Frontiers in clinical diabetes and healthcare最新文献

Background: This study aims to assess the global burden of type 2 diabetes mellitus (T2DM) attributable to low physical activity from 1990 to 2021 and forecast of its global burden by 2050 using GBD 2021 data.

Method: This study uses data from the GBD 2021 to examine the global burden of T2DM attributable to low physical activity, focusing on deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and Years of Life Lost (YLLs). Descriptive analysis was performed across gender, age, region, and country for 1990 and 2021, using age-standardized rates. Trend analysis assessed the average changes in these rates from 1990 to 2021 by calculating the estimated annual percentage change (EAPC). Projections for future burden were made using the exponential smoothing (ES) model and the autoregressive integrated moving average (ARIMA) model.

Result: In 2021, T2DM attributed to low physical activity caused 149,214 deaths and 5,523,050 DALYs, with significant increases since 1990. Both age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate (ASDR) rose, especially among females. The highest burden occurred in the 95+ and 70-74 age groups. High-SDI regions had the highest rates, with rapid increases in the high-middle SDI regions. Countries like the UAE, Montenegro, and Hungary showed the highest rates. Projections from 2022 to 2050 indicate a steady rise in deaths and DALYs, with a peak in 2050, though the rate of increase is slower according to the exponential smoothing model.

Conclusion: The burden of T2DM attributable to low physical activity has steadily increased, with concerning future trends.

Type 2 diabetes mellitus (T2DM) is a common metabolic disorder typically managed with medication; however, fasting has recently attracted attention for its potential benefits in glycemic control, weight management, and even potential remission. This case report examines the effects of repeated long-term fasting on weight reduction, glycemic control, and medication requirements in a 57-year-old man with T2DM. The patient, who had a history of inadequate glycemic control despite conventional treatment, opted for repeated long-term fasting under medical supervision. He completed several fasts ranging from 11 to 20 days each, with each fasting period followed by a gradual reintroduction of food via a hypocaloric lactovegetarian diet (800-1,800 kcal) over 4 to 16 days. The intervention resulted in sustained weight loss and improved blood sugar control. Notably, clinically meaningful improvements occurred in fasting blood glucose levels, which necessitated adjustments in his antidiabetic medications. Enhanced insulin sensitivity was evidenced by decreased HbA1c levels and a reduced dependence on hypoglycemic agents. Additionally, post-fasting evaluations indicated improvements in inflammatory markers and a reduction in fatty liver disease. In summary, repeated long-term fasting in this patient was associated with sustained weight loss, improved glycemic control, and reduced medication requirements, thereby enhancing the overall management of T2DM. Further research, including randomized controlled trials, is needed to better understand the long-term safety and effectiveness of this intervention.

Introduction: Increasing evidence shows that hyperglycemia-induced glucotoxicity and lipotoxicity that usually accompany diabetes development damage the endoplasmic reticulum and mitochondria of the hepatocytes in diabetic patients. Clinical studies highlighted the association between type 2 diabetes mellitus, comorbidities, and medications with liver function. The objective of this study is to explore the association between liver function tests' abnormalities and comorbidities, medications, and other risk factors in type 2 diabetes patients registered in the Best-Care system of the Saudi Ministry of National Guard-Health Affairs.

Methods: This is a cross-sectional study employing a chart of patients diagnosed with type 2 diabetes mellitus. We drew a simple random sample of 523 T2DM patients who had a liver function test from the Best-Care database of the Ministry. We applied various statistical analyses, including Student's independent t-test, Pearson's chi-squared test, Fisher's exact test, and odd ratios, to measure associations between different variables and liver function tests' abnormalities.

Results: About 35% of patients included in this study showed an abnormal level of gamma-glutamyl transferase and prothrombin time. Abnormalities of serum albumin, prothrombin time, and total serum protein tests were significantly associated with age (P < 0.05). Gamma-glutamyl transferase test abnormalities were significantly associated with gender (P < 0.05). The study found associations between several comorbidities and the abnormalities of liver function tests. These tests include the total bilirubin, albumin, total serum protein, gamma-glutamyl trans, international normalized ratio, and alanine aminotransferase. The associations were at significant levels (P < 0.05). Liraglutide was significantly associated with aspartate aminotransferase (OR = 14.40, 95% CI = 2.8, 73.2), while allopurinol was significantly associated with international normalized ratios (OR = 24.67, 95% CI = 2.95, 206.58) and total serum protein (OR = 5.44, 95% CI = 1.43, 20.83).

Discussion: This study is the first to examine the association between type 2 diabetes mellitus and liver function tests' abnormalities in Saudi Arabia. Although the results have a limited generalizability due to inherent biases, the findings align with similar studies in other populations. The study stresses the need to monitor liver functions, especially of T2DM patients who suffer from other conditions.

Background: Type 2 diabetes and lower-extremity peripheral artery disease (PAD) are growing global health problems associated with considerable cardiovascular and limb-related morbidity and mortality, poor quality of life, and high healthcare resource use and costs. Diabetes is a well-known risk factor for PAD, which further increases the risk of long-term complications. The primary aim of this systematic review was to ascertain the aggregated prevalence of PAD among individuals diagnosed with type 2 diabetes mellitus (T2DM) residing in sub-Saharan Africa.

Objective: The aim of this study was to determine the pooled prevalence and associated factors of PAD among patients with T2DM in sub-Saharan Africa.

Methods: A systematic review and meta-analysis was performed in alignment with the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. To identify papers published in English up to 8 November 2024, the electronic databases of Medline, Web of Science, Science Direct, Excerpta Medica Database, Cochrane Library, African Journals Online, and Google Scholar were searched. A random-effects model was employed to estimate the pooled prevalence and associated factors of PAD.

Results: This study revealed that the pooled prevalence of PAD among patients with T2DM was 35.7% [95% confidence interval (CI) 28.7, 42.7], reflecting the significant impact of DM on vascular health with statistically significant heterogeneity observed between studies (I ² = 94.9%, p < 0.001). Age, elevated low-density lipoprotein, elevated body mass index (BMI), and diabetes illness duration exceeding 10 years were the significant predictors.

Conclusion: The aggregate burden of PAD in individuals with T2DM within the sub-Saharan African region is estimated at 35.7%, suggesting that a considerable segment of the sub-Saharan population has been impacted. Epidemiological studies utilizing precise assessment tools can enhance the early detection and prevention of PAD in T2DM and improve the certainty of findings.

Clinical implication: There is a need for integrated care approaches that prioritize the screening and management of PAD in individuals with T2DM. Given the high prevalence and associated complications, healthcare providers should implement routine PAD assessments in diabetes care protocols. Future research should focus on longitudinal studies that explore the causal relationships between risk factors and the development of PAD in patients with T2DM.

Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42024611838.

Aims/introduction: Diabetic retinopathy (DR) often remains asymptomatic until it reaches advanced stages, when delayed treatment can lead to irreversible visual impairment. To promote timely ophthalmology visits, this study investigated the utility of a simple nerve conduction device, DPNCheck^®, as a predictor of DR severity. Previous research has established a relationship between diabetic neuropathy (assessed by conventional nerve conduction studies) and DR progression; however, the specialized equipment and expertise required limit its practicality. In contrast, DPNCheck^® is a simpler alternative that quantifies neuropathy severity through the severity of the estimated modified Baba classification (eMBC).

Materials and methods: Using electronic medical records (EHRs), we identified individuals with diabetes who underwent DPNCheck^® and subsequent ophthalmologic assessment for DR. Based on age and sural nerve conduction data, an eMBC was calculated. Meanwhile, DR severity was scored using a modified Davis classification, defining four stages (DR severity scores 0-3).

Results: Of 181 individuals extracted from our hospital's EHRs, 146 were eligible for analysis. Ordinal logistic regression showed that eMBC was significantly associated with DR stage, independent of diabetes duration and HbA1c. Receiver operating characteristic (ROC) curve analyses yielded eMBC cut-off values of 1.11, 1.51, and 1.51 to predict DR severity scores of ≥1, ≥2, and ≥3, respectively. Sensitivities ranged from 0.67 to 0.78, and specificities from 0.66 to 0.81. An eMBC of 1.51 or above was strongly associated with preproliferative or proliferative DR, indicating a need for urgent ophthalmology referral.

Conclusions: DPNCheck^®, a simple nerve conduction measurement device, may help predict DR severity and facilitate timely ophthalmologic care.

Diabetes mellitus is chronic disease with increasing prevalence, and may cause many organ complications, including kidneys. Reduced creatinine clearance and kidney failure are important, but hyperkalemia may be present in diabetic patients even before these problems. There may be many reasons of hyperkalemia in this group of patients. Type IV renal tubular acidosis is important cause of generally mild hyperkalemia, and it is a treatable condition. ''Polypharmacy'' -which is very common in diabetic patients due to accompanying other diseases- may trigger electrolyte imbalance. Underlying causes should be investigated and treatment should be done before it worsens.

Traditionally, Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs), a pivotal class of drug, mimics the actions of endogenous Glucagon-like peptide-1, which have been found to be remarkable in the treatment of type 2 diabetes alongside other comorbidities. GLP-1 receptors being widely available in the different organs and tissues such as the brain, lung, pancreas, stomach, heart, and endometrium has explained the broader therapeutic application of GLP-1RA. The recent studies have explored the physiological effects of GLP-1RA on body organs, establishing them as a potential therapeutic option for a wide range of diseases. Activation of GLP-1 receptors contribute to regulation of blood glucose levels, weight management, cardiovascular health, and potential neuroprotection, while also having a positive influence on musculoskeletal health. This review has emphasized the expanded role of GLP-1RA by highlighting the most significant and notable studies. While GLP-1RA has proven clinical efficacy, the need for more comprehensive studies, to ensure their long-term safety, is essential to optimize their therapeutic role and improve patient outcomes on a global scale. Addressing the significant gap for research on cost effectiveness of these drugs is also crucial for their accessibility in comparison to other drugs. Nevertheless, the limited data available calls for a platform for future research to carry out the expanded therapeutic effects of GLP-1RA.

Background: This study examines the correlation between skin autofluorescence (SAF) and blood glucose levels, emphasizing the accumulation of advanced glycation end-products (AGEs). We hypothesize that SAF levels are closely linked to type 1 diabetes complications in children. The aim is to evaluate SAF's relationship with type 1 diabetes progression in children and its potential as a non-invasive tool for disease detection and monitoring complications. The research was registered with PROSPERO (CRD42021284774).

Methods: We conducted a meta-analysis by extracting studies from databases including PubMed, MEDLINE, EMBASE, Cochrane, Science Direct, Scopus, and Web of Science. A random effects model was used to assess if SAF measurement could serve as a non-invasive marker for type 1 diabetes and its complications. SAF values were compared between children with type 1 diabetes and controls, calculating the mean difference and 95% confidence intervals.

Results: The analysis included three case-control studies and one retrospective cohort study, all using the AGE Reader^® (DiagnOptics Technologies). Data analysis showed significant heterogeneity (I² = 82%, P < 0.05). The random effects model revealed a positive correlation between higher SAF levels and type 1 diabetes in children [mean difference = 0.20 (0.16, 0.25)], indicating elevated SAF in diabetic children compared to non-diabetic peers.

Conclusion: This research supports SAF measurement as a non-invasive indicator for type 1 diabetes and its complications in children. However, further studies with larger samples and longer follow-up are needed for definitive conclusions and detailed insights into complications. Additionally, the skin's multifaceted roles require further investigation.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021284774.