Current Issue : July - September Volume : 2016 Issue Number : 3 Articles : 5 Articles
Backgrounds: The number and activity of circulating endothelial progenitor cells (EPCs) in prehypertension is\npreserved in premenopausal women. However, whether this favorable effect still exists in prehypertensive premenopausal\nwomen with diabetes is not clear.\nMethods: This study compared the number and functional activity of circulating EPCs in normotensive or\nprehypertensive premenopausal women without diabetes mellitus and normotensive or prehypertensive\npremenopausal women with diabetes mellitus, evaluated the vascular endothelial function in each groups,\nand investigated the possible underlying mechanism.\nResults: We found that compared with normotensive premenopausal women, the number and function of\ncirculating EPCs, as well as endothelial function evaluated by flow-mediated dilatation (FMD) in prehypertensive\npremenopausal women were preserved. In parallel, the Tie2/Akt/eNOS signaling pathway and the plasma NO level or\nNO secretion of circulating EPCs in prehypertensive premenopausal women was also retained. However, in presence\nof normotension or prehypertension with diabetes mellitus, the number or function of circulating EPCs and FMD in\npremenopausal women decreased. Similarly, the phosphorylation of Tie2/Akt/eNOS signaling pathway and the plasma\nNO level or NO secretion of circulating EPCs was reduced in prehypertension premenopausal with diabetes mellitus.\nConclusion: The present findings firstly demonstrate that the unfavorable effects of diabetes mellitus on number and\nactivity of circulating EPCs in prehypertension premenopausal women, which is at least partially related to the\nabnormal phosphorylation of Tie2/Akt/eNOS signaling pathway and subsequently reduced nitric oxide bioavailability. The\nTie2/Akt/eNOS signaling pathway may be a potential target of vascular protection in prehypertensive premenopausal\nwomen with diabetes mellitus...
Background: Islet cell transplantation is a method to stabilize type 1 diabetes patients with hypoglycemia unawareness\nand unstable blood glucose levels by reducing insulin dependency and protecting against severe hypoglycemia through\nrestoring endogenous insulin secretion. This study analyses the current cost-effectiveness of this technology and\nestimates the value of further research to reduce uncertainty around cost-effectiveness.\nMethods: We performed a cost-utility analysis using a Markov cohort model with a mean patient age of 49 to simulate\ncosts and health outcomes over a life-time horizon. Our analysis used intensive insulin therapy (IIT) as comparator and\ntook the provincial healthcare provider perspective. Cost and effectiveness data for up to four transplantations per patient\ncame from the University of Alberta hospital.\nCosts are expressed in 2012 Canadian dollars and effectiveness in quality-adjusted life-years (QALYs) and life years. To\ncharacterize the uncertainty around expected outcomes, we carried out a probabilistic sensitivity analysis within the\nBayesian decision-analytic framework. We performed a value-of-information analysis to identify priority areas for future\nresearch under various scenarios. We applied a structural sensitivity analysis to assess the dependence of outcomes on\nmodel characteristics.\nResults: Compared to IIT, islet cell transplantation using non-generic (generic) immunosuppression had additional\ncosts of $150,006 ($112,023) per additional QALY, an average gain of 3.3 life years, and a probability of being costeffective\nof 0.5 % (28.3 %) at a willingness-to-pay threshold of $100,000 per QALY. At this threshold the non-generic\ntechnology has an expected value of perfect information (EVPI) of $260,744 for Alberta. This increases substantially in\ncost-reduction scenarios. The research areas with the highest partial EVPI are costs, followed by natural history, and\neffectiveness and safety.\nConclusions: Current transplantation technology provides substantial improvements in health outcomes over\nconventional therapy for highly selected patients with ââ?¬Ë?unstableââ?¬â?¢ type 1 diabetes. However, it is much more costly and\nso is not cost-effective. The value of further research into the cost-effectiveness is dependent upon treatment costs.\nFurther, we suggest the value of information should not only be derived from current data alone when knowing that\nthis data will most likely change in the future....
Background: Effective prevention of type 2 diabetes (T2D) requires early identification of high-risk individuals who\nmight benefit from intervention. We sought to determine whether low serum testosterone, a novel risk factor for\nT2D in men, adds clinically meaningful information beyond current T2D risk models.\nMethods: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study population consists of\n2563 community-dwelling men aged 35ââ?¬â??80 years in Adelaide, Australia. Of the MAILES participants, 2038 (80.0 %)\nprovided information at baseline (2002ââ?¬â??2006) and follow-up (2007ââ?¬â??2010). After excluding participants with\ndiabetes (n = 317), underweight (n = 5), and unknown BMI status (n = 11) at baseline; and unknown diabetes\nstatus (n = 50) at follow-up; 1655 participants were followed for 5 years. T2D at baseline and follow-up was\ndefined by self-reported diabetes, or fasting plasma glucose (FPG) ââ?°Â¥7.0 mmol/L (126.1 mg/dL), or glycated\nhaemoglobin (HbA1c) ââ?°Â¥6.5 %, or diabetes medications. Risk models were tested using logistic regression\nmodels. Sensitivity, specificity, positive predictive values (PPV) were used to identify the optimal cut-off point for\nlow serum testosterone for incident T2D and the area under the receiver operating characteristic (AROC) curve\nwas used to summarise the predictive power of the model. 15.5 % of men had at least one missing predictor\nvariable; addressed through multiple imputation.\nResults: The incidence rate of T2D was 8.9 % (147/1655) over a median follow-up of 4.95 years (interquartile\nrange: 4.35-5.00). Serum testosterone level predicted incident T2D (relative risk 0.96 [95 % CI: 0.92,1.00], P = 0.032)\nindependent of current risk models including the AUSDRISK, but did not improve corresponding AROC\nstatistics. A cut-off point of <16 nmol/L for low serum testosterone, which classified about 43 % of men,\nreturned equal sensitivity (61.3 % [95 % CI: 52.6,69.4]) and specificity (58.3 % [95 % CI: 55.6,60.9) for predicting\nT2D risk, with a PPV of 12.9 % (95 % CI: 10.4,15.8).\nConclusions: Low serum testosterone predicts an increased risk of developing T2D in men over 5 years\nindependent of current T2D risk models applicable for use in routine clinical practice. Screening for low\nserum testosterone in addition to risk factors from current T2D risk assessment models or tools, including the\nAUSDRISK, would identify a large subgroup of distinct men who might benefit from targeted preventive\ninterventions....
Background: Diabetes mellitus is a worldwide epidemic. In 2002 there were 173 million diabetic\nadults worldwide, and these numbers are expected to reach up to 300 million people by 2030.\nMeanwhile, vitamin D deficiency has its worldwide prevalence directly influenced by factors as\nsolar radiation, skin color, latitude and seasons, cultural habits of populations such as clothing\nand food, and these factors are important to explain the different prevalences of vitamin D deficiency\nin the world. Methods: A prospective cross-sectional cohort study was conducted with patients\nin the outpatient clinic of the Health Unit of the city of Mangueirinha, Paran�¡, Southern Brazil.\nFifty-four type 2 diabetic patients were evaluated (38 women and 16 men), aged 55.8 �± 12.6\nyears. The following variables were evaluated: age, ethnicity, presence of type 2 diabetes (DM2),\nhypertension, dyslipidemia, weight, BMI, WC, blood pressure, blood glucose, glycated hemoglobin,\nionized calcium, PTH, 25-OH Vit, total cholesterol, HDL, LDL, urea, creatinine, uric acid and red\ncell/hematocrit. Results: mean BMI was 30.2 �± 4.4 kg/m2, indicating class 1 obesity in this population.\nFasting glucose levels were approximately 169.8 �± 74.5 mg/dL. The 25-OH vitamin D values\nfor this population were 23.4 �± 8.3 ng/mL, and 13% of them showed 25-OH vitamin D levels above\n30 mg/dL. Fifty percent of those patients had vitamin D levels lower than 30 mg/dL, and 37% had\nless than 20 mg/dL. Conclusions: this study suggests that vitamin D is associated with low levels of\nvitamin D in type 2 diabetic patients. Supplementation of vitamin D should be considered in diabetic\npatients, when levels under 30 mg/mL are found....
Background: Safe and effective insulin therapy for diabetes mellitus requires initial dose titration and regular\nadjustments based on blood glucose (BG) monitoring. Our objective was to explore the use of BG measurement in\nphase-III clinical studies of insulin analogs. These studies provide safety and efficacy information for regulatory\nauthorities and are the basis for insulin analog regulatory approval.\nMethods: A systematic review of phase-III studies of rapid-acting insulin analogs (insulin lispro, insulin aspart and\ninsulin glulisine) and pre-mixed insulin analogs (biphasic insulin aspart and insulin lispro mix) was conducted.\nStudies were identified using manufacturers� databases. Search for reports was performed in Medline and registry of\nclinical trials (clinicaltrials.gov). The European Medicines Agency was contacted to provide Clinical Study Reports.\nResults: Forty-five studies were included. Regular BG measurements were reported in 100 % of the studies and\nwere performed by either self-monitoring of blood glucose (SMBG) alone in 84 %, laboratory alone in 7 %, and\nboth SMBG and laboratory in 9 % of studies. In total, 93 % of the studies reported SMBG. Most studies (91 %)\nreported insulin therapy adjustments based on BG measurements.\nConclusions: The findings suggest that BG monitoring and specifically SMBG are co-dependent technologies with\ninsulin analogs. BG measurement is used in most phase-III registration studies for establishing safe and efficacious\ninsulin administration and is recommended in the insulin labels. The indispensable role of SMBG in treatment of\ninsulin-dependent patients should receive attention from health care payers to assess and reimburse SMBG along\nwith insulin to avoid adverse events from inappropriate insulin administration and associated costs....
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