Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 1. Abstract. Objective To investigate the long term effects of continuous subcutaneous insulin infusion (insulin pump therapy) on cardiovascular diseases and mortality in people with type 1 diabetes. Design Observational study. Setting Swedish National Diabetes Register, Sweden 2. Participants 1. 8 1. Main outcome measures Cox regression analysis was used to estimate hazard ratios for the outcomes, with stratification of propensity scores including clinical characteristics, risk factors for cardiovascular disease, treatments, and previous diseases. Results Follow- up was for a mean of 6. December 2. 01. 2, with 1. With multiple daily injections as reference, the adjusted hazard ratios for insulin pump treatment were significantly lower: 0. Hazard ratios were lower, but not significantly so, for fatal or non- fatal coronary heart disease and fatal or non- fatal cardiovascular disease. Unadjusted absolute differences were 3. When lower body mass index and previous cardiovascular diseases were excluded, results of subgroup analyses were similar to the results from complete data. A sensitivity analysis of unmeasured confounders in all individuals showed that an unmeasured confounders with hazard ratio of 1. Data on patient education and frequency of blood glucose monitoring were missing, which might have influenced the observed association. Conclusion Among people with type 1 diabetes use of insulin pump therapy is associated with lower cardiovascular mortality than treatment with multiple daily insulin injections. Introduction. Nobody disputes the fact that type 1 diabetes increases the risk of death from cardiovascular diseases. A recent study from the Swedish National Diabetes Register showed that individuals with type 1 diabetes who have a glycated haemoglobin A1c (Hb. A1c) concentration of 6. Hb. A1c concentrations. The Diabetes Control and Complication Trial and other recent studies have shown that tight glucose control reduces the risk, delays the onset, and slows the progression of complications. Other studies have shown that both hyperglycaemia and hypoglycaemia are risk factors for cardiovascular disease. Continuous subcutaneous insulin infusion involves connection of a catheter on the outside of the body to an insulin pump that is programmed to supply the body’s basal needs. Appendix b sps-b-1 of 25 published: 01/01 revised: appendix b pump station checklist and test procedures appendix b.1 acceptance performance testing requirements. Get your free download and resources for the Body Beast Workout Schedule here at Sweet Life Fitness. Learn the best Body Beast schedule for you to use. Is your workout setup for max results? Get emailed new blog updates, articles and tips. The 8 Absolute Worst Foods You Can Pump Into Your Body. The person with the pump administers doses to cover meals and correct blood glucose concentrations. Many pumps these days have a bolus wizard that calculates how much insulin the person needs, taking expected carbohydrate intake, current blood glucose concentrations and previously still active insulin into consideration. Pumps can provide an accurate history of insulin use through their menus. Often this history can be uploaded and displayed as a graph for purposes of trend analysis. Insulin pumps can result in fewer episodes of hyperglycaemia and hypoglycaemia than multiple daily injections. ![]() An insulin pump is a medical device used for the administration of insulin in the treatment of diabetes mellitus, also known as continuous subcutaneous insulin. Print the way you want. Can a Body Pump class help you to lose weight? Take a look at the calories burned by BodyPump and join in with the popular Les Mills workout! Coordinating Care for Patients With Chronic HF: Recommendations e295 11.2. Systems of Care to Promote Care Coordination for Patients With Chronic HF e296 11.3. Check out the latest fitness trends, workouts, gear, sports news and health nutrition and advice, all on SELF. Here you can download free Ford F150 Repair Manual. This is an online version of Ford F150 repair manual and it is only available as PDF file. Download Free Body Pump Routine Pdf FilesSome studies have shown that insulin pumps provide better glycaemic control than multiple daily injections. Three meta- analyses of randomised controlled trials investigated the association between treatment with a pump and the occurrence of hyperglycaemia. All three analyses found that insulin pump treatment was associated with improvement in Hb. A1c compared with multiple daily injections, without a higher rate of hypoglycaemia. Fredheim and colleagues found that insulin pump therapy reduced the rate of severe hypoglycaemia by 2. Given the importance of glycaemic control,1. In 2. 01. 3 in Swedish people with type 1 diabetes, one out of every four women and one out of every five men used insulin pump treatment. Over half of all Swedish children with type 1 diabetes also use insulin pumps. Sceptics argue that subcutaneous infusion of insulin by a pump could increase costs of treatment and cause practical problems for people with diabetes. Because of the scarcity of data, the relative risk for cardiovascular disease of associated with the treatments is unknown. Sweden offers excellent opportunities for studying individuals with type 1 diabetes. All affected people are treated at negligible personal cost. About 9. 5% of all individuals with type 1 diabetes have been entered in the National Diabetes Register, which includes detailed clinical data from each appointment. The register can be linked via Sweden’s unique personal identity number to the cause of death, inpatient, socioeconomic, and other population based registers. Our primary aim was to analyse the effect of insulin pump treatment on cardiovascular mortality. Methods. Swedish National Diabetes Register. The Swedish National Diabetes Register was initiated in 1. Trained doctors and nurses report annually to the register,1. Information is collected during appointments at hospital outpatient clinics and primary healthcare centres nationwide. Several previous reports have been published concerning trends in risk factor control and risk prediction based on the register,1. Swedish healthcare system for patients with diabetes. Patient involvement. There was no patient involvement in this study. The work within the Swedish National Diabetes Register, as this article, is done in a continuous but informal dialogue with people with diabetes. Participants. We included 1. Swedish National Diabetes Register for whom data were available about the use of insulin pump therapy or multiple daily injections. A total of 2. 44. Type 1 diabetes was epidemiologically defined as all patients who received insulin treatment only (for diabetes mellitus) and were aged under 3. Swedish hospitals. Baseline appointments took place in 2. December 2. 01. 2. Treatment with insulin pump has been documented in the register since the year 2. All individuals were recruited from the Swedish National Diabetes Register with no exclusion criteria. Examinations at baseline and the end of the study. Clinical characteristics at baseline included type of glucose lowering treatment, age, duration of diabetes, sex, Hb. A1c, systolic blood pressure, diastolic blood pressure, height, weight, waist circumference, physical activity, smoking habits, total cholesterol, high density lipoprotein cholesterol, triglycerides, microalbuminuria, plasma creatinine, use of antihypertensive drugs, lipid lowering drugs and acetylsalicylic acid (aspirin), atrial fibrillation, and histories of cardiovascular disease, heart failure and atrial fibrillation, Furthermore, baseline yearly income (in Swedish kroner), marital status (single, married, divorced, or widowed) and educational level (lower (up to school year 9), intermediate (years 1. Longitudinal Integration Database for Health Insurance and Labour Market Studies, Statistics Sweden. Body mass index (BMI) was calculated as weight/height. Waist circumference (cm) was measured at the height of the navel. Physical activity was graded as low (no activity or less than once a week) or higher (twice or more a week). Smoking was defined as one or more cigarettes a day, one pipe a day, or having quit within the past three months. The Swedish standard for recording blood pressure as used by the Swedish National Diabetes Register is the average (mm Hg) of two supine readings (Korotkoff sounds I- V) with a cuff of appropriate size after at least 5 minutes of rest. Analyses of Hb. A1c were quality assured nationwide by regular calibration with the HPLC Mono- S method and then converted to mmol/mol. Albuminuria was classed as urine albumin excretion > 2. A history of cardiovascular disease was defined the same way as for the outcome; ICD- 1. I5. 0 for heart failure; code I4. C0. 0- C0. 97 for all cancer; codes K7. F2. 0- 2. 9 and F3. We estimated updated mean Hb. A1c during the study period using all values from baseline until the year before an event occurred during the study or otherwise from baseline until 3. December 2. 01. 2. Change in Hb. A1c during the study period was estimated as the difference between baseline and final measurements, the latter estimated as the value before the year of an event or otherwise the value in 2. Hypoglycaemic attacks that required a hospital admission, with ICD- 1. December 2. 01. 2. Follow- up and definition of endpoints. All individuals were monitored from the baseline examination until death or the first incident or until 3. December 2. 01. 2. The mean follow- up period was 6. The major primary endpoints were fatal or non- fatal coronary heart disease, fatal or non- fatal cardiovascular disease, fatal cardiovascular disease, and total mortality. Non- fatal coronary heart disease was defined as non- fatal myocardial infarction (ICD- 1. I2. 1), unstable angina (ICD- 1. I2. 0. 0), percutaneous coronary intervention, and/or coronary artery bypass grafting. Fatal coronary heart disease was defined as ICD- 1. I2. 0- I2. 5. Stroke was defined as fatal or non- fatal cerebral infarction, intracerebral haemorrhage, or unspecified stroke (ICD- 1. I6. 1, I6. 3, I6. Cardiovascular disease was defined as the composite of coronary heart disease or stroke, whichever came first. A secondary endpoint was mortality from non- cardiovascular disease. A history of heart failure was defined as ICD- 1. I5. 0, and atrial fibrillation before the study start was defined as ICD- 1. I4. 8. All events were obtained by linking to the Swedish cause of death and hospital discharge registers, a reliable validated alternative to revised hospital discharge and death certificates. Statistical analysis. We applied five imputations using the Markov chain Monte Carlo technique for missing data in the sample of 1. SAS MI and MIANALYSE procedures. We recorded baseline clinical features as mean values (SD) or frequencies (%) of each multiple imputed variable in the two treatment groups (insulin pump therapy or multiple daily injections) and calculated significance for crude differences between the two groups with Student’s t test or .
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