Diabetes epidemiology and management最新文献

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.

Introduction

Many developed countries, including Canada, have observed reductions in incidence of diabetes. Given the latest improvements in the case definition of diabetes for the younger population in Quebec, Canada, we sought to examine the evolution of diabetes among adults and children in Quebec, between 2001 and 2019.

Methods

Crude and age-standardized incidence and prevalence of diabetes among individuals ≥1 year were calculated using data from the Quebec Integrated Chronic Disease Surveillance System (n≈8,351,500 in 2019), using two case definitions for adults and the youth respectively. Age-standardized all-cause hospitalizations and mortality proportions were calculated among the population ≥20 years.

Results

Between 2001 and 2019, age-standardized incidence decreased by 30%, with a crude incidence of 4.6 per 1,000 in 2019. Incidence rates decreased from age group ≥50 years but increased by 25% for the group of 1-19 years. Age-standardized prevalence increased by 42% (crude prevalence in 2019: 8.1%). Males had higher incidence and prevalence of diabetes, with an incremental gap between sexes increasing with age. All-cause hospitalization and mortality proportions among individuals with diabetes declined by 21% and 29% respectively between 2001 and 2019. Age-standardized hospitalizations and mortality ratios for individuals with/without diabetes remained stable and were 2.7 (99% Confidence Intervals [CI]: 2.7-2.8) and 2.2 (99% CI: 2.1-2.3) in 2019, respectively.

Conclusion

Despite the reduction of incidence among adults, diabetes incidence increased among the youth and remained high among adults, especially for males. These results highlight the importance of improving earlier preventive care and initiatives for reducing the diabetes burden in Quebec.

Background

There is variance in the incidence of lower extremity amputation across and within countries including within the UK. National data shows up to a fourfold variance in the amputation rate throughout the regions of England and differences in amputation incidence have been reported in Scotland and Ireland. Lower extremity amputation rate has yet to be documented within Wales. The aim of this cohort study was to examine trends in diabetes and non-diabetes related lower extremity amputation incidence within the Welsh population and to examine the influence of diabetes on the relative risk of amputation.

Materials and Methods

All first-time amputations between 2008-2018 were extracted from SAIL, a repository of all routine medical data of residents of Wales. People with diabetes were identified using an algorithm utilising data from several clinical and non-clinical sources. Crude and direct age and sex adjusted incidences were estimated over time.

Results

Over the period 3505 major amputations and 4335 minor amputations occurred. The diabetes population greater than 17 years of age increased by 29.4% from 143,595 in 2008 to 206,818 in 2018. There was a statistically significant rate reduction in major amputation in both populations. In the diabetes population the number of major amputations reduced from 6.9 [5.5–8.5]/10 000 person years (PY) in 2008 to 4.9 [5.4–6.2]/10 000 PY in 2018. However, for major amputation, the risk of incident amputation in people with diabetes was 7.3 fold higher [7.1–7.5] than those without diabetes. The relative risk of minor amputation for those with diabetes was higher at 11.9 [11.8 –1.01]. There was no reduction in this risk over the period.

Conclusion

This study found that rates of major amputation decreased over the study period but the risk of amputation for persons with diabetes remained substantial. As the population with diabetes increases so do crude rates of amputation, providing a substantial financial and societal cost to the Welsh Population.

The number of available automated insulin delivery (AID) systems is increasing in Austria and people with diabetes (PwD) replace sensor-augmented pump (SAP) therapy more and more frequently. The present study is the two years follow-up of our prior monocentric, retrospective analysis conducted between 2019 and 2021, comparing SAP and open-source AID systems in people with type 1 diabetes. This second-year analysis included 25 PwD and investigated glycemic changes based on ambulatory glucose profiles (AGP). In comparison to the first year, a worsening of mean glucose (125.4 to 135.2 mg/dl, P = 0.038), time in range ((TIR), 84.2 to 77.0%, P = 0.012), time above range ((TAR), 11.6% to 18.5%, P = 0.017) and glycemia risk index ((GRI), 24.8 to 35.0%, P = 0.026) was observed. The reduction of mean glucose and glucose variability with AID in the first year was due to a significant decrease in time in hyperglycemia with resulting higher TIR and lower GRI. In this second-year follow up, TIR and GRI showed a significant deterioration, a familiar phenomenon in diabetology. However, open-source AID systems showed continuous safety, as there was no increase in time below range (TBR) even after two years. Despite the slight deterioration in the glycemic parameters, open-source AID systems were able to demonstrate sufficient glycemic control according to international consensus guidelines while offering the characteristic benefits of a reduced burden of diabetes management. A descriptive comparison of different AID algorithms indicated an improved glycemic control with more advanced features such as basal rate modification, auto bolus function and autotuning.

Diabetes epidemiology has evolved rapidly since the 90 s and so are the technologies for diabetes treatment and care. With each new innovation coming to the market, hopes that technologies will solve the numerous, complex, issues related to diabetes are present. However, if it is now demonstrated that, overall, those technologies - when available - bring major benefits to people living with diabetes, they do not make the disease disappear. In this short review, we discuss the interconnections between technologies and diabetes distress, an often underlooked consequence of the continuous demands of diabetes. We define the concept of diabetes distress, discuss which dimensions can be positively impacted thanks to the use of diabetes technologies and what will likely not be solved by them. With the emergence of closed-loop insulin delivery systems, it is of utmost importance to give sufficient space to the assessment of the emotional dimension of diabetes care in clinical routine.