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1
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Jiang L, Li L, Zhang K, Zheng L, Zhang X, Hou Y, Cao M, Wang Y. A systematic review and meta-analysis of microRNAs in the diagnosis of early diabetic kidney disease. Front Endocrinol (Lausanne) 2025; 16:1432652. [PMID: 40331139 PMCID: PMC12052537 DOI: 10.3389/fendo.2025.1432652] [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: 05/14/2024] [Accepted: 03/28/2025] [Indexed: 05/08/2025] Open
Abstract
Objective The aim of this study was to comprehensively assess the overall diagnostic value of circulating microRNAs (miRNAs or miRs) as biomarkers for the early diagnosis of diabetic kidney disease (DKD) through Meta-analysis, and to identify potential molecular biomarkers with higher diagnostic value for early DKD. Methods The CNKI, Wanfang date, VIP, Pubmed, Embase, Web of Science, and Cochrane Library until January 2024 were searched. Relevant studies associated with the value of miRNAs in the diagnosis of early DKD were selected. Case numbers, sensitivity, and specificity were extracted from the included literature for both the observation and control groups. Results Nine studies including 655 cases of early DKD patients and 664 cases as a control group were conducted. The comprehensive sensitivity was 0.76, comprehensive specificity was 0.74, combined positive likelihood ratio was 2.9 and the combined negative likelihood ratio was 0.33, diagnostic odds ratio (DOR) was 9. The summary receiver operating characteristic (SROC) curve was drawn and the area under the curve (AUC) was 0.79. Blood and urine source data were analyzed and showed that urine source miRNA had a higher sensitivity (0.82vs 0.68) and a higher DOR (10.5vs 8.2) than blood source miRNA. Conclusion MiRNAs may serve as promising noninvasive biomarkers for the early diagnosis of DKD. The diagnostic value of miRNAs in urine samples may be higher than that in blood samples. The combined detection of some miRNAs or other clinical indicators can enhance the accuracy of early DKD diagnosis. Systematic Review Registration https://osf.io, identifier DOI: 10.17605/OSF.IO/FC6DK.
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Affiliation(s)
- Lujie Jiang
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Li Li
- Department of Endocrinology, The First People’s Hospital of Taian, Taian, Shandong, China
| | - Ke Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Liping Zheng
- Department of Endocrinology, The First People’s Hospital of Ningyang, Taian, Shandong, China
| | - Xinhuan Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Yanlian Hou
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Mingfeng Cao
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Yan Wang
- Department of Endocrinology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
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Pan HY, Yang PL, Lin CH, Chi CY, Lu CW, Lai TS, Yeh CF, Chen MYC, Wang TD, Kao HL, Lin YH, Wang MC, Wu CC. Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations. J Formos Med Assoc 2024:S0929-6646(24)00443-1. [PMID: 39322497 DOI: 10.1016/j.jfma.2024.09.023] [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: 06/12/2024] [Revised: 09/06/2024] [Accepted: 09/18/2024] [Indexed: 09/27/2024] Open
Abstract
To achieve a consensus on optimal blood pressure (BP) targets for older adults remains challenging, necessitating a trade-off between cardiovascular benefits and the risk of impaired organ perfusion. Evidence suggests that age and frailty have a minimal influence on the cardiovascular benefits of intensive BP control in community-dwelling elderly. Nonetheless, an increased incidence of acute kidney injury with intensive BP control has been observed in octogenarians. Therefore, it is recommended to maintain systolic BP below 130 mmHg for hypertensive patients aged 65-80 years. If well-tolerated, a systolic BP target below 120 mmHg can be recommended for patients with chronic kidney disease (CKD). However, no conclusive evidence supports a stringent BP target for patients aged 80 years and older. The selection of antihypertensive medications for elderly patients requires consideration of their cardiovascular condition and potential contraindications. Combination therapy may be necessary to achieve the desired BP target. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the primary choices for patients with CKD. Newer generation mineralocorticoid receptor antagonists may further reduce the risk of cardiovascular or renal events in this population. In conclusion, managing hypertension in elderly patients requires a personalized approach that balances cardiovascular benefits with potential risks, considering individual health profiles and tolerability.
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Affiliation(s)
- Heng-Yu Pan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Po-Lung Yang
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chun-Hsien Lin
- Division of Metabolism and Endocrinology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Chun-Yi Chi
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan
| | - Chia-Wen Lu
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
| | - Chih-Fan Yeh
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Michael Yu-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tzung-Dau Wang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Mu-Cyun Wang
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei City, Taiwan.
| | - Chih-Cheng Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan.
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Sun Y, Lu B, Hu Y, Lv Y, Zhong S. Glycemic Variability in Pancreatogenic Diabetes Mellitus: characteristics, Risks, Potential Mechanisms, and Treatment Possibilities. Int J Gen Med 2024; 17:4297-4309. [PMID: 39324147 PMCID: PMC11423834 DOI: 10.2147/ijgm.s477497] [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: 05/09/2024] [Accepted: 09/03/2024] [Indexed: 09/27/2024] Open
Abstract
In recent years, pancreatogenic diabetes mellitus has garnered significant attention due to its high incidence, complications, and mortality rates. Glycemic variability (GV) can increase the risk of pancreatogenic diabetes mellitus and its associated complications; however, the precise mechanism remains unclear. The effective control of GV is crucial for preventing the onset of pancreatic diabetes mellitus and improving prognosis. Both diet and antidiabetic medications have substantial effects on GV. However, many patients are prescribed suboptimal or even harmful drugs. Therefore, to provide a comprehensive treatment basis for clinicians to prevent and treat pancreatogenic diabetes mellitus, this study aimed to elucidate the relationship between GV and pancreatogenic diabetes mellitus; investigate the potential mechanisms (such as oxidative stress, inflammatory response, insulin resistance, and lipid metabolism disorders); provide lifestyle guidance; and recommend drug selections to reduce the GV in patients with pancreatogenic diabetes mellitus.
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Affiliation(s)
- Yuyan Sun
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Bing Lu
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Yuanwen Hu
- Department of Gastroenterology, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Yingqi Lv
- Division of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Shao Zhong
- Department of Endocrinology, Gusu School, Nanjing Medical University, The First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
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Calvo MJ, Parra H, Santeliz R, Bautista J, Luzardo E, Villasmil N, Martínez MS, Chacín M, Cano C, Checa-Ros A, D'Marco L, Bermúdez V, De Sanctis JB. The Placental Role in Gestational Diabetes Mellitus: A Molecular Perspective. TOUCHREVIEWS IN ENDOCRINOLOGY 2024; 20:10-18. [PMID: 38812661 PMCID: PMC11132656 DOI: 10.17925/ee.2024.20.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/01/2023] [Indexed: 05/31/2024]
Abstract
During pregnancy, women undergo several metabolic changes to guarantee an adequate supply of glucose to the foetus. These metabolic modifications develop what is known as physiological insulin resistance. When this process is altered, however, gestational diabetes mellitus (GDM) occurs. GDM is a multifactorial disease, and genetic and environmental factors play a crucial role in its aetiopathogenesis. GDM has been linked to both macroscopic and molecular alterations in placental tissues that affect placental physiology. This review summarizes the role of the placenta in the development of GDM from a molecular perspective, including hormonal and pro-inflammatory changes. Inflammation and hormonal imbalance, the characteristics dominating the GDM microenvironment, are responsible for placental changes in size and vascularity, leading to dysregulation in maternal and foetal circulations and to complications in the newborn. In conclusion, since the hormonal mechanisms operating in GDM have not been fully elucidated, more research should be done to improve the quality of life of patients with GDM and their future children.
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Affiliation(s)
- María José Calvo
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Heliana Parra
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Raquel Santeliz
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Jordan Bautista
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Eliana Luzardo
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Nelson Villasmil
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - María Sofía Martínez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Maricamen Chacín
- Facultad de Ciencias de la Salud, Barranquilla, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Clímaco Cano
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Ana Checa-Ros
- Research Group on Cardiorenal and Metabolic Diseases, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Luis D'Marco
- Research Group on Cardiorenal and Metabolic Diseases, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Barranquilla, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Juan Bautista De Sanctis
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
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Hussain Y, Abdullah, Khan F, Alam W, Sardar H, Khan MA, Shen X, Khan H. Role of Quercetin in DNA Repair: Possible Target to Combat Drug Resistance in Diabetes. Curr Drug Targets 2024; 25:670-682. [PMID: 38752634 DOI: 10.2174/0113894501302098240430164446] [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: 01/03/2024] [Revised: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 10/03/2024]
Abstract
Diabetes Mellitus (DM) is referred to as hyperglycemia in either fasting or postprandial phases. Oxidative stress, which is defined by an excessive amount of reactive oxygen species (ROS) production, increased exposure to external stress, and an excessive amount of the cellular defense system against them, results in cellular damage. Increased DNA damage is one of the main causes of genomic instability, and genetic changes are an underlying factor in the emergence of cancer. Through covalent connections with DNA and proteins, quercetin has been demonstrated to offer protection against the creation of oxidative DNA damage. It has been found that quercetin shields DNA from possible oxidative stress-related harm by reducing the production of ROS. Therefore, Quercetin helps to lessen DNA damage and improve the ability of DNA repair mechanisms. This review mainly focuses on the role of quercetin in repairing DNA damage and compensating for drug resistance in diabetic patients. Data on the target topic was obtained from major scientific databases, including SpringerLink, Web of Science, Google Scholar, Medline Plus, PubMed, Science Direct, and Elsevier. In preclinical studies, quercetin guards against DNA deterioration by regulating the degree of lipid peroxidation and enhancing the antioxidant defense system. By reactivating antioxidant enzymes, decreasing ROS levels, and decreasing the levels of 8-hydroxydeoxyguanosine, Quercetin protects DNA from oxidative damage. In clinical studies, it was found that quercetin supplementation was related to increased antioxidant capacity and decreased risk of type 2 diabetes mellitus in the experimental group as compared to the placebo group. It is concluded that quercetin has a significant role in DNA repair in order to overcome drug resistance in diabetes.
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Affiliation(s)
- Yaseen Hussain
- Lab of Controlled Release and Drug Delivery System, College of Pharmaceutical Sciences, Soochow University, Suzhou 215000, China
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan 23200, Pakistan
| | - Abdullah
- Department of Pharmacy, University of Malakand, Chakdara 18800, Pakistan
| | - Fazlullah Khan
- Faculty of Pharmacy, Capital University of Science & Technology, Islamabad 44000, Pakistan
| | - Waqas Alam
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan 23200, Pakistan
| | - Haseeba Sardar
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan 23200, Pakistan
| | - Muhammad Ajmal Khan
- Division of Life Sciences, Center for Cancer Research, and State Key Lab of Molecular Neuroscience, Hong Kong University of Science and Technology, Hong Kong
| | - Xiaoyan Shen
- Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan 23200, Pakistan
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Allam MM, Younan M, Abdelhamid M, Khan M, Elshafee M, Nada AM. A 5-structured visits multidisciplinary clinical care approach to optimize the care of patients with type 2 diabetes: a pilot study. Cardiovasc Endocrinol Metab 2023; 12:e0295. [PMID: 37859940 PMCID: PMC10584289 DOI: 10.1097/xce.0000000000000295] [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: 05/27/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
Introduction Multidisciplinary coordinated care has been associated with improvement of diabetes care. Aim and methods This is a retrospective cohort analysis aimed to assess the effect of application of the five-structured visits Multi-disciplinary Clinical Care Approach (FMCA) on each of T2DM control, complications and comorbidities. The patients' records were assessed for one year of regular diabetes care followed with a year after implementation of FMCA for patients attending the diabetes clinic at Zulekha hospital. The patients were divided according to HbA1c (cutoff 7%) at the end of the FMCA year of follow-up into a group of controlled and another group of uncontrolled diabetes designated CDM and UCDM, respectively. Results 49% of patients were males and the mean age was 44.22 years. HbA1c levels, LDL and urinary albumin/creatinine ratio (UACR) showed a marked decrease among the patients after implementation of FMCA (P = 0.02, P = 0.04, P = 0.003, respectively). Compared with an increase in the atherosclerotic cardiovascular risk score (ASCVD) during the regular period, exposure to FMCA significantly decreased the cardiovascular risk score (0.17%, 11.41%, P = 0.001, P = 0.001, respectively). A self-management score was significantly higher in CDM patients. After a multivariate regression analysis of factors affecting DM control, we detected that baseline HbA1c, UACR, self-management score and hospital admission rate were the most important factors to predict diabetes control. Conclusion The implementation of FMCA has shown a significant improvement in clinical and humanistic aspects of individuals with T2DM with a better outcome, more control and less complications.
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Affiliation(s)
- Magdy Mohamed Allam
- Alexandria University, Alexandria, Egypt
- Zulekha Hospital, Dubai, United Arab Emirates
| | - Mariam Younan
- Cairo University teaching Hospital, Cairo, Egypt
- Zulekha Hospital
| | | | | | | | - Aml Mohamed Nada
- Diabetes and Metabolism, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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7
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Li H, Zhang L, Wang X, Wang W, Zhang J, Pan Q, Guo L. Direct medical cost and medications for patient of diabetes retinopathy in Beijing, China, 2016 to 2018. Diabetes Res Clin Pract 2023:110796. [PMID: 37355099 DOI: 10.1016/j.diabres.2023.110796] [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: 05/07/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
AIMS Medications and costs of drug for diabetic retinopathy in outpatient in China have not been evaluated. The purpose of this study was to evaluate the hypoglycemic drugs and medical costs of diabetic retinopathy patients in the Beijing medical insurance system, analyze the characteristics of outpatient treatment, and investigate the changes in the quantity and cost of hypoglycemic drugs from 2016 to 2018 METHODS: This is a retrospective observational study, including diabetic patients with outpatient records in Beijing medical insurance from 2016 to 2018. Data on oral hypoglycemic drugs , insulin and non-hypoglycemic drugs, complications, treatment strategies, and annual medical costs were recorded Results: A total of 2,853,036 diabetic patients in Beijing medical insurance were enrolled in this study. 4.19%-4.67% of patients were diagnosed with retinopathy. Patients with retinopathy have more diabetic complications (1.65±0.71 vs 0.18±0.44. pp<.0001),and use more drugs (5.11±2.60 vs 3.85±2.34, pp <.0001), the annual total drug cost is also higher (¥ 13836±11244 vs ¥ 10030±9375, pp <.0001). The numbers of medication in retinopathy patients increased(5.11±2.60 vs 4.95±2.57, pp <.0001), and the annual total drug cost (¥13836±11244 vs ¥15642±13344, pp <.0001)decreased in 2018 compared with 2016. CONCLUSIONS Patients with retinopathy were associated with more complications. Compared with patients without retinopathy, the number of medications and total medical costs were significantly increased. From 2016 to 2018, there was an increase in the number of medication treatments for patients with retinopathy, but a decrease in cost.
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Affiliation(s)
- Hui Li
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xiaoxia Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jie Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
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Akgun-Unal N, Ozyildirim S, Unal O, Baltaci SB, Mogulkoc R, Baltaci AK. The effects of resveratrol and melatonin on cardiac dysfunction in diabetic elderly female rats. Physiol Res 2023; 72:187-198. [PMID: 37159853 PMCID: PMC10226403 DOI: 10.33549/physiolres.935024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/12/2023] [Indexed: 02/06/2025] Open
Abstract
We aimed to investigate the effects of melatonin and resveratrol on diabetes-related papillary muscle dysfunction and structural heart disorders. The protective effect of resveratrol and melatonin supplementation on cardiac functions was investigated in a diabetic elderly female rat model. 16-month-old rats (n=48) were allocated into 8 groups. Group1: Control, Group2: Resveratrol Control, Group3: Melatonin Control, Group4: Resveratrol and Melatonin Control, Group5: Diabetes, Group6: Diabetes Resveratrol, Group7: Diabetes Melatonin, Group8: Diabetes Resveratrol and Melatonin. Streptozotocin was injected intraperitoneally to the rats for experimental diabetes induction. Thereafter, resveratrol (intraperitoneal) and melatonin (subcutaneous) were administered for 4 weeks. Resveratrol and melatonin had a protective effect on the contractile parameters and structural properties of the papillary muscle, which was impaired by diabetes. it has been presented that diabetes impairs the contractile function of the papillary muscle for each stimulus frequency tested and the responses obtained as a result of Ca+2 uptake and release mechanisms from the Sarcoplasmic reticulum, and it has been observed that these effects are improved with resveratrol and melatonin injection. The decrease in myocardial papillary muscle strength in the diabetic elderly female rat can be reversed with the combination of resveratrol, melatonin and resveratrol+melatonin. Melatonin+resveratrol supplementation is no different from melatonin and/or resveratrol supplementation. Resveratrol and melatonin supplementation may have a protective effect on cardiac functions in a diabetic elderly female rat model.
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Affiliation(s)
- N Akgun-Unal
- Department of Biophysics, Medicine Faculty, Ondokuz Mayis University, Samsun, Turkey.
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Palacios A, Rodriguez Cairoli F, Balan D, Balmaceda C, Augustovski F, Pichon-Riviere A, Bardach A. Budget impact analysis of the freestyle libre flash continuous glucose monitoring system® in patients with diabetes mellitus type 1 in Chile. Expert Rev Pharmacoecon Outcomes Res 2023; 23:353-363. [PMID: 36701814 DOI: 10.1080/14737167.2023.2171989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To estimate the budget impact of covering the FreeStyle Libre Flash Continuous Glucose Monitoring System (FSL) for type 1 Diabetes Mellitus patients (T1DM), compared to self-monitoring of blood glucose (SMBG), from the perspective of public and private third-party payers in Chile. METHODS A budget impact model was developed to estimate the cost difference between SMBG and FSL over five years. Two FSL coverage schemes were assessed. Input parameters were retrieved from the literature review and complemented by expert opinion. Healthcare costs were estimated by a micro-costing approach and reported in USD. RESULTS For a public sector third-party payer, incorporating FSL implied a cost increase up to USD 0.013 per member per month (PMPM) for the fifth year under the broad coverage scheme and a net saving of 0.0001 PMPM (all years) under the restricted coverage scheme. From a private sector third-party payer, incorporating FSL implied savings up to USD 0.028 PMPM (fifth year) for the broad coverage scheme and up to USD 0.012 PMPM (fifth year) for the restricted scheme. CONCLUSION Incorporating the FSL for T1DM patients was associated with a marginal incremental cost for the public sector third-party payer and cost savings in Chile's private healthcare sector.
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Affiliation(s)
- Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,Centre for Health Economics, University of York, York, UK.,Department of Economics, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carlos Balmaceda
- Centre for Health Economics, University of York, York, UK.,Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Sun X, Wang G. Renal outcomes with sodium-glucose cotransporters 2 inhibitors. Front Endocrinol (Lausanne) 2022; 13:1063341. [PMID: 36531469 PMCID: PMC9752889 DOI: 10.3389/fendo.2022.1063341] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
Diabetic nephropathy (DN) is one of the most serious complications of diabetes. Therefore, delaying and preventing the progression of DN becomes an important goal in the clinical treatment of type 2 diabetes mellitus. Recent studies confirm that sodium-glucose cotransporters 2 inhibitors (SGLT2is) have been regarded as effective glucose-lowering drugs with renal protective effect. In this review, we summarize in detail the present knowledge of the effects of SGLT2is on renal outcomes by analyzing the experimental data in preclinical study, the effects of SGLT2is on estimated glomerular flitration rates (eGFRs) and urinary albumin-creatinine ratios (UACRs) from clinical trials and observational studies, and renal events (such as renal death or renal failure requiring renal replacement therapy) in some large prospective cardiovaslucar outcomes trials. The underlying mechanisms for renoprotective activity of SGLT2is have been demondtrated in multiple diabetic and nondiabetic animal models including kidney-specific effects and secondary kidney effects related to amelioration in blood glucose and blood pressure. In conclusion, these promising results show that SGLT2is act beneficially in terms of the kidney for diabetic patients.
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Affiliation(s)
| | - Guohong Wang
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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11
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Serum Level of MMP-3 and MMP-9 in Patients with Diabetes Mellitus Type 2 Infected with Epstein-Barr Virus. Int J Mol Sci 2022; 23:ijms232113599. [PMID: 36362386 PMCID: PMC9656098 DOI: 10.3390/ijms232113599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/29/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
Diabetes mellitus type 2 (DM2) has recently become one of the most important health problems in the world. Patients with DM2 with long-term glycaemia are more likely to become infected than the healthy population. Matrix metalloproteinases (MMPs) play a key role in tissue remodeling during various physiological processes. However, it has been reported that certain MMPs are overexpressed during the development of various human diseases. In this study, we analyzed the levels of MMP-3 and MMP-9 in the serum of DM2 patients with and without Epstein-Barr virus (EBV) infection. The study included 115 patients with DM2 hospitalized in the Internal Ward of the Masovian Specialist Hospital in Radom, Poland, who were divided into two groups: EBV-positive and EBV-negative. The levels of MMP-3 and MMP-9 were tested in the serum of patients using the ELISA method, while the presence of EBV in saliva was tested by polymerase chain reaction (PCR). The presented studies showed a significant difference in the concentration of both MMPs in diabetic patients additionally infected with EBV compared to the group of non-infected individuals. It seems that MMPs may be useful biomarkers in the diagnosis, prognosis, and monitoring of diabetes associated with EBV infection.
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Chuykin SV, Akatyeva GG, Malievsky OA, Makusheva NV, Bayburina EK, Kuchuk KN, Chuykin GL, Petrova EA. Analysis of dental status in children with type I diabetes mellitus: a literature review. Pediatr Dent 2022. [DOI: 10.33925/1683-3031-2022-22-3-236-243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Relevance. Diabetes mellitus is one of the most complex metabolic chronic diseases. Severe forms of type I diabetes mellitus are more common in children and adolescents, and its prevalence is increasing in many countries. Type I diabetes mellitus in children and adolescents remains an essential health issue in many countries despite the achieved scientific and practical results and progress in diabetology. Therefore, its early detection in children is still relevant and is associated with the early diagnosis of endocrinolog ical pathologies.Materials and methods. The study searched the publications in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), Medline (www.elibrary.ru, www.ncbi.nlm.nih.gov/pubmed) by the specific keywords.Results. In children with diabetes mellitus, vascular changes in periodontal tissues appear earlier than in other organs. On oral examination of children with diabetes mellitus, 50% of cases reveal periodontal lesions, and the lesions are often in the areas of the lower molars. If not treated, the following perio-dontitis signs are present in diabetic children: bleeding of the gingival papillae and the bright red colour of the gingival margin. There may be bulging of granulations from pathological gingival pockets. In most patients with type I diabetes mellitus, cytology of the periodontal pockets and gingival sulci demonstrated inflammatory cytologic responses, changes in the stratified squamous epithelium, and mixed bacterial microflora with leukocytes and erythrocytes.Conclusion. The study of type I diabetes mellitus impact on pathological changes in the oral cavity of children and the development of therapeutic and preventive measures is a relevant issue in pediatric dentistry, which justifies the need to continue research in this area.
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Affiliation(s)
| | | | - O. A. Malievsky
- Bashkir State Medical University; Republican Children's Clinical Hospital
| | | | | | - K. N. Kuchuk
- Bashkir State Medical University; Republican Children's Clinical Hospital
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13
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Wicik Z, Nowak A, Jarosz-Popek J, Wolska M, Eyileten C, Siller-Matula JM, von Lewinski D, Sourij H, Filipiak KJ, Postuła M. Characterization of the SGLT2 Interaction Network and Its Regulation by SGLT2 Inhibitors: A Bioinformatic Analysis. Front Pharmacol 2022; 13:901340. [PMID: 36046822 PMCID: PMC9421436 DOI: 10.3389/fphar.2022.901340] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Sodium–glucose cotransporter 2 (SGLT2), also known as solute carrier family 5 member 2 (SLC5A2), is a promising target for a new class of drugs primarily established as kidney-targeting, effective glucose-lowering agents used in diabetes mellitus (DM) patients. Increasing evidence indicates that besides renal effects, SGLT2 inhibitors (SGLT2i) have also a systemic impact via indirectly targeting the heart and other tissues. Our hypothesis states that the pleiotropic effects of SGLT2i are associated with their binding force, location of targets in the SGLT2 networks, targets involvement in signaling pathways, and their tissue-specific expression. Methods: Thus, to investigate differences in SGLT2i impact on human organisms, we re-created the SGLT2 interaction network incorporating its inhibitors and metformin and analyzed its tissue-specific expression using publicly available datasets. We analyzed it in the context of the so-called key terms ( autophagy, oxidative stress, aging, senescence, inflammation, AMPK pathways, and mTOR pathways) which seem to be crucial to elucidating the SGLT2 role in a variety of clinical manifestations. Results: Analysis of SGLT2 and its network components’ expression confidence identified selected organs in the following order: kidney, liver, adipose tissue, blood, heart, muscle, intestine, brain, and artery according to the TISSUES database. Drug repurposing analysis of known SGLT2i pointed out the influence of SGLT1 regulators on the heart and intestine tissue. Additionally, dapagliflozin seems to also have a stronger impact on brain tissue through the regulation of SGLT3 and SLC5A11. The shortest path analysis identified interaction SIRT1-SGLT2 among the top five interactions across six from seven analyzed networks associated with the key terms. Other top first-level SGLT2 interactors associated with key terms were not only ADIPOQ, INS, GLUT4, ACE, and GLUT1 but also less recognized ILK and ADCY7. Among other interactors which appeared in multiple shortest-path analyses were GPT, COG2, and MGAM. Enrichment analysis of SGLT2 network components showed the highest overrepresentation of hypertensive disease, DM-related diseases for both levels of SGLT2 interactors. Additionally, for the extended SGLT2 network, we observed enrichment in obesity (including SGLT1), cancer-related terms, neuroactive ligand–receptor interaction, and neutrophil-mediated immunity. Conclusion: This study provides comprehensive and ranked information about the SGLT2 interaction network in the context of tissue expression and can help to predict the clinical effects of the SGLT2i.
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Affiliation(s)
- Zofia Wicik
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Nowak
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Jarosz-Popek
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Marta Wolska
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Ceren Eyileten
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
- Genomics Core Facility, Centre of New Technologies, University of Warsaw, Warsaw, Poland
| | - Jolanta M. Siller-Matula
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dirk von Lewinski
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | | | - Marek Postuła
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Marek Postuła,
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Li W, Li Z, Liu W, Zhao P, Che G, Wang X, Di Z, Tian J, Sun L, Wang Z. Two-dimensional speckle tracking echocardiography in assessing the subclinical myocardial dysfunction in patients with gestational diabetes mellitus. Cardiovasc Ultrasound 2022; 20:21. [PMID: 35941651 PMCID: PMC9361647 DOI: 10.1186/s12947-022-00292-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) may increase the risk of cardiovascular disease and accompany asymptomatic deterioration of the myocardial function. This study aims to identify the subclinical impact of GDM on maternal left ventricular function by two-dimensional speckle tracking echocardiography (2D-STE). Methods We prospectively recruited 47 women with GDM and 62 healthy pregnant women who underwent transthoracic echocardiography (TTE) at 24 to 28 weeks of pregnancy. GDM diagnosis agreed with the IADPSG criteria. TTE was performed according to the criteria of the American Society of Echocardiography. Conventional echocardiographic data and 2D-STE parameters were compared between the two groups. Results Age, gestational weeks, heart rate, and conventional echocardiographic parameters had no difference between the two groups. The average LV global longitudinal strain (LV-GLS) of GDM patients was lower than controls (18.14 ± 2.53 vs. 22.36 ± 6.33, p < 0.001), and 31 patients (66%) in our study had an absolute LV-GLS less than 20%. The LA reservoir and conduit strain in patients with GDM were also significantly reduced (32.71 ± 6.64 vs. 38.00 ± 7.06, 20.41 ± 5.69 vs. 25.56 ± 5.73, p < 0.001). However, there was no significant difference in LA contractile function between the two groups. In multiple regression analysis, LV-GLS and LA conduit strain independently associated with GDM. Conclusions 2D-STE could detect the subclinical myocardial dysfunction more sensitively than conventional echocardiography, with LV-GLS and LA conduit strain as independent indicators of the GDM impact on maternal cardiac function during pregnancy.
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Affiliation(s)
- Wei Li
- Cardiovascular Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ziyao Li
- Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Liu
- Cardiovascular Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Peng Zhao
- Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guoying Che
- Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xudong Wang
- Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhixin Di
- Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiawei Tian
- Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Litao Sun
- Cardiovascular Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China.
| | - Zhenzhen Wang
- Cardiovascular Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China.
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Evaluation of Persistent Efficacy of Diabetes Remission and Decline of Cardiovascular Risk After Laparoscopic Sleeve Gastrectomy: a Preliminary 1-Year Study. Obes Surg 2022; 32:3289-3297. [DOI: 10.1007/s11695-022-06201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023]
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Xiao X, Su J, Su IJ. Psychosocial adjustment in young and middle-aged adults after coronary stent implantation: A mixed-method study. Heart Lung 2022; 52:86-94. [PMID: 34923208 DOI: 10.1016/j.hrtlng.2021.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 11/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Currently, the status and principal factors of psychosocial adjustment of young and middle-aged patients after coronary stent implantation (CSI) are understudied. OBJECTIVE To investigate the psychosocial adjustment and the life experiences of young and middle-aged patients after CSI and the corresponding support necessary to maintain psychosocial health for this patient population. METHODS This is a mixed-method study. Self-reported questionnaires were used to survey 236 patients after CSI from November 2019 to November 2020 in Guangdong, China. Eight of these patients were purposefully invited to participate in semi-structured interviews. RESULTS The mean score of psychosocial adjustment were 55.25 (SD=19.96), 55.91 (SD=17.99) for the young and middle-aged patients after CSI respectively. The results of regression analysis showed that resilience, social support, and having diabetes were predictors of psychosocial adjustment of young patients after CSI (R2=0.703, P<0.001). Resilience, social support, current cardiac function, and need to care for parents with chronic diseases were identified as predictors of psychosocial adjustment among middle-aged patients after CSI (R2=0.640, P<0.001). Two themes and six sub-themes related to adjustment challenges and adjustment efforts were identified from the in-depth interviews. CONCLUSIONS Psychosocial adjustment of young and middle-aged patients after CSI still needs to be improved. Higher level of social support and resilience would promote patient's psychosocial adjustment after CSI. Diabetes was a negative factor of psychosocial adjustment in young patients, whereas limited cardiac function, need to take care of parents with chronic diseases were negative factors in middle-aged patients. After CSI, both young and middle-aged patients faced various challenges of adjustment.
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Affiliation(s)
- Xiaomin Xiao
- Department of Nursing, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong Province, China
- Guangdong Chaozhou Health Vocational College, Zhongshan Road, Chaozhou, Guangdong Province, China
| | - Jing Su
- Department of Nursing, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong Province, China
| | - Irene J Su
- Department of Nursing, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong Province, China
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Fat-Free Mass and Skeletal Muscle Mass Gain Are Associated with Diabetes Remission after Laparoscopic Sleeve Gastrectomy in Males but Not in Females. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020978. [PMID: 35055799 PMCID: PMC8776008 DOI: 10.3390/ijerph19020978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/25/2022]
Abstract
Besides massive body weight loss, laparoscopic sleeve gastrectomy (LSG) causes massive lean mass, including fat-free mass (FFM) and skeletal muscle mass (SM) that present higher metabolic rates in males. This study examines sex differences in FFM and SM changes of type 2 diabetes (T2D) remission at 12 months post-LSG. This cohort study recruited 119 patients (53.7% females) with T2D and obesity (body mass index 42.2 ± 7.0 kg/m2) who underwent LSG. Fat-mass (FM) loss was higher in males than in females (−12.8 ± 6.2% vs. −9.9 ± 5.0%, p = 0.02) after one-year post-operation. Regardless of the weight-loss difference, males had higher FFM and SM gain than did females (12.8 ± 8.0 vs. 9.9 ± 5.0% p = 0.02 and 6.5 ± 4.3% vs. 4.9 ± 6.2%, p = 0.03, respectively). Positive correlations of triglyceride reduction with FM loss (r = 0.47, p = 0.01) and SM gain (r = 0.44, p = 0.02) over 12 months post-operation were observed in males who achieved T2D remission. The T2D remission rate significantly increased 16% and 26% for each additional percentage of FFM and SM gain one year after LSG, which only happened in males. Increased FFM and SM were remarkably associated with T2D remission in males, but evidence lacks for females.
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18
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Xu T, Yu Z, Liu Y, Lu M, Gong M, Li Q, Xia Y, Xu B. Hypoglycemic Effect of Electroacupuncture at ST25 Through Neural Regulation of the Pancreatic Intrinsic Nervous System. Mol Neurobiol 2022; 59:703-716. [DOI: doi：10.1007/s12035-021-02609-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/19/2021] [Indexed: 05/15/2025]
Abstract
AbstractElectroacupuncture (EA) is considered to have potential antidiabetic effects; however, the role of the pancreatic intrinsic nervous system (PINS) in EA-induced amelioration of type 2 diabetes (T2DM) remains unclear. Therefore, we investigated whether EA at ST25 exerts any beneficial effects on insulin resistance (IR), inflammation severity, and pancreaticβcell function via the PINS in a rat model of a high-fat diet-streptozotocin (HFD/STZ)-induced diabetes. To this end, Sprague Dawley rats were fed with HFD to induce IR, followed by STZ (35 mg/kg, i.p.) injection to establish the T2DM model. After hyperglycemia was confirmed as fasting glucose level > 16.7 mmol/L, the rats were treated with EA (2 mA, 2/15 Hz) for the next 28 days. Model rats showed increased serum glucose, insulin, IR, and TNF-αlevels with a concomitant decrease inβcell function. Microscopy examination of the pancreas revealed pathological changes in islets, which reverted to near-normal levels after EA at ST25. EA improved islet cell morphology by increasing islet area and reducing vacuolation. EA at ST25 decreased transient receptor potential vanilloid 1 (TRPV1) and increased substance P (SP) and calcitonin gene-related peptide (CGRP) expression. Subsequently, insulin secretion decreased and impaired pancreatic endocrine function was restored through the TRPV1 channel (SP/CGRP)-insulin circuit. EA increased choline acetyltransferase and neuropeptide Y expression and controlled inflammation. It also enhanced the cocaine and amphetamine-regulated transcript prepropeptide expression and promoted glucagon-like peptide-1 secretion. Additionally, the electrophysiological activity of PINS during acupuncture (2.71 ± 1.72 Hz) was significantly increased compared to the pre-acupuncture frequency (0.32 ± 0.37 Hz,P< 0.05). Thus, our study demonstrated the beneficial effect of EA onβcell dysfunction via the PINS in rat models of HFD-STZ-induced T2DM.
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Jeraiby M. Awareness of Preconception Care and Its Related Factors Among Women of Childbearing Age with Type 1 Diabetes in the South of Saudi Arabia: A Cross-Sectional Survey Study. Int J Gen Med 2021; 14:8583-8589. [PMID: 34849003 PMCID: PMC8627196 DOI: 10.2147/ijgm.s335914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pregnancies in women with type 1 diabetes mellitus (T1DM) are associated with an increased risk of poor outcomes for mothers and their infants. OBJECTIVE To assess the awareness of preconception care among women with T1DM and their self-management status in the southern region of Saudi Arabia. METHODS This study is a cross-sectional study that was done on 187 women participated of childbearing age with T1DM who were seen in diabetic centers between June 2019 and September 2020. Pre-pregnancy care and disease management were assessed via a questionnaire. RESULTS The prevalence of preconception awareness of diabetes management was 66.9%. Several factors significantly influenced the level of awareness, including education level (P= 0.001) and HbA1c (P= 0.014). In multivariate analysis, the lower educational level turns out to be a significant risk factor for low awareness (OR = 3.71, 95% CI [1.65, 8.31], P= 0.001). Additionally, compared to controlled DM, uncontrolled diabetes had a twofold increased risk of low awareness (OR = 2.03, 95% CI [1.08, 3.81], P= 0.027). CONCLUSION The awareness level was significantly correlated with a high educational level and better glycemic control. Meanwhile, it was not significantly correlated with diabetes duration.
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Affiliation(s)
- Mohammed Jeraiby
- Department of Biochemistry, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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20
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Xu T, Yu Z, Liu Y, Lu M, Gong M, Li Q, Xia Y, Xu B. Hypoglycemic Effect of Electroacupuncture at ST25 Through Neural Regulation of the Pancreatic Intrinsic Nervous System. Mol Neurobiol 2021; 59:703-716. [PMID: 34757591 PMCID: PMC8786791 DOI: 10.1007/s12035-021-02609-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023]
Abstract
Electroacupuncture (EA) is considered to have potential antidiabetic effects; however, the role of the pancreatic intrinsic nervous system (PINS) in EA-induced amelioration of type 2 diabetes (T2DM) remains unclear. Therefore, we investigated whether EA at ST25 exerts any beneficial effects on insulin resistance (IR), inflammation severity, and pancreatic β cell function via the PINS in a rat model of a high-fat diet-streptozotocin (HFD/STZ)-induced diabetes. To this end, Sprague Dawley rats were fed with HFD to induce IR, followed by STZ (35 mg/kg, i.p.) injection to establish the T2DM model. After hyperglycemia was confirmed as fasting glucose level > 16.7 mmol/L, the rats were treated with EA (2 mA, 2/15 Hz) for the next 28 days. Model rats showed increased serum glucose, insulin, IR, and TNF-α levels with a concomitant decrease in β cell function. Microscopy examination of the pancreas revealed pathological changes in islets, which reverted to near-normal levels after EA at ST25. EA improved islet cell morphology by increasing islet area and reducing vacuolation. EA at ST25 decreased transient receptor potential vanilloid 1 (TRPV1) and increased substance P (SP) and calcitonin gene-related peptide (CGRP) expression. Subsequently, insulin secretion decreased and impaired pancreatic endocrine function was restored through the TRPV1 channel (SP/CGRP)-insulin circuit. EA increased choline acetyltransferase and neuropeptide Y expression and controlled inflammation. It also enhanced the cocaine and amphetamine-regulated transcript prepropeptide expression and promoted glucagon-like peptide-1 secretion. Additionally, the electrophysiological activity of PINS during acupuncture (2.71 ± 1.72 Hz) was significantly increased compared to the pre-acupuncture frequency (0.32 ± 0.37 Hz, P < 0.05). Thus, our study demonstrated the beneficial effect of EA on β cell dysfunction via the PINS in rat models of HFD-STZ-induced T2DM.
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Affiliation(s)
- Tiancheng Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Zhi Yu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yun Liu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Mengjiang Lu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Meirong Gong
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Qian Li
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Youbing Xia
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, China. .,Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, 221004, China.
| | - Bin Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
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Ju Y, Cao ZT, Li Q, Tang L, Ou Y, Yu X, Liu W. Recommendations for proficiency testing criteria for hemoglobin A 1c based on the Shanghai Center for Clinical Laboratory's study. Clin Chem Lab Med 2021; 59:1728-1734. [PMID: 34225391 DOI: 10.1515/cclm-2020-1311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The US Centers for Medicare & Medicaid Services proposed in 2019 that glycated hemoglobin A1c (HbA1c) be a CLIA'88 regulated analyte. People who commented expressed concerns that the proposed acceptance limit (AL, HbA1c in NGSP unit) ±10% for proficiency testing (PT) would be unable to maintain already improved analytical performance and guarantee the clinical utility of HbA1c testing. Assessing impact of various ALs on PT performance is needed to provide scientific evidence for adopting an appropriate AL. METHODS Ten patient EDTA-whole blood specimens were distributed to 318 and 336 laboratories in the 2018 and 2019 PT events organized by Shanghai Center for Clinical Laboratory (SCCL). HbA1c concentrations were measured by participants using various methodologies commonly used in the USA and China. Targets were determined using secondary reference measurement procedures (SRM) at SCCL. "Failed Results" were those outside the SRM-defined target ± AL (5% through 10%). Laboratories with Failed Results ≥2 out of five samples per PT event obtained Event Unsatisfactory Status. RESULTS HbA1c target values ranged 33.3 mmol/mol (5.2 NGSP%) -102.2 mmol/mol (11.5 NGSP%) for 2018 event, and 33.3 mmol/mol (5.2 NGSP%) -84.7 mmol/mol (9.9 NGSP%) for 2019 event. Overall Laboratory Event Unsatisfactory Rates were 11.3-12.2%, 4.8-5.3%, 0.9-3.1%, 0.6-2.2%, 0.6-1.4% and 0.6-1.4%, at AL of ±5, ±6, ±7, ±8, ±9 and ±10%, respectively. CONCLUSIONS The AL (in NGSP unit) of ±6% or ±7% for PT evaluation of HbA1c results would be appropriate, with satisfactory event scores for about 95% of participant laboratories in a PT event.
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Affiliation(s)
- Yi Ju
- Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
| | - Zhimin Tim Cao
- Department of Pathology, Upstate Medical University, Syracuse, NY, USA
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Qing Li
- Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
| | - Liping Tang
- Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
| | - Yuanzhu Ou
- Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
| | - Xiaoxuan Yu
- Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
| | - Wenbin Liu
- Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
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22
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Widiyanti P, Suryohudoyo P. The role of hyperbaric oxygen to platelet aggregation in noninsulin-dependent diabetes mellitus (NIDDM). J Basic Clin Physiol Pharmacol 2021; 32:617-621. [PMID: 34214305 DOI: 10.1515/jbcpp-2020-0481] [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: 11/29/2020] [Accepted: 04/08/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hyperglycemia in diabetes mellitus (DM) could cause rheological disorder, such as platelet aggregation and blood hyperviscosity. Hyperbaric oxygen (HBO) could decrease collagen as platelet aggregation agonist. This study aimed to explore the effect of HBO treatment to platelet aggregation parameters (latency time(LT), aggregation speed, aggregation index, and aggregation percentage) with the collagen aggregator in the noninsulin dependent diabetes mellitus (NIDDM). METHODS The number of subjects in this study were 16 for each group normoxia normobaric (NONB) and HBO. NIDDM patients from DM polyclinic in Rumah Sakit Angkatan Laut (RSAL) Dr Ramelan Surabaya which was fulfilled inclusion criteria would receive HBO Therapy. Control Group/NONB were treated with NONB condition (20% O2 1 ATA) for 90 min and treatment group/HBO were treated with hyperoxia hyperbaric condition (100% O2 2.4 ATA) for 3 × 30 min with interval of 2 × 5 min for inhaling fresh air. Subject has been blood taken for platelet aggregation test before and after HBO Therapy. The length of treatment was 5 days for both condition (NONB and HBO). RESULTS The data from both groups, NONB and HBO were tested first by normality test, homogenity test, correlation test, analysis of covariance, and paired t-test. Based on paired t-test, the decrease on platelet aggregation speed, aggregation index, and aggregation percentage after HBO treatment was showed significant difference on the LT and aggregation index while in aggregation speed and aggregation percentage was not significant. NONB group after 5 days was showed a significant difference on the aggregation speed and aggregation index while in LT and aggregation percentage was not significant. CONCLUSIONS The utilization of HBO 2.4 ATA 100% O2 3 × 30 min, once a day, for 5 days could decrease the platelet aggregation parameters (LT, aggregation speed, aggregation index, and aggregation percentage) in patients with NIDDM.
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Affiliation(s)
- Prihartini Widiyanti
- Biomedical Engineering Study Program, Faculty of Science and Technology, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Purnomo Suryohudoyo
- Biochemistry Department, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Hamasaki-Matos AJ, Cóndor-Marín KM, Aquino-Ortega R, Carrillo-Ng H, Ugarte-Gil C, Silva-Caso W, Aguilar-Luis MA, Del Valle-Mendoza J. Characterization of the gut microbiota in diabetes mellitus II patients with adequate and inadequate metabolic control. BMC Res Notes 2021; 14:238. [PMID: 34167557 PMCID: PMC8223318 DOI: 10.1186/s13104-021-05655-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objective The objective of this study was to characterize the composition of the gut microbiota in type 2 Diabetes Mellitus (T2DM) patients with adequate and inadequate metabolic control, and its relationship with fiber consumption. Results A total of 26 patients with type 2 diabetes mellitus (T2DM) were enrolled, of which 7 (26.9%) cases had adequate metabolic control (HbA1c < 7%) and 19 (73.1%) inadequate metabolic control (HbA1c ≥ 7%). It was observed that among patients with controlled T2DM, 2 (28.6%) cases presented good intake of fiber and 5 (71.4%) cases a regular intake. In contrast, in patients with uncontrolled T2DM, 13 (68.4%) patients reported a regular intake and 6 (31.6%) a poor intake. In relation to the identification of the gut microbiota, both groups presented a similar characterization. There were differences in the population of bacteria identified in both groups, however, the results were not statistically significant. The most frequently identified bacteria in controlled and uncontrolled T2DM patients were Prevotella (71.4% vs 52.6%), followed by Firmicutes (71.4% vs 42.1%), Proteobacteria (71.4% vs 36.8%) and Bacteroidetes (57.1% vs 37.8%). On the other hand, Fusobacterium, Actinobacteria were not identified in either of the two groups of study. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05655-z.
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Affiliation(s)
| | | | - Ronald Aquino-Ortega
- Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Hugo Carrillo-Ng
- Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Cesar Ugarte-Gil
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Wilmer Silva-Caso
- Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Miguel Angel Aguilar-Luis
- Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Juana Del Valle-Mendoza
- Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. .,School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. .,Laboratorio de Biología Molecular, Instituto de Investigación Nutricional, Lima, Peru.
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Rojas M, Chávez-Castillo M, Bautista J, Ortega Á, Nava M, Salazar J, Díaz-Camargo E, Medina O, Rojas-Quintero J, Bermúdez V. Alzheimer’s disease and type 2 diabetes mellitus: Pathophysiologic and pharmacotherapeutics links. World J Diabetes 2021; 12:745-766. [PMID: 34168725 PMCID: PMC8192246 DOI: 10.4239/wjd.v12.i6.745] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/20/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
At present, Alzheimer’s disease (AD) and type 2 diabetes mellitus (T2DM) are two highly prevalent disorders worldwide, especially among elderly individuals. T2DM appears to be associated with cognitive dysfunction, with a higher risk of developing neurocognitive disorders, including AD. These diseases have been observed to share various pathophysiological mechanisms, including alterations in insulin signaling, defects in glucose transporters (GLUTs), and mitochondrial dysfunctions in the brain. Therefore, the aim of this review is to summarize the current knowledge regarding the molecular mechanisms implicated in the association of these pathologies as well as recent therapeutic alternatives. In this context, the hyperphosphorylation of tau and the formation of neurofibrillary tangles have been associated with the dysfunction of the phosphatidylinositol 3-kinase and mitogen-activated protein kinase pathways in the nervous tissues as well as the decrease in the expression of GLUT-1 and GLUT-3 in the different areas of the brain, increase in reactive oxygen species, and production of mitochondrial alterations that occur in T2DM. These findings have contributed to the implementation of overlapping pharmacological interventions based on the use of insulin and antidiabetic drugs, or, more recently, azeliragon, amylin, among others, which have shown possible beneficial effects in diabetic patients diagnosed with AD.
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Affiliation(s)
- Milagros Rojas
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Mervin Chávez-Castillo
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Jordan Bautista
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Ángel Ortega
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Manuel Nava
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Juan Salazar
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Edgar Díaz-Camargo
- Universidad Simón Bolívar, Facultad de Ciencias Jurídicas y Sociales, Cúcuta 540006, Colombia
| | - Oscar Medina
- Universidad Simón Bolívar, Facultad de Ciencias Jurídicas y Sociales, Cúcuta 540006, Colombia
| | - Joselyn Rojas-Quintero
- Pulmonary and Critical Care Medicine Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02155, United States
| | - Valmore Bermúdez
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla 080001, Colombia
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Ding Y, Zhang H, Li C, Zheng W, Wang M, Li Y, Sun H, Wu M. Safety and pharmacokinetic interaction between fotagliptin, a dipeptidyl peptidase-4 inhibitor, and metformin in healthy subjects. Expert Opin Drug Metab Toxicol 2021; 17:725-731. [PMID: 33899649 DOI: 10.1080/17425255.2021.1915283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dipeptidyl peptidase-4 (DPP-4) inhibitors have significant clinical efficacy for type 2 diabetes mellitus (T2DM). The combination of fotagliptin (FOT) with metformin (MET) is a promising therapeutic approach in MET-resistant patients. The aim of the present study was to evaluate the pharmacokinetic (PK) interaction between FOT and MET in healthy subjects after multiple-dose administration. METHODS Eighteen participants received a randomized open-label, three period treatment that included MET 1000 mg alone, co-administration of FOT 24 mg and MET, followed by FOT 24 mg alone. Serial blood samples were collected for PK analysis, which included geometric mean ratios (GMRs) with 90% confidence intervals (CIs), area under the concentration-time curve (AUC), and maximum plasma concentration (Cmax). RESULTS Analysis results showed that for FOT alone or combination therapy, the 90% CIs of the GMR for AUC0-24,ss and Cmax,ss were 102.08% (98.9%, 105.36%) and 110.65% (102.19%, 119.82%), respectively. For MET, they were 113.41% (100.32%, 128.22%) and 97.11% (83.80%, 112.55%) for AUC0-12,ss and Cmax,ss, respectively. FOT or MET monotherapy and the combination therapy with both drugs were well tolerated. CONCLUSIONS No PK drug-drug interactions were found in the combination therapy with FOT and MET. Therefore, FOT can be co-administered with MET without dose adjustment. TRIAL REGISTRATION The trial is registered at http://www.chinadrugtrials.org.cn/(Registration No. CTR20190221).
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Affiliation(s)
- Yanhua Ding
- Department of Phase I Clinical Trial Unit, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hong Zhang
- Department of Phase I Clinical Trial Unit, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Cuiyun Li
- Department of Phase I Clinical Trial Unit, The First Hospital of Jilin University, Changchun, Jilin, China
| | - WenBo Zheng
- Department of Phase I Clinical Trial Unit, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Meng Wang
- Department of Phase I Clinical Trial Unit, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Li
- Shenzhen Salubris Pharmaceuticals Co Ltd, Shenzhen, Guangdong China
| | - HaiGang Sun
- Shenzhen Salubris Pharmaceuticals Co Ltd, Shenzhen, Guangdong China
| | - Min Wu
- Department of Phase I Clinical Trial Unit, The First Hospital of Jilin University, Changchun, Jilin, China
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Yang H, Gao J, Li S, Xia H, Chen Z, Zhu S, Pan Z. Gender Differences in the Association Between Serum Uric Acid and Arteriosclerotic Cardiovascular Risk Among Chinese Type 2 Diabetes Mellitus Patients. Int J Gen Med 2021; 14:687-695. [PMID: 33688240 PMCID: PMC7935449 DOI: 10.2147/ijgm.s300196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Serum uric acid (sUA) level has been reported to be associated with arteriosclerotic cardiovascular risk, yet remains poorly defined in Chinese type 2 diabetes patients. The purpose of the current study was to evaluate gender differences in the association between sUA level and arteriosclerotic cardiovascular risk in Chinese type 2 diabetes patients. Methods The cross-sectional study was conducted in six community health service centers in Shanghai, China from December 2014 to December 2016. A stratified random sampling method was used to recruit participants. From a total of 3977 type 2 diabetic patients, 2537 were included for the analysis of the association between sUA level and arteriosclerotic cardiovascular risk. Clinical and biochemical data were obtained from participants. Arteriosclerotic cardiovascular risk was evaluated by the ten-year risk profile for arteriosclerotic cardiovascular disease. The associations between sUA level and arteriosclerotic cardiovascular risk were assessed via multiple logistic regression. Results Of the 2537 participants, the average sUA level was 317±77umol/L in men and 294±73 umol/L in women, and 54.8% (1391/2537) of participants had high ten-year risk of arteriosclerotic cardiovascular disease (ASCVD), which was ≥20%. High ten-year risk of ASCVD odds ratio was increased by 1.596 (95% CI, 1.113-2.289, p for trend 0.004) comparing fourth to first quartiles of sUA in women. However, no significant association was found between sUA and high ten-year risk of ASCVD in men. Conclusion This community-based study indicated that sUA levels were independently associated with high ten-year risk of ASCVD in women with type 2 diabetes mellitus, but not in men.
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Affiliation(s)
- Hua Yang
- Department of General Practice, Zhongshan Hospital of Fudan University, Shanghai, 200030, People's Republic of China
| | - Jian Gao
- Department of Nutrition, Zhongshan Hospital of Fudan University, Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, 200030, People's Republic of China
| | - Shuyu Li
- Department of General Practice, Zhongshan Hospital of Fudan University, Shanghai, 200030, People's Republic of China
| | - Huiling Xia
- Department of General Practice, Zhongshan Hospital of Fudan University, Shanghai, 200030, People's Republic of China
| | - Zhangyan Chen
- Department of General Practice, Zhongshan Hospital of Fudan University, Shanghai, 200030, People's Republic of China
| | - Shanzhu Zhu
- Department of General Practice, Zhongshan Hospital of Fudan University, Shanghai, 200030, People's Republic of China
| | - Zhigang Pan
- Department of General Practice, Zhongshan Hospital of Fudan University, Shanghai, 200030, People's Republic of China
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Garzón-Duque MO, Rodríguez-Ospina FL, Cardona D, Segura-Cardona ÁM, Borbón MC, Zuluaga-Giraldo AM, Echeverri-Loor JI. Sociodemographic, labor conditions, habits, lifestyles and diabetes mellitus in workers with subsistence jobs, Medellín-Colombia. Rev Bras Med Trab 2021; 18:280-292. [PMID: 33597978 PMCID: PMC7879464 DOI: 10.47626/1679-4435-2020-560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/01/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION According to American Diabetes Association, diabetes is a metabolic change characterized by the presence de hyperglycemia caused by a deficiency and/or malfunctioning of insulin secretion. OBJECTIVES To determine sociodemographic and labor conditions, habits and lifestyles that explain diabetes in a group of informal street workers in downtown Medellín, Colombia. METHODS This is a cross-sectional study with analytical intent based on primary sources information and on a survey with a sample of 686 workers in 2016, after obtaining informed consent. Study variables included sociodemographic and labor conditions, habits, lifestyles, and diagnosis of diabetes. Univariate, bivariate and multivariate analyses were performed. RESULTS Workers with 50 years, 57.6% men, with a partner (56.8%), and more than 20 years in their profession. Higher prevalence of diabetes in those aged 18 to 44 and 45 to 59 years of age, lower schooling, consumed mid-morning, mid-afternoon, and evening snacks, and of households with food insecurity. Higher prevalence of diabetes was explained by: lower age, higher education, consumption of sugars, sweets, and desserts; and lower prevalence by consumption of mid-morning snacks, and household food insecurity. CONCLUSIONS This disease of public health concern is explained by modifiable factors that can be controlled and avoided to improve the living and health conditions of this workers' population.
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Affiliation(s)
| | | | - Doris Cardona
- Universidad CES, Facultad de Medicina - Escuela de Graduados - Medellín (ANT), Colombia
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Marcolino MS, Oliveira JAQ, Cimini CCR, Maia JX, Pinto VSOA, Sá TQV, Amancio K, Coelho L, Ribeiro LB, Cardoso CS, Ribeiro AL. Development and Implementation of a Decision Support System to Improve Control of Hypertension and Diabetes in a Resource-Constrained Area in Brazil: Mixed Methods Study. J Med Internet Res 2021; 23:e18872. [PMID: 33427686 PMCID: PMC7834943 DOI: 10.2196/18872] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The low levels of control of hypertension and diabetes mellitus are a challenge that requires innovative strategies to surpass barriers of low sources, distance, and quality of health care. OBJECTIVE The aim of this study is to develop a clinical decision support system (CDSS) for diabetes and hypertension management in primary care, to implement it in a resource-constrained region, and to evaluate its usability and health care practitioner satisfaction. METHODS This mixed methods study is a substudy of HealthRise Brazil Project, a multinational study designed to implement pilot programs to improve screening, diagnosis, management, and control of hypertension and diabetes among underserved communities. Following the identification of gaps in usual care, a team of clinicians established the software functional requirements. Recommendations from evidence-based guidelines were reviewed and organized into a decision algorithm, which bases the CDSS reminders and suggestions. Following pretesting and expert panel assessment, pilot testing was conducted in a quasi-experimental study, which included 34 primary care units of 10 municipalities in a resource-constrained area in Brazil. A Likert-scale questionnaire evaluating perceived feasibility, usability, and utility of the application and professionals' satisfaction was applied after 6 months. In the end-line assessment, 2 focus groups with primary care physicians and nurses were performed. RESULTS A total of 159 reminders and suggestions were created and implemented for the CDSS. At the 6-month assessment, there were 1939 patients registered in the application database and 2160 consultations were performed by primary care teams. Of the 96 health care professionals who were invited for the usability assessment, 26% (25/96) were physicians, 46% (44/96) were nurses, and 28% (27/96) were other health professionals. The questionnaire included 24 items on impressions of feasibility, usability, utility, and satisfaction, and presented global Cronbach α of .93. As for feasibility, all professionals agreed (median scores of 4 or 5) that the application could be used in primary care settings and it could be easily incorporated in work routines, but physicians claimed that the application might have caused significant delays in daily routines. As for usability, overall evaluation was good and it was claimed that the application was easy to understand and use. All professionals agreed that the application was useful (score 4 or 5) to promote prevention, assist treatment, and might improve patient care, and they were overall satisfied with the application (median scores between 4 and 5). In the end-line assessment, there were 4211 patients (94.82% [3993/4211] with hypertension and 24.41% [1028/4211] with diabetes) registered in the application's database and 7960 consultations were performed by primary health care teams. The 17 participants of the focus groups were consistent to affirm they were very satisfied with the CDSS. CONCLUSIONS The CDSS was applicable in the context of primary health care settings in low-income regions, with good user satisfaction and potential to improve adherence to evidence-based practices.
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Affiliation(s)
- Milena Soriano Marcolino
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Antonio Queiroz Oliveira
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Junia Xavier Maia
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Thábata Queiroz Vivas Sá
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kaique Amancio
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lissandra Coelho
- Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, Brazil
| | - Leonardo Bonisson Ribeiro
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Antonio Luiz Ribeiro
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Goldman O, Ben-Assuli O, Rogowski O, Zeltser D, Shapira I, Berliner S, Zelber-Sagi S, Shenhar-Tsarfaty S. Non-alcoholic Fatty Liver and Liver Fibrosis Predictive Analytics: Risk Prediction and Machine Learning Techniques for Improved Preventive Medicine. J Med Syst 2021; 45:22. [PMID: 33426569 DOI: 10.1007/s10916-020-01693-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, with a prevalence of 20%-30% in the general population. NAFLD is associated with increased risk of cardiovascular disease and may progress to cirrhosis with time. The purpose of this study was to predict the risks associated with NAFLD and advanced fibrosis on the Fatty Liver Index (FLI) and the 'NAFLD fibrosis 4' calculator (FIB-4), to enable physicians to make more optimal preventive medical decisions. A prospective cohort of apparently healthy volunteers from the Tel Aviv Medical Center Inflammation Survey (TAMCIS), admitted for their routine annual health check-up. Data from the TAMCIS database were subjected to machine learning classification models to predict individual risk after extensive data preparation that included the computation of independent variables over several time points. After incorporating the time covariates and other key variables, this technique outperformed the predictive power of current popular methods (an improvement in AUC above 0.82). New powerful factors were identified during the predictive process. The findings can be used for risk stratification and in planning future preventive strategies based on lifestyle modifications and medical treatment to reduce the disease burden. Interventions to prevent chronic disease can substantially reduce medical complications and the costs of the disease. The findings highlight the value of predictive analytic tools in health care environments. NAFLD constitutes a growing burden on the health system; thus, identification of the factors related to its incidence can make a strong contribution to preventive medicine.
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Affiliation(s)
- Orit Goldman
- Faculty of Business Administration, Ono Academic College, 104 Zahal Street, 55000, Kiryat Ono, Israel.
| | - Ofir Ben-Assuli
- Faculty of Business Administration, Ono Academic College, 104 Zahal Street, 55000, Kiryat Ono, Israel
| | - Ori Rogowski
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Weizmann 6 St, Tel Aviv, Israel
| | - David Zeltser
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Weizmann 6 St, Tel Aviv, Israel
| | - Itzhak Shapira
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Weizmann 6 St, Tel Aviv, Israel
| | - Shlomo Berliner
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Weizmann 6 St, Tel Aviv, Israel
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, 3498838, Haifa, Israel.,Department of Gastroenterology, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Departments of Internal Medicine "C", "D" and "E", Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Weizmann 6 St, Tel Aviv, Israel
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Yao J, Wang H, Yan J, Shao D, Sun Q, Yin X. Understanding the Profiles of Blood Glucose Monitoring Among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Shandong, China. Patient Prefer Adherence 2021; 15:399-409. [PMID: 33654385 PMCID: PMC7910106 DOI: 10.2147/ppa.s292086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Blood glucose monitoring is essential in diabetic care and management. Monitoring using glucometers in home and in laboratories by professionals in certain health institutes were the common methods of blood glucose monitoring in clinical practice. This study aimed to characterize the profiles of blood glucose monitoring in the view of the discrepancy in methods and frequency conducted by the patients with type 2 diabetes mellitus (T2DM) in China, and to explore factors influencing the profiles. METHODS A cross-sectional, community-based study was conducted in Shandong province, China, with a multi-stage stratified sampling. A total of 2166 T2DM patients completed the structured questionnaires about the real-world status of blood glucose monitoring and other questions composed of demographic and clinical characteristic as well as the diabetes-related cognitive scales. Latent profile analysis (LPA) was used to identify the underlying profiles of blood glucose monitoring based on self-reported frequency of blood glucose monitoring through different methods. Univariate and multivariate logistic regression were used to analyze the characteristics of the profiles and to explore the factors associated with it. RESULTS Among the 2166 participants, the mean frequency of blood glucose monitoring was 2.77 times (standard deviation: 7.67) per month. LPA indicated that five-class model was the best solution for classifying the latent groups of blood glucose monitoring: Class 1 "Low frequency in all", Class 2 "High frequency in hospitals", Class 3 "High frequency in primary health institutes", Class 4 "High frequency in pharmacies", and Class 5 "High frequency in self-monitoring". The proportions of the patients in class 1, class 2, class 3, class 4, and class 5 were 88.1% (n=1909), 1.3% (n=28), 3.1% (n=67), 6.1% (n=133) and 1.3% (n=29), respectively. Multivariate logistic regression showed that participants who had higher income (OR: 1.58, 95% CI: 1.04~2.41, p<0.05), had diabetes complication(s) (OR=1.37, 95% CI: 1.03~1.02, p=0.03) and had a good knowledge of blood glucose control (OR=1.59, 95% CI: 1.17~2.16, p<0.01) were more likely to have high frequency of blood glucose monitoring (in class 2, 3, 4, 5), and the rural patients were less likely to had high frequency of blood glucose monitoring (OR=0.47, 95% CI: 0.35~0.63, p<0.01). CONCLUSION Low frequency dominates the characteristics of the profiles of blood glucose monitoring among T2DM patients in China, though distinct blood glucose monitoring groups can be identified by LPA. Educational and financial supports were recommended to increase the frequency of blood glucose monitoring in patients with T2DM, focusing on the patients with low socioeconomic status.
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Affiliation(s)
- Jiansen Yao
- Center for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, People’s Republic of China
- Institute for Hospital Management, Tsinghua University, Shenzhen, People’s Republic of China
| | - Haipeng Wang
- Center for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, People’s Republic of China
| | - Jingjing Yan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Di Shao
- Center for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, People’s Republic of China
| | - Qiang Sun
- Center for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, People’s Republic of China
| | - Xiao Yin
- Endocrinology Department, Jinan Central Hospital Affiliated to Shandong University, Jinan, People’s Republic of China
- Correspondence: Xiao Yin Jinan Central Hospital Affiliated to Shandong University, Jinan, 250012, People’s Republic of China Email
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Duffy S, Norton D, Kelly M, Chavez A, Tun R, Ramírez MNDG, Chen G, Wise P, Svenson J. Using Community Health Workers and a Smartphone Application to Improve Diabetes Control in Rural Guatemala. GLOBAL HEALTH, SCIENCE AND PRACTICE 2020; 8:699-720. [PMID: 33361237 PMCID: PMC7784066 DOI: 10.9745/ghsp-d-20-00076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The global prevalence of diabetes has nearly doubled since 1980. Seventy-five percent of patients with diabetes live in low- and middle-income countries, such as Guatemala, where health care systems are often poorly equipped for chronic disease management. Community health workers (CHWs) and mobile health technology have increasingly been applied to the diabetes epidemic in these settings, although mostly in supportive rather than primary roles in diabetes management. We sought to improve diabetes care in rural Guatemala through the development of a CHW-led diabetes program and a smartphone application to provide CHWs with clinical decision support. METHODS We worked with our local partners to develop a program model and the smartphone application (using the CommCare platform) and to train CHWs. We recruited patients with type 2 diabetes living in rural communities. Program evaluation used a single-group, pre-post design. Primary outcomes were hemoglobin A1c and the percentage of patients meeting A1c goals compared with baseline. We also followed a variety of process metrics, including application reliability. RESULTS Eighty-nine patients enrolled during the study period. The hemoglobin A1c percentage decreased significantly at 3 months (-1.0; 95% CI=-1.7, -0.6), 6 months (-1.5; 95% CI=-2.2, -0.8), 9 months (-1.3; 95% CI=-2.0, -0.6), and 12 months (-1.0; 95% CI=-1.7, -0.4). The percentage of patients with A1c ≤ 8% increased significantly at 3 months (23.6% to 44.4%, P=.007), 6 months (22.0% to 44.0%, P=.015), and 9 months (23.9% to 45.7%, P=.03). CHWs and supervising physicians agreed with application medication recommendations >90% of the time. CONCLUSION Our results suggest that CHWs can safely and effectively manage diabetes with the assistance of a smartphone application and remote physician supervision. This model should be evaluated versus other standards of care and could be adapted to other low-resource settings and chronic diseases.
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Affiliation(s)
- Sean Duffy
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA.
| | - Derek Norton
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Mark Kelly
- University of California-Los Angeles David Geffen School of Medicine, Internal Medicine Residency Program, Los Angeles, CA, USA
| | | | - Rafael Tun
- Hospital Obras Sociales Monseñor Gregorio Schaffer, San Lucas Tolimán, Guatemala
| | - Mariana Niño de Guzmán Ramírez
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | - Guanhua Chen
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Paul Wise
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jim Svenson
- University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, WI, USA
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Lee DY, Nam SM. Association between restrictive pulmonary disease and type 2 diabetes in Koreans: A cross-sectional study. World J Diabetes 2020; 11:425-434. [PMID: 33133390 PMCID: PMC7582118 DOI: 10.4239/wjd.v11.i10.425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes is a progressive disease that increases glucose levels in the blood. While studies have shown that patients with pulmonary disease (both obstructive and restrictive pulmonary disease) have a higher prevalence of type 2 diabetes mellitus (T2DM), there have been more studies on restrictive patterns than chronic obstructive pulmonary disease.
AIM To assess whether restrictive and obstructive pulmonary diseases are associated with T2DM in Koreans.
METHODS For our analysis, we used data from the Korea National Health and Nutrition Examination Survey. A total of 2830 subjects were included in this study. Spirometry results were categorized into three patterns: Normal, restrictive pulmonary disease (RPD), and obstructive pulmonary disease (OPD).
RESULTS The factors used as diabetic indicators (i.e. homeostatic model assessment of insulin resistance, homeostatic model assessment of beta-cell function, glycated hemoglobin, and fasting insulin) were among the highest in RPD but not in OPD. Based on multivariate logistic regression analysis, subjects with RPD were found with an increased odds ratio [OR: 1.907, 95% confidence interval (CI): 1.110-3.277] for T2DM compared with subjects with normal pulmonary function, whereas in patients with OPD, the OR had not increased. Model 4, which adjusted for the variables that could affect diabetes and pulmonary disease, showed a significant increase in the T2DM OR to RPD (OR: 2.025, 95%CI: 1.264-3.244). On the other hand, no statistically significant difference was shown in OPD (OR: 0.982, 95%CI: 0.634-1.519).
CONCLUSION RPD, not OPD, is highly associated with T2DM regardless of the risk factors of various T2DMs that can be confounds.
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Affiliation(s)
- Do Y Lee
- Department of Physical Therapy, Daegu University, Gyeongsan-si 38453, South Korea
| | - Seung M Nam
- Department of Physical Therapy, Daegu University, Gyeongsan-si 38453, South Korea
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Thrasher J, Polsky S, Hovsepian L, Nowotny I, Pierre S, Bois De Fer B, Bhargava A, Mukherjee B, Garg SK. Safety and Tolerability of Insulin Aspart Biosimilar SAR341402 Versus Originator Insulin Aspart (NovoLog) When Used in Insulin Pumps in Adults with Type 1 Diabetes: A Randomized, Open-Label Clinical Trial. Diabetes Technol Ther 2020; 22:666-673. [PMID: 31833801 PMCID: PMC7478191 DOI: 10.1089/dia.2019.0446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The aim was to assess the safety and tolerability of the insulin aspart biosimilar/follow-on product SAR341402 (100 U/mL solution; SAR-Asp) and originator insulin aspart (100 U/mL; NN-Asp; NovoLog®) self-administered through an insulin pump. Materials and Methods: This randomized, open-label, 2 × 4-week crossover study enrolled 45 adults with type 1 diabetes (T1D). Participants were randomized 1:1 to the treatment sequence SAR-Asp/NN-Asp or NN-Asp/SAR-Asp. The basal and prandial insulin doses were individually titrated. The primary outcome was the number of participants with at least one infusion set occlusion (infusion set change due to failure-to-correct hyperglycemia [plasma glucose ≥250 mg/dL] by insulin pump bolus) during the 4-week treatment. The main secondary outcome was the number of participants with at least one episode of unexplained hyperglycemia (regardless of correction by an insulin pump bolus without apparent material defect, medical, dietary, insulin dosing reason, or pump problem). Results: The number of participants reporting ≥1 infusion set occlusion were similar between treatments: 14/43 on SAR-Asp (33 events) and 12/43 on NN-Asp (24 events). The estimated difference in infusion set occlusion risk for SAR-Asp versus NN-Asp was 4.1% (95% confidence interval: -9.3% to 17.4%). The number of participants with ≥1 episode of unexplained hyperglycemia was similar between treatments (31/43 on SAR-Asp [154 events]; 32/43 on NN-Asp [175 events]). Hypoglycemia, treatment-emergent adverse events, hypersensitivity, and injection site reactions were similar between treatments. Conclusions: SAR-Asp and NN-Asp were well tolerated and had similar infusion set occlusions over a 4-week period in insulin pump users with T1D.
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Affiliation(s)
| | - Sarit Polsky
- Department of Medicine and Pediatrics, Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado
| | | | | | | | | | - Anuj Bhargava
- Iowa Diabetes & Endocrinology Research Center, West Des Moines, Iowa
| | | | - Satish K. Garg
- Department of Medicine and Pediatrics, Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado
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Zhang Y, Jin JL, Cao YX, Zhang HW, Guo YL, Wu NQ, Zhu CG, Gao Y, Hua Q, Li YF, Xu RX, Li JJ. Lipoprotein (a) predicts recurrent worse outcomes in type 2 diabetes mellitus patients with prior cardiovascular events: a prospective, observational cohort study. Cardiovasc Diabetol 2020; 19:111. [PMID: 32646432 PMCID: PMC7350185 DOI: 10.1186/s12933-020-01083-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Merging studies have reported the association of lipoprotein(a) [Lp(a)] with poor outcomes of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, the prognostic importance of Lp(a) for recurrent cardiovascular events (CVEs) is currently undetermined in patients with T2DM and prior CVEs. METHODS From April 2011 to March 2017, we consecutively recruited 2284 T2DM patients with prior CVEs. Patients were categorized into low, medium, and high groups by Lp(a) levels and followed up for recurrent CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Kaplan-Meier, Cox regression and C-statistic analyses were performed. RESULTS During 7613 patient-years' follow-up, 153 recurrent CVEs occurred. Lp(a) levels were significantly higher in patients with recurrent CVEs than counterparts (20.44 vs. 14.71 mg/dL, p = 0.002). Kaplan-Meier analysis revealed that the event-free survival rate was dramatically lower in high and medium Lp(a) groups than that in low group irrespective of HBA1c status (< 7.0%; ≥ 7.0%, both p < 0.05). Furthermore, multivariate Cox regression models indicated that Lp(a) was independently associated with high risk of recurrent CVEs [HR(95% CI): 2.049 (1.308-3.212)], such data remains in different HBA1c status (HR(95% CI): < 7.0%, 2.009 (1.051-3.840); ≥ 7.0%, 2.162 (1.148-4.073)). Moreover, the results of C-statistic were significantly improved by 0.029 when added Lp(a) to the Cox model. CONCLUSIONS Our data, for the first time, confirmed that Lp(a) was an independent predictor for recurrent CVEs in T2DM patients with prior CVEs, suggesting that Lp(a) measurement may help to further risk stratification for T2DM patients after they suffered a first CVE.
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Affiliation(s)
- Yan Zhang
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Jing-Lu Jin
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Ye-Xuan Cao
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Hui-Wen Zhang
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Yuan-Lin Guo
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Na-Qiong Wu
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Cheng-Gang Zhu
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Ying Gao
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Qi Hua
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan-Fang Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui-Xia Xu
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
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Deniz R, Yavuzkir S, Ugur K, Ustebay DU, Baykus Y, Ustebay S, Aydin S. Subfatin and asprosin, two new metabolic players of polycystic ovary syndrome. J OBSTET GYNAECOL 2020; 41:279-284. [PMID: 32608281 DOI: 10.1080/01443615.2020.1758926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Asprosin and subfatin are recently discovered two new hormones of adipocyte origin that play a role in the regulation of glucose metabolism. Polycystic ovary syndrome (PCOS) is a gynaecological syndrome presenting with energy turbulence. The aim of this study was to investigate whether asprosin and subfatin play a role in PCOS disease. Thirty participants with a diagnosis of PCOS and thirty control group participants were included in this case-control study. Hormone profiles of the participants (subfatin, asprosin, insulin, prolactin, thyroid-stimulating hormone (TSH), oestradiol (E2), follicle-stimulating hormone (FSH), luteinising hormone (LH), dehydroepiandrosterone sulphate (DHEA-SO4), lipid profiles [(total testosterone, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, cholesterol)], fasting blood sugar (FBS) and high-sensitivity C-reactive protein (hs-CRP) values were measured. While the levels of asprosin, LDL and triglyceride, TSH, E2, FSH, LH, DHEA-SO4 were found to be significantly higher in patients with PCOS compared to controls (p = .005; p = .01), subfatin and HDL levels were found to be low. Significantly decreasing subfatin and increasing asprosin levels in circulation in PCOS may play a role in the etiopathology of this disease and that they may also be new candidate molecules in addition to classical laboratory parameters in the diagnosis and follow-up of PCOS in the future.Impact statementWhat is already known on this subject? The studies investigating the relationship between PCOS and asprosin are contradictory. Although subfatin has been studied in many metabolic diseases, it has not been studied yet whether it is associated with PCOS. Furthermore, whether there is a mutual relationship between subfatin and asprosin in patients with PCOS has not been studied yet.What do the results of this study add? This available data indicates that significantly decreasing subfatin and increasing asprosin levels in the circulation in PCOS may play a role in the etiopathology of this disease.What are the implications of these findings for clinical practice and/or further research? The findings are promising in that decreasing subfatin and increasing asprosin levels will shed new light on reproductive endocrinology changes caused by PCOS and may help to clarify the pathophysiology of PCOS. Furthermore, in our study, the asprosin/subfatin ratio was above three in PCOS disease. This ratio reported here is anticipated to contribute to the course or follow-up of the disease in the future. Also, subfatin has been investigated here for the first time, may also be a new candidate molecule in addition to classical laboratory parameters in the diagnosis and follow-up of PCOS.
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Affiliation(s)
- Rulin Deniz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Kafkas University, Kars, Turkey
| | - Seyda Yavuzkir
- Department of Obstetrics and Gynecology, School of Medicine, Firat University, Elazig, Turkey
| | - Kader Ugur
- Department of Internal Medicine (Endocrinology and Metabolism Diseases), School of Medicine, Firat University, Elazig, Turkey
| | - Dondu Ulker Ustebay
- Department of Pediatrics, School of Medicine, Kafkas University, Kars, Turkey
| | - Yakup Baykus
- Department of Obstetrics, Gynecology and Reproductive Sciences, Kafkas University, Kars, Turkey
| | - Sefer Ustebay
- Department of Pediatrics, School of Medicine, Kafkas University, Kars, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry and Clinical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
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Heise T, Donnelly C, Barve A, Aubonnet P. Pharmacokinetic and pharmacodynamic bioequivalence of proposed biosimilar MYL-1501D with US and European insulin glargine formulations in patients with type 1 diabetes mellitus. Diabetes Obes Metab 2020; 22:521-529. [PMID: 31724253 PMCID: PMC7079113 DOI: 10.1111/dom.13919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 12/26/2022]
Abstract
AIMS To report phase 1 bioequivalence results comparing MYL-1501D, US reference insulin glargine (US IG), and European reference insulin glargine (EU IG). MATERIALS AND METHODS The double-blind, randomized, three-way crossover study compared the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of MYL-1501D, US IG and EU IG. In total, 114 patients with type 1 diabetes (T1DM) received 0.4 U/kg of each study treatment under automated euglycaemic clamp conditions. Insulin metabolite M1 concentrations, insulin glargine (IG) and glucose infusion rates (GIRs) were assessed over 30 hours. Primary PK endpoints were area under the serum IG concentration-time curve from 0 to 30 hours (AUCins.0-30h ) and maximum serum IG concentration (Cins.max ). Primary PD endpoints were area under the GIR-time curve from 0 to 30 hours (AUCGIR0-30h ) and maximum GIR (GIRmax ). RESULTS Bioequivalence among MYL-1501D, US IG and EU IG was demonstrated for the primary PK and PD endpoints. Least squares mean ratios were close to 1, and 90% confidence intervals were within 0.80 to 1.25. The PD GIR-time profiles were nearly superimposable. There were no noticeable differences in the safety profiles of the three treatments, and no serious adverse events were reported. CONCLUSIONS Equivalence with regard to PK and PD characteristics was shown among MYL-1501D, US IG and EU IG in patients with T1DM, and each treatment was well tolerated and safe.
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Grants
- Financial support for this study and preparation of the manuscript was provided by Mylan Inc., Canonsburg, Pennsylvania, and Biocon Ltd, Bangalore, India. Editorial assistance was provided under the direction of the authors by Ali Rosenberg, PhD and Jennifer Rossi, MA, ELS, MedThink SciCom, with support from Mylan Inc.
- Financial support for this study and preparation of the manuscript was provided by Mylan Inc., Canonsburg, Pennsylvania, and Biocon Ltd, Bangalore, India. Editorial assistance was provided under the direction of the authors by Ali Rosenberg, PhD and Jennifer Rossi, MA, ELS, MedThink SciCom, with support from Mylan Inc.
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Li Q, Lin F, Gao Z, Huang F, Zhu P. Chinese ASCVD risk equations rather than pooled cohort equations are better to identify macro- and microcirculation abnormalities. BMC Cardiovasc Disord 2020; 20:145. [PMID: 32204696 PMCID: PMC7092674 DOI: 10.1186/s12872-020-01425-0] [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: 05/24/2019] [Accepted: 03/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We hypothesized that discriminating the early subclinical organ damage would serve as a great opportunity for prevention against atherosclerotic cardiovascular disease (ASCVD). Brachial-ankle pulse wave velocity (baPWV), low retinal vascular fractal dimension, and albuminuria are surrogates of subclinical vascular changes. METHODS The aim of this study was to use Pooled Cohort Equations (PCE) and ASCVD risk equations derived from "Prediction for ASCVD Risk in China project (CHINA-PAR)" to observe the prevalence of macro- and microcirculation abnormalities. A total of 2166 subjects were involved. Characteristics were investigated using questionnaire and physical examinations. We calculated the urine albumin to creatinine ratio (UACR). The baPWV was measured using a fully automatic arteriosclerosis detector. The retinal vascular fractal dimension was measured by a semiautomated computer-based program. The 10-year ASCVD risk was estimated using the PCE and CHINA-PAR model. RESULTS The cut-off values for the elevated baPWV were 2.82 and 2.92% in the PCE model and CHINA-PAR model, respectively, with nearly 85% sensitivity and an average specificity of 74%. For low retinal fractal dimension, at the cut-off point of 3.8%, we acquired an acceptable sensitivity of 66.27-68.24% and specificity of 62.57-67.45%. All the C-statistics presented a significant improvement from the PCE model to the CHINA-PAR model (P < 0.05). For all categories-net reclassification improvement (NRI) values were significant and clearly varied (0.329, 0.183, and 0.104, respectively) depending on the cut-off set at 3%. CONCLUSION Our study demonstrated that the CHINA-PAR equations rather than PCE could provide better identification of macro- and microcirculation abnormalities. A lower cut-off point for the subclinical vascular changes may be selected in a population from southeast China.
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Affiliation(s)
- Qiaowei Li
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Provincial Key Laboratory of Geriatric Disease, Shengli Clinical Medical College of Fujian Medical University, 134 East Street, Fuzhou, 350001, Fujian, China
| | - Fan Lin
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Provincial Key Laboratory of Geriatric Disease, Shengli Clinical Medical College of Fujian Medical University, 134 East Street, Fuzhou, 350001, Fujian, China
| | - Zhonghai Gao
- Department of ophthalmology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Feng Huang
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Provincial Key Laboratory of Geriatric Disease, Shengli Clinical Medical College of Fujian Medical University, 134 East Street, Fuzhou, 350001, Fujian, China.
| | - Pengli Zhu
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Provincial Key Laboratory of Geriatric Disease, Shengli Clinical Medical College of Fujian Medical University, 134 East Street, Fuzhou, 350001, Fujian, China.
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Visceral Adipose Tissue Depth in Early Pregnancy and Gestational Diabetes Mellitus - a Cohort Study. Sci Rep 2020; 10:2032. [PMID: 32029868 PMCID: PMC7005273 DOI: 10.1038/s41598-020-59065-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/19/2020] [Indexed: 11/20/2022] Open
Abstract
Some studies have suggested that abdominal visceral adipose tissue depth (VAD) measured by ultrasound in early pregnancy, may predict the future onset of gestational diabetes mellitus (GDM). Wheter this is true, independent of pre-pregnancy body mass index (BMI), has been debated, leading the current study. A prospective cohort study was completed, in which VAD was measured at around 14 weeks’ gestation. GDM was later assessed by an oral glucose tolerance test at 24 to 28 weeks, according to the IADPSG criteria. Logistic regression analysis and receiver operating curve (ROC) analysis were used to estimate the predictive value of VAD, above and beyond pre-pregnancy BMI. 627 pregnant women were enrolled, and 518 completed the study. VAD was measured at a mean of 14.4 weeks’ gestation. 87 women (16.8%) subsequently developed GDM. The unadjusted odds ratio (OR) for developing GDM was 1.99 (95% CI 1.59–2.46) per 1-cm increase in VAD. After adjusting for maternal BMI and age, the OR was 2.00 (95% CI 1.61 to 2.50). The ROC under the curve for developing GDM was higher for VAD (0.70, 95% CI 0.63 to 0.75) than for pre-pregnancy BMI (0.57 95% CI 0.50 to 0.64) (p < 0.001). In conclusion, higher VAD may better predict GDM than pre-pregnancy BMI.
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Heller SR, Buse JB, Ratner R, Seaquist E, Bardtrum L, Hansen CT, Tutkunkardas D, Moses AC. Redefining Hypoglycemia in Clinical Trials: Validation of Definitions Recently Adopted by the American Diabetes Association/European Association for the Study of Diabetes. Diabetes Care 2020; 43:398-404. [PMID: 31658975 PMCID: PMC7411283 DOI: 10.2337/dc18-2361] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 09/17/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if the International Hypoglycaemia Study Group (IHSG) level 2 low glucose definition can identify clinically relevant hypoglycemia in clinical trials and offer value as an end point for future trials. RESEARCH DESIGN AND METHODS A post hoc analysis was performed of the SWITCH (SWITCH 1: n = 501, type 1 diabetes; SWITCH 2: n = 721, type 2 diabetes) and DEVOTE (n = 7,637, type 2 diabetes) trials utilizing the IHSG low glucose definitions. Patients in all trials were randomized to either insulin degludec or insulin glargine 100 units/mL. In the main analysis, the following definitions were compared: 1) American Diabetes Association (ADA) 2005 (plasma glucose [PG] confirmed ≤3.9 mmol/L with symptoms); and 2) IHSG level 2 (PG confirmed <3.0 mmol/L, independent of symptoms). RESULTS In SWITCH 2, the estimated rate ratios of hypoglycemic events indicated increasing differences between treatments with decreasing PG levels until 3.0 mmol/L, following which no additional treatment differences were observed. Similar results were observed for the SWITCH 1 trial. In SWITCH 2, the IHSG level 2 definition produced a rate ratio that was lower than the ADA 2005 definition. CONCLUSIONS The IHSG level 2 definition was validated in a series of clinical trials, demonstrating its ability to discriminate between basal insulins. This definition is therefore recommended to be uniformly adopted by regulatory bodies and used in future clinical trials.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/drug therapy
- Diagnostic Techniques, Endocrine/standards
- Europe
- Female
- Humans
- Hypoglycemia/blood
- Hypoglycemia/chemically induced
- Hypoglycemia/diagnosis
- Hypoglycemic Agents/therapeutic use
- Insulin Glargine/therapeutic use
- Insulin, Long-Acting/therapeutic use
- Male
- Middle Aged
- Practice Guidelines as Topic/standards
- Randomized Controlled Trials as Topic/methods
- Randomized Controlled Trials as Topic/standards
- Reference Standards
- Reference Values
- Societies, Medical/organization & administration
- Societies, Medical/standards
- Terminology as Topic
- United States
- Young Adult
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Affiliation(s)
- Simon R Heller
- Academic Unit of Diabetes, Oncology & Metabolism, University of Sheffield, Sheffield, U.K.
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Robert Ratner
- Division of Endocrinology and Metabolism, Georgetown University Medical School, Washington, DC
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Bennett DA, Du H, Bragg F, Guo Y, Wright N, Yang L, Bian Z, Chen Y, YU C, Wang S, Meng F, Lv J, Chen J, Li L, Clarke R, Chen Z. Physical activity, sedentary leisure-time and risk of incident type 2 diabetes: a prospective study of 512 000 Chinese adults. BMJ Open Diabetes Res Care 2019; 7:e000835. [PMID: 31908799 PMCID: PMC6936425 DOI: 10.1136/bmjdrc-2019-000835] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 01/19/2023] Open
Abstract
Objective Aim to examine the independent and joint associations of physical activity (PA) and sedentary leisure-time (SLT) with risk of diabetes and assess the extent to which these associations were mediated by adiposity. Research design and methods The prospective China Kadoorie Biobank recruited ~512 000 adults from 10 diverse areas across China. Self-reported PA was estimated based on type, frequency and duration of specific types of PA, covering four domains (occupation, leisure, household and commuting). SLT was defined as hours per day spent watching television, reading or playing card games. Stratified Cox proportional hazards models were used to estimate adjusted HRs (aHRs) for PA and SLT associated with incident diabetes. Analyses were stratified by age-at-risk (5-year intervals), sex and region and adjusted for household income, education, alcohol consumption, smoking, fresh fruit intake, self-reported general health status, family history of diabetes and body mass index (BMI) status. Analyses of total PA, occupational and non-occupational PA and SLT were mutually adjusted for each other, as appropriate. Results After ~9 years of follow-up, there were 14 940 incident diabetes cases among 460 736 participants without prior diabetes or cardiovascular diseases at baseline. The mean (SD) age at baseline was 51 (10.6) years, 59% were women and 43% resided in urban areas. Overall, the mean BMI was 23.5 (3.3) kg/m2, which differed by ~0.5 kg/m2 among individuals in the highest compared with the lowest PA and SLT groups. PA was inversely associated the risk of diabetes 16% (aHR: 0.84, 95% CI 0.81 to 0.88) lower in top than bottom fifth. After further adjustment for BMI this was attenuated to 0.99 (95% CI 0.98 to 1.00). SLT was positively associated with diabetes and each 1 hour per day higher usual level was associated with aHR of 1.13 (95% CI 1.09 to 1.17) for diabetes, attenuated to 1.05 (95% CI 1.01 to 1.09) after further adjustment for BMI. Conclusions Among Chinese adults, higher levels of PA and lower levels of SLT were associated with lower risks of diabetes with no evidence of effect modification by each other. These associations appeared to arise mainly through adiposity.
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Affiliation(s)
- Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Canqing YU
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Sisi Wang
- Non-Communicable Disease Prevention and Control Department, Liuzhou CDC, Liuzhou, Guangxi, China
| | - Fanwen Meng
- Non-Communicable Disease Prevention and Control Department, Liuzhou CDC, Liuzhou, Guangxi, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment (CFSA), Beijing, China
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Belo L, Rocha S, Valente MJ, Coimbra S, Catarino C, Bronze-da-Rocha E, Rocha-Pereira P, do Sameiro-Faria M, Oliveira JG, Madureira J, Fernandes JC, Miranda V, Santos-Silva A. Hepcidin and diabetes are independently related with soluble transferrin receptor levels in chronic dialysis patients. Ren Fail 2019; 41:662-672. [PMID: 31296086 PMCID: PMC6691825 DOI: 10.1080/0886022x.2019.1635893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/30/2019] [Accepted: 06/13/2019] [Indexed: 01/23/2023] Open
Abstract
Background: Soluble transferrin receptor (sTfR) is a biomarker of erythropoiesis, which is often impaired in dialysis patients. The aim of our study was to evaluate sTfR levels in chronically dialyzed patients and assess potential determinants of its levels. Methods: We performed a cross-sectional study by evaluating 246 end-stage renal disease patients undergoing dialysis and 32 healthy controls. Circulating levels of interleukin (IL)-6, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, hepcidin, sTfR, growth differentiation factor 15 (GDF15), and traditional iron metabolism markers were measured, as well as hemogram parameters. Clinical data was obtained from all patients. Results: Compared to controls, patients presented similar values of sTfR, reticulocytes and reticulocyte production index (RPI), and significantly higher levels of IL-6, CRP, ferritin, hepcidin, TNF-α, and GDF15. Iron, transferrin, hemoglobin levels, erythrocyte count, mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC) values were significantly lower in dialysis group. Within patients, sTfR values were higher in diabetic patients and were positively and significantly correlated with reticulocytes and erythrocytes, RPI, and therapeutic doses of erythropoiesis stimulating agents (ESA) and intravenous iron; and inversely and significantly correlated with circulating iron, ferritin, transferrin saturation, hepcidin, MCH, and MCHC. In multiple linear regression analysis, ESA dose, RPI, serum iron, diabetes, and hepcidin levels were independently associated with sTfR levels in dialysis patients and, thus, with erythropoiesis. Conclusion: Our data suggest that, besides RPI and ESA dose, diabetes and hepcidin are closely related to erythropoiesis in dialysis patients. The influence of diabetes on sTfR levels deserves further investigation.
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Affiliation(s)
- Luís Belo
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Susana Rocha
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Maria João Valente
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Susana Coimbra
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), Gandra-Paredes, Portugal
| | - Cristina Catarino
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Elsa Bronze-da-Rocha
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Petronila Rocha-Pereira
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Maria do Sameiro-Faria
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Hemodialysis Clinic of Felgueiras, CHF, Felgueiras, Portugal
| | - José Gerardo Oliveira
- Hemodialysis Clinic of Porto, CHP, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Madureira
- NefroServe Hemodialysis Clinic of Barcelos, Barcelos, Portugal
| | | | - Vasco Miranda
- Hemodialysis Clinic of Gondomar, CHD, Gondomar, Portugal
| | - Alice Santos-Silva
- UCIBIO, REQUIMTE, Laboratory of Biochemistry, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Proulx É, Auclair A, Piché ME, Harvey J, Pettigrew M, Biertho L, Marceau S, Poirier P. Safety of Blood Glucose Response Following Exercise Training After Bariatric Surgery. Obes Surg 2019; 28:3976-3983. [PMID: 30097897 DOI: 10.1007/s11695-018-3449-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Safety of exercise training in relationship with the risk of hypoglycemia post-bariatric surgery is unknown. OBJECTIVE To evaluate the safety and magnitude of changes in blood glucose levels during exercise training following bariatric surgery. MATERIAL AND METHODS Twenty-nine severely obese patients undergoing either sleeve gastrectomy (SG) (n = 16) or biliopancreatic diversion with duodenal switch (BPD-DS) (n = 13) were prospectively enrolled. Three months after surgery, patients participated in a 12-week supervised exercise training program, (35-min aerobic training with a 25-min resistance exercises) three times a week. Capillary blood glucose (CBG) levels were measured immediately before and after each exercise session. RESULTS Seven patients (24%) had type 2 diabetes before surgery (mean duration: 10 years); four patients still have type 2 diabetes 3 months post-bariatric surgery. A total of 577 exercise training sessions with CBG monitoring were recorded. Only seven sessions (1.2%) were associated with an episode of asymptomatic hypoglycemia (CBG ≤ 3.9 mmol/L). Patients with type 2 diabetes at baseline showed a larger decrease in CBG with pre-exercise CBG being between 6.1 and 8.0 mmol/L (- 1.6 ± 1.2 vs. - 1.1 ± 0.9 mmol/L, p = 0.02). BPD-DS patients with CBG ≥ 6.1 mmol/L showed higher reduction in CBG following exercise vs. SG patients (- 1.7 ± 1.0 vs. - 1.1 ± 1.1 mmol/L; p < 0.001 and - 4.3 ± 1.0 vs. - 2.2 ± 1.4 mmol/L, p < 0.001, respectively). CONCLUSION Three months after bariatric surgery, exercise training program in patients without and with type 2 diabetes is safe, and is associated with a desirable glycemic profile, with few episodes of asymptomatic hypoglycemia.
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Affiliation(s)
| | - Audrey Auclair
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Marie-Eve Piché
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Jany Harvey
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Myriam Pettigrew
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Laurent Biertho
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Simon Marceau
- Laval University, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada
| | - Paul Poirier
- Laval University, Québec, Canada.
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, QC, G1V 4G5, Canada.
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Luo D, Xu JJ, Cai X, Zhu M, Wang H, Yan D, Li MZ. The effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes. J Clin Nurs 2019; 28:4478-4487. [PMID: 31410916 DOI: 10.1111/jocn.15033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/24/2019] [Accepted: 08/03/2019] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. BACKGROUND Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. DESIGN This study was conducted using a survey with a convenience sample following the STROBE guidelines. METHODS A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. RESULTS The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. CONCLUSION In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. RELEVANCE TO CLINICAL PRACTICE This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.
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Affiliation(s)
- Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Jing-Jing Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Yan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming-Zi Li
- School of Nursing, Peking University, Beijing, China
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Hayashi Y. Detection of Lower Albuminuria Levels and Early Development of Diabetic Kidney Disease Using an Artificial Intelligence-Based Rule Extraction Approach. Diagnostics (Basel) 2019; 9:133. [PMID: 31569548 PMCID: PMC6963949 DOI: 10.3390/diagnostics9040133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to determine the lowest cut-off value for albuminuria levels, which can be used to detect diabetic kidney disease (DKD) using the urinary albumin-to-creatinine ratio (UACR). National Health and Nutrition Examination Survey (NHANES) data for US adults were used, and participants were classified as having diabetes or prediabetes based on a self-report and physiological measures. The study dataset comprised 942 diabetes and 524 prediabetes samples. This study clarified the significance of the lower albuminuria (UACR) levels, which can detect DKD, using an artificial intelligence-based rule extraction approach. The diagnostic rules (15 concrete rules) for both samples were extracted using a recursive-rule eXtraction (Re-RX) algorithm with continuous attributes (continuous Re-RX) to discriminate between prediabetes and diabetes datasets. Continuous Re-RX showed high test accuracy (77.56%) and a large area under the receiver operating characteristics curve (75%), which derived the two cut-off values (6.1 mg/g Cr and 71.00 mg/g Cr) for the lower albuminuria level in the UACR to detect early development of DKD. The early cut-off values for normoalbuminuria (NA) and microalbuminuria (MA) will be determined to help detect CKD and DKD, and to detect diabetes before MA develop and to prevent diabetic complications.
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Affiliation(s)
- Yoichi Hayashi
- Department of Computer Science, Meiji University, 1-1-1 Higashimita, Tama-ku, Kawasaki 214-8571, Japan.
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Cao B, Wang R, Gong C, Wu D, Su C, Chen J, Yi Y, Liu M, Liang X, Li W. An Evaluation of the Accuracy of a Flash Glucose Monitoring System in Children with Diabetes in comparison with Venous Blood Glucose. J Diabetes Res 2019; 2019:4845729. [PMID: 31583249 PMCID: PMC6754897 DOI: 10.1155/2019/4845729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS To evaluate the performance of a factory-calibrated flash glucose monitoring system in children with diabetes compared to venous blood glucose (BG). METHODS A total of 13 hospitalized participants newly diagnosed with type 1 diabetes, aged 1~14 years old, were involved in the study. Sensor glucose measurements on days 2, 3, 6, 7, 12, and 13 of wear were compared with venous BG. During these days, the venous BG results were obtained either 4 or 7 times per day. RESULTS The accuracy was evaluated against venous BG, with 469 of 469 (100.0%) sensor and venous BG pairs within consensus error grid zones A and B, including 94.7% in zone A. The overall mean absolute relative difference (MARD) was 11.67%. The MARD of blood glucose lower than 4.0 mmol/L (MARD = 16.89%) was higher than blood glucose between 4 and 10 mmol/L (MARD = 11.58%) and blood glucose higher than 10 mmol/L (MARD = 7.79%). Compared to venous BG, the MARDs of wear days 2, 3, 6, 7, 12, and 13 were 11.53%, 9.66%, 11.79%, 10.89%, 13.18%, and 13.92%, respectively, with no statistically significant difference (P = 0.25). The median ARD was highest when the glucose decreased >0.11 mmol/L/min (20.27%) and lower than 10.00% when the glucose changed between 0.06 and 0.11 mmol/L/min, changed <0.06 mmol/L/min, and increased >0.11 mmol/L/min. CONCLUSIONS The accuracy of the system is good and remains stable over 14 days of wear; however, the accuracy depends on the glucose level and rates of glucose concentration changes.
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Affiliation(s)
- Bingyan Cao
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Rui Wang
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Chunxiu Gong
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Di Wu
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Chang Su
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jiajia Chen
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yajun Yi
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Min Liu
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xuejun Liang
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wenjing Li
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Singh N, Stewart RAH, Benatar JR. Intensity and duration of lifestyle interventions for long-term weight loss and association with mortality: a meta-analysis of randomised trials. BMJ Open 2019; 9:e029966. [PMID: 31427335 PMCID: PMC6701694 DOI: 10.1136/bmjopen-2019-029966] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate the importance of the frequency and duration of lifestyle interventions for achieving weight loss over ≥1 year and associations with all-cause mortality. DESIGN Meta-analysis of randomised trials using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and RevMan software version 5·2 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen). DATA SOURCES MEDLINE, CENTRAL, Google and Science Direct databases alongside reference lists of appropriate articles and meta-analyses. ELIGIBILITY CRITERIA Randomised studies published in English-language journals from 1980 to June 2018 that assessed lifestyle compared with control interventions on weight loss and that included ≥100 subjects and reported weight change and mortality for ≥1 year. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% CI and OR with 95% CI as appropriate. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The Grading of Recommendations Assessment, Development, and Evaluation score was used to assess the certainty of the evidence. RESULTS 31 randomised trials with a total of 20 816 overweight or obese participants were included. 70% of participants had cardiometabolic risk factors. Body weight was lower for lifestyle intervention compared with the control at 1 year (3.63 kg, 95% CI 2.58 to 4.67) and at 3 years (2.45 kg, 95% CI 1.17 to 3.73). Weight loss at 1 year was greater in studies with >28 compared with ≤28 interventions per year (4.50 kg, 95% CI 3.03, 5.97 vs 2.38, 95% CI 0.78 to 3.98 kg, p=0.001). In all studies, there were 593 deaths (~0.3%/year). The ORs for mortality for weight loss interventions compared with the controls was 0.86 (95% CI 0.73 to 1.02), p=0.09. CONCLUSION In predominantly healthy populations with risk factors, there is a dose response with number of lifestyle interventions and weight loss. Frequent and sustained interventions are needed to achieve a clinically significant 5% weight loss. There was insufficient evidence to reliably evaluate the benefits in persons with known cardiovascular disease or cancer. TRIAL REGISTRATION NUMBER CRD42018095067.
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Affiliation(s)
- Navneet Singh
- School of Medicine, The University of Auckland, Auckland, New Zealand
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Ajjan RA, Jackson N, Thomson SA. Reduction in HbA1c using professional flash glucose monitoring in insulin-treated type 2 diabetes patients managed in primary and secondary care settings: A pilot, multicentre, randomised controlled trial. Diab Vasc Dis Res 2019; 16:385-395. [PMID: 31271312 PMCID: PMC6613178 DOI: 10.1177/1479164119827456] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Analyse the effects of professional flash glucose monitoring system (FreeStyle Libre Pro™) on glycaemic control in insulin-treated type 2 diabetes. METHODS Primary (n = 17) and secondary care centres (n = 5) randomised 148 type 2 diabetes patients into three groups: (A) self-monitoring of blood glucose (n = 52), (B) self-monitoring of blood glucose and two Libre Pro sensor wears (n = 46) or (C) self-monitoring of blood glucose and four sensor wears (n = 50). Primary endpoint was time in range (glucose 3.9-10 mmol/L) within group C comparing baseline with days 172-187. Predefined secondary endpoints included HbA1c, hypoglycaemia and quality of life measures analysed within and between groups (clinicaltrials.gov, NCT02434315). RESULTS In group C, time in range in the first 14 days (baseline) and days 172-187 was similar at 15.0 ± 5.0 and 14.1 ± 4.7 h/day (mean ± SD), respectively, (p = 0.1589). In contrast, HbA1c reduced from baseline to study end within group C by 4.9 ± 8.8 mmol/mol (0.44% ± 0.81%; p = 0.0003). HbA1c was also lower in group C compared with A at study end by 5.4 ± 1.79 mmol/mol (0.48% ± 0.16%; p = 0.0041, adjusted mean ± SE), without increased time in hypoglycaemia (p = 0.1795). Treatment satisfaction scores improved in group C compared with A (p = 0.0225) and no device-related serious adverse events were reported. CONCLUSIONS Libre Pro can improve HbA1c and treatment satisfaction without increasing hypoglycaemic exposure in insulin-treated type 2 diabetes individuals managed in primary/secondary care centres.
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Affiliation(s)
- Ramzi A Ajjan
- St James’s University Hospital, Leeds Teaching Hospitals NHS Trust and LIGHT Laboratories: Leeds Institute of Cardiovascular and Metabolic Research, University of Leeds, Leeds, UK
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Frier BM, Ratzki‐Leewing A, Harris SB. Reporting of hypoglycaemia in clinical trials of basal insulins: A need for consensus. Diabetes Obes Metab 2019; 21:1529-1542. [PMID: 30924567 PMCID: PMC6767397 DOI: 10.1111/dom.13732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 12/31/2022]
Abstract
Hypoglycaemia is a common side-effect of diabetes therapies, particularly insulin, and imposes a substantial burden on individuals and healthcare systems. Consequently, regulatory approval of newer basal insulin (BI) therapies has relied on demonstration of a balance between achievement of good glycaemic control and less hypoglycaemia. Randomized controlled trials (RCTs) are the gold standard for assessing efficacy and safety, including hypoglycaemia risk, of BIs and are invaluable for obtaining regulatory approval. However, their highly selected patient populations and their conditions lead to results that may not be representative of real-life situations. Real-world evidence (RWE) studies are more representative of clinical practice, but they also have limitations. As such, data both from RCTs and RWE studies provide a fuller picture of the hypoglycaemia risk with BI therapies. However, substantial differences exist in the way hypoglycaemia is reported across these studies, which confounds comparisons of hypoglycaemia frequency among different BIs. This problem is ongoing and persists in recent trials of second-generation BI analogues. Although they provide a lower risk of hypoglycaemia when compared with earlier BIs, they do not eliminate it. This review describes differences in the way hypoglycaemia is reported across RCTs and RWE studies of second-generation BI analogues and examines potential reasons for these differences. For studies of BIs, there is a need to standardize aspects of design, analysis and methods of reporting to better enable interpretation of the efficacy and safety of such insulins among studies; such aspects include length of follow-up, glycaemic targets, hypoglycaemia definitions and time intervals for determining nocturnal events.
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Affiliation(s)
- Brian M. Frier
- British Heart Foundation Centre for Cardiovascular ScienceThe Queen's Medical Research Institute, University of EdinburghEdinburghUK
| | - Alexandria Ratzki‐Leewing
- Department of Epidemiology and BiostatisticsSchulich School of Medicine and Dentistry, Western UniversityLondonOntario, Canada
| | - Stewart B. Harris
- Department of Family MedicineSchulich School of Medicine and Dentistry, Western UniversityLondonOntario, Canada
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Rawlings AM, Sharrett AR, Albert MS, Coresh J, Windham BG, Power MC, Knopman DS, Walker K, Burgard S, Mosley TH, Gottesman RF, Selvin E. The Association of Late-Life Diabetes Status and Hyperglycemia With Incident Mild Cognitive Impairment and Dementia: The ARIC Study. Diabetes Care 2019; 42:1248-1254. [PMID: 31221696 PMCID: PMC6609963 DOI: 10.2337/dc19-0120] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/23/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to examine associations in older adults among diabetes, glycemic control, diabetes duration, and biomarkers of hyperglycemia with incident mild cognitive impairment (MCI) and incident dementia. RESEARCH DESIGN AND METHODS We conducted a prospective analysis of 5,099 participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended the fifth (2011-2013) exam. Cognitive status was assessed during follow-up via telephone calls, death certificate codes, surveillance, and a follow-up examination (2016-2017). We defined incident cognitive impairment as incident MCI or incident dementia in persons dementia-free at the index examination; we also examined each outcome separately. Diabetes was defined using self-report, medications, or HbA1c ≥6.5%; poor glycemic control in persons with diabetes was defined as HbA1c ≥7%. We examined the following biomarkers of hyperglycemia: HbA1c, fructosamine, glycated albumin, and 1,5-anhydroglucitol. RESULTS Mean age at baseline was 76 years, 59% were female, and 21% were black. Diabetes (hazard ratio [HR] 1.14 [95% CI 1.00, 1.31]), poor glycemic control in persons with diabetes (HR 1.31 [95% CI 1.05, 1.63]), and longer diabetes duration (≥5 vs. <5 years; HR 1.59 [95% CI 1.23, 2.07]) were significantly associated with incident cognitive impairment. We found a J-shaped association between HbA1c and incident dementia. Glycated albumin and fructosamine were also associated with incident dementia, independently of HbA1c. HbA1c and fructosamine were also associated with incident MCI. CONCLUSIONS Diabetes status, poor glycemic control, and longer diabetes duration were associated with worse cognitive outcomes over a median follow-up of 5 years.
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Affiliation(s)
- Andreea M Rawlings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - B Gwen Windham
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - David S Knopman
- Department of Neurology, Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN
| | - Keenan Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sheila Burgard
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Rebecca F Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Díaz Vera AS, Abellán Alemán J, Segura Fragoso A, Martínez de Esteban JP, Lameiro Couso FJ, Golac Rabanal MDS, Díaz Vera LA, Matta Solis HH. The prevalence and risk factors associated with dyslipidemia in type 2 diabetic patients in the autonomous Region of Cantabria. ACTA ACUST UNITED AC 2019; 67:102-112. [PMID: 31235401 DOI: 10.1016/j.endinu.2019.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Dyslipidemia is one of the main risk factors in cardiovascular disease in patients with diabetes mellitus type 2 (DM2). The aim of this study is to evaluate the prevalence and risk factors associated with dyslipidemia in the population with diabetes mellitus type 2 in the region of Cantabria. MATERIAL AND METHODS This is a transversal study carried out at Cantabrian primary health care centres (n=680). A representative, random sample of the population with DM2, ranging from 18-85, was selected using a multistage procedure. The medical records were obtained, and by means of interviews the data of the risk factors to be studied was secured. The correlation with dyslipidemia was analysed by means of logistic regression. RESULTS There were 52.1% of males, the average age was 69.8, the evolution of diabetes was 9.99 years, 84.3% had arterial hypertension, 76.6% were overweight or obese and the average HbA1c was 6.96%. The prevalence of dyslipidemia was 85.3%, and in the bivariate analysis this is associated with a history of peripheral artery disease, controlled diabetes, antihypertensive treatment, glomerular filtration, HbA1c>7%, body fat estimated as being either overweight or obese, a history of cardiovascular disease, age and HbA1c. In the multivariate analysis the independent factors were being female and a history of cardiovascular disease. CONCLUSION The prevalence of dyslipidemia in our study was 85.3%, and is consistent with figures found in previous published studies. The independent associated risk factors were being female and a past medical history of cardiovascular disease.
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Affiliation(s)
| | - José Abellán Alemán
- Cátedra de Riesgo Cardiovascular, Universidad Católica San Antonio de Murcia, Murcia, España
| | - Antonio Segura Fragoso
- Servicio de Investigación, Instituto de Ciencias de la Salud, Universidad de Castilla-La Mancha, Talavera de la Reina (Toledo), España
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