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All-Cause Mortality and Cardiovascular and Microvascular Diseases in Latent Autoimmune Diabetes in Adults. 成人潜在自身免疫性糖尿病的全因死亡率与心血管和微血管疾病。
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc23-0739
Yuxia Wei, Katharina Herzog, Emma Ahlqvist, Tomas Andersson, Thomas Nyström, Yiqiang Zhan, Tiinamaija Tuomi, Sofia Carlsson

Objective: Latent autoimmune diabetes in adults (LADA) is a heterogenous, slowly progressing autoimmune diabetes. We aim to contribute new knowledge on the long-term prognosis of LADA with varying degrees of autoimmunity by comparing it to type 2 diabetes and adult-onset type 1 diabetes.

Research design and methods: This Swedish population-based study included newly diagnosed LADA (n = 550, stratified into LADAlow and LADAhigh by median autoimmunity level), type 2 diabetes (n = 2,001), adult-onset type 1 diabetes (n = 1,573), and control subjects without diabetes (n = 2,355) in 2007-2019. Register linkages provided information on all-cause mortality, cardiovascular diseases (CVDs), diabetic retinopathy, nephropathy, and clinical characteristics during follow-up.

Results: Mortality was higher in LADA (hazard ratio [HR] 1.44; 95% CI 1.03, 2.02), type 1 (2.31 [1.75, 3.05]), and type 2 diabetes (1.31 [1.03, 1.67]) than in control subjects. CVD incidence was elevated in LADAhigh (HR 1.67; 95% CI 1.04, 2.69) and type 2 diabetes (1.53 [1.17, 2.00]), but not in LADAlow or type 1 diabetes. Incidence of retinopathy but not nephropathy was higher in LADA (HR 2.25; 95% CI 1.64, 3.09), including LADAhigh and LADAlow than in type 2 diabetes (unavailable in type 1 diabetes). More favorable blood pressure and lipid profiles, but higher HbA1c levels, were seen in LADA than type 2 diabetes at baseline and throughout follow-up, especially in LADAhigh, which resembled type 1 diabetes in this respect.

Conclusions: Despite having fewer metabolic risk factors than type 2 diabetes, LADA has equal to higher risks of death, CVD, and retinopathy. Poorer glycemic control, particularly in LADAhigh, highlights the need for improved LADA management.

目的:成人潜伏性自身免疫性糖尿病(LADA)是一种异质性、进展缓慢的自身免疫型糖尿病。我们的目的是通过将具有不同程度自身免疫的LADA与2型糖尿病和成人发病的1型糖尿病进行比较,为其长期预后提供新的知识。研究设计和方法:这项基于瑞典人群的研究纳入了2007-2019年新诊断的LADA(n=550,按自身免疫水平中位数分为LADAlow和LADAhigh)、2型糖尿病(n=2001)、成人发病的1型糖尿病(n=1573)和无糖尿病的对照受试者(n=2355)。注册链接提供了全因死亡率、心血管疾病(CVD)、糖尿病视网膜病变、肾病和随访期间临床特征的信息。结果:LADA(危险比[HR]1.44;95%CI 1.03,2.02)、1型糖尿病(2.31[1.75,3.05])和2型糖尿病(1.31[1.03,1.67])的死亡率高于对照组。LADAIHgh(HR 1.67;95%CI 1.04,2.69)和2型糖尿病(1.53[1.17,2.00])的CVD发病率升高,但LADAlow或1型糖尿病的CVD发病没有升高。LADA(包括LADAihgh和LADAlow)的视网膜病变而非肾病的发生率高于2型糖尿病(1型糖尿病不可用)(HR 2.25;95%CI 1.64,3.09)。在基线和整个随访过程中,LADA的血压和血脂状况比2型糖尿病更有利,但HbA1c水平更高,尤其是在LADAhigh,在这方面与1型糖尿病相似。结论:尽管LADA的代谢危险因素比2型糖尿病少,但其死亡、CVD和视网膜病变的风险相当高。血糖控制较差,尤其是在LADAhigh,突出了改善LADA管理的必要性。
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引用次数: 0
Leisure-Time Physical Activity and Risk of Microvascular Complications in Individuals With Type 2 Diabetes: A UK Biobank Study. 2型糖尿病患者闲暇时间的体育活动与微血管并发症的风险:英国生物库研究。
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc23-0937
Frederik Pagh Bredahl Kristensen, Miguel Adriano Sanchez-Lastra, Knut Eirik Dalene, Borja Del Pozo Cruz, Mathias Ried-Larsen, Reimar Wernich Thomsen, Ding Ding, Ulf Ekelund, Jakob Tarp

Objective: The aim of this study was to determine dose-response associations, including the minimal effective level, between leisure-time physical activity and risk of incident neuropathy, nephropathy, and retinopathy.

Research design and methods: This cohort study included 18,092 individuals with type 2 diabetes from the UK Biobank. Self-reported leisure-time physical activity was converted into MET-hours per week. Participants were categorized into no physical activity (0 MET-h/week), below recommendations (0-7.49 MET-h/week), at recommendations (7.5-14.9 MET-h/week), and above recommendations (≥15 MET-h/week). Microvascular complications were identified from hospital inpatient records using diagnosis codes. We used Cox proportional hazards regression analysis to calculate adjusted hazard ratios (aHRs) and restricted cubic splines to identify the minimal effective level of physical activity.

Results: During a median follow-up of 12.1 years, 672 individuals (3.7%) were diagnosed with neuropathy, 1,839 (10.2%) with nephropathy, and 2,099 (11.7%) with retinopathy. Any level of physical activity was associated with a lower risk of neuropathy and nephropathy but not retinopathy. Compared with those reporting no physical activity, the aHR of neuropathy was 0.71 (95% CI 0.53, 0.90) below recommendations, 0.73 (0.56, 0.96) at recommendations, and 0.67 (0.52, 0.87) above recommendations. Corresponding aHRs for nephropathy were 0.79 (0.68, 0.92), 0.80 (0.67, 0.95), and 0.80 (0.68, 0.95). The association with retinopathy was weaker, with aHRs of 0.91 (0.78, 1.06), 0.91 (0.77, 1.08), and 0.98 (0.84, 1.15), respectively.

Conclusions: Any level of leisure-time physical activity was associated with a lower risk of neuropathy and nephropathy but not retinopathy in individuals with type 2 diabetes. For both neuropathy and nephropathy, the minimal effective physical activity level may correspond to <1.5 h of walking per week.

目的:本研究的目的是确定休闲时间体育活动与神经病变、肾病和视网膜病变发病风险之间的剂量反应相关性,包括最低有效水平。研究设计和方法:这项队列研究包括来自英国生物银行的18092名2型糖尿病患者。自我报告的休闲时间体力活动被转换为每周MET小时数。参与者被分为无体力活动(0 MET-h/周)、低于建议(0-7.49 MET-h/周)、处于建议(7.5-14.9 MET-h/每周)和高于建议(≥15 MET-h/星期)。使用诊断代码从医院住院记录中识别出微血管并发症。我们使用Cox比例风险回归分析来计算调整后的风险比(aHR),并使用限制三次样条来确定体力活动的最小有效水平。结果:在12.1年的中位随访中,672人(3.7%)被诊断为神经病变,1839人(10.2%)被确诊为肾病,2099人(11.7%)被误诊为视网膜病变。任何水平的体育活动都与神经病变和肾病的风险较低有关,但与视网膜病变无关。与那些报告没有体力活动的人相比,神经病变的aHR比建议低0.71(95%CI 0.53,0.90),比建议高0.73(0.56,0.96),比推荐高0.67(0.52,0.87)。肾病的相应aHRs分别为0.79(0.68,0.92)、0.80(0.67,0.95)和0.80(0.65,0.95)。与视网膜病变的相关性较弱,aHRs为0.91(0.78,1.06)、0.91(0.7,1.08)和0.98(0.84,1.15)。结论:在2型糖尿病患者中,任何水平的休闲体育活动都与较低的神经病变和肾病风险有关,但与视网膜病变无关。对于神经病变和肾病,最低有效体力活动水平可能对应于
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引用次数: 1
Care Management Processes Important for High-Quality Diabetes Care. 护理管理流程对高质量糖尿病护理至关重要。
IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc22-2372
Kevin A Peterson, Caroline S Carlin, Leif I Solberg, James Normington, Eric F Lock

Objective: Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes in care management processes (CMP) in primary care practices over 3 years.

Research design and methods: This repeated cross-sectional study tracked clinical performance measures for all diabetes patients seen in a cohort of 330 primary care practices in 2017 and 2019. Unit of analysis was patient-year with practice-level CMP exposures. Causal inference is based on dynamic changes in individual CMPs between years by practice. We used the Bayesian method to simultaneously estimate a five-outcome model: A1c, systolic and diastolic blood pressure, guideline-based statin use, and Optimal Diabetes Care (ODC). We control for unobserved time-invariant practice characteristics and secular change. We modeled correlation of errors across outcomes. Statistical significance was identified using 99% Bayesian credible intervals (analogous to P < 0.01).

Results: Implementation of 18 of 62 CMPs was associated with statistically significant improvements in patient outcomes. Together, these resulted in 12.1% more patients meeting ODC performance measures. Different CMPs affected different outcomes. Three CMPs accounted for 47% of the total ODC improvement, 68% of A1c decrease, 21% of SBP reduction, and 55% of statin use increase: 1) systems for identifying and reminding patients due for testing, 2) after-visit follow-up by a nonclinician, and 3) guideline-based clinician reminders for preventive services during a clinic visit.

Conclusions: Effective quality improvement in primary care focuses on practice redesign that clearly improves diabetes outcomes. Tailoring CMP adoption in primary care provides effective improvement in ODC performance through focused changes in diabetes outcomes.

目的:确定3年来初级保健实践中护理管理流程(CMP)的变化对糖尿病绩效指标和基于人群的临床结果的改善。研究设计和方法:这项重复的横断面研究跟踪了2017年和2019年330名初级保健机构队列中所有糖尿病患者的临床表现指标。分析单位为实践水平CMP暴露的患者年。因果推断是基于个体CMPs在不同年份之间的动态变化。我们使用贝叶斯方法同时估计了五个结果模型:A1c、收缩压和舒张压、基于指南的他汀类药物使用和最佳糖尿病护理(ODC)。我们控制未观察到的时间不变的实践特征和长期变化。我们对结果之间的误差相关性进行了建模。使用99%的贝叶斯可信区间确定统计学显著性(类似于P<0.01)。结果:62个CMPs中的18个CMPs的实施与患者结果的统计学显著改善相关。总之,这些结果使符合ODC绩效指标的患者增加了12.1%。不同的CMPs影响不同的结果。三种CMPs占ODC总改善的47%,A1c减少的68%,SBP减少的21%,他汀类药物使用增加的55%:1)识别和提醒应检测患者的系统,2)非临床医生的访视后随访,3)基于指南的临床医生在临床访视期间提醒预防服务。结论:有效提高初级保健质量的重点是重新设计实践,以明显改善糖尿病的结果。在初级保健中量身定制CMP的采用,通过重点改变糖尿病结果,有效改善ODC的表现。
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引用次数: 0
Change in the Relation Between Age and Cardiovascular Events Among Men and Women With Diabetes Compared With Those Without Diabetes in 1994-1999 and 2014-2019: A Population-Based Cohort Study. 1994-1999年和2014-2019年,患有糖尿病的男性和女性与未患有糖尿病的女性相比,年龄与心血管事件关系的变化:一项基于人群的队列研究。
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc23-0952
Calvin Ke, Lorraine L Lipscombe, Alanna Weisman, Limei Zhou, Peter C Austin, Baiju R Shah, Gillian L Booth
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引用次数: 2
Teplizumab: A Disease-Modifying Therapy for Type 1 Diabetes That Preserves β-Cell Function. 特普利珠单抗:一种保留β细胞功能的1型糖尿病疾病改良疗法。
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc23-0675
Kevan C Herold, Stephen E Gitelman, Peter A Gottlieb, Laura A Knecht, Ralph Raymond, Eleanor L Ramos

Objective: In November 2022, teplizumab-mzwv became the first drug approved to delay the onset of stage 3 type 1 diabetes in adults and children age ≥8 years with stage 2 type 1 diabetes on the basis of data from the pivotal study TN-10.

Research design and methods: To provide confirmatory evidence of the effects of teplizumab on preserving endogenous insulin production, an integrated analysis of C-peptide data from 609 patients (n = 375 patients receiving teplizumab and n = 234 control patients) from five clinical trials in stage 3 type 1 diabetes was conducted.

Results: The primary outcome of the integrated analysis, change from baseline in stimulated C-peptide, was significantly improved at years 1 (average increase 0.08 nmol/L; P < 0.0001) and 2 (average increase 0.12 nmol/L; P < 0.0001) after one or two courses of teplizumab. An analysis of exogenous insulin use was also conducted, showing overall reductions of 0.08 (P = 0.0001) and 0.10 units/kg/day (P < 0.0001) at years 1 and 2, respectively. An integrated safety analysis of five clinical trials that enrolled 1,018 patients with stage 2 or 3 type 1 diabetes (∼1,500 patient-years of follow-up for teplizumab-treated patients) was conducted.

Conclusions: These data confirm consistency in the preservation of β-cell function, as measured by C-peptide, across multiple clinical trials. This analysis showed that the most common adverse events included lymphopenia, rash, and headache, a majority of which occurred during and after the first few weeks of teplizumab administration and generally resolved without intervention, consistent with a safety profile characterized by self-limited adverse events after one or two courses of teplizumab treatment.

目的:2022年11月,在关键研究TN-10的数据基础上,替普利珠单抗mzvv成为首个被批准用于延迟成人和≥8岁的2型糖尿病儿童3期1型糖尿病发作的药物。研究设计和方法:为替普利珠mab在保持内源性胰岛素产生方面的作用提供验证性证据,对来自3期1型糖尿病5项临床试验的609名患者(n=375名接受替普利珠单抗治疗的患者和n=234名对照患者)的C肽数据进行了综合分析。结果:综合分析的主要结果,即刺激的C肽与基线相比的变化,在接受一个或两个疗程的替普利珠单抗治疗后的第1年(平均增加0.08 nmol/L;P<0.0001)和第2年(平均提高0.12 nmol/L,P<0.0001)显著改善。还对外源性胰岛素的使用进行了分析,结果显示,在第1年和第2年,总体胰岛素使用量分别减少了0.08(P=0.0001)和0.10单位/kg/天(P<0.0001)。对5项临床试验进行了综合安全性分析,纳入了1018名2或3期1型糖尿病患者(替普利珠单抗治疗患者的随访时间约为1500患者年)。结论:这些数据证实了在多个临床试验中,通过C肽测量的β细胞功能的保存是一致的。该分析表明,最常见的不良事件包括淋巴细胞减少、皮疹和头痛,其中大多数发生在替普利珠单抗给药的前几周期间和之后,通常在不干预的情况下解决,这与一个或两个疗程的替普利珠mab治疗后自限性不良事件的安全性特征一致。
{"title":"Teplizumab: A Disease-Modifying Therapy for Type 1 Diabetes That Preserves β-Cell Function.","authors":"Kevan C Herold, Stephen E Gitelman, Peter A Gottlieb, Laura A Knecht, Ralph Raymond, Eleanor L Ramos","doi":"10.2337/dc23-0675","DOIUrl":"10.2337/dc23-0675","url":null,"abstract":"<p><strong>Objective: </strong>In November 2022, teplizumab-mzwv became the first drug approved to delay the onset of stage 3 type 1 diabetes in adults and children age ≥8 years with stage 2 type 1 diabetes on the basis of data from the pivotal study TN-10.</p><p><strong>Research design and methods: </strong>To provide confirmatory evidence of the effects of teplizumab on preserving endogenous insulin production, an integrated analysis of C-peptide data from 609 patients (n = 375 patients receiving teplizumab and n = 234 control patients) from five clinical trials in stage 3 type 1 diabetes was conducted.</p><p><strong>Results: </strong>The primary outcome of the integrated analysis, change from baseline in stimulated C-peptide, was significantly improved at years 1 (average increase 0.08 nmol/L; P < 0.0001) and 2 (average increase 0.12 nmol/L; P < 0.0001) after one or two courses of teplizumab. An analysis of exogenous insulin use was also conducted, showing overall reductions of 0.08 (P = 0.0001) and 0.10 units/kg/day (P < 0.0001) at years 1 and 2, respectively. An integrated safety analysis of five clinical trials that enrolled 1,018 patients with stage 2 or 3 type 1 diabetes (∼1,500 patient-years of follow-up for teplizumab-treated patients) was conducted.</p><p><strong>Conclusions: </strong>These data confirm consistency in the preservation of β-cell function, as measured by C-peptide, across multiple clinical trials. This analysis showed that the most common adverse events included lymphopenia, rash, and headache, a majority of which occurred during and after the first few weeks of teplizumab administration and generally resolved without intervention, consistent with a safety profile characterized by self-limited adverse events after one or two courses of teplizumab treatment.</p>","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":" ","pages":"1848-1856"},"PeriodicalIF":16.2,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10545553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10425892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Genetic Evidence Strongly Supports Managing Weight and Blood Pressure in Addition to Glycemic Control in Preventing Vascular Complications in People With Type 2 Diabetes. 遗传证据有力地支持在控制血糖的同时控制体重和血压,以预防2型糖尿病患者的血管并发症。
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc23-0855
Altayeb Ahmed, Hasnat Amin, Fotios Drenos, Naveed Sattar, Hanieh Yaghootkar

Objective: To investigate the causal association of type 2 diabetes and its components with risk of vascular complications independent of shared risk factors obesity and hypertension and to identify the main driver of this risk.

Research design and methods: We conducted Mendelian randomization (MR) using independent genetic variants previously associated with type 2 diabetes, fasting glucose, HbA1c, fasting insulin, BMI, and systolic blood pressure as instrumental variables. We obtained summary-level data for 18 vascular diseases (15 for type 2 diabetes) from FinnGen and publicly available genome-wide association studies as our outcomes. We conducted univariable and multivariable MR, in addition to sensitivity tests to detect and minimize pleiotropic effects.

Results: Univariable MR analysis showed that type 2 diabetes was associated with 9 of 15 outcomes; BMI and systolic blood pressure were associated with 13 and 15 of 18 vascular outcomes, respectively; and fasting insulin was associated with 4 and fasting glucose with 2. No robust association was found for HbA1c instruments. With adjustment for correlated traits in the multivariable test, BMI and systolic blood pressure, consistent causal effects were maintained, while five associations with type 2 diabetes (chronic kidney disease, ischemic heart disease, heart failure, subarachnoid hemorrhage, and intracerebral hemorrhage) were attenuated to null.

Conclusions: Our findings add strong evidence to support the importance of BMI and systolic blood pressure in the development of vascular complications in people with type 2 diabetes. Such findings strongly support the need for better weight and blood pressure management in type 2 diabetes, independent of glucose lowering, to limit important complications.

目的:研究2型糖尿病及其成分与血管并发症风险的因果关系,不依赖于共同的风险因素肥胖和高血压,并确定这种风险的主要驱动因素。研究设计和方法:我们使用先前与2型糖尿病、空腹血糖、HbA1c、空腹胰岛素、BMI和收缩压相关的独立遗传变异作为工具变量进行了孟德尔随机化(MR)。我们从FinnGen获得了18种血管疾病(15种为2型糖尿病)的汇总数据,并将公开的全基因组关联研究作为我们的结果。除了灵敏度测试外,我们还进行了单变量和多变量MR,以检测并最大限度地减少多效性影响。结果:单变量MR分析显示,2型糖尿病与15种结果中的9种相关;BMI和收缩压分别与18种血管结果中的13种和15种相关;空腹胰岛素与4相关,空腹血糖与2相关。HbA1c检测仪之间没有发现强有力的相关性。通过调整多变量测试中的相关特征,BMI和收缩压,保持了一致的因果效应,而与2型糖尿病的五种关联(慢性肾脏疾病、缺血性心脏病、心力衰竭、蛛网膜下腔出血和脑出血)被减弱为零。结论:我们的研究结果为支持BMI和收缩压在2型糖尿病患者血管并发症发生中的重要性提供了有力的证据。这些发现有力地支持了对2型糖尿病进行更好的体重和血压管理的必要性,而不依赖于血糖降低,以限制重要的并发症。
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引用次数: 0
HLA Genotype and Probiotics Modify the Association Between Timing of Solid Food Introduction and Islet Autoimmunity in the TEDDY Study. 在TEDDY研究中,HLA基因型和益生菌改变了固体食物引入时间与胰岛自身免疫之间的关系。
IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc23-0417
Ulla Uusitalo, Lazarus K Mramba, Carin Andrén Aronsson, Kendra Vehik, Jimin Yang, Sandra Hummel, Åke Lernmark, Marian Rewers, William Hagopian, Richard McIndoe, Jorma Toppari, Anette-G Ziegler, Beena Akolkar, Jeffrey P Krischer, Suvi M Virtanen, Jill M Norris

Objective: To study the interaction among HLA genotype, early probiotic exposure, and timing of complementary foods in relation to risk of islet autoimmunity (IA).

Research design and methods: The Environmental Determinants of Diabetes in the Young (TEDDY) study prospectively follows 8,676 children with increased genetic risk of type 1 diabetes. We used a Cox proportional hazards regression model adjusting for potential confounders to study early feeding and the risk of IA in a sample of 7,770 children.

Results: Any solid food introduced early (<6 months) was associated with increased risk of IA if the child had the HLA DR3/4 genotype and no probiotic exposure during the 1st year of life. Rice introduced at 4-5.9 months compared with later in the U.S. was associated with an increased risk of IA.

Conclusions: Timing of solid food introduction, including rice, may be associated with IA in children with the HLA DR3/4 genotype not exposed to probiotics. The microbiome composition under these exposure combinations requires further study.

目的:研究HLA基因型、早期益生菌暴露和辅食时间与胰岛自身免疫(IA)风险之间的相互作用。研究设计和方法:青年糖尿病环境决定因素(TEDDY)研究前瞻性跟踪8676名1型糖尿病遗传风险增加的儿童。我们使用Cox比例风险回归模型对潜在的混杂因素进行了调整,以研究7770名儿童的早期喂养和IA风险。结果:任何早期引入的固体食物(结论:HLA DR3/4基因型儿童未接触益生菌时,固体食物(包括大米)的引入时间可能与IA有关。这些接触组合下的微生物组组成需要进一步研究。
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引用次数: 0
Executive Summary: Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. 执行摘要:糖尿病诊断和管理中实验室分析的指南和建议。
IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dci23-0048
David B Sacks, Mark Arnold, George L Bakris, David E Bruns, Andrea R Horvath, Åke Lernmark, Boyd E Metzger, David M Nathan, M Sue Kirkman

Background: Numerous laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. An expert committee compiled evidence-based recommendations for laboratory analysis in patients with diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments in the full version of the guideline). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association for Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association.

Content: Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (HbA1c) in the blood. Glycemic control is monitored by the patients measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring devices and also by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring; genetic testing; and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed.

Summary: The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.

背景:许多实验室检查被用于糖尿病患者的诊断和管理。支持使用这些化验的科学证据的质量差异很大。一个专家委员会为糖尿病患者的实验室分析编制了循证建议。对证据的总体质量和建议的力度进行了评估。受邀的审查人员对协商一致意见建议草案进行了评价,并提交给公众征求意见。作者认为适当时纳入了建议(见指南全文中的致谢部分)。该指南由循证实验室医学委员会、美国临床化学协会董事会和美国糖尿病协会专业实践委员会审查。内容:糖尿病可以通过静脉血浆中葡萄糖浓度升高或血液中血红蛋白A1c(HbA1c)升高来诊断。血糖控制是通过患者用血糖仪和/或连续间质血糖监测设备测量自己的血糖以及通过HbA1c的实验室分析来监测的。无创血糖监测的潜在作用;基因检测;以及酮、自身抗体、尿白蛋白、胰岛素、胰岛素原和C-肽的测量。摘要:准则根据公布的数据或根据专家共识提出了具体建议。目前发现几种分析物的临床价值很低,不建议对其进行测量。
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引用次数: 0
Real-world Accuracy of CGM in Inpatient Critical and Noncritical Care Settings at a Safety-Net Hospital. 安全网医院住院患者重症和非重症护理环境中CGM的真实世界准确性。
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc23-0089
Erin Finn, Lindsay Schlichting, Laura Grau, Ivor S Douglas, Rocio I Pereira

Objective: We sought to determine real-world accuracy of inpatient continuous glucose monitoring (CGM) at multiple levels of acuity in a large safety-net hospital.

Research design and methods: We analyzed records from hospitalized patients on Dexcom G6 CGM, including clinical, point of care (POC), and laboratory (Lab) glucose, and CGM data. POC/Lab values were matched to the closest timed CGM value. Encounters were divided into not critically ill (NCI) versus critically ill (CI). CGM accuracy was evaluated.

Results: Paired readings (2,744 POC-CGM; 3,705 Lab-CGM) were analyzed for 233 patients with 239 encounters (83 NCI, 156 CI). POC-CGM aggregated and average mean absolute relative differences (MARD) were 15.1% and 17.1%. Lab-CGM aggregated and average MARDs were 11.4% and 12.2%. Accuracy for POC-CGM and Lab-CGM was 96.5% and 99.1% in Clarke Error Grid zones A/B.

Conclusions: Real-world accuracy of inpatient CGM is acceptable for NCI and CI patients. Further exploration of conditions associated with lower CGM accuracy in real-world settings is warranted.

目的:我们试图确定在一家大型安全网医院中,在多个视力水平下住院患者连续血糖监测(CGM)的真实世界准确性。研究设计和方法:我们分析了住院患者在Dexcom G6 CGM上的记录,包括临床、护理点(POC)和实验室(实验室)葡萄糖以及CGM数据。POC/Lab值与最接近的定时CGM值相匹配。接触分为非危重症(NCI)和危重症(CI)。评估CGM的准确性。结果:对233名患者239次接触(83 NCI,156 CI)的配对读数(2744 POC-CGM;3705 Lab CGM)进行了分析。在Clarke误差网格区A/B中,POC-CGM的累计和平均绝对相对差(MARD)分别为15.1%和17.1%。实验室CGM的合计和平均MARD分别为11.4%和12.2%。结论:住院患者CGM的真实世界准确性对于NCI和CI患者是可接受的。有必要在现实世界环境中进一步探索与较低CGM精度相关的条件。
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引用次数: 0
Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study. 成人1型糖尿病和糖化血红蛋白高于目标的混合闭环治疗:一项真实世界的观察研究。
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-10-01 DOI: 10.2337/dc23-0635
Thomas S J Crabtree, Tomás P Griffin, Yew W Yap, Parth Narendran, Geraldine Gallen, Niall Furlong, Iain Cranston, Ali Chakera, Chris Philbey, Muhammad Ali Karamat, Sanjay Saraf, Shafie Kamaruddin, Eleanor Gurnell, Alyson Chapman, Sufyan Hussain, Jackie Elliott, Lalantha Leelarathna, Robert E J Ryder, Peter Hammond, Alistair Lumb, Pratik Choudhary, Emma G Wilmot

Objective: We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy.

Research design and methods: We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed-loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.5% who were willing to commence HCL therapy were included. Outcomes included change in HbA1c, sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), acute event rates, and user opinion of HCL.

Results: In total, 570 HCL users were included (median age 40 [IQR 29-50] years, 67% female, and 85% White). Mean baseline HbA1c was 9.4 ± 0.9% (78.9 ± 9.1 mmol/mol) with a median follow-up of 5.1 (IQR 3.9-6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8; P < 0.0001) (18.1 mmol/mol [95% CI 16.6, 19.6]; P < 0.0001). Time in range (70-180 mg/dL) increased from 34.2 to 61.9% (P < 0.001). Individuals with HbA1c of ≤58 mmol/mol rose from 0 to 39.4% (P < 0.0001), and those achieving ≥70% glucose time in range and <4% time below range increased from 0.8 to 28.2% (P < 0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7% [540 of 570]).

Conclusions: Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia, and diabetes-related distress and quality of life in people with type 1 diabetes in the real world.

目的:我们探讨了在1型糖尿病和HbA1c水平升高的成年人中,尽管使用了间歇性扫描连续血糖监测(isCGM)和胰岛素泵治疗,但与切换到混合闭环(HCL)胰岛素递送系统相关的纵向变化。研究设计和方法:我们对英国国家卫生服务局闭环试点的参与者进行了一项务实的、预先计划的观察性研究。纳入了在英格兰31个糖尿病中心使用isCGM和胰岛素泵且HbA1c≥8.5%且愿意开始HCL治疗的成年人。结果包括HbA1c、传感器血糖测量、糖尿病痛苦评分、黄金评分(低血糖意识)、急性事件发生率和HCL用户意见的变化。结果:总共包括570名HCL使用者(中位年龄40[IQR 29-50]岁,67%为女性,85%为白人)。平均基线HbA1c为9.4±0.9%(78.9±9.1 mmol/mol),中位随访时间为5.1(IQR 3.9-6.6)个月。在520名随访时继续服用HCL的患者中,平均调整后的HbA1c降低了1.7%(95%CI 1.5,1.8;P<0.0001)(18.1mmol/mol[95%CI 16.6,19.6];P<0.0001,以及那些在范围内达到≥70%血糖时间的人。结论:在现实世界中,使用HCL与1型糖尿病患者的HbA1c、范围内时间、低血糖、糖尿病相关的痛苦和生活质量的改善有关。
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Diabetes Care
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