Insulin treatment should be introduced in patients with slowly progressive type 1 diabetes (SPIDDM; definite), according to the revised diagnostic criteria of SPIDDM (2023). In contrast, SPIDDM (probable) patients are in a non-insulin-dependent state; therefore, a more flexible treatment can be considered, although sulfonylurea agents should be avoided. Insulin treatment has been shown to maintain endogenous insulin secretion capacity in SPIDDM (probable); however, this does not mean that all SPIDDM (probable) patients should use insulin from the early phase. Dipeptidyl peptidase-4 inhibitors and biguanides might be the treatment of choice for SPIDDM (probable), but no evidence exists for other hypoglycemic agents. In any case, careful monitoring of the endogenous insulin secretion capacity should be carried out, and if a decrease in insulin secretion capacity is suspected, a change in treatment should be considered to prevent progression to an insulin-dependent state.
{"title":"Practice guideline: Statement regarding treatment for suspected slowly progressive type 1 diabetes (SPIDDM; probable) cases (English version)","authors":"Akira Shimada, Eiji Kawasaki, Norio Abiru, Takuya Awata, Yoichi Oikawa, Haruhiko Osawa, Hiroshi Kajio, Junji Kozawa, Kazuma Takahashi, Daisuke Chujo, Shinsuke Noso, Tomoyasu Fukui, Junnosuke Miura, Kazuki Yasuda, Hisafumi Yasuda, Akihisa Imagawa, Hiroshi Ikegami","doi":"10.1111/jdi.14267","DOIUrl":"10.1111/jdi.14267","url":null,"abstract":"<p>Insulin treatment should be introduced in patients with slowly progressive type 1 diabetes (SPIDDM; definite), according to the revised diagnostic criteria of SPIDDM (2023). In contrast, SPIDDM (probable) patients are in a non-insulin-dependent state; therefore, a more flexible treatment can be considered, although sulfonylurea agents should be avoided. Insulin treatment has been shown to maintain endogenous insulin secretion capacity in SPIDDM (probable); however, this does not mean that all SPIDDM (probable) patients should use insulin from the early phase. Dipeptidyl peptidase-4 inhibitors and biguanides might be the treatment of choice for SPIDDM (probable), but no evidence exists for other hypoglycemic agents. In any case, careful monitoring of the endogenous insulin secretion capacity should be carried out, and if a decrease in insulin secretion capacity is suspected, a change in treatment should be considered to prevent progression to an insulin-dependent state.</p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 1","pages":"163-168"},"PeriodicalIF":3.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We investigated the association between the ankle reflex and the estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes.
Materials and Methods
This was a single-center, retrospective, observational cohort study. A total of 1,387 patients who underwent an ankle reflex examination between January 2005 and December 2015 were included in the analysis for the primary outcome. The findings of the ankle reflex examination were classified into three groups: normal, decreased, or absent. The primary outcome was defined as the incidence of a 40% loss of eGFR from baseline. A survival time analysis using the Kaplan–Meier method and a regression analysis using a Cox proportional hazards model were conducted to evaluate the association between the ankle reflex test results and loss of eGFR.
Results
The ankle reflex test results were as follows: normal, n = 678 (48.9%); decreased, n = 270 (19.5%); and absent, n = 439 (31.6%) patients. The median follow-up period was 5.6 years in the observational period. In the univariate regression analysis, decreased and absent ankle reflexes were significantly associated with loss of eGFR. Moreover, decreased ankle reflex (hazard ratio: 1.83, 95% confidence interval: 1.16–2.87) and absent ankle reflex (hazard ratio: 2.57, 95% confidence interval: 1.76–3.76) were independently associated with loss of eGFR after adjusting for prognostic risk factors.
Conclusions
Decreased and absent ankle reflexes are closely and independently associated with loss of eGFR in patients with type 2 diabetes.
{"title":"Deterioration in ankle reflex is associated with a reduced estimated glomerular filtration rate in patients with type 2 diabetes: A retrospective observational cohort study","authors":"Taichi Muramatsu, Daisuke Yamamuro, Akifumi Kushiyama, Takako Kikuchi","doi":"10.1111/jdi.14348","DOIUrl":"10.1111/jdi.14348","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>We investigated the association between the ankle reflex and the estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This was a single-center, retrospective, observational cohort study. A total of 1,387 patients who underwent an ankle reflex examination between January 2005 and December 2015 were included in the analysis for the primary outcome. The findings of the ankle reflex examination were classified into three groups: normal, decreased, or absent. The primary outcome was defined as the incidence of a 40% loss of eGFR from baseline. A survival time analysis using the Kaplan–Meier method and a regression analysis using a Cox proportional hazards model were conducted to evaluate the association between the ankle reflex test results and loss of eGFR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ankle reflex test results were as follows: normal, <i>n</i> = 678 (48.9%); decreased, <i>n</i> = 270 (19.5%); and absent, <i>n</i> = 439 (31.6%) patients. The median follow-up period was 5.6 years in the observational period. In the univariate regression analysis, decreased and absent ankle reflexes were significantly associated with loss of eGFR. Moreover, decreased ankle reflex (hazard ratio: 1.83, 95% confidence interval: 1.16–2.87) and absent ankle reflex (hazard ratio: 2.57, 95% confidence interval: 1.76–3.76) were independently associated with loss of eGFR after adjusting for prognostic risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Decreased and absent ankle reflexes are closely and independently associated with loss of eGFR in patients with type 2 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 2","pages":"225-235"},"PeriodicalIF":3.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We evaluated the effect of the MiniMed™ 770G, an insulin pump using hybrid closed-loop technology, on blood glucose management and quality of life in Japanese people with type 1 diabetes.
Materials and Methods
This was a 52-week, prospective, observational study. Fifty Japanese people with type 1 diabetes switched from the MiniMed™ 640G to 770G, and we analyzed the continuous glucose monitoring data of 24 subjects who used auto mode throughout the study. We also analyzed the scores of the Diabetes Therapy-Related Quality of Life questionnaire completed by 26 auto-mode users before and after the treatment change.
Results
The baseline time in range 70–180 mg/dL was 67.3 (54.8–78.4)%, with a significant improvement beginning 8 weeks after the switch and lasting until 52 weeks. The baseline time below range <70 mg/dL was 1.9 (0.6–3.6)%, with a significant increase at week 8; however, the mean value was less than 4% throughout the study period. On the other hand, the number of blood glucose measurements significantly increased. While there was no significant difference in the overall change in the total Diabetes Therapy-Related Quality of Life score, there was a significant decrease in the treatment satisfaction score.
Conclusions
Use of the MiniMed™ 770G improved continuous glucose monitoring metrics. However, treatment satisfaction decreased, probably due to the increased frequency of blood glucose monitoring necessary to maintain auto mode.
{"title":"Effects of switching from MiniMed™ 640G to 770G on continuous glucose monitoring metrics and DTR-QOL scores: An observational study of Japanese people with type 1 diabetes mellitus","authors":"Toshiki Kogai, Junko Sato, Haruna Yasuda, Tatsuhiro Ayame, Azusa Ozaki, Eri Takagi, Mami Koshibu, Yuya Nishida, Fuki Ikeda, Hirotaka Watada","doi":"10.1111/jdi.14350","DOIUrl":"10.1111/jdi.14350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>We evaluated the effect of the MiniMed™ 770G, an insulin pump using hybrid closed-loop technology, on blood glucose management and quality of life in Japanese people with type 1 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This was a 52-week, prospective, observational study. Fifty Japanese people with type 1 diabetes switched from the MiniMed™ 640G to 770G, and we analyzed the continuous glucose monitoring data of 24 subjects who used auto mode throughout the study. We also analyzed the scores of the Diabetes Therapy-Related Quality of Life questionnaire completed by 26 auto-mode users before and after the treatment change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The baseline time in range 70–180 mg/dL was 67.3 (54.8–78.4)%, with a significant improvement beginning 8 weeks after the switch and lasting until 52 weeks. The baseline time below range <70 mg/dL was 1.9 (0.6–3.6)%, with a significant increase at week 8; however, the mean value was less than 4% throughout the study period. On the other hand, the number of blood glucose measurements significantly increased. While there was no significant difference in the overall change in the total Diabetes Therapy-Related Quality of Life score, there was a significant decrease in the treatment satisfaction score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Use of the MiniMed™ 770G improved continuous glucose monitoring metrics. However, treatment satisfaction decreased, probably due to the increased frequency of blood glucose monitoring necessary to maintain auto mode.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 2","pages":"326-333"},"PeriodicalIF":3.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to assess the correlation between hip circumference (HC) and the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus using Mendelian randomization (MR) to overcome observational study limitations.
Design
MR analysis utilized genetic variation from the MR Base in a two-sample analysis. Three methods were employed: MR-Egger regression, weighted median estimator, and inverse variance weighting (IVW).
Setting
Data was acquired from MR Base, a platform summarizing genome-wide association study (GWAS) data for MR research.
Main Outcome Measures
Publicly available summary statistics datasets from GWAS meta-analyses were used, with HC and HC adjusted for body mass index (BMI) as exposures. Data for CVD and type 2 diabetes mellitus were obtained as outcomes.
Results
Results indicated a positive causal relationship between HC and CVD (IVW: P = 1.84e-07, OR: 1.37, 95% CI: 1.22–1.54) as well as type 2 diabetes mellitus (IVW: P = 0.04, OR: 1.62, 95% CI: 1.02–2.56), independent of BMI. However, HC after BMI adjustment showed no significant causal relationship with CVD (IVW: P = 0.05, OR: 1.09, 95% CI: 1.00–1.19) and exhibited a negative association with type 2 diabetes mellitus (IVW: P = 0.00, OR: 0.76, 95% CI: 0.66–0.88), suggesting a protective effect against type 2 diabetes mellitus.
Conclusions
After adjusting for BMI, adipose tissue concentrated in the hip region showed a protective effect against type 2 diabetes mellitus but not against CVD. These findings offer insights into diabetes prevention and treatment strategies, and may inform plastic surgery procedures. Further research is needed to validate these findings and explore underlying mechanisms.
{"title":"Investigating the correlation of hip circumference to cardiovascular disease and type-2 diabetes using Mendelian randomization","authors":"Hongtao Liu, Zhaoyu Li, Su Yan, Shaopeng Ming","doi":"10.1111/jdi.14344","DOIUrl":"10.1111/jdi.14344","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to assess the correlation between hip circumference (HC) and the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus using Mendelian randomization (MR) to overcome observational study limitations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>MR analysis utilized genetic variation from the MR Base in a two-sample analysis. Three methods were employed: MR-Egger regression, weighted median estimator, and inverse variance weighting (IVW).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Data was acquired from MR Base, a platform summarizing genome-wide association study (GWAS) data for MR research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Publicly available summary statistics datasets from GWAS meta-analyses were used, with HC and HC adjusted for body mass index (BMI) as exposures. Data for CVD and type 2 diabetes mellitus were obtained as outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Results indicated a positive causal relationship between HC and CVD (IVW: <i>P</i> = 1.84e-07, OR: 1.37, 95% CI: 1.22–1.54) as well as type 2 diabetes mellitus (IVW: <i>P</i> = 0.04, OR: 1.62, 95% CI: 1.02–2.56), independent of BMI. However, HC after BMI adjustment showed no significant causal relationship with CVD (IVW: <i>P</i> = 0.05, OR: 1.09, 95% CI: 1.00–1.19) and exhibited a negative association with type 2 diabetes mellitus (IVW: <i>P</i> = 0.00, OR: 0.76, 95% CI: 0.66–0.88), suggesting a protective effect against type 2 diabetes mellitus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>After adjusting for BMI, adipose tissue concentrated in the hip region showed a protective effect against type 2 diabetes mellitus but not against CVD. These findings offer insights into diabetes prevention and treatment strategies, and may inform plastic surgery procedures. Further research is needed to validate these findings and explore underlying mechanisms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 2","pages":"265-271"},"PeriodicalIF":3.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiarui Peng, Hong Zhu, Bin Ruan, Zhisheng Duan, Mei Cao
Objective
Diabetic foot ulcers (DFU) are one of the most destructive complications of diabetes mellitus. The aim of this study was to link miR-155 and SOX2 with DFU to explore the regulation of wound healing by DFU and its potential mechanism.
Methods
Human keratinocytes (HaCaT) were induced with advanced glycation end products (AGEs) to construct DFU models in vitro. AGE-induced HaCaT cells were subjected to CCK-8 assays, flow cytometry, and wound healing assays to evaluate cell proliferation, apoptosis, and migration capacity, respectively. RT–qPCR and Western blotting were used to determine gene and protein expression levels, respectively. N6-methyladenosine (M6A) levels in total RNA were assessed using an M6A methylation quantification kit.
Results
Our results suggested that the inhibition of miR-155 promoted wound healing in an in vitro DFU model, while the knockdown of HIF-1α reversed this process, and that HIF-1α was a target protein of miR-155. In addition, knockdown of HIF-1α promoted the m6A level of SOX2 mRNA, inhibited the expression of SOX2, and inhibited the activation of the EGFR/MEK/ERK signaling pathway, thus inhibiting the proliferation and migration of HaCaT cells and promoting the apoptosis of HaCaT cells, while overexpression of SOX2 reversed this effect. We also found that METTL3 knockdown had the opposite effect of HIF-1α knockdown.
Conclusions
Inhibition of miR-155 promoted the expression of HIF-1α and attenuated the m6A modification of SOX2 mRNA, thereby promoting the expression of SOX2 and activating the downstream EGFR/MEK/ERK signaling pathway to promote wound healing in an in vitro DFU model.
{"title":"miR-155 promotes m6A modification of SOX2 mRNA through targeted regulation of HIF-1α and delays wound healing in diabetic foot ulcer in vitro models","authors":"Jiarui Peng, Hong Zhu, Bin Ruan, Zhisheng Duan, Mei Cao","doi":"10.1111/jdi.14327","DOIUrl":"10.1111/jdi.14327","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Diabetic foot ulcers (DFU) are one of the most destructive complications of diabetes mellitus. The aim of this study was to link miR-155 and SOX2 with DFU to explore the regulation of wound healing by DFU and its potential mechanism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Human keratinocytes (HaCaT) were induced with advanced glycation end products (AGEs) to construct DFU models in vitro. AGE-induced HaCaT cells were subjected to CCK-8 assays, flow cytometry, and wound healing assays to evaluate cell proliferation, apoptosis, and migration capacity, respectively. RT–qPCR and Western blotting were used to determine gene and protein expression levels, respectively. N6-methyladenosine (M6A) levels in total RNA were assessed using an M6A methylation quantification kit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our results suggested that the inhibition of miR-155 promoted wound healing in an in vitro DFU model, while the knockdown of HIF-1α reversed this process, and that HIF-1α was a target protein of miR-155. In addition, knockdown of HIF-1α promoted the m6A level of SOX2 mRNA, inhibited the expression of SOX2, and inhibited the activation of the EGFR/MEK/ERK signaling pathway, thus inhibiting the proliferation and migration of HaCaT cells and promoting the apoptosis of HaCaT cells, while overexpression of SOX2 reversed this effect. We also found that METTL3 knockdown had the opposite effect of HIF-1α knockdown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Inhibition of miR-155 promoted the expression of HIF-1α and attenuated the m6A modification of SOX2 mRNA, thereby promoting the expression of SOX2 and activating the downstream EGFR/MEK/ERK signaling pathway to promote wound healing in an in vitro DFU model.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 1","pages":"60-71"},"PeriodicalIF":3.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In a multicenter trial, LX9211 significantly reduced pain in diabetic peripheral neuropathy (DPN) patients, with the 10 mg dose showing notable relief by the first week. Although the higher dose was less effective, side effects like dizziness and nausea were generally mild. These findings highlight the importance of exploring both pharmaceutical and natural treatments, such as flavonoids, for managing DPN.
{"title":"LX9211, a rising star for relieving of diabetic peripheral neuropathic pain","authors":"Chia-Chin Lee, Fu-Shun Ko, Fu-Shun Yen, Chii-Min Hwu","doi":"10.1111/jdi.14342","DOIUrl":"10.1111/jdi.14342","url":null,"abstract":"<p>In a multicenter trial, LX9211 significantly reduced pain in diabetic peripheral neuropathy (DPN) patients, with the 10 mg dose showing notable relief by the first week. Although the higher dose was less effective, side effects like dizziness and nausea were generally mild. These findings highlight the importance of exploring both pharmaceutical and natural treatments, such as flavonoids, for managing DPN.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 2","pages":"176-179"},"PeriodicalIF":3.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Han Li, Yixuan Li, Wenwen Guo, Xinwei Liu, Yuhao Wang, Tianshu Zeng, Wen Kong
Purpose
Previous studies have shown higher cardiovascular mortality risk with higher monocyte–lymphocyte ratio levels in general population. However, the levels of oxidative stress in individuals with type 2 diabetes are higher than those in the general population, which may affect the link between monocyte-to-lymphocyte ratio and cardiovascular disease deaths. And the association between the monocyte-to-lymphocyte ratio and mortality risk in people with type 2 diabetes still be unknown. This study aimed to investigate the prognostic significance of monocyte-to-lymphocyte ratio in type 2 diabetes.
Methods
This analysis involved 2,954 individuals with type 2 diabetes from the National Health and Nutrition Examination Survey 1999–2010. The National Death Index records through December 31, 2019, was used to determine all-cause and cardiovascular mortality. The prognostic roles were determined using Cox regression models, restricted cubic spline analysis, and time-dependent receiver operating characteristic curve analysis.
Results
During an average follow-up period of 12.4 years, a total of 1,007 deaths occurred, while 252 were due to cardiovascular disease. An elevated monocyte-to-lymphocyte ratio level exhibited a significant dose–response relationship with an increased risk of all-cause mortality (1.34 [95% CI 1.12, 1.60] for all-cause mortality [P trend = 0.001]). The multivariable-adjusted HR was 1.81 (95% CI 1.25, 2.63) (P trend = 0.001) for cardiovascular mortality indicating a U-shaped relationship (P nonlinear = 0.013).
Conclusions
The results of this study indicate a U-shaped relationship between the monocyte-to-lymphocyte ratio and cardiovascular mortality in individuals with diabetes. Both very low and high monocyte-to-lymphocyte ratio monocyte-to-lymphocyte ratio values were found to be associated with increased cardiovascular mortality risk.
目的：以往的研究表明，普通人群中单核细胞-淋巴细胞比率水平越高，心血管疾病死亡风险越高。然而，2 型糖尿病患者的氧化应激水平高于普通人群，这可能会影响单核细胞-淋巴细胞比率与心血管疾病死亡之间的联系。而2型糖尿病患者的单核细胞与淋巴细胞比值与死亡风险之间的关系仍然未知。本研究旨在探讨 2 型糖尿病患者单核细胞与淋巴细胞比值的预后意义：本分析涉及 2 954 名 2 型糖尿病患者，这些患者来自 1999-2010 年全国健康与营养调查（National Health and Nutrition Examination Survey 1999-2010）。使用截至 2019 年 12 月 31 日的国家死亡指数记录来确定全因死亡率和心血管死亡率。使用 Cox 回归模型、限制性三次样条分析和时间依赖性接收器操作特征曲线分析确定预后作用：在平均 12.4 年的随访期内，共有 1,007 人死亡，其中 252 人死于心血管疾病。单核细胞与淋巴细胞比值升高与全因死亡风险增加呈显著的剂量反应关系（全因死亡风险为 1.34 [95% CI 1.12, 1.60] [P 趋势 = 0.001]）。心血管疾病死亡率的多变量调整 HR 为 1.81（95% CI 1.25，2.63）（P 趋势 = 0.001），显示出 U 型关系（P 非线性 = 0.013）：本研究结果表明，单核细胞与淋巴细胞比值与糖尿病患者的心血管死亡率呈 U 型关系。单核细胞与淋巴细胞比值极低和极高都与心血管死亡风险增加有关。
{"title":"Monocyte–lymphocyte ratio predicts cardiovascular diseases death in individuals with type 2 diabetes","authors":"Han Li, Yixuan Li, Wenwen Guo, Xinwei Liu, Yuhao Wang, Tianshu Zeng, Wen Kong","doi":"10.1111/jdi.14329","DOIUrl":"10.1111/jdi.14329","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Previous studies have shown higher cardiovascular mortality risk with higher monocyte–lymphocyte ratio levels in general population. However, the levels of oxidative stress in individuals with type 2 diabetes are higher than those in the general population, which may affect the link between monocyte-to-lymphocyte ratio and cardiovascular disease deaths. And the association between the monocyte-to-lymphocyte ratio and mortality risk in people with type 2 diabetes still be unknown. This study aimed to investigate the prognostic significance of monocyte-to-lymphocyte ratio in type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This analysis involved 2,954 individuals with type 2 diabetes from the National Health and Nutrition Examination Survey 1999–2010. The National Death Index records through December 31, 2019, was used to determine all-cause and cardiovascular mortality. The prognostic roles were determined using Cox regression models, restricted cubic spline analysis, and time-dependent receiver operating characteristic curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During an average follow-up period of 12.4 years, a total of 1,007 deaths occurred, while 252 were due to cardiovascular disease. An elevated monocyte-to-lymphocyte ratio level exhibited a significant dose–response relationship with an increased risk of all-cause mortality (1.34 [95% CI 1.12, 1.60] for all-cause mortality [<i>P</i> trend = 0.001]). The multivariable-adjusted HR was 1.81 (95% CI 1.25, 2.63) (<i>P</i> trend = 0.001) for cardiovascular mortality indicating a U-shaped relationship (<i>P</i> nonlinear = 0.013).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results of this study indicate a U-shaped relationship between the monocyte-to-lymphocyte ratio and cardiovascular mortality in individuals with diabetes. Both very low and high monocyte-to-lymphocyte ratio monocyte-to-lymphocyte ratio values were found to be associated with increased cardiovascular mortality risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 1","pages":"137-145"},"PeriodicalIF":3.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We thank Saleh <i>et al</i>.<span><sup>1</sup></span> for their interest in and constructive and critical comments on our recent study<span><sup>2</sup></span> on sarcopenia obesity and atherosclerosis markers in the older patient with diabetes.</p><p>We would like to respond to the point about the site where the carotid intima-media thickness (cIMT) was measured. We agree that ideally, cIMT should be measured in all common carotid arteries, carotid sinuses, and the internal carotid arteries; subsequently, their maximum values should be used as the maximum value of cIMT (IMTmax). However, we believe that adopting the maximum value of cIMT in the common carotid artery as the IMTmax in our study was reasonable and appropriate for the following reasons. First, the cIMT measured in the common carotid artery has been used in many studies and is accepted as an indicator of atherosclerosis because it is associated with cardiovascular disease or cerebral stroke<span><sup>3-7</sup></span>. Second, cIMT measured in the internal carotid arteries is inadequately assessed in 20% of cases<span><sup>8</sup></span>. In addition, it is often challenging to measure the cIMT in the internal carotid arteries using carotid echocardiography in Japanese patients because the carotid bifurcation is often located above the angle of the mandible<span><sup>8, 9</sup></span>.</p><p>Next, we would like to respond to the point about cIMT measurement under electrocardiographic (ECG) synchronization. As Saleh <i>et al</i>. pointed out, the diameter of the carotid artery varies with the cardiac cycle. Nevertheless, this is not the case for atherosclerotic lesions such as cIMT, and measurements of cIMT under ECG synchronization are not necessary when evaluating atherosclerotic lesions<span><sup>8</sup></span>, including cIMT. Instead, ECG synchronization is recommended when measuring vessel diameter<span><sup>8</sup></span>. Accordingly, we believe that it is unlikely that measuring cIMT without ECG synchronization caused significant measurement errors in this study.</p><p>Take together, we are confident that the protocol for measuring cIMT in this study was appropriate despite some limitations. As indicated by Saleh <i>et al</i>., accurate and rigorous measurement protocols for cIMT are important for the reliability of the study results; therefore, we need to pay as much attention as possible to the measurement protocols when using cIMT in clinical research.</p><p>Araki A received speaker honoraria from Sumitomo Pharma Co., Ltd., Ono Pharmaceutical Co., Ltd., and Novo Nordisk Pharma Ltd. The other authors declare no conflicts of interest.</p><p>Approval of the research protocol: This study was conducted in accordance with the Declaration of Helsinki, and the study protocol was approved by the Ethics Committee of the Tokyo Metropolitan Geriatric Hospital (R21-012).</p><p>Informed consent: Since the Ethics Committee determined that written patient consent was not required, the s
{"title":"Reply to the comments of Saleh et al. on “Coexistence of high visceral fat area and sarcopenia and atherosclerotic markers in old-old patients with diabetes: Is there an association?”","authors":"Motoya Sato, Yoshiaki Tamura, Yuji Murao, Fumino Yorikawa, Yuu Katsumata, So Watanabe, Shugo Zen, Remi Kodera, Kazuhito Oba, Kenji Toyoshima, Yuko Chiba, Atsushi Araki","doi":"10.1111/jdi.14345","DOIUrl":"10.1111/jdi.14345","url":null,"abstract":"<p>We thank Saleh <i>et al</i>.<span><sup>1</sup></span> for their interest in and constructive and critical comments on our recent study<span><sup>2</sup></span> on sarcopenia obesity and atherosclerosis markers in the older patient with diabetes.</p><p>We would like to respond to the point about the site where the carotid intima-media thickness (cIMT) was measured. We agree that ideally, cIMT should be measured in all common carotid arteries, carotid sinuses, and the internal carotid arteries; subsequently, their maximum values should be used as the maximum value of cIMT (IMTmax). However, we believe that adopting the maximum value of cIMT in the common carotid artery as the IMTmax in our study was reasonable and appropriate for the following reasons. First, the cIMT measured in the common carotid artery has been used in many studies and is accepted as an indicator of atherosclerosis because it is associated with cardiovascular disease or cerebral stroke<span><sup>3-7</sup></span>. Second, cIMT measured in the internal carotid arteries is inadequately assessed in 20% of cases<span><sup>8</sup></span>. In addition, it is often challenging to measure the cIMT in the internal carotid arteries using carotid echocardiography in Japanese patients because the carotid bifurcation is often located above the angle of the mandible<span><sup>8, 9</sup></span>.</p><p>Next, we would like to respond to the point about cIMT measurement under electrocardiographic (ECG) synchronization. As Saleh <i>et al</i>. pointed out, the diameter of the carotid artery varies with the cardiac cycle. Nevertheless, this is not the case for atherosclerotic lesions such as cIMT, and measurements of cIMT under ECG synchronization are not necessary when evaluating atherosclerotic lesions<span><sup>8</sup></span>, including cIMT. Instead, ECG synchronization is recommended when measuring vessel diameter<span><sup>8</sup></span>. Accordingly, we believe that it is unlikely that measuring cIMT without ECG synchronization caused significant measurement errors in this study.</p><p>Take together, we are confident that the protocol for measuring cIMT in this study was appropriate despite some limitations. As indicated by Saleh <i>et al</i>., accurate and rigorous measurement protocols for cIMT are important for the reliability of the study results; therefore, we need to pay as much attention as possible to the measurement protocols when using cIMT in clinical research.</p><p>Araki A received speaker honoraria from Sumitomo Pharma Co., Ltd., Ono Pharmaceutical Co., Ltd., and Novo Nordisk Pharma Ltd. The other authors declare no conflicts of interest.</p><p>Approval of the research protocol: This study was conducted in accordance with the Declaration of Helsinki, and the study protocol was approved by the Ethics Committee of the Tokyo Metropolitan Geriatric Hospital (R21-012).</p><p>Informed consent: Since the Ethics Committee determined that written patient consent was not required, the s","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 2","pages":"348-349"},"PeriodicalIF":3.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Baige Cao, Huijuan Lu, Peng Liu, Yinan Zhang, Congrong Wang
Aims/Introduction
The aim of this study was to identify a metabolic signature of MIDD as compared to healthy controls and other types of diabetes.
Methods
We performed a comprehensive serum metabolomic analysis using gas chromatography-time of flight mass spectrometry (GC-TOFMS) in participants diagnosed with MIDD (n = 14), latent autoimmune diabetes in adults (LADA) (n = 14), type 2 diabetes mellitus (n = 14), and healthy controls (n = 14). Each group was matched for gender and age.
Results
There were significant metabolic differences among MIDD and other diabetic and control groups. Compared with control, MIDD patients had high levels of carbohydrates (glucose, galactose, mannose, sorbose, and maltose), fatty acids (2-Hydroxybutyric acid, eicosapentaenoic acid, and octadecanoic acid), and other metabolites (alanine, threonic acid, cholesterol, lactic acid, and gluconic acid), but low level of threonine. Compared with LADA, MIDD patients had high levels of threonic acid and some amino acids (alanine, tryptophan, histidine, proline, glutamine, and creatine) but low levels of serine. Compared with type 2 diabetes mellitus, MIDD patients had high levels of citrulline, creatine, 3-Amino-2-piperidone, but low levels of ornithine, fatty acids (arachidonic acid and octadecanoic acid), and intermediates of the tricarboxylic acid cycle (malic acid and succinic acid).
Conclusions
Our study identified a specific metabolic profile related to glycolysis and the tricarboxylic acid cycle in MIDD that differs from healthy controls and other types of diabetes. This unique metabolic signature provides new perspectives for understanding the pathophysiology and underlying mechanisms of MIDD.
{"title":"Serum metabolomics signature of maternally inherited diabetes and deafness by gas chromatography–time of flight mass spectrometry","authors":"Baige Cao, Huijuan Lu, Peng Liu, Yinan Zhang, Congrong Wang","doi":"10.1111/jdi.14334","DOIUrl":"10.1111/jdi.14334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>The aim of this study was to identify a metabolic signature of MIDD as compared to healthy controls and other types of diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a comprehensive serum metabolomic analysis using gas chromatography-time of flight mass spectrometry (GC-TOFMS) in participants diagnosed with MIDD (<i>n</i> = 14), latent autoimmune diabetes in adults (LADA) (<i>n</i> = 14), type 2 diabetes mellitus (<i>n</i> = 14), and healthy controls (<i>n</i> = 14). Each group was matched for gender and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were significant metabolic differences among MIDD and other diabetic and control groups. Compared with control, MIDD patients had high levels of carbohydrates (glucose, galactose, mannose, sorbose, and maltose), fatty acids (2-Hydroxybutyric acid, eicosapentaenoic acid, and octadecanoic acid), and other metabolites (alanine, threonic acid, cholesterol, lactic acid, and gluconic acid), but low level of threonine. Compared with LADA, MIDD patients had high levels of threonic acid and some amino acids (alanine, tryptophan, histidine, proline, glutamine, and creatine) but low levels of serine. Compared with type 2 diabetes mellitus, MIDD patients had high levels of citrulline, creatine, 3-Amino-2-piperidone, but low levels of ornithine, fatty acids (arachidonic acid and octadecanoic acid), and intermediates of the tricarboxylic acid cycle (malic acid and succinic acid).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study identified a specific metabolic profile related to glycolysis and the tricarboxylic acid cycle in MIDD that differs from healthy controls and other types of diabetes. This unique metabolic signature provides new perspectives for understanding the pathophysiology and underlying mechanisms of MIDD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 1","pages":"146-153"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study evaluated the usability, satisfaction, and accuracy of a real-time continuous glucose monitoring (rt-CGM) in children and adolescents with type 1 diabetes (T1D) attending a summer camp.
Materials and Methods
Seven children and adolescents with T1D (camper) and 31 of healthcare providers (HCPs) participating in a 2-day summer camp in Kumamoto, Japan were enrolled. The usability and satisfaction were evaluated by tailored questionnaire. The accuracy of rt-CGM was evaluated using self-monitoring of blood glucose (BG) and sensor glucose (SG) values before or after (off camp) and during (on camp) the camp.
Results
The score of the usefulness of rt-CGM showed 3.29 ± 0.90 in campers and 4.23 ± 0.87 in HCPs (P = 0.017). The degree of recommendation score for rt-CGM was 3.29 ± 1.11 in campers and 4.23 ± 0.79 in HCPs (P = 0.013). Time in range (TIR) off camp was 45.9% and that on camp was 57.0%. Time above range (TAR) off camp was 53.4% and that on camp was 42.4%. The mean absolute relative difference (MARD) off camp was 19.7% ± 25.2%, whereas that on camp was 16.0% ± 14.8% (P = 0.367). Clinically acceptable zones of the error grid analyses were approximately 96% in total.
Conclusions
Rt-CGM exhibited higher usability and recommendation scores in HCPs than those in campers. This may be related to relatively lower accuracy in rt-CGM. Overall usability and recommendation are clinically satisfactory, but due to relatively low accuracy, no decision should be made based on a single, non-verified SG value alone.
{"title":"The benefits and accuracy of real-time continuous glucose monitoring in children and adolescents with type 1 diabetes attending a summer camp","authors":"Tatsuya Kondo, Takafumi Senokuchi, Jun Morinaga, Azusa Miyashita, Mayumi Yano, Haruo Takeda, Kenro Nishida, Naoto Kubota","doi":"10.1111/jdi.14337","DOIUrl":"10.1111/jdi.14337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>This study evaluated the usability, satisfaction, and accuracy of a real-time continuous glucose monitoring (rt-CGM) in children and adolescents with type 1 diabetes (T1D) attending a summer camp.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Seven children and adolescents with T1D (camper) and 31 of healthcare providers (HCPs) participating in a 2-day summer camp in Kumamoto, Japan were enrolled. The usability and satisfaction were evaluated by tailored questionnaire. The accuracy of rt-CGM was evaluated using self-monitoring of blood glucose (BG) and sensor glucose (SG) values before or after (off camp) and during (on camp) the camp.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The score of the usefulness of rt-CGM showed 3.29 ± 0.90 in campers and 4.23 ± 0.87 in HCPs (<i>P</i> = 0.017). The degree of recommendation score for rt-CGM was 3.29 ± 1.11 in campers and 4.23 ± 0.79 in HCPs (<i>P</i> = 0.013). Time in range (TIR) off camp was 45.9% and that on camp was 57.0%. Time above range (TAR) off camp was 53.4% and that on camp was 42.4%. The mean absolute relative difference (MARD) off camp was 19.7% ± 25.2%, whereas that on camp was 16.0% ± 14.8% (<i>P</i> = 0.367). Clinically acceptable zones of the error grid analyses were approximately 96% in total.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rt-CGM exhibited higher usability and recommendation scores in HCPs than those in campers. This may be related to relatively lower accuracy in rt-CGM. Overall usability and recommendation are clinically satisfactory, but due to relatively low accuracy, no decision should be made based on a single, non-verified SG value alone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 1","pages":"154-162"},"PeriodicalIF":3.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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