Diabetes research and clinical practice最新文献

Background: This study aimed to evaluate the association between sodium-glucose cotransporter 2 inhibitor (SGLT2i) use and the risk of exacerbation and mortality among patients with chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM).

Methods: Taiwan's National Health Insurance Research Database was used to select the COPD patients with DM and those prescribed SGLT2i and dipeptidyl peptidase-4 inhibitor (DPP4i). To reduce the selection and confounding bias, an active comparator new user design was used in current study to estimate the SGLT2i effects. The risk of COPD exacerbation and mortality was calculated using Cox regression model.

Results: We identified 188 SGLT2i-useres and 181 DPP4i users. SGLT2i use was associated with a significantly lower risk of overall COPD exacerbation (HR, 0.69; 95% CI, 0.52-0.92). In addition, SGLT2i users demonstrated a significantly lower risk of severe acute exacerbations with Hazard ratio of 0.35 (95% CI, 0.20-0.61) than DPP4i users. However, no significant differences in mortality were observed between groups (HR, 1.51, 95% CI, 0.53-4.25).

Conclusion: SGLT2i use in COPD patients with DM was associated with reduced risks of COPD exacerbation, particularly for severe acute exacerbation compared with DPP4i. This finding suggested that SGLT2i therapy may have a protective effect against severe exacerbations in COPD management.

Objective: Diabetic foot (DF), especially DF ulcers (DFUs) are a relatively frequent and financially burdensome late-stage complication of diabetes. However, data on the costs of podiatric care in the Czech Republic are scarce. The aim of this prospective multicenter study was to determine the total costs associated with long-term podiatric care in selected foot clinics across the Czech Republic.

Research design and methods: A total of 119 patients with DFUs (mean age of 68 ± 11 years, diabetes duration of 19 ± 11 years, HbA1c level of 62 ± 14 mmol/mol, composite WIfI score of 3 ± 2, 33 % had new DFUs, 37 % previous amputations, and 50 % had peripheral artery disease (PAD)) from 10 podiatric foot clinics in the Czech Republic were enrolled in our financial analysis. Direct and indirect costs associated with podiatric care - diagnostic and treatment methods - including angiological, radiological, and microbiological examinations, blood sampling, prescribed materials for local therapy, antibiotics, surgical procedures, offloading devices, hospital services and additional expenses such as patient transportation, doctors' visits, home care assistance, and work incapacity - were monitored over a 6-month period using an electronic database.

Results: The average cost of podiatric care per patient over a 6-month period was €2,506 with median €1,320. The largest expenses were spent on therapeutic procedures (51.4 %). Costs for patients hospitalized during the study period were significantly higher than for outpatients (€7,923 vs. €1,304 on average; P < 0.001). Among hospitalized patients, the main costs were hospital services (32 %), therapeutic procedures (26 %), and antibiotic and local therapies (20 %). Among outpatients, therapeutic procedures accounted for 74 % of the total costs. Newly developed DFUs or PAD were not linked to significantly increased costs. The composite WIfI score, primarily the wound component, was the only parameter that significantly positively correlated with the total podiatric costs (r = 0.434; 95 % CI 0.279-0.559; P < 0.0001). Other patient characteristics such as age, diabetes duration, DFU duration, and HbA1c level did not show significant cost correlations.

Conclusions: On average, podiatric care for patients with DFUs in the Czech Republic is 3 to 9 times more expensive than standard diabetes healthcare. The expenses for hospitalized patients are almost 6 times higher than for outpatients. The composite WIfI score was the most significant indicator of podiatric financial burden.

Aims: The study aims to assess whether a radiation-crosslinked carboxymethyl-chitosan/gelatin hydrogel can exhibit superior healing properties in diabetic wounds through collagen synthesis, epithelial maturation, inflammation regulation and angiogenesis, and determine if it can be applied on alternate days to reduce patient compliance pressure.

Methods: The study used a full-thickness diabetic wound rat model. The hydrogel was applied either daily or on alternate days. H&E, Masson's trichrome, Sirius red and immunohistochemical staining were employed. Two patients with diabetes were recruited for case studies where the hydrogel was applied on alternate days.

Results: Under the application of the hydrogel, accelerated healing was observed, with enhanced re-epithelialization and dermal differentiation. The treated groups developed mature skin characteristics absent in the control group, and a well-organized collagen network was observed. There was also accelerated macrophage infiltration, phenotype shift and enhanced angiogenesis at different healing stages. In addition, two patients were positive with alternate-day application of the hydrogel.

Conclusions: The radiation-crosslinked carboxymethyl-chitosan/gelatin hydrogel shows great potential as a promising modality for diabetic wound management, with both daily and alternate-day applications having immunomodulatory and pro-angiogenic functions.

Aim: The STOP study is a proof-of-concept, aimed at evaluating the effectiveness and safety of IdegLira in deintensifying diabetes therapy in elderly insulin-treated persons with T2DM.

Methods: The study was a real world, single center retrospective observation.

Results: 96 persons were enrolled (46F, age 77 ± 7 yrs, HbA1C 7.5 ± 1.0, diabetes duration 21 ± 10 yrs; 75 % in basal/bolus insulin therapy). After 6 months (T6), fasting plasma glucose significantly decreased as compared to T0, as did HbA_1C. The switch to IdegLira was associated with significantly lower rates of level 1 (L1) hypoglycemia at T3 (IR 0.24, 95 % CI 0.11-0.58, p < 0.001) and T6 (IR 0.08, 95 % CI 0.02-0.34, p < 0.001) as compared to T0. Level 2 (L2) hypoglycemia rates significantly decreased at T3 (IR 0.04, 95 % CI 0.01-0.32, p < 0.001) as compared to T0. The proportion of persons (incidence) with L1 hypoglycemia decreased from 33.7 % at T0 to 17.4 % at T3 (p = 0.004) and to 5.8 % at T6 (p < 0.001). Incidence of L2 hypoglycemia decreased from 22.1 % at T0 to 1.16 % at T3 (p < 0.001). No patients had L2 hypoglycemia at T6. Rapid acting insulin was interrupted in 85 % of patients.

Conclusions: IdegLira represents a viable option in deintensifying insulin therapy in an elderly population.