Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 6 Articles
Background: We aimed to describe the safety and efficacy of insulin glargine in Chinese paediatric patients with\ntype 1 diabetes mellitus (T1DM). Neutral protamine Hagedorn (NPH) insulin was the reference therapy.\nMethods: This open-label, randomised, Phase III study was conducted at 10 sites in China. Children aged ââ?°Â¥6 to\n<18 years with T1DM were randomised (2:1) to insulin glargine or NPH insulin asbasal insulinfor a 24-week\ntreatment period. For all patients, insulin aspart was given as bolus insulin. The primary endpoint was absolute\nchange in glycated haemoglobin(HbA1c) from baseline to Week 24. Secondary endpoints included the percentage\nof patients reaching HbA1c <7.5% (<58.5 mmol/mol), and safety. The study was registered at clinicaltrials.gov\n(NCT01223131).\nResults: In total,196 patients were screened, and 162 were randomised (107 and 55 patients were randomised to\ninsulin glargine and NPH insulin, respectively). The mean Ã?± SD of absolute change in HbA1c wasââ?¬â??0.25 Ã?± 1.68% (ââ?¬â??2.69 Ã?±\n18.32 mmol/mol) in the insulin glargine group and ââ?¬â??0.54 Ã?± 1.67% (ââ?¬â??5.55 Ã?± 20.32 mmol/mol) in the NPH insulin group.\nAt Week 24, 18.7 and 21.6% of patients in the insulin glargine and NPH insulin groups achieved HbA1c <7.5% (<58.\n5 mmol/mol). Both treatments were generally well tolerated. A numerically lower rate of symptomatic hypoglycaemia\nper patient year was observed for insulin glargine versus NPH insulin (24.3 Ã?± 45.8 versus32.3 Ã?± 43.2); severe\nhypoglycaemia was rare (<2%).\nConclusions: Initiation of insulin glargine can aid Chinese paediatric patients with T1DM to safely reduce their HbA1c\nlevels....
Background: Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed\nscreening intervals typically based on expert opinion. This study aims to demonstrate that HbA1c screening\nintervals may differ substantially when considering individual risk for diabetes.\nMethods: This was a multi-institutional retrospective open cohort study. Data were collected between April 1999 to\nMarch 2014 from one urban and one rural cohort in Japan. After categorization by age, we stratified individuals\nbased on cardiovascular disease risk (Framingham 10-year cardiovascular risk score) and body mass index (BMI). We\nadapted a signal-to-noise method for distinguishing true HbA1c change from measurement error by constructing a\nlinear random effect model to calculate signal and noise of HbA1c. Screening interval for HbA1c was defined as\ninformative when the signal-to-noise ratio exceeded 1.\nResults: Among 96,456 healthy adults, 46,284 (48.0%) were male; age (range) and mean HbA1c (SD) were 48\n(30ââ?¬â??74) years old and 5.4 (0.4)%, respectively. As risk increased among those 30ââ?¬â??44 years old, HbA1c\nscreening intervals for detecting Type 2 DM consistently decreased: from 10.5 (BMI <18.5) to 2.4 (BMI > 30)\nyears, and from 8.0 (Framingham Risk Score <10%) to 2.0 (Framingham Risk Score ââ?°Â¥20%) years. This trend\nwas consistent in other age and risk groups as well; among obese 30ââ?¬â??44 year olds, we found substantially\nshorter intervals compared to other groups.\nConclusion: HbA1c screening intervals for identification of DM vary substantially by risk factors. Risk\nstratification should be applied when deciding an optimal HbA1c screening interval in the general population\nto minimize overdiagnosis and overtreatment....
Background: Identifying patients with diabetes at increased risk of chronic kidney disease (CKD) is essential to\nprevent/slow the progression to end-stage renal disease (ESRD). CKD and diabetic peripheral neuropathy (DPN)\nshare common mechanisms. Hence, we aimed to examine the relationship between foot insensitivity and CKD in\npatients with Type 2 diabetes.\nMethods: A prospective observational cohort study in adults with Type 2 diabetes. Patients with ESRD were excluded.\nFoot insensitivity was assessed using the 10-g monofilament test. Renal function was assessed using estimated glomerular\nfiltration rate (eGFR) based on the MDRD equation. Albuminuria was defined as the presence of urinary albumin/creatinine\nratio (ACR) >3.4 mg/mmol.\nResults: Two hundred and twenty eight patients were recruited and followed-up for 2.5 years. One hundred\nand ninety patients (83.4%) had eGFR ââ?°Â¥ 60 ml/min/1.73 m2. Seventy six (33.3%) patients had foot insensitivity\n(i.e. abnormal monofilament test). Patients with foot insensitivity had lower eGFR and higher prevalence of\nalbuminuria compared to patients with normal monofilament test. After adjustment for age, gender, ethnicity,\ndiabetes duration, HbA1c, body mass index, insulin treatment, number of anti-hypertensives, history of peripheral vascular\ndisease, and baseline eGFR (R2 0.87), baseline foot insensitivity was associated with study-end eGFR (B = âË?â??3.551, p = 0.036).\nConclusions: Patients with Type 2 diabetes and foot insensitivity are at increased risk of eGFR decline. Identifying these\npatients offers an opportunity to intensify metabolic and blood pressure control to prevent/retard the development of\nCKD. Future studies of larger sample size and longer follow up from multiple centres are needed to assess the diagnostic\nperformance of our findings in predicting CKD development, and to compare the performance of the monofilament test\nwith albuminuria....
Coronary heart disease (CHD) and stroke are common complications of type 2 diabetes mellitus (T2DM). We aimed to explore\nthe differences in the risks of CHD and stroke between Chinese women and men with T2DMand their association with metabolic\nsyndrome (MS). This study included 1514 patients with T2DM.The Asian Guidelines of ATPIII (2005) were used forMS diagnosis,\nand the UKPDS risk engine was used to evaluate the 10-year CHD and stroke risks. Women had lower CHD risk (15.3% versus\n26.3%), fatal CHD risk (11.8% versus 19.0%), stroke risk (8.4% versus 10.3%), and fatal stroke risk (1.4% versus 1.6%) compared with\nmenwith T2DM(...
The prevalence of gestational diabetes mellitus is increasing in parallel with the rising prevalence of type 2 diabetes and obesity\naround the world. Current evidence strongly suggests that women who have had gestational diabetes mellitus are at greater risk\nof cardiovascular disease later in life. Given the growing prevalence of gestational diabetes mellitus, it is important to identify\nappropriate reliable markers of cardiovascular disease and specific treatment strategies capable of containing obesity, diabetes, and\nmetabolic syndrome in order to reduce the burden of cardiovascular disease in the women affected....
Background: Initial classification of diabetes of young may require revision to improve diagnostic accuracy of\ndifferent forms of diabetes.\nThe aim of our study was to examine markers of beta-cell autoimmunity in a cohort of young (0ââ?¬â??25 years) patients\nwith type 1 diabetes and compare the presentation and course of the disease according to the presence of\npancreatic antibodies.\nMethods: Cross-sectional population-based study was performed covering 100% of pediatric (n = 860) and 70% of\n18ââ?¬â??25 years old adult patients (n = 349) with type 1 diabetes in Lithuania.\nResults: No antibodies (GAD65, IA-2, IAA and ICA) were found in 87 (7.5%) cases. Familial history of diabetes was\nmore frequent in those with antibodies-negative diabetes (24.1 vs. 9.4%, p < 0.001). Gestational age, birth weight\nand age at diagnosis was similar in both groups. Ketosis at presentation was more frequent in patients with\nautoimmune diabetes (88.1 vs. 73.5%, p < 0.05). HbA1c at the moment of investigation was 8.6 (3) vs. 8.7 (2.2)% in\nantibodies-negative and antibodies-positive diabetes groups, respectively, p > 0.05. In the whole cohort, neuropathy\nwas found in 8.8% and nephropathy - in 8.1% of cases, not depending on autoimmunity status. Adjusted for age at\nonset, disease duration and HbA1c, retinopathy was more frequent in antibodies-negative subjects (13.8 vs. 7.8%, p\n< 0.05).\nConclusion: Antibodies-negative pediatric and young adult patients with type 1 diabetes in this study had higher\nincidence of family history of diabetes, higher frequency of retinopathy, less frequent ketosis at presentation, but\nsimilar age at onset, HbA1c, incidence of nephropathy and neuropathy compared to antibodies-positive patients....
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