Age-adjusted Charlson comorbidity index is associated with the risk of osteoporosis in older fall-prone men: a retrospective cohort study.

BACKGROUND: There is growing evidence linking the age-adjusted Charlson comorbidity index (aCCI), an assessment tool for multimorbidity, to fragility fracture and fracture-related postoperative complications. However, the role of multimorbidity in osteoporosis has not yet been thoroughly evaluated. We aimed to investigate the association between aCCI and the risk of osteoporosis in older adults at moderate to high risk of falling. METHODS: A total of 947 men were included from January 2015 to August 2022 in a hospital in Beijing, China. The aCCI was calculated by counting age and each comorbidity according to their weighted scores, and the participants were stratified into two groups by aCCI: low (aCCI < 5), and high (aCCI ≥5). The Kaplan Meier method was used to assess the cumulative incidence of osteoporosis by different levels of aCCI. The Cox proportional hazards regression model was used to estimate the association of aCCI with the risk of osteoporosis. Receiver operating characteristic (ROC) curve was adapted to assess the performance for aCCI in osteoporosis screening. RESULTS: At baseline, the mean age of all patients was 75.7 years, the mean BMI was 24.8 kg/m2, and 531 (56.1%) patients had high aCCI while 416 (43.9%) were having low aCCI. During a median follow-up of 6.6 years, 296 participants developed osteoporosis. Kaplan-Meier survival curves showed that participants with high aCCI had significantly higher cumulative incidence of osteoporosis compared with those had low aCCI (log-rank test: P < 0.001). When aCCI was examined as a continuous variable, the multivariable-adjusted model showed that the osteoporosis risk increased by 12.1% (HR = 1.121, 95% CI 1.041-1.206, P = 0.002) as aCCI increased by one unit. When aCCI was changed to a categorical variable, the multivariable-adjusted hazard ratios associated with different levels of aCCI [low (reference group) and high] were 1.00 and 1.557 (95% CI 1.223-1.983) for osteoporosis (P <  0.001), respectively. The aCCI (cutoff ≥5) revealed an area under ROC curve (AUC) of 0.566 (95%CI 0.527-0.605, P = 0.001) in identifying osteoporosis in older fall-prone men, with sensitivity of 64.9% and specificity of 47.9%. CONCLUSIONS: The current study indicated an association of higher aCCI with an increased risk of osteoporosis among older fall-prone men, supporting the possibility of aCCI as a marker of long-term skeletal-related adverse clinical outcomes.

Effects of moderate intensity gymnastics on executive function in children aged 5 to 6 years / 中国学校卫生

Objective@#The study aims to investigate the impact of moderate intensity gymnastics on the development of executive function in children aged 5-6, thereby providing a theoretical foundation for exercise interventions targeting executive function.@*Methods@#A total of 63 preschool children, randomly seleted from 3 senior classes in a private kindergarten in Shangqiu, were randomly allocated to the intervention group ( n =31) and control group ( n =32). Children in the intervention group participated in 60 minute gymnastics at a moderate intensity, three times per week, for a total duration of 12 weeks. Concurrently, myzone technology was utilized to monitor exercise intensity throughout the entire intervention period. Children in the control group maintained their regular activities. Inhibitory control (Flanker task), working memory (Empty house task), and cognitive flexibility (Dots task) were assessed before and after the experiment.@*Results@#There was no statistically significant difference in the performance of inhibitory control, working memory, and cognitive flexibility tasks between the two groups of children before intervention ( P >0.05) .The results of covariance analysis revealed significant differences in reaction time [(782.88±24.29，805.13±23.74；719.90±119.99， 833.55± 177.87；1 042.39±72.75，1 091.29±49.42) ms] and accuracy[(73.86±7.26)%，(67.02±8.22)%;(86.36±7.63)%，( 80.50± 9.39 )%;(76.45±9.48)%，(69.59±7.66)%] across inhibitory control, working memory, and cognitive flexibility between the intervention group and the control group ( F =6.84, 4.50，4.87, 6.11, 3.74 , 5.06 , P <0.05). The intervention effect exhibited modest effects( d =0.17-0.74).@*Conclusions@#Moderate intensity gymnastics can make modest or moderate effect on improving children s executive function. Brain imaging technology can be incorporated into future research designs to investigate the underlying mechanisms of gymnastics impact on the brain structure and executive function in young children.

[Correlation analysis of serum calcium levels and risks of diabetes mellitus in middle-aged and elderly men].

OBJECTIVE: To investigate the correlation of serum calcium levels and the risks of diabetes mellitus (DM) in middle-aged elderly men. METHODS: A total of 3386 male subjects aged 40-79 years were selected from two local communities of Beijing using stratified random sampling for this cross-sectional survey. The survey was conducted using questionnaires, and all the subjects underwent physical examination and blood tests of serum calcium, vitamin D and other biochemical parameters. The subjects were divided into normal glucose group, prediabetic group and diabetic group to compare their blood biochemical parameters and analyze the risk factors of diabetes. RESULTS: The prevalence of diabetes and pre-diabetes was 32.31% in the 3386 subjects surveyed. Serum calcium, vitamin D and Creatinine (Cr) levels were significantly higher in pre-diabetic and diabetic groups than in the non-diabetic group (P/0.05), and age, body mass index, serum calcium, vitamin D, and Cr levels differed significantly between the former two groups (P/0.05). The prevalence of diabetes increased significantly with serum calcium level (P/0.05). Logistic regression analysis showed that age, body mass index, serum calcium, and serum vitamin D levels were independent risk factors for diabetes (P/0.05). CONCLUSION: Male diabetic patients have abnormal serum calcium levels. An increased age and increased serum calcium levels are associated with higher risks of diabetes, and age, serum calcium, serum vitamin D, Cr, and body mass index are all risk factors of diabetes in men.

[A new C21 steroidal saponins from Periplocae Cortex].

To study the chemical constituents of Periplocae Cortex, the separation and purification of 70% alcohol extract were carried out by column chromatographies on AB-8 macroporous resin, silica gel and preparative HPLC. The structure of the compounds were identified by NMR and TOF-MS. A new compound was isolated and identified as 21-O-methyl-Δ5-pregnene-3ß, 14ß, 17ß, 21-tetraol-20-one-3-O-ß-D-oleandropyranosyl(1-->4)-ß-D-cymaropyranosyl-(1-->4)-ß-D-cymaropyranosyl (1), named as periplocoside P.

[Determination of twelve active compounds in Qili Qiangxin capsules by UPLC-MS].

In order to establish an UPLC-MS method for determination of twelve active compounds in Qili Qiangxin capsules including astragaloside, calycosin-7-0-glucoside, ginsenoside Rb1, ginsenoside Re, ginsenoside Rd, ginsenoside Rg1, ginsenoside Rf, periplocin, periplocoside H1, hesperidin, narirutin, isoquercitrin, the chromatographic separations were performedon a Phenomenex UPLC Kinetex C18 column (2.1 mm x 100 mm, 2.6 microm) with gradient elution of acetonitrile and 0.1% aqueous formic acidat a flow rate of 0.4 mL x min(-1). The temperature was set as 40 degrees C and injection volume was 5 microL. The monitoring of all analytes was achieved under the negative ionization mode with TOF-MS and TOF-MS/MS method. The twelve analytes showed good linearity (R2 > 0.9990) within the test ranges, the average recoveries were 98.0%-102%, respectively, and the RSD were less than 3.9%, respectively. The established method is simple, rapid, and sensitive, and can be used for quality control of Qili Qiangxin capsules.

Insulin resistance correlates with the arterial stiffness before glucose intolerance.

OBJECTIVE: The elevated plasma glucose level and/or insulin resistance in diabetes or impaired glucose tolerance play important roles in the pathogenesis of arterial stiffness. The present study investigated whether insulin resistance correlated with arterial stiffness before the development of glucose intolerance. METHODS: We conducted a cross-sectional analysis in 872 young to middle-age individuals with normal glucose tolerance (aged 36.2±8.5 years, BMI 24.6±3.1 kg/m2 [mean±SD]). The homeostasis model assessment (HOMA) index was used as a quantitative assessment of the fasting insulin resistance (FIR), and the plasma insulin level after glucose loading was adopted as an index of the post-challenge insulin resistance (PIR). The Matsuda index [ISI (composite)] was used as a measurement of the insulin sensitivity. The arterial stiffness assessed by the brachial-ankle pulse wave velocity (baPWV) was adopted to quantify its independent associations with insulin resistance. RESULTS: The univariate linear regression analysis indicated that the fasting plasma glucose level (FPG, ß = 68.2; 95% CI 40.9, 95.6; p<0.001), post-challenge plasma glucose level (PPG, ß = 25.3; 95% CI 15.6, 35.0; p<0.001), FIR (ß = 24.5; 95% CI 14.1, 35.0; p<0.001), PIR (ß=1.30; 95% CI 0.87, 1.73; p<0.001) and ISI (composite) (ß = -3.55; 95% CI -5.02, -2.07; p<0.001) were all significantly correlated with the baPWV. After adjustment for sex, age, BMI, heart rate, smoking, systolic blood pressure, total cholesterol, LDL-cholesterol and family history of diabetes, the multivariate linear regression analysis demonstrated that the PIR (model 1, ß = 0.39, p=0.038; model 2, ß = 0.39, p=0.035; model 3, ß = 0.39, p=0.035) was an independent contributor to the baPWV, while the FIR, FPG, PPG and ISI (composite) failed to show any significant contribution. CONCLUSION: The insulin resistance correlated with the arterial stiffness before glucose intolerance.

[Simultaneous determination of six organic acids in Lonicerae japonicae flos and Lonicerae flos in different habitats by HPLC].

OBJECTIVE: To establish an HPLC method for simultaneous determination of six organic acids in Lonicerae japonicae Flos and Lonicerae Flos in different habitats. METHODS: The chromatographic separation was carried out on a Waters C18 column (4. 6 mm x 250 mm, 5 microm) with gradient elution of acetonitrile and 0.1% phosphoric acid at a flow rate of 1 mL/min. The detection wave-length was 326 nm. RESULTS: The contents of neochlorogenic acid and cryptochlorogenic acid in Lonicerae japonicae Flos in different habitats were very low. The contents of chlorogenic acid in Lonicerae japonicae Flos in Pingyi, Fei County, Fengqiu and Jvlu were significantly higher than that in Shangluo, but the contents of other organic acids were similar. The contents of six kinds of organic acids in Lonicerae Flos in different origins were obviously higher than those in Lonicerae japonicae Flos. CONCLUSION: A simple, accurate and credible method is developed and validated for quality control of six organic acids from Lonicerae japonicae Flos and Lonicerae Flos.

[The compliance in elderly male with osteoporosis treated with oral alendronate].

OBJECTIVE: To explore the compliance in elderly male with osteoporosis treated with oral alendronate and analyze the factors which affect the therapeutic compliance. METHODS: A total of 145 elderly male patients diagnosed with osteoporosis who had been initiated the treatment of oral alendronate in our clinic during January to June in 2011 were enrolled in the study. The medication compliance of one year was investigated. According to the different medication possession ratio (MPR), MPR ≥ 80% was considered as adherent and MPR < 80% was considered as non-adherent. The difference in the two groups was compared and the factors which affect the therapeutic compliance were analyzed. RESULT: A total of 139 patients had been followed up with 32 adherent cases (23.02%) and 107 non-adherent cases (76.98%). Logistic regression analysis showed the factors which affected the therapeutic compliance as the following: ostealgia (OR = 0.69, P = 0.043), no-reminder (OR = 1.37, P = 0.025), concern about drug related side effect (OR = 1.49, P = 0.018), more than 7 kinds of drugs (OR = 1.30, P = 0.036) and uncertain long-term effect (OR = 1.39, P = 0.021). CONCLUSIONS: Compliance of oral alendronate to treat osteoporosis in elderly male patients is poor. Ostealgia can promote the drug compliance. The factors which could decrease the drug compliance are no-reminder, concern about drug related side effect, more than 7 kinds of drugs and uncertain long-term efficacy.

[Body composition analysis among adults with different body weights].

OBJECTIVE: To explore the characteristics of body composition among male and female adults with different body weights. METHODS: A total of 61 379 healthy adults (39 855 males and 21 527 females) were referred to our health examination center between May 2005 and February 2011. Body mass index (BMI) and body composition contents of fat, water, muscle, protein and mineral salt were measured by anthropometric measurements and bioelectrical impedance analysis (BIA). The data were analyzed among groups divided by gender, age and BMI. RESULTS: (1) The prevalence of overweight and obesity defined by BMI was significantly higher in the male group than the female of the same age group under 70 years old (all P < 0.01). (2) Within a certain age range (< 60 in males, < 70 in females), the prevalence of both overweight and obesity defined by BMI increased with age (all P < 0.01). (3) The fat mass percentage was significantly higher in females than in males of the same age group. The difference became more and more significant with advancing age. And the most significant difference was found in the upper 70 years old group (fat mass rate of males vs females, 24% ± 7% vs 36% ± 6%, P < 0.01). (4) Body fat mass percentage progressively elevated with increases of BMI while there was a decreasing trend of other body composition contents. The total male subjects had higher percentage of muscle, water and mineral salt than females (percentage of muscle, water and mineral salt of males vs females, 0.708 ± 0.066 vs 0.664 ± 0.063, 0.520 ± 0.044 vs 0.474 ± 0.042, 0.040 ± 0.004 vs 0.036 ± 0.004, all P < 0.01) while the percentage of protein was higher in the total female group (P < 0.01). CONCLUSIONS: Females has more fat mass than males under the same BMI. So it is more reasonable to introduce adiposity for the evaluation of obesity, especially in females.

[Diagnostic values of self-assessment tool for Asians for osteoporosis in aged men].

OBJECTIVE: To evaluate the diagnostic values of osteoporosis self-assessment tool for Asians (OSTA) in aged men. METHODS: Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) in 382 male outpatients. Their data were collected. After excluding such influencing factors of BMD as diseases or drugs, they were divided into 3 groups according to the WHO osteoporosis diagnosis value or age. The correlation between OSTA index and BMD was analyzed by Spearman correlation. The concordance of OSTA and BMD were calculated and analyzed by a four-fold table. RESULTS: The prevalence of osteoporosis was 9.42% and osteopenia 42.67%. Age increased gradually in the osteoporosis, osteopenia and normal bone mass groups. But OSTA index, BMD (including lumbar vertebrae L(1-4), femoral neck, trochanter and hip) and weight decreased gradually in those groups. The percent of normal bone mass decreased with advancing age. And the percentages were 60.68%, 51.97% and 33.33% respectively. Osteoporosis increased in the older group (> 80 years old) and the percentage was 24.64% accounting for 94.44% of all osteoporotic subjects. Judging by the OSTA index, the rate of low osteoporotic risk decreased with advancing age. But the rates of mid-risk and high-risk increased. The correlation coefficients of OSTA index and BMD in femoral neck, trochanter, hip and L(1-4) was 0.33, 0.28, 0.29 and 0.06 respectively. And the correlation between OSTA index and BMD had statistical significance except for L(1-4). The sensitivity, specificity, coincidence and Youden index of OSTA index with a T score cutoff of -1 of BMD were 56.28%, 64.48%, 60.21% and 0.21 respectively versus 86.11%, 57.80%, 60.47% and 0.44 with a T score cutoff of -2.5. CONCLUSION: Correlation exists between OSTA index and BMD. The sensitivity, specificity and coincidence of OSTA index are excellent based upon the standard of BMD by DXA. It is a useful and simple diagnostic tool of osteoporosis.

[Association of ankle-brachial index with clinical coronary heart disease, stroke in aged Chinese hypertensive men].

OBJECTIVE: To assess the clinical significance of ankle-brachial index(ABI) in aged Chinese hypertensive men and to determine the association of ABI with clinical coronary heart disease, stroke. METHODS: Ankle-brachial index (ABI) was measured by means of peripheral vascular lab in aged hypertensive men from 301 Hospital and Anzhen Hospital while the clinical characteristics of the study population were investigated and collected. ABI < or = 0.9 was defined as peripheral arterial disease (PAD), 1.01 - 1.30 as borderline PAD. RESULTS: There were 244 aged Chinese hypertensive men with antihypertensive treatment and with mean age 76.47 +/- 9.75 enrolled in this study, in whom 15 men with missing data except general information and ABI measurement. The mean ABI was 0.941 +/- 0.258 with the highest frequency 1.01 - 1.30. Eighty five men were diagnosed as PAD, 22 as borderline PAD, 135 normal ABI and 2 with ABI > 1.3. ABI and rate of hypertension control in PAD and borderline PAD men were significantly lower than those with normal ABI. In both PAD and borderline PAD patients, the hypertension duration (except in borderline PAD), creatinine level, neutrophil count (except in borderline PAD), percentage of alcohol drinking, prevalence of diabetes mellitus (except in borderline PAD), coronary artery disease, stroke and dyslipidemia (except in borderline PAD) were significantly higher than those with normal ABI patients. The prevalences of PAD, borderline PAD, coronary artery disease and stroke in this study population were 35.1%, 9.1%, 64.0%, 40.5%, respectively. The prevalences of PAD, borderline PAD, coronary artery disease and stroke increased significantly with increasing age. Logistic regression analysis showed that lower ABI was inversely associated with clinical coronary artery disease and stroke after adjustment for age, body mass index, hypertension duration, rate of hypertension control, systolic blood pressure, diastolic blood pressure, status of smoking, alcohol drinking, diabetes mellitus, dyslipidemia. The fully-adjusted odds ratios (ORs) for PAD and borderline PAD group compared with normal ABI group for the prevalence of coronary artery disease, and stroke demonstrated that these conditions were conversely related to ABI. CONCLUSION: Aged hypertensive men have high prevalence of PAD. Low ABI level was independently associated with coronary artery disease and stroke.

[The correlation between hyperinsulinemia and pulse wave velocity].

OBJECTIVE: To study the correlation between hyperinsulinemia (HIns) and arteriosclerosis in one community in Beijing. METHODS: Subjects who received arteriosclerosis screening in physical examination annually were studied. All subjects were received 75g oral glucose tolerance test (OGTT) to evaluate glucose metabolic level, and brachial-ankle pulse wave velocity (baPWV) examination to evaluate arteriosclerosis. The correlation between hyperinsulinemia and pulse wave velocity was analyzed. RESULTS: Among all the 1046 subjects under investigation, baPWV of subjects with HIns was higher than subjects with normoinsulinemic (NIns) in different glucose metabolism status [normal glucose tolerance, (1381.2 ± 280.8) cm/s vs (1280.3 ± 218.7) cm/s; imparied glucose regulation, (1557.5 ± 319.3) cm/s vs (1474.7 ± 305.1) cm/s; diabetes, (1764.3 ± 476.6) cm/s vs (1664.2 ± 374.6) cm/s], especially in subjects with normal glucose tolerance (P < 0.01). The prevalence of cardiovascular risk factors in subjects with HIns was much higher than subjects with NIns (P < 0.01). Multiple logistic regression analysis showed that hyperinsulinemia was the risk factor of arteriosclerosis, and the OR (95%CI) of subjects with HIns was 1.91 (1.169 - 3.105, P < 0.01) as compared to the subjects with NIns. CONCLUSION: The subjects with HIns suffered from much more metabolic risk factors than NIns. Hyperinsulinemia that closely correlated with baPWV was a risk factor of arteriosclerosis.

Prevalence and risk factors of peripheral arterial diseases in male Chinese octogenarians and nonagenarians with hypertension / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the prevalence and risk factors of peripheral arterial disease (PAD) in male Chinese octogenarians and nonagenarians with hypertension.</p><p><b>METHODS</b>Ankle-brachial index (ABI) was measured in the noninvasive vascular laboratory for hypertensive male octogenarians and nonagenarians enrolled from outpatient and inpatient departments. The baseline conditions were investigated using standard questionnaire and by routine physical examinations. PAD was diagnosed when an ABI≤0.9 in either lower extremity.</p><p><b>RESULTS</b>Totally 290 male Chinese octogenarians and nonagenarians [age: (84.61±4.20) years] with hypertension who were receiving antihypertensive therapy were enrolled in this study, among whom 9 men with missing data except age and ABI measurements. The ABI was 0.948±0.258, with the range of highest frequency of 0.91-1.30, and 106 patients were diagnosed as PAD, 182 as non-PAD, and 2 had ABI>1.3. ABI in hypertensive men with PAD were significantly lower than in those without PAD (P<0.05). On the contrary, age, blood urea nitrogen, white blood cell counts, platelets and aspartic transaminase were significantly higher in PAD patients than in non-PAD patients (all P<0.05). The prevalence of PAD in this study population were 36.5%; more specifically, it significantly differed between different subgroups when stratified by age (28.6% vs. 46.3%, below and above 85 years), with and without hypertension (27.5% vs. 40.1%), stroke (44.7% vs. 27.5%), dyslipidemia (41.4% vs. 33.3%), coronary artery disease (44.1% vs. 13.9%), and diabetes mellitus (53.7% vs. 21.8%) (all P<0.05). The prevalences of PAD in hypertensive patients treated with diuretics, calcium antagonists, beta-blocker, or angiotensin receptor antagonist were 41.4%, 36.1%, 22.4%, and 26.8%, respectively. No association was observed between the prevalence of PAD and smoking/alcohol drinking in these subjects. Multivariate analysis showed that age (OR 1.12, 95%CI 1.014-1.238), blood urea nitrogen (OR 1.15, 95%CI 1.025-1.301), aspartic transaminase (OR 1.05, 95%CI 1.005-1.089), diabetes mellitus (OR 4.02, 95%CI 1.797-9.009), coronary artery disease (OR 6.34, 95%CI 1.734-23.214) were strong risk factors of PAD.</p><p><b>CONCLUSION</b>PAD is highly prevalent among aged Chinese hypertensive men, in which age, blood urea nitrogen, aspartic transaminase, diabetes mellitus, coronary artery disease may be involved in the development of this condition.</p>

[The clinical characteristics and trend of conversion to type 2 diabetes mellitus of individuals with normal glucose tolerance-hyperinsulinemia].

OBJECTIVE: To study the outcomes and influencing factors of the conversion from normal glucose tolerance-hyperinsulinemia (NGT-HINS) to diabetes in the population of a community in Beijing. METHODS: All the subjects investigated received 75 g oral glucose tolerance test (OGTT) for diabetes screening carried out in May, 2006 and May, 2008. Data were calculated to analyze the outcomes and influencing factors of the conversion. HINS was diagnosed if fasting serum insulin≥15 mIU/L and/or 2-hour serum insulin after glucose loading≥80 mIU/L. RESULTS: The prevalence of NGT-HINS in the community in 2006 and 2008 was 5.28% and 8.67% (P<0.01) respectively and that of diabetes mellitus (DM) and impaired glucose regulation (IGR) was 3.52%, 6.56% in 2006 and 4.42%, 6.47% in 2008. The probability of the conversion from NGT-HINS to IGR and DM was 18.6% and 2.3%, being much higher than that from normal glucose tolerance-normoinsulinemia (NGT-NINS) (5.4% and 0.7%, P<0.01). However, the probability of the conversion from NGT-HINS to DM was 2.3%, which was much lower than that from IGR (26.3%, P<0.01). The reason might be that individuals with NGT-HINS had a higher waist circumference, BMI, fasting plasma glucose, 2 h plasma glucose and TG but a lower HDL-C than individuals with NGT-NINS in 2006. The HOMA ß-cell function index/HOMA insulin resistance index (HBCI/IR) of individuals with NGT-HINS was much lower than that of individuals with NGT-NINS, but much higher than that of individuals with IGR. Logistic regression analysis showed that age, TG and HBCI/IR were the major influencing factors of the conversion from NGT to glucose metabolic disorders. CONCLUSIONS: The probability of conversion from NGT to DM was increased remarkably when HINS was diagnosed. The reason might be that individuals with NGT-HINS suffered more metabolic risk factors and had a decreased ß-cell function. Therefore, individuals with NGT-HINS should be paid attention to in diabetes prevention study.

[Safety of metformin in the treatment of elderly type 2 diabetes mellitus].

OBJECTIVE: To evaluate the safety of metformin in the treatment of elderly type 2 diabetes mellitus (T2DM). METHODS: Two hundred and forty-three cases of elderly T2DM hospitalized from Jan. 1996 to Dec. 2006 were reviewed; the changes of fasting blood glucose(FBG), postprandial blood glucose (PBG), glycosylated hemoglobin (HbA1c), liver and renal function and blood lactic acid were evaluate before and after treatment. RESULTS: The mean time of treatment with metformin was (6.6 +/- 3.9) years (3 months - 21 years) in these 243 cases. The levels of FBG, PBG and HbA1c significantly reduced after treatment with metformin only in 43 cases (17.7%), metformin combined with other oral hypoglycemic drugs in 124 cases (51.0%) and metformin combined with insulin in 76 cases (31.3%). There was only 18.1% of the cases with normal range (> 80 ml/min) of creatinine clearance rate (Ccr), and 25.8% of the cases with Ccr