Diabetes epidemiology and management最新文献

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.

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.