Comorbidity and Glycemic Control in Patients With Type 2 Diabetes

El‐Kebbi, Imad M.; Ziemer, David C.; Cook, Curtiss B.; Miller, Christopher D.; Gallina, Daniel L.; Phillips, Lawrence S.

doi:10.1001/archinte.161.10.1295

Cited by 43 publications

(34 citation statements)

References 43 publications

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“…It is known that a longer duration of diabetes is strongly related to poor glycemic control (37,38). Therefore, the increased risk of ED associated with increasing diabetes duration is likely to reflect some of the effects of glycemic control.…”

Section: Research Design and Methods -mentioning

confidence: 99%

Association of Type and Duration of Diabetes With Erectile Dysfunction in a Large Cohort of Men

Bacon¹,

Hu²,

et al. 2002

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OBJECTIVE -Differences in risk of erectile dysfunction (ED) by characteristics of diabetes among older men are not well understood. We examined the association of type and duration of diabetes with erectile function in men Ͼ50 years of age in a large prospective cohort study. RESULTS -Men with diabetes had an age-adjusted relative risk (RR) of 1.32 (95% CI 1.3-1.4) for having ED compared with men without diabetes. In multivariable regression analyses, men with type 1 and type 2 diabetes were at a significantly higher risk for ED (type 1 diabetes RR ϭ 3.0, 95% CI 1.5-5.9; type 2 diabetes RR ϭ 1.3, 1.1-1.5) than nondiabetic men. Men with type 2 diabetes had an increasingly greater risk of ED with increased duration since diagnosis (trend test P value Ͻ0.0001) (RR ϭ 1.7, 95% CI 1.1-2.7, for men diagnosed Ͼ20 years previously). CONCLUSIONS -For men over age 50 years, increasing duration of diabetes was positively associated with increased risk of ED relative to nondiabetic subjects. This association persisted despite the higher prevalence of other comorbid conditions. ED prevention and diabetes management efforts are likely to go hand-in-hand. RESEARCH DESIGN AND METHODS

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Section: Research Design and Methods -mentioning

confidence: 99%

Association of Type and Duration of Diabetes With Erectile Dysfunction in a Large Cohort of Men

Bacon¹,

Hu²,

et al. 2002

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“…Although current data suggest that socioeconomic factors do not predict glucose control (11)(12)(13)(14)(15)23), differences in educational levels, incomes, or literacy could explain some of the heterogeneity in HbA 1c outcome (24)(25)(26). Furthermore, the role of comorbid illnesses, which preliminary data indicate do not appear to affect the ability to reduce HbA 1c (27), needs to be further explored. These considerations need to be accounted for when designing future studies aimed at examining the contribution of the patient versus that of the provider to glycemic outcome.…”

mentioning

confidence: 99%

The Potentially Poor Response to Outpatient Diabetes Care in Urban African-Americans

et al. 2001

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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. The Potentially Poor Response to Outpatient Diabetes Care in Urban African-Americans O R I G I N A L A R T I C L EOBJECTIVE -HbA 1c levels can be reduced in populations of diabetic patients, but some individuals may exhibit little improvement. To search for reasons underlying differences in HbA 1c outcome, we analyzed patients managed in an outpatient diabetes clinic. RESEARCH DESIGN AND METHODS -African-Americans with type 2 diabetes were categorized as responders, intermediate responders or poor responders according to theirHbA 1c level after 1 year of care. Logistical regression was used to determine baseline characteristics that distinguished poor responders from responders. Therapeutic strategies were examined for each of the response categories.RESULTS -The 447 patients had a mean age and disease duration of 58 and 5 years, respectively, and BMI of 32 kg/m 2 . Overall, the mean HbA 1c level fell from 9.6 to 8.1% after 12 months. Mean HbA 1c levels improved from 8.8 to 6.2% in responders, and from 9.5 to 7.9% in intermediate responders. In poor responders, the average HbA 1c level was 10.8% on presentation and 10.9% at 1 year. The odds of being a poor responder were significantly increased with longer disease duration, higher initial HbA 1c level, and greater BMI. Although doses of oral agents and insulin were significantly higher among poor responders at most visits, the acceleration of insulin therapy did not occur until late in the follow-up period.CONCLUSIONS -Clinical diabetes programs need to devise methods to identify patients who are at risk for persistent hyperglycemia. Whereas patient characteristics explain some heterogeneity of HbA 1c outcome (and may aid in earlier identification of patients who potentially may not respond to conventional treatment), insufficient intensification of therapy may also be a component underlying the failure to achieve glycemic goals. C l i n i c a l C a r e / E d u c a t i o n / N u t r i t i o n 210DIABETES CARE, VOLUME 24, NUMBER 2, FEBRUARY 2001Poor response to diabetes care visits were anticipated over the course of 1 year. In type 2 diabetic patients presenting without symptomatic hyperglycemia, medications were traditionally reduced or discontinued (regardless of the presenting HbA 1c value) to permit an intensive 2-month trial of nonpharmacological management. If glycemic goals (HbA 1c Յ7.0%) were not met by the end of this 2-month period, pharmacological therapy was reinstituted or advanced. Patient selectionPatients were selected from an on-site patient registry if they had type 2 diabetes, had initial visits between 1 January 1992 and 31 December, 1996, and returned for scheduled follow-up appointments at 2, 4, 6, and 12 months; these return visits represented times when HbA 1c values were typically obtained (9). As previously reported (9), other than being slightly older, the characteristics (e.g., presenting BMI, HbA 1c lev...

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“…ElKebbi IM y Ziemer D llegaron a una conclusión similar al estudiar el grado de control glucémico en pacientes diabéticos con comorbilidades. 18 Las altas concentraciones de HbA1c encontradas en los pacientes diabéticos de la muestra analizada orillaron a utilizar un punto de corte para descontrol severo control >9.50%, lo que conforma un grupo de sujetos "mal controlados" con concentraciones de HbA1c ≤9.5% cuyo punto de corte también es elevado. Sabemos que los valores en los pacientes "mal controlados" no disminuirán la sintomatología ni la probabilidad de presentar complicaciones secundarias a la enfermedad.…”

Section: Discussionunclassified

“…[15][16][17] Los lineamientos internacionales recomiendan niveles menores a 7% de HbA1c como un buen control glucémico debido a que niveles debajo de esta cifra han demostrado atenuar las complicaciones microvasculares y neuropáticas de la diabetes tipo 1 y 2. 18 La reducción a niveles promedio de 7%, comparado con cifras cerca de 7.9% en un periodo de 10 años, con tratamiento, disminuye el riesgo de presentar cualquier complicación final de la diabetes en 12% y aminora en 25% la incidencia de enfermedades microvasculares, lo que incluye 16% en el infarto al miocardio (P=0.052). [19][20][21] El sistema de salud mexicano se ha esforzado por la mejora en el acceso a la atención y el cumplimiento de las Guías de Manejo del Paciente Diabético, sin embargo, los estudios muestran un inadecuado control metabólico de los diabéticos en el país.…”

Section: Control Glucémico Del Paciente Diabéticounclassified

Análisis de una encuesta poblacional para determinar los factores asociados al control de la diabetes mellitus en México

Hernández-Romieu¹,

Elnecavé-Olaiz²,

Huerta-Uribe³

et al. 2011

Salud pública Méx

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Comorbidity and Glycemic Control in Patients With Type 2 Diabetes

Abstract: Comorbidity does not appear to limit achievement of good glycemic control in patients with type 2 diabetes.

Cited by 43 publications

References 43 publications

Association of Type and Duration of Diabetes With Erectile Dysfunction in a Large Cohort of Men

Association of Type and Duration of Diabetes With Erectile Dysfunction in a Large Cohort of Men

The Potentially Poor Response to Outpatient Diabetes Care in Urban African-Americans

Análisis de una encuesta poblacional para determinar los factores asociados al control de la diabetes mellitus en México

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