Acta Diabetologica最新文献

Aims: To qualitatively evaluate the experiences and emotional responses of elderly individuals with type 2 diabetes regarding the use of an interactive virtual assistant device.

Methods and results: This qualitative study included elderly individuals who were diagnosed with type 2 diabetes and who had been using the Smart Speaker EchoDot 3rd Gen (Amazon Echo^®) device for three months. A structured face-to-face interview with open-ended questions was conducted to evaluate their experiences and emotional responses associated with the device. Data analysis was performed using inductive thematic content analysis with deductive coding followed by narrative synthesis to present the overall perceptions of the participants. Thirty individuals with a mean diabetes duration of 17.1 ± 9.45 years and a mean age of 71.9 ± 5.1 years were interviewed to ensure saturation of responses. Three major themes were identified through response analysis: (1) Emotional response to user experience; (2) Humanization feelings in human-device interactions; (3) Diabetes-related self-care. Overall, participants experienced a wide range of feelings regarding the use of the interactive virtual assistant device, predominantly with positive connotations, highlighting aspects of humanization of technology and its use, and experiencing assistance in self-care related to diabetes.

Conclusion: Our results highlight the overwhelmingly positive emotional responses and strong sense of humanization expressed by elderly individuals with diabetes toward an interactive virtual assistant device. This underscores its potential to improve mental health and diabetes care, although further studies are warranted to fully explore its impact.

Background: Considering the impact of adipokines on metabolic syndrome-related disorders and even chronic illnesses, it would appear vital to look for efficient treatments for these variables. The goal of this study was to thoroughly examine how the ketogenic diet (KD) affects adipokines.

Methods: Using standard keywords, the databases Scopus, PubMed/Medline, Web of Science, Cochrane, and Embase were searched to find all controlled trials looking into how KD affected adipokines (leptin, adiponectin, and ghrelin). By using a random-effects model analysis, pooled weighted mean difference and 95% confidence intervals were obtained.

Results: This article featured twenty-two studies. The combined results demonstrated that, as compared to the control group, leptin levels in all populations are significantly lower when KD is adhered to (WMD: - 0.14 ng/ml, 95% CI: - 8.66, - 3.61, P < 0.001). On the other hand, no discernible impact of this diet on ghrelin and adiponectin concentrations was noted. The subgroup analysis results demonstrated that the drop in leptin levels was considerably higher in persons with BMI > 30 kg/m² and in trials that followed the KD for ≤ 8 weeks than in the other groups.

Conclusions: Generally speaking, this diet can be utilized as a potentially helpful supplementary therapy to improve this adipokine, given the significance that leptin plays on numerous metabolic illnesses.

Aim: To evaluate the impact of a proactive action of a specialized diabetes team (SDT) on different health outcomes in patients hospitalized in high complexity surgery units, including solid organ transplant surgical units, of a tertiary hospital.

Methods: Nested case control study matched (1:1) by age and gender. The control group consisted of patients (n = 120) who were under the standard of care diabetes management admitted three months' prior the cases. The cases were admitted in the same surgical units (n = 120) and were treated in the setting of the so called "Smart Diabetes Hospital" (SDH) consisting in a SDT that prioritized their actions through a digital map showing blood glucose levels obtained during the previous 24 h.

Results: SDH implementation resulted in a significant reduction in both blood glucose levels (mean 162.1 ± SD 44.4 vs. mean 145.5 ± SD 48.0; p = 0.008) and hypoglycaemic episodes (19.7% vs. 8.4%: p = 0.002). Furthermore, a reduction of 3 days in the length of stay (LOS) was observed (15.6 ± 10.3 vs. 12.4 ± 6.0), which represents a significant cost-saving. Moreover, more new cases of diabetes were detected during the SDT period (2.5% vs. 6.7%, p = 0.04).

Conclusion: SDH is effective in diabetes management and reduce LOS in complex surgical units.

Aims: To assess the effects of IDegLira on glucometric indices deriving from intermittently scanned Continuous Glucose Monitoring (isCGM) in patients with type 2 diabetes (T2D).

Methods: Retrospective, observational, cohort, multi-center, "pre - post" study. All adults consecutively identified in the medical records who started treatment with IDegLira, and for whom an isCGM report before and after the initiation of IDegLira was available were included in the study. Time in range (TIR) represented the primary endpoint. Additional glucometric indices, insulin doses and body weight were also assessed.

Results: Overall, 87 patients were included by 5 diabetes centers [mean age 70.2 ± 11.0 years, mean duration of T2D 15.5 ± 9.6 years; BMI 29.4 ± 5.4 kg/m², baseline HbA1c 9.1 ± 2.1%, 33% insulin naïve, 20.7% treated with basal-oral therapy (BOT), and 46% treated with multiple daily injections of insulin (MDI)]. After an average of 1.7 weeks from IDegLira initiation, TIR significantly increased from 56.8 ± 23.5% to 81.3 ± 13.5% (p < 0.0001), TAR decreased from 42.3 ± 24.2% to 17.1 ± 13.6% (p < 0.0001), while TBR remained steadily low (from 1.3 ± 2.3% to 1.4 ± 2.6%; p = 0.62). Estimated HbA1c decreased from 9.1 ± 2.1% to 6.7 ± 0.6% (p < 0.0001) and percentage of patients with a blood glucose coefficient of variation ≥ 36% dropped from 33.2 to 13.8% (p = 0.0005). In patients on MDI, the reduction in the total insulin dose was substantial (from 55.8 ± 31.2 IU to 27.2 ± 12.3 U).

Conclusions: In T2D patients with poor metabolic control, either insulin naïve or treated with BOT or MDI, the introduction of IDegLira produces a significant increase in the time spent in good metabolic control and a marked reduction in glycemic fluctuations.

Aims: Plasma levels of Vitamin D (25(OH)D) have been suggested as a predictor for developing type 2 diabetes. The purpose of this study was therefore to investigate if a measurement of plasma 25(OH)D could predict the development of type 2 diabetes in a cohort of 222,311 individuals from primary healthcare in Denmark.

Methods: The CopD-study database containing data from the Copenhagen General Practitioners Laboratory on blood tests conducted from April 2004 to January 2012 was used for identification of the study population. Incident type 2 diabetes was then defined as having at least two redeemed prescriptions of antidiabetics or at least two hospital contacts due to type 2 diabetes or one redeemed prescription and one hospital contact regarding type 2 diabetes.

Results: A total of 222,311 individuals were included in the study, of whom 7652 (3.4%) developed type 2 diabetes during the follow-up period of minimum one year. Individuals who developed type 2 diabetes had a significantly lower median 25(OH)D level than persons in the non-diabetes group. The hazard ratio for development of type 2 diabetes increased by 15% per 10 n mol/L decrease in 25(OH)D level.

Conclusion: In this study of 222,311 persons from primary health care in Denmark, we found a clear inverse relationship between 25(OH)D and the risk of developing type 2 diabetes. Further studies should be conducted to clarify the mechanisms behind the relationship between 25(OH)D and type 2 diabetes and the effect of oral vitamin D supplementation on the development of type 2 diabetes.

Maternally inherited diabetes and deafness (MIDD) is a mitochondrial disorder with diverse characteristics, which make early diagnosis difficult. We report a case of 32-year-old woman with diabetes who was admitted due to weight loss and poor glycemic control. She had a history of gestational diabetes at age 26. Pancreatic function was evaluated by oral glucose tolerance. An ophthalmologic examination detected conjunctivitis and refractive errors and hearing tests were normal. The patient had a family of diabetes. Then we tested the patient and her first-degree relatives with a confirmed genetic mutation at position 3243 in the tRNA. After two years of treatment with linagliptin, both glycated hemoglobin and pancreatic function have shown improvement to some extent. Although MIDD is a rare form of diabetes, due to distinctive management and associated comorbidities it is important to diagnose.

Aims: This study aimed to identify the longitudinal associations between protein intake, and composite renal outcomes in people with type 2 diabetes.

Methods: To examine the association between baseline total, animal, and plant protein intake and the risk of developing a composite renal outcome in 3,109 Japanese people with type 2 diabetes who participated in a cohort study at a tertiary care hospital, we used a Cox proportional hazards model.

Results: During a median follow-up of 6.0 years, we observed 185 renal outcomes. Compared with the 1st quintile, the multivariable-adjusted HRs for outcome were 1.13 (p = 0.440), 1.04 (pp= 0.874), 1.40 (p = 0.215), and 2.16 (p = 0.001), respectively for the 2nd to 5th quintile of total protein intake, and 0.93 (p = 0.681), 1.1 (p= 0.596), 1.1 (p = 0.607), and 2.02 (p < 0.001), respectively for the 2nd to 5th quintile of animal protein intake. However, a significant association of total plant intake was not observed. In the analysis evaluating the joint association between protein intake and composite renal outcome with baseline estimated glomerular filtration ratio (eGFR), total protein and animal protein intake were substantially associated with a higher risk of composite renal outcome when the baseline eGFR was below approximately 60 mL/min/1.73².

Conclusions: Baseline total protein intake is associated with a higher risk of developing a composite renal outcome during follow-up in people with type 2 diabetes and low baseline eGFR, and this association may be elucidated by a higher animal protein intake. Plant protein was not associated with renal outcome.