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Leveraging a genetically-informative study design to explore depression as a risk factor for type 2 diabetes: Rationale and participant characteristics of the Mood and Immune Regulation in Twins Study. 利用基因信息研究设计探索抑郁症作为 2 型糖尿病风险因素的可能性:双胞胎情绪与免疫调节研究的原理与参与者特征。
Pub Date : 2023-03-17 eCollection Date: 2023-01-01 DOI: 10.3389/fcdhc.2023.1026402
Briana Mezuk, Kristen Kelly, Erica Bennion, Jeannie B Concha

Background: Comorbidity between depression and type 2 diabetes is thought to arise from the joint effects of psychological, behavioral, and biological processes. Studies of monozygotic twins may provide a unique opportunity for clarifying how these processes inter-relate. This paper describes the rationale, characteristics, and initial findings of a longitudinal co-twin study aimed at examining the biopsychosocial mechanisms linking depression and risk of diabetes in mid-life.

Methods: Participants in the Mood and Immune Regulation in Twins (MIRT) Study were recruited from the Mid-Atlantic Twin Registry. MIRT consisted of 94 individuals who do not have diabetes at baseline, representing 43 twin pairs (41 monozygotic and 2 dizygotic), one set of monozygotic triplets, and 5 individuals whose co-twin did not participate. A broad set of variables were assessed including psychological factors (e.g., lifetime history major depression (MD)); social factors (e.g., stress perceptions and experiences); and biological factors, including indicators of metabolic risk (e.g., BMI, blood pressure (BP), HbA1c) and immune functioning (e.g., pro- and anti-inflammatory cytokines), as well as collection of RNA. Participants were re-assessed 6-month later. Intra-class correlation coefficients (ICC) and descriptive comparisons were used to explore variation in these psychological, social, and biological factors across time and within pairs.

Results: Mean age was 53 years, 68% were female, and 77% identified as white. One-third had a history of MD, and 18 sibling sets were discordant for MD. MD was associated with higher systolic (139.1 vs 132.2 mmHg, p=0.05) and diastolic BP (87.2 vs. 80.8 mmHg, p=0.002) and IL-6 (1.47 vs. 0.93 pg/mL, p=0.001). MD was not associated with BMI, HbA1c, or other immune markers. While the biological characteristics of the co-twins were significantly correlated, all within-person ICCs were higher than the within-pair correlations (e.g., HbA1c within-person ICC=0.88 vs. within-pair ICC=0.49; IL-6 within-person ICC=0.64 vs. within-pair=0.54). Among the pairs discordant for MD, depression was not substantially associated with metabolic or immune markers, but was positively associated with stress.

Conclusions: Twin studies have the potential to clarify the biopsychosocial processes linking depression and diabetes, and recently completed processing of RNA samples from MIRT permits future exploration of gene expression as a potential mechanism.

背景:抑郁症和 2 型糖尿病之间的合并症被认为是由心理、行为和生物过程的共同作用引起的。对单卵双生子的研究可为阐明这些过程之间的相互关系提供一个独特的机会。本文介绍了一项纵向同卵双胞胎研究的原理、特点和初步发现,该研究旨在探讨抑郁症与中年糖尿病风险之间的生物-心理-社会机制:双胞胎情绪与免疫调节(MIRT)研究的参与者是从大西洋中部双胞胎登记处招募的。MIRT由94名基线时未患糖尿病的个体组成,其中包括43对双胞胎(41对单卵双胞胎和2对双卵双胞胎)、一组单卵三胞胎和5名未参与研究的同卵双胞胎。对一系列广泛的变量进行了评估,包括心理因素(如终生重度抑郁症病史)、社会因素(如压力感知和经历)和生物因素,包括代谢风险指标(如体重指数、血压、血糖)和免疫功能(如促炎和抗炎细胞因子),以及 RNA 采集。参与者在 6 个月后接受再次评估。使用类内相关系数(ICC)和描述性比较来探讨这些心理、社会和生物因素在不同时间段和不同组内的变化:平均年龄为 53 岁,68% 为女性,77% 为白人。1/3的人有MD病史,18对兄弟姐妹的MD不一致。MD与较高的收缩压(139.1 vs. 132.2 mmHg,p=0.05)和舒张压(87.2 vs. 80.8 mmHg,p=0.002)以及IL-6(1.47 vs. 0.93 pg/mL,p=0.001)有关。MD与体重指数(BMI)、HbA1c或其他免疫指标无关。虽然同卵双胞胎的生物特征具有显著相关性,但所有的人内 ICC 均高于对内相关性(例如,HbA1c 人内 ICC=0.88 vs. 对内 ICC=0.49;IL-6 人内 ICC=0.64 vs. 对内 ICC=0.54)。在MD不一致的配对中,抑郁与代谢或免疫标记物没有实质性关联,但与压力呈正相关:结论:双生子研究有可能阐明抑郁症与糖尿病之间的生物心理社会过程,最近完成的 MIRT RNA 样本处理工作允许未来探索基因表达这一潜在机制。
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引用次数: 0
Effectiveness of educational intervention in improving medication adherence among patients with diabetes in Klang Valley, Malaysia 教育干预在改善马来西亚巴生谷糖尿病患者药物依从性方面的有效性
Pub Date : 2023-03-13 DOI: 10.3389/fcdhc.2023.1132489
Emmanuel Timilehin Atolagbe, P. Sivanandy, P. Ingle
Background The diabetes patients’ adherence to prescription medication is 67.5%, which is lower than that of patients with any other medical conditions. Patients with low medication adherence are more likely to experience clinical complications, repeated hospitalizations, increased mortality, and increased healthcare costs, hence, education on disease and medication adherence is vital now. This study aimed to assess the level of medication adherence, medicine and information-seeking behaviour, and the effectiveness of online educational intervention in improving medication adherence and medicine and information-seeking behaviours among patients with diabetes in Klang Valley, Malaysia. Methods Individuals aged 12 years and above with a prior diagnosis of diabetes were identified and randomly divided into (control (n=183), and intervention groups (n = 206). Data about their medication adherence and information-seeking behaviour were obtained. As part of the online educational intervention, a month of daily general reminders to take their medications and educational materials about diabetes had provided to them via WhatsApp groups. After a month, the groups were reassessed, and the data were compared. Results The results showed that, at baseline, most of the respondents in the control (58.8% females and 53.08% males) and intervention (65.52% females and 85.12% males) groups had a low level of medication adherence. After a month of intervention, medication adherence was significantly improved in the intervention group (91.4% females and 71.28% males) compared to the control group (38.23% females and 44.44% males). At baseline, only 96 (52.45%) respondents in the control group and 110 (52.38%) in the intervention group preferred to read online educational materials to know more about their condition(s), it was improved after a month of intervention in the intervention group where 204 (99.02%) respondents prefer online materials, however no change in the control group response. Conclusion The study concludes that medication adherence and information-seeking behaviours among the study population have been significantly improved after a month of structured intervention. Medication adherence plays a crucial role in risk reduction strategies subsequently it improves the patient’s quality of life. Thus, well-planned more robust educational interventions on chronic diseases are warranted to improve the health outcomes of the patients.
背景糖尿病患者对处方药的依从性为67.5%,低于其他疾病患者。药物依从性低的患者更有可能出现临床并发症、反复住院、死亡率增加和医疗成本增加,因此,对疾病和药物依从性的教育现在至关重要。本研究旨在评估马来西亚巴生谷糖尿病患者的药物依从性、药物和信息寻求行为水平,以及在线教育干预在改善药物依从性和药物和信息寻找行为方面的有效性。方法将12岁及以上既往诊断为糖尿病的患者随机分为对照组(n=183)和干预组(n=206)。获得了关于他们药物依从性和信息寻求行为的数据。作为在线教育干预的一部分,通过WhatsApp群组向他们提供了一个月的日常药物提醒和糖尿病教育材料。一个月后,对各组进行了重新评估,并对数据进行了比较。结果结果显示,在基线时,对照组(58.8%女性和53.08%男性)和干预组(65.52%女性和85.12%男性)的大多数受访者的药物依从性水平较低。干预一个月后,与对照组(38.23%的女性和44.44%的男性)相比,干预组(91.4%的女性和71.28%的男性)的药物依从性显著改善。在基线时,对照组只有96名(52.45%)受访者和干预组只有110名(52.38%)受访者更喜欢阅读在线教育材料来了解更多关于他们病情的信息。干预组在干预一个月后有所改善,其中204名(99.02%)受访者更爱在线材料,但对照组的反应没有变化。结论经过一个月的结构化干预,研究人群的药物依从性和信息寻求行为得到了显著改善。药物依从性在降低风险策略中起着至关重要的作用,随后它提高了患者的生活质量。因此,有必要对慢性病采取计划周密、更有力的教育干预措施,以改善患者的健康状况。
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引用次数: 2
Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A qualitative study applying the Theoretical Domains Framework. 曾患妊娠糖尿病的妇女进行 2 型糖尿病筛查的障碍和促进因素:应用理论领域框架的定性研究。
Pub Date : 2023-02-24 eCollection Date: 2023-01-01 DOI: 10.3389/fcdhc.2023.1086186
Amelia J Lake, Amelia Williams, Adriana C H Neven, Jacqueline A Boyle, James A Dunbar, Christel Hendrieckx, Melinda Morrison, Sharleen L O'Reilly, Helena Teede, Jane Speight

Introduction: Women with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content.

Research design and methods: Semi-structured interviews with participants recruited via Australia's National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify 'important' domains which we then mapped to the Capability, Opportunity, Motivation-Behavior (COM-B) model.

Results: Nineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: 'knowledge', 'memory, attention, and decision-making processes', 'environmental context and resources', 'social influences', 'emotion', 'beliefs about consequences', 'social role and identity', and 'beliefs about capabilities'. Study strengths include a methodologically rigorous design; limitations include low recruitment and homogenous sample.

Conclusions: This study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM. .

导言:曾患妊娠糖尿病(GDM)的妇女罹患 2 型糖尿病(T2D)的风险更高。指南建议产后糖尿病筛查(口服葡萄糖耐量试验或 HbA1c)一般在婴儿出生后 6-12 周进行,并在此后定期进行筛查。尽管如此,仍有一半左右的妇女没有接受筛查,这意味着错过了早期识别糖尿病前期或 2 型糖尿病的重要机会。虽然政策和实践层面的建议是全面的,但个人层面的建议主要侧重于提高筛查知识和风险意识,可能会忽略其他有影响力的行为决定因素。我们的目的是找出影响曾患妊娠糖尿病的澳大利亚妇女产后 2 型糖尿病筛查的可改变的个人层面因素,并推荐干预功能和行为改变技术,作为干预内容的基础:采用基于理论领域框架(TDF)的指南,对通过澳大利亚国家妊娠糖尿病登记处招募的参与者进行半结构式访谈。我们采用归纳-演绎法,根据 TDF 领域对数据进行编码。我们使用既定标准确定 "重要 "领域,然后将其映射到能力、机会、动机-行为(COM-B)模型中:结果:19 名妇女参加了调查:年龄(34 ± 4)岁,产后(19 ± 4)个月,63%在澳大利亚出生,90%居住在大都市,58%根据指南筛查出患有 T2D。确定了八个 TDF 领域:知识"、"记忆、注意力和决策过程"、"环境背景和资源"、"社会影响"、"情绪"、"对后果的信念"、"社会角色和身份 "以及 "对能力的信念"。研究的优点包括方法严谨;不足之处包括招募人数少和样本单一:本研究为曾患 GDM 的妇女产后筛查 T2D 找出了许多可改变的障碍和促进因素。通过与 COM-B 的映射,我们确定了干预功能和行为改变技术,为干预内容奠定了基础。这些发现为制定信息和干预措施提供了宝贵的证据基础,这些信息和干预措施针对的是最有可能优化曾患 GDM 的妇女接受 T2D 筛查的行为决定因素。.
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引用次数: 0
A critical review of the relationship between type 1 diabetes mellitus, inhibition, and behavioral management. 对 1 型糖尿病、抑制和行为管理之间关系的批判性回顾。
Pub Date : 2023-02-01 eCollection Date: 2022-01-01 DOI: 10.3389/fcdhc.2022.1080415
Neville Dean Robertson, Elmari Deacon, Karel Botha

Type 1 diabetes mellitus (T1DM) is a chronic and lifelong condition that requires adequate behavior management in order to meet desired health outcomes. The effects of T1DM on the neurocognitive functioning of affected individuals raise concerns about how the disease may influence executive functioning. Inhibition is a core component of executive functioning, and plays a vital role in self-regulation and the restriction of impulsive behaviors. Inhibition may thus play a vital role in the behavior management of people with T1DM. The aim of this study was to identify current gaps in existing knowledge regarding the relationship between T1DM, inhibition, and behavior management. This study employed a critical review design to analyze and synthesize the current scientific literature. Twelve studies were identified through an appraisal process, and the data extracted were thematically analyzed and integrated. The findings of this study indicate that a possible cycle arises between these three constructs, in which T1DM affects inhibition, inhibition affects behavior management, and poor behavior management affects inhibition. It is recommended that future research should focus more specifically on this relationship.

1 型糖尿病(T1DM)是一种慢性终生疾病,需要适当的行为管理才能达到预期的健康效果。T1DM 对患者神经认知功能的影响引起了人们对该疾病如何影响执行功能的关注。抑制是执行功能的核心组成部分,在自我调节和限制冲动行为方面起着至关重要的作用。因此,抑制在 T1DM 患者的行为管理中可能扮演着重要角色。本研究旨在找出 T1DM、抑制和行为管理之间关系的现有知识空白。本研究采用批判性综述设计来分析和综合当前的科学文献。通过鉴定过程确定了 12 项研究,并对提取的数据进行了专题分析和整合。研究结果表明,T1DM 影响抑制,抑制影响行为管理,不良行为管理又影响抑制,这三个因素之间可能存在一个循环。建议今后的研究应更具体地关注这种关系。
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引用次数: 0
Effective assay technologies fit for large-scale population screening of type 1 diabetes. 适合大规模人群 1 型糖尿病筛查的有效检测技术。
Pub Date : 2023-01-23 eCollection Date: 2022-01-01 DOI: 10.3389/fcdhc.2022.1034698
Xiaofan Jia, Liping Yu

While worldwide prevention efforts for type 1 diabetes (T1D) are underway to abrogate or slow progression to diabetes, mass screening of islet autoantibodies (IAbs) in the general population is urgently needed. IAbs, the most reliable biomarkers, play an essential role in prediction and clinical diagnosis of T1D. Through laboratory proficiency programs and harmonization efforts, a radio-binding assay (RBA) has been well established as the current 'gold' standard assay for all four IAbs. However, in view of the need for large-scale screening in the non-diabetic population, RBA consistently faces two fundamental challenges, cost-efficiency and disease specificity. While all four IAbs are important for disease prediction, the RBA platform, with a separate IAb test format is laborious, inefficient and expensive. Furthermore, the majority of IAb positivity in screening, especially from individuals with single IAb were found to be low risk with low affinity. It is well documented from multiple clinical studies that IAbs with low affinity are low risk with less or no disease relevance. At present, two non-radioactive multiplex assays, a 3-assay ELISA combining three IAbs and a multiplex ECL assay combining all four IAbs, have been successfully used as the primary methods for general population screenings in Germany and the US, respectively. Recently, the TrialNet Pathway to Prevention study has been organizing an IAb workshop which aims to analyze the 5-year T1D predictive values of IAbs. A T1D-specific assay with high efficiency, low cost and requiring low volume of sample will definitely be necessary to benefit general population screening.

虽然全世界都在努力预防 1 型糖尿病(T1D),以消除或延缓糖尿病的发展,但在普通人群中大规模筛查胰岛自身抗体(IAbs)仍是当务之急。IAbs是最可靠的生物标志物,在T1D的预测和临床诊断中起着至关重要的作用。通过实验室能力计划和协调努力,放射结合测定(RBA)已被确立为目前所有四种 IAbs 的 "黄金 "标准测定方法。然而,鉴于需要在非糖尿病人群中进行大规模筛查,放射结合测定始终面临着两个基本挑战:成本效益和疾病特异性。虽然所有四种 IAb 对疾病预测都很重要,但采用独立 IAb 检测形式的 RBA 平台费力、低效且昂贵。此外,筛查中发现的大多数 IAb 阳性,尤其是来自单个 IAb 阳性的个体,都是低亲和力的低风险个体。多项临床研究充分表明,低亲和力的 IAb 是低风险的,与疾病的相关性较低或没有。目前,德国和美国已分别成功地将两种非放射性的多重检测方法--结合三种 IAb 的三重 ELISA 检测法和结合所有四种 IAb 的多重 ECL 检测法--作为普通人群筛查的主要方法。最近,TrialNet Pathway to Prevention 研究组织了一次 IAb 研讨会,旨在分析 IAbs 的 5 年 T1D 预测值。高效、低成本、低样本量的 T1D 特异性检测对普通人群筛查的益处是绝对必要的。
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引用次数: 2
Hyperinsulinemia: an early biomarker of metabolic dysfunction. 高胰岛素血症:代谢功能障碍的早期生物标志物。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1159664
Rama A Vaidya, Sharvari Desai, Panchali Moitra, Sheryl Salis, Shubhada Agashe, Rekha Battalwar, Anushree Mehta, Jagmeet Madan, Soumik Kalita, Shobha A Udipi, Ashok B Vaidya

Introduction: Hyperinsulinemia in the absence of impaired glucose tolerance and normal HbA1c is considered indicative of pre-diabetes. Very few Indian studies have focused on hyperinsulinemia particularly in young adults. The present study aimed to determine whether hyperinsulinemia may be present despite HbA1c being normal.

Methods: This was a cross-sectional study conducted on adolescents and young adults aged 16-25 years living in Mumbai, India. The participants attended various academic institutions and were those who underwent screening as the first step of a clinical trial for studying the efficacy of almond intake in prediabetes.

Results: Among this young population (n=1313), 4.2% (n=55) of the participants were found to be prediabetic (ADA criteria) and 19.7% of them had HbA1c levels between 5.7%-6.4%. However, almost, 30.5% had hyperinsulinemia inspite of normal blood glucose levels and normal HbA1c. Among those with HbA1c<5.7 (n=533), 10.5% (n=56) participants had fasting insulin>15 mIU/L and a higher percentage (39.4%, n=260) had stimulated insulin above 80 mIU/L. These participants had higher mean anthropometric markers than those with normal fasting and/or stimulated insulin.

Conclusion: Hyperinsulinaemia in the absence of impaired glucose tolerance and normal HbA1c may provide a much earlier indicator of detection for risk of metabolic disease and progression to metabolic syndrome and diabetes mellitus.

在没有糖耐量受损和HbA1c正常的情况下,高胰岛素血症被认为是糖尿病前期的指示。很少有印度研究关注高胰岛素血症,特别是在年轻人中。本研究旨在确定在HbA1c正常的情况下是否存在高胰岛素血症。方法:这是一项横断面研究,对居住在印度孟买的16-25岁的青少年和年轻人进行了研究。参与者参加了不同的学术机构,他们接受了筛选,作为研究杏仁摄入对前驱糖尿病疗效的临床试验的第一步。结果:在这些年轻人群(n=1313)中,4.2% (n=55)的参与者被发现为糖尿病前期(ADA标准),19.7%的人HbA1c水平在5.7%-6.4%之间。然而,尽管血糖水平和HbA1c正常,但仍有近30.5%的人患有高胰岛素血症。在hba1c为15 mIU/L的患者中,刺激胰岛素超过80 mIU/L的比例较高(39.4%,n=260)。这些参与者的平均人体测量指标高于正常禁食和/或胰岛素刺激的参与者。结论:在糖耐量不受损和HbA1c正常的情况下,高胰岛素血症可能为代谢性疾病和进展为代谢综合征和糖尿病的风险提供更早的检测指标。
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引用次数: 2
Nutrition education to type 1 diabetes patients: few changes over the time. 1型糖尿病患者的营养教育:随时间变化不大。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1243237
Aurélien Clerc
COPYRIGHT © 2023 Clerc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Opinion PUBLISHED 29 August 2023 DOI 10.3389/fcdhc.2023.1243237
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引用次数: 1
Psychological care of patients during the pancreas transplantation process: issues and prospects. 胰腺移植过程中患者的心理护理:问题与展望。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1205964
Vasiliki Galani, Orianne Villard, Valérie Olivier, Andrea Peloso, Philippe Compagnon, Fadi Haidar, Paco Prada

Pancreas transplantation for patients with type 1 diabetes is a therapeutic option when other treatments are not effective and physical complications occur. Psychological burden is prominent in patients, and non-adherence to treatment is often one manifestation of such difficulties. Time projection is an important factor affected by chronic disease. The prospect of transplantation has the potential to repair this disruption. It could re-establish a continuity in the patient's self and history, by connecting the future to a life that was only about past and present. Taking care of oneself, adhering to treatment, being part of a long-term therapeutic project and going through transplantation are all processes that need a good ability to self-project in time. This is specifically a domain of psychotherapeutic interventions. In this article, the psychological implications of pancreas transplantation for patients and caregivers alike will be discussed, as well as the role of the psychiatrist in the transplantation process.

胰腺移植是1型糖尿病患者在其他治疗无效和出现身体并发症时的治疗选择。患者心理负担突出,不坚持治疗往往是这种困难的表现之一。时间投射是影响慢性疾病的重要因素。移植的前景有可能修复这种破坏。它可以通过将未来与只关于过去和现在的生活联系起来,重新建立病人自我和历史的连续性。照顾好自己,坚持治疗,成为长期治疗项目的一部分,接受移植,这些都是需要良好的及时自我投射能力的过程。这是心理治疗干预的一个具体领域。在这篇文章中,将讨论胰腺移植对患者和护理人员的心理影响,以及精神科医生在移植过程中的作用。
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引用次数: 0
Automatic inference of hypoglycemia causes in type 1 diabetes: a feasibility study. 1型糖尿病低血糖原因的自动推断:可行性研究。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.1095859
Aleksandr Zaitcev, Mohammad R Eissa, Zheng Hui, Tim Good, Jackie Elliott, Mohammed Benaissa

Background: Hypoglycemia is the most common adverse consequence of treating diabetes, and is often due to suboptimal patient self-care. Behavioral interventions by health professionals and self-care education helps avoid recurrent hypoglycemic episodes by targeting problematic patient behaviors. This relies on time-consuming investigation of reasons behind the observed episodes, which involves manual interpretation of personal diabetes diaries and communication with patients. Therefore, there is a clear motivation to automate this process using a supervised machine learning paradigm. This manuscript presents a feasibility study of automatic identification of hypoglycemia causes.

Methods: Reasons for 1885 hypoglycemia events were labeled by 54 participants with type 1 diabetes over a 21 months period. A broad range of possible predictors were extracted describing a hypoglycemic episode and the subject's general self-care from participants' routinely collected data on the Glucollector, their diabetes management platform. Thereafter, the possible hypoglycemia reasons were categorized for two major analysis sections - statistical analysis of relationships between the data features of self-care and hypoglycemia reasons, and classification analysis investigating the design of an automated system to determine the reason for hypoglycemia.

Results: Physical activity contributed to 45% of hypoglycemia reasons on the real world collected data. The statistical analysis provided a number of interpretable predictors of different hypoglycemia reasons based on self-care behaviors. The classification analysis showed the performance of a reasoning system in practical settings with different objectives under F1-score, recall and precision metrics.

Conclusion: The data acquisition characterized the incidence distribution of the various hypoglycemia reasons. The analyses highlighted many interpretable predictors of the various hypoglycemia types. Also, the feasibility study presented a number of concerns valuable in the design of the decision support system for automatic hypoglycemia reason classification. Therefore, automating the identification of the causes of hypoglycemia may help objectively to target behavioral and therapeutic changes in patients' care.

背景:低血糖是治疗糖尿病最常见的不良后果,通常是由于患者自我护理不理想所致。卫生专业人员的行为干预和自我保健教育有助于通过针对有问题的患者行为来避免低血糖复发。这依赖于对观察到的事件背后的原因进行耗时的调查,其中包括人工解释个人糖尿病日记和与患者沟通。因此,有一个明确的动机是使用监督机器学习范式自动化这个过程。本文提出了低血糖原因自动识别的可行性研究。方法:54名1型糖尿病患者在21个月内标记1885次低血糖事件的原因。从参与者在糖尿病管理平台Glucollector上例行收集的数据中,提取了描述低血糖发作和受试者一般自我护理的广泛可能的预测因子。随后,对可能的低血糖原因进行了分类,主要分为两部分分析:对自我保健数据特征与低血糖原因之间关系的统计分析,以及研究低血糖原因自动判断系统设计的分类分析。结果:体育活动对现实世界中收集到的45%的低血糖原因有贡献。统计分析为基于自我护理行为的不同低血糖原因提供了一些可解释的预测因子。分类分析显示了在f1得分、召回率和精度指标下,在不同目标的实际设置下,推理系统的性能。结论:数据采集反映了各种低血糖原因的发生率分布。分析强调了各种低血糖类型的许多可解释的预测因素。此外,可行性研究还提出了低血糖原因自动分类决策支持系统设计中一些有价值的问题。因此,自动识别低血糖的原因可能有助于客观地针对患者的护理行为和治疗改变。
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引用次数: 0
Dopamine receptor agonists mechanism of actions on glucose lowering and their connections with prolactin actions. 多巴胺受体激动剂的降糖作用机制及其与催乳素作用的联系。
Pub Date : 2023-01-01 DOI: 10.3389/fcdhc.2023.935872
Hung-Yu Chien, Su-Mei Chen, Wan-Chun Li

Robust experiment evidence suggests that prolactin can enhance beta-cell proliferation and increase insulin secretion and sensitivity. Apart from acting as an endocrine hormone, it also function as an adipokine and act on adipocytes to modulate adipogenesis, lipid metabolism and inflammation. Several cross-sectional epidemiologic studies consistently showed that circulating prolactin levels positive correlated with increased insulin sensitivity, lower glucose and lipid levels, and lower prevalence of T2D and metabolic syndrome. Bromocriptine, a dopamine receptor agonist used to treat prolactinoma, is approved by Food and Drug Administration for treatment in type 2 diabetes mellitus since 2009. Prolactin lowering suppress insulin secretion and decrease insulin sensitivity, therefore dopamine receptor agonists which act at the pituitary to lower serum prolactin levels are expected to impair glucose tolerance. Making it more complicating, studies exploring the glucose-lowering mechanism of bromocriptine and cabergoline have resulted in contradictory results; while some demonstrated actions independently on prolactin status, others showed glucose lowering partly explained by prolactin level. Previous studies showed that a moderate increase in central intraventricular prolactin levels stimulates hypothalamic dopamine with a decreased serum prolactin level and improved glucose metabolism. Additionally, sharp wave-ripples from the hippocampus modulates peripheral glucose level within 10 minutes, providing evidence for a mechanistic link between hypothalamus and blood glucose control. Central insulin in the mesolimbic system have been shown to suppress dopamine levels thus comprising a feedback control loop. Central dopamine and prolactin levels plays a key role in the glucose homeostasis control, and their dysregulation could lead to the pathognomonic central insulin resistance depicted in the "ominous octet". This review aims to provide an in-depth discussion on the glucose-lowering mechanism of dopamine receptor agonists and on the diverse prolactin and dopamine actions on metabolism targets.

强有力的实验证据表明,催乳素可以促进β细胞增殖,增加胰岛素分泌和敏感性。除了作为内分泌激素外,它还具有脂肪因子的作用,作用于脂肪细胞,调节脂肪生成、脂质代谢和炎症。几项横断面流行病学研究一致表明,循环催乳素水平与胰岛素敏感性升高、血糖和脂质水平降低、T2D和代谢综合征患病率降低呈正相关。溴隐亭是一种用于治疗催乳素瘤的多巴胺受体激动剂,自2009年以来被美国食品和药物管理局批准用于治疗2型糖尿病。降低催乳素抑制胰岛素分泌,降低胰岛素敏感性,因此多巴胺受体激动剂作用于垂体降低血清催乳素水平,预计会损害葡萄糖耐量。更复杂的是,探索溴隐亭和卡麦角林降血糖机制的研究结果相互矛盾;虽然一些显示作用独立于催乳素状态,其他显示血糖降低部分解释催乳素水平。先前的研究表明,中枢性脑室内催乳素水平的适度增加刺激下丘脑多巴胺,降低血清催乳素水平,改善葡萄糖代谢。此外,来自海马体的尖锐波纹在10分钟内调节外周葡萄糖水平,为下丘脑和血糖控制之间的机制联系提供了证据。中脑边缘系统的中枢胰岛素已被证明可以抑制多巴胺水平,从而构成一个反馈控制回路。中枢多巴胺和催乳素水平在葡萄糖稳态控制中起着关键作用,它们的失调可能导致“不祥八体”中描述的病态中枢胰岛素抵抗。本文旨在就多巴胺受体激动剂的降糖机制以及催乳素和多巴胺对代谢靶点的不同作用进行深入探讨。
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引用次数: 3
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Frontiers in clinical diabetes and healthcare
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