Journal of Diabetes Research最新文献

Background: Diabetic nephropathy (DN) is a severe complication of diabetes, characterized by progressive renal dysfunction and proteinuria. Suyin Detoxification Prescription (SDP), a traditional Chinese medicine (TCM) formulation, has shown promising clinical efficacy in alleviating DN symptoms. This study is aimed at comprehensively evaluating the therapeutic effects of SDP through clinical observations, network pharmacology analysis, and molecular mechanism exploration.

Methods: This study employed a randomized controlled trial combined with network pharmacology, pathological analysis, immunofluorescence, and Western blot to comprehensively investigate the therapeutic efficacy and mechanisms of SDP in DN treatment.

Results: Clinical data revealed that SDP significantly reduces serum creatinine levels (p = 0.009) and reduced proteinuria (p = 0.03) in DN patients. Network pharmacology successfully established an interaction network among active components of SDP, FXR targets, and DN pathological processes. Experimental validation demonstrated that the formula significantly downregulated TNF-α, gp91, and P-MLK1 expression in renal tissues of diabetic mice. Notably, FXR knockout markedly attenuated the renal protective effects of SDP in DN mice.

Conclusion: SDP exerts renal protective effects in DN through FXR activation, mitigating oxidative stress and inflammatory damage, while reducing proteinuria and renal function impairment, providing novel therapeutic strategies for DN management.

Background: The uric acid/albumin ratio (UAR) has been shown to correlate with coronary disease severity and clinical outcome. This study investigated the predictive value of UAR on coronary collateralization (CC) in patients with type 2 diabetes mellitus (T2DM) and stable coronary artery disease.

Methods: Serum levels of uric acid and albumin were determined and UAR was calculated in 1558 T2DM patients with chronic total occlusion of at least one major coronary artery. The degree of collaterals supplying to the distal occluded bed from the contra-lateral vessel was graded by Rentrop scoring system.

Results: Serum uric acid decreased and albumin increased gradually across Rentrop score 0 to 3, resulting in a higher UAR in patients with poor collaterals (Rentrop score 0 or 1) compared to those with good collaterals (Rentrop score 2 or 3) (9.74 [8.53-11.95] vs. 7.74 [6.61-8.84], p < 0.001). After adjusting for various confounders, elevated UAR was an independent factor for poor CC (adjusted OR 1.887, 95% CI 1.746-2.040, p < 0.001). UAR provided a better prediction for poor CC than uric acid and albumin alone (AUC 0.803 vs. 0.715 and 0.652; all p < 0.001). There existed an interaction between UAR and eGFR (p = 0.016); high UAR being associated with a greater risk (OR 2.253 vs. 1.776) and having a better predictive ability for poor CC (AUC 0.830 vs. 0.786; p = 0.041) in patients with eGFR ≥ 90 mL/min/1.73 m² compared to those with eGFR < 90 mL/min/1.73 m².

Conclusions: Elevated UAR predicts poor coronary collateral circulation in T2DM patients with stable coronary disease especially when renal function is preserved. These findings may help physicians better identify high-risk patients and guide individualized management strategies.

Trial registration: ClinicalTrials.gov identifier: NCT06054126.

Diabetic retinopathy (DR) is a prevalent chronic ocular complication of diabetes, which ranks as the leading cause of blindness in individuals aged 40 and above. Recent studies have demonstrated that neuroglial vascular unit (NGVU) injury leads to distinct fundus changes in DR, including exudates, cotton-fluff spots, microangiomas, hemorrhages, and neovascularization. Currently, the primary clinical treatment options primarily target retinal microvascular degeneration during the middle and late stages of DR through techniques such as retinal laser photocoagulation, antivascular endothelial growth factor (VEGF) therapy, and vitrectomy. However, progression to these stages often results in irreversible damage to visual acuity with limited treatment efficacy. In recent years, relevant research has confirmed that NGVU injury occurs prior to retinal microangiopathy in patients with DR, and it is closely associated with impaired visual function. Therefore, targeting NGVU holds potential for future therapeutic interventions aimed at preventing and treating early-stage DR. This review identifies six key molecular targets (P2X7 receptor, NLRP3 inflammasome, retinal microglial cell necroptosis pathway, spermine oxidase, and AQP4-AS1 lncRNA) that mitigate NGVU dysfunction in preclinical models. Literature search was conducted in PubMed/Embase using keywords "diabetic retinopathy," "neuroglial vascular unit," and "targeted therapy" (2018-2024), focusing on preclinical studies with in vivo efficacy data.

Background: Insomnia is common in patients with Type 2 diabetes and can negatively affect glycemic control. However, the effect of hypnotic use on glycemic variability remains unclear. Therefore, we investigated the association between hypnotic use and glycemic variability in patients with Type 2 diabetes.

Methods: This cross-sectional study enrolled patients with Type 2 diabetes who underwent continuous glucose monitoring (CGM) between June 1, 2017, and February 28, 2022. Patients were classified into six groups based on their insomnia status and hypnotic use: noninsomnia, hypnotic nonusers, benzodiazepine (BZD) users, nonbenzodiazepine (non-BZD) users, orexin receptor antagonist (ORA) users, and melatonin receptor agonist (MRA) users. We used the standard deviation (SD) of glucose, the coefficient of variation (CV) of glucose, and the mean of daily difference (MODD) as indicators of glycemic variability. The independent association between hypnotic use and glycemic variability was assessed using a multiple linear regression model.

Results: A total of 534 patients were included in the analysis (mean age: 67.7 ± 10.1 years old; mean diabetes duration: 14.5 ± 8.4 years). Thirty-seven patients (6.9%) used hypnotics, including BZD (n = 13), non-BZD (n = 10), ORA (n = 11), and MRA (n = 3). The SD was significantly higher in non-BZD users (53.6 mg/dL, 95% confidence interval [CI]: 42.9-64.3) than in the noninsomnia group (40.5 mg/dL, 95% CI: 39.5-41.5). MODD was also significantly higher in non-BZD users (50.1 mg/dL, 95% CI: 38.0-62.1) than in the noninsomnia group (35.6 mg/dL, 95% CI: 34.5-36.7). In contrast, the CV was not significantly different between non-BZD users and the noninsomnia group. When analyzed separately for different times of the day, the nocturnal CV was significantly higher in non-BZD users than in the noninsomnia group.

Conclusions: The use of non-BZDs was associated with within-day and between-day glycemic variability measured by CGM in patients with Type 2 diabetes.

[This retracts the article DOI: 10.1155/2020/2521590.].

Aims: The aim of providing disease management programs (DMPs) for T2D is to increase the understanding of disease etiology, enhance self-care management, and promote effective strategies for use of healthcare services. Despite large expenses associated with DMPs within universal welfare states, no current evidence exists on healthcare utilization following participation in DMPs.

Methods: The source population covered all individuals living in Copenhagen Municipality with diagnosed T2D during the period 2016-2021 (n = 21,132) and of which 2323 individuals were enrolled in the DMP (i.e., cases). Cases were matched with 6812 nonparticipants (i.e., controls) on sociodemography and disease status and information from nationwide registers. Difference-in-difference estimates were conducted to assess the effects of the DMP program on the utilization of healthcare services, general practitioner visits, checkups with podiatrists, and diabetic retinopathy screening. We also studied subgroup effects within socioeconomic groups.

Results: Among individuals enrolled in the DMP, the proportion adhering to the recommendations of one yearly visit increased for foot (15%) and eye (10%) examinations, while the average number of GP visits decreased (-10%). No significant changes were observed among controls. Substantial gains from enrolling in the DMP were seen in selected subgroups of the population; for example, individuals with a long history of T2D increased participation rates in foot (58%) and eye (38%) examinations.

Conclusions: The results suggest that patients with longstanding T2D and their primary GP have insufficient resources or competencies to promote disease management and underline the value of the DMP in promoting care-seeking and navigating the healthcare system.

Purpose: The purpose of this study is to explore the association between serum growth differentiation factor 15 (GDF15) and metabolic syndrome (MS), as well as its components in patients with Type 2 diabetes mellitus (T2DM).

Patients and methods: Data on 125 patients with T2DM admitted to the Department of Endocrinology of the Second People's Hospital of Hefei City between August 2022 and June 2023 were retrospectively collected. According to the diagnostic criteria of MS, the patients were divided into two groups: T2DM alone (67 cases) and T2DM combined with MS (58 cases). General conditions and laboratory indicators of the patients were collected to analyze the correlation of GDF15 expression in T2DM and combined MS.

Results: The GDF15 level in the T2DM with MS group was higher than that in the T2DM group (p < 0.001); specifically, the median (interquartile range) of GDF15 in the T2DM with MS group was 494.86 (355.72, 925.77) pg/mL, compared with 266.47 (174.49, 405.09) pg/mL in the T2DM alone group. Serum GDF15 was used as a grouping variable, and the prevalence of MS increased as GDF15 levels increased. Correlation analysis showed that GDF15 was found to be positively correlated (p < 0.05) with systolic blood pressure (r = 0.274), body mass index (r = 0.239), uric acid (r = 0.182), triglycerides (r = 0.314), and MS prevalence (r = 0.506). Binary logistic regression results showed that GDF15 was a statistically independent risk factor for T2DM combined with MS (p < 0.05). The diagnostic value of GDF15 for T2DM with MS was validated by ROC curve analysis (AUC [95%CI] = 0.793 [0.716-0.870], p < 0.001) with an optimal cut-off value of 395.81 pg/mL, a sensitivity of 71%, and a specificity of 73%.

Conclusion: Serum GDF15 is strongly correlated with T2DM combined with MS and its components, and elevated GDF15 is valuable for the diagnosis of T2DM combined with MS.

Background: Compared with individuals without diabetes, patients with diabetes have a higher susceptibility to urinary tract infection (UTI), and the infection is often more severe. Women are particularly vulnerable compared with men. This study attempted to explore predicted indicators and risk factors of the occurrence of UTI in women with Type 2 diabetes mellitus (T2DM).

Aim: The aim of this study is to identify bacterial distribution and antimicrobial resistance patterns and to assess clinical risk factors for UTI in women with T2DM.

Methods: A retrospective study was carried out on 136 patients with diabetes mellitus hospitalized in the Endocrinology Department of Taizhou Central Hospital (Taizhou University Hospital). The levels of fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c), hemoglobin, peripheral blood leukocyte count, neutrophil count, monocyte count, C-reactive protein, and urine pH were collected. Demographic data, physical examination data, and medical history were also collected. Urine culture was performed using the Autof ms1000, while antimicrobial susceptibility testing was conducted with the VITEK 2.

Results: One hundred thirty-six patients aged 60.49 ± 13.02 years old were enrolled in our study, and a total of 30 patients had positive urine cultures. Height, marital status, HbA1c, FBG, prognostic nutritional index (PNI), urine pH, and peripheral blood leucocyte-to-monocyte ratio were associated with UTI (p < 0.05). Multivariable logistic regression analysis showed that marital status (odds ratio = 6.33, 95%CI = [1.06 ~ 37.82], p = 0.043), FBG (odds ratio = 1.26, 95%CI = [1.08 ~ 1.46], p = 0.004), and PNI (odds ratio = 0.89, 95%CI = [0.81 ~ 0.99], p = 0.025) were the influencing factors for UTI. Escherichia coli (14/30, 46.7%) was the most common pathogen, and the susceptibility rate of levofloxacin to E. coli was low (1/14, 7.1%).

Conclusion: The levels of PNI, FBG, and marital status were identified as risk factors for UTI in women with T2DM. E. coli was the most common causative agent.

Background: Diabetic retinopathy (DR) is a progressive microangiopathy affecting the retinal microvasculature and is a leading cause of preventable blindness in adults globally. Despite its significance, DR remains under-investigated in sub-Saharan Africa. This study was aimed at determining the prevalence of DR and its associated factors in Type 2 diabetes mellitus (T2DM) patients attending a specialized hospital in Asmara, Eritrea.

Methods: A cross-sectional study was conducted involving 309 T2DM patients from the diabetes follow-up clinic at Halibet Referral Hospital, Asmara. Data were collected through structured questionnaires, clinical records, and biochemical analysis of blood samples. Ophthalmologic evaluation for DR was performed by eye specialists using ophthalmoscopy. Statistical analysis, including logistic regression, was performed to identify factors associated with DR.

Results: The mean age of the participants was 57.8 ± 11.47 years, with an average disease duration of 12.14 ± 7.42 years. The prevalence of DR was 39.5% (95% CI: 34.03-44.9). Among these, 17.6% (95% CI: 11-25.1) had vision-threatening DR. Factors significantly associated with DR included reduced estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m²) (aOR = 1.84, 95% CI: 1.05-3.20; p = 0.033), insulin use (aOR = 0.523, 95% CI: 0.295-0.93; p = 0.039), and longer duration of diabetes (> 8 years) (aOR = 0.24, 95% CI: 0.006-0.935; p = 0.040). Other factors associated with DR in the adjusted model were abnormal waist circumference (aOR = 0.298, 95% CI: 0.11-0.83; p = 0.021) and C-reactive protein positivity (aOR = 2.65, 95% CI: 1.05-6.66; p = 0.039).

Conclusions: The prevalence of DR among T2DM patients in Eritrea is high. Longer disease duration, reduced eGFR, and insulin use were significantly associated with DR. Early detection and management of these risk factors may help mitigate the burden of DR in diabetic patients.

Background: Diabetes mellitus is a metabolic disorder marked by elevated blood sugar levels. This study is aimed at identifying the factors influencing fasting blood sugar levels and at assessing treatment changes both within and across patients.

Methods: A retrospective cohort study design was employed to collect relevant data from 100 patients with diabetes, comprising 861 repeated measurements, aged 18 years and above, between September 11, 2018, and October 11, 2021. We utilized a multilevel random coefficient model with time-varying covariates to identify determinants and growth curve analysis to describe patterns of change over time. Additionally, pairwise least square means differences were analyzed to evaluate treatment effects during the follow-up period.

Results: The variability in fasting blood sugar levels among patients was 29.8%, while 70.2% of the variability was attributed to changes within individual patients. Significant associations were found between fasting blood sugar levels and pulse rate, high-density lipoprotein cholesterol levels, and baseline fasting blood sugar levels.

Conclusion: The findings indicate that fasting blood sugar levels in patients increase as pulse rate, high-density lipoprotein levels, and baseline fasting blood sugar levels rise, with statistical significance at the 5% alpha level. Therefore, it is crucial to monitor these factors closely during patient follow-ups to optimize management strategies.