Classification of glucose records from patients at diabetes risk using a combined permutation entropy algorithm

[EN] Background and objectives : The adoption in clinical practice of electronic portable blood or interstitial glucose monitors has enabled the collection, storage, and sharing of massive amounts of glucose level readings. This availability of data opened the door to the application of a multitude of mathematical methods to extract clinical information not discernible with conventional visual inspection. The objective of this study is to assess the capability of Permutation Entropy (PE) to find differences between glucose records of healthy and potentially diabetic subjects. Methods : PE is a mathematical method based on the relative frequency analysis of ordinal patterns in time series that has gained a lot of attention in the last years due to its simplicity, robustness, and per- formance. We study in this paper the applicability of this method to glucose records of subjects at risk of diabetes in order to assess the predictability value of this metric in this context. Results : PE, along with some of its derivatives, was able to find significant differences between diabetic and non¿diabetic patients from records acquired up to 3 years before the diagnosis. The quantitative results for PE were 3.5878 ±0.3916 for the nondiabetic class, and 3.1564 ±0.4166 for the diabetic class. With a classification accuracy higher than 70%, and by means of a Cox regression model, PE demonstrated that it is a very promising candidate as a risk stratification tool for continuous glucose monitoring. Conclusion : PE can be considered as a prospective tool for the early diagnosis of the glucoregulatory system.Cuesta Frau, D.; Miró Martínez, P.; Oltra Crespo, S.; Jordán Núñez, J.; Vargas-Rojo, B.; Vigil-Medina, L. (2018). Classification of glucose records from patients at diabetes risk using a combined permutation entropy algorithm. Computer Methods and Programs in Biomedicine. 165:197-204. https://doi.org/10.1016/j.cmpb.2018.08.018S19720416

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Improvement in cardiovascular prognosis of type 2 diabetes mellitus, is it a reality?

Sin financiación0.104 SJR (2016) Q4, 119/126 Internal Medicine, 324/344 Cardiology and Cardiovascular MedicineUE

Delay in the Detrended Fluctuation Analysis Crossover Point as a Risk Factor for Type 2 Diabetes Mellitus

Detrended Fluctuation Analysis (DFA) measures the complexity of a glucose time series obtained by means of a Continuous Glucose Monitoring System (CGMS) and has proven to be a sensitive marker of glucoregulatory dysfunction. Furthermore, some authors have observed a crossover point in the DFA, signalling a change of dynamics, arguably dependent on the beta-insular function. We investigate whether the characteristics of this crossover point have any influence on the risk of developing type 2 diabetes mellitus (T2DM). To this end we recruited 206 patients at increased risk of T2DM (because of obesity, essential hypertension, or a first-degree relative with T2DM). A CGMS time series was obtained, from which the DFA and the crossover point were calculated. Patients were then followed up every 6 months for a mean of 17.5 months, controlling for the appearance of T2DM diagnostic criteria. The time to crossover point was a significant predictor risk of developing T2DM, even after adjusting for other variables. The angle of the crossover was not predictive by itself but became significantly protective when the model also considered the crossover point. In summary, both a delay and a blunting of the crossover point predict the development of T2DM.Sin financiación2.717 JCR (2016) Q2, 55/128 Medicine, Research & Experimental; Q3, 75/138 Endocrinology & MetabolismUE

Uricemia y síndrome metabólico en pacientes con hipertensión arterial

Objetivo: Los niveles de uricemia se han asociado con el síndrome metabólico (SM). Sin embargo, la relación entre estas 2 variables en pacientes con hipertensión arterial (HTA) esencial no ha sido estudiada. Pacientes y métodos: Estudio observacional, transversal, de 592 pacientes con HTA esencial. Para la definición de SM se emplearon ≥3 criterios de la ATP-III. Se excluyeron a los pacientes con tratamiento hipouricemiante. Resultados: La prevalencia de SM fue del 52% (IC del 95%: 48-56%) y aumentó gradualmente a medida que se incrementaba la uricemia (uricemia: ≤4,7mg/dl, 36%; uricemia ≥6,8mg/dl, 70%; p<0,001). Los enfermos hipertensos con SM mostraron una uricemia media más elevada que los que no tenían esta comorbilidad (6,1±1,5mg/dl vs 5,4±1,3mg/dl; p<0,0001). La prevalencia de hiperuricemia (varones: ≥7,0mg/dl; mujeres: ≥6,0mg/dl) en los pacientes hipertensos que no recibían tratamiento diurético fue del 24,3% (en aquellos con SM, 40,5% frente a un 11,4% en los que no tenían SM; p<0,001). En el análisis multivariante los triglicéridos (OR: 1,008; IC del 95%: 1,004-1,012; p<0,001) y el índice de masa corporal (IMC) (OR: 1,118; IC del 95%: 1,059-1,181; p<0,001) fueron predictores independientes de la uricemia. Conclusiones: En los pacientes con HTA esencial, aproximadamente la mitad padecen SM y uno de cada 4 presenta hiperuricemia. El determinante más relevante del incremento de la concentración sérica de uratos es el aumento del IMC.0,257 JCR (2012) Q2, posición 786 de 1840 (Medicine (miscellaneous)

Glucose series complexity in hypertensive patients

Nonlinear methods have been applied to the analysis of biological signals. Complexity analysis of glucose time series may be a useful tool for the study of the initial phases of glucoregulatory dysfunction. This observational, cross-sectional study was performed in patients with essential hypertension. Glucose complexity was measured with detrended fluctuation analysis (DFA), and glucose variability was measured by the mean amplitudes of glycemic excursion (MAGE). We included 91 patients with a mean age of 59 ± 10 years. We found significant correlations for the number of metabolic syndrome (MS)-defining criteria with DFA (r = 0.233, P = .026) and MAGE (r = 0.396, P < .0001). DFA differed significantly between patients who complied with MS and those who did not (1.44 vs. 1.39, P = .018). The MAGE (f = 5.3, P = .006), diastolic blood pressures (f = 4.1, P = .018), and homeostasis model assessment indices (f = 4.2, P = .018) differed between the DFA tertiles. Multivariate analysis revealed that the only independent determinants of the DFA values were MAGE (β coefficient = 0.002, 95% confidence interval: 0.001-0.004, P = .001) and abdominal circumference (β coefficient = 0.002, 95% confidence interval: 0.000015-0.004, P = .048). In our population, DFA was associated with MS and a number of MS criteria. Complexity analysis seemed to be capable of detecting differences in variables that are arguably related to the risk of the development of type 2 diabetes.Sin financiación2.606 JCR (2014) Q3, 31/60 Peripheral Vascular DiseaseUE

Basal glycaemia and glycosilated hemoglobine as a predictors of type 2 diabetes mellitus development

Objective: The diagnosis of type 2 diabetes mellitus (TDM2) is based either on the plasmatic glycaemia or on HbA1c criteria. Our purpose was to compare the prognostic value of both determinations to identify subjects at increased risk of developing TDM2. Design and method: Observational, longitudinal study of a cohort of patients with an increased risk of T2DM, based on the presence of one of the following criteria: essential hypertension, obesity (BMI > = 30 kg/m2) or a 1st degree relative with TDM2. Routine analysis, including HbA1c and fasting plasma glucose, were obtained at baseline and subsequently every six months. The diagnosis of TDM2 was established according to standard criteria. Results: 206 patients were included. Basal clinical characteristics are showed at table 1. During 17.5 months of mean follow-up 18 patients eventually developed T2DM (58,25 cases /1000 patients /year). In a Cox survival analysis, adjusted for the main clinical and analytical variables, only basal glycaemia and HbA1c resulted as independent predictors of T2DM development (table 2). JOURNAL/jhype/04.02/00004872-201609002-00403/figure1-403/v/2017-07-26T042813Z/r/image-tiff Conclusions: In our population with an increased risk of T2DM, including 92% of hypertensive patients, only basal glycaemia and HbA1c were independent predictors of the new onset of T2DM. HbA1c should be included in the routine evaluation of these patients.Sin financiación4.085 JCR (2106) Q1, 12/63 Peripheral Vascular DiseaseUE

Cystatin C is Associated with Serum Uric Acid in a Hypertensive Population

Hyperuricemia has been related with the development of arterial hypertension Cystatin C, a marker of renal function has been proposed recently as a marker of cardiovascular risk, independently of renal function. We investigate if serum uric acid is related with serum cystatin C in patients with essential hypertension. We included 885 patients (50.7% males), aged 57,8 +/- 14,9 y., diagnosed of essential hypertension and attended in our Hypertension Unit during a 12 month. We performed in all of them a clinical history, a physical examination and routine analysis, including cystatin C (Nephelometry, Behring). Hyperuricemia was defined as serum uric acid > 7 mg/dl (males) or >6 mg/dl (females) or being on treatment with allopurinol. The result was that 272 patients had hyperuricemia (30,7%) with male predominance (36.1%) vs. females (25.5%), [p < 0.0001]. Serum cystatin C did not shown gender differences (males 0.87 +/- 0.269 mg/L and females (0.90 +/- 0.47 mg/L), [p: 0.061]. After adjusting for age, gender, estimated glomerular filtration rate (e-GFR) and diuretic (38.2%) and allopurinol treatment (8.1%), serum uric acid showed a positive correlation with abdominal circumference(r:0.277, p< 0,0001), triglycerides(r:0.195, p < 0.0001), body mass index (r:0,274, p< 0.0001), total cholesterol (r:0.136, p =0.009, LDL-cholesterol (r:0.104; p= 0.049), microalbuminuria (r:0.163, p =0.002), serum ferritin (r.0.108, p= 0.041) and cystatin C (r:0.302, p < 0.0001). Others partial correlations analysed (HDL-cholesterol, glucose, CRP, fibrinogen and systolic and diastolic blood pressure) did not shown significant differences. Multivariate analysis, adjusted for age, gender, MDRD-GFR, and diuretic and allopurinol treatment, showed that triglycerides (B = 0.004, IC 95%:0.002–0.005; p< 0.0001), BMI (B = 0.038, IC 95%: 0.012–0.065; p = 0.005), abdominal circumference (B = 0.013, IC 95%: 0.002–0.25; p = 0.023 and cystatin C (B= 0.875, IC 95%: 0.509–1.241; p < 0.0001) as independent determinants of uric acid levels (model R2= 0.36). In conclusion, in our hypertensive patients serum cystatin C was the main independent predictor of serum uric acid levels. This association, independent of renal function and diuretic and allopurinol treatment, support the relationship of both parameters as cardiovascular risk factors in hypertensive patients.3.980 JCR (2010) Q1, 13/68 Peripheral vascular diseas

Metabolic Syndrome and the Risk of Chronic Renal Disease in a Hypertensive Population

The metabolic syndrome (MS) has been related to the development of renal disease in different populations. Our aim was to study the association of MS with chronic renal disease a hypertensive population. We did the study between a population of 1231 patients attended in our Hypertension Unit with a previous diagnosis of essential hypertension we selected 581 (51.6% males), with a age of 56,8 ± 13,7 years, and basal normal renal function (estimated glomerular filtration rate [e-GFR] calculated by MDRD formula >60/ml/min/1.73m2) and without microalbuminuria (albumin/creatinine ratio <22 mg/gr males and <30 mg/gr females). MS was defined according ATP-III criteria. 310 patients (52%) accomplished for MS criteria and 17 (13%) had type 2 diabetes mellitus. Basal e-GFR was 87.6 ± 18 /ml/min./1.73m2 and basal microalbuminuria 6.5 ± 5.8 mg/gr creatinine. After 4.2 years of follow-up 102 patients (17.3%) developed microalbuminuria: 72 (12.2%) in the group with MS and 30 (5%) in the group without it. 46 patients (7%) developed chronic renal insufficiency: 27 (4, 5%) in whose with MS and 19 (3,2%) in whose without it. In the multivariate analysis the odds ratio (adjusted for age, gender, e-GFR body mass index and treatment with angiotensin system inhibitors), for the development of microalbuminuria was 2.3 (95% CI: 1.36–3.31, p = 0.001) in the group wit MS with respect to the group without it. Excluding diabetics patients this risk decreased but remain significant (OR = 1.88, 95% CI: 1.19–2.98, p = 0.005). Between the MS criteria just fasting glucose predicted the development of microalbuminuria ((OR = 1.82, 95% CI: 1.1–2.9, p = 0.012). The evolution to chronic renal insufficiency did not show differences between the two groups (OR = 1.14, 95% CI: 0.63–2.06, p = 0.66). In conlusión, in our hypertensive population the presence of MS doubled the risk for the development of microalbuminuria, even after excluding diabetics patients. However the risk of chronic renal insufficiency was not higher in the MS group, probably as a consequence of a follow-up period too short in relation to a well preserved basal renal function.3.980 JCR (2010) Q1, 13/68 Peripheral vascular diseas