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1.
Cardiovasc Diabetol ; 21(1): 110, 2022 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-35717169

RESUMO

BACKGROUND: Compared with enalapril, sacubitril/valsartan lowered HbA1c and reduced new insulin therapy in patients with heart failure with reduced ejection fraction (HFrEF) and diabetes in the PARADIGM-HF trial. We sought to assess the glycemic effects of sacubitril/valsartan in heart failure with preserved ejection fraction (HFpEF) and diabetes, and across the spectrum of left ventricular ejection fraction (LVEF) in heart failure and diabetes. METHODS: We compared the effect of sacubitril/valsartan, relative to valsartan, on HbA1c, new insulin therapy and hypoglycemia in the randomized controlled trial PARAGON-HF, and performed pooled analyses of PARAGON-HF and PARADIGM-HF. RESULTS: Among 2395 patients with HFpEF and diabetes in PARAGON-HF, sacubitril/valsartan compared with valsartan reduced HbA1c (baseline-adjusted between-group difference in HbA1c change at 48 weeks: - 0.24%, 95% CI - 0.33 to - 0.16%, P < 0.001). Numerically, new insulin treatment was initiated less often in the sacubitril/valsartan group than in the valsartan group, but the difference was not statistically significant (12.8% vs. 16.1%; HR: 0.80, 95% CI 0.62-1.02, P = 0.07). Hypoglycemia adverse event reports were low, but more frequent in those receiving sacubitril/valsartan than in the valsartan group (4.2% vs. 2.6%; HR: 1.64, 95% CI 1.05-2.56, P = 0.030). In a pooled analysis of PARAGON-HF and PARADIGM-HF, the effect of sacubitril/valsartan on change in HbA1c was not significantly modified by LVEF (Pinteraction = 0.56). Across the spectrum of LVEF, sacubitril/valsartan reduced new insulin therapy (HR: 0.75, 95% CI 0.63-0.89, P = 0.001), compared with enalapril or valsartan. CONCLUSIONS: Sacubitril/valsartan reduced HbA1c and new insulin therapy in patients with heart failure and diabetes across the spectrum of LVEF but may be associated with a slightly higher risk for hypoglycemia. Trial registration ClinicalTrials.gov NCT01920711.


Assuntos
Diabetes Mellitus , Insuficiência Cardíaca , Hipoglicemia , Insulinas , Aminobutiratos/efeitos adversos , Antagonistas de Receptores de Angiotensina/efeitos adversos , Compostos de Bifenilo/efeitos adversos , Glicemia , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Enalapril/efeitos adversos , Hemoglobina A Glicada , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hipoglicemia/induzido quimicamente , Insulinas/farmacologia , Volume Sistólico , Tetrazóis/efeitos adversos , Valsartana/efeitos adversos , Função Ventricular Esquerda
2.
Environ Int ; 165: 107301, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35598418

RESUMO

BACKGROUND: Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM). METHODS: We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference. RESULTS: Per 10 ug/m3 increase of particles with an aerodynamic diameter < 2.5 µm (PM2.5), particles with an aerodynamic diameter < 10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbonic oxide (CO) and ozone (O3) corresponded to a 0.64% (95% CI: 0.57 to 0.71), 0.52% (95% CI: 0.46 to 0.57), 0.93% (95% CI: 0.67 to 1.20), 0.98% (95% CI: 0.81 to 1.16), 1.66% (95% CI: 1.18 to 2.14) and 0.53% (95% CI: 0.45 to 0.61) increment for CVD-DM patients' admissions. Among the six pollutants, particulate pollutants (PM2.5 and PM10) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m3 increase in PM2.5 and PM10, the absolute increase with LOS will increase 62.08 days (95% CI: 28.93 to 95.23) and 51.77 days (95% CI:22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI: 49.27 to 160.81) and 81.76 CNY (95% CI: 42.01 to 121.51) in PM2.5 and PM10, respectively. Given WHO 2021 air quality guideline as the reference, PM2.5 had the maximum attributable fraction of 3.34% (95% CI: 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI: 57,953 to 73,812) patients with CVD-DM. CONCLUSION: PM2.5 and PM10 are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Doenças Cardiovasculares , Diabetes Mellitus , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Pequim/epidemiologia , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/epidemiologia , Custos Hospitalares , Hospitais , Humanos , Tempo de Internação , Material Particulado/análise
3.
Chemosphere ; 301: 134471, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35367493

RESUMO

OBJECTIVE: Organophosphorus pesticides (OPPs) are commonly used pesticides across the world, however there is little epidemiological evidence linking their exposure to diabetes. Hence, this study aimed at investigating the effect of OPP exposure on the prevalence of diabetes in American adults. METHODS: Adults (≥20 years old) were eligible for this study from the National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression model was employed to explore the associations of six main urinary OPPs metabolites with diabetes. Subgroup analyses were performed by age and gender. Combined effect of OPPs metabolites on the overall association with diabetes was evaluated by weighted quantile sum regression (WQS). Furthermore, Bayesian kernel machine regression (BKMR) model was implemented to explore joint effect of multiple OPPs metabolites on diabetes. RESULTS: Ultimately, 6,593 adults were included in our analysis. Of them, 1,044 participants were determined as diabetes patients. The results of logistic regression shown that urinary OPPs metabolites concentrations, whether taken as continuous variables or quantiles, were in positive correlation with diabetes. Notably, the p for trend of diethylphosphate (DEP), a kind of OPPs metabolites, was less than 0.05 indicated that a linear trend may exist between levels of DEP and prevalence of diabetes among adults while this trend was not obversed in other OPPs metabolites. In the WQS model, combined exposure of OPPs metabolites had a significantly positive association with diabetes (OR: 1.057; 95% CI: 1.002, 1.114) and diethylphosphate (36.84%) made the largest contributor to the WQS index. The result of BKMR also suggested a positive trend of association between mixed OPPs metabolites and diabetes. CONCLUSION: Our results add credibility to the argument that OPP exposure might trigger diabetes. Certainly, prospective data are required to corroborate our findings.


Assuntos
Diabetes Mellitus , Praguicidas , Adulto , Teorema de Bayes , Estudos Transversais , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/epidemiologia , Humanos , Inquéritos Nutricionais , Compostos Organofosforados/toxicidade , Estudos Prospectivos , Estados Unidos/epidemiologia , Adulto Jovem
4.
Am J Emerg Med ; 56: 171-177, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35398707

RESUMO

OBJECTIVES: Biguanides and sulfonylureas are anti-hyperglycemic drugs commonly used in the United States. Poisoning with these drugs may lead to serious consequences. The diagnosis of biguanide and sulfonylurea poisoning is based on history, clinical manifestations, and laboratory studies. METHODS: This study is a six-year retrospective cohort analysis based on the National Poison Data System. Clinical effects of 6183 biguanide and sulfonylurea exposures were identified using binary logistic regression. RESULTS: The mean age of patients with biguanide and sulfonylurea exposure was 39.27 ± 28.91 and 28.91 ± 30.41 years, respectively. Sulfonylurea exposure is most commonly seen via unintentional exposure, while biguanide exposure frequently occurs as a result of intentional ingestion. Minor and moderate outcomes commonly developed following biguanide and sulfonylurea exposure, respectively. Sulfonylurea exposure was less likely to develop clinical effects abdominal pain, metabolic acidosis, diarrhea, nausea, vomiting, and elevated creatinine than patients ingesting biguanides. However, sulfonylurea exposure was more likely to cause dizziness or vertigo, tremor, drowsiness or lethargy, agitation, diaphoresis, and hypoglycemia. CONCLUSIONS: Our study is the first to use a wide range of national data to describe the clinical characteristics that differentiate the toxicologic exposure to biguanides and sulfonylureas. Sulfonylurea exposure is commonly seen via unintentional exposure, while metformin exposure is frequently seen via intentional exposure. Sulfonylurea toxicity is more likely to cause agitation, dizziness or vertigo, tremor, diaphoresis, and hypoglycemia, while metformin exposure induces abdominal pain, acidosis, diarrhea, nausea, vomiting, and elevated creatinine.


Assuntos
Acidose , Diabetes Mellitus , Hipoglicemia , Metformina , Dor Abdominal/tratamento farmacológico , Acidose/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Creatinina , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Diarreia , Tontura , Humanos , Hipoglicemia/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Pessoa de Meia-Idade , Náusea/tratamento farmacológico , Estudos Retrospectivos , Compostos de Sulfonilureia/efeitos adversos , Tremor , Estados Unidos/epidemiologia , Vertigem/tratamento farmacológico , Vômito/tratamento farmacológico , Adulto Jovem
5.
J Med Case Rep ; 16(1): 163, 2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35462530

RESUMO

BACKGROUND: Capecitabine is widely used in chemotherapy for breast, colorectal, and gastric cancers. The frequent adverse reactions of capecitabine mainly include gastrointestinal side effects, anemia, and cardiovascular toxicity. Here, we report a rare case of severe hyperglycemia and hypokalemia during long-term treatment with capecitabine. CASE PRESENTATION: A 48-year-old Chinese female was hospitalized with the complaint of breathlessness and weakness after activity, for 1 month. Her past history is significant for a diagnosis of right-sided breast cancer 7 years ago. She underwent right mastectomy, following which capecitabine was started 1.5 years prior to the current admission as part of her primary treatment at the discovery of systemic osseous metastasis. Her fasting plasma glucose and hemoglobin A1c levels were quite normal 7 months ago but increased to 15.3 mmol/L and 11.2%, respectively, at the present admission. Her serum potassium level was as low as 2.5 mmol/L. Plasma autoantibodies related to islets and insulin were all negative. Capecitabine was discontinued, and an insulin pump and potassium supplement were given after admission. Her blood sugar and potassium levels returned to their normal ranges soon. Self-injection of insulin was withdrawn completely at 2 months after discharge, and no oral hypoglycemic agents were added. Her plasma glucose and electrolyte levels were at normal levels at her 1-year follow-up. CONCLUSION: Glucose intolerance and hypokalemia may be rare but serious adverse effects during long-term chemotherapy with capecitabine.


Assuntos
Neoplasias da Mama , Diabetes Mellitus , Hipopotassemia , Glicemia , Neoplasias da Mama/tratamento farmacológico , Capecitabina/efeitos adversos , Diabetes Mellitus/induzido quimicamente , Feminino , Fluoruracila/efeitos adversos , Humanos , Hipopotassemia/induzido quimicamente , Insulina , Mastectomia , Pessoa de Meia-Idade , Potássio
6.
Artigo em Inglês | MEDLINE | ID: mdl-35490091

RESUMO

OBJECTIVE: To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital. METHODS: A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate is estimated at 90 days after finishing the treatment. RESULTS: A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000 mg followed by 500 mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%). CONCLUSION: Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.


Assuntos
Doenças Transmissíveis , Diabetes Mellitus , Pé Diabético , Osteomielite , Idoso , Antibacterianos , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Pé Diabético/induzido quimicamente , Pé Diabético/complicações , Pé Diabético/tratamento farmacológico , Feminino , Humanos , Masculino , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Estudos Retrospectivos , Teicoplanina/análogos & derivados
7.
BMJ Open ; 12(3): e055529, 2022 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-35256444

RESUMO

OBJECTIVES: This study aimed to investigate the efficacy of providing education on injection technique to patients with diabetes with lipohypertrophy (LH). DESIGN: We conducted a systematic review and meta-analysis. METHODS: We included patients with diabetes who use insulin and have LH, and excluded patients without LH. We performed a literature search on CENTRAL, MEDLINE, EMBASE, ICTRP and ClinicalTrials.gov in November 2021 for randomised controlled trials (RCTs). We used the revised Cochrane Risk of Bias 2 tool to evaluate the risk of bias in each outcome in each study. We then pooled the data using a random-effects model and evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. OUTCOME MEASURES: The primary endpoints were change in total daily dose (TDD) of insulin, change in HbA1c levels and prevalence of hypoglycaemia. RESULTS: We screened 580 records and included three RCTs (637 participants) in the meta-analysis. Education on injection technique may slightly increase the change of TDD of insulin (three studies, 637 participants: mean difference (MD) -6.26; 95% CI -9.42 to -3.10; p<0.001; I2=38%; low certainty of evidence) and may have little to no effect on change in HbA1c but the evidence is very uncertain compared with that in the control group (three studies, 637 participants: MD -0.59; 95% CI -1.71 to 0.54; p=0.31; I2=98%; very low certainty of evidence). Providing education about injection technique may have little to no effect on the prevalence of hypoglycaemia (three studies, 637 participants: risk ratio 0.44; 95% CI 0.06 to 3.13; p=0.41; I2=90%; very low certainty of evidence). CONCLUSIONS: The present meta-analysis suggests that injection technique education may result in a slight reduction in the TDD of insulin. However, the effect of education on HbA1c, hypoglycaemia and cured LH is uncertain. PROTOCOL REGISTRATION: DOI: dx.doi.org/10.17504/protocols.io.btiinkce.


Assuntos
Diabetes Mellitus , Hipoglicemia , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Hemoglobina A Glicada , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle , Insulina/uso terapêutico
8.
Am J Cardiol ; 171: 49-54, 2022 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-35277255

RESUMO

The relation between diabetes mellitus (DM) and bleeding complications after percutaneous coronary intervention (PCI) is controversial. This study investigates the role of low platelet reactivity (LPR) in the bleeding risk stratification of patients who underwent PCI according to DM status. A total of 472 patients who underwent PCI on aspirin and clopidogrel were included retrospectively. Platelet reactivity was assessed using the VerifyNow P2Y(12) assay. LPR was defined as platelet reactivity unit ≤178. The primary end point was the occurrence of any bleeding at 5 years stratified by DM status and LPR. DM was present in 30.5% of patients. LPR was less frequent in patients with DM (p = 0.077). Overall, 11.9% of patients experienced a bleeding complication at 5 years. The incidence of bleeding did not differ in subjects with and without DM (p = 0.24). LPR had a similar value for stratifying the increased bleeding risk in patients with and without DM (interaction p between DM and LPR 0.69). A stepwise increase in the crude rates of bleeding complications was observed across patients with and without LPR and DM (log-rank p = 0.004), with those affected by both conditions having the highest crude incidence rate. In conclusion, on top of aspirin, approximately 1/3 of patients who underwent PCI on clopidogrel have LPR. Assessment of LPR provides a significant incremental value for predicting bleeding irrespective of DM status. Although the presence of DM per se does not increase the incidence of hemorrhagic complications, the coexistence of DM and LPR identifies the subgroup with the highest bleeding risk.


Assuntos
Diabetes Mellitus , Intervenção Coronária Percutânea , Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Diabetes Mellitus/induzido quimicamente , Hemorragia/induzido quimicamente , Hemorragia/etiologia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Estudos Retrospectivos
9.
Curr Opin Ophthalmol ; 33(3): 167-173, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35266896

RESUMO

PURPOSE OF REVIEW: To review the available data supporting the use of brolucizumab in the treatment of diabetic macular edema (DME). RECENT FINDINGS: Brolucizumab is a humanized single- chain variable antibody fragment (scFv), the smallest functional subunit of an antibody approved for intravitreal use. Three phase III studies demonstrate that at 52 weeks, brolucizumab has statistically superior anatomical outcomes of reducing retinal thickness (54.0-57.5% of brolucizumab treated eyes achieved central subfield thickness <280 µm compared to 40.1 - 41.4% of aflibercept treated eyes) and retinal fluid (present in 54.2-60.3% of brolucizumab treated eyes compared to 72.9-78.2% of aflibercept treated eyes). Brolucizumab also demonstrated a prolonged durability up to 16 weeks, thus reducing treatment burden. The visual outcomes appear noninferior to current anti-VEGF agents with an increased risk for intraocular inflammatory events (0.3-4.7% compared to 0.6-1.7%). SUMMARY: Results from recent phase III trials showing the efficacy and safety of brolucizumab presents an additional therapeutic option in the DME treatment landscape. It can reduce treatment burden in DME with increased inter-treatment intervals while conferring efficacy in both functional and anatomical outcomes. Caution should be taken regarding the risks of intraocular inflammation, retinal vasculitis, and retinal vascular occlusion.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Uveíte , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Retinopatia Diabética/tratamento farmacológico , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Uveíte/tratamento farmacológico , Transtornos da Visão , Acuidade Visual
10.
Environ Res ; 210: 113018, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35227676

RESUMO

We have performed a systematic review and meta-analysis of the association between DDT/DDE and diabetes, searching PubMed, Embase, and Cochrane for relevant articles published up to August 30, 2021, and eventually including 43 publications. Our researchers evaluate included studies' quality and risk of bias via the recommended tool. This study uses meta-analyses of random effects of each exposure and outcome to estimate combined odds ratios (ORs) and 95% confidence intervals (CIs). Our research identified 43 cross-sectional, case-control, and cohort studies, including 40,141 individuals in America, Europe, Asia, and Africa. The summary ORs (95% CIs) of incident diabetes were 1.61 (1.10-2.39) for DDT, 1.67 (1.41-1.98) for DDE. The subgroup analysis indicated that the association is significantly higher in the region of Asia for both DDT (OR = 2.73) and DDE (OR = 2.62). Besides, we also tried various types of stratification to identify the more influential confounding factors, among which regional factors have a significant influence. Study evidence suggests that exposure to DDT and its breakdown product, DDE, might be associated with the risk of incident diabetes. Among Asian patients, DDT/DDE concentrations are more closely associated with diabetes. Further studies in specific regions will be considered in the future.


Assuntos
Diabetes Mellitus , Diclorodifenil Dicloroetileno , Estudos de Coortes , Estudos Transversais , DDT/toxicidade , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/epidemiologia , Diclorodifenil Dicloroetileno/toxicidade , Humanos
11.
Nutr Metab Cardiovasc Dis ; 32(6): 1402-1409, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35282981

RESUMO

BACKGROUND AND AIMS: Prior studies suggest a positive association between dietary AGEs and adverse health outcomes but have not well-characterized AGEs intake and its association with mortality in a general adult population in the United States. METHODS AND RESULTS: We included 5474 adults with diabetes from the 2003 to 2018 National Health and Nutrition Examination Survey, a nationally representative sample of the non-institutionalized civilian population in the United States. Concordance to dietary guidelines (Healthy Eating Index 2015 [HEI-2015]) and intake of the AGE Nϵ-(carboxymethyl)lysine (CML) were estimated using an existing database and two 24-h food recalls. Multivariable Cox regression evaluated the association between AGEs intake and all-cause mortality. A secondary analysis measured CML, Nϵ-(1-carboxyethyl)lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MGH1) from an alternative database. Higher AGEs intake was associated with lower concordance to dietary guidelines (Means and standard errors of HEI-2015 score, by quartiles of AGEs intake: Q1 = 55.2 ± 0.6, Q2 = 54.1 ± 0.5, Q3 = 52.1 ± 0.5, Q4 = 49.0 ± 0.5; p < 0.001). There were 743 deaths among 3884 adults in the mortality analysis (mean follow-up = 3.8 years). AGEs intake was not significantly associated with all-cause mortality (Q2 vs. Q1: Hazard Ratio [HR] = 0.91 [0.69-1.21], Q3 vs. Q1: HR = 0.90 [0.63-1.27], Q4 vs. Q1: HR = 1.16 [0.84-1.60]). Results were similar in secondary analyses. CONCLUSION: While dietary AGEs intake was associated with concordance to dietary guidelines, it was not significantly associated with all-cause mortality among adults with diabetes. Further research may consider other health outcomes as well as the evaluating specific contribution of dietary AGEs to overall AGEs burden.


Assuntos
Diabetes Mellitus , Produtos Finais de Glicação Avançada , Adulto , Diabetes Mellitus/induzido quimicamente , Dieta/efeitos adversos , Ingestão de Alimentos , Produtos Finais de Glicação Avançada/efeitos adversos , Humanos , Lisina , Inquéritos Nutricionais
12.
Andrologia ; 54(6): e14421, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35301742

RESUMO

This study aimed to evaluate the effectiveness of ICI of platelet-rich plasma (PRP) in addition to daily oral tadalafil intake in diabetic erectile dysfunction (ED) patients non-responding to PDE5 inhibitors. Overall, 48 patients complaining of ED non-responding to on-demand PDE5 inhibitors were allocated into 2 equal groups, diabetics and non-diabetics that were given a daily dose of 5 mg tadalafil plus vardenafil 20 mg on demand during the study besides being subjected to 3 doses of ICI of PRP, 4 weeks apart. Responses to on-demand PDE5 inhibitors, International index of erectile function-5 (IIEF-5) score, erection hardness scores (EHS) and pharmaco-dynamic duplex studies were assessed. After PRP injections, 33% and 50% of cases were satisfied with on-demand PDE5 inhibitors, respectively, whereas 41% and 66% of them showed improved EHS response. Compared with baseline scores, the mean IIEF-5 scores were significantly improved after PRP therapy in the diabetic ED group (12.1 vs. 8.04, p = 0.003) as well as in the non-diabetic ED group (14.8 vs. 10.2, p = 0.001) linked to pharmaco-penile duplex readings. Both good and fair diabetic control exhibited significant responses to ICI therapy of PRP compared with bad controlled cases. The significant improvement included; the IIEF-5 score increase (86.7%, 126% vs. 16.1%), improved EHS as well as penile duplex readings. Baseline HbA1C demonstrated a significant negative correlation with IIEF-5 score before (p = 0.019) and after PRP therapy (p = 0.002) respectively. It could be concluded that ICI of PRP could be an effective therapy for treating ED patients non-responding to on-demand oral PDE5 treatment.


Assuntos
Diabetes Mellitus , Disfunção Erétil , Plasma Rico em Plaquetas , Carbolinas/efeitos adversos , Carbolinas/uso terapêutico , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/etiologia , Humanos , Masculino , Ereção Peniana , Inibidores da Fosfodiesterase 5/efeitos adversos , Piperazinas , Sulfonas/farmacologia , Tadalafila/farmacologia , Tadalafila/uso terapêutico , Resultado do Tratamento
14.
PLoS One ; 17(2): e0258054, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35180212

RESUMO

Progressive loss of pancreatic ß-cell functional mass and anti-diabetic drug responsivity are classic findings in diabetes, frequently attributed to compensatory insulin hypersecretion and ß-cell exhaustion. However, loss of ß-cell mass and identity still occurs in mouse models of human KATP-gain-of-function induced Neonatal Diabetes Mellitus (NDM), in the absence of insulin secretion. Here we studied the temporal progression and mechanisms underlying glucotoxicity-induced loss of functional ß-cell mass in NDM mice, and the effects of sodium-glucose transporter 2 inhibitors (SGLT2i) therapy. Upon tamoxifen induction of transgene expression, NDM mice rapidly developed severe diabetes followed by an unexpected loss of insulin content, decreased proinsulin processing and increased proinsulin at 2-weeks of diabetes. These early events were accompanied by a marked increase in ß-cell oxidative and ER stress, without changes in islet cell identity. Strikingly, treatment with the SGLT2 inhibitor dapagliflozin restored insulin content, decreased proinsulin:insulin ratio and reduced oxidative and ER stress. However, despite reduction of blood glucose, dapagliflozin therapy was ineffective in restoring ß-cell function in NDM mice when it was initiated at >40 days of diabetes, when loss of ß-cell mass and identity had already occurred. Our data from mouse models demonstrate that: i) hyperglycemia per se, and not insulin hypersecretion, drives ß-cell failure in diabetes, ii) recovery of ß-cell function by SGLT2 inhibitors is potentially through reduction of oxidative and ER stress, iii) SGLT2 inhibitors revert/prevent ß-cell failure when used in early stages of diabetes, but not when loss of ß-cell mass/identity already occurred, iv) common execution pathways may underlie loss and recovery of ß-cell function in different forms of diabetes. These results may have important clinical implications for optimal therapeutic interventions in individuals with diabetes, particularly for those with long-standing diabetes.


Assuntos
Compostos Benzidrílicos/administração & dosagem , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/genética , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Mutação com Ganho de Função , Glucosídeos/administração & dosagem , Doenças do Recém-Nascido/tratamento farmacológico , Doenças do Recém-Nascido/genética , Células Secretoras de Insulina/metabolismo , Canais KATP/genética , Estresse Oxidativo/efeitos dos fármacos , Substâncias Protetoras/administração & dosagem , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Administração Oral , Animais , Glicemia/metabolismo , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/metabolismo , Modelos Animais de Doenças , Feminino , Mutação com Ganho de Função/efeitos dos fármacos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/induzido quimicamente , Doenças do Recém-Nascido/metabolismo , Células Secretoras de Insulina/efeitos dos fármacos , Masculino , Camundongos , Camundongos Transgênicos , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Resultado do Tratamento
15.
Pain Manag ; 12(5): 595-609, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35152709

RESUMO

Treatment of painful diabetic peripheral neuropathy (PDPN) is challenging and often limited by drug tolerability and adverse effects. This review article focuses on the high-dose (8%) capsaicin patch that allows for improved efficacy and reduced application frequency in comparison to low-dose capsaicin formulations. Systemic absorption is minimal resulting in fewer systemic side effects than first-line oral medications. There is evidence that capsaicin patch treatment is well-tolerated, safe and provides effective pain relief maintained for several weeks; well-powered studies are needed to confirm these findings. The capsaicin 8% patch may benefit patients at high risk for adverse effects from oral medication, polypharmacy or inadequate pain relief from first-line therapies.


Treatment of nerve pain in the feet and other regions due to nerve damage from diabetes is challenging, often due to the unwanted side effects of medications. This review article focuses on the high-dose (8%) capsaicin patch, which can be applied directly to the feet. It is more potent than the low-dose formulations, allowing patients to apply it less often while also working more effectively compared with low-dose capsaicin creams. Because it acts directly on the skin, there are fewer systemic side effects such as drowsiness or urinary retention. There is evidence that capsaicin patch treatment is safe and provides pain relief for several weeks. More large studies are needed to confirm these findings. The capsaicin 8% patch may benefit patients at high risk for side effects from oral medications or inadequate pain relief from first-line medications.


Assuntos
Diabetes Mellitus , Neuropatias Diabéticas , Neuralgia , Capsaicina/efeitos adversos , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Neuropatias Diabéticas/induzido quimicamente , Neuropatias Diabéticas/tratamento farmacológico , Humanos , Neuralgia/tratamento farmacológico , Manejo da Dor
16.
Minerva Cardiol Angiol ; 70(3): 393-402, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35212508

RESUMO

The burden of cardiovascular comorbid conditions was significantly higher in patients with atrial fibrillation (AF); most of them are affected by hypertension, chronic kidney disease (CKD) and/or diabetes mellitus (DM). DM represents a well-known risk factor for the development and maintenance of AF; the coexistence of DM and AF is also associated with an increased risk of mortality and stroke. Moreover, DM is currently the main cause of renal impairment and the leading cause of dialysis in the world. The hyperglycemia is responsible for inducing redox imbalance and both systemic and intrarenal inflammation, playing a critical role in the pathogenesis of diabetic kidney disease. Long-term thromboembolic preventive therapy in AF patients with DM and CKD may be more challenging because both DM and CKD have been independently associated with an increased thromboembolic and bleeding risk, which results from the prothrombotic and proinflammatory status. Vitamin K antagonists (VKAs) are characterized by numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. On the other hand, Direct Oral Anticoagulants (DOACs) are currently contraindicated in dialysis patients even if mounting evidence suggests that they may have a nephroprotective role in AF patients with DM and CKD. Consequently, the choice of anticoagulant therapy in this setting of patient seems to be very challenging. The aim of this review is to investigate the role of DOACs in diabetic patients and its nephroprotective role by reviewing the current literature.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Renal Crônica , Acidente Vascular Cerebral , Administração Oral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
17.
Diabet Med ; 39(6): e14821, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35213749

RESUMO

AIMS: The association between metformin use and neurodegenerative disease (ND) onset remains controversial. In this systematic review and meta-analysis, we aimed to determine the relationship between metformin use and ND risk based on data from population-based cohort studies. METHODS: Articles were systematically searched in PubMed, EMBASE and Cochrane Library databases. Pooled relative risks (RRs) with 95% CIs were obtained using a random-effects model. Subgroup analyses, sensitivity analyses and meta-regression were performed to identify the sources of heterogeneity and strengthen the results. RESULTS: Twelve population-based cohort studies involving 194,792 participants (94,462 metformin users and 100,330 metformin non-users) were eligible for inclusion in this meta-analysis. The pooled RR of NDs reached 0.77 (95% CI 0.67-0.88) when comparing metformin users with non-users. The effects were more prominent in long-term metformin users (≥4 years) (RR 0.29, 95% CI 0.13-0.44) and studies from Asian countries (RR 0.69, 95% CI 0.64-0.74). The effect estimates were stable when stratified by subtypes of NDs, study designs, and control definitions (p for interaction >0.05). Meta-regression did not identify the coefficients as the sources of heterogeneity (all p > 0.05). CONCLUSIONS: This systematic review and meta-analysis found that metformin use, especially long-term use, was associated with lower ND risk. However, because there was substantial heterogeneity among studies, high-quality randomized controlled trials are still needed to confirm this finding.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Metformina , Doenças Neurodegenerativas , Estudos de Coortes , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Doenças Neurodegenerativas/epidemiologia
19.
Am J Cardiol ; 169: 57-63, 2022 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-35063269

RESUMO

Atrial fibrillation (AF) is often asymptomatic. The prognosis of asymptomatic AF is at least similar or worse than symptomatic AF, but there are no such data from Middle East patients with AF. The Gulf-SAFE (Gulf Survey of Atrial Fibrillation Events) registry is a multicenter prospective survey of patients presenting with AF to participate medical institutions in 6 countries in the Gulf region. We investigated the prognostic outcomes of patients with asymptomatic AF in relation to clinical subtypes. A total of 2043 patients with AF were included; 541 were identified as having asymptomatic AF (26.5%) who tended to be older, with higher prevalences of hypertension, heart failure, coronary artery disease, diabetes, stroke, renal dysfunction, chronic obstructive pulmonary disease, and had higher Congestive heart failure, Hypertension, Age ≥75, Stroke (2 points), Congestive heart failure, Hypertension, Age ≥75 (2 points), Diabetes, Stroke (2 points), Vascular disease, Age 65-74, Sex category (CHA2DS2-VASc), and Hypertension, Age ≥65, Stroke, Bleeding history, liable INR, Elderly, Drug or alcohol use (HAS-BLED) scores (all p <0.05). After multivariable adjustment, asymptomatic AF was associated with higher risks of stroke/systematic embolism (SE) (adjusted odds ratio [aOR] 2.18, 95% confidence interval [CI] 1.10 to 4.34), all-cause mortality (aOR 2.85, 95% CI 1.90 to 4.28), and the composite outcome of stroke/SE, bleeding, and all-cause mortality (aOR 1.74, 95% CI 1.26 to 2.41). Patients with asymptomatic AF had fewer admissions for AF (aOR 0.53, 95% CI 0.32 to 0.83) and heart failure (aOR 0.58, 95% CI 0.38 to 0.86). The increased risk of stroke/SE in asymptomatic AF was more prominent among paroxysmal AF subtype (p for interaction = 0.028). In conclusion, in the Gulf-SAFE registry, patients with asymptomatic AF represent a nonbenign entity with worse outcomes compared with symptomatic AF. In paroxysmal AF, the higher risks of events were more prominent. The absence of "warning signs" and lack of timely admission in asymptomatic AF may be major reasons for the unfavorable prognosis.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Embolia , Insuficiência Cardíaca , Hipertensão , Acidente Vascular Cerebral , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Diabetes Mellitus/induzido quimicamente , Embolia/epidemiologia , Insuficiência Cardíaca/complicações , Hemorragia/epidemiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Prognóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia
20.
Zhongguo Fei Ai Za Zhi ; 25(1): 61-65, 2022 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-35078286

RESUMO

Immune checkpoint inhibitors (ICIs) are widely used in clinic, and the incidence of rare adverse events are increasing. The aim of this paper is to better define the rare adverse effect of diabetes mellitus associated with ICIs. We report 2 cases of diabetes mellitus associated with ICIs. Literature review was conducted and we discussed the clinical presentation, potential mechanisms and suggestions for optimal management. Two patients were both elderly women, case 1 had increased blood glucose after 7 months of using Durvalumab, and cases 2 had diabetic ketoacidosis after 6 weeks of using Pembrolizumab. Both patients were administered exogenous insulin to control blood glucose. Case 1 has been treated with Durvalumab until now and case 2 discontinued using of Pembrolizumab. HLA genotypes and other factors may explain the risk factors of diabetes associated with ICIs in some individuals. Diabetes mellitus associated with ICIs is an uncommon but potentially life-threatening endocrine system adverse event, which requires doctors to be vigilant. The patients who use ICIs need to monitor blood glucose. If they have hyperglycemia, endocrinologists should be asked to assist in diagnosis and treatment.
.


Assuntos
Diabetes Mellitus , Inibidores de Checkpoint Imunológico/efeitos adversos , Neoplasias Pulmonares , Idoso , Glicemia , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico
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