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Real-world study of the multimorbidity and health service utilisation among individuals with non-diabetic hyperglycemia and type 2 diabetes mellitus in North West London. 对伦敦西北部非糖尿病高血糖和 2 型糖尿病患者的多病症和医疗服务使用情况的真实世界研究。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-08 DOI: 10.1136/bmjdrc-2023-003873
Rakesh Dattani, Zia Ul-Haq, Moulesh Shah, Tahereh Kamalati, Benjamin Pierce, Amanda Lucas, Ahmed Baruwa, Livi Bickford-Smith, Jack Chilcott, Thomas Griffiths, Andrew Howard Frankel, Tony Willis, Frederick Wai Keung Tam

Introduction: The prevalence of non-diabetic hyperglycemia (NDH) and type 2 diabetes mellitus (T2DM) is increasing. While T2DM is recognised to be associated with multimorbidity and early mortality, people with NDH are frequently thought to be devoid of such complications, potentially exposing individuals with NDH to suboptimal care. We therefore used the Discover London Secure Data Environment (SDE) dataset to appreciate the relationship of NDH/T2DM with multimorbidity, healthcare usage, and clinical outcomes.

Research design and methods: The dataset was retrospectively analysed between January 1, 2015 and December 31, 2020 to understand the relationship between NDH/T2DM and multimorbidity primary/secondary healthcare usage and clinical outcomes. This was compared with a cohort of individuals with thyroid disease but no NDH/T2DM.

Results: The dataset identified 152,384 and 124,190 adults with NDH and T2DM compared with 11,626 individuals with thyroid disease (control group). Individuals with NDH and individuals with T2DM had a high burden of disease, with only 13.1% of individuals with either NDH or T2DM not found to be suffering from at least one of the disease states of interest. The three most common comorbidities experienced by individuals with NDH were hypertension (41.4%), hypercholesterolemia (37.5%), and obesity (29.8%) compared with retinopathy (68.7%), hypertension (59.4%), and obesity (45.8%) in individuals with T2DM. Comparatively, the most common comorbidities in the control group were depression (30.8%), hypercholesterolemia (24.4%), and hypertension (17.1%). 28 (control group), 12 (NDH), and 16 (T2DM) primary care contacts per individual per year were identified, with 27,881, 282,371, and 314,880 inpatient admissions for the control, NDH, and T2DM cohorts, respectively. Prescription of drugs used to treat T2DM in individuals with NDH and T2DM was 27,772 (18.2%) and 109,361 (88.1%), respectively, accounting for approximately one in five individuals with NDH developing T2DM.

Conclusion: Both NDH and T2DM were associated with significant multimorbidity alongside primary and secondary care utilisation. Given the morbidity highlighted with NDH, we highlight the need for earlier detection of NDH, recognition of multimorbidity associated with both NDH and T2DM, as well as the need for the further implementation of interventions to prevent progression to T2DM/multimorbidity.

简介非糖尿病性高血糖(NDH)和 2 型糖尿病(T2DM)的发病率正在上升。人们认识到 T2DM 与多病症和早期死亡有关,而非糖尿病性高血糖患者通常被认为没有此类并发症,这可能会使非糖尿病性高血糖患者受到次优护理。因此,我们利用 "发现伦敦安全数据环境"(SDE)数据集来了解 NDH/T2DM 与多病症、医疗保健使用和临床结果之间的关系:对 2015 年 1 月 1 日至 2020 年 12 月 31 日期间的数据集进行回顾性分析,以了解 NDH/T2DM 与多病症初级/二级医疗保健使用和临床结果之间的关系。分析结果与患有甲状腺疾病但无NDH/T2DM的人群进行了比较:数据集发现,分别有 152,384 和 124,190 名成年人患有 NDH 和 T2DM,而患有甲状腺疾病的人数为 11,626 人(对照组)。NDH患者和T2DM患者的疾病负担很重,只有13.1%的NDH患者或T2DM患者没有发现至少患有一种相关疾病。NDH 患者最常见的三种合并症是高血压(41.4%)、高胆固醇血症(37.5%)和肥胖(29.8%),而 T2DM 患者最常见的合并症是视网膜病变(68.7%)、高血压(59.4%)和肥胖(45.8%)。相比之下,对照组最常见的合并症是抑郁症(30.8%)、高胆固醇血症(24.4%)和高血压(17.1%)。对照组、NDH 组和 T2DM 组的每人每年初级保健接触次数分别为 28 次(对照组)、12 次(NDH 组)和 16 次(T2DM 组),住院人次分别为 27,881 次、282,371 次和 314,880 次。在 NDH 和 T2DM 患者中,用于治疗 T2DM 的药物处方分别为 27,772 份(18.2%)和 109,361 份(88.1%),大约每五名 NDH 患者中就有一人患上了 T2DM:结论:NDH 和 T2DM 都与严重的多病并发症以及初级和中级医疗服务的使用有关。鉴于 NDH 的发病率较高,我们强调需要更早地发现 NDH,认识到 NDH 和 T2DM 相关的多病症,以及需要进一步实施干预措施,防止发展为 T2DM/多病症。
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引用次数: 0
Metabolic features of neutrophilic differentiation of HL-60 cells in hyperglycemic environments. 高血糖环境下 HL-60 细胞中性分化的代谢特征
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-08 DOI: 10.1136/bmjdrc-2024-004181
Jorge Andrés Cázares-Preciado, Alejandra López-Arredondo, José Antonio Cruz-Cardenas, Luis Alberto Luévano-Martínez, Gerardo García-Rivas, Heriberto Prado-Garcia, Marion E G Brunck

Introduction: Chronic hyperglycemia affects neutrophil functions, leading to reduced pathogen killing and increased morbidity. This impairment has been directly linked to increased glycemia, however, how this specifically affects neutrophils metabolism and their differentiation in the bone marrow is unclear and difficult to study.

Research design and methods: We used high-resolution respirometry to investigate the metabolism of resting and activated donor neutrophils, and flow cytometry to measure surface CD15 and CD11b expression. We then used HL-60 cells differentiated towards neutrophil-like cells in standard media and investigated the effect of doubling glucose concentration on differentiation metabolism. We measured the oxygen consumption rate (OCR), and the enzymatic activity of carnitine palmitoyl transferase 1 (CPT1) and citrate synthase during neutrophil-like differentiation. We compared the surface phenotype, functions, and OCR of neutrophil-like cells differentiated under both glucose concentrations.

Results: Donor neutrophils showed significant instability of CD11b and OCR after phorbol 12-myristate 13-acetate stimulation at 3 hours post-enrichment. During HL-60 neutrophil-like cell differentiation, there was a significant increase in surface CD15 and CD11b expression together with the loss of mitochondrial mass. Differentiated neutrophil-like cells also exhibited higher CD11b expression and were significantly more phagocytic. In higher glucose media, we measured a decrease in citrate synthase and CPT1 activities during neutrophil-like differentiation.

Conclusions: HL-60 neutrophil-like differentiation recapitulated known molecular and metabolic features of human neutrophil differentiation. Increased glucose concentrations correlated with features described in hyperglycemic donor neutrophils including increased CD11b and phagocytosis. We used this model to describe metabolic features of neutrophil-like cell differentiation in hyperglycemia and show for the first time the downregulation of CPT1 and citrate synthase activity, independently of mitochondrial mass.

导言慢性高血糖会影响中性粒细胞的功能,导致病原体杀伤力下降和发病率增加。这种损害与血糖升高直接相关,但血糖升高如何具体影响中性粒细胞的新陈代谢及其在骨髓中的分化还不清楚,也很难研究:我们使用高分辨率呼吸测定法研究静止和活化供体中性粒细胞的新陈代谢,并使用流式细胞仪测量表面 CD15 和 CD11b 的表达。然后,我们使用在标准培养基中向中性粒细胞样细胞分化的 HL-60 细胞,研究葡萄糖浓度加倍对分化代谢的影响。我们测量了中性粒细胞样分化过程中的耗氧率(OCR)以及肉碱棕榈酰基转移酶1(CPT1)和柠檬酸合成酶的酶活性。我们比较了在两种葡萄糖浓度下分化的中性粒细胞的表面表型、功能和OCR:结果:供体中性粒细胞在富集后3小时受到光稳定剂12-肉豆蔻酸13-乙酸酯刺激后,CD11b和OCR表现出明显的不稳定性。在 HL-60 中性粒细胞样细胞分化过程中,表面 CD15 和 CD11b 表达明显增加,同时线粒体质量下降。分化的中性粒细胞样细胞也表现出较高的 CD11b 表达,吞噬能力明显增强。在较高的葡萄糖培养基中,我们测得嗜中性粒细胞样分化过程中柠檬酸合成酶和CPT1活性下降:结论:HL-60 中性粒细胞样分化再现了人类中性粒细胞分化的已知分子和代谢特征。葡萄糖浓度的增加与高血糖供体中性粒细胞的特征相关,包括CD11b和吞噬功能的增加。我们利用该模型描述了高血糖状态下中性粒细胞样分化的代谢特征,并首次显示了与线粒体质量无关的 CPT1 和柠檬酸合成酶活性下调。
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引用次数: 0
Risk of healthcare visits from influenza in subjects with diabetes and impacts of early vaccination. 糖尿病患者因流感就医的风险及早期接种疫苗的影响。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-06 DOI: 10.1136/bmjdrc-2023-003841
Ronald Horswell, San Chu, Addison E Stone, Daniel Fort, Gabriel Uwaifo, Vivian A Fonseca, Elizabeth B Norton

Introduction: The objective of this study was to determine the burden of influenza disease in patients with or without diabetes in a population of American adults to understand the benefits of seasonal vaccination.

Research design and methods: We performed a retrospective cohort study using electronic medical records totaling 1,117,263 from two Louisiana healthcare providers spanning January 2012 through December 2017. Adults 18 years or older with two or more records within the study period were included. The primary outcome quantified was influenza-related diagnosis during inpatient (IP) or emergency room (ER) visits and risk reduction with the timing of immunization.

Results: Influenza-related IP or ER visits totaled 0.0122-0.0169 events per person within the 2013-2016 influenza seasons. Subjects with diabetes had a 5.6-fold more frequent influenza diagnosis for IP or ER visits than in subjects without diabetes or 3.7-fold more frequent when adjusted for demographics. Early immunization reduced the risk of influenza healthcare utilization by 66% for subjects with diabetes or 67% for subjects without diabetes when compared with later vaccination for the 2013-2016 influenza seasons. Older age and female sex were associated with a higher incidence of influenza, but not a significant change in risk reduction from vaccination.

Conclusions: The risk for influenza-related healthcare utilization was 3.7-fold higher if patients had diabetes during 2013-2016 influenza seasons. Early immunization provides a significant benefit to adults irrespective of a diabetes diagnosis. All adults, but particularly patients with diabetes, should be encouraged to get the influenza vaccine at the start of the influenza season.

导言:本研究旨在确定美国成年人群中有无糖尿病患者的流感疾病负担,以了解接种季节性疫苗的益处:我们利用路易斯安那州两家医疗机构 2012 年 1 月至 2017 年 12 月期间共计 1,117,263 份电子病历进行了一项回顾性队列研究。研究对象包括在研究期间有两次或两次以上记录的 18 岁或 18 岁以上的成年人。量化的主要结果是住院(IP)或急诊室(ER)就诊期间与流感相关的诊断,以及免疫接种时机的风险降低情况:2013-2016年流感季节期间,与流感相关的住院或急诊就诊总计为0.0122-0.0169次/人。与无糖尿病的受试者相比,糖尿病受试者的流感诊断IP或急诊就诊频率高出5.6倍,经人口统计学调整后,则高出3.7倍。与2013-2016年流感季节较晚接种疫苗的情况相比,早期接种疫苗可将糖尿病患者使用流感医疗服务的风险降低66%,将非糖尿病患者使用流感医疗服务的风险降低67%。高龄和女性性别与较高的流感发病率有关,但接种疫苗后降低的风险没有显著变化:结论:在2013-2016年流感季节,如果患者患有糖尿病,则其使用流感相关医疗服务的风险要高出3.7倍。无论诊断出糖尿病与否,早期免疫接种都能为成年人带来显著益处。应鼓励所有成年人,尤其是糖尿病患者,在流感季节开始时接种流感疫苗。
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引用次数: 0
Early screening for foot problems in people with diabetes is the need of the hour: 'Save the Feet and Keep Walking Campaign' in India. 当务之急是及早筛查糖尿病患者的足部问题:印度的 "拯救双足,坚持行走运动"。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-03 DOI: 10.1136/bmjdrc-2024-004064
Vijay Viswanathan, Amit Gupta, Arutselvi Devarajan, Satyavani Kumpatla, Sharvari Shukla, Sanjay Agarwal, Brij Mohan Makkar, Banshi Saboo, Vasanth Kumar, Rakesh Kumar Sahay

Introduction: Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India.

Research design and methods: A cross-sectional national-level project 'Save the Feet and Keep Walking' campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023.

Results: Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet.

Conclusions: One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.

导言:印度缺乏全国范围内糖尿病患者足部问题患病率的证据。因此,本研究旨在评估印度全国糖尿病患者的高风险(HR)足部负担:印度糖尿病研究学会(RSSDI)于 2022 年 7 月 10 日至 2022 年 8 月 10 日开展了一项国家级横断面项目 "拯救足部,继续行走 "运动。该活动采用了经过改进的 3 分钟足部检查来评估足部问题。约 10,000 名拥有 RSSDI 会员资格的医生接受了在线足部筛查培训,并获得了用于检测保护性感觉丧失的标准化单丝。在研究期间到诊所就诊的 18 岁以上糖尿病患者均接受了足部问题检查。数据通过半结构式问卷在线收集。最终分析共纳入 33 259 名信息完整的参与者。根据国际糖尿病足工作组 2023 年指南对足部风险进行了分类:近 75% 的参与者年龄在 45 岁以上。约 49% 的人糖尿病病程超过 5 年,且糖尿病未得到控制(血红蛋白 A1c >8%)。研究发现,参与者中有足部溃疡病史(20%)、下肢截肢(15.3%)、足部畸形(24.5%)以及足背和胫骨后搏动减弱(26.4%)。其中约 25.2% 的人患有 HR 足,男性发病率较高。分别有 70% 和 75.5% 的 HR 足患者出现糖尿病肾脏和视网膜并发症。足跟裂缝(OR (95% CI) 4.6 (4.2 to 5.1))和胼胝或鸡眼(OR (95% CI) 3.6 (3.3 to 4.0))的存在与 HR 足有显著相关性:结论:在印度,四分之一的糖尿病患者被发现患有HR足。结论:在印度,有四分之一的糖尿病患者被发现患有 "HR足"。研究结果表明,应定期对糖尿病患者进行足部问题筛查,并加强初级医疗保健。
{"title":"Early screening for foot problems in people with diabetes is the need of the hour: 'Save the Feet and Keep Walking Campaign' in India.","authors":"Vijay Viswanathan, Amit Gupta, Arutselvi Devarajan, Satyavani Kumpatla, Sharvari Shukla, Sanjay Agarwal, Brij Mohan Makkar, Banshi Saboo, Vasanth Kumar, Rakesh Kumar Sahay","doi":"10.1136/bmjdrc-2024-004064","DOIUrl":"10.1136/bmjdrc-2024-004064","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India.</p><p><strong>Research design and methods: </strong>A cross-sectional national-level project 'Save the Feet and Keep Walking' campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023.</p><p><strong>Results: </strong>Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet.</p><p><strong>Conclusions: </strong>One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiovascular disease risk factors and their associations with inflammation among US adolescents: NHANES, 2015 to March 2020. 美国青少年心血管疾病风险因素及其与炎症的关系:NHANES,2015 年至 2020 年 3 月。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-03 DOI: 10.1136/bmjdrc-2024-004148
Sarah S Casagrande, Jean M Lawrence

Introduction: The prevalence of obesity and glycemic dysfunction in adolescents has increased over the past several decades but less is known on how these conditions are associated with systemic inflammation in this population. This study determined the associations between cardiovascular disease (CVD) risk factors and inflammation among a nationally representative sample of US. adolescents.

Research design and methods: Cross-sectional analyses were conducted among 2693 adolescents aged 12-19 years who participated in the 2015 to March 2020 National Health and Nutrition Examination Surveys. Chronic inflammation was determined using laboratory measures for high-sensitivity C reactive protein (hs-CRP). Adjusted ORs (aOR, 95% CI) were calculated from logistic regression models to determine the association between CVD risk factors (obesity, overweight, dysglycemia, hypertension, hyperlipidemia) and elevated hs-CRP (>3.0 mg/L) while controlling for sociodemographic characteristics and other CVD risk factors.

Results: Overall, 15.3% of adolescents had elevated hs-CRP. Adolescents who were older (16-19 years vs 12-15 years), obese, had A1c ≥5.7% (≥39 mmol/mol), high total cholesterol, or low high-density lipoprotein had hs-CRP distributions that were more high risk (χ2 p value <0.001). Adolescents with obesity or A1c ≥5.7% had a sixfold and a nearly twofold higher odds of elevated hs-CRP compared those without obesity and A1c <5.7% after full adjustment (aOR=6.39, 4.64 to 8.79 and aOR=1.70, 1.05 to 3.06, respectively). Adolescents with hypertension or hyperlipidemia were significantly more likely to have elevated hs-CRP compared with those without these conditions after adjustment for sociodemographic characteristics (aOR=2.46, 1.08 to 5.60 and aOR=2.19, 1.36 to 3.54, respectively), but the association was not significant after further adjustment for obesity.

Conclusions: Among US adolescents, obesity was strongly associated with elevated hs-CRP, a marker for future CVD risk. Given the obesity epidemic and the marked proportion with elevated CRP, concern should be given to future CVD risk in younger adults.

导言:在过去几十年中,青少年肥胖症和血糖功能障碍的发病率有所上升,但人们对这些疾病与该人群全身炎症的关系却知之甚少。本研究确定了具有全国代表性的美国青少年样本中心血管疾病(CVD)风险因素与炎症之间的关联:对参加 2015 年至 2020 年 3 月全国健康与营养调查的 2693 名 12-19 岁青少年进行了横断面分析。慢性炎症是通过实验室测量高敏C反应蛋白(hs-CRP)来确定的。通过逻辑回归模型计算调整后的ORs(aOR,95% CI),以确定心血管疾病风险因素(肥胖、超重、血糖异常、高血压、高脂血症)与hs-CRP升高(>3.0 mg/L)之间的关系,同时控制社会人口学特征和其他心血管疾病风险因素:总体而言,15.3%的青少年的hs-CRP升高。年龄较大(16-19 岁与 12-15 岁)、肥胖、A1c ≥5.7%(≥39 mmol/mol)、总胆固醇较高或高密度脂蛋白较低的青少年的 hs-CRP 分布更高风险(χ2 p 值):在美国青少年中,肥胖与 hs-CRP 升高密切相关,而 hs-CRP 是未来心血管疾病风险的标志。鉴于肥胖症的流行和 CRP 升高的显著比例,应关注年轻成年人未来的心血管疾病风险。
{"title":"Cardiovascular disease risk factors and their associations with inflammation among US adolescents: NHANES, 2015 to March 2020.","authors":"Sarah S Casagrande, Jean M Lawrence","doi":"10.1136/bmjdrc-2024-004148","DOIUrl":"10.1136/bmjdrc-2024-004148","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of obesity and glycemic dysfunction in adolescents has increased over the past several decades but less is known on how these conditions are associated with systemic inflammation in this population. This study determined the associations between cardiovascular disease (CVD) risk factors and inflammation among a nationally representative sample of US. adolescents.</p><p><strong>Research design and methods: </strong>Cross-sectional analyses were conducted among 2693 adolescents aged 12-19 years who participated in the 2015 to March 2020 National Health and Nutrition Examination Surveys. Chronic inflammation was determined using laboratory measures for high-sensitivity C reactive protein (hs-CRP). Adjusted ORs (aOR, 95% CI) were calculated from logistic regression models to determine the association between CVD risk factors (obesity, overweight, dysglycemia, hypertension, hyperlipidemia) and elevated hs-CRP (>3.0 mg/L) while controlling for sociodemographic characteristics and other CVD risk factors.</p><p><strong>Results: </strong>Overall, 15.3% of adolescents had elevated hs-CRP. Adolescents who were older (16-19 years vs 12-15 years), obese, had A1c ≥5.7% (≥39 mmol/mol), high total cholesterol, or low high-density lipoprotein had hs-CRP distributions that were more high risk (χ<sup>2</sup> p value <0.001). Adolescents with obesity or A1c ≥5.7% had a sixfold and a nearly twofold higher odds of elevated hs-CRP compared those without obesity and A1c <5.7% after full adjustment (aOR=6.39, 4.64 to 8.79 and aOR=1.70, 1.05 to 3.06, respectively). Adolescents with hypertension or hyperlipidemia were significantly more likely to have elevated hs-CRP compared with those without these conditions after adjustment for sociodemographic characteristics (aOR=2.46, 1.08 to 5.60 and aOR=2.19, 1.36 to 3.54, respectively), but the association was not significant after further adjustment for obesity.</p><p><strong>Conclusions: </strong>Among US adolescents, obesity was strongly associated with elevated hs-CRP, a marker for future CVD risk. Given the obesity epidemic and the marked proportion with elevated CRP, concern should be given to future CVD risk in younger adults.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in use and hospital outcomes of bariatric surgery in Spain (2016-2022): analysis of the role of type 2 diabetes using propensity score matching. 西班牙减肥手术的使用和住院效果变化(2016-2022 年):利用倾向得分匹配分析 2 型糖尿病的作用。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-03 DOI: 10.1136/bmjdrc-2024-004351
Ana Lopez-de-Andres, Rodrigo Jimenez-Garcia, Natividad Cuadrado-Corrales, David Carabantes-Alarcon, Valentin Hernandez-Barrera, Javier de Miguel-Diez, Ana Jimenez-Sierra, José Javier Zamorano-Leon

Introduction: The objectives of this study were to examine temporal trends in the incidence of bariatric surgery (Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)) in patients with and without type 2 diabetes mellitus (T2DM). Outcomes of hospitalization and the impact of T2DM on these outcomes were also analyzed.

Research design and methods: We performed an observational study with the Spanish national hospital discharge database. Obese patients with and without T2DM who underwent RYGB and SG between 2016 and 2022 were identified. Propensity score matching (PSM) and logistic regression were used to compare patients with and without T2DM and to evaluate the effect of T2DM and other variables on outcomes of surgery. A variable "severity" was created to cover patients who died in hospital or were admitted to the intensive care unit (ICU).

Results: A total of 32,176 bariatric surgery interventions were performed (28.86% with T2DM). 31.57% of RYGBs and 25.53% of SG patients had T2DM. The incidence of RYGB and SG increased significantly between 2016 and 2022 (p<0.001), with a higher incidence in those with T2DM than in those without (incidence rate ratio 4.07 (95% CI 3.95 to 4.20) for RYGB and 3.02 (95% CI 2.92 to 3.14) for SG). In patients who underwent SG, admission to the ICU and severity were significantly more frequent in patients with T2DM than in those without (both p<0.001). In the multivariate analysis, having T2DM was associated with more frequent severity in those who received SG (OR 1.23; 95% CI 1.07 to 1.42).

Conclusions: Between 2016 and 2022, bariatric surgery procedures performed in Spain increased in patients with and without T2DM. More interventions were performed on patients with T2DM than on patients without T2DM. RYGB was the most common procedure in patients with T2DM. The presence of T2DM was associated with more severity after SG.

简介:本研究旨在探讨2型糖尿病(T2DM)患者和非2型糖尿病患者接受减肥手术(Roux-en-Y胃旁路术(RYGB)和袖状胃切除术(SG))的时间趋势。研究设计和方法:我们利用西班牙国家医院出院数据库进行了一项观察性研究。确定了在 2016 年至 2022 年期间接受 RYGB 和 SG 治疗的有 T2DM 和无 T2DM 的肥胖患者。采用倾向评分匹配(PSM)和逻辑回归对有 T2DM 和无 T2DM 的患者进行比较,并评估 T2DM 和其他变量对手术结果的影响。此外,还创建了一个变量 "严重程度",以涵盖在医院死亡或住进重症监护室(ICU)的患者:共实施了 32 176 例减肥手术(28.86% 的患者患有 T2DM)。31.57%的 RYGB 和 25.53% 的 SG 患者患有 T2DM。2016年至2022年间,RYGB和SG的发病率显著增加(P结论:2016年至2022年期间,西班牙实施的减肥手术在T2DM患者和非T2DM患者中均有所增加。对T2DM患者实施的干预手术多于非T2DM患者。RYGB是T2DM患者最常见的手术。T2DM与SG术后的严重程度有关。
{"title":"Changes in use and hospital outcomes of bariatric surgery in Spain (2016-2022): analysis of the role of type 2 diabetes using propensity score matching.","authors":"Ana Lopez-de-Andres, Rodrigo Jimenez-Garcia, Natividad Cuadrado-Corrales, David Carabantes-Alarcon, Valentin Hernandez-Barrera, Javier de Miguel-Diez, Ana Jimenez-Sierra, José Javier Zamorano-Leon","doi":"10.1136/bmjdrc-2024-004351","DOIUrl":"10.1136/bmjdrc-2024-004351","url":null,"abstract":"<p><strong>Introduction: </strong>The objectives of this study were to examine temporal trends in the incidence of bariatric surgery (Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)) in patients with and without type 2 diabetes mellitus (T2DM). Outcomes of hospitalization and the impact of T2DM on these outcomes were also analyzed.</p><p><strong>Research design and methods: </strong>We performed an observational study with the Spanish national hospital discharge database. Obese patients with and without T2DM who underwent RYGB and SG between 2016 and 2022 were identified. Propensity score matching (PSM) and logistic regression were used to compare patients with and without T2DM and to evaluate the effect of T2DM and other variables on outcomes of surgery. A variable \"severity\" was created to cover patients who died in hospital or were admitted to the intensive care unit (ICU).</p><p><strong>Results: </strong>A total of 32,176 bariatric surgery interventions were performed (28.86% with T2DM). 31.57% of RYGBs and 25.53% of SG patients had T2DM. The incidence of RYGB and SG increased significantly between 2016 and 2022 (p<0.001), with a higher incidence in those with T2DM than in those without (incidence rate ratio 4.07 (95% CI 3.95 to 4.20) for RYGB and 3.02 (95% CI 2.92 to 3.14) for SG). In patients who underwent SG, admission to the ICU and severity were significantly more frequent in patients with T2DM than in those without (both p<0.001). In the multivariate analysis, having T2DM was associated with more frequent severity in those who received SG (OR 1.23; 95% CI 1.07 to 1.42).</p><p><strong>Conclusions: </strong>Between 2016 and 2022, bariatric surgery procedures performed in Spain increased in patients with and without T2DM. More interventions were performed on patients with T2DM than on patients without T2DM. RYGB was the most common procedure in patients with T2DM. The presence of T2DM was associated with more severity after SG.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of mitigating obesity, smoking, and physical inactivity on type 2 diabetes mellitus burden in Oman: insights from mathematical modeling. 减轻肥胖、吸烟和缺乏运动对阿曼 2 型糖尿病负担的影响:数学建模的启示。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-03 DOI: 10.1136/bmjdrc-2024-004248
Asalah Alareeki, Susanne F Awad, Adhra Al-Mawali, Magdi Morsi, Julia A Critchley, Jawad A Al-Lawati, Laith J Abu-Raddad

Introduction: To estimate the impact of reducing obesity, smoking, and physical inactivity (PIA) prevalence, and of introducing physical activity (PA) as an explicit intervention, on the prevalence, incidence, and mortality of type 2 diabetes mellitus (T2DM) in Oman.

Research design and methods: A deterministic population-level mathematical model was employed to investigate the impact of different scenarios for reducing T2DM risk factors on T2DM epidemiology. The model was stratified by sex, age group, risk factor status, T2DM status, and intervention status and parameterized with nationally representative data. Intervention scenarios were calculated and compared with a baseline (no-intervention) scenario for changes in T2DM prevalence, incidence, and mortality among adult Omanis between 2020 and 2050.

Results: In the no-intervention scenario, T2DM prevalence increased from 15.2% in 2020 to 23.8% in 2050. Achieving the goals of halting the rise of obesity, reducing smoking by 30%, and reducing PIA by 10% as outlined in the WHO's Global Action Plan for Non-communicable Diseases (implemented between 2020 and 2030 and then maintained between 2031 and 2050) would reduce T2DM prevalence by 32.2%, cumulative incidence by 31.3%, and related deaths by 19.3% by 2050. Halting the rise of or reducing obesity prevalence by 10%-50% would reduce T2DM prevalence by 33.0%-51.3%, cumulative incidence by 31.9%-53.0%, and related deaths by 19.5%-35.6%. Reducing smoking or PIA prevalence by 10%-50% would lead to smaller reductions of less than 5% in T2DM prevalence, cumulative incidence, and related deaths. Introducing PA with varying intensities at a 25% coverage would reduce T2DM prevalence by 4.9%-14.1%, cumulative incidence by 4.8%-13.8%, and related deaths by 3.4%-9.6% by 2050.

Conclusions: Intervention-for-prevention efforts targeting obesity reduction and introducing PA could result in major reductions in the T2DM burden. Prioritizing such interventions could alleviate the burden of T2DM in Oman and other countries with similarly high T2DM and obesity burdens.

导言:目的:估算减少肥胖、吸烟和缺乏运动(PIA)的发生率,以及引入体育锻炼(PA)作为明确的干预措施,对阿曼 2 型糖尿病(T2DM)的发生率、发病率和死亡率的影响:采用确定性人口数学模型研究减少 T2DM 风险因素的不同方案对 T2DM 流行病学的影响。该模型按性别、年龄组、风险因素状况、T2DM 状况和干预状况进行了分层,并使用具有全国代表性的数据进行了参数化。计算了干预方案,并与基线(无干预)方案比较了 2020 年至 2050 年阿曼成年人 T2DM 患病率、发病率和死亡率的变化:结果:在无干预情景下,T2DM 患病率从 2020 年的 15.2% 上升到 2050 年的 23.8%。如果能实现世界卫生组织《非传染性疾病全球行动计划》(2020 年至 2030 年期间实施,然后在 2031 年至 2050 年期间保持实施)中提出的阻止肥胖增加、减少吸烟 30% 和减少 PIA 10% 的目标,到 2050 年,T2DM 患病率将降低 32.2%,累计发病率降低 31.3%,相关死亡人数降低 19.3%。阻止肥胖率上升或将肥胖率降低 10%-50%,将使 T2DM 患病率降低 33.0%-51.3%,累计发病率降低 31.9%-53.0%,相关死亡人数降低 19.5%-35.6%。将吸烟或 PIA 患病率降低 10%-50%,可使 T2DM 患病率、累积发病率和相关死亡人数的降低幅度较小,均低于 5%。到 2050 年,以 25% 的覆盖率引入不同强度的体育锻炼将使 T2DM 患病率降低 4.9%-14.1%,累计发病率降低 4.8%-13.8%,相关死亡人数降低 3.4%-9.6%:结论:以减少肥胖和引入体育锻炼为目标的预防干预措施可大幅减少 T2DM 的负担。在阿曼和其他 T2DM 和肥胖负担同样较重的国家,优先采取此类干预措施可减轻 T2DM 的负担。
{"title":"Impact of mitigating obesity, smoking, and physical inactivity on type 2 diabetes mellitus burden in Oman: insights from mathematical modeling.","authors":"Asalah Alareeki, Susanne F Awad, Adhra Al-Mawali, Magdi Morsi, Julia A Critchley, Jawad A Al-Lawati, Laith J Abu-Raddad","doi":"10.1136/bmjdrc-2024-004248","DOIUrl":"https://doi.org/10.1136/bmjdrc-2024-004248","url":null,"abstract":"<p><strong>Introduction: </strong>To estimate the impact of reducing obesity, smoking, and physical inactivity (PIA) prevalence, and of introducing physical activity (PA) as an explicit intervention, on the prevalence, incidence, and mortality of type 2 diabetes mellitus (T2DM) in Oman.</p><p><strong>Research design and methods: </strong>A deterministic population-level mathematical model was employed to investigate the impact of different scenarios for reducing T2DM risk factors on T2DM epidemiology. The model was stratified by sex, age group, risk factor status, T2DM status, and intervention status and parameterized with nationally representative data. Intervention scenarios were calculated and compared with a baseline (no-intervention) scenario for changes in T2DM prevalence, incidence, and mortality among adult Omanis between 2020 and 2050.</p><p><strong>Results: </strong>In the no-intervention scenario, T2DM prevalence increased from 15.2% in 2020 to 23.8% in 2050. Achieving the goals of halting the rise of obesity, reducing smoking by 30%, and reducing PIA by 10% as outlined in the WHO's Global Action Plan for Non-communicable Diseases (implemented between 2020 and 2030 and then maintained between 2031 and 2050) would reduce T2DM prevalence by 32.2%, cumulative incidence by 31.3%, and related deaths by 19.3% by 2050. Halting the rise of or reducing obesity prevalence by 10%-50% would reduce T2DM prevalence by 33.0%-51.3%, cumulative incidence by 31.9%-53.0%, and related deaths by 19.5%-35.6%. Reducing smoking or PIA prevalence by 10%-50% would lead to smaller reductions of less than 5% in T2DM prevalence, cumulative incidence, and related deaths. Introducing PA with varying intensities at a 25% coverage would reduce T2DM prevalence by 4.9%-14.1%, cumulative incidence by 4.8%-13.8%, and related deaths by 3.4%-9.6% by 2050.</p><p><strong>Conclusions: </strong>Intervention-for-prevention efforts targeting obesity reduction and introducing PA could result in major reductions in the T2DM burden. Prioritizing such interventions could alleviate the burden of T2DM in Oman and other countries with similarly high T2DM and obesity burdens.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888402","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 personality, lifestyle behaviors, and cardiovascular diseases in type 2 diabetes mellitus: a population-based cohort study of UK Biobank data 2 型糖尿病患者的性格、生活方式行为与心血管疾病之间的关系:基于英国生物数据库数据的人群队列研究
IF 4.1 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-08-01 DOI: 10.1136/bmjdrc-2024-004244
Chan Soon Park, Jaewon Choi, Soongu Kwak, Seung-Pyo Lee, Hyung-Kwan Kim, Yong-Jin Kim, Soo Heon Kwak, Jun-Bean Park
Introduction Various strategies aim to better assess risks and refine prevention for patients with type 2 diabetes mellitus (T2DM), who vary in cardiovascular disease (CVD) risk. However, the prognostic value of personality and its association with lifestyle factors remain elusive. Research design and methods We identified 8794 patients with T2DM from the UK Biobank database between 2006 and 2010 and followed them up until the end of 2021. We assessed personality traits using the Big Five proxies derived from UK Biobank data: sociability, warmth, diligence, curiosity, and nervousness. Healthy lifestyle behaviors were determined from information about obesity, smoking status, and physical activity. The primary outcome was a composite of incident CVD, including myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), and heart failure (HF). Results During a median follow-up of 13.6 years, a total of 2110 patients experienced CVDs. Among personality traits, diligence was significantly associated with a reduced risk of primary and secondary outcomes. The adjusted HRs with 95% CIs were: composite CVD, 0.93 (0.89–0.97); MI 0.90 (0.82–1.00); IS 0.83 (0.74–0.94); AF 0.92 (0.85–0.98); HF 0.84 (0.76–0.91). Healthy lifestyle behaviors significantly reduced the risk of composite CVDs in groups with high and low diligence. The findings of a structural equation model showed that diligence directly affected the risk of the primary outcome or indirectly by modifying lifestyle behaviors. Conclusion This study revealed which personality traits can influence CVD risk during T2DM and how patients might benefit from adopting healthy lifestyle behaviors in relation to personality. Data are available upon reasonable request. The data used in the present research are available via a direct application to the UK Biobank () and this research was conducted with approved access to UK Biobank data under application ID 91312. All other data supporting the research findings are available within the article and its supplementary information files and from the corresponding author upon reasonable request.
导言:2 型糖尿病(T2DM)患者的心血管疾病(CVD)风险各不相同,为了更好地评估患者的风险并完善其预防措施,我们采取了各种策略。然而,性格的预后价值及其与生活方式因素的关系仍然难以捉摸。研究设计和方法 我们从英国生物库数据库中确定了 2006 年至 2010 年期间的 8794 名 T2DM 患者,并对他们进行了跟踪调查,直至 2021 年底。我们使用从英国生物库数据中提取的五大代用指标来评估人格特质:交际能力、热情、勤奋、好奇和紧张。健康的生活方式行为是通过肥胖、吸烟状况和体育锻炼等信息确定的。主要结果是心血管疾病(包括心肌梗死、缺血性中风、心房颤动和心力衰竭)的综合指数。结果 在中位 13.6 年的随访期间,共有 2110 名患者发生了心血管疾病。在人格特质中,勤奋与主要和次要结局风险的降低有显著相关性。调整后的HRs(95% CIs)为:综合心血管疾病0.93(0.89-0.97);心肌梗死0.90(0.82-1.00);IS 0.83(0.74-0.94);房颤0.92(0.85-0.98);高血压0.84(0.76-0.91)。在勤奋程度高和勤奋程度低的人群中,健康生活方式行为可明显降低复合心血管疾病的风险。结构方程模型的结果表明,勤奋程度直接影响主要结果的风险,或通过改变生活方式行为间接影响主要结果的风险。结论 本研究揭示了哪些性格特征会影响 T2DM 患者的心血管疾病风险,以及患者如何从与性格相关的健康生活方式行为中获益。如有合理要求,可提供相关数据。本研究中使用的数据可通过向英国生物库(UK Biobank)直接申请获得,本研究是在获得批准后访问英国生物库数据进行的,申请编号为 91312。支持研究结果的所有其他数据可在文章及其补充信息文件中获取,也可向相应作者索取。
{"title":"Association between personality, lifestyle behaviors, and cardiovascular diseases in type 2 diabetes mellitus: a population-based cohort study of UK Biobank data","authors":"Chan Soon Park, Jaewon Choi, Soongu Kwak, Seung-Pyo Lee, Hyung-Kwan Kim, Yong-Jin Kim, Soo Heon Kwak, Jun-Bean Park","doi":"10.1136/bmjdrc-2024-004244","DOIUrl":"https://doi.org/10.1136/bmjdrc-2024-004244","url":null,"abstract":"Introduction Various strategies aim to better assess risks and refine prevention for patients with type 2 diabetes mellitus (T2DM), who vary in cardiovascular disease (CVD) risk. However, the prognostic value of personality and its association with lifestyle factors remain elusive. Research design and methods We identified 8794 patients with T2DM from the UK Biobank database between 2006 and 2010 and followed them up until the end of 2021. We assessed personality traits using the Big Five proxies derived from UK Biobank data: sociability, warmth, diligence, curiosity, and nervousness. Healthy lifestyle behaviors were determined from information about obesity, smoking status, and physical activity. The primary outcome was a composite of incident CVD, including myocardial infarction (MI), ischemic stroke (IS), atrial fibrillation (AF), and heart failure (HF). Results During a median follow-up of 13.6 years, a total of 2110 patients experienced CVDs. Among personality traits, diligence was significantly associated with a reduced risk of primary and secondary outcomes. The adjusted HRs with 95% CIs were: composite CVD, 0.93 (0.89–0.97); MI 0.90 (0.82–1.00); IS 0.83 (0.74–0.94); AF 0.92 (0.85–0.98); HF 0.84 (0.76–0.91). Healthy lifestyle behaviors significantly reduced the risk of composite CVDs in groups with high and low diligence. The findings of a structural equation model showed that diligence directly affected the risk of the primary outcome or indirectly by modifying lifestyle behaviors. Conclusion This study revealed which personality traits can influence CVD risk during T2DM and how patients might benefit from adopting healthy lifestyle behaviors in relation to personality. Data are available upon reasonable request. The data used in the present research are available via a direct application to the UK Biobank (<http://www.ukbiobank.ac.uk/register-apply/>) and this research was conducted with approved access to UK Biobank data under application ID 91312. All other data supporting the research findings are available within the article and its supplementary information files and from the corresponding author upon reasonable request.","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"59 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217228","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
Assessment of neuropathy subtypes in type 1 diabetes. 评估 1 型糖尿病的神经病变亚型。
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-18 DOI: 10.1136/bmjdrc-2024-004289
Pall Karlsson, Marie Balle Sjogaard, Karoline Schousboe, Hatice Isik Mizrak, Huda Kufaishi, Troels Staehelin Jensen, Jens Randel Nyengaard, Christian Stevns Hansen, Knud Bonnet Yderstræde, Christian Selmer Buhl

Introduction: Diabetic polyneuropathy (DPN), a common complication of diabetes, can manifest as small, large, or mixed fiber neuropathy (SFN, LFN, and MFN, respectively), depending on the type of fibers involved. Despite evidence indicating small fiber involvement prior to large fiber involvement in type 1 diabetes mellitus (T1DM)-associated DPN, no evidence has been produced to determine the more prevalent subtype. We aim to determine the more prevalent type of nerve fiber damage-SFN, LFN, and MFN-in T1DM-associated DPN, both with and without pain.

Research design and methods: In this cross-sectional study, participants (n=216) were divided into controls; T1DM; T1DM with non-painful DPN (NP-DPN); and T1DM with painful DPN (P-DPN). DPN was further subgrouped based on neuropathy severity. The more prevalent type of fiber damage was determined applying small and large fiber-specific tests and three diagnostic models: model 1 (≥1 abnormal test); model 2 (≥2 abnormal tests); and model 3 (≥3 abnormal tests).

Results: MFN showed the highest prevalence in T1DM-associated DPN. No differences in neuropathy subtype were found between NP-DPN and P-DPN. DPN, with prevalent SFN plateaus between models 2 and 3. All models showed increased prevalence of MFN according to DPN severity. Model 3 showed increased DPN with prevalent LFN in early neuropathy. DPN with prevalent SFN demonstrated a similar, but non-significant pattern.

Conclusions: DPN primarily manifests as MFN in T1DM, with no differentiation between NP-DPN and P-DPN. Additionally, we propose model 2 as an initial criterion for diagnosing DPN with a more prevalent SFN subtype in T1DM. Lastly, the study suggests that in mild stages of DPN, one type of nerve fiber (either small or large) is more susceptible to damage.

简介糖尿病多发性神经病变(DPN)是糖尿病的一种常见并发症,可表现为小纤维神经病变、大纤维神经病变或混合纤维神经病变(分别为 SFN、LFN 和 MFN),具体取决于受累纤维的类型。尽管有证据表明,在 1 型糖尿病(T1DM)相关的 DPN 中,小纤维受累先于大纤维受累,但还没有证据表明哪种亚型更普遍。我们旨在确定在 T1DM 相关 DPN 中更常见的神经纤维损伤类型--SFN、LFN 和 MFN,包括有疼痛和无疼痛:在这项横断面研究中,参与者(n=216)被分为对照组、T1DM、T1DM伴非疼痛性DPN(NP-DPN)和T1DM伴疼痛性DPN(P-DPN)。根据神经病变的严重程度对 DPN 进一步分组。通过小纤维和大纤维特异性测试以及三种诊断模型:模型 1(≥1 次异常测试)、模型 2(≥2 次异常测试)和模型 3(≥3 次异常测试),确定了更普遍的纤维损伤类型:MFN在T1DM相关DPN中发病率最高。神经病变亚型在 NP-DPN 和 P-DPN 之间无差异。在模型 2 和模型 3 之间,DPN 和 SFN 的患病率处于高位。所有模型均显示,MFN的患病率随DPN严重程度的增加而增加。模型 3 显示,在早期神经病变中,DPN 的 LFN 患病率增加。DPN与普遍的SFN表现出相似的模式,但并不显著:结论:DPN 在 T1DM 中主要表现为 MFN,在 NP-DPN 和 P-DPN 之间没有区别。此外,我们建议将模型 2 作为诊断 T1DM 中较常见的 SFN 亚型 DPN 的初步标准。最后,研究表明,在轻度 DPN 阶段,一种类型的神经纤维(小或大)更容易受到损伤。
{"title":"Assessment of neuropathy subtypes in type 1 diabetes.","authors":"Pall Karlsson, Marie Balle Sjogaard, Karoline Schousboe, Hatice Isik Mizrak, Huda Kufaishi, Troels Staehelin Jensen, Jens Randel Nyengaard, Christian Stevns Hansen, Knud Bonnet Yderstræde, Christian Selmer Buhl","doi":"10.1136/bmjdrc-2024-004289","DOIUrl":"10.1136/bmjdrc-2024-004289","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic polyneuropathy (DPN), a common complication of diabetes, can manifest as small, large, or mixed fiber neuropathy (SFN, LFN, and MFN, respectively), depending on the type of fibers involved. Despite evidence indicating small fiber involvement prior to large fiber involvement in type 1 diabetes mellitus (T1DM)-associated DPN, no evidence has been produced to determine the more prevalent subtype. We aim to determine the more prevalent type of nerve fiber damage-SFN, LFN, and MFN-in T1DM-associated DPN, both with and without pain.</p><p><strong>Research design and methods: </strong>In this cross-sectional study, participants (n=216) were divided into controls; T1DM; T1DM with non-painful DPN (NP-DPN); and T1DM with painful DPN (P-DPN). DPN was further subgrouped based on neuropathy severity. The more prevalent type of fiber damage was determined applying small and large fiber-specific tests and three diagnostic models: model 1 (≥1 abnormal test); model 2 (≥2 abnormal tests); and model 3 (≥3 abnormal tests).</p><p><strong>Results: </strong>MFN showed the highest prevalence in T1DM-associated DPN. No differences in neuropathy subtype were found between NP-DPN and P-DPN. DPN, with prevalent SFN plateaus between models 2 and 3. All models showed increased prevalence of MFN according to DPN severity. Model 3 showed increased DPN with prevalent LFN in early neuropathy. DPN with prevalent SFN demonstrated a similar, but non-significant pattern.</p><p><strong>Conclusions: </strong>DPN primarily manifests as MFN in T1DM, with no differentiation between NP-DPN and P-DPN. Additionally, we propose model 2 as an initial criterion for diagnosing DPN with a more prevalent SFN subtype in T1DM. Lastly, the study suggests that in mild stages of DPN, one type of nerve fiber (either small or large) is more susceptible to damage.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of insonification on repairing the renal injury of diabetic nephropathy rats. 胰岛素对修复糖尿病肾病大鼠肾损伤的影响
IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-07-18 DOI: 10.1136/bmjdrc-2024-004146
Xinfang Xiao, Liu Wu, Juan Deng, Junfen Li, Yiqing Zhou, Sicheng He, Faqi Li, Yan Wang

Introduction: Prolonged hyperglycemia in diabetes mellitus can result in the development of diabetic nephropathy (DN) and increase the susceptibility to kidney failure. Low-intensity pulsed ultrasound (LIPUS) is a non-invasive modality that has demonstrated effective tissue repair capabilities. The objective of this study was to showcase the reparative potential of LIPUS on renal injury at both animal and cellular levels, while also determining the optimal pulse length (PL).

Research design and methods: We established a rat model of DN, and subsequently subjected the rats' kidneys to ultrasound irradiation (PL=0.2 ms, 10 ms, 20 ms). Subsequently, we assessed the structural and functional changes in the kidneys. Additionally, we induced podocyte apoptosis and evaluated its occurrence following ultrasound irradiation.

Results: Following irradiation, DN rats exhibited improved mesangial expansion and basement membrane thickening. Uric acid expression increased while urinary microalbumin, podocalyxin in urine, blood urea nitrogen, and serum creatinine levels decreased (p<0.05). These results suggest that the optimal PL was 0.2 ms. Using the optimal PL further demonstrated the reparative effect of LIPUS on DN, it was found that LIPUS could reduce podococyte apoptosis and alleviate kidney injury. Metabolomics revealed differences in metabolites including octanoic acid and seven others and western blot results showed a significant decrease in key enzymes related to lipolysis (p<0.05). Additionally, after irradiating podocytes with different PLs, we observed suppressed apoptosis (p<0.05), confirming the optimal PL as 0.2 ms.

Conclusions: LIPUS has been demonstrated to effectively restore renal structure and function in DN rats, with an optimal PL of 0.2 ms. The mechanism underlying the alleviation of DN by LIPUS is attributed to its ability to improve lipid metabolism disorder. These findings suggest that LIPUS may provide a novel perspective for future research in this field.

导言:糖尿病患者长期高血糖会导致糖尿病肾病(DN)的发生,并增加肾衰竭的易感性。低强度脉冲超声(LIPUS)是一种无创方式,已被证明具有有效的组织修复能力。本研究的目的是展示 LIPUS 在动物和细胞水平上对肾损伤的修复潜力,同时确定最佳脉冲长度 (PL):我们建立了 DN 大鼠模型,随后对大鼠肾脏进行超声波照射(PL=0.2 毫秒、10 毫秒、20 毫秒)。随后,我们评估了肾脏的结构和功能变化。此外,我们还诱导了荚膜细胞凋亡,并评估了超声照射后荚膜细胞凋亡的发生情况:结果:照射后,DN 大鼠的肾间质扩张和基底膜增厚得到改善。尿酸表达增加,而尿微量白蛋白、尿液中的荚膜萼萼酶、血尿素氮和血清肌酐水平下降(p结论:实验证明,LIPUS 能有效恢复 DN 大鼠的肾脏结构和功能,最佳 PL 为 0.2 毫秒。LIPUS缓解DN的机制在于其改善脂质代谢紊乱的能力。这些研究结果表明,LIPUS 可为这一领域的未来研究提供新的视角。
{"title":"Effects of insonification on repairing the renal injury of diabetic nephropathy rats.","authors":"Xinfang Xiao, Liu Wu, Juan Deng, Junfen Li, Yiqing Zhou, Sicheng He, Faqi Li, Yan Wang","doi":"10.1136/bmjdrc-2024-004146","DOIUrl":"10.1136/bmjdrc-2024-004146","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged hyperglycemia in diabetes mellitus can result in the development of diabetic nephropathy (DN) and increase the susceptibility to kidney failure. Low-intensity pulsed ultrasound (LIPUS) is a non-invasive modality that has demonstrated effective tissue repair capabilities. The objective of this study was to showcase the reparative potential of LIPUS on renal injury at both animal and cellular levels, while also determining the optimal pulse length (PL).</p><p><strong>Research design and methods: </strong>We established a rat model of DN, and subsequently subjected the rats' kidneys to ultrasound irradiation (PL=0.2 ms, 10 ms, 20 ms). Subsequently, we assessed the structural and functional changes in the kidneys. Additionally, we induced podocyte apoptosis and evaluated its occurrence following ultrasound irradiation.</p><p><strong>Results: </strong>Following irradiation, DN rats exhibited improved mesangial expansion and basement membrane thickening. Uric acid expression increased while urinary microalbumin, podocalyxin in urine, blood urea nitrogen, and serum creatinine levels decreased (p<0.05). These results suggest that the optimal PL was 0.2 ms. Using the optimal PL further demonstrated the reparative effect of LIPUS on DN, it was found that LIPUS could reduce podococyte apoptosis and alleviate kidney injury. Metabolomics revealed differences in metabolites including octanoic acid and seven others and western blot results showed a significant decrease in key enzymes related to lipolysis (p<0.05). Additionally, after irradiating podocytes with different PLs, we observed suppressed apoptosis (p<0.05), confirming the optimal PL as 0.2 ms.</p><p><strong>Conclusions: </strong>LIPUS has been demonstrated to effectively restore renal structure and function in DN rats, with an optimal PL of 0.2 ms. The mechanism underlying the alleviation of DN by LIPUS is attributed to its ability to improve lipid metabolism disorder. These findings suggest that LIPUS may provide a novel perspective for future research in this field.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11261688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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BMJ Open Diabetes Research & Care
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