Glycaemia and high blood pressure are associated with type 2 diabetes complications over time

2001 ◽  
Vol 5 (2) ◽  
pp. 47-48
Author(s):  
Inger Njølstad
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
High Blood Pressure ◽  
Diabetes Complications ◽  
Over Time

scholarly journals Effective Treatment Recommendations for Type 2 Diabetes Management Using Reinforcement Learning: Treatment Recommendation Model Development and Validation (Preprint)

2021 ◽  
Author(s):  
Xingzhi Sun ◽  
Yong Mong Bee ◽  
Shao Wei Lam ◽  
Zhuo Liu ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Reinforcement Learning ◽  
Blood Lipids ◽  
Diabetes Complications ◽  
Data Driven ◽  
Lipid Lowering ◽  
Treatment Recommendation

BACKGROUND Type 2 diabetes mellitus (T2DM) and its related complications represent a growing economic burden for many countries and health systems. Diabetes complications can be prevented through better disease control, but there is a large gap between the recommended treatment and the treatment that patients actually receive. The treatment of T2DM can be challenging because of different comprehensive therapeutic targets and individual variability of the patients, leading to the need for precise, personalized treatment. OBJECTIVE The aim of this study was to develop treatment recommendation models for T2DM based on deep reinforcement learning. A retrospective analysis was then performed to evaluate the reliability and effectiveness of the models. METHODS The data used in our study were collected from the Singapore Health Services Diabetes Registry, encompassing 189,520 patients with T2DM, including 6,407,958 outpatient visits from 2013 to 2018. The treatment recommendation model was built based on 80% of the dataset and its effectiveness was evaluated with the remaining 20% of data. Three treatment recommendation models were developed for antiglycemic, antihypertensive, and lipid-lowering treatments by combining a knowledge-driven model and a data-driven model. The knowledge-driven model, based on clinical guidelines and expert experiences, was first applied to select the candidate medications. The data-driven model, based on deep reinforcement learning, was used to rank the candidates according to the expected clinical outcomes. To evaluate the models, short-term outcomes were compared between the model-concordant treatments and the model-nonconcordant treatments with confounder adjustment by stratification, propensity score weighting, and multivariate regression. For long-term outcomes, model-concordant rates were included as independent variables to evaluate if the combined antiglycemic, antihypertensive, and lipid-lowering treatments had a positive impact on reduction of long-term complication occurrence or death at the patient level via multivariate logistic regression. RESULTS The test data consisted of 36,993 patients for evaluating the effectiveness of the three treatment recommendation models. In 43.3% of patient visits, the antiglycemic medications recommended by the model were concordant with the actual prescriptions of the physicians. The concordant rates for antihypertensive medications and lipid-lowering medications were 51.3% and 58.9%, respectively. The evaluation results also showed that model-concordant treatments were associated with better glycemic control (odds ratio [OR] 1.73, 95% CI 1.69-1.76), blood pressure control (OR 1.26, 95% CI, 1.23-1.29), and blood lipids control (OR 1.28, 95% CI 1.22-1.35). We also found that patients with more model-concordant treatments were associated with a lower risk of diabetes complications (including 3 macrovascular and 2 microvascular complications) and death, suggesting that the models have the potential of achieving better outcomes in the long term. CONCLUSIONS Comprehensive management by combining knowledge-driven and data-driven models has good potential to help physicians improve the clinical outcomes of patients with T2DM; achieving good control on blood glucose, blood pressure, and blood lipids; and reducing the risk of diabetes complications in the long term.

scholarly journals The 14 bp Del/Ins HLA-G Polymorphism Is Related with High Blood Pressure in Acute Coronary Syndrome and Type 2 Diabetes Mellitus

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Ilian Janet García-González ◽  
Yeminia Valle ◽  
Fernando Rivas ◽  
Luis Eduardo Figuera-Villanueva ◽  
José Francisco Muñoz-Valle ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
High Blood Pressure ◽  
Negative Regulator ◽  
Native Page ◽  
Coronary Syndrome

Immunologic and inflammatory processes are involved in the pathogenesis of acute coronary syndrome (ACS) and type 2 diabetes mellitus (DM2). Human leukocyte antigen-G (HLA-G) is a negative regulator of the immune response. This study evaluates the 14 bp Del/Ins HLA-G polymorphism in ACS and DM2. Three hundred and seventy individuals from Western Mexico were recruited and categorized into three groups: ACS (86), DM2 without coronary complications (70), and healthy subjects (214). Genotyping of the 14 bp Del/Ins HLA-G polymorphism was performed by PCR and Native-PAGE. The most common risk factors were hypertension and overweight in ACS and DM2, respectively. The genetic distribution of the 14 bp Del/Ins HLA-G polymorphism showed no significant differences between groups (P≥0.23). Nonetheless, the Ins/Ins genotype was associated with high blood pressure (HBP) in the DM2 group (ORc = 1.65,P=0.02). The genetic recessive model showed similar findings (ORc = 3.03,P=0.04). No association was found in ACS, with aPof 0.05; nevertheless, the prevalence of Ins/Ins carriers was quite similar to that found in the DM2-HBP group. The 14 bp Del/Ins HLA-G polymorphism was not a susceptibility factor for ACS or DM2; however, the Ins/Ins genotype might have contributed to the development of HBP in the studied groups.

scholarly journals Genetic Predisposition to High Blood Pressure Associates With Cardiovascular Complications Among Patients With Type 2 Diabetes: Two Independent Studies

Diabetes ◽  
2012 ◽  
Vol 61 (11) ◽  
pp. 3026-3032 ◽  
Author(s):  
Q. Qi ◽  
J. P. Forman ◽  
M. K. Jensen ◽  
A. Flint ◽  
G. C. Curhan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
High Blood Pressure ◽  
Genetic Predisposition ◽  
Cardiovascular Complications

scholarly journals Canagliflozin Prevents Intrarenal Angiotensinogen Augmentation and Mitigates Kidney Injury and Hypertension in Mouse Model of Type 2 Diabetes Mellitus

2019 ◽  
Vol 49 (4) ◽  
pp. 331-342 ◽  
Author(s):  
T. Cooper Woods ◽  
Ryousuke Satou ◽  
Kayoko Miyata ◽  
Akemi Katsurada ◽  
Courtney M. Dugas ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
High Blood Pressure ◽  
Kidney Injury ◽  
Renal Tubules ◽  
Glucose Levels

Background: Hypertension and renal injury are common complications of type 2 diabetes mellitus (T2DM). Hyperglycemia stimulates renal proximal tubular angiotensinogen (AGT) expression via elevated oxidative stress contributing to the development of high blood pressure and diabetic nephropathy. The sodium glucose cotransporter 2 (SGLT2) in proximal tubules is responsible for the majority of glucose reabsorption by renal tubules. We tested the hypothesis that SGLT2 inhibition with canagliflozin (CANA) prevents intrarenal AGT augmentation and ameliorates kidney injury and hypertension in T2DM. Methods: We induced T2DM in New Zealand obese mice with a high fat diet (DM, 30% fat) with control mice receiving regular fat diet (ND, 4% fat). When DM mice exhibited > 350 mg/dL blood glucose levels, both DM- and ND-fed mice were treated with 10 mg/kg/day CANA or vehicle by oral gavage for 6 weeks. We evaluated intrarenal AGT, blood pressure, and the development of kidney injury. Results: Systolic blood pressure in DM mice (133.9 ± 2.0 mm Hg) was normalized by CANA (113.9 ± 4.0 mm Hg). CANA treatment ameliorated hyperglycemia-associated augmentation of renal AGT mRNA (148 ± 21 copies/ng RNA in DM, and 90 ± 16 copies/ng RNA in DM + CANA) and protein levels as well as elevation of urinary 8-isoprostane levels. Tubular fibrosis in DM mice (3.4 ± 0.9-fold, fibrotic score, ratio to ND) was suppressed by CANA (0.9 ± 0.3-fold). Furthermore, CANA attenuated DM associated increased macrophage infiltration and cell proliferation in kidneys of DM mice. Conclusions: CANA prevents intrarenal AGT upregulation and oxidative stress and which may mitigate high blood pressure, renal tubular fibrosis, and renal inflammation in T2DM.

The Association Between Meeting Physical Activity Guidelines and Chronic Diseases Among Canadian Adults

2011 ◽  
Vol 8 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Shirley N. Bryan ◽  
Peter T. Katzmarzyk
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Chronic Diseases ◽  
High Blood Pressure ◽  
Leisure Time ◽  
Poor Health ◽  
Physical Activity Guidelines ◽  
Fair Poor

Background:Physical activity is associated with a reduced risk of chronic disease. This study describes the relationship between meeting the guidelines for physical activity described in Canada’s Physical Activity Guide and heart disease, type 2 diabetes, hypertension, obesity, and low levels of general health.Methods:Leisure-time energy expenditure (LTEE) was calculated from leisure-time physical activities reported by adults who participated in the 2007 Canadian Community Health Survey. Respondents were classified as meeting the guidelines for physical activity or not, and were stratified by sex into quartiles of LTEE. Logistic regression was used to determine the odds for all conditions associated with not meeting the guidelines and by quartile of LTEE, adjusting for covariates.Results:The odds of type 2 diabetes, obesity, and fair/poor health were significantly higher among those not meeting the guidelines for both sexes and for high blood pressure among women. Significantly higher odds were seen between the lowest and highest quartiles of LTEE for type 2 diabetes and high blood pressure and across all quartiles for obesity and fair/poor health for both sexes.Conclusions:Canadian adults meeting the physical activity guidelines have lower odds of chronic diseases and fair/poor health than those not meeting the guidelines.

scholarly journals EFFECTS OF LONG-TERM ROUX-EN-Y GASTRIC BYPASS ON BODY WEIGHT AND CLINICAL METABOLIC COMORBIDITIES IN BARIATRIC SURGERY SERVICE OF A UNIVERSITY HOSPITAL

2016 ◽  
Vol 29 (suppl 1) ◽  
pp. 20-23 ◽  
Author(s):  
Cátia Ferreira da SILVA ◽  
Larissa COHEN ◽  
Luciana d'Abreu SARMENTO ◽  
Felipe Monnerat Marino ROSA ◽  
Eliane Lopes ROSADO ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Type 2 Diabetes Mellitus ◽  
Body Weight ◽  
High Blood Pressure

ABSTRACT Background: Due to the high failure rate observed in the clinical treatment of morbid obesity an increase in bariatric surgery indications, as an alternative for the control of obesity and comorbidities, is noticeable. Aim: To evaluate the performance of type 2 diabetes mellitus, high blood pressure and dyslipidemia in patients submitted to Roux-en-Y gastric bypass in late follow-up. Methods: Retrospective analysis of 59 patients included in the bariatric surgery program. Anthropometric (height and body weight) and laboratory (LDLc, HDLc, VLDLc, triglyceride -TG - and glucose) data were collected on pre- and postoperative stages, through medical records. Results: Among the patients, 86% were female aged 43±11, of whom 52% had attended high school. The average postoperative time was 7±3 years. During the postoperative period, there were decreases of weight and body mass index, respectively (133±06 kg vs 91±04 kg p<0.05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0.05). In comparison to the preoperative stage, lower concentrations of glucose (101.00±26.99 vs 89,11±15.19, p=0.014), total cholesterol rates (179.00±37,95 vs 167.48±28,50, p=0.016), LDLc (104.30±33.12 vs 91.46±24.58, p=0.016), VLDLc (25.40±11,12 vs 15.68±7.40, p<0.01), and TG (143.35±86.35 vs 82.45±37.39, p<0.01) and higher concentrations of HDLc (43.53±8.23 vs 57.90±15.60, p<0.01) were identified in the postoperative stage. 40% of hypertensive patients were still undergoing high blood pressure treatment during the postoperative stage. There was remission of type 2 diabetes mellitus and dyslipidemia on 81% and 94% of the cases, respectively. Conclusion: Roux-en-Y gastric bypass has proven itself to be an effective long term procedure, promoting weight loss, remission of DM2 and dyslipidemia.

P-061: Type 2 diabetes and high blood pressure

2015 ◽  
Vol 64 ◽  
pp. S44
Author(s):  
I. Ksira ◽  
K. Ounaissa ◽  
W. Grira ◽  
H. Sfar ◽  
A. Ben Brahim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
High Blood Pressure
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