Background A five-year follow-up study of intensive multifactorial intervention was undertaken to assess the changes of circulating serum amyloid A （SAA） levels and the incidence of atherosclerosis （AS） in patient...Background A five-year follow-up study of intensive multifactorial intervention was undertaken to assess the changes of circulating serum amyloid A （SAA） levels and the incidence of atherosclerosis （AS） in patients with short-duration type 2 diabetes mellitus （T2DM） without macroangiopathy, and whether intensive multifactorial intervention could prevent or at least postpone the occurence of macroangiopathy. Methods Among 150 patients with short-duration T2DM, 75 were assigned to receive conventional outpatient treatment （conventional group） and the others underwent intensive multifactorial integrated therapy targeting hyperglycemia, hypertension, dyslipidemia and received aspirin simultaneously （intensive group）. Results Plasma SAA levels were higher in diabetic patients than those in healthy control subjects, and decreased obviously after intensive multifactorial intervention. The levels of SAA were positively correlated with body mass index （BMI）, waist hip ratio （WHR）, triglyceride （TG）, high sensitive C-reactive protein （hs-CRP） and common carotid intima-media thickness （CC-IMT）. The standard-reaching rates of glycemia, blood pressure and lipidemia were significantly higher in intensive group than those of conventional group. The incidence of macroangiopathy decreased by 58.96% in intensive group compared with conventional group. Conclusions Intensive multifactorial intervention may significantly reduce the SAA levels and prevent the occurrence of AS in short-duration patients with T2DM. SAA might be one of the risk factors of T2DM combined with AS.展开更多
BACKGROUND Achieving optimal glycemic control is a cornerstone of cardiovascular risk reduction in type 2 diabetes(T2D).However,the extent to which multifactorial interventions influence this relationship remains unce...BACKGROUND Achieving optimal glycemic control is a cornerstone of cardiovascular risk reduction in type 2 diabetes(T2D).However,the extent to which multifactorial interventions influence this relationship remains uncertain.AIM To evaluate the association between glycated hemoglobin(HbA1c)target achievement and long-term cardiovascular outcomes in patients receiving standard of care(SoC)or multifactorial intensive therapy(MT).METHODS This post-hoc analysis of the nephropathy in diabetes type 2 cluster-randomized trial included 323 patients with T2D,albuminuria,and retinopathy(SoC:n=139;MT:n=184),who underwent a 4-year intervention phase.Outcomes were major adverse cardiovascular events(MACE)and all-cause mortality.Associations with HbA1c target achievement(≤7%vs>7%)were assessed using Kaplan-Meier curves and shared frailty Cox regression models.RESULTS During a median follow-up of 12.1 years,190 MACEs and 139 deaths occurred.Achievement of the HbA1c target was not associated with reduced mortality in either group.However,a significant reduction in MACEs was observed only among SoC patients achieving HbA1c≤7%(P=0.031),whereas no benefit was seen in the MT group(P=0.645).In multivariable Cox regression models adjusted for cluster effect,in the MT group age[hazard ratio(HR)=1.07,P<0.001]and female sex(HR=0.38,P<0.001)were independent predictors of MACE,while in the SoC group only age(HR=1.04,P=0.009).For all-cause mortality,age(HR=1.11,P<0.001)and blood pressure control(HR=0.55,P=0.041)were significant predictors in the MT group,whereas age(HR=1.06,P=0.002)was independently associated with increased mortality in the SoC group.CONCLUSION In high-risk patients with T2D receiving standard care,achieving an HbA1c≤7%was associated with fewer cardiovascular events only under standard care,but not with reduced mortality.This association was not observed in patients managed with a multifactorial strategy.These findings suggest that the prognostic value of glycemic control depends on the broader treatment context and highlight the central role of comprehensive risk factor management in microvascularcomplicated T2D.展开更多
Chronic disease management requires achievement of critical individualised targets to mitigate again long-term morbidity and premature mortality associated with diabetes mellitus.The responsibility for this lies with ...Chronic disease management requires achievement of critical individualised targets to mitigate again long-term morbidity and premature mortality associated with diabetes mellitus.The responsibility for this lies with both the patient and health care professionals.Care plans have been introduced in many healthcare settings to provide a patient-centred approach that is both evidence-based to deliver positive clinical outcomes and allow individualised care.The Alphabet strategy(AS) for diabetes is based around such a care plan and has been evidenced to deliver high clinical standards in both well-resourced and underresourced settings.Additional patient educational resources include special care plans for those people with diabetes undertaking fasting during Ramadan,Preconception Care, Prevention and Remission of Diabetes.The Strategy and Care Plan has facilitated evidence-based,cost-efficient multifactorial intervention with an improvement in the National Diabetes Audit targets for blood pressure,cholesterol levels and glycated haemoglobin.Many of these attainments were of the standard seen in intensively treated cohorts of key randomized controlled trials in diabetes care such as the Steno-2 and United Kingdom Prospective Diabetes Study.This is despite working in a relatively under-resourced service within the United Kingdom National Health Service.The AS for diabetes care is a useful tool to consider for planning care, education of people with diabetes and healthcare professional.During the time of the coronavirus disease 2019 pandemic the risk factors for the increased mortality observed have to be addressed aggressively.The AS has the potential to help with this aspiration.展开更多
文摘Background A five-year follow-up study of intensive multifactorial intervention was undertaken to assess the changes of circulating serum amyloid A （SAA） levels and the incidence of atherosclerosis （AS） in patients with short-duration type 2 diabetes mellitus （T2DM） without macroangiopathy, and whether intensive multifactorial intervention could prevent or at least postpone the occurence of macroangiopathy. Methods Among 150 patients with short-duration T2DM, 75 were assigned to receive conventional outpatient treatment （conventional group） and the others underwent intensive multifactorial integrated therapy targeting hyperglycemia, hypertension, dyslipidemia and received aspirin simultaneously （intensive group）. Results Plasma SAA levels were higher in diabetic patients than those in healthy control subjects, and decreased obviously after intensive multifactorial intervention. The levels of SAA were positively correlated with body mass index （BMI）, waist hip ratio （WHR）, triglyceride （TG）, high sensitive C-reactive protein （hs-CRP） and common carotid intima-media thickness （CC-IMT）. The standard-reaching rates of glycemia, blood pressure and lipidemia were significantly higher in intensive group than those of conventional group. The incidence of macroangiopathy decreased by 58.96% in intensive group compared with conventional group. Conclusions Intensive multifactorial intervention may significantly reduce the SAA levels and prevent the occurrence of AS in short-duration patients with T2DM. SAA might be one of the risk factors of T2DM combined with AS.
基金Supported by the Ministero dell’Universitàe della Ricerca(Italian Ministry of University and Research),No.2007PSYLRX.
文摘BACKGROUND Achieving optimal glycemic control is a cornerstone of cardiovascular risk reduction in type 2 diabetes(T2D).However,the extent to which multifactorial interventions influence this relationship remains uncertain.AIM To evaluate the association between glycated hemoglobin(HbA1c)target achievement and long-term cardiovascular outcomes in patients receiving standard of care(SoC)or multifactorial intensive therapy(MT).METHODS This post-hoc analysis of the nephropathy in diabetes type 2 cluster-randomized trial included 323 patients with T2D,albuminuria,and retinopathy(SoC:n=139;MT:n=184),who underwent a 4-year intervention phase.Outcomes were major adverse cardiovascular events(MACE)and all-cause mortality.Associations with HbA1c target achievement(≤7%vs>7%)were assessed using Kaplan-Meier curves and shared frailty Cox regression models.RESULTS During a median follow-up of 12.1 years,190 MACEs and 139 deaths occurred.Achievement of the HbA1c target was not associated with reduced mortality in either group.However,a significant reduction in MACEs was observed only among SoC patients achieving HbA1c≤7%(P=0.031),whereas no benefit was seen in the MT group(P=0.645).In multivariable Cox regression models adjusted for cluster effect,in the MT group age[hazard ratio(HR)=1.07,P<0.001]and female sex(HR=0.38,P<0.001)were independent predictors of MACE,while in the SoC group only age(HR=1.04,P=0.009).For all-cause mortality,age(HR=1.11,P<0.001)and blood pressure control(HR=0.55,P=0.041)were significant predictors in the MT group,whereas age(HR=1.06,P=0.002)was independently associated with increased mortality in the SoC group.CONCLUSION In high-risk patients with T2D receiving standard care,achieving an HbA1c≤7%was associated with fewer cardiovascular events only under standard care,but not with reduced mortality.This association was not observed in patients managed with a multifactorial strategy.These findings suggest that the prognostic value of glycemic control depends on the broader treatment context and highlight the central role of comprehensive risk factor management in microvascularcomplicated T2D.
文摘Chronic disease management requires achievement of critical individualised targets to mitigate again long-term morbidity and premature mortality associated with diabetes mellitus.The responsibility for this lies with both the patient and health care professionals.Care plans have been introduced in many healthcare settings to provide a patient-centred approach that is both evidence-based to deliver positive clinical outcomes and allow individualised care.The Alphabet strategy(AS) for diabetes is based around such a care plan and has been evidenced to deliver high clinical standards in both well-resourced and underresourced settings.Additional patient educational resources include special care plans for those people with diabetes undertaking fasting during Ramadan,Preconception Care, Prevention and Remission of Diabetes.The Strategy and Care Plan has facilitated evidence-based,cost-efficient multifactorial intervention with an improvement in the National Diabetes Audit targets for blood pressure,cholesterol levels and glycated haemoglobin.Many of these attainments were of the standard seen in intensively treated cohorts of key randomized controlled trials in diabetes care such as the Steno-2 and United Kingdom Prospective Diabetes Study.This is despite working in a relatively under-resourced service within the United Kingdom National Health Service.The AS for diabetes care is a useful tool to consider for planning care, education of people with diabetes and healthcare professional.During the time of the coronavirus disease 2019 pandemic the risk factors for the increased mortality observed have to be addressed aggressively.The AS has the potential to help with this aspiration.
