Diabetes research and clinical practice最新文献_第3页

Real-world efficacy and safety of open-source automated insulin delivery for people with type 1 diabetes mellitus: Experience from mainland China. 1 型糖尿病患者使用开源自动胰岛素给药的实际效果和安全性：中国大陆的经验。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-29 DOI: 10.1016/j.diabres.2024.111910

Yongwen Zhou, Mengyun Lei, Daizhi Yang, Ping Ling, Ying Ni, Hongrong Deng, Wen Xu, Xubin Yang, Jinhua Yan, Benjamin John Wheeler, Jianping Weng

Background: Open-source automated insulin delivery systems are increasingly adopted yet predominantly discussed outside of Asia. This study aimed to describe efficacy and safety of android artificial pancreas (AAPS) in people with type 1 diabetes mellitus (T1DM) from mainland China.

Methods: This real-world study recruited people who initiated AAPS for ≥ 3 months between 2019 and 2024. Key outcomes included glycated hemoglobin A1c (HbA1c) and metrics from continuous glucose monitoring, rates of diabetic ketoacidosis (DKA) and severe hypoglycemia.

Findings: 292 (male, 46·9 %) participants aged 25·7 (14·7, 35·0) years were included, with 183 (62·7 %) and 68 (23·3 %) using AAPS for 6 and 12 months. Prior-AAPS HbA1c was 7·6 ± 1·7 % with 44·5 % achieving < 7·0 %. After 3 months, mean HbA1c improved by -1·5 ± 2·0 % to 6·3 ± 0·8 % (P < 0.01), with 82·9 % achieving < 7.0 %. Time in range 3·9-10·0 mmol/L (TIR) improved to 78·8 ± 12·9 %, with 80·5 % achieving > 70 %, followed by time below 3·9 mmol/L of 3·9 (2·1, 6·1) %. After 12 months, HbA1c and TIR remained similar at 6·4 ± 1·0 % and 77·9 ± 12·2 %. No DKA and severe hypoglycemia was observed.

Interpretation: Real-world data from mainland China highlights current uptake of open-source AAPS with potential glycemic benefits. No safety signals are seen. More support to enhance access and utilization of all AID systems in this region is warranted.

背景：开放源码的胰岛素自动给药系统正被越来越多地采用，但在亚洲以外的地区讨论较少。本研究旨在描述安卓人工胰岛（AAPS）在中国大陆 1 型糖尿病（T1DM）患者中的有效性和安全性：这项真实世界研究招募了在2019年至2024年期间开始使用人工胰岛素≥3个月的患者。主要结果包括糖化血红蛋白A1c（HbA1c）和连续血糖监测指标、糖尿病酮症酸中毒（DKA）和严重低血糖的发生率。研究结果：共纳入292名（男性，46-9%）参与者，年龄为25-7（14-7，35-0）岁，其中183人（62-7%）和68人（23-3%）使用AAPS 6个月和12个月。使用 AAPS 之前的 HbA1c 为 7-6 ± 1-7 %，其中 44-5 % 达到 70%，其次是低于 3-9 mmol/L 的时间为 3-9 (2-1, 6-1)%。12 个月后，HbA1c 和 TIR 保持相似，分别为 6-4 ± 1-0 % 和 77-9 ± 12-2%。未观察到 DKA 和严重低血糖：来自中国大陆的真实世界数据突显了目前对开源 AAPS 的接受程度以及潜在的血糖效益。未发现安全信号。有必要提供更多支持，以提高该地区所有 AID 系统的接入和利用率。

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引用次数: 0

Reproductive factors predict risks of cardiovascular disease and premature death in postmenopausal women with type 2 diabetes: The Fukuoka Diabetes Registry 生殖因素可预测绝经后 2 型糖尿病妇女罹患心血管疾病和过早死亡的风险：福冈糖尿病登记

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-29 DOI: 10.1016/j.diabres.2024.111907

Ayaka Oshiro , Toshiaki Ohkuma , Masanori Iwase , Taiki Higashi , Masahito Yoshinari , Takanari Kitazono

Aims

Reproductive factors (reproductive period, age at menarche, and age at menopause) are associated with a risk of cardiovascular disease (CVD) and death in individuals without focusing on comorbid diabetes. However, it remains unclear whether this association also applies to individuals with diabetes. This study investigated the relationship between reproductive factors and the risk of CVD and death in postmenopausal Japanese women with type 2 diabetes.

Methods

1,592 postmenopausal women with type 2 diabetes without pre-existing CVD were subclassified based on reproductive period (age at menopause minus age at menarche). The primary outcome was a composite of CVD incidence and all-cause death.

Results

The risk of the outcome decreased with a longer reproductive period. Compared with a reproductive period of ≤ 29 years, the multivariable-adjusted hazard ratios (95 % CI) were 0.80 (0.39–1.66), 0.73 (0.37–1.43), and 0.43 (0.19–0.99) for reproductive periods of 30–34, 35–39, and ≥ 40 years, respectively (p for trend = 0.046). Earlier age at menarche and later age at menopause were also associated with a decreased risk of the outcome.

Conclusions

Evaluating reproductive factors may help predict the risks of CVD and death in postmenopausal women with type 2 diabetes.

目的：生殖因素（生育期、月经初潮年龄和绝经年龄）与心血管疾病（CVD）和死亡风险有关，但与合并糖尿病无关。然而，这种关联是否也适用于糖尿病患者，目前仍不清楚。本研究调查了绝经后患有 2 型糖尿病的日本妇女的生殖因素与心血管疾病和死亡风险之间的关系。方法：根据生殖期（绝经年龄减去月经初潮年龄）对 1,592 名绝经后患有 2 型糖尿病且未合并心血管疾病的妇女进行了亚分类。主要结果是心血管疾病发病率和全因死亡的复合结果：结果：生育期越长，结果风险越低。与生育期≤29年相比，生育期为30-34年、35-39年和≥40年的多变量调整危险比（95 % CI）分别为0.80（0.39-1.66）、0.73（0.37-1.43）和0.43（0.19-0.99）（趋势比=0.046）。月经初潮年龄较早和绝经年龄较晚也与结果风险降低有关：结论：评估生殖因素有助于预测绝经后2型糖尿病女性患者的心血管疾病和死亡风险。

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引用次数: 0

Unraveling the impaired incretin effect in obesity and type 2 diabetes: Key role of hyperglycemia-induced unscheduled glycolysis and glycolytic overload 揭示肥胖和 2 型糖尿病中增量素效应受损的原因：高血糖诱导的计划外糖酵解和糖酵解超负荷的关键作用。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-22 DOI: 10.1016/j.diabres.2024.111905

Naila Rabbani , Paul J. Thornalley

Glucagon-like peptide-1 (GLP-1) agonists and GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) co-agonists are major treatment options for subjects with obesity and patients with type 2 diabetes mellitus (T2DM). They counter without addressing the mechanistic cause of the impaired incretin effect associated with obesity and T2DM. Incretin effect impairment is characterized by decreased secretion of incretins from enteroendocrine cells and incretin resistance of pancreatic β-cells. It is linked to hyperglycemia. We present evidence that subversion of the gating of glucose entry into glycolysis, mainly by glucokinase (hexokinase-4), during persistent hyperglycemia in enteroendocrine cells, pancreatic β- and α-cells and appetite-regulating neurons contributes to the biochemical mechanism of the impaired incretin effect. Unscheduled glycolysis and glycolytic overload thereby produced decreases cell signalling of incretin secretion to glucose and other secretion stimuli and incretin receptor responses. This mechanism provides a guide for development of alternative therapies targeting recovery of the impaired incretin effect.

胰高血糖素样肽-1（GLP-1）激动剂以及 GLP-1 和葡萄糖依赖性促胰岛素多肽（GIP）联合激动剂是肥胖症患者和 2 型糖尿病（T2DM）患者的主要治疗选择。但它们并没有解决肥胖和 2 型糖尿病患者增量素效应受损的机理原因。增量素效应受损的特点是肠内分泌细胞分泌的增量素减少和胰腺β细胞的增量素抵抗。它与高血糖有关。我们提出的证据表明，在肠道内分泌细胞、胰腺β细胞和α细胞以及食欲调节神经元持续高血糖期间，主要通过葡萄糖激酶（己糖激酶-4）对葡萄糖进入糖酵解过程的门控进行颠覆，是增量素效应受损的生化机制之一。由此产生的计划外糖酵解和糖酵解过载会降低细胞对葡萄糖和其他分泌刺激物的增量素分泌信号以及增量素受体反应。这一机制为开发以恢复受损的增量素效应为目标的替代疗法提供了指导。

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引用次数: 0

Pancreatic fat infiltration is associated with risk of vertebral fracture in older patients with type 2 diabetes: A longitudinal multicenter study 胰腺脂肪浸润与老年 2 型糖尿病患者椎体骨折的风险有关：一项纵向多中心研究

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-22 DOI: 10.1016/j.diabres.2024.111904

Jiangchuan Wang , Zicheng Wei , Yu Wang , Dingzhe Zhang , Miaomiao Wang , Xin Chen , Peng Xia , Jianhua Wang , Chao Xie , Xiao Chen

Aims

Patients with type 2 diabetes mellitus (T2DM) have high fracture risk. This study explored the associations between pancreatic computed tomography (CT) attenuation, a marker of pancreatic fat, and risk of vertebral fracture in T2DM patients.

Methods

A total of 1486 T2DM patients who aged 50 years and older and without preexisting vertebral fractures during 2019–2023 at our institutions were followed up until January 2024. CT attenuation of the pancreas, bone and spleen were measured. Pancreatic attenuation/spleen attenuation ratio (P/S) was calculated. Vertebral fractures were evaluated on spine CT images according to Genant’s semiquantitative scoring system.

Results

A total of 135 cases of vertebral fracture were identified during 26 months of follow-up and 270 patients without vertebral fracture were matched. Pancreatic CT attenuation and the P/S ratio were negatively associated with the risk of vertebral fracture (adjusted hazard ratio (aHR) = 0.97, 95 %confidence interval (CI): 0.96–0.99; aHR = 0.26, 95 %CI: 0.12–0.58). Addition of pancreatic attenuation or P/S ratio improved the performance of bone attenuation-based model (area under the curve = 0.72–0.763 vs 0.63–0.728).

Conclusion

Pancreatic fat infiltration is an associated factor for vertebral fracture in T2DM patients. Addition of pancreatic fat infiltration improved the predictive performance of the bone-based model.

目的：2型糖尿病（T2DM）患者的骨折风险很高。本研究探讨了胰腺计算机断层扫描（CT）衰减（胰腺脂肪的标志物）与 T2DM 患者椎体骨折风险之间的关联：方法：对本院2019-2023年期间年龄在50岁及以上且无椎体骨折的1486名T2DM患者进行随访，直至2024年1月。测量了胰腺、骨骼和脾脏的 CT 衰减。计算胰腺衰减/脾脏衰减比（P/S）。根据 Genant 半定量评分系统对脊柱 CT 图像上的椎体骨折进行评估：结果：在26个月的随访中，共发现135例椎体骨折病例，并与270例未发生椎体骨折的患者进行了配对。胰腺 CT 衰减和 P/S 比值与椎体骨折风险呈负相关（调整后危险比 (aHR) = 0.97，95% 置信区间 (CI)：0.96-0.99；aHR = 0.26，95%CI：0.12-0.58）。加入胰腺衰减或 P/S 比值可提高基于骨衰减模型的性能（曲线下面积 = 0.72-0.763 vs 0.63-0.728）：结论：胰腺脂肪浸润是T2DM患者椎体骨折的相关因素。结论：胰腺脂肪浸润是 T2DM 患者椎体骨折的相关因素，加入胰腺脂肪浸润可提高基于骨的模型的预测性能。

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引用次数: 0

Salivary glycated albumin could be as reliable a marker of glycemic control as blood glycated albumin in people with diabetes 唾液糖化白蛋白与血液糖化白蛋白一样，可以作为糖尿病患者血糖控制的可靠指标。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-22 DOI: 10.1016/j.diabres.2024.111903

Masakazu Aihara , Kouji Yano , Tomoko Irie , Mitsumi Nishi , Kenji Yachiku , Itsushi Minoura , Koshin Sekimizu , Yoshitaka Sakurai , Takashi Kadowaki , Toshimasa Yamauchi , Naoto Kubota

Aims

Measurements of diabetes-related biomarkers are necessary to assess glycemic control. The commonly used finger-prick blood glucose and HbA1c measurements are invasive, as is blood glycated albumin (GA) measurement. Therefore, we developed a non-invasive method, namely, measurement of the salivary GA with high accuracy using a high-performance liquid chromatography (HPLC) method.

Methods

We recruited participants with diabetes mellitus admitted to The University of Tokyo Hospital. Blood and saliva samples were collected at three time points (fasting and 2-hour postprandial at admission and fasting at discharge). After partial purification using an antibody-based column, the samples were subjected to GA measurement by HPLC method.

Results

Among the 56 participants with diabetes mellitus enrolled in the study, there was a correlation between the GA levels measured in blood and saliva at the three time points described above (n = 45, R² = 0.985, P < 0.001; n = 48, R² = 0.973, P < 0.001; n = 51, R² = 0.979, P < 0.001). Multiple regression analysis revealed the associations were maintained even after adjustments for age, BMI, and nephropathy stage.

Conclusions

This exploratory research revealed that the salivary GA levels by this method were accurate and might be able to replace blood GA measurement. The home salivary GA measurement is expected to be developed that may reduce the burden and complications in people with diabetes mellitus and improve the quality of life.

目的：要评估血糖控制情况，就必须测量与糖尿病相关的生物标志物。常用的指刺血糖和 HbA1c 测量以及血液糖化白蛋白（GA）测量都是侵入性的。因此，我们开发了一种非侵入性方法，即使用高效液相色谱法（HPLC）测量唾液中的糖化白蛋白（GA），其准确性很高：方法：我们招募了东京大学医院的糖尿病患者。在三个时间点（入院时空腹、餐后 2 小时和出院时空腹）采集血液和唾液样本。使用抗体柱对样本进行部分纯化后，采用高效液相色谱法测量 GA：结果：在参与研究的 56 名糖尿病患者中，在上述三个时间点测量的血液和唾液中的 GA 含量之间存在相关性（n = 45，R2 = 0.985，P 2 = 0.973，P 2 = 0.979，P 结论：研究结果表明，血液中的 GA 含量与唾液中的 GA 含量之间存在相关性（n = 45，R2 = 0.985，P 2 = 0.973，P 2 = 0.979，P 结论）：这项探索性研究表明，用这种方法测量唾液 GA 水平是准确的，有可能取代血液 GA 测量。家庭唾液 GA 测量有望得到开发，从而减轻糖尿病患者的负担，减少并发症，提高生活质量。

{"title":"Salivary glycated albumin could be as reliable a marker of glycemic control as blood glycated albumin in people with diabetes","authors":"Masakazu Aihara , Kouji Yano , Tomoko Irie , Mitsumi Nishi , Kenji Yachiku , Itsushi Minoura , Koshin Sekimizu , Yoshitaka Sakurai , Takashi Kadowaki , Toshimasa Yamauchi , Naoto Kubota","doi":"10.1016/j.diabres.2024.111903","DOIUrl":"10.1016/j.diabres.2024.111903","url":null,"abstract":"<div><h3>Aims</h3><div>Measurements of diabetes-related biomarkers are necessary to assess glycemic control. The commonly used finger-prick blood glucose and HbA1c measurements are invasive, as is blood glycated albumin (GA) measurement. Therefore, we developed a non-invasive method, namely, measurement of the salivary GA with high accuracy using a high-performance liquid chromatography (HPLC) method.</div></div><div><h3>Methods</h3><div>We recruited participants with diabetes mellitus admitted to The University of Tokyo Hospital. Blood and saliva samples were collected at three time points (fasting and 2-hour postprandial at admission and fasting at discharge). After partial purification using an antibody-based column, the samples were subjected to GA measurement by HPLC method.</div></div><div><h3>Results</h3><div>Among the 56 participants with diabetes mellitus enrolled in the study, there was a correlation between the GA levels measured in blood and saliva at the three time points described above (n = 45, <em>R</em><sup>2</sup> = 0.985, <em>P</em> < 0.001; n = 48, <em>R</em><sup>2</sup> = 0.973, <em>P</em> < 0.001; n = 51, <em>R</em><sup>2</sup> = 0.979, <em>P</em> < 0.001). Multiple regression analysis revealed the associations were maintained even after adjustments for age, BMI, and nephropathy stage.</div></div><div><h3>Conclusions</h3><div>This exploratory research revealed that the salivary GA levels by this method were accurate and might be able to replace blood GA measurement. The home salivary GA measurement is expected to be developed that may reduce the burden and complications in people with diabetes mellitus and improve the quality of life.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"218 ","pages":"Article 111903"},"PeriodicalIF":6.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

5-Year effects of a novel continuous remote care model with carbohydrate-restricted nutrition therapy including nutritional ketosis in type 2 diabetes: An extension study 新型持续远程护理模式与碳水化合物限制营养疗法（包括营养酮症）对 2 型糖尿病的 5 年疗效：扩展研究。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-20 DOI: 10.1016/j.diabres.2024.111898

Amy L. McKenzie , Shaminie J. Athinarayanan , Michelle R. Van Tieghem , Brittanie M. Volk , Caroline G.P. Roberts , Rebecca N. Adams , Jeff S. Volek , Stephen D. Phinney , Sarah J. Hallberg

Aims

This study assessed the five-year effects of a continuous care intervention (CCI) delivered via telemedicine, counseling people with type 2 diabetes (T2D) on a very low carbohydrate diet with nutritional ketosis.

Methods

Participants with T2D were enrolled in a 2-year, open-label, non-randomized study comparing CCI and usual care (UC). After 2 years, 194 of the 262 CCI participants were approached for a three-year extension. Of these, 169 consented, and 122 remained in the study for five years. Primary outcomes were changes in diabetes status assessed using McNemars’ test, including remission and HbA1c < 6.5 % on no glucose lowering medication or only on metformin at 5 years. Changes in body mass, glycemia, and cardiometabolic markers from baseline to 5 years were assessed using linear mixed-effects models.

Results

Twenty percent (n = 24) of the five-year completers achieved remission, with sustained remission observed over three years in 15.8 % (n = 19) and four years in 12.5 % (n = 15). Reversal to HbA1c < 6.5 % without medication or only metformin was seen in 32.5 % (n = 39). Sustained improvements were noted in body mass (−7.6 %), HbA1c (−0.3 %), triglycerides (−18.4 %), HDL-C (+17.4 %), and inflammatory markers, with no significant changes in LDL-C and total cholesterol.

Conclusions

Over five years, the very low carbohydrate intervention showed excellent retention and significant health benefits, including diabetes remission, weight loss, and improved cardiometabolic markers.

目的：本研究评估了通过远程医疗提供的持续护理干预（CCI）对 2 型糖尿病（T2D）患者进行极低碳水化合物和营养酮症饮食指导的五年效果：一项为期 2 年的开放标签、非随机研究对 CCI 和常规护理（UC）进行了比较。2 年后，262 名 CCI 参与者中的 194 人被要求延长 3 年。其中，169 人同意，122 人继续参加了为期 5 年的研究。主要结果是使用 McNemars' 测试评估糖尿病状况的变化，包括缓解率和 HbA1c 结果：在完成五年研究的患者中，20%（n = 24）的患者病情得到缓解，15.8%（n = 19）的患者病情在三年内得到持续缓解，12.5%（n = 15）的患者病情在四年内得到持续缓解。HbA1c 逆转结论：在五年的时间里，超低碳水化合物干预措施显示出良好的持续性和显著的健康益处，包括糖尿病缓解、体重减轻和心血管代谢指标改善。

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引用次数: 0

Early screening and diagnosis of gestational diabetes mellitus (GDM) and its impact on perinatal outcomes 妊娠糖尿病（GDM）的早期筛查和诊断及其对围产期结果的影响。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-19 DOI: 10.1016/j.diabres.2024.111890

Beenu Bastian , Lisa Gaye Smithers , Alexia Pape , Warren Davis , K. Fu , Monique Francois

Aims

To compare the maternal and neonatal outcomes following early diagnosis compared with routine diagnosis of gestational diabetes (GDM).

Methods

In this observational study, 3494 women were categorised by weeks of gestation at GDM diagnosis: early GDM (≤20 weeks) and routine GDM (>20 weeks). The early GDM group was further divided by treatment commencement as immediate (<12 weeks) and delayed (12–20 weeks) and by diagnostic fasting blood glucose as higher-FBG (5.3–6.0 mmol/L) and lower-FBG group (FBG 5.1–5.2 mmol/L). Primary outcomes were large for gestational age (LGA) and small for gestational age (SGA). Generalized linear models used to calculate risk ratios and adjusted for confounding.

Results

Risk ratios (RR) for LGA and SGA were similar for early versus routine diagnosis, and immediate versus delayed treatment. The higher-FBG immediate treatment group had a lower risk of newborn respiratory distress (RR 0.52, 95 %CI 0.34, 0.81) and emergency caesarean (RR 0.55, 95 %CI 0.34, 0.88) compared to the higher-FBG delayed treatment group. Among the lower-FBG group, no such benefits were seen.

Conclusions

Fasting glucose levels modified the effects of early treatment of GDM where a higher-FBG with immediate treatment appears to reduce perinatal complications, but treating women with lower-FBG early has no benefits.

目的：比较妊娠期糖尿病（GDM）早期诊断与常规诊断的产妇和新生儿结局：在这项观察性研究中，3494 名妇女按确诊 GDM 时的妊娠周数分为：早期 GDM（≤20 周）和常规 GDM（>20 周）。早期 GDM 组又按治疗开始时间分为立即治疗组（结果：立即治疗组的风险比（RR）为 1:1）：早期诊断与常规诊断、立即治疗与延迟治疗的 LGA 和 SGA 风险比（RR）相似。与 FBG 较高的延迟治疗组相比，FBG 较高的立即治疗组发生新生儿呼吸窘迫（RR 0.52，95 %CI 0.34，0.81）和紧急剖腹产（RR 0.55，95 %CI 0.34，0.88）的风险较低。结论：空腹血糖水平改变了 GDM 早期治疗的效果，FBG 较高并立即治疗似乎可减少围产期并发症，但早期治疗 FBG 较低的妇女则没有益处。

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引用次数: 0

Beyond the insulin pump: Unraveling diabetes tech dependency 超越胰岛素泵：揭开糖尿病技术依赖症的神秘面纱。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-19 DOI: 10.1016/j.diabres.2024.111896

Emanuele Feliziani , Maria Caterina Chios , Paolo Pozzilli

The use of technology for Type 1 diabetes (T1D) has significantly developed in the last 20 years leading to several benefits in life-style management but also to potentially overreliance and addiction to such life changing devices. Insulin pumps (CSII) being small, discreet and sophisticated, offer features such as customizable basal rates, bolus calculators and integration with Continuous Glucose Monitoring (CGM) systems becoming a must have for diabetic patients. Indeed CGM, firstly introduced in the late 1990s and now being highly sophisticated provide trends and patterns hence allowing a better management of T1D.

In this review we inquire the multifactorial aspects of dependency on diabetes technology, focusing not only on the benefits and the advancements these automations offer, but also the challenges, limits and possible risks associated with overreliance on them. Specifically, the impact that early introduction to technology had on patients, the dependency on CSII and CGM, the importance of learning and self-management skills and strategies for addressing unexpected events.

在过去的 20 年里，1 型糖尿病（T1D）技术的应用有了长足的发展，为生活方式管理带来了诸多益处，但也可能导致对这种改变生活的设备的过度依赖和上瘾。胰岛素泵（CSII）小巧、隐蔽、精密，具有可定制基础率、栓剂计算器和与连续血糖监测（CGM）系统集成等功能，已成为糖尿病患者的必备设备。事实上，连续血糖监测系统于 20 世纪 90 年代末首次问世，如今已变得非常复杂，能提供各种趋势和模式，从而更好地管理 T1D。在这篇综述中，我们探究了依赖糖尿病技术的多因素方面，不仅关注这些自动化技术带来的益处和进步，还关注过度依赖这些技术带来的挑战、限制和可能的风险。具体而言，早期引入技术对患者的影响、对 CSII 和 CGM 的依赖、学习和自我管理技能的重要性以及应对突发事件的策略。

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引用次数: 0

The impact of glucagon-like peptide-1 receptor agonist on the gastric residue in upper endoscopy 胰高血糖素样肽-1 受体激动剂对上消化道内窥镜检查中胃残留物的影响。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-19 DOI: 10.1016/j.diabres.2024.111900

Naim Abu-Freha , Zohar Levi , Anat Nevo-Shor , Revital Guterman , Ruhama Elhayany , Avraham Yitzhak , Dana Zelnik Yovel , Daniel L. Cohen , Haim Shirin

Aim

We aimed to investigate the association between Glucagon-like-peptide-1 receptors agonists (GLP1-RA) use and gastric residue on esophagogastroduodenoscopy (EGD).

Methods

A multicenter, retrospective study included all EGDs conducted across seven gastroenterology departments. EGDs with the diagnosis of “poor preparation” or described as a poor preparation in the endoscopist’s report were considered as gastric residue.

Results

120,879 EGDs were included in the analysis. Of these, 1671 patients treated with GLP1-RA were compared to 119,208 without GLP1-RA treatment. Of the GLP1-RA group, 93 (5.6 %) had gastric residue compared to 2327 (2.0 %) among the non-GLP1-RA group (p < 0.001). Sup-group analysis: 71 (6.2 %) of the 1141 DM patients treated with GLP1-RA compared to 307 (3.0 %) of the 10,152 DM patients without GLP1-RA treatment (p < 0.001). Additionally, 22 (4.2 %) of 503 non-DM patients treated with GLP1-RA had gastric residue compared to 2065 (2.0 %) of the non-DM non-GLP1-RA group (n = 109,056) (p < 0.001). In multivariate analysis, DM and GLP1-RA were both found to be independent risk factors for excess gastric residue.

Conclusion

Our results may have important clinical relevance for EGD preparation among GLP1-RA treated patients, either requiring a longer fasting time prior to EGD or holding the medication prior to EGD according to the half-life of the drug.

目的：我们旨在研究胰高血糖素样肽-1受体激动剂（GLP1-RA）的使用与食管胃十二指肠镜检查（EGD）胃残留物之间的关系：这项多中心回顾性研究纳入了七家消化内科进行的所有胃肠镜检查。诊断为 "准备不良 "或在内镜医师报告中描述为准备不良的胃肠镜检查被视为胃残留：分析共纳入 120,879 例胃肠造影检查。其中，1671 名接受 GLP1-RA 治疗的患者与 119 208 名未接受 GLP1-RA 治疗的患者进行了比较。在 GLP1-RA 组中，93 人（5.6%）有胃残留，而在非 GLP1-RA 组中，有 2327 人（2.0%）有胃残留（P 结论：我们的结果可能与胃癌的临床治疗有重要关系：我们的研究结果可能对接受 GLP1-RA 治疗的患者进行胃肠造影术前准备具有重要的临床意义，根据药物的半衰期，胃肠造影术前需要延长空腹时间或暂停用药。

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引用次数: 0

Development of a machine learning model for precision prognosis of rapid kidney function decline in people with diabetes and chronic kidney disease 针对糖尿病和慢性肾脏病患者肾功能快速衰退的精准预后开发机器学习模型。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-10-19 DOI: 10.1016/j.diabres.2024.111897

Woo Vin Lee , Yuri Song , Ji Sun Chun , Minoh Ko , Ha Young Jang , In-Wha Kim , Sehoon Park , Hajeong Lee , Hae-Young Lee , Soo Heon Kwak , Jung Mi Oh

Aims

To develop a machine learning model for predicting rapid kidney function decline in people with type 2 diabetes (T2D) and chronic kidney disease (CKD) and to pinpoint key modifiable risk factors for targeted interventions.

Methods

We conducted a retrospective cohort study on 6,924 individuals with T2D and CKD at Seoul National University Hospital. Kidney function decline was assessed using estimated glomerular filtration rate slopes. The performance of the eXtreme Gradient Boosting (XGBoost) model was evaluated through model diagnosis and time-to-event analyses. Copula simulation was conducted to stratify risk subgroups using modifiable risk factors.

Results

A total of 906 (13.1 %) individuals experienced rapid kidney function decline. The XGBoost model demonstrated optimal performance (area under the receiver operating characteristic curve: 0.826). The hazard of end-stage kidney disease within eight years increased across risk quartiles, with statistically significant hazard ratios in Q3 (2.06; 95 % confidence interval [CI]: 1.29–3.29) and Q4 (10.9; 95 % CI: 7.36–16.2). Simulation analysis identified high-risk subgroups by stage A3 albuminuria and at least two of the following: haematocrit < 39.0 %, systolic blood pressure > 120 mmHg, and glycated hemoglobin A1c > 6.5 %.

Conclusions

The XGBoost model, augmented by copula simulation, successfully stratified kidney prognosis in individuals with T2D and CKD.

目的：开发一种机器学习模型，用于预测2型糖尿病（T2D）和慢性肾脏病（CKD）患者肾功能的快速衰退，并找出关键的可调整风险因素，以便采取有针对性的干预措施：我们对首尔国立大学医院的 6924 名 T2D 和 CKD 患者进行了回顾性队列研究。肾功能衰退通过估计肾小球滤过率斜率进行评估。通过模型诊断和时间-事件分析评估了极梯度提升（XGBoost）模型的性能。利用可改变的风险因素对风险亚组进行了Copula模拟分层：共有 906 人（13.1%）出现肾功能急剧下降。XGBoost 模型显示出最佳性能（接收器操作特征曲线下面积：0.826）。八年内患终末期肾病的风险在不同的风险四分位数之间呈上升趋势，其中第三季度（2.06；95% 置信区间 [CI]：1.29-3.29）和第四季度（10.9；95% 置信区间：7.36-16.2）的风险比具有显著的统计学意义。模拟分析确定了 A3 阶段白蛋白尿和以下至少两项的高风险亚组：血细胞比容 120 mmHg 和糖化血红蛋白 A1c >6.5 %：结论：XGBoost 模型通过 copula 仿真成功地对 T2D 和 CKD 患者的肾脏预后进行了分层。

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