Journal of Diabetes最新文献_第8页

Antenatal oral glucose tolerance test abnormalities in the prediction of future risk of postpartum diabetes in women with gestational diabetes: Results from the LIVING study 产前口服葡萄糖耐量试验异常在预测妊娠糖尿病妇女未来产后糖尿病风险中的作用：LIVING 研究的结果

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-05-06 DOI: 10.1111/1753-0407.13559

Yashdeep Gupta, Deksha Kapoor, Josyula K. Lakshmi, Devarsetty Praveen, Joseph Alvin Santos, Laurent Billot, Aliya Naheed, H. Asita de Silva, Ishita Gupta, Noshin Farzana, Renu John, Saumiyah Ajanthan, Neerja Bhatla, Ankush Desai, Arunasalam Pathmeswaran, Dorairaj Prabhakaran, Helena Teede, Sophia Zoungas, Anushka Patel, Nikhil Tandon

Objectives

To explore associations between type and number of abnormal glucose values on antenatal oral glucose tolerance test (OGTT) with postpartum diabetes in South Asian women diagnosed with gestational diabetes (GDM) using International Association of the Diabetes and Pregnancy Study Groups criteria.

Methods

This post-hoc evaluation of the Lifestyle Intervention IN Gestational Diabetes (LIVING) study, a randomized controlled trial, was conducted among women with GDM in the index pregnancy, across 19 centers in Bangladesh, India, and Sri Lanka. Postpartum diabetes (outcome) was defined on OGTT, using American Diabetes Association (ADA) criteria.

Results

We report data on 1468 women with GDM, aged 30.9 (5.0) years, and with median (interquartile range) follow-up period of 1.8 (1.4–2.4) years after childbirth following the index pregnancy. We found diabetes in 213 (14.5%) women with an incidence of 8.7 (7.6–10.0)/100 women-years. The lowest incidence rate was 3.8/100 women years, in those with an isolated fasting plasma glucose (FPG) abnormality, and highest was 19.0/100 women years in participants with three abnormal values. The adjusted hazard ratios for two and three abnormal values compared to one abnormal value were 1.73 (95% confidence interval [CI], 1.18–2.54; p = .005) and 3.56 (95% CI, 2.46–5.16; p < .001) respectively. The adjusted hazard ratio for the combined (combination of fasting and postglucose load) abnormalities was 2.61 (95% CI, 1.70–4.00; p < .001), compared to isolated abnormal FPG.

Conclusions

Risk of diabetes varied significantly depending upon the type and number of abnormal values on antenatal OGTT. These data may inform future precision medicine approaches such as risk prediction models in identifying women at higher risk and may guide future targeted interventions.

目的探讨根据国际糖尿病和妊娠研究小组协会标准诊断为妊娠糖尿病（GDM）的南亚妇女产前口服葡萄糖耐量试验（OGTT）血糖异常值的类型和数量与产后糖尿病之间的关系。方法孟加拉国、印度和斯里兰卡的 19 个中心对妊娠期糖尿病生活方式干预（LIVING）研究（一项随机对照试验）进行了事后评估。根据美国糖尿病协会（ADA）的标准，产后糖尿病（结果）根据 OGTT 进行定义。结果我们报告了 1468 名 GDM 妇女的数据，这些妇女的年龄为 30.9 (5.0)岁，产后随访时间的中位数（四分位数间距）为 1.8 (1.4-2.4)年。我们在 213 名（14.5%）妇女中发现了糖尿病，发病率为 8.7（7.6-10.0）/100 名妇女-年。在仅有一次空腹血浆葡萄糖（FPG）异常的妇女中，发病率最低，为 3.8/100妇女年；在有三次异常值的妇女中，发病率最高，为 19.0/100妇女年。与一个异常值相比，两个和三个异常值的调整后危险比分别为 1.73（95% 置信区间 [CI]，1.18-2.54；p = .005）和 3.56（95% 置信区间，2.46-5.16；p <.001）。与单独的 FPG 异常相比，合并（空腹和糖负荷后的合并）异常的调整后危险比为 2.61 (95% CI, 1.70-4.00; p <.001)。结论患糖尿病的风险因产前 OGTT 异常值的类型和数量不同而有显著差异。这些数据可为未来的精准医疗方法（如风险预测模型）提供参考，以识别高风险产妇，并为未来的针对性干预措施提供指导。

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引用次数: 0

Clustering of health behaviors and their associations with cardiometabolic risk factors among adults at high risk for type 2 diabetes in India: A latent class analysis 印度 2 型糖尿病高危成人健康行为的聚类及其与心脏代谢风险因素的关联：潜类分析

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-05-06 DOI: 10.1111/1753-0407.13550

Gabrielli T. de Mello, Sathish Thirunavukkarasu, Panniyammakal Jeemon, Kavumpurathu R. Thankappan, Brian Oldenburg, Yingting Cao

Background

We aimed to identify clusters of health behaviors and study their associations with cardiometabolic risk factors in adults at high risk for type 2 diabetes in India.

Methods

Baseline data from the Kerala Diabetes Prevention Program (n = 1000; age 30–60 years) were used for this study. Information on physical activity (PA), sedentary behavior, fruit and vegetable intake, sleep, and alcohol and tobacco use was collected using questionnaires. Blood pressure, waist circumference, 2-h plasma glucose, high-density lipoprotein and low-density lipoprotein cholesterol, and triglycerides were measured using standardized protocols. Latent class analysis was used to identify clusters of health behaviors, and multilevel mixed-effects linear regression was employed to examine their associations with cardiometabolic risk factors.

Results

Two classes were identified, with 87.4% of participants in class 1 and 12.6% in class 2. Participants in both classes had a high probability of not engaging in leisure-time PA (0.80 for class 1; 0.73 for class 2) and consuming <5 servings of fruit and vegetables per day (0.70 for class 1; 0.63 for class 2). However, participants in class 1 had a lower probability of sitting for >=3 h per day (0.26 vs 0.42), tobacco use (0.10 vs 0.75), and alcohol use (0.08 vs 1.00) compared to those in class 2. Class 1 had a significantly lower mean systolic blood pressure (β = −3.70 mm Hg, 95% confidence interval [CI] −7.05, −0.36), diastolic blood pressure (β = −2.45 mm Hg, 95% CI −4.74, −0.16), and triglycerides (β = −0.81 mg/dL, 95% CI −0.75, −0.89).

Conclusion

Implementing intervention strategies, tailored to cluster-specific health behaviors, is required for the effective prevention of cardiometabolic disorders among high-risk adults for type 2 diabetes.

背景我们旨在确定印度 2 型糖尿病高危成人的健康行为群组，并研究它们与心脏代谢风险因素之间的关联。方法本研究使用了喀拉拉邦糖尿病预防计划的基线数据（n = 1000；年龄 30-60 岁）。通过问卷调查收集了有关体力活动（PA）、久坐行为、水果和蔬菜摄入量、睡眠、酗酒和吸烟的信息。采用标准化方案测量了血压、腰围、2 小时血浆葡萄糖、高密度脂蛋白和低密度脂蛋白胆固醇以及甘油三酯。采用潜类分析法确定健康行为群组，并采用多层次混合效应线性回归法研究它们与心脏代谢风险因素的关系。结果发现了两个类别，87.4%的参与者属于第一类，12.6%属于第二类。两个等级的参与者都有很高的概率不进行闲暇时间的体育锻炼（1级为0.80；2级为0.73），并且每天食用<5份水果和蔬菜（1级为0.70；2级为0.63）。不过，与 2 类人群相比，1 类人群每天坐 3 小时（0.26 对 0.42）、吸烟（0.10 对 0.75）和饮酒（0.08 对 1.00）的概率较低。1 类人群的平均收缩压（β = -3.70 mm Hg，95% 置信区间 [CI] -7.05，-0.36）、舒张压（β = -2.45 mm Hg，95% 置信区间 [CI] -4.74，-0.16）和甘油三酯（β = -0.81 mg/dL，95% 置信区间 [CI] -0.75，-0.89）均明显降低。结论要有效预防 2 型糖尿病高危成人的心脏代谢紊乱，就必须针对特定人群的健康行为实施干预策略。

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引用次数: 0

Clinical investigation of glucokinase activators for the restoration of glucose homeostasis in diabetes 葡萄糖激酶激活剂用于恢复糖尿病患者葡萄糖稳态的临床研究

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-04-25 DOI: 10.1111/1753-0407.13544

Ping Li, Dalong Zhu

As a sensor, glucokinase (GK) controls glucose homeostasis, which progressively declines in patients with diabetes. GK maintains the equilibrium of glucose levels and regulates the homeostatic system set points. Endocrine and hepatic cells can both respond to glucose cooperatively when GK is activated. GK has been under study as a therapeutic target for decades due to the possibility that cellular GK expression and function can be recovered, hence restoring glucose homeostasis in patients with type 2 diabetes. Five therapeutic compounds targeting GK are being investigated globally at the moment. They all have distinctive molecular structures and have been clinically shown to have strong antihyperglycemia effects. The mechanics, classification, and clinical development of GK activators are illustrated in this review. With the recent approval and marketing of the first GK activator (GKA), dorzagliatin, GKA's critical role in treating glucose homeostasis disorder and its long-term benefits in diabetes will eventually become clear.

作为一种传感器，葡萄糖激酶（GK）控制着糖尿病患者体内逐渐下降的葡萄糖平衡。GK 可维持葡萄糖水平的平衡，并调节体内平衡系统的设定点。当 GK 被激活时，内分泌细胞和肝细胞都能对葡萄糖做出协同反应。由于细胞 GK 的表达和功能有可能恢复，从而恢复 2 型糖尿病患者的葡萄糖稳态，几十年来，GK 一直被作为治疗靶点进行研究。目前，全球正在研究五种针对 GK 的治疗化合物。它们都具有独特的分子结构，临床显示具有很强的抗高血糖作用。本综述阐述了 GK 激活剂的机制、分类和临床开发。随着首个 GK 激活剂（GKA）多扎格列汀（dorzagliatin）最近获得批准并上市，GKA 在治疗糖稳态紊乱中的关键作用及其对糖尿病的长期益处终将变得清晰可见。

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引用次数: 0

Acellular fish skin grafts in the treatment of diabetic wounds: Advantages and clinical translation 细胞鱼皮移植治疗糖尿病伤口：优势与临床应用

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-04-25 DOI: 10.1111/1753-0407.13554

Chenyu Zhao, Mengyi Feng, Martin Gluchman, Xianghe Ma, Jinhao Li, Hui Wang

Diabetic wounds cannot undergo normal wound healing due to changes in the concentration of hyperglycemia in the body and soon evolve into chronic wounds causing amputation or even death of patients. Diabetic wounds directly affect the quality of patients and social medical management; thus researchers started to focus on skin transplantation technology. The acellular fish skin grafts (AFSGs) are derived from wild fish, which avoids the influence of human immune function and the spread of the virus through low-cost decellularization. AFSGs contain a large amount of collagen and omega-3 polyunsaturated fatty acids and they have an amazing effect on wound regeneration. However, after our search in major databases, we found that there were few research trials in this field, and only one was clinically approved. Therefore, we summarized the advantages of AFSGs and listed the problems faced in clinical use. The purpose of this paper is to enable researchers to better carry out original experiments at various stages.

糖尿病伤口由于体内高血糖浓度的变化而无法正常愈合，很快就会演变成慢性伤口，导致患者截肢甚至死亡。糖尿病伤口直接影响患者的生活质量和社会医疗管理，因此研究人员开始关注皮肤移植技术。无细胞鱼皮移植（AFSGs）来源于野生鱼类，通过低成本的脱细胞处理，避免了人体免疫功能的影响和病毒的传播。AFSGs 含有大量胶原蛋白和欧米加-3 多不饱和脂肪酸，对伤口再生有显著效果。然而，我们在各大数据库中搜索后发现，该领域的研究试验很少，仅有一项获得临床批准。因此，我们总结了 AFSGs 的优点，并列举了临床使用中面临的问题。本文旨在让研究人员更好地开展各阶段的原创性实验。

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引用次数: 0

Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50-year, single-center experience 儿童和青少年 1 型糖尿病的流行病学：长达 50 年的单一中心经验

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-04-25 DOI: 10.1111/1753-0407.13562

Nurgun Kandemir, Dogus Vuralli, Alev Ozon, Nazlı Gonc, Didem Ardicli, Lala Jalilova, Omer Nazim Gulcek, Ayfer Alikasifoglu

Background

Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50 years.

Methods

Clinical characteristics of 925 patients with T1DM over last 30 years (1990–2019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey.

Results

Mean age at diagnosis decreased from 9.5 ± 4.0 to 7.1 ± 3.6 years within the past 50 years (p < .001). Age at diagnosis peaked at 12–14 years between 1969 and 1990, then fell to 10–11.9 years between 1990 and 1999, and to 4–5.9 years between 2000–2009 and 2010–2019 (p = .005). Although the percentage of patients diagnosed <6 years of age is gradually increasing, the percentage between the ages of 6 and 11.9 years is decreasing, and the percentage diagnosed ≥12 years remained stable. A total of 47.5% of patients had ketoacidosis, 38.2% had ketosis, and 14.3% had only hyperglycemia. 23% of patients had severe diabetic ketoacidosis (DKA), whereas 42% had moderate. Over last 3 decades, there has been no change in frequency of ketoacidosis at presentation, but there has been significant decline in severity (p = .865, and p < .001, respectively). Although the frequency of patients with mild DKA increased over time, frequency of patients with moderate DKA decreased; however, no significant difference was observed among patients with severe ketoacidosis. DKA was more frequent and severe in patients <6 years of age (p = .005, and p < .001, respectively).

Conclusion

Age at diagnosis shifted to younger ages in T1DM in the past 50 years. Half of patients had ketoacidosis at diagnosis and frequency of presentation with DKA did not decrease, but severity decreased slightly. Increase in prevalence of T1DM in the younger age group and the fact that half of patients present with DKA indicate that awareness should be increased in terms of early diagnosis and treatment.

背景 1 型糖尿病（T1DM）的流行病学存在全球性差异。本研究旨在探讨过去 30 年间 T1DM 的人口统计学和临床特征，以及过去 50 年间流行病学的演变趋势。方法对过去 30 年（1990-2019 年）925 名 T1DM 患者的临床特征进行评估，并与之前发表的土耳其一家主要糖尿病转诊中心在 1969 年至 1990 年期间确诊的 477 名患者的数据进行比较。结果在过去 50 年中，确诊时的平均年龄从 9.5 ± 4.0 岁降至 7.1 ± 3.6 岁（p < .001）。确诊年龄在 1969 年至 1990 年间达到 12-14 岁的峰值，随后在 1990 年至 1999 年间降至 10-11.9 岁，在 2000-2009 年和 2010-2019 年间降至 4-5.9 岁（p = .005）。虽然确诊患者年龄为6岁的比例逐渐上升，但6-11.9岁的比例却在下降，确诊患者年龄≥12岁的比例保持稳定。47.5%的患者有酮症酸中毒，38.2%的患者有酮症，14.3%的患者仅有高血糖。23%的患者有严重的糖尿病酮症酸中毒（DKA），42%的患者有中度酮症酸中毒。在过去的 30 年中，出现酮症酸中毒的频率没有变化，但严重程度却显著下降（分别为 p = .865 和 p <.001）。虽然随着时间的推移，轻度 DKA 患者的发病率有所上升，但中度 DKA 患者的发病率有所下降；不过，在重度酮症酸中毒患者中没有观察到明显的差异。6 岁患者的 DKA 发生率更高，病情更严重（分别为 p = .005 和 p <.001）。结论在过去的 50 年中，T1DM 患者的确诊年龄向年轻化转变。半数患者在确诊时患有酮症酸中毒，出现 DKA 的频率没有降低，但严重程度略有下降。T1DM发病率在年轻群体中的增加以及半数患者出现 DKA 的事实表明，应提高对早期诊断和治疗的认识。

{"title":"Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50-year, single-center experience","authors":"Nurgun Kandemir, Dogus Vuralli, Alev Ozon, Nazlı Gonc, Didem Ardicli, Lala Jalilova, Omer Nazim Gulcek, Ayfer Alikasifoglu","doi":"10.1111/1753-0407.13562","DOIUrl":"https://doi.org/10.1111/1753-0407.13562","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical characteristics of 925 patients with T1DM over last 30 years (1990–2019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean age at diagnosis decreased from 9.5 ± 4.0 to 7.1 ± 3.6 years within the past 50 years (<i>p</i> < .001). Age at diagnosis peaked at 12–14 years between 1969 and 1990, then fell to 10–11.9 years between 1990 and 1999, and to 4–5.9 years between 2000–2009 and 2010–2019 (<i>p</i> = .005). Although the percentage of patients diagnosed <6 years of age is gradually increasing, the percentage between the ages of 6 and 11.9 years is decreasing, and the percentage diagnosed ≥12 years remained stable. A total of 47.5% of patients had ketoacidosis, 38.2% had ketosis, and 14.3% had only hyperglycemia. 23% of patients had severe diabetic ketoacidosis (DKA), whereas 42% had moderate. Over last 3 decades, there has been no change in frequency of ketoacidosis at presentation, but there has been significant decline in severity (<i>p</i> = .865, and <i>p</i> < .001, respectively). Although the frequency of patients with mild DKA increased over time, frequency of patients with moderate DKA decreased; however, no significant difference was observed among patients with severe ketoacidosis. DKA was more frequent and severe in patients <6 years of age (<i>p</i> = .005, and <i>p</i> < .001, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Age at diagnosis shifted to younger ages in T1DM in the past 50 years. Half of patients had ketoacidosis at diagnosis and frequency of presentation with DKA did not decrease, but severity decreased slightly. Increase in prevalence of T1DM in the younger age group and the fact that half of patients present with DKA indicate that awareness should be increased in terms of early diagnosis and treatment.</p>\u0000 \u0000 <div>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":189,"journal":{"name":"Journal of Diabetes","volume":"16 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1753-0407.13562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140648236","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}

引用次数: 0

Gamma-glutamyl transferase and the risk of all-cause and disease-specific mortality in patients with diabetes: A nationwide cohort study γ-谷氨酰转移酶与糖尿病患者的全因和特定疾病死亡风险：全国性队列研究

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-04-25 DOI: 10.1111/1753-0407.13551

Goh Eun Chung, Su-Min Jeong, Su Jong Yu, Jeong-Ju Yoo, Yuri Cho, Kyu-na Lee, Dong Wook Shin, Yoon Jun Kim, Jung-Hwan Yoon, Kyungdo Han, Eun Ju Cho

Background

There exists a paucity of data regarding whether gamma-glutamyl transferase is associated with disease-specific mortality in patients with type 2 diabetes mellitus. This study aimed to investigate the association of serum gamma-glutamyl transferase levels with all-cause and disease-specific mortality in patients with diabetes mellitus using a Korean nationwide health-screening database.

Methods

A total of 9 687 066 patients without viral hepatitis or liver cirrhosis who underwent health examination in 2009 were included. These patients were divided into four groups according to sex-specific quartiles of serum gamma-glutamyl transferase levels.

Results

During a median follow-up period of 8.1 years, 222 242 deaths were identified. The all-cause mortality rate increased as the serum gamma-glutamyl transferase levels became higher (highest quartile vs lowest quartile: hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.55–1.59; p for trend <.001). Similar trends were observed for cardiovascular disease (HR, 1.57; 95% CI, 1.53–1.62), ischemic heart disease (HR, 1.40; 95% CI, 1.33–1.48), and stroke (HR, 1.72; 95% CI, 1.60–1.85) in the highest quartile, as compared with the lowest quartile (p for trend <.001). As the gamma-glutamyl transferase quartiles became higher, mortality rates related to cancer (HR, 1.56; 95% CI, 1.52–1.60), liver disease (HR, 9.42; 95% CI, 8.81–10.07), respiratory disease (HR, 1.55; 95% CI, 1.49–1.62), and infectious disease (HR, 1.73; 95% CI, 1.59–1.87) also increased in the highest quartile, compared with the lowest quartile (p for trend <.001).

Conclusions

Serum gamma-glutamyl transferase levels may be useful for the risk assessment of all-cause and disease-specific mortality among patients with type 2 diabetes mellitus.

背景有关γ-谷氨酰转移酶是否与2型糖尿病患者的疾病特异性死亡率有关的数据很少。本研究旨在利用韩国全国健康筛查数据库，调查血清γ-谷氨酰转移酶水平与糖尿病患者全因死亡率和疾病特异性死亡率的关系。方法共纳入 9 687 066 名在 2009 年接受健康检查的无病毒性肝炎或肝硬化患者。根据血清γ-谷氨酰转移酶水平的性别特异性四分位数将这些患者分为四组。结果在中位 8.1 年的随访期间，共发现 222 242 例死亡病例。血清γ-谷氨酰转移酶水平越高，全因死亡率越高（最高四分位数与最低四分位数：危险比[HR]，1.57；95%置信区间[CI]，1.55-1.59；趋势 p<.001）。在心血管疾病（HR，1.57；95% CI，1.53-1.62）、缺血性心脏病（HR，1.40；95% CI，1.33-1.48）和中风（HR，1.72；95% CI，1.60-1.85）方面，最高四分位数与最低四分位数相比也观察到类似的趋势（p 为趋势 <.001）。随着γ-谷氨酰转移酶四分位数越高，癌症（HR，1.56；95% CI，1.52-1.60）、肝脏疾病（HR，9.42；95% CI，8.81-10.07）、呼吸系统疾病（HR，1.55；95% CI，1.49-1.62）和传染病（HR，1.73；95% CI，1.59-1.87）的死亡率在最高四分位数也比最低四分位数高（p为趋势<.001）。结论血清γ-谷氨酰转移酶水平可能有助于对2型糖尿病患者的全因死亡率和疾病特异性死亡率进行风险评估。

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引用次数: 0

Cost saving analysis of prediabetes intervention modalities in comparison with inaction using Markov state transition model—A multiregional case study 利用马尔可夫状态转换模型对糖尿病前期干预方式与不作为进行成本节约分析--多区域案例研究

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-04-25 DOI: 10.1111/1753-0407.13553

Hussain Abdulrahman Al-Omar, Marcin Czech, Tran Quang Nam, Ulrike Gottwald-Hostalek, Nikola Vesic, James Whitehouse, Maddy Dawson

Background

Prediabetes management is a priority for policymakers globally, to avoid/delay type 2 diabetes (T2D) and reduce severe, costly health consequences. Countries moving from low to middle income are most at risk from the T2D “epidemic” and may find implementing preventative measures challenging; yet prevention has largely been evaluated in developed countries.

Methods

Markov cohort simulations explored costs and benefits of various prediabetes management approaches, expressed as “savings” to the public health care system, for three countries with high prediabetes prevalence and contrasting economic status (Poland, Saudi Arabia, Vietnam). Two scenarios were compared up to 15 y: “inaction” (no prediabetes intervention) and “intervention” with metformin extended release (ER), intensive lifestyle change (ILC), ILC with metformin (ER), or ILC with metformin (ER) “titration.”

Results

T2D was the highest-cost health state at all time horizons due to resource use, and inaction produced the highest T2D costs, ranging from 9% to 34% of total health care resource costs. All interventions reduced T2D versus inaction, the most effective being ILC + metformin (ER) “titration” (39% reduction at 5 y). Metformin (ER) was the only strategy that produced net saving across the time horizon; however, relative total health care system costs of other interventions vs inaction declined over time up to 15 y. Viet Nam was most sensitive to cost and parameter changes via a one-way sensitivity analysis.

Conclusions

Metformin (ER) and lifestyle interventions for prediabetes offer promise for reducing T2D incidence. Metformin (ER) could reduce T2D patient numbers and health care costs, given concerns regarding adherence in the context of funding/reimbursement challenges for lifestyle interventions.

背景糖尿病前期管理是全球政策制定者的首要任务，以避免/延缓 2 型糖尿病（T2D）的发生，减少严重的、代价高昂的健康后果。从低收入到中等收入的国家最容易受到 T2D "流行病 "的威胁，可能会发现实施预防措施具有挑战性；然而，大部分发达国家都对预防措施进行了评估。方法马尔科夫队列模拟探讨了三个糖尿病前期发病率较高且经济状况截然不同的国家（波兰、沙特阿拉伯和越南）的各种糖尿病前期管理方法的成本和效益，这些成本和效益表现为公共医疗系统的 "节约"。比较了两种最长达 15 年的方案："不作为"（不对糖尿病前期进行干预）和 "干预"：二甲双胍缓释片（ER）、生活方式强化改变（ILC）、二甲双胍缓释片（ER）ILC 或二甲双胍缓释片（ER）ILC "滴定"。结果在所有时间跨度内，T2D都是因资源使用而产生的成本最高的健康状况，而不作为产生的T2D成本最高，占医疗资源总成本的9%到34%不等。与不采取行动相比，所有干预措施都能减少 T2D，其中最有效的是 ILC + 二甲双胍（ER）"滴定"（5 年后减少 39%）。二甲双胍（ER）是唯一能在整个时间跨度内产生净节省的策略；然而，其他干预措施与不作为相比，医疗系统的相对总成本随着时间的推移而下降，直至15年。通过单向敏感性分析，越南对成本和参数变化最为敏感。结论针对糖尿病前期的二甲双胍（ER）和生活方式干预有望降低T2D发病率。二甲双胍（ER）可减少T2D患者人数和医疗成本，但在生活方式干预面临资金/报销挑战的情况下，人们对患者的依从性存在担忧。

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引用次数: 0

The metabolic effects of habitual leg shaking: A randomized crossover trial 习惯性抖腿对新陈代谢的影响：随机交叉试验

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-04-25 DOI: 10.1111/1753-0407.13556

Riqiang Bao, Yixiang Hu, Rui Xu, Chong Gao, Yuhan Guo, Yashu Zhu, Shijia Pan, Weiqing Wang

Aims

The adverse effects of sedentary behavior on obesity and chronic diseases are well established. However, the prevalence of sedentary behavior has increased, with only a minority of individuals meeting the recommended physical activity guidelines. This study aimed to investigate whether habitual leg shaking, a behavior traditionally considered unfavorable, could serve as an effective strategy to improve energy metabolism.

Materials and Methods

A randomized crossover study was conducted, involving 15 participants (mean [SD] age, 25.4 [3.6]; mean [SD] body mass index, 22 [3]; 7 women [46.7%]). The study design involved a randomized sequence of sitting and leg shaking conditions, with each condition lasting for 20 min. Energy expenditure, respiratory rate, oxygen saturation, and other relevant variables were measured during each condition.

Results

Compared to sitting, leg shaking significantly increased total energy expenditure [1.088 kj/min, 95% confidence interval, 0.69–1.487 kj/min], primarily through elevated carbohydrate oxidation. The average metabolic equivalent during leg shaking exhibited a significant increase from 1.5 to 1.8. Leg shaking also raised respiratory rate, minute ventilation, and blood oxygen saturation levels, while having no obvious impact on heart rate or blood pressure. Electromyography data confirmed predominant activation of lower leg muscles and without increased muscle fatigue. Intriguingly, a significant correlation was observed between the increased energy expenditure and both the frequency of leg shaking and the muscle mass of the legs.

Conclusions

Our study provides evidence that habitual leg shaking can boost overall energy expenditure by approximately 16.3%. This simple and feasible approach offers a convenient way to enhance physical activity levels.

目的久坐不动对肥胖和慢性疾病的不良影响已得到公认。然而，久坐行为的发生率却在增加，只有少数人达到了推荐的体育锻炼指南的要求。本研究旨在探讨习惯性抖腿这种传统上被认为不利于健康的行为能否作为改善能量代谢的有效策略。材料与方法进行了一项随机交叉研究，共有 15 名参与者（平均 [SD] 年龄，25.4 [3.6]；平均 [SD] 体重指数，22 [3]；7 名女性 [46.7%]）参加。研究设计包括坐姿和抖腿状态的随机序列，每个状态持续 20 分钟。在每个条件下测量能量消耗、呼吸频率、血氧饱和度和其他相关变量。结果与坐姿相比，抖腿能显著增加总能量消耗[1.088 kj/min，95% 置信区间，0.69-1.487 kj/min]，主要是通过提高碳水化合物的氧化作用。抖腿时的平均代谢当量从 1.5 显著增加到 1.8。抖腿还提高了呼吸频率、分钟通气量和血氧饱和度水平，但对心率和血压没有明显影响。肌电图数据证实，抖腿主要激活的是小腿肌肉，肌肉疲劳程度没有增加。耐人寻味的是，能量消耗的增加与抖腿频率和腿部肌肉质量之间存在明显的相关性。结论我们的研究提供了证据，证明习惯性抖腿可以将总体能量消耗提高约 16.3%。这种简单可行的方法为提高体育锻炼水平提供了便捷途径。

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引用次数: 0

Prevalence of nonalcoholic fatty liver disease and liver cirrhosis in Chinese adults with type 2 diabetes mellitus 中国成人 2 型糖尿病患者非酒精性脂肪肝和肝硬化的患病率

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-04-25 DOI: 10.1111/1753-0407.13564

Xinyu Han, Xin Zhang, Zhenqiu Liu, Hong Fan, Chengnan Guo, Haili Wang, Yu Gu, Tiejun Zhang

Background

Nonalcoholic fatty liver disease (NAFLD) and liver cirrhosis are significant clinical concerns, especially among individuals with type 2 diabetes mellitus (T2DM). However, in China, there is a paucity of reliable evidence detailing the characteristics of NAFLD and liver cirrhosis in T2DM. Furthermore, the relationship between blood glucose levels and NAFLD prevalence remains unclear.

Methods

Data from the Shanghai Suburban Adult Cohort and Biobank were analyzed, including 6621 participants with T2DM. NAFLD was diagnosed by ultrasonography and liver cirrhosis was performed according to the health information systems. Logistic regression and restricted cubic spline analysis were used to explore the potential risk factors for NAFLD and liver cirrhosis.

Results

The prevalence of NAFLD was 59.36%, and liver cirrhosis was 1.43% among T2DM patients. In these patients, factors like age, being female, marital status, and obesity significantly increased the risk of NAFLD. Specifically, obesity had a strong positive association with NAFLD (odds ratio [OR] = 4.70, 95% confidence interval [CI]: 4.13–5.34). The higher glycated hemoglobin (HbA1c) quartile was associated with a heightened NAFLD risk compared to the lowest quartile (all p < .001). The HbA1c-NAFLD relationship displayed a linear that mimicked an inverted L-shaped pattern. A significant positive association existed between HbA1c levels and NAFLD for HbA1c <8.00% (OR = 1.59, 95% CI: 1.44–1.75), but this was not observed for HbA1c >8.00% (OR = 1.03, 95% CI: 0.92–1.15).

Conclusion

Systematic screening for NAFLD is essential in T2DM patients, especially with poor glucose control and obesity in female.

背景非酒精性脂肪肝（NAFLD）和肝硬化是临床关注的重要问题，尤其是在 2 型糖尿病（T2DM）患者中。然而，在中国，有关 T2DM 非酒精性脂肪肝和肝硬化特征的可靠证据却很少。此外，血糖水平与非酒精性脂肪肝发病率之间的关系仍不明确。方法分析了上海郊区成人队列和生物库的数据，其中包括 6621 名 T2DM 患者。非酒精性脂肪肝通过超声波诊断，肝硬化则根据卫生信息系统进行诊断。采用逻辑回归和限制性立方样条分析来探讨非酒精性脂肪肝和肝硬化的潜在风险因素。结果在 T2DM 患者中，非酒精性脂肪肝患病率为 59.36%，肝硬化患病率为 1.43%。在这些患者中，年龄、女性、婚姻状况和肥胖等因素会显著增加非酒精性脂肪肝的风险。具体来说，肥胖与非酒精性脂肪肝有很强的正相关性（比值比 [OR] = 4.70，95% 置信区间 [CI]：4.13-5.34）。与最低四分位数相比，糖化血红蛋白（HbA1c）四分位数越高，非酒精性脂肪肝的风险越高（均为 p <.001）。HbA1c 与非酒精性脂肪肝的关系呈现出一种类似倒 L 型的线性关系。对于 HbA1c <8.00%（OR = 1.59，95% CI：1.44-1.75），HbA1c >8.00%（OR = 1.03，95% CI：0.92-1.15），HbA1c 水平与非酒精性脂肪肝之间存在明显的正相关。结论对 T2DM 患者，尤其是血糖控制不佳和肥胖的女性患者进行非酒精性脂肪肝的系统筛查至关重要。

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引用次数: 0

Continuous subcutaneous insulin infusion versus multiple daily injection therapy in pregnant women with type 1 diabetes 1 型糖尿病孕妇皮下持续输注胰岛素与每日多次注射疗法的比较

IF 4.5 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes

Pub Date : 2024-04-25 DOI: 10.1111/1753-0407.13558

Yixin Gong, Tian Wei, Yujie Liu, Jing Wang, Jinhua Yan, Daizhi Yang, Sihui Luo, Jianping Weng, Xueying Zheng

Introduction

The study aimed to compare glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) using multiple daily injection therapy (MDI) and continuous subcutaneous insulin infusion (CSII) and to compare outcomes of women treated with long-acting insulin or neutral protamine Hagedorn (NPH).

Methods

This multicenter prospective cohort study involved women with pregestational T1DM treated with MDI and CSII. Primary outcome was glycated hemoglobin (HbA1c) before and during pregnancy. Secondary outcomes included maternal and neonatal outcomes and quality of life.

Results

Of the 121 studied women, the average age was 28.48 years, and the average body mass index was 21.29 kg/m² at conception and 26.32 kg/m² at delivery. Of the studied women, 78.51% had planned pregnancy. Women treated with MDI and CSII had comparable HbA1c before pregnancy or in the first and second trimesters. In the third trimester, women on CSII therapy had significantly lower HbA1c (6.07 ± 0.62 vs 6.20 ± 0.88%, p = .017), higher HbA1c on-target rate (71.43% vs 64.62%, p = .030), and greater decline of HbA1c from preconception to the third trimester (−0.65 vs −0.30%, p = .047). Fewer daily insulin requirements were observed in those used CSII compared with MDI-treated women (0.60 ± 0.22 vs 0.73 ± 0.25 U/kg/day, p = .004). Newborns born of mothers treated with the CSII method were more likely to have neonatal jaundice (adjusted odds ratio [OR] 2.76, 95% confidence interval [CI] 1.16–6.57) and neonatal intensive care unit (adjusted OR 3.73, 95%CI 1.24–11.16), and women on CSII had lower scores in patient-reported quality of life (p = .045). In the MDI group, those receiving long-acting insulin had nonsignificant lower HbA1c and higher HbA1c on-target rate in the second and third trimesters, compared with those treated with NPH.

Conclusions

Insulin pump users may achieve better glycemic control than multiple daily insulin injections, which did not substantially improve pregnancy outcome.

引言该研究旨在比较采用每日多次注射疗法（MDI）和持续皮下注射胰岛素疗法（CSII）的 1 型糖尿病（T1DM）女性患者的血糖控制和妊娠结局，并比较采用长效胰岛素或中性原研胰岛素（NPH）治疗的女性患者的妊娠结局。方法这项多中心前瞻性队列研究涉及接受 MDI 和 CSII 治疗的妊娠前 T1DM 女性患者。主要结果是孕前和孕期糖化血红蛋白（HbA1c）。次要结果包括产妇和新生儿的预后以及生活质量。结果在研究的 121 名妇女中，平均年龄为 28.48 岁，受孕时的平均体重指数为 21.29 kg/m2，分娩时的平均体重指数为 26.32 kg/m2。在研究的妇女中，78.51%是计划怀孕。接受 MDI 和 CSII 治疗的妇女在孕前或孕期前三个月和后三个月的 HbA1c 值相当。在第三个孕期，接受 CSII 治疗的女性 HbA1c 明显降低（6.07 ± 0.62 vs 6.20 ± 0.88%，p = .017），HbA1c 达标率更高（71.43% vs 64.62%，p = .030），从怀孕前到第三个孕期的 HbA1c 下降幅度更大（-0.65 vs -0.30%，p = .047）。与使用 MDI 的妇女相比，使用 CSII 的妇女每日胰岛素需求量更少（0.60 ± 0.22 vs 0.73 ± 0.25 U/kg/天，p = .004）。使用 CSII 方法的母亲所生的新生儿更有可能出现新生儿黄疸（调整后的几率比 [OR] 2.76，95% 置信区间 [CI] 1.16-6.57）和新生儿重症监护室（调整后的几率比 3.73，95% 置信区间 [CI] 1.24-11.16），使用 CSII 的妇女在患者报告的生活质量方面得分较低（p = 0.045）。在 MDI 组中，与接受 NPH 治疗的产妇相比，接受长效胰岛素治疗的产妇在第二和第三孕期的 HbA1c 和 HbA1c 达标率均无显著降低。结论胰岛素泵使用者可能比每日多次注射胰岛素者获得更好的血糖控制，但每日多次注射胰岛素并不能显著改善妊娠结局。

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引用次数: 0