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      Association Between Diabetes and Increased Prevalence of Paranasal Sinus Disease: A Cross-Sectional Study in Japanese Adults Translated title: 糖尿病と副鼻腔病変の有病率の関連:日本人成人健診集団における横断研究

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          Abstract

          Background

          The association between diabetes and paranasal sinus disease has not been thoroughly investigated.

          Methods

          We cross-sectionally investigated the association between diabetes and the presence of paranasal sinus disease, which was confirmed by a head MRI scan in 1350 adults who underwent a health screening program focusing on brain diseases and metabolic syndrome. Logistic regression, which was adjusted for age, sex, body mass index, waist-to-hip ratio, hypertension, smoking status, alcohol intake, and white blood cell count, was performed to calculate the odds ratio (OR) of having paranasal sinus disease among adults with diabetes in relation to those without. The dose-response relationship between hemoglobin A1c (HbA1c) levels and the presence of paranasal sinus disease was also investigated.

          Results

          Of the 1350 participants (mean age, 61.6 ± 10.0 years; 71.6% men), 220 diabetes cases were identified. Paranasal sinus disease was diagnosed in 151 adults. The adjusted OR of having paranasal sinus disease was 1.74 (95% confidence interval [CI], 1.12–2.71) in those with diabetes. The odds of having paranasal sinus disease increased with HbA1c levels. Compared to those with HbA1c of ≤5.4%, those with HbA1c of 5.5%–6.4%, 6.5%–7.9%, and ≥8.0% were more likely to have paranasal sinus disease, with adjusted ORs of 1.32 (95% CI, 0.88–1.98), 1.63 (95% CI, 0.86–3.09) and 2.71 (95% CI, 1.12–6.61), respectively ( P for trend = 0.019).

          Conclusions

          Diabetes may be significantly associated with higher prevalence of paranasal sinus disease in Japanese adults. We should keep this increased risk in mind when a diabetic patient is suspected of having paranasal sinus disease.

          Translated abstract

          【背景】

          糖尿病と副鼻腔病変の関連は過去の報告は少ない。この研究では日本人成人の健診集団において糖尿病の有無・血糖値の状態と副鼻腔病変の有病率の関連を横断的に調査した。

          【方法】

          東京都済生会中央病院において2007年から2011年に健康診断を受け、かつその際に頭部MRI検査を施行している40歳以上の成人1350例を対象とした。糖尿病は、質問票による糖尿病の自己申告と採血データによって診断し、副鼻腔病変は頭部MRIにて副鼻腔に粘膜肥厚、ポリープ、液体貯留があるものを副鼻腔病変の有所見者とした。ロジスティック回帰分析を用いて、糖尿病があることによる副鼻腔病変のオッズ比を算出した。また、HbA1cの値と副鼻腔病変のオッズ比も算出し血糖値の状態との用量依存性を検証した。これらのオッズ比は年齢、性別、BMI、ウェスト・ヒップ比、高血圧、喫煙、飲酒、白血球数にて調整を行った。

          【結果】

          1350名(平均61歳、男性72%)のうち220名が糖尿病を有しており、副鼻腔病変を有する者は151名であった。糖尿病があることによる副鼻腔病変を有する調整後オッズ比は1.74(95%信頼区間 1.27-2.71)であった。また、HbA1cが5.5%未満の人を基準として5.5-6.4%、6.5-7.9%、8%以上の人では、副鼻腔病変を有する調整後オッズ比は、各1.32(95%信頼区間 0.88-1.98)、1.63(95%信頼区間 0.86-3.09)、2.71(95%信頼区間 1.12-6.61)であった(傾向検定 P=0.019)。

          【結論】

          この研究にて、日本人成人において糖尿病を有することと副鼻腔病変の有病率が高いことの関連が示唆された。また、血糖値の状態と副鼻腔病変の有病率に正の用量依存関係を認めた。副鼻腔疾患を疑う場合、糖尿病者・血糖値が高い症例ではその有病率が高いことを念頭に診療にあたるべきであろう。

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          Most cited references22

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          Infections in patients with diabetes mellitus.

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            Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis.

            To systematically review the medical literature on the prognosis and outcomes of patients with community-acquired pneumonia (CAP). A MEDLINE literature search of English-language articles involving human subjects and manual reviews of article bibliographies were used to identify studies of prognosis in CAP. Review of 4573 citations revealed 122 articles (127 unique study cohorts) that reported medical outcomes in adults with CAP. Qualitative assessments of studies' patient populations, designs, and patient outcomes were performed. Summary univariate odds ratios (ORs) and rate differences (RDs) and their associated 95% confidence intervals (CIs) were computed to estimate a summary effect size for the association of prognostic factors and mortality. The overall mortality for the 33,148 patients in all 127 study cohorts was 13.7%, ranging from 5.1% for the 2097 hospitalized and ambulatory patients (in six study cohorts) to 36.5% for the 788 intensive care unit patients (in 13 cohorts). Mortality varied by pneumonia etiology, ranging from less than 2% to greater than 30%. Eleven prognostic factors were significantly associated with mortality using both summary ORs and RDs: male sex (OR = 1.3; 95% CI, 1.2 to 1.4), pleuritic chest pain (OR = 0.5; 95% CI, 0.3 to 0.8), hypothermia (OR = 5.0; 95% CI, 2.4 to 10.4), systolic hypotension (OR = 4.8; 95% CI, 2.8 to 8.3), tachypnea (OR = 2.9; 95% CI, 1.7 to 4.9), diabetes mellitus (OR = 1.3; 95% CI, 1.1 to 1.5), neoplastic disease (OR = 2.8; 95% CI, 2.4 to 3.1), neurologic disease (OR = 4.6; 95% CI, 2.3 to 8.9), bacteremia (OR = 2.8; 95% CI, 2.3 to 3.6), leukopenia (OR = 2.5, 95% CI, 1.6 to 3.7), and multilobar radiographic pulmonary infiltrate (OR = 3.1; 95% CI, 1.9 to 5.1). Assessments of other clinically relevant medical outcomes such as morbid complications (41 cohorts), symptoms resolution (seven cohorts), return to work or usual activities (five cohorts), or functional status (one cohort) were infrequently performed. Mortality for patients hospitalized with CAP was high and was associated with characteristics of the study cohort, pneumonia etiology, and a variety of prognostic factors. Generalization of these findings to all patients with CAP should be made with caution because of insufficient published information on medical outcomes other than mortality in ambulatory patients.
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              International clinical harmonization of glycated hemoglobin in Japan: From Japan Diabetes Society to National Glycohemoglobin Standardization Program values

              In 1999, the Japan Diabetes Society (JDS) launched the previous version of the diagnostic criteria of diabetes mellitus, in which JDS took initiative in adopting glycated hemoglobin (HbA1c) as an adjunct to the diagnosis of diabetes. In contrast, in 2009 the International Expert Committee composed of the members of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) manifested the recommendation regarding the use of HbA1c in diagnosing diabetes mellitus as an alternative to glucose measurements based on the updated evidence showing that HbA1c has several advantages as a marker of chronic hyperglycemia 2–4 . The JDS extensively evaluated the usefulness and feasibility of more extended use of HbA1c in the diagnosis of diabetes based on Japanese epidemiological data, and then the ‘Report of the Committee on the Classification and Diagnostic Criteria of Diabetes Mellitus’ was published in the Journal of Diabetes Investigation 5 and Diabetology International 6 . The new diagnostic criterion in Japan came into effect on 1 July 2010. According to the new version of the criteria, HbA1c (JDS) ≥6.1% is now considered to indicate a diabetic type, but the previous diagnosis criteria of high plasma glucose (PG) levels to diagnose diabetes mellitus also need to be confirmed. Those are as follows: (i) FPG ≥126 mg/dL (7.0 mmol/L); (ii) 2‐h PG ≥200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test; or (iii) casual PG ≥200 mg/dL (11.1 mmol/L). If both PG criteria and HbA1c in patients have met the diabetic type, those patients are immediately diagnosed to have diabetes mellitus 5,6 . In the report, the HbA1c measurements in Japan are well calibrated with Japanese‐Clinical‐Laboratory‐Use Certified Reference Material (JCCRM). The certified values are determined by a high‐resolution type ion‐exchange high performance liquid chromatography (HPLC) (KO 500 method) and certified using the designated comparison method (DCM) of the Japan Society of Clinical Chemistry (JSCC) and the JDS. After incorporating a proportional bias correction to the value anchored to the peptide mapping method of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), the DCM actually measures β‐N‐mono‐deoxyfructosyl hemoglobin and has an intercept approximately equal to zero against the peptide mapping method of IFCC in measuring fresh raw human blood samples. Furthermore, standardization of HbA1c in Japan was initiated in 1993, and the serial reference materials from JDS Lot 1 to JDS Lot 4 are well certified using the DCM until now. In the new diagnosis criteria 5,6 , the new cut‐point of HbA1c (JDS) for diagnosis of diabetes mellitus is 6.1%, which is equivalent to the internationally‐used HbA1c (National Glycohemoglobin Standardization Program [NGSP]) 6.5%, as HbA1c (NGSP)(%) is reported to be equivalent to 1.019 × HbA1c (JDS)% + 0.3%, which is reasonably estimated by the equation of HbA1c (JDS)% + 0.4%, as the difference between the two equations is within error of HbA1c measurements (2∼3%). However, on 1 October 2011, the Reference Material Institute for Clinical Chemistry Standards (ReCCS, Kanagawa, Japan) was certified as an Asian Secondary Reference Laboratory (ASRL) using the KO 500 method and the reference materials JCCRM411‐2 (JDS Lot 4) after successful completion of NGSP network laboratory certification. Therefore, the HbA1c unit is now traceable to the Diabetes Control and Complications Trial (DCCT) reference method. The comparison was carried out with the Central Primary Reference Laboratory (CPRL) in the University of Missouri School of Medicine. The conversion equation from HbA1c (JDS) to HbA1c (NGSP) units is officially certified as follows: NGSP (%) = 1.02 × JDS (%) + 0.25%; conversely, JDS (%) = 0.980 × NGSP (%) – 0.245%. Based on this equation, in the range of JDS values ≤4.9%, NGSP (%) = JDS (%) + 0.3%; in the range of JDS 5.0∼9.9%, NGSP (%) = JDS (%) + 0.4%; and in the range of JDS 10∼14.9%, NGSP (%) = JDS (%) + 0.5%. These results show that the previous equation of NGSP (%) = JDS (%) + 0.4% is also confirmed in the present equation, considering a 2∼3% error of HbA1c measurements. The council meeting of the JDS finally decided to use HbA1c (NGSP) values in clinical practice from 1 April 2012, although HbA1c (JDS) values will be included until people become familiar with the new expression. Finally, it is also important to emphasize that the new HbA1c (NGSP) values can be directly measured and printed out from 1 April 2012. However, both new diagnostic reference values and target values of glycemic control have been adjusted to those equivalent values of HbA1c (JDS), as shown in the Table 1. Table 1  Differences in glycated hemoglobin values between Japan Diabetes Society and National Glycohemoglobin Standardization Program for assessments of diagnosis and treatment of diabetes mellitus (a) Diagnostic reference values of HbA1c (NGSP) and HbA1c (JDS) Diagnostic reference values HbA1c (NGSP) HbA1c (JDS) Standard range (%) 4.6–6.2 4.3–5.8 Diabetes range (%) ≥6.5 ≥6.1 Possible diabetes range (%) 6.0–6.4 5.6–6.0 High risk range for diabetes (%) 5.6–5.9 5.2–5.5 (b) Assessments of the glycemic control using HbA1c Assessment of control state HbA1c (NGSP) HbA1c (JDS) Excellent (%) <6.2 <5.8 Good (%) 6.2–6.8 5.8–6.4 Fair  Inadequate (%) 6.9–7.3 6.5–6.9  Not good (%) 7.4–8.3 7.0–7.9 Poor (%) ≥8.4 ≥8.0 HbA1c, glycated hemoglobin; JDS, Japan Diabetes Society; NGSP, National Glycohemoglobin Standardization Program.
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                Author and article information

                Journal
                J Epidemiol
                J Epidemiol
                JE
                Journal of Epidemiology
                Japan Epidemiological Association
                0917-5040
                1349-9092
                5 April 2015
                28 February 2015
                2015
                : 25
                : 4
                : 297-302
                Affiliations
                [01]Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan 東京都済生会中央病院 内科
                Author notes
                Address for correspondence. Yusuke Kabeya, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan (e-mail: ykabeyan@ 123456yahoo.co.jp ).
                Article
                JE20140163
                10.2188/jea.JE20140163
                4375284
                25728620
                f87ffdee-9778-400a-9e3d-12db1ea33a2e
                © 2015 Yusuke Kabeya et al.

                This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 24 August 2014
                : 19 November 2014
                Categories
                Original Article
                Clinical Epidemiology

                diabetes,glycemic status,paranasal sinus disease
                diabetes, glycemic status, paranasal sinus disease

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