Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy最新文献

Aim: Attenuated insulin-sensitivity (IS) is a characteristic of type 2 diabetes (T2D) and is closely linked to non-alcoholic fatty liver disease (NAFLD). In recent years, many surrogate markers of IS have emerged to predict NAFLD. A natural log transformation of the glucose disposal rate (log_e GDR) has been proposed as a new model for IS in patients with T2D. Our aim is to explore the correlation between log_e GDR and NAFLD in normoalbuminuric patients with T2D.

Methods: A total of 1227 normoalbuminuric patients with T2D were involved in our study. NAFLD was evaluated by ultrasound. Biochemical and clinical data were collected, including parameters essential for calculating the log_e GDR (triglycerides, urinary albumin-to-creatinine ratio, γ-glutamyl transferase and body mass index), as well as other relevant covariates required for adjustment. The relationship between the log_e GDR and NAFLD was analyzed.

Results: NAFLD patients showed lower log_e GDR values than non-NAFLD (P < 0.001). As the log_e GDR tertiles increased, the prevalence of NAFLD was decreased (P < 0.001). Multivariate analysis displayed that log_e GDR was independently corrected with NAFLD (OR: 0.084; 95% CI: 0.040-0.177). Furthermore, receiver operating characteristic (ROC) analysis showed that log_e GDR (area under the curves: 0.797) was superior to other evaluation variables.

Conclusion: The log_e GDR was strongly associated with NAFLD and might be a useful predictor in normoalbuminuric patients with T2D.

Objective: To evaluate the application value of STOP-Bang questionnaire (SBQ) in predicting abnormal metabolites.

Methods: Totally 121 patients were included into the study and filled the questionnaires, and their clinical data were collected at the same time. These patients were grouped according to the questionnaire scores. The clinical data of patients in various groups were compared using R4.3.1 statistical software.

Results: Based on the SBQ score, the patients were divided into the following groups: low-risk group (0-2 scores), mid-risk group (3-4 scores), and high-risk group (5-8 scores). SBQ score was related to several abnormal metabolites. A higher SBQ score indicated elevated uric acid (UA), waist circumference (WC), fasting blood glucose (FBG), hemoglobin A1c (HbA1c) and triacylglycerol (TG), but notably lower high density lipoprotein-cholesterol (HDL-C). In respect of liver function, alanine aminotransferase (ALT) and aspartate transaminase (AST) were both in low/mid-risk group than in high-risk group. With respect to renal function, there was a statistically significant difference in serum creatinine (SCr) (lowest in the low-risk group and highest in the high-risk group) but no such difference in estimated glomerular filtration rate (eGFR) among the three groups. The diagnosability analysis showed that the AUROC proved the good performance of SBQ in predicting metabolic syndrome (MetS) and hyperuricemia (HUA).

Conclusion: OSA frequently co-occurs with various metabolic disorders. SBQ, a widely used tool for assessing the risk of OSA, may also be a potential tool for predicting the presence of metabolic diseases. A higher SBQ score indicates a heightened susceptibility to more abnormal metabolites, but SBQ is poor in predicting liver and renal functions. The patients with SBQ score ≥3 are suggested to pay a visit to the Endocrine Department and Sleep Disorders Center for a comprehensive evaluation of comorbid Obstructive sleep apnea (OSA) and the management of systematic metabolism.

Purpose: Imeglimin is a novel oral antidiabetic agent that improves glucose tolerance. This study aimed to investigate the efficacy of combining imeglimin with dipeptidyl peptidase-4 inhibitor (DPP-4i), the most frequently prescribed first-line treatment for patients with type 2 diabetes (T2D) in Japan, to improve glycemic control.

Patients and methods: Eleven patients with T2D treated with DPP-4i alone (6.5% ≤ hemoglobin A1C [HbA1c] < 10%) received 1000 mg imeglimin twice daily for 16 weeks. A meal tolerance test (MTT) was conducted on seven of these patients to assess parameters associated with islet function or insulin tolerance, such as homeostasis model assessment (HOMA)-β-cell function (HOMA-β), HOMA-insulin resistance (HOMA-IR), C-peptide immunoreactivity (CPR) index, and glucagon kinetics. Continuous glucose monitoring was conducted to evaluate parameters for glycemic variability.

Results: Sixteen weeks after imeglimin administration, the HbA1c level improved from 7.5%±1.3% to 6.5%±0.5% (p < 0.05), the casual blood glucose level significantly improved from 168.2±55.4 to 127.8±20.0 mg/dL (p=0.027), time in range increased from 65.0%±0.34% to 90.0%±0.08% (p < 0.05), and time above range reduced from 34.0%±0.034% to 9.0%±0.08% (p < 0.05). During MTT, we observed significantly reduced area under the curve (AUC)0-180 glucose, increased AUC0-180 CPR/AUC0-180 glucose, CPR index, and HOMA-β (p<0.05). HOMA-IR and glucagon kinetics did not change with the addition of imeglimin.

Conclusion: The addition of imeglimin to DPP-4i significantly improved glycemic control and glycemic variability, based on increased glucose-induced insulin secretion, indicating its potential as a therapeutic option for patients with T2D.

With the aging of China's population and lifestyle changes, the number of patients with type 2 diabetes (T2D) has surged, posing a significant challenge to the public health system. This study explores the application and effectiveness of artificial intelligence (AI) technology in T2D management from a Chinese perspective. AI demonstrates substantial potential in personalized treatment planning, real-time monitoring and early warning, telemedicine, and health management. It not only enhances the precision and convenience of treatment but also aids in preventing and managing complications. Despite challenges in data privacy, technology popularization, standardization, and regulation, AI technology's continuous maturation and expanded application suggest its increasingly pivotal role in T2D management. In the future, through interdepartmental collaboration, policy support, and cultural adaptation, AI is poised to bring revolutionary changes to diabetes management in China and globally.

Background: Diabetes mellitus (DM) is a chronic disease that remains a global health problem with increasing prevalence, particularly in Indonesia. The presence of oral manifestations in patients with DM is influenced by changes in immune system function. Interleukin-10 (IL-10) is an inflammatory marker implicated in DM. However, no studies have investigated the differences in IL-10 levels between non-DM and DM patients with and without oral manifestations.

Objective: This study aimed to compare the serum levels of IL-10 between non-DM and DM patients with and without oral manifestations at Dr. Hasan Sadikin Hospital Bandung.

Methodology: This observational study used a cross-sectional design. A total of 88 serum samples that met the inclusion criteria were selected, consisting of 37 (42%) samples from non-DM patients, 35 (39.8%) samples from DM patients with oral manifestations, and 16 (18.2%) samples from DM patients without oral manifestations. Serum levels of IL-10 were measured using an enzyme-linked immunosorbent assay (ELISA) kit.

Results: Among the 35 DM patients with oral manifestations, xerostomia was the most common (80%). The mean serum IL-10 level was 0.93 pg/mL in non-DM patients, 0.80 pg/mL in DM patients with oral manifestations, and 1.08 pg/mL in DM patients without oral manifestations. Statistical analysis using the Kruskal-Wallis test showed a p-value of 0.008 (p ≤ 0.05), indicating a significant difference in serum levels of IL-10 between non-DM and DM patients with and without oral manifestations.

Conclusion: DM patients with oral manifestations had lower IL-10 serum levels compared to non-DM patients and DM patients without oral manifestations. These findings suggest that monitoring IL-10 levels could help identify diabetic patients at higher risk for oral complications.

Purpose: To identify the key populations for Hospital Hyperglycemia (HH) management and to assess recent trends in the management of HH.

Patients and methods: This retrospective study analyzed 1,136,092 point-of-care blood glucose (POC-BG) measurements from 40,758 patients with HH in non-intensive care unit (non-ICU) wards at Ningbo No.2 hospital from January 2020 to December 2022. We compared glucose monitoring and management across varying years, age groups, and hospital departments.

Results: The overall incidence of HH was 16.87%. From 2020 to 2022, the number of patients with HH increased from 9,893 to 15,639, accompanied by a marginal improvement in average BG levels (slope difference, -8.137E-09 [CI, -8.742E-09 to -7.531E-09]; p <0.001). In the ≥80 years group, the median BG was 9.4 mmol/L, significantly higher than in other age groups (p<0.001). Hypoglycemia in this group was most frequently detected during nighttime and bedtime, with an incidence of 2.67%, significantly higher than at other times of the day (p<0.001). The daily POC-BG testing rate was significantly higher in the medical ward group than it in the surgical ward group (57.9% vs 51.7%, p<0.05). Proportions of glycemic targets days were 35.66% and 39.90% in the medical wards on day 1 and day 7, respectively (Day 7 39.90% vs Day 1 35.66%, p>0.05), and 46.16% and 45.07% in the surgical wards (Day 7 45.07% vs Day 1 46.16%, p>0.05), showing no significant improvements in glycemic control. Endocrinology consultations occurred at rates of 14.2% in the medical wards and 14.9% in the surgical wards (p>0.05).

Conclusion: Although the prevalence of HH is consistently high and the number of affected patients continues to rise, modest improvements in glycemic management have been observed. However, control among the elderly remains poor, with a notably high risk of hypoglycemia during nighttime and bedtime periods.

Background: Direct Observation of Procedural Skills (DOPS) is a clinical assessment tool that enables trainers to observe medical students' procedural abilities in real-time clinical settings. It assesses students' knowledge application, decision-making, and skill proficiency during clinical tasks.

Methods: This study modifies the DOPS to evaluate the operation of insulin pumps (PUMP) and continuous glucose monitoring systems (CGMS) in diabetes management. Key elements of the modified DOPS include 1) Knowledge Assessment: Evaluating understanding of PUMP and CGMS, including interpreting CGMS data for insulin adjustments; 2) Operational Skills: Assessing correct PUMP needle insertion, programming, and adjustments; 3) Patient Safety: Ensuring safe and aseptic procedures; 4) Feedback: Providing constructive feedback to help students improve their skills.

Results: Training through DOPS led to significant improvements in all domains, overall performance scores, and reduced execution time for each domain. Correlations between domains showed that PUMP indication scores were linked to all other domains and execution times, including re-evaluation. Communication skills and seeking assistance were crucial factors influencing other domains. Multilinear regression analysis revealed that while DOPS-CGMS (R square 1.0) fully explained performance scores, DOPS-PUMP (R square 0.984) indicated that additional personal qualities significantly impacted students' PUMP operation performance.

Conclusion: This customized DOPS form offers insights into students' abilities in managing diabetes with PUMP and CGMS, while emphasizing the need for training on both technical skills and interpersonal skills in future educational models.

Purpose: Investigate the knowledge, attitude, and practices (KAP) of type 2 diabetes patients regarding continuous glucose monitoring (CGM).

Methods: A cross-sectional study was undertaken at the First People's Hospital of Jiujiang City from Sep 20, 2023, to Dec 10, 2023.

Results: A total of 633 patients with type 2 diabetes mellitus accessed the questionnaire link. Of these, 544 patients completed the questionnaires. After data cleaning, 493 questionnaires were included in the analysis, resulting in a response rate of 86% and an effective rate of 91%. Among the 493 participants, 66.9% were male, and 70.8% reported using continuous glucose monitoring (CGM). Median scores: knowledge 17 (14, 26), attitude 34 (32, 40), and practice 20 (17, 24). Positive correlations existed between knowledge and attitude (r = 0.562, P < 0.001), knowledge and practice (r = 0.653, P < 0.001), and attitude and practice (r = 0.661, P < 0.001). Logistic regression revealed that being male, participating in diabetes education, and possessing higher knowledge and attitude scores were independently associated with positive practices. Structural equation model (SEM) showed knowledge directly influenced attitude (β = 0.538, P = 0.010) and practice (β = 0.433, P = 0.010), while attitude directly influenced practice (β = 0.450, P = 0.010). Knowledge indirectly impacted practice through its influence on attitude (β = 0.242, P = 0.010).

Conclusion: Type 2 diabetes patients exhibited insufficient knowledge but positive attitudes and practices toward CGM. Recommends educational interventions to enhance knowledge, potentially improving CGM utilization and outcomes in this population. Regular and comprehensive diabetes education should be integrated into routine clinical practice to optimize self-management and overall patient outcomes.

Purpose: Mitochondrial dysfunction mediated by c-Jun N-terminal kinase (JNK) plays an important role in lipotoxic liver injury in nonalcoholic steatohepatitis (NASH). This study aims to investigate the pharmacological mechanism of Jiangzhi Granule (JZG), a Chinese herbal formula against NASH, with a focus on its regulation of JNK signaling-mediated mitochondrial function.

Methods: Hepatocytes were induced by palmitic acid (PA) for 24 h to establish an in vitro lipotoxic model, which was simultaneously treated with either JZG or vehicle control. Male C57BL/6J mice were fed a high-fat diet (HFD) for 22 weeks and then treated with JZG via gavage for additional 8 weeks. Lipotoxic injury in hepatocytes or mice liver tissues, as well as JNK signaling-related molecules, were further investigated.

Results: JZG improved PA-induced lipid deposition, cell viability, apoptosis, and mitochondrial dysfunction in hepatocytes. In NASH mice, JZG reduced hepatosteatosis, and inflammatory infiltration, and improved mitochondrial morphology and quantity in liver tissues. Additionally, elevated phosphorylation ratio of non-receptor tyrosine kinase c-Src (Src) and reduced phosphorylation ratio of JNK and SH2-containing protein tyrosine phosphatase (SHP-1) were found in both hepatocytes and mice liver tissues treated with JZG versus those with the vehicle.

Conclusion: Taken together, JZG could improve mitochondrial dysfunction and reduce lipotoxic liver injury in NASH in vivo and in vitro models. The inhibition of the JNK signaling pathway may contribute to the underlying mechanism of JZG in preventing and reversing NASH development.