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PRiMER (Leawood, Kan.) 2024The Education-Centered Medical Home (ECMH) is a longitudinal clerkship that emphasizes continuity and quality improvement in primary care. We aimed to evaluate our...
INTRODUCTION
The Education-Centered Medical Home (ECMH) is a longitudinal clerkship that emphasizes continuity and quality improvement in primary care. We aimed to evaluate our ECMH's ability to improve type 2 diabetes mellitus (T2DM) care through a systematic chart audit and care planning process. The effect of this intervention was measured by adherence to process and outcome measures.
METHODS
From November 2015 to March 2017, medical students were educated on and performed monthly chart audits of guideline-based quality metrics: hemoglobin A1c systolic blood pressure; lipid and microalbuminuria evaluation; annual ophthalmic and foot examinations; flu, hepatitis, and pneumonia vaccination; and statin therapy. Patients were included if they had a diagnosis of T2DM and were seen by the ECMH clinic before and after the audits started. Students shared audit logs, using them to plan patient appointments. We assessed changes in proportion of patients meeting each guideline with Fisher's exact test.
RESULTS
The project included 11 patients with T2DM. ECMH adherence to the annual eye exam increased significantly 1 year postintervention, compared to preintervention (73% vs 55%; =.03) and 6 months (73% vs 46%, =.01).
CONCLUSION
The metric with significant improvement during the chart audit, annual eye exam, is a process measure requiring advance planning. This small study suggests that a formal, regular audit process can improve student adherence to evidence-based care guidelines, particularly for tasks that require advance planning or action by the care team outside the day of a patient visit.
PubMed: 38681807
DOI: 10.22454/PRiMER.2024.436038 -
Scientific Reports Mar 2024Several studies have shown an association between albuminuria and obstructive sleep apnea (OSA). However, studies on the relationship between the STOP-BANG questionnaire...
Several studies have shown an association between albuminuria and obstructive sleep apnea (OSA). However, studies on the relationship between the STOP-BANG questionnaire that can screen for OSA and microalbuminuria are still insufficient. Therefore, this study attempted to clarify the relationship between microalbuminuria and OSA risk using the STOP-BANG questionnaire in Korean adults. A total of 7478 participants (3289 men and 4189 women) aged over 40 were enrolled in the Korean National Health and Nutrition Examination Survey from 2019 to 2020. STOP-BANG questionnaire to screen OSA was obtained from subjects. The urinary albumin/creatinine ratio (ACR) and proteinuria were measured via a single dipstick to evaluate renal function. The high OSA risk group had a higher mean ACR value than the low OSA risk group (36.8 ± 172.2 vs 17.7 ± 82.5; P < 0.001). The proportion of subjects with values of 30 ≤ ACR < 300 mg/g (11.9% vs 6.1%; P < 0.001) and ACR > 300 mg/g (2.1% vs 0.7%; P < 0.001) was significantly higher in high OSA risk group. Multivariate logistic regression results confirmed that microalbuminuria (OR 1.279, 95% confidence interval (CI) 1.068-1.532, P = 0.008) was significantly correlated with high OSA risk. In addition, significant correlation with high OSA risk was also found in macroalbuminuria (OR 1.684, 95% CI 1.073-2.530, P = 0.022) and proteinuria (OR 1.355, 95% CI 1.030-1.783, P = 0.030). We confirmed a significant correlation between high OSA risk and albuminuria/proteinuria in Korean adults. Therefore, renal function evaluation is required in high OSA risk patients, and OSA diagnosis through PSG test and treatment is necessary.
Topics: Adult; Male; Humans; Female; Middle Aged; Cross-Sectional Studies; Albuminuria; Nutrition Surveys; Polysomnography; Surveys and Questionnaires; Sleep Apnea, Obstructive; Republic of Korea
PubMed: 38509240
DOI: 10.1038/s41598-024-57394-3 -
Journal of Renal Nutrition : the... Mar 2024While diet plays a key role in chronic kidney disease (CKD) management, the potential for diet to impact CKD prevention in the general population is less clear. Using a...
OBJECTIVE
While diet plays a key role in chronic kidney disease (CKD) management, the potential for diet to impact CKD prevention in the general population is less clear. Using a priori knowledge, we derived disease-related dietary patterns (DPs) through reduced rank regression (RRR) and investigated associations with kidney function, separately focusing on generally healthy individuals and those with self-reported kidney diseases, hypertension, or diabetes mellitus.
METHODS
Eight thousand six hundred eighty-six participants from the population-based Cooperative Health Research in South Tyrol study were split into a group free of kidney disease, hypertension and diabetes (n = 6,133) and a group with any of the 3 conditions (n = 2,553). Diet was assessed through the self-administered Global Allergy and Asthma Network of Excellence food frequency questionnaire and DPs were derived through RRR selecting food frequency questionnaire-derived sodium, potassium, phosphorus, and protein intake as mediators. Outcomes were creatinine-based estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, CKD and microalbuminuria. Multiple linear and logistic models were used to assess associations between RRR-based DPs and kidney outcomes separately in the 2 analytic groups.
RESULTS
We identified 3 DPs, where high adherence reflected high levels of all nutrients (DP1), high potassium-phosphorus and low protein-sodium levels (DP2), and low potassium-sodium and high protein-phosphorus levels (DP3), respectively. We observed heterogeneous associations with kidney outcomes, varying by analytic group and sex. Kidney outcomes were much more strongly associated with DPs than with single nutrients.
CONCLUSION
RRR is a feasible approach to estimate disease-related DPs and explore the combined effects of nutrients on kidney health. Heterogeneous associations across kidney outcomes suggest possible specificity to kidney function or damage. In individuals reporting kidney disease, hypertension or diabetes, specific dietary habits were associated with better kidney health, indicating that disease-specific dietary interventions can be effective for disease control.
PubMed: 38521380
DOI: 10.1053/j.jrn.2024.03.003 -
International Journal of Molecular... Dec 2023Zinc (Zn) and copper (Cu) have been shown to have the potential to improve glucose metabolism through interactions with cytokines and signaling events with multiple...
Zinc (Zn) and copper (Cu) have been shown to have the potential to improve glucose metabolism through interactions with cytokines and signaling events with multiple genes. miRNA-375 and the Calpin-10 gene are potential genetic biomarkers for the early prediction of diabetic nephropathy (DN). 128 healthy controls and 129 type 2 diabetic (T2DM) participants were matched for age and sex. Three subgroups were identified from the T2DM group: 39 patients had microalbuminuria, 41 had macroalbuminuria, and 49 patients had renal problems. Circulating miR-375 expression levels were measured via qPCR. Calpain-10 SNP 19 (rs3842570) genotyping was assessed with allele-specific PCR in all the included participants. Spectrophotometry was used to measure the concentrations of serum copper, zinc, and magnesium, while ELISA was used to measure the levels of TGF-β and IL-17. There was significant up-regulation in the expression of miR-375 and serum levels of TGF-β, IL-17, Cu, and the Cu/Zn ratio, whereas, in contrast to the control group, the Zn and Mg levels were lower in the T2DM group. The DN groups had significantly lower miR-375, TGF-β, IL-17, Mg, and Zn levels compared with the T2DM without nephropathy group. Furthermore, between TGF-β, IL-17, and miRNA-375, there were notable correlations. Calpain-10 SNP 19 genotype 22 and allele 2 were linked to a higher incidence of T2DM and DN. Significant TGF-β, Cu, Cu/Zn ratio, HbAc1, and creatinine levels, but insignificant miRNA-375 levels, were associated with genotype 22 of Calpain-10 SNP 19. interactions between the Calpain-10 SNP 19 genotype 22 and IL-17, TGF-β, mineral levels, and miRNA-375 might contribute to the aetiology of DN and T2DM and may have clinical implications for diagnosis and management.
Topics: Humans; Calpain; Copper; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Interleukin-17; MicroRNAs; Transforming Growth Factor beta; Zinc
PubMed: 38139275
DOI: 10.3390/ijms242417446 -
Diabetologia Jan 2024While the risk factors for diabetic peripheral neuropathy (DPN) are now well recognised, the risk factors for painful DPN remain unknown. We performed analysis of the...
AIMS/HYPOTHESIS
While the risk factors for diabetic peripheral neuropathy (DPN) are now well recognised, the risk factors for painful DPN remain unknown. We performed analysis of the EURODIAB Prospective Complications Study data to elucidate the incidence and risk factors of painful DPN.
METHODS
The EURODIAB Prospective Complications Study recruited 3250 participants with type 1 diabetes who were followed up for 7.3±0.6 (mean ± SD) years. To evaluate DPN, a standardised protocol was used, including clinical assessment, quantitative sensory testing and autonomic function tests. Painful DPN (defined as painful neuropathic symptoms in the legs in participants with confirmed DPN) was assessed at baseline and follow-up.
RESULTS
At baseline, 234 (25.2%) out of 927 participants with DPN had painful DPN. At follow-up, incident DPN developed in 276 (23.5%) of 1172 participants. Of these, 41 (14.9%) had incident painful DPN. Most of the participants who developed incident painful DPN were female (73% vs 48% painless DPN p=0.003) and this remained significant after adjustment for duration of diabetes and HbA (OR 2.69 [95% CI 1.41, 6.23], p=0.004). The proportion of participants with macro- or microalbuminuria was lower in those with painful DPN compared with painless DPN (15% vs 34%, p=0.02), and this association remained after adjusting for HbA, diabetes duration and sex (p=0.03).
CONCLUSIONS/INTERPRETATION
In this first prospective study to investigate the risk factors for painful DPN, we definitively demonstrate that female sex is a risk factor for painful DPN. Additionally, there is less evidence of diabetic nephropathy in incident painful, compared with painless, DPN. Thus, painful DPN is not driven by cardiometabolic factors traditionally associated with microvascular disease. Sex differences may therefore play an important role in the pathophysiology of neuropathic pain in diabetes. Future studies need to look at psychosocial, genetic and other factors in the development of painful DPN.
Topics: Female; Humans; Male; Diabetic Neuropathies; Prospective Studies; Risk Factors; Diabetes Complications; Diabetes Mellitus, Type 1
PubMed: 37870649
DOI: 10.1007/s00125-023-06025-z -
Internal Medicine (Tokyo, Japan) May 2024We herein present the case of a 21-year-old male Japanese diabetic patient with Temple syndrome, caused by maternal uniparental disomy of chromosome 14. The patient was...
We herein present the case of a 21-year-old male Japanese diabetic patient with Temple syndrome, caused by maternal uniparental disomy of chromosome 14. The patient was overweight and had type 2 diabetes, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, and microalbuminuria. He had an increased fat mass in the truncal region and a decreased lean mass throughout the body. This may lead to insulin resistance due to the absence of delta-like homolog 1 (DLK1) and retrotransposon gag-like 1 (RTL1). The patient had experienced social withdrawal at home (hikikomori in Japanese), had poorly controlled type 2 diabetes, and was overweight despite receiving diet therapy and oral hypoglycemic agents.
PubMed: 38749734
DOI: 10.2169/internalmedicine.2743-23 -
Cureus Sep 2023Background Diabetic nephropathy is a significant concern among individuals with diabetes mellitus, warranting early diagnosis for effective management. This study...
A Cross-Sectional Study on the Estimation of Urine Albumin for the Early Diagnosis of Diabetic Nephropathy Among Patients With Diabetes Mellitus at a Tertiary Care Hospital in Central India.
Background Diabetic nephropathy is a significant concern among individuals with diabetes mellitus, warranting early diagnosis for effective management. This study focuses on the potential of urine albumin estimation as an early diagnostic tool for diabetic nephropathy among patients in central India. Methods A cross-sectional methodology involved 65 individuals diagnosed with diabetes mellitus at a tertiary care hospital. Demographic factors, including age, gender, family history, duration of diabetes, and dietary patterns, were gathered. Urine albumin levels were categorized as "normal," "microalbuminuria," and "macroalbuminuria." The collected data were analyzed using IBM SPSS Statistics, version 24.0 (IBM Corp., Armonk, NY). Qualitative variables were presented as percentages and counts. The comparison between groups was conducted using the chi-square exact test. Quantitative variables were described as mean (±standard deviation) and median. Results The study reveals that 78.5% of cases exhibited normal levels below 30 mg, with a mean value of 1.00 ± 0.414. Microalbuminuria, characterized by 30-300 mg levels, was observed in 21.5% of cases. Importantly, no instances of macroalbuminuria, with levels exceeding 300 mg, were detected among the participants. There are associations between demographic variables and diabetic nephropathy findings. Age and gender displayed non-significant associations. Family history of diseases, particularly diabetes, showed significance. Diabetes duration demonstrated a significant link, while diet patterns displayed no significant associations. Conclusion This study contributes insights into the complex interactions of demographic factors in diabetic nephropathy. Early identification and intervention, guided by the associations observed, could enhance patient outcomes and mitigate the burden of diabetic nephropathy-related complications. Further research is warranted to validate and extend these findings to diverse populations.
PubMed: 37868453
DOI: 10.7759/cureus.45522 -
Clinical Cardiology Dec 2023Left ventricular and left atrial strain are sensitive and reliable markers for evaluating cardiac function in patients with type 2 diabetes mellitus (T2DM), with...
OBJECTIVE
Left ventricular and left atrial strain are sensitive and reliable markers for evaluating cardiac function in patients with type 2 diabetes mellitus (T2DM), with interactions between the two parameters. The present study aimed to analyze the correlation between global longitudinal strain (GLS) of the left ventricle and glycated hemoglobin (HbA1c) levels in patients with T2DM.
METHODS
A total of 292 patients clinically diagnosed with T2DM were selected and divided into three groups according to HbA1c level. The strains of the left atrium and left ventricle in the three groups of T2DM patients with different HbA1c levels were compared. Univariate and multivariate (including left atrial functional indicators) linear regression analyses were performed to assess the relationship between strain indicators and HbA1c levels. Generalized additive models were used to examine the relationship between strain indicators and HbA1c levels.
RESULTS
There were significant differences among the three groups in terms of age, microalbuminuria, total cholesterol, fasting blood glucose, postprandial blood glucose, and HbA1c level, and left atrial conduit longitudinal strain (LAScd) and GLS (p < .05). Univariate and multivariate linear regression analyses revealed that, as HbA1c levels increased, the absolute value of GLS gradually decreased (p < .001). Curve fitting revealed a positive correlation between HbA1c level and GLS, which was not affected by left atrial function.
CONCLUSION
Left ventricular GLS was independently correlated with HbA1c level in patients with T2DM and was not affected by left atrial function.
Topics: Humans; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Ventricular Function, Left; Blood Glucose; Ventricular Dysfunction, Left; Heart Ventricles
PubMed: 37621117
DOI: 10.1002/clc.24136 -
The Medical Journal of Malaysia Mar 2024The rise in the cases of chronic kidney disease (CKD) with the increasing prevalence of non-communicable diseases such as type 2 diabetes mellitus and hypertension is a...
INTRODUCTION
The rise in the cases of chronic kidney disease (CKD) with the increasing prevalence of non-communicable diseases such as type 2 diabetes mellitus and hypertension is a major public health concern in Malaysia. This results in the many cases of chronic kidney disease being managed in primary healthcare clinics. This study examines the pre- and post-clinical outcomes of scheduled nephrologist visits on CKD patients in a primary health care clinic in Ipoh, Perak.
MATERIALS AND METHODS
This is a retrospective crosssectional study reviewing the medical records of patients seen by visiting nephrologists from January 2019 to December 2021 in Greentown Health Clinic. The study population are patients with CKD stage 3b, 4 and 5 who are followed up in Greentown Health Clinic. Universal sampling was done, a total of 87 patients reviewed at least once by the visiting nephrologist and with retrievable medical records were included in the study. Those whose medical records were irretrievable were excluded. Blood pressure, urine protein, fasting blood sugar (FBS), glycated haemoglobin (HbA1c), serum creatinine, eGFR and fasting lipid profile (FLP) pre- and post-visits were collected by reviewing patient medical records and laboratory results. The results were then analysed and compared using SPSS version 26.
RESULTS
The median age of patients in this study was 66 years of age, the majority were male patients (54%) and Malay ethnicity (62.1%). Absence of urine microalbuminuria pre and post referral remain the same (n = 11). During prenephrologist visits, a higher percentage of patients exhibited moderate (30-300 mg/g) and severe (>300 mg/g) increase in urine albuminuria (15.7% and 7.2%, respectively) compared to the post-referral period. In patients with significant urine protein pre-referral, patient group with urine protein 3+ showed the highest increment of 30.1% (n = 22), in comparison to 19.3% (n = 16) observed during prereferral. Statistically significant clinical outcomes between pre- and post-referral to the nephrologist include reduction of systolic blood pressure [141±15 mmHg versus 135 ±12 mmHg, p = 0.001] and diastolic blood pressure [median = 80 mmHg (IQR: 10) versus median=71 mmHg (IQR: 17), p < 0.001]. Similarly, total cholesterol [median = 4.4 mmol/L (IQR: 1.4) versus median = 4.0 mmol/L (IQR: 1.5, p = 0.001] and LDL [median = 2.5 mmol/L (IQR: 1.2) versus median = 2.2 mmol/L (IQR: 1.2), p < 0.001)] exhibited statistically significant differences between pre- and post-referral. However, HDL remained unchanged and other outcome variables showed no significant differences.
CONCLUSION
Incorporating nephrologist visits in primary care seems to have positive impact towards patient clinical outcomes. Results shown in this study can aid other primary care clinics in the decision to initiate nephrologist services in the primary care setting as a multidisciplinary approach to managing CKD patients.
Topics: Humans; Male; Female; Aged; Nephrologists; Diabetes Mellitus, Type 2; Retrospective Studies; Renal Insufficiency, Chronic; Primary Health Care
PubMed: 38553917
DOI: No ID Found -
Frontiers in Endocrinology 2023Japan has the second highest prevalence of dialysis use in the world. Approximately 40% of patients who begin dialysis have diabetic kidney disease (DKD). Local...
BACKGROUND
Japan has the second highest prevalence of dialysis use in the world. Approximately 40% of patients who begin dialysis have diabetic kidney disease (DKD). Local governments and medical facilities are required to provide preventive measures against worsening diabetes mellitus (DM). However, the percentage of patients with DM who receive such screening or interventions for DKD is unclear. This study aimed to reveal to what extent screening for DKD and preventive measures against worsening DKD are performed in patients with DM, using an administrative database in a municipality.
METHODS
This was a cross-sectional study that used the Kyoto-city's administrative medical and long-term care database. Patients with a diagnosis of DM and receiving antidiabetic medication between 2013 and 2018 were defined as patients with DM and included. Patients with DKD were defined as those diagnosed with diabetic nephropathy or those with chronic kidney disease. We described the characteristics of patients with DM, diabetic complications, and extent of DKD screenings and preventive efforts against worsening of DM by fiscal year.
RESULTS
Across fiscal years, 25.8% to 27.5% of patient with DM had DKD. More than 3% of patients were on dialysis due DM in each fiscal year; approximately 15% started receiving dialysis that year. The percentage of patients who were regularly prescribed antidiabetic medication and received glycosylated hemoglobin testing ranged from 64.0% to 67.2% and from 30.6% to 36.5%, respectively. Urine microalbuminuria testing at least once a year occurred in 9.3% to 10.0%. The percentage of patients who received nutritional guidance ranged from 19.0% to 21.0%. Approximately 1% of patients received guidance for preventing DM from progressing to a disease that requires dialysis each fiscal year.
CONCLUSION
This study from Japan, where a super-aging society has developed, using an administrative database in a municipality covering most of the elderly population clearly demonstrated an evidence-practice gap in efforts to prevent worsening of DKD. Strengthening cooperation between government and medical facilities and support for providing preventive measures against DKD are urgently needed.
Topics: Humans; Aged; Diabetic Nephropathies; Japan; Cross-Sectional Studies; Diabetes Complications; Hypoglycemic Agents; Diabetes Mellitus
PubMed: 37576956
DOI: 10.3389/fendo.2023.1195167