In Europe, 27 % of patients with a podiatric complication of diabetes are referred to a specialized structure for surgery after more than 3 months’ disease progression. Our study aimed to analyze access to healthcare and future self-projection in patients with severe diabetic foot conditions.
Methods
We performed a qualitative study with semi-structured interviews in patients hospitalized with diabetic foot conditions requiring surgical treatment. We collected quantitative data on the diabetes characteristics, levels of social precariousness, anxiety and depression.
Results
We conducted 13 interviews with 2 females and 11 males; mean age 62.7 years. Five had undergone surgical debridement, six toe amputation, and two mid-tarsal amputation. Most were socioeconomically deprived and/or isolated. Three discourse themes emerged: 1) heterogeneity in the care pathway, with systemic barriers, negligence or overtrust 2) relationship between social support and the ability to project oneself into the future, 3) poverty of speech.
Conclusions
Education should emphasize the importance of prompt referral to a specialized structure after the onset of a wound. The lack of support from loved ones and social support appeared to be associated with patients’ failure to plan for their future. We advocate for a psychological evaluation and support for all these patients.
{"title":"Patients with type 2 diabetes and surgical foot wounds: Overtrust in primary care physicians, isolation, and difficulties contemplating the future","authors":"Judith Charbit , Marie-Laure Gbessoua , Juliette Jacquot , Nathalie Garnier , Veronique Labbe Gentils , Meriem Sal , Narimane Berkane , Sopio Tatulashvili , Emmanuel Cosson , Hélène Bihan","doi":"10.1016/j.diabres.2024.111861","DOIUrl":"10.1016/j.diabres.2024.111861","url":null,"abstract":"<div><h3>Aims</h3><div>In Europe, 27 % of patients with a podiatric complication of diabetes are referred to a specialized structure for surgery after more than 3 months’ disease progression. Our study aimed to analyze access to healthcare and future self-projection in patients with severe diabetic foot conditions.</div></div><div><h3>Methods</h3><div>We performed a qualitative study with semi-structured interviews in patients hospitalized with diabetic foot conditions requiring surgical treatment. We collected quantitative data on the diabetes characteristics, levels of social precariousness, anxiety and depression.</div></div><div><h3>Results</h3><div>We conducted 13 interviews with 2 females and 11 males; mean age 62.7 years. Five had undergone surgical debridement, six toe amputation, and two mid-tarsal amputation. Most were socioeconomically deprived and/or isolated. Three discourse themes emerged: 1) heterogeneity in the care pathway, with systemic barriers, negligence or overtrust 2) relationship between social support and the ability to project oneself into the future, 3) poverty of speech.</div></div><div><h3>Conclusions</h3><div>Education should emphasize the importance of prompt referral to a specialized structure after the onset of a wound. The lack of support from loved ones and social support appeared to be associated with patients’ failure to plan for their future. We advocate for a psychological evaluation and support for all these patients.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111861"},"PeriodicalIF":6.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.diabres.2024.111901
Andrew P. Demidowich , Camille Stanback , Mihail Zilbermint
{"title":"Reply to “Relevance of gastric emptying to the timing of prandial insulin administration in hospitalised patients with diabetes”","authors":"Andrew P. Demidowich , Camille Stanback , Mihail Zilbermint","doi":"10.1016/j.diabres.2024.111901","DOIUrl":"10.1016/j.diabres.2024.111901","url":null,"abstract":"","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111901"},"PeriodicalIF":6.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460376","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}
Pub Date : 2024-10-16DOI: 10.1016/j.diabres.2024.111887
Joseph Henson , Gema Hernández Ibarburu , Zuzanna Drebert , Tommy Slater , Andrew P. Hall , Kamlesh Khunti , Jack A. Sargeant , Francesco Zaccardi , Melanie J. Davies , Thomas Yates
Aims
To explore the 5-year incidence and relative rates of sleep disorders in younger (16-≤40 years) and middle-older (=>40 years) age adults with and without newly diagnosed type 2 diabetes.
Methods
This retrospective, observational cohort study utilised data from the US Collaborative Network within the TriNetX database. We compared 5-year cumulative incidence of sleep disorders in younger (n = 110,088) and middle-older populations (n = 1,185,961).
Results
The absolute risk of developing any type of sleep disorder was greater in individuals with type 2 diabetes vs. those without. Over the 5-year follow-up period, 14.2 % of younger adults and 18.5 % of middle-older age adults with newly diagnosed type 2 diabetes developed any form of sleep disorder, compared to 4.5 % and 7.9 % propensity matched individuals without diabetes. We observed a more pronounced relative rate across the observed sleep disorders in younger adults.
Conclusions
The 5-year risk of sleep disorders is higher in those with newly diagnosed type 2 diabetes vs. those without. A higher absolute risk was seen in middle-older adults, but relative rates were consistently higher in younger adults with type 2 diabetes. Sleep should be regularly discussed as part of a holistic approach to diabetes care, particularly in those aged ≤40.
{"title":"Sleep disorders in younger and middle-older age adults with newly diagnosed type 2 diabetes mellitus: A retrospective cohort study in >1million individuals","authors":"Joseph Henson , Gema Hernández Ibarburu , Zuzanna Drebert , Tommy Slater , Andrew P. Hall , Kamlesh Khunti , Jack A. Sargeant , Francesco Zaccardi , Melanie J. Davies , Thomas Yates","doi":"10.1016/j.diabres.2024.111887","DOIUrl":"10.1016/j.diabres.2024.111887","url":null,"abstract":"<div><h3>Aims</h3><div>To explore the 5-year incidence and relative rates of sleep disorders in younger (16-≤40 years) and middle-older (=>40 years) age adults with and without newly diagnosed type 2 diabetes.</div></div><div><h3>Methods</h3><div>This retrospective, observational cohort study utilised data from the US Collaborative Network within the TriNetX database. We compared 5-year cumulative incidence of sleep disorders in younger (n = 110,088) and middle-older populations (n = 1,185,961).</div></div><div><h3>Results</h3><div>The absolute risk of developing any type of sleep disorder was greater in individuals with type 2 diabetes vs. those without. Over the 5-year follow-up period, 14.2 % of younger adults and 18.5 % of middle-older age adults with newly diagnosed type 2 diabetes developed any form of sleep disorder, compared to 4.5 % and 7.9 % propensity matched individuals without diabetes. We observed a more pronounced relative rate across the observed sleep disorders in younger adults.</div></div><div><h3>Conclusions</h3><div>The 5-year risk of sleep disorders is higher in those with newly diagnosed type 2 diabetes vs. those without. A higher absolute risk was seen in middle-older adults, but relative rates were consistently higher in younger adults with type 2 diabetes. Sleep should be regularly discussed as part of a holistic approach to diabetes care, particularly in those aged ≤40.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111887"},"PeriodicalIF":6.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.diabres.2024.111895
Si Chen , Jingyi Lu , Danfeng Peng , Fengjing Liu , Wei Lu , Wei Zhu , Yuqian Bao , Jian Zhou , Weiping Jia
Objective
This study aimed to assess the current state of self-monitoring of blood glucose (SMBG) in Chinese patients initiating premixed insulin and its influential factors.
Research Design and Methods
This is a single-arm, multi-center, prospective real-world study enrolling a total of 8214 adult patients with type 2 diabetes mellitus (T2DM) newly initiated premixed insulin analogues. Each patient was followed up for 12 weeks, and the data related to SMBG was collected at week 1, week 4, week 8 and week 12, while data related to glycated hemoglobin were collected at week 1 and week 12. The primary outcome was the frequency of SMBG over 12 weeks.
Results
At week 12, 83.3 % monitored blood glucose at least once, while 20.3 % of participants continued SMBG every week. The average monitoring frequency was 4.78 times/week over the first 4 weeks and 3.33 times/week over 12 weeks. The patients with a higher frequency of SMBG had better control of blood glucose.
Conclusions
This study found that most T2DM patients would take SMBG but the adherence decreased over time. The adherence to SMBG in Chinese T2DM patients was influenced by age, insulin dosage, education level, and diabetes duration. SMBG benefited the improvement of glycemic control.
{"title":"The status of blood glucose monitoring and its influencing factors in Chinese patients with type 2 diabetes initiating premixed insulin: A prospective real-world study","authors":"Si Chen , Jingyi Lu , Danfeng Peng , Fengjing Liu , Wei Lu , Wei Zhu , Yuqian Bao , Jian Zhou , Weiping Jia","doi":"10.1016/j.diabres.2024.111895","DOIUrl":"10.1016/j.diabres.2024.111895","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess the current state of self-monitoring of blood glucose (SMBG) in Chinese patients initiating premixed insulin and its influential factors.</div></div><div><h3>Research Design and Methods</h3><div>This is a single-arm, multi-center, prospective real-world study enrolling a total of 8214 adult patients with type 2 diabetes mellitus (T2DM) newly initiated premixed insulin analogues. Each patient was followed up for 12 weeks, and the data related to SMBG was collected at week 1, week 4, week 8 and week 12, while data related to glycated hemoglobin were collected at week 1 and week 12. The primary outcome was the frequency of SMBG over 12 weeks.</div></div><div><h3>Results</h3><div>At week 12, 83.3 % monitored blood glucose at least once, while 20.3 % of participants continued SMBG every week. The average monitoring frequency was 4.78 times/week over the first 4 weeks and 3.33 times/week over 12 weeks. The patients with a higher frequency of SMBG had better control of blood glucose.</div></div><div><h3>Conclusions</h3><div>This study found that most T2DM patients would take SMBG but the adherence decreased over time. The adherence to SMBG in Chinese T2DM patients was influenced by age, insulin dosage, education level, and diabetes duration. SMBG benefited the improvement of glycemic control.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"218 ","pages":"Article 111895"},"PeriodicalIF":6.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460379","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}
Pub Date : 2024-10-16DOI: 10.1016/j.diabres.2024.111892
Charity Wambui Kanyoro, Mercy Karoney, Henry Nyamogoba, Jemimah Kamano
Aims
To compare nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae among patients with and without diabetes at Moi Teaching and Referral Hospital (MTRH) in western Kenya.
Methods
A cross-sectional study was conducted at MTRH diabetes and eye clinics. Participants were selected using systematic random sampling. Sociodemographic data and risk factors were collected through interviewer-administered questionnaires. Blood samples were taken to measure random blood sugar and HbA1c levels. Nasopharyngeal swabs were cultured and tested for antibiotic susceptibility within 24 h. Data analysis was performed using STATA version 13. Associations were assessed using Pearson’s chi-square, Fisher’s exact test, unpaired t-test, and Wilcoxon test.
Results
A total of 124 participants with diabetes and 121 without diabetes were enrolled. Overall, 7.4 % (95 % CI: 4.4, 11.4) of participants carried S. pneumoniae. Carriage was higher in diabetes (12.1 % [95 % CI: 7.0, 19.0]) than non-diabetes participants (2.48 % [95 % CI: 1.0, 7.0]), with a statistically significant difference (p = 0.004). Diabetes was associated with higher odds of carriage (adjusted OR 6.2, p = 0.012). No association was found with age, sex, cooking fuel, presence of children under 5, or prior antibiotic use. Among participants with diabetes, carriage of Streptococcus Pneumoniae was only associated with insulin use. Antibiotic resistance was highest for cotrimoxazole (94.44 %), followed by amoxicillin (16.7 %) and cefuroxime (11.1 %). No resistance to macrolides was observed.
Conclusion
Nasopharyngeal carriage of S. pneumoniae is higher in patients with diabetes, with significant resistance to common antibiotics, though macrolides remain effective.
{"title":"Nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae among diabetes patients in western Kenya","authors":"Charity Wambui Kanyoro, Mercy Karoney, Henry Nyamogoba, Jemimah Kamano","doi":"10.1016/j.diabres.2024.111892","DOIUrl":"10.1016/j.diabres.2024.111892","url":null,"abstract":"<div><h3>Aims</h3><div>To compare nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae among patients with and without diabetes at Moi Teaching and Referral Hospital (MTRH) in western Kenya.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted at MTRH diabetes and eye clinics. Participants were selected using systematic random sampling. Sociodemographic data and risk factors were collected through interviewer-administered questionnaires. Blood samples were taken to measure random blood sugar and HbA1c levels. Nasopharyngeal swabs were cultured and tested for antibiotic susceptibility within 24 h. Data analysis was performed using STATA version 13. Associations were assessed using Pearson’s chi-square, Fisher’s exact test, unpaired <em>t</em>-test, and Wilcoxon test.</div></div><div><h3>Results</h3><div>A total of 124 participants with diabetes and 121 without diabetes were enrolled. Overall, 7.4 % (95 % CI: 4.4, 11.4) of participants carried S. pneumoniae. Carriage was higher in diabetes (12.1 % [95 % CI: 7.0, 19.0]) than non-diabetes participants (2.48 % [95 % CI: 1.0, 7.0]), with a statistically significant difference (p = 0.004). Diabetes was associated with higher odds of carriage (adjusted OR 6.2, p = 0.012). No association was found with age, sex, cooking fuel, presence of children under 5, or prior antibiotic use. Among participants with diabetes, carriage of <em>Streptococcus Pneumoniae</em> was only associated with insulin use. Antibiotic resistance was highest for cotrimoxazole (94.44 %), followed by amoxicillin (16.7 %) and cefuroxime (11.1 %). No resistance to macrolides was observed.</div></div><div><h3>Conclusion</h3><div>Nasopharyngeal carriage of S. pneumoniae is higher in patients with diabetes, with significant resistance to common antibiotics, though macrolides remain effective.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111892"},"PeriodicalIF":6.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446364","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}
Pub Date : 2024-10-15DOI: 10.1016/j.diabres.2024.111891
Rocco Mollace , Susanna Longo , Matteo Nardin , Annamaria Tavernese , Vincenzo Musolino , Antonio Cardamone , Massimo Federici
Metabolic dysfunction-associated steatotic liver disease (MASLD), represents a growing health concern due to its strong association with metabolic syndrome, obesity, and type 2 diabetes mellitus (T2DM). This condition, characterized by excessive fat accumulation in the liver not attributed to alcohol consumption, has emerged as a leading cause of chronic liver disease globally. MASLD significantly elevates the risk of major adverse cardiovascular events (MACE) through mechanisms like increased oxidative stress, insulin resistance, and chronic inflammation, all of which contribute to the development of atherosclerosis and endothelial dysfunction.
Effective management of MASLD is crucial not only for liver health but also for cardiovascular disease (CVD) prevention. Lifestyle modifications, particularly weight loss achieved through dietary changes and increased physical activity, are the cornerstone of MASLD treatment. Additionally, pharmacological interventions, especially antihyperglycemic agents, play a pivotal role in treating MASLD in patients with T2DM. Novel therapeutic agents targeting various pathways of metabolic and liver dysfunction are under investigation, offering hope for more effective management strategies. This review explores the interconnectedness of MASLD and CVD, highlighting current and emerging therapeutic approaches.
{"title":"Role of MASLD in CVD: A review of emerging treatment options","authors":"Rocco Mollace , Susanna Longo , Matteo Nardin , Annamaria Tavernese , Vincenzo Musolino , Antonio Cardamone , Massimo Federici","doi":"10.1016/j.diabres.2024.111891","DOIUrl":"10.1016/j.diabres.2024.111891","url":null,"abstract":"<div><div>Metabolic dysfunction-associated steatotic liver disease (MASLD), represents a growing health concern due to its strong association with metabolic syndrome, obesity, and type 2 diabetes mellitus (T2DM). This condition, characterized by excessive fat accumulation in the liver not attributed to alcohol consumption, has emerged as a leading cause of chronic liver disease globally. MASLD significantly elevates the risk of major adverse cardiovascular events (MACE) through mechanisms like increased oxidative stress, insulin resistance, and chronic inflammation, all of which contribute to the development of atherosclerosis and endothelial dysfunction.</div><div>Effective management of MASLD is crucial not only for liver health but also for cardiovascular disease (CVD) prevention. Lifestyle modifications, particularly weight loss achieved through dietary changes and increased physical activity, are the cornerstone of MASLD treatment. Additionally, pharmacological interventions, especially antihyperglycemic agents, play a pivotal role in treating MASLD in patients with T2DM. Novel therapeutic agents targeting various pathways of metabolic and liver dysfunction are under investigation, offering hope for more effective management strategies. This review explores the interconnectedness of MASLD and CVD, highlighting current and emerging therapeutic approaches.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111891"},"PeriodicalIF":6.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.diabres.2024.111889
Hardeep Vora , Preet Kaur
Background
The relentless rise in Type 2 diabetes mellitus (T2DM) and prediabetes presents a complex challenge to India’s healthcare system. This study analyses the prevalence and trends of these conditions in adults across Indian states using laboratory data collected during 2023.
Methods
HbA1c values from 19,66,449 samples from adults alongside demographic and geographic details were retrospectively analysed. Data were stratified by state, age, and gender and evaluated against national statistics parameters such as food consumption and socio-economic status.
Results
Substantial regional variation was seen across the country where 22.25% of the tested population was considered having prediabetes, and 27.18% with diabetes. Odisha had the highest rates, while J&K reported the lowest. Gender-specific trends indicate an increase in prevalence of diabetes among males compared to females. Age-wise data stratification shows a significant burden of prediabetes and diabetes in the economically productive age groups. Correlations between disease prevalence and state-specific grain consumption were observed, suggesting dietary influences.
Conclusions
The reported prevalence of prediabetes and diabetes higher than previous studies highlights the importance of regular screening. The use of HbA1c for estimation as a long-term average blood sugar marker helps to identify previously undiagnosed diabetes. The correlation of prevalence with food production underscores the importance of diet in disease management.
{"title":"Prediabetes and diabetes in India: An HbA1c based epidemiology study","authors":"Hardeep Vora , Preet Kaur","doi":"10.1016/j.diabres.2024.111889","DOIUrl":"10.1016/j.diabres.2024.111889","url":null,"abstract":"<div><h3>Background</h3><div>The relentless rise in Type 2 diabetes mellitus (T2DM) and prediabetes presents a complex challenge to India’s healthcare system. This study analyses the prevalence and trends of these conditions in adults across Indian states using laboratory data collected during 2023.</div></div><div><h3>Methods</h3><div>HbA1c values from 19,66,449 samples from adults alongside demographic and geographic details were retrospectively analysed. Data were stratified by state, age, and gender and evaluated against national statistics parameters such as food consumption and socio-economic status.</div></div><div><h3>Results</h3><div>Substantial regional variation was seen across the country where 22.25% of the tested population was considered having prediabetes, and 27.18% with diabetes. Odisha had the highest rates, while J&K reported the lowest. Gender-specific trends indicate an increase in prevalence of diabetes among males compared to females. Age-wise data stratification shows a significant burden of prediabetes and diabetes in the economically productive age groups. Correlations between disease prevalence and state-specific grain consumption were observed, suggesting dietary influences.</div></div><div><h3>Conclusions</h3><div>The reported prevalence of prediabetes and diabetes higher than previous studies highlights the importance of regular screening. The use of HbA1c for estimation as a long-term average blood sugar marker helps to identify previously undiagnosed diabetes. The correlation of prevalence with food production underscores the importance of diet in disease management.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111889"},"PeriodicalIF":6.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460375","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}
Pub Date : 2024-10-15DOI: 10.1016/j.diabres.2024.111893
Evelyn B. Parr , Bridget E. Radford , Rebecca C. Hall , Nikolai Steventon-Lorenzen , Steve A. Flint , Zoe Siviour , Connie Plessas , Shona L. Halson , Leah Brennan , Imre W.K. Kouw , Rich D. Johnston , Brooke L. Devlin , John A. Hawley
Aims
To test the efficacy of time-restricted eating (TRE) in comparison to dietitian-led individualised dietary guidance to improve HbA1c in people with Type 2 diabetes mellitus.
Methods
In a parallel groups design, 51 adults (35–65 y) with Type 2 diabetes mellitus and overweight/obesity (HbA1c ≥6.5% (48 mmol/mol), BMI ≥25-≤40 kg/m2) commenced a six-month intervention. Following baseline, participants were randomised to TRE (1000–1900 h) or DIET (individualised dietetic guidance) with four consultations over four months. Changes in HbA1c (primary), body composition, and self-reported adherence (secondary) were analysed using linear mixed models. A non-inferiority margin of 0.3% (4 mmol/mol) HbA1c was set a priori.
Results
Forty-three participants (56 ± 8 y, BMI: 33 ± 5 kg/m2, HbA1c: 7.6 ± 0.8%) completed the intervention. HbA1c was reduced (P=0.002; TRE: −0.4% (−5 mmol/mol), DIET: −0.3% (−4 mmol/mol)) with no group or interaction effects; TRE was non-inferior to DIET (−0.11%, 95%CI: −0.50% to 0.28%). Body mass reduced in both groups (TRE: −1.7 kg; DIET: −1.2 kg) via ∼900 kJ/d spontaneous energy reduction (P<0.001). Self-reported adherence was higher in TRE versus DIET (P<0.001).
Conclusions
When individualised dietary guidance is not available, effective, and/or suitable, TRE may be an alternative dietary strategy to improve glycaemic control in people with Type 2 diabetes mellitus.
{"title":"Comparing the effects of time-restricted eating on glycaemic control in people with type 2 diabetes with standard dietetic practice: A randomised controlled trial","authors":"Evelyn B. Parr , Bridget E. Radford , Rebecca C. Hall , Nikolai Steventon-Lorenzen , Steve A. Flint , Zoe Siviour , Connie Plessas , Shona L. Halson , Leah Brennan , Imre W.K. Kouw , Rich D. Johnston , Brooke L. Devlin , John A. Hawley","doi":"10.1016/j.diabres.2024.111893","DOIUrl":"10.1016/j.diabres.2024.111893","url":null,"abstract":"<div><h3>Aims</h3><div>To test the efficacy of time-restricted eating (TRE) in comparison to dietitian-led individualised dietary guidance to improve HbA1c in people with Type 2 diabetes mellitus.</div></div><div><h3>Methods</h3><div>In a parallel groups design, 51 adults (35–65 y) with Type 2 diabetes mellitus and overweight/obesity (HbA1c ≥6.5% (48 mmol/mol), BMI ≥25-≤40 kg/m<sup>2</sup>) commenced a six-month intervention. Following baseline, participants were randomised to TRE (1000–1900 h) or DIET (individualised dietetic guidance) with four consultations over four months. Changes in HbA1c (primary), body composition, and self-reported adherence (secondary) were analysed using linear mixed models. A non-inferiority margin of 0.3% (4 mmol/mol) HbA1c was set <em>a priori</em>.</div></div><div><h3>Results</h3><div>Forty-three participants (56 ± 8 y, BMI: 33 ± 5 kg/m<sup>2</sup>, HbA1c: 7.6 ± 0.8%) completed the intervention. HbA1c was reduced (P=0.002; TRE: −0.4% (−5 mmol/mol), DIET: −0.3% (−4 mmol/mol)) with no group or interaction effects; TRE was non-inferior to DIET (−0.11%, 95%CI: −0.50% to 0.28%). Body mass reduced in both groups (TRE: −1.7 kg; DIET: −1.2 kg) via ∼900 kJ/d spontaneous energy reduction (P<0.001). Self-reported adherence was higher in TRE versus DIET (P<0.001).</div></div><div><h3>Conclusions</h3><div>When individualised dietary guidance is not available, effective, and/or suitable, TRE may be an alternative dietary strategy to improve glycaemic control in people with Type 2 diabetes mellitus.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111893"},"PeriodicalIF":6.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To explore the separate and joint association of estimated glucose disposal rate (eGDR) and high-sensitivity C-reactive protein (hsCRP) with cardiometabolic multimorbidity (CMM).
Methods
A total of 6900 participants aged 45 years or older with available data on eGDR and hsCRP and without cardiometabolic diseases at baseline from the China Health and Retirement Longitudinal Study were included. CMM was defined as the coexistence of two or more cardiometabolic diseases, including heart diseases, stroke, and diabetes.
Results
During a median follow-up of 9.0 years, 464 (6.7 %) participants developed CMM. Low eGDR and high hsCRP separately and jointly increased the risk of CMM. The adjusted hazard ratio (HR) was 1.67 (95 % confidence interval [CI] 1.33–2.09) for low eGDR versus high eGDR, 1.43 (95 % CI 1.12–1.82) for high hsCRP versus low hsCRP) and 2.40 (95 % CI 1.77–3.27) for low eGDR plus high hsCRP versus high eGDR plus low hsCRP. The C-statistic, discriminatory power and risk reclassification significantly improved with the addition of combined eGDR and hsCRP for CMM (P < 0.001).
Conclusions
Low eGDR and high hsCRP were individually and jointly associated with increased risk of incident CMM. The findings highlighted the importance of joint evaluation of eGDR and hsCRP for primary prevention of CMM.
{"title":"Estimated glucose disposal rate, high sensitivity C-reactive protein and cardiometabolic multimorbidity in middle-aged and older Chinese adults: A nationwide prospective cohort study","authors":"Qin Xu , Xue Tian , Xue Xia , Yijun Zhang , Manqi Zheng , Anxin Wang","doi":"10.1016/j.diabres.2024.111894","DOIUrl":"10.1016/j.diabres.2024.111894","url":null,"abstract":"<div><h3>Aim</h3><div>To explore the separate and joint association of estimated glucose disposal rate (eGDR) and high-sensitivity C-reactive protein (hsCRP) with cardiometabolic multimorbidity (CMM).</div></div><div><h3>Methods</h3><div>A total of 6900 participants aged 45 years or older with available data on eGDR and hsCRP and without cardiometabolic diseases at baseline from the China Health and Retirement Longitudinal Study were included. CMM was defined as the coexistence of two or more cardiometabolic diseases, including heart diseases, stroke, and diabetes.</div></div><div><h3>Results</h3><div>During a median follow-up of 9.0 years, 464 (6.7 %) participants developed CMM. Low eGDR and high hsCRP separately and jointly increased the risk of CMM. The adjusted hazard ratio (HR) was 1.67 (95 % confidence interval [CI] 1.33–2.09) for low eGDR versus high eGDR, 1.43 (95 % CI 1.12–1.82) for high hsCRP versus low hsCRP) and 2.40 (95 % CI 1.77–3.27) for low eGDR plus high hsCRP versus high eGDR plus low hsCRP. The C-statistic, discriminatory power and risk reclassification significantly improved with the addition of combined eGDR and hsCRP for CMM (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Low eGDR and high hsCRP were individually and jointly associated with increased risk of incident CMM. The findings highlighted the importance of joint evaluation of eGDR and hsCRP for primary prevention of CMM.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111894"},"PeriodicalIF":6.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446365","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}
Pub Date : 2024-10-10DOI: 10.1016/j.diabres.2024.111866
Zhihao Zheng , Rui Zhang , Shanshan Shi , Jining He , Lei Feng , Changdong Guan , Lei Song , Chenggang Zhu , Dong Yin , Jia Li , Kefei Dou
Background
Functional complete revascularization (CR) after percutaneous coronary intervention (PCI), as assessed by the residual functional SYNTAX score (rFSS), has been correlated with enhanced prognostic outcomes.
Methods
A total of 1,555 patients with available post-PCI quantitative flow ratio (QFR) were included, whose data were collected from PANDA III trial. Functional CR was defined as rFSS=0, while anatomic CR was defined as residual SYNTAX score (rSS) = 0. Structural equation modeling was used to analysis whether functional CR explained the relationship between T2DM (Type 2 diabetes mellitus) and the risk of 2-year rates of major adverse cardiac events (including all-cause death, all myocardial infarction, or any ischemia-driven revascularization).
Results
Multiple cox regression revealed that T2DM was associated with MACE (P=0.007), but not after adding functional CR to the model (P=0.05), suggesting a mediation effect. Structural equation modeling analysis revealed a significant indirect effect of T2DM on MACE through functional CR (P=0.006, Mediated [%] = 27.3), suggesting a partial mediation effect.
Conclusion
The degree of functional revascularization may emerge as a central mechanism pivotal in elucidating the association between T2DM and the risk of MACE. Cardiologists should prioritize functional complete revascularization during the initial PCI procedure for patients with diabetes mellitus.
背景：经皮冠状动脉介入治疗（PCI）后的功能性完全血运重建（CR）由残余功能性SYNTAX评分（rFSS）评估，与预后结果的改善相关：方法：共纳入 1,555 例有 PCI 后定量血流比（QFR）的患者，其数据来自 PANDA III 试验。功能性CR定义为rFSS=0，解剖性CR定义为残余SYNTAX评分（rSS）=0。采用结构方程模型分析功能性CR是否能解释T2DM（2型糖尿病）与2年主要不良心脏事件（包括全因死亡、所有心肌梗死或任何缺血驱动的血管再通术）风险之间的关系：多重考克斯回归显示，T2DM与MACE相关（P=0.007），但在模型中加入功能性CR后与MACE无关（P=0.05），这表明存在中介效应。结构方程建模分析显示，T2DM通过功能性CR对MACE有显著的间接影响（P=0.006，中介[%] = 27.3），表明存在部分中介效应：结论：功能性血管再通的程度可能是阐明 T2DM 与 MACE 风险之间关系的核心机制。心脏病专家在对糖尿病患者进行初次PCI手术时，应优先考虑功能性完全血管再通。
{"title":"Cardiovascular prognosis in patients with type 2 diabetes mellitus mediated by the functional completeness after revascularization","authors":"Zhihao Zheng , Rui Zhang , Shanshan Shi , Jining He , Lei Feng , Changdong Guan , Lei Song , Chenggang Zhu , Dong Yin , Jia Li , Kefei Dou","doi":"10.1016/j.diabres.2024.111866","DOIUrl":"10.1016/j.diabres.2024.111866","url":null,"abstract":"<div><h3>Background</h3><div>Functional complete revascularization (CR) after percutaneous coronary intervention (PCI), as assessed by the residual functional SYNTAX score (rFSS), has been correlated with enhanced prognostic outcomes.</div></div><div><h3>Methods</h3><div>A total of 1,555 patients with available post-PCI quantitative flow ratio (QFR) were included, whose data were collected from PANDA III trial. Functional CR was defined as rFSS=0, while anatomic CR was defined as residual SYNTAX score (rSS) = 0. Structural equation modeling was used to analysis whether functional CR explained the relationship between T2DM (Type 2 diabetes mellitus) and the risk of 2-year rates of major adverse cardiac events (including all-cause death, all myocardial infarction, or any ischemia-driven revascularization).</div></div><div><h3>Results</h3><div>Multiple cox regression revealed that T2DM was associated with MACE (<em>P</em>=0.007), but not after adding functional CR to the model (<em>P</em>=0.05), suggesting a mediation effect. Structural equation modeling analysis revealed a significant indirect effect of T2DM on MACE through functional CR (<em>P</em>=0.006, Mediated [%] = 27.3), suggesting a partial mediation effect.</div></div><div><h3>Conclusion</h3><div>The degree of functional revascularization may emerge as a central mechanism pivotal in elucidating the association between T2DM and the risk of MACE. Cardiologists should prioritize functional complete revascularization during the initial PCI procedure for patients with diabetes mellitus.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111866"},"PeriodicalIF":6.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406229","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}
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