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1.
Fergus William Gardiner Ezekiel Uba Nwose Phillip Taderera Bwititi Judith Crockett Lexin Wang 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(3):291-300
Aims
To determine the extent to which targets for blood pressure (BP) (<140.90?mmHg) and random blood glucose level (BGL) (<7.7?mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM).Methods
Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence.Results
Eighty-seven (n?=?87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4?mmHg, adhering to recommendations of <140/90?mmHg. The average CKD patient pre-admission BP was 134.8/72.2?mmHg compared to the discharge BP of 129.8/72.2?mmHg. At admission, 63.3% and 93.1% of patients adhered to systolic and diastolic BP recommendations, which significantly (p?=?<?.05) increased at discharge to a systolic and diastolic BP adherence of 83.9% and 98.8%, respectively. The average random hospital BGL was 7.7?mmol/L, indicating good control, whereas the pre-hospital HbA1c average was 7.58%, indicating poor control (>7.0% >53?mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p?=?<.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8?mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%).Conclusion
Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment. 相似文献2.
Ghada Youssef Sherif Nagy Ahmed El-gengehe Amr Abdel Aal Magdy Abdel Hamid 《The Egyptian Heart Journal》2018,70(4):369-373
Background
There are limited data on ‘masked uncontrolled hypertension’ (MUCH) in patients with treated and apparently well-controlled BP is unknown.Objectives
To define the prevalence and predictors of MUCH among hypertensive patients with controlled office blood pressure.Methods
One hundred ninety-nine hypertensive patients presented to the specialized hypertension clinics at two University Hospitals. All patients had controlled office blood pressure (less than 140/90?mmHg). Patients were assessed regarding history, clinical examination, and laboratory data. All patients underwent ambulatory blood pressure monitoring (ABPM) for 24?h, within a week after the index office visit. MUCH was diagnosed if average 24-h ABPM was elevated (systolic BP?≥?130?mmHg and/or diastolic BP?≥?80?mmHg) despite controlled clinic BP.Results
Sixty-six patients (33.2%) had MUCH according to 24-h ABPM criteria (mean age 53.5?±?9.3?years, 60.6% men). MUCH was mostly caused by the poor control of nocturnal BP; with the percentage of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that due to daytime BP elevation (57.3% vs. 27.1%, P?<?0.001). The most common predictors of MUCH were smoking, DM and positive family history of DM.Conclusion
The prevalence of masked suboptimal BP control is high. Office BP monitoring alone is thus inadequate to ascertain optimal BP control because many patients have an elevated nocturnal BP. ABPM is needed to confirm proper BP control, especially in patients with high cardiovascular risk profile. Smoking, DM and positive family history of DM were the most common predictors of MUCH. 相似文献3.
Glenn M. Chertow Gerald B. Appel Geoffrey A. Block Melanie P. Chin Daniel W. Coyne Angie Goldsberry Kamyar Kalantar-Zadeh Colin J. Meyer Mark E. Molitch Pablo E. Pergola Philip Raskin Arnold L. Silva Bruce Spinowitz Stuart M. Sprague Peter Rossing 《Journal of diabetes and its complications》2018,32(12):1113-1117
Aims
Obesity is associated with progression of chronic kidney disease (CKD). Treatment with bardoxolone methyl in a multinational phase 3 trial, Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes (BEACON), resulted in increases in estimated glomerular filtration rate (eGFR) with concurrent reductions in body weight. We performed post-hoc analyses to further characterize reductions in body weight with bardoxolone methyl.Methods
Eligible patients with type 2 diabetes (T2DM) and CKD stage 4 (eGFR 15 to <30?mL/min/1.73?m2) were randomized 1:1 to receive once-daily oral dose of bardoxolone methyl (20?mg) or placebo.Results
BEACON enrolled 2185 patients. Patients randomized to bardoxolone methyl experienced significant reductions in body weight from baseline relative to patients randomized to placebo (?5.7?kg; 95% CI: ?6.0 to ?5.3?kg; p?<?0.001). In patients randomized to bardoxolone methyl, rate and magnitude of body weight loss were proportional to baseline BMI. Bardoxolone methyl resulted in significant reductions in waist circumference and improved glycemic control.Conclusions
Bardoxolone methyl resulted in significant weight loss in a generally obese patient population with T2DM and stage 4 CKD, with the magnitude and rate dependent on baseline BMI. 相似文献4.
Kazuo Eguchi Takahiro Komori Toshinobu Saito Satoshi Hoshide Kazuomi Kario 《Journal of electrocardiology》2018,51(1):21-26
Background
We tested the hypothesis that an alpha-glucosidase inhibitor (α-GI), miglitol, is effective in protecting the cardiovascular system in type 2 diabetes mellitus (T2DM).Methods
We studied 19 hospitalized heart disease patients with T2DM in whom we performed continuous glucose monitoring, Holter electrocardiogram, and ambulatory blood pressure (BP) monitoring simultaneously for 48 h. The α-GI miglitol was administered for half of the study period by a cross-over fashion. T-wave alternans (TWA), a marker of future fatal arrhythmic events, was also analyzed by Holter ECG.Results
Of the 19 patients, the measures of glucose variability were significantly lower during miglitol therapy than in control period. BP variability was similar with/without miglitol. However, TWA was significantly lower during the miglitol period compared to control period (63 ± 4.8 vs. 75.8 ± 5.1 μV, p = 0.032).Conclusion
An α-GI, miglitol, can reduce TWA by reducing the fluctuation of glucose in heart disease patients with T2DM. 相似文献5.
Eda Unal Konstantinos Giakoumidakis Ehsan Khan Evridiki Patelarou 《Heart & lung : the journal of critical care》2018,47(4):351-359
Objective
The aim of this study was to identify, retrieve, critically appraise and synthesize information regarding existing mobile phone text messaging interventions that have been done for secondary prevention of cardiovascular disease (CVD).Methods
A systematic review was conducted. The searching was conducted by using the MEDLINE, EMBASE, PsychINFO, CINAHL, PubMed and ScienceDirect databases. Nine randomized controlled trials (RCTs) were eligible and included.Results
The preventive factors measured among studies varied. While the majority of studies examined medication adherence as a main outcome (4), the other 3 studies focused on CVD risk factors combining blood pressure (BP), smoking, body mass index (BMI), physical activity and dietary habits, only 2 studies examined both medication adherence and risk factor modification of CVD.Conclusion
Even though mobile phone text messaging may be beneficial for the secondary prevention of CVD, reliable conclusions on the effects of text messaging cannot be drawn. 相似文献6.
Aim
To investigate the clinical significance of serum α-Klotho and β-Klotho levels in patients with type 2 diabetes mellitus (T2DM) and its associated complications.Methods
Serum α-Klotho and β-Klotho levels were measured using an ELISA kit in 817 individuals, including 127 with T2DM, 106 with diabetic nephropathy, 99 with diabetic retinopathy, 108 with diabetic neuropathy, 102 with diabetic foot disease, 135 with T2DM and more than one complication and 140 healthy controls.Results
Both α-Klotho and β-Klotho levels were significantly decreased in the T2DM group and the groups with associated complications compared with the levels in control group. The differences between the T2DM group and the T2DM with complications groups were not significant, except between the diabetic nephropathy group and the other diabetic complications groups. In addition, α-Klotho and β-Klotho levels were negatively correlated with serum fructosamine and HbA1c but were not associated with serum glucose in the model including all participants. Moreover, decreases in α-Klotho and β-Klotho levels in the high glucose-exposed cell culture model, which was dependent on glucose exposure time, were confirmed.Conclusions
Levels of α-Klotho and β-Klotho were downregulated in patients in the T2DM and complications groups. Our findings indicate that serum Klotho levels were associated with the development of T2DM, and long-term control of blood glucose will be beneficial in ameliorating changes to α-Klotho and β-Klotho levels in patients with T2DM and complications. 相似文献7.
Xuemei Hu Jie Liu Li Sun Linjie Liu Yimeng Hu Yin Yuan Guijun Wu Ye Wang Jing Chen Yancheng Xu 《Journal of diabetes and its complications》2018,32(3):335-341
Aims
To investigate TAp63 expression in patients with type 2 diabetes mellitus (T2DM) and the potential correlations between TAp63 and proinflammatory cytokines production and other clinical parameters.Methods
Peripheral blood mononuclear cells (PBMCs) and plasma were collected from 72 T2DM (cases) and 72 healthy subjects (controls). Fasting blood glucose (FBG), fasting insulin (FIN) and a blood lipid profile were measured. The homeostasis model assessment (HOMA) was used to estimate insulin resistance (IR). Plasma tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 were determined. PBMCs isolated from healthy subjects were cultured with or without 33.3 mmol/l glucose or 0.5 mmol/l palmitic acid (PA) for 6 h, 24 h, 48 h, and 72 h. The expression of TAp63 at mRNA and protein levels in PBMCs was analyzed using real-time qRT-PCR and western blots, respectively.Results
TAp63 expression was significantly lower in T2DM patients compared with that of the controls. In addition, TAp63 expression showed a negative correlation with FBG, FIN, HbA1c, HOMA-IR, FFAs, TNF-α, and IL-6 levels. Treatment with 33.3 mmol/l glucose or 0.5 mmol/l PA increased TAp63 expression in the cultured PBMCs.Conclusions
TAp63 level may be correlated with chronic inflammatory state and perturbed glucose and lipid metabolism in T2DM. 相似文献8.
Clement Lo Edward Zimbudzi Helena J. Teede Peter G. Kerr Sanjeeva Ranasinha Alan Cass Gregory Fulcher Martin Gallagher Kevan R. Polkinghorne Grant Russell Tim Usherwood Rowan Walker Sophia Zoungas 《Journal of diabetes and its complications》2019,33(1):63-68
Aims
In patients with comorbid diabetes and chronic kidney disease, the extent to which patient-reported barriers to health-care and patient reported outcomes influence the quality of health care is not well established. This study explored the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets.Methods
This cross-sectional study recruited adults with diabetes and CKD (eGFR 20 to <60?ml/min/1.73m2) across four hospitals. We combined clinical data with results from a questionnaire comprising measures of patient-identified barriers to care, the Patient Activation Measure (PAM), 12-Item Short Form Survey (SF-12), and the Summary of Diabetes Self-Care Activity (SDSCA).Results
199 patients, mean age 68.7 (SD 9.6), 70.4% male and 90.0% with type 2 diabetes were studied. Poor glycaemic control was associated with increased odds of patient reported “poor family support” (OR 4.90; 95% CI 1.80 to 13.32, p?<?0.002). Poor BP control was associated with increased odds of patient reported, “not having a good primary care physician” (OR 6.01; 2.42 to 14.95, p?<?0.001). The number of barriers was not associated with increased odds of poor control (all p?>?0.05).Conclusions
Specific patient-reported barriers, lack of patient perceived family and primary care physician support, are associated with increased odds of poor glycaemic and blood pressure control respectively. Interventions addressing these barriers may improve treatment target attainment. 相似文献9.
Monia Garofolo Eleonora Russo Roberto Miccoli Daniela Lucchesi Laura Giusti Veronica Sancho-Bornez Giuseppe Daniele Stefano Del Prato Giuseppe Penno 《Journal of diabetes and its complications》2018,32(6):550-557
Aims
Albuminuric and non-albuminuric phenotypes of chronic kidney disease (CKD) may have different cardiovascular risk and survival in type 1 diabetes (T1DM). Herein we estimated risk of major vascular outcomes by the EURODIAB PCS score and determined all-cause mortality rate in 774 T1DM according to CKD phenotypes.Methods
We evaluated the distribution of CKD phenotypes [no CKD, stages 1–2, non-albuminuric stage ≥3 (Alb?CKD), albuminuric stage ≥3 (Alb+CKD)], the EURODIAB risk score for major vascular outcomes [low- (LS), intermediate- (IS), and high- (HS) risk] and all-cause mortality over a follow-up of 8.25?±?2.34?years.Results
Out of 774 subjects, 692 (89.4%) had no CKD, 53 (6.8%) CKD stages 1–2, 17 (2.2%) Alb?CKD and 12 (1.6%) Alb+CKD; 466 (60.2%) had LS, 205 (26.5%) IS and 103 (13.3%) HS. Distribution of HS was: no CKD, 9.1%; CKD stages 1–2, 34.0%; Alb?CKD, 64.7%; Alb+CKD, 91.7% (P?<?0.0001). Mortality increased from no CKD, 3.0%; to stages 1–2, 15.1% (HR 4.504); Alb?CKD, 29.4% (8.573); Alb+CKD, 50.0% (20.683, P?<?0.0001). Accounting for age and sex, HRs for mortality compared to no CKD were: CKD stages 1–2, 3.84 (P?=?0.001); Alb?CKD, 2.97 (P?=?0.046); Alb+CKD, 7.44 (P?<?0.0001). Adjusting for sex and the EURODIAB score, HRs for mortality compared to no CKD were: CKD stages 1–2, 2.57 (P?=?0.027); Alb?CKD, 2.77 (P?=?0.058); Alb+CKD, 4.58 (P?=?0.003).Conclusions
In our T1DM cohort, one fifth of those with CKDs were non-albuminuric. This phenotype was associated with higher risk of major outcomes and similar rate of mortality as compared to CKD stages 1–2. The greatest risk and highest mortality occur in patients with Alb+CKD. 相似文献10.
Yicheng K. Bao Maamoun Salam Deborah Parks Janet B. McGill Jing Hughes 《Journal of diabetes and its complications》2018,32(8):737-739
Background
The prevalence of systemic rheumatic diseases (SRDs) in T1DM has not been described.Method
This observational study compares SRD prevalence across age, race, and gender in 1,212 adults with T1DM.Findings
There is an age-dependent enrichment of SRDs in women with T1DM: 9.2% prevalence in women overall and 14% in women over age 50.Conclusion
Clinicians taking care of older women with T1DM should monitor for these SRDs. 相似文献11.
Li Liu Xiuhua Wang Xi Cao Can Gu Chen Yang Yu OuYang 《Heart & lung : the journal of critical care》2018,47(3):216-221
Background
Existing theory and evidence suggest that self-care confidence may mediate the relationship between Type D personality and self-care adherence.Objectives
To assess the mediating role of self-care confidence between Type D personality and self-care adherence in Chinese HF patients.Methods
This is a secondary analysis of a cross-sectional study. Self-care confidence and self-care adherence (maintenance) were measured by the subscales of the Self-Care of Heart Failure Index (v6). The Type D Scale-14 was administered to assess negative affect (NA), social inhibition (SI), and Type D personality. Mediation analysis based on Baron and Kenny was performed.Results
A total of 127 HF patients were included. Self-care confidence partially mediated the relationship between Type D personality and self-care adherence but completely mediated the relationship between NA/SI and self-care adherence.Conclusions
Clinicians may effectively improve self-care adherence by enhancing self-care confidence in HF patients with Type D personality. 相似文献12.
Thinzar Min Gareth I. Davies Sam Rice James Chess Jeffrey W. Stephens 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(2):123-127
Aims
Chronic kidney disease (CKD) is common in type 2 diabetes and limits the treatment choices for glycaemic control. Our aim was to examine real-world prescribing for managing hyperglycaemia in the presence of CKD.Methods
The SAIL (Secure Anonymised Information Linkage) databank was used to examine prescribing during the period from the 1st of January to 30th December 2014. CKD was defined as:- none or mild CKD, eGFR ≥60 mL/min/1.73m2; moderate CKD eGFR <60 mL/min/1.73m2; and severe CKD eGFR <30 mL/min/1.73m2 or requiring dialysis.Results
We identified 9585 subjects who received any form of glucose lowering therapy (8363 had no/mild CKD; 1137 moderate CKD; 85 severe CKD). There was a linear association between insulin use and CKD severity with approximately 54% of those with severe CKD receiving insulin. Sulphonylureas use did not differ among the CKD groups and was approximately 40%. Metformin showed a linear decrease across the groups, however approximately 21% in the severe CKD group received metformin. The use of dipeptidyl peptidase 4 inhibitors (DPP-4i) was approximately 20% and did not differ among groups. The DPP-4 inhibitor choice was:- 1% vildagliptin, 9% saxagliptin, 58% sitagliptin, and 32% linaglitpin. With respect to sitagliptin and saxagliptin, 72% and 62% received an inappropriately high dose in the setting of CKD.Conclusions
We observed that a considerable proportion of patients with type 2 diabetes and CKD were receiving metformin and non dose-adjusted DPP-4 inhibitors. Careful consideration of medication use and dosaging is required in the setting of CKD and type 2 diabetes. 相似文献13.
Mamta Jaiswal Lynn Ang Kara Mizokami-Stout Rodica Pop-Busui 《Journal of diabetes and its complications》2018,32(10):947-950
Aim
To assess the relationship between glucose variability (GV) and non-dipping of blood pressure (BP) as a marker of cardiovascular autonomic neuropathy (CAN) among patients with type 1 diabetes (T1D).Methods
Forty-one subjects with T1D (age 34?±?13?years, duration 13?±?6?years, HbA1c 8?±?1.2%) without cardiovascular disease, dyslipidemia, or hypertension at baseline were enrolled in a 3-year observational cohort study. Subjects were phenotyped for CAN with heart rate variability, cardiovascular autonomic reflex tests, and 24-h BP profiles at baseline and during follow-up. Non-dipping was defined as nocturnal systolic and diastolic BP fall of ≤10%. Reverse dipping BP was defined as a <0% change in the day to night for systolic and diastolic BP. Indices of GV were derived from 5-day continuous glucose monitoring obtained at 3-month intervals, and serum inflammatory biomarkers in all subjects.Results
At baseline 10% of the T1D subjects were non-dippers. The dippers and non-dippers were similar in age, diabetes duration, glucose control, traditional cardiovascular risk factors, GV and inflammatory markers. No significant correlations were found at baseline between non-dipping nocturnal blood pressure and measures of GV. At 3?years there were no differences in risk factor profile of subjects who were non-dippers over time (progressors) and those who were dippers (non-progressors).Conclusion
In a cohort of contemporary patients with T1D following the current standard of care in diabetes, the prevalence of non-dipping is relatively low. There were no clear phenotypes that explained the difference in the risk for non-dipping, including GV. Ambulatory blood pressure monitoring could be used as a tool for improved CVD risk stratification and development of therapeutic interventions in these patients. 相似文献14.
Shan Xing Gregory S. Calip Alex D. Leow Shiyun Kim Glen T. Schumock Daniel R. Touchette Todd A. Lee 《Journal of diabetes and its complications》2018,32(5):492-500
Aims
To compare adherence and persistence to oral antidiabetic drugs (OAD) between patients who are new users of second generation antipsychotics (SGA) versus new users of other depression therapies in adults with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD).Methods
Adults 18–64?years with previously-treated T2DM and MDD (past OAD and SSRI/SNRI use) who are new users of SGA or non-SGA therapies (bupropion, lithium, mirtazapine, thyroid hormone, tricyclic antidepressant) were identified in the 2009–2015 MarketScan® Commercial Claims and Encounters database. Multivariate regression models were used to determine the odds of a ≥10% decline in OAD adherence over 180- and 365-days, and time to OAD discontinuation, adjusting for differences between groups.Results
A total of 8664 (21.5% SGA), 8311 (22.1% SGA), and 17,524 (21.3% SGA) patients met inclusion criteria for the 180-day adherence, 365-day adherence, and persistence cohorts, respectively. Over 180-days, 16.6% of SGA and 13.3% of non-SGA initiators had a ≥10% decline in OAD adherence (adjusted odds ratio [OR]?=?1.41, 95% CI 1.21–1.63). Over 365-days, 22.3% of SGA and 18.9% of non-SGA initiators had a?≥?10% decline (OR?=?1.34, 95% CI 1.17–1.53). Time to OAD discontinuation was similar between groups (adjusted hazard ratio?=?1.03, 95% CI 0.94–1.12).Conclusion
Use of SGA was associated with a 1.3–1.4 times higher odds of a ≥10% decline in OAD adherence. Adherence to OAD is critical for optimal diabetes control and reductions in this magnitude may impact A1C. Close monitoring of OAD adherence after SGA initiation is warranted. 相似文献15.
Purpose of Review
Chronic kidney disease (CKD) is recognized as a worldwide epidemic. Hypertension commonly coexists with CKD and its prevalence is progressively increasing as kidney function declines.Recent Findings
For patients with established CKD and/or diabetes with albuminuria, the updated hypertension guidelines have recommended a blood pressure (BP) goal <?130/80 mmHg. Blood pressure level above 130/80 mmHg in CKD patients requires lifestyle modifications and multiple antihypertensive medications. According to recent guidelines, angiotensin-converting enzyme (ACE) inhibitors should be the drugs of first choice. Angiotensin II receptor blockers (ARBs) should be used if the ACE inhibitor is not tolerated. Non-dihydropyridine CCBs consistently reduce albuminuria and slow the decline in kidney function. Dihydropyridine CCBs should not be used as monotherapy in proteinuric CKD patients but always in combination with a RAAS blocker. Diuretics are commonly used and represent the cornerstone in the management of CKD patients. All the other agents are used when treatment with the other primary agents have failed.Summary
In patients with CKD, an intensive BP goal <?130/80 mmHg has been recommended. We review current treatment options.16.
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17.
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18.
William H. Herman Barbara H. Braffett Shihchen Kuo Joyce M. Lee Michael Brandle Alan M. Jacobson Lisa A. Prosser John M. Lachin 《Journal of diabetes and its complications》2018,32(10):934-939
Objective
To simulate the cost-effectiveness of historical and modern treatment scenarios that achieve excellent vs. poor glycemic control in type 1 diabetes (T1DM).Research design and methods
We describe and compare the costs of intensive and conventional therapies for T1DM as performed during DCCT, and modern intensive and basic therapy scenarios using insulin analogs, pens, pumps, and continuous glucose monitoring (CGM) to achieve excellent or poor glycemic control. We then assess the differences in treatment costs and the costs of outcomes over 30?years and report incremental cost-effectiveness ratios.Results
Over 30?years, DCCT intensive therapy cost $127,500 to $181,600 more per participant than DCCT conventional therapy, and modern intensive therapy cost $87,700 to $409,000 more per individual than modern basic therapy. Excellent glycemic control averted as much as $90,900 in costs from complications and added ~1.62 quality-adjusted life-years (QALYs) per participant over 30?years. When costs and QALYs were discounted at 3% annually, DCCT intensive therapy and modern intensive therapies that use multiple daily injections (MDI) or pumps are cost-saving or cost-effective (<$100,000/QALY-gained). If applied to all patients with T1DM, modern intensive therapy using pumps and CGM is not cost-effective (>$250,000/QALY-gained) but would be more cost-effective if associated with less hypoglycemia, better glycemic control, fewer complications, or improved health-related quality-of-life.Conclusions
Use of the least expensive intensive therapy needed to safely achieve treatment goals for patients with T1DM represents a good value for money.19.
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20.
Vybhav Venkatesh Rakesh Kumar Dinesh Kumar Varma Prateek Bhatia Jaivinder Yadav Devi Dayal 《Journal of diabetes and its complications》2018,32(9):833-838
