Journal of Diabetes Investigation最新文献_第4页

Glycemic metrics in Japanese isCGM users – Analysis by diabetes type and therapy 日本 isCGM 用户的血糖指标 - 按糖尿病类型和疗法进行分析。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-29 DOI: 10.1111/jdi.14233

Wataru Ogawa, Tatsuhiko Urakami, Takashi Kadowaki, Kalvin Kao, Laura Brandner, Kenichiro Shimizu, Timothy C. Dunn

Aims/Introduction

The FreeStyle Libre (FSL) intermittently scanned continuous glucose monitoring (isCGM) system continually measures interstitial glucose levels and provides the data to users in numerical and graphical formats that guide users in their daily diabetes self-management. Although numerous studies have demonstrated the glycemic benefits of FSL in pediatric and adult populations, few studies have characterized FSL use specifically by Japanese adults with type 1 or 2 diabetes. We utilized established CGM metrics to assess glycemic control in a large cohort of Japanese adults with type 1 and 2 diabetes.

Materials and Methods

A total of 3,463 anonymized FSL users provided categorization into one of four therapy groups of interest: type 1 diabetes (n = 1,768), type 2 diabetes-multiple daily injections (MDI) (n = 612), type 2 diabetes-basal (BOI) (n = 343), and type 2 diabetes-non-insulin (NIT) (n = 740). Established CGM metrics were used to assess glycemic control.

Results

All study groups showed relatively good glycemic control. Type 1 diabetes users showed the highest glucose variability (SD, 61 mg/dL; and %CV, 40%), above the established target level (%CV ≤ 36%). type 2 diabetes-MDI and type 2 diabetes-BOI users had similar levels of glucose variability (both within target). Type 2 diabetes-NIT users had the highest mean % time in range (TIR) (84.3%) and largest percentage of users that met the target of %TIR > 70% (87.4%). In contrast, type 1 diabetes users had the lowest mean %TIR (62.6%) and the lowest percentage meeting the established %TIR target (30.5%).

Conclusions

By utilizing CGM devices in daily diabetes care, both healthcare professionals and patients can monitor glycemic excursions and gain insights into their historical glucose control patterns.

目的/简介：FreeStyle Libre（FSL）间歇扫描连续血糖监测（isCGM）系统可持续测量血糖间期水平，并以数字和图表形式向用户提供数据，指导用户进行日常糖尿病自我管理。尽管许多研究都证明了 FSL 在儿童和成人群体中的血糖效益，但很少有研究专门描述日本 1 型或 2 型糖尿病成人使用 FSL 的情况。我们利用已有的 CGM 指标评估了一大批日本 1 型和 2 型糖尿病成人患者的血糖控制情况：共有 3,463 名匿名 FSL 用户提供了四个治疗组中的一个治疗组：1 型糖尿病（n = 1,768）、2 型糖尿病-每日多次注射（MDI）（n = 612）、2 型糖尿病-基础（BOI）（n = 343）和 2 型糖尿病-非胰岛素（NIT）（n = 740）。使用既定的 CGM 指标评估血糖控制情况：所有研究组的血糖控制情况都相对较好。1 型糖尿病患者的血糖变异性最高（SD，61 mg/dL；%CV，40%），高于既定目标水平（%CV ≤ 36%）。二型糖尿病-NIT 用户的平均血糖范围内时间百分比（TIR）最高（84.3%），血糖范围内时间百分比大于 70% 的用户百分比最高（87.4%）。相比之下，1 型糖尿病用户的平均 TIR 百分比最低（62.6%），达到既定 TIR 百分比目标的比例也最低（30.5%）：结论：通过在日常糖尿病护理中使用 CGM 设备，医护人员和患者都可以监测血糖偏移，并深入了解他们的历史血糖控制模式。

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引用次数: 0

Young-onset type 2 diabetes mellitus enhances proteinuria, but not glomerular filtration rate decline: A Japanese cohort study 年轻时发病的 2 型糖尿病会增加蛋白尿，但不会导致肾小球滤过率下降：一项日本队列研究。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-26 DOI: 10.1111/jdi.14272

Haruka Saito, Hayato Tanabe, Hiroyuki Hirai, Moritake Higa, Kenichi Tanaka, Satoshi Yamaguchi, Gulinu Maimaituxun, Hiroaki Masuzaki, Junichiro J Kazama, Michio Shimabukuro

Aims/Introduction

The time course of chronic kidney disease in young-onset type 2 diabetes mellitus remains unclear. We compared the trajectories of proteinuria and estimated glomerular filtration rate (eGFR) decline between young-onset (aged ≤40 years) and late-onset (aged >40 years) type 2 diabetes mellitus in a Japanese multicenter cohort.

Materials and Methods

Participants without diabetic kidney disease were divided into two groups according to age at diagnosis: young- and late-onset. The primary endpoint was eGFR <60 mL/min/1.73 m², proteinuria or both. Multivariable Cox proportional hazards were calculated to estimate incidence.

Results

Among 626 participants with type 2 diabetes mellitus, 78 (12.4%) had young-onset and 548 (87.6%) had late-onset diabetes. The incidence of eGFR <60 mL/min/1.73 m² was lower (16.7% vs 33.5%, P = 0.003), but that of proteinuria was higher (46.2% vs 28.9%, P = 0.002) in the young-onset type 2 diabetes mellitus group. The Kaplan–Meyer curve showed that young-onset type 2 diabetes mellitus was associated with a decreased hazard ratio (HR) for eGFR <60 mL/min/1.73 m² and an increased HR for proteinuria compared with late-onset type 2 diabetes mellitus. In the multivariate Cox analysis, young-onset type 2 diabetes mellitus increased the HR (95% confidence interval) of proteinuria (1.53, 95% confidence interval 1.03–2.26), but did not change the eGFR <60 mL/min/1.73 m² HR.

Conclusions

Young-onset type 2 diabetes mellitus has a lower HR of eGFR <60 mL/min/1.73 m² and an increased HR of proteinuria compared with late-onset type 2 diabetes mellitus, indicating that young-onset type 2 diabetes mellitus has a different time course for the development of proteinuria and subsequent eGFR decline.

目的/引言：年轻2型糖尿病患者慢性肾脏病的时间进程仍不清楚。我们在日本的一个多中心队列中比较了年轻（年龄小于 40 岁）和晚发（年龄大于 40 岁）2 型糖尿病患者蛋白尿和估计肾小球滤过率（eGFR）下降的轨迹：根据确诊年龄将无糖尿病肾病的参与者分为两组：年轻发病组和晚期发病组。主要终点是 eGFR 2、蛋白尿或两者。通过计算多变量考克斯比例危险系数来估算发病率：结果：在626名2型糖尿病患者中，78人（12.4%）为年轻发病者，548人（87.6%）为晚期发病者。年轻发病的 2 型糖尿病组 eGFR 2 的发生率较低（16.7% 对 33.5%，P = 0.003），但蛋白尿的发生率较高（46.2% 对 28.9%，P = 0.002）。Kaplan-Meyer 曲线显示，与晚期发病的 2 型糖尿病相比，年轻发病的 2 型糖尿病与 eGFR 2 的危险比（HR）降低和蛋白尿的危险比升高有关。在多变量考克斯分析中，年轻发病的2型糖尿病增加了蛋白尿的HR（95%置信区间）（1.53，95%置信区间1.03-2.26），但没有改变eGFR 2的HR：结论：与晚发的2型糖尿病相比，年轻的2型糖尿病患者的eGFR 2 HR较低，而蛋白尿的HR较高，这表明年轻的2型糖尿病患者出现蛋白尿和随后eGFR下降的时间过程不同。

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引用次数: 0

Efficacy of long-term low carbohydrate diets for patients with type 2 diabetes: A systematic review and meta-analysis 长期低碳水化合物饮食对 2 型糖尿病患者的疗效：系统回顾和荟萃分析。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-24 DOI: 10.1111/jdi.14271

Takahiro Ichikawa, Hiroshi Okada, Junya Hironaka, Hanako Nakajima, Takuro Okamura, Saori Majima, Takafumi Senmaru, Emi Ushigome, Naoko Nakanishi, Masahide Hamaguchi, Erina Joo, Kenichiro Shide, Michiaki Fukui

Aims/Introduction

Efficacy of long-term low-carbohydrate diets (LCD) to improve glycemic management for type 2 diabetes remains controversial. Thus, we investigated the association between long-term LCD and glycemic control in individuals with type 2 diabetes.

Materials and Methods

We searched PubMed, Embase and the Cochrane Database for articles published up to June 2023, and included randomized controlled trials conducted on LCD interventions for >12 months in adults with type 2 diabetes. Primary outcome was the difference in glycated hemoglobin between long-term LCD and control groups. Additionally, we evaluated the differences in changes in systolic and diastolic blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, and weight between long-term LCD and control groups.

Results

Six studies were identified and met the inclusion criteria. This study did not show significant differences in changes in glycated hemoglobin between long-term LCD and control diets (standardized mean difference −0.11, 95% confidence interval −0.33 to 0.11, P = 0.32). As with glycemic control, there were no significant differences in the changes in weight loss, blood pressure, and low-density lipoprotein cholesterol between long-term LCD and control diets. However, long-term LCD were associated with greater elevation in high-density lipoprotein cholesterol (standardized mean difference 0.22, 95% confidence interval 0.04–0.41; P = 0.02) and decrease in triglyceride (standardized mean difference −0.19; 95% confidence interval −0.37 to 0.02; P = 0.03) than that in control diets.

Conclusions

Our findings suggest efficacy of long-term LCD in treating dyslipidemia in individuals with type 2 diabetes, but do not recommend long-term LCD for glycemic control in the individuals.

目的/引言：长期低碳水化合物饮食（LCD）改善 2 型糖尿病血糖控制的效果仍存在争议。因此，我们研究了长期低碳水化合物饮食与 2 型糖尿病患者血糖控制之间的关系：我们检索了 PubMed、Embase 和 Cochrane 数据库中截至 2023 年 6 月发表的文章，并纳入了对 2 型糖尿病成人患者进行 LCD 干预超过 12 个月的随机对照试验。主要结果是长期LCD组和对照组之间糖化血红蛋白的差异。此外，我们还评估了长期LCD组和对照组之间收缩压和舒张压、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯和体重变化的差异：共有六项研究符合纳入标准。该研究未显示长期液晶显示饮食与对照饮食之间糖化血红蛋白变化的显著差异（标准化平均差异-0.11，95% 置信区间-0.33 至 0.11，P = 0.32）。与血糖控制一样，长期液晶显示饮食与对照饮食在体重减轻、血压和低密度脂蛋白胆固醇方面的变化也没有显著差异。然而，与对照组饮食相比，长期液晶显示与高密度脂蛋白胆固醇的升高（标准化平均差异为 0.22，95% 置信区间为 0.04-0.41；P = 0.02）和甘油三酯的降低（标准化平均差异为-0.19；95% 置信区间为-0.37-0.02；P = 0.03）相关：结论：我们的研究结果表明，长期液晶饮食对治疗 2 型糖尿病患者的血脂异常具有疗效，但不建议长期使用液晶饮食控制血糖。

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引用次数: 0

Sheffield One-Stop Service: A potential model to improve the screening uptake of diabetic peripheral neuropathy and other microvascular complications of diabetes 谢菲尔德一站式服务：提高糖尿病周围神经病变和其他糖尿病微血管并发症筛查率的潜在模式。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-22 DOI: 10.1111/jdi.14268

Gordon Sloan, Pepito Dela Pena, Aimee Andag-Silva, Elaine Cunanan, Cecilia Jimeno, Jeremy Jones Robles, Solomon Tesfaye

The world is experiencing an enormous rise in the prevalence of diabetes, which is associated with massive healthcare costs that threaten to overwhelm many healthcare systems. Most of the diabetes expenditure is attributed to the management of chronic diabetes complications, including diabetic peripheral neuropathy (DPN)/diabetic foot complications, chronic kidney disease, sight-threatening retinopathy and cardiovascular diseases. Of these complications, the most overlooked is DPN. Most consultations around the world do not even involve taking off shoes and socks to carry out a foot examination, and even when carried out, the peripheral neurological examination using the 10-g monofilament diagnoses DPN when it is already at an advanced stage. Thus, all too often diabetes complications are diagnosed late, resulting in devastating outcomes, particularly in low- to middle-income countries. There is, therefore, an urgent need to instigate new strategies to improve microvascular screening uptake using a holistic protocol for annual diabetes health checks outside the busy diabetes clinic. One such approach, the Sheffield One-Stop Microvascular Screening Service, which involves modern point of care devices to diagnose DPN, has been shown to be feasible and effective, resulting in high uptake and early management of diabetes complications. This article outlines the advantages of this One-Stop Microvascular Screening Service and a plan to trial an adapted version of this service to a resource-limited country, the Philippines. If successful, this model has the potential for implementation in other countries around the world.

全球糖尿病发病率急剧上升，随之而来的巨额医疗费用有可能使许多医疗系统不堪重负。大部分糖尿病支出都用于治疗糖尿病慢性并发症，包括糖尿病周围神经病变（DPN）/糖尿病足并发症、慢性肾病、危及视力的视网膜病变和心血管疾病。在这些并发症中，最容易被忽视的是糖尿病周围神经病变。世界各地的大多数会诊甚至不需要脱掉鞋袜进行足部检查，即使进行了足部检查，使用 10 克单丝进行周围神经检查诊断 DPN 时也已是晚期。因此，糖尿病并发症往往很晚才被诊断出来，导致灾难性的后果，尤其是在中低收入国家。因此，迫切需要制定新的战略，在繁忙的糖尿病门诊之外，利用糖尿病年度健康检查的整体方案，提高微血管筛查率。谢菲尔德 "一站式微血管筛查服务 "就是这样一种方法，它采用了现代护理点设备来诊断 DPN，已被证明是可行且有效的，可提高接受率并及早控制糖尿病并发症。本文概述了这种一站式微血管筛查服务的优势，以及在菲律宾这个资源有限的国家试行该服务改良版的计划。如果取得成功，这种模式有可能在世界其他国家推广。

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引用次数: 0

Evaluation of the transition program at the University Hospital of Reims from 2015 to 2020 兰斯大学医院 2015 至 2020 年过渡计划评估。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-22 DOI: 10.1111/jdi.14263

Sonia Chibane, Aurélie Berot, Céline Lukas-croisier, Laure Dollez, Sara Barraud, Brigitte Delemer, Géraldine Vitellius

The transition of young type 1 diabetic (T1D) patients from pediatric to adult healthcare is a high-risk period of loss to follow-up. Since 2015, we have implemented a transition program, involving both pediatric and adult clinicians. The main objective was to evaluate the number of patients who had succeeded this transition program at 1 year. We found that 86% of patients underwent the complete transition program. However, adverse outcomes occurred in 19.1% of patients at 1 year but decreased to 2.9% after 3 years. In 63% of patients their HbA1c level had deteriorated 1 year after the transition day and this level stabilized at around 8% in the following 2 and 3 years. In patients who had improved HbA1c levels the body mass index was lower (P = 0.03) and they lived alone (P = 0.04). Although our program seemed to allow a better follow-up than previously described, this study highlights the importance of further supporting this transition period.

年轻的 1 型糖尿病（T1D）患者从儿科医疗向成人医疗过渡是随访损失的高风险时期。自 2015 年起，我们实施了一项过渡计划，儿科和成人临床医生都参与其中。我们的主要目标是评估在一年后成功完成过渡计划的患者人数。我们发现，86% 的患者完成了完整的过渡计划。然而，19.1%的患者在一年后出现了不良后果，但在三年后降至 2.9%。63%的患者在过渡日 1 年后 HbA1c 水平有所下降，而在随后的 2 年和 3 年中，这一水平稳定在 8%左右。在 HbA1c 水平有所改善的患者中，体重指数较低（P = 0.03），而且他们都是独居（P = 0.04）。虽然我们的计划似乎比之前描述的更好，但这项研究强调了进一步支持这一过渡时期的重要性。

引用次数: 0

Second-trimester triglyceride-glucose index to predict adverse outcomes in women with gestational diabetes mellitus: A retrospective multicenter cohort study 预测妊娠糖尿病妇女不良预后的二胎甘油三酯-葡萄糖指数：一项回顾性多中心队列研究。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-15 DOI: 10.1111/jdi.14269

Xueqi Bai, Qingyi Zhu, Wenli Wang, Sutong Kan, Shiman Hu, Runrun Hao, Shanshan Wang, Zhonghua Shi

Aims/Introduction

Women with gestational diabetes mellitus are at high risk for adverse maternal and neonatal outcomes. The study aimed to evaluate the performance of the triglyceride-glucose index in predicting the risk of developing adverse outcomes in women with gestational diabetes mellitus.

Materials and Methods

This retrospective multicenter cohort study included 8,808 pregnant women with gestational diabetes mellitus in two grade-A tertiary hospitals in China during 2018–2022. The triglyceride-glucose index was defined as ln [triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. Significant adverse gestational diabetes mellitus outcomes were chosen by generalized linear models as the main outcomes. Multivariable logistic regression models evaluated their association with the triglyceride-glucose index. Areas under the receiver operating characteristic curves predicted adverse pregnancy outcomes. The prediction efficiency was validated in the sensitivity analysis dataset and validation cohort.

Results

The triglyceride-glucose index was associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia before and after adjusting for confounding factors (P < 0.05). The predictive performance of the triglyceride-glucose index was relatively moderate. Incorporating the triglyceride-glucose index into the baseline clinical risk model improved the area under curves for the diagnosis of preeclampsia (0.749 [0.714–0.784] vs 0.766 [0.734–0.798], P = 0.033) and macrosomia (0.664 [0.644–0.685] vs 0.676 [0.656–0.697], P = 0.002). These predictive models exhibited good calibration and robustness.

Conclusions

The triglyceride-glucose index is positively associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia and is useful for the early prediction and prevention of adverse outcomes in women with gestational diabetes mellitus.

目的/引言：患有妊娠糖尿病的妇女是孕产妇和新生儿不良结局的高危人群。本研究旨在评估甘油三酯-葡萄糖指数在预测妊娠糖尿病妇女不良结局风险方面的性能：这项回顾性多中心队列研究纳入了2018-2022年间中国两家甲级三甲医院的8808名妊娠期糖尿病孕妇。甘油三酯-血糖指数定义为ln[甘油三酯（mg/dL）×空腹血糖（mg/dL）/2]。通过广义线性模型选择显著的妊娠糖尿病不良结局作为主要结局。多变量逻辑回归模型评估了这些结果与甘油三酯-血糖指数的关系。接收者操作特征曲线下的区域可预测不良妊娠结局。在敏感性分析数据集和验证队列中验证了预测效率：结果：在调整混杂因素之前和之后，甘油三酯-葡萄糖指数与子痫前期、重度子痫前期、早产、胎盘早剥和巨大儿相关（P 结论：甘油三酯-葡萄糖指数与子痫前期、重度子痫前期、早产、胎盘早剥和巨大儿相关：甘油三酯-葡萄糖指数与子痫前期、重度子痫前期、早产、胎盘早剥和巨大儿呈正相关，有助于早期预测和预防妊娠期糖尿病妇女的不良结局。

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引用次数: 0

A novel predictive model for optimizing diabetes screening in older adults 优化老年人糖尿病筛查的新型预测模型。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-11 DOI: 10.1111/jdi.14262

Yushuang Lin, Ya Shen, Rongbo He, Quan Wang, Hongbin Deng, Shujunyan Cheng, Yu Liu, Yimin Li, Xiang Lu, Zhengkai Shen

Introduction

The fasting blood glucose test is widely used for diabetes screening. However, it may fail to detect early-stage diabetes characterized by elevated postprandial glucose levels. Hence, we developed and internally validated a nomogram to predict the diabetes risk in older adults with normal fasting glucose levels.

Materials and Methods

This study enrolled 2,235 older adults, dividing them into a Training Set (n = 1,564) and a Validation Set (n = 671) based on a 7:3 ratio. We employed the least absolute shrinkage and selection operator regression to identify predictors for constructing the nomogram. Calibration and discrimination were employed to assess the nomogram's performance, while its clinical utility was evaluated through decision curve analysis.

Results

Nine key variables were identified as significant factors: age, gender, body mass index, fasting blood glucose, triglycerides, alanine aminotransferase, the ratio of alanine aminotransferase to aspartate aminotransferase, blood urea nitrogen, and hemoglobin. The nomogram demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.824 in the Training Set and 0.809 in the Validation Set. Calibration curves for both sets confirmed the model's accuracy in estimating the actual diabetes risk. Decision curve analysis highlighted the model's clinical utility.

Conclusions

We provided a dynamic nomogram for identifying older adults at risk of diabetes, potentially enhancing the efficiency of diabetes screening in primary healthcare units.

简介空腹血糖检测被广泛用于糖尿病筛查。然而，它可能无法检测出以餐后血糖水平升高为特征的早期糖尿病。因此，我们开发了一种预测空腹血糖水平正常的老年人患糖尿病风险的提名图，并进行了内部验证：本研究招募了 2,235 名老年人，按照 7:3 的比例将他们分为训练集（n = 1,564 人）和验证集（n = 671 人）。我们采用最小绝对缩减法和选择算子回归法来确定构建提名图的预测因子。我们采用校准和判别来评估提名图的性能，并通过决策曲线分析来评估其临床实用性：结果：九个关键变量被确定为重要因素：年龄、性别、体重指数、空腹血糖、甘油三酯、丙氨酸氨基转移酶、丙氨酸氨基转移酶与天冬氨酸氨基转移酶的比率、血尿素氮和血红蛋白。提名图显示出良好的分辨能力，训练集和验证集的接收者操作特征曲线下面积分别为 0.824 和 0.809。两组的校准曲线证实了该模型在估计实际糖尿病风险方面的准确性。决策曲线分析凸显了该模型的临床实用性：我们提供了一个动态提名图，用于识别有糖尿病风险的老年人，有望提高基层医疗机构糖尿病筛查的效率。

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引用次数: 0

Clinical lessons for diabetes treatment from the COVID-19 pandemic 从 COVID-19 大流行中汲取糖尿病治疗的临床经验。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-11 DOI: 10.1111/jdi.14266

Yoshiyuki Hamamoto

<p>A high rate of severe Coronavirus Disease 2019 (COVID-19) illness and mortality in people with diabetes was recognized from the early period of the pandemic. Indeed, many individuals with diabetes, especially older patients, feared leaving home even as the pandemic waned. While extreme caution may well have prevented some instances of infection, it also increased distress and disease stigma as well as physical inactivity in the effort to avoid contact with people who may be infected. Interruption of treatment can negatively impact clinical glycemic management and lead to the development of diabetic complications. Fear of infection also was a factor in the disruption of optimal management for patients with type 1 diabetes, many of whom are relatively young and for whom regular treatment with insulin is essential. Although Japan has a national health insurance program, all costs are not covered, and financial distress also impacted the maintenance of optimal diabetes care.</p><p>Moreover, although Japan has a robust health checkup system as well as a health insurance program, many individuals with diabetes nevertheless remain undiagnosed; Uchihara <i>et al</i>.<span><sup>1</sup></span> report that patients hospitalized for COVID-19 infection, who are newly diagnosed with diabetes, progress to a critical condition at more than twice the rate of those already under diabetes management and show higher levels of HbA1c and inflammatory markers and require more oxygen. Moreover, it is especially difficult to manage glycemia in the early phase of COVID-19 treatment in such patients; steroid drugs, the recommended treatment for infection in cases of moderate to severe pneumonia, can exacerbate hyperglycemia. They also report that while both individuals with undiagnosed diabetes and those under treatment have worse COVID-19 outcomes including invasive mechanical ventilation, extracorporeal membrane oxygenation support, intensive care unit admission, and transfer to another medical facility for more advanced care as well as in-hospital death when compared with those who do not have the disease, individuals with undiagnosed diabetes exhibit an acute glycemic deterioration upon COVID-19 infection that poses a substantial additional risk. Interestingly, only those individuals receiving treatment for diabetes who had poor glycemic management (HbA1c ≥8.0%) were found to have worse COVID-19 outcomes, indicating that it is hyperglycemia rather than diabetes itself that exacerbates COVID-19 outcomes<span><sup>2</sup></span>. Moreover, during the first year of the pandemic, Okada <i>et al</i>.<span><sup>3</sup></span> reported lower susceptibility to COVID-19 infection among individuals with diabetes who maintained optimal HbA1c management goals. Thus, the management of glycemia in diabetes on a routine basis not only mitigates the severity of COVID-19 infection should it occur, but also may reduce the infection rate.</p><p>In the early summer of 2020, just after

为尽量减少偏差，他未参与所有与接受本文发表相关的编辑决策：不适用。知情同意书：不适用：研究的登记和注册编号：不适用：动物实验动物研究：不适用。

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引用次数: 0

A consensus statement from the Japan Diabetes Society: A proposed algorithm for pharmacotherapy in people with type 2 diabetes – 2nd edition (English version) 日本糖尿病学会共识声明：2 型糖尿病患者药物治疗的拟议算法--第 2 版（英文版）。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-11 DOI: 10.1111/jdi.14202

Ryotaro Bouchi, Tatsuya Kondo, Yasuharu Ohta, Atsushi Goto, Daisuke Tanaka, Hiroaki Satoh, Daisuke Yabe, Rimei Nishimura, Norio Harada, Hideki Kamiya, Ryo Suzuki, Toshimasa Yamauchi, JDS Committee on Consensus Statement Development

This algorithm was issued for the appropriate use of drugs for the treatment of type 2 diabetes mellitus in Japan. The revisions include safety considerations, fatty liver disease as a comorbidity to be taken into account and the position of tirzepatide.

该算法是针对日本 2 型糖尿病治疗药物的合理使用而发布的。修订内容包括安全性考虑、应考虑的合并症脂肪肝以及替扎帕肽的地位。

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Genetic variant profiling of neonatal diabetes mellitus in Iranian patients: Unveiling 58 distinct variants in 14 genes 伊朗新生儿糖尿病基因变异分析：揭示 14 个基因中的 58 个不同变异。

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Investigation

Pub Date : 2024-07-06 DOI: 10.1111/jdi.14254

Hamidreza Mianesaz, Safoura Ghalamkari, Farzaneh Abbasi, Maryam Razzaghy-Azar, Fatemeh Sayarifard, Rahim Vakili, Maryam Sedghi, Samaneh Noroozi Asl, Sousan Hosseini, Mahsa M Amoli, Hanieh Yaghootkar

Introduction

Neonatal diabetes mellitus (NDM) is a rare non-immunological monogenic disorder characterized by hyperglycemic conditions primarily occurring within the first 6 months of life. The majority of cases are attributed to pathogenic variants in genes affecting beta-cell survival, insulin regulation, and secretion. This study aims to investigate the genetic landscape of NDM in Iran.

Methods

We recruited a total of 135 patients who were initially diagnosed with diabetes at <12 months of age in Iran and referred to pediatric endocrinology clinics across the country. These patients underwent genetic diagnostic tests conducted by the Exeter Molecular Genetics Laboratory in the UK. The pathogenic variants identified were sorted and described based on type, pathogenicity (according to ACMG/AMP criteria), novelty, and the affected protein domain.

Results

Genetic defects were identified in 93 probands, presenting various pathogenic abnormalities associated with NDM and its associated syndromes. 76% of the patients were born as a result of consanguineous marriage, and a familial history of diabetes was found in 43% of the cases. A total of 58 distinct variants in 14 different genes were discovered, including 20 variants reported for the first time. Causative variants were most frequently identified in EIF2AK3, KCNJ11, and ABCC8, respectively. Notably, EIF2AK3 and ABCC8 exhibited the highest number of novel variants.

Discussion

These findings provide valuable insights into the genetic landscape of NDM in the Iranian population and contribute to the knowledge of novel pathogenic variants within known causative genes.

导言：新生儿糖尿病（NDM）是一种罕见的非免疫性单基因疾病，主要表现为出生后 6 个月内出现高血糖。大多数病例归因于影响β细胞存活、胰岛素调节和分泌的基因中的致病变异。本研究旨在调查伊朗 NDM 的遗传情况：方法：我们共招募了 135 名初步诊断为糖尿病的患者：结果：在 93 名探究者中发现了遗传缺陷，这些人表现出与 NDM 及其相关综合征有关的各种致病异常。76%的患者为近亲结婚，43%的患者有糖尿病家族史。共发现了 14 个不同基因中的 58 个不同变异，其中 20 个变异是首次报道。最常见的致病变异分别出现在 EIF2AK3、KCNJ11 和 ABCC8 中。值得注意的是，EIF2AK3 和 ABCC8 的新型变体数量最多：这些发现为了解伊朗人群中 NDM 的遗传情况提供了有价值的见解，并有助于了解已知致病基因中的新型致病变体。

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