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Physical activity and sedentary behaviour in relation to body composition, estimated insulin sensitivity and arterial stiffness in adults with type 1 diabetes 体力活动和久坐行为与 1 型糖尿病成人患者的身体成分、估计胰岛素敏感性和动脉僵化的关系
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-16 DOI: 10.1016/j.diabres.2024.111860

Aims

To examine the association of daily PA levels and sedentary behaviour with body composition, estimated insulin sensitivity, and arterial stiffness in adults with type 1 diabetes (T1D).

Methods

Cross-sectional study in adults with T1D (n = 54). PA levels (daily steps, and time in moderate-to-vigorous intensity PA (MVPA)) and sedentary behaviour were measured using accelerometry for 7 days (McRoberts® DynaPort MoveMonitor). Cardiopulmonary exercise test for VO2max. Anthropometrics were collected, and body composition (total and % of fat mass (FMtot, FM%), total and % of lean mass (LMtot, LM%), and estimated visceral adipose tissue (VAT)) volume was assessed with dual energy X-ray-absorptiometry (DXA). Estimates of insulin sensitivity were determined (estimated glucose disposal rate (eGDR) and total daily insulin dose). Arterial stiffness was assessed with carotid-femoral pulse wave velocity (cf-PWV (m/s); SphygmoCor®).

Results

Lower 10-years HbA1c associated moderately with all PA measures. Favourable moderate associations were also found between PA measures and BMI, waist, VAT but not FM and LM. PA measures were favourably associated with a lower total daily insulin dose and higher eGDR. All PA parameters associated moderately with cf-PWV however not independent from traditional risk factors. VO2max was inversely associated with cf-PWV independent of age, T1D duration and 24-hour mean blood pressure.

Conclusions

Higher levels of PA, lower sedentary behaviour and greater exercise capacity are favourably associated with long-term glycaemic control, body composition, insulin dosage, estimated insulin sensitivity and arterial stiffness in adults with T1D. Therefore, regular PA and limiting sedentary time should be encouraged to improve metabolic and cardiovascular health in this population. Future longitudinal studies should explore mutual interactions and synergistic effects of PA on these outcomes.

目的 研究 1 型糖尿病(T1D)成人患者的日常活动量水平和久坐行为与身体成分、估计胰岛素敏感性和动脉僵化的关系。方法 对 T1D 成人患者(n = 54)进行横断面研究。使用加速度计(McRoberts® DynaPort MoveMonitor)测量了7天的PA水平(每日步数和中高强度PA(MVPA)时间)和久坐行为。心肺运动测试(VO2max)。收集了人体测量数据,并使用双能 X 射线吸附测量仪(DXA)评估了身体成分(脂肪总量和脂肪百分比(FMtot,FM%)、瘦肉总量和瘦肉百分比(LMtot,LM%)以及内脏脂肪组织(VAT)的估计值)。胰岛素敏感性估计值(估计葡萄糖排出率(eGDR)和每日胰岛素总剂量)也已确定。用颈动脉-股动脉脉搏波速度(cf-PWV (m/s); SphygmoCor®)评估动脉僵化程度。PA 指标与体重指数(BMI)、腰围、腹部脂肪含量(VAT)之间也存在有利的中度相关性,但与 FM 和 LM 无关。PA 指标与较低的每日胰岛素总剂量和较高的 eGDR 呈有利相关。所有 PA 参数均与 cf-PWV 呈中度相关,但与传统风险因素无关。结论较高水平的业余爱好、较少的久坐行为和较强的运动能力与 T1D 成人的长期血糖控制、身体成分、胰岛素用量、胰岛素敏感性估计值和动脉僵硬度密切相关。因此,应鼓励定期进行体育锻炼并限制久坐时间,以改善这一人群的代谢和心血管健康。未来的纵向研究应探讨体育锻炼对这些结果的相互影响和协同作用。
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引用次数: 0
Association of ideal cardiovascular health and history of gestational diabetes mellitus in NHANES 2007–2018 2007-2018 年国家健康调查(NHANES)中理想心血管健康与妊娠糖尿病病史的关系
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-14 DOI: 10.1016/j.diabres.2024.111857

Background

Population-based studies of ideal cardiovascular health (CVH) and gestational diabetes mellitus (GDM) are scarce.

Methods

We conducted a cross-sectional analysis of 2007–2018 National Health Examination and Nutrition Survey women aged ≥ 20 years, who had data on Life’s Simple 7 (LS7) metrics and self-reported GDM history. Each LS7 metric was assigned a score of 0 (non-ideal) and 1(ideal) and summed to obtain total ideal CVH scores (0–7). We used logistic regression models to assess associations between LS7 ideal CVH scores (0–7) and GDM history, accounting for socio-demographic factors.

Results

Among 9199 women (mean age: 46 years, 8 % with a GDM history), there was a progressive decrease in the odds of past GDM history across increasing ideal CVH scores. Compared to females with 0–1 ideal CVH scores, females with ideal CVH scores of 3, 4 and 5–7 had an associated 39 % lower [odds ratio: 0.61 (95 % CI: 0.41–0.90)], 50 % lower [0.50 (0.33–0.76)] and 66 % lower [0.34 (0.20–0.56)] odds of past GDM history, respectively. There were notable racial/ethnic and citizenship/nativity differences in these associations.

Conclusions

Women with higher ideal CVH scores had lower odds of GDM history. Our findings underscore the importance of optimizing cardiometabolic health among women with GDM history.

背景基于人群的理想心血管健康(CVH)和妊娠糖尿病(GDM)研究很少。方法我们对2007-2018年全国健康检查和营养调查中年龄≥20岁的女性进行了横断面分析,这些女性拥有生命简单7(LS7)指标数据和自我报告的GDM病史。每项 LS7 指标的得分分别为 0 分(非理想)和 1 分(理想),相加得出理想 CVH 总分(0-7)。我们使用逻辑回归模型评估了 LS7 理想 CVH 分数(0-7 分)与 GDM 病史之间的关联,并考虑了社会人口因素。结果在 9199 名女性(平均年龄:46 岁,8% 有 GDM 病史)中,随着理想 CVH 分数的增加,既往 GDM 病史的几率逐渐降低。与理想 CVH 分数为 0-1 的女性相比,理想 CVH 分数为 3、4 和 5-7 的女性既往 GDM 病史的相关几率分别降低了 39% [几率比:0.61 (95 % CI:0.41-0.90)]、50% [0.50 (0.33-0.76)] 和 66% [0.34 (0.20-0.56)]。结论 理想 CVH 分数越高的妇女,其 GDM 病史几率越低。我们的研究结果强调了在有 GDM 病史的妇女中优化心脏代谢健康的重要性。
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引用次数: 0
Role of microRNAs in diabetic foot ulcers: Mechanisms and possible interventions 微RNA在糖尿病足溃疡中的作用:机制和可能的干预措施
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-14 DOI: 10.1016/j.diabres.2024.111858

Diabetic foot ulcer (DFU) is a common and serious complication among diabetic patients, and its incidence and difficulty in treatment have placed large burdens on patient health and quality of life. Diabetic foot tissue typically exhibits chronic wounds, ulcers, or necrosis that are difficult to heal, are prone to infection, and, in severe cases, may even lead to amputation. Recent studies have shown that microRNAs (miRNAs) play key roles in the development and healing of DFUs. miRNAs are a class of short noncoding RNA molecules that regulate gene expression to affect cellular functions and physiological processes. miRNAs may be involved in the development of DFUs by regulating cell growth, proliferation, differentiation and apoptosis. miRNAs can also participate in the healing and recovery of DFUs by regulating key steps, such as inflammation, angiogenesis, cell migration and proliferation, tissue repair and matrix remodeling. Therefore, altering the pathological processes of diabetic foot by modulating the expression of miRNAs could improve the recovery and treatment outcomes of patients. This review provides new insights and perspectives for the treatment of DFUs by summarizing the roles of miRNAs in the development and healing of DFUs and the mechanisms.

糖尿病足溃疡(DFU)是糖尿病患者常见的严重并发症,其发病率和治疗难度给患者的健康和生活质量带来了沉重负担。糖尿病足组织通常表现为慢性伤口、溃疡或坏死,难以愈合,容易感染,严重者甚至可能导致截肢。最近的研究表明,微小核糖核酸(miRNA)在脚趾溃疡的发展和愈合过程中起着关键作用。miRNA 是一类非编码 RNA 短分子,可调节基因表达,从而影响细胞功能和生理过程。miRNAs 还可通过调节炎症、血管生成、细胞迁移和增殖、组织修复和基质重塑等关键步骤,参与 DFU 的愈合和恢复。因此,通过调节 miRNAs 的表达来改变糖尿病足的病理过程,可以改善患者的康复和治疗效果。本综述通过总结 miRNAs 在糖尿病足的发生、发展和愈合中的作用及其机制,为糖尿病足的治疗提供了新的见解和视角。
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引用次数: 0
Early life socioeconomic inequalities and type 2 diabetes incidence: Longitudinal analyses in the Maastricht study 早期生活中的社会经济不平等与 2 型糖尿病发病率:马斯特里赫特研究的纵向分析
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-13 DOI: 10.1016/j.diabres.2024.111855

Aim

Type 2 diabetes (T2D) is a common chronic disease that disproportionally affects groups with a low socioeconomic position (SEP). This study aimed to examine associations between childhood SEP and incident T2D, independent of adult SEP.

Methods

Longitudinal data from The Maastricht Study were used (N=6,727, 55.2 % female, mean (SD) age 58.7(8.7) years). Childhood SEP was determined by asking for the highest completed educational level for the father and mother and childhood income inadequacy. Adult SEP was determined by highest completed educational level, equivalent household income, and occupational position. Incident T2D was self-reported yearly (up to 12 years of follow-up). Associations were studied with Cox regression analyses.

Results

In participants without T2D at baseline, 3.7% reported incident T2D over 8.2 (median) years of follow-up. Incident T2D was most common in people with low childhood and adult SEP and lowest in those with high childhood and adult SEP (1.7 vs. 7.5 per 1,000 person years). The association between childhood SEP and incident T2D was mainly explained by adult SEP, except for childhood income inadequacy which was independently associated with incident T2D.

Conclusion

Socioeconomic inequalities in childhood and adulthood are risk factors for incident T2D. More attention is needed to reduce childhood poverty and improve adult SEP to reduce the T2D risk.

目的 2 型糖尿病(T2D)是一种常见的慢性疾病,对社会经济地位(SEP)较低的群体的影响尤为严重。本研究旨在探讨儿童社会经济地位与 T2D 发病之间的关系,而与成人社会经济地位无关。方法 采用马斯特里赫特研究的纵向数据(样本数=6727,55.2% 为女性,平均(标清)年龄为 58.7(8.7)岁)。儿童时期的 SEP 是通过询问父亲和母亲的最高学历以及儿童时期的收入不足情况来确定的。成人 SEP 则根据最高教育程度、同等家庭收入和职业职位确定。T2D病例每年自行报告一次(随访时间长达12年)。结果 在基线时未患 T2D 的参与者中,有 3.7% 的人在 8.2 年(中位数)的随访期间报告了 T2D 事件。在儿童期和成年期SEP较低的人群中,T2D的发病率最高,而在儿童期和成年期SEP较高的人群中,T2D的发病率最低(每千人年1.7例与每千人年7.5例)。儿童期社会经济不平等与 T2D 发病之间的关系主要由成人期社会经济不平等所解释,但儿童期收入不足与 T2D 发病有独立关系。结论儿童期和成年期的社会经济不平等是终末期糖尿病发病的风险因素,需要更多关注减少儿童期贫困和改善成年期社会经济不平等以降低终末期糖尿病风险。
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引用次数: 0
Pathophysiological characteristics of subjects with intermediate hyperglycemia and type 2 diabetes identified by 1-hour plasma glucose during an oral glucose tolerance test 在口服葡萄糖耐量试验中,通过 1 小时血浆葡萄糖确定中度高血糖和 2 型糖尿病受试者的病理生理学特征
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-10 DOI: 10.1016/j.diabres.2024.111856

Aims

The International Diabetes Federation (IDF) has recently recommended determination of 1-hour plasma glucose (1-hPG) during an oral glucose tolerance test (OGTT) to diagnose intermediate hyperglycemia (IH) and type 2 diabetes (T2DM). Herein, we investigated the cardiometabolic characteristics of individuals with IH and T2DM according to IDF criteria.

Methods

We studied 3086 individuals stratified on the basis of fasting, 1-hPG and 2-hPG in four groups: 1) normal glucose tolerance (NGT), 2) isolated impaired fasting glucose (iIFG,), 3) IH (fasting glucose < 126 mg/dL, 1-hPG 155–208 mg/dL, and/or 2-hPG 140–199 mg/dL, and 4) newly diagnosed T2DM (fasting glucose, 1-hPG and/or 2-hPG≥126 mg/dL, 209 mg/dL and 200 mg/dL, respectively).

Results

Individuals with IH and T2DM exhibited higher adiposity, blood pressure, uric acid, a worse lipid and inflammatory profile and a progressive reduction in Matsuda index of insulin sensitivity, insulinogenic index, and disposition index as compared to the NGT group. Moreover, individuals with IH and T2DM exhibited lower Matsuda, insulinogenic, and disposition indexes as compared to the iIFG group.

Conclusions

1-h PG-based criteria for diagnosis of IH and diabetes identify individuals having an unfavorable cardiometabolic risk profile with a progressive reduction in insulin sensitivity associated with impaired β cell function.

目的国际糖尿病联盟(IDF)最近建议在口服葡萄糖耐量试验(OGTT)中测定1小时血浆葡萄糖(1-hPG),以诊断中度高血糖(IH)和2型糖尿病(T2DM)。在此,我们根据 IDF 标准研究了 IH 和 T2DM 患者的心脏代谢特征。方法我们对 3086 人进行了研究,根据空腹血糖、1-hPG 和 2-hPG 分为四组:1)糖耐量正常(NGT);2)孤立性空腹血糖受损(iIFG);3)IH(空腹血糖 126 mg/dL,1-hPG 155-208 mg/dL,和/或 2-hPG 140-199 mg/dL;4)新诊断的 T2DM(空腹血糖、1-hPG 和/或 2-hPG 分别≥126 mg/dL、209 mg/dL 和 200 mg/dL)。结果与 NGT 组相比,IH 和 T2DM 患者的脂肪率、血压、尿酸更高,血脂和炎症情况更差,胰岛素敏感性松田指数、胰岛素生成指数和处置指数逐渐降低。此外,与 iIFG 组相比,IH 和 T2DM 患者的 Matsuda 指数、胰岛素生成指数和处置指数均较低。
{"title":"Pathophysiological characteristics of subjects with intermediate hyperglycemia and type 2 diabetes identified by 1-hour plasma glucose during an oral glucose tolerance test","authors":"","doi":"10.1016/j.diabres.2024.111856","DOIUrl":"10.1016/j.diabres.2024.111856","url":null,"abstract":"<div><h3>Aims</h3><p>The International Diabetes Federation (IDF) has recently recommended determination of 1-hour plasma glucose (1-hPG) during an oral glucose tolerance test (OGTT) to diagnose intermediate hyperglycemia (IH) and type 2 diabetes (T2DM). Herein, we investigated the cardiometabolic characteristics of individuals with IH and T2DM according to IDF criteria<strong>.</strong></p></div><div><h3>Methods</h3><p>We studied 3086 individuals stratified on the basis of fasting, 1-hPG and 2-hPG in four groups: 1) normal glucose tolerance (NGT), 2) isolated impaired fasting glucose (iIFG,), 3) IH (fasting glucose &lt; 126 mg/dL, 1-hPG 155–208 mg/dL, and/or 2-hPG 140–199 mg/dL, and 4) newly diagnosed T2DM (fasting glucose, 1-hPG and/or 2-hPG≥126 mg/dL, 209 mg/dL and 200 mg/dL, respectively).</p></div><div><h3>Results</h3><p>Individuals with IH and T2DM exhibited higher adiposity, blood pressure, uric acid, a worse lipid and inflammatory profile and a progressive reduction in Matsuda index of insulin sensitivity, insulinogenic index, and disposition index as compared to the NGT group. Moreover, individuals with IH and T2DM exhibited lower Matsuda, insulinogenic, and disposition indexes as compared to the iIFG group.</p></div><div><h3>Conclusions</h3><p>1-h PG-based criteria for diagnosis of IH and diabetes identify individuals having an unfavorable cardiometabolic risk profile with a progressive reduction in insulin sensitivity associated with impaired β cell function.</p></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244246","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
Comparing the different phenotypes of diabetes in pregnancy: Are outcomes worse for women with young-onset type 2 diabetes compared to type 1 diabetes? 比较妊娠期糖尿病的不同表型:与 1 型糖尿病相比,2 型糖尿病年轻患者的预后是否更差?
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-06 DOI: 10.1016/j.diabres.2024.111848

Aims

Pregnancies are increasingly affected by young-onset type 2 diabetes mellitus (YT2DM), an aggressive phenotype associated with a higher vascular risk profile compared to type 1 diabetes mellitus (T1DM). We compared pregnancy outcomes to illuminate areas where differing management guidance might be needed.

Methods

This retrospective single-centre study (2010 2019) included 259 singleton pregnancies affected by pregestational T1DM (N = 124) or YT2DM (N = 135) diagnosed at < 40 years. Primary outcomes included preterm delivery, large for gestational age (LGA) infants, and pre-eclampsia.

Results

The YT2DM cohort were older, with more obesity, greater apparent sociodemographic disadvantage, and lower measures of pregnancy preparedness. Overweight/obesity were also prevalent in the T1DM cohort (46 % affected). The second/third trimester mean HbA1c measurements were significantly higher in the T1DM cohort. Pre-eclampsia and preterm delivery rates were similar between the cohorts. Significantly lower rates of LGA infants, NICU admission, neonatal hypoglycaemia, and neonatal respiratory distress were seen in the YT2DM cohort (p < 0.05 for all).

Conclusions

In pregnancy, YT2DM appears to be the lower-risk cohort compared to T1DM despite higher obesity rates. Gaps in achieving glycaemic targets exist for both subtypes but particularly for T1DM. The relative impact of increasing BMI in pregnancies affected by T1DM requires further elucidation.

目的:年轻2型糖尿病(YT2DM)对妊娠的影响越来越大,与1型糖尿病(T1DM)相比,YT2DM是一种侵袭性表型,具有更高的血管风险。我们对妊娠结果进行了比较,以揭示可能需要不同管理指导的领域:这项回顾性单中心研究(2010-2019 年)纳入了 259 例妊娠前 T1DM(124 例)或 YT2DM(135 例)的单胎妊娠:YT2DM队列中的孕妇年龄较大,肥胖症较多,明显处于社会人口劣势,备孕水平较低。超重/肥胖在 T1DM 组群中也很普遍(46% 受影响)。在 T1DM 组群中,孕期第二/三个月的平均 HbA1c 测量值明显更高。两个组群的子痫前期和早产率相似。YT2DM 组群的 LGA 婴儿、入住新生儿重症监护室、新生儿低血糖和新生儿呼吸窘迫的发生率明显较低(p 结论:YT2DM 组群的新生儿低血糖和呼吸窘迫的发生率明显较高:在妊娠期,尽管肥胖率较高,但与 T1DM 相比,YT2DM 似乎是风险较低的人群。两个亚型在实现血糖目标方面都存在差距,但 T1DM 的差距尤为明显。在受 T1DM 影响的妊娠中,BMI 增加的相对影响需要进一步阐明。
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引用次数: 0
Diabetes as a risk factor for MASH progression 糖尿病是 MASH 进展的风险因素。
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-06 DOI: 10.1016/j.diabres.2024.111846

Non-alcoholic (now: metabolic) steatohepatitis (MASH) is the progressive inflammatory form of metabolic dysfunction-associated steatotic liver disease (MASLD), which often coexists and mutually interacts with type 2 diabetes (T2D), resulting in worse hepatic and cardiovascular outcomes. Understanding the intricate mechanisms of diabetes-related MASH progression is crucial for effective therapeutic strategies. This review delineates the multifaceted pathways involved in this interplay and explores potential therapeutic implications.

The synergy between adipose tissue, gut microbiota, and hepatic alterations plays a pivotal role in disease progression. Adipose tissue dysfunction, particularly in the visceral depot, coupled with dysbiosis in the gut microbiota, exacerbates hepatic injury and insulin resistance. Hepatic lipid accumulation, oxidative stress, and endoplasmic reticulum stress further potentiate inflammation and fibrosis, contributing to disease severity. Dietary modification with weight reduction and exercise prove crucial in managing T2D-related MASH. Additionally, various well-known but also novel anti-hyperglycemic medications exhibit potential in reducing liver lipid content and, in some cases, improving MASH histology. Therapies targeting incretin receptors show promise in managing T2D-related MASH, while thyroid hormone receptor-β agonism has proven effective as a treatment of MASH and fibrosis.

非酒精性(现为:代谢性)脂肪性肝炎(MASH)是代谢功能障碍相关性脂肪性肝病(MASLD)的进行性炎症形式,经常与 2 型糖尿病(T2D)同时存在并相互影响,导致肝脏和心血管预后恶化。了解糖尿病相关 MASH 进展的复杂机制对于制定有效的治疗策略至关重要。本综述描述了参与这种相互作用的多方面途径,并探讨了潜在的治疗意义。脂肪组织、肠道微生物群和肝脏改变之间的协同作用在疾病进展中起着关键作用。脂肪组织功能障碍,尤其是内脏脂肪组织功能障碍,加上肠道微生物群失调,加剧了肝损伤和胰岛素抵抗。肝脏脂质积累、氧化应激和内质网应激进一步加剧了炎症和纤维化,导致疾病的严重程度。在控制与 T2D 相关的 MASH 的过程中,通过减轻体重和锻炼来调整饮食是至关重要的。此外,各种众所周知的新型降糖药物也具有降低肝脏脂质含量的潜力,在某些情况下还能改善MASH组织学。针对胰岛素受体的疗法有望控制与T2D相关的MASH,而甲状腺激素受体-β激动剂已被证明可有效治疗MASH和肝纤维化。
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引用次数: 0
Letter to the Editor: Sex differences in the plasma glucagon responses to a high carbohydrate meal and a glucose drink in type 2 diabetes 致编辑的信:2型糖尿病患者对高碳水化合物膳食和葡萄糖饮料的血浆胰高血糖素反应的性别差异。
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-05 DOI: 10.1016/j.diabres.2024.111847
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引用次数: 0
Advancements and best practices in diabetic foot Care: A comprehensive review of global progress 糖尿病足护理的进步与最佳实践:全面回顾全球进展。
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-05 DOI: 10.1016/j.diabres.2024.111845

Diabetic foot care has become a critical focus in global healthcare due to the rising prevalence of diabetes and its associated complications. This review aims to consolidate recent advancements and best practices in managing diabetic foot conditions, encompassing foot ulcers, neuropathy, vascular disease, and the risk of amputation. Emphasizing a multidisciplinary approach, the review advocates for collaboration among diabetologists, podiatrists, vascular surgeons, and wound care specialists to enhance patient outcomes.

Key advancements highlighted include innovative wound care techniques like advanced dressings and bioengineered skin substitutes, alongside effective offloading devices to prevent pressure-related injuries. Early detection and intervention strategies for neuropathy and vascular disease are underscored, with a particular focus on vascular evaluation as a baseline investigation, including Ankle-Brachial Index (ABI) and Toe-Brachial Index (TBI) assessments by trained podiatrists and the use of arterial color Doppler/duplex scans for suspected Peripheral Artery Disease (PAD).

The review also examines the impact of technological innovations such as telemedicine and wearable devices, facilitating enhanced patient monitoring and timely interventions. It stresses the importance of patient education and self-care practices in mitigating complications. Addressing global disparities, the review advocates for accessible and equitable healthcare services across diverse regions.

Concluding with recommendations for future research and policy initiatives, this review serves as a vital resource for healthcare professionals, policymakers, and researchers committed to advancing diabetic foot care and improving global patient outcomes.

由于糖尿病及其相关并发症的发病率不断上升,糖尿病足护理已成为全球医疗保健领域的一个重要焦点。本综述旨在总结管理糖尿病足病症的最新进展和最佳实践,包括足部溃疡、神经病变、血管疾病和截肢风险。该综述强调多学科方法,主张糖尿病专科医生、足病医生、血管外科医生和伤口护理专家通力合作,以提高患者的治疗效果。重点介绍的主要进展包括创新的伤口护理技术,如先进的敷料和生物工程皮肤替代品,以及有效的卸载装置,以防止与压力相关的损伤。报告还强调了神经病变和血管疾病的早期检测和干预策略,尤其关注作为基线调查的血管评估,包括由训练有素的足病医生进行的踝肱指数 (ABI) 和趾肱指数 (TBI) 评估,以及使用动脉彩色多普勒/双工扫描检查疑似外周动脉疾病 (PAD)。综述还探讨了远程医疗和可穿戴设备等技术创新的影响,这些创新有助于加强对患者的监测和及时干预。它强调了患者教育和自我护理方法在减少并发症方面的重要性。针对全球差异,该综述倡导在不同地区提供可获得的、公平的医疗保健服务。本综述最后对未来的研究和政策措施提出了建议,是致力于推进糖尿病足护理和改善全球患者预后的医疗保健专业人员、政策制定者和研究人员的重要资源。
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引用次数: 0
Low-carbohydrate diet in children and young people with type 1 diabetes: A randomized controlled trial with cross-over design 1 型糖尿病儿童和青少年的低碳水化合物饮食:交叉设计的随机对照试验。
IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-09-03 DOI: 10.1016/j.diabres.2024.111844

Aims

We investigated whether a short period of tightly controlled low-carbohydrate diet (LCD) leads to higher time in range without increasing the associated risks in children and young people with diabetes (CYPwD).

Methods

Thirty-five (CYPwD) were recruited into this randomized controlled cross-over study (20 female; 20 CSII; age 14.5 ± 2.9 years; HbA1c 48.9 ± 9.4 mmol/mol). The interventions were five and five weeks of ready-made food box deliveries of isocaloric diets in random order: either LCD (94.5 ± 4.7 g/day) or recommended carbohydrate diet (RCD) (191 ± 19.2 g/day). The outcomes were continuous glucose monitoring parameters, anthropometric, laboratory and quality of life (QoL) data.

Results

Time in range was significantly higher in the LCD than in the RCD period (77.1 % vs. 73.8 %, P=0.008). Times in hyperglycemia and average glycaemia were significantly lower in the LCD. There was no difference between the diets in time in hypoglycemia or glycemic variability. The subjects’ body weight and BMI were significantly lower during the LCD. There was no significant difference in the LDL-cholesterol levels. No significant differences were observed in the self-assessed QoL.

Conclusions

Short-term LCD led to an improvement of glycemic parameters without increasing time in hypoglycemia, disturbing the lipid profile or negatively affecting the quality of life of CYPwD.

目的:我们研究了短期严格控制低碳水化合物饮食(LCD)是否会在不增加相关风险的情况下延长儿童和青少年糖尿病患者(CYPwD)的服药时间:这项随机对照交叉研究招募了 35 名儿童和青少年糖尿病患者(20 名女性;20 名 CSII;年龄 14.5 ± 2.9 岁;HbA1c 48.9 ± 9.4 mmol/mol)。干预措施是按随机顺序分别提供五周和五周的现成盒装等热量饮食:LCD(94.5 ± 4.7 克/天)或推荐碳水化合物饮食(191 ± 19.2 克/天)。研究结果包括连续血糖监测参数、人体测量、实验室和生活质量(QoL)数据:结果:LCD 阶段在血糖范围内的时间明显高于 RCD 阶段(77.1% 对 73.8%,P=0.008)。LCD 的高血糖时间和平均血糖值明显低于 RCD。两种饮食在低血糖时间和血糖变异性方面没有差异。LCD期间,受试者的体重和体重指数明显降低。低密度脂蛋白胆固醇水平没有明显差异。在自我评估的 QoL 方面没有观察到明显差异:短期液晶显示可改善血糖参数,但不会增加低血糖时间,也不会扰乱血脂状况或对 CYPwD 的生活质量产生负面影响。
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Diabetes research and clinical practice
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