Renal Evaluation and Protection

Socioeconomic and ethnic inequalities increase the risk of type 2 diabetes: an analysis of NHS health check attendees in Birmingham

Introduction

Birmingham has a significantly higher type-II diabetes prevalence than the national average. This study aimed to investigate the association of socioeconomic deprivation and ethnicity on the risk of diabetes in Birmingham.

Methods

Data were included from 108,514 NHS Health Checks conducted in Birmingham between 2018 and 2023. Attributable fraction and multinomial logistic regression were used to estimate the number of events avoidable and the prevalence odds ratios (POR) of determinants respectively.

Results

Attributable fraction analysis estimated that 64% of diabetes and 44% of pre-diabetes cases could be attributed to socioeconomic deprivation. Specifically, if Asian attendees in the least deprived areas had the same risk as White individuals in the least deprived areas, there would have been 1,056 fewer cases of diabetes and 2,226 fewer cases of pre-diabetes. Diabetes was significantly associated with Asian ethnicity (POR = 5.43, p < 0.001), Black ethnicity (POR = 3.15, p < 0.001) and Mixed ethnicity (POR = 2.79, p < 0.001). Pre-diabetes was also significantly associated with Asian ethnicity (POR = 3.06, p < 0.001), Black ethnicity (POR = 2.70, p < 0.001) and Mixed ethnicity (POR = 2.21, p < 0.001). The interaction effects between ethnicity and deprivation posed a greater risk of diabetes, especially for Asian attendees in the first (POR = 9.34, p < 0.001) and second (POR = 6.24, p < 0.001) most deprived quintiles.

Discussion

The present findings demonstrate the association of ethnicity and socioeconomic deprivation on the risk of diabetes and pre-diabetes. It underscores the necessity for targeted interventions and policies to address these inequalities.

The Interaction Between Age and Risk Factors for Diabetes and Prediabetes: A Community-Based Cross-Sectional Study

OBJECTIVE

This study aimed to investigate the interaction between age groups and risk factors for diabetes and prediabetes in Shanghai communities and to identify the effect of age on other risk factors for diabetes and prediabetes.

METHODS

This study recruited 3540 participants with undiagnosed diabetes or prediabetes in 14 communities in Shanghai from February to August 2019. All participants underwent a comprehensive examination, including filling out a detailed questionnaire, physical examination, 75 g oral glucose tolerance test, and blood sample collection. In addition, logistic regression was used to analyze the interaction between age and risk factors for prediabetes and diabetes.

RESULTS

The statistical analysis included 2776 people. In this study, the prevalence of diabetes and prediabetes were 15.1% and 52.3%, respectively. The prevalence of diabetes and prediabetes is higher in the elderly than in the middle-aged group. Among the risk factors for diabetes, overweight was associated with higher age (P-interaction 0.028). In addition, among the risk factors for prediabetes, a high level of education was associated with higher age (P-interaction 0.039) and elevated serum cholesterol level was associated with lower age (P-interaction 0.019).

CONCLUSION

This study confirmed an interaction between age and other influencing factors, which may be important in explaining differences in risk factors for diabetes and prediabetes in the middle-aged and elderly populations. Community health facilities can provide health guidance to people of different age groups to prevent and control prediabetes and diabetes.

Extracellular Vesicles Released from Stem Cells as a New Therapeutic Strategy for Primary and Secondary Glomerulonephritis

Current treatment of primary and secondary glomerulopathies is hampered by many limits and a significant proportion of these disorders still evolves towards end-stage renal disease. A possible answer to this unmet challenge could be represented by therapies with stem cells, which include a variety of progenitor cell types derived from embryonic or adult tissues. Stem cell self-renewal and multi-lineage differentiation ability explain their potential to protect and regenerate injured cells, including kidney tubular cells, podocytes and endothelial cells. In addition, a broad spectrum of anti-inflammatory and immunomodulatory actions appears to interfere with the pathogenic mechanisms of glomerulonephritis. Of note, mesenchymal stromal cells have been particularly investigated as therapy for Lupus Nephritis and Diabetic Nephropathy, whereas initial evidence suggest their beneficial effects in primary glomerulopathies such as IgA nephritis. Extracellular vesicles mediate a complex intercellular communication network, shuttling proteins, nucleic acids and other bioactive molecules from origin to target cells to modulate their functions. Stem cell-derived extracellular vesicles recapitulate beneficial cytoprotective, reparative and immunomodulatory properties of parental cells and are increasingly recognized as a cell-free alternative to stem cell-based therapies for different diseases including glomerulonephritis, also considering the low risk for potential adverse effects such as maldifferentiation and tumorigenesis. We herein summarize the renoprotective potential of therapies with stem cells and extracellular vesicles derived from progenitor cells in glomerulonephritis, with a focus on their different mechanisms of actions. Technological progress and growing knowledge are paving the way for wider clinical application of regenerative medicine to primary and secondary glomerulonephritis: this multi-level, pleiotropic therapy may open new scenarios overcoming the limits and side effects of traditional treatments, although the promising results of experimental models need to be confirmed in the clinical setting.

The Suffering of Advanced Chronic Renal Patients and Their Relationship with Symptoms in Loja, Ecuador

Advanced Chronic Kidney Disease (ACKD) supposes a public health problem in Ecuador that requires a comprehensive approach. In view of the scarcity of studies on the subject in this country, the objective of this research was to determine the signs and symptoms associated with the patients’ physical, social and psychological spheres that allow properly developing palliative care. A longitudinal, prospective and observational study was conducted with ACKD patients. In order to assess the symptomatic burden and suffering of these patients, the Edmonton Symptom Assessment System Revised: renal (ESAS-r) for renal patients and the Distress Thermometer (DT) were used. The sample consisted of a total of 246 patients. The most common symptoms that affect them, causing them suffering in their daily lives, are those related to well-being, difficulty falling asleep and itching. It is necessary that health professionals adapt care measures and help patients undergoing renal treatment, especially those who have suffered the disease for a longer period of time, in order to alleviate the patients’ suffering and therefore improve their daily lives. To such an end, a care plan could be designed that includes early palliative care.