BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-incom...BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-income countries.However,the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.AIM To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.METHODS We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota,Colombia.Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included.A total of 583 patients participated in the study.We performed descriptive,bivariate,and binary logistic regression analyses,adjusting for confounding variables.RESULTS Among the 583 patients included,urban residency[odds ratio(OR)=3.05,95%confidence interval(CI):1.01-9.20]and a middle or high educational level(OR=2.33,95%CI:1.14-4.72)were associated with an increased risk of coronary artery disease.Additionally,receiving diabetes education beyond that provided by the clinic(OR=2.15,95%CI:1.14-4.05)and lack of access to spaces for physical activity(OR=4.05,95%CI:1.31-12.5)were associated with a higher risk of diabetic nephropathy and cerebrovascular disease,respectively.CONCLUSION Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs.Population-based studies are needed to guide targeted interventions and clarify causal relationships.展开更多
BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease pe...BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment,including tumor size,vertical and horizontal extensions of the adenoma,hyperintensity in T2-weighted magnetic resonance imaging,granulation density,and pre-and postoperative GH and insulin-like growth factor 1(IGF-1)levels.AIM To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.METHODS This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs,IGF-1 levels before and after surgery,disease control during follow-up,and the line of therapy required for disease control in a cohort of patients treated at two centers:Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas,Bogotá,Colombia.RESULTS A total of 77 patients with acromegaly(42 men,35 women)were included in this study.The mean age at diagnosis was 42 years(SD:12),with a mean disease duration of 9.9 years(SD:7.2).The mean pituitary tumor volume was 4358 mm^(3)(SD:6291,interquartile range[IQR]:13602).Patients with controlled acromegaly had a mean PitNET volume of 3202 mm^(3)(SD:4845,95%CI:621-5784)compared to 5513 mm^(3)(SD:7447,95%CI:1545-9482)in the uncontrolled group(P=0.15).A PitNET volume exceeding 3697 mm^(3)was associated with a higher likelihood of requiring third or fourth-line therapy(50%vs 36%;P=0.03).CONCLUSION PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre-or postsurgical IGF-1 levels.Nevertheless,a trend towards an inverse relationship between tumor volume and future disease control was observed.While macroadenoma classification remains crucial,among patients with macroadenomas,those with a volume exceeding 3697 mm³could have worse prognosis.展开更多
文摘BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-income countries.However,the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.AIM To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.METHODS We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota,Colombia.Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included.A total of 583 patients participated in the study.We performed descriptive,bivariate,and binary logistic regression analyses,adjusting for confounding variables.RESULTS Among the 583 patients included,urban residency[odds ratio(OR)=3.05,95%confidence interval(CI):1.01-9.20]and a middle or high educational level(OR=2.33,95%CI:1.14-4.72)were associated with an increased risk of coronary artery disease.Additionally,receiving diabetes education beyond that provided by the clinic(OR=2.15,95%CI:1.14-4.05)and lack of access to spaces for physical activity(OR=4.05,95%CI:1.31-12.5)were associated with a higher risk of diabetic nephropathy and cerebrovascular disease,respectively.CONCLUSION Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs.Population-based studies are needed to guide targeted interventions and clarify causal relationships.
文摘BACKGROUND Acromegaly is caused by a pituitary neuroendocrine tumor(PitNET)with excessive production of growth hormone(GH),leading to multisystem complications.Previous studies have identified predictors of disease persistence following surgery and poor response to medical treatment,including tumor size,vertical and horizontal extensions of the adenoma,hyperintensity in T2-weighted magnetic resonance imaging,granulation density,and pre-and postoperative GH and insulin-like growth factor 1(IGF-1)levels.AIM To evaluate PitNET volume as a complementary prognostic factor in patients with acromegaly.METHODS This is a retrospective descriptive study with an analytical component evaluating the correlation between the volumetric analysis of GH-producing PitNETs,IGF-1 levels before and after surgery,disease control during follow-up,and the line of therapy required for disease control in a cohort of patients treated at two centers:Endocrinology Department of the Central Military Hospital and Centros Médicos Colsanitas,Bogotá,Colombia.RESULTS A total of 77 patients with acromegaly(42 men,35 women)were included in this study.The mean age at diagnosis was 42 years(SD:12),with a mean disease duration of 9.9 years(SD:7.2).The mean pituitary tumor volume was 4358 mm^(3)(SD:6291,interquartile range[IQR]:13602).Patients with controlled acromegaly had a mean PitNET volume of 3202 mm^(3)(SD:4845,95%CI:621-5784)compared to 5513 mm^(3)(SD:7447,95%CI:1545-9482)in the uncontrolled group(P=0.15).A PitNET volume exceeding 3697 mm^(3)was associated with a higher likelihood of requiring third or fourth-line therapy(50%vs 36%;P=0.03).CONCLUSION PitNET volume was associated with the need for higher-line therapy to manage acromegaly but did not correlate with long-term disease control or with pre-or postsurgical IGF-1 levels.Nevertheless,a trend towards an inverse relationship between tumor volume and future disease control was observed.While macroadenoma classification remains crucial,among patients with macroadenomas,those with a volume exceeding 3697 mm³could have worse prognosis.
