Journal of diabetes and its complications最新文献_第7页

Characterizing the relationship between social determinants of health and risk of albuminuria among children with type 1 diabetes 描述 1 型糖尿病患儿健康的社会决定因素与白蛋白尿风险之间的关系

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-10-09 DOI: 10.1016/j.jdiacomp.2024.108880

Jia Xin Huang , T. Charles Casper , Casey Pitts , Sage R. Myers , Rebecca Lynch , Lindsey Loomba , Janani Ramesh , Nathan Kuppermann , Elaine Ku , Nicole Glaser

In a cohort of 2303 children with type 1 diabetes (T1D), we found that non-English speaking status (HR 2.82, 95% CI 1.54–5.18) and public insurance (HR 1.48, 95% CI 1.07–2.05) were associated with an increased risk of incident albuminuria, after adjusting for T1D-related variables (age, hemoglobin A1c, diabetic ketoacidosis episodes with acute kidney injury).

在一个由2303名1型糖尿病（T1D）儿童组成的队列中，我们发现，在调整了T1D相关变量（年龄、血红蛋白A1c、糖尿病酮症酸中毒发作和急性肾损伤）后，非英语状态（HR 2.82，95% CI 1.54-5.18）和公共保险（HR 1.48，95% CI 1.07-2.05）与发生白蛋白尿的风险增加有关。

引用次数: 0

Endothelial dysfunction markers syndecan-1 and thrombomodulin are associated with higher albuminuria levels in type 2 diabetes with no history of clinical cardiovascular disease 内皮功能障碍标志物辛迪加-1 和血栓调节蛋白与无临床心血管疾病史的 2 型糖尿病患者较高的白蛋白尿水平有关

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-10-09 DOI: 10.1016/j.jdiacomp.2024.108879

Luis F. Ferreira-Divino , Christina G. Poulsen , Viktor Rotbain Curovic , Oliver B. Pedersen , Nete Tofte , Marie Frimodt-Møller , Tine W. Hansen , Anne-Mette Hvas , Peter Rossing

Introduction

Individuals with type 2 diabetes and increased albuminuria, a well-established marker of microvascular complications, are at a higher risk for cardiovascular disease (CVD) and premature mortality. Therefore, a better understanding of the underlying pathophysiology is needed to improve risk stratification and tailor prevention and intervention.

Methods

We conducted a cross-sectional study including 463 individuals with type 2 diabetes, various degrees of albuminuria and without CVD. We analysed the association between albuminuria and markers of endothelial function (thrombomodulin and syndecan-1), thrombin generation (thrombin-antithrombin complex, prothrombin fragment 1 + 2), fibrinogen, platelet function (activation using soluble plasma selectin and aggregation using Multiplate® Analyzer) using regression models.

Results

In the study cohort 33 % were women, the mean ± SD age was 65 ± 9 years, and median [IQR] diabetes duration was 15 [9–20] years. In total, 344 (74 %) individuals had normal albuminuria, 87 (19 %) moderately- and 32 (7 %) severely increased albuminuria levels. Higher markers of endothelial function and fibrinogen were independently associated with higher albuminuria levels (p < 0.01). No association between albuminuria and markers of thrombin generation and platelet was demonstrated.

Conclusion

We demonstrated an independent association between albuminuria and markers of endothelial function and fibrinogen in individuals with type 2 diabetes and no history of CVD.

导言：白蛋白尿是微血管并发症的公认标志，2 型糖尿病患者白蛋白尿增加，患心血管疾病（CVD）和过早死亡的风险更高。因此，需要更好地了解其潜在的病理生理学，以改善风险分层，并进行有针对性的预防和干预。我们使用回归模型分析了白蛋白尿与内皮功能（血栓调节蛋白和辛迪加-1）、凝血酶生成（凝血酶-抗凝血酶复合物、凝血酶原片段 1 + 2）、纤维蛋白原、血小板功能（使用可溶性血浆选择素激活和使用 Multiplate® 分析仪分析聚集）等指标之间的关系。结果在研究队列中，33%为女性，平均（±SD）年龄为65±9岁，糖尿病病程中位数[IQR]为15[9-20]年。共有 344 人（74%）的白蛋白尿水平正常，87 人（19%）的白蛋白尿水平中度升高，32 人（7%）的白蛋白尿水平严重升高。较高的内皮功能指标和纤维蛋白原与较高的白蛋白尿水平独立相关（p < 0.01）。结论我们发现，在没有心血管疾病史的 2 型糖尿病患者中，白蛋白尿与内皮功能和纤维蛋白原指标之间存在独立关联。

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引用次数: 0

The importance of arterial stiffness in pediatric patients with type 1 diabetes mellitus: What's new? 1 型糖尿病儿童患者动脉僵化的重要性：有什么新发现？

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-10-01 DOI: 10.1016/j.jdiacomp.2024.108877

Evangelos C. Rizos , Evangelia E. Ntzani , Imran Rashid Rangraze , Mohamed El-Tanani , Manfredi Rizzo

Youths with type 1 diabetes (T1D) exhibits higher levels of pulse wave velocity (PWV) compared to healthy controls. Higher PWV in T1D subjects is associated with increased hazard of progression in albuminuria, decline in eGFR, cardiovascular (CV) events and mortality. In the recently published work by Georeli et al., increased PWV was associated with poor glycemic control as expressed by time-in-range (TIR) < 50 % in T1D children, adolescents and young adults. This finding is of great interest, since it is well known that glycemic control, as measured by TIR, is an important contributor of CV risk. The duration of TIR < 50 % is not reported by the authors, but is of importance, knowing that CGM provide data for the last 3–6 months, depending on the CGM model. In conclusion, PWV looks promising for risk stratification in T1D, but its exact role in T1D still remains to be fully explored.

与健康对照组相比，1 型糖尿病（T1D）患者的脉搏波速度（PWV）更高。T1D 患者的脉搏波速度越高，白蛋白尿、电子胃泌素抵抗率下降、心血管（CV）事件和死亡率的风险就越高。在 Georeli 等人最近发表的研究中，脉搏波速度增加与血糖控制不佳有关，表现为时间-范围（TIR）

引用次数: 0

Lower extremity amputation rates in patients with chronic kidney disease: A database study comparing patients with and without diabetes mellitus 慢性肾病患者的下肢截肢率：一项比较有糖尿病和无糖尿病患者的数据库研究。

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-09-28 DOI: 10.1016/j.jdiacomp.2024.108876

Dhruv Nandakumar , Matthew J. Johnson , Lawrence A. Lavery , Benjamin M. Conover , Katherine M. Raspovic , David H. Truong , Dane K. Wukich

Lower extremity amputation (LEA) is one of the most feared consequences of diabetes mellitus (DM). The purpose of this study was to evaluate the impact of DM on LEA rates in patients at various stages of chronic kidney disease (CKD).

A commercially available de-identified database was searched for patients undergoing LEA and for CKD patients, from 2010 to 2023. Patients with DM and patients without DM who were followed for at least 5 years were included. LEA rates were then compared for patients at all 5 CKD stages in patients with and without diabetes.

Rates of all LEA were found to be significantly higher at all CKD stages for patients with diabetes (overall, minor and major LEA). Compared to patients without DM who have CKD stage 5 (end stage renal disease), patients with DM and CKD stage 5 have a 30 fold increased likelihood of undergoing overall LEA [OR 30.2 (24.48–37.19), p < 0.001], 29 fold increased likelihood of undergoing minor LEA [28.9i (22.91–36.35), p < 0.001] and 40 times fold increased likelihood of undergoing major LEA [40.1 (26.59–60.42), p < 0.001]. For all stages of CKD, independent of diabetes status, minor LEA were performed with greater frequency than major LEA. In patients with DM, LEA rates significantly increased with CKD progression between stages 2–5 with a substantial jump between stages 4 and 5 [OR 2.6 (CI 2.49–2.74), p < 0.001]. However, CKD progression between stages 1 and 2 was not significantly associated with increased LEA rates (OR 1.1 (CI 0.92–1.21), p = 0.24) in patients with diabetes.

Patients with comorbid diabetes have elevated risk for LEA at all stages of CKD compared to those without diabetes.

下肢截肢（LEA）是糖尿病（DM）最令人担忧的后果之一。本研究旨在评估糖尿病对处于不同阶段的慢性肾脏病（CKD）患者下肢截肢率的影响。研究人员在一个商业化的去身份化数据库中搜索了 2010 年至 2023 年接受 LEA 的患者和 CKD 患者。其中包括随访至少 5 年的 DM 患者和非 DM 患者。然后比较了CKD所有5个分期中糖尿病患者和非糖尿病患者的LEA率。结果发现，糖尿病患者在所有 CKD 阶段的所有 LEA 率（总体、轻微和严重 LEA）都明显较高。与未患有糖尿病且处于 CKD 第 5 阶段（终末期肾病）的患者相比，患有糖尿病且处于 CKD 第 5 阶段的患者接受总体 LEA 的可能性增加了 30 倍[OR 30.2 (24.48-37.19)，p

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引用次数: 0

Association of detectable C-peptide levels with glycemic control and chronic complications in individuals with type 1 diabetes mellitus: A systematic review and meta-analysis

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-09-26 DOI: 10.1016/j.jdiacomp.2024.108867

Mahin Seifi Alan , Amirhossein Tayebi , Elmira Jafari Afshar , Sanaz Seifi Alan , Mahnaz Seifi Alan , Ramina Fazeli , Tooba Sohbatzade , Parham Samimisedeh , Hadith Rastad

Aims

Multiple studies have addressed the association between detectable levels of C-peptide and glycemic control, as well as the development of chronic complications of type 1 diabetes mellitus (T1DM), including both macrovascular and microvascular diseases. We aimed to summarize the available evidence on the clinical significance of detectable levels of C-peptide in T1DM.

Method

A systematic search was performed on online databases using the following key terms: T1DM, C-peptide, diabetes mellitus complications, and glycemic parameters. We pooled standardized mean difference (SMD) and odds ratios (OR).

Results

Of the 1519 articles retrieved from the initial search, 38 (12 cohort and 26 cross-sectional studies) met our eligibility criteria. Individuals with T1DM in the detectable C-peptide group, compared with the undetectable C-peptide group, had lower mean HbA1c [pooled SMD (95 % confidence interval (95 % CI)): −0.08 (−0.13 to −0.02), I² = 0 %, p.value: 0.005] and daily insulin dose [−0.41 (−0.65 to −0.18), I² = 83 %, p.value < 0.001]. They also showed lower odds for retinopathy [pooled crude OR (95 % CI): 0.53 (0.41 to 0.69), I² = 65 %, p.value < 0.001] and nephropathy complications [0.62 (0.55 to 0.70), I² = 19 %, p.value < 0.001]; however, the two groups were similar regarding neuropathy [0.92 (0.65 to 1.31), I² = 0 %, p.value: 0.31].

Conclusions

The available evidence suggests that individuals with T1DM in the detectable C-peptide group may experience better clinical outcomes.

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引用次数: 0

Monitoring the liver as a part of the cardio-renal-metabolic continuum – What is cooking and burning with non-invasive tests and treatment options? 监测肝脏是心-肾-代谢连续体的一部分--无创检测和治疗方案的烹饪和燃烧是什么？

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-09-24 DOI: 10.1016/j.jdiacomp.2024.108875

Špela Volčanšek , Andrej Janež , Manfredi Rizzo , Emir Muzurović

引用次数: 0

Association between Mediterranean diet adherence and peripheral artery disease in type 2 diabetes mellitus: An observational study 2型糖尿病患者坚持地中海饮食与外周动脉疾病之间的关系：一项观察性研究。

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-09-23 DOI: 10.1016/j.jdiacomp.2024.108871

Sara Zúnica-García , José F. Javier Blanquer-Gregori , Ruth Sánchez-Ortiga , Esther Chicharro-Luna , María Isabel Jiménez-Trujillo

Introduction

To evaluate the relationship between adherence to the Mediterranean diet (MD) and periphereal artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM).

Methods

An observational sectional study was conducted with 174 patients diagnosed with T2DM, of which 78 patients had PAD. A patient was considered to have PAD if they obtained an ankle-brachial index (ABI) < 0.9 and/or absence of both distal pulses in one of the two feet. Data on sociodemographic and anthropometric variables, physical activity, smoking habits, biochemical blood parameters, and comorbidities were recorded. Good adherence to the MD was considered with a score ≥ 9 in MEDAS-14. Vascular factors independently associated with adherence to the MD in patients with T2DM were identified through multivariate logistic regression analysis.

Results

ABI, DFU, intermittent claudication and pedal pulse absence correlated with MD adherence. DFU, intermittent claudication and posterior tibial pulse absence were associated with the final score obtained in the MEDAS-14. Nut consumption, white meat preference and sautéed dish intake were associated with PAD presence. Multivariate analysis linked MD adherence to sex (OR = 0.044, 95 % CI 0.003–0619), age (OR = 0.139, 95 % CI 0.029–0.666), duration of T2DM (OR = 7.383, 95 % CI 1.523–35.779) and age at diagnosis of T2DM (OR = 6082, 95 % IC 1.415–26.136), as well as the presence of DFU (OR = 0.000, 95 % IC 0.000–0.370) and intermittent claudication (OR = 0.004, 95 % IC 0.000–0.534).

Conclusions

Adherence to the MD is associated with a reduction in vascular complications in T2DM, highlighting its potential as a dietary intervention strategy.

简介：目的：评估2型糖尿病（T2DM）患者坚持地中海饮食（MD）与周身动脉疾病（PAD）之间的关系：评估地中海饮食（Mediterranean diet，MD）与 2 型糖尿病（T2DM）患者周身动脉疾病（PAD）之间的关系：方法：对 174 名确诊为 T2DM 的患者进行了观察性分段研究，其中 78 名患者患有 PAD。如果患者获得了踝肱指数（ABI），则被认为患有 PAD：ABI、DFU、间歇性跛行和足部脉搏缺失与坚持用药相关。DFU、间歇性跛行和胫后脉搏缺失与 MEDAS-14 的最终得分相关。坚果摄入量、白肉偏好和炒菜摄入量与是否存在 PAD 相关。多变量分析显示，MD 的坚持率与性别（OR = 0.044，95 % CI 0.003-0619）、年龄（OR = 0.139，95 % CI 0.029-0.666）、T2DM 持续时间（OR = 7.383，95 % CI 1.523-35.779）和诊断年龄有关。779）、诊断 T2DM 时的年龄（OR = 6082，95 % IC 1.415-26.136）以及是否存在 DFU（OR = 0.000，95 % IC 0.000-0.370）和间歇性跛行（OR = 0.004，95 % IC 0.000-0.534）：结论：坚持MD与T2DM血管并发症的减少有关，突出了其作为饮食干预策略的潜力。

{"title":"Association between Mediterranean diet adherence and peripheral artery disease in type 2 diabetes mellitus: An observational study","authors":"Sara Zúnica-García , José F. Javier Blanquer-Gregori , Ruth Sánchez-Ortiga , Esther Chicharro-Luna , María Isabel Jiménez-Trujillo","doi":"10.1016/j.jdiacomp.2024.108871","DOIUrl":"10.1016/j.jdiacomp.2024.108871","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate the relationship between adherence to the Mediterranean diet (MD) and periphereal artery disease (PAD) in patients with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>An observational sectional study was conducted with 174 patients diagnosed with T2DM, of which 78 patients had PAD. A patient was considered to have PAD if they obtained an ankle-brachial index (ABI) < 0.9 and/or absence of both distal pulses in one of the two feet. Data on sociodemographic and anthropometric variables, physical activity, smoking habits, biochemical blood parameters, and comorbidities were recorded. Good adherence to the MD was considered with a score ≥ 9 in MEDAS-14. Vascular factors independently associated with adherence to the MD in patients with T2DM were identified through multivariate logistic regression analysis.</div></div><div><h3>Results</h3><div>ABI, DFU, intermittent claudication and pedal pulse absence correlated with MD adherence. DFU, intermittent claudication and posterior tibial pulse absence were associated with the final score obtained in the MEDAS-14. Nut consumption, white meat preference and sautéed dish intake were associated with PAD presence. Multivariate analysis linked MD adherence to sex (OR = 0.044, 95 % CI 0.003–0619), age (OR = 0.139, 95 % CI 0.029–0.666), duration of T2DM (OR = 7.383, 95 % CI 1.523–35.779) and age at diagnosis of T2DM (OR = 6082, 95 % IC 1.415–26.136), as well as the presence of DFU (OR = 0.000, 95 % IC 0.000–0.370) and intermittent claudication (OR = 0.004, 95 % IC 0.000–0.534).</div></div><div><h3>Conclusions</h3><div>Adherence to the MD is associated with a reduction in vascular complications in T2DM, highlighting its potential as a dietary intervention strategy.</div></div>","PeriodicalId":15659,"journal":{"name":"Journal of diabetes and its complications","volume":"38 11","pages":"Article 108871"},"PeriodicalIF":2.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lipid profile is similar in both subjects with high 1-hour postload glucose and 2-hour postload glucose and is related to cardio-metabolic profile in prediabetes 负荷后 1 小时血糖高和负荷后 2 小时血糖高的受试者的血脂状况相似，并且与糖尿病前期的心血管代谢状况有关。

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-09-18 DOI: 10.1016/j.jdiacomp.2024.108869

Rumyana Dimova, Nevena Chakarova, Mina Serdarova, Tsvetalina Tankova

Aim

The study aimed to investigate a lipid profile in people with normal glucose tolerance (NGT), NGT and 1hrOGTT > 8.6 mmol/l, and impaired glucose tolerance (IGT); and to assess its association with some cardio-metabolic parameters.

Material and methods

A total of 90 subjects, of mean age 46.7 ± 10.5 years and mean BMI of 32.0 ± 6.3 kg/m² were enrolled. They were divided into 3 groups: 19 with NGT, 22 with NGT and 1hrOGTT > 8.6 mmol/l, and 49 with IGT; and subdivided into 2 subgroups according to HOMA-IR: 40 with HOMA-IR < 2.5 and 50 with HOMA-IR ≥ 2.5. Body composition (Inbody 720) and advanced glycation end products (AGE Reader) were assessed. Two functional tests (OGTT; MMTT) were performed and AUC for glucose, insulin and triglycerides were calculated.

Results

There was no difference across the glucose tolerance groups for all evaluated lipids. The results showed higher AUC_insulin during OGTT (p = 0.037 and 0.020), AUC_{triglycerides} during MMTT (p = 0.048) and triglycerides/HDL ratio (p = 0.064 and 0.016) in the 1hrOGTT and IGT subgroups with HOMA-IR ≥ 2.5 in comparison to those with HOMA-IR < 2.5. AUC_{triglycerides} during OGTT is independently related to body composition, b-cell function and insulin sensitivity; and AUC_{triglycerides} during MMTT is independently related to blood pressure and hsCRP in prediabetes. Triglycerides/HDL-C ratio emerged as an independent contributor to glycaemia and insulinemia.

Conclusion

Our results demonstrate a similar lipid profile in subjects with 1hrOGTT > 8.6 mmol/l and IGT, whereas increased AUC_{triglycerides} during OGTT, AUC_{triglycerides} during MMTT and triglycerides/HDL-C ratio have been found in the subgroups with insulin resistance. The triglycerides/HDL-C ratio outlined as an independent predictor of insulin secretion and action, and postload triglycerides appear to be independently related to most of the metabolic parameters.

目的：该研究旨在调查正常糖耐量（NGT）、NGT 和 1hrOGTT > 8.6 mmol/l 以及糖耐量受损（IGT）人群的血脂状况，并评估其与一些心血管代谢参数的关系：共招募了 90 名受试者，平均年龄为 46.7 ± 10.5 岁，平均体重指数为 32.0 ± 6.3 kg/m2。他们被分为 3 组：19 人患有 NGT，22 人患有 NGT 且 1hrOGTT > 8.6 mmol/l，49 人患有 IGT；根据 HOMA-IR 再分为 2 个亚组：40 人患有 HOMA-IR 结果：各糖耐量组的血脂评估结果均无差异。结果显示，与 HOMA-IR ≥ 2.5 的 1hrOGTT 和 IGT 亚组相比，HOMA-IR ≥ 2.5 的 1hrOGTT 和 IGT 亚组在 OGTT 期间的胰岛素 AUC（p = 0.037 和 0.020）、MMTT 期间的甘油三酯 AUC（p = 0.048）和甘油三酯/高密度脂蛋白比率（p = 0.064 和 0.016）更高。与 HOMA-IR ≥ 2.5 的亚组相比，OGTT 期间的甘油三酯与身体组成、b 细胞功能和胰岛素敏感性独立相关；MMTT 期间的甘油三酯 AUC 与糖尿病前期的血压和 hsCRP 独立相关。甘油三酯/高密度脂蛋白胆固醇比率是导致血糖和胰岛素血症的独立因素：我们的研究结果表明，1hrOGTT > 8.6 mmol/l 和 IGT 受试者的血脂状况相似，而在胰岛素抵抗亚组中，OGTT 期间的 AUCtriglycerides、MMTT 期间的 AUCtriglycerides 和甘油三酯/HDL-C 比率均有所增加。甘油三酯/HDL-C比率是胰岛素分泌和作用的独立预测指标，负荷后甘油三酯似乎与大多数代谢参数都有独立的关系。

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引用次数: 0

Effectiveness of screening for foot complications in people with diabetes – A systematic review 糖尿病患者足部并发症筛查的有效性--系统性综述

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-09-18 DOI: 10.1016/j.jdiacomp.2024.108865

Aleksandra Staniszewska , Amy Jones , Sarah Rudd , Frank de Vocht , Robert Hinchliffe

Background

A quarter of people with diabetes develop foot ulcer in their lifetime and are six times more likely to require a major lower limb amputation compared to the general population. Risk stratification tools can reliably identify those at the highest risk of ulceration, but it remains unclear if screening for foot complications can prevent limb loss in people with diabetes.

Aims

The aim of this systematic review was to determine whether population-based foot screening in people with diabetes reduces lower limb complications as assessed by development of foot ulceration, minor and major lower limb amputations, hospitalisation, or death.

Methods

MEDLINE, Embase, Emcare and CINAHL databases were searched to identify randomised and non-randomised controlled trials and observational studies (cohort, case-control and cross-sectional surveys). The screening process, study quality assessment and data extraction were performed by two independent reviewers.

Results

Following abstract screening and assessment for eligibility, five out of 10,771 identified studies were included in the analysis. Of these studies, one demonstrated 24 % reduction in development of new ulceration following introduction of screening. Major amputations decreased by between 17 and 96 % in three studies. Hospitalisation rates were contradictory, with one study showing doubling in hospital admissions and another one reduction by 33 %. One study demonstrated no impact of screening on minor or major amputation rates. None of the studies addressed the effect of foot screening on all-cause mortality.

Conclusions

The number and quality of studies to support population-based foot screening to prevent lower limb complications in people with diabetes is low. Current evidence suggests variable impact of screening on important clinical outcomes.

背景四分之一的糖尿病患者在其一生中会出现足部溃疡，与普通人群相比，他们需要进行下肢大截肢的几率要高出六倍。风险分层工具可以可靠地识别出溃疡风险最高的人群，但目前仍不清楚足部并发症筛查能否预防糖尿病患者的肢体损失。目的本系统性综述旨在确定糖尿病患者的足部筛查是否能减少下肢并发症，其评估指标包括足部溃疡、轻度和重度下肢截肢、住院或死亡。方法检索了MEDLINE、Embase、Emcare和CINAHL数据库，以确定随机和非随机对照试验以及观察性研究（队列、病例对照和横断面调查）。筛选过程、研究质量评估和数据提取由两名独立审稿人完成。结果经过摘要筛选和资格评估，10771 项已确定的研究中有 5 项纳入了分析。在这些研究中，有一项研究表明，在引入筛查后，新发溃疡减少了 24%。在三项研究中，重大截肢减少了 17% 到 96%。住院率则存在矛盾，一项研究显示住院率增加了一倍，而另一项研究则减少了 33%。一项研究表明，筛查对轻度或重度截肢率没有影响。没有一项研究涉及足部筛查对全因死亡率的影响。结论：支持通过足部筛查预防糖尿病患者下肢并发症的研究数量少、质量低。目前的证据表明，筛查对重要临床结果的影响各不相同。

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引用次数: 0

Circulating CD31+ Angiogenic T cells are reduced in prediabetes and increase with exercise training 循环 CD31+ 血管生成 T 细胞在糖尿病前期会减少，在运动训练后会增加

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications

Pub Date : 2024-09-17 DOI: 10.1016/j.jdiacomp.2024.108868

Callum J. Baker , Danqing Min , Felix Marsh-Wakefield , Elisha Siwan , James Gerofi , Xiaoyu Wang , Samantha L. Hocking , Stephen Colagiuri , Nathan A. Johnson , Stephen M. Twigg

Aims

To investigate circulating angiogenic cells in adults with prediabetes and the effect of a structured exercise program.

Methods

A cohort of adults with overweight/obesity and either normal glucose (NG) or prediabetes were randomised to receive exercise (Exercise) (as twice weekly supervised combined high intensity aerobic exercise and progressive resistance training, and once weekly home-based aerobic exercise) or an unsupervised stretching intervention (Control) for 12 weeks. Circulating angiogenic T cells, muscle strength, and cardiovascular disease risk factors, including blood lipids, arterial stiffness, central haemodynamic responses, and cardiorespiratory fitness (VO₂peak) in those with prediabetes (n = 35, 16 Control, 19 Exercise) and NG (n = 37, 17 Control, 20 Exercise) were analysed at baseline and after the 12-week intervention.

Results

At baseline, compared with NG those with prediabetes demonstrated reduced VO₂peak, angiogenic CD31⁺CD8⁺ T cells and VEGFR2⁺CD4⁺ T cells, and increased systolic blood pressure. CD31⁺ T cells were negatively correlated with cardiovascular disease (CVD) risk. Compared with Control, exercise training increased muscle strength, VO₂peak, and CD31⁺CD4⁺ and CD31⁺CD8⁺ T cells in NG and prediabetes.

Conclusions

Circulating angiogenic CD31⁺ T cells are decreased in people with prediabetes and are enhanced with exercise training. Exercise increases CD31⁺ T cells, and through this mechanism it is proposed that it may reduce CVD risk.

Trial registration

Australian New Zealand Clinical Trials Registry number: ACTRN12617000552381.

方法将一组超重/肥胖、血糖正常（NG）或糖尿病前期的成年人随机分配到接受运动（运动）（每周两次有监督的高强度有氧运动和渐进阻力训练，每周一次在家进行有氧运动）或无监督拉伸干预（对照组）的人群中，为期 12 周。对糖尿病前期患者（n = 35，16 个对照组，19 个运动组）和 NG 患者（n = 37，17 个对照组，20 个运动组）在基线和 12 周干预后的循环血管生成 T 细胞、肌肉力量和心血管疾病风险因素（包括血脂、动脉僵化、中心血流动力学反应和心肺功能（VO2 峰值））进行分析。结果基线时，与 NG 相比，糖尿病前期患者的 VO2 峰值、血管生成 CD31+CD8+ T 细胞和 VEGFR2+CD4+ T 细胞均有所降低，收缩压也有所升高。CD31+ T细胞与心血管疾病（CVD）风险呈负相关。与对照组相比，运动训练可增加 NG 和糖尿病前期患者的肌力、VO2 峰值、CD31+CD4+ 和 CD31+CD8+ T 细胞。运动可增加 CD31+ T 细胞，通过这一机制，运动可降低心血管疾病风险：ACTRN12617000552381。

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引用次数: 0