Diabetes care
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Letter Case Reports
Severe diabetic ketoacidosis associated with acute myocardial necrosis.
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Multicenter Study Comparative Study Clinical Trial Controlled Clinical Trial
Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes.
The Diabetes Prevention Program (DPP) demonstrated that intensive lifestyle and metformin interventions reduced the incidence of type 2 diabetes compared with a placebo intervention. The aim of this study was to assess the cost-effectiveness of the lifestyle and metformin interventions relative to the placebo intervention. ⋯ Over 3 years, the lifestyle and metformin interventions were effective and were cost-effective from the perspective of a health system and society. Both interventions are likely to be affordable in routine clinical practice, especially if implemented in a group format and with generic medication pricing.
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Advanced glycation end products (AGEs) are a complex and heterogenous group of proteins that are formed by nonenzymatic glycation in a series of reactions. It is hypothesized that they may play a role in the pathogenesis of diabetes-related complications; at present, however, their exact biological role is scarcely understood. Clinical studies so far have shown that serum levels of AGEs are correlated with clinical stages of diabetes complications such as retinopathy and nephropathy. This study was performed in children and adolescents with type 1 diabetes to examine the putative role of serum AGEs in respect to metabolic control and diabetes complications in relation to a number of clinical and laboratory parameters. ⋯ In this study we demonstrated a clear age-dependent increase of fluorescent AGEs but not of CML-AGEs in children and adolescents with diabetes type 1. Moreover we showed a strong association between serum AGEs and serum triglycerides and cholesterol. The observed effect may be caused by a loss of optimal regulation of lipid metabolism. It could suggest a link between triglycerides and formation of AGEs. This new and interesting finding and its impact on metabolic control and the development of diabetes complications should be examined in the future.
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Randomized Controlled Trial Clinical Trial
Renoprotective effects of adding angiotensin II receptor blocker to maximal recommended doses of ACE inhibitor in diabetic nephropathy: a randomized double-blind crossover trial.
We evaluated the renoprotective effects as reflected by short-term changes in albuminuria of dual blockade of the renin-angiotensin system (RAS) by adding an angiotensin II receptor blocker (ARB) to treatment with maximal recommended doses of an ACE inhibitor (ACEI) in patients with type 2 diabetes and nephropathy. ⋯ Dual blockade of the RAS provides superior short-term renoprotection independent of systemic blood pressure changes in comparison with maximally recommended doses of ACEI in patients with type 2 diabetes as well as nephropathy.
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To determine racial differences in the prevalence of diabetic nephropathy, cardiovascular disease (CVD), and risk of mortality in a national health care system. ⋯ We conclude that when access to care is comparable, microvascular complications, macrovascular disease, and subsequent death occur with different frequencies among various racial groups.