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de Vries SAG, Verheugt CL, Mul D, Nieuwdorp M, Sas TCJ. Do sex differences in paediatric type 1 diabetes care exist? A systematic review. Diabetologia 2023; 66:618-630. [PMID: 36700969 PMCID: PMC9947056 DOI: 10.1007/s00125-022-05866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/25/2022] [Indexed: 01/27/2023]
Abstract
AIMS/HYPOTHESIS Sex differences are present in cardiovascular care and in outcomes among adults with type 1 diabetes mellitus, which typically commences in childhood. Whether sex influences care and outcomes in childhood is not known. This systematic review provides an overview of sex differences in children with type 1 diabetes, focusing on patient and disease characteristics, treatment, comorbidities and complications. METHODS Literature in MEDLINE up to 15 June 2021 was searched, using the terms diabetes mellitus, sex characteristics, sex distribution, children and/or adolescents. All primary outcome studies on children with type 1 diabetes that mentioned a sex difference in outcome were included, with the exception of qualitative studies, case reports or case series. Studies not pertaining to the regular clinical care process and on incidence or prevalence only were excluded. Articles reporting sex differences were identified and assessed on quality and risk of bias using Joanna Briggs Institute critical appraisal tools. Narrative synthesis and an adapted Harvest plot were used to summarise evidence by category. RESULTS A total of 8640 articles were identified, rendering 90 studies for review (n=643,217 individuals). Studies were of observational design and comprised cohort, cross-sectional and case-control studies. Most of the included studies showed a higher HbA1c in young female children both at diagnosis (seven studies, n=22,089) and during treatment (20 out of 21 studies, n=144,613), as well as a steeper HbA1c increase over time. Many studies observed a higher BMI (all ages, ten studies, n=89,700; adolescence, seven studies, n=33,153), a higher prevalence of being overweight or obese, and a higher prevalence of dyslipidaemia among the female sex. Hypoglycaemia and partial remission occurred more often in male participants, and ketoacidosis (at diagnosis, eight studies, n=3561) and hospitalisation was more often seen in female participants. Most of the findings showed that female participants used pump therapy more frequently (six studies, n=211,324) and needed higher insulin doses than male participants. Several comorbidities, such as thyroid disease and coeliac disease, appeared to be more common in female participants. All studies reported lower quality of life in female participants (15 studies, n=8722). Because the aim of this study was to identify sex differences, studies with neutral outcomes or minor differences may have been under-targeted. The observational designs of the included studies also limit conclusions on the causality between sex and clinical outcomes. CONCLUSIONS/INTERPRETATION Sex disparities were observed throughout diabetes care in children with type 1 diabetes. Several outcomes appear worse in young female children, especially during adolescence. Focus on the cause and treatment of these differences may provide opportunities for better outcomes. REGISTRATION This systematic review is registered in PROSPERO (CRD42020213640).
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Affiliation(s)
- Silvia A G de Vries
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Dick Mul
- Diabeter, Center for Paediatric and Adult Diabetes Care and Research, Rotterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Theo C J Sas
- Diabeter, Center for Paediatric and Adult Diabetes Care and Research, Rotterdam, the Netherlands
- Department of Paediatrics, Division of Paediatric Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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Rugg-Gunn CEM, Dixon E, Jorgensen AL, Usher-Smith JA, Marcovecchio ML, Deakin M, Hawcutt DB. Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients: A Systematic Review. JAMA Pediatr 2022; 176:1248-1259. [PMID: 36215053 DOI: 10.1001/jamapediatrics.2022.3586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Presenting with diabetic ketoacidosis (DKA) at onset of type 1 diabetes (T1D) remains a risk. Following a 2011 systematic review, considerable additional articles have been published, and the review required updating. OBJECTIVE To evaluate factors associated with DKA at the onset of T1D among pediatric patients. EVIDENCE REVIEW In this systematic review, PubMed, Embase, Scopus, CINAHL, Web of Science, and article reference lists were searched using the population, intervention, comparison, outcome search strategy for primary research studies on DKA and T1D onset among individuals younger than 18 years that were published from January 2011 to November 2021. These studies were combined with a 2011 systematic review on the same topic. Data were pooled using a random-effects model. FINDINGS A total of 2565 articles were identified; 149 were included, along with 46 from the previous review (total 195 articles). Thirty-eight factors were identified and examined for their association with DKA at T1D onset. Factors associated with increased risk of DKA were younger age at T1D onset (<2 years vs ≥2 years; odds ratio [OR], 3.51; 95% CI, 2.85-4.32; P < .001), belonging to an ethnic minority population (OR, 0.40; 95% CI, 0.21-0.74; P = .004), and family history of T1D (OR, 0.46; 95% CI, 0.37-0.57; P < .001), consistent with the 2011 systematic review. Some factors that were not associated with DKA in the 2011 systematic review were associated with DKA in the present review (eg, delayed diagnosis: OR, 2.27; 95% CI, 1.72-3.01; P < .001). Additional factors associated with risk of DKA among patients with new-onset T1D included participation in screening programs (OR, 0.35; 95% CI, 0.21-0.59; P < .001) and presentation during the COVID-19 pandemic (OR, 2.32; 95% CI, 1.76-3.06; P < .001). CONCLUSIONS AND RELEVANCE In this study, age younger than 2 years at T1D onset, belonging to an ethnic minority population, delayed diagnosis or misdiagnosis, and presenting during the COVID-19 pandemic were associated with increased risk of DKA. Factors associated with decreased risk of DKA included greater knowledge of key signs or symptoms of DKA, such as a family history of T1D or participation in screening programs. Future work should focus on identifying and implementing strategies related to these factors to reduce risk of DKA among new patients with T1D.
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Affiliation(s)
| | - Eleanor Dixon
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Andrea L Jorgensen
- Department of Biostatistics, University of Liverpool, Liverpool, England
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, England
| | | | - Mark Deakin
- Alder Hey Children's Hospital, Liverpool, England
| | - Daniel B Hawcutt
- NIHR Alder Hey Clinical Research Facility, Liverpool, England.,Department of Women's and Children's Health, University of Liverpool, Liverpool, England
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Esmaeili S, Saeedi Moghaddam S, Namazi N, Bandarian F, Esfahani Z, Peimani M, Shahin S, Nasli-Esfahani E, Akbarzadeh I, Ghanbari A, Rezaei N, Rezaei N, Larijani B, Farzadfar F. Burden of type 1 diabetes mellitus in the North Africa and Middle East Region, 1990-2019; findings from the global burden of disease study. Diabetes Res Clin Pract 2022; 188:109912. [PMID: 35537522 DOI: 10.1016/j.diabres.2022.109912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/15/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
AIMS We aimed to report the burden of type 1 diabetes mellitus (T1DM) in the North Africa and Middle East region and its 21 countries from 1990 to 2019. METHODS Information related to incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and years lived with disability (YLDs) of T1DM was acquired from the 2019 Global Burden of Disease study. The burden was estimated by sex, age groups, and socio-demographic index (SDI) in 21 countries. RESULTS Over the past 30 years, regional incidence, prevalence, mortality, and DALYs of T1DM increase by 188.7%, 304.8%, 43.7%, and 71.6%, respectively. While the age-standardized incidence and prevalence rates increased by 84% and 91%, the mortality and DALYs rates decreased by 34% and 13%. During these years, the contribution of YLDs to total DALYs increased considerably (from 17% to 42%). The highest increase in the incidence and prevalence rates occurred in high SDI countries. Moreover, the Mortality to Incidence Ratio (MIR) decreased in the region countries. CONCLUSIONS Despite progress made in diabetes care, there is a persistently increasing burden of T1DM in the region countries. This indicates that T1DM is still one of the major health challenges in the region countries, especially in high SDI Arab countries.
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Affiliation(s)
- Shahnaz Esmaeili
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Namazi
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bandarian
- Cell therapy and regenerative medicine research center, endocrinology and metabolism, molecular cellular sciences institute, Tehran University of Medical Science, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Peimani
- Metabolomics and genomics research center endocrinology and metabolism molecular- cellular sciences institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Shahin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Isa Akbarzadeh
- Department of epidemiology and biostatics, school of public health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ebrahimi F, Kutz A, Christ ER, Szinnai G. Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study. Front Endocrinol (Lausanne) 2022; 13:940990. [PMID: 36093075 PMCID: PMC9449722 DOI: 10.3389/fendo.2022.940990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) is a life-threatening complication of both type 1 and type 2 diabetes. We aimed to assess population-based rates, trends and outcomes of patients with DKA. DESIGN AND METHODS This is a nationwide cohort study using hospital discharge claims data from 2010 to 2018 in Switzerland. Incidence rates and in-hospital outcomes of DKA were analyzed throughout lifetime for children (0-9 years), adolescents (10-19 years), and adults (20-29, 30-59, and 60-90 years). Analyses were stratified for type of diabetes mellitus and sex. RESULTS In total, 5,544 hospitalizations with DKA were identified, of whom 3,847 were seen in patients with type 1 diabetes and 1,697 in type 2 diabetes. Incidence rates of DKA among patients with type 1 diabetes were highest during adolescence with 17.67 (girls) and 13.87 (boys) events per 100,000 person-years (incidence rate difference [IRD]: -3.80 [95% CI, -5.59 to -2.02]) and decreased with age in both sexes thereafter. Incidence rates of DKA in patients with type 2 diabetes were low up to an age of 40 years and rose to 5.26 (females) and 6.82 (males) per 100,000 person-years in adults aged 60-90 years. Diabetic ketoacidosis was associated with relevant health-care burden independent of age, sex, or type of diabetes. The population-based incidence rate of DKA increased over time from 7.22 per 100,000 person-years in 2010 to 9.49 per 100,000 person-years in 2018. CONCLUSIONS In type 1 diabetes highest incidence rates of DKA hospitalizations were observed among adolescent females. In comparison, in patients with type 2 diabetes the risk for DKA steadily increased with age with higher rates in adult males. Over the 9 year study period, incidence rates of DKA were increasing irrespective of type of diabetes. DKA was associated with a high burden of disease reflected by high rates of intensive care unit admission, prolonged hospital stay and high mortality rates, especially in elderly.
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Affiliation(s)
- Fahim Ebrahimi
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Remigius Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
| | - Gabor Szinnai
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
- pt?> Pediatric Endocrinology and Diabetology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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Chae HW, Seo GH, Song K, Choi HS, Suh J, Kwon A, Ha S, Kim HS. Incidence and Prevalence of Type 1 Diabetes Mellitus among Korean Children and Adolescents between 2007 and 2017: An Epidemiologic Study Based on a National Database. Diabetes Metab J 2020; 44:866-874. [PMID: 33142054 PMCID: PMC7801766 DOI: 10.4093/dmj.2020.0212] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus (T1DM) among children is high in Europe and the USA and relatively low in Asia, including Korea. The present study aimed to investigate the incidence and prevalence of childhood-onset T1DM in Korea and examine trends in incidence. METHODS This study was conducted using the national registry data provided by the Health Insurance Review and Assessment Service in Korea from 2007 to 2017. We included children aged 0 to 14 years who were newly registered with a T1DM diagnosis each year (code E10). RESULTS A total of 29,013 children were registered. The overall incidence of T1DM was 4.45 per 100,000 persons (girls, 4.93; boys, 4.01). The overall incidence of childhood-onset T1DM in Korea increased from 3.70 in 2008 to 4.77 in 2016 (P=0.002). The incidence of T1DM increased from 3.07 in 2008 to 4.89 in 2016 (P<0.001) among boys. Although the incidence of the disease increased significantly among boys aged 5-9 and 10-14 years, it remained constant among girls (4.39 in 2008, 4.64 in 2016). The overall prevalence of childhood-onset T1DM in Korea increased from 32.85 in 2007 to 41.03 per 100,000 persons in 2017 (girls, 35.54 to 43.88; boys, 32.85 to 41.03). CONCLUSION We calculated relatively accurate incidence and prevalence of childhood-onset T1DM from a nation-based registry. The incidence increased by 3% to 4% every year from 2007 to 2017. The increasing trend is noteworthy compared with previous reports.
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Affiliation(s)
- Hyun Wook Chae
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hyeon Seo
- Korean Health Insurance Review and Assessment Service, Seoul, Korea
| | - Kyungchul Song
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Han Saem Choi
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Junghwan Suh
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sangmi Ha
- Korean Health Insurance Review and Assessment Service, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
- Corresponding author: Ho-Seong Kim Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea E-mail:
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Al Hayek AA, Robert AA, Al-Shaikh R, Alhojele M, Aloufi S, Sabri D, Alenazi M, Hassan AH, Al Dawish M. Factors associated with the presence of diabetic ketoacidosis: A retrospective analysis of patients with type 1 diabetes in Saudi Arabia. Diabetes Metab Syndr 2020; 14:2117-2122. [PMID: 33395771 DOI: 10.1016/j.dsx.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS To Investigate the factors associated with Diabetic Ketoacidosis (DKA) among patients with type 1 diabetes (T1D). METHODS This was a descriptive, retrospective study conducted among 1118 patients with T1D, at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia. After, exclusion process, 336 patients were selected for analysis. Among these, 105 patients with T1D were hospitalized for DKA, whereas 231 patients without DKA were outpatients who visited the hospital for T1D follow-up treatment. RESULTS Bivariate analysis between patients with DKA and those without DKA revealed significant relationships in terms of gender (p = 0.014), age (p = 0.0001), body mass index (BMI) (p = 0.017), hemoglobin A1c (HbA1c) (p = 0.0001), duration of diabetes (p = 0.001) and clinic appointments (p = 0.001). From the logistic regression analysis, it was clear that females (OR 1.88; p = 0.038) had a higher risk for DKA. As compared to the age group of ≥30 years, those in the age category of 20-29 years (OR 1.35; p = 0.001) and teenagers (OR 3.64; p = 0.001) faced a higher risk of having DKA episodes. Compared with patients having HbA1c levels <8%, those showing HbA1c levels 8-9.9% (OR 1.77; p = 0.224) and ≥10% (OR 4.06; p = 0.003) revealed higher risk for DKA. Likewise, in comparison with the patients who were compliant to clinic appointments, those who were non-compliant to clinic appointments exhibited higher than six times the risk (OR 6.38; p = 0.0001) of being more prone to experiencing the DKA episodes. CONCLUSION Patients with higher risk for DKA comprise, those having high HbA1c levels, longer period of diabetes duration, teenagers, female gender and non-compliant to clinic appointments.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Ruqayah Al-Shaikh
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Mohammed Alhojele
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Shaza Aloufi
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Daniyah Sabri
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Mohammed Alenazi
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Alshehri Hanan Hassan
- King Khaled University, College of Medicine, Internal Medicine Department, Riyadh, Saudi Arabia.
| | - Mohamed Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
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Kurabayashi A, Iwashita W, Tanaka C, Naganuma S, Furihata M, Inoue K, Kakinuma Y. Murine remote ischemic preconditioning suppresses diabetic ketoacidosis by enhancing glycolysis and entry into tricarboxylic acid cycle in the liver. Life Sci 2020; 253:117748. [PMID: 32387415 DOI: 10.1016/j.lfs.2020.117748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 11/25/2022]
Abstract
AIMS Hindlimb ischemia-reperfusion (IR) was previously demonstrated by our group to decrease blood sugar levels by suppressing hepatic gluconeogenesis and enhancing glucose uptake using activation of the parasympathetic nervous system. While IR attenuated hyperglycemia in diabetic mice, it was unclear whether IR regulated energy metabolism in the liver. We investigated the mechanisms by which IR regulates energy metabolism in the liver from type1 diabetic mice. MAIN METHODS Streptozotocin-induced diabetic male C57BL/6J mice were used to determine the effect of IR on the factors involved in energy metabolism in the liver (i.e., activation levels of AMP-activated protein kinase, aconitase and pyruvate dehydrogenase; adenosine triphosphate and fumarate concentrations; sirtuin (Sirt) 1 expression). These various signaling pathways and key enzyme activities were examined using western blot analysis and a biochemical technique including a colorimetric assay. KEY FINDINGS Under feeding conditions (free access to normal murine chow and water), blood glucose levels and serum ketone body levels were significantly suppressed by IR, whereas phospho-AMP-activated protein kinase and its activity, pyruvate dehydrogenase, aconitase activity, and Sirt 1expression were upregulated. In contrast, peroxisome proliferator-activated receptor γ coactivator-1, which accelerated fatty acid use, was suppressed by IR. SIGNIFICANCE These results indicated that in the IR-treated diabetic liver, energy production was promoted through acceleration of the tricarboxylic acid cycle linked with increased glucose preference rather than fatty acid under feeding conditions. Therefore, IR may be beneficial against diabetic hyperglycemia, but also ketoacidosis.
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Affiliation(s)
| | - Waka Iwashita
- Departments of Pathology, Kochi Medical School, Kochi 783-8505, Japan
| | - Chiharu Tanaka
- Departments of Pathology, Kochi Medical School, Kochi 783-8505, Japan
| | - Seiji Naganuma
- Departments of Pathology, Kochi Medical School, Kochi 783-8505, Japan
| | - Mutsuo Furihata
- Departments of Pathology, Kochi Medical School, Kochi 783-8505, Japan
| | - Keiji Inoue
- Departments of Urology, Kochi Medical School, Kochi 783-8505, Japan
| | - Yoshihiko Kakinuma
- Department of Bioregulatory Science (Physiology), Nippon Medical School Graduate School of Medicine, Tokyo 113-8602, Japan.
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Saraswathi S, Al-Khawaga S, Elkum N, Hussain K. A Systematic Review of Childhood Diabetes Research in the Middle East Region. Front Endocrinol (Lausanne) 2019; 10:805. [PMID: 31824422 PMCID: PMC6882272 DOI: 10.3389/fendo.2019.00805] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Diabetes mellitus (DM) is a common chronic disorder in children and is caused by absolute or relative insulin deficiency, with or without insulin resistance. There are several different forms of childhood DM. Children can suffer from neonatal diabetes mellitus (NDM), type 1 diabetes (T1DM), type 2 diabetes (T2DM), Maturity Onset Diabetes of the Young (MODY), autoimmune monogenic, mitochondrial, syndromic and as yet unclassified forms of DM. The Middle East has one of the highest incidences of several types of DM in children; however, it is unclear whether pediatric diabetes is an active area of research in the Middle East and if ongoing, which research areas are of priority for DM in children. Objectives: To review the literature on childhood DM related to research in the Middle East, summarize results, identify opportunities for research and make observations and recommendations for collaborative studies in pediatric DM. Methods: We conducted a thorough and systematic literature review by adhering to a list recommended by PRISMA. We retrieved original papers written in English that focus on childhood DM research, using electronic bibliographic databases containing publications from the year 2000 until October 2018. For our final assessment, we retrieved 429 full-text articles and selected 95 articles, based on our inclusion and exclusion criteria. Results: Our literature review suggests that childhood DM research undertaken in the Middle East has focused mainly on reporting retrospective review of case notes, a few prospective case studies, systemic reviews, questionnaire-based studies, and case reports. These reported studies have focused mostly on the incidence/prevalence of different types of DM in childhood. No studies report on the establishment of National Childhood Diabetes Registries. There is a lack of consolidated studies focusing on national epidemiology data of different types of childhood DM (such as NDM, T1DM, T2DM, MODY, and syndromic forms) and no studies reporting on clinical trials in children with DM. Conclusions: Investing in and funding basic and translational childhood diabetes research and encouraging collaborative studies, will bring enormous benefits financially, economically, and socially for the whole of the Middle East region.
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Affiliation(s)
- Saras Saraswathi
- Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | - Sara Al-Khawaga
- Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
| | - Naser Elkum
- Biostatistics Section, Clinical Research Center, Research Services, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
- *Correspondence: Khalid Hussain
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