1
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Laker RC, Egolf S, Will S, Lantier L, McGuinness OP, Brown C, Bhagroo N, Oldham S, Kuszpit K, Alfaro A, Li X, Kang T, Pellegrini G, Andréasson AC, Kajani S, Sitaula S, Larsen MR, Rhodes CJ. GLP-1R/GCGR dual agonism dissipates hepatic steatosis to restore insulin sensitivity and rescue pancreatic β-cell function in obese male mice. Nat Commun 2025; 16:4714. [PMID: 40399267 PMCID: PMC12095689 DOI: 10.1038/s41467-025-59773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/29/2025] [Indexed: 05/23/2025] Open
Abstract
An early driver of Type 2 diabetes mellitus (T2D) is ectopic fat accumulation, especially in the liver, that impairs insulin sensitivity. In T2D, GLP-1R/GCGR dual-agonists reduce glycaemia, body weight and hepatic steatosis. Here, we utilize cotadutide, a well characterized GLP-1R/GCGR dual-agonist, and demonstrate improvement of insulin sensitivity during hyperinsulinemic euglycemic clamp following sub-chronic dosing in male, diet-induced obese (DIO) mice. Phosphoproteomic analyses of insulin stimulated liver from cotadutide-treated mice identifies previously unknown and known phosphorylation sites on key insulin signaling proteins associated with improved insulin sensitivity. Cotadutide or GCGR mono-agonist treatment also increases brown adipose tissue (BAT) insulin-stimulated glucose uptake, while GLP-1R mono-agonist shows a weak effect. BAT from cotadutide-treated mice have induction of UCP-1 protein, increased mitochondrial area and a transcriptomic profile of increased fat oxidation and mitochondrial activity. Finally, the cotadutide-induced improvement in insulin sensitivity is associated with reduction of insulin secretion from isolated pancreatic islets indicating reduced insulin secretory demand. Here we show, GLP-1R/GCGR dual agonism provides multimodal efficacy to decrease hepatic steatosis and consequently improve insulin sensitivity, in concert with recovery of endogenous β-cell function and reduced insulin demand. This substantiates GLP-1R/GCGR dual-agonism as a potentially effective T2D treatment.
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Affiliation(s)
- Rhianna C Laker
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
| | - Shaun Egolf
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Sarah Will
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Louise Lantier
- Vanderbilt University Mouse Metabolic Phenotyping Center, Nashville, TN, USA
| | - Owen P McGuinness
- Vanderbilt University Mouse Metabolic Phenotyping Center, Nashville, TN, USA
| | - Charles Brown
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD, USA
| | - Nicholas Bhagroo
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Stephanie Oldham
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Kyle Kuszpit
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD, USA
| | - Alex Alfaro
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD, USA
| | - Xidan Li
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Taewook Kang
- Department of Biochemistry and Molecular Biology, PR group, University of Southern Denmark, Odense, Denmark
| | - Giovanni Pellegrini
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anne-Christine Andréasson
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Sarina Kajani
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Sadichha Sitaula
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Martin R Larsen
- Department of Biochemistry and Molecular Biology, PR group, University of Southern Denmark, Odense, Denmark
| | - Christopher J Rhodes
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
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2
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Chen J, Chen D, Chen J, Shen T, Jin T, Zeng B, Li L, Yang C, Mu Z, Deng H, Cai X. An all-in-one CO gas therapy-based hydrogel dressing with sustained insulin release, anti-oxidative stress, antibacterial, and anti-inflammatory capabilities for infected diabetic wounds. Acta Biomater 2022; 146:49-65. [PMID: 35500813 DOI: 10.1016/j.actbio.2022.04.043] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/16/2022]
Abstract
To effectively treat diabetic wounds, the development of versatile medical dressings that can long-term regulate blood glucose and highly effective anti-oxidative stress, antibacterial and anti-inflammatory are critical. Here, an all-in-one CO gas-therapy-based versatile hydrogel dressing (ICOQF) was developed via the dynamic Schiff base reaction between the amino groups on quaternized chitosan (QCS) and the aldehyde groups on benzaldehyde-terminated F108 (F108-CHO) micelles. CORM-401 (an oxidant-sensitive CO-releasing molecules) was encapsulated in the hydrophobic core of F108-CHO micelles and insulin was loaded in the three-dimensional network structure of ICOQF. The dynamic Schiff base bonds not only endowed ICOQF with good tissue adhesion, injectability and self-healing, but also gave it sustained and controllable insulin release ability. In addition, ICOQF could quickly generate CO in inflamed wound tissue by consuming reactive oxygen species. The generated CO could effectively anti-oxidative stress by activating the expression of heme oxygenase; antibacterial by inducing the rupture of bacterial cell membranes and mitochondrial dysfunction and inhibiting the synthesis of adenosine triphosphate; and anti-inflammatory by inhibiting the proliferation of activated macrophages and promoting the polarization of the M1 phenotype to the M2 phenotype. Due to these outstanding properties, ICOQF significantly promoted the healing of STZ-induced MRSA-infected diabetic wounds accompanied by good biocompatibility. This study clearly shows that ICOQF is a versatile hydrogel dressing with great application potential for the management of diabetic wounds. STATEMENT OF SIGNIFICANCE: The development of some versatile hydrogel dressings that can not only provide a prolonged and controlled insulin release property but also utilize a non-antibiotic treatment modality for highly effective antibacterial, anti-inflammatory, and anti-oxidative stress effects is vital for the successful treatment of diabetic wounds. Herein, we developed an all-in-one CO gas-therapy-based versatile hydrogel dressing (ICOQF) with sustained and controllable insulin release abilities. Moreover, ICOQF could not only quickly release CO in the inflamed wound tissue by consumption of reactive oxygen species but also utilize the generated CO to highly effectively anti-oxidative stress, antibacterial, and anti-inflammatory. ICOQF therapy substantially promoted the healing of STZ-induced MRSA-infected diabetic wounds. Overall, this work provides a multifunctional hydrogel dressing for the management of diabetic wounds.
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Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, Neijens AMJ, Topsever P, Khunti K. 2022 update to the position statement by Primary Care Diabetes Europe: a disease state approach to the pharmacological management of type 2 diabetes in primary care. Prim Care Diabetes 2022; 16:223-244. [PMID: 35183458 DOI: 10.1016/j.pcd.2022.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes and its associated comorbidities are growing more prevalent, and the complexity of optimising glycaemic control is increasing, especially on the frontlines of patient care. In many countries, most patients with type 2 diabetes are managed in a primary care setting. However, primary healthcare professionals face the challenge of the growing plethora of available treatment options for managing hyperglycaemia, leading to difficultly in making treatment decisions and contributing to treatment and therapeutic inertia. This position statement offers a simple and patient-centred clinical decision-making model with practical treatment recommendations that can be widely implemented by primary care clinicians worldwide through shared-decision conversations with their patients. It highlights the importance of managing cardiovascular disease and elevated cardiovascular risk in people with type 2 diabetes and aims to provide innovative risk stratification and treatment strategies that connect patients with the most effective care.
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Affiliation(s)
- S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
| | - X Cos
- Sant Marti de Provenҫals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - S Brunton
- Primary Care Metabolic Group, Winnsboro, SC, USA
| | - S B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - S P O Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - M Mata-Cases
- La Mina Primary Care Centre, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - A M J Neijens
- Praktijk De Diabetist, Nurse-Led Case Management in Diabetes, QOL-consultancy, Deventer, The Netherlands
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, 34752 Atasehir, Istanbul, Turkey
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
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Mokdad AH, Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Shirude S, Finegold SB, Callender C, Naghavi M, Murray CJL. Trends and patterns of disparities in diabetes and chronic kidney disease mortality among US counties, 1980-2014. Popul Health Metr 2022; 20:9. [PMID: 35193593 PMCID: PMC8862531 DOI: 10.1186/s12963-022-00285-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 01/31/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Diabetes and chronic kidney diseases are associated with a large health burden in the USA and globally. OBJECTIVE To estimate age-standardized mortality rates by county from diabetes mellitus and chronic kidney disease. DESIGN AND SETTING Validated small area estimation models were applied to de-identified death records from the National Center for Health Statistics (NCHS) and population counts from the census bureau, NCHS, and the Human Mortality Database to estimate county-level mortality rates from 1980 to 2014 from diabetes mellitus and chronic kidney disease (CKD). EXPOSURES County of residence. MAIN OUTCOMES AND MEASURES Age-standardized mortality rates by county, year, sex, and cause. RESULTS Between 1980 and 2014, 2,067,805 deaths due to diabetes were recorded in the USA. The mortality rate due to diabetes increased by 33.6% (95% UI: 26.5%-41.3%) between 1980 and 2000 and then declined by 26.4% (95% UI: 22.8%-30.0%) between 2000 and 2014. Counties with very high mortality rates were found along the southern half of the Mississippi river and in parts of South and North Dakota, while very low rates were observed in central Colorado, and select counties in the Midwest, California, and southern Florida. A total of 1,659,045 deaths due to CKD were recorded between 1980 and 2014 (477,332 due to diabetes mellitus, 1,056,150 due to hypertension, 122,795 due to glomerulonephritis, and 2,768 due to other causes). CKD mortality varied among counties with very low mortality rates observed in central Colorado as well as some counties in southern Florida, California, and Great Plains states. High mortality rates from CKD were observed in counties throughout much of the Deep South, and a cluster of counties with particularly high rates was observed around the Mississippi river. CONCLUSIONS AND RELEVANCE This study found large inequalities in diabetes and CKD mortality among US counties. The findings provide insights into the root causes of this variation and call for improvements in risk factors, access to medical care, and quality of medical care.
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Affiliation(s)
- Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Amelia Bertozzi-Villa
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Rebecca W. Stubbs
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Chloe Morozoff
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Shreya Shirude
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Sam B. Finegold
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Charlton Callender
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98195 USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
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5
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Chan JCN, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, Lau ESH, Eliasson B, Kong APS, Ezzati M, Aguilar-Salinas CA, McGill M, Levitt NS, Ning G, So WY, Adams J, Bracco P, Forouhi NG, Gregory GA, Guo J, Hua X, Klatman EL, Magliano DJ, Ng BP, Ogilvie D, Panter J, Pavkov M, Shao H, Unwin N, White M, Wou C, Ma RCW, Schmidt MI, Ramachandran A, Seino Y, Bennett PH, Oldenburg B, Gagliardino JJ, Luk AOY, Clarke PM, Ogle GD, Davies MJ, Holman RR, Gregg EW. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet 2021; 396:2019-2082. [PMID: 33189186 DOI: 10.1016/s0140-6736(20)32374-6] [Citation(s) in RCA: 409] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China.
| | - Lee-Ling Lim
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Ping Zhang
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric S H Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Medical Research Council Centre for Environment and Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Disease, Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jean Adams
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paula Bracco
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gabriel A Gregory
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jingchuan Guo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, KS, USA
| | - Xinyang Hua
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma L Klatman
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Boon-Peng Ng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - David Ogilvie
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenna Panter
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Meda Pavkov
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nigel Unwin
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin White
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Constance Wou
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Maria I Schmidt
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - Yutaka Seino
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of NCDs, University of Melbourne, Melbourne, VIC, Australia
| | - Juan José Gagliardino
- Centro de Endocrinología Experimental y Aplicada, UNLP-CONICET-CICPBA, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW and ACT, Glebe, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Edward W Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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Jang C, Park JK, Lee HJ, Yun GH, Yook JG. Sensitivity-Enhanced Fluidic Glucose Sensor Based on a Microwave Resonator Coupled With an Interferometric System for Noninvasive and Continuous Detection. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:1017-1026. [PMID: 34570708 DOI: 10.1109/tbcas.2021.3112744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this paper, a microwave fluidic glucose sensor based on a microwave resonator coupled with an interferometric system is proposed for sensitivity enhancement. The proposed glucose sensor consists of two parts: a sensing part and a sensitivity enhancement part. The former is composed of a rectangular complementary split ring resonator (CSRR), and the latter is composed of a variable attenuator, a variable phase shifter, two hybrid couplers, and an RF power detector. Because the variation in the electrical properties, which is utilized in the microwave detection scheme, with glucose concentration over the possible concentration range in the human body is very small, improvement of the sensitivity is critical for practical use. Thus, the effective sensing area of the rectangular CSRR is determined by considering the electric field distribution. In addition, magnitude and phase conditions for the effective sensitivity enhancement are derived from a mathematical analysis of the proposed interferometric system. In the present experiment, aimed at demonstrating the detection performance as a function of the glucose concentration in the range of 0 mg/dL to 400 mg/dL, the sensitivity is significantly improved by 48 times by applying the derived conditions for effective sensitivity enhancement. Furthermore, the accuracy of the proposed glucose sensor for glucose concentrations at a step of 100 mg/dL is verified by the Clarke error grid. Based on the measurement results, the proposed glucose sensor is demonstrated to be applicable to noninvasive and continuous monitoring in practical environments.
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7
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Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, Neijens AMJ, Topsever P, Khunti K. A disease state approach to the pharmacological management of Type 2 diabetes in primary care: A position statement by Primary Care Diabetes Europe. Prim Care Diabetes 2021; 15:31-51. [PMID: 32532635 DOI: 10.1016/j.pcd.2020.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes and its associated comorbidities are growing more prevalent, and the complexity of optimising glycaemic control is increasing, especially on the frontlines of patient care. In many countries, most patients with type 2 diabetes are managed in a primary care setting. However, primary healthcare professionals face the challenge of the growing plethora of available treatment options for managing hyperglycaemia, leading to difficultly in making treatment decisions and contributing to therapeutic inertia. This position statement offers a simple and patient-centred clinical decision-making model with practical treatment recommendations that can be widely implemented by primary care clinicians worldwide through shared-decision conversations with their patients. It highlights the importance of managing cardiovascular disease and elevated cardiovascular risk in people with type 2 diabetes and aims to provide innovative risk stratification and treatment strategies that connect patients with the most effective care.
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Affiliation(s)
- S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
| | - X Cos
- Sant Marti de Provençals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - S Brunton
- Primary Care Metabolic Group, Los Angeles, CA, USA
| | - S B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - S P O Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - M Mata-Cases
- La Mina Primary Care Centre, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - A M J Neijens
- Praktijk De Diabetist, Nurse-Led Case Management in Diabetes, QOL-consultancy, Deventer, The Netherlands
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, Atasehir 34752, Istanbul, Turkey
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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8
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Abstract
OBJECTIVE To assess the performance of an adapted American Diabetes Association (ADA) risk score and the concise Finnish Diabetes Risk Score (FINRISC) for predicting type 2 diabetes development in women with and at risk of HIV infection. DESIGN Longitudinal analysis of the Women's Interagency HIV Study. METHODS The women's Interagency HIV Study is an ongoing prospective cohort study of women with and at risk for HIV infection. Women without prevalent diabetes and 3-year data on fasting blood glucose, hemoglobin A1c, self-reported diabetes medication use, and self-reported diabetes were included. ADA and FINRISC scores were computed at baseline and their ability to predict diabetes development within 3 years was assessed [sensitivity, specificity and area under the receiver operating characteristics (AUROC) curve]. RESULTS A total of 1111 HIV-positive (median age 41, 60% African American) and 454 HIV-negative women (median age 38, 63% African-American) were included. ADA sensitivity did not differ between HIV-positive (77%) and HIV-negative women (81%), while specificity was better in HIV-negative women (42 vs. 49%, P = 0.006). Overall ADA discrimination was suboptimal in both HIV-positive [AUROC = 0.64 (95% CI: 0.58, 0.70)] and HIV-negative women [AUROC = 0.67 (95% CI: 0.57, 0.77)]. FINRISC sensitivity and specificity did not differ between HIV-positive (72 and 49%, respectively) and HIV-negative women (86 and 52%, respectively). Overall FINRISC discrimination was suboptimal in HIV-positive [AUROC = 0.68 (95% CI: 0.62, 0.75)] and HIV-negative women [AUROC = 0.78 (95% CI: 0.66, 0.90)]. CONCLUSION Model performance was suboptimal in women with and at risk of HIV, while greater misclassification was generally observed among HIV-positive women. HIV-specific risk factors known to contribute to diabetes risk should be explored in these models.
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Jang C, Park JK, Lee HJ, Yun GH, Yook JG. Temperature-Corrected Fluidic Glucose Sensor Based on Microwave Resonator. SENSORS 2018; 18:s18113850. [PMID: 30423976 PMCID: PMC6263380 DOI: 10.3390/s18113850] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 02/04/2023]
Abstract
In this paper, a fluidic glucose sensor that is based on a complementary split-ring resonator (CSRR) is proposed for the microwave frequency region. The detection of glucose with different concentrations from 0 mg/dL to 400 mg/dL in a non-invasive manner is possible by introducing a fluidic system. The glucose concentration can be continuously monitored by tracking the transmission coefficient S21 as a sensing parameter. The variation tendency in S21 by the glucose concentration is analyzed with equivalent circuit model. In addition, to eradicate the systematic error due to temperature variation, the sensor is tested in two temperature conditions: the constant temperature condition and the time-dependent varying temperature condition. For the varying temperature condition, the temperature correction function was derived between the temperature and the variation in S21 for DI water. By applying the fitting function to glucose solution, the subsidiary results due to temperature can be completely eliminated. As a result, the S21 varies by 0.03 dB as the glucose concentration increases from 0 mg/dL to 400 mg/dL.
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Affiliation(s)
- Chorom Jang
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul 03722, Korea.
| | - Jin-Kwan Park
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul 03722, Korea.
| | - Hee-Jo Lee
- Department of Physics Education, College of Education, Daegu University, Gyeongsan 38453, Korea.
| | - Gi-Ho Yun
- Department of Information and Communications Engineering, Sungkyul University, Gyeonggi-Do 14097, Korea.
| | - Jong-Gwan Yook
- Department of Electrical and Electronic Engineering, Yonsei University, Seoul 03722, Korea.
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Narayan KMV, Jagannathan R. Two in One: Diagnosing Type 2 Diabetes With Single-Sample Testing. Ann Intern Med 2018; 169:193-194. [PMID: 29913515 DOI: 10.7326/m18-1477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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11
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Galaviz KI, Narayan KMV, Lobelo F, Weber MB. Lifestyle and the Prevention of Type 2 Diabetes: A Status Report. Am J Lifestyle Med 2018; 12:4-20. [PMID: 30202378 PMCID: PMC6125024 DOI: 10.1177/1559827615619159] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/11/2022] Open
Abstract
Diabetes is a costly disease affecting 387 million individuals globally and 28 million in the United States. Its precursor, prediabetes, affects 316 and 86 million individuals globally and in the United States, respectively. People living with elevated blood glucose levels are at high risk for all-cause mortality and numerous cardiometabolic ailments. Fortunately, diabetes can be prevented or delayed by maintaining a healthy lifestyle and a healthy body weight. In this review, we summarize the literature around lifestyle diabetes prevention programs and provide recommendations for introducing prevention strategies in clinical practice. Overall, evidence supports the efficacy and effectiveness of lifestyle diabetes prevention interventions across clinical and community settings, delivery formats (eg, individual-, group-, or technology-based), and implementers (eg, clinicians, community members). Evidence-based diabetes prevention strategies that can be implemented in clinical practice include brief behavior change counseling, group-based education, community referrals, and health information technologies. These strategies represent opportunities where practitioners, communities, and health care systems can work together to provide individuals with education, support and opportunities to maintain healthy, diabetes-free lifestyles.
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Affiliation(s)
- Karla I. Galaviz
- Karla I. Galaviz, MSc, PhD, Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, No. 1518 Clifton Rd, Atlanta, GA 30322; e-mail:
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Dunkley AJ, Tyrer F, Gray LJ, Bhaumik S, Spong R, Chudasama Y, Cooper SA, Ganghadaran S, Davies M, Khunti K. Type 2 diabetes and glucose intolerance in a population with intellectual disabilities: the STOP diabetes cross-sectional screening study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:668-681. [PMID: 28544066 DOI: 10.1111/jir.12380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/31/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) may be at increased risk of developing type 2 diabetes and cardiovascular disease, due to lifestyle factors, medications and other diagnosed conditions. Currently, there is lack of evidence on prevalence and prevention in this population. The aim of this study was to conduct a diabetes screening programme to determine prevalence of previously undiagnosed type 2 diabetes and impaired glucose regulation in people with ID. METHODS Screening was conducted in a variety of community settings in Leicestershire, UK. Adults with ID were invited via: general practices; the Leicestershire Learning Disability Register; ID psychiatric services; and some people directly contacted the research team due to publicity about the study. Screening involved collection of anthropometric, biomedical and questionnaire data. Type 2 diabetes and impaired glucose regulation were defined according to (venous) fasting plasma glucose or HbA1c, following current World Health Organisation criteria. RESULTS Nine hundred thirty adults (29% of those approached) participated. Mean age was 43 years, 58% were male and 16% of South Asian ethnicity. Most participants were either overweight or obese (68%). Diabetes status was successfully assessed for 675 (73%) participants: Nine (1.3%, 95% confidence interval 0.6 to 2.5) were found to have undiagnosed type 2 diabetes, and 35 (5.2%, 95% confidence interval 3.6 to 7.1) had impaired glucose regulation. Key factors associated with abnormal glucose regulation included the following: non-white ethnicity and a first degree family history of diabetes. CONCLUSIONS Results from this large multi-ethnic cohort suggest a low prevalence of screen-detected (previously undiagnosed) type 2 diabetes and impaired glucose regulation in adults with ID. However, the high levels of overweight and obesity we found emphasise the need for targeted lifestyle prevention strategies, which are specifically tailored for the needs of people with ID.
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Affiliation(s)
- A J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - F Tyrer
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK
| | - S Bhaumik
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicester, LE4 8PQ, UK
| | - R Spong
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Y Chudasama
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK
| | - S Ganghadaran
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicester, LE4 8PQ, UK
| | - M Davies
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
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Abstract
Diabetes is among the biggest of the 21st-century global health challenges. In the U.S. and other high-income countries, thanks to investments in science, dedication to implementing these findings, and measurement of quality of care, there have been improvements in diabetes management and declines in rate of diabetes complications and mortality. This good news, however, is overshadowed by the ever-increasing absolute numbers of people with diabetes and its complications and the unprecedented growth of diabetes in low- and middle-income countries of the world. To comprehensively win the war against diabetes requires 1) concerted attention to prevention and 2) expansion of global research to better inform population-level policies to curb diabetes but also to better understand individual- and population-level variations in pathophysiology and phenotypes globally so that prevention and treatment can be tailored. For example, preliminary data show that thin people in low- and middle-income countries such as India commonly experience type 2 diabetes. Global studies comparing these thin Asian Indians with other high-risk groups such as Pima Indians, a population with a high mean BMI, suggest that type 2 diabetes may not be a single pathophysiological entity. Pima Indians may represent the well-studied phenotype of poor insulin action (type 2A), whereas Asian Indians represent the grossly understudied phenotype of poor insulin secretion (type 2B). This has major implications for diagnosis, prevention, and treatment and highlights the mismatch between where diabetes burdens occur (i.e., low- and middle-income countries) and where research happens (i.e., high-income countries). Correcting this imbalance will advance our knowledge and arsenal to win the global war against diabetes.
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Affiliation(s)
- K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA
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Venkat Narayan KM, Rhodes EC. Addressing noncommunicable diseases in primary care: the case of type 2 diabetes. J R Coll Physicians Edinb 2016; 46:272-277. [DOI: 10.4997/jrcpe.2016.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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