Journal of Diabetes and Metabolic Disorders最新文献

Objective: Diabetic retinopathy (DR) is a common problem of diabetes, and it is the cause of blindness worldwide. Detection of diabetic radiology disease in the early detection stage is crucial for preventing vision loss. In this work, a deep learning-based binary classification of DR images has been proposed to classify DR images into healthy and unhealthy. Transfer learning-based 20 pre-trained networks have been fine-tuned using a robust dataset of diabetic radiology images. The combined dataset has been collected from three robust databases of diabetic patients annotated by experienced ophthalmologists indicating healthy or non-healthy diabetic retina images.

Method: This work has improved robust models by pre-processing the DR images by applying a denoising algorithm, normalization, and data augmentation. In this work, three rubout datasets of diabetic retinopathy images have been selected, named DRD- EyePACS, IDRiD, and APTOS-2019, for the extensive experiments, and a combined diabetic retinopathy image dataset has been generated for the exhaustive experiments. The datasets have been divided into training, testing, and validation sets, and the models use classification accuracy, sensitivity, specificity, precision, F1-score, and ROC-AUC to assess the model's efficiency for evaluating network performance. The present work has selected 20 different pre-trained networks based on three categories: Series, DAG, and lightweight.

Results: This study uses pre-processed data augmentation and normalization of data to solve overfitting problems. From the exhaustive experiments, the three best pre-trained have been selected based on the best classification accuracy from each category. It is concluded that the trained model ResNet101 based on the DAG category effectively identifies diabetic retinopathy disease accurately from radiological images from all cases. It is noted that 97.33% accuracy has been achieved using ResNet101 in the category of DAG network.

Conclusion: Based on the experiment results, the proposed model ResNet101 helps healthcare professionals detect retina diseases early and provides practical solutions to diabetes patients. It also gives patients and experts a second opinion for early detection of diabetic retinopathy.

Purpose: To evaluate ECG-gated retinal vessel calibre as a novel measure of aberrant pulsatile retinal flow in diabetes mellitus.

Methods: A novel mydriatic ECG-gated fundoscope was used to acquire retinal vessel calibre measurements at four cardiac cycle time points from end diastole to early diastole. An inhouse software recorded the exact time when an image was captured to corroborate ECG-synchronisation. Arterial applanation tonometry, an alternative method of assessing aberrant blood flow, was used to measure carotid-femoral pulse wave velocity (cPWV) and augmentation index (AIx). The intraclass correlation (ICC) was used to perform intra- and inter-observer reliability analyses. Two reviewers measured the retinal vessel calibre in single retinal arterioles and venules. A receiver operating characteristic curve determined associations with diabetes mellitus.

Results: In this study 119 controls and 120 participants with diabetes mellitus were recruited. Mean peak change in retinal arteriolar calibre from baseline was higher in diabetes mellitus compared with controls (controls: 0.92%, IQR 0.63 vs diabetes mellitus: 2.05%, IQR 1.25, p<0.0001). In a subset of 9 controls and 11 participants, the intra-and inter-observer reliability was high (ICC 0.87-0.97) in mean peak changes in retinal vascular responses from baseline. In a subset of 36 controls and 95 participants with diabetes mellitus, diabetes mellitus was more strongly associated with retinal arteriolar pulsatility (AUC 0.85, 95%CI 0.76-0.93) than applanation tonometry (cfPWV AUC 0.72, 95%CI 0.62-0.82 vs AIx AUC 0.56, 95%CI 0.45-0.68).

Conclusion: Higher retinal arteriolar pulsatility appears to be more strongly correlated with diabetes mellitus than arterial applanation tonometry.

Objectives: The aim of the present study was to investigate if major dietary patterns (DPs) interact with psychological disorders (PDs) in association with sleep quality and quantity among a large sample of Iranian adults living in Yazd, Iran.

Methods: This cross-sectional investigation was conducted on the baseline data of a population-based Iranian cohort study (Yazd Health Study-Taghzieh Mardom-e-YaZd: YaHS-TAMYZ). All data regarding dietary intakes, PDs, and sleep status were collected via validated questionnaires. The interaction between major DPs and PDs in relation to sleep parameters was determined using multivariable adjusted binary logistic regression.

Results: A total of 6048 adults participated in this study. Compared to subjects with the lowest adherence to each DP and without any severe PDs: a) individuals with the highest adherence to the "western" DP and with severe anxiety had higher risk of "short sleep duration" (P = 0.030) and "insufficient sleep" (P = 0.020); b) subjects in the "western" DP's top tertile and with severe depression had lower chance of having "short sleep duration" (P = 0.029) and "insufficient sleep" (P = 0.029); c) those with the highest adherence to the "high animal protein" DP and with severe anxiety had significantly greater odds of "long sleep duration" (P = 0.044); d) a lower chance of "low sleep quality" was observed in participants in the "high animal protein" DP's top tertile and with severe stress (P = 0.05).

Conclusions: The "western" and "high animal protein" DPs might interact with PDs in association with the quality and duration of sleep. Further investigations are needed to confirm our findings.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-024-01494-4.

Objectives: Glucose monitoring in diabetes is changing overtime with a constant development of new devices for continuous glucose monitoring (CGM). Aim of this observational, prospective study was to evaluate the clinical performance of a novel intermittently scanned CGM system, the Glunovo Flash in a cohort of patients with type 1 diabetes.

Methods: A total of 45 patients with T1D followed at the Endocrinology Unit of the ASST-FBF-Sacco (Milan) were enrolled. All patients were habitual CGM users and were asked to wear simultaneously the Glunovo Flash system and their habitual CGM device for 14 days. A comparison of CGM glucose metrics was performed. Patients' opinions on the new device were also collected.

Results: Thirty-five patients completed the study period of two weeks (7 habitual real time CGM users, 28 habitual intermittently scanned CGM users). Mean Time In Range resulted significantly higher with the novel studied sensor respect to intermittently scanned CGM comparator. No differences were found considering other glucose metrics. A positive correlation was found between the Time In Range recorded by Glunovo Flash and intermittently scanned CGM comparators as well as for Time Above Range, Glucose Management Indicator, Time Below Range and Coefficient of Variation. No correlations were found between glucose metrics recorded by Glunovo Flash and real time CGM comparators. Patients reported a positive experience of use with the new sensor but some elements appeared improvable.

Conclusions: The CGM device Glunovo Flash for patients with diabetes shows similar performance to other intermittently scanned CGM systems.

Objectives: The significant health differences between sexes in Iran in terms of burden of non-communicable diseases (NCDs) point to the urgency of developing policies. We aim to explore sex disparities in NCDs.

Methods: We used Global Burden of Disease 2019 study to compare estimates of incidence, prevalence, disability-adjusted life years (DALYs), years lived with disabilities (YLDs), years of life lost (YLLs), and deaths among sexes for NCDs, and their main subgroups; neoplasms, cardiovascular diseases (CVDs), chronic respiratory diseases (CRDs), diabetes mellitus (DM) during 1990-2019.

Results: In 2019, there were 62,476,274 (59517167.5, 65759931) incident NCDs in men and 78758640.6 (75222093.7, 82272935.8) in women. There were 7734064.3 (6744951.2, 8846192) DALYs in men and 7760484.2 (6496609, 9218299.9) in women. Fatal estimates (deaths and YLLs) of NCDs were higher for men, while non-fatal estimates (prevalence, YLDs) were higher for women. Men were superior in all burden indices of NCDs subgroups, except for all indices of DM and YLDs in CVDs. Compared to 1990-2010, the period 2010-2019 confirmed a marked stagnation in decline rates of burden indices, as well as an increase in incidence and prevalence which was more pronounced among men. Despite shrinking sex gaps in NCDs subgroups since 1990, sex gap in DM is widening in 2019.

Conclusions: There is a notable sex disparity in NCDs prevalence in Iran, which has become increasingly evident in DM burden. It will be imperative to continue monitoring sexual differences in NCDs burden to determine if disease rates between sexes continue to diverge in the future.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-024-01489-1.

Objectives: Impaired awareness of hyperglycaemia (IAH) affects approximately 20-40% of people living with type 1 diabetes (T1D), predisposing them to severe hypoglycaemia. This systematic review evaluated the efficacy of closed-loop automated insulin delivery systems (CL-AID) in restoring IAH compared with standard diabetes care, including other diabetes technologies.

Methods: Six electronic databases were searched for published and unpublished observational and randomised-control studies (RCTs) from inception to 29th of May 2024. The results of observational studies and RCTs were meta-analysed separately to calculate the effect of CL-AID on IAH in people living with T1D. Quality assessment of studies was performed using the Joanna-Briggs appraisal tool for cohort studies and the Risk of Bias (Rob-2) tool for RCTs.

Results: Meta-analysis of four prospective observations studies (n = 583) demonstrated a statistically significant improvement in hypoglycaemia awareness upon transition to a hybrid closed-loop (HCL) system compared with standard diabetes care in people with T1D, Clarke score mean difference (MD) of -0.45 (-0.69 to -0.22, p = 0.0001). However, this was less than 1 point, which is the minimum clinically important difference (MCID) of Clarke score. Meta-analysis of three RCTs (n = 55) comparing standard diabetes care did not demonstrate any statistically significant effect on hypoglycaemia awareness, Clarke score MD of -0.69 (-1.89 to 0.50, p = 0.26).

Conclusions: This systematic review demonstrated that transition from standard diabetes care to HCL has the potential to improve hypoglycaemia awareness in people with T1D and IAH, but this might not be of major clinical significance. Hence, psychoeducational interventions continue to be the cornerstone of IAH management. Novel therapeutic modalities, such as bi-hormonal automated delivery systems, need to be further explored to help restore hypoglycaemia awareness.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-024-01492-6.

Objectives: Adipogenesis, the process of fat accumulation in adipose tissue, is closely linked to obesity, a condition characterized by excessive fat storage. Genetic factors significantly contribute to an individual's susceptibility to adipogenesis and the development of obesity.

Methods: In this study, we conducted a comprehensive bioinformatic analysis, including Weighted Gene Co-expression Analysis, differentially expressed gene analysis, and protein-protein interaction analysis, to identify hub genes and miRNAs associated with obesity.

Results: Our findings highlight the potential involvement of genes such as ATP5F1A, FN1, CCl2, RPS14, and RPS16, as well as miRNAs including hsa-miR-6844, hsa-miR-4528, hsa-miR-3686, hsa-miR-3124-3p, hsa-miR-381-3p, and hsa-miR-300 in obesity.

Conclusions: The findings from this study contribute to the growing knowledge of adipogenesis and obesity genetics, and provide potential biomarkers for further investigation and translation into clinical or research applications.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-024-01490-8.

Purpose: A growing number of evidence have assessed the association between bisphenol A (BPA) as an endocrine-disrupting agent and the risk of gestational diabetes (GDM). This meta-analysis aimed to reassess the data on the association of BPA levels in women with GDM compared to the control.

Methods: A comprehensive literature search was conducted in Medline, Embase, Scopus, and Web of Science to extract relevant published studies up to May 2024. 12 articles were included in the meta-analysis. DerSimonian and Liard random-effects model was used to estimate the pooled odds ratio (OR). Sensitivity analysis was conducted to assess the robustness of the pooled results by removing each study from the pooled effect size. Subgroup analyses were performed depending on the subgroups of gestational age, GDM trimester, BMI, study design and geographical area.

Results: The results showed that there was no significant association between circulating and urinary BPA concentrations with the risk of GDM (OR: 0.79; 95% CI 0.60-1.04; P = 0.095). No significant heterogeneity was found among the studies. Using Begg's correlation (P = 0.95) and Egger's linear regression (P = 0.86) tests, no publication bias was observed. The sensitivity analysis shows that our findings were completely robust and stable. Meta-regression indicated a significant association between BPA levels and study design and geometric mean as an index of the risk of GDM.

Conclusion: The present meta-analysis demonstrates exposure to BPA was associated with a reduced risk of GDM. Further studies are needed for obtain the reliable results.

Graphical abstract:

Objectives: Primary hyperparathyroidism (PHPT) is a disorder marked by chronic parathyroid hormone hypersecretion, which affects bone turnover and remodelling processes. With a loss of bone density and an increase in bone porosity, the cortical compartment is most severely impacted. The study's goal is to assess PHPT's effects on the volumetric bone mineral density (vBMD) of the femur's trabecular compartment as well as the vBMD and thickness of the cortical bone.

Methods: This is a retrospective case-control study, valuating age, biochemical doses, anthropometric measurements, and bone measurements. Between 2011 and 2016, 74 Caucasian Italian women and men with PHPT were sought out. Biochemical analyses were added to bone mineral density (BMD) values found in the lumbar spine and femoral neck. Proximal femur parameters such as cortical and trabecular volumetric (v) BMD, cortical thickness (CTh) and surface (s) BMD were analyzed by 3D-DXA software (3D-SHAPER Medical, Spain).

Results: The findings showed a negative correlation between PHPT patients and controls, which was equally affecting the cortical and trabecular compartments. This correlation was especially evident in the areal BMD (aBMD) and vBMD measurements. Nonetheless, no appreciable correlation was found between the cortical level and the thickness of the cortical bone.

Conclusions: Parathormone (PHT) levels had an adverse effect on the cortical, trabecular volumetric density in this investigation, as was expected. Cortical thickness, however, is unaffected significantly. The literature and these findings are consistent.