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1.
Aim
The role of glycaemic control in the mortality of elderly diabetic patients remains uncertain. GERODIAB is the first multi-centre, prospective, observational study that aims to describe the link between HbA1c and 5-year mortality in French, type 2 diabetic patients aged ≥ 70 years.Methods
Consecutive patients (n = 987; mean age 77 years) were included from 56 diabetes centres and followed for five years. Individual histories, risk factors, standard diabetes parameters and geriatric evaluations were regularly recorded. Survival was studied using the Kaplan–Meier method. Multivariable analyses used Cox regression.Results
Twenty-one percent of the patients died, 13% were lost during follow-up. Patients with a 5-year mean HbA1c in the range [40–50) mmol/mol ([5.8–6.7) %) had the highest survival (84%); those in the range [50–70) mmol/mol ([6.7–8.6) %) or < 40 mmol/mol (< 5.8%) an intermediary survival rate (79%); patients with HbA1c ≥ 70 mmol/mol (≥ 8.6%) the worst survival (71%). Patients with mean HbA1c ≥ 70 mmol/mol (≥ 8.6%) had a significantly higher mortality than those with lower HbA1c (P = 0.011), and HbA1c remained a significant predictor of mortality after adjusting for individual, diabetic and geriatric factors (hazards ratio [95%CI]: 1.76 [1.21 to 2.57], P = 0.0033). Survival was also significantly associated with both HbA1c variability and with the frequency of HbA1c determinations.Conclusion
In this large sample of elderly French type 2 diabetic patients, an HbA1c level < 70 mmol/mol (< 8.6%) was associated with lower mortality. The range [40–50) mmol/mol ([5.8–6.7) %) could be an acceptable target provided patients are not exposed to hypoglycaemia. 相似文献2.
Attila Nagy Nóra Kovács Anita Pálinkás Valéria Sipos Ferenc Vincze Gergő Szőllősi Orsolya Csenteri Róza Ádány János Sándor 《Primary Care Diabetes》2018,12(3):199-211
Aims
The study aimed to launch a T2DM adult cohort that is representative of Hungary through a cross-sectional study, to produce the most important quality indicators for T2DM care, to describe social inequalities, and to estimate the absolute number of T2DM adult patients with uncontrolled HbA1c levels in Hungary.Methods
A representative sample of the Hungarian T2DM adults (N = 1280) was selected in 2016. GPs collected data on socio-demographic status by questionnaire, and on history and laboratory parameters from medical records. The process and outcome indicators used in the international monitoring practice were calculated. The socio-economic status influence was determined by multivariate logistic regression models.Results
Target achievement was 61.66%, 53.48%, and 54.00% for HbA1c, LDL-C, and blood pressure, respectively, in the studied sample (N = 1176). In Hungary, 294,534 patients have above target HbA1c value out of 495,801 T2DM adults. The education-dependent positive association with majority of process indicators was not reflected in HbA1c, LDL-C, and blood pressure target achievements. The risk of microvascular complications and requirement of insulin treatment were higher among less educated.Conclusions
According to our observations, the education-independent target achievement for HbA1c and LDL-C is similar as, for blood pressure is less effective in Hungary than in Europe. 相似文献3.
Ramya Kateel Alfred J. Augustine Shivananda Prabhu Sheetal Ullal Manohar Pai Prabha Adhikari 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(1):27-30
Aim
To evaluate the clinical and microbiological profile of diabetic foot ulcer patients admitted to a tertiary care hospital.Methodology
This study recruited 120 diabetic foot ulcer patients of all grade. Their medical records were evaluated retrospectively.Results
We found that median age of patient was 60(52, 67.75) years. 68.3% of patients were males. Median duration of diabetes mellitus was 15(10, 20) years. Mean HbA1C and fasting glucose was 10.3 ± 2.3 and 167.6 ± 52.42 respectively. Neuropathy (35%) and peripheral vascular disease (23.3%) was major micro vascular and macro vascular complication associated. Different locations of ulcers were toe (23.3%), sole (20%), dorsum (18.3%), shin (16.6%), heel (13.3%), and ankle (8.3%). Bacterial infection was seen in 81.66% patients out of which 23.3% had poly microbial infection.Conclusion
Diabetic foot ulcer patient had poor blood glucose control with elevated HbA1C and fasting blood glucose level. Neuropathy and peripheral vascular disease, hypertension were major complications. Staphylococcus aureus, Pseudomonas aeruginosa were common infecting bacteria. 相似文献4.
T.G. Kebede C. Pink W. Rathmann B. Kowall H. Völzke A. Petersmann P. Meisel T. Dietrich T. Kocher B. Holtfreter 《Diabetes & metabolism》2018,44(3):243-249
Aim
As periodontitis may contribute to the pathogenesis of diabetes, the effects of periodontitis on diabetes incidence and HbA1c change was quantified in a prospective cohort.Methods
Data from an 11-year follow-up of the Study of Health in Pomerania were analyzed to evaluate the effects of periodontitis on incident diabetes and long-term HbA1c changes in 2047 subjects aged 20–81 years. Diabetes was based on self-reported physician diagnoses, antidiabetic medication use, or HbA1c ≥ 6.5% or non-fasting blood glucose levels ≥ 11.1 mmol/L. To assess periodontal status, periodontal pockets were probed, and their depth and clinical attachment levels measured. For both measures, means and percentages of sites ≥ 3 mm were calculated. In addition, all probing depths ≥ 4 mm were summed (cumulative probing depth). Modified Poisson and multivariable linear models were applied, adjusted for age, gender, highest level of general education, marital status, waist circumference, physical activity, smoking status and follow-up time.Results
Over a mean follow-up period of 11.1 years, 207 subjects developed diabetes. Baseline mean clinical attachment levels (CAL) and probing depths (PPD) were not significantly associated with either diabetes incidence [mean CALs, fourth quartile, incidence rate ratio = 0.819, 95% confidence interval (CI): 0.489–1.370; P = 0.446] or long-term changes in HbA1c (mean CAL, fourth quartile, β = ?0.086, 95% CI: ?0.187, ?0.016; P = 0.098). Sensitivity analyses using alternative exposure definitions confirmed these results.Conclusion
Contrary to the currently available literature, no convincing evidence was found of any potential association between periodontitis and diabetes incidence or HbA1c change. 相似文献5.
Osama B. Albasheer Mohammed S. Mahfouz Yahia Solan Duaa A. Khan Mohammed A. Muqri Haneen A. Almutairi Ali M. Alelyani Hussain A. Alahmed 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(2):117-121
Purpose
To determine the prevalence of depression and related risk factors among type 2 diabetes mellitus patients (T2DM) in Jazan area, Saudi Arabia.Method
A cross sectional, self-administered questionnaire study was conducted among T2DM patients in Jazan area, Saudi Arabia. A total of 385 patients were selected at randomly. The Patient Health Questionnaire (PHQ-9) was utilized to measure symptoms and signs of depression.Results
The overall prevalence of depression among T2DM patients was 37.6%. Of them, 24.2% were mildly depressed, 9.6% were moderately severely depressed, and 4.2% were severely depression. Significant predictors of depression include the presence of diabetic foot (P = 0.000), cardio-vascular diseases (P = 0.000), eye complication (P = 0.073), and erectile dysfunction (P = 0.090). The prevalence of depression was not significantly associated with the age (P = 0.375) and gender (P = 0.374). Similarly no association was found with duration of diabetes (P = 0.475) and HbA1c (P = 0.555).Conclusion
The study revealed that diabetes complications are strong predictors of the rate of depression among T2DM patients. Therefore, early depression screening is needed to improve the quality of life of diabetic patients. 相似文献6.
7.
Marilina Santero Daniela Morelli Analía Nejamis Luz Gibbons Vilma Irazola Andrea Beratarrechea 《Primary Care Diabetes》2018,12(6):510-516
Aim
To evaluate the one-year post effect of the implementation of a diabetes program that includes mHealth interventions on the quality of diabetic care in public primary care centers.Method
It is a quasi-experimental study with outcome measurements at baseline, 6 and 12 months. The program includes primary care team training, a diabetes registry with a decision support tool in an app. and text messages for patients.Results
At baseline, 947 patients were included in the registry, 62.3% women with a mean age of 53.6 ± 11.5 years and 92% with type 2 diabetes. Common comorbidities were hypertension (61.3%) and obesity (59%). Only 16.9% had one HbA1c and 48.9% a cholesterol lab in the last year, 61.9% were screened for diabetic peripheral neuropathy, and 29.0% had one eye exam in the previous year. With respect to blood sugar, lipid and blood pressure control: 44.4% of those with HbA1c measurements had levels ≥8%, total cholesterol was over 200 mg/dL in 40.6% and 48.2% had uncontrolled blood pressure values.Conclusion
Patients with diabetes received a low quality of care at public primary care clinics. A diabetes registry allowed us to draw an epidemiological profile of diabetic patients and determine the quality of care provided. 相似文献8.
Sharon H. Saydah Edward W. Gregg Henry S. Kahn Mohammed K. Ali 《Primary Care Diabetes》2018,12(1):3-12
Aims
Determine the mortality experience among adults with diabetes in meeting and not meeting less intense control for glycated hemoglobin (HbA1c), blood pressure (BP), and cholesterol.Methods
National Health and Nutrition Examination Survey 1999–2010 participants with self-report of diagnosed diabetes (N = 3335), measured HbA1c, BP and non-HDL cholesterol were linked to the National Death Index through December 31, 2011. Proportional hazards models were used to estimate hazard ratios (HR) of meeting HbA1c < 9% and BP < 160/110, and non-HDL cholesterol < 190 mg/dL. Models used age as the time scale and adjusted for demographics (sex, race/ethnicity, education), diabetes duration, history of cardiovascular and chronic kidney disease, and treatments for elevated glucose, BP, and cholesterol.Results
Over a mean 5.4 person-years of follow-up, participants meeting all less intense control had a 37% lower mortality (HR = 0.63, 95% CI 0.54, 0.74) relative to those who did not meet the goals. Of approximately 306,000 deaths per year that occur among Americans with diabetes, we estimate 39,400 might have been averted by improving the care of those who have not met these less intense control goals.Conclusions
Meeting the less intense control goals is associated with 37% reduction in mortality and could lead to 39,400 fewer deaths per year. 相似文献9.
Aims
Vitamin D is associated with diabetes mellitus (DM) occurrence by affecting insulin secretion and resistance. However, variations exist due to differences in vitamin D sensitivity among individuals. We investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] status and various indices of DM in a Korean population without DM.Methods
Large-scaled population-based analysis was conducted from the Korea National Health and Nutrition Examination Survey data (2010–2012) were analyzed. Adult survey participants >20 years without diabetes (n = 15,169) were included.Results
The mean 25(OH)D levels were lower in females, subjects aged 20–39 years, and subjects with body mass index <21.1 kg/m2 and less physical activity (p < 0.001). Further, the mean 25(OH)D levels tended to be lower in subjects with FBG >126 mg/dL. After adjustment for potential confounders, 25(OH)D was not correlated with FBG (p = 0.925) or HbA1c (p = 0.336); however, fasting insulin (β = ?0.072, p = 0.011) and homeostasis model assessment of β-cell function (β = ?0.007, p < 0.001) showed significant negative correlations with 25(OH)D levels.Conclusion
Although 25(OH)D status was not significantly associated with FBG or HbA1c, low 25(OH)D levels were associated with compensative insulin increase and ongoing increase in insulin resistance. Thus, vitamin D deficiency is assumed to influence DM occurrence. 相似文献10.
Mohammed R. Halawa Yara M. Eid Rana A. El-Hilaly Mona M. Abdelsalam Amr H. Amer 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(2):99-104
Introduction
Foot disease is a common complication of type 2 diabetes that can have tragic consequences. Abnormal plantar pressures are considered to play a major role in the pathologies of neuropathic ulcers in the diabetic foot.Aim
To examine Relationship of Planter Pressure and Glycemic Control in Type 2 Diabetic Patients with and without Neuropathy.Materials and methods
The study was conducted on 50 type 2 diabetic patients and 30 healthy volunteers. BMI calculation, disease duration, Hemoglobin A1c and presence of neuropathy (by history, foot examination and DN4 questionnaire) were recorded. Plantar pressure was recorded for all patients using the Mat-scan (Tekscan, Inc.vers. 6.34 Boston USA) in static conditions (standing) and dynamic conditions (taking a step on the Mat-scan). Plantar pressures (kPa) were determined at the five metatarsal areas, mid foot area, medial and lateral heel areas and medial three toes.Results
Static and dynamic plantar pressures in both right and left feet were significantly higher in diabetic with neuropathy group than in control group in measured areas (P < 0.05). Static and dynamic pressures in right and left feet were significantly higher in diabetic with neuropathy group than in diabetic without neuropathy group in measured areas (P < 0.05). On comparison between controls and diabetic without neuropathy group there was a significant difference in plantar pressures especially in metatarsal areas (P < 0.05). No significant correlations were present between the studied variables age, disease duration, BMI and HbA1c and plantar pressures in all studied areas.Conclusion
Persons with diabetic neuropathy have elevated peak plantar pressure (PPP) compared to patients without neuropathy and control group. HbA1c% as a surrogate for glycemic control had no direct impact on peak planter pressure, yet it indirectly impacts neuropathy evolution through out disease duration eventually leading to the drastic planter pressure and gait biomechanics changes. 相似文献11.
M. Koubaa F. Smaoui S. Gargouri H. Ben Ayed K. Rekik I. Abid I. Maaloul J. Feki C. Marrakchi M. Ben Jemaa 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2018,39(5):326-331
Objectives
Ocular tuberculosis is a rare form of extra pulmonary tuberculosis. It represents 1–2% of all clinical forms. The aim of this work was to focus on diagnostic and therapeutic characteristics of ocular tuberculosis.Methods
We report a case series of 14 patients with ocular tuberculosis seen in an infectious diseases department between 2006 and 2015. The diagnosis was retained on clinical data and a positive tuberculin skin test or interferon-gamma release assay.Results
The patient's mean age was 40.7 ± 9 years. The most common clinical presentation was uveitis (11 patients and 16 eyes). An extra ocular involvement was associated in three patients. The mean duration of antitubercular therapy was 10 ± 2.5 months. Corticosteroid therapy was associated in 11 cases. The outcome was favorable in all cases. Two patients had maintained visual sequelae.Conclusion
Ocular tuberculosis is a rare disease but still remains a diagnostic problem. It should be considered in case of any chronic ocular symptoms, especially in endemic countries. Early management can improve the visual prognosis. 相似文献12.
Nailya Bulatova Violet Kasabri Amenah Qotineh Taiba AL-Athami Al-Motassem Yousef Salah AbuRuz Munther Momani Aymen Zayed 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(3):257-267
Background
Targeting biomarkers of oxidative-proinflammatory stress may result in improvement of modifiable metabolic syndrome, pre-diabetes and diabetes risk factors and subsequent risk reduction.Methods
64 newly diagnosed antihyperglycemic treatment-naïve prediabetic and type 2 diabetes mellitus (T2DM) patients were randomly assigned using block design to either metformin combined with therapeutic lifestyle changes (TLC) or TLC alone. Body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), fasting lipid profile, plasma oxidative status and tumor necrosis factor (TNF)-α were measured at baseline, after 3 months and after 6 months from baseline.Results
Except for HbA1c, baseline values did not differ significantly between the two groups. The post 3-months relative reductions in BMI (P = 0.014) and HbA1c (P = 0.037) in metformin combined with TLC intervention were significantly greater than those in TLC alone group. TNFα plasma levels were decreased significantly vs. baseline by metformin combined with TLC intervention (?22.90 ± 46.76%, P = 0.01). Conversely, TLC alone basically worsened proinflammatory status (42.40 ± 40.82 %), P < 0.001. Metformin with TLC treatment effected a therapeutic decrement of the oxidative stress (?15.44 ± 35.32%, P = 0.029 vs. baseline) unlike TLC alone (61.49 ± 122.66%, P = 0.01 vs. baseline). Both interventions' effects were sustained in the 6-month follow up periods.Conclusion
In both intervention groups, the relative changes in plasma TNFα were significantly correlated (P < 0.01) with systolic blood pressure and the relative changes in oxidative stress were markedly correlated (P < 0.05) with total cholesterol. 相似文献13.
Andreas Heltberg John Sahl Andersen Håkon Sandholdt Volkert Siersma Jakob Kragstrup Christina Ellervik 《Primary Care Diabetes》2018,12(1):13-22
Aims
To investigate how self-reported risk factors (including socioeconomic status) predict undiagnosed, prevalent type 2 diabetes mellitus (T2DM). To externally validate Leicester Risk Assessment Score (LRAS), Finnish Diabetes Risk Score (FINDRISC) and Danish Diabetes Risk Score (DDRS), and to investigate how these predict a European Heart SCORE ≥ 5% in a Danish population study.Methods
We included 21,205 adults from the Danish General Suburban Population Study. We used relative importance calculations of self-reported variables in prediction of undiagnosed T2DM. We externally validated established prediction models reporting ROC-curves for undiagnosed T2DM, pre-diabetes and SCORE.Results
More than 20% of people with T2DM were undiagnosed. The 7 most important self-rated predictors in sequential order were high BMI, antihypertensive-therapy, age, cardiovascular disease, waist-circumference, fitness compared to peers and family disposition for T2DM. The Area Under the Curve for prediction of undiagnosed T2DM was 77.1 for LRAS; 75.4 for DDRS and 67.9 for FINDRISC. AUCs for SCORE was 75.1 for LRAS; 62.3 for DDRS and 54.3 for FINDRISC.Conclusions
BMI and self-reported cardiovascular disease are important risk factors for undiagnosed T2DM. LRAS performed better than DDRS and FINDRISC in prediction of undiagnosed T2DM and SCORE ≥ 5%. SCORE performed best in predicting pre-diabetes. 相似文献14.
Srujitha Marupuru Padmanav Senapati Swathi Pathadka Sonal Sekhar Miraj Mazhuvancherry Kesavan Unnikrishnan Mohan K. Manu 《The Brazilian journal of infectious diseases》2017,21(3):312-316
Background
World Health Organization estimated that people with diabetes (DM) are at 2–3 times higher risk for tuberculosis (TB). Studies have shown that DM not only increases the risk of active TB, but also puts co-affected persons at increased risk of poor outcomes.Objectives
To determine the protective effect of metformin against TB in DM patients and also, to investigate the relationship between poor glycemic control and TB.Methods
A case–control study was conducted over 8 months, where cases and controls were selected based on the inclusion and exclusion criteria of the study. The diabetics diagnosed with TB were selected as study group (SG = 152) and without TB were as control group (CG = 299). Exposure status of metformin in both groups were analyzed.Results
The mean (SD) age of both CG and SG were 55.54 ± 11.82 and 52.80 ± 11.75, respectively. Majority of the subjects in the study were males. The mean hospital stay of SG and CG were 7 days and 6 days, respectively. Poor glycemic control (HbA1c > 8) observed in SG (51.7%) vs CG (31.4%). HbA1c value <7 is associated protective factor for TB occurrence [OR = 0.52 (95% CI 0.29–0.93)]. The protective effect of metformin against TB was 3.9-fold in diabetics (OR = 0.256, 0.16–0.40).Conclusion
Poor glycemic control among diabetics is a risk factor for TB occurrence. The result shows metformin use is a protective agent against TB infection in diabetics. Hence, incorporation of metformin into standard clinical care would offer a therapeutic option for the prevention of TB. 相似文献15.
Abdul Hakeem Alrawahi Patricia Lee Zaher A.M. Al-Anqoudi Muna Alrabaani Ahmed Al-Busaidi Faisal Almahrouqi Ahmed M. Albusaidi 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(2):105-110
Aim
To date, no cardiovascular risk assessment tool has been developed specifically for any Arabian population including Omanis. This study aims to develop a suitable cardiovascular risk prediction model in the form of a statistical equation, for Omanis with type 2 diabetes.Materials and methods
A sample of 2039 patients with type 2 diabetes selected from primary care settings in the Aldakhiliyah Province of Oman were involved in a retrospective cohort study. All patients were free of cardiovascular disease at baseline (in 2009–2010) and were followed up until: 1) their first cardiovascular event occurred; 2) the patient died, or 3) the end of the data collection in December 2015.Results
Among the total sample, 192 cardiovascular disease events were recorded within a mean follow-up period of 5.3-year. The 5-year probability of a cardiovascular event was given as 1 ? 0.9991Exp∑XiBi, where Exp ∑XiBi (hazard ratio) = Exp (0.038 age + 0.052 DM duration + 0.102 HbA1c + 0.201 total cholesterol + 0.912 albuminuria [1 if present] + 0.166 hypertension [1 if present] + 0.005 BMI).Conclusion
The first cardiovascular risk prediction tool in the Arab world was developed in this study. It may be used to estimate the 5-year cardiovascular risk among Omanis with type 2 diabetes in order to plan patient management and preventive measures. However, further validation studies are required to determine the accuracy of the model. 相似文献16.
M. Urrutia-Pereira L.P. Mocellin R.B. de Oliveira L. Simon L. Lessa D. Solé 《Allergologia et immunopathologia》2018,46(5):421-430
Introduction
Allergic diseases have become an increasingly common reality in the last years, extending beyond the family context.Objective
Assessing the level of knowledge on asthma, food allergies and anaphylaxis of asthmatic children's parents/caregivers (PC), elementary school teachers (EST) and university students (US) in Uruguaiana, RS, Brazil.Method
577 individuals (PC – N = 111; EST – N = 177; US – N = 299) took part in the study, answering the Newcastle Asthma Knowledge Questionnaire (validated for Portuguese) and another questionnaire on Food Allergy (FA) and anaphylaxis.Results
Although PC have asthmatic children, their asthma knowledge level was average, slightly above that of EST and EU. The lack of knowledge on passive smoking, use of medications and their side effects should be highlighted. US have shown to be better informed about FA and anaphylaxis. However, even though a significant proportion of respondents know the most common symptoms of FA and anaphylaxis, few named subcutaneous adrenaline as the drug of choice for treating anaphylaxis. Although a significant number of respondents know about the possibility of anaphylactic reactions happening at school or in activities outside the school, we were surprised by the absence of conditions in schools to provide emergency care to such students.Conclusion
Despite the high prevalence of allergic diseases in childhood, asthmatic children's parents/caregivers, elementary school teachers and university students have inadequate levels of knowledge to monitor these patients. 相似文献17.
Rebecka Husdal Eva Thors Adolfsson Janeth Leksell Björn Eliasson Stefan Jansson Lars Jerdén Jan Stålhammar Lars Steen Thorne Wallman Ann-Marie Svensson Andreas Rosenblad 《Primary Care Diabetes》2019,13(2):176-186
Aims
To describe and analyse the associations between primary health care centres’ (PHCCs’) quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).Methods
This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.Results
Of the participants, 56% had controlled (≤52 mmol/mol), 31.9% intermediate (53–69 mmol/mol), and 12.1% uncontrolled (≥70 mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs’ results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all p < 0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (p < 0.05).Conclusions
This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs’ QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c. 相似文献18.
Thorsten Siegmund Martin Pfohl Thomas Forst Stefan Pscherer Peter Bramlage Johannes Foersch Anja Borck Jochen Seufert 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2017,11(1):51-57
Aim
Optimal treatment intensification strategies in patients with type-2 diabetes mellitus (T2DM) receiving basal insulin supported oral antidiabetic therapy (BOT) remain controversial. The objective of the present study was to compare outcomes of BOT-intensification by either the uptitration of long-acting insulin glargine or by the immediate addition of a rapid acting insulin analogue (RAIA).Methods
This was a prospective, observational, 24-week study in T2DM patients with BOT using insulin glargine and baseline glycated hemoglobin (HbA1c) between 7.0 and 8.5%. Patients were stratified by their physicians to one of the following treatment intensification strategies: Basal insulin titration to target with discretionary subsequent addition of RAIA at weeks 12 or 24 (GLAR), or immediate addition of RAIA at baseline (GLARplus).Results
A total of 3266 patients were prescreened of whom 2202 fulfilled the selection criteria. Of these, 1684 patients were documented in the GLAR group and 518 in the GLARplus group. In the GLAR group, in 91 (5.5%) and 21 patients (1.3%) RAIA was added at weeks 12 and 24, respectively. The groups displayed similar baseline characteristics; except, mean diabetes duration was slightly shorter in the GLAR group (8.7 vs. 9.4 years). During the study, insulin glargine dose was increased from 18.7 to 26.4 U (plus 7.7 U) in GLAR and from 24.9 to 27.3 U (plus 2.4 U) in GLARplus patients. Mean RAIA dose was 9.6 ± 4.7 U at the final visit. After 24 weeks, HbA1c was reduced by 0.8 and 0.9% in the GLAR and GLARplus groups, respectively (both p < 0.001). An HbA1c of ≤7.0% was achieved in 49.2% of GLAR and 48.5% of GLARplus patients. In both groups, we observed improvements in cardiovascular risk factors such as lipids and blood pressure. The rates of symptomatic (1.6 vs. 1.7%) and severe (0.18 vs. 0.19%) hypoglycemic episodes were low and comparable in both groups.Conclusion
These findings provide evidence that treatment intensification in patients with type 2 diabetes not at glycemic target on BOT with insulin glargine is equally safe and effective using either long-acting insulin titration alone or the addition of a rapid-acting insulin analogue. 相似文献19.
Mercedes Ramas Maria G. Donday Adrian G. McNicholl Javier P. Gisbert 《Gastroenterologia y hepatologia》2017,40(10):658-662
Background
A progressive decrease in Helicobacter pylori eradication rates has been described over the years, driving the need for new antibiotic treatments.Aim
To evaluate the efficacy and safety of the addition of rifaximin (Spiraxin®) to standard triple therapy (omeprazole, amoxicillin and clarithromycin) for the eradication of H. pylori.Methods
Independent prospective clinical trial (EUDRACT no.: 2013-001080-23). Forty consecutive adult patients were included with H. pylori infection, dyspeptic symptoms and naive to eradication treatment. A full blood test was performed in the first five patients enrolled to evaluate the safety of the treatment. H. pylori eradication was confirmed with the 13C-urea breath test at least four weeks after the end of treatment with rifaximin 400 mg/8 h, clarithromycin 500 mg/12 h, amoxicillin 1 g/12 h and omeprazole 20 mg/12 h for 10 days.Results
Forty patients were consecutively enrolled, 53% woman, mean age 44 years. Indication for eradication: 60% non-investigated dyspepsia, 38% functional dyspepsia and 2% gastric ulcer. Four patients did not attend the eradication confirmatory breath test. The eradication rate was 61% (95% CI: 45–77%) for the protocol and 55% (40–70%) for intention-to-treat. About 76% of the patients experienced adverse events (35% diarrhea, 14% nausea and 24% metallic taste), none of which was serious. The blood tests did not show significant alterations.Conclusion
Acceptable H. pylori eradication rates are not achieved with rifaximin associated with standard triple therapy for 10 days. 相似文献20.
Andrii Dudnyk Svitlana Blyzniuk Oleksandr Pavel’chuk Olena Zakharchenko Dmytro Butov Sergiі Zaіkov 《The Indian journal of tuberculosis》2018,65(1):63-69
Tuberculosis (TB) may have a similar spirometry findings as a chronic obstructive pulmonary disease but the prevalence of TB-induced airflow obstruction (AO) is still unknown.