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Hypoglycemic Response to Dorzagliatin in a Patient With GCK-MODY 一名 GCK-MODY 患者对多扎格列汀的降糖反应
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-05-01 DOI: 10.2337/dc23-2417
Yilin Zhao, Yumin Ma, Tianhao Ba, Xueyao Han, Qian Ren, Linong Ji
OBJECTIVE Metformin, insulin, and insulin secretagogues do not alter HbA1c levels in glucokinase-maturity-onset diabetes of the young (GCK-MODY). However, the efficacy of the new hypoglycemic drugs on GCK-MODY remains unclear. RESEARCH DESIGN AND METHODS We describe a case of GCK-MODY with unchanged blood glucose under different therapies during an 8 years’ follow-up. His HbA1c and biochemical indices under different hypoglycemic treatments were recorded. RESULTS Oral antidiabetic drugs, including thiazolidinediones, dipeptidyl peptidase IV inhibitor, α-glucosidase inhibitor, and sodium-glucose cotransporter 2 inhibitor that had not been evaluated previously, did not improve the HbA1c level in this patient. However, the glucokinase activator dorzagliatin effectively and safely lowered his HbA1c level. CONCLUSIONS Dorzagliatin was effective and safe in this patient with GCK-MODY, providing potential application prospects for precise treatment of GCK-MODY with dorzagliatin.
目的:二甲双胍、胰岛素和胰岛素促泌剂不会改变葡萄糖激酶-成熟期糖尿病(GCK-MODY)患者的 HbA1c 水平。然而,新型降糖药对 GCK-MODY 的疗效仍不明确。研究设计与方法 我们描述了一例 GCK-MODY 病例,在 8 年的随访期间,他在不同疗法下的血糖均保持不变。记录了他在不同降糖治疗下的 HbA1c 和生化指标。结果 包括噻唑烷二酮类药物、二肽基肽酶 IV 抑制剂、α-葡萄糖苷酶抑制剂和钠-葡萄糖共转运体 2 抑制剂在内的口服抗糖尿病药物并未改善该患者的 HbA1c 水平。然而,葡萄糖激酶激活剂多扎格雷丁却有效、安全地降低了他的 HbA1c 水平。结论 多扎格利铂对该 GCK-MODY 患者有效且安全,为多扎格利铂精确治疗 GCK-MODY 提供了潜在的应用前景。
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引用次数: 0
Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? 基于胰岛素的减肥药物疗法:阻力运动能优化身体成分的变化吗?
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-30 DOI: 10.2337/dci23-0100
João Carlos Locatelli, Juliene Gonçalves Costa, Andrew Haynes, Louise H. Naylor, P. Gerry Fegan, Bu B. Yeap, Daniel J. Green
This narrative review highlights the degree to which new antiobesity medications based on gut-derived nutrient-stimulated hormones (incretins) cause loss of lean mass, and the importance of resistance exercise to preserve muscle. Glucagon-like peptide 1 receptor agonists (GLP-1RA) induce substantial weight loss in randomized trials, effects that may be enhanced in combination with glucose-dependent insulinotropic polypeptide (GIP) receptor agonists. Liraglutide and semaglutide (GLP-1RA), tirzepatide (GLP-1 and GIP receptor dual agonist), and retatrutide (GLP-1, GIP, and glucagon receptor triple agonist) are peptides with incretin agonist activity that induce ∼15–24% weight loss in adults with overweight and obesity, alongside beneficial impacts on blood pressure, cholesterol, blood glucose, and insulin. However, these agents also cause rapid and significant loss of lean mass (∼10% or ∼6 kg), comparable to a decade or more of aging. Maintaining muscle mass and function as humans age is crucial to avoiding sarcopenia and frailty, which are strongly linked to morbidity and mortality. Studies indicate that supervised resistance exercise training interventions with a duration >10 weeks can elicit large increases in lean mass (∼3 kg) and strength (∼25%) in men and women. After a low-calorie diet, combining aerobic exercise with liraglutide improved weight loss maintenance compared with either alone. Retaining lean mass during incretin therapy could blunt body weight (and fat) regain on cessation of weight loss pharmacotherapy. We propose that tailored resistance exercise training be recommended as an adjunct to incretin therapy to optimize changes in body composition by preserving lean mass while achieving fat loss.
这篇叙述性综述强调了基于肠道源性营养刺激激素(胰高血糖素)的新型抗肥胖药物会在多大程度上导致瘦体重的减少,以及阻力运动对保持肌肉的重要性。在随机试验中,胰高血糖素样肽1受体激动剂(GLP-1RA)会导致体重大幅下降,与葡萄糖依赖性促胰岛素多肽(GIP)受体激动剂联用可能会增强这种效果。利拉鲁肽和赛马鲁肽(GLP-1RA)、替泽帕肽(GLP-1 和 GIP 受体双重激动剂)和雷他鲁肽(GLP-1、GIP 和胰高血糖素受体三重激动剂)是具有增量素激动剂活性的多肽类药物,可使超重和肥胖成人的体重减轻 15-24% 左右,同时对血压、胆固醇、血糖和胰岛素产生有益影响。然而,这些药物也会导致瘦体重快速显著下降(10% 或 6 公斤),相当于衰老十年或更长时间。随着年龄的增长,保持肌肉质量和功能对于避免肌肉疏松症和虚弱至关重要,而肌肉疏松症和虚弱与发病率和死亡率密切相关。研究表明,持续时间为 10 周的有监督阻力运动训练干预可以使男性和女性的瘦体重(∼3 公斤)和力量(∼25%)大幅增加。在低热量饮食后,有氧运动与利拉鲁肽的结合比单独使用任何一种方法都能更好地维持体重。在增量胰岛素治疗期间保持瘦体重可以减轻体重(和脂肪)在停止减肥药物治疗后的反弹。我们建议将有针对性的阻力运动训练作为胰岛素疗法的辅助疗法,在实现减脂的同时保留瘦体重,从而优化身体成分的变化。
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引用次数: 0
Nutritional Status, Dietary Intake, and Nutrition-Related Interventions Among Older Adults With Type 1 Diabetes: A Systematic Review and Call for More Evidence Toward Clinical Guidelines 1 型糖尿病老年患者的营养状况、膳食摄入量以及与营养相关的干预措施:系统综述和呼吁为临床指南提供更多证据
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-30 DOI: 10.2337/dci23-0099
Angelica Cristello Sarteau, Gabriella Ercolino, Rashmi Muthukkumar, Angela Fruik, Elizabeth J. Mayer-Davis, Anna R. Kahkoska
There is an emerging population of older adults (≥65 years) living with type 1 diabetes. Optimizing health through nutrition during this life stage is challenged by multiple and ongoing changes in diabetes management, comorbidities, and lifestyle factors. There is a need to understand nutritional status, dietary intake, and nutrition-related interventions that may maximize well-being throughout the life span in type 1 diabetes, in addition to nutrition recommendations from clinical guidelines and consensus reports. Three reviewers used Cochrane guidelines to screen original research (January 1993–2023) and guidelines (2012–2023) in two databases (MEDLINE and CENTRAL) to characterize nutrition evidence in this population. We found limited original research explicitly focused on nutrition and diet in adults ≥65 years of age with type 1 diabetes (six experimental studies, five observational studies) and meta-analyses/reviews (one scoping review), since in the majority of analyses individuals ≥65 years of age were combined with those age ≥18 years, with diverse diabetes durations, and also individuals with type 1 and type 2 diabetes were combined. Further, existing clinical guidelines (n = 10) lacked specificity and evidence to guide clinical practice and self-management behaviors in this population. From a scientific perspective, little is known about nutrition and diet among older adults with type 1 diabetes, including baseline nutrition status, dietary intake and eating behaviors, and the impact of nutrition interventions on key clinical and patient-oriented outcomes. This likely reflects the population’s recent emergence and unique considerations. Addressing these gaps is foundational to developing evidence-based nutrition practices and guidelines for older adults living with type 1 diabetes.
现在有越来越多的老年人(≥65 岁)患有 1 型糖尿病。在这一生命阶段,通过营养优化健康面临着糖尿病管理、并发症和生活方式等多重持续变化的挑战。除了临床指南和共识报告中的营养建议外,还需要了解 1 型糖尿病患者的营养状况、膳食摄入量以及与营养相关的干预措施,这些措施可能会最大限度地提高 1 型糖尿病患者一生中的健康水平。三位审稿人使用 Cochrane 指南筛选了两个数据库(MEDLINE 和 CENTRAL)中的原始研究(1993 年 1 月至 2023 年)和指南(2012 年至 2023 年),以确定该人群的营养证据特征。我们发现明确关注年龄≥65 岁的 1 型糖尿病成人营养和饮食的原创研究(6 项实验研究、5 项观察研究)和荟萃分析/综述(1 项范围界定综述)非常有限,因为在大多数分析中,年龄≥65 岁的患者与年龄≥18 岁的患者合并在一起,糖尿病持续时间各不相同,而且 1 型和 2 型糖尿病患者也合并在一起。此外,现有的临床指南(n = 10)缺乏特异性和证据来指导该人群的临床实践和自我管理行为。从科学角度来看,人们对 1 型糖尿病老年患者的营养和饮食知之甚少,包括基线营养状况、饮食摄入和饮食行为,以及营养干预对主要临床和以患者为导向的结果的影响。这可能反映了这一人群的新近出现和独特的考虑因素。弥补这些不足是为 1 型糖尿病老年人制定循证营养实践和指南的基础。
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引用次数: 0
Glycemic Control, Cognitive Aging, and Impairment Among Diverse Hispanics/Latinos: Study of Latinos–Investigation of Neurocognitive Aging (Hispanic Community Health Study/Study of Latinos) 不同西班牙裔/拉美裔的血糖控制、认知老化和损伤:拉美裔研究--神经认知老化调查(拉美裔社区健康研究/拉美裔研究)
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-30 DOI: 10.2337/dc23-2003
Hector M. González, Wassim Tarraf, Ariana M. Stickel, Alejandra Morlett, Kevin A. González, Alberto R. Ramos, Tatjana Rundek, Linda C. Gallo, Gregory A. Talavera, Martha L. Daviglus, Richard B. Lipton, Carmen Isasi, Melissa Lamar, Donglin Zeng, Charles DeCarli
OBJECTIVE Hispanics/Latinos in the United States have the highest prevalence of undiagnosed and untreated diabetes and are at increased risk for cognitive impairment. In this study, we examine glycemic control in relation to cognitive aging and impairment in a large prospective cohort of middle-aged and older Hispanics/Latinos of diverse heritages. RESEARCH DESIGN AND METHODS Study of Latinos–Investigation of Neurocognitive Aging (SOL-INCA) is a Hispanic Community Health Study/Study of Latinos (HCHS/SOL) ancillary study. HCHS/SOL is a multisite (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA), probability sampled prospective cohort study. SOL-INCA enrolled 6,377 diverse Hispanics/Latinos age 50 years and older (2016–2018). The primary outcomes were cognitive function, 7-year cognitive decline and mild cognitive impairment (MCI). The primary glycemia exposure variables were measured from fasting blood samples collected at HCHS/SOL visit 1 (2008–2011). RESULTS Visit 1 mean age was 56.5 years ± 8.2 SD, and the average glycosylated hemoglobin A1C (HbA1c) was 6.12% (43.5 ± 14.6 mmol/mol). After covariates adjustment, higher HbA1c was associated with accelerated 7-year global (b = −0.045; 95% CI = −0.070; −0.021; in z-score units) and executive cognitive decline, and a higher prevalence of MCI (odds ratio = 1.20; 95% CI = 1.11;1.29). CONCLUSIONS Elevated HbA1c levels were associated with 7-year executive cognitive decline and increased MCI risk among diverse middle-aged and older Hispanics/Latinos. Our findings indicate that poor glycemic control in midlife may pose significant risks for cognitive decline and MCI later in life among Hispanics/Latinos of diverse heritages.
目的 在美国,西班牙裔/拉美裔未确诊和未治疗糖尿病的发病率最高,认知障碍的风险也更高。在本研究中,我们将在一个大型前瞻性队列中,研究不同血统的中老年西班牙裔/拉美裔人群的血糖控制与认知老化和认知障碍的关系。研究设计和方法 拉丁人神经认知老化调查研究(SOL-INCA)是西班牙裔社区健康研究/拉丁人研究(HCHS/SOL)的一项辅助研究。HCHS/SOL 是一项多地点(纽约州布朗克斯、伊利诺伊州芝加哥、佛罗里达州迈阿密和加利福尼亚州圣地亚哥)、概率抽样的前瞻性队列研究。SOL-INCA 共招募了 6377 名年龄在 50 岁及以上的西班牙裔/拉美裔美国人(2016-2018 年)。主要结果为认知功能、7 年认知功能下降和轻度认知障碍(MCI)。主要血糖暴露变量由 HCHS/SOL 第 1 次就诊(2008-2011 年)时收集的空腹血样测量得出。结果 第 1 次就诊时的平均年龄为 56.5 岁 ± 8.2 SD,平均糖化血红蛋白 A1C (HbA1c) 为 6.12% (43.5 ± 14.6 mmol/mol)。经过协变量调整后,较高的 HbA1c 与 7 年的整体(b = -0.045;95% CI = -0.070;-0.021;以 z 评分单位表示)和执行认知能力下降速度加快以及 MCI 患病率较高(几率比 = 1.20;95% CI = 1.11;1.29)有关。结论 HbA1c 水平升高与不同的中老年西班牙裔/拉美裔人的 7 年执行认知能力下降和 MCI 风险增加有关。我们的研究结果表明,中年时期血糖控制不佳可能会对不同血统的西班牙裔/拉美裔人日后的认知能力下降和 MCI 构成重大风险。
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引用次数: 0
Association of Water Arsenic With Incident Diabetes in U.S. Adults: The Multi-Ethnic Study of Atherosclerosis and the Strong Heart Study 水砷与美国成人糖尿病发病率的关系:多种族动脉粥样硬化研究和强心研究
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-24 DOI: 10.2337/dc23-2231
Maya Spaur, Marta Galvez-Fernandez, Qixuan Chen, Melissa A. Lombard, Benjamin C. Bostick, Pam Factor-Litvak, Amanda M. Fretts, Steven J. Shea, Ana Navas-Acien, Anne E. Nigra
OBJECTIVE We examined the association of arsenic in federally regulated community water systems (CWSs) and unregulated private wells with type 2 diabetes (T2D) incidence in the Strong Heart Family Study (SHFS), a prospective study of American Indian communities, and the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective study of racially and ethnically diverse urban U.S. communities. RESEARCH DESIGN AND METHODS We evaluated 1,791 participants from SHFS and 5,777 participants from MESA who had water arsenic estimates available and were free of T2D at baseline (2001–2003 and 2000–2002, respectively). Participants were followed for incident T2D until 2010 (SHFS cohort) or 2019 (MESA cohort). We used Cox proportional hazards mixed-effects models to account for clustering by family and residential zip code, with adjustment for sex, baseline age, BMI, smoking status, and education. RESULTS T2D incidence was 24.4 cases per 1,000 person-years (mean follow-up, 5.6 years) in SHFS and 11.2 per 1,000 person-years (mean follow-up, 14.0 years) in MESA. In a meta-analysis across the SHFS and MESA cohorts, the hazard ratio (95% CI) per doubling in CWS arsenic was 1.10 (1.02, 1.18). The corresponding hazard ratio was 1.09 (0.95, 1.26) in the SHFS group and 1.10 (1.01, 1.20) in the MESA group. The corresponding hazard ratio (95% CI) for arsenic in private wells and incident T2D in SHFS was 1.05 (0.95, 1.16). We observed statistical interaction and larger magnitude hazard ratios for participants with BMI <25 kg/m2 and female participants. CONCLUSIONS Low to moderate water arsenic levels (<10 µg/L) were associated with T2D incidence in the SHFS and MESA cohorts.
目的 我们研究了美国印第安人社区前瞻性研究 "强心家庭研究"(SHFS)和美国城市种族和民族多样性社区前瞻性研究 "多种族动脉粥样硬化研究"(MESA)中联邦政府监管的社区供水系统(CWS)和未受监管的私人水井中的砷与 2 型糖尿病(T2D)发病率的关系。研究设计与方法 我们评估了 1,791 名来自 SHFS 的参与者和 5,777 名来自 MESA 的参与者,他们都有水砷估计值,并且在基线(分别为 2001-2003 年和 2000-2002 年)时没有 T2D。对参与者的 T2D 发病情况进行随访,直至 2010 年(SHFS 队列)或 2019 年(MESA 队列)。我们使用 Cox 比例危害混合效应模型来考虑家庭和居住地邮编的聚类,并对性别、基线年龄、体重指数、吸烟状况和教育程度进行了调整。结果 在 SHFS 中,T2D 发病率为每千人年 24.4 例(平均随访 5.6 年),在 MESA 中为每千人年 11.2 例(平均随访 14.0 年)。在一项横跨 SHFS 和 MESA 队列的荟萃分析中,CWS 砷每增加一倍的危险比(95% CI)为 1.10(1.02, 1.18)。SHFS 组的相应危险比为 1.09 (0.95, 1.26),MESA 组为 1.10 (1.01, 1.20)。私人水井中的砷与 SHFS 中 T2D 发生率的相应危险比(95% CI)为 1.05 (0.95, 1.16)。我们观察到统计交互作用,体重指数为 25 kg/m2 的参与者和女性参与者的危险比值更大。结论 在 SHFS 和 MESA 队列中,中低水平的水砷(<10 µg/L)与 T2D 发病率有关。
{"title":"Association of Water Arsenic With Incident Diabetes in U.S. Adults: The Multi-Ethnic Study of Atherosclerosis and the Strong Heart Study","authors":"Maya Spaur, Marta Galvez-Fernandez, Qixuan Chen, Melissa A. Lombard, Benjamin C. Bostick, Pam Factor-Litvak, Amanda M. Fretts, Steven J. Shea, Ana Navas-Acien, Anne E. Nigra","doi":"10.2337/dc23-2231","DOIUrl":"https://doi.org/10.2337/dc23-2231","url":null,"abstract":"OBJECTIVE We examined the association of arsenic in federally regulated community water systems (CWSs) and unregulated private wells with type 2 diabetes (T2D) incidence in the Strong Heart Family Study (SHFS), a prospective study of American Indian communities, and the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective study of racially and ethnically diverse urban U.S. communities. RESEARCH DESIGN AND METHODS We evaluated 1,791 participants from SHFS and 5,777 participants from MESA who had water arsenic estimates available and were free of T2D at baseline (2001–2003 and 2000–2002, respectively). Participants were followed for incident T2D until 2010 (SHFS cohort) or 2019 (MESA cohort). We used Cox proportional hazards mixed-effects models to account for clustering by family and residential zip code, with adjustment for sex, baseline age, BMI, smoking status, and education. RESULTS T2D incidence was 24.4 cases per 1,000 person-years (mean follow-up, 5.6 years) in SHFS and 11.2 per 1,000 person-years (mean follow-up, 14.0 years) in MESA. In a meta-analysis across the SHFS and MESA cohorts, the hazard ratio (95% CI) per doubling in CWS arsenic was 1.10 (1.02, 1.18). The corresponding hazard ratio was 1.09 (0.95, 1.26) in the SHFS group and 1.10 (1.01, 1.20) in the MESA group. The corresponding hazard ratio (95% CI) for arsenic in private wells and incident T2D in SHFS was 1.05 (0.95, 1.16). We observed statistical interaction and larger magnitude hazard ratios for participants with BMI <25 kg/m2 and female participants. CONCLUSIONS Low to moderate water arsenic levels (<10 µg/L) were associated with T2D incidence in the SHFS and MESA cohorts.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":null,"pages":null},"PeriodicalIF":16.2,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140642181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early-Onset Hypertension and Sex-Specific Residual Risk for Cardiovascular Disease in Type 2 Diabetes 早发高血压与 2 型糖尿病心血管疾病的性别特异性残余风险
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-24 DOI: 10.2337/dc23-2275
Hongwei Ji, Joseph E. Ebinger, Alan C. Kwan, Karen Reue, Jennifer C. Sullivan, John Shyy, Susan Cheng
OBJECTIVE To investigate whether the sex disparities in type 2 diabetes–associated cardiovascular disease (CVD) risks may be related to early-onset hypertension that could benefit from intensive blood pressure (BP) control. RESEARCH DESIGN AND METHODS We analyzed intensive versus standard BP control in relation to incident CVD events in women and men with type 2 diabetes, based on their age of hypertension diagnosis. RESULTS Among 3,792 adults with type 2 diabetes (49% women), multivariable-adjusted CVD risk was increased per decade earlier age at hypertension diagnosis (hazard ratio 1.11 [1.03–1.21], P = 0.006). Excess risk associated with early-diagnosed hypertension was attenuated in the presence of intensive versus standard antihypertensive therapy in women (P = 0.036) but not men (P = 0.76). CONCLUSIONS Women with type 2 diabetes and early-onset hypertension may represent a higher-risk subpopulation that not only contributes to the female excess in diabetes-related CVD risk but may benefit from intensive BP control.
目的 探讨 2 型糖尿病相关心血管疾病(CVD)风险的性别差异是否可能与早期高血压有关,而早期高血压可从强化血压(BP)控制中获益。研究设计与方法 我们根据 2 型糖尿病患者的高血压诊断年龄,分析了强化血压控制与标准血压控制在女性和男性 2 型糖尿病患者心血管疾病事件中的关系。结果 在 3,792 名 2 型糖尿病成人患者中(49% 为女性),高血压诊断年龄每提前十年,经多变量调整后的心血管疾病风险就会增加(危险比 1.11 [1.03-1.21],P = 0.006)。与早期诊断的高血压相关的过高风险在女性接受强化降压治疗与标准降压治疗的情况下有所降低(P = 0.036),而男性则没有降低(P = 0.76)。结论 患有 2 型糖尿病和早发性高血压的女性可能是高风险亚群,她们不仅导致女性糖尿病相关心血管疾病风险过高,而且可能从强化血压控制中获益。
{"title":"Early-Onset Hypertension and Sex-Specific Residual Risk for Cardiovascular Disease in Type 2 Diabetes","authors":"Hongwei Ji, Joseph E. Ebinger, Alan C. Kwan, Karen Reue, Jennifer C. Sullivan, John Shyy, Susan Cheng","doi":"10.2337/dc23-2275","DOIUrl":"https://doi.org/10.2337/dc23-2275","url":null,"abstract":"OBJECTIVE To investigate whether the sex disparities in type 2 diabetes–associated cardiovascular disease (CVD) risks may be related to early-onset hypertension that could benefit from intensive blood pressure (BP) control. RESEARCH DESIGN AND METHODS We analyzed intensive versus standard BP control in relation to incident CVD events in women and men with type 2 diabetes, based on their age of hypertension diagnosis. RESULTS Among 3,792 adults with type 2 diabetes (49% women), multivariable-adjusted CVD risk was increased per decade earlier age at hypertension diagnosis (hazard ratio 1.11 [1.03–1.21], P = 0.006). Excess risk associated with early-diagnosed hypertension was attenuated in the presence of intensive versus standard antihypertensive therapy in women (P = 0.036) but not men (P = 0.76). CONCLUSIONS Women with type 2 diabetes and early-onset hypertension may represent a higher-risk subpopulation that not only contributes to the female excess in diabetes-related CVD risk but may benefit from intensive BP control.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":null,"pages":null},"PeriodicalIF":16.2,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140642247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
β-Cell Function, Incretin Effect, and Glucose Kinetics in Response to a Mixed Meal in Patients With Type 2 Diabetes Treated With Dapagliflozin Plus Saxagliptin 达帕格列净加沙格列汀治疗的 2 型糖尿病患者对混合餐的β细胞功能、内分泌作用和血糖动力学反应
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-23 DOI: 10.2337/dc23-2051
Giuseppe Daniele, Andrea Tura, Alex Brocchi, Alessandro Saba, Beatrice Campi, Veronica Sancho-Bornez, Angela Dardano, Stefano Del Prato
OBJECTIVE To explore the complementary effects of a combination of dipeptidyl peptidase 4 and sodium–glucose cotransporter 2 inhibitors added to metformin on hormonal and metabolic responses to meal ingestion. RESEARCH DESIGN AND METHODS Forty-five patients (age 58 ± 8 years; HbA1c 58 ± 6 mmol/mol; BMI 30.7 ± 3.2 kg/m2) with type 2 diabetes uncontrolled with metformin were evaluated at baseline and 3 and 28 days after 5 mg saxagliptin (SAXA), 10 mg dapagliflozin (DAPA), or 5 mg saxagliptin plus 10 mg dapagliflozin (SAXA+DAPA) using a mixed-meal tolerance test (MMTT) spiked with dual-tracer glucose to assess glucose metabolism, insulin secretion, and sensitivity. RESULTS At day 3, fasting and mean MMTT glucose levels were lower with SAXA+DAPA (−31.1 ± 1.6 and −91.5 ± 12.4 mg/dL) than with SAXA (−7.1 ± 2.1 and −53 ± 10.5 mg/dL) or DAPA (−17.0 ± 1.1 and −42.6 ± 10.0 mg/dL, respectively; P < 0.001). Insulin secretion rate (SAXA+DAPA +75%; SAXA +11%; DAPA 3%) and insulin sensitivity (+2.2 ± 1.7, +0.4 ± 0.7, and +0.4 ± 0.4 mg ⋅ kg−1⋅ min−1, respectively) improved with SAXA+DAPA (P < 0.007). Mean glucagon-like peptide 1 (GLP-1) was higher with SAXA+DAPA than with SAXA or DAPA. Fasting glucagon increased with DAPA and SAXA+DAPA but not with SAXA. Fasting endogenous glucose production (EGP) increased with SAXA+DAPA and DAPA. During MMTT, EGP suppression was greater (48%) with SAXA+DAPA (vs. SAXA 44%; P = 0.02 or DAPA 34%; P = 0.2). Metabolic clearance rate of glucose (MCRglu) increased more with SAXA+DAPA. At week 4, insulin secretion rate, β-cell glucose sensitivity, and insulin sensitivity had further increased in the SAXA+DAPA group (P = 0.02), with no additional changes in GLP-1, glucagon, fasting or MMTT EGP, or MCRglu. CONCLUSIONS SAXA+DAPA provided superior glycemic control compared with DAPA or SAXA, with improved β-cell function, insulin sensitivity, GLP-1 availability, and glucose clearance.
目的 探讨在二甲双胍基础上联合使用二肽基肽酶 4 和钠-葡萄糖共转运体 2 抑制剂对进餐后激素和代谢反应的互补作用。研究设计与方法 45 名 2 型糖尿病患者(年龄 58 ± 8 岁;HbA1c 58 ± 6 mmol/mol;体重指数 30.7 ± 3.2 kg/m2)进行了基线评估,并在服用 5 毫克沙格列汀 (SAXA)、10 毫克达帕格列净 (DAPA) 或 5 毫克沙格列汀加 10 毫克达帕格列净 (SAXA+DAPA) 3 天和 28 天后进行了双踪葡萄糖混合餐耐受试验 (MMTT),以评估葡萄糖代谢、胰岛素分泌和敏感性。结果 在第 3 天,SAXA+DAPA 的空腹和平均 MMTT 葡萄糖水平(-31.1 ± 1.6 和 -91.5 ± 12.4 mg/dL)低于 SAXA(-7.1 ± 2.1 和 -53 ± 10.5 mg/dL)或 DAPA(分别为 -17.0 ± 1.1 和 -42.6 ± 10.0 mg/dL;P < 0.001)。胰岛素分泌率(SAXA+DAPA +75%;SAXA +11%;DAPA 3%)和胰岛素敏感性(分别为 +2.2±1.7、+0.4±0.7 和 +0.4±0.4 mg ⋅ kg-1⋅ min-1)在 SAXA+DAPA 的作用下有所改善(P &;lt;0.007)。SAXA+DAPA的平均胰高血糖素样肽1(GLP-1)高于SAXA或DAPA。DAPA 和 SAXA+DAPA 会增加空腹胰高血糖素,而 SAXA 不会。SAXA+DAPA 和 DAPA 会增加空腹内源性葡萄糖生成量(EGP)。在 MMTT 期间,SAXA+DAPA 的 EGP 抑制率更高(48%)(与 SAXA 44%; P = 0.02 或 DAPA 34%; P = 0.2 相比)。SAXA+DAPA的葡萄糖代谢清除率(MCRglu)增加得更多。第 4 周时,SAXA+DAPA 组的胰岛素分泌率、β 细胞葡萄糖敏感性和胰岛素敏感性进一步提高(P = 0.02),而 GLP-1、胰高血糖素、空腹或 MMTT EGP 或 MCRglu 均无额外变化。结论 SAXA+DAPA 的血糖控制效果优于 DAPA 或 SAXA,β 细胞功能、胰岛素敏感性、GLP-1 利用率和葡萄糖清除率均有所改善。
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引用次数: 0
Ten Years of Improving Glycemic Control in Pediatric Diabetes Care: Data From the Norwegian Childhood Diabetes Registry 改善儿童糖尿病护理中血糖控制的十年:挪威儿童糖尿病登记数据
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-22 DOI: 10.2337/dc24-0086
Heiko Bratke, Eva Biringer, Anastasia Ushakova, Hanna D. Margeirsdottir, Siv Janne Kummernes, Pål R. Njølstad, Torild Skrivarhaug
OBJECTIVE To evaluate, from 2013 to 2022, how HbA1c, the incidence of acute complications, and use of diabetes technology changed at the national level in Norway and how glycemic control was associated with use of diabetes technology, carbohydrate counting, or participation in a quality improvement project. RESEARCH DESIGN AND METHODS This longitudinal observational study was based on 27,214 annual registrations of 6,775 children from the Norwegian Childhood Diabetes Registry from 2013 to 2022. Individuals aged >18 years, those with diabetes other than type 1, and those without HbA1c measurements were excluded. The outcome measure was HbA1c. The predictor variables in the adjusted linear mixed-effects model were 1) the use of diabetes technology, 2) the use of carbohydrate counting for meal bolusing, and 3) whether the patient’s diabetes team participated in a quality improvement project. RESULTS Mean HbA1c decreased from 8.2% (2013) to 7.2% (2021), and the proportion of youth reaching an HbA1c <7.0% increased from 13% (2013) to 43% (2022). Insulin pump use increased from 65% (2013) to 91% (2022). Continuous glucose monitoring (CGM) use increased from 34% (first recorded in 2016) to 97% (2022). Insulin pump, CGM, and carbohydrate counting were associated with lower HbA1c and higher achievement of glycemic targets. Girls had a higher mean HbA1c than boys. Mean HbA1c levels were lower in clinics that participated in a quality improvement project for the following 4 years after the project. CONCLUSIONS Diabetes technology, carbohydrate counting, and systematic quality improvement in pediatric departments led to improved glycemic control.
目的 评估 2013 年至 2022 年挪威全国 HbA1c、急性并发症发病率和糖尿病技术使用情况的变化,以及血糖控制与糖尿病技术使用、碳水化合物计数或参与质量改进项目的关系。研究设计与方法 这项纵向观察研究基于2013年至2022年期间挪威儿童糖尿病登记处对6775名儿童进行的27214次年度登记。研究对象不包括年龄在18岁以下的儿童、1型糖尿病以外的糖尿病患者以及未进行HbA1c测量的儿童。结果指标为 HbA1c。调整后线性混合效应模型的预测变量为:1)糖尿病技术的使用情况;2)使用碳水化合物计数法进餐;3)患者所在的糖尿病团队是否参与了质量改进项目。结果 平均 HbA1c 从 8.2%(2013 年)降至 7.2%(2021 年),HbA1c <7.0% 的青少年比例从 13%(2013 年)增至 43%(2022 年)。胰岛素泵的使用率从 65%(2013 年)增至 91%(2022 年)。连续葡萄糖监测(CGM)的使用率从 34%(2016 年首次记录)增至 97%(2022 年)。胰岛素泵、CGM 和碳水化合物计数与较低的 HbA1c 和较高的血糖目标实现率相关。女孩的 HbA1c 平均值高于男孩。参与质量改进项目的诊所在项目结束后的 4 年中平均 HbA1c 水平较低。结论 儿科采用糖尿病技术、碳水化合物计数和系统性质量改进可改善血糖控制。
{"title":"Ten Years of Improving Glycemic Control in Pediatric Diabetes Care: Data From the Norwegian Childhood Diabetes Registry","authors":"Heiko Bratke, Eva Biringer, Anastasia Ushakova, Hanna D. Margeirsdottir, Siv Janne Kummernes, Pål R. Njølstad, Torild Skrivarhaug","doi":"10.2337/dc24-0086","DOIUrl":"https://doi.org/10.2337/dc24-0086","url":null,"abstract":"OBJECTIVE To evaluate, from 2013 to 2022, how HbA1c, the incidence of acute complications, and use of diabetes technology changed at the national level in Norway and how glycemic control was associated with use of diabetes technology, carbohydrate counting, or participation in a quality improvement project. RESEARCH DESIGN AND METHODS This longitudinal observational study was based on 27,214 annual registrations of 6,775 children from the Norwegian Childhood Diabetes Registry from 2013 to 2022. Individuals aged >18 years, those with diabetes other than type 1, and those without HbA1c measurements were excluded. The outcome measure was HbA1c. The predictor variables in the adjusted linear mixed-effects model were 1) the use of diabetes technology, 2) the use of carbohydrate counting for meal bolusing, and 3) whether the patient’s diabetes team participated in a quality improvement project. RESULTS Mean HbA1c decreased from 8.2% (2013) to 7.2% (2021), and the proportion of youth reaching an HbA1c <7.0% increased from 13% (2013) to 43% (2022). Insulin pump use increased from 65% (2013) to 91% (2022). Continuous glucose monitoring (CGM) use increased from 34% (first recorded in 2016) to 97% (2022). Insulin pump, CGM, and carbohydrate counting were associated with lower HbA1c and higher achievement of glycemic targets. Girls had a higher mean HbA1c than boys. Mean HbA1c levels were lower in clinics that participated in a quality improvement project for the following 4 years after the project. CONCLUSIONS Diabetes technology, carbohydrate counting, and systematic quality improvement in pediatric departments led to improved glycemic control.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":null,"pages":null},"PeriodicalIF":16.2,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140636154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early-Onset Type 2 Diabetes and Tirzepatide Treatment: A Post Hoc Analysis From the SURPASS Clinical Trial Program 早发 2 型糖尿病与替哌肽治疗:SURPASS 临床试验项目的事后分析
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-19 DOI: 10.2337/dc23-2356
Philip Zeitler, Rodolfo J. Galindo, Melanie J. Davies, Brandon K. Bergman, Vivian T. Thieu, Claudia Nicolay, Sheryl Allen, Robert J. Heine, Clare J. Lee
OBJECTIVE We evaluated baseline characteristics of participants with early-onset type 2 diabetes (T2D) from the SURPASS program and tirzepatide’s effects on glycemic control, body weight (BW), and cardiometabolic markers. RESEARCH DESIGN AND METHODS This post hoc analysis compared baseline characteristics and changes in mean HbA1c, BW, waist circumference (WC), lipids, and blood pressure (BP) in 3,792 participants with early-onset versus later-onset T2D at week 40 (A Study of Tirzepatide [LY3298176] in Participants With Type 2 Diabetes Not Controlled With Diet and Exercise Alone [SURPASS-1], A Study of Tirzepatide [LY3298176] Versus Semaglutide Once Weekly as Add-on Therapy to Metformin in Participants With Type 2 Diabetes [SURPASS-2]) or week 52 (A Study of Tirzepatide [LY3298176] Versus Insulin Degludec in Participants With Type 2 Diabetes [SURPASS-3]). Analyses were performed by study on data from participants while on assigned treatment without rescue medication in case of persistent hyperglycemia. RESULTS At baseline in SURPASS-2, participants with early-onset versus later-onset T2D were younger with longer diabetes duration (9 vs. 7 years, P < 0.001) higher glycemic levels (8.5% vs. 8.2%, P < 0.001), higher BW (97 vs. 93 kg, P < 0.001) and BMI (35 vs. 34 kg/m2, P < 0.001), and a similarly abnormal lipid profile (e.g., triglycerides 167 vs. 156 mg/dL). At week 40, similar improvements in HbA1c (−2.6% vs. −2.4%), BW (−14 vs. −13 kg), WC (−10 vs. −10 cm), triglycerides (−26% vs. −24%), HDL (7% vs. 7%), and systolic BP (−6 vs. −7 mmHg) were observed in both subgroups with tirzepatide. CONCLUSIONS Despite younger age, participants with early-onset T2D from the SURPASS program had higher glycemic levels and worse overall metabolic health at baseline versus those with later-onset T2D. In this post hoc analysis, similar improvements in HbA1c, BW, and cardiometabolic markers were observed with tirzepatide, irrespective of age at T2D diagnosis. Future studies are needed to determine long-term outcomes of tirzepatide in early-onset T2D.
目的 我们评估了 SURPASS 计划中早发 2 型糖尿病 (T2D) 参与者的基线特征以及替扎帕肽对血糖控制、体重 (BW) 和心脏代谢指标的影响。研究设计与方法 本项事后分析比较了 3792 名早发与晚发 T2D 参与者在第 40 周时的基线特征以及平均 HbA1c、体重、腰围 (WC)、血脂和血压 (BP) 的变化(单靠饮食和运动无法控制血糖的 2 型糖尿病患者服用替扎帕肽 [LY3298176] 的研究 [SURPASS-1])、2型糖尿病患者二甲双胍附加疗法中替唑帕肽[LY3298176]与塞马鲁肽每周一次的比较研究[SURPASS-2])或第52周(2型糖尿病患者中替唑帕肽[LY3298176]与德格鲁德胰岛素的比较研究[SURPASS-3])。研究分析了参与者在接受指定治疗期间的数据,在出现持续高血糖时未使用抢救药物。结果 在 SURPASS-2 的基线研究中,早发与晚发 T2D 患者的年龄更小,糖尿病病程更长(9 年 vs. 7 年,P < 0.001),血糖水平更高(8.5% vs. 8.2%,P < 0.001)。5% vs. 8.2%,Pamp;lt; 0.001),体重(97 kg vs. 93 kg,Pamp;lt; 0.001)和体重指数(35 kg/m2 vs. 34 kg/m2,Pamp;lt; 0.001)较高,血脂也同样异常(如甘油三酯 167 vs. 甘油三酯 167 vs. 甘油三酯 34 kg/m2,Pamp;lt; 0.001)、甘油三酯 167 vs. 156 mg/dL)。第 40 周时,观察到两个亚组的 HbA1c(-2.6% vs. -2.4%)、体重(-14 kg vs. -13kg)、腹围(-10 cm vs. -10cm)、甘油三酯(-26% vs. -24%)、高密度脂蛋白(7% vs. 7%)和收缩压(-6 mmHg vs. -7mmHg)在使用替扎帕肽后均有类似改善。结论 尽管 SURPASS 计划的早发性 T2D 参与者年龄较小,但与晚发性 T2D 参与者相比,他们的血糖水平较高,整体代谢健康状况较差。在这项事后分析中,无论确诊 T2D 时的年龄如何,使用替扎帕肽对 HbA1c、体重和心脏代谢指标都有类似的改善。未来还需要进行研究,以确定替扎帕肽对早发性 T2D 的长期疗效。
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引用次数: 0
Trends in Incidence of Hospitalization for Hypoglycemia and Diabetic Ketoacidosis in Individuals With Type 1 or Type 2 Diabetes With and Without Severe Mental Illness in Denmark From 1996 to 2020: A Nationwide Study 1996 年至 2020 年丹麦患有或未患有严重精神疾病的 1 型或 2 型糖尿病患者因低血糖和糖尿病酮症酸中毒住院的发病率趋势:一项全国性研究
IF 16.2 1区 医学 Q1 Nursing Pub Date : 2024-04-19 DOI: 10.2337/dc23-2394
Stine H. Scheuer, Gregers S. Andersen, Bendix Carstensen, Lars Diaz, Vanja Kosjerina, Nanna Lindekilde, Sarah H. Wild, Caroline A. Jackson, Frans Pouwer, Michael E. Benros, Marit E. Jørgensen
OBJECTIVE To examine trends in incidence of acute diabetes complications in individuals with type 1 or type 2 diabetes with and without severe mental illness (SMI) in Denmark by age and calendar year. RESEARCH DESIGN AND METHODS We conducted a cohort study using nationwide registers from 1996 to 2020 to identify individuals with diabetes, ascertain SMI status (namely, schizophrenia, bipolar disorder, or major depression) and identify the outcomes: hospitalization for hypoglycemia and diabetic ketoacidosis (DKA). We used Poisson regression to estimate incidence rates (IRs) and incidence rate ratios (IRRs) of recurrent hypoglycemia and DKA events by SMI, age, and calendar year, accounting for sex, diabetes duration, education, and country of origin. RESULTS Among 433,609 individuals with diabetes, 8% had SMI. Risk of (first and subsequent) hypoglycemia events was higher for individuals with SMI than for those without SMI (for first hypoglycemia event, IRR: type 1 diabetes, 1.77 [95% CI 1.56–2.00]; type 2 diabetes, 1.64 [95% CI 1.55–1.74]). Individuals with schizophrenia were particularly at risk for recurrent hypoglycemia events. The risk of first DKA event was higher in individuals with SMI (for first DKA event, IRR: type 1 diabetes, 1.78 [95% CI 1.50–2.11]; type 2 diabetes, 1.85 [95% CI 1.64–2.09]). Except for DKA in the type 2 diabetes group, IR differences between individuals with and without SMI were highest in younger individuals (<50 years old) but stable across the calendar year. CONCLUSIONS SMI is an important risk factor for acute diabetes complication and effective prevention is needed in this population, especially among the younger population and those with schizophrenia.
目的 研究丹麦患有或未患有严重精神疾病(SMI)的 1 型或 2 型糖尿病患者的急性糖尿病并发症发病率在不同年龄和日历年的变化趋势。研究设计与方法 我们利用 1996 年至 2020 年的全国性登记资料开展了一项队列研究,以确定糖尿病患者的身份、SMI 状态(即精神分裂症、双相情感障碍或重度抑郁症),并确定结果:因低血糖和糖尿病酮症酸中毒 (DKA) 而住院。我们使用泊松回归法估算了按 SMI、年龄和日历年分列的复发性低血糖和糖尿病酮症酸中毒事件的发病率 (IRs) 和发病率比 (IRRs),并考虑了性别、糖尿病病程、教育程度和原籍国等因素。结果 在 433 609 名糖尿病患者中,8% 患有 SMI。与非 SMI 患者相比,SMI 患者发生(首次和后续)低血糖事件的风险更高(首次低血糖事件,IRR:1 型糖尿病,1.77 [95% CI 1.56-2.00];2 型糖尿病,1.64 [95% CI 1.55-1.74])。精神分裂症患者反复发生低血糖的风险尤其高。精神分裂症患者首次发生低血糖的风险较高(首次发生低血糖的 IRR:1 型糖尿病,1.78 [95% CI 1.50-2.11];2 型糖尿病,1.85 [95% CI 1.64-2.09])。除了 2 型糖尿病组中的 DKA 外,有 SMI 和无 SMI 患者之间的 IR 差异在年轻患者(<50 岁)中最大,但在整个日历年中保持稳定。结论 SMI 是糖尿病急性并发症的一个重要风险因素,需要对这一人群进行有效预防,尤其是在年轻人群和精神分裂症患者中。
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引用次数: 0
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Diabetes Care
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