Diabetes research and clinical practice最新文献_第5页

Balanced diets are associated with a lower risk of type 2 diabetes than plant-based diets 与植物性饮食相比，均衡饮食与患2型糖尿病的风险较低有关。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111977

Bing Kang , Xiaoqin Yin , Deqing Chen , Yandan Wang , JiangYan Lv , Jiyong Zhou , Xiangjun Chen , Xiaoxia Kou , Xin Hang , Qing Yang , Rui Wu , Xu Luo , Changyu Wang , Shumin Yang , Qifu Li , Jinbo Hu

Background & Aims

Plant-based diets benefit human health, while the deficient in some nutrients limits its application. We aimed to examine whether balanced diets could be better in reducing diabetes risk than plant-based diets.

Methods

In cross-sectional analysis of Environment-Inflammation-Metabolic-Diseases Study (EIMDS), we used a questionnaire to investigate the habit of balanced and plant-based diets. In the prospective analysis of UK Biobank, we used the plant-based diet index of health (hPDI) and unhealth (uPDI) to evaluate the plant-based diets, and defined the balanced diet as a daily intake of 5 categories and at least 12 types of food. After analyzing proteomic data in UK Biobank, we explored the causal relationship between signature proteins of balanced diets and incident diabetes based on summary-data-based Mendelian randomization (SMR).

Results

Compared to participants who had plant-based diets, those who had balanced diets showed a lower risk of diabetes in EIMDS (Odd Ratio 0.65, 95%CI 0.44–0.95). In UK Biobank, after excluding participants with unhealthy plant-based diets, participants with balanced diets still showed a lower diabetes risk than participants with plant-based diets (Hazard Ratio 0.86, 95%CI 0.77–0.95). Proteomic analysis identified 107 downregulated and 2 upregulated proteins that were associated with higher and lower risk of diabetes, respectively. In SMR analyses, the downregulated signature proteins of balanced diets (AGR2, DBI, IL17RA and SERPINH1) were causally associated with diabetes incidence.

Conclusion

Adhered to a balanced diet is associated with a lower risk of diabetes compared to plant-based diet, which might be attributed to signature proteins such as AGR2, DBI, IL17RA and SERPINH1.

背景与目的：植物性饮食有利于人类健康，但某些营养素的缺乏限制了其应用。我们的目的是研究平衡饮食是否比植物性饮食更能降低糖尿病风险。方法：在环境-炎症-代谢-疾病研究（EIMDS）的横断面分析中，我们使用问卷调查平衡饮食和植物性饮食的习惯。在UK Biobank的前瞻性分析中，我们使用植物性饮食健康指数（hPDI）和不健康指数（uPDI）来评估植物性饮食，并将平衡饮食定义为每天摄入5类至少12种食物。在分析了英国生物银行（UK Biobank）的蛋白质组学数据后，我们基于基于汇总数据的孟德尔随机化（SMR），探讨了平衡饮食中特征蛋白与糖尿病发病之间的因果关系。结果：与植物性饮食的参与者相比，均衡饮食的参与者在EIMDS中患糖尿病的风险较低（奇比0.65,95%CI 0.44-0.95）。在英国生物银行，在排除不健康植物性饮食的参与者后，饮食平衡的参与者仍然比植物性饮食的参与者显示出更低的糖尿病风险（风险比0.86,95%CI 0.77-0.95）。蛋白质组学分析确定了107个下调蛋白和2个上调蛋白，分别与糖尿病的高风险和低风险相关。在SMR分析中，均衡饮食中下调的特征蛋白（AGR2、DBI、IL17RA和SERPINH1）与糖尿病发病率有因果关系。结论：与植物性饮食相比，坚持均衡饮食与较低的糖尿病风险相关，这可能归因于AGR2、DBI、IL17RA和SERPINH1等特征蛋白。

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引用次数: 0

Men with type 1 diabetes had a more than 7-fold odds of elevated depressive symptoms compared to men without diabetes 与没有糖尿病的男性相比，患有1型糖尿病的男性抑郁症状升高的几率超过7倍。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111947

Kimberly A. Driscoll , Cristy R. Geno Rasmussen , Holly O’Donnell , Paige Trojanowski , Amy C. Alman , Amena Keshawarz , Janet K. Snell-Bergeon

Objective

To examine: 1) differences in prevalence of elevated depressive symptoms between individuals with type 1 diabetes (T1D) and without any type of diabetes overall and by sex; and 2) associations between depressive symptoms and HbA1c, self-management behaviors, and cardiovascular health.

Research Design and Methods: Adults (n = 414) with T1D (mean age = 52 ± 9 years, mean duration = 38 ± 9 years; mean HbA1c = 7.8 ± 1.1 mg/dL or 177 mmol/L; 55 % female) and without any type of diabetes (n = 488; mean age = 51 ± 9 years; 51 % female) from the fourth study visit of CACTI, an observational study, completed questionnaires about depressive symptoms and dietary intake. Only adults with T1D completed a questionnaire about diabetes self-management. Hierarchical logistic regression models were used to examine demographic and clinical characteristics associated with depressive symptoms.

Results

Depressive scores were higher in people with T1D overall and in both sexes. Men with T1D had >7-fold increased odds of elevated depressive symptoms compared to men without diabetes (OR 7.4, 95 % CI: 2.1–26.4), whereas there were no increased odds in women (OR 1.4, 95 % CI: 0.6–2.9, significant sex x diabetes interaction [p = 0.03]). Higher levels of depressive symptoms were associated with both lower engagement in self-management behaviors and physical activity.

Conclusions

Our results demonstrate that there is an urgent need to screen adults with T1D for depressive symptoms as part of routine medical care and to test interventions to minimize their impact on physical health outcomes.

目的：研究：1)1型糖尿病患者和非1型糖尿病患者抑郁症状升高的患病率总体和性别差异；2)抑郁症状与糖化血红蛋白、自我管理行为和心血管健康之间的关系。研究设计和方法:成人(n = 414)1型糖尿病患者(平均年龄 = 52 ± 9年,意味着时间 = 38 ± 9年;平均HbA1c = 7.8 ± 1.1 mg/dL或177 mmol/L；55 %女性)，没有任何类型的糖尿病(n = 488；平均年龄 = 51 ± 9岁；51（ %女性）从观察性研究CACTI的第四次研究访问中完成了关于抑郁症状和饮食摄入的问卷调查。成人1型糖尿病患者完成一份糖尿病自我管理问卷。分层逻辑回归模型用于检查与抑郁症状相关的人口学和临床特征。结果：1型糖尿病患者的抑郁得分总体上更高，无论男女。与没有糖尿病的男性相比，1型糖尿病男性抑郁症状升高的几率增加了7倍（OR 7.4, 95 % CI: 2.1-26.4），而女性的几率没有增加（OR 1.4, 95 % CI: 0.6-2.9，显著的性别 与 糖尿病相互作用[p = 0.03]）。较高水平的抑郁症状与较低的自我管理行为和体力活动相关。结论：我们的研究结果表明，迫切需要筛查成人1型糖尿病患者的抑郁症状，作为常规医疗护理的一部分，并测试干预措施，以尽量减少其对1型糖尿病结局的影响。

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引用次数: 0

Comparing ADA and IDF diagnostic criteria for intermediate hyperglycaemia and diabetes in the SHiDS study 比较ADA和IDF在SHiDS研究中诊断中度高血糖和糖尿病的标准。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111963

Yinan Zhang , Shuang Liu , Baige Cao , Jinfang Xu , Weiping Jia , Congrong Wang

Aims

This study aimed to assess the prevalence of IH and diabetes, as well as insulin secretion, insulin sensitivity, and related curve patterns in subjects with different glucose tolerance categories according to the diagnostic criteria established by the American Diabetes Association (ADA) and the more recently published International Diabetes Federation (IDF) guidelines.

Methods

We used data of 5,387 adult participants from the Shanghai High-risk Diabetic Screen (SHiDS) study. All participants underwent a five-point 75 g oral glucose tolerance test (OGTT). Glycemic states were then classified according to the ADA/IDF diagnostic criteria, while OGTT-derived indices were employed to evaluate insulin secretion and sensitivity.

Results

Overall, 3,729 subjects were diagnosed consistently under ADA/IDF criteria; while 941 and 717 subjects exhibited inconsistencies in the diagnostic classification for diabetes and IH, respectively. Notably, all of these individuals with discrepant diagnoses displayed β-cell dysfunction and/or insulin resistance compared to the NGT/NGT group.

Conclusions

The ADA criteria can identify individuals with elevated haemoglobinA1c (HbA1c) levels when the 1-hour plasma glucose (1-h PG) stay within the normal range, while the IDF criteria can identify subjects with impaired insulin sensitivity and secretion when fasting plasma glucose (FPG), 2-hour plasma glucose (2-h PG) and HbA1c values are in the normal range.

目的：本研究旨在根据美国糖尿病协会（ADA）和最近出版的国际糖尿病联合会（IDF）指南建立的诊断标准，评估IH和糖尿病的患病率，以及胰岛素分泌、胰岛素敏感性和不同糖耐量类别受试者的相关曲线模式。方法：我们使用来自上海高危糖尿病筛查（SHiDS）研究的5387名成年参与者的数据。所有参与者都进行了5分75 g口服葡萄糖耐量试验（OGTT）。然后根据ADA/IDF诊断标准对血糖状态进行分类，同时使用ogtt衍生指标评估胰岛素分泌和敏感性。结果：总体而言，3729名受试者被诊断符合ADA/IDF标准；941名和717名受试者在糖尿病和IH的诊断分类上分别表现出不一致。值得注意的是，与NGT/NGT组相比，所有这些诊断有差异的个体都表现出β细胞功能障碍和/或胰岛素抵抗。结论：ADA标准可识别1小时血糖（1小时PG）在正常范围内时血红蛋白a1c （HbA1c）水平升高的个体，而IDF标准可识别空腹血糖（FPG）、2小时血糖（2小时PG）和HbA1c在正常范围内时胰岛素敏感性和分泌受损的个体。

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引用次数: 0

Real-world experience of adjunct weekly semaglutide in Type 1 diabetes. Is it worth it? 1型糖尿病患者每周服用西马鲁肽的实际经验。值得吗？

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111979

Neale Cohen , Asher Yeung , Alicia Jenkins

引用次数: 0

Health disparities in diabetes treatment: The challenge of G6PD deficiency 糖尿病治疗中的健康差异：G6PD缺乏症的挑战

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111965

Ariel Israel , Itamar Raz , Ilan Green , Avivit Golan-Cohen , Matitiahu Berkovitch , Eli Magen , Shlomo Vinker , Eugene Merzon

Aims

To assess the impact of Glucose-6-phosphate dehydrogenase (G6PD) deficiency, an enzymatic deficiency prevalent in individuals of African or Asian descent, on Hemoglobin A1c (HbA1c) levels, diabetes medication purchases, and the cumulative incidence of diabetes related complications.

Methods

A large cohort study was conducted within a national health organization, comparing 3,913 G6PD-deficient patients to a matched control group without G6PD deficiency over two decades. The main measures and outcomes were the HbA1c levels, patterns of diabetes medication purchases, and the incidence of severe diabetes-related complications.

Results

HbA1c levels significantly underestimated blood glucose concentrations in G6PD-deficient individuals. Individuals with diabetes and G6PD deficiency had lower rates of treatment with most diabetes medications, notably GLP-1 receptor agonists and SGLT2 inhibitors. Severe diabetes-related complications were more frequent among G6PD-deficient patients, with adjusted hazards ratios [95% confidence intervals] of 1.44 [1.16–1.81] for severe kidney insufficiency, 1.75 [1.23–2.49] for myocardial infarction, and 1.27 [1.02–1.58] for neuropathy.

Conclusions

This research highlights serious gaps in the management of G6PD-deficient patients with diabetes, who suffer from insufficient medication management and higher rates of complications. These findings underscore the need to account for G6PD deficiency in diabetes treatment to ensure equitable and effective healthcare for this vulnerable population.

目的：评估葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症（一种普遍存在于非洲或亚洲血统的酶缺乏症）对血红蛋白A1c （HbA1c）水平、糖尿病药物购买和糖尿病相关并发症累积发生率的影响。方法：在一个国家卫生组织内进行了一项大型队列研究，比较了3913名G6PD缺陷患者和20多年来没有G6PD缺陷的匹配对照组。主要测量和结果是HbA1c水平、糖尿病药物购买模式和严重糖尿病相关并发症的发生率。结果：HbA1c水平显著低估了g6pd缺乏个体的血糖浓度。糖尿病和G6PD缺乏症患者接受大多数糖尿病药物治疗的几率较低，尤其是GLP-1受体激动剂和SGLT2抑制剂。严重糖尿病相关并发症在g6pd缺乏患者中更为常见，严重肾功能不全的校正危险比[95%可信区间]为1.44[1.16-1.81]，心肌梗死的校正危险比为1.75[1.23-2.49]，神经病变的校正危险比为1.27[1.02-1.58]。结论：本研究突出了g6pd缺陷糖尿病患者治疗方面的严重差距，这些患者的药物治疗不足，并发症发生率较高。这些发现强调了在糖尿病治疗中考虑G6PD缺乏的必要性，以确保这一弱势群体获得公平有效的医疗保健。

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引用次数: 0

Efficacy of flash glucose monitoring on HbA1c in type 2 diabetes: An individual patient data meta-analysis of real-world evidence 快速血糖监测对2型糖尿病患者HbA1c的疗效：现实世界证据的个体患者数据荟萃分析

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111950

Randeep S. Heer, Joshua Lovegrove, Zoë Welsh

Aims

There is a growing body of evidence demonstrating the benefit of flash glucose monitoring in type 2 diabetes mellitus (T2DM). This individual patient data meta-analysis aimed to investigate the impact of commencing flash glucose monitoring on HbA1c in people living with T2DM treated with insulin in a real-world setting.

Methods

A meta-analysis of eight observational studies which assessed change in HbA1c at 3–6 months following initiating flash glucose monitoring for which Abbott Diabetes Care could provide individual patient data was performed. Studies included adults with T2DM managed with insulin and baseline HbA1c between 8.0 %–12.0 % (64–108 mmol/mol). A one-stage model was created to explore heterogeneity.

Results

A total of 803 patients were included in the analysis (mean(SD) age: 62.8(11.4) years, BMI: 32.2(6.8) kg/m², baseline HbA1c 9.0(0.9) % [75 (10) mmol/mol]). Commencement of flash glucose monitoring was associated with an HbA1c reduction of 0.89 % (95 % CI 0.71 to 1.08) (9.8 mmol/mol (95 % CI 7.8 to 11.8)) at 3–6 months. In the one stage model, age, BMI and baseline HbA1c accounted for the substantial heterogeneity observed between studies.

Conclusions

Commencement of flash glucose monitoring was associated with a significant reduction in HbA1c at 3–6 months in a real-world setting in T2DM managed with insulin.

目的：越来越多的证据表明，快速血糖监测对2型糖尿病（T2DM）有益。这项个体患者数据荟萃分析旨在调查在现实世界中胰岛素治疗的T2DM患者开始快速血糖监测对HbA1c的影响方法：对8项观察性研究进行荟萃分析，评估在开始快速血糖监测3-6 个月后HbA1c的变化，雅培糖尿病护理公司可以提供个体患者数据。研究纳入胰岛素治疗的T2DM成人患者，基线HbA1c在8.0 %-12.0 %（64-108 mmol/mol）之间。我们建立了一个单阶段模型来探讨异质性。结果：共有803例患者纳入分析(平均（SD）年龄：62.8（11.4）岁，BMI: 32.2(6.8) kg/m2，基线HbA1c 9.0（0.9) % [75 (10) mmol/mol]）。在3-6个月至 个月内，开始快速血糖监测与HbA1c降低0.89 %(95 % CI 0.71至1.08)(9.8 mmol/mol（95 % CI 7.8至11.8）相关。在单阶段模型中，年龄、BMI和基线HbA1c是研究间观察到的实质性异质性的原因。结论：在胰岛素治疗的T2DM患者中，在3-6 个月时，开始快速血糖监测与HbA1c显著降低相关。

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引用次数: 0

The impact of cold application on pain and comfort during the process of diabetic foot care 冷敷对糖尿病足护理过程中疼痛和舒适的影响。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111968

Mensure Turan , Hediye Özbay , Melek Avşar

Background and Aim

Given the significance of pain management in the context of diabetic foot ulcer (DFU) care, particularly in terms of ensuring patient adherence to treatment regimens, this study was undertaken to ascertain the impact of cold washing on pain and comfort levels during diabetic foot care.

Methods

A single-blind randomized controlled trial was conducted in the chronic wound care clinic of a teaching and research hospital in the southeastern region of Turkey. The sample consisted of 68 patients, with 34 assigned to the cold application group and 34 assigned to the control group. Pain and comfort levels were recorded at baseline, and during and after the application of a 0.9% NaCl solution (cold or warm) during DFU care.

Results

A comparison of the Cold Application group with the control group revealed a statistically significant reduction in post-intervention pain scores (p = 0.000) and a statistically significant increase in comfort scores (p = 0.000) over time.

Conclusion

It can be posited that cold washing represents an efficacious intervention in the management of pain and discomfort associated with diabetic foot care.

背景和目的：考虑到疼痛管理在糖尿病足溃疡（DFU）护理中的重要性，特别是在确保患者遵守治疗方案方面，本研究旨在确定冷洗对糖尿病足护理期间疼痛和舒适度的影响。方法：在土耳其东南部某教研型医院慢性伤口护理门诊进行单盲随机对照试验。样本包括68名患者，其中34名被分配到冷敷组，34名被分配到对照组。在DFU护理期间，分别在基线、0.9% NaCl溶液（冷或温）应用期间和之后记录疼痛和舒适水平。结果：冷敷组与对照组的比较显示，随着时间的推移，干预后疼痛评分有统计学意义的降低（p = 0.000），舒适度评分有统计学意义的增加（p = 0.000）。结论：可以假设，冷洗是糖尿病足护理相关疼痛和不适管理的有效干预。

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引用次数: 0

Responses to lifestyle interventions among individuals with distinct pre-diabetes phenotypes: A systematic review and Meta-Analysis 不同糖尿病前期表型个体对生活方式干预的反应：一项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 : 2025-01-01 DOI: 10.1016/j.diabres.2024.111939

Jincheng Rong, Mandy Ho, Disheng Zhou, Pui Hing Chau

Aims

To assess responses to lifestyle interventions (LIs) among individuals with distinct pre-diabetes phenotypes (isolated impaired fasting glucose [i-IFG], isolated impaired glucose tolerance [i-IGT], and combined IFG + IGT) for reducing diabetes incidence, reversing pre-diabetes, and improving glycemic control and insulin sensitivity.

Methods

PubMed, Embase, Cochrane Library, and Web of Science were searched until December 6th, 2023. We included randomized controlled trials examining responses to LIs (including diet and/or physical activity) among adults with i-IFG, i-IGT, and IFG + IGT. Outcomes included diabetes incidence, normoglycemia incidence, fasting plasma glucose (FPG), 2-hour plasma glucose (2 h-PG), hemoglobin A1c, fasting insulin (FI), and homeostasis model assessment-insulin resistance (HOMA-IR). Random-effects meta-analyses were performed to estimate risk ratios (RRs) and mean differences.

Results

Twenty-seven studies were included. Meta-analysis of 10 studies that performed stratified analyses by pre-diabetes phenotype found that LIs significantly reduced diabetes incidence in i-IGT (RR = 0.69 [0.56; 0.85], I² = 14 %) and IFG + IGT (RR = 0.56 [0.48; 0.66], I² = 0 %) but not in i-IFG (RR = 0.85 [0.66; 1.11], I² = 0 %; p_subgroup = 0.02). Meta-analysis of 20 studies using IGT for participant recruitment showed that LIs significantly decreased diabetes incidence, increased normoglycemia incidence, and improved FPG, 2 h-PG, FI and HOMA–IR.

Conclusions

LIs are effective for IGT (with or without IFG), but tailored LIs are needed for i-IFG to prevent diabetes.

目的：评估生活方式干预（LIs）对不同糖尿病前期表型个体（孤立空腹血糖受损[i-IFG]，孤立糖耐量受损[i-IGT]，以及IFG + IGT联合治疗）的反应，以降低糖尿病发病率，逆转糖尿病前期，改善血糖控制和胰岛素敏感性。方法：检索PubMed， Embase, Cochrane Library, Web of Science，截止2023年12月6日。我们纳入了随机对照试验，研究了患有i-IFG、i-IGT和IFG + IGT的成年人对LIs（包括饮食和/或身体活动）的反应。结果包括糖尿病发病率、血糖正常发生率、空腹血糖（FPG）、2小时血糖（2 h-PG）、血红蛋白A1c、空腹胰岛素（FI）和稳态模型评估-胰岛素抵抗（HOMA-IR）。随机效应荟萃分析用于估计风险比（rr）和平均差异。结果：纳入27项研究。对10项研究进行糖尿病前期表型分层分析的荟萃分析发现，LIs可显著降低i-IGT的糖尿病发病率(RR = 0.69 [0.56；0.85], I2 = 14 %)和IFG + IGT (RR = 0.56 (0.48;0.66], I2 = 0 %)而不是i-IFG (RR = 0.85 (0.66;1.11], I2 = 0 %;psubgroup = 0.02)。使用IGT招募参与者的20项研究的荟萃分析显示，LIs显著降低糖尿病发病率，增加正常血糖发病率，改善FPG， 2 h-PG， FI和HOMA-IR。结论：LIs对IGT（有或没有IFG）有效，但需要针对i-IFG定制LIs来预防糖尿病。

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引用次数: 0

Diabetes specialist nurse support, training and ‘virtual’ advice reduces district nurse visits and improves outcomes for people with diabetes requiring visits for insulin administration 糖尿病专科护士支持、培训和“虚拟”咨询减少了地区护士就诊，并改善了需要就诊接受胰岛素治疗的糖尿病患者的结果。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111948

Laura Gilligan , Emma Page , Jo Hall , Kelly Ward , William K. Gray , Tim W.R. Briggs , Gerry Rayman

Aims

We evaluated the effectiveness of a community diabetes specialist nurse (cDSN) working with district nurses (DNs) to optimise insulin therapy on DN workload and patient outcomes.

Methods

This was an observational clinical improvement study of outcomes pre- and post-introduction of an intervention within a community diabetes service in an areas of England. Patients were followed up for 6 months. The intervention was a cDSN providing advice and support to DNs in safe diabetes management, with a particular focus on insulin use.

Results

in total, 148 of 224 patients were reviewed; 130 (87.8 %) were available for follow up 6 months after their first review. Comparing pre- to post-intervention outcomes, number of patients with a hypoglycaemic event reduced from 21/129 to 1/128 (X² = 19.71, p < 0.001) as did the number with a hyperglycaemic event; 53/129 to 23/128 (X² = 16.48, p < 0.001). Number of DN visits and use of acute hospital services also improved significantly. Estimated cost savings through reduced DN visits, insulin usage, and hospital service use totalled £1.9 million.

Conclusions

Significant financial savings and reduced patient harms were identified following our intervention in this cohort. Roll-out to other sites in England is a next step.

目的：我们评估了社区糖尿病专科护士（cDSN）与地区护士（DN）合作优化胰岛素治疗对DN工作量和患者预后的有效性。方法：这是一项观察性临床改善研究，对英格兰某地区社区糖尿病服务引入干预前后的结果进行了观察性临床改善研究。随访6 个月。干预是一个cDSN，为dn提供安全糖尿病管理方面的建议和支持，特别关注胰岛素的使用。结果：224例患者中，共纳入148例；130例（87.8 %）在首次复查后6 个月随访。与干预前和干预后的结果相比，发生低血糖事件的患者数量从21/129减少到1/128 （X2 = 19.71,p 2 = 16.48,p ）结论：在我们的干预后，该队列中发现了显著的经济节约和患者伤害的减少。下一步是向英国其他网站推广。

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引用次数: 0

Type 2 diabetes and the minor allele of PNPLA3 consistently identify high-risk metabolic dysfunction associated steatotic liver disease 2型糖尿病和PNPLA3的次要等位基因一致地确定了与脂肪变性肝病相关的高危代谢功能障碍。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2025-01-01 DOI: 10.1016/j.diabres.2024.111960

Zobair M. Younossi , J.Michael Estep , Sean Felix , Brian Lam , Zaid Younossi , Andrei Racila , Maria Stepanova

Background

Association of genetic factors with non-invasive tests (NITs) for MASLD has not been well established.

Methods

Clinical and laboratory data, liver biopsy and/or liver stiffness measurement (LSM) by transient elastography were collected from MASLD patients seen in tertiary care hepatology practices. Minor allele frequency for genomic loci rs641738 (MBOAT7), rs58542926 (TM6SF2), rs738409 (PNPLA3), rs62305723 (HSD1713B) were evaluated for association with high ELF (≥11.3), high FIB-4 (≥3.25), high LSM (≥10 kPa), histologic fibrosis (stage 3/4 vs. stages 0–2).

Results

Among 2289 MASLD patients with available polymorphism and liver fibrosis/NIT data [52 ± 13 years, 46 % male, BMI 36.6 ± 9.9, 35 % type 2 diabetes (T2D)], 53 % had high-risk allele (C > G) at rs738409 (PNPLA3), 70 % high-risk allele (C > T) at rs641738 (MBOAT7), 18 % high-risk minor allele (C > T) at rs58542926 (TM6SF2), 11 % low-risk minor allele (G > A) at rs62305723 (HSD17b13). Only PNPLA3-rs738409 (47 % CC, 40 % CG, 13 % GG) was significantly associated with higher NIT scores and histologic fibrosis: high ELF 2.8 % CC vs. 8.1 % CG/GG; high FIB-4 4.7 % CC vs. 11.6 % CG/GG; high LSM 10 % vs. 19 %; advanced histologic fibrosis 34 % CC vs. 60 % CG/GG (all p < 0.01). Similar associations of PNPLA3-rs738409 with NITs were observed in a subgroup of MASLD patients with T2D (n = 799; all p < 0.05). The PNPLA3-rs738409 CG/GG genotype, older age and T2D were independently associated with high ELF [OR (95 % CI) = 3.25 (2.03–5.20)], FIB-4 [OR = 2.75 (1.90–3.98)], LSM [OR = 2.71 (1.60–4.59)] scores and advanced histologic fibrosis [OR = 2.56 (1.81–3.62)].

Conclusions

The polymorphism rs738409 in the PNPLA3 gene, T2D, and older age were independent predictors of high-risk MASLD.

背景：遗传因素与MASLD的无创检测（NITs）之间的关系尚未得到很好的证实。方法：临床和实验室数据，肝活检和/或肝刚度测量（LSM）通过瞬时弹性成像收集从三级护理肝病实践中看到的MASLD患者。评估基因组位点rs641738 （MBOAT7）、rss58542926 （TM6SF2）、rs738409 （PNPLA3）、rs62305723 （HSD1713B）的次要等位基因频率与高ELF（≥11.3）、高FIB-4（≥3.25）、高LSM（≥10 kPa）、组织学纤维化（3/4期vs 0-2期）的相关性。结果:在2289个患者MASLD可用的多态性和肝纤维化/ NIT数据(52 ±  13年,46 %男,BMI 36.6±9.9 ,35 % 2型糖尿病(T2D)], 53 %有高风险的等位基因(C > G)在rs738409 (PNPLA3), 70 %高风险等位基因(C > T)在rs641738 (MBOAT7), 18 %高风险小等位基因(C > T)在rs58542926 (TM6SF2), 11 %低风险较小的等位基因(G > A)在rs62305723 (HSD17b13)。只有PNPLA3-rs738409（47 % CC, 40 % CG, 13 % GG）与较高的NIT评分和组织学纤维化显著相关：高ELF 2.8 % CC vs. 8.1 % CG/GG；高FIB-4 4.7 % CC vs. 11.6 % CG/GG；高LSM 10 % vs. 19 %；结论：PNPLA3基因rs738409多态性、T2D和年龄是高危MASLD的独立预测因子。

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