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Therapy of Type 2 Diabetes. 2型糖尿病的治疗。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-09-01 Epub Date: 2022-07-15 DOI: 10.1055/a-1624-3449
Rüdiger Landgraf, Jens Aberle, Andreas L Birkenfeld, Baptist Gallwitz, Monika Kellerer, Harald Klein, Dirk Müller-Wieland, Michael A Nauck, Tobias Wiesner, Erhard Siegel
Affiliations 1 German Diabetes Foundation, Munich, Germany 2 Division of Endocrinology and Diabetology, University Obesity Centre Hamburg, University Hospital HamburgEppendorf, Germany 3 German Centre for Diabetes Research (DZD e. V.), Neuherberg, Germany 4 Department of Internal Medicine IV, Diabetology, Endocrinology, Nephrology, University Hospital Tübingen, Germany 5 Department of Internal Medicine I, Marienhospital, Stuttgart, Germany 6 Department of Internal Medicine I, University Hospital Bergmannsheil, Bochum, Germany 7 Department of Internal Medicine I, University Hospital RWTH, Aachen, Germany 8 Diabetes Centre Bochum-Hattingen, St.-Josef-Hospital, Ruhr-University, Bochum, Germany 9 MVZ Metabolic Medicine Leipzig, Leipzig, Germany 10 Department of Internal Medicine – Gastroenterology, Diabetology/Endocrinology and Nutritional Medicine, St. Josefkrankenhaus Heidelberg GmbH, Heidelberg, Germany Bibliography Exp Clin Endocrinol Diabetes DOI 10.1055/a-1624-3449 ISSN 0947-7349 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG, Rüdigerstraße 14, 70469 Stuttgart, Germany
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引用次数: 18
COVID-19 Lockdown Periods in 2020: Good Maintenance of Metabolic Control in Adults with Type 1 and Type 2 Diabetes. 2020年COVID-19封锁期:1型和2型糖尿病成人代谢控制的良好维持
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-09-01 Epub Date: 2022-02-18 DOI: 10.1055/a-1743-2537
B Hartmann, S R Tittel, M Femerling, M Pfeifer, S Meyhöfer, K Lange, S Milek, L Stemler, F Best, R W Holl

During the COVID-19 pandemic, there were increased concerns about glycemic control in patients with diabetes. Therefore, we aimed to assess changes in diabetes management during the COVID-19 lockdown for patients with type 1 or type 2 diabetes mellitus (T1DM, T2DM) in Germany. We included data from 24,623 patients (age>18 years) with T1DM (N=6,975) or T2DM (N=17,648) with documented data in 2019 and 2020 from the multicenter Diabetes-Prospective Follow-up registry (DPV). We conducted a groupwise comparison of identical patients in 2019 and 2020 for different time periods of pandemia. Pairwise differences of continuous parameters of treatment modalities and metabolic outcome between 2019 and 2020 were adjusted for seasonality, age, and diabetes duration. We presented these outcomes as adjusted medians with 95% confidence intervals. Rates were compared using negative-binomial models, dichotomous outcomes were compared using logistic models. Models were additionally adjusted for age and diabetes duration. These outcomes were presented as least-square means with 95% confidence intervals, p-values of<.05 were considered significant.In participants with T1DM, CGI (combined glucose indicator) increased only by 0.11-0.12% in all time periods of 2020 compared to 2019 (all p<0.001) while BMI decreased slightly by -(0.09-0.10) kg/m² (p<0.0001). In participants with T2DM, HbA1c increased by 0.12%, while BMI decreased slightly by -(0.05-0.06) kg/m² (p<0.0001).During the COVID-19 lockdown period, patients with T1DM and T2DM experienced only clinically insignificant changes in glucose control or body weight. Despite lockdown restrictions, patients were able to maintain metabolic control.

在2019冠状病毒病大流行期间,人们越来越关注糖尿病患者的血糖控制。因此,我们旨在评估德国1型或2型糖尿病(T1DM、T2DM)患者在COVID-19封锁期间糖尿病管理的变化。我们纳入了24,623例T1DM (N=6,975)或T2DM (N=17,648)患者(年龄>18岁)的数据,这些数据来自2019年和2020年多中心糖尿病前瞻性随访登记(DPV)。我们对2019年和2020年不同大流行时期的相同患者进行了分组比较。根据季节性、年龄和糖尿病病程调整2019年至2020年治疗方式和代谢结局连续参数的两两差异。我们以95%置信区间的调整中位数表示这些结果。比率比较采用负二项模型,二分类结果比较采用logistic模型。模型还根据年龄和糖尿病持续时间进行了调整。这些结果以95%置信区间的最小二乘平均值表示,p值为
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引用次数: 10
Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents. 儿童青少年糖尿病的诊断、治疗及随访。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-09-01 Epub Date: 2022-07-29 DOI: 10.1055/a-1624-3388
Martin Holder, Thomas Kapellen, Ralph Ziegler, Jutta Bürger-Büsing, Thomas Danne, Axel Dost, Reinhard W Holl, Paul-Martin Holterhus, Beate Karges, Olga Kordonouri, Karin Lange, Susanne Müller, Klemens Raile, Roland Schweizer, Simone von Sengbusch, Rainer Stachow, Verena Wagner, Susanna Wiegand, Andreas Neu
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引用次数: 1
Direct Costs of Healthcare for Children with Type 1 Diabetes Using a CGM System: A Health Economic Analysis of the VIDIKI Telemedicine Study in a German Setting. 使用CGM系统治疗1型糖尿病儿童的直接医疗成本:德国设置的VIDIKI远程医疗研究的健康经济分析
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-09-01 Epub Date: 2022-01-03 DOI: 10.1055/a-1708-3134
Fabian Simon Frielitz, Nora Eisemann, Kristin Werner, Olaf Hiort, Alexander Katalinic, Karin Lange, Simone von Sengbusch

Aims: The Virtual Diabetes Outpatient Clinic for Children and Adolescents (VIDIKI) study was a 6-month quasi-randomized, multicentre study followed by an extension phase to evaluate the effects of monthly video consultations in addition to regular care. A health economic analysis was conducted to assess the direct costs.

Methods: The cost data of 240 study participants (1-16 years of age) with type 1 diabetes who were already using a continuous glucose monitoring system were collected in the first 6 months of the study. The intervention group (IG) received monthly video consultations plus regular care, and the waiting control group (WG) received only regular care. Cost data were collected for a comparable anonymized group of children from the participating health insurance companies during the 6-month period before the study started (aggregated data group [AG]).

Results: Cost data were analysed for the AG (N=840) 6 months before study initiation and those for the study participants (N=225/240). Hospital treatment was the highest cost category in the AG. There was a cost shift and cost increase in the IG and WG, whereby diabetes supplies were the highest cost category. The mean direct diabetes-associated 6-month costs were € 4,702 (IG) and € 4,936 (WG).

Conclusion: The cost development within the cost collection period over two years possibly reflects the switch to higher-priced medical supplies. Video consultation as an add-on service resulted in a small but nonsignificant reduction in the overall costs.

目的:儿童和青少年虚拟糖尿病门诊(VIDIKI)研究是一项为期6个月的准随机、多中心研究,随后是一个扩展阶段,以评估除常规护理外每月视频咨询的效果。进行了卫生经济分析以评估直接成本。方法:在研究的前6个月收集240名已经使用连续血糖监测系统的1型糖尿病患者(1-16岁)的成本数据。干预组(IG)每月接受视频咨询和常规护理,而等待对照组(WG)仅接受常规护理。在研究开始前的6个月期间,从参与的健康保险公司收集了一组可比较的匿名儿童的成本数据(汇总数据组[AG])。结果:对研究开始前6个月的AG (N=840)和研究参与者(N=225/240)的成本数据进行了分析。在澳大利亚,住院治疗是费用最高的类别。在IG和WG中出现了成本转移和成本增加,其中糖尿病用品是成本最高的类别。与糖尿病直接相关的6个月平均成本为4,702欧元(IG)和4,936欧元(WG)。结论:2年多的费用征收期内的费用发展可能反映了医疗用品向高价位的转变。视频咨询作为一项附加服务,在总成本上产生了很小但不显著的减少。
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引用次数: 4
Maprotiline Ameliorates High Glucose-Induced Dysfunction in Renal Glomerular Endothelial Cells. 马普替林改善高糖诱导的肾小球内皮细胞功能障碍。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-09-01 Epub Date: 2022-03-23 DOI: 10.1055/a-1713-7719
Zhihong Zhou, Shangjun Liu

Maprotiline is an antidepressant that has been found to cause hypoglycemia. However, the effect of maprotiline on diabetic nephropathy (DN) has not been investigated. Here, we explored the effect of maprotiline on human renal glomerular endothelial cells (HRGECs) in response to high glucose (HG) stimulation. We found that maprotiline attenuated HG-induced oxidative stress in HRGECs with decreased reactive oxygen species production and increased superoxide dismutase activity. Maprotiline repressed the HG-induced expression of cyclooxygenases 2 at both mRNA and protein levels in HRGECs. The increased thromboxane B2 level and decreased 6-keto-prostaglandin F1α level induced by HG were significantly attenuated by maprotiline treatment. Maprotiline also prevented the HG-induced increase in the permeability of HRGECs and the decrease in the zonula occludens-1 expression and downregulated HG-induced increase in the expression of protein kinase C-α (PKC-α) in HRGECs. This protective effect of maprotiline on HG-induced HRGECs dysfunction was abolished by overexpression of PKC-α. In conclusion, maprotiline displayed a protective effect on HG-challenged HRGECs, which was mediated by the regulation of PKC-α. These findings provide further evidence for the potential use of maprotiline for the treatment of DN.

马普替林是一种抗抑郁药,已被发现会导致低血糖。然而,马普替林对糖尿病肾病(DN)的影响尚未被研究。在这里,我们探讨了马普替林对高糖刺激下人肾小球内皮细胞(hrgec)的影响。我们发现,马普替林可以减轻hg诱导的hrgec氧化应激,减少活性氧的产生,增加超氧化物歧化酶的活性。马普替林在mRNA和蛋白水平上抑制hg诱导的hrgec中环氧化酶2的表达。马普替林可显著降低HG引起的血栓素B2升高和6-酮前列腺素F1α降低。马普替林还能抑制hg诱导的hrgcs通透性升高和闭塞带-1表达降低,下调hg诱导的hrgcs蛋白激酶C-α (PKC-α)表达升高。马普替林对hg诱导的hrgcs功能障碍的保护作用被PKC-α的过表达所消除。综上所述,马普替林对hg攻击的hrgcs具有保护作用,其机制可能是通过调节PKC-α介导的。这些发现为马普替林治疗DN的潜在应用提供了进一步的证据。
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引用次数: 1
Comorbidities in Mild Autonomous Cortisol Secretion - A Clinical Review of Literature. 轻度自主皮质醇分泌的合并症-临床文献综述。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-09-01 Epub Date: 2022-07-11 DOI: 10.1055/a-1827-4113
Aleksandra Czapla-Iskrzycka, Renata Świątkowska-Stodulska, Krzysztof Sworczak

Mild autonomous cortisol secretion (mACS) is a state of cortisol excess usually associated with existence of adrenal incidentaloma. Because of the lack of symptoms of the disease, the biochemical evaluation is the most important to determine a diagnosis. However, scientific societies have different diagnostic criteria for mACS, which makes the treatment of this disease and using results of original papers in daily practice more difficult. Chronic hypercortisolemic state, even if mild, may lead to diseases that are mostly connected with overt Cushing's syndrome. Some of them can cause a higher mortality of patients with mACS and those problems need to be addressed. In this review we describe the comorbidities associated with mACS: cardiovascular disorders, arterial hypertension, diabetes mellitus, insulin resistance, dyslipidemia, obesity, metabolic syndrome, non-alcoholic fatty liver disease, vertebral fractures and osteoporosis. The point of this paper is to characterise them and determine if and how these conditions should be managed. Two databases - PubMed and Web of Science were searched. Even though the evidence are scarce, this is an attempt to lead clinicians through the problems associated with this enigmatic condition.

轻度自主皮质醇分泌(mACS)是一种皮质醇过量的状态,通常与肾上腺偶发瘤的存在有关。由于该病缺乏症状,因此生化评价是确定诊断的最重要方法。然而,由于各科学学会对mACS的诊断标准不同,使得该疾病的治疗和在日常实践中使用原始论文的结果变得更加困难。慢性高皮质醇状态,即使是轻微的,也可能导致主要与显性库欣综合征相关的疾病。其中一些会导致mACS患者的死亡率更高,这些问题需要解决。在这篇综述中,我们描述了与mACS相关的合并症:心血管疾病、动脉高血压、糖尿病、胰岛素抵抗、血脂异常、肥胖、代谢综合征、非酒精性脂肪性肝病、椎体骨折和骨质疏松症。本文的重点是描述它们并确定是否以及如何管理这些条件。检索了两个数据库——PubMed和Web of Science。尽管证据很少,但这是一种尝试,可以引导临床医生解决与这种神秘疾病相关的问题。
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引用次数: 3
Intracellular ATP Signaling Contributes to FAM3A-Induced PDX1 Upregulation in Pancreatic Beta Cells. 细胞内ATP信号参与fam3a诱导的胰腺β细胞PDX1上调。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-08-01 Epub Date: 2021-09-30 DOI: 10.1055/a-1608-0607
Han Yan, Zhenzhen Chen, Haizeng Zhang, Weili Yang, Xiangyang Liu, Yuhong Meng, Rui Xiang, Zhe Wu, Jingjing Ye, Yujing Chi, Jichun Yang

FAM3A is a recently identified mitochondrial protein that stimulates pancreatic-duodenal homeobox 1 (PDX1) and insulin expressions by promoting ATP release in islet β cells. In this study, the role of intracellular ATP in FAM3A-induced PDX1 expression in pancreatic β cells was further examined. Acute FAM3A inhibition using siRNA transfection in mouse pancreatic islets significantly reduced PDX1 expression, impaired insulin secretion, and caused glucose intolerance in normal mice. In vitro, FAM3A overexpression elevated both intracellular and extracellular ATP contents and promoted PDX1 expression and insulin secretion. FAM3A-induced increase in cellular calcium (Ca2+) levels, PDX1 expression, and insulin secretion, while these were significantly repressed by inhibitors of P2 receptors or the L-type Ca2+ channels. FAM3A-induced PDX1 expression was abolished by a calmodulin inhibitor. Likewise, FAM3A-induced β-cell proliferation was also inhibited by a P2 receptor inhibitor and an L-type Ca2+ channels inhibitor. Both intracellular and extracellular ATP contributed to FAM3A-induced PDX1 expression, insulin secretion, and proliferation of pancreatic β cells.

FAM3A是最近发现的一种线粒体蛋白,通过促进胰岛β细胞ATP的释放来刺激胰十二指肠同源盒1 (PDX1)和胰岛素的表达。本研究进一步探讨了细胞内ATP在fam3a诱导的胰腺β细胞PDX1表达中的作用。用siRNA转染小鼠胰岛急性FAM3A抑制可显著降低正常小鼠的PDX1表达,胰岛素分泌受损,并引起葡萄糖耐受不良。在体外,FAM3A过表达可提高细胞内和细胞外ATP含量,促进PDX1表达和胰岛素分泌。fam3a诱导细胞钙(Ca2+)水平、PDX1表达和胰岛素分泌增加,而这些被P2受体或l型Ca2+通道抑制剂显著抑制。fam3a诱导的PDX1表达被钙调素抑制剂消除。同样,fam3a诱导的β细胞增殖也被P2受体抑制剂和l型Ca2+通道抑制剂抑制。细胞内和细胞外ATP都有助于fam3a诱导的PDX1表达、胰岛素分泌和胰腺β细胞的增殖。
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引用次数: 5
The Effect of Educational Program on Pain Management, Self-Efficacy Behavior, and Quality of Life among Adult Diabetic Patients with Peripheral Neuropathy Pain: A Randomized Controlled Trial. 教育计划对成年糖尿病周围神经病变疼痛患者疼痛管理、自我效能行为和生活质量的影响:一项随机对照试验。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-08-01 Epub Date: 2021-08-26 DOI: 10.1055/a-1561-8392
Jawad Ahmad Abu-Shennar, Nurhan Bayraktar

Objective: Jordan has a high prevalence of painful diabetic peripheral neuropathy (PDPN), leg complications, and amputations due to diabetes. This study evaluated the effect of educational programs on pain management, self-efficacy behaviors, and quality of life (QoL) among adult patients with PDPN.

Methods: The randomized controlled trial study was conducted at the Jordanian Ministry of Health hospitals between October 2019 - March 2020. Seventy-two adult patients with PDPN were randomized to an experimental group of 36 patients who attended an educational program and a control group who followed routine diabetic care in the study setting. The data were collected using a socio-demographic and diabetes clinical/laboratory data form, the numeric rating scale (NRS), diabetes self-efficacy scale (DSES), and the quality-of-life questionnaire (EQ-5D). The intervention program consisted of four educational sessions at weekly intervals. Pre-test and post-test evaluations were conducted.

Results: After the educational intervention, the mean scores of the NRS (p=0.020), DSES (p<0.001), and EQ-5D (p<0.001) in the experimental group improved significantly improved compared to those in the control group. Additionally, while there were no significant correlations between the three study outcomes in the pre-test stage, correlations were observed to be significant after the educational intervention.

Conclusion: This study shows that the design and implementation of educational intervention combined with routine diabetic care facilitate effective pain management, self-efficacy behaviors, and QoL of patients with PDPN. The health care providers are recommended to use the educational programs for such patients at various levels of services in both health centers and diabetes clinics.

目的:约旦有高患病率疼痛性糖尿病周围神经病变(PDPN),腿部并发症和截肢由于糖尿病。本研究评估教育计划对成年PDPN患者疼痛管理、自我效能行为和生活质量(QoL)的影响。方法:随机对照试验研究于2019年10月至2020年3月在约旦卫生部医院进行。72名成年PDPN患者被随机分为实验组(36名患者)和对照组(36名患者参加教育项目),对照组在研究环境中接受常规糖尿病护理。数据采用社会人口学和糖尿病临床/实验室数据表、数字评定量表(NRS)、糖尿病自我效能量表(DSES)和生活质量问卷(EQ-5D)收集。干预计划包括每周四次的教育课程。进行测试前和测试后的评估。结果:教育干预后,实验组的NRS评分(p=0.020)、DSES评分(p0.001)、EQ-5D评分(p0.001)均较对照组显著提高。此外,虽然三个研究结果在测试前阶段之间没有显著的相关性,但在教育干预后发现相关性显著。结论:本研究表明,教育干预的设计和实施结合糖尿病常规护理可促进PDPN患者有效的疼痛管理、自我效能行为和生活质量。建议卫生保健提供者在卫生中心和糖尿病诊所的各级服务中对这类患者使用教育计划。
{"title":"The Effect of Educational Program on Pain Management, Self-Efficacy Behavior, and Quality of Life among Adult Diabetic Patients with Peripheral Neuropathy Pain: A Randomized Controlled Trial.","authors":"Jawad Ahmad Abu-Shennar,&nbsp;Nurhan Bayraktar","doi":"10.1055/a-1561-8392","DOIUrl":"https://doi.org/10.1055/a-1561-8392","url":null,"abstract":"<p><strong>Objective: </strong>Jordan has a high prevalence of painful diabetic peripheral neuropathy (PDPN), leg complications, and amputations due to diabetes. This study evaluated the effect of educational programs on pain management, self-efficacy behaviors, and quality of life (QoL) among adult patients with PDPN.</p><p><strong>Methods: </strong>The randomized controlled trial study was conducted at the Jordanian Ministry of Health hospitals between October 2019 - March 2020. Seventy-two adult patients with PDPN were randomized to an experimental group of 36 patients who attended an educational program and a control group who followed routine diabetic care in the study setting. The data were collected using a socio-demographic and diabetes clinical/laboratory data form, the numeric rating scale (NRS), diabetes self-efficacy scale (DSES), and the quality-of-life questionnaire (EQ-5D). The intervention program consisted of four educational sessions at weekly intervals. Pre-test and post-test evaluations were conducted.</p><p><strong>Results: </strong>After the educational intervention, the mean scores of the NRS (<i>p=</i>0.020), DSES (<i>p<</i>0.001), and EQ-5D (<i>p<</i>0.001<i>)</i> in the experimental group improved significantly improved compared to those in the control group. Additionally, while there were no significant correlations between the three study outcomes in the pre-test stage, correlations were observed to be significant after the educational intervention.</p><p><strong>Conclusion: </strong>This study shows that the design and implementation of educational intervention combined with routine diabetic care facilitate effective pain management, self-efficacy behaviors, and QoL of patients with PDPN. The health care providers are recommended to use the educational programs for such patients at various levels of services in both health centers and diabetes clinics.</p>","PeriodicalId":12241,"journal":{"name":"Experimental and Clinical Endocrinology & Diabetes","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39371832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Statin Therapy Among Bariatric Patients: The Impact on Metabolic Outcomes and Diabetes Status. 肥胖患者的他汀类药物治疗:对代谢结局和糖尿病状态的影响。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-08-01 Epub Date: 2022-03-23 DOI: 10.1055/a-1743-2335
Fernando M Mendonça, Maria M Silva, Marta Borges-Canha, João S Neves, Cláudia Costa, Pedro M Cabral, Vanessa Guerreiro, Rita Lourenço, Patrícia Meira, Maria J Ferreira, Daniela Salazar, Jorge Pedro, Ana Varela, Selma Souto, Eva Lau, Paula Freitas, Davide Carvalho, Crio Group

Introduction: Statin therapy is associated with an increased risk of developing diabetes. Among bariatric patients, the influence of this therapy on various metabolic outcomes, such as diabetes status and its remission, is largely unknown.

Methods: This was a retrospective study of 1710 patients who underwent bariatric surgery at our hospital between January/2010 and June/2017. We compared patients with and without statin therapy at baseline, 12 and 24 months after surgery regarding statin use and its impact on several clinical and analytical parameters. Multiple linear regression was performed, adjusting differences for age, sex, surgery type, antidiabetic drugs at baseline, hypertension at baseline, LDL cholesterol ˃ 130 mg/dL, weight variation one year after surgery, and age of obesity onset.

Results: The overall prevalence of statin use was 20.2% before, 13.6% 12 months after surgery, and 15.0% 24 months after surgery. There was a larger reduction in fasting glucose and HbA1c at 12 and 24 months after surgery among statin-treated patients, with the opposite trend for weight reduction and BMI. Statin-treated patients with diabetes had lower diabetes remission rates (45.3 vs 68.5%) 12 months after surgery, with the highest reduction in HbA1c (1.3±1.3 vs -1.1±1.2%; p=0.042), fasting glucose (-40.8±48.8 vs -30.9±41.6 mg/dL; p=0.028), and insulin (-21.7±28.2 vs -13.4±14.2 mIU/L; p=0.039). The proportion of new-onset cases of diabetes was equal between statin-treated vs non-treated individuals at 12 months (1.9%) and 24 months (1.0%) after surgery.

Conclusion: Bariatric surgery seems to lead to diabetes remission more frequently in patients not treated with statins. A larger reduction was observed in fasting glucose and HbA1c among statin-treated patients. Statin did not contribute to an increased proportion of new-onset diabetes after surgery.

他汀类药物治疗与糖尿病发生风险增加有关。在肥胖患者中,这种疗法对各种代谢结果的影响,如糖尿病状态及其缓解,在很大程度上是未知的。方法:对2010年1月至2017年6月在我院接受减肥手术的1710例患者进行回顾性研究。我们比较了基线、术后12个月和24个月接受他汀类药物治疗和未接受他汀类药物治疗的患者及其对一些临床和分析参数的影响。采用多元线性回归,调整年龄、性别、手术类型、基线降糖药、基线高血压、低密度脂蛋白胆固醇、术后1年体重变化、肥胖发病年龄等因素的差异。结果:术前他汀类药物使用率为20.2%,术后12个月为13.6%,术后24个月为15.0%。他汀类药物治疗患者术后12个月和24个月的空腹血糖和HbA1c下降幅度较大,体重和BMI下降趋势相反。他汀类药物治疗的糖尿病患者术后12个月糖尿病缓解率较低(45.3 vs 68.5%), HbA1c降低最高(1.3±1.3 vs -1.1±1.2%;p=0.042),空腹血糖(-40.8±48.8 vs -30.9±41.6 mg/dL;p=0.028),胰岛素(-21.7±28.2 vs -13.4±14.2 mIU/L;p = 0.039)。术后12个月(1.9%)和24个月(1.0%),接受他汀治疗的患者与未接受他汀治疗的患者的新发糖尿病病例比例相等。结论:在没有接受他汀类药物治疗的患者中,减肥手术似乎更容易导致糖尿病缓解。在他汀类药物治疗的患者中,空腹血糖和HbA1c的降低幅度更大。他汀类药物不会增加手术后新发糖尿病的比例。
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引用次数: 0
Shear Wave Elastography Reveals a High Prevalence of NAFLD-related Fibrosis even in Type 1 Diabetes. 横波弹性成像显示即使在1型糖尿病中nafld相关纤维化的高患病率。
IF 1.8 4区 医学 Q2 Medicine Pub Date : 2022-08-01 Epub Date: 2021-11-16 DOI: 10.1055/a-1666-0431
Gesine Meyer, Nina Dauth, Matthias Grimm, Eva Herrmann, Joerg Bojunga, Mireen Friedrich-Rust

Background: The association between type 2 diabetes mellitus (T2DM) and advanced stages of non-alcoholic fatty liver disease is well known. Some studies indicate a relevant prevalence also in type 1 diabetes mellitus (T1DM), but so far there is only limited data.

Objective: To determine the prevalence of non-alcoholic fatty liver disease (NAFLD)-related liver fibrosis in individuals with T1DM and compare to those with type 2 diabetes.

Methods: Diabetic patients from a single diabetes care centre were screened for liver fibrosis by sonographic shear wave elastography (SWE). In addition, all patients received laboratory evaluation including non-alcoholic fatty liver fibrosis score and Fibrosis-4 Index.

Results: Three hundred and forty patients were included in the study, of these, 310 received SWE. Overall 254 patients (93 with type 1 and 161 with type 2 diabetes) had reliable measurements and were included in the final analysis. In patients with type 1 diabetes, the prevalence of NAFLD-related liver fibrosis was 16-21%, depending on the method of detection. Significant liver fibrosis was observed in 30-46% of patients with type 2 diabetes.

Conclusions: Our data revealed an unexpectedly high prevalence of NAFLD-related liver fibrosis in patients with type 1 diabetes. To our knowledge, this is one of the first studies using SWE to diagnose advanced NAFLD in type 1 diabetes in a non-preselected cohort. Considering the findings of our study, regular screening for hepatic complications must be recommended for all diabetic patients, even for those with type 1 diabetes.

背景:2型糖尿病(T2DM)与晚期非酒精性脂肪性肝病之间的关系是众所周知的。一些研究表明,在1型糖尿病(T1DM)中也有相关的患病率,但迄今为止只有有限的数据。目的:确定非酒精性脂肪性肝病(NAFLD)相关肝纤维化在T1DM患者中的患病率,并与2型糖尿病患者进行比较。方法:采用超声剪切波弹性成像(SWE)对某糖尿病护理中心的糖尿病患者进行肝纤维化筛查。此外,所有患者均接受实验室评估,包括非酒精性脂肪性肝纤维化评分和纤维化-4指数。结果:340例患者纳入研究,其中310例接受SWE治疗。总共有254名患者(93名1型糖尿病患者和161名2型糖尿病患者)具有可靠的测量结果,并被纳入最终分析。在1型糖尿病患者中,nafld相关肝纤维化的患病率为16-21%,这取决于检测方法。在30-46%的2型糖尿病患者中观察到明显的肝纤维化。结论:我们的数据显示,在1型糖尿病患者中,nafld相关肝纤维化的患病率出乎意料地高。据我们所知,这是首次在非预选队列中使用SWE诊断1型糖尿病晚期NAFLD的研究之一。考虑到我们的研究结果,必须推荐所有糖尿病患者定期筛查肝脏并发症,即使是1型糖尿病患者。
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引用次数: 5
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Experimental and Clinical Endocrinology & Diabetes
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