Canadian journal of diabetes最新文献

Objectives: In this study we investigated uptake of flash glucose monitoring (FGM) among Ontario residents ≥66 years of age who require insulin and are eligible for Ontario's universal drug coverage program (the Ontario Drug Benefit [ODB]). Specifically, we assessed differences based on immigration status.

Methods: Using administrative data, we conducted a population-based, repeated cross-sectional study among Ontarians ≥66 years of age with insulin-requiring diabetes between September 1, 2019, and March 31, 2023. The primary outcome was the monthly rate of unique individuals receiving publicly funded FGM through the ODB program. We compared characteristics of FGM users based on immigration status by considering demographic, neighbourhood, and health care use factors.

Results: We found a total of 14,151 immigrants and 85,710 long-term residents who had FGM over the study period. In the first month of funding, the rate of new users was lower among immigrants (37.1 per 1,000) compared with long-term residents (48.8 per 1,000). Rates peaked at 98.0 and 96.0 per 1,000, for immigrants and long-term residents respectively, in October 2019, declining thereafter and stabilizing in April 2020. Immigrants receiving FGM were younger, more likely to reside in neighbourhoods with greater racialized and newcomer populations, and more likely to have received noninsulin diabetes medications in the prior year, when compared with long-term residents receiving FGM.

Conclusions: We observed significant FGM uptake in the first months after public funding among both immigrants and long-term residents. Although long-term residents showed slightly higher initial uptake, differences between groups were minimal after the first month of funding.

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.