International Journal of Diabetes in Developing Countries最新文献

Abstract

Objective

Estimation of average glucose (AG) from hemoglobin A1c (HbA1c) helps guide diabetes management, and thus several AG-HbA1c equations have been constructed. However, it is not clear whether estimated AG calculated from existing AG-HbA1c equations could evaluate glycemic control in patients diabetic kidney disease (DKD) before dialysis. This study is aimed at evaluating the accuracy of estimated AG which is calculated from existing equations to assess glycemic control in DKD before dialysis. Additionally, we examined the relationship between AG and HbA1c in DKD before dialysis.

Methods

In this retrospective study, we collected data of 71 Chinese patients with DKD before dialysis who had a complete flash glucose monitoring (FGM) data during hospitalization in a single center between August 2018 and August 2021 by casually sampling. Measured AG was derived from the FGM system and compared to estimated AG derived from a frequently used AG-HbA1c equation (that developed in ADAG study), in addition to a formula established in CKD (that of ADAG-CKD equation). Performance of AG-HbA1c equations was evaluated by mean absolute difference (MAD)/mean absolute relative difference (MARD) and Bland–Altman test. Linear regression analysis was used to investigate the relationship of AG and HbA1c in DKD before dialysis.

Results

Among the 71 DKD before dialysis, 80% were type 2 diabetes. The mean age was 57 ± 13.8 years, and mean eGFR was 66.3 ± 32.3 mL.min/(1.73 m²). Mean HbA1c was 8.4 ± 2.2 (%), and measured AG was 150.2 ± 40.3 (mg/dL). Measured AG was significantly overestimated by equations ADAG and ADAG-CKD. Both ADAG and ADAG-CKD equations did not reflect the measured AG accurately (MAD 2.42 vs. 3.42 mmol/L; MARD 33.3% vs. 46.7%, respectively; p < 0.01). We examined the relationship between AG and HbA1c in DKD before dialysis as follows: AG (mmol/L) = 0.48 × HbA1c (%) + 4.36. In addition, using multiple regression analysis, HbA1c, diabetes type, body mass index (BMI), and CKD stage explained 42% of the variability in measured AG (r = 0.68, R² = 0.42, p < 0.01).

Conclusions

HbA1c-derived estimated AG from existing equations may not accurately reflect measured AG in patients with DKD before dialysis. Diabetes type, BMI, and CKD stage should be considered when translating HbA1c into AG value in DKD before dialysis. It is advisable to adjust the AG-HbA1c equations for target population.

Background

Diabetic foot is one of the most serious complications of type 2 diabetes mellitus (T2DM), and its incidence is increasing in China. Early detection of abnormal microcirculation in the foot is very important for the prevention and treatment of diabetic foot.

Objective

To investigate the value of contrast-enhanced ultrasound (CEUS) in diagnosing microcirculatory alterations in the dorsum of the foot for patients with type 2 diabetes mellitus (T2DM).

Methods

Eighty-eight T2DM patients were included, among them 30 patients sustained diabetes mellitus without complications (group A), 28 with lesions in the dorsum of the foot (no acute infection) that can be classified as Wagner grade 0 ~ 1 (group B), and 30 with lesions in the dorsum of the foot that can be classified as Wagner grade 2–5 (group C). Another 30 healthy adults were included as the control group. All subjects underwent CEUS to examine the dorsalis pedis arteries and blood perfusion to the underlying soft tissues. Parameters of the time-intensity curve (TIC), including rise time (RT), ascending slope (AS), time to peak (TTP), peak intensity (PI), area under the curve (AUC), and half of drop time (DT/2) were analyzed.

Results

The analysis of TIC data of the dorsalis pedis arteries showed that group C had decreased AS, PI, and AUC and increased TTP, RT, and DT/2 compared with groups A, B, and the control group; the differences were statistically significant (p < 0.05). The analysis of TIC data of the perfusion to the underlying soft tissues showed that AS, PI, and AUC decreased from the control group through group A, B, and then C; the differences were all statistically significant (p < 0.05). The TIC data were correlated with the severity of microcirculatory impairment in the dorsum of the foot and among them the AUC, PI, and AS had higher predictive value.

Conclusions

Microcirculatory impairment in the dorsum of the foot in T2DM patients presents itself as “delayed wash-in, delayed wash-out, and weak enhancement” on CEUS images. CEUS can provide quantification of the microcirculatory changes in the soft tissues in the dorsum of the foot and reflect the differences of microcirculatory perfusion across different grades of lesions.

Background

An ideal glucose-lowering drug is expected to not only improve glycemic control, but also have positive effects on weight, blood pressure, dyslipidemia, and also cardiovascular and renal outcomes.

Objective

To investigate and compare the impact of Sodium-glucose transport protein 2 (SGLT2) inhibitors on glycemic and extraglycemic laboratory parameters and the parameters which affect this impact.

Methods

This retrospective study was conducted between January 2022 and December 2022. A total of 250 patients diagnosed with type 2 diabetes mellitus (T2DM) using SGLT2i were included in the study.

Results

Patients had a mean age of 55.4 ± 9.6, and 53.6% (n = 134) were male. Among the patients, 19.6% (n = 49) used dapagliflozin and 80.4% (n = 201) used empagliflozin. Glucose, HbA1c, and triglyceride levels at 3 and 6 months showed significant reductions compared to baseline, while serum sodium and HDL-C levels showed significant increases (p < 0.001). Additionally, creatinine and serum potassium levels at 6 months were significantly higher than baseline, while LDL-C and urine albumin-to-creatinine ratio levels were significantly lower. Empagliflozin users exhibited significantly higher creatinine levels only at 3. months, higher serum sodium levels only at 6. months, and lower HbA1c levels only at 6. months compared to dapagliflozin users.

Conclusion

While SGLT2i seem to provide positive effects on the lipid profile, as well as their well-recognized effects on glycemic parameters, there may be value in further evaluating renal safety and the long-term alterations in lipid profile.

Objective

Genetic polymorphisms of the angiogenesis, inflammatory cascade, or apoptosis genes can influence chronic complications in diabetic patients. Cytokine gene polymorphisms are considered vital in diabetes and diabetic nephropathy (DN) susceptibility. The present study evaluated the role of cytokine gene polymorphism in type 2 diabetes and diabetic nephropathy.

Methods

A total number of 648 participants comprising 180 healthy individuals, 164 type 2 diabetes mellitus patients without any complications, 148 individuals with diabetic nephropathy, and 156 with non-diabetic nephropathy were included in this study. The IL-6 (-634 C/G), IL-18 (-607 A/C), IL-4 (-590C/T), and IL-10 (-592 C/A) polymorphism were analyzed using the PCR-RFLP method, and their expression analysis was done using real-time PCR

Results

We found a significant difference in the genotype frequency of IL-6 and IL-10 in the diabetic nephropathy group compared to the control, whereas no significant difference was found in IL-18 and IL-4.

Conclusion

The IL-6 -634C/G and IL-10-592 C/A polymorphisms were found to be associated with diabetic nephropathy in the West Indian population. The higher transcript level of inflammatory cytokines in patient groups compared to the control group may suggest the essential role of inflammation in the pathogenesis of diabetes and diabetic nephropathy.

Background/Purpose

The aim of the study was to assess the effect of obesity on the diagnostic accuracy of HbA1c.

Methods

This retrospective cross sectional study was conducted in 108 overweight/obese and 40 normal weight Bangladeshi adults. Those satisfying the exclusion and inclusion criteria were included. Diabetes and pre-diabetes were diagnosed by oral glucose tolerance test (OGTT) and HbA1c using the 2006 World Health Organization (WHO) diagnostic criteria. HbA1c was estimated by capillary electrophoresis method.

Results

108 overweight and obese (mean body mass index (BMI) 36.33 ± 8.86 kg/m², mean age 29.12 ± 9.28 years) and 40 normal weight (mean BMI 20.35 ± 1.68 kg/m², mean age 28.13 ± 6.22 years) adults were included in the study. Significantly greater number of patients were diagnosed with prediabetes using HbA1c criteria than OGTT criteria (39.68% vs 19.05%, p = 0.005) in overweight and obese group. The concordance between OGTT and HbA1c for the diagnosis of prediabetes was low in overweight and obese adults [Ƙ with 95%CI = 0.031(-0.194 to 0.256), n = 52]. The specificity and discrimination of HbA1c for the diagnosis of prediabetes were low in overweight and obese compared to normal weight group (52.3% vs 93.9%; 0.64 vs 0.89, p = 0.056, 95% CI = -0.01 to 0.51, respectively). The specificity of HbA1c for the diagnosis of prediabetes in adults with BMI ≥ 23 kg/m² increased to 90% at a cut-off of 6.15%.

Conclusion

HbA1c was not accurate in the diagnosis of prediabetes in adults with BMI ≥ 23 kg/m². A higher cut-off value for HbA1c should be used for the diagnosis of prediabetes, but not diabetes.

Objective

This study was carried out to determine the relationship between parental monitoring status of the children with type 1 DM and their quality of life.

Methods

This descriptive-correlational type study was conducted in the pediatric endocrine outpatient clinic of a university hospital located in the northern region of Turkey and included 126 children with type 1 diabetes. The data of the study were collected with the “Parental monitoring of diabetes care scale (PMDC) in adolescents with type 1 diabetes” and “Pediatric quality of life inventory (PedsQL 3.0) diabetes module for children.”

Results

It was determined that 20.6% of the children were hospitalized for a reason related to diabetes and 7.1% received psychological support due to their disease. The mean score of the parents on the parental monitoring in diabetes care scale in adolescents with type 1 diabetes was found to be 65.40 ± 15.38, and the mean score on the pediatric quality of life inventory for children with type 1 diabetes was found to be 109.11 ± 16.99. No statistically significant correlation was determined between the parents’ scores of the parental monitoring in diabetes care scale in adolescents with type 1 diabetes and the scores of the pediatric quality of life inventory for children with type 1 diabetes (p > 0.05).

Conclusion

Although it was observed in the study that the levels of parental monitoring in type 1 diabetes care and pediatric quality of life were above the moderate level, parental monitoring was not found to affect children’s quality of life.

Abstract

Background

The Renal Pathology Society developed a universal pathological classification of diabetic nephropathy in 2010. Some research has been conducted to validate this classification’s ability to predict the outcome. However, the clinical implications of these pathological abnormalities are still being investigated.

Objectives

In this study, we aimed to demonstrate the clinical reflections of these lesions to better understand the underlying mechanisms.

Methods

Data of 119 patients with biopsy proven diabetic nephropathy from a single center were included in the study. Pathology specimens were reclassified according to 2010 criteria suggested by the RPS.

Results

Diabetic retinopathy was more frequently present in patients with advanced glomerular class, IFTA score, interstitial inflammation score, arteriolar hyalinosis score, arteriosclerosis score, and in patients with exudative lesions present (p < 0.05). The proteinuria levels of patients with advanced glomerular classes and exudative lesions were significantly higher, and serum albumin levels were lower (p < 0.05). Hematuria occurrence was more frequent in glomerular class III and IV patients and in patients with advanced arteriolar hyalinosis (p < 0.05).

Conclusion

This large, single center, retrospective study reveals that diabetic retinopathy is associated with glomerular and arteriolar lesions but not with interstitial lesions. Proteinuria and hematuria were independent predictors of glomerular lesions, but not other renal lesions. Nevertheless, prospective studies which include all the confounding clinical factors are required to reach a conclusion on the relationship of hematuria and renal lesions.

Objective

This retrospective longitudinal study analyzed the demographic profile, insulin usage pattern, and outcomes of insulin-naive adults with type 2 diabetes mellitus (T2DM) who initiated insulin glargine.

Methods

The study included 1006 insulin naive T2DM individuals aged ≥ 18 years, treated with any insulin type between January 2016 and December 2018, using electronic medical records.

Results

Majority of participants were men (55.8%) with a mean age of 59.8 ± 11.9 years and average T2DM duration of 12.0 ± 6.6 years. Insulin glargine was the most commonly used insulin (66.9%), followed by insulin aspart (16.4%), insulin degludec (15.1%), human insulin (11.1%), and insulin isophane (9.2%). At baseline, the mean glycated hemoglobin (HbA1c) was 8.9 ± 1.9%, mean fasting plasma glucose (FPG) was 190 ± 59 mg/dL, and mean post-prandial plasma glucose (PPG) was 264 ± 78 mg/dL. In the insulin glargine group, baseline HbA1c was 9.0 ± 1.7%, FPG was 196 ± 62 mg/dL, and PPG was 283 ± 81 mg/dL. Throughout the study, there was an improvement in HbA1c, FPG, and PPG levels in the insulin glargine group. Body weight remained relatively stable, and the number of hypoglycemic events was minimal and non-life-threatening.

Conclusion

The REALITY study in India demonstrated that initiating basal insulin treatment in insulin-naive individuals with T2DM led to improved glycemic parameters over a 12-month period.