Patients with diabetes mellitus type 2 and chronic kidney disease (T2DM-CKD) have a 5 times higher risk of developing severe SARS-CoV-2 infection than those without these 2 diseases. The goal of this ...study is to provide information on T2DM-CKD and COVID-19 outcomes, with an emphasis on the association with anti-diabetic medications.
Study is designed as a retrospective cohort analysis covering the years 2020 and 2021. Data from the National Diabetes Registry (CroDiab) were linked to hospital data, primary healthcare data, Causes of Death Registry data, the SARS-CoV-2 vaccination database, and the SARS-CoV-2 test results database. Study outcomes were cumulative incidence of SARS-CoV-2 positivity, COVID-19 hospitalizations, and COVID-19 deaths. For outcome predictors, logistic regression models were developed.
Of 231 796 patients with diabetes mellitus type 2 in the database, 7 539 were T2DM-CKD (3.25%). The 2-year cumulative incidences of all three studies' outcomes were higher in T2DM-CKD than in diabetes patients without CKD (positivity 18.1% vs. 14.4%; hospitalization 9.7% vs. 4.2%; death 3.3% vs. 1.1%, all p<0.001). For COVID-19 hospitalization, protective factors were SGLT-2 inhibitors use (OR 0.430; 95%CI 0.257-0.719) and metformin use (OR 0.769; 95% CI 0.643-0.920), risk factors were insulin use (1.411; 95%CI 1.167-1.706) and sulfonylureas use (OR 1.226; 95% CI 1.027-1.464). For SARS-CoV-2 positivity protective factors were SGLT-2 inhibitors (0.607; 95% CI 0.448-0.823), repaglinide use (OR 0.765; 95% CI 0.593-0.986) and metformin use (OR 0.857; 95% CI 0.770-0.994). DPP-4 inhibitors showed a non-significant decrease in risk for COVID-19 death (OR 0.761; 95% CI 0.568-1.019).
T2DM-CKD are heavily burdened by COVID-19 disease. Our results suggest no association between antidiabetic drugs and COVID-19 death outcome while SGLT-2 and metformin show to be protective against COVID-19 hospitalization and infection, repaglinide against infection, and insulin and sulfonylureas show to be risk factors for COVID-19 hospitalization and infection. Further research in T2DM-CKD is needed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose. The pathogenesis of diabetic retinopathy (DR) is insufficiently understood but may possibly involve chronic, low-grade inflammation. The aim of this cross-sectional study was to investigate ...the relationship between inflammatory and haemostatic markers, other markers of endothelial dysfunction and anthropometric parameters, and their association with DR in patients with type 2 diabetes. Methods. According to the DR status patients were divided into three groups: no retinopathy, mild/moderate nonproliferative (NPDR), and severe NPDR/proliferative retinopathy (PDR). Results. The groups did not differ in the levels of inflammatory and haemostatic markers, other markers of endothelial dysfunction, and anthropometric parameters. After dividing the patients according to the level of obesity (defined by BMI, WC, and WHR) into three groups ANOVA showed the differences in C-reactive protein according to the WC (P=0.0265) and in fibrinogen according to the WHR (P=0.0102) as well as in total cholesterol (P=0.0109) and triglycerides (P=0.0133) according to the BMI. Logistic regression analyses showed that diabetes duration and prolonged poor glycemic control are the main predictors of retinopathy in patients with type 2 diabetes. Conclusion. Interrelations between obesity, inflammation, haemostatic disturbance, and other risk factors may possibly play an important additional role in endothelial dysfunction involved in the pathogenesis of diabetic retinopathy.
Diabetes is one of the leading public health problems worldwide. Diabetic macular
edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of
diabetes is the ...primary goal of treatment and the basic way of preventing and stopping the progression
of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three
decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy.
Novel treatment option for DME depends on visual acuity and location/extent of macular thickening
based on optical coherence tomography scans. According to the International Clinical Classification
Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New
guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME
and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be
treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment
of choice for patients with a tractional component of DME. Nowadays, traditional treatment
goal of preventing blindness in patients with DME has been changed by the new goal aiming to
restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials
addressing this new concept have been underway worldwide.
We aimed to assess health-related quality of life (HRQoL) among people with diabetes or hypertension, estimate the effect of cardiovascular comorbidities on HRQoL as well as compare HRQoL in these ...groups with that of healthy individuals.
A total of 9,070 respondents aged 18 years and over were assessed for HRQoL. Data were obtained from the Croatian Adult Health Survey. Respondents were divided into five groups according to their medical history: participants with hypertension (RR), hypertension and cardiovascular comorbidities (RR+), diabetes mellitus (DM), diabetes and cardiovascular comorbidities (DM+) and participants free of these conditions (healthy individuals, HI). HRQoL was assessed on 8 dimensions of the SF-36 questionnaire.
Participants with diabetes and those with hypertension reported comparably limited (p > 0.05) HRQoL in all dimensions of SF-36, compared with healthy individuals (p < 0.05). If cardiovascular comorbidities were present, both participants with diabetes and participants with hypertension had lower results on all SF-36 scales (p > 0.05) than participants without such comorbidities (p < 0.05). The results remained after adjustment for sociodemographic variables (age, sex, employment, financial status and education).
Diabetes and hypertension seem to comparably impair HRQoL. Cardiovascular comorbidities further reduce HRQoL in participants with both chronic conditions. Future research of interventions aimed at improving these participants' HRQoL is needed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To determine the prevalence of common somatic comorbidities among coronavirus disease 2019 (COVID-19) positive patients in Croatia in the first pandemic wave, and assess the differences in clinical ...outcomes depending on the presence of comorbidities.
We analyzed data from patients confirmed to be SARS-CoV-2-positive from February through May 2020. The data were obtained from clinical laboratories, primary health care providers, and hospitals. Previously recorded comorbidities, including diabetes, cancer, circulatory diseases, chronic pulmonary, and kidney disease, were analyzed.
Among 2249 patients, 46.0% were men (median age 51 years; median disease duration 27 days). Hospitalization was required for 41.8% patients, mechanical ventilation for 2.5%, while 4.7% of all patients died. Patients who died were significantly older (median 82 vs 50 years, P<0.001) with a higher prevalence of all investigated comorbidities (all p's <0.001), more frequently required mechanical ventilation (34% vs 1%, P<0.001), and had shorter length of hospital stay (median 13 vs 27 days, P<0.001) with no sex preponderance. Patients requiring mechanical ventilation were significantly older (median age 70 vs 51 years, P<0.001), more frequently men (59.6% vs 45.7%, P=0.037), showed a higher prevalence of all comorbidities except ischemic heart and chronic kidney disease (all p's <0.001), and demonstrated a higher case-fatality rate (63.2% vs 3.2%, P<0.001).
COVID-19 patients who died in the first pandemic wave in Croatia were more likely to suffer previous somatic comorbidities. This corroborates the findings of similar studies and calls for further research into the underlying disease mechanisms, hence providing ground for more efficient preventive measures.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Induction of labour (IOL) is of increasing prevalence worldwide and reliable prediction of its successful outcome is important. Traditional clinical methods for predicting successful IOL outcomes ...have been supplemented with newer technologies. The aim of this study was to compare transvaginal sonographic (TVS) cervical length measurement with Bishop score in predicting labour induction outcomes.
This study included pregnant women with term pregnancy, indication for IOL and unfavourable cervix (Bishop score >6) who had TVS performed prior to IOL. Exclusion critetia were regular contractions, ruptured membranes, non-cephalic presentation, uterine scar and pregnancy complications potentially influencing study outcomes. Outcomes measured were successful IOL defined as achievement of active phase of labour and vaginal delivery. Receiver operating characteristic (ROC) curves were used to determine diagnostic accuracy and sensitivity, specificity, positive and negative predictive values. Statistical significance was defined as p<0.05.
Among 112 studied participants, IOL was successful in 101 (90.2%) pregnant women. AUC for Bishop score >2 was 0.831 (95% CI, 0.744-0.917, p<0.001) and for cervical length <30 mm 0.679 (95% CI 0.514-0.844, p<0.052). A total of 81 (72.3%) pregnant women delivered vaginally; AUC for Bishop score >2 was 0.754 (95% CI 0.648-0.861, p<0.001) and for cervical length <30 mm 0.602 (95% CI 0.484-0.720, p=0.092) which was the only insignificant predictor.
Bishop score >2 is a better predictor for both successful IOL and vaginal delivery among induced women with term pregnancy and unfavourable cervix compared to cervical length <30 mm.
Objective Trends in diabetes and cardiovascular mortality rates are considerably different between women and men; this can be partially explained by differences in diabetes control. The aim of this ...cross-sectional study was to assess whether sex differences exist in effective control of cardiovascular risk factors among persons with type 2 diabetes treated at the Vuk Vrhovac University Clinic in 2008. Materials and Methods We performed a cross-sectional analysis including 8,775 patients who attended the clinic in 2008. Levels of HbA1c, systolic and diastolic blood pressure (SBP, DBP), LDL-cholesterol (LDL) and triglycerides (TG) were analyzed. Multiple adjusted odds-ratios were calculated for categories of cardiovascular risk factors considered not being in control (HbA1c ≥7%, SBP ≥130 mmHg, DBP ≥80 mmHg, LDL ≥2.5 mmol/L, TG ≥1.7 mmol/L). Results Women had higher levels of HbA1c (7.05 vs. 6.86%; p<0.001), despite the fact that a larger proportion of women were receiving insulin therapy than men (51.3% vs. 44%). Women also had higher mean values of SBP (144.7 vs. 141.9 mmHg; p<0.001) and LDL (2.92 vs. 2.84 mmol/L). There were no differences in DBP (86.1 vs. 86.0 mmHg; p=0.748) and only triglyceride levels were higher in men (2.04 vs. 1.94 mmol/L; p=0.003). In multi-adjusted logistic regression model female sex was associated with a higher odds ratio of having uncontrolled values of HbA1c (OR=1.21; 95%CI 1.11-1.32), SBP (OR=1.21; 95%CI 1.07-1.37) and LDL (OR=1.13; 95%CI 1.04-1.23). Conclusion Women with diabetes have poorer control of main potentially modifiable cardiovascular risk factors than men. This could contribute to disparities in trends in cardiovascular mortality and it demands clinicians' and public health awareness.
Organization and policy declarations and documents support breastfeeding within Croatian healthcare from early pregnancy until long after birth.However, results regarding the implementation ...efficiency and existing policy gaps are still missing. We aimed to identify hospital midwives’ challenges in providing breastfeeding support and to recognize implementation policy gaps in hospitals in Croatia, in the field of breastfeeding.Qualitative study designed in line with COREQ criteria, using semi-structured interviews in 12 healthcare professionals working in delivery room and maternity ward in 1 clinical hospital. Content was analyzed inductively by 3 researchers.The analyses identified 5 themes: 1. self-awareness of hospital-midwives regarding their importance and success in breastfeeding-establishment, 2. focusing on mother’s motivation instead of on problem solving; 3. lack of continuity of care within the healthcare system, 4. lack of standard operating procedures and other organizational issues, 5. satisfaction of hospital staff with their level of knowledge despite lacking of breastfeeding education.The hospital’s midwives invest lots of resources and individual efforts in breastfeeding management, however, the interventions are not efficient, and the staff has no firm guidance on which topics to focus their efforts on.Possible areas for intervention are day-to-day work organization, structuring in-house education, new employees’ utilization, influencing midwifery-schools’ curricula, and establishing standard operating procedures to help the staff to deal with the most common breastfeeding problems. National breastfeeding policy does not seem to be fully and efficiently implemented in Croatia. In order to tackle breastfeeding challenges, revision of existing policies, good implementation management and clear definition of responsibilities regarding breastfeeding protection and promotion in hospitals are needed.
Improvements in agricultural practices in Croatia have reduced exposure to consumption of aristolochic acid-contaminated flour and development of endemic (Balkan) nephropathy. Therefore, it was ...hypothesized that Bosnian immigrants who settled in an endemic area in Croatia 15-30 years ago would be at lower risk of developing endemic nephropathy because of reduced exposure to aristolochic acid. To test this hypothesis, past and present exposure to aristolochic acid, proximal tubule damage as a hallmark of endemic nephropathy, and prevalence of CKD in Bosnian immigrants were analyzed.
In this cross-sectional observational study from 2005 to 2010, 2161 farmers were divided into groups: indigenous inhabitants from endemic nephropathy and nonendemic nephropathy villages and Bosnian immigrants; α-1 microglobulin-to-creatinine ratio >31.5 mg/g and eGFR<60 ml/min per 1.73 m(2) were considered to be abnormal.
CKD and proximal tubule damage prevalence was significantly lower in Bosnian immigrants than inhabitants of endemic nephropathy villages (6.9% versus 16.6%; P<0.001; 1.3% versus 7.3%; P=0.003, respectively); 20 years ago, Bosnian immigrants observed fewer Aristolochia clematitis in cultivated fields (41.9% versus 67.8%) and fewer seeds among wheat seeds (6.1% versus 35.6%) and ate more purchased than homemade bread compared with Croatian farmers from endemic nephropathy villages (38.5% versus 14.8%, P<0.001). Both Croatian farmers and Bosnian immigrants observe significantly fewer Aristolochia plants growing in their fields compared with 15-30 years ago. Prior aristolochic acid exposure was associated with proximal tubule damage (odds ratio, 1.64; 95% confidence interval, 1.04 to 2.58; P=0.02), whereas present exposure was not (odds ratio, 1.31; 95% confidence interval, 0.75 to 2.30; P=0.33). Furthermore, immigrant status was an independent negative predictor of proximal tubule damage (odds ratio, 0.40; 95% confidence interval, 0.19 to 0.86; P=0.02).
Bosnian immigrants and autochthonous Croats residing in endemic areas are exposed significantly less to ingestion of aristolochic acid than in the past. The prevalence of endemic nephropathy and its associated urothelial cancers is predicted to decrease over time.
The aim of this study was to determine the association of maternal pre-pregnancy body mass index (BMI) and pregnancy outcome among pregnant women in Croatia. Women who gave birth in Croatia in 2017 ...were categorised into four groups according to pre-pregnancy BMI and analysed regarding maternal characteristics and perinatal outcomes. Among 32,051 pregnant women, 5.3% were underweight, 65.5% had normal BMI, 20.4% were overweight and 8.8% were obese. Overweight and obese women had a higher prevalence of induction of labour and delivery by caesarean section compared to normal-BMI women (p < .001), while underweight and obese women had a higher prevalence of preterm birth (p < .001). Gestational diabetes (GD), gestational hypertension and preeclampsia were higher in overweight and obese group. Multivariate logistic regression model showed that older maternal age, higher BMI, GD, gestational hypertension and preeclampsia were significant predictors of having non-spontaneous onset of labour and of not delivering vaginally.
Impact statement
What is already known on this subject? Women with abnormal body mass index (BMI) compared to women with normal BMI have an increased risk of various complications during pregnancy and labour such as preterm birth and low birth weight for underweight women, and foetal macrosomia, labour induction and delivery by caesarean section for obese women.
What do the results of this study add? This study was performed on a large national cohort of pregnant women and its results show that the majority of adverse perinatal outcomes present in obese women are also present among overweight women. Additional attention should be paid to women with a modest increase in BMI who present the majority of women with abnormal BMI.
What are the implications of these findings for clinical practice and/or further research? Risks identified in this study must be acknowledged and taken into account when counselling and managing women before and during pregnancy and labour. Women must be encouraged throughout pregnancy to either gain weight or limit weight gain if they are in adverse BMI group.
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