Egészségügyi szakmai irányelv : A diabetes mellitus kórismézéséről, a cukorbetegek antihyperglykaemiás kezeléséről és gondozásáról felnőttkorban

Gaál, Zsolt; Gerö, L.; Hídvégi, Tibor; Jermendy, György; Kempler, Péter; Lengyel, Csaba; Várkonyi, Tamás; Winkler, Gábor; Wittmann, István

doi:10.24121/dh.2020.14

Cited by 13 publications

(7 citation statements)

References 162 publications

(232 reference statements)

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“…The situation is similar in Scotland, 16 Poland 17 and Hungary. 18,19 Guidelines in the Netherlands also mostly follow KDIGO and ADA but suggest even lower blood pressure goals. However, statin therapy is recommended only in patients with serum cholesterol levels >2.5 mmol/L and thiazide diuretics should be administered as first-line therapy in patients without micro- or macroalbuminuria.…”

Section: Discussionmentioning

confidence: 99%

Guidelines and clinical practice at the primary level of healthcare in patients with type 2 diabetes mellitus with and without kidney disease in five European countries

Eder

Leierer

Kerschbaum

et al. 2018

Diabetes and Vascular Disease Research

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Background: The number of patients with type 2 diabetes mellitus and diabetes mellitus-associated chronic kidney disease varies considerably between countries. Next to differences in genetic as well as life style risk factors, varying practices in medical care delivery might cause this diversity. Method: The PROVALID study recruited 4000 patients with type 2 diabetes mellitus at the primary level of healthcare in five European countries (Austria, Hungary, The Netherlands, Poland and Scotland). Baseline data were used to describe patient characteristics and compare the adherence to ADA (American Diabetes Association) and KDIGO (Kidney Disease: Improving Global Outcomes) guidelines with respect to metabolic and blood pressure control, use of renin-angiotensin system-blocking agents, statins and acetylsalicylic acid between the countries. Results: About 34.8% of the population had evidence of diabetes mellitus-associated chronic kidney disease. The median HbA1c level of the cohort was 6.8% (ranging from 6.5 in Poland to 7.0% in Scotland). Mean blood pressure was 136/79 (±17/10) and significantly higher in subjects with elevated albuminuria. These individuals also were more often treated with renin-angiotensin system-blocking agents (74.1% vs 84.6%), whereas the use of statins was driven by cardiovascular comorbidity. Acetylsalicylic acid was used in only 28.9% subjects. Despite similar cardiovascular comorbidities and renal function, the use of renin-angiotensin system-blocking agents varied significantly between the countries from 66.7% to 87.4%. An even higher variability was observed for patients >40 years of age using statins (39.8%-82.7%) and administration of acetylsalicylic acid in patients older than 50 years (5.2%-43.8%). Conclusion: Our study shows that medical practice in type 2 diabetes mellitus patients with and without renal disease is different in European countries. Longitudinal follow-up will reveal if this diversity affects clinical endpoints.

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Section: Discussionmentioning

confidence: 99%

Guidelines and clinical practice at the primary level of healthcare in patients with type 2 diabetes mellitus with and without kidney disease in five European countries

Eder

Leierer

Kerschbaum

et al. 2018

Diabetes and Vascular Disease Research

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“…From fasting trigliceride (TG), glucose and insulin levels insulin resistance indices: Trigliceride-Glucose index: TyG = ln[38,67*Tg(mg/dl)*18*glucose(mg/ dl)/2], and homeostasis model assessement 2 insulin resistance index (HOMA2-IR) values were calculated [35,36]. Diabetes mellitus (DM) and prediabetes (impaired fasting glucose (IFG)/impaired glucose tolerance (IGT)) were diagnosed according to the WHO, 2016 American Diabetes Association (ADA), and Hungarian guidelines [37][38][39] based on the 75 g OGTT and/or HbA1c results.…”

Section: Phenotypingmentioning

confidence: 99%

PNPLA3 rs738409 risk genotype decouples TyG index from HOMA2-IR and intrahepatic lipid content

Nádasdi

Gál

Masszi

et al. 2023

Cardiovasc Diabetol

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Background Recent reports suggested a different predictive value for TyG index compared to HOMA-IR in coronary artery calcification (CAC) and other atherosclerotic outcomes, despite that both indices are proposed as surrogate markers of insulin resistance. We hypothesized a key role for liver pathology as an explanation and therefore assessed the relationship among the two indices and the intrahepatic lipid content stratified by PNPLA3 rs738409 genotypes as a known non-alcoholic fatty liver disease (NAFLD) genetic risk. Methods Thirty-nine women from a prior GDM-genetic study were recalled with PNPLA3 rs738409 CC and GG genotypes for metabolic phenotyping and to assess hepatic triglyceride content (HTGC). 75 g OGTT was performed, fasting lipid, glucose, insulin levels and calculated insulin resistance indices (TyG and HOMA2-IR) were used. HTGC was measured by MR based methods. Mann–Whitney-U, χ2 and for the correlation analysis Spearman rank order tests were applied. Results The PNPLA3 rs738409 genotype had a significant effect on the direct correlation between the HOMA2-IR and TyG index: the correlation (R = 0.52, p = 0.0054) found in the CC group was completely abolished in those with the GG (NAFLD) risk genotype. In addition, the HOMA2-IR correlated with HTGC in the entire study population (R = 0.69, p < 0.0001) and also separately in both genotypes (CC R = 0.62, p = 0.0006, GG: R = 0.74, p = 0.0058). In contrast, the correlation between TyG index and HTGC was only significant in rs738409 CC genotype group (R = 0.42, p = 0.0284) but not in GG group. A similar pattern was observed in the correlation between TG and HTGC (CC: R = 0.41, p = 0.0335), when the components of the TyG index were separately assessed. Conclusions PNPLA3 rs738409 risk genotype completely decoupled the direct correlation between two surrogate markers of insulin resistance: TyG and HOMA2-IR confirming our hypothesis. The liver lipid content increased in parallel with the HOMA2-IR independent of genotype, in contrast to the TyG index where the risk genotype abolished the correlation. This phenomenon seems to be related to the nature of hepatic fat accumulation and to the different concepts establishing the two insulin resistance markers.

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“…Az adatgyűjtés természetéből eredően munkánk nem ad választ arra vonatkozóan, hogy a cukorbetegség növelheti-e a fertőződés kockázatát. Kétségtelen, hogy anyagunkban a diabetesesek aránya magasabb az ismert hazai populációs megfigyelésekből származókénál, 30 Feldolgozásunkban a vércukorszint, a glykaemiás állapot prognózist befolyásoló szerepe nem volt reálisan megítélhető. Részben, mert a felvételi vércukorszint vegyesen volt éhomi, illetve étkezés utáni minta, részben, mert betegeink életkorából adódóan nem volt szükség "szoros" anyagcserekontroll elérésére.…”

Section: Betegek Módszerekunclassified

Koronavírus-fertőzés cukorbetegeken – A 2020. évi COVID-19-járvány első fázisának tapasztalatai az ÉKC Új Szent János Kórházban

Schandl¹,

Veress²,

Lengyel³

et al. 2020

Diabetologia Hungarica

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Egészségügyi szakmai irányelv : A diabetes mellitus kórismézéséről, a cukorbetegek antihyperglykaemiás kezeléséről és gondozásáról felnőttkorban

Abstract: A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

Cited by 13 publications

References 162 publications

Guidelines and clinical practice at the primary level of healthcare in patients with type 2 diabetes mellitus with and without kidney disease in five European countries

Guidelines and clinical practice at the primary level of healthcare in patients with type 2 diabetes mellitus with and without kidney disease in five European countries

PNPLA3 rs738409 risk genotype decouples TyG index from HOMA2-IR and intrahepatic lipid content

Koronavírus-fertőzés cukorbetegeken – A 2020. évi COVID-19-járvány első fázisának tapasztalatai az ÉKC Új Szent János Kórházban

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