Acta Diabetologica最新文献

Aims: Given the notable rise in the prevalence of metabolic syndrome (MS) in China, it is urgent to identify early screening indicators. Extensive dose-response meta-analyses have been conducted to investigate the association between resting heart rate (RHR) and MS, and additional relevant studies have been updated in the last five years. Therefore, this paper aims to update the results of previous meta-analyses.

Data synthesis: PubMed, Cochrane Library, Web of Science, and Embase databases were searched from the inception to 25th May 2023. Additional relevant references were manually screened. Quality assessment was performed independently by authors using the Newcastle-Ottawa Scale. Stata 15.0 software was applied for data analysis. A random-effects model was adopted to pool the effect size of hazard ratio (HR) and 95% confidence interval (CI). A restricted cubic spline function was utilized to assess dose-response relationships. The protocol was prospectively registered in PROSPERO (number CRD42023458979). 35 studies from 21 reports were included, with 433,365 adults and 84,354 events of MS and/or diabetes mellitus. The highest RHR tertile was positively associated with the risk of MS [HR = 1.80, 95% CI (1.60, 2.04)]. Dose-response analysis suggested a non-linear correlation between RHR and MS, with a 3.5% increase in risk per unit increase in RHR, at a RHR of 42.5.

Conclusions: Both high RHR and its increasing rate are significantly associated with the risk of MS. Therefore, RHR might be a non-invasive and convenient community-based screening tool for the management and monitoring of MS.

Aims: Diabetic retinopathy (DR) is a major complication of diabetes that leads to vision impairment. The aim of this study was to investigate the regulatory role of miR-509-3p in DR, focusing on its interaction with SLC25A13 and its impact on retinal endothelial cell function, oxidative stress, apoptosis, and ferroptosis.

Methods: HRVECs were cultured in high-glucose (HG) conditions to establish an in vitro DR model. miR-509-3p mimics and inhibitors were transfected into HRVECs to assess their effects on SLC25A13 expression, cell viability, apoptosis, reactive oxygen species (ROS) levels, and ferroptosis markers. A luciferase reporter assay and RNA immunoprecipitation were used to confirm the binding of miR-509-3p to SLC25A13 mRNA. For in vivo validation, agomiR-509-3p was injected into the vitreous of DR mice, and retinal thickness, pathological damage, and apoptosis were evaluated. Ferroptosis-related markers (GPX4, TlR4, ASCL4) were analyzed in HRVECs to explore the mechanism of miR-509-3p in regulating ferroptosis.

Results: In vitro, miR-509-3p significantly decreased SLC25A13 expression, resulting in enhanced HRVEC viability, reduced apoptosis, and lower ROS levels under HG conditions. Overexpression of SLC25A13 reversed these protective effects, while miR-509-3p knockdown exacerbated oxidative stress and apoptosis. In vivo, agomiR-509-3p increased retinal thickness, reduced pathological damage, and decreased apoptosis in DR mice. Ferroptosis marker analysis revealed that miR-509-3p upregulated GPX4 expression and downregulated TlR4 and ASCL4, whereas SLC25A13 overexpression reversed these effects, further linking miR-509-3p to the regulation of ferroptosis.

Conclusions: miR-509-3p exerts a protective effect in DR by targeting SLC25A13, reducing oxidative stress, apoptosis, and ferroptosis in retinal endothelial cells. These findings highlight the potential of miR-509-3p as a therapeutic target for DR management.

Aims: Diabetic autonomic neuropathy is a severe complication of diabetes, estimated to affect up to 44% in type 1 diabetes (T1D) and 73% in type 2 diabetes (T2D) based on clinical studies. Currently, the assessment of diabetic autonomic neuropathy is not implemented in Denmark's clinical guidelines, complicating the estimation of the true prevalence. Thus, this study investigated the prevalence of self-reported symptoms of autonomic dysfunction in people living with diabetes in the North Denmark Region using the Composite Autonomic Symptoms Score (COMPASS)-31 questionnaire.

Methods: In 2022, all adults with T1D or T2D in the North Denmark Region (n = 29,155) were identified using The National Health Insurance Service Registry and invited to an online survey including the Danish version of COMPASS-31. The prevalence and associated 95% confidence intervals (CI) for symptomatic autonomic dysfunction were determined using a cut-off value of 16.

Results: In total, 7,377 completed COMPASS-31, of which 82.4% reported having T2D and 13.7% T1D. The prevalence of symptomatic autonomic dysfunction was 36.8% (95% CI: 34-40) after a median of 26 years with diabetes for T1D and 44.2% (95% CI: 43-45) after a median of 10 years for T2D. Pupillary and orthostatic intolerance were the most frequent moderate to severe symptoms, respectively (38.4% and 24.0% in T1D and 32.8% and 26.3% in T2D).

Conclusion: Symptoms of autonomic dysfunction are very common in individuals with diabetes living in the North Denmark Region, emphasizing the unmet need for regular testing to increase awareness and allow for adequate management, ultimately reducing the morbidity of diabetes.

Background: Osteomyelitis (OM) associated with diabetic foot ulceration (DFU) is a growing public health challenge worldwide. Since 2012 the number of patients presenting with DFU per year to our centre has doubled.

Objective: This study aims to evaluate outcomes from outpatient antibiotic therapy (OPAT) in the management of OM in DFU patients.

Methods: A retrospective analysis was performed of medical notes, radiology, and vascular laboratory reports for all DFU patients with OM treated from April 2016 to April 2020. Variables analyzed included age, gender, site of OM, WIfI Score (Wound Ischaemia and foot Infection Score), probe-to-bone test (PTB), imaging (X-ray/magnetic resonance imaging (MRI), co-morbidities (peripheral arterial disease (PAD), chronic kidney disease (CKD), hypertension (HTN), smoking, ischemic heart disease (IHD), and dyslipidaemia. Outcomes evaluated were healing, recurrent DFU, and freedom from amputation at 12 months.

Results: 185 patients were admitted with 264 infected digits (Male 223; Female 41). The mean age was 66 years. Only 168 (63.6%) were fully healed at 12 months. Of the 96 patients who failed to heal, 43 underwent a repeat course of prolonged antibiotics without improvement. Factors associated with treatment failure were PAD, poorly controlled HbA1c and Deep or Extensive Ulcer or Gangrene.

Conclusion: Extended outpatient antibiotic therapy (with an inpatient multidisciplinary approach) is an effective treatment for digital OM in DFU with a success rate of 63%. In recurrence, repeating prolonged antibiotics is unlikely to achieve healing. PAD, poorly controlled HbA1c and Deep or Extensive Ulcer or Gangrene are predictors of treatment failure.

Aims: Diabetic retinopathy (DR) is a severe complication of diabetes mellitus (DM), and it is challenging to diagnose DR at an early stage by conventional methods. The aim of the present work is to propose an innovative approach to monitor the process of DR from scratch.

Methods: The plasma metabolites changed with DM were obtained by time-dependent metabolomics and lipidomics; the change of retinal function was measured by b-wave amplitude and total Ops-wave amplitude in electroretinography (ERG). Multivariate statistical analysis, logistic regression and correlation analysis were employed to identify metabolic markers from metabolites for the monitoring of DR and investigate the relationship between metabolic markers and retinal function.

Results: The metabolic markers LPE18:0, LPC15:0, SM d14:2/26:0, SM d12:0/28:2 and MG 21:0 associated with DR can be utilized as metabolic markers to monitor the process of DR; The decrease in myo-inositol and LPC22:5 and increase in xylonic acid and TAG10:0/16:0/18:1 indicated retinal dysfunction.

Conclusions: The levels of metabolic markers can be used as an indicator of the onset of DR or as a means of monitoring changes in retinal function.

Aim: Type 2 diabetes (T2DM) manifests as pancreatic disorder as a consequence of low-grade systemic inflammation, attributed to upregulated levels of interleukin-6 (IL-6). This in turn is associated with a reduced incretin effect with lower circulatory GLP-1 levels. Therefore, its important to monitor the circulating IL-6 and GLP-1 levels for better management and outcomes in T2DM patients.

Methods: Limited studies being available in literature on circulating concentrations of GLP-1 and IL-6 in T2DM patients, a meta-analysis was conducted by identifying 1558 studies from 3 databases. As per inclusion and exclusion criteria, the studies were screened for the 2-markers.Forest plots were drawn for standardized mean differences and median values were deduced from the datasets. In parallel, analysis was conducted to ascertain the expression levels of the markers by ELISA (n = 52 T2DM patients) in real time.

Results: The meta-analysis showed a significant (p < 0.01) standardized mean difference of 3.82 and 1.04 for IL-6 and GLP-1 respectively. The median values obtained from analysis for IL-6 were 26.50 pg/ml which were higher than the controls downregulated levels of GLP-1(8.77 pg/ml) were noted. The above findings are corroborated by the results of our experimental analysis with IL-6 concentrations at 11.603pg/ml and GLP-1 at 13.05pg/ml.

Conclusion: The study highlights that systemic concentrations of IL-6 and GLP-1 correspond to a persistent low-grade inflammation and decreased incretin effect in T2DM patients which manifest as pancreatic β-cell dysfunction. The expression of the markers is inversely correlated and monitoring their levels is clinically important for targeting them through their potential antagonists thus reducing the risk of complications, thereby improving the quality of life of the patients.

Introduction: The MiniMed™ 780G system is an advanced insulin pump system incorporating an AHCL (Advanced Hybrid Close Loop) algorithm that automatically adjusts insulin delivery based on glucose levels. All guidelines recommend the use of Automated Insulin Delivery therapy for people with type 1 diabetes (PWT1D) and they highlight that a specifically trained and expert team should provide training on HCL systems for PWT1D, but none of the publications detail the curriculum profile that diabetes educators should have. This paper aims to establish a consensus on the optimal educational pathway for diabetes educators on the MiniMed™ 780G system.

Methods: An Expert Panel (EP) of 11 key opinion educators in diabetes technology in the EMEA area was assembled. Using the Delphi method, a consensus questionnaire based on the literature research was created, discussed and validated by the EP members. An agreement level of ≥ 75% was considered a strong consensus.

Results: EP members had on average 16.3 years of clinical experience and followed at least 50 PWT1D using the MiniMed™ 780G system. All EP members agreed that a structured educational pathway to train diabetes educators in the use of the MiniMed™ 780G system is needed. 100% of the EP members agreed that the pathway should include a mentorship programme and in-field training; 90% agreed on using face-to-face training with the support of e-learning modules. The EP members believed that minimum competency standards for diabetes educators around the principles of diabetes care and education are needed.

Conclusion: The educational pathway created by the EP showed that skills are needed at an advanced level and that mentorship in developing these skills is critical. This pathway is vital for supporting the implementation of diabetes technology into everyday life and can remove barriers and increase access to PWT1D.

Background: The interaction and combined effect of the triglyceride-glucose (TyG) index, an alternative parameter of insulin resistance, along with hypertension (HT), on the risk of peripheral arterial disease (PAD), a specific type of atherosclerotic cardiovascular disease, in individuals with type 2 diabetes (T2D) seems straightforward. However, specific research on this topic remains scarce.

Methods: In this cross-sectional study, 2027 adult participants with T2D were devided into four groups based on the mean values of TyG index and various blood pressure parameters along with its category. Binary logistic regression, interaction analysis, combined effect size, and goodness-of-fit of the constructed models were performed.

Results: The TyG index's individual effect and it's combined effect with HT, or higher systolic blood pressure (SBP) or higher mean arterial pressure in patients with T2D correlated with a higher PAD risk respectively (odds ratio [OR], 0.50, [95% confidence interval {CI} 0.28-0.89]; OR, 0.32, [95% CI 0.12-0.90]; OR, 0.35, [95% CI 0.13-0.94]; OR, 0.35, [95% CI 0.12-0.98], respectively). Only an interaction effect exists between the TyG index and SBP (multiplicative interaction{INT_M}: 1.02 [1.002, 1.038]). Combining them can significantly improve the accuracy of predicting PAD (area under the receiver operating characteristic curve {AUC}_MAX = 0.7, AUC_{Model3 + TyG index + SBP}-AUC_Model3 = 0.027). All P values were < 0.05.

Conclusion: This study suggested that TyG index and hypertension, as well as their combined and interaction effect were significantly correlated with the risk of PAD in T2D individuals.

Purpose: To evaluate different quantitative non-invasive retinal biomarkers of microvascular impairment and neurodegeneration in patients affected by mild and moderate non proliferative diabetic retinopathy (NPDR) with or without macular microaneurysms (MAs).

Methods: A cross-sectional case-control study. Ninety-seven eyes with NPDR, 49 with no central MAs and 48 with central MAs, underwent color fundus photography and optical coherence tomography (OCT)/OCT-angiography (OCT-A). Thickness of central macula, retinal nerve fiber layer (NFL), ganglion cell layer (GCL+) and NFL + GCL + was evaluated on OCT. FAZ metrics (ImageJ), perfusion and vessel density (PD/VD), and fractal dimension (FD) (MATLAB) were evaluated on 3 × 3 OCT-A slabs of both superficial and deep capillary plexuses (SCP/DCP). All evaluations were performed on the full image and after subdivision in 4 quadrants.

Results: In the MA group, 77 MAs were detected (45.5% in the DCP). The MA group showed: increased FAZ area and perimeter in the SCP (p < 0.01) and DCP (p = 0.02), and reduced circularity index in the SCP (p = 0.03); reduced VD in the SCP (p < 0.01) and reduced PD, VD (p < 0.01) and FD (p = 0.02) in the DCP; decreased VD and FD in the SCP (p = 0.02 and p = 0.05), and in VD and FD in the DCP in the inferior quadrant (p = 0.04 and p = 0.03); a decrease in VD in the SCP in the nasal quadrant (p = 0.05). No differences have been detected in OCT parameters.

Conclusions: Our results suggest that the presence of central MAs in patients with NPDR may correlate with more pronounced macular microvascular impairment, particularly during the mild and moderate stages of the disease.