BACKGROUND/AIMS: Pre-existing diabetes mellitus (DM) has been identified as an adverse prognostic variable associated with increased mortality in various cancers. Although DM and hyperglycemia are considered risk factors for pancreatic cancer (PC), antidiabetic treatments for patients with advanced PC have been overlooked. This study aimed to evaluate the impact of hemoglobin A1c (HbA1c) levels on PC survival. METHODS: We retrospectively reviewed the medical records of first-diagnosed patients with advanced PC who were admitted to Konkuk University Medical Center from 2005 to 2011. RESULTS: A total of 127 patients were enrolled, and there were 111 deaths (87.4%) within the 7-year observational period. The most common etiology was disease progression (n=108). DM before PC diagnosis was observed in 65 patients (51.1%), including 28 patients with new-onset DM. The overall median survival times in patients with and without DM were 198 and 263 days, respectively (p=0.091). Survival time according to HbA1c was significantly different between the <7.0% and > or =7.0% groups (362 and 144 days, respectively; p=0.038). In the HbA1c > or =7.0% group, the median overall survival time was 273 days for the metformin group and 145 days for the nonmetformin oral agent group; however, there was no significant difference between the two groups (p=0.058). CONCLUSIONS: A high HbA1c level may be associated with worse survival in patients with advanced PC with DM. Antidiabetic treatment, metformin in particular, was associated with an improved outcome.
Adult ; Aged ; Aged, 80 and over ; Diabetes Complications/*blood/complications/*mortality ; Female ; Hemoglobin A, Glycosylated/*metabolism ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pancreatic Neoplasms/*blood/complications/*mortality ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies

There is a close relationship between diabetes mellitus and heart failure, both of which are known to increase morbidity and mortality. Diabetes can cause or aggravate heart failure, and heart failure can precipitate diabetes. Diabetes mellitus causes structural and functional changes in the heart, such as fibrosis of the myocardium and left ventricular dysfunction. The mechanisms of diabetic cardiomyopathy are metabolic disturbance, myocardial fibrosis, microvascular disease, and autonomic dysfunction. Improper blood glucose control leads to deterioration of heart failure, but the role of strict glycemic control in reducing heart failure is unclear. The role of SGLT2 inhibitors in reducing the incidence of heart failure is of great importance in the treatment of diabetic patients. However, further long-term follow-up and safety studies are needed.
Blood Glucose ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Cardiomyopathies ; Fibrosis ; Follow-Up Studies ; Heart Failure ; Heart ; Humans ; Incidence ; Mortality ; Myocardium ; Ventricular Dysfunction, Left

BACKGROUND: The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. This study compared the effects of sevoflurane and propofol on the incidence of hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.METHODS: This retrospective study included 176 patients with type 2 diabetes mellitus who had undergone lung surgery. Blood glucose levels and clinical outcomes from the preoperative period to the first 2 postoperative days (PODs) were retrospectively examined in patients who received sevoflurane (group S, n= 87) and propofol (group P, n=89) for maintenance of general anesthesia. The primary endpoint was the incidence of persistent hyperglycemia (2 consecutive blood glucose levels > 180 mg/dL [10.0 mmol/L]) during the perioperative period. The secondary composite endpoint was the incidence of major postoperative complications and 30-day mortality rate after surgery.RESULTS: Blood glucose levels similarly increased from the preoperative period to the second POD in both groups (p=0.857). Although blood glucose levels at 2 hours after surgery were significantly lower in group P than in group S (p=0.022; 95% confidence interval for mean difference, −27.154 to −2.090), there was no difference in the incidence of persistent hyperglycemia during the perioperative period (group S, 70%; group P, 69%; p=0.816). The composite of major postoperative complications and all-cause in-hospital and 30-day mortality rates were also comparable between the two groups.CONCLUSION: Sevoflurane and propofol were associated with a comparable incidence of perioperative hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.
Anesthesia ; Anesthesia, General ; Blood Glucose ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Humans ; Hyperglycemia ; Incidence ; Lung ; Mortality ; Perioperative Period ; Postoperative Complications ; Preoperative Period ; Propofol ; Retrospective Studies

BACKGROUNDThere is no agreement as to whether intensive glucose control in type 2 diabetes can reduce the incidence of macrovascular events in these patients. We performed a meta-analysis comparing intensive glucose control or conventional glucose control in randomized controlled trials.

METHODSDatabases including MEDLINE, EMBASE, and Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were the incidence of major macrovascular events.

RESULTSSix trials involving 28 065 patients were included. Analysis suggested that there was an obviously decreased incidence of major macrovascular events in patients having intensive glucose treatment vs. controls (RR 0.92; 95%CI 0.87, 0.98; P = 0.005). However, intensive glycemia control strategies in type 2 diabetes showed no significant impact on the incidence of death from any cause compared with conventional glycemia control strategies, intensive 14.7%, controls 12.0% (RR 0.95; 95%CI 0.80, 1.12; P = 0.55), as well as on the incidence of cardiovascular death, intensive 3.7%, controls 3.6% (RR 1.10, 95%CI 0.79, 1.53; P = 0.57).

CONCLUSIONSControl of glycemia to normal (or near normal levels) in type 2 diabetes appears to be effective in reducing the incidence of major macrovascular events, but there were no significant differences of either the mortality from any cause or from cardiovascular death between the two glycemia-control strategies.

Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; blood ; complications ; drug therapy ; mortality ; Diabetic Angiopathies ; prevention & control ; Glycated Hemoglobin A ; analysis ; Humans ; Randomized Controlled Trials as Topic

OBJECTIVES: Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD). METHODS: Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model. RESULTS: Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m2), lean subjects with diabetes (BMI <21 kg/m2) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI > or =25 kg/m2) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension. CONCLUSIONS: This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.
Aged ; Blood Glucose/analysis ; *Body Mass Index ; Cardiovascular Diseases/etiology/*mortality ; Cohort Studies ; Diabetes Complications ; Diabetes Mellitus/*pathology ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Stroke/etiology/mortality

The factors related to death and functional recovery after primary pontine hemorrhage (PPH) in Koreans has not been well defined. The authors sought to identify independent predictors of death and functional recovery after PPH using data obtained at a single institute. Data were collected retrospectively on 281 patients with PPH admitted to the Stroke Unit at our hospital between January 1, 2000 and December 31, 2009. Multivariate logistic regression analysis was used to evaluate the associations between selected variables and 30-day mortality and 90-day functional recovery after PPH. One-hundred and ten patients (39.1%) died within 30 days of PPH and 27 patients (9.6%) achieved functional recovery within 90 days. By multivariate analysis, unconsciousness, dilated pupils, abnormal respiration, systolic blood pressure < 100 mmHg, hydrocephalus, and conservative treatment were found to be predictors of 30-day mortality, whereas consciousness, intact motor function, no history of hypertension or diabetes mellitus, intact eye movement, a hematoma volume of < 5 mL, no ventricular hemorrhage, and normally sized ventricle were found to be predictors of 90-day functional recovery. The present findings suggest that systolic hypotension of less than 100 mmHg may predict 30-day mortality and a history of underlying hypertension and diabetes mellitus may predict 90-day functional recovery.
Adult ; Aged ; Aged, 80 and over ; Blood Pressure ; *Brain Stem ; Diabetes Complications ; Female ; Humans ; Hydrocephalus/complications ; Hypertension/complications ; Intracranial Hemorrhages/complications/epidemiology/*mortality ; Logistic Models ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; *Recovery of Function ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Time Factors ; Unconsciousness/complications

BACKGROUND: Several epidemiologic studies have shown that increased uric acid is a risk factor of cardiovascular mortality. Elevated serum uric acid is also a feature of insulin resistance. However, increased or decreased levels of uric acid have been variably reported in diabetes and impaired glucose tolerance. The aim of the present study is to evaluate the relation between uric acid and metabolic parameters and chronic complications in type 2 diabetes. METHODS: Total 387 patients with type 2 diabetes were evaluated and divided according to their uric acid level in quartiles. Plasma glucose, lipid profiles, blood pressure, C-peptide levels and complications including nephropathy and retinopathy were compared between four groups according to plasma uric acid levels. Patients were divided as follows : Quartile 1 (<3.7 mg/dL, n=94), Quartile 2 (>or=3.7 mg/dL and < 4.5 mg/dL, n=96), Quartile 3 (>or=4.5 mg/dL and < 5.4 mg/dL, n=101), Quartile 4 (>or=5.4 mg/dL, n=96). RESULTS: Patients within the highest quartile showed significantly longer duration of diabetes, higher prevalence of retinopathy and higher blood pressure, higher level of triglyceride, creatinine and C-peptide (p<0.05). Patients within the lowest quartile showed significantly higher concentrations of fasting plasma glucose, postprandial glucose and HbA1c (p<0.05). In the multiple regression analysis after adjustment for age, sex, duration of diabetes, a positive correlation was found between uric acid levels and creatinine (beta=0.245, p<0.01), triglyceride (beta=0.127, p<0.05), diastolic blood pressure (beta=0.156, p<0.05) and percentage of proliferative diabetic retinopathy (beta=0.141, p<0.05). After readjustment for age, sex, duration of diabetes and creatinine, the strong predictor of uric acid was triglyceride levels (beta=0.161, p<0.05) and diastolic pressure (beta=0.227, p<0.05). CONCLUSION: In type 2 diabetes, elevated uric acid level was related with the components of insulin resistance syndrome and the degree of microvascular complications.
Blood Glucose ; Blood Pressure ; C-Peptide ; Creatinine ; Diabetes Complications* ; Diabetes Mellitus ; Diabetic Retinopathy ; Epidemiologic Studies ; Fasting ; Glucose ; Humans ; Hypertension ; Insulin Resistance ; Mortality ; Plasma* ; Prevalence ; Risk Factors ; Triglycerides ; Uric Acid*

Malnutrition and inflammation are related to high rates of morbidity and mortality in hemodialysis patients. Resistin is associated with nutrition and inflammation. We attempted to determine whether resistin levels may predict clinical outcomes in hemodialysis patients. We conducted a prospective evaluation of 100 outpatients on hemodialysis in a single dialysis center (male, 46%; mean age, 53.7 +/- 16.4 yr). We stratified the patients into 4 groups according to quartiles of serum resistin levels. During the 18-month observational period, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival (log rank test, P = 0.016). After adjustment of all co-variables, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival, compared with reference resistin levels. Higher levels of interleukin-6 were an independent predictor of poor hospitalization-free survival. In contrast, serum resistin levels were not correlated with interleukin-6 levels. The current data showed that low resistin levels may independently predict poor hospitalization free survival in hemodialysis patients.
Adult ; Aged ; Diabetes Complications ; Female ; Hospitalization ; Humans ; Interleukin-6/blood ; Kidney Failure, Chronic/blood/*mortality ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; *Renal Dialysis ; Resistin/*blood ; Survival Analysis

Postoperative acute renal failure is a major problem in surgical patients and may result from varieties of prerenal, renal, and postrenal causes. Mortality of this disorder was distressingly high despite improvement in dialysis and intensive general care. Clinical data from 31 patients with postoperative acute renal failure treated between 1989 and 1993 were reviwed. The results were summerized as follows: 1) There were 16 men and 15 women with a median age of 49 years. Twenty one(6896) of 31 patients were over 50 years old. 2) General surgery 14 cases(45%), cardiac surgery 11 cases(35%), neurologic surgery 3 cases, orthopedic surgery 2 cases and gynecologic surgery 1 case were performed. 3) Preoperative clinical characteristics were over 50 years old in 21 cases(68%), antibiotics in 9 cases(29%), infections in 6 cases, hypertention in 5 cases, diabetes mellitus in 4 cases, radiocontrast agent in 3 cases, jaundice in 3 cases, cardiovascular disease in 3 cases, emergeney operation in 10 cases(32%), and trauma in 4 cases. 4) Perioperative hypotension was 9 cases(29%) and massive blood transfusion was 20 cases(65%). Fourteen of the 31 patients(45%) received intraoperative diuretics, and twenty of 31 patients(66%) received diuretics within 24 hours after operation. 5) Enflurane(66%) was the most commonly used anesthetic, followed by intravenous anesthetics(16%), isoflurane(10%), and halothane(10%). 6) When acute renal failure was diagnosed, urinalysis showed gross or microhematuria in 27 cases (87%), pyuria in 10 cases(32%), and proteinuria in 21 cases(68%). Urine specific gravity in 7 patients(23%) were below 1.010. Routine CBC showed anemia less than 10 g/dl in 16 cases(52%), and thrombocytopenia less than 50,000/mm in 10 cases(32%). During postoperative period blood chemistry showed elevated BUN in most of the cases. BUN levels in 20 cases(65%) were above 60 mg/dl and serum creatinine levels in 26 cases(84%) were above 3mg/dl. Serum sodium levels in 4 cases were below 125 mEq/L and serum potassium levels in 11 cases(35%) were above 6 mEq/L. 7) Nineteen(61%) of 31 patients were nonoliguric type, nine(29%) were oliguric type and three(10%) were anuric type. Fourteen(45%) of 31 patients underwent hemodialysis. 8) Postoperative complications were developed in 25 cases(81%) and pulmonary complications were most common. 9) Median time interval between onset of acute renal failure and death was 18 days(rang to 45 days) and. median time to recovery was 24 days(range, 3 to 72 days). 10) Twenty(6496) of 31 patients were died. Main causes of death were respiratary failure, cardiac failure and sepsis. The high mortality rate was seen in patients with abdceninal operation(79%), postoperative complications(80%), over 50 years old(71%) and oliguric(78%) or anuric(100%) renal failure.
Acute Kidney Injury* ; Anemia ; Anti-Bacterial Agents ; Blood Transfusion ; Cardiovascular Diseases ; Cause of Death ; Chemistry ; Contrast Media ; Creatinine ; Diabetes Mellitus ; Dialysis ; Diuretics ; Female ; Gynecologic Surgical Procedures ; Heart Failure ; Humans ; Hypotension ; Jaundice ; Male ; Middle Aged ; Mortality ; Orthopedics ; Postoperative Complications ; Postoperative Period ; Potassium ; Proteinuria ; Pyuria ; Renal Dialysis ; Renal Insufficiency ; Sepsis ; Sodium ; Specific Gravity ; Thoracic Surgery ; Thrombocytopenia ; Urinalysis