Journal of Diabetes Research最新文献

In utero exposure to gestational diabetes mellitus (GDM) is associated with adverse long-term outcomes. Little is known about how mothers perceive these outcomes and the support they need for optimal outcomes for their children. We aimed to explore how women perceive the risk of adverse outcomes for their children exposed to GDM and the support they require for their optimal health. We conducted semistructured interviews with women who experienced GDM in at least one previous pregnancy. Data collection continued until saturation, and analysis followed an iterative thematic approach. Twenty-five mothers participated, and their perceptions about later outcomes for children exposed to GDM varied. Five themes were identified: relating GDM to the offspring's later health; reactions to the potential for poor later outcomes; impact on child growth, development, and behavior; maintaining optimal health from childhood to adulthood; and recommendations for long-term care. Most mothers received no information about potential later child outcomes; some based their views on assumptions. Some mothers who believed their children were at increased risk of poor outcomes expressed fear and worry, while others proactively ensured their children engaged in healthy lifestyle choices. Mothers emphasized the need for support within health facilities (information provision, linking antenatal with child records, and risk assessment) and in the community (social groups, home visits) to ensure optimal health of their children. These findings have potential implications for policy and practice changes to optimize later health outcomes for children exposed to GDM.

Background: The prevalence of diabetes mellitus among children, youth, and young adults is increasing, yet limited information is known about the characteristics and management of these groups with Type 1 (T1D) and Type 2 (T2D) diabetes in primary care. The aim of the study is to explore the characteristics of people with T1D and T2D aged < 25 years across the Auckland and Waikato regions of New Zealand. Methods: Sociodemographic and clinical data were collected from electronic primary care records (February 2021-July 2022) of four primary healthcare organisations, with medication data sourced from the National Pharmaceutical dataset. Associations between sociodemographic and clinical data were conducted using chi-square and nonparametric ANOVA. Results: Of 1198 patients, 72% had T1D and 28% had T2D. People with T1D were evenly distributed by gender but more commonly of European descent (66.7%) compared to other ethnic groups. A higher proportion of T2D was observed in females (58.2%) compared to males (41.6%) and among Māori (38.2% vs. 20.3% European; p < 0.001). Over 95% of individuals with T2D were overweight/obese. Overall, 9.5% and 23.9% of individuals with T1D and T2D, respectively, were at target for HbA1c, though median HbA1c was higher for Māori and Pasifika compared to other ethnicities (p < 0.001). In T1D, 94.7% of individuals were dispensed insulin and 7.5% and 4.4% were dispensed angiotensin-converting enzyme (ACE) inhibitors and statins, respectively. In T2D, medication use included metformin (84.9%), insulin (76.1%), and SGLT2i/GLP1RA (59.5%). Conclusions: The increasing burden of diabetes among young individuals in New Zealand underscores the urgent need for comprehensive strategies to address obesity and socioeconomic disparities, especially among marginalised communities. Addressing socioeconomic factors such as affordable housing, living wages, and healthcare access may be important for improving diabetes outcomes, as these factors significantly influence overall childhood health and well-being.

Over the past decades, the global prevalence of Type 2 diabetes mellitus (T2D) and impaired glucose tolerance (IGT) has been increasing at an epidemic rate, yet the exact cause remains unknown. It is widely accepted that glucose metabolism can be impaired by circadian rhythms and sleep disturbances. Concurrently, exposures to light at night have been closely linked to circadian and sleep disturbances. However, there is no direct experiment on primates to demonstrate the precise extent of how serious light pollution impairs glucose metabolism, whether people will eventually become accustomed to this environment, and whether the pollution has synergistic impairing effects with aging and weight on glucose metabolism. To quantitatively address these questions, 137 cynomolgus were exposed to three distinct nocturnal light intensities for consecutive 10 months. Monthly glucose metabolism assessments were conducted. Data pertaining to the mortality rate of preexisting diabetes, incidence of light-induced diabetes and IGT, and alterations in insulin secretion were collected and analyzed. The results show that nocturnal light (1) caused premature deaths in individuals with preexisting diabetes; (2) intensity-dependently induced diabetes and IGT in previous healthy monkeys; (3) intensity-dependently reduced melatonin secretion; (4) had a synergistic impairing effect on glucose metabolism with aging and weight; and (5) although monkeys would eventually adapt to the environment, the disrupted glucose metabolism would not fully recover in most individuals. In conclusion, nocturnal light is associated with the global high prevalence of T2D and IGT. The harmful effects of light pollution on glucose metabolism are synergistic with age and weight.

Mushrooms and fenugreek are widely used to reduce hyperglycemia, and fenugreek is also used as a culinary ingredient to enhance flavor and aroma. This study is aimed at investigating the underlying mechanisms of the hypoglycemic effects of mushrooms and fenugreek in a Type 2 diabetic rat model. Adenosine monophosphate (AMP)-activated protein kinase (AMPK) functions to reduce hyperglycemia through insulin-independent pathways and protects beta-cells. Diabetic model rats were administered standard diets supplemented with 5% oyster mushroom powder (mushroom-treated (MT) group) and 5% fenugreek seed powder (fenugreek-treated (FT) group) for 8 weeks. The results showed improvements in both glycemic and lipid profiles, with both oyster mushroom and fenugreek enhancing the phosphorylation of AMPK in muscle tissue. However, no effect on insulin secretion was observed. These findings suggest that both substances reduce hyperglycemia through an insulin-independent pathway. In silico analysis of both mushroom and fenugreek seed extracts revealed bioactive compounds having a strong binding affinity to α-glucosidase, which suggests mushroom and fenugreek supplements might control postprandial blood glucose levels.

Peripheral neuropathy is a common cause of morbidity in diabetes. Despite recent advancements in early diagnosis methods, there is a need for practical, highly sensitive, and cost-effective screening methods in clinical practice. This study summarizes evidence from systematic reviews and meta-analyses on the diagnostic accuracy of validated screening methods for diabetic peripheral neuropathy. Two independent reviewers assessed methodological quality and bias using AMSTAR and ROBIS tools. Seven reviews with 19,531 participants were included. The monofilament test showed inconsistent sensitivity (S: 0.53-0.93) and specificity (Sp: 0.64-1.00), along with high variability in its application. Neuropad exhibited high S (86%, 95% CI 79-91). However, variations in the interpretation of results across the included studies may have impacted its Sp (65%, 95% CI 51-76). The Ipswich touch test exhibited adequate diagnostic accuracy (S: 0.77, Sp: 0.96, DOR: 75.24) but lacked comparison with gold standard tests. In vibration perception studies, the biothesiometer outperformed the tuning fork (S: 0.61-0.80 vs. 0.10-0.46). In general, heterogeneity was observed due to varied reference tests, thresholds, and patient differences. The development of automated analysis methods, as well as determination of predictive value of the combination of screening tools, is needed for further studies. Based on the study results, we suggest that clinicians should select screening tools tailored to their patient population, clinical setting, and available resources, as no single test can be universally recommended for all clinical scenarios.

Introduction: Circuit training is a form of body conditioning with endurance and resistance components. Given the function of skeletal muscle as an endocrine organ secreting various myokines involved in maintaining glucose metabolism homeostasis, our study focused on estimating the impact of the implemented training program on the direction of changes in myokines such as interleukin (IL)-6, IL-10, fibroblast growth factor 21 (FGF21), and irisin in women newly diagnosed with insulin resistance. Methods: This prospective controlled trial randomly divided 42 women into two groups. The training group performed circuit training combining strength (50%-80% of one-repetition maximum) and endurance (50%-75% of heart rate reserve) exercises for 3 months, three 33-min sessions weekly. Exercises were performed on five weight and two cardio machines. The control nontraining group did not change their previous activity. Body composition indicators and IL-6, IL-10, FGF21, and irisin levels were measured before and after the intervention. The data for 27 patients were analysed using two-way repeated measures analyses of variance. Results: The pattern of change in serum IL-6 levels over time differed significantly between the groups (p < 0.05). The patterns of change did not differ significantly between groups for IL-10, FGF21, and irisin. Conclusion: The circuit training program implemented in women newly diagnosed with insulin resistance significantly increased their serum IL-6 and not their IL-10, FGF21, and irisin levels. Trial Registration: ClinicalTrials.gov: NCT04528693.

Background: No comprehensive meta-analysis has evaluated the efficacy and safety of the protective effect of Jiedu Tongluo Therapy on the kidney of DKD until now. This meta-analysis covers this gap in knowledge. Methods: We have conducted an extensive search of databases, including CNKI, Wanfang, PubMed, and Web of Science. The selection was based on conventional treatment, including information and education on DKD, blood glucose, hypertension control methods, and lifestyle. The control group was composed of conventional western medicine or proprietary Chinese medicine, and the experimental group was composed of Jiedu Tongluo therapy controlled trials (RCTs) between 2003 and 2023. R 4.1.0 software was used to perform statistical analysis. Results: A total of 1871 patients from 19 RCTs were analyzed. Meta-analysis results showed that the Jiedu Tongluo therapy was effective in improving clinical efficacy (OR = 2.47, 95% CI [1.94, 3.15], I ² = 0%), and these trials were more effective in reducing Scr (MD = -19.81, 95% CI [-27.64, -11.97], p < 0.01), BUN (MD = -0.70, 95% CI [-1.13, -0.27], p < 0.01), UAER (MD = -29.97, 95% CI [-37.33, -22.61], p < 0.01), FBG (MD = -0.85, 95% CI [-1.22, -0.47], p < 0.01), and certain medication safety (OR = 0.75, 95% CI [0.27, 2.11]). Conclusions: For treating diabetic kidney disease, TCM-based Jiedu Tongluo therapy showed optimal clinical efficacy and safety. However, further rational experiments are needed to validate the above conclusions.

Purpose: This study is aimed at investigating health literacy (HL) among diabetes mellitus (DM) patients using a comprehensive, scientific, feasible, and suitable HL assessment indicator system tailored for the diabetic population in mainland China and systematically analyzing the factors influencing HL in this population. Methods: The Delphi expert consultation method was employed to initially draft and refine the Diabetes Health Literacy Evaluation Indicator System (DHLEIS). The reliability and representativeness of the indicator system were tested through metrics including the active coefficient, authority degree, and coordination degree. A HL survey questionnaire for diabetic patients was developed based on DHLEIS and administered to diabetic patients across five hospitals in Nantong and Yancheng cities, Jiangsu Province. The random forest method was utilized to deeply analyze the impact of various factors on HL and its four dimensions and to identify the core influencing factors. Results: Analysis of 707 questionnaires based on the DHLEIS revealed that nine factors-age, sex, body shape, income, exercise, education level, duration of DM, whether insulin is injected, and the number of cohabitants-significantly impact the HL levels. Among these, age, duration of DM, education level, and number of cohabitants were particularly influential across the four dimensions of health knowledge, awareness, behavior, and skills. Factors related to health knowledge and skills were the most significant contributors to overall HL. Conclusions: The multidimensional analysis of factors influencing HL offers valuable insights into characterizing varying levels of HL among diabetic patients. This approach supports targeted cognitive improvements and the effective enhancement of health skills, ultimately leading to better health outcomes.

Background: This study investigates the impact of a high-sugar environment on H9C2 cardiomyocytes and explores the protective effects of carvedilol in the context of diabetic cardiomyopathy (Dia-CM). Transcriptomic analysis identified 21,655 differentially expressed genes associated with Dia-CM, demonstrating significant separation among samples. Methods: H9C2 cardiomyocytes were cultured in a high-sugar environment to simulate Dia-CM conditions. Cell viability, cytokine levels, and protein expression were assessed using CCK-8 assays, ELISA, and Western blot techniques. Intervention experiments with NLRP3, caspase-1, and ROS inhibitors were conducted to evaluate their protective effects. The therapeutic potential of carvedilol was assessed by examining its impact on cell viability, cytokine levels, and key biomarkers. An in-depth analysis of carvedilol's regulatory effects on ROS and key proteins in H9C2 cells was also conducted. Results: In vitro, a high-sugar environment significantly reduced H9C2 cell survival, increased ROS levels, activated inflammatory responses, and upregulated NLRP3, caspase-1, and GSDMD-N proteins. Inhibitors of NLRP3, caspase-1, and ROS ameliorated these effects. Carvedilol treatment improved cell activity, reduced inflammatory cytokine levels, suppressed ROS production, and downregulated NLRP3, pro-caspase-1, GSDMD-N, and p-NF-κB proteins. Moderate-dose carvedilol exhibited optimal intervention effects. Conclusions: A high-sugar environment induces cardiomyocyte damage through ROS production and NLRP3 inflammasome activation. Inhibitors of NLRP3, caspase-1, and ROS provide effective protection. Carvedilol significantly mitigates the detrimental effects of a high-sugar environment on H9C2 cardiomyocytes, potentially through inhibiting the NLRP3-ASC inflammasome and caspase-1/GSDMD-dependent signaling pathway-mediated pyroptosis. These findings offer insights into Dia-CM mechanisms and highlight carvedilol as a promising therapeutic intervention.

Diabetic retinopathy (DR) is one of the most common complications of diabetes and induces severe visual impairment worldwide. Endothelial cell dysfunction plays an important role in the pathogenesis of DR. Here, we keep a watchful eye on α/β-hydrolase domain-containing 1 (ABHD1), a potential regulator in lipid metabolism and neovascularization. Results revealed that ABHD1 expression increased both in retina tissues of DR patients and in high-glucose-treated human retina endothelial cells. Inhibition of ABHD1 remitted endothelial cell proliferation and migration. And GSEA uncovered that ABHD1 knockdown remits endothelial cell chemotaxis and intermediate filament (IF) might be mediated in the progress by regulating keratin 1 (KRT1) and keratin 2 (KRT2). Therefore, we assume that ABHD1 is concerned with endothelial cell proliferation and migration in DR, consequently leading to pathological neovascularization. The findings may provide a potential therapeutic target for DR.