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Pancreatic cancer is highly malignant with low 5‑year survival rate because it is hard to be diagnosed in early stage. So far, a standardized screening strategy of early pancreatic cancer has not been achieved in China. Based on updated research evidence, a total of 26 recommendations are proposed for screening aims, high ‑ risk individuals, initial screening age, follow ‑ up interval, monitoring methods and timing of operation. Chinese consensus for early pancreatic cancer screening and surveillance is finally formulated.
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To investigate the postoperative serum triglyceride (TG) levels in predicting the risk of new-onset diabetes mellitus (NODM) in patients following allogeneic liver transplantation. One hundred and forty three patients undergoing allogeneic liver transplantation in Shanghai General Hospital from July 2007 to July 2014 were enrolled in this study. The NODM developed in 33 patients after liver transplantation. The curve of dynamic TG levels in the early period after liver transplantation was generated. Independent risk factors of NODM were determined by univariate and multivariant logistic regression analyses. The clinical value of TG in predicting NODM was analyzed by area under the ROC curve (AUC). Serum TG levels were gradually rising in the first week and then reached the plateau phase (stable TG, sTG) in patients after surgery. The sTG in NODM group were significantly higher than that in non-NODM group (=-2.31, <0.05). Glucocorticoid therapy (=4.054, <0.01), FK506 drug concentration in the first week after operation (=3.482, <0.05) and sTG (=3.156, <0.05) were independent risk factors of NODM. ROC curve analysis showed that the AUC of sTG in predicting NODM was 0.72. TG shows a gradual recovery process in the early period after liver transplantation, and the higher TG level in stable phase may significantly increase the risk of NODM in patients.
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Humans , China/epidemiology , Diabetes Mellitus/etiology , Liver Transplantation/adverse effects , Risk Factors , Tacrolimus/adverse effects , TriglyceridesABSTRACT
AIM: To analyze the influence of donor and recipient CYP3A5 genotype on tacrolimus trough concentrations in the early stage after liver transplantation and its clinical significance under therapeutic drug monitoring (TDM) strategy retrospectively. METHODS: A total of 125 patients undergoing liver transplantation in Shanghai General Hospital from January 2015 to March 2019 were involved in this study. Clinical pharmacology parameters and liver function indexes from 1 to 28 days after operation, the occurrence of new onset diabetes mellitus (NODM) was collected. Donor and recipient cytochrome P450, family 3, subfamily A, polypeptide 5 (CYP3A5) gene rs776746 locus were genotyped by RT-PCR technology.RESULTS: Median trough concentration (Ct
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Objective:To summarize the clinical characteristics and therapeutic drug selection of post-transplantation diabetes mellitus(PTDM)after kidney transplantation in children.Methods:From May 2014 to March 2021, a total of 5 cases(5.38%)of 93 paediatric kidney transplant recipients with a median follow-up period of 34 months were diagnosed with PTDM in our centre.Retrospective data analysis was performed for these 5 paediatric recipients.The characteristics of the disease, treatment data and outcomes were summarized.Among the five paediatric recipients, one was male and four patients were female, ranging the age from 12 to 17 years.All recipients received a tacrolimus-based immunosuppressive regimen with prednisone discontinued no later than 3 months after kidney transplant.Results:The onset of PTDM ranged from 1 month to 46 months(median: 17 months)after transplantation.The blood glucose of two children returned to normal gradually after tacrolimus conversion to cyclosporine, with one of them was given insulin temporarily.Three children received oral hypoglycaemic agents, including one received acarbose, one received metformin, and one received metformin combined with acarbose.After a median follow-up of 6 months, the levels of blood glucose in five children were stable, and there was no significant change in serum creatinine and urine protein.Conclusions:The treatment of PTDM in children should be individualized with considering of age, gender and immunosuppressive regimen. Switch from tacrolimus to cyclosporine is effective. Metformin or other hypoglycemic agentsis helpful when tacrolimus is maintained.
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Objective:To investigate the association between pulse pressure(PP) and new-onset diabetes in overweight and obese people.Methods:A prospective cohort study was conducted in overweight or obese participants selected from Kailuan Study who underwent 2006-2007 annual checkup and met the inclusion and exclusion criteria. PP was calculated by blood pressure and participants were divided into 4 groups according to PP quartile. The cumulative incidence of new-onset diabetes of different PP groups was calculated by Kaplan- Meier method and compare by Log- Rank test. The multivariate Cox proportional hazards model was used to analyze the association between different PP groups and new-onset diabetes. Results:During an average follow-up of 8.45 years, 8 922 diabetes was identified. The cumulative incidence rate of the Q1, Q2, Q3, and Q4 groups were 22.12%, 24.48%, 27.97%, and 33.44% respectively, which were statistically different( χ2=368.16, P<0.01). Cox proportional hazards regression analysis showed that after adjusting for multiple confounding factors, compared with Q1 group, the hazard ratio for diabetes in Q2, Q3, and Q4 groups were 1.07(1.00-1.14), 1.13(1.05-1.21), and 1.17(1.09-1.27) respectively. And the HR of diabetes event in pulse pressure(per 1 SD increase) was 1.04(1.02-1.07). Similar results were found in participants who were over-weight, obese, with normal blood pressure or hypertensive without drugs use. Conclusion:PP is positively correlated with the new-onset diabetes. High PP is one of the risk factors for developing diabetes in overweight and obese people.
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Diabetic patients are at risk of developing unfavorably from SARS-COV19 disease, especially when they have poor glycemic control. On the other hand, in the case of diabetic patients with severe COVID, they evolve with severe hyperglycemia, often difficult to manage. Marked hyperglycemia has also been described in people without a known history of previous diabetes, even there have been reported cases of insulin-dependent diabetes debut in days after the disease. The aim of this review is to analyze possible mechanisms involved in the relationship between COVID-19 and DIABETES.
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Humans , Diabetes Mellitus/epidemiology , COVID-19/epidemiology , Hyperglycemia/complications , Prognosis , Blood Glucose/metabolism , Diabetes Mellitus/physiopathology , COVID-19/physiopathology , COVID-19/virology , Hospitalization/statistics & numerical data , Hyperglycemia/physiopathologyABSTRACT
Background: Statins (?-hydroxy ?-methylglutaryl-CoA (HMG-CoA) reductase inhibitors) are the most prescribed medications worldwide to treat hyperlipidaemia with a proven ability to reduce major cardiovascular events. Recent data have revealed that statin therapy is associated with an increased risk for developing diabetes. The risk was most significant in patients taking atorvastatin, rosuvastatin and simvastatin.Methods: Rats were divided into 3 groups, each comprising of 6 rats. Hyperlipidaemia was induced in all the animals after feeding with high fat diet for 15 days. Rats of groups 1, 2 and 3 were given atorvastatin 1.8 mg/kg (low-dose), 3.6 mg/kg (moderate-dose) and 7.2 mg/kg (intensive-dose) respectively orally for 60 days. 12 hours fasted blood samples were collected and analyzed for serum lipid profile, fasting blood glucose and HbA1c levels.Results: The percentage increase in plasma blood glucose after 60 days of treatment in groups 1, 2, and 3 is 29.93%, 60.03% and 72.42% respectively and the variation in all the groups is statistically significant, p<0.0001. Regarding HbA1c values, the variation in low-dose group is statistically insignificant whereas the percentage increase in moderate-dose and intensive-dose groups is 19.45% (p<0.001) and 43.37% (p<0.0001) respectively.Conclusions: In conclusion, there is significant increase in blood glucose and HbA1c levels leading to new-onset diabetes in both moderate-dose and intensive-dose groups. The risk is more in intensive-dose group when compared to moderate-dose group.
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Background: Several observational studies, well controlled randomized trials and meta-analyses reported that patients treated with statins has high risk of new onset diabetes mellitus (NODM), but the exact incidence and mechanism is still unclear and controversy. The present study was planned to find out the incidence of prediabetes and NODM and possible mechanism of action.Methods: This was a prospective, cross‑sectional study carried out at the Department of General Medicine for a period of one and half year between August 2017 and February 2019. Normoglycemic patients whose fasting blood glucose levels below 100 mg/dL and at least one year of treatment with statins were recruited in the study. Glycaemic status, development of prediabetes and NODM and insulin resistance were the primary outcomes whereas lipid profile, adverse drug effects of statins were secondary outcomes. Collected data was analysed by suitable statistical methods.Results: A total of 146 patients were recruited and 120 completed the entire study. Mean fasting blood glucose levels before initiation of statin therapy was 89.45±10.21. After one year of statin therapy, patients were separated as prediabetics and new onset diabetics and there mean fasting blood glucose levels were 116.24±12.86 (n=10) and 152.44±20.12 (n=12) respectively. A total of 12 (10.0%) patients were developed NODM and 10 (8.2%) patients developed prediabetes at the end of statin therapy. Atorvastatin 40mg was most frequency prescribed statin followed by Atorvastatin 20mg. A total of 70 (58.3%) study participants developed mild to moderate drug related adverse effects (ADRs), statin‑induced myalgia (55.7%) was the most common ADR.Conclusions: Patients treatment with statins had developed prediabetes and NODM. Atorvastatin 40mg and greater dose significantly induced NODM. Fasting blood glucose levels should be measured periodically with prescription contains higher doses of statins
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ABSTRACT Objectives: This study aims to verify the new-onset diabetes after kidney transplant (NODAT) incidence in recipients within 1 year after kidney transplantation from a single center in Southern Brazil and to assess the associated conditions. Subjects and methods: A retrospective study of 258 post-renal transplant patients was performed. Demographic (gender, age, ethnic background) and clinical (origin of graft, associated infections, body mass index (BMI) at transplant time and 6 and 12 months after, causes of renal failure, and comorbidities) data were analyzed. All patients were on tacrolimus, mycophenolate mofetil, and prednisone treatment. Patients with and without NODAT were compared. Results: A NODAT incidence of 31.2% was noted 1 year post transplantation. In the univariate analysis, patients with NODAT were older (p = 0.001), mostly had African-American ethnic background (p = 0.02), and had renal failure secondary to high blood pressure (HBP) (p = 0.001). The group of patients with NODAT also had more incidence of post-transplant HBP (p = 0.01), heart failure (p = 0.02), and dyslipidemia (p = 0.001). Logistic regression showed that African-American ethnic background, post-transplant HBP, and dyslipidemia were independently associated with NODAT. Conclusion: This study shows a NODAT incidence that is greater in patients with African-American ethnic background and that is associated with HBP and dyslipidemia.
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Humans , Male , Female , Adult , Middle Aged , Postoperative Complications/etiology , Kidney Transplantation/adverse effects , Diabetes Mellitus/etiology , Postoperative Complications/epidemiology , Brazil/epidemiology , Logistic Models , Incidence , Retrospective Studies , Risk Factors , Tacrolimus/adverse effects , Statistics, Nonparametric , Diabetes Mellitus/epidemiology , Dyslipidemias/etiology , Hypertension/etiology , Immunosuppressive Agents/adverse effectsABSTRACT
Objective To investigate the risk factors and clinical significances in the patients with pancreatic cancer(PC). Methods The clinical data of 936 patients with PC in the Affiliated Hospital of Chongqing Medical University during the past 10 years were retrospectively analyzed,and contemporaneous 832 age and sex-matched cases of non-complicating tumor and disease of digestive system and metabolic abnormality were collected as the control group.The differences and correlation between the two groups were analyzed retrospectively,including the gender,age,incidence and course of diabetes mellitus(DM),category of hypogly-cemic drugs,body mass index(BMI),history of pancreatitis,family history of PC and family history of diabetes.Results (1)There were more males than females in PC group,moreover the male proportion was much higher than the female proportion with the age growing.In the PC group,251 cases(26.8%)were complicating DM,which was significantly higher than 13.0% of DM occurrence rate in the control group(P<0.01);in the PC group,new onset DM was up to 14.1%(132/936),which was obviously higher than 3.4% in the control group(P<0.01).The family history of PC,history of pancreatitis,family history of diabetes,overweight and obesity were the independent risk factors for PC.The risk of PC in new-onset DM patients was increased by 4.9 times.Metformin could decrease the risk of developing PC.The time from diagnosed DM to PC in the metformin group was longest[(18.86 ± 3.46) months],which in the non-medication group was shortest[(6.44 ± 1.07)months].Conclusion New-onset DM patients with fami-ly history of DM,family history of PC,history of pancreatitis,overweight and obese should be vigilant to develop PC.For the new-onset DM patients,anti-diabetic drugs influence the onset time of PC and metformin may have effect to delay the occurrence and de-velopment of PC.
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The consecutive data of 822 senior public officials in Chengdu undergoing health checkup from 2011 to 2016 were retrospectively reviewed.Among them,56 new cases of diabetes was diagnosed with a cumulative incidence of 6.81％.Fifty six age-and sex-matched healthy subjects served as controls,the risk factors of new-onset diabetes were analyzed with multivariate logistic regression.The results showed that BMI (OR =1.82,95％ CI:1.27-2.59,P =0.00) and fasting plasma glucose (OR =13.63,95％ CI:2.71-68.43,P =0.00) were independent risk factors of new-onset diabetes in senior public officials.
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BACKGROUND/AIMS: Metformin (MET) is a first-line drug for type 2 diabetes mellitus (DM); its effect on new-onset diabetes after transplantation caused by immunosuppressant therapy is unclear. We compared the effects of MET on DM caused by tacrolimus (TAC) or sirolimus (SRL). METHODS: DM was induced by injection of TAC (1.5 mg/kg) or SRL (0.3 mg/kg) for 2 weeks in rats, and MET (200 mg/kg) was injected for 2 more weeks. The effects of MET on DM caused by TAC or SRL were evaluated using an intraperitoneal glucose tolerance test (IPGTT) and by measuring plasma insulin concentration, islet size, and glucose-stimulated insulin secretion (GSIS). The effects of MET on the expression of adenosine monophosphate-activated protein kinase (AMPK), a pharmacological target of MET, were compared between TAC- and SRL-treated islets. RESULTS: IPGTT showed that both TAC and SRL induced hyperglycemia and reduced plasma insulin concentration compared with vehicle. These changes were reversed by addition of MET to SRL but not to TAC. Pancreatic islet cell size was decreased by TAC but not by SRL, but addition of MET did not affect pancreatic islet cell size in either group. MET significantly increased GSIS in SRL- but not in TAC-treated rats. AMPK expression was not affected by TAC but was significantly decreased in SRL-treated islets. Addition of MET restored AMPK expression in SRL-treated islets but not in TAC-treated islets. CONCLUSIONS: MET has different effects on hyperglycemia caused by TAC and SRL. The discrepancy between these drugs is related to their different mechanisms causing DM.
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Animals , Rats , Adenosine , AMP-Activated Protein Kinases , Cell Size , Diabetes Mellitus, Type 2 , Glucose Tolerance Test , Hyperglycemia , Insulin , Islets of Langerhans , Metformin , Models, Theoretical , Plasma , Protein Kinases , Sirolimus , TacrolimusABSTRACT
New onset diabetes after transplantation is one of the most common metabolic complications following organ transplantation and closely correlates with the post transplant onsets of cardiovascular diseases, chronic graft loss, severe infection, decreasing long-term survival rate etc. The incidences of new onset diabetes following different organ transplantations vary greatly, so as the risk factors. In this review, the different incidences and risk factors following kidney, liver, heart, and lung transplantations are reviewed and summarized.
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New onset diabetes after transplantation is one of the most common metabolic complications following organ transplantation and closely correlates with the post transplant onsets of cardiovascular diseases, chronic graft loss, severe infection, decreasing long-term survival rate etc. The incidences of new onset diabetes following different organ transplantations vary greatly, so as the risk factors. In this review, the different incidences and risk factors following kidney, liver, heart, and lung transplantations are reviewed and summarized.
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Despite strict pre- and post-transplantation screening, the incidence of new-onset diabetes after transplantation (NODAT) remains as high as 60%. This complication affects the risk of cardiovascular events and patient and graft survival rates. Thus, reducing the impact of NODAT could improve overall transplant success. The pathogenesis of NODAT is multifactorial, and both modifiable and nonmodifiable risk factors have been implicated. Monitoring and controlling the blood glucose profile, implementing multidisciplinary care, performing lifestyle modifications, using a modified immunosuppressive regimen, administering anti-metabolite agents, and taking a conventional antidiabetic approach may diminish the incidence of NODAT. In addition to these preventive strategies, inhibition of dipeptidyl peptidase-4 (DPP4) by the gliptin family of drugs has recently gained considerable interest as therapy for type 2 diabetes mellitus and NODAT. This review focuses on the role of DPP4 inhibitors and discusses recent literature regarding management of NODAT.
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Animals , Humans , Blood Glucose/drug effects , Diabetes Mellitus/diagnosis , Dipeptidyl Peptidase 4/metabolism , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Organ Transplantation/adverse effects , Risk Assessment , Risk Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To comprehensively evaluate the influence of antihypertensive agents on new-onset diabetes, including diuretics, beta-antagonists, angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) and calcium channel blockers (CCB). METHODS: Clinical trials were searched about antihypertensive agents and NOD. The ORs and rankings of the five classes of drugs and placebo were estimated, using random effects Bayesian models in WinBUGS version 1.4.3. RESULTS: Twenty-eight clinical trials were included in this study. Compared to placebo, the ORs of the five classes of drugs for causing NOD were as follows: ARB 1.23(95%CI:1.087-1.399), ACEI 1.204(95%CI:1.033-1.424), CCB 0.9289(95%CI:0.7793-1.095), beta-antagonists 0.7384(95%CI:0.6047-0.8906), diuretics 0.7894(95%CI:0.654~0.9283). CONCLUSION: The probability of causing NOD is lowest for ARB followed by ACEI, placebo, CCB, diuretics and beta-antagonists. ARB and ACEI can reduce the risk of NOD. CCB, diuretics and beta-antagonists can increase the risk of NOD.
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While long-standing diabetes is a risk factor of pancreatic cancer, new-onset diabetes could be a consequence of underlying pancreatic malignancy. About 30% to 50% of pancreatic cancer patients have new-onset diabetes. Because diabetes develops in preclinical or early stages of pancreatic cancer, it could serve as an excellent clue for early detection of pancreatic cancer. Insulin resistance associated with hyperglycemia and hyperinsulinemia by diabetogenic factors secreted from cancer cells have been suggested to be a possible mechanism of pancreatic cancer-induced diabetes. It is difficult to differentiate pancreatic cancer-induced diabetes from the more common type 2 diabetes. Although several clinical features and potential biomarkers have been investigated, optimal strategies and modalities to screen pancreatic cancer among the new-onset diabetes have not yet been fully determined.