Progression to microalbuminuria in patients with type 1 diabetes: a seven-year prospective study

<p>Abstract</p> <p>Background</p> <p>The presence of microalbuminuria can be associated with overt nephropathy and cardiovascular disease in patients with type 1 diabetes (T1D). We aimed to determine the incidence and evaluate the baseline predictors for the development of microalbuminuria in patients with T1D.</p> <p>Methods</p> <p>This study is a longitudinal cohort study of 122 normoalbuminuric patients with T1D who were receiving routine clinical care at baseline. A detailed medical history was taken, and a physical examination was performed at baseline. All of the patients were regularly examined for diabetes-associated complications. An analysis of predictors was performed using the Cox regression.</p> <p>Results</p> <p>Over 6.81 (3.59-9.75) years of follow-up, 50 (41%) of the patients developed microalbuminuria. The incidence density was 6.79/100 people per year (95% CI 5.04-8.95), and the microalbuminuria developed after 5.9 (2.44-7.76) and 11 (5-15) years of follow-up and diabetes duration, respectively. After an individual Cox regression, the baseline variables associated with the development of microalbuminuria were age, age at diagnosis, duration of diabetes, systolic and diastolic blood pressure, fasting glycemia, body mass index (BMI), total cholesterol and triglycerides levels, cholesterol/HDL ratio and a family history of type 2 diabetes.After a multivariate Cox regression, the only independent factors associated with the development of microalbuminuria were BMI [HR 1.12 (1.03-1.21)] and cholesterol/HDL ratio [HR 1.32 (1.05-1.67)].</p> <p>Conclusions</p> <p>A higher BMI and cholesterol/HDL ratio increased the risk of developing microalbuminuria in young patients with T1D after a short follow-up. Both risk factors are modifiable and should be identified early and followed closely.</p

ERAS in Spine Surgery

Enhanced recovery after surgery (ERAS) programs afford the opportunity to remedy several challenges within spine surgery. Increasing surgical demand, rising costs, and variability in outcomes favor the need for development of ERAS recommendations in spine surgery. Therefore, official guideline recommendations will likely be published in the coming year. These guidelines were completed following a comprehensive literature search for each of 16 enhanced recovery topics. The majority of interventions remain similar to ERAS recommendations in other subspecialties, consisting primarily of preoperative education and health optimization strategies, multimodal medication protocols during the intraoperative and postoperative periods, and early mobilization with rehabilitation following surgery. Prior to the advent of published ERAS recommendations in spine surgery, several programs have already successfully implemented elements of enhanced recovery for a variety of spine procedures. The success of these programs provides stronger evidence for the utility of ERAS within spine surgery and demonstrates that full implementation of an ERAS program will likely improve recovery for these patients. International and multidisciplinary collaboration will serve to guide ERAS implementation into the future of spine surgery