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Microvascular and Macrovascular Complications of Diabetes

Michael J. Fowler
Apr 1, 2008; 26:77-82
Diabetes Foundation




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Hyperglycemie and Microvascular and Macrovascular Disease in Diabetes

Ronald Klein
Feb 1, 1995; 18:258-268
Kelly West Lecture 1994




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Erratum. Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach. Diabetes Care 2020;43:852-859




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Predicting the Risk of Inpatient Hypoglycemia With Machine Learning Using Electronic Health Records

OBJECTIVE

We analyzed data from inpatients with diabetes admitted to a large university hospital to predict the risk of hypoglycemia through the use of machine learning algorithms.

RESEARCH DESIGN AND METHODS

Four years of data were extracted from a hospital electronic health record system. This included laboratory and point-of-care blood glucose (BG) values to identify biochemical and clinically significant hypoglycemic episodes (BG ≤3.9 and ≤2.9 mmol/L, respectively). We used patient demographics, administered medications, vital signs, laboratory results, and procedures performed during the hospital stays to inform the model. Two iterations of the data set included the doses of insulin administered and the past history of inpatient hypoglycemia. Eighteen different prediction models were compared using the area under the receiver operating characteristic curve (AUROC) through a 10-fold cross validation.

RESULTS

We analyzed data obtained from 17,658 inpatients with diabetes who underwent 32,758 admissions between July 2014 and August 2018. The predictive factors from the logistic regression model included people undergoing procedures, weight, type of diabetes, oxygen saturation level, use of medications (insulin, sulfonylurea, and metformin), and albumin levels. The machine learning model with the best performance was the XGBoost model (AUROC 0.96). This outperformed the logistic regression model, which had an AUROC of 0.75 for the estimation of the risk of clinically significant hypoglycemia.

CONCLUSIONS

Advanced machine learning models are superior to logistic regression models in predicting the risk of hypoglycemia in inpatients with diabetes. Trials of such models should be conducted in real time to evaluate their utility to reduce inpatient hypoglycemia.




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The Association of Energy and Macronutrient Intake at Dinner Versus Breakfast With Disease-Specific and All-Cause Mortality Among People With Diabetes: The U.S. National Health and Nutrition Examination Survey, 2003-2014

OBJECTIVE

This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes.

RESEARCH DESIGN AND METHODS

A total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences () in energy and macronutrient intake between dinner and breakfast ( = dinner – breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between and diabetes, cardiovascular disease (CVD), and all-cause mortality.

RESULTS

Among the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR]energy 1.92, 99% CI 1.08–3.42; HRprotein 1.92, 99% CI 1.06–3.49) and CVD (HRenergy 1.69, 99% CI 1.02–2.80; HRprotein 1.96, 99% CI 1.14–3.39). The highest quintile of total fat was related to CVD mortality (HR 1.67, 99% CI 1.01–2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94–0.98) and CVD (HR 0.95, 95% CI 0.93–0.97) mortality, respectively.

CONCLUSIONS

Higher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.




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Gujarat university, second MBBS examination, pharmacology question papers (2010-2014)

Gujarat university, second MBBS examination, pharmacology question papers (2010-2014)




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Gujarat university, second MBBS examination, pharmacology question papers, January 2015

Gujarat university, second MBBS examination, pharmacology question papers, January 2015




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MD pharmacology examination, question papers, Gujarat university, April 2012

MD pharmacology examination, question papers, Gujarat university, April 2012




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MD pharmacology examination, question papers, Gujarat university, October 2012

MD pharmacology examination, question papers, Gujarat university, October 2012




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MD pharmacology examination, question papers, Gujarat university, April 2013

MD pharmacology examination, question papers, Gujarat university, April 2013




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Immigration Enforcement in the United States: The Rise of a Formidable Machinery

MPI has released a major study that describes and analyzes today’s immigration enforcement programs, as they have developed and grown in the 25 years since IRCA launched the current enforcement era.




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Immigration Enforcement in the United States: The Rise of a Formidable Machinery

Release of a major report that describes and analyzes the immigration enforcement system in the United States as it has developed and grown in the quarter century since the Immigration Reform and Control Act of 1986 launched the current era of enforcement.




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Introduction to The Old Ways: A Journey on Foot by Robert Macfarlane

My first exposure to Robert Macfarlane happened a year ago when I picked up a battered copy of The Wild Places in order to shelve it. Instead, I checked it out from my branch and stayed up past midnight to read it. Thanks to Macfarlane, I was exposed to Roger Deakin's Wild Wood and Notes from Walnut Tree Farm. I found photos of Walnut Tree Farm, the late Deakin's house, much visited by Macfarlane, while searching for more information about both of them online.

I am from probably the last generation of American children to be raised on English children's books. I know that there is a generation of Quidditch-playing adults that were weaned on the Harry Potter books of British-born J. K. Rowling. While the Harry Potter books are gripping, they lack an essential British characteristic shared by many successful authors of British children's books:

  • Rudyard Kipling - the two Puck of Pook's Hill books
  • Rosemary Sucliff - all of her books
  • Elizabeth Goudge - Rowling helped get Linnets & Valerians and The Little White Horse republished
  • L. M. Boston - the Greene Knowe series
  • William Mayne
  • Robert Westall
  • Diana Wynne Jones - the British landscape of an alternative Britain
  • J. R. R. Tolkein -The Hobbit
  • Kenneth Graham - The Wind in the Willows
  • T. H. White - The Once and Future King
  • Susan Cooper - The Dark is Rising series
I'm sure that there are many more. What these authors and books have in common is a palpable sense of landscape; the English and Welsh earth itself is as present and influential as any of the characters. In any Harry Potter book I had the sense that the only character connected to the land was Hagrid; the rest of the wizards were interested in nature only insofar as they could exploit it for magical potions or familiars.

Both Macfarlane and his late mentor Deakin possessed the same sense of awareness of the land as these children's authors. Deakin kept his hedgerows alive to shelter birds and let animals wander at will through his house. Macfarlane travels, mostly on foot, as he did while he hiked and climbed in both The Wild Places and The Old Ways.




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Sticky pineapple and macadamia upside-down cake

This is what I think of as an honest cake - not tizzy, just homely, buttery and ever-so more-ish with its tender, nutty crumb and sweet, caramelised pineapple topping. I particularly love the way the sides, through some kind of magical alchemy of heat and sugar, become ever-so-slightly crunchy. There are a couple of little things I've noticed when I bake it - the first is that it cooks better and looks better when baked in a regular, not a non-stick, cake tin. And the second is that it's really important not to overload the tin with pineapple or it will release too much liquid and the centre of the cake will be soggy.




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Greek chicken with polenta and sumac crumb

6 chicken thighs 1 egg 1/2 cup polenta 1 tbsp. sumac 1 tsp cumin seeds salt flakes and freshly ground pepper, to season 60 ml (1/4 cup) pomegranate molasses Avocado Tzatziki: 1 cup)Greek-style yoghurt 1 ripe avocado, flesh coarsely mashed with a fork 3 Lebanese cucumbers, grated, squeeze to remove excess liquid 3 garlic cloves, crushed 1/4 cup chopped coriander leaves 1 tbsp. chopped mint leaves juice of 1/2 lime pinch of Himalayan salt




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Chocolate brownies with crystallised ginger and macadamia nuts

140g unsalted butter 200g dark chocolate 100g light brown sugar 100g caster sugar 2 teaspoons vanilla extract 2 eggs 1 egg yolk 85g plain flour 55g macadamia nuts, lightly toasted, chopped 30g crystallised ginger, chopped Sifted cocoa powder, to dust




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Malaysian chicken satay with roasted macadamia dipping sauce

I seriously love cooking on the Weber more in winter cooler temperature make us feel more cosy and accentuate the taste buds and smell . Replaced the traditional peanuts with our wonderful local macadamias




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Eucalyptus smoked Marburg emu fillet, beets, macadamia plus Lilly Pilly and finger lime spritzer

Delicious Australian dish with fresh Lilly Pilly and finger lime spritzer.




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Bush food macadamia, white chocolate and pepperleaf cookies

125g butter, softened 1 cup caster sugar 1 egg 1 tsp vanilla essence 1 and 1/2 cups plain flour, sifted 1 tsp baking powder 1/4 tsp. pepper leaf spice, ground 1 cup white chocolate chips 1/3 cup raw macadamia nuts, chopped




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MACADAMIA PESTO POTATO SALAD WITH CRISPY PROSCIUTTO AND MARKET CHERRY TOMATOES

Love this time of year where our makers are abundant with the sweet aroma of fresh basil . Here is my take on a fancy potato salad of macadamia pesto , crispy prosciutto, sweet cherry tomatoes




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Lady finger parfait with warm chocolate sauce and crushed Honey Macadamias

The local lady finger bananas are so sweet and moorish!




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Raw and char-grilled broccoli salad with macadamia and semi-hard goats cheese

This salad is inspired by a good chef friend of mine who cooked with me last weekend. Such a healthy way to enjoy broccoli which is so delicious at the moment. It's wonderful to utilize the whole vegetable and the added fibre in the stalk which we use in the salad.Feel free to explore with certain quantities in this recipe therefore I encourage you to taste and adjust to your own personal taste. You can also add chopped green olives which add an extra dimension.




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Autumn roasted vegetables with lemon thyme and a drizzle of macadamia honey

Nothing beats beautifully roasted vegetables caramelized in their own sugar content to accompany a simple roast dinner or even on their own with a nice salad. The addition of perfumed lemon thyme and macadamia gives a nice touch.




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Rice and macadamia salad

This salad is our go-to staple. Everyone loves it. It's healthy, colourful and so, so easy. It can also be made entirely with local ingredients.




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Impact of Glucose Level on Micro- and Macrovascular Disease in the General Population: A Mendelian Randomization Study

OBJECTIVE

To evaluate whether high glucose levels in the normoglycemic range and higher have a causal genetic effect on risk of retinopathy, neuropathy, nephropathy, chronic kidney disease (CKD), peripheral arterial disease (PAD), and myocardial infarction (MI; positive control) in the general population.

RESEARCH DESIGN AND METHODS

This study applied observational and one-sample Mendelian randomization (MR) analyses to individual-level data from 117,193 Danish individuals, and validation by two-sample MR analyses on summary-level data from 133,010 individuals from the Meta-Analyses of Glucose and Insulin-Related Traits Consortium (MAGIC), 117,165 from the CKDGen Consortium, and 452,264 from the UK Biobank.

RESULTS

Observationally, glucose levels in the normoglycemic range and higher were associated with high risks of retinopathy, neuropathy, diabetic nephropathy, PAD, and MI (all P for trend <0.001). In genetic causal analyses, the risk ratio for a 1 mmol/L higher glucose level was 2.01 (95% CI 1.18–3.41) for retinopathy, 2.15 (1.38–3.35) for neuropathy, 1.58 (1.04–2.40) for diabetic nephropathy, 0.97 (0.84–1.12) for estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, 1.19 (0.90–1.58) for PAD, and 1.49 (1.02–2.17) for MI. Summary-level data from the MAGIC, the CKDGen Consortium, and the UK Biobank gave a genetic risk ratio of 4.55 (95% CI 2.26–9.15) for retinopathy, 1.48 (0.83–2.66) for peripheral neuropathy, 0.98 (0.94–1.01) for eGFR <60 mL/min/1.73 m2, and 1.23 (0.57–2.67) for PAD per 1 mmol/L higher glucose level.

CONCLUSIONS

Glucose levels in the normoglycemic range and higher were prospectively associated with a high risk of retinopathy, neuropathy, diabetic nephropathy, eGFR <60 mL/min/1.73 m2, PAD, and MI. These associations were confirmed in genetic causal analyses for retinopathy, neuropathy, diabetic nephropathy, and MI, but they could not be confirmed for PAD and seemed to be refuted for eGFR <60 mL/min/1.73 m2.




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Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach

OBJECTIVE

To construct and internally validate prediction models to estimate the risk of long-term end-organ complications and mortality in patients with type 2 diabetes and obesity that can be used to inform treatment decisions for patients and practitioners who are considering metabolic surgery.

RESEARCH DESIGN AND METHODS

A total of 2,287 patients with type 2 diabetes who underwent metabolic surgery between 1998 and 2017 in the Cleveland Clinic Health System were propensity-matched 1:5 to 11,435 nonsurgical patients with BMI ≥30 kg/m2 and type 2 diabetes who received usual care with follow-up through December 2018. Multivariable time-to-event regression and random forest machine learning models were built and internally validated using fivefold cross-validation to predict the 10-year risk for four outcomes of interest. The prediction models were programmed to construct user-friendly web-based and smartphone applications of Individualized Diabetes Complications (IDC) Risk Scores for clinical use.

RESULTS

The prediction tools demonstrated the following discrimination ability based on the area under the receiver operating characteristic curve (1 = perfect discrimination and 0.5 = chance) at 10 years in the surgical and nonsurgical groups, respectively: all-cause mortality (0.79 and 0.81), coronary artery events (0.66 and 0.67), heart failure (0.73 and 0.75), and nephropathy (0.73 and 0.76). When a patient’s data are entered into the IDC application, it estimates the individualized 10-year morbidity and mortality risks with and without undergoing metabolic surgery.

CONCLUSIONS

The IDC Risk Scores can provide personalized evidence-based risk information for patients with type 2 diabetes and obesity about future cardiovascular outcomes and mortality with and without metabolic surgery based on their current status of obesity, diabetes, and related cardiometabolic conditions.




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Interdisciplinary Team Care for Diabetic Patients by Primary Care Physicians, Advanced Practice Nurses, and Clinical Pharmacists

David Willens
Apr 1, 2011; 29:60-68
Feature Articles




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Microvascular and Macrovascular Complications of Diabetes

Michael J. Fowler
Apr 1, 2008; 26:77-82
Diabetes Foundation




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Mind or Stomach? Imagination or Necessity?

"An army marches on its stomach" said Napoleon, who is also credited with saying "Imagination rules the world". Is history driven by raw necessity and elementary needs? Or is history hewn by people from their imagination, dreams and ideas?

The answer is simple: 'Both'. The challenge is to untangle imagination from necessity. Consider these examples:

An ancient Jewish saying is "Without flour, there is no Torah. Without Torah there is no flour." (Avot 3:17) Scholars don't eat much, but they do need to eat. And if you feed them, they produce wonders.

Give a typewriter to a monkey and he might eventually tap out Shakespeare's sonnets, but it's not very likely. Give that monkey an inventive mind and he will produce poetry, a vaccine against polio, and the atom bomb. Why the bomb? He needed it.

Necessity is the mother of invention, they say, but it's actually a two-way street. For instance, human inventiveness includes dreams of cosmic domination, leading to war. Hence the need for that bomb. Satisfying a need, like the need for flour, induces inventiveness. And this inventiveness, like the discovery of genetically modified organisms, creates new needs. Necessity induces inventiveness, and inventiveness creates new dangers, challenges and needs. This cycle is endless because the realm of imagination is boundless, far greater than prosaic reality, as we discussed elsewhere.

Imagination and necessity are intertwined, but still are quite different. Necessity focusses primarily on what we know, while imagination focusses on the unknown.

We know from experience that we need food, shelter, warmth, love, and so on. These requirements force themselves on our awareness. Even the need for protection against surprise is known, though the surprise is not.

Imagination operates in the realm of the unknown. We seek the new, the interesting, or the frightful. Imagination feeds our fears of the unknown and nurtures our hopes for the unimaginable. We explore the bounds of the possible and try breaking through to the impossible.

Mind or stomach? Imagination or necessity? Every 'known' has an 'unknown' lurking behind it, and every 'unknown' may some day be discovered or dreamed into existence. Every mind has a stomach, and a stomach with no mind is not human.




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Intimacy vs Isolation: Why Do Some People Struggle to Form Intimate Relationships?

Loneliness is a surprisingly common phenomenon in the 21st century. In 2018, a survey conducted by The Economist and the Kaiser Family Foundation revealed that 22% of adults in the United States and 23% of adults in the United Kingdom often or always feel lonely or left out. Interestingly, many people who describe themselves as […]




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Retirement living contracts : advising residents / [Danielle Macolino], Fisher Jefferies Barristers & Solicitors.




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Superfund Death Benefits -Suzanne Mackenzie - SLIDES.




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Along the macadam road / Fotoula Reynolds.




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Report of the Independent Review Panel- Gaming machines licensing process: regulatory review.




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Stigma & Resilience Framework : (National strategic framework to address HIV stigma and build resilience capacity for people living with HIV) / written and edited by Brent Allan and Kirsten Machon.

"The HIV resilience framework will be of relevance to a wide range of people involved at all levels of the HIV response. We hope it provides encouragement for government decision makers and policy developers to pursue consistent and enabling policy and legislative environments and work cooperatively between jurisdictions and across departments to achieve best practice. Our consultation suggests that consistent legislation with the goal of supporting strong health outcomes, making disclosure safe, and eliminating stigmatising laws is crucial to creating environments in which people with HIV feel safe to access testing, treatment, and care. The HIV resilience framework also contains valuable insights for those who have responsibility for HIV health program management and service delivery, providing guidance to help ensure that programs, services, interventions or strategies supporting people living with HIV are developed and delivered in a way that is mindful of the interlinked twin goals of building personal resilience and eliminating stigma and discrimination." --President's message (page 6).




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An evaluation of bicycle passing distances in the ACT / JRR Mackenzie, JK Dutschke, G Ponte.

To evaluate bicycle passing distances in the Australian Capital Territory (ACT), specialised passing distance measurement devices (PDMDs) were installed on a sample of 23 cyclists who ride in the ACT. Passing distance data and GPS data was collected by cyclists using the PDMDs for a four week period, during a trial phase of a newly legislated minimum passing distance (MPD) rule The MPD rule requires drivers to provide more than 1 metre of space when passing a cyclist on a road with a speed limit of 60 km/h or below, and 1.5 meters of space when passing a cyclist on a road with a speed limit above 60 km/h.-- Abstract.




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Macquarie atlas of Indigenous Australia / general editors, Bill Arthur & Frances Morphy ; [foreword by Patrick Dodson].

Aboriginal Australians -- Names.




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Rage inside the machine : the prejudice of algorithms, and how to stop the internet making bigots of us all / Robert Elliott Smith.

Internet -- Social aspects.




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[Phrommachat]

19th century




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[Phrommachat]

19th century




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[Phrommachat]




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Dr. Macker.




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Des médications hypothermique et hyperthermique, et des moyens thérapeutiques qui les remplissent. De la pharmacothermogenèse, ou Théories de l'action des médicaments sur la température animale / par P.F. da Costa.

Lisbonne : Impr. de l'Académie royale des sciences, 1881.




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Diabetes : its pathological physiology / by John J.R. Macleod.

London : Edward Arnold, 1913.




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Dictionnaire de médecine, de chirurgie, de pharmacie, des sciences accessoires et de l'art vétérinaire / de P.-H. Nysten.

Londres : J.-B. Baillière, 1855.




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Dictionnaire des drogues simples et composées, ou dictionnaire d'histoire naturelle médicale, de pharmacologie et de chimie pharmaceutique / par A. Chevallier... et A. Richard.

Paris : Béchet jeune, 1827-1829.




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Dictionnaire des termes de médecine, chirurgie, art vétérinaire, pharmacie, histoire naturelle, botanique, physique, chimie, etc.; / Par Bégin [and others].

Paris : Béchet : Bailliere : Crevot, 1823.




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Die chemische und mikroskopisch-bakteriologische Untersuchung des Wassers, zum Gebrauche für Chemiker, Ärzte, Medicinalbeamte, Pharmaceuten, Fabrikanten und Techniker / bearbeitet von F. Tiemann und A. Gärtner.

Braunschweig : F. Vieweg, 1889.




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Die Cholera Asiatica, deren, Ursachen, Behandlung und Verhütung auf Grund der während der 1866 er Epidemie in der Seidau bei Budissin gemachten Erfahrungen / monographisch dargestellt von Carl Julius Büttner.

Leipzig : Duncker & Humblot, 1868.




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Die Ohnmacht bei der Geburt vom gerichtsärztlichen Standpunkt : eine Abhandlung für Aerzte und praktische Juristen / von Moritz Freyer.

Berlin : J. Springer, 1887.