Frontiers in clinical diabetes and healthcare最新文献

Background: The UK National Paediatric Diabetes Audit (NPDA) data reports disparities in Haemoglobin A1c (HbA1c) levels among children and young people (CYP) with Type 1 Diabetes (T1D), with higher levels in those of Black ethnic background and lower socioeconomic status who have less access to technology. We investigate HbA1c differences in a T1D cohort with higher than national average technology uptake where > 60% come from an ethnic minority and/or socioeconomically deprived population.

Design & methods: Retrospective cross-sectional study investigating the influence of demographic factors, technology use, and socioeconomic status (SES) on glycaemic outcomes. The study population was 222 CYP with T1D who attended the diabetes clinic in 2022 at a single tertiary paediatric diabetes centre.

Results: Among 222 CYP, 60% were of ethnic minority (Asian, Black, Mixed and Other were 32%, 12%, 6% and 10% respectively) and 40% of white heritage. 94% used Continuous Glucose Monitoring (CGM) and 60% used Continuous Subcutaneous Insulin Infusion (CSII) via open or closed loop. 6% used Self-Monitoring of Blood Glucose (SMBG) and Multiple Daily Injections (MDI), 34% used CGM and MDI, 38% used CGM and CSII and 22% used Hybrid Closed-Loop (HCL) systems. Significant differences in HbA1c across therapy groups (p < 0.001) was noted with lowest HbA1c in HCL group (55 mmol/mol; p <0.001). Despite adjusting for therapy type, the Black group had higher HbA1c than their white and Asian counterparts (p<0.001). CYP from the most deprived tertile had significantly higher HbA1c levels (p < 0.001) but the difference was not sustained after adjusting for therapy type.

Conclusion: Advanced diabetes technologies improve glycaemic control. Whilst equalising technology access mitigates socioeconomic disparities in HbA1c, CYP from Black ethnic background continue to display a higher HbA1c. The study underscores the necessity of fair technology distribution and further research into elevated HbA1c levels among Black CYP using advanced diabetes technology.

Type 2 Diabetes is a highly prevalent chronic disorder that affects multiple systems through microvascular complications. Complications such as diabetic peripheral neuropathy, diabetic retinopathy, and diabetic vestibular dysfunction (vestibulopathy) all directly interfere with the sensory components of balance and postural stability. The resulting impairments cause increased falls risk and instability, making it difficult to perform daily task or exercise. This commentary will provide clarity on the causes and relationship between the sensory complications of T2D, balance, and excise, while also providing recommendations and precautions for exercising with one of these sensory complications.

This study explores the use of Instant Messaging Services (IMS) for peer support among individuals with Type 2 Diabetes Mellitus (T2DM). Leveraging the popularity of IMS within the affected age group, the DiabPeerS study implemented a peer support intervention aimed at improving long-term blood glucose levels (HbA1c) in a randomized controlled trial (RCT). This article describes the development and acceptance of the IMS intervention used in the DiabPeerS study. The intervention included a communication strategy and content designed for lay moderators to facilitate group interaction among people with Type 2 Diabetes mellitus (PWT2D). The intervention's acceptance was determined by conducting participant interviews, moderator meetings, and analysis of IMS chat protocols. Results indicate that the intervention was well-received, with participants engaging in meaningful exchange about diabetes self-management (DSM). However, those less familiar with online communication may benefit from preparational training and initial face-to-face meetings could enhance group cohesion. This research offers insights into the practical application of IMS for diabetes peer support, highlighting both its benefits and room for improvement.

Background: Complications of diabetes and its associated comorbidities can cause rapid progression of type II diabetes mellitus (T2DM). It comes at high costs and affects a patient's quality of life. We aim to assess T2DM in KSA, including the demographics, medications, complications, and comorbidities, as it remains an integral part of Vision 2030.

Methods: Observational retrospective study was designed spanning five administrative regions of KSA. A total of 638 patients' records were randomly selected from general hospitals and diabetes centers from 2017 to 2020, and the collected were statistically analyzed.

Results: Most (77%) selected patients had uncontrolled diabetes, showing a statistically significant correlation between regions and diabetes control. The Northern, Central, and Southern regions had the highest uncontrolled percentage with less than 20% control, while Western and Eastern regions' control percentages were around 40% of subjects. Eighty percent of the uncontrolled BP patients had uncontrolled diabetes contrasting the 68% of the BP-controlled patients. Biguanides, DPP-4 inhibitors, GLP-1 agonists, Insulin, and SGLT-2 inhibitors are the most common diabetes medications. Metformin was the most prescribed in all regions, followed by DPP4. Results showed that patients used one to four non-diabetes drugs on average. Dispensing of vitamin B complex and statins were higher in diabetes centers than in hospitals. Retinopathy and peripheral neuropathy were the most common complications, while hypertension and ASCVD were the most common comorbidities.

Conclusion: Results showed a poor glycemic control situation in the kingdom that necessitates implementing stricter measures to hinder disease progression and reduce complications and comorbidities. Increasing awareness, training, and monitoring programs with larger sample sizes and broader distribution is highly recommended nationally.

Introduction: Type 1 diabetes involves immune-mediated destruction of insulin-producing beta cells, with eosinophils potentially playing a significant role. Recent studies suggest that leukotriene inhibition might influence this process. This case report presents a novel observation of montelukast, a leukotriene receptor antagonist, reducing insulin requirements in a patient with Latent Autoimmune Diabetes in Adults (LADA). A 55-year-old male with LADA experienced substantial reductions in insulin dosage when treated with montelukast for respiratory symptoms. Initially diagnosed with LADA in 2018, the patient had been on insulin therapy. Montelukast therapy, initiated due to respiratory symptoms, led to a 60.5% reduction in insulin requirements which increased upon discontinuation. A subsequent montelukast course resulted in an 87.9% insulin reduction. Although the insulin-lowering effect diminished with continued montelukast use, the patient reported reduced postprandial hyperglycemia. Blood tests indicated stable glucose levels despite reduced insulin doses.

Conclusions: This case suggests that montelukast may reduce insulin needs in type 1 diabetes patients, potentially through its anti-inflammatory effects on eosinophils. These findings highlight the need for further research into montelukast's role in type 1 diabetes management and its potential to preserve beta-cell function or reduce insulin dependence.

Introduction: Infants of diabetic mothers (IDMs) may exhibit decreased oral intake, requiring nasogastric feedings and prolonged hospitalization. The objective of this study was to explore whether saliva serves as an informative biofluid for detecting expression of hunger signaling and energy homeostasis modulator genes and to perform exploratory analyses examining expression profiles, body composition, and feeding outcomes in late preterm and term IDMs and infants born to mothers with normoglycemia during pregnancy.

Methods: In this prospective cohort pilot study, infants born at ≥ 35 weeks' gestation to mothers with gestational or type II diabetes (IDM cohort) and normoglycemic mothers (control cohort) were recruited. The presence of known hunger signaling genes: 5'AMP-activated protein kinase (PRKAA2) and neuropeptide Y2 receptor (NPY2R); adipokines: leptin (LEP) and adiponectin (ADIPOQ); and energy homeostasis regulators: ghrelin (GHRL) and proopiomelanocortin (POMC) in neonatal saliva was determined with RT-qPCR and compared between cohorts. Body composition was assessed via skinfold measurements and compared between cohorts. Feeding outcomes were recorded. Exploratory analyses were performed examining associations between infant body composition, energy homeostasis and hunger signaling gene expression.

Results: Twenty-three infants in the IDM cohort and 22 infants in the control cohort were recruited. LEP and ADIPOQ were not reliably detected in neonatal saliva in either cohort. PRKAA2, GHRL and NPY2R were less likely to be detected in the IDM cohort, whereas POMC was more likely to be detected in the IDM cohort. Infants in the IDM cohort had greater adiposity compared to infants in the normoglycemia cohort. Only 3 IDMs had documented poor feeding; no infant in the control group struggled to feed. In exploring associations between hunger signaling gene expression with energy homeostasis gene expression and body composition, the odds of detecting salivary NPY2R expression decreased as fat mass increased, and the odds of detecting PRKAA2 expression increased in the presence of GHRL expression.

Discussion: Non-invasive assessment of hunger signaling and energy homeostasis gene expression is possible through neonatal salivary analysis. This pilot study lays the foundation for a larger scale study to further investigate the link between in utero exposure to diabetes with body composition and regulation of appetite.

The 'Developmental Origins of Health and Disease' (DOHaD) hypothesis postulates that exposures during critical periods of development and growth, including maternal hyperglycemia, can have significant consequences for short- and long-term health in offspring. The influence of fetal status on maternal (patho)physiology is less well understood but gaining attention. Fetal sex specifically may be an independent risk factor for a range of adverse pregnancy outcomes, including increased gestational diabetes mellitus (GDM) frequency with male fetuses in multi-ethnic populations. Fetal sex has been thought to modulate maternal glucose metabolism, including insulin dynamics, through complex genetic and hormonal interactions. Mechanisms have not been fully elucidated, however, but may relate to sexual dimorphism in maternal-fetal-placental interactions. We review current evidence on the potential influence of fetal sex on maternal glucose and insulin dynamics, and fetal outcomes.

Background: The integration of digital health applications into type 2 diabetes mellitus (T2DM) management presents promising opportunities for optimizing glycemic control, enhancing adherence, and improving health outcomes. MyTatva's Glycemic Lifestyle Intervention in Diabetes Empowerment (GLIDE) program, which integrates dietary and exercise regimens, cognitive behavioral therapy (CBT), and Internet of Things (IoT) devices, potentiates this approach. This study aimed to evaluate the effectiveness of the GLIDE program's personalized, comprehensive approach in improving glycemic control over 90 days among T2DM patients.

Methods: During the study period, 30 diabetic patients completed their GLIDE journey with expert dieticians, physiotherapists, and behavior therapists. Each patient received a personalized root cause analysis based on lifestyle assessment and disease-specific parameters. Statistical analysis was conducted using a paired t-test on the deidentified HbA1c, FBS, and PPBS data at baseline and post-intervention.

Results: Throughout the study, 27 patients actively adhered to the GLIDE program. All the parameters showed statistically significant (p<0.05) changes post-intervention. HbA1c decreased by 11.79% from 8.43% ± 1.32 to 7.44% ± 0.64. Significant reductions were observed in PPBS (47.7%), decreasing from 260.89 mg/dL ± 36.31 to 136.27 mg/dL± 6.36, compared to FBS (31.1%), which decreased from 8.43 mg/dL± 1.32 to 7.44 mg/dL± 0.64.

Conclusions: The effectiveness of the GLIDE program is based on a comprehensive root cause analysis approach. The detailed analysis of the patient's clinical journey by health experts at regular intervals enables precise goal management, resulting in expected outcomes for better glycemic control. Therefore, personalized digital health plans are vital for achieving clinically significant changes.