Canadian journal of diabetes最新文献

Diabetic retinopathy (DR) is a leading cause of vision loss among working-age adults and one of the most frequent complications of diabetes mellitus. Current therapies, including laser photocoagulation and intravitreal anti-VEGF agents, are effective only in advanced disease and remain invasive and palliative. The multifactorial pathogenesis of DR involves hyperglycemia-driven oxidative stress, chronic inflammation, dyslipidemia, and disruption of the blood-retinal barrier. Peroxisome proliferator-activated receptors (PPARs) have emerged as key regulators of metabolic and inflammatory signaling in the retina. PPARα agonists such as fenofibrate and pemafibrate exert antioxidant, anti-inflammatory, and vasoprotective effects, while PPARγ agonists (e.g., pioglitazone) improve insulin sensitivity and attenuate oxidative damage, albeit with safety concerns such as fluid retention. Dual PPARα/γ agonists, including saroglitazar, provide synergistic benefits by reducing leukostasis, neovascularization, and inflammatory signaling, whereas PPARβ/δ is gaining attention for its role in retinal energy metabolism. In parallel, non-PPAR targets such as the AGE-RAGE axis, VEGF signaling, aldose reductase, and AMPK pathways represent complementary mechanisms. Natural compounds (e.g., curcumin, resveratrol), statins, and metabolic modulators have demonstrated promising preclinical efficacy. Targeting both PPAR and non-PPAR pathways may enable preventive and multimodal management of DR. Future efforts should prioritize early-stage interventions, combination strategies, and innovative ocular drug delivery systems to overcome current therapeutic limitations and shift from reactive to preventive care.

Background: Non-adherence to diabetes treatment leads to persistent hyperglycemia, a key driver of non-healing diabetic foot ulcers (DFUs). Continuous glucose monitoring (CGM) and telemedicine have independently improved glycemic control, HbA1c, and time in range. This study reviews the various components of telemedicine and CGM to gain insight that can contribute to future directions for enhancing DFU interventions.

Method: a scoping review was conducted in PubMed, Embase, CINAHL, and Scopus.

Results: 16 studies were included. Aggregated, three main implication areas, one with subdivisions were identified: 1) Components in a remote treatment package, a) The telemedicine term, b) The specialized healthcare professional, c) Monitoring health data, and d) Supervision and feedback on monitored data, 2) Improved glycemic control with remote treatment, and 3) Future directions for DFU interventions.

Conclusion: Selected components of telemedicine and CGM may be utilized in future DFU interventions but needs to be tested in a future feasibility study.

Purpose: Glaucocalyxin B (GLB) has documented anti-inflammatory activity in several disease contexts; however, its role in diabetic cardiomyopathy (DCM)-associated inflammatory injury remains insufficiently defined. This study aimed to evaluate whether GLB alleviates myocardial inflammation and injury in DCM and to explore the underlying mechanisms.

Methods: We combined network pharmacology with experimental validation using an STZ-induced diabetic rat model (8-week protocol) and high-glucose-challenged H9c2 rat cardiomyocytes. Oxidative stress-related indices (e.g., ROS and MDA) and antioxidant capacity were assessed in vivo and in vitro. Gut microbiota composition was profiled by 16S rRNA sequencing. Activation of inflammatory signaling was evaluated with a focus on the NF-κB/NLRP3 axis.

Results: Network pharmacology suggested that GLB targets were enriched in pathways related to cardiomyocyte regulation and DCM-associated processes, including inflammation, apoptosis, and oxidative stress responses. In both diabetic rat myocardium and high-glucose-treated H9c2 cells, GLB reduced oxidative stress burden, evidenced by decreased ROS and MDA levels, and improved antioxidant-related readouts. In addition, GLB was associated with increased gut microbial richness and diversity in diabetic rats. Mechanistically, GLB treatment was accompanied by suppression of NF-κB/NLRP3 pathway activation, consistent with attenuation of inflammatory injury.

Conclusions: These findings provide initial evidence that GLB mitigates oxidative stress and inflammatory damage in DCM. The cardioprotective effects of GLB appear to involve modulation of the NF-κB/NLRP3 signaling pathway and partial restoration of gut microbial diversity, supporting GLB as a promising candidate for further investigation in DCM.

Objective: Basal insulin treatments have historically been administered once daily (OD) or twice daily (BD). Once weekly (OW) treatments are now available. This study aimed to quantify the relative importance of frequency of administration in basal insulin treatment preferences of Canadians living with type 2 diabetes (T2D) when glycemic control and cost are held constant, using a discrete choice experiment (DCE).

Methods: A targeted literature review and qualitative interviews informed the development of an attributes and levels grid. Pilot interviews assessed survey feasibility. Hierarchical Bayesian estimation was used to identify the relative importance of each attribute.

Results: The DCE survey was completed by N=155 participants across three treatment experience categories: basal insulin naïve but injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) experienced (n=55), basal insulin experienced (n=53), and basal insulin and injectable GLP-1 RA naïve (n=47). Frequency of administration had a relative importance of 41% (confidence interval: 38%, 45%), more than double any other attribute tested in this study. A preference for OW administration was observed relative to OD or BD. A reduction in the frequency of missing doses and taking doses at the prescribed time were considered the most positive impacts of OW administration.

Conclusion: This study demonstrates the importance of frequency of administration in basal insulin treatment decisions when glycemic control and cost are held constant. Per pre-specified conditions, participants indicated a preference for OW dosing, making trade-offs between treatment risks and convenience. Findings have implications for healthcare decision-makers in ensuring patient preferences are considered in treatment decisions.

Introduction: Population surveillance of diabetes relies on administrative data, which requires accurate case definitions to inform public health decision making. The objective of this study was to compare the Canadian Chronic Disease Surveillance System (CCDSS) diabetes definition with an expanded definition in a pediatric population cohort from British Columbia (BC).

Methods: This was a retrospective population-level study using linked administrative databases in BC between April 1, 1996, and March 31, 2024. A sub-cohort was linked with a prospectively collected cohort of pediatric diabetes patients from the BC Pediatric Database Registry (BCPDR). Rates of Type 1 and 2 pediatric diabetes were compared between the CCDSS definition, based on hospital and physician claim information, and an expanded BC definition encompassing prescription information. Both definitions were validated against a gold-standard diagnosis data from the BCDPR.

Results: There were 6716 cases of diabetes using the CCDSS definition. Under the expanded BC definition, the total number of cases increased by 1074 (16.0%). Further, 458 met the CCDSS definition but not the BC definition, the majority (67.7%) of whom never received a diabetes related medication. The differences between definitions were similar for both sexes but increased with increasing age. When compared to the gold standard BCPDR the sensitivity of the BC and CCDSS definitions were 94.0% and 72.7%, respectively.

Conclusion: The CCDSS definition of diabetes does not capture all patients with diabetes and results in a number of false positive cases when compared to an expanded definition and to gold standard diagnoses from a provincial registry.

Addressing psychosocial factors in diabetes care has a significant impact on clinical outcomes. There is limited research exploring how Australian men assigned male at birth who identify as male and gay may influence the management of type 2 diabetes (T2D), creating a lack of awareness among healthcare providers and gay people living with diabetes. This study examined how sexual orientation impacts the experience and management of T2D. A sequential mixed-methods design explored the experiences of Australian men assigned male at birth, identifying as male and gay with T2D. Two data collection phases started with an electronic survey of 83 gay men with T2D (7 screening, 63 questions covering characteristics and where sexuality and diabetes intersect) and 82 without T2D (5 questions covering thoughts on gay men with T2D), to explore community perceptions, followed by a second phase of 12 in-depth interviews with gay men with T2D. Descriptive statistics were used to analyse survey data, and reflexive thematic analysis, grounded in constructivist assumptions, was used for interview data. Twenty-one per cent of participants had not disclosed their sexual orientation to their doctor, indicating a prevalent barrier. Four themes emerged that reduce the ability of gay men to bring their whole selves into healthcare consultations, creating a barrier, including:[1] Discomfort around sexual orientation and diabetes; [2] Navigating uncomfortable patient-provider conversations; and [3] Sexuality and diabetes, an unknown connection. These findings underscore the need for tailored interventions by diabetes specialists or educators to address identity-related barriers and potentially reduce diabetes-related complications.

Background: Rates of progression to kidney failure have been shown to differ by age of diabetes diagnosis in many populations. We evaluated clinically performed kidney biopsies to better understand this observation. We hypothesized that youth with a diabetes diagnosis have more non-diabetic kidney pathology than young adults.

Methods: This retrospective cohort study used a kidney biopsy registry linked to the Manitoba Centre for Health Policy (MCHP) to evaluate all kidney biopsies (2002-2021) from young adults (age 19-40) with a diagnosis of diabetes. Kidney biopsies of youth (≤18 years) and additional adult biopsies from 2022-23 were manually reviewed. Clinical data were extracted from MCHP (young adults) and clinical charts (youth) including sex, age, diabetes duration, hemoglobin A1c(HbA1c), estimated glomerular filtration rate(eGFR), urine albumin:creatinine ratio (ACR), hypertension status, and medications.

Results: 153 young adult and 34 youth biopsies were included. Diabetes duration at time of biopsy was a median of 5.0 (1.0-10.0) (young adults) and 2.8 (1.3-4.9) years (youth). Young adults had lower HbA1c (7.6 vs. 10.3%, p<0.0001), more albuminuria (median ACR 330.0 (172.3-591.5) vs. 94.0 (34.9-204.8) mg/mmol, p<0.0001), and lower eGFR (37 vs. 143 ml/min/1.73m², p<0.0001) at time of biopsy. Youth had more non-diabetic kidney pathology compared to diabetic pathology in young adults, including non-proliferative glomerulonephritis (29.4% vs. 13.7%, p=0.05). Young adults had more severe tubulointerstitial scarring (52.2% vs. 5.9%, p<0.0001).

Conclusions: Youth with diabetes are more likely to have non-diabetic kidney diseases, whereas adult biopsies demonstrate more severe diabetic nephropathy and chronic scarring. Further research is needed to explore associations between clinicopathologic changes and eGFR trajectories.

Objectives: To determine how birthweight and exposure to diabetes in pregnancy (DIP) contribute to early-onset diabetes mellitus (DM) in Saskatchewan First Nations (FN) and non-FN offspring.

Methods: Using Ministry of Health administrative databases, we conducted a retrospective cohort study of FN and non-FN children born between 1980-2009 and followed to March 31, 2013. Using Cox regression models and cumulative survival analysis, we determined DM risk by birthweight (small [SGA], normal [NGA] or large for gestational age [LGA]); maternal DIP (gestational diabetes [GDM], pre-existing diabetes [pre-Gest/DM] or no DIP); and ethnicity.

Results: Among 360,508 offspring, 763/52,818 (1.4%) FN and 2,143/307,696 (0.7%) non-FN developed DM. FN were over twice as likely as non-FN to develop DM but the strongest DM predictor in both populations was DIP exposure (HRs 4.1 for FN and 4.9 for non-FN exposed to pre-Gest/DM; HRs 3.1 and 1.6 for FN and non-FN exposed to GDM). SGA and LGA were independent DM predictors in the total population, but only LGA interacted with DIP exposure to amplify DM risk in offspring. By 34 years, 38% of LGA FN (9% of non-FN) exposed to pre-Gest/DM and 22% of LGA FN (4% of non-FN) exposed to GDM developed DM.

Conclusions: GDM is a key to the epidemic of T2DM among Indigenous peoples. It is the strongest predictor of T2DM among younger FN women and a precursor to their high rates of pre-Gest/DM. Offspring exposed to GDM and especially pre-Gest/DM are at high risk for early-onset T2DM, further worsened by being LGA.

Objectives: Type 2 diabetes (T2D) can cause psychosocial difficulties, burdensome self-care, and stigmatization, which can lead to diabetes distress, reduced quality of life, and suboptimal diabetes management. Guided self-determination (GSD) has been identified as valuable in alleviating diabetes distress. In this study we explored the experience of a GSD intervention among people with T2D and aimed to understand the potential impact on diabetes distress.

Methods: A qualitative study was undertaken using semistructured interviews (n=10) and reflexive thematic analysis by Braun and Clarke. The study adhered to the COREQ checklist.

Results: Four themes revealed: "Person-centred reflection creates self-insight," becoming aware of how one deals with diabetes and finding renewed optimism; "Unburdening myself," characterized by room and support for psychosocial aspects; "Making sense of diabetes: Creating meaning through reflection and dialogue," reflecting on current difficulties while simultaneously making sense of diabetes; and "Barriers to changes: Between acceptance, effort, and everyday realities," where readiness, motivation, and energy impacted possible changes.

Conclusions: GSD may improve the ability to alleviate stressors related to diabetes. However, some patients experienced no changes. Readiness, motivation, and energy appear to be critical for the potential to change.