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1.
Medicine (Baltimore) ; 100(6): e24733, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578620

RESUMO

ABSTRACT: Studies comparing long-term clinical outcomes of statin treatment between acute myocardial infarction (AMI) patients with prediabetes and those with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) with the newer-generation drug-eluting stents (DESs) are limited. We compared 2-year clinical outcomes between these patients.A total of 11,962 AMI patients were classified as statin users (n = 10,243) and statin nonusers (n = 1719). Thereafter, statin users and nonusers were further divided into the normoglycemia, prediabetes, and T2DM groups. The major outcome was the occurrence of major adverse cardiac event (MACE) defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat coronary revascularization.After statin treatment, the cumulative incidences of MACE (P = .314), all-cause death, cardiac death (CD), Re-MI, and any repeat revascularization were similar between the prediabetes and T2DM groups. However, the cumulative incidences of MACE (P = .025) and all-cause death (P = .038) in the prediabetes group and those of MACE (P = .001), all-cause death (P = .009), and CD (P = .048) in the T2DM group were significantly higher than those in the normoglycemia group. Moreover, in all the 3 glycemic groups, the cumulative incidences of MACE, all-cause death, and CD were significantly higher among statin nonusers than among statin users.This study revealed that AMI patients with prediabetes had worse clinical outcomes than those with normoglycemia and comparable to those with T2DM after 2-year statin treatment. However, further studies are warranted to confirm the current findings.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/terapia , Estado Pré-Diabético/complicações , Sistema de Registros , Idoso , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea , República da Coreia/epidemiologia , Estudos Retrospectivos
2.
N Engl J Med ; 384(11): 989, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33567185

RESUMO

BACKGROUND: Obesity is a global health challenge with few pharmacologic options. Whether adults with obesity can achieve weight loss with once-weekly semaglutide at a dose of 2.4 mg as an adjunct to lifestyle intervention has not been confirmed. METHODS: In this double-blind trial, we enrolled 1961 adults with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or greater (≥27 in persons with ≥1 weight-related coexisting condition), who did not have diabetes, and randomly assigned them, in a 2:1 ratio, to 68 weeks of treatment with once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo, plus lifestyle intervention. The coprimary end points were the percentage change in body weight and weight reduction of at least 5%. The primary estimand (a precise description of the treatment effect reflecting the objective of the clinical trial) assessed effects regardless of treatment discontinuation or rescue interventions. RESULTS: The mean change in body weight from baseline to week 68 was -14.9% in the semaglutide group as compared with -2.4% with placebo, for an estimated treatment difference of -12.4 percentage points (95% confidence interval [CI], -13.4 to -11.5; P<0.001). More participants in the semaglutide group than in the placebo group achieved weight reductions of 5% or more (1047 participants [86.4%] vs. 182 [31.5%]), 10% or more (838 [69.1%] vs. 69 [12.0%]), and 15% or more (612 [50.5%] vs. 28 [4.9%]) at week 68 (P<0.001 for all three comparisons of odds). The change in body weight from baseline to week 68 was -15.3 kg in the semaglutide group as compared with -2.6 kg in the placebo group (estimated treatment difference, -12.7 kg; 95% CI, -13.7 to -11.7). Participants who received semaglutide had a greater improvement with respect to cardiometabolic risk factors and a greater increase in participant-reported physical functioning from baseline than those who received placebo. Nausea and diarrhea were the most common adverse events with semaglutide; they were typically transient and mild-to-moderate in severity and subsided with time. More participants in the semaglutide group than in the placebo group discontinued treatment owing to gastrointestinal events (59 [4.5%] vs. 5 [0.8%]). CONCLUSIONS: In participants with overweight or obesity, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight. (Funded by Novo Nordisk; STEP 1 ClinicalTrials.gov number, NCT03548935).


Assuntos
Fármacos Antiobesidade/administração & dosagem , Peptídeo 1 Semelhante ao Glucagon/agonistas , Peptídeos Semelhantes ao Glucagon/administração & dosagem , Obesidade/tratamento farmacológico , Adulto , Fármacos Antiobesidade/efeitos adversos , Composição Corporal/efeitos dos fármacos , Índice de Massa Corporal , Colelitíase/induzido quimicamente , Diarreia/induzido quimicamente , Método Duplo-Cego , Feminino , Peptídeos Semelhantes ao Glucagon/efeitos adversos , Estilo de Vida Saudável , Humanos , Injeções Subcutâneas , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Obesidade/complicações , Estado Pré-Diabético/complicações , Perda de Peso/efeitos dos fármacos
3.
Vnitr Lek ; 66(7): 20-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380130

RESUMO

Diabetes is an established risk factor of cardiovascular disease including the coronary heart disease (CHD) and elevates the risk of cardiovascular death 2 times. Based on current evidence the risk of acquiring the CHD increases accordingly to the level of fasting blood glucose even in the prediabetic range. In the range of 5.6-6.0mmol/l the risk is 1.11, in the range of 6.1-6.9mmol/l the risk is 1.17. In the range of HbA1c of 42-47mmol/l the risk of the CHD is 1.28. The probability of the CHD occurrence therefore does indeed increase in conjunction with the fasting blood glucose levels but the dependence is not linear.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Estado Pré-Diabético , Glicemia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Jejum , Hemoglobina A Glicada/análise , Humanos , Estado Pré-Diabético/complicações , Estado Pré-Diabético/epidemiologia , Fatores de Risco
4.
Nat Commun ; 11(1): 4592, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32929089

RESUMO

Prediabetes is a state of glycaemic dysregulation below the diagnostic threshold of type 2 diabetes (T2D). Globally, ~352 million people have prediabetes, of which 35-50% develop full-blown diabetes within five years. T2D and its complications are costly to treat, causing considerable morbidity and early mortality. Whether prediabetes is causally related to diabetes complications is unclear. Here we report a causal inference analysis investigating the effects of prediabetes in coronary artery disease, stroke and chronic kidney disease, complemented by a systematic review of relevant observational studies. Although the observational studies suggest that prediabetes is broadly associated with diabetes complications, the causal inference analysis revealed that prediabetes is only causally related with coronary artery disease, with no evidence of causal effects on other diabetes complications. In conclusion, prediabetes likely causes coronary artery disease and its prevention is likely to be most effective if initiated prior to the onset of diabetes.


Assuntos
Doenças Cardiovasculares/complicações , Estado Pré-Diabético/complicações , Glicemia/metabolismo , Doenças Cardiovasculares/genética , Intervalos de Confiança , Doença da Artéria Coronariana/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Jejum/sangue , Humanos , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Razão de Chances , Estado Pré-Diabético/sangue , Estado Pré-Diabético/genética , Insuficiência Renal Crônica/complicações , Fatores de Risco , Acidente Vascular Cerebral/complicações
5.
Cogn Behav Neurol ; 33(3): 218-225, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889954

RESUMO

BACKGROUND: Individuals with diabetes can develop cognitive impairment due to dysfunction of glucose metabolism; however, it remains unclear whether cognition becomes altered in the prediabetic stage. Substantial evidence links cognitive impairment in diabetes to aberrant serum insulin-degrading enzyme (s[IDE]) levels. This relationship remains to be investigated in individuals with prediabetes. OBJECTIVE: To investigate the relationship between cognitive function and s[IDE] levels in individuals with prediabetes. METHOD: The study group consisted of 47 individuals who had been diagnosed with prediabetes and 41 healthy controls. Cognitive functions were evaluated using the Montreal Cognitive Assessment (MoCA), and s[IDE] levels were measured using enzyme-linked immunosorbent assay. RESULTS: The MoCA total scores and s[IDE] levels of the individuals with prediabetes were significantly lower (P = 0.001, 0.006) than those of the controls, and the MoCA Attention measure of the individuals with prediabetes was also very low (P = 0.001). To determine cognitive impairment, we divided the prediabetics into two subgroups according to the MoCA cutoff value. Scores on all of the MoCA tests were significantly lower in the group with mild cognitive impairment (P < 0.05). There was no correlation between MoCA scores and s[IDE] levels (P > 0.05), but serum-fasting glucose levels showed a negative correlation with MoCA scores (P < 0.05, ρ = -0.287). CONCLUSION: Evidence of mild cognitive impairment was high in the individuals with prediabetes and showed a negative correlation with serum-fasting glucose levels but not with s[IDE] levels.


Assuntos
Cognição/fisiologia , Insulisina/efeitos adversos , Testes Neuropsicológicos/normas , Estado Pré-Diabético/complicações , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Int Heart J ; 61(4): 673-684, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684595

RESUMO

Hyperglycemia is an important risk factor for poor clinical outcomes in patients with acute myocardial infarction (AMI). The relative superiority of the long-term clinical outcomes of durable-polymer (DP) -based and biodegradable-polymer (BP) -based newer-generation drug-eluting stents (DESs) after successful percutaneous coronary intervention (PCI) in patients with AMI and prediabetes is not well established. We compared the clinical outcomes in such patients between DP-based and BP-based newer-generation DESs.A total of 4,377 patients with AMI and prediabetes were divided into the following two groups: the DP-DES group (n = 3,775; zotarolimus-eluting stents [ZES; n = 1,546] and everolimus-eluting stents [EES; n = 2,229]) and the BP-DES group (n = 602; biolimus-eluting stents [BES]). The primary endpoint was the occurrence of major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction (re-MI), or any repeat revascularization. The secondary endpoint was the occurrence of stent thrombosis (ST).The 2-year adjusted hazard ratio (aHR) of MACEs for ZES versus EES, ZES versus BES, EES versus BES, and ZES/EES versus BES (aHR: 1.125; 95% confidence interval [CI], 0.834-1.518; P = 0.440) were similar. The cumulative incidence of ST was also comparable between the DP-DES and BP-DES groups (aHR: 1.407; 95% CI, 0.476-4.158; P = 0.537). Moreover, the 2-year aHRs of all-cause death, CD, re-MI, target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR were similar.Patients with AMI and prediabetes who received DP-DES or BP-DES during PCI showed comparable safety and efficacy during the 2-year follow-up period.


Assuntos
Implantes Absorvíveis/estatística & dados numéricos , Stents Farmacológicos/estatística & dados numéricos , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/instrumentação , Estado Pré-Diabético/complicações , Idoso , Antineoplásicos/administração & dosagem , Everolimo/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Sirolimo/administração & dosagem , Sirolimo/análogos & derivados
7.
BMJ ; 370: m2297, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32669282

RESUMO

OBJECTIVE: To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. DESIGN: Updated meta-analysis. DATA SOURCES: Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. REVIEW METHODS: Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke. RESULTS: A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10). CONCLUSIONS: Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.


Assuntos
Doenças Cardiovasculares/mortalidade , Doença das Coronárias/mortalidade , Estado Pré-Diabético/complicações , Acidente Vascular Cerebral/mortalidade , Idoso , Aterosclerose/complicações , Aterosclerose/epidemiologia , Aterosclerose/mortalidade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/prevenção & controle , Estudos de Casos e Controles , Ensaios Clínicos como Assunto , Doença das Coronárias/epidemiologia , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estado Pré-Diabético/epidemiologia , Risco , Fatores de Risco , Prevenção Secundária/métodos , Acidente Vascular Cerebral/epidemiologia
8.
Pain Res Manag ; 2020: 8239474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32676137

RESUMO

Background: Diabetes is a debilitating chronic health condition that is associated with certain pain syndromes. The present study sought to evaluate chronic pain and its association with diabetes mellitus at a population level. Methods: A population-based cross-sectional questionnaire survey study was conducted in Al-Kharj, Saudi Arabia, from January 2016 to June 2016. Participants from both private and governmental institutions were selected following a multistage sampling technique and using a cluster sampling method. Anthropometric measurements were taken, including body weight, height, body mass index (BMI) and waist circumference. A blood sample was also drawn from each respondent for fasting blood sugar, HbA1c, and fasting lipid profile. A P value of less than 0.05 indicated statistical significance. Results: A total of 1003 subjects were included for final analysis. Compared to prediabetic and nondiabetic individuals, diabetic subjects had a higher prevalence of lower limb pain (11.1%), back pain (8.9%), abdominal pain (6.7%), and neck pain (4.4%) (X 2 = 27.792, P = 0.015). In a multiple logistic regression model, after adjusting for age, gender, education level, cholesterol, and smoking status, diabetic/prediabetic patients had a significantly higher prevalence of chronic pain ((OR) = 1.931 (95% CI = 1.536-2.362), P = 0.037). Increased age was also significantly associated with chronic pain ((OR) = 1.032 (95% CI = 1.010-1.054, P = 0.004). Conclusion: Results of this study found a significant association between diabetes and prediabetes and chronic pain symptoms. Prospective studies are needed to explore temporality of such association.


Assuntos
Dor Crônica/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus , Estado Pré-Diabético/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Inquéritos e Questionários
9.
Nat Rev Endocrinol ; 16(10): 545-555, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32690918

RESUMO

Evidence from observational studies and randomized trials suggests that prediabetes and type 2 diabetes mellitus (T2DM) can develop in genetically susceptible individuals in parallel with weight (that is, fat) gain. Accordingly, studies show that weight loss can produce remission of T2DM in a dose-dependent manner. A weight loss of ~15 kg, achieved by calorie restriction as part of an intensive management programme, can lead to remission of T2DM in ~80% of patients with obesity and T2DM. However, long-term weight loss maintenance is challenging. Obesity and T2DM are associated with diminished glucose uptake in the brain that impairs the satiating effect of dietary carbohydrate; therefore, carbohydrate restriction might help maintain weight loss and maximize metabolic benefits. Likewise, increases in physical activity and fitness are an important contributor to T2DM remission when combined with calorie restriction and weight loss. Preliminary studies suggest that a precision dietary management approach that uses pretreatment glycaemic status to stratify patients can help optimize dietary recommendations with respect to carbohydrate, fat and dietary fibre. This approach might lead to improved weight loss maintenance and glycaemic control. Future research should focus on better understanding the individual response to dietary treatment and translating these findings into clinical practice.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Dietoterapia , Terapia por Exercício , Obesidade/prevenção & controle , Restrição Calórica , Diabetes Mellitus Tipo 2/complicações , Humanos , Obesidade/complicações , Estado Pré-Diabético/complicações , Estado Pré-Diabético/prevenção & controle , Resultado do Tratamento , Perda de Peso
11.
Ann Endocrinol (Paris) ; 81(2-3): 101-109, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32413342

RESUMO

Diabetes is among the most frequently reported comorbidities in patients infected with COVID-19. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. On the other hand, diabetes is a risk factor for developing severe and critical forms of COVID-19, the latter requiring admission to an intensive care unit and/or use of invasive mechanical ventilation, with high mortality rates. The characteristics of diabetic patients at risk for developing severe and critical forms of COVID-19, as well as the prognostic impact of diabetes on the course of COVID-19, are under current investigation. Obesity, the main risk factor for incident type 2 diabetes, is more common in patients with critical forms of COVID-19 requiring invasive mechanical ventilation. On the other hand, COVID-19 is usually associated with poor glycemic control and a higher risk of ketoacidosis in diabetic patients. There are currently no recommendations in favour of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Metformin and SGLT2 inhibitors should be discontinued in patients with severe forms of COVID-19 owing to the risks of lactic acidosis and ketoacidosis. Finally, we advise for systematic screening for (pre)diabetes in patients with proven COVID-19 infection.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Acidose Láctica/induzido quimicamente , Acidose Láctica/epidemiologia , Acidose Láctica/virologia , Betacoronavirus/fisiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Estado Terminal/epidemiologia , Estado Terminal/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Cetoacidose Diabética/induzido quimicamente , Cetoacidose Diabética/epidemiologia , Cetoacidose Diabética/virologia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Metformina/uso terapêutico , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/terapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Estado Pré-Diabético/complicações , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/terapia , Sistema Renina-Angiotensina/fisiologia , Fatores de Risco , Gestão de Riscos , Índice de Gravidade de Doença , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Suspensão de Tratamento
12.
Int J Behav Nutr Phys Act ; 17(1): 29, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131847

RESUMO

BACKGROUND: Physical activity, sedentary time and sleep have been shown to be associated with cardio-metabolic health. However, these associations are typically studied in isolation or without accounting for the effect of all movement behaviours and the constrained nature of data that comprise a finite whole such as a 24 h day. The aim of this study was to examine the associations between the composition of daily movement behaviours (including sleep, sedentary time (ST), light intensity physical activity (LIPA) and moderate-to-vigorous activity (MVPA)) and cardio-metabolic health, in a cross-sectional analysis of adults with pre-diabetes. Further, we quantified the predicted differences following reallocation of time between behaviours. METHODS: Accelerometers were used to quantify daily movement behaviours in 1462 adults from eight countries with a body mass index (BMI) ≥25 kg·m- 2, impaired fasting glucose (IFG; 5.6-6.9 mmol·l- 1) and/or impaired glucose tolerance (IGT; 7.8-11.0 mmol•l- 1 2 h following oral glucose tolerance test, OGTT). Compositional isotemporal substitution was used to estimate the association of reallocating time between behaviours. RESULTS: Replacing MVPA with any other behaviour around the mean composition was associated with a poorer cardio-metabolic risk profile. Conversely, when MVPA was increased, the relationships with cardiometabolic risk markers was favourable but with smaller predicted changes than when MVPA was replaced. Further, substituting ST with LIPA predicted improvements in cardio-metabolic risk markers, most notably insulin and HOMA-IR. CONCLUSIONS: This is the first study to use compositional analysis of the 24 h movement composition in adults with overweight/obesity and pre-diabetes. These findings build on previous literature that suggest replacing ST with LIPA may produce metabolic benefits that contribute to the prevention and management of type 2 diabetes. Furthermore, the asymmetry in the predicted change in risk markers following the reallocation of time to/from MVPA highlights the importance of maintaining existing levels of MVPA. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01777893).


Assuntos
Exercício Físico/fisiologia , Obesidade , Estado Pré-Diabético , Comportamento Sedentário , Glicemia/análise , Índice de Massa Corporal , Estudos Transversais , Humanos , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Estado Pré-Diabético/complicações , Estado Pré-Diabético/epidemiologia , Fatores de Risco
13.
Klin Padiatr ; 232(4): 210-216, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32176935

RESUMO

BACKGROUND: Oral glucose tolerance (OGT) deteriorates progressively in cystic fibrosis (CF). Clinical registries provide a unique basis to study real-world data. PATIENTS & METHODS: OGT tests (OGTTs) documented in the German CF-registry in 2016 were classified according WHO, modified by ADA: normal glucose tolerance (NGT), indeterminate glycaemia (INDET), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT, diabetes mellitus (DM). To study the association with lung function, multivariable regression adjusted for age, sex, and CFTR mutation was performed. RESULTS: Overall, OGTT screening was done in 35% of CF patients ≧10 years. Of the 996 patients (46.4% females; median age (IQR): 19 (14-27) years) with evaluable OGTTs, 56.2% had either NGT or INDET, whereas 34% had a pre-diabetic OGTT (IFG; IGT; IFG+IGT) and 9.8% a diabetic OGTT. 7 patients had glucose tolerance abnormalities <10 years. DM was more common in females or patients with F508del homozygote mutation, whereas IFG was more frequent in males (all p<0.05). Nearly 75% of patients after transplantation and about half with enteral/parental nutrition and/or steroid use had either a pre-diabetic or diabetic glucose tolerance. In the adjusted model, age (p<0.001) and OGTT category (p=0.013) had both a significant impact on %FEV1. CONCLUSION: Our data of the German CF-registry highlights incidence of glucose tolerance abnormalities in second decade of life in CF patients. However, it also underlines the need for improvement of the documentation and/or performance of OGTT screening in real-world CF care. HINTERGRUND: Bei Mukoviszidose (zystischer Fibrose: CF) verschlechtert sich die orale Glukosetoleranz (OGT) im Krankheitsverlauf. PATIENTEN & METHODEN: OGT Tests (OGTTs), die 2016 im Deutschen CF-Register dokumentiert waren, wurden gemäß WHO (modifiziert nach ADA) kategorisiert: Normale Glukosetoleranz (NGT), intermittierende Glykämie (INDET), eingeschränkte Nüchternglukosetoleranz (IFG), gestörte Glukosetoleranz (IGT), IFG+IGT, Diabetes Mellitus (DM). Um den Zusammenhang mit der Lungenfunktion zu analysieren, wurde eine multivariable Regressionsanalyse adjustiert für Alter, Geschlecht und CFTR Mutation durchgeführt. ERGEBNISSE: Insgesamt wurden 35% der CF-Patienten ≥10 Jahre mittels OGTT gescreent. Von den 996 Patienten (46,4% weiblich, medianes Alter (IQR): 19 (14-27) Jahre) mit auswertbaren OGTTs hatten 56,2% entweder NGT oder INDET, wohingegen bei 34% ein prädiabetischer (IFG; IGT; IFG+IGT) und bei 9,8% ein diabetischer OGTT beobachtet wurde. Bei 7 Patienten zeigten sich vor dem 10. LJ Abnormalitäten im Glukosestoffwechsel. DM war häufiger bei Frauen und Patienten mit homozygoter F508del Mutation, wobei IFG öfters bei Männern vorlag (alle p<0,05). Ca. 75% der Patienten mit Transplantation und etwa die Hälfte der Patienten mit künstlicher Ernährung und/oder Steroidgabe hatten eine prädiabetische oder diabetische Glukosetoleranz. Das Alter (p<0,001) und die OGTT Kategorie (p=0,013) zeigten im adjustierten Modell eine signifikante Assoziation mit %FEV1. SCHLUSSFOLGERUNG: Unsere Daten unterstreichen das Auftreten von Abnormalitäten im Glukosestoffwechsel bei CF im 2. Lebensjahrzehnt. Jedoch weißt es auf die Notwendigkeit eines regelmäßigen Diabetesscreenings und/oder Dokumentation von OGTTs bei CF hin.


Assuntos
Fibrose Cística/fisiopatologia , Teste de Tolerância a Glucose , Adolescente , Adulto , Fibrose Cística/complicações , Diabetes Mellitus , Feminino , Alemanha , Glucose , Humanos , Masculino , Estado Pré-Diabético/complicações , Sistema de Registros , Adulto Jovem
14.
Rev. clín. esp. (Ed. impr.) ; 220(2): 135-138, mar. 2020.
Artigo em Espanhol | IBECS | ID: ibc-186427

RESUMO

Existe una asociación bidireccional entre la insuficiencia cardiaca (IC) y la diabetes mellitus tipo 2 (DM2) que hace que la combinación de ambas enfermedades en un mismo paciente haya pasado a tener un incremento exponencial. Dicha combinación, parte de múltiples causas comunes que llevan a vías fisiopatológicas que resultan en un efecto deletéreo de la DM2 sobre la IC. La consecuencia clínica inevitable es que ante dicha situación el paciente presente peor clínica y peor pronóstico que el paciente con IC sin DM2. Por todo ello debemos tener en cuenta cómo tratar la DM2 en pacientes con IC, y cómo tratar la IC en pacientes con DM2. En esta revisión se hace hincapié en los últimos datos publicados al respecto


There is a bidirectional association between heart failure (HF) and type 2 diabetes mellitus (DM2), which has resulted in an exponential increase in the combination of the 2 diseases in a single patient. This combination is one of many common causes that lead to the pathophysiological pathways resulting in the deleterious effect of DM2 on HF. The inevitable clinical consequence is that, when faced with this situation, patients present worse symptoms and a poorer prognosis than patients with HF but without DM2. We should therefore consider how to treat DM2 in patients with HF and how to treat HF in patients with DM2. In this review, we highlight the latest published data on this issue


Assuntos
Humanos , Insuficiência Cardíaca/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Metformina/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Insuficiência Cardíaca/complicações , Hemoglobina A Glicada/análise , Fatores de Risco , Suscetibilidade a Doenças/epidemiologia , Estado Pré-Diabético/complicações
15.
J Med Case Rep ; 14(1): 34, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32079542

RESUMO

BACKGROUND: Lipodystrophies are a group of diseases which are characterized by abnormal adipose tissue deposition and are frequently associated with metabolic changes. Congenital generalized lipodystrophy is an autosomal recessive syndrome, with a prevalence < 1:10 million. Acromegaly is a rare disease, secondary to the chronic hypersecretion of growth hormone and insulin-like growth factor-1, with characteristic metabolic and somatic effects. "Acromegaloidism" is a term used for patients who manifest clinical features of acromegaly, but do not present a demonstrable hormone growth hypersecretion. The extreme shortage of subcutaneous adipose tissues and muscle hypertrophy confer an acromegaloid-like appearance in these patients. CASE PRESENTATION: We describe a case of a patient with the rare combination of Berardinelli-Seip congenital lipodystrophy and acromegaly; our patient is a 63-year-old white man, who was referred to an endocrinology consultation for suspected lipodystrophy. He had lipoatrophy of upper and lower limbs, trunk, and buttocks, with muscular prominence, acromegaloid facial appearance, large extremities, and soft tissue tumescence. In addition, he had dyslipidemia and prediabetes. His fat mass ratio (% trunk fat mass/% lower limbs fat mass) was 1.02 by densitometry and he also had hepatomegaly, with mild steatosis (from an abdominal ultrasound), and left ventricular hypertrophy (from an electrocardiogram). His first oral glucose tolerance test had growth hormone nadir of 0.92 ng/mL, and the second test, 10 months afterwards, registered growth hormone nadir of 0.64 ng/mL (growth hormone nadir < 0.3 ng/mL excludes acromegaly). Pituitary magnetic resonance imaging identified an area of hypocaptation of contrast product in relation to a pituitary adenoma and he was subsequently submitted to transsphenoidal surgical resection of the mass. A pathological evaluation showed pituitary adenoma with extensive expression of growth hormone and adrenocorticotropic hormone, as well as a rare expression of follicle-stimulating hormone and prolactin. A genetic study revealed an exon 3/exon 4 deletion of the AGPAT2 gene in homozygosity. CONCLUSIONS: Congenital generalized lipodystrophy is a rare disease which occurs with acromegaloid features. As far as we know, we have described the first case of genetic lipodystrophy associated with true acromegaly. Although this is a rare association, the presence of congenital generalized lipodystrophy should not exclude the possibility of simultaneous acromegaly.


Assuntos
Acromegalia/complicações , Adenoma/patologia , Hormônio do Crescimento Humano/metabolismo , Lipodistrofia Generalizada Congênita/complicações , Neoplasias Hipofisárias/patologia , Aciltransferases/genética , Hormônio Adrenocorticotrópico/metabolismo , Dislipidemias/complicações , Éxons , Hormônio Foliculoestimulante/metabolismo , Teste de Tolerância a Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/complicações , Prolactina/metabolismo
16.
BMC Infect Dis ; 20(1): 139, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059707

RESUMO

BACKGROUND: Diabetes mellitus (DM) is thought to affect tuberculosis (TB) clinical presentation and treatment response. Whether DM impacts radiological manifestations of pulmonary TB is still not clear. This study investigated the impact of glycemic status on radiological manifestations of pulmonary TB cases and its relationship with concentration of biochemical parameters in peripheral blood. METHODS: A retrospective cross-sectional study used data from 132 microbiologically confirmed pulmonary TB patients from Lima, Peru, evaluated in a previous investigation performed between February and December 2017. Chest radiographs were analyzed by a radiologist and a pulmonologist. Radiographic lesions were identified as cavities, alveolar infiltrates and fibrous tracts. Hyperglycemia in TB patients was identified by use of fasting plasma glucose, HbA1c and oral glucose tolerance test. Clinical, biochemical and hematological parameters were also analyzed. RESULTS: TB patients with hyperglycemia presented more frequently with cavities, alveolar infiltrates and fibrous tracts than those with normoglycemia. Hierarchical clustering analysis indicated that patients with more diverse and higher number of lung lesions exhibited a distinct laboratorial profile characterized by heightened white blood cell counts and circulating levels of total cholesterol, triglycerides and transaminases and simultaneously low levels of albumin and hemoglobin. Multivariable regression analyses adjusted for age, sex, prior TB, hemoglobin levels and acid-fast bacilli ≥2+ in sputum smears, demonstrated that presence of prediabetes or diabetes in TB patients was associated with increased odds of having 3 pulmonary lesion types (p = 0.003 and p < 0.01 respectively) or ≥ 4 lesions (p = 0.001 and p = 0.01 respectively). CONCLUSION: Hyperglycemia (both DM and prediabetes) significantly affected the presentation of radiographic manifestations and the number of lesions in pulmonary TB patients as well as the biochemical profile in peripheral blood.


Assuntos
Hiperglicemia/sangue , Hiperglicemia/complicações , Pulmão/patologia , Estado Pré-Diabético/sangue , Tuberculose Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Análise por Conglomerados , Estudos Transversais , Diabetes Mellitus/sangue , Feminino , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/microbiologia , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Peru , Estado Pré-Diabético/complicações , Análise de Regressão , Estudos Retrospectivos , Escarro/microbiologia , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/patologia
17.
Sci Rep ; 10(1): 1976, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32029793

RESUMO

The study aimed to investigate whether the glucose level improves and what factors affect the improvement in glucose control after the eradication of hepatitis C virus (HCV). A total of 1090 patients with HCV infections were enrolled, among which 278 (25.5%) patients were diagnosed with prediabetes, and 89 (8.16%) patients were diagnosed with diabetes. In the cohort, 990 patients belonged to sustained virological response (SVR) group and 100 belonged to non-SVR group. Decreases in the fasting plasma glucose (FPG) level were found in the SVR group but not in the non-SVR group (p < 0.001; p = 0.267). In the SVR group, subjects with baseline FPG ≥ 5.6 mmol/L were further stratified into glycometabolism-improved (N = 182) and unimproved (N = 150) groups according to their FPG after viral eradication. Multivariate analysis showed that older age, higher baseline HCV RNA, glucose, total bilirubin and alanine aminotransferase levels were independent risk factors for insufficient glucose improvement. In conclusion, patients with HCV infection had a higher prevalence of abnormal glycometabolism. It could be improved after viral eradication, indicating that HCV may influence glycometabolism. Moreover, Age, baseline HCV RNA, glucose, total bilirubin and alanine aminotransferase levels were impact factor for glycometabolism improvement after viral eradication.


Assuntos
Antivirais/farmacologia , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Hepacivirus/isolamento & purificação , Hepatite C Crônica/sangue , Estado Pré-Diabético/sangue , Adulto , Fatores Etários , Antivirais/uso terapêutico , Glicemia/análise , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Quimioterapia Combinada/métodos , Jejum/sangue , Feminino , Hepacivirus/genética , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/metabolismo , Humanos , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/complicações , Estado Pré-Diabético/tratamento farmacológico , Estado Pré-Diabético/metabolismo , RNA Viral/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , Resposta Viral Sustentada
18.
PLoS One ; 15(2): e0228570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040497

RESUMO

BACKGROUND: Diabetes is a metabolic disorder, characterized by hyperglycemic state of the body. A silent killer, which can take the lives of victims if undiagnosed at the earliest stage. Prediabetes has become an important health concern across countries due to its huge potential for the development of diabetes and other complications. The objectives of this study were to determine the prevalence of prediabetes and diabetes and its associated factors among rural fishing communities in Penang, Malaysia. METHODS: A cross-sectional study was conducted among fishing communities in Southwest District of Penang, Malaysia from August to November 2017. Blood sample (finger prick test) and physical examination were performed on sample of 168 participants consented in this study. Pre-validated Malay versions of International Physical Activity 7 (IPAQ-7) and Perceived Stress Scale (PSS) questionnaires were used to assess the level of physical activity and stress levels of the participants. Multinomial logistic regression models were fitted to identify factors associated with prediabetes and diabetes. RESULTS: The prevalence of diabetes and prediabetes were 19.6% (95% CI: 14.3, 26.4) and 10.12% (95% CI: 6.4, 15.7) respectively. The median physical activity (interquartile range) in MET-minutes per week for those with diabetes (1071.0 (2120.0)) and prediabetes (1314.0 (1710.0)) was generally lower as compared to non-diabetes. Majority reported moderate stress (57.3%) from PSS system. Abdominal obesity, family history of diabetes and being hypertensive were significant factors associated with diabetes; while older age, bigger waist circumference and self-perceived poor routine diet were factors associated with prediabetes. CONCLUSIONS: The screening for prediabetes in this population gives the opportunity to implement lifestyle interventions at the earliest possible, which could prevent the development of diabetes. The identification of diabetic individuals provides an opportunity to conduct health promotion and education to ensure good metabolic control and hence reduce the risks of complications.


Assuntos
Diabetes Mellitus/epidemiologia , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Glicemia , Estudos Transversais , Complicações do Diabetes/epidemiologia , Exercício Físico , Feminino , Pesqueiros , Humanos , Estilo de Vida , Malásia/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Estado Pré-Diabético/complicações , Prevalência , Análise de Regressão , Risco , População Rural , Estresse Psicológico , Inquéritos e Questionários , Circunferência da Cintura
19.
Diabetes Res Clin Pract ; 161: 108037, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32004696

RESUMO

AIMS: Obesity measurement is a vital component of most type 2 diabetes screening tests; while studies had shown that waist circumference (WC) is a better predictor in South Asians, there is evidence that BMI is also effective. Our objective was to evaluate the efficacy of BMIWC, a composite measure, against BMI and WC. METHODS: Using data from a nationwide randomized cluster sample survey (NMB-2017), we analyzed 7496 adults at high risk for type 2 diabetes. WC, BMI, and BMIWC were evaluated using Odds Ratio (OR), and Classification scores (Sensitivity, Specificity, and Accuracy). These were validated using Indian Diabetes Risk Score (IDRS) by replacing WC with BMI and BMIWC, and calculating Sensitivity, Specificity, and Accuracy. RESULTS: BMIWC had higher OR (2·300) compared to WC (1·87) and BMI (2·26). WC, BMI, and BMIWC were all highly Sensitive (0·75, 0·81, 0·70 resp.). But BMIWC had significantly higher Specificity (0.36) when compared to WC and BMI (0.27 each). IDRSWC, IDRSBMI, and IDRSBMIWC were all highly Sensitive (0·87, 0·88, 0·82 resp.). But IDRSBMIWC had significantly higher Specificity (0·39) compared to IDRSWC and IDRSBMI (0·30, 0·31 resp.). CONCLUSIONS: Both WC and BMI are good predictors of risk for T2DM, but BMIWC is a better predictor, with higher Specificity; this may indicate that Indians with high values of both central (high WC) and general (BMI > 23) obesity carry higher risk for type 2 diabetes than either one in isolation. Using BMIWC in IDRS improves its performance on Accuracy and Specificity.


Assuntos
Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/etiologia , Obesidade/diagnóstico , Estado Pré-Diabético/diagnóstico , Circunferência da Cintura , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/etnologia , Estado Pré-Diabético/complicações , Estado Pré-Diabético/etnologia , Prognóstico , Fatores de Risco , Sensibilidade e Especificidade , Adulto Jovem
20.
Diabetes Care ; 43(2): 382-388, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31776141

RESUMO

OBJECTIVE: Diabetes in older age is heterogeneous, and the treatment approach varies by patient characteristics. We characterized the short-term all-cause and cardiovascular mortality risk associated with hyperglycemia in older age. RESEARCH DESIGN AND METHODS: We included 5,791 older adults in the Atherosclerosis Risk in Communities Study who attended visit 5 (2011-2013; ages 66-90 years). We compared prediabetes (HbA1c 5.7% to <6.5%), newly diagnosed diabetes (HbA1c ≥6.5%, prior diagnosis <1 year, or taking antihyperglycemic medications <1 year), short-duration diabetes (duration ≥1 year but <10 years [median]), and long-standing diabetes (duration ≥10 years). Outcomes were all-cause and cardiovascular mortality (median follow-up of 5.6 years). RESULTS: Participants were 58% female, and 24% had prevalent cardiovascular disease. All-cause mortality rates, per 1,000 person-years, were 21.2 (95% CI 18.7, 24.1) among those without diabetes, 23.7 (95% CI 20.8, 27.1) for those with prediabetes, 33.8 (95% CI 25.2, 45.5) among those with recently diagnosed diabetes, 29.6 (95% CI 25.0, 35.1) for those with diabetes of short duration, and 48.6 (95% CI 42.4, 55.7) for those with long-standing diabetes. Cardiovascular mortality rates, per 1,000 person-years, were 5.8 (95% CI 4.6, 7.4) among those without diabetes, 6.6 (95% CI 5.2, 8.5) for those with prediabetes, 11.5 (95% CI 7.0, 19.1) among those with recently diagnosed diabetes, 8.2 (95% CI 5.9, 11.3) for those with diabetes of short duration, and 17.3 (95% CI 13.8, 21.7) for those with long-standing diabetes. After adjustment for other cardiovascular risk factors, prediabetes and newly diagnosed diabetes were not significantly associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.03 [95% CI 0.85, 1.23] and HR 1.31 [95% CI 0.94, 1.82], respectively) or cardiovascular mortality (HR 1.00 [95% CI 0.70, 1.43] and HR 1.35 [95% CI 0.74, 2.49], respectively). Excess mortality risk was primarily concentrated among those with long-standing diabetes (all-cause: HR 1.71 [95% CI 1.40, 2.10]; cardiovascular: HR 1.72 [95% CI 1.18, 2.51]). CONCLUSIONS: In older adults, long-standing diabetes has a substantial and independent effect on short-term mortality. Older individuals with prediabetes remained at low mortality risk over a median 5.6 years of follow-up.


Assuntos
Diabetes Mellitus/mortalidade , Hiperglicemia/mortalidade , Estado Pré-Diabético/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/epidemiologia , Aterosclerose/etiologia , Aterosclerose/mortalidade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/mortalidade , Feminino , Humanos , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Masculino , Estado Pré-Diabético/complicações , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Prevalência , Prognóstico , Fatores de Risco , Fatores de Tempo
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