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Ramirez M, Bastien E, Chae H, Gianello P, Gilon P, Bouzin C. 3D evaluation of the extracellular matrix of hypoxic pancreatic islets using light sheet fluorescence microscopy. Islets 2024; 16:2298518. [PMID: 38267218 PMCID: PMC10810165 DOI: 10.1080/19382014.2023.2298518] [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: 08/02/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Pancreatic islet transplantation is a promising treatment for type 1 diabetes, but the survival and function of transplanted islets are hindered by the loss of extracellular matrix (ECM) during islet isolation and by low oxygenation upon implantation. This study aimed to evaluate the impact of hypoxia on ECM using a cutting-edge imaging approach based on tissue clearing and 3D microscopy. Human and rat islets were cultured under normoxic (O2 21%) or hypoxic (O2 1%) conditions. Immunofluorescence staining targeting insulin, glucagon, CA9 (a hypoxia marker), ECM proteins (collagen 4, fibronectin, laminin), and E-cadherin (intercellular adhesion protein) was performed on fixed whole islets. The cleared islets were imaged using Light Sheet Fluorescence Microscopy (LSFM) and digitally analyzed. The volumetric analysis of target proteins did not show significant differences in abundance between the experimental groups. However, 3D projections revealed distinct morphological features that differentiated normoxic and hypoxic islets. Under normoxic conditions, ECM could be found throughout the islets. Hypoxic islets exhibited areas of scattered nuclei and central clusters of ECM proteins, indicating central necrosis. E-cadherin was absent in these areas. Our results, demonstrating a diminution of islets' functional mass in hypoxia, align with the functional decline observed in transplanted islets experiencing low oxygenation after grafting. This study provides a methodology combining tissue clearing, multiplex immunofluorescence, Light Sheet Fluorescence Microscopy, and digital image analysis to investigate pancreatic islet morphology. This 3D approach allowed us to highlight ECM organizational changes during hypoxia from a morphological perspective.
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Affiliation(s)
- Matias Ramirez
- Pole of Experimental Surgery and Transplantation, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Estelle Bastien
- Pole of Pharmacology and Therapeutics, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Heeyoung Chae
- Pole of Endocrinology, Diabetes and Nutrition, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Gianello
- Laboratory of Experimental Surgery and Transplantation, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Patrick Gilon
- Pole of Endocrinology, Diabetes and Nutrition, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Caroline Bouzin
- Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Brussels, Belgium
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2
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Mohamed AA, Abdallah GM, Ibrahim IT, Ali NS, Hussein MA, Thabet GM, azzam OM, Mohamed AY, farghly MI, Al Hussain E, Alkhalil SS, Abouaggour AAM, Ibrahem Fathy Hassan NA, Iqbal S, Mohamed AA, Hafez W, Mahmoud MO. Evaluation of miRNA-146a, miRNA-34a, and pro-inflammatory cytokines as a potential early indicators for type 1 diabetes mellitus. Noncoding RNA Res 2024; 9:1249-1256. [PMID: 39036602 PMCID: PMC11259987 DOI: 10.1016/j.ncrna.2024.06.001] [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: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024] Open
Abstract
Background Type I diabetes mellitus (T1DM) is one of the most common chronic autoimmune diseases worldwide. miRNAs are a class of small non-coding RNA molecules that have been linked to immune system functions, β-cell metabolism, proliferation, and death, all of which contribute to pathogenesis of TIDM. Dysregulated miRNAs have been identified in Egyptian TIDM patients. Aim Several miRNAs were profiled in Egyptian TIDM patients to determine whether they can be used as molecular biomarkers for T1DM. The relationship between the investigated miRNAs and pro-inflammatory cytokines (TNF-α and IL-6) has also been evaluated in the development of TIDM, in addition to the creation of a proposed model for TIDM prediction. Patients & methods Case-control study included 177 Egyptian patients with confirmed type I diabetes mellitus and 177 healthy individuals. MiRNA-34 and miRNA-146 were detected in serum samples using real-time PCR, whereas TNF-α and IL-6 levels were assessed using ELIZA. Results Patients with TIDM showed a significant decrease in the expression of miRNA-146, with a cut-off value ≤ 3.3, 48 % specificity, and 92.1 % sensitivity, whereas miRNA-34 had the highest sensitivity (95.5 %) and specificity (97.2 %) for differentiating diabetic patients from controls. Furthermore, other diagnostic proinflammatory markers showed lower sensitivity and specificity. Conclusion Serum levels of miRNA-34a, miRNA-146, IL-6, and TNF-α provide new insights into T1DM pathogenesis and could be used for screening and diagnosis purposes. They can be also a potential therapeutic target, as well as allowing for more strategies to improve T1DM disease outcomes.
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Affiliation(s)
- Amal A. Mohamed
- Biochemistry and Molecular Biology Department, National Hepatology and Tropical Medicine Research Institute, GOTHI, Cairo, Egypt
| | - Gamil M. Abdallah
- Biochemistry Department, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Ibrahim T. Ibrahim
- Biochemistry Department, Faculty of Pharmacy, Beni Suef University, Beni Suef, Egypt
| | - Nada S. Ali
- Biochemistry Department, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Mona A. Hussein
- Internal Medicine Department, National Institute of Diabetes and Endocrinology, GOTHI, Cairo, Egypt
| | - Ghada Maher Thabet
- Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Omar M. azzam
- Internal Medicine Department, Ahmed Maher Teaching Hospital, GOTHI, Cairo, Egypt
| | - Amira Yones Mohamed
- Internal medicine department, ELmatareya Teaching Hospital, GOTHI, Cairo, Egypt
| | - Maysa I. farghly
- Department of Clinical Pathology, Faculty of Medicine, Suez University, Suez, Egypt
| | - Eman Al Hussain
- Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samia S. Alkhalil
- Medical Laboratories Department, College of Applied Medical Sciences in Al Quway'iyah, Shaqraa University, Saudi Arabia
| | | | | | | | | | - Wael Hafez
- Internal Medicine Department, Medical Research and Clinical Studies Institute, The National Research Centre, 33 El Buhouth St, Ad Doqi, Dokki, Cairo Governorate 12622, Egypt
| | - Mohamed O. Mahmoud
- Biochemistry Department, Faculty of Pharmacy, Beni Suef University, Beni Suef, Egypt
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3
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Seuc AH, Mirabal-Sosa M, Garcia-Serrano Y, Alfonso-Sague K, Fernandez-Gonzalez L. Mortality attributable to diabetes in Cuba: Estimates for 2019. PUBLIC HEALTH IN PRACTICE 2024; 8:100537. [PMID: 39263243 PMCID: PMC11389546 DOI: 10.1016/j.puhip.2024.100537] [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: 03/05/2024] [Revised: 07/21/2024] [Accepted: 08/06/2024] [Indexed: 09/13/2024] Open
Abstract
Objective To estimate the national and provincial number of excess deaths due to diabetes across Cuba in 2019. Study design Cross-sectional design with secondary data. Methods We used DISMODII, a computerized generic disease model, to assess disease burden by modelling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, total mortality, and age- and sex-specific estimates for diabetes prevalence from the Cuban National Health Survey 2019, and available published estimates of the relative risk of death for people with diabetes compared to people without diabetes. The results were internally validated with DISMODII output for duration of diabetes (years). Results In 2019, we estimated an excess of mortality attributable to diabetes of 7.5 times the diabetes mortality reported by the National Death Registry, which is equivalent to 16.4 % of all deaths in Cuba. The percentages of all-cause mortality among provinces varied between 10.7 % in Villa Clara and 24.5 % in Ciego de Avila. Conclusions These are the first estimates of mortality attributable to diabetes in Cuba and its provinces. Diabetes is likely to be a much more prominent leading cause of death than the 9th ranking reported by the Cuban National Death Registry 2019. Disease models similar to DISMODII are important tools to validate the epidemiologic indicators used in the burden of disease calculations.
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Affiliation(s)
- A H Seuc
- Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta 1151, e/ Clavel y Llinas, Centro Habana, La Habana, 10300, Cuba
| | - M Mirabal-Sosa
- Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta 1151, e/ Clavel y Llinas, Centro Habana, La Habana, 10300, Cuba
| | - Y Garcia-Serrano
- Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta 1151, e/ Clavel y Llinas, Centro Habana, La Habana, 10300, Cuba
| | - K Alfonso-Sague
- Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta 1151, e/ Clavel y Llinas, Centro Habana, La Habana, 10300, Cuba
| | - L Fernandez-Gonzalez
- Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta 1151, e/ Clavel y Llinas, Centro Habana, La Habana, 10300, Cuba
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4
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Ni Y, Wu X, Yao W, Zhang Y, Chen J, Ding X. Evidence of traditional Chinese medicine for treating type 2 diabetes mellitus: from molecular mechanisms to clinical efficacy. PHARMACEUTICAL BIOLOGY 2024; 62:592-606. [PMID: 39028269 PMCID: PMC11262228 DOI: 10.1080/13880209.2024.2374794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
CONTEXT The global prevalence of type 2 diabetes mellitus (T2DM) has increased significantly in recent decades. Despite numerous studies and systematic reviews, there is a gap in comprehensive and up-to-date evaluations in this rapidly evolving field. OBJECTIVE This review provides a comprehensive and current overview of the efficacy of Traditional Chinese Medicine (TCM) in treating T2DM. METHODS A systematic review was conducted using PubMed, Web of Science, Wanfang Data, CNKI, and Medline databases, with a search timeframe extending up to November 2023. The search strategy involved a combination of subject terms and free words in English, including 'Diabetes,' 'Traditional Chinese Medicine,' 'TCM,' 'Hypoglycemic Effect,' 'Clinical Trial,' and 'Randomized Controlled Trial.' The studies were rigorously screened by two investigators, with a third investigator reviewing and approving the final selection based on inclusion and exclusion criteria. RESULTS A total of 108 relevant papers were systematically reviewed. The findings suggest that TCMs not only demonstrate clinical efficacy comparable to existing Western medications in managing hypoglycemia but also offer fewer adverse effects and a multitarget therapeutic approach. Five main biological mechanisms through which TCM treats diabetes were identified: improving glucose transport and utilization, improving glycogen metabolism, promoting GLP-1 release, protecting pancreatic islets from damage, and improving intestinal flora. CONCLUSIONS TCM has demonstrated significant protective effects against diabetes and presents a viable option for the prevention and treatment of T2DM. These findings support the further exploration and integration of TCM into broader diabetes management strategies.
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Affiliation(s)
- Yadong Ni
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xianglong Wu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Wenhui Yao
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yuna Zhang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jie Chen
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xuansheng Ding
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Precision Medicine Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
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5
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Amadou C, Wei Y, Feychting M, Carlsson S. Early-Life Factors Associated With Adult-Onset Type 1 Diabetes: A Swedish Nationwide Cohort and Family-Based Study. Diabetes Care 2024; 47:1740-1749. [PMID: 39046992 DOI: 10.2337/dc24-0896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Childhood-onset type 1 diabetes (T1D) is associated with perinatal factors, but data related to adult-onset T1D are scarce. This study aimed at investigating the association between early-life factors and adult-onset T1D in a Swedish nationwide cohort and family-based study. RESEARCH DESIGN AND METHODS We included 1,813,415 individuals aged ≥18 years, born in Sweden 1983 to 2002, followed until 2020. T1D diagnosis (n = 3,283) was identified from the National Diabetes, Patient and Prescribed Drugs Registers, and perinatal exposures were obtained from the Medical Birth Register. We performed Cox proportional hazard (hazard ratio [95% CI]) regression with mutual adjustment for perinatal exposures, sex, birth year, and parental sociodemographic background and history of diabetes. We also compared T1D risks among siblings' groups identified from the Multiple Generation Register. RESULTS The incidence rate of adult-onset T1D was 18.8 per 100,000 person-years. Year of birth (1.06 [1.01-1.10], per five additional years) and history of maternal (4.10 [3.09-5.43]) and paternal (6.24 [5.10-7.64]) T1D were associated with a higher incidence of adult-onset T1D, whereas female sex (0.69 [0.64-0.74]) and having parents born outside Sweden were associated with a lower incidence. Regarding perinatal exposures, only non-full-term birth (<39 weeks vs. ≥39 weeks) was associated with a higher incidence of adult-onset T1D (1.12 [1.04-1.22]). The sibling cohort results were consistent with the full cohort analysis. CONCLUSIONS Perinatal factors seem to play a minor role in the development of adult-onset T1D compared with childhood-onset T1D, suggesting that triggers or accelerators of autoimmunity occurring later in life are more significant.
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Affiliation(s)
- Coralie Amadou
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Paris-Saclay University, Corbeil-Essonnes, France
| | - Yuxia Wei
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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6
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Ostrominski JW, Jemma Cho SM, Vaduganathan M, Honigberg MC. Cardiorenal Outcomes in Middle-Aged and Older Adults With Type 1 and Type 2 Diabetes. J Am Coll Cardiol 2024; 84:1363-1366. [PMID: 39140954 PMCID: PMC11424244 DOI: 10.1016/j.jacc.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 08/15/2024]
Affiliation(s)
- John W Ostrominski
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - So Mi Jemma Cho
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael C Honigberg
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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7
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Escobar Vasco MA, Fantaye SH, Raghunathan S, Solis-Herrera C. The potential role of finerenone in patients with type 1 diabetes and chronic kidney disease. Diabetes Obes Metab 2024; 26:4135-4146. [PMID: 39021345 DOI: 10.1111/dom.15773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/20/2024]
Abstract
Chronic kidney disease (CKD) represents a global health concern, associated with an increased risk of cardiovascular morbidity and mortality and decreased quality of life. Many patients with type 1 diabetes (T1D) will develop CKD over their lifetime. Uncontrolled glucose levels, which occur in patients with T1D as well as type 2 diabetes (T2D), are associated with substantial mortality and cardiovascular disease burden. T2D and T1D share common pathological features of CKD, which is thought to be driven by haemodynamic dysfunction, metabolic disturbances, and subsequently an influx of inflammatory and profibrotic mediators, both of which are major interrelated contributors to CKD progression. The mineralocorticoid receptor is also involved, and, under conditions of oxidative stress, salt loading and hyperglycaemia, it switches from homeostatic regulator to pathophysiological mediator by promoting oxidative stress, inflammation and fibrosis. Progressive glomerular and tubular injury leads to macroalbuminuria a progressive reduction in the glomerular filtration rate and eventually end-stage renal disease. Finerenone, a non-steroidal, selective mineralocorticoid receptor antagonist, is approved for treatment of patients with CKD associated with T2D; however, the benefit of finerenone in patients with T1D has yet to be determined. This narrative review will discuss treatment of CKD in T1D and the potential future role of finerenone in this setting.
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Affiliation(s)
| | - Samuel H Fantaye
- Division of Endocrinology, University of Texas Health, San Antonio, Texas, USA
| | - Sapna Raghunathan
- Division of Endocrinology, University of Texas Health, San Antonio, Texas, USA
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8
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Reinders EFH, de Vries R, Wouters-van Poppel PCM, Van Riel NAW, Haak HR. Serious digital games for diabetes Mellitus: A scoping review of its current State, Accessibility, and functionality for patients and healthcare providers. Diabetes Res Clin Pract 2024; 216:111833. [PMID: 39179114 DOI: 10.1016/j.diabres.2024.111833] [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: 03/22/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 08/26/2024]
Abstract
The global rise in diabetes prevalence poses a significant challenge to healthcare providers, stimulating interest in digital interventions such as educational games. However, the impact and availability of research-developed diabetes games remain uncertain. This scoping review aimed to provide a comprehensive overview of serious games for diabetes, encompassing their availability, characteristics and health effects. Through an electronic search in multiple databases, a total of 21 articles addressing 23 games were included in the literature review. The majority of these games were inaccessible outside of research settings, despite demonstrating positive effects on various aspects of diabetes management, including knowledge, physical activity, self-management, mental well-being, and HbA1c levels. Most games were designed for mobile phones, targeting both children and adults. A subsequent app store search revealed 13 additional diabetes games, however nearly none (7.7%) of these underwent research scrutiny, leaving their expected effects uncertain. The disparity between evidence-based games and those available in app stores underscores the need for bridging this gap to ensure the availability of effective digital games for diabetes management worldwide.
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Affiliation(s)
- Edouard F H Reinders
- Máxima MC, Department of Internal Medicine, Eindhoven/Veldhoven, the Netherlands; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Ryan de Vries
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Natal A W Van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Harm R Haak
- Máxima MC, Department of Internal Medicine, Eindhoven/Veldhoven, the Netherlands; Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
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9
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Gluvic Z, Obradovic M, Manojlovic M, Vincenza Giglio R, Maria Patti A, Ciaccio M, Suri JS, Rizzo M, Isenovic ER. Impact of different hormones on the regulation of nitric oxide in diabetes. Mol Cell Endocrinol 2024; 592:112325. [PMID: 38968968 DOI: 10.1016/j.mce.2024.112325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/10/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
Polymetabolic syndrome achieved pandemic proportions and dramatically influenced public health systems functioning worldwide. Chronic vascular complications are the major contributors to increased morbidity, disability, and mortality rates in diabetes patients. Nitric oxide (NO) is among the most important vascular bed function regulators. However, NO homeostasis is significantly deranged in pathological conditions. Additionally, different hormones directly or indirectly affect NO production and activity and subsequently act on vascular physiology. In this paper, we summarize the recent literature data related to the effects of insulin, estradiol, insulin-like growth factor-1, ghrelin, angiotensin II and irisin on the NO regulation in physiological and diabetes circumstances.
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Affiliation(s)
- Zoran Gluvic
- University Clinical-Hospital Centre Zemun-Belgrade, Clinic of Internal Medicine, Department of Endocrinology and Diabetes, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Milan Obradovic
- Department of Radiobiology and Molecular Genetics, VINČA Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Mia Manojlovic
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Rosaria Vincenza Giglio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy; Department of Laboratory Medicine, University Hospital, Palermo, Italy
| | - Angelo Maria Patti
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Marcello Ciaccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy; Department of Laboratory Medicine, University Hospital, Palermo, Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA
| | - Manfredi Rizzo
- Internal Medicine Unit, "Vittorio Emanuele II" Hospital, Castelvetrano, Italy
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, VINČA Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Eroukhmanoff J, Ballot Schmit C, Baron S, Bahloul A, Beltrand J, Salame Z, Borot S, Dalla Vale F, Mosnier Pudar H, Nicolino M, Penfornis A, Renard E. Transition from Paediatric to Adult Diabetes Care in People with Type 1 Diabetes: An Online Survey from France. Diabetes Ther 2024; 15:2211-2222. [PMID: 39126554 PMCID: PMC11411039 DOI: 10.1007/s13300-024-01630-6] [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: 04/22/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION The transition from paediatric to adult diabetes care (TPA) of children/adolescents with type 1 diabetes (T1D) represents a unique challenge and remains a critical phase in the T1D care pathway. This study aims to describe and understand the experience of the transition process from a participant's perspective in young adults who are living in France with T1D and to measure their satisfaction. METHODS An online questionnaire was presented to people with T1D in France on a global online participant community platform. The questionnaire was developed by a scientific committee including paediatric and adult diabetologists and refined by a group of participants. Thematic qualitative analysis was performed on the responses. RESULTS A total of 104 respondents were included in the survey (mean age 24.4 years [95% CI 23.8-25.0]; 61.5% female). The mean age at the time of transition was 18.4 years (95% CI 17.8-18.9), and 56% of respondents had their first adult diabetology follow-up in the same institution. During TPA, of the 76 participants who experienced personal issues, 74% experienced at least one issue with their diabetes management in the months following the transition. In the following months, 61% experienced new or unexpected problems in monitoring their diabetes after transition and 44% reported unusual glycaemic imbalances, including hypoglycaemia (8%) and hyperglycaemia (9%) requiring hospitalisation. Presence of personal issues during TPA was significantly associated with occurrence of problems with diabetes management or glycaemic imbalance. Three factors identified for a successful transition were (i) early meeting with the 'adult' diabetes care team, (ii) letting the participants choose the right age to leave paediatric clinic and (iii) having good diabetes control at the beginning of the TPA process. CONCLUSION Most young adults with T1D report experiencing issues around TPA with significant consequences on their disease management. Hence, it is necessary to identify these issues to better support them and improve diabetes management during this phase.
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Affiliation(s)
- Juliette Eroukhmanoff
- Department of Diabetology-Endocrinology, Hospital Center Sud Francilien (Centre Hospitalier Sud Francilien), Corbeil-Essonnes, France.
| | | | - Sabine Baron
- Paediatric Diabetology Department, University Hospital, Nantes, France
| | | | - Jacques Beltrand
- Department of Paediatric Endocrinology, Diabetology and Gynecology, Necker-Enfants Malades University Hospital, Public Assistance of Paris-Centre Hospitals, Paris, France
| | | | - Sophie Borot
- Department of Endocrinology, Diabetology and Nutrition, Besançon University Hospital, Besançon, France
| | - Fabienne Dalla Vale
- Paediatric Diabetology Unit, Arnaud De Villeneuve Hospital, Montpellier University Hospital, Saint-Pierre Institute, Palavas-les-Flots, France
| | | | - Marc Nicolino
- Paediatric Diabetology, University Hospital, Lyon, France
| | | | - Eric Renard
- Department of Endocrinology-Diabetology, Montpellier University Hospital, University of Montpellier, Montpellier, France
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11
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Tian Y, Jing G, Ma M, Yin R, Zhang M. Microglial activation and polarization in type 2 diabetes-related cognitive impairment: A focused review of pathogenesis. Neurosci Biobehav Rev 2024; 165:105848. [PMID: 39142542 DOI: 10.1016/j.neubiorev.2024.105848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/29/2024] [Accepted: 08/11/2024] [Indexed: 08/16/2024]
Abstract
Microglia, as immune cells in the central nervous system, are closely related to cognitive impairment associated with type 2 diabetes (T2D). Preliminary explorations have investigated the relationship between T2D-related cognitive impairment and the activation and polarization of microglia. This review summarizes the potential mechanisms of microglial activation and polarization in the context of T2D. It discusses central inflammatory responses, neuronal apoptosis, amyloid-β deposition, and abnormal phosphorylation of Tau protein mediated by microglial activation and polarization, exploring the connections between microglial activation and polarization and T2D-related cognitive impairment from multiple perspectives. Additionally, this review provides references for future treatment targeting microglia in T2D-related cognitive impairment and for clinical translation.
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Affiliation(s)
- Yue Tian
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Guangchan Jing
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mei Ma
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ruiying Yin
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mengren Zhang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
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12
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Tannus LRM, Pedrosa HC, Aguiar CH, Drummond KG, Pinheiro A, Leal FS, Negrato CA, Gomes MB. Prevalence of cardiovascular autonomic neuropathy in an admixed population of patients with type 1 diabetes. Lessons from a pioneer multicentre study in Brazil. Prim Care Diabetes 2024; 18:539-546. [PMID: 39152087 DOI: 10.1016/j.pcd.2024.08.001] [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: 07/12/2023] [Revised: 07/18/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024]
Abstract
AIMS To evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) and its associated factors in Brazilian patients with type 1 diabetes (T1D). METHODS This cross-sectional, multicentre study was conducted in 14 public clinics in ten Brazilian cities. From 1760 patients, 1712 were included (97.3 %): 953 females (55.7 %), 930 (54.3 %) Caucasians, aged 29.9 ±11.9 years and with diabetes duration of 15.4 ± 9.2 years. CAN was evaluated using cardiovascular autonomic reflex tests. RESULTS The prevalence of CAN was 23.4 %. Multivariable hierarchical logistic regression showed CAN associated with age, smoking, lower socioeconomic status, higher yearly medical appointments, insulin therapeutic regimens, higher levels of HbA1c, total cholesterol, uric acid, diastolic blood pressure and heart rate, presence of retinopathy, diabetic kidney disease and a tendency to be associated with severe hypoglycemia. Lower health-related quality of life was also found in univariate analysis in these patients. CONCLUSIONS Patients with T1D presented an important prevalence of CAN that was associated with other diabetes-related chronic complications, and also with demographic, clinical and laboratorial traditional risk factors. Considering lack of formal policy, our data could be used for guiding public health approach to awareness and CAN's screening, diagnosis and clinical management in patients with T1D in Brazil.
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Affiliation(s)
| | - Hermelinda Cordeiro Pedrosa
- Unit of Endocrinology of the Regional Hospital of Taguatinga and Research Center of the Foundation for Education and Research in Health Sciences, Secretariat of Health of the Federal District, Brasilia, Brazil
| | - Cejana Hamu Aguiar
- Unit of Endocrinology of the Regional Hospital of Taguatinga and Research Center of the Foundation for Education and Research in Health Sciences, Secretariat of Health of the Federal District, Brasilia, Brazil
| | - Karla Guerra Drummond
- Department of Ophthalmology, Sao Paulo Federal University, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, SP, Brazil
| | - André Pinheiro
- Department of Ophthalmology, Regional Hospital of Taguatinga, QNC, Área Especial nº 24 - Taguatinga Norte, Brasília, DF, Brazil
| | - Franz Schubert Leal
- Department of Ophthalmology, University of Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo, Brazil
| | - Carlos Antonio Negrato
- Medical Doctor Program, University of São Paulo, School of Dentistry, Bauru, São Paulo, Brazil
| | - Marilia Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Brazil
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13
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Zuniga-Kennedy M, Wang OH, Fonseca LM, Cleveland MJ, Bulger JD, Grinspoon E, Hansen D, Hawks ZW, Jung L, Singh S, Sliwinski M, Verdejo A, Miller KM, Weinstock RS, Germine L, Chaytor N. Nocturnal hypoglycemia is associated with next day cognitive performance in adults with type 1 diabetes: Pilot data from the GluCog study. Clin Neuropsychol 2024; 38:1627-1646. [PMID: 38380810 PMCID: PMC11336034 DOI: 10.1080/13854046.2024.2315749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Individuals with type 1 diabetes (T1D) have increased risk for cognitive dysfunction and high rates of sleep disturbance. Despite associations between glycemia and cognitive performance using cross-sectional and experimental methods few studies have evaluated this relationship in a naturalistic setting, or the impact of nocturnal versus daytime hypoglycemia. Ecological Momentary Assessment (EMA) may provide insight into the dynamic associations between cognition, affective, and physiological states. The current study couples EMA data with continuous glucose monitoring (CGM) to examine the within-person impact of nocturnal glycemia on next day cognitive performance in adults with T1D. Due to high rates of sleep disturbance and emotional distress in people with T1D, the potential impacts of sleep characteristics and negative affect were also evaluated. METHODS This pilot study utilized EMA in 18 adults with T1D to examine the impact of glycemic excursions, measured using CGM, on cognitive performance, measured via mobile cognitive assessment using the TestMyBrain platform. Multilevel modeling was used to test the within-person effects of nocturnal hypoglycemia and hyperglycemia on next day cognition. RESULTS Results indicated that increases in nocturnal hypoglycemia were associated with slower next day processing speed. This association was not significantly attenuated by negative affect, sleepiness, or sleep quality. CONCLUSIONS These results, while preliminary due to small sample size, showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive fluctuation in real world settings, an approach that may be utilized in other populations. Findings suggest reducing nocturnal hypoglycemia may improve cognition in adults with T1D.
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Affiliation(s)
| | - Olivia H Wang
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Luciana M. Fonseca
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Old Age Research Group (PROTER), Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Devon Hansen
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | - Shifali Singh
- McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | | | | | | | | | | | - Naomi Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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14
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Li J, Cui HL, Xie DD, Wang QY, Luo C, Tian L, Shi LK, Sheng ZF. Global and regional estimates of hip fracture burden associated with type 1 diabetes from 1990 to 2021. Diabetes Obes Metab 2024. [PMID: 39323371 DOI: 10.1111/dom.15970] [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: 06/20/2024] [Revised: 08/28/2024] [Accepted: 09/06/2024] [Indexed: 09/27/2024]
Abstract
AIM To assess the global and regional burden of hip fractures associated with type 1 diabetes (T1D) from 1990 to 2021. MATERIALS AND METHODS The population attributable fraction was calculated by combining the published risk ratio with T1D prevalence (age ≥ 20 years) from the Global Burden of Disease study to estimate the T1D-associated hip-fracture burden. Trends were assessed using the age-standardized incidence rate (ASIR) and estimated annual percentage change (EAPC). RESULTS The global incidence of T1D-related hip fractures was 290 180 in 2021 with an ASIR of 3.96 (95% confidence interval: 1.92-5.87) per 100 000 population and a male-to-female ratio of 0.54. At the super-regional level, the highest incidence (204 610) and ASIR (13.09 per 100 000 population; 6.40-25.53) were observed in high-income regions, in particular in Australasia and Western Europe. Notably, Australasia exhibited the highest EAPC, 2.90% in T1D-associated ASIR, followed by East Asia (2.73%). The incidence among those aged 45-64 years grew significantly in 14 regions over the past decade. Nationally, the ASIR increased in 166 countries from 1990 to 2021. CONCLUSIONS High-income regions experienced the greatest burden of T1D-associated hip fracture, while Australasia and East Asia witnessed the largest increase over the last 32 years. Prioritizing the promotion of T1D treatment and hip-fracture screening for middle-aged females living with T1D is crucial in these regions.
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Affiliation(s)
- Jing Li
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hao-Liang Cui
- School of Public Health, Peking University, Beijing, China
| | - Dan-Dan Xie
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
- School of Basic Medical Sciences and Life Sciences, Hainan Medical University, Haikou, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Qin-Yi Wang
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chuo Luo
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lin Tian
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lin-Ke Shi
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhi-Feng Sheng
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
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15
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Madhu SV, Shukla P, Kaur T, Dhaliwal RS. Mortality in type 1 diabetes mellitus: A single centre experience from the ICMR - Youth onset diabetes registry in India. Diabetes Res Clin Pract 2024:111868. [PMID: 39332535 DOI: 10.1016/j.diabres.2024.111868] [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: 05/16/2024] [Revised: 09/19/2024] [Accepted: 09/24/2024] [Indexed: 09/29/2024]
Abstract
INTRODUCTION The prevalence of youth onset diabetes is rising globally along with a greater burden of complications and mortality in them. The current study was undertaken to examine the mortality and causes of death in patients with youth onset diabetesregistered in a tertiary care hospital in North India. METHODS We analyzed mortality and causes of death in 1088 patients with youth onset diabetes registered from 2006 to 2019 at University College of Medical Sciences, Delhi. Information of death was obtained telephonically or by home visit or from hospital records wherever available. Verbal autopsy according to ICMR questionnaire was performed and cause of death determined as per WHO ICD-10/11. RESULTS Among 898 youth onset type 1 diabetes mellitus (T1D) patients who had a mean follow up of 6.4 years, 105 deaths (11.6 %) occurred. Forty three percent of deaths had diabetes onset at 15 years or below, and 75.6 % had HbA1C > 10 %. Deaths occurred in 24.2 % within 2 years and in 53.6 % within 3 years of diagnosis. Chronic Kidney disease, infections and ketoacidosis were the commonest causes. CONCLUSION We found poor glycaemic control and high mortality in people with youth onset T1D being treated at a tertiary care hospital in north India.
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Affiliation(s)
- S V Madhu
- Department of Endocrinology, University College of Medical Sciences, Delhi, India.
| | - P Shukla
- Department of Endocrinology, University College of Medical Sciences, Delhi, India
| | - T Kaur
- Division of Non Communicable Diseases, Indian Council of Medical Research, Delhi, India
| | - R S Dhaliwal
- Division of Non Communicable Diseases, Indian Council of Medical Research, Delhi, India
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16
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Collins J, Barra JM, Holcomb K, Ocampo A, Fremin A, Kratz A, Akolade J, Hays JK, Shilleh A, Sela A, Hodson DJ, Broichhagen J, Russ HA, Farnsworth NL. Peptide-Coated Polycaprolactone-Benzalkonium Chloride Nanocapsules for Targeted Drug Delivery to the Pancreatic β-Cell. ACS APPLIED BIO MATERIALS 2024. [PMID: 39315885 DOI: 10.1021/acsabm.4c00621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Targeting current therapies to treat or prevent the loss of pancreatic islet β-cells in Type 1 Diabetes (T1D) may provide improved efficacy and reduce off-target effects. Current efforts to target the β-cell are limited by a lack of β-cell-specific targets and the inability to test multiple targeting moieties with the same delivery vehicle. Here, we fabricate a tailorable polycaprolactone nanocapsule (NC) in which multiple different targeting peptides can be interchangeably attached for β-cell-specific delivery. Incorporation of a cationic surfactant in the NC shell allows for the attachment of Exendin-4 and an antibody for ectonucleoside triphosphate diphosphohydrolase 3 (ENTPD3) for β-cell-specific targeting. The average NC size ranges from 250 to 300 nm with a polydispersity index under 0.2. The NCs are nontoxic, stable in media culture, and can be lyophilized and reconstituted. NCs coated with a targeting peptide were taken up by human cadaveric islet β-cells and human stem cell-derived β-like cells (sBC) in vitro with a high level of specificity. Furthermore, NCs successfully delivered both hydrophobic and hydrophilic cargo to human β-cells. Additionally, Exendin-4-coated NCs were stable and targeted the mouse pancreatic islet β-cell in vivo. Overall, our tailorable NCs have the potential to improve cell-targeted drug delivery and can be utilized as a screening platform to test the efficacy of cell-targeting peptides.
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Affiliation(s)
- Jillian Collins
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, Colorado 80401, United States
| | - Jessie M Barra
- Depart of Pharmacology and Therapeutics, Diabetes Institute, University of Florida, Gainesville, Florida 32610, United States
| | - Keifer Holcomb
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, Colorado 80401, United States
| | - Andres Ocampo
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, Colorado 80401, United States
| | - Ashton Fremin
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, Colorado 80401, United States
| | - Austin Kratz
- Depart of Pharmacology and Therapeutics, Diabetes Institute, University of Florida, Gainesville, Florida 32610, United States
| | - Jubril Akolade
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, Colorado 80401, United States
| | - Julianna K Hays
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, Colorado 80401, United States
| | - Ali Shilleh
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, Churchill Hospital, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Amit Sela
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, Colorado 80401, United States
| | - David J Hodson
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, Churchill Hospital, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Johannes Broichhagen
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie, Robert-Roessle-Str. 10, Berlin 13125, Germany
| | - Holger A Russ
- Depart of Pharmacology and Therapeutics, Diabetes Institute, University of Florida, Gainesville, Florida 32610, United States
| | - Nikki L Farnsworth
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, Colorado 80401, United States
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17
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Virtanen SM, Peltonen EJ, Hakola L, Niinistö S, Takkinen HM, Ahonen S, Åkerlund M, Uusitalo U, Mattila M, Salo TEI, Ilonen J, Toppari J, Veijola R, Knip M, Nevalainen J. Food Consumption and Risk of Islet Autoimmunity and Type 1 Diabetes in Children at Increased Genetic Susceptibility for Type 1 Diabetes. J Nutr 2024:S0022-3166(24)01035-6. [PMID: 39313195 DOI: 10.1016/j.tjnut.2024.09.018] [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: 07/16/2024] [Revised: 08/28/2024] [Accepted: 09/18/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Prospective longitudinal evidence considering the entire childhood food consumption in relation to development of islet autoimmunity (IA or) type 1 diabetes is lacking. OBJECTIVES We studied the associations of consumption of various foods and their combinations with IA and type 1 diabetes risk. METHODS Children with genetic susceptibility to type 1 diabetes born in 1996-2004 were followed from birth up to 6 years of age in the prospective birth cohort Type 1 Diabetes Prediction and Prevention Study (n=5674). Exposure variables included 34 food groups covering the entire diet based on repeated 3-day food records at age 3 months to 6 years. Endpoints were islet cell antibodies (ICA) plus biochemical IA (n=247), multiple biochemical IA (n=206), and type 1 diabetes (n=94). We analyzed associations between longitudinally observed foods and the risk of IA/type 1 diabetes using a Bayesian approach to joint models in one-food and multi-food models adjusted for energy intake, sex, human leukocyte antigen (HLA) genotype, and familial diabetes. RESULTS The final multi-food model for ICA plus biochemical IA included oats [hazard ratio (HR) 1.09, 95% credible interval (CI) 1.04-1.14], banana (HR 1.07, 95% CI 1.03-1.11), and cruciferous vegetables (HR 0.83, 95% CI 0.73-0.94). The final model for multiple biochemical IA included, in addition to above-mentioned foods, fermented dairy (HR 1.42, 95% CI 1.12-1.78) and wheat (HR 1.10, 95% CI 1.03-1.18). The final multi-food model for type 1 diabetes included rye (HR 1.27, 95% CI 1.07-1.50), oats (HR 1.15, 95% CI 1.03-1.26), fruits (HR 1.05, 95% CI 1.01-1.09), and berries (HR 0.67, 95% CI 0.50-0.93). CONCLUSIONS Higher consumption of oats, gluten-containing cereals, and fruits was associated with increased and that of cruciferous vegetables with decreased risk of several type 1 diabetes related endpoints when considering all the foods in combination. Further etiological and mechanistic studies are warranted.
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Affiliation(s)
- Suvi M Virtanen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Wellbeing Services County of Pirkanmaa; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Essi J Peltonen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Wellbeing Services County of Pirkanmaa
| | - Leena Hakola
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Wellbeing Services County of Pirkanmaa; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sari Niinistö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna-Mari Takkinen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Wellbeing Services County of Pirkanmaa; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Suvi Ahonen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Wellbeing Services County of Pirkanmaa; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mari Åkerlund
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Wellbeing Services County of Pirkanmaa; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ulla Uusitalo
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Markus Mattila
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Tampere University Hospital, Wellbeing Services County of Pirkanmaa; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuuli E I Salo
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Centre for Population Health Research, University of Turku, Turku, Finland; Turku University Hospital, Department of Pediatrics, Turku, Finland
| | - Riitta Veijola
- Department of Paediatrics, Research Unit of Clinical Medicine, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Mikael Knip
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Tampere University Hospital, Department of Pediatrics, Tampere, Finland
| | - Jaakko Nevalainen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
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18
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Tomaszewska E, Dobrowolski P, Muszyński S, Donaldson J, Gołyński M, Zwolska J, Szadkowski M, Osęka M, Mielnik-Błaszczak M, Balicki I. Longitudinal Analysis of Bone Metabolic Markers and Bone Mechanical Properties in STZ-Induced Diabetic Rats. J Clin Med 2024; 13:5595. [PMID: 39337082 PMCID: PMC11433195 DOI: 10.3390/jcm13185595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Background: This longitudinal study examined the early effects of type 1 diabetes on bone mechanical properties and metabolic markers in mature rats, focusing on the natural progression of diabetes-induced changes without external treatments. Methods: Forty-eight 8-month-old male Wistar rats were divided into two groups, with one group receiving a single dose of streptozotocin (STZ, 60 mg/kg). Assessments were performed 2, 4, and 8 weeks post-administration, including serum biochemical analyses, bone marker assessments, and mechanical bone tests. The data were analyzed using two-way ANOVA to evaluate the impact of time and treatment. Results: At 2 weeks, diabetic rats showed increased fasting blood glucose (p < 0.001), decreased insulin levels (p = 0.03), and changes in HOMA markers (p < 0.001), liver enzymes (p < 0.001), inflammatory markers (p < 0.001), and bone metabolism markers (osteocalcin (p < 0.001), OPG (p = 0.006), RANKL (p < 0.001), and OPG/RANKL ratio (p < 0.001)), with initial alterations in bone geometry. By week 4, decreased body weight in the diabetic group (p < 0.001) led to further changes in bone geometry and initial differences in mechanical properties. At 8 weeks, significant declines in body (p < 0.001) and bone (p < 0.001) weights were observed, along with further deterioration in bone geometry and mechanical properties. Conclusions: The study highlights the significant impact of STZ-induced diabetes on bone health as early as two weeks post-STZ administration, with marked temporal changes in biochemical markers and mechanical properties.
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Affiliation(s)
- Ewa Tomaszewska
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Piotr Dobrowolski
- Department of Functional Anatomy and Cytobiology, Institute of Biology, Maria Curie Sklodowska University, 20-033 Lublin, Poland
| | - Siemowit Muszyński
- Department of Biophysics, Faculty of Environmental Biology, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Janine Donaldson
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa
| | - Marcin Gołyński
- Veterinary Medicine Institute, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland
| | - Jowita Zwolska
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Mateusz Szadkowski
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Maciej Osęka
- Hospital Emergency Ward, Specialist Hospital Miedzylesie, 04-749 Warsaw, Poland
| | - Maria Mielnik-Błaszczak
- Chair and Department of Developmental Dentistry, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ireneusz Balicki
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-950 Lublin, Poland
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19
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Rao C, Cater DT, Roy S, Xu J, Olivera ADG, Evans-Molina C, Piganelli JD, Eizirik DL, Mirmira RG, Sims EK. Beta cell extracellular vesicle PD-L1 as a novel regulator of CD8+ T cell activity and biomarker during the evolution of Type 1 Diabetes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.18.613649. [PMID: 39345410 PMCID: PMC11429676 DOI: 10.1101/2024.09.18.613649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Aims/hypothesis Surviving beta cells in type 1 diabetes respond to inflammation by upregulating programmed death-ligand 1 (PD-L1) to engage immune cell programmed death-1 (PD-1) and limit destruction by self-reactive immune cells. Extracellular vesicles (EVs) and their cargo can serve as biomarkers of beta cell health and contribute to islet intercellular communication. We hypothesized that the inflammatory milieu of type 1 diabetes increases PD-L1 in beta cell EV cargo and that EV PD-L1 may protect beta cells against immune-mediated cell death. Methods Beta cell lines and human islets were treated with proinflammatory cytokines to model the proinflammatory type 1 diabetes microenvironment. EVs were isolated using ultracentrifugation or size exclusion chromatography and analysed via immunoblot, flow cytometry, and ELISA. EV PD-L1: PD-1 binding was assessed using a competitive binding assay and in vitro functional assays testing the ability of EV PD-L1 to inhibit NOD CD8 T cells. Plasma EV and soluble PD-L1 were assayed in plasma of individuals with islet autoantibody positivity (Ab+) or recent-onset type 1 diabetes and compared to non-diabetic controls. Results PD-L1 protein colocalized with tetraspanin-associated proteins intracellularly and was detected on the surface of beta cell EVs. 24-h IFN-α or IFN-□ treatment induced a two-fold increase in EV PD-L1 cargo without a corresponding increase in number of EVs. IFN exposure predominantly increased PD-L1 expression on the surface of beta cell EVs and beta cell EV PD-L1 showed a dose-dependent capacity to bind PD-1. Functional experiments demonstrated specific effects of beta cell EV PD-L1 to suppress proliferation and cytotoxicity of murine CD8 T cells. Plasma EV PD-L1 levels were increased in islet Ab+ individuals, particularly in those with single Ab+, Additionally, in from individuals with either Ab+ or type 1 diabetes, but not in controls, plasma EV PD-L1 positively correlated with circulating C-peptide, suggesting that higher EV-PD-L1 could be protective for residual beta cell function. Conclusions/interpretation IFN exposure increases PD-L1 on the beta cell EV surface. Beta cell EV PD-L1 binds PD1 and inhibits CD8 T cell proliferation and cytotoxicity. Circulating EV PD-L1 is higher in islet autoantibody positive patients compared to controls. Circulating EV PD-L1 levels correlate with residual C-peptide at different stages in type 1 diabetes progression. These findings suggest that EV PD-L1 could contribute to heterogeneity in type 1 diabetes progression and residual beta cell function and raise the possibility that EV PD-L1 could be exploited as a means to inhibit immune-mediated beta cell death. Research in context What is already known about this subject? (maximum of 3 bullet points): Extracellular vesicles (EVs) serve as paracrine effectors in the islet microenvironment in health and disease.Interferon-alpha (IFN-α) and IFN-gamma (IFN-□) are key cytokines contributing to type 1 diabetes pathophysiology and islet IFN signalling increases beta cell programmed death-ligand 1 (PD-L1) expression.Up-regulation of beta cell PD-L1 in the non-obese diabetic (NOD) mouse model delays progression of type 1 diabetes.What is the key question? (one bullet point only; formatted as a question): Do beta cells exposed to IFNs upregulate EV PD-L1 and can these changes be detected in circulation?What are the new findings? (maximum of 3 bullet points): IFN-α or IFN-□ exposure increases beta cell EV PD-L1 cargo in beta cell lines and human islets.PD-L1 is present on the surface of beta cell EVs, binds PD-1 and EV PD-L1 inhibits proliferation, activation and cytotoxicity of murine CD8 T cells.EV PD-L1 levels are higher in islet autoantibody positive individuals compared to nondiabetic controls and levels of circulating EV PD-L1 positively correlate with residual beta cell function in islet autoantibody positive individuals as well as in individuals with recent-onset type 1 diabetes.How might this impact on clinical practice in the foreseeable future? (one bullet point only): A beneficial effect of PD-L1+ EVs could ultimately be harnessed as an intervention to prevent autoimmune beta cell destruction. Circulating EV PD-L1 cargo has potential as a minimally invasive and informative biomarker to offer insights into the pathogenesis and progression of type 1 diabetes.
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Silfer JL, Tonyushkina KN. Global trends in type 1 diabetes in adolescents and young adults (1990-2019). Pediatr Res 2024:10.1038/s41390-024-03554-0. [PMID: 39294242 DOI: 10.1038/s41390-024-03554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 08/22/2024] [Accepted: 08/27/2024] [Indexed: 09/20/2024]
Affiliation(s)
| | - Ksenia N Tonyushkina
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Rainbow Babies and Children's Hospital/CWRU School of Medicine, Cleveland, OH, USA.
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Qi L, Wang Z, Huang X, Gao X. Biological function of type 1 regulatory cells and their role in type 1 diabetes. Heliyon 2024; 10:e36524. [PMID: 39286070 PMCID: PMC11402939 DOI: 10.1016/j.heliyon.2024.e36524] [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: 06/28/2024] [Revised: 08/12/2024] [Accepted: 08/18/2024] [Indexed: 09/19/2024] Open
Abstract
The collapse of immune homeostasis induces type 1 diabetes (T1D). In T1D, uncontrolled immune attacks against islet β cells reduce insulin secretion, resulting in hyperglycaemia and various complications. Type 1 regulatory (Tr1) cell therapy is a promising approach for the treatment of T1D. Tr1 cells are a subset of regulatory T (Treg) cells that are characterised by high interleukin-10 secretion and forkhead box protein P3 non-expression. Tr1 cells are reduced and have impaired function in patients with T1D. Immunotherapy is used to treat various diseases, and Treg cells have been applied to treat T1D in animal models and clinical trials. However, the safety and efficacy of Tr1 cells in treating diabetes and other diseases remain unclear. In this review, we aim to investigate the identification and biological function of Tr1 cells and related studies on immune diseases; additionally, we discuss the feasibility, limitations, and possible solutions of Tr1 cell therapy in T1D. This review shows that T1D is caused by an immune imbalance where defective Tr1 cells fail to control effector T cells, leading to the destruction of islet β cells. However, Tr1 cell therapy is safe and effective for other immune diseases, suggesting its potential for treating T1D.
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Affiliation(s)
- Lingli Qi
- Department of Gastroenterology, Children's Medical Center, The First Hospital of Jilin University, China
| | - Zhichao Wang
- Department of Surgery, Children's Medical Center, The First Hospital of Jilin University, China
| | - Xinxing Huang
- Department of Gastroenterology, Children's Medical Center, The First Hospital of Jilin University, China
| | - Xiuzhu Gao
- Department of Public Laboratory Platform, The First Hospital of Jilin University, Changchun, China
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22
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Su J, Zhang Y. Risk factors of osteoporosis in postmenopausal Chinese type 2 diabetes patients: A meta-analysis. Asian J Surg 2024:S1015-9584(24)01994-8. [PMID: 39271328 DOI: 10.1016/j.asjsur.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Affiliation(s)
- Jiazi Su
- School of Medicine, Henan Polytechnic University, Jiaozuo, China.
| | - Yanru Zhang
- School of Medicine, Henan Polytechnic University, Jiaozuo, China.
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Koo DJ, Moon SJ, Moon S, Park SE, Rhee EJ, Lee WY, Park CY. Long-Term Glycemic Control Improvement After the Home and Self-Care Program for Patients With Type 1 Diabetes: Real-World-Based Cohort Study. J Med Internet Res 2024; 26:e60023. [PMID: 39259960 PMCID: PMC11425018 DOI: 10.2196/60023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/09/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND The prevalence of type 1 diabetes (T1D) is increasing worldwide, with a much higher proportion of adult patients. However, achieving stable glycemic control is difficult in these patients. OBJECTIVE After periodic implementation of structured education for patients with T1D through the Home and Self-Care Program, a pilot home health care project promoted by the Korean government, we evaluated the program's effects on glycemic control. METHODS This study was conducted from April 2020 to March 2023. We analyzed 119 participants with T1D aged >15 years. Nursing and nutrition education were provided separately up to 4 times per year, with physician consultation up to 6 times per year. A distinguishing feature of this study compared with previous ones was the provision of remote support using a general-purpose smartphone communication app offered up to 12 times annually on an as-needed basis to enhance the continuity of in-person education effects. Patients were followed up on at average intervals of 3 months for up to 24 months. The primary end point was the mean difference in glycated hemoglobin (HbA1c) at each follow-up visit from baseline. For continuous glucose monitoring (CGM) users, CGM metrics were also evaluated. RESULTS The mean HbA1c level of study participants was 8.6% at baseline (mean duration of T1D 10.02, SD 16.10 y). The HbA1c level reduction in participants who received at least 1 structured educational session went from 1.63% (SD 2.03%; P<.001; adjustment model=1.69%, 95% CI 1.24%-2.13% at the first follow-up visit) to 1.23% (SD 1.31%; P=.01; adjustment model=1.28%, 95% CI 0.78%-1.79% at the eighth follow-up visit). In the adjustment model, the actual mean HbA1c values were maintained between a minimum of 7.33% (95% CI 7.20%-7.46% at the first follow-up visit) and a maximum of 7.62% (95% CI 7.41%-7.82% at the sixth follow-up visit). Among CGM users, after at least 1 session, the mean time in the target range was maintained between 61.59% (adjusted model, 95% CI 58.14%-65.03% at the second follow-up visit) and 54.7% (95% CI 50.92%-58.48% at the eighth follow-up visit), consistently staying above 54.7% (corresponding to an HbA1c level of <7.6%). The mean time below the target range (TBR) also gradually improved to the recommended range (≤4% for TBR of <70 mg/dL and ≤1% for TBR of <54 mg/dL). CONCLUSIONS The Home and Self-Care Program protocol for glycemic control in patients with T1D is effective, producing significant improvement immediately and long-term maintenance effects, including on CGM indexes.
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Affiliation(s)
- Dae-Jeong Koo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Republic of Korea
| | - Sun-Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suhyeon Moon
- Division of Biostatistics, Department of Academic Research, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ayis S, Mangelis A, Fountoulakis N, Collins J, Alobaid TS, Gnudi L, Hopkins D, Vas P, Thomas S, Goubar A, Karalliedde J. Ten years trajectories of estimated glomerular filtration rate (eGFR) in a multiethnic cohort of people with type 1 diabetes and preserved renal function. BMJ Open 2024; 14:e083186. [PMID: 39260863 PMCID: PMC11409247 DOI: 10.1136/bmjopen-2023-083186] [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] [Indexed: 09/13/2024] Open
Abstract
OBJECTIVES We aim to evaluate estimated glomerular filtration rate (eGFR) patterns of progression in a multiethnic cohort of people with type I diabetes mellitus and with baseline eGFR ≥45 mL/min/1.73 m2. DESIGN Observational cohort. SETTING People with a clinical diagnosis of type 1 diabetes, attending two university hospital-based outpatient diabetes clinics, in South London between 2004 and 2018. PARTICIPANTS We studied 1495 participants (52% females, 81% white, 12% African-Caribbean and 7% others). PRIMARY AND SECONDARY OUTCOME MEASURES Clinical measures including weight and height, systolic blood pressure, diastolic blood pressure and laboratory results (such as serum creatinine, urine albumin to creatinine ratio (ACR), HbA1c were collected from electronic health records (EHRs) and eGFR was estimated by the Chronic Kidney Disease-Epidemiology Collaboration. Ethnicity was self-reported. RESULTS Five predominantly linear patterns/groups of eGFR trajectories were identified. Group I (8.5%) had a fast eGFR decline (>3 mL/min/1.73 m2 year). Group II (23%) stable eGFR, group III (29.8%), groups IV (26.3%) and V (12.4%) have preserved eGFR with no significant fall. Group I had the highest proportion (27.6%) of African-Caribbeans. Significant differences between group I and the other groups were observed in age, gender, HbA1C, systolic and diastolic blood pressure, body mass index, cholesterol and urine ACR, p<0.05 for all. At 10 years of follow-up, 33% of group I had eGFR <30 and 16.5%<15 (mL/min/1.73 m2). CONCLUSIONS Distinct trajectories of eGFR were observed in people with type 1 diabetes. The group with the highest risk of eGFR decline had a greater proportion of African-Caribbeans compared with others and has higher prevalence of traditional modifiable risk factors for kidney disease.
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Affiliation(s)
- Salma Ayis
- Population Health Sciences, King's College London, London, UK
| | | | - Nikolaos Fountoulakis
- King's Health Partners and School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Julian Collins
- King's College Hospital NHS Trust, King's College London, London, UK
| | | | - Luigi Gnudi
- King's Health Partners and King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular & Metabolic Medicine and Sciences, King's College London, London, UK
| | - David Hopkins
- King's College Hospital NHS Foundation Trust / King's Health Partners, King's College London, London, UK
| | - Prashanth Vas
- Diabetes and Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen Thomas
- Guy's and St Thomas' NHS Trust, King's Health Partners, London, UK
| | - Aicha Goubar
- Population Health Sciences, King's College London, London, UK
| | - Janaka Karalliedde
- King's Health Partners and King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular & Metabolic Medicine and Sciences, King's College London, London, UK
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Nóvoa-Medina Y, Marcelino-Rodriguez I, Suárez NM, Barreiro-Bautista M, Rivas-García E, Sánchez-Alonso S, González-Martínez G, Quinteiro-González S, Domínguez Á, Cabrera M, López S, Pavlovic S, Flores C, Wägner AM. Does HLA explain the high incidence of childhood-onset type 1 diabetes in the Canary Islands? The role of Asp57 DQB1 molecules. BMC Pediatr 2024; 24:569. [PMID: 39243072 PMCID: PMC11378579 DOI: 10.1186/s12887-024-04983-w] [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: 03/16/2024] [Accepted: 07/29/2024] [Indexed: 09/09/2024] Open
Abstract
The Canary Islands inhabitants, a recently admixed population with significant North African genetic influence, has the highest incidence of childhood-onset type 1 diabetes (T1D) in Spain and one of the highest in Europe. HLA accounts for half of the genetic risk of T1D. AIMS To characterize the classical HLA-DRB1 and HLA-DQB1 alleles in children from Gran Canaria with and without T1D. METHODS We analyzed classic HLA-DRB1 and HLA-DQB1 alleles in childhood-onset T1D patients (n = 309) and control children without T1D (n = 222) from the island of Gran Canaria. We also analyzed the presence or absence of aspartic acid at position 57 in the HLA-DQB1 gene and arginine at position 52 in the HLA-DQA1 gene. Genotyping of classical HLA-DQB1 and HLA-DRB1 alleles was performed at two-digit resolution using Luminex technology. The chi-square test (or Fisher's exact test) and odds ratio (OR) were computed to assess differences in allele and genotype frequencies between patients and controls. Logistic regression analysis was also used. RESULTS Mean age at diagnosis of T1D was 7.4 ± 3.6 years (46% female). Mean age of the controls was 7.6 ± 1.1 years (55% female). DRB1*03 (OR = 4.2; p = 2.13-13), DRB1*04 (OR = 6.6; p ≤ 2.00-16), DRB1* 07 (OR = 0.37; p = 9.73-06), DRB1*11 (OR = 0.17; p = 6.72-09), DRB1*12, DRB1*13 (OR = 0.38; p = 1.21-05), DRB1*14 (OR = 0.0; p = 0.0024), DRB1*15 (OR = 0.13; p = 7.78-07) and DRB1*16 (OR = 0.21; p = 0.003) exhibited significant differences in frequency between groups. Among the DQB1* alleles, DQB1*02 (OR: 2.3; p = 5.13-06), DQB1*03 (OR = 1.7; p = 1.89-03), DQB1*05 (OR = 0.64; p = 0.027) and DQB1*06 (OR = 0.19; p = 6.25-14) exhibited significant differences. A total of 58% of the studied HLA-DQB1 genes in our control population lacked aspartic acid at position 57. CONCLUSIONS In this population, the overall distributions of the HLA-DRB1 and HLA-DQB1 alleles are similar to those in other European populations. However, the frequency of the non-Asp-57 HLA-DQB1 molecules is greater than that in other populations with a lower incidence of T1D. Based on genetic, historical and epidemiological data, we propose that a common genetic background might help explain the elevated pediatric T1D incidence in the Canary Islands, North-Africa and middle eastern countries.
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Affiliation(s)
- Yeray Nóvoa-Medina
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
- Asociación Canaria para la Investigación Pediátrica (ACIP canarias), Las Palmas, Spain.
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias de la Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Itahisa Marcelino-Rodriguez
- Preventive Medicine and Public Health Area, University of La Laguna, Santa Cruz de Tenerife, Spain
- Institute of Biomedical Technologies, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Nicolás M Suárez
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias de la Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marta Barreiro-Bautista
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias de la Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva Rivas-García
- Servicio de Inmunología, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Santiago Sánchez-Alonso
- Servicio de Inmunología, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Gema González-Martínez
- Servicio de Inmunología, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sofía Quinteiro-González
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ángela Domínguez
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - María Cabrera
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara López
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Svetlana Pavlovic
- Servicio de Pediatría Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carlos Flores
- Institute of Biomedical Technologies, University of La Laguna, Santa Cruz de Tenerife, Spain
- Genomics Division, Instituto Tecnológico y de Energías Renovables (ITER), Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Fernando de Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Ana M Wägner
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias de la Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Bombaci B, Torre A, Longo A, Pecoraro M, Papa M, Sorrenti L, La Rocca M, Lombardo F, Salzano G. Psychological and Clinical Challenges in the Management of Type 1 Diabetes during Adolescence: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1085. [PMID: 39334618 PMCID: PMC11430186 DOI: 10.3390/children11091085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/22/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024]
Abstract
Adolescence, a critical period of physical and psychological development, presents unique challenges in type 1 diabetes (T1D) management due to endocrinological changes, reduced therapeutic adherence, and elevated susceptibility to psychological issues such as depression, anxiety, and eating disorders. This narrative review explores the impact of psychological and behavioral factors on glycemic control in adolescents with T1D. We examine the prevalence and influence of mental health disorders, lifestyle factors, harmful behaviors, and social dynamics on diabetes management and glycemic outcomes. Strategies for improving metabolic control are also reviewed, including cognitive behavioral therapy, technological devices, and educational interventions. The importance of tailored psychological support, family involvement, and targeted interventions to improve adherence to treatment and glycemic control in adolescents with T1D should be emphasized.
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Affiliation(s)
- Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Arianna Torre
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Alessandro Longo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Maria Pecoraro
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Mattia Papa
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Lacrima Sorrenti
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Mariarosaria La Rocca
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98122 Messina, Italy; (A.T.); (M.P.); (M.P.); (L.S.); (M.L.R.); (F.L.); (G.S.)
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Semenova JF, Yushin AY, Korbut AI, Klimontov VV. Glucose Variability in People with Type 1 Diabetes: Associations with Body Weight, Body Composition, and Insulin Sensitivity. Biomedicines 2024; 12:2006. [PMID: 39335526 PMCID: PMC11428493 DOI: 10.3390/biomedicines12092006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/18/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
The prevalence of overweight and obesity increases in people with type 1 diabetes (T1D). However, the impact of fat accumulation on glucose dynamics in T1D is poorly understood. We assessed continuous glucose monitoring (CGM) parameters in patients with T1D depending on their body weight, body composition, and insulin sensitivity. In 547 patients, including 238 overweight/obese individuals, CGM-derived time in range (TIR) and glucose variability (GV) were estimated. Body composition was assessed by DXA. Estimated glucose disposal rate (eGDR) was used as an indicator of insulin sensitivity. Overweight/obese patients, when compared to normal-weight ones, have a lower time below range (TBR) (<3 mmol/L), GV, and experienced fewer episodes of low glucose. In men, lower TIR, higher time above range (TAR), and GV reduction were associated with central adiposity assessed by total, trunk, and android fat mass. In women, gynoid fat mass only was associated with a lower TIR and higher TAR. The eGDR was a positive predictor of TIR and a negative predictor of TAR, TBR, and GV in men and women. In conclusion, adiposity in people with T1D is associated with a lower risk of CGM-confirmed hypoglycemia, higher TAR, and reduced GV. These features of daily glucose dynamics may be mediated by insulin resistance.
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Affiliation(s)
| | | | | | - Vadim V. Klimontov
- Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia; (J.F.S.); (A.Y.Y.); (A.I.K.)
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Rubin-Falcone H, Lee JM, Wiens J. Learning control-ready forecasters for Blood Glucose Management. Comput Biol Med 2024; 180:108995. [PMID: 39126789 PMCID: PMC11426357 DOI: 10.1016/j.compbiomed.2024.108995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Type 1 diabetes (T1D) presents a significant health challenge, requiring patients to actively manage their blood glucose (BG) levels through regular bolus insulin administration. Automated control solutions based on machine learning (ML) models could reduce the need for manual patient intervention. However, the accuracy of current models falls short of what is needed. This is due in part to the fact that these models are often trained on data collected using a basal bolus (BB) strategy, which results in substantial entanglement between bolus insulin and carbohydrate intake. Under standard training approaches, this entanglement can lead to inaccurate forecasts in a control setting, ultimately resulting in poor BG management. To address this, we propose a novel algorithm for training BG forecasters that disentangles the effects of insulin and carbohydrates. By exploiting correction bolus values and leveraging the monotonic effect of insulin on BG, our method accurately captures the independent effects of insulin and carbohydrates on BG. Using an FDA-approved simulator, we evaluated our approach on 10 individuals across 30 days of data. Our approach achieved on average higher time in range compared to standard approaches (81.1% [95% confidence interval (CI) 80.3,81.9] vs 53.6% [95%CI 52.7,54.6], p<0.001), indicating that our approach is able to reliably maintain healthy BG levels in simulated individuals, while baseline approaches are not. Utilizing proxy metrics, our approach also demonstrates potential for improved control on three real world datasets, paving the way for advancements in ML-based BG management.
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Affiliation(s)
- Harry Rubin-Falcone
- Division of Computer Science and Engineering, University of Michigan, 2260 Hayward St, Ann Arbor, 48109, MI, USA.
| | - Joyce M Lee
- Division of Pediatric Endocrinology, University of Michigan, 1540 E Hospital Dr, Ann Arbor, 48109, MI, USA
| | - Jenna Wiens
- Division of Computer Science and Engineering, University of Michigan, 2260 Hayward St, Ann Arbor, 48109, MI, USA
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Somolinos-Simón FJ, García-Sáez G, Tapia-Galisteo J, Corcoy R, Elena Hernando M. Cluster analysis of adult individuals with type 1 diabetes: Treatment pathways and complications over a five-year follow-up period. Diabetes Res Clin Pract 2024; 215:111803. [PMID: 39089589 DOI: 10.1016/j.diabres.2024.111803] [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: 02/23/2024] [Revised: 06/14/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
AIMS To identify subgroups of adults with type 1 diabetes and analyse their treatment pathways and risk of diabetes-related complications over a 5-year follow-up. METHODS We performed a k-means cluster analysis using the T1DExchange Registry (n = 6,302) to identify subgroups based on demographic and clinical characteristics. Annual reassessments linked treatment trajectories with these clusters, considering drug and technology use. Complication risks were analysed using Cox regression. RESULTS Five clusters were identified: 1) A favourable combination of all variables (31.67 %); 2) Longer diabetes duration (22.63 %); 3) Higher HbA1c levels (13.28 %); 4) Higher BMI (15.25 %); 5) Older age at diagnosis (17.17 %). Two-thirds of patients remained in their initial cluster annually. Technology adoption showed improved glycaemic control over time. Cox proportional hazards showed different risk patterns: Cluster 1 had low complication risk; Cluster 2 had the highest risk for retinopathy, coronary artery disease and autonomic neuropathy; Cluster 3 had the highest risk for albuminuria, depression and diabetic ketoacidosis; Cluster 4 had increased risk for multiple complications; Cluster 5 had the highest risk for hypertension and severe hypoglycaemia, with elevated coronary artery disease risk. CONCLUSIONS Clinical characteristics can identify subgroups of patients with T1DM showing differences in treatment and complications during follow-up.
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Affiliation(s)
- Francisco J Somolinos-Simón
- Centre for Biomedical Technology (CTB), ETSI de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Gema García-Sáez
- Centre for Biomedical Technology (CTB), ETSI de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; CIBER-BBN, ISCIII, Madrid, Spain.
| | - Jose Tapia-Galisteo
- Centre for Biomedical Technology (CTB), ETSI de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; CIBER-BBN, ISCIII, Madrid, Spain
| | - Rosa Corcoy
- CIBER-BBN, ISCIII, Madrid, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Institut de Recerca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Elena Hernando
- Centre for Biomedical Technology (CTB), ETSI de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; CIBER-BBN, ISCIII, Madrid, Spain
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30
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Phillip M, Achenbach P, Addala A, Albanese-O'Neill A, Battelino T, Bell KJ, Besser REJ, Bonifacio E, Colhoun HM, Couper JJ, Craig ME, Danne T, de Beaufort C, Dovc K, Driscoll KA, Dutta S, Ebekozien O, Larsson HE, Feiten DJ, Frohnert BI, Gabbay RA, Gallagher MP, Greenbaum CJ, Griffin KJ, Hagopian W, Haller MJ, Hendrieckx C, Hendriks E, Holt RIG, Hughes L, Ismail HM, Jacobsen LM, Johnson SB, Kolb LE, Kordonouri O, Lange K, Lash RW, Lernmark Å, Libman I, Lundgren M, Maahs DM, Marcovecchio ML, Mathieu C, Miller KM, O'Donnell HK, Oron T, Patil SP, Pop-Busui R, Rewers MJ, Rich SS, Schatz DA, Schulman-Rosenbaum R, Simmons KM, Sims EK, Skyler JS, Smith LB, Speake C, Steck AK, Thomas NPB, Tonyushkina KN, Veijola R, Wentworth JM, Wherrett DK, Wood JR, Ziegler AG, DiMeglio LA. Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes. Diabetologia 2024; 67:1731-1759. [PMID: 38910151 PMCID: PMC11410955 DOI: 10.1007/s00125-024-06205-5] [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] [Indexed: 06/25/2024]
Abstract
Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programmes are being increasingly emphasised. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody-positive (IAb+) children and adults who are at risk of (confirmed single IAb+) or living with (multiple IAb+) early-stage (stage 1 and stage 2) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in non-specialised settings. To inform this monitoring, JDRF in conjunction with international experts and societies developed consensus guidance. Broad advice from this guidance includes the following: (1) partnerships should be fostered between endocrinologists and primary-care providers to care for people who are IAb+; (2) when people who are IAb+ are initially identified there is a need for confirmation using a second sample; (3) single IAb+ individuals are at lower risk of progression than multiple IAb+ individuals; (4) individuals with early-stage type 1 diabetes should have periodic medical monitoring, including regular assessments of glucose levels, regular education about symptoms of diabetes and DKA, and psychosocial support; (5) interested people with stage 2 type 1 diabetes should be offered trial participation or approved therapies; and (6) all health professionals involved in monitoring and care of individuals with type 1 diabetes have a responsibility to provide education. The guidance also emphasises significant unmet needs for further research on early-stage type 1 diabetes to increase the rigour of future recommendations and inform clinical care.
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Affiliation(s)
- Moshe Phillip
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolism, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Kirstine J Bell
- Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rachel E J Besser
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre Human Genetics, Nuffield Department of Medicine Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Faculty of Medicine, Technical University of Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden, Helmholtz Centre Munich at the University Clinic Carl Gustav Carus of TU Dresden and Faculty of Medicine, Dresden, Germany
| | - Helen M Colhoun
- The Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Public Health, NHS Fife, Kirkcaldy, UK
| | - Jennifer J Couper
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Division of Paediatrics, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Maria E Craig
- Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia
| | | | - Carine de Beaufort
- International Society for Pediatric and Adolescent Diabetes (ISPAD), Berlin, Germany
- Diabetes & Endocrine Care Clinique Pédiatrique (DECCP), Clinique Pédiatrique/Centre Hospitalier (CH) de Luxembourg, Luxembourg City, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-Belval, Luxembourg
| | - Klemen Dovc
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolism, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Kimberly A Driscoll
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL, USA
| | | | | | - Helena Elding Larsson
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Malmö and Lund, Sweden
| | | | - Brigitte I Frohnert
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Carla J Greenbaum
- Center for Interventional Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA, USA
| | - Kurt J Griffin
- Sanford Research, Sioux Falls, SD, USA
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - William Hagopian
- Pacific Northwest Diabetes Research Institute, University of Washington, Seattle, WA, USA
| | - Michael J Haller
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL, USA
- Division of Endocrinology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, VIC, Australia
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Emile Hendriks
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Heba M Ismail
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laura M Jacobsen
- Division of Endocrinology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Suzanne B Johnson
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Leslie E Kolb
- Association of Diabetes Care & Education Specialists, Chicago, IL, USA
| | | | - Karin Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | | | - Åke Lernmark
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Ingrid Libman
- Division of Pediatric Endocrinology and Diabetes, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Markus Lundgren
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Department of Pediatrics, Kristianstad Hospital, Kristianstad, Sweden
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - M Loredana Marcovecchio
- Department of Pediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | | | - Holly K O'Donnell
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tal Oron
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shivajirao P Patil
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Marian J Rewers
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Desmond A Schatz
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Rifka Schulman-Rosenbaum
- Division of Endocrinology, Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Kimber M Simmons
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Emily K Sims
- Division of Pediatric Endocrinology and Diabetology, Herman B Wells Center for Pediatric Research, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jay S Skyler
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Laura B Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cate Speake
- Center for Interventional Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA, USA
| | - Andrea K Steck
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Ksenia N Tonyushkina
- Division of Endocrinology and Diabetes, Baystate Children's Hospital and University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA
| | - Riitta Veijola
- Research Unit of Clinical Medicine, Department of Pediatrics, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - John M Wentworth
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Diane K Wherrett
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jamie R Wood
- Department of Pediatric Endocrinology, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Forschergruppe Diabetes, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Khaledi N, Jeddi S, Abbasi S, Eftekharzadeh M, Khodadadi H, Namdari M, Noye Tuplin E. The impact of early-life exercise on CREB-signaling pathway and hippocampus neuroplasticity in diabetic adult male rats; the study of developmental model. Neurol Res 2024; 46:835-847. [PMID: 38808654 DOI: 10.1080/01616412.2024.2359265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Childhood exercise enhances brain structure, while diabetes detrimentally affects it. This study examines early-life exercise's influence on adult diabetic rats' memory and neuroplasticity. METHODS Male Wistar pups were divided into Control, Diabetes, Exercise Training, and Diabetes exercise groups. Diabetes was induced on day 23 with Alloxan (200 mg/kg). A 3-week regimen included aerobic and resistance training thrice weekly. The aerobic intensity was 70%, and resistance varied from 50% to 100% of the maximal carrying capacity (MCC). Following the last training sessions, spatial memory and retrieval tests were performed in infancy, childhood, and emerging adulthood using the Morris Water Maze test (MWM). The hippocampus was excised to measure protein and gene expression of brain-derived neurotrophic factor (BDNF), calmodulin-dependent protein kinase (CAMKII), N-methyl-D-aspartate receptors (NMDAR), and cAMP-response element-binding protein (CREB) by western blotting and reverse transcription-polymerase-chain reaction (RT-PCR) methods. Blood samples were collected during each developmental stage to measure glucose levels, at the study's conclusion, to assess Interleukin-1β levels using the ELISA method. The Nissel staining assessed dead hippocampal cells in CA1. RESULTS Post-natal exercise improved spatial memory (p < 0.05) and glucose levels (p < 0.05) in diabetic rats during adolescence and emerging adulthood. Despite reduced mRNA expression (NMDAR 40%, BDNF 62%, CREB 43%, CAMKII 66%), diabetic rats, by study end, showed increased BDNF, NMDARR, CAMKII, CREB protein/gene expression (p < 0.05) in emerging adulthood for both training groups. CONCLUSION Early-life exercise influenced hippocampal BDNF/NMDAR-CAMKII/CREB pathways in a diabetic rat model, highlighting post-natal exercise's role in neuroplasticity memory enhancement and improved glucose level.
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Affiliation(s)
- Neda Khaledi
- Department of Exercise Physiology, Faculty of Physical Education, Kharazmi University, Tehran, Iran
- Faculty of Kinesiology, The University of Calgary, Calgary, Canada
| | - Sajjad Jeddi
- Endocrine Physiology Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Abbasi
- Department of Exercise Physiology, Faculty of Physical Education, Kharazmi University, Tehran, Iran
| | - Mina Eftekharzadeh
- Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hashem Khodadadi
- Department of Exercise Physiology, Faculty of Physical Education, Kharazmi University, Tehran, Iran
| | - Maryam Namdari
- Department of Exercise Physiology, Faculty of Physical Education, Kharazmi University, Tehran, Iran
| | - Erin Noye Tuplin
- Faculty of Kinesiology, The University of Calgary, Calgary, Canada
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Medenica S, Stojanovic V, Capece U, Mazzilli R, Markovic M, Zamponi V, Vojinovic T, Migliaccio S, Defeudis G, Cinti F. The interlink between thyroid autoimmunity and type 1 diabetes and the impact on male and female fertility. Hormones (Athens) 2024; 23:429-437. [PMID: 38748060 DOI: 10.1007/s42000-024-00563-w] [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: 11/01/2023] [Accepted: 04/18/2024] [Indexed: 09/28/2024]
Abstract
The aim of this review is to discuss the several interconnections between thyroid autoimmunity and type 1 diabetes in terms of epidemiology, immunoserology, genetic predisposition, and pathogenic mechanisms. We will also analyze the impact of these conditions on both male and female fertility. A literature search was carried out using the MEDLINE/PubMed, Scopus, Google Scholar, ResearchGate, and Clinical Trials Registry databases with a combination of keywords. It was found that the prevalence of thyroid autoantibodies in individuals with type 1 diabetes (T1DM) varied in different countries and ethnic groups from 7 to 35% in both sexes. There are several types of autoantibodies responsible for the immunoserological presentation of autoimmune thyroid diseases (AITDs) which can be either stimulating or inhibiting, which results in AITD being in the plus phase (thyrotoxicosis) or the minus phase (hypothyroidism). Different types of immune cells such as T cells, B cells, natural killer (NK) cells, antigen presenting cells (APCs), and other innate immune cells participate in the damage of the beta cells of the islets of Langerhans, which inevitably leads to T1D. Multiple genetic and environmental factors found in variable combinations are involved in the pathogenesis of AITD and T1D. In conclusion, although it is now well-known that both diabetes and thyroid diseases can affect fertility, only a few data are available on possible effects of autoimmune conditions. Recent findings nevertheless point to the importance of screening patients with immunologic infertility for AITDs and T1D, and vice versa.
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Affiliation(s)
- Sanja Medenica
- Department of Endocrinology, Internal Medicine Clinic, Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Vukasin Stojanovic
- Emergency Medicine Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Umberto Capece
- UOS Centro Malattie Endocrine e Metaboliche, UOC Endocrinologia e Diabetologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rossella Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - Milica Markovic
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Virginia Zamponi
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - Tanja Vojinovic
- Faculty of Medicine, University od Montenegro, Podgorica, Montenegro
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, University Foro Italico of Rome, Rome, 00135, Italy
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Defeudis
- Department of Movement, Human and Health Sciences, University Foro Italico of Rome, Rome, 00135, Italy.
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, Rome, Italy.
| | - Francesca Cinti
- UOS Centro Malattie Endocrine e Metaboliche, UOC Endocrinologia e Diabetologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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Molaee MC, Naseri ZG, Karami MA. Long-Term Cost-Effectiveness of Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Adults With Type 1 Diabetes in Iran. Value Health Reg Issues 2024; 43:101002. [PMID: 38820700 DOI: 10.1016/j.vhri.2024.101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES This study aimed to determine long-term cost-effectiveness of continuous glucose monitoring (CGM) technology versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes (T1D) using multiple daily injections in Iran. METHODS According to available data, the long-term costs and clinical outcomes of CGM and SMBG were estimated using the Sheffield Type 1 Diabetes Model, with a lifetime horizon from a payer's perspective. The primary outcome was the cost per quality-adjusted life year (QALY) gained. RESULTS The lifetime cost-effectiveness analysis demonstrated that on average, the use of CGM increased life expectancy by 1.32 years and QALYs by 1.63, compared with SMBG. The CGM group had an average discounted total cost of $40 093 US dollars, whereas the SMBG group had an average discounted total cost of $13 366. This resulted in an incremental cost-effectiveness ratio (ICER) of $16 386 per QALY gained, which is less than the threshold of 3 times the gross domestic product (GDP) per capita of Iran ($24 561). CONCLUSIONS Considering 3 times the GDP per capita as the threshold, CGM is likely to be cost-effective in Iran. However, for CGM to be very cost-effective (ie, have an ICER less than 1 times the GDP per capita) and presumably more accessible, the price of CGM should decrease to $40 per sensor, each with a lifespan of 14 days.
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Affiliation(s)
- Mohsen Choband Molaee
- Department of Pharmaceutics, Faculty of pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Gharib Naseri
- Department of pharmacoeconomics and pharmaceutical management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Ali Karami
- Department of Pharmaceutics, Faculty of pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Mabala DS, Stokholm L, Andersen N, Andresen J, Bek T, Heegaard S, Hajari J, Højlund K, Kawasaki R, Laugesen CS, Möller S, Pedersen FN, Schielke KC, Thykjær AS, Grauslund J. Diabetic retinopathy as an independent marker of cardiovascular disease in type 1 diabetes: Results from a nationwide longitudinal matched case-cohort study. Acta Ophthalmol 2024; 102:635-642. [PMID: 38345204 DOI: 10.1111/aos.16653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE To investigate diabetic retinopathy (DR) as a potential marker of cardiovascular disease (CVD) in adults with type 1 diabetes attending the Danish DR-screening programme and non-diabetes adults. METHODS In this registry-based matched case-cohort study, we identified 16 547 adults with type 1 diabetes, who were registered in the Danish Registry of Diabetic Retinopathy (DiaBase). Each case was age- and sex-matched by five non-diabetes individuals (n = 82 399), and odds ratios (ORs) and hazard ratios (HRs) were estimated for incident and upcoming CVD in multivariable models. RESULTS Adults with type 1 diabetes (median age 44.5 years, 57.6% male) were more likely to have prevalent CVD (OR 1.29; 95% CI, 1.20-1.38) and to develop CVD within 5 years (HR 1.19; 95% CI, 1.08-1.30) as compared to non-diabetes control. However, adults without DR were less likely to develop CVD (HR 0.84; 95% CI, 0.72-0.97) compared to the reference population. For adults with type 1 diabetes, there was an increasing risk for incident CVD for increasing levels of DR (HR 1.33, 1.95, 1.71 and 2.39 for DR-levels 1-4, respectively). Patients with CVD at the time of the first screening had a higher risk to develop DR during follow-up (HR 1.23; 95% CI, 1.02-1.49). CONCLUSION In a nationwide matched case-cohort study adjusted for potential confounders, DR was identified as an independent marker of prevalent and incident CVD in type 1 diabetes with increasing risk demonstrated for higher levels of DR. Likewise, CVD also independently predicted the risk of incident DR.
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Affiliation(s)
- Ditte Simmelkær Mabala
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, Odense, Denmark
| | - Frederik Nørregaard Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Anne Suhr Thykjær
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Iftikhar M, Saqib M, Qayyum SN, Asmat R, Mumtaz H, Rehan M, Ullah I, Ud-Din I, Noori S, Khan M, Rehman E, Ejaz Z. Artificial intelligence-driven transformations in diabetes care: a comprehensive literature review. Ann Med Surg (Lond) 2024; 86:5334-5342. [PMID: 39238969 PMCID: PMC11374247 DOI: 10.1097/ms9.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/05/2024] [Indexed: 09/07/2024] Open
Abstract
Artificial intelligence (AI) has been applied in healthcare for diagnosis, treatments, disease management, and for studying underlying mechanisms and disease complications in diseases like diabetes and metabolic disorders. This review is a comprehensive overview of various applications of AI in the healthcare system for managing diabetes. A literature search was conducted on PubMed to locate studies integrating AI in the diagnosis, treatment, management and prevention of diabetes. As diabetes is now considered a pandemic now so employing AI and machine learning approaches can be applied to limit diabetes in areas with higher prevalence. Machine learning algorithms can visualize big datasets, and make predictions. AI-powered mobile apps and the closed-loop system automated glucose monitoring and insulin delivery can lower the burden on insulin. AI can help identify disease markers and potential risk factors as well. While promising, AI's integration in the medical field is still challenging due to privacy, data security, bias, and transparency. Overall, AI's potential can be harnessed for better patient outcomes through personalized treatment.
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Affiliation(s)
| | | | | | | | | | - Muhammad Rehan
- Al-Nafees Medical College and Hospital, Islamabad, Pakistan
| | | | | | - Samim Noori
- Nangarhar University, Faculty of Medicine, Nangarhar, Afghanistan
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Stahl-Pehe A, Baechle C, Lanzinger S, Urschitz MS, Reinauer C, Kamrath C, Holl RW, Rosenbauer J. Trends in the incidence of type 1 diabetes and type 2 diabetes in children and adolescents in North Rhine-Westphalia, Germany, from 2002 to 2022. DIABETES & METABOLISM 2024; 50:101567. [PMID: 39095014 DOI: 10.1016/j.diabet.2024.101567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
Abstract
AIMS The objective of this study was to assess overall and segmented trends in the incidence of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in children and adolescents younger than 20 years, from 2002 to 2022. METHODS This study used registry data on physician-diagnosed T1DM or T2DM from primary and secondary sources, covering the German federal state of North Rhine-Westphalia with 18 million inhabitants. The ages at T1DM and T2DM onset ranged from 0 to 19 and 10-19 years, respectively. The main outcomes were direct age- and/or sex-standardized incidence rates per 100,000 person-years (PYs) and trends estimated as annual percentage changes (APCs), both with 95 % confidence intervals. The segmented trends for subperiods were based on joinpoint regression models. RESULTS From 2002-2022, 17,470 and 819 persons had incident T1DM and T2DM, respectively. The total number of PYs was 73,743,982 for T1DM and 39,210,453 for T2DM, with a mean coverage rate of 98 % for T1DM and 90 % for T2DM. The standardized T1DM incidence increased from 17.6 [16.3;18.9} in 2002 to 33.2 [31.3;35.1] in 2022, with an APC of 2.7 % [2.3 %;3.1 %]. The standardized T2DM incidence increased from 1.3 [0.8;1.7] in 2002 to 2.8 [2.0;3.6] in 2022, with an APC of 6.4 % [4.9 %;8.0 %]. There were four different segmented trends for T1DM and T2DM, with the incidence peaking in 2021 and subsequently declining. CONCLUSIONS The incidence rates of T1DM and T2DM have increased over the past 20 years, with a wave-like pattern during the Covid-19 pandemic.
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Affiliation(s)
- Anna Stahl-Pehe
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Christina Baechle
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Stefanie Lanzinger
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
| | - Michael S Urschitz
- German Paediatric Surveillance Unit, Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christina Reinauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Düsseldorf, Germany
| | - Clemens Kamrath
- Department of General Pediatrics, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhard W Holl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Yang Q, Zeng B, Hao J, Yang Q, Sun F. Real-world glycaemic outcomes of automated insulin delivery in type 1 diabetes: A meta-analysis. Diabetes Obes Metab 2024; 26:3753-3763. [PMID: 38888056 DOI: 10.1111/dom.15718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
AIM To evaluate the real-world effectiveness of automated insulin delivery (AID) systems in patients with type 1 diabetes (T1D). MATERIALS AND METHODS PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched for studies published up until 2 March 2024. We included pragmatic randomized controlled trials (RCTs), cohort studies, and before-after studies that compared AID systems with conventional insulin therapy in real-world settings and reported continuous glucose monitoring outcomes. Percent time in range (TIR; 3.9-10 mmol/L), time below range (TBR; <3.9 mmol/L), time above range (TAR; >10 mmol/L), and glycated haemoglobin (HbA1c) level were extracted. Data were summarized as mean differences (MDs) with 95% confidence interval. RESULTS A total of 23 before-after studies (101 704 participants) were included in the meta-analysis. AID systems were associated with an increased percentage of TIR (11.61%, 10.47 to 12.76; p < 0.001). The favourable effect of AID systems was consistently observed when used continuously for 6 (11.76%) or 12 months (11.33%), and in both children (12.16%) and adults (11.04%). AID systems also showed favourable effects on TBR (-0.53%, -0.63 to -0.42), TAR (-9.65%, -10.63 to -8.67) and HbA1c level (-0.42%, -0.47 to -0.37) when compared with previous treatments. CONCLUSIONS Similar improvements in glycaemic parameters were observed in real-world settings in RCTs using AID systems in T1D. AID systems benefit both children and adults by increasing TIR for both short- and long-term interventions.
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Affiliation(s)
- Qin Yang
- Department of Cardiology, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Baoqi Zeng
- Medical Research Center, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Department of Emergency, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
| | - Jiayi Hao
- Medical Research Center, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China
| | - Qingqing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
- Xinjiang Medical University, Xinjiang, China
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Pichardo-Lowden A, Goodarzi MO, Trikudanathan G, Serrano J, Dungan KM. Risk and factors determining diabetes after mild, nonnecrotizing acute pancreatitis. Curr Opin Gastroenterol 2024; 40:396-403. [PMID: 38935336 PMCID: PMC11305911 DOI: 10.1097/mog.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) is relatively common following acute pancreatitis (AP), even after mild acute pancreatitis (MAP), the most frequent AP presentation, in which there is no overt beta cell injury. Post-AP related diabetes is widely misdiagnosed, resulting in potentially inappropriate treatment and worse outcomes than type 2 diabetes (T2D). Thus, it is important to understand risk across the spectrum of AP severity. RECENT FINDINGS Biological mechanisms are unclear and may include local and systemic inflammation leading to beta cell dysfunction and insulin resistance, altered gut barrier and/or gut peptides and possibly islet autoimmunity, though no studies have specifically focused on MAP. While studies examining clinical risk factors on MAP exclusively are lacking, there are studies which include MAP. These studies vary in scientific rigor, approaches to rule out preexisting diabetes, variable AP severity, diagnostic testing methods, and duration of follow-up. Overall, disease related factors, including AP severity, as well as established T2D risk factors are reported to contribute to the risk for DM following AP. SUMMARY Though numerous studies have explored risk factors for DM after AP, few studies specifically focused on MAP, highlighting a key knowledge gap that is relevant to the majority of patients with AP.
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Affiliation(s)
- Ariana Pichardo-Lowden
- Division of Endocrinology, Diabetes and Metabolism, Penn State Health, Penn State College of Medicine, Hershey, PA
| | - Mark O. Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD
| | - Kathleen M. Dungan
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH
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Zinellu A, Mangoni AA. A systematic review and meta-analysis of ischemia-modified albumin in diabetes mellitus. Heliyon 2024; 10:e35953. [PMID: 39224304 PMCID: PMC11366936 DOI: 10.1016/j.heliyon.2024.e35953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Aim There is an ongoing search for novel biomarkers of diabetes. We conducted a systematic review and meta-analysis of the serum concentrations of ischemia-modified albumin (IMA), a candidate biomarker of oxidative stress, acidosis, and ischemia, in patients with pre-diabetes, different types of diabetes mellitus (type 1, T1DM, type 2, T2DM, and gestational, GDM), and healthy controls. Methods We searched for case-control studies published in PubMed, Web of Science, and Scopus from inception to December 31, 2023. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. Results In 29 studies, T2DM patients had significantly higher IMA concentrations when compared to controls (standard mean difference, SMD = 1.83, 95 % CI 1.46 to 2.21, p˂0.001; I2 = 95.7 %, p < 0.001; low certainty of evidence). Significant associations were observed between the SMD and glycated hemoglobin (p = 0.007), creatinine (p = 0.003), triglycerides (p = 0.029), and the presence of diabetes complications (p = 0.003). Similar trends, albeit in a smaller number of studies, were observed in T1DM (two studies; SMD = 1.59, 95 % CI -0.09 to 3.26, p˂0.063; I2 = 95.8 %, p < 0.001), GDM (three studies; SMD = 3.41, 95 % CI 1.14 to 5.67, p = 0.003; I2 = 97.0 %, p < 0.001) and pre-diabetes (three studies; SMD = 15.25, 95 % CI 9.86 to 20.65, p˂0.001; I2 = 99.3 %, p < 0.001). Conclusion Our study suggests that IMA is a promising biomarker for determining the presence of oxidative stress, acidosis, and ischemia in pre-diabetes and T1DM, T2DM, and GDM. However, the utility of measuring circulating IMA warrants confirmation in prospective studies investigating clinical endpoints in pre-diabetes and in different types of diabetes (PROSPERO registration number: CRD42024504690).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
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Buddhavarapu V, Dhillon G, Grewal H, Sharma P, Kashyap R, Surani S. Safety of teplizumab in patients with high-risk for diabetes mellitus type 1: A systematic review. World J Diabetes 2024; 15:1793-1801. [PMID: 39192866 PMCID: PMC11346092 DOI: 10.4239/wjd.v15.i8.1793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The incidence of diabetes mellitus type 1 (DM1) has been rising worldwide because of improvements in diagnostic techniques and improved access to care in countries with lower socioeconomic status. A new anti-CD4 antibody, Tep-lizumab, has been shown to delay the progression of DM1 and is the only medication approved for this indication. However, more information is needed about the safety profile of this drug. AIM To identify the odds ratios (OR) of systems-based adverse effects for Teplizumab when compared to Placebo. METHODS An extensive systematic review was conducted from the inception of the medication until December 31, 2023. All clinical trials and studies that evaluated Teplizumab vs placebo were included in the initial review. The study protocol was designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guidelines and was registered in PROSPERO (ID: CRD42024496169). Crude OR were generated using RevMan Software version 5.4. RESULTS After screening and review, 5 studies were selected to determine the risk of adverse effects of teplizumab compared to placebo. A total of 561 patients were included in the study population. Total adverse effects and system-based adverse effects were studied and reported. We determined that patients receiving Teplizumab had a higher risk of developing gastrointestinal (GI) (OR = 1.60, 95%CI: 1.01-2.52, P = 0.04), dermatological (OR = 6.33, 95%CI: 4.05-9.88, P < 0.00001) and hematological adverse effects (OR = 19.03, 95%CI: 11.09-32.66, P < 0.00001). These patients were also significantly likely to have active Epstein-Barr Virus infection (OR = 3.16, 95%CI: 1.51-6.64, P < 0.002). While our data showed that patients receiving Teplizumab did have a higher incidence of total adverse effects vs placebo, this finding did not reach statistical significance (OR = 2.25, 95%CI: 0.80-6.29, P = 0.12). CONCLUSION Our systematic review suggests that Teplizumab patients are at risk for significant adverse effects, primarily related to GI, dermatological, and hematological systems. The total adverse effect data is limited as study populations are small. More studies should be conducted on this medication to better inform the target population of potential adverse effects.
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Affiliation(s)
- Venkata Buddhavarapu
- Department of Medicine, Banner Baywood Medical Center, Banner Health, Mesa, AZ 85206, United States
| | - Gagandeep Dhillon
- Department of Medicine, UM Baltimore Washington Medical Center, Glen Burnie, MD 21061, United States
| | - Harpreet Grewal
- Department of Radiology, Ascension Sacred Heart Hospital, Pensacola, FL 32504, United States
| | - Pranjal Sharma
- Department of Medicine, Northeast Ohio Medical Center, Rootstown, OH 44272, United States
| | - Rahul Kashyap
- Department of Research, Wellspan Health, York, PA 17403, United States
- Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
- Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
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Wang N, Wang G, Feng X, Yang T. Identification of Immune Gene Signature Associated with T Cells and Natural Killer Cells in Type 1 Diabetes. Diabetes Metab Syndr Obes 2024; 17:2983-2996. [PMID: 39139741 PMCID: PMC11321349 DOI: 10.2147/dmso.s470738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose This study aimed to investigate the abnormal infiltration of immune cells in type 1 diabetes mellitus (T1D) and elucidate their regulatory mechanisms. Methods Public T1D-related gene expression data were obtained from the Gene Expression Omnibus database.The GSE123658 dataset analyzed whole blood RNA-seq data from type 1 diabetic patients and healthy volunteers. The GSE110914 dataset analyzed neutrophils purified from peripheral blood of patients with symptomatic and pre-symptomatic type 1 diabetes (T1D), at risk of T1D, and healthy controls. Immune cell infiltration analysis was performed to identify abnormally infiltrating immune cells. Differentially expressed immune genes (DEIGs) in T1D samples were identified, followed by the construction of an immune gene signature (IGS) using a protein-protein interaction (PPI) network and Least absolute shrinkage and selection operator Cox regression analyses (LASSO Cox regression analyses). The regulatory mechanisms underlying IGS were explored using gene set enrichment analysis. Furthermore, expression validation, diagnostic efficacy evaluation, and upstream miRNA prediction of hub signature genes were performed. We verified the miRNA expression of the key gene colony stimulating factor 1 (CSF1) and microRNA-326 (miR-326) by reverse transcription-quantitative PCR (RT‒qPCR). Results The proportion of infiltrating T and natural killer (NK) cells differed between the T1D and control samples, and 207 immune genes (IGs) related to these immune cells were extracted. After differential expression, PPI, and LASSO Cox regression analyses, four signature DEIGs were identified for IGS construction: notch receptor 1 (NOTCH1), Janus kinase 3 (JAK3), tumor necrosis factor receptor superfamily member 4(TNFRSF4), and CSF1. Key pathways such as the Toll-like receptor signaling pathway were significantly activated in the high-risk group. Moreover, the upregulation of CSF1 in T1D samples was confirmed using a validation dataset, and CSF1 showed high diagnostic efficacy for T1D. Furthermore, CSF1 was targeted by miR-326.We used validated key genes in T1D patients, several of which were confirmed by RT‒qPCR. Conclusion In conclusion, the identified key IGs may play an important role in T1D. CSF1 can be developed as a novel diagnostic biomarker for T1D.
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Affiliation(s)
- Na Wang
- Department of Endocrinology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang City, Jiangsu Province, 222000, People's Republic of China
- Department of Endocrinology, Jinzhou Medical University(The First People's Hospital of Lianyungang), Lianyungang City, Jiangsu Province, 222000, People's Republic of China
| | - Guofeng Wang
- Department of Endocrinology, Jinzhou Medical University(The First People's Hospital of Lianyungang), Lianyungang City, Jiangsu Province, 222000, People's Republic of China
| | - Xiuli Feng
- Department of Endocrinology, Jinzhou Medical University(The First People's Hospital of Lianyungang), Lianyungang City, Jiangsu Province, 222000, People's Republic of China
| | - Teng Yang
- Department of Endocrinology, Jinzhou Medical University(The First People's Hospital of Lianyungang), Lianyungang City, Jiangsu Province, 222000, People's Republic of China
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Zhang Y, Kuo L, Woodhouse KA, Fitzpatrick LE. Therapeutic Insulin Analogue Concentrations at Infusion Sites Enhanced the Pro-Inflammatory Response and Apoptosis in an In Vitro Macrophage-Material Interaction Model. ACS Pharmacol Transl Sci 2024; 7:2544-2556. [PMID: 39156741 PMCID: PMC11325997 DOI: 10.1021/acsptsci.4c00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 08/20/2024]
Abstract
Continuous subcutaneous insulin infusion for Type 1 diabetes relies upon insulin infusion sets (IIS) to reliably deliver insulin to a subcutaneous depot, where it is absorbed into systemic circulation. However, IIS are plagued by short wear times and high failure rates, due in part to inconsistent insulin absorption that can arise over time. While emerging evidence suggests that the local inflammatory response to the IIS cannula may impact both wear times and unreliable insulin adsorption, the mechanisms are poorly understood. Here, we investigated the effects of local infused insulin concentrations on the biomaterial host response to better understand the underlying factors that limit the IIS performance. We first modeled the insulin concentration for a constant basal infusion rate to select a relevant insulin concentration range of 0.1-10 U/mL within the infusion site. We then examined the influence of a commercial insulin analogue (Humulin-N) using an in vitro macrophage-material model, which uses adsorbed fibroblast lysate (containing damage-associated molecular patterns) to activate macrophages and recapitulates macrophage responses on implanted biomaterials. RAW-Blue macrophages cultured on lysate-adsorbed surfaces had increased nuclear factor-κB (NF-κB) and activating protein 1 (AP-1) activity and intracellular reactive oxygen species (ROS) accumulation compared to control surfaces. Humulin-N concentration (0.5-10 U/mL) enhanced the NF-κB/AP-1 activity and ROS accumulation in macrophages on lysate-adsorbed surfaces. However, Humulin-N had no effect on NF-κB/AP-1 or ROS in the absence of the inflammatory stimulus. Additionally, high insulin concentrations arising from therapeutic doses induced macrophage apoptosis with and without adsorbed lysate. This study contributes to emerging evidence that infused insulin affects the tissue response to IIS.
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Affiliation(s)
- Yuxi Zhang
- Department
of Chemical Engineering, Queen’s
University, Kingston, ON K7L 3N6, Canada
| | - Luke Kuo
- Department
of Chemical Engineering, Queen’s
University, Kingston, ON K7L 3N6, Canada
| | - Kimberly A. Woodhouse
- Department
of Chemical Engineering, Queen’s
University, Kingston, ON K7L 3N6, Canada
| | - Lindsay E. Fitzpatrick
- Department
of Chemical Engineering, Queen’s
University, Kingston, ON K7L 3N6, Canada
- Department
of Biomedical and Molecular Sciences, Queen’s
University, Kingston, ON K7L 3N6, Canada
- Centre
for Health Innovation, Queen’s University, Kingston, ON K7L 3N6, Canada
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Carrigan A, Meulenbroeks I, Sarkies M, Dammery G, Halim N, Singh N, Lake R, Davis E, Jones TW, Braithwaite J, Zurynski Y. Benefits, implementation and sustainability of innovative paediatric models of care for children with type 1 diabetes: a systematic review. BMC Pediatr 2024; 24:502. [PMID: 39103837 DOI: 10.1186/s12887-024-04945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 07/15/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND AND AIM The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. METHODS A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. RESULTS Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. CONCLUSION Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes.
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Affiliation(s)
- Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Isabelle Meulenbroeks
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Mitchell Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Nicole Halim
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Rebecca Lake
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Elizabeth Davis
- Telethon Kids Institute, Perth Children's Hospital, Western, Australia
- Perth Children's Hospital, Perth, Western, Australia
| | - Timothy W Jones
- Telethon Kids Institute, Perth Children's Hospital, Western, Australia
- Perth Children's Hospital, Perth, Western, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia.
- Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
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Breuker C, Macioce V, Lasse A, Zogheib ML, Cavallin L, Herman F, Picot MC, Gourdy P, Sallerin B, Avignon A, Sultan A. Attainment of LDL-cholesterol target in high cardiovascular risk type 1 diabetic French people. DIABETES & METABOLISM 2024; 50:101568. [PMID: 39098658 DOI: 10.1016/j.diabet.2024.101568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/04/2024] [Accepted: 07/28/2024] [Indexed: 08/06/2024]
Abstract
AIMS As people with type 1 diabetes have increased risk of cardiovascular morbi-mortality, management of cardiovascular risk factors is of crucial importance. We assessed the prevalence and factors associated with LDL-cholesterol (LDL-c) target achievement in patients with type 1 diabetes at high and very-high cardiovascular risk. METHODS In this observational multicenter study, we included hospitalized patients with type 1 diabetes who had a fasting blood lipid analysis at admission. Cardiovascular risk level and LDL-c target values were defined according to ESC/EAS guidelines into force at admission: LDL-c target for very-high risk (VHR) and high risk (HR) patients was 1.4 and 1.8 mmol/l respectively for patients included from September 2019 (2019 guidelines) and 1.8 and 2.6 mmol/l respectively for patients included in 2016-2019 (2016 guidelines). LDL-c target attainment was assessed in HR and VHR patients, and factors associated with attainment were identified with multivariable analysis. RESULTS We included 85 HR patients (median age 37y [interquartile range: 27;45], 64 % females) and 356 VHR patients (49 [35;61] years, 42 % females). In HR patients, 7 % were treated with statins, and 35.3 % achieved the LDL-c target. Increasing age (odds ratio 0.58 [95 % confidence interval: 0.38;0.89]), body mass index (0.86 [0.75;0.98]), and HbA1c (0.69 [0.50;0.94]) were independently associated with lower odds of attaining LDL-c target. In VHR patients, 36 % were treated with statins, and 17.4 % achieved LDL-c target. Statin treatment (2.33 [1.22;4.43]), secondary prevention (2.33 [1.21;4.48]) and chronic renal failure (2.82 [1.42;5.61]) were associated with higher odds of attaining LDL-c target. CONCLUSION Control of LDL-c is highly insufficient in both HR and VHR patients. Cardiovascular risk evaluation and better control of risk factors may help decrease cardiovascular morbi-mortality in patients with type 1 diabetes. REGISTRATION NUMBER NCT03449784.
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Affiliation(s)
- Cyril Breuker
- Clinical pharmacy department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Valérie Macioce
- Clinical research and epidemiology unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Alexandre Lasse
- Clinical pharmacy department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Marie-Lou Zogheib
- Clinical pharmacy department, Toulouse University Hospital, Toulouse, France
| | - Leslie Cavallin
- Clinical pharmacy department, Toulouse University Hospital, Toulouse, France
| | - Fanchon Herman
- Clinical research and epidemiology unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Clinical Research and Epidemiology Unit, INSERM, Centre d'Investigation Clinique 1411, CHU Montpellier, Univ Montpellier, France
| | - Pierre Gourdy
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France; Endocrinology, Diabetology and Nutrition Department, Toulouse University Hospital, Toulouse, France
| | - Brigitte Sallerin
- Clinical pharmacy department, Toulouse University Hospital, Toulouse, France
| | - Antoine Avignon
- Nutrition-Diabetes Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Ariane Sultan
- Nutrition-Diabetes Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.
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Gunaid AA, Ogle GD, Al-Qadasi FA, Al-Radaei AN, Maniam J, El-Shoubaki HR. Clinical features, biomarkers and diabetic ketoacidosis at diagnosis of type 1 diabetes among children and adolescents in Sana'a, Yemen. BMJ Paediatr Open 2024; 8:e002680. [PMID: 39097331 PMCID: PMC11298739 DOI: 10.1136/bmjpo-2024-002680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/18/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION There is little published information on type 1 diabetes (T1D) in children in Yemen. We aimed to identify the clinical characteristics, biomarkers and diabetic ketoacidosis (DKA) at diagnosis of T1D among children and adolescents in a diabetes centre in Sana'a, Yemen. METHODS A total of 485 children and adolescents aged ≤18 years diagnosed with T1D during the period 2010-2020 were included in the study. The variables investigated were demographic and clinical characteristics, biomarkers, subtypes of T1D, and the risk factors for severe DKA at diagnosis. RESULTS At diagnosis, children aged <10 years compared with those aged ≥10 years had higher mean plasma glucose (p<0.001) and mean HbA1c (p=0.026), and lower mean C-peptide (pmol/L) (p=0.019), and a higher frequency of DKA at diagnosis than older children (p<0.001). A majority of the study population (383, 79%) presented in DKA . Children aged <10 years presenting with DKA had significantly longer median appraisal interval (p=0.009) and median total diagnosis interval (p=0.025), and significantly lower mean C-peptide (p=0.001) as compared with their peers without DKA. The prevalence of autoantibody-negative 'idiopathic' T1D was 36 (32%) of the total number tested for autoantibody and familial T1D 61 (12.6%) of all the study population. CONCLUSION In Yemen children aged <10 years with new-onset T1D frequently faced the challenge of a delay in diagnosis and treatment initiation, with severe hyperglycaemia and a higher risk of DKA at diagnosis.
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Affiliation(s)
| | - Graham D Ogle
- Life for a Child (LFAC) Programme, Diabetes Australia New South Wales, Glebe, New South Wales, Australia
| | | | | | - Jayanthi Maniam
- Life for a Child (LFAC) Programme, Diabetes Australia New South Wales, Glebe, New South Wales, Australia
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Grimus S, Sarangova V, Welzel PB, Ludwig B, Seissler J, Kemter E, Wolf E, Ali A. Immunoprotection Strategies in β-Cell Replacement Therapy: A Closer Look at Porcine Islet Xenotransplantation. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2401385. [PMID: 38884159 PMCID: PMC11336975 DOI: 10.1002/advs.202401385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/28/2024] [Indexed: 06/18/2024]
Abstract
Type 1 diabetes mellitus (T1DM) is characterized by absolute insulin deficiency primarily due to autoimmune destruction of pancreatic β-cells. The prevailing treatment for T1DM involves daily subcutaneous insulin injections, but a substantial proportion of patients face challenges such as severe hypoglycemic episodes and poorly controlled hyperglycemia. For T1DM patients, a more effective therapeutic option involves the replacement of β-cells through allogeneic transplantation of either the entire pancreas or isolated pancreatic islets. Unfortunately, the scarcity of transplantable human organs has led to a growing list of patients waiting for an islet transplant. One potential alternative is xenotransplantation of porcine pancreatic islets. However, due to inter-species molecular incompatibilities, porcine tissues trigger a robust immune response in humans, leading to xenograft rejection. Several promising strategies aim to overcome this challenge and enhance the long-term survival and functionality of xenogeneic islet grafts. These strategies include the use of islets derived from genetically modified pigs, immunoisolation of islets by encapsulation in biocompatible materials, and the creation of an immunomodulatory microenvironment by co-transplanting islets with accessory cells or utilizing immunomodulatory biomaterials. This review concentrates on delineating the primary obstacles in islet xenotransplantation and elucidates the fundamental principles and recent breakthroughs aimed at addressing these challenges.
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Affiliation(s)
- Sarah Grimus
- Chair for Molecular Animal Breeding and BiotechnologyGene Center and Department of Veterinary SciencesLMU MunichD‐81377MunichGermany
- Center for Innovative Medical Models (CiMM)LMU MunichD‐85764OberschleißheimGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU)LMU MunichD‐81377MunichGermany
| | - Victoria Sarangova
- Leibniz‐Institut für Polymerforschung Dresden e.V.Max Bergmann Center of Biomaterials DresdenD‐01069DresdenGermany
| | - Petra B. Welzel
- Leibniz‐Institut für Polymerforschung Dresden e.V.Max Bergmann Center of Biomaterials DresdenD‐01069DresdenGermany
| | - Barbara Ludwig
- Department of Medicine IIIUniversity Hospital Carl Gustav CarusTechnische Universität DresdenD‐01307DresdenGermany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at the University Hospital Carl Gustav Carus and Faculty of Medicine of the Technische Universität DresdenD‐01307DresdenGermany
- German Center for Diabetes Research (DZD e.V.)D‐85764NeuherbergGermany
- DFG‐Center for Regenerative Therapies DresdenTechnische Universität DresdenD‐01307DresdenGermany
| | - Jochen Seissler
- Medizinische Klinik und Poliklinik IVDiabetes Zentrum – Campus InnenstadtKlinikum der Ludwig‐Maximilians‐Universität MünchenD‐80336MunichGermany
| | - Elisabeth Kemter
- Chair for Molecular Animal Breeding and BiotechnologyGene Center and Department of Veterinary SciencesLMU MunichD‐81377MunichGermany
- Center for Innovative Medical Models (CiMM)LMU MunichD‐85764OberschleißheimGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU)LMU MunichD‐81377MunichGermany
- German Center for Diabetes Research (DZD e.V.)D‐85764NeuherbergGermany
| | - Eckhard Wolf
- Chair for Molecular Animal Breeding and BiotechnologyGene Center and Department of Veterinary SciencesLMU MunichD‐81377MunichGermany
- Center for Innovative Medical Models (CiMM)LMU MunichD‐85764OberschleißheimGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU)LMU MunichD‐81377MunichGermany
- German Center for Diabetes Research (DZD e.V.)D‐85764NeuherbergGermany
| | - Asghar Ali
- Chair for Molecular Animal Breeding and BiotechnologyGene Center and Department of Veterinary SciencesLMU MunichD‐81377MunichGermany
- Center for Innovative Medical Models (CiMM)LMU MunichD‐85764OberschleißheimGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU)LMU MunichD‐81377MunichGermany
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Lo YL, Chen YS, Wang PY, Chang CM, Wei GT, Hung WC. Non-invasive glucose extraction by a single polarization rotator system in patients with diabetes. BIOMEDICAL OPTICS EXPRESS 2024; 15:4909-4924. [PMID: 39346983 PMCID: PMC11427183 DOI: 10.1364/boe.529032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 10/01/2024]
Abstract
This study utilizes a Mueller matrix-based system to extract accurate glucose levels from human fingertips, addressing challenges in skin complexity. Integration of domain knowledge and data science aims to enhance prediction accuracy using a Random Forest model. The primary goal is to improve glucose level predictions by selecting effective features based on the Pearson product-moment correlation coefficient (PPMCC). The interpolation compensates for delayed glucose concentration. This study integrates domain knowledge and data science, combining a Mueller matrix-based system and a random forest model. It is noted that 16 effective features were identified from 27 test points collected from a healthy volunteer in the laboratory. These features were divided into training and prediction sets in a ratio of 8:2. As a result, the regression coefficient, R2, was 0.8907 and the mean absolute relative difference (MARD) was 6.8%, respectively. This significantly improves prediction accuracy, demonstrating the model's robustness and reliability in accurately forecasting outcomes based on the identified features. In addition, in the Institutional Review Board (IRB) tests at NCKU's hospital, all data passed the same preprocessing and model. The measurement results from an individual diabetic patient demonstrate high accuracy for blood glucose concentrations below 150 mg/dL, with acceptable deviation at higher levels and no severe error zones. Over a three-month period, data from the participating diabetic patient showed a MARD of 4.44% with the R2 of 0.836, and the other patient recorded a MARD of 7.79% with the R2 of 0.855. The study shows the proposed approach accurately extracts glucose levels. Integrating domain knowledge, data science, and effective strategies significantly improves prediction accuracy.
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Affiliation(s)
- Yu-Lung Lo
- Department of Mechanical Engineering, National Cheng Kung University (NCKU), Tainan 701401, Taiwan
- Academy of Innovative Semiconductor and Sustainable Manufacturing (AISSM), National Cheng Kung University (NCKU), Tainan 701401, Taiwan
| | - Yi-Sheng Chen
- Department of Mechanical Engineering, National Cheng Kung University (NCKU), Tainan 701401, Taiwan
| | - Po-Yu Wang
- Department of Mechanical Engineering, National Cheng Kung University (NCKU), Tainan 701401, Taiwan
| | - Ching-Min Chang
- Department of Electrical Engineering, Da-Yeh University, Changhua 515006, Taiwan
| | - Guan-Ting Wei
- Department of Mechanical Engineering, National Cheng Kung University (NCKU), Tainan 701401, Taiwan
| | - Wei-Chun Hung
- Department of Mechanical Engineering, National Cheng Kung University (NCKU), Tainan 701401, Taiwan
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48
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Fuhri Snethlage CM, de Wit D, Wortelboer K, Rampanelli E, Hanssen NMJ, Nieuwdorp M. Can fecal microbiota transplantations modulate autoimmune responses in type 1 diabetes? Immunol Rev 2024; 325:46-63. [PMID: 38752578 DOI: 10.1111/imr.13345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
Type 1 diabetes (T1D) is a chronic autoimmune disease targeting insulin-producing pancreatic beta cells. T1D is a multifactorial disease incorporating genetic and environmental factors. In recent years, the advances in high-throughput sequencing have allowed researchers to elucidate the changes in the gut microbiota taxonomy and functional capacity that accompany T1D development. An increasing number of studies have shown a role of the gut microbiota in mediating immune responses in health and disease, including autoimmunity. Fecal microbiota transplantations (FMT) have been largely used in murine models to prove a causal role of the gut microbiome in disease progression and have been shown to be a safe and effective treatment in inflammatory human diseases. In this review, we summarize and discuss recent research regarding the gut microbiota-host interactions in T1D, the current advancement in therapies for T1D, and the usefulness of FMT studies to explore microbiota-host immunity encounters in murine models and to shape the course of human type 1 diabetes.
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Affiliation(s)
- Coco M Fuhri Snethlage
- Department of Internal and Vascular Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Douwe de Wit
- Department of Internal and Vascular Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Koen Wortelboer
- Department of Internal and Vascular Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Elena Rampanelli
- Department of Internal and Vascular Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands
| | - Nordin M J Hanssen
- Department of Internal and Vascular Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
- Amsterdam Diabeter Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
- Amsterdam Diabeter Center, Amsterdam UMC, Amsterdam, The Netherlands
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Watso JC, Robinson AT, Singar SAB, Cuba JN, Koutnik AP. Advanced cardiovascular physiology in an individual with type 1 diabetes after 10-year ketogenic diet. Am J Physiol Cell Physiol 2024; 327:C446-C461. [PMID: 38912731 PMCID: PMC11427101 DOI: 10.1152/ajpcell.00694.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024]
Abstract
Adults with type 1 diabetes (T1D) have an elevated risk for cardiovascular disease (CVD) compared with the general population. HbA1c is the primary modifiable risk factor for CVD in T1D. Fewer than 1% of patients achieve euglycemia (<5.7% HbA1c). Ketogenic diets (KD; ≤50 g carbohydrate/day) may improve glycemia and downstream vascular dysfunction in T1D by reducing HbA1c and insulin load. However, there are concerns regarding the long-term CVD risk from a KD. Therefore, we compared data collected in a 60-day window in an adult with T1D on exogenous insulin who consumed a KD for 10 years versus normative values in those with T1D (T1D norms). The participant achieved euglycemia with an HbA1c of 5.5%, mean glucose of 98 [5] mg/dL (median [interquartile range]), 90 [11]% time-in-range 70-180 mg/dL (T1D norms: 1st percentile for all), and low insulin requirements of 0.38 ± 0.03 IU/kg/day (T1D norms: 8th percentile). Seated systolic blood pressure (SBP) was 113 mmHg (T1D norms: 18th percentile), while ambulatory awake SBP was 132 ± 15 mmHg (T1D target: <130 mmHg), blood triglycerides were 69 mg/dL (T1D norms: 34th percentile), low-density lipoprotein was 129 mg/dL (T1D norms: 60th percentile), heart rate was 56 beats/min (T1D norms: >1SD below the mean), carotid-femoral pulse wave velocity was 7.17 m/s (T1D norms: lowest quartile of risk), flow-mediated dilation was 12.8% (T1D norms: >1SD above mean), and cardiac vagal baroreflex gain was 23.5 ms/mmHg (T1D norms: >1SD above mean). Finally, there was no indication of left ventricular diastolic dysfunction from echocardiography. Overall, these data demonstrate below-average CVD risk relative to T1D norms despite concerns regarding the long-term impact of a KD on CVD risk.NEW & NOTEWORTHY Adults with type 1 diabetes (T1D) have a 10-fold higher risk for cardiovascular disease (CVD) compared with the general population. We assessed cardiovascular health metrics in an adult with T1D who presented with a euglycemic HbA1c after following a ketogenic diet for the past 10 years. Despite concerns about the ketogenic diet increasing CVD risk, the participant exhibited below-average CVD risk relative to others with T1D when considering all outcomes together.
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Affiliation(s)
- Joseph C Watso
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Austin T Robinson
- Neurovascular Physiology Laboratory, Indiana University, Bloomington, Indiana, United States
| | - Saiful Anuar Bin Singar
- Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Jens N Cuba
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, and Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Andrew P Koutnik
- Sansum Diabetes Research Institute, Santa Barbara, California, United States
- Human Healthspan, Resilience, and Performance, Florida Institute for Human and Machine Cognition, Pensacola, Florida, United States
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50
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D'Souza SE, Khan K, Jalal K, Hassam M, Uddin R. The Gene Network Correlation Analysis of Obesity to Type 1 Diabetes and Cardiovascular Disorders: An Interactome-Based Bioinformatics Approach. Mol Biotechnol 2024; 66:2123-2143. [PMID: 37606877 DOI: 10.1007/s12033-023-00845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
The current study focuses on the importance of Protein-Protein Interactions (PPIs) in biological processes and the potential of targeting PPIs as a new treatment strategy for diseases. Specifically, the study explores the cross-links of PPIs network associated with obesity, type 1 diabetes mellitus (T1DM), and cardiac disease (CD), which is an unexplored area of research. The research aimed to understand the role of highly connected proteins in the network and their potential as drug targets. The methodology for this research involves retrieving genes from the NCBI online gene database, intersecting genes among three diseases (type 1 diabetes, obesity, and cardiovascular) using Interactivenn, determining suitable drug molecules using NetworkAnalyst, and performing various bioinformatics analyses such as Generic Protein-Protein Interactions, topological properties analysis, function enrichment analysis in terms of GO, and Kyoto Encyclopedia of Genes and Genomes (KEGG), gene co-expression network, and protein drug as well as protein chemical interaction network. The study focuses on human subjects. The results of this study identified 12 genes [VEGFA (Vascular Endothelial Growth Factor A), IL6 (Interleukin 6), MTHFR (Methylenetetrahydrofolate reductase), NPPB (Natriuretic Peptide B), RAC1 (Rac Family Small GTPase 1), LMNA (Lamin A/C), UGT1A1 (UDP-glucuronosyltransferase family 1 membrane A1), RETN (Resistin), GCG (Glucagon), NPPA (Natriuretic Peptide A), RYR2 (Ryanodine receptor 2), and PRKAG2 (Protein Kinase AMP-Activated Non-Catalytic Subunit Gamma 2)] that were shared across the three diseases and could be used as key proteins for protein-drug/chemical interaction. Additionally, the study provides an in-depth understanding of the complex molecular and biological relationships between the three diseases and the cellular mechanisms that lead to their development. Potentially significant implications for the therapy and management of various disorders are highlighted by the findings of this study by improving treatment efficacy, simplifying treatment regimens, cost-effectiveness, better understanding of the underlying mechanism of these diseases, early diagnosis, and introducing personalized medicine. In conclusion, the current study provides new insights into the cross-links of PPIs network associated with obesity, T1DM, and CD, and highlights the potential of targeting PPIs as a new treatment strategy for these prevalent diseases.
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Affiliation(s)
- Sharon Elaine D'Souza
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Lab 103 PCMD Ext., Karachi, 75270, Pakistan
| | - Kanwal Khan
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Lab 103 PCMD Ext., Karachi, 75270, Pakistan
| | - Khurshid Jalal
- HEJ Research Institute of Chemistry International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Muhammad Hassam
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Lab 103 PCMD Ext., Karachi, 75270, Pakistan
| | - Reaz Uddin
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Lab 103 PCMD Ext., Karachi, 75270, Pakistan.
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