Long-term effects of the combination of pegvisomant with somatostatin analogs (SSA) on glucose homeostasis in non-diabetic patients with active acromegaly partially resistant to SSA

<p><strong>Abstract.</strong> Development of information technology and expansion of geospatial information systems have realized the planning managers and urban policy-makers’ wishes in making more informed decisions about urban management. At the same time, population growth and the provision of its health should be considered as one of the most important and remarkable issues for many researchers and medical specialists. So, in recent years there have been an increasing number of researches related to the study of effective factors such as environment parameters on the people’s health. In previous research, the long-term exposure effects of environmental parameters such as greenspace and air pollution on people’s health have been mostly ignored or access to reliable data has not been accomplished. The aim of this research is to study how the long-term exposure to greenspace surrounding the type 2 diabetes mellitus (T2DM) affects the average values of four years glycolized hemoglobin (HbA1c) levels. Moreover, in order to study the effects of the data type on reliability of the results, land-use data base (LDB) and satellite imagery have been employed. Pearson product and regression model have been used in this research for correlation and buffer analyse to calculate the degree of exposure of T2DM persons to greenspace. According to the results, negative correlation between long-term exposure to greenspace and the average values of four years HbA1c levels becomes statistically significant. Pearson correlation coefficients for the LDB (r&thinsp;=&thinsp;&minus;0.366, p&thinsp;=&thinsp;0.001) and satellite imagery (r&thinsp;=&thinsp;&minus;0.276, p&thinsp;=&thinsp;0.006) at 250-meter buffer from diabetic patients’ habitat is significant at 99% confidence level.</p>

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Diabetes

10.1093/med/9780198759782.003.0007 ◽

2018 ◽

Author(s):

Hugh Devlin ◽

Rebecca Craven

Keyword(s):

Insulin Resistance ◽

Blood Glucose ◽

Periodontal Disease ◽

Oral Candidiasis ◽

Medical Complications ◽

Diabetic Patients ◽

Long Term Effects ◽

Defence Mechanisms ◽

Head And Neck Infections

Diabetes in relation to dentistry is the topic of this chapter. The incidence of diabetes is increasingly rapidly, hand-in-hand with the increase in obesity. Obesity predisposes patients to an increased insulin resistance, i.e. reduces their ability to increase the glucose transport into adipocytes, muscle, and liver cells. The pancreas responds by producing more insulin but when it can no longer produce enough to overcome the insulin resistance, the blood glucose rises. Diabetes is characterized by raised blood glucose. We describe the devastating long-term effects of diabetes, in particular the microvascular and macrovascular medical complications. The dental complications include an increased severity of periodontal disease, oral candidiasis, and dry mouth but in those who are poorly controlled the impaired defence mechanisms can lead to severe head and neck infections and osteomyelitis. A final summary lists the important clinical recommendations for treatment of diabetic patients.

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Early Response in Albuminuria and Long-Term Kidney Protection during Treatment with an Endothelin Receptor Antagonist: A Prespecified Analysis from the SONAR Trial

Journal of the American Society of Nephrology ◽

10.1681/asn.2021030391 ◽

2021 ◽

pp. ASN.2021030391

Author(s):

Hiddo Heerspink ◽

Di Xie ◽

George Bakris ◽

Ricardo Correa-Rotter ◽

Fan-Fan Hou ◽

...

Keyword(s):

Chronic Kidney Disease Stage ◽

Renin Angiotensin System ◽

Treatment Phase ◽

Early Response ◽

Disease Stage ◽

Diabetic Patients ◽

Long Term Effects ◽

Double Blind ◽

The Difference

Background Whether early reduction in albuminuria with atrasentan treatment predicts its longterm kidney protective effect is unknown. Methods To assess long-term effects on kidney outcomes of atrasentan versus placebo in the SONAR trial, we enrolled diabetic patients with chronic kidney disease (stage 2-4) and a urinary albumin creatinine ratio (UACR) of 300 mg/g-5000 mg/g; participants were receiving maximum tolerated renin angiotensin system inhibition. After 6 weeks exposure to 0.75 mg/day atrasentan (enrichment period), participants were randomized (stratified by UACR response during enrichment, ranging from ≤60% to >0%) to continue atrasentan or transition to placebo. Primary kidney outcome was a composite of sustained serum creatinine doubling or end-stage kidney disease. Results UACR response to atrasentan during enrichment persisted throughout the double-blind treatment phase and predicted the primary kidney outcome, whereas UACR levels with placebo remained below pre-enrichment values in the two highest UACR response strata and exceeded pre-enrichment values in the two lowest strata. As a result, early UACR response to atrasentan during enrichment was also associated with the primary kidney outcome during placebo. Accordingly, the predictive effect of early albuminuria changes during atrasentan was eliminated after placebo correction, leading to a consistent relative risk reduction for the primary kidney outcome with atrasentan compared with placebo, irrespective of the initial UACR response. The difference between atrasentan and placebo in UACR during double-blind treatment was also consistent across UACR response strata. Conclusions Our findings do not support UACR response as a causal predictor of atrasentan's treatment effect. However, because of UACR's variable trajectory with placebo, aspects of the trial design, day-to-day variability in albuminuria, and potential long-lasting effects of atrasentan may have contributed.

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