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Glycemic control and vascular complications in type 2 diabetes mellitus - UpToDate
[tl;dr: Glycemic control improves microvascular outcomes in type 2 diabetes, including progression of nephropathy, manifestation and progression of retinopathy, and retinal photocoagulation; and showed a beneficial effect of intensive therapy on the development of more advanced clinical outcomes in renal disease and its precursors in the one study with long-enough follow up to assess effect. Cardiovascular risk benefit "has not been established as clearly" for type 2 as for type 1.]

Although the role of glycemic control on microvascular disease in type 2 diabetes was documented in the United Kingdom Prospective Diabetes Study (UKPDS), its role in reducing cardiovascular risk has not been established as clearly for type 2 diabetes....

improving glycemic control improves microvascular outcomes, as illustrated by the findings of a meta-analysis of randomized trials (34,912 participants) [5]. There was a reduction in the risk of microvascular complications (a composite outcome including progression of nephropathy, manifestation and progression of retinopathy, and retinal photocoagulation) in the intensive compared with standard glycemic control group (relative risk [RR] 0.88, 95% CI 0.82-0.95). There were significant reductions in risk for each of the individual components.

In other meta-analyses of trials (over 28,000 adults) evaluating the benefits of intensive versus conventional glycemic control specifically on renal outcomes, there was a statistically significant reduction in the risk of microalbuminuria and macroalbuminuria in patients randomly assigned to intensive glycemic control (risk ratios of 0.86 and 0.74, respectively) [6,7]. The reduction in risk of end-stage renal disease did not reach statistical significance (RR 0.69, 95% CI 0.46-1.05). There was no reduction in the risk of doubling of the serum creatinine level or death from renal disease (RRs 1.06 and 0.99, respectively) [6]. Of note, the majority of the trials in the meta-analyses were not of long enough duration to show a beneficial effect of glycemic control on end-stage renal disease, which typically manifests after 10 to 20 years of diabetes duration [8]. In the trials included in the meta-analyses, the absolute rates of severe renal outcomes were low in both the intensive- and conventional-therapy groups, reducing the ability of the analysis to demonstrate a benefit, if one exists. In the one trial with longer-term follow-up (United Kingdom Prospective Diabetes Study [UKPDS] cohort followed for 22 years), there was a beneficial effect of intensive therapy on the development of more advanced clinical outcomes, including renal disease
type  2  T2D  diabetes  risk  tight  management  glucose  control  blood  benefit  morbidity  mortality  microvascular  complications  kidneys  eyes  retinopathy  nephropathy  renal  disease  cardiovascular  peer-reviewed  research  review  meta-analysis  overview  in  vivo  situ  human  clinical  trial  symptoms  comorbidities  self  treatment  care 
september 2018 by Michael.Massing
Psychological morbidity and general health among family caregivers during end-of-life cancer care: A retrospective census survey - Gunn Grande, Christine Rowland, Bernard van den Berg, Barbara Hanratty, 2018
National 4-month post-bereavement postal census survey of family carers of people who died from cancer, retrospectively measuring carers’ psychological health (General Health Questionnaire-12) and general health (EuroQoL EQ-Visual Analogue Scale) during the patient’s last 3 months of life.

N = 1504 (28.5%) of all 5271 people who registered the death of a relative from cancer in England during 2 weeks in 2015 compared with data from the Health Survey for England 2014 (N = 6477–6790).

Psychological morbidity at clinically significant levels (General Health Questionnaire-12 ⩾4) was substantially higher among carers than the general population (83% vs 15%), with prevalence five to seven times higher across all age groups. Overall, carers’ general health scores were lower than population scores, median 75 (interquartile range, 50–80) versus 80 (interquartile range, 70–90), but differences were more marked at younger ages. Female carers had worse psychological morbidity and general health than male carers.

Levels of psychological morbidity among family carers during end-of-life caregiving are far higher than indicated by previous research, indicating a substantial public health problem. Consistent assessment and support for carers to prevent breakdown in caregiving may produce cost savings in long term.
caring  caregiving  end-of-life  terminal  cancer  patients  family  members  depression  correlation  anxiety  stress  toll  peer-reviewed  research  human  in  vivo  situ  general  health 
september 2018 by Michael.Massing
Long-Chain Omega-3 Fatty Acid Supplements in Depressed Heart Failure Patients: Results of the OCEAN Trial - ScienceDirect
Patients with CHF and depression had low blood omega-3 concentrations that were associated with an elevated risk of mortality.


This study was a randomized, double-blind, placebo-controlled pilot clinical trial using a 400/200 eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) fish oil at 2 g and an almost pure EPA at 2 g, compared with a matched placebo, daily for 12 weeks for patients with CHF and major depressive disorder. Statistical analyses included the intention-to-treat population and “completers” (defined as participants consuming ≥70% of the capsules and completing the final endpoint evaluation between 10 and 14 weeks).


A total of 108 patients with CHF and major depressive disorder and a score ≥18 on the Hamilton Depression Scale who were randomized at 1:1:1 to the 3 interventions at 3 enrolling centers from June 12, 2014, to May 19, 2016; 80 (74.1%) qualified as completers. Intention-to-treat analyses revealed that the levels of all omega-3 variables were significantly elevated in the omega-3 groups, whereas the placebo group showed little change; there were no between-group differences with overall depression measurements. Per-protocol exploratory analyses showed that scores on the social functioning measurement of the 36-item Short Form Health Survey improved notably in the 400/200 EPA/DHA (p = 0.040) and EPA (p = 0.10) groups compared with the placebo group. Spearman correlation analysis indicated that increased omega-3 indices were associated with improved cognitive depressive symptoms.


Omega-3 supplementation resulted in significant increases in omega-3 levels in red blood cell counts, corresponding to a particular compound of omega-3. Changes in cognitive depressive symptoms and social function were in favor of the omega-3 supplementation. Further studies with larger sample sizes are necessary to confirm the benefits of omega-3 supplementation on modifying psychosocial factors for patients with CHF. (Omega-3 Supplementation for Co-Morbid Depression and Heart Failure Treatment [OCEAN]; NCT02057406)
depression  CHF  major  depressive  disorder  peer-reviewed  research  human  clinical  trial  in  vivo  situ  cognition  functional  improvement  treatment  cognitive  comorbidity  mortality  risk  benefit  supplements  omega-3  DHA  EPA  RCT 
september 2018 by Michael.Massing
Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia | Cardiology | JAMA | JAMA Network
These findings may support the promotion of cardiovascular health to prevent development of risk factors associated with dementia.
cardiovascular  heart  brain  risk  health  dementia  benefit  correlation  peer-reviewed  research  human  in  situ  cohort  vivo 
august 2018 by Michael.Massing
Air Pollution Linked to Infant Deaths | Global Health | JAMA | JAMA Network
Poor air quality is responsible for 1 in 5 infant deaths in sub-Saharan Africa, according to a study published in Nature.

To quantify the effect of breathable air pollutants on premature deaths among infants in Africa, the investigators examined recent satellite-based estimates of air pollutant particles (ambient respirable particulate matter with an aerodynamic diameter less than 2.5 μm [PM2.5]). They combined the air quality data with results from 65 household surveys across 30 sub-Saharan African countries on the timing and location of almost 1 million infant births—and any subsequent deaths in the first year of life—between 2001 and 2015. They then matched the location and timing of each birth to satellite-based estimates of PM2.5 exposure from 9 months before birth to 12 months after.

The investigators found a strong linear association of infant mortality with increases in PM2.5 exposure. Specifically, with every 10 μg per cubic meter increase in the concentration of breathable particulate matter in the first 12 months of life, there was about a 9% increase in infant mortality. This association was consistent over the study’s 15 years and was independent of household wealth.

Concentrations of PM2.5 higher than minimum exposure levels were responsible for 22% of infant deaths in 30 countries and led to 449 000 additional infant deaths in 2015. This estimate is more than 3 times higher than earlier data, suggesting poor air quality is an even bigger problem than previously appreciated.
air  pollution  environmental  factors  environment  infant  mortality  Africa  particulate  matter  risk  peer-reviewed  research  correlation  human  in  vivo  population  situ 
august 2018 by Michael.Massing
Can a Sauna Session Count as a Workout?
Those who sweated it out two to three times per week were 23 percent less likely to suffer from coronary heart disease or cardiovascular disease. People who sauna-bathed four to seven times per week were 48 percent less likely to die of those heart diseases — and 40 percent less likely to die of any other causes than people who only sauna-bathed once per week. 

The longer people spent in the heat during each sauna session — which ran from two- to 90-minutes(!) long — the greater their risk of survival. Guys who spent more than 19 minutes in the sauna were 52 percent less likely to suffer sudden cardiac death that men who sauna-bathed for less than 11 minutes at a time.
sauna  bathing  risk  benefit  cardiac  cardiovascular  morbidity  mortality  correlation  human  cohort  prospective  in  vivo  situ  peer-reviewed  research  all-cause 
july 2018 by Michael.Massing
Sauna bathing reduces the risk of stroke in Finnish men and women | Neurology
Baseline habits of sauna bathing were assessed in 1,628 adult men and women aged 53–74 years (mean age, 62.7 years) without a known history of stroke in the Finnish Kuopio Ischemic Heart Disease prospective cohort study. Three sauna bathing frequency groups were defined: 1, 2–3, and 4–7 sessions per week. Hazard ratios (HRs) (95% confidence intervals [CIs]) were estimated for incident stroke.

Results During a median follow-up of 14.9 years, 155 incident stroke events were recorded. Compared with participants who had one sauna bathing session per week, the age- and sex-adjusted HR (95% CI) for stroke was 0.39 (0.18–0.83) for participants who had 4–7 sauna sessions per week. After further adjustment for established cardiovascular risk factors and other potential confounders, the corresponding HR (95% CI) was 0.39 (0.18–0.84) and this remained persistent on additional adjustment for physical activity and socioeconomic status at 0.38 (0.18–0.81). The association between frequency of sauna bathing and risk of stroke was not modified by age, sex, or other clinical characteristics (p for interaction > 0.10 for all subgroups). The association was similar for ischemic stroke but modest for hemorrhagic stroke, which could be attributed to the low event rate (n = 34).

Conclusions This long-term follow-up study shows that middle-aged to elderly men and women who take frequent sauna baths have a substantially reduced risk of new-onset stroke.
sauna  risk  reduction  benefit  bathing  peer-reviewed  research  human  in  vivo  situ  prospective  cohort  stroke  ischemic  correlation 
july 2018 by Michael.Massing
Glycemic Control in Nonpregnant Adults With Type 2 Diabetes | Guidelines | JAMA | JAMA Network
[As is so often the case, the discussion of treatment risk vs. benefit in glycemic control/management is distorted by an actually or effectively exclusive focus on drug therapy. —DMM]

In the United States, type 2 diabetes affects 30 million people and is a major cause of morbidity and mortality.1 Glycemic control has been shown to reduce diabetes complications, particularly for microvascular disease.2,3 However, increasing recognition of adverse events due to intensive diabetes treatments has prompted major disagreements about optimal glycemic targets.
glycemic  control  tight  management  glucose  complications  late-stage  symptoms  risk  mitigation  prevention  microvascular  diabetes  type  2  T2D  drug  therapy  treatment  peer-reviewed  research  in  vivo  situ  human  clinical  trial  blood  benefit  comorbidities  morbidity  self  care  behavioral 
july 2018 by Michael.Massing
Who Killed the Kiev Protesters? A 3-D Model Holds the Clues. - The New York Times
Brad Samuels, a principal of SITU, an architecture firm and research lab in Brooklyn. The firm combined traditional architecture work with grant-funded deep dives at the outer limits of human rights research.

“The problem was how to take multiple vantage points and put them together into a coherent analysis,” he said. “Maidan was the same problem set, but on steroids.”

The quantity of raw footage amassed by Nefertari was overwhelming, running into the thousands of hours. The problem was how to fuse it into a whole that would persuade the judges and stand up to cross-examination.
ee  SITU  forensics  human_rights 
may 2018 by osi_info_program
Getting to Goal in Type 2 Diabetes: Role of Postprandial Glycemic Control
In the continuum of chronic glucose exposure, fasting hyperglycemia being persistently a problem is how we develop microvascular complications. That's a person who clearly has something other than the episodic exposure to hyperglycemia, which we see in the prediabetic or the IGT state. And yet in the IGT state or the prediabetic condition, you are at risk for macrovascular disease.

Microvascular disease is the hallmark of clinical diabetes. So it is legitimate to ask the question, is the threshold for the initiation of macrovascular damage lower than that required for initiation of microvascular disease? Or, is postprandial hyperglycemia to be considered as a first strike that leads to the outcomes, coronary heart disease and other significant vascular abnormalities, which we are the most concerned about in diabetes?

So this is, indeed, the leading cause of death in people with diabetes and it is strongly driven by postprandial hyperglycemia.
postprandial  hyperglycemia  glucose  blood  risk  factor  epidemiology  rhythms  metabolic  circadian  self  care  management  mitigation  peer-reviewed  research  in  vivo  situ  human 
october 2017 by Michael.Massing
n collaboration with Amnesty International, SITU Research designed this interactive digital platform to facilitate the organization, analysis and presentation of evidence documenting scorched earth and chemical weapons attacks of civilians in Jebel Marra, Darfur.

Accessing geo-spatial information, satellite imagery, witness testimony and photographs within a single interface, this tool is intended to provide a spatial and temporal account of previously undocumented violations.

The goal of this collaboration and the platform itself is to render visible the developments and scale of ongoing human rights violations in a remote and inaccessible part of Sudan.
ee  human_rights  amnesty  SITU  Sudan 
october 2016 by osi_info_program
For First Time, Destruction Of Cultural Sites Leads To War Crime Conviction : The Two-Way : NPR
As the Two-Way reported earlier this year, the ICC normally handles allegations of massacres and other human rights abuses. Mahdi's case instead centered on the intentional destruction of significant buildings in the ancient city of Timbuktu in Mali:
ee  SITU  ICC  presentation 
september 2016 by osi_info_program
Favorable Effects of Insulin Sensitizers Pertinent to Peripheral Arterial Disease in Type 2 Diabetes
The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial randomly assigned participants to insulin sensitization (IS) therapy versus insulin-providing (IP) therapy for glycemic control. Results showed similar 5-year mortality in the two glycemic treatment arms. In secondary analyses reported here, we examine the effects of treatment assignment on the incidence of PAD. A total of 1,479 BARI 2D participants with normal ankle-brachial index (ABI) (0.91–1.30) were eligible for analysis. The following PAD-related outcomes are evaluated in this article: new low ABI ≤0.9, a lower-extremity revascularization, lower-extremity amputation, and a composite of the three outcomes.


During an average 4.6 years of follow-up, 303 participants experienced one or more of the outcomes listed above. Incidence of the composite outcome was significantly lower among participants assigned to IS therapy than those assigned to IP therapy (16.9 vs. 24.1%; P < 0.001). The difference was significant in time-to-event analysis (hazard ratio 0.66 [95% CI 0.51–0.83], P < 0.001) and remained significant after adjustment for in-trial HbA1c (0.76 [0.59–0.96], P = 0.02).


In participants with type 2 diabetes who are free from PAD, a glycemic control strategy of insulin sensitization may be the preferred therapeutic strategy to reduce the incidence of PAD and subsequent outcomes.
limb  risk  amputation  PAD  peripheral  arterial  disease  clinical  research  human  in  vivo  retrospective  insulin  sensitizer  mimetic  leg  foot  trial  postmarket  situ  cardiovascular 
june 2016 by Michael.Massing
D-is-for-Diabetes: Medicare's Competitive Bidding Program Puts Beneficiaries' Lives at Risk
The Forum built upon the GAO's analysis by examining access to diabetes testing supplies for Medicare beneficiaries living with diabetes and requiring insulin therapy.  Working with some of the nation's leading endocrinologists,* the Forum's study found that the Competitive Bidding Program disrupted beneficiaries' ability to access diabetes testing supplies, and this disruption was associated with an increase in mortality, higher hospitalization rates and inpatient costs.

"Self-monitoring blood glucose supplies are a critical component of diabetes care among insulin-treated individuals and the value of safe, effective testing supplies cannot be underestimated," said Jaime Davidson, M.D., clinical professor of Medicine at the University of Texas Southwestern Medical Center, and an author of the study. "We are particularly concerned about the disruption we detected in our analysis given the predominant use of rapid- and short-acting insulin by Medicare beneficiaries, who are at significantly greater risk for hypoglycemia than younger individuals with insulin-treated diabetes."

"We are troubled that CMS failed to detect these 'unintended' consequences and, instead, reported that the program was a success," said Gary A. Puckrein, Ph.D., president and CEO of the National Minority Quality Forum and a study author. "Based on our findings and employing the safety monitoring protocols commonly used to protect human subjects, we believe policymakers should immediately suspend the program until CMS can demonstrate its ability to effectively monitor the effects of the program, correct the structural flaws causing this problem and ensure that the lives of America's greatest generation are no longer at risk." 

The ahead of print article "Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis" can be found online: Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis . The full article will also be published here:
watchdog  diabetes  insulin-dependent  SMBG  supplies  cost  benefit  mortality  hospitalization  competitive  bidding  Medicare  in  vivo  situ  human  peer-reviewed  research  health  disparities  healthcare 
may 2016 by Michael.Massing

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