Standards of medical care in diabetes--2013

Association of Sodium-Glucose Cotransporter-2 Inhibitors With Incident Atrial Fibrillation in Older Adults With Type 2 Diabetes

Importance

Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have demonstrated many cardiovascular and kidney function benefits for patients with type 2 diabetes (T2D). However, the results of SGLT-2i use in primary prevention of atrial fibrillation (AF) were inconsistent in clinical trials, and incident AF was not a prespecified end point.

Objective

To examine incident AF with initiation of an SGLT-2i compared with initiation of a dipeptidyl peptidase-4 inhibitor (DPP-4i) or a glucagonlike peptide-1 receptor agonist (GLP-1RA) among older adults (aged ≥66 years) with T2D in routine clinical practice.

Design, Setting, and Participants

A population-based new-user cohort study included older adults with T2D who had no history of AF and were enrolled in Medicare fee-for-service from April 1, 2013, to December 31, 2018. Data analysis was performed from June 28 to December 1, 2021.

Exposures

To control for potential confounding, new users of SGLT-2i were 1:1 propensity score (PS)-matched to new users of DPP-4is or GLP-1RAs in 2 pairwise comparisons based on 138 baseline covariates.

Main Outcomes and Measures

The primary outcome was incident AF, defined as an inpatient diagnosis code for AF. Hazard ratios (HRs) and rate differences (RDs) per 1000 person-years, with their 95% CIs, were estimated in the PS-matched groups.

Results

New users of SGLT-2is were 1:1 PS-matched to new users of a DPP-4i (n = 74 868) or GLP-1RA (n = 80 475). Overall, the mean (SD) age of study participants was 72 (5) years, and 165 984 were women (53.4%). The risk of incident AF was lower in the SGLT-2i group than the matched DPP-4i group (HR, 0.82; 95% CI, 0.76 to 0.89; RD, -3.7; 95% CI, -5.2 to -2.2 per 1000 person-years) or the matched GLP-1RA group (HR, 0.90; 95% CI, 0.83 to 0.98; RD, -1.8; 95% CI, -3.2 to -0.3 per 1000 person-years). Results were consistent across several sensitivity and subgroup analyses.

Conclusions and Relevance

The findings of this study suggest that the initiation of an SGLT-2i was associated with a reduced risk of incident AF compared with a DPP-4i or GLP-1RA. The results may be helpful when weighing the potential risks and benefits of various glucose level-lowering agents in older adults with T2D.

The usefulness of the estimated average glucose/fasting blood glucose ratio for pancreatic β-cell function assessment in hyperglycemia during health checkups

BACKGROUND

Type 2 diabetes (T2DM) is a disease marked by inadequate insulin secretion by pancreatic beta-cell function (BCF) failure and insulin resistance (IR). Assessing and managing the BCF and IR should be started early to prevent or delay the progression of the disease. The aim of this study was to determine the usefulness of the estimated average glucose (eAG)/fasting blood glucose (FBG) ratio for pancreatic BCF in hyperglycemia.

METHODS

This cross-sectional study consecutively selected 10,594 subjects who underwent a health checkup at 16 health checkup centers in 13 Korean cities between 2019 and 2021. The subjects consisted of 3003 patients with normoglycemia, 3413 with impaired fasting glucose and 4178 with T2DM. The eAG was calculated using Nathan's regression equation. BCF and IR were estimated by the homeostasis model assessment (HOMA)-β and HOMA-IR, respectively. Multivariate (adjusted) regression analysis was performed to evaluate the association between the eAG/FBG ratio and HOMA.

RESULTS

The median values among FBG groups for the eAG/FBG ratio, HOMA-β, -IR and insulin differed significantly (p < 0.001). The second-, third- and fourth-quartile groups of the eAG/FBG ratio had positive higher correlation coefficients [9.533, 10.080 and 12.021, respectively (all p < 0.001)] for HOMA-β than the first quartile group, and higher negative coefficients for HOMA-IR [-0.696, -0.727 and -0.598, respectively (all p = 0.001)].

CONCLUSION

The eAG/FBG ratio was significantly correlated with both HOMA-β and -IR, which suggests that eAG/FBG ratio reveals BCF and IR in hyperglycemia. Measurement of this ratio could be useful for monitoring BCF and IR in prediabetes and T2DM.

Association between glycosylated hemoglobin, diabetes mellitus, and preoperative deep vein thrombosis in patients undergoing total joint arthroplasty: a retrospective study

Background

To investigate the association between the level of glycosylated hemoglobin (HbA1c) and preoperative deep vein thrombosis (DVT) and that between diabetes mellitus (DM) and preoperative DVT in patient undergoing total joint arthroplasty (TJA).

Methods

A total of 1386 patients were enrolled. We created the receiver operating characteristic (ROC) curve of HbA1c, and based on the cutoff value, patients were divided into two groups. Risk factors were subsequently examined. Chi-square test or Fisher’s exact test was adopted for enumeration data. The results were expressed in percentages (%), and DVT-related variates were analyzed. We included the variates that were statistically significant in the univariate analysis in the multivariate binary logistic regression analysis and calculated the adjusted odds ratio (OR) and 95% confidence interval (95% CI).

Results

Preoperative DVT was 100 cases (7.22%) and DM in 301 cases (21.7%). We determined the cutoff value of HbA1c of 6.15% using the ROC curve as the area under the curve (AUC) was 0.548. Univariate logistic regression revealed that the risk of preoperative DVT in TJA patients with HbA1c ≥ 6.15%, HbA1c between 7 and 7.9%, HbA1c ≥ 8%, DM, female, and major surgery in the last 12 months increased by 1.84 (P = 0.005; 95% CI [1.20–2.80]), 2.22 (P = 0.028, 95% CI [1.09–4.52]), 2.47 (P = 0.013, 95% CI [1.21–5.04]), 2.03 (P = 0.004, 95% CI [1.25–3.30]); 1.85 (P = 0.010, 95% CI [1.16–2.95]); and 2.86 times (P = 0.006, 95% CI [1.35–6.05]), respectively. And multivariate logistic regression revealed that the risk of preoperative DVT in TJA patients with HbA1c ≥ 6.15%, HbA1c between 7 and 7.9%, HbA1c ≥ 8%, DM patients, female patients, and major surgery in the last 12 months increased by 1.77 (P = 0.009, 95% CI [1.16–2.72]); 2.10 (P = 0.043, 95% CI [1.02–4.30]); 2.50 (P = 0.013, 95% CI [1.22–5.14]); 2.01 (P = 0.005, 95% CI [1.23–3.28]); 1.80 (P = 0.014, 95% CI [1.13–2.89]); and 3.04 times (P = 0.004, 95% CI [1.42–6.49]), respectively.

Conclusion

We conclude that HbA1c ≥ 6.15%, DM, female and major surgery in the last 12 months are the independent risk factors for preoperative DVT in patients undergoing TJA. And patients with a higher HbA1c level are at an increased risk of preoperative DVT.

Trial registration: ChiCRT2100054844.

Circulating 1,5-Anhydroglucitol as a Biomarker of ß-cell Mass Independent of a Diabetes Phenotype in Human Subjects

CONTEXT

During an asymptomatic prediabetic state, the functional ß-cell mass decreases to a critical threshold, triggering diabetes and related symptoms. To date, there are no reliable readouts able to capture in vivo a potential drop of the ß-cell mass.

OBJECTIVE

Beside its use as a short-term marker of glycemic control, the deoxyhexose 1,5-anhydroglucitol was identified in rodents as a circulating biomarker of the functional ß-cell mass already in the asymptomatic prediabetic stage. The present study investigated the putative corresponding relevance of circulating 1,5-anhydroglucitol in different human cohorts.

METHODS

We analyzed clinical and blood parameters in patients with established type 2 diabetes and subjects considered at high risk of developing diabetes, as well as patients with no history of diabetes scheduled for pancreaticoduodenectomy.

RESULTS

Circulating 1,5-anhydroglucitol was reduced in type 2 diabetic patients, negatively correlating with fasting plasma glucose (P < 0.0001) and hemoglobin A1c (P < 0.0001). In healthy subjects, 1,5-AG levels positively correlated with body mass index (P = 0.004) and Homeostatic Model Assessment of Insulin Resistance %S (P < 0.03) and was particularly high in nondiabetic obese individuals, potentially accounting for compensatory ß-cell expansion. Patients with no history of diabetes undergoing pancreaticoduodenectomy exhibited a 50% reduction of circulating 1,5-anhydroglucitol levels following surgery leading to an acute loss of their ß-cell mass (P = 0.002), regardless their glucose tolerance status.

CONCLUSION

In summary, plasma concentration of 1,5-anhydroglucitol follows the ß-cell mass and its noninvasive monitoring may alert about the loss of ß cells in subjects at risk for diabetes, an event that cannot be captured by other clinical parameters of glycemic control.

DNA Methylation in Gestational Diabetes and its Predictive Value for Postpartum Glucose Disturbances

CONTEXT

DNA methylation in the diagnosis of gestational diabetes.

OBJECTIVE

To assess the value of DNA methylation in the diagnosis of gestational diabetes (GDM) and in the prediction of maternal postpartum glucose disturbances.

METHODS

Two-stage observational study performed between July 2006 and December 2010, at University Hospital. Forty-eight randomly selected pregnant women formed the discovery cohort (24 with GDM and 24 controls) and 252 pregnant women (94 with GDM and 158 controls) formed the replication cohort. GDM women were re-evaluated 4 years postpartum. The main outcome measures were GDM, type 2 diabetes or prediabetes at 4 years postpartum.

RESULTS

We identified 3 CpG sites related to LINC00917, TRAPPC9, and LEF1 that were differentially methylated in women with GDM and abnormal glucose tolerance; and sites associated with LINC00917 and TRAPPC9 were independently associated with an abnormal glucose tolerance status 4 years postpartum after controlling for clinical variables. Moreover, the site associated with LINC00917 and the combination of the 3 sites had the highest predictive values.

CONCLUSION

Our results suggest that some of these sites may be implicated in the development of GDM and postpartum abnormal glucose tolerance.

Integrating Gestational Diabetes Screening and Care and Type 2 Diabetes Mellitus Prevention After GDM Into Community Based Primary Health Care in South Africa-Mixed Method Study

Background:

Despite high gestational diabetes mellitus (GDM) prevalence in South Africa (9.1% in 2018), its screening and management are not well integrated into routine primary health care and poorly linked to post-GDM prevention of type 2 diabetes mellitus (T2DM) in South Africa’s fragmented health system. This study explored women’s, health care providers’ and experts’ experiences and perspectives on current and potential integration of GDM screening and prevention of T2DM post-GDM within routine, community-based primary health care (PHC) services in South Africa.

Methods:

This study drew on the Behaviour Change Wheel (BCW) framework and used a mixed method, sequential exploratory design for data collection, analysis and interpretation. Individual semi-structured interviews were conducted with key informants (n = 5) from both national and provincial levels and health care providers (n = 18) in the public health system of the Western Cape Province. Additionally, focus group discussions (FGDs) with Community Health Workers (CHWs n = 15) working with clinics in the Western Cape province. A further four FGDs and brief individual exit interviews were conducted with women with GDM (n = 35) followed-up at a tertiary hospital: Groote Schuur Hospital (GSH). Data collection with women diagnosed and treated for GDM happened between March and August 2018.

Thematic analysis was the primary analytical method with some content analysis as appropriate. Statistical analysis of quantitative data from the 35 exit interview questionnaires was conducted, and correlation with qualitative variables assessed using Cramér’s V coefficient.

Results:

Shortage of trained staff, ill-equipped clinics, socio-economic barriers and lack of knowledge were the major reported barriers to successful integration of GDM screening and postnatal T2DM prevention. Only 43% of women reported receiving advice about all four recommendations to improve GDM and decrease T2DM risk (improve diet, reduce sugar intake, physical exercise and regularly take medication). All participants supported integrating services within routine, community-based PHC to universally screen for GDM and to prevent or delay development of T2DM after GDM.

Conclusion:

GDM screening and post-GDM prevention of T2DM are poorly integrated into PHC services in South Africa. Integration is desired by stakeholders (patients and providers) and may be feasible if PHC resource, training constraints and women’s socio-economic barriers are addressed.

Study of Health in Primary Care of the Amazonas Population: Protocol for an Observational Study on Diabetes Management in Brazil

BACKGROUND

Changes in the profiles of patients have significant impacts on the health care system. Diabetes mellitus type 2 (T2DM) prevention and management should be studied in different contexts.

OBJECTIVE

The Study of Health in Primary Care for the Amazonas Population (SAPPA) primarily aims to describe T2DM prevention and management actions offered by primary health care settings in Brazil and whether the care delivered is consistent with the chronic care model (CCM). Second, the study aims to examine the impact of T2DM management actions on health and lifestyle, and third, to understand how sociodemographic characteristics, health, and subjective outcomes impact diabetes management.

METHODS

As part of this observational study, managers and health professionals complete a questionnaire containing information about T2DM prevention and management actions and CCM dimensions. During in-home visits, patients are asked about their health, lifestyle, sociodemographics, diabetes care, and subjective variables.

RESULTS

A total of 34 managers, 1560 professional health workers, and 955 patients will be recruited. The data collection will be completed in October 2022.

CONCLUSIONS

The SAPPA is an observational study that intends to understand the T2DM management process in primary health care, including planning, execution, reach, and impact on patient motivation and adherence.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/37572.

Gut Microbiota Functional Traits, Blood pH, and Anti-GAD Antibodies Concur in the Clinical Characterization of T1D at Onset

Alterations of gut microbiota have been identified before clinical manifestation of type 1 diabetes (T1D). To identify the associations amongst gut microbiome profile, metabolism and disease markers, the 16S rRNA-based microbiota profiling and 1H-NMR metabolomic analysis were performed on stool samples of 52 T1D patients at onset, 17 T1D siblings and 57 healthy subjects (CTRL). Univariate, multivariate analyses and classification models were applied to clinical and -omic integrated datasets. In T1D patients and their siblings, Clostridiales and Dorea were increased and Dialister and Akkermansia were decreased compared to CTRL, while in T1D, Lachnospiraceae were higher and Collinsella was lower, compared to siblings and CTRL. Higher levels of isobutyrate, malonate, Clostridium, Enterobacteriaceae, Clostridiales, Bacteroidales, were associated to T1D compared to CTRL. Patients with higher anti-GAD levels showed low abundances of Roseburia, Faecalibacterium and Alistipes and those with normal blood pH and low serum HbA1c levels showed high levels of purine and pyrimidine intermediates. We detected specific gut microbiota profiles linked to both T1D at the onset and to diabetes familiarity. The presence of specific microbial and metabolic profiles in gut linked to anti-GAD levels and to blood acidosis can be considered as predictive biomarker associated progression and severity of T1D.

Impact of low-protein diet on cardiovascular risk factors and kidney function in diabetic nephropathy: A systematic review and meta-analysis of randomized-controlled trials

AIM

To assess the efficacy of low-protein diets (LPD) on cardiovascular risk factors and kidney function in diabetic nephropathy (DN) based on randomized controlled trials (RCTs).

METHODS

A comprehensive systematic search was undertaken in PubMed/MEDLINE, Web of Science, SCOPUS and Embase databases from inception until January 2022 without using time or language restrictions. RCTs which reported the effects of LPD on cardiovascular risk factors and kidney function in DN were considered.

RESULTS

The results of the present study showed that a LPD significantly reduces urinary urea (WMD: -244.49 g/day, 95 % CI: -418.83, -70.16, P = 0.006) and HbA1c (WMD: -0.20, 95 % CI: -0.39, -0.01, P = 0.036) levels. However, the results did not show neither significant nor beneficial effect on other renal function and cardiovascular risk factors. Furthermore, the results of subgroup analysis showed LPD caused a further decrease in HbA1c during the follow-up period of ≤ 24 weeks, protein intake less than 0.8 g/kg/d and in individuals younger than 50 years. Albuminuria also showed a greater reduction in people under the age of 50 with type 1 diabetes (DMT1) following a LPD.

CONCLUSION

The results of the present study showed that LPD significantly reduces urinary urea and HbA1c.

Metabolically obese phenotype and its dynamic change are associated with increased carotid intima-media thickness: Results from a cohort study

BACKGROUND AND AIMS

To examine associations between metabolically obese phenotypes or their changes and increased carotid intima-media thickness (CIMT).

METHODS AND RESULTS

This prospective cohort included 13,681 Chinese adults aged 20-80 years who completed follow-up health examination with carotid ultrasound and were divided according to metabolic and weight status: metabolically healthy and normal weight (MHNW); metabolically obese but normal weight (MONW); metabolically healthy but obese (MHO); metabolically abnormal and obese (MAO). Cox and logistic regression were used to evaluate the associations of the phenotypes or their changes with increased CIMT. During a mean follow-up of 33 months, 1927 participants developed increased CIMT. After adjusting for age, sex and potential biochemical confounders, MAO was significantly associated with increased CIMT (HR 1.22, 95% CI [1.07, 1.4]); the association remained significant in those 40 years or older. Compared with stable MHNW, increased CIMT risk was higher for stable MAO (OR 1.35 [1.16, 1.57]), transitional MAO from MONW (OR 1.44 [1.04, 1.97]), and transitional MHO from MHNW (OR 1.59 [1.10, 2.26]) in demographic adjusted models; only stable MAO remained significant in the multivariate adjusted model (OR 1.23 [1.05, 1.45]).

CONCLUSION

MAO significantly elevated the risk of increased CIMT. Stable MAO and obese transitions also promoted CIMT progression.

Natural products for the treatment and management of diabetes mellitus in Zimbabwe-a review

Use of medicinal plants and herbs in the treatment and management of diseases, including diabetes mellitus and its complications remains an integral part of African tradition. In Zimbabwe, nearly one million people are living with diabetes mellitus. The prevalence of diabetes mellitus in Zimbabwe is increasing every year due to lifestyle changes, and has accelerated the use of traditional medicines for its treatment and management in urban areas. In addition, the high cost of modern medicine has led many people in rural parts of Zimbabwe to rely on herbal plant medicine for the treatment of diabetes mellitus and its complications. This review highlights a number of studies carried out to evaluate the antidiabetic properties of indigenous plants found in Zimbabwe with the goal of treating diabetes mellitus. Further, we discuss the mechanism of action of various plant extracts in the treatment and management of diabetes mellitus. Together, this review article can open pathways leading to discovery of new plant derived medicines and regularization of use of crude plant remedies to treat diabetes mellitus by the Zimbabwean government and others across Africa.

Assessment of the Knowledge and Self- Care Practice on Hypoglycemia among Patients with Diabetic Mellitus Attending Medical Opd at Smch

Introduction: Hypoglycemia is a clinical emergency that needs to be recognized and treated promptly to avoid organ damage and death. Knowledge of hypoglycemia prevention is an essential step in self-care practices due to the fact knowledgeable individuals are much more likely to practice hypoglycemia prevention. Prevention of hypoglycemia relies on adequate awareness and rightself-care. Objectives: To evaluate the level of knowledge and to self - care practice of hypoglycemia with their selected demographic variables among diabetic patients. Methods: A cross sectional descriptive research design was adopted with hundred samples who met the inclusion criteria in the hospital setting. Self-structured questionnaire method was used to acquire the data. Data have been through descriptive and inferential statistics. Result: Of 100 samples, 76(76%) had adequate knowledge and 63(63%)had good self-care practice on hypoglycemia. Spearman’s correlation showed positive relationship between knowledge and self-care practice of hypoglycemia (r value = 0.720, p<0.001). In respect to level of knowledge, there was a significant association noted among age, education, occupation, income, religion, marital status, family history and with regards to self-care practice along with all variables including gender is significant at p<0.05. Conclusion: This study result emphasized that majority of the diabetic patients had adequate knowledge and good self-care practice on hypoglycemia. Enlightening the patients further with regular self-monitoring of blood glucose level and obtain medical guidance and support may help the patients to stay fit.

Effectiveness of an integrated primary care intervention in improving psychosocial outcomes among Latino adults with diabetes: the LUNA-D study

OBJECTIVE

To compare the effectiveness of usual care (UC) versus a culturally tailored integrated care model in improving mental health symptoms for Latino patients with Type 2 diabetes mellitus (T2DM).

METHODS

We conducted a two-arm randomized controlled trial from 2015 to 2019 at a federally qualified health center. Participants were 456 adults ages 23-80 years who had a previous diagnosis of T2DM and were not currently using insulin. Participants were randomly assigned to Integrated Care Intervention (ICI; including behavioral/mental healthcare, medical visits, health education and care coordination) or UC; standard of care including referrals for health education and behavioral/mental health care where appropriate. Intention-to-treat, multilevel models were used to compare group × time changes in depression and anxiety symptoms (PHQ-8; GAD-7) and perceived stress (PSS-10) across 6 months.

RESULTS

Participant mean age was 55.7 years, 36.3% were male, and 63.7% were primarily Spanish speaking. Baseline sociodemographic factors and mental health symptoms across study arms were balanced. Significant group × time interaction effects were observed for anxiety and depression symptoms (p < .05). Within the ICI and UC groups, mean depression symptom changes were -0.93 and -0.39 (p < .01); anxiety symptom changes were -0.97 (p < .01) and -0.11 (p = .35); and perceived stress changes were -1.56 and -1.27 (p < .01), respectively.

CONCLUSIONS

Although both ICI and UC showed decreases over time, the ICI group evidenced larger, statistically significant changes in both depression and anxiety. Adapted integrated models of behavioral and chronic disease management appear to be effective and could be considered for usual care practices.

CLINICALTRIALS.GOV IDENTIFIER

NCT03983499.

Prevalence of hypertension and its associated factors among professional drivers: a population-based study

OBJECTIVE

Hypertension is one of the most important causes of cardiovascular disease. It has been found that professional drivers are at high risk of hypertension. This study has been performed to determine the prevalence of hypertension and its associated factors among professional drivers in Shahroud.

METHODS AND RESULTS

In this study, the prevalence of hypertension was determined according to the definition by the American Heart Association among 1461 professional drivers participating in the first cross-sectional phase of Shahroud drivers' prospective cohort study. The prevalence of elevated blood pressure and hypertension was examined based on the initial age, and gender presented, along with the factors affecting this disease based on multinomial logistic regression. The prevalence of elevated blood pressure, stage 1 and 2 hypertension was 46.9%, 6%, and 1.3%, respectively. In the multivariate multinomial logistic regression model, having diabetes, Body Mass Index ≥25, and driving years was associated with an increased chance of developing elevated blood pressure and hypertension.

CONCLUSIONS

Attention should be paid to high prevalence of elevated blood pressure and hypertension among professional drivers in Iran as a health priority for drivers. Plans should be made to reduce it as well as to prevent its complications.

Salivary Biomarkers Associated with Psychological Alterations in Patients with Diabetes: A Systematic Review

The care of individuals with diabetes needs a holistic perspective, taking into account both the physical disease and the mental health problems that may be associated. Different studies show a higher prevalence of depression or anxiety issues in diabetes patients than in the general population, which is why diabetes can be considered one of the chronic diseases in which psychological care is crucial to maintain quality of life. The objective of this review is to examine the published articles that relate the bidirectional associations between objective and subjective measures of anxiety, depressive symptomatology, stress, sleep quality, and salivary biomarkers in patients with diabetes. For this, a search was carried out in the electronic databases PubMed, Cochrane, and SCOPUS using the keywords "diabetes", "saliva", "sleep", "anxiety", "depression", and "stress" for works published up until May 2022 and limited to the English and Spanish languages. The sample comprised 14 articles, 5 of which analysed the associations between depressive symptomatology and salivary biomarkers in people with diabetes. Among the salivary biomarkers most frequently used to evaluate psychological alterations in persons with diabetes are cortisol and melatonin. Thus, significant changes in the levels of these biomarkers were observed in most studies. Four out of five studies reported a statistically significant relationship between increased salivary cortisol in the evening/midnight or the cortisol awakening response and depressive symptoms. In contrast, lower cortisol levels upon waking in the morning were observed when there was no depression or anxiety. Regarding the association between salivary cortisol values and sleep quality in patients with diabetes, lower morning cortisol values related to prolonged nighttime sleep were common in the analysed studies. Low melatonin concentrations showed a negative correlation with sleep quality. As it is an easy-to-apply and non-invasive method, the measurement of salivary biomarkers can be very useful for predicting psychological alterations in patients with diabetes. Further scientific studies are required to determine the sensitivity of these biological substances acting as biomarkers for detecting sleep disorders and psychological alterations.

Thirty years of research on physical activity, mental health, and wellbeing: A scientometric analysis of hotspots and trends

The sheer volume of research publications on physical activity, mental health, and wellbeing is overwhelming. The aim of this study was to perform a broad-ranging scientometric analysis to evaluate key themes and trends over the past decades, informing future lines of research. We searched the Web of Science Core Collection from inception until December 7, 2021, using the appropriate search terms such as "physical activity" or "mental health," with no limitation of language or time. Eligible studies were articles, reviews, editorial material, and proceeding papers. We retrieved 55,353 documents published between 1905 and 2021. The annual scientific production is exponential with a mean annual growth rate of 6.8% since 1989. The 1988-2021 co-cited reference network identified 50 distinct clusters that presented significant modularity and silhouette scores indicating highly credible clusters (Q = 0.848, S = 0.939). This network identified 6 major research trends on physical activity, namely cardiovascular diseases, somatic disorders, cognitive decline/dementia, mental illness, athletes' performance, related health issues, and eating disorders, and the COVID-19 pandemic. A focus on the latest research trends found that greenness/urbanicity (2014), concussion/chronic traumatic encephalopathy (2015), and COVID-19 (2019) were the most active clusters of research. The USA research network was the most central, and the Chinese research network, although important in size, was relatively isolated. Our results strengthen and expand the central role of physical activity in public health, calling for the systematic involvement of physical activity professionals as stakeholders in public health decision-making process.

Chronic Kidney Disease in a Large National Human Immunodeficiency Virus Treatment Program

Tenofovir disoproxil fumarate (TDF) is associated with a risk of chronic kidney disease (CKD), especially in Asian populations. Data from the Thai national health insurance system was used to assess CKD incidence in patients receiving antiretroviral therapy in real-world practice. We analyzed data from patients who initiated one of the following first-line regimens: zidovudine + lamivudine + nevirapine (AZT + 3TC + NVP); zidovudine + lamivudine + efavirenz (AZT + 3TC + EFV); tenofovir + lamivudine + nevirapine (TDF + 3TC + NVP); tenofovir + lamivudine/emtricitabine + efavirenz (TDF + 3TC/FTC + EFV); and tenofovir +lamivudine +lopinavir/ritonavir (TDF + 3TC + LPV/r). CKD was defined as glomerular filtration rate <60 mL/min/1.73 m2 for >3 months, or a confirmed 2010 WHO diagnosis (ICD-10 code N183, N184, or N185). Death competing risk survival regression models were used. Among 27,313 participants, with a median age of 36.8 years and median follow-up of 2.3 years, 245 patients (0.9%) were diagnosed with CKD (incidence 3.2 per 1000 patient-years; 95% CI 2.8−3.6). Compared with patients receiving AZT + 3TC + NVP, the risk of CKD measured by adjusted sub-distribution hazard ratio (aSHR) was 6.5 (95% CI 3.9−11.1) in patients on TDF + 3TC + LPV/r, 3.8 (95% CI 2.3−6.0) in TDF + 3TC + NVP, and 1.6 (95% CI 1.2−2.3) in TDF + 3TC/FTC + EFV. Among patients receiving TDF, compared with those receiving TDF + 3TC/FTC + EFV, the aSHR was 4.0 (95% CI 2.3−6.8) in TDF + 3TC + LPV/r and 2.3 (95% CI 1.4−3.6) in TDF + 3TC + NVP. TDF was associated with an increased risk of CKD, especially when combined with LPV/r or NVP.

Myo-inositol oxygenese activity in second trimester of pregnancy: altered myoinositol catabolism in gestational diabetes mellitus

OBJECTIVE

We aimed to determine myo-inositol oxygenase (MIOX) activity in gestational diabetes mellitus (GDM).

MATERIAL AND METHODS

The insulin, HbA1c, and MIOX levels of 80 pregnant women were analysed after 75 g OGTT. Group I included patients with no risk factor for GDM, Group II: patients with high risk for GDM, and Group III: GDM patients.

RESULTS

Fasting plasma glucose and Homeostatic Model Assessment for Insulin Resistance index were significantly higher in GDM cases (Group 3). Regarding the MIOX levels, significantly higher levels were recorded at 0-h in Group 3 compared to Groups 1 and 2. Significant alteration in MIOX activity was found between 0- and 2-h in Group 3 compared to Groups 1 and 2 (p < .029).

CONCLUSIONS

MIOX levels were higher in GDM cases so, it may be have a role in myo-inositol catabolism.

Association of gut microbiota with sort-chain fatty acids and inflammatory cytokines in diabetic patients with cognitive impairment: A cross-sectional, non-controlled study

Emerging evidence suggests that gut microbiota, short-chain fatty acids (SCFAs), and inflammatory cytokines play important roles in the pathogenesis of diabetic cognitive impairment (DCI). However, little is known about alterations of gut microbiota and SCFA levels as well as the relationships between inflammatory cytokines and cognitive function in Chinese DCI patients. Herein, the differences in the gut microbiota, plasma SCFAs, and inflammatory cytokines in DCI patients and type 2 diabetes mellitus (T2DM) patients were explored. A cross-sectional study of 30 DCI patients and 30 T2DM patients without mild cognitive impairment (MCI) was conducted in Tianjin city, China. The gut microbiota, plasma SCFAs, and inflammatory cytokines were determined using 16S ribosomal RNA (rRNA) gene sequencing, gas chromatography-mass spectrometry (GC-MS), and Luminex immunofluorescence assays, respectively. In addition, the correlation between gut microbiota and DCI clinical characteristics, SCFAs, and inflammatory cytokines was investigated. According to the results, at the genus level, DCI patients presented a greater abundance of Gemmiger, Bacteroides, Roseburia, Prevotella, and Bifidobacterium and a poorer abundance of Escherichia and Akkermansia than T2DM patients. The plasma concentrations of acetic acid, propionic acid, isobutyric acid, and butyric acid plummeted in DCI patients compared to those in T2DM patients. TNF-α and IL-8 concentrations in plasma were significantly higher in DCI patients than in T2DM patients. Moreover, the concentrations of acetic acid, propionic acid, butyric acid, and isovaleric acid in plasma were negatively correlated with TNF-α, while those of acetic acid and butyric acid were negatively correlated with IL-8. Furthermore, the abundance of the genus Alloprevotella was negatively correlated with butyric acid, while that of Holdemanella was negatively correlated with propanoic acid and isobutyric acid. Fusobacterium abundance was negatively correlated with propanoic acid. Clostridium XlVb abundance was negatively correlated with TNF-α, while Shuttleworthia abundance was positively correlated with TNF-α. It was demonstrated that the gut microbiota alterations were accompanied by a change in SCFAs and inflammatory cytokines in DCI in Chinese patients, potentially causing DCI development. These findings might help to identify more effective microbiota-based therapies for DCI in the future.

Type 2 diabetes is more closely associated with risk of colorectal cancer based on elevated DNA methylation levels of ADCY5

Type 2 diabetes mellitus (T2DM) has an increased risk of cancer. In the present study, the relationship between T2DM and 13 types of cancer was analyzed and key methylation genes were searched. First, DNA methylation and mRNA expression were obtained data for T2DM and 13 types of cancer from The Cancer Genome Atlas and Gene Expression Omnibus. The t-test was used to screen the differentially methylated expression overlapping genes (DE-MGs) in T2DM and cancer on both methylation and expression levels. DE-MGs are weighted based on the methylation and projected into the human protein interaction network. The correlation between T2DM and each type of cancer was analyzed, and key genes were identified. The results showed that 293 DE-MGs were related to T2DM and 3307 were related to cancer. The network found that T2DM is more related to colorectal cancer (CRC) compare with the other 12 types of cancer. A total of 5 from 8 candidate genes were associated with CRC. A total of 28 clinical patients were used to validate these 5 genes. A CRC tissue sample was collected from each patient, as well as a paracancerous sample that served as a control. A total of 56 tissue samples were divided into 4 groups: control group, T2DM group, CRC group and T2DM with CRC group (combination group). Compared with the control group, the methylation level of adenylate cyclase 5 (ADCY5), neuregulin 1 and ELAV-like RNA-binding protein 4 in the combination group was significantly upregulated, and the mRNA level was significantly downregulated. Furthermore, based on the methylation level of ADCY5, the correlation coefficient between the combination group and the T2DM group was greater than that of the CRC group. In conclusion, T2DM is most likely to be associated with CRC among 13 common types of cancer based on methylation characteristics. An upregulated methylation of ADCY5 in T2DM may have a higher risk of CRC.

Health-Related Quality-of-Life and Associated Factors Among Children and Adolescents with Type 1 Diabetes Mellitus: A Cross-Sectional Study

Background

Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases during childhood and adolescence. It threatens the health and endangers life with consequences for the physical and emotional development of the child and adolescent. Our study aimed at determining the health-related quality-of-life (HRQoL) and factors affecting it in children and adolescents with T1DM.

Methods

A hospital-based cross-sectional study was conducted among 379 randomly selected children and adolescents, 5-18 years of age, with T1DM on follow-up at endocrine clinics from 25 August to 25 September 2021. PedsQLTM 4.0 generic core scales were used to collect the data. Paired sample t-test was used to compare children's and adolescents' self-reports and caregiver's reports. Bivariable and multivariable linear regression is used to explore to identify significant predictor factors of HRQoL.

Results

Total mean score of HRQoL was 88.42±10.82 as reported by the children and adolescents and 82.17±12.65 reported by their primary caregivers. According to self-reports, age (β=-0.197, p=0.028), mothers' educational status (β=0.242, p<0.001), fathers' educational status (β=0.259, p<0.001), fathers' occupation (β=0.170, p=0.038), frequency of insulin administration (β=-0.132, p=0.007), diabetes duration (β=-0.101, p=0.050), and frequency of monitoring of blood glucose (β=0.165, p=0.006) were statistically significant predictors of HRQoL, explaining 21.6% of the variability of total HRQoL scores of children and adolescents (R2=0.216, F(21,357)=5.968, p<0.001).

Conclusion

Children and adolescents with T1DM in Ethiopia have relatively good HRQoL. Increased age, longer diabetes duration, and insulin administrations of three times per day were associated with decreased HRQoL scores. Educated parents, having an employed father, and frequent blood glucose monitoring were associated with higher HRQoL scores.

Active coating of immediate-release evogliptin tartrate to prepare fixed dose combination tablet with sustained-release metformin HCl

This study was aimed to develop a fixed dose combination (FDC) tablet containing a low dose of evogliptin tartrate (6.87 mg) for immediate release combined with a high dose (1000 mg) of sustained-release (SR) metformin HCl appropriate for once daily dosing the treatment of type 2 diabetes. To prepare the FDC tablets, an active coating was used in this study, whereby evogliptin tartrate film was layered on a matrix core tablet containing metformin HCl. To overcome the problem caused by a low-dose drug in combination with a relatively large matrix tablet containing high-dose drug, it was also aimed to confirm the formulation and coating operation for satisfactory content uniformity, and to describe the chemical stability during storage of the amorphous active coating layer formulation in relation to molecular mobility. Furthermore, the in vitro release and in vivo pharmacokinetic profiles of metformin HCl and evogliptin tartrate in the FDC active coating tablet were compared to those of the commercially marketed reference drugs, Diabex XR® (Daewoong, Seoul, Korea) containing metformin HCl and Suganon® (Donga ST, Seoul, Korea) containing evogliptin tartrate. In conclusion, the newly developed FDC active coating tablet in this study was confirmed to be bioequivalent to the reference marketed products in beagle dogs, with satisfactory content uniformity and stability.

Hand Grip Strength and Likelihood of Moderate-to-Severe Airflow Limitation in the General Population

Background and Objective

Sarcopenia is mainly results from aging; however, it is more prevalent in chronic airway disease such as obstructive pulmonary disease (COPD). Hand grip strength (HGS) can be used as an indicator to evaluate sarcopenia. We aimed to assess the association between HGS and severity of airflow limitation (AFL) in the general population.

Methods

We conducted a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2018. Subjects aged ≥40 years who underwent both spirometry and HGS tests were included. AFL was defined by spirometry revealed forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) <0.70). A propensity score-matched comparison was performed, and the risk for moderate-to-very severe AFL was analyzed using logistic regression analysis.

Results

Among 15,950 subjects, 2277 (14.3%) had AFL with mean FEV₁ was 77.1% of the predicted value. Male was predominant in both individuals without AFL and with AFL (74.2% vs 73.5%, p = 0.613). The HGS was 32.9 ± 9.5 kg and 33.3 ± 9.5 kg in participants without AFL and with AFL (p = 0.109). However, HGS was significantly decreased as AFL getting more severe: 34.0 ± 9.6 kg in mild, 33.0 ± 9.5 kg in moderate, and 30.8 ± 8.5 kg in severe to very severe AFL group (p<0.001). As HGS decreased, adjusted odds for moderate-to-very severe AFL increased compared to those with mild AFL (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.951–0.987) and both without AFL and mild AFL group (aOR, 0.98; 95% CI, 0.967–0.995) in age-, sex-, and body mass index (BMI)-matched comparisons.

Conclusion

Lower HGS is significantly associated with moderate-to-very severe AFL in age-, sex-, and BMI-matched comparisons.

Association Between High Deductible Health Plans and Cost-Related Non-adherence to Medications Among Americans with Diabetes: an Observational Study

BACKGROUND

For people with diabetes, adherence to prescribed medications is essential. However, the rising prevalence of high-deductible health plans (HDHPs), and prices of diabetes medications such as insulin, could deter adherence.

OBJECTIVE

To assess the impact of HDHP on cost-related medication non-adherence (CRN) among non-elderly adults with diabetes in the US.

DESIGN

Repeated cross-sectional survey.

SETTING

National Health Interview Survey, 2011-2018.

PARTICIPANTS

A total of 7469 privately insured adults ages 18-64 with diabetes who were prescribed medications and enrolled in a HDHP or a traditional commercial health plan (TCP).

MAIN MEASURES

Self-reported measures of CRN were compared between enrollees in HDHPs and TCPs overall and among the subset using insulin. Analyses were adjusted for demographic and clinical characteristics using multivariable linear regression models.

KEY RESULTS

HDHP enrollees were more likely than TCP enrollees to not fill a prescription (13.4% vs 9.9%; adjusted percentage point difference (AD) 3.4 [95% CI 1.5 to 5.4]); skip medication doses (11.4% vs 8.5%; AD 2.8 [CI 1.0 to 4.7]); take less medication (11.1% vs 8.8%; AD 2.3 [CI 0.5 to 4.0]); delay filling a prescription to save money (14.4% vs 10.8%; AD 3.0 [CI 1.1 to 4.9]); and to have any form of CRN (20.4% vs 15.5%; AD 4.4 [CI 2.2 to 6.7]). Among those taking insulin, HDHP enrollees were more likely to have any CRN (25.1% vs 18.9%; AD 5.9 [CI 1.1 to 10.8]).

CONCLUSION

HDHPs are associated with greater CRN among people with diabetes, particularly those prescribed insulin. For people with diabetes, enrollment in non-HDHPs might reduce CRN to prescribed medications.

Associations of complete blood count parameters with pancreatic beta-cell function and insulin resistance in prediabetes and type 2 diabetes mellitus

INTRODUCTION

Previous studies found controversial associations of CBC parameters with pancreatic beta-cell function (BCF) and insulin resistance (IR). The aim of this was to determine the independent associations of CBC parameters with BCF and IR in prediabetes and type 2 diabetes mellitus (T2DM).

METHODS

This study selected subjects who underwent health checkups at 16 health-promotion centers in 13 Korean cities during 2021. The subjects comprised 1470 patients with normoglycemia, 1124 with prediabetes, and 396 with T2DM. BCF and IR were assessed using the homeostasis model assessment (HOMA)-β and HOMA-IR, respectively. Correlation and multiple linear regression analyses were used to determine the correlation between CBC parameters and HOMA.

RESULTS

While HOMA-IR gradually increased according to red blood cell count quartiles (1.22, 1.40, 1.47, and 1.91, in the first, second, third, and fourth quartiles, respectively; p < 0.001), there was no correlation after adjusting for waist circumference (WC) and HbA1c. The red blood cell distribution width (RDW) was associated with HOMA-β [coefficient (β) = 15.527, p = 0.002], but not with HOMA-IR. White blood cells (WBCs) were associated with HOMA-IR and HOMA-β, which was stronger in HOMA-β (β = 0.505 vs 15.171, p = 0.002) after adjusting for WC and HbA1c. The platelet count was correlated with HOMA-IR and HOMA-β, which only remained in HOMA-β (β = 15.581, p = 0.002) after adjusting for WC and HbA1c.

CONCLUSION

RDW, WBC, and platelet counts were independently associated with only HOMA-β in prediabetes and T2DM. This suggests that these CBC parameters could represent BCF in prediabetes and T2DM.

α-Glucosidase-Mediated Glucometer Readout for Portable Monitoring of Acarbose and Migliol

The α-glucosidase inhibitor is regarded as one of the most important drugs for the treatment of diabetes, which can control postprandial blood glucose levels via prolonging the carbohydrate digestion time and retarding the carbohydrates’ absorption. The present work aims to establish a facile bioanalytical method, based on α-glucosidase catalyzing the hydrolysis of 2-O-alpha-D-Glucopyranosyl-L-ascorbic acid (AA-2G), for the quantification of acarbose and migliol using a personal glucose meter (PGM). The hydrolysis products (ascorbic acid and glucose) can trigger the reduction of K3[Fe(CN)6] to K4[Fe(CN)6] in the glucose test strips, which results in the formation of the electron, which can be measured by PGM. Thus, ascorbic acid and glucose can be simultaneously measured by a simplified and miniaturized PGM method. However, the products produced by the hydrolysis of AA-2G will be decreased after the addition of acarbose or migliol to inhibit the activity of α-glucosidase, thereby resulting in a decreased PGM readout. After being incubated with α-glucosidase for 3.0 min and enzymatic reaction for 5.0 min, the quantitative detection of acarbose and migliol can be achieved within the ranges of 1.0–30.0 μM with the limit of detection of 0.33 μM and 3.0–33.3 μM with the limit of detection of 1.0 μM, respectively. IC50 values for acarbose and migliol are calculated to be 10.0 μM and 16.0 μM, respectively. The recoveries of the acarbose and migliol spiked with three different concentrations (final concentrations of 10.0, 20.0, and 30.0 μM) in human serum sample are in the ranges of 89.6–114.5% and 93.9–106.5%, respectively. These results demonstrate that the developed PGM method may be useful in future studies on therapeutic monitoring of acarbose and migliol.

Trends in Influenza Vaccination Rates in Participants With Airflow Limitation: The Korea National Health and Nutrition Examination Survey 2007-2018

Background

Influenza vaccination is strongly recommended for people with chronic lung diseases, including chronic obstructive pulmonary disease, to reduce risk of exacerbation. We assess the influenza vaccination rate and its related factors in participants with airflow limitation (AFL) using nationally representative data in Korea.

Methods

We conducted a cross-sectional study from the Korea National Health and Nutrition Examination Survey from 2007 to 2018. Individuals ≥ 40 years who underwent spirometry and had identifiable information on influenza vaccination status were included.

Results

Overall influenza vaccination coverage was 61.2% in participants with AFL and 41.8% in participants without AFL. Age had a significant impact on the yearly vaccination rate in participants with AFL. Over the 10 years of study period, while the yearly vaccination rate steadily increased from 58.3 to 61.9% in elderly participants (≥65 years) with AFL (p for trend = 0.117), the yearly vaccination rate decreased from 41.5% to 30.8% in younger participants (<65 years) (p for trend = 0.038). In multivariable analyses, younger age [adjusted odds ratio (OR) for unvaccinated = 0.88, 95% confidence interval (CI) = 0.87-0.90], male (adjusted OR = 1.64; 95% CI = 1.23-2.19), and current smokers (adjusted OR = 1.42, 95% CI = 1.01-2.00) were associated with increased odds of being unvaccinated.

Conclusions

The vaccination rate in participants with AFL affected by age. Younger age, male sex, and current smoking were associated with unvaccinated status. More attention and targeted interventions are required to improve the influenza vaccination rate in those with AFL.

Quality of life and factors associated with a good quality of life among diabetes mellitus patients in northern Thailand

Background

Quality of life (QOL) is a good indicator of lifespan, especially for individuals who are suffering from a particular illness. QOL among patients with diabetes mellitus (DM) could be used for further implementations in addition to improving patient care and disease management, especially during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess QOL and identify factors associated with a good QOL among DM patients in northern Thailand.

Methods

A cross-sectional study was conducted to gather information from DM patients attending six randomly selected hospitals in the Chiang Rai province, northern Thailand. A validated questionnaire and the 26-item quality of life brief version (WHOQOL-BREF) were used to collect socioeconomic factors and assess QOL, respectively. Chi-square tests and logistic regression were used to detect the associations between variables at a significance level of α = 0.05.

Results

A total of 967 participants were enrolled in the study: 58.8% were female, 52.3% were aged ≥ 60 years, 79.7% graduated primary school and had no additional education, 68.7% had an annual income ≤ 50,000 baht, and 29.3% were unemployed. The majority of patients had a poor-to-moderate overall QOL (49.4%); 90.1% reported a moderate QOL in the physical domain, 54.7% reported a moderate QOL in the mental domain, 63.4% reported a good QOL in the social relationship domain, and 50.6% reported a good QOL in the environmental domain. In multivariate analysis, seven variables were found to be associated with good QOL among the participants. Those aged ≤ 59 years had 1.90 times (95% CI 1.32–2.73) greater odds of having good QOL than those aged ≥ 60. Those who had annual income ≥ 100,001 baht had 2.16 times (95% CI 1.17–3.96) greater odds of having good QOL than those who had annual income ≤ 50,000 baht. Those who lived alone and with spouses had 3.38 times (95% CI 1.42–8.02) and 2.20 times (95% CI 1.20–4.02) greater odds of having good QOL, respectively, than those who lived with relatives. Those who exercised regularly had 4.72 times (95% CI 2.71–8.19) greater odds of having good QOL than those who never exercised. Those who had a high level of knowledge regarding prevention and care had 3.26 times (95% CI 1.22–5.55) greater odds of having good QOL than those who had low knowledge. Those who did not have diabetic nephropathy had 7.41 times (95% CI 4.99–11.01) greater odds of having good QOL than those who were diagnosed with diabetic nephropathy, and those whose medical fees were supported by the government under the universal scheme had 4.31 times (95% CI 1.15–16.7) greater odds of having good QOL than those who had to support themselves.

Conclusions

Almost a half of DM patients in northern Thailand reported having a low-to-moderate QOL, which can be improved by focusing on socioeconomic factors, family support as well as improving knowledge regarding DM prevention and care, including the support of medical fees.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-01986-y.

Role of cannabinoids and the endocannabinoid system in modulation of diabetic cardiomyopathy

Diabetic complications, chiefly seen in long-term situations, are persistently deleterious to a large extent, requiring multi-factorial risk reduction strategies beyond glycemic control. Diabetic cardiomyopathy is one of the most common deleterious diabetic complications, being the leading cause of mortality among diabetic patients. The mechanisms of diabetic cardiomyopathy are multi-factorial, involving increased oxidative stress, accumulation of advanced glycation end products (AGEs), activation of various pro-inflammatory and cell death signaling pathways, and changes in the composition of extracellular matrix with enhanced cardiac fibrosis. The novel lipid signaling system, the endocannabinoid system, has been implicated in the pathogenesis of diabetes and its complications through its two main receptors: Cannabinoid receptor type 1 and cannabinoid receptor type 2, alongside other components. However, the role of the endocannabinoid system in diabetic cardiomyopathy has not been fully investigated. This review aims to elucidate the possible mechanisms through which cannabinoids and the endocannabinoid system could interact with the pathogenesis and the development of diabetic cardiomyopathy. These mechanisms include oxidative/ nitrative stress, inflammation, accumulation of AGEs, cardiac remodeling, and autophagy. A better understanding of the role of cannabinoids and the endocannabinoid system in diabetic cardiomyopathy may provide novel strategies to manipulate such a serious diabetic complication.

Different Interactive Effects of Metformin and Acarbose With Dietary Macronutrient Intakes on Patients With Type 2 Diabetes Mellitus: Novel Findings From the MARCH Randomized Trial in China

Antidiabetic oral agents and nutrition management are frequently used together as first-line therapies for type 2 diabetes mellitus (T2DM). However, less is known about their interaction. The interactive effect of two classic antidiabetic medications, namely, acarbose and metformin, with dietary intakes of macronutrients on glycemic control and cardiometabolic risk factors was investigated in the metformin and acarbose in Chinese as the initial hypoglycemic treatment (MARCH) randomized clinical trial. The patients with newly diagnosed T2DM from China were included in the trial. Participants were randomized to receive either metformin or acarbose monotherapy as the initial treatment, followed by a 24-week treatment phase, during which add-on therapy was used if necessary. Dietary intakes of carbohydrate, protein, fat, and total energy were calculated by a 24-h food diary recall method. Linear mixed-effect models combined with a subgroup analysis were used to investigate independent and interactive effects of drugs and diet on clinical outcomes. A data analysis was performed on 551 of the 788 patients randomly assigned to treatment groups. Metformin therapy was independently associated with higher triglycerides (TGs, β = 0.471, P = 0.003), 2 h postprandial plasma glucose (2hPPG, β = 0.381, P = 0.046) but lower low-density lipoprotein cholesterol (LDL-C, β = −0.149, P = 0.013) compared with acarbose therapy. Higher carbohydrates and lower fat intakes were independently associated with poorer glycemic control, less weight loss, and greater insulin secretion. Higher total energy intake was also independently associated with higher fasting (β = 0.0002, P = 0.001) and postprandial blood glucose (β = 0.0004, P = 0.001). Interaction and subgroup analyses demonstrated that glucagon-like peptide-1 (GLP-1) was positively related to total energy (β = 0.268, P = 0.033), carbohydrates intake, and insulin secretion (β = 2,045.2, P = 0.003) only in the acarbose group, while systolic blood pressure (SBP) was negatively related to protein intake in the metformin group (β = 23.21, P = 0.014). The results of this study showed that metformin and acarbose mainly exerted different interactive effects with dietary energy, carbohydrate, and protein intakes on GLP-1 secretion, insulin release, and SBP. The interaction between drug therapy and nutrition intervention in glycemia highlights the complexity of combination therapy.

Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome in Women: Effects of Lifestyle Modifications

Non-alcoholic fatty liver disease (NAFLD) is the most widespread liver disease, characterized by fatty acids liver accumulation and subsequent fibrosis. NAFLD prevalence ranges from 80% to 90% in obese subjects and is estimated to be around 50% in patients with metabolic syndrome. In this clinical scenario, diet and lifestyle modifications can play an important role. There are several imaging techniques that can accurately diagnose fatty liver. Recently, ultrasound has acquired a leading role in the diagnosis and follow-up of fatty liver disease. Furthermore, elastosonography represents a valid alternative to liver biopsy. Shear wave elastosonography evaluates the elastic and mechanical properties of liver tissue. The aim is to evaluate the effects of lifestyle and nutritional interventions and a loss of body weight during hepatic steatosis through ultrasonographic and elastosonographic techniques. Thirty-two female subjects with metabolic syndrome were subjected to clinical, anthropometric, and laboratory assessments, as well as abdominal ultrasonographic/elastosonographic measurements taken from enrollment time (T0) and after 3 months (T1) of lifestyle modifications. After 3 months of lifestyle changes, significant weight loss was observed, with a marked improvement in all adiposity indices. The laboratory parameters at T1 showed significant decreases in total and LDL cholesterol, triglycerides, basal blood glucose, 120 min glycaemia, basal insulin and HOMA Index (p < 0.001). A similar improvement was observed at T1 for steatosis degree (p < 0.01) and elastosonographic measurements (Kpa p < 0.001). The linear regression analysis of the baseline conditions documented that the size of the liver positively correlated with body weight, BMI, neck and waist circumferences, waist to height ratio (WhtR), insulin and HOMA Index, fat mass and visceral fat, and steatosis grade. After 3 months, the liver size showed improvement with positive correlations to all previous variables. Hepatic stiffness (Kpa) positively correlated with neck circumference, visceral fat, and ALT, with basal insulin, gamma-GT, and AST, and with waist circumference, WhtR, and fat mass. The degree of steatosis was positively correlated with more variables and with greater statistical significance at T1 with respect to T0. Particularly, the positive correlations between the degree of steatosis and neck circumference (p < 0.001), HOMA Index, and triglycerides (p < 0.001) appeared to be very significant. NAFLD management in women with metabolic syndrome should be focused on lifestyle modifications. Moreover, liver involvement and improvement at follow-up could be evaluated in a non-invasive manner through ultrasonographic and elastosonographic techniques.

Effects of Moringa oleifera Lam. Supplementation on Inflammatory and Cardiometabolic Markers in Subjects with Prediabetes

Different parts of the Moringa oleifera Lam. (MO) tree are consumed as food or food supplements for their nutritional and medicinal value; however, very few human studies have been published on the topic. The current work was aimed to provide ancillary analysis to the antidiabetic effects previously reported in a double-blind, randomized, placebo-controlled, parallel group intervention conducted in patients with prediabetes. Thus, the effect of MO leaves on blood and fecal inflammatory markers, serum lipid profile, plasma antioxidant capacity and blood pressure was studied in participants who consumed 6 × 400 mg capsule/day of MO dry leaf powder (MO, n = 31) or placebo (PLC, n = 34) over 12 weeks. Differences between groups were assessed using each biomarker’s change score with, adjustment for fat status and the baseline value. In addition, a decision tree analysis was performed to find individual characteristics influencing the glycemic response to MO supplementation. No differences in the biomarker’s change scores were found between the groups; however, the decision tree analysis revealed that plasma TNF-α was a significant predictor of the subject’s HbA1c response (improvement YES/NO; 77% correct classification) in the MO group. In conclusion, TNF-α seems to be a key factor to identify potential respondents to MO leaf powder.

Adherence to the American Diabetes Association's Glycemic Goals in the Treatment of Diabetes Among Older Americans, 2001-2018

OBJECTIVE

To assess trends in HbA1c and appropriateness of diabetes medication use by patient health status.

RESEARCH DESIGN AND METHODS

We conducted cross-sectional analysis of 2001-2018 National Health and Nutrition Examination Survey (NHANES). We included older adults age ≥65 years who had ever been told they had diabetes, had HbA1c >6.4%, or had fasting plasma glucose >125 mg/dL. Health status was categorized as good, intermediate, or poor. Being below goal was defined as taking medication despite having HbA1c ≥1% below the glycemic goals of the American Diabetes Association (ADA), which varied by patient health status and time period. Drugs associated with hypoglycemia included sulfonylureas, insulin, and meglitinides.

RESULTS

We included 3,539 patients. Mean HbA1c increased over time and did not differ by health status. Medication use increased from 59% to 74% with metformin being the most common drug in patients with good or intermediate health and sulfonylureas and insulin most often prescribed to patients with poor health. Among patients taking medications, prevalence of patients below goal increased while prevalence of those above goal decreased from 2001 to 2018. One-half of patients with poor health and taking medications had below-goal HbA1c; two-thirds received drugs associated with hypoglycemia. Patients with poor health who were below goal had 4.9 (95% CI 2.3-10.4) times the adjusted odds of receiving drugs associated with hypoglycemia than healthy patients.

CONCLUSIONS

In accordance with ADA's newer Standards of Medical Care in Diabetes, HbA1c goals were relaxed but did not differ by health status. Below-goal HbA1c was common among patients with poor health; many were prescribed medications associated with a higher risk of hypoglycemia.

Self-management Effectiveness on the Quality of Life of Type 2 Diabetes Mellitus Patients during the COVID-19 Pandemic in Aceh, Indonesia

Background: Type 2 Diabetes Mellitus (DM) is a comorbid factor with a double risk of increased morbidity and mortality due to COVID-19. Therefore, diabetic patients need to prevent COVID-19 seriously. However, they also need to regularly check their condition in health care services, such as hospitals and community health centers, making them more vulnerable to Covid-19 infection. One factor playing a significant role in controlling diabetes is self-management. Self-management activities can increase independence in caring for and controlling the health of diabetic patients. Then, it also enhances self-efficacy to improve the quality of life among diabetic patients. This study aimed to examine the effect of self-management on quality of life among patients with type 2 DM. Method: Fifty patients with type 2 DM consented to participate in the study. The patients were assigned to either the control group receiving standard care or the experimental group receiving standard care and self-management. The program was constructed using Kanfer’s three self-management steps, including self-monitoring, self-assessment, and self-reinforcement. The effect of the intervention was measured by the WHO Quality of Life Questionnaire (WHOQOL-BREF), consisting of 26 statement items on a 5-point Likert scale and a self-management intervention evaluation checklist. Data were analyzed using an independent sample t-test. Results: The results showed a significant difference between the pre and post-intervention in the experimental group's quality of life of type 2 DM patients (p=0.000 and α = 0.01). Conclusion: This study found that self-management effectively increases the quality of life among diabetic patients. The health care providers, especially the nurses interested in community and family health nursing, are suggested to improve the self-management of diabetic patients to prevent complications and improve the quality of life of the patients.

International comparison of glycaemic control in people with type 1 diabetes: an update and extension

AIMS

To update and extend a previous cross-sectional international comparison of glycaemic control in people with type 1 diabetes.

METHODS

Data were obtained for 520,392 children and adults with type 1 diabetes from 17 population and five clinic-based data sources in countries or regions between 2016 and 2020. Median HbA_1c (IQR) and proportions of individuals with HbA_1c < 58 mmol/mol (<7.5%), 58-74 mmol/mol (7.5-8.9%) and ≥75 mmol/mol (≥9.0%) were compared between populations for individuals aged <15, 15-24 and ≥25 years. Logistic regression was used to estimate the odds ratio (OR) of HbA_1c < 58 mmol/mol (<7.5%) relative to ≥58 mmol/mol (≥7.5%), stratified and adjusted for sex, age and data source. Where possible, changes in the proportion of individuals in each HbA_1c category compared to previous estimates were calculated.

RESULTS

Median HbA_1c varied from 55 to 79 mmol/mol (7.2 to 9.4%) across data sources and age groups so a pooled estimate was deemed inappropriate. OR (95% CI) for HbA_1c < 58 mmol/mol (<7.5%) were 0.91 (0.90-0.92) for women compared to men, 1.68 (1.65-1.71) for people aged <15 years and 0.81 (0.79-0.82) aged15-24 years compared to those aged ≥25 years. Differences between populations persisted after adjusting for sex, age and data source. In general, compared to our previous analysis, the proportion of people with an HbA_1c  < 58 mmol/l (<7.5%) increased and proportions of people with HbA_1c ≥ 75 mmol/mol (≥9.0%) decreased.

CONCLUSIONS

Glycaemic control of type 1 diabetes continues to vary substantially between age groups and data sources. While some improvement over time has been observed, glycaemic control remains sub-optimal for most people with Type 1 diabetes.

Appropriate use of plasma glucose tests for diagnosis of diabetes mellitus in Ibadan, Nigeria

Background: Diabetes mellitus is a growing epidemic in Africa. Its diagnosis relies exclusively on laboratory evidence, which differs based on clinical circumstances.Objective: The study described the appropriateness of plasma glucose test requests per the American Diabetes Association criteria.Methods: We reviewed the plasma glucose test requests received by the chemical pathology laboratory of the University College Hospital, Ibadan, Nigeria between June 2018 and November 2018. The American Diabetes Association diabetes diagnostic criteria were used to define the appropriateness of test requests and determine the potential for ill-informed clinical decisions.Results: Four hundred and twenty-three requisition forms were included, with the majority from the medical wards/clinics (72.3%); the most frequent reason for a plasma glucose test was systemic hypertension (28.6%). Fasting plasma glucose was most requested (254; 60.0%). One hundred and sixteen (27.4%) requests were potentially inappropriate, with the 2-h postprandial plasma glucose (2hPPG) test requests (83; 71.6%) being the most inappropriate. The difference in the proportion of inappropriate requests was not statistically significantly between medical or surgical wards/clinics (Odds ratio 1.131, 95% confidence interval 0.709–1.803, p = 0.605). Inappropriate requests in six cases may have triggered inappropriate action.Conclusion: A third of the glucose tests requested for querying diabetes mellitus may have been inappropriate. Results of such testing may trigger inappropriate clinical action. To improve the quality of care and for economic reasons, laboratories should have programmes to improve the appropriate use of their services.

Robot-enhanced diabetes care for middle-aged and older adults living with diabetes in the community: A small sample size mixed-method evaluation

Purpose

This study assessed robot-enhanced healthcare in practical settings for the purpose of community diabetes care.

Methods

A mixed method evaluation collected quantitative and qualitative data on diabetes patients over 45 (N = 30) and community pharmacists (N = 10). It took 15–20 min for the diabetes patients to interact with the robot. Before and after the interaction, questionnaires including a diabetes knowledge test, self-efficacy for diabetes, and feasibility of use of the robot was administered. In-depth interviews with both pharmacists and patients were also conducted.

Results

After interacting with the robot, a statistically significant improvement in diabetes knowledge (p < .001) and feasibility of the robot (p = .012) was found, but self-efficacy (p = .171) was not significantly improved. Five themes emerged from interviewing the diabetes patients: Theme 1: meets the needs of self-directed learning for the elderly; Theme 2: reduces alertness and creates comfortable interaction; Theme 3: vividness and richness enhance interaction opportunities; Theme 4: Robots are not without disadvantages, and Theme 5: Every person has unique tastes. Three themes emerged from interviewing pharmacists: Theme 1: Technology must meet the real needs of the patient; Theme 2: creates new services, and Theme 3: The use of robots must conform to real-life situations.

Conclusions

Both the diabetes patients and the pharmacist reported more positive feedback on the robot-enhanced diabetes care than concerns. Self-directed learning, comfortable interaction, and vividness were the most focuses when using robot to enhance self-management for the patients. Pharmacists were most receptive to fit conforming with reality and creating new services.

Implications of Bariatric Surgery on the Pharmacokinetics of Antiretrovirals in People Living with HIV

Bariatric surgery is increasingly applied among people living with HIV to reduce obesity and the associated morbidity and mortality. In people living with HIV, sufficient antiretroviral exposure and activity should always be maintained to prevent development of resistance and disease progression. However, bariatric surgery procedures bring various gastrointestinal modifications including changes in gastric volume, and acidity, gastrointestinal emptying time, enterohepatic circulation and delayed entry of bile acids. These alterations may affect many aspects of antiretroviral pharmacokinetics. Some drug characteristics may result in subtherapeutic exposure and the potential related risk of treatment failure and resistance. Antiretrovirals that require low pH, administration of fatty meals, longer intestinal exposure, and an enterohepatic recirculation for their absorption may be most impacted by bariatric surgery procedures. Additionally, some antiretrovirals can interact with the polyvalent cations in supplements or drugs inhibiting gastric acid, thereby preventing their use as these comedications are commonly prescribed post-bariatric surgery. Predicting pharmacokinetics on the basis of drug characteristics solely proved to be challenging, therefore pharmacokinetic studies remain crucial in this population. Here, we discuss general implications of bariatric surgery on antiretroviral outcomes in people living with HIV as well as drug properties that are relevant for the choice of antiretroviral treatment in this special patient population. Additionally, we summarise studies that evaluated the pharmacokinetics of antiretrovirals post-bariatric surgery. Finally, we performed a comprehensive analysis of theoretical considerations and published pharmacokinetic and pharmacodynamic data to provide recommendations on antiretrovirals for people living with HIV undergoing bariatric surgery.

The global trend of exosome in diabetes research: A bibliometric approach

BACKGROUND AND AIMS

Exosome as a novel biomarker reflecting cell behavior in normal and pathological conditions such as diabetes is being the center of academic attention. Therefore, we aimed to study the research output of exosome in diabetes globally.

METHODS

We conducted a bibliometric approach to analyze publications on exosome and diabetes from the beginning to 2021 based on keyword search in the Scopus. Annual publications, citations, contributions, co-authorships, and co-occurrences were analyzed and plotted using VOSviewer and GraphPad Prism.

RESULTS

410 original articles and 149 reviews have published between 2009 and 2021. China and the USA were top countries in research output, sponsorship, and international collaborations. The top journals were Scientific Reports, Stem Cell Research and Therapy and Diabetes. The top institution was the University of Queensland in Australia. The top author was Chopp M. Co-occurrence analysis indicated that researchers focused on 1) extracellular vesicles in insulin resistance induced by metabolic disorders like obesity and diabetes mellitus; 2) diagnostic applicability of exosomal microRNAs as biomarkers for diabetic nephropathy; 3) therapeutic effect of exosome in wound healing and endothelial dysfunction during diabetes mellitus; and 4) The oxidative stress, autophagy, apoptosis, fibrosis, inflammation and angiogenesis mediated by exosomes during diabetes.

CONCLUSION

The trend in research output has been increased in this field, and advanced countries are involved much more than other countries in terms of research, financial support, and international collaboration. The bibliometric results could be beneficial for further studies in better understanding of novel ideas in exosome and diabetes fields.

Plasma Calcium and Phosphorus Levels and Cardiovascular Disease Risks in Egyptian Type 2 Diabetic Patients

Background: Cardiovascular complication of diabetes is considered an important issue that needs deep investigations. The levels of plasma calcium (Ca) and phosphorus (P) have been implicated as having an association to cardiovascular diseases. AIM: The objective of the present research was to study the plasma levels of both Ca and P and their association to the atherogenic ratio; total cholesterol: high density lipoprotein-cholesterol and the plasma albumin in male and female patients with type 2-diabetes. The interrelation between anthropometric parameters represented by body mass index (BMI), waist circumference and waist/hip ratio with Ca and P were studied. Also, the association between plasma Ca and P with their dietary intake were investigated. Subjects and METODS: Thirty-one type 2-diabetic male and female patients participated in the study, in addition of ten healthy subjects. Biochemical parameters, anthropometric measurements and nutrients′ intake were assessed. Biochemical parameters include plasma Ca, P, lipid profile, albumin, liver function tests and creatinine. RESULTS: Plasma Ca levels of female patients of BMI> 30 kg/m2 demonstrated significant increase compared to the control group.  All male and female patients showed significant increase in plasma P compared to the control group. Glycosylated hemoglobin of male and females showed significant high values compared to the control group except for diabetic male of BMI>30 kg/m2 that showed insignificant increase. No significant changes in plasma TG and LDL-C levels were noticed compared to the control.  Plasma TC of patients showed significant high levels compared to the control group. The levels of HDL-C of patients were significantly lower than that of the control. The ratios of TC/HDL-C diabetic patients either male or female and whatever their BMI were significantly higher than that of the control. No significant changes in plasma activities of ALT and AST and bilirubin levels were observed among the different groups including the control.  Plasma albumin levels demonstrated significant reduction compared to the control group whatever their sexes or BMI. Plasma creatinine levels of the different diabetic groups showed insignificant change from the control group except for the male group of BMI<30 kg/m2 that showed significant elevation. In male, plasma Ca showed significant negative correlation with albumin and positive correlation with creatinine and dietary vitamin D. In female, a significant positive correlation was noticed between plasma and dietary P while a negative correlation was observed between plasma Ca and dietary iron. CONCLUSION: Elevated of plasma P together with reduced plasma albumin and elevated TC/HDL-C may reflect an association of plasma P to CVD in male and female diabetic subjects while high plasma Ca might predict CVD in only female diabetic patients of BMI > 30 kg/m2.

The effect of timing and dosing of 5% and 10% Dextrose versus Saline on postoperative nausea and vomiting in high-risk women following ambulatory surgeries: a randomized double-blind controlled trial

BACKGROUND

A common complication after outpatient surgeries is postoperative nausea and vomiting (PONV) which is concomitant with high levels of patient distress and dissatisfaction. Perioperative dextrose-containing fluid administration has been used as a non-pharmacologic preventive measure against postoperative nausea and vomiting (PONV). However, its efficacy remains unclear. This study aimed to compare different concentrations of dextrose solution on PONV for 24 hours after surgery.

METHODS

A randomized double-blind controlled study of 120 women were divided into three equal groups. Group C, was infused with IV 0.9% saline 100 ml/h for 2 hours (200 ml) starting 1 hour before anesthesia and ending during surgery. Group D5%, was infused with dextrose 5%. Group D10%, was infused with D10%. PONV within 24 hours was compared between groups by PONV score. Other outcomes were the antiemetic drugs needed, VAS score, total fentanyl consumption, hemodynamic data, unplanned admission, and complications RESULTS: The incidence of nausea and vomiting was significantly reduced in dextrose 10% and 5% patients in comparison to the control group (5 patients (12.5%), 18 (42.5%), and 39 (87.5%) respectively). The request for antiemetic drugs decreased significantly in groups D10% and 5% than in group C (36 patients did not receive any antiemetics (90%), 29 (72.5%) and 19 (47.5%) respectively, P-value=0.002). Postoperative pain prevalence in patients with PONV was significantly different only at 24 h, P-value=0.03.

CONCLUSIONS

There was a potential role for preoperative IV infusion of dextrose 10% solution that significantly reduces the incidence and severity of PONV and pain in patients at high risk for PONV.

A Triplex Ultrasound Evaluation of Preclinical Changes in Type 2 Diabetes in Foot Arteries

Background and objective: Type 2 diabetes mellitus (T2DM) is a significant health problem that is becoming more prevalent worldwide. This study aimed to assess hemodynamic and morphological parameters in diabetic patients' foot arteries and compare them to those obtained in asymptomatic control group.

Materials and methods: This is a cross-sectional case-control study. B-mode ultrasound, color Doppler, and pulse wave Doppler were conducted to assess the dorsalis pedis arteries (DPAs) and posterior tibial arteries (PTAs). The morphological, total vascular diameter, wall thickness, and flow Doppler indices were measured. A total of 200 hundred participants were selected randomly using a random sampling technique. One hundred diabetic patients and 100 non-diabetic persons were determined.

Results: In diabetic patients, the overall grayscale diameter and wall thickness of foot arteries were statistically significantly larger than the asymptomatic group in the right DPA (p<0.01), left DPA (p<0.001), right PTA (p<0.001), and left PTA (p<0.001). In the diabetic group, the level of hemoglobin A1c (HbA1c) was positively correlated with blood flow resistive index (RI) in the right DPA (r=0.839; p<0.001), left DPA (r=0.801; p<0.001), right PTA (r=0.801; p<0.001), and left PTA (r=0.801; p<0.001). No significant differences were noted in both groups in blood flow Doppler parameters - pulsatility index (PI) and resistive index (RI).

Conclusion: Overall grayscale diameters of foot arteries are larger in the diabetes group than in the control group, indicating arterial wall thickening as an early indicator of diabetes-related alterations. PI of both DPA and RI of right DPA were increased in diabetic patients more than the control group. The level of glycosylatedhemoglobin A1c (HbA1c) was strongly linked with the blood flow resistive index in diabetes patients.

Efficiency of a multidisciplinary team care approach through a short hospitalization of patients with poorly controlled diabetes mellitus: a 12 months prospective monocentric study

A multidisciplinary team is composed of various healthcare professionals that ensure a multifaceted approach on a group of patients. Standards for diabetes medical care note the importance of multidisciplinary diabetes care teams. We applied our model of multidisciplinary approach by structuring it in a determined five days hospitalization. The aim of this study was to determine if the interdisciplinary approach applied on a short hospitalization is of benefit in patients with poorly controlled diabetes mellitus. Sixty-seven patients were included and ensured a short hospitalization in which they received a multiple educational advice and a treatment adaptation. Sixty-one patients out of 67 (91%) were retained for evaluation with sufficient data at one year, i.e. 9% of patients with poor compliance. Evolution in glycosylated haemoglobin (HbA1c), weight and treatments was analyzed. After a 12 months follow-up, we observed significant improvement in HbA1c (-1.73%; p < 103) without weight loss (BMI=-0.42 kg/m2), p=0.28). HbA1c mean levels correlated negatively to body mass index (BMI) during the regular follow-up (r=-0.22, p=0.05). More than 90% of patients with poorly controlled diabetes mellitus responded to the multi-disciplinary approach with a decrease in HbA1c.

Placental lipid transport and content in response to maternal overweight and gestational diabetes mellitus in human term placenta

BACKGROUND AND AIMS

Placental lipid transport is altered in women with high prepregnancy body mass index (pre-BMI) or gestational diabetes (GDM), which consequently affects foetal growth. However, the interaction of maternal overweight (OW) and GDM on placental lipid metabolism and possible adaptations are less studied. We aimed to examine whether maternal OW or GDM is the main factor disrupting placental lipid processing in human term placenta.

METHODS AND RESULTS

A total of 152 lean (18.5 ≤ pre-BMI ≤ 23.9 kg/m²) and OW (24 ≤ pre-BMI ≤ 27.9 kg/m²) pregnant women with or without GDM with a scheduled delivery by caesarean section were recruited. Maternal venous blood samples were used to measure metabolic parameters during pregnancy. Term placentas and cord blood were collected at delivery to determine placental lipid metabolism and foetal circulating lipid levels. Maternal OW significantly increased the placental mRNA expression of genes involved in lipid metabolism (FAT/CD36, FATP1, FATP4, FATP6, and PPAR-α), elevated placental lipid content (triglyceride, cholesterol), enhanced placental mTORC1-rpS6 and ERK1/2 signalling, increased cord blood insulin levels and birth weight. Neonatal birth weight was positively correlated with maternal pre-BMI, placental ERK1/2 signalling and cord blood insulin. There was an interaction between OW and GDM in regulating key placental fuel transport and storage gene expression (LPL, FATP6, FABP7, PPAR-α, PPAR-β, PPAR-γ, IR-β, GLUT1, SNAT2, SNAT4, and LAT1).

CONCLUSION

Maternal OW mainly affects placental lipid metabolism, which may contribute to foetal overgrowth and may impact long-term offspring health. GDM plays a less significant role in affecting placental lipid transfer and other mechanisms may be involved.

Fasting plasma glucose level to guide the need for an OGTT to screen for gestational diabetes mellitus

AIMS

To determine the fasting plasma glucose (FPG) level at which an oral glucose tolerance test (OGTT) could be avoided to screen for gestational diabetes (GDM) and to evaluate the characteristics of women across this FPG threshold.

METHODS

A multi-centric prospective cohort study with 1843 women receiving universal screening for GDM with a 75 g OGTT.

RESULTS

In the total population, GDM prevalence was 12.5% (231). A FPG < 78 mg/dL was the cut-off with best trade-off to limit the number of missed GDM cases [44 (19.0%)] with a negative predictive value of 97.3% (95% CI 96.5-98.0) for GDM, while avoiding 52.2% OGTTs. Compared to GDM with FPG ≥ 78 mg/dL [187 (81.0%)], GDM women with FPG < 78 mg/dL had a significantly lower BMI (27.1 ± 4.5 vs. 29.6 ± 5.2 kg/m², p = 0.003), less insulin resistance [Matsuda: 0.4 (0.4-0.7) vs. 0.3 (0.2-0.5), p < 0.001] and better β-cell function [ISSI-2: 0.13 (0.08-0.25) vs. 0.09 (0.04-0.15), p = 0.004]. Compared to NGT women (1612) with FPG ≥ 78 mg/dL [846 (52.5%)], NGT with FPG < 78 mg/dL [766 (47.5%)] had a significantly lower BMI (26.0 ± 3.9 vs. 27.8 ± 4.7 kg/m², p < 0.001), less insulin resistance [Matsuda: 0.7 (0.5-0.9) vs. 0.5 (0.4-0.7), p < 0.001], better β-cell function [ISSI-2: 0.17 (0.10-0.30) vs. 0.12 (0.07-0.21), p < 0.001], and less often large-for-gestational age infants [9.2 (70) vs. 16.2% (136), p < 0.001].

CONCLUSIONS

FPG < 78 mg/dL can be used to limit the number of OGTTs when screening for GDM. Women with FPG < 78 mg/dL had a better metabolic profile and in NGT women also less fetal overgrowth.

Prediction of Personal Glycemic Responses to Food for Individuals With Type 1 Diabetes Through Integration of Clinical and Microbial Data

OBJECTIVE

Despite technological advances, results from various clinical trials have repeatedly shown that many individuals with type 1 diabetes (T1D) do not achieve their glycemic goals. One of the major challenges in disease management is the administration of an accurate amount of insulin for each meal that will match the expected postprandial glycemic response (PPGR). The objective of this study was to develop a prediction model for PPGR in individuals with T1D.

RESEARCH DESIGN AND METHODS

We recruited individuals with T1D who were using continuous glucose monitoring and continuous subcutaneous insulin infusion devices simultaneously to a prospective cohort and profiled them for 2 weeks. Participants were asked to report real-time dietary intake using a designated mobile app. We measured their PPGRs and devised machine learning algorithms for PPGR prediction, which integrate glucose measurements, insulin dosages, dietary habits, blood parameters, anthropometrics, exercise, and gut microbiota. Data of the PPGR of 900 healthy individuals to 41,371 meals were also integrated into the model. The performance of the models was evaluated with 10-fold cross validation.

RESULTS

A total of 121 individuals with T1D, 75 adults and 46 children, were included in the study. PPGR to 6,377 meals was measured. Our PPGR prediction model substantially outperforms a baseline model with emulation of standard of care (correlation of R = 0.59 compared with R = 0.40 for predicted and observed PPGR respectively; P < 10-10). The model was robust across different subpopulations. Feature attribution analysis revealed that glucose levels at meal initiation, glucose trend 30 min prior to meal, meal carbohydrate content, and meal's carbohydrate-to-fat ratio were the most influential features for the model.

CONCLUSIONS

Our model enables a more accurate prediction of PPGR and therefore may allow a better adjustment of the required insulin dosage for meals. It can be further implemented in closed loop systems and may lead to rationally designed nutritional interventions personally tailored for individuals with T1D on the basis of meals with expected low glycemic response.

Incidence of Referable Retinal Disease in Diabetic Patients at a Primary Care Practice

Purpose:

This work tests the feasibility of remote ophthalmic imaging to identify referable retinal abnormalities and assesses the effectiveness of color fundus photography (CFP) vs optical coherence tomography (OCT) for this purpose.

Methods:

This prospective, nonrandomized study included 633 patients with diabetes at Duke Primary Care. Undilated patients underwent screening with CFP and OCT camera (MaestroCare, Topcon). Images were graded independently for interpretability and the presence of predetermined retinal disease. Retinal disease was classified as diabetic retinopathy (DR) referable to a retina specialist or incidental findings referable to either a retina specialist or a general ophthalmologist, depending on severity.

Results:

Mean (SD) age of screened patients was 66 (13) years, and 49% were women. The average glycated hemoglobin A1c level was 7.6 % (SD, 1.7%), and 30% of the patients were on insulin. The average duration of diabetes was 5.9 (SD, 7.3) years. Remote images from OCT were significantly more interpretable than CFP (98% vs 83%, respectively; P < .001). Referral rates were 9% for DR and 28% for incidental findings. Among patients with DR, OCT and CFP were helpful in 58% and 87% of cases, respectively ( P < .001).

Conclusions:

Remote diagnosis of ophthalmic imaging at the point of service may allow for early identification of retinal disease and timely referral and treatment. Our approach showed that OCT had significantly better interpretability, while CFP was more helpful in identifying DR. These findings may be important when choosing the screening device in a specific context.