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1.
Niger J Clin Pract ; 23(1): 71-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929210

RESUMO

Background: Neonatal hyperglycemia (NNH) like hypoglycemia is a dangerous metabolic disorder often associated with adverse consequences, if undetected and untreated. This study was set out to determine the prevalence, risk factors, and outcomes of babies with the point of admission hyperglycaemia at the Wesley Guild Hospital (WGH), Ilesa. Methods: The study was descriptive and cross-sectional, involving 300 consecutively recruited neonates admitted into the special care baby unit (SCBU) of the hospital. All subjects had blood glucose done at the point of admission using Accu-Chek Active® glucometer (Roche Diagnostics GmbH, Germany). Hyperglycemia was defined as blood glucose ≥7.0 mmol/L. Factors associated with NNH were determined using univariate and multivariate analyses. Results: Of the 300 subjects (Male: Female 1.5:1), there were 74 (24.7%) preterms, 35 (11.7%) small-for-gestational age and 85 (28.3%) low-birth-weight babies. Eighteen (6.0%) babies had hyperglycemia. Parental low socioeconomic class, maternal lack of antenatal care (ANC), vaginal delivery, grand multiparity, outborn status, respiratory distress, probable sepsis, and neonatal anemia at presentation were associated with NNH (P < 0.05). Respiratory distress (OR = 3.800, 95% CI = 1.122-12.873, P = 0.032), and probable sepsis (OR = 4.090, 95% CI = 1.206-13.872, P = 0.024) were independent predictors of hyperglycemia. Hyperglycemia was significantly associated with mortality. (38.9% vs. 11.0%; P = 0.001). Conclusion: Neonatal hyperglycemia was detected in 6.0% of neonatal admission at the WGH, Ilesa and it was associated with increased mortality. Hyperglycemia should be suspected and promptly managed at the point of admission of ill newborns particularly those with respiratory distress and signs of sepsis.


Assuntos
Hospitalização/estatística & dados numéricos , Hiperglicemia/epidemiologia , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Sepse Neonatal/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Estudos Transversais , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/mortalidade , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Sepse Neonatal/epidemiologia , Sepse Neonatal/mortalidade , Nigéria/epidemiologia , Gravidez , Prevalência , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Fatores de Risco
2.
BMC Neurol ; 19(1): 342, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881850

RESUMO

BACKGROUND: Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting. METHODS: A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 h of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as > 140 mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively. RESULTS: A total of 103 first-ever acute stroke patients were included (mean age = 55.5 + 15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10-19) compared to normoglycemic patients 11 (IQR 8-15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99-6.19) more likely to be functionally impaired (mRS = 3-5) at 30-days compared to normoglycemic patients (P = 0.041).Older age (≥ 65 years) (P = 0.017) and stroke severity (NIHSS > 14) (P = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association. CONCLUSIONS: Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-day of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.


Assuntos
Hiperglicemia/complicações , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Etiópia , Feminino , Humanos , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
3.
Med J Aust ; 211(10): 454-459, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31680269

RESUMO

OBJECTIVE: To determine whether routine blood glucose assessment of patients admitted to hospital from emergency departments (EDs) results in higher rates of new diagnoses of diabetes and documentation of follow-up plans. DESIGN, SETTING: Cluster randomised trial in 18 New South Wales public district and tertiary hospitals, 31 May 2011 - 31 December 2012; outcomes follow-up to 31 March 2016. PARTICIPANTS: Patients aged 18 years or more admitted to hospital from EDs. INTERVENTION: Routine blood glucose assessment at control and intervention hospitals; automatic requests for glycated haemoglobin (HbA1c ) assessment and notification of diabetes services about patients at intervention hospitals with blood glucose levels of 14 mmol/L or more. MAIN OUTCOME MEASURE: New diagnoses of diabetes and documented follow-up plans for patients with admission blood glucose levels of 14 mmol/L or more. RESULTS: Blood glucose was measured in 133 837 patients admitted to hospital from an ED. The numbers of new diabetes diagnoses with documented follow-up plans for patients with blood glucose levels of 14 mmol/L or more were similar in intervention (83/506 patients, 16%) and control hospitals (73/278, 26%; adjusted odds ratio [aOR], 0.83; 95% CI 0.42-1.7; P = 0.61), as were new diabetes diagnoses with or without plans (intervention, 157/506, 31%; control, 86/278, 31%; aOR, 1.51; 95% CI, 0.83-2.80; P = 0.18). 30-day re-admission (31% v 22%; aOR, 1.34; 95% CI, 0.86-2.09; P = 0.21) and post-hospital mortality rates (24% v 22%; aOR, 1.07; 95% CI, 0.74-1.55; P = 0.72) were also similar for patients in intervention and control hospitals. CONCLUSION: Glucose and HbA1c screening of patients admitted to hospital from EDs does not alone increase detection of previously unidentified diabetes. Adequate resourcing and effective management pathways for patients with newly detected hyperglycaemia and diabetes are needed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12611001007921.


Assuntos
Glicemia/análise , Diabetes Mellitus/diagnóstico , Testes Diagnósticos de Rotina/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , New South Wales
4.
Zhonghua Nei Ke Za Zhi ; 58(12): 889-893, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31775451

RESUMO

Objective: To evaluate the effect of mobile application (APP) based interactive peer support on glycemic control in patients with type 1 diabetes mellitus (T1DM). Methods: The data of the present study were from the largest mobile APP platform for patients with T1DM in China, Tangtangquan. Patients with T1DM who has registered in the APP for at least 1 year and had completed data entry were recruited. According to the monthly interaction index during the first year of APP registration (including four indicators: praise, comment, posting and collection), the eligible patients were divided into the high-interaction group and the low-interaction group. The changes from baseline of self-blood glucose monitoring frequency (SMBG), glycosylated hemoglobin (HbA1c), incidence of hyperglycemia and incidence of hypoglycemia were compared between the two groups after one year of using the APP. Results: A total of 238 patients with T1DM with an age of (27±8) years were included. Among them, 77.3% (184/238) were female. The baseline SMBG [the low-interaction group (1.71±1.14) times/day vs. the high-interaction group (1.82±1.15) times/day] and HbA1c [the low-interaction group (6.72±0.99)% vs. the high-interaction group (6.76±1.04)%] were comparable between the two groups. After one year use of the APP, the frequency of SMBG in the high-interaction group was significantly higher than that in the low-interaction group [ΔSMBG (0.59+2.06) times/d vs. (0.08+1.69) times/d, t=4.280, P=0.04), and the reduction of HbA1c was more obvious in the high-interaction group [ΔHbA1c (-0.40+1.10)% vs. (-0.06+1.13)%, t=5.651, P=0.018] than in the lower-interaction group. The incidence of hyperglycemia in the high-interaction group was significantly lower than that in the low-interaction group [13.19(6.22,23.19)% vs. 17.69(10.56,30.49)%, Z=2.850, P=0.005]. There was no significant difference in the incidence of hypoglycemia between the two groups [4.62(2.14, 8.03)% vs. 4.83(2.06, 8.87)%, Z=1.276, P=0.204]. The correlation analysis showed that interaction index was significantly associated with the reduction of HbA1c and incidence of hyperglycemia. Conclusion: Participation in interactive peer education via mobile APP may be beneficent for glycemic control in patients with T1DM.


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 1/sangue , Aplicativos Móveis , Grupo Associado , Adulto , Glicemia , China , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Hemoglobina A Glicada , Humanos , Hiperglicemia/epidemiologia , Incidência , Pessoa de Meia-Idade , Cooperação do Paciente
5.
Diabetes Res Clin Pract ; 157: 107841, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31518656

RESUMO

AIM: Hyperglycaemia in pregnancy (HIP) is one of the most common complications of pregnancy. This study aims to examine the projected HIP prevalence in 2030 and 2045 using multiple methods. METHODS: The International Diabetes Federation Diabetes Atlas 2019 prevalence was projected to 2030 and 2045 by: (1) carrying forward the 2019 age-adjusted prevalence rates; (2) applying a linear regression of the past four editions of the IDF Diabetes Atlas; (3) applying a regression of the previous editions with the most consistent trend, followed by extrapolation from the 9th edition HIP estimate. RESULTS: Respectively, for 2030 and 2045, Method 1 projected a declining HIP rate with prevalences of 14.0% and 13.3%, Method 2 projected an increasing HIP prevalence at 16.5% and 18.3%, Method 3 predicted stabilisation of the rate from 16.0% to 15.8%. CONCLUSION: Assuming other factors remain unchanged, our best estimation of age-adjusted HIP will show stabilisation between 2019 and 2045 of 15.8% to 16.0%. However, this estimate is confounded by the heterogeneity of studies and the influence of different gestational diabetes mellitus diagnostic criteria. To provide accurate future comparisons we recommend standardising the diagnostic criteria to the International Association of Diabetes in Pregnancy Study Groups.


Assuntos
Diabetes Gestacional/epidemiologia , Hiperglicemia/epidemiologia , Adulto , Feminino , História do Século XXI , Humanos , Pessoa de Meia-Idade , Gravidez , Prevalência , Adulto Jovem
6.
Asian Pac J Cancer Prev ; 20(9): 2619-2624, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31554355

RESUMO

Background: Hyperglycaemia is a common side effect of steroid and L-asparaginase combinations, occurring most often during acute lymphoblastic leukemia (ALL) induction phase. To date in Indonesia, it has not been obtained data on the incidence of hyperglycemia in children with ALL in the induction phase and how the role of combinations of L-asparaginase and different type of steroid used. The purpose of this study is to determine the incidence of hyperglycemia in children ALL induction phase, knowing the difference between prednisone and dexamethasone (in combination with L-asparaginase) in causing hyperglycemia in children with ALL and determine the relationship of other factors related to hyperglycaemia. Methods: This was a prospective analytic study with a pre- and post-test design, conducted in three hospitals (Cipto Mangunkusumo Hospital, Dharmais Cancer Hospital, and Gatot Soebroto Hospital). Patient's blood glucose levels (BGL) were checked at the 3rd (pretest), 4th, 5th and 6th week of protocol (post-test). Result: Of the 57 patients, 5.2% had hyperglycemia. The patients' age ranged from 1.4 years old to 15.8 years old (6.7 years old). There was no relationship between age, central nervous system (CNS) infiltration, leukocytosis, Down syndrome, nutritional status, family history of diabetes, infections and ALL stratification with hyperglycemia (p>0.05). Dexamethasone has more chance of obtaining higher mean rate of change in BGL compared to prednisone. (p < 0.05; RR 10.68; CI 95% 1.52-74.73). Conclusion: The incidence of hyperglycemia in this study is 5.2%. Dexamethasone, in combination with L-asparaginase, despite having no difference in causing hyperglycemia, has an increased risk of changing BGL compared to prednisone.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Hiperglicemia/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Asparaginase/administração & dosagem , Criança , Pré-Escolar , Dexametasona/administração & dosagem , Feminino , Seguimentos , Humanos , Hiperglicemia/induzido quimicamente , Incidência , Indonésia/epidemiologia , Lactente , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Prednisona/administração & dosagem , Prognóstico , Estudos Prospectivos
7.
Ghana Med J ; 53(2): 156-162, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31481812

RESUMO

Background: Glucocorticoids (steroids) play a key role in the management of multiple medical conditions including haematological disorders. This study looked at the prevalence of steroid induced dysglycaemia in patients with haematological disorders receiving steroids as part of their treatment with the view of modifying its use and selection of patients where necessary. Methods: A retrospective review of haematology patients on treatment regimens including steroids. Information extracted included, demographic characteristics, clinical information such as age, gender, haematological disorder, type of steroid, daily and cumulative dose of steroid, duration of therapy, family history of diabetes and alcohol use. Results: The case records of 351 haematology patients were reviewed. However, eight patients with dysglycaemia before therapy were excluded. The median age of patients was 51.0 ± 26.0(IQR: Interquartile Range) years, with an age range of 13 to 87 years, and a female: male ratio of 1.2: 1 (p= 0.778). The prevalence of Steroid-Induced Dysglycaemia (SID) was 3.79% with a mean diagnosis interval of 8.8 + 2.1 months. Overall, 245 (71.4%) patients were on continuous steroids. Among the 13 patients who developed SID, 11 (84.6%) were on continuous steroids. In the majority of the patients (97.1%) there was no family history of diabetes in a first degree relative. Significant differences were found between patients with normoglycaemia and those with dysglycaemia with respect to age (p=0.049) and duration of steroid therapy (p=0.024). Conclusion: The prevalence of steroid-induced dysglycaemia is relatively low among Ghanaian patients with haematological disorders on steroid based chemotherapy. Funding: None declared.


Assuntos
Glucocorticoides/efeitos adversos , Doenças Hematológicas/tratamento farmacológico , Hiperglicemia/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gana/epidemiologia , Humanos , Hiperglicemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
8.
BMC Res Notes ; 12(1): 488, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387638

RESUMO

OBJECTIVES: The aim of this study is to determine the prevalence of poor sleep quality and its associated factors among people with type 2 diabetes mellitus at Jimma University Medical Center, Jimma, Ethiopia 2018. Comparative cross-sectional study was employed on 198 participants (99 cases and 99 controls). Data were collected using Pittsburgh Sleep Quality Index (PSQI) and analyzed using SPSS version 20. Variables with p value ≤ 0.05 in multivariable logistic regression were treated as significant predictors of poor sleep quality. RESULTS: The prevalence of poor sleep quality was 55.6% among people with type 2 diabetes mellitus and 32.3% among controls. Longer duration of diabetes since diagnosis (> 10 years) [AOR = 4.88 CI (1.27, 18.66) p = 0.021], co-morbid hypertension [AOR = 3.2, CI (1.16, 8.84) p = 0.025], poor glycemic control [AOR = 3.16 CI (1.2, 8.27), p = 0.02] and current khat chewing [AOR = 3.06, CI (1.04, 8.98), p = 0.042] were factors significantly associated with poor sleep quality. The prevalence of poor sleep quality was significantly higher among people with diabetes than those who didn't have diabetes (controls). Poor sleep quality may bring about mental impairment and reduce working capacity of individuals with diabetes mellitus. Therefore, diabetes mellitus patients need to have heath education about risk factors for poor sleep quality.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hiperglicemia/epidemiologia , Hipertensão/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Centros Médicos Acadêmicos , Adulto , Comorbidade , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Sono/fisiologia , Inquéritos e Questionários
9.
Diabetes Metab Syndr ; 13(4): 2585-2591, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405680

RESUMO

BACKGROUND: Illness perceptions (IP) involve coping strategies and behavioural responses that can influence glycaemic control. Despite the importance of good glycaemic control, the majority of patients in Asia are not achieving glycaemic targets. An evaluation of IP in association with glycaemic control, medication adherence and chronic kidney disease (CKD) in Type 2 diabetes mellitus patients (T2DM) was carried out in an outpatient setting in Malaysia METHOD: A cross-sectional study was conducted using the Revised Illness Perception Questionnaire in a purposive sample of 384 T2DM patients. RESULTS: There were 55.7% females, median age was 58.2 years and median duration of diabetes was 13 years. The majority (79.4%) of patients had poor diabetes control (HbA1c ≥ 7.0%) and 39.6% of patients had low medication adherence. Patients with good glycaemic control had a higher Timeline Acute/Chronic and Emotional Representations score, hence they held the correct belief that diabetes is chronic and experienced negative emotions. Highly adherent patients had a higher Illness Coherence (χ2 = 21.385, p < 0.001) score but a lower Consequences (χ2 = 17.592, p < 0.001) and Emotional Representations (χ2 = 16.849, p < 0.001) score indicating good understanding and less negative perceptions of disease burden. Patients in a more advanced stage of CKD had a significantly higher Timeline Cyclical score (χ2 = 18.718, p = 0.001), believing that diabetes was unpredictable. CONCLUSION: Dimensions of IP have been shown to be significantly associated with the assessed variables, therefore intervention studies with education, support and counselling should be conducted in Asia with the ultimate aim of empowering patients through IP-targeted management.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Hiperglicemia/psicologia , Hipoglicemia/psicologia , Hipoglicemiantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Insuficiência Renal Crônica/psicologia , Idoso , Biomarcadores/análise , Estudos Transversais , Diabetes Mellitus Tipo 2/psicologia , Feminino , Seguimentos , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Malásia/epidemiologia , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Percepção , Prevalência , Prognóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/prevenção & controle , Inquéritos e Questionários
10.
Postgrad Med ; 131(8): 597-606, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31419922

RESUMO

The association between cancer and dysglycemia has been well documented. It is underappreciated, however, that sustained dysglycemia could potentially be a catalyst toward a pro-cancer physiologic milieu and/or increase the burden of cancer. Hyperglycemia, hyperinsulinemia and energy metabolism at large impact a cascade of growth pathways, epi/genetic modifications, and mitochondrial changes that could feasibly link to tumor processes. Oxidative stress is a recurring motif in cell dysfunction: in diabetes, oxidative stress and reactive oxygen species (ROS) feature prominently in the damage and demise of pancreatic beta cells, as well as cell damage contributing to diabetes-related complications. Oxidative stress may be one intersection at which metabolic and oncogenic processes cross paths with deleterious results in the development of precancer, cancer, and cancer progression. This would augur for tight glucose control. Regrettably, some medical societies have recently relaxed hemoglobin A1c targets. A framework for the hyperglycemic state is presented that helps account and translate the full scope of effects of dysglycemia to ultimately improve clinical best practices.


Assuntos
Hiperglicemia/epidemiologia , Hiperglicemia/fisiopatologia , Neoplasias/epidemiologia , Neoplasias/fisiopatologia , Proteínas de Ligação a DNA/biossíntese , Progressão da Doença , Metabolismo Energético/fisiologia , Hemoglobina A Glicada , Humanos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/genética , Hiperinsulinismo/fisiopatologia , Hipoglicemiantes/farmacologia , Hipoglicemiantes/uso terapêutico , Neoplasias/genética , Obesidade/epidemiologia , Estresse Oxidativo/fisiologia , Prognóstico , Proteínas Proto-Oncogênicas/biossíntese , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/fisiologia
11.
BMC Endocr Disord ; 19(1): 91, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464602

RESUMO

OBJECTIVE AND BACKGROUND: In 2015 approximately 5.0 million people were estimated to have died from diabetes. Poor glycemic control is the most determinant of diabetes-related complication and death. The percentage of patients whose blood glucose level are not well controlled remains high yet. The aim of this study is to identify the determinants of poor glycemic control at the diabetes clinic of the Jimma University Medical Center from April 01 to June 30/2017. METHODS: Facility-based case-control study design was conducted on patients with type 2 diabetes mellitus on follow-up at the diabetes clinic of Jimma University medical center. The consecutive sampling technique was employed and data were collected from April to June 2017. The data were entered using Epidata manager version 4.0.2 and exported to SPSS Version 21 for analysis. Logistic regression analysis was performed and variables with the p-value of less than 0.05 were considered as statistically significant determinants of poor glycemic control. RESULT: The study was conducted on 410 patients, of which 228 males and 182 females. The determinants of poor glycemic control were comorbidities [Adjusted odd ratio(AOR) = 2.56, 95%CI = 1.10-5.96], lack of self-monitoring blood glucose [AOR = 3.44,95%CI = 1.33-8.94], total cholesterol level of 200 mg/dl or more [AOR = 3.62, 95%CI = 1.46-8.97], diabetes duration of greater than 7 years [AOR = 3.08, 95%CI = 1.33-7.16], physical activity of three or less than three days [AOR = 4.79, 95%CI = 1.70-13.53], waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female [AOR = 3.52, 95%CI = 1.23-10.11], being on metformin plus insulin [AOR = 9.22, 95%CI = 2.90-29.35] and being on insulin [AOR = 4.48, 95%CI = 1.52-13.16]. CONCLUSION: Lack of Self-monitoring blood glucose, presence of comorbidities, duration of diabetes mellitus, physical activity of three or less than three days, total cholesterol of 200 mg/dl or more, waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female, and types of antidiabetic medication were the independent predictors of poor glycemic control. Effort should be made towards reducing these factors by the concerned body.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Hipoglicemiantes/efeitos adversos , Adulto , Idoso , Glicemia/análise , Estudos de Casos e Controles , Estudos Transversais , Etiópia/epidemiologia , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/induzido quimicamente , Hiperglicemia/diagnóstico , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
12.
Nutr Metab Cardiovasc Dis ; 29(11): 1230-1236, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31427048

RESUMO

BACKGROUND AND AIMS: The Great Leap Forward Famine during 1959-1961 was the world's largest famine, and its adverse long-term effects might be more apparent in the coming decade with ageing of the exposed populations. The aim of this study was to examine whether the Chinese Famine modified the effect of hyperglycaemia on cardiovascular disease (CVD). METHODS AND RESULTS: We used data of 4337 adults born between 1952 and 1964 collected from the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression was used to estimate the odds ratios (ORs) and confidence intervals (CIs) between hyperglycaemia and CVD. The prevalence of CVD showed significant difference among different famine exposure cohorts (P = 0.0156). After multivariable adjustment, the ORs (95% CIs) were as follows: 1.46 (0.94, 2.26) for late childhood, 1.76 (1.06, 2.90) for mid childhood, 1.40 (0.86, 2.27) for early childhood, 2.55 (1.30, 5.02) for the foetal cohort and 1.10 (0.63, 1.95) for the non-exposed cohort. There was a significant interaction between hyperglycaemia and famine exposure for CVD (P = 0.0374). In addition, the subgroup analyses showed that the effect of hyperglycaemia on CVD in the foetal exposure cohort was significantly higher than those in any of the other famine-exposed cohorts, especially in those who lived in rural areas (OR: 4.67, 95% CI: 1.70-12.84), those who lived in severe famine areas (OR: 5.01, 95% CI: 1.22-20.66) and those who were men (OR: 3.66, 95% CI: 1.01-13.33). CONCLUSION: Exposure to the Chinese Famine, especially during the foetal stage of life, aggravated the association between hyperglycaemia and CVD.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Hiperglicemia/epidemiologia , Acontecimentos que Mudam a Vida , Desnutrição/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Fatores Etários , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Fenômenos Fisiológicos da Nutrição Materna , Pessoa de Meia-Idade , Gravidez , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
13.
BMC Pregnancy Childbirth ; 19(1): 315, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455272

RESUMO

BACKGROUND: Hyperglycemia in pregnancy is a medical condition resulting from either pre-existing diabetes or insulin resistance developed during pregnancy. This study aimed to determine the prevalence of hyperglycemia in pregnancy and influence of body fat percentage and other determinants on developing hyperglycemia in pregnancy among women in Arusha District, Tanzania. METHODS: A cross-sectional study was conducted between March and December 2018 at selected health facilities in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Blood glucose was tested by Gluco-Plus™ using the World Health Organization criteria at fasting and 2 h after consuming 75 g of glucose dissolved in 300 ml of water. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regulated tape, weight using SECA™, blood pressure using a GT-868UF Geratherm™ machine, and height using a stadiometer. Demographic and maternal characteristics were collected through face to face interviews using a structured questionnaire. RESULTS: The participants' mean age was 28 years (SD ± 6), mid-upper arm circumference 27 cm (SD ± 3.7), body fat 33.72% (SD ± 7.2) and pre-pregnancy body mass index 25.6 kg/m2 (SD ± 5.5). One-third of participants had mid-upper arm circumferences ≥28 cm with 25% being overweight and 22.7% obese before pregnancy. Prevalence of hyperglycemia in pregnancy was 16.2% (n = 76) of which 13% had gestational diabetes and 3.2% diabetes in pregnancy. Hyperglycemia in pregnancy was significantly associated with body fat percentage (AOR 1.33; 95% CI: 1.22-1.44), family history of Type 2 diabetes mellitus (AOR 6.95, 95% CI: 3.11-15.55), previous delivery of babies ≥4 kg (AOR 2.3, 95% CI: 1.00-5.28), mid-upper arm circumference ≥ 28 cm (AOR 1.2, 95% CI: 1.09-1.32), and Type 2 diabetes mellitus symptoms (AOR 2.83, 95% CI: 1.53-6.92). CONCLUSION: The prevalence of hyperglycemia in pregnancy was high, particularly among women with history of delivering ≥4-kg babies, increased body fat, mid-upper arm circumference, symptoms and/or family history of Type 2 diabetes mellitus. These findings identify opportunities to further explore the utility of body fat percentage and other determinants for rapid screening and management of hyperglycemia in pregnancy.


Assuntos
Tecido Adiposo , Hiperglicemia/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/etiologia , Feminino , Humanos , Hiperglicemia/etiologia , Sobrepeso , Gravidez , Complicações na Gravidez/etiologia , Prevalência , Fatores de Risco , Tanzânia/epidemiologia , População Urbana , Adulto Jovem
14.
Nutrients ; 11(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31382699

RESUMO

Little is known about the association between dietary patterns and hyperglycemia incidence among Korean adults. Hence, we aimed to prospectively investigate the major dietary patterns associated with hyperglycemia among middle-aged and older Korean adults. In total, 55,457 adults (18,292 men and 37,165 women) aged 40 to 79 years, who were previously enrolled in the Health Examinee Study of the Korean Genome and Epidemiology Study and had no history of type 2 diabetes mellitus (T2DM) or cancer at baseline, were included. Dietary patterns were identified by a factor analysis based on dietary data, which were assessed at baseline using a validated food-frequency questionnaire. Participants were classified as having hyperglycemia if fasting blood glucose levels were ≥126 mg/dL or physician diagnosed T2DM during follow-up. Multivariable Cox proportional hazard models were used to examine the associations between each dietary pattern and future hyperglycemia risk after adjusting for potential confounders. After a mean follow-up of 4.9 years, 2574 new cases of hyperglycemia were identified. Using a factor analysis, four distinct dietary patterns were identified: "prudent;" "fatty fish, meat, and flour-based food;" "coffee and sweets;" and "whole grain (men)" or "white rice (women)." The "prudent" pattern was inversely associated with hyperglycemia risk only in women (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.63-0.89; p for trend = 0.0003). Conversely, women in the highest quintile of the "fatty fish, meat, and flour-based food" pattern showed an increased risk of hyperglycemia (HR, 1.22; 95% CI, 1.03-1.44; p for trend = 0.0210) compared with those in the lowest quintile. The "coffee and sweets" and "white rice" patterns were not associated with hyperglycemia risk in women. The dietary patterns observed in men had no associations with hyperglycemia incidence. Our findings suggest that a diet rich in vegetables, mushrooms, seaweeds, fruits, and soy products and low in fatty fish and high-fat meat may potentially play a protective role in T2DM development with sex differences in middle-aged and older Korean adults.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Dieta/efeitos adversos , Comportamento Alimentar , Hiperglicemia/epidemiologia , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Valor Nutritivo , Estudos Prospectivos , Fatores de Proteção , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Fatores Sexuais
15.
J Pediatr Endocrinol Metab ; 32(8): 843-849, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31318694

RESUMO

Background To evaluate the safety of fasting during the holy month of Ramadan among children and adolescent with type 1 diabetes (T1D). Methods A retrospective cohort study of 50 children and adolescents with T1D whose mean age was 12.7 ± 2.1 years was conducted. Twenty-seven patients (54%) were on multiple daily injections (MDI) insulin regimen and 23 (46%) were on insulin pump therapy. Before fasting for Ramadan, children and their families were evaluated and educated about diabetes management during Ramadan. Hemoglobin A1c (HbA1c), weight, number of days fasted, hypoglycemia and hyperglycemia episodes, and emergency hospital visits were collected and analyzed after completing the month. Participants were compared according to the insulin treatment regimen and their glycemic control level before Ramadan. Results The children were able to fast 20 ± 9.9 days of Ramadan, and the most common cause for breaking the fast was mild hypoglycemia (7.8% among all cases). There was no significant difference between the two insulin regimen groups in breaking fast days, frequency of hypo- or hyperglycemia, weight and HbA1c changes post Ramadan. Patients with HbA1c ≤ 8.5% were able to fast more days during Ramadan with significantly less-frequent hypoglycemic attacks as compared to patients with HbA1c > 8.5 (1.2 ± 1.5 vs. 3.3 ± 2.9 days of hypoglycemia, p = 0.01, respectively). Conclusions Fasting for children with T1D above the age of 10 years is feasible and safe in both pump and non-pump users, and well-controlled patients are less likely to develop complications. Education of the families and their children before Ramadan, along with intensive monitoring of fasting children during the month are crucial.


Assuntos
Peso Corporal , Diabetes Mellitus Tipo 1/tratamento farmacológico , Jejum/efeitos adversos , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Sistemas de Infusão de Insulina/efeitos adversos , Insulina/administração & dosagem , Adolescente , Biomarcadores/análise , Glicemia/análise , Criança , Diabetes Mellitus Tipo 1/sangue , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/induzido quimicamente , Hiperglicemia/epidemiologia , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Incidência , Insulina/efeitos adversos , Islamismo , Kuweit/epidemiologia , Masculino , Prognóstico , Estudos Retrospectivos
16.
Nutrients ; 11(7)2019 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261967

RESUMO

Background: The effect of dietary fat intake on the metabolic syndrome (MetS) and in turn on cardiovascular disease (CVD) remains unclear in individuals at high CVD risk. Objective: To assess the association between fat intake and MetS components in an adult Mediterranean population at high CVD risk. Design: Baseline assessment of nutritional adequacy in participants (n = 6560, men and women, 55-75 years old, with overweight/obesity and MetS) in the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial. Methods: Assessment of fat intake (total fat, monounsatured fatty acids: MUFA, polyunsaturated fatty acids: PUFA, saturated fatty acids: SFA, trans-fatty acids: trans-FA, linoleic acid, α-linolenic acid, and ω-3 FA) using a validated food frequency questionnaire, and diet quality using 17-item Mediterranean dietary questionnaire and fat quality index (FQI). Results: Participants in the highest quintile of total dietary fat intake showed lower intake of energy, carbohydrates, protein and fiber, but higher intake of PUFA, MUFA, SFA, TFA, LA, ALA and ω-3 FA. Differences in MetS components were found according to fat intake. Odds (5th vs. 1st quintile): hyperglycemia: 1.3-1.6 times higher for total fat, MUFA, SFA and ω-3 FA intake; low high-density lipoprotein cholesterol (HDL-c): 1.2 higher for LA; hypertriglyceridemia: 0.7 lower for SFA and ω-3 FA intake. Conclusions: Dietary fats played different role on MetS components of high CVD risk patients. Dietary fat intake was associated with higher risk of hyperglycemia.


Assuntos
Doenças Cardiovasculares/epidemiologia , Gorduras na Dieta/efeitos adversos , Dislipidemias/epidemiologia , Hiperglicemia/epidemiologia , Síndrome Metabólica/epidemiologia , Idoso , Biomarcadores/sangue , Glicemia/análise , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Estudos Transversais , Dieta Mediterrânea , Gorduras na Dieta/administração & dosagem , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/dietoterapia , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/dietoterapia , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/dietoterapia , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Resultado do Tratamento
17.
J Pediatr Endocrinol Metab ; 32(9): 929-933, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31323008

RESUMO

Background The main objective of this study was to compare future glycemic control in children diagnosed with type 1 diabetes mellitus (T1DM) at toddler age and preschool/school age. In addition, we aimed to examine risk factors known to be associated with future glycated hemoglobin A1c (HbA1c) levels in children diagnosed with T1DM. Methods This is a retrospective cohort study of 85 patients diagnosed with T1DM at toddler age (group 1; 0-2.9 years; n = 36) or preschool/school age (group 2; 5-6.9 years; n = 49) who were followed up at the University Children's Hospital in Zurich for at least 10 consecutive years or until the age of 15 years. Results The mean HbA1c level in the first year after diagnosis had a highly predictive value about glycemic control in the following 6 years. In addition, a longer duration of T1DM was associated with higher HbA1c values. HbA1c values did not differ significantly within 11 years after diagnosis between children in the two age groups. Neither was a difference found when comparing the two groups in respect to their chronological age, although a trend was noted (p = 0.09). This trend is very likely due to a longer duration of diabetes in group 1. Conclusions HbA1c level in the first year predicts glycemic control for the next 6 years and deterioration of HbA1c values can be noted with longer duration of T1DM. Moreover, our study demonstrated similar future glycemic control in patients diagnosed with T1DM at toddler age and preschool/school age.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Glicemia/análise , Criança , Pré-Escolar , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/sangue , Hiperglicemia/epidemiologia , Hipoglicemia/sangue , Hipoglicemia/epidemiologia , Lactente , Recém-Nascido , Masculino , Prognóstico , Fatores de Risco
18.
BMC Pregnancy Childbirth ; 19(1): 263, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340766

RESUMO

BACKGROUND: The oral glucose-tolerance test (OGTT) is currently the standard method for diagnosis of gestational diabetes (GDM). We conducted a post hoc analysis using the Australian Hyperglycemia and Adverse Pregnancy Outcome (HAPO) data to determine seasonal variations in OGTT results, the consequent prevalence of GDM, and association with select perinatal parameters. METHOD: Women enrolled in the Australian HAPO study sites (Brisbane and Newcastle) from 2001 to 2006 were included if OGTT results between 24 to 32 weeks gestation were available (n = 2120). Fasting plasma glucose, 1-h plasma glucose, 2-h plasma glucose, HbA1c, HOMA-IR, and umbilical cord C-peptide and glucose values were categorized by season and correlated to monthly temperature records from the Australian Bureau of Meteorology for Brisbane and Newcastle. GDM was defined post hoc using the IADPSG/WHO criteria. RESULTS: Small but significant (p <  0.01 on ANOVA) elevations in fasting glucose (+ 0.12 mM), HbA1c (+ 0.09%), and HOMA-IR (+ 0.88 units) were observed during the winter months. Conversely, higher 1-h (+ 0.19 mM) and 2-h (+ 0.33 mM) post-load glucose values (both p <  0.01) were observed during the summer months. The correlations between fasting glucose, 1-h glucose, 2-h glucose, and HbA1c with average monthly temperatures confirmed this trend, with positive Pearson's correlations between 1-h and 2-h glucose with increasing average monthly temperatures, and negative correlations with fasting glucose and HbA1c. Further, umbilical cord C-peptide and glucose displayed negative Pearson's correlation with average monthly temperature, aligned with trends seen in the fasting plasma glucose. Overall prevalence of GDM did not display significant seasonal variations due to the opposing trends seen in the fasting versus 1-h and 2-h post-load values. CONCLUSION: A significant winter increase was observed for fasting plasma glucose, HbA1c, and HOMA-IR, which contrasted with changes in 1-h and 2-h post-load venous plasma glucose values. Interestingly, umbilical cord C-peptide and glucose displayed similar trends to that of the fasting plasma glucose. While overall prevalence of GDM did not vary significantly by seasons, this study illustrates that seasonality is indeed an additional factor when interpreting OGTT results for the diagnosis of GDM and provides new direction for future research into the seasonal adjustment of OGTT results.


Assuntos
Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Teste de Tolerância a Glucose , Estações do Ano , Adulto , Austrália , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Gestacional/enzimologia , Feminino , Humanos , Hiperglicemia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Adulto Jovem
19.
Diabetes Metab Syndr ; 13(2): 1241-1244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336471

RESUMO

AIMS: Visceral Adiposity Index (VAI) is suggested as a surrogate marker for visceral adipose tissue dysfunction. It is an empirical-mathematical model, sex-specific, based on metabolic and anthropometric parameters. Diabetes mellitus is growing in an expanding fashion globally. The aim of this study to study the association between VAI and glycemic control in women with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A total of 300 T2DM female aged (25-60 years) were enrolled in this cross-sectional study. Subjects were recruited from Baghdad medical city during the period from January 2017 to July 2018. Body mass index (BMI), waist circumference (WC), blood pressure was measured and fasting blood sample was analyzed for blood glucose, glycated hemoglobin(HbA1c), and lipid profile. VAI was calculated in addition to triglyceride-glucose (TyG) derived indices. Statistical analysis was done by SPSS version 23. The study was ethically approved. RESULTS: Patients with high VAI showed poor glycemic control, dyslipidemia, elevated TYG index, TYGWC and TYGBMI. The number of diabetics with poor glycemic control increased across the VAI quartiles. The area under the curve in ROC analysis demonstrated that VAI had a good predictive ability to identify the state of glycemic control as compared to other anthropometric measures (WC, BMI) or combined metabolic and anthropometric measures (TyGWC, TyGBMI). CONCLUSION: increased VAI adversely affects the glycemic control in women with T2DM.


Assuntos
Adiposidade , Biomarcadores/análise , Diabetes Mellitus Tipo 2/complicações , Hiperglicemia/diagnóstico , Gordura Intra-Abdominal/fisiopatologia , Obesidade Abdominal/fisiopatologia , Adulto , Glicemia/análise , Estudos Transversais , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/etiologia , Iraque/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Fatores de Risco , Circunferência da Cintura
20.
BMC Infect Dis ; 19(1): 627, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311495

RESUMO

BACKGROUND: Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction. METHODS: We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI. RESULTS: Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant. CONCLUSIONS: BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.


Assuntos
Diabetes Mellitus/epidemiologia , Estado Nutricional , Tuberculose/epidemiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus/microbiologia , Características da Família , Feminino , Humanos , Hiperglicemia/epidemiologia , Índia/epidemiologia , Tuberculose Latente/epidemiologia , Tuberculose Latente/etiologia , Masculino , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Magreza/epidemiologia , Tuberculose/etiologia
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