Glycemic control and survival of diabetic hemodialysis patients—Importance of lower hemoglobin A1C levels

Ishimura, Eiji; Okuno, Senji; Kono, Kei; Fujino-Kato, Y.; Maeno, Yoshifumi; Kagitani, S.; Tsuboniwa, Naoki; Nagasue, Kyoko; Maekawa, Kiyoshi; Yamakawa, Tomoyuki; Inaba, Masaaki; Nishizawà, Yoshiki

doi:10.1016/j.diabres.2008.11.038

Cited by 49 publications

(34 citation statements)

References 33 publications

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“…DM is the most common cause of kidney failure [2,3], and glycemic control is necessary for the prevention of renal insufficiency. Moreover, glycemic control to improve hyper-or hypoglycemia is an important factor in the overall prognosis of patients with endstage renal disease receiving hemodialysis (HD) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Linagliptin inhibits lipopolysaccharide-stimulated interleukin-6 production, intranuclear p65 expression, and p38 mitogen-activated protein kinase phosphorylation in human umbilical vein endothelial cells

et al. 2016

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Background: Linagliptin, the only bile-excreted dipeptidyl peptidase-4 (DPP-4) inhibitor, is a therapeutic drug for patients with diabetes receiving hemodialysis, for whom inflammation is a prognosis-related factor, because of its potential anti-inflammatory effects. Although the anti-inflammatory effects of linagliptin in vivo are reported, no study has described these effects in vitro. DPP-4 degrades glucagon-like peptide-1 (GLP-1), which is known to have anti-inflammatory properties. Since GLP-1 is a gut hormone secreted by intestinal L cells, in vivo examination of the GLP-1-independent anti-inflammatory effects of DPP-4 inhibitors is difficult. We evaluated the mitogen-activated protein kinase (MAPK)-dependent, GLP-1-independent, anti-inflammatory effects of linagliptin in lipopolysaccharide (LPS)-stimulated human umbilical vein endothelial cells (HUVECs) which do not secrete GLP-1. Furthermore, to determine whether linagliptin has unique pharmacological actions compared with other DPP-4 inhibitors, we assessed the anti-inflammatory effects of sitagliptin (a DPP-4 inhibitor without xanthine-related skeletal system activity), caffeine (a phosphodiesterase inhibitor), loxoprofen, and diclofenac sodium. Methods: HUVECs were cultured for 24 h at densities of 1-2 × 10 5 cells/mL. We pretreated HUVECs with or without linagliptin (1, 5, 10, 50, and 100 nM), 150 nM sitagliptin, 50 nM caffeine, 17 μM loxoprofen, or 1.3 μM diclofenac sodium for 1 h prior to incubation with LPS. The concentration of LPS used (1 μg/mL) was sufficient to induce an inflammatory response in HUVECs. Five hours after incubation with LPS, culture media was evaluated for interleukin (IL)-6 expression. Intranuclear p65 (a subunit of nuclear factor kappa-B (NFκB)) levels were measured 5 h after treatment with LPS and 50 nM linagliptin, while phosphorylated p38 MAPK levels were measured in the cytosolic fractions obtained 30 min after treatment with LPS and 50 nM linagliptin.

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Section: Introductionmentioning

confidence: 99%

Linagliptin inhibits lipopolysaccharide-stimulated interleukin-6 production, intranuclear p65 expression, and p38 mitogen-activated protein kinase phosphorylation in human umbilical vein endothelial cells

et al. 2016

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“…5 A primary measure of glycemic control is hemoglobin A1c (HbA1c). 6 Among patients with diabetes, lower HbA1c levels have been associated with decreased mortality [7][8][9] and fewer complications. [10][11][12][13][14] Research suggests that performance of self-care behaviors, [15][16][17][18][19][20][21] increased diabetes knowledge, [22][23][24] and greater medication adherence [25][26][27][28] are associated with improved glycemic control.…”

mentioning

confidence: 99%

Associations Between Health Literacy, Diabetes Knowledge, Self-Care Behaviors, and Glycemic Control in a Low Income Population with Type 2 Diabetes

Bains

Egede

2011

Diabetes Technology & Therapeutics

245

225

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Objective: This study assessed associations among health literacy, diabetes knowledge, self-care, and glycemic control in a low income, predominately minority population with type 2 diabetes. Methods: One hundred twenty-five adults with diabetes were recruited from a primary care clinic. Subjects completed validated surveys to measure health literacy, diabetes knowledge, and self-care (medication adherence, diet, exercise, blood sugar testing, and foot care). Hemoglobin A1c values were extracted from the medical record. Spearman's correlation and multiple linear regression were used to assess the relationship among health literacy, diabetes knowledge, self-care, and glycemic control controlling for covariates. Results: Cronbach's a was 0.95 for the Revised Rapid Estimate of Adult Literacy in Medicine. The majority of the sample was <65 years old (50.7%), female (72.5%), and African American (71.4%), had less than a high school education (68.2%) and a household income <$15,000 (64.2%), and reported their health status as worse than last year (73.9%). In adjusted models that examined the associations among health literacy, diabetes knowledge, medication adherence, and self-care, health literacy was only significantly associated with diabetes knowledge (b ¼ 0.55; 95% confidence interval [CI] 0.29, 0.82). In the final adjusted model for independent factors associated with glycemic control, both diabetes knowledge (b ¼ 0.12; 95% CI 0.01, 0.23) and perceived health status (b ¼ 1.14; 95% CI 0.13, 2.16) were significantly associated with glycemic control, whereas health literacy was not associated with glycemic control (b ¼ À0.03; 95% CI À0.19, 0.13). Conclusions: Diabetes knowledge and perceived health status are the most important factors associated with glycemic control in this population. Health literacy appears to exert its influence through diabetes knowledge and is not directly related to self-care or medication adherence.

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“…Diabetic nephropathy is the second cause leading to CKD in Brazil and glycemic control is an important element to predict the survival rate for Type 2 diabetic patients, both in pre-dialysis (10) and after beginning renal replacement therapy (11)(12)(13)(14). In addition, glycemic control is essential for reducing the risk of vascular complications and for improving the quality of life of these patients (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Glycemic and lipidic profile in diabetic patients undergoing dialysis

Fortes

Mendes

Sesiuk

et al. 2010

Arq Bras Endocrinol Metab

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Objective: The aim of this study is to assess the clinical care pattern and to compare the lipid and glycemic profile in a group of diabetic patients undergoing both hemodialysis (HD) and peritoneal dialysis (PD) and to correlate these data using biomarkers of cardiovascular risk. Subjects and methods: The first phase consisted in performing a survey on demographic data, questions about the medical team and glycemic control. In the second phase, patients were assessed through laboratorial data on their glycemic and lipid profile at a single center for HD and PD. Results: 91 patients was the total population; 70 patients (77%) answered the survey; 66 patients (94%) considered the nephrologist the physician responsible for caring for their glycemic control. Second phase: 59 patients were assessed, 29 undergoing HD and 30 undergoing PD. Fifty-seven percent of the patients had HbA1c above 7%; the level of glycemic markers in patients undergoing peritoneal dialysis was significantly higher than in patients undergoing hemodialysis: HbA1c (9.37 ± 0.5) vs. (7.37 ± 0.49) p < 0.01; fasting glycemia (170 ± 15) vs. (126 ± 15) mg/dL p < 0.05. We found a positive correlation between HbA1c and hyperfibrinogenemia (r = 0.4437, p < 0.0005). Conclusions: The data reveal that glycemic control in diabetic patients undergoing renal replacement therapy (RRT) is neglected. Peritoneal dialysis is related to the worst level of glycemic markers, possibly due to the glucose content in the dialysis solution, and higher levels from HbA1c have a positive correlation with hyperfibrinogenesis in this population. Arq Bras Endocrinol Metab. 2010;54(9):793-800 Keywords Glycemic control; insulin resistance; chronic kidney disease; peritoneal dialysis; inflammation RESUMO Objetivo: Avaliar as características dos cuidados clínicos dos pacientes em diálise, comparar o controle glicêmico e lipídico entre os pacientes diabéticos em hemodiálise (HD) e em diálise peritoneal (DP) e correlacionar os dados laboratoriais com biomarcadores de risco cardiovascular. Sujeitos e métodos: A primeira etapa consistiu de um questionário abordando variáveis demográficas, questões sobre a equipe multidisciplinar, incluindo a equipe médica e sobre o controle glicêmico. Na segunda, os pacientes foram avaliados com exames laboratoriais para controle glicêmico e perfil lipídico numa unidade de HD e DP. Resultados: Dos 91 pacientes avaliados, setenta (77%) responderam ao questionário. Destes, 66 (94%) consideraram o nefrologista o médico responsá-vel pelo cuidado do seu controle glicêmico. Na segunda etapa, foram avaliados 59 pacientes: 29 em HD e 30 em DP. Cinquenta e sete por cento dos pacientes diabéticos em diálise apresentaram HbA1c acima de 7%, sendo que aqueles em diálise peritoneal apresentam níveis de marcadores glicêmicos significativamente piores do que os pacientes diabéticos em HD, HbA1c: (9,37 ± 0,5) vs. (7,37 ± 0,49) p < 0.01; glicemia de jejum: (170 ± 15) vs. (126 ± 15) mg/dL, p < 0.05. Encontramos uma correlação positiva entre HbA1c e hiperfibrinoge...

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Glycemic control and survival of diabetic hemodialysis patients—Importance of lower hemoglobin A1C levels

Cited by 49 publications

References 33 publications

Linagliptin inhibits lipopolysaccharide-stimulated interleukin-6 production, intranuclear p65 expression, and p38 mitogen-activated protein kinase phosphorylation in human umbilical vein endothelial cells

Linagliptin inhibits lipopolysaccharide-stimulated interleukin-6 production, intranuclear p65 expression, and p38 mitogen-activated protein kinase phosphorylation in human umbilical vein endothelial cells

Associations Between Health Literacy, Diabetes Knowledge, Self-Care Behaviors, and Glycemic Control in a Low Income Population with Type 2 Diabetes

Glycemic and lipidic profile in diabetic patients undergoing dialysis

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