerebral blood flow (CBF) and it seems that the effect of acute hyperglycemia on CBF is different from the changes in CBF caused by chronic diabetes. The aim of the study was to check whether there are changes in CBF measured using transcranial Doppler (TCD) in patients with hyperglycemia before and after normalization of glycemia. METHODS: The study involved 29 patients with diabetes and 27 healthy subjects (control group). The TCD test evaluated mean flow velocity (Vm), systolic velocity (Vs) and Gosling's pulsatility index (PI) in both middle cerebral arteries (MCAs). It was performed twice in patients with diabetes (during hyperglycemia and after normalization of glycemia) and once in the control group. RESULTS: The baseline blood flow parameters were similar in both groups. After the normalization of glycemia in patients with diabetes, they showed lower values of Vm and Vs compared to the control group (p < 0.001). Also, the normalization of glycemia caused a decrease in Vm and Vs (p < 0.001) in patients with diabetes. There were no significant differences in PI. CONCLUSIONS: In the patients with hyperglycemia, Vm and Vs in the MCA were higher than during normoglycemia, which was probably related to vasoconstriction and hypervolemia.


Assuntos
Glicemia/metabolismo , Circulação Cerebrovascular/fisiologia , Diabetes Mellitus/sangue , Hiperglicemia/complicações , Glicemia/análise , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler Transcraniana
12.
Clin Podiatr Med Surg ; 36(3): 361-370, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079603

RESUMO

The accurate assessment of peripheral perfusion is a critical step in caring for a diabetic patient with active ulceration. This article guides the provider through diagnostic and therapeutic options. The perfusion assessment begins with a physical examination and augmented using noninvasive tests. Although some of these tests can be performed at the bedside, often a dedicated vascular laboratory is required. Additional cross-sectional imaging studies or formal angiography should be performed as well. These tools aid in the creation of the best therapeutic plan, which aims to restore perfusion and allow for rapid wound healing via open or endovascular means.


Assuntos
Diabetes Mellitus/fisiopatologia , Pé Diabético/cirurgia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/cirurgia , Índice Tornozelo-Braço , Circulação Sanguínea/fisiologia , Pressão Sanguínea/fisiologia , Pé Diabético/diagnóstico por imagem , Diagnóstico por Imagem , Procedimentos Endovasculares , Pé/irrigação sanguínea , Pé/diagnóstico por imagem , Humanos , Doença Arterial Periférica/fisiopatologia , Exame Físico , Pulso Arterial , Procedimentos Cirúrgicos Vasculares
14.
Acta Diabetol ; 56(9): 1037-1044, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30989380

RESUMO

AIMS: Observational studies indicated that resting heart rate (RHR) was associated with diabetes mellitus (DM) risk; however, it remains unclear whether the association between RHR and DM is causal. We aimed to examine whether there was causal association of RHR with DM risk. METHODS: A prospective study including 16,201 middle-aged and older Chinese (7031 males and 9170 females) derived from the Dongfeng-Tongji cohort was performed. Cox proportional hazard regression models were conducted to estimate the associations between RHR and incident DM risk. In 7481 participants, 65 single nucleotide polymorphisms related to RHR were genotyped. A genetic risk score (GRS) of RHR was calculated based on the RHR-associated variants. The causal associations of RHR with DM risk were investigated by Mendelian randomization analysis. RESULTS: During a mean (SD) follow-up of 4.5 (0.5) years, 1110 diabetes were identified. Compared with the referential RHR group (≤ 60 beats per minute [bpm]), individuals with RHR > 80 bpm have a higher incident diabetes risk, with a hazard ratio of 1.40 (95% confidence interval [CI], 1.05-1.88). With per SD increase in the weighted genetic risk score, the resting heart rate increased by 0.71 bpm (95% CI 0.49-0.93). By using the GRS to estimate the unconfounded effect, we found that higher resting heart rate did not have a causal effect on diabetes risk (OR 1.00 [95% CI 0.95-1.05]). CONCLUSIONS: The present study supported a positive but not a causal association of RHR with incident diabetes risk. More studies are needed to verify our findings.


Assuntos
Diabetes Mellitus/epidemiologia , Diabetes Mellitus/genética , Diabetes Mellitus/fisiopatologia , Frequência Cardíaca/genética , Polimorfismo de Nucleotídeo Único , Descanso/fisiologia , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/genética , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , China/epidemiologia , Estudos de Coortes , Feminino , Estudos de Associação Genética/métodos , Estudos de Associação Genética/estatística & dados numéricos , Predisposição Genética para Doença/epidemiologia , Genótipo , Humanos , Incidência , Masculino , Análise da Randomização Mendeliana , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
16.
J Diabetes Res ; 2019: 5874603, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31019977

RESUMO

Background: Physical activity is effective in preventing chronic diseases. However, the impact of different durations of exercise on human health is unknown, especially among people with diabetes or prediabetes. Objective: To explore the relationship between high MET hours per week and the change in glomerular filtration rate (eGFR) in the total population and different subgroups. Methods: A total of 43767 individuals from eight provinces, in China, were recruited. Logistic analysis was used to investigate the association. Participants were divided into 3 groups based on MET hours per week. The primary outcome was an eGFR ≤ 90 mL/min/1.73 m2. Results: The average eGFR was 100.10 (92.43-106.43) mL/min/1.732. Logistic regression analysis revealed that more than 7.5 MET hours per week (equivalent to more than 150 minutes of moderate-intensity of exercise) was associated with the higher risk of the decreased eGFR even after adjusting for confounding factors (7.5 to <21: OR = 1.18, 95% CI [1.09, 1.29]; ≥21: OR = 1.12, 95% CI [1.05, 1.19], p for trend: 0.0047). After adjusting for confounding factors, in stratified analyses, there still existed a significant relationship among participants aged from 55 to less than 65 years, but not among participants younger than 55 or older than 65 years. Similarly, there existed a positive association between high MET hours per week and the decreased eGFR in participants without diabetes and prediabetes, but not in participants with diabetes or prediabetes, and the interactions of age and diabetic states were found. However, there was no significant difference in women or men. Conclusions: More than 7.5 MET hours per week (equivalent to more than 150 minutes per week or 60 minutes per day of moderate-intensity exercise) was associated with decreased eGFR among participants aged from 55 to less than 65 years and participants without diabetes and prediabetes, but not among participants aged younger than 55 years and older than 65 years and participants with diabetes or prediabetes. The importance of planning individualized physical activities is highlighted.


Assuntos
Diabetes Mellitus/fisiopatologia , Exercício/fisiologia , Taxa de Filtração Glomerular/fisiologia , Estado Pré-Diabético/fisiopatologia , Adulto , Fatores Etários , Idoso , China , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
17.
J Diabetes Investig ; 10(3): 868-875, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31020808

RESUMO

It is expected that a large amount of data related to diabetes and other chronic diseases will be generated. However, databases constructed without standardized data item sets can be limited in their usefulness. To address this, the Collaborative Committee of Clinical Informatization in Diabetes Mellitus was established in 2011 by the Japan Diabetes Society and Japan Association for Medical Informatics. The committee has developed core item sets and self-management item sets for diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease in collaboration with the Japanese Society of Hypertension, Japan Atherosclerosis Society, Japanese Society of Nephrology, and Japanese Society of Laboratory Medicine, as well as a mapping table that aligns the self-management item sets with the Japanese standardized codes for laboratory testing. The committee also determined detailed specifications for implementing the four self-management item sets in personal health record (PHR) applications to facilitate risk stratification, the generation of alerts using information and communications technology systems, the avoidance of data input errors, and the generation of reminders to input the self-management item set data. The approach developed by the committee may be useful for combining databases for various purposes (such as for clinical studies, patient education, and electronic medical record systems) and for facilitating collaboration between PHR administrators.


Assuntos
Doença Crônica/epidemiologia , Diabetes Mellitus/fisiopatologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/normas , Registros de Saúde Pessoal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Criança , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Relatório de Pesquisa , Adulto Jovem
18.
Biomed Res Int ; 2019: 5907195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31011577

RESUMO

Background and Objectives: About 5% of the world's population is affected by diabetes; these patients must be further treated during medical and surgical treatments. These patients, due to the glycemic conditions, realize during their life multiorgan changes, in different body districts. Moreover, this condition obliges them to undertake hypoglycemic therapies. Diabetes is a risk factor for many diseases, including those concerning the oral district with immunological implications. Materials and Methods: A comprehensive review of the literature was conducted according to PRISMA guidelines accessing the NCBI PubMed database. Authors conducted the search of articles in English language. The results of the last 10 years have been considered, which present useful information regarding the oral conditions. A total of 17 relevant studies were included in the review. The study evaluated only papers with specific inclusion criteria regarding oral health. The works initially taken into consideration were 782; subsequently applying the inclusion and exclusion criteria, there were 42 works. After a careful analysis of the work obtained by two academics who have worked separately, there have been 17 studies. All data from the studies were compared and many of these confirmed alteration in the oral district. Results: The studies taken into consideration evaluated different factors, such as OHRQoL, QoL, and oral alterations, involving soft tissue, dental structures, and postrehabilitative complications, as well as immunological alterations. Conclusions: We can affirm, in conclusion, that this study has brought to light those that are complications due to diabetic pathology, from different points of view. The psychological and psychosocial alterations, certainly present in these patients, are probably due to local and systemic alterations; this is confirmed by the correlation between oral health and quality of life reported by the patients.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/fisiopatologia , Hipoglicemiantes/uso terapêutico , Animais , Humanos , Saúde Bucal , Qualidade de Vida
19.
Sci Total Environ ; 668: 1004-1012, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31018442

RESUMO

Arsenic (As) toxicity and diabetes mellitus (DM) are emerging public health concerns worldwide. Although exposure to high levels of As has been associated with DM, whether there is also an association between low and moderate As exposure and DM remains unclear. We explored the dose-dependent association between As exposure levels and hyperglycemia, with special consideration of the impact of demographic variables, in 641 subjects from rural Bangladesh. The total study participants were divided into three groups depending on their levels of exposure to As in drinking water (low, moderate and high exposure groups). Prevalence of hyperglycemia, including impaired glucose tolerance (IGT) and DM was significantly associated with the subjects' drinking water arsenic levels. Almost all exposure metrics (As levels in the subjects' drinking water, hair and nails) showed dose-dependent associations with the risk of hyperglycemia, IGT and DM. Among the variables considered, sex, age, and BMI were found to be associated with higher risk of hyperglycemia, IGT and DM. In sex-stratified analyses, As exposure showed a clearer pattern of dose-dependent risk for hyperglycemia in females than males. Finally, drinking water containing low-to-moderate levels of As (50.01-150 µg/L) was found to confer a greater risk of hyperglycemia than safe drinking water (As ≤10 µg/L). Thus the results suggested that As exposure was dose-dependently associated with hyperglycemia, especially in females.


Assuntos
Intoxicação por Arsênico/complicações , Diabetes Mellitus/fisiopatologia , Exposição Ambiental , Hiperglicemia/fisiopatologia , Poluentes Químicos da Água/análise , Adulto , Arsênico/análise , Intoxicação por Arsênico/epidemiologia , Bangladesh/epidemiologia , Índice de Massa Corporal , Diabetes Mellitus/epidemiologia , Suscetibilidade a Doenças , Água Potável/química , Feminino , Cabelo/química , Humanos , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Unhas/química , Prevalência , Abastecimento de Água
20.
Artigo em Inglês | MEDLINE | ID: mdl-30978913

RESUMO

Objectives: The aim of this study is to identify the relationship between diabetes status including characteristics of diabetes and cognition among the middle-aged and elderly population (≥45 years) in China. Methods: A sample of 8535 people who participated in the China Health and Retirement Longitudinal Study (CHARLS) from June 2011 to March 2012 was analyzed. Two cognitive domains including episodic memory and executive function were measured through questionnaires. People were classified into four groups: no diabetes, controlled diabetes, untreated diabetes, treated but uncontrolled diabetes. Weighted multiple regression model was conducted to explore the association between diabetes and cognition in full sample as well as three different age groups (45-59, 60-74, ≥75). Adjustments were made for demographics and cardiovascular risk factors. Results: After adjusting several covariates, untreated diabetes (ß = -0.192, p < 0.05) was significantly associated with episodic memory. In the age group of 45-69 years, untreated diabetes (ß = -0.471, p < 0.05) and HbA1c level (ß = -0.074, p < 0.05) were significantly associated with episodic memory. When adjusting for cardiovascular risk factors, all correlations were non-significant. Conclusion: The cross-sectional study suggests that untreated diabetes and HbA1c are the potential risk factor for cognitive impairment, and these associations are more significant in the age group of 45-59 years old. Cardiovascular factors are important mediating factors in the pathway between diabetes and cognitive impairment. More longitudinal studies are needed to confirm these associations.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Complicações do Diabetes/etiologia , Diabetes Mellitus/fisiopatologia , Função Executiva/fisiologia , Memória Episódica , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários
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