Diabetes research and clinical practice最新文献_第2页

Association of gestational and childhood circulating C-peptide concentrations in the hyperglycemia and adverse pregnancy outcomes follow-up study 妊娠期和儿童期循环c肽浓度与高血糖和不良妊娠结局随访研究的关系

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2024.111967

Ananthi Rajamoorthi , Hao Zheng , Alicja A. Skowronski , Noelia Zork , Uma M. Reddy , Pei Wen Tung , Allison Kupsco , Dympna Gallagher , Rany M. Salem , Rudolph L. Leibel , Charles A. LeDuc , Vidhu V. Thaker

Aims

This study examined the association of gravida C-peptide with progeny islet function and insulin sensitivity in the Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS).

Methods

Pregnancy 3rd trimester oral glucose tolerance test (OGTT), cord blood, and offspring OGTT glucose, C-peptide and insulin at age 10–14 years were analyzed for 4,121 mother–child dyads. Gravida fasting and 1-hour C-peptide concentration correlations with cord blood and childhood C-peptide, insulin, insulinogenic index and insulin sensitivity, and insulin resistance [HOMA-IR]), were assessed by multiple linear regression. Maternal covariates included age, gestational age, BMI and glucose at OGTT; child covariates included age, sex, pubertal stage, BMI z score and glucose.

Results

Gravida fasting and 1-hour OGTT C-peptide was positively correlated with cord blood C-peptide, offspring OGTT C-peptide and insulin concentrations at fasting, 30 min, 1-hour and 2-hour at 10–14 years of age. Maternal fasting and 1-hour C-peptide concentrations were positively correlated with the insulinogenic index and HOMA-IR but inversely correlated with insulin sensitivity. Maternal C-peptide explained more variance than maternal glucose concentrations (3.0–17.9 % vs 0.2–3.5 %).

Conclusions/Interpretation

The correlation between gravida and offspring C-peptide suggests that without crossing the placenta, insulin may influence the offspring pancreatic beta-cell development and insulin sensitivity.

目的：本研究在高血糖和不良妊娠结局随访研究（HAPO FUS）中探讨妊娠c肽与子代胰岛功能和胰岛素敏感性的关系。方法：对4121例妊娠第3个月口服糖耐量试验（OGTT）、脐带血及10 ~ 14岁子代OGTT葡萄糖、c肽和胰岛素进行分析 。通过多元线性回归评估妊娠期禁食和1小时c肽浓度与脐带血和儿童c肽、胰岛素、胰岛素原性指数和胰岛素敏感性以及胰岛素抵抗[HOMA-IR])的相关性。母亲协变量包括OGTT时的年龄、胎龄、BMI和血糖；儿童协变量包括年龄、性别、青春期阶段、BMI z评分和血糖。结果：妊娠期禁食及1小时OGTT c肽与脐带血c肽、子代OGTT c肽及10-14 岁空腹、30 min、1小时、2小时胰岛素浓度呈正相关。孕妇空腹和1小时c肽浓度与胰岛素生成指数和HOMA-IR呈正相关，与胰岛素敏感性呈负相关。母体c肽比母体葡萄糖浓度解释更多的差异（3.0-17.9 % vs 0.2-3.5 %）。结论/解释：妊娠与子代c肽的相关性提示，在不通过胎盘的情况下，胰岛素可能会影响子代胰腺β细胞发育和胰岛素敏感性。

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引用次数: 0

Applying 1-hour postload plasma glucose diagnostic criteria reveals high Progressive Risks of potential MASLD 应用负荷后1小时血糖诊断标准显示潜在MASLD的高进展风险。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2024.111973

Long Teng , Ling Luo , Yanhong Sun , Wei Wang , Zhi Dong , Xiaopei Cao , Junzhao Ye , Bihui Zhong

Background

Recently, a 1-h PG value of ≥ 8.6 mmol/L, a more sensitive predictor of diabetes mellitus-related long-term cardiovascular complications than routine glucose markers, has been recommended as an additional diagnostic criterion for diabetes in the International Diabetes Federation Position Statement. However, its value in MASLD remains uncertain.

Methods

Consecutive participants with imaging assessments of fatty liver and a 75-g oral glucose tolerance test, including 1154 participants with MASLD, 161 fulfilling the nonalcoholic fatty liver disease but not the MASLD diagnostic criteria (NAFLD-non-MASLD) and 1026 subjects with non-fatty liver, were retrospectively enrolled from June 2009 to May 2024.

Results

Patients with MASLD or NAFLD-non-MASLD had higher 1-h PG levels than those with non-fatty liver (p < 0.001). In patients with MASLD or NAFLD-non-MASLD, 1-h PG ≥ 8.6 mmol/L was associated with the risk of moderate-to-severe steatosis (p < 0.001), ALT elevation (p < 0.001), advanced fibrosis (p = 0.03), and cardiovascular diseases (p < 0.001). Furthermore, NAFLD-non-MASLD patients with 1-h PG ≥ 8.6 mmol/L showed a higher prevalence of advanced fibrosis than MASLD patients with or without 1-h PG ≥ 8.6 mmol/L (p < 0.05).

Conclusions

NAFLD-non-MASLD patients with 1-h PG ≥ 8.6 mmol/L are still at high risk of poor clinical outcomes. These findings support including 1-h PG ≥ 8.6 mmol/L as a component of the metabolic dysfunction definition.

背景：最近，与常规血糖指标相比，1 h PG值≥ 8.6 mmol/L能更灵敏地预测与糖尿病相关的长期心血管并发症，国际糖尿病联盟立场声明建议将其作为糖尿病的附加诊断标准。然而，它在 MASLD 中的价值仍不确定：方法：对2009年6月至2024年5月期间连续接受脂肪肝影像学评估和75克口服葡萄糖耐量试验的患者进行回顾性研究，其中包括1154名MASLD患者、161名符合非酒精性脂肪肝诊断标准但不符合MASLD诊断标准的患者（NAFLD-non-MASLD）和1026名非脂肪肝患者：MASLD或NAFLD-non-MASLD患者的1-h PG水平高于非脂肪肝患者（P1-h PG≥ 8.6 mmol/L的非酒精性脂肪肝-非MASLD患者仍面临不良临床结局的高风险。这些发现支持将 1-h PG ≥ 8.6 mmol/L 作为代谢功能障碍定义的一个组成部分。

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引用次数: 0

Duration of physical activity required to Ameliorate hyperglycemia without causing hypoglycemia in type 1 diabetes: A T1DEXI adults and pediatric cohort analyses 改善 1 型糖尿病患者高血糖而不导致低血糖所需的体力活动持续时间：T1DEXI成人和儿童队列分析。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2024.111981

John Pemberton , Zoey Li , Robin L. Gal , Lauren V. Turner , Simon Bergford , Peter Calhoun , Michael C. Riddell

Aims

To estimate physical activity (activity) duration required to lower glucose from above target range (>180 mg/dL) to within target range (TIR: 70–180 mg/dL) in individuals with type 1 diabetes (T1D).

Methods

Continuous glucose monitoring and activity data were collected from 404 adults (28-day observation) and 149 adolescents (10-day observation) with T1D. Activities (N = 1902) with a starting glucose between 181-300 mg/dL, duration 10–60 min, and no reported meals during activity were included in the analysis. Kaplan-Meier curves were used to estimate activity duration required to drop starting glucose levels from above to within TIR.

Results

An overall starting glucose value of 181–199, 200–224, 225–249, and 250–300 mg/dL required an estimated activity duration of 15, 31, 59, and ≥ 60 min, respectively, to have a 50 % chance of reducing glucose to be within target range, with a 0–11 % incidence of hypoglycemia in the hour after activity. Activity duration requirements increased irrespective of starting glucose levels when glucose was trending upwards before activity and with zero bolus insulin on board at the start of activity. Adult and adolescent results were similar.

Conclusions

Time-limited activity is an effective means of restoring TIR when hyperglycemia exists in adolescents and adults with T1D.

目的：估计1型糖尿病（T1D）患者将血糖从高于目标范围（>180 mg/dL）降至目标范围（TIR: 70-180 mg/dL）所需的体力活动（活动）持续时间。方法：对404例成人T1D患者（观察28天）和149例青少年T1D患者（观察10天）进行连续血糖监测和活动数据采集。活动（N = 1902），起始葡萄糖在181- 300 mg/dL之间，持续时间10-60 min，活动期间未报告膳食。Kaplan-Meier曲线用于估计将起始葡萄糖水平从以上降至TIR内所需的活动时间。结果：总体起始葡萄糖值为181- 199,200 -224,225-249和250-300 mg/dL，分别需要估计的活动持续时间为15,31,59和 ≥ 60 min，才能有50% %的机会将葡萄糖降至目标范围内，活动后一小时内低血糖发生率为0- 11% %。当葡萄糖在运动前呈上升趋势，并且在运动开始时没有注射胰岛素时，无论开始时葡萄糖水平如何，运动持续时间要求都会增加。成人和青少年的结果相似。结论：在青少年和成人T1D患者存在高血糖时，限时活动是恢复TIR的有效手段。

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引用次数: 0

Association between sex, age, temporal trends, and glycemic control of 221,769 adults with type 2 diabetes in a multi-ethnic middle-income Asian country 亚洲一个多种族中等收入国家221769名2型糖尿病成年人的性别、年龄、时间趋势和血糖控制之间的关系

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2024.111976

Swee Hung Ang , Lee-Ling Lim , Feisul Idzwan Mustapha , Eliana Ahmad , Sanjay Rampal

Aims

We examined the association between sex, age, temporal trends, and glycemic control among people with type 2 diabetes (T2D) in a multi-ethnic middle-income Asian country.

Methods

Using the National Diabetes Registry (2011–2020), we analyzed data for 221,769 adult Malaysians with T2D. We used quantile regressions to estimate the association of sex, age, and their interaction on HbA_1clevels at the 5th, 50th, and 95th percentile and logistic regression to estimate the odds of good control (HbA_1c < 7 %).

Results

The participants were Malays (61.8 %), females (59.3 %), and aged 50–69 years (63.5 %). The median (interquartile range [IQR]) HbA_1c was 7.2 % (6.4 %, 8.9 %) for males and 7.3 % (6.4 %, 9.0 %) for females. The prevalence of good control was 42.8 % for males and 41.8 % for females. Glycemic control improved from 2011 to 2020 for both females and males above 40. Control significantly improved with age among both sexes. However, females had increasingly better control than men with increasing age (P_{Heterogeneity} < 0.001). The adjusted odds (95 % CI) of good control comparing females to males at 30, 50, and 70 years was 0.90 (0.81, 0.99), 0.93 (0.90, 0.97), and 1.12 (1.08, 1.16) respectively.

Conclusions

A more aggressive approach to type 2 diabetes management is needed for both sexes, targeting especially the younger age groups, to improve glycemic control and reduce diabetes burden.

目的：我们研究了亚洲一个多种族中等收入国家2型糖尿病（T2D）患者的性别、年龄、时间趋势和血糖控制之间的关系。方法：使用国家糖尿病登记处（2011-2020），我们分析了221,769名马来西亚成年T2D患者的数据。我们使用分位数回归来估计性别、年龄及其相互作用在第5、第50和第95百分位对HbA1c水平的相关性，并使用逻辑回归来估计良好控制的几率（HbA1c ）结果：参与者是马来人（63.8% %）、女性（59.3% %）和年龄在50-69岁 岁（63.5% %）。男性HbA1c中位数（四分位间距[IQR]）为7.2 %(6.4 %,8.9 %)，女性为7.3 %（6.4 %,9.0 %）。良好控制率男性为42.8% %，女性为41.8% %。从2011年到2020年，40岁以上的男性和女性的血糖控制都有所改善。随着年龄的增长，控制性显著提高。然而，随着年龄的增长，女性的控制越来越好于男性（异质性 ）。结论：2型糖尿病的管理需要更积极的方法，尤其是针对年轻人群，以改善血糖控制和减轻糖尿病负担。

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引用次数: 0

The impact of diabetes on Sepsis-induced cardiomyopathy 糖尿病对败血症性心肌病的影响。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2025.112001

Weiwei Lai, Li Liu, Shuhang Wang, Qing Tang, Yancun Liu, Yanfen Chai

Purpose

This study investigated the association between diabetes and Sepsis-induced cardiomyopathy (SIC), focusing on how changes in inflammatory response and cardiac function influence SIC prognosis. The aim is to provide clinicians with more accurate treatment and management strategies, ultimately enhancing patient outcomes and quality of life.

Methods

This retrospective cohort study analyzed 258 Sepsis-induced cardiomyopathy (SIC) patients, stratified by diabetes status and HbA1C levels. Data were collected from electronic medical records. Statistical tests included the Kolmogorov-Smirnov, t-test, Mann-Whitney U, Kruskal-Wallis, chi-square, and Spearman correlation. Univariate and multivariate logistic regression assessed diabetes’ impact on SIC severity. Model fit was evaluated with the Hosmer–Lemeshow and negative log-likelihood ratio tests. A nomogram was constructed and validated using ROC curves, calibration curves, and decision curve analysis. Subgroup and interaction analyses were performed (P < 0.05).

Results

Diabetes worsened inflammation and immune responses in SIC, significantly affecting markers like LVEF, TnI, CK-MB, BNP, NLR, IL-6, PCT, CRP, APACHE II, and SOFA scores (P < 0.05). Grouping by HbA1C levels revealed no significant differences in LVEF (P = 0.078), Alb (P = 0.105), or L/A (P = 0.211), but differences were found for TnI, CK-MB, BNP, NLR, IL-6, PCT, CRP, APACHE II, and SOFA (P < 0.05). HbA1C strongly correlated with CRP (rs = 0.8664). BNP (OR 1.001) and HbA1C (OR 1.302) were significant risk factors for SIC, with the nomogram showing good predictive performance (AUC 0.693). No significant interaction between HbA1C and BNP on SIC severity was observed (P = 0.791).

Conclusion

Diabetes exacerbates inflammatory and immune responses in Sepsis-induced cardiomyopathy patients, leading to worsened cardiac function.

目的：本研究探讨糖尿病与败血症性心肌病（SIC）的关系，重点探讨炎症反应和心功能的变化对SIC预后的影响。目的是为临床医生提供更准确的治疗和管理策略，最终提高患者的治疗效果和生活质量。方法：本回顾性队列研究分析了258例败血症性心肌病（SIC）患者，按糖尿病状态和HbA1C水平分层。数据是从电子病历中收集的。统计检验包括Kolmogorov-Smirnov、t检验、Mann-Whitney U、Kruskal-Wallis、卡方和Spearman相关。单因素和多因素logistic回归评估糖尿病对SIC严重程度的影响。采用Hosmer-Lemeshow检验和负对数似然比检验评估模型拟合。通过ROC曲线、校正曲线和决策曲线分析，构建并验证了nomogram。结果：糖尿病加重了SIC患者的炎症和免疫反应，显著影响LVEF、TnI、CK-MB、BNP、NLR、IL-6、PCT、CRP、APACHE II和SOFA评分等指标(P结论：糖尿病加重败血症性心肌病患者的炎症和免疫反应，导致心功能恶化。

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引用次数: 0

Global, regional and national burdens of chronic kidney disease due to T1DM and T2DM among adolescents and young adults aged 10–35 years from 1990–2021: A trend analysis based on the global burden of disease study 2021 1990-2021年10-35岁 青少年和年轻人中由T1DM和T2DM引起的慢性肾脏疾病的全球、区域和国家负担：基于2021年全球疾病负担研究的趋势分析

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2024.111985

Bingrong Wu , Yang Zhou , Qing Ni

Backgrounds

Chronic kidney disease (CKD) is a major complication of diabetes, which is rising among adolescents and young adults worldwide, but data on the trends of these diseases are sparse. This study examined the burden of CKD due to type 1 diabetes (CKD-T1D) and type 2 diabetes (CKD-T2D) among those aged 10–35 from 1990 to 2021 on global, regional, and national levels.

Methods

Using Global Burden of Disease 2021 data, joinpoint regression analysis and decomposition analysis were employed to identify significant changes in CKD-T1D and CKD-T2D trends, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs).

Results

Globally, CKD-T1D incidence rose until 2019 before declining, while CKD-T2D incidence declined initially, then increased after 2019. Males generally had higher values of all indicators, except for CKD-T1D prevalence, which was higher in females. Central Latin America saw the largest mortality increase, while Oceania had the highest mortality rates. Oceania countries reported the highest DALYs for both CKD types in 2021.

Conclusion

The burden of CKD-T1D and CKD-T2D showed a pandemic-related shift. Middle-SDI countries face high incidence and mortality, while high-SDI countries report lower mortality but higher prevalence. Public health interventions are especially needed in low and middle-SDI countries and island nations.

背景：慢性肾脏疾病（CKD）是糖尿病的主要并发症，在世界范围内的青少年和年轻人中发病率正在上升，但关于这些疾病趋势的数据很少。本研究在全球、地区和国家层面调查了1990年至2021年10-35岁人群中由1型糖尿病（CKD- t1d）和2型糖尿病（CKD- t2d）引起的CKD负担。方法：使用全球疾病负担2021数据，采用联点回归分析和分解分析来确定CKD-T1D和CKD-T2D趋势的显著变化，包括发病率、患病率、死亡率和残疾调整生命年（DALYs）。结果：在全球范围内，CKD-T1D的发病率在2019年之前呈上升趋势，然后下降，而CKD-T2D的发病率在2019年之后先下降后上升。除CKD-T1D患病率高于女性外，男性的各项指标普遍较高。中拉丁美洲的死亡率增幅最大，而大洋洲的死亡率最高。大洋洲国家报告了2021年两种CKD类型的最高伤残调整年。结论：CKD-T1D和CKD-T2D的负担表现出与大流行相关的变化。中等sdi国家的发病率和死亡率较高，而高sdi国家的死亡率较低，但患病率较高。在低、中等发展指数国家和岛屿国家，特别需要公共卫生干预措施。

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引用次数: 0

Use of continuous glucose monitoring and point-of-care glucose testing in hospitalized patients with diabetes mellitus in non-intensive care unit settings: A systematic review and meta-analysis of randomized controlled trials 在非重症监护病房的糖尿病住院患者中使用连续血糖监测和即时血糖检测：随机对照试验的系统回顾和荟萃分析

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2024.111986

Gabriel Cavalcante Lima Chagas , Larissa Teixeira , Mariana R.C. Clemente , Rafael Cavalcante Lima Chagas , Diego Vinicius Santinelli Pestana , Lorenna Rodrigues Silva Sombra , Bruno B. Lima , Rodolfo J. Galindo , Marconi Abreu

The benefits of using continuous glucose monitoring (CGM) in hospitalized patients with diabetes remain uncertain. Point-of-care (POC) glucose testing is the standard of care in this setting. We compared the effect of adding CGM to POC testing versus POC testing alone on glycemic outcomes in this population. We have searched the Cochrane Library, Embase, and MEDLINE databases and relevant conferences up to May 2024. We have included six randomized controlled trials (n = 979 patients) comparing CGM plus POC testing to POC testing alone in non-pregnant, non-critically ill hospitalized adults with diabetes. The addition of CGM improved time in range (mean difference [MD] + 7.24 %; 95 % confidence interval [CI]: +5.06, +9.42; P < 0.00001; I² = 35 %), reduced time below range < 70 mg/dL (MD: −1.23 %; 95 %CI: −2.27, −0.18; P = 0.02; I² = 64 %) and < 54 mg/dL (MD: −0.95 %; 95 %CI: −1.19, −0.70; P < 0.00001; I² = 0 %), and time above range > 250 mg/dL (MD: −3.70 %; 95 %CI: −6.10, −1.29; P = 0.003; I² = 39 %) compared to POC testing alone. We observed no statistically significant differences in glycemic variability or insulin doses. In non-critically ill, hospitalized adults with diabetes, the addition of CGM to POC testing for insulin dosing resulted in superior glycemic control and reduction of hypoglycemia compared to POC testing alone.

在住院糖尿病患者中使用连续血糖监测（CGM）的益处仍不确定。即时（POC）血糖检测是这种情况下的标准护理。在该人群中，我们比较了在POC检测中加入CGM与单独进行POC检测对血糖结局的影响。我们检索了Cochrane Library、Embase和MEDLINE数据库以及截止到2024年5月的相关会议。我们纳入了6项随机对照试验（n = 979例患者），比较CGM + POC检测与单独POC检测在非妊娠、非危重住院糖尿病成人患者中的作用。CGM的加入改善了时间范围(平均差[MD] + 7.24 %；95 %置信区间[CI]: +5.06, +9.42；P 2 = 35 %),减少时间低于范围 2 = 64 %)和 2 = 0 %),和时间范围以上 >  250 mg / dL (MD: -3.70 %;95 % ci: -6.10, -1.29；P = 0.003;I2 = 39 %)与单独POC测试相比。我们观察到血糖变异性和胰岛素剂量没有统计学上的显著差异。在非危重症、住院的成人糖尿病患者中，与单独进行POC试验相比，在POC试验中加入CGM可获得更好的血糖控制和低血糖的减少。

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引用次数: 0

Diabetes in the Western Pacific: Unravelling complexities, forging solutions

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2025.112011

引用次数: 0

Incidence trends in ischaemic and non-ischaemic heart failure in people with and without type 2 diabetes, 2000–2019: An observational study in England 2000-2019年2型糖尿病患者和非2型糖尿病患者缺血性和非缺血性心力衰竭发病率趋势：英国的一项观察性研究

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2024.111980

Kajal Panchal , Claire Lawson , Sharmin Shabnam , Kamlesh Khunti , Francesco Zaccardi

Aim

To investigate trends in ischaemic and non-ischaemic heart failure (HF) in adults with type 2 diabetes and without diabetes between 1st January 2000 and 31st December 2019 in England.

Methods

We used the Clinical Practice Research Datalink datasets, linked to the Hospital Episode Statistics and Office for National Statistics, to estimate sex-specific crude and age-standardised rates of incident ischaemic and non-ischaemic HF up to 10 years per calendar year of diabetes diagnosis and diabetes status.

Results

In a cohort of 735,810 individuals, 5,073 ischaemic (2,038 in people with type 2 diabetes and 3,035 in those without) and 16,501 non-ischaemic (6,358 and 10,143, respectively) HF events were recorded during a median follow-up of 10 years. From 2000 to 2004 to 2005–2009, the age-standardised rates of ischaemic HF marginally declined, while rates remained stable for non-ischaemic HF and were consistently higher for non-ischaemic than ischaemic HF, regardless of diabetes status or sex. Adjusted incidence rate ratios demonstrated negligible impact on trends after accounting for differences in demographics, comorbidities and medications.

Conclusions

Improving HF prevention and management strategies remains crucial to decrease the risk of HF in the general population and reduce the persistent risk-gap associated with type 2 diabetes in England.

目的：调查2000年1月1日至2019年12月31日期间英国2型糖尿病和非糖尿病成人缺血性和非缺血性心力衰竭（HF）的趋势。方法：我们使用临床实践研究数据链数据集，与医院发作统计和国家统计办公室相关联，估计每日历年10 年的缺血性和非缺血性心力衰竭发生率。结果：在735,810人的队列中，在中位随访10 年期间，记录了5,073例缺血性HF事件（2型糖尿病患者2,038例，无2型糖尿病患者3,035例）和16,501例非缺血性HF事件（分别为6,358例和10,143例）。从2000年到2004年到2005-2009年，缺血性HF的年龄标准化率略有下降，而非缺血性HF的发病率保持稳定，并且与糖尿病状态或性别无关，非缺血性HF的发病率始终高于缺血性HF。在考虑了人口统计学、合并症和药物方面的差异后，调整后的发病率比对趋势的影响可以忽略不计。结论：在英国，改善心衰预防和管理策略对于降低普通人群心衰风险和减少与2型糖尿病相关的持续风险差距至关重要。

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引用次数: 0

Bidirectional interplay of sleep apnea syndrome and cardio-vascular disorders in diabetes 糖尿病患者睡眠呼吸暂停综合征与心血管疾病的双向相互作用。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-02-01 DOI: 10.1016/j.diabres.2024.111984

Paul Valensi , Karima Benmohammed , Mohamed Zerguine

Although often overlooked sleep apnea has emerged as a significant public health concern. Obstructive sleep apnea (OSA) and diabetes commonly co-exist with a vicious cycle worsening the incidence and severity of both conditions. OSA has many implications including cardiometabolic disorders and impaired cardiovascular (CV) prognosis. OSA combined with diabetes generates a cumulative effect on CV outcomes. The association of OSA with several comorbidities including CV disease and heart failure is bi-directional meaning that some of them are likely to contribute to OSA. In patients with diabetes, OSA treatment should be integrated in a holistic strategy of prevention of CV and microvascular complications. This article provides some clues to advance the understanding of the interplay between OSA and CV disorders in diabetes and to consider the role of some CV risk markers like cardiac autonomic neuropathy and artery stiffness and of novel metrics for hypoxic-related events in CV risk stratification, and offers a discussion on the effects of medical approaches including weight loss strategies, GLP1-receptor agonists and sodium–glucose cotransporter 2 inhibitors. It provides a guidance to improve screening and diagnosis of OSA, and adherence to OSA treatment in patients with diabetes.

虽然经常被忽视的睡眠呼吸暂停已经成为一个重要的公共卫生问题。阻塞性睡眠呼吸暂停（OSA）和糖尿病通常共存，恶性循环加剧了这两种疾病的发病率和严重程度。OSA具有许多意义，包括心脏代谢紊乱和心血管预后受损。OSA合并糖尿病会对心血管结果产生累积效应。OSA与包括心血管疾病和心力衰竭在内的几种合并症的关联是双向的，这意味着其中一些合并症可能导致OSA。对于糖尿病患者，OSA治疗应纳入预防心血管和微血管并发症的整体策略。本文提供了一些线索，以促进对糖尿病患者OSA和心血管疾病之间相互作用的理解，并考虑一些心血管风险标志物（如心脏自主神经病变和动脉僵硬）和缺氧相关事件的新指标在心血管风险分层中的作用，并讨论了包括减肥策略、glp1受体激动剂和钠-葡萄糖共转运蛋白2抑制剂在内的医学方法的影响。为提高糖尿病患者OSA的筛查和诊断以及OSA治疗的依从性提供指导。

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