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Circulating Metabolite Biomarkers of Glycemic Control in Youth-Onset Type 2 Diabetes 青年 2 型糖尿病患者血糖控制的循环代谢物生物标志物
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-27 DOI: 10.2337/dc23-2441
Zsu-Zsu Chen, Chang Lu, Jonathan M. Dreyfuss, Gaurav Tiwari, Xu Shi, Shuning Zheng, Danielle Wolfs, Laura Pyle, Petter Bjornstad, Laure El Ghormli, Robert E. Gerszten, Elvira Isganaitis
OBJECTIVE We aimed to identify metabolites associated with loss of glycemic control in youth-onset type 2 diabetes. RESEARCH DESIGN AND METHODS We measured 480 metabolites in fasting plasma samples from the TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study. Participants (N = 393; age 10–17 years) were randomly assigned to metformin, metformin plus rosiglitazone, or metformin plus lifestyle intervention. Additional metabolomic measurements after 36 months were obtained in 304 participants. Cox models were used to assess baseline metabolites, interaction of metabolites and treatment group, and change in metabolites (0–36 months), with loss of glycemic control adjusted for age, sex, race, treatment group, and BMI. Metabolite prediction models of glycemic failure were generated using elastic net regression and compared with clinical risk factors. RESULTS Loss of glycemic control (HbA1c ≥8% or insulin therapy) occurred in 179 of 393 participants (mean 12.4 months). Baseline levels of 33 metabolites were associated with loss of glycemic control (q < 0.05). Associations of hexose and xanthurenic acid with treatment failure differed by treatment randomization; youths with higher baseline levels of these two compounds had a lower risk of treatment failure with metformin alone. For three metabolites, changes from 0 to 36 months were associated with loss of glycemic control (q < 0.05). Changes in d-gluconic acid and 1,5-AG/1-deoxyglucose, but not baseline levels of measured metabolites, predicted treatment failure better than changes in HbA1c or measures of β-cell function. CONCLUSIONS Metabolomics provides insight into circulating small molecules associated with loss of glycemic control and may highlight metabolic pathways contributing to treatment failure in youth-onset diabetes.
目的 我们旨在确定与青少年 2 型糖尿病患者血糖失控有关的代谢物。研究设计与方法 我们测量了 TODAY(青少年 2 型糖尿病治疗方案)研究中空腹血浆样本中的 480 种代谢物。参与者(N = 393;年龄 10-17 岁)被随机分配到二甲双胍、二甲双胍加罗格列酮或二甲双胍加生活方式干预。304名参与者在36个月后接受了额外的代谢组测量。Cox模型用于评估基线代谢物、代谢物与治疗组的交互作用以及代谢物的变化(0-36个月),血糖控制的丧失按年龄、性别、种族、治疗组和体重指数进行了调整。使用弹性净回归法生成血糖失效的代谢物预测模型,并与临床风险因素进行比较。结果 393 名参与者中有 179 人血糖失控(HbA1c ≥8% 或胰岛素治疗)(平均 12.4 个月)。33 种代谢物的基线水平与血糖失控相关(q < 0.05)。正己糖和黄嘌呤核酸与治疗失败的关系因治疗随机化而异;这两种化合物基线水平较高的青少年单用二甲双胍治疗失败的风险较低。就三种代谢物而言,从 0 个月到 36 个月的变化与血糖控制的丧失有关(q < 0.05)。d-葡萄糖酸和1,5-AG/1-脱氧葡萄糖的变化(而非所测代谢物的基线水平)比 HbA1c 或 β 细胞功能指标的变化更能预测治疗失败。结论 代谢组学有助于深入了解与血糖控制失效相关的循环小分子,并可突出导致青年糖尿病治疗失败的代谢途径。
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引用次数: 0
The Gut Microbiota and Diabetes: Research, Translation, and Clinical Applications—2023 Diabetes, Diabetes Care, and Diabetologia Expert Forum 肠道微生物群与糖尿病:研究、转化和临床应用--2023 年糖尿病、糖尿病护理和糖尿病学专家论坛
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-24 DOI: 10.2337/dci24-0052
Mariana Byndloss, Suzanne Devkota, Frank Duca, Jan Hendrik Niess, Max Nieuwdorp, Marju Orho-Melander, Yolanda Sanz, Valentina Tremaroli, Liping Zhao
This article summarizes the state of the science on the role of the gut microbiota (GM) in diabetes from a recent international expert forum organized by Diabetes, Diabetes Care, and Diabetologia, which was held at the European Association for the Study of Diabetes 2023 Annual Meeting in Hamburg, Germany. Forum participants included clinicians and basic scientists who are leading investigators in the field of the intestinal microbiome and metabolism. Their conclusions were as follows: 1) the GM may be involved in the pathophysiology of type 2 diabetes, as microbially produced metabolites associate both positively and negatively with the disease, and mechanistic links of GM functions (e.g., genes for butyrate production) with glucose metabolism have recently emerged through the use of Mendelian randomization in humans; 2) the highly individualized nature of the GM poses a major research obstacle, and large cohorts and a deep-sequencing metagenomic approach are required for robust assessments of associations and causation; 3) because single–time point sampling misses intraindividual GM dynamics, future studies with repeated measures within individuals are needed; and 4) much future research will be required to determine the applicability of this expanding knowledge to diabetes diagnosis and treatment, and novel technologies and improved computational tools will be important to achieve this goal.
本文总结了最近由《糖尿病》(Diabetes)、《糖尿病护理》(Diabetes Care)和《糖尿病学》(Diabetologia)组织的国际专家论坛上有关肠道微生物群(GM)在糖尿病中的作用的科学现状,该论坛是在德国汉堡举行的欧洲糖尿病研究协会 2023 年年会上召开的。论坛与会者包括临床医生和基础科学家,他们都是肠道微生物组和新陈代谢领域的主要研究人员。他们的结论如下1) 微生物组可能与 2 型糖尿病的病理生理学有关,因为微生物产生的代谢物与该疾病既有正相关关系,也有负相关关系、2) 基因改造的高度个体化性质构成了研究的主要障碍,需要大量的队列和深度测序的元基因组方法才能对相关性和因果关系进行可靠的评估;3)由于单时点取样会错过个体内基因组的动态变化,因此未来的研究需要在个体内进行重复测量;以及4)要确定这些不断扩展的知识在糖尿病诊断和治疗中的适用性,还需要进行大量的未来研究,而新技术和改进的计算工具对实现这一目标非常重要。
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引用次数: 0
Hyperglycemic Crises in Adults With Diabetes: A Consensus Report 成人糖尿病患者的高血糖危象:共识报告
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-22 DOI: 10.2337/dci24-0032
Guillermo E. Umpierrez, Georgia M. Davis, Nuha A. ElSayed, Gian Paolo Fadini, Rodolfo J. Galindo, Irl B. Hirsch, David C. Klonoff, Rozalina G. McCoy, Shivani Misra, Robert A. Gabbay, Raveendhara R. Bannuru, Ketan K. Dhatariya
The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Joint British Diabetes Societies for Inpatient Care (JBDS), American Association of Clinical Endocrinology (AACE), and Diabetes Technology Society (DTS) convened a panel of internists and diabetologists to update the ADA consensus statement on hyperglycemic crises in adults with diabetes, published in 2001 and last updated in 2009. The objective of this consensus report is to provide up-to-date knowledge about the epidemiology, pathophysiology, clinical presentation, and recommendations for the diagnosis, treatment, and prevention of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in adults. A systematic examination of publications since 2009 informed new recommendations. The target audience is the full spectrum of diabetes health care professionals and individuals with diabetes.
美国糖尿病协会 (ADA)、欧洲糖尿病研究协会 (EASD)、英国糖尿病住院护理联合协会 (JBDS)、美国临床内分泌协会 (AACE) 和糖尿病技术协会 (DTS) 召集了一个由内科医生和糖尿病专家组成的小组,以更新 2001 年发布、2009 年最后一次更新的 ADA 关于成人糖尿病患者高血糖危象的共识声明。本共识报告旨在提供有关成人糖尿病酮症酸中毒 (DKA) 和高血糖高渗状态 (HHS) 的流行病学、病理生理学、临床表现以及诊断、治疗和预防建议等方面的最新知识。对 2009 年以来的出版物进行了系统性检查,为新建议提供了依据。目标受众是所有糖尿病医护人员和糖尿病患者。
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引用次数: 0
Increasing Medication Use and Polypharmacy in Type 2 Diabetes: The Danish Experience From 2000 to 2020 增加 2 型糖尿病患者的用药量和多重用药:丹麦 2000 年至 2020 年的经验
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-05-06 DOI: 10.2337/dc24-0011
Karl Sebastian Johansson, Espen Jimenez-Solem, Tonny Studsgaard Petersen, Mikkel Bring Christensen
OBJECTIVE Type 2 diabetes often coexists with other conditions that are amenable to pharmacological treatment. We hypothesized that polypharmacy among individuals with type 2 diabetes has increased since 2000. RESEARCH DESIGN AND METHODS Using Danish national registries, we established a cohort of all Danish individuals (aged ≥18 years) with type 2 diabetes between 2000 and 2020. We analyzed their medication use and prevalence of varying degrees of polypharmacy (≥5 or ≥10 medications), stratifying by age, sex, number of chronic diseases, and socioeconomic status. RESULTS The cohort grew from 84,917 patients in 2000 to 307,011 in 2020, totaling 461,849 unique patients. The number of daily medications used per patient increased from (mean ± SD) 3.7 ± 2.8 (in 2000) to 5.3 ± 3.2 (in 2020). The lifetime risk of polypharmacy was substantial, with 89% (n = 409,062 of 461,849) being exposed to ≥5 medications at some point and 47% (n = 217,467of 461,849) to ≥10 medications. The increases were driven by an expanding group of medications, with analgesics, antihypertensives, proton pump inhibitors, and statins having the largest net increase. Advanced age, male sex, lower socioeconomic status, and Danish ethnicity positively correlated with polypharmacy but could not explain the overall increase in polypharmacy. CONCLUSIONS Medication use and polypharmacy have increased among patients with type 2 diabetes. Although the implications and appropriateness of this increased medication use are uncertain, the results stress the increasing need for health care personnel to understand the potential risks associated with polypharmacy, including medication interactions, adverse effects, and over- and underprescribing.
目的 2 型糖尿病患者往往同时患有其他可接受药物治疗的疾病。我们假设,自 2000 年以来,2 型糖尿病患者的多重用药情况有所增加。研究设计和方法 我们利用丹麦国家登记资料,建立了 2000 年至 2020 年期间所有丹麦 2 型糖尿病患者(年龄≥18 岁)的队列。我们按照年龄、性别、慢性病数量和社会经济地位对他们的用药情况和不同程度的多重用药(≥5 种或≥10 种药物)患病率进行了分析。结果 患者群从 2000 年的 84,917 人增加到 2020 年的 307,011 人,共有 461,849 名患者。每位患者每天使用的药物数量从(平均值±标准差)3.7±2.8(2000 年)增加到 5.3±3.2(2020 年)。终生使用多种药物的风险很大,89%的患者(461849 人中的 409062 人)在某一阶段使用的药物≥5 种,47%的患者(461849 人中的 217467 人)使用的药物≥10 种。增加的原因是药物种类不断增加,其中镇痛药、降压药、质子泵抑制剂和他汀类药物的净增加量最大。高龄、男性、较低的社会经济地位和丹麦种族与多重用药呈正相关,但不能解释多重用药的总体增长。结论 2 型糖尿病患者的用药和多重用药情况有所增加。虽然这种用药增加的影响和适当性尚无定论,但研究结果强调,医护人员越来越需要了解与多种药物治疗相关的潜在风险,包括药物相互作用、不良反应以及用药过多和过少。
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引用次数: 0
Continuous Glucose Monitoring Profiles in Pregnancies With and Without Gestational Diabetes Mellitus 妊娠糖尿病和非妊娠糖尿病孕妇的连续血糖监测图谱
IF 16.2 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-05-03 DOI: 10.2337/dc23-2149
Celeste Durnwald, Roy W. Beck, Zoey Li, Elizabeth Norton, Richard M. Bergenstal, Mary Johnson, Sean Dunnigan, Matthew Banfield, Katie Krumwiede, Judy Sibayan, Peter Calhoun, Anders L. Carlson
OBJECTIVE To determine whether continuous glucose monitoring (CGM)-derived glycemic patterns can characterize pregnancies with gestational diabetes mellitus (GDM) as diagnosed by standard oral glucose tolerance test at 24–28 weeks’ gestation compared with those without GDM. RESEARCH DESIGN AND METHODS The analysis includes 768 individuals enrolled from two sites prior to 17 weeks’ gestation between June 2020 and December 2021 in a prospective observational study. Participants wore blinded Dexcom G6 CGMs throughout gestation. Main outcome of interest was a diagnosis of GDM by oral glucose tolerance test (OGTT). Glycemic levels in participants with GDM versus without GDM were characterized using CGM-measured glycemic metrics. RESULTS Participants with GDM (n = 58 [8%]) had higher mean glucose (109 ± 13 vs. 100 ± 8 mg/dL [6.0 ± 0.7 vs. 5.6 ± 0.4 mmol/L], P < 0.001), greater glucose SD (23 ± 4 vs. 19 ± 3 mg/dL [1.3 ± 0.2 vs. 1.1 ± 0.2 mmol/L], P < 0.001), less time in range 63–120 mg/dL (3.5–6.7 mmol/L) (70% ± 17% vs. 84% ± 8%, P < 0.001), greater percent time >120 mg/dL (>6.7 mmol/L) (median 23% vs. 12%, P < 0.001), and greater percent time >140 mg/dL (>7.8 mmol/L) (median 7.4% vs. 2.7%, P < 0.001) than those without GDM throughout gestation prior to OGTT. Median percent time >120 mg/dL (>6.7 mmol/L) and time >140 mg/dL (>7.8 mmol/L) were higher as early as 13–14 weeks of gestation (32% vs. 14%, P < 0.001, and 5.2% vs. 2.0%, P < 0.001, respectively) and persisted during the entire study period prior to OGTT. CONCLUSIONS Prior to OGTT at 24–34 weeks’ gestation, pregnant individuals who develop GDM have higher CGM-measured glucose levels and more hyperglycemia compared with those who do not develop GDM.
目的 确定连续血糖监测(CGM)得出的血糖模式是否能描述妊娠 24-28 周时通过标准口服葡萄糖耐量试验诊断出的妊娠糖尿病(GDM)孕妇与非 GDM 孕妇的血糖模式。研究设计和方法 该分析包括在 2020 年 6 月至 2021 年 12 月期间,在两个地点对妊娠 17 周前的 768 名妊娠者进行的前瞻性观察研究。参与者在整个妊娠期间佩戴盲法 Dexcom G6 CGM。主要研究结果是通过口服葡萄糖耐量试验(OGTT)诊断出 GDM。使用 CGM 测量的血糖指标对 GDM 患者和非 GDM 患者的血糖水平进行分析。结果 患有 GDM 的参与者(n = 58 [8%])平均血糖更高(109 ± 13 vs. 100 ± 8 mg/dL [6.0 ± 0.7 vs. 5.6 ± 0.4 mmol/L],P < 0.001),血糖 SD 更大(23 ± 4 vs. 19 ± 3 mg/dL [1.3 ± 0.2 vs. 1.1 ± 0.2 mmol/L],P < 0.001),在 63-120 mg/dL (3.5-6.7毫摩尔/升)的时间较少(70% ± 17% vs. 84% ± 8%,P < 0.001),在>120毫克/分升(>6.7毫摩尔/升)范围内的时间百分比较高(中位数23% vs. 12%,P < 0.001),以及在 OGTT 之前的整个妊娠期间,与无 GDM 者相比,更长的时间 >140 mg/dL (>7.8 mmol/L)(中位数为 7.4% vs. 2.7%,P < 0.001)。中位时间>120 mg/dL(>6.7 mmol/L)和时间>140 mg/dL(>7.8 mmol/L)的百分比早在妊娠 13-14 周时就较高(分别为 32% vs. 14%,P< 0.001 和 5.2% vs. 2.0%,P< 0.001),并在 OGTT 前的整个研究期间持续存在。结论 在妊娠 24-34 周进行 OGTT 之前,与未发生 GDM 的孕妇相比,发生 GDM 的孕妇的 CGM 测量血糖水平更高,高血糖现象更严重。
{"title":"Continuous Glucose Monitoring Profiles in Pregnancies With and Without Gestational Diabetes Mellitus","authors":"Celeste Durnwald, Roy W. Beck, Zoey Li, Elizabeth Norton, Richard M. Bergenstal, Mary Johnson, Sean Dunnigan, Matthew Banfield, Katie Krumwiede, Judy Sibayan, Peter Calhoun, Anders L. Carlson","doi":"10.2337/dc23-2149","DOIUrl":"https://doi.org/10.2337/dc23-2149","url":null,"abstract":"OBJECTIVE To determine whether continuous glucose monitoring (CGM)-derived glycemic patterns can characterize pregnancies with gestational diabetes mellitus (GDM) as diagnosed by standard oral glucose tolerance test at 24–28 weeks’ gestation compared with those without GDM. RESEARCH DESIGN AND METHODS The analysis includes 768 individuals enrolled from two sites prior to 17 weeks’ gestation between June 2020 and December 2021 in a prospective observational study. Participants wore blinded Dexcom G6 CGMs throughout gestation. Main outcome of interest was a diagnosis of GDM by oral glucose tolerance test (OGTT). Glycemic levels in participants with GDM versus without GDM were characterized using CGM-measured glycemic metrics. RESULTS Participants with GDM (n = 58 [8%]) had higher mean glucose (109 ± 13 vs. 100 ± 8 mg/dL [6.0 ± 0.7 vs. 5.6 ± 0.4 mmol/L], P < 0.001), greater glucose SD (23 ± 4 vs. 19 ± 3 mg/dL [1.3 ± 0.2 vs. 1.1 ± 0.2 mmol/L], P < 0.001), less time in range 63–120 mg/dL (3.5–6.7 mmol/L) (70% ± 17% vs. 84% ± 8%, P < 0.001), greater percent time >120 mg/dL (>6.7 mmol/L) (median 23% vs. 12%, P < 0.001), and greater percent time >140 mg/dL (>7.8 mmol/L) (median 7.4% vs. 2.7%, P < 0.001) than those without GDM throughout gestation prior to OGTT. Median percent time >120 mg/dL (>6.7 mmol/L) and time >140 mg/dL (>7.8 mmol/L) were higher as early as 13–14 weeks of gestation (32% vs. 14%, P < 0.001, and 5.2% vs. 2.0%, P < 0.001, respectively) and persisted during the entire study period prior to OGTT. CONCLUSIONS Prior to OGTT at 24–34 weeks’ gestation, pregnant individuals who develop GDM have higher CGM-measured glucose levels and more hyperglycemia compared with those who do not develop GDM.","PeriodicalId":11140,"journal":{"name":"Diabetes Care","volume":"52 1","pages":""},"PeriodicalIF":16.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140821671","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
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 ENDOCRINOLOGY & METABOLISM 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 ENDOCRINOLOGY & METABOLISM 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 ENDOCRINOLOGY & METABOLISM 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 ENDOCRINOLOGY & METABOLISM 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 ENDOCRINOLOGY & METABOLISM 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。
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引用次数: 0
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Diabetes Care
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