Current Diabetes Reports最新文献

Purpose of review: To provide an update on diabetes management during labour and delivery in women with type 1 diabetes with focus on appropriate insulin administration, carbohydrate supply and use of diabetes technology to support safe delivery and neonatal well-being.

Recent findings: During active labour and elective cesarean section capillary blood glucose monitoring or continuous glucose monitoring at least hourly is recommended. Infusion with isotonic (5%) glucose can be given with adjustable infusion rate to address maternal carbohydrate requirements and to prevent maternal hypoglycemia. Subcutaneous insulin administration with multiple injections or insulin pump therapy is considered at least as safe and efficient as intravenous administration to obtain tight glycemic targets. Automated insulin delivery via insulin pump can be continued during labour and delivery. Diabetes management during labour and delivery involves intensive glucose monitoring, adequate insulin administration and carbohydrate administration to support safe delivery and neonatal well-being.

Purpose of review: This review explores the role of the endocannabinoid system (ECS) in regulating energy balance, food intake, and metabolism, with a focus on how ECS dysregulation contributes to obesity. The goal is to provide insights into the mechanisms underlying obesity and its associated metabolic disorders.

Recent findings: Recent research indicates that the ECS significantly influences food intake, fat storage, insulin sensitivity, and inflammation, all of which are central to the development and progression of obesity. New research areas include the interaction between the ECS and gut microbiota, circadian rhythms of the ECS, and the impact of genetic and epigenetic factors on ECS function. Interest in the therapeutic potential of targeting the ECS has grown, with earlier treatments like CB1 receptor antagonists showing mixed results in efficacy and safety. Evidence from both animal and human studies highlight the impact of elevated levels of the endocannabinoids anandamide and 2-AG on food intake, insulin resistance, visceral fat accumulation, and metabolic disturbances associated with obesity. The review explores the interaction between the ECS and other physiological systems, including gut-brain communication, circadian rhythms, as well as leptin and ghrelin signaling. Additionally, genetic and epigenetic factors influencing ECS function are examined, emphasizing their contribution to obesity susceptibility. While therapeutic approaches targeting the ECS, particularly CB1 receptor antagonism, have shown potential in managing obesity, the review acknowledges the challenges posed by central nervous system side effects in earlier treatments like rimonabant. However, recent advancements in peripherally restricted CB1 antagonists offer renewed hope for safer and more effective obesity treatments. The review concludes by addressing future research directions and therapeutic strategies to combat this global health challenge.

Purpose of review: Provide a concise update on metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), as well as a practical approach to screening and initial evaluation.

Recent findings: Nomenclature changes have placed a greater focus on cardiometabolic risk factors in the definition of MASLD. Screening for MASLD is by stepwise noninvasive serum and imaging tests which can identify patients at risk for advanced fibrosis and liver-related complications. MASLD has been increasing in prevalence and disease burden but is underrecognized in primary care and endocrinology clinics. Multiple society guidelines, synthesized here, provide a framework for the initial approach in the diagnosis and evaluation of MASLD. Recent advances in pharmacologic treatment underline the importance of screening for patients who are at risk for advanced fibrosis as they are most likely to benefit from new drug classes, such as the liver-directed thyroid receptor agonist resmiterom.

Purpose of review: Supplementation of nicotinamide mononucleotides (NMN) has been claimed to improve metabolic function. We reviewed human randomised controlled trials (RCTs) of NMN to evaluate its effect on markers of glucose and lipid metabolism.

Recent findings: Eight RCTs on NMN (dosage ranged 250-2000 mg/d for a duration of 14 days to 12 weeks) involving a total of 342 middle-age/older adults (49% females, mainly non-diabetic) reporting at least one outcome on glucose control or lipid profile published in 2021-2023 were reviewed. The random-effects meta-analyses indicated no significant benefit of NMN on fasting glucose, fasting insulin, glycated hemoglobin, homeostatic model assessment for insulin resistance and lipid profile. Based on the small number of RCTs involving mainly relatively healthy adults, short-term supplementation of NMN of 250-2000 mg/d did not show significantly positive impacts on glucose control and lipid profile.

Purpose of review: The aim of this review is to provide an updated commentary on the current literature examining the impact of normal weight obesity (NWO) and normal weight central obesity (NWCO) on type 2 diabetes mellitus in adults.

Recent findings: Total 14 studies were included, comprising 9 cross-sectional and 5 cohort studies with 334,438 subjects. The quality of evidence was mixed. The pooled prevalence of NWO was 16.1% (95% CI: 12.7-19.4) and NWCO was 21.1% (95% CI: 12.2-30.1). The prevalence of NWO and NWCO higher in females and non-Asians. This review also showed that type 2 diabetes was significantly associated with NWO and NWCO (pooled OR: 1.82 [1.62, 2.04], p < 0.01, I2 = 64%). Subgroup analyses revealed consistent relationships between type 2 diabetes and NWO/NWCO across sex, region and definition approach. There was a relative high prevalence of NWO and NWCO, particularly in females and non-Asian populations. There was a consistent association of NWO/NWCO with type 2 diabetes. Implications for future research to guide intervention optimization in clinical practice and public health promotion are provided.

Purpose of review: To review the evidence on the relationship between daytime napping and obesity.

Recent findings: There is concern that napping may be harmful to metabolic health. Prospective studies have shown long time daytime napping (> 1 h) is associated with increased diabetes risk which may be partly associated with obesity. Evidence from numerous cross-sectional studies and meta-analyses of cross-sectional studies have shown that long time napping (> 1 h) but not short time napping is associated with increased risk of obesity, and this is seen worldwide. Inference regarding the nature of association from cross-sectional studies is limited; it is suggested the association is bidirectional. Prospective studies on the association between daytime napping and obesity are few and results unclear. Large longitudinal studies integrating daytime napping duration and night-time sleep behaviour and detailed information on lifestyle influences is needed to help elucidate further the associations of long time napping with obesity.

Purpose of review: This scoping review aimed to identify implementation science (IS) research in pediatric diabetes, report integration of IS theory and terminology, and offer guidance for future research.

Recent findings: Of 23 papers identified, 19 were published since 2017 and 21 focused on type 1 diabetes. Most involved medical evidence-based practices (EBPs; n = 15), whereas fewer focused on psychosocial (n = 7) and diabetes education (n = 2). The majority either identified barriers and facilitators of implementing an EBP (n = 11) or were implementation trials (n = 11). Fewer studies documented gaps in EBP implementation in standard care (n = 7) or development of implementation strategies (n = 1). Five papers employed IS theories and two aimed to improve equity. There is a paucity of IS research in pediatric diabetes care literature. Few papers employed IS theory, used consistent IS terminology, or described IS strategies or outcomes. Guidance for future research to improve IS research in pediatric diabetes is offered.

Purpose of review: To explore the impact of digitally-enabled peer support interventions on diabetes distress and depression for individuals living with Type 1 Diabetes (T1D).

Recent findings: We synthesized the results of nine key studies from a review of 3,623 English-language articles published between January 2012 and January 2024. Three studies demonstrated significant reductions in diabetes distress, and two studies reported reductions in depression. Data were analyzed using a narrative approach, including thematic synthesis. This process was structured around the Behavior Change Wheel framework Effective interventions shared several common features such as (1) involved participatory development approaches, (2) included diabetes education, (3) lasted over a longer time, (4) designed with a psychological framework, and (5) utilized peer mentors. Studies showed that digitally-enabled peer support has the potential to improve diabetes distress and depression among people living with T1D despite heterogeneity in intervention approaches. Moreover, designing interventions with certain features may enhance key psychosocial outcomes.

Purpose of review: While preliminary evidence for use of real-time continuous glucose monitoring (rtCGM) in the hospital setting is encouraging, challenges with currently available devices and technology will need to be overcome as part of real-world integration. This paper reviews the current evidence and guidelines regarding use of rtCGM in the hospital and suggests a practical approach to implementation.

Recent findings: There is now a considerable body of real-world evidence on the benefits of reducing dysglycemia in the hospital using both traditional point-of-care (POC) glucose testing and rtCGM. Benefits of rtCGM include decreased frequency of hypo- and hyperglycemia with reduced need of frequent POC checks and it is both feasible and well-accepted by nursing staff and providers. If expansion to additional sites is to be considered, practical solutions will need to be offered. Recommendations for an operational workflow and tools are described to guide implementation in the non-ICU setting. Further testing in randomized controlled trials and real-world dissemination and implementation designs is needed, together with industry and technology collaborations, to further streamline the integration into health systems.