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1.
Clin Perinatol ; 49(2): 405-426, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35659094

RESUMO

This article summarizes the available evidence reporting the relationship between perinatal dysglycemia and long-term neurodevelopment. We review the physiology of perinatal glucose metabolism and discuss the controversies surrounding definitions of perinatal dysglycemia. We briefly review the epidemiology of hypoglycemia and hyperglycemia in fetal, preterm, and term infants. We discuss potential pathophysiologic mechanisms contributing to dysglycemia and its effect on neurodevelopment. We highlight current strategies to prevent and treat dysglycemia in the context of neurodevelopmental outcomes. Finally, we discuss areas of future research and the potential role of continuous glucose monitoring.


Assuntos
Doenças do Sistema Endócrino , Hiperglicemia , Hipoglicemia , Glicemia , Automonitorização da Glicemia , Feminino , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Lactente , Recém-Nascido , Gravidez
2.
Artigo em Inglês | MEDLINE | ID: mdl-35682027

RESUMO

We examined whether the number of teeth could be a surrogate marker for metabolic syndrome (MetS) risk in cross-section. A total of 3771 individuals from the general urban Japanese population (1690 men, 2081 women; mean age 67.1 ± 11.0 years) participated in this study. Participants were diagnosed with MetS with three or more components hypertension, hyperglycemia, lipid metabolism abnormality, and abnormal abdominal girth. Questionnaires were administered to determine the number of teeth, smoking status, drinking status, and past illnesses. To clarify the relationships between the number of teeth and the presence of MetS components, we divided subjects into two groups: those with less than 20 residual teeth and those with 20 or more, then statistical analyses (Mantel-Haenszel tests and logistic regression analysis) were performed. MetS were higher for those with ≤19 teeth than those with ≥20 teeth when examining all participants and women-only groups. Hyperglycemia, low HDL cholesterol, high triglycerides, and diagnosis with MetS were all significantly higher in the ≤19 teeth group for both sexes combined and for women. These results suggest that less than 20 teeth may be a surrogate marker for MetS risk, but further studies on gender differences and pathological background are needed.


Assuntos
Hiperglicemia , Síndrome Metabólica , Perda de Dente , Idoso , Estudos Transversais , Feminino , Humanos , Hiperglicemia/epidemiologia , Japão/epidemiologia , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
3.
Front Endocrinol (Lausanne) ; 13: 903731, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35692404

RESUMO

Background: Numerous studies validated frequent glucose dysfunction in patients with acute pancreatitis (AP). However, the prevalence of new-onset diabetes in individuals after a first episode of AP varies widely among previous studies. This study aims to determine the incidence of post-acute pancreatitis diabetes mellitus (PPDM-A) in Chinese people and further identify potential risk factors that influence diabetes development in patients with AP. Methods: This was a multi-center retrospective cohort study including 6009 inpatients with a first attack of AP. A total of 1804 patients with AP without known endocrine pancreatic disorders or other pancreatic exocrine diseases were eligible for analysis. Data was collected from medical records by hospital information system and telephone follow-ups after discharge. The multiple logistic regression analysis was established to evaluate the potential influencing factors of PPDM-A. Results: The prevalence of newly diagnosed diabetes after a first episode of AP in China was 6.2%. Data showed that patients who developed PPDM-A were more likely to be younger (X2 = 6.329, P = 0.012), experienced longer hospital stays (X2 = 6.949, P = 0.008) and had a higher frequency of overweight or obesity (X2 = 11.559, P = 0.003) compared to those with normal glycemia. The frequency of stress hyperglycemia on admission (X2 = 53.815, P < 0.001), hyperlipidemia (X2 = 33.594, P < 0.001) and non-alcoholic fatty liver disease (NAFLD) (X2 = 36.335, P < 0.001) were significantly higher among individuals with PPDM-A compared with control group. Also, patients with PPDM-A were more likely to be hyperlipidemic AP (X2 = 16.304, P = 0.001) and show a higher degree of severity (X2 = 7.834, P = 0.020) and recurrence rate (X2 = 26.908, P < 0.001) of AP compared to those without diabetes. In addition, multiple logistic regression analysis indicated that stress hyperglycemia, hyperlipidemia, NAFLD and repeated attacks of AP were the independent influence factors for developing PPDM-A. Conclusion: Our study first demonstrated the prevalence of secondary diabetes in Chinese patients after AP. The disorder of glucose metabolism in individuals with AP should be regularly evaluated in clinical practice. Further studies are needed to verify the relationship between liver and pancreas in keeping glucose homeostasis under AP condition.


Assuntos
Diabetes Mellitus , Hiperglicemia , Hiperlipidemias , Hepatopatia Gordurosa não Alcoólica , Pancreatite , Doença Aguda , Diabetes Mellitus/diagnóstico , Glucose , Humanos , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Hiperlipidemias/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Pancreatite/complicações , Pancreatite/etiologia , Estudos Retrospectivos , Fatores de Risco
4.
Glob Heart ; 17(1): 23, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35586740

RESUMO

Background: Stress hyperglycemia is a common finding during acute myocardial infarction and associated with poor prognosis. To reduce the occurrence of no-reflow, prognostic factors must be identified before primary percutaneous coronary intervention (PPCI). Our objective was to investigate the impact of stress hyperglycemia in non-diabetic and diabetic patients on no-reflow phenomenon after PPCI. Methods: The study comprised 480 patients with ST elevation myocardial infarction (STEMI) who were managed by PPCI. Patients were classified into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade: Group I (Patients with normal flow, TIMI 3 flow) and Group II (Patients with no-reflow, TIMI 0-2 flow). Patients were analyzed for clinical outcomes including mortality and major adverse cardiac events. Results: Incidence of stress hyperglycemia was 14.8% in non-diabetic patients and 22.2% in diabetic patients; the incidence of no-reflow phenomenon was 13.5% and no-reflow was significantly higher in patients with stress hyperglycemia. Multivariate regression analysis identified the independent predictors of no-reflow phenomenon: stress hyperglycemia OR 3.247 (CI95% 1.656-6.368, P = 0.001), Killip class >1 OR 1.893 (CI95% 1.004-3.570, P = 0.049) and cardiogenic shock OR 3.778 (CI95% 1.458-9.790, P = 0.006). Conclusion: Stress hyperglycemia was associated with higher incidence of no-reflow phenomenon. The independent predictors of no-reflow were stress hyperglycemia, Killip class >1 and cardiogenic shock.


Assuntos
Diabetes Mellitus , Hiperglicemia , Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária/efeitos adversos , Diabetes Mellitus/epidemiologia , Humanos , Hiperglicemia/epidemiologia , Fenômeno de não Refluxo/complicações , Fenômeno de não Refluxo/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico/complicações
5.
Nutrients ; 14(9)2022 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-35565652

RESUMO

Cataract is the leading cause of blindness worldwide, and metabolic syndrome (MetS) is a known risk factor. In this study, we investigated the association between the risk of cataract with MetS and its components in a large-scale study. Data were derived from the Taiwan Biobank, and 121,380 individuals were included. The NCEP-ATP III criteria modified for use in an Asian population were used to define MetS and its components. The occurrence of cataract was identified through a standardized interview and self-reported questionnaire. Multivariable analysis showed that MetS (OR, 1.129; 95% CI, 1.0175-1.184; p < 0.001), low high-density lipoprotein (HDL)-cholesterol (OR, 1.057; 95% CI, 1.005-1.113; p = 0.032), and hyperglycemia (OR, 1.162; 95% CI, 1.108-1.218; p < 0.001) were significantly associated with cataract. Furthermore, a stepwise increase in the prevalence of cataract corresponding to the number of MetS components was found. The presence of three MetS components (vs. 0; OR, 1.103; 95% CI, 1.024-1.188; p = 0.010), four MetS components (vs. 0; OR, 1.137; 95% CI, 1.040-1.242; p = 0.005), and five MetS components (vs. 0; OR, 1.208; 95% CI, 1.059-1.378; p = 0.005) were significantly associated with cataract. In conclusion, significant associations were found between a high incidence of cataract with MetS and its components, including low HDL-cholesterolemia and hyperglycemia. Further, a stepwise increase in the prevalence of cataract corresponding to the number of MetS components was also found. The results of this study indicate that MetS may increase the development of cataract in Taiwan.


Assuntos
Catarata , Hiperglicemia , Síndrome Metabólica , Catarata/epidemiologia , Humanos , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Prevalência , Fatores de Risco
6.
J Ayub Med Coll Abbottabad ; 34(2): 345-350, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35576300

RESUMO

BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) has increased recently in Pakistan. Visceral adiposity index (VAI) appears to be a better predictor for metabolic syndrome associated with insulin resistance. VAI has been shown to be linearly and positively associated with diabetes mellitus (DM) in many populations. It is, however, uncertain whether VAI could be associated with T2DM in the Pakistani adult population.. METHODS: This is a cross-sectional study of 300 outpatients with a newly diagnosed T2DM. Subjects were recruited from Lady Reading Hospital, Pakistan, during the period from April, 2020 to January, 2021. For all study subjects, anthropometric measurements were performed. Blood samples were collected for the assessment of high-density lipoproteins (HDL-C), triglycerides (TGs), glycated hemoglobin (HbA1c), and random blood glucose. RESULTS: Participants with high VAI showed poor glycemic control. The number of patients with poor glycemic control increased across the VAI quartiles. VAI showed significant correlations with TGs (r=0.715, p=<0.001), total cholesterol (TC) (r=0.256, p=<0.001), low density lipoprotein (LDL-C) (r=0.154, p=0.007), uric acid (r=0.205, p=0.019), duration of diabetes (r=0.171, p=0.033), TSH (r=0.163, p=0.007), and random blood glucose (r=0.195, p=0.019). CONCLUSIONS: Our data suggest that VAI is significantly and positively correlated with the risk factors of DM such as random blood glucose, uric acid and TSH. The findings of the study do not imply a significant direct association between VAI and DM among the Pakistani adult population. Prospective-large scale studies can help inform an effectiveness of VAI for the prediction of the risk of T2DM among Pakistani population.


Assuntos
Diabetes Mellitus Tipo 2 , Hiperglicemia , Adiposidade , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Hiperglicemia/epidemiologia , Gordura Intra-Abdominal/metabolismo , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/metabolismo , Estudos Prospectivos , Tireotropina , Triglicerídeos , Ácido Úrico
7.
Cardiovasc Diabetol ; 21(1): 77, 2022 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-35570280

RESUMO

BACKGROUND: The inflammatory response occurring in acute myocardial infarction (AMI) has been proposed as a potential pharmacological target. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) currently receive intense clinical interest in patients with and without diabetes mellitus (DM) for their pleiotropic beneficial effects. We tested the hypothesis that SGLT2-I have anti-inflammatory effects along with glucose-lowering properties. Therefore, we investigated the link between stress hyperglycemia, inflammatory burden, and infarct size in a cohort of type 2 diabetic patients presenting with AMI treated with SGLT2-I versus other oral anti-diabetic (OAD) agents. METHODS: In this multicenter international observational registry, consecutive diabetic AMI patients undergoing percutaneous coronary intervention (PCI) between 2018 and 2021 were enrolled. Based on the presence of anti-diabetic therapy at the admission, patients were divided into those receiving SGLT2-I (SGLT-I users) versus other OAD agents (non-SGLT2-I users). The following inflammatory markers were evaluated at different time points: white-blood-cell count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR), and C-reactive protein. Infarct size was assessed by echocardiography and by peak troponin levels. RESULTS: The study population consisted of 583 AMI patients (with or without ST-segment elevation): 98 SGLT2-I users and 485 non-SGLT-I users. Hyperglycemia at admission was less prevalent in the SGLT2-I group. Smaller infarct size was observed in patients treated with SGLT2-I compared to non-SGLT2-I group. On admission and at 24 h, inflammatory indices were significantly higher in non-SGLT2-I users compared to SGLT2-I patients, with a significant increase in neutrophil levels at 24 h. At multivariable analysis, the use of SGLT2-I was a significant predictor of reduced inflammatory response (OR 0.457, 95% CI 0.275-0.758, p = 0.002), independently of age, admission creatinine values, and admission glycemia. Conversely, peak troponin values and NSTEMI occurrence were independent predictors of a higher inflammatory status. CONCLUSIONS: Type 2 diabetic AMI patients receiving SGLT2-I exhibited significantly reduced inflammatory response and smaller infarct size compared to those receiving other OAD agents, independently of glucose-metabolic control. Our findings are hypothesis generating and provide new insights on the cardioprotective effects of SGLT2-I in the setting of coronary artery disease. TRIAL REGISTRATION: Data are part of the ongoing observational registry: SGLT2-I AMI PROTECT. CLINICALTRIALS: gov Identifier: NCT05261867.


Assuntos
Diabetes Mellitus Tipo 2 , Hiperglicemia , Infarto do Miocárdio , Intervenção Coronária Percutânea , Inibidores do Transportador 2 de Sódio-Glicose , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hiperglicemia/epidemiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Sistema de Registros , Transportador 2 de Glucose-Sódio , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Troponina/metabolismo
8.
Int J Hyg Environ Health ; 242: 113973, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35447399

RESUMO

BACKGROUND: Ambient particles have been associated with gestational diabetes mellitus (GDM), however, no study has evaluated the effects of traffic-related ambient particles on the risks of GDM subgroups classified by oral glucose tolerance test (OGTT) values. METHODS: A retrospective analysis was conducted among 24,001 pregnant women who underwent regular prenatal care and received OGTT at Haidian Maternal and Child Health Hospital in Beijing, China, 2014-2017. A total of 3,168 (13.2%) pregnant women were diagnosed with GDM, including 1,206 with isolated fasting hyperglycaemia (GDM-IFH). At a fixed-location monitoring station, routinely monitored ambient particles included fine particulate matter (PM2.5), black carbon (BC) and particles in size ranges of 5-560 nm (PNC5-560). Contributions of PNC5-560 sources were apportioned by positive matrix factorization model. Logistic regression model was applied to estimate odds ratio (OR) of ambient particles on GDM risk. RESULTS: Among the 24,001 pregnancy women recruited in this study, 3,168 (13.2%) were diagnosed with GDM, including 1,206 with isolated fasting hyperglycaemia (GDM-IFH) and 1,295 with isolated post-load hyperglycaemia (GDM-IPH). We observed increased GDM-IFH risk with per interquartile range increase in first-trimester exposures to PM2.5 (OR = 1.94; 95% Confidence Intervals: 1.23-3.07), BC (OR = 2.14; 1.73-2.66) and PNC5-560 (OR = 2.46; 1.90-3.19). PNC5-560 originated from diesel and gasoline vehicle emissions were found in associations with increases in GDM-IFH risk, but not in GDM-IPH risk. CONCLUSION: Our findings suggest that exposure to traffic-related ambient particles may increase GDM risk by exerting adverse effects on fasting glucose levels during pregnancy, and support continuing efforts to reduce traffic emissions for protecting vulnerable population who are at greater risk of glucose metabolism disorder.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Diabetes Gestacional , Hiperglicemia , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Pequim/epidemiologia , Glicemia/análise , Criança , Diabetes Gestacional/induzido quimicamente , Diabetes Gestacional/epidemiologia , Jejum , Feminino , Humanos , Hiperglicemia/epidemiologia , Exposição Materna/efeitos adversos , Material Particulado/análise , Gravidez , Estudos Retrospectivos
9.
J Int AIDS Soc ; 25(4): e25901, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35419976

RESUMO

INTRODUCTION: Cardiovascular disease is one of the leading causes of mortality for people living with HIV, but limited population-based data are available from sub-Saharan Africa. This study aimed to determine the prevalence of key cardiovascular disease risk factors, 10-year risk of cardiovascular disease and type 2 diabetes mellitus through risk scores by HIV status, as well as investigate factors associated with hyperglycaemia, hypertension and dyslipidaemia in South-Central Uganda. METHODS: A cross-sectional study was conducted in 37 communities of the population-based Rakai Community Cohort Study from May 2016 to May 2018. In total, 990 people living with HIV and 978 HIV-negative participants aged 35-49 years were included. Prevalence estimates and 10-year cardiovascular and type 2 diabetes risk were calculated by sex and HIV serostatus. Multivariable logistic regression was used to determine associations between socio-demographic, lifestyle and body composition risk factors and hyperglycaemia, hypertension and dyslipidaemia. RESULTS: Overweight (21%), obesity (9%), abdominal obesity (15%), hypertension (17%) and low high-density lipoprotein (HDL) (63%) were the most common cardiovascular risk factors found in our population. These risk factors were found to be less common in people living with HIV apart from hypertension. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low in this population with <1% categorized as high risk. In HIV-adjusted multivariable analysis, obesity was associated with a higher odds of hypertension (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.35-3.96) and high triglycerides (OR = 2.08, CI 1.25-3.47), and abdominal obesity was associated with a higher odds of high triglycerides (OR = 2.55, CI 1.55-4.18) and low HDL (OR = 1.36, CI 1.09-1.71). A positive HIV status was associated with a lower odds of low HDL (OR = 0.43, CI 0.35-0.52). CONCLUSIONS: In this population-based study in Uganda, cardiovascular risk factors of obesity, abdominal obesity, hypertension and dyslipidaemia were found to be common, while hyperglycaemia was less common. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low. The majority of cardiovascular risk factors were not affected by HIV status. The high prevalence of dyslipidaemia in our study requires further research.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Dislipidemias , Infecções por HIV , Hiperglicemia , Hipertensão , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/complicações , Dislipidemias/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Fatores de Risco de Doenças Cardíacas , Humanos , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Obesidade/epidemiologia , Obesidade Abdominal/complicações , Prevalência , Fatores de Risco , Triglicerídeos , Uganda/epidemiologia
10.
JAMA Netw Open ; 5(4): e226407, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35389498

RESUMO

Importance: Evidence on the timing of fetal growth alterations associated with gestational diabetes or on the association of the maternal glycemic trajectory with fetal growth during pregnancy remains lacking. Objective: To examine the associations between maternal glucose levels and offspring intrauterine growth. Design, Setting, and Participants: This cohort study used data from 4574 eligible pregnant women and their offspring in the Shanghai Maternal-Child Pairs Cohort collected from April 10, 2016, to April 30, 2018. Group-based trajectory modeling was used to classify fasting plasma glucose levels during pregnancy into 3 glycemic trajectories (trajectory 1, consistently normal glucose levels in all 3 trimesters; trajectory 2, hyperglycemia only in late pregnancy; and trajectory 3, hyperglycemia in all 3 trimesters [ie, consistently high glucose levels]). Statistical analysis was performed from April 25, 2020, to October 1, 2021. Exposures: Gestational diabetes, which was defined using the results of an oral glucose tolerance test. Main Outcomes and Measures: Longitudinal fetal biometrics during gestational weeks 11 to 40 and birth outcomes were obtained from medical records. Pregnancy was partitioned into 3 periods (<24, 24-34, and >34 weeks' gestational age). The differences in offspring growth (log-transformed) and maternal glucose levels were compared using generalized linear mixed models. Results: A total of 4121 pregnant women had oral glucose tolerance test results (mean [SD] age, 28.8 [4.1] years), 3746 of whom had glycemic trajectory data (mean [SD] age, 28.6 [4.1] years); 983 women (23.8%) had gestational diabetes. Throughout the pregnancy period and compared with the women without gestational diabetes or with women in the trajectory 1 group, the fetal biometrics for the women with gestational diabetes or for those in the trajectory 3 group were significantly higher (except for biparietal diameter), with an estimated increase in fetal weight in the group with gestational diabetes (ß = 1.82; 95% CI, 1.03-2.61) and in the trajectory 3 group (ß = 1.50; 95% CI, 0.54-2.47; P = .002). Fetal biometric alterations among women with gestational diabetes appeared before 24 weeks' gestational age, with neonatal birth weight significantly higher than in the group without gestational diabetes at 40.4 g (95% CI, 9.8-71.1 g) along with an increased risk of large size for gestational age (odds ratio, 1.36; 95% CI, 1.05-1.75) and macrosomia (odds ratio, 1.47; 95% CI, 1.12-1.94). However, pregnant women in the trajectory 2 group manifested significantly reduced fetal biometrics, and abdominal circumference was significantly augmented after 34 weeks' gestational age (increase, ß = 1.92; 95% CI, 0.87-2.99). Conclusions and Relevance: In this cohort study, pregnant women who received a diagnosis of gestational diabetes in midpregnancy or had hyperglycemia during all 3 trimesters showed an association with altered fetal growth patterns, including increased estimated fetal weight that appeared before 24 weeks' gestational age, increased birth weight, and the risk for large size for gestational age and macrosomia.


Assuntos
Diabetes Gestacional , Hiperglicemia , Adulto , Biometria , Peso ao Nascer , Glicemia , China/epidemiologia , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Peso Fetal , Humanos , Hiperglicemia/epidemiologia , Recém-Nascido , Gravidez , Ganho de Peso
11.
BMC Geriatr ; 22(1): 277, 2022 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-35369877

RESUMO

BACKGROUND: It remains unclear whether stress hyperglycemia is associated with delirium. We performed this cohort study to determine the association between stress hyperglycemia and delirium. METHODS: We consecutively enrolled patients aged ≥70 years who were admitted to the Geriatric Department of West China Hospital between March 2016 and July 2017. Stress hyperglycemia ratio (SHR) was calculated as fasting blood glucose divided by estimated average glucose derived from glycosylated hemoglobin (HbA1c) and was classified into three tertiles. Delirium was screened within 24 h of admission and three times daily thereafter, using the confusion assessment method. The Cox proportional hazards models were used to assess the association of SHR with delirium. RESULTS: Among 487 included patients (mean age 83.0 years, 72.0% male), 50 (10.3%) patients experienced delirium during hospitalization. Compared to the second tertile, both the lowest and the highest SHR tertiles were independently associated with delirium (hazard ratio [HR] 3.71, 95% confidence interval [CI] 1.45-9.51; and HR 2.97, 95% CI 1.29-6.81, respectively). Similar results were found after further adjusting for statin comedication. Multiple-adjusted restricted cubic splines revealed a nonlinear relationship between SHR and delirium (Pnonlinearity=0.04). Adding SHR to conventional risk factors improved the risk prediction of delirium (net reclassification index 0.39, P=0.01; integrated discrimination improvement 0.07, P=0.03). Subgroup analyses indicated that the relationship between SHR and delirium was more apparent in patients with HbA1c <6.5%, with significantly higher HR in the first (3.65, 95% CI 1.11-11.97) and third (3.13, 95% CI 1.13-8.72) SHR tertiles compared to the second tertile, while there was no significant association between SHR and delirium in those with HbA1c ≥6.5%. CONCLUSIONS: Both lower and higher SHR were associated with increased risk of delirium but only in patients with HbA1c <6.5%. Admission SHR may serve as a promising predictor of delirium, and incorporating this biomarker into prediction algorithms might have potential clinical utility in aiding delirium risk stratification, especially in those with HbA1c <6.5%.


Assuntos
Delírio , Hiperglicemia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Delírio/diagnóstico , Delírio/epidemiologia , Feminino , Hemoglobina A Glicada , Hospitalização , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Masculino
12.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35443392

RESUMO

Coronary Artery Disease (CAD) has become a prominent source of illness and mortality around the world, particularly in emerging nations such as India. Diabetes mellitus (DM) is one of the important and independent predictors of mortality in CAD. Diabetes affects outcomes after an ACS in addition to being a risk factor for development of coronary disease. MATERIAL: We included 200 patients of Acute Coronary Syndrome who were not previously diagnosed with Diabetes mellitus. Detailed history, clinical examination and relevant blood investigations were sent. OGTT was done once the patient was stabilised and free from clinical symptoms of CAD and started on full oral meals. OBSERVATION: We found that the prevalence of undiagnosed diabetes mellitus in ACS patients was 22%, prevalence of prediabetics was 14%, stress induced hyperglycemia was 12% of ACS patients and the remaining 52% had normal glycemic status. CONCLUSION: Diabetes was shown to be common among ACS patients in our area, according to our findings. These findings emphasise the necessity of early diabetes detection and control in ACS patients, as well as the use of certain medicines that had been shown to enhance outcomes.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Diabetes Mellitus , Hiperglicemia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Glicemia , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Humanos , Hiperglicemia/epidemiologia , Prevalência , Fatores de Risco
13.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35443403

RESUMO

Myocardial infarction is the death of a portion of myocardium due to a prolonged ischaemia. Myocardial infarction is the leading cause of mortality around the globe. Mortality could be due to various complications of mi such as ventricular failure, cardiogenic shock and arrhythmias. With the rise in sedentary lifestyle and poor dietary habits, the incidence of diabetes is increasing too. Diabetes is an independent risk factor for coronary artery disease. Acute hyperglycemia is a response seen commonly during stressful conditions including myocardial infarction. Raised blood sugar levels could be due to diabetes or a marker of pre existing diabetes which is not yet diagnosed. Raised sugar levels increase oxidative stress, endothelial dysfunction and impair fibrinolysis thereby leading to adverse outcomes in patients of mi. Raised sugar levels could also indicate insulin resistance or beta cell failure which could have a detrimental impact in patients with mi via various other pathways. Random blood sugar is a relatively easy test to perform and can hence be used as marker of prognosis in mi patients. MATERIAL: an observational study of 50 patients who were admitted in a tertiary care centre for myocardial infarction. All patients were closely monitored and all clinical manifestations, laboratory parameters and relevant scans were studied. OBSERVATION: out of the total patients studied, 42% had stemi and 58% had n stemi, most patients belonged to age group between 40-80 years. From the total patients studied, adverse cardiovascular outcomes were seen more commonly in patients having on admission rbs readings above 200mg/dl and hba1c of greater than 8% the most common adverse outcome noted was heart failure with reduced ejection fraction. Second most common adverse outcome was arrhythmia of which most common was ventricular tachycardia. Adverse outcomes were more common in newly detected diabetics than patients who were a known case of diabetes having mi. Death was seen in 8% of cases, all having rbs readings ranging from 154 to 436 mg/dl. CONCLUSION: myocardial infarction is the most common cause of mortality in the world. Hyperglycaemia and diabetes are independent risk factors for various life threatening complications of myocardial infarction. Hyperglycaemia causes endothelial dysfunction by increasing oxidative stress via multiple pathways. The likelihood of developing complications post myocardial infarction is higher with hyperglycaemia.


Assuntos
Diabetes Mellitus , Hiperglicemia , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas , Glicemia , Diabetes Mellitus/epidemiologia , Humanos , Hiperglicemia/epidemiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Centros de Atenção Terciária
14.
Diabetes Res Clin Pract ; 187: 109859, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35367312

RESUMO

AIMS: We aimed to describe differences in the prevalence of intermediate hyperglycaemia (IH) between six ethnic groups. Moreover, to investigate differences in the association of the classifications of IH with the incidence of T2DM between ethnic groups. METHODS: We included 3759 Dutch, 2826 African Surinamese, 1646 Ghanaian, 2571 Turkish, 2691 Moroccan and 1970 South Asian Surinamese origin participants of the HELIUS study. IH was measured by fasting plasma glucose (FPG) and HbA1c. We calculated age-, BMI and physical-activity-adjusted prevalence of IH by sex, and calculated age and sex-adjusted hazard ratios (HR)for the association between IH and T2DM in each ethnic group. RESULTS: The prevalence of IH was higher among ethnic minority groups (68.6-41.7%) than the Dutch majority (34.9%). The prevalence of IH categories varied across subgroups. Combined increased FPG and HbA1c was most prevalent in South-Asian Surinamese men (27.6%, 95 %CI: 24.5-30.9%), and in Dutch women (4.2%, 95 %CI: 3.4-5.1%). The HRs for T2DM for each IH-classification did not differ significantly between ethnic groups. HRs were highest for the combined classification, e.g., HR = 8.1, 95 %CI: 2.5-26.6 in the Dutch. CONCLUSION: We found a higher prevalence of IH in ethnic minority versus majority groups, but did not find evidence for a differential association of IH with incident T2DM.


Assuntos
Diabetes Mellitus Tipo 2 , Hiperglicemia , Diabetes Mellitus Tipo 2/etiologia , Feminino , Gana , Hemoglobina A Glicada , Humanos , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Incidência , Masculino , Grupos Minoritários , Países Baixos/epidemiologia , Prevalência
15.
Pan Afr Med J ; 41: 115, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35465373

RESUMO

Introduction: diabetes mellitus is an increasing public health burden in developing countries. The magnitude of diabetes association with traditional risk factors for diabetes have been given less attention in rural population. This study aims to determine the prevalence of diabetes and impaired fasting glucose and to assess associated characteristics to hyperglycemia in rural and urban Rwanda. Methods: this is a secondary analysis of data from a population-based cross-sectional study of 7240 people describing risk factors for non-communicable diseases using the WHO stepwise methods (STEPS). Relative frequencies of variables of interest were compared in rural and urban residence using Pearson chi-square tests. Diabetes and impaired fasting glucose were combined in a single hyperglycemia variable and odds ratios with 95% confidence intervals were used to explore associations between hyperglycemia, socio-demographic and health factors in urban and rural populations. Results: the prevalence in rural and urban areas was 7.5% and 9.7% (p.005) for diabetes and 5.0% and 6.2% for impaired fasting glucose (p.079) respectively. Obesity (AOR 2.57: CI: 0.86-7.9), high total cholesterol (AOR 3.83: CI: 2.03-7.208), hypertension (AOR 1.18: CI: 0.69-2.00), increasing age were associated with hyperglycemia in urban participants but only high total cholesterol and low high density lipoproteins (HDL) cholesterol were risk factors for hyperglycemia in rural participants. Conclusion: approximately one in six people in Rwanda have hyperglycemia. The magnitude of the association with traditional risk factors for diabetes differ in rural and urban settings. Different approaches to primary and secondary prevention of diabetes may be needed in rural populations.


Assuntos
Diabetes Mellitus , Hiperglicemia , Colesterol , Estudos Transversais , Análise de Dados , Diabetes Mellitus/epidemiologia , Jejum , Glucose , Humanos , Hiperglicemia/epidemiologia , Prevalência , Fatores de Risco , População Rural , Ruanda/epidemiologia , População Urbana , Organização Mundial da Saúde
16.
Diabetes Care ; 45(6): 1438-1444, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35275995

RESUMO

OBJECTIVE: Stress hyperglycemia is associated with an increased risk of diabetes among survivors of critical illness. We investigated whether patients without diabetes hospitalized for bacteremia or nonbacteremic diseases with transient stress hyperglycemia would have a higher risk of subsequent diabetes development compared with those who remained normoglycemic. RESEARCH DESIGN AND METHODS: This retrospective observational study was conducted on 224,534 in-patients with blood culture records. Stress hyperglycemia was defined based on the highest random glucose level ≥7.8 mmol/L during the index admission period. Diagnosis of diabetes, as the primary end point of interest, was defined based on diagnostic codes, blood test results, or medication records. Differences in cumulative incidence and hazard ratios (HRs) of diabetes between groups were assessed using the Kaplan-Meier estimator and Cox regression. RESULTS: After exclusion of patients with preexisting or undiagnosed diabetes or indeterminate diabetes status and propensity score matching, bacteremic patients with stress hyperglycemia had a significantly higher cumulative incidence of diabetes (HR 1.7, 95% CI 1.2-2.4) compared with those who remained normoglycemic. Stress hyperglycemia was further confirmed to be a diabetes predictor independent of age, sex, comorbidity, and other serological markers. For the nonbacteremic patients, stress hyperglycemia was similarly associated with a higher cumulative incidence of diabetes (HR 1.4, 95% CI 1.2-1.7). CONCLUSIONS: Hospitalized patients with transient stress hyperglycemia had a higher risk of subsequent diabetes development compared with their normoglycemic counterparts. Recognition of an increased risk of diabetes in these patients can allow early detection and monitoring in their subsequent follow-ups.


Assuntos
Bacteriemia , Diabetes Mellitus , Hiperglicemia , Bacteriemia/complicações , Bacteriemia/epidemiologia , Glicemia , Diabetes Mellitus/epidemiologia , Hospitalização , Humanos , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Estudos Retrospectivos
17.
J Epidemiol Community Health ; 76(6): 586-594, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35277436

RESUMO

BACKGROUND: A cluster randomised trial of mHealth and participatory learning and action (PLA) community mobilisation interventions showed that PLA significantly reduced the prevalence of intermediate hyperglycaemia and type 2 diabetes mellitus (T2DM) and the incidence of T2DM among adults in rural Bangladesh; mHealth improved knowledge but showed no effect on glycaemic outcomes. We explore the equity of intervention reach and impact. METHODS: Intervention reach and primary outcomes of intermediate hyperglycaemia and T2DM were assessed through interview surveys and blood fasting glucose and 2-hour oral glucose tolerance tests among population-based samples of adults aged ≥30 years. Age-stratified, gender-stratified and wealth-stratified intervention effects were estimated using random effects logistic regression. RESULTS: PLA participants were similar to non-participants, though female participants were younger and more likely to be married than female non-participants. Differences including age, education, wealth and marital status were observed between individuals exposed and those not exposed to the mHealth intervention.PLA reduced the prevalence of T2DM and intermediate hyperglycaemia in all age, gender and wealth strata. Reductions in 2-year incidence of T2DM of at least 51% (0.49, 95% CI 0.26 to 0.92) were observed in all strata except among the oldest and least poor groups. mHealth impact on glycaemic outcomes was observed only among the youngest group, where a 47% reduction in the 2-year incidence of T2DM was observed (0.53, 95% CI 0.28 to 1.00). CONCLUSION: Large impacts of PLA across all strata indicate a highly effective and equitable intervention. mHealth may be more suitable for targeting higher risk, younger populations. TRIAL REGISTRATION NUMBER: ISRCTN41083256.


Assuntos
Diabetes Mellitus Tipo 2 , Hiperglicemia , Telemedicina , Adulto , Bangladesh/epidemiologia , Glicemia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Poliésteres
18.
Prim Care Diabetes ; 16(3): 361-364, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35283068

RESUMO

BACKGROUND: Blood sugar (BS) has been proposed as a prognostic factor for COVID-19. In this historical cohort study we evaluated the association between admission time BS and COVID-19 outcome. METHODS: First, hospitalized COVID-19 patients were divided into three groups; Non-diabetic patients with BS < 140 mg/dl (N = 394), non-diabetic patients with BS ≥ 140 mg/dl (N = 113) and diabetic patients (N = 315). Mortality, ICU admission, and length of hospital stay were compared between groups and odds ratio was adjusted using logistic regression. RESULTS: After adjustment with pre-existing conditions and drugs, it was shown that non-diabetic patients with BS ≥ 140 mg/dl are at increased risk of mortality (aOR 1.89 (0.99-3.57)) and ICU admission (aOR 2.62 (1.49-4.59)) even more than diabetic patients (aOR 1.72 (1.07-2.78) for mortality and aOR 2.28 (1.47-3.54) for ICU admission. CONCLUSIONS: Admission time hyperglycemia predicts worse outcome of COVID-19 and BS ≥ 140 mg/dl is associated with a markedly increase in ICU admission and mortality.


Assuntos
COVID-19 , Diabetes Mellitus , Hiperglicemia , Glicemia , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Prognóstico , Estudos Retrospectivos
19.
Endocrine ; 76(3): 601-611, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35349030

RESUMO

BACKGROUND: We aimed to determine, in patients with type 1 diabetes (T1DM), the impact of excluding hyperglycemia as a criterion from the International Diabetes Federation (IDF) definition of the metabolic syndrome (MetS), both on its prevalence and on its association with micro and macrovascular complications and markers of subclinical inflammation. METHODS: A cross-sectional design, including 280 patients with T1DM. We defined MetS by three different models: (i) the standard IDF criteria, (ii) a modification consisting of excluding of hyperglycemia as a criterion (modified IDF criteria) and (iii) a modification consisting in changing the hyperglycemia by insulin resistance (MetS + IR model) defined by the estimated glucose disposal rate. Microvascular complications and cardioautonomic neuropathy were assessed. We measured an inflammatory panel including high sensitivity C reactive protein, erythrocyte sedimentation rate, homocysteine, and fibrinogen concentrations. RESULTS: After excluding hyperglycemia, the prevalence of MetS was 6.4% (95%CI: 4.1 to 9.9) compared with 20.7% (95%CI: 16.3 to 25.8) using standard IDF criteria. After adjusting for duration of diabetes, all three MetS definitions increased the odds for having microvascular complications [OR: 6.012 (2.208-16.307) for modified definition; OR: 5.176 (2.555-10.486) for standard definition and [OR: 3.374 (1.649-8.456) for MetS+IR model]. However, the both modified IDF models for MetS showed better predictive performance than standard criteria for suffering from neuropathy, nephropathy, cardiovascular disease and were associated with markers of subclinical inflammation. CONCLUSIONS: The prevalence of MetS significantly varies as a function whether or not hyperglycemia is included as a diagnostic criterion. The subset of patients fulfilling the modified MetS definitions may reflect better the concept of metabolic syndrome in T1DM. These modified definitions were accompanied by a poorer metabolic control and lipid profile, showing the worse inflammatory biomarker profiles and higher odds for micro- and macrovascular complications. In patients with T1DM, the inclusion of insulin resistance instead of hyperglycemia as a criterion of MetS may be of interest in routine clinical practice.


Assuntos
Diabetes Mellitus Tipo 1 , Hiperglicemia , Resistência à Insulina , Síndrome Metabólica , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Humanos , Hiperglicemia/complicações , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Inflamação/complicações , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Prevalência , Fatores de Risco
20.
Lancet HIV ; 9 Suppl 1: S5, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35304847

RESUMO

BACKGROUND: The lifespan of people living with HIV is increasing, and non-communicable diseases (NCDs) are becoming an important driver of morbidity in this population. We examined the prevalence of NCDs in older people with HIV and factors associated with development of NCDs. METHODS: The African Cohort Study is a prospective cohort enrolling adults with and without HIV at 12 sites in Kenya, Tanzania, Uganda, and Nigeria. Using data collected from Jan 21, 2013 to June 30, 2021, we assessed the prevalence and odds of NCDs, including renal insufficiency (estimated glomerular filtration rate [GFR] <60 mL/min/1·73 m²), elevated blood pressure (any systolic blood pressure >139 mm Hg or diastolic BP >89 mm Hg), obesity (body mass index >30), diabetes (fasting glucose ≥126 mg/dL or receiving medication for diabetes) or hyperglycaemia (fasting glucose ≥99 mg/dL or non-fasting ≥199 mg/dL). Diabetes and hyperglycaemia were collectively evaluated as dysglycaemia. We used multivariable logistic regression with generalised estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with NCDs. Diabetes and hyperglycaemia models were adjusted for potential confounders including study site and sex. Renal insufficiency models had similar adjustments with the addition of elevated blood pressure and hyperglycaemia. FINDINGS: Of 3434 participants, 2003 (59·3%) were female and 1431 (40·7%) were male, and 2949 (85·9%) were living with HIV. Of people living with HIV, 2188 (74·2%) were younger than 50 years and 761 (25·8%) were aged 50 years or older. Among people living with HIV aged 50 or older, 27·5% (n=209 had elevated blood pressure, 13·4% (102) had dysglycaemia, 4·3% (33) had renal insufficiency, and 11·7% (89) had obesity at last visit. Compared with people without HIV under 50, people living with HIV aged 50 or older had increased adjusted odds of having diabetes (5·29, 95% CI 2·61-10·70), hyperglycaemia (1·86, 1·38-2·50), and renal insufficiency (6·37, 2·38-17·1). We found no differences between individuals aged 50 years or older with and without HIV for diabetes, hyperglycaemia, and renal insufficiency. INTERPRETATION: There was a high burden of NCDs in this cohort. HIV status was not associated with NCD prevalence, although the study was probably underpowered to detect such an association. Screening and treatment for common NCDs, such as raised blood pressure and dysglycaemia, should be considered as part of HIV integrated care. Such an approach might help to prevent other NCDs, such as renal insufficiency, and improve the span of healthy life. FUNDING: PEPFAR via cooperative agreements between HJF and the US Department of Defense.


Assuntos
Diabetes Mellitus , Infecções por HIV , Hiperglicemia , Hipertensão , Doenças não Transmissíveis , Insuficiência Renal , Adulto , Idoso , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Feminino , Glucose/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Hiperglicemia/epidemiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Doenças não Transmissíveis/epidemiologia , Obesidade , Prevalência , Estudos Prospectivos , Insuficiência Renal/complicações , Insuficiência Renal/epidemiologia , Fatores de Risco , Uganda/epidemiologia
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