Diabetes epidemiology and management最新文献

Observational studies based on cohorts built from electronic health records (EHR) form the backbone of our current understanding of the risk of new-onset diabetes following COVID. EHR-based research is a powerful tool for medical research but is subject to multiple sources of bias. In this viewpoint, we define key sources of bias that threaten the validity of EHR-based research on this topic (namely misclassification, selection, surveillance, immortal time, and confounding biases), describe their implications, and suggest best practices to avoid them in the context of COVID-diabetes research.

Aims

To describe the incidence of type 1 diabetes (T1D), and incidence of comorbidities in addition to T1D, in adults over a 22-year period in Denmark and explore the associations between socioeconomic status (SES) and the development of comorbidities.

Methods

We conducted a retrospective cohort study on nationwide registry data to describe incidences of T1D and comorbidities in adults (≥21 years) from 1996 to 2018. People were followed from T1D diagnosis until a first event of interest, death, or end of follow-up, whichever came first. Cox proportional hazards models were used to quantify the associations between SES and development of comorbidities.

Results

We included 7877 adults with T1D. Overall, the incidence of T1D decreased (411 in 1996 to 191 in 2018) while it increased for comorbidities in addition to T1D (< 3 to 38 and 10 to 53). Low education and income, compared to higher counterparts, increased the risks of comorbidity by 55 % (HR 1.55, 95 % CI 1.36–1.77) and 82 % (HR 1.82, 95 % CI 1.60–2.06), respectively.

Conclusions

Low SES increases the risk of comorbidities in adults with T1D. This indicates that SES is an important factor to consider when aiming to prevent or predict development of comorbidities in adults with T1D.

Introduction

Successful diabetes management is associated with an effective partnership between People with Diabetes (PwD) and healthcare professionals. Though possible to measure using Patient-Reported Experience Measures (PREMs), none are specific to Type 1 or Type 2 Diabetes (T1D/T2D) and validated in French. Thus, we developed and validated the DREMS (Diabetes Reported Experience MeasureS) e-questionnaire.

Methodology

DREMS is comprised of 18 items evaluating 5 different factors. Validation for use by PwT1D and PwT2D (recruited online) was performed using: Exploratory Factor Analysis (EFA); Confirmatory Factor Analysis (CFA) and Cronbach's Alpha. Test-retest reliability was evaluated through Intraclass Correlation Coefficients (ICC) in a subsample.

Results

DREMS was tested by 2,513 respondents, including 942 PwT1D and 1,571 PwT2D. For both groups, EFA results indicated 18 items loaded substantially onto 5 clear factors. CFA showed all coefficients were significant in their respective factors. Goodness-of-fit, assessed using the Comparative Fit Index was >0.90 and by the RMSEA was <0.080. Cronbach's α for the entire DREMS e-questionnaire was ≥0.90. ICC was 0.87 for PwT1D (n = 136) and 0.74 for PwT2D (n = 169).

Innovation

DREMS is the first validated French-language diabetes-specific PREM for both PwT1D and PwT2D and can be useful to evaluate and improve health care management and patient health.

Atherosclerotic cardiovascular disease (ASCVD), heart failure (HF) and chronic kidney disease (CKD) are major complications of type 2 diabetes (T2DM). The objectives of preventing these complications are not fully reached in clinical practice. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have proven their efficacy in reducing major cardiovascular events, diminishing hospitalization for HF and limiting the progression of CKD to end-stage kidney disease in placebo-controlled randomised trials in high-risk patients with T2DM. These evidence-based benefits were confirmed in real-life cohort studies worldwide compared with other glucose-lowering agents. However, real-world data showed that only a minority of eligible patients with T2DM received an SGLT2i, yet encouraging increase was observed in recent years. Surprisingly, in several studies less patients with comorbidities (especially CKD) were treated with SGLT2is compared with T2DM patients without these complications. Bridging the gap between evidence-based cardiorenal protection with SGLT2is and their underuse in daily clinical practice in patients with T2DM at high risk is crucial from a public health viewpoint. Multifaceted and coordinated interventions involving all actors should be implemented to incite the adoption of SGLT2is as part of routine cardiovascular and renal care among patients with T2DM at high risk for these comorbidities.

Aims

literature outlining the impact of diabetes on the inner ear environment and the exact etiology of diabetes-induced hearing malfunctioning is scarce.

Methods

The Scopus, Pubmed and google scholar databases were used to source relevant epidemiological, clinical, biomedical, histopathological, otolaryngological and pharmacological articles published between 1960 and 2020 using keywords ‘diabetes, hearing loss, inner ear, cellular, cochlea, microangiopathy, neuropathy’. AG and CD preidentified and reviewed selected articles to structure and construct the manuscripts based on relevant inclusion criteria of epidemiological, animal histopathological as well as human temporal bone findings in diabetes setting.

Results

several histopathological findings in different animal models of diabetes have highlighted the existence of various abnormalities in their ears, compared with healthy control animals. The prevalence of such associations on the other hand has recently been observed in numerous epidemiological studies across various populations. A plethora of events associated with diabetes and dysglycaemia are linked to biochemical alterations, impaired physiological homeostasis, perturbed blood rheological characteristics and architectural disturbances in the vestibulocochlear system. While various hypotheses have been put forward to explain such associations, microvascular impairment of the inner ear vasculature as well as neuropathic involvement constitute two major ones to date.

Conclusions

this review highlights associations between diabetes as a serious endocrinological manifestation and hearing impairment (an overlooked sequalae of diabetes), discusses fundamental etiologies (microangiopathy and neuropathy) of hearing dysfunction in patients with diabetes and sheds light on the otological and audiological impacts of diabetes on the inner ear environment.

Objective

To estimate diabetic retinopathy (DR) prevalence in primary care scenarios in Mexico.

Materials and methods

We evaluated adult patients with type 2 diabetes with conventional care in primary care units. A mydriatic fundus examination was performed by an ophthalmologist with retinal photographs.

Results

Implementing a strategy for screening diabetic retinopathy in primary care settings in patients with type 2 diabetes in Mexico reported a prevalence of 33.6 %, comprising non-sight-threatening retinopathy at 24.2 %, and sight-threatening retinopathy at 9.4 %. The number needed to screen to detect DR obtained in the screened population was 3.

Conclusions

Our study reveals the need for DR screening strategies for its timely detection in primary care scenarios.

Background

Both abdominal obesity and diabetes are two major public health problems in India. This study aimed to find out the association between abdominal obesity and diabetes in Indian adult population using nationally representative National Family Health Survey 2019–21 data.

Methods

Diabetes was defined as having a raised blood glucose level or seeking treatment for diabetes. Abdominal obesity was defined as a waist-hip ratio of >0.90 for males and >0.85 for females. After adjusting for covariates (including body mass index), multivariable logistic regression was carried out to identify the association between abdominal obesity and diabetes.

Findings

In total, 687,607 samples were included. The prevalence of diabetes was 8.65% and 7.39% among male and female participants, respectively. The prevalence of abdominal obesity was 51.77% and 57.91% among male and female, respectively. In both gender, abdominal obesity was associated with diabetes. Among the male and female, the odds of having diabetes 27% (AOR:1.27; 95% CI: 1.13–1.42) and 5% (AOR: 1.05; 95% CI: 1.00–1.11) higher among those who had abdominal obesity than those who did not have abdominal obesity. A significant interaction was observed between abdominal obesity and high body mass index (overweight and obesity) regarding the odds of diabetes.

Conclusion

Abdominal obesity was significantly associated with diabetes in Indian population. The high burden of abdominal obesity should be addressed to prevent diabetes.

Purpose

The aim of this meta-analysis is to evaluate the role of Imeglimin in glycemic control (HbA1c & FPG), Homeostatic Model Assessment of β-cell function, pro-insulin to c-peptide ratio and its safety outcomes in patients with type 2 diabetes mellitus.

Methods

A thorough literature search was performed on PubMed Central, PubMed, Cochrane, Wiley online library databases and efficacy outcomes such as changes in HbA1c, FPG, pro-insulin to c-peptide ratio and HOMA- β were summarized as standardized mean difference and safety outcomes were summarized as odds ratio. (PROSPERO registration no. CRD42023422787).

Results

Seven randomized controlled trials conducted on 1,454 patients with type 2 diabetes mellitus were included. Overall the random effects model meta-analysis of standardized mean difference demonstrated that Imeglimin was significantly associated with HbA1c reduction of -0.85% (95% CI -1.08 to -0.62, p<0.00001) with heterogeneity (i² = 70%, p = 0.002), fasting plasma glucose (FPG) reduction of -0.64 mmol/L (95% CI -0.81 to -0.47, p<0.00001) with non-significant low heterogeneity (i² = 35%, p = 0.16) and significantly improved HOMA-β function by 0.46 (95% CI 0.25 to 0.67, p<0.0001) compared to control groups with non-significant heterogeneity (i² = 4%, p = 0.31). Further, the overall analysis of gastrointestinal (GI) adverse events demonstrated that Imeglimin was significantly associated with GI events (OR, 1.83; 95% CI, 1.19 to 2.82; p = 0.006) with no heterogeneity (i² = 0%, p = 0.80).

Conclusion

Our results demonstrated that Imeglimin is significantly associated with the glycemic control (reduction of HbA1c by -0.85% & FPG by -0.64 mmol/L), improved beta cell function (HOMA-β by 0.46) and associated with GI adverse events by 1.83 fold increased odds as compared to controls.

Purpose

Alterations in retinal structure and function have been well documented in type 2 diabetes (T2DM). However, few studies have evaluated the eye in prediabetes (preDM), a precursor to T2DM. It is unknown which retinal deficits, if any, occur before T2DM diagnosis. This study evaluates retinal structure via optical coherence tomography (OCT) and retinal function via multifocal electroretinogram (mfERG) N1 and P1 in those with PreDM. The goal is to evaluate associations between structure and function across glucose dysfunction.

Methods

85 subjects (aged 28–69yrs) were tested with VERIS mfERG and Heidelberg Spectralis OCT. Demographic and health information was collected. Subjects were grouped by HbA1c: 33 controls (HbA1c <5.7%), 31 with preDM (HbA1c 5.7–6.4%), and 21 with T2DM (HbA1c >6.4% at the time of testing or diagnosed by physician) and mild or no retinopathy. mfERG N1 and P1 latency and amplitude were measured for the right eye in the foveal hexagon (central 2.4°). Average macular thickness was also measured over the central 3.3°. Groups were compared with ANOVA and corrected t-tests. Models of these associations with diabetes diagnosis (in groups above) were created with backward multivariate regression.

Results

The T2DM group was exceptionally well-controlled with an HbA1c of 7.0% ± 0.68 but also had elevated systolic blood pressure compared to other groups (P<0.01). The age of the control group was younger (P<0.01), so other testing was age controlled. There was a borderline but statistically significant difference in P1 between the control group and both the preDM and T2DM groups after Bonferroni corrections (P<0.03). There was also a difference in N1 latency between the control and other groups (P<0.001). A multivariate model demonstrated a significant relationship between T2DM/PreDM diagnosis and delayed N1 latency, reduced foveal thickness, and age.

Conclusions

Structure and function together can provide an associative model of preDM or T2DM changes for patients. Based on this multivariate model, N1 is strongly associated with preDM and T2DM. N1 findings and decreasing foveal thickness are additive and can together inform ocular health related to preDM. Future longitudinal studies are needed to understand changes in function and structure in preDM and T2DM.