Diabetes epidemiology and management最新文献

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.

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.

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.

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.

Type 2 diabetes (T2DM) and liver disease, mainly metabolic-associated fatty liver disease (MAFLD), previously named non-alcoholic fatty liver disease (NAFLD), coexist in many patients. While physicians were reluctant to use glucose-lowering agents other than insulin in patients with T2DM and liver disease for many decades, the scene changed in recent years. While metformin gave controversial results in patients with MAFLD, pioglitazone was the first to demonstrate unequivocal positive effects, but its use in clinical practice is limited by safety concerns. New glucose-lowering agents, both glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, raised new hope. Indeed, besides a good safety profile, these agents, which are associated with weight loss, pleitotropic effects and cardiorenal protection, have also proven their efficacy in improving MAFLD. The positive effects on liver fat content, hepatic enzymes used as markers of steatosis and indices of tissue inflammation are now well demonstrated, yet available data on fibrosis are more limited. Thus, more dedicated studies, using liver biopsies, are still warranted to demonstrate the efficacy of these two pharmacological classes in preventing the progression from simple steatosis to fibrosis/cirrhosis and further confirm this new opportunity for the management of patients with T2DM and MAFLD.

AIMS

Data on the clinical course of patients with cystic fibrosis (CF) from childhood to CF-related diabetes (CFRD) diagnosis in adulthood are limited. We evaluate whether childhood trajectories of parameters of interest in CF are associated with the risk of abnormal glucose tolerance (AGT) in early adulthood.

Methods

Pediatric and adult data from 108 subjects with CF followed annually were paired. Participants were grouped according to predominant childhood trajectories for weight, height, body mass index, lung function, glycated hemoglobin levels, fasting glycemia, and 2h post-oral glucose tolerance test glucose levels. Multivariable logistic regression was performed to identify parameters that predict glucose tolerance status in adulthood.

Results

Univariate analyses reveal that the risk of developing an AGT in adulthood is greater in subjects who are homozygous vs. heterozygous for the ΔF508 mutation, have pancreatic insufficiency vs. sufficiency, or have higher fasting glycemia values at 10 years old rising rapidly vs. lower values that are gradually rising until 17 years old. Multivariable logistic regression retains only fasting glycemia as a significant predictor for the occurrence of AGT in adulthood.

Conclusions

Fasting glycemia may be a clinical marker of interest to better target children with CF at risk of developing an AGT in early adulthood.

Background

Studies assessing the concordance of albuminuria and retinal microvascular dysfunction (RMD) in type 2 diabetes (T2D) have yielded inconsistent results. Similar to ethnicity, hypertension may be a potential explanatory variable. We compared the association between albuminuria and RMD in West Africans with T2D with and without hypertension.

Materials and methods

This was a cross-sectional study among 177 systematically sampled Ghanaians with T2D aged ≥ 35 years. Albuminuria was based on urinary albumin-creatinine ratio≥30 mg/g. Retinal images were analyzed and graded according to the Early Treatment Diabetic Retinopathy Study criteria. Logistic regression was used to examine the associations of albuminuria and RMD with adjustments for age, sex, socioeconomic status, diabetes duration, HbA1c, smoking, systolic blood pressure (BP), BMI, and total cholesterol.

Results

RMD was more prevalent in individuals with albuminuria than in those without albuminuria (41.7% vs. 24.0%, p = 0.026). In the fully adjusted model, albuminuria remained significantly associated with RMD (odds ratio 2.41[95% CI:1.00–5.80], p = 0.049); the association between albuminuria and RMD was more pronounced in individuals with hypertension (3.10 [1.01–9.50], 0.048) than without hypertension (1.70[0.33–8.77],0.523). In analyses stratified by BP control, albuminuria was significantly associated with RMD in individuals with suboptimal BP (2.76[1.07–7.14], 0.037) but not in individuals with optimal BP (0.24[0.00–17.04],0.512)

Conclusion

Our study shows positive associations between albuminuria and RMD among West Africans with T2D, with the strength of association, accentuated in individuals with hypertension/suboptimal BP. Future studies could further characterize the role of hypertension in the associations between albuminuria and RMD.

Background

Diabetic retinopathy (DR), a microangiopathy caused by Type 2 Diabetes Mellitus (T2DM), is associated with significant visual disability leading to suboptimal quality of life. Retinal microvasculature changes can reflect similar changes in the grey matter and blood-brain barrier. Microvascular changes in the brain are associated with cognitive dysfunction. The present study aimed to find the association between Diabetic Retinopathy (DR) and Cognitive Impairment (CI) and its relationship with Quality of Life (QoL).

Methodology

A cross-sectional observational study was conducted in a tertiary care hospital among patients (aged 18 years and above) with pre-existing T2DM as per Standards of Care in Diabetes-2023 criteria. Patients with visual acuity less than 3/60, or education below 6th grade, or with comorbid mental or neurocognitive disorders illness were excluded from the study. DR grading was done using the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. Cognitive functions and quality of life were measured using Montreal cognitive assessment (MoCA) and World Health Organization – Quality of Life scale – brief version (WHO-QOL BREF). The primary outcome measures (cognitive impairment and quality of life) were compared between patients with DR (DR+) and patients without DR (DR-). A P < 0.05 was considered statistically significant.

Results

Diabetic retinopathy was diagnosed in 48.5% (83 out of 171) of the sample. The DR+ group were predominantly male, significantly older, had comorbid immature cataract and hypertension than the DR- group. Also, the DR+ group had significantly reduced scores in all domains of MoCA and QoL. among patients with DR, those with severe and moderate NPDR had more cognitive impairment than mild NPDR. Age and duration of diabetes did not correlate with MoCA and QoL scores.

Conclusion

The presence of diabetic retinopathy is associated with cognitive impairment and reduced quality of life in this study population. The association is independent of the age of patient and the duration of diabetes mellitus.

Aims

To examine associations of SARS-CoV-2 infection/COVID-19 with insulin treatment in new-onset diabetes.

Methods

We conducted a retrospective cohort study using Veterans Health Administration data (March 1, 2020–June 1, 2022). Individuals with ≥1 positive nasal swab for SARS-CoV-2 (n = 6,706) comprised the exposed group, and individuals with no positive swab and ≥1 laboratory test of any type (n = 20,518) the unexposed group. For exposed, the index date was the date of first positive swab, and for unexposed a random date during the month of the qualifying laboratory test. Among Veterans with new-onset diabetes after the index date, we modeled associations of SARS-CoV-2 with most recent A1c prior to insulin treatment or end of follow-up and receipt of >1 outpatient insulin prescription starting within 120 days.

Results

SARS-CoV-2 was associated with a 40% higher odds of insulin treatment compared to no positive test (95%CI 1.2–1.8) but not with most recent A1c (ß 0.00, 95%CI -0.04–0.04). Among Veterans with SARS-CoV-2, ≥2 vaccine doses prior to the index date was marginally associated with lower odds of insulin treatment (OR 0.6, 95%CI 0.3–1.0).

Conclusions

SARS-CoV-2 is associated with higher odds of insulin treatment but not with higher A1c. Vaccination may be protective.

Objective

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are associated with risk of euglycemic ketoacidosis. Guidelines recommend withholding SGLT2i prior to surgery and considering procedure delay in the presence of ketosis. Literature to support this in setting of routine outpatient colonoscopy is limited. Our aim was to clarify the incidence and range of ketosis in all individuals presenting for elective colonoscopies to help setting guidelines and threshold for concern.

Methods

This single-centre prospective study recruited patients ≥18 of age who underwent routine outpatient colonoscopies in a medium metropolitan hospital in Brisbane, Australia between August and November 2021. SGLT2i were withheld for 48 h prior and blood glucose and capillary ketone concentrations were recorded within 90 minutes before procedure commencement.

Results

315 individuals were consecutively recruited; 179 (56.8%) were female. Sixty-nine (21.9%) had a previous diagnosis of type 2 diabetes mellitus (T2DM) and 17 (5.4%) were taking SGLT2i. The mean age was 57.79 (± 15.21). Significant ketone levels defined as >1.0 mmol/L were noted in 41 individuals (13.0%). Of these, 13 (33%) were diabetic with ketosis ranging from 1.0-4.2mmol/L. The range of significant ketosis in the 28 non-diabetics was 1.0-5.7mmol/L. Only a diagnosis of T2DM and increased fasting times (>45 mins) conferred a greater trend towards ketosis risk. Patients with T2DM as a whole were 2.06 times more likely to develop ketosis with or without SGLT2i. This did not reach statistical significance (p = 0.05).

Conclusion

A wide range of periprocedural ketosis commonly occurs in patients undergoing colonoscopies with or without T2DM. This phenomenon is not unique to diabetics or in those on SGLT2i. Hence, previously defined significant ketosis cut-offs are unlikely to be useful in the unique context of colonoscopies. Avoiding procedural delays and early commencement oral intake should be a priority.