Journal of diabetes and its complications最新文献

Background: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme implicated in inflammation and oxidative stress, and has been associated with cardiovascular conditions and adverse outcomes, particularly in diabetes and its complications. However, no prior studies have examined the relationship between Lp-PLA2 and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM). This research aims to explore the potential association between Lp-PLA2 and DPN.

Methods: This retrospective study included 880 hospitalized patients with T2DM treated between March 2024 and August 2024 at Nanjing First Hospital. To assess the relationship between Lp-PLA2 and DPN, multiple logistic regression models were applied. The study also utilized restricted cubic spline (RCS) modeling, segmented regression, stratified analysis, and receiver operating characteristic (ROC) curve assessments.

Results: Patients diagnosed with DPN exhibited elevated Lp-PLA2 levels compared to those without DPN. Even after adjusting for multiple variables, Lp-PLA2 was independently associated with a higher likelihood of DPN (odds ratio [OR] 1.011, 95 % confidence interval [CI] 1.008-1.014, P < 0.001). The RCS analysis revealed a nonlinear association, with an inflection point at 215.8 ng/mL. In ROC curve analysis, the area under the curve (AUC) for Lp-PLA2 was 0.664, while the combined indicator AUC was 0.739.

Conclusions: Serum Lp-PLA2 levels show a significant correlation with the presence of DPN in patients with T2DM. These findings suggest that Lp-PLA2 could serve as a valuable biomarker for identifying patients at risk for DPN, emphasizing the need for close monitoring of T2DM individuals with elevated Lp-PLA2 to mitigate the risk of developing DPN and associated adverse health outcomes.

Background: Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is widely used for treating heart failure and chronic kidney disease (CKD). While its renoprotective effects are well established, concerns remain regarding its impact on muscle mass and function, especially in elderly patients.

Objective: To assess the effects of dapagliflozin on renal function, body composition, and muscle strength in elderly CKD patients.

Methods: Twelve elderly CKD patients (75.6 ± 1.4 years) were treated with dapagliflozin for 12 months. Body composition, serum parameters, and muscle function were evaluated at baseline, 6 months, and 12 months. Measurements included changes in eGFR, liver function, HbA1c, and muscle strength.

Results: Dapagliflozin treatment stabilized eGFR without significant improvement, but proteinuria was notably reduced in most patients, indicating a positive renal effect. AST and ALT levels showed significant reduction after 12 months, suggesting improved liver function. No significant changes were observed in body weight, BMI, or muscle mass. Muscle function, as measured by the 5-sit-to-stand test, improved significantly, while grip strength remained stable. No serious adverse events were reported.

Conclusion: Dapagliflozin is a safe and effective treatment for CKD in elderly patients, demonstrating renal protection and improved liver function without adversely affecting muscle mass or strength. The study supports the use of dapagliflozin as part of a comprehensive approach, combining pharmacotherapy, lifestyle modification, and exercise to optimize patient outcomes in CKD management.

Peripheral artery disease leading to chronic limb threatening ischemia (CLTI) represents a significant concern for up to 11.0 % of patients with diabetes, often culminating in amputation of the affected limb. This retrospective cohort study explores frequency of comorbid behavioral health conditions (CBHCs) in patients with diabetes and hospital stay characteristics related to post-lower extremity amputation (LEA). Utilizing patient data from the Healthcare Cost and Utilization Project from 2020, patients were categorized into groups including having comorbid depression only, alcohol abuse only, drug abuse only, more than one CBHC, or no CBHC. On average, patients with at least one CBHC underwent LEA over three years earlier (59.3±12.0 years versus 62.6±12.1 years, respectively). A greater proportion of patients with at least one CBHC were non-Hispanic White people, reside in a county metro area <250,000 people, and were insured by Medicaid. Despite generally low mortality rates, patients with depression only display significantly higher survival rates relative to those without a CBHC. These findings begin exploring the socioeconomic complexities and healthcare disparities faced by patients with diabetes and behavioral health diagnoses, emphasizing the need for targeted preventive mental health screening and intervention prior to development of CLTI.

Background: Atherosclerotic cardiovascular disease is the leading cause of death in people with type 2 diabetes (T2D) and chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Glucagon-Like Peptide-1 receptor agonists (GLP-1RA) reduce cardiovascular events, improve glycemic control, promote weight loss, and slow progression of nephropathy. Despite these benefits and professional society treatment guidelines recommendations, GLP-1RAs remain under-utilized in people with advanced CKD and ESKD due to tolerability and safety concerns.

Methods: We conducted a retrospective cohort study comparing clinical outcomes and medication use details after initiating GLP-1RA or dipeptidyl-peptidase 4 inhibitor (DPP-4i) in people with T2D and advanced CKD or ESKD. Eligible patients were identified via electronic health record query with extraction of baseline demographics, vital signs, and laboratory values. A manual chart review was undertaken to confirm eligibility, medication use, and extract a detailed account of all side effects.

Results: A total of 236 eligible patients (149 in the GLP-1RA group and 87 in the DPP-4i group) were identified. The average duration of treatment was 1036 (±909.9) and 1109 (±1090.9) days for GLP-1RA and DPP-4i, respectively. The average percentage weight loss from baseline to 36 months of treatment in the GLP-1RA group was -9.6 % (95 % CI, -11.3 to -7.8) versus -2.4 % (95 % CI, -5.4 to 0.5) in the DPP-4i group (estimated treatment difference (ETD) -7.1 (95 % CI, -10.6 to -3.7) percentage-points, p < 0.001). The change in HbA1c from baseline to 36 months of treatment was significantly greater in the GLP-1RA (-1.0 %) compared with the DPP-4i group (0.2 %) (ETD -1.2 (95 % CI, -2.1 to -0.3) percentage-points, p = 0.04).

Conclusion: In patients with T2D and advanced CKD or ESKD, treatment with GLP-1RAs in a real-world setting had long treatment persistence, and compared to DPP-4is, was associated with greater weight loss and glycemic improvement.

Aims: This study aimed to investigate the correlations between glycated hemoglobin (HbA1C) variability and diabetes distress (DD) and its subscales in older patients with type 2 diabetes mellitus.

Methods: The cross-sectional study analyzed 175 patients with type 2 diabetes mellitus, aged ≥60 years, and underwent HbA1C testing at least three times within a 2-year. HbA1C variability was assessed using the coefficient of variation (CV), standard deviation (SD), variability independent of the mean (VIM), and variability score. DD was assessed using a diabetes distress scale (DDS) questionnaire. We analyzed four DDS subscales, including emotional burden (EB), regimen distress (RD), interpersonal distress (ID), and physician distress (PD). Significant DD was defined as a total score ≥ 34.

Results: All four indices of HbA1C variability were positively correlated with DDS (r = 0.19, P = 0.01 in CV; r = 0.19, P = 0.01 in SD; r = 0.19, P = 0.02 in VIM; and r = 0.18, P = 0.02 in variability score). For the DD subscales, only EB showed a significant correlation with HbA1C variability (β = 0.72, SE = 0.35 in CV; β = 0.70, SE = 0.35 in SD; β = 0.66, SE = 0.31 in VIM; and β = 0.77, SE = 0.35 in variability score).

Conclusions: HbA1C variability was independently linked to DD, particularly the EB subscale in older type 2 diabetes patients. This underscores the need for DD screening and intervention in patients with high HbA1C variability, irrespective of their HbA1C levels or depressive symptoms.

Aims: Our study examined the association between the Cambridge Risk Score (CRS), new hyperglycemia (NH), and complications in patients undergoing elective surgery.

Methods: In this retrospective cross-sectional study, adult surgical patients, without diabetes, with NH (blood glucose ≥140 mg/dL) were identified, and the CRS was calculated. We used univariate regression models to evaluate the relationship between CRS and NH with 30-day readmission, length of stay (LOS), and complications. Models were stratified by surgical specialty (cardiac/vascular, general, orthopedic, neurologic).

Results: Of 10,531 patients in the study, 24 % had NH. After adjusting for covariates, the CRS was associated with increased odds of complications [OR 2.09; 95%CI:1.69, 2.59] and NH [OR 1.95; 95%CI:1.66, 2.29]. NH was associated with increased odds of 30-day readmission [β 1.60; 95%CI:1.31, 1.96], and increased LOS [β 0.64; 95%CI:0.59, 0.68]. When stratified by surgery type, the CRS was associated with increased LOS in neurosurgery, decreased LOS in orthopedics, and increased odds of complications and NH in neurosurgery and orthopedics.

Conclusion: The CRS is associated with NH, complications, and LOS in patients undergoing elective neurosurgery, orthopedic surgery, and general surgery. This suggests that CRS may have potential to help identify surgical patients at high risk for NH and complications.

Patients with diabetic are at a higher risk of developing hepatic disorders compared to non-diabetic individuals. This increased risk can be attributed to the diabetic environment, which triggers and exacerbates harmful pathways involved in both diabetic complications and hepatic disorders. Therefore, it is important to consider the use of antidiabetic agents that offer benefits beyond glycemic control and have positive effects on liver tissues. Glucagon-like peptide-1 (GLP-1) mimetics are a novel class of antidiabetic medications known for their potent blood sugar-lowering effects. Emerging evidence suggests that these drugs also have favorable effects on the liver. However, the precise effects and underlying mechanisms are not yet fully understood. In this review, we aim to provide a mechanistic perspective on the liver benefits of GLP-1 mimetics and outline the mediating mechanisms involved.

Background: Left ventricular hypertrophy (LVH) is an important and common pathologic change in the heart of patients with diabetes mellitus. Microvascular complications have been reported to be involved in the development and process of LVH. This study aimed to explore the association between diabetic microvascular complications and LVH in patients with type 2 diabetes mellitus (T2DM).

Material and methods: This is a cross-sectional study. A total of 2912 patients with T2DM were enrolled, including 360 patients with LVH and 2552 patients without LVH. Demographic data, medical history and laboratory indices were collected, along with information on diabetic microvascular complications and results from cardiac ultrasonography. The study utilized multivariable logistic regression to evaluate the independent effects of microvascular complications (DR, DPN, or DKD) and the cumulative number of these complications on the presence of LVH, while adjusting for potential confounding factors.

Result: In patients with T2DM, those with LVH were older and had higher body mass index, waist circumference and hip circumference than those without LVH. Additionally, the proportion of patients with diabetic retinopathy (DR) and diabetic kidney disease (DKD) was larger among those with LVH compared to those without LVH. After adjusting for potential confounding factors, DR and DKD were associated with increased odds of LVH (odds ratio [OR] = 1.351 and OR = 1.404, respectively). The risk of LVH also increased progressively in patients with two or more diabetic microvascular conditions compared to those with only one. In subgroup analysis, the risk of LVH increased with the number of microvascular conditions in male patients with T2DM.

Conclusions: Diabetic microvascular complications were significantly associated with LVH in T2DM. Moreover, the risk of LVH increased with the number of microvascular complications, particularly in males with T2DM.

Background: Patients with type 1 diabetes (DM1), even in the setting of adequate glycaemic control, have an excess risk for developing cardiovascular disease. Residual insulin secretion (RIS), measured by detectable C-peptide levels in patients with DM1, might protect against diabetes-related complications. This study aimed to examine the relationship between residual insulin secretion and prognostic markers of cardiovascular complications in patients with DM1.

Methods: A total of 137 patients with DM1 were included in this analysis. They were of young age (<45 years), with an established diagnosis of over two years before the study entry and without a history of cardiovascular complications. All patients underwent complete clinical and laboratory evaluation. A c-peptide measurement of ≥0.05 ng/ml was used to identify the presence of RIS. Pulse wave velocity (PWV), cardiac autonomic function assessed both at rest, by total power of heart rate variability and dynamically, by the expiration to inspiration (e/i) index, albumin to creatinine ratio (ACR), and high sensitivity CRP (hs-CRP) were used as predictive biomarkers of cardiovascular complications.

Results: Female participants represented 63.5% of the population [mean age: 29.7 (±8.1) years, mean HbA1c: 7.6% (±1.4), median diabetes duration:15 (10-21) years, median age at diabetes diagnosis: 13 (8-17) years]]. The median value of fasting c-peptide was 0.04 (0.03-0.05) ng/ml, and RIS was detected in 32 patients (23.4%). Patients with RIS had a shorter diabetes duration, an older age at diagnosis and a lower BMI, while no significant association was found between residual c-peptide and age or HbA1c. RIS was significantly associated with lower PWV values [8.1 m/s² (7-8.7) vs 9.2 m/s² (7.8-10.1), p <0,001], higher total power values [1124 Hz (600-3277) vs 577 Hz (207-2091), p <0,001], and higher E/I measurements [1.4 (1.2-1.5) vs. 1.3 (1.2-1.4), p=0.01]. No significant association was noted between RIS and either ACR or hs-CRP. In multivariable linear regression analysis, the association between RIS and lower PWV values remained significant (p= 0.007) regardless of age, sex, diabetes duration or age of diagnosis, blood pressure and BMI. Similarly, residual insulin secretion retained a significant independent association with total power (p= 0.032) and E/I (p=0.045).

Conclusion: In young patients with DM1, free of macrovascular complications, residual insulin secretion is independently associated with more favorable prognostic markers of subclinical atherosclerosis and cardiac autonomic function.

Aims: To identify factors associated with use of novel diabetes medications among patients hospitalized under general internal medicine.

Methods: We conducted a cohort study of patients with type 2 diabetes mellitus (T2DM) hospitalized in Ontario, Canada between 2015 and 2020. We evaluated the patient- and physician-level factors associated with sodium-glucose cotransporter 2 inhibitor (SGLT2) and glucagon-like peptide 1 receptor agonist (GLP1R) use using a multivariable logistic regression model.

Results: There were 253,152 hospitalizations and 68,126 involved patients who had T2DM. Prior to discharge, 3.7 % (N = 2490) of patients with T2DM received an SGLT2 and 0.2 % (N = 121) received a GLP1R. The strongest predictors for receiving a novel diabetes medication were hemoglobin A1C > 9.0 % (Odds Ratio (OR) = 1.81, 95 % Confidence Interval (CI) 1.28, 2.60) and patients aged 40-60 compared with patients <40 years old (OR = 1.81, 95 % CI 1.33, 2.68). The strongest predictors for not receiving a novel diabetes medication were dementia (OR = 0.47, 95 % CI 0.39, 0.56) and creatinine ≥200 μmol/L (OR = 0.11, 95 % CI 0.08, 0.15). Overall, 46.8 % of patients hospitalized with T2DM not receiving a novel diabetes medication would potentially benefit from an SGLT2 inhibitor.

Conclusions: Novel diabetes medications were rarely continued or initiated during hospitalization despite a high prevalence of cardiovascular disease, raising the concern for systematic under-utilization after discharge.