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Vera-Ponce VJ, Vásquez-Romero LEM, Zuzunaga-Montoya FE, Loayza-Castro JA, Hidalgo JRA, De Carrillo CIG. A metabolic epidemic? Prevalence and sex-based disparities of metabolic alterations in the peruvian population using multiple diagnostic criteria. J Diabetes Metab Disord 2025; 24:110. [PMID: 40309310 PMCID: PMC12040778 DOI: 10.1007/s40200-025-01622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 04/14/2025] [Indexed: 05/02/2025]
Abstract
Introduction Metabolic alterations constitute a growing challenge for global public health, with significant implications for cardiovascular morbidity and mortality. Early identification of these alterations, even from the presence of a single component, is crucial for effectively preventing and managing chronic diseases. Objective To determine the prevalence of metabolic states based on one or more alterations in the Peruvian population and to evaluate possible sex disparities. Methods An analytical cross-sectional study used data from two Peruvian national databases: Surveillance of Nutritional Indicators by Life Stages (VIANEV) and PERU MIGRANT. Data from 885 adults from VIANEV and 986 participants from PERU MIGRANT with complete information for all study variables were analyzed. Graphs were generated to illustrate metabolic states according to different combinations of diagnostic criteria. Bar charts were created to visualize the individual prevalences of each state. Ordinal logistic regression was employed to examine sex disparities and the outcome. Results The prevalence of metabolic alterations (at least one alteration) ranged from 87.04% to 87.55%, depending on the criteria used. Significant discrepancies were found in the prevalences of hyperglycemia and abdominal obesity according to the different diagnostic criteria applied. The ordinal logistic regression analysis showed that men had a lower probability of presenting metabolic alterations compared to women, regardless of the diagnostic method used. Conclusions This study reveals a high prevalence of metabolic alterations in the Peruvian population, with notable variations depending on the diagnostic criteria employed. The observed discrepancies underscore the need to re-evaluate these criteria for the Peruvian population. The identified disparities between sexes suggest the importance of developing differentiated prevention and management strategies.
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Affiliation(s)
- Víctor Juan Vera-Ponce
- Instituto de Investigación de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Amazonas, Perú
- Facultad de Medicina (FAMED), Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Amazonas, Perú
| | - Luisa Erika Milagros Vásquez-Romero
- Instituto de Investigación de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Amazonas, Perú
| | | | - Joan A. Loayza-Castro
- Instituto de Investigación de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Amazonas, Perú
| | | | - Carmen Inés Gutierrez De Carrillo
- Instituto de Investigación de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Amazonas, Perú
- Facultad de Medicina (FAMED), Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Amazonas, Perú
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Wang N, Zhao TY, Ma X. Increased colorectal cancer risk in prediabetes: A meta-analysis. World J Diabetes 2025; 16:103403. [DOI: 10.4239/wjd.v16.i5.103403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/21/2025] [Accepted: 02/21/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Previous research yielded conflicting results regarding the association between prediabetes and colorectal cancer (CRC).
AIM To systematically assess the incidence of CRC in individuals with prediabetes compared with individuals with normoglycemia via a meta-analysis.
METHODS Relevant cohort studies were acquired by searching MEDLINE, Web of Science, and EMBASE. A random-effects model was applied to combine the findings after accounting for heterogeneity. Several subgroup analyses were conducted to assess the impact of study characteristics on the results.
RESULTS Eleven cohort studies involving 4996352 participants, including 383917 (7.7%) with prediabetes at baseline, were analyzed in this meta-analysis. Over a mean follow-up period of 6.5 years, the combined findings revealed that individuals with prediabetes at baseline had a higher likelihood of developing CRC than those with normoglycemia [risk ratio (RR) = 1.18, 95% confidence interval = 1.11 to 1.25, P < 0.001] with low statistical heterogeneity (I2 = 27%). Subgroup analyses indicated that the association between prediabetes and an increased risk of CRC was mainly observed in studies defining prediabetes using impaired fasting glucose (RR = 1.24) and slightly elevated hemoglobin A1c levels (RR = 1.18) but not in those that defined prediabetes using impaired glucose tolerance (RR = 1.06). Other study characteristics such as design, country, participant age and sex, the duration of follow-up, or adjustment for body mass index did not significantly impact the results (all P > 0.05).
CONCLUSION People with prediabetes might have a higher likelihood of developing CRC than individuals with normoglycemia.
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Affiliation(s)
- Na Wang
- Physical Examination Center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Tian-Yi Zhao
- Physical Examination Center, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiao Ma
- Physical Examination Center, China-Japan Friendship Hospital, Beijing 100029, China
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Chen AM, He QY, Wu YC, Chen JQ, Ma XQ, Hu LY, Wang GNY, Wang ZT, Wu ZY, Zheng ZJ, Jia YJ. Association of quantified cardiovascular health status with all-cause mortality risk in prediabetic patients. World J Diabetes 2025; 16:102052. [DOI: 10.4239/wjd.v16.i5.102052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 12/04/2024] [Accepted: 03/21/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Patients with prediabetes are at increased risk of developing cardiovascular disease. The Life's Essential 8 (LE8) score, updated by the American Heart Association in 2022, is a tool used to quantify cardiovascular health (CVH). Quantifying healthy living status on the basis of the uniform standard LE8 will be useful for confirming whether health interventions can reduce the risk of death in prediabetic patients.
AIM To investigate the associations between all-cause mortality risk and CVH status (as quantified by the LE8 score) in prediabetic patients.
METHODS This study included 5344 participants with prediabetes (age: 52.9 ± 15.8 years; 51.6% men). The LE8 score includes four health indicators and four health behaviors. Cox proportional hazard ratios were calculated for all-cause mortality in the high CVH (LE8 ≥ 80), low CVH (LE8 ≤ 50), and moderate CVH (LE8 50-79) subgroups, and restricted cubic spline analyses were performed. Separate analyses of the associations of all-cause mortality risk with each LE8 component and CVH health behaviors and indicators were also performed.
RESULTS In the median follow-up period of 8.33 years, 658 deaths occurred. Compared with those among participants with high CVH, the covariate-adjusted HRs (95% confidence intervals) for mortality among participants with moderate and low CVH were 2.55 (1.23-5.31) and 3.92 (1.70-9.02), respectively. There was a linear relationship between an improvement in CVH status and a reduction in all-cause mortality risk (P-overall < 0.0001, P-nonlinear = 0.7989). Improved CVH health behaviors had a more significant protective effect on patients with prediabetes than did the improvement in CVH health indicators.
CONCLUSION High CVH status (as quantified by the LE8 score) is significantly associated with reduced mortality risk in prediabetic adults in the United States.
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Affiliation(s)
- Ao-Miao Chen
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Qiu-Yu He
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yi-Chuan Wu
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- School of Stomatology, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Jia-Qi Chen
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xiao-Qin Ma
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Ling-Yuan Hu
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Ge-Ning-Yue Wang
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- School of Stomatology, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Zhuo-Tong Wang
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Zhi-Yong Wu
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Zong-Ji Zheng
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yi-Jie Jia
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of Endocrinology & Metabolism, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- De Feng Academy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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Moon SJ, Kim MS, Kim YT, Lee HE, Lee YW, Lee SJ, Chung ES, Park CY. Use of an insulin titration protocol based on continuous glucose monitoring in postoperative cardiac surgery patients with type 2 diabetes and prediabetes: a randomized controlled trial. Cardiovasc Diabetol 2025; 24:210. [PMID: 40369552 DOI: 10.1186/s12933-025-02747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Accepted: 04/18/2025] [Indexed: 05/16/2025] Open
Abstract
BACKGROUND Maintaining optimal glucose control is critical for postoperative care cardiac surgery patients. Continuous glucose monitoring (CGM) in this setting remains understudied. We evaluated the efficacy of CGM with a specialized titration protocol in cardiac surgery patients with type 2 diabetes (T2D) and prediabetes. METHODS In this randomized-controlled trial, 54 cardiac surgery patients were randomized one day post-surgery, with 27 CGM and 25 point-of-care (POC) patients completing the study. The CGM group used Dexcom G6 with a CGM-specialized titration protocol, while the POC group used standard monitoring with blinded CGM. The primary outcome was time-in-range (TIR) 100-180 mg/dL for 7 days post-surgery. Secondary outcomes included various glycemic metrics and surgical outcomes. Multiple comparison adjustments were performed using false-discovery-rate (FDR). RESULTS Thirty-one (59.6%) had diabetes and 21 (40.4%) had prediabetes. While TIR 100-180 mg/dL showed no difference (74.7% vs. 71.6%, FDR-adjusted p = 0.376), the CGM group demonstrated improvements in TIR 70-180 mg/dL (83.8% vs. 75.8%, FDR-adjusted p = 0.026), time-in-tight-range (TITR) 100-140 mg/dL (46.3% vs. 36.3%, FDR-adjusted p = 0.018), and TITR 70-140 mg/dL (55.3% vs. 40.5%, FDR-adjusted p = 0.003). Both groups maintained very low rates of time below range (< 70 mg/dL: 0.03% vs. 0.18%, FDR-adjusted p = 0.109). The CGM group showed lower postoperative atrial fibrillation (AF) (18.8% vs. 55.6%, FDR-adjusted p = 0.04999). CONCLUSION While the primary outcome was not achieved, CGM with a specialized titration protocol demonstrated safe glycemic control with improvements in TIR 70-180 mg/dL and TITRs in cardiac surgery patients with T2D and prediabetes. The observed reduction in postoperative AF warrants further investigation. TRIAL REGISTRATION ClinicalTrials.gov NCT06275971.
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Affiliation(s)
- Sun-Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Min-Su Kim
- Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Yun Tae Kim
- Division of Biostatistics, Department of Academic Research, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Ha-Eun Lee
- Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Young-Woo Lee
- Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Su-Ji Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Euy-Suk Chung
- Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
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Jiang J, Feng Q, Yan L, Guo Y, Yang Q. Perceptions and Experiences of Self-Management in Patients with Prediabetes: A Qualitative Study in China. Patient Prefer Adherence 2025; 19:1283-1293. [PMID: 40337289 PMCID: PMC12057631 DOI: 10.2147/ppa.s513389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 04/07/2025] [Indexed: 05/09/2025] Open
Abstract
Purpose This study aimed to investigate self-management experiences among individuals with prediabetes and analyze their potential self-management needs, thereby informing strategies to enhance self-management efficacy and facilitate the development of evidence-based, personalized interventions. Patients and Methods Twelve prediabetes patients from a physical examination center in Nanchong, China, were recruited using purposive sampling. An interpretive phenomenological research method was employed. Semi-structured, in-depth interviews were conducted to explore patients' self-management experiences. The interviews were audio-recorded, transcribed, and analyzed thematically to develop the results. In addition, web-based information support and peer support facilitated patient self-management. Results Four overarching themes emerged: (1) cognitive limitations, (2) intrinsic motivation, (3) hurdles to overcome, (4) perceived social support. Revealed the debilitating effect of non-medical terminology expression on the potential harm of the disease, neglect of diagnosis and health education by healthcare providers exacerbated the lack of awareness of prediabetes among patients. The complex social environment (unhealthy food environment, heavy work pressure, etc.) confronts prediabetes with self-management dilemmas. It was also revealed that patients' behavioral change motivation was "threat-benefit" dual-driven and was strongly influenced by family ethics, with family culture significantly influencing health decision-making. In addition, web-based information support and peer support facilitate patient self-management. Conclusion This study investigated the perceptions and self-management experiences of individuals with prediabetes, proposing targeted intervention strategies. Key recommendations include: (1) Healthcare providers' perceptions and attitudes toward prediabetes significantly influence patient engagement, necessitating standardized diagnostic and treatment protocols that emphasize disease progression risks during initial diagnosis to enhance clinical awareness; (2) Implementation of motivational interviewing (MI) techniques could effectively strengthen patients' intrinsic motivation for behavioral modification; (3) Multidimensional support systems should be established through AI-powered medical question-answering systems, standardized nutritional labeling regulations, family-involved health education programs, and peer-led "health coach" initiatives. These strategies provide a framework for developing comprehensive prediabetes management interventions aimed at improving self-management ability.
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Affiliation(s)
- Jinfeng Jiang
- Endocrinology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Qiongyao Feng
- Faculty of Nursing, North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Lihua Yan
- Faculty of Nursing, North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Yingchao Guo
- Faculty of Nursing, North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | - Qiu Yang
- Endocrinology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
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Guo H, Zhang J, Qi Y, Sun C, Wu J. Association of oxidative balance scores with the prevalence of prediabetes, impaired fasting glucose, and impaired glucose tolerance in the general US adult population: Evidence from NHANES 1999-2018. J Int Med Res 2025; 53:3000605251340616. [PMID: 40372129 DOI: 10.1177/03000605251340616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2025] Open
Abstract
ObjectiveOxidative stress likely contributes to the pathogenesis of prediabetes. The oxidative balance score is an emerging metric for quantifying exposure to dietary and lifestyle oxidative stress. This study aimed to investigate the association between oxidative balance score and the prevalence of prediabetes, impaired fasting glucose, and impaired glucose tolerance based on data from the National Health and Nutrition Examination Survey 1999-2018.MethodsIn this cross-sectional study, the oxidative balance score was derived from 16 dietary and 4 lifestyle components, as outlined in previous research. Prediabetes, impaired fasting glucose, and impaired glucose tolerance were diagnosed based on the American Diabetes Association criteria. Multivariate logistic regression models were employed to analyze these associations.ResultsIn total, 22,960 participants with a mean age of 44.7 years were included in this study. In fully adjusted models, dietary oxidative balance score, lifestyle oxidative balance score, and overall oxidative balance score were all inversely associated with the prevalence of prediabetes among the general US adult population (odds ratios and 95% confidence intervals of 0.956 (0.949, 0.963), 0.914 (0.891, 0.937), and 0.957 (0.950, 0.964), respectively; all p <0.0001). Compared with quartile 1, dietary oxidative balance score, lifestyle oxidative balance score, and overall oxidative balance score at quartile 4 were all associated with a significantly lower prevalence of prediabetes (odds ratios and 95% confidence intervals 0.515 (0.449, 0.591), 0.834 (0.740, 0.940), and 0.505 (0.440, 0.579), respectively; all p for trend <0.0001). Similar results were observed for impaired fasting glucose and impaired glucose tolerance. Restricted cubic spline analysis showed that most of the associations were nonlinear and that significant negative correlations were observed only after a certain threshold. Stratified and sensitivity analyses confirmed the robustness of the findings.ConclusionsAdherence to an antioxidant-rich diet and healthy lifestyle may aid in the prevention of prediabetes, impaired fasting glucose, and impaired glucose tolerance among the general US adult population. Further cohort studies are needed to validate these findings.
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Affiliation(s)
- Hongpeng Guo
- Department of General Surgery, Central Hospital Affiliated to Shenyang Medical College, China
| | - Junjie Zhang
- Department of Pathology, Central Hospital Affiliated to Shenyang Medical College, China
| | - Ying Qi
- Department of General Surgery, Central Hospital Affiliated to Shenyang Medical College, China
| | - Chenglin Sun
- Department of General Surgery, Central Hospital Affiliated to Shenyang Medical College, China
| | - Ji Wu
- School of Public Health, Shenyang Medical College, China
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Zhang Z, Wang C, Zhao L, Wang Z, Zhou X, Yang W, Meng X. Association of depression, traditional risk factor control and genetic risk with incident cardiovascular disease among individuals with prediabetes: A population-based prospective study from UK biobank. Diabetes Obes Metab 2025; 27:2833-2843. [PMID: 39996371 DOI: 10.1111/dom.16293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 02/10/2025] [Accepted: 02/11/2025] [Indexed: 02/26/2025]
Abstract
BACKGROUND The relationship between depression and cardiovascular disease (CVD) in individuals with prediabetes, its relative importance compared with traditional risk factors and whether genetic risk modifies this association remain unclear. AIMS To explore the potential interactive effects of controlling traditional risk factors and depression on CVD, and to assess how depression compares with traditional risk factors in terms of its relative contribution to CVD risk in individuals with prediabetes. MATERIALS AND METHODS We analysed a prospective cohort of 42,020 individuals from the UK Biobank, all free of prevalent CVD. Depression was determined using multiple sources to accurately assess the exposure. The five traditional risk factors considered were sleep duration, smoking, blood pressure (BP), low-density lipoprotein (LDL) cholesterol and renal function. We used Cox proportional hazards regression models to examine the associations between depression, risk factor control and CVD events. RESULTS Over a median follow-up of 13.1 years, 5865 individuals developed CVD, including 4764 cases of coronary heart disease and 1415 strokes. Compared with controlling 4-5 risk factors, both depression and controlling 0-1 risk factor significantly increased the risk of CVD in individuals with prediabetes. The corresponding multivariable-adjusted hazard ratios (95% CI) for CVD were 1.18 (1.09-1.28) and 1.44 (1.29-1.60), respectively. Depression ranked second in predicting CVD among the selected risk factors. A synergistic effect between depression and risk factor control was observed for CVD, with a relative excess risk due to interaction of 0.16 (0.06-0.26). Furthermore, these associations were independent of the genetic susceptibility to CVD. CONCLUSIONS Among individuals with prediabetes, both depression and suboptimal control of traditional risk factors are associated with an increased risk of CVD, independent of genetic susceptibility.
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Affiliation(s)
- Zenglei Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunqi Wang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeyu Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ji Y, Lyu Z, Cui B, Wang W. Diabetes Status and Cardiovascular Complications Risk in Noncardiac Surgery: A Population-Based Cohort Study. Endocr Pract 2025; 31:585-591. [PMID: 40015631 DOI: 10.1016/j.eprac.2025.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/10/2025] [Accepted: 02/12/2025] [Indexed: 03/01/2025]
Abstract
OBJECTIVE Patients with diabetes are considered to be at high surgical risk due to the potential occurrence of cardiovascular and diabetes-related complications. Limited research exists on the cardiovascular risk profiles of patients with prediabetes and undiagnosed diabetes in noncardiac surgery. In this population-based cohort study, we investigated different glycated hemoglobin levels and their associated postoperative cardiovascular risks. METHODS In this perioperative cohort study, participants were categorized into four groups: nondiabetes, prediabetes, undiagnosed diabetes, and diagnosed diabetes. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) at 30 days postoperatively, with secondary outcomes assessed at 90 days. The association between various groups and postoperative MACE was evaluated using Cox proportional hazards models and Kaplan-Meier curves. Subgroup analyses and sensitivity analyses were also performed. RESULTS We enrolled 13 207 eligible patients undergoing noncardiac surgeries, among whom 3841 (29.08%) had prediabetes and 1521 (11.52%) had undiagnosed diabetes. In the 30-day postoperative period, the prediabetes group (hazard ratio [HR] [95% CI]: 1.70 [1.15, 2.52]), undiagnosed diabetes group (HR [95% CI]: 2.36 [1.15, 3.68]), and diagnosed diabetes group (HR [95% CI]: 2.33 [1.54, 3.53]) exhibited increased risks of MACE compared to the nondiabetes group. Similar findings were observed for the 90-day postoperative MACE. Further subgroup analysis revealed a significant interaction between sex and states of glycemic regulation (P for interaction < 0.005). CONCLUSION In this cohort, a notable proportion of patients with prediabetes or undiagnosed diabetes were found to be undergoing noncardiac surgeries. They were associated with an increased risk of developing postoperative MACE.
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Affiliation(s)
- Yunxi Ji
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihan Lyu
- Department of General Medicine, Shanghai Ninth People 's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Cui
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Meng H, So H, Lam SH, Tam LS. Impaired fasting glucose and sulfonylureas increased the risk of major cardiovascular events in patients with inflammatory arthritis. Diabetol Metab Syndr 2025; 17:132. [PMID: 40251690 PMCID: PMC12008961 DOI: 10.1186/s13098-025-01689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 04/02/2025] [Indexed: 04/20/2025] Open
Abstract
OBJECTIVES To evaluate the effect of impaired fasting glucose (IFG) and various anti-diabetic agents on the risk of incident major cardiovascular events (MACE) in patients with inflammatory arthritis (IA) including rheumatoid arthritis (RA) and psoriatic arthritis (PsA). METHODS This was a population-based retrospective cohort study. Patient identification and data retrieval were conducted using a big data platform (The Hospital Authority Data Collaboration Lab) in Hong Kong. Patients with IA were recruited from Jan 2006 to Dec 2015 and followed up until the end of 2018. Time-dependent Cox proportional hazards regression models were used to analyze the association between fasting glucose (FG) levels and anti-diabetic drug use with MACE in IA patients. RESULTS A total of 13,905 patients (12,233 RA and 1,672 PsA) were included. 934 patients (6.7%) developed the first MACE after a total of 119,571 patient-years of follow-up. More patients in the MACE group had IFG (FG 5.6-6.9 mmol/l) (19.4% vs. 15.2%, p < 0.001) and FG ≥ 7 mmol/l (17.6% vs. 8.1%, p < 0.001) at baseline. In the subgroup of patients who were not taking any anti-diabetic medications, a prediabetic state was found to be independently associated with a higher risk of MACE (HR 2.43, 95%CI 1.97-2.99 in CRP model and HR 2.54, 95%CI 1.50-7.71 in ESR model). On the other hand, in patients with diabetes, sulfonylurea use increased the risk of MACE development by 55% (HR 1.55, 95%CI 1.14-2.09) after adjusting for other covariates. CONCLUSIONS In a large cohort of patients with IA, IFG and sulfonylureas use were found to be independently associated with an increased risk of incident MACE.
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Affiliation(s)
- Huan Meng
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ho So
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Steven H Lam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Liang X, Lai K, Li X, Ren D, Gui S, Xing Z, Li Y. Association between estimated glucose disposal rate and future cardiovascular disease risk across glucose metabolism status: a prospective cohort study. Diabetol Metab Syndr 2025; 17:131. [PMID: 40251696 PMCID: PMC12007373 DOI: 10.1186/s13098-025-01697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 04/08/2025] [Indexed: 04/20/2025] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains a major global health challenge, particularly affected by glucose metabolism status. However, the relationship between estimated glucose disposal rate (eGDR) and future CVD risk across different glucose metabolism status remains unclear. METHODS We analyzed data from the China Health and Retirement Longitudinal Study (2011-2020) of participants aged ≥ 45 years. The eGDR was calculated using waist circumference, hypertension status, and HbA1c levels. CVD events (stroke or cardiac events) were the outcome. Participants were categorized by glucose metabolism status (normoglycemia, prediabetes, diabetes). Cox proportional hazards models and restricted cubic splines were used to assess associations and potential non-linear relationships. RESULTS Among 7,828 participants (52.84% male, mean age 59.01 ± 9.21 years) followed for an average of 8.29 years, 1,944 participants (24.83%) developed CVD. Higher eGDR was inversely associated with CVD risk across all glucose metabolism states. Below the inflection points (11.77, 11.15, and 11.56 mg/kg/min for normoglycemia, prediabetes, and diabetes, respectively), each 1-unit increase in eGDR reduced CVD risk by 14% (HR = 0.86, 95%CI: 0.83-0.89), 10% (HR = 0.90, 95%CI: 0.86-0.93), and 14% (HR = 0.86, 95%CI: 0.81-0.91), respectively. CONCLUSION The eGDR demonstrates a potentially non-linear inverse association with future CVD risk across different glucose metabolism states.
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Affiliation(s)
- Xiaomin Liang
- Department of Critical Care Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Kai Lai
- Department of Critical Care Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaohong Li
- Department of Critical Care Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Di Ren
- Department of Critical Care Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shuiqing Gui
- Department of Critical Care Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Zemao Xing
- Department of Critical Care Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Ying Li
- Department of Critical Care Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
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Dong G, Wu T, Gu X, Wu L. Endothelial Activation and Stress Index Predicts All-Cause and Cardiovascular Mortality in Hypertensive Individuals: A Nationwide Study. J Clin Hypertens (Greenwich) 2025; 27:e70057. [PMID: 40270299 PMCID: PMC12018906 DOI: 10.1111/jch.70057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 03/14/2025] [Accepted: 04/06/2025] [Indexed: 04/25/2025]
Abstract
Emerging evidence links the Endothelial Activation and Stress Index (EASIX) and mortality risk in coronary artery disease, but its relevance in hypertensive patients remains unclear. This study examines the association between EASIX and all-cause and cardiovascular mortality in hypertensive individuals. The analysis included 6138 hypertensive patients from seven National Health and Nutrition Examination Survey (NHNES) cycles (2003-2016), with mortality data obtained from the National Death Index (NDI). Over a median follow-up of 98 months, 1435 (23.4%) participants died, including 400 (6.5%) from cardiovascular causes. Restricted cubic spline analysis revealed a positive association between EASIX and both all-cause and cardiovascular mortality. Weighted multivariable Cox regression indicated that each 1-unit increase in EASIX corresponding to a 25% and 23% rise in mortality risk, respectively. Based on the optimal cutoff value determined using the maximally selected rank statistics method, participants were stratified into higher (>0.79) and lower (≤0.79) EASIX groups. Higher EASIX was significantly associated with increased all-cause mortality risk (HR 1.46, 95% CI 1.23-1.73, p < 0.0001). Higher EASIX scores were associated with increased cardiovascular mortality, especially in former/current smokers and those with diabetes/prediabetes. Time-dependent receiver operating characteristic analysis assessed the predictive accuracy of EASIX, yielding area under the curve (AUC) for 1-, 3-, 5-, and 10-year survival of 0.71, 0.67, 0.67, and 0.67 for all-cause mortality and 0.79, 0.73, 0.73, and 0.71 for cardiovascular mortality. In conclusion, elevated EASIX is independently associated with increased all-cause and cardiovascular mortality in hypertensive patients, suggesting its potential as a predictive biomarker in clinical practice.
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Affiliation(s)
- Gaiying Dong
- Department of Medical UltrasoundGuangzhou First People's HospitalSouth China University of TechnologyGuangzhouGuangdongChina
| | - Tingting Wu
- Department of Thoracic SurgeryAnhui Public Health Clinical Centerthe First Affiliated Hospital of Anhui University North DistrictHefeiAnhuiChina
| | - Xiaofan Gu
- Department of Laboratory MedicineGuangzhou First People's HospitalSouth China University of TechnologyGuangzhouGuangdongChina
| | - Liangliang Wu
- Department of HematologyGuangzhou First People's HospitalSouth China University of TechnologyGuangzhouGuangdongChina
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12
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Huang X, He S, Wang C, Jian G, Jiang K, Lu Z, Wang W, Sheng G, Zou Y. Association between estimated glucose disposal rate and prediabetes reversion and progression: a nationwide cohort study of middle-aged and elderly people in China. Front Endocrinol (Lausanne) 2025; 16:1500993. [PMID: 40190399 PMCID: PMC11968371 DOI: 10.3389/fendo.2025.1500993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 02/24/2025] [Indexed: 04/09/2025] Open
Abstract
Objective Prediabetes is a chronic condition characterized by elevated blood glucose levels that are not yet high enough to be classified as diabetes. It is particularly prevalent among middle-aged and elderly populations. This study aims to investigate the association between a novel marker of insulin resistance-the estimated glucose disposal rate (eGDR)-and the reversion of prediabetes to normoglycaemia or progression to diabetes in a Chinese population. Methods This prospective cohort study utilized baseline data from the 2011 China Health and Retirement Longitudinal Study involving 2,600 prediabetic participants aged 45 years and older, along with follow-up data from 2015. The study's endpoints were defined according to the American Diabetes Association criteria, including maintenance of the prediabetic state, reversion to normoglycaemia, or progression to diabetes. Multivariable Cox regression models and restricted cubic spline regression were used to assess the association between eGDR and the reversion or progression of prediabetes in middle-aged and elderly populations, followed by stratified analyses to explore potential population-specific dependencies. Results Over a median follow-up period of 4 years, 1,615 (62.1%) participants remained in the prediabetic state, 586 (22.5%) reverted to normoglycaemia, and 399 (15.3%) progressed to diabetes. In multivariable Cox regression analyses, our results indicated that eGDR was positively associated with the reversion of prediabetes to normoglycaemia [Hazard Ratio = 1.14, 95% Confidence Interval: 1.05, 1.23], and negatively associated with the progression of prediabetes to diabetes (HR = 0.81, 95% CI: 0.70, 0.93). Restricted cubic spline analysis revealed a nonlinear, L-shaped association between eGDR and the reversion of prediabetes to normoglycaemia, with segmented Cox regression identifying an eGDR threshold of 6.81 as the point of significant change in the likelihood of prediabetes reversion. Conclusion This prospective cohort study among middle-aged and elderly Chinese populations suggested that higher eGDR promoted the reversion of prediabetes and provided a protective effect against its progression to diabetes.
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Affiliation(s)
- Xin Huang
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Shiming He
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Chao Wang
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Guoan Jian
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Kun Jiang
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Zihao Lu
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Wei Wang
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Zhao X, Zhuang Y, Tang S, Ruan Y, Li Q, Liu Y, Lei J, Han Y, Chen Y, Zhao Y, Fan Z. Prognostic impact of prediabetes on long-term cardiovascular outcomes in patients under 35 with premature acute myocardial infarction. Diabetol Metab Syndr 2025; 17:90. [PMID: 40102916 PMCID: PMC11921701 DOI: 10.1186/s13098-025-01662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 03/07/2025] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND Prediabetes (pre-DM) is recognized as an intermediate state of glucose metabolism with a high potential to progress to diabetes mellitus (DM). However, its prognostic value in patients with premature acute myocardial infarction (PAMI) under the age of 35 remains unclear. This study aimed to investigate the relationship between pre-DM and long-term cardiovascular outcomes in this unique population. METHODS This retrospective cohort study included 796 PAMI patients under 35 years of age who were categorized into three groups based to glycated hemoglobin levels or previous history: normal glucose regulation (NGR), pre-DM, and DM. The primary endpoint was the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, non-fatal myocardial infarction, non-fatal stroke, or revascularization. Multivariable Cox regression, Kaplan-Meier and Subgroup analyses were performed. RESULTS Pre-DM was observed in 22.1% of the PAMI cohort. During the median follow-up of 81 months, the incidence of MACCE was 23.5%, with significantly higher rates in the pre-DM and DM group compared to the NGR group (18.4%, 27.3%, 34.2%; p < 0.001). After adjusting for confounding variables, pre-DM remained independently associated with an increased risk of MACCE (HR 1.51, 95%CI 1.05-2.18, p = 0.027). Subgroup analysis demonstrated that pre-DM status was a robust risk factor compared to NGR. Moreover, pre-DM had a similar impact on MACCE events as DM in patients with PAMI. CONCLUSIONS Pre-DM is associated with a poor prognosis in young AMI patients under 35 years old, suggesting that it may be an independent predictor of adverse events in this population.
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Affiliation(s)
- Xinlong Zhao
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yuansong Zhuang
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Siqi Tang
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
- Department of Internal Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yanping Ruan
- Department of Echocardiography, Beijing Anzhen Hospital, Maternal-Fetal Medicine Research Consultation Center, Capital Medical University, Beijing, 100029, China
| | - Quan Li
- Center for Coronary Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yanbo Liu
- Department of Healthcare, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jinyan Lei
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yitao Han
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yuxiong Chen
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
- Department of Internal Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yakun Zhao
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
- Department of Internal Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhongjie Fan
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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Jastreboff AM, le Roux CW, Stefanski A, Aronne LJ, Halpern B, Wharton S, Wilding JPH, Perreault L, Zhang S, Battula R, Bunck MC, Ahmad NN, Jouravskaya I. Tirzepatide for Obesity Treatment and Diabetes Prevention. N Engl J Med 2025; 392:958-971. [PMID: 39536238 DOI: 10.1056/nejmoa2410819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
BACKGROUND Obesity is a chronic disease and causal precursor to myriad other conditions, including type 2 diabetes. In an earlier analysis of the SURMOUNT-1 trial, tirzepatide was shown to provide substantial and sustained reductions in body weight in persons with obesity over a 72-week period. Here, we report the 3-year safety outcomes with tirzepatide and its efficacy in reducing weight and delaying progression to type 2 diabetes in persons with both obesity and prediabetes. METHODS We performed a phase 3, double-blind, randomized, controlled trial in which 2539 participants with obesity, of whom 1032 also had prediabetes, were assigned in a 1:1:1:1 ratio to receive tirzepatide at a once-weekly dose of 5 mg, 10 mg, or 15 mg or placebo. The current analysis involved the participants with both obesity and prediabetes, who received their assigned dose of tirzepatide or placebo for a total of 176 weeks, followed by a 17-week off-treatment period. The three key secondary end points, which were controlled for type I error, were the percent change in body weight from baseline to week 176 and onset of type 2 diabetes during the 176-week and 193-week periods. RESULTS At 176 weeks, the mean percent change in body weight among the participants who received tirzepatide was -12.3% with the 5-mg dose, -18.7% with the 10-mg dose, and -19.7% with the 15-mg dose, as compared with -1.3% among those who received placebo (P<0.001 for all comparisons with placebo). Fewer participants received a diagnosis of type 2 diabetes in the tirzepatide groups than in the placebo group (1.3% vs. 13.3%; hazard ratio, 0.07; 95% confidence interval [CI], 0.0 to 0.1; P<0.001). After 17 weeks off treatment or placebo, 2.4% of the participants who received tirzepatide and 13.7% of those who received placebo had type 2 diabetes (hazard ratio, 0.12; 95% CI, 0.1 to 0.2; P<0.001). Other than coronavirus disease 2019, the most common adverse events were gastrointestinal, most of which were mild to moderate in severity and occurred primarily during the dose-escalation period in the first 20 weeks of the trial. No new safety signals were identified. CONCLUSIONS Three years of treatment with tirzepatide in persons with obesity and prediabetes resulted in substantial and sustained weight reduction and a markedly lower risk of progression to type 2 diabetes than that with placebo. (Funded by Eli Lilly; SURMOUNT-1 ClinicalTrials.gov number, NCT04184622.).
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Affiliation(s)
- Ania M Jastreboff
- Y-Weight Yale Obesity Research Center, Section of Endocrinology and Metabolism, Department of Medicine, Yale School of Medicine, New Haven, CT
- Section of Pediatric Endocrinology, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin
| | | | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York
| | | | - Sean Wharton
- University of Toronto, Toronto
- Wharton Weight Management Clinic, Toronto
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom
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Wang X, Guo R, Huang M, Li Z, Lai Z, Yang R, Li L, Gao S, Yu C. Fibrinogen-to-Albumin Ratio and Glucose Metabolic States in Patients With Coronary Heart Disease. Angiology 2025; 76:271-280. [PMID: 37939004 DOI: 10.1177/00033197231206235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This study investigated the relationship between fibrinogen-to-albumin ratio (FAR) and glucose metabolic state in patients with coronary heart disease (CHD). A total of 52,062 patients were enrolled in this study. Patients were classified according to FAR tertiles (T1: FAR < 0.0073; T2: 0.0073 ≤ FAR ≤ 0.0886; T3: FAR ≥ 0.0887). Patients were also classified into the normal glucose regulation (NGR) and elevated blood glucose (EBG) groups. The relationship between FAR and EBG was analyzed using logistic regression, and the association was evaluated according to sex and age. Among the participants, 32,471 (62.4%) had EBG, which was positively associated with FAR (odds ratio [OR], 1.19; 95% confidence interval [CI] 1.15-1.23). The OR of the FAR for EBG in males was higher than that in females (1.25; 95% CI 1.18-1.33 vs 1.15; 95% CI 1.10-1.20). Moreover, the OR of FAR for EBG was greater in patients aged 60 or younger (OR: 1.25; 95% CI 1.18-1.33) than in the elderly patients (over 60 years of age) (OR: 1.15; 95% CI 1.10-1.20). The results indicated a significant relationship between FAR and EBG and this association was higher in males and middle-aged patients.
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Affiliation(s)
- Xu Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ruiying Guo
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mengnan Huang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhu Li
- Zhejiang Chinese Medical University, Zhejiang, China
| | - Ziqin Lai
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Rongrong Yang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lin Li
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shan Gao
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunquan Yu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Singh AK, Singh A, Gangopadhyay KK. Metformin in prediabetes: Opportunity or over-treatment? Int J Diabetes Dev Ctries 2025; 45:13-23. [DOI: 10.1007/s13410-025-01447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Accepted: 01/06/2025] [Indexed: 05/03/2025] Open
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Yang G, Luo Y, Ma K, Yang B, Tang P, Zhang M, Dong Q, Mao M. Association between lipoprotein(a) and atherosclerosis with different diabetic status: a cross-sectional study in a Chinese population. Cardiovasc Diagn Ther 2025; 15:100-115. [PMID: 40115096 PMCID: PMC11921193 DOI: 10.21037/cdt-24-410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 12/09/2024] [Indexed: 03/23/2025]
Abstract
Background Lipoprotein(a) [Lp(a)] levels and diabetic status have been recognized as risk factors for atherosclerosis. However, no studies on atherosclerosis have integrated these two indicators. This study aimed to evaluate the relationship between Lp(a) levels, diabetic status, and their combined effects on subclinical atherosclerosis. Methods This cross-sectional study included patients presenting with a first episode of chest pain at the First Affiliated Hospital of Chongqing Medical University from June 2018 to February 2022. All participants underwent coronary computed tomography angiography (CCTA) and carotid ultrasound to evaluate subclinical atherosclerosis. Logistic regression analysis was used to examine the associations of Lp(a) levels and diabetic status-both individually and in combination-with coronary artery calcium (CAC) and carotid arteriopathy. Results Among 912 patients, 473 (51.9%) had CAC and 637 (69.8%) had carotid arteriopathy. After adjusting the confounding variables, elevated Lp(a) levels associated with CAC [odds ratio (OR) 1.51, 95% confidence interval (CI): 1.02-2.24, P=0.040] and carotid arteriopathy (OR 1.77, 95% CI: 1.10-2.86, P=0.02) were statistically significant. After combining diabetic status, almost all Lp(a) levels were significantly associated with CAC and CAC score categories (CAC scores: 0.1-99.9, 100-399.9, ≥400) in the diabetes mellitus (DM) group. In this group, the highest risk for CAC and the most severe CAC score categories were observed in patients with Lp(a) levels of >300 mg/L. Among patients with DM, in the lower Lp(a) level group, the prevalence and severity of CAC were more pronounced than those in the medium Lp(a) level group. Additionally, in patients with DM only, elevated Lp(a) levels were associated with carotid arteriopathy (OR 3.38, 95% CI: 1.24-9.20; P=0.02), increased carotid intima-media thickness (cIMT; OR 3.67, 95% CI: 1.10-12.30; P=0.04), and stable/vulnerable carotid plaque (OR 3.39, 95% CI: 1.09-10.55; P=0.04; OR 3.21, 95% CI: 1.07-9.65; P=0.04). However, there were no significant differences between prediabetes and CAC or carotid arteriopathy. Conclusions In patients with chest pain and DM without cardiovascular disease (CVD), Lp(a) level was significantly associated with subclinical atherosclerosis and had a synergistic effect with DM. Notably, lower Lp(a) levels in patients with DM may lead to an additional subclinical atherosclerosis risk, whereas prediabetes does not show the same association. Therefore, these findings highlight the importance of formulating early preventive strategies for subclinical atherosclerosis based on Lp(a) levels and diabetic status.
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Affiliation(s)
- Guoli Yang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Luo
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kanghua Ma
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bao Yang
- Department of Cardiology, the Southwest Hospital of Army Medical University (AMU), Chongqing, China
| | - Ping Tang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Zhang
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Dong
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Mao
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lundgrin EL, Hatipoglu B. Trending Modalities in Type 2 Diabetes Prevention. J Clin Endocrinol Metab 2025; 110:S187-S192. [PMID: 39998920 DOI: 10.1210/clinem/dgaf040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Indexed: 02/27/2025]
Abstract
CONTEXT Prediabetes now affects a substantial proportion of the population, marking a growing group of individuals at increased risk for the development of type 2 diabetes (T2D). Given the profound effect of T2D on an individual's morbidity and mortality, T2D prevention is of critical importance. EVIDENCE ACQUISITION We searched PubMed and Ovid MEDLINE databases for recent systematic reviews, meta-analyses, and original research articles pertaining to prediabetes and the prevention of T2D. EVIDENCE SYNTHESIS T2D prevention strategies have focused on intensive lifestyle modification as well as numerous medications that ultimately improve insulin resistance. Recently, a better understanding of the gut microbiome's role in diabetes progression has suggested a possible preventive role for fecal transplant. Finally, multiple incretin pharmaceutical agents have been developed that show promise in the prevention and treatment of T2D. CONCLUSION The number of novel ways to prevent T2D is rapidly growing. A thorough understanding of the indications, outcomes, and limitations of these new therapies is critical for all who care for individuals with diabetes.
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Affiliation(s)
- Erika L Lundgrin
- Department of Pediatric Endocrinology, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA
- Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Betul Hatipoglu
- Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
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Thirunavukkarasu S, Ziegler TR, Weber MB, Staimez L, Lobelo F, Millard-Stafford ML, Schmidt MD, Venkatachalam A, Bajpai R, El Fil F, Prokou M, Kumar S, Tapp RJ, Shaw JE, Pasquel FJ, Nocera JR. High-Intensity Interval Training for Individuals With Isolated Impaired Fasting Glucose: Protocol for a Proof-of-Concept Randomized Controlled Trial. JMIR Res Protoc 2025; 14:e59842. [PMID: 39977858 PMCID: PMC11888011 DOI: 10.2196/59842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/16/2024] [Accepted: 10/09/2024] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Standard lifestyle interventions have shown limited efficacy in preventing type 2 diabetes among individuals with isolated impaired fasting glucose (i-IFG). Hence, tailored intervention approaches are necessary for this high-risk group. OBJECTIVE This study aims to (1) assess the feasibility of conducting a high-intensity interval training (HIIT) study and the intervention acceptability among individuals with i-IFG, and (2) investigate the preliminary efficacy of HIIT in reducing fasting plasma glucose levels and addressing the underlying pathophysiology of i-IFG. METHODS This study is a 1:1 proof-of-concept randomized controlled trial involving 34 physically inactive individuals (aged 35-65 years) who are overweight or obese and have i-IFG. Individuals will undergo a 3-step screening procedure to determine their eligibility: step 1 involves obtaining clinical information from electronic health records, step 2 consists of completing questionnaires, and step 3 includes blood tests. All participants will be fitted with continuous glucose monitoring devices for approximately 80 days, including 10 days prior to the intervention, the 8-week intervention period, and 10 days following the intervention. Intervention participants will engage in supervised HIIT sessions using stationary "spin" cycle ergometers in groups of 5 or fewer. The intervention will take place 3 times a week for 8 weeks at the Aerobic Exercise Laboratory in the Rehabilitation Hospital at Emory University. Control participants will be instructed to refrain from engaging in intense physical activities during the study period. All participants will receive instructions to maintain a eucaloric diet throughout the study. Baseline and 8-week assessments will include measurements of weight, blood pressure, body composition, waist and hip circumferences, as well as levels of fasting plasma glucose, 2-hour plasma glucose, and fasting insulin. Primary outcomes include feasibility parameters, intervention acceptability, and participants' experiences, perceptions, and satisfaction with the HIIT intervention, as well as facilitators and barriers to participation. Secondary outcomes comprise between-group differences in changes in clinical measures and continuous glucose monitoring metrics from baseline to 8 weeks. Quantitative data analysis will include descriptive statistics, correlation, and regression analyses. Qualitative data will be analyzed using framework-driven and thematic analyses. RESULTS Recruitment for the study is scheduled to begin in February 2025, with follow-up expected to be completed by the end of September 2025. We plan to publish the study findings by the end of 2025. CONCLUSIONS The study findings are expected to guide the design and execution of an adequately powered randomized controlled trial for evaluating HIIT efficacy in preventing type 2 diabetes among individuals with i-IFG. TRIAL REGISTRATION Clinicaltrials.gov NCT06143345; https://clinicaltrials.gov/study/NCT06143345. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/59842.
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Affiliation(s)
- Sathish Thirunavukkarasu
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, United States
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mindy L Millard-Stafford
- Exercise Physiology Laboratory, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Michael D Schmidt
- Department of Kinesiology, University of Georgia, Atlanta, GA, United States
| | | | - Ram Bajpai
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Farah El Fil
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Maria Prokou
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Siya Kumar
- College of Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Robyn J Tapp
- Research Institute for Health and Wellbeing, Coventry University, Coventry, United Kingdom
| | | | - Francisco J Pasquel
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Joe R Nocera
- Division of Physical Therapy, Departments of Neurology and Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, United States
- Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, United States
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20
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Wu J, Chen Q, Zou JZ, Chen YY, Chen HH, Lin YY, Huang XD. Association between hepatic steatosis index and glucose status conversion from impaired fasting glucose base on Chinese adults: a cohort study from real-world. Eur J Med Res 2025; 30:100. [PMID: 39953638 PMCID: PMC11827240 DOI: 10.1186/s40001-025-02354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/03/2025] [Indexed: 02/17/2025] Open
Abstract
OBJECTIVE Evidence regarding the relationship between the hepatic steatosis index (HSI) and glycemic conversion outcomes in individuals with impaired fasting glucose (IFG) is still limited. Our study aims to explore the role of HSI in the reversion to normoglycemia or the progression to diabetes among Chinese IFG individuals. METHODS We conducted a retrospective analysis using data from 11,327 IFG individuals who had undergone wellness examinations at Rich Healthcare Group. To analyze the association between the baseline HSI and glucose status conversion, a Cox regression model was used, and the hazard ratio (HR) and 95% confidence interval (CI) were computed. A generalized additive model was used to examine non-linear relationships. A two-piecewise binary logistic regression model was employed to further elucidate the non-linearity. Sensitivity and subgroup analyses were also conducted. RESULTS Over an observation period spanning 33,892 person-years, the rate of normoglycemia reversion was found to be 41.75%, whereas the rate of progression to diabetes was 11.63%. After accounting for potential confounding variables, our analysis demonstrated that among IFG individuals, there was an inverse relationship between HSI and the likelihood of returning to normoglycemia (HR = 0.93, 95% CI: 0.90-0.96, P < 0.001), and a positive association between the HSI and progression to diabetes (HR = 1.49, 95% CI: 1.40-1.58, P < 0.001). The smooth curve-fitting plot revealed a nonlinear association between the HSI and diabetes progression, with inflection points at 26.55 and 40.74. Sensitivity analysis and subgroup analysis confirmed the stability of the study's findings. CONCLUSION HSI was significantly linked to normoglycemia reversion and diabetes progression in IFG individuals, indicating its potential as a risk indicator for diabetes and a guide for prevention strategies. However, further research is needed to confirm this.
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Affiliation(s)
- Juan Wu
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Qi Chen
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Jun-Zhong Zou
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Yi-Ying Chen
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Hua-Hong Chen
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Yu-Ye Lin
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Xu-Dong Huang
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China.
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21
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Jain PR, Ng HK, Tay D, Mina T, Low D, Sadhu N, Kooner IK, Gupta A, Li TF, Bertin N, Chin CWL, Fang CJ, Goh LL, Mok SQ, Peh SQ, Sabanayagam C, Jha V, Kasturiratne A, Katulanda P, Khawaja KI, Lim WK, Leong KP, Cheng CY, Yuan JM, Elliott P, Riboli E, Sing LE, Lee J, Ngeow J, Liu JJ, Best J, Kooner JS, Tai ES, Tan P, van Dam RM, Koh WP, Xueling S, Loh M, Chambers JC. Nuclear regulatory disturbances precede and predict the development of Type-2 diabetes in Asian populations. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.02.14.25322264. [PMID: 39990582 PMCID: PMC11844604 DOI: 10.1101/2025.02.14.25322264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
To identify biomarkers and pathways to Type-2 diabetes (T2D), a major global disease, we completed array-based epigenome-wide association in whole blood in 5,709 Asian people. We found 323 Sentinel CpGs (from 314 genetic loci) that predict future T2D. The CpGs reveal coherent, nuclear regulatory disturbances in canonical immune activation pathways, as well as metabolic networks involved in insulin signalling, fatty acid metabolism and lipid transport, which are causally linked to development of T2D. The CpGs have potential clinical utility as biomarkers. An array-based composite Methylation Risk Score (MRS) is predictive for future T2D (RR: 5.2 in Q4 vs Q1; P=7×10-25), and is additive to genetic risk. Targeted methylation sequencing revealed multiple additional CpGs predicting T2D, and synthesis of a sequencing-based MRS that is strongly predictive for T2D (RR: 8.3 in Q4 vs Q1; P=1.0×10-11). Importantly, MRS varies between Asian ethnic groups, in a way that explains a large fraction of the difference in T2D risk between populations. We thus provide new insights into the nuclear regulatory disturbances that precede development of T2D, and reveal the potential for sequence-based DNA methylation markers to inform risk stratification in diabetes prevention.
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Affiliation(s)
- Pritesh R Jain
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hong Kiat Ng
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Darwin Tay
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Theresia Mina
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Dorrain Low
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Nilanjana Sadhu
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ishminder K Kooner
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Ananya Gupta
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Tai Fei Li
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Nicolas Bertin
- Precision Health Research (PRECISE), Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | | | - Chai Jin Fang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Liuh Ling Goh
- Personalised Medicine Service, Tan Tock Seng Hospital, Singapore
| | - Shi Qi Mok
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Su Qin Peh
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | | | | | | | | | - Weng Khong Lim
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore
- SingHealth Duke-NUS Genomic Medicine Centre, Singapore
- Cancer & Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | - Khai Pang Leong
- Personalised Medicine Service, Tan Tock Seng Hospital, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jian-Min Yuan
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Lee Eng Sing
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jimmy Lee
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Institute of Mental Health, Singapore
| | - Joanne Ngeow
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Jian Jin Liu
- Human Genomics, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Best
- Melbourne Medical School, University of Melbourne, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jaspal S Kooner
- Department of Cardiology, Ealing Hospital, London North West Healthcare NHS Trust, Middlesex, United Kingdom
- Imperial College Healthcare NHS Trust, Imperial College London, London, United Kingdom
- Medical Research Council-Public Health England Centre for Environment and Health, Imperial College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - E-Shyong Tai
- Precision Health Research (PRECISE), Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Division of Endocrinology, National University Hospital, Singapore
| | - Patrick Tan
- Precision Health Research (PRECISE), Singapore
- Duke-NUS Medical School, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Woon-Puay Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Sim Xueling
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Marie Loh
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
- National Skin Centre, Research Division, Singapore
| | - John C Chambers
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
- Precision Health Research (PRECISE), Singapore
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Wang Z, Wu C, Yin D, Dou K. Ferroptosis: mechanism and role in diabetes-related cardiovascular diseases. Cardiovasc Diabetol 2025; 24:60. [PMID: 39920799 PMCID: PMC11806630 DOI: 10.1186/s12933-025-02614-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 01/24/2025] [Indexed: 02/09/2025] Open
Abstract
Cardiovascular diseases represent the principal cause of death and comorbidity among people with diabetes. Ferroptosis, an iron-dependent non-apoptotic regulated cellular death characterized by lipid peroxidation, is involved in the pathogenesis of diabetic cardiovascular diseases. The susceptibility to ferroptosis in diabetic hearts is possibly related to myocardial iron accumulation, abnormal lipid metabolism and excess oxidative stress under hyperglycemia conditions. Accumulating evidence suggests ferroptosis can be the therapeutic target for diabetic cardiovascular diseases. This review summarizes ferroptosis-related mechanisms in the pathogenesis of diabetic cardiovascular diseases and novel therapeutic choices targeting ferroptosis-related pathways. Further study on ferroptosis-mediated cardiac injury can enhance our understanding of the pathophysiology of diabetic cardiovascular diseases and provide more potential therapeutic choices.
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Affiliation(s)
- Ziyi Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cardiometabolic Medicine Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cardiometabolic Medicine Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yin
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Cardiometabolic Medicine Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Kefei Dou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Cardiometabolic Medicine Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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23
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Teimouri A, Ebrahimpour Z, Feizi A, Iraj B, Saffari E, Akbari M, Karimifar M. Pre-diabetes and cardiovascular risk factors in NAFLD patients: a retrospective comparative analysis. Front Endocrinol (Lausanne) 2025; 16:1416407. [PMID: 39991738 PMCID: PMC11842249 DOI: 10.3389/fendo.2025.1416407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 01/13/2025] [Indexed: 02/25/2025] Open
Abstract
Objectives Insulin resistance plays a critical role in the pathophysiology of diabetes mellitus and non-alcoholic fatty liver disease (NAFLD). Moreover, insulin resistance has a central role in atherogensis as the major leading cause of cardiovascular disease (CVD). The aim of the present study was to assess the frequency of pre-diabetes and evaluate the cardiometabolic risk factors among NAFLD patients, comparing those with pre-diabetes to those with normal glucose tolerance. Methods In the current retrospective case-control study, the data of 1031 NAFLD patients was retrieved. Based on blood glucose levels, 337 diabetics, 340 pre-diabetes, and, 354 normal glucose patients were diagnosed. After excluding diabetic NAFLD patients, 694 individuals were divided into two groups: normal glucose and pre-diabetes. Various variables, such as age, anthropometric measurements, hypertension, systolic and diastolic blood pressure, and lipid profiles, were extracted from patient files. Statistical analysis was conducted to assess cardiovascular risk factors in NAFLD patients. Results Higher age, female gender, higher BMI, triglyceride, waist and hip circumference and waist-to-hip ratio were found in pre-diabetic NAFLD individuals compared with normoglycemic ones (P-value<0.05). Multivariable age-, sex-, BMI- and smoking- adjusted logistic regression showed a predicting role of pre-diabetes and NAFLD concurrence with metabolic syndrome (P-value<0.001, OR:4.31, 95% CI: 2.95- 6.29), but not CVD (P-value=0.353, OR:1.37, 95% CI: 0.71- 2.61). Conclusion In this study, nearly one-third of NAFLD patients had pre-diabetes. The mean value of age, BMI, TG, waist and Hip circumference was significantly higher in pre-diabetic patients. The concurrence of pre-diabetes and NAFLD was a predicting factor for metabolic syndrome, but not CVD events.
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Affiliation(s)
- Azam Teimouri
- Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Ebrahimpour
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Saffari
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mozhgan Karimifar
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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Dong G, Gu X, Qiu C, Xie Y, Hu Z, Wu L. Neutrophil-lymphocyte ratio is a predictor for all-cause and cardiovascular mortality in individuals with prediabetes in a National study. Endocrine 2025; 87:589-598. [PMID: 39438396 DOI: 10.1007/s12020-024-04075-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 10/09/2024] [Indexed: 10/25/2024]
Abstract
PURPOSE We aimed to investigate the value of the neutrophil-lymphocyte ratio (NLR) in predicting the all-cause and cardiovascular mortality risk of individuals with prediabetes. METHODS A total of 11,504 prediabetic patients from the National Health and Nutrition Examination Survey (NHANES) 2003-2016 were included in the present study. Mortality and the underlying cause of death were ascertained by linkage to National Death Index records through December 31, 2019. Restricted cubic spline (RCS) analysis was conducted to visualize the association between the NLR and mortality risk. The optimal NLR cutoff value corresponding to the most significant correlation with survival outcomes was calculated by the maximally selected rank statistics method (MSRSM). Weighted multivariable Cox regression models and subgroup analyses were used to calculate HRs and 95% CIs for all-cause and cardiovascular mortality. RESULTS During a median follow-up of 101 months (interquartile range, 64.0-138.0 months), 1654 (14.38%) deaths were documented, including 422 (3.67%) and 1232 (10.71%) due to cardiovascular and non-cardiovascular events, respectively. RCS regression analysis indicated that the NLR was positively associated with all-cause and cardiovascular mortality. Individuals were divided into lower (≤2.94) and higher (>2.94) NLR groups using the MSRSM. In the multivariable-adjusted model, compared with the lower NLR group, the higher NLR group had a HR of 1.63 (95% CI, 1.38-1.93) and 2.19 (95% CI, 1.55-3.01) for all-cause and cardiovascular mortality, respectively. CONCLUSIONS The NLR was a valuable marker for predicting all-cause and cardiovascular mortality risk in prediabetic patients.
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Affiliation(s)
- Gaiying Dong
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Xiaofan Gu
- Department of Laboratory Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Chunhua Qiu
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Yanlin Xie
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Zhiwen Hu
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.
| | - Liangliang Wu
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.
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25
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Stedman M, Heald AH, Holland D, Halsall I, Green L, Wu P, Patel K, Scargill J, Gibson M, Hanna FWF, Fryer AA. The Impact of Age and Sex on Fasting Plasma Glucose and Glycated Haemoglobin (HbA1c) in the Non-diabetes Population. Diabetes Ther 2025; 16:257-267. [PMID: 39704964 PMCID: PMC11794718 DOI: 10.1007/s13300-024-01680-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 11/29/2024] [Indexed: 12/21/2024] Open
Abstract
INTRODUCTION We previously reported sex differences in the distribution of glycated haemoglobin (HbA1c) for men/women aged < 50 years vs older individuals, with implications for delayed diabetes diagnosis. Here, we explored whether this pattern was also seen in matched fasting plasma glucose (FPG) levels. METHODS We extracted data on same-day, paired HbA1c and FPG levels from clinical biochemistry laboratory databases from Mersey and West Lancashire Teaching Hospitals NHS Trust (n = 10,153) and Cambridge University Hospitals NHS Foundation Trust (n = 10,022) between Jan 2019 and Dec 2023. Only cases with a single, general-practice HbA1c test were utilised to minimise the risk of including non-diagnostic tests and tests from specialist care (e.g. endocrinology, antenatal services; final dataset: n = 17,271). We examined the links of HbA1c and FPG levels to age and sex. RESULTS Median HbA1c levels were 1 mmol/mol lower in women aged < 45 years compared to men aged < 45 years but not in those aged ≥ 45 years. This pattern was not seen with FPG, where median levels in women were 0.1-0.2 mmol/L lower across all ages. The HbA1c:FPG ratio was significantly higher in women than men in the 45-54 and ≥ 55 years age groups (p = 0.004, Z-score = 2.9 and p = < 0.001, Z-score = 8.9, respectively) but not in the < 45 years age group (p = 0.649, Z-score = 0.5). We confirmed our previous finding that median HbA1c levels in women aged ≥ 55 years and 45-55 years were the same as those in men (39 and 37 mmol/mol, respectively) and that for women aged < 45 years, the median HbA1c (34 mmol/mol) was 1 mol/mol lower than for men (35 mmol/mol). This is reflected in the Z-scores, which showed the largest deviation from zero in the < 45 years age group (- 9.1) and the smallest in the older age group (- 2.9). CONCLUSION We showed differences in HbA1c and FPG patterns with age between men and women, with implications for the diabetes diagnostic threshold for HbA1c in pre-menopausal women, the underdiagnosis of type 2 diabetes in younger women, and missed opportunities for intervention. We propose that a suggested change to HbA1c reference ranges in this group warrants serious consideration and detailed evaluation.
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Affiliation(s)
| | - Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
| | | | - Ian Halsall
- Department of Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lewis Green
- Department of Clinical Biochemistry, St. Helens & Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Pensee Wu
- School of Medicine, Keele University, Staffordshire, UK
- Department of Obstetrics & Gynaecology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Kashyap Patel
- NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK
| | - Jonathan Scargill
- Department of Clinical Biochemistry, The Royal Oldham Hospital, The Northern Care Alliance, Oldham, UK
| | - Martin Gibson
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Fahmy W F Hanna
- School of Medicine, Keele University, Staffordshire, UK
- Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Rooney MR, Wallace AS, Echouffo Tcheugui JB, Fang M, Hu J, Lutsey PL, Grams ME, Coresh J, Selvin E. Prediabetes is associated with elevated risk of clinical outcomes even without progression to diabetes. Diabetologia 2025; 68:357-366. [PMID: 39531040 PMCID: PMC11732724 DOI: 10.1007/s00125-024-06315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 09/24/2024] [Indexed: 11/16/2024]
Abstract
AIMS/HYPOTHESIS Prediabetes (HbA1c 39-47 mmol/mol [5.7-6.4%] or fasting glucose 5.6-6.9 mmol/l) is associated with elevated risks of microvascular and macrovascular complications. It is unknown to what extent these risks in prediabetes remain after accounting for progression to diabetes. METHODS In 10,310 participants from the Atherosclerosis Risk in Communities (ARIC) Study (aged 46-70 years, ~55% women, ~20% Black adults) without diabetes at baseline (1990-1992), we used Cox regression to characterise age- and sex-adjusted associations of prediabetes with ~30 year incidence of complications (composite and separately), including atherosclerotic CVD (ASCVD), heart failure, chronic kidney disease (CKD) and all-cause mortality before and after accounting for intervening incidence of diabetes, modelled as a time-varying variable. We calculated the excess risk of complications in prediabetes remaining after accounting for progression to diabetes. RESULTS Of the 60% of adults with prediabetes at baseline, ~30% progressed to diabetes (median time to diabetes, 7 years). Over the maximum follow-up of ~30 years, there were 7069 events (1937 ASCVD, 2109 heart failure, 3288 CKD and 4785 deaths). Prediabetes was modestly associated with risk of any complication (HR 1.21 [95% CI 1.15, 1.27]) vs normoglycaemia. This association remained significant after accounting for progression to diabetes (HR 1.18 [95% CI 1.12, 1.24]) with 85% (95% CI 75, 94%) of the excess risk of any complication in prediabetes remaining. Results were similar for the individual complications. CONCLUSIONS/INTERPRETATION Progression to diabetes explained less than one-quarter of the risks of clinical outcomes associated with prediabetes. Prediabetes contributes to the risk of clinical outcomes even without progression to diabetes.
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Affiliation(s)
- Mary R Rooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Amelia S Wallace
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin B Echouffo Tcheugui
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael Fang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jiaqi Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Morgan E Grams
- Division of Precision Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Josef Coresh
- Optimal Aging Institute, New York University Grossman School of Medicine, New York, NY, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wu Y, Li Z, Zhao P, Xu J, Yuan M. Sleep patterns and cardiovascular disease risk in US participants: a comprehensive analysis. Front Neurosci 2025; 18:1447543. [PMID: 39850623 PMCID: PMC11754222 DOI: 10.3389/fnins.2024.1447543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 12/04/2024] [Indexed: 01/25/2025] Open
Abstract
Background and purpose To evaluate the association between sleep-related factors, including sleep duration, self-reported sleep disturbances, and diagnosed sleep disorders, and the risk of cardiovascular disease (CVD) in US participants. Methods The data of this study from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2014. Sleep factors were assessed using a standardized questionnaire, and overall sleep scores were calculated on a scale of 0 to 3. The participants were classified into three sleep pattern groups: poor sleep pattern (overall sleep score ≤ 1), intermediate sleep pattern (overall sleep score = 2), and healthy sleep pattern (overall sleep score = 3). CVD was defined based on self-reported questionnaire responses. Logistic regression models were used to investigate the association between sleep factors and CVD. Results Among 21,115 participants, 2,245 (10.6%) were diagnosed with CVD. Participants with poor sleep patterns had a significantly higher risk of CVD (OR = 1.82, 95% CI: 1.52-2.16, p < 0.001). Self-reported trouble sleeping (OR = 1.53, 95% CI: 1.32-1.78, p < 0.001), and sleep disorder (OR = 2.09, 95% CI: 1.75-2.50, p < 0.001) were related to an increased risk of CVD. However, no such association was observed for either short (OR = 1.12, 95% CI: 0.95-1.33, p = 0.174) or long sleep durations (OR = 1.14, 95% CI: 0.90-1.45, p = 0.266). Our study also suggested an interaction between sleep patterns and age (P for interaction = 0.002). Conclusion This study highlights the significant association between poor sleep patterns and an increased risk of CVD in US participants.
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Affiliation(s)
- Yue Wu
- Department of Cardiovascular Medicine, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Zhizheng Li
- Department of Cardiovascular Medicine, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Peng Zhao
- Department of Neurology, Zixi Hospital of Jiangxi Provincial People’s Hospital, Zixi County People’s Hospital, Fuzhou, China
| | - Jiajing Xu
- Department of Neurology, Zixi Hospital of Jiangxi Provincial People’s Hospital, Zixi County People’s Hospital, Fuzhou, China
| | - Min Yuan
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Tully PJ, Schutte N, Guppy MP, Garatva P, Wittert G, Baumeister H. Psychological interventions for depression in people with diabetes mellitus. Cochrane Database Syst Rev 2025; 1:CD016005. [PMID: 39775486 PMCID: PMC11707823 DOI: 10.1002/14651858.cd016005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of psychological interventions for depression in people with diabetes mellitus.
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Affiliation(s)
- Phillip J Tully
- School of Psychology, Deakin University, Burwood, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
- School of Psychology, University of New England, Armidale, Australia
| | - Nicola Schutte
- School of Psychology, University of New England, Armidale, Australia
| | - Michelle Pb Guppy
- School of Rural Medicine, University of New England, Armidale, Australia
| | - Patricia Garatva
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Gary Wittert
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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Song C, Qiao Z, Cheng J, Zhang Y, Liu W, Yuan S, He J, Song Y, Bian X, Lin Z, Fu R, Wang C, Liu Q, Feng L, Tao J, Dou K. Optimal Definition and Risk Stratification in Prediabetes With Stable Coronary Heart Disease: A Prospective Cohort Study. J Am Heart Assoc 2025; 14:e037492. [PMID: 39719409 PMCID: PMC12054434 DOI: 10.1161/jaha.124.037492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 11/19/2024] [Indexed: 12/26/2024]
Abstract
BACKGROUND The optimal definition and risk stratification approach to identify high-risk patients with prediabetes and stable coronary heart disease has not been well studied to date. The objective of the current study is to compare the prognostic value of different definitions of prediabetes, and to explore the role of "very-high-risk" (VHR) criteria according to the 2018 American Heart Association/American College of Cardiology cholesterol guideline in the risk stratification of patients with prediabetes and stable coronary heart disease. METHODS AND RESULTS This prospective large-cohort study enrolled a total of 7930 patients with stable coronary heart disease. Prediabetes was defined according to various guidelines and further classified on the basis of the VHR criteria according to the 2018 American Heart Association/American College of Cardiology guideline. The primary end point was major adverse cardiovascular events (MACEs), which was defined as the composite end point of cardiac death, nonfatal acute myocardial infarction, and stroke. During a median of 3 years' follow-up, a total of 256 MACEs occurred. Prediabetes defined according to the World Health Organization/International Expert Committee criteria was associated with significant increased MACE risk compared with normoglycemia (adjusted hazard ratio [HR], 1.484 [95% CI, 1.139-1.935]; P=0.0035). The VHR group was associated with increased MACE risk compared with the non-VHR group (adjusted HR, 1.783 [95% CI, 1.344-2.366], P<0.0001). The VHR criteria played an important role in risk stratification, and prediabetes combined with VHR criteria was associated with higher MACE risk regardless of the prediabetes definition. CONCLUSIONS Our findings suggested the potential use of the World Health Organization/International Expert Committee definition and VHR criteria in risk stratification of patients with prediabetes and stable coronary heart disease.
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Affiliation(s)
- Chenxi Song
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Zheng Qiao
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Jiaxi Cheng
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Yuze Zhang
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Weida Liu
- Department of Echocardiography, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Sheng Yuan
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Jining He
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Yanjun Song
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Xiaohui Bian
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Zhangyu Lin
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Rui Fu
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Chunyue Wang
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Qianqian Liu
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Lei Feng
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
| | - Jin Tao
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
- Department of Echocardiography, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Kefei Dou
- Cardiometabolic Medicine Center, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Cardiology, Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- State Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijingChina
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Wei Q, Zhou L, Sun J, Wu G, Gong S, Gao Z, Wu J, Wang Y, Xiao Y, Li Y. Rapid detection of drugs in blood using "molecular hook" surface-enhanced Raman spectroscopy and artificial intelligence technology for clinical applications. Biosens Bioelectron 2025; 267:116855. [PMID: 39426281 DOI: 10.1016/j.bios.2024.116855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/24/2024] [Accepted: 10/12/2024] [Indexed: 10/21/2024]
Abstract
Accurate detection of cardiovascular drugs in blood is complicated by interference from serum biomolecules. This study introduces a novel surface-enhanced Raman spectroscopy (SERS) platform incorporating "molecular hooks" to capture small drug molecules while excluding larger biomolecules selectively. The self-assembled nanoparticles with the A13 molecule enhance Raman signals by creating dense electromagnetic "hotspot" regions, achieving detection limits of 10 pg/mL for dobutamine hydrochloride and 10 ng/mL for milrinone-substantially below therapeutic thresholds. Artificial intelligence (AI) integration enables automated spectral analysis, allowing rapid and precise drug detection in clinical blood samples. This approach offers a transformative solution for real-time diagnostics, significantly advancing personalized treatment strategies in clinical settings.
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Affiliation(s)
- Qingbin Wei
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang 150086, PR China
| | - Liping Zhou
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Research Center for Innovative Technology of Pharmaceutical Analysis, College of Pharmacy, Harbin Medical University, Heilongjiang, 150081, PR China
| | - Jin Sun
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Research Center for Innovative Technology of Pharmaceutical Analysis, College of Pharmacy, Harbin Medical University, Heilongjiang, 150081, PR China
| | - Guangrun Wu
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Research Center for Innovative Technology of Pharmaceutical Analysis, College of Pharmacy, Harbin Medical University, Heilongjiang, 150081, PR China
| | - Siqi Gong
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Research Center for Innovative Technology of Pharmaceutical Analysis, College of Pharmacy, Harbin Medical University, Heilongjiang, 150081, PR China
| | - Zibo Gao
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Research Center for Innovative Technology of Pharmaceutical Analysis, College of Pharmacy, Harbin Medical University, Heilongjiang, 150081, PR China
| | - Jing Wu
- School of Physics and Technology, Nantong University Nantong, Jiangsu 226019, PR China
| | - Yingji Wang
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Research Center for Innovative Technology of Pharmaceutical Analysis, College of Pharmacy, Harbin Medical University, Heilongjiang, 150081, PR China
| | - Yanlong Xiao
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, 130041, PR China
| | - Yang Li
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Research Center for Innovative Technology of Pharmaceutical Analysis, College of Pharmacy, Harbin Medical University, Heilongjiang, 150081, PR China; Research Unit of Health Sciences and Technology (HST), Faculty of Medicine University of Oulu 90014, Finland.
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Chianelli M, Armellini M, Carpentieri M, Coccaro C, Cuttica CM, Fusco A, Marucci S, Nelva A, Nizzoli M, Ponziani MC, Sciaraffia M, Tassone F, Busetto L. Obesity in Prediabetic Patients: Management of Metabolic Complications and Strategies for Prevention of Overt Diabetes. Endocr Metab Immune Disord Drug Targets 2025; 25:8-36. [PMID: 38778593 PMCID: PMC11826913 DOI: 10.2174/0118715303282327240507184902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024]
Abstract
Obesity and prediabetes affect a substantial part of the general population, but are largely underdiagnosed, underestimated, and undertreated. Prediabetes differs from diabetes only in the degree of hyperglycaemia consequent to the progressive decline in residual beta-cell function. Both prediabetes and diabetes occur as a consequence of insulin resistance that starts several years before the clinical onset of overt diabetes. Macrovascular complications in patients with diabetes are mainly caused by insulin resistance. This is why in prediabetes, the overall cardiovascular risk is, by all means, similar to that in patients with diabetes. It is important, therefore, to identify prediabetes and treat patients not only to prevent or delay the onset of diabetes, but to reduce the cardiovascular risk associated with prediabetes. This review provides an overview of the pathophysiology of prediabetes in patients with obesity and the progression toward overt diabetes. We have reviewed nutritional and pharmacological approaches to the management of obesity and reduced glucose tolerance, and the treatment of the major comorbidities in these patients, including hypertension, dyslipidaemia, and Metabolic dysfunction-associated Steatotic Liver Disease (MASLD), has also been reviewed. In patients with obesity and prediabetes, the nutritional approach is similar to that adopted for patients with obesity and diabetes; treatments of dyslipidaemia and hypertension also have the same targets compared to patients with diabetes. MASLD is a critical issue in these patients; in the prediabetic state, MASLD rarely progresses into fibrosis. This highlights the importance of the early recognition of this pathological condition before patients become diabetic when the risk of fibrosis is much higher. It is necessary to raise awareness of the clinical relevance of this pathological condition in order to prompt early intervention before complications occur. The single most important therapeutic goal is weight loss, which must be early and persistent.
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Affiliation(s)
- Marco Chianelli
- Unit of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Marina Armellini
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, Udine, Italy
| | - Maria Carpentieri
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, Udine, Italy
| | - Carmela Coccaro
- Department of Civil Disability, Istituto Nazionale della Previdenza Sociale, Rome, Italy
| | | | - Alessandra Fusco
- Diabetology Center Villaricca, Azienza Sanitaria 2 Naples, Naples, Italy
| | - Simonetta Marucci
- Scienza dell'Alimentazione e Nutrizione Umana, University Campus Biomedico, Rome, Italy
| | - Anna Nelva
- Unit of Endocrinology and Diabetology, Ospedale degli Infermi, Ponderano, Italy
| | - Maurizio Nizzoli
- Unit of Endocrinology and Metabolism G.B. Morgagni Hospital, Forlì, Italy
| | | | | | - Francesco Tassone
- Department of Endocrinology, Diabetes & Metabolism, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy
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He Y, Ye M, Xia Y, Zhong Z, Li Q. Serum uric acid and prediabetes progression and regression: a retrospective cohort study. Postgrad Med J 2024:qgae183. [PMID: 39723556 DOI: 10.1093/postmj/qgae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 11/10/2024] [Accepted: 12/03/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND The impact of serum uric acid (SUA) levels on metabolic disorders, particularly concerning the development or reversal of prediabetes, is not well understood. While high uric acid is recognized for its association with metabolic disturbances, its specific influence on prediabetes progression and regression has been insufficiently explored. This study investigates how SUA levels correlate with the natural course of prediabetes, shedding light on its management. METHODS A cohort of 3659 individuals diagnosed with prediabetes at Nanjing First Hospital was tracked over three years. Follow-up assessments included fasting plasma glucose and hemoglobin A1c (HbA1c) measurements. Serum uric acid was measured initially and categorized into quartiles (Q1 through Q4). To assess the impact of uric acid levels on shifting prediabetes status, methods such as restricted cubic spline, segmented regression, stratified analysis, and receiver operating characteristic curves were utilized in a multinomial logistic regression framework. RESULTS At baseline, all 3659 participants had prediabetes; by the three-year mark, 2626 remained in this category, 523 reverted to normal fasting glucose (NFG), and 510 advanced to diabetes. After adjustment for potential confounders, a positive correlation was found between higher SUA levels and progression to diabetes (Odds ratio [OR] 1.182, 95% confidence interval [CI]: 1.095-1.276), with no significant link to reversion to NFG (OR: 0.987, 95% CI: 0.909-1.073). CONCLUSION Elevated SUA levels are linked with a higher likelihood of progressing from prediabetes to diabetes but do not significantly forecast a regression to NFG.
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Affiliation(s)
- Yijia He
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Miaomin Ye
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Yin Xia
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Ziyi Zhong
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Qian Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
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Alessa T, Al Awadi F, Al Kaabi J, Al Mamari A, Al Ozairi E, Alromaihi D, Elhadd T, Gunaid AA, Hassanein M, Jayyousi AA, Kalimat R, Brand KMG. Modern-Day Management of the Dysglycemic Continuum: An Expert Viewpoint from the Arabian Gulf. Diabetes Metab Syndr Obes 2024; 17:4791-4802. [PMID: 39712240 PMCID: PMC11662629 DOI: 10.2147/dmso.s491591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 10/26/2024] [Indexed: 12/24/2024] Open
Abstract
Prediabetes is the first stage of a continuum that extends through the diagnosis of clinical type 2 diabetes towards long-standing diabetes with multiple comorbidities. The diagnosis of prediabetes provides an opportunity to interrupt the diabetes continuum at an early stage to ensure long-term optimization of clinical outcomes. All people with prediabetes should receive intervention to improve their lifestyles (quality of diet and level of physical activity), as this has been proven beyond doubt to reduce substantially the risk of conversion to diabetes. Additionally, a large base of clinical evidence supports the use of metformin in preventing or delaying the transition from prediabetes to clinical type 2 diabetes, for some people with prediabetes. For many years, guidelines for the management of type 2 diabetes focused on lowering blood glucose, with metformin prescribed first for those without contraindications. More recently, guidelines have shifted towards prevention of diabetes complications as the primary goal, with increased use of GLP-1 receptor agonists (or multi-agonist incretin peptides) or SGLT-2 inhibitors for patients with existing atherosclerotic cardiovascular disease, heart failure or chronic kidney disease. Access to these medications often remains challenging. Metformin remains a suitable option for initial pharmacologic intervention to manage glycemia for many people with prediabetes or type 2 diabetes along with other therapy to maintain control of blood glucose or to address specific comorbidities as the patient progresses along the diabetes continuum.
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Affiliation(s)
- Thamer Alessa
- Division of Endocrinology, Jaber Al-Ahmad Hospital, Kuwait City, Kuwait
| | - Fatheya Al Awadi
- Endocrine Department, Dubai Hospital, Dubai Academic Health Corporation (DAHC), Dubai, United Arab Emirates
| | - Juma Al Kaabi
- Department of Internal Medicine, College of Medicine and Health Sciences, The United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ali Al Mamari
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ebaa Al Ozairi
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait
| | - Dalal Alromaihi
- Internal Medicine Department, Royal College of Surgeons in Ireland-Medical University of Bahrain, Adliya, Kingdom of Bahrain
| | - Tarik Elhadd
- Endocrine Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Abdallah A Gunaid
- Internal Medicine, Sana’a University Faculty of Medicine, Sanaa, Yemen
| | - Mohamed Hassanein
- Department of Endocrinology and Diabetes, Dubai Hospital, Dubai Academic Health Corporation (DAHC), Dubai, United Arab Emirates
| | - Amin A Jayyousi
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Raya Kalimat
- Medical Affairs, Merck Serono Middle East FZ-LLC, Dubai, United Arab Emirates
| | - Kerstin M G Brand
- Global Research & Development Medical – MU CM&E, Merck Healthcare KGaA, Darmstadt, Germany
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Banach M, Surma S, Dzida G, Józwiak J, Okopień B, Rysz J, Szosland K, Grzybowski A. The prevention opportunities of retinopathy in diabetic patients - position paper endorsed by the Polish Lipid Association. Arch Med Sci 2024; 20:1754-1769. [PMID: 39967951 PMCID: PMC11831340 DOI: 10.5114/aoms/197331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 12/11/2024] [Indexed: 02/20/2025] Open
Abstract
Cardiovascular diseases (CVD) prevention does not only mean effective fight against the existing and well-recognized cardiovascular risk factors, but also against their complications, including micro- and macrovascular complications. Only then we might comprehensively reduce CVD burden and cardiovascular and cause-specific morbidity and mortality. In relation to obesity, prediabetes and especially diabetes, we recognize a number of potential dangerous non-cardiovascular complications, such as neuropathy, nephropathy and retinopathy. The latter's prevalence is even 30-40% and may appear in as many as 15% of patients with prediabetes. If not treated well it might result in the need for eye surgery or even vision loss. Fenofibrate has had a long history of evidence suggesting its preventive role in primary and especially secondary prevention of retinopathy, what has been investigated since the FIELD trial 19 years ago. Thus, given the obesity (the prevalence of 30% in Poland) and diabetes (10% which is predicted to be doubled in next 25 years) epidemic, we should look for the effective methods not only to optimize fasting blood glucose and haemoglobin A1C, but also atherogenic dyslipidaemia and their complications, including retinopathy. In this Position Paper by the Polish Lipid Association (PoLA) we have reviewed the current stage of knowledge on possible mechanisms by which fenofibrate may contribute to retinopathy prevention, available data on safety and efficacy, to finally recommend administering fenofibrate in prevention of this dangerous diabetic complication, which significantly affects quality of life and disability-adjusted life-years (DALY). This intervention - well-recognized and already in common use in diabetic patients - may significantly improve population health in Poland and worldwide.
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Affiliation(s)
- Maciej Banach
- Center for the Atherosclerosis and Cardiovascular Diseases Prevention, Faculty of Medicine, the John Paul II Catholic University of Lublin (KUL), Lublin, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Liverpool Centre for Cardiovascular Science (LCCS), Liverpool, UK
| | - Stanisław Surma
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Dzida
- Department of Internal Medicine, Medical University of Lublin, Lublin, Poland
| | - Jacek Józwiak
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, Opole, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz (MUL), Lodz, Poland
| | - Konrad Szosland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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Liu Y, Liu Y, Zhang M, Wang X, Zhou X, Guo H, Wang B, Wang D, Sun Z, Qiu S. Cluster-based subgroups of prediabetes and its association with prediabetes progression and regression: a prospective cohort study. Acta Diabetol 2024:10.1007/s00592-024-02433-8. [PMID: 39666111 DOI: 10.1007/s00592-024-02433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 12/02/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND Cluster analysis provides an effective approach in stratifying prediabetes into different subgroups; however, the association of the cluster-based subgroups with prediabetes progression and regression has not been investigated. We aimed to address this issue in a Chinese population. METHODS A total of 4,128 participants with prediabetes were included to generate cluster-based subgroups of prediabetes based on age, body mass index (BMI), triglyceride-and-glucose (TyG) index, and hemoglobin A1c (HbA1c), using a k-means clustering model. Among them, 1,554 participants were followed-up for about three years to ascertain prediabetes progression and regression. Their association with the cluster-based subgroups of prediabetes was assessed using multinomial logistic regression analyses. RESULTS Three clusters of prediabetes were identified among the 4,128 participants, with cluster 0, 1 and 2 accounting for 28.0%, 31.4% and 40.6%, respectively. Participants with prediabetes were featured by the youngest age and the lowest HbA1c in cluster 0, the highest BMI and TyG index in cluster 1, and the oldest age and the lowest BMI in cluster 2. After multivariable-adjustment, both cluster 1 [odds ratio (OR) 3.31, 95% confidence interval (CI): 2.01-5.44] and cluster 2 (OR 2.58, 95% CI: 1.60-4.18) were associated with increased odds of progression to diabetes when compared with cluster 0. They were also associated with decreased odds of regression to normoglycemia (OR 0.54, and 0.56, respectively). CONCLUSIONS Prediabetes participants featured by older age, higher degree of insulin resistance, higher BMI and worse glycemic condition had higher probability of progression to diabetes but lower chance of regression to normoglycemia.
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Affiliation(s)
- Yan Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, No.87 Dingjiaqiao Street, 210009, Nanjing, China
| | - Yu Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, No.87 Dingjiaqiao Street, 210009, Nanjing, China
| | - Min Zhang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, No.87 Dingjiaqiao Street, 210009, Nanjing, China
| | - Xinchen Wang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, No.87 Dingjiaqiao Street, 210009, Nanjing, China
| | - Xiaoying Zhou
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, No.87 Dingjiaqiao Street, 210009, Nanjing, China
| | - Haijian Guo
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, No.87 Dingjiaqiao Street, 210009, Nanjing, China.
| | - Shanhu Qiu
- Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, No.87 Dingjiaqiao Street, 210009, Nanjing, China.
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Gómez-Peralta F, Luque Romero LG, Puppo-Moreno A, Riesgo J. Performance of a Non-Invasive System for Monitoring Blood Glucose Levels Based on Near-Infrared Spectroscopy Technology ( Glucube®). SENSORS (BASEL, SWITZERLAND) 2024; 24:7811. [PMID: 39686350 DOI: 10.3390/s24237811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 11/26/2024] [Accepted: 12/04/2024] [Indexed: 12/18/2024]
Abstract
BACKGROUND The need for frequent blood glucose (BG) monitoring and the inconveniences associated with self-monitoring of BG (SMBG) have driven the development of non-invasive approaches. METHODS This prospective study aimed to investigate the accuracy of glucose level calculation using the near-infrared spectroscopy (NIRS) technology Glucube® system. People with Type 1 diabetes, Type 2 diabetes, prediabetes, and normal glucose metabolism were included. Over one week, individuals performed glucose measurements with the Glucube® system and capillary blood fingersticks with a standard glucometer (Ascensia Contour® Next). To assess the impact of the improvement in dexterity, the accuracy variables were compared with the point-of-care (POC) glucometer Accu-Chek® Inform II in a one-week sub-study. RESULTS Overall, 105 subjects (mean age 53.8 ± 13.8 years, 50.5% female) participated, resulting in 1914 paired glucose measurements between 49 and 331 mg/dL. Total mean absolute relative difference (MARD) was 20.3%, MARD for values >100 mg/dL was 18.3%, and mean absolute deviation (MAD) for values <100 mg/dL was 24.9%. A total of 97.3% of measurements fell within A+B Parkes zones, and 58.8%, 76.9%, and 88.1% within +-20%, +-30%, or +-40% error, respectively. On completion, 62 participants (59%) fulfilled the one-week prospective sub-study. In this subgroup, the total MARD was reduced between day 1 and day 8 from 22.8 to 18.3% (p = 0.068). The percentages within Zone A were 51.6 vs. 61.2%, Zone B 46.8 vs. 33.9%, and Zone C 1.6 vs. 4.8%, and the sum of Parkes Zones A+B was 98.4 vs. 95.2% (p = 0.311) for day 1 and day 8, respectively. CONCLUSIONS Glucube® is a novel non-invasive system based on NIRS technology for monitoring blood glucose levels. Its promising capabilities support further research.
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Affiliation(s)
- Fernando Gómez-Peralta
- Endocrinology and Nutrition Unit, Segovia General Hospital, Luis Erik Clavería Neurólogo S.N Street, 40002 Segovia, Spain
| | - Luis Gabriel Luque Romero
- Health Care Center La Algaba, 41980 La Algaba, Spain
- Investigation Unit of the Aljarafe District-Sevilla Norte, 41008 Seville, Spain
| | - Antonio Puppo-Moreno
- Intensive Care Unit, Hospital Universitario Virgen Del Rocío, Avda. Manuel Siurot, s/n, 41013 Seville, Spain
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Cai X, Xu M, Chen J, Mao Y, Hu J, Li L, Pan J, Jin M, Chen L. Association Between the Trajectories of the Atherogenic Index of Plasma and Prediabetes Progression to Diabetes: A Retrospective Cohort Study. Diabetes Metab Syndr Obes 2024; 17:4689-4699. [PMID: 39660340 PMCID: PMC11629674 DOI: 10.2147/dmso.s481578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 11/26/2024] [Indexed: 12/12/2024] Open
Abstract
Purpose This study aims to analyze baseline profiles and longitudinal changes in Atherogenic Index of Plasma (AIP) among individuals with prediabetes to identify distinct AIP trajectories and assess their significance in predicting diabetes onset. Methods This retrospective cohort study analyzed data from 8346 participants who underwent multiple general health checks. Utilizing latent class trajectory modeling and Cox proportional hazards analyses, it examined the association between the AIP index and health outcomes. Results Over about 2 years, 2897 people progressed from prediabetes to diabetes. Individuals in the highest quartile of AIP had a higher diabetes risk compared to the lowest quartile (HR = 1.138, 95% CI1.013-1.278). Trajectory analysis revealed three groups: low-stable, moderate-stable, and high-stable, based on AIP index. The moderate-stable group showed a 1.117-fold risk of diabetes progression (95% CI1.026-1.217), while the high-stable group had an elevated risk (HR = 1.224, 95% CI1.059-1.415). Conclusion The study highlights a clear association between higher AIP index levels at baseline and an increased risk of diabetes progression. It underscores the significance of utilizing the AIP index as a predictive tool to identify those at risk, emphasizing the need for targeted preventive measures in managing diabetes progression.
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Affiliation(s)
- XiXuan Cai
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - MingYing Xu
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - JieRu Chen
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - YueChun Mao
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - JingYu Hu
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - LuSha Li
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - JianJiang Pan
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - MengQi Jin
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - LiYing Chen
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310020, People’s Republic of China
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Lai X, Chen T. Association of serum uric acid to high-density lipoprotein cholesterol ratio with all-cause and cardiovascular mortality in patients with diabetes or prediabetes: a prospective cohort study. Front Endocrinol (Lausanne) 2024; 15:1476336. [PMID: 39703865 PMCID: PMC11655219 DOI: 10.3389/fendo.2024.1476336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 11/19/2024] [Indexed: 12/21/2024] Open
Abstract
Background and aims The serum uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) is a novel biomarker that indicates inflammation and metabolic disorders. Also, it has been shown that UHR correlates with the risk of cardiovascular disease. Despite this, limited research exists on its prognostic significance. This study aimed to explore the association of UHR with all-cause and cardiovascular mortality in patients with diabetes or prediabetes. Methods This cohort study included 18,804 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 with diabetes or prediabetes aged 20 years or older, followed until December 31, 2019. Patients with diabetes or prediabetes were grouped according to quartiles of UHR, which was calculated as serum UA (mg/dL)/HDL-C (mg/dL). Kaplan-Meier survival analysis, multivariable Cox proportional hazards regression models, restricted cubic spline analysis, and threshold effects were performed to assess the association between baseline UHR and all-cause and cardiovascular mortality. Subgroup analysis and sensitivity analysis were also conducted. Results During a median follow-up of 80 months, a total of 2,748 (14.61%) deaths occurred, including 869 (4.63%) cardiovascular deaths. Kaplan-Meier survival analysis revealed that the highest quartile of UHR had the highest mortality rates. Multivariable Cox regression analysis indicated that individuals in the highest quartile of UHR had a significantly higher risk of all-cause mortality (HR: 1.24, 95% CI: 1.07-1.45) and cardiovascular mortality (HR: 1.56, 95% CI: 1.19-2.04) compared to those in the second quartile. A J-shaped association between UHR and both all-cause and cardiovascular mortality was observed, with threshold points of 13.73% and 9.39%, respectively. Specifically, when UHR was above the respective thresholds, the HRs of a 10% increment of UHR for all-cause mortality and cardiovascular mortality were 1.45 (95% CI: 1.31-1.61) and 1.38 (95% CI: 1.20-1.60). However, UHR below the threshold did not significantly correlate with mortality. Furthermore, subgroup analyses showed that the correlation of UHR with all-cause mortality was significantly modified by sex and age, with a persistent positive correlation observed in women and those aged < 60. Conclusion Higher UHR was correlated with increased all-cause and cardiovascular mortality in patients with diabetes or prediabetes.
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Affiliation(s)
- Xiaoli Lai
- Department of Endocrinology and Metabolism, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Tao Chen
- Department of Endocrinology and Metabolism, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
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Dauriz M, Csermely A, Santi L, Tregnaghi E, Grotto A, Lucianer T, Altomari A, Rinaldi E, Tardivo S, Bonetti B, Bonora E. Diabetes mellitus in stroke unit: prevalence and outcomes-the Verona acute coronary syndrome and stroke in diabetes outcome (VASD-OUTCOME) study. Acta Diabetol 2024; 61:1543-1552. [PMID: 38951223 DOI: 10.1007/s00592-024-02318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/02/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Cerebrovascular accidents (CVA) represent a major complication in diabetes (DM). Real-life evidence as to whether modern management of CVA and DM have softened this relationship is limited. Therefore, we estimated prevalence and impact of DM on in-hospital survival and complications in a contemporary cohort of subjects with CVA. METHODS We retrospectively evaluated the records of 937 patients admitted for CVA at the Stroke Unit of Verona University Hospital during a 3-year period. Pre-existing or de novo DM was ascertained by prior diagnosis, glucose-lowering therapy at admission/discharge or admittance plasma glucose ≥ 200 mg/dL. Multiple regressions were applied to test DM as predictor of in-hospital mortality, complications (composite of infections, cardio- and cerebrovascular complications, major bleeding and pulmonary complications), duration and costs of hospitalization. RESULTS Diabetes prevalence was 21%, of which 22% de novo diagnoses. Compared to non-DM, diabetic individuals were older and carried an increased burden of cardiovascular risk factors. Compared to known DM, de novo DM individuals were younger, had higher admittance plasma glucose and poorer cardiovascular comorbidities. Overall, DM versus non-DM individuals did not show significantly increased risk of death (14.0 vs. 9.3%; crude-OR 1.59 95% CI 0.99-2.56). Controlling for confounders did not improve significance. DM resulted independent predictor for in-hospital complications (36.2% vs. 26.9%; adj-OR 1.49, 1.04-2.13), but not for duration and costs of hospitalization. CONCLUSION DM frequently occurs in patients admitted for stroke and carries an excess burden of adverse in-hospital complications, urgently calling for strategies to anticipate DM diagnosis and tailored treatment in high-risk individuals.
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Affiliation(s)
- Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Alessandro Csermely
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Elena Tregnaghi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Alberto Grotto
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Tiziano Lucianer
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Anna Altomari
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Elisabetta Rinaldi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Bruno Bonetti
- Division of Neurology, Department of Neurological Sciences, Hospital Trust of Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
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Saba L, Maindarkar M, Khanna NN, Puvvula A, Faa G, Isenovic E, Johri A, Fouda MM, Tiwari E, Kalra MK, Suri JS. An Artificial Intelligence-Based Non-Invasive Approach for Cardiovascular Disease Risk Stratification in Obstructive Sleep Apnea Patients: A Narrative Review. Rev Cardiovasc Med 2024; 25:463. [PMID: 39742217 PMCID: PMC11683711 DOI: 10.31083/j.rcm2512463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/01/2024] [Accepted: 10/18/2024] [Indexed: 01/03/2025] Open
Abstract
Background Obstructive sleep apnea (OSA) is a severe condition associated with numerous cardiovascular complications, including heart failure. The complex biological and morphological relationship between OSA and atherosclerotic cardiovascular disease (ASCVD) poses challenges in predicting adverse cardiovascular outcomes. While artificial intelligence (AI) has shown potential for predicting cardiovascular disease (CVD) and stroke risks in other conditions, there is a lack of detailed, bias-free, and compressed AI models for ASCVD and stroke risk stratification in OSA patients. This study aimed to address this gap by proposing three hypotheses: (i) a strong relationship exists between OSA and ASCVD/stroke, (ii) deep learning (DL) can stratify ASCVD/stroke risk in OSA patients using surrogate carotid imaging, and (iii) including OSA risk as a covariate with cardiovascular risk factors can improve CVD risk stratification. Methods The study employed the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) search strategy, yielding 191 studies that link OSA with coronary, carotid, and aortic atherosclerotic vascular diseases. This research investigated the link between OSA and CVD, explored DL solutions for OSA detection, and examined the role of DL in utilizing carotid surrogate biomarkers by saving costs. Lastly, we benchmark our strategy against previous studies. Results (i) This study found that CVD and OSA are indirectly or directly related. (ii) DL models demonstrated significant potential in improving OSA detection and proved effective in CVD risk stratification using carotid ultrasound as a biomarker. (iii) Additionally, DL was shown to be useful for CVD risk stratification in OSA patients; (iv) There are important AI attributes such as AI-bias, AI-explainability, AI-pruning, and AI-cloud, which play an important role in CVD risk for OSA patients. Conclusions DL provides a powerful tool for CVD risk stratification in OSA patients. These results can promote several recommendations for developing unique, bias-free, and explainable AI algorithms for predicting ASCVD and stroke risks in patients with OSA.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138 Cagliari, Italy
| | - Mahesh Maindarkar
- School of Bioengineering Sciences and Research, MIT Art, Design and Technology University, 412021 Pune, India
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, 110001 New Delhi, India
| | - Anudeep Puvvula
- Department of Radiology, and Pathology, Annu’s Hospitals for Skin and Diabetes, 524101 Nellore, India
| | - Gavino Faa
- Department of Radiology, and Pathology, Azienda Ospedaliero Universitaria, 09123 Cagliari, Italy
- Now with Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Esma Isenovic
- Department of Radiobiology and Molecular Genetics, National Institute of the Republic of Serbia, University of Belgrade, 192204 Belgrade, Serbia
| | - Amer Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
| | - Ekta Tiwari
- Cardiology Imaging, Visvesvaraya National Institute of Technology Nagpur, 440010 Nagpur, India
| | - Manudeep K. Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Jasjit S. Suri
- University Center for Research & Development, Chandigarh University, 140413 Mohali, India
- Department of CE, Graphics Era Deemed to be University, 248002 Dehradun, India
- Symbiosis Institute of Technology, Nagpur Campus, Symbiosis International (Deemed University), 440008 Pune, India
- Stroke Diagnostic and Monitoring Division, AtheroPoint™️, Roseville, CA 95661, USA
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Li C, Gu L, Shi F, Xiong S, Wu G, Peng J, Wang R, Yuan Y, Jiang Y, Huang C, Luo H. Serum liver enzymes and risk of stroke: Systematic review with meta-analyses and Mendelian randomization studies. Eur J Neurol 2024; 31:e16506. [PMID: 39387527 PMCID: PMC11555028 DOI: 10.1111/ene.16506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/11/2024] [Accepted: 09/18/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND AND PURPOSE Previous observational studies have identified correlations between liver enzyme levels and stroke risk. However, the strength and consistency of these associations vary. To comprehensively evaluate the relationship between liver enzymes and stroke risk, we conducted meta-analyses complemented by Mendelian randomization (MR) analyses. METHODS Following the PRISMA guidelines, we performed meta-analyses of prospective studies and conducted subgroup analyses stratified by sex and stroke subtype. Subsequently, adhering to the STROBE-MR guidelines, we performed two-sample bidirectional univariable MR (UVMR) and multivariable MR (MVMR) analyses using the largest genome-wide association studies summary data. Finally, the single-nucleotide polymorphisms associated with liver enzymes on sex differences underwent gene annotation, gene set enrichment, and tissue enrichment analyses. RESULTS In the meta-analyses of 17 prospective studies, we found the relative risks for serum γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) were 1.23 (95% CI: 1.16-1.31) and 1.3 (95% CI: 1.19-1.43), respectively. Subgroup analyses revealed sex and stroke subtype differences in liver enzyme-related stroke risk. Bidirectional UVMR analyses confirmed that elevated GGT, alanine aminotransferase, and aspartate aminotransferase levels were associated with increased stroke occurrence. The primary results from the MVMR analyses revealed that higher ALP levels significantly increased the risk of stroke and ischemic stroke. Gene set and tissue enrichment analyses supported genetic differences in liver enzymes across sexes. CONCLUSIONS Our study provides evidence linking liver enzyme levels to stroke risk, suggesting liver enzymes as potential biomarkers for early identification of high-risk individuals. Personalized, sex-specific interventions targeting liver enzymes could offer new strategies for stroke prevention.
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Affiliation(s)
- Chun Li
- State Key Laboratory of Quality Research in Chinese MedicineMacau University of Science and TechnologyTaipaMacaoChina
- Clinical Trial Research CenterThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouSichuanChina
| | - Long Gu
- Laboratory of Neurological Diseases and Brain FunctionThe Affiliated Hospital, Southwest Medical UniversityLuzhouSichuanChina
| | - Fu‐Yi Shi
- Key Laboratory of Luzhou City for Aging Medicine, Department of PharmacologySchool of Pharmacy, Southwest Medical UniversityLuzhouSichuanChina
| | - Shi‐Ying Xiong
- State Key Laboratory of Quality Research in Chinese MedicineMacau University of Science and TechnologyTaipaMacaoChina
| | - Gui‐Sheng Wu
- Key Laboratory of Luzhou City for Aging Medicine, Department of PharmacologySchool of Pharmacy, Southwest Medical UniversityLuzhouSichuanChina
- Central Nervous System Drug Key Laboratory of Sichuan ProvinceLuzhouSichuanChina
| | - Jian‐Hua Peng
- Laboratory of Neurological Diseases and Brain FunctionThe Affiliated Hospital, Southwest Medical UniversityLuzhouSichuanChina
- Department of NeurosurgeryThe Affiliated Hospital, Southwest Medical UniversityLuzhouSichuanChina
| | - Ruo‐Lan Wang
- Clinical Trial Research CenterThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouSichuanChina
| | - Yuan Yuan
- Clinical Trial Research CenterThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouSichuanChina
| | - Yong Jiang
- State Key Laboratory of Quality Research in Chinese MedicineMacau University of Science and TechnologyTaipaMacaoChina
- Laboratory of Neurological Diseases and Brain FunctionThe Affiliated Hospital, Southwest Medical UniversityLuzhouSichuanChina
- Department of NeurosurgeryThe Affiliated Hospital, Southwest Medical UniversityLuzhouSichuanChina
| | - Chen Huang
- State Key Laboratory of Quality Research in Chinese MedicineMacau University of Science and TechnologyTaipaMacaoChina
| | - Huai‐Rong Luo
- State Key Laboratory of Quality Research in Chinese MedicineMacau University of Science and TechnologyTaipaMacaoChina
- Key Laboratory of Luzhou City for Aging Medicine, Department of PharmacologySchool of Pharmacy, Southwest Medical UniversityLuzhouSichuanChina
- Central Nervous System Drug Key Laboratory of Sichuan ProvinceLuzhouSichuanChina
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Cohen N, Toledano Y, Shafir M, Lavie O, Zilberlicht A. Evaluation of postpartum dysglycemia by serum glycosylated hemoglobin in patients with gestational diabetes mellitus: a national data analysis. Arch Gynecol Obstet 2024; 310:3029-3035. [PMID: 39607441 DOI: 10.1007/s00404-024-07845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 11/14/2024] [Indexed: 11/29/2024]
Abstract
PURPOSE To assess the postpartum sensitivity and accuracy of serum HbA1c levels, compared to the gold standard of 75-g Oral Glucose Tolerance Test (OGTT), for diagnosis of dysglycemia in patients with a history of gestational diabetes mellitus (GDM). METHODS A nationwide retrospective analysis of individuals with a history of GDM and with records of both postpartum 2 h-OGTT and serum HbA1c measured anytime between delivery until 12 months post-delivery. Results were stratified into 3 different intervals: 0-3 months, 3-12 months, and > 12 months after delivery, according to the timing of both OGTT and HbA1c performance. RESULTS Between January 1st, 2015, until December 31st, 2021, a total of 55,119 individuals were screened, and 9,118 were diagnosed with GDM. Overall, 677 of the 9,118 individuals with GDM had laboratory results of both serum HbA1c levels and 2 h 75-gm-OGTT values after delivery. The overall Pearson correlation coefficient between HbA1c and 2 h-OGTT was 0.21 (P < 0.0001). However, when the OGTT results were stratified into 2 h-glucose values ≥ 200 mg/dL, a ROC curve yielded an Area Under the Curve (AUC) of 91.4% [95% CI: 83.9%-98.9%], with HbA1c levels of 5.7% yielding 80.0% sensitivity and 80.8% specificity (95% CI: 44.39-97.48%). CONCLUSIONS In patients with a recent diagnosis of GDM, serum HbA1c may be used as an auxiliary tool for postpartum diagnosis of dysglycemia.
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Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Rappaport Faculty of Medicine, Lady Davis Carmel Medical Center, Technion University, 7 Michal Street, 34361, Haifa, Israel.
| | - Yoel Toledano
- Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - May Shafir
- Department of Obstetrics and Gynecology, Rappaport Faculty of Medicine, Lady Davis Carmel Medical Center, Technion University, 7 Michal Street, 34361, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Rappaport Faculty of Medicine, Lady Davis Carmel Medical Center, Technion University, 7 Michal Street, 34361, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Rappaport Faculty of Medicine, Lady Davis Carmel Medical Center, Technion University, 7 Michal Street, 34361, Haifa, Israel
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Gautam SK, Kumar B, Pandey PKNK. Dynamics of Dairy Product Consumption, Confounding Factors, and Their Influence on the Risk of Type 2 Diabetes. Int J Prev Med 2024; 15:68. [PMID: 39742125 PMCID: PMC11687685 DOI: 10.4103/ijpvm.ijpvm_356_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/15/2024] [Indexed: 01/03/2025] Open
Abstract
It has long been debated whether or not dairy consumption increases the risk of type 2 diabetes (T2D). This link has been assessed by a large number of case-control studies, prospective cohort studies, systematic reviews, and meta-analyses. The majority of their studies demonstrated an inverse relationship between the risk of T2D and dairy consumption. It is yet unclear how dairy products specifically contribute to metabolic diseases like type 2 diabetes. However, a surprising number of studies have indicated either no association or a positive correlation between the development of type 2 diabetes and certain dairy products. The objective of this narrative review is to collate research findings from diverse geographical contexts, exploring the impact of dairy product consumption on the incidence and risk of Type 2 diabetes (T2D). This review includes studies that addressed this research issue and were released between the years 2000 and 2023. This will help the public draw logical inferences and validate the body of recent research. To shed light on this matter, the writers conduct a comprehensive search of electronic scientific databases such as PubMed, Scopus, and Web of Science. Thus, this review emphasizes the connection between the usage of different dairy products and the risk of T2D. After controlling for confounding variables, this review indicates that the relationship between the incidence of type 2 diabetes and consumption of dairy products is context-dependent. In conclusion, not all dairy products help to prevent type 2 diabetes. There is no association between most other dairy products and T2D, while in some cases benefits of yogurt and other low-fat dairy products have been reported.
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Affiliation(s)
- Sanjeev K. Gautam
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Bimlesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
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Riopel C, Trudel X, Milot A, Laurin D, Gilbert-Ouimet M, Brisson C. Effort-reward imbalance at work assessed at midlife and prediabetes prevalence assessed 18 years later in a prospective cohort of white-collar workers. Ann Work Expo Health 2024; 68:940-950. [PMID: 39312482 PMCID: PMC11586276 DOI: 10.1093/annweh/wxae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/20/2024] [Indexed: 09/25/2024] Open
Abstract
OBJECTIVES Evidence suggests that workers exposed to psychosocial stressors at work from the effort-reward imbalance (ERI) model are at increased risk for type 2 diabetes mellitus (T2DM). However, evidence about the effect of ERI on prediabetes is scarce. This study aimed to examine the association between effort-reward imbalance at work, glycated hemoglobin level and the prevalence of prediabetes in women and men from a prospective cohort study. METHODS This study was conducted among 1354 white-collar workers followed for an average of 18 years. Effort-reward imbalance at work was measured in 1999 to 2001 using a validated instrument. Glycated hemoglobin was assessed at follow-up (2015 to 2018). Differences in mean glycated hemoglobin levels were estimated with linear models. Prediabetes prevalence ratios (PRs) were computed using robust Poisson regression models. RESULTS In women, those exposed to effort-reward imbalance at work at baseline had a higher prevalence of prediabetes (PR = 1.60, 95% confidence interval: 1.02-2.49) at follow-up following adjustment for sociodemographic, lifestyle-related, clinical, and other occupational risk factors. There was no difference in mean glycated hemoglobin levels. CONCLUSION Among women, effort-reward imbalance at work at midlife was associated with the prevalence of prediabetes, at older age. Preventive workplace interventions aiming to reduce the prevalence of effort-reward imbalance at work may be effective to reduce the prevalence of prediabetes among women.
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Affiliation(s)
- Camille Riopel
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, QC G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, 1050 Ch Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Xavier Trudel
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, QC G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, 1050 Ch Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Alain Milot
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, QC G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, 1050 Ch Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Danielle Laurin
- Centre de recherche du CHU de Québec-Université Laval, 1050 Ch Ste-Foy, Québec, QC G1S 4L8, Canada
- Centre d’excellence sur le vieillissement de Québec, Centre de recherche VITAM en santé durable, CIUSSS-Capitale Nationale, 2480, chemin de la Canardière, Québec, QC G1J 2G1, Canada
- Faculty of Pharmacy, Université Laval, 1050 Av. de la Médecine, Québec, QC G1V 0A6, Canada
| | - Mahée Gilbert-Ouimet
- Centre de recherche du CHU de Québec-Université Laval, 1050 Ch Ste-Foy, Québec, QC G1S 4L8, Canada
- Health Sciences Department, Université du Québec à Rimouski Campus de Lévis, 1595 Bd Alphonse-Desjardins, Lévis, QC G6V 0A6, Canada
- Canada Research Chair in Sex and Gender in Occupational Health, Université du Québec à Rimouski Campus de Lévis, 1595 Bd Alphonse-Desjardins, Lévis, QC G6V 0A6, Canada
| | - Chantal Brisson
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, QC G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, 1050 Ch Ste-Foy, Québec, QC G1S 4L8, Canada
- Centre d’excellence sur le vieillissement de Québec, Centre de recherche VITAM en santé durable, CIUSSS-Capitale Nationale, 2480, chemin de la Canardière, Québec, QC G1J 2G1, Canada
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Basiri R, Cheskin LJ. Enhancing the Impact of Individualized Nutrition Therapy with Real-Time Continuous Glucose Monitoring Feedback in Overweight and Obese Individuals with Prediabetes. Nutrients 2024; 16:4005. [PMID: 39683399 DOI: 10.3390/nu16234005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/13/2024] [Accepted: 11/18/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND/OBJECTIVES prediabetes is a significant risk factor for the development of type 2 diabetes, cardiovascular diseases, chronic kidney disease, and other complications. Early diagnosis of prediabetes, coupled with education on lifestyle changes that support blood glucose management, are crucial for the prevention or delay of type 2 diabetes and related complications. This study aimed to evaluate the impact of incorporating real-time feedback from continuous glucose monitoring (CGM) into individualized nutrition therapy (INT) on blood glucose control in individuals with prediabetes who are overweight or obese. METHODS participants (mean age ± SD: 55 ± 6 years; BMI: 31.1 ± 4.1 kg/m²) were randomly assigned to either the treatment group (n = 15) or the control group (n = 15). Both groups received INT and CGM, but the control group was blinded to the CGM data until the end of this study. Participants were followed for 30 days and visited the lab every 10 days for CGM replacement, study measurements, and dietary consultations. RESULTS the treatment group showed a significant increase in the percentage of time spent in the target blood glucose range (p = 0.02) and a significant decrease in the mean blood glucose concentration (p < 0.05), glucose management indicator (p = 0.02), percent coefficient of variation for blood glucose (p = 0.01), and percent time spent in the high or very high blood glucose ranges (p = 0.04). These changes were not statistically significant for the control group. CONCLUSIONS adding CGM feedback to INT resulted in better management of blood glucose levels in overweight or obese individuals with prediabetes.
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Affiliation(s)
- Raedeh Basiri
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Institute for Biohealth Innovation, George Mason University, Fairfax, VA 22030, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Institute for Biohealth Innovation, George Mason University, Fairfax, VA 22030, USA
- Department of Medicine (GI), Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Choi W, Park M, Park S, Park JY, Hong AR, Yoon JH, Ha KH, Kim DJ, Kim HK, Kang HC. Combined impact of prediabetes and hepatic steatosis on cardiometabolic outcomes in young adults. Cardiovasc Diabetol 2024; 23:422. [PMID: 39574105 PMCID: PMC11583572 DOI: 10.1186/s12933-024-02516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 11/17/2024] [Indexed: 11/24/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the impact of hepatic steatosis on cardiometabolic outcomes in young adults with prediabetes. METHODS A nationwide cohort study was conducted with 896,585 young adults under 40 years old without diabetes or previous history of cardiovascular disease. Hepatic steatosis was identified using a fatty liver index of ≥ 60. The outcomes of this study were incident diabetes (DM) and composite major adverse cardiovascular events (MACE), including myocardial infarction, stroke, or cardiovascular death. RESULTS During a median follow-up of 11.8 years, 27,437 (3.1%) incident DM cases and 6,584 (0.7%) MACE cases were recorded. Young adults with prediabetes had a significantly higher risk of incident DM (hazard ratio [HR]: 2.81; 95% confidence interval [CI]: 2.74-2.88; P-value: <0.001) and composite MACE risk (HR: 1.10; 95% CI: 1.03-1.17; P-value: 0.003) compared to individuals with normoglycemia, after adjusting for relevant covariates. Stratification based on hepatic steatosis showed that the combination of prediabetes and hepatic steatosis posed the highest risk for these outcomes, after adjusting for relevant covariates. For incident DM, the HRs (95% CI; P-value) were: 3.15 (3.05-3.26; <0.001) for prediabetes without hepatic steatosis, 2.89 (2.78-3.01; <0.001) for normoglycemia with hepatic steatosis, and 6.60 (6.33-6.87; <0.001) for prediabetes with hepatic steatosis. For composite MACE, the HRs (95% CI; P-value) were 1.05 (0.97-1.13; 0.235) for prediabetes without hepatic steatosis, 1.39 (1.27-1.51; <0.001) for normoglycemia with hepatic steatosis, and 1.60 (1.44-1.78; <0.001) for prediabetes with hepatic steatosis. CONCLUSIONS Prediabetes and hepatic steatosis additively increased the risk of cardiometabolic outcomes in young adults. These findings hold significance for physicians as they provide insights into assessing high-risk individuals among young adults with prediabetes.
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Affiliation(s)
- Wonsuk Choi
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun, 58128, Jeollanam-do, Republic of Korea.
- Department of Biological Chemistry, University of California Irvine School of Medicine, Irvine, CA, USA.
| | - Minae Park
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Korea
| | - Ji Yong Park
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun, 58128, Jeollanam-do, Republic of Korea
| | - A Ram Hong
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun, 58128, Jeollanam-do, Republic of Korea
| | - Jee Hee Yoon
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun, 58128, Jeollanam-do, Republic of Korea
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun, 58128, Jeollanam-do, Republic of Korea.
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun, 58128, Jeollanam-do, Republic of Korea
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Chavez-Alfaro MA, Mensink RP, Gravesteijn E, Joris PJ, Plat J. Effects of long-term almond consumption on markers for vascular function and cardiometabolic risk in men and women with prediabetes: results of a randomized, controlled cross-over trial. Eur J Nutr 2024; 64:7. [PMID: 39546040 DOI: 10.1007/s00394-024-03510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 10/06/2024] [Indexed: 11/17/2024]
Abstract
PURPOSE The aim of this study was to investigate the long-term effects of almond consumption on peripheral vascular function, ambulant blood pressure profiles (ABP), and serum/plasma markers reflecting endothelial dysfunction and inflammation in participants with overweight/obesity and prediabetes. METHODS Thirty-four participants completed this single-blinded, randomized, cross-over trial with 5-month intervention and control periods, separated by a 2-month wash-out. During the intervention period, participants consumed 50 g of whole almonds daily. At the end of each intervention period, peripheral vascular function was assessed by measuring the carotid-to-femoral and carotid-to-radial pulse wave velocities (PWVc-f and PWVc-r, respectively) and retinal microvascular calibers. Serum/plasma concentrations of soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha (TNFα), serum amyloid A protein (SAA) and high-sensitivity C-reactive protein (hs-CRP) and 24-hour ABP were also analyzed. RESULTS Almond consumption did not significantly affect arterial stiffness (PWVc-f and PWVc-r), while central retinal venular equivalent (CRVE) was minimally increased by 2 μm (P = 0.019). Central retinal arteriolar equivalent (CRAE), the arteriolar-to-venular ratio (AVR), and endothelial and inflammatory serum/plasma markers showed no significant changes after almond consumption. Almond consumption reduced systolic blood pressure (SBP; -3 mmHg 24-hour P = 0.035, -4 mmHg daytime P = 0.046, and - 4 mmHg during nighttime P = 0.029), SBP variability during 24-hour, daytime, and nighttime (P = 0.005, P = 0.019, and P = 0.003, respectively), and diastolic blood pressure variability during nighttime (P ≤ 0.001). CONCLUSION Almond consumption did not affect arterial stiffness, retinal microvasculature calibers, or serum and plasma markers for endothelial dysfunction and inflammation in participants with prediabetics, while BP and BP variability were improved. CLINICAL TRIAL REGISTRATION This clinical trial was registered in February 2018 as NCT03419702.
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Affiliation(s)
- Marco A Chavez-Alfaro
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Elske Gravesteijn
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Peter J Joris
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
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Sheng G, Kuang M, Yang R, Zou Y. Association of metabolic score for insulin resistance with progression or regression of prediabetes: evidence from a multicenter Chinese medical examination cohort study. Front Endocrinol (Lausanne) 2024; 15:1388751. [PMID: 39600950 PMCID: PMC11589820 DOI: 10.3389/fendo.2024.1388751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 10/23/2024] [Indexed: 11/29/2024] Open
Abstract
Objective Few studies have evaluated the changes in blood glucose status in individuals with prediabetes, and this study aimed to analyze the association between metabolic score for insulin resistance (MetS-IR) and the progression or regression of prediabetes. Methods This retrospective cohort study used research data from medical examination institutions under the Rich Healthcare Group in 32 regions across 11 cities in China. Progression of prediabetes to diabetes and regression to normal fasting glucose (NFG) were defined based on glycemic changes during follow-up. The association between MetS-IR and the progression or regression of prediabetes was analyzed using multivariate Cox regression, restricted cubic splines, and piecewise regression models. Results Data from 15,421 prediabetic subjects were analyzed. Over an average follow-up of 2.96 years, 6,481 individuals (42.03%) returned to NFG, and 2,424 (15.72%) progressed to diabetes. After controlling for confounding factors, an increase in MetS-IR was observed to increase the risk of diabetes onset in the prediabetic population, whereas a decrease in MetS-IR had a protective effect for returning to NFG. Additionally, a nonlinear relationship between MetS-IR and prediabetes regression was observed, with 37.22 identified as the inflection point; prediabetes regression rates were significantly higher before this point and markedly decreased after it. Conclusion For individuals with prediabetes, an increase in MetS-IR may lead to an increased risk of diabetes; conversely, a decrease in MetS-IR enhances the protective effect for returning to NFG and keeping MetS-IR below 37.22 is significant for the regression of prediabetes.
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Affiliation(s)
- Guotai Sheng
- Jiangxi Provincial Geriatric Hospital, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Maobin Kuang
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Ruijuan Yang
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Arnardóttir E, Sigurdardóttir ÁK, Skinner T, Graue M, Kolltveit BCH. Prediabetes and cardiovascular risk factors: the effectiveness of a guided self-determination counselling approach in primary health care, a randomized controlled trial. BMC Public Health 2024; 24:3035. [PMID: 39487428 PMCID: PMC11529228 DOI: 10.1186/s12889-024-20538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 10/28/2024] [Indexed: 11/04/2024] Open
Abstract
BACKGROUND Identify individuals who are at risk of Type 2 diabetes, who also are at a greater risk of developing cardiovascular disease is important. The rapid worldwide increase in diabetes prevalence call for Primary Health Care to find feasible prevention strategies, to reduce patient risk factors and promote lifestyle changes. Aim of this randomized controlled trial was to investigate how a nurse-lead Guided Self-Determination counselling approach can assist people at risk of type 2 diabetes to lower their coronary heart disease risk. METHODS In this randomized controlled study, 81 people at risk of developing type 2 diabetes were assigned into an intervention group (n = 39) receiving Guided Self-Determination counselling from Primary Health Care nurses over three months and a control group (n = 42) that received a diet leaflet only. Measurements included the Finnish Diabetes Risk Score questionnaire and biological measurements of Hemoglobin A1c protein, Body Mass Index, fasting blood glucose, Blood pressure, Cholesterol, High-density lipoprotein, and triglycerides, at baseline (time1), 6 (time2) and 9 months (time 3). RESULTS A total of 56 participants, equal number in intervention and control groups, completed all measurements. A significant difference between the intervention and control groups, in coronary heart disease risk was not found at 6 nor 9-months. However, within-group data demonstrated that 55.4% of the participants had lower coronary heart disease risk in the next ten years at the 9-month measurement. Indicating an overall 18% relative risk reduction of coronary heart disease risk by participating in the trial, with the number needed to treat for one to lower their risk to be nine. Within the intervention group a significant difference was found between time 1 and 3 in lower body mass index (p = 0.046), hemoglobin A1c level (p = 0.018) and diastolic blood pressure (p = 0.03). CONCLUSIONS Although unable to show significant group differences in change of coronary heart disease risk by this 12-weeks intervention, the process of regular measurements and the guided self-determination counselling seem to be beneficial for within-group measures and the overall reduction of coronary heart disease risk factors. TRIAL REGISTRATION This study is a part of the registered study 'Effectiveness of Nurse-coordinated Follow-Up Programme in Primary Care for People at Risk of T2DM' at www. CLINICALTRIALS gov (NCT04688359) (accessed on 30 December 2020).
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Affiliation(s)
- Elín Arnardóttir
- School of Health, Business and Natural Sciences-Faculty of Nursing, University of Akureyri, Akureyri, 600, Iceland.
- Health Care Institution of North Iceland, Siglufjordur, 580, Iceland.
| | - Árún K Sigurdardóttir
- School of Health, Business and Natural Sciences-Faculty of Nursing, University of Akureyri, Akureyri, 600, Iceland
- Akureyri Hospital, Akureyri, 600, Iceland
| | - Timothy Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen K, 1017, Denmark
- Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, 3053, Australia
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, 5063, Norway
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Tian Y, Qiu Z, Wang F, Deng S, Wang Y, Wang Z, Yin P, Huo Y, Zhou M, Liu G, Huang K. Associations of Diabetes and Prediabetes With Mortality and Life Expectancy in China: A National Study. Diabetes Care 2024; 47:1969-1977. [PMID: 39255435 DOI: 10.2337/dca24-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE To investigate the excess mortality and life-years lost associated with diabetes and prediabetes in China. RESEARCH DESIGN AND METHODS This national cohort study enrolled 135,405 participants aged 18 years or older from the general population in China. Cox proportional hazards regression models were used to estimate adjusted mortality rate ratio (RR). The life table method was used to estimate life expectancy. RESULTS Among the 135,405 participants, 10.5% had diabetes and 36.2% had prediabetes in 2013. During a median follow-up of 6 years, 5517 deaths were recorded, including 1428 and 2300 deaths among people with diabetes and prediabetes, respectively. Diabetes and prediabetes were significantly associated with increased risk of all-cause (diabetes: RR, 1.61 [95% CI 1.49, 1.73]; prediabetes: RR, 1.08 [95% CI 1.01, 1.15]), and cardiovascular disease (diabetes: RR, 1.59 [95% CI 1.41, 1.78]; prediabetes: RR, 1.10 [95% CI 1.00, 1.21]) mortality. Additionally, diabetes was significantly associated with increased risks of death resulting from cancer, respiratory disease, liver disease, and diabetic ketoacidosis or coma. Compared with participants with normoglycemia, life expectancy of those with diabetes and prediabetes was shorter, on average, by 4.2 and 0.7 years at age 40 years, respectively. The magnitude of the associations of diabetes and prediabetes with all-cause and cardiovascular disease mortality varied by age and residence. CONCLUSIONS In this national study, diabetes and prediabetes were significantly associated with reduced life expectancy and increased all-cause and cause-specific mortality risks. The disparities in excess mortality associated with diabetes and prediabetes between different ages and residences have implications for diabetes and prediabetes prevention and treatment programs.
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Affiliation(s)
- Yunli Tian
- Department of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zixin Qiu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feixue Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shan Deng
- Department of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Wang
- Department of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zi Wang
- Liyuan Cardiovascular Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Prevention and Therapeutic Center for Cardiovascular Diseases, Wuhan, Hubei, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China; Hypertension Precision Diagnosis and Treatment Research Center, Peking University First Hospital, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Huang
- Department of Cardiovascular Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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