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Puangpet T, Pongkunakorn T, Chulkarat N, Bunlangjit C, Surawit A, Pinsawas B, Mongkolsucharitkul P, Mayurasakorn K. Control and complications of diabetes in urban primary care units in Thailand: a cross-sectional study. BMC PRIMARY CARE 2022; 23:212. [PMID: 35996081 PMCID: PMC9396826 DOI: 10.1186/s12875-022-01823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Primary health care system plays a central role in caring for persons with diabetes. Thai National Health Examination Survey (NHES) reports that only 40% of patients with type 2 diabetes mellitus (T2DM) achieve optimal glycemic control. We sought to evaluate the quality of diabetic care (QOC), prevalence of microvascular complications, and associated risk factors among T2DM patients treated at primary care units in urban areas in Thailand.
Methods
A population-based, cross-sectional study of 488 T2DM patients aged over 35 years from 25 primary care units in Samutsakhon, Thailand was conducted during February 2018 to March 2019. Clinical targets of care (TOC) and processes of care (POC) were measured to evaluate QOC. Multivariate logistic regression models were applied to explore the association between risk factors and glycemic control.
Results
41.2% of women and 44.4% of men achieved hemoglobin A1C (A1C) < 53 mmol/mol, while 31.3% of women and 29.7% of men had poor glycemic control (A1C > 63 mmol/mol). 39 participants (8%) achieved all TOC and 318 participants (65.2%) achieved all POC. Significant risk factors for poor glycemic control included diabetes duration > 6 years (AOR = 1.83, 95% CI = 1.20–2.79), being overweight (AOR = 2.54, 95% CI = 1.58–4.08), obesity (AOR = 1.71, 95% CI = 1.05–2.89), triglycerides > 1.7 mmol/l (AOR = 1.81, 95% CI = 1.25–2.78), low density lipoprotein-cholesterol (LDL-C) ≥ 2.6 mmol/l (AOR = 1.55, 95% CI = 1.04–2.28). On the other hand, participants aged > 65 years (AOR = 0.25, 95% CI = 0.14–0.55) or achieved TOC indicators (AOR = 0.69, 95% CI = 0.43–0.89) were significantly associated with glycemic control. Diabetic retinopathy was significantly related to obesity (AOR = 2.21, 95% CI = 1.00–4.86), over waist circumference (AOR = 2.23, 95% CI = 0.77–2.31), and diastolic blood pressure > 90 mmHg (AOR = 1.81, 95% CI = 1.48–1.96).
Conclusion
Access to essential diabetic screening in primary care units is crucial to determine status of disease control and guide disease management. Duration of T2DM, high body mass index, triglyceride and LDL-C were independently associated with poor glycemic control. Obesity was highly associated with diabetes retinopathy. Effort should be taken seriously toward monitoring these factors and providing effective care.
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Goyal S, Sood A, Gautam I, Pradhan S, Mondal P, Singh G, Jaura RS, Singh TG, Sibia RS. Serum protease-activated receptor (PAR-1) levels as a potential biomarker for diagnosis of inflammation in type 2 diabetic patients. Inflammopharmacology 2022; 30:1843-1851. [PMID: 35974263 DOI: 10.1007/s10787-022-01049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inflammation is a prominent clinical manifestation in type 2 diabetes mellitus (T2DM) patients, often associated with insulin resistance, metabolic dysregulation, and other complications. AIM OF THE STUDY The present study has been designed to check the serum levels of PAR-1 and correlate with various clinical manifestations and inflammatory cytokines levels in type 2 diabetic subjects. MATERIAL AND METHODS The study population was divided into two groups, healthy volunteers (n = 15): normal glycated hemoglobin (HbA1c) (4.26 ± 0.55) and type 2 diabetic subjects (n = 30): HbA1c levels (7.80 ± 2.41). The serum levels of PAR-1 (ELISA method) were studied in both groups and correlated with demographic parameters age, weight, body mass index (BMI), and conventional inflammation biomarkers like C-reactive protein (CRP), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumour necrosis factor-alpha (TNF-α). RESULTS The demographic variables including the body weight (77.38 ± 10.00 vs. controls 55.26 ± 6.99), BMI (29.39 ± 3.61 vs. controls 25.25 ± 4.01), glycemic index HbA1c (7.80 ± 2.41 vs. controls 4.26 ± 0.55) were found to be statistically increased in T2DM subjects than the healthy control group. The levels of various inflammatory biomarkers and PAR-1 were significantly elevated in T2DM groups in comparison to healthy volunteers. The univariate and multivariate regression analysis revealed that elevated PAR-1 levels positively correlated with increased body weight, BMI, HbA1c, and inflammatory cytokines. CONCLUSION Our findings indicate that the elevated serum PAR-1 levels serve as an independent predictor of inflammation in T2DM subjects and might have prognostic value for determining T2DM progression.
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Affiliation(s)
- Sanjay Goyal
- Government Medical College, Patiala, Punjab, India
| | - Ankita Sood
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala National Highway (NH-64), Tehsil, Rajpura District, Patiala, 140401, Punjab, India
| | - Isha Gautam
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala National Highway (NH-64), Tehsil, Rajpura District, Patiala, 140401, Punjab, India
| | - Soumyadip Pradhan
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala National Highway (NH-64), Tehsil, Rajpura District, Patiala, 140401, Punjab, India
| | - Puskar Mondal
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala National Highway (NH-64), Tehsil, Rajpura District, Patiala, 140401, Punjab, India
| | - Gaaminepreet Singh
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala National Highway (NH-64), Tehsil, Rajpura District, Patiala, 140401, Punjab, India.
| | - Ravinder Singh Jaura
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala National Highway (NH-64), Tehsil, Rajpura District, Patiala, 140401, Punjab, India
| | - Thakur Gurjeet Singh
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala National Highway (NH-64), Tehsil, Rajpura District, Patiala, 140401, Punjab, India
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Sims TJ, Boye KS, Robinson S, Kennedy-Martin T. Treatment-Related Attributes of Diabetes Therapies and How People with Type 2 Diabetes Report Their Impact on Indicators of Medication-Taking Behaviors. Patient Prefer Adherence 2022; 16:1919-1939. [PMID: 35958887 PMCID: PMC9359496 DOI: 10.2147/ppa.s367046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Understanding the treatment-related attributes influencing medication-taking behaviors in people with type 2 diabetes (T2D) is important for delivery of patient-centered care. This review aimed to identify and summarize studies in which people with T2D (PwD) directly indicated the treatment-related attributes associated with medication-taking behaviors or intentions. Materials and Methods EMBASE and PubMed were searched for studies (Jan 2005-May 2021) reporting the link between PwD-expressed diabetes treatment-related attributes and the decision to initiate, adhere to, or discontinue a T2D medication. Eligible studies reported attributes associated with oral antidiabetes drugs or injectables (not insulin). Studies not explicitly exploring the link between attributes and indicators of behaviors (eg most discrete-choice experiments [DCE] and those interrogating electronic medical records or claims databases) were excluded, as were studies where the link between attribute and behavior came from anyone but the PwD. Results Of the 6464 studies identified, 16 were included. Studies were conducted across multiple countries; the USA was most represented (n = 8 studies). The impact of treatment attributes was described on indicators of initiation (n = 3), adherence (n = 12), and discontinuation (n = 4). Some studies evaluated multiple behaviors. PwD perspectives were solicited by structured questionnaires (n = 10), qualitative approaches (n = 4), or DCE explicitly exploring the link to medication-taking behaviors (n = 2). Closed- (n = 9) and open-ended questions (n = 7) were employed. Across studies, several factors including glycemic efficacy (n = 9), weight change (n = 9), dosing frequency (n = 9), hypoglycemia (n = 8), gastrointestinal adverse events (n = 8), regimen complexity (n = 6), route of administration (n = 3), and cardiovascular risk (n = 1) were reported as influencing behaviors, being motivators or barriers to initiation, adherence, or discontinuation. Conclusion Several attributes influence how PwD take their medications. Insights gained directly from PwD have the potential to assist stakeholders in making more informed, patient-centered, treatment decisions, thus choosing and managing medications that PwD are comfortable initiating and persisting with over the longer term.
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Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme. BMJ Open 2022. [PMCID: PMC9362792 DOI: 10.1136/bmjopen-2021-052611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents. Design A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted. Participants A hypothetical cohort of 100 adolescents with a mean age of 13 years. Interventions An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling. Outcome measure Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained. Results The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane. Conclusions The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting. Trail registration number ISRCTN74109264.
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Vrátná E, Husáková J, Jarošíková R, Dubský M, Wosková V, Bém R, Jirkovská A, Králová K, Pyšková B, Lánská V, Fejfarová V. Effects of a 12-Week Interventional Exercise Programme on Muscle Strength, Mobility and Fitness in Patients With Diabetic Foot in Remission: Results From BIONEDIAN Randomised Controlled Trial. Front Endocrinol (Lausanne) 2022; 13:869128. [PMID: 35865313 PMCID: PMC9294221 DOI: 10.3389/fendo.2022.869128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Diabetic foot syndrome (DFS) is a serious late diabetic complication characterised by limited joint mobility and other biomechanical and muscle abnormalities. Aim To evaluate the effect of an interventional exercise programme on anthropometric parameters, muscle strength, mobility and fitness in patients with diabetic foot in remission. Data Sources and Study Selection Thirty-eight patients with type 2 diabetes and DFS without active lesions (mean age 65 ± 6.9 years, BMI 32 ± 4.7 kg.m-2, waist-hip ratio (WHR)1.02 ± 0.06) were enrolled in our randomised controlled trial. All subjects were randomised into two groups: an intervention group (I; n=19) and a control group (C; n=19). The 12-week exercise intervention focused on ankle and small-joint mobility in the foot, strengthening and stretching of the lower extremity muscles, and improvements in fitness. Changes (Δ=final minus initial results) in physical activity were assessed using the International Physical Activity Questionnaire (IPAQ), with joint mobility detected by goniometry, muscle strength by dynamometry, and fitness using the Senior Fitness Test (SFT). Data extraction Due to reulceration, 15.8% of patients from group I (3/19) and 15.8% of patients from group C were excluded. Based on the IPAQ, group I was more active when it came to heavy (p=0.03) and moderate physical activity (p=0.06) after intervention compared to group C. Group I improved significantly in larger-joint flexibility (p=0.012) compared to controls. In group I, dynamometric parameters increased significantly in both lower limbs (left leg; p=0.013, right leg; p=0.043) compared to group C. We observed a positive trend in the improvement of fitness in group I compared to group C. We also confirmed positive correlations between heavy physical activity and selected parameters of flexibility (r=0.47; p=0.007), SFT (r=0.453; p=0.011) and dynamometry (r=0.58; p<0.0025). Anthropometric parameters, such as BMI and WHR, were not significantly influenced by the intervention programme. Conclusion Our 12-week interventional exercise programme proved relatively safe, resulting in improved body flexibility and increased muscle strength in DF patients in remission.
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Affiliation(s)
- Eliška Vrátná
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
- Clinical Rehabilitation Division, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Jitka Husáková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Radka Jarošíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Michal Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Veronika Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Robert Bém
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Alexandra Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Kateřina Králová
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Bára Pyšková
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Věra Lánská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Vladimíra Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- Second Faculty of Medicine, Charles University, Prague, Czechia
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Zhang S, Sun D, Qian X, Li L, Wu W. Combined Effects of Obesity and Dyslipidaemia on the Prevalence of Diabetes Amongst Adults Aged ≥45 Years: Evidence from a Nationally Representative Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138036. [PMID: 35805693 PMCID: PMC9266151 DOI: 10.3390/ijerph19138036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 12/23/2022]
Abstract
Objectives: This study aimed to explore the combined effects of different types of obesity and dyslipidaemia on the prevalence of diabetes in middle-aged and elderly residents. Methods: Data were obtained from the 2015 China Health and Retirement Longitudinal Studydatabase, and 5023 valid participants were included after excluding those with missing data. A Chi-square test was used to test the difference in the prevalence of diabetes between the groups. Binary logistic regression was used to analyse the relationship between different types of obesity combined with dyslipidaemia and the prevalence of diabetes. Results: Multivariate logistic regression analysis showed that, compared with those with a body mass index <24/ortholiposis, the subgroup with systemic obesity/dyslipidaemia had 4.37 times the risk of diabetes (OR = 4.37, 95% CI = 2.36−8.10, p < 0.001). In addition, compared with those with a normal waist circumference (WC)/ortholiposis, the subgroup with abdominal obesity/dyslipidaemia had 3.58 times the risk of diabetes (OR = 3.58, 95% CI = 2.49−5.13, p < 0.001). Conclusions: The coexistence of obesity and dyslipidaemia can significantly increase the risk of diabetes, suggesting that the strict control of weight, WC and lipid level is beneficial to the prevention of diabetes.
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Affiliation(s)
- Simin Zhang
- School of Public Health, Hubei University of Medicine, Shiyan 442000, China; (S.Z.); (X.Q.)
| | - Donghan Sun
- Institute for Evidence-Based Nursing, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China;
| | - Xiaoyi Qian
- School of Public Health, Hubei University of Medicine, Shiyan 442000, China; (S.Z.); (X.Q.)
| | - Li Li
- Institute for Evidence-Based Nursing, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China;
- Correspondence: (L.L.); (W.W.)
| | - Wenwen Wu
- School of Public Health, Hubei University of Medicine, Shiyan 442000, China; (S.Z.); (X.Q.)
- Institute for Evidence-Based Nursing, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China;
- Correspondence: (L.L.); (W.W.)
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Chronic high-fat diet consumption exacerbates pyroptosis- and necroptosis-mediated HMGB1 signaling in the brain after ischemia and reperfusion injury. J Physiol Biochem 2022; 78:833-844. [PMID: 35749032 DOI: 10.1007/s13105-022-00906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
Obesity is categorized as a common comorbidity found in people who experience an ischemic stroke. However, the mechanisms to explain this correlation have still not been elucidated fully. Pyroptosis and necroptosis are novel forms of programmed cell death that occur upon intracellular danger signals. The major feature of pyroptosis and necroptosis is damage to the lipid membrane, which consequently results in lytic cell death and allows the release of high mobility group box protein 1 (HMGB1) into the extracellular space. We aimed to investigate the influences of high-fat diet (HFD) consumption on cerebral ischemia and reperfusion (I/R) injury and hypothesized that HFD consumption exacerbated the activation of pyroptosis, necroptosis, and HMGB1 signaling pathways. All rats received normal diet (ND) or HFD for 16 weeks. Subsequently, both groups were divided into either a sham- or an I/R-operated group. Twenty-four hours after the surgery, all rats were evaluated for neurological deficits and then sacrificed. After I/R injury, there were more severe functional deficits and larger brain infarcts in the HFD compared with the ND group. The histological observation revealed an increase in tissue abnormalities in the HFD group, consistent with the massive reduction of intact neurons along the peri-infarct region. Furthermore, cerebral I/R injury dramatically activated the pyroptotic, necroptotic, and HMGB1 signaling pathways in HFD-fed rats compared with ND-fed rats. These findings suggest that chronic HFD consumption worsens ischemic brain pathology and leads to poor post-stroke outcomes by exacerbating pyroptotic and necroptotic cell death.
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Early Prediction for Prediabetes and Type 2 Diabetes Using the Genetic Risk Score and Oxidative Stress Score. Antioxidants (Basel) 2022; 11:antiox11061196. [PMID: 35740093 PMCID: PMC9231325 DOI: 10.3390/antiox11061196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to use a genetic risk score (GRS) constructed with prediabetes and type 2 diabetes-related single nucleotide polymorphisms (SNPs) and an oxidative stress score (OSS) to construct an early-prediction model for prediabetes and type 2 diabetes (T2DM) incidence in a Korean population. The study population included 549 prediabetes and T2DM patients and 1036 normal subjects. The GRS was constructed using six prediabetes and T2DM-related SNPs, and the OSS was composed of three recognized oxidative stress biomarkers. Among the nine SNPs, six showed significant associations with the incidence of prediabetes and T2DM. The GRS was profoundly associated with increased prediabetes and T2DM (OR = 1.946) compared with individual SNPs after adjusting for age, sex, and BMI. Each of the three oxidative stress biomarkers was markedly higher in the prediabetes and T2DM group than in the normal group, and the OSS was significantly associated with increased prediabetes and T2DM (OR = 2.270). When BMI was introduced to the model with the OSS and GRS, the area under the ROC curve improved (from 69.3% to 70.5%). We found that the prediction model composed of the OSS, GRS, and BMI showed a significant prediction ability for the incidence of prediabetes and T2DM.
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Moosaie F, Ghaemi F, Mechanick JI, Shadnoush M, Firouzabadi FD, Kermanchi J, Poopak A, Esteghamati S, Forouzanfar R, Abhari SMF, Mansournia MA, Khosravi A, Gholami E, Nakhjavani M, Esteghamati A. Obesity and Diabetic Complications: A Study from the Nationwide Diabetes Report of the National Program for Prevention and Control of Diabetes (NPPCD-2021) Implications for Action on Multiple Scales. Prim Care Diabetes 2022; 16:422-429. [PMID: 35396199 DOI: 10.1016/j.pcd.2022.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/16/2022] [Accepted: 03/17/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Obesity plays a major role in the pathogenesis and development of macro- and microvascular complications of type 2 diabetes (T2D) and type 1 diabetes (T1D). We aimed to assess the association between obesity and macrovascular and microvascular complications of diabetes. METHODS This study consisted of 111,830 patients (age range: 1-106) with diabetes including 10,641 T1D (3187 obese [38.2% men] and 7454 non-obese [45.5% men]) and 101,189 T2D (51,873 obese [27.5% men] and 49,316 non-obese [33.4% men]) from the National Program for Prevention and Control of Diabetes (NPPCD-2021) in Iran, who attended academic tertiary care outpatient clinics from February 2016 to April 2021. A pooled logistic regression model was used to examine the association between obesity and diabetic complications. RESULTS Among patients with T1D, a significant association was found between obesity and cardiovascular disease (CVD), neuropathy, nephropathy and retinopathy (OR= 1.75, 1.56, 1.80 and 1.92, P-value= 0.001, 0.004, 0.001 and <0.001, respectively). In T2D, a statistically significant association was found between obesity and CVD, neuropathy and nephropathy (OR= 1.63, 1.98, 1.21, respectively, P-values <0.001). CONCLUSION Obesity was independently associated with CVD, neuropathy and nephropathy in patients with T1D and T2D and with retinopathy only in T1D, to different degrees. The association between obesity and retinopathy and neuropathy was the strongest among T1D and T2D, respectively. Findings from this study suggest that obesity affects diabetic complications differently among the two types of diabetes, in terms of epidemiology and pathophysiology. This signifies the importance of different preventive and therapeutic approaches to obesity in T1D compared to T2D, on a national and global scale.
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Affiliation(s)
- Fatemeh Moosaie
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ghaemi
- Department of transplantation & disease management, Deputy of Health, Ministry of Health and Medical Education (MOHME), Tehran, Iran
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mahdi Shadnoush
- Department of Clinical Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Kermanchi
- Deputy of Curative Afairs, Ministry of Health and Medical Education (MOHME), Tehran, Iran
| | - Amirhossein Poopak
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Forouzanfar
- Department of Emergency Medicine, Shahed University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Emad Gholami
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Platikanova M, Yordanova A, Hristova P. Dependence of Body Mass Index on Some Dietary Habits: An Application of Classification and Regression Tree. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:1283-1294. [PMID: 36447974 PMCID: PMC9659541 DOI: 10.18502/ijph.v51i6.9672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/21/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND The purpose of this study was to determine the influence of some eating habits on body mass index (BMI) using a regression model created via the classification and regression tree method (CART). METHODS The study was conducted using a questionnaire specially developed for the study, evaluated for reliability and validity. In addition to demographics (age and sex), the questions concern the timing of the meals and the type of food consumed. The data contains records for 533 people (322 women and 211 men) aged 18 to 65 years. The survey was conducted in the period 2019-2021 in Stara Zagora, Bulgaria. Data were processed using descriptive statistics, and regression and classification data mining method CART. RESULTS A CART model with a dependent variable BMI and predictors Sex, Age, Breakfast type, Breakfast time, Lunchtime, Lunch type, Dinner time, Dinner type have been created. The obtained model is statistically significant at a significance level of P<0.0001 and a coefficient of determination R2 = 0.495. The normalized importance of the factors that affect the BMI is as follows: Sex (100%), Age (61.4%), Lunch type (26. 0%), Lunchtime (18.8%), Dinner time (13.9%), and Breakfast type (13.2%). Women have a lower BMI than men. BMI increases with age. CONCLUSION The CART method allows to make a classification by the predictors used and gives opportunities for a more in-depth analysis of the reasons for the increase in BMI. The level of influence of diet and eating habits (type of food, time of consumption) on BMI was determined.
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Affiliation(s)
- Magdalena Platikanova
- Department of Hygiene, Epidemiology, Microbiology, Parasitology and Infectious Diseases, Medical Faculty, Trakia University, Stara Zagora 6000, Bulgaria
| | | | - Petya Hristova
- Department of Hygiene, Epidemiology, Microbiology, Parasitology and Infectious Diseases, Medical Faculty, Trakia University, Stara Zagora 6000, Bulgaria
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Tuppad S, Medala K, Umesh M, Gaur A, Ganji V, Sakthivadivel V, Kumar P. Serum Adiponectin and Nitric Oxide Levels in Type II Diabetes and Its Correlation With Lipid Profile. Cureus 2022; 14:e24613. [PMID: 35664415 PMCID: PMC9149778 DOI: 10.7759/cureus.24613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Various markers for diabetes have been identified in this new era of medicine, the most recent being adiponectin, which is primarily secreted from adipose tissue and has anti-diabetic, anti-inflammatory, and anti-atherogenic properties. It is also known to increase insulin sensitivity. Adiponectin deficiency or decreased secretion causes a variety of complications, including insulin resistance and the onset of type 2 diabetes mellitus (T2DM). One such complication of T2DM is endothelial dysfunction, which leads to decreased synthesis of nitric oxide (NO), another potent marker that normally disrupts key events in the progression of atherosclerosis. Aims and objectives The aim of the study was to compare and correlate serum adiponectin and nitric oxide levels with glycemic status in patients with T2DM and healthy controls. Materials and methods This comparative cross-sectional study included known cases of type II diabetes under group I and healthy age-matched controls under group II. Serum levels of adiponectin and nitric oxide were assessed in both the groups along with glycemic status [fasting blood sugar (FBS) and glycated hemoglobin (HbA1c)] and these parameters were compared between both groups using a t-test. Adiponectin and NO levels were correlated using Pearson’s correlation with glycemic status in group I. Results The mean adiponectin levels in group I were 5.94 ± 1.490 μg/mL, which was significantly (p<0.00) less than in group II, 10.30 ±1.669 μg/mL. The mean NO levels in group I (42.98 ± 6.300 μmol/L) were also significantly (p<0.00) less than in group II (56.126 ± 7.579 μmol/L). FBS and HbA1C levels were significantly higher in group I than in group II. Conclusion Adiponectin and NO levels were significantly reduced in individuals with T2DM when compared to healthy controls. Therapeutic interventions that increase adiponectin and NO levels may be useful targets for improving diabetes control and reducing complications.
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Boraka Ö, Klintman M, Rosendahl AH. Physical Activity and Long-Term Risk of Breast Cancer, Associations with Time in Life and Body Composition in the Prospective Malmö Diet and Cancer Study. Cancers (Basel) 2022; 14:cancers14081960. [PMID: 35454864 PMCID: PMC9025884 DOI: 10.3390/cancers14081960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022] Open
Abstract
Being physically active as part of everyday life reduces breast cancer risk. Less is known whether the benefits of an active lifestyle differ depending on the timing of physical activity in life or anthropometric characteristics. The aim of this study was to bring further insights to the association of physical activity in relation to menopausal status and body composition with breast cancer risk by making use of a prospective Swedish cohort (Malmö Diet and Cancer Study) with long-term follow-up. Physical activity information of 15,983 participants for the past 12 months prior to study entry was assessed according to metabolic equivalent task (MET)-hours/week to integrate duration and intensity of reported activities. During 23.2 years median follow-up, 1302 invasive breast cancers occurred. Women reporting a high physical activity at study baseline, corresponding to >1 h daily walking/week (≥28.5 MET-h/week), had a 23% lower long-term breast cancer risk (HRadj = 0.77, 95% CI 0.66−0.90) than those reporting low physical activity, being most pronounced among perimenopausal and postmenopausal women, and women with waist circumference, body fat percentage, or BMI in the upper-normal and overweight range. For premenopausal women or women having obesity or the largest body composition, high physical activity alone did not modify the breast cancer risk, suggesting additional preventive measures indicated in these groups to reduce the long-term risk of breast cancer.
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Covantsev S, Corlateanu O, Volkov SI, Uzdenov R, Botnaru V, Corlateanu A. COPD and diabetes mellitus: down the rabbit hole. CURRENT RESPIRATORY MEDICINE REVIEWS 2022. [DOI: 10.2174/1573398x18666220411123508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract:
: One of the important comorbidities that has a longstanding research history in COPD is diabetes. Although there are multiple studies on COPD and diabetes the exact links between these two conditions is still controversial. The exact prevalence of diabetes in COPD varies between 2 and 37 %. The true nature of this relationship is complex and may be partially related to the traditional risk factors for diabetes such as smoking, cardiovascular disease and use of steroids. However, COPD is a disease that has multiple phenotypes and is no longer regarded as a homogeneous condition. It seems that some COPD patients who have overlap with asthma or the obese phenotype at a particular risk for T2DM. The aim of this review is to analyze the prevalence, risk factors and possible interactions between COPD and diabetes mellitus.
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Affiliation(s)
- Serghei Covantsev
- S.P. Botkin State Clinical Hospital, Moscow, Department of General Oncology, Moscow, Russian Federation
| | - Olga Corlateanu
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
| | - Stanislav I. Volkov
- Russian Medical Academy of Continuous Postgraduate Education, Department of Endocrinology, Moscow, Russian Federation
| | - Rasul Uzdenov
- North-Caucasus Federal University, Department of Hospital Surgery with the Course of Anesthesiology and Intensive Care, Stavropol, Russian Federation
| | - Victor Botnaru
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
| | - Alexandru Corlateanu
- Nicolae Testemițanu State University of Medicine and Pharmacy, Department of Internal Medicine, Division of Pneumology and Allergology, Chisinau, Republic of Moldova
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Sani S, Akhtar MS, Kapur P, Sharma G, Tabassum F, Khan MF, Sharma M. Evaluation of prescribing pattern, therapeutic adherence, and occurrence of adverse drug reactions in patients with type 2 diabetes mellitus. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220408110650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Persistent hyperglycemia in diabetes mellitus (DM) is considered as the leading cause of morbidity and mortality associated with both microvascular and macrovascular complications and has a greater economic impact. This study aimed to assess the impact of socioeconomic status, prescribing patterns, and patient compliance in type 2 diabetes mellitus patients.
Method:
This study was carried out in the department of medicine and diabetic clinic of Hakeem Abdul Hameed (HAH) Centenary Hospital at Hamdard University, New Delhi, India. We conducted a prospective observational study on prescribing patterns and monitoring of adverse drug reactions (ADRs) in patients with type 2 DM (T2DM) taking standard care. We enrolled 150 confirmed cases and data was obtained from pre-validated questionnaires and then coded and analyzed to observe the association between variables.
Results:
The glycosylated haemoglobin level in 56 % of cases was between 6.4 to 8.0 and cardiovascular complications were observed as the major comorbidities. 45.33 % of cases were on mono drug therapy and Metformin (23. 52 %) was the drug of choice followed by Glimepiride (23.52 %). Among the dual drug therapies, Sitagliptin with Metformin and in triple-drug therapy, Glimepiride concurrent with Metformin and Voglibose was the most preferred drug in the treatment of T2DM. Sitagliptin was observed to be a major patient burden (46.213 USD). In only 7.33 % of cases, we observed definite ADR in T2DM patients. Underprivileged awareness, mainly due to low literacy, was a major concern in the development of new cases of T2DM.
Conclusion:
We observed better patient compliance and disease awareness program is required to be implemented. The use of oral hypoglycaemic drugs is still dominant in clinical practice and cardiovascular disorders as comorbidities emerge as a greater challenge in terms of patient outcome and cost burden.
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Affiliation(s)
- Sanusi Sani
- Department of Pharmacology, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi-110062 (India)
| | - Md. Sayeed Akhtar
- College of Pharmacy, King Khalid University, Abha–21974 (Kingdom of Saudi Arabia)
| | - Prem Kapur
- Department of Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, 110062, (India)
| | - Gunjan Sharma
- Department of Pharmacology, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh-, 201303, (India)
| | - Fauzia Tabassum
- Deparmtent of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, 11942, (Kingdom of Saudi Arabia)
| | - Mohd Faiyaz Khan
- Department of Pharmacology, Santosh Medical College and Hospital, Ghaziabad, 201009, (India)
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi-110062 (India)
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Baroni I, Caruso R, Dellafiore F, Arrigoni C, Fabrizi D, Luciani M, Rebora P, Ausili D. Diabesity in Adults With Type 2 Diabetes Mellitus: A Cross-sectional Study Exploring Self-care and Its Determinants. Can J Diabetes 2022; 46:S1499-2671(22)00072-7. [PMID: 35927172 DOI: 10.1016/j.jcjd.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The purpose of this study was to describe self-care maintenance, self-care monitoring, self-care management and self-care self-efficacy in adults with type 2 diabetes (T2DM) and body mass index (BMI)<30 kg/m2 and adults with T2DM and BMI≥30 kg/m2 ("diabesity"), and to identify their clinical and sociodemographic determinants. Self-care is one of the main treatments for adults with T2DM. However, self-care has been poorly described in people with diabesity, and differences in clinical and sociodemographic determinants of self-care between patients with diabesity and patients with T2DM and BMI<30 kg/m2 have, to our knowledge, not been assessed. METHODS A secondary analysis was performed of sociodemographic and clinical data using a multicentre, observational, cross-sectional design, wherein 540 adults diagnosed with T2DM were included in a consecutive and convenience sampling procedure. RESULTS Self-care maintenance and management were significantly lower among patients with diabesity (p<0.001 and p=0.025, respectively). Among patients with diabesity, low income (relative risk [RR]=3.27, p=0.01) and presence of diabetic neuropathy (RR=4.16; p=0.03) were strongly associated with inadequate self-care maintenance; completion of high school (RR=0.45; p=0.01), availability of a family caregiver (RR=0.52; p=0.04) and the use of insulin as the main treatment (RR=2.09; p=0.01) decreased the likelihood of inadequate self-care monitoring. CONCLUSIONS The unfavourable behavioural profile of patients with diabesity could be further worsened by their lower level of confidence in performing adequate self-care.
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Affiliation(s)
- Irene Baroni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Diletta Fabrizi
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Paola Rebora
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
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Guilbert E, Perry R, Whitmarsh A, Sauchelli S. Short-term effectiveness of nutrition therapy to treat type 2 diabetes in low-income and middle-income countries: systematic review and meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e056108. [PMID: 35273056 PMCID: PMC8915303 DOI: 10.1136/bmjopen-2021-056108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This review examined the evidence arising from randomised controlled trials regarding the impact of nutrition therapy on glycaemic control in people living with type 2 diabetes mellitus (T2DM) in low/middle-income countries (LMICs). DESIGN Systematic review and meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Approach. DATA SOURCES MEDLINE, EMBASE, Web of Science, OpenGrey and the International Clinical Trials Registry were searched (up to July 3 2020). ELIGIBILITY CRITERIA Trials were included if they evaluated nutrition therapy in adults diagnosed with T2DM, were conducted in LMICs, measured glycaemic control and the trial included a 3-month post-intervention assessment. Nutrition therapy was defined according to American Diabetes Association recommendations. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened the database. Study characteristics and outcome data were extracted using a data collection form. Meta-analyses were conducted for glycated haemoglobin (HbA1c) and fasting blood glucose. Trials were assessed for risk of bias (Cochrane Risk-of-Bias, Version 2.0) and overall certainty of evidence (GRADE). RESULTS Four trials met inclusion criteria (total n=463), conducted in Malaysia, Iran and South Africa. All trials focused on nutrition education with no direct prescription or manipulation of diet. Mean differences between intervention and standard care were -0.63% (95% CI -1.47% to 0.21%) for HbA1c and -13.63 mg/dL (95% CI -37.61 to 10.34) for fasting blood glucose in favour of the intervention. Given the small number of eligible trials, moderate to high risk of publication bias and serious concerns regarding consistency and precision of the evidence, certainty of evidence was deemed to be very low. CONCLUSIONS There is a lack of well-conducted randomised controlled trials that examine the long-term impact of nutrition therapy in LMICs, preventing firm conclusions to be made on their effectiveness. Further research is essential to discover realistic, evidence-based solutions. PROSPERO REGISTRATION NUMBER CRD42020188435.
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Affiliation(s)
| | - Rachel Perry
- National Institute for Health Research Bristol Biomedical Research Centre; University Hospitals of Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Alex Whitmarsh
- National Institute for Health Research Bristol Biomedical Research Centre; University Hospitals of Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Sarah Sauchelli
- National Institute for Health Research Bristol Biomedical Research Centre; University Hospitals of Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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Garcia KC, Confortin SC, Meneghini V, d’Orsi E, Barbosa AR. Metabolic syndrome and its association with changes in modifiable risk factors: Epifloripa aging study. J Diabetes Metab Disord 2022; 21:77-84. [PMID: 35673433 PMCID: PMC9167349 DOI: 10.1007/s40200-021-00937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/11/2021] [Indexed: 01/29/2023]
Abstract
Purpose To estimate the prevalence of Metabolic Syndrome (MetS) and its association with changes in modifiable risk factors in older adults from southern Brazil. Methods A longitudinal study was performed with data from EpiFloripa Aging study. We defined MetS by the existence of three or more of the following risk factors for cardiovascular disease (CVD): waist circumference (WC) (≥ 92 cm in men and ≥ 87 cm in women); fasting glucose (≥100 mg/dl); decreased HDL cholesterol (<40 mg/dl in men and <50 mg/dl in women); hypertriglyceridemia (≥150 mg/dl) and blood pressure (≥130/85 mmHg). We evaluated the changes in modifiable risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity, and body mass index) between the two moments of the study (2009/10 and 2013/14). Directed acyclic graph and logistic regression models were used. Results Among the 599 participants, the prevalence of MetS was 64.0% (95% CI, 58.7-68.9). In the adjusted analysis, those who remained or became persons who are overweight (OR = 4.59; 95% CI: 3.05-6.89) and those who remained or became insufficiently active (OR = 1.92; 95% CI: 1.23-2.98) were more likely to present MetS. Conclusion Our findings suggest that being or becoming overweight and being or becoming insufficiently active are modifiable factors associated with MetS. These results highlight the need for developing preventive strategies for the observed risk indicators to mitigate the prevalence of MetS in older adults.
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Affiliation(s)
- Karyne C. Garcia
- Postgraduate Program in Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC Brazil
| | - Susana C. Confortin
- Center for Biological and Health Sciences, Universidade Federal do Maranhão (UFMA), São Luís, MA Brazil
| | | | - Eleonora d’Orsi
- School of Health Sciences, Universidade Federal de Santa Catarina (UFSC), Campus Trindade, Florianópolis, SC Brazil
| | - Aline Rodrigues Barbosa
- School of Sports, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC Brazil
- Centro de Desportos/Universidade Federal de Santa Catarina, Campus Reitor João David Ferreira Lima, s/n, Trindade 88040, Florianópolis, Santa Catarina –900 Brazil
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Boye KS, Shinde S, Kennedy-Martin T, Robinson S, Thieu VT. Weight Change and the Association with Adherence and Persistence to Diabetes Therapy: A Narrative Review. Patient Prefer Adherence 2022; 16:23-39. [PMID: 35023906 PMCID: PMC8747793 DOI: 10.2147/ppa.s328583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Type 2 diabetes (T2D) medication adherence is poor and is impacted by individual drug characteristics. Treatment-associated weight change can affect medication-taking behavior. This review aimed to explore weight change on T2D therapy and consider its impact on adherence and discontinuation. METHODS Searches were conducted in MEDLINE and EMBASE (2005 to September 2020), and among recent congress abstract books for studies providing data on medication adherence or discontinuation and weight change in people with T2D (PwD). RESULTS Nine studies meeting the inclusion criteria were identified from 9188 bibliographic records. All three studies exploring weight change and discontinuation reported weight loss to be associated with higher persistence. Seven studies of varying design explored weight change and adherence. Four reported absolute weight change (kg) and adherence: one pooled data from different diabetes medications and demonstrated that self-reported adherence was significantly associated with weight loss; however, three studies found that weight change in adherent PwD was in the direction of the known weight profile (loss/gain) of the evaluated drug. Categorical weight loss (≥3%) and adherence were reported in two studies: one reported that numerically more adherent versus non-adherent PwD lost ≥3% weight regardless of the drug's weight profile, the other showed that early weight loss with a glucagon-like peptide-1 agonist was significantly associated with better adherence. One study reported adherence by categorical weight change; as weight loss increased, adherence scores improved, regardless of drug type. CONCLUSION Findings suggest that discontinuation rates may be lower in PwD who lose as compared to those who gain weight on T2D treatment. The evidence base on adherence and weight change is more challenging to interpret due to the range of study designs. Given the importance of weight control in T2D, further research exploring the individual's treatment, weight journey, and behaviors over time should be undertaken.
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Affiliation(s)
- Kristina S Boye
- Eli Lilly and Company, Indianapolis, IN, USA
- Correspondence: Kristina S Boye Eli Lilly and Company, Indianapolis, IN, USATel +1-317-651-4039 Email
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Li J, Cheng W, Ma H. A Comparative Study of Health Efficacy Indicators in Subjects with T2DM Applying Power Cycling to 12 Weeks of Low-Volume High-Intensity Interval Training and Moderate-Intensity Continuous Training. J Diabetes Res 2022; 2022:9273830. [PMID: 35071605 PMCID: PMC8776485 DOI: 10.1155/2022/9273830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
This study is aimed at comparing the effects of different exercise intensities, namely, high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), on body composition, heart and lung fitness, and blood glucose, and blood pressure indices in patients with type 2 diabetes mellitus (T2DM), using power cycling. A total of 96 T2DM volunteers who met the inclusion criteria were recruited from a hospital in Yangpu, Shanghai. Based on the blood index data of their medical examination results which comprised blood pressure, fasting blood glucose, hemoglobin A1c (HbA1c), and insulin, 37 volunteers were included in the study. Exercise prescription was determined based on T2DM exercise guidelines combined with medical diagnosis and exercise test results, and the patients were randomly assigned to three groups: HIIT group, MICT group, and control (CON) group. HIIT involved one-minute power cycling (80%-95% maximal oxygen uptake (VO2max)), one-minute passive or active rest (25%-30% VO2max), and two-minute rounds of eight groups. MICT required the use of a power bike for 30 minutes of continuous training (50%-70% VO2max) five times a week. The CON group was introduced to relevant medicine, exercise, and nutrition knowledge. The exercise interventions were completed under the supervision of an exercise instructor and hospital doctors. The same indicators were measured after 12 weeks of intervention, and the results of the two tests within and between groups were analyzed for comparison. The weight index of the MICT intervention showed statistically significant within-group differences (difference = 3.52, 95% CI = 2.11-4.92, p = 0.001 < 0.01); group differences for the MICT and CON groups were also statistically significant (difference = 3.52 ± 2.09, Cd1 = -0.39 ± 1.25, p = 0.004 < 0.01). Body mass index (BMI) analysis revealed that the overall means of BMI indicators were not statistically different between groups (F = 0.369, p = 0.694 > 0.05) and the before and after values of the MICT and CON (difference = -1.30 ± 0.79, Cd1 = -0.18 ± 0.45, p = 0.001 < 0.01). No statistically significant difference was observed in the overall mean VO2max index between the groups after the 12-week intervention (F = 2.51, p = 0.100 > 0.05). A statistically significant difference was found in the overall means of the data between the two groups (difference = 0.32, 95% CI = 0.23-0.40, p = 0.001 < 0.01). Analysis of fasting blood glucose (FBG) indicators revealed statistically significant differences between the MICT and control groups (p = 0.028 < 0.05). Analysis of HbA1c and fasting insulin (FI) indicators revealed no statistically significant difference in the overall HbA1c index after the 12-week exercise intervention (F = 0.523, p = 0.598 > 0.05), and the overall difference before and after the experiment between the groups was statistically significant (F = 6.13, p = 0.006 < 0.01). No statistically significant difference was found in the FI index overall after the 12-week exercise intervention (F = 2.50, p = 0.1 > 0.05). Analysis of systolic blood pressure (SBP) revealed statistically significant difference before and after the HIIT and CON interventions (Hd7 = -1.10 ± 1.79, Cd7 = 1.2 ± 1.31, p = 0.018 < 0.05) and statistically significant difference before and after the MICT and CON interventions (Md7 = -0.99 ± 0.91, Cd7 = 1.40 ± 1.78, p = 0.02 < 0.05). The diastolic blood pressure (DBP) revealed no statistically significant within-group differences before and after. Exercise interventions applying both low-volume HIIT and MICT, with both intensity exercises designed for power cycling, improved health-related indicators in the participants; low-volume HIIT had more time advantage. The current experiment compared HIIT with MICT in a safe manner: 50% of the exercise time produced similar benefits and advantages in the two indicators of VO2max and FI. However, MICT was superior to HIIT in the two indicators of body weight (weight) and BMI. The effect of power cycling on FI has the advantages of both aerobic and resistance exercise, which may optimize the type, intensity, and time of exercise prescription according to the individual or the type of exercise program. Our results provide a reference for the personalization of exercise prescription for patients with T2DM.
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Affiliation(s)
- Jun Li
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai 200438, China
| | - Wei Cheng
- Department of Endocrinology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, China
| | - Haifeng Ma
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai 200438, China
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The association between FTO polymorphisms and type 2 diabetes in Asian populations: A meta-analysis. Meta Gene 2021. [DOI: 10.1016/j.mgene.2021.100958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Mehta S, Nain P, Agrawal BK, Singh RP, Kaur J, Maity S, Bhattacharjee A, Peela J, Nauhria S, Nauhria S. Effectiveness of Empagliflozin With Vitamin D Supplementation in Peripheral Neuropathy in Type 2 Diabetic Patients. Cureus 2021; 13:e20208. [PMID: 35004028 PMCID: PMC8730350 DOI: 10.7759/cureus.20208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Neuropathy is the most prevalent broad-spectrum microvascular complication of diabetes. The present study aims to evaluate the effect of empagliflozin with vitamin D supplementation on diabetic peripheral neuropathy. Methods: A prospective, randomized, controlled study was conducted for six months including 150 type 2 diabetic patients, divided into three groups (n=50/group): Group 1, patients on oral hypoglycemic agents; Group 2, patients on empagliflozin and Group 3, patients on empagliflozin with vitamin D. Biochemical parameters were estimated for outcome measurements and patients’ neuropathic pain was analysed using Douleur Neuropathique 4 Questions, Neuropathic Pain Symptom Inventory and Ipswich Touch the toes test questionnaire. Data were analysed using a one-way analysis of variance. Results: Diabetic neuropathy in males was more prevalent (more than 50%) as compared to females in all three groups, with an average age of 50±6 years, along with a diabetic history of 15±4.5 years and a glycated hemoglobin A1C (HbA1C) level of >10%. The mean value of serum vitamin D level significantly increased by 64.7% (19±5 to 54±8 ng/mL; p<0.05). A remarkable decrease (by 17.4%) from baseline in the HbA1C level was observed after six months of treatment only in Group 3, whereas in other groups (1 and 2), there was a non-significant decrease in HbA1C levels when compared to baseline. Moreover, a significant improvement in neuropathic condition was seen only in Group 3. Conclusion: The results indicated that empagliflozin with vitamin D supplementation significantly controlled or reduced HbA1C and improved diabetic neuropathic symptoms in patients. It is suggested that this combination can be considered as the primary therapeutic approach for neuropathic complications in diabetic patients.
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Affiliation(s)
- Sanjana Mehta
- Department of Pharmacy Practice, Maharishi Markandeshwar College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Ambala, IND
| | - Parminder Nain
- Department of Pharmacy Practice, Maharishi Markandeshwar College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Ambala, IND
| | - Bimal K Agrawal
- Department of Internal Medicine, Maharishi Markandeshwar Institute of Medical Science and Research, Maharishi Markandeshwar (Deemed to be University), Ambala, IND
| | | | - Jaspreet Kaur
- Department of Pharmacy Practice, Maharishi Markandeshwar College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Ambala, IND
| | - Sabyasachi Maity
- Department of Physiology, St. George's University School of Medicine, St. George's, GRD
| | | | - Jagannadha Peela
- Department of Medical Genetics and Biochemistry, St. Matthew's University, George Town, CYM
| | - Shreya Nauhria
- Department of Psychology, University of Leicester, Leicester, GBR
| | - Samal Nauhria
- Department of Pathology, St. Matthew's University, George Town, CYM
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Impact of metabolic surgery on cost and long-term health outcome: a cost-effectiveness approach. Surg Obes Relat Dis 2021; 18:260-270. [PMID: 34782294 DOI: 10.1016/j.soard.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 09/20/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The increase in obesity has become a major public health concern. Morbid obesity is associated with co-morbidities, reduced quality-of-life, and death. Metabolic surgery (MS) is the most effective treatment for obesity. OBJECTIVES The aim of this study was to evaluate the costs and outcomes of MS compared with no surgery in patients with a body mass index ≥30 kg/m2. SETTING Health care system, Austria METHODS: A total of 177 patients who underwent MS were documented retrospectively, based on the hospital records of 2 specialized centers in Austria, over a 1-year period. At baseline 26.0% of patients exhibited type 2 diabetes (T2D), 52.5% cardiovascular disease (CVD), 23.2% hyperlipidemia, and 23.7% depression. Following the observation period, a Markov chain simulation model was developed to analyze the long-term consequences of T2D, including diabetic complications, CVD, hyperlipidemia, depression, non-alcoholic steatohepatitis (NASH), myocardial infarction, and stroke, over a total of 20 years. Direct medical costs were expressed in 2017 euros from the payer's perspective. Quality-adjusted life years (QALYs), life years (LYs), and costs were discounted. RESULTS MS led to costs of €40,427 and 9.58 QALYs (15.58 LYs) per patient over 20 years. No MS was associated with €64,819 and 6.33 QALYs (13.92 LYs). Total cost-savings amounted to €24,392, which offset the cost of the procedure including re-operations. Over 20 years MS saved -6.7 patient-years per patient with T2D, -5.8 patient-years with CVD, -1.5 patient-years with hyperlipidemia, -1.8 patient-years with depression, and -3.8 patient-years with NASH. CONCLUSION MS is associated with substantial savings in long-term costs, expected health benefits, and reduced onset of complications. MS significantly increases quality of life.
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Arabi Z, Bukhari M, Hamad A, Altheaby A, Kaysi S. Practice Patterns in the Acceptance of Medically Complex Living Kidney Donors with Obesity, Hypertension, Family History of Kidney Disease, or Donor-Recipient Age Discrepancy. Avicenna J Med 2021; 11:172-184. [PMID: 34881200 PMCID: PMC8648409 DOI: 10.1055/s-0041-1736541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To assess the practice patterns of the acceptance of medically complex living kidney donors (MCLKDs). Methods We distributed a survey to nephrologists and transplant surgeons (TS) across the world through major international transplant societies. The survey contained questions regarding obesity, abnormal blood glucose profile, mild hypertension, donor-recipient age discrepancy, or family history of kidney disease of unknown etiology. Results In total, 239 respondents from 29 countries (42% were nephrologists and 58% were TS). Most respondents would allow donations from obese donors, especially if they intended to lose weight but would be cautious if these donors had abnormal blood glucose or family history of diabetes mellitus. In hypertensive donors, future pregnancy plans mattered in decisions regarding the acceptance of female donors. Most respondents would allow young donors but would be more cautious if they had a future risk of hypertension or a family history of kidney disease of unknown etiology. They would also allow donations from an older person if prolonged waiting time was anticipated. We found multiple areas of consensus of practice among the diverse members of international transplant societies, with some interesting variations among nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with these conditions.
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Affiliation(s)
- Ziad Arabi
- Department of the Organ Transplant Center, Division of Adult Transplant Nephrology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Muhammad Bukhari
- Department of Medicine, Division of Adult Nephrology, Taif University, Taif, Saudi Arabia
| | - Abdullah Hamad
- Department of Medicine, Division of Nephrology, Regional Medical Center of Orangeburg and Calhoun Counties, Orangeburg, South Carolina, United States
| | - Abdulrahman Altheaby
- Department of the Organ Transplant Center, Division of Adult Transplant Nephrology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Kaysi
- Department of Medicine, Division of Nephrology, CHU, Clermont-Ferrand, France
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Parental Alcohol Problems, Parental Divorce, and Type 2 Diabetes in Adulthood: A Longitudinal Prospective Cohort Study in Middle-Aged Men. Psychosom Med 2021; 82:817-822. [PMID: 32976314 DOI: 10.1097/psy.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Type 2 diabetes is a chronic disease and a serious global public health concern increasing both mortality and morbidity. Previous studies have found evidence for an association between early psychological stress and diabetes later in life. METHODS This study examined the association between parental alcohol problems and parental divorce and the incidence of type 2 diabetes in Finnish men aged 42 to 61 years (n = 754) in a prospective setting. Information on parental alcohol problems and parental divorce was derived from school records and subjective experiences of the same events from self-rated questionnaires. The average follow-up time for the participants until the first type 2 diabetes diagnosis was 23.3 years (25th-75th percentile, 21.2-27.9 years). RESULTS Cox regression analyses revealed that parental alcohol problems (hazard ratio = 3.09, 95% confidence interval = 1.38-6.88) were associated with an increased risk of type 2 diabetes during the follow-up, even after adjustment for age, marital status, education, Human Population Laboratory Depression Scale scores, smoking, alcohol consumption, body mass index, and serum high-sensitivity C-reactive protein. In a similar model, parental divorce (hazard ratio = 1.69, 95% confidence interval = 0.40-7.05) was not associated with an increased risk of type 2 diabetes during the follow-up. CONCLUSIONS Our findings suggest that not all adverse childhood experiences contribute equally to the risk of type 2 diabetes. Parental alcohol problems, but not parental divorce, were associated with an increased risk of type 2 diabetes in men. These findings highlight the need for early interventions targeting parents with excessive alcohol consumption to reduce their offspring's risk of life-style-related disorders.
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Effects of diabetes self-management education program on lowering blood glucose level, stress, and quality of life among females with type 2 diabetes mellitus in Thailand. Prim Health Care Res Dev 2021; 22:e46. [PMID: 34521493 PMCID: PMC8444461 DOI: 10.1017/s1463423621000505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: The aim of this study is to assess the effect of diabetes self-management education (DSME) on lowering blood glucose level, stress, and quality of life (QoL) among female patients with type 2 diabetes mellitus (T2DM) in Thailand. Background: The burden of noncommunicable diseases has increased globally, and it has negatively affected the QoL of diabetic patients. Methods: A quasi-experimental study was conducted by including 77 T2DM patients selected from 2 public health centers in Thailand. The respondents were randomly selected 38 in control group and 39 in intervention group. Pretested, piloted, and validated tool were used during this study. Knowledge on blood glucose level, stress, and QoL was measured at baseline and then compared to end line after 3 months of the intervention. The effects of intervention were estimated by regression coefficient of intervention on blood glucose level and QoL. The study was ethically approved by the Chulalongkorn University, Thailand. Findings: Baseline characteristics of both the groups were similar before the start of the intervention and there were no significant differences observed in age, education, blood sugar monitoring behavior, medical checkup, knowledge, self-care, stress, and hemoglobin HbA1c (>0.05). However, blood HbA1c, stress level, and QoL among the T2DM patients had significant changes (<0.05) after the intervention. The control group was remained same and there was no statistically significant difference reported (>0.05). Conclusions: The study concluded that the designed intervention of DSME has proved effective in lowering the blood sugar level, HbA1c level, stress level, and improved QoL among T2DM patients during this limited period of time. Hence, policy-makers can replicate this intervention for diabetic patients in a similar context.
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Iwai K, Azuma T, Yonenaga T, Ekuni D, Watanabe K, Obora A, Deguchi F, Kojima T, Morita M, Tomofuji T. Association between Self-Reported Chewing Status and Glycemic Control in Japanese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189548. [PMID: 34574470 PMCID: PMC8465592 DOI: 10.3390/ijerph18189548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
This cross-sectional study investigated the relationship between self-reported chewing status and glycemic control in 30,938 Japanese adults who participated in health checkups. Chewing status was evaluated using a self-reported questionnaire. We defined high hemoglobin A1c (HbA1c) levels as a HbA1c level ≥6.5%; 692 (2.2%) respondents met this criterion. After adjusting for gender, age, smoking status, exercise habits, body mass index and eating speed, high HbA1c levels was found to be associated with male gender (odds ratio (OR), 1.568; 95% confidence interval (CI), 1.310 to 1.878; p < 0.001), older age (OR, 1.077; 95% CI, 1.068 to 1.087; p < 0.001), higher body mass index (OR, 1.246; 95% CI, 1.225 to 1.268; p < 0.001), current smoker status (OR, 1.566; 95% CI, 1.303 to 1.882; p < 0.001) and chewing difficulty (OR, 1.302; 95% CI, 1.065 to 1.591; p < 0.05). In conclusion, self-reported chewing difficulty was associated with high HbA1c levels in Japanese adults.
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Affiliation(s)
- Komei Iwai
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851 Hozumi, Mizuho, Gifu 501-0296, Japan; (K.I.); (T.A.); (T.Y.)
| | - Tetsuji Azuma
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851 Hozumi, Mizuho, Gifu 501-0296, Japan; (K.I.); (T.A.); (T.Y.)
| | - Takatoshi Yonenaga
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851 Hozumi, Mizuho, Gifu 501-0296, Japan; (K.I.); (T.A.); (T.Y.)
| | - Daisuke Ekuni
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; (D.E.); (M.M.)
| | - Kazutoshi Watanabe
- Medical Check-Up Center, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu 500-8523, Japan; (K.W.); (A.O.); (F.D.); (T.K.)
| | - Akihiro Obora
- Medical Check-Up Center, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu 500-8523, Japan; (K.W.); (A.O.); (F.D.); (T.K.)
| | - Fumiko Deguchi
- Medical Check-Up Center, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu 500-8523, Japan; (K.W.); (A.O.); (F.D.); (T.K.)
| | - Takao Kojima
- Medical Check-Up Center, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu 500-8523, Japan; (K.W.); (A.O.); (F.D.); (T.K.)
| | - Manabu Morita
- Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; (D.E.); (M.M.)
| | - Takaaki Tomofuji
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851 Hozumi, Mizuho, Gifu 501-0296, Japan; (K.I.); (T.A.); (T.Y.)
- Correspondence: ; Tel.: +81-58-329-1496
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An Exceedingly Rare Case of Liraglutide-Induced Liver Injury. Case Rep Gastrointest Med 2021; 2021:6306149. [PMID: 34471551 PMCID: PMC8405313 DOI: 10.1155/2021/6306149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022] Open
Abstract
Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used for the treatment of type 2 diabetes mellitus. We are reporting the second case of liraglutide-induced liver injury, with complete resolution of liver injury after discontinuation of the drug.
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Zhang Y, Cheng Y, Jiang W, Ye Y, Lu Q, Zhao H. Comparison of methods for estimating genetic correlation between complex traits using GWAS summary statistics. Brief Bioinform 2021; 22:bbaa442. [PMID: 33497438 PMCID: PMC8425307 DOI: 10.1093/bib/bbaa442] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 01/03/2023] Open
Abstract
Genetic correlation is the correlation of phenotypic effects by genetic variants across the genome on two phenotypes. It is an informative metric to quantify the overall genetic similarity between complex traits, which provides insights into their polygenic genetic architecture. Several methods have been proposed to estimate genetic correlation based on data collected from genome-wide association studies (GWAS). Due to the easy access of GWAS summary statistics and computational efficiency, methods only requiring GWAS summary statistics as input have become more popular than methods utilizing individual-level genotype data. Here, we present a benchmark study for different summary-statistics-based genetic correlation estimation methods through simulation and real data applications. We focus on two major technical challenges in estimating genetic correlation: marker dependency caused by linkage disequilibrium (LD) and sample overlap between different studies. To assess the performance of different methods in the presence of these two challenges, we first conducted comprehensive simulations with diverse LD patterns and sample overlaps. Then we applied these methods to real GWAS summary statistics for a wide spectrum of complex traits. Based on these experiments, we conclude that methods relying on accurate LD estimation are less robust in real data applications due to the imprecision of LD obtained from reference panels. Our findings offer guidance on how to choose appropriate methods for genetic correlation estimation in post-GWAS analysis.
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Affiliation(s)
- Yiliang Zhang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
| | - Youshu Cheng
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
| | - Wei Jiang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
| | - Yixuan Ye
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT 06510, USA
| | - Qiongshi Lu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Statistics, University of Wisconsin-Madison, Madison, WI 53706, USA
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT 06510, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
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Ng Yin Ling C, Lim SC, Jonas JB, Sabanayagam C. Obesity and risk of age-related eye diseases: a systematic review of prospective population-based studies. Int J Obes (Lond) 2021; 45:1863-1885. [PMID: 33963292 DOI: 10.1038/s41366-021-00829-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/18/2021] [Accepted: 04/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obesity is a public health challenge worldwide. The relationship between obesity and age-related eye diseases including cataract, glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy (DR) have remained elusive. DESIGN AND METHODS We conducted a systematic review of three electronic databases for longitudinal population-based studies that described associations between measures of obesity including body mass index (BMI), waist-circumference (WC), and waist-to-hip ratio (WHR), and age-related eye diseases. RESULTS Our search yielded 1731 articles, of which 14, 10, 16 and 8 articles met our eligibility criteria for cataract, glaucoma, AMD and DR, respectively. BMI-defined obesity was positively associated with incident cataract, incident AMD and incident DR in Western populations, but in Asian populations associations for incident AMD were not significant and associations for incident DR were inverse. WC-defined obesity was associated with incident glaucoma in non-Western populations. WHR-defined obesity but not BMI-defined obesity was associated with the incidence or progression of AMD in two Western studies. CONCLUSIONS Overall, we found strong evidence supporting associations between obesity and age-related eye diseases. Further research on the association of abdominal obesity and effect of weight loss and physical activity on age-related eye diseases is warranted to support clinical and public health recommendations.
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Affiliation(s)
| | - Su Chi Lim
- Khoo Tech Puat Hospital, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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Design of intelligent diabetes mellitus detection system using hybrid feature selection based XGBoost classifier. Comput Biol Med 2021; 136:104664. [PMID: 34329866 DOI: 10.1016/j.compbiomed.2021.104664] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/20/2022]
Abstract
In this work, a non-invasive diabetes mellitus detection system is proposed based on the wristband photoplethysmography (PPG) signal and basic physiological parameters (PhyP) to enable easy detection of diabetes mellitus (DM). A dataset of 217 participants with diabetes, prediabetes and normal conditions is used to develop the system. The Mel frequency cepstral coefficients (MFCC) extracted from 5s PPG signal segments and the PhyP are used as input for the machine learning algorithms. The K-nearest neighbors, support vector machine, random forest and extreme gradient boost (XGBoost) classifiers are used for classification. In addition, a hybrid feature selection method (Hybrid FS) is proposed to reduce the size of the input data. The Hybrid FS-based XGBoost system achieves a high accuracy of 99.93 % for non-invasive diabetes detection with fewer features and less computational effort. The analysis suggests that the PPG signal from a wearable sensor is a good alternative for simple non-invasive blood glucose measurements in routine applications.
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81
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Brown E, Wilton MM, Sprung VS, Harrold JA, Halford JCG, Stancak A, Burgess M, Howarth E, Umpleby AM, Kemp GJ, Wilding JP, Cuthbertson DJ. A randomis ed, controlled, double blind study to assess mechan istic effects of combination therapy of dapag liflozin with exenatide QW versus dapagliflozin alone i n obese patients with type 2 diabetes mellitus (RESILIENT): study protocol. BMJ Open 2021; 11:e045663. [PMID: 34285005 PMCID: PMC8292819 DOI: 10.1136/bmjopen-2020-045663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The newer glucose-lowering therapies for type 2 diabetes (T2D), the glucagon-like peptide-1 receptor agonists (GLP1-RAs) and the sodium-glucose co-transporter 2 inhibitors (SGLT2i), have additional clinical benefits beyond improving glycaemic control; promoting weight loss, addressing associated cardiovascular risk factors and reducing macrovascular and microvascular complications. Considering their independent mechanisms of actions, there is a potential for significant synergy with combination therapy, yet limited data exist. This 32-week randomised, double-blind, placebo-controlled trial will gain mechanistic insight into the effects of coadministration of exenatide QW, a weekly subcutaneous GLP1-RA, with dapagliflozin, a once daily oral SGLT2i, on the dynamic, adaptive changes in energy balance, total, regional and organ-specific fat mass and multiorgan insulin sensitivity. METHODS AND ANALYSIS 110 obese patients with diagnosed T2D (glycated haemoglobin, HbA1c ≥48 mmol/mol) will be treated for 32 weeks with dapagliflozin (10 mg once daily either alone or in combination with exenatide QW (2 mg once weekly); active treatments will be compared with a control group (placebo tablet and sham injection). The primary objective of the study is to compare the adjusted mean reduction in total body fat mass (determined by dual-energy X-ray absorptiometry, DEXA) from baseline following 32 weeks of treatment with exenatide QW and dapagliflozin versus dapagliflozin alone compared with control (placebo). Secondary outcome measures include changes in (1) energy balance (energy intake and energy expenditure measured by indirect calorimetry); (2) appetite (between and within meals) and satiety quotient; (3) body composition including visceral adipose tissue, subcutaneous adipose tissue, liver and pancreatic fat. Exploratory outcome measures include metabolic changes in hepatic and peripheral insulin sensitivity (using a two-stage hyperinsulinaemic, euglycaemic clamp), central nervous system responses to food images using blood oxygen level-dependent (BOLD) functional MRI (fMRI) and changes in cardiovascular function (using transthoracic echocardiography, cardiac MR and duplex ultrasonography). ETHICS AND DISSEMINATION This study has been approved by the North West Liverpool Central Research Ethics Committee (14/NW/1147) and is conducted in accordance with the Declaration of Helsinki and the Good Clinical Practice. Results from the study will be published in peer-reviewed scientific and open access journals and/or presented at scientific conferences and summarised for distribution to the participants. TRIAL SPONSOR University of Liverpool. TRIAL REGISTRATION NUMBER ISRCTN 52028580; EUDRACT number 2015-005242-60.
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Affiliation(s)
- Emily Brown
- Metabolism and Nutrition Research Group, University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Moon M Wilton
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Victoria S Sprung
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Joanne A Harrold
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Andrej Stancak
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Malcolm Burgess
- Department of Cardiology, University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Elaine Howarth
- Liverpool Clinical Trials Centre, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | - A Margot Umpleby
- Department of Nutritional Sciences, University of Surrey, Guildford, UK
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - John Ph Wilding
- Metabolism and Nutrition Research Group, University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
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Xiao MX, Lu CH, Ta N, Wei HC, Haryadi B, Wu HT. Machine learning prediction of future peripheral neuropathy in type 2 diabetics with percussion entropy and body mass indices. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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83
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Chu H, Chen L, Yang X, Qiu X, Qiao Z, Song X, Zhao E, Zhou J, Zhang W, Mehmood A, Pan H, Yang Y. Roles of Anxiety and Depression in Predicting Cardiovascular Disease Among Patients With Type 2 Diabetes Mellitus: A Machine Learning Approach. Front Psychol 2021; 12:645418. [PMID: 33995200 PMCID: PMC8113686 DOI: 10.3389/fpsyg.2021.645418] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease (CVD) is a major complication of type 2 diabetes mellitus (T2DM). In addition to traditional risk factors, psychological determinants play an important role in CVD risk. This study applied Deep Neural Network (DNN) to develop a CVD risk prediction model and explored the bio-psycho-social contributors to the CVD risk among patients with T2DM. From 2017 to 2020, 834 patients with T2DM were recruited from the Department of Endocrinology, Affiliated Hospital of Harbin Medical University, China. In this cross-sectional study, the patients' bio-psycho-social information was collected through clinical examinations and questionnaires. The dataset was randomly split into a 75% train set and a 25% test set. DNN was implemented at the best performance on the train set and applied on the test set. The receiver operating characteristic curve (ROC) analysis was used to evaluate the model performance. Of participants, 272 (32.6%) were diagnosed with CVD. The developed ensemble model for CVD risk achieved an area under curve score of 0.91, accuracy of 87.50%, sensitivity of 88.06%, and specificity of 87.23%. Among patients with T2DM, the top five predictors in the CVD risk model were body mass index, anxiety, depression, total cholesterol, and systolic blood pressure. In summary, machine learning models can provide an automated identification mechanism for patients at CVD risk. Integrated treatment measures should be taken in health management, including clinical care, mental health improvement, and health behavior promotion.
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Affiliation(s)
- Haiyun Chu
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Lu Chen
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Xiuxian Yang
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Xiaohui Qiu
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Zhengxue Qiao
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Xuejia Song
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Erying Zhao
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Jiawei Zhou
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Wenxin Zhang
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Anam Mehmood
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Hui Pan
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Yanjie Yang
- Department of Medical Psychology, Harbin Medical University, Harbin, China
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André P, Proctor G, Driollet B, Garcia-Esquinas E, Lopez-Garcia E, Gomez-Cabrero D, Neyraud E, Rodriguez-Artalejo F, Morzel M, Féart C. The role of overweight in the association between the Mediterranean diet and the risk of type 2 diabetes mellitus: a mediation analysis among 21 585 UK biobank participants. Int J Epidemiol 2021; 49:1582-1590. [PMID: 32754745 DOI: 10.1093/ije/dyaa103] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is growing evidence that the Mediterranean (Medi) diet may lower the risk of type 2 diabetes mellitus (T2DM). Whether this association is due to the Medi diet by itself or is mediated by a diet-associated lower rate of overweight is uncertain. Our aim was to disentangle these relationships among UK adults. METHODS Based on 21 585 participants from the UK Biobank cohort, the adherence to the Medi diet (high fruits, vegetables, legumes, cereals, fish, olive oil; low meat, dairy products; and intermediate alcohol intakes) was assessed (range 0-18). Data on diabetes were self-reported, and overweight was defined as a body mass index (BMI) ≥ 25 kg/m². A mediation analysis was implemented to disentangle the role of overweight in the Medi diet-T2DM relationship. RESULTS The average baseline Medi diet score was 8.8 [standard deviation (SD) 2.6]. During a mean follow-up of 6.1 years, 473 individuals developed T2DM. A higher adherence to a Medi diet (+1 point) was associated with 14% decreased risk of T2DM [hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.82-0.90]. This association split into an indirect effect of 10%, mediated by lower odds of overweight (HR: 0.90, 95% CI: 0.87-0.92), and a direct effect of the Medi diet of 4% (HR: 0.96, 95% CI: 0.93-0.99), regardless of the effect mediated by overweight. CONCLUSIONS Considered as a single mediator, reduced overweight mainly contributes to the association between greater Medi diet adherence and lower risk of T2DM on this British subsample. However, the direct effect of the diet on the risk of T2DM, even weaker, should not be overlooked.
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Affiliation(s)
- Perrine André
- Team Lifelong Exposures, Health and Aging, Inserm, Bordeaux Population Health Research Center, University Bordeaux, Bordeaux, France
| | - Gordon Proctor
- Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College, London, UK
| | - Bénédicte Driollet
- Team Lifelong Exposures, Health and Aging, Inserm, Bordeaux Population Health Research Center, University Bordeaux, Bordeaux, France
| | - Esther Garcia-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, Madrid, Spain.,IMDEA-Food Institute, Madrid, Spain
| | - David Gomez-Cabrero
- Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College, London, UK
| | - Eric Neyraud
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université de Bourgogne Franche-Comté, Dijon, France
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, Madrid, Spain.,IMDEA-Food Institute, Madrid, Spain
| | - Martine Morzel
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université de Bourgogne Franche-Comté, Dijon, France
| | - Catherine Féart
- Team Lifelong Exposures, Health and Aging, Inserm, Bordeaux Population Health Research Center, University Bordeaux, Bordeaux, France
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Cataldi S, Costa V, Ciccodicola A, Aprile M. PPARγ and Diabetes: Beyond the Genome and Towards Personalized Medicine. Curr Diab Rep 2021; 21:18. [PMID: 33866450 DOI: 10.1007/s11892-021-01385-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Full and partial synthetic agonists targeting the transcription factor PPARγ are contained in FDA-approved insulin-sensitizing drugs and used for the treatment of metabolic syndrome-related dysfunctions. Here, we discuss the association between PPARG genetic variants and drug efficacy, as well as the role of alternative splicing and post-translational modifications as contributors to the complexity of PPARγ signaling and to the effects of synthetic PPARγ ligands. RECENT FINDINGS PPARγ regulates the transcription of several target genes governing adipocyte differentiation and glucose and lipid metabolism, as well as insulin sensitivity and inflammatory pathways. These pleiotropic functions confer great relevance to PPARγ in physiological regulation of whole-body metabolism, as well as in the etiology of metabolic disorders. Accordingly, PPARG gene mutations, nucleotide variations, and post-translational modifications have been associated with adipose tissue disorders and the related risk of insulin resistance and type 2 diabetes (T2D). Moreover, PPARγ alternative splicing isoforms-generating dominant-negative isoforms mainly expressed in human adipose tissue-have been related to impaired PPARγ activity and adipose tissue dysfunctions. Thus, multiple regulatory levels that contribute to PPARγ signaling complexity may account for the beneficial as well as adverse effects of PPARγ agonists. Further targeted analyses, taking into account all these aspects, are needed for better deciphering the role of PPARγ in human pathophysiology, especially in insulin resistance and T2D. The therapeutic potential of full and partial PPARγ synthetic agonists underlines the clinical significance of this nuclear receptor. PPARG mutations, polymorphisms, alternative splicing isoforms, and post-translational modifications may contribute to the pathogenesis of metabolic disorders, also influencing the responsiveness of pharmacological therapy. Therefore, in the context of the current evidence-based trend to personalized diabetes management, we highlight the need to decipher the intricate regulation of PPARγ signaling to pave the way to tailored therapies in patients with insulin resistance and T2D.
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Affiliation(s)
- Simona Cataldi
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", CNR, Via P. Castellino 111, 80131, Naples, Italy
| | - Valerio Costa
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", CNR, Via P. Castellino 111, 80131, Naples, Italy
| | - Alfredo Ciccodicola
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", CNR, Via P. Castellino 111, 80131, Naples, Italy.
- Department of Science and Technology, University of Naples "Parthenope", 80131, Naples, Italy.
| | - Marianna Aprile
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", CNR, Via P. Castellino 111, 80131, Naples, Italy
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Vasta R, D'Ovidio F, Logroscino G, Chiò A. The links between diabetes mellitus and amyotrophic lateral sclerosis. Neurol Sci 2021; 42:1377-1387. [PMID: 33544228 PMCID: PMC7955983 DOI: 10.1007/s10072-021-05099-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023]
Abstract
ALS etiology and prognostic factors are mostly unknown. Metabolic diseases and especially diabetes mellitus (DM) have been variously related to ALS. However, pieces of evidence have been variegated and often conflicting so far. This review aims to give an overview of recent contributions focusing on the relationship between DM and ALS. DM seems to reduce the risk of developing ALS if diagnosed at a younger age; conversely, when diagnosed at an older age, DM seems protective against ALS. Such a relationship was not confirmed in Asian countries where DM increases the risk of ALS independently of the age of onset. Interestingly, DM does not affect ALS prognosis, possibly weakening the potential causal relationship between the two diseases. However, since most studies are observational, it is difficult to state the exact nature of such a relationship and several hypotheses have been made. A recent study using Mendelian randomization suggested that DM is indeed protective against ALS in the European population. However, these analyses are not without limits and further evidence is needed. DM is usually the core of a larger metabolic syndrome. Thus, other metabolic changes such as dyslipidemia, body mass index, and cardiovascular diseases should be collectively considered. Finally, hypermetabolism usually found in ALS patients should be considered too since all these metabolic changes could be compensation (or the cause) of the higher energy expenditure.
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Affiliation(s)
- Rosario Vasta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.
| | - Fabrizio D'Ovidio
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Italy
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Adriano Chiò
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
- Neurology 1, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
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Polemiti E, Baudry J, Kuxhaus O, Jäger S, Bergmann MM, Weikert C, Schulze MB. BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study. Diabetologia 2021; 64:814-825. [PMID: 33452586 PMCID: PMC7940263 DOI: 10.1007/s00125-020-05362-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/02/2020] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Studies suggest decreased mortality risk among people who are overweight or obese compared with individuals with normal weight in type 2 diabetes (obesity paradox). However, the relationship between body weight or weight change and microvascular vs macrovascular complications of type 2 diabetes remains unresolved. We investigated the association between BMI and BMI change with long-term risk of microvascular and macrovascular complications in type 2 diabetes in a prospective cohort study. METHODS We studied participants with incident type 2 diabetes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, who were free of cancer, cardiovascular disease and microvascular disease at diagnosis (n = 1083). Pre-diagnosis BMI and relative annual change between pre- and post-diagnosis BMI were evaluated in multivariable-adjusted Cox models. RESULTS There were 85 macrovascular (myocardial infarction and stroke) and 347 microvascular events (kidney disease, neuropathy and retinopathy) over a median follow-up of 10.8 years. Median pre-diagnosis BMI was 29.9 kg/m2 (IQR 27.4-33.2), and the median relative annual BMI change was -0.4% (IQR -2.1 to 0.9). Higher pre-diagnosis BMI was positively associated with total microvascular complications (multivariable-adjusted HR per 5 kg/m2 [95% CI]: 1.21 [1.07, 1.36], kidney disease 1.39 [1.21, 1.60] and neuropathy 1.12 [0.96, 1.31]) but not with macrovascular complications (HR 1.05 [95% CI 0.81, 1.36]). Analyses according to BMI categories corroborated these findings. Effect modification was not evident by sex, smoking status or age groups. In analyses according to BMI change categories, BMI loss of more than 1% indicated a decreased risk of total microvascular complications (HR 0.62 [95% CI 0.47, 0.80]), kidney disease (HR 0.57 [95% CI 0.40, 0.81]) and neuropathy (HR 0.73 [95% CI 0.52, 1.03]), compared with participants with a stable BMI; no clear association was observed for macrovascular complications (HR 1.04 [95% CI 0.62, 1.74]). The associations between BMI gain compared with stable BMI and diabetes-related vascular complications were less apparent. Associations were consistent across strata of sex, age, pre-diagnosis BMI or medication but appeared to be stronger among never-smokers compared with current or former smokers. CONCLUSIONS/INTERPRETATION Among people with incident type 2 diabetes, pre-diagnosis BMI was positively associated with microvascular complications, while a reduced risk was observed with weight loss when compared with stable weight. The relationships with macrovascular disease were less clear.
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Affiliation(s)
- Elli Polemiti
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Julia Baudry
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Olga Kuxhaus
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Susanne Jäger
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Manuela M Bergmann
- Human Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Cornelia Weikert
- German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.
- German Center for Diabetes Research (DZD), Neuherberg, Germany.
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.
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88
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Haggar F, Einarsdóttir K. Trends in cesarean birth rates in Iceland over a 19-year period. Birth 2021; 48:36-43. [PMID: 32945001 DOI: 10.1111/birt.12503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/04/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cesarean birth (CB) rates have increased in high-resource countries during the past two decades, yet it is not known whether CB rates have changed according to maternal age and/or gestational age. METHODS All singleton live births in Iceland between 1997 and 2015 were identified from the Icelandic Medical Birth Registry (80 130). Rates of cesarean births (intrapartum and prelabor) were calculated overall and separately for maternal age groups and gestational age groups and by parity. Logit binomial regression was used to calculate odds ratios (ORs) and confidence intervals (CIs) for annual change in cesarean birth rates adjusted for maternal characteristics and clinical indication groups. RESULTS The overall CB rate was 15.7% in 1997 and 15.8% in 2015; the CB rate did not change significantly during the study period. The overall CB rate for early-term deliveries (37-38 weeks) decreased for multiparas (annual aOR = 0.99 [95% CI = 0.98-0.99]), and the preterm (<37 weeks) prelabor cesarean rate increased significantly (1.11 [1.09-1.14]) for both primiparas and multiparas. For multiparas only, the intrapartum CB rate decreased (0.97 [0.97-0.98]), whereas the prelabor CB rate increased, predominantly for women aged over 35 years (1.03 [1.02-1.04]). Adjustment for clinical indication groups did not change these results. CONCLUSIONS Findings indicate a rise in prelabor cesarean for preterm births and women aged over 35 years (multiparas only). As adjustment for clinical indications did not affect these results, changes in obstetric practice are more likely to have affected these rate changes rather than changes in clinical indications.
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Affiliation(s)
- Fatima Haggar
- Chadian League Against Cancer (Ligue Tchadienne de Lutte Contre le Cancer), Ndjamena, Chad
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Amar D, Sinnott-Armstrong N, Ashley EA, Rivas MA. Graphical analysis for phenome-wide causal discovery in genotyped population-scale biobanks. Nat Commun 2021; 12:350. [PMID: 33441555 PMCID: PMC7806647 DOI: 10.1038/s41467-020-20516-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
Causal inference via Mendelian randomization requires making strong assumptions about horizontal pleiotropy, where genetic instruments are connected to the outcome not only through the exposure. Here, we present causal Graphical Analysis Using Genetics (cGAUGE), a pipeline that overcomes these limitations using instrument filters with provable properties. This is achievable by identifying conditional independencies while examining multiple traits. cGAUGE also uses ExSep (Exposure-based Separation), a novel test for the existence of causal pathways that does not require selecting instruments. In simulated data we illustrate how cGAUGE can reduce the empirical false discovery rate by up to 30%, while retaining the majority of true discoveries. On 96 complex traits from 337,198 subjects from the UK Biobank, our results cover expected causal links and many new ones that were previously suggested by correlation-based observational studies. Notably, we identify multiple risk factors for cardiovascular disease, including red blood cell distribution width.
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Affiliation(s)
- David Amar
- Center for Inherited Cardiovascular Disease, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | | | - Euan A Ashley
- Center for Inherited Cardiovascular Disease, Stanford University, Stanford, CA, USA
| | - Manuel A Rivas
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.
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Impact of Bariatric Surgery in Reducing Macrovascular Complications in Severely Obese T2DM Patients. Obes Surg 2021; 31:1929-1936. [PMID: 33409981 DOI: 10.1007/s11695-020-05155-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evidence from real-world studies have suggested a reduced rate of macrovascular complications following bariatric surgery. We undertook this meta-analysis to investigate the impact of bariatric surgery on macrovascular disease outcomes in severely obese type 2 diabetes mellitus (T2DM) patients. METHODS An extensive literature search was performed in PubMed from inception until March 2020. All cohort studies assessing the association between bariatric surgery and macrovascular complications in severely obese T2DM patients were included. Two independent reviewers screened the articles, extracted data, and assessed the quality using the Newcastle-Ottawa Scale. The primary outcome was to assess the impact of bariatric surgery and the risk of macrovascular complications. Statistical analysis was performed using Review Manager 5.3. RESULTS This meta-analysis comprised of five studies including 49,211 participants (75% female), of which 14,434 underwent bariatric surgery and 34,777 underwent usual care. Participants who underwent bariatric surgery had a significantly lower risk of macrovascular complications as compared to those with non-surgical interventions (RR: 0.50 [95% CI: 0.35-0.73], p = 0.0003). In the subgroup analysis, based on the geographical regions, studies conducted in the USA showed a higher reduction (RR: 0.41 [95% CI: 0.32-0.53], p < 0.00001) in macrovascular complications as compared to other parts of the world. The risk of all-cause mortality was also significantly lower in patients with bariatric surgery (RR 0.39 [95% CI: 0.30-0.50], p < 0.00001). CONCLUSION Bariatric surgery was associated with a 50% reduction in macrovascular complications along with 61% reduction in risk of all-cause mortality in morbidly obese T2DM patients.
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91
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Review, Performance Comparison, and Validation of Models Predicting Type 2 Diabetes Remission After Bariatric Surgery in a Western European Population. Obes Surg 2021; 31:1549-1560. [PMID: 33398626 DOI: 10.1007/s11695-020-05157-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The majority of patients with type 2 diabetes (T2DM) achieve remission after bariatric surgery. Several models are available to preoperatively predict T2DM remission. This study compares the performance of these models in a Western population one year after surgery and explores their predictive value in comparison to a model specifically designed for our study population. MATERIALS AND METHODS Prediction models were retrieved using a literature search. Patients were retrospectively selected from a database of the Antwerp University Hospital. Performance of the models was assessed by determining the area under the receiver operating characteristic curve (AUROC), the accuracy, and the goodness of fit, and by comparing them to a custom-made logistic model. RESULTS The probability of T2DM remission was calculated using 11 predictive scoring models and 8 regression models in a cohort of 250 patients. Complete T2DM remission occurred in 64.0% of patients. The IMS score (AUROC = 0.912; accuracy = 83.6%), DiaBetter score (0.907; 82.0%), and Ad-DiaRem score (0.903; 82.8%) best predicted T2DM remission and closely approached the performance of the custom-constructed model (0.917; 84.0%). The model by Ioffe et al. (0.630; 69.2%), Umemura et al. (0.692; 71.4%), and the ABCD score (0.757; 72.8%) were the least accurate. CONCLUSION Most T2DM remission models reliably predicted one-year T2DM remission, with limited inter-model differences. The accuracy of most models approached that of the custom-constructed model, indicating a high predictive capability and performance in our patient cohort. To date, most models are only validated to estimate T2DM remission one year after surgery and they do not predict long-term remission.
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Oral Health, Nutritional-Related Patterns and Body Mass Index in Children. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:575-580. [PMID: 35444820 PMCID: PMC8987463 DOI: 10.12865/chsj.47.04.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Regarding the influence of obesity on general health of children, scientific literature showed the importance of early management of children's overweight. In terms of oral health, overweight and obese children were shown to have accelerated dental development and increased prevalence of caries. OBJECTIVES The aim of the present study is to evaluate the influence of Body Mass Index (BMI) and dietary behaviors on the oral status, eruptions and hygiene in children. MATERIAL AND METHODS Ninety-two children aged 6-12 years were investigated about the oral hygiene habits, nutritional related behaviors, presence of systemic diseases. Values of BMI and oral status were noted. Statistical analysis was performed. RESULTS Significant moderate correlations between the values of BMI with tooth eruption and weak but significantly with dental lesions were determined. CONCLUSIONS The dietary behaviors and BMI could influence the oral status, eruptions and oral hygiene in children.
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Joud H, Mohamed E, Mirza S, Tabbaa H, Tabbaa M, Khan F, Ayoubi N, MacDonald M, Woodard L, Oxner A, Guerra L, Bakour C, Mirza AS. Prevalence and management of diabetes among the uninsured: A multicenter study in Tampa Bay, FL. Diabetes Res Clin Pract 2021; 171:108560. [PMID: 33271229 DOI: 10.1016/j.diabres.2020.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/03/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022]
Abstract
AIMS This study describes the prevalence and management of uninsured patients with diabetes in free clinics around the Tampa Bay area. METHODS A retrospective chart review collected data from uninsured patients who visited nine free clinics from January 2016 to December 2017. The data included sociodemographics, chronic disease diagnoses and treatments, and social history. Statistical analysis including chi-square tests and logistic regression were used to describe patients with diabetes. RESULTS With a prevalence of 19.41% among 6815 uninsured patients and a mean HbA1c of 7.9% (63 mmol/mol), patients with diabetes were more likely to be White, women, obese, unemployed, and have hypertension and depression compared to patients without diabetes. There were no significant differences in sociodemographic variables between those with controlled and uncontrolled diabetes. Among the variables studied by logistic regression, unemployment was found to be a significant predictor of poor glycemic control among men. CONCLUSIONS Diabetes is a challenging chronic disease among the uninsured of Tampa Bay due to its prevalence and suboptimal glycemic control. Obesity and unemployment represent significant challenges that increase the burden of diabetes among the uninsured. Free clinics may benefit from additional resources and intervention programs, with future research assessing their effects on care outcomes.
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Affiliation(s)
- Hadi Joud
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA.
| | - Eslam Mohamed
- Family Medicine, Ocala Regional Medical Center, 1431 SW 1st Ave, Ocala, FL 34478, USA
| | - Sabbir Mirza
- William Carey University College of Osteopathic Medicine, 710 William Carey Parkway, Hattiesburg, MS 39401, USA
| | - Hozaifa Tabbaa
- Lake Erie College of Osteopathic Medicine, 5000 Lakewood Ranch Blvd., Bradenton, FL 34211, USA
| | - Mouaz Tabbaa
- College of Arts and Sciences, University of South Florida, 4202 E. Fowler Avenue, CPR 107, Tampa, FL 33620, USA
| | - Firaas Khan
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Noura Ayoubi
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Madeline MacDonald
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Laurie Woodard
- Department of Family Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Asa Oxner
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Lucy Guerra
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Chighaf Bakour
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA
| | - Abu-Sayeef Mirza
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
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Ryu KS, Kang HYJ, Lee SW, Park HW, You NY, Kim JH, Hwangbo Y, Choi KS, Cha HS. Screening Model for Estimating Undiagnosed Diabetes among People with a Family History of Diabetes Mellitus: A KNHANES-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8903. [PMID: 33266117 PMCID: PMC7730533 DOI: 10.3390/ijerph17238903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Abstract
A screening model for estimating undiagnosed diabetes mellitus (UDM) is important for early medical care. There is minimal research and a serious lack of screening models for people with a family history of diabetes (FHD), especially one which incorporates gender characteristics. Therefore, the primary objective of our study was to develop a screening model for estimating UDM among people with FHD and enable its validation. We used data from the Korean National Health and Nutrition Examination Survey (KNHANES). KNAHNES (2010-2016) was used as a developmental cohort (n = 5939) and was then evaluated in a validation cohort (n = 1047) KNHANES (2017). We developed the screening model for UDM in male (SMM), female (SMF), and male and female combined (SMP) with FHD using backward stepwise logistic regression analysis. The SMM and SMF showed an appropriate performance (area under curve (AUC) = 76.2% and 77.9%) compared with SMP (AUC = 72.9%) in the validation cohort. Consequently, simple screening models were developed and validated, for the estimation of UDM among patients in the FHD group, which is expected to reduce the burden on the national health care system.
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Affiliation(s)
- Kwang Sun Ryu
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Ha Ye Jin Kang
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Sang Won Lee
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Hyun Woo Park
- Healthcare AI Team, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (H.W.P.); (Y.H.)
| | - Na Young You
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Jae Ho Kim
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (H.W.P.); (Y.H.)
- Division of Endocrinology, Department of Internal Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea
| | - Kui Son Choi
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea
| | - Hyo Soung Cha
- Cancer Big Data Center, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (K.S.R.); (H.Y.J.K.); (S.W.L.); (N.Y.Y.); (J.H.K.); (K.S.C.)
- Healthcare AI Team, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea; (H.W.P.); (Y.H.)
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, Gyeonggi-do, Korea
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95
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Waongenngarm P, van der Beek AJ, Akkarakittichoke N, Janwantanakul P. Perceived musculoskeletal discomfort and its association with postural shifts during 4-h prolonged sitting in office workers. APPLIED ERGONOMICS 2020; 89:103225. [PMID: 32755740 DOI: 10.1016/j.apergo.2020.103225] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
This study examined the characteristics of perceived discomfort and postural shifts at different magnitudes during a 4-h sitting period and the association between perceived discomfort and number of postural shifts. Forty healthy participants continuously typed a standardized text passage at a computer work station for 4 h. Subjects rated perceived body discomfort using Borg's CR-10 scale in 10 body regions (i.e. neck, shoulder, elbow, wrist/hand, upper back, lower back, buttock, thigh, knee, and ankle/foot). A seat pressure mat device was used to gather seat pressure data during sitting. Postural shifts were determined by analysis of the dispersion index of both ischial tuberosities from seat pressure data. The threshold for a postural shift was set at ±10% and ±20%. Perceived discomfort in all body regions increased continuously during a 4-h sitting period. The body regions with the highest perceived discomfort were the low back, buttocks, upper back, thigh, and neck. The average (±SD) numbers of postural shifts during the 1st, 2nd, 3rd, and 4th hour of sitting were 14.8 ± 9.5, 17.8 ± 9.4, 18.2 ± 11.1, and 18.1 ± 9.8 shifts per hour for the 10% threshold, and were 4.8 ± 4.4, 6.0 ± 5.6, 7.4 ± 6.7, and 7.7 ± 6.6 shifts per hour for the 20% threshold, respectively. Prolonged sitting led to an increase in perceived musculoskeletal discomfort over time. The number of postural shifts at both magnitudes increased in the first 2 h of sitting and, in the second 2-h period of sitting, only the number of larger postural shifts (with 20% threshold) increased. The findings extend our understanding of sitting behaviors.
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Affiliation(s)
- Pooriput Waongenngarm
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Nipaporn Akkarakittichoke
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
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96
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Keep Them in the Game: Screening for Cardiovascular Disease and Diabetes in Aging Athletes. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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97
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Zantour B, Bouchareb S, El Ati Z, Boubaker F, Alaya W, Kossomtini W, Sfar MH. Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study. BMC Endocr Disord 2020; 20:128. [PMID: 32831070 PMCID: PMC7444199 DOI: 10.1186/s12902-020-00608-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Diabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) classification, stratify patients into risk categories and identify factors associated with higher-risk grade. METHODS Cross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. RESULTS Among 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10 g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher-risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR = 2.529, CI95 [1.131-5.655], p = 0.024), hyperkeratosis (OR = 2.658, CI95 [1.222-5.783], p = 0.014) and school level (OR = 0.489, CI95 [0.253-9.44], p = 0.033). CONCLUSIONS Risk factors for foot ulceration were rather common in outpatients with diabetes. The screening of patients at risk for foot ulceration should start early, integrated with sustainable patient education.
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Affiliation(s)
- B Zantour
- Department of endocrinology and internal medicine, Tahar Sfar hospital, 5100, Mahdia, Tunisia.
| | - S Bouchareb
- Department of endocrinology and internal medicine, Tahar Sfar hospital, 5100, Mahdia, Tunisia
| | - Z El Ati
- Department of endocrinology and internal medicine, Tahar Sfar hospital, 5100, Mahdia, Tunisia
| | - F Boubaker
- Department of endocrinology and internal medicine, Tahar Sfar hospital, 5100, Mahdia, Tunisia
| | - W Alaya
- Department of endocrinology and internal medicine, Tahar Sfar hospital, 5100, Mahdia, Tunisia
| | - W Kossomtini
- Department of physical medicine and rehabilitation, Tahar Sfar Hospital, 5100, Mahdia, Tunisia
| | - M H Sfar
- Department of endocrinology and internal medicine, Tahar Sfar hospital, 5100, Mahdia, Tunisia
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98
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Cohen RV, Pereira TV, Aboud CM, Petry TBZ, Lopes Correa JL, Schiavon CA, Pompílio CE, Pechy FNQ, da Costa Silva ACC, de Melo FLG, Cunha da Silveira LP, de Paris Caravatto PP, Halpern H, Monteiro FDLJ, da Costa Martins B, Kuga R, Palumbo TMS, Docherty NG, le Roux CW. Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity: A Randomized Clinical Trial. JAMA Surg 2020; 155:e200420. [PMID: 32492126 DOI: 10.1001/jamasurg.2020.0420] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Early-stage chronic kidney disease (CKD) characterized by microalbuminuria is associated with future cardiovascular events, progression toward end-stage renal disease, and early mortality in patients with type 2 diabetes. Objective To compare the albuminuria-lowering effects of Roux-en-Y gastric bypass (RYGB) surgery vs best medical treatment in patients with early-stage CKD, type 2 diabetes, and obesity. Design, Setting, and Participants For this randomized clinical trial, patients with established type 2 diabetes and microalbuminuria were recruited from a single center from April 1, 2013, through March 31, 2016, with a 5-year follow-up, including prespecified intermediate analysis at 24-month follow-up. Intervention A total of 100 patients with type 2 diabetes, obesity (body mass indexes of 30 to 35 [calculated as weight in kilograms divided by height in meters squared]), and stage G1 to G3 and A2 to A3 CKD (urinary albumin-creatinine ratio [uACR] >30 mg/g and estimated glomerular filtration rate >30 mL/min) were randomized 1:1 to receive best medical treatment (n = 49) or RYGB (n = 51). Main Outcomes and Measures The primary outcome was remission of albuminuria (uACR <30 mg/g). Secondary outcomes were CKD remission rate, absolute change in uACR, metabolic control, other microvascular complications, quality of life, and safety. Results A total of 100 patients (mean [SD] age, 51.4 [7.6] years; 55 [55%] male) were randomized: 51 to RYGB and 49 to best medical care. Remission of albuminuria occurred in 55% of patients (95% CI, 39%-70%) after best medical treatment and 82% of patients (95% CI, 72%-93%) after RYGB (P = .006), resulting in CKD remission rates of 48% (95% CI, 32%-64%) after best medical treatment and 82% (95% CI, 72%-92%) after RYGB (P = .002). The geometric mean uACRs were 55% lower after RYGB (10.7 mg/g of creatinine) than after best medical treatment (23.6 mg/g of creatinine) (P < .001). No difference in the rate of serious adverse events was observed. Conclusions and Relevance After 24 months, RYGB was more effective than best medical treatment for achieving remission of albuminuria and stage G1 to G3 and A2 to A3 CKD in patients with type 2 diabetes and obesity. Trial Registration ClinicalTrials.gov Identifier: NCT01821508.
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Affiliation(s)
- Ricardo Vitor Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Tiago Veiga Pereira
- Applied Health Research Center, St Michael's Hospital, Toronto, Ontario, Canada.,Health Technology Assessment Unit, International Research Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Helio Halpern
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | - Rogerio Kuga
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | - Neil Gerard Docherty
- Diabetes Complications Research Center, UCD Conway Institute, University College Dublin School of Medicine, Dublin, Ireland.,Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carel Wynand le Roux
- Diabetes Complications Research Center, UCD Conway Institute, University College Dublin School of Medicine, Dublin, Ireland.,Investigative Medicine, Imperial College London, London, United Kingdom
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99
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Lord J, Roberson S, Odoi A. Investigation of geographic disparities of pre-diabetes and diabetes in Florida. BMC Public Health 2020; 20:1226. [PMID: 32787830 PMCID: PMC7425001 DOI: 10.1186/s12889-020-09311-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 07/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Diabetes is a leading cause of death and disability in the United States, and its precursor, pre-diabetes, is estimated to occur in one-third of American adults. Understanding the geographic disparities in the distribution of these conditions and identifying high-prevalence areas is critical to guiding control and prevention programs. Therefore, the objective of this study was to investigate clusters of pre-diabetes and diabetes risk in Florida and identify significant predictors of the conditions. METHODS Data from the 2013 Behavioral Risk Factor Surveillance System were obtained from the Florida Department of Health. Spatial scan statistics were used to identify and locate significant high-prevalence local clusters. The county prevalence proportions of pre-diabetes and diabetes and the identified significant clusters were displayed in maps. Logistic regression was used to identify significant predictors of the two conditions for individuals living within and outside high-prevalence clusters. RESULTS The study included a total of 34,186 respondents. The overall prevalence of pre-diabetes and diabetes were 8.2 and 11.5%, respectively. Three significant (p < 0.05) local, high-prevalence spatial clusters were detected for pre-diabetes, while five were detected for diabetes. The counties within the high-prevalence clusters had prevalence ratios ranging from 1.29 to 1.85. There were differences in the predictors of the conditions based on whether respondents lived within or outside high-prevalence clusters. Predictors of both pre-diabetes and diabetes regardless of region or place of residence were obesity/overweight, hypertension, and hypercholesterolemia. Income and physical activity level were significant predictors of diabetes but not pre-diabetes. Arthritis, sex, and marital status were significant predictors of diabetes only among residents of high-prevalence clusters, while educational attainment and smoking were significant predictors of diabetes only among residents of non-cluster counties. CONCLUSIONS Geographic disparities of pre-diabetes and diabetes exist in Florida. Information from this study is useful for guiding resource allocation and targeting of intervention programs focusing on identified modifiable predictors of pre-diabetes and diabetes so as to reduce health disparities and improve the health of all Floridians.
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Affiliation(s)
- Jennifer Lord
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Shamarial Roberson
- Bureau of Chronic Disease Prevention, Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL, USA
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA.
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100
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Gruneck L, Kullawong N, Kespechara K, Popluechai S. Gut microbiota of obese and diabetic Thai subjects and interplay with dietary habits and blood profiles. PeerJ 2020; 8:e9622. [PMID: 32832269 PMCID: PMC7409811 DOI: 10.7717/peerj.9622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
Obesity and type 2 diabetes mellitus (T2DM) have become major public health issues globally. Recent research indicates that intestinal microbiota play roles in metabolic disorders. Though there are numerous studies focusing on gut microbiota of health and obesity states, those are primarily focused on Western countries. Comparatively, only a few investigations exist on gut microbiota of people from Asian countries. In this study, the fecal microbiota of 30 adult volunteers living in Chiang Rai Province, Thailand were examined using next-generation sequencing (NGS) in association with blood profiles and dietary habits. Subjects were categorized by body mass index (BMI) and health status as follows; lean (L) = 8, overweight (OV) = 8, obese (OB) = 7 and diagnosed T2DM = 7. Members of T2DM group showed differences in dietary consumption and fasting glucose level compared to BMI groups. A low level of high-density cholesterol (HDL) was observed in the OB group. Principal coordinate analysis (PCoA) revealed that microbial communities of T2DM subjects were clearly distinct from those of OB. An analogous pattern was additionally illustrated by multiple factor analysis (MFA) based on dietary habits, blood profiles, and fecal gut microbiota in BMI and T2DM groups. In all four groups, Bacteroidetes and Firmicutes were the predominant phyla. Abundance of Faecalibacterium prausnitzii, a butyrate-producing bacterium, was significantly higher in OB than that in other groups. This study is the first to examine the gut microbiota of adult Thais in association with dietary intake and blood profiles and will provide the platform for future investigations.
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Affiliation(s)
- Lucsame Gruneck
- School of Science, Mae Fah Luang University, Muang, Chiang Rai, Thailand.,Gut Microbiome Research Group, Mae Fah Luang University, Muang, Chiang Rai, Thailand
| | - Niwed Kullawong
- Gut Microbiome Research Group, Mae Fah Luang University, Muang, Chiang Rai, Thailand.,School of Health Science, Mae Fah Luang University, Muang, Chiang Rai, Thailand
| | | | - Siam Popluechai
- School of Science, Mae Fah Luang University, Muang, Chiang Rai, Thailand.,Gut Microbiome Research Group, Mae Fah Luang University, Muang, Chiang Rai, Thailand
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