Differences in clinical and biological characteristics and prevalence of chronic complications related to aging in patients with type 2 diabetes

Trends and future predictions of chronic kidney disease due to diabetes mellitus type 2 attributable to dietary risks: insights based on GBD 2021 data

Background

The 2021 Global Burden of Disease (GBD) study shows a continuous increase in the burden of chronic kidney disease due to diabetes mellitus type 2 (CKD-T2DM) from 1990 to 2021. This study examines the influence of dietary risk factors across various populations and socioeconomic groups.

Methods

Utilizing the 2021 GBD data, we analyzed age-standardized CKD-T2DM metrics-including mortality, disability-adjusted life years (DALY), and age-standardized rates (ASR)-stratified by age, gender, and region. The study employs estimated annual percentage changes (EAPC) to monitor temporal trends and project future trends from 2022 to 2035 using bayesian age-period-cohort (BAPC) analysis.

Results

The results indicate that, in 2021, 20.55% of CKD-T2DM mortality and 23.21% of CKD-T2DM DALY were attributed to poor diets, especially those low in fruits and high in red and high processed meat. Throughout this period, both mortality and DALY rates associated with dietary risks increased significantly, with the most rapid increase in diet high in sugar-sweetened beverages, highlighting the considerable impact of dietary factors on the global CKD-T2DM landscape. Geographic disparities in T2DM trends are evident, with the most significant increases in age-standardized mortality rates (ASMR) and age-standardized DALY rates (ASDR) observed in regions such as high-income North America and Central Latin America. Socio-demographic index (SDI) is negatively correlated with the CKD-T2DM burden attributable to dietary risk factors.

Conclusion

Public health interventions that target dietary changes can significantly reduce the global burden of CKD-T2DM.

The burden of type 2 diabetes attributable to dietary risks in China: Insights from the global burden of disease study 2021

OBJECTIVES

This study aims to comprehensively assess how dietary risk factors have influenced the prevalence of Type 2 Diabetes Mellitus (T2DM) in China from 1990 to 2021. The study seeks to provide robust data and scientific evidence essential for formulating effective preventive and control strategies to combat T2DM in China.

STUDY DESIGN

This cross-sectional study conducted secondary analyses using data from the Global Burden of Disease 2021 (GBD 2021) to assess the burden of T2DM in China attributable to dietary risks.

METHODS

The study analyzed age-adjusted metrics related to T2DM, including death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASRs), using GBD 2021 data, stratified by age and sex. Additionally, Estimated Annual Percentage Changes (EAPCs) were employed to track trends over time.

RESULTS

In 2021, the results show that 21.43 % of T2DM-related deaths and 23.51 % of DALYs were attributable to dietary risk factors, notably a diet low in whole grains and high in red and processed meats. Over the period from 1990 to 2021, there has been an increasing trend in the EAPCs of death rates and DALYs associated with dietary risks in China, suggesting a substantial impact of dietary factors on the burden of T2DM in the country.

CONCLUSION

This study highlights the urgent need for targeted public health interventions to promote dietary changes and reduce the burden of T2DM in China.

Causes and Preventive Measures of Sports Injuries in Physical Fitness Tests in Colleges and Universities Based on Biological Characteristics

Biological characteristics refer to the morphological and physiological characteristics exhibited by individual organisms. The indicators of individual biological characteristics mainly include physical indicators such as height, weight, chest circumference, and health-related physical indicators such as blood pressure, grip strength, and vital capacity. This article mainly introduces the cause analysis and preventive measures of a physical fitness test in colleges and universities based on biological characteristics and intends to provide ideas and directions for the cause analysis and preventive measures of a physical fitness test in colleges and universities. This paper proposes a research method for the cause analysis and preventive measures of sports injuries in college physical fitness tests based on biological characteristics. Research experiments on the cause analysis and preventive measures of sports injuries in the physical fitness test of colleges and universities. The experimental results in this paper show that the most frequent cause of sports injuries among boys is lack of self-protection awareness, with a probability of 24.24%; among girls, the most frequent cause of sports injuries is insufficient flexibility, with a probability of 22.86%.

Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review

BACKGROUND

Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients.

METHODS

The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed.

RESULTS

Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients' race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies.

CONCLUSIONS

Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients.

Sex Differences in Age-Associated Type 2 Diabetes in Rats-Role of Estrogens and Oxidative Stress

Females live longer than males, and the estrogens are one of the reasons for this difference. We reported some years ago that estrogens are able to protect rats against oxidative stress, by inducing antioxidant genes. Type 2 diabetes is an age-associated disease in which oxidative stress is involved, and moreover, some studies show that the prevalence is higher in men than in women, and therefore there are sex-associated differences. Thus, the aim of this study was to evaluate the role of estrogens in protecting against oxidative stress in type 2 diabetic males and females. For this purpose, we used Goto-Kakizaki rats, which develop type 2 diabetes with age. We found that female diabetic rats showed lower glycaemia levels with age than did diabetic males and that estrogens enhanced insulin sensitivity in diabetic females. Moreover, glucose uptake, measured by positron emission tomography, was higher in the female brain, cerebellum, and heart than in those from male diabetic rats. There were also sex-associated differences in the plasma metabolic profile as determined by metabolomics. The metabolic profile was similar between estrogen-replaced and control diabetic rats and different from ovariectomized diabetic rats. Oxidative stress is involved in these differences. We showed that hepatic mitochondria from females produced less hydrogen peroxide levels and exhibited lower xanthine oxidase activity. We also found that hepatic mitochondrial glutathione oxidation and lipid oxidation levels were lower in diabetic females when compared with diabetic males. Ovariectomy induced oxidative stress, and estrogen replacement therapy prevented it. These findings provide evidence for estrogen beneficial effects in type 2 diabetes and should be considered when prescribing estrogen replacement therapy to menopausal women.

Dietary program and physical activity impact on biochemical markers in patients with type 2 diabetes: A systematic review

OBJECTIVES

Evaluate the effectiveness of the implementation of independently or combined dietary and physical activity programs on the blood glucose values and lipid profile in patients with type 2 diabetes, including participants aged 60 years and over.

DESIGN

Systematic review.

DATA SOURCE

PubMed/Medline database, with language restrictions. Papers published between 2010 and 2016 were included.

STUDY SELECTION

A total of 30 randomised controlled trials were included that focused on physical activity and dietary interventions in patients with type 2 diabetes mellitus and include participants aged 60 years and over.

RESULTS

The selected articles have shown that the implementation of physical activity programs (aerobic, resistance, flexibility and combined exercises), and programs based on a higher intake of vegetables, grains, legumes, fruits, unsaturated fatty acids, as well as consumption of foods with low glycaemic index, calorie restriction, intake of probiotics, vitamin D supplementation and educational sessions about diabetes improves blood glucose levels, as well as the lipid profile, in patients with type 2 diabetes.

CONCLUSIONS

Physical activity and dietary programs are fundamental in the treatment and metabolic control of type 2 diabetes mellitus.

Comorbidity of chronic kidney disease, diabetes and lower glycated hemoglobin predicts support/care-need certification in community-dwelling older adults

AIM

Chronic kidney disease (CKD), diabetes and lower glycated hemoglobin (HbA_1c ) range in diabetes patients are associated with higher mortality. We investigated whether these conditions were associated with the risk of loss of independence in community-dwelling older adults.

METHODS

We analyzed 1078 older adults with no history of support/care-need certification in Long-Term Care Insurance aged 65-94 years. Associations of baseline CKD, diabetes, and lower HbA_1c range of <6.0% in the diabetes patients, at baseline health checkup with risk of later certification and/or death for 5 years were estimated using the Cox proportional hazards regression model.

RESULTS

The prevalence of both CKD and diabetes in the total population increased with age, due to a net increase in the coexistence of CKD and diabetes. The prevalence of the lower HbA_1c range also increased with age in participants with the coexistence. During 5 years, 135 certifications and 53 deaths occurred. After adjustment, patients with comorbidity of the triad of CKD, diabetes and the lower HbA_1c range had significantly higher hazard ratios (HR) for certification (HR 3.52, 95% confidence interval [CI] 1.91-6.48, P < 0.001) and for death (HR 3.79, 95% CI 1.46-9.85, P = 0.006) compared with those without CKD and diabetes. The harmful impact of the lower HbA_1c range on later certification compared with higher HbA_1c range of ≥6.0% was maintained in diabetes patients with use of antidiabetic agents and CKD (HR 2.40, 95% CI 1.06-6.45, P = 0.036).

CONCLUSIONS

Excessive HbA_1c reduction might cause discontinuance of disability-free survival in community-dwelling older diabetes patients with CKD. Geriatr Gerontol Int 2018; 18: 521-529.