Diabetes & metabolism最新文献_第4页

Non-dioxin-like polychlorinated biphenyls (NDL-PCBs) dietary exposure is associated with an increased risk of type 2 diabetes in the European prospective investigation into cancer and nutrition (EPIC) cohort 在欧洲癌症与营养前瞻性调查（EPIC）队列中，非二恶英类多氯联苯（NDL-PCBs）膳食暴露与 2 型糖尿病风险增加有关。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-11-01 DOI: 10.1016/j.diabet.2024.101587

Xuan Ren , Geneviève Nicolas , Pauline Frenoy , Keren Papier , Conchi Moreno-Iribas , Giovanna Masala , Christina C. Dahm , Jie Zhang , Franziska Jannasch , Matthias B. Schulze , Elisabete Weiderpass , Paolo Chiodini , Claudia Vener , Paolo Vineis , Alicia K. Heath , Fulvio Ricceri , Sandra M. Colorado-Yohar , Chloé Marques , Thibault Fiolet , Gianluca Severi , Francesca Romana Mancini

Aims/hypothesis

The aim of the present study was to investigate the association between dietary exposures to dioxins, dioxin-like polychlorinated biphenyls (DL-PCBs) and non-dioxin-like polychlorinated biphenyls (NDL-PCBs) and the incidence of type 2 diabetes mellitus (T2DM) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Methods

This prospective cohort study with a median 11.7 years of follow-up, included 318,416 individuals recruited in 21 centers in eight countries. Dietary intake of dioxins and PCBs was calculated by combining EPIC food consumption data with food contamination data from the European Food Safety Authority (EFSA). To identify incident cases of T2DM, a thorough review of various sources including self-reported information, linkage to primary and secondary care registers, drug registers, hospital admissions, and mortality data was conducted. Associations between dietary intake of dioxins and PCBs and T2DM were evaluated using multivariable Cox regressions.

Results

Higher T2DM risk was observed for higher estimated dietary intake of non-dioxin-like PCBs (NDL-PCBs; HR _{per 1 SD increment} = 1.03 [95 %CI 1.01;1.04], and HR _(Q4 _{vs Q1)} = 1.15 [1.08;1.22], P-trend < 0.001). The results were consistent in analyses stratified by gender, body mass index, country, median follow-up, or self-reported hypertension and hyperlipidemia, as well as when adjusting for fat intake. No consistent association was observed between dioxins+DL-PCBs intake and T2DM risk.

Conclusion / interpretation

Results obtained in this large European prospective study indicate a positive and linear association between dietary intake of NDL-PCBs and risk of T2DM. This association remained consistent across various stratified and sensitivity analyses. Further studies are warranted to better understand the biological mechanisms underlying this association.

目的/假设：本研究旨在调查欧洲癌症与营养前瞻性调查（EPIC）队列中二恶英、二恶英类多氯联苯（DL-PCBs）和非二恶英类多氯联苯（NDL-PCBs）的膳食暴露与 2 型糖尿病（T2DM）发病率之间的关系：这项前瞻性队列研究的中位随访时间为 11.7 年，包括 8 个国家 21 个中心招募的 318416 人。二恶英和多氯联苯的膳食摄入量是通过将 EPIC 的食品消费数据与欧洲食品安全局（EFSA）的食品污染数据相结合计算得出的。为了确定 T2DM 的发病病例，对各种来源的数据进行了全面审查，包括自我报告的信息、与初级和二级医疗登记、药物登记、入院和死亡数据的关联。采用多变量考克斯回归法评估了二恶英和多氯联苯的膳食摄入量与 T2DM 之间的关系：结果：非二恶英类多氯联苯（NDL-PCBs；HR 每 1 SD 增量 = 1.03 [95%CI 1.01;1.04]，HR (Q4 vs Q1) = 1.15 [1.08;1.22], P-趋势 < 0.001）的估计膳食摄入量越高，T2DM 风险越高。按性别、体重指数、国家、随访中位数或自我报告的高血压和高脂血症进行分层分析，以及对脂肪摄入量进行调整后，结果一致。在二恶英+DL-多氯联苯摄入量与T2DM风险之间没有发现一致的关联：这项大型欧洲前瞻性研究的结果表明，膳食中 NDL-PCBs 的摄入量与 T2DM 风险之间呈线性正相关。在各种分层分析和敏感性分析中，这种关联仍然保持一致。为了更好地了解这种关联的生物机制，有必要开展进一步的研究。

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引用次数: 0

Association of SGLT2 inhibitors with incident cancer SGLT2 抑制剂与癌症发病率的关系：SGLT2i 与癌症发病率。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-11-01 DOI: 10.1016/j.diabet.2024.101585

Yuta Suzuki , Hidehiro Kaneko , Akira Okada , Toshiyuki Ko , Takahiro Jimba , Katsuhito Fujiu , Norifumi Takeda , Hiroyuki Morita , Jin Komuro , Masaki Ieda , Koichi Node , Issei Komuro , Hideo Yasunaga , Norihiko Takeda

Aim

It remains unknown whether sodium-glucose cotransporter 2 inhibitors (SGLT2i) could be associated with incident cancer.

Methods

We analyzed individuals having diabetes and newly prescribed SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i) in a large-scale epidemiological database. The primary outcome was the incidence of cancer. A propensity score matching algorithm was employed to compare the subsequent development of cancer between the SGLT2i and DPP4i groups.

Results

After 1:2 propensity score matching, 26,823 individuals (8,941 SGLT2i, 17,882 DPP4i) were analyzed. During the mean follow-up duration of 2.0 ± 1.6 years, 1,076 individuals developed cancer. SGLT2i administration was associated with a reduced risk of cancer (HR 0.80, 95 % CI 0.70–0.91). Particularly, SGLT2i administration was related to a lower risk of colorectal cancer (HR 0.71, 95 % CI 0.50–0.998). Our primary findings remained consistent across various sensitivity analyses, including overlap weighting analysis (HR 0.79, 95 % CI 0.66–0.94), inverse probability of treatment weighting 0.75 (95 % CI 0.65–0.86), and induction period settings 0.78 (95 % CI 0.65–0.93). The risk of developing cancer was comparable among individual SGLT2is (P-value of 0.1738).

Conclusion

Our investigation using nationwide real-world data demonstrated the potential advantage of SGLT2i over DPP4i in reducing the development of cancer in individuals with diabetes.

目的：钠-葡萄糖共转运体 2 抑制剂（SGLT2i）是否与癌症的发生有关仍是一个未知数：我们分析了大规模流行病学数据库中新处方 SGLT2i 或二肽基肽酶 4 抑制剂 (DPP4i) 的糖尿病患者。主要结果是癌症发病率。采用倾向得分匹配算法对 SGLT2i 组和 DPP4i 组的癌症发病率进行比较：经过1:2倾向得分匹配后，共分析了26,823名患者（8,941名SGLT2i患者，17,882名DPP4i患者）。在平均 2.0 ± 1.6 年的随访期间，有 1,076 人罹患癌症。服用 SGLT2i 可降低癌症风险（HR 0.80，95% CI 0.70-0.91）。特别是，服用 SGLT2i 与结直肠癌风险降低有关（HR 0.71，95% CI 0.50-0.998）。我们的主要研究结果在各种敏感性分析中保持一致，包括重叠加权分析（HR 0.79，95% CI 0.66-0.94）、治疗反概率加权 0.75（95% CI 0.65-0.86）和诱导期设置 0.78（95% CI 0.65-0.93）。不同 SGLT2is 的癌症发病风险相当（P 值为 0.1738）：我们利用全国范围内的真实数据进行的调查表明，在减少糖尿病患者罹患癌症方面，SGLT2i 比 DPP4i 具有潜在优势。

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引用次数: 0

Periodontitis adversely affects lipoprotein subfractions – results from the cohort study SHIP-TREND 牙周炎对脂蛋白亚组分有不利影响--SHIP-TREND 队列研究的结果：牙周炎对脂蛋白亚组分有不利影响。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-10-11 DOI: 10.1016/j.diabet.2024.101584

Pascal Basdorf , Thomas Kocher , Sebastian-Edgar Baumeister , Christiane Pink , Kathrin Budde , Astrid Petersmann , Nele Friedrich , Henry Völzke , Matthias Nauck , Birte Holtfreter

Aim

We aimed to investigate the medium-term associations of periodontitis and the number of missing teeth with serum lipoproteins and their plasma subfractions using follow-up data from the population-based Study of Health in Pomerania (SHIP-TREND).

Methods

A total of 2,058 participants with 7-year follow-up data underwent periodontal examinations, serum lipid panel tests, and proton nuclear magnetic resonance (¹H-NMR) spectroscopy of plasma lipoproteins and their subfractions. Generalized models with gamma distribution and loglink were used to analyze associations between periodontal variables and lipoproteins and their subfractions, adjusting for confounders using propensity score weighting.

Results

Periodontal variables were consistently associated with elevated follow-up serum levels of triglycerides, total cholesterol, and low-density lipoprotein cholesterol levels. When plasma lipoprotein subfractions were evaluated, periodontal variables were associated with elevated levels of triglycerides and cholesterol-enriched apolipoprotein B-containing lipoprotein particles, particularly small dense low-density lipoprotein, very-low-density lipoprotein and intermediate density lipoprotein. In addition, altered high-density lipoprotein particle composition was observed, suggesting potential functional changes.

Conclusion

This study provides evidence for causal effects of periodontitis on conventional serum lipids and plasma lipoprotein subfractions. As the underlying biological mechanisms are not fully understood, further research is needed.

目的：我们旨在利用波美拉尼亚健康人群研究（SHIP-TREND）的随访数据，研究牙周炎和缺牙数量与血清脂蛋白及其血浆亚组分的中期关联：共有 2058 名参与者接受了为期 7 年的牙周检查、血清脂质全套检测以及血浆脂蛋白及其亚组分的质子核磁共振 (1H-NMR) 光谱分析。采用伽马分布和对数链接的广义模型分析牙周变量与脂蛋白及其亚组分之间的关系，并利用倾向得分加权法调整混杂因素：结果：牙周变量与随访血清中甘油三酯、总胆固醇和低密度脂蛋白胆固醇水平的升高持续相关。在评估血浆脂蛋白亚组分时，牙周变量与甘油三酯和富含胆固醇的载脂蛋白B脂蛋白颗粒水平升高有关，尤其是小密度低密度脂蛋白、极低密度脂蛋白和中密度脂蛋白。此外，还观察到高密度脂蛋白颗粒的组成发生了改变，这表明可能存在功能性变化：本研究为牙周炎对常规血清脂质和血浆脂蛋白亚组分的因果影响提供了证据。结论：本研究提供了牙周炎对常规血清脂质和血浆脂蛋白亚组分产生因果效应的证据，由于尚未完全了解其潜在的生物学机制，因此需要进一步研究。

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引用次数: 0

Perirenal fat and chronic kidney disease in type 2 diabetes: The mediation role of afferent arteriolar resistance 肾周脂肪与 2 型糖尿病慢性肾病：传入动脉阻力的中介作用。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-10-09 DOI: 10.1016/j.diabet.2024.101583

Xiangjun Chen , Yao Qin , Jinbo Hu , Yan Shen , Yun Mao , Lianghua Xie , Jia Li , Jie Wang , Shumin Yang , Qifu Li , John Cijiang He , Zhihong Wang

Aim

Perirenal fat (PRF) is an independent predictor for chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) patients. Previous studies speculated that PRF may promote renal dysfunction through affecting renal hemodynamics. To verify this hypothesis, we studied the relationship between PRF and renal hemodynamics in T2DM.

Methods

91 T2DM patients were included. PRF thickness (PRFT) was measured by magnetic resonance imaging. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined by renal dynamic imaging. Renal vascular resistance (RVR), glomerular hydrostatic pressure (P_GLO), afferent (R_A) and efferent (R_E) arteriolar resistance were calculated by Gomez equations. Multiple linear regression was used to determine the relationship between PRFT and renal hemodynamics. Mediation analysis was conducted to estimate the mediation effects of renal hemodynamics on the relationship between PRF and CKD.

Results

All patients were divided into three groups according to the tertiles of PRFT. Compared with patients in tertile 1, GFR and ERPF were significantly decreased in patients in tertile 3, while RVR and R_A were significantly increased. PRFT was negatively correlated with GFR, ERPF and P_GLO, and positively correlated with RVR and R_A after adjustment for sex, age, visceral adipose tissue and treatments with ACE inhibitors/angiotensin receptor blockers and sodium-glucose cotransporter protein-2 inhibitors. Moreover, RVR and R_A mediated the effect of PRF on GFR, with a mediated proportion of 29.1 % and 41.4 % respectively.

Conclusion

In T2DM patients, PRF was negatively correlated with GFR, and positively correlated with R_A. R_A mediated the relationship between PRF and CKD.

目的：肾周脂肪（PRF）是 2 型糖尿病（T2DM）患者慢性肾脏疾病（CKD）的独立预测因子。以前的研究推测，肾周脂肪可能通过影响肾血流动力学促进肾功能不全。为了验证这一假设，我们研究了 PRF 与 T2DM 患者肾血流动力学之间的关系。方法：纳入 91 例 T2DM 患者，通过磁共振成像测量 PRF 厚度（PRFT）。肾动态成像测定肾小球滤过率（GFR）和有效肾血浆流量（ERPF）。肾血管阻力（RVR）、肾小球静水压（PGLO）、传入（RA）和传出（RE）动脉阻力由戈麦斯方程计算得出。多元线性回归用于确定 PRFT 与肾脏血液动力学之间的关系。进行中介分析以估计肾血流动力学对 PRFT 与 CKD 关系的中介效应：根据 PRFT 的分层将所有患者分为三组。与分层 1 的患者相比，分层 3 的患者的 GFR 和 ERPF 明显下降，而 RVR 和 RA 则明显上升。在对性别、年龄、内脏脂肪组织以及 ACE 抑制剂/血管紧张素受体阻滞剂和钠-葡萄糖共转运蛋白-2 抑制剂的治疗进行调整后，PRFT 与 GFR、ERPF 和 PGLO 呈负相关，而与 RVR 和 RA 呈正相关。此外，RVR和RA介导了PRF对GFR的影响，介导比例分别为29.1%和41.4%：结论：在 T2DM 患者中，PRF 与 GFR 呈负相关，与 RA 呈正相关。RA 在 PRF 与 CKD 的关系中起中介作用。

{"title":"Perirenal fat and chronic kidney disease in type 2 diabetes: The mediation role of afferent arteriolar resistance","authors":"Xiangjun Chen , Yao Qin , Jinbo Hu , Yan Shen , Yun Mao , Lianghua Xie , Jia Li , Jie Wang , Shumin Yang , Qifu Li , John Cijiang He , Zhihong Wang","doi":"10.1016/j.diabet.2024.101583","DOIUrl":"10.1016/j.diabet.2024.101583","url":null,"abstract":"<div><h3>Aim</h3><div>Perirenal fat (PRF) is an independent predictor for chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) patients. Previous studies speculated that PRF may promote renal dysfunction through affecting renal hemodynamics. To verify this hypothesis, we studied the relationship between PRF and renal hemodynamics in T2DM.</div></div><div><h3>Methods</h3><div>91 T2DM patients were included. PRF thickness (PRFT) was measured by magnetic resonance imaging. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined by renal dynamic imaging. Renal vascular resistance (RVR), glomerular hydrostatic pressure (P<sub>GLO</sub>), afferent (R<sub>A</sub>) and efferent (R<sub>E</sub>) arteriolar resistance were calculated by Gomez equations. Multiple linear regression was used to determine the relationship between PRFT and renal hemodynamics. Mediation analysis was conducted to estimate the mediation effects of renal hemodynamics on the relationship between PRF and CKD.</div></div><div><h3>Results</h3><div>All patients were divided into three groups according to the tertiles of PRFT. Compared with patients in tertile 1, GFR and ERPF were significantly decreased in patients in tertile 3, while RVR and R<sub>A</sub> were significantly increased. PRFT was negatively correlated with GFR, ERPF and P<sub>GLO</sub>, and positively correlated with RVR and R<sub>A</sub> after adjustment for sex, age, visceral adipose tissue and treatments with ACE inhibitors/angiotensin receptor blockers and sodium-glucose cotransporter protein-2 inhibitors. Moreover, RVR and R<sub>A</sub> mediated the effect of PRF on GFR, with a mediated proportion of 29.1 % and 41.4 % respectively.</div></div><div><h3>Conclusion</h3><div>In T2DM patients, PRF was negatively correlated with GFR, and positively correlated with R<sub>A</sub>. R<sub>A</sub> mediated the relationship between PRF and CKD.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"50 6","pages":"Article 101583"},"PeriodicalIF":4.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Diuretics and risk of major adverse limb events in patients with type-2 diabetes: An observational retrospective study 利尿剂与 2 型糖尿病患者肢体重大不良事件的风险：一项观察性回顾研究。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-10-03 DOI: 10.1016/j.diabet.2024.101582

Khadija Ba , Laurence Salle , Laudy Serhal , Mamadou Adama Sow , Julien Magne , Philippe Lacroix , Lucie Chastaingt , Victor Aboyans

Aim

In patients with type-2 diabetes mellitus (T2DM), sodium-glucose co-transporter 2 inhibitors are suspected to increase the risk of amputation. “Traditional” diuretics may increase major adverse limb events (MALEs), but the evidence is weak. We studied the association between common diuretics (i.e. thiazides, loop- and potassium-sparing diuretics) and MALEs/amputations in patients with T2DM.

Methods

Consecutive T2DM patients without cardiovascular history referred to our center for cardiovascular check-ups were retrospectively studied. Follow-up data on MALEs were collected. We used Cox models to assess the association between diuretics and MALEs, or amputation alone. A propensity score with inverse probability of diuretic treatment weighting (IPTW) analysis was performed.

Results

We studied 1309 patients, (59.5 ± 10.7 years, 51 % females) with diabetes duration of 9.1 ± 8.5 years, among whom 402 (30 %) were taking diuretics. During a follow-up of 3.8 ± 1.64 years, 121 (9.1 %) had MALEs, including 19 (1.4 %) amputations. Death occurred in 111 patients and the proportion of death was significantly different between groups: patients with diuretics n = 49, 44.1% vs patients without diuretics n = 62, 55.9 %, P = 0.001. Diuretics, in multivariable analysis, were associated with MALEs (aHR[95 %CI] 1.96[1.32;2.91] P = 0.001), even after adjustment on propensity score (aHR 1.66[1.08;2.56] P = 0.02) and IPTW analysis (aHR 1.76[1.67;1.84] P < 0.0001). This risk was particularly increased in case of an abnormal ankle-brachial index (aHR 2.29[1.32;3.96], P = 0.003) at baseline. Looking at diuretic classes separately, the adjusted risk was increased with loop diuretics (aHR 2.56[1.16;5.64] P = 0.020), thiazides (aHR 2.21[1.37;3.57] P = 0.001) or potassium sparing diuretics (aHR 2.56[1.16;5.64] P = 0.020).

Conclusion

Diuretic treatment weighting may be associated with increased risk of MALEs. We identified several markers of increased risk of limb events where the use of diuretics should be considered with caution.

目的：在 2 型糖尿病（T2DM）患者中，钠-葡萄糖共转运体 2 抑制剂被怀疑会增加截肢风险。"传统 "利尿剂可能会增加肢体主要不良事件（MALEs），但证据不足。我们研究了常见利尿剂（即噻嗪类、襻利尿剂和保钾利尿剂）与 T2DM 患者肢体重大不良事件/截肢之间的关系：对转诊至本中心进行心血管检查的无心血管病史的连续 T2DM 患者进行回顾性研究。我们收集了MALEs的随访数据。我们使用 Cox 模型评估了利尿剂与 MALEs 或单独截肢之间的关联。我们还进行了倾向评分与利尿剂治疗逆概率加权（IPTW）分析：我们研究了 1309 名患者（59.5±10.7 岁，51% 为女性），他们的糖尿病病程为 9.1±8.5 年，其中 402 人（30%）服用了利尿剂。在 3.8±1.64 年的随访期间，121 例（9.1%）患者出现男性糖尿病，其中 19 例（1.4%）截肢。111名患者死亡，不同组间的死亡比例有显著差异：使用利尿剂的患者n=49，44.1%；未使用利尿剂的患者n=62，55.9%，P=0.001。在多变量分析中，利尿剂与男性死亡率相关（aHR[95%CI] 1.96[1.32;2.91] P = 0.001），即使根据倾向评分（aHR 1.66[1.08;2.56] P = 0.02）和IPTW分析（aHR 1.76[1.67;1.84] P < 0.0001）进行调整后也是如此。基线踝肱指数异常（aHR 2.29[1.32;3.96]，P = 0.003）的风险尤其增加。从利尿剂类别分别来看，襻利尿剂（aHR 2.56[1.16;5.64] P = 0.020）、噻嗪类（aHR 2.21[1.37;3.57] P = 0.001）或排钾利尿剂（aHR 2.56[1.16;5.64] P = 0.020）的调整后风险增加：结论：利尿剂治疗加权可能与男性乳腺癌风险增加有关。我们发现了几种肢体事件风险增加的标志物，应谨慎使用利尿剂。

{"title":"Diuretics and risk of major adverse limb events in patients with type-2 diabetes: An observational retrospective study","authors":"Khadija Ba , Laurence Salle , Laudy Serhal , Mamadou Adama Sow , Julien Magne , Philippe Lacroix , Lucie Chastaingt , Victor Aboyans","doi":"10.1016/j.diabet.2024.101582","DOIUrl":"10.1016/j.diabet.2024.101582","url":null,"abstract":"<div><h3>Aim</h3><div>In patients with type-2 diabetes mellitus (T2DM), sodium-glucose co-transporter 2 inhibitors are suspected to increase the risk of amputation. “Traditional” diuretics may increase major adverse limb events (MALEs), but the evidence is weak. We studied the association between common diuretics (i.e. thiazides, loop- and potassium-sparing diuretics) and MALEs/amputations in patients with T2DM.</div></div><div><h3>Methods</h3><div>Consecutive T2DM patients without cardiovascular history referred to our center for cardiovascular check-ups were retrospectively studied. Follow-up data on MALEs were collected. We used Cox models to assess the association between diuretics and MALEs, or amputation alone. A propensity score with inverse probability of diuretic treatment weighting (IPTW) analysis was performed.</div></div><div><h3>Results</h3><div>We studied 1309 patients, (59.5 ± 10.7 years, 51 % females) with diabetes duration of 9.1 ± 8.5 years, among whom 402 (30 %) were taking diuretics. During a follow-up of 3.8 ± 1.64 years, 121 (9.1 %) had MALEs, including 19 (1.4 %) amputations. Death occurred in 111 patients and the proportion of death was significantly different between groups: patients with diuretics <em>n</em> = 49, 44.1% vs patients without diuretics <em>n</em> = 62, 55.9 %, <em>P</em> = 0.001. Diuretics, in multivariable analysis, were associated with MALEs (aHR[95 %CI] 1.96[1.32;2.91] <em>P</em> = 0.001), even after adjustment on propensity score (aHR 1.66[1.08;2.56] <em>P</em> = 0.02) and IPTW analysis (aHR 1.76[1.67;1.84] <em>P</em> < 0.0001). This risk was particularly increased in case of an abnormal ankle-brachial index (aHR 2.29[1.32;3.96], <em>P</em> = 0.003) at baseline. Looking at diuretic classes separately, the adjusted risk was increased with loop diuretics (aHR 2.56[1.16;5.64] <em>P</em> = 0.020), thiazides (aHR 2.21[1.37;3.57] <em>P</em> = 0.001) or potassium sparing diuretics (aHR 2.56[1.16;5.64] <em>P</em> = 0.020).</div></div><div><h3>Conclusion</h3><div>Diuretic treatment weighting may be associated with increased risk of MALEs. We identified several markers of increased risk of limb events where the use of diuretics should be considered with caution.</div></div>","PeriodicalId":11334,"journal":{"name":"Diabetes & metabolism","volume":"50 6","pages":"Article 101582"},"PeriodicalIF":4.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase IV inhibitors and risk of dementia among patients with type 2 diabetes and comorbid mental disorders: A population-based cohort study 葡萄糖钠转运体 2 抑制剂与二肽基肽酶 IV 抑制剂以及 2 型糖尿病合并精神障碍患者的痴呆风险：基于人群的队列研究

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-09-28 DOI: 10.1016/j.diabet.2024.101581

Bin Hong , Hyesung Lee , Ahhyung Choi , Woo Jung Kim , Young Min Cho , Dong Keon Yon , Ju-Young Shin

Aim

To evaluate whether the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors which have shown potential neuroprotective effects, is associated with lower risk of dementia in patients with type 2 diabetes (T2D) and comorbid mental disorders, who are considerably more susceptible to dementia.

Methods

Using the nationwide healthcare data of South Korea between 2010 and 2022, we conducted a retrospective cohort study among patients with T2D and comorbid mental disorders initiating SGLT2 inhibitors versus active comparator (Dipeptidyl Peptidase IV (DPP4) inhibitors). Hazard ratios (HRs) and rate differences (RDs) per 1000 person-years of incident dementia were estimated after weighting by propensity score fine stratification method.

Results

Over a 4.8-year median follow-up, SGLT2 inhibitors were associated with a 12 % lower risk of dementia compared with DPP4 inhibitors (11.31 vs. 12.86 events per 1000 person years; HR 0.88, 95 % CI 0.84 to 0.92; RD -1.55, -2.13 to -0.97). The results were consistent when stratified by age, sex, individual component, severe mental disorders, presence of insulin, history of cardiovascular disease, or history of hypertension.

Conclusions

SGLT2 inhibitors versus DPP4 inhibitors were associated with a lower risk of incident dementia in patients with T2D and comorbid mental disorders. Further randomized controlled trials are required to confirm our findings.

目的：评估具有潜在神经保护作用的钠-葡萄糖共转运体-2（SGLT2）抑制剂的使用是否与2型糖尿病（T2D）患者痴呆风险的降低有关：我们利用 2010 年至 2022 年期间韩国全国范围内的医疗保健数据，对开始服用 SGLT2 抑制剂和活性比较药（二肽基肽酶 IV (DPP4) 抑制剂）的 T2D 和合并精神障碍患者进行了一项回顾性队列研究。通过倾向评分精细分层法进行加权后，估算了每千人年痴呆症发病率的危险比（HRs）和比率差异（RDs）：在4.8年的中位随访期间，与DPP4抑制剂相比，SGLT2抑制剂的痴呆风险降低了12%（11.31 vs. 12.86次/1000人年；HR 0.88，95% CI 0.84 to 0.92；RD -1.55, -2.13 to -0.97）。按年龄、性别、个体成分、严重精神障碍、是否使用胰岛素、心血管疾病史或高血压史进行分层后，结果一致：SGLT2抑制剂与DPP4抑制剂相比，可降低合并精神障碍的T2D患者发生痴呆症的风险。需要进一步的随机对照试验来证实我们的研究结果。

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引用次数: 0

Low hemoglobin, even within the normal range, is associated with diabetic kidney disease 血红蛋白低，即使在正常范围内，也与糖尿病肾病有关。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-09-18 DOI: 10.1016/j.diabet.2024.101580

Wenjun Wang , Yetong Wang , Fangli Tang , Huanhuan Liu , Yaujiunn Lee , Sofianos Andrikopoulos , Qingqing Lou

Aim

To investigate the association between hemoglobin (Hb) levels and incident diabetic kidney disease (DKD) in patients with type 2 diabetes.

Methods

This retrospective cohort study included 1,657 patients with diabetes, without DKD at baseline, recruited from six clinics affiliated with Lee's United Clinic in Taiwan. Demographic data and laboratory results were collected and analyzed. Participants were stratified into quartiles based on their baseline Hb levels. A subgroup analysis was conducted specifically for patients with normal Hb levels (men: Hb ≥ 120 g/l, women: Hb ≥ 110 g/l). Cox regression analysis assessed the relation between Hb levels and incident DKD, adjusting for relevant covariates.

Results

Among the initial cohort, 93 (5.6 %) had anemia at baseline. Over an average follow-up period of 5.7 ± 2.6 years, 594 patients (35.8 %) developed DKD. Cox regression analysis revealed that, after adjusting for multiple variables, compared with patients in the highest quartile of baseline Hb levels (Q4: Hb ≥ 154 g/l), the hazard of DKD was 1.6 times higher in the lowest quartile (Q1: Hb ≤ 130 g/l) HR [95 % CI] 1.58 [1.19;2.21] P < 0.001. In patients with normal Hb levels, Cox regression analysis also revealed that compared to the highest quartile (Q’4, Hb ≥ 154 g/l) the hazard of developing DKD was 1.3 times higher in the lowest quartile (Q’1, Hb ≤ 132 g/l) HR [95 % CI ] 1.29 [1.08;1.72] P = 0.042.

Conclusions

Lower Hb is associated with incident DKD, even in patients with normal Hb levels, independent of other risk factors.

目的：研究 2 型糖尿病患者的血红蛋白（Hb）水平与糖尿病肾病（DKD）之间的关系：这项回顾性队列研究纳入了从台湾李氏联合诊所下属六家诊所招募的 1,657 名糖尿病患者，这些患者基线时没有糖尿病肾病。研究人员收集并分析了人口统计学数据和实验室结果。根据基线血红蛋白水平将参与者分为四等分。专门针对 Hb 水平正常的患者（男性：Hb ≥ 120 克/升，女性：Hb ≥ 110 克/升）进行了亚组分析。Cox回归分析评估了Hb水平与DKD发病率之间的关系，并对相关协变量进行了调整：在初始队列中，93 人（5.6%）在基线时患有贫血。在平均 5.7 ± 2.6 年的随访期间，594 名患者（35.8%）出现了 DKD。Cox 回归分析显示，在对多种变量进行调整后，与基线 Hb 水平最高四分位数（Q4：Hb ≥ 154 g/l）的患者相比，最低四分位数（Q1：Hb ≤ 130 g/l）的 DKD 危险性高出 1.6 倍（HR [95% CI] 1.58 [1.19-2.21] P < 0.001）。在 Hb 水平正常的患者中，Cox 回归分析还显示，与最高四分位数（Q'4，Hb ≥ 154 g/l）相比，最低四分位数（Q'1，Hb ≤ 132 g/l）的 DKD 患病风险高出 1.3 倍：81.29 [1.08;1.72] P = 0.042.结论：即使是 Hb 水平正常的患者，较低的 Hb 也与 DKD 的发生有关，与其他风险因素无关。

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引用次数: 0

A very rare cause of markedly elevated CA 19–9: Glucagon-like peptide-1 receptor agonists 导致 CA 19-9 明显升高的一个非常罕见的原因：胰高血糖素样肽-1 受体激动剂

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-09-11 DOI: 10.1016/j.diabet.2024.101578

Rongyue Liang , Zhifang Fu , Long Chen , Shuang Zhou , Hongmei Jiao

Aim

Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP1-RAs) are commonly used to treat type 2 diabetes mellitus (T2DM). Various adverse reactions have been gradually reported. This case presents a rare phenomenon in which a GLP1-RA caused a marked elevation in carbohydrate antigen 19–9(CA 19–9) without evidence of a tumor.

Methods

A mixed-methods approach was utilized, incorporating medical history obtained from regular outpatient consultations and follow-up visits, along with ancillary examinations derived from laboratory tests and imaging.

Results

The use of a GLP1-RA for treating T2DM resulted in an increase in CA 19–9 without evidence of a tumor, which gradually normalized after discontinuation of the drug.

Conclusion

GLP1-RAs may lead to elevated levels of tumor markers during the treatment of T2DM, necessitating monitoring during therapy. Antidiabetic management should be adjusted on an individual basis as needed.

目的胰高血糖素样肽-1（GLP-1）受体激动剂（GLP1-RAs）常用于治疗 2 型糖尿病（T2DM）。各种不良反应已逐渐见诸报端。本病例介绍了一种罕见的现象，即 GLP1-RA 导致碳水化合物抗原 19-9（CA 19-9）明显升高，但无肿瘤证据。方法采用混合方法，结合从定期门诊和随访中获得的病史，以及从实验室检查和影像学检查中获得的辅助检查。结论 GLP1-RA在治疗T2DM期间可能导致肿瘤标志物水平升高，因此有必要在治疗期间进行监测。应根据个人情况调整抗糖尿病治疗方案。

引用次数: 0

Discovery of a TRMT10A mutation in a case of atypical diabetes: Case report 在一例非典型糖尿病患者中发现 TRMT10A 突变：病例报告。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-09-05 DOI: 10.1016/j.diabet.2024.101572

C. Samhani , B. Guerci , C. Larose

It is notable that monogenic forms of diabetes are exceedingly uncommon, with only 28 genes thus far identified. Such conditions frequently result in the dysfunction of pancreatic cells responsible for insulin production. Mutation in the TRMT10A gene leads to a rare genetic disease that is associated with endocrine and metabolic disorders, including diabetes and short stature. This article presents a review of the existing literature on the subject, describing the association between TRMT10A gene mutation and diabetes. It also presents the clinical case of a young girl with type 1 diabetes and facial dysmorphia. TRMT10A gene mutation has been linked to syndromic juvenile diabetes in a manner analogous to Wolfram's syndrome. This form of diabetes, which manifests in early childhood and is associated with microcephaly, epilepsy and intellectual disability, is caused by mutations in the gene for homolog A of tRNA methyltransferase 10 (TRMT10A).

This emphasizes the importance of using a targeted panel to recognize previously unidentified monogenic diabetes among early-onset non-insulin-dependent diabetes in the absence of obesity and autoimmunity.

In view of the aforementioned data, it is recommended that TRMT10A sequencing be considered in children or adults with early-onset diabetes and a history of intellectual disability, microcephaly and epilepsy.

值得注意的是，单基因糖尿病极为罕见，迄今只发现了 28 个基因。这种情况经常导致负责产生胰岛素的胰腺细胞功能失调。TRMT10A 基因突变会导致一种罕见的遗传疾病，这种疾病与内分泌和代谢紊乱有关，包括糖尿病和身材矮小。本文回顾了现有的相关文献，描述了 TRMT10A 基因突变与糖尿病之间的关联。文章还介绍了一名患有 1 型糖尿病和面部畸形的年轻女孩的临床病例。TRMT10A 基因突变与综合征性青少年糖尿病有关联，其方式类似于沃尔夫拉姆综合征。这种糖尿病在儿童早期出现，与小头畸形、癫痫和智力障碍有关，是由 tRNA 甲基转移酶 10 的同源物 A（TRMT10A）基因突变引起的。这就强调了在没有肥胖和自身免疫的情况下，使用靶向面板识别早发性非胰岛素依赖型糖尿病中以前未识别的单基因糖尿病的重要性。鉴于上述数据，建议考虑对患有早发糖尿病并有智力障碍、小头畸形和癫痫病史的儿童或成人进行 TRMT10A 测序。

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引用次数: 0

Association between gastrectomy and the risk of type 2 diabetes in gastric cancer survivors: A nationwide cohort study 胃切除术与胃癌幸存者罹患 2 型糖尿病风险之间的关系：一项全国性队列研究。

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism

Pub Date : 2024-09-01 DOI: 10.1016/j.diabet.2024.101569

Gyuri Kim , Kyung-do Han , So Hyun Cho , Rosa Oh , You-Bin Lee , Sang-Man Jin , Kyu Yeon Hur , Jae Hyeon Kim

Aim

Postprandial glycemic fluctuations after gastrectomy are seen in patients with gastric cancer but, no studies have investigated the association between gastrectomy and type 2 diabetes mellitus (T2DM) in gastric cancer survivors. This study aimed to elucidate the relationship between gastrectomy (total or subtotal) and incident T2DM. In addition, we explored whether vitamin B12 supplementation modulates this risk among patients who have undergone total gastrectomy.

Methods

In this large nationwide population-based retrospective cohort study using the National Health Insurance Service database of South Korea, we identified patients aged >20 years who underwent gastrectomy from 2008 to 2015 (n = 150,074) and age- and sex-matched controls without gastrectomy (n = 301,508). A Cox proportional hazards model was used.

Results

During the median follow-up duration of 4.4 years after the 2-year time lag after gastrectomy, of the 78,006 subjects, 4,597 (5.9 %) developed T2DM. Compared with matched controls, the adjusted hazard ratio (AHR[95 % confidence interval]) for T2DM of patients with total gastrectomy was 1.34[1.23;1.47]. The corresponding AHR after subtotal gastrectomy was 0.81[0.76;0.86]. Among the patients with total gastrectomy, the risk of T2DM was significantly increased in those who did not receive any vitamin B12 supplementation (AHR=1.60[1.33;1.92]), whereas the risk of T2DM was lower (close to being statistically significant) in those who received continuous vitamin B12 supplementation after gastrectomy (AHR=0.70[0.49;1.01]).

Conclusion

These results show a significantly reduced risk of T2DM in gastric cancer patients undergoing subtotal gastrectomy and a significantly increased risk of T2DM in gastric cancer patients undergoing total gastrectomy, which is mitigated by continuous vitamin B12 supplementation.

目的：胃癌患者在胃切除术后会出现餐后血糖波动，但还没有研究调查胃切除术与胃癌幸存者 2 型糖尿病（T2DM）之间的关系。本研究旨在阐明胃切除术（全胃切除术或次全胃切除术）与T2DM之间的关系。此外，我们还探讨了维生素 B12 的补充是否会调节全胃切除术患者的这一风险：在这项基于韩国国民健康保险服务数据库的全国性大型人群回顾性队列研究中，我们确定了2008年至2015年期间接受胃切除术的年龄大于20岁的患者（n=150,074）和未接受胃切除术的年龄与性别匹配的对照组（n=301,508）。研究采用了考克斯比例危险模型：结果：在胃切除术后2年的中位随访时间（4.4年）内，78,006名受试者中有4,597人（5.9%）患上了T2DM。与匹配对照组相比，全胃切除术患者发生 T2DM 的调整危险比（AHR[95% 置信区间]）为 1.34[1.23;1.47]。次全胃切除术后的相应危险比为0.81[0.76;0.86]。在全胃切除术患者中，未接受任何维生素B12补充剂的患者发生T2DM的风险显著增加（AHR=1.60[1.33;1.92]），而胃切除术后持续接受维生素B12补充剂的患者发生T2DM的风险较低（接近统计学意义）（AHR=0.70[0.49;1.01]）：这些结果表明，接受胃次全切除术的胃癌患者罹患 T2DM 的风险明显降低，而接受全胃切除术的胃癌患者罹患 T2DM 的风险则明显升高，但持续补充维生素 B12 可降低罹患 T2DM 的风险。

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引用次数: 0