Evaluate the Impact of Diabetes on RA-related outcomes in an Electronic Health Record-Based Rheumatology Registry

Objective RA patients with diabetes might have worse clinical outcomes and adverse events compared to non-diabetes patients. We evaluated the effects of diabetes on HAQ (Health Assessment Questionnaire) change and outpatient infection in RA patients. Methods Using the ACR’s Rheumatology Informatics System for Effectiveness (RISE) EHR-based registry, we identified RA patients who had ≥1 rheumatologist visit with a HAQ measured (index visit) in 2016, ≥1 previous visit, and a subsequent outcome visit with same HAQ measured at 12 months (± 3 months). We identified diabetes by diagnosis codes, medications, or lab values. Outpatient infection was defined by diagnosis codes or anti-infective medications. We calculated mean HAQ change and incidence rate (IR) of outpatient infections among patients with and without diabetes. Generalized linear models and Cox regression were used to calculate the adjusted mean HAQ change and hazard ratios (HR). Results We identified 3,853 RA patients with diabetes and 18,487 without diabetes. The mean HAQ change between index and outcome visit among diabetes patients was 0.03 and non-diabetic was 0.002 (p<0.01). We identified 761 outpatient infections for diabetic patients with an IR of 22.6 (95% CI: 21.0-24.2) per 100 person years and 3,239 among non-diabetic patients with an IR of 19.8 (19.1-20.5). The adjusted HR of outpatient infection among diabetes was 0.99 (0.91-1.07), compared to non-diabetes patients. Conclusion RA patients with concomitant diabetes had greater worsening, or less improvement, in their functional status, suggesting additional interventions may be needed for RA patients with diabetes to optimize treatment and other comorbidities.

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Diabetic Patients with Comorbidities had Worse Outcomes When Suffered with COVID-19 and Acarbose might have Protective Effects

10.21203/rs.3.rs-57456/v1 ◽

2020 ◽

Author(s):

Weihua Hu ◽

Shunkui Luo ◽

Zhanjin Lu ◽

Chang Li ◽

Qijian Chen ◽

...

Keyword(s):

Cox Regression ◽

Survival Curve ◽

Hubei Province ◽

Diabetic Patients ◽

Protective Effects ◽

Diabetes Group ◽

Risk Of Death ◽

Significant Difference ◽

Patients With Diabetes ◽

Diabetes Patients

Abstract Background: Previous studies showed that diabetes was a common comorbidity of COVID-19, but the effects of diabetes or anti-diabetic drugs on the mortality of COVID-19 have not been well described. To investigate the outcome of different status (with or without comorbidity) and anti-diabetic medication before admission of diabetic patients after SARS-CoV-2 infected, we collected clinical data of COVID-19 patients from Hubei Province and compared between diabetes and non-diabetes.Methods: In this multicenter and retrospective study, we enrolled 1,422 cases of consecutive hospitalized patients from January 21, 2020 to March 25, 2020 at six hospitals in Hubei Province, China. The primary endpoint was in-hospital mortality.Results: Diabetes patients were 10-years older than non-diabetes (p<0.001), had higher prevalence of comorbidities such as hypertension (p<0.001), coronary heart disease (p<0.001), cerebrovascular disease (CVD) (p<0.001), chronic kidney disease (CKD) (p=0.007). The incidence of mortality (p=0.003) were more prevalent among the diabetes group. Further analysis revealed that diabetes patients who took alpha-glucosidase inhibitor (AGI) had lower mortality rate(p<0.01). Multivariable Cox regression showed that male sex, hypertension, CKD, CVD, age were risk factors for the mortality of COVID-19. Survival curve revealed that, compared with diabetes only group, the mortality was increased in diabetes with comorbidities (p=0.009), but had no significant difference in the non-comorbidity group, p=0.59).Conclusions: Patients with diabetes had worse outcome when suffered with COVID-19, however, it was not associated with diabetes itself but the comorbidities. Furthermore, the administration of AGI could reduce the risk of death in patients with diabetes.

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Adjuvant Supplementation with L-Carnitine in Diabetic Population and its effects on Lipid Parameters

10.53350/pjmhs211582017 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2017-2019

Author(s):

Rao Salman Aziz ◽

Usman Saeed ◽

Nasim Aslam Ghumman ◽

Muhammad Arshad ◽

Asif Sohail ◽

...

Keyword(s):

Diabetes Mellitus ◽

Triglyceride Level ◽

Clinical Care ◽

Diabetic Patients ◽

Healthy Population ◽

Patients With Diabetes ◽

Diabetic Population ◽

Large Discount ◽

The Impact ◽

Lipid Parameters

Background: Diabetes is a complicated disease requires continuous clinical care, to govern blood sugar. Aim: To decides the impact of management of L carentin to diabetics at the lipid profile. Methods: This study turned into performed on 120 diabetic Patients had been decided on from endocrinology and diabetes, inside decided on standards. The Patients distributed into three Strata (1st Strata of healthy population and two Strata of patients with diabetes who were on metformin and glibenclamide, one Strata took a L carnitine in a dose of 1000 mg TDS and a Strata dealing with a placebo for a period of ninety days). Results: It is observed those who are on Lcarnitine, confirmed a large discount (p <0.05) with inside the triglyceride level, at the same time as no large adjustments had been located withinside the level of cholesterol and HDL and LDL. Conclusion: These study outcomes that management of L carentin improved profile of lipid in type-2diabetic Patients. Keyword: Dyslipidemia, Diabetes mellitus (DM), l-carnitine (LC).

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H3K27M-mutant Diffuse Midline Gliomas should be Further Molecularly Stratified: An Integrated Analysis of 669 Patients

10.21203/rs.3.rs-949930/v1 ◽

2021 ◽

Author(s):

Huy Gia Vuong ◽

Hieu Trong Le ◽

Tam N.M. Ngo ◽

Kar-Ming Fung ◽

James D. Battiste ◽

...

Keyword(s):

Cox Regression ◽

Fatal Outcome ◽

Extent Of Resection ◽

Tumor Location ◽

Genetic Alterations ◽

Integrated Analysis ◽

Prognostic Impact ◽

Kaplan Meier ◽

Hazard Ratios ◽

The Impact

Abstract Introduction: H3K27M-mutated diffuse midline gliomas (H3-DMGs) are aggressive tumors with a fatal outcome. This study integrating individual patient data (IPD) from published studies aimed to investigate the prognostic impact of different genetic alterations on survival of these patients.Methods: We accessed PubMed and Web of Science to search for relevant articles. Studies were included if they have available data of follow-up and additional molecular investigation of H3-DMGs. For survival analysis, Kaplan-Meier analysis and Cox regression models were utilized, and corresponding hazard ratios (HR) and 95% confidence intervals (CI) were computed to analyze the impact of genetic events on overall survival (OS).Result: We included 30 studies with 669 H3-DMGs. TP53 mutations were the most common second alteration among these neoplasms. In univariate Cox regression model, TP53 mutation was an indicator of shortened survival (HR = 1.446; 95% CI = 1.143-1.829) whereas ACVR1 (HR = 0.712; 95% CI = 0.518-0.976) and FGFR1 mutations (HR = 0.408; 95% CI = 0.208-0.799) conferred prolonged survival. In addition, ATRX loss was also associated with a better OS (HR = 0.620; 95% CI = 0.386-0.996). Adjusted for age, gender, tumor location, and the extent of resection, the presence of TP53 mutations, the absence of ACVR1 or FGFR1 mutations remained significantly poor prognostic factors.Conclusions: We outlined the prognostic importance of additional genetic alterations in H3-DMGs and recommended that these neoplasms should be further molecularly segregated. It could help neuro-oncologists better evaluate the risk stratification of patients and consider pertinent treatments.

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Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽

10.1515/med-2018-0048 ◽

2018 ◽

Vol 13 (1) ◽

pp. 304-323 ◽

Cited By ~ 3

Author(s):

Hernando Vargas-Uricoechea ◽

Manuel Felipe Cáceres-Acosta

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Angiotensin Receptor Blockers ◽

Pharmacological Therapy ◽

Current Evidence ◽

Diabetic Patients ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Patients With Diabetes ◽

The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

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Abstract 3230: Elevated Glucose and Mortality in Patients Hospitalized with Heart Failure

Circulation ◽

10.1161/circ.118.suppl_18.s_1117-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Mikhail Kosiborod ◽

Silvio Inzucchi ◽

John A Spertus ◽

Yongfei Wang ◽

Frederick A Masoudi ◽

...

Keyword(s):

Heart Failure ◽

Cox Regression ◽

Linear Trend ◽

Adverse Outcomes ◽

Entire Cohort ◽

Hazard Ratios ◽

Elevated Glucose ◽

Nationally Representative ◽

Support Resource ◽

The Impact

Background: While some professional societies recommend target-driven blood glucose (BG) control for all hospitalized patients, the association between elevated BG and adverse outcomes has not been well established in patients hospitalized with heart failure (HF). Methods: We evaluated a nationally representative cohort of 50,532 patients hospitalized with HF between 04/1998 – 06/2001. Admission BG was analyzed as a categorical variable (≤110, >110 –140, >140 –170, >170 –200, >200 mg/dL), and in 10 mg/dL increments. The association between BG and all-cause mortality over 30 days and 1 year was analyzed using Cox regression, both in the entire cohort and in patients with and without diabetes (DM). Results: After multivariable adjustment, there was no significant relationship between BG and 30-day mortality (for BG >110 to 140, >140 to 170, >170 to 200, and >200, hazard ratios and 95% confidence intervals were: 1.09 (0.98 –1.22), 1.27 (1.11–1.45), 1.16 (0.98–1.37), 1.00 (0.87–1.15) respectively vs. BG ≤110, P for linear trend 0.53). Results were similar for 1-year mortality, and did not differ between patients with and without DM (P values for DM*BG interaction 0.11 and 0.55 for 30-day and 1-year mortality respectively). A lack of association between BG and mortality over 30-days and 1-year was also observed when BG was analyzed in 10mg/dL increments (Figure ). Conclusions: We found no significant association between BG and mortality in a large cohort of hospitalized HF patients. While the impact of BG lowering on outcomes cannot be determined based on this study, our findings do not support resource-intensive interventions for BG monitoring and management in this patient group.

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Prevalence of Depression and Associated Factors among Diabetic Patients in an Outpatient Diabetes Clinic

Psychiatry Journal ◽

10.1155/2019/2083196 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Zahra D. Khan ◽

Janet Lutale ◽

Sibtain M. Moledina

Keyword(s):

Associated Factors ◽

Diabetic Patients ◽

Mild Depression ◽

Diabetes Clinic ◽

Cross Sectional ◽

Adequate Treatment ◽

Moderate Depression ◽

Prevalence Of Depression ◽

Patients With Diabetes ◽

Diabetes Patients

Despite adequate treatment for diabetes, it is estimated that 15%- 20% of people with diabetes are struggling with a moderate to severe form of depression daily. Little is known about depression in diabetes in East Africa, particularly in Tanzania. The study is aimed at determining the prevalence of depression and associated factors among patients with diabetes. A descriptive cross-sectional study was carried out at the diabetes clinic of Muhimbili National Hospital. The 9-item Patient Health Questionnaire (PHQ 9) scale was used to assess presence of depressive symptoms among diabetes patients at the clinic. In addition, patient’s sociodemographic and clinical characteristics were obtained and analysed for their association with depression. A total of 353 participants were recruited, of whom 229 (64.9%) patients were female and 156 (44.2%) were aged between 41 and 60 years. The overall prevalence of depression among diabetes patients at the diabetes clinic was 87%. Most (56.7%) had minimal depression, 22.1% had mild depression, and 8.2% had moderate depression. None had severe depression. Factors independently associated with a diagnosis of mild to moderate depression were being on insulin therapy and being a current smoker. There was a high prevalence of depression in this diabetic population. Majority of patients had minimal depression but about 30% had either mild or moderate depression. A holistic approach that focuses on the identification and management of depression among patients with diabetes is recommended.

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A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01778-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhubin Lun ◽

Li Lei ◽

Dianhua Zhou ◽

Ming Ying ◽

Liwei Liu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Angiography ◽

Cox Regression ◽

Kidney Injury ◽

Diabetic Patients ◽

Patients With Diabetes ◽

Long Term Prognosis ◽

Population Attributable Risks ◽

Long Term Mortality

Abstract Background The definitions of contrast-associated acute kidney injury (CA-AKI) are diverse and have different predictive effects for prognosis, which are adverse for clinical practice. Few articles have discussed the relationship between these definitions and long-term prognosis in patients with diabetes. Methods A total of 1154 diabetic patients who were undergoing coronary angiography (CAG) were included in this study. Two definitions of CA-AKI were used: CA-AKIA was defined as an increase ≥ 0.3 mg/dl or > 50% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIB was defined as an increase ≥ 0.5 mg/dl or > 25% in SCr from baseline within 72 h after CAG. We used Cox regression to evaluate the association of these two CA-AKI definitions with long-term mortality and calculate the population attributable risks (PARs) of different definitions for long-term prognosis. Results During the median follow-up period of 7.4 (6.2–8.2) years, the overall long-term mortality was 18.84%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 36.73% and 28.86%, respectively. We found that CA-AKIA (HR: 2.349, 95% CI 1.570–3.517, p = 0.001) and CA-AKIB (HR: 1.608, 95% CI 1.106–2.339, p = 0.013) were associated with long-term mortality. The PARs were the highest for CA-AKIA (31.14%), followed by CA-AKIB (14.93%). Conclusions CA-AKI is a common complication in diabetic patients receiving CAG. The two CA-AKI definitions are significantly associated with a poor long-term prognosis, and CA-AKIA, with the highest PAR, needs more clinical attention.

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Impact of Diabetes Mellitus and Its Comorbidities on Elderly Patients Hospitalized in Internal Medicine Wards: Data from the RePoSi Registry

Healthcare ◽

10.3390/healthcare10010086 ◽

2022 ◽

Vol 10 (1) ◽

pp. 86

Author(s):

Christiano Argano ◽

Giuseppe Natoli ◽

Salvatore Mularo ◽

Alessandro Nobili ◽

Marika Lo Monaco ◽

...

Keyword(s):

Internal Medicine ◽

Elderly Patients ◽

Real Life ◽

Chronic Obstructive ◽

Laboratory Findings ◽

Obstructive Pulmonary Disease ◽

Patients With Diabetes ◽

The Impact ◽

Diabetes Patients

Background: Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients affected by diabetes. Methods: In this observational study, we retrospectively analyzed data collected from the REgistro dei pazienti per lo studio delle POlipatologie e politerapie in reparti della rete Simi (RePoSI) registry. Socio-demographic, clinical characteristics, and laboratory findings were considered. The association between variables and in-hospital and 1-year follow-up were analyzed. Results: Among 4708 in-patients, 1378 (29.3%) had a diagnosis of diabetes. Patients with diabetes had more previous hospitalization, a clinically significant disability, and more need for a urinary catheter in comparison with subjects without diabetes. Patients affected by diabetes took more drugs, both at admission, at in-hospital stay, at discharge, and at 1-year follow-up. Thirty-five comorbidities were more frequent in patients with diabetes, and the first five were hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and chronic obstructive pulmonary disease (22.7%). Heart rate was an independent predictor of in-hospital mortality. At 1-year follow-up, cancer and male sex were strongly independently associated with mortality. Conclusions: Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes.

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Incidence and Risk Factors for Amputation in Patients With Diabetes in Japan: A Historical Cohort Study Using a Nationwide Claims Database

10.21203/rs.3.rs-125853/v1 ◽

2020 ◽

Author(s):

Masanori Kaneko ◽

Kazuya Fujihara ◽

Taeko Osawa ◽

Masahiko Yamamoto ◽

Mayuko Yamada Harada ◽

...

Keyword(s):

Cox Regression ◽

Historical Cohort ◽

Cox Regression Analysis ◽

Claims Database ◽

Hazard Ratios ◽

Patients With Diabetes ◽

Mortality Predictors ◽

Hba1c Levels

Abstract Background: Because amputation negatively affects the quality of life of patients with diabetes and increases the risk of cardiovascular events and mortality, predictors of amputation must be identified. However, no large cohort studies have been conducted regarding the incidence of amputation in patients with diabetes in East Asia.Methods: We analyzed data from a nationwide claims database in Japan accumulated from 2008–2016, involving 17,288 patients with diabetes aged 18–72 y (2942 women, mean age 50.2 y, HbA1c 7.2%).Results: The mean follow-up time was 5.3 years, and 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age and HbA1c levels were independent predictors of amputation (hazard ratios [HRs], 1.09 and 1.43; 95% confidence intervals [CIs], 1.01–1.16 and 1.12–1.82, respectively). Compared with patients aged <60 y and with HbA1c <8%, the HR for patients aged ≥60 y and with HbA1c ≥8% was 32.1 (95% CI, 7.30–141.2).Conclusions: Improved glycemic control may lower amputation risk.

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Effect of nutrition education on dietary diversity score of type 2 diabetes patients

10.21203/rs.3.rs-51087/v1 ◽

2020 ◽

Author(s):

Robert Mutagwanya ◽

Christine Magala Nyago ◽

Fredrick Nelson Nakwagala

Keyword(s):

Type 2 Diabetes ◽

Nutrition Education ◽

Diabetes Management ◽

Dietary Diversity ◽

Control Group ◽

Mulago Hospital ◽

Diabetic Patients ◽

The Impact ◽

Diabetes Patients

Abstract Background: Consumption of a varied diet reduces the risk of developing a deficiency or excess of any one nutrient. One of the three corner stones of diabetes management is diet and therefore, dietary diversity is key among diabetes patients. Objective: The objective of this study was to establish the impact of nutrition education on the dietary diversity scores (DDS) among type 2 diabetes patients. Methods: Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 21). Pair sample t-test was used to compare total DDS after and before nutrition education. P< 0.05 was considered as statistically significant.Subjects: One hundred type 2 diabetic patients were randomly selected and divided into two groups of intervention and control (50 patients in each group) to participate in the study. Data were collected using a pre-tested questionnaire before and after intervention every after one month for a period of four months of intervention.Results: The average age of patients who participated in the study was 48 (40–51) years. Most of the patients were females (65.39%), compared to males (34.01%). At the end of the study period of four months, DDS in the control group decreased from 40.08% to 38.49% (p=0.064) while in the intervention group, DDS increased from 35.30 % to 54.20% (p<0.001). Conclusion: Dietary diversity increased after nutrition education among type 2 diabetes patients.Trial registration: The study was registered and approved on 17th April 2013 by the Research and Ethics committee of Mulago Hospital and Institutional Review Board of Mulago hospital (Protocol MREC 113).

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