Is there a “burnt-out diabetes” phenomenon in patients on hemodialysis?
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There are several different definitions of the combination of multiple nosology within one organism: comorbidity, multimorbidity, syntropy, and dystropy, etc. Comorbidity is an important component of pathophysiological processes, which has a significant impact on the course and outcome of cardiac diseases in patients. Therefore, in recent decades, researchers have been actively engaged in the problem of assessing the degree of contribution of comorbidity to the overall state of the body. For this purpose, a number of scales and indices of comorbidity have been developed, which allow estimating the burden of comorbidity on the underlying disease within certain groups of diseases. Consideration of comorbidity in routine clinical practice allows to increase reliable prognostic assumptions and correctly build a therapeutic strategy. As a result, it improves patients’ quality of life, allows them to achieve favorable outcomes, and most effectively prevents complications in patients with comorbidity. The assessment of comorbidity in cardiological, endocrinological, oncological, and neurological pathologies is particularly important, since they have the most general negative effect on the entire patient’s body.
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Although the level of glycated hemoglobin (HbA 1C ) reflects chronic glycemic control, treatment-induced decreases in HbA 1C in patients who have established diabetes do not always predict beneficial clinical outcomes. Clinical outcomes are dramatically influenced by the history of previous glycemic control, the extent of current clinical complications, and the side effects of therapeutic agents. Rational approaches to the intensity of glycemic control in individual patients should take these factors into consideration, as well as in setting an appropriate goal for the HbA 1C target.
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在治疗的选择和老病人的幸存上识别 comorbidity 的影响的目的(≥ 70 年) 与先进非小的房间肺癌症(NSCLC ) 。方法临床的特征和 177 个老病人，有好表演地位，的治疗的选择 PS ≤ 1 ) 回顾地在肿瘤学部门被分析，上海肺的医院，在到 2005 年 12 月的 2005 年 1 月之间。幸存数据仅仅在收到了化疗的那些被分析。所有病人被 comorbidity 的数字作为没有(0 ) 成层，温和(1 2 ) 并且严重(≥ 3 ) 组。结果病人，收到了化疗，的比例温和、严重的 comorbidity 是显著地不同的(79.3%，76.2%和57.4%， P = 0.038 )，并且也有关于在三个组之中的辩解的放射疗法率显著地不同(21.7%，11.7%和37.0%， P = 0.014 )。中部的幸存和 1 年的幸存在没有评价，温和、严重的 comorbidity 组，是 13.6 对 10.2 对 7.6 个月并且 53.5% 对 41.3% 对 20.8% 分别地(木头等级， P = 0.071 ) 。在 univariate 并且多，变量考克斯为分析建模，仅仅严重的 comorbidity 是有 NSCLC 的老病人的幸存的一个独立危险因素。相对比率(RR， 95% CI ) ：(2.09， 1.06 4.15 ) ， P = 0.034。结论 Comorbidity 可以稍微与先进 NSCLC 影响老病人的治疗的选择，但是仅仅严重的 comorbidity 是幸存的一个独立预示的因素。
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According to this study: In non-insulin-treated patients who have type 2 diabetes, structured self-monitoring of blood glucose leads to clinically significant improvements in glycated hemoglobin. Patients with suboptimal glycemic control derive the most benefit from self-monitoring.
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Comorbidity may be an important reason for head and neck surgeons to treat elderly patients less intensively. This article provides an overview of the influence of age and comorbidity on choice of therapy, postoperative complications, and survival.Several retrospective studies show that elderly patients can undergo surgery if they do not have severe comorbid disorders. Severe comorbidity influences the rate of postoperative complications, and the higher complication rate in older patients reported in some studies is probably due to a higher level of comorbidity. Comorbidity also affects the survival of cancer patients, but several studies have failed to detect a relation between age and survival after correction for comorbidity. Thus, although severe comorbidity may influence the choice of treatment, patient age as such should not be a reason to exclude patients from intensive therapy.If severe comorbidity is not present, elderly patients should receive standard treatment for head and neck cancer. Treatment choice should be based on medical findings and patient preference, not on chronologic age.
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Vascular complications of diabetes result from long lasting unsatisfactory glycemic control. We usually assess glycemic control based on the value of glycated hemoglobin HbA1c. The glycated hemoglobin test, however, says nothing about short-term glycemic fluctuations. Recently, continuous monitoring of glycemia has enabled us an in-depth assessment of changes in glucose concentrations, called glycemic variability. Together with the research of short-term glycemic variability, also the study of long-term fluctuations in glycemic control based on HbA1c variability has now intensified. Glycemic variability may be related to oxidation stress, endothelial dysfunction and inflammation, the factors traditionally associated with vascular damage. This overview summarizes the recent findings in the field of glycemic variability and its possible association with microvascular complications in patients with type 1 and type 2 diabetes.Key words: glycemic variability, HbA1c variability, microvascular complications, type 1 and type 2 diabetes mellitus.
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In this study, we investigated which predictors from people with type 1 diabetes at initiation of intensive treatment that increase the risk of not achieving glycemic target. Data from a clinical trial with type 1 diabetes people (n=460) were used in a logistic regression model to analyze the effect of the predictors on achievement of glycemic target. Results indicate that age, smoking, glycated hemoglobin, 1,5-anhydroglucitol and fluctuation from continuous glucose monitoring are predictors of achievement of glycemic target, which can be used in an algorithm to predict people who fail to achieve glycemic target.
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