مستخلص: Background: Tobacco smoking and diabetes mellitus contribute significantly to the overall health burden and mortality of Australians. We aimed to assess the relationship of smoking with glycemic control, metabolic profile and complications in Australian patients living with diabetes. Method(s): We analysed the 2011-2017 biennial Australian National Diabetes Audit cross-sectional data. Patients were classified as current, past or never smokers. Linear (or quantile) and logistic regression models were used to assess for associations. Result(s): Data from 15,352 patients were analysed, including 72.2% with type 2 diabetes. Current smokers comprised 13.5% of the study population. Current and past smokers had a median HbA1c that was 0.49% and 0.14% higher than never smokers, respectively, as well as higher triglyceride and lower HDL levels (all p values <.0001). Compared to never smokers, current smokers had higher odds of severe hypoglycemia and current and past smokers had higher odds of myocardial infarction, stroke, peripheral vascular disease, lower limb amputation, erectile dysfunction and peripheral neuropathy (all p values <=.001), with no significant change over time. Conclusion(s): When compared to never smokers, current and past smokers had poorer glycemic and lipid control and higher odds of macrovascular and microvascular complications. Despite this, current smoking remains prevalent among Australians with diabetes.Copyright © 2020 Elsevier Inc.

مصطلحات الفهرس: body mass, cerebrovascular accident, clinical outcome, coronary artery recanalization, cross-sectional study, current smoker, diabetic complication/co [Complication], diabetic foot, diabetic neuropathy, diabetic retinopathy, disease severity, erectile dysfunction, ex-smoker, female, glycemic control, heart infarction, high density lipoprotein cholesterol level, human, hypoglycemia, leg amputation, macroalbuminuria, major clinical study, male, metabolic fingerprinting, microalbuminuria, never smoker, non insulin dependent diabetes mellitus, observational study, people by smoking status, peripheral vascular disease, risk factor, triacylglycerol blood level, hemoglobin A1c/ec [Endogenous Compound], high density lipoprotein cholesterol/ec [Endogenous Compound], triacylglycerol/ec [Endogenous Compound], priority journal, adult, aged, article, Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/29080Test
Journal of Diabetes and its Complications
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مستخلص: Background: Tobacco smoking and diabetes mellitus contribute significantly to the overall health burden and mortality of Australians. We aimed to assess the relationship of smoking with glycemic control, metabolic profile and complications in Australian patients living with diabetes. Method(s): We analysed the 2011-2017 biennial Australian National Diabetes Audit cross-sectional data. Patients were classified as current, past or never smokers. Linear (or quantile) and logistic regression models were used to assess for associations. Result(s): Data from 15,352 patients were analysed, including 72.2% with type 2 diabetes. Current smokers comprised 13.5% of the study population. Current and past smokers had a median HbA1c that was 0.49% and 0.14% higher than never smokers, respectively, as well as higher triglyceride and lower HDL levels (all p values <.0001). Compared to never smokers, current smokers had higher odds of severe hypoglycemia and current and past smokers had higher odds of myocardial infarction, stroke, peripheral vascular disease, lower limb amputation, erectile dysfunction and peripheral neuropathy (all p values <=.001), with no significant change over time. Conclusion(s): When compared to never smokers, current and past smokers had poorer glycemic and lipid control and higher odds of macrovascular and microvascular complications. Despite this, current smoking remains prevalent among Australians with diabetes.Copyright © 2020 Elsevier Inc.

مصطلحات الفهرس: body mass, cerebrovascular accident, clinical outcome, coronary artery recanalization, cross-sectional study, current smoker, diabetic complication/co [Complication], diabetic foot, diabetic neuropathy, diabetic retinopathy, disease severity, erectile dysfunction, ex-smoker, female, glycemic control, heart infarction, high density lipoprotein cholesterol level, human, hypoglycemia, leg amputation, macroalbuminuria, major clinical study, male, metabolic fingerprinting, microalbuminuria, never smoker, non insulin dependent diabetes mellitus, observational study, people by smoking status, peripheral vascular disease, risk factor, triacylglycerol blood level, hemoglobin A1c/ec [Endogenous Compound], high density lipoprotein cholesterol/ec [Endogenous Compound], triacylglycerol/ec [Endogenous Compound], priority journal, adult, aged, article, Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/29080Test
Journal of Diabetes and its Complications
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مستخلص: Background The adipocytokines leptin and adiponectin have been variously associated with diabetic microvascular complications. No comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Methods This is a systematic review of cross-sectional studies comparing circulating adipocytokines in patients with type 2 diabetes mellitus (T2DM), with and without microvascular complications. Studies were retrieved from MEDLINE, EMBASE, Scopus and Cochrane databases. Study quality was evaluated using a modified Newcastle-Ottawa Scale. Meta-analysis was performed using an inverse-variance model, providing standardised mean differences (SMD) and 95% confidence intervals (CI). Heterogeneity was determined by I2 statistic. Results Amongst 554 identified studies, 28 were included in the review. Study quality range was 3.5-9 (maximum 11). Higher leptin levels were associated with microalbuminuria (SMD = 0.41; 95% CI = 0.14-0.67; n = 901; p = 0.0003), macroalbuminuria (SMD = 0.68; 95% CI = 0.30-1.06; n = 406; p = 0.0004), and neuropathy (SMD = 0.26; 95% CI = 0.07-0.44; n = 609; p = 0.008). Higher adiponectin levels were associated with microalbuminuria (SMD = 0.55; 95% CI = 0.29-0.81, n = 274; p < 0.001), macroalbuminuria (SMD = 1.37; 95% CI = 0.78-1.97, n = 246; p < 0.00001), neuropathy (SMD = 0.25; 95% CI = 0.14-0.36; n = 1516; p < 0.00001), and retinopathy (SMD = 0.38; 95% CI = 0.25-0.51; n = 1306; p < 0.00001). Meta-regression suggested no influence of body mass index and duration of diabetes on effect size, and a weak trend in terms of age on effect size. Discussion Our meta-analysis suggests leptin and adiponectin levels are higher in T2DM patients with microvascular complications. Studies were limited by cross-sectional design. Large prospective analyses are required to validate these findings.Copyright © 2016 The Authors.

مصطلحات الفهرس: Medline, meta analysis, microalbuminuria, priority journal, proliferative diabetic retinopathy, protein blood level, quality control, rating scale, Scopus, sensitivity analysis, systematic review, trend study, vascular disease/co [Complication], adipocytokine/ec [Endogenous Compound], adiponectin/ec [Endogenous Compound], Newcastle-Ottawa scale, non insulin dependent diabetes mellitus, leptin/ec [Endogenous Compound], diabetic microvascular complication/co [Complication], article, body mass, Cochrane Library, confidence interval, cross-sectional study, diabetic nephropathy, diabetic neuropathy, diabetic patient, diabetic retinopathy, disease association, disease duration, effect size, Embase, human, macroalbuminuria, Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/40009Test
Journal of Diabetes and its Complications
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مستخلص: Background The adipocytokines leptin and adiponectin have been variously associated with diabetic microvascular complications. No comprehensive clinical data exist examining the association between adipocytokines and the presence of these complications. Methods This is a systematic review of cross-sectional studies comparing circulating adipocytokines in patients with type 2 diabetes mellitus (T2DM), with and without microvascular complications. Studies were retrieved from MEDLINE, EMBASE, Scopus and Cochrane databases. Study quality was evaluated using a modified Newcastle-Ottawa Scale. Meta-analysis was performed using an inverse-variance model, providing standardised mean differences (SMD) and 95% confidence intervals (CI). Heterogeneity was determined by I2 statistic. Results Amongst 554 identified studies, 28 were included in the review. Study quality range was 3.5-9 (maximum 11). Higher leptin levels were associated with microalbuminuria (SMD = 0.41; 95% CI = 0.14-0.67; n = 901; p = 0.0003), macroalbuminuria (SMD = 0.68; 95% CI = 0.30-1.06; n = 406; p = 0.0004), and neuropathy (SMD = 0.26; 95% CI = 0.07-0.44; n = 609; p = 0.008). Higher adiponectin levels were associated with microalbuminuria (SMD = 0.55; 95% CI = 0.29-0.81, n = 274; p < 0.001), macroalbuminuria (SMD = 1.37; 95% CI = 0.78-1.97, n = 246; p < 0.00001), neuropathy (SMD = 0.25; 95% CI = 0.14-0.36; n = 1516; p < 0.00001), and retinopathy (SMD = 0.38; 95% CI = 0.25-0.51; n = 1306; p < 0.00001). Meta-regression suggested no influence of body mass index and duration of diabetes on effect size, and a weak trend in terms of age on effect size. Discussion Our meta-analysis suggests leptin and adiponectin levels are higher in T2DM patients with microvascular complications. Studies were limited by cross-sectional design. Large prospective analyses are required to validate these findings.Copyright © 2016 The Authors.

مصطلحات الفهرس: Medline, meta analysis, microalbuminuria, priority journal, proliferative diabetic retinopathy, protein blood level, quality control, rating scale, Scopus, sensitivity analysis, systematic review, trend study, vascular disease/co [Complication], adipocytokine/ec [Endogenous Compound], adiponectin/ec [Endogenous Compound], Newcastle-Ottawa scale, non insulin dependent diabetes mellitus, leptin/ec [Endogenous Compound], diabetic microvascular complication/co [Complication], article, body mass, Cochrane Library, confidence interval, cross-sectional study, diabetic nephropathy, diabetic neuropathy, diabetic patient, diabetic retinopathy, disease association, disease duration, effect size, Embase, human, macroalbuminuria, Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/40009Test
Journal of Diabetes and its Complications
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مستخلص: Background:The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI.Methods and Findings:We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.0-48.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.96-1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.63-2.00, p = 0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration. Conclusion(s):Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis.Trial registration:http://www.ClinicalTrials.govTest NCT00221013 Please see later

مصطلحات الفهرس: glomerulus filtration rate, acute kidney failure, adult, aged, APACHE, article, death, dialysis, diastolic blood pressure, female, follow up, human, incidence, intensive care, long term survival, macroalbuminuria, major clinical study, male, microalbuminuria, middle aged, mortality, outcome assessment, prevalence, prospective study, quality of life, randomized controlled trial, Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/41615Test
PLoS Medicine
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مستخلص: OBJECTIVE-The structural basis of normoalbuminuric renal insufficiency in patients with type 2 diabetes remains to be elucidated. We compared renal biopsy findings in patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) and measured GFR of <60 mL/min/1.73 m2, associated with either normo-, micro-, or macroalbuminuria. RESEARCH DESIGN AND METHODS-In patients with normo- (n = 8) ormicroalbuminuria (n = 6), renal biopsies were performed according to a research protocol. In patients with macroalbuminuria (n = 17), biopsies were performed according to clinical indication. Findings were categorized according to the Fioretto classification: category 1 (C1), normal/near normal; category 2 (C2), typical diabetic nephropathy (DN)with predominantly glomerular changes; and category 3 (C3), atypical with disproportionately severe interstitial/tubular/vascular damage and with no/mild diabetic glomerular changes. RESULTS-In our study population (mean eGFR 35 mL/min/1.73 m2), typical glomerular changes (C2) of DN were observed in 22 of 23 subjects with micro- or macroalbuminuria compared with 3 of 8 subjects with normoalbuminuria (P = 0.002). By contrast, predominantly interstitial or vascular changes (C3) were seen in only 1 of 23 subjects with micro- or macroalbuminuria compared with 3 of 8 normoalbuminuric subjects (P = 0.08). Mesangial area increased progressively fromnormal controls to patients with type 2 diabetes and normo-, micro-, and macroalbuminuria. Varying degrees of arteriosclerosis, although not necessarily the predominant pattern, were seen in seven of eight subjects with normoalbuminuria. CONCLUSIONS-Typical renal structural changes of DN were observed in patients with type 2 diabetes and elevated albuminuria. By contrast, in normoalbuminuric renal insufficiency, these changes were seen less frequently, likely reflecting greater contributions from aging, hypertension, and arteriosclerosis. © 2013 by the American Diabetes Association.

مصطلحات الفهرس: diabetic nephropathy/et [Etiology], disease classification, disease course, female, glomerulonephritis/co [Complication], glomerulonephritis/di [Diagnosis], glomerulonephritis/et [Etiology], glomerulopathy/co [Complication], glomerulopathy/di [Diagnosis], glomerulopathy/et [Etiology], glomerulus filtration rate, hematuria, histopathology, human, hyaline degeneration/co [Complication], hyaline degeneration/di [Diagnosis], hyaline degeneration/et [Etiology], hypertension, immunoglobulin A nephropathy/co [Complication], immunoglobulin A nephropathy/di [Diagnosis], immunoglobulin A nephropathy/et [Etiology], kidney hypertrophy/et [Etiology], kidney structure, macroalbuminuria, male, microalbuminuria, nephrosclerosis/co [Complication], nephrosclerosis/di [Diagnosis], nephrosclerosis/et [Etiology], non insulin dependent diabetes mellitus, pathophysiology, sex difference, smoking, antinuclear antibody/ec [Endogenous Compound], glomerular basement membrane thickness/co [Complication], glomerular basement membrane thickness/di [Diagnosis], glomerular basement membrane thickness/et [Etiology], trend study, interstitial nephritis/co [Complication], interstitial nephritis/di [Diagnosis], interstitial nephritis/et [Etiology], kidney amyloidosis/co [Complication], kidney amyloidosis/di [Diagnosis], kidney amyloidosis/et [Etiology], kidney biopsy, kidney dysfunction/co [Complication], kidney dysfunction/di [Diagnosis], kidney dysfunction/et [Etiology], kidney failure/co [Complication], kidney failure/di [Diagnosis], kidney failure/et [Etiology], kidney hypertrophy/co [Complication], kidney hypertrophy/di [Diagnosis], aged, albuminuria, article, clinical article, cryoglobulinemia, diabetic nephropathy/co [Complication], diabetic nephropathy/di [Diagnosis], Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/27567Test
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مستخلص: Background:The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI.Methods and Findings:We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.0-48.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.96-1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.63-2.00, p = 0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration. Conclusion(s):Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis.Trial registration:http://www.ClinicalTrials.govTest NCT00221013 Please see later

مصطلحات الفهرس: glomerulus filtration rate, acute kidney failure, adult, aged, APACHE, article, death, dialysis, diastolic blood pressure, female, follow up, human, incidence, intensive care, long term survival, macroalbuminuria, major clinical study, male, microalbuminuria, middle aged, mortality, outcome assessment, prevalence, prospective study, quality of life, randomized controlled trial, Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/41615Test
PLoS Medicine
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مستخلص: OBJECTIVE-The structural basis of normoalbuminuric renal insufficiency in patients with type 2 diabetes remains to be elucidated. We compared renal biopsy findings in patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) and measured GFR of <60 mL/min/1.73 m2, associated with either normo-, micro-, or macroalbuminuria. RESEARCH DESIGN AND METHODS-In patients with normo- (n = 8) ormicroalbuminuria (n = 6), renal biopsies were performed according to a research protocol. In patients with macroalbuminuria (n = 17), biopsies were performed according to clinical indication. Findings were categorized according to the Fioretto classification: category 1 (C1), normal/near normal; category 2 (C2), typical diabetic nephropathy (DN)with predominantly glomerular changes; and category 3 (C3), atypical with disproportionately severe interstitial/tubular/vascular damage and with no/mild diabetic glomerular changes. RESULTS-In our study population (mean eGFR 35 mL/min/1.73 m2), typical glomerular changes (C2) of DN were observed in 22 of 23 subjects with micro- or macroalbuminuria compared with 3 of 8 subjects with normoalbuminuria (P = 0.002). By contrast, predominantly interstitial or vascular changes (C3) were seen in only 1 of 23 subjects with micro- or macroalbuminuria compared with 3 of 8 normoalbuminuric subjects (P = 0.08). Mesangial area increased progressively fromnormal controls to patients with type 2 diabetes and normo-, micro-, and macroalbuminuria. Varying degrees of arteriosclerosis, although not necessarily the predominant pattern, were seen in seven of eight subjects with normoalbuminuria. CONCLUSIONS-Typical renal structural changes of DN were observed in patients with type 2 diabetes and elevated albuminuria. By contrast, in normoalbuminuric renal insufficiency, these changes were seen less frequently, likely reflecting greater contributions from aging, hypertension, and arteriosclerosis. © 2013 by the American Diabetes Association.

مصطلحات الفهرس: diabetic nephropathy/et [Etiology], disease classification, disease course, female, glomerulonephritis/co [Complication], glomerulonephritis/di [Diagnosis], glomerulonephritis/et [Etiology], glomerulopathy/co [Complication], glomerulopathy/di [Diagnosis], glomerulopathy/et [Etiology], glomerulus filtration rate, hematuria, histopathology, human, hyaline degeneration/co [Complication], hyaline degeneration/di [Diagnosis], hyaline degeneration/et [Etiology], hypertension, immunoglobulin A nephropathy/co [Complication], immunoglobulin A nephropathy/di [Diagnosis], immunoglobulin A nephropathy/et [Etiology], kidney hypertrophy/et [Etiology], kidney structure, macroalbuminuria, male, microalbuminuria, nephrosclerosis/co [Complication], nephrosclerosis/di [Diagnosis], nephrosclerosis/et [Etiology], non insulin dependent diabetes mellitus, pathophysiology, sex difference, smoking, antinuclear antibody/ec [Endogenous Compound], glomerular basement membrane thickness/co [Complication], glomerular basement membrane thickness/di [Diagnosis], glomerular basement membrane thickness/et [Etiology], trend study, interstitial nephritis/co [Complication], interstitial nephritis/di [Diagnosis], interstitial nephritis/et [Etiology], kidney amyloidosis/co [Complication], kidney amyloidosis/di [Diagnosis], kidney amyloidosis/et [Etiology], kidney biopsy, kidney dysfunction/co [Complication], kidney dysfunction/di [Diagnosis], kidney dysfunction/et [Etiology], kidney failure/co [Complication], kidney failure/di [Diagnosis], kidney failure/et [Etiology], kidney hypertrophy/co [Complication], kidney hypertrophy/di [Diagnosis], aged, albuminuria, article, clinical article, cryoglobulinemia, diabetic nephropathy/co [Complication], diabetic nephropathy/di [Diagnosis], Article

URL: https://repository.monashhealth.org/monashhealthjspui/handle/1/27567Test
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