Diabetes epidemiology and management最新文献

Objective

The risk of nonalcoholic fatty liver disease (NAFLD) is increased significantly in individuals having Type 2 diabetes mellitus (T2DM) and the presence of T2DM enormously drives NAFLD progression. However, in clinical practice, it is overlooked despite the significant clinical effects of NAFLD in T2DM. Our study aimed to estimate the prevalence of NAFLD in T2DM patients from the eastern region of India.

Methods

This cross-sectional study assessed 132 T2DM patients for NAFLD. Anthropometry and lipid estimations were done in all the individuals. Hepatic fibrosis was diagnosed by transient elastography (TE) using a TOUCH 502 Fiber Scanner using M‑probe. A fibrosis score ≥ 11 kgpascals (kPa) was used to define advanced fibrosis (F3).

Results

Overall prevalence of NAFLD in T2DM patients was 57% (75/132 subjects) and the prevalence is higher in males (54.6%). Results showed that approximately 26% of patients with NAFLD will develop into NASH, among them 37.3% developed mild to moderate steatosis and 26.6% developed severe steatosis.

Conclusion

The prevalence of NAFLD is high in the eastern region of India, need for early diagnosis and treatment of NAFLD in T2DM. The use of TE with other serum markers can be helpful for the diagnosis of advanced fibrosis.

Background

Diabetes has become a major public health issue in India, and understanding its impact on skeletal muscle health is crucial for addressing the elevated risk of sarcopenia among individuals with diabetes. While the association between diabetes and sarcopenia has been extensively studied worldwide, there is a notable lack of research focusing on this relationship within the Indian community-dwelling geriatric population. Therefore, this study aimed to explore the influence of diabetes on sarcopenia among older adults living in community settings in India.

Methodology

The study used data from the Longitudinal Aging Study in India (LASI), Wave 1 (2017–18). It was focused on older adults aged 60 years and above living in community settings in India, including both males and females. This study followed the Asian Working Group on Sarcopenia (2019) guidelines, utilizing a screening tool that assessed sarcopenia through muscle (handgrip) strength, physical performance, and appendicular skeletal muscle mass (ASM). The presence of diabetes was determined through a self-reported approach, where participants disclosed their diabetes diagnosis as provided by healthcare professionals. To examine the association between diabetes and sarcopenia, the study utilized logistic regression analysis to calculate the adjusted odds ratio (AOR) and corresponding 95% confidence interval (CI).

Results

Present study included 27,241 individuals, with sarcopenia prevalent in 27.0% of participants. 3.4% had both sarcopenia and diabetes, 23.5% had sarcopenia only, 11.7% had diabetes only, and 61.3% had neither. After adjusting for confounding variables, participants with diabetes had a significantly higher odds ratio of 1.14 (95% CI 1.06–1.26, p < 0.001) for sarcopenia.

Conclusions

The study established that diabetes is a risk factor for sarcopenia in older adults living in India. Early identification and management are essential to mitigate sarcopenia, emphasizing the importance of addressing both conditions in healthcare.

Objective

The aim is to describe the characteristics of people with type 1 diabetes who are meeting all seven glycemic targets set by international consensus.

Research Design & Methods

We analyzed continuous glucose monitoring (CGM) data from 497 participants (aged 18-70 yrs). Time-in-range, time above and below range, co-efficient of variability, and glucose management indicator (GMI) were combined with demographic data, insulin delivery, and exercise.

Results

While 68% of participants achieved a GMI below 7% (53 mmol/mol), 39% met all seven glycemic targets. Older people and those of White ethnicity were more likely to meet these targets. Men and women were equally likely to meet all targets, although men were more likely to experience hypoglycemia while women were more likely to experience hyperglycemia. Hybrid-closed loop (HCL) system users were more likely to meet all targets than people using a standard pump or multiple daily injections.

Conclusions

Only 56% of those with a GMI below 7% (53 mmol/mol) met all seven targets, illustrating how glycemic management involves more than GMI/HbA_1c lowering alone, which has implications for estimates of optimally managed participants in the wider population of people with type 1 diabetes. Demographic inequalities were prevalent. Using a HCL system clearly facilitated the achievement of glycemic targets.

Aims

DiabetesFlex Care is a patient-reported outcome (PRO)-based telehealth service for adults with type 1 diabetes, intended to enable patient perspectives in consultations. The study aimed to explore endocrinologists' experiences of using PRO to support dialog in diabetes consultations.

Methods

Thematic analysis was conducted on data from participant observations and semi-structured interviews with 13 endocrinologists engaging in DiabetesFlex consultations at a Danish hospital-based diabetes clinic.

Results

Two themes were extracted: 'Perceiving PRO as ambiguous information' and 'Integrating PRO in the care for people with diabetes'. Endocrinologists perceived PRO as situational information with variable quality and validity, depending on patient competencies and commitment. Therefore, endocrinologists used different approaches to integrate PRO in their efforts to improve care for the individual patient. The study also showed that patients’ PRO-responses were rarely discussed among endocrinologists.

Conclusion

Endocrinologists experienced both potentials and challenges in using PRO to support diabetes consultations. To optimize DiabetesFlex Care and similar PRO-based diabetes consultations, a culture should be built up where clinicians share experiences to improve the quality and solve PRO-related problems in consultations.

The mutualistic relationship between human health and gut microbiota has gained growing attention as a result of its far-reaching consequences. Diabetes medications, essential for managing type 2 diabetes, which regulate glucose metabolism, have shown effects that go beyond glycemic control by receiving attention for their possible influence on gut microbiota. Notably, metformin, a cornerstone therapy, has received a lot of attention for its ability to influence the gut microbiota. Metformin administration has been linked to changes in the abundance of specific bacterial taxa, including an uprise in beneficial microbes like Akkermansia muciniphila. These modifications have been linked to increased insulin sensitivity and better metabolic outcomes. Other classes of diabetes drugs, in addition to metformin, have shown potential effects on the gut microbiota. SGLT-2 inhibitors, for example, may contribute to changes in gut microbial communities, which could explain their cardiovascular and metabolic benefits. However, the processes underlying these interactions, are complicated and not entirely understood. Direct interactions between the gut microbiota and drug, changes in intestinal permeability, and modulation of bile acid metabolism are all possible mechanisms. Individual differences and genetic factors complicate the relationship even more. Understanding the intricate interplay between diabetes drugs and gut microbiota holds promise for developing personalized diabetes management approaches. Taking advantage of these interactions could lead to novel therapeutic strategies that improve drug efficacy and overall metabolic health. More studies are required to determine the exact mechanisms underlying these effects and to capitalize on their potential for improved patient outcomes. This review provides a concise overview of the effects of diabetes medications on gut microbiota composition and its importance.

Background

Stroke represents a major burden in patients with type 2 diabetes. Yet, this cerebrovascular complication has been less well studied than coronary artery disease and heart failure. Some cardiovascular outcome data suggested that sodium-glucose cotransporter 2 inhibitors (SGLT2is) exert a less pronounced protection against stroke compared with glucagon peptide-1 receptor agonists (GLP-1RAs) despite similar efficacy regarding major cardiovascular events (MACE-3 points). However, this conclusion was derived from indirect comparisons of placebo- controlled trials (RCTs).

Methods

The present comprehensive review analyses the effects of SGLT2is versus GLP-1RAs on nonfatal and fatal/nonfatal strokes in real-life studies carried out worldwide.

Results

A large majority of retrospective observational cohort studies (19 out of 21) failed to find any significant difference in the risk of stroke between the two pharmacological classes, independently of the presence of established cardiovascular disease. Available, yet limited, findings suggested that SGLT2is could be more efficacious against haemorrhagic than ischaemic strokes, in patients at risk for atrial fibrillation or with chronic kidney disease.

Conclusion

In contrast to what was reported in RCTs, most observational studies showed similar incidence of stroke in SGLT2i users versus GLP-1RA users. Because both indirect comparisons of RCTs and retrospective cohort studies have limitations, a head-to-head RCT comparing the effects on stroke of an SGLT2i versus a GLP-1RA is needed to draw any definite conclusion.

Aims

The present study aimed to explore the relationship between fear of hypoglycemia and exercise management strategies in active Qatari adults with T1D during the COVID-19 pandemic, and to explore the potential role of continuous glucose monitoring (CGM) devices in promoting safe physical activity practices.

Methods

Participants completed the Hypoglycemia Fear Survey (HFS) questionnaire and the International Physical Activity Questionnaire (IPAQ). Out of the 102 participants, 41 were considered "active" and under CGM and were included in the analysis.

Results

Multiple linear regression analysis revealed a significant positive correlation between the behavior dimension of the HFS scores and both vigorous physical activity and MET-minutes per week (R² adj. = 0.055; β = 0.56; p = 0.05 and R² adj. = 0.039; β = 0.38; p = 0.04). The results showed a significant positive association between HbA1c levels and the behavior dimension of the HFS (R = 0.39, p = 0.005), as well as between the number of episodes of severe hypoglycemia and the behavior dimension (R = 0.46, p = 0.042).

Conclusion

These findings highlight the need for effective strategies to manage fear of hypoglycemia and promote physical activity in individuals with T1D. The use of CGM devices may provide added safety to physical activity practices by reducing the risk of hypoglycemia.

Aim

To investigate the association between serum vitamin D (SVD) level and DFU development and to emphasize the involved pathomechanism.

Methods

The search was performed on 12 databases for literature published until 10 March 2023. The protocol has been registered on PROSPERO (CRD42023415744). The selection for the included records followed PRISMA framework. Meta-analyses using random effects model were performed and the data were presented as SMD and 95% CI. Meta-regression was performed to identify factors contributing to the heterogeneity in the pooled analysis.

Results

Twenty-one studies were included in the systematic review with a total number of patients reaching 9,570. Of which, as many as 18 studies were eligible for the meta-analysis. The SDV level is significantly lower in DFU group (p-total=0.0037; SMD= -1.2758; [95% CI: -2.0786 to -0.4730]). Based on the meta-regression, age, study location (based on the continent), and total cholesterol level contribute to the high heterogeneity (p<0.01). In the pooled analysis, inflammatory markers such as serum levels of CRP (n = 4), ESR (n = 3), IL-6 (n = 3), and IL-8 (n = 2) are found significantly higher in DFU group at p<0.01.

Conclusion

Lowered SVD level is associated with DFU, where the pathomechanism for this relationship might involve inflammation and infection susceptibility.

Objectives

Diabetic foot ulcer (DFU) is a prevalent and serious complication of diabetes, associated with significant morbidity and mortality rates. Platelet-rich plasma (PRP) is a promising therapy for accelerating DFU healing, with numerous randomized controlled trials (RCTs) supporting its efficacy and safety. Therefore, this systematic review aims to identify, critically assess, and synthesize the most recent available RCTs regarding the effectiveness of clinical PRP for treating DFU compared to standard treatment or other alternative therapies.

Methods

This study uses a comprehensive review and synthesis of existing research according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched selected databases using a combination of search terms: “((PRP) OR ("platelet-rich plasma")) AND ("diabetic foot ulcer")) OR ("diabetic lower-extremity ulcer"))” from PubMed, ProQuest, ScienceDirect, and Google Scholar in the last five years (2018–2023). Following a systematic review protocol, we selected 9 eligible articles for final analysis. Pertinent data was examined using MedCalc ver 20.215 then the results were displayed visually using forest plots.

Results

The findings from the meta-analysis revealed that PRP exhibited a healing rate that was twice as high as the control group (Relative Effects (REs) = 2.338; 95% Confidence Interval (CI) = 1.056 to 1.857, P = 0.019). Additionally, the healing time was shortened by 2 days (REs = -2.815; 95% CI = -3.252 to -0.576, P = 0.005), and there was a difference of 0.482 cm² in the reduction of ulcer area between the two groups (REs = 0.482; 95% CI = -2.428 to 4.002, P = 0.630). Importantly, none of the Randomized Controlled Trials (RCT) studies reported any adverse events in the PRP group.

Conclusions

PRP represents a feasible and secure supplementary therapeutic alternative for managing DFU.