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Diabetes Mellitus and Its Effects on All-Cause Mortality After Radiopeptide Therapy for Neuroendocrine Tumors.
Umlauft, M, Radojewski, P, Spanjol, PM, Dumont, R, Marincek, N, Kollar, A, Brunner, P, Beyersmann, J, Müller-Brand, J, Maecke, HR, et al
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2017;(1):97-102
Abstract
UNLABELLED We aimed to assess the risk of developing diabetes mellitus and its effects on all-cause mortality after radiopeptide therapy for neuroendocrine tumors (NETs). METHODS NET patients received somatostatin radiopeptide therapy with 90Y-DOTATOC or 177Lu-DOTATOC. The incidence of diabetes mellitus and its mortality were assessed using univariate and multivariate regression. RESULTS Overall, 1,535 NET patients were enrolled and received 3,807 treatment cycles. After treatment, 72 patients developed diabetes mellitus, including 47 cases after 90Y-DOTATOC and 25 cases after combined treatment. The diabetes mellitus risk was higher before than after DOTATOC (estimate, 0.0032; P < 0.001), and overall survival was similar in patients with and without diabetes mellitus (hazard ratio, 1.13; 95% confidence interval, 0.91-1.39; n = 1,535; P = 0.27). CONCLUSION Radiopeptide therapy does not appear to increase the risk of developing diabetes mellitus in NET patients, whereas diabetes mellitus does not appear to increase the mortality of NET patients undergoing receptor-targeted radiopeptide therapy.
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The Vasopressin 2 Receptor Antagonist Tolvaptan Improves Nutrition and Inflammatory States in Peritoneal Dialysis Patients with Diabetes Mellitus.
Hiramatsu, T, Asai, K, Ozeki, A, Saka, M, Hobo, A, Furuta, S
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis. 2015;:30-3
Abstract
Previously, we reported that, in peritoneal dialysis (PD) patients, tolvaptan preserves residual renal function and ameliorates left ventricular hypertrophy. Here, we evaluated the effect of tolvaptan in terms of nutrition and inflammatory states. Of 24 incident PD patients with diabetes, 12 were assigned to a control group that did not receive tolvaptan, and 12, to a group that, 2 weeks after initiation of PD, received tolvaptan 15 mg daily for 12 months. At baseline and at 6 and 12 months after initiation of PD, we evaluated serum C-reactive protein (CRP), albumin, urine volume, peritoneal ultrafiltration (UF), phosphate elimination, protein uptake, left ventricular mass index (LVMI), and the diameter of the inferior vena cava (IVC). Compared with the control group, the tolvaptan group experienced preserved urine volume and UF, lower LVMI and IVC diameter, and higher protein uptake. The average protein uptake was significantly correlated with urine volume, albumin, and CRP; and serum CRP was significantly correlated with albumin. Our study results suggest that tolvaptan improves not only fluid management, but also nutrition state in PD patients.
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3.
Community-based peer support significantly improves metabolic control in people with Type 2 diabetes in Yaoundé, Cameroon.
Assah, FK, Atanga, EN, Enoru, S, Sobngwi, E, Mbanya, JC
Diabetic medicine : a journal of the British Diabetic Association. 2015;(7):886-9
Abstract
AIMS: To examine the effectiveness of a community-based multilevel peer support intervention in addition to usual diabetes care on improving glycaemic levels, blood pressure and lipids in patients with Type 2 diabetes in Yaoundé, Cameroon. METHODS A total of 96 subjects with poorly controlled Type 2 diabetes (intervention group) and 96 age- and sex-matched controls were recruited and followed up over 6 months. The intervention subjects underwent a peer support intervention through peer-led group meetings, personal encounters and telephone calls. Both intervention subjects and controls continued their usual clinical care. HbA1c , blood pressure, blood lipids and self-care behaviours were measured at 0 and 6 months. RESULTS There was significant reduction in HbA1c in the intervention group [-33 mmol/mol (-3.0%)] compared with controls [-14 mmol/mol (-1.3%)]; P < 0.001. Peer support also led to significant reductions in fasting blood sugar (-0.83 g/l P < 0.001), cholesterol (-0.54 g/l P < 0.001), HDL (-0.09 g/l, P < 0.001), BMI (-2.71 kg/m² P < 0.001) and diastolic pressure (-6.77 mmHg, P < 0.001) over the 6-month period. Also, diabetes self-care behaviours in the intervention group improved significantly over the 6 months of peer support. CONCLUSION Community-based peer support, in addition to usual care, significantly improved metabolic control in patients with uncontrolled Type 2 diabetes in Yaoundé, Cameroon. This could provide a model for optimizing diabetes care and control in other settings with limited healthcare and financial resources.
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Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial.
Russell, AW, Baxter, KA, Askew, DA, Tsai, J, Ware, RS, Jackson, CL
Diabetic medicine : a journal of the British Diabetic Association. 2013;(9):1112-21
Abstract
AIMS: To evaluate patient outcomes for a novel integrated primary/specialist model of community care for complex Type 2 diabetes mellitus management compared with outcomes for usual care at a tertiary hospital for diabetes outpatients. METHODS This was a prospective open controlled trial performed in a primary and tertiary care setting in Australia. A total of 330 patients with Type 2 diabetes aged >18 years were allocated to an intervention (n=185) or usual care group (n=145). The intervention arm was a community-based model of care led by a general practitioner with advanced skills and an endocrinologist partnership. Usual care was provided via the hospital diabetes outpatient department. The primary end point was HbA(1c) concentration at 12 months. Secondary end points included serum lipids and blood pressure. RESULTS The mean change in HbA1c concentration in the intervention group was -9 mmol/mol (-0.8%) at 12 months and in the usual care group it was -2 mmol/mol (-0.2%) (95% CI -5,1). The percentage of patients in the intervention group achieving the HbA(1c) target of ≤53 mmol/mol (7%) increased from 21 to 42% (P<0.001); for the usual care group there was a 1% increase to 39% of patients attaining this target (P=0.99). Patients in the intervention group experienced significant improvements in blood pressure and total cholesterol compared with those in the usual care group. The percentage of patients achieving clinical targets was greater in the intervention group for the combined target of HbA(1c) concentration, blood pressure and LDL cholesterol. CONCLUSIONS A community-based, integrated model of complex diabetes care, delivered by general practitioners with advanced skills, produced clinical and process benefits compared with a tertiary diabetes outpatient clinic.
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Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrown toenails in people with diabetes.
Tatlican, S, Eren, C, Yamangokturk, B, Eskioglu, F, Bostanci, S
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2010;(2):219-22
Abstract
BACKGROUND Treatment of ingrown toenails using chemical matricectomy in patients with diabetes has been difficult, because delayed wound healing, wound infections, and digital ischemia can interfere with the procedure. Chemical matricectomy with 10% sodium hydroxide is an effective treatment for ingrown toenails in a normal population. OBJECTIVES Investigation of the effectiveness and safety of chemical matricectomy with 10% sodium hydroxide solution for ingrown toenails in patients with diabetes. MATERIAL AND METHODS Thirty patients with diabetes with 40 ingrown toenails and 30 patients without diabetes with 41 ingrown toenails were enrolled in the study. After partial avulsion of the affected edge, germinal matrix was treated for 1 minute with 10% sodium hydroxide. Patients were observed on alternate days until complete healing was achieved and followed for up to 24 months for recurrence. RESULTS Assessment of the treatment in both groups for complete healing, postoperative pain, tissue damage, drainage, infections, and rate of recurrences revealed no statistically significant difference. CONCLUSIONS The partial avulsion of the affected edge and the treatment of the germinal matrix for 1 minute with 10% sodium hydroxide preceded by matrix curettage is an effective and safe treatment modality for ingrown toenails in people with diabetes.