Journal of Diabetes最新文献

Background

Vertical transmission of microbes from a mother's gut to their offspring plays a crucial role in the genesis of the early life gut microbiome. Gestational Diabetes Mellitus (GDM) is the commonest metabolic disorder during pregnancy, which has adverse short- and long-term effects on both maternal and infant health. We aimed to capture the GDM-associated biosignatures in infants' gut microbiome from birth to the first 6 weeks of life.

Methods

53 GDM mother-infant dyads and 16 healthy mother-infant dyads were recruited. We performed targeted 16S rRNA gene amplicon sequencing on stool samples. Various statistical analyses were performed to understand the changes in the microbiome profile of infants and identify GDM-associated bacterial biomarkers in mothers and their transfer to infants.

Results

GDM altered the gut microbiome of pregnant women as compared to healthy counterparts (PERMANOVA, p.adjusted < 0.05), with predominance of bacterial members associated with insulin resistance, proinflammatory conditions, and other metabolic processes. Infants born to GDM mothers have distinctive early life microbiome (meconium and six weeks stools) compared to infants born to control mothers (PERMANOVA, p.adjusted < 0.05). We also identified the presence of various GDM-associated microbial signatures such as Blautia and Collinsella in both meconium and one-month-old stool samples of infants born to GDM mothers.

Conclusion

This study provides a better understanding of the impact of GDM on the seeding of a specific set of microbes during the early life colonization event in the infant gut that increases the risk of inflammatory and metabolic diseases in the future.

Background

Fasting blood glucose (FBG) reflects cardiometabolic health, but the long-term effects of childhood hypertension (HTN) on adult FBG are unclear.

Methods

Using data from the Bogalusa Heart Study, we examined the link between childhood HTN and FBG in early adulthood, adjusting for race, BMI, pulse rate, and blood pressure.

Results

Individuals with childhood HTN had higher FBG in early adulthood (mean difference 8.96 mg/dL) and a 4.16-fold higher risk of high FBG (≥ 126 mg/dL). The effect was stronger in African Americans, those with higher pulse rate, overweight individuals, or those with low diastolic BP.

Conclusions

Childhood HTN is linked to elevated FBG in early adulthood. Early management of hypertensive children, especially those at metabolic risk, may help prevent diabetes and cardiovascular disease later.

Background

This randomized controlled trial (RCT) was designed to evaluate the effects of sitagliptin on diabetic foot ulcers (DFUs).

Methods

This was a randomized, open-label clinical trial. The participants were assigned to either the control group, which received standard conventional therapy alone, or the sitagliptin treatment group, which received an oral administration of sitagliptin (100 mg once daily) in conjunction with standard conventional therapy. The primary endpoints were the ulcer healing rate and adverse reactions. The secondary endpoints included the time to ulcer healing, peripheral blood CD34+ endothelial progenitor cells (EPCs) count, serum levels of stromal cell-derived factor-1α (SDF-1α), and glycosylated hemoglobin A1c (HbA1c).

Results

A total of 62 subjects were enrolled in this trial, with 31 individuals assigned to each group. One participant from each group was lost to follow-up. Posttrial analysis revealed that, compared with the control group, the sitagliptin group demonstrated a significantly greater reduction in ulcer area and improved efficacy in terms of ulcer healing (p < 0.05). Although not statistically significant (p = 0.071), the sitagliptin group also tended to have a shorter ulcer healing time. Additionally, the sitagliptin group presented significantly greater numbers of CD34+ EPCs and higher SDF-1α levels compared to the control group (p < 0.05). No statistically significant difference in HbA1c levels was observed between the two groups (p > 0.05). No adverse events associated with sitagliptin treatment were reported.

Conclusions

The DPP-4 inhibitor sitagliptin may facilitate the healing of DFUs independent of its glucose-lowering effects, potentially by enhancing the mobilization of CD34 + EPCs in peripheral blood.

Trial Registration: Registration number: ChiCTR 2000029230, Approval date: 2020/01/19

Aims

Diabetes is a global public health crisis, especially when it is accompanied by microvascular complications such as diabetic kidney disease (DKD). The purpose of this study was to explore the relationship between the combined lifestyle factors of diabetes patients and their joint effects with genetic risk and the risk of DKD.

Materials and Methods

We included individuals diagnosed with diabetes at baseline from UK Biobank. Their lifestyle information was collected through a baseline questionnaire. Favorable lifestyle scores were constructed based on 5 common lifestyle factors and categorized into three levels. Genetic susceptibility to CKD was estimated by polygenic risk scores and further categorized into high, and low genetic risk categories. Cox proportional hazards regression model was used to estimate the hazard ratios (HR) and 95% confidence interval (CI) for their associations.

Results

By the end of follow-up, 1335 of 11 981 diabetes patients progressed to diabetes nephropathy. The COX regression results indicate that BMI ≥ 25 mg/m² and current or past smoking were risk factors for DKD, while alcohol consumption and moderate to high-intensity pysical exercise were protective factors. High genetic risk is significantly associated with increased risk of DKD (HR1.29, 95% CI 1.13–1.47, p < 0.001), while a favorable lifestyle had a protective effect (HR0.47, 95% CI 0.37–0.59, p < 0.001). Interaction analysis shows that there was neither additive nor multiplicative interaction between genetic risk and lifestyle.

Conclusions

Lifestyle factors and genetics are independently associated with susceptibility to incident DKD. A healthy lifestyle may attenuate elevated DKD risks due to genetic vulnerability.

Background

Despite increased risk of ischemic events in diabetes, the optimal anti-thrombotic strategy for secondary prevention has not been defined. We aimed to assess the efficacy and safety of optimal antiplatelet agents such as indobufen-based dual antiplatelet therapy (DAPT) in patients with diabetes after coronary stenting.

Methods

OPTION trial was a randomized, open-label, noninferiority, and multicentric study in China. Enrolled subjects were randomized 1:1 to indobufen-based DAPT or aspirin-based DAPT. This post hoc analysis from OPTION trial was performed by the presence of diabetes. The primary endpoint was a 1-year composite of cardiovascular death, nonfatal myocardial infarction, ischemic stroke, definite or probable stent thrombosis, or Bleeding Academic Research Consortium (BARC) criteria type 2, 3, or 5 bleeding.

Results

Of 4551 OPTION patients, the primary endpoint occurred in 93/1570 patients with diabetes (5.92%), as compared to 148/2981 without diabetes (4.96%) (HR: 0.72, 95% CI: 0.47–1.08, and HR: 0.73, 95% CI: 0.53–1.01, respectively), without significant interaction between diabetes status and treatment effect (P_interaction = 0.935). The secondary efficacy endpoint was comparable between patients with (HR: 1.31, 95% CI: 0.60–2.84) and without diabetes (HR: 0.95, 95% CI: 0.51–1.76) (P_interaction = 0.526). Similarly, both subgroups derived similar benefits for the safety endpoint (HR, 0.56; 95% CI, 0.34–0.92 for subjects with diabetes vs. HR, 0.66; 95% CI, 0.45–0.98 for those without diabetes; P_interaction = 0.609).

Conclusions

In patients receiving DES implantation, indobufen-based DAPT might be considered as a reasonable alternative to aspirin-based DAPT in the secondary prevention for those with diabetes, especially in patients at high bleeding risk.

Background

Limited empirical evidence exists on the link between exposure to various stressful life events (SLEs) and the heightened risk of Diabetes Mellitus (DM) within the mainland Chinese population.

Methods

We conducted this prospective cohort study with 455,464 participants from the China Kadoorie Biobank (CKB); we examined associations between SLEs exposures and DM outcomes. We employed multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders.

Results

Over a median follow-up of 10.1 years, 14,218 DM cases were identified. A dose–response relationship was observed between the number of SLEs, personal-related events, and the risk of DM. The higher the number of SLEs experienced, the higher the risk of developing diabetes (HR = 1.06, 95% CI = 1.01–1.12); individuals who experienced personal-related events had a higher risk of developing DM (HR = 1.17, 95% CI = 1.01–1.36), and those who experienced marital separation/divorce had a 53% increased risk of DM (HR = 1.53, 95% CI = 1.12–2.09). Subgroup analyses revealed effect modifications based on birth cohort, sex, and area.

Conclusion

By exploring the association of multiple SLEs with the development of DM, we identified marital separation/divorce as a driver of increased DM risk.

Background

This meta-analysis aims to assess the association between exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and the incidence of suicidal behavior in patients with type 2 diabetes mellitus (T2DM)/obesity.

Methods

A comprehensive search of electronic databases, including PubMed, Web of Science, the Cochrane Library, and ClinicalTrials.gov, was conducted from the inception of the databases. The risk ratio (RR) and 95% confidence intervals (95% CI) were calculated.

Results

This meta-analysis included data from 25 randomized controlled trials (RCTs). The results indicated no significant difference in the incidence of suicidal behavior between the GLP-1 RA exposure group and the control group (RR = 0.84, 95% CI: 0.54–1.32, p = 0.46, I² = 0%). Subgroup analysis showed no significant differences in the incidence of suicidal behavior among participants with T2DM (RR = 0.74), obesity (RR = 1.07), adolescents (RR = 0.91), and adults (RR = 0.84). Additionally, no significant differences were observed between the two groups in any type of suicidal behavior, including suicidal ideation (RR = 1.04), suicide attempts (RR = 0.68), depression-related suicides (RR = 0.65), and completed suicides (RR = 1.06). There were also no significant differences between the groups for any type of GLP-1 RA, including dulaglutide (RR = 0.46), exenatide (RR = 0.98), semaglutide (RR = 0.82), lixisenatide (RR = 1.25), and liraglutide (RR = 0.92). No significant differences were observed between the exposure group and control group according to different comparators, including placebo (RR = 0.91) and others (RR = 1.08). All subgroup analyses showed p-values greater than 0.05 (two-sided tests) and I² values of 0%.

Conclusion

Our findings suggest that there is no significant association between GLP-1 RA exposure and suicidal behaviors in patients with T2DM or obesity.