Current diabetes reviews最新文献

Objective: This network meta-analysis [NMA] investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy [NSPT] in the glycemic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D).

Methods: Seven databases, grey literature, and registry platforms were searched up to February 2024 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane's tool (RoB 2). Two frequentist NMA were performed using a random-effects model to calculate mean differences (MD) as an effect measure and to quantitatively evaluate the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was assessed through the GRADE approach in a partially contextualized framework for interpreting results. Ten RCTs were included.

Results: In total, 261 patients were treated with eight different local antimicrobials adjuvants to NSPT (azithromycin gel, clarithromycin gel, tetracycline fiber or ointment, chlorhexidine gel, doxycycline nanospheres, minocycline gel, and satranidazole gel), while 249 patients received NSPT alone or associated to placebo. Considering PPD reduction (8 included studies), the best results were found after six months for satranidazole gel (MD -2.64mm; 95%CI -3.56, -1.72; moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel (MD - 0.80%; 95%CI -1.70, 0.10), chlorhexidine gel (MD -0.68%; 95%CI -1.34, -0.02), and tetracycline fiber (MD -0.62%; 95%CI -0.85, -0.39) showed promising results after three months (low evidence certainty).

Conclusion: The adjunctive use of satranidazole gel probably reduces PPD after a 6-month follow-up, while doxycycline gel, chlorhexidine gel, and tetracycline fiber may decrease HbA1c values in patients with T2D and periodontitis treated with NSPT after a 3-month follow up.

Background: There are numerous cross-sectional studies showing an association between arterial stiffness and diabetes, but the temporality of the association is unclear.

Objective: To investigate the temporal relationship between arterial stiffness and diabetes.

Methods: We searched MEDLINE and Embase from inception to 31 August 2023, to identify cohort studies that assessed whether arterial stiffness, as measured by pulse wave velocity (PWV), was predictive of the development of diabetes and vice versa. We summarised study data, and where possible undertook meta-analysis.

Results: We identified 19 studies that included people with type 1, type 2 and gestational diabetes. All 11 studies investigating arterial stiffness as a predictor of diabetes found a significant relationship. Six of those studies were suitable for meta-analysis. The risk of developing diabetes was greater in people with higher PWV at baseline than lower PWV (RR = 2.14, 95%CI 1.65 to 2.79, p < 0.00001) and the mean difference in baseline PWV was higher in people who developed diabetes than those who did not (mean difference: 0.77 m/s, 95%CI 0.47 to 1.06, p < 0.00001). Of 8 studies investigating diabetes as a predictor of arterial stiffness, 7 found a significant relationship.

Conclusion: There is evidence of a bidirectional relationship between arterial stiffness and diabetes. Arterial stiffness may provide a causal link between diabetes and future cardiovascular disease.

In this complex realm of diabetes, hyperinsulinemia is no longer regarded as just a compensatory response to insulin resistance but rather has evolved into an integral feature. This comprehensive review provides a synthesis of the current literature, including various aspects associated with hyperinsulinemia in diabetic complications. Hyperinsulinemia has been shown to be more than just a compensatory mechanism, and the key findings demonstrate how hyperinsulinism affects the development of cardiovascular events as well as microvascular complications. Additionally, recognizing hyperinsulinemia as a modifiable factor, the diabetes management paradigm shifts towards cognitive ones that consider the use of lifestyle modifications in combination with newer pharmacotherapies and precision medicine approaches. These findings have crucial implications for the clinical work, requiring a careful appreciation of hyperinsulinemia's changing aspects as well as incorporation in personalized treatment protocol. In addition, the review focuses on bigger issues related to public health, showing that prevention and early diagnosis will help reduce the burden of complications. Research implications favor longitudinal studies, biomarker discovery, and the study of emerging treatment modalities; clinical practice should adopt global evaluations, patient education, and precision medicine adaptation. Finally, this critical review provides an overview of the underlying processes of hyperinsulinemia in diabetes and its overall health effects.

Background: Prevention and reduction of liver fat accumulation and maintenance of Glomerular Filtration Rate (GFR) have been proposed as important therapeutic goals in patients with Type 2 Diabetes Mellitus (T2DM).

Aim: This study aimed to determine the effect of Low-Volume High-Intensity Interval Training (LV-HIIT) on fatty liver index (FLI) and GFR estimation in patients with T2DM.

Methods: This randomized controlled trial included 80 patients with T2DM and a sedentary lifestyle, randomly divided into HIIT (n=40) and a control group (n=40). Patients with a history of T2DM for at least one year and HbA1C levels between 6.4% and 10% were selected. The intervention group underwent a 4-week LV-HIIT course, comprising 3 sessions per week, while the control group did not receive any intervention. FLI, eGFR, anthropometric measurements, and laboratory variables were assessed in all participants before and after the intervention.

Results: FLI (62.0 at baseline, 53.0 at follow-up) significantly decreased in the LV-HIIT group after the intervention, while eGFR (71.0 at baseline, 73.6 at follow-up) significantly increased (P<0.001). However, the control group showed a significant reduction only in Fasting Blood Sugar (FBS) (P<0.05). After the intervention, the LV-HIIT group had significantly lower FBS (129.0 at baseline, 121.0 at follow-up), Alanine Aminotransferase (ALT) (24.0 at baseline, 18.0 at follow-up), and Gamma-Glutamyl Transferase (GGT) (22.0 at baseline, 19.0 at follow-up), as well as higher eGFR, compared to the control group (P<0.05).

Conclusions: LV-HIIT exercise appears to be a promising and effective training method for improving FLI and eGFR in patients diagnosed with T2DM.

Diabetes mellitus (DM) is an intricate metabolic disorder marked by persistent hyperglycemia, arising from disruptions in glucose metabolism, with two main forms, type 1 and type 2, involving distinct etiologies affecting β-cell destruction or insulin levels and sensitivity. The islets of Langerhans, particularly β-cells and α-cells, play a pivotal role in glucose regulation, and both DM types lead to severe complications, including retinopathy, nephropathy, and neuropathy. Plant-derived anthocyanins, rich in anti-inflammatory and antioxidant properties, show promise in mitigating DM-related complications, providing a potential avenue for prevention and treatment. Medicinal herbs, fruits, and vegetables, abundant in bioactive compounds like phenolics, offer diverse benefits, including glucose regulation and anti-inflammatory, antioxidant, anticancer, anti-mutagenic, and neuroprotective properties. Anthocyanins, a subgroup of polyphenols, exhibit diverse isoforms and biosynthesis involving glycosylation, making them potential natural replacements for synthetic food colorants. Clinical trials demonstrate the efficacy and safety of anthocyanins in controlling glucose, reducing oxidative stress, and enhancing insulin sensitivity in diabetic patients, emphasizing their therapeutic potential. Preclinical studies revealed their multifaceted mechanisms, positioning anthocyanins as promising bioactive compounds for managing diabetes and its associated complications, including retinopathy, nephropathy, and neuropathy.

Background: Diabetic Cardiomyopathy (DCM) poses a substantial healthcare challenge, necessitating innovative therapeutic strategies. This review delves into the evolving role of traditional Indian dietary herbs in managing DCM, aiming to shed light on their potential contributions.

Methods: A comprehensive examination of the existing body of literature was conducted, synthesizing data from studies exploring the effects of various Indian dietary herbs on DCM. Molecular mechanisms, clinical outcomes, and safety profiles were scrutinized to establish a holistic perspective on their therapeutic potential.

Results: The review illuminates the multifaceted benefits of Indian dietary herbs in DCM management. These herbs have demonstrated efficacy in mitigating cardiac dysfunction, reducing oxidative stress, and modulating inflammatory responses. Molecular insights highlight their role in the intricate signaling pathways underlying DCM. Furthermore, their safety profiles render them promising candidates for adjunct therapy.

Conclusion: Indian dietary herbs emerge as promising allies in the battle against DCM, offering a holistic approach to the management of this intricate condition. Their cardioprotective effects, coupled with their ability to address the underlying molecular mechanisms, herald a new era in DCM therapy. This review underscores the need for further research to harness the potential of these herbs fully and provides a beacon of hope for individuals affected by DCM.

Introduction: Patients with hypertension and diabetes are more susceptible to cardiovascular diseases (CVD) and mortality. This study aimed to evaluate the individual and combined effects of hypertension and diabetes on cardiovascular events and mortality in a Middle Eastern population-based cohort.

Methods: Fifteen-year follow-up data were collected for 6323 adults aged 35 years and older who were free from CVD at baseline. The subjects were categorized into different groups according to hypertension and diabetes at baseline. Cox proportional hazards regression was implemented to estimate hazard ratios (HRs) of hypertension and diabetes for cardiovascular events (CVE), CVD mortality, and all-cause mortality. Population-attributable hazard fraction (PAHF) was used to assess the proportion of hazards of CVE and mortality attributable to hypertension or diabetes.

Results: The incidence rates (95% CI) of CVE, CVE mortality, and all-cause mortality in the total population were 13.77(12.84-14.77), 3.01(2.59-3.49), and 9.92(9.15-10.77) per 1000 persons per year respectively. The HR of hypertension for CVE in the diabetic population was 1.98 (1.47-2.66) with a PAHF of 27.65(15.49-39.3). When the HRs and PAHF of diabetes were evaluated in hypertensive patients, they were statistically significant for CVE, CVE mortality, and all-cause mortality.

Conclusion: Our study indicated that the joint effect of diabetes and hypertension is the dramatic increased risk of CVE. A considerable fraction of the excess risk of CVE in patients with diabetes was attributable to hypertension, on the other hand, diabetes was associated with a substantial hazard fraction of CVE and mortality in hypertensive patients.

Background: The control of blood pressure (BP) is a challenge in diabetic patientsand is associated with adverse outcomes of diabetes. In this systematic review and metaanalysis, we investigated the BP control rate among hypertensive diabetic patients in the EasternMediterranean Region (EMR) countries.

Methods: We systematically searched PubMed, Scopus, Embase, Cochrane, and Web of Science databases up to January 2023 for observational studies on BP control among hypertensivediabetic patients in all EMR countries. We included studies reporting the proportion of hypertensive, type 2 diabetic patients with controlled BP, defined as systolic/diastolic BP < 140/90 or<130/80 mmHg. Study quality was assessed using modified STROBE guidelines, and a random-effect meta-analysis was conducted to pool prevalence data and calculate overall rates.Subgroup analysis was performed by gender, study design, country, and BP control cut-offs(140/90 and 130/80).

Results: Among the 1949 retrieved studies, 20 studies assessing 27956 individuals were included. The proportion of BP control regardless of cut-off points was 36.8% (95% CI=29.1%45.3%)based on the studies reported for both genders.The prevalence was 53.2% (95% CI=36.1%-69.6%) and 43.5% (95% CI=20.0%-70.3%) based on the studies reported just for women ormen, respectively.

Conclusion: Our findings indicate that BP control targets are not successfully achieved in hypertensive diabetic patients in the Eastern Mediterranean region. It is recommended to placegreater emphasis on the quality of hypertension care in the management of type 2 diabetes.

Diabetes is a chronic medical condition that causes high glycaemic levels, leading to damage to vital organs over time. It is a common disease worldwide, affecting around 422 million individuals living in middle- and low-income countries, which make up most of the population. Unfortunately, diabetes results in 1.5 million deaths annually. Diabetic patients are at a higher risk for developing cardiovascular conditions. Diabetic heart disease constitutes multiple genres, including diabetic cardiomyopathy, coronary artery disease, and heart failure. Hypoglycaemic agents aim to prevent these metabolic issues however some of these are cardiotoxic in nature. In contrast, other hypoglycaemic agents work beyond controlling glycaemic levels with their cardioprotective properties. Given that there is an alarming increase in diabetic heart disease cases universally, we have attempted to review the existing data on the topic and the effects of hypoglycaemic drugs on heart diseases.

Background and objectives: Contrast agents directly cause kidney toxicity in patients undergoing Percutaneous Intervention for cardiovascular disease with Type 2 diabetes. This meta-analysis aims to evaluate the effects of SGLT2-i on renal function in individuals undergoing Percutaneous Intervention.

Methods: The databases used for the search included PubMed, Scopus, Cochrane Central Registry of Controlled Trials, and Google Scholar. We considered Randomized controlled trials and observational studies published from January 2013 to August 2023. The eligibility to include the studies was assessed independently. The Cochrane modified data extraction form, and Joanna Briggs Institute was used. The Cochrane risk of bias tool and Newcastle-Ottawa quality assessment scale were used to assess the quality of the studies. The certainty of the evidence was assessed using GradePro software.

Results: The pooled estimate showed a substantial reduction in serum creatinine levels at 48- and 72-hours post-PCI who received SGLT2i (MD -9.57; 95% CI -18.36, -0.78; p-value 0.03) and (MD -14.40; 95% CI -28.57, -0.22; p-value 0.05). There was a decrease in the incidence of the CI-AKI among SGT2i users (RR: 0.46; 95% CI: 0.32, 0.67; p value< 0.0001). There was no significant difference in the number of patients requiring hemodialysis, but a smaller number of patients required hemodialysis among the SGLT2i users (RR: 0.88; 95% CI: 0.19, 4.07; p-value = 0.87).

Conclusions: The use of SGLT2i confers substantial beneficial effects on kidney function and reduction of incidence of Contrast-induced acute kidney injury among patients undergoing PCI procedures for cardiovascular disease with diabetes.