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Unusual infections and diabetes: dangerous fungi 异常感染和糖尿病:危险的真菌
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-01-01 DOI: 10.1002/pdi.2440
R. Hillson
World Health Organisation In October 2022, WHO issued a warning: ‘Fungal pathogens are a major threat to public health as they are becoming increasingly common and resistant to treatment...Most fungal pathogens lack rapid and sensitive diagnostics...During the COVID-19 pandemic, the reported incidence of invasive fungal infections increased significantly among hospitalized patients... Despite the growing concern, fungal infections receive very little attention and resources.’2
2022年10月,世卫组织发出警告:“真菌病原体正变得越来越普遍,并且对治疗具有抗药性,因此对公众健康构成了重大威胁……大多数真菌病原体缺乏快速和敏感的诊断……在2019冠状病毒病大流行期间,住院患者中侵袭性真菌感染的发病率显著增加……尽管人们越来越关注真菌感染,但真菌感染得到的关注和资源却很少
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引用次数: 1
Prediabetes screening, treatment, and follow‐up in primary health care: a cross‐sectional survey 初级卫生保健中的糖尿病前期筛查、治疗和随访:一项横断面调查
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2425
Katri Harcke, M. Graue, T. Skinner, Christina B Olsson, Nouha Saleh Stattin
Aim: This study aimed to describe routines for screening, treatment, and follow‐up for prediabetes at primary health care centres in Region Stockholm, Sweden.
目的:本研究旨在描述瑞典斯德哥尔摩地区初级卫生保健中心对前驱糖尿病的常规筛查、治疗和随访。
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引用次数: 0
Combined COVID‐19 and influenza infection: an imminent ‘double whammy’ ahead? COVID - 19和流感合并感染:迫在眉睫的“双重打击”?
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2421
K. Shaw
A the winter of 2022–23 approaches, concern is already developing about the prospect of a dual co-infection with simultaneous SARS-CoV-2 (COVID-19/ Omicron) and influenza A (currently H3N2). Furthermore, as a result of essential measures put in place over the last couple of years to mitigate risk of transmitting COVID infection, the incidence of seasonal influenza has been substantially less than in previous years, raising the potential probability of a more susceptible population with a lessened natural immunity to influenza infection. Indeed, present reports from Australia, inevitably the prelude to later western experience, indicate a rapid rise in influenza A notifications, a challenge reinforced by declining uptake of seasonal influenza vaccine both in Australia and the UK.1
随着2022-23年冬季的临近,人们已经开始担心SARS-CoV-2 (COVID-19/ Omicron)和甲型流感(目前为H3N2)双重合并感染的前景。此外,由于过去几年为降低传播COVID感染的风险而采取的基本措施,季节性流感的发病率已大大低于往年,从而增加了对流感感染的天然免疫力降低的易感人群的潜在可能性。事实上,目前来自澳大利亚的报告,不可避免地是后来西方经验的前奏,表明甲型流感报告迅速增加,澳大利亚和英国季节性流感疫苗的接种率下降加强了这一挑战
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引用次数: 0
Common tests for diabetic peripheral neuropathy 糖尿病周围神经病变的常用检查
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2428
K. Bishop, R. Poole
In this fifth article in our ‘Test Tips’ series, Dr Katherine Bishop and Dr Ruth Poole examine the relative benefits and limitations of the four commonly‐used tests for diabetic peripheral neuropathy.
在我们“测试提示”系列的第五篇文章中,Katherine Bishop博士和Ruth Poole博士研究了糖尿病周围神经病变的四种常用测试的相对益处和局限性。
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引用次数: 0
Supporting people with type 2 diabetes who need insulin 支持需要胰岛素的2型糖尿病患者
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2424
K. Winkley
The year 2022 marks 100 years since the first person with diabetes received an insulin injection and supporting people with insulin self‐management is a core role for diabetes nurses. Janet Kinson was a diabetes nurse and author. She developed the first diabetes education programme for nurses and the topic of insulin was central to the curriculum. This article will honour the contribution she made by focusing on diabetes education for people with type 2 diabetes who need insulin. It will start by tracing why and when people with type 2 diabetes should start insulin treatment followed by an exploration of the barriers to starting insulin at the level of the individual, the health care professional and the health system. We know that around 50% of people with type 2 diabetes delay starting insulin for seven years when it is clinically indicated. We also know that around a third of people with type 2 diabetes who are insulin treated remain hyperglycaemic or experience frequent hypoglycaemia. Therefore, there is a need for interventions that address delay, optimise starting insulin as well as consider how we best support people with type 2 diabetes to persist with and intensify their insulin over the diabetes journey. This article presents the current literature on interventions to support people with type 2 diabetes with insulin and identify gaps in support that may be addressed in future research. Copyright © 2022 John Wiley & Sons..
2022年是第一位糖尿病患者接受胰岛素注射100周年,支持患者进行胰岛素自我管理是糖尿病护士的核心职责。珍妮特·金森是一名糖尿病护士和作家。她为护士制定了第一个糖尿病教育计划,胰岛素的主题是课程的核心。这篇文章将表彰她对需要胰岛素的2型糖尿病患者的糖尿病教育做出的贡献。它将首先追踪2型糖尿病患者为什么以及何时应该开始胰岛素治疗,然后探索在个人、卫生保健专业人员和卫生系统层面开始胰岛素治疗的障碍。我们知道,约有50%的2型糖尿病患者在临床需要时延迟7年才开始使用胰岛素。我们还知道,大约三分之一接受胰岛素治疗的2型糖尿病患者仍然患有高血糖或经常出现低血糖。因此,有必要采取干预措施,解决延迟问题,优化胰岛素启动,并考虑如何最好地支持2型糖尿病患者在糖尿病过程中坚持并加强胰岛素治疗。这篇文章介绍了目前关于支持2型糖尿病患者使用胰岛素的干预措施的文献,并确定了在未来研究中可能解决的支持差距。版权所有©2022 John Wiley & Sons。
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引用次数: 0
Dapagliflozin and euglycaemic diabetic ketoacidosis – ‘But doctor my sugars were normal!’ 达格列净和糖尿病酮症酸中毒——但是医生,我的血糖是正常的!”
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2430
K. Watters, V. Greener, Akaterini Theodoraki, E. Nogueira, K. Shotliff
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引用次数: 0
Clinical/biochemical characteristics and related outcomes in people with new‐onset diabetes and COVID‐19: experience from a single centre 新发糖尿病和COVID - 19患者的临床/生化特征和相关结果:来自单一中心的经验
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2426
Diego Mun oz Moreno, R. J. Ramos, Laura González Fernández, Alejandra Maricel Rivas Montenegro, María Miguélez González, Noemí Brox Torrecilla, O. G. Albarrán
Aims: It is known that there is a bidirectional relationship between diabetes mellitus (DM) and coronavirus disease (COVID‐19). It has been described that those patients infected with SARS‐CoV‐2 could develop severe metabolic decompensation of pre‐existing or new‐onset DM, although diabetogenic effect of SARS‐CoV‐2 has still not been well consolidated. In fact, the coexistence of SARS‐CoV‐2 infection and new‐onset DM is an infrequent situation.
目的:糖尿病(DM)与冠状病毒病(COVID - 19)之间存在双向关系。尽管SARS - CoV - 2的致糖尿病作用尚未得到很好的证实,但已有研究表明,感染SARS - CoV - 2的患者可能会出现严重的糖尿病代谢性失代偿。事实上,SARS - CoV - 2感染与新发糖尿病共存是一种罕见的情况。
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引用次数: 3
Window of opportunity: screening for GCK monogenic diabetes in the antenatal diabetes clinic 机会之窗:筛查GCK单基因糖尿病在产前糖尿病诊所
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2427
Aarthi Surendran, A. Brackenridge, S. White
Monogenic diabetes (MODY) is a rare, inherited form of diabetes, of which glucokinase (GCK) mutation is one of the most common forms. Correct diagnosis is important, particularly during pregnancy, as treatment should be tailored accordingly. In our antenatal diabetes clinic, we audited those eligible for genetic screening over a one‐year period as per European Best Practice guidelines (2008) and new NHS England criteria (2021), as well as those identified with the mutation. Our audit recorded a significant drop in the number of eligible women identified using new criteria (2.6% vs 5.2%), with a notable reduction in women of African ethnicity (15.2% vs 29.2%). The audit highlighted the need for increased health care professional awareness and the implementation of clear pathways within the antenatal diabetes service to facilitate identification of women for genetic screening and subsequent appropriate management. It also underlined the importance of ongoing assessment of the clinical performance of the new screening criteria. Copyright © 2022 John Wiley & Sons.
单基因糖尿病(MODY)是一种罕见的遗传性糖尿病,其中葡萄糖激酶(GCK)突变是最常见的形式之一。正确的诊断很重要,特别是在怀孕期间,因为治疗应该相应地量身定制。在我们的产前糖尿病诊所,我们根据欧洲最佳实践指南(2008年)和新的NHS英格兰标准(2021年)审核了那些符合一年遗传筛查条件的患者,以及那些确定有突变的患者。我们的审计记录显示,使用新标准确定的符合条件的妇女人数显著下降(2.6%对5.2%),非洲裔妇女人数显著减少(15.2%对29.2%)。审计突出指出,需要提高保健专业人员的认识,并在产前糖尿病服务部门内实施明确的途径,以便利查明妇女进行遗传筛查和随后的适当管理。它还强调了对新筛查标准的临床表现进行持续评估的重要性。版权所有©2022 John Wiley & Sons。
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引用次数: 0
Teeth and gums in diabetes 糖尿病患者的牙齿和牙龈
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2422
R. Hillson
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引用次数: 0
Faricimab for treatment of diabetic macular oedema 法利昔单抗治疗糖尿病性黄斑水肿
IF 0.6 Q4 ENDOCRINOLOGY & METABOLISM Pub Date : 2022-11-01 DOI: 10.1002/pdi.2423
Adriana Kovacova
8 PRACTICAL DIABETES Vol. 39 No. 6 Copyright © 2022 John Wiley & Sons D macular oedema (DME) is a common cause of sight impairment in people with diabetes. Twentyseven percent of people with type 1 diabetes develop DME within nine years of the disease onset.1 For people with type 2 diabetes, 25.4% of insulin dependent and 13.9% of those who do not use insulin have DME.2 Alarmingly, diabetes is estimated to increase by 56% in the United States by 2030, with DME causing visual impairment in up to 25% of patients.2 Given the current therapeutic options, there is a strong need for innovative drugs designed to reduce treatment burden by improved efficacy and durability.3–5 NICE recently approved faricimab (Vabysmo), a novel bispecific monoclonal antibody designed for the intravitreal treatment of diabetic eye disease.6 By targeting both vascular endothelial growth factor A (VEGF-A) and the angiopoietin–tyrosine kinase endothelial receptors pathway (Ang/ Tie pathway) it displays an improved and sustained efficacy over longer treatment intervals, delivering superior vision outcomes and reducing the treatment burden.7,8 DME is the accumulation of excess fluid within the central area of the retina, called the macula. Risk factors include duration of diabetes, elevated HbA1c, hypertension, hyperlipidaemia, impaired renal function and the use of thiazolidinediones.9 DME usually causes distorted and blurred vision and creates difficulty especially with detailed tasks such as reading, watching television, driving and recognising faces. It gets diagnosed by a combination of clinical examination (dilated fundoscopy) and optical coherence tomography. The treatment of DME is systemic involving optimising control of diabetes, blood pressure and lipid profile as well as cessation of smoking. In addition, ophthalmic treatments are often indicated. Retinal laser has been conventionally used to treat macular thickening not directly involving the central vision.10 Fovea involving DME is managed by two main classes of intravitreal medication: anti-VEGF injections and steroid implants.4,9,11–13 Discovery of the VEGF pathway has facilitated treatments that are currently being used as mainstay of care in DME sufferers. Vascular endothelial growth factors (VEGFs) are a family of cytokines, that are involved in the process of angiogenesis. They function as signal proteins that bind with their respective transmembrane tyrosine kinase receptors (VEGFR) leading to proliferation of endothelial cells and growth of new blood vessels from existing vasculature. There are five main isoforms in the VEGF family: VEGF A–D and placental growth factor (PIGF). In patients with DME, VEGF levels are upregulated – in particular VEGF-A levels, a key component in pathological neoangiogenesis and vascular permeability.7,14,15 Anti-VEGF agents are engineered humanised antibodies that block the effects of VEGF on the leaking capillaries in DME, therefore ‘dry up’ the macula. Anti-VEGF ranibizumab
8 PRACTICAL DIABETES Vol. 39 No. 6版权所有©2022 John Wiley & Sons D黄斑水肿是糖尿病患者视力损害的常见原因。27%的1型糖尿病患者在发病后的9年内会发生二甲醚对于2型糖尿病患者,25.4%的胰岛素依赖者和13.9%的不使用胰岛素的人患有DME.2令人震惊的是,到2030年,美国糖尿病患者估计将增加56%,DME导致多达25%的患者视力受损鉴于目前的治疗选择,迫切需要创新药物,旨在通过提高疗效和持久性来减轻治疗负担。3-5 NICE最近批准了faricimab (Vabysmo),一种新的双特异性单克隆抗体,设计用于玻璃体内治疗糖尿病性眼病通过靶向血管内皮生长因子A (VEGF-A)和血管生成素-酪氨酸激酶内皮受体途径(Ang/ Tie途径),它在更长的治疗间隔内显示出改善和持续的疗效,提供卓越的视力结果并减轻治疗负担。7,8 DME是视网膜中心区域(称为黄斑)内过量液体的积聚。危险因素包括糖尿病病程、HbA1c升高、高血压、高脂血症、肾功能受损和噻唑烷二酮类药物的使用二甲醚通常会导致视觉扭曲和模糊,尤其是在阅读、看电视、驾驶和识别面孔等细节任务上造成困难。它可以通过临床检查(扩大眼底镜检查)和光学相干断层扫描相结合来诊断。二甲醚的治疗是全身性的,包括优化糖尿病、血压和血脂的控制以及戒烟。此外,经常需要眼科治疗。视网膜激光通常用于治疗不直接累及中央视力的黄斑增厚涉及二甲醚的中央窝主要通过两类玻璃体内药物治疗:抗vegf注射和类固醇植入。4,9,11 - 13 VEGF通路的发现促进了目前作为DME患者主要治疗手段的治疗。血管内皮生长因子(vegf)是一类细胞因子,参与血管生成过程。它们作为信号蛋白与各自的跨膜酪氨酸激酶受体(VEGFR)结合,导致内皮细胞的增殖和现有血管的新血管的生长。VEGF家族有五个主要亚型:VEGF A-D和胎盘生长因子(PIGF)。在DME患者中,VEGF水平上调,尤其是VEGF- a水平,这是病理新生血管生成和血管通透性的关键成分。7,14,15抗VEGF药物是工程化的人源化抗体,可阻断VEGF对DME中渗漏毛细血管的作用,从而“干燥”黄斑。抗vegf雷尼珠单抗和阿非利西普已被作为dme的一线治疗药物。14这两种药物都需要每4 - 8周重复注射一次以保持其疗效。如此频繁的注射间隔和相关费用的负担促使人们努力研究其他替代分子途径,作为可能的新治疗靶点。此外,通过专门靶向VEGF,对抗VEGF亚反应患者的需求尚未得到满足有些可以用皮质类固醇植入物治疗;然而,这些药物有较高的副作用,如白内障和青光眼的发展。在这个方向上,Ang/Tie通路的作用已经被研究,并在治疗dme方面取得了有希望的结果。4,9,17,18在成年期,Ang/Tie通路负责调节血管稳态,调节血管通透性,新生血管生成和炎症。有两种异构体,Ang-1和Ang-2,它们对Tie-2受体具有相似的亲和力。Ang-1作为Tie-2受体的强激动剂,具有血管稳定作用。Ang-2是一种情境依赖性激动剂/拮抗剂。在血管内皮病理缺血条件下,Ang-2上调,因此作为竞争性拮抗剂抑制Tie-2磷酸化,从而导致血管不稳定。它使血管更容易受到VEGF和其他促炎细胞因子的影响,导致血管渗漏、周细胞丢失和炎症。除VEGF-A外,阻断Ang-2可导致Tie-2活化和血管稳定。在抗vegf治疗中使用单克隆抗体提供了一个单一分子靶向视网膜血管疾病的两种生长因子的机会。
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Practical Diabetes
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