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Diabetes mellitus and periodontal disease: education, collaboration and information sharing between doctors, dentists and patients 糖尿病和牙周病:医生、牙医和患者之间的教育、合作和信息共享
IF 0.6 Pub Date : 2023-04-28 DOI: 10.15277/bjd.2023.403
Chris Turner, P. Bouloux
People living with diabetes (DM) are at higher risk of developing periodontal disease than those without diabetes. This observation was first recorded in 1928. It is now believed that the risk is 3-4 times greater than for people without DM, and more for smokers. However, many doctors are not aware of this.DM and periodontal disease are bi-directionally linked, the one affecting the other and vice versa, although the mechanism is not fully understood. Periodontal disease has an adverse effect on glycaemic control. That improves when periodontitis is successfully treated.Doctors should consider periodontal disease when their patients have persistently high glycated haemoglobin (HbA1c) levels, and dentists should consider diabetes or pre-diabetes when they have patients with unstable periodontitis.Doctors and dentists, and their teams, need to share results. This paper considers what that shared information should be. A system of red, amber and green for both medical and dental risks is proposed. Until there are reliable methods of information exchanges and a paradigm shift in inter-professional working, patients should obtain their medical and dental results and share them with their respective advisors.Those patients who do not attend for dental care should be advised by their doctor about the potential benefits of dental screening for periodontitis.
患有糖尿病的人比没有糖尿病的人患牙周病的风险更高。这一观察首次记录于1928年。现在人们认为,这种风险是没有糖尿病的人的3-4倍,吸烟者的风险更大。然而,许多医生并没有意识到这一点。糖尿病和牙周病是双向联系的,一种影响另一种,反之亦然,尽管其机制尚不完全清楚。牙周病对血糖控制有不良影响。当牙周炎得到成功治疗时,情况会有所改善。当患者糖化血红蛋白(HbA1c)水平持续高时,医生应考虑牙周病,当患者患有不稳定牙周炎时,牙医应考虑糖尿病或糖尿病前期。医生、牙医和他们的团队需要分享结果。本文考虑了共享信息应该是什么。提出了一个红色、琥珀色和绿色的医疗和牙科风险系统。在有可靠的信息交流方法和跨专业工作模式转变之前,患者应该获得他们的医疗和牙科结果,并与各自的顾问分享。那些没有参加牙科护理的患者应该由医生告知牙周炎牙科筛查的潜在益处。
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引用次数: 0
CRY1 polymorphism may influence the association of low carbohydrate diet (LCD) score on glucose homeostasis in overweight and obese women CRY1多态性可能影响超重和肥胖女性低碳水化合物饮食(LCD)评分与葡萄糖稳态的关联
IF 0.6 Pub Date : 2023-03-30 DOI: 10.15277/bjd.2023.402
A. Mirzababaei, Farideh Shiraseb, Sara Hajishizari, Mena Farazi, Hadith Tangestani, Leila Khorraminezhad, C. Clark, K. Mirzaei
Background and aims: We sought to examine the interaction between CRY1 genotypes and low carbohydrate diet (LCD) score and the effect on insulin resistance, insulin sensitivity, homeostasis model assessment of insulin resistance (HOMA- IR) and quantitative insulin sensitivity check index (ISQUKI).Methods: This cross-sectional study was conducted with a total of 228 overweight and obese women. The data related to anthropometric and biochemical measures were collected and a food frequency questionnaire (FFQ), with 147 items, was used to assess dietary intake. Based on the FFQ, we calculated an LCD score for each study participant, ranging from 0 to 70. Biochemical assessments, including TC, HDL, LDL, TG, FBS, insulin and HOMA-IR, were performed. Deoxyribonucleic acid (DNA) samples were assessed to be genotyped for the rs2287161, which was genotyped by the restriction fragment length polymorphism (PCR-RFLP) method. A generalised linear model was performed for interaction analysis.Results: The results of the study demonstrated that, after controlling for several confounders, increased adherence to an LCD (T3 vs. T1) in the interaction with one risk allele genotype (CG) increases ISQUKI level (β: 0.001, CI: 0.00, 0.002, p=0.041). Also, there was a marginally negative interaction between higher adherence to LCD and two risk alleles genotype (CC) on insulin level (β: -0.012, CI: 0-0.024, 0.001, p=0.054).Conclusions: This study revealed a negative interaction of CRY1 genotypes with two risk allele and higher LCD adherence on insulin level, and a positive interaction on ISQUKI. However, the mechanism of interaction between LCDs and CRY1 genotypes remains unclear.
背景与目的:研究CRY1基因型与低碳水化合物饮食(LCD)评分之间的相互作用,以及对胰岛素抵抗、胰岛素敏感性、胰岛素抵抗稳态模型评估(HOMA- IR)和胰岛素敏感性定量检查指数(ISQUKI)的影响。方法:对228名超重和肥胖妇女进行横断面研究。收集了与人体测量和生化测量相关的数据,并使用包含147个项目的食物频率问卷(FFQ)来评估膳食摄入量。基于FFQ,我们计算了每个研究参与者的LCD得分,范围从0到70。进行生化评估,包括TC、HDL、LDL、TG、FBS、胰岛素和HOMA-IR。采用限制性内切片段长度多态性(PCR-RFLP)方法对rs2287161进行基因分型。采用广义线性模型进行相互作用分析。结果:研究结果表明,在控制了几个混杂因素后,与一个风险等位基因基因型(CG)相互作用中增加对LCD的依从性(T3 vs. T1)会增加ISQUKI水平(β: 0.001, CI: 0.00, 0.002, p=0.041)。此外,高依从性LCD与两个风险等位基因基因型(CC)对胰岛素水平有轻微负交互作用(β: -0.012, CI: 0-0.024, 0.001, p=0.054)。结论:CRY1基因型与两个风险等位基因存在负交互作用,与胰岛素水平有较高的LCD依从性,与ISQUKI呈正交互作用。然而,lcd与CRY1基因型之间相互作用的机制尚不清楚。
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引用次数: 0
British Journal of Diabetes (and Vascular Disease): a brief history 英国糖尿病(及血管疾病)杂志:简史
IF 0.6 Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.365
C. Day, Cliff Bailey
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引用次数: 0
Gazing into the future. The next 100 years: the Medtronic perspective 展望未来。下一个100年:美敦力的视角
IF 0.6 Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.376
D. Turner
While it is difficult to predict the next 100 years of development, the current Medtronic product innovation pipeline is changing the lives of people with diabetes. The MiniMedTM 780G system with GuardianTM 4 sensor and extended wear infusion set is the advanced hybrid closed-loop pump system currently available in the UK from Medtronic. It has been clinically proven to achieve >70% time in range and to lower HbA1c levels in people with diabetes. Medtronic continues to innovate in the hybrid closed-loop and insulin pump and sensor area. The company is developing new sensor technology and personalised closed-loop options for future patients. Medtronic recognises that not all people with diabetes will want to use an insulin pump and therefore is launching a Smart MDI system for people looking for more from MDI therapy. The Smart MDI system brings together a collection of tools that provides real-time insights and comprehensive reports. These make it easier for people with diabetes to manage life on multiple daily injections. The system combines predictive glucose management with the GuardianTM 4 sensor, with no finger pricks and personalised high and low alerts up to 60 minutes in advance. Personalised insulin management with the inpen device allows informed insulin dosing with integrated real-time glucose data trends and shareable insight reports. The Medtronic extended-wear infusion set is due to launch in the UK soon. It is focused on improving user experience. It is the only infusion set approved for longer wear (with a wear twice as long as standard infusion sets) without compromising comfort, safety or insulin delivery. This new set will also reduce traditional infusion set plastic waste by half.
虽然很难预测未来100年的发展,但目前美敦力的产品创新管道正在改变糖尿病患者的生活。MiniMedTM 780G系统具有GuardianTM 4传感器和扩展磨损输液器,是美敦力公司目前在英国提供的先进混合闭环泵系统。临床证明,它能在70%的范围内达到>,并降低糖尿病患者的HbA1c水平。美敦力继续在混合式闭环和胰岛素泵及传感器领域进行创新。该公司正在为未来的患者开发新的传感器技术和个性化闭环选项。美敦力认识到,并非所有糖尿病患者都想使用胰岛素泵,因此推出了一款智能MDI系统,供那些希望从MDI治疗中获得更多好处的人使用。智能MDI系统汇集了一系列工具,提供实时洞察和全面报告。这使得糖尿病患者更容易通过每天多次注射来管理生活。该系统将预测血糖管理与guarantm 4传感器相结合,没有手指刺痛和个性化的高低警报,可提前60分钟。使用inpen设备进行个性化胰岛素管理,可以通过集成的实时葡萄糖数据趋势和可共享的洞察报告来告知胰岛素剂量。美敦力延长磨损输液器将很快在英国推出。它专注于改善用户体验。它是唯一被批准使用更长时间的输液器(使用时间是标准输液器的两倍),而不会影响舒适度、安全性或胰岛素输送。这套新设备还将减少传统输液器塑料废物的一半。
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引用次数: 0
#We don't have to wait any more Closed-loop systems: transforming the landscape 我们不需要再等待任何闭环系统:改变景观
IF 0.6 Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.374
C. Boughton, R. Hovorka
Hybrid closed-loop systems are transforming the clinical management of T1DM. Large randomised controlled trials of hybrid closed-loop systems have demonstrated safety and efficacy, with significant improvements in glycaemic control compared to control therapy, and there are now several commercially approved hybrid closed-loop systems available in the UK. There is also a growing body of evidence demonstrating the quality of life benefits associated with hybrid closed-loop systems, both for users and also for parents/caregivers and other family members.We review the clinical evidence supporting currently available hybrid closed-loop systems in the UK and also new systems on the horizon. We discuss the emerging evidence for associated psychosocial benefits of hybrid closed-loop therapy. We also address future challenges around healthcare professional readiness to deliver closed-loop technology and ensuring equitable access across the UK.
混合闭环系统正在改变T1DM的临床管理。混合闭环系统的大型随机对照试验已经证明了其安全性和有效性,与对照治疗相比,血糖控制有显著改善,目前英国有几种商业批准的混合闭环系统。还有越来越多的证据表明,混合闭环系统对用户、父母/照顾者和其他家庭成员的生活质量都有好处。我们回顾了支持英国目前可用的混合闭环系统以及即将推出的新系统的临床证据。我们讨论了混合闭环治疗相关心理社会益处的新证据。我们还应对未来围绕医疗保健专业人员提供闭环技术的准备情况以及确保在英国各地公平使用的挑战。
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引用次数: 0
100 years of insulin; 50 years of diabetic life* 胰岛素100年;糖尿病患者50年的生活*
IF 0.6 Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.379
Maggie Loughran
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引用次数: 0
Islet cell transplantation 胰岛细胞移植
IF 0.6 Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.364
Y. Cheah
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引用次数: 0
brief history of the UK Prospective Diabetes Study 英国前瞻性糖尿病研究简史
IF 0.6 Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.359
R. Holman
The UK Prospective Diabetes Study (UKPDS) epidemiological findings confirmed that T2DM is not a “mild” disease, with roughly 50% of patients having clinically evident complica- tions at diagnosis, emphasising the need for its early detection and treatment. Hyperglycaemia was identified as an independent coronary heart disease risk factor, with progressive hyperglycaemia shown to be a major pathophysiological feature of T2DM, driven by declining beta-cell function. People with T2DM and hypertension were found to be at double jeopardy for any diabetes endpoint, and worsening kidney function was shown to increase the risk of death substantially.The UKPDS 20-year trial results were the first to demon- strate that diabetic complications are not inevitable but can be prevented by more intensive blood glucose control and by metformin therapy, changing T2DM management guide- lines worldwide. The UKPDS also showed that tighter blood pressure control prevents diabetic complications; the benefits of the glucose and blood pressure interventions are additive. The UKPDS 10-year post-trial monitoring study was the first to identify the T2DM glycaemic and metformin legacy effects, with early more intensive therapy having continuing benefits long after the trial terminated. The trial demon- strated the need to achieve good glycaemic control as early as possible to minimise the risk of future complications.
英国前瞻性糖尿病研究(UKPDS)的流行病学结果证实,T2DM不是一种“轻度”疾病,大约50%的患者在诊断时有临床明显的并发症,强调了早期发现和治疗的必要性。高血糖被确定为一种独立的冠心病风险因素,进展性高血糖被证明是T2DM的主要病理生理特征,由β细胞功能下降驱动。研究发现,T2DM和高血压患者在任何糖尿病终点都面临双重危险,肾功能恶化会大大增加死亡风险。UKPDS 20年的试验结果首次证明,糖尿病并发症并非不可避免,但可以通过更严格的血糖控制和二甲双胍治疗来预防,从而改变了世界范围内的T2DM管理指南。UKPDS还表明,更严格的血压控制可以预防糖尿病并发症;葡萄糖和血压干预的益处是相加的。UKPDS的10年试验后监测研究首次确定了T2DM的血糖和二甲双胍遗留影响,早期更强化的治疗在试验终止后很长一段时间内都具有持续的益处。该试验表明,需要尽早实现良好的血糖控制,以将未来并发症的风险降至最低。
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引用次数: 2
Reflections on 60 years of caring for people with diabetes 糖尿病患者60年护理回顾
IF 0.6 Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.362
A. Wright
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引用次数: 0
beginning of the end for insulin? – enter immunotherapy for T1DM 胰岛素的终结开始了吗?-进入T1DM的免疫治疗
IF 0.6 Pub Date : 2022-12-22 DOI: 10.15277/bjd.2022.369
C. Dayan
Although we have treated type 1 diabetes (T1DM) with insulin for more than 100 years, it has been apparent since the discovery of insulitis in the 1960s and islet cell antibodies in 1974 that T1DM is fundamentally an autoimmune disease, not a metabolic disease.1 Almost all other autoimmune diseases, from inflammatory bowel disease to rheumatoid arthritis, are treated with immunotherapy but not T1DM. In large part this is because of the discovery of insulin: unlike most other autoimmune diseases, a replacement therapy exists for T1DM. As a result, the discovery of insulin can be viewed as both a blessing and a curse. It is a “curse” because most of the major drug companies have developed their large immunotherapy portfolios of drugs for autoimmune diseases other than T1DM, including some such as psoriasis or alopecia areata that might be considered less life-threatening. And it is likely that diabetes practitioners are also partly to blame since they fear immunotherapy since it is a treatment with which they are not familiar. It is important to remind ourselves of the challenges of insulin therapy. It is not a drug without risk: deaths still occur from underdosage (DKA) and overdosage (hypoglycaemia). According to ONS data, in 2021 in England and Wales, 44 people under the age of 50 died of DKA and 154 died of hypoglycaemia.2 Set against this, even despite the introduction of CGM and insulin pumps, fewer than 30% of adults and children with diabetes achieve a target HbA1c < 7.0%, or 53 mmol/mol which obviates the risks of longterm complications.3 Furthermore, insulin management consumes millions of hours of patients and healthcare professional time in training, adjustments, testing and decision-making. Despite this, 36% of children and families continue to need psychological support more than five years after diagnosis (NPDA national audit 2018-2019,3 and up to 50% of adults with T1DM report significant diabetes-related distress. 4 There is a large and expanding world of highly selective immunotherapies that does not include the classic immunosuppressents (e.g. cyclosporin, tacrolimus) used in transplantation. Rather, it includes many drugs known as “biologics” that have been widely used and have been very well tolerated in other autoimmune diseases for more than 20 years. Many are monoclonal antibodies, but small molecule inhibitors such as JAK kinase inhibitors are being introduced.5 At least seven selective immunotherapies have shown efficacy in Phase 2 studies in preserving beta cell function from diagnosis compared to controls.6,7 These treatments reduce progression of the underlying disease process but do not cause regrowth of beta cells. In current clinical practice, T1DM is diagnosed at the time that insulin replacement is required. This is late in the disease course, when it is estimated that more than 80% of functional beta cells have been lost. When selective immunotherapy is given at this stage, some impact on insulin dose (and in some
尽管我们用胰岛素治疗1型糖尿病(T1DM)已有100多年的历史,但自20世纪60年代发现胰岛炎和1974年发现胰岛细胞抗体以来,T1DM从根本上说是一种自身免疫性疾病,而不是代谢性疾病,用免疫疗法治疗,但不治疗T1DM。这在很大程度上是因为胰岛素的发现:与大多数其他自身免疫性疾病不同,T1DM有一种替代疗法。因此,胰岛素的发现可以被视为福与祸。这是一个“诅咒”,因为大多数主要制药公司都开发了针对T1DM以外的自身免疫性疾病的大型免疫疗法药物组合,包括一些可能被认为不那么危及生命的银屑病或斑秃。糖尿病从业者可能也要承担部分责任,因为他们害怕免疫疗法,因为这是一种他们不熟悉的治疗方法。提醒我们自己胰岛素治疗的挑战是很重要的。它不是一种没有风险的药物:剂量不足(DKA)和过量(低血糖)仍会导致死亡。根据英国国家统计局的数据,2021年,英格兰和威尔士有44名50岁以下的人死于DKA,154人死于低血糖。2与此相反,即使引入了CGM和胰岛素泵,仍只有不到30%的糖尿病成人和儿童达到目标HbA1c<7.0%,即53 mmol/mol,从而消除了长期并发症的风险。3此外,胰岛素管理消耗了数百万小时的患者和医疗保健专业人员在培训、调整、测试和决策方面的时间。尽管如此,36%的儿童和家庭在确诊后五年以上仍需要心理支持(NPDA 2018-2019年国家审计3,多达50%的T1DM成年人报告了严重的糖尿病相关痛苦移植相反,它包括许多被称为“生物制剂”的药物,这些药物已经被广泛使用,并且在20多年的其他自身免疫性疾病中耐受性很好。许多是单克隆抗体,但正在引入小分子抑制剂,如JAK激酶抑制剂。5与对照组相比,在2期研究中,至少有7种选择性免疫疗法在保护β细胞功能方面显示出有效性。6,7这些疗法可以减少潜在疾病过程的进展,但不会导致β细胞的再生。在目前的临床实践中,T1DM是在需要胰岛素替代的时候被诊断出来的。这是在病程后期,据估计,超过80%的功能性β细胞已经丧失。当在这个阶段给予选择性免疫治疗时,可以看到对胰岛素剂量的一些影响(在一些研究中,还可以看到HbA1c和低血糖率),但现在消除对胰岛素的需求已经太晚了。幸运的是,早期诊断T1DM是可能的。对T1DM患者亲属和普通人群的出生队列进行的多项研究表明,80-90%的无症状儿童如果被发现有两种或两种以上的胰岛自身抗体(包括抗GAD、抗IA-2、抗ZNT8或抗胰岛素),将继续发展为T1DM(图1)。一旦出现低血糖(相当于糖耐量受损),高血糖水平通信地址:Colin M Dayan教授临床糖尿病和代谢教授,加的夫大学,Heath Park,Cardiff,CF14 4XN,英国电子邮件:DayanCM@cardiff.ac.uk
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引用次数: 0
期刊
British Journal of Diabetes
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