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Association of GLP-1 secretion with parameters of glycemic control in women after gestational diabetes mellitus. GLP-1 分泌与妊娠糖尿病妇女血糖控制参数的关系。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-10 DOI: 10.1136/bmjdrc-2023-003706
Eleni Pappa, Kristina Busygina, Saori Harada, Hana Hermann, Cornelia Then, Andreas Lechner, Uta Ferrari, Jochen Seissler

Introduction: Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes, while the exact mechanisms underlying its pathophysiology are still unclear. We investigated the association of glucagon-like peptide-1 (GLP-1) response to oral glucose with parameters of glycemic control in women with previous GDM in the prospective PPSDiab (Prediction, Prevention, and Subclassification of Type 2 Diabetes) study.

Research design and methods: Glucose metabolism parameters and GLP-1 secretion were analyzed during oral glucose tolerance test (OGTT) in women with previous GDM (n=129) and women with a history of normal glucose tolerance (n=67) during pregnancy (controls). First- and second-phase insulin and GLP-1 secretion in relation to plasma glucose (PG) levels were assessed, and development of pre-diabetes was analyzed after 5-year follow-up among women with previous GDM and a normal glycemic state at baseline (n=58).

Results: The area under the curve (AUC during the OGTT 0-120 min) of PG and insulin but not GLP-1 differed significantly between post-GDM women and controls. However, women with previous GDM had a significantly decreased GLP-1 response in relation to PG and plasma insulin during the second phase of the OGTT. After a follow-up of 5 years, 19.0% post-GDM women with a normal glycemic state at the baseline visit developed abnormal glucose metabolism. The total, first- and second-phase AUC GLP-1/PG and GLP-1/insulin ratios were not associated with development of abnormal glucose tolerance.

Conclusions: Women with previous GDM showed a reduced GLP-1 response in relation to PG and insulin concentrations indicating early abnormalities in glucose metabolism. However, the altered GLP-1 response to oral glucose did not predict progression to pre-diabetes and type 2 diabetes in the first 5 years after GDM.

导言:有妊娠糖尿病(GDM)病史的妇女患2型糖尿病的风险很高,但其病理生理学的确切机制仍不清楚。在前瞻性 PPSDiab(2 型糖尿病的预测、预防和亚分类)研究中,我们调查了胰高血糖素样肽-1(GLP-1)对口服葡萄糖的反应与曾患 GDM 妇女血糖控制参数的关联:研究设计:在口服葡萄糖耐量试验(OGTT)期间,对既往患过 GDM 的妇女(129 人)和孕期糖耐量正常的妇女(67 人)(对照组)的葡萄糖代谢参数和 GLP-1 分泌进行了分析。评估了第一和第二阶段胰岛素和GLP-1分泌与血浆葡萄糖(PG)水平的关系,并对曾患过GDM且基线血糖状态正常的妇女(58人)进行了为期5年的随访,分析了糖尿病前期的发展情况:结果:GDM 后妇女与对照组之间的 PG 和胰岛素曲线下面积(OGTT 0-120 分钟期间的 AUC)有显著差异,但 GLP-1 无显著差异。然而,与 PG 和血浆胰岛素相比,曾患 GDM 的妇女在 OGTT 的第二阶段对 GLP-1 的反应明显降低。随访 5 年后,19.0% 的 GDM 后妇女在基线访问时血糖状态正常,但后来出现了糖代谢异常。总、第一阶段和第二阶段的AUC GLP-1/PG和GLP-1/胰岛素比率与糖耐量异常的发生无关:结论:既往患过 GDM 的妇女的 GLP-1 反应与 PG 和胰岛素浓度相关性降低,表明葡萄糖代谢早期出现异常。然而,对口服葡萄糖的 GLP-1 反应的改变并不能预测 GDM 后最初 5 年中糖尿病前期和 2 型糖尿病的进展。
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引用次数: 0
Should insulin resistance (HOMA-IR), insulin secretion (HOMA-β), and visceral fat area be considered for improving the performance of diabetes risk prediction models. 为提高糖尿病风险预测模型的性能,是否应考虑胰岛素抵抗(HOMA-IR)、胰岛素分泌(HOMA-β)和内脏脂肪面积。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-08 DOI: 10.1136/bmjdrc-2023-003680
Huan Hu, Tohru Nakagawa, Toru Honda, Shuichiro Yamamoto, Tetsuya Mizoue

Introduction: Insulin resistance and defects in pancreatic beta cells are the two major pathophysiologic abnormalities that underlie type 2 diabetes. In addition, visceral fat area (VFA) is reported to be a stronger predictor for diabetes than body mass index (BMI). Here, we tested whether the performance of diabetes prediction models could be improved by adding HOMA-IR and HOMA-β and replacing BMI with VFA.

Research design and methods: We developed five prediction models using data from a cohort study (5578 individuals, of whom 94.7% were male, and 943 had incident diabetes). We conducted a baseline model (model 1) including age, sex, BMI, smoking, dyslipidemia, hypertension, and HbA1c. Subsequently, we developed another four models: model 2, predictors in model 1 plus fasting plasma glucose (FPG); model 3, predictors in model 1 plus HOMA-IR and HOMA-β; model 4, predictors in model 1 plus FPG, HOMA-IR, and HOMA-β; model 5, replaced BMI with VFA in model 2. We assessed model discrimination and calibration for the first 10 years of follow-up.

Results: The addition of FPG to model 1 obviously increased the value of the area under the receiver operating characteristic curve from 0.79 (95% CI 0.78, 0.81) to 0.84 (0.83, 0.85). Compared with model 1, model 2 also significantly improved the risk reclassification and discrimination, with a continuous net reclassification improvement index of 0.61 (0.56, 0.70) and an integrated discrimination improvement index of 0.09 (0.08, 0.10). Adding HOMA-IR and HOMA-β (models 3 and 4) or replacing BMI with VFA (model 5) did not further materially improve the performance.

Conclusions: This cohort study, primarily composed of male workers, suggests that a model with BMI, FPG, and HbA1c effectively identifies those at high diabetes risk. However, adding HOMA-IR, HOMA-β, or replacing BMI with VFA does not significantly improve the model. Further studies are needed to confirm our findings.

引言胰岛素抵抗和胰岛β细胞缺陷是导致 2 型糖尿病的两大病理生理异常。此外,据报道,内脏脂肪面积(VFA)比体重指数(BMI)更能预测糖尿病。在此,我们测试了通过增加 HOMA-IR 和 HOMA-β,并用 VFA 取代 BMI,是否能提高糖尿病预测模型的性能:我们利用一项队列研究的数据(5578 人,其中 94.7% 为男性,943 人患有糖尿病)开发了五个预测模型。我们建立了一个基线模型(模型 1),包括年龄、性别、体重指数、吸烟、血脂异常、高血压和 HbA1c。随后,我们又建立了四个模型:模型 2,模型 1 中的预测因素加上空腹血浆葡萄糖(FPG);模型 3,模型 1 中的预测因素加上 HOMA-IR 和 HOMA-β;模型 4,模型 1 中的预测因素加上 FPG、HOMA-IR 和 HOMA-β;模型 5,在模型 2 中用 VFA 取代 BMI。我们对随访前 10 年的模型区分度和校准进行了评估:结果:在模型 1 中加入 FPG 后,接收者操作特征曲线下的面积值明显增加,从 0.79 (95% CI 0.78, 0.81) 增加到 0.84 (0.83, 0.85)。与模型 1 相比,模型 2 也显著提高了风险再分类和分辨能力,连续净再分类提高指数为 0.61(0.56, 0.70),综合分辨能力提高指数为 0.09(0.08, 0.10)。加入 HOMA-IR 和 HOMA-β(模型 3 和 4)或用 VFA 代替 BMI(模型 5)并没有进一步提高性能:这项主要由男性工人组成的队列研究表明,使用体重指数、血脂饱和度和 HbA1c 的模型可以有效识别糖尿病高危人群。然而,加入 HOMA-IR、HOMA-β 或用 VFA 代替 BMI 并不能显著改善模型。我们需要进一步的研究来证实我们的发现。
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引用次数: 0
Incident dementia risk among patients with type 2 diabetes receiving metformin versus alternative oral glucose-lowering therapy: an observational cohort study using UK primary healthcare records 接受二甲双胍与其他口服降糖药治疗的 2 型糖尿病患者的痴呆症发病风险:利用英国初级医疗保健记录开展的一项观察性队列研究
IF 4.1 2区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/bmjdrc-2023-003548
William Doran, Louis Tunnicliffe, Rutendo Muzambi, Christopher T Rentsch, Krishnan Bhaskaran, Liam Smeeth, Carol Brayne, Dylan M Williams, Nish Chaturvedi, Sophie V Eastwood, Susanna J Dunachie, Rohini Mathur, Charlotte Warren-Gash
Introduction 4.2 million individuals in the UK have type 2 diabetes, a known risk factor for dementia and mild cognitive impairment (MCI). Diabetes treatment may modify this association, but existing evidence is conflicting. We therefore aimed to assess the association between metformin therapy and risk of incident all-cause dementia or MCI compared with other oral glucose-lowering therapies (GLTs). Research design and methods We conducted an observational cohort study using the Clinical Practice Research Datalink among UK adults diagnosed with diabetes at ≥40 years between 1990 and 2019. We used an active comparator new user design to compare risks of dementia and MCI among individuals initially prescribed metformin versus an alternative oral GLT using Cox proportional hazards regression controlling for sociodemographic, lifestyle and clinical confounders. We assessed for interaction by age and sex. Sensitivity analyses included an as-treated analysis to mitigate potential exposure misclassification. Results We included 211 396 individuals (median age 63 years; 42.8% female), of whom 179 333 (84.8%) initiated on metformin therapy. Over median follow-up of 5.4 years, metformin use was associated with a lower risk of dementia (adjusted HR (aHR) 0.86 (95% CI 0.79 to 0.94)) and MCI (aHR 0.92 (95% CI 0.86 to 0.99)). Metformin users aged under 80 years had a lower dementia risk (aHR 0.77 (95% CI 0.68 to 0.85)), which was not observed for those aged ≥80 years (aHR 0.95 (95% CI 0.87 to 1.05)). There was no interaction with sex. The as-treated analysis showed a reduced effect size compared with the main analysis (aHR 0.90 (95% CI 0.83 to 0.98)). Conclusions Metformin use was associated with lower risks of incident dementia and MCI compared with alternative GLT among UK adults with diabetes. While our findings are consistent with a neuroprotective effect of metformin against dementia, further research is needed to reduce risks of confounding by indication and assess causality. Data may be obtained from a third party and are not publicly available. The data used for this study were obtained from the CPRD. Access to CPRD data is subject to protocol approval via CPRD’s Research Data Governance Process (see ). Data acquisition is associated with a fee and data protection requirements. Code lists used to define health conditions in this study have been made openly available on LSHTM Data Compass: ().
导言:英国有 420 万人患有 2 型糖尿病,这是痴呆症和轻度认知障碍 (MCI) 的已知风险因素。糖尿病治疗可能会改变这种关联,但现有证据并不一致。因此,我们旨在评估二甲双胍治疗与其他口服降糖药物 (GLT) 相比,与全因痴呆或 MCI 发病风险之间的关联。研究设计与方法 我们利用临床实践研究数据链对 1990 年至 2019 年间确诊糖尿病的年龄≥40 岁的英国成年人进行了一项观察性队列研究。我们采用主动比较者新用户设计,在控制社会人口学、生活方式和临床混杂因素的情况下,使用 Cox 比例危险度回归法比较了最初处方二甲双胍与替代口服 GLT 的患者患痴呆症和 MCI 的风险。我们评估了年龄和性别的交互作用。敏感性分析包括治疗分析,以减少潜在的暴露误分类。结果 我们纳入了 211 396 人(中位年龄为 63 岁;42.8% 为女性),其中 179 333 人(84.8%)开始接受二甲双胍治疗。在中位 5.4 年的随访中,服用二甲双胍可降低痴呆症(调整 HR (aHR) 0.86 (95% CI 0.79 至 0.94))和 MCI(调整 HR 0.92 (95% CI 0.86 至 0.99))的风险。80岁以下二甲双胍使用者的痴呆风险较低(aHR 0.77 (95% CI 0.68 to 0.85)),而年龄≥80岁者的痴呆风险则较低(aHR 0.95 (95% CI 0.87 to 1.05))。与性别没有交互作用。与主要分析(aHR 0.90 (95% CI 0.83 to 0.98))相比,治疗分析显示效应大小有所降低。结论 在英国成年糖尿病患者中,与替代 GLT 相比,使用二甲双胍与较低的痴呆症和 MCI 发病风险相关。虽然我们的研究结果与二甲双胍对痴呆症的神经保护作用一致,但仍需进一步研究,以减少适应症混淆的风险并评估因果关系。数据可能来自第三方,不对外公开。本研究使用的数据来自 CPRD。访问 CPRD 数据需通过 CPRD 的研究数据管理流程(见)进行方案审批。数据获取需要支付一定的费用,并有数据保护要求。本研究中用于定义健康状况的代码表已在 LSHTM Data Compass 上公开发布:()。
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引用次数: 0
High prevalence of retinopathy in young-onset type 2 diabetes and possible sex differences: insights from Norwegian general practice 年轻 2 型糖尿病患者视网膜病变的高发病率和可能的性别差异:挪威全科医生的见解
IF 4.1 2区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/bmjdrc-2023-003624
Katrina Tibballs, Anne Karen Jenum, Lars Kirkebøen, Tore Julsrud Berg, Tor Claudi, John Graham Cooper, Kjersti Nøkleby, Sverre Sandberg, Jørund Straand, Esben Selmer Buhl
Introduction People with young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, have a high lifetime risk of vascular complications. We aimed to estimate the prevalence of YOD among adults with type 2 diabetes (T2D) in Norwegian general practice and explore associations between age at diabetes diagnosis and retinopathy overall and in men and women. Research design and methods We collected cross-sectional data from general practice electronic medical records of 10 241 adults with T2D in 2014, and repeated measurements of hemoglobin A1c (HbA1c) from 2012 to 2014. Using multivariate logistic regression, we assessed associations between YOD and later-onset T2D, sex and retinopathy. Results Of all individuals with T2D, 10% were diagnosed before 40 years of age in both sexes. Compared with later-onset T2D, HbA1c increased faster in YOD, and at the time of diagnosis HbA1c was higher in men, particularly in YOD. Retinopathy was found in 25% with YOD, twice as frequently as in later onset. After adjustments for confounders (age, country of origin, education, body mass index), OR of retinopathy was increased in both men with YOD (OR 2.6 (95% CI 2.0 to 3.5)) and women with YOD (OR 2.2 (1.5 to 3.0)). After further adjustments for potential mediators (diabetes duration and HbA1c), the higher OR persisted in men with YOD (OR 1.8 (1.3 to 2.4)) but was attenuated and no longer significant for women with YOD. Conclusions Retinopathy prevalence was more than twice as high in YOD as in later-onset T2D. The increased likelihood of retinopathy in YOD was partly mediated by higher HbA1c and longer T2D duration, but after accounting for these factors it remained higher in men with YOD. Data may be obtained from a third party and are not publicly available. The data underlying this article cannot be shared publicly due to the privacy of individuals who participated in the study. The data will be shared on reasonable request to the corresponding author if approved by the ethics committee.
导言 年轻的2型糖尿病患者(YOD)是指在40岁之前诊断出糖尿病的患者,他们一生中发生血管并发症的风险很高。我们的目的是估算挪威全科医生中2型糖尿病(T2D)成人患者的发病率,并探讨糖尿病确诊年龄与视网膜病变之间的总体关联以及男性和女性患者的关联。研究设计与方法 我们从全科医生的电子病历中收集了2014年10 241名成年2型糖尿病患者的横断面数据,并重复测量了2012年至2014年的血红蛋白A1c(HbA1c)。通过多变量逻辑回归,我们评估了YOD与晚发T2D、性别和视网膜病变之间的关联。结果 在所有 T2D 患者中,10% 的男女患者在 40 岁之前确诊。与后期发病的 T2D 患者相比,YOD 患者的 HbA1c 上升更快,在诊断时,男性的 HbA1c 更高,尤其是在 YOD 患者中。25%的青年糖尿病患者出现视网膜病变,是晚期发病者的两倍。在对混杂因素(年龄、原籍国、教育程度、体重指数)进行调整后,男性 YOD 患者(OR 2.6(95% CI 2.0 至 3.5))和女性 YOD 患者(OR 2.2(1.5 至 3.0))的视网膜病变发生率均有所增加。在进一步调整潜在的中介因素(糖尿病病程和 HbA1c)后,男性 YOD 患者的 OR 值仍然较高(OR 值为 1.8 (1.3 至 2.4)),但女性 YOD 患者的 OR 值则有所降低,且不再显著。结论 YOD 视网膜病变患病率是晚发性 T2D 患病率的两倍多。YOD发生视网膜病变的可能性增加,部分原因是HbA1c较高和T2D持续时间较长,但考虑到这些因素后,男性YOD患者发生视网膜病变的可能性仍然较高。数据可能来自第三方,不对外公开。由于涉及参与研究的个人隐私,本文所依据的数据不能公开共享。如果得到伦理委员会的批准,在通讯作者的合理要求下,我们将共享这些数据。
{"title":"High prevalence of retinopathy in young-onset type 2 diabetes and possible sex differences: insights from Norwegian general practice","authors":"Katrina Tibballs, Anne Karen Jenum, Lars Kirkebøen, Tore Julsrud Berg, Tor Claudi, John Graham Cooper, Kjersti Nøkleby, Sverre Sandberg, Jørund Straand, Esben Selmer Buhl","doi":"10.1136/bmjdrc-2023-003624","DOIUrl":"https://doi.org/10.1136/bmjdrc-2023-003624","url":null,"abstract":"Introduction People with young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, have a high lifetime risk of vascular complications. We aimed to estimate the prevalence of YOD among adults with type 2 diabetes (T2D) in Norwegian general practice and explore associations between age at diabetes diagnosis and retinopathy overall and in men and women. Research design and methods We collected cross-sectional data from general practice electronic medical records of 10 241 adults with T2D in 2014, and repeated measurements of hemoglobin A1c (HbA1c) from 2012 to 2014. Using multivariate logistic regression, we assessed associations between YOD and later-onset T2D, sex and retinopathy. Results Of all individuals with T2D, 10% were diagnosed before 40 years of age in both sexes. Compared with later-onset T2D, HbA1c increased faster in YOD, and at the time of diagnosis HbA1c was higher in men, particularly in YOD. Retinopathy was found in 25% with YOD, twice as frequently as in later onset. After adjustments for confounders (age, country of origin, education, body mass index), OR of retinopathy was increased in both men with YOD (OR 2.6 (95% CI 2.0 to 3.5)) and women with YOD (OR 2.2 (1.5 to 3.0)). After further adjustments for potential mediators (diabetes duration and HbA1c), the higher OR persisted in men with YOD (OR 1.8 (1.3 to 2.4)) but was attenuated and no longer significant for women with YOD. Conclusions Retinopathy prevalence was more than twice as high in YOD as in later-onset T2D. The increased likelihood of retinopathy in YOD was partly mediated by higher HbA1c and longer T2D duration, but after accounting for these factors it remained higher in men with YOD. Data may be obtained from a third party and are not publicly available. The data underlying this article cannot be shared publicly due to the privacy of individuals who participated in the study. The data will be shared on reasonable request to the corresponding author if approved by the ethics committee.","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139077737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between brain imaging biomarkers and continuous glucose monitoring-derived glycemic control indices in Japanese patients with type 2 diabetes mellitus 日本 2 型糖尿病患者脑成像生物标志物与连续血糖监测得出的血糖控制指数之间的关系
IF 4.1 2区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/bmjdrc-2023-003744
Chikako Inoue, Yoshiki Kusunoki, Mana Ohigashi, Keiko Osugi, Kazuhiro Kitajima, Ayako Takagi, Maki Inoue, Chisako Yagi, Taku Tsunoda, Miki Kakutani, Manabu Kadoya, Kosuke Konishi, Tomoyuki Katsuno, Hidenori Koyama
Introduction Although type 2 diabetes mellitus (T2DM) is associated with alterations in brain structure, the relationship between glycemic control indices and brain imaging markers remains unclear. This study aimed to investigate the association between continuous glucose monitoring (CGM)-derived glycemic control indices and brain imaging biomarkers assessed by MRI. Research design and methods This cross-sectional study included 150 patients with T2DM. The severity of cerebral white matter lesions (WMLs) was assessed using MRI for deep and subcortical white matter and periventricular hyperintensities. The degree of medial temporal lobe atrophy (MTA) was assessed using voxel-based morphometry. Each participant wore a retrospective CGM for 14 consecutive days, and glycemic control indices, such as time in range (TIR) and glycemia risk index (GRI), were calculated. Results The proportion of patients with severe WMLs showed a decreasing trend with increasing TIR ( P for trend=0.006). The proportion of patients with severe WMLs showed an increasing trend with worsening GRI ( P for trend=0.011). In contrast, no significant association was observed between the degree of MTA and CGM-derived glycemic control indices, including TIR ( P for trend=0.325) and GRI ( P for trend=0.447). Conclusions The findings of this study indicate that the severity of WMLs is associated with TIR and GRI, which are indices of the quality of glycemic control. Trial registration number UMIN000032143. Data are available upon reasonable request. The individual de-identified participant data will be shared with the corresponding author upon reasonable request.
导言:尽管2型糖尿病(T2DM)与大脑结构的改变有关,但血糖控制指数与大脑成像标志物之间的关系仍不清楚。本研究旨在探讨连续血糖监测(CGM)得出的血糖控制指数与核磁共振成像评估的脑成像生物标志物之间的关系。研究设计和方法 这项横断面研究纳入了 150 名 T2DM 患者。脑白质病变(WMLs)的严重程度是通过核磁共振成像对深部和皮层下白质以及脑室周围高密度进行评估的。内侧颞叶萎缩(MTA)的程度则通过基于体素的形态测量进行评估。每位参与者连续 14 天佩戴回顾性 CGM,并计算血糖控制指数,如在量程内的时间(TIR)和血糖风险指数(GRI)。结果 随着 TIR 的增加,严重 WML 患者的比例呈下降趋势(趋势值=0.006)。随着 GRI 的恶化,重度 WMLs 患者的比例呈上升趋势(趋势值=0.011)。相比之下,MTA 的程度与 CGM 衍生的血糖控制指数(包括 TIR ( 趋势值=0.325) 和 GRI ( 趋势值=0.447))之间并无明显关联。结论 本研究结果表明,WMLs 的严重程度与 TIR 和 GRI(血糖控制质量指标)相关。试验注册号为 UMIN000032143。如有合理要求,可提供数据。如提出合理要求,我们将与通讯作者共享去标识化的参与者个人数据。
{"title":"Association between brain imaging biomarkers and continuous glucose monitoring-derived glycemic control indices in Japanese patients with type 2 diabetes mellitus","authors":"Chikako Inoue, Yoshiki Kusunoki, Mana Ohigashi, Keiko Osugi, Kazuhiro Kitajima, Ayako Takagi, Maki Inoue, Chisako Yagi, Taku Tsunoda, Miki Kakutani, Manabu Kadoya, Kosuke Konishi, Tomoyuki Katsuno, Hidenori Koyama","doi":"10.1136/bmjdrc-2023-003744","DOIUrl":"https://doi.org/10.1136/bmjdrc-2023-003744","url":null,"abstract":"Introduction Although type 2 diabetes mellitus (T2DM) is associated with alterations in brain structure, the relationship between glycemic control indices and brain imaging markers remains unclear. This study aimed to investigate the association between continuous glucose monitoring (CGM)-derived glycemic control indices and brain imaging biomarkers assessed by MRI. Research design and methods This cross-sectional study included 150 patients with T2DM. The severity of cerebral white matter lesions (WMLs) was assessed using MRI for deep and subcortical white matter and periventricular hyperintensities. The degree of medial temporal lobe atrophy (MTA) was assessed using voxel-based morphometry. Each participant wore a retrospective CGM for 14 consecutive days, and glycemic control indices, such as time in range (TIR) and glycemia risk index (GRI), were calculated. Results The proportion of patients with severe WMLs showed a decreasing trend with increasing TIR ( P for trend=0.006). The proportion of patients with severe WMLs showed an increasing trend with worsening GRI ( P for trend=0.011). In contrast, no significant association was observed between the degree of MTA and CGM-derived glycemic control indices, including TIR ( P for trend=0.325) and GRI ( P for trend=0.447). Conclusions The findings of this study indicate that the severity of WMLs is associated with TIR and GRI, which are indices of the quality of glycemic control. Trial registration number UMIN000032143. Data are available upon reasonable request. The individual de-identified participant data will be shared with the corresponding author upon reasonable request.","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139481219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ocular microvascular complications in diabetic retinopathy: insights from machine learning 糖尿病视网膜病变的眼部微血管并发症:机器学习的启示
IF 4.1 2区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/bmjdrc-2023-003758
Thiara S Ahmed, Janika Shah, Yvonne N B Zhen, Jacqueline Chua, Damon W K Wong, Simon Nusinovici, Rose Tan, Gavin Tan, Leopold Schmetterer, Bingyao Tan
Introduction Diabetic retinopathy (DR) is a leading cause of preventable blindness among working-age adults, primarily driven by ocular microvascular complications from chronic hyperglycemia. Comprehending the complex relationship between microvascular changes in the eye and disease progression poses challenges, traditional methods assuming linear or logistical relationships may not adequately capture the intricate interactions between these changes and disease advances. Hence, the aim of this study was to evaluate the microvascular involvement of diabetes mellitus (DM) and non-proliferative DR with the implementation of non-parametric machine learning methods. Research design and methods We conducted a retrospective cohort study that included optical coherence tomography angiography (OCTA) images collected from a healthy group (196 eyes), a DM no DR group (120 eyes), a mild DR group (71 eyes), and a moderate DR group (66 eyes). We implemented a non-parametric machine learning method for four classification tasks that used parameters extracted from the OCTA images as predictors: DM no DR versus healthy, mild DR versus DM no DR, moderate DR versus mild DR, and any DR versus no DR. SHapley Additive exPlanations values were used to determine the importance of these parameters in the classification. Results We found large choriocapillaris flow deficits were the most important for healthy versus DM no DR, and became less important in eyes with mild or moderate DR. The superficial microvasculature was important for the healthy versus DM no DR and mild DR versus moderate DR tasks, but not for the DM no DR versus mild DR task—the stage when deep microvasculature plays an important role. Foveal avascular zone metric was in general less affected, but its involvement increased with worsening DR. Conclusions The findings from this study provide valuable insights into the microvascular involvement of DM and DR, facilitating the development of early detection methods and intervention strategies. No data are available.
导言 糖尿病视网膜病变(DR)是劳动适龄人口中可预防失明的主要原因,主要是由长期高血糖引起的眼部微血管并发症造成的。理解眼部微血管变化与疾病进展之间的复杂关系是一项挑战,假定线性或逻辑关系的传统方法可能无法充分捕捉这些变化与疾病进展之间错综复杂的相互作用。因此,本研究旨在采用非参数机器学习方法评估糖尿病(DM)和非增殖性DR的微血管参与情况。研究设计和方法 我们进行了一项回顾性队列研究,其中包括从健康组(196 只眼)、DM 无 DR 组(120 只眼)、轻度 DR 组(71 只眼)和中度 DR 组(66 只眼)收集的光学相干断层血管成像(OCTA)图像。我们采用非参数机器学习方法完成了四项分类任务,这些任务使用从 OCTA 图像中提取的参数作为预测因子:DM无DR与健康、轻度DR与DM无DR、中度DR与轻度DR、任何DR与无DR。使用 SHapley Additive exPlanations 值来确定这些参数在分类中的重要性。结果 我们发现,大的绒毛膜血流缺陷对健康眼与无DR的DM眼来说最重要,而对轻度或中度DR眼来说则不那么重要。表层微血管在健康与无DR的DM和轻度DR与中度DR的任务中很重要,但在无DR的DM与轻度DR的任务中却不重要--在这一阶段,深层微血管起着重要作用。一般来说,眼窝无血管区指标受到的影响较小,但随着 DR 的恶化,其参与程度会增加。结论 本研究的结果为了解 DM 和 DR 的微血管受累情况提供了宝贵的信息,有助于开发早期检测方法和制定干预策略。暂无数据。
{"title":"Ocular microvascular complications in diabetic retinopathy: insights from machine learning","authors":"Thiara S Ahmed, Janika Shah, Yvonne N B Zhen, Jacqueline Chua, Damon W K Wong, Simon Nusinovici, Rose Tan, Gavin Tan, Leopold Schmetterer, Bingyao Tan","doi":"10.1136/bmjdrc-2023-003758","DOIUrl":"https://doi.org/10.1136/bmjdrc-2023-003758","url":null,"abstract":"Introduction Diabetic retinopathy (DR) is a leading cause of preventable blindness among working-age adults, primarily driven by ocular microvascular complications from chronic hyperglycemia. Comprehending the complex relationship between microvascular changes in the eye and disease progression poses challenges, traditional methods assuming linear or logistical relationships may not adequately capture the intricate interactions between these changes and disease advances. Hence, the aim of this study was to evaluate the microvascular involvement of diabetes mellitus (DM) and non-proliferative DR with the implementation of non-parametric machine learning methods. Research design and methods We conducted a retrospective cohort study that included optical coherence tomography angiography (OCTA) images collected from a healthy group (196 eyes), a DM no DR group (120 eyes), a mild DR group (71 eyes), and a moderate DR group (66 eyes). We implemented a non-parametric machine learning method for four classification tasks that used parameters extracted from the OCTA images as predictors: DM no DR versus healthy, mild DR versus DM no DR, moderate DR versus mild DR, and any DR versus no DR. SHapley Additive exPlanations values were used to determine the importance of these parameters in the classification. Results We found large choriocapillaris flow deficits were the most important for healthy versus DM no DR, and became less important in eyes with mild or moderate DR. The superficial microvasculature was important for the healthy versus DM no DR and mild DR versus moderate DR tasks, but not for the DM no DR versus mild DR task—the stage when deep microvasculature plays an important role. Foveal avascular zone metric was in general less affected, but its involvement increased with worsening DR. Conclusions The findings from this study provide valuable insights into the microvascular involvement of DM and DR, facilitating the development of early detection methods and intervention strategies. No data are available.","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139077641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Increased glycemic variability in pregnant women with Roux-en-Y gastric bypass compared with sleeve gastrectomy 与袖带胃切除术相比,Roux-en-Y 胃旁路术孕妇血糖变异性增加
IF 4.1 2区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/bmjdrc-2023-003642
Kleopatra Alexiadou, Saleem Ansari, Bryony Jones, Christina Yu, Anne Dornhorst, Nick Oliver, Christos Tsironis, Sanjay Purkayastha, Ahmed Ahmed, Rochan Agha-Jaffar, Bernard Khoo, Tricia M-M Tan
Introduction Bariatric surgery is associated with adverse pregnancy outcomes such as reduced birth weight and premature birth. One possible mechanism for this is increased glycemic variability (GV) which occurs after bariatric surgery. The objective of this study was to compare the effect of Roux-en-Y gastric bypass (RYGB) versus vertical sleeve gastrectomy (SG) on GV during pregnancy and to investigate the relationships of GV, type of bariatric surgery and maternal and neonatal outcomes. Research design and methods Fourteen pregnant women after RYGB and 14 after SG were investigated with continuous glucose monitoring in their second or third trimester in this observational study carried out as part of routine clinical care. Results Pregnant women with RYGB had similar mean interstitial glucose values but significantly increased indices of GV and a lower %time in range 3.9–7.8 mmol/L (70–140 mg/dL), compared with SG. Conclusions Pregnant women who have undergone RYGB have greater GV during pregnancy compared with those who have undergone SG. Further research is needed to establish the relationship between GV and pregnancy outcomes to determine the preferred bariatric operation in women of reproductive age, and whether interventions to reduce GV might improve outcomes. Data are available on reasonable request. Some or all datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.
导言:减肥手术与出生体重下降和早产等不良妊娠结局有关。其中一个可能的机制是减肥手术后血糖变异性(GV)增加。本研究的目的是比较Roux-en-Y胃旁路术(RYGB)和垂直袖带胃切除术(SG)对孕期血糖变异性的影响,并调查血糖变异性、减肥手术类型、孕产妇和新生儿预后之间的关系。研究设计和方法 在这项观察性研究中,作为常规临床护理的一部分,对 14 名接受 RYGB 和 14 名接受 SG 手术的孕妇在妊娠第二或第三个月进行了连续血糖监测。结果 与 SG 相比,RYGB 孕妇的平均间质葡萄糖值相似,但 GV 指数显著升高,在 3.9-7.8 mmol/L (70-140 mg/dL) 范围内的时间百分比较低。结论 与接受 SG 的孕妇相比,接受 RYGB 的孕妇在怀孕期间的 GV 更大。需要进一步研究确定 GV 与妊娠结局之间的关系,以确定育龄妇女首选的减肥手术,以及减少 GV 的干预措施是否可以改善妊娠结局。如有合理要求,可提供相关数据。本研究中生成和/或分析的部分或全部数据集未公开,但可向通讯作者索取。
{"title":"Increased glycemic variability in pregnant women with Roux-en-Y gastric bypass compared with sleeve gastrectomy","authors":"Kleopatra Alexiadou, Saleem Ansari, Bryony Jones, Christina Yu, Anne Dornhorst, Nick Oliver, Christos Tsironis, Sanjay Purkayastha, Ahmed Ahmed, Rochan Agha-Jaffar, Bernard Khoo, Tricia M-M Tan","doi":"10.1136/bmjdrc-2023-003642","DOIUrl":"https://doi.org/10.1136/bmjdrc-2023-003642","url":null,"abstract":"Introduction Bariatric surgery is associated with adverse pregnancy outcomes such as reduced birth weight and premature birth. One possible mechanism for this is increased glycemic variability (GV) which occurs after bariatric surgery. The objective of this study was to compare the effect of Roux-en-Y gastric bypass (RYGB) versus vertical sleeve gastrectomy (SG) on GV during pregnancy and to investigate the relationships of GV, type of bariatric surgery and maternal and neonatal outcomes. Research design and methods Fourteen pregnant women after RYGB and 14 after SG were investigated with continuous glucose monitoring in their second or third trimester in this observational study carried out as part of routine clinical care. Results Pregnant women with RYGB had similar mean interstitial glucose values but significantly increased indices of GV and a lower %time in range 3.9–7.8 mmol/L (70–140 mg/dL), compared with SG. Conclusions Pregnant women who have undergone RYGB have greater GV during pregnancy compared with those who have undergone SG. Further research is needed to establish the relationship between GV and pregnancy outcomes to determine the preferred bariatric operation in women of reproductive age, and whether interventions to reduce GV might improve outcomes. Data are available on reasonable request. Some or all datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139481231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Young-onset type 2 diabetes and retinopathy: evidence of an adverse phenotype 年轻发病的 2 型糖尿病和视网膜病变:不良表型的证据
IF 4.1 2区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/bmjdrc-2023-003899
Soon H Song
The landscape of type 2 diabetes (T2D) has changed with an increasing number of people being diagnosed under age 40 years. The principal concern with young-onset T2D is the early development of complications, with associated morbidity and premature mortality. In view of the potential impact on the working-age population and the associated personal, societal and economic ramifications, it is important to understand the factors that drive the pathogenesis of these complications in order to mitigate or prevent their occurrence. Few studies have investigated the impact of young-onset T2D on microvascular disease such as retinopathy. As one of the leading causes of blindness and visual impairment in adults under age 40 years,1 this is a feared complication among people with diabetes and merits further investigation. In this issue of the journal, Tibballs et al 2 report that young adult-onset T2D, diagnosed between the ages of 18 and 39 years and constituting 10% of the overall population with T2D, had a higher burden of retinopathy and a greater risk of developing this complication, including severe retinal disease, compared with those diagnosed with T2D later in life. Young-onset male subjects were particularly susceptible to this complication. Despite receiving more intensive diabetes treatment, including insulin, the young-onset cohort exhibited more rapid deterioration in glycemic control. Compared with females with T2D, the young-onset males had higher HbA1c at diagnosis and this difference in glycemic control persisted …
随着越来越多的人在 40 岁以下确诊为 2 型糖尿病(T2D),2 型糖尿病(T2D)的发病形势发生了变化。年轻发病的 T2D 的主要问题是并发症的早期发展,以及相关的发病率和过早死亡率。鉴于这些并发症对工作年龄人口的潜在影响以及相关的个人、社会和经济后果,了解这些并发症的发病因素以减轻或预防其发生非常重要。很少有研究调查年轻时患 T2D 对视网膜病变等微血管疾病的影响。视网膜病变是导致 40 岁以下成年人失明和视力受损的主要原因之一1 ,是糖尿病患者最担心的并发症,值得进一步研究。在本期杂志上,Tibballs 等人2 报告说,与晚期确诊的 T2D 患者相比,在 18 岁至 39 岁之间确诊的年轻成人 T2D 患者占 T2D 患者总人数的 10%,他们的视网膜病变负担更重,患这种并发症(包括严重视网膜病变)的风险更大。年轻的男性患者尤其容易出现这种并发症。尽管接受了包括胰岛素在内的更密集的糖尿病治疗,但年轻发病人群的血糖控制恶化得更快。与患有 T2D 的女性患者相比,年轻男性患者在确诊时的 HbA1c 较高,而且这种血糖控制方面的差异持续存在......
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引用次数: 0
Adverse perinatal outcomes in gestational diabetes mellitus with and without SARS-CoV-2 infection during pregnancy: results from two nationwide registries in Germany 孕期感染或未感染 SARS-CoV-2 的妊娠糖尿病患者的围产期不良结局:德国两个全国性登记的结果
IF 4.1 2区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/bmjdrc-2023-003724
Tatjana P Liedtke, Katharina S Weber, Heinke Adamczewski, Dietmar Weber, Babett Ramsauer, Ute M Schaefer-Graf, Tanja Groten, Eike A Strathmann, Wolfgang Lieb, Mario Rüdiger, Ulrich Pecks, Helmut J Kleinwechter
Introduction Pregnancy is a known independent risk factor for a severe course of COVID-19. The relationship of SARS-CoV-2 infection and gestational diabetes mellitus (GDM) on neonatal outcomes is unclear. Our aim was to determine if SARS-CoV-2 infection represents an independent risk factor for adverse perinatal outcomes in pregnancy with GDM. Research design and methods We compared data from two German registries including pregnant women with GDM, established during the SARS-CoV-2 pandemic (COVID-19-Related Obstetric and Neonatal Outcome Study (CRONOS), a multicenter prospective observational study) and already existing before the pandemic (German registry of pregnant women with GDM; GestDiab). In total, 409 participants with GDM and SARS-CoV-2 infection and 4598 participants with GDM, registered 2018–2019, were eligible for analyses. The primary fetal and neonatal outcomes were defined as: (1) combined: admission to neonatal intensive care unit, stillbirth, and/or neonatal death, and (2) preterm birth before 37+0 weeks of gestation. Large and small for gestational age, maternal insulin therapy, birth weight >4500 g and cesarean delivery were considered as secondary outcomes. Results Women with SARS-CoV-2 infection were younger (32 vs 33 years) and had a higher median body mass index (28 vs 27 kg/m²). In CRONOS, more neonates developed the primary outcome (adjusted OR (aOR) 1.48, 95% CI 1.11 to 1.97) and were born preterm (aOR 1.50, 95% CI 1.07 to 2.10). Fasting glucose was higher in women in CRONOS versus GestDiab (5.4 vs 5.3 mmol/L) considering each 0.1 mmol/L increase was independently associated with a 5% higher risk of preterm birth among women in CRONOS only (aOR 1.05, 95% CI 1.01 to 1.09). Conclusions GDM with SARS-CoV-2 infection in pregnancy is associated with an increased risk of adverse fetal and neonatal outcomes as compared with GDM without SARS-CoV-2 infection. No data are available. Not provided due to data protection reasons.
导言:众所周知,妊娠是 COVID-19 严重病程的一个独立危险因素。SARS-CoV-2 感染与妊娠糖尿病(GDM)对新生儿预后的关系尚不清楚。我们的目的是确定 SARS-CoV-2 感染是否是妊娠合并 GDM 的围产期不良结局的独立风险因素。研究设计和方法 我们比较了两个德国登记处的数据,其中包括在 SARS-CoV-2 大流行期间建立的 GDM 孕妇登记处(COVID-19 相关产科和新生儿结局研究 (CRONOS),一项多中心前瞻性观察研究)和在大流行之前已经存在的 GDM 孕妇登记处(德国 GDM 孕妇登记处;GestDiab)。共有 409 名 GDM 和 SARS-CoV-2 感染者以及 4598 名 2018-2019 年登记的 GDM 患者符合分析条件。主要的胎儿和新生儿结局定义为:(1)合并:入住新生儿重症监护室、死产和/或新生儿死亡;(2)妊娠 37+0 周前早产。胎龄大、胎龄小、母体胰岛素治疗、出生体重大于 4500 克和剖宫产被视为次要结果。结果 感染 SARS-CoV-2 的妇女更年轻(32 岁对 33 岁),体重指数中位数更高(28 公斤/平方米对 27 公斤/平方米)。在 CRONOS 中,更多新生儿出现主要结果(调整 OR (aOR) 1.48,95% CI 1.11 至 1.97)和早产(aOR 1.50,95% CI 1.07 至 2.10)。CRONOS孕妇的空腹血糖高于GestDiab孕妇(5.4 mmol/L vs 5.3 mmol/L),每增加0.1 mmol/L,仅CRONOS孕妇的早产风险就会增加5%(aOR为1.05,95% CI为1.01至1.09)。结论 与未感染 SARS-CoV-2 的 GDM 相比,妊娠期感染 SARS-CoV-2 的 GDM 与胎儿和新生儿不良预后风险增加有关。无数据。因数据保护原因未提供。
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引用次数: 0
Association of urinary albumin-to-creatinine ratio with cardiometabolic risk markers and pre-diabetes in adults with normoglycemia, normoalbuminuria, and normotension with parental type 2 diabetes 血糖正常、正常白蛋白尿和正常血压且父母患有 2 型糖尿病的成年人的尿白蛋白-肌酐比值与心脏代谢风险指标和糖尿病前期的关系
IF 4.1 2区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1136/bmjdrc-2023-003609
Matthew Everett, Natasha Rushing, Peace Asuzu, Jim Wan, Samuel Dagogo-Jack
Introduction This is a post hoc analysis of urinary albumin-to-creatinine ratio (uACR) within the normoalbuminuric range in relation to cardiometabolic risk factors among initially normoglycemic, normotensive participants in the Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) Study. Research design and methods 308 healthy African American (AA) and European American (EA) participants in the POP-ABC Study underwent baseline assessments, including oral glucose tolerance test, anthropometry, urinary albumin-to-creatinine ratio (uACR), lipids, adipocytokines, insulin sensitivity and secretion. Participants were followed quarterly for 5.5 years (mean 2.62 years) for the primary outcome of incident pre-diabetes. Results The cohort’s mean fasting glucose was 92.1±6.90 mg/dL, 2-hour plasma glucose was 123±25.0 mg/dL, systolic blood pressure was 123±15.9 mm Hg, and diastolic blood pressure was 74±8.80 mm Hg. Baseline uACR levels (range 1–29 mg/g) were similar in AA versus EA participants (6.40 mg/g±4.80 vs 6.80±5.40 mg/g, p=0.52), higher in women than men (7.30 mg/g±5.30 vs 4.60±3.90 mg/g, p<0.0001), and showed significant associations with cardiometabolic risk factors, including age, insulin sensitivity, high-density lipoprotein cholesterol, and adiponectin levels (p=0.03–0.004). During 5.5 years of follow-up, 104 participants developed pre-diabetes and 204 maintained normoglycemia. Baseline uACR quartiles were associated with incident pre-diabetes (r=0.19, p=0.0011). Conclusions Baseline uACR levels were associated with cardiometabolic risk markers and incident pre-diabetes risk among adults with normoglycemia, normoalbuminuria and normotension with parental diabetes. Data are available upon reasonable request.
导言:这是对 "双种族队列糖尿病前期病理生物学研究"(POP-ABC)中最初血糖正常、血压正常的参与者的正常白蛋白尿范围内的尿白蛋白-肌酐比值(uACR)与心脏代谢风险因素的关系进行的一项事后分析。研究设计和方法 POP-ABC 研究的 308 名健康非裔美国人(AA)和欧洲裔美国人(EA)参与者接受了基线评估,包括口服葡萄糖耐量试验、人体测量、尿白蛋白与肌酐比值(uACR)、血脂、脂肪细胞因子、胰岛素敏感性和分泌。每季度对参与者进行一次为期 5.5 年(平均 2.62 年)的跟踪调查,主要结果为糖尿病前期。结果 组群的平均空腹血糖为 92.1±6.90 mg/dL,2 小时血浆葡萄糖为 123±25.0 mg/dL,收缩压为 123±15.9 mm Hg,舒张压为 74±8.80 mm Hg。AA与EA参与者的基线uACR水平(范围1-29 mg/g)相似(6.40 mg/g±4.80 vs 6.80±5.40 mg/g,p=0.52),女性高于男性(7.30 mg/g±5.30 vs 4.60±3.90 mg/g,p<0.0001),并与年龄、胰岛素敏感性、高密度脂蛋白胆固醇和脂肪连通素水平等心脏代谢风险因素有显著关联(p=0.03-0.004)。在5.5年的随访中,104名参与者发展为糖尿病前期,204名参与者保持正常血糖。基线 uACR 四分位数与糖尿病前期事件相关(r=0.19,p=0.0011)。结论 在血糖正常、白蛋白尿正常和血压正常且父母患有糖尿病的成年人中,基线 uACR 水平与心脏代谢风险指标和糖尿病前期发病风险相关。如有合理要求,可提供相关数据。
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BMJ Open Diabetes Research & Care
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