Canadian journal of diabetes最新文献

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.

Objectives: 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 subcohort 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 claims information, and an expanded BC definition encompassing prescription information. Both definitions were validated against "gold-standard" diagnosis data from the BCDPR.

Results: There were 6,716 cases of diabetes using the CCDSS definition. Under the expanded BC definition, the total number of cases increased by 1,074 (16.0%). Furthermore, 458 cases met the CCDSS definition but not the BC definition, with the majority (67.7%) never having received a diabetes-related medication. The differences between definitions were similar for both sexes but increased with increasing age. When compared with the gold-standard BCPDR, the sensitivity of the BC and CCDSS definitions was 94.0% and 72.7%, respectively.

Conclusions: The CCDSS definition of diabetes does not capture all patients with diabetes and results in false positive cases when compared with an expanded definition and with 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.

Objectives: 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 nondiabetic 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 to 2021) from young adults (19 to 40 years of age) with a diagnosis of diabetes. Kidney biopsies of youth (≤18 years) and additional adult biopsies from the 2022-2023 period were manually reviewed. Clinical data were extracted from MCHP (young adults) and clinical charts (youth), including sex, age, diabetes duration, glycated hemoglobin (A1C), estimated glomerular filtration rate (eGFR), urine albumin:creatinine ratio (ACR), hypertension status, and medications.

Results: One hundred fifty-three young adult and 34 youth biopsies were included in the study. Diabetes duration at time of biopsy was a median of 5.0 (1.0 to 10.0) years for young adults and 2.8 (1.3 to 4.9) years for youth. Young adults had lower A1C (7.6 vs 10.3%, p<0.0001), more albuminuria (median ACR 330.0 [172.3 to 591.5] vs 94.0 [34.9 to 204.8] mg/mmol, p<0.0001), and lower eGFR (37 vs 143 mL/min per 1.73 m², p<0.0001) at time of biopsy. Youth had more nondiabetic kidney pathology compared with diabetic pathology in young adults, including nonproliferative 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 nondiabetic kidney diseases, whereas adult biopsies demonstrated more severe diabetic nephropathy and chronic scarring. Further research is needed to explore associations between clinicopathologic changes and eGFR trajectories.

Objectives: Our aim in this study was 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 and 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 diabetes in pregnancy (DIP) (gestational diabetes [GDM], pre-existing diabetes [pre-Gest/DM], or no DIP), and ethnicity.

Results: Among 360,508 offspring, 763 of 52,818 (1.4%) FN and 2,143 of 307,696 (0.7%) non-FN developed DM. FN people were over twice as likely as non-FN to develop DM, but the strongest DM predictor in both populations was DIP exposure (hazard ratios [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) people exposed to pre-Gest/DM and 22% of LGA FN (4% of non-FN) people 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: Our aim in this study was to gain further insight into the way emerging adults with type 1 diabetes experience and manage conflicts between their desire to take good care of their diabetes and reaching daily goals in other life domains.

Methods: Participants were recruited from 3 locations of a Dutch type 1 diabetes care and research centre until researchers considered data saturation to have been reached. Sixteen emerging adults were interviewed and completed a diary for 3 days. Interview transcripts were analyzed by 2 researchers, using directed content analysis.

Results: Participants had daily conflicts between self-management and attaining goals in various life domains (including food, alcohol, sports, school/work, and leisure activities); social goals figured prominently. Generally, participants first tried to combine their diabetes goal and other goals by means of flexible self-care supported by modern technology, thorough planning, and social support. When combining was not possible, most participants tended to prioritize nondiabetes goals, unless they perceived a high risk for adverse health outcomes. Prioritization of diabetes goals, as well as nondiabetes goals, often resulted in negative emotions such as sadness and guilt.

Conclusions: For emerging adults, good care of diabetes is a challenge to undertake while also addressing other goals of daily life. Combination and prioritization strategies both play a role in efforts to deal with these goal conflicts, although the latter often trigger negative emotions. The present findings can be used for the optimization of diabetes self-management support by taking the broader life context into account.

Background: Diabetes is a global health emergency, affecting more than 420 million people worldwide, but care gaps persist. Patient engagement (PE) in research may address these gaps, but meaningful engagement with representative populations of diverse race, language and socioeconomic status is lacking. Power imbalances and tokenistic engagement are common.

Objective: To understand what diverse patient partners (PPs) who live with diabetes need to participate in research and how to integrate and engage them meaningfully.

Design: Qualitative study of focus groups.

Methods: A purposive sampling strategy was used to recruit PPs from the Diabetes Action Canada (DAC) research network. A semi-structured focus group guide was used to conduct focus group sessions. Sessions were audio-recorded and transcribed verbatim. Data analysis and synthesis involved Braun and Clark's reflexive thematic analysis to develop patterned meanings across the dataset.

Results: 35 PPs participated in 13 focus groups (9 English, 4 French). PPs had a mean age of 55 years, living with type 2 (46%) or type 1 (37%) diabetes, identified as female/woman (77%), residing in Ontario (47%) or Quebec (40%); 34% identified as racialized. Themes were developed across three broad domains: 1) enablers, 2) opportunities for improvement (challenges and recommendations); and 3) diabetes-specific considerations, highlighting distinct challenges and enablers related to participants' lived experiences with diabetes. We used this data to co-design research-stage-specific recommendations to optimize patient integration and engagement in research.

Conclusions: Our focus group study identified enablers and opportunities for improvement to integrate PP perspectives into the DAC research network more meaningfully.

Objectives: The prevalence of type 2 diabetes (T2D) has increased substantially over the last decade among young populations living in Canada, with certain ethnic groups, such as African, Caribbean, and Black (ACB), being disproportionately affected. However, little is known about the suitability of the widely adopted T2D risk assessment tool, Canadian Diabetes Risk Questionnaire (CANRISK), for this population.

Methods: Two analytical samples of individuals aged 18 to 39 years were identified from 3 phases of CANRISK validation data collection: 1) young individuals from ACB ethnicities; and 2) all young individuals. Descriptive analyses were conducted for all predictors from the CANRISK and for prevalent dysglycemia (assessed by oral glucose tolerance test). The discriminatory ability of the CANRISK model was assessed by generating the area under the curve (AUC) and other model metrics. In addition, we assessed several cut points for the ACB subgroup to identify the optimal threshold.

Results: The prevalence of dysglycemia was higher among the ACB subgroup (n=715) than the overall young sample (n=3,960) (8.4% vs 7.7%). The CANRISK model performance was comparable for both groups, but slightly more accurate in the ACB subgroup (AUC 71.9% vs AUC 71.5%). The optimal cutoff for young ACB individuals was the same optimal cutoff of 19 as for the general Canadian youth population.

Conclusions: Our findings indicate that the CANRISK tool, with a modified cutoff point, is a suitable tool to identify T2D risk among young adults from ACB ethnicities. Future studies could explore the tool's predictive ability via longitudinal studies to assess long-term diabetes risk.