Journal of Diabetes and Metabolic Disorders最新文献

[This corrects the article DOI: 10.1007/s40200-024-01470-y.].

[This corrects the article DOI: 10.1007/s40200-024-01467-7.].

Objective: Patient data is subject to missingness and errors. Patient portals enable patients managing type 2 diabetes mellitus (T2DM) to review and correct data to avoid retesting, medication errors, and diagnostic mistakes. We examined whether patient portal use was associated with electronic health record (EHR) data timeliness in T2DM care.

Research design and methods: We analyzed EHR data from a panel of adult patients to determine whether portal use improved data timeliness. EHR data timeliness is measured as the number of days between patient encounters, accounting for mean attribute update periods, where available EHR attribute updates for T2DM measurements were present, including body mass, weight, glycated hemoglobin A1c, cholesterol, blood pressure, serum creatinine, and smoking status. We performed negative binomial regressions with fixed effects to estimate the association between patient portal use and EHR data timeliness. Sensitivity analyses were conducted using Poisson regressions.

Results: Nearly a third (31.3%) of patients in our sample actively used the health portal. There were fewer days (111.9 days vs. 136.7 days; p < 0.001) between EHR attribute updates for patients who used health portals compared to patients who did not. Data timeliness was lower among female, non-Hispanic White Medicare beneficiaries. Based on regression analyses, portal use was associated with an expected 3.6 (p < 0.001) percentage point decrease in days between attribute updates, indicating improved EHR timeliness.

Conclusion: Improving the quality of health information may streamline decision-making in partnership with patients who produce data points across clinical settings. Active use of patient portals and digital health tools in chronic disease care are critical for care management and clinical decision-making, especially for patients managing type 2 diabetes across clinical settings.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-024-01468-6.

Diabetic cardiomyopathy is a condition characterized by ventricular dysfunction in diabetic patients that is not caused by other cardiac ailments. It is associated with factors such as left ventricular hypertrophy, metabolic disturbances, and oxidative stress. Tight junctions, which form a barrier between cells, play a role in the vascular complications of diabetes. Proteins such as claudins and occludens are important for the structure and function of tight junctions. Zona occludens (ZO) proteins are also involved in tight junctions and their expression may be affected by diabetes. The review discusses the impact of diabetes on the tight junctions and the role of ZO proteins in diabetic cardiovascular dysfunction.

Purpose: Reduced capillary number in skeletal muscle due to disuse can hinder the delivery of insulin and amino acid delivery to muscle cells, diminishing insulin activity and muscle protein synthesis, ultimately contributing to anabolic resistance. However, it remains unknown whether mitigating capillary regression during inactivity improves anabolic resistance. This study aimed to investigate the effect of increasing capillary number through the administration of prazosin, which can increase blood flow and prevent capillary regression, on anabolic resistance in skeletal muscle induced by disuse.

Methods: Male Sprague Dawley rats were divided into control and hindlimb unloading (HU) groups, with half of each group receiving prazosin (50 mg/L) in their drinking water for 2 weeks. Histological analysis of the soleus muscles was conducted to measure the capillary-to-fiber (C/F) ratio, while western blotting was performed to measure the activation of the Akt/mTORC1 muscle protein synthesis pathway before and after insulin stimulation.

Results: The C/F ratios were significantly lower in the HU and HU + Prz groups than in the control group but were significantly higher in the HU + Prz group than in the HU group. Following insulin stimulation, the phosphorylation levels of Akt, p70S6K, and S6RP increased in all groups, with a significantly greater increase observed in the HU + Prz group compared to the HU group, indicating improved molecular signaling related to muscle protein synthesis.

Conclusion: Administration of prazosin during hindlimb unloading mitigated capillary regression and enhanced insulin-stimulated muscle protein synthesis response. These findings suggest that enhancing capillary number may reduce the anabolic resistance caused by muscle disuse.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-024-01454-y.

Purpose: Clarified butter, contain harmful saturated and beneficial trans-fatty acids. Canola oil is a promising alternative to other oils for reducing saturated fat intake. This trial aimed to investigate the effects of replacing clarified butter with canola oil in patients with metabolic syndrome on various metabolic syndrome components, fatty liver index (FLI), and insulin resistance.

Methods: In this trial, 42 individuals with metabolic syndrome referred to the clinic in Imam Khomeini University Hospital in Urmia, Iran, were enrolled. The participants, who commonly consumed (3 to 8 serving per day) clarified butter, were instructed to follow a healthy diet and replace their consumption of clarified butter with an equivalent amount of canola oil for 3 months. To compare the differences of outcomes in the group, the paired samples T-test and cohen's d effect size were applied. To analyze the changes in dietary intakes and Metabolic equivalent of task (MET), repeated measures of ANOVA was used.

Results: There was a significant decrease in fasting blood sugar (FBS) (< 0.001), triglyceride (TG) (0.003), and anthropometric measurements (< 0.001). Furthermore, significant reductions were observed in total cholesterol (TC) (< 0.001), low-density lipoprotein (LDL) (0.009), gamma-glutamyl transferase (GGT) levels (0.003), FLI (< 0.001), insulin levels (0.007), and homeostatic model assessment for insulin resistance (HOMA-IR) (0.002), and increase in quantitative insulin-sensitivity check index (QUICKI) (< 0.001). Unfavorably, there was a significant reduction in the high-density lipoprotein (HDL) (< 0.001).

Conclusion: The replacement of clarified butter with canola oil demonstrated potential benefits in improving metabolic syndrome.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-024-01453-z.

Introduction: The region on chromosome 9p21 has consistently been identified in genome-wide association studies (GWAS) as the top locus for type 2 diabetes (T2D), however, genetic variations in this locus affecting both T2D and coronary artery disease (CAD) require further characterized. Our aim was to assess the effects of rs10811661, a variant validated in GWAS, on log (TG/HDL-C), which has been associated with an atherogenic lipid profile.

Methods: A total of 121 patients with T2D who underwent coronary angiographic examination were included in this study. The patients were categorized into two groups, those with angiographically normal coronary arteries or less than 50% stenosis (non-CAD) and those having at least 70% stenosis in one of the main coronary arteries (severe CAD). The rs10811661 variant was genotyped using the restricted fragment length polymorphism (RFLP) analysis after PCR amplification.

Results: When the data was divided into tertiles according to HbA1c, our findings revealed that in tertile 3 (HbA1c ≥ 7.8%), the frequency of TT genotypes was higher compared to CT + CC genotypes (37.1% vs. 27.8%). T2D patients with CAD who carried the TT genotype had higher concentrations of log (TG/HDL) (p = 0.037) and TG (p = 0.003) compared to those with the C allele (CC or CT genotypes). After adjustment for covariates, the T allele of rs10811661 indicated significant associations with TG (OR = 1.66, 95% CI: 1.22-2.33, p = 0.002) and log (TG/HDL-C) (OR = 1.12, 95% CI: 1.02-2.13, p = 0.023) levels.

Conclusion: Our findings provide insight into how a GWAS-validated variant, rs10811661, can influence atherogenicity in patients with T2D and establish a link between this functional variant in the 9p21 locus and lipid factors associated with atherosclerosis. Further investigations are needed to understand the mechanisms by which this important variant influences lipid and lipoprotein levels, which could be useful in developing personalized medicine interventions.

Background: Assessing body fat levels in particular groups is crucial, because excess body fat plays a significant role in various metabolic disorders. The purpose of the present study is to recognize optimal sex-specific reference values of percent body fat (PBF) in a healthy Iranian population using a statistical approach to normality.

Methods: In this cross-sectional study, among the 7986 participants who had bioelectrical impedance analyzer (BIA) data, after considering the exclusion criteria, 212 healthy individuals with the age of 20-30 years old (89 men and 123 women), with the lowest PBF values, were selected from Tehran Lipid and Glucose Study (TLGS). Height, weight, waist circumference, and PBF were obtained. Data of blood tests, including the lipid and glucose profiles, were also gathered. PBF was measured using a BIA. The relation between PBF and age was evaluated using second-degree regression models. Reference values for males and females were established considering the 95th percentile values of PBF for young reference groups.

Results: The lower values of body fat mass for men and women were 16.6 ± 4.9 and 31.1 ± 5.4 Kg, respectively and the age at the lower PBF was between 20 and 30 years. The cutoff points for PBF were 38.7% and 22.5% for women and men, respectively.

Conclusion: This study suggested specific PBF cutoff values for healthy Iranian adults of both sexes. More studies from different regions are required to obtain reference values for populations, enabling researchers to provide more reliable reports regarding obesity cutoff points.

Purpose: To identify the independent risk variables that contribute to the emergence of microalbuminuria(MAU) in type 2 diabetes mellitus(T2DM), to develop two different prediction models, and to show the order of importance of the factors in the better prediction model combined with a SHAP(Shapley Additive exPlanations) plot.

Methods: Retrospective analysis of data from 981 patients with T2DM from March 2021 to March 2023. This dataset included socio-demographic characteristics, disease attributes, and clinical biochemical indicators. After preprocessing and variable screening, the dataset was randomly divided into training and testing sets at a 7:3 ratio. To address class imbalance, the Synthetic Minority Oversampling Technique (SMOTE) was applied to balance the training set. Subsequently, prediction models for MAU were constructed using two algorithms: Random Forest and BP neural network. The performance of these models was evaluated using k-fold cross-validation (k = 5), and metrics such as the area under the ROC curve (AUC), accuracy, precision, recall, specificity, and F1 score were utilized for assessment.

Results: The final variables selected through multifactorial logistic regression analysis were age, BMI, stroke, diabetic retinopathy(DR), diabetic peripheral vascular disease (DPVD), 25 hydroxyvitamin D (25(OH)D), LDL cholesterol, neutrophil-to-lymphocyte ratio (NLR), and glycated haemoglobin (HbA1c) were used to construct the risk prediction models of Random Forest and BP neural network, respectively, and the Random Forest model demonstrated superior overall performance (AUC = 0.87, Accuracy = 0.80, Precision = 0.79, Recall = 0.84, Specificity = 0.76, F1 Score = 0.81). The SHAP feature matrix plot revealed that HbA1c, NLR, and 25(OH)D were the three most significant factors in predicting the development of MAU in T2DM, with 25(OH)D acting as an independent protective factor.

Conclusion: Effective identification of MAU in T2DM, therapeutic strategies for controllable high-risk factors, and prevention or delay of diabetic kidney disease(DKD) can all be achieved with the help of the risk prediction model developed in this study.

Purpose: The incidence of prediabetes has been on the rise, indicating a growing public health concern, as individuals with prediabetes are at higher risk of developing type 2 diabetes. This study aimed to determine the effects of simple interventions on the regression of pre-diabetes status into normoglycemia and also prevent progression to diabetes in a pragmatic community trial.

Methods: A total of 2073 (761 intervention; 1,312 controls) participants with pre-diabetes were included in the present secondary data analysis; cases with diabetes or normoglycemia were identified during nine years of follow-up. We utilized multinomial logistic regression to calculate relative risk reductions (RRR, 95% CIs) for educational interventions targeting lifestyle changes in both men and women. Additionally, we employed a linear regression model that considered the ordinal outcomes ranging from normal to prediabetes and diabetes.

Results: In men, after adjusting for confounders, the intervention group had a 53% (95% CI = 1.11-2.10) more significant chance of returning to normoglycemia than the control group after three years of follow-up. In addition, men in the intervention group also had an increased risk of developing type 2 diabetes than men in the control group (RRR = 1.53, 95% CI = 1.02-2.31) after three years of follow-up. These findings among men remained consistent even after a six-year follow-up period. In women, after adjusting for age, the chance of returning to normoglycemia after three years in the intervention group was 1.30 times higher than in women in the control group (95% CI = 1.00-1.69), which disappeared after adjusting for other covariates or after six years of follow-up. The results of the regression analysis showed that the intervention had no effect on changing the status of the outcome from normal to prediabetes and diabetes.

Conclusion: We could not demonstrate any effect of a simple intervention in improving prediabetes. This high-risk population may require more gender-specific intensive interventions and attention.