Canadian journal of diabetes最新文献

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.

Objectives: Our aim in this study was to explore adolescents' experiences of type 2 diabetes (T2D), particularly those concerning 1) diagnosis and management and 2) emotional well-being.

Methods: Participants, recruited from an Australian tertiary pediatric hospital, took part in a focus group or semistructured interview. Data were analyzed using inductive thematic analysis.

Results: Eight adolescents participated in the study (7 female youths and 1 male youth; mean ± standard deviation age: 16.2±2.3 years; median [interquartile range] diabetes duration: 1.7 [0.8 to 2.5] years; glycated hemoglobin: 7.5% [6.2% to 8.4%]; and body mass index z score: 1.97 [0.70 to 2.29]). Most participants (n=6) were from linguistically diverse backgrounds. Their diabetes management varied from lifestyle measures alone to medication(s). The thematic analysis generated 3 themes relating to diagnosis and management: 1) "Dietary modification as the biggest encumbrance in managing T2D"; 2) "Medications pose a significant challenge to managing T2D"; and 3) "The value of reminders in managing T2D varies in adolescents." Furthermore, 4 themes were generated concerning emotional well-being: 1) "Diverse feelings are experienced at the time of diagnosis"; 2) "Diabetes has varying impacts on the daily lives of adolescents with T2D"; 3) "Young people fear stigma and judgement"; and 4) "Having a good support network matters."

Conclusions: Adolescents with T2D experience difficulties with dietary modification and medication management. Adolescents' feelings at diagnosis and the impact of T2D on a young person's life vary. They fear judgement and stigma, and a diverse support network is paramount in supporting their T2D management and emotional well-being. The findings can assist health professionals in supporting adolescents with T2D.

Objective: Our aim in this study was to identify the contemporary annual incidence rates of hospitalization for diabetes-related foot complication (DFC) and lower extremity amputation in Canada.

Methods: The time frame of this study was April 2011 to March 2022. The population included people at least 20 years of age throughout Canada, except for Québec. From the Canadian Institute for Health Information Discharge Abstract Database of acute care hospitalizations, a person's 1) first DFC, 2) first diabetes-related major amputation, and 3) first diabetes-related major or minor amputation were identified. Using population data from Statistics Canada, age- and sex-adjusted annual rates were calculated for each of these events. Regression models for temporal trends in these rates were fitted for the full population and by province or territory.

Results: Over the 11-year study period, there were 20,886 first major amputations, 41,643 first major or minor amputations, and 48,526 first DFCs. The average incidence rates across years for major amputation, major or minor amputation, and DFC were 8.8, 17.5, and 20.3 per 100,000 population, respectively. The major amputation rate decreased over time (-0.06 per year [95% confidence interval -0.11 to -0.01]), but there was no change over time for other events. A declining rate for major amputations was observed in Ontario, Manitoba, and Saskatchewan, but not in the other provinces or territories.

Conclusions: The national rate of major amputation related to diabetes has decreased, but the burden of DFCs requiring hospitalization has not. These contemporary data support the need to strengthen foot screening and limb preservation efforts for people living with diabetes across Canada.

Objectives: Gestational diabetes mellitus (GDM) increases future risks of type 2 diabetes and cardiovascular disease. Despite Diabetes Canada guidelines recommending postpartum glucose testing after GDM, uptake remains low. Canadian population-based studies are needed to examine system-level factors affecting uptake.

Methods: We used linked Alberta Health data sets, including births from 2017 to 2018, to identify prenatal care provider specialty (general practitioner [GP], obstetrician [OB], or midwife [RM]), postpartum glucose tests, and cohort demographics. Outcomes were 1) gold standard testing, which is oral glucose tolerance testing (OGTT) within 6 weeks to 6 months postpartum; and 2) any glucose test within 6 weeks to 1 year. We used adjusted logistic regression modelling to estimate the association between test incidence and provider specialty.

Results: From 105,691 births, we identified a cohort of 9,884 with GDM. Uptake of postpartum glucose testing was low: 22.2% (95% confidence interval [CI] 21.4% to 23.1%) received gold standard testing and 53.9% (95% CI 52.9% to 54.9%) received any glucose test. When compared with the OB group, GP patients were less likely to receive both glucose test outcomes (odds ratio [OR]_GS=0.86, 95% CI 0.77 to 0.95; OR_Any=0.88, 95% CI 0.81 to 0.96). Patients of RMs were also less likely to receive both glucose test outcomes (OR_GS=0.67, 95% CI 0.46 to 0.96; OR_Any=0.88, 95% CI 0.67 to 1.15).

Conclusions: We report low postpartum glucose testing overall and found no clinically meaningful differences across provider specialties. The higher incidence of any glucose testing suggests that providers may be prioritizing alternative tests over the OGTT protocol for GDM patients.