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

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.

Purpose: This study aims to analyze the impact of serum C-peptide levels in patients with newly diagnosed type 2 diabetes (T2DM) on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD).

Patients and methods: A total of 1923 patients with newly diagnosed T2DM were selected and categorized into four groups based on the interquartile range of fasting C-peptide (FCP) levels: Q1 group (FCP≤0.568 ng/mL), Q2 group (0.568 < FCP≤0.751 ng/mL), Q3 group (0.751 < FCP≤0.980 ng/mL), and Q4 group (FCP > 0.980 ng/mL). Clinical data were collected, and the China-PAR model was employed to evaluate the risk score of ASCVD within 10 years. Additionally, the correlation between FCP levels and the risk of ASCVD was analyzed.

Results: As the quartiles of FCP increased, the 10-year ASCVD risk exhibited a gradual increase. The risk score in the FCP > 0.980 ng/mL group was significantly higher than that in the other groups, with noted differences related to gender and weight. Multiple linear regression analysis indicated that, even after adjusting for confounding factors such as gender, age, body mass index (BMI), and glycosylated hemoglobin, FCP levels remained a positive predictor of the 10-year ASCVD risk.

Conclusion: High FCP levels are identified as a risk factor for ASCVD within 10 years in patients with newly diagnosed T2DM.

Objective: To explore the efficacy and safety of intermittent use of flash glucose monitoring (FGM) for improving glycemic control in Chinese elderly patients with type 2 diabetes mellitus (T2DM).

Methods: This is a prospective observational study involving patients with T2DM aged ≥60 years. The study period spans 12 weeks, with participants wearing FGM at weeks 0, 5, and 10. Participants were divided into two subgroups based on HbA1c at enrollment: < 7.0% and ≥7.0%. The primary outcome of the study was HbA1c level. Secondary outcomes included time in range (3.9-10mmol/L) (TIR), time below range (<3.9mmol/L) (TBR), time above range (>10.0mmol/L) (TAR), and glycemic variability (GV).

Results: A total of 68 patients completed the 12-week FGM follow-up (age 67.9 ± 5.2 years; BMI 25.4 ± 3.3kg/m²). Overall findings revealed that compared to baseline, HbA1c decreased from 7.81 ± 1.25% to 7.44±1.10% after 12 weeks of intermittent wearing of FGM (p <0.001). In the subgroup analysis with HbA1c ≥7.0%, the results showed a significant reduction in HbA1c of 0.51mmol/L after 12 weeks (8.36 ± 0.95% vs 7.75 ± 0.97%, p < 0.001). And there was a significant reduction in TBR in the subgroup with HbA1c < 7% (p = 0.028). Multiple linear regression analysis showed that the baseline HbA1c (β = -0.529, P<0.001), duration of T2DM (β = 0.341, P = 0.001), and the frequency of sensor use (β = -0.269, P = 0.043) were associated with the reduction in HbA1c level.

Conclusion: Intermittent use of FGM is associated with an improvement in glycemic outcomes and reduces the risk of hypoglycemia in Chinese elderly patients with T2DM.

Background: Morin is a flavonol with beneficial effects on diabetic-related injuries. However, the effect of morin on diabetic cardiomyopathy and its association with autophagy, apoptosis, inflammation, and oxidative stress remains unclear. The current study aimed to reveal the mechanisms underlying morin-mediated protection against cardiac failure in diabetic rats.

Methods: Diabetic cardiomyopathy in albino Wistar rats was induced by streptozotocin (STZ). After treatment with a dose of 25, 50, and 100 mg/kg/day orally for the next 60 days, autophagic (p62, LC3, and BECN1), apoptotic (BCL2, CASP-3, and CASP9), inflammatory (IL-1β, IL-6, TNF-α), and oxidative stress (CAT, SOD, and MDA) markers in protein and gene levels as well as cardiac function tests were measured.

Results: The findings revealed that long-term morin treatment improved weight gain, lipid and glycemic profile, hypertension, and cardiac hypertrophy and fibrosis in diabetic rats compared to controls (p-value<0.001). Moreover, the upregulation of BCL-2, LC3, and BECN1 along with the downregulation of p62, CASP-3, and CASP-9 revealed that morin suppressed apoptosis and promoted autophagy in the cardiac tissue of rats with diabetes (p-value<0.05). Additionally, the reduction in IL-1β, IL-6, TNF-α, and MDA levels and the increment of SOD and CAT activity suggested that morin decreased inflammation and apoptosis in the heart of the rat models of diabetes (p-value<0.01).

Conclusion: These results may highlight the potential properties of morin as a therapeutic strategy for diabetic cardiomyopathy.

Purpose: Coronary artery stenosis caused by atherogenesis is a major pathological link in coronary heart disease (CHD), which is a leading cause of global morbidity and mortality. Junctional adhesion molecule C (JAM-C) presents more and more association with atherosclerosis. However, no studies have shown the relationship between soluble JAM-C (sJAM-C) and the degree of coronary artery stenosis. This study aimed to analyze the effect of sJAM-C on coronary artery stenosis and to verify whether sJAM-C could be a biomarker for coronary artery stenosis.

Patients and methods: The participants registered at the Beijing Luhe Hospital, Capital Medical University in the cross-sectional study. A total of 121 patients without coronary stenosis and 408 patients with coronary artery stenosis were enrolled after matching age and sex. Demographic information, medication history, and laboratory data were collected. The level of serum sJAM-C was detected by enzyme-linked immunosorbent assay (ELISA) kits. We used the logistic regression model to evaluate the association between sJAM-C and coronary artery stenosis. Furthermore, the receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the diagnostic value of sJAM-C on coronary artery stenosis.

Results: The serum level of sJAM-C was remarkably higher in patients with coronary artery stenosis than those without stenosis (p < 0.0001). Logistic regression models showed that there were positive association between serum sJAM-C level and coronary artery stenosis after adjustment, with corresponding ORs were 3.088 (95% CI 1.922-4.960, p < 0.0001). And the ROC curve revealed a sensitivity of 65.7% and specificity of 60.3% with AUC of 0.676 (95% CI 0.622-0.730) for the diagnosis of coronary artery stenosis with serum sJAM-C at a cut-off value of 18.1 pg/mL, indicating a certain diagnostic value.

Conclusion: In summary, higher serum sJAM-C level was possibly associated with the more severe coronary artery stenosis. Additionally, sJAM-C demonstrates a certain diagnostic value of coronary artery stenosis. These findings suggest sJAM-C may be a biomarker for coronary artery stenosis.