Frontiers in clinical diabetes and healthcare最新文献

Background: Type 2 diabetes (T2DM) is a chronic metabolic disorder that affects approximately 10.5% of the world's population and is an independent risk factor for cardiovascular complications, including sudden cardiac death (SCD). Inhibitors of sodium-glucose co-transporter type 2 (iSGLT2), particularly dapagliflozin, have emerged as promising treatments in patients with T2DM and with heart failure and chronic kidney disease, demonstrating the ability to significantly reduce major cardiovascular events. However, the exact mechanisms that promote the observed benefits are still not fully understood.

Objective: In this study, we sought to understand the mechanisms associated with the benefits of dapagliflozin by evaluating various electrophysiological parameters of the electrocardiogram (ECG) in patients with T2DM. A randomized, multicenter, prospective study with 174 patients with T2DM divided into two groups: one receiving dapagliflozin plus optimized guideline directed medical therapy (GDMT) and the other optimized GDMT without SGLT2 inhibitors. Clinical, electrocardiographic, laboratory, and echocardiographic evaluations were performed initially and after three months. Descriptive and inferential statistics were used, with a significance level of 0.05.

Result: This study shows that in patients treated with dapagliflozin plus GDMT, a significant reduction in the duration of the interval from the peak of the T wave to the end of the T wave (TpTe), the QTc interval, and the ratio between the TpTe/QT intervals was observed, with no change in other electrocardiographic variables such as QT interval dispersion, JT peak interval, or changes in the QRS complex and T wave axes (QRS-T angle).

Conclusion: In patients with T2DM, dapagliflozin significantly shortened the TpTe and QTc intervals, as well as the TpTe/QT ratio. These results suggest a reduction in ventricular electrical remodeling, highlighting a potential cardioprotective effect of dapagliflozin.

Clinical trial registration: https://clinicaltrials.gov/study/NCT06721442, identifier NCT06721442.

Introduction: Oral semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) approved for the treatment of type 2 diabetes mellitus (T2DM). Findings from randomized controlled trials (RCTs) and real-world studies indicate that oral semaglutide leads to significant improvements in HbA1c and body weight, comparable to those observed with injectable GLP-1 RAs. Consequently, oral semaglutide is expected to significantly reduce barriers to initiating GLP-1 RA therapy in individuals with diabetes and may lead to an increased transition from dipeptidyl peptidase-4 inhibitors (DPP-4is) to GLP-1 RA therapy. This study was conducted to prospectively investigate the clinical characteristics predicting the achievement of HbA1c < 7% (52 mmol/mol) in Japanese individuals with T2DM who switched from DPP-4is to oral semaglutide.

Methods: The study enrolled a total of 74 patients who switched from DPP-4is to oral semaglutide between December 2021 and October 2022, with the dose being uptitrated to achieve HbA1c < 7% (52 mmol/mol) in these patients.

Results: The study included a total of 44 individuals who achieved the target with oral semaglutide 3 mg (n=7), 7 mg (n=24), or 14 mg (n=13), and 17 individuals who did not (un-achieved group; n=17), based on their clinical characteristics and hematological findings. In the comparison between the Un-achieved group and the Achieved (3 to 14 mg) group, the proportions of "Current alcohol drinking (p = 0.030)" and "Current alcohol drinking and smoking (p = 0.029)" were higher in the Un-achieved group, whereas the proportion of "Taking 31 minutes or longer to have breakfast after drug administration (p = 0.022)" was higher in the Achieved (3 to 14 mg) group. A logistic regression analysis using the stepwise method identified "No current history of both smoking and alcohol drinking (0.083[0.014-0.485]; p = 0.006)" and "Taking 31 minutes or longer to eat breakfast after drug administration (0.117[0.029-0.480]; p = 0.003)" as factors predicting the achievement of the HbA1c < 7% (52 mmol/mol).

Conclusion: Study findings suggest when considering switching T2D patients from DPP-4is to oral semaglutide, a detailed assessment of "current alcohol drinking and smoking status" and "the duration between the administration of oral semaglutide and breakfast" may be useful as a predictive indicator for achieving HbA1c < 7% (52 mmol/mol).

Introduction: In patients with diabetes intending to fast, Ramadan, risk assessment, and stratification are essential for an individualized treatment plan. It seems that the new IDF-DAR risk stratification tool (International Diabetes Federation - Diabetes and Ramadan Alliance) has become the primary tool in this setting. This study aims to validate this tool in the Abu Dhabi population.

Method: The assessment was performed before Ramadan, followed by an evaluation of any significant outcome after Ramadan through tele-interview and an electronic medical records review. Patients were included if the attending physicians used the tool in the risk assessment of the patients within 6 weeks before Ramadan 1,444 (CE 2022) in the AHS healthcare center.

Results: The study included 435 patients. Half (51.7%) were in the low-risk category of the IDF-DAR risk stratification tool, 28.5% were in the moderate-risk category, and 19.8% were in the higher-risk category. Of the total patients, 81.3% fasted during the entire Ramadan period and 18.7% attempted to fast. A total of 14 (3.8%) patients were admitted at least once, and 56 (12.9%) had at least one significant event, including admission to the hospital. Using univariable logistic regression, the occurrence of adverse events was significantly associated with more days not fasted, B = -0.126, p < 0.001, OR = 0.88 (0.839-0.927). Using multivariable logistic regression, and after controlling for all variables studied, other risk factors identified with the occurrence of adverse events in this study were as follows: being in the low-risk category of the DAR risk assessment tool, B = -1.1, OR = 0.34 (0.157-0.744), p = 0.0072; being in the frail category compared to the reference category, the robust category, B = 1.54, OR = 4.6 (1.3-16.6), p = 0.018; and older age B = -0.034, OR = 0.966 (0.938-0.995). There was no significant difference between moderate- and high-risk categories in the occurrence of significant adverse events (SAEs). Similar determinants of fasting were identified during the entire Ramadan period using multivariable logistic regression.

Conclusion: According to the IDF-DAR risk assessment, patients with diabetes in the low-risk category had a better outcome than those in the moderate- or high-risk categories regarding SAEs. Another independent risk factor is if the patient is frail, according to the FRAIL scoring.

Introduction: Continuous Glucose Monitoring (CGM) systems are crucial in diabetes management, offering clinical and psychological benefits despite operational challenges. Usability assessment of real-time and intermittently-scanned CGM systems is a notable research gap. This study, in collaboration with diabetes patient associations, explores CGM usability from the perspective of Italian individuals with diabetes.

Methods: A roundtable discussion with patient association representatives was conducted to discuss CGM usability, followed by a detailed online survey of 281 Italian patients on CGM usage, satisfaction, and feature preferences.

Results: Findings show a significant positive impact on Quality of Life (87/100) and moderate usability (66/100). Core CGM functions are widely used, while data sharing with healthcare professionals is underutilized. The study offers diverse insights into CGM usability from both the roundtable and survey data.

Conclusions: The study underscores the importance of CGM in diabetes management and highlights the need for continuous technological improvements. It emphasizes the role of patient associations in enhancing communication with manufacturers and CGM education. Effective collaboration between healthcare professionals and patients is vital for optimal CGM use, advocating for personalized care strategies tailored to individual patient needs.

Vitamin D is a hormone which is involved in many physiological processes in addition to bone metabolism and the muscular system. Based on several animal and human studies, it has been established that vitamin D plays an important role in the development of diabetic nephropathy (DN). DN is a frequent and severe chronic microvascular complication of diabetes mellitus (DM). As such, DN and cardiovascular complications are considered the main risk factors for the death of patients with DM. Recent studies have shown the renoprotective effect of VD and its receptor activators (VDRAs or VD analogs based on its effect on endothelial function, preservation of podocytes, anti-inflammatory effect, and direct influence on the renin-angiotensin aldosterone system. The renoprotective effect of VD has been shown to potentially delay the onset of DN, which is the main cause of end stage renal diseases (ESRD). The impact of vitamin D on the recovery of already existing kidney damage is debatable and doubtful. Increasing evidence has shown that the VD/VDR interaction possesses a series of renoprotective effects in DN patients based on the anti-proteinuric, anti-fibrotic, and anti-inflammatory effect, as well as the preventive effect of podocyte damage. Based on this important renoprotective effect, important data for therapeutic and effective methods for DN have also been presented. It was performed a structured search of published research literature for several databases regarding the impact of VD on the pathophysiology of DN as well as its therapeutic implications in terms of renoprotection of VD and VDRA in animal research and human clinical research as RCT, observational studies, systematic reviews and meta-analyses over the last decade.

Background: Hypoglycemia is a major public health problem that negatively influences blood glucose control in the treatment of type 1 diabetes. It has more severe clinical and economic effects in patients living with T1D patients. However, real-world clinical evidence of reported hypoglycemia is limited. Thus, the purpose of the study was to determine the prevalence of self-reported hypoglycemia and its associated factors among patients living with T1Dat the University of Gondar Comprehensive Specialized Hospital (UOGCSH).

Methods: A prospective hospital-based cross-sectional study was conducted among patients living with T1D attending the ambulatory clinic of UOGCSH from November 1, 2021, to April 30, 2022. To select the study participants, a convenient sampling technique was used. Multivariable binary logistic regression was used to identify predictors of self-reported hypoglycemia. A P-value < 0.05 was considered statistically significant and reported as a 95% Confidence Interval (CI).

Results: A total of 216 patients living with T1D (mean age: 50.91 ± 18.98 years) were included. The mean duration of DM diagnosis and insulin use were 9.41 ± 8.00 and 7.10 ± 6.00 years, respectively. Self-reported hypoglycemia was prevalent among 86.6% (95% CI: 82.1-91.0) of the study participants, with 69% experiencing non-severe and 31% experiencing severe hypoglycemia. More than half of the patients, 122 (56.5%), reported experiencing four or more (≥ 4) episodes of hypoglycemia. Knowledge of insulin self-administration, specifically a low level of knowledge (AOR=4.87; 95% CI: 1.55-15.26), was significantly associated with self-reported hypoglycemia. The majority of patients living with T1D, 155 (71.8%), had impaired awareness of hypoglycemia.

Conclusion: Self-reported hypoglycemia was considerably high among Patients living with T1D. Knowledge of insulin self-administration, specifically at a low level, was associated with an increased risk of reported hypoglycemia. Thus, continued health education of Patients living with T1D regarding insulin self-administration and awareness of hypoglycemia symptoms is necessary to prevent further complications.

Diabetes mellitus is a much-studied disorder, characterized by hyperglycemia and numerous oral and medical complications. The latter includes (above all) decreased life-span - and these are widely discussed in the dental and medical literature. The oral complications include impaired wound healing; increased severity of periodontal disease and peri-implantitis; dry mouth (xerostomia); and dental caries. The relationship between diabetes and oral health is bi-directional: Optimal management of local oral disease can profoundly affect the systemic metabolic control of the diabetic patient, and strict management of the patient's hyperglycemia can reduce its impact on oral disease. The only host modulation therapy (HMT), approved by the U.S. Food and Drug Administration (FDA) to treat periodontal disease, is a novel NON-antimicrobial (low-dose) formulation of doxycycline (Periostat^®; 20 mg b.i.d). A publication in Scientific Reports (2017), which supported the clinical rationale of efficacy and safety of low-dose doxycycline in diabetics, stated: "doxycycline not only ameliorated insulin resistance, fasting blood glucose, and insulin levels, and lipid profiles in the circulation and liver, but also improved islet morphology and increased glucose-stimulated insulin secretion." Additional developments include the biphenolic chemically-modified curcumins, as HMT for managing oral diseases. A lead compound, chemically-modified curcumin 2.24 (CMC2.24), has demonstrated safety and efficacy in vitro, in cell culture, and in vivo using mouse, rat, rabbit, and dog models of disease. In conclusion, novel host-modulation compounds have shown significant promise as adjuncts to traditional local therapy in the clinical management of periodontal and other oral diseases.

Background: Diabetes is a leading cause of death, affecting nearly half a billion adults worldwide. With projections indicating a significant increase in prevalence, understanding the genetic factors that contribute to diabetes, particularly type 2, is crucial.

Methods: This study investigated the association of specific polymorphisms with type 2 diabetes (T2D) in the Uzbek population. A total of 165 individuals, including 125 patients with T2D and 40 controls, were genotyped for variants located in the DOCK7, ABCG8, UBE2E2, SYN2, HNF1A, and IGF2BP2 genes using real-time polymerase chain reaction.

Results: The analysis revealed significant associations between these polymorphisms and T2D under various genetic models. The distribution of the genotype frequencies was consistent with the Hardy-Weinberg equilibrium.

Conclusion: The findings of this study underscore the importance of ethnic and geographical diversity in genetic studies and contribute to the understanding of T2D in the Uzbek population. Further research is needed to explore the clinical implications of these genetic associations.

Background: Diabetes mellitus (DM) is linked to complications such as retinopathy, nephropathy, neuropathy, and cardiovascular disease, impacting patient quality of life and increasing healthcare costs. Periodontal disease, more prevalent in diabetic patients, is associated with worsened glycemic control and systemic inflammation, suggesting a possible bidirectional relationship. While some studies indicate periodontal treatment may improve glycemic control and reduce inflammation, overall evidence is inconsistent. It remains unclear if periodontal therapy reliably enhances diabetes outcomes or if certain patient subgroups benefit more than others.

Objective: To systematically review randomized controlled trials (RCTs) evaluating the effects of periodontal therapy on glycemic control (HbA1c) and systemic inflammation (CRP) in type 1 and type 2 diabetes patients.

Methods: Following PRISMA guidelines, a comprehensive PubMed search identified RCTs comparing HbA1c and CRP outcomes in diabetic patients with periodontal therapy versus controls. Inclusion criteria required at least three to six months of follow-up. Meta-analyses using a random effects model were conducted for HbA1c and CRP changes.

Results: Eleven studies met inclusion criteria. Meta-analyses showed significant reductions in HbA1c at three months (-0.64; CI95%=-0.96 to -0.32; I2 = 73%) and six months (-0.33; CI95%=-0.65 to -0.01; I2 = 12%). CRP also declined significantly, indicating an improvement in systemic inflammation.

Conclusion: Periodontal therapy appears to significantly reduce HbA1c and CRP levels over short-term periods in diabetic patients, suggesting potential as a beneficial adjunct to diabetes management. These findings support incorporating periodontal care into diabetes treatment to reduce systemic inflammation and potentially lower healthcare costs. Future long-term, standardized RCTs are needed to confirm sustained effects and investigate responses in diverse patient populations.