Pancreatic Cancer-Associated Diabetes is Clinically Distinguishable From Conventional Diabetes.
J Surg Res. 2021 Jan 13;261:215-225
Authors: Yoon BH, Ang SM, Alabd A, Furlong K, Yeo CJ, Lavu H, Winter JM
BACKGROUND: Type 3c diabetes mellitus (T3cDM) is diabetes secondary to other pancreatic diseases such as chronic pancreatitis, pancreatic resection, cystic fibrosis, and pancreatic ductal adenocarcinoma (PDA). Clinically, it may easily be confused with conventional type 2 diabetes mellitus (T2DM). A delay in pancreatic cancer diagnosis and treatment leads to a worse outcome. Therefore, early recognition of PDA-associated T3cDM and distinction from conventional T2DM represents an opportunity improve survival in patients with PDA.
METHODS: Six hundred and sixty four patients with PDA underwent pancreatic resection. Patients were classified as per whether or not they had diabetes. The specific type of diabetes was determined. T3cDM surgical patients (n = 127) were compared with a control group of medical patients with T2DM who did not have PDA (n = 127).
RESULTS: Patients with T3cDM were older (66 versus 61 y, P < 0.001), had lower body mass indices (25.9 versus 32.1, P < 0.001), more favorable hemoglobin A1c levels (7.0 versus 8.8, P < 0.001), higher alanine aminotransferase levels (39 versus 20, P < 0.001), and lower creatinine levels (0.8 versus 0.9 mg/dL, P < 0.001). In addition, they were more likely to be insulin dependent. In a subgroup analysis of surgical patients, T3cDM (versus surgical patients with T2DM and no diabetes) was not associated with surrogate markers of main pancreatic duct obstruction and glandular atrophy.
CONCLUSIONS: PDA-associated T3cDM has a distinctive presenting phenotype compared with medical patients with conventional T2DM. Greater attention to associated signs, symptoms, and biochemical data could identify patients at risk for harboring an underlying pancreatic malignancy and trigger diagnostic pathways leading to earlier PDA diagnosis and treatment.
PMID: 33453685 [PubMed - as supplied by publisher]
Relationship between type 2 diabetes mellitus and markers of cutaneous melanoma aggressiveness: An observational multi-centric study in 443 patients with melanoma.
Br J Dermatol. 2021 Jan 16;:
Authors: Nagore E, Martinez-Garcia MA, Gomez-Olivas JD, Manrique-Silva E, Martorell A, Bañuls J, Carrera C, Ortiz P, Gardeazabal J, Boada A, de Eusebio E, Chiner E, Gonzalez C, Pérez-Gil A, Cullen D, Formigón M, de Unamuno B, Navarro-Soriano C, Muriel A, Gozal D
BACKGROUND: Some studies have suggested a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. Efforts are underway to identify preventable and treatable factors associated with greater melanoma aggressiveness, but no studies to date have examined the relationship between T2DM and the aggressiveness of cutaneous melanoma at diagnosis.
OBJECTIVES: To explore potential associations between T2DM, glycaemic control and metformin treatment and the aggressiveness of cutaneous melanoma.
METHODS: Cross-sectional multi-centric study in 443 patients diagnosed with cutaneous melanoma. At diagnosis, all patients completed a standardised protocol and a fasting blood sample was extract to analyse their glucose levels, glycated haemoglobin concentration and markers of systemic inflammation. Melanoma characteristics and aggressiveness factors (Breslow thickness, ulceration, tumour mitotic rate (TMR), sentinel lymph node (SLN) involvement and tumour stage) were also recorded.
RESULTS: The patients' mean age was 55.9±15.5 (SD) years and 50.6% were male. Their median Breslow thickness was 0.85, with 56% at ≤ 1 mm, 21.7% at >1-2 mm, 14.2% at >2-4 mm and 8.1 at >4 mm. Forty-eight (10.8%) patients were diagnosed with T2DM. and this finding was associated with a Breslow thickness >2 (OR 2.6; 95%CI: 1.4-4.9; p=0.004) and > 4 mm (OR 3.6; 95%CI: 1.7-7.9; p=0.001), TMR >5/mm2 (OR 4.5; 95%CI: 1.4-13.7; p=0.009), SLN involvement (OR 2.3; 95%CI: 1-5.7; p=0.038) and tumour stages III-IV (vs. I-II) (OR 3.4; 95%CI: 1.6-7.4; p=0.002), after adjusting for age, gender, obesity, alcohol intake and smoking habits. No significant associations emerged between glycated haemoglobin levels, metformin treatment and melanoma aggressiveness.
CONCLUSIONS: T2DM, rather than glycaemic control and metformin treatment, is associated with increased cutaneous melanoma aggressiveness at diagnosis.
PMID: 33453061 [PubMed - as supplied by publisher]
Interdisciplinary Primary Care Team Expertise and Diabetes Care Management.
J Am Board Fam Med. 2021 Jan-Feb;34(1):151-161
Authors: Miller-Rosales C, Rodriguez HP
BACKGROUND: Interdisciplinary primary care team expertise can aid patient self management of type 2 diabetes, but small community health centers (CHCs) may not have the volume to consistently provide interprofessional care. We examine whether care team role expertise is associated with patients' experiences of chronic care and whether the relationship is stronger for small CHC sites.
METHODS: Surveys of 1277 adults with diabetes (2012; response rate = 47%) that assessed nonphysician team roles involved in managing their chronic care, including community health workers, diabetes educators, nutritionists, pharmacists, mental health providers, and other general staff, were integrated with clinical and administrative data from 14 CHCs. Random effects regression models estimated the association of team expertise, CHC size, and 1) patients' experiences of chronic care; and 2) hemoglobin A1c control, controlling for patient comorbidities, sex, race/ethnicity/primary language, age, and insurance coverage.
RESULTS: Care teams with community health workers ( β = 7.67, P < .01), diabetes educators ( β = 6.05, P < .01), nutritionists ( β = 5.21, P < .01), and other general staff ([Formula: see text] =4.96, P = .02) were associated with better patients' experiences of chronic care, but not hemoglobin A1c control. Patients of small CHC sites reported better experiences of care ( β = 2.15, P = .03) with each additional team role reported, but the relationship was not significant for large CHCs.
CONCLUSIONS: Patients with access to care team expertise in self-management support, including diabetes educators, nutritionists, community health workers, and other general staff report better experiences of chronic care. These team roles may reduce barriers to patient self management and improve patients' overall experiences of chronic care, particularly in small CHC sites.
PMID: 33452093 [PubMed - as supplied by publisher]
Inter-relationship of risk factors and pathways associated with chronic kidney disease in patients with type 2 diabetes mellitus: a structural equation modelling analysis.
Public Health. 2021 Jan 12;:
Authors: Wang CP, Lu YC, Hung WC, Tsai IT, Chang YH, Hu DW, Hsu CC, Wu CC, Wei CT, Chung FM, Lee YJ
OBJECTIVES: Diabetes mellitus is the most common cause of chronic kidney disease (CKD); however, the inter-relationships and pathogenetic mechanisms among risk factors are still largely unknown. Structural equation modelling (SEM) was applied to test a hypothesis of causal pathways related to CKD in patients with type 2 diabetes mellitus (T2DM).
STUDY DESIGN: This is a prospective observational study.
METHODS: A total of 3395 patients with T2DM were enrolled in this study. A hypothesised SEM was applied to assess associations among demographic data, diabetic self-management behaviours, diabetes control, lifestyle, psycho-social, chronic inflammation factors, anthropometric and metabolic variables simultaneously and the risk of CKD.
RESULTS: Demographic data (including education, marital status and mini-mental state examination score) (-0.075), white blood cell count (0.084), high blood pressure (0.144), World Health Organisation (WHO) 5 well-being index (-0.082), diabetes control (0.099), triglyceride (0.091) and uric acid (0.282) levels had direct effects on the risk of CKD. The final model could explain 26% of the variability in baseline CKD status. In addition, the same direct and specific indirect factors at baseline CKD status analysis contributed to the risk of CKD at the 12-month follow-up. The final model could explain 31% of the variability in the risk of CKD at the 12-month follow-up.
CONCLUSIONS: This study investigates associations between factors obtained from real-world daily practice and CKD status simultaneously and delineates the potential pathways and inter-relationships of the risk factors that contribute to the development of CKD in patients with T2DM.
PMID: 33451823 [PubMed - as supplied by publisher]