International Journal of Diabetes in Developing Countries最新文献

Objective

This study aims to explore the association between the triglyceride glucose (TyG) index and type 2 diabetes mellitus (T2DM) in Chinese men and women while assessing its predictive capability by gender.

Methods

Data from the DRYAD database were used in this study, which also performed a secondary analysis of 48,230 participants from the China Rui-Ci group. Data on lifestyle habits, detailed health indicators, and demographics were gathered. The TyG index was calculated, and statistical techniques such as multivariate Cox regression and generalized additive models were used to analyze the correlation between the TyG index and the incidence of T2DM. Gender-specific predictive capacity was evaluated through subgroup analyses and receiver operating characteristic curves (ROC).

Results

A cohort of 48,230 individuals demonstrated a significant positive link between the TyG index and T2DM risk in both genders. In the adjusted model, T2DM risk rose by 1.68 times (95% CI, 1.23–2.28) in males and 3.59 times (95% CI, 2.29–5.65) in females. Female participants showed a higher TyG index predictive value for T2DM (AUC = 0.812) compared to males (AUC = 0.721). Notably, females with hypertension displayed significantly elevated T2DM risk in various age groups compared to males (p for interaction < 0.05).

Conclusion

The study reveals a positive correlation between the TyG index and T2DM risk in both genders. Moreover, the predictive capacity of this relationship is notably stronger in females.

Objective

This study is to explore the relationship between serum fasting and postprandial glucose-dependent insulinotropic polypeptide (GIP) and glucagon levels and glycemic variability in type 1 diabetes (T1D).

Methods

Twenty patients with T1D and 20 healthy controls were included in the study. Parameters of glycemic variability were obtained from 14-day sensor data provided by a flash glucose monitoring system. A mixed meal at breakfast was provided for the participants and fasting, and postprandial blood samples were collected to evaluate serum GIP and glucagon levels.

Results

There were no significant differences in terms of fasting or postprandial GIP and glucagon levels between the two groups (p > 0.05). However, a negative correlation between duration of diabetes and fasting GIP levels ((r=-0.510,p=0.02)) and a positive correlation between total daily insulin dose and fasting and postprandial GIP levels (r = 0.48, p = 0.03) were found in patients with T1D. Postprandial glucagon correlated positively with time above range (TAR 180) (r = 0.56, p < 0.001) and negatively with the number of hypoglycemic events ((r=-0.46,p=0.03)).

Conclusion

Our results indicate that serum GIP was associated with the duration of diabetes and daily insulin dose. Moreover, postprandial glucagon is linked to hyperglycemic and hypoglycemic indices in cases of T1D.

Objective

This study evaluates Diabetology.co.in, an innovative algorithm-driven prescription system developed for personalized and precision treatment of treatment-naive patients with type 2 diabetes. It focuses on integrating computational medicine with clinical practice, leveraging artificial intelligence for optimized diabetes management.

Methods

A retrospective pilot study was conducted at a tertiary multispeciality hospital, assessing Diabetology.co.in’s alpha version. Data from the last fifty adult patients with type 2 diabetes from the outpatient Endocrinology OPD were analyzed. These patients were treatment-naive, excluding pregnant women and those with positive insulin antibodies or glucocorticoid use. Data, including clinical and laboratory parameters, were manually input into the system, which then generated evidence-based prescription recommendations using its algorithmic processing.

Results

The system processed data from 50 patients, with an average age of 41.9 years and a 40% female demographic. The application effectively utilized inputs like body mass index, glomerular filtration rate, and HbA1c levels to generate prescriptions. Metformin was universally recommended, with insulin prescribed for half of the patients, and SGLT2 inhibitors for 30%. The software’s suggestions showed a significant match with actual clinical prescriptions, indicating its accuracy and potential in aiding clinical decision-making. Notably, the software identified an overprescription tendency in clinician practices and provided insights into patient profiles through advanced data analysis capabilities, such as correlations between triglyceride levels and BMI.

Conclusion

Diabetology.co.in demonstrated high efficacy in generating precise and personalized treatment recommendations for newly diagnosed type 2 diabetes patients. It aligns closely with actual clinical prescriptions, showcasing its potential in reducing overprescription and contributing to evidence-based diabetes care.

Gestational diabetes mellitus (GDM) frequently complicates pregnancy and is associated with adverse outcomes both in the mother and her offspring. Usually, screening for GDM is recommended in the second/third trimester of pregnancy but GDM occurring in the first trimester is being increasingly reported and this is called as early gestational diabetes mellitus (eGDM). Thus, GDM can be classified as conventional gestational diabetes mellitus (cGDM) and early gestational diabetes mellitus (eGDM). The prevalence of eGDM varies widely due to different criteria being used. Women with eGDM present with a unique metabolic profile. The pathophysiology of eGDM appears to be the combined effects of beta-cell dysfunction and insulin resistance. Increased occurrence of adverse pregnancy outcomes, higher incidence of postpartum dysglycemia and a greater need for insulin use have been reported in women with eGDM. The Treatment Of BOoking Gestational diabetes Mellitus (ToBOGM) study, which is a randomised control trial, showed the benefits of early treatment in women with eGDM in terms of better neonatal outcomes. We have also identified some of the gaps in eGDM literature for future research in this field.

Background

Sodium glucose co-transporter-2 (SGLT2) inhibitors prevent the kidneys from reabsorbing glucose from the urine. In addition to glucose-lowering effect, SGLT2 inhibitors can also reduce blood pressure and result in weight loss. In spite of the benefits of this drug, it predisposes patients to genitourinary tract infections.

Objective

This study aimed to assess the prevalence of genitourinary symptoms (GUS) in individuals with type 2 diabetes prescribed SGLT2 inhibitors and to evaluate the impact of these symptoms on treatment discontinuation.

Methods

In this cross-sectional study, a total of 320 (M:F 216:104) participants recently initiated with SGLT2 inhibitors were included from a tertiary care center for diabetes, Chennai from January to September 2022. Basic demographic, anthropometric, biochemical parameters, clinical profile, use of concomitant diabetes medications, history of GUS prior to intake of SGLT2 inhibitors, and GUS after intake of SGLT2 inhibitors were collected.

Results

The mean age of the participants was 54.5 ± 10.3 years, and the mean duration of diabetes was 12.7 ± 7.9 years. The prevalence of GUS was 18.4%. The median BMI and HbA1c were significantly high among people with GUS than without GUS (29.6 vs. 27.5 kg/m², p = 0.004) and (8.2 vs. 7.8%, p = 0.037). Among people with GUS, almost 3/4th (72.9%) were taking dapagliflozin. Around 16.9% were advised to discontinue the drug. In 18.6%, the drug was changed, and the remaining 47.5% were advised to continue the drug with precautions to drink plenty of water and maintain genital hygiene. Of those who had minimal symptoms, 10.2% were prescribed oral antifungal and antibiotics, and 6.8% were prescribed antifungal creams as the drug has several other health benefits.

Conclusion

Genitourinary symptoms were common among people with type 2 diabetes who were initiated with SGLT2 inhibitors. Prior education about the adverse events of the drug is necessary during the initiation of the treatment.

Background

Type II diabetes mellitus onset is linked with hormonal imbalances. However, the knowledge about hormonal alterations in pre-diabetes is limited.

Objective

The study aimed to examine type II diabetes mellitus-associated hormone levels during the pre-diabetes phase in participants aged 25–45 in a Durban-based clinical setting in South Africa.

Methods

Stored plasma samples from a retrospective study collected 364 samples that were divided into pre-diabetes and non-pre-diabetes groups. From the 364, 38 samples from the group of persons without pre-diabetes and 38 from persons with glycated haemoglobin determined pre-diabetes were blindly selected. The hormone concentrations (C-peptide, cortisol, adipokines, thyroids, incretins, and sex steroids) of the study participants were measured using the BIO-RAD Bio-Plex MAGPIX instrument.

Results

Hormone imbalances in several hormones were detected in study participants with pre-diabetes. Most of the hormone dysregulation associated with T2DM begins in pre-diabetes but at a moderate level.

Conclusion

The findings reveal new possible hormone therapy targets for pre-diabetes and contribute to the growing support for targeting pre-diabetes as a preventative measure for T2DM prevention.

Background

Nuclear factor erythroid-2-related factor 2 (Nrf2) is a crucial transcription factor in maintaining cellular homeostasis. The regulation of Nrf2 expression is an essential target for treating diabetic nephropathy (DN), and this regulation has been reported to be influenced by epigenetics. Few studies highlighted that Nrf2 regulation is associated with epigenetic markers such as histone deacetylases (HDAC) and DNA methyltransferase (DNMTs).

Objective

This cross-sectional study aimed to investigate the association of all isoform-specific HDACs and their correlation with Nrf2 expression with the development of DN among south Indian people with type 2 diabetes (T2DM).

Methods

A case–control cross-sectional study was performed using 108 T2DM individuals, comprising 23 participants with only T2DM and 60 participants with DN without any other complications, and 25 healthy volunteers. The gene expression of Nrf2, its downstream targets, and all HDAC targets involved in this study were assessed using qPCR.

Results

We observed a significant decrease in the gene expression of Nrf2 in the DN group compared to healthy controls. In parallel, a significant downregulation of HDAC3/7/8/9/10/11 and SIRT1/2/3/4/7 has been observed in DN subjects compared to T2DM. On the other hand, HDAC1/2/4/5/6 showed a significant upregulation in DN groups compared to T2DM. A significant negative correlation between Nrf2 and HDAC1/2/4/5 was observed, which infers an imbalance in the Nrf2-HDAC axis.

Discussion

In summary, our study findings provide compelling evidence of the association between HDACs and Nrf2 in the pathogenesis of DN, shedding light on potential therapeutic avenues for this condition.

Objective

GDM has conventionally been defined as any degree of glucose intolerance with onset or first recognition during pregnancy warranting early recognition and management to improve maternal foetal outcomes. In India alone, GDM complicates almost four million pregnancies every year, depicting a large proportion of population at high risk for adverse perinatal morbidity and mortality. This makes it prudent to recommend universal screening for GDM for all women especially amongst SE Asian ethnicity.

Methods

This prospective, observational twin-centre study was carried out to observe maternal and foetal outcomes in two groups diagnosed as having GDM by two different criteria: 50 pregnant women were diagnosed with GDM by IADPSG criteria by performing a 75 g OGTT in a fasting state at 24–28 weeks. GDM was diagnosed if fasting ≥ 92 mg/dl or 1 h ≥ 180 mg/dl or 2 h ≥ 153 mg/dl — labelled as Group 1 — 50 pregnant women were diagnosed with GDM using DIPSI criteria by performing the single-step non-fasting 75 gm oral glucose challenge at 24–28 weeks. GDM was diagnosed with plasma glucose values ≥ 140 mg/dL at 2 h post glucose — labelled as Group 2 Both the groups were followed prospectively till the delivery of new born for assessment of immediate maternal and foetal outcomes.

Results

There was no statistical difference in foetal and maternal outcomes in groups.

Conclusions

Single-step DIPSI criteria can be used for screening and diagnosis of GDM for its simplicity, feasibility, economy and convenience. It has the potential to be applied to the entire obstetric population from India as well as the Indian subcontinent, meeting the needs of the developing world where the complicated three-step IADPSG can be challenging.

Background

Glycemic control is a significant step in reducing diabetic complications. The purpose of this study was to determine the prevalence and risk factors for poor glycemic control and diabetic nephropathy in patients with type 2 diabetes mellitus (T2DM) in Dhamar, Yemen.

Methods

A study was carried out in which 200 patients with type 2 diabetes were recruited from the outpatient departments of Dhamar General Hospital. Information on their sociodemographic and clinical factors were collected. Blood and urine samples were taken following an overnight fast. Automated instruments were utilized to evaluate HbA1c, microalbuminuria, creatinine, and fasting blood sugar (FBS) using standardized procedures.

Results

This study revealed that 58% of people with diabetes have poor glycemic control, while 14% have fair glycemic control. Multivariate logistic analysis showed that combined antihyperglycaemic drugs (oral tablet + insulin) [adjusted odds ratio (AOR) = 3.77; %CI = 1.36- 10.44], poor diet adherence (AOR = 1.97; %CI = 1.03–3.77) and lack of education (2.34; %CI = 0.93–5.90) were potential risk factors for poor glycemic control. The prevalence of diabetic nephropathy was 32%. It was found that age over 50 years (AOR = 2.37; %CI = 1.15–4.90), hypertension (AOR = 3.22; %CI = 1.39–7.47), uncontrolled blood glucose (AOR = 2.67; %CI = 1.16–6.16), the duration of diabetes of 5 years or more (AOR = 1.78; %CI = 1.05–3.00), and a lack of education (AOR = 1.90; %CI = 1.16–3.11) were risk factors for diabetic nephropathy.

Conclusion

The prevalence of uncontrolled glycemic status and diabetic nephropathy is significantly high among Yemeni T2DM patients in Dhamar, which may contribute to an increasing prevalence of complications and thus pose extra challenges to the poor health care services in Yemen.

Objective

Several studies have reported the rising prevalence of diabetes in young adults globally. ADA currently recommends routine screening for diabetes starting at the age of 35 years. Indians are known to develop diabetes at a younger age, although there is a scarcity of large studies looking at the prevalence of diabetes in Young Indians. Objective of the study was to assess prevalence of diabetes in young Indians below the age of 35 years.

Methods

The data of 225,955 individuals from a nationwide screening campaign was analyzed for the prevalence of diabetes among individuals younger than 35 years.

Results

The overall prevalence of diabetes among those below 35 years, 30 years, and 25 years of age was found to be 17.9%, 13.3%, and 9.8% respectively. Among those with a family history of diabetes, the prevalence was as high as 40.1%, 31.8%, and 26.4% respectively.

Conclusions

The current study highlights a very high prevalence of diabetes in young Indians. It might be worth considering screening for diabetes as early as 18 years of age among Indians, especially in those with a family history of diabetes.