Higher Prevalence Of Diabetes Mellitus Research Articles

Outcomes of STEMI patients with chronic kidney disease treated with percutaneous coronary intervention: the Malaysian National Cardiovascular Disease Database \u2013 Percutaneous Coronary Intervention (NCVD-PCI) registry data from 2007 to 2014

BackgroundPatients with renal impairment often left out from most major clinical trials assessing the optimal treatment for ST-elevation myocardial infarction (STEMI). Large body of evidence from various cardiovascular registries reflecting more ‘real-world’ experience might contribute to the knowledge on how best to treat this special cohort. We aim to analyze the outcomes of Malaysian STEMI patients with renal impairment treated with coronary angioplasty.MethodsUtilizing the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry data from 2007 to 2014, STEMI patients treated with percutaneous coronary intervention (PCI) were stratified into presence (GFR < 60 mls/min/1.73m2) or absence (GFR ≥ 60 mls/min/1.73m2) of chronic kidney disease (CKD). Patient’s demographics, extent of coronary artery disease, procedural data, discharge medications, short (in-hospital) and long (1 year) term outcomes were critically assessed.ResultsA total of 6563 patients were included in the final analysis. STEMI CKD cohort was predominantly male (80%) with mean age of 61.02 ± 9.95 years. They had higher cardiovascular risk factors namely diabetes mellitus (54.6%), hypertension (79.2%) and dyslipidemia (68.8%) in contrast to those without CKD. There were notably higher percentage of CKD patients presented with Killip class 3 and 4; 24.9 vs 8.7%. Thrombolytic therapy remained the most commonly instituted treatment regardless the status of kidney function. Furthermore, our STEMI CKD cohort also was more likely to receive less of evidence-based treatment upon discharge. In terms of outcomes, patients with CKD were more likely to develop in-hospital death (OR: 4.55, 95% CI 3.11–6.65), MACE (OR: 3.42, 95% CI 2.39–4.90) and vascular complications (OR: 1.88, 95% CI 0.95–3.7) compared to the non-CKD patients. The risk of death at 1-year post PCI in STEMI CKD patients was also reported to be high (HR: 3.79, 95% CI 2.84–5.07).ConclusionSTEMI and CKD is a deadly combination, proven in our cohort, adding on to the current evidence in the literature. We noted that our STEMI CKD patients tend to be younger than the Caucasian with extremely high prevalence of diabetes mellitus. The poor outcome mainly driven by immediate or short term adverse events peri-procedural, therefore suggesting that more efficient treatment in this special group is imperative.

Diabetes and Associated Cardiovascular Complications in American Indians/Alaskan Natives: A Review of Risks and Prevention Strategies.

Diabetes mellitus (DM) is the seventh leading cause of death in the United States and the leading cause of death in the U.S. American Indian/Alaskan Natives (AI/ANs), who comprise only 2% of the total population. The AI/AN population has a high prevalence of DM in adults aged 20 years or older and is developing DM at a younger age than the general U.S. population. DM is a major risk factor for cardiovascular disease (CVD), and mortality from CVD is higher in AI/ANs than the general population, as is the prevalence of stroke and 1-year poststroke mortality for both genders when compared to non-Hispanic whites. A genome-wide scan found a number of chromosome linkages in the AI/AN population that suggest that genetic factors may contribute to their high risk of DM and CVD. Importantly, studies also suggest that in addition to race/ethnicity, cultural norms and historic conditions play important roles in the prevalence of DM and CVD in this population. Therefore, multiple factors should be taken into consideration when establishing prevention programs to decrease the prevalence of obesity, diabetes, and CVD incidence among adults and children in the AI/AN population. Prevention programs should focus on behavioral risk factors and lifestyle changes like encouraging smoking cessation, healthy diet, and increased physical activity while taking into consideration cultural, economic, and geographic factors.

Diabetic Patients Who are Amateur Divers

Abstract Diabetes is an “epidemic of the 21st century” and it is estimated that in 2011 6.7% of Poland’s population suffered from diabetes, one quarter of which was unaware of the disease. Such a high prevalence of diabetes mellitus results in an increasing number of physicians being confronted with the problem of qualifying patient with diabetes to partake in amateur sports, including diving. This publication presents the most important information concerning risk assessment, admission of diabetic patients to amateur diving and some proposed protocols of management before and during sport practice.

Diabetes mellitus in Russian Federation: prevalence, morbidity, mortality, parameters of glycaemic control and structure of glucose lowering therapy according to the Federal Diabetes Register, status 2017

BACKGROUND: The enormous social lesion caused by high prevalence of diabetes mellitus (DM) determines the state importance of clinical and epidemiological monitoring organization.&#x0D; AIMS: To analyze epidemiological characteristics (prevalence, mortality, morbidity), the level ofHbA1c, evaluate the therapy in Russian Federation in 20132017.&#x0D; METHODS: We have used the database of the Russian Federal Diabetes register 81 regions included in the online register system.&#x0D; RESULTS: The total number of patients with DM was 4,498m. (3.06% RF population), including: Type 1 (T1) 5,7% (0,26 m), T2 92,1% (4,15m), other DM types 1,9% (83,8 ths). Distribution male/female: T1 53.5%/46.5%, T2 29%/71%, other DM types 24%/76%. The proportion of men decreases with aging. Number of patients 65 years was 2.293.520, including T1 21.97ths (3.6%), T2 2m271.5ths (54.7%). The prevalence 20132017 per 100,000 population was as follows: T1 159,8169,6; T2 2455.32775.6; other DM types 51,265,8. Morbidity: T1 9,87,0; T2 226,7185,2; other DM types 7,812,4. The structure of causes of death 20132017: T1: diabetic coma 2,01,5%, myocardial infarction 4,04,4%, cerebral circulation disorders 8,27,6%, cardiovascular insufficiency 18,516,4%, chronic renal failure 6,16,0%; T2 0,20,2%, 4,54,5%, 12,712,2%, 29,028,6%, 1,21,8%, respectively. Mortality: T1 2.3; T2 68.4, other DM types 0,8. Life expectancy (average age of death of patients): T1 male 50.350.2, female 60.257.2; T2 69.870.3, 75.175.9 respectively. The number of patients with targetHbA1clevel 7%: T1 22.334.0%, T2 38.052.4%;HbA1c9.0%: T1 29.221.1%, T2 12.68.8%. The most commonly prescribed classes of glucose lowering medications (GLM) in 2017: in monotherapy Metformin (57.3%), Sulfonilurea (SU) (41,1%); in combination of 2 GLM: Metformin+SU 92,58% Metformin+iDPP-4 5.63%; 3 or more GLM: Metformin+SU+iDPP-4 83,9%, Metformin+SU+iSGLT-2 8.98%. The proportion of patients on aGPP-1 therapy is 0.01%.&#x0D; CONCLUSIONS: We observed the growth of prevalence of DM in Russian Federation and decrease in registered morbidity rate; an increase in life expectancy in T2; decrease in mortality due to diabetic coms and stable mortality rate from cardiovascular events (heart attack, stroke, cv deficiency), gangrene, chronic renal failure in both types of DM; a steady improvement in glycemic control. In the structure of T2 therapy the oral GLMs are dominated, especially Metformin and SU. In the dynamics the prescription of Metformin, insulin, iDPP-4, iSGLT-2 has increased, the proportion of SU has decreased.

Benefit and Risk of Prolonged DAPT After Coronary Stenting in Women.

Women may derive differential benefit from prolonged DAPT (dual antiplatelet therapy) after coronary stenting than men. We assessed whether the risks/benefits of prolonged DAPT differ between women and men. The DAPT study was a randomized double-blind, placebo-controlled trial comparing continued thienopyridine versus placebo beyond 12 months after coronary stenting. We compared rates of myocardial infarction, stent thrombosis, major adverse cardiovascular and cerebrovascular events, and bleeding by sex and randomized treatment. Of 11 648 patients, women (N=2925) were older, with higher prevalence of diabetes mellitus and lower rates of acute coronary syndrome than men. At 12 to 30 months, women had similar adjusted ischemic and bleeding events as men. The effects of continued thienopyridine therapy did not differ significantly by sex for stent thrombosis (women: hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.22-1.36; men: HR, 0.26; 95% CI, 0.15-0.44; interaction P=0.17), myocardial infarction (women: HR, 0.75; 95% CI, 0.50-1.14; men: HR, 0.46; 95% CI, 0.36-0.60; interaction P=0.052), major adverse cardiovascular and cerebrovascular events (women: HR, 0.87; 95% CI, 0.62-1.22; men: HR, 0.70; 95% CI, 0.58-0.85; interaction P=0.26), and bleeding (women: HR, 1.45; 95% CI, 0.88-2.40; men: HR, 1.78; 95% CI, 1.28-2.49; interaction P=0.50). Women had similar late risks of ischemia and bleeding as men after coronary stent procedures. URL: https://www.clinicaltrials.gov . Unique identifier: NCT00977938.

Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa.

Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. A qualitative descriptive approach was used to collect and analyse data. Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant's utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant's utilisation of rehabilitation. Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation. Rehabilitation is essential in preparation for prosthetic fitting. If a person cannot access rehabilitation services, they will remain dependent on caregivers. Highlighting the challenges to utilisation of rehabilitation in rural areas can assist to reduce these barriers and improve the functional status of persons with lower-limb amputations.

Renal Dysfunction - a Possible Marker of Severity of Heart Failure

Heart failure (HF) and renal dysfunction are frequent associated in the same patient. The purpose of our study was to assess the prevalence of renal dysfunction and the clinical status in admitted patients for decompensated HF. Material and Methods. 397 patients succesively hospitalized for decompensated HF, NYHA III or IV functional class, with left ventricular ejection fraction (LVEF) � 45% were included in the study. Renal dysfunction was defined by glomerular filtration rate (GFR) [ 60 mL/min/1.73 m 2. The mean GFR in patients with HF was 63.89 � 21.5 mL/min/1.73 m2 .The prevalence of renal dysfunction was 49.6%. Patients with GFR [ 60 mL/min/1.73m2, compared with those with preserved renal function were significantly more frequent older (75.37 � 6.84 vs. 71.33 � 8.08 years; p [0.001), females (53,8% vs. 43.5%; p = 0.04), had a significantly higher prevalence of diabetes mellitus (50.2% vs. 28.5%; p [0.001), atrial fibrillation (53.8% vs 46.2%, p = 0.04) and anemia (47.7% vs. 29.5% ; p [0.001). Also, patients with renal dysfunction had more severe HF than those without renal dysfunction (NYHA class IV: 65% vs 45%, p [0.001, clinical congestion: 78.2% vs 68%, p = 0.02, LVEF [35%: 47.21% vs � 35%, p [0.001). Renal dysfunction can be considered an additional marker of severe cardiac dysfunction along with NYHA IV class and low LVEF. The presence of both renal dysfunction and anemia could represent prognostic markers in HF patients with reduced LVEF.

Prevalence and Comorbidities of Resistant Hypertension: A Collaborative Population-Based Observational Study.

Resistant hypertension, is a clinical condition that may confer high cardiovascular risk. Aim of the observational study was to evaluate the prevalence of resistant hypertension, and the association with cardiovascular risk factors or diseases in the Verona urban area. Eleven family doctors retrieved anonymised data concerning blood pressure, diagnosis of hypertension and treatments from a population of 17,502 adult subjects. The prevalence of resistant hypertension was estimated considering patients who had been consecutively treated with at least four antihypertensive medications, regardless of blood pressure values. Further search concerning the clinical characteristics associated with resistant hypertension was performed in a random subsample of 55 patients. The prevalence of hypertension was 21.9%, that of resistant hypertension was 2.1%, approximately 10% of the whole hypertensive population. High prevalence of diabetes mellitus (53%) and hyperlipidemia (83%) was found in association with resistant hypertension. As for end organ damage, high prevalence of carotid artery stenosis (45%), ischemic heart disease (43%) and left ventricular hypertrophy (40%) was observed in patients with resistant hypertension. Blood pressure was higher than 140/90mmHg in 58% of patients in spite of treatment with four or more different antihypertensive drugs. The average age, systolic and pulse pressure were significantly higher in the subgroup of patients with resistant hypertension. Patients with resistant hypertension are characterised by a higher systolic and pulse pressure and a very high attributable cardiovascular risk, due to high prevalence of cardiovascular risk factors and overt organ damage and cardiovascular disease.

The Prevalence and Impact of Diabetes Mellitus among Undocumented Immigrants in an Indigent Care Program in Riverside, California

Background: Acculturated undocumented immigrants (UI) in the U.S. with sedentary lifestyle and poor eating habits are at risk for diabetes mellitus (DM). UI also face adverse social, economic, and psychological stressors that may lead to poor clinical outcomes. No study to date has assessed DM prevalence and clinical outcomes among UI. Methods: Riverside University Health System, a county health system, provides medical care for indigent patients including UI. Of 8,466 UI receiving indigent care as of March, 2017, 500 UI were randomly selected to assess DM prevalence and clinical outcomes. Results: The mean age was 46.2 with more females (59%) accessing medical care. Over 95% were Hispanics and 74% were born in Mexico. Most were married and only 11% worked full time. A majority of UI never smoked (67%), and only 18% consumed alcohol. The prevalence of DM was 27%, and diabetics were older than nondiabetics (52.2 vs. 43.9, p&amp;lt;0.001) with comparable BMIs (29.9 vs. 28.9, p=0.12). The mean hemoglobin A1c was 8.3 and insulin and oral anti-hyperglycemic medication use was 8% and 19%, respectively. The total clinic visits among diabetics was 19 compared to 13 in nondiabetics (p=0.018) while total emergency department visits were comparable between two groups (2 vs. 2, p=0.100). The use of prescription medications was higher in diabetics than nondiabetics (7 vs. 4, p=&amp;lt;0.001). Diabetics had a higher rate of hypertension compared to nondiabetics (57% vs. 20%, p&amp;lt;0.001), but other clinical conditions were similar [congestive heart failure (1% vs. 3%), cancer (4% vs. 3%), depression (6% vs. 3%), chronic kidney disease (7% vs. 3%)]. Conclusions: The prevalence of DM among UI is high with poor glycemic control. Diabetics had more clinic visits than nondiabetics and were taking more prescription medications. Despite high prevalence of DM, diabetes-related complication and comorbidity rates were low, which may be due to medical care access through the indigent care program. Disclosure H. Lee: None. B.L. Zakhary: None. M.A. Firek: None. H. Lange: None. C.A. Gomez: None. A. Firek: None.

The Precision of Screening Questionnaires for Diabetes Mellitus Type 2 and Hypertension Compared with the Gold Standard in Primary Care

Background: Diabetes mellitus (DM) and hypertension are health issues that are the focus of the Indonesian government, especially in the era of Universal Health Coverage/Jaminan Kesehatan Nasional (JKN). The prevalences have been steadily increasing daily. Special Region of Yogyakarta (DIY) has the highest prevalence of DM in Indonesia, while hypertension prevalence is 25.7% according to data from Riskesdas 2013. Complications from diabetes and hypertension lead to decreased quality of life and premature death, therefore it is necessary to have a better management strategy to reduce the risks. Nowadays, there are no diabetes and hypertension screening questionnaires which have been validated and implemented in the district of Bantul. Therefore, it is important to develop screening questionnaires for early detection of diabetes and hypertension as a tool for primary care physicians to perform tasks at the preventive level.Objective: This study aimed to measure the accuracy of screening questionnaires to detect diabetes mellitus and hypertension in primary care in Bantul DIY.Methods: This study used a cross-sectional method. The subjects of the study were a group of individuals aged 40-60 years in Bantul who met the criteria inclusion and the criteria exclusion. The study subjects were asked to complete the screening questionnaires of diabetes and hypertension. The results were then compared with the gold standard of fasting blood sugar and blood pressure check. The data were analyzed by using multivariate regression tests.Results: The results of multivariate analysis showed that the risk factors were a history of baby born weight ≥ 4 kg or gestational diabetes mellitus and the abdominal circumference was an independent risk factor for the incidence of diabetes in general population. Being a baby born with weight ≥ 4 kg and abdominal circumference had p = 0.001: RR 2.75 (CI 95%: 1.5 to 5.0) and p = 0.036: RR of 8.08 (CI 95%: 1.15 to 56.8), respectively. The risk factor of age was an independent risk factor for hypertension with p = 0.003: RR of 3.1 (CI 95%: 1.4 to 6.6).Conclusion: History of a baby born with weight ≥ 4 kg and abdominal circumference were appropriate for screening DM, meanwhile the age was appropriate for screening hypertension.

Yellow Tongue Coating is Associated With Diabetes Mellitus Among Japanese Non-smoking Men and Women: The Toon Health Study.

BackgroundYellow tongue coating is one of the clinical signs for diabetes mellitus according to traditional East Asian medicine. Few reports have been available on the association between yellow tongue coating and the prevalence of type 2 diabetes in the general population. We examined that association among population samples of non-smoking men and women.MethodsThe study subjects were Japanese non-smoking men (n = 315) and women (n = 654) aged 30–79 years who resided in Toon city and participated in the Toon Health Study from July 2011 through November 2014. Tongue coating was assessed by a nationally licensed acupuncturist and classified into three categories of white (normal), light yellow, and yellow. We performed an oral glucose tolerance test to confirm the presence of diabetes mellitus and prediabetes. The associations between yellow tongue coating and the prevalence of diabetes mellitus and prediabetes were examined using multivariable logistic regression analyses, adjusting for age, sex, body mass index, drinking status, and physical activity.ResultsThe multivariable odds ratios of diabetes mellitus were 1.39 (95% confidence interval [CI], 0.72–2.67) for light yellow tongue coating and 2.23 (95% CI, 1.16–4.30) for yellow tongue coating compared with white tongue coating. The respective multivariable odds ratios of prediabetes were 1.13 (95% CI, 0.80–1.61) and 1.43 (95% CI, 0.96–2.12).ConclusionsYellow tongue coating was associated with higher prevalence of diabetes mellitus and tended to be associated with that of prediabetes among Japanese non-smoking men and women.

Phenotypic Homozygous Familial Hypercholesterolemia and Elevated Lipoprotein (a)

The sentinel acute pancreatitis event (SAPE) hypothesis for pathogenesis of chronic pancreatitis (CP) postulates that acute pancreatitis (AP), especially recurrent AP (RAP), precedes development of CP. However, in a recent population-based study, 52/89 (58.4%) of CP had no prior episodes of AP. In a large clinic-based CP cohort, we aimed to determine the incidence and timing of prior AP in patients diagnosed with CP.We retrospectively identified 499 consecutive patients with classic CP diagnosed at our institution from January 2013 through December 2015. We abstracted their demographic and clinical data, especially regarding prior AP.We identified 3 cohorts: 1) CP with no AP (n = 231 [46.3%]), 2) AP before CP (n = 250 [50.1%]), and 3) AP after CP (n = 18 [3.6%]). At CP diagnosis, 249 patients (49.9%) had no prior AP. Compared with the “CP preceded by AP” cohort, the “CP without AP”’ cohort was older (59.2 ± 13.9 vs 48.6 ± 15.7 years; P < .001), had a higher prevalence of diabetes mellitus (30.3% vs 12.4%; P < .001), reported less pain (52.8% vs 87.6%; P < .001), and had a lower rate of endoscopic interventions (16.0% vs 39.2%; P < .001). In the “CP preceded by AP” cohort, 117 (46.8%) had a single episode of AP and 133 (53.2%) had RAP.Nearly half the patients with classic CP did not have prior AP. Only a quarter of patients had CP that could potentially have evolved from prior RAP. Development of CP may be attributable to an altogether different pathogenesis (a non-SAPE pathway) for a considerable proportion of patients.

Impact of socioeconomic status on adverse cardiac events after coronary angioplasty: a cohort study

BackgroundSocioeconomic status (SES) has been associated with adverse cardiovascular events in coronary atherosclerotic disease. However, it is unclear how SES impacts adverse cardiac events in patients treated with percutaneous coronary...

Type 2 diabetes mellitus and its determinants among adults in an urban area of Kancheepuram district, Tamil Nadu

Background: Type 2 diabetes mellitus (T2DM) is a modern day epidemic of epic proportions, affecting all strata of the society. The prevalence is becoming alarmingly high among younger age groups. The impact of this disease on physical, mental, social and economic wellbeing is huge and therefore warrants early detection and prevention. Aim of the study was to estimate the prevalence and determinants of T2DM among the adult population in an urban area.Methods: This cross sectional descriptive study was done in Anakaputhur, an urban area in Kancheepuram district. Based on 10.4% prevalence of T2DM, reported by the ICMR-INDIAB data (2011), the sample size was calculated to be 1680. Data was collected by convenient sampling method using a structured questionnaire from among the adult population. Fasting and postprandial plasma blood glucose was estimated. Data was analyzed using SPSS ver.16 software.Results: Mean age of the participants was 44.2 years. Females constituted 51.1% and 19.4% were known hypertensives, 10.9% were smokers and 55.3% were overweight/obese. The prevalence of T2DM was found to be 21.2%. Around 20% of affected individuals were belonging to &lt;45 years of age. Overweight and obesity were significantly associated with occurrence of diabetes mellitus.Conclusions: This study has shown a high prevalence of Diabetes Mellitus. The associated determinants are found to be high and changing. This indicates that diabetes is resulting in an epidemiological and genetic transition of a disease of susceptibility. This necessitates the need for strategies for increasing the awareness, broad based screening, focused treatment and follow up.

Clinical characteristics of patients with type 2 diabetes mellitus and severe osteoarthritis

Purpose: Type 2 diabetes mellitus (DM) and associated complications can make effective clinical management of osteoarthritis (OA) challenging. Prior studies have focused on the prevalence of OA among DM patients, but few studies have considered the reverse. Examining DM among patients with OA merits benefits for patients and musculoskeletal clinicians. Patients with DM undergoing a total knee (TKA) or hip (THA) arthroplasty, a viable intervention for terminal OA, are at high risks for adverse outcomes. Hence, gaining insight into the impact of DM on THA/TKA are necessary for reducing risks and determining effective intervention algorithms. The aims of this study are to examine patients with terminal OA and subsequent THA/TKA for: (1) determining the prevalence of DM; and (2) identifying the clinical severity and comorbidities of DM. Methods: We retrospectively screened 500 consecutive patients at University of Texas Medical Branch between January 2008 and April 2013 using the Current Procedure Terminology (CPT) codes for THA and TKA. Patients, who met a priori determined criteria to ensure THA and TKA were due to terminal OA, were reviewed for demographics (i.e., age and sex); clinical severity of DM and OA (i.e., smoking, body mass index, BMI, hemoglobin A1c, HgbA1c, DM management, bilateral OA, prior arthroplasty and time from DM to THA/TKA); and DM comorbidities (i.e., hypertension, dyslipidemia, nephropathy, diabetic neuropathy). We used omnibus comparisons to determine group differences within THA and TKA sub-groups with one-way ANOVA for continuous and chi-square for nominal variables. We used descriptive statistics to characterize DM. As a secondary, post hoc, analyses we graphed and visually examined the relationship between age and BMI for those with and without DM. Results: Of 137 THA and 223 TKA patients that met the a priori criteria, the prevalence of DM was 19% for THA and 24.2% for TKA. Patients with DM, for both THA and TKA sub-groups, were older than no DM (Table 1). We found significant group differences for sex, hypertension, nephropathy, dyslipidemia, bilateral OA, and prior arthroplasty (Table 1). The average time between DM diagnosis and TKA/THA was 9.8 years, the average HgbA1c level was 7.0, and DM management included oral (71.3%), insulin (6.30%), and both oral and insulin (10.0%). Peripheral neuropathy was present in 18.5% of TKA and 42.3% of THA cases. From secondary analyses of age and BMI, we observed slopes for the DM and no DM groups that were paralleling but had a larger y-intercept for DM (Fig. 1). Conclusions: We found a high prevalence of DM and comorbidities, among patients pursuing THA/TKA for terminal OA. Thus, musculoskeletal clinicians must consider DM presence when developing THA/TKA algorithms. DM, hypertension, and dyslipidemia, together, make up the metabolic syndrome. Metabolic syndrome has its own OA phenotype and includes patients with the most advanced ages and largest BMI than other OA phenotypes. In this study, those with DM are older than without DM when at the same BMI, which, in turn, may be due to THA/TKA delays. THA/TKA delays for patients with DM occur when HgbA1c levels are > 7.0 with the hopes of avoiding adverse events. However, this practice is problematic, because, for some patients, waiting for Hgb1Ac levels to drop below 7.0 may never occur, require up to 3 years, or be ineffective at avoiding adverse events. Delaying TKA/THA can also progress DM comorbidities including diabetic neuropathy, which facilitates inefficient movements and OA progression. The prevalence of diabetic neuropathy for our DM and THA/TKA cohort are larger than reported in the literature for those with DM only. Although more research is needed, this study suggests that current management algorithm for patients with DM are inadequate and delaying THA/TKA. We speculate that due to the inherent and progressive compromises of DM, terminal OA intervention algorithms need to consider earlier THA/TKA and to be defined for this sub-group.

Urban–rural differences in the prevalence of diabetes mellitus among 25–74 year-old adults of the Yangon Region, Myanmar: two cross-sectional studies

ObjectivesTo investigate the association between urban–rural location and the occurrence of diabetes mellitus (DM) in the Yangon Region, and to estimate the proportion of urban and rural participants already diagnosed...

Fatty liver disease, an emerging etiology of hepatocellular carcinoma in Argentina.

AIMTo investigate any changing trends in the etiologies of hepatocellular carcinoma (HCC) in Argentina during the last years.METHODSA longitudinal cohort study was conducted by 14 regional hospitals starting in 2009 through 2016. All adult patients with newly diagnosed HCC either with pathology or imaging criteria were included. Patients were classified as presenting non-alcoholic fatty liver disease (NAFLD) either by histology or clinically, provided that all other etiologies of liver disease were ruled out, fatty liver was present on abdominal ultrasound and alcohol consumption was excluded. Complete follow-up was assessed in all included subjects since the date of HCC diagnosis until death or last medical visit.RESULTSA total of 708 consecutive adults with HCC were included. Six out of 14 hospitals were liver transplant centers (n = 484). The prevalence of diabetes mellitus was 27.7%. Overall, HCV was the main cause of liver disease related with HCC (37%) including cirrhotic and non-cirrhotic patients, followed by alcoholic liver disease 20.8%, NAFLD 11.4%, cryptogenic 9.6%, HBV 5.4% infection, cholestatic disease and autoimmune hepatitis 2.2%, and other causes 9.9%. A 6-fold increase in the percentage corresponding to NAFLD-HCC was detected when the starting year, i.e., 2009 was compared to the last one, i.e., 2015 (4.3% vs 25.6%; P < 0.0001). Accordingly, a higher prevalence of diabetes mellitus was present in NAFLD-HCC group 61.7% when compared to other than NAFLD-HCC 23.3% (P < 0.0001). Lower median AFP values at HCC diagnosis were observed between NAFLD-HCC and non-NAFLD groups (6.6 ng/mL vs 26 ng/mL; P = 0.02). Neither NAFLD nor other HCC etiologies were associated with higher mortality.CONCLUSIONThe growing incidence of NAFLD-HCC documented in the United States and Europe is also observed in Argentina, a confirmation with important Public Health implications.

Impact of diabetes mellitus and hepatitis B virus coinfection on patients with chronic hepatitis C: A territory‐wide cohort study

Studies have demonstrated a higher prevalence of diabetes mellitus (DM) in patients with chronic hepatitis C (CHC). Furthermore, coinfection with hepatitis B virus (HBV) is common because of its endemicity in Asian-Pacific regions. The aim of the present study was to investigate the impact of DM and HBV coinfection on the clinical outcomes in Chinese CHC patients. A territory-wide cohort study was conducted using the database from Hospital Authority, the sole public medical service provider in Hong Kong. CHC patients were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, diagnosed between 2000 and 2012. The primary outcome was overall mortality. A total of 7149 CHC patients were included. Seven hundred twenty-two (10.1%) patients were coinfected with HBV. Their mean age was 56years; 69.0% were men. The prevalence of DM was similar in mono-infection and coinfection cohorts (22.3% and 21.3%, respectively). Multivariable analysis identified DM as an independent risk factor for death and antiviral treatment for hepatitis C virus (HCV) as an independent protective factor against death. The 5-year survival of CHC patients with mono-infection was better than that of HBV coinfected patients (62.5% vs 57.0%; P=0.001). The 5-year survival of patients who did or did not receive antiviral treatment for HCV was 94.7% and 55.2%, respectively (P<0.001). Hepatitis B virus coinfection and DM were independent risk factors for death in Hong Kong CHC patients. Antiviral treatment for HCV but not HBV was a protective factor against death.

The double burden of tuberculosis and diabetes prevalance of diabetes melitus in tuberculosis

Background: The burden of diabetes mellitus is increasing worldwide. The prevalence of TB has been rising in recent years globally. Aging, changes in life style, socioeconomic factors, and population growth have lead to an increased prevalence of DM, particularly, type 2 DM. Diabetes Mellitus (DM) almost triples the risk of developing tuberculosis (TB). India, the nation with the highest number of TB cases in the world, is also undergoing epidemic growth in DM rates. With the demographic transition underway globally, increase in life expectancy, improvements in provision of health services and a subsequent increase in the elderly population, the absolute numbers of cases of diabetes will increase exponentially. As a result, DM and TB are increasingly present together, and this calls for renewed interest in this topic. Various studies done in different parts of India and in other parts of globe where TB is endemic have shown a higher prevalence of DM among PT infected with tuberculosis. We in our study undertaken in Department of medicine in IIMS&amp;R Lucknow UP found a high prevalence of DM amongst TB patients. Routine screening of TB patients for DM will help detect cases of diabetes and pre-diabetes early, so that primary prevention methods may be initiated early and effectively.Methods: This hospital-based cross-sectional study was undertaken in Department of medicine in IIMS and R Lucknow UP. All TB cases more than 18 years of age, including new and re-treatment cases, sputum positive, sputum negative and extra-pulmonary cases currently on treatment in the were included in the study.Results: Using the diagnostic criteria, as mentioned in the methodology, the prevalence of diabetes among TB patients in this study was found to be 24.5% of which 18.5% were known DM cases and 5.9% were newly diagnosed.Conclusions: The burden of diabetes mellitus is increasing worldwide. The association between diabetes and tuberculosis is the next challenge for global tuberculosis control. Improved understanding of the bidirectional relationship of the two diseases is necessary for proper planning and collaboration to reduce the dual burden of diabetes and TB. In people with TB, it may be appropriate to actively screen for DM. Prevention, screening, and treatment of both diseases together is more effective.

Hyperleptinemia positively associated with central arterial stiffness in hemodialysis patients

ObjectiveLeptin plays a role in stimulating vascular inflammation, vascular smooth muscle hypertrophy, and augmenting blood pressure, which contributes to the pathogenesis of atherosclerosis and leads to arterial stiffness. This vascular damage, measured by carotid-femoral pulse wave velocity (cfPWV), is recognized as an independent predictor of cardiovascular mortality in hemodialysis (HD) patients. The aim of this study was to evaluate the relationship between serum leptin and arterial stiffness in HD patients.Patients and methodsIn 112 of the 126 HD patients were eligible and their biochemical data were collected for analysis. Serum leptin level was measured using a commercial enzyme-linked immunosorbent assay kit. Carotid-femoral pulse wave velocity was measured by a validated tonometry system (SphygmoCor). Those have cfPWV values above 10 m/s are defined as the high arterial stiffness group.ResultsAmong the participants, thirty-eight of them who were in the high arterial stiffness group, had a higher prevalence of diabetes mellitus (p = 0.002), age (p = 0.029), body mass index (BMI, p = 0.018), body fat mass (p = 0.001), hemoglobin (p = 0.040), and serum leptin levels (P<0.001). Multivariable logistic regression analysis showed that leptin (odds ratio [OR] 1.09; 95% confidence interval [CI] 1.04–1.14; p <0.001), diabetes (OR 7.17; CI 1.39–37.00; p = 0.019), body fat mass (OR 1.16; CI 1.02–1.33; p = 0.027); and hemoglobin (OR 2.11; CI 1.15–3.87; p = 0.015) were independently associated with arterial stiffness in HD patients.ConclusionIn our study, hyperleptinemia was positively correlated to the high cfPWV and thus was related to high arterial stiffness in HD patients.