Diabetes research and clinical practice最新文献_第6页

Ethnic differences in the effects of lifestyle interventions on adverse pregnancy outcomes among women with gestational diabetes mellitus: A systematic review and meta-analysis 生活方式干预对妊娠糖尿病妇女不良妊娠结局影响的种族差异：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 : 2024-09-29 DOI: 10.1016/j.diabres.2024.111875

Yingjun Mu , Junyao Huang , Jie Yang , Hui Zuo , Matteo Monami , Nayla Cristina do Vale Moreira , Akhtar Hussain

Aims

Lifestyle interventions are widely used among women with gestational diabetes mellitus (GDM). This study aimed to assess the ethnic disparities in the effectiveness of lifestyle interventions on reducing adverse pregnancy outcomes, particularly macrosomia and neonatal hypoglycemia among women with GDM.

Methods

We systematically searched the PubMed/MEDLINE, Web of Science, and Cochrane Library databases from January 1, 2000, up to March 31, 2024, to identify randomized controlled trials (RCTs) examining the effects of lifestyle interventions in GDM patients. Subgroup analysis was performed to investigate heterogeneity across different ethnic groups (including Asians, Whites/Caucasians, Hispanics/ Latinos, and Unknown ethnicity). The random effects model was used to calculate the relative risk (RR) and 95% confidence interval (CI).

Results

After applying inclusion and exclusion criteria, twenty-one studies comprising 4567 participants were included. Lifestyle interventions significantly reduced the incidence of macrosomia ((RR = 0.54; 95 % CI: 0.42–0.70, P < 0.001), with consistent effects observed across racial groups. Conversely, lifestyle interventions were associated with a significant reduction in the risk of neonatal hypoglycemia only among Asians (RR = 0.56; 95 % CI: 0.38–0.84, P = 0.004), while no significant effects were observed in Whites/Caucasians or Hispanics/Latinos (all P > 0.05). Sensitivity analyses confirmed the robustness of the findings.

Conclusions

Regardless of ethnic background, this study emphasizes the significant benefits of lifestyle interventions in reducing the risk of macrosomia among women with GDM. However, lifestyle interventions seem to reduce the risk of neonatal hypoglycemia only among Asians, which warrants further studies.

目的：生活方式干预在妊娠糖尿病（GDM）妇女中被广泛使用。本研究旨在评估生活方式干预对减少不良妊娠结局（尤其是妊娠糖尿病妇女中的巨大儿和新生儿低血糖）的有效性方面存在的种族差异：我们系统地检索了从 2000 年 1 月 1 日至 2024 年 3 月 31 日的 PubMed/MEDLINE、Web of Science 和 Cochrane Library 数据库，以确定研究生活方式干预对 GDM 患者影响的随机对照试验 (RCT)。为了研究不同种族群体（包括亚洲人、白人/高加索人、西班牙裔/拉丁裔和未知种族）之间的异质性，进行了分组分析。随机效应模型用于计算相对风险（RR）和95%置信区间（CI）：结果：采用纳入和排除标准后，共纳入了 21 项研究，4567 名参与者。生活方式干预大大降低了巨型畸形的发生率（RR = 0.54; 95 % CI: 0.42-0.70, P < 0.001），不同种族群体的效果一致。相反，生活方式干预仅在亚洲人中显著降低了新生儿低血糖风险（RR = 0.56; 95 % CI: 0.37-0.84, P = 0.004），而在白人/高加索人或西班牙裔/拉丁裔中未观察到显著影响（所有 P > 0.05）。敏感性分析证实了研究结果的稳健性：无论种族背景如何，本研究强调了生活方式干预在降低 GDM 女性巨型畸形风险方面的显著益处。然而，生活方式干预似乎只在亚洲人中降低了新生儿低血糖的风险，这值得进一步研究。

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引用次数: 0

All-cause and cause-specific mortality risks in individuals with diabetes living alone: A large-scale population-based cohort study 独居糖尿病患者的全因和特定原因死亡风险：大规模人群队列研究。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-09-27 DOI: 10.1016/j.diabres.2024.111876

Jae-Seung Yun , Kyungdo Han , Bongseong Kim , Seung-Hyun Ko , Hyuk-Sang Kwon , Yu-Bae Ahn , Yong-Moon Mark Park , Seung-Hwan Lee

Aims

The rise in one-person households is a global trend. We aimed to investigate mortality risk in individuals with diabetes living alone (IDLA) using a large-scale population-based database.

Methods

A total of 2,447,557 adults with type 2 diabetes were identified from the Korean National Health Information Database. One-person households were defined based on the number of registered family members. The risks of all-cause and cause-specific mortalities were estimated using a multivariable Cox proportional hazards regression model.

Results

During a median follow-up period of 6.0 years, 191,084 deaths (7.8 %) occurred. IDLA had a higher risk of mortality compared to those not living alone after adjusting for potential confounders (HR 1.20, 95 % CI: 1.18–1.22). This association was more prominent in younger individuals, men, and those with low income, and it was dependent on the duration of living alone. The risks of cause-specific mortality were all significantly higher in the IDLA group compared with the non-IDLA group. Adherence to favorable lifestyle behaviors was associated with a significant reduction in all-cause mortality, particularly in IDLA.

Conclusions

The elevated risk of mortality in IDLA highlights the need for tailored medical interventions and social assistance, particularly for those with unhealthy lifestyles or low income.

目的：独居家庭的增加是全球趋势。我们旨在利用大规模人口数据库调查独居糖尿病患者（IDLA）的死亡风险：方法：我们从韩国国家健康信息数据库中找到了 2,447,557 名 2 型糖尿病成人患者。一人家庭是根据登记的家庭成员数量定义的。采用多变量考克斯比例危险回归模型估算了全因和特定原因死亡的风险：中位随访期为 6.0 年，共有 191 084 人死亡（7.8%）。在调整了潜在的混杂因素后，与非独居者相比，IDLA的死亡风险更高（HR 1.20，95 % CI：1.18-1.22）。这种关联在年轻人、男性和低收入人群中更为突出，并且取决于独居时间的长短。与非IDLA组相比，IDLA组的特定病因死亡风险都明显较高。坚持良好的生活方式与全因死亡率的显著降低有关，尤其是在IDLA人群中：结论：IDLA 患者的死亡风险较高，这凸显了对有针对性的医疗干预和社会援助的需求，尤其是对那些生活方式不健康或收入较低的人而言。

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引用次数: 0

An evaluation of how exercise position statement guidelines are being used in the real world in type 1 diabetes: Findings from the type 1 diabetes exercise initiative (T1DEXI) 评估 1 型糖尿病患者在现实世界中如何使用运动立场声明指南：1 型糖尿病运动倡议 (T1DEXI) 的研究结果。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-09-27 DOI: 10.1016/j.diabres.2024.111874

Peter G. Jacobs , Martin Chase Marak , Peter Calhoun , Robin L. Gal , Jessica R. Castle , Michael C. Riddell

Aims

Position statement guidelines should help people with type 1 diabetes (T1D) improve glucose outcomes during exercise.

Methods

In a 4-week observational study, continuous glucose, insulin, and nutrient data were collected from 561 adults with T1D. Glucose outcomes were calculated during exercise, post-exercise, and overnight, and were compared for sessions when participants used versus did not use exercise guidelines for open-loop (OL) and automated insulin delivery (AID) therapy.

Results

Guidelines requiring behaviour modification were rarely used while guidelines not requiring modification were often used. The guideline recommending reduced meal insulin before exercise was associated with lower time <3.9 mmol/L during exercise (−2.2 %, P=0.02) for OL but not significant for AID (−1.4 %, P=0.27). Compared to exercise with low glucose (<3.9 mmol/L) in prior 24-hours, sessions without recent low glucose had lower time <3.9 mmol/L during exercise (−1.2 %, P<0.001). The AID guideline for no carbohydrates before exercise when CGM is flat, or increasing, was not associated with improved glycaemia.

Conclusions

Free-living datasets may be used to evaluate usage and benefit of position statement guidelines. Evidence suggests OL participants who reduced meal insulin prior to exercise and did not have low glucose in the prior 24 h had less time below range.

目的：立场声明指南应帮助 1 型糖尿病（T1D）患者改善运动时的血糖结果：在一项为期 4 周的观察研究中，收集了 561 名 1 型糖尿病成人患者的连续血糖、胰岛素和营养数据。对运动中、运动后和隔夜的血糖结果进行了计算，并对参与者使用与未使用开环（OL）和胰岛素自动给药（AID）疗法运动指南的情况进行了比较：结果：需要改变行为的指南很少被使用，而不需要改变行为的指南则经常被使用。建议在运动前减少餐后胰岛素用量的指南与较低的时间相关：自由生活数据集可用于评估立场声明指南的使用情况和益处。有证据表明，运动前减少餐后胰岛素用量且在之前 24 小时内未出现低血糖的 OL 参与者，其血糖低于范围值的时间较短。

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引用次数: 0

Relevance of gastric emptying to the timing of prandial insulin administration in hospitalised patients with diabetes 胃排空与糖尿病住院患者餐前胰岛素用药时间的相关性。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-09-27 DOI: 10.1016/j.diabres.2024.111877

Yixuan Sun , Yong Luo , Cong Xie , Karen L Jones , Michael Horowitz , Christopher K Rayner , Tongzhi Wu

引用次数: 0

A post-hoc pooled analysis to evaluate efficacy and safety of insulin glargine 300 U/mL in insulin-naïve people with type 2 diabetes with/without prior use of glucagon-like peptide-1 receptor agonist therapy 一项事后汇总分析，旨在评估格列美脲胰岛素 300 U/mL对胰岛素无效的 2 型糖尿病患者的疗效和安全性，这些患者既往接受过胰高血糖素样肽-1 受体激动剂治疗，也未接受过胰高血糖素样肽-1 受体激动剂治疗。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-09-27 DOI: 10.1016/j.diabres.2024.111871

Alice Y.Y. Cheng , Didac Mauricio , Robert Ritzel , Mohammed E. Al-Sofiani , Timothy Bailey , Maria Aileen Mabunay , Mireille Bonnemaire , Lydie Melas-Melt , Safia Mimouni , Melanie Davies

Aims

To evaluate treatment advancement with insulin glargine 300 U/mL (Gla-300), with or without prior glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in type 2 diabetes (T2D).

Methods

Efficacy and safety outcomes of insulin-naïve patients intensifying with Gla-300, with/without prior GLP-1 RA therapy, were evaluated in three analyses (N = 3562): a pooled analysis of seven interventional studies, a subanalysis comparing participants who stopped GLP-1 RA therapy and initiated Gla-300 with those who received add-on Gla-300, and an expanded analysis including two observational studies.

Results

Glycaemic outcomes, including HbA1c improvement and fasting plasma glucose, were similar between groups with/without prior GLP-1 RA use. HbA1c least squares mean change from baseline was − 1.7 % and − 1.6 % with and without prior GLP-1 RA, respectively. Glycaemic outcomes were similar between participants who stopped GLP-1 RA therapy when initiating Gla-300 and those who received add-on Gla-300, although more participants receiving add-on Gla-300 achieved HbA1c targets. The expanded analysis yielded similar results. Incidence of hypoglycaemia was low with no clinically relevant weight changes in all analyses.

Conclusions

Treatment advancement with Gla-300 in patients with T2D, with/without prior GLP-1 RA therapy, improved glycaemic outcomes with no relevant impact on weight, while maintaining a low hypoglycaemia risk.

目的：评估 2 型糖尿病（T2D）患者在接受或未接受胰高血糖素样肽-1 受体激动剂（GLP-1 RA）治疗的情况下使用胰岛素格列卫 300 U/mL（Gla-300）的治疗进展：方法：在三项分析（N = 3562）中评估了胰岛素无效患者接受 Gla-300 强化治疗后的疗效和安全性结果（无论之前是否接受过 GLP-1 RA 治疗）：对七项干预性研究的汇总分析、对停止 GLP-1 RA 治疗并开始使用 Gla-300 的患者与接受 Gla-300 附加治疗的患者进行比较的子分析，以及包括两项观察性研究在内的扩展分析：结果：血糖结果（包括 HbA1c 改善和空腹血浆葡萄糖）在使用/未使用 GLP-1 RA 的组别之间相似。使用和未使用过 GLP-1 RA 的 HbA1c 最小二乘法平均值与基线相比的变化分别为 - 1.7 % 和 - 1.6 %。在开始使用 Gla-300 时停止 GLP-1 RA 治疗的参与者与接受附加 Gla-300 治疗的参与者的血糖结果相似，但更多接受附加 Gla-300 治疗的参与者达到了 HbA1c 目标。扩大分析得出了类似的结果。在所有分析中，低血糖发生率较低，体重没有发生临床相关变化：结论：对既往接受过/未接受过 GLP-1 RA 治疗的 T2D 患者使用 Gla-300 提前治疗可改善血糖结果，对体重无相关影响，同时低血糖风险较低。

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引用次数: 0

Ambulatory blood pressure monitoring and vascular complications in patients with type 1 diabetes mellitus – Systematic review and meta-analysis of observational studies 1 型糖尿病患者的非卧床血压监测与血管并发症--观察性研究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 : 2024-09-27 DOI: 10.1016/j.diabres.2024.111873

Mariana Costa Hoffmeister , Vinicius Hammel Lovison , Eduardo Priesnitz Friedrich , Ticiana da Costa Rodrigues

Aims

This study aimed to evaluate the role of the 24-Hour Ambulatory Blood Pressure Monitoring (ABPM) as a possible predictor of vascular outcomes in office normotensive people with type 1 diabetes mellitus (T1DM).

Methods

This is a systematic review including cohort studies from the Embase, PubMed/Medline, and Web of Science databases on people with T1DM undergoing ABPM and subsequent evaluation of vascular complications. Measurements of difference (MD) were obtained using random effect model meta-analysis.

Results

We found 364 articles and 49 duplicates. Seven studies were included, comprising 635 participants aged 25.8 ± 6.2 years. Most (57.5 %) were men, mean duration of diabetes was 11.8 ± 5.3 years, mean glycated hemoglobin level among participants was 8.5 % ± 1.6 %, and mean follow-up time was 4.2 years. Lower night systolic blood pressure MD − 4.37 mmHg (p = 0.0009) and night diastolic blood pressure MD − 3.97 mmHg (p < 0.0001) were associated with lower incidence of albuminuria. People with T1DM who presented no beginning or progression of retinopathy were those with lower night diastolic blood pressure MD − 3.62 mmHg (p = 0.042), diurnal diastolic blood pressure MD − 2.69 mmHg (p = 0.0138), and 24-hour diastolic blood pressure MD − 3.65 mmHg (p = 0.037).

Conclusion

Small mean differences in blood pressure parameters, as measured by ABPM, between people with T1DM are associated with a lower incidence or risk of progression of nephropathy and retinopathy.

目的：本研究旨在评估 24 小时动态血压监测（ABPM）在预测办公室血压正常的 1 型糖尿病（T1DM）患者血管并发症方面的作用：这是一项系统性综述，包括 Embase、PubMed/Medline 和 Web of Science 数据库中关于接受 ABPM 监测的 T1DM 患者的队列研究以及随后的血管并发症评估。通过随机效应模型荟萃分析获得了差异测量值（MD）：我们发现了 364 篇文章，49 篇重复。共纳入 7 项研究，635 名参与者的年龄为 25.8 ± 6.2 岁。大多数（57.5%）为男性，平均糖尿病病程为（11.8 ± 5.3）年，参与者的平均糖化血红蛋白水平为（8.5 ± 1.6）%，平均随访时间为 4.2 年。夜间收缩压 MD - 4.37 mmHg（p = 0.0009）和夜间舒张压 MD - 3.97 mmHg（p 结论：夜间收缩压和舒张压的平均值差异较小：通过 ABPM 测量，T1DM 患者之间血压参数的平均值差异较小，这与肾病和视网膜病变的发生率或进展风险较低有关。

{"title":"Ambulatory blood pressure monitoring and vascular complications in patients with type 1 diabetes mellitus – Systematic review and meta-analysis of observational studies","authors":"Mariana Costa Hoffmeister , Vinicius Hammel Lovison , Eduardo Priesnitz Friedrich , Ticiana da Costa Rodrigues","doi":"10.1016/j.diabres.2024.111873","DOIUrl":"10.1016/j.diabres.2024.111873","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to evaluate the role of the 24-Hour Ambulatory Blood Pressure Monitoring (ABPM) as a possible predictor of vascular outcomes in office normotensive people with type 1 diabetes mellitus (T1DM).</div></div><div><h3>Methods</h3><div>This is a systematic review including cohort studies from the Embase, PubMed/Medline, and Web of Science databases on people with T1DM undergoing ABPM and subsequent evaluation of vascular complications. Measurements of difference (MD) were obtained using random effect model <em>meta</em>-analysis.</div></div><div><h3>Results</h3><div>We found 364 articles and 49 duplicates. Seven studies were included, comprising 635 participants aged 25.8 ± 6.2 years. Most (57.5 %) were men, mean duration of diabetes was 11.8 ± 5.3 years, mean glycated hemoglobin level among participants was 8.5 % ± 1.6 %, and mean follow-up time was 4.2 years. Lower night systolic blood pressure MD − 4.37 mmHg (p = 0.0009) and night diastolic blood pressure MD − 3.97 mmHg (p < 0.0001) were associated with lower incidence of albuminuria. People withT1DM who presented no beginning or progression of retinopathy were those with lower night diastolic blood pressure MD − 3.62 mmHg (p = 0.042), diurnal diastolic blood pressure MD − 2.69 mmHg (p = 0.0138), and 24-hour diastolic blood pressure MD − 3.65 mmHg (p = 0.037).</div></div><div><h3>Conclusion</h3><div>Small mean differences in blood pressure parameters, as measured by ABPM, between people with T1DM are associated with a lower incidence or risk of progression of nephropathy and retinopathy.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"217 ","pages":"Article 111873"},"PeriodicalIF":6.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343567","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

Identifying subtypes of type 2 diabetes mellitus based on real-world electronic medical record data in China 基于真实世界电子病历数据识别中国 2 型糖尿病亚型。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-09-26 DOI: 10.1016/j.diabres.2024.111872

Jiayu Wang , Bixia Gao , Jinwei Wang , Wenwen Liu , Weijia Yuan , Yangfan Chai , Jun Ma , Yangyang Ma , Guilan Kong , Minchao Liu

Aims

To replicate the European subtypes of type 2 diabetes mellitus (T2DM) in the Chinese diabetes population and investigate the risk of complications in different subtypes.

Methods

A diabetes cohort using real-world patient data was constructed, and clustering was employed to subgroup the T2DM patients. Kaplan–Meier analysis and the Cox models were used to analyze the association between diabetes subtypes and the risk of complications.

Results

A total of 2,652 T2DM patients with complete clustering data were extracted. Among them, 466 (17.57 %) were classified as severe insulin-deficient diabetes (SIDD), 502 (18.93 %) as severe insulin-resistant diabetes (SIRD), 672 (25.34 %) as mild obesity-related diabetes (MOD), and 1,012 (38.16 %) as mild age-related diabetes (MARD). The risk of chronic kidney disease (CKD) and diabetic retinopathy (DR) were different in the four subtypes. Compared with MARD, SIRD had a higher risk of CKD (HR 2.40 [1.16, 4.96]), and SIDD had a higher risk of DR (HR 2.16 [1.11, 4.20]). The risk of stroke and coronary events had no difference.

Conclusions

The European T2DM subtypes can be replicated in the Chinese diabetes population. The risk of CKD and DR varied among different subtypes, indicating that proper interventions can be taken to prevent specific complications in different subtypes.

目的：在中国糖尿病人群中复制欧洲2型糖尿病（T2DM）亚型，并研究不同亚型的并发症风险：方法：利用真实世界的患者数据构建糖尿病队列，并采用聚类方法对T2DM患者进行分组。方法：利用真实世界的患者数据构建糖尿病队列，并采用聚类方法对 T2DM 患者进行分组，采用 Kaplan-Meier 分析和 Cox 模型分析糖尿病亚型与并发症风险之间的关系：共提取了 2,652 名 T2DM 患者的完整聚类数据。其中，466人（17.57%）被归类为严重胰岛素缺乏性糖尿病（SIDD），502人（18.93%）被归类为严重胰岛素抵抗性糖尿病（SIRD），672人（25.34%）被归类为轻度肥胖相关性糖尿病（MOD），1 012人（38.16%）被归类为轻度年龄相关性糖尿病（MARD）。四个亚型的慢性肾脏病（CKD）和糖尿病视网膜病变（DR）风险不同。与 MARD 相比，SIRD 罹患 CKD 的风险更高（HR 2.01 [1.03, 3.91]），SIDD 罹患 DR 的风险更高（HR 2.17 [1.12, 4.20]）。中风和冠状动脉事件的风险没有差异：结论：欧洲 T2DM 亚型可在中国糖尿病人群中复制。结论：欧洲的 T2DM 亚型可在中国糖尿病人群中复制，不同亚型发生 CKD 和 DR 的风险不同，这表明可以采取适当的干预措施来预防不同亚型的特定并发症。

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引用次数: 0

Association of glycemic variability and prognosis in patients with traumatic brain injury: A retrospective study from the MIMIC-IV database 脑外伤患者血糖变化与预后的关系：来自 MIMIC-IV 数据库的回顾性研究。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-09-26 DOI: 10.1016/j.diabres.2024.111869

Linrui Qi , Xin Geng , Rongliang Feng , Shuaishuai Wu , Tengyue Fu , Ning Li , Hongming Ji , Rui Cheng , Hao Wu , Dan Wu , Lian Huang , Qingshan Long , Xiangyu Wang

Background

Elevated glycemic variability (GV) often occurs in intensive care unit (ICU) patients and is associated with patient prognosis. However, the association between GV and prognosis in ICU patients with traumatic brain injury (TBI) remains unclear.

Method

Clinical data of ICU patients with TBI were obtained from the Medical Information Mart for Intensive Care (MIMIC) -IV database. The coefficient of variation (CV) was utilized to quantify GV, while the Glasgow Coma Scale (GCS) was employed to evaluate the consciousness status of TBI patients. Pearson linear correlation analysis, linear regression, COX regression and restricted cubic spline (RCS) were used to investigate the relationship between CV and consciousness impairment, as well as the risk of in-hospital mortality.

Result

A total of 1641 ICU patients with TBI were included in the study from the MIMIC-IV database. Pearson linear correlation and restricted cubic spline (RCS) analysis results showed a negative linear relationship between CV and the last GCS (P = 0.002) with no evidence of nonlinearity (P for nonlinear = 0.733). Multivariable linear regression suggested a higher CV was associated with a lower discharge GCS [β (95 %CI) = −1.86 (−3.08 ∼ −0.65), P = 0.003]. Furthermore, multivariable COX regression indicated that CV ≥ 0.3 was a risk factor for in-hospital death in TBI patients [HR (95 %CI) = 1.74 (1.15–2.62), P = 0.003], and this result was also consistent across sensitivity and subgroup analyses.

Conclusion

Higher GV is related to poorer consciousness outcomes and increased risk of in-hospital death in ICU patients with TBI. Additional research is needed to understand the logical relationship between GV and TBI progression.

背景：重症监护病房（ICU）患者的血糖变异性（GV）通常会升高，并且与患者的预后有关。然而，重症监护病房创伤性脑损伤（TBI）患者的血糖变异性与预后之间的关系仍不清楚：方法：重症监护病房创伤性脑损伤患者的临床数据来自重症监护医学信息市场（MIMIC）-IV 数据库。变异系数（CV）用于量化GV，格拉斯哥昏迷量表（GCS）用于评估TBI患者的意识状态。研究采用了皮尔逊线性相关分析、线性回归、COX回归和受限立方样条线（RCS）来研究变异系数与意识障碍之间的关系以及院内死亡风险：研究共纳入了1641名来自MIMIC-IV数据库的ICU创伤性脑损伤患者。皮尔逊线性相关和限制性立方样条曲线（RCS）分析结果显示，CV 与最后一次 GCS 之间存在负线性关系（P = 0.002），且无证据表明存在非线性关系（非线性关系的 P = 0.733）。多变量线性回归表明，较高的 CV 与较低的出院 GCS 相关[β（95 %CI）=-1.86 (-3.08 ∼ -0.65)，P = 0.003]。此外，多变量 COX 回归表明，CV ≥ 0.3 是导致 TBI 患者院内死亡的危险因素 [HR (95 %CI) = 1.74 (1.15-2.62)，P = 0.003]，这一结果在敏感性分析和亚组分析中也是一致的：结论：较高的 GV 与创伤性脑损伤重症监护病房患者较差的意识状况和较高的院内死亡风险有关。要了解 GV 与创伤性脑损伤进展之间的逻辑关系，还需要进行更多的研究。

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引用次数: 0

Association of age at diagnosis of type 2 diabetes mellitus with the risks of the morbidity of cardiovascular disease, cancer and all-cause mortality: Evidence from a real-world study with a large population-based cohort study 确诊 2 型糖尿病时的年龄与心血管疾病、癌症和全因死亡率的发病风险之间的关系：一项基于大型人群队列研究的真实世界研究提供的证据。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-09-26 DOI: 10.1016/j.diabres.2024.111870

Yuhao Li , Jinbin Luo , Kaifang Bao , Qiaohui Wei , Xiaohong Wang , Jieping Chen , Tao Zhang , Fengying Wang , Yimin Zhu

Aims

To investigate the impact of diagnosis age of type 2 diabetes mellitus (T2DM) on subsequent adverse outcomes within the Chinese population.

Methods

549,959 eligible T2DM patients were included from Ningbo and Jinhua city in Zhejiang province, China. Standardized ratio was used to evaluate the risks of coronary heart disease (CHD), stroke, cancer and all-cause death in different T2DM diagnosis age groups.

Results

For all adverse outcomes, higher excess risks were observed in the youngest age group (30–39) than in the oldest age group (≥80) with T2DM. The standardized incidence ratios (SIR) were 5.93 (95% CI: 3.46, 10.14) for CHD, 5.45 (95% CI: 3.72, 7.99) for stroke and 1.85 (95% CI: 1.38, 2.49) for cancer in the youngest age group, and were 1.32 (95% CI: 1.08, 1.60) for CHD, 1.25 (95% CI: 1.08, 1.44) for stroke, and 0.78 (95% CI: 0.56, 1.09) for cancer, respectively, in the oldest age group. The standardized mortality ratios (SMR) for all-cause death were 3.15 (1.69, 5.84) vs. 1.12 (0.88, 1.43). These excess risks decreased with increasing diagnosis age (all P value < 0.001). Consistent results were observed when individuals were stratified by sex or further excluded with the time from T2DM diagnosis to endpoints less than 1 or 2 years.

Conclusions

Th earlier the diagnosis of T2DM, the higher the risk for subsequent adverse outcomes. It is imperative to enhance the management and monitoring of early-onset patients during follow-up.

目的：研究中国人群中2型糖尿病（T2DM）诊断年龄对后续不良结局的影响。方法：纳入浙江省宁波市和金华市549 959名符合条件的T2DM患者。结果：在所有不良后果中，T2DM 患者的超额风险越高，其不良后果越严重：结果：在所有不良后果中，T2DM 患者中最年轻年龄组（30-39 岁）的超额风险高于最年长年龄组（≥80 岁）。在最年轻的年龄组中，冠心病的标准化发病率（SIR）为 5.93 (95% CI: 3.46, 10.14)，中风为 5.45 (95% CI: 3.72, 7.99)，癌症为 1.85 (95% CI: 1.38, 2.49)。在最年长的年龄组中，冠心病、中风和癌症的标准化死亡率分别为 1.32（95% CI：1.08，1.60）、1.25（95% CI：1.08，1.44）和 0.78（95% CI：0.56，1.09）。全因死亡的标准化死亡率（SMR）为 3.15 (1.69, 5.84) vs. 1.12 (0.88, 1.43)。这些超额风险随着诊断年龄的增加而降低（均为 P 值）：T2DM 诊断越早，随后出现不良后果的风险越高。在随访过程中加强对早发患者的管理和监测势在必行。

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引用次数: 0

Mortality in type 1 diabetes mellitus: A single centre experience from the ICMR – Youth onset diabetes registry in India 1 型糖尿病患者的死亡率：来自印度 ICMR - 青年糖尿病登记中心的单一中心经验。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice

Pub Date : 2024-09-25 DOI: 10.1016/j.diabres.2024.111868

S.V. Madhu , P. Shukla , T. Kaur , R.S. Dhaliwal

Introduction

The prevalence of youth onset diabetes is rising globally along with a greater burden of complications and mortality in them. The current study was undertaken to examine the mortality and causes of death in patients with youth onset diabetes registered in a tertiary care hospital in North India.

Methods

We analyzed mortality and causes of death in 1088 patients with youth onset diabetes registered from 2006 to 2019 at University College of Medical Sciences, Delhi. Information of death was obtained telephonically or by home visit or from hospital records wherever available. Verbal autopsy according to ICMR questionnaire was performed and cause of death determined as per WHO ICD-10/11.

Results

Among 898 youth onset type 1 diabetes mellitus (T1D) patients who had a mean follow up of 6.4 years, 105 deaths (11.6 %) occurred. Forty three percent of deaths had diabetes onset at 15 years or below, and 75.6 % had HbA1C > 10 %. Deaths occurred in 24.2 % within 2 years and in 53.6 % within 3 years of diagnosis. Chronic Kidney disease, infections and ketoacidosis were the commonest causes.

Conclusion

We found poor glycaemic control and high mortality in people with youth onset T1D being treated at a tertiary care hospital in north India.

导言：在全球范围内，青少年糖尿病发病率不断上升，并发症和死亡率也随之增加。本研究旨在调查在印度北部一家三级医院登记的青年糖尿病患者的死亡率和死亡原因：我们分析了 2006 年至 2019 年在德里大学医学院登记的 1088 名青年糖尿病患者的死亡率和死亡原因。死亡信息通过电话、家访或医院记录获得。根据 ICMR 调查问卷进行了口头尸检，并根据世界卫生组织 ICD-10/11 确定了死因：结果：在平均随访 6.4 年的 898 名青年 1 型糖尿病（T1D）患者中，有 105 人（11.6%）死亡。43%的死亡病例起病年龄在 15 岁或以下，75.6%的死亡病例 HbA1C > 10%。24.2%的患者在确诊后两年内死亡，53.6%的患者在确诊后三年内死亡。慢性肾病、感染和酮症酸中毒是最常见的原因：我们发现，在印度北部一家三甲医院接受治疗的青年 T1D 患者血糖控制不佳，死亡率较高。

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