Diabetes research and clinical practice最新文献

Aims

To evaluate the impact of elexacaftor/tezacaftor/ivacaftor (ETI) therapy on Cystic Fibrosis Related Diabetes (CFRD) glycemic control and insulin treatment in patients with CFRD during clinical practice.

Methods

We carried out a retrospective observational study of 23 adult patients with CFRD who started treatment with ETI. They had, at least, one F508del mutation. Data were collected before ETI initiation and 3, 6, and 12 months after.

Results

Glycemic control measured by HbA1c significantly improved by 0.3 % (0.1–0.5) after 3 months of ETI therapy (p = 0.004) and kept this improvement during follow-up (p < 0.001). The proportion of patients needing multiple daily injections of insulin was reduced by 16 % (p = 0.023). Total daily insulin dose dropped by 0.12 (0.05–0.18) UI/kg/day (p < 0.001). Data derived from Flash Continuous Glucose Monitoring (CGM) for patients treated with insulin stayed unchanged after insulin reduction, except for a significant 8 % (0.3–15.6) increase in the Time In Tight Range (TITR) between 70 and 140 mg/dL (p = 0.043).

Conclusion

ETI therapy impacted CFRD in clinical practice reducing insulin needs and improving glycemic control measured by HbA1c and CGM. The improvements can be observed from the first 3 months of treatment.

The global rise in diabetes prevalence poses a significant challenge to healthcare providers, stimulating interest in digital interventions such as educational games. However, the impact and availability of research-developed diabetes games remain uncertain. This scoping review aimed to provide a comprehensive overview of serious games for diabetes, encompassing their availability, characteristics and health effects. Through an electronic search in multiple databases, a total of 21 articles addressing 23 games were included in the literature review. The majority of these games were inaccessible outside of research settings, despite demonstrating positive effects on various aspects of diabetes management, including knowledge, physical activity, self-management, mental well-being, and HbA1c levels. Most games were designed for mobile phones, targeting both children and adults. A subsequent app store search revealed 13 additional diabetes games, however nearly none (7.7%) of these underwent research scrutiny, leaving their expected effects uncertain. The disparity between evidence-based games and those available in app stores underscores the need for bridging this gap to ensure the availability of effective digital games for diabetes management worldwide.

Background

The aim of the study was to analyze the real-world performance of MiniMed 780G (MM780G) Advanced Hybrid Closed Loop (AHCL) system users from Poland (PL) and compare it to the European region excluding Poland (EU-PL) in order to identify factors contributing to potential differences. The former achieved some of the best Time in Range (TIR) results globally using this technology.

Methods

CareLink Personal data uploaded by MM780G system users from August 2020 to December 2022 were analyzed.

Results

The Polish users (N=1304) on average reached to TIR of 79.1 ± 8.7 % (vs 73.0 ± 10.0 % for EU-PL, N=55659), a TBR<54 mg/dL of 0.6 ± 0.7 % (vs 0.4 ± 0.6 %) and a TBR<70 mg/dL of 2.9 ± 2.1 % (vs 2.1 ± 1.8 %). The adoption rate of optimal settings (i.e, GT=100 mg/dL, AIT=2hr) in PL was high (19.7 % vs 6.3 %), and filtering on optimal setting users led to less pronounced differences in glycemic control between PL and EU-PL. A univariable analysis with post-AHCL TIR showed that geography itself (PL vs EU-PL) is not a significant contributor to a high post-AHCL TIR (p = 0.15), and that much of the Polish post-AHCL TIR can be explained by the high pre-AHCL TIR.

Conclusion

The Polish MM780G users achieved better glycemic control than the general European population (excluding Poland). This is largely attributable to the adoption of optimal settings in Poland and the already high glycemic outcomes at system start. As these characteristics can be implemented elsewhere, we believe this outstanding result can be obtained in other countries as well.

Background

Gestational Diabetes Mellitus (GDM) poses significant risks to maternal and fetal health, yet its precise etiology remains unclear. Observational studies have demonstrated a link between specific inflammatory cytokines and the occurrence of GDM, but the causal relationships remain uncertain.

Methods

Utilizing publicly accessible genetic data, we performed a bidirectional two-sample mendelian randomization (MR) analysis to elucidate the causal association between 91 inflammatory cytokines and GDM. Sensitivity analysis was carried out to evaluate the robustness, heterogeneity, and potential presence of horizontal pleiotropy within the results.

Results

Elevated levels of Interleukin-7 (IL7) and Neurturin (NRTN) (OR=1.104, 95 % CI=1.003–1.216, p = 0.042; OR=1.102, 95 % CI=1.023–1.187, p = 0.010), along with decreased levels of Glial cell line-derived neurotrophic factor (GDNF), Interleukin-12 subunit beta (IL12β), and Interleukin-20 (IL20) (OR=0.911, 95 % CI=0.849–0.979, p = 0.010;OR=0.955, 95 % CI=0.916–0.996, p = 0.033; OR=0.892, 95 % CI=0.819–0.971, p = 0.008), are associated with increased GDM risk. Additionally, GDM occurrence correlates with increased Matrix metalloproteinase-10 (MMP-10) and decreased Interleukin-20 receptor subunit alpha (IL-20Rα) levels (OR=1.042, 95 % CI=1.002–1.084, p = 0.038; OR=0.949, 95 % CI=0.909–0.992, p = 0.021). Sensitivity analyses detected no significant heterogeneity or pleiotropy.

Conclusion

This study has clarified the causal link between inflammatory cytokines and GDM, thereby enhancing our comprehension of the potential mechanisms involved in GDM pathogenesis. These findings offer new insights into the etiology, diagnosis, and therapeutic strategies for GDM.

Type 2 diabetes mellitus (T2DM) and pre-diabetes (pre-DM) are significant health concerns in Pakistan. This systematic review and meta-analysis estimate the prevalence of T2DM and pre-DM, assessing regional, gender, and urban–rural differences. We searched PubMed, Scopus, Cochrane, and PakMediNet databases, identifying 3478 articles. After screening, 17 studies from 1995 to 2018 were included. The pooled prevalence of T2DM and pre-DM in Pakistan was found to be 10.0 % and 11.0 %, respectively. This equates to approximately 24 million individuals with T2DM and 26 million with pre-DM, totaling 50 million affected. Rural areas showed higher T2DM prevalence post-2000, with an odds ratio (OR) of 1.25 (95 % CI: 0.73 to 2.14). Gender analysis revealed a slightly higher, though statistically insignificant, prevalence of T2DM in females and a significantly higher prevalence of pre-DM in males (OR: 0.79, 95 % CI: 0.63 to 0.98). Regionally, Punjab had the highest T2DM prevalence (16 %), followed by Baluchistan (15 %), Sindh (14 %), and Khyber Pakhtunkhwa (KPK) (11 %). There is a substantial burden of T2DM and pre-DM in Pakistan, with significant regional and gender differences. Targeted interventions and resource allocation are needed to address the rising prevalence of diabetes, focusing on early detection and lifestyle modifications.

The pathogenesis of type 2 diabetes (T2D) involves dysfunction in multiple organs, including the liver, muscle, adipose tissue, and pancreas, leading to insulin resistance and β cell failure. Recent studies highlight the significant role of extracellular vesicles (EVs) in mediating inter-organ communication in T2D. This review investigates the role of EVs, focusing on their presence and biological significance in human plasma and tissues affected by T2D. We explore specific EV cargo, such as miRNAs and proteins, which affect insulin signaling and glucose metabolism, emphasizing their potential as biomarkers. By highlighting the diagnostic and therapeutic potential of EVs, we aim to provide new insights into their role in early detection, disease monitoring, and innovative treatment strategies for T2D.

Aim

To explore how introduction of the lower WHO gestational diabetes (GDM) glucose criteria in Sweden affected prediabetes/type-2-diabetes (T2D) incidence two years postpartum.

Methods

Women included in the PREvention of PostPartum (PREPP) diabetes study were diagnosed with GDM according to EASD 1991 criteria (GDM_OLD; n = 93) or only WHO 2013 criteria (GDM_WHO; n = 174). Both groups were further stratified by BMI, and BMI-matched normoglycemic pregnancy controls were included (n = 88). Postpartum assessments included oral glucose tolerance tests (OGTT) and anthropometric measurements.

Results

There was a higher postpartum incidence of T2D in GDM_OLD versus GDM_WHO (P < 0.001). Despite similar BMI, GDM_OLD exhibited higher fasting and OGTT glucose levels, lower fat-free-mass, and hip circumference compared to GDM_WHO. In normal-weight women, both GDM groups displayed higher HOMA-IR and lower fat-free-mass compared to controls, with GDM_OLD additionally showing lower HOMA-β, slower insulin release during OGTT, and worse glucose tolerance than GDM_WHO. Among obese women, the main differences were lower fat-free-mass and hip circumference in GDM_OLD.

Conclusion

The lower glucose cut-offs during pregnancy resulted in lower postpartum incidence of T2D, irrespective of BMI. Fat-free-mass emerged as a key determinant in glucose levels across BMI categories, while lower beta-cell function played a significant role in normal-weight women.

Aims

To estimate prevalence of diagnosed (dDM) and undiagnosed diabetes (uDM) in Hungary and investigate determinants of uDM.

Methods

Data was obtained from the nationally representative H-UNCOVER study. As laboratory measurements were available for 11/19 Hungarian counties, n = 5,974/17,787 people were eligible. After exclusions, 5,673 (representing 4,976,097 people) were included. dDM was defined by self-reporting, while uDM as negative self-reporting and elevated fasting glucose (≥7 mmol/l) and/or HbA1c (≥48 mmol/mol). Logistic regression for complex samples was used to calculate comparisons between dDM and uDM adjusted for age and BMI.

Results

Diabetes prevalence was 12.0 %/11.9 % (women/men, 95 %CI:10.7–13.4 %/10.7–13.2 %), while 2.2 %/2.8 % (1.7–2.8 %/2.2–3.6 %) of women/men were uDM. While the proportion of uDM vs. dDM was similar for women ≥ 40, men in their forties had the highest odds for uDM. Neither unemployment (women/men OR:0.58 [0.14–2.45]/0.50 [0.13–1.92]), nor education level (tertiary vs. primary; women/men OR: 1.16 [0.53–2.56]/ 0.53 [0.24–1.18]) were associated with uDM. The risk of uDM was lower in both sexes with chronic morbidities.

Conclusions

We report higher prevalence of diabetes and undiagnosed diabetes than previous Hungarian estimates. The finding that socioeconomic factors are not associated to uDM suggests that universal health care could provide equitable access to diabetes diagnosis.

Aims

Metabolic characteristics and outcomes were compared among pregnant individuals with varying levels of glucose intolerance.

Methods

827 participants from a randomized clinical trial comparing the IADPSG and Carpenter Coustan Criteria were grouped as follows: normal glucose tolerance, mild glucose intolerance (100 g OGTT with one abnormal value) and treated GDM (diagnosed by Carpenter Coustan or IADPSG criteria). Differences in metabolic characteristics and perinatal outcomes were assessed using inverse probability of treatment weighting.

Results

Mild glucose intolerance had lower insulin sensitivity and beta cell response than normal glucose tolerance, and similar findings to treated GDM. Small for gestational age (SGA) (OR 0.13, 95% CI 0.08–0.24) and neonatal composite morbidity were lower (OR 0.53, 95% CI 0.38–0.74), and maternal composite morbidity higher (OR 2.03, 95% CI 1.57–2.62) when comparing mild intolerance to normal glucose tolerance. Large for gestational age (OR 3.42 95% CI 1.39–8.41) was higher while SGA (OR 0.21, 95% CI 0.05–0.81) and neonatal composite morbidity (OR 0.31, 95% CI 0.17–0.57) were lower with mild glucose intolerance compared to treated GDM.

Conclusions

Mild glucose intolerance has a similar metabolic profile to treated GDM, and outcome differences are likely related to knowledge of diagnosis and treatment.

Clinical trials registry: NCT02309138.

Aims

This study endeavors to explore the ramifications of early dynamic blood glucose (BG) trajectories within the initial 48 h of intensive care unit (ICU) admission on mortality among critically ill heart failure (HF) patients.

Methods

The study employed a retrospective observational design, analyzing dynamic BG data of HF patients from the Medical Information Mart for Intensive Care IV database. The BG trajectory subphenotypes were identified using the hierarchical clustering based on the dynamic time-warping algorithm. The primary outcome of the study was 28-day mortality, with secondary outcomes including 180-day and 1-year mortality.

Results

We screened a total of 21,098 HF patients and finally 15,092 patients were included in the study. Our results identified three distinct BG trajectory subphenotypes: increasing (n = 3503), stabilizing (n = 6250), and decreasing (n = 5339). The increasing subphenotype was associated with the highest mortality risk at 28 days, 180 days, and 1 year. The stabilizing and decreasing subphenotypes showed significantly lower mortality risks across all time points, with hazard ratios ranging from 0.85 to 0.88 (P<0.05 for all). Sensitivity analyses confirmed the robustness of these findings after adjusting for various covariates.

Conclusions

Increasing BG trajectory within 48 h of admission is significantly associated with higher mortality in patients with HF. It is necessary to devote greater attention to the early BG dynamic changes in HF patients to optimize clinical BG management and enhance patient prognosis.