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Mitchell ES, Andrea S, Guttmann-Bauman I. Telemedicine care coordination and visit frequency in pediatric patients with type 1 diabetes in Oregon. J Clin Transl Endocrinol 2024; 36:100338. [PMID: 38559804 PMCID: PMC10979081 DOI: 10.1016/j.jcte.2024.100338] [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: 12/11/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Children with type 1 diabetes require close monitoring with visits every 3-4 months. COVID-19-induced telemedicine expansion may alleviate the challenge of high visit frequency that children with type 1 diabetes face. However, telemedicine's impact on access to care may be limited if patients lack adequate support for telemedicine. The purpose of this study was to evaluate the impact of telemedicine care coordination services on visit frequency in an urban medical center without care coordination services versus a rural outreach program with established care coordination services serviced by the same providers. Methods We evaluated EHR data from 790 children receiving care between July 2018 and December 2021 at a single academic center in Oregon. We estimated differences in likelihood of adequately timed monitoring care over time by patient care coordination services status using Generalized Estimating Equations. Results Just prior to telemedicine expansion, patients receiving care coordination services were 25.6 % less likely to receive adequately timed monitoring care (95 % CI: 51.6 %, 114 %). Following telemedicine expansion, likelihood of adequately timed monitoring care increased from 28.8 % to 58.2 % among those receiving care coordination services and decreased from 38.7 % to 22.0 % among those not receiving care coordination services; increases in adequately timed monitoring care were 3.55 times greater in patients receiving care coordination services relative to those not (95 % CI: 2.10, 6.01). Discussion For pediatric patients with type 1 diabetes, telemedicine care coordination may be an important factor for increasing visit adherence and may increase the number of patients meeting goal visit frequency beyond levels seen prior to widespread telemedicine availability.
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Affiliation(s)
- Emily S. Mitchell
- Oregon Health and Science University, School of Medicine, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA
- Oregon Health and Science University – Portland State University School of Public Health, 1810 SW 5th Avenue, Suite 510, Portland, OR 97201, USA
| | - Sarah Andrea
- Oregon Health and Science University – Portland State University School of Public Health, 1810 SW 5th Avenue, Suite 510, Portland, OR 97201, USA
| | - Ines Guttmann-Bauman
- Oregon Health and Science University, Department of Pediatrics, Division of Endocrinology, 700 S.W. Campus Drive, Portland, OR 97239, USA
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Ishii H, Maeda Y, Sato M, Cai Z, Imori M. Therapy-Related Satisfaction and Quality of Life for Japanese People with Diabetes Using Rapid-Acting Insulin Analogs: A Web-Based Survey. Diabetes Ther 2024:10.1007/s13300-024-01584-9. [PMID: 38760595 DOI: 10.1007/s13300-024-01584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/15/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION People with diabetes require insulin to regulate blood glucose (BG); rapid-acting insulin analogs (RAIA) represent one approach for BG management. New fast-acting RAIA administered at the start of a meal suppress postprandial BG better than conventional RAIA. New RAIA are expected to confer higher treatment satisfaction and improved quality of life (QOL) than conventional RAIA. METHODS This cross-sectional, web-based survey in Japan (November 2022) included people with diabetes (type 1/2), aged ≥ 18 years, registered in the Rakuten Insight Diabetes Panel, using new and/or conventional RAIA. RAIA-specific satisfaction was evaluated by questions on RAIA use (scores: 1 [not at all satisfied]; 7 [very satisfied]) and QOL by the Diabetes Therapy-Related (DTR)-QOL questionnaire (scores: 0-100, 100 = best) for the whole population (primary endpoint) and for new versus conventional RAIA users (secondary endpoint). Multiple regression models were used to compare new versus conventional RAIA users. RESULTS The analysis population comprised 217 people with diabetes (new RAIA, n = 109; conventional RAIA, n = 108). Mean (standard deviation) RAIA-specific satisfaction scores ranged from 5.1 (1.2) to 5.4 (1.2); DTR-QOL total score was 51.6 (20.4). RAIA satisfaction scores were numerically higher for new versus conventional RAIA users; no difference in DTR-QOL total score was observed. DTR-QOL satisfaction with treatment domain score was significantly higher in new versus conventional RAIA users (least squares mean difference [standard error]: 7.3 [3.1]; 95% confidence interval: 1.2, 13.4; P = 0.0197). RAIA-specific satisfaction was higher among patients who discussed BG sufficiently with their doctor versus those who did not. CONCLUSIONS New RAIA users have greater treatment satisfaction than conventional RAIA users. QOL was similar among new and conventional RAIA users, except for satisfaction with treatment, which was significantly higher among new RAIA users. Detailed explanations from the doctor to the person with diabetes about the relationship between new RAIA and BG status are essential. A graphical plain language summary is available with this article.
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Affiliation(s)
- Hitoshi Ishii
- Department of Doctor-Patient Relationships, Nara Medical University, Nara, Japan
| | | | - Manaka Sato
- Japan Drug Development & Medical Affairs, Eli Lilly Japan K.K., Lilly Plaza One Bldg., 5-1-28, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan.
| | - Zhihong Cai
- Japan Drug Development & Medical Affairs, Eli Lilly Japan K.K., Lilly Plaza One Bldg., 5-1-28, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan
| | - Makoto Imori
- Japan Drug Development & Medical Affairs, Eli Lilly Japan K.K., Lilly Plaza One Bldg., 5-1-28, Isogamidori, Chuo-ku, Kobe, 651-0086, Japan
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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024:S0735-1097(24)00381-4. [PMID: 38752899 DOI: 10.1016/j.jacc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Espinosa-Montero J, Monterrubio-Flores E, Aguilar-Tamayo M, Macías-Morales N, Sanchez-Dominguez M, Campos-Nonato I. Indicators of Dietary Behavior and Physical Activity Change Associated with Metabolic Control of Obesity, Hypertension, and Type 2 Diabetes Mellitus in Mexican Adults: National Nutrition and Health Survey in Mexico, 2016. Metab Syndr Relat Disord 2024. [PMID: 38683637 DOI: 10.1089/met.2023.0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Introduction: Obesity (OB), type 2 diabetes mellitus (T2D), and hypertension (HTN) are health issues in Mexico linked to unhealthy behaviors. This study investigates the relationship between behavior change indicators and metabolic control in Mexican adults with OB, T2D, and HTN. Methods: We used data from the 2016 National Health and Nutrition Survey Midway (ENSANUT MC-2016), representing ∼59.5 million Mexican adults aged 20-59 with these conditions. We assessed behavior change indicators, including stages of change, self-efficacy, and perceptions of benefits and barriers. In addition, we conducted descriptive analyses and used statistical tests, such as Pearson's chi-squared test and logistic regression models, adjusted for multiple variables. Results: We found that adults in the action and maintenance stages of physical activity (PA) were four times more likely to have adequate HTN control than those in the precontemplation stage. Self-efficacy for PA was related to better control in T2D and HTN. Self-efficacy for reducing the consumption of sugary beverages was positively associated with control in OB and T2D. No significant association was observed with self-efficacy for consuming fruits and vegetables. Conclusion: Behavior-change indicators are significantly linked to metabolic control in adults with HTN. These results support the importance of these indicators in managing chronic diseases such as HTN and their potential use in public health strategies.
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Affiliation(s)
- Juan Espinosa-Montero
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Eric Monterrubio-Flores
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Manuel Aguilar-Tamayo
- Institute of Education Sciences, Autonomous University of the State of Morelos, Mexico City, Mexico
| | - Nayeli Macías-Morales
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Mario Sanchez-Dominguez
- Health Equity Research Department, Center for Research in Health Systems, National Institute of Public Health, México City, Mexico
| | - Ismael Campos-Nonato
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
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Lopes MS, Baptistella GB, Nunes GG, Ferreira MV, Cunha JM, de Oliveira KM, Acco A, Lopes MLC, Couto Alves A, Valdameri G, Moure VR, Picheth G, Manica GCM, Rego FGM. A Non-Toxic Binuclear Vanadium(IV) Complex as Insulin Adjuvant Improves the Glycemic Control in Streptozotocin-Induced Diabetic Rats. Pharmaceuticals (Basel) 2024; 17:486. [PMID: 38675446 PMCID: PMC11054326 DOI: 10.3390/ph17040486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Diabetes mellitus (DM) complications are a burden to health care systems due to the associated consequences of poor glycemic control and the side effects of insulin therapy. Recently. adjuvant therapies, such as vanadium compounds, have gained attention due to their potential to improve glucose homeostasis in patients with diabetes. In order to determine the anti-diabetic and antioxidant effects of the oxidovanadium(IV) complex (Et3NH)2[{VO(OH}2)(ox)2(µ-ox)] or Vox2), rats with streptozotocin (STZ)-induced diabetes were treated with 30 and 100 mg/kg of Vox2, orally administered for 12 days. Vox2 at 100 mg/kg in association with insulin caused a 3.4 times decrease in blood glucose in STZ rats (424 mg/dL), reaching concentrations similar to those in the normoglycemic animals (126 mg/dL). Compared to insulin alone, the association with Vox2 caused an additional decrease in blood glucose of 39% and 65% at 30 and 100 mg/kg, respectively, and an increased pancreatic GSH levels 2.5 times. Vox2 alone did not cause gastrointestinal discomfort, diarrhea, and hepatic or renal toxicity and was not associated with changes in blood glucose level, lipid profile, or kidney or liver function. Our results highlight the potential of Vox2 in association with insulin in treating diabetes.
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Affiliation(s)
- Mateus S. Lopes
- Post-Graduation Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba 80210-170, PR, Brazil; (M.S.L.); (M.L.C.L.); (G.V.); (V.R.M.); (G.P.)
| | - Gabriel B. Baptistella
- Department of Chemistry, Federal University of Paraná, Curitiba 81531-980, PR, Brazil; (G.B.B.); (G.G.N.)
| | - Giovana G. Nunes
- Department of Chemistry, Federal University of Paraná, Curitiba 81531-980, PR, Brazil; (G.B.B.); (G.G.N.)
| | - Matheus V. Ferreira
- Post-Graduation Program in Pharmacology, Federal University of Paraná, Curitiba 81531-980, PR, Brazil; (M.V.F.); (J.M.C.); (K.M.d.O.); (A.A.)
| | - Joice Maria Cunha
- Post-Graduation Program in Pharmacology, Federal University of Paraná, Curitiba 81531-980, PR, Brazil; (M.V.F.); (J.M.C.); (K.M.d.O.); (A.A.)
| | - Kauê Marcel de Oliveira
- Post-Graduation Program in Pharmacology, Federal University of Paraná, Curitiba 81531-980, PR, Brazil; (M.V.F.); (J.M.C.); (K.M.d.O.); (A.A.)
| | - Alexandra Acco
- Post-Graduation Program in Pharmacology, Federal University of Paraná, Curitiba 81531-980, PR, Brazil; (M.V.F.); (J.M.C.); (K.M.d.O.); (A.A.)
| | - Maria Luiza C. Lopes
- Post-Graduation Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba 80210-170, PR, Brazil; (M.S.L.); (M.L.C.L.); (G.V.); (V.R.M.); (G.P.)
| | - Alexessander Couto Alves
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
| | - Glaucio Valdameri
- Post-Graduation Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba 80210-170, PR, Brazil; (M.S.L.); (M.L.C.L.); (G.V.); (V.R.M.); (G.P.)
| | - Vivian R. Moure
- Post-Graduation Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba 80210-170, PR, Brazil; (M.S.L.); (M.L.C.L.); (G.V.); (V.R.M.); (G.P.)
| | - Geraldo Picheth
- Post-Graduation Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba 80210-170, PR, Brazil; (M.S.L.); (M.L.C.L.); (G.V.); (V.R.M.); (G.P.)
| | - Graciele C. M. Manica
- Department of Bioscience One Health of Federal University of Santa Catarina, Curitibanos 88520-000, SC, Brazil;
| | - Fabiane G. M. Rego
- Post-Graduation Program in Pharmaceutical Sciences, Federal University of Paraná, Curitiba 80210-170, PR, Brazil; (M.S.L.); (M.L.C.L.); (G.V.); (V.R.M.); (G.P.)
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Boussageon R, Meunier PY, Chanelière M, Shaughnessy AF, Cosgrove L. Are American Diabetes Association's new guidelines reliable? J Eval Clin Pract 2024; 30:403-405. [PMID: 38083876 DOI: 10.1111/jep.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 04/18/2024]
Affiliation(s)
- Rémy Boussageon
- Collège Universitaire de Médecine Générale, UCBL Lyon 1, Lyon, France
- UMR 5558, LBBE, EMET, CNRS, Université Claude Bernard, Lyon 1, Lyon, France
| | | | - Marc Chanelière
- Collège Universitaire de Médecine Générale, UCBL Lyon 1, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Lisa Cosgrove
- University of Massachusetts-Boston, Boston, Massachusetts, USA
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Powell LH, Daniels BT, Drees BM, Karavolos K, Lohse B, Masters KS, Nicklas JM, Ruder EH, Suzuki S, Trabold N, Zimmermann LJ. Enhancing Lifestyles in the Metabolic syndrome (ELM) multisite behavioral efficacy trial. Design and baseline cohort. Am Heart J 2024; 270:136-155. [PMID: 38215918 DOI: 10.1016/j.ahj.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Prevalence of metabolic syndrome (MetS) increased from one-quarter to one-third of the U.S. adult population over 8 years and is spreading to young adults and Asian and Hispanic Americans. Diagnosed when >3 out of 5 cardiometabolic risk factors are present, there is widespread agreement that its fundamental roots are in a lifestyle characterized by poor dietary quality and physical inactivity. Past lifestyle trials for MetS produce benefits that have limited sustainability, suggesting the need for new treatment approaches. METHODS This is the design and baseline cohort of the Enhancing Lifestyles in the Metabolic Syndrome (ELM) multi-site trial. The trial tests the hypothesis that a habit-based lifestyle treatment offered over 6 months, followed by 18 monthly maintenance contacts, can produce 4 new diet, physical activity, and mindfulness habits and, if so, sustained MetS remission. The design is an individually randomized, partially clustered group treatment trial of 618 participants with the MetS recruited from 5 sites in the U.S. and randomized to a small group lifestyle treatment or an enhanced standard of care education comparator. The primary outcome is MetS remission at 24 months. Secondary outcomes compare arms at 6, 15, and 24 months on MetS components, lifestyle targets, weight, body mass index, hemoglobin A1c, LDL cholesterol, medications, quality of life, psychosocial factors, and cost-effectiveness. RESULTS The cohort of 618 participants was recruited by screening 14,817 over 2.5 years (screening to enrollment ratio 24:1). Recruitment exceeded the target of 600 despite 2 COVID-19 pauses. The mean age was 55.5 years, 24.3% were male, 25.5% were a racial minority, 9.7% identified as Hispanic, and 83.0% were classified as obese (body mass index >30). The most common MetS components were abdominal obesity (97.7%) and elevated blood pressure or antihypertensive medication (86.2%). CONCLUSIONS The geographic, sociodemographic, and clinical diversity of the cohort, combined with rigorous behavioral efficacy trial methods, will provide a conclusive answer to the question of whether this habit-based lifestyle program can produce sustained 24-month remission of the MetS and thereby help to curb a significant and growing public health problem.
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Li X, Li C, Huang H, Bai D, Wang J, Chen A, Gong Y, Leng Y. Anti-vascular endothelial growth factor drugs combined with laser photocoagulation maintain retinal ganglion cell integrity in patients with diabetic macular edema: study protocol for a prospective, non-randomized, controlled clinical trial. Neural Regen Res 2024; 19:923-928. [PMID: 37843230 PMCID: PMC10664114 DOI: 10.4103/1673-5374.382104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 10/17/2023] Open
Abstract
The integrity of retinal ganglion cells is tightly associated with diabetic macular degeneration that leads to damage and death of retinal ganglion cells, affecting vision. The major clinical treatments for diabetic macular edema are anti-vascular endothelial growth factor drugs and laser photocoagulation. However, although the macular thickness can be normalized with each of these two therapies used alone, the vision does not improve in many patients. This might result from the incomplete recovery of retinal ganglion cell injury. Therefore, a prospective, non-randomized, controlled clinical trial was designed to investigate the effect of anti-vascular endothelial growth factor drugs combined with laser photocoagulation on the integrity of retinal ganglion cells in patients with diabetic macular edema and its relationship with vision recovery. In this trial, 150 patients with diabetic macular edema will be equally divided into three groups according to therapeutic methods, followed by treatment with anti-vascular endothelial growth factor drugs, laser photocoagulation therapy, and their combination. All patients will be followed up for 12 months. The primary outcome measure is retinal ganglion cell-inner plexiform layer thickness at 12 months after treatment. The secondary outcome measures include retinal ganglion cell-inner plexiform layer thickness before and 1, 3, 6, and 9 months after treatment, retinal nerve fiber layer thickness, best-corrected visual acuity, macular area thickness, and choroidal thickness before and 1, 3, 6, 9, and 12 months after treatment. Safety measure is the incidence of adverse events at 1, 3, 6, 9, and 12 months after treatment. The study protocol hopes to validate the better efficacy and safety of the combined treatment in patients with diabetic macula compared with the other two monotherapies alone during the 12-month follow-up period. The trial is designed to focus on clarifying the time-effect relationship between imaging measures related to the integrity of retinal ganglion cells and best-corrected visual acuity. The trial protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Beihua University with approval No. (2023)(26) on April 25, 2023, and was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2300072478, June 14, 2023, protocol version: 2.0).
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Affiliation(s)
- Xiangjun Li
- Department of Ophthalmology, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China
| | - Chunyan Li
- Department of Endocrinology, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China
| | - Hai Huang
- Department of Endocrinology, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China
| | - Dan Bai
- Department of Ophthalmology, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China
| | - Jingyi Wang
- Department of Ophthalmology, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China
| | - Anqi Chen
- Department of Endocrinology, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China
| | - Yu Gong
- Department of Endocrinology, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China
| | - Ying Leng
- Department of Ophthalmology, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China
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Shalit A, Gerontiti E, Boutzios G, Korakianiti E, Kanouta F, Vasileiou V, Psaltopoulou T, Paschou SA. Nutrition of aging people with diabetes mellitus: Focus on sarcopenia. Maturitas 2024; 185:107975. [PMID: 38522145 DOI: 10.1016/j.maturitas.2024.107975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/20/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Abstract
As populations age, chronic diseases accumulate, and new health conditions emerge. One noteworthy pair that warrants further evaluation is diabetes mellitus and sarcopenia, given that the latter occurs in 28 % of the population aged over 50 who have diabetes mellitus. The management of both entails nutritional interventions, making the development of unified dietary recommendations an alluring strategy. This review aims to elucidate the current recommendations for the combined management of sarcopenia and diabetes, while featuring elements that require further research. The goal of nutritional management is to improve muscle mass and strength while regulating metabolic risk and glucose levels. To ensure muscle synthesis in the elderly, recommendations align at daily calorie intake that exceeds 30 kcal/kg, with adjustments based on comorbidities. Additionally, a protein intake of at least 1-1.2 g/kg/d is essential, emphasizing both daily and per-meal intake, and can be achieved through diet or branched-amino-acids supplements. Specific considerations for diabetes include restricted protein intake in diabetic nephropathy and exploring the potential link between branched amino acids and insulin resistance. Further recommendations that both promote metabolic health and have demonstrated at least a potential to increase muscle strength include prioritizing polyunsaturated fatty acids as a fat source and maintaining adequate levels of vitamin D. Clinicians should consult their patients on dietary optimization, but evidence is insufficient to recommend additional supplementation. Lastly, an emerging challenge of diabetes and sarcopenia is sarcopenic obesity, which requires the combination of a hypocaloric diet with increased protein intake.
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Affiliation(s)
- Almog Shalit
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Section of Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Eleni Gerontiti
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Boutzios
- Endocrine Unit, Department of Pathophysiology, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Fotini Kanouta
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | | | - Theodora Psaltopoulou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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10
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Sherrill CH, Hwang AY. Use of Cardioprotective Antidiabetic Medications in Adults With and Without Cardiovascular Disease, 2015 to March 2020. Ann Pharmacother 2024; 58:248-254. [PMID: 37323006 DOI: 10.1177/10600280231178886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Certain glucagon-like peptide-1 receptor (GLP-1) agonists and sodium-glucose cotransporter-2 inhibitors (SGLT2-inhibitors) can reduce cardiovascular risk in individuals with type 2 diabetes and cardiovascular disease (CVD). However, these medications can be expensive, potentially limiting their use. Objectives: The primary objective was to characterize the use of cardioprotective GLP-1 agonists and SGLT2-inhibitors among adults with diabetes with and without CVD. The secondary objective was to investigate the association of socioeconomic factors and health care utilization with the use of these medications. METHODS Adults aged ≥20 years old with self-reported diabetes, A1c ≥6.5%, or fasting glucose ≥126 mg/dL were identified using the 2015 to March 2020 National Health and Nutrition Examination Survey. The primary outcome was the use of cardioprotective GLP-1 agonists or SGLT2-inhibitors compared in individuals with and without CVD. Secondary analyses included identification of socioeconomic factors and health care utilization associated with the use of cardioprotective antidiabetic medications, stratified by CVD status. Weighted analyses were conducted to account for the complex survey design. RESULTS Use of cardioprotective antidiabetic medications was higher in adults with CVD compared to those without CVD (7.8% vs. 4.6%, P = 0.02), which was driven by the use of cardioprotective SGLT2-inhibitors (4.6% versus 1.9%, P = 0.002). Lower income level and less frequent health care visits within the past year were associated with lower likelihood of using these medications. CONCLUSION AND RELEVANCE Despite preferential use in individuals with diabetes and CVD, the prevalence of cardioprotective antidiabetic medication use remains relatively low. Disparities in use appear to exist based on income level and health care utilization.
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Affiliation(s)
- Christina H Sherrill
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC, USA
| | - Andrew Y Hwang
- Department of Pharmacy Practice, School of Pharmacy, MCPHS University, Boston, MA, USA
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de Andrade CES, Souza KSCD, Galdino OA, de Lima MAF, de Medeiros PJ, Abbott Galvão Ururahy M, Pereira MG, de Almeida JB, de Rezende AA. New-onset diabetes after kidney transplantation: Assessing urinary Wilm's tumor-1 protein to predict renal allograft dysfunction. Adv Med Sci 2024; 69:153-159. [PMID: 38490331 DOI: 10.1016/j.advms.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/21/2023] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication associated with podocyte damage and renal allograft dysfunction. Thus, Wilm's tumor-1 (WT-1) protein, as a podocyte marker, holds promise as an option to evaluate renal allograft dysfunction in NODAT. Therefore, the study aimed to investigate urinary WT-1 levels in NODAT patients during the first year after kidney transplantation (KTx). MATERIALS AND METHODS KTx patients were categorized into non-NODAT and NODAT groups. Fasting blood glucose, glycated hemoglobin (HbA1c), urinary albumin/creatinine ratio (ACR), serum creatinine, estimated glomerular filtration rate (eGFR), and urinary WT-1 were measured at 3, 6, 9, and 12-months post-KTx. RESULTS The NODAT group manifested elevated levels of blood glucose and HbA1c during the first year post-KTx. Also, exhibited elevations in ACR and serum creatinine levels at 6, 9, and 12-months post-KTx when compared to non-NODAT group. Conversely, eGFR values in the NODAT group demonstrated significant declines at 3, 6, and 9-months post-KTx relative to non-NODAT. Furthermore, NODAT group exhibited a median annual eGFR of 47 mL/min/1.73 m2. Urinary WT-1 levels at 3, 6, 9, and 12-months post-KTx were significantly higher in the NODAT group compared to non-NODAT. Additionally, noteworthy positive correlations were identified between urinary WT-1 and HbA1c levels, along with significant negative correlations between urinary WT-1 and eGFR at the 3, 6, 9, and 12-months post-KTx. CONCLUSION The increased urinary WT-1 levels from 3-months post-KTx in NODAT patients may indicate the first sign of podocyte injury, predicting a renal allograft dysfunction in these patients.
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Affiliation(s)
| | - Karla Simone Costa de Souza
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ony Araújo Galdino
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Paulo José de Medeiros
- Division of Nephrology, Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Maurício Galvão Pereira
- Division of Nephrology, Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - José Bruno de Almeida
- Division of Nephrology, Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Adriana Augusto de Rezende
- Department of Clinical and Toxicological Analyses, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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12
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Bancks MP, Pilla SJ, Balasubramanyam A, Yeh HC, Johnson KC, Rigdon J, Wagenknecht LE, Espeland MA. Association of Lifestyle Intervention With Risk for Cardiovascular Events Differs by Level of Glycated Hemoglobin. J Clin Endocrinol Metab 2024; 109:e1012-e1019. [PMID: 37978826 PMCID: PMC10876384 DOI: 10.1210/clinem/dgad674] [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: 08/07/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE We reevaluated the Action for Health in Diabetes (Look AHEAD) intensive lifestyle intervention (ILI) to assess whether the effect of ILI on cardiovascular disease (CVD) prevention differed by baseline glycated hemoglobin (HbA1c). METHODS Look AHEAD randomized 5145 adults, aged 45 to 76 years with type 2 diabetes and overweight/obesity to ILI or a diabetes support and education (DSE) control group for a median of 9.6 years. ILI focused on achieving weight loss through decreased caloric intake and increased physical activity. We assessed the parent trial's primary composite CVD outcome. We evaluated additive and multiplicative heterogeneity of the intervention on CVD risk by baseline HbA1c. RESULTS Mean baseline HbA1c was 7.3% (SD 1.2) and ranged from 4.4% (quintile 1) to 14.5% (quintile 5). We observed additive and multiplicative heterogeneity of the association between ILI and CVD (all P < .001) by baseline HbA1c. Randomization to ILI was associated with lower CVD risk for HbA1c quintiles 1 [hazard ratio (HR): 0.68, 95% confidence interval (CI): 0.53, 0.88] and 2 (HR: 0.80, 95% CI: 0.66, 0.96) and associated with higher CVD risk for HbA1c quintile 5 (HR: 1.27, 95% CI: 1.02, 1.58), compared to DSE. CONCLUSION Among adults with type 2 diabetes and overweight/obesity, randomization to a lifestyle intervention was differentially associated with CVD risk by baseline HbA1c such that it was associated with lower risk at lower HbA1c levels and higher risk at higher HbA1c levels. There is a critical need to develop and tailor lifestyle interventions to be successful for individuals with type 2 diabetes and high HbA1c.
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Affiliation(s)
- Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Scott J Pilla
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | | | - Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Lynne E Wagenknecht
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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13
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Beltran J, Valli C, Medina-Aedo M, Canelo-Aybar C, Niño de Guzmán E, Song Y, Orrego C, Ballester M, Suñol R, Noordman J, Heijmans M, Seitidis G, Tsokani S, Kontouli KM, Christogiannis C, Mavridis D, Graaf GD, Groene O, Grammatikopoulou MG, Camalleres-Guillem F, Perestelo-Perez L, McGloin H, Winkley K, Mueller BS, Saz-Parkinson Z, Corcoy R, Alonso-Coello P. COMPAR-EU Recommendations on Self-Management Interventions in Type 2 Diabetes Mellitus. Healthcare (Basel) 2024; 12:483. [PMID: 38391858 PMCID: PMC10887949 DOI: 10.3390/healthcare12040483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Self-management interventions (SMIs) offer a promising approach to actively engage patients in the management of their chronic diseases. Within the scope of the COMPAR-EU project, our goal is to provide evidence-based recommendations for the utilisation and implementation of SMIs in the care of adult individuals with type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, utilising a core outcome set (COS), identified critical outcomes and established effect thresholds for each outcome. The panel formulated recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, a transparent and rigorous framework for developing and presenting the best available evidence for the formulation of recommendations. All recommendations are based on systematic reviews (SR) of the effects and of values and preferences, a contextual analysis, and a cost-effectiveness analysis. The COMPAR-EU panel is in favour of using SMIs rather than usual care (UC) alone (conditional, very low certainty of the evidence). Furthermore, the panel specifically is in favour of using ten selected SMIs, rather than UC alone (conditional, low certainty of the evidence), mostly encompassing education, self-monitoring, and behavioural techniques. The panel acknowledges that, for most SMIs, moderate resource requirements exist, and cost-effectiveness analyses do not distinctly favour either the SMI or UC. Additionally, it recognises that SMIs are likely to enhance equity, deeming them acceptable and feasible for implementation.
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Affiliation(s)
- Jessica Beltran
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Claudia Valli
- Avedis DonabedianResearch Institute (FAD), Universitat Autònoma de Barcelona, 008037 Barcelona, Spain
| | - Melixa Medina-Aedo
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Yang Song
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Carola Orrego
- Avedis DonabedianResearch Institute (FAD), Universitat Autònoma de Barcelona, 008037 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
| | - Marta Ballester
- Avedis DonabedianResearch Institute (FAD), Universitat Autònoma de Barcelona, 008037 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
| | - Rosa Suñol
- Avedis DonabedianResearch Institute (FAD), Universitat Autònoma de Barcelona, 008037 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 08007 Barcelona, Spain
| | - Janneke Noordman
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands
| | - Georgios Seitidis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Katerina-Maria Kontouli
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Christos Christogiannis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Gimon de Graaf
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3062 PA Rotterdam, The Netherlands
| | | | - Maria G Grammatikopoulou
- Immunonutrition and Clinical Nutrition Unit, Department of Rheumatology and Clinical Immunology, Medical School, University of Thessaly, Biopolis Campus, 43100 Larissa, Greece
| | | | - Lilisbeth Perestelo-Perez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Tenerife, Spain
| | - Helen McGloin
- School of Nursing, Health Science and Disability Studies, ATU St Angelas, F91 C643 Sligo, Ireland
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London SE1 8WA, UK
| | - Beate Sigrid Mueller
- Institute of General Practice, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | | | - Rosa Corcoy
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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14
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Magro G, Tosto F, Laterza V, Di Benedetto O. The Dark side of the White Matter. Diffuse subcortical White Matter Hypointensity on T2/FLAIR: A systematic review of a frequently underrecognized sign. J Neurol Sci 2024; 457:122882. [PMID: 38224629 DOI: 10.1016/j.jns.2024.122882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Many reversible brain MRI abnormalities have been described, among these the most frequently reported are cortical hyperintensities on FLAIR/T2 occurring during seizures. Much less attention has been given to those situations where White Matter goes Dark: subcortical white matter hypointensity on T2/FLAIR. Our aim is to identify the medical condition "Dark White Matter" (DWM) is more frequently associated with. This is the first systematic review on DWM. METHODS PubMed was searched in August 2023. Included studies were those reporting Diffuse Subcortical White Matter Hypointensity on T2/FLAIR. Mainly case reports were included. Individual patient-level data was included whenever available. Frequency measures of the different diseases were calculated. RESULTS 56 studies were included, 228 patients were eligible for analysis. DWM happened in isolation, with no cortical abnormalities, in 71 cases and was associated with seizures in >61.4% of cases. The most frequently DWM-associated disease was Non-Ketotic Hyperglycaemic hyperosmolar state (NKH), followed by Encephalitis, Moyamoya disease, Genetic Causes, and Subdural Hematoma. Frequency of NKH was 32%. NKH was associated with seizures in 100% of cases and the most frequently involved lobe was the occipital one. When considering only the subgroup of patients with seizures, DWM was indicative of NKH in 51.4% of cases and Encephalitis in 26.4% of cases. Key limitations are heterogeneity and missing data. DISCUSSION DWM is frequently underdiagnosed. This sign can exist alone and it is not merely a consequence of cortical involvement. Moreover, it has important implications, both diagnostic and therapeutic, as it is more frequently associated with NKH, especially in the context of seizures, where anti-seizure medication is not the first line of treatment. We also discuss the pathogenesis of DWM by finding a common link between the most frequently associated diseases.
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Affiliation(s)
- Giuseppe Magro
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy.
| | - Federico Tosto
- Department of Neuroscience, "Giovanni Paolo II" Hospital, Catanzaro, Italy
| | - Vincenzo Laterza
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Olindo Di Benedetto
- Department of Medical and Surgical Sciences, Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
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15
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Julián MT, Pérez-Montes de Oca A, Julve J, Alonso N. The double burden: type 1 diabetes and heart failure-a comprehensive review. Cardiovasc Diabetol 2024; 23:65. [PMID: 38347569 PMCID: PMC10863220 DOI: 10.1186/s12933-024-02136-y] [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: 10/06/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Heart failure (HF) is increasing at an alarming rate, primary due to the rising in aging, obesity and diabetes. Notably, individuals with type 1 diabetes (T1D) face a significantly elevated risk of HF, leading to more hospitalizations and increased case fatality rates. Several risk factors contribute to HF in T1D, including poor glycemic control, female gender, smoking, hypertension, elevated BMI, and albuminuria. However, early and intensive glycemic control can mitigate the long-term risk of HF in individuals with T1D. The pathophysiology of diabetes-associated HF is complex and multifactorial, and the underlying mechanisms in T1D remain incompletely elucidated. In terms of treatment, much of the evidence comes from type 2 diabetes (T2D) populations, so applying it to T1D requires caution. Sodium-glucose cotransporter 2 inhibitors have shown benefits in HF outcomes, even in non-diabetic populations. However, most of the information about HF and the evidence from cardiovascular safety trials related to glucose lowering medications refer to T2D. Glycemic control is key, but the link between hypoglycemia and HF hospitalization risk requires further study. Glycemic variability, common in T1D, is an independent HF risk factor. Technological advances offer the potential to improve glycemic control, including glycemic variability, and may play a role in preventing HF. In summary, HF in T1D is a complex challenge with unique dimensions. This review focuses on HF in individuals with T1D, exploring its epidemiology, risk factors, pathophysiology, diagnosis and treatment, which is crucial for developing tailored prevention and management strategies for this population.
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Affiliation(s)
- María Teresa Julián
- Department of Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Alejandra Pérez-Montes de Oca
- Department of Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Julve
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Alonso
- Department of Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
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16
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Huang Z, Zhuang X, Huang R, Liu M, Xu X, Fan Z, Dai R, Li H, Xiong Z, Guo Y, Liang Q, Liao X. Physical Activity and Weight Loss Among Adults With Type 2 Diabetes and Overweight or Obesity: A Post Hoc Analysis of the Look AHEAD Trial. JAMA Netw Open 2024; 7:e240219. [PMID: 38386318 PMCID: PMC10884882 DOI: 10.1001/jamanetworkopen.2024.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Importance Prior findings from the Look AHEAD trial showed no significant reduction in the risk of cardiovascular events by lifestyle-induced weight loss among individuals with type 2 diabetes (T2D) and overweight or obesity. However, physical activity (PA) may modify the changes in cardiovascular risk associated with weight loss. Objective To examine the joint association of weight loss and PA with the risk of adverse cardiovascular events in patients with T2D and overweight or obesity. Design, Setting, and Participants This cohort study was a post hoc analysis of the Look AHEAD randomized clinical trial, which compared the cardiovascular effects of weight loss by intensive lifestyle intervention vs diabetes support and education among individuals with T2D and overweight or obesity. The study was conducted from June 2001 to September 2012, and participants were patients in the substudy of accelerometry-measured PA from 8 locations in the United States. Data were analyzed from June to August 2023. Exposures Body weight change and accelerometer-derived PA volume across the first 4 years. Main Outcomes and Measures The primary outcome was a composite cardiovascular outcome including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina. Results Among a total of 1229 participants (mean [SD] age, 60 [7] years; 533 male [43%]), 333 (27%) achieved and maintained weight loss for the first 4 years. Among the individuals who maintained weight loss, 105 (32%) maintained high PA volume. During a median of 9.5 years of follow-up, 198 participants (16.1%) experienced the primary outcome. Compared with those with low PA volume and no weight loss (105 [15.8%]), maintaining high PA volume and weight loss was associated with a 61% lower risk of the primary end point (hazard ratio, 0.39; 95% CI, 0.19-0.81; P = .01). However, there was no significant difference in the risk of the primary end point among those with either weight loss only or high PA only. The multiplicative interaction between weight loss and PA for the risk of cardiovascular events was also significant (P for interaction = .01). Conclusions and Relevance In this cohort study, maintaining weight loss and higher PA volume was associated with a lower risk of the composite cardiovascular outcome. The findings suggest that the cardiovascular benefits of PA may vary and be enhanced by weight loss among individuals with T2D and overweight or obesity.
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Affiliation(s)
- Zihao Huang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Rihua Huang
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xinghao Xu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Ziyan Fan
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rongling Dai
- School of Journalism and Communication, Sun Yat-Sen University, Guangzhou, China
| | - Hansheng Li
- School of Critical Studies, University of Glasgow, Glasgow, United Kingdom
| | - Zhenyu Xiong
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yue Guo
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Qi Liang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
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17
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Grech J, Norman IJ, Sammut R. Exploring the smoking cessation needs of individuals with diabetes using the Information-Motivation-Behavior Skills model. Tob Prev Cessat 2024; 10:TPC-10-07. [PMID: 38313659 PMCID: PMC10831727 DOI: 10.18332/tpc/181366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Smoking cessation is an important aspect of diabetes management. Despite the increased risk for diabetes complications when smoking, evidence suggests that people living with type 1 and type 2 diabetes are less likely to quit smoking when compared to those without diabetes. Guided by the Information-Motivation-Behavioral Skills model, this study aimed to identify the needs of individuals living with type 1 and type 2 diabetes to quit smoking. METHODS A qualitative descriptive design was adopted. Semi-structured telephone interviews were held between April and June 2021, with 20 former and current Maltese smokers living with type 1 or type 2 diabetes, recruited from the diabetic clinics within the two main acute public hospitals. The interview transcriptions were analyzed using applied thematic analysis. RESULTS Individuals with diabetes need more information on the effects of smoking on diabetes to encourage cessation. Preventing diabetic complications was reported as a motivator to quit smoking. However, having diabetes was identified as a challenge to quitting. Participants welcomed the provision of health professional support for quitting smoking, identifying the need to provide smoking cessation support within diabetic clinics. The provision of information on tobacco-associated diabetic complications, by using video messages featuring former smokers' stories was also suggested. CONCLUSIONS To promote smoking cessation among individuals with diabetes, they need to be informed about how smoking affects their condition. Utilizing video messages featuring real-life stories of former smokers with diabetes who experienced tobacco-associated diabetic complications may be influential. Additionally, providing diabetes-specific intensive smoking cessation support is crucial to help them quit.
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Affiliation(s)
- Joseph Grech
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Ian J. Norman
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, United Kingdom
| | - Roberta Sammut
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
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18
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Huang L, Yu H, Fang Y. A diabetic patient increased premature ventricular contractions after using liraglutide: a case report. Front Cardiovasc Med 2024; 11:1332754. [PMID: 38357515 PMCID: PMC10865887 DOI: 10.3389/fcvm.2024.1332754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
The common adverse reactions of liraglutide are hypoglycemia and gastrointestinal reactions. This case reports a patient with type 2 diabetes mellitus who had an increase in ventricular premature beats after using liraglutide and a decrease in ventricular premature beats after stopping liraglutide, suggesting that clinicians should rule out the possibility of drug-related adverse reactions when using liraglutide in the treatment of diabetes mellitus complicated with coronary heart disease and arrhythmia.
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Affiliation(s)
- Lilan Huang
- Medical School of the Ministry of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - He Yu
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Ying Fang
- Department of Endocrinology, CR & WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
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19
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Pangrace M, Dolan S, Grace T, Greene E, Long E, McClelland S, Moore J, Morgan DE, Mullins H, Wescott S. AMCP Market Insights Health Plan Best Practice: Implementing continuous glucose monitoring to improve patient outcomes in diabetes. J Manag Care Spec Pharm 2024; 30:S1-S15. [PMID: 38190244 DOI: 10.18553/jmcp.2024.30.1-a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Diabetes is a complex chronic condition that affects the body's ability to produce or use insulin effectively, resulting in elevated blood glucose levels. It is associated with various complications and comorbidities, significantly impacting both individuals and the health care system. Effective management involves a combination of lifestyle adjustments, medication adherence, monitoring, education, and support. The expanding use of continuous glucose monitoring (CGM) has been transformative in diabetes care, providing valuable real-time data and insights for better management. To understand the opportunity for health plans to support improved patient outcomes with CGM, AMCP sponsored a multifaceted approach to identify best practices consisting of expert interviews, a national payer survey, an expert panel workshop with clinical experts and managed care stakeholders, and a national webcast to communicate the program findings. This article summarizes current evidence for CGM to support managed care and payer professionals in making collaborative, evidence-based decisions to optimize outcomes among patients with diabetes. In addition, this review also presents the findings of a national payer survey and describes expert-supported health plan best practices around coverage and access to CGM.
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Affiliation(s)
| | - Sheri Dolan
- Bureau of Professional and Ancillary Services, University of Illinois at Chicago
| | | | | | | | | | - Josh Moore
- MO HealthNet Division, Missouri Department of Social Services, Columbia
| | - Diane E Morgan
- Government Programs Pharmacy, UnitedHealthcare, Severn, MD
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Cervilla Suárez FJ, Muñoz Cobos F, García Ruiz A, Gálvez Alcaraz LF. [Is the use of the Ankle-Brachial Index useful in patients with diabetes in primary care?]. Aten Primaria 2024; 56:102769. [PMID: 37741184 PMCID: PMC10520299 DOI: 10.1016/j.aprim.2023.102769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023] Open
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21
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Zhang YY, Chen BX, Chen Z, Wan Q. Correlation study of renal function indices with diabetic peripheral neuropathy and diabetic retinopathy in T2DM patients with normal renal function. Front Public Health 2023; 11:1302615. [PMID: 38174078 PMCID: PMC10762307 DOI: 10.3389/fpubh.2023.1302615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Background The anticipation of diabetes-related complications remains a challenge for numerous T2DM patients, as there is presently no effective method for early prediction of these complications. This study aims to investigate the association between renal function-related indicators and the occurrence of peripheral neuropathy and retinopathy in individuals diagnosed with type 2 diabetes mellitus (T2DM) who currently have normal renal function. Methods Patients with T2DM who met the criteria were selected from the MMC database and divided into diabetic peripheral neuropathy (DPN) and diabetic retinopathy (DR) groups, with a total of 859 and 487 patients included, respectively. Multivariate logistic regression was used to analyze the relationship between blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), urine albumin(ALB), albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and diabetic peripheral neuropathy and retinopathy. Spearman correlation analysis was used to determine the correlation between these indicators and peripheral neuropathy and retinopathy in diabetes. Results In a total of 221 patients diagnosed with DPN, we found positive correlation between the prevalence of DPN and eGFR (18.2, 23.3, 35.7%, p < 0.05). Specifically, as BUN (T1: references; T2:OR:0.598, 95%CI: 0.403, 0.886; T3:OR:1.017, 95%CI: 0.702, 1.473; p < 0.05) and eGFR (T1: references; T2:OR:1.294, 95%CI: 0.857, 1.953; T3:OR:2.142, 95%CI: 1.425, 3.222; p < 0.05) increased, the odds ratio of DPN also increased. Conversely, with an increase in Cr(T1: references; T2:OR:0.86, 95%CI: 0.56, 1.33; T3:OR:0.57, 95%CI: 0.36, 0.91; p < 0.05), the odds ratio of DPN decreased. Furthermore, when considering sensitivity and specificity, eGFR exhibited a sensitivity of 65.2% and specificity of 54.4%, with a 95% confidence interval of 0.568-0.656. Conclusion In this experimental sample, we found a clear positive correlation between eGFR and DPN prevalence.
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Affiliation(s)
- Yue-Yang Zhang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
- Southwest Medical University, Luzhou, China
| | | | - Zhuang Chen
- Medical Laboratory Centre, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qin Wan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Diabetes and Metabolism, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
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Fedulovs A, Pahirko L, Jekabsons K, Kunrade L, Valeinis J, Riekstina U, Pīrāgs V, Sokolovska J. Association of Endotoxemia with Low-Grade Inflammation, Metabolic Syndrome and Distinct Response to Lipopolysaccharide in Type 1 Diabetes. Biomedicines 2023; 11:3269. [PMID: 38137490 PMCID: PMC10740930 DOI: 10.3390/biomedicines11123269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/24/2023] Open
Abstract
The association of endotoxemia with metabolic syndrome (MS) and low-grade inflammation in type 1 diabetes (T1D) is little-studied. We investigated the levels of lipopolysaccharide (LPS), lipopolysaccharide-binding protein (LBP), endogenous anti-endotoxin core antibodies (EndoCAb IgG and IgM) and high-sensitivity C-reactive protein (hsCRP) in 74 T1D patients with different MS statuses and 33 control subjects. Within the T1D group, 31 patients had MS. These subjects had higher levels of LPS compared to patients without MS (MS 0.42 (0.35-0.56) or no MS 0.34 (0.3-0.4), p = 0.009). MS was associated with LPS/HDL (OR = 6.5 (2.1; 20.0), p = 0.036) and EndoCAb IgM (OR = 0.32 (0.11; 0.93), p = 0.036) in patients with T1D. LBP (β = 0.30 (0.09; 0.51), p = 0.005), EndoCAb IgG (β = 0.29 (0.07; 0.51), p = 0.008) and the LPS/HDL ratio (β = 0.19 (0.03; 0.41, p = 0.084) were significantly associated with log-transformed hsCRP in T1D. Higher levels of hsCRP and EndoCAb IgG were observed in T1D compared to the control (p = 0.002 and p = 0.091, respectively). In contrast to the situation in the control group, LPS did not correlate with LBP, EndoCAb, leukocytes or HDL in T1D. To conclude, endotoxemia is associated with low-grade inflammation, MS and a distinct response to LPS in T1D.
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Affiliation(s)
- Aleksejs Fedulovs
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia; (A.F.); (K.J.); (L.K.); (U.R.); (V.P.)
| | - Leonora Pahirko
- Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1004 Riga, Latvia; (L.P.); (J.V.)
| | - Kaspars Jekabsons
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia; (A.F.); (K.J.); (L.K.); (U.R.); (V.P.)
| | - Liga Kunrade
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia; (A.F.); (K.J.); (L.K.); (U.R.); (V.P.)
| | - Jānis Valeinis
- Faculty of Physics, Mathematics and Optometry, University of Latvia, LV-1004 Riga, Latvia; (L.P.); (J.V.)
| | - Una Riekstina
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia; (A.F.); (K.J.); (L.K.); (U.R.); (V.P.)
| | - Valdis Pīrāgs
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia; (A.F.); (K.J.); (L.K.); (U.R.); (V.P.)
- Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
| | - Jelizaveta Sokolovska
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia; (A.F.); (K.J.); (L.K.); (U.R.); (V.P.)
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Düzgün G, Polat G, Ünsal Avdal E. Perspective on insulin use in gestational diabetes: A phenomenological study. Medicine (Baltimore) 2023; 102:e35831. [PMID: 38065916 PMCID: PMC10713104 DOI: 10.1097/md.0000000000035831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/06/2023] [Indexed: 12/18/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is characterized by carbohydrate metabolism intolerance during pregnancy in individuals with normal blood glucose levels before pregnancy. The first-line treatment for GDM is nutrition and exercise, and insulin therapy is initiated when these are insufficient. Pregnant women who are started on insulin often think that they use drugs that may be harmful to the baby. Therefore, this study aimed to examine the perspectives of women diagnosed with gestational diabetes on insulin use using a phenomenological approach. Qualitative research was conducted using phenomenological patterns. The interviews were recorded on an online/face-to-face voice recorder in a semi-structured form, and thematic content analysis was performed using MAXQDA22. Based on the inclusion criteria of the 2 hospitals specific to the study, 15 patients were included, and the study reached saturation. Three main themes and 2 subthemes were obtained from the coding. The main themes were derived from, "fear," "baby protector," and "last remedy" coding. Pregnant women diagnosed with GDM can define gestational diabetes because of the training provided. Because the pregnancy period is sensitive, pregnant women delay control and insulin application for the health of their babies. Moreover, they sometimes experience pain during the injection, and believe that it may harm their babies.
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Affiliation(s)
- Gönül Düzgün
- Health Services Vocational School First Aid and Emergency Program, Izmir Tinaztepe University, Buca/Izmir, Turkey
| | - Gökşen Polat
- Health Services Vocational School First Aid and Emergency Program, Izmir Tinaztepe University, Buca/Izmir, Turkey
| | - Elif Ünsal Avdal
- Faculty of Health Sciences, Department of Nursing, Internal Medical Nursing Izmir Katip Celebi University, Izmir, Turkey
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da Cunha AN, Zanetti ML, Santos JLF, Rodrigues RAP. Frailty Syndrome and sarcopenia in older adults with and without type 2 diabetes mellitus in the municipality of Sinop, Mato Grosso: an epidemiological study. Rev Lat Am Enfermagem 2023; 31:e4076. [PMID: 38055592 PMCID: PMC10695296 DOI: 10.1590/1518-8345.6677.4076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/06/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to relate Frailty Syndrome and sarcopenia in older adults with and without type 2 diabetes mellitus and identify potential risk factors for frailty and sarcopenia. METHOD this descriptive epidemiological study was conducted with 140 older adults in the municipality of Sinop, Mato Grosso, Brazil. The frailty phenotype was used for the assessment of Frailty Syndrome, and a physical assessment questionnaire with calf circumference measurement was used for the assessment of sarcopenia. RESULTS regarding Frailty Syndrome, a higher percentage was observed in older adults with type 2 diabetes mellitus compared to those without the disease (p = 0.00). Concerning the presence of sarcopenia, older adults with and without type 2 diabetes mellitus showed similar values, with no statistical significance (p = .74). Frailty Syndrome was associated with physical inactivity (95%CI: 3.29-56.55), age over 75 years (95%CI: 3.30- 27.82), low family income (95%CI: 1.80-50.98), and comorbidities (95%CI: 4.90-5.40). However, sarcopenia was associated with the presence of physical inactivity (95%CI: 1.26-10.44), low weight/ eutrophic (95%CI: 3.32-26.76), and malnutrition/nutritional risk (95%CI: 1.30-7.70) for older adults with and without type 2 diabetes mellitus. CONCLUSION older adults with diabetes have a higher vulnerability to develop Frailty Syndrome, necessitating the adoption of preventive measures in primary healthcare.
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Affiliation(s)
| | - Maria Lucia Zanetti
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil
| | | | - Rosalina Aparecida Partezani Rodrigues
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil
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March C, Sherman J, Bannuru RR, Fischer A, Gabbay RA, Rodriguez H, Rodriguez J, Weissberg-Benchell J, Woodward C, ElSayed NA. Care of Young Children With Diabetes in the Childcare and Community Setting: A Statement of the American Diabetes Association. Diabetes Care 2023; 46:2102-2111. [PMID: 37902975 DOI: 10.2337/dci23-0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Diabetes management in children extends from the home to other settings where children spend a significant portion of their waking hours. For young children (generally, aged <5 years) with diabetes, this includes childcare centers. Given their age and developmental stage, young children require a carefully thought-out, proactive diabetes care plan for the childcare setting, developed jointly by the health care provider and parents/guardians, and implemented by childcare staff. In the U.S., federal laws and some state laws protect the rights of children with diabetes in childcare and other settings to ensure they receive appropriate assistance with the diabetes management and care. This American Diabetes Association (ADA) Statement addresses the legal rights of children in the childcare setting, outlines the current best practices for diabetes care, and provides resources and responsibilities for parents/guardians, childcare providers, and health care providers. The ADA intends for these tools and information to support the health and well-being of young children with diabetes and offer helpful guidance to those caring for them.
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Affiliation(s)
- Christine March
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | | | | | | | - Henry Rodriguez
- University of South Florida Morsani College of Medicine, Tampa, FL
| | | | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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26
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Smith AP, Overton K, Rakotz M, Wozniak G, Sanchez E. Target: BP™: A National Initiative to Improve Blood Pressure Control. Hypertension 2023; 80:2523-2532. [PMID: 37855141 PMCID: PMC10651269 DOI: 10.1161/hypertensionaha.123.20389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
TARGET BP™ is a national initiative launched by the American Heart Association and the American Medical Association in 2017 in response to the high prevalence of uncontrolled blood pressure (BP) in the United States. TARGET BP™ provides support to health care organizations and health care teams, with no user fees, to improve the quality of care for adults with hypertension by providing education and resources and recognizing organizations committed to prioritizing and reporting their rate of BP control. Through Target: BP™, the American Heart Association and the American Medical Association also collaborate to align policy with evidence through federal, state, and institutional policy advocacy and raise public awareness through media campaigns. In 2022, Target: BP™ recognized 1309 health care organizations serving 8.4 million patients with hypertension for prioritizing BP control, 675 of which affirmed performance of evidence-based BP measurement activities and 551 of which reported BP control rates ≥70%. With the proportion of US adults with controlled BP falling to 48.2% from 2017 to 2020, Target: BP™ remains focused on regaining lost ground in national BP control rates by emphasizing accurate BP measurement, rapid treatment intensification, healthful lifestyle changes, and evidence-based use of self-measured BP monitoring. TARGET BP™ also emphasizes adoption of team-based care models and prioritizing equitable health outcomes. More than 1.37 million unique users have visited https://targetbp.org/ and downloaded 98 341 Target: BP™ resources from 2017 to 2022.
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Affiliation(s)
- Alison P. Smith
- Target: BP™ (A.P.S.), American Heart Association, Dallas, TX
- American Medical Association, Chicago, IL (A.P.S)
| | - Katherine Overton
- Outpatient Program Development (K.O.), American Heart Association, Dallas, TX
| | - Michael Rakotz
- Michael Rakotz, Improving Health Outcomes (M.R.), Chicago, IL
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Wittman JT, Bullard KM, Benoit SR. Trends in Preventive Care Services Among U.S. Adults With Diagnosed Diabetes, 2008-2020. Diabetes Care 2023; 46:2285-2291. [PMID: 37844212 DOI: 10.2337/dc23-1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Preventive care services are important to prevent or delay complications associated with diabetes. We report trends in receipt of six American Diabetes Association-recommended preventive care services during 2008-2020. RESEARCH DESIGN AND METHODS We used 2008-2020 data from the cross-sectional Medical Expenditures Panel Survey to calculate the proportion of U.S. adults ≥18 years of age with diagnosed diabetes who reported receiving preventive care services, overall and by subpopulation (n = 25,616). We used joinpoint regression to identify trends during 2008-2019. The six services completed in the past year included at least one dental examination, dilated-eye examination, foot examination, and cholesterol test; at least two A1C tests, and an influenza vaccine. RESULTS From 2008 to 2020, proportions of U.S. adults with diabetes receiving any individual preventive care service ranged from 32.6% to 89.9%. From 2008 to 2019, overall trends in preventive services among these adults were flat except for an increase in influenza vaccination (average annual percent change: 2.6% [95% CI 1.1%, 4.2%]). Trend analysis of subgroups was heterogeneous: influenza vaccination and A1C testing showed improvements among several subgroups, whereas cholesterol testing (patients aged 45-64 years; less than a high school education; Medicaid insurance) and dental visits (uninsured) declined. In 2020, 8.2% (95% CI 4.5%, 11.9%) of those with diabetes received none of the recommended preventive care services. CONCLUSIONS Other than influenza vaccination, we observed no improvement in preventive care service use among U.S. adults with diabetes. These data highlight services and specific subgroups that could be targeted to improve preventive care among adults with diabetes.
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Affiliation(s)
- Jacob T Wittman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stephen R Benoit
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Caballero AE, ElSayed NA, Golden SH, Bannuru RR, Gregg B. Implicit or Unconscious Bias in Diabetes Care. Clin Diabetes 2023; 42:308-313. [PMID: 38694247 PMCID: PMC11060613 DOI: 10.2337/cd23-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
"Implicit bias," also called "unconscious bias," refers to associations outside of conscious awareness that adversely affect one's perception of a person or group. Awareness of implicit bias has been increasing in the realm of diabetes care. Here, the authors highlight several types of unconscious bias on the part of clinicians and patients, including biases based on race, ethnicity, and obesity. They discuss how these biases can negatively affect patient-centered clinical interactions and diabetes care delivery, and they recommend implementation of evidence-based interventions and other health system policy approaches to reduce the potential impact of such biases in health care settings.
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Affiliation(s)
| | - Nuha A. ElSayed
- Harvard Medical School, Boston, MA
- American Diabetes Association, Arlington, VA
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Ndumele CE, Neeland IJ, Tuttle KR, Chow SL, Mathew RO, Khan SS, Coresh J, Baker-Smith CM, Carnethon MR, Després JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV, Rangaswami J. A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1636-1664. [PMID: 37807920 DOI: 10.1161/cir.0000000000001186] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidney-metabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidney-metabolic syndrome.
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Rosenstock J, Frías JP, Rodbard HW, Tofé S, Sears E, Huh R, Fernández Landó L, Patel H. Tirzepatide vs Insulin Lispro Added to Basal Insulin in Type 2 Diabetes: The SURPASS-6 Randomized Clinical Trial. JAMA 2023; 330:1631-1640. [PMID: 37786396 PMCID: PMC10548360 DOI: 10.1001/jama.2023.20294] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
Importance Tirzepatide is a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist used for the treatment of type 2 diabetes. Efficacy and safety of adding tirzepatide vs prandial insulin to treatment in patients with inadequate glycemic control with basal insulin have not been described. Objective To assess the efficacy and safety of tirzepatide vs insulin lispro as an adjunctive therapy to insulin glargine. Design, Setting, and Participants This open-label, phase 3b clinical trial was conducted at 135 sites in 15 countries (participants enrolled from October 19, 2020, to November 1, 2022) in 1428 adults with type 2 diabetes taking basal insulin. Interventions Participants were randomized (in a 1:1:1:3 ratio) to receive once-weekly subcutaneous injections of tirzepatide (5 mg [n = 243], 10 mg [n = 238], or 15 mg [n = 236]) or prandial thrice-daily insulin lispro (n = 708). Main Outcomes and Measures Outcomes included noninferiority of tirzepatide (pooled cohort) vs insulin lispro, both in addition to insulin glargine, in HbA1c change from baseline at week 52 (noninferiority margin, 0.3%). Key secondary end points included change in body weight and percentage of participants achieving hemoglobin A1c (HbA1c) target of less than 7.0%. Results Among 1428 randomized participants (824 [57.7%] women; mean [SD] age, 58.8 [9.7] years; mean [SD] HbA1c, 8.8% [1.0%]), 1304 (91.3%) completed the trial. At week 52, estimated mean change from baseline in HbA1c with tirzepatide (pooled cohort) was -2.1% vs -1.1% with insulin lispro, resulting in mean HbA1c levels of 6.7% vs 7.7% (estimated treatment difference, -0.98% [95% CI, -1.17% to -0.79%]; P < .001); results met noninferiority criteria and statistical superiority was achieved. Estimated mean change from baseline in body weight was -9.0 kg with tirzepatide and 3.2 kg with insulin lispro (estimated treatment difference, -12.2 kg [95% CI, -13.4 to -10.9]). The percentage of participants reaching HbA1c less than 7.0% was 68% (483 of 716) with tirzepatide and 36% (256 of 708) with insulin lispro (odds ratio, 4.2 [95% CI, 3.2-5.5]). The most common adverse events with tirzepatide were mild to moderate gastrointestinal symptoms (nausea: 14%-26%; diarrhea: 11%-15%; vomiting: 5%-13%). Hypoglycemia event rates (blood glucose level <54 mg/dL or severe hypoglycemia) were 0.4 events per patient-year with tirzepatide (pooled) and 4.4 events per patient-year with insulin lispro. Conclusions and Relevance In people with inadequately controlled type 2 diabetes treated with basal insulin, weekly tirzepatide compared with prandial insulin as an additional treatment with insulin glargine demonstrated reductions in HbA1c and body weight with less hypoglycemia. Trial Registration ClinicalTrials.gov Identifier: NCT04537923.
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Affiliation(s)
| | | | | | - Santiago Tofé
- Department of Endocrinology and Nutrition, University Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Ruth Huh
- Eli Lilly and Company, Indianapolis, Indiana
| | | | - Hiren Patel
- Eli Lilly and Company, Indianapolis, Indiana
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Huang JH, Lo HJ. Lasting effects of a brief, scalable diabetes conversation map psychosocial intervention on health beliefs and health behaviors: A large randomized controlled trial in Taiwan. Appl Psychol Health Well Being 2023; 15:1507-1529. [PMID: 37114440 DOI: 10.1111/aphw.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
The current study aimed to examine the effects of a conversation map (CM) psychosocial intervention on diet and exercise health beliefs and health behaviors among people with diabetes (PWD). Based on the Health Belief Model, this large-scale randomized controlled trial (N = 615) investigated whether an added 1-h theory-driven CM intervention (N = 308), compared with usual shared-care service only (N = 307), could significantly better improve PWD's diet and exercise health beliefs and health behaviors at 3-month posttest. Multivariate linear autoregression analysis demonstrated that, controlling for baseline, the CM group had significantly better diet (β = .270) and exercise (β = .280) health behaviors at 3-month posttest than the control group. The intervention effects on health behavior change were primarily mediated through desired changes in targeted health beliefs, as informed by the theory. For example, as regards diet, the CM group had significantly greater increases in perceived susceptibility (β = .121), perceived benefits (β = .174), and cues to action (β = .268), as well as greater decreases in perceived barriers (β = -.156), between pretest and 3-month posttest. In conclusion, future diabetes care may integrate brief theory-driven CM interventions, as in this study, into current shared-care practice to help PWD improve diabetes self-management health behaviors more effectively. Implications for practice, policy, theory, and research are discussed.
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Affiliation(s)
- Jiun-Hau Huang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Jung Lo
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Community Medicine, Wei-Gong Memorial Hospital, Toufen, Taiwan
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Hernández-Teixidó C, López-Simarro F, Arranz Martínez E, Escobar Lavado FJ, Miravet Jiménez S. [Vulnerability and social determinants in diabetes]. Semergen 2023; 49:102044. [PMID: 37481793 DOI: 10.1016/j.semerg.2023.102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023]
Abstract
Social determinants of health significantly influence the development and progression of chronic diseases such as type2 diabetes (T2DM). This article examines key social determinants including education, economic stability, neighborhood, and factors such as ethnicity, race, or religion that impact individuals with T2DM. The role of gender as a social determinant is also explored, emphasizing the need for gender-specific considerations in T2DM management and research. Additionally, the impact of poverty on health outcomes is analyzed, highlighting the bidirectional relationship between poverty and disease. Comprehensive measures addressing these determinants are crucial to improving the health and well-being of individuals with T2DM. Addressing social inequalities through targeted interventions can contribute to better treatment outcomes and equitable healthcare.
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Affiliation(s)
- C Hernández-Teixidó
- Medicina de Familia, Centro de Salud de Alconchel, Alconchel, Badajoz, España; Miembro del grupo de trabajo de diabetes. Semergen.
| | - F López-Simarro
- Medicina de Familia, Barcelona, España; Miembro del grupo de trabajo de diabetes. Semergen
| | - E Arranz Martínez
- Medicina de Familia, Centro de Salud San Blas, Parla, Madrid, España; Miembro del grupo de trabajo de diabetes. Semergen
| | - F J Escobar Lavado
- Medicina de Familia, Centro de Salud Valsequillo, Valsequillo, Las Palmas de Gran Canaria, España; Miembro del grupo de trabajo de diabetes. Semergen
| | - S Miravet Jiménez
- Medicina de Familia, SAP Alt Penedès-Garraf-Baix Llobregat Nord, Institut Català de la Salut, Vilanova i la Geltrú, Barcelona, España; Miembro del grupo de trabajo de diabetes. Semergen
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Vaillancourt M, Mok E, Frei J, Dasgupta K, Rahme E, Bell L, Da Costa D, Nakhla M. Qualitative study exploring the perspectives of emerging adults with type 1 diabetes after transfer to adult care from a paediatric diabetes centre in Montreal, Canada. BMJ Open 2023; 13:e076524. [PMID: 37879699 PMCID: PMC10603410 DOI: 10.1136/bmjopen-2023-076524] [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: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Among youth living with type 1 diabetes (T1D), the increasing demands to diabetes self-care and medical follow-up during the transition from paediatric to adult care has been associated with greater morbidity and mortality. Inadequate healthcare support for youth during the transition care period could exacerbate psychosocial risks and difficulties that are common during emerging adulthood. The current investigation sought to explore the post-transfer perceptions of emerging adults living with T1D relating to their transition to adult care. RESEARCH DESIGN AND METHODS Thirty-three emerging adults living with T1D were recruited during paediatric care and contacted for a semistructured interview post-transfer to adult care (16.2±4.2 months post-transfer) in Montreal, Canada. We analysed data using thematic analysis. RESULTS We identified four key themes: (1) varied perceptions of the transition process from being quick and abrupt with minimal advice or information from paediatric healthcare providers (HCP) to more positive including a greater motivation for self-management and the transition being concurrent with the developmental period; (2) facilitators to the transition process included informational and tangible social support from HCPs and family or friends, a positive relationship with adult HCP and a greater ease in communicating with the adult care clinic or adult HCP; (3) barriers to adequate transition included lack of advice or information from paediatric HCPs, loss of support from HCPs and friends or family, the separation of healthcare services and greater difficulty in making appointments with adult clinic or HCP and (4) participants recommendations for improving the transition included increasing the length and frequency of appointments in adult care, having access to educational information, and better transition preparation from paediatric HCPs. CONCLUSIONS The experiences and perceptions of emerging adults are invaluable to guide the ongoing development and improvement of transition programmes for childhood-onset chronic illnesses.
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Affiliation(s)
| | - Elise Mok
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Jennifer Frei
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Lorraine Bell
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Deborah Da Costa
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Meranda Nakhla
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
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Jacobsen LM, Sherr JL, Considine E, Chen A, Peeling SM, Hulsmans M, Charleer S, Urazbayeva M, Tosur M, Alamarie S, Redondo MJ, Hood KK, Gottlieb PA, Gillard P, Wong JJ, Hirsch IB, Pratley RE, Laffel LM, Mathieu C. Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:132. [PMID: 37794113 PMCID: PMC10550996 DOI: 10.1038/s43856-023-00358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The greatest change in the treatment of people living with type 1 diabetes in the last decade has been the explosion of technology assisting in all aspects of diabetes therapy, from glucose monitoring to insulin delivery and decision making. As such, the aim of our systematic review was to assess the utility of these technologies as well as identify any precision medicine-directed findings to personalize care. METHODS Screening of 835 peer-reviewed articles was followed by systematic review of 70 of them (focusing on randomized trials and extension studies with ≥50 participants from the past 10 years). RESULTS We find that novel technologies, ranging from continuous glucose monitoring systems, insulin pumps and decision support tools to the most advanced hybrid closed loop systems, improve important measures like HbA1c, time in range, and glycemic variability, while reducing hypoglycemia risk. Several studies included person-reported outcomes, allowing assessment of the burden or benefit of the technology in the lives of those with type 1 diabetes, demonstrating positive results or, at a minimum, no increase in self-care burden compared with standard care. Important limitations of the trials to date are their small size, the scarcity of pre-planned or powered analyses in sub-populations such as children, racial/ethnic minorities, people with advanced complications, and variations in baseline glycemic levels. In addition, confounders including education with device initiation, concomitant behavioral modifications, and frequent contact with the healthcare team are rarely described in enough detail to assess their impact. CONCLUSIONS Our review highlights the potential of technology in the treatment of people living with type 1 diabetes and provides suggestions for optimization of outcomes and areas of further study for precision medicine-directed technology use in type 1 diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mustafa Tosur
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Selma Alamarie
- Stanford University School of Medicine, Stanford, CA, USA
| | - Maria J Redondo
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Korey K Hood
- Stanford University School of Medicine, Stanford, CA, USA
| | - Peter A Gottlieb
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Jessie J Wong
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Irl B Hirsch
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Koonmen LA, Lennie TA, Hieronymus LB, Rayens MK, Ickes M, Miller JL, Mudd-Martin G. COVID-19 Impact Predicts Diabetes Distress Among Individuals With Type 2 Diabetes. Sci Diabetes Self Manag Care 2023; 49:392-400. [PMID: 37658648 DOI: 10.1177/26350106231196300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE The purpose of this study was to determine whether COVID-19 impact and Diabetes Self-Management Education and Support (DSMES) service attendance predicted diabetes distress among individuals with type 2 diabetes during the pandemic. METHODS Eighty-six adults with type 2 diabetes who either attended (n = 29) or did not previously attend (n = 57) DSMES services completed a cross-sectional survey. Participants' mean age was 57 ± 12.3 years, 50% were female, and 71.3% were diagnosed with diabetes >5 years. The Coronavirus Impact Scale was used to measure impact of the pandemic on daily life. The Diabetes Distress Scale was used to measure distress overall and within 4 subscales (emotional burden, interpersonal distress, physician-related distress, regimen distress). Separate multiple linear regressions were conducted for each outcome, controlling for age, sex, marital status, financial status, and time since diabetes diagnosis. RESULTS Higher COVID-19 impact predicted higher diabetes-related distress for all subscales and overall. Only the subscale for interpersonal distress was predicted by DSMES attendance, which decreased with DSMES attendance. CONCLUSION This study identifies a link between the effects of the COVID-19 pandemic and diabetes distress. The findings highlight the negative impact of the pandemic on diabetes distress and the importance of DSMES services for diabetes-related distress. Interventions are needed to reduce psychological distress among this population during public health crises.
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Affiliation(s)
- Leigh Anne Koonmen
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan
| | - Terry A Lennie
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | | | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Melinda Ickes
- College of Education, College of Nursing, University of Kentucky, Lexington, Kentucky
| | | | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, Lexington, Kentucky
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36
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Kim YC, Wolf RM, Busin KM, Vanderhoek SM. Perioperative maintenance of hybrid closed loop insulin pump systems in youth with type 1 diabetes mellitus: A case series. Paediatr Anaesth 2023; 33:862-867. [PMID: 37489542 DOI: 10.1111/pan.14732] [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: 04/11/2023] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
Current guidelines support the use of continuous glucose monitoring devices and insulin pumps in minor surgical procedures for pediatric patients with type 1 diabetes mellitus. However, there are few reported cases of using hybrid closed loop technology in the perioperative period. This retrospective case series presents seven pediatric patients with type 1 diabetes who underwent eight surgical procedures with maintenance of hybrid closed loop systems. This paper also provides considerations for future use of hybrid closed loop systems perioperatively.
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Affiliation(s)
- Yoohee Claire Kim
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risa M Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly M Busin
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samuel M Vanderhoek
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesia, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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37
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Bozkurt AK, VAN Rijn MJ, Bouskela E, Gastaldi G, Glauser F, Haller H, Rosas-Saucedo J, Zingg D, Calabrese A, Rabe E, Mansilha A. Enhancing identification and treatment of patients with concomitant chronic venous insufficiency and diabetes mellitus. A modified Delphi study from the CODAC (ChrOnic venous disease and Diabetes Advisory Council) group. INT ANGIOL 2023; 42:427-435. [PMID: 37962898 DOI: 10.23736/s0392-9590.23.05061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Chronic venous insufficiency (CVI) and diabetes mellitus (DM) pose significant burdens to patients and healthcare systems. While the two diseases share a number of commonalities in risk factors and pathophysiology, they are often assessed and managed separately. This can lead to a worsening of comorbidities and limitations in a patient's quality of life. This project aims to develop recommendations to enhance the identification and treatment of patients with concomitant CVI and DM. METHODS Using a modified Delphi method, a panel of experts developed 38 Likert Scale and two multiple choice questions across six key themes. These were used to form an online survey which was disseminated through a convenience sampling approach to CVI and DM healthcare professionals across Europe, Central America, South America, and the Middle East. The threshold for consensus was set at ≥75%. RESULTS A total of 238 responses were received. 27/38 statements attained >90% agreement, nine of 38 attained between 75-90%, and two failed to meet the threshold (<75%). The awareness around the impact of the two diseases was high, but a gap was highlighted in the identification of patients with concomitant CVI and DM. CONCLUSIONS The high level of agreement shows that healthcare professionals are aware of the gaps in identification and treatment of patients with concomitant CVI and DM, and of the need to approach this as a combined therapy area. An algorithm is proposed to help the identification of at-risk patients and to provide recommendations on the management of patients with concomitant disease.
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Affiliation(s)
- Ahmet K Bozkurt
- Department of Cardiovascular Surgery, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Marie J VAN Rijn
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands -
| | - Eliete Bouskela
- Biomedical Center, Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giacomo Gastaldi
- Division of Endocrinology, Diabetology, Nutrition, and Patient Education, University Hospital of Geneva, Geneva, Switzerland
| | - Frederic Glauser
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Hermann Haller
- Hannover Medical School, Department of Nephrology and Hypertension, Hanover, Germany
| | | | | | | | - Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Armando Mansilha
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Angiology and Vascular Surgery, Hospital de S. João, Porto, Portugal
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38
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Parissis J, Georgiou C, Bistola V, Karavidas A, Vassilikos VP, Kanakakis J, Davlouros P, Tziakas DN, Alexanian IP, Kochiadakis G, Triposkiadis F, Karvounis H, Gourlis D, Papoutsidakis N, Polyzogopoulou E, Vlachopoulos C. Rationale and Design of Heart Failure Prevalence and Evolution of Heart Failure in Diabetes Mellitus Type II Patients at High Risk (HF-LanDMark Study). J Clin Med 2023; 12:6319. [PMID: 37834963 PMCID: PMC10573953 DOI: 10.3390/jcm12196319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Patients with diabetes mellitus (DM) are at increased risk for heart failure (HF). Accurate data regarding the prevalence of HF stages among diabetics in Greece are scarce. (2) Aim: The present study will examine the prevalence and evolution of HF stages among patients with type II DM (T2DM) diagnosed in the past 10 years, with no previous history of HF and at high CV risk, in Greece, as well as will explore the potential determinants of the development of symptomatic HF in these patients. (3) Methods: Through a non-interventional, epidemiological, single-country, multi-center, prospective cohort study design, a sample of 300 consecutive patients will be enrolled in 11 cardiology departments that are HF centers of excellence. Patients will be either self-referred or referred by primary or secondary care physicians and will be followed for up to 24 months. Demographic, clinical, echocardiography, electrocardiography, cardiac biomarkers (troponin, NT-proBNP) and health-related quality of life questionnaire data will be recorded as well as clinical events, including mortality, HF hospitalizations and HF-related healthcare resource utilization. The primary outcomes are the proportion of patients diagnosed with symptomatic HF (ACC/AHA Stage C) at enrolment in the overall study population and the proportions of patients with HF stages A, B and C, as well as by NYHA functional classification in the overall study population. (4) Conclusions: The HF-LanDMark study is the first epidemiological study that will assess the prevalence of HF among T2DM patients in Greece that could potentially enhance prompt therapeutic interventions shown to delay the development of HF in the T2DM patient population (HF-LanDMark, Clinical Trials.gov number, NCT04482283).
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Affiliation(s)
- John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12461 Athens, Greece; (C.G.); (E.P.)
| | - Christos Georgiou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12461 Athens, Greece; (C.G.); (E.P.)
| | - Vasiliki Bistola
- Heart Failure Unit, 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12461 Athens, Greece
| | - Apostolos Karavidas
- Department of Cardiology, “G. Gennimatas” General Hospital, 11527 Athens, Greece;
| | - Vassilios P. Vassilikos
- 3rd Cardiology Department, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece;
| | - John Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, 11527 Athens, Greece;
| | - Periklis Davlouros
- Department of Cardiology, School of Medicine, University of Patras, 26504 Patras, Greece;
| | - Dimitrios N. Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Ioannis P. Alexanian
- Second Department of Cardiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece;
| | - George Kochiadakis
- Department of Cardiology, Heraklion University Hospital, 71500 Iraklio, Greece;
| | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, 41334 Larissa, Greece;
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Dimitrios Gourlis
- AstraZeneca Greece, Agisilaou 6-8, 15123 Maroussi, Greece; (D.G.); (N.P.)
| | | | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12461 Athens, Greece; (C.G.); (E.P.)
| | - Charalambos Vlachopoulos
- First Cardiology Department, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece;
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Tokarek J, Budny E, Saar M, Stańczak K, Wojtanowska E, Młynarska E, Rysz J, Franczyk B. Molecular Processes Involved in the Shared Pathways between Cardiovascular Diseases and Diabetes. Biomedicines 2023; 11:2611. [PMID: 37892985 PMCID: PMC10604380 DOI: 10.3390/biomedicines11102611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
Cardiovascular diseases and diabetes mellitus are currently among the diseases with the highest morbidity and mortality. The pathogenesis and development of these diseases remain strongly connected, along with inflammation playing a major role. Therefore, the treatment possibilities showing a positive impact on both of these diseases could be especially beneficial for patients. SGLT-2 inhibitors and GLP-1 receptor agonists present this dual effect. Moreover, the hostile composition of the gut microbiota could influence the progression of these conditions. In this review, the authors present the latest knowledge on and innovations in diabetes mellitus and CVD-with the focus on the molecular mechanisms and the role of the microbiota.
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Affiliation(s)
- Julita Tokarek
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland (K.S.); (E.W.)
| | - Emilian Budny
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland (K.S.); (E.W.)
| | - Maciej Saar
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland (K.S.); (E.W.)
| | - Kamila Stańczak
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland (K.S.); (E.W.)
| | - Ewa Wojtanowska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland (K.S.); (E.W.)
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland (K.S.); (E.W.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland (K.S.); (E.W.)
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Tanase DM, Gosav EM, Botoc T, Floria M, Tarniceriu CC, Maranduca MA, Haisan A, Cucu AI, Rezus C, Costea CF. Depiction of Branched-Chain Amino Acids (BCAAs) in Diabetes with a Focus on Diabetic Microvascular Complications. J Clin Med 2023; 12:6053. [PMID: 37762992 PMCID: PMC10531730 DOI: 10.3390/jcm12186053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) still holds the title as one of the most debilitating chronic diseases with rising prevalence and incidence, including its complications such as retinal, renal, and peripheral nerve disease. In order to develop novel molecules for diagnosis and treatment, a deep understanding of the complex molecular pathways is imperative. Currently, the existing agents for T2DM treatment target only blood glucose levels. Over the past decades, specific building blocks of proteins-branched-chain amino acids (BCAAs) including leucine, isoleucine, and valine-have gained attention because they are linked with insulin resistance, pre-diabetes, and diabetes development. In this review, we discuss the hypothetical link between BCAA metabolism, insulin resistance, T2DM, and its microvascular complications including diabetic retinopathy and diabetic nephropathy. Further research on these amino acids and their derivates may eventually pave the way to novel biomarkers or therapeutic concepts for the treatment of diabetes and its accompanied complications.
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Affiliation(s)
- Daniela Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.T.); (E.M.G.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Evelina Maria Gosav
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.T.); (E.M.G.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Tina Botoc
- Department of Ophthalmology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (C.F.C.)
- 2nd Ophthalmology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.T.); (E.M.G.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Claudia Cristina Tarniceriu
- Department of Morpho-Functional Sciences I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Hematology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Minela Aida Maranduca
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Haisan
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Emergency Department, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Andrei Ionut Cucu
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, “Ștefan cel Mare” University, 720229 Suceava, Romania;
- Department of Neurosurgery, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.T.); (E.M.G.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Claudia Florida Costea
- Department of Ophthalmology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (C.F.C.)
- 2nd Ophthalmology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
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Li X, Song X, Han Y, Qiu Z, Cao W, Li T. Risk factors and longitudinal changes of dyslipidemia among Chinese people living with HIV receiving antiretroviral therapy. BMC Infect Dis 2023; 23:598. [PMID: 37705002 PMCID: PMC10500758 DOI: 10.1186/s12879-023-08587-0] [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: 09/11/2022] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) improved the prognosis of people living with human immunodeficiency virus (HIV) (PLWH). Life-long treatment is required in PLWH and is accompanied by various metabolic abnormalities in the disease course. Data about the epidemiology and the dynamic changes of dyslipidemia in PLWH receiving antiretroviral therapy were scarce in Asian countries. This study aimed to explore the risk factors of dyslipidemia and analyze the longitudinal changes of dyslipidemia among Chinese PLWH receiving HAART. METHODS We conducted a longitudinal analysis of PLWH enrolled in two large multicenter clinical trials across China, and outpatients followed at the clinic of Peking Union Medical College Hospital. Demographic data and clinical parameters were collected. The risk factors and longitudinal changes in lipid profiles associated with HIV-1 infection were analyzed. The definition of dyslipidemia was made based on the National Cholesterol Education Program, Adult Treatment Panel (NCEP-ATP) III guidelines. RESULTS A total of 1542 PLWH were included. The median follow-up was 6 years. At baseline, the concentrations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were 4.1 ± 0.91 mmol/L, 1.2 (interquartile ranges [IQR] 0.85-1.75) mmol/L, 1.1 ± 0.37 and 2.4 ± 0.76 mmol/L, respectively. The rate of hypercholesterolemia, hyperglyceridemia, high LDL-C, and low HDL-C were 10.18%, 26.39%, 9.08%, and 44.94%, respectively. The overall prevalence of dyslipidemia was 69.3%, which raised to 84.3% after antiretroviral therapy, substantially higher. CD4/CD8 ratio < 0.3 and viral load > 105 copies/mL were risk factors associated with any subtype of dyslipidemia. A negative correlation between CD8+CD38+ percentage and HDL-C concentration was found. The regimens including efavirenz (EFV) and tenofovir (TDF) showed better lipid profiles. Longitudinal analysis revealed that both the level and the percentage of abnormal TG and HDL-C occurred drastic change in the first 6 months after ART initiation (from 4.07 to 4.41, from 1.11 to 1.28mmol/L, from 26.39 to 31.1% and from 44.94 to 29.5%, respectively). CONCLUSIONS The prevalence of dyslipidemia is high in PLWH and increases after ART, mainly represented as high TG and low HDL-C and associated with advanced stage of HIV-1 infection. The greatest changes in lipids occurred in the early stage after initiating ART therapy. The results suggest that dyslipidemia should be monitored and managed when starting ART.
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Affiliation(s)
- Xiuxia Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Yang Han
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Zhifeng Qiu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Wei Cao
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
- Clinical Immunology Center, Chinese Academy of Medical Sciences, Beijing, China.
- Tsinghua University Medical College, Beijing, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Lazarus JV, Mark HE, Allen AM, Arab JP, Carrieri P, Noureddin M, Alazawi W, Alkhouri N, Alqahtani SA, Arrese M, Bataller R, Berg T, Brennan PN, Burra P, Castro-Narro GE, Cortez-Pinto H, Cusi K, Dedes N, Duseja A, Francque SM, Hagström H, Huang TTK, Wajcman DI, Kautz A, Kopka CJ, Krag A, Miller V, Newsome PN, Rinella ME, Romero D, Sarin SK, Silva M, Spearman CW, Tsochatzis EA, Valenti L, Villota-Rivas M, Zelber-Sagi S, Schattenberg JM, Wong VWS, Younossi ZM. A global research priority agenda to advance public health responses to fatty liver disease. J Hepatol 2023; 79:618-634. [PMID: 37353401 DOI: 10.1016/j.jhep.2023.04.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND & AIMS An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. METHODS Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. RESULTS The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of 'agree' responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement ('agree' + 'somewhat agree'); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% 'agree'), 13 priorities had <80% 'agree', with greater reliance on 'somewhat agree' to achieve >90% combined agreement. CONCLUSIONS Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community's efforts to advance and accelerate responses to this widespread and fast-growing public health threat. IMPACT AND IMPLICATIONS An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA.
| | - Henry E Mark
- European Association for the Study of the Liver (EASL), Geneva, Switzerland; Independent Consultant, Nottingham, UK
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juan Pablo Arab
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Mazen Noureddin
- Houston Methodist Hospital, Houston Research Institute, Houston, TX, USA
| | - William Alazawi
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - Naim Alkhouri
- Fatty Liver Program, Arizona Liver Health, Phoenix, AZ, USA
| | - Saleh A Alqahtani
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ramon Bataller
- Liver Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Paul N Brennan
- Division of Hepatology, University of Dundee, Dundee, Scotland, UK
| | - Patrizia Burra
- Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology and Gastroenterology at the Padua University Hospital, Padua, Italy
| | - Graciela E Castro-Narro
- Department of Hepatology and Transplant, Hospital Médica Sur, Mexico City, Mexico; Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Asociación Latinoamericana para el Estudio del Hígado (ALEH), Santiago, Chile
| | - Helena Cortez-Pinto
- Clinica Universitária de Gastrenterologia, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sven M Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium; InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Terry T-K Huang
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA; CUNY Center for Systems and Community Design and NYU-CUNY Prevention Research Center, New York, NY, USA
| | - Dana Ivancovsky Wajcman
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Veronica Miller
- University California Berkeley School of Public Health, Berkeley, CA, USA
| | - Philip N Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Mary E Rinella
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Diana Romero
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Marcelo Silva
- Hepatology and Clinical Research Units, Hospital Universitario Austral, Buenos Aires, Argentina
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Luca Valenti
- Precision Medicine, Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany
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Ha J, Chung ST, Bogardus C, Jagannathan R, Bergman M, Sherman AS. One-hour glucose is an earlier marker of dysglycemia than two-hour glucose. Diabetes Res Clin Pract 2023; 203:110839. [PMID: 37482221 PMCID: PMC10592221 DOI: 10.1016/j.diabres.2023.110839] [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: 05/15/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
AIMS The timing of increase in 1-hour PG and its utility as an earlier predictor of both prediabetes (PreDM) and type 2 diabetes (T2D) compared to 2-hour PG (2 h-PG) are unknown. To evaluate the timing of crossing of the 1 h-PG ≥ 155 mg/dl (8.6 mmol/L) for PreDM and 209 mg/dl (11.6 mmol/L) for T2D and respective current 2 h-PG thresholds of 140 mg/dl (7.8 mmol/L) and 200 mg/dl (11.1 mmol/L). METHODS Secondary analysis of 201 Southwest Native Americans who were followed longitudinally for 6-10 years and had at least 3 OGTTs. RESULTS We identified a subset of 43 individuals who first developed PreDM by both 1 h-PG and 2 h-PG criteria during the study. For most (32/43,74%), 1 h-PG ≥ 155 mg/dl was observed before 2 h-PG reached 140 mg/dl (median [IQR]: 1.7 [-0.25, 4.59] y; mean ± SEM: 5.3 ± 1.9 y). We also identified a subset of 33 individuals who first developed T2D during the study. For most (25/33, 75%), 1 h-PG reached 209 mg/dl earlier (median 1.0 [-0.56, 2.02] y; mean ± SEM: 1.6 ± 0.8 y) than 2 h-PG reached 200 mg/dl, diagnostic of T2D. CONCLUSIONS 1 h-PG ≥ 155 mg/dl is an earlier marker of elevated risk for PreDM and T2D than 2 h-PG ≥ 140 mg/dl.
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Affiliation(s)
- Joon Ha
- Department of Mathematics, Howard University, Washington, DC, USA
| | - Stephanie T Chung
- Section on Pediatric Diabetes, Obesity, and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Clifton Bogardus
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 445 N 5th Street, Phoenix, AZ 85004, USA
| | - Ram Jagannathan
- Hubert Department of Global Health, Emory University School of Public Health Atlanta, GA, USA
| | - Michael Bergman
- NYU Grossman School of Medicine, Departments of Medicine and Population Health, Division of Endocrinology, Diabetes, Metabolism, VA New York Harbor Healthcare System, Manhattan Campus, New York, NY 10010, USA
| | - Arthur S Sherman
- Laboratory of Biological Modeling, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
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Berkowitz SA, Orr CJ. Three Lessons About Diabetes and the Social Determinants of Health. Diabetes Care 2023; 46:1587-1589. [PMID: 37354315 PMCID: PMC10465981 DOI: 10.2337/dci23-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Colin J. Orr
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Schönberger E, Mihaljević V, Steiner K, Šarić S, Kurevija T, Majnarić LT, Bilić Ćurčić I, Canecki-Varžić S. Immunomodulatory Effects of SGLT2 Inhibitors-Targeting Inflammation and Oxidative Stress in Aging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6671. [PMID: 37681811 PMCID: PMC10487537 DOI: 10.3390/ijerph20176671] [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: 07/14/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
Given that the increase in the aging population has grown into one of the largest public health issues, inflammation and oxidative stress, which are closely associated with the aging process, became a focus of recent research. Sodium-glucose co-transporter 2 (SGLT2) inhibitors, a group of drugs initially developed as oral antidiabetics, have shown many beneficial effects over time, including improvement in renal function and cardioprotective effects. It has been shown that SGLT2 inhibitors, as a drug class, have an immunomodulatory and antioxidative effect, affecting endothelial function as well as metabolic parameters. Therefore, it is not surprising that various studies have investigated the potential mechanisms of action of SGLT2 inhibitors in age-related diseases. The proposed mechanisms by which SGLT2 inhibitors can achieve their anti-inflammatory effects include influence on AMPK/SIRT1/PGC-1α signaling, various cytokines, and the NLRP3 inflammasome. The antioxidative effect is related to their action on mitochondria and their influence on the signaling pathways of transforming growth factor β and nuclear erythroid 2-related factor 2/antioxidant response element. Also, SGLT2 inhibitors achieve their anti-inflammatory and antioxidative effects by affecting metabolic parameters, such as uric acid reduction, stimulation of ketogenesis, reduction of body weight, lipolysis, and epicardial fat tissue. Finally, SGLT2 inhibitors display anti-atherosclerotic effects that modulate inflammatory reactions, potentially resulting in improvement in endothelial function. This narrative review offers a complete and comprehensive overview of the possible pathophysiologic mechanisms of the SGLT2 inhibitors involved in the aging process and development of age-related disease. However, in order to use SGLT2 inhibitor drugs as an anti-aging therapy, further basic and clinical research is needed to elucidate the potential effects and complex mechanisms they have on inflammation processes.
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Affiliation(s)
- Ema Schönberger
- Department of Endocrinology, University Hospital Osijek, 31000 Osijek, Croatia; (E.S.); (K.S.); (S.C.-V.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vjera Mihaljević
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia;
| | - Kristina Steiner
- Department of Endocrinology, University Hospital Osijek, 31000 Osijek, Croatia; (E.S.); (K.S.); (S.C.-V.)
| | - Sandra Šarić
- Department for Cardiovascular Disease, University Hospital Osijek, 31000 Osijek, Croatia;
- Department of Internal Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Tomislav Kurevija
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; (T.K.); (L.T.M.)
- Health Center Osjecko-Baranjska County, 31000 Osijek, Croatia
| | - Ljiljana Trtica Majnarić
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia; (T.K.); (L.T.M.)
| | - Ines Bilić Ćurčić
- Department of Endocrinology, University Hospital Osijek, 31000 Osijek, Croatia; (E.S.); (K.S.); (S.C.-V.)
- Department of Pharmacology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Silvija Canecki-Varžić
- Department of Endocrinology, University Hospital Osijek, 31000 Osijek, Croatia; (E.S.); (K.S.); (S.C.-V.)
- Department of Pathophysiology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
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Frias JP, Deenadayalan S, Erichsen L, Knop FK, Lingvay I, Macura S, Mathieu C, Pedersen SD, Davies M. Efficacy and safety of co-administered once-weekly cagrilintide 2·4 mg with once-weekly semaglutide 2·4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial. Lancet 2023; 402:720-730. [PMID: 37364590 DOI: 10.1016/s0140-6736(23)01163-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Combining the GLP-1 receptor agonist semaglutide with the long-acting amylin analogue cagrilintide has weight-loss benefits; the impact on glycated haemoglobin (HbA1c) is unknown. This trial assessed the efficacy and safety of co-administered semaglutide with cagrilintide (CagriSema) in participants with type 2 diabetes. METHODS This 32-week, multicentre, double-blind, phase 2 trial was conducted across 17 sites in the USA. Adults with type 2 diabetes and a BMI of 27 kg/m2 or higher on metformin with or without an SGLT2 inhibitor were randomly assigned (1:1:1) to once-weekly subcutaneous CagriSema, semaglutide, or cagrilintide (all escalated to 2·4 mg). Randomisation was done centrally using an interactive web response system and was stratified according to use of SGLT2 inhibitor treatment (yes vs no). The trial participants, investigators, and trial sponsor staff were masked to treatment assignment throughout the trial. The primary endpoint was change from baseline in HbA1c; secondary endpoints were bodyweight, fasting plasma glucose, continuous glucose monitoring (CGM) parameters, and safety. Efficacy analyses were performed in all participants who had undergone randomisation, and safety analyses in all participants who had undergone randomisation and received at least one dose of the trial medication. This trial is registered on ClinicalTrials.gov (NCT04982575) and is complete. FINDINGS Between Aug 2 and Oct 18, 2021, 92 participants were randomly assigned to CagriSema (n=31), semaglutide (n=31), or cagrilintide (n=30). 59 (64%) participants were male; the mean age of participants was 58 years (SD 9). The mean change in HbA1c from baseline to week 32 (CagriSema: -2·2 percentage points [SE 0·15]; semaglutide: -1·8 percentage points [0·16]; cagrilintide: -0·9 percentage points [0·15]) was greater with CagriSema versus cagrilintide (estimated treatment difference -1·3 percentage points [95% CI -1·7 to -0·8]; p<0·0001), but not versus semaglutide (-0·4 percentage points [-0·8 to 0·0]; p=0·075). The mean change in bodyweight from baseline to week 32 (CagriSema: -15·6% [SE 1·26]; semaglutide: -5·1% [1·26]; cagrilintide: -8·1% [1·23]) was greater with CagriSema versus both semaglutide (p<0·0001) and cagrilintide (p<0·0001). The mean change in fasting plasma glucose from baseline to week 32 (CagriSema: -3·3 mmol/L [SE 0·3]; semaglutide: -2·5 mmol/L [0·4]; cagrilintide: -1·7 mmol/L [0·3]) was greater with CagriSema versus cagrilintide (p=0·0010) but not versus semaglutide (p=0·10). Time in range (3·9-10·0 mmol/L) was 45·9%, 32·6%, and 56·9% at baseline and 88·9%, 76·2%, and 71·7% at week 32 with CagriSema, semaglutide, and cagrilintide, respectively. Adverse events were reported by 21 (68%) participants in the CagriSema group, 22 (71%) in the semaglutide group, and 24 (80%) in the cagrilintide group. Mild or moderate gastrointestinal adverse events were most common; no level 2 or 3 hypoglycaemia was reported. No fatal adverse events were reported. INTERPRETATION In people with type 2 diabetes, treatment with CagriSema resulted in clinically relevant improvements in glycaemic control (including CGM parameters). The mean change in HbA1c with CagriSema was greater versus cagrilintide, but not versus semaglutide. Treatment with CagriSema resulted in significantly greater weight loss versus semaglutide and cagrilintide and was well tolerated. These data support further investigation of CagriSema in this population in longer and larger phase 3 studies. FUNDING Novo Nordisk.
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Affiliation(s)
- Juan P Frias
- Velocity Clinical Research, Los Angeles, CA, USA.
| | | | | | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ildiko Lingvay
- Division of Endocrinology, Department of Internal Medicine and Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Chantal Mathieu
- Clinical and Experimental Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Sue D Pedersen
- C-ENDO Diabetes and Endocrinology Clinic, Calgary, AB, Canada
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
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de Souza SW, Lopes MS, Martins BR, da Costa MA, Nesi-França S, Manica GCM, Winter Boldt AB, Couto Alves A, Moure VR, Valdameri G, Picheth G, Rego FGDM. Apolipoprotein M gene polymorphisms in childhood-onset type 1 diabetes in southern Brazil. INTERNATIONAL JOURNAL OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2023; 14:51-61. [PMID: 37736389 PMCID: PMC10509533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/27/2023] [Indexed: 09/23/2023]
Abstract
Type 1 diabetes mellitus (T1DM), associated with autoimmune destruction of pancreatic β cells, is observed in children and adolescents. OBJECTIVE We investigated the potential association of the apolipoprotein M (APOM) polymorphisms rs707921, rs805264, rs805296, rs805297, and rs9404941 in childhood-onset T1DM (n = 144) and compared them to those in healthy (mostly Euro-Brazilian) children (n = 168). METHODS This project was approved by the Ethics Committee of the Federal University of Parana (CAAE 24676613.6.0000.0102). Genotyping was performed using PCR-restriction fragment length polymorphisms (rs805296 and rs9404941) and TaqMan probes (rs707921, rs805264, and rs805297). RESULTS All polymorphisms were in Hardy-Weinberg equilibrium. In the codominant model, no significant differences (P > 0.05) were observed in genotype and allele frequencies between healthy controls and children with T1DM. The minor allele frequencies (95% CI) for healthy subjects were rs707921 (A, 10.7%; 7-14%), rs805264 (A, 6.5%; 4-9%), rs805296 (C, 3.6%; 2-6%), rs805297 (A, 22.6%; 22-31%), and rs9404941 (C, 2.7%; 1-4%). The frequencies of the rs805297 A allele and rs805296 C allele were similar to those of other Caucasian populations; both the rs707921 and rs805264 A alleles were similar to American and Latin American populations, whereas that of the rs9404941 C allele was lower than that observed in the Caucasian and Asian populations. CONCLUSIONS Haplotype analysis suggests that rs805297-C, rs9404941-T, rs805296-T, rs805264-G, and rs707921-C conferred risk (OR: 4.25; 95% CI: 1.81-10.1) to childhood-onset T1DM in the Euro-Brazilian population.
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Affiliation(s)
- Susan Webber de Souza
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
| | - Mateus Santana Lopes
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
| | - Bruna Rodrigues Martins
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
| | - Manoella Abrão da Costa
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
| | - Suzana Nesi-França
- Pediatric Endocrinology Unit, Department of Pediatrics, Federal University of ParanaCuritiba, PR, Brazil
| | - Graciele Cristiane More Manica
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
| | | | - Alexessander Couto Alves
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of SurreyGuildford, Surrey, UK
| | - Vivian Rotuno Moure
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
| | - Glaucio Valdameri
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
| | - Geraldo Picheth
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
| | - Fabiane Gomes de Moraes Rego
- Department of Clinical Analysis, Post-Graduate Program in Pharmaceutical Sciences, Federal University of ParanaCuritiba, PR, Brazil
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Alfaifi A. Association between non-pharmacological therapy and healthcare use and expenditure of patients with diabetes mellitus. Saudi Pharm J 2023; 31:101685. [PMID: 37448845 PMCID: PMC10336783 DOI: 10.1016/j.jsps.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
This study explored the sociodemographic and clinical characteristics of patients with diabetes who incorporated two non-pharmacological therapies into their lifestyle and the association between non-pharmacological therapy and healthcare utilization and expenditure. In the USA, 26.4 million people were reportedly diagnosed with diabetes and treated with diet modification or physical activity in the 2019 Medical Expenditure Panel Survey. Physical activity was defined as moderate-to-vigorous physical exercise five times per week, whereas dietary modification involved healthy eating that reduced glucose levels. Only 4.8 million patients with diabetes did not integrate any non-pharmacological intervention into their therapy regimen. Those who did not include non-pharmacological interventions had higher annual total healthcare expenditures (M = $18,428) than those who incorporated either single (M = $17,058) or dual intervention (M = $15,134). A significant difference was observed in prescribed medicine utilization per year for those who did not include lifestyle modifications or non-pharmacological interventions. Propensity score-matched participants revealed significant differences in hospital stays, outpatient visits, and emergency department expenditures. Patients with diabetes who adhered to two non-pharmacological interventions showed significantly lower healthcare utilization. Being active and following a healthy diet can help prevent the progression of diabetes mellitus complications and reduce the cost associated with diabetes.
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García-Compeán D, Jiménez-Rodríguez AR, Muñoz-Ayala JM, González-González JA, Maldonado-Garza HJ, Villarreal-Pérez JZ. Post-acute pancreatitis diabetes: A complication waiting for more recognition and understanding. World J Gastroenterol 2023; 29:4405-4415. [PMID: 37576704 PMCID: PMC10415972 DOI: 10.3748/wjg.v29.i28.4405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Post-acute pancreatitis diabetes (PAPD) is the second most common type of diabetes below type 2 diabetes mellitus. Due to the boom in research on this entity carried out during the last decade, its recognition has increased. However, much of the medical community still does not recognize it as a medium and long-term complication of acute pancreatitis (AP). Recent prospective cohort studies show that its incidence is about 23% globally and 34.5% in patients with severe AP. With the overall increase in the incidence of AP this complication will be certainly seen more frequently. Due to its high morbidity, mortality and difficult control, early detection and treatment are essential. However, its risk factors and pathophysiological mechanisms are not clearly defined. Its diagnosis should be made excluding pre-existing diabetes and applying the criteria of the American Diabetes Association after 90 d of resolution of one or more AP episodes. This review will show the evidence published so far on the incidence and prevalence, risk factors, possible pathophysiological mechanisms, clinical outcomes, clinical characteristics and preventive and corrective management of PAPD. Some important gaps needing to be clarified in forthcoming studies will also be discussed.
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Affiliation(s)
- Diego García-Compeán
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Alan R Jiménez-Rodríguez
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Juan M Muñoz-Ayala
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - José A González-González
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Héctor J Maldonado-Garza
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Jesús Z Villarreal-Pérez
- Department of Endocrinology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
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Agarwal S, Wade AN, Mbanya JC, Yajnik C, Thomas N, Egede LE, Campbell JA, Walker RJ, Maple-Brown L, Graham S. The role of structural racism and geographical inequity in diabetes outcomes. Lancet 2023; 402:235-249. [PMID: 37356447 DOI: 10.1016/s0140-6736(23)00909-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.
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Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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