Frontiers in clinical diabetes and healthcare最新文献

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder characterized by the destruction of pancreatic β-cells, necessitating lifelong exogenous insulin. This review synthesizes key advances that are shifting T1DM management from symptomatic control to disease modification and potential cure. We examine progress in novel insulin formulations and automated insulin delivery systems, alongside groundbreaking immunomodulatory therapies and gene-edited stem cell therapies that aim to restore native β-cell function and achieve insulin independence. The article also discusses the potential of phytomedicines and gut microbiota modulation. This review provides insights into the unique challenges of implementing these innovations within the Chinese healthcare context, highlighting the need for high-quality clinical research, personalized strategies, and improved healthcare accessibility to enhance long-term patient outcomes.

Introduction: There are limited data regarding the role of oral glucose tolerance test (OGTT) in classifying glycemic alterations in patients with adrenal incidentaloma (AI). This study aims to compare the frequency of dysglycemia [pre-diabetes mellitus (DM) and DM] among patients with non-functioning adrenal incidentalomas (NFAI), mild autonomous cortisol secretion (MACS), and controls; and to assess the area under the curve (AUC) in the OGTT and determine whether the OGTT was decisive in diagnosing dysglycemia in each population.

Methods: A cross-sectional study was conducted on 65 NFAI (1mg-dexamethasone suppression test [DST] ≤1.8μg/dL), 45 MACS (1mg-DST ≥1.9μg/dL), and 56 controls. The control group was selected based on normal adrenal imaging. Patients were classified as normoglycemic or dysglycemic based on fasting glucose, glycated hemoglobin, and OGTT.

Results: AUC >290mg.h/dL was found in 75% of MACS, 55% of NFAI, and 22% of controls (p=0.008). The presence of AI was determinant for this result. Glucose levels ≥155 mg/dL at the 1-hour during the OGTT were observed in 75% of MACS, 65% of NFAI, and 28% of controls (p=0.01). Dysglycemia frequency was higher in MACS and NFAI than controls (91.1 vs. 90.8 vs. 73.2%; p=0.01). The OGTT changed the classification in 27% of MACS, 23% of NFAI, and 3% of controls (p=0.03). Presence of AI increased the odds ratio for benefiting from OGTT to obtain a more accurate dysglycemia classification by 9.5 times.

Conclusion: Patients with AI had a higher dysglycemia frequency, and a significant number of these patients benefited from OGTT in classifying glycemic alterations.

The obesity paradox describes a counterintuitive phenomenon where overweight or mildly obese individuals with chronic diseases show better survival compared to those with normal weight. While this paradox has been reported in conditions such as heart failure and type 2 diabetes, its presence in type 1 diabetes (T1D) remains uncertain. This mini review summarizes current evidence from large cohort studies and a meta-analysis examining the association between body mass index (BMI) and clinical outcomes in individuals with T1D. Most findings do not support a protective effect of higher BMI; instead, both underweight and obesity are associated with increased risks of cardiovascular events and all-cause mortality. Notably, some evidence suggests that individuals with advanced diabetic nephropathy or chronic kidney disease (CKD) may show the lowest mortality at mildly elevated BMI levels. However, these observations may reflect the limitations of using BMI alone to evaluate obesity. Given that individuals with T1D often have reduced skeletal muscle mass, and that those with advanced diabetic complications or comorbidities such as CKD or cancer may develop cachexia, body composition analysis is essential. Accurate assessment of fat mass, muscle mass, bone mass, and water content is critical for understanding obesity-related risks. Future research should integrate body composition metrics to improve risk stratification in T1D.

Objective: This study constructed a tertiary hospital-community health service center diabetes linkage management model with the participation of clinical pharmacists, assessed the changes in clinical indicators and medication treatment of patients with type 2 diabetes before and after the implementation of the model, and evaluated the model, with a view to providing a model reference in the participation of clinical pharmacists in the management of type 2 diabetes and other chronic diseases. Given the current situation that diabetes management at the community level in China is still unsatisfactory, with an HbA1c control rate of less than 10% compared to about 50% in tertiary hospitals, there is an urgent need to explore innovative, pharmacist-involved models to bridge this gap.

Methods: Using the principle of randomization, patients who met the enrollment criteria were divided into the experimental group and the control group. A total of 210 patients were enrolled from three community health service centers in Nanjing in collaboration with Drum Tower Hospital, and were followed up for 12 months. Clinical indicators and medication adherence were used as evaluation endpoints to compare the differences in management effects between the two groups. This study was registered with the Chinese Clinical Trial Registry (ChiCTR2300074444).

Results: Under the diabetes linkage management model, patients in the intervention group showed improvement in blood glucose, glycated hemoglobin and other indicators compared with the control group; the medication adherence score of patients in the intervention group was significantly higher than that of the control group.

Conclusion: The clinical efficacy and medication level of diabetic patients were significantly improved after management by this management model, which provides a reference for clinical pharmacists to carry out pharmacy services in the context of hierarchical diagnosis and treatment. This model may contribute to narrowing the quality gap between tertiary hospitals and community health service centers in diabetes care.

Introduction: Chronic kidney disease (CKD) may improve with appropriate management and close monitoring to prevent the risk of progression to end-stage kidney disease (ESKD). The present study aimed to determine oxidative damage and DNA repair in early kidney disease in patients with and without type 2 diabetes (T2D).

Methods: Using ELISA, serum levels of the oxidative DNA damage marker (8OHdG) and the DNA repair marker (hOGG1) were determined in 100 patients with T2D and 88 without T2D in stages 1, 2, and 3 of CKD.

Results: The mean number of years of T2D in patients in stages 1, 2, and 3 was 13.93 ± 2.09 years. Significantly increased levels of the 8-OHdG marker were found in stage 3 CKD patients with T2D, 4.96(4.17-5.08) ng/mL vs. 4.13(3.49-4.60) ng/mL without T2D (p=0.006). hOGG1 enzyme levels were significantly decreased in patients with T2D from stage 2, 0.08(0.063-0.082) ng/mL vs. 0.37(0.18-0.36) ng/mL, (p=0.006) and in stage 3 with T2D 0.09(0.08-0.11) ng/mL vs. 0.53(0.07-0.96) ng/mL without T2D (p=0.007). A positive correlation was found between CKD stage and hOGG1 levels in patients with T2D (rho=0.473, p<0.001). 8-OHdG concentration showed an inverse correlation with CKD stage in patients without T2D (rho=-0-274, p=0.030). In conclusion, we found an imbalance of DNA repair enzymes in stages 2 and 3 of CKD in T2D patients and an increase of oxidative DNA damage markers in stage 3 of CKD in T2D patients. Determination of DNA damage and repair markers in the early stages of CKD may facilitate timely diagnosis and treatment of CKD.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used to improve glycemic control and induce weight loss in individuals with type 2 diabetes (T2D), yet treatment responses vary significantly among individuals. Eating behavior has been hypothesized to influence therapeutic efficacy, but supporting evidence remains limited.

Methods: In this multicenter, prospective observational study, we enrolled 92 individuals with T2D initiating GLP-1RA therapy (liraglutide, dulaglutide, oral semaglutide, or injectable semaglutide) at four institutions in Gifu Prefecture, Japan. Participants were assessed at baseline, 3 months, and 12 months for clinical parameters, dietary intake, and eating behaviors using validated tools (Food Frequency Questionnaire and the Japanese version of the Dutch Eating Behavior Questionnaire [DEBQ-J]). Primary and secondary outcomes included changes in HbA1c, body weight, and eating behavior patterns over 12 months.

Results: GLP-1RA therapy significantly reduced HbA1c, body weight, and body fat percentage at 12 months. Notably, external eating scores showed a sustained decrease, while emotional and restrained eating scores exhibited transient changes. Higher baseline external eating scores were independently associated with greater weight reduction and showed a trend toward enhanced glycemic improvement. No significant associations were observed between emotional or restrained eating scores and clinical outcomes.

Conclusion: This study demonstrates that GLP-1RAs improve both metabolic parameters and external eating behavior in T2D individuals. External eating emerged as a potential behavioral marker predictive of treatment response. These findings suggest that integrating eating behavior assessments may help personalize GLP-1RA therapy and optimize outcomes in clinical practice.

Clinical trial registration: UMIN Clinical Trials identifier, UMIN000045362.

Introduction: Food insecurity is a multidimensional issue that has been related with poor overall health, obesity and chronic diseases and not only related with increased prevalence of diabetes but also with increasing health care expenses. There is paucity of researches conducted to assess food insecurity and its associated factors among adult diabetic clients in Ethiopia. Hence this study was aimed to assess food insecurity and its associated factors among adult diabetic patients in Gambella town public hospitals.

Methods: A facility based cross sectional study was conducted among adult diabetic clients in Gambella town public hospital from May 1 to June 30, 2023. A systematic sampling technique was used to select a sample of 412 patients. Data were collected by trained data collectors using structured questionnaires. Data were checked for its completeness and consistence then entered into Epidata 4.6 and transported to SPSS version 26 for analysis. Bivariate analysis was done to make variables candidate for multivariate analysis at p-value <0.25. In multivariate analysis AOR with 95% CI were used to declare factors associated with food insecurity at p-value <0.05.

Results: The prevalence of food insecurity was found to be 59.5% (95% CI: 54.6%-64.3%). In multivariate analysis the variables age 18 to 24 years (AOR=0.093,95% CI:0.02-0.30), able to read and write (AOR=4.31, CI:1.246-11.250), employed (AOR=0.20; 95% CI: 0.063-0.63), low wealth status (AOR=3.02, CI:1.265-4.788) OR=2.46, CI:1.265-4.788), medium wealth status (AOR=1.88, CI:1.002-3.815). Family size (AOR=0.48; 95% CI: 0.27-0.87), and family history of diabetes (AOR=2.86, CI: 1.43- 5.72) were significantly associated with food insecurity. income and (AOR=1.88, CI:1.002-3.815).

Conclusion and recommendations: The prevalence of food insecurity among adult diabetic patients was high. Therefore, health professionals should give emphasis to encourage self-management for those who have family history of diabetes in order to screen the clients at early before the occurrence of DM complication and health care expenditure.