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

Background: This study sought to explore the interrelationship between diabetes-related distress, patient evaluations of chronic illness management, and self-management practices among older adults diagnosed with T2DM and associated chronic complications.

Methods: This was a cross-sectional study including 264 older adults with T2DM in Shanghai, China. Chinese version of Problem Areas in Diabetes Scale (PAID-C), Patient Assessment of Chronic Illness Care (PACIC) and Diabetes Self-Management Behaviour for Older (DSMB-O) were employed. Student's t-test, one-way ANOVA or the nonparametric analysis (Mann-Whitney U-test), Pearson correlation coefficient and structural equation model (SEM) were used to analyse the data.

Results: A total of 264 participants (157 males [59.47%], with an average age of 71.07±6.47 years) were included in the study; their duration of T2DM ranged from 5 to 30 years, with a mean duration of 11.19±6.96 years. The DSMB-O scores exhibited a negative correlation with the PAID-C scores (r=-0.250, p<0.01), while showing a positive correlation with PACIC scores (r=0.348, p<0.01). Additionally, PAID-C scores demonstrated a negative correlation with PACIC scores (r=-0.182, p<0.01). The indirect effect of PAID-C on DSMB-O through PACIC was calculated as (-0.70*-0.39=0.27). Furthermore, the total effect of PAID-C on DSMB-O via PACIC was determined to be (0.27+0.22=0.49). Notably, the mediating effect accounted for 54.99%.

Conclusion: Psychological distress is intricately linked to self-management behaviour among elderly patients suffering from T2DM and chronic complications. Our findings carry significant implications for T2DM healthcare, indicating that addressing psychological distress may enhance the quality of chronic illnesses, ultimately fostering improved self-management practices and yielding better health outcomes.

Background/objective: Considering the uncertain relationship between high-density lipoprotein cholesterol (HDL-C) and uric acid (UA) with diabetic retinopathy (DR),this study investigates the link between Uric Acid to High-Density Lipoprotein Cholesterol (UHR) and DR in T2DM patients, evaluating its potential for DR diagnosis and early prediction.

Study design and data collection: This retrospective study analyzed 1450 type 2 diabetes patients, divided into NDR and DR groups by retinal exams. We gathered demographic and clinical data, calculated UHR, and explored its correlation with DR development.

Outcomes: Individuals diagnosed with diabetic retinopathy (DR) exhibited a markedly elevated uric acid to high-density lipoprotein cholesterol (UHR) ratio when contrasted with those without DR (NDR), achieving statistical significance with a P-value below 0.001. The Mantel-Haenszel chi-square test for linear association validated a pronounced positive correlation between the UHR ratio and the incidence of DR (P<0.001). Binary logistic regression analysis revealed that age, glycated hemoglobin (HbA1c), uric acid (UA), high-density lipoprotein cholesterol (HDL-C), and the UHR ratio were all independent risk factors for the development of DR in patients with type 2 diabetes. Furthermore, the receiver operating characteristic (ROC) curve analysis indicated that the UHR ratio was the most precise predictor for diagnosing DR, with an area under the ROC curve (AUC) of 78.4%, a sensitivity of 87%, and a specificity of 60.6%.

Conclusion: Our research has found that the UHR ratio is an independent risk factor for diabetic retinopathy (DR) in patients with type 2 diabetes and can serve as a readily available indicator that takes into account both metabolic status and inflammatory status for the early detection of DR.

Purpose: Readmission within a period time of discharge is common and costly. Diabetic patients are at risk of readmission because of comorbidities and complications. It is crucial to monitor patients with diabetes with risk factors for readmission and provide them with target suggestions. We aim to develop a nomogram to predict the risk of readmission within 90 days of discharge in diabetic patients.

Patients and methods: This is a prospective observational survey. A total of 784 adult patients with diabetes recruited in two tertiary hospitals in central China were randomly assigned to a training set or a validation set at a ratio of 7:3. Depression, anxiety, self-care, physical activity, and sedentary behavior were assessed during hospitalization. A 90-day follow-up was conducted after discharge. Multivariate logistic regression was employed to develop a nomogram, which was validated with the use of a validation set. The AUC, calibration plot, and clinical decision curve were used to assess the discrimination, calibration, and clinical usefulness of the nomogram, respectively.

Results: In this study, the 90-day readmission rate in our study population was 18.6%. Predictors in the final nomogram were previous admissions within 1 year of the index admission, self-care scores, anxiety scores, physical activity, and complicating with lower extremity vasculopathy. The AUC values of the predictive model and the validation set were 0.905 (95% CI=0.874-0.936) and 0.882 (95% CI=0.816-0.947). Hosmer-Lemeshow test values were p = 0.604 and p = 0.308 (both > 0.05). Calibration curves showed significant agreement between the nomogram model and actual observations. Decision curve analysis indicated that the nomogram improved the clinical net benefit within a probability threshold of 0.02-0.96.

Conclusion: The nomogram constructed in this study was a convenient tool to evaluate the risk of 90-day readmission in patients with diabetes and contributed to clinicians screening the high-risk populations.

Purpose: To investigate the relationship between serum uric acid (SUA) levels and femoral neck bone mineral density (BMD) in patients with metabolic dysfunction-associated fatty liver disease (MAFLD).

Patients and methods: This cross-sectional study included 597 adult inpatients with type 2 diabetes mellitus and ultrasonography-confirmed fatty liver disease. Participants were stratified into tertiles based on femoral neck BMD. Gender-stratified linear regression analyses were performed to assess the relationship between SUA and femoral neck BMD. Nonlinear associations were explored using generalized additive models and two-piece linear regression.

Results: No significant linear association was observed between SUA and femoral neck BMD in either gender (all P > 0.05). However, after adjusting for confounders, a nonlinear relationship was identified in male patients, with a threshold at 388 μmol/L. The effect sizes for SUA levels below and above this threshold were 0.001 (95% CI: 0.000 to 0.002, P = 0.008) and -0.000 (95% CI: -0.002 to 0.000, P = 0.117), respectively. No nonlinear relationship was observed in female patients.

Conclusion: In male MAFLD patients, SUA levels exhibit a nonlinear relationship with femoral neck BMD, with a positive association observed between 300 μmol/L and 388 μmol/L. This relationship was not observed in female patients, suggesting gender-specific effects of SUA on bone health in MAFLD.

Diabetes mellitus (DM) is recognized and classified as a group of conditions marked by persistent high blood glucose levels. It is also an inflammatory condition that may influence concurrent disease states, including Coronavirus Disease 2019 (COVID-19). Currently, no effective drug has been found to treat COVID-19, especially in DM patients. Many herbal medicines, such as the well-known Andrographis paniculata, have been explored as drugs and complementary therapies due to their antidiabetic, antibacterial, antiviral, anti-inflammatory, and immunomodulatory effects. This study aimed to examine the potential of herbal medicines as complementary therapy in DM patients with COVID-19 complications, drawing from in-vitro and in-vivo investigations. This study analyzed articles published within the last 15 years using keywords including "herbal medicines", "COVID-19", "Diabetes Mellitus", "antidiabetics", "antiviral", and "anti-inflammatory". The results showed that several herbal medicines could serve as complementary therapy for DM patients with COVID-19 complications. These include Andrographis paniculata, Ageratum conyzoides, Artocarpus altilis, Centella asiatica, Momordica charantia, Persea gratissima, Phyllanthus urinaria, Physalis angulata, Tinospora cordifolia, and Zingiber zerumbet. Herbal medicines may serve as a complementary therapy for DM patients with COVID-19, but these claims need experimental validation in infection models and among affected patients.

Objective: To investigate the relationship between triglyceride-glucose (TyG) index and metabolic-associated fatty liver disease (MAFLD), and to evaluate the predictive value of the TyG index for MAFLD in individuals with different metabolic obese phenotypes. The aim is to provide a novel approach for the screening and early diagnosis of MAFLD in the general population.

Methods: A total of 2614 subjects were recruited and classified into four categories of metabolic obese phenotypes based on their body mass index (BMI) and metabolic status. Basic data and general blood indices were collected and analyzed. The TyG index was calculated, and an abdominal ultrasound was performed to detect the presence of fatty liver disease. The aforementioned data were then subjected to statistical analysis.

Results: The TyG index was significantly higher in the MAFLD group than in the non-MAFLD group (P < 0.001). Furthermore, the TyG index in the metabolically unhealthy and obese (MUO) group and the metabolically unhealthy normal weight (MUNW) group was significantly higher than that in the metabolically healthy and obese (MHO) group and the metabolically healthy normal weight (MHNW) group (P < 0.001). The area under the curve (AUC) of the TyG index for predicting MAFLD in the MHNW, MUNW, MHO, and MUO groups was 0.765, 0.766, 0.659, and 0.650, respectively. The critical values were 8.575, 9.075, 8.795, and 9.165, respectively.

Conclusion: The TyG index is a reliable predictor of MAFLD risk, exhibiting a higher predictive ability for the risk of developing MAFLD in individuals with normal BMI compared to those with abnormal BMI. The findings of this study lend support for the use of the TyG index as a screening tool and for guiding subsequent management of patients with MAFLD.

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.