Diabetes epidemiology and management最新文献

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.

Aims

Machine learning (ML) approaches are beneficial when automatic identification of relevant features among numerous candidates is desired. We investigated the predictive ability of several ML models for new onset of diabetes mellitus.

Methods

In 10,248 subjects who received annual health examinations, 58 candidates including fatty liver index (FLI), which is calculated by using waist circumference, body mass index and levels of triglycerides and γ-glutamyl transferase, were used.

Results

During a 10-year follow-up period (mean period: 6.9 years), 322 subjects (6.5 %) in the training group (70 %, n=7,173) and 127 subjects (6.2 %) in the test group (30 %, n=3,075) had new onset of diabetes mellitus. Hemoglobin A1c, fasting glucose and FLI were identified as the top 3 predictors by random forest feature selection with 10-fold cross-validation. When hemoglobin A1c and FLI were used as the selected features, C-statistics analogous in receiver operating characteristic curve analysis in ML models including logistic regression, naïve Bayes, extreme gradient boosting and artificial neural network were 0.874, 0.869, 0.856 and 0.869, respectively. There was no significant difference in the discriminatory capacity among the ML models.

Conclusions

ML models incorporating hemoglobin A1c and FLI provide an accurate and straightforward approach for predicting the development of diabetes mellitus.

Aims

This study reports the implementation of a diabetic retinopathy (DR) screening program in Aracaju, Brazil, emphasizing the challenges and premature termination.

Methods

The program, a collaboration between local health authorities, national DR screening experts, private clinics, trained retinal imaging technicians, a portable retinal camera with artificial intelligence (AI), telemedicine, and AI-assisted image analysis, was established. Screening occurred at primary care centers, with free specialized treatment for high-risk DR cases.

Results

After a public tender, two clinics were selected for screening, and four for secondary management. Initially, diabetic patient attendance at primary care clinics varied considerably, posing a challenge. Nonetheless, the screening continued, with 3,561 patients screened within six months. However, due to complaints and disputes between providers and authorities, the program was prematurely terminated, achieving less than a quarter of the initial screening target.

Conclusions

The DR screening program faced significant challenges, including low adherence and organizational issues at primary care centers. This experience highlights the need to standardize clinical workflows, enhance organization and integration among primary care units, and address cultural factors to improve adherence rates. These insights are valuable for implementing screening programs, particularly in low- and middle-income countries.

Aims

The objective was to compare anxiety, depression, and quality of life (QoL) in individuals living with type 1 (T1D) and type 2 (T2D) diabetes with matched controls during the second wave of the COVID-19 pandemic.

Methods

Via randomization, individuals living with diabetes T1D (n = 203) and T2D (n = 413), were identified during February-July 2021 through health-care registers. Population controls (n = 282) were matched for age, gender, and residential area. Questionnaires included self-assessment of anxiety, depression, QoL, and demographics in relation to SARS-CoV-2 exposure. Blood was collected through home-capillary sampling, and SARS-CoV-2 Nucleocapsid (NCP) and Spike antibodies (SC2_S1) were determined by multiplex Antibody Detection by Agglutination-PCR (ADAP) assays.

Results

Younger age and health issues were related to anxiety, depression, and QoL, with no differences between the study groups. Female gender was associated with anxiety, while obesity was associated with lower QoL. The SARS‑CoV‑2 NCP seroprevalence was higher in T1D (8.9 %) compared to T2D (3.9 %) and controls (4.0 %), while the SARS‑CoV‑2 SC2_S1 seroprevalence was higher for controls (25.5 %) compared to T1D (16.8 %) and T2D (14.0 %).

Conclusions

A higher SARS‑CoV‑2 infection rate in T1D may be explained by younger age and higher employment rate, and the associated increased risk for viral exposure.

Background

Diabetes-related lower extremity complications contribute significantly to the overall disability burden of type 2 diabetes (T2D). The screening of Diabetic Foot Ulcer (DFU) risk is essential for the early identification of its components, thereby preventing the progression to advanced complications. Unfortunately, identifying elements associated with foot ulcer development is often poorly executed, especially in primary care settings, particularly in low-middle-income countries. We assess the prevalence of DFU risk and its components while exploring sociodemographic, clinical, and behavioral characteristics linked to DFU risk in patients with T2D.

Methods

This cross-sectional study examined the characteristics of the feet of subjects involved in an initiative to enhance the quality of diabetes care in primary healthcare settings. The assessment included the presence of foot deformities, peripheral neuropathy through Loss of Protective Sensation (LOPS) evaluation, peripheral arterial disease (PAD), and a history of foot ulcer or lower extremity amputations. Participants were classified according to the IWGDF Risk Classification and subsequently divided into two groups for analysis: those at high risk for DFU (Groups 1, 2, or 3) and those at low risk for DFU (Group 0). Logistic regression was employed to identify the factors associated with DFU risk and its components.

Results

Among the 1361 patients evaluated, 63.8 % were found to be at an increased risk for DFU. The reported prevalence of foot deformities, LOPS, PAD, and a history of foot ulcer was 91.9 %, 44.3 %, 36.5 %, and 4.5 %, respectively. In the adjusted analysis, factors significantly associated with DFU risk included male gender (OR =2.01; 95 % IC 1.54–2.61), secondary education or less (OR =1.65, 95 % IC 1.27–2.14), diabetes duration exceeding 10 years (OR = 1.75, 95 % IC 1.34–2.30), chronic kidney disease (OR =1.44, 95 % IC 1.11 – 1.88), diabetic retinopathy (OR =1.93, 95 % IC 1.42–2.62), onychomycosis (OR =1.46, 95 % IC 1.14–1.88) properly cut toenails (OR =0.60, 95 % IC 0.45–0.79), and sedentary behavior (OR =1.56, 95 % IC 1.14–2.14).

Conclusions

Risk assessment of DFU within a comprehensive care program for adults with T2D receiving conventional primary care showed that a substantial proportion of these patients are at an increased risk and, thus, qualify as candidates for interventions aimed at mitigating foot-related risks. We recommend that diabetes healthcare schemes incorporate preventive organizational interventions to facilitate the timely identification of DFU risk, particularly in primary care scenarios, thereby alleviating the burden of diabetes-related lower limb complications.