Diabetic nephropathy and quality of life among youths with long-duration type 1 diabetes: A population-based cross-sectional study

Current status, trend changes, and future predictions of the disease burden of type 1 diabetes kidney disease in global and China

Objective

This study analyzes the global and China trends in the prevalence, disease burden, and future projections of Type 1 Diabetic Nephropathy (T1DN) over the past three decades, providing data to inform public health policies and clinical interventions.

Methods

Data from the Global Burden of Disease (GBD) 2021 database were used to analyze the incidence, prevalence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) of T1DN globally and in China from 1990 to 2021. Trend analysis was conducted using R and Joinpoint software, and the ARIMA model was applied to predict future trends in T1DN prevalence for the next 20 years. A significance level of p<0.05 was applied.

Results

Globally, deaths from T1DN increased from 49,300(95% CI: 39,088-61,207) in 1990 to 94,020 (95% CI: 71,456-119,984)in 2021, with the age-standardized mortality rate remaining stable. DALYs rose from 2,227,518(95% CI: 1,835,372-2,679,207) in 1990 to 3,875,628 (95% CI: 3,062,395-4,845,503) in 2021, though the age-standardized rate slightly decreased. In China, the mortality rate declined significantly, and DALYs decreased, with the age-standardized DALYs dropping from 80.915/100,000(95% CI: 65.121-98.391)to 47.953/100,000(95% CI: 36.9-60.734). Globally, both incidence and prevalence increased, with global incidence reaching 95,140(95% CI: 82,236-111,471) cases and prevalence rising to 6,295,711 (95% CI: 5,459,693-7,114,345)cases. In China, incidence showed a declining trend, but prevalence continued to rise. The ARIMA model forecasts global incidence will reach 115,000 cases, with prevalence reaching 7,000,000 by 2041. In China, incidence is expected to stabilize, while prevalence may increase to approximately 2,500,000 cases.

Conclusion

The burden of T1DN is rising globally, especially in terms of prevalence, while China has made progress in reducing mortality and disease burden. However, challenges remain in chronic disease management. Over the next 20 years, global prevalence is projected to continue increasing, while China's prevalence may stabilize. Targeted interventions for different age groups and genders will be essential in reducing the T1DN burden.

Sulforaphane and ophthalmic diseases

Sulforaphane (SFN) is an organosulfur compound categorized as an isothiocyanate (ITC), primarily extracted from cruciferous vegetables like broccoli and cabbage. The molecular formula of sulforaphane (SFN) is C6H11NOS2. SFN is generated by the hydrolysis of glucoraphanin (GRP) through the enzyme myrosinase, showing notable properties including anti-diabetic, anti-inflammatory, antimicrobial, anti-angiogenic, and anticancer attributes. Ongoing clinical trials are investigating its potential in diseases such as cancer, neurodegenerative diseases, diabetes-related complications, chronic kidney disease, cardiovascular disease, and liver diseases. Several animal carcinogenesis models and cell culture models have shown it to be a very effective chemopreventive agent, and the protective effects of SFN in ophthalmic diseases have been linked to multiple mechanisms. In murine models of diabetic retinopathy and age-related macular degeneration, SFN delays retinal photoreceptor cell degeneration through the Nrf2 antioxidative pathway, NF-κB pathway, AMPK pathway, and Txnip/mTOR pathway. In rabbit models of keratoconus and cataract, SFN has been shown to protect corneal and lens epithelial cells from oxidative stress injury by activating the Keap1-Nrf2-ARE pathway and the Nrf-2/HO-1 antioxidant pathway. Oral delivery or intraperitoneal injection at varying concentrations are the primary strategies for SFN intake in current preclinical studies. Challenges remain in the application of SFN in eye disorders due to its weak solubility in water and limited bioavailability because of the presence of blood-ocular barrier systems. This review comprehensively outlines recent research on SFN, elucidates its mechanisms of action, and discusses potential therapeutic benefits for eye disorders such as age-related macular degeneration (AMD), diabetic retinopathy (DR), cataracts, and other ophthalmic diseases, while also indicating directions for future clinical research to achieve efficient SFN treatment for ophthalmic diseases.

Application of urinary N-acetyl-β-D-glucosaminidase combined with serum retinol-binding protein in early detection of diabetic nephropathy

BACKGROUND

Diabetic nephropathy (DN) is a microangiopathy of type 2 diabetes mellitus (T2DM), which can damage the kidney through various ways and mechanisms due to the nature of the disease, involving the renal interstitium and glomeruli. However, in the early stage of the disease, patients only showed kidney volume increase and glomerular hyperthyroidism, and typical symptoms that are difficult to arouse individual attention were noticed.

AIM

To observe the expression of serum retinol-binding protein (RBP) and urinary N-acetyl-β-D-glucosaminidase (NAG) in patients with DN, and to analyze their value in disease prediction, so as to provide new targets for early diagnosis and treatment of DN.

METHODS

The baseline data of 50 T2DM patients treated in our hospital between January 2021 and December 2022 were retrospectively reviewed and included in group A. The baseline data of 50 patients with type 2 DN admitted to our hospital during the same period were collected and included in group B. The baseline data and serum RBP and urine NAG expression were compared between the two groups to analyze their value in the early prediction of DN.

RESULTS

There was no significant difference in age, gender, duration of diabetes, combined hyperlipidemia and combined hypertension between the two groups (P > 0.05); the expression of urinary NAG and serum RBP in group B was higher than that in group A, and the difference was statistically significant (P < 0.05); a multiple logistic regression model was established, and the results showed that urinary NAG and serum RBP were related to the presence or absence of injury in diabetic patients, and overexpression of urinary NAG and serum RBP may be risk factors for renal injury in T2DM patients (OR > 1, P < 0.05); receiver operating curve curve was plotted, and the results showed that the area under the curve of urinary NAG and serum RBP expression alone and in combination for predicting DN was > 0.80, and the predictive value was satisfactory; bivariate Spearman linear correlation analysis showed that there was a positive correlation between urinary NAG and serum RBP expression in patients with DN (r = 0.566, P = 0.000).

CONCLUSION

The increased expression of urinary NAG and serum RBP may be the risk factors leading to the progression of T2DM to DN. The possibility of DN can be considered in patients with urinary NAG and serum RBP overexpression by examining the expression of urinary NAG and serum RBP in patients with T2DM in clinical practice.

Induction of Pyroptosis in Renal Tubular Epithelial Cells Using High Glucose

Background

The micro-inflammatory state is important for the occurrence of diabetic kidney disease (DKD). Here, we aimed to explore the expression of pyroptosis related indicators and ultrastructural characteristics in DKD, and investigate pyroptosis in renal tubular epithelial cells induced by high glucose.

Methods

Immunohistochemistry was used to detect expression of the inflammation-related protein NOD-like receptor protein 3 (NLRP3) and pyroptosis key protein gasdermin D (GSDMD) in kidney tissues of DKD patients. HK-2 cells were cultured in vitro and stimulated with different concentrations of glucose. The changes in HK-2 cell ultrastructure were observed using electronmicroscopy, and western blot was used to detect NLRP3, caspase-1 p20, GSDMD-N, interleukin (IL)-1β, and IL-18 expression.

Results

NLRP3 and GSDMD expression in kidney tissues of DKD patients was higher than that in control subjects. Further, GSDMD expression was positively correlated with that of NLRP3 (r = 0.847, P = 0.02). After stimulating HK-2 cells for 24 h with different glucose concentrations, compared with the control group, the 15 and 30 mmol/L glucose groups showed typical ultrastructural changes of pyroptosis. The protein expression of NLRP3, caspase-1 p20, GSDMD-N, IL-1β, and IL-18 expression in high glucose group increased significantly compared with the control group, and was glucose-concentration-dependent.

Conclusion

High glucose can activate inflammasome, cause inflammatory cytokines release, and induce pyroptosis in HK-2 cells. NLRP3-caspase-1 may be involved in GSDMD-mediated pyroptosis. This study shows a novel relationship between glucose concentration and pyroptosis, which can be studied further to design better therapies for patients with DKD.

Evaluation of Functional Magnetic Resonance Imaging under Artificial Intelligence Algorithm on Plan-Do-Check-Action Home Nursing for Patients with Diabetic Nephropathy

This study aimed to evaluate the effect of functional magnetic resonance imaging (fMRI) under the fuzzy C-means (FCM) clustering algorithm on plan-do-check-action (PDCA) home nursing for patients with diabetic nephropathy (DN). As the characteristics of fMRI image data were combined, the FCM algorithm was improved and applied into the clustering processing of fMRI activation regions of patients. 64 patients with DN were chosen as the research objects and were divided into the research group with PDCA home nursing and the control group with routine home nursing. The patients were randomly divided into the research group (n = 32) and the control group (n = 32). The curative effect, nursing satisfaction, and quality of life of patients after nursing were compared. The results showed that the coverage of fMRI activation points was significantly higher as being detected by the FCM algorithm, and the running time was shortened by 33.6 min. After nursing, the total effective rates in the research group and the control group were 87.5% vs. 34.4% in 3 months, 93.8% vs. 68.8% in 6 months, and 96.9% vs. 75.0% in 12 months, respectively; those in the research group were significantly higher than those in the control group (P < 0.05). The nursing satisfaction score (91.3 ± 4.5 vs. 80.9 ± 5.2) and nursing service quality score (89.7 ± 6.6 vs. 80.3 ± 7.1) in the research group were also significantly higher than those in the control group (P < 0.05). Meanwhile, the scores of each item after nursing in the research group were significantly higher than those in the control group (P < 0.05). The improved FCM algorithm detected the activation regions in the fMRI images more effectively, which could provide help for diagnosis and reduce error and misdiagnosis. At the same time, the PDCA home nursing also offered great help to the recovery of patients with DN, which was more superior for the curative effect of hospitalization, the promotion of recovery, and the improvement of patients' quality of life.

The Correlation between Selenium-Dependent Glutathione Peroxidase Activity and Oxidant/Antioxidant Balance in Sera of Diabetic Patients with Nephropathy

Background

Oxidative stress is an imbalance between free radical's production and the body's ability to counteract or detoxify their harmful effects through neutralization by antioxidants, oxidative stress is thought to be involved in the pathogenesis of diabetic nephropathy. One of the key enzymatic antioxidants is glutathione peroxidase (GPx), which plays an important protective function in diabetes complications, by reducing the rising state of oxidative stress and removing toxicity from peroxides and converting them into a non-toxic substance. The objective of this research was to evaluate the rule of glutathione peroxidase in regulate oxidants/antioxidants levels diabetic patients with nephropathy.

Methods

In a case-control study, we assessed serum GPx activity (Se-Dependent, non-selenium dependent and total GPx), total oxidant, lipid peroxidation, total antioxidant, and catalase in healthy control subjects (group 1), in diabetic patients without diabetic nephropathy (group 2) and diabetic patients with nephropathy (group 3).

Results

GPx activity was significantly lower in T2D patients with and without nephropathy compared to healthy subject's control. Total oxidants and lipids peroxidation have a negative correlation with the GPx and other antioxidants.

Conclusion

Decreased GPx activity indicate a relationship between GPx activity and diabetic nephropathy.

Novel biphenyl diester derivative AB-38b inhibits NLRP3 inflammasome through Nrf2 activation in diabetic nephropathy

Inflammation reaction mediated by NLRP3 inflammasome and Nrf2-related oxidative stress are vital participants in the development of diabetic nephropathy (DN) and closely associated to kidney fibrosis. Nrf2, a known antioxidative transcription factor, has been reported to activate NLRP3 inflammasome through its downstream factors (HO-1, NQO1, etc.) recently. AB38b is a newly synthesized biphenyl diester derivative with a Nrf2 activation property. This research aims to evaluate the renal protective effects of AB-38b and to elucidate the anti-inflammation mechanisms involved. Type 2 diabetic mice induced by high fat diet with streptozocin (STZ) and high glucose-cultured mouse glomerular mesangial cells (GMCs) were used in current study. Results showed that administration of AB-38b improved the kidney function while attenuated renal fibrosis progression in diabetic mice together with reducing the extracellular matrix (ECM) accumulation of GMCs cultured in high glucose. Mechanistically, treatment with AB-38b significantly decreased the high level of NLRP3 inflammasome in diabetic condition by inhibiting the ROS/TXNIP/NLRP3 signaling pathway. And meanwhile, AB-38b treatment effectively improved Nrf2 signaling during diabetic condition. Furthermore, knocking down the gene expression of Nrf2 by siRNA in GMCs abolished the inhibition effect of AB-38b on NLRP3 inflammasome activation and ECM accumulation. Taken together, our data suggest that AB-38b was able to improve the renal function of diabetic mice, and the NLRP3 inflammasome inhibition effect of AB-38b was responsible for the renal protective effect. Further exploration indicate that Nrf2 plays pivotal role in AB-38b's attenuation of DN progression through inhibiting NLRP3 inflammasome activation.