Diabetes epidemiology and management最新文献

Background

Diabetes and tobacco use are well-established risk factors for stroke. However, the intersection of prediabetes, tobacco use, and stroke among young individuals remains underexplored. This study aims to investigate the association between pre-diabetes and stroke risk in young tobacco users.

Methods

Using the National Inpatient Sample (2019) and relevant ICD-10 codes, we identified young patients with tobacco use disorder and pre-diabetes. Regression analysis considered risk factors (gender, demographics, income, comorbidities) to assess stroke odds.

Results

Among 1,017,540 stroke hospitalizations, 1.9 % were pre-diabetic. Pre-diabetics were often older (median age 36 vs. 31), male (59.4 %), Black (33.8 %), and Hispanic (12.2 %), with higher rates of comorbidities, including drug abuse, alcohol abuse, COPD, and CKD (p < 0.001). They also exhibited higher rates of stroke events (1.9 % vs. 0.5 %, p < 0.001). Multivariable analysis after adjusting for confounders, young metabolically healthy smokers with pre-diabetes had a higher risk of stroke (aOR 3.31, 95 % CI [1.67–6.55], p < 0.001).

Conclusion

Prediabetes could potentially triple stroke risk in young tobacco smokers. Prospective research is warranted to explore the causal association between pre-diabetes and stroke in the setting of tobacco use.

Background

There remains a paucity of research comparing the diagnostic and therapeutic outcomes between Magnetic Resonance Imaging (MRI) and x-ray modalities for Charcot neuro-osteoarthropathy CNO. This retrospective study investigates the use of offloading devices, duration of offloading and final footwear outcomes dependent on imaging at diagnosis.

Methods

Medical records from a secondary hospital high-risk foot clinic in Perth, Western Australia, were systematically reviewed. Data collected included baseline medical history, location of CNO, Eichenholtz stage or Chantelau and Grutznel grade at diagnosis, type and duration of offloading, and final footwear outcomes.

Results

Twenty-eight patients met the inclusion criteria. All had diabetes and peripheral neuropathy. All patients received either an MRI (43%) or x-ray (57%) to confirm the diagnosis of active CNO. Five (17.9%) patients who were diagnosed on MRI had grade 0 CNO whilst 23 (82.1%) patients who were diagnosed on x-ray had stage 1 CNO. No statistical significance was found between the type and duration of offloading, resolution of CNO, footwear and transtibial amputation (TTA) outcomes across those diagnosed with MRI or x-ray.

Conclusion

No statistical significance in patient outcomes was found between those diagnosed with grade 0 on MRI and those diagnosed with stage 1 on x-ray.

Aims

This study seeks to provide insights into the practical application and effects of oral semaglutide in Saudi T2DM patients under routine medical supervision.

Methods

The primary outcome measure was the laboratory HbA1c. Secondary measures included fasting blood glucose (FBG), weight, and hypoglycemia. All variables were checked after six months and 12 months of initiation.

Results

The analysis of this study included 245 uncontrolled (HbA1c > 7 %) T2DM patients. The mean baseline HbA1c was 10.1 % (1.2). HbA1c was reduced by an average of 3.1 % (0.8) and 3.2 % (0.8) at 6 and 12 months, respectively. The frequency of hypoglycemia events in the last three months before semaglutide was initiated was 4.4 (1.1). The frequency of hypoglycemia events in the last three months was 2.2 (0.8) and 0.7 (0.4) at 6-month and 12-month follow-up visits, respectively. The percent reduction in body mass index (BMI) was an average of 13.0 % (1.4) and 19.7 % (3.4) at six months and 12 months, respectively. Lipid profile and blood pressure were improved at six months and 12 months.

Conclusions

Oral semaglutide provided substantial glycemic and weight-loss benefits in adult individuals with T2DM.

Background

Insulin resistance (IR) and diabetes are common chronic conditions amongst elderly patients, that may lead to increase in abdominal adipose tissue deposits and pancreatic size.

Methods

A cross-sectional study was conducted in the geriatric OPD in a tertiary care hospital for a period of six months to correlate fasting C-peptide levels, abdominal adipose tissue thickness, and pancreatic size in poorly controlled diabetic elderly patients. Diabetic elderly patients with HBA1c level >7 % were enrolled with their consent. Body mass index (BMI), fasting C-peptide, abdominal adipose tissue thickness and pancreatic size were measured using standard laboratory techniques. The data obtained were assessed categorically and represented as [n (%)]. T-test was used to compare the two groups (p < 0.05).

Results

A total of 101 patients were enrolled. The study results showed no significant correlation between subcutaneous fat and pre-peritoneal fat thickness; and fasting c-peptide levels (p = 0.801, p = 0.316). However, there was a significant correlation between the fasting c-peptide levels and pancreatic size (p = 0.001). It was also observed the study participants had a decreased pancreatic size, with the mean size being 4.837 cm in males, and 4.4418 cm in females.

Conclusion

Intra-peritoneal fat thickness and pancreatic size can be used as surrogate marker for IR along with C-peptide. All elderly with uncontrolled type 2 diabetes mellitus behaving like type 1 diabetes mellitus needs further evaluation and pathogenic process must be explored. Sarcopenic obesity evaluation must be a part of uncontrolled type diabetes mellitus management.

The case emphasizes the risk of euglycemic diabetic ketoacidosis (DKA) after bariatric surgery and SGLT2 inhibitor use, highlighting the importance of patient education and healthcare provider monitoring. Potential causes include increased urinary glucose excretion from SGLT2 inhibitors, reduced carbohydrate intake post-surgery, and possible insulin discontinuation effects. The current recommendation from AACE to discontinue SGLT2 inhibitors 24 h before surgery may require additional research to determine the optimal timing of discontinuation.

Objective

Educational material on type 1 diabetes (T1D) is limited. An educational application named Sten-O Starter has been implemented for children and adolescents with T1D and their parents; however, its effect on glycemic management is unknown. The objective was therefore to examine the clinical impact of the Sten-O Starter on glycemic management among children and adolescents with T1D.

Methods

The levels of glycated hemoglobin (HbA1c) at 0–12 months after diagnosis were compared between two cohorts (the intervention received Sten-O Starter and the control received usual care). A mixed model of repeated measurements adjusted for age, sex, and HbA1c at diagnosis was used. A subgroup analysis of the cohorts was performed in which the time in range, time above range, and time below range (TBR) were compared at 6 months and 12 months after diagnosis using the Wilcoxon rank sum test.

Results

181 children and adolescents were included and all HbA1c measurements from the time of diagnosis to 12-month follow-up: No significant difference (p = 0.35) was found in HbA1c changes between the cohorts. However, the difference in median HbA1c at the 12-month follow-up between the intervention cohort and the control cohort (50 mmol/mol vs. 54 mmol/mol) was borderline significant (p = 0.059). A subgroup analysis of 30 children and adolescents revealed that TBR was significantly different (intervention: 1.2 % vs control: 2.6 %; p = 0.02) at 6 months and at 12 months (intervention: 1 % vs control; 2 %; p = 0.05).

Conclusion

The results indicate improved glycemic management among children and adolescents with T1D after use of the Sten-O Starter.

Background

Addressing mental health of diabetic pregnant women is important as it might increase the chance of obstetric complications, preterm birth, and neonatal complications.

Aim

The present study investigated the prevalence of anxiety and depression among pregnant women with diabetes and their predictors.

Methods

A cross-sectional study was conducted in 2023. The sample comprised 350 pregnant women with diabetes (pre-pregnancy or gestational) referred to comprehensive health centers in Qazvin Province, Iran. Fertility and demographic characteristics, anxiety, depression, partner social support, self-efficacy, medication adherence, and fear of hypoglycemia were assessed.

Results

Among the sample, 28.9 % had pre-pregnancy diabetes and 71.1 % had gestational diabetes. Anxiety and depression were reported by 74.9 % and 79.4 % of all participants (significantly higher among those with pre-existing diabetes compared to gestational diabetes). Self-efficacy (OR: 0.91 [95 % CI: 0.86; 0.96]) and spouse's social support (OR: 0.68 [95 % CI: 0.56; 0.82]) were significant predictors of abnormal anxiety. Fear of hypoglycemia (OR: 1.06 [95 % CI: 1.02; 1.09]), medication adherence (OR: 1.05 [95 % CI: 1.01; 1.09]), self-efficacy (OR: 0.86 [95 % CI: 0.82; 0.91]), partner social support (OR: 0.62 [95 % CI: 0.49; 0.78]), diabetes type (pregnancy vs. pre-pregnancy diabetes; OR: 0.26 [95 % CI: 0.09; 0.77]), perceived family economic status (fair vs. good; OR: 3.08 [95 % CI: 1.12; 8.49]), and diabetes treatment (insulin vs. diet; OR: 0.21 [95 % CI: 0.08; 0.55]) were significant predictors of abnormal depression.

Conclusion

Diabetic pregnant women should be evaluated for anxiety and depression during their prenatal visit. Improving self-efficacy, increasing medication adherence, reducing the fear of hypoglycemia, and improving the spouse's social support might all be helpful in reducing anxiety and depression among pregnant women with diabetes.

Introduction

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of cardiovascular (CV) complications in patients with type 2 diabetes (T2DM) and atherosclerotic cardiovascular disease (ASCVD) in placebo-controlled CV outcome trials, yet the use of these cardioprotective agents remains rather low in clinical practice.

Methods

Analysis of the proportion of T2DM patients treated with GLP-1RAs in retrospective observational studies by comparing patients with versus without established ASCVD.

Results

Nine cohorts from seven studies were collected in the international literature between 2019 and 2022. Overall, the percentages of patients treated with GLP-1RAs were low (< 10 %) in most studies, yet a progressive increase was noticed over time. The use of GLP-1RAs in patients with ASCVD was slightly lower in 7 out of 9 cohorts not higher when compared to the use in patients without ASCVD (odds ratio 0.80, 95 % CI 0.79–0.81).

Conclusion

Despite a positive trend over the last decade, the real-world use of GLP-1RAs remains limited, especially in patients with established ASCVD. Bridging the gap between clinical evidence of cardioprotective effects of GLP-1RAs and their underuse in clinical practice in T2DM patients at high/very high CV risk should be considered as a key objective for health care providers, especially cardiologists.

Aims

To compare obstetric and neonatal outcomes in patients with type 2 diabetes mellitus (T2DM) who had scheduled delivery at full term (≥ 39 0/7 weeks) compared to early term (37 0/7 – 38 6/7 weeks) for T2DM indications.

Methods

This was a retrospective cohort study that included all singletons with T2DM with a scheduled delivery at a single tertiary care center between January 2008 and March 2022. Outcomes were compared using Fisher's exact test.

Results

107 singleton pregnancies were included. There was no significant difference in primary cesarean delivery between the two groups. The early term group had significantly higher rates of NICU admission compared to the term group (52% vs 32%, p = 0.05, OR 2.3, 95% CI 1.0–5.0), a finding that remained statistically significant on adjusted analysis (adjusted OR 2.81, 95% CI 1.04–7.58).

Conclusions

In singleton pregnancies undergoing scheduled delivery for T2DM-specific indications, early term deliveries were associated with significantly increased odds of NICU admission when compared to term deliveries, even after adjusting for surrogate markers of glycemic control. These findings suggest that early term delivery contributes to risk of NICU admission, rather than the indication for delivery itself. These findings should be replicated in a larger cohort.