Prognostic Significance Of Diabetes Research Articles

Prognostic significance of diabetes and stress hyperglycemia in acute stroke patients

BackgroundHyperglycemic non-diabetic stroke patients have a worse prognosis than both normoglycemic and diabetic patients. Aim of this study was to assess whether hyperglycemia is an aggravating factor or just an epiphenomenon of most severe strokes.MethodsIn this retrospective study, 1219 ischemic or hemorrhagic stroke patients (73.7 ± 13.1 years) were divided into 4 groups: 0 = non-hyperglycemic non-diabetic, 1 = hyperglycemic non-diabetic, 2 = non-hyperglycemic diabetic and 3 = hyperglycemic diabetic. Hyperglycemia was defined as fasting blood glucose ≥ 126 mg/dl (≥ 7 mmol/l) measured the morning after admission, while the diagnosis of diabetes was based on a history of diabetes mellitus or on a glycated hemoglobin ≥ 6.5% (≥ 48 mmol/mol), independently of blood glucose levels. All diabetic patients, except 3, had Type 2 diabetes. The 4 groups were compared according to clinical history, stroke severity indicators, acute phase markers and main short term stroke outcomes (modified Rankin scale ≥ 3, death, cerebral edema, hemorrhagic transformation of ischemic lesions, fever, oxygen administration, pneumonia, sepsis, urinary infection and heart failure).ResultsGroup 1 patients had more severe strokes, with larger cerebral lesions and higher inflammatory markers, compared to the other groups. They also had a high prevalence of atrial fibrillation, prediabetes, previous stroke and previous arterial revascularizations. In this group, the highest frequencies of cerebral edema, hemorrhagic transformation, pneumonia and oxygen administration were obtained. The prevalence of dependency at discharge and in-hospital mortality were equally high in Group 1 and Group 3. However, in multivariate analyses including stroke severity, cerebral lesion diameter, leukocytes and C-reactive protein, Group 1 was only independently associated with hemorrhagic transformation (OR 2.01, 95% CI 0.99–4.07), while Group 3 was independently associated with mortality (OR 2.19, 95% CI 1.32–3.64) and disability (OR 1.70, 95% CI 1.01–2.88).ConclusionsHyperglycemic non-diabetic stroke patients had a worse prognosis than non-hyperglycemic or diabetic patients, but this group was not independently associated with mortality or disability when size, severity and inflammatory component of the stroke were accounted for.

Abstract C51: Ethnic differences in the relationship between diabetes, early age adiposity, and mortality among breast cancer survivors: The Breast Cancer Health Disparities Study

Abstract Hispanic women have a high prevalence of type 2 diabetes and obesity. Breast cancer (BC) has become the leading cause of death among Hispanic women. Limited information exists on the relationship between diabetes, obesity, and mortality in Hispanic women diagnosed with BC. In a multicenter study we examined the associations between diabetes, obesity measures and survival outcomes. The study included 1,180 Hispanic and 1,298 non-Hispanic white (NHW) women who were diagnosed with incident invasive BC from the San Francisco Bay Area, New Mexico, Utah, Colorado and Arizona. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated by Cox proportional hazards regression models. The median follow-up time from BC diagnosis to death was 10.8 years and 267 of 466 deaths that occurred were from BC. Diabetes was significantly associated with BC-specific mortality (HR, 1.63 95% CI 1.08-2.47), with a stronger association among Hispanics (HR, 1.85 95% CI 1.11-3.09) compared to NHWs (HR, 1.33 95% CI 0.67-2.62). Among diabetic Hispanic women with estrogen receptor negative tumors, BC-specific mortality was increased three-fold (HR, 2.93 95% CI 1.09-7.88). In contrast, obesity at age 30 years was positively associated with BC-specific mortality in NHW women after adjusting for diabetes and known prognostic factors (HR, 2.33 95% CI 1.36-3.97, p interaction< 0.05), but not in Hispanics. In conclusion, we observed differences in the prognostic significance of diabetes and obesity by ethnicity among women with BC. Larger prospective studies are needed to evaluate ethnic differences in associations between diabetes and mortality for less common BC subtypes. Citation Format: Avonne E. Connor, Kala Visvanathan, Kathy B. Baumgartner, Richard N. Baumgartner, Stephanie D. Boone, Lisa M. Hines, Anna R, Giuliano, Roger K. Wolff, Esther M. John, Martha L. Slattery. Ethnic differences in the relationship between diabetes, early age adiposity, and mortality among breast cancer survivors: The Breast Cancer Health Disparities Study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C51.

Impaired Oral Glucose Tolerance Test and Diabetes mellitus Predict Short Term Prognosis of Patients with Liver Cirrhosis

Objective: The aim of this study was to evaluate whether oral glucose tolerance test (OGTT) and manifest diabetes mellitus are useful in prediction of short term prognosis of patients with liver cirrhosis. Methods: Seventy-nine patients with liver cirrhosis of different etiologies were enrolled in a prospective cohort study. Diabetes mellitus (DM) and impaired glucose tolerance (IGT), which was diagnosed by a 75-g OGTT, were defined according to current World Health Organization criteria. The relationship of clinical variables to the cirrhosis-related prognosis was investigated using regression analysis. Results: IGT was diagnosed in 29 subjects (37%), DM in 27 subjects (34%), and normal glucose tolerance (NGT) in 23 subjects (29%). 3-month survival analysis showed that compared to normal glucose tolerance, disturbed metabolic status (IGT and DM) is a predictor of poor survival (odds-ratio 4,3), as well as liver cirrhosis classified as stadium Child-Pugh C compared to patients with liver cirrhosis stadium Child-Pugh A and B (odds ratio 3,9). Multiple regression analysis yielded Child-Pugh C and disturbed metabolic status (IGT and DM) as the most powerful negative predictors of short-time survival. Conclusions: IGT and DM appear to be useful for evaluating the prognosis of cirrhotic patients not only in long-term survival, as it was shown by Nishida et al.(1) and Bianchi et al. (2) before, but also in evaluating short-term prognosis. Literatur: (1) Nishida T. et al., Oral Glucose Tolerance Test Predicts Prognosis of Patients with Liver Cirrhosis, Am J Gastroenterol. 2006 Jan;101(1):70-5. (2) Bianchi G. et al., Prognostic significance of diabetes in patients with cirrhosis, Hepatology. 1994 Jul;20(1 Pt 1):119-25.

Abstract 558: Association of Chronic Kidney Disease and Diabetes Mellitus with 5-Year Outcomes after Acute Myocardial Infarction

Several studies have shown that both chronic kidney disease (CKD) and diabetes mellitus are risk factors for mortality in patients with acute myocardial infarction (AMI). This study was undertaken to investigate influence of CKD on the prognostic significance of diabetes in patients with AMI. Between January 1996 and December 2005, 888 patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain. CKD was difined estimated glomerular filtration rate (eGFR) of less than 60.0 ml/minute/1.73 m 2 of body-surface area (stage3–5). Kaplan-Meier method was used to compare 5-year survival of diabetic and non-diabetic patients, in the presence (n=337) or absence (n=551). Kaplan-Meier curves for 5-year survival rate are shown in Figure . In the absence of CKD, there was no significant difference in 5-year survival rate between patients with diabetes and those without (93 % v.s. 94 %, p=0.82). In patients with CKD, however, diabetes was associated with lower 5-year survival rate (65 % v.s. 87 %, p<0.001). Multivariate analysis showed that diabetes was an independent predictor for 5-year survival in patients with CKD (OR 3.2, 95%CI 1.8–5.8, p=0.0002), but not in patients without CKD (OR 1.1, 95%CI 0.4–2.5, p=0.82). Diabetes mellitus was an independent predictor for death after AMI in patients with CKD. Aggressive treatment after AMI should be advocated in diabetic patients with CKD.

The Prognostic Significance of Diabetes in Patients Diagnosed With Peripheral Arterial Disease

RESUME OBJECTIF Evaluer les repercussions du diabete sur le devenir des patients atteints d'arteriopathie peripherique (AP). METHODES Le devenir de 16 440 patients atteints d'AP de la Saskatchewan,Canada (1985 a 1995) a ete compare selon que les patients etaient diabetiques ou non. Les dossiers des patients contenaient leurs antecedents et leurs caracteristiques depuis janvier 1980 et les donnees du suivi jusqu'a decembre 2000. Des analyses des hasards proportionnels ont mesure l'effet du diabete sur la mortalite et l'incidence de l'infarctus du myocarde (IM) et de l'accident vasculaire cerebral chez les patients atteints d'AP. On a aussi calcule le delai de survenue de l'hospitalisation. RESULTATS Le quart (23,9 %) des patients etaient diabetiques. Le taux de mortalite a ete de 37 % superieur chez ces patients et les risques d'IM et d'accident ischemique cerebral etaient aussi considerablement superieurs (rapports des risques > 1,50). Les patients diabetiques ont ete hospitalises plus souvent et plus tot pour diverses causes. Les taux d'hospitalisation ont ete de 50 a 100 % plus eleves chez les patients diabetiques. CONCLUSION Le diabete chez les patients atteints d'AP est associe a des taux considerablement superieurs de morbidite et de mortalite.

Late complications of NASH: a challenge for hepatologists

Long-term outcomes of cirrhosis in nonalcoholic steatohepatitis compared with hepatitis C. Hui JM, Kench JG, Chitturi S, Sud A, Farrell GC, Byth K, Hall P, Khan M, George J. Data on the long-term outcome of nonalcoholic steatohepatitis (NASH)-associated cirrhosis are few, and most reports describe cases of cryptogenic cirrhosis associated with risk factors for NASH but without histologic definition. In this prospective cohort study, we describe the long-term morbidity and mortality of 23 patients with NASH-associated cirrhosis defined by strict clinicopathologic criteria. Outcomes were compared with 46 age- and gender-matched patients with cirrhosis from chronic hepatitis C virus (HCV) infection: 23 untreated and 23 nonresponders to antiviral therapy. During follow-up (mean, 84 months; median, 60 months; range, 5–177 months), 9 of the 23 NASH-associated cirrhosis cases developed liver-related morbidity (8 ascites and/or encephalopathy, 1 variceal bleeding). The probability of complication-free survival was 83, 77, and 48% at 1, 3, and 10 years, respectively, and the cumulative probability of overall survival was 95, 90, and 84% at 1, 3, and 10 years, respectively. Five deaths were from liver failure, 1 from a non-liver-related cause. By multivariate analysis, bilirubin ( P =0.02) and platelet ( P =0.04) were independent predictors of complication-free survival; bilirubin ( P =0.05) was the only predictor for overall survival. After controlling for these factors, there was no difference in complication-free or overall survival between the NASH-cirrhosis cohort and either group of HCV-cirrhosis. However, 8 cases of liver cancer occurred in the HCV-cirrhosis groups compared with none among NASH cases. In conclusion, liver failure is the main cause of morbidity and mortality in NASH-associated cirrhosis. The prognosis is either similar or less severe than HCV-cirrhosis, except that HCC appears less common. [Abstract reproduced by permission of Hepatology 2003;38:420–427].

Prognostic significance of diabetes as a predictor of survival after cardiac catheterization

PURPOSE: Diabetes is a recognized risk factor for the development of cardiac disease, but its importance as a prognostic factor among patients with known cardiovascular disease is less clear. We evaluated survival in patients with and without diabetes who underwent cardiac catheterization for presumed coronary artery disease. SUBJECTS AND METHODS: We analyzed data from a prospective cohort study that captures detailed clinical information and longitudinal outcomes for all patients who undergo cardiac catheterization in Alberta, Canada. We studied 11,468 patients, 1959 (17%) of whom had diabetes. Logistic regression was used to model predictors of 1-year mortality, and proportional hazards analysis was used to model predictors of survival up to 3 years after cardiac catheterization. RESULTS: One-year mortality was 7.6% for patients with diabetes versus 4.1% for those without diabetes (odds ratio = 1.9, 95% confidence interval [CI]: 1.6 to 2.3). After adjusting for other characteristics of the patients, including comorbid conditions, previous cardiac history, coronary anatomy, and renal function, the odds ratio for 1-year mortality was 1.1 (95% CI: 0.8 to 1.3). Similarly, the adjusted hazard ratio for longer term mortality was 1.2 (95% CI: 1.0 to 1.4, mean follow-up of 702 days). CONCLUSIONS: These results suggest that there is little or no independent association between diabetes and mortality for up to 3 years after cardiac catheterization. Estimates of short- to intermediate-term prognosis for diabetic patients with coronary artery disease should be based on the presence of other prognostic factors associated with diabetes.

Prognostic significance of diabetes in acute myocardial infarction. Are the differences linked to female gender?

Sir at variance with the Diabetes Mellitus and Acute We read with interest the recent paper by GalceraMyocardial Infarction (DIAGAMI) Study [10,11] Tomas et al. [1] in The Journal, which found that where gender was not an independent predictor of diabetes mellitus was not an independent predictor of mortality. mortality post-myocardial infarction. Interestingly, Such variation in outcome following myocardial female gender was associated with an increased risk infarction may be due, in part, to gender-related of adverse events following acute myocardial infarcdifferences in the interaction between the left ventrition but only in the diabetic population. cle and the arterial tree (ventriculo-vascular couThe link between diabetes mellitus and carpling). An important determinant of which is the diovascular disease is well described [2], and previshape of the central pressure waveform. A recent ous studies have demonstrated a worse prognosis for study by Hayward and Kelly demonstrated differdiabetics post-myocardial infarction [3]. However, ences in the aortic pressure waveform between men the effect of gender on cardiovascular risk, and the and women [12]. Augmentation index (AIx) – a interaction between gender and diabetes mellitus is measure of the degree to which systolic pressure is complex. Women have a lower incidence of isaugmented by wave reflection – was consistently chaemic heart disease than men until they reach the greater in women compared with men throughout all menopause [4] or develop diabetes [5]. However, the decades of life [12]. This was due mainly to shorter mechanisms involved in the protective effect of stature and a different ejection pattern in women, female gender remain poorly understood, although resulting in earlier return of the reflected pressure oestrogens may clearly be important. This is despite a wave to the ascending aorta. Increased augmentation greater age-related rise in left ventricular mass, an not only raises central systolic pressure and left important and independent predictor of all cause ventricular workload, which may explain why healthy mortality, amongst women compared with men [6]. women have a greater left ventricular mass compared A number of studies have investigated the effect of with men, but also reduces the subendocardial viabiligender on prognosis following myocardial infarction. ty index [12]. This may account for the correlation In non-diabetics, at least, the results appear to be between short stature and the risk of coronary heart consistent, with higher rates of heart failure postdisease and stroke in both men [13] and women [14]. infarction [7,8], and a significantly greater risk of Moreover, since women are, in general, shorter than ventricular rupture [9] amongst women. Within the men, height may be a potential confounding variable diabetic population, the results are less consistent. in studies assessing the effect of gender on carIndeed, the findings from Galcera-Tomas et al. [1] are diovascular risk. Unfortunately, although body mass