scholarly journals Potential overtreatment of type 2 diabetes therapy in real clinical practice: Omsk Oblast register data

2021 ◽  
Vol 24 (2) ◽  
pp. 100-110
Author(s):  
I. V. Druk ◽  
D. I. Snarskaya ◽  
O. I. Goroshchenya
Keyword(s):  
Risk Factors ◽  
Severe Hypoglycemia ◽  
Tight Glycemic Control ◽  
Older Age ◽  
Age Group ◽  
Target Level ◽  
Aged Patients ◽  
Number Of Patients ◽  
Hypoglycemic Therapy

Backgraund: The total number of patients with type 2 diabetes mellitus (T2DM) in the Russian Federation as of 01.01.2019 is 4.24 million. The majority of patients with T2DM are elderly people and older, forming groups with high comorbidity and the risk of severe hypoglycemia, including those associated with excess hypoglycemic therapy. Foreign studies indicate that a significant proportion of older adults with diabetes are potentially exposed to excessive sugar-lowering therapy.Aims: to study the frequency of excessive decrease in HbA1c in a group of patients with T2DM according to a sample from the regional diabetes register.Materials and methods: A content analysis of the regional register of diabetes mellitus was carried out as of ­December 31, 2019. Based on the register data, an individual target level of HbA1c was calculated and the compliance of the achieved HbA1c level with the target level was assessed.Results: The analysis included data from 1202 patients with T2DM, which amounted to 2.35% of the total number of patients with T2DM in the region (n = 51,163). The age of the included individuals was 66 years (LQ 60.0; UQ 72), 360 men (29.95%). The duration of T2DM 8.0 years. The HbA1c level in the general group was 7.1%. Persons over 60 years of age accounted for 75.21% (n = 904). When analyzing HbA1c in the age groups, there were no statistically significant differences (p> 0.05). HbA1c was above the target level in 43.34% of cases (n = 521). The level of HbA1c <6.5% was noted in a quarter of cases (24.62%), including HbA1c <6.0% was recorded in 97 cases, which accounted for a third of all cases of tight glycemic control. At the same time, the majority of observations of HbA1c <6.5% were in patients 60 years and older (79.73%). Among young and middle-aged patients with HbA1c <6.5%, 8.33% of cases had risk factors for severe hypoglycemia in the presence of SU and / or insulin therapy. In the older age group (in comparison with young and middle-aged patients), HbA1c <7% (p <0.05) was significantly more often detected, there was a tendency for a higher frequency of HbA1c <6.5% (p = 0.067). Among elderly and senile patients with HbA1c <6.5%, in 41.53% of cases there were risk factors for severe hypoglycemia, in a quarter of cases in T2DM therapy SU and / or insulin were used (24.58%), almost every fifth patient (19.07%), risk factors for severe hypoglycemia, received SU and / or insulin.Conclusion: According to our data, at least a quarter of patients in the older age group (24.58%) had overtreatment and need de-intensification of therapy. Perhaps that in this group of patients, the risks associated with treatment may outweigh the benefits of tight glycemic control, and these patients require planned de-intensification of glucose-lowering therapy. Taking into account the position of some expert communities on determining the target range of HbA1c in the older age group, the need for de-intensification of antihyperglycaemic therapy may be even higher. Further research is required in order to develop a full-fledged domestic concept of de-intensification of hypoglycemic therapy.

scholarly journals A study to assess prevalence of diabetes mellitus and its associated risk factors among adult residents of rural Khammam

2018 ◽  
Vol 5 (4) ◽  
pp. 1360 ◽  
Author(s):  
K. Nithesh Kumar ◽  
Sushma Katkuri ◽  
I. Ramyacharitha
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Screening Methods ◽  
Age Group ◽  
Early Screening ◽  
Total Prevalence ◽  
Prevalence Of Diabetes Mellitus

Background: Type 2 diabetes mellitus is a chronic, debilitating disease characterized by insulin resistance, impaired insulin secretion and hyperglycemia. It represents more than 90% of total prevalence of diabetes in the world and is responsible for 9% of the global mortality corresponding to four million deaths per year. The objective of the study was to assess the prevalence of diabetes mellitus type-2 in a rural population of age 30 years and above.Methods: A community based cross sectional study carried out in population 30 years and above in rural area of Khammam district in Telangana during the study period from 1st January to 31st December 2015. A total of 910 persons aged 30 years or more were included in study.Results: Near about 74 (8.1%) were diagnosed as type -2 diabetes mellitus. The prevalence of DM was 16.22% in 30-40 years age group, 24.32% in 41-50 years age group, 43.34% in 51-60 years age group and 16.2% in 61-70 years age group which shows that DM increases with age and the association between age and prevalence of type 2 DM was found to be statistically significant.Conclusions: There is a need to increase awareness of type–2 diabetes mellitus in the general population. Health education should be given in terms of risk factors of diabetes. They should be made aware about early screening methods. 

scholarly journals Prevalence and risk factors of vitamin D insufficiency and deficiency among 6–24-month-old underweight and normal-weight children living in an urban slum of Bangladesh

2015 ◽  
Vol 20 (10) ◽  
pp. 1718-1728 ◽  
Author(s):  
AM Shamsir Ahmed ◽  
Tahmeed Ahmed ◽  
Kurt Z Long ◽  
Ricardo J Soares Magalhaes ◽  
Md Iqbal Hossain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Maternal Education ◽  
Urban Slum ◽  
Vitamin D Insufficiency ◽  
Normal Weight ◽  
Older Age ◽  
Age Group ◽  
Vitamin D Status ◽  
Weight For Age

AbstractObjectiveWe quantified the prevalence of vitamin D status in 6–24-month-old underweight and normal-weight children and identified the socio-economic and dietary predictors for status.DesignCross-sectional, baseline data from a nutritional intervention study were analysed. Multinomial logistic regression was used to estimate the odds of being vitamin D deficient or insufficient with the reference being vitamin D sufficient.SettingUrban slum area of Mirpur field site, Dhaka, Bangladesh.SubjectsUnderweight (weight-for-age Z-score <−2·00) and normal-weight (weight-for-age Z-score ≥−1·00) children aged 6–24 months.ResultsAmong 468 underweight children, 23·1 % were sufficient, 42·3 % insufficient, 31·2 % deficient and 3·4 % severely vitamin D deficient. Among 445 normal-weight children, 14·8 % were sufficient, 39·6 % insufficient and 40·0 % deficient and 5·6 % severely deficient. With adjusted multinominal regression analysis, risk factors (OR (95 % CI)) for vitamin D deficiency in underweight children were: older age group (18–24 months old; 2·9 (1·5–5·7)); measurement of vitamin D status during winter (3·0 (1·4–6·4)) and spring (6·9 (3·0–16·1)); and maternal education (≥6 years of institutional education; 2·2 (1·0–4·9)). In normal-weight children, older age group (3·6 (1·2–10·6)) and living in the richest quintile (3·7 (1·1–12·5)) were found to be significantly associated with vitamin D insufficiency.ConclusionsThe study demonstrates a significant burden of vitamin D insufficiency and deficiency in both underweight and normal-weight children <2 years of age from an urban slum of Bangladesh. Identification of risk factors may help in mitigating the important burden in such children.

scholarly journals Top Three Risk Factors of Coronary Artery Disease in Chittagong, Bangladesh

2017 ◽  
Vol 16 (1) ◽  
pp. 26-28
Author(s):  
Abu Tarek Iqbal ◽  
M Jalal Uddin ◽  
Shaikh Md Hasan Mamun ◽  
Rajat Sankar Roy Biswas
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Age Group ◽  
Primordial Prevention ◽  
Male Preponderance ◽  
The Subject ◽  
Artery Disease ◽  
Type 2 Diabetic

Background: Many studies were conducted on the subject in home and abroad but there is none in Chittagong, Bangladesh. To know about top three risk factors for coronary artery disease we conducted the study.Methods: It was a retrospective study. Records of a private cardiac center from July 2013 to June 2014 was collected. Only coronary stenosed cases (As per angiogram) was studied. Age, sex, BMI, diabetes mellitus, hypertension, smoking and other risk factors were considered. Collected data was managed manually. Finally discussion was made and conclusion was done.Results: Majority cases 58(76%) were of 40-60 years age group. Male preponderance was there 64(83%). BMI of 45(60%) cases was normal (<25). Family history was positive among 11(14%) cases. Dyslipidemia was found in 08(10%) cases, 56(73%) cases were hypertensive, 43(56%) cases were type-2 diabetic and 35(45%) were smoker.Conclusion: Hypertension, Diabetes and Smoking are top 03 risk factors for coronary artery disease. All are modifiable. So, primordial prevention should be taken to reduce prevalence of coronary artery disease.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 26-28

scholarly journals Cardiovascular Event Risk in Rheumatoid Arthritis Compared with Type 2 Diabetes: A 15-year Longitudinal Study

2019 ◽  
Vol 47 (3) ◽  
pp. 316-324 ◽  
Author(s):  
Rabia Agca ◽  
Luuk H.G.A. Hopman ◽  
Koen J.C. Laan ◽  
Vokko P. van Halm ◽  
Mike J.L. Peters ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Incidence Rate ◽  
Cvd Risk ◽  
Cardiovascular Research ◽  
Number Of Patients ◽  
Cv Disease ◽  
Reference Cohort

Objective.Cardiovascular (CV) disease (CVD) risk is increased in rheumatoid arthritis (RA). However, longterm followup studies investigating this risk are scarce.Methods.The CARRÉ (CARdiovascular research and RhEumatoid arthritis) study is a prospective cohort study investigating CVD and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline and 3, 10, and 15 years after the start of the study and are compared to a reference cohort (n = 2540), including a large number of patients with type 2 diabetes (DM).Results.Ninety-five patients with RA developed a CV event over 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. Two hundred fifty-seven CV events were reported in the reference cohort during 18,874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age- and sex-adjusted HR for CV events were increased for RA (HR 2.07, 95% CI 1.57–2.72, p < 0.01) and DM (HR 1.51, 95% CI 1.02–2.22, p = 0.04) compared to the nondiabetic participants. HR was still increased in RA (HR 1.82, 95% CI 1.32–2.50, p < 0.01) after additional adjustment for CV risk factors. Patients with both RA and DM or insulin resistance had the highest HR for developing CVD (2.21, 95% CI 1.01–4.80, p = 0.046 and 2.67, 95% CI 1.30–5.46, p < 0.01, respectively).Conclusion.The incidence rate of CV events in established RA was more than double that of the general population. Patients with RA have an even higher risk of CVD than patients with DM. This risk remained after adjustment for traditional CV risk factors, suggesting that systemic inflammation is an independent contributor to CV risk.

Changes in the Hierarchy of Risk Factors with Older Age in De-Novo Acute Myeloid Leukemia (AML).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1977-1977
Author(s):  
Thomas Buchner ◽  
Wolfgang E. Berdel ◽  
Claudia Schoch ◽  
Torsten Haferlach ◽  
Hubert L. Serve ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Complete Remission ◽  
De Novo ◽  
Older Age ◽  
High Dose ◽  
Age Group ◽  
Risk Profiles ◽  
Age Related ◽  
De Novo Aml

Abstract After recent reports addressed prognostic factors and outcome in older age AML (Burnett et al. Blood106:162a,2005; Wheatley et al. Blood106:199a,2005; Appelbaum et al. Blood107:3481–5,2006; Farag et al. Blood108:63–73,2006) we evaluated 764 patients of 60–85 (median 66) years reduced to those with de-novo AML, known karyotype, and identical consolidation-maintenance chemotherapy, who were part of the 1992 and 1999 multicenter randomized trials by the German AMLCG (Buchner et al. J Clin Oncol21:4496–504,2003;24:2480–9,2006). 521 patients were 60 -< 70 (median 64) and 243 patients were 70–85 (median 73) years of age. 64% and 50% patients respectively went into complete remission, 24% and 29% remained with persistent AML, 12% and 21% succumbed to early and hypoplastic death (p<.001). The overall survival in the younger (60- < 70y) and older (70+) patients was at a median of 13 vs 6 months and 18% vs 8% survived at 5 years (p<.001). Once in complete remission, the remission duration was 14 vs 12 months (median) and equally 18% at 5 years; the relapse-free survival is 13 vs 11 months (median) and 14% vs 13% at 5 years. While all patients were randomized up-front for 2 versions of induction either by TAD-HAM (HAM, high-dose araC 1g/m2x6 and mitox 10mg/m2x3) or by HAM-HAM, response and survival did not differ between the two arms in neither age group. In contrast to response and survival between the younger (60-<70y) and older (70+y) age group corresponding differences in the risk profiles were missing. Thus, favorable/intermediate/unfavorable karyotypes accounted for 8% vs 4% / 67% vs 73% / and 25% vs 24% of patients (p=.073); WBC > 20.000/ccm was found in 40% vs 39% (p=.52); LDH > 700U/L was remarkably 26% vs 18% (p=.014), and the day 16 b.m. blasts ≥ 10% accounted for 41% and 41% of patients. Conclusion: Approximately 50% of patients 70 years of age or older benefit from standard or intensive chemotherapy by complete remission which continues after 1 year in about 50% of responders. The inferior overall survival in the patients of 70+ versus those of 60- < 70 years is mainly explained by more frequent early and hypoplastic death (21% vs 12%) (p=.0016) and death with persistent AML (26% vs 18%) (p=.0145); while death in remission (7% vs 6%), relapse rate (50% vs 53%) and death after relapse (21% vs 26%) did not show this trend. In contrast to the important differences in outcome, established risk factors such as cytogenetic groups, WBC, and early blast clearance show concordance between the two age groups. The even lower LDH may support assumptions of older age AML as a less proliferative disease (Appelbaum et al. Blood 107:3481–5,2006). Thus, the hierarchical risk profiles cannot predict the age related outcome beyond 60 years in patients with de-novo AML.

Frequency and risk factors of severe hypoglycemia in insulin-treated type 2 diabetes: a literature survey

2006 ◽  
Vol 20 (6) ◽  
pp. 402-408 ◽  
Author(s):  
Kamran Akram ◽  
Ulrik Pedersen-Bjergaard ◽  
Knut Borch-Johnsen ◽  
Birger Thorsteinsson
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Severe Hypoglycemia ◽  
Literature Survey

scholarly journals Assessment of the risk factors of glycemic variability in patients with diabetes mellitus type 2

2020 ◽  
pp. 62-68
Author(s):  
E. S. Makhlina ◽  
Y. L. Navmenova ◽  
O. N. Kononova
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetes Mellitus Type 2 ◽  
Glycemic Variability ◽  
Diabetes Mellitus Type ◽  
Outpatient Basis ◽  
Patients With Diabetes ◽  
Hypoglycemic Therapy ◽  
Dm Type 2

Objective: to assess the presence of glycemic variability in patients with diabetes mellitus type 2 (DM Type 2), as well as to identify the risk factors which affect the degree of expression of the variability indices. Material and methods. Glycemic variability indices were assessed in 92 patients with DM Type 2 receiving different hypoglycemic therapy regimens. Results . It has been found that glycemic variability in 78 % of the examined patients with DM Type 2 was expressed and depended on the regimen of hypoglycemic therapy. The use of insulin therapy in the treatment regimen in patients with DM Type 2 and a BMI of less than 28.6 kg/m2 is a risk factor that increases glycemic variability. Postprandial hyperglycemia (2 hours after breakfast) is caused by high variability regardless of the regimen of hypoglycemic therapy. SD variability indices and glycemic amplitude are the assessment criteria for the degree of glycemic variability in the postprandial period of time. Conclusion . Glycemic variability in patients with DM Type 2 is expressed and depends on the regimen of hypoglycemic therapy. Calculation of glycemic variability indices in glycemic self-control will improve individual target glycemia values and it will make it possible to correct the tactical scheme of hypoglycemic therapy on an outpatient basis.

scholarly journals Chronic Kidney Disease and Associated Risk Factors Assessment among Diabetes Mellitus Patients at A Tertiary Hospital, Northwest Ethiopia

1970 ◽  
Vol 28 (6) ◽  
Author(s):  
Shewaneh Damtie ◽  
Belete Biadgo ◽  
Habtamu Wondifraw Baynes ◽  
Sintayehu Ambachew ◽  
Tadele Melak ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Older Age ◽  
Diabetic Patients ◽  
Study Participants

BACKGROUND: The prevalence of chronic kidney disease, particularly in diabetic patients, is increasing rapidly throughout the world. Nowadays, many individuals in developing nations are suffering from diabetes which is one of the primary risk factors of chronic kidney disease.METHODS: Institution based cross-sectional study was conducted at the University of Gondar Hospital from February to April 2016. A total of 229 study participants were selected using systematic random sampling technique. Urine sample was collected for albumin determination by dipstick. The Simplified Modification of Diet in Renal Disease study equation was used to estimate glomerular filtration rate. Binary logistic regression model was used to identify risk factors.RESULTS: Of the total 229 study participants, 50.2% were females and the mean age was 47±15.7 years. Among study participants, the prevalence of chronic kidney disease (CKD) was found to be 21.8% (95% CI: 16% - 27%). Of all study participants, 9(3.9%) had renal impairment (eGFR < 60 ml/min/ 1.73 m2) and 46 (20.1%) had albuminuria. Older age (AOR: 5.239, 95% CI: 2.255-12.175), systolic blood pressure ≥140mmHg (AOR: 3.633, 95% CI: 1.597-8.265), type 2 diabetes mellitus (AOR: 3.751, 95% CI: 1.507-9.336) and longer duration of diabetes (AOR: 3.380, 95% CI: 1.393-8.197) were independent risk factors of CKD.CONCLUSIONS: The study identified high prevalence (21.8%) of CKD among diabetic adults. CKD was significantly associated with older age, systolic blood pressure, type 2 DM and longer duration of DM. Thus, DM patients should be diagnosed for chronic kidney disease and then managed accordingly. 

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