The American journal of medicine
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Randomized Controlled Trial Multicenter Study Comparative Study
A(1c) control in a primary care setting: self-titrating an insulin analog pre-mix (INITIATEplus trial).
To study glycemic control and hypoglycemia development upon initiation of insulin through a self-titration schedule in a 24-week trial, conducted with 4875 insulin-naïve patients with poorly controlled type 2 diabetes, predominantly in a primary care setting. ⋯ In the primary care setting, self-titration of biphasic insulin aspart 70/30 was effective in achieving recommended HbA(1c) goals even with minimal dietary counseling.
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Randomized Controlled Trial Comparative Study
Reducing blood sample hemolysis at a tertiary hospital emergency department.
To determine the causes for sample hemolysis and measure the effect of an intervention to reduce sample hemolysis in the Emergency Department of a large hospital. ⋯ Introduction of an educational program at a hospital Emergency Department was able to significantly reduce rates of sample hemolysis.
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Randomized Controlled Trial
The effect of a hypertension self-management intervention on diabetes and cholesterol control.
Most patient chronic disease self-management interventions target single-disease outcomes. We evaluated the effect of a tailored hypertension self-management intervention on the unintended targets of glycosylated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C). ⋯ There was a significant effect of the self-management intervention on the unintended target of HbA1c, but not LDL-C. Chronic disease self-management interventions might have "spill-over" effects on patients' comorbid chronic conditions.
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Randomized Controlled Trial
Obesity paradox in patients with hypertension and coronary artery disease.
An obesity paradox, a "paradoxical" decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known. ⋯ In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.
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Randomized Controlled Trial
Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women.
Hemoglobin A1c (HbA1c) is a marker of cumulative glycemic exposure over the preceding 2- to 3-month period. Whether mild elevations of this biomarker provide prognostic information for development of clinically evident type 2 diabetes and cardiovascular disease among individuals at usual risk for these disorders is uncertain. ⋯ These prospective findings suggest that HbA1c levels are elevated well in advance of the clinical development of type 2 diabetes, supporting recent recommendations for lowering of diagnostic thresholds for glucose metabolic disorders. In contrast, the association of HbA1c with incident cardiovascular events is modest and largely attributable to coexistent traditional risk factors.