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1.
Using routine HbA1c measurements in stroke and the associations of dysglycaemia with stroke outcomes
Jeremy Lew Vincent Thijs Leonid Churilov Geoffrey Donnan Warwick Park Raymond Robbins Graeme K. Hart Christopher Bladin Kaylyn Khoo Lik-Hui Lau Alanna Tan Que Lam Douglas Johnson Jeffrey D. Zajac Elif I. Ekinci 《Journal of diabetes and its complications》2018,32(11):1056-1061
Aims
Diabetes is a major risk factor for stroke. We aimed to investigate the prevalence of diabetes and pre-diabetes within a stroke cohort and examine the association of glycaemia status with mortality and morbidity.Methods
Inpatients aged ≥54 who presented with a diagnosis of stroke had a routine HbA1c measurement as part of the Austin Health Diabetes Discovery Initiative. Additional data were attained from hospital databases and Australian Stroke Clinical Registry. Outcomes included diabetes and pre-diabetes prevalence, length of stay, 6-month and in-hospital mortality, 28-day readmission rates, and 3-month modified Rankin scale score.Results
Between July 2013 and December 2015, 610 patients were studied. Of these, 31% had diabetes while 40% had pre-diabetes. Using multivariable regression analyses, the presence of diabetes was associated with higher odds of 6-month mortality (OR?=?1.90, p?=?0.022) and higher expected length of stay (IRR?=?1.29, p?=?0.004). Similarly, a higher HbA1c was associated with higher odds of 6-month mortality (OR?=?1.27, p?=?0.005) and higher expected length of stay (IRR?=?1.08, p?=?0.010).Conclusions
71% of this cohort had diabetes or pre-diabetes. Presence of diabetes and higher HbA1c were associated with higher 6-month mortality and length of stay. Further research is necessary to determine if improved glycaemic control may improve stroke outcomes. 相似文献2.
Stuart Chalew Ricardo Gomez Alfonso Vargas Jodi Kamps Brittney Jurgen Richard Scribner James Hempe 《Journal of diabetes and its complications》2018,32(12):1085-1090
Introduction
Black youth with type 1 diabetes (T1D) have higher HbA1c than whites. To understand HbA1c differences, we examined the relationship of psycho-social factors and glucose testing with HbA1c.Methods
Glucose tests per day (BGs/d) and mean blood glucose (MBG) were calculated from meter data of youth self-identified as black (n?=?33) or white (n?=?53) with T1D. HbA1c, family income, insurance status, concentrated disadvantage (CDI), psychological depression (DSC), mother educational attainment (MEA), and insulin delivery method (IDM) data was were analyzed.Results
Black patients had significantly higher HbA1c, MBG and disadvantage measures compared to whites. BGs/d correlated with HbA1c, MBG, age and CDI. Race (p?<?0.0158), age (p?<?0.0001) and IDM (p?<?0.0036) accounted for 50% of the variability (R2?=?0.5, p?<?0.0001) in BGs/d. Regardless of age, black patients had lower BGs/d than whites. MBG (p?<?0.0001) and BGs/d (p?<?0.0001) accounted for 61% of the variance in HbA1c (p?<?0.0001).Conclusions
BGs/d is easily assessed and closely associated with HbA1c racial disparity. BGs/d is intricately linked with greater social disadvantage. Innovative management approaches are needed to overcome obstacles to optimal outcomes. 相似文献3.
Daniel Restifo Joni S. Williams Emma Garacci Rebekah J. Walker Mukoso N. Ozieh Leonard E. Egede 《Journal of diabetes and its complications》2018,32(9):819-823
Background
Diabetes has been identified as a risk factor for developing colorectal cancer (CRC); however, the literature identifying groups most at risk is sparse. This study aims to understand the relationship between CRC and diabetes by age and race/ethnicity.Methods
This is a cross-sectional study of data from the 2001–2014 National Health and Nutrition Examination Survey (unweighted n?=?37,173; weighted n?=?214,363,348). Individuals were categorized as having CRC if diagnosed with colon or rectal cancer and as having diabetes if told by a doctor they had diabetes, were taking insulin, or had an HbA1c?≥?6.5%. Covariates included gender, age, race, marital status, educational level and income as a ratio of the poverty line. Multivariable logistic regression was used to assess the relationship between CRC and diabetes overall and stratified by age and by race.Results
24.32% of the sample with CRC also had diabetes. After adjusting for covariates, individuals with diabetes had a 47% greater probability of having CRC (p?=?0.03). While significance did not persist after stratification for those ≥65?years (OR?=?1.06, p?=?0.74), those <65?years with diabetes had nearly 5-times higher odds of having CRC (OR?=?4.78, p?<?0.001). When stratified by race, both groups had statistically higher odds of having CRC; however, the odds for non-whites (OR?=?1.87, p?=?0.04) were higher compared to whites (OR?=?1.54, p?=?0.03).Conclusion
Individuals younger than 65 and racial/ethnic minorities have higher odds of CRC when also diagnosed with diabetes. Targeted interventions for these populations, especially regarding screening recommendations, may result in earlier detection of CRC and improved health outcomes. 相似文献4.
Konstantinos Kostopoulos Emmanouil Alhanatis Konstantinos Pampoukas Georgios Georgiopoulos Andromahi Zourla Athanasios Panoutsopoulos Anastasios Kallianos Lemonia Velentza Paul Zarogoulidis Georgia Trakada 《Sleep & breathing》2016,20(2):483-493
Background
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for hypertension, coronary artery disease, and diabetes mellitus. Epicardial fat has been recently recognized as a new risk factor and active participant on cardiometabolic risk. The aim of this study was to assess an independent relationship between sleep apnea severity, metabolic and vascular markers, and epicardial fat, at baseline and after 3 months of continuous positive airway pressure (CPAP) therapy.Materials and method
Our study group consisted of 48 patients with suspected OSAHS and no prior history of cardiovascular disease or diabetes mellitus. All patients underwent full overnight polysomnography. Thickness of epicardial and visceral adipose tissue, brachial artery flow-mediated dilation (FMD), carotid intima media thickness (cIMT), pulse wave velocity (PWV), plasma C-reactive protein (CRP) levels, fasting glucose levels, HbA1c, homeostatic model assessment of insulin resistance index (HOMA), and lipid profile were measured at baseline and after 3 months of CPAP use in patients with moderate to severe OSAHS.Results
In OSAHS patients (Apnea-hypopnea index (AHI) ≥15/h, N?=?28), epicardial fat correlated with fasting glucose (rho?=?0.406, p?=?0.04) and HOMA (rho?=?0.525, p?=?0.049) but was not associated with visceral fat (rho?=?0.126, p?=?0.595). Epicardial adipose tissue (EAT) (p?=?0.022) increased across AHI severity along with PWV (p?=?0.045) and carotid intima media thickness (IMT) (p?=?0.034) while FMD (p?=?0.017) decreased. Therapy with CPAP reduced both epicardial (p?<?0.001) and visceral fat (p?=?0.001). Alterations in epicardial fat across the follow-up were associated with changes in PWV (p?=?0.026) and HOMA (p?=?0.037) independently of major confounders.Conclusions
Epicardial fat thickness was associated with OSA severity and may be an additional marker of cardiovascular risk as well as of future diabetes in these patients. CPAP therapy reduced epicardial fat, suggesting its potentially beneficial role in reducing cardiometabolic risk in OSA patients.5.
Delnaz Roshandel Rose Gubitosi-Klug Shelley B. Bull Angelo J. Canty Marcus G. Pezzolesi George L. King Hillary A. Keenan Janet K. Snell-Bergeon David M. Maahs Ronald Klein Barbara E. K. Klein Trevor J. Orchard Tina Costacou Michael N. Weedon DCCT/EDIC Research Group Richard A. Oram Andrew D. Paterson 《Diabetologia》2018,61(5):1098-1111
Aims/hypothesis
The aim of this study was to identify genetic variants associated with beta cell function in type 1 diabetes, as measured by serum C-peptide levels, through meta-genome-wide association studies (meta-GWAS).Methods
We performed a meta-GWAS to combine the results from five studies in type 1 diabetes with cross-sectionally measured stimulated, fasting or random C-peptide levels, including 3479 European participants. The p values across studies were combined, taking into account sample size and direction of effect. We also performed separate meta-GWAS for stimulated (n?=?1303), fasting (n?=?2019) and random (n?=?1497) C-peptide levels.Results
In the meta-GWAS for stimulated/fasting/random C-peptide levels, a SNP on chromosome 1, rs559047 (Chr1:238753916, T>A, minor allele frequency [MAF] 0.24–0.26), was associated with C-peptide (p?=?4.13?×?10?8), meeting the genome-wide significance threshold (p?<?5?×?10?8). In the same meta-GWAS, a locus in the MHC region (rs9260151) was close to the genome-wide significance threshold (Chr6:29911030, C>T, MAF 0.07–0.10, p?=?8.43?×?10?8). In the stimulated C-peptide meta-GWAS, rs61211515 (Chr6:30100975, T/–, MAF 0.17–0.19) in the MHC region was associated with stimulated C-peptide (β [SE]?=???0.39 [0.07], p?=?9.72?×?10?8). rs61211515 was also associated with the rate of stimulated C-peptide decline over time in a subset of individuals (n?=?258) with annual repeated measures for up to 6 years (p?=?0.02). In the meta-GWAS of random C-peptide, another MHC region, SNP rs3135002 (Chr6:32668439, C>A, MAF 0.02–0.06), was associated with C-peptide (p?=?3.49?×?10?8). Conditional analyses suggested that the three identified variants in the MHC region were independent of each other. rs9260151 and rs3135002 have been associated with type 1 diabetes, whereas rs559047 and rs61211515 have not been associated with a risk of developing type 1 diabetes.Conclusions/interpretation
We identified a locus on chromosome 1 and multiple variants in the MHC region, at least some of which were distinct from type 1 diabetes risk loci, that were associated with C-peptide, suggesting partly non-overlapping mechanisms for the development and progression of type 1 diabetes. These associations need to be validated in independent populations. Further investigations could provide insights into mechanisms of beta cell loss and opportunities to preserve beta cell function.6.
Giuseppe d&#x;Annunzio Andrea Beccaria Angela Pistorio Enrico Verrina Nicola Minuto Roberto Pontremoli Alberto La Valle Mohamad Maghnie 《Journal of diabetes and its complications》2018,32(10):955-960
Aims
Diabetic Nephropathy (DN) is rarely encountered in childhood, otherwise early subclinical abnormalities are detectable few years after diabetes diagnosis. Our aim was to evaluate the incidence rate of microalbuminuria in childhood onset type 1 diabetes (DM1) patients. Secondary aim was to examine which variables could influence the development of DN.Methods
We longitudinally evaluated 137 young patients with DM1 from diagnosis (1994–2004) for a median of 11.8?years (1st–3rd q: 9.7–15.0). Overnight albumin excretion rate, degree of metabolic control, presence of microangiopathic complications and autoimmune co-morbidities were retrospectively collected.Results
DN was observed in 16/137 cases (11.7%), with an incidence rate of 10.0 per 1000?person-years. Young T1D patients with persistent micro/macro-albuminuria were more likely to have higher HbA1c concentrations over the last four years (P?=?0.04), and were more likely to have retinopathy (P?=?0.011) and subclinical peripheral neuropathy (P?=?0.003).Conclusions
DN predictors were age at DM1 diagnosis and mean HbA1c levels. Even if DN incidence is lower than reported, periodical screening is mandatory. Moreover, borderline microalbuminuria as additional risk factor deserves attention. 相似文献7.
Cornelis A.J. van Beers Martine G. Caris J. Hans DeVries Erik H. Serné 《Journal of diabetes and its complications》2018,32(1):100-103
Aims
We aimed to re-assess the previously shown but recently disputed association between HbA1c and severe hypoglycemia.Methods
52 Patients with T1D and IAH participated in an earlier reported randomized, crossover trial with two 16-week intervention periods comparing continuous glucose monitoring (CGM) with self-monitoring of blood glucose (SMBG). In this previous study, time spent in normoglycemia (the primary outcome), was improved by 9.6% (p < 0.0001). We performed post-hoc analyses using a zero-inflated Poisson regression model to assess the relationship between severe hypoglycemia and HbA1c, glucose variability and duration of diabetes.Results
During SMBG use, HbA1c and the number of severe hypoglycemic events were negatively associated (OR 0.20 [95% CI 0.09 to 0.44]). During CGM use, this relationship showed an odds ratio of 0.65 (95% CI 0.42 to 1.01). There was no significant relationship between glucose variability or duration of diabetes and severe hypoglycemia.Conclusions
In patients with T1D and IAH, treated with standard SMBG, a negative association exists between HbA1c and the number of severe hypoglycemic events. Thus, reaching target HbA1c values still comes with a higher risk of severe hypoglycemia. CGM weakens this association, suggesting CGM enables patients to reach their target HbA1c more safely. 相似文献8.
Jingchuan Guo Rachel G. Miller Tina Costacou William P. Follansbee Trevor J. Orchard 《Journal of diabetes and its complications》2018,32(3):298-304
Objectives
We aimed to assess association between abnormal LVEF, in the absence of coronary artery disease (CAD), and 25-year incidence of major outcomes of diabetes (MOD) in a cardiology substudy of the Pittsburgh Epidemiology of Diabetes Complications cohort of childhood-onset type 1 diabetes.Methods
115 normotensive type 1 diabetes individuals without known CAD, underwent a baseline exercise radionuclide ventriculography. Abnormal LVEF was defined as a resting ejection fraction <50% or a failure to increase ejection fraction with exercise by >5% (men) or a fall in ejection fraction with exercise (women). Cox proportional hazards models were used to predict the composite endpoint of MOD (first instance of major CAD, stroke, end-stage renal disease, blindness, amputation or diabetes-related death).Results
Mean baseline age was 28 and diabetes duration 19?years. In a mean follow-up of 19?years, 50 MOD events were identified. Allowing for established risk factors at baseline, abnormal LVEF (n?=?22) independently predicted MOD incidence (HR?=?2.12, 95% CI: 1.12–4.00, p?=?0.022) but not major CAD (HR?=?1.33, 95% CI: 0.53–3.33, p?=?0.539).Conclusions
An abnormal LVEF may identify diabetic cardiomyopathy and predict long term risk of MOD (but not CAD alone) in type 1 diabetes individuals, consistent with it reflecting microvascular disease. 相似文献9.
Mee Kyoung Kim Jee Sun Jeong Jae-Seung Yun Hyuk-Sang Kwon Ki Hyun Baek Ki-Ho Song Yu-Bae Ahn Seung-Hyun Ko 《Journal of diabetes and its complications》2018,32(10):906-910
Background and aims
Previous studies have suggested that the hemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications. We examined the prognostic significance of a high HGI for cardiovascular disease (CVD) in an ongoing hospital-based cohort.Methods
From March 2003 to December 2004, 1302 consecutive patients with type 2 diabetes and without a prior history of CVD were enrolled. CVD was defined as the occurrence of coronary artery disease or ischemic stroke. The HGI was calculated as the measured glycated hemoglobin (HbA1c) minus predicted HbA1c. Predicted HbA1c were calculated for 1302 participants by inserting fasting blood glucose (FBG) into the equation, Predicted HbA1c level?=?0.02106?×?FBG [mg/dL]?+?4.973. Cox proportional hazards models were used to identify the associations between the HGI and CVD after adjusting for confounding variables.Results
During 11.1?years of follow-up, 225 participants (17.2%) were newly diagnosed with CVD. The baseline HGI was significantly higher in subjects with incident CVD than in those without CVD, although the baseline FBG levels did not differ according to the occurrence of CVD. Compared with patients without CVD, those with CVD were older, had a longer duration of diabetes and hypertension, and used more insulin at baseline. A Cox hazard regression analysis revealed that the development of CVD was significantly associated with baseline HGI (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.31–2.87; p?<?0.001, comparing the highest and lowest quartiles of HGI). This relationship was unchanged after additional adjustment for baseline HbA1c level (HR, 1.74; 95% CI, 1.08–2.81). The HRs of HbA1c in relation to outcomes were similar to or lower than those seen for HGI. After adjustment for HGI, the effect of the highest HbA1c on incident CVD disappeared.Conclusions
High HGI was independently associated with incident CVD in patients with type 2 diabetes. Patients with high HGI at baseline had a higher inherent risk for CVD. 相似文献10.
Takahiro Yajima Kumiko Yajima Makoto Hayashi Hiroshi Takahashi Keigo Yasuda 《Journal of diabetes and its complications》2018,32(3):310-315
Aims
To evaluate the efficacy and safety of adding once-weekly dulaglutide to insulin therapy in type 2 diabetes mellitus (T2DM) patients on hemodialysis.Methods
Fifteen insulin-treated T2DM patients on hemodialysis were enrolled. Continuous glucose monitoring was performed before (1st hospitalization) and after the fifth dulaglutide administration (2nd hospitalization). The insulin dose was reduced after the first administration of dulaglutide (1st hospitalization day 6). Parameters of glycemic control were compared on 1st hospitalization days 4–5, 2nd hospitalization days 3–4, and days 6–7.Results
The median total daily insulin dose was reduced significantly from 12 (12–25) to 0 (0?12) U (p?<?0.0001) after treatment with dulaglutide. Mean glucose level on 2nd hospitalization days 3–4 significantly decreased and that on days 6–7 tended to decrease compared with that on 1st hospitalization days 4–5 (median, 8.2 to 6.7?mmol/L, P?=?0.006 and 8.2 to 6.9?mmol/L, P?=?0.053, respectively). %CV of glucose levels decreased significantly after dulaglutide administration (28.1 to 19.8, P?=?0.003 and 28.1 to 21.0, P?=?0.019). However, the incidence of hypoglycemia remained unchanged.Conclusions
Dulaglutide may improve glycemic control and excursion and allow total daily insulin to be reduced without increasing the risk of hypoglycemia in T2DM patients on hemodialysis. 相似文献11.
Timothy M. Hughes Kaycee M. Sink Jeff D. Williamson Christina E. Hugenschmidt Benjamin C. Wagner Christopher T. Whitlow Jianzhao Xu S. Carrie Smith Lenore J. Launer Joshua I. Barzilay Faramarz Ismail-Beigi R. Nick Bryan Fang-Chi Hsu Donald W. Bowden Joseph A. Maldjian Jasmin Divers Barry I. Freedman 《Journal of diabetes and its complications》2018,32(10):916-921
Background
Relationships between cognitive function and brain structure remain poorly defined in African Americans with type 2 diabetes.Methods
Cognitive testing and cerebral magnetic resonance imaging in African Americans from the Diabetes Heart Study Memory IN Diabetes (n?=?480) and Action to Control Cardiovascular Risk in Diabetes MIND (n?=?104) studies were examined for associations. Cerebral gray matter volume (GMV), white matter volume (WMV) and white matter lesion volume (WMLV) and cognitive performance (Mini-mental State Exam [MMSE and 3MSE], Digit Symbol Coding (DSC), Stroop test, and Rey Auditory Verbal Learning Test) were recorded. Multivariable models adjusted for age, sex, BMI, scanner, intracranial volume, education, diabetes duration, HbA1c, LDL-cholesterol, smoking, hypertension and cardiovascular disease assessed associations between cognitive tests and brain volumes by study and meta-analysis.Results
Mean(SD) participant age was 60.1(7.9) years, diabetes duration 12.1(7.7) years, and HbA1c 8.3(1.7)%. In the fully-adjusted meta-analysis, lower GMV associated with poorer global performance on MMSE/3MSE (?=?7.1?×?10?3, SE 2.4?×?10?3, p?=?3.6?×?10?3), higher WMLV associated with poorer performance on DSC (?=??3?×?10?2, SE 6.4?×?10?3, p?=?5.2?×?10?5) and higher WMV associated with poorer MMSE/3MSE performance (?=??7.1?×?10?3, SE?=?2.4?×?10?3, p?=?3.6?×?10?3).Conclusions
In African Americans with diabetes, smaller GMV and increased WMLV associated with poorer performance on tests of global cognitive and executive function. These data suggest that WML burden and gray matter atrophy associate with cognitive performance independent of diabetes-related factors in this population. 相似文献12.
Sridharan Raghavan Wenhui G. Liu P. Michael Ho Mary E. Plomondon Anna E. Barón Liron Caplan Karen E. Joynt Maddox David Magid David R. Saxon Corrine I. Voils Steven M. Bradley Thomas M. Maddox 《Journal of diabetes and its complications》2018,32(5):480-487
Aims
This study examined whether the association between hemoglobin A1c (HbA1c) and short-term clinical outcomes is moderated by CAD severity.Methods
We studied 17,394 US Veterans with type 2 diabetes who underwent elective cardiac catheterization between 2005 and 2013. CAD severity was categorized as obstructive, non-obstructive, or no CAD. Using multivariable Cox proportional hazards regression, we assessed associations between time-varying HbA1c and two-year all-cause mortality and non-fatal MI, with an interaction term between HbA1c and CAD severity.Results
61%, 22%, and 17% of participants had obstructive, non-obstructive, and no CAD, respectively. CAD severity modified the relationship between HbA1c and each outcome (interaction p-value 0.0005 for mortality and <0.0001 for MI). Low HbA1c (<42?mmol/mol) was associated with increased mortality, relative to HbA1c of 48–52?mmol/mol, in individuals with obstructive CAD (HR 1.52 [1.17, 1.97]) and non-obstructive CAD (HR 2.61 [1.61, 4.23]), but not in those with no CAD (HR 0.91 [0.46, 1.79]). In contrast, higher HbA1c levels (≥53?mmol/mol) were associated with increased MI risk only in individuals with obstructive CAD.Conclusions
The associations between HbA1c and mortality and MI were moderated by CAD severity. Measures of cardiovascular disease severity may inform optimal individualized diabetes management. 相似文献13.
M. Regina Castro Gyorgy Simon Stephen S. Cha Barbara P. Yawn L. Joseph MeltonIII Pedro J. Caraballo 《Journal of general internal medicine》2016,31(5):502-508
BACKGROUND
The association between the use of statins and the risk of diabetes and increased mortality within the same population has been a source of controversy, and may underestimate the value of statins for patients at risk.OBJECTIVE
We aimed to assess whether statin use increases the risk of developing diabetes or affects overall mortality among normoglycemic patients and patients with impaired fasting glucose (IFG).DESIGN AND PARTICIPANTS
Observational cohort study of 13,508 normoglycemic patients (n?=?4460; 33 % taking statins) and 4563 IFG patients (n?=?1865; 41 % taking statin) among residents of Olmsted County, Minnesota, with clinical data in the Mayo Clinic electronic medical record and at least one outpatient fasting glucose test between 1999 and 2004. Demographics, vital signs, tobacco use, laboratory results, medications and comorbidities were obtained by electronic search for the period 1999–2004. Results were analyzed by Cox proportional hazards models, and the risk of incident diabetes and mortality were analyzed by survival curves using the Kaplan–Meier method.MAIN MEASURES
The main endpoints were new clinical diagnosis of diabetes mellitus and total mortality.KEY RESULTS
After a mean of 6 years of follow-up, statin use was found to be associated with an increased risk of incident diabetes in the normoglycemic (HR 1.19; 95 % CI, 1.05 to 1.35; p?=?0.007) and IFG groups (HR 1.24; 95%CI, 1.11 to 1.38; p?=?0.0001). At the same time, overall mortality decreased in both normoglycemic (HR 0.70; 95 % CI, 0.66 to 0.80; p?<?0.0001) and IFG patients (HR 0.77, 95 % CI, 0.64 to 0.91; p?=?0.0029) with statin use.CONCLUSION
In general, recommendations for statin use should not be affected by concerns over an increased risk of developing diabetes, since the benefit of reduced mortality clearly outweighs this small (19–24 %) risk.14.
Amena Keshawarz Andrew R. Piropato Talia L. Brown Lindsey M. Duca Rachel M. Sippl R. Paul Wadwa Janet K. Snell-Bergeon 《Journal of diabetes and its complications》2018,32(11):975-981
Aims
Compare physical activity (PA) levels in adults with and without type 1 diabetes and identify diabetes-specific barriers to PA.Methods
Forty-four individuals with type 1 diabetes and 77 non-diabetic controls in the Coronary Artery Calcification in Type 1 Diabetes study wore an accelerometer for 2?weeks. Moderate-to-vigorous physical activity (MVPA) was compared by diabetes status using multiple linear regression. The Barriers to Physical Activity in Type 1 Diabetes questionnaire measured diabetes-specific barriers to PA, and the Clarke hypoglycemia awareness questionnaire measured hypoglycemia frequency.Results
Individuals with type 1 diabetes engaged in less MVPA, fewer bouts of MVPA, and spent less time in MVPA bouts per week than individuals without diabetes (all p?<?0.05), despite no difference in self-reported PA (p?>?0.05). The most common diabetes-specific barrier to PA was risk of hypoglycemia. Individuals with diabetes reporting barriers spent less time in MVPA bouts per week than those not reporting barriers (p?=?0.047).Conclusions
Individuals with type 1 diabetes engage in less MVPA than those without diabetes despite similar self-reported levels, with the main barrier being perceived risk of hypoglycemia. Adults with type 1 diabetes require guidance to meet current PA guidelines and reduce cardiovascular risk. 相似文献15.
Eloísa Urrechaga 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(6):1051-1055
Aims
Hemoglobin A1c (HbA1c) is gold-standard for the assessment of glycemic control in diabetic patients. Previous studies have reported that iron deficiency may elevate A1c concentrations, independent of glycemia. This study aimed to analyze the effect of iron status on HbA1c levels in diabetic patients.Methods
661 patients 336 females (228 menopausal and 108 premenopausal) and 325 males (237 age> 50 years and 88 age < 50 years) were recruited.HbA1c, ferritin, fasting plasma glucose, hemogram and medical history were recorded.Analysis of variance ANOVA and Pearson’s regression were applied.Results
patients were divided according gender, age, glycemia and iron status (normal, latent iron deficiency LID, iron deficiency anemia IDA).All groups presented increasing HbA1c values in parallel with iron deficiency, subclinical and anemia, but the level of significance was not homogeneous in the different groups.Controlled premenopausal women HbA1c in normal iron status and IDA groups P?=?0.0048, between normal and LID, P?=?0.033.Not controlled premenopausal women Normal group and IDAP?<?0.001, normal iron status and LID P?=?0.019.Controlled menopausal women normal group and IDAP?<?0.0001, LID and IDA P?=?0.01.Not controlled menopausal women normal group and IDA P?=?0.04.Controlled men over 50 years normal and IDA groups P?=?0.002, LID and IDA P?=?0.02.Controlled young men normal group and LID P?=?0.03.Conclusion
This study found a positive correlation between iron deficiency and increased HA1c levels. In diabetic patients with IDA should be interpreted with caution, due to the possibility of spurious increment in HbA1c. 相似文献16.
Georgios I. Tsiaoussis Eleni C. Papaioannou Eleni P. Kourea Stelios F. Assimakopoulos Georgios I. Theocharis Michalis Petropoulos Vasileios I. Theopistos Georgia G. Diamantopoulou Zoi Lygerou Iris Spiliopoulou Konstantinos C. Thomopoulos 《Digestive diseases and sciences》2018,63(10):2582-2592
Aim
The present study investigates the role of innate and adaptive immune system of intestinal mucosal barrier function in cirrhosis.Methods
Forty patients with decompensated (n?=?40, group A), 27 with compensated cirrhosis (n?=?27, group B), and 27 controls (n?=?27, group C) were subjected to duodenal biopsy. Expression of α-defensins 5 and 6 at the intestinal crypts was evaluated by immunohistochemistry and immunofluorescence. Serum endotoxin, intestinal T-intraepithelial, and lamina propria B-lymphocytes were quantified.Results
Cirrhotic patients presented higher endotoxin concentrations (p?<?0.0001) and diminished HD5 and HD6 expression compared to healthy controls (p?=?0.000287, p?=?0.000314, respectively). The diminished HD5 and HD6 expressions were also apparent among the decompensated patients compared to compensated group (p?=?0.025, p?=?0.041, respectively). HD5 and HD6 expressions were correlated with endotoxin levels (r?=?-0.790, p?<?0.0001, r?=???0.777, p?<?0.0001, respectively). Although intraepithelial T-lymphocytes were decreased in group A compared to group C (p?=?0.002), no notable alterations between groups B and C were observed. The B-lymphocytic infiltrate did not differ among the investigated groups.Conclusions
These data demonstrate that decreased expression of antimicrobial peptides may be considered as a potential pathophysiological mechanism of intestinal barrier dysfunction in liver cirrhosis, while remodeling of gut-associated lymphoid tissue as an acquired immune response to bio-pathogens remains an open field to illuminate.17.
Jose Kuzhively Bettina Tahsin Peter Hart Leon Fogelfeld 《Journal of diabetes and its complications》2018,32(5):474-479
Aim
Evaluate legacy effect on renal outcomes after the end of a multifactorial-multidisciplinary intervention in patients with advanced diabetic nephropathy (ADN trial) CKD 3–4.Methods
A retrospective electronic review was conducted of 72 patients who completed the ADN trial ESRD-free with subsequent follow-up of two years or until ESRD development.Results
At baseline, reflecting ADN trial end, 38 post-intervention and 34 post-control patients were similar except for lower HbA1c, SBP and age in the post-intervention group. In post-trial follow-up, ESRD developed in both groups at similar rates (23 vs 20%). ESRD occurred mainly in baseline CKD 4 (75%). In CKD 3, only those in post-control developed ESRD (28.6%, p?=?0.067). A significant decline in eGFR occurred within both groups. In multivariate analyses, ESRD was associated with baseline yearly eGFR decline. Greater yearly eGFR decline was associated with higher albumin/creatinine ratio at follow-up, lower age, and baseline SBP not being at target (p?=?0.005, with an R2 of 0.197).Conclusions
There was no significant post-intervention effect on ESRD progression in the two groups. Minimal legacy effect was observed in less advanced nephropathy (CKD 3). These renal and risk outcomes emphasize the importance and potential benefits of continuous and long-term multifactorial care. 相似文献18.
Pedro Brito Jorge Costa Nuno Gomes Sandra Costa Jorge Correia-Pinto Rufino Silva 《Journal of diabetes and its complications》2018,32(7):643-649
Purpose
To study the relationship between systemic pro-inflammatory factors and macular structural response to intravitreal bevacizumab for diabetic macular edema (DME).Methods
Prospective study including 30 cases with DME, treated with bevacizumab and a minimum follow-up of 6?months. All cases underwent baseline laboratory testing for cardiovascular risk (high sensitivity C-reactive protein (hsCRP), homocystein), dyslipidemia, renal dysfunction and glucose control. Serum levels of VEGF, soluble ICAM-1, MCP-1 and TNF-α were assessed by enzyme-linked immunosorbent assay kits. Significant associations between systemic factors and quantitative and qualitative spectral-domain optical coherence macular features were analyzed.Results
A mean of 4.82?±?0.56 intravitreal injections was performed, resulting in significant improvement of central foveal thickness (CFT) (p?<?0.001). A significant association with third month CFT decrease <10% was found for hsCRP (3.33?±?2.01 vs 1.39?±?1.15?mg/l, p?=?0.007) and ICAM1 (975.54?±?265.49 vs 727.07?±?336.09?pg/ml, p?=?0.012). ROC curve analysis indicated hsCRP and ICAM1 as significant biomarkers for 3rd month reduced anatomic response (area under the curve (AUC)?=?0.807, p?=?0.009 for hsCRP; AUC?=?0.788, p?=?0.014 for ICAM1). ROC curve analysis revealed hsCRP as a significant biomarker for 6th month CFT decrease <10% (AUC?=?0.903, p?<?0.001, cutoff value?=?1.81?mg/l). A significant association with 6th month CFT decrease ≥25% was found for serum MCP1 (244.69?±?49.34?pg/ml vs 319.24?±?94.88?pg/ml, p?=?0.017) and serum VEGF (90.84?±?37.33 vs 58.28?±?25.19 pg/ml, p?=?0.027). The combined model of serum VEGF and LDL-cholesterol was found to be predictive of 6th month hard exudate severity (p?=?0.001, r2?=?0.463).Conclusions
Increased levels of hsCRP and ICAM1 were found to be significant biomarkers for early reduced anatomic response to anti-VEGF treatment. Cases with higher serum levels of such factors had increased CFT values, despite treatment, suggesting inner blood-retinal barrier breakdown that is not adequately responsive to anti-VEGF monotherapy. 相似文献19.
Yi Yang Zhaopin Wang Minjia Mo Xiamusiye Muyiduli Shuojia Wang Minchao Li Shuying Jiang Yimin Wu Bule Shao Yu Shen Yunxian Yu 《Journal of diabetes and its complications》2018,32(7):635-642
Aims
Gestational diabetes mellitus (GDM) and different time-point glucose levels might have different effects on fetal birth weight. The aim of this study was to further evaluate the associations of GDM and different time-point blood glucose levels with fetal birth weight in a prospective cohort study.Methods
This prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from August 2011 to May 2015. 1232 pairs of singleton, full-term newborns and their mothers without other pregnant and perinatal complications were selected as participants.Results
Of the 1232 women, 234 had GDM. GDM was positively associated with birth weight (β?=?99.5?g, P?=?0.0002), gestational age-specific Z-score of birth weight (β?=?0.23, P?=?0.0003), and an increased risk of large for gestational age (LGA; OR?=?1.79, 95%CI: 1.11–2.89) and macrosomia (OR?=?2.13, 95%CI: 1.34–3.40). Compared with abnormal fasting plasma glucose (FPG) during the second trimester, abnormal postload glucose in oral glucose tolerance test had significantly higher birth weight and gestational age-specific Z-score of birth weight, and an increased risk of macrosomia. Abnormal FPG and abnormal postload glucose had significantly joint effect on birth weight (β?=?161.4?g, P?=?0.0192), gestational age-specific Z-score of birth weight (β?=?0.42, P?=?0.0121) and risk of macrosomia (OR?=?3.24, 95%CI: 1.21–8.67) and LGA (OR?=?5.73, 95%CI: 2.20–14.90). Compared with abnormal blood glucose during the first trimester, GDM had significantly higher birth weight and gestational age-specific Z-score of birth weight. Abnormal blood glucose during the first trimester and GDM had significantly joint effect on birth weight (β?=?125.8?g, P?=?0.0010), gestational age-specific Z-score of birth weight (β?=?0.30, P?=?0.0013) and risk of macrosomia (OR?=?2.34, 95%CI: 1.28–4.30) and LGA (OR?=?2.53, 95%CI: 1.37–4.67). However, we did not find blood glucose during the first trimester independently associated with birth weight.Conclusions
GDM was significantly associated with higher birth weight and an increased risk of LGA and macrosomia. Fetal growth was mostly influenced by postload glucose levels, rather than FBG. Moreover, different time-point blood glucose levels had significantly joint effects on birth weight and risk of LGA and macrosomia. 相似文献20.
Signe T. Andersen Kasper Grosen Hatice Tankisi Morten Charles Niels T. Andersen Henning Andersen Ioannis N. Petropoulos Rayaz A. Malik Troels S. Jensen Pall Karlsson 《Journal of diabetes and its complications》2018,32(12):1153-1159