OBJECTIVES: Impaired glucose metabolism represents one the most important cardiovascular risk factors, with steeply raising prevalence in overall population. We aimed to compare mortality risk of impaired fasting glycaemia (IFG) and overt diabetes mellitus (DM) in patients with coronary heart disease (CHD). STUDY DESIGN: prospective cohort study METHODS: A total of 1685 patients, 6-24 months after myocardial infarction and/or coronary revascularization at baseline, were followed in a prospective cohort study. Overt DM was defined as fasting glucose ≥ 7 mmol/L and/or use of antidiabetic treatment, while IFG as fasting glucose 5.6-6.99 mmol/L, but no antidiabetic medication. The main outcomes were total and cardiovascular mortality during 5 years of follow-up. RESULTS: During follow-up of 1826 days, 172 patients (10.2%) deceased, and of them 122 (7.2%) from a cardiovascular cause. Both exposures, overt DM (n=623, 37.0% of the whole sample) and IFG (n=436, 25.9%) were associated with an independent increase of 5-year total mortality, compared to normoglycemic subjects [fully adjusted hazard risk ratio (HRR) 1.63 (95%CI: 1.01-2.61)]; p=0.043 and 2.25 (95%CI: 1.45-3.50); p<0.0001, respectively]. In contrast, comparing both glucose disorders one with each other, no significant differences were found for total mortality [HRR 0.82 (0.53-1.28); p=0.33]. Taking 5-years cardiovascular mortality as outcome, similar pattern was observed [HRR 1.96 (95%CI: 1.06-3.63) and 3.84 (95%CI: 2.19-6.73) for overt DM and IFG, respectively, with HRR 0.63 (95%CI: 0.37-1.07) for comparison of both disorders]. CONCLUSIONS: Impaired fasting glycaemia adversely increases mortality of CHD patients in the same extent as overt DM.
- MeSH
- diabetes mellitus krev diagnóza farmakoterapie mortalita MeSH
- komorbidita MeSH
- krevní glukóza metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- nemoci koronárních tepen krev mortalita MeSH
- omezení příjmu potravy krev MeSH
- prediabetes krev mortalita MeSH
- prognóza MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Kontinuální monitorace glykemie (CGM) poskytuje podrobné informace o průběhu glykemických změn během dne, což umožňuje mnohem přesnější nastavení inzulinoterapie. Nabízí také nové parametry, které je pak možné v klinické praxi využít k hodnocení míry kompenzace diabetu. Jako nejsilnější indikátor glykemické kompenzace se ukazuje procento času stráveného v cílovém glykemickém rozmezí, tzv. čas v cílovém rozmezí, neboli time-in-range (TIR). Za to je považováno pásmo glykemie od 3,9 do 10 mmol/l. Od roku 2019 existují konkrétní doporučení vymezující čas v rozmezí u různých skupin pacientů s diabetem (diabetiků 1. a 2. typu, těhotných diabetiček a rizikových/křehkých pacientů), jež umožňují interpretovat výsledky z CGM na více individuální bázi.
Continuous glucose monitoring (CGM) provides detailed information about the course of glycaemic changes during the day, which allows for a much more accurate setting of insulin therapy. Also, it offers new parameters, which can then be used in clinical practice to assess the degree of compensation for diabetes. The strongest indicator of glycaemic compensation is the percentage of time spent in the target glycaemic range, the so-called time-in-range (TIR). It is considered to range from 3.9 to 10 mmol/L. Since 2019, there have been specific TIR recommendations for different groups of diabetic patients (type 1 and type 2 diabetics, pregnant diabetics, and at-risk/fragile patients) that allow CGM results to be interpreted on a more individual basis.
- Klíčová slova
- kontinuální monitor glykemie,
- MeSH
- časové faktory MeSH
- diabetes mellitus * krev prevence a kontrola MeSH
- lidé MeSH
- selfmonitoring glykemie * MeSH
- Check Tag
- lidé MeSH
In the pandemic "Corona Virus Disease 2019" (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycemia and glycemic variability may significantly improve the outcome. In this case, intravenous insulin infusion with continuous glucose monitoring should be the choice. No evidence suggests stopping angiotensin-converting-enzyme inhibitors, angiotensin-renin-blockers or statins, even it has been suggested that they may increase the expression of Angiotensin-Converting-Enzyme-2 (ACE2) receptor, which is used by "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to penetrate into the cells. A real issue is the usefulness of several biomarkers, which have been suggested to be measured during the COVID-19. N-Terminal-pro-Brain Natriuretic-Peptide, D-dimer and hs-Troponin are often increased in diabetes. Their meaning in the case of diabetes and COVID-19 should be therefore very carefully evaluated. Even though we understand that in such a critical situation some of these requests are not so easy to implement, we believe that the best possible action to prevent a worse outcome is essential in any medical act.
- MeSH
- antihypertenziva terapeutické užití MeSH
- Betacoronavirus patogenita MeSH
- biologické markery krev MeSH
- diabetes mellitus krev diagnóza farmakoterapie mortalita MeSH
- dyslipidemie farmakoterapie mortalita MeSH
- hodnocení rizik MeSH
- hypertenze farmakoterapie mortalita MeSH
- hypoglykemika škodlivé účinky terapeutické užití MeSH
- interakce hostitele a patogenu MeSH
- jednotky intenzivní péče * MeSH
- koronavirové infekce diagnóza mortalita terapie virologie MeSH
- krevní glukóza účinky léků metabolismus MeSH
- lidé MeSH
- pandemie MeSH
- rizikové faktory MeSH
- statiny terapeutické užití MeSH
- virová pneumonie diagnóza mortalita terapie virologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Patients with established coronary artery disease or peripheral artery disease often have diabetes mellitus. These patients are at high risk of future vascular events. METHODS: In a prespecified analysis of the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies), we compared the effects of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg daily) versus placebo plus aspirin in patients with diabetes mellitus versus without diabetes mellitus in preventing major vascular events. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included all-cause mortality and all major vascular events (cardiovascular death, myocardial infarction, stroke, or major adverse limb events, including amputation). The primary safety end point was a modification of the International Society on Thrombosis and Haemostasis criteria for major bleeding. RESULTS: There were 10 341 patients with diabetes mellitus and 17 054 without diabetes mellitus in the overall trial. A consistent and similar relative risk reduction was seen for benefit of rivaroxaban plus aspirin (n=9152) versus placebo plus aspirin (n=9126) in patients both with (n=6922) and without (n=11 356) diabetes mellitus for the primary efficacy end point (hazard ratio, 0.74, P=0.002; and hazard ratio, 0.77, P=0.005, respectively, Pinteraction=0.77) and all-cause mortality (hazard ratio, 0.81, P=0.05; and hazard ratio, 0.84, P=0.09, respectively; Pinteraction=0.82). However, although the absolute risk reductions appeared numerically larger in patients with versus without diabetes mellitus, both subgroups derived similar benefit (2.3% versus 1.4% for the primary efficacy end point at 3 years, Gail-Simon qualitative Pinteraction<0.0001; 1.9% versus 0.6% for all-cause mortality, Pinteraction=0.02; 2.7% versus 1.7% for major vascular events, Pinteraction<0.0001). Because the bleeding hazards were similar among patients with and without diabetes mellitus, the prespecified net benefit for rivaroxaban appeared particularly favorable in the patients with diabetes mellitus (2.7% versus 1.0%; Gail-Simon qualitative Pinteraction=0.001). CONCLUSIONS: In stable atherosclerosis, the combination of aspirin plus rivaroxaban 2.5 mg twice daily provided a similar relative degree of benefit on coronary, cerebrovascular, and peripheral end points in patients with and without diabetes mellitus. Given their higher baseline risk, the absolute benefits appeared larger in those with diabetes mellitus, including a 3-fold greater reduction in all-cause mortality. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01776424.
- MeSH
- antikoagulancia aplikace a dávkování MeSH
- Aspirin aplikace a dávkování MeSH
- diabetes mellitus krev farmakoterapie epidemiologie MeSH
- dvojitá slepá metoda MeSH
- inhibitory agregace trombocytů aplikace a dávkování MeSH
- inhibitory faktoru Xa MeSH
- kardiovaskulární nemoci krev farmakoterapie epidemiologie MeSH
- kombinovaná farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- rivaroxaban aplikace a dávkování MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
Available data from observational studies on the association of admission hyperglycemia (aHG) with outcomes of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) are contradictory, especially when stratified by diabetes mellitus (DM) history. We assessed the association of aHG (≥144 mg/dL) with outcomes stratified by DM history using propensity score-matched (PSM) data from the SITS-ISTR. The primary safety outcome was symptomatic intracranial hemorrhage (SICH); 3-month functional independence (FI) (modified Rankin Scale [mRS] scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-DM (n = 12,318) and DM (n = 6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3-month FI rates (53.3% vs. 57.9%, P < 0.001), higher 3-month mortality rates (19.2% vs. 16.0%, P < 0.001), and similar symptomatic intracerebral hemorrhage (SICH) rates (1.7% vs. 1.8%, P = 0.563) compared with patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favorable functional outcome (mRS scores 0-1, 34.1% vs. 39.3%, P < 0.001) and FI (48.2% vs. 52.5%, P < 0.001), higher 3-month mortality rates (23.7% vs. 19.9%, P < 0.001), and similar SICH rates (2.2% vs. 2.7%, P = 0.224) compared with patients without aHG. In conclusion, aHG was associated with unfavorable 3-month clinical outcomes in patients with and without DM and AIS treated with IVT.
- MeSH
- cévní mozková příhoda krev komplikace farmakoterapie MeSH
- diabetes mellitus krev MeSH
- fibrinolytika terapeutické užití MeSH
- hyperglykemie krev komplikace MeSH
- ischemie mozku krev komplikace farmakoterapie MeSH
- krevní glukóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- prognóza MeSH
- registrace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tendenční skóre MeSH
- tkáňový aktivátor plazminogenu terapeutické užití MeSH
- trombolytická terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- diabetes mellitus * diagnóza dietoterapie farmakoterapie genetika krev veterinární MeSH
- glykosurie moč veterinární MeSH
- hyperglykemie krev veterinární MeSH
- katarakta veterinární MeSH
- morčata * MeSH
- zvířata MeSH
- Check Tag
- morčata * MeSH
- zvířata MeSH
- Publikační typ
- kazuistiky MeSH
