Canadian journal of diabetes最新文献

Background: Gestational Diabetes Mellitus (GDM) is a significant metabolic disorder affecting pregnant women, leading to increased risks of adverse maternal and fetal outcomes. Effective management and preventive strategies are crucial to mitigate its short- and long-term complications.

Objective: This study aims to elucidate the causal relationships between multiple modifiable risk factors and GDM using a two-sample Mendelian randomization (MR) approach.

Methods: We analyzed 41 modifiable risk factors, categorized into metabolic and weight factors, dietary habits, smoking and alcohol behaviors, and physical activities. Genetic variants associated with these risk factors were identified from genome-wide association studies (GWAS). GDM data came from the largest GWAS on gestational diabetes, including 12,332 GDM cases and 131,109 Finnish ancestry controls from the FinnGen study. MR analysis was performed using inverse variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode methods.

Results: Preliminary screening identified 12 significant modifiable risk factors, with fasting glucose, fasting insulin, glycated hemoglobin levels, triglycerides, body mass index (BMI), two-hour glucose, and processed meat intake increasing GDM risk, while high-density lipoprotein (HDL) cholesterol, tea consumption, cheese intake, lamb/mutton intake, and dried fruit intake decreased the risk. After correction for multiple comparisons, fasting glucose, fasting insulin, glycated hemoglobin levels, triglycerides, BMI, and HDL cholesterol remained significant and consistent across various methods.

Conclusion: This comprehensive MR study provides strong evidence for the causal effects of various modifiable risk factors on GDM, highlighting the importance of lifestyle interventions targeting metabolic and dietary factors to prevent GDM and improve maternal and fetal outcomes.

Objective: Globally, the prevalence of Type 2 Diabetes (T2D) among adolescents is increasing. While T2D is known to bring physical health challenges, less is known about adolescents' psychosocial experiences of T2D. We aimed to identify and synthesize existing qualitative research about adolescents' psychosocial experiences of T2D to inform healthcare recommendations.

Method: Guided by PRISMA and JBI guidelines, we conducted a systematic review and meta-synthesis using a meta-aggregative approach. We searched five electronic databases to identify qualitative or mixed-methods primary studies examining adolescents' psychosocial experiences of T2D, published in English, in a peer-reviewed journal from database inception to August 2024.

Results: Eight studies were included, with findings aggregated into two synthesized findings related to the diagnosis of T2D and living with T2D. At diagnosis, adolescents had limited knowledge of T2D, often obtained via observing family members with T2D and desired further education. Adolescents also described a range of negative emotions, some of which influenced disclosure of their diagnosis. In living with T2D, adolescents contended with psychosocial challenges, with some viewing T2D as a burden and others as an opportunity for positive self-care and lifestyle changes. Adolescents described challenges with health behaviour changes and medical management. Social support was noted to be important.

Conclusions: Adolescents with T2D have limited knowledge about the condition and desire greater education. They experience a range of emotions and challenges with T2D management and benefit from support. Based on our findings, we propose recommendations that may optimize adolescents' physical, psychological and social wellbeing.

Objective: Diabetic foot ulcer (DFU), a complication of diabetes, is associated with an increased risk of major amputation and mortality. However, the underlying pathogenesis of DFU remains unclear. Our goal in this study was to identify the role and underlying mechanism of MAF bZIP transcription factor G (MAFG) in DFU wound healing.

Methods: Human umbilical vein endothelial cells (HUVECs) were subjected to high-glucose (HG) treatment. Real-time quantitative polymerase chain reaction and western blot were used to determine the expression of MAFG and autophagy/ferroptosis-related markers. Cell proliferation was tested using the cell counting kit-8 (CCK-8) assay. Wound healing and tube formation assays were used to assess cell migration and angiogenesis, respectively. Enzyme-linked immunoassay and 2',7'-dichlorofluorescein diacetate staining were performed to measure intracellular oxidative stress and iron content. Light-chain 3B expression was detected by immunofluorescent staining. Luciferase reporter assay investigated MAFG-mediated transcriptional regulation of ATG7/BECN1.

Results: Increased MAFG levels were observed in DFU patients and HG-exposed HUVECs. The suppression of MAFG resulted in improved proliferation and angiogenesis in HG-induced HUVECs. MAFG knockdown effectively mitigated HG-induced oxidative stress and ferroptosis. Notably, the beneficial effect of MAFG silence on HG-induced HUVECs was diminished after 3-methyladenine administration (a specific autophagy inhibitor). Biologically, MAFG acted as a transcriptional repressor in HUVECs by directly targeting the promoters of autophagy-related genes ATG7 and BECN1. The depletion of ATG7 or BECN1 reversed the protective effects of MAFG knockdown on HG-stimulated angiogenesis and ferroptosis inhibition in HUVECs.

Conclusion: Taken together, MAFG knockdown inhibited ferroptosis and promoted angiogenesis to improve DFU wound healing via modulating ATG7/BECN1-mediated autophagy, providing a novel therapeutic target for DFU treatment.

Objectives: Children and youth with type 1 diabetes (T1D) must have support to manage their condition while at school. In 2017, Ontario students and their parents were surveyed to assess the level of school support and the extent to which that support met perceived needs. In 2018, a provincial policy was established, providing high-level guidance regarding children with T1D in school. We redistributed our survey in 2023 to determine whether support for children with T1D has improved and where gaps remain.

Methods: An online survey was circulated to patients and families through the 35 pediatric diabetes education centres in the Ontario Pediatric Diabetes Network in 2017 and 2023. Survey responses were collected via REDCap software. Results were analyzed using descriptive statistics and the Pearson chi-square test. The Mann-Whitney U test was used to compare satisfaction with school support.

Results: A total of 1,060 responses were received in 2017, and 437 responses in 2023. Between the 2 time points, respondents reported increased use of individual care plans, continuous glucose monitoring, and improved management of hypoglycemia at school. There was no improvement in support for blood glucose monitoring or insulin administration. Overall, there was no increase in satisfaction with school support. Importantly, 37% of caregivers stopped work related to diabetes care at school.

Conclusions: School support for children with T1D has improved in specific domains. However, gaps remain, and many families remain adversely affected by lack of support in school. Our findings suggest a need for ongoing advocacy to address care gaps.