This document discusses a protocol for a systematic review that aims to synthesize evidence on the relative risk of mortality in type 2 diabetes mellitus (T2DM). It provides background on the prevalence of T2DM and discusses inconsistencies in reported mortality rates. The systematic review will explore all-cause mortality risk in T2DM expressed as hazard ratios, and examine subgroups based on age, gender, socioeconomic factors and causes of death. The review expects to pool data from large cohort studies to accurately summarize the actual mortality risk in T2DM with limited bias and help direct future research.
There has been an increase in the predominance of diabetes mellitus over the past 40 years worldwide. The worldwide occurrence of diabetes in 2000 was approximately 2.8% and is estimated to grow to 4.4% by 2030. This data interprets a projected rise of diabetes from 171 million in 2000 to well over 350 million in 2030. The presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease, stroke, nephropathy and retinopathy. Indeed, when hypertension coexists with diabetes, the risk of CVD is increased by 75%, which further contributes to the overall morbidity and mortality of an already high risk population. Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is associated with high prevalence of well-established risk factors such as hypertension, dyslipidaemia and obesity in these patients. Hypertension plays a major role in the development and progression of microvascular and macrovascular disease in people with diabetes. Lifestyle Modifications and pharmacotherapy are the choice for the Management of Hypertension in Patients with Diabetes.
Glycemic control and excess mortality in type 1 diabetes mellitisDrJawad Butt
This study analyzed mortality rates in 33,915 Swedish patients with type 1 diabetes compared to 169,249 age- and sex-matched controls from the general population. It found that patients with type 1 diabetes and an average HbA1c of 6.9% or lower had twice the risk of death from any cause and cardiovascular causes than controls. Risks increased incrementally with higher HbA1c levels, with risks of death 8-10 times higher in patients with poor control. Excess mortality in type 1 diabetes was mainly due to cardiovascular disease and diabetes-related causes.
Three famous individuals struggled with chronic kidney disease: former rugby player Jonah Lomu who had a transplant, film director Alfred Hitchcock who died of renal failure, and the fictional Tiny Tim from A Christmas Carol who appeared to have chronic kidney disease alongside rickets. Chronic kidney disease can have various causes such as genetics, obesity, diabetes or environmental factors as represented by these three examples. Chronic kidney disease is defined as long term kidney damage and is associated with increased mortality, often progressing to end stage renal disease. It affects millions worldwide and prevalence is expected to increase significantly in coming decades due to aging populations and risk factors like diabetes and hypertension.
This study aimed to determine the prevalence of cardiovascular diseases among diabetes patients attending Kampala International University Teaching Hospital. The study found a cardiovascular disease prevalence of 54.1% among the 98 diabetes patients. Hypertension was the most common complication at 53%, followed by diabetic retinopathy at 14%. Poor blood sugar monitoring and control was also observed. The study concludes that the cardiovascular disease prevalence among diabetes patients is high, calling for improved diabetes management and care.
This document summarizes a study on mortality trends among type 2 diabetes patients in two hospitals in Nigeria. The study found that diabetic foot ulcer had the highest percentage of deaths at 42.8% of cases. Other leading causes of death were diabetic ketoacidosis, hypertension, and hyperglycemia. Married patients accounted for the majority of diabetes-related deaths at both hospitals. The study aimed to identify causes of premature death in diabetes patients to help reduce complications and mortality.
This document reviews traditional and non-traditional risk factors for cardiovascular disease. It discusses how hypertension, diabetes, high total cholesterol, high LDL cholesterol, high triglycerides, and low HDL cholesterol are traditional risk factors. It also examines non-traditional markers like homocysteine, plasminogen activator inhibitor-1, fibrinogen, and various inflammatory markers that may help predict cardiovascular risk. While many non-traditional markers show promise, most are not routinely used in clinical practice and their predictive value requires further confirmation.
This document summarizes a literature review on the causes of high prevalence of Type 2 Diabetes in Turkish and Moroccan immigrants in the Netherlands. The review finds several reasons for the high prevalence, including genetic factors, obesity, lower socioeconomic status, hypertension, and lifestyle factors like diet and physical inactivity. Migration is also found to influence prevalence, as immigrants often adopt a more western diet and lifestyle, which can increase obesity and diabetes risk. Overall, the review concludes that both immigration factors like changes to lifestyle and diet, as well as ethnic factors, contribute to the high rates of Type 2 Diabetes in Turkish and Moroccan immigrants in the Netherlands.
Cardiovascular disease is a leading cause of death in Canada, accounting for over 78,000 deaths in 1998. While mortality rates have declined, it remains unclear if incidence rates have also decreased. Women experience a 10 year delay in onset compared to men but have higher rates of hospitalization and longer hospital stays. Risk factors like hypertension, high cholesterol, and diabetes disproportionately impact women's cardiovascular health. Vulnerable subgroups including low-income women and some ethnic minorities experience even greater rates of cardiovascular disease.
There has been an increase in the predominance of diabetes mellitus over the past 40 years worldwide. The worldwide occurrence of diabetes in 2000 was approximately 2.8% and is estimated to grow to 4.4% by 2030. This data interprets a projected rise of diabetes from 171 million in 2000 to well over 350 million in 2030. The presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease, stroke, nephropathy and retinopathy. Indeed, when hypertension coexists with diabetes, the risk of CVD is increased by 75%, which further contributes to the overall morbidity and mortality of an already high risk population. Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is associated with high prevalence of well-established risk factors such as hypertension, dyslipidaemia and obesity in these patients. Hypertension plays a major role in the development and progression of microvascular and macrovascular disease in people with diabetes. Lifestyle Modifications and pharmacotherapy are the choice for the Management of Hypertension in Patients with Diabetes.
Glycemic control and excess mortality in type 1 diabetes mellitisDrJawad Butt
This study analyzed mortality rates in 33,915 Swedish patients with type 1 diabetes compared to 169,249 age- and sex-matched controls from the general population. It found that patients with type 1 diabetes and an average HbA1c of 6.9% or lower had twice the risk of death from any cause and cardiovascular causes than controls. Risks increased incrementally with higher HbA1c levels, with risks of death 8-10 times higher in patients with poor control. Excess mortality in type 1 diabetes was mainly due to cardiovascular disease and diabetes-related causes.
Three famous individuals struggled with chronic kidney disease: former rugby player Jonah Lomu who had a transplant, film director Alfred Hitchcock who died of renal failure, and the fictional Tiny Tim from A Christmas Carol who appeared to have chronic kidney disease alongside rickets. Chronic kidney disease can have various causes such as genetics, obesity, diabetes or environmental factors as represented by these three examples. Chronic kidney disease is defined as long term kidney damage and is associated with increased mortality, often progressing to end stage renal disease. It affects millions worldwide and prevalence is expected to increase significantly in coming decades due to aging populations and risk factors like diabetes and hypertension.
This study aimed to determine the prevalence of cardiovascular diseases among diabetes patients attending Kampala International University Teaching Hospital. The study found a cardiovascular disease prevalence of 54.1% among the 98 diabetes patients. Hypertension was the most common complication at 53%, followed by diabetic retinopathy at 14%. Poor blood sugar monitoring and control was also observed. The study concludes that the cardiovascular disease prevalence among diabetes patients is high, calling for improved diabetes management and care.
This document summarizes a study on mortality trends among type 2 diabetes patients in two hospitals in Nigeria. The study found that diabetic foot ulcer had the highest percentage of deaths at 42.8% of cases. Other leading causes of death were diabetic ketoacidosis, hypertension, and hyperglycemia. Married patients accounted for the majority of diabetes-related deaths at both hospitals. The study aimed to identify causes of premature death in diabetes patients to help reduce complications and mortality.
This document reviews traditional and non-traditional risk factors for cardiovascular disease. It discusses how hypertension, diabetes, high total cholesterol, high LDL cholesterol, high triglycerides, and low HDL cholesterol are traditional risk factors. It also examines non-traditional markers like homocysteine, plasminogen activator inhibitor-1, fibrinogen, and various inflammatory markers that may help predict cardiovascular risk. While many non-traditional markers show promise, most are not routinely used in clinical practice and their predictive value requires further confirmation.
This document summarizes a literature review on the causes of high prevalence of Type 2 Diabetes in Turkish and Moroccan immigrants in the Netherlands. The review finds several reasons for the high prevalence, including genetic factors, obesity, lower socioeconomic status, hypertension, and lifestyle factors like diet and physical inactivity. Migration is also found to influence prevalence, as immigrants often adopt a more western diet and lifestyle, which can increase obesity and diabetes risk. Overall, the review concludes that both immigration factors like changes to lifestyle and diet, as well as ethnic factors, contribute to the high rates of Type 2 Diabetes in Turkish and Moroccan immigrants in the Netherlands.
Cardiovascular disease is a leading cause of death in Canada, accounting for over 78,000 deaths in 1998. While mortality rates have declined, it remains unclear if incidence rates have also decreased. Women experience a 10 year delay in onset compared to men but have higher rates of hospitalization and longer hospital stays. Risk factors like hypertension, high cholesterol, and diabetes disproportionately impact women's cardiovascular health. Vulnerable subgroups including low-income women and some ethnic minorities experience even greater rates of cardiovascular disease.
Chronic kidney disease (CKD) is a global public health problem
worldwide. The worldwide prevalence of CKD has increased in
various countries such as the U.S. (13.1%), Taiwan (9.8-11.9%),
Norway (10.2%), Japan (12.9-15.1%) China (3.2-11.3%), Korea (7.2- 13.7%), Thailand (8.45-16.3%), Singapore (3.2-18.6%), and Australia(11.2%)
Heart disease causes prevention and currentArhamSheikh1
This document summarizes an article from the JCCC Honors Journal that discusses heart disease, including its causes, prevention, and current research. The article provides an overview of lipids like fatty acids and cholesterol, and how dietary recommendations have historically focused on limiting saturated fats and cholesterol. However, recent studies call into question the benefits of strictly limiting these or replacing them with polyunsaturated fatty acids. Exercise is shown to benefit heart health for all. Overall, the causes of heart disease are complex with interactions between diet, genetics, and environment not fully understood.
Physical activity and risk of cardiovascular disease—aArhamSheikh1
High levels of both leisure time physical activity and moderate levels of occupational physical activity are associated with a 20-30% lower risk of cardiovascular disease among men and women. The meta-analysis included 21 prospective cohort studies with over 650,000 participants followed for an average of 10 years. Both high leisure time physical activity and moderate occupational physical activity were associated with roughly a 20-30% lower risk of coronary heart disease and stroke for men and women. No evidence of publication bias was found across the studies.
Artigo joga dúvidas sobre a necessidade/ ou mesmo contraindicação de insulina em DM2. A hiperinsulinemia que precede a clínica do DM, quando associada à aplicação exógena do hormônio pode trazer efeitos adversos. O artigo põe em dúvida a aplicação de insulina no DM.
HIV infection is increasingly affecting older individuals as treatment allows for longer lifespans. Older adults with HIV have higher rates of age-related comorbidities like cardiovascular disease, cancer, liver disease, kidney disease, lung disease, and bone disease than HIV-negative individuals of the same age. Management of these conditions in HIV requires screening for comorbidities, treating underlying viral infections, modifying lifestyle factors, and following guidelines for prevention and treatment of common age-related diseases.
Diabetes mellitus type 2: One monster eating allApollo Hospitals
Type 2 diabetes mellitus (T2DM) has become one of the most prevalent non-communicable diseases worldwide. If left uncontrolled, T2DM can damage almost every organ system in the body and lead to numerous serious complications. The main complications discussed in the document are cardiovascular disease, diabetic retinopathy (damage to the retina), diabetic nephropathy (kidney damage), pulmonary dysfunction, diabetic neuropathy, and hepatic dysfunction. Uncontrolled hyperglycemia increases the risks of all these complications through mechanisms like increased advanced glycation end products, oxidative stress, and inflammation. Studies have shown T2DM poses a major threat in India as well, with Indians at high risk of related cardiovascular and metabolic issues.
C11 nonpharmacologic therapy and exercise in diabetes preventionDiabetes for all
Randomized controlled trials have demonstrated that lifestyle interventions focusing on diet and exercise can significantly prevent or delay the onset of type 2 diabetes. These trials showed that people with impaired glucose tolerance who received lifestyle advice like diet modification and increased physical activity had approximately a 50% lower risk of developing type 2 diabetes over follow-up periods ranging from 2-20 years compared to control groups. Maintaining a healthy lifestyle through diet and exercise can protect against most cases of type 2 diabetes.
A Study of the Prevalence of Cardio-Vascular Diseases and Its Risk Factors (B...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This study examined dyslipidemia among type 2 diabetes patients in Somalia. The study found:
- 22.5% of patients had dyslipidemia, slightly lower than other African studies.
- Risk factors for dyslipidemia included female sex, insufficient physical activity, and high BMI.
- Many patients had multiple cardiovascular risk factors like hypertension and a family history of heart disease, despite a short time since diabetes diagnosis.
- Management challenges for diabetes in Somalia include lack of funding, unreliable access to medications, and inequity in healthcare access between public and private sectors. Effective prevention and treatment strategies are needed that address Somalia's unique healthcare context.
This study examined seasonal variations in the onset of acute pancreatitis at a hospital in Islamabad, Pakistan from 2005-2006. The researchers found:
- There were 121 cases of acute pancreatitis included in the study, with slightly more male patients. The average age was 42.
- Gallstones and alcoholism were the leading risk factors, accounting for 39.7% and 12.4% of cases respectively.
- There was a peak in onset of acute pancreatitis in the months of September-December, particularly for patients with gallstones or a history of alcoholism.
- Events occurring in October-December had a significantly higher mortality rate compared to other times of year.
Degree of Suspicion of Peripheral Artery Disease among Geriatrics and Policem...Jan Igor Galinato
This document summarizes a study that examined the degree of suspicion of peripheral artery disease (PAD) among geriatrics and policemen in Iligan City, Philippines. The study utilized a descriptive-correlational-comparative research design and purposive sampling to gather data from 40 respondents, including 20 geriatrics and 20 policemen, using a modified standardized questionnaire. The results showed that 50% of respondents were 50 years or older, and 65% were male. Age and lifestyle factors like diet and exercise were found to have a significant relationship with degree of suspicion of PAD, but not other factors like gender, family history of diseases, smoking, or alcohol use. While age cannot be controlled, the study concludes that
This document discusses hyperglycemic crises in adult patients with diabetes, specifically diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). It outlines:
1) DKA and HHS are metabolic complications of diabetes caused by insulin deficiency and counterregulatory hormone excess, leading to hyperglycemia, ketosis, and metabolic acidosis in DKA or severe hyperglycemia and dehydration in HHS.
2) Common precipitating factors are infection, discontinuation of insulin therapy, and acute illnesses. Symptoms can range from mild to life-threatening coma.
3) Diagnosis is based on clinical history and lab criteria including blood
The document discusses the potential for modulating gasotransmitters like nitric oxide, carbon monoxide, and hydrogen sulfide to treat vascular complications of diabetes. It summarizes that these gasotransmitters play roles in vasodilation and reducing oxidative stress, but their levels are reduced in diabetes. Modulating their levels may offer a novel treatment approach by targeting the pathogenesis of microvascular and macrovascular complications. However, more research is needed to validate this approach through animal and human studies before any related therapies can be used clinically.
1. Cardiovascular diseases are the leading cause of death globally, accounting for 31% of all deaths in 2016. Accurately assessing CVD risk allows for early prevention efforts.
2. The original Framingham Risk Score from 1998 predicts 10-year risk of coronary heart disease based on age, sex, cholesterol, blood pressure, smoking, and diabetes. However, it does not include other outcomes like stroke and underestimates risk in other populations.
3. Several risk calculators have been developed to address limitations of the FRS. Models like SCORE and QRISK2 predict fatal cardiovascular risk and account for additional risk factors like ethnicity and deprivation level respectively.
This document summarizes a study examining causes of death among HIV-infected patients treated with antiretroviral therapy (ART) between 1996-2006. The study analyzed data from 13 cohorts including 39,272 patients. The main causes of death were AIDS-related (49.5% of deaths), non-AIDS malignancies (11.8%), non-AIDS infections (8.2%), and liver disease (7%). Rates of AIDS-related death were higher with lower CD4 count or higher viral load. Rates of several non-AIDS causes, like liver and respiratory disease, were higher in injection drug users. The proportion of AIDS-related deaths decreased with longer duration of ART, suggesting ART improves survival from
NAFDL: un approccio clinico multidisciplinareGiancarlo Ralli
This document summarizes information about non-alcoholic fatty liver disease (NAFLD). It begins by defining NAFLD as a spectrum of liver disease ranging from simple fatty liver or steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. It then discusses the global prevalence of NAFLD, key risk factors like obesity, diabetes, genetic factors, and demographic information. Mortality risks associated with NAFLD are also summarized, showing increased risks of death from liver-related causes and all-cause mortality correlated with fibrosis stage. The document concludes by noting NAFLD is now considered a systemic disease with potential extrahepatic manifestations affecting other organ systems.
The document discusses the importance of glycemic control for hospitalized patients with diabetes or hyperglycemia. It notes that hyperglycemia is common in hospitalized patients and associated with worse outcomes. The document reviews evidence that intensive insulin therapy to maintain tight glycemic control can reduce mortality, infection rates, and length of stay in intensive care units and improve outcomes for patients with acute myocardial infarction. It discusses guidelines developed for recommended glycemic targets in hospitals.
This study aimed to identify correlations between biochemical markers and risk factors for cardiovascular disease (CVD) and type 2 diabetes (T2D) in people under 40. The study found significant positive correlations between triglycerides, glucose, and cholesterol and known CVD/T2D risk factors like blood pressure and BMI in the total cohort. Separating results by sex, significant correlations were seen between triglycerides and factors like weight, waist circumference, and body fat percentage in males, and between triglycerides, glucose, and blood pressure in females. While most results aligned with past studies, some discrepancies were found, such as no correlation between glucose and risk factors in males.
Planning for the future - when does the future start? Laura-Jane Smith
Presentation at PLAN Network event, on advance care planning in chronic respiratory disease. NB last few slides are resources for the group task, and references. Let me know i I missed any!
This document reviews the association between diabetes mellitus, alcohol abuse, and various cancers. It discusses the mechanisms by which hyperglycemia and hyperinsulinemia associated with diabetes can promote cancer growth. Alcohol metabolism produces acetaldehyde, which is carcinogenic and may initiate or promote cancer development in several tissues. The review summarizes studies showing diabetes and alcohol abuse are risk factors for cancers like breast, colorectal, liver and others. It explores the molecular pathways like IGF-1, MAPK and cytokines through which diabetes and alcohol abuse can increase cancer incidence and mortality.
Diabetes-related Clinical Complications: Novel Approaches for Diagnosis and M...asclepiuspdfs
Metabolic diseases such as hypertension, obesity, diabetes, and vascular diseases have reached epidemic proportions worldwide. In the past four decades, childhood and adolescent obesity has increased four-fold worldwide. During the same period, obesity in adults has doubled and diabetes has increased by four-fold. In China, India, and the USA, the number of prediabetes is more than diabetics. This population is at considerable risk for developing diabetes, its clinical complications, and acute vascular events. The management of modifiable risks for cardiometabolic risks has improved considerably. Several major studies have demonstrated, that robust management of modifiable risks for cardiovascular diseases (CVDs), significantly reduces premature mortality from CVDs. Considering the progress made in the risk assessment, risk management, we feel strongly, that not much progress is made in the areas of primary prevention and early risk assessment, for clinical complications associated with metabolic diseases, in particular, diabetes. The majority of the clinical complications associated with diabetes are due to dysfunction of the vascular system or nervous system. Complications include vasculopathy leading to subclinical atherosclerosis, heart attacks, and stroke.
Chronic kidney disease (CKD) is a global public health problem
worldwide. The worldwide prevalence of CKD has increased in
various countries such as the U.S. (13.1%), Taiwan (9.8-11.9%),
Norway (10.2%), Japan (12.9-15.1%) China (3.2-11.3%), Korea (7.2- 13.7%), Thailand (8.45-16.3%), Singapore (3.2-18.6%), and Australia(11.2%)
Heart disease causes prevention and currentArhamSheikh1
This document summarizes an article from the JCCC Honors Journal that discusses heart disease, including its causes, prevention, and current research. The article provides an overview of lipids like fatty acids and cholesterol, and how dietary recommendations have historically focused on limiting saturated fats and cholesterol. However, recent studies call into question the benefits of strictly limiting these or replacing them with polyunsaturated fatty acids. Exercise is shown to benefit heart health for all. Overall, the causes of heart disease are complex with interactions between diet, genetics, and environment not fully understood.
Physical activity and risk of cardiovascular disease—aArhamSheikh1
High levels of both leisure time physical activity and moderate levels of occupational physical activity are associated with a 20-30% lower risk of cardiovascular disease among men and women. The meta-analysis included 21 prospective cohort studies with over 650,000 participants followed for an average of 10 years. Both high leisure time physical activity and moderate occupational physical activity were associated with roughly a 20-30% lower risk of coronary heart disease and stroke for men and women. No evidence of publication bias was found across the studies.
Artigo joga dúvidas sobre a necessidade/ ou mesmo contraindicação de insulina em DM2. A hiperinsulinemia que precede a clínica do DM, quando associada à aplicação exógena do hormônio pode trazer efeitos adversos. O artigo põe em dúvida a aplicação de insulina no DM.
HIV infection is increasingly affecting older individuals as treatment allows for longer lifespans. Older adults with HIV have higher rates of age-related comorbidities like cardiovascular disease, cancer, liver disease, kidney disease, lung disease, and bone disease than HIV-negative individuals of the same age. Management of these conditions in HIV requires screening for comorbidities, treating underlying viral infections, modifying lifestyle factors, and following guidelines for prevention and treatment of common age-related diseases.
Diabetes mellitus type 2: One monster eating allApollo Hospitals
Type 2 diabetes mellitus (T2DM) has become one of the most prevalent non-communicable diseases worldwide. If left uncontrolled, T2DM can damage almost every organ system in the body and lead to numerous serious complications. The main complications discussed in the document are cardiovascular disease, diabetic retinopathy (damage to the retina), diabetic nephropathy (kidney damage), pulmonary dysfunction, diabetic neuropathy, and hepatic dysfunction. Uncontrolled hyperglycemia increases the risks of all these complications through mechanisms like increased advanced glycation end products, oxidative stress, and inflammation. Studies have shown T2DM poses a major threat in India as well, with Indians at high risk of related cardiovascular and metabolic issues.
C11 nonpharmacologic therapy and exercise in diabetes preventionDiabetes for all
Randomized controlled trials have demonstrated that lifestyle interventions focusing on diet and exercise can significantly prevent or delay the onset of type 2 diabetes. These trials showed that people with impaired glucose tolerance who received lifestyle advice like diet modification and increased physical activity had approximately a 50% lower risk of developing type 2 diabetes over follow-up periods ranging from 2-20 years compared to control groups. Maintaining a healthy lifestyle through diet and exercise can protect against most cases of type 2 diabetes.
A Study of the Prevalence of Cardio-Vascular Diseases and Its Risk Factors (B...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This study examined dyslipidemia among type 2 diabetes patients in Somalia. The study found:
- 22.5% of patients had dyslipidemia, slightly lower than other African studies.
- Risk factors for dyslipidemia included female sex, insufficient physical activity, and high BMI.
- Many patients had multiple cardiovascular risk factors like hypertension and a family history of heart disease, despite a short time since diabetes diagnosis.
- Management challenges for diabetes in Somalia include lack of funding, unreliable access to medications, and inequity in healthcare access between public and private sectors. Effective prevention and treatment strategies are needed that address Somalia's unique healthcare context.
This study examined seasonal variations in the onset of acute pancreatitis at a hospital in Islamabad, Pakistan from 2005-2006. The researchers found:
- There were 121 cases of acute pancreatitis included in the study, with slightly more male patients. The average age was 42.
- Gallstones and alcoholism were the leading risk factors, accounting for 39.7% and 12.4% of cases respectively.
- There was a peak in onset of acute pancreatitis in the months of September-December, particularly for patients with gallstones or a history of alcoholism.
- Events occurring in October-December had a significantly higher mortality rate compared to other times of year.
Degree of Suspicion of Peripheral Artery Disease among Geriatrics and Policem...Jan Igor Galinato
This document summarizes a study that examined the degree of suspicion of peripheral artery disease (PAD) among geriatrics and policemen in Iligan City, Philippines. The study utilized a descriptive-correlational-comparative research design and purposive sampling to gather data from 40 respondents, including 20 geriatrics and 20 policemen, using a modified standardized questionnaire. The results showed that 50% of respondents were 50 years or older, and 65% were male. Age and lifestyle factors like diet and exercise were found to have a significant relationship with degree of suspicion of PAD, but not other factors like gender, family history of diseases, smoking, or alcohol use. While age cannot be controlled, the study concludes that
This document discusses hyperglycemic crises in adult patients with diabetes, specifically diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). It outlines:
1) DKA and HHS are metabolic complications of diabetes caused by insulin deficiency and counterregulatory hormone excess, leading to hyperglycemia, ketosis, and metabolic acidosis in DKA or severe hyperglycemia and dehydration in HHS.
2) Common precipitating factors are infection, discontinuation of insulin therapy, and acute illnesses. Symptoms can range from mild to life-threatening coma.
3) Diagnosis is based on clinical history and lab criteria including blood
The document discusses the potential for modulating gasotransmitters like nitric oxide, carbon monoxide, and hydrogen sulfide to treat vascular complications of diabetes. It summarizes that these gasotransmitters play roles in vasodilation and reducing oxidative stress, but their levels are reduced in diabetes. Modulating their levels may offer a novel treatment approach by targeting the pathogenesis of microvascular and macrovascular complications. However, more research is needed to validate this approach through animal and human studies before any related therapies can be used clinically.
1. Cardiovascular diseases are the leading cause of death globally, accounting for 31% of all deaths in 2016. Accurately assessing CVD risk allows for early prevention efforts.
2. The original Framingham Risk Score from 1998 predicts 10-year risk of coronary heart disease based on age, sex, cholesterol, blood pressure, smoking, and diabetes. However, it does not include other outcomes like stroke and underestimates risk in other populations.
3. Several risk calculators have been developed to address limitations of the FRS. Models like SCORE and QRISK2 predict fatal cardiovascular risk and account for additional risk factors like ethnicity and deprivation level respectively.
This document summarizes a study examining causes of death among HIV-infected patients treated with antiretroviral therapy (ART) between 1996-2006. The study analyzed data from 13 cohorts including 39,272 patients. The main causes of death were AIDS-related (49.5% of deaths), non-AIDS malignancies (11.8%), non-AIDS infections (8.2%), and liver disease (7%). Rates of AIDS-related death were higher with lower CD4 count or higher viral load. Rates of several non-AIDS causes, like liver and respiratory disease, were higher in injection drug users. The proportion of AIDS-related deaths decreased with longer duration of ART, suggesting ART improves survival from
NAFDL: un approccio clinico multidisciplinareGiancarlo Ralli
This document summarizes information about non-alcoholic fatty liver disease (NAFLD). It begins by defining NAFLD as a spectrum of liver disease ranging from simple fatty liver or steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. It then discusses the global prevalence of NAFLD, key risk factors like obesity, diabetes, genetic factors, and demographic information. Mortality risks associated with NAFLD are also summarized, showing increased risks of death from liver-related causes and all-cause mortality correlated with fibrosis stage. The document concludes by noting NAFLD is now considered a systemic disease with potential extrahepatic manifestations affecting other organ systems.
The document discusses the importance of glycemic control for hospitalized patients with diabetes or hyperglycemia. It notes that hyperglycemia is common in hospitalized patients and associated with worse outcomes. The document reviews evidence that intensive insulin therapy to maintain tight glycemic control can reduce mortality, infection rates, and length of stay in intensive care units and improve outcomes for patients with acute myocardial infarction. It discusses guidelines developed for recommended glycemic targets in hospitals.
This study aimed to identify correlations between biochemical markers and risk factors for cardiovascular disease (CVD) and type 2 diabetes (T2D) in people under 40. The study found significant positive correlations between triglycerides, glucose, and cholesterol and known CVD/T2D risk factors like blood pressure and BMI in the total cohort. Separating results by sex, significant correlations were seen between triglycerides and factors like weight, waist circumference, and body fat percentage in males, and between triglycerides, glucose, and blood pressure in females. While most results aligned with past studies, some discrepancies were found, such as no correlation between glucose and risk factors in males.
Planning for the future - when does the future start? Laura-Jane Smith
Presentation at PLAN Network event, on advance care planning in chronic respiratory disease. NB last few slides are resources for the group task, and references. Let me know i I missed any!
This document reviews the association between diabetes mellitus, alcohol abuse, and various cancers. It discusses the mechanisms by which hyperglycemia and hyperinsulinemia associated with diabetes can promote cancer growth. Alcohol metabolism produces acetaldehyde, which is carcinogenic and may initiate or promote cancer development in several tissues. The review summarizes studies showing diabetes and alcohol abuse are risk factors for cancers like breast, colorectal, liver and others. It explores the molecular pathways like IGF-1, MAPK and cytokines through which diabetes and alcohol abuse can increase cancer incidence and mortality.
Diabetes-related Clinical Complications: Novel Approaches for Diagnosis and M...asclepiuspdfs
Metabolic diseases such as hypertension, obesity, diabetes, and vascular diseases have reached epidemic proportions worldwide. In the past four decades, childhood and adolescent obesity has increased four-fold worldwide. During the same period, obesity in adults has doubled and diabetes has increased by four-fold. In China, India, and the USA, the number of prediabetes is more than diabetics. This population is at considerable risk for developing diabetes, its clinical complications, and acute vascular events. The management of modifiable risks for cardiometabolic risks has improved considerably. Several major studies have demonstrated, that robust management of modifiable risks for cardiovascular diseases (CVDs), significantly reduces premature mortality from CVDs. Considering the progress made in the risk assessment, risk management, we feel strongly, that not much progress is made in the areas of primary prevention and early risk assessment, for clinical complications associated with metabolic diseases, in particular, diabetes. The majority of the clinical complications associated with diabetes are due to dysfunction of the vascular system or nervous system. Complications include vasculopathy leading to subclinical atherosclerosis, heart attacks, and stroke.
RunningHead: PICOT Question 1
RunningHead: PICOT Question 7
PICOT Question
Avery Bryan
NRS-433V
Professor Christine Vannelli
May 19, 2019
Clinical Problem
A report from the Center for Disease Control and Prevention in 2015 revealed that (9.4%) 30.3 million Americans are diabetic and 84.1 million have prediabetes. This is a total population of over 100 million is at risk of developing type 2 diabetes which is a growing health problem being the seventh leading cause of death in the U.S. An estimated 1.5 million new cases were among 18-year old bracket and the rates of diagnosed diabetes increased proportionally to age. Below 44 years accounted for 4%, below 64 years at 17 % and 25% for those above 65 years across both genders. One-third of adults in America has prediabetes but sadly, they are unaware despite reports released by The National Diabetes Statistics Report every year. These reports elaborate on prevalence and incidence, prediabetes, long-term complications, risk factors, mortality, and cost. Diabetes poses the risk of serious complications like death, blindness, stroke, kidney disorders, cardiac diseases and health problems that lead to amputation of legs. However, the risks can be mitigated through physical body activities, proper dieting and prescribed use of insulin and other related measures to control the blood sugar levels. Diabetes Prevention Program was funded by NIH to research a yearly evidence-based program to improve healthy weight loss through diet and physical activities. There also efforts to determine the effectiveness of public service campaigns in improving the real-life experience in the diagnosis and treatment of diabetes.
PICOT Question.
The population affected by diabetes cuts across all ages, gender, race, and ethnicity. The prevalence is significantly high from 18 years and it increases with age to about 25% above 65 years. In terms of gender, men are at higher risk accounting for 37% while women are at 30% across races and educational levels. On races, the rates were higher among Indians/Alaska natives at 15%, non-Hispanic blacks at 12.7% and Hispanics at 12%. Among Asians, the rates were lower at 8% and 7.4% for non-Hispanic whites.
Intervention indicator for diabetes shows that individuals who do not observe a healthy diet are more exposed to the disease. Some risk behaviors include lack of exercise and excessive intake of junk foods that lead to obesity and increased blood sugar levels. Diabetes prevalence varied according to education levels were those with less than high school education at 12.6% and 7.2% for those higher than high school education.
Comparison and use of a control group from the popularity of Complementary and Alternative Medicine and Traditional Chinese Medicine showed distinct knowledge of diabetes, blood sugar control, and self-care. The experimental group received education through interactive multimedia for three months while the control group received.
This study compared the 7-year risk of heart attack in people with and without type 2 diabetes. It found:
1) The risk of heart attack over 7 years was much higher in people with prior heart attack (18.8% without diabetes, 45% with diabetes) compared to those without (3.5% without diabetes, 20.2% with diabetes).
2) People with diabetes but no prior heart attack had a similar risk of death from heart disease as people without diabetes but with a prior heart attack.
3) These findings suggest that people with diabetes should be treated as aggressively for cardiovascular risk factors as nondiabetic people with established heart disease.
This document discusses type 3c diabetes, which is diabetes caused by diseases of the exocrine pancreas. It is the third most common form of diabetes after type 1 and type 2. The most common causes are chronic pancreatitis and pancreatic cancer. The document reviews the epidemiology and pathogenesis of type 3c diabetes caused by these conditions. It estimates that type 3c diabetes accounts for 1-9% of all diabetes cases worldwide based on prevalence data, with a reasonable estimate of 4-5%. The diagnosis requires that patients meet criteria for both diabetes and a disease of the exocrine pancreas, with the diabetes considered secondary to the pancreatic condition.
Ueda 2016 diabetes mellitus and heart failure - yahia kishkueda2015
Diabetes and heart failure have a bidirectional relationship where each condition can lead to or worsen the other. Over 60% of asymptomatic type 2 diabetes patients have left ventricular diastolic dysfunction. The prevalence of heart failure is higher in diabetics and increases with age. Diabetes increases the risk of heart failure through hypertension, coronary artery disease, diabetic nephropathy and cardiomyopathy. Intensive glucose control can help prevent microvascular complications but does not significantly reduce cardiovascular events. Several diabetes medications need to be used cautiously in heart failure patients. Both conditions are serious with high mortality rates so treatment must target overall improvement.
Diabetes is a significant cause of mortality and morbidity in different continents of the world. Many diabetes victims are found in developing countries like Sub-Saharan Africa. However, some developed nations like United States and Europe record significant records on diabetes prevalence. Studies project a dramatic increase of the infection spread in the world. Also, it provides visible results on the effects of the infection among the victims and the society at large. Studies of type 2 diabetes prevalence indicate minimal rates in rural population and moderate results in the developed regions of the same country. Such results create an alarm to the unaffected regions. The frequent observation of modestly high prevalence of impaired glucose tolerance in areas with low prevalence of diabetes indicate risk of early stage of diabetes epidemics.
Running head illness and disease managementillness and disearyan532920
Chronic kidney disease is a debilitating disease that affects many organ systems and is associated with high risks of cardiovascular disease and early death. It has numerous comorbidities such as diabetes, hypertension, heart disease, and impacts patients' quality of life through disability and high medical costs. About 10% of the global population is affected by CKD, and it is a leading cause of death worldwide. Goals for improving CKD include reducing the disease burden through early detection and treatment of risk factors like diabetes and hypertension.
A study on awareness of diabetic complications among type 2 diabetes patientsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Review ArticlePotential role of sugar (fructose) in the ep.docxronak56
Review Article
Potential role of sugar (fructose) in the epidemic of hypertension,
obesity and the metabolic syndrome, diabetes, kidney disease, and
cardiovascular disease1�3
Richard J Johnson, Mark S Segal, Yuri Sautin, Takahiko Nakagawa, Daniel I Feig, Duk-Hee Kang, Michael S Gersch,
Steven Benner, and Laura G Sánchez-Lozada
ABSTRACT
Currently, we are experiencing an epidemic of cardiorenal disease
characterized by increasing rates of obesity, hypertension, the met-
abolic syndrome, type 2 diabetes, and kidney disease. Whereas ex-
cessive caloric intake and physical inactivity are likely important
factors driving the obesity epidemic, it is important to consider
additional mechanisms. We revisit an old hypothesis that sugar,
particularly excessive fructose intake, has a critical role in the epi-
demic of cardiorenal disease. We also present evidence that the
unique ability of fructose to induce an increase in uric acid may be a
major mechanism by which fructose can cause cardiorenal disease.
Finally, we suggest that high intakes of fructose in African Ameri-
cans may explain their greater predisposition to develop cardiorenal
disease, and we provide a list of testable predictions to evaluate this
hypothesis. Am J Clin Nutr 2007;86:899 –906.
KEY WORDS Fructose, uric acid, sugar, arteriosclerosis, en-
dothelial dysfunction, hypertension, obesity, chronic kidney dis-
ease, metabolic syndrome
INTRODUCTION
Despite our best efforts, the epidemic of cardiorenal disease
continues to increase at an alarming rate. Obesity affects one-
third of adults and one-sixth of children in the United States and
continues to increase; although dietary interventions are often
initially successful, they often fail over time because of attrition
(1). Likewise, hypertension affects nearly one-third of the pop-
ulation, but despite the presence of effective antihypertensive
agents, nearly two-thirds of these patients remain either un-
treated or are treated ineffectively (2). Furthermore, even if the
hypertension is controlled, these subjects continue to have in-
creased cardiovascular mortality (3). Diabetes, a complication of
obesity, now affects 7% of our population, with approximately
one-third doomed to develop various complications such as ret-
inopathy or nephropathy (4). Kidney disease also continues to
increase at a deplorable rate, a consequence of the increasing
frequency of hypertension and diabetes (5). Today, nearly 20
million Americans have stage 1 kidney disease or greater (de-
fined as the presence of microalbuminuria or a glomerular fil-
tration rate �90 mL�min�1�1.73 m�2; 6), and, although treat-
ments such as angiotensin-converting enzyme inhibitors are
beneficial, they act primarily to delay the progression to renal
failure as opposed to halting the process (7).
It is our opinion that the potential mechanisms underlying the
epidemic should be carefully reappraised. On the basis of both
the experimental studies performed in our laboratorie ...
ABSTRACT- In today’s modern lifestyle high blood cholesterol is one of the most dreaded causes of heart diseases among the global population. Fast lifestyle, lack of exercise, obesity and improper food intake all sum up to deranged lipid profile as well as diabetes. Diabetes and high blood cholesterol goes hand in hand which leads to an increased incidence of coronary artery and cardiovascular disorders which still remains as one of the leading causes of mortality overall. In the present study there has been an effort put to draw a correlation between glycosylated hemoglobin which is a marker for level of blood glucose in diabetic patients as well as deranged lipid profile. Blood samples collected in sterile vials were first centrifuged and then put into analyzer for the computation of the lipid profile and the glycosylated hemoglobin. Results computed were made a note of and then prepared for statistical analysis. Results thus obtained showed that females showed significantly higher levels of total serum cholesterol and Non-HDL compared to males other than that their lipid parameters were a little higher than males in general. Diabetic female patients showed a significantly higher level of glycosylated hemoglobin. There was a significant difference in the HDL values of patients in pre diabetic state and worst control of glycemic hemoglobin. There were also significant differences observed in the TGL, TGL/HDL and VLDL values between Diabetic and control patients. In general there were increased correlation of HbA1c with TSC and LDL and the respective ratios as HbA1c increases while LDL/HDL showed a significant increase with HbA1c.
Key-words- Cholesterol, Diabetes mellitus, Lipid profile, HDL, LDL, Lipid ratios
Trategies for preventing type 2 diabetes an update for cliniciansRodrigo Diaz
The document discusses strategies for preventing type 2 diabetes. It provides background on the rising prevalence of diabetes and obesity globally. Individuals with prediabetes, defined as impaired fasting glucose or impaired glucose tolerance, are at high risk of progressing to type 2 diabetes. Lifestyle interventions targeting diet and exercise changes are the main strategy recommended for preventing or delaying the onset of type 2 diabetes in prediabetic individuals.
Objective: Diabetic nephropathy is one of the most serious complications of diabetes mellitus. It develops in approximately one-third of diabetic patients, years after the onset of metabolic abnormalities.
Study Design: The biopsy specimens were evaluated with the focus on light microscopy. The aim of our study was to reveal differences in the details and the frequency of occurrence of individual histomorphological changes in diabetic nephropathy and other glomerulonephritides.
Results: Diabetic nephropathy accounted for 14 out of 82 analyzed biopsies. Isolated thickening of the glomerular basement membrane was not present in any case, but along with some degree of mesangial expansion, hypercellularity or glomerulosclerosis was seen in 12 out of 14 findings of diabetic nephropathy. In other glomerular diseases, mesangial changes, but without glomerular basement membrane thickening, were the most frequent findings. In addition to glomerular lesions, some of the tubular, interstitial, and vascular changes were seen in 13 out of 14 patients with diabetic nephropathy. In other glomerulonephritides the combination of all these changes was a rare finding.
Conclusion: There are cases where immunofluorescence and electron microscopy cannot be performed or their results are not helpful. In such cases we must rely on light microscopic histomorphological changes.
Cardiovascular disease is a major global health burden. Large epidemiological studies and genetic studies have shown a causal relationship between LDL-C levels and cardiovascular risk. People with lifelong low LDL-C due to genetic mutations, such as loss-of-function mutations in PCSK9, have a significantly reduced risk of cardiovascular events. However, there remains unmet need as cardiovascular risk persists in many patients despite standard therapies due to difficulties achieving LDL-C treatment goals.
The effects of_the_mediterranean_diet_on_chronic_dArnon Ngoenyuang
This document summarizes the effects of the Mediterranean diet on chronic diseases. It discusses how the Mediterranean diet, characterized by high consumption of vegetables, fruits, whole grains, nuts, legumes, olive oil and fish, is associated with reduced risk of cardiovascular diseases, diabetes, cancer, neurodegenerative diseases and obesity. The Mediterranean diet contains beneficial compounds like polyphenols, flavonoids, phytosterols and omega-3 fatty acids that are anti-inflammatory and antioxidant, and have been shown to lower risk of chronic diseases through various mechanisms like reducing oxidative stress and inflammation. Adherence to the Mediterranean diet is associated with significant reductions in mortality, cardiovascular disease incidence and incidence of neurodegenerative diseases.
This study examined the prevalence of diabetes and impaired fasting glucose in 7 major Latin American cities through the CARMELA study. The study found:
1) The overall prevalence of diabetes was 7.0% and increased with age, ranging from 9-22% in those 55-64 years old.
2) Only 16.3% of those previously diagnosed with diabetes and on medication had good glycemic control.
3) The prevalence of diabetes was approximately two times higher in those with abdominal obesity and was also associated with hypertension, high triglycerides, and increased carotid intima-media thickness.
Mr. AH is a 70-year-old man who was diagnosed with T2DM 10 years ago. He was initially treated with lifestyle management and metformin.
3 years later, his doctors advised him to add long acting basal insulin analogue to metformin, reached to 40U/day .
Other current medical conditions include: hypertension, hypothyroidism, and mild osteoporosis without fracture history.
Current medications; Metformin 1000 mg bid, long acting basal insulin analogue 40U/day , Candesartan 16 mg qd, Alendronate 70 mg once weekly, Levothyroxine 100 mg qd.
Physical exam: BMI 26 kg/m2, BP 140/80 mmHg, otherwise unremarkable.
His current FPG 140 mg/dL and HbA1c 8.5%. Kidney and liver functions are normal.
CVD Egypt Clinical Diabetes Reprint Summer 2010Mahmoud IBRAHIM
This document summarizes a study on screening Egyptian patients for diabetes and cardiovascular risk factors. The study found:
- 22.9% of patients had diabetes, 30.7% had hypertension, 33.4% had dyslipidemia, and 43% were smokers.
- Cardiovascular risk factors were more prevalent in females (57.7%) and urban populations (72.2%).
- Obesity affected 29% of patients and was correlated with higher blood pressure. Family history of diabetes was associated with higher BMI, waist circumference, blood sugar, and triglycerides.
- The high prevalence of risk factors indicates a need for national prevention programs in Egypt targeting obesity, diabetes, hypertension
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
1) The document discusses the role of platelets in malaria-related acute lung injury (MALI) and acute respiratory distress syndrome (MARDS). Platelets are recognized as playing a role in immune responses and their presence in the lungs suggests they may contribute to respiratory diseases.
2) Two key steps in the pathogenesis of both MALI/MARDS and non-malarial ALI/ARDS are neutrophil activation/infiltration into the lungs and increased pulmonary capillary permeability. The document hypothesizes that platelets may facilitate these steps in MALI/MARDS through physical interactions with immune cells and secretion of inflammatory factors.
3) Studies of mouse models of MALI/MARDS have provided insights
The letter describes the author's negative experiences with medical treatment that have left her disabled. She details being mistreated during childbirth and receiving epidural steroid injections for back pain that caused permanent damage, leaving her unable to care for herself. The author believes the injections were performed for profit without proper patient consent. She now suffers constant pain and loss of mobility due to adhesive arachnoiditis caused by the medical procedures. The letter calls for reform to prevent other patients from experiencing similar harm.
A 53-year-old man experienced a seizure after taking 20mg of fluoxetine daily for 3 weeks to treat depression. He had no known risk factors for seizures. While fluoxetine is generally considered to have a low risk of seizures, there have been some reports of isolated cases of fluoxetine-induced seizures. The clinician concluded that fluoxetine was likely associated with the seizure in this case, as most potential risk factors were ruled out. Clinicians should be aware of the potential for fluoxetine and other antidepressants to lower seizure thresholds, especially in the first few weeks of treatment or at higher than normal doses.
This document reports on two cases of patients with Wilson's disease who developed severe gastric ulcers after beginning treatment with zinc acetate. Both patients presented with epigastric pain months after starting zinc acetate therapy. Endoscopies revealed gastric ulcers in both patients, which resolved after discontinuing zinc acetate and starting proton pump inhibitor therapy. This is the first reported case of zinc acetate-induced gastric ulcers in Wilson's disease patients. Clinicians should be aware of this potential side effect when prescribing zinc salts to Wilson's disease patients.
This document discusses the relationship between vitamin D, calcium levels, and type 2 diabetes (T2DM). It suggests that low vitamin D and calcium levels may play a role in the development of T2DM by impacting insulin secretion and resistance. The document reviews studies showing associations between low vitamin D levels and impaired glucose tolerance/diabetes. While vitamin D's main role is maintaining calcium levels and bone health, emerging evidence indicates it may also influence T2DM risk and glycemic control through effects on insulin and immune function.
This document discusses the importance of therapists addressing their own unresolved issues and childhood conflicts in order to effectively help patients. It notes that unresolved problems in a therapist's life can negatively influence the therapeutic process through countertransference. The document recommends therapy for therapists to help recognize and manage countertransference responses that could violate patient boundaries or priorities. It emphasizes the need for self-reflection in therapists to prevent their own needs from interfering with the patient's therapeutic process.
This document discusses nutrigenomics and nutrigenetics, which are two related but distinct fields that examine the relationship between genetics and nutrition. Nutrigenomics looks at how foods and nutrients influence gene expression, while nutrigenetics focuses on how genetic variations impact an individual's response to specific foods and nutrients. The document provides examples of how knowledge in these fields can help identify personalized diets and nutritional interventions tailored to one's genetic profile that may help prevent or treat chronic diseases like obesity, cardiovascular disease, and cancer. It also discusses some specific genetic disorders like lactose intolerance and phenylketonuria where restricting certain foods can benefit affected individuals.
This study aimed to determine the correlation between stature and cranial measurements in a population from North India. Cranial length, breadth, and height were measured on 800 medical students aged 17-25 years. Regression analyses found significant positive correlations between stature and both cranial length and breadth for both males and females. Regression equations were generated that could estimate stature based on cranial measurements, which the authors concluded could be useful for forensic and anthropological applications when only skull remains are available. Measurement reliability was high, with technical error of less than 0.5 cm. The study provides population-specific equations for estimating height from cranial dimensions in North Indians.
1) The study investigated the dietary patterns and prevalence of anemia among 108 female adolescent garment workers in Bangladesh.
2) It found extremely high prevalence of anemia, with 92% of participants anemic, including 54% moderately anemic and 38% mildly anemic.
3) The participants' diets were found to be generally inadequate, as most did not consume foods like milk, meat, or snacks regularly during the week.
This study examined the correlation between body height and cranial measurements in 800 medical students (400 male, 400 female) aged 17-25 years in North India. Cranial length and breadth were measured and found to be significantly larger in males than females. A positive correlation was found between height and cranial dimensions in both sexes. Regression equations were derived that could estimate height from cranial length or breadth measurements. Precision estimates for height and cranial dimension measurements showed a high degree of accuracy. The results indicate cranial dimensions could help estimate height, which has importance for anthropology and forensic sciences.
This study examined the correlation between body height and cranial measurements in 800 medical students (400 male, 400 female) aged 17-25 years in North India. Cranial length and breadth were measured and found to be significantly larger in males than females. A positive correlation was found between height and cranial dimensions in both sexes. Regression equations were derived that could estimate height from cranial length or breadth measurements. Precision estimates for height and cranial dimension measurements showed a high degree of accuracy. The results indicate cranial dimensions could help estimate height, which has importance for anthropology and forensic sciences.
This document summarizes a study that assessed the prevalence of anxiety and depression in tuberculosis patients and its impact on their quality of life. Some key findings include:
- 37.1% of tuberculosis patients were found to have anxiety and 37.1% had depression according to the Hospital Anxiety and Depression Scale, compared to only 8.6% and 2.9% respectively in the control group.
- Quality of life parameters like perceived health, relationships, and occupational role were found to be significantly impacted in tuberculosis patients compared to healthy individuals.
- Higher levels of anxiety and depression were found in tuberculosis patients who had been undergoing treatment for less than 3 months compared to those being treated for longer durations.
- A study examined the effects of a one-week dietary supplement program consisting of protein shakes and liquid supplements on weight, body fat, cholesterol, and triglycerides in 35 overweight adults.
- After one week, participants experienced statistically significant weight loss of 7.5 lbs on average accompanied by decreased body fat percentage, waist circumference, and other measurements. Cholesterol and triglycerides also decreased significantly.
- Those who continued the program for a second week saw further decreases in weight, body fat, and circumference measurements, suggesting the supplement combination can safely and effectively aid in short-term weight and fat loss.
This study evaluated isolated proteinuria in 100 patients with hepatitis A virus (HAV) or hepatitis E virus (HEV) infections in Bangladesh. The researchers found that 43% of HAV patients and 45% of HEV patients had protein in their urine. Proteinuria was most common in patients in their third decade of life. The level and pattern of proteinuria differed between HAV and HEV patients. HEV female patients had significantly higher urine protein levels than HAV females. The study suggests that urine protein tests should be routinely performed in patients recovering from HAV or HEV infections to detect any underlying kidney impairment.
This document discusses issues with the methodology used to compute suicide rates. It analyzes suicide rate data from India from 1991-2013 when excluding different age populations from 6-9 years old from the total population. Excluding younger ages who likely do not have the cognitive capacity to understand death increases the computed suicide rate, with rates increasing from 11.2 to 14.6 depending on the age cut-off. The percent increase in rates also rises when excluding younger populations, from 16.1% to 33.7%, highlighting that including the entire population dilutes the suicide rate calculation. The document argues for a standardized definition of suicide and debate on a child's concept of death across cultures to better understand suicide rates.
This study used scanning electron microscopy to examine the protoscoleces and hooks of Echinococcus granulosus extracted from infected organs of sheep and camels in Libya. SEM images showed morphological variations in the protoscoleces and differences between large and small hooks. Measurements of the hooks found significant statistical differences between hook sizes from different organs and hosts. The findings suggest the need to further study relationships between hook morphology and E. granulosus strains to aid in identification and epidemiological investigations.
This study used scanning electron microscopy to examine the protoscoleces and hooks of Echinococcus granulosus collected from infected organs in Libya. SEM images showed morphological variations in the protoscoleces and differences between large and small hooks. Measurements of the hooks found significant statistical differences between hook sizes from different organs and hosts. While some hooks appeared normal, others showed abnormalities in shape, notches or guard structure. This suggests a need to further study relationships between hook morphology and E. granulosus strains to help with identification and epidemiological investigations.
This study investigated the morphological and functional aspects of the hand in relation to age, gender, and sports participation. The researchers measured hand dimensions and grip strength in 546 children aged 9-18 years who were grouped as little (9-11 years), youth (12-14 years), and junior (15-18 years). The children were further divided into sporting and non-sporting groups. The results showed statistically significant differences in several hand measurements and grip strength between the sporting and non-sporting groups, with differences seen in both males and females of different age groups. The findings suggest sports participation is associated with morphological and functional differences in the hand.
This study examined the potential protective effects of mesenchymal stem cell (MSC) therapy against cisplatin-induced nephrotoxicity in rats. Rats were treated with cisplatin to induce kidney damage and divided into groups that received either MSCs or no additional treatment. Kidney tissue was analyzed histologically and biochemically after 4 weeks. Cisplatin caused significant kidney damage including atrophied glomeruli, thickened membranes, and tubule damage. It also increased serum markers of kidney injury and electrolyte levels. Rats treated with MSCs after cisplatin showed substantially reduced kidney damage on histology and ultrastructure. Biochemical markers and electrolyte levels were also largely restored to normal
The editorial discusses whether there is a genetic basis for recidivism, or re-offending, among sex offenders and violent criminals. It notes that recidivism rates are around 18.9% for rapists and 12.7% for child molesters. Recent genetic research suggests that certain genes may predispose individuals to impulsive or antisocial behaviors, putting them at greater risk of criminal involvement. Specifically, studies have found a link between low levels of the MAOA enzyme and increased antisocial behavior. While genetics cannot determine behavior directly, an understanding of biological and social factors related to criminality could help develop more preventative and humane criminal justice policies that incorporate genetic risk factors.
1. Measure of the Rate at which Mortality in
Type 2 Diabetes Mellitus Occurs: Protocol for a
Systematic Review
Corresponding Author:
Dr Chukwuemeka Nwaneri, Department of Community Health & Wellbeing, Faculty of Health & Social Care, University of Chester, CH1 1SL, UK.
E-mail: nwaneric@tcd.ie. c.nwaneri@chester.ac.uk Systematic Review
Nwaneri C1,2, Cooper H1,3, Jones DB2, Agwu-Umahi O1, Osho T4
¹Department of Community Health & Wellbeing, Faculty of Health & Social Care, University of Chester, CH1 1SL, UK, ²Department of
Medicine, Centre for Diabetes & Endocrinology, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Upton
CH49 5PE, UK, ³Research and Development, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK, 4Department
of Clinical Sciences and Nutrition, University of Chester, CH1 4BJ, UK
ABSTRACT
Introduction: Type 2 diabetes is the third largest cause of mortality in the United Kingdom, with about 50% of patients’ having
developed complications at time of diagnosis. We consider that the evidence which explores the actual hazard ratios of mortality has
not been consistent. n this paper we discuss methodology and review the most recent accurate data on mortality in type 2 diabetes.
Methods: A systematic review will be undertaken aimed at synthesis of evidence of relative risk of mortality in type 2 diabetes, using
the Centre for Reviews and Dissemination guidelines. We will explore conflicting and unanswered questions in relation to mortality.
The primary outcome is all-cause, overall-cause or total mortality expressed as hazard ratios. Sub-groups will also be explored; age,
gender, socio-economic factors and causes of death. We will review abstracts published after 1990 in the English language. Our data
source will include electronic databases; the Cochrane library, the Centre for Reviews and Dissemination, Medline/PubMed, and
other grey literature. The study populations are type 2 diabetes patients whose mortality outcome, expressed as hazard ratio, has
been evaluated. Data extraction will be undertaken by one reviewer and triangulated by the second and third reviewer. The quality
of the included studies will be evaluated in accordance with the inclusion/exclusion criteria; methodological quality that meets the
critical appraisal framework and the relevance to the research questions. Evidence from data will be synthesised through a descriptive
epidemiological review from included studies; meta-analysis will be used if appropriate. Result & Conclusion: We expect to pool
homogenous studies of large population cohorts which explore the hazard ratio of mortality, and to summarise the evidence of the
actual mortality risk in type 2 diabetes, with limited bias. This will help direct future research in areas of unanswered questions and
may influence healthcare policy decisions.
Keywords: All-cause mortality, Hazard ratio, Meta-analysis, Systematic review, Type 2 diabetes mellitus
cerebrovascular diseases and cancer but diabetes is not
always noted. Diabetes is a poor prognostic predictor
in patients with cancer, heart failure, acute myocardial
infarction, and other medical conditions. Nevertheless,
the prognosis for diabetes patients varies greatly.
It has been recognised for many years that T2D is
associated with an increase in mortality rate, in the range
of between four to five times of those in the general
mortality statistics.6 More recent studies have suggested
that it is twice that seen in the non-diabetic population.7
Even though it is known that diabetes reduces life
expectancy by 10-12 years this does not translate to an
ability to predict death in patients with T2D.
More recently in Europe and UK an increased incidence
of certain carcinomas have been implicated in diabetes-related
mortality,8,9 although not seen in the study from
UK Health Information Network.10 Carcinomas of the
liver, pancreas and endometrium were associated with
INTRODUCTION
Globally, the 2010 projection is that about 285 million
people suffer from type 1 or type 2 diabetes (T2D)1; in
the United Kingdom (UK), the estimate is of 3 million
diagnosed,2 with undiagnosed diabetes accounting for
an additional 1 million individuals.3 At least 180 million
of these patients have T2D.4 As the life expectancy in
the general population in UK is increasing there is
limited evidence for a corresponding increase in the
diabetic population. Accurate mortality indices of T2D
are essential since countries rely on these for resource
allocation and health systems prioritization.
The reported low mortality indices of T2D seen in the
UK population have been questioned by many, as it is
known that inaccuracy in the recorded cause of death on
death certificates is widespread.5 This is because diabetes
has been implicated in the mechanisms leading to death
in many medical conditions including cardiovascular,
| Jul - Dec 2014 | Vol 1 | Issue 2 | Acta Medica International 110
2. Nwaneri, et al.: Mortality in Type 2 Diabetes Mellitus
more than a two fold increase in relative risks, whereas
colo-rectal, breast and bladder cancers were associated
with less than 1.5 fold increase in relative risk.11,12 There
was no association with lung cancer while the study was
inconclusive for renal and non-Hodgkin’s lymphomas.
Unexplainably, prostatic carcinoma was less often associated
with T2D.11 It is widely believed that this association is
partly due to increasing incidence of both diseases with
increasing age and their complex and multi-factorial
pathophysiologies.
Other studies have suggested a possible increased
malignancy risk with insulin therapy or its secretagogues
in T2D while other authors provide contradictory
evidences.10,13,14 Sulfonylureas are the most implicated
secretagogues amongst oral diabetes medications with
possible increased malignancy risk,10 whereas metformin
has been seen to be associated with reduced cancer rates
and mortality in patients with T2D.15
In 1998 the United Kingdom Prospective Diabetes Study
(UKPDS) study identified that sulfonylurea therapy was
not associated with increased risk of death, although a more
recently published Canadian study identified a possible
dose response relationship between sulfonylureas and
mortality in T2D.16 In addition, metformin monotherapy
although associated with improved glycaemic control and
reduction of all-cause mortality especially in obese T2D, its
early addition to sulfonylurea therapy resulted in increased
diabetes-related mortality when compared to sulfonylurea
alone.17 There is also additional limited evidence that some
therapeutic agents, e.g. long-acting sulfonylureas, some
thiazolelinediones and insulin are also associated with
increased mortality rates in T2D.10,14 Thiazolidinediones,
especially rosiglitazone have been implicated in their
effects on heart failure, myocardial infarction and cardiac
mortality.18
Barnett et al. from their study in Tayside in UK showed that
the age at diagnosis and duration of diabetes in patients
with T2D affect both relative and absolute mortality risks
and all-cause mortality.19 Diabetes-related morbidity and
mortality is age-related, it tends to be less in patients
who develop T2D in their late seventies when compared
to those who develop T2D in their mid-forties.12 The risk
of silent myocardial infarction (autonomic neuropathy)
and hypoglycaemic unawareness increases with diabetes
duration, obesity and hyperglycaemia. In one study in New
Zealand it was concluded that in patients who had had
myocardial infarction and/or congestive heart failure, the
relative risk of death remains high for at least four years after
hospitalisation regardless of glycaemic and cardiovascular
risk factor regulation.20
Gender has been an independent factor in the mortality
risks in T2D. Researchers have noted that in people above
49 years of age, females have greater mortality rates than
males. This could be due to the risk of death from coronary
heart disease (following the loss of cardioprotective effects
of circulating oestrogen).21
There is also excess mortality associated with social
deprivation in T2D.22 This was stressed by other researchers
who noted that diabetes mortality seen in those with poor
social deprivation status was twice as high as the national
average of those in the wealthiest areas.23
Various studies have proposed differing pathophysiological
mechanisms in the acute effects of diabetes itself and to the
accumulating adverse risks of mortality. The important
mechanism implicated in the increase in mortality rate
seen in T2D results from vascular and circulatory changes
leading to endothelial dysfunction, platelet adhesions,
viscosity and increased thrombosis.24 More recently insulin
and insulin-like growth factors (IGFs) receptor dynamics
and in their expression of insulin-mediated abnormal
cell proliferation have been established.25 Although other
explanatory biological pathways do exist, as documented in
the literature on the pathogenesis of carcinomas in T2D there
still remains unclear answers especially regarding the role of
insulin resistance, hyperinsulinaemia and hyperglycaemia
in the aetiology of cancers in T2D, as cancer and diabetes
share similar risk factors.
With the ushering in of newer oral hypoglycaemic drugs
it was expected that glycaemic regulation and mortality
indices would start to normalise. The UKPDS reported
that tight glycaemic control should be aimed at, with
HbA1c of less than 7% but a more recent meta-analysis
whilst showing that tight glycaemic control reduced
microvascular complication,17 and the risk for some
cardiovascular disease events such as nonfatal myocardial
infarction, it did not decrease the risks of cardiovascular
endpoint or all-cause mortality. It also increased the risk of
severe hypoglycaemia which is associated with morbidity
and mortality.26
It is also surprising that even with improved patient
education, specialist care, multi-disciplinary team working,
technological advances and newer medications which
have removed some obstacles, the attainment of improved
life expectancy and decreasing mortality remains elusive.
This raises questions pertaining to whether this is due to
the complex interplay of some other variables, or lack of
knowledge of the actual figures.
As the Diabetes UK and its research Network continues to
explore avenues to unveil areas of unanswered research
111 Acta Medica International | Jul - Dec 2014 | Vol 1 | Issue 2 |
3. Nwaneri, et al.: Mortality in Type 2 Diabetes Mellitus
questions with regards to improving life expectancy and
reducing mortality from T2D, several questions need to be
answered: these include;
At what stage should T2D patients commence cholesterol
lowering agents?
Should calcium-channel blockers be commenced earlier in
patients without overt nephrological complications?
In T2D, macrovascular complication is the predominant
cause of mortality. As a consequence, preventable and
modifiable risk factors such as cardiovascular risks should
be aggressively reduced. Modifiable factors are considered
to be important in about 70% of cases of mortality. Tight
glycaemic regulation has been shown to be difficult to
maintain and the evidence shows that in itself it has little
effect on morbidity and mortality from cardiovascular
disease in T2D. However there are also reports of adverse
mortality associations in some patients where glycaemia is
reduced after long duration of diabetes., Efforts should be
aimed at continual optimisation of treatments for the four
atherogenic factors in cardiovascular diseases: hypertension
(anti-hypertensives), cholesterol and hyperlipidaemia
(cholesterol lowering agents), obesity (weight reduction
and diet modification), and smoking (smoking cessation),
as well as hyperglycaemia.
Previous systematic reviews have shown varying increased
relative mortality in type 2 diabetes combining different
proxies of measure of degree of mortality, such as relative
risks, standardised mortality ratios, and hazard ratios.
These pose uncertainties in the true effect size. Furthermore,
they were published prior to the changes in the clinical
diagnostic criteria made by the WHO and American
Diabetes Association in 1999. This study will update
previous reviews and assess the actual relative mortality
using the measure of degree of mortality.
In summary, this systematic review will explore the
conflicting and unanswered questions in studies involving
mortality risk and mortality predictors in T2D in relation to;
actual causes of death and risk factors. Sub-groups within
the Type 2 population will also be explored in relation to
age, gender and socio-economic factors.
The systematic review will aim to answer these questions
using the following methodology.
METHODS
A systematic review of the literature will be undertaken
using published and unpublished articles including grey
literature. The review will follow the Centre for Reviews
and Dissemination (CRD) (March 2001) report number 4
guidance on methodological quality scoring criteria27 and
adhere to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) statement on
reporting quality.28
Ethics approval was approved from the University of
Chester Ethics Committee and from the Integrated Research
Application System, UK.
Data Source
Electronic database search will be conducted including; The
Cochrane Library, Centre for Reviews and Dissemination
(CRD; DARE-database of abstracts of reviews of effects,
HTA-health technology assessments, and NHS EED
databases), Ovid Medline/PubMed, CINAHL, Web of
Science (Web of Knowledge), World Health Organisation
Library and Information Network for knowledge database
(WHOLIS), The Centre for Evidenced-Based Medicine,
PsycInfo, Google Scholar, EMBASE, National Library for
Health, Ongoing Reviews database, British Nursing Index
and SCOPUS. Others would include UK National Research
Register (NRR), ReFeR, Kings Fund and Conference Papers
Index. Also grey literature search will be conducted for
unpublished articles using FADE, Proquest Dissertation and
Theses, and other Indexed Citations up to 2014.
References of all retrieved articles will be checked for
relevant studies, and if needed experts will be contacted
for advice, and to identify additional published and
unpublished references. The process of conducting the
search will be documented as it develops to ensure
transparency.
Search Terms
Keywords and phrases, including Medical Subject Headings
(MeSH) to be searched will include; ‘‘Type 2 diabetes
mellitus mortality’’, “Type 2 diabetes mortality”, ‘‘mortality
and type 2 diabetes’’, ‘‘excess mortality and type 2 diabetes’’,
‘‘mortality rates and type 2 diabetes’’, ‘‘mortality and
diabetes’’, “type II diabetes and mortality”, “type 2 DM and
mortality”, “type II DM and mortality”, “determinants of
mortality and type 2 diabetes”, ‘‘mortality predictors and
diabetes’’, and an effective combination of search terms
will be conducted. The details of the search strategies are
shown in Table 1.
Study Selection and Eligibility Criteria
Studies will be included if they fulfil the following criteria:
Study design: Existing systematic reviews, epidemiological
studies and RCTs of intervention for treating T2D
Participants: People with T2D
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4. Nwaneri, et al.: Mortality in Type 2 Diabetes Mellitus
Table 1: The search strategy to be used in the systematic review
Search strategy Combination of free text words and controlled terms (MeSH)
Search #1
Search #2
Type 2 diabetes mellitus mortality, Type 2 diabetes mortality, mortality and type 2 diabetes, excess
mortality and type 2 diabetes, mortality rates and type 2 diabetes, mortality and diabetes, type II
diabetes and mortality, type 2 DM and mortality, type II DM and mortality, determinants of mortality
and type 2 diabetes, mortality predictors and diabetes, type 2 diabetes survival, type 2 diabetes death
Diabet* OR type 2 diabet* OR T2DM OR NIDDM OR type II diabet* NOT (type 1 diabet* OR type 1
DM OR type I DM OR IDDM)
Search #3 Mortality OR mortalit* OR mortality indices OR mortality predictors OR survival OR survival* OR death
OR death* OR Type 2/*complications/mortality
Search #4
Search #1 AND #2
AND #3 AND #4
Diabetes/*adverse outcome/mortality OR diabetes/*outcome/death OR diabetes/*outcome/mortality
OR diabetes/*complications/mortality
Limit: English language
Types of outcome: All-cause-, cause-specific mortality in
T2D expressed as hazard ratio, or if it is possible to calculate
from the data available.
Studies will only be included if they report sufficient detail
and constitutes a partial or complete review of mortality in
T2D, and the search will be streamlined to research in the
English language from 1990 through 2014. Search restriction
was limited to studies published after 1990, as previous
systematic reviews on mortality in T2D have produced
conflicting and inconsistent evidence, and were published
prior to the changes in the clinical diagnostic criteria by
the World Health Organisation, and American Diabetes
Association in 1999.
The following exclusion criteria will be used in this study:
studies not published in English language and only
available as an abstract; poor quality studies as decided
by quality appraisal; and articles published prior to 1990.
Titles and abstracts of articles will be checked by two
reviewers (CN and HC). Full texts of selected studies
will be assessed for inclusion by one reviewer (CN) and
triangulated by the other reviewer (HC and DBJ). Any
variations in comments will be resolved by discussion.
Figure 1 demonstrates the PRISMA flow chart for the
selection of the studies.28
Data Extraction
Data extraction will be undertaken by one reviewer (CN,
OAU, TO) and triangulated by the second reviewer,
(HC) and if possible a third, (DBJ) especially if there
are areas of conflicting comments. In the study we will
utilise a standard paper format for easy extraction of
data from the selected studies. Data from individually
selected studies will be extracted as follows: author,
year of publication, study design, setting/location, year
of study, comparison population, study size, number
of deaths, patients’ characteristics, follow-up years,
outcome measure of mortality, and degree of mortality
in hazard ratios.
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5. Figure 1: Flow diagram of study selection procedure [28]
The quality of the included studies will be evaluated
in accordance with, the inclusion/exclusion criteria;
methodological quality that meets the critical appraisal
framework; and relevance to the research questions. The
criteria used in the assessment of quality of included studies
will be documented and clearly stated, and scored.
Quality Appraisal
The methodological quality of included studies will be
assessed using CRD’s guidance check list (critical quality
appraisal programme, CASP) for quantitative research:
systematic reviews, case control and cohort studies.27 With
little variations in the CASP’s tool for various types of study,
there are still 3 broad areas common to all; validity, results
and relevance of results locally. The CASP tools for case
control, systematic review and cohort studies comprise
of 11-item, 10-item, and 12-item questions respectively as
shown in Table 2.29 We defined the quality of methodology
as low, medium and high using the parameters from CASP
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6. Nwaneri, et al.: Mortality in Type 2 Diabetes Mellitus
Table 2: A 12‑item questionnaire to assess the
methodological quality of systematic review29
SECTION A: Screening questions (Are the results of the study valid?)
Did the study address a clearly a clearly focused issue?
□ Yes □ No □ Unclear
Did the authors use an appropriate method to answer their
questions?
□ Yes □ No □ Unclear
If ‘Yes’ in both questions 1 2, then it is worth proceeding with
the remaining questions
Was the cohort or cases recruited in an acceptable way?
□ Yes □ No □ Unclear
Was the exposure accurately measured to minimise bias?
□ Yes □ No □ Unclear
Was the outcome accurately measured to minimise bias?
□ Yes □ No □ Unclear
A) Have the authors identified all important confounding
factors? (B) Have they taken account of the confounding factors in
the design and/or analysis?
□ Yes □ No □ Unclear
A) Was the follow‑up of subjects complete enough? (B).Was the
follow‑up of subjects long enough?
□ Yes □ No □ Unclear
SECTION B: What are the results?
What are the results of the study?
□ Yes □ No □ Unclear
A) How precise are the results? B) How precise is the estimate of
the risk?
□ Yes □ No □ Unclear
Do you believe the results?
□ Yes □ No □ Unclear
SECTION C: Will the results help me locally?
Was the follow‑up of subjects complete enough?
□ Yes □ No □ Unclear
Do the results of this study fit with other available evidence?
□ Yes □ No □ Unclear
tool to categorise the papers based on their measurement
properties. The CASP tool contains 12-item questions that
assess reliability, content-, criterion-, and construct validity,
measurement error, responsiveness and generalizability
of the results. Each of these measurement properties were
evaluated separately and scored for each study. An item
was scored ‘high’ if the relevant aspect of methodological
quality was presented clearly and adequately. Whereas
a score of ‘medium’ indicated that there was evidence of
adequacy of the methodological quality but not overtly
stated. An item scored ‘poor’, if there was doubt or lack of
clarity in the adequacy of the methodological quality and/
or flaws in the design or statistical analysis. For uniformity
and transparency PRISMA checklist tools will be used to
assess the quality of reporting. Three reviewers will do
this independently based on the availability of the data in
the articles. The quality assessment and risk of bias will
further be carried out using the Newcastle-Ottawa Scale.30
Funnel plots will be explored for assessment of publication
and related biases (language bias, poor methodological
quality, and clinical heterogeneity), therefore the external
validity of the data analysis.
Synthesis of Evidence
Evidence from data on mortality in T2D will be
synthesised through a descriptive epidemiological review
from included studies; meta-analysis will be used if
appropriate as we expect the studies to be heterogenous
in nature judging from the wide variations of population,
and variability in complications and co-morbidities of the
population. Data synthesis comprising of an overview
of the included studies with respect to characteristics of
the populations, interventions, designs and outcomes
will be narrated. Data from included studies will be
summarised in a table to maintain evidence. The point
of estimate derived from each of the study design will
then be taken for data synthesis. In addition, the quality
of design and their effects will be included. In the data
synthesis, hazard ratios were appropriate as measures
of risks, and were illustrated using tables, figures and
other computations. This will highlight the possible
comparisons to be analysed, and the outcomes to be
used in the meta-analysis, if appropriate. The summary
evidence will be tabulated to help in ascertain and enhance
transparency and precision.
Meta-analysis will be carried out to show precise estimate
of mortality risk. Adjustments for confounding factors and
sub-analyses of the effects of gender, drugs, cardiovascular
diseases, smoking and alcohol, age at diagnosis and cancer
on mortality risks will be also assessed. We will then
narrate the results of the systematic review in line with
the outcome of the meta-analysis. Tables of the selected
studies will be shown as well as the figures of the meta-analysis.
In addition it will show precision and statistical
significance, measured by p-values. The point estimate,
lower and upper limits of 95% confidence intervals will
be log scaled and the effects observed in the studies will
be pooled to produce a weighted average effect of all the
studies. If there is a large effect size, meta-analysis may
not be appropriate as nothing new would be added to
inference. During the meta-analysis in order to check
for the robustness of summary effect, larger studies are
weighted preferentially by fixed effect models, whereas
smaller studies are weighted preferentially by random
effect models.32 This therefore produces wider confidence
intervals around the summary effect as they take into
account variability in studies. However, the most precise
tests of heterogeneity, the Cochran’s Q score (Q-statistics),
Inconsistency Index (I2), Tau-square estimate (t2), will be
used and with a p-value 0.1 indicating a statistically
significant difference between studies. A high value of I2
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7. Nwaneri, et al.: Mortality in Type 2 Diabetes Mellitus
and Q-statistics translates to high heterogeneity. The Chi-square,
a statistical test that defines the degree of freedom
and goodness to fit within a distribution of independent
variables, can also aid in the interpretations. An attempt
will be made to explain the possible reasons for the
heterogeneity.
Subgroup Analysis
Further exploration of heterogeneity results will be carried
out using subgroup analysis.31 Subgroup analysis will also
be explored with respect to age, gender, socioeconomic
status and cause of death, if adequate data are obtained
from the selected studies. We will separately synthesise
the results of subgroup of studies with different designs to
ascertain if differences exist in the summary effect.
Sensitivity analysis will be used to ascertain the effects
of different assumptions on the results i.e. repetition of
analysis using the best and worst outcomes for the missing
observations in each subgroup studied to ascertain the
degree to which they affect the summary effect. Reviewers
independently will triangulate the narrative write up by
the lead reviewer with comments.
DISCUSSION
The results are expected to show the degree of mortality
risks in T2D when compared with the general population.
The strengths and limitations of the included studies will
also be presented. The outcome of this study will help policy
makers and healthcare managers direct resources for quality
care in patients with diabetes.
EDITOR’S COMMENT
Upon completion, the result will be disseminated both
locally and internationally through peer-reviewed journal.
AUTHOR’S CONTRIBUTION
OAU, TO, CN, HC and DBJ are principal investigators for
the systematic review. CN and HC proposed the study.
DBJ and HC are reviewers and supervisors of the study.
All authors read and approved the final manuscript. We
intend to re-evaluate and update the review after 2 years.
LISTS OF ABBREVIATIONS
• T2D: Type 2 Diabetes
• UK: United Kingdom
• UKPDS: United Kingdom Prospective Diabetes Study
• HbA1C: Glycated haemoglobin
• CRD: Centre for Reviews and Dissemination
• DARE: Database of Abstracts of Reviews of Effects
• HTA: Health Technology Assessment
• PRISMA: Preferred Reporting Items for Systematic
Reviews and Meta-Analyses
• CASP: Critical Quality Appraisal Programme
• DPP-4 inhibitors: Dipeptidyl peptidase 4-inhibitors
COMPETING OF INTEREST
OAU is a postgraduate student at the University of Chester.
TO is researcher at the Clinical Sciences and Nutrition
department of the University of Chester. CNwas doctoral
student under the auspices of Gladstone Fellowship,
University of Chester and The Wirral University Teaching
Hospital Foundation Trust, and presently a visiting Senior
Lecturer in the Faculty of Health Social Care. No financial
and non-financial competing interest.
ACKNOWLEDGEMENT
We sincerely wish to acknowledge the assistance from the
University of Chester and the Mc Ardle Librarians for their
devoted and unreserved facilitation of the search process
and retrieval of the studies. We also thank Prof Rod Owen
for his critical appraisal of the initial drafts and concepts.
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How to cite this article: Nwaneri C, Cooper H, Jones DB, Umahi O,
Osho T. Measure of the rate at which mortality in type 2 diabetes
mellitus occurs: Protocol for a systematic review. Acta Medica
International. 2014;1(2):110-116.
Source of Support: Nil, Conflict of Interest: None declared.
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