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Lu J, Cao X, Chang X, Zheng G, Zhu H, Gao S, Wang Z, Jia X, Shi X, Yang Y. Associations between physical activity and all-cause and cardiovascular mortality in adults with type 2 diabetes mellitus: A prospective cohort study from NHANES 2007-2018. Prim Care Diabetes 2024; 18:44-51. [PMID: 38052713 DOI: 10.1016/j.pcd.2023.11.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 12/07/2023]
Abstract
AIMS To investigate the dose-response association between physical activity and all-cause and cardiovascular mortality in adults with type 2 diabetes mellitus and the effects of replacing sedentary behavior with physical activity. METHODS 4808 adults with type 2 diabetes mellitus were included in NHANES 2007-2018. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals. Isotemporal substitution analyses were further to determine the possible benefit of replacing sedentary time. RESULTS During a median follow-up of 6.58 years, 902 deaths occurred, including 290 deaths from cardiovascular disease. Compared with the inactive group, the low-active and high-active groups were associated with declined risks of all-cause mortality [HRs (95% CIs) 0.64 (0.50, 0.83); 0.60 (0.50, 0.73), respectively] and cardiovascular mortality [0.50 (0.29, 0.88); 0.54 (0.39, 0.76)), respectively]. Dose-response analysis showed a significant U-shaped curve between physical activity and all-cause and cardiovascular mortality. Replacing 30 min/day of sedentary time with physical activity was substantially linked to a reduced risk of 8-32% mortality. CONCLUSION A high level of PA of 40.52 and 31.66 MET-h/week was respectively related to the lowest risk of all-cause and cardiovascular mortality. Replacing sedentary time with physical activity could benefit the type 2 diabetes mellitus population.
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Affiliation(s)
- Jie Lu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Xiting Cao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Xinyu Chang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Guowei Zheng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Hao Zhu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Shuaijie Gao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Zhenwei Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Xiaocan Jia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China
| | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, No. 100, Science Avenue, Zhongyuan District, Zhengzhou 450001, Henan, China.
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Rojas-Martínez R, Escamilla-Nuñez C, Aguilar-Salinas CA, Castro-Porras L, Romero-Martínez M, Lazcano-Ponce E. Trends in the mortality of diabetes in Mexico from 1998 to 2022: a joinpoint regression and age-period-cohort effect analysis. Public Health 2024; 226:128-137. [PMID: 38056400 DOI: 10.1016/j.puhe.2023.10.038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/04/2023] [Accepted: 10/22/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. STUDY DESIGN Joinpoint regression and age-period-cohort effect analysis. METHODS Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. RESULTS From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). CONCLUSION The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.
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Affiliation(s)
- R Rojas-Martínez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - C Escamilla-Nuñez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - C A Aguilar-Salinas
- Direction of Investigation, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - L Castro-Porras
- Policies, Population and Health Research Center, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - M Romero-Martínez
- Center for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - E Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Bjornstad P, Chao LC, Cree-Green M, Dart AB, King M, Looker HC, Magliano DJ, Nadeau KJ, Pinhas-Hamiel O, Shah AS, van Raalte DH, Pavkov ME, Nelson RG. Youth-onset type 2 diabetes mellitus: an urgent challenge. Nat Rev Nephrol 2023; 19:168-184. [PMID: 36316388 PMCID: PMC10182876 DOI: 10.1038/s41581-022-00645-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) and its complications are increasing worldwide. Youth-onset T2DM has been reported in all racial and ethnic groups, but Indigenous peoples and people of colour are disproportionately affected. People with youth-onset T2DM often have a more aggressive clinical course than those with adult-onset T2DM or those with type 1 diabetes mellitus. Moreover, the available treatment options for children and adolescents with T2DM are more limited than for adult patients. Intermediate complications of youth-onset T2DM, such as increased albuminuria, often develop in late childhood or early adulthood, and end-stage complications, including kidney failure, develop in mid-life. The increasing frequency, earlier onset and greater severity of childhood obesity in the past 50 years together with increasingly sedentary lifestyles and an increasing frequency of intrauterine exposure to diabetes are important drivers of the epidemic of youth-onset T2DM. The particularly high risk of the disease in historically disadvantaged populations suggests an important contribution of social and environmental factors, including limited access to high-quality health care, healthy food choices and opportunities for physical activity as well as exposure to stressors including systemic racism and environmental pollutants. Understanding the mechanisms that underlie the development and aggressive clinical course of youth-onset T2DM is key to identifying successful prevention and management strategies.
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Affiliation(s)
| | - Lily C Chao
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Allison B Dart
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Malcolm King
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Helen C Looker
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | | | - Orit Pinhas-Hamiel
- Paediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amy S Shah
- Cincinnati Children's Hospital and The University of Cincinnati, Cincinnati, OH, USA
| | | | - Meda E Pavkov
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.
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Kondakis K, Grammatikaki E, Kondakis M, Molnar D, Gómez-Martínez S, González-Gross M, Kafatos A, Manios Y, Pavón DJ, Gottrand F, Beghin L, Kersting M, Castillo MJ, Moreno LA, De Henauw S. Developing a risk assessment tool for identifying individuals at high risk for developing insulin resistance in European adolescents: the HELENA-IR score. J Pediatr Endocrinol Metab 2022; 35:1518-1527. [PMID: 36408818 DOI: 10.1515/jpem-2022-0265] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To develop and validate an easy-to-use screening tool for identifying adolescents at high-risk for insulin resistance (IR). METHODS Α total of 1,053 adolescents (554 females), aged 12.5 to 17.5 years with complete data on glucose and insulin levels were included. Body mass index (BMI), fat mass index (FMI) and the homeostasis model assessment for insulin resistance (HOMA-IR) were calculated. VO2max was predicted using 20 m multi-stage fitness test. The population was randomly separated into two cohorts for the development (n=702) and validation (n=351) of the index, respectively. Factors associated with high HOMA-IR were identified by Spearman correlation in the development cohort; multiple logistic regression was performed for all identified independent factors to develop a score index. Finally, receiver operating characteristic (ROC) analysis was performed in the validation cohort and was used to define the cut-off values that could identify adolescents above the 75th and the 95th percentile for HOMA-IR. RESULTS BMI and VO2max significantly identified high HOMA-IR in males; and FMI, TV watching and VO2max in females. The HELENA-IR index scores range from 0 to 29 for males and 0 to 43 for females. The Area Under the Curve, sensitivity and specificity for identifying males above the 75th and 95th of HOMA-IR percentiles were 0.635 (95%CI: 0.542-0.725), 0.513 and 0.735, and 0.714 (95%CI: 0.499-0.728), 0.625 and 0.905, respectively. For females, the corresponding values were 0.632 (95%CI: 0.538-0.725), 0.568 and 0.652, and 0.708 (95%CI: 0.559-0.725), 0.667 and 0.617, respectively. Simple algorithms were created using the index cut-off scores. CONCLUSIONS Paediatricians or physical education teachers can use easy-to-obtain and non-invasive measures to apply the HELENA-IR score and identify adolescents at high risk for IR, who should be referred for further tests.
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Affiliation(s)
- Katerina Kondakis
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Evangelia Grammatikaki
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Kallithea, Greece
| | - Marios Kondakis
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Denes Molnar
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Sonia Gómez-Martínez
- Immunonutrition Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - Marcela González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Kallithea, Greece.,Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - David Jiménez Pavón
- Department of Physiology, School of Medicine, University of Granada, Granada, Spain
| | | | | | - Mathilde Kersting
- Research Institute of Child Nutrition, Rheinische Friedrich-Wilhelms-Universität Bonn, Dortmund, Germany
| | - Manuel J Castillo
- Department of Physiology, School of Medicine, University of Granada, Granada, Spain
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facutlad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.,Instituto Agroalimentario de Aragon (IA2), Zaragoza, Spain.,Instituto de Investigacion Sanitaria Aragon (IIS Aragon), Zaragoza, Spain
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Hernández-Montoya D, Cedillo-Escobar EE, Esparza-Aguilar M, Muñoz-Torres AV. Undiagnosed prediabetes in Mexican adolescents under poverty in contexts affected by collective violence: A clinical comparison among health services users and hidden population. Front Nutr 2022; 9:1007781. [DOI: 10.3389/fnut.2022.1007781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
IntroductionThe epidemiological pattern of prediabetes in adolescents is understudied. In Mexico, adolescents are exposed to social adversity conditions, including poverty and violence. Therefore, understanding their clinical profiles and how the social determinants of health impose barriers to access to health services is important to address detection, in those who, by their vulnerability, remain a hidden population.AimThis study aimed to describe undiagnosed prediabetes in Mexican adolescents under poverty in violent contexts and to compare the clinical features among health services users and hidden population.MethodsThis cross-sectional study included 371 adolescents from difficult access locations in violent contexts. Poverty, lack of health services access, and perceived vulnerability were determined in all samples. Endocrine markers (BMI, HOMA-IR, HbA1c, and cortisol) were measured in those with high violence perception.ResultsA total of 61.7% of the adolescents had a suburban grid and urban cluster residence, and 77.7–85.7% of them belonged to locations where 35–50% of their population lived below the poverty line. In total, 40–75% had a lack of 10–20% access to health services, and 18.8% had a high perceived vulnerability due to collective violence and were screened. Overall, 61.9% of respondents were newly diagnosed with prediabetes and showed the worst HbA1c (p = 0.001) compared to the health services subsample, which showed the highest BMI (p = 0.031) and insulin resistance (p = 0.025).ConclusionThere is a prediabetes hidden population living in violent contexts under poverty. These social determinants promote poor outcomes in perceived vulnerability and endocrine response and represent barriers to access to health services.
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Zhong C, Bai X, Chen Q, Ma Y, Li J, Zhang J, Luo Q, Cai K. Gut microbial products valerate and caproate predict renal outcome among the patients with biopsy-confirmed diabetic nephropathy. Acta Diabetol 2022; 59:1469-1477. [PMID: 35947193 DOI: 10.1007/s00592-022-01948-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
AIMS Valerate and caproate are two subtypes of short-chain fatty acids produced by gut microbiota. We aimed to measure the serum valerate and caproate levels and analyze the associations between them and renal prognosis of diabetic nephropathy (DN). METHODS The serum samples of patients with biopsy-confirmed diagnosis of DN were collected in the First Affiliated Hospital of Zhejiang University, from April 1, 2013, to March 31, 2018. One hundred patients were included and divided into an early DN group (eGFR ≥ 60 ml/min, n = 42) and an advanced DN group (eGFR < 60 ml/min, n = 58). The valerate and caproate were measured using gas chromatography-mass spectrometry. Participants were followed up until the cutoff date of August 31, 2018, or if they met the primary endpoint of end-stage renal disease (ESRD). RESULTS There were 71 males and 29 females in this study, and 29 patients developed ESRD. We observed a significant lower concentration of valerate and caproate in the advanced DN group. There were negative correlations between valerate and glomerular classification (r = - 0.20, P = 0.03) and between caproate and interstitial fibrosis and tubular atrophy (IFTA) (r = - 0.24, P = 0.01). And there were positive correlations between valerate or caproate and eGFR (r = 0.22, P = 0.02; r = 0.38, P < 0.01). Multivariate Cox analysis revealed higher levels of valerate and caproate were negatively related to progression to ESRD (HR = 0.024, P = 0.016; HR = 0.543, P = 0.030). The area under the curve values of valerate and caproate levels were 0.66 and 0.63, respectively, in predicting progression to ESRD. CONCLUSION This study showed alterations in serum valerate and caproate in DN and demonstrates lower valerate and caproate levels with progression of DN to ESRD.
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Affiliation(s)
- Chenyu Zhong
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, Zhejiang Province, People's Republic of China
| | - Xu Bai
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, Zhejiang Province, People's Republic of China
| | - Qinghuo Chen
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, Zhejiang Province, People's Republic of China
| | - Yanhong Ma
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jianhui Li
- Department of Endocrinology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang Province, People's Republic of China
| | - Jie Zhang
- Department of Endocrinology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang Province, People's Republic of China
| | - Qun Luo
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, Zhejiang Province, People's Republic of China
| | - Kedan Cai
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, Zhejiang Province, People's Republic of China.
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Baechle C, Stahl-Pehe A, Prinz N, Meissner T, Kamrath C, Holl RW, Rosenbauer J. Prevalence trends of type 1 and type 2 diabetes in children and adolescents in North Rhine-Westphalia, the most populous federal state in Germany, 2002-2020. Diabetes Res Clin Pract 2022; 190:109995. [PMID: 35853531 DOI: 10.1016/j.diabres.2022.109995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/01/2022] [Revised: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 12/28/2022]
Abstract
AIMS To estimate the prevalence and temporal trends of type 1 and type 2 diabetes mellitus in children and adolescents (type 1 diabetes: 0-19 years, type 2 diabetes: 10-19 years) in North Rhine-Westphalia (NRW), Germany, from 2002 to 2020. METHODS The NRW Diabetes Registry records new cases based on three data sources (median completeness of ascertainment 99% for type 1 diabetes, 94% for type 2 diabetes). We determined age- and/or sex-standardized prevalence estimates (95% confidence intervals) per 100,000 individuals. Differences in age and sex, as well as time trends, were examined by Poisson regression. Furthermore, joinpoint regression was used to evaluate changes in prevalence trends over time. RESULTS At the end of 2020, the estimated type 1 diabetes prevalence was 247.1 (240.3; 253.9) with an annual increase of 2.9% (2.7%; 3.1%). The type 2 diabetes prevalence was 12.7 (10.6; 14.9) and increased by 6.4% (5.6%; 7.3%) per year. The prevalence trends were not uniform over the total period and flattened considerably in recent years. CONCLUSIONS The prevalence of type 1 and type 2 diabetes has increased significantly but at a lower rate in recent years. Continued surveillance of the prevalence is essential for the planning of health care resources and prevention measures.
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Affiliation(s)
- C Baechle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - A Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - N Prinz
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - T Meissner
- University Children's Hospital, Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty at Heinrich Heine University, Moorenstraße 5, D-40225 Düsseldorf, Germany.
| | - C Kamrath
- Justus Liebig University, Center of Child and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetology, Feulgenstraße 10-12, D-35392 Giessen, Germany.
| | - R W Holl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - J Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
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Cai K, Ma Y, Cai F, Huang X, Xiao L, Zhong C, Ren P, Luo Q, Chen J, Han F. Changes of gut microbiota in diabetic nephropathy and its effect on the progression of kidney injury. Endocrine 2022; 76:294-303. [PMID: 35246764 DOI: 10.1007/s12020-022-03002-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 09/13/2021] [Accepted: 01/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to illustrate gut microbiota and short chain fatty acid (SCFA) levels in diabetic nephropathy (DN) patients, and investigate the mechanism of sodium butyrate in diabetic mellitus (DM) rats. METHODS Gut microbiota and serum SCFA levels were measured by 16S rDNA and GC-MS. After being built by streptozotocin (DM rats), the DM rats were administered 300 mg/kg sodium butyrate for 12 weeks (DM + BU rats). Gut microbiota, serum and fecal butyrate level were measured. RT-PCR, WB and transmission electron microscopy were performed to explore LC3mRNA or LC3B protein expression, and autophagosomes in kidney tissues. AMPK/mTOR protein expression in renal tissue were also measured. RESULTS The gut microbial dysbiosis was found in DM and DN groups, and some SCFAs-producing bacteria were decreased in DN group. The serum butyrate concentrations were lower in SCFA-DN group compared with SCFA-HC group and SCFA-DM group in the other cohort. Serum butyrate level was positively correlated with eGFR. Sodium butyrate increased serum and fecal butyrate levels, and improved the enlargement of glomerular area and fibronectin and collagen IV expressions in renal tissues in DM + BU rats. The LC3 mRNA, LC3BII/I ratio and number of autophagosomes were increased in renal tissue of DM + BU rats. Higher p-AMPK/AMPK ratio and lower p-mTOR/ mTOR ratio were shown in renal tissue of DM + BU rats compared with DM rats. CONCLUSIONS We found the decrease in SCFAs-producing bacteria and low SCFAs concentrations in DN patients. Oral butyrate supplementation may improve kidney injury in DM rats, possibly by increasing autophagy via activating AMPK/mTOR pathway.
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Affiliation(s)
- Kedan Cai
- HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China
| | - Yanhong Ma
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China
| | - Fanghao Cai
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China
| | - Xiaohan Huang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China
| | - Liang Xiao
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China
| | - Chenyu Zhong
- HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Pingping Ren
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China
| | - Qun Luo
- HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China
| | - Fei Han
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, Zhejiang Province, China.
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Yitbarek GY, Ayehu GW, Asnakew S, Chanie ES, Bayih WA, Feleke DG, Amare TJ, Teshome F, Teshome AA, Arage G, Ayele FY, Gebremariam AD, Engidaw MT, Tiruneh SA. Undiagnosed diabetes mellitus and associated factors among adults in Ethiopia: a systematic review and meta-analysis. Sci Rep 2021; 11:24231. [PMID: 34931004 DOI: 10.1038/s41598-021-03669-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/03/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetes has become a major public health problem, with 4.6 million deaths annually. The number of people living with undiagnosed diabetes is on the rise and has a diverse prevalence. Thus, this systematic review and meta-analysis was aimed to synthesize the pooled estimate prevalence of undiagnosed diabetes mellitus, impaired fasting glucose and its associated factors in Ethiopia. The databases Medline, Hinari, Google Scholar, and Google search were used to find potential studies published from January 2013 until January 2021. Extracted data were entered into the excel spreadsheet. The random effects model with Der Simonian-Laird weights was used to assess the pooled estimate of prevalence of undiagnosed diabetes, impaired fasting glucose, and its associated factors. The Cochrane Q-test and I2 statistics were used to screen for statistical heterogeneity. A funnel plot and Egger's statistical test were also used to search for any publication bias (small study effect). After extensive searching of articles on different databases, a total of nine studies were included for this systematic review and meta-analysis. In random effects model, the pooled prevalence of undiagnosed diabetes mellitus and impaired fasting glucose was 5.75%, 95% CI (3.90-7.59%), and 8.94%, 95% CI (2.60-15.28%), respectively. Regarding the associated factors, participants family history of diabetes was significantly associated with diabetes status. The pooled odds of developing diabetes mellitus among participants with a family history of diabetes mellitus were about 3.56 times higher than those without a family history of diabetes mellitus (OR = 3.56, 95% CI (2.23, 5.68)). In this review, the higher prevalence of undiagnosed diabetes mellitus and impaired fasting glucose was observed among adults in Ethiopia. Family history of diabetes was found to have an association with increased risk of diabetes mellitus. Our finding highlights the need of screening at the community level, with special focus on adults with family history of diabetes mellitus.
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Ghodsi M, Keshtkar AA, Razi F, Mohammad Amoli M, Nasli-Esfahani E, Zarrabi F, Khashayar P, Khajavi A, Larijani B, Mohajeri-Tehrani MR. Association of vitamin D receptor gene polymorphism with the occurrence of low bone density, osteopenia, and osteoporosis in patients with type 2 diabetes. J Diabetes Metab Disord 2021; 20:1375-83. [PMID: 34900789 DOI: 10.1007/s40200-021-00871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
Purpose This study aims to analyze the association between VDR gene polymorphism and the occurrence of "low bone density (LBD)/osteopenia/osteoporosis" or LBDOO in type 2 diabetes (T2D) patients among a clustered population in northwest of Iran. The studied VDR gene polymorphism included ApaI (rs7975232), BsmI (rs1544410), FokI (rs2228570), EcoRV (rs4516035) and, TaqI (rs731236). Methods In this population-based cross-sectional study, patients with T2D were identified within a group of 1266 participants based on self-report of diabetes, history of diabetes medication, and recorded laboratory data. Separately for each polymorphism and gender, crude and adjusted (age, BMI) odds ratios (ORs) were calculated for participants with T2D through logistic regression analysis. Results The prevalence of T2D was 16.41% in people residing in the city of Sanandaj in 2011. Of the participants with T2D, 13.92% and 81.29% had osteoporosis and vitamin D deficiency, respectively. In women, the tt genotype of the TaqI gene significantly decreased the risk of LBDOO versus the Tt genotype, after adjusting for BMI and age (adjusted OR:0.18, CI95%: 0.03-0.97). Conversely, the EE genotype of the EcoRV gene enhanced the risk of LBDOO versus the Ee genotype (adjusted OR:7.64, CI95%: 2.03-28.72). Conclusion The polymorphism of both TaqI and EcoRV genes was associated with the risk of LBDOO in women with T2D. This is the first time a study has highlighted this effect for the polymorphism of the EcoRV gene; we believe that this study would serve as a basis for future studies.
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11
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Li P, Patel R, Guo J, Vouri SM, Shi L, Fonseca V, Shao H. The diminishing cost-effectiveness of the newer glucose-lowering drug classes in the United States: 2010-2018. Curr Med Res Opin 2021; 37:1875-1880. [PMID: 34429001 DOI: 10.1080/03007995.2021.1971181] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The difference between the costs of the newer and older glucose-lowering drugs (GLMs) has been steadily increasing since 2010. In 2018, newer drugs cost 8-12 times more than older drugs (except for insulin). This study aimed to understand how the cost change influenced the cost-effectiveness of the newer GLMs. METHODS Based on our previous literature review on US-based cost-effectiveness studies comparing newer (i.e. dipeptidyl peptidase-4 inhibitors (DPP4), glucagon-like peptide 1 receptor agonists (GLP1-RA), and sodium-glucose transport protein 2 inhibitors) with older GLMs, we identified 12 studies that reported the cost-effectiveness of newer drugs based on drug costs estimated before 2010. We updated the corresponding cost-effectiveness of each study by replacing the old cost estimates with 2018 estimates from the 2018 IBM MarketScan Commercial Claims Databases. The time window and willingness to pay threshold were consistent with the original studies. RESULTS Only 8% of the original studies suggested that the older drugs were cost-effective. However, 58% of studies were in favor of the older drugs after the cost update. Among the four studies comparing newer drugs with thiazolidinediones, all the original results favored newer drugs. However, all studies suggested thiazolidinedione to be cost-effective in the updated analysis. For the four studies comparing newer drugs with sulfonylureas, two studies suggested the sulfonylureas to be cost-effective after the cost update. All four studies suggested newer drugs to be cost-effective when compared with insulin in the original study. Only 1 flipped its conclusion when 2018 costs were used. Our sensitivity analysis shows that our results are robust under a 30% rebate. CONCLUSION Significant changes in the cost of GLMs have impacted the economic value of different GLM classes substantially. More cost-effectiveness analyses are warranted to support the drug choice in T2DM management.
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Affiliation(s)
- Piaopiao Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Rahul Patel
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Vivian Fonseca
- Department of Medicine and Pharmacology, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
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12
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Zhong C, Dai Z, Chai L, Wu L, Li J, Guo W, Zhang J, Zhang Q, Xue C, Lin H, Luo Q, Cai K. The change of gut microbiota-derived short-chain fatty acids in diabetic kidney disease. J Clin Lab Anal 2021; 35:e24062. [PMID: 34689373 PMCID: PMC8649351 DOI: 10.1002/jcla.24062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/22/2022] Open
Abstract
Background Previous studies found the dysbiosis of intestinal microbiota in diabetic kidney disease (DKD), especially the decreased SCFA‐producing bacteria. We aimed to investigate the concentration of the stool and serum short‐chain fatty acids (SCFAs), gut microbiota‐derived metabolites, in individuals with DKD and reveal the correlations between SCFAs and renal function. Methods A total of 30 participants with DKD, 30 participants with type 2 diabetes mellitus (DM), and 30 normal controls (NC) in HwaMei Hospital were recruited from 1/1/2018 to 12/31/2019. Participants with DKD were divided into low estimated glomerular filtration rate (eGFR)(eGFR<60ml/min, n=14) and high eGFR (eGFR≥60ml/min, n=16) subgroups. Stool and serum were measured for SCFAs with gas chromatograph‐mass spectrometry. Results The DKD group showed markedly lower levels of fecal acetate, propionate, and butyrate versus NC (p<0.001, p<0.001, p=0.018, respectively) [1027.32(784.21–1357.90)]vs[2064.59(1561.82–2637.44)]μg/g,[929.53(493.65–1344.26)]vs[1684.57(1110.54–2324.69)]μg/g,[851.39(409.57–1611.65)] vs[1440.74(1004.15–2594.73)]μg/g, respectively, and the lowest fecal total SCFAs concentration among the groups. DKD group also had a lower serum caproate concentration than that with diabetes (p=0.020)[0.57(0.47–0.61)]vs[0.65(0.53–0.79)]μmol/L. In the univariate regression analysis, fecal and serum acetate correlated with eGFR (OR=1.013, p=0.072; OR=1.017, p=0.032). The correlation between serum total SCFAs and eGFR showed statistical significance (OR=1.019, p=0.024) unadjusted and a borderline significance (OR=1.024, p=0.063) when adjusted for Hb and LDL. The decrease in serum acetate and total SCFAs were found of borderline significant difference in both subgroups (p=0.055, p=0.050). Conclusion This study provides evidence that in individuals with DKD, serum and fecal SCFAs levels (fecal level in particular) were lowered, and there was a negative correlation between SCFAs and renal function.
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Affiliation(s)
- Chenyu Zhong
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhiwei Dai
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Lingxiong Chai
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Lingping Wu
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jianhui Li
- Department of Endocrinology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Weiying Guo
- Department of Endocrinology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jie Zhang
- Department of Endocrinology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Qun Zhang
- Department of Endocrinology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Congping Xue
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Haixue Lin
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Qun Luo
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Kedan Cai
- Department of Nephrology, HwaMei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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Spurr S, Bally J, Mcharo SK, Hyslop S. Beyond "Watching the Sweets": An interpretive description of adolescent's understandings and insights into preventing prediabetes and type 2 diabetes. J SPEC PEDIATR NURS 2021; 26:e12351. [PMID: 34080280 DOI: 10.1111/jspn.12351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to explore adolescents' experiences and knowledge of type 2 diabetes (T2D) and identify appropriate T2D education and prevention interventions for this population. DESIGN AND METHODS This interpretive description study was conducted at two urban high schools in midwestern Canada. Participants had been previously screened and considered at high risk for T2D, prediabetes, or as having T2D. Individual, semistructured interviews were conducted with twelve adolescents between the age of 14-19 years meeting these criteria. Thematic analysis was completed using interview transcripts. RESULTS Themes and subthemes identified included (1) Type 2 Diabetes: More Than Too Many Sweets (Mostly Diet but Insulin Does Play a Role, and A Serious but Common Disease); (2) Who Holds the Power? (Personal Responsibility for Health, Family as Role Models, and Community Connections); and (3) Bringing Home the Message (Our Considerations for Schools, I need the Expert's Support, and Using Technology to Get the Points Across). PRACTICE IMPLICATIONS Findings from this study provide target areas for education and prevention interventions and approaches for working with adolescents surrounding prediabetes and T2D that may be effective.
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Affiliation(s)
- Shelley Spurr
- College of Nursing, University of Saskatchewan, Saskatchewan, Canada
| | - Jill Bally
- College of Nursing, University of Saskatchewan, Saskatchewan, Canada
| | - Solomon K Mcharo
- College of Nursing, University of Saskatchewan, Saskatchewan, Canada
| | - Shannon Hyslop
- College of Nursing, University of Saskatchewan, Saskatchewan, Canada
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Abbs E, Daniels R, Schillinger D. Type 2 Diabetes as a Socioecological Disease: Can Youth Poets of Color Become Messengers of Truth and Catalysts for Change? Health Promot Pract 2021; 23:583-593. [PMID: 33989074 DOI: 10.1177/15248399211007818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Efforts to confront the type 2 diabetes (T2D) epidemic have been stymied by an absence of effective communication on policy fronts. Whether art can be harnessed to reframe the T2D discourse from an individual, biomedical problem to a multilevel, communal and social problem is not known. METHOD We explored whether spoken word workshops enable young artists of color to convey a critical consciousness about T2D. The Bigger Picture fosters creation and dissemination of art to shift from the narrow biomedical model toward a comprehensive socioecological model (SEM). Workshops offer (1) public health content, (2) writing exercises, and (3) feedback on drafts. Based on Freire and Boal's participatory pedagogy, workshops encourage youth to tap into their lived experiences when creating poetry. We analyzed changes in public health literary and activation among participants and mapped poems onto the SEM to assess whether their poetry conveyed the multilevel perspective critical to public health literacy. RESULTS Participants reported significant increases in personal relevance of T2D prevention, T2D discussions with peers, concern about corporations' targeted marketing, and interest in community organizing to confront the epidemic. Across stanzas, nearly all poems (95%) featured >three of five SEM levels (systemic forces, sectors of influence, societal norms, behavioral settings, individual factors); three-quarters (78%) featured >four levels. CONCLUSIONS Engaging youth poets of color to develop artistic content to combat T2D can increase their public health literary and social activation and foster compelling art that communicates how complex, multilevel forces interact to generate disease and disease disparities.
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Affiliation(s)
- Elizabeth Abbs
- University of California San Francisco, San Francisco, CA, USA
| | - Ryane Daniels
- University of California San Francisco, San Francisco, CA, USA
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15
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De Silva K, Lim S, Mousa A, Teede H, Forbes A, Demmer RT, Jönsson D, Enticott J. Nutritional markers of undiagnosed type 2 diabetes in adults: Findings of a machine learning analysis with external validation and benchmarking. PLoS One 2021; 16:e0250832. [PMID: 33951067 PMCID: PMC8099133 DOI: 10.1371/journal.pone.0250832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Using a nationally-representative, cross-sectional cohort, we examined nutritional markers of undiagnosed type 2 diabetes in adults via machine learning. METHODS A total of 16429 men and non-pregnant women ≥ 20 years of age were analysed from five consecutive cycles of the National Health and Nutrition Examination Survey. Cohorts from years 2013-2016 (n = 6673) was used for external validation. Undiagnosed type 2 diabetes was determined by a negative response to the question "Have you ever been told by a doctor that you have diabetes?" and a positive glycaemic response to one or more of the three diagnostic tests (HbA1c > 6.4% or FPG >125 mg/dl or 2-hr post-OGTT glucose > 200mg/dl). Following comprehensive literature search, 114 potential nutritional markers were modelled with 13 behavioural and 12 socio-economic variables. We tested three machine learning algorithms on original and resampled training datasets built using three resampling methods. From this, the derived 12 predictive models were validated on internal- and external validation cohorts. Magnitudes of associations were gauged through odds ratios in logistic models and variable importance in others. Models were benchmarked against the ADA diabetes risk test. RESULTS The prevalence of undiagnosed type 2 diabetes was 5.26%. Four best-performing models (AUROC range: 74.9%-75.7%) classified 39 markers of undiagnosed type 2 diabetes; 28 via one or more of the three best-performing non-linear/ensemble models and 11 uniquely by the logistic model. They comprised 14 nutrient-based, 12 anthropometry-based, 9 socio-behavioural, and 4 diet-associated markers. AUROC of all models were on a par with ADA diabetes risk test on both internal and external validation cohorts (p>0.05). CONCLUSIONS Models performed comparably to the chosen benchmark. Novel behavioural markers such as the number of meals not prepared from home were revealed. This approach may be useful in nutritional epidemiology to unravel new associations with type 2 diabetes.
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Affiliation(s)
- Kushan De Silva
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Andrew Forbes
- Biostatistics Unit, Division of Research Methodology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America.,Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Daniel Jönsson
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden.,Swedish Dental Service of Skane, Lund, Sweden
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
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James-Todd T, Connolly L, Preston EV, Quinn MR, Plotan M, Xie Y, Gandi B, Mahalingaiah S. Hormonal activity in commonly used Black hair care products: evaluating hormone disruption as a plausible contribution to health disparities. J Expo Sci Environ Epidemiol 2021; 31:476-486. [PMID: 33958708 PMCID: PMC8812815 DOI: 10.1038/s41370-021-00335-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Certain types of hair products are more commonly used by Black women. Studies show hair products contain several endocrine-disrupting chemicals that are associated with adverse health outcomes. As chemical mixtures of endocrine disruptors, hair products may be hormonally active, but this remains unclear. OBJECTIVE To assess the hormonal activity of commonly used Black hair products. METHODS We identified six commonly used hair products (used by >10% of the population) from the Greater New York Hair Products Study. We used reporter gene assays (RGAs) incorporating natural steroid receptors to evaluate estrogenic, androgenic, progestogenic, and glucocorticoid hormonal bioactivity employing an extraction method using bond elution prior to RGA assessment at dilutions from 50 to 500. RESULTS All products displayed hormonal activity, varying in the amount and effect. Three samples showed estrogen agonist properties at levels from 12.5 to 20 ng/g estradiol equivalent concentrations All but one sample showed androgen antagonist properties at levels from 20 to 25 ng/g androgen equivalent concentrations. Four samples showed antagonistic and agonistic properties to progesterone and glucocorticoid. SIGNIFICANCE Hair products commonly used by Black women showed hormonal activity. Given their frequent use, exposure to hormonally active products could have implications for health outcomes and contribute to reproductive and metabolic health disparities.
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Affiliation(s)
- Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Division of Women's Health, Department of Medicine, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Lisa Connolly
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Emma V Preston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marlee R Quinn
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Monika Plotan
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Yuling Xie
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Bharathi Gandi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Boston, MA, USA
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17
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Le P, Zhang L, Misra-Hebert AD, Taksler GB, Herman WH, Rothberg MB. Trends in Age at Diagnosis of Type 2 Diabetes Among US Adults from 2001 to 2016. J Gen Intern Med 2021; 36:1144-1146. [PMID: 32193815 PMCID: PMC8042053 DOI: 10.1007/s11606-020-05767-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Phuc Le
- Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Lu Zhang
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX, USA
| | | | - Glen B Taksler
- Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - William H Herman
- University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael B Rothberg
- Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, USA
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18
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Twarog JP, Russo BN, Russo AT, Krichevsky AF, Peraj E, Sonneville KR. Self-perceived risk for diabetes among non-diabetic adolescents with overweight/obesity: Findings from NHANES. Prim Care Diabetes 2021; 15:156-161. [PMID: 33129750 DOI: 10.1016/j.pcd.2020.05.017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Abstract
AIMS The prevalence of Type 2 Diabetes Mellitus among adolescents in the United States continues to rise, following the trajectory of the obesity epidemic which posits not only a substantial health burden to our society, but also a significant threat to the wellbeing of America's youth. While a number of studies have explored the perception of the risk for developing diabetes in the adult population in the United States, this data is minimal for the adolescent population. In this study, we examined the self-perceived risk of diabetes among adolescents with overweight/obesity. METHODS Cross-sectional study of 808 non-diabetic U.S. adolescents overweight or obese, ages 12-19, who completed a physical exam and in-home interview during the 2011-2014 National Heath and Nutritional Examination Survey (NHANES). RESULTS Of adolescents with obesity, African Americans (aOR 0.27, 95% CI: 0.15, 0.51) and Hispanic Americans (aOR 0.50, 95% CI: 0.28, 0.90) were significantly less likely to perceive themselves as being at risk for developing diabetes/prediabetes compared to Non-Hispanic Whites. Additionally, individuals with overweight (aOR 13.1, 95% CI: 4.54, 37.5) and obesity (aOR 3.40, 95% CI: 1.71, 6.74) who had been informed by their physician that they were at risk for diabetes, were significantly more likely to perceive themselves to be at risk for diabetes. CONCLUSIONS Significant racial differences exist in the self-perceived risk for diabetes among U.S. adolescents with overweight and obesity. Further investigation focused on preventing the development of diabetes among at-risk adolescents who do not comprehend their risk, i.e. through more effective healthcare communication, is warranted.
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Affiliation(s)
- John P Twarog
- New York College of Podiatric Medicine, New York, NY, USA.
| | - Brittany N Russo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Ashley T Russo
- New York College of Podiatric Medicine, New York, NY, USA
| | | | - Elizabet Peraj
- New York College of Podiatric Medicine, New York, NY, USA
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Khlaifat AM, Al-Hadid LA, Dabbour RS, Shoqirat N. Cross-sectional survey on the diabetes knowledge, risk perceptions and practices among university students in South Jordan. J Diabetes Metab Disord 2020; 19:849-858. [PMID: 33520807 PMCID: PMC7843691 DOI: 10.1007/s40200-020-00571-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetes mellitus is a major health problem in Jordan. This study measured the knowledge, risk perception and practice of diabetes in a sample of Jordanian university students. It also explored predictors to the relationship between the KAP sections and each section with the associated characteristics. METHOD A cross-sectional study was carried out in seven university campuses in South Jordan. A total of 3000 participants received and were asked to fill in a self- administered structured questionnaire about their diabetes knowledge, risk perception and practice. RESULTS A total of 2158 respondents (1031 male and 1127 females) with ages ranging between 18 and 50 years (97.2% < 30 years) were included in the final analysis. Participants' scoring was poor in diabetes knowledge (41.9%), moderate (52.5%) in risk perception of diabetes and slightly higher (61.9%) in practice. Prediction of diabetes knowledge included: age, studying health sciences, being in the first or fifth academic year, with a family history of diabetes, overweight and caring for a relative with diabetes. Without a family history of diabetes and caring for a relative with diabetes significantly predicted diabetes risk perception. Diabetes knowledge and caring for a relative with diabetes were the only predictors of diabetes practice. CONCLUSION In spite of the educational status, university students' level of DM- related knowledge and the perceived risks and practices toward the disease were not adequate. Programs aiming to increase awareness about diabetes for students in all levels and for the general public should be initiated in order to help prevent or delay the occurrence of the disease.
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Affiliation(s)
- Ali M. Khlaifat
- Princess Aisha Bint Al Hussein College of Nursing and Health Sciences, Nursing Department, Al Hussein Bin Talal University, Maan, Jordan
| | - Lourance A. Al-Hadid
- Princess Aisha Bint Al Hussein College of Nursing and Health Sciences, Nursing Department, Al Hussein Bin Talal University, Maan, Jordan
| | - Rasha S. Dabbour
- Princess Aisha Bint Al Hussein College of Nursing and Health Sciences, Nursing Department, Al Hussein Bin Talal University, Maan, Jordan
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20
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Leong KSW, Jayasinghe TN, Wilson BC, Derraik JGB, Albert BB, Chiavaroli V, Svirskis DM, Beck KL, Conlon CA, Jiang Y, Schierding W, Vatanen T, Holland DJ, O'Sullivan JM, Cutfield WS. High prevalence of undiagnosed comorbidities among adolescents with obesity. Sci Rep 2020; 10:20101. [PMID: 33208826 PMCID: PMC7674474 DOI: 10.1038/s41598-020-76921-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Metabolic diseases are increasing among adolescents with obesity. Although the reported prevalence of metabolic syndrome is approximately 30% worldwide, its prevalence is largely unknown among New Zealand adolescents. Therefore, we assessed the health of adolescents with obesity (BMI ≥ 30 kg/m2) enrolled in a randomised clinical trial (Gut Bugs Trial), to identify the prevalence of undiagnosed comorbidities. Assessments included anthropometry, 24-h ambulatory blood pressure monitoring, and insulin sensitivity. We report on baseline data (pre-randomisation) on 87 participants (14–18 years; 59% females), with mean BMI 36.9 ± 5.3 kg/m2 (BMI SDS 3.33 ± 0.79). Approximately 40% of participants had undiagnosed metabolic syndrome, which was twice as common among males. Half (53%) had pre-diabetes and 92% a reduction in insulin sensitivity. Moreover, 31% had pre-hypertension/hypertension, 69% dyslipidaemia, and 25% abnormal liver function. Participants with class III obesity had a greater risk of metabolic syndrome than those with classes I/II [relative risk 1.99 (95% CI 1.19, 3.34)]. Risks for pre-hypertension/hypertension and inflammation were also greater among those with class III obesity. We identified a high prevalence of undiagnosed comorbidities among adolescents with obesity in New Zealand. As adolescent obesity tracks into adulthood, early interventions are needed to prevent progression to overt cardiometabolic diseases.
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Affiliation(s)
- Karen S W Leong
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, Auckland, New Zealand
| | | | - Brooke C Wilson
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, Auckland, New Zealand.,Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Benjamin B Albert
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, Auckland, New Zealand
| | - Valentina Chiavaroli
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
| | - Darren M Svirskis
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | | | - Tommi Vatanen
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - David J Holland
- Department of Infectious Diseases, Counties Manukau District Health Board, Auckland, New Zealand
| | - Justin M O'Sullivan
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start-National Science Challenge, Auckland, New Zealand.
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start-National Science Challenge, Auckland, New Zealand. .,Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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21
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Abstract
BACKGROUND The optimal approach to screening and diagnosis of prediabetes and diabetes in youth is uncertain. METHODS We conducted a cross-sectional analysis of 14 119 youth aged 10 to 19 years in the 1999-2016 NHANES. First, we examined the performance of American Diabetes Association risk-based screening criteria. Second, we evaluated the performance of current clinical definitions of prediabetes and diabetes based on hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), either HbA1c or FPG, or both HbA1c and FPG (confirmatory definition) to identify youth at high cardiometabolic risk. RESULTS Overall, 25.5% of US youth (10.6 million in 2016) were eligible for screening. Sensitivity and specificity of the screening criteria for detecting any hyperglycemia were low for both HbA1c ≥5.7% (sensitivity = 55.5%, specificity = 76.3%) and FPG ≥100 mg/dL (sensitivity = 35.8%, specificity = 77.1%). Confirmed undiagnosed diabetes (HbA1c ≥6.5% and FPG ≥126 mg/dL) was rare, <0.5% of youth. Most (>85%) cases of diabetes were diagnosed. Associations with cardiometabolic risk were consistently stronger and more specific for HbA1c-defined hyperglycemia (specificity = 98.6%; sensitivity = 4.0%) than FPG-defined hyperglycemia (specificity = 90.1%; sensitivity = 19.4%). CONCLUSIONS One-quarter of US youth are eligible for screening for diabetes and prediabetes; however, few will test positive, especially for diabetes. Most cases of diabetes in US youth are diagnosed. Regardless of screening eligibility, we found that HbA1c is a specific and useful nonfasting test to identify high-risk youth who could benefit from lifestyle interventions to prevent diabetes and cardiovascular risk in adulthood.
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Affiliation(s)
- Amelia S Wallace
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland; and
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Dan Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland; and
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland; and
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland; and
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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22
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Kim G, DeSalvo D, Guffey D, Minard CG, Cephus C, Moodie D, Lyons S. Dyslipidemia in adolescents and young adults with type 1 and type 2 diabetes: a retrospective analysis. Int J Pediatr Endocrinol 2020; 2020:11. [PMID: 32536946 PMCID: PMC7288506 DOI: 10.1186/s13633-020-00081-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Abstract
Background Youth onset type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing and associated with earlier vascular complications and mortality. Dyslipidemia is an important modifiable cardiovascular (CVD) risk factor that is under-recognized and undertreated in youth with T1D and T2D. Given this, we evaluated the prevalence and associations between lipid concentrations and clinical CVD risk factors in youth with T1D compared to T2D at our large ethnically diverse diabetes center. Methods A retrospective chart review was performed, evaluating patients with T1D or T2D seen at least once in clinic from 2015 to 2017, age 10–22 years of age, duration of diabetes at least 6 months on the date of most recent LDL-cholesterol (LDL-C) concentration, and not on statin therapy. We performed independent and multivariable linear regressions of LDL-C and HDL-cholesterol (HDL-C) concentrations. Results There were 32.7% with T1D (n = 1701) and 47.7% with T2D (n = 298) with LDL-C above recommend goal (> 100 mg/dL/2.6 mmol/L). Furthermore, there were 9% with T1D and 16.4% with T2D with LDL > 130 mg/dL (> 3.4 mmol/L), who likely met criteria for starting statin therapy. Higher LDL-C and/or lower HDL-C were associated with increased age, diabetes duration, higher HbA1C, female sex, Hispanic ethnicity, obesity, and T2D. After adjusting for these risk factors in a multivariable linear regression model, the association of higher LDL-C and lower HDL-C was higher with T2D than T1D. Conclusions This highlights the need for more aggressive dyslipidemia screening and treatment in youth with diabetes, especially T2D. At our institution we have created and instituted quality improvement algorithms to try to address this need.
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Affiliation(s)
- Grace Kim
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
| | - Daniel DeSalvo
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030 USA
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030 USA
| | - Constance Cephus
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
| | - Douglas Moodie
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
| | - Sarah Lyons
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
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23
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Le P, Chaitoff A, Misra-Hebert AD, Ye W, Herman WH, Rothberg MB. Use of Antihyperglycemic Medications in U.S. Adults: An Analysis of the National Health and Nutrition Examination Survey. Diabetes Care 2020; 43:1227-1233. [PMID: 32234720 DOI: 10.2337/dc19-2424] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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] [Received: 12/02/2019] [Accepted: 03/06/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE 1) To examine trends in the use of diabetes medications and 2) to determine whether physicians individualize diabetes treatment as recommended by the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS We conducted a retrospective, cross-sectional analysis of 2003-2016 National Health and Nutrition Examination Survey (NHANES) data. We included people ≥18 years who had ever been told they had diabetes, had an HbA1c >6.4%, or had a fasting plasma glucose >125 mg/dL. Pregnant women and patients aged <20 years receiving only insulin were excluded. We assessed trends in use of ADA's seven preferred classes from 2003-2004 to 2015-2016. We also examined use by hypoglycemia risk (sulfonylureas, insulin, and meglitinides), weight effect (sulfonylureas, thiazolidinediones [TZDs], insulin, and meglitinides), cardiovascular benefit (canagliflozin, empagliflozin, and liraglutide), and cost (brand-name medications and insulin analogs). RESULTS The final sample included 6,323 patients. The proportion taking any medication increased from 58% in 2003-2004 to 67% in 2015-2016 (P < 0.001). Use of metformin and insulin analogs increased, while use of sulfonylureas, TZDs, and human insulin decreased. Following the 2012 ADA recommendation, the choice of drug did not vary significantly by older age, weight, or presence of cardiovascular disease. Patients with low HbA1c, or HbA1c <6%, and age ≥65 years were less likely to receive hypoglycemia-inducing medications, while older patients with comorbidities were more likely. Insurance, but not income, was associated with the use of higher-cost medications. CONCLUSIONS Following ADA recommendations, the use of metformin increased, but physicians generally did not individualize treatment according to patients' characteristics. Substantial opportunities exist to improve pharmacologic management of diabetes.
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Affiliation(s)
- Phuc Le
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH
| | - Alexander Chaitoff
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | | | - Wen Ye
- University of Michigan School of Public Health, Ann Arbor, MI
| | - William H Herman
- University of Michigan School of Public Health, Ann Arbor, MI.,University of Michigan Medical School, Ann Arbor, MI
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24
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Magliano DJ, Sacre JW, Harding JL, Gregg EW, Zimmet PZ, Shaw JE. Young-onset type 2 diabetes mellitus - implications for morbidity and mortality. Nat Rev Endocrinol 2020; 16:321-331. [PMID: 32203408 DOI: 10.1038/s41574-020-0334-z] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
Accumulating data suggest that type 2 diabetes mellitus (T2DM) in younger people (aged <40 years), referred to as young-onset T2DM, has a more rapid deterioration of β-cell function than is seen in later-onset T2DM. Furthermore, individuals with young-onset T2DM seem to have a higher risk of complications than those with type 1 diabetes mellitus. As the number of younger adults with T2DM increases, young-onset T2DM is predicted to become a more frequent feature of the broader diabetes mellitus population in both developing and developed nations, particularly in certain ethnicities. However, the magnitude of excess risk of premature death and incident complications remains incompletely understood; likewise, the potential reasons for this excess risk are unclear. Here, we review the evidence pertaining to young-onset T2DM and its current and future burden of disease in terms of incidence and prevalence in both developed and developing nations. In addition, we highlight the associations of young-onset T2DM with premature mortality and morbidity.
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Affiliation(s)
- Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
| | - Julian W Sacre
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jessica L Harding
- Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Edward W Gregg
- Faculty of Medicine, School of Public Health, Imperial College, London, UK
| | - Paul Z Zimmet
- Monash University, Department of Diabetes, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
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25
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Barkai L, Kiss Z, Rokszin G, Abonyi-Tóth Z, Jermendy G, Wittmann I, Kempler P. Changes in the incidence and prevalence of type 1 and type 2 diabetes among 2 million children and adolescents in Hungary between 2001 and 2016 - a nationwide population-based study. Arch Med Sci 2020; 16:34-41. [PMID: 32051703 PMCID: PMC6963129 DOI: 10.5114/aoms.2019.88406] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/07/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aim of the present study was to assess changes in the incidence and prevalence of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in children and adolescents in Hungary during the period 2001 to 2016 in order to provide nationwide population-based epidemiology data on diabetes in youths aged 0-18 years. MATERIAL AND METHODS This was a retrospective cohort study of Hungarian children and adolescents aged 18 years or younger. Pharmacologically treated diabetes cases were obtained through a population-based registry of the Hungarian National Health Insurance Fund. Time series analysis was used to evaluate the changing patterns of the incidence and prevalence for type 1 and type 2 diabetes covering a 16-year period. RESULTS During the study period, 6,138 and 1,997 new T1DM and T2DM cases were observed, respectively. Newly diagnosed T2DM cases accounted for 24.5% of all incident diabetes cases. Incidence of T1DM increased from 16/100,000 to 23/100,000 (R 2 = 0.7681; p < 0.0001). The male-to-female ratio among newly diagnosed T1DM patients did not change over the study period. Prevalence of T1DM rose from 114/100,000 to 209/100,000 (R 2 = 0.9909; p < 0.0001). The prevalent T1DM cases showed significant male predominance in every year (p < 0.05). Incidence of T2DM decreased from 8/100,000 to 5/100,000 (R 2 = 0.4977; p < 0.0014). The overall prevalence of T2DM did not change significantly. Prevalent T2DM cases showed significant female predominance in every year (p < 0.0001). A significant decrease in male-to female ratio was observed among newly diagnosed T2DM cases over the study period (p < 0.0001). CONCLUSIONS According to these population-based Hungarian data of children and adolescents with diabetes, T1DM is still the most common form and its frequency continues to rise, affecting more males than females. A high proportion of patients have T2DM, affecting more females than males, but the occurrence of medically treated cases is not increasing. The decrease in male-to-female ratio in newly diagnosed T2DM cases needs further investigations.
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Affiliation(s)
- László Barkai
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Zoltán Kiss
- 2 Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | | | | | | | - István Wittmann
- 2 Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Péter Kempler
- 1 Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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26
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Kelsey MM, Zeitler PS, Drews K, Chan CL. Normal Hemoglobin A1c Variability in Early Adolescence: Adult Criteria for Prediabetes Should Be Applied with Caution. J Pediatr 2020; 216:232-235. [PMID: 31405525 PMCID: PMC6917915 DOI: 10.1016/j.jpeds.2019.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Received: 04/17/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 12/17/2022]
Abstract
American Diabetes Association adult criteria are used to screen youth for diabetes, but little is known about normal glycemia in youth. In the HEALTHY Study (total n = 8814), hemoglobin A1c was ≥5.7% in 2% of normal weight youth. This suggests need for cautious interpretation of prediabetes hemoglobin A1s in youth.
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Affiliation(s)
- Megan M. Kelsey
- University of Colorado School of Medicine, Department of Pediatrics
| | | | - Kimberly Drews
- George Washington University, Department of Biostatistics
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Spurr S, Bally J, Hill P, Gray K, Newman P, Hutton A. Exploring the Prevalence of Undiagnosed Prediabetes, Type 2 Diabetes Mellitus, and Risk Factors in Adolescents: A Systematic Review. J Pediatr Nurs 2020; 50:94-104. [PMID: 31786470 DOI: 10.1016/j.pedn.2019.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 11/16/2022]
Abstract
PROBLEM The prevalence of prediabetes and type 2 diabetes (T2D) is increasing in adolescents worldwide. Most studies have focused on the clinical features, treatment, and complications for adolescents and so the need to generate insight into the risk factors and prevalence of undiagnosed prediabetes and T2D in adolescents across the globe remains. ELIGIBILITY CRITERIA Relevant articles that were published from 2007 up to and including January 2017 were identified through electronic searches of CINAHL, Cochrane, Medline, PsycInfo, PubMed, Scopus, Web of Science, and Sociological Abstracts (Proquest). Four independent researchers examined the articles for eligibility. SAMPLE Sixteen studies were included that investigated the risk and prevalence of undiagnosed prediabetes and T2D in adolescents aged 12-19. RESULTS The most commonly measured risk factors included obesity/overweight, family history, and ethnicity. Other studies measured risk factors associated with insulin resistance, including hypertension, acanthosis nigricans, and dyslipidemia. Prevalence of undiagnosed prediabetes and T2D varied among regions globally with rates ranging from 3.3 to 14.3% and 0.1 to 2.2%, respectively. CONCLUSIONS Undiagnosed prediabetes and T2D and the associated risk factors are prevalent in many regions in countries worldwide, significantly impacting adolescents and their families. IMPLICATIONS Future research is required to inform interventions aimed at preventative measures for early screening and detection of prediabetes and T2D in adolescents, as well as the development of multi-disciplinary teams that include pediatric nurses and the specialized care they provide.
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Affiliation(s)
- Shelley Spurr
- University of Saskatchewan, College of Nursing, Saskatoon, Saskatchewan Canada.
| | - Jill Bally
- University of Saskatchewan, College of Nursing, Saskatoon, Saskatchewan Canada.
| | - Pauline Hill
- School of Nursing and Midwifery, University of Flinders, Australia.
| | - Katherine Gray
- School of Nursing and Midwifery, University of Newcastle, Australia
| | | | - Alison Hutton
- School of Nursing and Midwifery, University of Newcastle, Australia.
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28
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Reinehr T. Type 2 Diabetes Mellitus in Adolescents: Should We Reconsider Screening? Horm Res Paediatr 2019; 89:56-57. [PMID: 29084400 DOI: 10.1159/000481912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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29
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Chen Y, Wang T, Liu X, Shankar RR. Prevalence of type 1 and type 2 diabetes among US pediatric population in the MarketScan Multi-State Database, 2002 to 2016. Pediatr Diabetes 2019; 20:523-529. [PMID: 30861241 DOI: 10.1111/pedi.12842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of type 1 (T1DM) and type 2 diabetes mellitus (T2DM) among U.S. Medicaid pediatric population aged <18 years 2002 to 2016 by age, sex, and race/ethnicity. METHODS Participants aged <18 years old from 2002 to 2016 were identified from the MarketScan Multi-State Medicaid Database. Diabetes was defined as having (a) ≥1 claims for an outpatient or inpatient diabetes diagnosis and ≥2 prescriptions for any anti-diabetes medications or (b) records of ≥2 claims for an outpatient or inpatient diabetes diagnosis that were at least 30 days apart. Annual prevalence of diabetes and 95% confidence intervals (CIs) were calculated. Age-, sex-, and race-stratified prevalence were also assessed. RESULTS The annual prevalence of T1DM increased from 1.29 to 2.34/1000 pediatric persons from 2002 to 2016. The prevalence of T2DM rose from 0.70 in 2002 to 2.76/1000 in 2011, but then dropped to 2.12/1000 pediatric persons in 2016 in the Medicaid population. Prevalence of both T1DM and T2DM increased with age. While the prevalence of T1DM was similar in both sexes, and was most prevalent in Whites, prevalence of T2DM was higher in girls and was most prevalent in Blacks. CONCLUSIONS While the annual prevalence of T1DM in pediatric persons enrolled in Medicaid increased continuously from 2002 to 2016, the annual prevalence of T2DM increased from 2002 to 2011, with a subsequent decrease in 2016, possibly because of the increase of relatively healthier participants with the expanded eligibility through the ACA between 2011 and 2016.
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Affiliation(s)
- Yong Chen
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, New Jersey.,Department of Patient & Health Impact, Pfizer Inc., Collegeville, Pennsylvania
| | - Tongtong Wang
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, New Jersey
| | - Xinyue Liu
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, New Jersey
| | - R Ravi Shankar
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey
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30
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Marshall AC, Damstra M, Tuley M, Schifando EL. Assessment of Taste and Grittiness of Riomet ® ER Strawberry, Riomet ® ER Grape, Riomet ® Cherry, and Metformin Immediate-Release Tablets in Healthy Subjects. Drugs R D 2019; 19:57-66. [PMID: 30649711 PMCID: PMC6380966 DOI: 10.1007/s40268-018-0260-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective This study was conducted to evaluate the taste and grittiness of two formulations of Riomet® ER (metformin hydrochloride for extended release [ER] oral suspension 100 mg/mL) differing only in their flavoring agents (strawberry and grape) in comparison with two commercially available immediate-release (IR) formulations of metformin, Riomet® Cherry (metformin hydrochloride oral solution 500 mg/5 mL) and metformin IR tablets (metformin hydrochloride IR tablets 500 mg), in healthy human subjects aged 10–70 years. Methods Five comparison sets (i.e., Riomet® Cherry vs. Riomet® ER Strawberry; Riomet® Cherry vs. Riomet® ER Grape; metformin IR vs. Riomet® ER Strawberry; metformin IR vs. Riomet® ER Grape; and Riomet® Cherry vs. metformin IR) were evaluated. Riomet® ER was reconstituted as instructed on the label. Metformin IR tablets were crushed one at a time into a fine powder using a pharmaceutical pill crusher and mixed with 5 mL of water. A 2.5-mL dose of each product was administered to each subject. Subjects were instructed not to swallow any of the products. Each product in the comparison set was rated by the subjects for taste and grittiness according to a 7-point hedonic facial scale and a 5-point level of agreement scale. A comparison questionnaire was also completed by the subjects after evaluating each set. In all, 56 subjects were enrolled and 55 subjects completed the study. The taste preference was statistically evaluated. Results and Conclusions All Riomet® formulations were significantly preferred overall to metformin IR crushed tablets. Both the strawberry and the grape flavors of Riomet® ER tended to be preferred to Riomet® Cherry. Electronic supplementary material The online version of this article (10.1007/s40268-018-0260-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allyson C Marshall
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA.
| | - Maureen Damstra
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA
| | - Michael Tuley
- TKL Research, Inc., One Promenade Boulevard, Suite 1201, Fair Lawn, NJ, 07410, USA
| | - Elena L Schifando
- Sun Pharmaceuticals Industries, Inc., 2 Independence Way, Princeton, NJ, 08540, USA
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Tao S, Li L, Li L, Liu Y, Ren Q, Shi M, Liu J, Jiang J, Ma H, Huang Z, Xia Z, Pan J, Wei T, Wang Y, Li P, Lan T, Tang X, Zeng X, Lei S, Tang H, Ma L, Fu P. Understanding the gut-kidney axis among biopsy-proven diabetic nephropathy, type 2 diabetes mellitus and healthy controls: an analysis of the gut microbiota composition. Acta Diabetol 2019; 56:581-592. [PMID: 30888537 DOI: 10.1007/s00592-019-01316-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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: 10/23/2018] [Accepted: 02/23/2019] [Indexed: 02/05/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) has a rising prevalence and gut microbiota involvement is increasingly recognized. Diabetic nephropathy (DN) is a major complication of T2DM. The aim of the study was to understand the gut-kidney axis by an analysis of gut microbiota composition among biopsy-proven DN, T2DM without kidney disease, and healthy control. METHODS Fecal samples were collected from 14 DNs, 14 age/gender-matched T2DMs without renal diseases (DM), 14 age and gender-matched healthy controls (HC) and household contacts (HH) of DM group. The microbiota composition was analyzed by 16sRNA microbial profiling approach. RESULTS Substantial differences were found in the richness of gut microbiota and the variation of bacteria population in DM compared to HC, and DN compared to DM, respectively. DM could be accurately distinguished from age/gender-matched healthy controls by the variable of genus g_Prevotella_9 (AUC = 0.9), and DN patients could be accurately distinguished from age/gender-matched DM by the variables of two genera (g_Escherichia-Shigella and g_Prevotella_9, AUC = 0.86). The microbiota composition of HH group was close to that of HC group, and was different from DM group. Under the same diet, DM could be more accurately detected by the same genus (g_Prevotella_9, AUC = 0.92). CONCLUSION Gut microbiota composition was explored to be related to the occurrence of biopsy-proven DN from DM. DM could be distinguished from HC by detecting g_Prevotella_9 level in feces, while DN was different from DM by the variables of g_Escherichia-Shigella and g_Prevotella_9, which potentially contributed to the physiopathological diagnosis of DN from DM.
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Affiliation(s)
- Sibei Tao
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Lingzhi Li
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ling Li
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yuan Liu
- Chinese Health Service Management Department, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Qian Ren
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Min Shi
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jing Liu
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jing Jiang
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Huichao Ma
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Zhuo Huang
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Zijing Xia
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jing Pan
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Tiantian Wei
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yan Wang
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Peiyun Li
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Tian Lan
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xi Tang
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiaoxi Zeng
- West China Biomedical Big Data Center, Sichuan University, Chengdu, 610041, China
| | - Song Lei
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Huairong Tang
- Chinese Health Service Management Department, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Liang Ma
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing Key Laboratory of Kidney Disease, Beijing, 10000, China.
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Asmelash D, Asmelash Y. The Burden of Undiagnosed Diabetes Mellitus in Adult African Population: A Systematic Review and Meta-Analysis. J Diabetes Res 2019; 2019:4134937. [PMID: 31183383 PMCID: PMC6512017 DOI: 10.1155/2019/4134937] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/23/2019] [Accepted: 03/28/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The prevalence of diabetes is rapidly increasing in Africa. Type two diabetes may remain undetected for many years, leading to severe complications and healthcare costs. This underlines the importance of understanding the magnitude of undiagnosed diabetes in different populations of Africa. This study is intended to summarize and pool the results of community-based studies to provide a continental level estimate of the undiagnosed diabetes mellitus. METHODS We searched MEDLINE/PubMed, HINARI, Cochrane Library, and Google Scholar for community-based studies on diabetes mellitus in Africa. Descriptive information for the original studies was presented in a table, and the quantitative results were presented in forest plots. The Cochran's Q test and I 2 test statistic were used to test heterogeneity across studies. The pooled prevalence of undiagnosed diabetes and subgroup analyses within urban and rural population and diagnostic methods were computed by a random effects model from 2011 to 2017. RESULTS One hundred fifty-seven articles were identified through electronic searching using keywords. Of these, seventeen studies, with a total population of 20,350, met the inclusion criteria. A random effects meta-analysis showed that the pooled prevalence of undiagnosed diabetes mellitus in African population was 5.37% (95% CI: 4.57, 6.81). The pooled prevalence from subgroup analyses indicated that undiagnosed diabetes mellitus in the urban population (8.68%, 95% CI: 5.33, 12.03) is twice higher than that in the rural population (3.93%, 95% CI: 2.91, 4.95). The prevalence of UDM by OGTT (8.84%, 95% CI: 1.95, 15.73) was higher than that by the FPG diagnostic method (4.54%, 95% CI: 3.59, 5.49). CONCLUSION This study found high proportions of undiagnosed diabetes mellitus in different communities of the African countries. Policy makers must consider diagnostic strategies to improve screening for the undiagnosed diabetes mellitus cases for effective care, which can bring about a substantial reduction in diabetes-related complications and mortality. This review is registered with PROSPERO registration number CRD42018092637.
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Affiliation(s)
- Daniel Asmelash
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yemane Asmelash
- Department of Statistics, College of Computational and Natural Science, Aksum University, Aksum, Ethiopia
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Al-Ibrahim AA, Jackson RT. Healthy eating index versus alternate healthy index in relation to diabetes status and health markers in U.S. adults: NHANES 2007-2010. Nutr J 2019; 18:26. [PMID: 30995902 PMCID: PMC6471947 DOI: 10.1186/s12937-019-0450-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 03/27/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It remains to be determined whether the Alternate Healthy Eating Index 2010 (AHEI-2010) or the Healthy Eating Index 2010 (HEI-2010) is preferably recommended as means to assess dietary quality in people with type 2 diabetes (T2DM). METHODS The purpose of this study was to determine whether the AHEI-2010 provides a more accurate assessment of dietary quality than the HEI-2010 in relation to diabetes status, while controlling for health markers, sociodemographic and lifestyle factors. The 2007-2010 National Health and Nutrition Examination Survey (NHANES) was used as a representative sample of U.S. adults age 20+ years (n = 4097). HEI-2010 and the AHEI-2010 scores were used as measures of dietary quality and were calculated using data from the first 24-h dietary recall. Health markers evaluated include anthropometrics, blood pressure, lipid and inflammatory markers, and presence of co-morbid diseases. Least Squares Means were computed to determine differences across diabetes status (nondiabetes, prediabetes, T2DM) for total and sub-component HEI-2010 and AHEI-2010 scores, and to determine differences across total HEI-2010 and AHEI-2010 quartiles for health markers. Covariate-adjusted logistic regression was used to examine the association between total HEI-2010 and AHEI-2010 scores and diabetes status. RESULTS Adults with T2DM showed higher HEI-2010 and AHEI-2010 scores compared to adults with prediabetes and nondiabetes but did not have better health markers. For HEI-2010 component scores, adults with T2DM had highest consumption (highest score) of total protein foods and lowest consumption (highest score) for empty calories (p < 0.01). For AHEI-2010 component scores, adults with T2DM had the lowest consumption (highest score) for sugar-sweetened beverages and fruit juice, sodium, and alcohol (lowest score). In addition, adults with T2DM had the highest consumption (lowest score) for red and/or processed meats (p < 0.01). However, neither total HEI-2010 nor AHEI-2010 scores were significantly associated with diabetes status (p > 0.05). Results suggest that neither index was clearly superior to the other in terms of its predictive ability in relation to T2DM. CONCLUSION Neither total HEI-2010 nor AHEI-2010 scores performed better in terms of their relationship with diabetes status. However, the significant relationships between 1) diabetes status and health markers and 2) between HEI-2010 and AHEI-2010 scores and health markers suggest that diet has some influence on T2DM.
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Affiliation(s)
- Afnan A Al-Ibrahim
- Department of Nutrition and Food Science, University of Maryland, 0112 Skinner Building, College Park, MD, 20742, USA.
| | - Robert T Jackson
- Department of Nutrition and Food Science, University of Maryland, 0112 Skinner Building, College Park, MD, 20742, USA
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Hasan MM, Tasnim F, Tariqujjaman M, Ahmed S. Socioeconomic Inequalities of Undiagnosed Diabetes in a Resource-Poor Setting: Insights from the Cross-Sectional Bangladesh Demographic and Health Survey 2011. Int J Environ Res Public Health 2019; 16:E115. [PMID: 30609855 DOI: 10.3390/ijerph16010115] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/22/2018] [Accepted: 12/27/2018] [Indexed: 01/21/2023]
Abstract
Diabetes mellitus is rising disproportionately but is not frequently diagnosed until complications appear, which results in adverse health consequences. We estimated the prevalence of undiagnosed diabetes among adult diabetic patients and associated socioeconomic inequalities in Bangladesh. We used nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2011 data. Among patients with diabetes, we identified undiagnosed cases as having fasting plasma glucose ≥ 7.0 mmol/L, never having taken prescribed medicine and being told by health professionals. Among 938 patients with diabetes, 53.4% remained undiagnosed. The poorest (75.9%) and rural (59.0%) patients had significantly higher undiagnosed cases than the richest (36.0%) and urban (42.5%), respectively. Multiple logistic regression analysis revealed that the likelihood of being undiagnosed was lower among patients with age ≥ 70 years vs. 35–39 years (adjusted odds ratio (AOR) = 0.35; 95% confidence interval (CI) 0.19, 0.64) and patients with higher education vs. no education (AOR = 0.36; 95% CI 0.21, 0.62). Conversely, a high level of physical activity and being in a poor socioeconomic quintile were associated with a higher risk of remaining undiagnosed for diabetes. The Concentration Index (C) also showed that undiagnosed diabetes was largely distributed among the socioeconomically worse-off group in Bangladesh (C = −0.35). Nationwide diabetes screening programs may reduce this problem in Bangladesh and other similar low-income settings.
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Hao L, Li ZS, Hu LH. The Quality of Life Measurement in Recurrent Acute Pancreatitis Needs to be More Accurate. Am J Gastroenterol 2018; 113:1900. [PMID: 30214013 DOI: 10.1038/s41395-018-0244-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/07/2018] [Indexed: 12/11/2022]
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Beach LB, Turner B, Felt D, Marro R, Phillips GL. Risk factors for diabetes are higher among non-heterosexual US high-school students. Pediatr Diabetes 2018; 19:1137-1146. [PMID: 30006958 PMCID: PMC6175635 DOI: 10.1111/pedi.12720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/22/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022] Open
Abstract
Low physical activity (PA), high sedentary behavior (SB), and overweight and obesity have been shown to associate with increased Type 2 diabetes risk among adolescents. We investigated PA, SB, and overweight and obesity among Youth Risk Behavior Survey (YRBS) respondents to determine if non-heterosexual youth may be at increased diabetes risk compared to heterosexual youth. Weighted city and state YRBS data were pooled across 44 jurisdictions biennially from 2009 to 2015, resulting in a sample size of 350 673 students. Overall, 88.4% identified as heterosexual, 2.1% as gay or lesbian, 5.7% as bisexual, and 3.7% as unsure. With the exception of lesbian female students, after adjusting for age, race/ethnicity, body mass index, and survey year, all non-heterosexual youth reported significantly fewer days per week of PA compared to their sex-matched heterosexual counterparts. Similarly, compared to heterosexual female youth, bisexual and not sure female youth reported significantly more hours per day of SB. These PA and SB findings remained significant after adjustment for depressive symptoms and in-school bullying among bisexual female youth only. In fully adjusted models, lesbian students were 1.85 times more likely to be overweight and lesbian, bisexual, and not sure female youth were 1.55 to 2.07 times more likely to be obese than heterosexual female students. No significant differences in SB, overweight, or obesity were found among gay, bisexual, or unsure male youth compared to heterosexual male youth. Non-heterosexual youth may be at increased risk for developing type 2 diabetes mellitus compared to heterosexual youth. Future studies should characterize diabetes prevalence among non-heterosexual youth.
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Affiliation(s)
- Lauren B. Beach
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, 60611
| | - Blair Turner
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, 60611
| | - Dylan Felt
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, 60611
| | - Rachel Marro
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, 60611
| | - Gregory L. Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, 60611
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Van Hulst A, Paradis G, Harnois-Leblanc S, Benedetti A, Drapeau V, Henderson M. Lowering Saturated Fat and Increasing Vegetable and Fruit Intake May Increase Insulin Sensitivity 2 Years Later in Children with a Family History of Obesity. J Nutr 2018; 148:1838-1844. [PMID: 30383280 PMCID: PMC6533243 DOI: 10.1093/jn/nxy189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023] Open
Abstract
Background Identifying dietary factors that determine insulin sensitivity and secretion in children entering puberty may provide valuable information for the early prevention of type 2 diabetes. Objectives We assessed whether macronutrients and food groups are longitudinally associated with insulin sensitivity and secretion over a 2-y period in children with a family history of obesity, and whether associations differ by level of adiposity. Methods Data were derived from the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) Study, an ongoing prospective cohort including 630 children recruited at ages 8-10 y, with ≥1 obese parent, and followed 2 y later (n = 564). The intake of macronutrients and foods was assessed at baseline using three 24-h dietary recalls. At age 10-12 y, insulin sensitivity was assessed by the Matsuda Insulin Sensitivity Index (ISI) and the homeostatic model assessment of insulin resistance. Insulin secretion was assessed by the ratio of the area under the curve of insulin to the area under the curve of glucose at 30 min and at 120 min of an oral-glucose-tolerance test. Multivariable linear regression models were fitted for each dietary factor while adjusting for age, sex, puberty, physical activity, screen time, total energy intake, and percentage of body fat; and interaction terms between dietary factors and percentage of body fat were tested. Results Saturated fat intake was associated with a 1.95% lower (95% CI: -3.74%, -0.16%) Matsuda ISI, whereas vegetable and fruit intake was associated with a 2.35% higher (95% CI: 0.18%, 4.52%) Matsuda ISI 2 y later. The association of saturated fat intake with insulin sensitivity was most deleterious among children with a higher percentage of body fat (P-interaction = 0.023). Other than fiber intake, no longitudinal associations between dietary intake and insulin secretion were found. Conclusions Lowering saturated fat and increasing vegetable and fruit intakes during childhood may improve insulin sensitivity as children enter puberty. This study was registered at www.clinicaltrials.gov as NCT03356262.
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Affiliation(s)
| | - Gilles Paradis
- Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Soren Harnois-Leblanc
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada,School of Public Health, University of Montreal, Montreal, Canada
| | - Andrea Benedetti
- Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada,Medicine, McGill University, Montreal, Canada
| | - Vicky Drapeau
- Faculty of Educational Sciences, Department of Physical Education,Institute of Nutrition and Functional Foods, Laval University, Quebec City, Canada,Quebec Heart and Lung Institute/Research Center, Quebec City, Canada
| | - Mélanie Henderson
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Canada,Division of Endocrinology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and University of Montreal, Montreal, Canada,Address correspondence to MH (e-mail: )
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Guevara E, Torres-Galván JC, Ramírez-Elías MG, Luevano-Contreras C, González FJ. Use of Raman spectroscopy to screen diabetes mellitus with machine learning tools. Biomed Opt Express 2018; 9:4998-5010. [PMID: 30319917 PMCID: PMC6179393 DOI: 10.1364/boe.9.004998] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/18/2018] [Indexed: 05/03/2023]
Abstract
Type 2 diabetes mellitus (DM2) is one of the most widely prevalent diseases worldwide and is currently screened by invasive techniques based on enzymatic assays that measure plasma glucose concentration in a laboratory setting. A promising plan of action for screening DM2 is to identify molecular signatures in a non-invasive fashion. This work describes the application of portable Raman spectroscopy coupled with several supervised machine-learning techniques, to discern between diabetic patients and healthy controls (Ctrl), with a high degree of accuracy. Using artificial neural networks (ANN), we accurately discriminated between DM2 and Ctrl groups with 88.9-90.9% accuracy, depending on the sampling site. In order to compare the ANN performance to more traditional methods used in spectroscopy, principal component analysis (PCA) was carried out. A subset of features from PCA was used to generate a support vector machine (SVM) model, albeit with decreased accuracy (76.0-82.5%). The 10-fold cross-validation model was performed to validate both classifiers. This technique is relatively low-cost, harmless, simple and comfortable for the patient, yielding rapid diagnosis. Furthermore, the performance of the ANN-based method was better than the typical performance of the invasive measurement of capillary blood glucose. These characteristics make our method a promising screening tool for identifying DM2 in a non-invasive and automated fashion.
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Affiliation(s)
- Edgar Guevara
- CONACYT-Universidad Autónoma de San Luis Potosí, Mexico
- Terahertz Science and Technology Center (C2T2) and Science and Technology National Lab (LANCyTT), Universidad Autónoma de San Luis Potosí, Mexico
| | - Juan Carlos Torres-Galván
- Terahertz Science and Technology Center (C2T2) and Science and Technology National Lab (LANCyTT), Universidad Autónoma de San Luis Potosí, Mexico
| | | | | | - Francisco Javier González
- Terahertz Science and Technology Center (C2T2) and Science and Technology National Lab (LANCyTT), Universidad Autónoma de San Luis Potosí, Mexico
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Calero Bernal M, Varela Aguilar J. Infant-juvenile type 2 diabetes. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE We examined bone mineral density (BMD) and osteoporosis prevalence in those with type 1 compared to type 2 diabetes derived from a nationally representative sample from the civilian community in the United States. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) for 2005-2006, 2007-2008, 2009-2010, and 2013-2014 were merged to obtain a large sample of diabetics at least 20 years of age with participation in the interview and medical examination. Osteoporosis status was defined by BMD at the total femur, femoral neck, or total lumbar spine. Self-reported diabetics that were prescribed insulin within the first year of diagnosis, are currently taking insulin, and reported no prescriptions for any diabetic pills were classified as type 1. Remaining self-reported diabetics were deemed as having type 2. RESULTS A total of 2050 diabetics were included in which 87 (4%) were classified as type 1. Type 1 diabetics were found to have a significantly lower BMD at the total femur and femoral neck, but not at the lumbar spine in the adjusted models. Diabetics with type 1 were 4.7 times more likely to have osteoporosis than those with type 2. There was no significant relationship between diabetes type and BMD or osteoporosis prior to adjustment for confounders. CONCLUSIONS Although our results show an increased likelihood of osteoporosis among those with type 1 diabetes, future studies including a larger sample from a community population are needed. It may benefit diabetics, especially those with type 1, to initiate osteoporosis screening methods including evaluation of fracture risk, bone quality, and BMD measurements at multiple sites earlier than recommended.
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Affiliation(s)
- S C DeShields
- The Center for Health Analytics and Discovery, Eastern Virginia Medical School, Harry Lester Building, 651 Colley Avenue, Room 402, Norfolk, VA, 23507, USA.
| | - T D Cunningham
- The Center for Health Analytics and Discovery, Eastern Virginia Medical School, Harry Lester Building, 651 Colley Avenue, Room 402, Norfolk, VA, 23507, USA
- Master of Healthcare Delivery Science Program, Eastern Virginia Medical School, Norfolk, VA, 23501, USA
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Liu B, Sun Y, Snetselaar LG, Sun Q, Yang Q, Zhang Z, Liu L, Hu FB, Bao W. Association between plasma trans-fatty acid concentrations and diabetes in a nationally representative sample of US adults. J Diabetes 2018; 10:653-664. [PMID: 29446544 PMCID: PMC6093805 DOI: 10.1111/1753-0407.12652] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/03/2018] [Accepted: 02/11/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A diet high in trans-fatty acids (TFA) induces insulin resistance in rodent models and primates. However, previous epidemiological studies on the association between TFAs, based primarily on self-reported intake from the diet, and diabetes in humans have yielded conflicting results. Herein we examined the associations of objectively measured plasma TFA concentrations with diabetes in a large population-based study among US adults. METHODS We included 3801 participants aged ≥20 years from the National Health and Nutrition Examination Survey 1999-2000 and 2009-10. Four major TFAs, namely palmitelaidic acid (C16:1 n-7t), elaidic acid (C18:1 n-9t), vaccenic acid (C18:1 n-7t), and linolelaidic acid (C18:2 n-6t, 9t), were measured in fasting plasma using gas chromatography-mass spectrometry. Diabetes was defined by self-reported physician diagnosis, plasma fasting glucose ≥126 mg/dL, or HbA1c ≥6.5%. RESULTS After adjustment for other major risk factors, the odds ratios (95% confidence intervals) of diabetes comparing the highest with lowest quintile of plasma TFAs was 2.19 (1.27-3.79) for total TFAs (Ptrend = 0.01), 2.34 (1.48-3.72) for elaidic acid (Ptrend = 0.0004), 1.33 (0.82-2.15) for linolelaidic acid (Ptrend = 0.18), 1.58 (0.97-2.58) for palmitelaidic acid (Ptrend = 0.02), and 1.64 (0.95-2.84) for vaccenic acid (Ptrend = 0.08). In addition, total TFAs, elaidic acid, palmitelaidic acid, and vaccenic acid were significantly associated with fasting glucose, fasting insulin, the insulin resistance index, and HbA1c. CONCLUSIONS In a nationally representative population, plasma TFAs, in particular elaidic acid, were positively associated with diabetes and biomarkers of glucose metabolism.
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Affiliation(s)
- Buyun Liu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | - Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Liegang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Wuhan 430030, China
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
- Obesity Research and Education Initiative, University of Iowa, Iowa City, IA 52242, USA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA 52242, USA
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Chava S, Chennakesavulu S, Gayatri BM, Reddy ABM. A novel phosphorylation by AMP-activated kinase regulates RUNX2 from ubiquitination in osteogenesis over adipogenesis. Cell Death Dis. 2018;9:754. [PMID: 29988028 PMCID: PMC6037667 DOI: 10.1038/s41419-018-0791-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/10/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022]
Abstract
Mesenchymal stem cells (MSCs) function as progenitors to a variety of cell types. The reported association between osteogenic and adipogenic commitment during differentiation is due to the regulation of key transcription factors in the signaling pathways. However, the process of adipogenesis at the expense of osteogenic phenotype during metabolic stress is still unclear. In this study, we showed for the first time that RUNX2 is a novel substrate of AMP-activated kinase (AMPK), which directly phosphorylates at serine 118 residue in the DNA-binding domain of RUNX2. Our results in in vitro MSC lineage differentiation models confirmed that active AMPK and RUNX2-S118 phosphorylation are preferentially associated with osteogenic commitment, whereas the lack of this phosphorylation leads to adipogenesis. This interplay is regulated by the ubiquitination of non-phosphorylated RUNX2-S118, which is evident in the dominant mutant RUNX2-S118D. Pharmacological activation of AMPK by metformin significantly abrogated the loss of RUNX2-S118 phosphorylation and protected from tunicamycin-induced endoplasmic reticulum stress, high glucose-induced in vitro adipogenesis and streptozotocin-induced in vivo bone adiposity and bone phenotype. In conclusion, results from this study demonstrated that RUNX2 is a direct target of AMPK which simplified the outlook towards several complex mechanisms that are currently established concerning cellular metabolism and pathogenesis.
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Al-Kafaji G, Aljadaan A, Kamal A, Bakhiet M. Peripheral blood mitochondrial DNA copy number as a novel potential biomarker for diabetic nephropathy in type 2 diabetes patients. Exp Ther Med 2018; 16:1483-1492. [PMID: 30116398 DOI: 10.3892/etm.2018.6319] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 03/03/2018] [Accepted: 05/02/2018] [Indexed: 12/19/2022] Open
Abstract
The mitochondrial DNA copy number (mtDNA-CN) is a surrogate measure of mitochondrial function and altered mtDNA-CN reflects the oxidant-induced cell damage. A previous study by our group demonstrated that a reduction in the renal mtDNA-CN is implicated in the pathogenesis of diabetic nephropathy (DN), a leading cause of end-stage renal disease in diabetic patients. In the present study, it was investigated whether the mtDNA-CN in the peripheral blood may be utilized as a biomarker for DN in type 2 diabetes (T2D) patients. The study included 50 non-diabetic and 100 diabetic subjects. The diabetic subjects were sub-divided based on their albumin-to-creatinine ratio (ACR) into T2D patients with normoalbuminuria (n=50), DN patients with microalbuminuria (n=29) and DN patients with macroalbuminuria (n=21). The mtDNA-CN was measured in the peripheral blood by real-time polymerase chain reaction analysis. Patients with DN had a lower mtDNA-CN than patients with T2D and healthy controls (P<0.05). A sub-group analysis with stratification by the ACR indicated that a decreased mtDNA-CN was associated with the severity and the presence of DN, as it was lower in DN patients with macroalbuminuria than in DN patients with microalbuminuria and T2D patients with normoalbuminuria (P<0.01). The area under the receiver operating characteristic curve (AUC) for mtDNA-CN was 0.916 (sensitivity, 86% and specificity, 74%) and 0.961 (sensitivity, 96% and specificity, 88%) for differentiating DN patients from T2D patients without DN and from healthy controls, respectively. Furthermore, the AUC of mtDNA-CN for differentiating DN patients with microalbuminuria from those with macroalbuminuria was 0.895 (sensitivity, 83% and specificity, 85%). Multivariate analysis revealed that the mtDNA-CN was significantly associated with the occurrence and progression of DN, even after adjustment for age, mean blood pressure, glycated haemoglobin A1c and total cholesterol (P<0.05). In patients with DN, a decreased mtDNA-CN was negatively correlated with albuminuria and conventional risk factors for DN, and was positively correlated with the estimated glomerular filtration rate. The present results therefore suggest the utilization of circulating mtDNA-CN as a novel biomarker for the early diagnosis of DN and indicate the significance of decreased mtDNA-CN as another independent risk factor for DN.
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Affiliation(s)
- Ghada Al-Kafaji
- Department of Molecular Medicine and Al-Jawhara Centre for Molecular Medicine, Genetics and Inherited Disorders, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Kingdom of Bahrain
| | - Abdulah Aljadaan
- Department of Molecular Medicine and Al-Jawhara Centre for Molecular Medicine, Genetics and Inherited Disorders, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Kingdom of Bahrain
| | - Amer Kamal
- Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Kingdom of Bahrain
| | - Moiz Bakhiet
- Department of Molecular Medicine and Al-Jawhara Centre for Molecular Medicine, Genetics and Inherited Disorders, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Kingdom of Bahrain
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Rodrigo N, Glastras SJ. The Emerging Role of Biomarkers in the Diagnosis of Gestational Diabetes Mellitus. J Clin Med 2018; 7:E120. [PMID: 29882903 PMCID: PMC6024961 DOI: 10.3390/jcm7060120] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 02/06/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy; its rising incidence is a result of increased maternal obesity and older maternal age together with altered diagnostic criteria identifying a greater proportion of pregnant women with GDM. Its consequences are far-reaching, associated with poorer maternal and neonatal outcomes compared to non-GDM pregnancies, and GDM has implications for metabolic health in both mother and offspring. Objective markers to identify women at high risk for the development of GDM are useful to target therapy and potentially prevent its development. Established clinical risk factors for GDM include overweight/obesity, age, ethnicity, and family history of diabetes, though they lack specificity for its development. The addition of biomarkers to predictive models of GDM may improve the ability to identify women at risk of GDM prior to its development. These biomarkers reflect the pathophysiologic mechanisms of GDM involving insulin resistance, chronic inflammation, and altered placental function. In addition, the role of epigenetic changes in GDM pathogenesis highlights the complex interplay between genetic and environmental factors, potentially offering further refinement of the prediction of GDM risk. In this review, we will discuss the clinical challenges associated with the diagnosis of GDM and its current pathophysiologic basis, giving rise to potential biomarkers that may aid in its identification. While not yet validated for clinical use, we explore the possible clinical role of biomarkers in the future. We also explore novel diagnostic tools, including high throughput methodologies, that may have potential future application in the identification of women with GDM.
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Affiliation(s)
- Natassia Rodrigo
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia.
- The Kolling Institute of Medical Research, St Leonards, Sydney 2065, Australia.
- Faculty of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia.
- The Kolling Institute of Medical Research, St Leonards, Sydney 2065, Australia.
- Faculty of Medicine, The University of Sydney, Sydney 2006, Australia.
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Abstract
In recent years, we have witnessed an increase in the number of cases of type 2 diabetes mellitus (DM2) in children and adolescents, which has paralleled the increase in the worldwide prevalence of obesity. Although screening the general population does not appear to be cost-effective, special attention should be paid to children with excess weight, obesity or other factors that predispose them to a state of insulin resistance. When faced with the diagnosis of childhood DM2, the presence of comorbidities (such as hypertension, dyslipidemia and microalbuminuria) should be assessed, and appropriate treatment and follow-up should be administered to prevent the onset of complications, given that the DM2 in this population group will last longer than that started in adulthood.
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Affiliation(s)
- M L Calero Bernal
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España; Grupo de trabajo de Diabetes y Obesidad de SEMI, España.
| | - J M Varela Aguilar
- Grupo de trabajo de Diabetes y Obesidad de SEMI, España; Servicio de Medicina Interna, Hospital Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública, Sevilla, España
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Strand E, Rebnord EW, Flygel MR, Lysne V, Svingen GFT, Tell GS, Løland KH, Berge RK, Svardal A, Nygård O, Pedersen ER. Serum Carnitine Metabolites and Incident Type 2 Diabetes Mellitus in Patients With Suspected Stable Angina Pectoris. J Clin Endocrinol Metab 2018; 103:1033-1041. [PMID: 29325058 DOI: 10.1210/jc.2017-02139] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/04/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Carnitine and its metabolites are centrally involved in fatty acid metabolism. Although elevated circulating concentrations have been observed in obesity and insulin resistance, prospective studies examining whether these metabolites are associated with incident type 2 diabetes mellitus (T2D) are sparse. OBJECTIVE We performed a comprehensive evaluation of metabolites along the carnitine pathway relative to incident T2D. DESIGN A total of 2519 patients (73.1% men) with coronary artery disease, but without T2D, were followed for median 7.7 years until the end of 2009, during which 173 (6.9%) new cases of T2D were identified. Serum levels of free carnitine, its precursors trimethyllysine (TML) and γ-butyrobetaine, and the esters acetyl-, propionyl-, (iso)valeryl-, octanoyl-, and palmitoylcarnitine were measured by liquid chromatography/tandem mass spectrometry. Risk associations were explored by logistic regression and reported per (log-transformed) standard deviation increment. RESULTS Median age at inclusion was 62 years and median body mass index (BMI) 26.0 kg/m2. In models adjusted for age, sex, fasting status, BMI, estimated glomerular filtration rate, glycated hemoglobin A1c, triglyceride and high-density lipoprotein cholesterol levels, and study center, serum levels of TML and palmitoylcarnitine associated positively [odds ratio (95% confidence interval), 1.22 (1.04 to 1.43) and 1.24 (1.04 to 1.49), respectively], whereas γ-butyrobetaine associated negatively [odds ratio (95% confidence interval) 0.81 (0.66 to 0.98)] with T2D risk. CONCLUSION Serum levels of TML, γ-butyrobetaine, and the long-chained palmitoylcarnitine predict long-term risk of T2D independently of traditional risk factors, possibly reflecting dysfunctional fatty acid metabolism in patients susceptible to T2D development.
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Affiliation(s)
- Elin Strand
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Eirik W Rebnord
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Center for Diabetes Research, University of Bergen, Children and Youth Hospital, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Malin R Flygel
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Vegard Lysne
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjetil H Løland
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rolf K Berge
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Asbjørn Svardal
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Center for Diabetes Research, University of Bergen, Children and Youth Hospital, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eva R Pedersen
- Department of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Center for Diabetes Research, University of Bergen, Children and Youth Hospital, Bergen, Norway
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Bjarnason TA, Hafthorsson SO, Kristinsdottir LB, Oskarsdottir ES, Aspelund T, Sigurdsson S, Gudnason V, Andersen K. Oral glucose tolerance test predicts increased carotid plaque burden in patients with acute coronary syndrome. PLoS One 2017; 12:e0183839. [PMID: 28854264 PMCID: PMC5576679 DOI: 10.1371/journal.pone.0183839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/12/2017] [Indexed: 12/30/2022] Open
Abstract
Background Type 2 diabetes and prediabetes are established risk factors for atherosclerosis. The aim of this study was to evaluate the atherosclerotic plaque burden in the carotid arteries of patients with acute coronary syndrome according to their glycemic status. Methods Patients with acute coronary syndrome and no previous history of type 2 diabetes were consecutively included in the study. Glucose metabolism was evaluated with fasting glucose in plasma, HbA1c and a standard two-hour oral glucose tolerance test. Atherosclerotic plaque in the carotid arteries was evaluated with a standardized ultrasound examination where total plaque area was measured and patients classified as having no plaque or a significant plaque formation. Results A total of 245 acute coronary syndrome patients (male 78%, 64 years (SD: 10.9)) were included. The proportion diagnosed with normal glucose metabolism, prediabetes and type 2 diabetes was 28.6%, 64.1% and 7.3%, respectively. A significant atherosclerotic plaque was found in 48.5%, 66.9% and 72.2% of patients with normal glucose metabolism, prediabetes and type 2 diabetes, respectively. An incremental increase in total plaque area was found from normal glucose metabolism to prediabetes (25.5%) and from normal glucose metabolism to type 2 diabetes (35.9%) (p = 0.04). When adjusted for conventional cardiovascular risk factors the OR of having significant atherosclerotic plaque in the carotid arteries was 2.17 (95% CI 1.15–4.15) for patients with newly diagnosed dysglycemia compared to patients with normal glucose metabolism. When additionally adjusted for the 2-hour plasma glucose after glucose loading (2hPG) the OR attenuated to 1.77 (95% CI 0.83–3.84). Conclusion Newly detected dysglycemia is an independent predictor of significant atherosclerotic plaque in the carotid arteries with oral glucose tolerance test as a major determinant of carotid plaque burden in this group of individuals with acute coronary syndrome.
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Affiliation(s)
- Thorarinn A. Bjarnason
- Department of Medicine, Division of Cardiology, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland
- University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | | | | | | | - Thor Aspelund
- University of Iceland, School of Health Sciences, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - Sigurdur Sigurdsson
- University of Iceland, School of Health Sciences, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | | | - Karl Andersen
- Department of Medicine, Division of Cardiology, Landspitali the National University Hospital of Iceland, Reykjavik, Iceland
- University of Iceland, School of Health Sciences, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
- * E-mail:
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48
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Cropano C, Santoro N, Groop L, Dalla Man C, Cobelli C, Galderisi A, Kursawe R, Pierpont B, Goffredo M, Caprio S. The rs7903146 Variant in the TCF7L2 Gene Increases the Risk of Prediabetes/Type 2 Diabetes in Obese Adolescents by Impairing β-Cell Function and Hepatic Insulin Sensitivity. Diabetes Care 2017; 40:1082-1089. [PMID: 28611053 PMCID: PMC5521977 DOI: 10.2337/dc17-0290] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/06/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In this study, we aimed to explore the mechanism by which TCF7L2 rs7903146 risk allele confers susceptibility to impaired glucose tolerance (IGT) or type 2 diabetes (T2D) in obese adolescents. RESEARCH DESIGN AND METHODS The rs7903146 variant in the TCF7L2 gene was genotyped in a multiethnic cohort of 955 youths. All subjects underwent an oral glucose tolerance test with the use of the Oral Minimal Model to assess insulin secretion, and 33 subjects underwent a hyperinsulinemic-euglycemic clamp. In 307 subjects, a follow-up oral glucose tolerance test was repeated after 3.11 ± 2.36 years. RESULTS The TCF7L2 rs7903146 risk allele was associated with higher 2-h glucose levels in Caucasians (P = 0.006) and African Americans (P = 0.009), and a trend was seen also in Hispanics (P = 0.072). Also, the T allele was associated with decreased β-cell responsivity and IGT (P < 0.05). Suppression of endogenous hepatic glucose production was lower in subjects with the risk variant (P = 0.006). Finally, the odds of showing IGT/T2D at follow-up were higher in subjects carrying the minor allele (odds ratio 2.224; 95% CI 1.370-3.612; P = 0.0012). CONCLUSIONS The rs7903146 variant in the TCF7L2 gene increases the risk of IGT/T2D in obese adolescents by impairing β-cell function, and hepatic insulin sensitivity predicts the development of IGT/T2D over time.
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Affiliation(s)
- Catrina Cropano
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Nicola Santoro
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Leif Groop
- Department of Clinical Sciences, Diabetes and Endocrinology, Lund University, Malmo, Sweden.,Lund University Diabetes Center, Lund University, Malmo, Sweden
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Alfonso Galderisi
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Bridget Pierpont
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Martina Goffredo
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Sonia Caprio
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Abstract
BACKGROUND Childhood obesity and obesity-associated diabetes and metabolic syndrome (MetS) continue to rise. Obesity has been linked to structural and functional brain abnormalities, particularly in the frontal lobe. METHODS One hundred sixty-two adolescents (aged 19.53 ± 1.53 years) underwent medical, neurocognitive, and brain magnetic resonance imaging assessments. Participants were either healthy weight (BMI <25.0 kg/m2 or BMI percentile <85%) or obese (BMI ≥30.0 kg/m2 or BMI percentile ≥95%). We evaluated frontal lobe cognitive functions and the size of the corpus callosum (CC). RESULTS Groups differed on four measures of processing speed contained in four different cognitive tests, but not on executive function. A confirmatory factor analysis verified that the significant processing speed variables loaded on the same factor. We also found differences between the weight groups on the area of the anterior portion of the CC, but not the overall CC. Only the Controlled Oral Word Association Test (COWAT) was significantly correlated with the area of the anterior portion of the CC. In the obese group, 32.4% met criteria for MetS. No differences were found between obese participants with or without MetS and none of the MetS factors contributed consistently to cognitive performance. CONCLUSIONS Obese adolescents show slower cognitive processing speed while maintaining equivalent performance on executive functioning compared with their healthy weight peers. The group differences in the anterior portion of the CC, responsible for frontal lobe interhemispheric communication, may in part explain our processing speed findings. Future studies should include a longitudinal design and diffusion tensor imaging to examine the integrity of white matter.
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Affiliation(s)
- Victoria Sweat
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Kathy F. Yates
- Department of Psychiatry, New York University School of Medicine, New York, NY.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY
| | - Renee Migliaccio
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Antonio Convit
- Department of Psychiatry, New York University School of Medicine, New York, NY.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY.,Department of Radiology, New York University School of Medicine, New York, NY.,Department of Medicine, New York University School of Medicine, New York, NY
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50
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Shen JZ, Ge WH, Fang Y, Liu H. A novel polymorphism in protein kinase AMP-activated catalytic subunit alpha 2 (PRKAA2) is associated with type 2 diabetes in the Han Chinese population. J Diabetes 2017; 9:606-612. [PMID: 27427333 DOI: 10.1111/1753-0407.12449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 03/17/2016] [Revised: 05/24/2016] [Accepted: 07/12/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND It has been proposed that the energy-sensing enzyme AMP-activated protein kinase (AMPK) is a key agent in the pathophysiology of type 2 diabetes mellitus (T2DM). The gene encoding protein kinase AMP-activated catalytic subunit alpha 2 (PRKAA2) is located at one of the Asian T2DM loci (1p32). Therefore, the aim of the present study was to test for the association of common variants in PRKAA2 with T2DM in the Han Chinese population. METHODS We genotyped 221 T2DM patients and 111 controls to assess possible associations of two tagging single nucleotide polymorphisms (tSNPs) in the PRKAA2 gene with T2DM. RESULTS The clinical characteristics of T2DM cases compared with controls differed significantly. No significant association was observed with the rs2143754 polymorphism whereas the rs2746342 polymorphism exhibited a highly significant association with T2DM. Fasting plasma glucose (FPG) of subjects carrying the G/G genotype of the rs2746342 polymorphism was higher than that of subjects carrying the T allele (P = 0.0049). These associations were magnified in the presence of the G/G genotype of the rs2143754 polymorphism. CONCLUSIONS The rs2746342 polymorphism is significantly associated with susceptibility to T2DM and seems to interact with the rs2143754 polymorphism in the modulation of FPG in the Han Chinese population.
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Affiliation(s)
- Ji-Zhong Shen
- Department of Pharmacy, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
| | - Wei-Hong Ge
- Department of Pharmacy, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
| | - Yun Fang
- Department of Pharmacy, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
| | - Hang Liu
- Department of Pharmacy, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
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