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Sökning: WFRF:(Schwarcz Erik) > (2020)

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  • Papakokkinou, Eleni, et al. (författare)
  • Excess Morbidity Persists in Patients With Cushing's Disease During Long-term Remission : A Swedish Nationwide Study
  • 2020
  • Ingår i: The Journal of clinical endocrinology and metabolism. - Oxford University Press. - 1945-7197. ; 105:8
  • Tidskriftsartikel (refereegranskat)abstract
    • CONTEXT: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined. OBJECTIVE: To investigate comorbidities in patients with CD. DESIGN, SETTING, AND PATIENTS: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status. MAIN OUTCOMES: Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission. RESULTS: We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission. CONCLUSION: Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.
  • Seyed Ahmadi, Shilan, et al. (författare)
  • The Association Between HbA(1c)and Time in Hypoglycemia During CGM and Self-Monitoring of Blood Glucose in People With Type 1 Diabetes and Multiple Daily Insulin Injections: A Randomized Clinical Trial (GOLD-4)
  • 2020
  • Ingår i: Diabetes Care. - AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 43:9, s. 2017-2024
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>OBJECTIVE According to recent guidelines, individuals with type 1 diabetes should spend &amp;lt;4.0% of time per day with glucose levels &amp;lt;3.9 mmol/L (&amp;lt;70 mg/dL) and &amp;lt;1.0% per day with glucose levels &amp;lt;3.0 mmol/L (&amp;lt;54 mg/dL). RESEARCH DESIGN AND METHODS In the GOLD randomized crossover trial, 161 individuals with type 1 diabetes treated with multiple daily insulin injections (MDI) were randomized to continuous glucose monitoring (CGM) or conventional therapy with self-monitoring of blood glucose (SMBG) and evaluated over 16 months. We estimated the association between time spent in hypoglycemia and various mean glucose and HbA(1c)levels. RESULTS Time spent in hypoglycemia (&amp;lt;3.9 mmol/L and &amp;lt;3.0 mmol/L) increased significantly with lower mean HbA(1c)and mean glucose levels during both CGM and conventional therapy. During CGM, 24 (57.1%) individuals with HbA(1c)&amp;lt;7.5% (&amp;lt;58 mmol/mol) had &amp;lt;1.0% time spent in hypoglycemia &amp;lt;3.0 mmol/L and 23 (54.8%) had &amp;lt;4.0% time spent in hypoglycemia &amp;lt;3.9 mmol/L. During CGM, mean time spent in hypoglycemia for individuals with mean HbA(1c)7.0% (52 mmol/mol) was estimated to be 5.4% for &amp;lt;3.9 mmol/L and 1.5% for &amp;lt;3.0 mmol/L. The corresponding values during SMBG were 9.2% and 3.5%, respectively. Individuals with mean glucose levels of 8 mmol/L spent 4.9% units more time with glucose levels CONCLUSIONS Reaching current targets for time in hypoglycemia while at the same time reaching HbA(1c)targets is challenging for patients with type 1 diabetes treated with MDI both with CGM and SMBG monitoring. However, CGM is associated with considerably less time in hypoglycemia than SMBG at a broad range of HbA(1c)levels and is crucial for patients with MDI treatment if they are to have a chance to approach hypoglycemia targets.</p>
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