Du et al.1 conducted a prospective study to investigate the effect of healthy sleep pattern on subsequent mortality risk of acute myocardial infarction (AMI) in people with diabetes. The adjusted hazard ratio (HR) (95% confidence interval [CI]) of healthy sleep score for AMI mortality was 0.87 (0.77–0.98). Especially, adequate sleep duration reduced 29% risk of AMI mortality. They finally mentioned that types of diabetes should be stratified for the analysis, and I think that interactions of diabetes on the inverse association between healthy sleep score and AMI mortality may be existed. In their Figure 1, there is a wide range of HR for the risk of AMI mortality in lower healthy sleep score, which did not reach a significant level. There is a possibility that people with lower healthy sleep score would have several cardiometabolic risk factors, and contribution rate of sleep variables to the risk of AMI would become smaller. I speculate that irregular sleep pattern in daily life reflects one of the unhealthy lifestyles, and it would contribute to diabetes and AMI risk. I present recent reports on the association between irregular sleep and subsequent risk of type 2 diabetes (T2D) or cardiometabolic disorder.
Zuraikat et al.2 defined irregular sleep pattern as the standard deviation of each sleep parameter, and it was closely related to the increased risk of T2D and cardiometabolic risk. Although causal association cannot be determined, irregular sleep pattern may contribute to the risk of several metabolic disorders.
Liu et al.3 conducted a meta-analysis on the relationship between daytime napping and incident diabetes, and longer period of napping should be avoided to reduce a risk of diabetes. I suppose that long napping would affect nighttime sleep depth and duration, which may also relate to irregular sleep pattern.
Zhang and Qin4 reported the potential mechanisms regarding the effect of irregular sleep pattern on subsequent cardiometabolic risk, including circadian dysfunction, inflammation, autonomic dysfunction, endocrinological disorder, and gut dysbiosis. Glucose metabolism may be affected by unstable sleep–wake cycle and their duration, which would be closely related to the level of physical activity and nutritional intake.
Finally, Zhu et al.5 reviewed and concluded that sleep variability was significantly associated with weight gain and increased hemoglobin A1c, although decreased insulin sensitivity was not consistent findings in several studies.
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The author declares that he has no competing interests. No ethical statement is needed for this study.
It is known that the risk of ischemic heart disease increases in patients with type 2 diabetes mellitus (T2DM). For female patients, the incidence of heart disease can be even greater after menopause, accompanied by dramatic changes in sex hormones. We investigated the correlations between sex hormones and markers of ischemic heart diseases in postmenopausal females with T2DM patients.
This cross-sectional study collected data from 324 hospitalized postmenopausal females with T2DM. Multiple linear regression analyses were conducted to determine the correlations between sex hormones and cardiac markers including high-sensitive cardiac troponin T (hs-cTnT) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels.
Multiple linear regression analyses revealed that luteinizing hormone (LH) was positively and independently associated with hs-cTnT concentrations in postmenopausal females with T2DM (β = 0.189, p = 0.002). Postmenopausal females with T2DM and subclinical myocardial injury had higher LH levels than those without subclinical myocardial injury (29.67 vs. 25.08 mIU/mL, p < 0.001). A multivariate logistic regression analysis confirmed an independent and significant association between elevated LH and subclinical myocardial injury in postmenopausal females with T2DM (adjusted odds ratio [OR] = 1.077, 95% confidence interval [CI], 1.033–1.124; p < 0.001). As another gonadotropin, the follicle-stimulating hormone did not show independent correlations with hs-cTnT or NT-proBNP (p > 0.05). Neither estrogen nor testosterone was correlated with cardiac markers.
Elevated LH levels were positively and independently associated with increased hs-cTnT levels in postmenopausal women with T2DM. Our findings suggest that LH could serve as a potential marker for assessing the risk of subclinical myocardial injury in postmenopausal females with T2DM.
The global prevalence of diabetes has increased significantly, leading to various complications and a negative impact on quality of life. Hyperglycemia hyperglycemic-induced oxidative stress (OS) and inflammation are closely associated with the development and progression of type 2 diabetes mellitus (T2D) and its complications. This review explores the effect of T2D on target organ damage and potential treatments to minimize this damage. The paper examines the pathophysiology of T2D, focusing on low-grade chronic inflammation and OS and on their impact on insulin resistance. The review discusses the role of inflammation and OS in the development of microvascular and macrovascular complications. The findings highlight the mechanisms by which inflammatory cytokines, stress kinases, and reactive oxygen species (ROS) interfere with insulin signaling pathways, leading to impaired glucose metabolism and organ dysfunction. Lifestyle interventions, including a balanced diet and exercise, can help reduce chronic inflammation and OS, thereby preventing and controlling T2D and its associated complications. Additionally, various antioxidants and anti-inflammatory agents show potential in reducing OS and inflammation. Some anti-diabetic drugs, like pioglitazone, metformin, and glucagon-like peptide-1 (GLP-1) agonists, may also have anti-inflammatory effects. Further research, including randomized controlled trials, is needed to evaluate the efficacy of these interventions.
The objective of this study was to evaluate the impact of dysglycemia on perioperative outcomes, in patients with and without diabetes, and how prior glycemic control modifies these relationships.
Consecutive surgical patients admitted to six South Australian tertiary hospitals between 2017 and 2023 were included. Blood glucose levels within 48 h pre- and post-operatively were assessed in an adjusted analyses against a priori selected covariates. Dysglycemia metrics were hyperglycemia (>10.0 mmol/L), hypoglycemia (<4.0 mmol/L), glycemic variability (standard deviation of mean blood glucose >1.7 mmol/L), and stress hyperglycemic ratio (SHR). The primary outcome was hospital mortality.
Of 52 145 patients, 7490 (14.4%) had recognized diabetes. Inpatient mortality was observed in 787 patients (1.5%), of which 150 (19.1%) had diabetes mellitus. Hyperglycemia was associated with increased mortality in patients with diabetes (odds ratio [OR] = 2.99, 95% CI: 1.63–5.67, p = 0.004) but not in non-diabetics, who instead had an increased odds of intensive care unit (ICU) admission if hyperglycemic (OR = 1.95, 95% CI: 1.40–2.72, p < 0.0001). Glycemic variability was associated with increased mortality in patients with diabetes (OR = 1.46, 95% CI: 1.05–2.01, p < 0.05) but not in non-diabetics. Preoperative glycemic control (HbA1c) attenuated both of these associations in a dose-dependent fashion. Hypoglycemia was associated with increased mortality in non-diabetics (OR = 2.14, 95% CI: 1.92–2.37, p < 0.001) but not in patients with diabetes.
In surgical patients with diabetes, prior exposure to hyperglycemia attenuates the impact of perioperative hyperglycemia and glycemic variability on inpatient mortality and ICU admission. In patients without diabetes mellitus, all absolute thresholds of dysglycemia are associated with ICU admission, unlike those with diabetes, suggesting the need to use more relative measures such as the SHR.
Foot ulcers are a major complication of diabetes mellitus that increase morbidity and mortality in patients with diabetes, affect their quality of life, and increase the overall social burden. A considerable number of patients with diabetic foot ulcers (DFUs) require amputations every year.
This nation population–based study included 1 923 483 patients with diabetes who underwent regular health screening through the National Health Insurance Service during January 2009 and December 2012. We investigated the association between changes in physical activity (PA) status and the incidence of lower extremity amputation (LEA). Based on changes in PA status, participants were categorized into four groups: “remained inactive,” “remained active,” “active-to-inactive,” and “inactive-to-active.”
Regular PA is an independent factor associated with a decreased risk of LEA in patients with diabetes. During the follow-up period, 0.23% (n = 4454) of the patients underwent LEA. Compared with the “remained inactive” group, the “remained active” group were at the lowest risk of LEA (adjusted hazard ratio 0.5888; 95% confidence interval 0.524–0.66). A protective effect of regular PA against LEA was observed in the “remaining active” group.
Our findings suggest a protective role of PA against LEA in individuals with diabetes. This highlights the importance of recommending appropriate levels of PA for patients with diabetes. The study also showed a dose–response relationship, indicating that engaging in vigorous-intensity PA was most beneficial, and higher amounts of PA may provide additional benefits.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a class of injectable antidiabetic drugs, have shown significant efficacies in improving glycemic and weight control in patients with type 2 diabetes (T2D). However, the long-term safety of GLP-1 RAs remains insufficiently studied. This study aimed to provide real-world evidence on potential adverse outcomes associated with GLP-1 RAs use in T2D patients without major chronic diseases including impaired cardiac or renal function.
We conducted a retrospective cohort study involving 7746 T2D patients on GLP-1 RAs in Shenzhen, China. They were compared with 124 371 metformin-only users and 36 146 insulin-only users, forming two therapy control groups. GLP-1 RAs users were also further 1:2 paired with the control groups. Competing risk survival analyses were conducted to assess the incidence risks, presenting subdistributional hazard ratios (sHRs) with 95% confidence intervals (CIs) for various adverse outcomes associated with GLP-1 RAs use.
Compared with metformin-only users, GLP-1 RAs use was associated with increased risks of various adverse outcomes (sHRs with 95% CIs), including pancreatitis (2.01, 1.24–3.24), acute nephritis (3.20, 2.17–4.70), kidney failure (3.73, 2.74–5.08), thyroid cancer (2.25, 1.23–4.10), and thyroid dysfunction (1.27, 1.00–1.63), respectively; Similar results were also found when compared with insulin-only users. Importantly, long-term (≥12 months) GLP-1 RAs use may further elevate the incidence risks of pancreatitis, acute nephritis, thyroid cancer, and thyroid dysfunction.
Compared with traditional T2D treatments, GLP-1 RAs use may be associated with increased risks of various adverse outcomes in a Chinese population. Cautions were strongly warranted in the use of GLP-1 RAs. Further validation is crucial across diverse populations.
Cardiovascular diseases are a common cause of death among patients with type 2 diabetes (T2DM). Major adverse cardiovascular event (MACE) risks can be significantly reduced under adequate glycemic control (GC). This study aims to identify factors that influence MACE risk among patients with T2DM, including Hemoglobin A1c variability score (HVS) and early use of MACE-preventive glucose-lowering medications (GLMs).
We conducted a longitudinal cohort study to retrospectively review electronic health records between 2011 and 2022. Patients with T2DM ≥18 years without previous stroke or acute myocardial infarction (AMI) were included. Cox regression was utilized to investigate MACE risk factors and compare MACE risk reduction associated with early use of MACE-preventive GLMs.
A total of 19 685 subjects were included, with 5431 having MACE, including 4453 strokes, 977 AMI, and 1 death. There were 11 123 subjects with good baseline GC. Subjects with good baseline GC had 0.837 (confidence interval [CI]: 0.782–0.895) times lower MACE risk than their counterpart. Subjects with a single MACE-preventive GLM at baseline with continuous use >365 days showed a decreased MACE hazard ratio (0.681; CI: 0.635–0.731). Among all MACE-preventive GLMs, semaglutide provided a more significant MACE-preventive effect.
This study identified that GLM, early GC, and HVS are MACE determinants among patients with T2DM. Novel GLM, adequate GC, and reduction of HVS can benefit MACE outcomes.
Artificial light at night (ALAN) is a common phenomenon and contributes to the severe light pollution suffered by more than 80% of the world's population. This study aimed to evaluate the relationship between outdoor ALAN exposure and cardiovascular health (CVH) in patients with diabetes and the influence of various modifiable factors.
A survey method based on the China Diabetes and Risk Factor Monitoring System was adopted. Study data were extracted for 1765 individuals with diabetes in Anhui Province. Outdoor ALAN exposure (nW/cm2/sr) within 1000 m of each participant's residential address was obtained from satellite imagery data, with a resolution of ~1000 m. Health risk behaviors (HRBs) were measured via a standardized questionnaire. A linear regression model was employed to estimate the relationship between outdoor ALAN, HRBs, and CVH.
Participants' mean age was 59.10 ± 10.0 years. An association was observed between ALAN and CVH in patients with diabetes (β = 0.205) and exercise (β = −1.557), moderated by HRBs, or metabolic metrics. There was an association between ALAN, ALAN, vegetable intake, and CVH.
Exploring the relationship between ALAN exposure and cardiovascular and metabolic health provides policy data for improving light pollution strategies and reducing the risk of cardiovascular and metabolic disease in patients with diabetes.
Although research has explored the association between atherogenic index of plasma (AIP) and prediabetes and diabetes, there is still not sufficient available evidence the role of physical activity (PA) in this relationship. Our purpose is to examine the complex connections between AIP, PA, and prediabetes and diabetes in a young and middle-aged population.
This study included 2220 individuals from the general population, aged 20–60 years. AIP was calculated from the logarithm of the triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio. PA was assessed depending to the American Heart Association (AHA) criteria and categorized into medium-high and low PA levels. We used binary logistic regression to explore associations and subsequently performed sensitivity and subgroup analyses.
The 2220 participants had a mean age of 38 years, with a mean AIP of −0.1185, and a prediabetes and diabetes prevalence of 7.2%. After adjusting for auxiliary variables, AIP was positively correlated with prediabetes and diabetes (odds ratio [OR]: 3.447, 95% confidence interval [CI]: 1.829–6.497). In the low PA population, the prevalence of prediabetes and diabetes raised significantly with higher AIP (OR: 3.678, 95% CI: 1.819–7.434). This association was not meaningful in the medium to high PA population (OR: 1.925, 95% CI: 0.411–9.007). Joint and sensitivity analyze results also showed agreement. Restricted cubic spline identified a linear relationship between AIP and the prevalence of prediabetes and diabetes. Notably, the prevalence significantly increases when AIP values exceed −0.16 (p for linearity <0.05). The findings revealed heterogeneity across subgroups stratified by sex and age.
PA may modify the link as regards AIP with prediabetes and diabetes in young and middle-aged populations. Adherence to PA prevents the adverse effects of abnormal glucose metabolism caused by dyslipidemia, particularly in women.
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