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Sacco S, Foschi M, Ornello R, De Santis F, Pofi R, Romoli M. Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities. Diabetologia 2024; 67:1192-1205. [PMID: 38625582 PMCID: PMC11153285 DOI: 10.1007/s00125-024-06146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
Diabetes mellitus is a significant risk factor for both ischaemic and haemorrhagic stroke, affecting up to a third of individuals with cerebrovascular diseases. Beyond being a risk factor for stroke, diabetes and hyperglycaemia have a negative impact on outcomes after ischaemic and haemorrhagic stroke. Hyperglycaemia during the acute ischaemic stroke phase is associated with a higher risk of haemorrhagic transformation and poor functional outcome, with evidence in favour of early intervention to limit and manage severe hyperglycaemia. Similarly, intensive glucose control nested in a broader bundle of care, including blood pressure, coagulation and temperature control, can provide substantial benefit for clinical outcomes after haemorrhagic stroke. As micro- and macrovascular complications are frequent in people with diabetes, cardiovascular prevention strategies also need to consider tailored treatment. In this regard, the broader availability of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists can allow tailored treatments, particularly for those with heart failure and chronic kidney disease as comorbidities. Here, we review the main concepts of hyperacute stroke management and CVD prevention among people with diabetes, capitalising on results from large studies and RCTs to inform clinicians on preferred treatments.
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Affiliation(s)
- Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico De Santis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
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Liu YJ, Zhao JY, Han WW, Yang HH, Wu XB, Xie F, Wang HP, Wang J, Zhao X, Wan ZX, Chen GC, Qin LQ, Li FR. Microvascular burden and long-term risk of stroke and dementia in type 2 diabetes mellitus. J Affect Disord 2024; 354:68-74. [PMID: 38479499 DOI: 10.1016/j.jad.2024.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/27/2024] [Accepted: 03/09/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE To examine the associations between microvascular disease (MVD) and risk of stroke, dementia, and their major subtypes among individuals with type 2 diabetes mellitus (T2DM). METHODS We included 26,173 participants with T2DM from the UK Biobank who had no known stroke or dementia at baseline. MVD burden was reflected by the presence of retinopathy, peripheral neuropathy, and chronic kidney disease. Cox regression models were used to estimate hazard ratios (HRs) and 95 % confidential intervals (CIs) of stroke and dementia associated with overall MVD burden and individual MVD. RESULTS During a median follow-up of 11.5 years, 1103 incident stroke (964 ischemic and 269 hemorrhagic stroke) and 813 incident dementia (312 Alzheimer's disease and 304 vascular dementia) cases were identified. The risk of stroke, dementia, and their major subtypes all increased with an increasing number of MVD (all P-trend <0.001). The adjusted HRs (95 % CIs) comparing three with no MVD were 5.03 (3.16, 8.02) for all stroke, 4.57 (2.75, 7.59) for ischemic stroke, and 6.60 (2.65, 16.43) for hemorrhagic stroke. The corresponding estimates were 4.28 (2.33, 7.86) for all-cause dementia, 6.96 (3.02, 16.01) for Alzheimer's disease, and 3.81 (1.40, 10.42) for vascular dementia. Among the three MVD, chronic kidney disease showed the strongest associations with both stroke subtypes, while peripheral neuropathy was most strongly associated with both dementia subtypes. CONCLUSIONS Risk of stroke, dementia, and their major subtypes increased with an increasing number of MVD. The associations of individual MVD with stroke and dementia varied substantially by types of MVD.
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Affiliation(s)
- Yu-Jie Liu
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jun-Yu Zhao
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Wen-Wen Han
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Huan-Huan Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xian-Bo Wu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Fei Xie
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hai-Peng Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Juan Wang
- Changzhou Geriatric Hospital affiliated to Soochow University, Changzhou, China
| | - Xin Zhao
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong-Xiao Wan
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Guo-Chong Chen
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Changzhou Geriatric Hospital affiliated to Soochow University, Changzhou, China.
| | - Fu-Rong Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China; School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China; Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Shenzhen, China.
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Zubkova V, Ševčenko A, Miļuhins I, Ķikule I, Haritončenko I, Karelis G. Chronic Kidney Disease and Cerebrovascular Pathology: Incidence and Functional Outcomes in Riga East University Hospital. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:219. [PMID: 38399507 PMCID: PMC10890602 DOI: 10.3390/medicina60020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The aim of this study was to investigate the incidence of cerebrovascular pathology in patients with chronic kidney disease and its effect on functional outcomes. Materials and Methods: In a retrospective cross-sectional study (2018-2021), the medical records of patients with acute hemorrhagic and ischemic stroke with concomitant chronic kidney disease who received treatment in Riga East University Hospital Stroke Unit were analyzed. Data were analyzed using IBM SPSS 26.0. The Kruskal-Wallis, Mann-Whitney U test, and Spearman's rank correlation coefficient methods were used. Results: The final sample consisted of 305 acute cerebrovascular pathology patients (56.4% females). Overall, 57.3% of stroke patients had second-stage chronic kidney disease with average serum creatinine levels of 104.3 mmol/L (±32.8). The functional outcome of the stroke depended on the stage of chronic kidney disease. There was a statistically significant non-linear correlation between glomerular filtration rate and NIHSS (National Institute of Health Stroke Scale) score on admission (Rho -0.194, p = 0.016), glomerular filtration rate and NIHSS score on discharge (Rho -0.186, p = 0.020), and glomerular filtration rate and modified Rankin score on admission (Rho -0.237, p = 0.003) and discharge (Rho -0.224, p = 0.05). The mean NIHSS score of ischemic stroke patients was 8.3 ± 5.9 on admission and 6.5 ± 5.8 on discharge. In the hemorrhagic stroke patient group, the mean NIHSS score was 9.5 ± 7.3 on admission and 7.1 ± 6.9 on discharge. On average, 34.0% of ischemic stroke patients had an mRS score of 5 on admission, while in the hemorrhagic stroke patient group, this figure was 41%. There was no statistical difference in the glomerular filtration rate between the thrombolyzed versus non-thrombolyzed patient groups (Mann-Whitney U test = 1457, p = 0.794). Conclusions: Chronic kidney disease is an important predictor of the severity and functional outcome of a stroke; furthermore, the early management and prevention of complications should be a top priority in the prophylaxis of this cerebrovascular pathology.
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Affiliation(s)
- Violeta Zubkova
- Stroke Unit, Neurovascular Department, Riga East University Hospital, 1038 Riga, Latvia; (I.Ķ.); (I.H.); (G.K.)
- Neurology and Neurosurgery Department, Rīga Stradiņš University, 1007 Riga, Latvia; (A.Š.); (I.M.)
| | - Aleksejs Ševčenko
- Neurology and Neurosurgery Department, Rīga Stradiņš University, 1007 Riga, Latvia; (A.Š.); (I.M.)
| | - Igors Miļuhins
- Neurology and Neurosurgery Department, Rīga Stradiņš University, 1007 Riga, Latvia; (A.Š.); (I.M.)
| | - Ilga Ķikule
- Stroke Unit, Neurovascular Department, Riga East University Hospital, 1038 Riga, Latvia; (I.Ķ.); (I.H.); (G.K.)
- Neurology and Neurosurgery Department, Rīga Stradiņš University, 1007 Riga, Latvia; (A.Š.); (I.M.)
| | - Iveta Haritončenko
- Stroke Unit, Neurovascular Department, Riga East University Hospital, 1038 Riga, Latvia; (I.Ķ.); (I.H.); (G.K.)
- Neurology and Neurosurgery Department, Rīga Stradiņš University, 1007 Riga, Latvia; (A.Š.); (I.M.)
| | - Guntis Karelis
- Stroke Unit, Neurovascular Department, Riga East University Hospital, 1038 Riga, Latvia; (I.Ķ.); (I.H.); (G.K.)
- Infectology Department, Rīga Stradiņš University, 1007 Riga, Latvia
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Sacareau C, Nacher M, Drak Alsibai K, Ntoutoum A, Adenis A, Hounnou M, Liebart M, Cardoso CS, Aurelus JM, Demar M, Casse O, Amokrane S, Carod JF, Hafsi N, Sabbah N. Factors associated with chronic kidney disease in patients with diabetes in French Guiana. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1167852. [PMID: 37953925 PMCID: PMC10634610 DOI: 10.3389/fcdhc.2023.1167852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
Introduction With over half of the population living under the poverty threshold, the social and health context in French Guiana is more difficult than in mainland France. The prevalence of diabetes is twice as great and end-stage renal failure is 45% higher than in mainland France. Objective Our objective was to describe the profile of diabetic patients with chronic kidney disease in French Guiana and search for possible risk factors. Method We conducted a multicenter cross-sectional observational study based on the CODIAM cohort (Cohort of Diabetes in French Amazonia). We analyzed 1,287 patients followed up between May 2019 and June 2021 at Cayenne Hospital, Saint Laurent Hospital, and delocalized health centers. Results In our cohort, chronic kidney disease was present after an average of 12 years of diabetes. Compared with the French population, 41% of diabetic patients had chronic kidney disease (i.e., 12% more), and had an average age of 56 years (i.e., 10 years younger). Forty-eight per cent of these patients were obese (i.e., 7% more). Seventy-four per cent of patients were precarious and 45% were foreigners but neither was associated with chronic kidney disease, contrary to countries where the health system is not universal. Conclusion Screening of patients with chronic kidney disease among diabetics in French Guiana remains a real challenge. Patients were younger and more obese than in other French territories. In this cohort, precariousness and immigration were not associated with the presence of chronic kidney disease. However, particular attention should be paid to hypertensive patients and those over 65 years of age, which are, with diabetes itself, the two most obvious risk factors for developing chronic kidney disease among diabetic patients in our territory.
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Affiliation(s)
- Christopher Sacareau
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Mathieu Nacher
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
- Department of Pathology and Center of biological Resources (CRB Amazonie), Cayenne Hospital Center, Cayenne, French Guiana
| | - Andre Ntoutoum
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Antoine Adenis
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Marianne Hounnou
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Marion Liebart
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Clara Salasar Cardoso
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Jean-Markens Aurelus
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory of Parasitology-Mycology, Cayenne Hospital Center, Cayenne, French Guiana
- EA3593, Amazon Ecosystems and Tropical Diseases, University of Guiana, Cayenne, French Guiana
| | - Olivier Casse
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Samia Amokrane
- Department of Medicine, Ouest Guyane Hospital Center, Saint-Laurent, French Guiana
| | - Jean-François Carod
- Laboratory of Biology, Ouest Guyane Hospital Center, Saint-Laurent, French Guiana
| | - Nezha Hafsi
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
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Rahman H, Khan SU, Lone AN, Ghosh P, Kunduru M, Sharma S, Sattur S, Kaluski E. Sodium-Glucose Cotransporter-2 Inhibitors and Primary Prevention of Atherosclerotic Cardiovascular Disease: A Meta-Analysis of Randomized Trials and Systematic Review. J Am Heart Assoc 2023; 12:e030578. [PMID: 37581396 PMCID: PMC10492958 DOI: 10.1161/jaha.123.030578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
Background Sodium-glucose cotransporter-2 (SGLT2) inhibitors reduce atherosclerotic cardiovascular disease (ASCVD) events in patients with prior ASCVD and type 2 diabetes; however, this benefit is uncertain in patients without established ASCVD. Methods and Results Large-scale cardiovascular outcome randomized controlled trials or their prespecified subgroup analyses were selected, evaluating SGLT2 inhibitors versus placebo for primary prevention of ASCVD (inception, March 2023). The primary outcome was atherosclerotic major adverse cardiovascular events (MACEs), which was a composite of cardiovascular mortality, myocardial infarction, and stroke. The secondary outcomes were individual components of MACEs and all-cause mortality. The outcomes were reported as random-effect relative risk (RR) with a 95% CI. This analysis, comprising 23 987 patients enrolled in 5 randomized controlled trials with a mean follow-up duration of ≈135 weeks, found no significant reduction in atherosclerotic MACEs with SGLT2 inhibitors in comparison to placebo (RR, 0.85 [95% CI, 0.71-1.01]; P=0.07; I2=44). There were no significant differences in cardiovascular mortality (RR, 0.93 [95% CI, 0.77-1.14]; P=0.50; I2=0), myocardial infarction (RR, 0.88 [95% CI, 0.69-1.11]; P=0.28; I2=23), and stroke (RR, 0.84 [95% CI, 0.62-1.16]; P=0.29; I2=46). SGLT2 inhibitors significantly improved all-cause mortality (RR, 0.85 [95% CI, 0.72-1.0]; P=0.04; I2=23). On subgroup analyses, the use of SGLT2 inhibitors led to significant reductions in MACEs (RR, 0.74 [95% CI, 0.61-0.89]; P=0.001), myocardial infarction (RR, 0.67 [95% CI, 0.47-0.97]; P=0.03), and stroke (RR, 0.61 [95% CI, 0.41-0.91]; P=0.01) primarily in patients with chronic kidney disease along with type 2 diabetes, whereas these benefits were not observed in patients with type 2 diabetes without chronic kidney disease. Conclusions SGLT2 inhibitors significantly reduced atherosclerotic MACEs in subjects having both chronic kidney disease and type 2 diabetes without established ASCVD.
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Affiliation(s)
- Hammad Rahman
- Division of CardiologyGuthrie Robert Packer HospitalSayrePA
| | - Safi U. Khan
- Division of CardiologyMethodist HospitalHoustonTX
| | - Ahmad N. Lone
- Division of CardiologyGuthrie Robert Packer HospitalSayrePA
| | - Priyanka Ghosh
- Division of CardiologyGuthrie Robert Packer HospitalSayrePA
| | | | - Saurabh Sharma
- Division of CardiologyGuthrie Health System/Robert Packer HospitalSayrePA
| | - Sudhakar Sattur
- Division of CardiologyGuthrie Health System/Robert Packer HospitalSayrePA
| | - Edo Kaluski
- Division of CardiologyGuthrie Health System/Robert Packer HospitalSayrePA
- Division of CardiologyRutgers New Jersey Medical SchoolNewarkNJ
- Division of CardiologyThe Geisinger Commonwealth Medical CollegeScrantonPA
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Vujosevic S, Fantaguzzi F, Salongcay R, Brambilla M, Torti E, Cushley L, Limoli C, Nucci P, Peto T. Multimodal Retinal Imaging in Patients with Diabetes Mellitus and Association with Cerebrovascular Disease. Ophthalmic Res 2023; 66:1044-1052. [PMID: 37253334 DOI: 10.1159/000531249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION This study aimed to evaluate the association between macular optical coherence tomography angiography (OCT-A) metrics, characteristics of ultrawide field (UWF) imaging, and cerebrovascular disease in patients with diabetes mellitus (DM) with different stages of diabetic retinopathy (DR). METHODS 516 eyes of 258 DM patients were enrolled in two centers (Milan and Belfast). UWF color fundus photos (CFPs) were obtained with Optos California (Optos, PLC) and graded for both DR severity and predominantly peripheral lesions presence (>50% of CFP lesions) by two independent graders. OCT-A (3 × 3 mm), available in 252 eyes of 136 patients, was used to determine perimeter, area, and circularity index of the foveal avascular zone and vessel density (VD); perfusion density (PD); fractal dimension on superficial, intermediate (ICP), and deep capillary plexuses; flow voids (FVs) in the choriocapillaris. RESULTS Out of 516 eyes, 108 eyes (20.9%) had no DR, and 6 eyes were not gradable. The remaining 402 eyes were as follows: 10.3% (53) had mild nonproliferative DR (NPDR), 38.2% (197) had moderate NPDR, 11.8% (61) had severe NPDR, and 17.6% (91) had proliferative DR. A worse DR stage was associated with a history of stroke (p = 0.044). Logistic regression analysis after taking into account sex, type of DM, age, DM duration, and OCT-A variables found that PD and VD on ICP were significantly associated with presence of stroke and DR severity. CONCLUSION OCT-A metrics show an association with the presence of cerebrovascular complications, providing potentially useful parameters to estimate vascular risk in patients with DM.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | | | | | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy
| | - Emanuele Torti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Laura Cushley
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Celeste Limoli
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
- University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Bibliometric Analysis and Visualization of Research Progress in the Diabetic Nephropathy Field from 2001 to 2021. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:4555609. [PMID: 36718276 PMCID: PMC9884171 DOI: 10.1155/2023/4555609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/14/2022] [Accepted: 12/01/2022] [Indexed: 01/22/2023]
Abstract
Methods The PubMed database was searched to identify all studies related to DN that were published from 2001 to 2021, with these studies being separated into four time-based groups. The characteristics of these studies were analyzed and extracted using BICOMB. Biclustering analyses for each of these groups were then performed using gCLUTO, with these results then being analyzed and GraphPad Prism 5 being used to construct strategy diagrams. The social network analyses (SNAs) for each group of studies were conducted using NetDraw and UCINET. Results In total, 18,889 DN-associated studies published from 2001 to 2021 and included in the PubMed database were incorporated into the present bibliometric analysis. Biclustering analysis and strategy diagrams revealed that active areas of research interest in the DN field include studies of the drug-based treatment, diagnosis, etiology, pathology, physiopathology, and epidemiology of DN. The specific research topics associated with these individual areas, however, have evolved over time in a dynamic manner. Strategy diagrams and SNA results revealed podocyte metabolism as an emerging research hotspot in the DN research field from 2010 to 2015, while DN-related microRNAs, signal transduction, and mesangial cell metabolism have emerged as more recent research hotspots in the interval from 2016 to 2021. Conclusion Through analyses of PubMed-indexed studies pertaining to DN published since 2001, the results of this bibliometric analysis offer a knowledge framework and insight into active and historical research hotspots in the DN research space, enabling investigators to readily understand the dynamic evolution of this field over the past two decades. Importantly, these analyses also enable the prediction of future DN-related research hotspots, thereby potentially guiding more focused and impactful research efforts.
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Rao NL, Kotian GB, Shetty JK, Shelley BP, Dmello MK, Lobo EC, Shankar SP, Almeida SD, Shah SR. Receptor for Advanced Glycation End Product, Organ Crosstalk, and Pathomechanism Targets for Comprehensive Molecular Therapeutics in Diabetic Ischemic Stroke. Biomolecules 2022; 12:1712. [PMID: 36421725 PMCID: PMC9687999 DOI: 10.3390/biom12111712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 08/10/2023] Open
Abstract
Diabetes mellitus, a well-established risk factor for stroke, is related to higher mortality and poorer outcomes following the stroke event. Advanced glycation end products(AGEs), their receptors RAGEs, other ligands, and several other processes contribute to the cerebrovascular pathomechanism interaction in the diabetes-ischemic stroke combination. Critical reappraisal of molecular targets and therapeutic agents to mitigate them is required to identify key elements for therapeutic interventions that may improve patient outcomes. This scoping review maps evidence on the key roles of AGEs, RAGEs, other ligands such as Leukotriene B4 (LTB4), High-mobility group box 1 (HMGB1) nuclear protein, brain-kidney-muscle crosstalk, alternate pathomechanisms in neurodegeneration, and cognitive decline related to diabetic ischemic stroke. RAGE, HMGB1, nitric oxide, and polyamine mechanisms are important therapeutic targets, inflicting common consequences of neuroinflammation and oxidative stress. Experimental findings on a number of existing-emerging therapeutic agents and natural compounds against key targets are promising. The lack of large clinical trials with adequate follow-up periods is a gap that requires addressing to validate the emerging therapeutic agents. Five therapeutic components, which include agents to mitigate the AGE-RAGE axis, improved biomarkers for risk stratification, better renal dysfunction management, adjunctive anti-inflammatory-antioxidant therapies, and innovative neuromuscular stimulation for rehabilitation, are identified. A comprehensive therapeutic strategy that features all the identified components is needed for outcome improvement in diabetic stroke patients.
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Affiliation(s)
- Nivedita L Rao
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
| | - Greeshma B Kotian
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
| | - Jeevan K Shetty
- Department of Biochemistry, School of Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, Muharraq 228, Bahrain
| | - Bhaskara P Shelley
- Department of Neurology, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
| | - Mackwin Kenwood Dmello
- Department of Public Health, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore 575018, Karnataka, India
| | - Eric C Lobo
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
| | - Suchetha Padar Shankar
- College of Physiotherapy, Dayananda Sagar University, Bangalore 560111, Karnataka, India
| | - Shellette D Almeida
- School of Physiotherapy, D. Y. Patil (Deemed to be University), Navi Mumbai 400706, Maharashtra, India
| | - Saiqa R Shah
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
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Cervantes CE, Hanouneh M, Jaar BG. From screening to treatment: the new landscape of diabetic kidney disease. BMC Med 2022; 20:329. [PMID: 36203185 PMCID: PMC9540735 DOI: 10.1186/s12916-022-02537-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Globally, diabetes mellitus is the leading cause of chronic kidney disease (CKD), and it is predicted to increase in the following years. Despite its high prevalence, CKD remains under diagnosed. In this BMC Medicine collection of articles on diabetic kidney disease (DKD), we place in context the importance of screening and early detection of DKD and the most accurate tools to monitor for optimal glycemic control in this his risk population. Further, we address this population's risk for severe complications such as stroke and all-cause mortality. We close this editorial by summarizing recent advances in management of this vulnerable population of patients with DKD, including guideline-directed medical therapy, novel treatments, and predictors of treatment failure.
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Affiliation(s)
- C Elena Cervantes
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD, 21205, USA
| | - Mohamad Hanouneh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD, 21205, USA.,Nephrology Center of Maryland, Baltimore, USA
| | - Bernard G Jaar
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD, 21205, USA. .,Nephrology Center of Maryland, Baltimore, USA. .,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. .,The Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, USA.
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10
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Hu J, Zheng X, Shi G, Guo L. Associations of multiple chronic disease and depressive symptoms with incident stroke among Chinese middle-aged and elderly adults: a nationwide population-based cohort study. BMC Geriatr 2022; 22:660. [PMID: 35953770 PMCID: PMC9373457 DOI: 10.1186/s12877-022-03329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the population aging, multiple chronic diseases, depressive symptoms, and stroke are increasingly common among middle-aged and elderly adults worldwide. This study aimed to explore the independent associations of multiple chronic diseases and depressive symptoms as well as their combination with incident stroke in a prospective cohort of Chinese middle-aged and elderly adults, and to sensitively estimate the association between each type of chronic disease and incident stroke. METHODS This study used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 8389 participants meeting the inclusion criteria at baseline (between 2011 and 2012) survey were included, and 7108 eligible participants completed the follow-up survey over 8 years (Wave 4, in 2018). Questionnaire information, physical examination, and clinical and biochemical measurements were collected. RESULTS The mean (SD) age at baseline was 58.5 (± 9.1) years. Multiple chronic disease and depressive symptoms were independently associated with incident stroke. After adjusting for control variables, patients having 1 type of chronic disease and depressive symptoms were at 1.943 (95% CI = 1.166-3.238) times higher risk of incident stroke than those without chronic disease and depressive symptoms, and patients having at least 2 types of chronic diseases and depressive symptoms were at 3.000 (95% CI = 1.846-4.877) times higher risk of incident stroke; the magnitudes of the associations increased by the numbers of having chronic diseases and depressive symptoms. Sensitivity analyses incorporating all five types of chronic disease (i.e., hypertension, dyslipidemia, heart disease, diabetes, and chronic kidney disease) showed that the magnitude of the associations between hypertension and incident stroke was most significant. CONCLUSIONS We identified significant independent and combined longitudinal associations of multiple chronic diseases and depressive symptoms with incident stroke, and the combined associations reflected a dose-response relationship. The association between hypertension and incident stroke was strongest among the five chronic diseases.
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Affiliation(s)
- Jingyang Hu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
| | - Xinyu Zheng
- Cerebrovascular Disease Department, Zhuhai People's Hospital Medical Group, 519000, Zhuhai, People's Republic of China
| | - Guangduoji Shi
- Cerebrovascular Disease Department, Zhuhai People's Hospital Medical Group, 519000, Zhuhai, People's Republic of China
| | - Lan Guo
- Cerebrovascular Disease Department, Zhuhai People's Hospital Medical Group, 519000, Zhuhai, People's Republic of China.
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11
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Wang DD, Zhang C, Yang Y, He SM, Zhu P, Chen X. Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Urine Albumin to Creatinine Ratio in Type 2 Diabetes Mellitus Patients and Medication Care. J Diabetes Res 2022; 2022:5854200. [PMID: 35910530 PMCID: PMC9328955 DOI: 10.1155/2022/5854200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The purpose of this study was to explore the effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on urine albumin to creatinine ratio (UACR) in type 2 diabetes mellitus (T2DM) patients and to recommend appropriate medication care scheme. METHODS 8371 T2DM patients from four dapagliflozin studies and two canagliflozin studies were collected for analyzing with nonlinear mixed effect model (NONMEM). The change rates of UACR from baseline were intended to be evaluation indicators. RESULTS In the present study, there was no significant difference in the effects on UACR using dapagliflozin or canagliflozin treatment in T2DM patients. The maximal effect (E max) and the treatment duration of reaching half of E max (ET50) from SGLT-2 inhibitors on UACR in T2DM patients were -19.2% and 0.448 weeks, respectively. Further, the treatment duration to reach 25%, 50%, 75%, and 80% E max was 0.150 weeks, 0.448 weeks, 1.344 weeks, and 1.792 weeks, respectively. Namely, for achieving the plateau period (80% of E max) of SGLT-2 inhibitors on UACR in T2DM patients, 10 mg/day dapagliflozin (or 100 mg/day canagliflozin) should be taken for at least 1.792 weeks. CONCLUSIONS To our knowledge, the present study explored the effects of SGLT-2 inhibitors on UACR in T2DM patients, meanwhile, recommended appropriate medication care scheme for the first time.
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Affiliation(s)
- Dong-Dong Wang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy & School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Cun Zhang
- Department of Pharmacy, Xuzhou Oriental Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Yang Yang
- Department of Pharmacy, The Affiliated Changzhou Children's Hospital of Nantong University, Changzhou 213003, China
| | - Su-Mei He
- Department of Pharmacy, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou Jiangsu 215153, China
| | - Ping Zhu
- Department of Endocrinology, Huaian Hospital of Huaian City, Huaian, Jiangsu 223200, China
| | - Xiao Chen
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
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