scholarly journals Haemoglobin A1c variability as an independent correlate of atherosclerosis and cardiovascular disease in Chinese type 2 diabetes

2018 ◽  
Vol 15 (5) ◽  
pp. 402-408 ◽  
Author(s):  
Yifei Mo ◽  
Jian Zhou ◽  
Xiaojing Ma ◽  
Wei Zhu ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Standard Deviation ◽  
Diabetes Management ◽  
Early Stage ◽  
Multivariable Logistic Regression Analysis ◽  
Haemoglobin A1c ◽  
Macrovascular Complication ◽  
Deviation Coefficient

Objective: To examine the association between haemoglobin A1c variability and macrovascular complication in type 2 diabetes. Methods: We retrospectively enrolled 5278 diabetes patients with no history of cardiovascular disease and atherosclerosis by ultrasound at their first visit to the hospital from 1999 to 2010. Patients had a median of 4 haemoglobin A1c (range = 3–9) measurements during follow-up. Average haemoglobin A1c and haemoglobin A1c variability were calculated as intra-individual mean, standard deviation, coefficient of variation and adjusted standard deviation. Cardiovascular disease events and ultrasound results were re-evaluated from the medical history at the end of the study. Results: A total of 972 patients had macrovascular complication. Compared to those without atherosclerosis/cardiovascular disease (n = 4306), haemoglobin A1c intra-individual mean and haemoglobin A1c variability levels were significantly higher in patients with macrovascular complication ( p < 0.001). Multivariable logistic regression analysis showed that haemoglobin A1c variability was associated with macrovascular complication. Moreover, 488 patients with only atherosclerosis had significantly higher haemoglobin A1c intra-individual mean and haemoglobin A1c variability values than those without atherosclerosis/cardiovascular disease ( p < 0.001), but in 484 patients with cardiovascular disease incidents, only higher haemoglobin A1c intra-individual mean level was found ( p = 0.004). Conclusions: In Chinese type 2 diabetes, haemoglobin A1c variability was associated with macrovascular complication. Long-term stabilization of glucose is important in diabetes management, especially in the early stage of atherosclerosis.

scholarly journals Hyperinsulinemia and Its Pivotal Role in Aging, Obesity, Type 2 Diabetes, Cardiovascular Disease and Cancer

2021 ◽  
Vol 22 (15) ◽  
pp. 7797
Author(s):  
Joseph A. M. J. L. Janssen
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Insulin Secretion ◽  
Early Stage ◽  
Insulin Clearance ◽  
Future Research ◽  
Age Related ◽  
Hepatic Insulin Clearance

For many years, the dogma has been that insulin resistance precedes the development of hyperinsulinemia. However, recent data suggest a reverse order and place hyperinsulinemia mechanistically upstream of insulin resistance. Genetic background, consumption of the “modern” Western diet and over-nutrition may increase insulin secretion, decrease insulin pulses and/or reduce hepatic insulin clearance, thereby causing hyperinsulinemia. Hyperinsulinemia disturbs the balance of the insulin–GH–IGF axis and shifts the insulin : GH ratio towards insulin and away from GH. This insulin–GH shift promotes energy storage and lipid synthesis and hinders lipid breakdown, resulting in obesity due to higher fat accumulation and lower energy expenditure. Hyperinsulinemia is an important etiological factor in the development of metabolic syndrome, type 2 diabetes, cardiovascular disease, cancer and premature mortality. It has been further hypothesized that nutritionally driven insulin exposure controls the rate of mammalian aging. Interventions that normalize/reduce plasma insulin concentrations might play a key role in the prevention and treatment of age-related decline, obesity, type 2 diabetes, cardiovascular disease and cancer. Caloric restriction, increasing hepatic insulin clearance and maximizing insulin sensitivity are at present the three main strategies available for managing hyperinsulinemia. This may slow down age-related physiological decline and prevent age-related diseases. Drugs that reduce insulin (hyper) secretion, normalize pulsatile insulin secretion and/or increase hepatic insulin clearance may also have the potential to prevent or delay the progression of hyperinsulinemia-mediated diseases. Future research should focus on new strategies to minimize hyperinsulinemia at an early stage, aiming at successfully preventing and treating hyperinsulinemia-mediated diseases.

scholarly journals Efficacy of Nutrition Counseling by a Dietitian in Improving Clinical Outcomes for People with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of RCTs

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 281-281
Author(s):  
George Siopis ◽  
Stephen Colagiuri ◽  
Margaret Allman-Farinelli
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Outcomes ◽  
Healthcare Professionals ◽  
Diabetes Management ◽  
Meta Analysis ◽  
Intervention Group ◽  
Nutrition Therapy ◽  
Nutrition Intervention ◽  
Haemoglobin A1c

Abstract Objectives Nutrition therapy is crucial for the treatment of type 2 diabetes. Preliminary data indicate that nutrition therapy delivered by accredited dietitians achieves better clinical outcomes than when delivered by other healthcare professionals. We compared dietetic intervention provided by accredited dietitians with nutrition advice provided by other healthcare professionals. Methods Systematic literature review and meta-analysis of RCTs of type 2 diabetes management programmes (3 months or more) implementing medical nutrition therapy and reporting changes in haemoglobin A1c (HbA1c) and other clinical outcomes that have been published in CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO between 2008 to 18th June 2019. Results Seven studies with a total of 950 participants were included in the meta-analysis. The mean changes [95% CI:] at six or twelve months follow-up in HbA1c, BMI, weight and low-density lipoprotein (LDL) were –0.37 [–0.56, –0.19], –0.56 [–1.14, 0.02], –2.40 [–3.59, –1.20] and –0.16 [–0.29, –0.02] respectively in favour of the intervention group. Conclusions Nutrition intervention provided by a dietitian results in better clinical outcomes of type 2 diabetes, compared with that delivered by other healthcare professionals. Further longitudinal randomised studies are warranted to elucidate long-term (more than one year) effects of the interventions. Funding Sources Nil funding.

scholarly journals Patient characteristics related to metabolic disorders and chronic complications in type 2 diabetes mellitus patients hospitalized at the Qingdao Endocrine and Diabetes Hospital from 2006 to 2012 in China

2016 ◽  
Vol 14 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Yanhu Dong ◽  
Weiguo Gao ◽  
Lei Zhang ◽  
Jia Wei ◽  
Niklas Hammar ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Metabolic Disorders ◽  
Diabetes Management ◽  
Density Lipoprotein ◽  
Insulin Injection ◽  
Chinese Patients ◽  
Haemoglobin A1c

Objective: To study the clinical characteristics related to metabolic disorders and complications in type 2 diabetes mellitus patients hospitalized in the Qingdao Endocrine and Diabetes Hospital from 2006 to 2012 in Qingdao, China. Patient population and methods: Data from 14,289 (51% males) type 2 diabetes mellitus patients hospitalized between 2006 and 2012 were collected and analysed. Information on patients’ demographic, anthropometric, laboratory and disease histories were extracted from electronic medical records. Results: The mean age of the patients was 60.5 years, with median diabetes duration of 9.0 years. Mean haemoglobin A1c was 8.4%, where <30.0% of patients had haemoglobin A1c <7.0%. In all, 34.5% of patients had low-density lipoprotein cholesterol lower than 2.6 mmol/L and 31.9% had hypertriglyceridaemia. Retinopathy was diagnosed in 51.1% of patients, nephropathy in 21.6%, neuropathy in 50.4%, hypertension in 77.4%, coronary heart disease in 27.6% and peripheral vascular disease in 58.6%. Once hospitalized, 71.1% of patients underwent insulin injection treatments, either mono-therapy or combined with other anti-diabetic drugs. Metformin was prescribed to 36.9% of patients, followed by acarbose 29.9%, thiazolidinediones 18.1%, meglitinides 14.8% and sulfonylureas 10.7%. Conclusion: Inadequate control of hyperglycaemia, poor metabolic profiles and diabetic complications were common challenges for long-term diabetes management in Chinese patients with type 2 diabetes mellitus.

scholarly journals Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 580
Author(s):  
Yu-Ting Li ◽  
Yi Wang ◽  
Xiu-Jing Hu ◽  
Jia-Heng Chen ◽  
Yun-Yi Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Diabetes Management ◽  
Clinical Laboratory ◽  
Clinical Inertia ◽  
Diabetic Patients ◽  
Haemoglobin A1c ◽  
Ordinal Logistic Regression Analysis

A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to ‘clinical inertia’ in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words)

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