Lipid measures for prediction of incident cardiovascular disease in diabetic and non-diabetic adults: results of the 8.6 years follow-up of a population based cohort study

<p>Abstract</p> <p>Background</p> <p>Diabetes is a strong risk factor for cardiovascular disease (CVD).The relative role of various lipid measures in determining CVD risk in diabetic patients is still a subject of debate. We aimed to compare performance of different lipid measures as predictors of CVD using discrimination and fitting characteristics in individuals with and without diabetes mellitus from a Middle East Caucasian population.</p> <p>Methods</p> <p>The study population consisted of 1021 diabetic (men = 413, women = 608) and 5310 non-diabetic (men = 2317, women = 2993) subjects, aged ≥ 30 years, free of CVD at baseline. The adjusted hazard ratios (HRs) for CVD were calculated for a 1 standard deviation (SD) change in total cholesterol (TC), log-transformed triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using Cox proportional regression analysis. Incident CVD was ascertained over a median of 8.6 years of follow-up.</p> <p>Results</p> <p>A total of 189 (men = 91, women = 98) and 263(men = 169, women = 94) CVD events occurred, in diabetic and non-diabetic population, respectively. The risk factor adjusted HRs to predict CVD, except for HDL-C, TG and TG/HDL-C, were significant for all lipid measures in diabetic males and were 1.39, 1.45, 1.36 and 1.16 for TC, LDL-C, non- HDL-C and TC/HDL-C respectively. In diabetic women, using multivariate analysis, only TC/HDL-C had significant risk [adjusted HR1.31(1.10-1.57)].Among non-diabetic men, all lipid measures, except for TG, were independent predictors for CVD however; a 1 SD increase in HDL-C significantly decreased the risk of CVD [adjusted HR 0.83(0.70-0.97)].In non-diabetic women, TC, LDL-C, non-HDL-C and TG were independent predictors.</p> <p>There was no difference in the discriminatory power of different lipid measures to predict incident CVD in the risk factor adjusted models, in either sex of diabetic and non-diabetic population.</p> <p>Conclusion</p> <p>Our data according to important test performance characteristics provided evidence based support for WHO recommendation that along with other CVD risk factors serum TC vs. LDL-C, non-HDL-C and TC/HDL-C is a reasonable lipid measure to predict incident CVD among diabetic men. Importantly, HDL-C did not have a protective effect for incident CVD among diabetic population; given that the HDL-C had a protective effect only among non- diabetic men.</p

Perceived barriers to the production of scientific articles among faculty members of some of Iranian dental schools

Objectives To evaluate barriers for production of scientific dental articles by Iranian dental faculty members.Methods An anonymous self-administered questionnaire distributed among faculty members of all dental schools in Iran during June-December 2010. The respondents rated their level of agreement with eleven sentences regarding what they perceive as barriers on scientific dental article production based on a 5-point Likert scale. The data were analyzed using Chi-square test.Results Totally, 330 faculty members completed the questionnaires; &gt;50% were men, and &gt;40 year-olds. About three-fourth of the respondents were assistant professor. More than 80% of the respondents reported to have at least one published Persian article and &gt;50% at least one published English article; older faculty members more than younger, and associate professors more than other academic ranks (p&lt;0.01). “No access to an English editing center”, “insufficient skill for scientific writing in English”, “inappropriate condition for writing in dental school”, and “time limit due to high load of clinical work in dental school” were top four rated perceived barriers.Conclusion The concerns of faculty members for the production of scientific dental documents must be considered. Provision of proper time and condition for writing in the dental school, enhancement of their capacity for scientific writing and establishment of an English editing center in each university may facilitate scientific article production

Clinical Outcomes of Community-Acquired Pneumonia in Patients with Diabetes Mellitus

Background: Studies have found admission hyperglycemia as a predictor of poor outcomes in Community acquired Pneumonia (CAP), whereas others have not. The objective of this study was to evaluate the impact of diabetes mellitus (DM) on mortality as well as Length of stay (LOS) and Time to clinical stability (TCS) of hospitalized patients with CAP. Materials and Methods: Adult patients hospitalized with CAP enrolled at Community-Acquired Pneumonia Organization (CAPO) database with DM were categorized as admission blood glucose ≥ 250 mg/dL (diabetes mellitus blood sugar (BG) \u3e 250) and admission blood glucose ≤ 250 mg/dL (DM BG ≤ 250). CAP outcomes included: all-cause in-hospital mortality, all-cause 28-day mortality, length of stay (LOS) and time to clinical stability (TCS). Results: From a total of 7,303 patients with CAP, 294 (17.7%) had DM; out of whom 960 (13.1%) patients had BG ≤ 250 mg/dL, and 334 (4.6%) patients had BG \u3e 250 mg/dL. The in-hospital mortality was 9.3% for controls, 9.9% for the DM BG ≤ 250 mg/dL group and 13.4% for DM BG \u3e 250 mg/dL group (p = 0.04). Patients with DM BG \u3e 250 mg/dL compared to the control group had a higher risk of in-hospital mortality (Hazard ratio (RR) = 1.32, 95% CI: 1.02-1.72, p = 0.034) and 28-day mortality (RR = 1.31, 95% CI: 1.01-1.71, p = 0.048). Patients in the DM BG ≤ 250 mg/dL group compared to the control group did not have a greater risk for in-hospital mortality (RR = 1.23, 95% CI: 0.16-8.09, p = 0.237), 28-day mortality (RR = 1.09, 95% CI: 0.90-1.32, p = 0.398), LOS (HR = 0.93, 95% CI: 0.85-1.02, p = 0.130), or TCS (HR = 0.95, 95% CI: 0.87-1.05, p = 0.320). Conclusions: DM patients with BG \u3e 250 mg/dL were associated with increased in-hospital mortality and 28-day mortality. Further studies are needed to link the role of hyperglycemia to CAP outcome

Population-based incidence of Type 2 diabetes and its associated risk factors: results from a six-year cohort study in Iran

<p>Abstract</p> <p>Background</p> <p>The Middle East is estimated to have the largest increase in prevalence of diabetes by 2030; yet there is lack of published data on the incidence of Type 2 diabetes in this region. This study aimed to estimate Type 2 diabetes incidence and its associated risk factors in an Iranian urban population.</p> <p>Methods</p> <p>Among 3307 non-diabetics ≥ 20 years (mean age 42 ± 13 years, 42% males), glucose tolerance test was performed at baseline in 1999–2001 and at two consecutive phases in 2001–2005 and 2005–2008. Diabetes and glucose tolerance status were defined according to the ADA 1997 criteria. Logistic regression was used to determine the independent variables associated with incident diabetes and their odds ratios (OR).</p> <p>Results</p> <p>After median follow-up of 6 years, 237 new cases of diabetes were ascertained corresponding to an age and sex standardized cumulative incidence of 6.4% (95%CI: 5.6–7.2) and incidence rate of 10.6 (9.2–12.1) per 1000 person years. Besides classical diabetes risk factors, female sex and low education level significantly increased risk of diabetes in age adjusted models. In full model, the independent predictors were age [OR, 95%CI: 1.2 (1.1–1.3)], family history of diabetes [1.8 (1.3–2.5)], body mass index ≥ 30 kg/m²[2.3 (1.5–3.6)], abdominal obesity [1.9 (1.4–2.6)], high triglyceride [1.4 (1.1–1.9)], Isolated impaired fasting glucose (IFG) [7.4 (3.6–15.0)], Isolated impaired glucose tolerance (IGT) [5.9 (4.2–8.4)] and combined IFG and IGT [42.2 (23.8–74.9)].</p> <p>Conclusion</p> <p>More than 1% of the Iranian urban population older than 20 years develops Type 2 diabetes each year. Combination of IFG and IGT was the strongest predictor of incident diabetes among the modifiable risk factors.</p

Association of liver enzymes with incident type 2 diabetes: A nested case control study in an Iranian population

<p>Abstract</p> <p>Background</p> <p>To investigate the association of Aspartate aminotransferase (AST), Alanin aminotranferase (ALT) and Gamma glutamyl transferase (GGT) with incident type 2 diabetes.</p> <p>Methods</p> <p>In a nested case-control study, AST, ALT, GGT as well as classic diabetes risk factors, insulin and C-reactive protein (CRP) were measured in 133 non-diabetic subjects at baseline of which 68 were cases and 65 were controls. Incident diabetes was defined by the WHO 1999 criteria. Conditional logistic regression was used to calculate the odds ratio (OR) of incident diabetes associated with different hepatic markers. We used factor analysis for clustering of classic diabetes risk factors.</p> <p>Results</p> <p>In Univariate analysis both ALT and GGT were associated with diabetes with ORs of 3.07(1.21–7.79) and 2.91(1.29–6.53) respectively. After adjustment for CRP and insulin, ALT and GGT were still predictive of incident diabetes. When the model was further adjusted for anthropometric, blood pressure and metabolic factors, only ALT was independently associated with diabetes [OR = 3.18 (1.02–9.86)]. No difference was found between the area under the receiver operating characteristic curves of the models with and without ALT (0.820 and 0.802 respectively, P = 0.4)</p> <p>Conclusion</p> <p>ALT is associated with incident type 2 diabetes independent of classic risk factors. However, its addition to the classic risk factors does not improve the prediction of diabetes.</p