Xiaoyan Lin, Xiaoling Li, Junsheng Wang, Huiheng Liu
Objective: To determine the value of lymphocyte subsets and granulocyte/monocyte surface markers in predicting the risk of post-acute pancreatitis diabetes (PPDM-A).
Methods: This study included 308 in patients with acute pancreatitis (AP). The markers of granulocytes and monocytes and lymphocyte subsets were detected by flow cytometry, and the fluorescence intensity, absolute count and percentage were obtained. Based on the occurrence of diabetes after AP, patients were divided into two groups: PPDM-A and PPNG-A (post-acute pancreatitis with normal glucose). Correlations between granulocyte and monocyte surface markers and lymphocyte subsets were analyzed. Binary logistic regression was used to analyze the potential influencing factors of PPDM-A.
Methods: Compared with patients with PPNG-A, patients with PPDM-A tend to be younger (p < 0.001) and have a higher proportion of fatty liver, recurrent pancreatitis, and hyperlipidemic pancreatitis. The results of linear regression showed that B% was negatively correlated with MFI of HLA-DR on monocytes (R2 = 0.145, p < 0.001), B% was positively correlated with CD10-NEUT% (R2 = 0.291, p < 0.001), and MFI of HLA-DR on monocytes was negatively correlated with CD10-NEUT% (R2 = 0.457, p < 0.001). Multivariate logistic regression analysis revealed that age, serous effusion, fatty liver, recurrent pancreatitis, and B% were independent risk factors for the occurrence of PPDM-A.
Conclusion: Our study has first confirmed the correlation between PPDM-A and lymphocyte subsets and CD10-NEUT%. Furthermore we indicated that age, fatty liver, serous effusion, recurrent AP, and B% were independent risk factors for PPDM-A. The mechanism of granulocyte and monocyte surface markers and B lymphocytes on PPDM-A is worthy of study. This would help clarify the pathogenesis of PPDM-A at the cellular level and potentially provide new strategies for immunotherapy and even disease prevention.
{"title":"B Lymphocyte-A Prognostic Indicator in Post-Acute Pancreatitis Diabetes Mellitus.","authors":"Xiaoyan Lin, Xiaoling Li, Junsheng Wang, Huiheng Liu","doi":"10.1111/1753-0407.70047","DOIUrl":"10.1111/1753-0407.70047","url":null,"abstract":"<p><strong>Objective: </strong>To determine the value of lymphocyte subsets and granulocyte/monocyte surface markers in predicting the risk of post-acute pancreatitis diabetes (PPDM-A).</p><p><strong>Methods: </strong>This study included 308 in patients with acute pancreatitis (AP). The markers of granulocytes and monocytes and lymphocyte subsets were detected by flow cytometry, and the fluorescence intensity, absolute count and percentage were obtained. Based on the occurrence of diabetes after AP, patients were divided into two groups: PPDM-A and PPNG-A (post-acute pancreatitis with normal glucose). Correlations between granulocyte and monocyte surface markers and lymphocyte subsets were analyzed. Binary logistic regression was used to analyze the potential influencing factors of PPDM-A.</p><p><strong>Methods: </strong>Compared with patients with PPNG-A, patients with PPDM-A tend to be younger (p < 0.001) and have a higher proportion of fatty liver, recurrent pancreatitis, and hyperlipidemic pancreatitis. The results of linear regression showed that B% was negatively correlated with MFI of HLA-DR on monocytes (R<sup>2</sup> = 0.145, p < 0.001), B% was positively correlated with CD10<sup>-</sup>NEUT% (R<sup>2</sup> = 0.291, p < 0.001), and MFI of HLA-DR on monocytes was negatively correlated with CD10<sup>-</sup>NEUT% (R<sup>2</sup> = 0.457, p < 0.001). Multivariate logistic regression analysis revealed that age, serous effusion, fatty liver, recurrent pancreatitis, and B% were independent risk factors for the occurrence of PPDM-A.</p><p><strong>Conclusion: </strong>Our study has first confirmed the correlation between PPDM-A and lymphocyte subsets and CD10<sup>-</sup>NEUT%. Furthermore we indicated that age, fatty liver, serous effusion, recurrent AP, and B% were independent risk factors for PPDM-A. The mechanism of granulocyte and monocyte surface markers and B lymphocytes on PPDM-A is worthy of study. This would help clarify the pathogenesis of PPDM-A at the cellular level and potentially provide new strategies for immunotherapy and even disease prevention.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 1","pages":"e70047"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: Type 2 diabetes mellitus (T2DM) contributes to the heavy burden, but there lacks latest and comprehensive global research on the burden of T2DM attributable to low physical activity (LPA). This study aimed to quantify the global and regional burden of T2DM attributable to LPA from 1990 to 2021.
Methods: We utilized data including disability-adjusted life years (DALYs), mortality, age-standardized disability-adjusted life years (ASDR), and age-standardized mortality rates (ASMR) from the Global Burden of Disease (GBD) 2021. We assessed the burden across different ages, genders, and sociodemographic index (SDI). Joinpoint regression analysis was applied to estimated average annual percent change (AAPC).
Results: Between 1990 and 2021, DALYs and mortality of T2DM attributable to LPA increased rapidly. There was an increase in the ASDR and ASMR, with AAPC of 1.09 (95% CI: 1.03-1.16) and 0.32 (95% CI: 0.2-0.43), which was increased faster in males. Low-middle SDI countries have the highest ASDR and highest ASMR. The global PAF for ASDR and ASMR in 2021 is 7.38% and 9.45%. A U-shaped drift pattern was observed in most SDI quintiles in APC model. Population growth is a major contributor to the burden of T2DM, especially in countries with low SDI. Epidemiological changes also play an important role in DALYs and mortality. A negative correlation existed between SDI and both ASMR and ASDR.
Conclusion: Between 1990 and 2021, there was a marked rise in the global burden of T2DM associated with LPA. The findings lay the groundwork for informed decision-making a public health and healthcare delivery.
{"title":"Global and Regional Burden of Type 2 Diabetes Mellitus Attributable to Low Physical Activity From 1990 to 2021.","authors":"Lihang Yang, Diya Xie, Fengmin Liu, Jiaying Lin, Xin Lin, Yuquan Chen, Kun Zhang","doi":"10.1111/1753-0407.70043","DOIUrl":"https://doi.org/10.1111/1753-0407.70043","url":null,"abstract":"<p><strong>Aim: </strong>Type 2 diabetes mellitus (T2DM) contributes to the heavy burden, but there lacks latest and comprehensive global research on the burden of T2DM attributable to low physical activity (LPA). This study aimed to quantify the global and regional burden of T2DM attributable to LPA from 1990 to 2021.</p><p><strong>Methods: </strong>We utilized data including disability-adjusted life years (DALYs), mortality, age-standardized disability-adjusted life years (ASDR), and age-standardized mortality rates (ASMR) from the Global Burden of Disease (GBD) 2021. We assessed the burden across different ages, genders, and sociodemographic index (SDI). Joinpoint regression analysis was applied to estimated average annual percent change (AAPC).</p><p><strong>Results: </strong>Between 1990 and 2021, DALYs and mortality of T2DM attributable to LPA increased rapidly. There was an increase in the ASDR and ASMR, with AAPC of 1.09 (95% CI: 1.03-1.16) and 0.32 (95% CI: 0.2-0.43), which was increased faster in males. Low-middle SDI countries have the highest ASDR and highest ASMR. The global PAF for ASDR and ASMR in 2021 is 7.38% and 9.45%. A U-shaped drift pattern was observed in most SDI quintiles in APC model. Population growth is a major contributor to the burden of T2DM, especially in countries with low SDI. Epidemiological changes also play an important role in DALYs and mortality. A negative correlation existed between SDI and both ASMR and ASDR.</p><p><strong>Conclusion: </strong>Between 1990 and 2021, there was a marked rise in the global burden of T2DM associated with LPA. The findings lay the groundwork for informed decision-making a public health and healthcare delivery.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 1","pages":"e70043"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saixian Shi, Xiaofeng Li, Ye Chen, Jiahao Li, Yan Dai
Objective: Provide an evidence-based basis for the selection of cardiovascular benefit drugs in Type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD).
Methods: Conduct a comprehensive search of all relevant literature from PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials.gov from their establishment until December 13, 2023, and select randomized controlled trials (RCTs) that meet the pre-established inclusion and exclusion criteria. Use the Cochrane bias risk assessment tool to evaluate the quality of the included literature. Use R 4.3.2 software to conduct network meta-analysis for drug category comparison.
Results: A total of 24 large-scale randomized controlled trials (RCTs) were included, including 19 intervention measures, and 172 803 patients participated in the study. The results of the network meta-analysis show that: GLP1RA (OR 0.89, 95% CI 0.81-0.97) and SGLT2i (OR 0.91, 95% CI 0.83-0.99) can reduce the occurrence of major adverse cardiovascular events (MACE), GLP1RA (OR 0.88, 95% CI 0.79-0.97) and SGLT2i (OR 0.89, 95% CI 0.81-0.99) reduced the risk of cardiovascular death. SGLT2i (OR 0.68, 95% CI 0.62-0.75) reduced the occurrence of hospitalization for heart failure, GLP1RA (OR 0.88, 95% CI 0.81-0.97) and SGLT2i (OR 0.89, 95% CI 0.80-0.97) reduced the occurrence of all-cause death.
Conclusion: In the comparison of new hypoglycemic drug classes, GLP1RA and SGLT2i reduced MACE, cardiovascular mortality and all-cause mortality in T2DM patients with CVD, with no significant difference in efficacy, and DPP4i was noninferior to placebo. Only GLP1RA reduced the risk of nonfatal stroke, and only SGLT2i reduced the risk of HHF.
{"title":"Cardiovascular Therapy Benefits of Novel Antidiabetic Drugs in Patients With Type 2 Diabetes Mellitus Complicated With Cardiovascular Disease: A Network Meta-Analysis.","authors":"Saixian Shi, Xiaofeng Li, Ye Chen, Jiahao Li, Yan Dai","doi":"10.1111/1753-0407.70044","DOIUrl":"10.1111/1753-0407.70044","url":null,"abstract":"<p><strong>Objective: </strong>Provide an evidence-based basis for the selection of cardiovascular benefit drugs in Type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD).</p><p><strong>Methods: </strong>Conduct a comprehensive search of all relevant literature from PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials.gov from their establishment until December 13, 2023, and select randomized controlled trials (RCTs) that meet the pre-established inclusion and exclusion criteria. Use the Cochrane bias risk assessment tool to evaluate the quality of the included literature. Use R 4.3.2 software to conduct network meta-analysis for drug category comparison.</p><p><strong>Results: </strong>A total of 24 large-scale randomized controlled trials (RCTs) were included, including 19 intervention measures, and 172 803 patients participated in the study. The results of the network meta-analysis show that: GLP1RA (OR 0.89, 95% CI 0.81-0.97) and SGLT2i (OR 0.91, 95% CI 0.83-0.99) can reduce the occurrence of major adverse cardiovascular events (MACE), GLP1RA (OR 0.88, 95% CI 0.79-0.97) and SGLT2i (OR 0.89, 95% CI 0.81-0.99) reduced the risk of cardiovascular death. SGLT2i (OR 0.68, 95% CI 0.62-0.75) reduced the occurrence of hospitalization for heart failure, GLP1RA (OR 0.88, 95% CI 0.81-0.97) and SGLT2i (OR 0.89, 95% CI 0.80-0.97) reduced the occurrence of all-cause death.</p><p><strong>Conclusion: </strong>In the comparison of new hypoglycemic drug classes, GLP1RA and SGLT2i reduced MACE, cardiovascular mortality and all-cause mortality in T2DM patients with CVD, with no significant difference in efficacy, and DPP4i was noninferior to placebo. Only GLP1RA reduced the risk of nonfatal stroke, and only SGLT2i reduced the risk of HHF.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 1","pages":"e70044"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To determine whether the use of herbal medicines combined with conventional treatment is more effective than conventional medication alone in improving clinical symptoms in patients with diabetic distal symmetric polyneuropathy (DSPN).
Methods: This multicenter, placebo-controlled, double-blind, randomized controlled clinical trial recruited patients from 6 clinical centers in mainland China. A total of 188 patients were randomly assigned in a 1:1 ratio to the treatment group (Tangbi Formula plus methylcobalamin) and the control group (placebo plus methylcobalamin). Subjects were reassessed after the 24-week intervention. The primary outcomes were differences in changes in clinical signs and symptoms and changes in the Michigan Diabetic Neuropathy Score (MDNS) between the two groups before and after treatment. Secondary outcomes were changes in nerve conduction velocity (NCV) and single clinical signs and symptoms as measured by the visual-analogue scale (VAS) and Toronto clinical scoring system (TCSS).
Results: Compared with the placebo group, after 24 weeks of treatment, the MDNS score of TangBi Formula group was significantly reduced (p < 0.001). There were no significant changes in NCV results in either group before or after treatment. Compared with baseline, the difference in the change value of VAS score between the two groups after treatment was statistically significant (p = 0.031). A statistically significant difference in the change value of TCSS after treatment compared to baseline was found between the two groups (p = 0.033 at 12 weeks and p = 0.030 at 24 weeks). No severe adverse events due to study participation or study intervention were reported.
Conclusions and relevance: This trial demonstrated that combining Tangbi Formula with basal therapy can be safer and more effective in improving the symptoms of DSPN patients.
{"title":"TangBi Formula for Painful Diabetic Distal Symmetric Polyneuropathy: A Multicenter, Randomized, Double-Blind, Placebo-Controlled and Parallel-Group Trial.","authors":"Xuefei Zhao, Xuedong An, Yashan Cui, Liu Dong, Zhaohui Fang, Zhonghua Zheng, Xinhe Zuo, Huailin Gao, Tianshu Gao, Qing Ni, Fengmei Lian, Xiaolin Tong","doi":"10.1111/1753-0407.70045","DOIUrl":"10.1111/1753-0407.70045","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the use of herbal medicines combined with conventional treatment is more effective than conventional medication alone in improving clinical symptoms in patients with diabetic distal symmetric polyneuropathy (DSPN).</p><p><strong>Methods: </strong>This multicenter, placebo-controlled, double-blind, randomized controlled clinical trial recruited patients from 6 clinical centers in mainland China. A total of 188 patients were randomly assigned in a 1:1 ratio to the treatment group (Tangbi Formula plus methylcobalamin) and the control group (placebo plus methylcobalamin). Subjects were reassessed after the 24-week intervention. The primary outcomes were differences in changes in clinical signs and symptoms and changes in the Michigan Diabetic Neuropathy Score (MDNS) between the two groups before and after treatment. Secondary outcomes were changes in nerve conduction velocity (NCV) and single clinical signs and symptoms as measured by the visual-analogue scale (VAS) and Toronto clinical scoring system (TCSS).</p><p><strong>Results: </strong>Compared with the placebo group, after 24 weeks of treatment, the MDNS score of TangBi Formula group was significantly reduced (p < 0.001). There were no significant changes in NCV results in either group before or after treatment. Compared with baseline, the difference in the change value of VAS score between the two groups after treatment was statistically significant (p = 0.031). A statistically significant difference in the change value of TCSS after treatment compared to baseline was found between the two groups (p = 0.033 at 12 weeks and p = 0.030 at 24 weeks). No severe adverse events due to study participation or study intervention were reported.</p><p><strong>Conclusions and relevance: </strong>This trial demonstrated that combining Tangbi Formula with basal therapy can be safer and more effective in improving the symptoms of DSPN patients.</p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"17 1","pages":"e70045"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Diabetes mellitus, affecting 537 million people globally [<span>1</span>], is a chronic metabolic disorder with well-documented “legacy effects” of early hyperglycemia on complications that persist for decades [<span>2</span>]. The importance of early intensive glycemic control is evidenced by long-term follow-up data from the United Kingdom Prospective Diabetes Study, demonstrating that it lowers the risks of mortality and both microvascular and macrovascular complications, yielding life-long benefits [<span>3</span>].</p><p>Nevertheless, glycemic control in type 2 diabetes (T2DM) remains inadequate globally, particularly in China, where only fewer than 50% of patients achieve HbA1c < 7% [<span>4</span>]. Moreover, severe hyperglycemia at diagnosis is prevalent. A retrospective study in China showed that 44.5% of newly diagnosed patients present with HbA1c > 9% [<span>5</span>]. This fact poses a substantial challenge for achieving early and sustained glycemic control.</p><p>The traditional stepwise escalation approach, which gradually intensifies treatment in response to worsening hyperglycemia, often fails to achieve optimal glycemic control and prevent progressive β-cell dysfunction. Timely initiation of combination therapy is recommended for marked hyperglycemia. Current guidelines from the American Diabetes Association recommend combination therapy when HbA1c exceeds treatment targets by 1.5% (≥ 8.5%) and insulin for HbA1c > 10%, expecting simplifying treatment after correction of glucotoxicity [<span>6</span>]. However, because high-quality evidence is lacking, no standardized guidance could be provided. Indeed, more potent combination regimens may result in superior glycemic control. As shown in the EDICT study, a triple therapy regimen consisting of metformin, pioglitazone, and exenatide achieved HbA1c < 6.5% in 78% of participants over 3 years [<span>7</span>]. However, real-world challenges, including adherence, tolerability, and cost, limit broader implementation of combination therapy, particularly that with injectable agents [<span>8</span>].</p><p>Simplified treatment regimens have consistently been an urgent need for healthcare providers and patients. Nevertheless, as Leonardo da Vinci famously said, “Simplicity is the ultimate sophistication.” Achieving both optimal glycemic control and treatment simplification requires a shift in strategy to pay more attention to the reversibility of β-cell dysfunction in early T2DM. This requires addressing the major mechanisms of disease progression. In patients with significant hyperglycemia, glucotoxicity plays a central role in β-cell dysfunction, reducing β-cell secretory capacity through mechanisms such as triggering β-cell dedifferentiation and endoplasmic reticulum stress [<span>9, 10</span>]. Our previous studies have shown that short-term intensive insulin therapy (SIIT) effectively alleviates glucotoxicity, significantly improving β-cell function and insulin sensitivit
{"title":"Simplicity: The Ultimate Sophistication in Managing Type 2 Diabetes With Severe Hyperglycemia","authors":"Liehua Liu, Yanbing Li","doi":"10.1111/1753-0407.70042","DOIUrl":"10.1111/1753-0407.70042","url":null,"abstract":"<p>Diabetes mellitus, affecting 537 million people globally [<span>1</span>], is a chronic metabolic disorder with well-documented “legacy effects” of early hyperglycemia on complications that persist for decades [<span>2</span>]. The importance of early intensive glycemic control is evidenced by long-term follow-up data from the United Kingdom Prospective Diabetes Study, demonstrating that it lowers the risks of mortality and both microvascular and macrovascular complications, yielding life-long benefits [<span>3</span>].</p><p>Nevertheless, glycemic control in type 2 diabetes (T2DM) remains inadequate globally, particularly in China, where only fewer than 50% of patients achieve HbA1c < 7% [<span>4</span>]. Moreover, severe hyperglycemia at diagnosis is prevalent. A retrospective study in China showed that 44.5% of newly diagnosed patients present with HbA1c > 9% [<span>5</span>]. This fact poses a substantial challenge for achieving early and sustained glycemic control.</p><p>The traditional stepwise escalation approach, which gradually intensifies treatment in response to worsening hyperglycemia, often fails to achieve optimal glycemic control and prevent progressive β-cell dysfunction. Timely initiation of combination therapy is recommended for marked hyperglycemia. Current guidelines from the American Diabetes Association recommend combination therapy when HbA1c exceeds treatment targets by 1.5% (≥ 8.5%) and insulin for HbA1c > 10%, expecting simplifying treatment after correction of glucotoxicity [<span>6</span>]. However, because high-quality evidence is lacking, no standardized guidance could be provided. Indeed, more potent combination regimens may result in superior glycemic control. As shown in the EDICT study, a triple therapy regimen consisting of metformin, pioglitazone, and exenatide achieved HbA1c < 6.5% in 78% of participants over 3 years [<span>7</span>]. However, real-world challenges, including adherence, tolerability, and cost, limit broader implementation of combination therapy, particularly that with injectable agents [<span>8</span>].</p><p>Simplified treatment regimens have consistently been an urgent need for healthcare providers and patients. Nevertheless, as Leonardo da Vinci famously said, “Simplicity is the ultimate sophistication.” Achieving both optimal glycemic control and treatment simplification requires a shift in strategy to pay more attention to the reversibility of β-cell dysfunction in early T2DM. This requires addressing the major mechanisms of disease progression. In patients with significant hyperglycemia, glucotoxicity plays a central role in β-cell dysfunction, reducing β-cell secretory capacity through mechanisms such as triggering β-cell dedifferentiation and endoplasmic reticulum stress [<span>9, 10</span>]. Our previous studies have shown that short-term intensive insulin therapy (SIIT) effectively alleviates glucotoxicity, significantly improving β-cell function and insulin sensitivit","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>A bit over a year ago, we argued in these pages against a consensus statement recommendation from the American Society of Anesthesiologists that patients taking glucagon-like peptide-1 receptor agonists (GLP-1RA) should not take these agents for 1 week before elective procedures [<span>1</span>]. We pointed out the number of medications potentially interfering with gastric motility, including opiate analgesics, anticholinergics, antidepressants, calcium channel blockers, and gastric acid suppressants, with the lack of specific requirements that such treatments be held in preparation for anesthesia and sedation [<span>1</span>]. Some institutions now require that GLP-1RA be withheld for several weeks before procedures, and indeed evidence based on drug levels suggests that “complete dissipation of the effect” would require 4–5 half-lives, although this would likely be “potentially harmful” by virtue of requiring complete reorganization of diabetes treatment for many patients [<span>2</span>].</p><p>The imposition of these guidelines on people with diabetes has burdened them with the dilemma of not using important glucose-lowering and appetite-suppressing treatments with evidence of cardiovascular, renal, hepatic, and pulmonary benefits. Has there been interim progress?</p><p>In a study of 133 patients with type 2 diabetes undergoing 192 upper endoscopies, gastric contents were present in 19% of those taking versus 5% of those not taking a GLP-1RA [<span>3</span>]. Another study of 124 patients with type 2 diabetes undergoing endoscopy found residual gastric contents in 56% versus 19% of those taking versus not taking a GLP-1RA [<span>4</span>]. A study comparing 24 824 GLP-1RA users with 18 541 sodium-glucose cotransporter-2 inhibitor users undergoing upper endoscopy, however, found similar pulmonary aspiration risks of 4.2 versus 4.3 per 1000, respectively, although endoscopy discontinuation rates were 9.8 versus 4.9 per 1000, respectively, the significantly greater risk with GLP-1RA seen only among those with BMI ≥ 30 kg/m<sup>2</sup>, which the authors speculated might be related to retained gastric contents [<span>5</span>]. A study of 274 211 outpatient upper endoscopy procedures among individuals aged 18–64 with type 2 diabetes from 2005 to 2021 compared claims for aspiration and associated pulmonary adverse events in the 14 days following upper endoscopy, highlighting the infrequency of such events, with aspiration, aspiration pneumonia, and respiratory failure occurring with frequencies of 6.8, 7.6, and 25.6 cases per 10 000 endoscopies, respectively; there was no significant difference in event rates between users of GLP1-RA and those of dipeptidyl peptidase 4 inhibitors (DPP4i), and significantly lower rates of pneumonia, respiratory failure, and hospitalization and ER visits among those using GLP-1RA compared with individuals using chronic opioids, albeit without significant changes in documented aspiration or aspiration pneumonia [<
{"title":"Glucagon-Like Peptide-1 Receptor Agonists and Anesthesia—Are We Clearer on the Correct Approach?","authors":"Zachary Bloomgarden","doi":"10.1111/1753-0407.70041","DOIUrl":"10.1111/1753-0407.70041","url":null,"abstract":"<p>A bit over a year ago, we argued in these pages against a consensus statement recommendation from the American Society of Anesthesiologists that patients taking glucagon-like peptide-1 receptor agonists (GLP-1RA) should not take these agents for 1 week before elective procedures [<span>1</span>]. We pointed out the number of medications potentially interfering with gastric motility, including opiate analgesics, anticholinergics, antidepressants, calcium channel blockers, and gastric acid suppressants, with the lack of specific requirements that such treatments be held in preparation for anesthesia and sedation [<span>1</span>]. Some institutions now require that GLP-1RA be withheld for several weeks before procedures, and indeed evidence based on drug levels suggests that “complete dissipation of the effect” would require 4–5 half-lives, although this would likely be “potentially harmful” by virtue of requiring complete reorganization of diabetes treatment for many patients [<span>2</span>].</p><p>The imposition of these guidelines on people with diabetes has burdened them with the dilemma of not using important glucose-lowering and appetite-suppressing treatments with evidence of cardiovascular, renal, hepatic, and pulmonary benefits. Has there been interim progress?</p><p>In a study of 133 patients with type 2 diabetes undergoing 192 upper endoscopies, gastric contents were present in 19% of those taking versus 5% of those not taking a GLP-1RA [<span>3</span>]. Another study of 124 patients with type 2 diabetes undergoing endoscopy found residual gastric contents in 56% versus 19% of those taking versus not taking a GLP-1RA [<span>4</span>]. A study comparing 24 824 GLP-1RA users with 18 541 sodium-glucose cotransporter-2 inhibitor users undergoing upper endoscopy, however, found similar pulmonary aspiration risks of 4.2 versus 4.3 per 1000, respectively, although endoscopy discontinuation rates were 9.8 versus 4.9 per 1000, respectively, the significantly greater risk with GLP-1RA seen only among those with BMI ≥ 30 kg/m<sup>2</sup>, which the authors speculated might be related to retained gastric contents [<span>5</span>]. A study of 274 211 outpatient upper endoscopy procedures among individuals aged 18–64 with type 2 diabetes from 2005 to 2021 compared claims for aspiration and associated pulmonary adverse events in the 14 days following upper endoscopy, highlighting the infrequency of such events, with aspiration, aspiration pneumonia, and respiratory failure occurring with frequencies of 6.8, 7.6, and 25.6 cases per 10 000 endoscopies, respectively; there was no significant difference in event rates between users of GLP1-RA and those of dipeptidyl peptidase 4 inhibitors (DPP4i), and significantly lower rates of pneumonia, respiratory failure, and hospitalization and ER visits among those using GLP-1RA compared with individuals using chronic opioids, albeit without significant changes in documented aspiration or aspiration pneumonia [<","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mustafa Jamal Ahmed, Omer Ali, Saf Naqvi, Aisha Ahmed, Waseem Omar
<p>Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder and has become a global health challenge, projected to affect approximately 780 million people by 2045.<span><sup>1, 2</sup></span> T2DM is linked to several micro and macrovascular complications.<span><sup>3, 4</sup></span> A high prevalence of chronic kidney disease (CKD, 4%–20%) and cardiovascular disease (CVD, 6%–27%) has been observed in patients with T2DM.<span><sup>5-8</sup></span> The pathophysiological interactions among diabetes, CKD, and CVD are defined as cardiovascular–kidney–metabolic (CKM) syndrome by the American Health Association (AHA).<span><sup>9</sup></span> Managing CKM syndrome involves addressing several risk factors glycated hemoglobin (HbA1c), BP, higher low-density lipoprotein (LDL) cholesterol, body mass index (BMI), low estimated glomerular filtration rate (eGFR) and high albumin creatinine ratio (ACR).<span><sup>9-11</sup></span> Guidelines from Kidney Disease: Improving Global Outcomes (KDIGO, 2024) help in assessing the stage and severity of CKD based on eGFR and ACR.<span><sup>12</sup></span></p><p>In recent years, United Arab Emirates (UAE) has experienced an increased risk of metabolic syndromes due to a shift toward less healthy lifestyle habits.<span><sup>13, 14</sup></span> The present study aimed to explore the prevalence of T2DM-associated renal risk in UAE population. The risk factors and T2DM treatment modalities were also evaluated in high and very high-risk patients. This cross-sectional study collected data from 33 524 T2DM patients aged ≥18 years registered at the Imperial College Diabetic Center across the seven Emirates. Critical parameters such as age, sex, BMI, systolic and diastolic BP, eGFR, ACR, Hb1Ac, and LDL were collected from the patients. Additionally, data on treatment modalities, SGLT-2, GLP-1, RASi, and Finerenone, for treating T2DM were recorded. Statistical analyses were performed to understand the stage of CKD based on KDIGO heat map to find frequency and percentage of patients at high and very high-risk of CKD.</p><p>The study highlighted prevalence of T2DM (53.43%) in the Emirati population and was found to be concurrent with earlier studies.<span><sup>15-17</sup></span> Among these patients, the overall prevalence of renal risk was segregated based on eGFR and ACR values (KDIGO heat map). As per eGFR values, 24.25% of population had eGFR values between 60 and 89, while 7.74% T2DM patients exhibited eGFR values less than 60, indicating increased renal risk (Figure 1A). These results are consistent with earlier studies in China, Italy, and United States.<span><sup>18-20</sup></span> The Albuminuria (ACR values between 3.5 and 30) was observed in approximately 18% of T2DM patients while severely increased albuminuria (ACR between 30 and 1000) was observed in 5.23% of T2DM patients (Figure 1B). Similar percentage of albuminuria patients has been reported in earlier studies.<span><sup>21, 22</sup></span> The patients at
{"title":"Prevalence of associated renal risk in type 2 diabetes mellitus in the United Arab Emirates","authors":"Mustafa Jamal Ahmed, Omer Ali, Saf Naqvi, Aisha Ahmed, Waseem Omar","doi":"10.1111/1753-0407.70038","DOIUrl":"https://doi.org/10.1111/1753-0407.70038","url":null,"abstract":"<p>Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder and has become a global health challenge, projected to affect approximately 780 million people by 2045.<span><sup>1, 2</sup></span> T2DM is linked to several micro and macrovascular complications.<span><sup>3, 4</sup></span> A high prevalence of chronic kidney disease (CKD, 4%–20%) and cardiovascular disease (CVD, 6%–27%) has been observed in patients with T2DM.<span><sup>5-8</sup></span> The pathophysiological interactions among diabetes, CKD, and CVD are defined as cardiovascular–kidney–metabolic (CKM) syndrome by the American Health Association (AHA).<span><sup>9</sup></span> Managing CKM syndrome involves addressing several risk factors glycated hemoglobin (HbA1c), BP, higher low-density lipoprotein (LDL) cholesterol, body mass index (BMI), low estimated glomerular filtration rate (eGFR) and high albumin creatinine ratio (ACR).<span><sup>9-11</sup></span> Guidelines from Kidney Disease: Improving Global Outcomes (KDIGO, 2024) help in assessing the stage and severity of CKD based on eGFR and ACR.<span><sup>12</sup></span></p><p>In recent years, United Arab Emirates (UAE) has experienced an increased risk of metabolic syndromes due to a shift toward less healthy lifestyle habits.<span><sup>13, 14</sup></span> The present study aimed to explore the prevalence of T2DM-associated renal risk in UAE population. The risk factors and T2DM treatment modalities were also evaluated in high and very high-risk patients. This cross-sectional study collected data from 33 524 T2DM patients aged ≥18 years registered at the Imperial College Diabetic Center across the seven Emirates. Critical parameters such as age, sex, BMI, systolic and diastolic BP, eGFR, ACR, Hb1Ac, and LDL were collected from the patients. Additionally, data on treatment modalities, SGLT-2, GLP-1, RASi, and Finerenone, for treating T2DM were recorded. Statistical analyses were performed to understand the stage of CKD based on KDIGO heat map to find frequency and percentage of patients at high and very high-risk of CKD.</p><p>The study highlighted prevalence of T2DM (53.43%) in the Emirati population and was found to be concurrent with earlier studies.<span><sup>15-17</sup></span> Among these patients, the overall prevalence of renal risk was segregated based on eGFR and ACR values (KDIGO heat map). As per eGFR values, 24.25% of population had eGFR values between 60 and 89, while 7.74% T2DM patients exhibited eGFR values less than 60, indicating increased renal risk (Figure 1A). These results are consistent with earlier studies in China, Italy, and United States.<span><sup>18-20</sup></span> The Albuminuria (ACR values between 3.5 and 30) was observed in approximately 18% of T2DM patients while severely increased albuminuria (ACR between 30 and 1000) was observed in 5.23% of T2DM patients (Figure 1B). Similar percentage of albuminuria patients has been reported in earlier studies.<span><sup>21, 22</sup></span> The patients at","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ayah Talal Zaidalkilani, Hayder M. Al-kuraishy, Esraa H. Fahad, Ali I. Al-Gareeb, Yaser Hosny Ali Elewa, Mahmoud Hosny Zahran, Athanasios Alexiou, Marios Papadakis, Ammar AL-Farga, Gaber El-Saber Batiha
Type 2 diabetes (T2D) is a chronic metabolic disorder caused by defective insulin signaling, insulin resistance, and impairment of insulin secretion. Autophagy is a conserved lysosomal-dependent catabolic cellular pathway involved in the pathogenesis of T2D and its complications. Basal autophagy regulates pancreatic β-cell function by enhancing insulin release and peripheral insulin sensitivity. Therefore, defective autophagy is associated with impairment of pancreatic β-cell function and the development of insulin rersistance (IR). However, over-activated autophagy increases apoptosis of pancreatic β-cells leading to pancreatic β-cell dysfunction. Hence, autophagy plays a double-edged sword role in T2D. Therefore, the use of autophagy modulators including inhibitors and activators may affect the pathogenesis of T2D. Hence, this review aims to clarify the potential role of autophagy inhibitors and activators in T2D.
{"title":"Autophagy modulators in type 2 diabetes: A new perspective","authors":"Ayah Talal Zaidalkilani, Hayder M. Al-kuraishy, Esraa H. Fahad, Ali I. Al-Gareeb, Yaser Hosny Ali Elewa, Mahmoud Hosny Zahran, Athanasios Alexiou, Marios Papadakis, Ammar AL-Farga, Gaber El-Saber Batiha","doi":"10.1111/1753-0407.70010","DOIUrl":"10.1111/1753-0407.70010","url":null,"abstract":"<p>Type 2 diabetes (T2D) is a chronic metabolic disorder caused by defective insulin signaling, insulin resistance, and impairment of insulin secretion. Autophagy is a conserved lysosomal-dependent catabolic cellular pathway involved in the pathogenesis of T2D and its complications. Basal autophagy regulates pancreatic β-cell function by enhancing insulin release and peripheral insulin sensitivity. Therefore, defective autophagy is associated with impairment of pancreatic β-cell function and the development of insulin rersistance (IR). However, over-activated autophagy increases apoptosis of pancreatic β-cells leading to pancreatic β-cell dysfunction. Hence, autophagy plays a double-edged sword role in T2D. Therefore, the use of autophagy modulators including inhibitors and activators may affect the pathogenesis of T2D. Hence, this review aims to clarify the potential role of autophagy inhibitors and activators in T2D.</p><p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142826526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander J. Eckert, Stefan Zimny, Marcus Altmeier, Ana Dugic, Anton Gillessen, Latife Bozkurt, Gabriele Götz, Wolfram Karges, Frank J. Wosch, Stephan Kress, Reinhard W. Holl, for the DPV-Wiss-Initiative
<p>We thank the authors for this commentary and for considering our manuscript a valuable contribution to the topic of diabetic foot ulcers and lower limb amputations in adults with type 1 or type 2 diabetes.</p><p>Regarding the capturing of biomarkers and inflammatory markers, we want to point out that the listed parameters, namely, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), the systemic inflammation response index (SIRI), and the systemic immune-inflammation index (SII) are subject to a wide range of fluctuation. A blood sedimentation rate is nowadays rarely used in everyday practice, especially in outpatient care, as this marker is very unspecific. Of the above mentioned parameters, CRP alone is an acceptable predictor of systemic inflammation. The other indices or blood parameters from the differential blood count are not used clinically, neither in outpatient foot clinics nor in private practice, their relevance for treatment decisions is questionable. Further, not all of the included clinics and praxes in this study are specialized foot centres, and this is meaningful, since we want to provide data from everyday clinical practice in a real-world setting. CRP might have been available in some, but not in all individuals included. The strength of our study on registry data is not to provide information on inconsistently raised parameters, but rather to provide well-documented parameters and comorbidities that are available is most of the treated individuals as it is reflected in the real-world care of these people. We agree, that some comorbidities might have been additionally investigated, but we wanted to focus on the most relevant and best captured information, in order to include as many individuals as possible in our analysis.</p><p>We agree, that there are some limitations in our study regarding wound classification. Again, we could only use what is routinely captured and documented in representative German-speaking clinics and practices. Nevertheless, the Wagner wound classification is internationally accepted and widely used in Germany and in other countries.</p><p>Regarding the duration of DFU, we want to point out, that this consideration was the main reason, why we did not use regression models solely, but additionally did longitudinal Kaplan–Meyer analysis and calculated hazard ratios for amputations in order to include this time factor in the analysis. We also excluded individuals with amputations within a very short time (100 days) after the initial documentation of DFU for this specific analysis.</p><p>Lastly, we totally agree that Charcot foot is a risk factor for DFU, but the incidence of Charcot foot is below 1% in people with diabetes<span><sup>1</sup></span> and would therefore be an independent topic for analysis.</p><p>In conclusion, we want to thank the authors for the critical and valuable response to our manuscript, and we w
{"title":"Response to “Commentary on factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real-world data from the German/Austrian DPV registry”","authors":"Alexander J. Eckert, Stefan Zimny, Marcus Altmeier, Ana Dugic, Anton Gillessen, Latife Bozkurt, Gabriele Götz, Wolfram Karges, Frank J. Wosch, Stephan Kress, Reinhard W. Holl, for the DPV-Wiss-Initiative","doi":"10.1111/1753-0407.70036","DOIUrl":"https://doi.org/10.1111/1753-0407.70036","url":null,"abstract":"<p>We thank the authors for this commentary and for considering our manuscript a valuable contribution to the topic of diabetic foot ulcers and lower limb amputations in adults with type 1 or type 2 diabetes.</p><p>Regarding the capturing of biomarkers and inflammatory markers, we want to point out that the listed parameters, namely, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), the systemic inflammation response index (SIRI), and the systemic immune-inflammation index (SII) are subject to a wide range of fluctuation. A blood sedimentation rate is nowadays rarely used in everyday practice, especially in outpatient care, as this marker is very unspecific. Of the above mentioned parameters, CRP alone is an acceptable predictor of systemic inflammation. The other indices or blood parameters from the differential blood count are not used clinically, neither in outpatient foot clinics nor in private practice, their relevance for treatment decisions is questionable. Further, not all of the included clinics and praxes in this study are specialized foot centres, and this is meaningful, since we want to provide data from everyday clinical practice in a real-world setting. CRP might have been available in some, but not in all individuals included. The strength of our study on registry data is not to provide information on inconsistently raised parameters, but rather to provide well-documented parameters and comorbidities that are available is most of the treated individuals as it is reflected in the real-world care of these people. We agree, that some comorbidities might have been additionally investigated, but we wanted to focus on the most relevant and best captured information, in order to include as many individuals as possible in our analysis.</p><p>We agree, that there are some limitations in our study regarding wound classification. Again, we could only use what is routinely captured and documented in representative German-speaking clinics and practices. Nevertheless, the Wagner wound classification is internationally accepted and widely used in Germany and in other countries.</p><p>Regarding the duration of DFU, we want to point out, that this consideration was the main reason, why we did not use regression models solely, but additionally did longitudinal Kaplan–Meyer analysis and calculated hazard ratios for amputations in order to include this time factor in the analysis. We also excluded individuals with amputations within a very short time (100 days) after the initial documentation of DFU for this specific analysis.</p><p>Lastly, we totally agree that Charcot foot is a risk factor for DFU, but the incidence of Charcot foot is below 1% in people with diabetes<span><sup>1</sup></span> and would therefore be an independent topic for analysis.</p><p>In conclusion, we want to thank the authors for the critical and valuable response to our manuscript, and we w","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 12","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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