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1.
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2.
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3.
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4.
Pramod Meduru Drew Helmer Mangala Rajan Chin-Lin Tseng Leonard Pogach Usha Sambamoorthi 《Journal of general internal medicine》2007,22(3):408-418
OBJECTIVE
To evaluate the association between chronic illness with complexity (CIC) and optimal glycemic control.PARTICIPANTS
Cross-sectional and longitudinal analyses of Diabetes Epidemiologic Cohort database of Veterans Health Administration (VHA) users with diabetes, less than 75 years old, with HbA1c tests in fiscal year (FY) 1999 and 2000, alive at FY2000 end (N?=?95,423).DESIGN/MEASUREMENTS
Outcomes were HbA1c?<?7% in each FY. CIC included three domains: nondiabetes physical illness, diabetes-related, and mental illness/substance abuse conditions. Other independent variables included age, gender, race, marital status, VHA priority status, and diabetes severity. Longitudinal analyses were restricted to patients with HbA1c ≥ 7% in FY1999 and included hospitalizations between final HbA1c’s in FY1999 and FY2000. Multiple logistic regressions examined associations between CIC categories and HbA1c.RESULTS
In FY1999, 33% had HbA1c <7%. In multivariate analyses, patients with nondiabetes physical illness and mental illness/substance abuse were more likely to have HbA1c <7% in FY1999 [adjusted odds ratios for cancer (AOR), 1.31; 95% CI (1.25–1.37); mental illness only, 1.18; 95% CI (1.14–1.22)]. Those with diabetes-related complications were less likely to have HbA1c <7% in FY1999. Associations generally held in FY2000. However, conditions in the mental illness/substance abuse complexity domain were less strongly associated with HbA1c <7%. Macrovascular-related hospitalizations were positively associated with HbA1c <7% [AOR, 1.41; 95% CI (1.34–1.49)].CONCLUSIONS
The association between CIC and HbA1c <7% is heterogeneous and depends on the domain of complexity. The varying associations of CIC categories with optimal glycemic control suggest the need for appropriate risk adjustment when using HbA1c <7% as a valid performance measure for diabetes quality of care.5.
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6.
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7.
Xiang Fang Brenda Dorcely Xi-ping Ding Shi Yin Ni-Huiping Son Shi-Lian Hu Ira J. Goldberg 《Journal of diabetes and its complications》2018,32(11):1027-1034
Objective
Systemic inflammation contributes to cardiovascular disease in patients with type 2 diabetes, and elevated white blood cell (WBC) counts are an established risk factor. Our goal is to describe changes in WBCs and inflammatory markers after glycemic reductions in diabetes.Research design and methods
This study enrolled 63 subjects with poorly controlled diabetes, defined as hemoglobin A1c (HbA1c) ≥8% [64?mmol/mol]. Circulating granulocytes and mononuclear cells were separated by histopaque double-density protocol. Inflammatory markers from these isolated WBCs were assessed at baseline and after 3?months of medical management.Results
After 3?months, significant glycemic reduction, defined as a decrease in HbA1c?≥?1.5%, occurred in 42 subjects. Fasting plasma glucose decreased by 47% (165.6?mg/dL), and HbA1c decreased from 10.2?±?1.8 to 6.8?±?0.9. Glycemic reductions were associated with a 9.4% decrease in total WBC counts, 10.96% decrease in neutrophils, and 21.74% decrease in monocytes. The mRNA levels of inflammatory markers from granulocytes and mononuclear cells decreased, including receptor for advanced glycation endproducts; S100 calcium binding proteins A8, A9, A12; krüppel-like factor 5; and IL-1. Also, circulating levels of IL-1β and C-reactive protein decreased. Insulin dose was a mediator between HbA1c and both total WBC and neutrophil counts, but not changes in WBC inflammatory markers. In contrast, the 17 subjects without significant glycemic reductions showed no significant differences in their WBC counts and proteins of inflammatory genes.Conclusion
Significant glycemic reduction in subjects with poorly controlled diabetes led to reduced circulating WBC counts and inflammatory gene expression. 相似文献8.
Agnieszka Szypowska Lidia Groele Marta Wysocka-Mincewicz Artur Mazur Lucyna Lisowicz Iwona Ben-Skowronek Joanna Sieniawska Bożenna Klonowska Dorota Charemska Jolanta Nawrotek Irena Jałowiec Artur Bossowski Klaudyna Noiszewska Beata Pyrżak Izabela Rogozińska Mieczysław Szalecki 《Journal of diabetes and its complications》2018,32(6):570-574
Aims
The level of C-peptide can identify individuals most likely to respond to immune interventions carried out to prevent pancreatic β-cell damage.The aim of the study was to evaluate factors associated with C-peptide levels at type 1 diabetes (T1D) diagnosis.Methods
This study included 1098 children aged 2-17 with newly recognized T1D. Data were collected from seven Polish hospitals. The following variables were analyzed: date of birth, fasting C-peptide, HbA1c, sex, weight, height, pH at diabetes onset.Results
A correlation was observed between fasting C-peptide level and BMI-SDS (p?=?0.0001), age (p?=?0.0001), and HbA1c (p?=?0.0001). The logistic regression model revealed that fasting C-peptide ≥0.7 ng/ml at diabetes diagnosis was dependent on weight, HbA1c, pH and sex (p?<?0.0001).Overweight and obese children (n?=?124) had higher fasting C-peptide (p?=?0.0001) and lower HbA1c (p?=?0.0008) levels than other subjects. Girls had higher fasting C-peptide (p?=?0.036) and higher HbA1c (p?=?0.026) levels than boys.Conclusion
Obese and overweight children are diagnosed with diabetes at an early stage with largely preserved C-peptide levels. Increased awareness of T1D symptoms as well as improved screening and diagnostic tools are important to preserve C-peptide levels. There are noticeable gender differences in the course of diabetes already at T1D diagnosis. 相似文献9.
Lasse Bjerg Adam Hulman Morten Charles Marit Eika Jørgensen Daniel Rinse Witte 《Journal of diabetes and its complications》2018,32(4):393-399
Aims
To describe to what extent microvascular complications exhibit clustering in persons with Type 1 diabetes, and to assess whether the presence of one complication modified the strength of the association between the other two.Methods
We conducted a cross-sectional analysis of the electronic medical records of 2276 persons with Type 1 diabetes treated in a specialized care hospital in Denmark in 2013. We used log-linear analysis to describe associations between diabetic kidney disease, neuropathy and retinopathy and logistic regression models to quantify the magnitude of associations adjusting for potential confounders.Results
The median duration of diabetes was 24?years and median HbA1c was 63?mmol/mol (7.9%). We found strong indication of clustering and found no evidence that presence of one complication modified the association between the other two. In models adjusted for diabetes duration and HbA1c, persons with neuropathy had an OR of 2.15 (95% CI: 1.73–2.66) for concurrent diabetic kidney disease. Those with retinopathy had an OR of 2.49 (1.92–3.24) for diabetic kidney disease and of 2.66 (1.94–3.64) for neuropathy.Conclusions
Microvascular complications in persons with Type 1 diabetes exhibit strong clustering. However, the association between any pair of complications is not modified by the presence of the third. 相似文献10.
Hadii M. Mamudu Pooja Subedi Timir Paul Ali E. Alamin Arsham Alamian Liang Wang David Stewart Antwan Jones Sam Harirforoosh Gerald Blackwell Matthew Budoff 《Journal of diabetes and its complications》2018,32(10):900-905
Aim
To examine the risk factor of coronary artery calcium (CAC) in individuals with diabetes and those without diabetes in Central Appalachia.Methods
Study population included 2479 asymptomatic participants who underwent CAC screening between August 2012 and November 2016. CAC score was classified into four categories [0 (no plaque), 1–99 (mild plaque), 100–399 (moderate plaque), and ≥400 (severe plaque)]. Multinomial logistic regression analyses were conducted to test the association between CAC and cardiovascular disease (CVD) risk factors among participants with diabetes, age and gender matched controls, and randomly selected controls.Results
13.6% of total participants had diabetes. Around 69%, 59.8%, and 57.7% of the participants with diabetes, matched controls, and randomly selected controls had CAC score ≥1, respectively. Participants with diabetes had higher prevalence of all CVD risk factors than controls. Among participants with diabetes, hypertension and physical inactivity increased the odds of CAC?=?100–399, while among those without diabetes, hypertension and hypercholesteremia increased the odds of having CAC?=?1–99 and CAC?≥?400.Conclusion
Half of study participants had subclinical atherosclerosis (i.e., CAC), and individuals with diabetes had higher CAC scores. This study suggests that individuals with diabetes in Central Appalachia might benefit from screening for CAC. 相似文献11.
Rasmus Bo Jansen Bo Jørgensen Per E. Holstein Klaus Kirketerp Møller Ole Lander Svendsen 《Journal of diabetes and its complications》2018,32(12):1141-1147
Aims
Charcot foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot foot on a case-by-case basis, in order to assess the consequences of an acute Charcot foot and its complications.Methods
The study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry.Results
In total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7?±?21.4?mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5?±?20.3?mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3?months). The 5-year mortality was 14% with a mean survival time of 12.7?years. There was an association between lack of compliance and occurrence of foot complications, as well as between having a Charcot foot and leaving the workforce.Conclusion
More patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot foot. 相似文献12.
Søren L. Kristensen Pardeep S. Jhund Matthew M. Y. Lee Lars Køber Scott D. Solomon Christopher B. Granger Salim Yusuf Marc A. Pfeffer Karl Swedberg John J. V. McMurray CHARM Investigators Committees 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2017,31(5-6):545-549
Purpose
The prevalence and consequences of prediabetic dysglycemia and undiagnosed diabetes is unknown in patients with heart failure (HF) and preserved ejection fraction (HFpEF) and has not been compared to heart failure and reduced ejection fraction (HFrEF).Methods
We examined the prevalence and outcomes associated with normoglycemia, prediabetic dysglycemia and diabetes (diagnosed and undiagnosed) among individuals with a baseline glycated hemoglobin (hemoglobin A1c, HbA1c) measurement stratified by HFrEF or HFpEF in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity programme (CHARM). We studied the primary outcome of HF hospitalization or cardiovascular (CV) death, and all-cause death, and estimated hazard ratios (HR) by use of multivariable Cox regression models.Results
HbA1c was measured at baseline in CHARM patients enrolled in the USA and Canada and was available in 1072/3023 (35%) of patients with HFpEF and 1578/4576 (34%) patients with HFrEF. 18 and 16% had normoglycemia (HbA1c < 6.0), 20 and 22% had prediabetes (HbA1c 6.0–6.4), respectively. Finally among patients with HFpEF 22% had undiagnosed diabetes (HbA1c > 6.4), and 40% had known diabetes (any HbA1c), with corresponding prevalence among HFrEF patients being 26 and 35%. The rates of both clinical outcomes of interest were higher in patients with undiagnosed diabetes and prediabetes, compared to normoglycemic patients, irrespective of HF subtype, and in general higher among HFrEF patients. For the primary composite outcome among HFpEF patients, the HRs were 1.02 (95% CI 0.63–1.65) for prediabetes, HR 1.18 (0.75–1.86) for undiagnosed diabetes and 2.75 (1.83–4.11) for known diabetes, respectively, p value for trend across groups < 0.001. Dysglycemia was also associated with worse outcomes in HFrEF.Conclusions
These findings confirm the remarkably high prevalence of dysglycemia in heart failure irrespective of ejection fraction phenotype, and demonstrate that dysglycemia is associated with a higher risk of adverse clinical outcomes, even before the diagnosis of diabetes and institution of glucose lowering therapy in patients with HFpEF as well as HFrEF.13.
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14.
The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes
Anna R. Kahkoska Scott Isom Jasmin Divers Elizabeth J. Mayer-Davis Lawrence Dolan Amy S. Shah Maryam Afkarian David J. Pettitt Jean M. Lawrence Santica Marcovina Sharon H. Saydah Dana Dabelea David M. Maahs Amy K. Mottl 《Journal of diabetes and its complications》2018,32(12):1160-1168
Aims
To determine among adolescents and young adults with youth-onset type 1 diabetes and type 2 diabetes the rates and risk factors for albuminuria regression and progression.Methods
Data from SEARCH, a longitudinal observational study of youth-onset type 1 diabetes (N?=?1316) and type 2 diabetes (N?=?143) were analyzed. Urine albumin:creatinine ratio (UACR) was measured from random urine specimens at baseline and follow-up visits (mean 7?years later). Albuminuria regression was defined as halving of baseline UACR when baseline UACR was ≥30?μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30?μg/mg, respectively. Multivariable regression assessed risk factors associated with low-risk albuminuria category (combined persistently-low albuminuria and regression) versus moderate-risk albuminuria category (combined persistently-high albuminuria and progression).Results
Albuminuria progression was more common in type 2 diabetes versus type 1 diabetes (15.4% versus 6.0%, p<0.001). Moderate-risk albuminuria was associated with increasing HbA1c (adjusted OR (aOR)?=?1.3, 95% CI 1.1–1.6) and lack of private health insurance (aOR?=?2.7, 95%CI 1.1–6.5) in type 1 diabetes; and African American race (OR?=?4.6, 95% CI 1.2–14.2), lower estimated insulin sensitivity score (aOR?=?2.1, 95% CI 1.4–3.3), baseline UACR (aOR?=?3.2, 95% CI 1.7–5.8), and follow-up estimated glomerular filtration rate (eGFR) (10-unit increase aOR?=?1.3, 95% CI 1.0, 1.5) in type 2 diabetes.Conclusions
In the first decade of diabetes duration, kidney complications in type 2 diabetes are significantly more aggressive than in type 1 diabetes and may be associated with less modifiable risk factors including race, insulin sensitivity, and eGFR. Early interventions may help reduce long-term kidney complications. 相似文献15.
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
Aims
In this cross-sectional study, we explored the utility of corneal confocal microscopy (CCM) measures for detecting diabetic polyneuropathy (DPN) and their association with clinical variables, in a cohort with type 2 diabetes.Methods
CCM, nerve conduction studies, and assessment of symptoms and clinical deficits of DPN were undertaken in 144 participants with type 2 diabetes and 25 controls. DPN was defined according to the Toronto criteria for confirmed DPN.Results
Corneal nerve fiber density (CNFD) was lower both in participants with confirmed DPN (n?=?27) and in participants without confirmed DPN (n?=?117) compared with controls (P?=?0.04 and P?=?0.01, respectively). No differences were observed for CNFD (P?=?0.98) between participants with and without DPN. There were no differences in CNFL and CNBD between groups (P?=?0.06 and P?=?0.29, respectively). CNFD was associated with age, height, total- and LDL cholesterol.Conclusions
CCM could not distinguish patients with and without neuropathy, but CNFD was lower in patients with type 2 diabetes compared to controls. Age may influence the level of CCM measures. 相似文献16.
Anita D. Misra-Hebert Bo Hu Glen Taksler Robert Zimmerman Michael B. Rothberg 《Journal of general internal medicine》2016,31(8):871-877
Background
Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse.Objective
To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals.Design
Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008–December 2012.Participants
Employee patients with diabetes covered by the organization’s self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance.Intervention
Financial incentives for employer-sponsored disease management program participation and achieving goals.Main Measures
Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight.Results
A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p?<?0.001). Longitudinal mixed modeling demonstrated improved diabetes and cardiovascular risk factor control in employees vs. non-employees [HbA1c yearly change ?0.05 employees vs. 0.00 non-employees, difference in change (DIC) p <0.001]. In their first participation year, employees had larger declines in HbA1c and weight vs. non-employees (0.33 vs. 0.14, DIC p?=?0.04) and (2.3 kg vs. 0.1 kg, DIC p?<?0.001), respectively. Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p?>?0.05).Conclusions
Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.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.
Xianfeng Zhou Xiaonan Ruan Lipeng Hao Yi Zhou Jianjun Gu Hua Qiu Kang Wu Siyu Yu Xinyi Rui Xiaonan Wang Xiaolin Liu Juzhong Ke Genming Zhao Qiao Sun 《Primary Care Diabetes》2018,12(3):238-244
Aims
Due to the diversity of the Chinese population, it requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycemia.Methods
We included 7909 subjects aged ≥15 without known diabetes from the baseline of Pudong community cohort in 2013. Participants took oral glucose tolerance test (OGTT) and HbA1c assay. Receiver operating characteristic curve determined the HbA1c threshold in the diagnosis of hyperglycemia.Results
The optimal HbA1C threshold for diagnosing newly diagnosed diabetes (NDD) and pre-diabetes in this population was 6.0% (AUC = 0.798, 95%CI: 0.779–0.818) and 5.6% (AUC = 0.655, 95%CI: 0.638–0.671). When compared with elderly age group (≥70 years), HbA1c for detecting NDD performed better in youth (15–39 years: P = 0.003, 40–49 years: P < 0.001). There were 13.81% and 13.34% of participants would be newly detected as NDD and pre-diabetes via HbA1c criteria; meanwhile 3.20% and 15.52% diagnosed as NDD and pre-diabetes by OGTT criteria would be missed diagnosis.Conclusions
The optimal HbA1c thresholds for NDD and pre-diabetes were lower than ADA criteria. It is necessary to carefully consider whether choose HbA1c as a diagnostic criterion or combine two diagnostic standards. Age-specific diagnostic thresholds should be considered when HbA1c was recommended as diagnostic standard. 相似文献19.
Mona Hussein El-Samahy AA Adly Yasmine Ibrahim Elhenawy EA Ismail Shaimaa Abdelmalik Pessar Mohamed El-Sayed Mowafy Mohammed Salah Saad Hossam Hassan Mohammed 《Journal of diabetes and its complications》2018,32(2):185-192
Background
Urinary microRNAs (miRNAs) play a role in the pathogenesis of chronic kidney disease (CKD).Aim
To identify the expression of urinary miR-377 and miR-216a in 50 children and adolescents with type 1 diabetes (T1DM) compared with 50 healthy controls and assess their relation to the degree of albuminuria, glycemic control and carotid intimal thickness (CIMT) as an index of atherosclerosis.Methods
Diabetic subjects were divided into normoalbuminuric and microalbuminuric groups according to urinary albumin creatinine ration (UACR). Urinary miRNAs were assessed using real time polymerase chain reaction. CIMT was measured using high resolution carotid ultrasound.Results
The expression of urinary miR-377 was significantly higher in patients with microalbumiuria (median, 3.8) compared with 2.65 and 0.98 in normoalbuminic patients and healthy controls, respectively (p < 0.05). Urinary miR-216a was significantly lower in all patients with type 1 diabetes and the lowest levels were among the microalbumiuric group. Significant positive correlations were found between urinary miR-377 and HbA1C, UACR and CIMT while urinary miR-216a was negatively correlated to these variables.Conclusions
Urinary miR-377 and miR-216a can be considered early biomarkers of nephropathy in pediatric type 1 diabetes. Their correlation with CIMT provides insights on the subclinical atherosclerotic process that occurs in diabetic nephropathy. 相似文献20.
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