Diabetes Therapy最新文献

Introduction: The study aimed to explore the association between type 2 diabetes (T2D) and heart failure (HF) using echocardiography and NT-proBNP. The study also derived an NT-proBNP cut-off for diagnosing HF by echo in Asian Indians with T2D.

Methods: A retrospective study was performed using data from individuals with T2D, aged ≥ 18 years, who visited diabetes clinics in India between March 2019 and December 2023. NT-proBNP levels were quantified by chemiluminescence, and left ventricular ejection fraction (LVEF) was assessed from echo using two-dimensional (2D) echocardiography. Heart failure was classified based on the European Society of Cardiology (ESC) guidelines. Receiver operating characteristic (ROC) curve was performed to determine the optimal NT-proBNP cut-off for diagnosing HF by echo.

Results: Among the 1189 study individuals included in the study (714 men and 475 women), 5.9% were identified as having HF with reduced ejection fraction (HFrEF), 5.5% had mildly reduced ejection fraction (HFmrEF), and 14.1% had HF with preserved ejection fraction (HFpEF) while the rest (74.5%) had LVEF > 50%. Elevated NT-proBNP levels were observed in those with reduced ejection fraction. ROC analysis identified an optimal NT-proBNP threshold of 398 pg/mL for diagnosing HF, with 87% sensitivity and 78% specificity. HF prevalence increased with age, peaking at 30.6% in individuals aged 61-70 years. Women with HF had higher NT-proBNP levels than men.

Conclusions: In this diabetes clinic population, 11.5% of individuals with T2D had moderate to reduced LVEF. Early identification of HF using echocardiography and NT-proBNP in a diabetes clinic could help improve prognosis.

Diabetic retinopathy (DR) is a preventable, frequent, and serious complication of diabetes, with a large impact on morbidity and disability. More than 125 million people worldwide suffer from DR. The pathogenesis of DR involves different pathways, many of them exacerbated by chronic hyperglycemia, but not necessarily a direct consequence of it. Fibrates are a well-known family of medications traditionally employed for the treatment of hypertriglyceridemia and low HDL cholesterol, which act through binding to the nuclear receptor peroxisome proliferator-activated receptors (PPAR)-alpha in several tissues. PPAR-alpha is expressed in the human retina. Animal and cellular models have demonstrated that PPAR activation by fibrates improves cellular phenomena involved in the genesis of DR, including chronic inflammation, oxidative damage, vascular hyperpermeability and microglial activation. Secondary analyses of fenofibrate trials originally designed to assess cardiovascular outcomes, systematically found an apparent benefit from fenofibrate treatment on diverse measures of DR appearance and severity. Finally, the LENS (Lowering Events in Non-Proliferative Retinopathy) study proved in a dedicated randomized trial that early fenofibrate use lowers the risk of DR progression in a statistically significant and clinically meaningful manner. These results have positioned fenofibrate as the first agent proven to specifically delay DR, without mediation by glycemic control. Future studies will test whether this effect extends to other microvascular diabetes complications.

Introduction: The appropriate use of glycated haemoglobin (HbA1c), the international standard for assessing overall glycaemic status in diabetes mellitus, is critical to ensuring optimal clinical outcome and minimise complications. We describe a clinical laboratory-led general practice service development to facilitate targeted follow-up in high-risk patients.

Methods: The service development comprised monthly reports identifying high-risk individuals (HbA1c ≥ 58 mmol/mol) overdue HbA1c testing, sent by the Clinical Biochemistry Laboratory to general practices in the 'Intervention' group (n = 60). A 'Non-intervention' group comprised 51 practices not sent the reports. Comparisons comprised: (i) intervention vs non-intervention groups during two time periods (pre-intervention: 2017-2020; 275,843 tests; 59,206 patients, and post-intervention: 2020-2023; 307,525 tests; 65,449 patients), (ii) pre- versus post-intervention in each group.

Results: The intervention group (vs non-intervention group) showed larger net change in proportion overdue a test (- 20.6% vs - 10.3%, p < 0.001), particularly in the > 75 mmol/mol category (7.8-fold larger improvement, p < 0.001). Improvements were also observed in median time overdue in the 58-75 mmol/mol group (- 14.3 vs - 4.3%; p = 0.027). Improvements were identified in median HbA1c (p = 0.012) and overall proportion with HbA1c ≥ 58 mmol/mol (p = 0.037), compared with the non-intervention group, despite performing more tests/patient/year (p < 0.001). All remained significant after adjustment for practice characteristics (age, sex, social deprivation, list size, diabetes prevalence) and pre-intervention levels.

Conclusions: Our findings indicate that clinical laboratories can support general practices facilitating targeting monitoring to high-risk patients. Providing succinct reports that identify patients overdue for testing can reduce the number of such patients, thereby improving diabetes control and increasing the achievement of target levels.

Introduction: Type 2 diabetes mellitus (T2DM) is a global health concern with significant mortality rate associated with comorbidities like diabetic kidney disease (DKD) and cardiovascular disease (CVD). Thus, treatment guidelines recommend first-line treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2Is) and/or glucagon-like peptide 1 (GLP-1) agonists for T2DM with comorbidities. However, in patients when these treatments are not tolerated, contraindicated, or considered expensive, dipeptidyl peptidase 4 inhibitors (DPP4Is) serve as an add-on or alternative for glycemic control without hypoglycemia risk. This study aimed to understand patients' preferences in three South Asian countries between SGLT2I (medication A) and DPP4I (medication B) and the reasons influencing their preference for effective management of T2DM.

Methods: In this cross-sectional study (November 2021 to November 2022) across India, Taiwan, and the Philippines, patients with T2DM on both SGLT2I and DPP4I or neither completed the survey to identify their medication preferences. Differences in baseline characteristics and preferred medication (chi-squared/Fisher's exact tests) and potential attributes influencing preferences (logistic regression) were analyzed.

Results: Among 1224 participants, SGLT2I (64.5%) was significantly preferred over DPP4I (35.5%). Mean age of participants was 59.3 years and the majority were female patients/individuals (52.5%), overweight/obese (56.6%), with glycated hemoglobin levels ≥ 7% (57.6%). Common comorbidities included hypertension (62.7%) and dyslipidemia (75.5%); the majority were without history of CVD (83.7%) or CKD (84%). The most prescribed T2DM medication was biguanide (83.9%), followed by combination of SGLT2Is and DPP4Is (51.3%). The most influential attributes were blood sugar reduction (56.9%), reduced heart failure hospitalization (14.4%), and kidney disease risk reduction (12.1%). SGLT2I users showed a higher preference for heart failure hospitalization reduction (16.5%) or weight reduction (11.1%). Country of residence, thiazolidinedione use, and SGLT2I/DPP4I use were significant factors in logistic regression analyses.

Conclusion: Asian patients with T2DM preferred medication profile resembling SGLT2Is over DPP4Is. Understanding patient preferences may aid optimal glycemic control while reducing cardiovascular and renal risks.

The association of sleep apnoea with insulin resistance and type 2 diabetes mellitus (T2DM) is well studied. However, little is known on the impact of sleep apnoea on glycaemic variability (GV). Continuous glucose monitoring (CGM) systems shed light on GV not only during sleep but throughout the day among people with or without diabetes mellitus (DM) and obstructive sleep apnoea syndrome (OSAS). In this narrative review, we aimed to summarise the evidence on the role of CGM in assessing GV among individuals with sleep apnoea. Articles related to CGM use among individuals with OSAS were included. Emerging data suggests a significant impact of OSAS on glucose metabolism during sleep and wakefulness. Of note, OSAS affects GV irrespective of glycaemic status. Moreover, the severity of OSAS has been associated with increased GV. As GV triggers oxidative stress, it contributes to adverse outcomes in people with diabetes and/or OSAS. Interestingly, a beneficial effect of continuous positive airway pressure (CPAP) treatment on blood glucose and on GV in individuals with both T2DM and OSAS has emerged, but evidence is conflicting. Additionally, among pregnant women with gestational diabetes and sleep-disordered breathing, CGM could detect nocturnal hyperglycaemic episodes, improving glycaemic control and perinatal outcomes. Future studies are needed to investigate the exact impact of OSAS treatment on GV.

Introduction: We aimed to examine a cohort of people with diabetes to prospectively determine the association between diabetes therapy-related quality of life (DTR-QOL) and the subsequent risk of all-cause mortality.

Methods: Longitudinal data of 3795 individuals with diabetes were obtained from a single-center diabetes registry from 2011. To assess the association between DTR-QOL at baseline and the subsequent risk of all-cause mortality, a Cox proportional hazards model was used with adjustment for baseline potential confounders (age, sex, duration of diabetes, body mass index [BMI], glycated hemoglobin [HbA1c] level, urinary albumin/creatinine ratio, history of diabetic retinopathy, symptomatic diabetic neuropathy, medical history, type of diabetes, and diabetes prescriptions).

Results: We observed 425 deaths during a median follow-up of 8.7 years. The median (interquartile range) age and HbA1c level were 66 (60-74) years and 6.9% (6.7-8.1%), respectively. The DTR-QOL was significantly associated with younger age, female sex, higher BMI, higher HbA1c level, higher proportion of symptomatic diabetic neuropathy, higher proportion of diabetic retinopathy, and higher proportion of insulin use. In total, 425 deaths occurred during the study period. Compared with the third tertile group of DTR-QOL scores, the hazard ratios (HRs) were consistently 1.38 times higher in the first tertile group. Lower scores on "burden on social activities and daily activities" domain were associated with a higher HR, while lower scores on the other domains ("anxiety and dissatisfaction with therapy," "hypoglycemia," and "satisfaction with therapy") were not.

Conclusion: A lower QOL related to diabetes therapy in people with diabetes was found to be associated with an increased risk of future mortality. Graphical Abstract available for this article.

Introduction: Despite advancements in diabetes therapeutics and innovations, suboptimal dosing continues to be a barrier to glycaemic control for people with diabetes (PwD). This study aimed to understand the extent of suboptimal insulin dosing and the factors underlying this behaviour from the perspective of PwD and healthcare professionals (HCPs) in Germany.

Methods: This analysis included 400 German PwD employing analogue insulin pens (type 1 diabetes, n = 100; type 2 diabetes, n = 300) and 160 HCPs (general practitioners, n = 80; specialists, n = 80), and was part of a cross-sectional, multinational, noninterventional web-based survey (1150 PwD and 640 HCPs). The proportion of PwD reporting missed/mistimed/miscalculated insulin doses and the mean ± SD number of insulin doses missed/mistimed/miscalculated within the last 30 days were analysed.

Results: Among the 400 PwD (69.5% male, 30.5% female), the mean age was 47.1 ± 13.0 years. Within the last 30 days, 47.3% of PwD missed basal insulin doses (3.5 ± 2.9 mean number of insulin doses missed) and 58.0% missed bolus insulin doses (5.0 ± 10.1). Additionally, 47.3% and 51.0% mistimed basal insulin doses (3.9 ± 4.3 mean number of insulin doses mistimed) and bolus insulin doses (5.0 ± 7.1), respectively, and 47.5% and 63.3% PwD miscalculated basal insulin doses (4.5 ± 5.0 mean number of insulin doses miscalculated) and bolus insulin doses (5.5 ± 7.5), respectively. Of the 160 HCPs (73.1% male, 26.9% female), 98.1% were qualified for > 5 years. Overall, ≥ 67% HCPs indicated that up to 30% of PwD missed/forgot/skipped, mistimed, or miscalculated an insulin dose in the last 30 days. Reasons reported by PwD and HCPs included forgetting, being out of their normal routine, being too busy or distracted, or being unsure of how much insulin to take. PwD and HCPs suggested that having a device that automatically records glucose measurements, insulin doses, and timing and having dosing calculation guidance and real-time feedback on how insulin dosing impacts glucose levels would optimise insulin dosing.

Conclusion: PwD are mismanaging insulin doses largely for preventable reasons. Integrated and automated insulin dosing support may optimise insulin management and improve communication between PwD and HCPs.

Introduction: Insulin resistance (IR) is a major feature of type 2 diabetes mellitus (T2DM) and plays a crucial role in the accelerated progression of diabetic kidney disease (DKD). It has been found that surrogates of IR are of high value in assessing IR status. This study aims to evaluate the associations between surrogates of IR and DKD in T2DM.

Methods: A total of 1026 patients with T2DM from January 2021 to February 2022 were selected in our final analysis. Logistic regression analysis and the receiver operating characteristic (ROC) curve analysis were performed to assess the correlation between IR surrogates and DKD.

Results: The levels of triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist to height ratio (TyG-WHtR), visceral adiposity index (VAI), and lipid accumulation product (LAP) were significantly higher in the microalbuminuria group and macroalbuminuria group compared with the normoalbuminuria group (P < 0.05). The results of multivariate logistic regression analysis showed that the highest quartile of triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C), triglyceride glucose (TyG) index, TyG-WHtR, TyG-WC, LAP, and VAI were significantly correlated with DKD (all P < 0.05). The ROC curves and results showed that TyG area under the curve (AUC) > VAI AUC > TG/HDL-C AUC > TyG-WHtR AUC > LAP AUC > 0.7 > TyG-WC AUC > metabolic index of insulin resistance (METS-IR) AUC > 0.6 > triglyceride glucose-body mass index (TyG-BMI) AUC > 0.5.

Conclusions: The predictive value of IR surrogates for DKD in T2DM varies. TG/HDL-C, TyG, TyG-WHtR, LAP, and VAI can effectively predict DKD and are expected to be simple and economic biological indicators of DKD risk.

Type 2 diabetes mellitus (T2DM) is a global health priority, with an estimated 629 million people projected to be affected by the year 2045. T2DM significantly increases the risk of atherosclerotic cardiovascular disease and other complications. Hyperglycaemia imprints early molecular and cellular changes, often termed "metabolic memory", predisposing individuals to long-term microvascular and macrovascular complications, even after glycaemic normalisation. T2DM remission is increasingly recognised as an achievable target, offering substantial benefits such as reduced morbidity, improved quality of life, and preservation of beta-cell function. Among therapeutic options, metabolic surgery (MS) demonstrates the most significant impact, particularly for long-term outcomes. MS induces profound hormonal changes, including increased glucagon-like peptide 1 (GLP-1) levels and improved bile acid metabolism, alongside reductions in ectopic fat in the liver and pancreas, which improve insulin sensitivity and secretion. However, intensive lifestyle and pharmacological interventions, such as GLP-1 receptor agonists and glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 dual agonists like tirzepatide, also show promise, particularly when implemented early in the disease course. Predictors of sustained remission include younger age, shorter diabetes duration, lower baseline HbA1c, absence of insulin use, fewer medications and greater total weight loss percentage. Emerging tools such as the DiaRem score, machine learning models, and biomarkers like FGF-21 enhance patient stratification and predict remission likelihood. This narrative review explores the mechanisms and therapeutic options for T2DM remission, evaluates their impact on long-term outcomes and highlights the importance of early, multidisciplinary, and personalised interventions to optimize remission and improve metabolic health.