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1.
Isr Med Assoc J ; 21(8): 546-551, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474018

RESUMO

BACKGROUND: The Bedouins living in southern Israel are a Muslim-Arab population that is transitioning from a nomadic lifestyle to life in permanent settlements. The population has unique characteristics that could affect hemoglobin A1c (HbA1c) measurements. The objective of this study was to describe the socio-demographic and unique morbidity characteristics of this community and their effect on HbA1c measurements. Consanguinity, especially among cousins in the Bedouin population, results in a high prevalence of autosomal recessive genetic diseases such as thalassemia (underestimate of HbA1c), hemoglobinopathies (underestimate and overestimate), Gilbert's disease, and glucose-6-phosphate dehydrogenase deficiency, an X-linked disorder, which can cause hyperbilirubinemia with an overestimate of HbA1c. Furthermore, nutritional deficiencies, autosomal recessive diseases, high birth rates, parasitic infections, and poverty can all cause high rates of anemia (iron and vitamin B12 deficiencies) that can raise HbA1c levels. Congenital dyserythropoietic anemia is found among Bedouin tribes in the Negev region and can lead to an underestimation of HbA1c levels. Pregnancy can also affect HbA1c levels. Medical teams working in the Bedouin community and in other Muslim populations with similar morbidity characteristics throughout the world should identify patients with medical conditions that can affect HbA1c measurements and be aware of possible measurement alternatives such as fructosamine and glycated albumin.


Assuntos
Anemia/etnologia , Hemoglobina A Glicada/análise , Hemoglobinopatias/etnologia , Desnutrição/etnologia , Complicações na Gravidez/etnologia , Anemia/sangue , Anemia/complicações , Árabes , Feminino , Hemoglobinopatias/sangue , Hemoglobinopatias/complicações , Humanos , Islamismo , Israel/etnologia , Masculino , Desnutrição/sangue , Desnutrição/complicações , Gravidez , Complicações na Gravidez/sangue , Reprodutibilidade dos Testes , Fatores Socioeconômicos
2.
Klin Lab Diagn ; 64(8): 453-458, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479598

RESUMO

The article contains the literature review on laboratory criteria of detection and monitoring of the progression of the disease in patients with the diagnosis of diabetes mellitus. It also covers the issues of methodical approaches to the identification of glycated hemoglobin (HbA1c). The findings of author's researches of glycated hemoglobin in 149 patients have been given within the framework of comparison of two methodical approaches and comparison of the results with the subsequent classification of the received data. A random laboratory finding of qualitative hemoglobinopathy has been demonstrated, and the results recognized as unqualifiable and the approach to classification of such values have been discussed.Comparison of the results of glycated hemoglobin identification performed by different methods. 149 patients underwent a one-stage identification of glycated hemoglobin from plasma stabilized with K2-EDTA on Bio-Rad D10 and Sebia Capillarys Flex Piercing 2. Comparative study of the results of glycated hemoglobin identification has shown a difference in absolute values. However, a statistically reliable (p < 0.05) correlation between the values of glycated hemoglobin, expressed as a percentage obtained by different methods, has been revealed. In this case, the choice of a method for identifying glycated hemoglobin is not a matter of principal but it is important to adhere to the same method in treatment and long-term monitoring.


Assuntos
Diabetes Mellitus/diagnóstico , Hemoglobina A Glicada/análise , Eletroforese Capilar , Humanos
3.
West Afr J Med ; 36(2): 133-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385599

RESUMO

BACKGROUND: Anaemia is a common disorder occurring in about 33% of the global population. It is an important cardiovascular risk factor and a key indicator of some chronic complications of Diabetes Mellitus (DM). This study aimed to determine the burden of anaemia and its correlation with some clinical and biochemical parameters among patients with DM attending a tertiary health facility in Zaria, Northwestern Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a case-control study in which 168 participants were enrolled (84 DM patients, 84 controls). It was conducted in the Endocrinology and Metabolic clinics of Ahmadu Bello University Teaching Hospital, Zaria. Consenting DM patients were enrolled consecutively and subsequently, sex- and age-matched with non-diabetic controls. Data on age, gender and Haemoglobin (Hb) concentrations were collated for all study participants. Additional data on type of DM, duration of DM once diagnosis, treatment, type of treatment, history of hypertension, chronic kidney disease, peripheral neuropathy, and Fasting Blood Sugar (FBS) were collated for all cases. Data were collated and analyzed using SPSS version 21. Level of significance was set at <0.05. Ethical approval for the study was obtained from the Institutional Health Research Ethics Committee and informed consent was obtained from the all the participants. RESULTS: Females constituted 39/84(46.4%) of each arm of the study. The mean ± SD of age for both cases and controls was 53.7 ± 8.9 years. The mean ± SD duration of DM, treatment for DM and FBS were 8.4 ± 5.7 years, 5.0 ± 3.6 years and 6.1 ± 2.5mmol/L respectively. Cases had significantly lower Hb concentration compared to controls (12.1±2.2g/dl vs. 13.1 ± 1.4g/dl, t= -3.446, p = 0.001). Overall prevalence of anaemia among cases and controls was 36/84(42.9%) vs. 26/84(31.0%) Z = 1.6, p = 0.110. Among cases, haemoglobin concentration had very weak, inverse and non-statistically significant relationships with age, duration of DM diagnosis, duration of therapy and FBS levels. There was a significant relationship between anaemia on one hand and type of DM and treatment on the other. The odds of DM patients with history of CKD or uncontrolled FBS having anaemia were OR= 0.600 (95% CI 0.196, 1.836) and OR=1.755 (95% CI 0.737, 4.181) respectively. CONCLUSION: The burden of anaemia amongst patients with DM is high in Zaria, Northwestern Nigeria, and it is associated with poor glycaemic control. Hence, the need to include haematological assessment as part of routine care of patients with DM.


Assuntos
Anemia/epidemiologia , Glicemia/análise , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobina A Glicada/análise , Adulto , Idoso , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Prevalência , Insuficiência Renal Crônica/epidemiologia
4.
BMJ ; 366: l4697, 2019 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-31434641

RESUMO

OBJECTIVE: To assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism. DESIGN: Systematic review and meta-analyses. DATA SOURCES: Medline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews. ELIGIBILITY CRITERIA: Randomised controlled trials of at least 24 weeks' duration assessing effects of increasing α-linolenic acid, long chain omega-3, omega-6, or total PUFA, which collected data on diabetes diagnoses, fasting glucose or insulin, glycated haemoglobin (HbA1c), and/or homoeostatic model assessment for insulin resistance (HOMA-IR). DATA SYNTHESIS: Statistical analysis included random effects meta-analyses using relative risk and mean difference, and sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline risk of diabetes and use of antidiabetes drugs, trial duration, and dose. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE. RESULTS: 83 randomised controlled trials (mainly assessing effects of supplementary long chain omega-3) were included; 10 were at low summary risk of bias. Long chain omega-3 had little or no effect on likelihood of diagnosis of diabetes (relative risk 1.00, 95% confidence interval 0.85 to 1.17; 58 643 participants, 3.7% developed diabetes) or measures of glucose metabolism (HbA1c mean difference -0.02%, 95% confidence interval -0.07% to 0.04%; plasma glucose 0.04, 0.02 to 0.07, mmol/L; fasting insulin 1.02, -4.34 to 6.37, pmol/L; HOMA-IR 0.06, -0.21 to 0.33). A suggestion of negative outcomes was observed when dose of supplemental long chain omega-3 was above 4.4 g/d. Effects of α-linolenic acid, omega-6, and total PUFA on diagnosis of diabetes were unclear (as the evidence was of very low quality), but little or no effect on measures of glucose metabolism was seen, except that increasing α-linolenic acid may increase fasting insulin (by about 7%). No evidence was found that the omega-3/omega-6 ratio is important for diabetes or glucose metabolism. CONCLUSIONS: This is the most extensive systematic review of trials to date to assess effects of polyunsaturated fats on newly diagnosed diabetes and glucose metabolism, including previously unpublished data following contact with authors. Evidence suggests that increasing omega-3, omega-6, or total PUFA has little or no effect on prevention and treatment of type 2 diabetes mellitus. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017064110.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/prevenção & controle , Gorduras Insaturadas na Dieta/uso terapêutico , Prevenção Primária/métodos , Prevenção Secundária/métodos , Adulto , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Suplementos Nutricionais , Jejum/sangue , Ácidos Graxos Ômega-3/uso terapêutico , Ácidos Graxos Ômega-6/uso terapêutico , Ácidos Graxos Insaturados/uso terapêutico , Feminino , Hemoglobina A Glicada/análise , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Medicine (Baltimore) ; 98(31): e16723, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374068

RESUMO

Fasting hyperglycemia is associated with poor neurologic outcome in acute ischemic stroke (AIS), but its relationship with in-hospital outcome in elderly patients remains largely unknown. To assess the association of in-hospital outcome with fasting plasma glucose (FPG) levels at admission in individuals with AIS.This retrospective propensity score-matched case-control study included patients aged over 60 years suffering from AIS and who were admitted to the emergency department from November 2013 to October 2016. Subjects were grouped into the poor-outcome and good-outcome groups based on mortality and intensive care unit (ICU) admission.The poor- and good-outcome groups comprised 74 and 1927 cases, respectively, before propensity score matching (PSM), and 74 and 296 cases, respectively, after PSM. Univariable logistic regression analysis showed that initial FPG after admission was associated with poor in-hospital outcome. Multivariable logistic regression analysis showed that initial FPG after admission was an independent predictor of poor in-hospital outcome (odds ratio = 1.11, 95% confidence interval: 1.037-1.188, P = .003).This study used PSM and strongly suggests that FPG is an independent predictive factor of poor in-hospital outcome in elderly patients with AIS. High initial FPG levels after admission may predict poor in-hospital outcome. Prospective studies are needed to confirm these findings.


Assuntos
Isquemia Encefálica/sangue , Hipoglicemia/sangue , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Acidente Vascular Cerebral/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/análise , Isquemia Encefálica/complicações , Estudos de Casos e Controles , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/complicações , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações
6.
Medicine (Baltimore) ; 98(27): e16096, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277108

RESUMO

Osteoporosis (OP) is a disease characterized by decreased bone mineral density (BMD) and an increased risk of osteoporotic fractures. Nutritional factors (including glucose and fats lipids), have been implicated in OP.We hypothesized that the levels of blood glucose and lipids could be biomarkers for predicting the risk of OP. To test this hypothesis, we evaluated the potential relationship between BMD and levels of blood glucose and lipids via a community-based study in China.This was a community-based cross-section analysis, and a total of 8584 cases were investigated. The BMD of the left calcaneus was measured using an ultrasonic bone densitometer. The levels of blood glucose (fasting blood glucose [FBG], 2-h blood glucose [2hBG], and glycosylated hemoglobin [HbAlc]), and lipids (triglyceride [TG], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], and high-density lipoprotein cholesterol [HDL-C]) were measured and analyzed.In our study population, the levels of FBG, 2hBG, HbAlc, TC, LDL-C and HDL-C were higher in the OP group than in the low bone density and the normal bone density groups, while the levels of HbAlc, TC, and LDL-C in the low bone density group were higher than those in the normal bone density group. In males, the level of blood LDL-C in the low bone density group was higher than that in the normal bone density group. In postmenopausal subjects, the levels of FBG, 2hBG and HbA1C were higher than those in the normal bone density groups, and the level of HbA1C in the low bone density group was higher than that in the normal bone density group. Pearson linear trend analysis demonstrated that BMD was positively associated with TC and LDL-C in males and negatively associated with FBG, 2hBG and HbA1C in postmenopausal females. Moreover, logistic analysis showed that BMD was correlated with TC in premenopausal females and HbA1C in postmenopausal females.OP is generally associated with abnormal levels of blood glucose and/or lipids; nevertheless, the relationship between OP and abnormal levels of blood glucose and/or lipids is complicate and different subpopulations may have different susceptibilities. Therefore, further detailed studies are warranted.


Assuntos
Glicemia/análise , Densidade Óssea/fisiologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Osteoporose/sangue , Absorciometria de Fóton , Adulto , Idoso , Biomarcadores/sangue , Calcâneo/diagnóstico por imagem , Estudos Transversais , Feminino , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco , Inquéritos e Questionários
7.
Rev Med Chil ; 147(4): 451-457, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344206

RESUMO

BACKGROUND: Few studies have evaluated the details of insulin therapy for type 1 diabetes mellitus (T1D) in Chile. AIM: To describe clinical features and treatment details of adults with T1D and its association with metabolic control. MATERIAL AND METHODS: Review of medical records of patients with T1D treated in a clinical network. Demographic and clinical features, types and doses of insulin and glycated hemoglobin levels were registered. The use flash glucose monitors (FGM) and insulin pumps (CSII) were also recorded. RESULTS: 205 records were reviewed, with T1d lasting 12 ± 10 years. Twenty six percent had hypothyroidism, 1% had celiac disease, 12% had hypertension, 20% had dyslipidemia; 13% had diabetic retinopathy, 2% had diabetic nephropathy, 8% had neuropathy and 2% cardiovascular diseases. Mean body mass index was 25 kg/ m2 and mean glycated hemoglobin was 8%. Eighty-two percent used multiple daily injections, 18% used CSII and 24% used FGM. As basal insulin, 35% used slow acting analogs and 65% used ultra-slow analogs. As rapid acting insulin, 69 patients used Lispro, 79 Aspart and 50 Glulisin. Bolus doses were calculated using only capillary glucose in 22%, while 78% also considered carbohydrate consumption. Variables significantly associated to better control were the use of carbohydrates for dosing rapid insulin (A1c 7,85% vs 8,59%, p = 0,008), use of CSII (A1c 7,36% vs 8,16%, p = 0,008), and basal dose < 0,4 U/kg (A1c 7,81% vs 8,58%, p = 0,003). There were no differences regarding insulin type or use of FGM. CONCLUSIONS: The use of formulas considering carbohydrates for dosing rapid insulin, use of infusion pumps and physiological doses of basal insulin are significantly associated with a better metabolic control in adults with T1d.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/prevenção & controle , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adulto , Análise de Variância , Chile , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Hemoglobina A Glicada/análise , Humanos , Sistemas de Infusão de Insulina , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
Rev Med Chil ; 147(4): 480-489, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344211

RESUMO

Physical training is recommended in several studies and guidelines for the control of type 2 diabetes mellitus (DM2) and its complications. We performed a systematic review about the effects of aerobic training (AT), resistance (RT) or the combination of both (AT/ RT), on glycated hemoglobin (HbA1c) in patients with DM2. Therefore, we included 15 clinical trials with at least 12 weeks duration about training program or recommendations of physical exercise, that evaluated the reduction in HbA1c levels in patients with DM2. Information was obtained on training modality (AT, RT or AT / RT), training parameters, duration and weekly training frequency. The results showed increases in peak or maximal oxygen uptake, exercise tolerance time and muscle strength, depending on the type of training, and a reduction in HbA1c levels. We conclude that exercise training is associated with reductions of HbA1c in patients with DM2. Thus, it can be a complementary tool in the management of these patients.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/fisiopatologia , Condicionamento Físico Humano/métodos , Treinamento de Resistência/métodos , Diabetes Mellitus Tipo 2/metabolismo , Hemoglobina A Glicada/análise , Humanos , Condicionamento Físico Humano/fisiologia , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 660-665, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238615

RESUMO

Objective: To investigate the association between fresh fruit consumption and status of glycemic control, among patients with type 2 diabetes mellitus (T2DM). Methods: Using the stratified cluster sampling method, a cross-sectional study was conducted among 19 473 diabetic patients who were under the Disease Management Program related to the National Basic Public Health Service in Changshu county, Huai'an and Qinghe districts of Huai'an city from December 2013 to January 2014, under the combination of fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) methods, the glycemic control status in T2DM patients was assessed. Multiple logistic regression method was used to explore the relationship between fresh fruit consumption and status of glycemic control among T2DM patients. Results: 62.4% of the T2DM patients reported their amount of fruits intake in the past year. Both the levels of FPG and HbA1c decreased in T2DM patients, when the frequency and amount of fresh fruit consumption were increasing. Compared with patients who did not take fresh fruits, the risk of poor glycemic control in patients with fresh fruit consumption of 1-4 times/week and ≥5 times/week decreased 20% (OR=0.80, 95%CI: 0.73-0.87) and 30% (OR=0.70, 95%CI: 0.62-0.80), respectively. Patients with fruit consumption of 50-99 g/day and ≥100 g/day had lower risk of poor glycemic control, with ORs (95%CI) as 0.71 (95%CI: 0.62-0.83) and 0.68 (95%CI: 0.59-0.78), respectively. Conclusions: The association of fresh fruit intake and glycemic control was statistically significant in patients with type 2 diabetes. With the increase of frequencies and amounts of fresh fruit consumption, the levels of FPG and HbA1c showed a decreasing trend. Our findings suggested that fresh fruit intake seemed helpful for glycemic control.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Frutas , Hemoglobina A Glicada/análise , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Humanos
10.
Medicine (Baltimore) ; 98(23): e15935, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169714

RESUMO

BACKGROUND: Patients requiring posterior lumbar surgery have increased annually. Incision infection after lumbar surgery has serious consequences for patients. However, data on the related factors of incision infection after lumbar surgery in diabetic patients are limited. Therefore, this study aimed to analyze diabetic patients who underwent lumbar surgery and to explore the risk factors of perioperative incision infection to provide a scientific basis for perioperative intervention of lumbar spine surgery and reduce risk of incision infection in such patients. METHODS: We retrospectively reviewed data of diabetic patients who underwent posterior lumbar surgery from 2011 to 2016. A total of 523 diabetic patients undergoing posterior lumbar surgery were analyzed for the influence of various risk factors on postoperative incision infection. Univariate and multivariate logistic regression was performed. The test level was α=.05, and P < .05 was considered statistically significant. RESULTS: In the past 6 years, among the 523 diabetic patients, the incidence of incision infection after posterior lumbar surgery was approximately 7.1%, of which the shallow incision infection rate was 4.2% and the deep incision infection rate was 2.9%. Incision infection of posterior lumbar surgery in diabetic patients is related to smoking, preoperative glycosylated hemoglobin A1c, postoperative albumin (Alb), surgical segment, operation time, and intraoperative blood loss, especially on postoperative fasting blood glucose, postoperative postprandial blood glucose, local subcutaneous fat thickness, and operation sequence (odds ratio >5.00). Meanwhile, sex, age, body mass index (BMI), preoperative Alb, and newly diagnosed diabetes were not highly correlated with incision infection after posterior lumbar surgery. CONCLUSION: Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery.


Assuntos
Complicações do Diabetes/cirurgia , Diabetes Mellitus/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Idoso , Glicemia , Índice de Massa Corporal , Complicações do Diabetes/sangue , Complicações do Diabetes/patologia , Diabetes Mellitus/sangue , Diabetes Mellitus/patologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Fatores de Risco , Gordura Subcutânea/patologia , Infecção da Ferida Cirúrgica/sangue , Infecção da Ferida Cirúrgica/epidemiologia
11.
Folia Histochem Cytobiol ; 57(2): 74-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31187872

RESUMO

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease which becomes a rapidly growing health problem in the Western countries. The development of the disease is most often connected to obesity. NAFLD is also considered as the hepatic manifestation of metabolic syndrome. Transforming growth factor b1 (TGF-b1) plays an important role in the pathogenesis of liver fibrosis, being involved in activation of hepatic stellate cells, stimulation of collagen gene transcription, and suppression of matrix metalloproteinase expression. The objective of the study was to evaluate by immunohistochemistry the expression of TGF-b1 in the liver tissue of NAFLD patients and correlate it with anthropometric, biochemical and routine histological parameters. MATERIAL AND METHODS: The study group consisted of 48 patients with diagnosed NAFLD. Liver steatosis, NAFLD Activity Score (NAS) and METAVIR score of fibrosis were evaluated in liver biopsies. The immunoreactivity of TGF-b1 was evaluated semi-quantitatively separately in portal, septal, lobular hepatocytic and lobular sinu-soidal liver compartments. The results were analyzed in regard to patients' clinical and biochemical parameters. RESULTS: Neither steatosis nor NAS correlated with TGF-b1 expression in any liver compartment, whereas METAVIR score of fibrosis was associated with increased immunoreactivity of TGF-b1 in most of the studied liver compartments. TGF-b1 immunoreactivity showed positive correlation with patients' age and its expression in septal compartment disclosed positive correlation with body mass index, and waist and hip circumference. Hyaluronic acid serum level was positively and iron concentration was negatively associated with TGF-b1 ex-pression in the selected consecutive liver compartments. CONCLUSIONS: The immunohistochemical expression of TGF-b1 may be complementary to routine methods of liver fibrosis evaluation.


Assuntos
Cirrose Hepática/imunologia , Fígado/imunologia , Hepatopatia Gordurosa não Alcoólica/imunologia , Fator de Crescimento Transformador beta1/imunologia , Adulto , Peptídeo C/sangue , Fígado Gorduroso/patologia , Feminino , Hemoglobina A Glicada/análise , Haptoglobinas/análise , Humanos , Ácido Hialurônico/sangue , Imuno-Histoquímica , Ferro/sangue , Fígado/patologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/patologia , Fator de Crescimento Transformador beta1/sangue
12.
Medicine (Baltimore) ; 98(25): e16076, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232947

RESUMO

RATIONALE: In recent years, there are more new insights into the clinical susceptibility, pathophysiological mechanism, and progression of classification and treatment of ketosis-prone diabetes mellitus (KPDM), which was once described as Idiopathic Type 1 Diabetes, Type 1B Diabetes or Flatbush Diabetes. ketosis-prone diabetes mellitus is still a heterogeneous syndrome reported in African-American or western Sub-Sahara-African, Hispanic descendant, and recently in Asian. PATIENT CONCERNS: An obese 17-year-old student was admitted to a tertiary referral hospital (teaching hospital), presenting with thirst, polyuria fatigue, and a 9 kg weight loss in the preceding two weeks. DIAGNOSES: Physical examination showed body mass index (BMI) was 32.77 kg/m, arterial blood gas revealed a pH of 7.31. Serum glucose was 27.8 mmol/L with strong positive uric ketones (++++). Hemoglobin A1c (HbA1c) was 13.6%. The glucose disposal ratio (GDR) during the steady-state of euglycemic clamp test was 5.62 mg/kg/min and M value was 2.87 mg/kg/min during hyperglycemic clamp test. Those findings were sufficient to establish a diagnosis of ketosis-prone diabetes mellitus. INTERVENTIONS: This obese patient with KPDM received intensive insulin therapy and fluids infusion, and during the remainder of hospitalization his insulin requirement was approximately 1.5 U per kilogram of body weight per day. Blood glucose monitoring was rigorous until the diabetic ketoacidosis under control. OUTCOMES: He achieved the near-nomalglycemic remission uneventfully. At 12-month follow-up, his treatment was adjusted from insulin subcutaneous injection to oral hypoglycemic drugs. LESSON: The present study of this obese adolescent with negative auto-antibodies but unprovoked diabetic ketoacidosis and partially preserved beta cell functional reserve after the acute of diabetic ketosis suggested that he has the phenotype of "A-ß" KPDM. Further study of this syndrome will help illustrate the inadequacy of current classification and targeted therapies.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética/etiologia , Obesidade/complicações , Adolescente , Índice de Massa Corporal , China , Diabetes Mellitus Tipo 1/metabolismo , Cetoacidose Diabética/metabolismo , Glucose/análise , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Sede
13.
Diabetes Res Clin Pract ; 152: 166-170, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31150726

RESUMO

OBJECTIVES: Fasting in summer months for Muslim people with diabetes during Ramadan is challenging, particularly in temperate climates, where duration of fasting is prolonged. Risk of fasting may be greater in people with diabetes and chronic kidney disease (CKD). We aimed to prospectively monitor the outcomes of patients with diabetes and CKD stage 3 during Ramadan 2018 in East London. METHODS: Patients with type 2 diabetes (T2D) and CKD stage 3 attending community diabetes clinics were approached prior to Ramadan 2018 to discuss fasting. Patients were risk categorised according to Diabetes and Ramadan Alliance guidelines. If they chose to fast, Ramadan education was given, and biomedical assessments were undertaken within one week prior to and one week after fasting. Outcomes between patients fasting and non-fasting groups were compared. RESULTS: Fasting (n = 68) and non-fasting groups (n = 71) were similar apart from slightly higher insulin use in the non-fasting group. Median days fasted was 21 (range 12-29). There were no significant changes in weight, blood pressure, creatinine, glycated haemoglobin, cholesterol and urinary PCR pre- and post-Ramadan, and no significant differences between the fasting and non-fasting groups. There was no difference in adverse events (acute kidney injury, hypoglycaemia or cardiovascular events) between the fasting and non-fasting groups. CONCLUSIONS: No significant differences were seen in clinical or biochemical parameters, or adverse events between fasting and non-fasting patients. Patients with T2D and stable CKD stage 3 may be able to fast safely during Ramadan.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Nefropatias Diabéticas/diagnóstico , Jejum/fisiologia , Islamismo , Insuficiência Renal Crônica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal/fisiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/epidemiologia , Jejum/sangue , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemia/sangue , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários
15.
N Engl J Med ; 381(9): 841-851, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31185157

RESUMO

BACKGROUND: Establishing cardiovascular safety of new therapies for type 2 diabetes is important. Safety data are available for the subcutaneous form of the glucagon-like peptide-1 receptor agonist semaglutide but are needed for oral semaglutide. METHODS: We assessed cardiovascular outcomes of once-daily oral semaglutide in an event-driven, randomized, double-blind, placebo-controlled trial involving patients at high cardiovascular risk (age of ≥50 years with established cardiovascular or chronic kidney disease, or age of ≥60 years with cardiovascular risk factors only). The primary outcome in a time-to-event analysis was the first occurrence of a major adverse cardiovascular event (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke). The trial was designed to rule out 80% excess cardiovascular risk as compared with placebo (noninferiority margin of 1.8 for the upper boundary of the 95% confidence interval for the hazard ratio for the primary outcome). RESULTS: A total of 3183 patients were randomly assigned to receive oral semaglutide or placebo. The mean age of the patients was 66 years; 2695 patients (84.7%) were 50 years of age or older and had cardiovascular or chronic kidney disease. The median time in the trial was 15.9 months. Major adverse cardiovascular events occurred in 61 of 1591 patients (3.8%) in the oral semaglutide group and 76 of 1592 (4.8%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.57 to 1.11; P<0.001 for noninferiority). Results for components of the primary outcome were as follows: death from cardiovascular causes, 15 of 1591 patients (0.9%) in the oral semaglutide group and 30 of 1592 (1.9%) in the placebo group (hazard ratio, 0.49; 95% CI, 0.27 to 0.92); nonfatal myocardial infarction, 37 of 1591 patients (2.3%) and 31 of 1592 (1.9%), respectively (hazard ratio, 1.18; 95% CI, 0.73 to 1.90); and nonfatal stroke, 12 of 1591 patients (0.8%) and 16 of 1592 (1.0%), respectively (hazard ratio, 0.74; 95% CI, 0.35 to 1.57). Death from any cause occurred in 23 of 1591 patients (1.4%) in the oral semaglutide group and 45 of 1592 (2.8%) in the placebo group (hazard ratio, 0.51; 95% CI, 0.31 to 0.84). Gastrointestinal adverse events leading to discontinuation of oral semaglutide or placebo were more common with oral semaglutide. CONCLUSIONS: In this trial involving patients with type 2 diabetes, the cardiovascular risk profile of oral semaglutide was not inferior to that of placebo. (Funded by Novo Nordisk; PIONEER 6 ClinicalTrials.gov number, NCT02692716.).


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Peptídeos Semelhantes ao Glucagon/administração & dosagem , Hipoglicemiantes/administração & dosagem , Administração Oral , Idoso , Diabetes Mellitus Tipo 2/complicações , Método Duplo-Cego , Feminino , Peptídeos Semelhantes ao Glucagon/efeitos adversos , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Risco
16.
Ophthalmic Res ; 62(2): 111-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167215

RESUMO

OBJECTIVES: To study the efficacy and safety of different treatments for diabetic neovascular glaucoma (NVG). We additionally attempt to determine if the presence of NVG could be a predictor of cardiovascular disease or death. METHOD: This is a retrospective, observational cohort study including patients diagnosed with diabetic NVG from 2006 to 2016 at the Hospital Clínico Universitario de Valladolid (Spain). Extracted data included clinical characteristics of the patients, glycated haemoglobin levels, and ocular treatment. Visual acuity (VA), intraocular pressure (IOP), cardiovascular events, and deaths were registered. RESULTS: 30 eyes from 23 patients were followed for a mean of 4.48 years (SD = 2.82 years). The IOP-lowering intervention groups were: Ahmed implant (11 eyes), laser cyclo-photocoagulation (CPC; 6 eyes), both (4 eyes), or none (9 eyes). IOP success was achieved in 100% of the eyes with Ahmed and/or laser CPC and in 44.4% of the eyes with no IOP-lowering procedure (p= 0.002). Most eyes with Ahmed implant (with or without CPC) maintained or improved their VA (100 and 63.6%, respectively). 33.3% of the eyes with laser CPC and 25% of those with no IOP-lowering intervention maintained or improved their VA (p = 0.028). Hypotony was the only adverse effect (after laser CPC). No statistically significant difference could be established between low VA (finger count or worse), poor IOP control, or bad metabolic control and mortality or cardiovascular event (p > 0.05), however, the four patients who died had poor VA at the time of NVG diagnosis. CONCLUSIONS: Ahmed implant surgery is a safe and effective treatment option for diabetic NVG. Medical treatment alone is not the best option for most cases. Advanced NVG could be an indicator of higher mortality risk in diabetic patients.


Assuntos
Diabetes Mellitus , Retinopatia Diabética/terapia , Implantes para Drenagem de Glaucoma , Glaucoma Neovascular/terapia , Fotocoagulação a Laser/métodos , Adulto , Idoso , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual
17.
J Agric Food Chem ; 67(27): 7694-7705, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31250637

RESUMO

Liver plays a central role in modulating blood glucose level. Our most recent findings suggested that supplementation with microbiota metabolite sodium butyrate (NaB) could ameliorate progression of type 2 diabetes mellitus (T2DM) and decrease blood HbA1c in db/db mice. To further investigate the role of butyrate in homeostasis of blood glucose and glycogen metabolism, we carried out the present study. In db/db mice, we found significant hypertrophy and steatosis in hepatic lobules accompanied by reduced glycogen storage, and expression of GPR43 was significantly decreased by 59.38 ± 3.33%; NaB administration significantly increased NaB receptor G-protein coupled receptor 43 (GPR43) level and increased glycogen storage in both mice and HepG2 cells. Glucose transporter 2 (GLUT2) and sodium-glucose cotransporter 1 (SGLT1) on cell membrane were upregulated by NaB. The activation of intracellular signaling Protein kinase B (PKB), also known as AKT, was inhibited while glycogen synthase kinase 3 (GSK3) was activated by NaB in both in vivo and in vitro studies. The present study demonstrated that microbiota metabolite NaB possessed beneficial effects on preserving blood glucose homeostasis by promoting glycogen metabolism in liver cells, and the GPR43-AKT-GSK3 signaling pathway should contribute to this effect.


Assuntos
Ácido Butírico/administração & dosagem , Diabetes Mellitus Tipo 2/metabolismo , Glicogênio Hepático/metabolismo , Animais , Glicemia/análise , Ácido Butírico/metabolismo , Imunofluorescência , Microbioma Gastrointestinal/fisiologia , Transportador de Glucose Tipo 2/análise , Hemoglobina A Glicada/análise , Quinase 3 da Glicogênio Sintase/metabolismo , Células Hep G2 , Homeostase/efeitos dos fármacos , Humanos , Fígado/química , Fígado/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Proto-Oncogênicas c-akt/metabolismo , Receptores Acoplados a Proteínas-G/análise , Transdução de Sinais/efeitos dos fármacos , Transportador 1 de Glucose-Sódio/análise
18.
Clin Interv Aging ; 14: 789-796, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190766

RESUMO

Objective: Ageing is one of the major risks for atherosclerosis. The age-related changes of interactions between plasma lipids, oxidative stress, antioxidant defense, and glycation processes are still not established while we age. Thus, the aim of the study was to analyze such relationships in individuals at risk for atherosclerosis due to their age. Methods: Elderly and middle-aged persons with no acute disease or severe chronic disorder were assessed. Fasting plasma lipids (total cholesterol (T-C), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol, and triacylglycerols), thiobarbituric acid reacting substances (TBARS), plasma total antioxidant status (TAS), and glucose and glycated proteins (fructosamine (FA) and glycated hemoglobin (HbA1c)) were determined. An oral glucose tolerance test allowed exclusion of persons with type 2 diabetes. Results: Lipid profiles were significantly profitable, increased HDL-C especially (p<0.0001), in the elderly versus middle-aged group. Decreased TBARS and TAS were found in the elderly versus middle-aged group (p=0.0001 and p=0.00002, respectively). Increased fructosamine was found in the elderly (255±30 µmol/L) versus middle-aged (236±33 µmol/L) group (p=0.006). Multiple regression analysis showed that in the middle-aged group TBARS correlated with T-C and HDL-C, and in the elderly group with HbA1c and FA independently of other factors. Conclusion: The factors which have an impact on oxidant-antioxidant status are crucial to understanding the pathomechanisms of senescence as well as the development of chronic diseases. Healthy aging may be maintained throughout proper lipid control. Moreover, data support the premise that the balance between lipid metabolism and oxidative stress may play a role in the initial phases of glycation plasma proteins particularly among elderly persons.


Assuntos
Antioxidantes/análise , Aterosclerose/epidemiologia , Aterosclerose/fisiopatologia , Hemoglobina A Glicada/análise , Lipídeos/sangue , Idoso , Envelhecimento/fisiologia , Antioxidantes/metabolismo , Glicemia/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Substâncias Reativas com Ácido Tiobarbitúrico/análise
19.
BMC Public Health ; 19(1): 817, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234815

RESUMO

BACKGROUND: There are few available data regarding the prevalence of diabetes in the sub-Himalayan region of India. The aim of this study was to determine the prevalence of pre-diabetes and diabetes in rural Garhwal based on glycosylated hemoglobin. METHODS: In a cross-sectional survey of 500 adults from five randomly selected villages in Chamba, a mountainous Tehri Garhwal district in Uttarakhand in north-west India, we determined the prevalence of diabetes (hemoglobin (Hb) A1c ≥ 6.5%) and pre-diabetes (5.7% ≤ HbA1c ≤ 6.4%). In a sub-sample of those diagnosed with diabetes or pre-diabetes (n = 140), fasting blood glucose (FBG, n = 117) or postprandial blood glucose (PBG, n = 23), and blood hemoglobin concentration, was measured at follow-up. RESULTS: Based on HbA1c, 10.0% had diabetes and 56.4% pre-diabetes. Of those diagnosed as diabetic by HbA1c, 10 of 16 (62.5%) were diagnosed as diabetic by FBG (> 125 mg/dL) or PBG (≥200 mg/dL). In those diagnosed as pre-diabetic by HbA1c, only 55 of 124 (44.4%) were diagnosed as pre-diabetic by FBG (100-125 mg/dL) or PBG (140-199 mg/dL). A large proportion of these 140 individuals (67.1%) were moderately to severely anemic (Hb < 11.4 mg/dL). The diagnostic gap for pre-diabetes between HbA1c and FBG/PBG was similar for the groups with and without moderate to severe anemia. CONCLUSIONS: HbA1c and FBG/PBG have similar diagnostic performance for diabetes in this population. However, many individuals were diagnosed with pre-diabetes by HbA1c but not FBG/PBG. The relative excess diagnosis of pre-diabetes with HbA1c does not appear to be explained by anemia, an endemic condition in India. The prognostic significance of diagnosis of pre-diabetes by HbA1c but not FBG/PBG remains unknown, but merits investigation.


Assuntos
Diabetes Mellitus/epidemiologia , Estado Pré-Diabético/epidemiologia , População Rural/estatística & dados numéricos , Adulto , Glicemia/análise , Estudos Transversais , Diabetes Mellitus/diagnóstico , Feminino , Hemoglobina A Glicada/análise , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Estado Pré-Diabético/diagnóstico , Prevalência
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