Endocrinology, Diabetes and Metabolism最新文献

Introduction

Peripheral circulatory complication (PCC), a significant complication of type 2 diabetes mellitus (T2DM), poses a considerable mortality burden in the United States. This study aimed to analyse demographic and geographic disparities in PCC-related mortality in T2DM patients from 1999 to 2020.

Methods

Utilising the CDC WONDER database, we utilised death certificates to identify PCC-related deaths using ICD-10 Code E11.5 and calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals. Joinpoint regression analysis was used to assess annual percent changes (APCs) in mortality rates.

Results

PCC caused 81,793 deaths. The AAMR increased from 1999 to 2004 (APC: 5.88, 95% CI: 2.44 to 12.70), followed by a decrease from 2004 to 2014 (APC: −3.70, 95% CI: −5.83 to −2.45), and an increase again until 2020 (APC: 8.34, 95% CI: 6.05 to 11.50). Males consistently exhibited higher mortality rates (AAMR: 11.08, 95% CI: 11.00 to 11.6) than females (AAMR: 8.34, 95% CI: 8.26 to 8.43). Racial/ethnic disparities were evident, with American Indian or Alaskan natives showing the highest AAMR (19.76) compared to Asian or Pacific Islanders (6.11). Geographic disparities were observed, with the Midwest region (AAMR: 12.86) and West Virginia (AAMR: 18.52) exhibiting significantly higher mortality rates.

Conclusion

Mortality trends associated with PCC in T2DM patients have shown complex trajectories, with notable disparities across demographic and geographic lines. Further research is needed to comprehensively understand the dynamics of PCC and its implications for public health.

Background

Diabetes mellitus is the most prevalent endocrine disorder in individuals under 30 years, encompassing type 1 diabetes mellitus (T1DM), early-onset type 2 diabetes mellitus (T2DM), monogenic diabetes, and maturity-onset diabetes of the young (MODY). This study investigated the prevalence, types, and complications associated with early-onset diabetes (EOD) in the Upper East Region of Ghana.

Methods

The study used anonymised patient data from the Ghana Health Service's electronic data system, focusing on inpatient records of individuals aged 0 to 30 diagnosed with diabetes. After removing personal identifiers, incomplete records, gestational diabetes cases, and duplicates, the dataset included variables such as age, sex, education level, admission year, outcomes, diagnoses, and complications, but lacked laboratory and treatment information.

Results

The prevalence of EOD among patients under 30 years of age was calculated to be 0.16% (52 out of 33,282). T1DM was diagnosed in 15 out of 52 patients (28.8%), while only one case of T2DM was identified. Secondary diabetes due to unknown etiologies was the most common diagnosis (22 out of 52 cases, 42.3%), indicating the potential presence of undiagnosed monogenic diabetes or MODY. Reported complications included diabetic foot (5 cases), diabetic nephropathy (2 cases), infections (4 cases), retinopathy (4 cases), and ketoacidosis (13 cases). The data showed 3 deaths, 1 referral, and 1 absconded case were recorded.

Conclusion

These findings highlight the need for accurate diagnosis, targeted management strategies, and further research into secondary diabetes and its potential underlying causes in Ghana. Improved diagnostic capabilities, awareness, and healthcare resources are essential to address EOD and its complications at the study site.

Background

Conventional cardiometabolic risk assessment relies primarily on a patient's current body mass index, yet individuals who have lost weight after a period of obesity may continue to harbour elevated metabolic risk. We sought to quantify the persistent impact of past obesity on glycaemic control and to develop a clinical risk score that integrates weight history with current risk factors.

Methods

We performed a cross-sectional analysis of 15,422 adults (≥ 18 years) from the 2011–2020 NHANES cycles. Participants with complete self-reported weight history (highest adult weight, weight 1 year ago, number of ≥ 5% weight-loss episodes) and measured BMI were included. Metabolic scarring was defined by elevated haemoglobin A1c (HbA1c ≥ 5.7%) or HOMA-IR ≥ 2.5. We applied inverse-probability-weighted logistic regression to estimate the association between prior obesity and current HbA1c, adjusting for confounders. We then refit a survey-weighted logistic model using age per decade, current BMI, weight-history category, sex and race/ethnicity, converting regression coefficients into an integer point-based score. Discrimination was evaluated by survey-weighted area under the receiver-operating characteristic curve (AUC).

Results

Formerly obese individuals exhibited significantly higher HbA1c than never-obese peers (adjusted β = 0.58%, p < 0.002), indicative of metabolic scarring. The derived risk score ranged from −31 to +90 points (median = 6; IQR = −3 to 16) and achieved an AUC of 0.79 (95% CI 0.77–0.81). Age per decade, BMI, and weight history contributed 4, 1 and up to 4 points, respectively; female sex and Non-Hispanic White race subtracted points. Calibration across predicted-risk deciles was excellent (slope = 0.98).

Conclusions

A history of obesity imparts a lasting glycemic risk that is not captured by current BMI alone. Our metabolic scarring risk score offers a pragmatic tool for identifying individuals at elevated metabolic risk despite weight normalisation.

Aim

To synthesise contemporary evidence on physical activity (PA) levels in people with type two diabetes and lower limb complications (i.e., foot ulcer, peripheral neuropathy [PN], peripheral arterial disease and amputations).

Methods

A scoping review following the JBI methodology was conducted using six databases: Medline, Embase, PubMed, Cochrane Library, SPORTDiscus and CINAHL. We included observational studies that primarily examined PA (all levels and types) in people with diabetes-related lower limb complications. Studies published before December 2024 were included. We excluded reviews, intervention studies, and studies that examined the association between PA and T2DM risks. Findings were collated into tables and figures and reported narratively.

Results

Sixteen studies met the inclusion criteria. Participants were reported to have PN, foot ulcer, peripheral arterial disease, or lower limb amputation. PA was assessed either by questionnaires or activity trackers. PA levels were reported as step count, duration of PA of different intensities, time spent in various postures, gait velocity, step rate and activity score. Mean daily step counts ranged between 1721 (amputation) and 7754 (PN). Mean moderate-intensity PA was reported to be 2 min per day (amputation) to 37 min per day (PN).

Conclusion

People living with diabetes-related lower limb complications engage in low levels of PA. The findings suggest that people with more severe lower limb complications engage in less PA than those with less severe lower limb complications. Future research should standardise PA measurement in individuals with T2DM-related lower limb complications and use the findings of this review to inform tailored, evidence-based recommendations.

Background

The pathological changes in the lining of blood vessels associated with diabetes are a well-established risk factor for stroke, with some studies suggesting a two times increase in risk compared to non-diabetics.

Methods

Death certificates from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2019 for ischemic stroke-related mortality in patients with type 2 diabetes mellitus (T2DM). Annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, and race/ethnicity.

Results

From 1999 to 2019 there were 18,135 deaths from ischemic stroke in patients with T2DM. The AAMR remained relatively constant from 0.31 in 1999 to 0.32 in 2004, gradually declining to 0.14 in 2014 (APC: −6.74), followed by a rapid increase to 0.44 in 2017 (APC: 53.11). Men showed consistently higher AAMR than women in 1999 (AAMR men: 0.34 vs. women: 0.29) and 2019 (AAMR men: 0.55 vs. women: 0.42). When comparing race, African Americans (AA) presented with a consistently higher AAMR in 1999 (AAMR AA: 0.4 vs. white: 0.29) and in 2019 (AAMR AA: 0.62 vs. white:0.44). Notably, a significant escalation in AAMR occurred from 2014 to 2019, affecting both populations; this trend reached its pinnacle in 2019 (2016 AAMR AA: 0.4 vs. white: 0.26) (2019 AAMR AA: 0.62 vs. white: 0.44).

Conclusion

The findings highlight fluctuating trends in AAMRs with distinct shifts observed after 2014. Noteworthy gender and racial disparities in AAMRs were also evident. The study emphasises the need for ongoing vigilance and focused interventions to address the evolving dynamics of ischaemic stroke-related mortality in the T2DM population.

Background

Procalcitonin (PCT) is an effective inflammatory marker for diagnosing infection. We assessed the clinical utility of procalcitonin in diagnosing diabetic foot infections.

Method

This meta-analysis adhered to the PRISMA guidelines. We searched PubMed, Web of Science, Embase and the Cochrane Library for studies on PCT for the diagnosis of diabetic foot published before 1 July 2024. The primary outcome was the standardised mean difference (SMD) in PCT levels between IDFU and non-IDFU groups, with corresponding 95% confidence intervals (CI). The included studies were cross-sectional and cohort studies, so the quality of the literature was assessed using the Newcastle–Ottawa Scale (NOS) evaluation criteria. This study's statistical analyses were conducted solely with STATA 15.0 software.

Result

Ten studies comprising 928 patients were ultimately included. There were six cross-sectional studies and four cohort studies. In total, 532 patients were assigned to the IDFU group and 396 to the non-infected diabetic foot ulcers (NIDFU) group. The relationship between PCT and DFU was evaluated in ten studies, with significant heterogeneity among the included studies (x² = 54.10, p = 0.00001; I² = 83.6%). Therefore, a random effects model was used with a pooled standardised mean difference of 0.79 (95% confidence interval [CI]: 0.43–1.14). The Egger experiment results (t = 0.43, p = 0.680) indicated that there was no publication bias. Analysis of sensitivity revealed that the results were reliable. Subgroup analyses identified the area as a significant source of heterogeneity. The random-effects model's meta-regression results revealed that BMI (p = 0.026) and HbA1c (p = 0.016) had a significant impact on the heterogeneity of the association between IDFU and PCT levels.

Conclusion

Our study showed a significant correlation between serum PCT levels and IDFU. Identification and treatment of IDFUs as soon as possible can help reduce amputation and mortality rates.

This systematic review and meta-analysis evaluated the association between serum procalcitonin levels and diabetic foot infections. Ten studies were included, and a random-effects model showed significantly higher procalcitonin levels in infected patients, supporting its role as a potential diagnostic biomarker for early infection detection in dia