Diabetes epidemiology and management最新文献

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.

Aims

To assess the prevalence of prediabetes and diabetes in France between 2013 and 2014 using data from the CONSTANCES cohort, and to identify factors associated with prediabetes and undiagnosed diabetes.

Methods

The study population comprised participants recruited in 2013–2014 in CONSTANCES, an ongoing French national prospective cohort following participants aged 18–69 years who are covered by France's general health insurance scheme. Participants completed a questionnaire at baseline and underwent a medical examination which included providing blood samples. Undiagnosed diabetes was defined as a fasting plasma glucose (FPG) ≥ 7 mmol/l and diagnosed diabetes as self-report or identification of reimbursements for anti-diabetics. Prediabetes was defined as a FPG ≥ 6 mmol/l but < 7 mmol/l.

Results

25,137 participants were included in the analyses. The overall prevalence of prediabetes was 7.2% [95% confidence interval: 6.7–7.7], 1.6% [1.4–1.9] for undiagnosed diabetes, and 4.0% [3.6–4.4] for diagnosed diabetes. These rates were significantly higher in men, in older persons, in persons with obesity, and in those with lower education levels. In multivariate regression models, excessive corpulence was the variable most strongly associated with undiagnosed diabetes (adjusted Odds Ratio=9.31) and prediabetes (aOR=3.85). Additionally, male sex, older age, family history of diabetes, at-risk alcohol use, and lower education level were all positively associated with undiagnosed diabetes and prediabetes.

Conclusion

Diabetes and prediabetes prevention together with screening for undiagnosed diabetes must be strengthened for persons with low socioeconomic status and for those with obesity or overweight.

Introduction

L-carnitine possibly impacts insulin sensitivity and glucose metabolism. However, its therapeutic role in diabetes is poorly understood.

Methods

A systematic review and meta-analysis were conducted using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception through June 30, 2021. Included studies evaluated the use of L-carnitine in diabetes on fasting blood glucose (FBG), hemoglobin A1c (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), weight, or body mass index (BMI). Weighted mean difference (WMD) and 95% confidence intervals (CI) were calculated using the DerSimonian and Laird random-effects model.

Results

Seventeen studies involving 1622 patients were included. Reductions in FBG (WMD = -0.46 mmol/L, 95% CI = -0.68 to -0.23 mmol/L), HbA1c (WMD = -0.5%, 95% CI = -0.8 to -0.1%), TC (WMD = -0.29 mmol/L, 95% CI = -0.42 to -0.16 mmol/L), and LDL-C (WMD = -0.23 mmol/L, 95% CI = -0.39 to -0.07 mmol/L) were significant. Effects on HDL-C, TG, weight, or BMI were insignificant. Doses between 1001 to 2000 mg showed greatest benefit (p < 0.02 for all).

Discussion/Conclusion

L-carnitine plays a potential role as adjunctive therapy in diabetes. Additional research is necessary for patients with higher baseline HbA1c and type 1 diabetes.

Aims

Women with a history of gestational diabetes (GDM) have an increased risk of developing type 2 diabetes (T2DM). We studied the risk for T2DM in women with and without GDM in relation to body mass index (BMI) and examined whether insulin treatment for GDM associates with the risk of developing T2DM. In addition, we investigated whether the risk of developing T2DM after GDM had changed in 15 years.

Methods

We used data by linking four registers; Medical Birth Register, Hospital Discharge Register and Primary Care Register run by THL Finnish Institute for Health and Welfare, and Medical Reimbursement Statistics run by the Social Insurance Institution of Finland (Kela). Registry data were collected from 2005 to 2020. The follow-up started from woman's delivery in 2006-2020 and ended to the diagnosis of T2DM or December 2020. Cox proportional hazard modelling was used to estimate the effect of GDM exposure to T2DM. To assess whether the risk of developing T2DM after GDM had changed in 15 years, we compared the HR between years 2006-2008 and 2018-2020.

Results

In total, 462 401 women were included in the study: 96 353 (21%) women had previous GDM. There were 5370 (1.2%) women who developed T2DM after childbirth during the follow-up. Among women with prior GDM, 3995 (4.1%) developed T2DM, while 1375 (0.4%) women without prior GDM developed T2DM during follow-up. The mean follow-up was 6.86 years (SD 4.21) for women with GDM and 9.07 years (SD 4.35) for women without GDM. The hazard ratio (HR) for developing T2DM after GDM was 18.49 (95% CI 17.39-19.67). The incidence of T2DM in women with a history of GDM began to rise almost steadily from the first year of follow-up. As BMI increased, T2DM incidence increased in both women with and without prior GDM but more in women with prior GDM. Insulin treatment had an independent association with increased risk of T2DM (HR 3.81, 95% CI 3.57-4.07). We did not observe any difference in HR between years 2006-2008 and 2018-2020.

Conclusions

The relative risk for T2DM was 11-fold for women with previous GDM compared to women without previous GDM. A higher BMI and insulin treatment increased the risk of future diabetes. All measures to prevent the conversion of GDM to T2DM should be taken especially among women with overweight or obesity.