BMC Endocrine Disorders最新文献

Background: Diabetes, a known syndrome marked by hyperglycemia and glucose intolerance, is increasing at an alarming rate worldwide. Over half a billion people worldwide have DM, and most live in low- and middle-income countries. Poor glycemic control is a public health concern in type 2 diabetes mellitus. Glycemic control and identifying factors associated with poor glycemic control can help healthcare providers design programs that improve glycemic control and the quality of services provided to patients.

Objectives: This study was designed to assess the level of glycemic control and associated factors in patients with type 2 diabetes in Jimma Medical Center, Southwest Ethiopia.

Methods: This institution-based prospective observational study was conducted among 420 patients with type 2 diabetes at Jimma Medical Center's diabetic clinics. A pretested structured interviewer-administered questionnaire was used to collect data, and a checklist was used to assess patient documents. The data were analyzed using SPSS version 26. The variables linked to poor glycemic control were investigated using binary logistic regression. Variables with p values less than 0.05 were considered statistically significant.

Results: Six-month follow-ups were conducted among 420 patients with type 2 diabetes, among whom 220 (52.38%) were women. The median age of the participants was 54(IQR = 40-60 years old). The proportion of respondents with uncontrolled fasting blood glucose was 58.1%. Sex (AOR = 2.576, 95% CI [2.80-11.479], P = 0.001), age(≥ 60) (AOR = 2.024, 95% CI [1.794-4.646], P = 0.002), diabetes duration > 10 years (AOR = 3.036, 95% CI [2.616-8.306], P = 0.003), type 2 diabetes mellitus on insulin + oral antidiabetic (OADs) (AOR = 2.08, 95% CI [298-3.918], P = 0.004), obesity (AOR = 2.18, 95% CI [(1.218-4.218)], P = 0.003), diabetic complications (AOR = 3.193, 95% CI [2.324-6.05], p = 0.002) and poor self-care practices (AOR = 3.034, 95% CI [5.821-7.02], P = 0.005) were found to be significantly associated with poor glycemic control.

Conclusion: At the Jimma Medical Center, the prevalence of poor glycemic control was high. Based on these findings, teaching and counseling provided by healthcare providers should focus on improving diabetes self-care activities, weight reduction, and diabetic complications to achieve good glycemic control.

Clinical trial number: Not applicable.

Background: The triglyceride-glucose (TyG) index and related parameters, as well as the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), have been developed as insulin resistance markers to identify individuals at risk for non-alcoholic fatty liver disease (NAFLD). However, its use for predicting NAFLD in patients with type 2 diabetes mellitus (T2DM) remains unclear. In this study, we aimed to observe the performance of insulin resistance indices in diagnosing NAFLD combined with T2DM and to compare their diagnostic values in clinical practice.

Patients and methods: Overall, 268 patients with T2DM from the Endocrinology Department of Jiangsu Provincial Hospital of Traditional Chinese Medicine were enrolled in this study and divided into two groups: an NAFLD group (T2DM with NAFLD) and a T2DM group (T2DM without NAFLD). General information and blood indicators of the participants were collected, and insulin resistance indices were calculated based on these data. Receiver operating characteristic (ROC) analysis was conducted to calculate the area under the curve (AUC) for insulin resistance-related indices, aiming to assess their ability to discriminate between T2DM patients with and without NAFLD.

Results: ROC analysis revealed that among the five insulin resistance-related indices, four parameters (TyG, TyG-body mass index [BMI], TyG-waist circumference [WC], and TyG- (waist-hip ratio [WHR]) exhibited high predictive performance for identifying NAFLD, except for HOMA-IR (AUCs:0.710,0.738,0.737 and 0.730, respectivly). TyG-BMI demonstrated superior predictive value, especially in males. For males, the AUC for TyG-BMI was 0.764 (95% confidence interval [CI] 0.691-0.827). The sensitivity and specificity for male NAFLD were 90.32% and 47.89%, respectively. Moreover, in the Generalized linear regression models, there were positive associations of TyG, TyG-BMI, TyG-WC, TyG-WHR, and HOMA-IR with controlled attenuation parameter (CAP), with β values of 21.30, 0.745, 0.247, and 2.549 (all P < 0.001), respectively.

Conclusion: TyG-BMI is a promising predictor of NAFLD combined with T2DM, particularly in lean male patients.

Background: Diabetic kidney disease populations are categorized as high risk for fasting in Ramadan due to various potential fasting-related complications. Insulin analogues are recommended to be used in place of human insulin during fasting, as they carry a lower risk of hypoglycaemia and stable glycaemic variability. A paucity of data exits on the safety and efficacy of different basal insulin types during fasting for this population. This study aims to evaluate the safety and efficacy of three basal insulin among patients with Type 2 Diabetes Mellitus and concomitant mild to moderate chronic kidney disease who are keen to fast during Ramadan.

Materials and methods: A single-centered, prospective observational study was conducted among 46 patients with type 2 diabetes mellitus and concomitant chronic kidney disease stage 2 and 3 who were on three different types of basal insulin (Glargine U-100, Levemir, and Insulatard), fasted in Ramadan 2022. All variables were listed as median (IQR). Hypoglycaemia events and glycemic variability obtained from Freestyle Libre continuous glucose monitoring were compared between insulin groups. Changes in glycated haemoglobin, fasting plasma glucose, renal profile, body weight, body mass index, and waist circumference pre and post-Ramadan were evaluated.

Results: The glycaemic variability was found highest in Insulatard with a median (IQR) of 37.2(33)% versus Levemir 34.4(32.4)% versus Glargine U-100 36.8(30.6)%, p = NS. Levemir had reported the lowest median time of below range of 2.5(13)% followed by Glargine 4(25)% and Insulatard 5(8)%; p = NS. The findings of this study indicated that glycated haemoglobin, fasting plasma glucose, renal profile, body weight, body mass index, and waist circumference did not alter statistically between the three groups post-Ramadan. Individually, Insulatard showed a significant reduction in weight and waist circumference (0.9kg, p = 0.026; 0.44 cm, p = 0.008) while Levemir showed a reduction in waist circumference (0.75cm, p = 0.019).

Conclusion: This study revealed that Insulatard, Levemir, and Glargine demonstrated similar levels of safety and efficacy among those with diabetic kidney disease who observed fasting during Ramadan.

Background: Recent evidence suggests that diabetes-related lower-extremity complications (DRLECs) may be associated with cognitive changes in people with diabetes. However, existing literature has produced inconsistent findings, and no systematic reviews have been conducted to investigate whether DRLECs impact the cognition of people with diabetes. This systematic review evaluated existing studies that investigated cognition in people with diabetes with DRLECs and without DRLECs.

Method: Seven databases; MEDLINE, PubMed, CINAHL, EMBASE, Cochrane, PsycINFO and Web of Science were searched from inception until 22/8/2022 for studies that compared cognition in people with diabetes with and without DRLECs. Results were independently screened for eligibility and assessed for methodological quality by two authors, with key data extracted. Studies were eligible for meta-analysis if the studies reported similar cases, controls, and outcome measures.

Results: Thirteen studies were included in the review, with eleven of medium methodological quality, one of high quality, and one of low quality. Four studies found significant differences in cognition between those with and without DRLECs, four found significant associations between diabetes-related lower-extremity complications and cognition, and five found no differences or associations. One small meta-analysis of eligible studies found that there was no statistically significant difference in cognition in people without, compared to with, peripheral neuropathy (Mean difference = -0.49; 95%CI: -1.59-0.61; N = 3; n = 215). Leave-one-out sensitivity analyses further confirmed that there was no significant difference in cognition among people with and without peripheral neuropathy (p > 0.05).

Conclusion: DRLECs may be related to cognition in people with diabetes, however, existing evidence is unclear due to variability in used methodologies that may challenge concluding the findings. Future high-quality studies investigating cognition among people with and without DRLECs are needed.

Background: There is a belief that consuming a significant amount of omega-3 and omega-6 fatty acids can positively affect chronic diseases. However, the connection between these fatty acids and type 2 diabetes mellitus (T2DM) risk remains unclear. To explore this further, we conducted a study to investigate the relationship between dietary intake of omega-3 and omega-6 fatty acids (FA), as well as omega-6 to omega-3 ratio, and the odds of T2DM.

Methods: Our research involved a cross-sectional analysis of data from the Ravansar Non-Communicable Disease (RaNCD) cohort. We evaluated their dietary habits using a comprehensive 118-item food frequency questionnaire (FFQ). To determine the aforementioned association, we employed logistic regression analysis to calculate odds ratios (OR) and 95% confidence intervals (CIs).

Results: The prevalence of T2DM among 8744 qualified participants was 751 (8.6%). After considering all the possible factors that could affect the outcome, high dietary omega-3 intake was associated with a 58% lower likelihood of T2DM (OR: 0.42; 95% CI: 0.32, 0.56; P-trend: <0.001). In contrast, participants at the fourth quartile of the dietary omega 6 to omega 3 FA ratio had a higher odd of T2DM (OR: 1.42; 95%CI: 1.11, 1.84; P-trend: 0.01). Nevertheless, there was no significant connection between the highest and lowest quartile of dietary omega-6 intake (OR: 0.91; 95% CI: 0.71, 1.17; P-trend: 0.80).

Conclusion: According to the study, consuming omega-3 fatty acids through diet was linked with lower odds of type 2 diabetes. Conversely, an elevated omega-6 to omega-3 ratio was associated with a greater likelihood of T2DM.

Background: Metabolic syndrome is a prevalent and common health problem and numerous studies have revealed the role of diet and lifestyle change in prevention of metabolic syndrome. However, the novel dietary index, cardioprotective index (CPI) and its association with metabolic syndrome is not investigated yet. In the current study, we evaluated the association between metabolic syndrome and its components, CPI, Nesfatin-1 and Omentin-1in a cross-sectional study.

Methods: Three hundred forty eight overweight and obese individuals with metabolic syndrome were recruited. Subjects underwent anthropometric and laboratory assays including metabolic markers, Nesfatin-1 and Omentin-1 with commercial kits.

Results: Those at the first tertile of CPI had lower high density lipoprotein concentrations (HDL) and higher low density lipoprotein concentrations (LDL), triglyceride (TG), systolic and diastolic blood pressures (SBP, DBP) levels compared with those at the highest tertiles (P < 0.05). After adjustment for the confounding effects of age, sex, body mass index, physical activity and total calorie intake, LDL lost its significance across CPI tertiles. Moreover, serum total cholesterol, insulin and insulin resistance were not significant across CPI tertiles neither in crude nor in adjusted models (P > 0.05). Additionally, being at the third tertile of CPI was accompanied with significantly higher Nesfatin-1 and Omentin-1 levels compared with lowest tertiels (P < 0.05) in crude and confounder - adjusted models.

Conclusions: To our findings, CPI was in positive relationship with metabolic parameters, blood pressure, Nesfatin-1 and Omentin-1 levels in metabolic syndrome. Further future studies will help to elaborate the causality.

Clinical trial number: Not applicable.

Background: Chronic low-grade inflammation is related to bone metabolism in patients with type 2 diabetes mellitus (T2DM). However, credible data indicating the relationship between inflammation and fragility fracture risk in postmenopausal anemic females with T2DM are sparse. The current study sought to investigate the relationships between the systemic immune-inflammatory index (SII) and fragility fracture events, as well as the future 10-year fragility fracture probability evaluated using the fracture risk assessment tool (FRAX) in postmenopausal females with T2DM.

Methods: According to the tertiles of SII, 423 postmenopausal females with T2DM were divided into three groups: low-level (≤ 381.32, n = 141), moderate-level (381.32-629.46, n = 141), and high-level (≥ 629.46, n = 141). All participants were followed up for 7 years with a median of 46.8 months (1651 person-years). The association between SII and fragility fracture risk was assessed.

Results: Of 423 subjects, 75 experienced a fragility fracture event. Spearman partial correlation analysis revealed that SII was negatively related to bone mineral density (BMD) and was positively associated with the future 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF). Restricted cubic spline (RCS) analysis revealed a positive correlation between SII and fragility fracture risk in an approximately inverted J-shaped dose-response pattern (P for overall < 0.0001). Multivariate Cox regression analysis demonstrated that patients with a high SII presented a greater risk of fragility fractures (P = 0.011). Stratified analysis revealed that fragility fractures in the high-level SII were predominantly associated with anemia with an increase of 4.15 times (P = 0.01). Kaplan‒Meier analysis indicated a greater cumulative incidence of fragility fractures in patients with a high SII (log-rank, all P = 0.0012). Receiver operating characteristic (ROC) analysis indicated an optimal SII cut-off value of 537.34, with an area under the curve (AUC) of 0.646, a sensitivity of 60%, and a specificity of 64.1% (P < 0.001).

Conclusion: The SII revealed a significant positive association with a real-world fragility fracture event and a future 10-year fragility fracture probability in postmenopausal females with T2DM, particularly evident in individuals with anemia. Therefore, monitoring the SII and hemoglobin in postmenopausal older women with T2DM is helpful in routine clinical practice to identify individuals at high risk for fragility fractures and to promptly execute appropriate fracture intervention procedures.

Objective: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by hormonal imbalances and insulin resistance (IR). Among the metabolic abnormalities associated with PCOS, obesity is often present concurrently. Nevertheless, the correlation between obesity, sex hormone levels, and blood lipid profiles in PCOS patients with IR remains uncertain.

Methods: This is a cross-sectional study including a total of 206 Chinese women diagnosed with PCOS, enrolled between March 2016 and December 2021. The participants' anthropometric measurements, such as weight, height, waist circumference, and hip circumference, were recorded. Additionally, fasting blood samples were collected to measure various parameters, including fasting glucose, insulin levels, lipid profiles, and sex hormone levels.

Results: Our findings highlight that obesity exhibited a significant correlation with lower levels of sex hormone binding globulin (SHBG) and elevated levels of free androgen index (FAI), fasting insulin, and HOMA-IR in PCOS patients diagnosed with IR. However, no significant association between obesity and blood lipid profiles was observed within this particular group of women.

Conclusion: This study suggests that among PCOS patients with IR, lower levels of SHBG and higher levels of FAI are associated with obesity. These findings indicate that SHBG and FAI may have the potential to serve as a biomarker for the initial identification and prognosis of IR in PCOS patients.

Trial registration: Retrospectively registered on 25/04/2020 at ClinicalTrials.gov Identifer: NCT04264832.