Diabetes epidemiology and management最新文献

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.

Objective

To estimate rates of severe hypoglycemia and falls among older adults with diabetes and evaluate their association.

Research Design and Methods

Survey in an age-stratified, random sample adults with diabetes age 65–100 years; respondents were asked about severe hypoglycemia (requiring assistance) and falls in the past 12 months. Prevalence ratios (adjusted for age, sex, race/ethnicity) estimated the increased risk of falls associated with severe hypoglycemia.

Results

Among 2,158 survey respondents, 79 (3.7%) reported severe hypoglycemia, of whom 68 (86.1%) had no ED visit or hospitalization for hypoglycemia. Falls were reported by 847 (39.2%), of whom 745 (88.0%) had no fall documented in outpatient or inpatient records. Severe hypoglycemia was associated with a 70% greater prevalence of falls (adjusted prevalence ratio = 1.7 (95% CI, 1.3–2.2)).

Conclusion

While clinical documentation of events likely reflects severity or care-seeking behavior, severe hypoglycemia and falls are common, under-reported life-threatening events.

Diabetes mellitus is a chronic metabolic condition marked by persistent hyperglycemia. It is a major issue of public health with wide-ranging effects. Telomeres are protective caps at chromosome ends, essential for preserving genomic stability and cellular integrity. Research highlights the complex link between diabetes and telomere biology and the potential interactions between the two. This review aims to present a summary of the relationship between diabetes and telomeres, highlighting significant discoveries and probable underlying mechanisms. Telomere shortening in those with diabetes and those at risk of getting the condition provides evidence that telomere dysfunction is linked to diabetes. It is said that telomere attrition, which is influenced by elements such as oxidative stress, inflammation, insulin resistance, and hyperglycemia, plays a major role in the pathophysiology of diabetes. Diabetes Mellitus's hallmark symptoms are chronic inflammation and oxidative stress, accelerating telomere shortening via pro-inflammatory cytokines production and reactive oxygen species, respectively. Telomere dysfunction is enhanced further by the long-term effects of insulin resistance and hyperglycemia. The onset of diabetic comorbidities such as cardiovascular disease, nephropathy, retinopathy, and neuropathy has also been linked to telomere shortening. Understanding how telomeres contribute to these issues may offer new therapeutic ideas. Diabetes and its consequences may be treated with telomere-targeted medicines, such as telomerase activators, telomerase gene therapy, and treatments that target telomere-associated proteins. However, more investigation is required to assess these strategies' security, effectiveness, and long-term impacts.

Aims

GLP-1-analogues, DPP4-inhibitors, and SGLT2-inhibitors have become available to treat type 2 diabetes. The extent to which these glucose regulating agents (GRA) are prescribed to older patients is unknown.

Methods

We performed a retrospective observational cohort study including all clinical admissions of patients with one or more prescriptions for non-insulin GRA between 2017 and 2021. We analyzed prescription trends and differences in prescription prevalences for frail and non-frail older patients, as well as older (≥ 70 years) versus younger patients.

Results

In total 11.5% of admissions had one prescription or more of newer GRA; GLP-1-analogues 1.6%, DPP4-inhibitors 7.3% and SGLT2-inhibitors 2.3%. Total prescription prevalence increased from 8.4% to 16.3% (p < 0.001). Prescription prevalence was 11.1% (N = 129) in admissions of frail patients versus 14.6% (N = 344) of non-frail patients (p = 0.005) and 15.0% in admissions of younger patients versus 11.5% of older patients (p < 0.001).

Conclusions

Prescription prevalence of newer GRA in clinical admissions of older patients (≥ 70 years) increased from 2017 to 2021. Prevalence was lower in admissions of frail and older patients, possibly because they are undertreated due to a lack of clear recommendations for older patients in guidelines and underrepresentation in clinical trials.

Background

In type 2 diabetes mellitus (T2D), cardiovascular risk factors including glycemic control differentially affect various microcirculatory beds. To date, studies comparing the impact of blood pressure (BP) on various microvascular beds in T2D are limited. We assessed the associations of BP and its control with neural, renal, and retinal microvascular dysfunction.

Methods

This was a cross-sectional study among 403 adults with T2D. Microvascular dysfunction was based on nephropathy (albumin-creatinine ratio ≥ 30 mg/g), neuropathy (vibration perception threshold ≥ 25 V and/or Diabetic Neuropathy Symptom score > 1), and retinopathy (based on retinal photography). Logistic regression was used to examine the associations of hypertension, systolic BP, and diastolic BP with microvascular dysfunction with adjustments for age, sex, diabetes duration, smoking pack years, HbA1c concentration, total cholesterol concentration, and BMI.

Results

The mean age (± SD), proportion of females, and proportion of hypertensives were 56.35 (± 9.91) years, 75.7%, and 49.1%, respectively. In a fully adjusted model, hypertension was significantly associated with neuropathy [odds ratio 3.44, 95% confidence interval 1.96–6.04, P < 0.001] and nephropathy [2.05 (1.09–3.85), 0.026] but not for retinopathy [0.98 (0.42–2.31), 0.970]. Increasing Z-score systolic BP was significantly associated with nephropathy [1.43 (1.05–1.97), 0.025] but not for neuropathy [1.28 (0.98–1.67), 0.075] or retinopathy [1.27 (0.84–1.91), 0.261]. Increasing Z-score diastolic BP was significantly associated with nephropathy [1.81 (1.32 – 2.49), < 0.001] but not retinopathy [1.38 (0.92–2.05), 0.120] or neuropathy [0.86 (0.67–1.10), 0.230].

Conclusion

Our study shows varying strengths of associations of hypertension, systolic BP, and diastolic BP with microvascular dysfunction in different microcirculatory beds. Hypertension prevention and/or control may be valuable in the prevention/treatment of microvascular disease, especially nephropathy, and neuropathy.

Aims

The present study was conducted to assess the level of medication adherence and factors affecting adherence among Type-2 Diabetes Mellitus (T2DM) patients.

Methods

A prospective cross-sectional study was carried out among T2DM patients who were presented to the outpatient department of general medicine. A well-designed data collection form was used to gather information pertaining to various socio-demographic and medical variables. A previously validated and translated 8-item self-reported questionnaire was used to assess the level of medication adherence. Data was analysed using SPSS Version 29.0.

Results

Among the total 369 subjects enrolled, a majority were found to be males, and the mean age of the population was observed as 56.84 ± 11.32. A total of 125 (33.8%) subjects were found to be within the category of high adherence, 161 (43.6%) subjects were found to have moderate level of adherence and 83 (22.4%) had low level of adherence. On analysis, various medical variables were found to have a statistically significant association with medication adherence.

Conclusion

The findings of the present study would form the basis for all the future implications including education intervention programmes to improve the level of adherence towards anti-diabetic medications, which ultimately results in better health outcomes.

Bullous Diabeticorum is a skin condition that occurs rarely in diabetic patients. It is a specific type of skin lesions characterized by non-inflammatory blisters that heals spontaneously. It is usually found in long standing diabetic patients with poor glycemic control, although the relationship between BD and blood glucose level in diabetic patients remains unclear. It frequently goes undiagnosed because it resembles other vesicobullous illnesses. Few published articles reported such cases. This case report describes a rare case of Saudi female patient presented to the clinic with a well demarcated erythematic fluid-filled lesion. Based on medical history and clinical examination diagnosis of diabetic bullae was made. We present this case to shed light on the rare occurrence of Bullous Diabeticorum in diabetic patients, to highlight the role of interprofessional team in its management and to improve the patients’ outcome.