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Lavelle K, Chamberlain C, German M, Anderson M, Nip A, Gitelman SE. The Role of Imatinib in Pediatric Type 1 Diabetes. JCEM CASE REPORTS 2024; 2:luae065. [PMID: 38707652 PMCID: PMC11066799 DOI: 10.1210/jcemcr/luae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Indexed: 05/07/2024]
Abstract
We report the first case of imatinib use in an adolescent with diabetes and suggest that it impacts the natural course of disease. A 14-year-old male patient presented in diabetic ketoacidosis (DKA) and was diagnosed with presumed autoantibody-negative type 1 diabetes (T1D) as well as myeloid neoplasm with platelet-derived growth factor receptor beta (PDGFRB) rearrangement. After starting exogenous insulin and imatinib, he experienced a 1.7-point reduction in glycated hemoglobin (HbA1c) and a 71% reduction in insulin requirement with sustained partial diabetes remission. Our case suggests imatinib as a potential therapeutic agent for pediatric T1D.
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Affiliation(s)
- Kristen Lavelle
- Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, CA 94143, USA
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA 94143, USA
- Diabetes Center, University of California, San Francisco, CA 94143, USA
| | - Chester Chamberlain
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA 94143, USA
- Diabetes Center, University of California, San Francisco, CA 94143, USA
| | - Michael German
- Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, CA 94143, USA
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA 94143, USA
- Diabetes Center, University of California, San Francisco, CA 94143, USA
| | - Mark Anderson
- Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Francisco, CA 94143, USA
- Diabetes Center, University of California, San Francisco, CA 94143, USA
| | - Angel Nip
- Department of Pediatrics, Division of Endocrinology, University of California, San Francisco, CA 94143, USA
| | - Stephen E Gitelman
- Diabetes Center, University of California, San Francisco, CA 94143, USA
- Department of Pediatrics, Division of Endocrinology, University of California, San Francisco, CA 94143, USA
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Ferreira ROM, Trevisan T, Pasqualotto E, Chavez MP, Marques BF, Lamounier RN, van de Sande-Lee S. Continuous Glucose Monitoring Systems in Noninsulin-Treated People with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Technol Ther 2024; 26:252-262. [PMID: 38090767 DOI: 10.1089/dia.2023.0390] [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: 02/16/2024]
Abstract
Introduction: Continuous glucose monitoring (CGM) has shown favorable outcomes in patients with type 2 diabetes (T2D) who are on insulin therapy. However, the efficacy of CGM in managing glucose levels in noninsulin-treated people with T2D remains controversial. Methods: PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing CGM to self-monitoring of blood glucose (SMBG) in people with T2D not using insulin. We computed weighted mean differences (WMDs) and standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Statistical analyses were performed using R version 4.2.3. Results: We included six RCTs comprising 407 noninsulin-treated people with T2D of whom 228 were randomized to CGM. Diabetes duration ranged from 5.4 to 13.9 years. The mean age was 57.9 years and the mean body mass index was 30.8 kg/m2. Four trials used real-time CGM (rt-CGM) and two intermittent scanning CGM (is-CGM). Compared with SMBG, CGM significantly reduced the glycated hemoglobin level (WMD -0.31%; 95% CI -0.42 to -0.21; I2 = 0%), glucose level (WMD -11.16 mg/dL; 95% CI -19.94 to -2.39; I2 = 0%), time in hypoglycemia level 2 (WMD -0.28%; 95% CI -0.52 to -0.03; I2 = 91%), glucose time >180 mg/dL (WMD -7.75%; 95% CI -12.04 to -3.45; I2 = 0%), and the standard deviation of glucose variation (WMD -4.00 mg/dL; 95% CI -6.86 to -1.14; I2 = 0%). CGM also increased time in range (WMD 8.63%; 95% CI 4.54-12.71; I2 = 0%) and treatment satisfaction (SMD 0.79; 95% CI 0.54-1.05; I2 = 0%). Conclusion: In this meta-analysis, rt-CGM and is-CGM were associated with improvement in glycemic control in people with T2D not using insulin when compared to SMBG.
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Affiliation(s)
| | - Talita Trevisan
- Private Practice, Talita Trevisan Endocrinologia, Itajaí, Brazil
| | - Eric Pasqualotto
- Federal University of Santa Catarina, Department of Internal Medicine, Florianopolis, Brazil
| | - Matheus Pedrotti Chavez
- Federal University of Santa Catarina, Department of Internal Medicine, Florianopolis, Brazil
| | | | | | - Simone van de Sande-Lee
- Federal University of Santa Catarina, Department of Internal Medicine, Florianopolis, Brazil
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Inkeri J, Harjutsalo V, Martola J, Putaala J, Groop PH, Gordin D, Thorn LM. No correlation between carotid intima-media thickness and long-term glycemic control in individuals with type 1 diabetes. Acta Diabetol 2024; 61:441-449. [PMID: 38071692 DOI: 10.1007/s00592-023-02211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/07/2023] [Indexed: 03/27/2024]
Abstract
AIMS To determine whether carotid intima-media thickness (CIMT), a surrogate marker of cardiovascular disease (CVD), is associated with long-term blood glucose control in individuals with type 1 diabetes (T1D). METHODS We recruited 508 individuals (43.4% men; median age 46.1, IQR 37.8-55.9 years) with T1D (median diabetes duration of 30.4, IQR 21.2-40.8 years) in a cross-sectional retrospective sub-study, part of the Finnish Diabetic Nephropathy (FinnDiane) Study. Glycated hemoglobin (HbA1c) data were collected retrospectively over the course of ten years (HbA1c-meanoverall) prior to the clinical study visit that included a clinical examination, biochemical sampling, and ultrasound of the common carotid arteries. RESULTS Individuals with T1D had a median CIMT of 606 μm (IQR 538-683 μm) and HbA1c of 8.0% (7.3-8.8%) during the study visit and HbA1c-meanoverall of 8.0% (IQR 7.3-8.8%). CIMT did not correlate with HbA1c (p = 0.228) at visit or HbA1c-meanoverall (p = 0.063). After controlling for relevant factors in multivariable linear regression analysis, only age was associated with CIMT (p < 0.001). After further dividing CIMT into quartiles, no correlation between long-term glucose control and CIMT (%, 1st 8.1 [IQR 7.2-8.9] vs 4th 7.9 [7.4-8.7], p = 0.730) was found. CONCLUSIONS We observed no correlation between long-term blood glucose control and CIMT in individuals with T1D. This finding suggests that the development of early signs of macrovascular atherosclerosis is not strongly affected by the glycemic control in people with T1D.
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Affiliation(s)
- Jussi Inkeri
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, P.O. Box 63 (C318b), 00014, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, P.O. Box 63 (C318b), 00014, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Martola
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jukka Putaala
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, P.O. Box 63 (C318b), 00014, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.
| | - Daniel Gordin
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lena M Thorn
- Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, P.O. Box 63 (C318b), 00014, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Akasha R, Ahmad S, Abdeen R, Abulgasim S, Barnawi H, Elhussein N, Hussien A R, Alshammari DN, Elafandy N, Alouffi S. Linking elevated HbA1c with atherogenic lipid profile among high risk cardiovascular patients at Qassim, Saudi Arabia. Bioinformation 2024; 20:212-216. [PMID: 38711997 PMCID: PMC11069612 DOI: 10.6026/973206300200212] [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: 03/01/2024] [Revised: 03/31/2024] [Accepted: 03/31/2024] [Indexed: 05/08/2024] Open
Abstract
The relationship between glycated hemoglobin (HbA1c) and an atherogenic lipid profile which is associated with a higher risk of cardiovascular disease is of interest. A retrospective cross-sectional study was conducted on 83 participants aged between 14 and 77 years. Their venous blood was drawn to determine the HbA1c and fasting lipid profile including total cholesterol triglycerides and high-density lipoprotein cholesterol (HDL-C) low-density lipoprotein cholesterol (LDL-C) non-HDL cholesterol and the LDL/HDL ratio were also calculated. The correlations between HbA1c levels and these lipid profile parameters were analyzed. The study showed a significant correlation between HbA1c and LDL-C non-HDL-C and the LDL/HDL ratio. Although there was no significant difference in total cholesterol levels among all groups the levels of total cholesterol and HbA1c were positively correlated. HDL-C exhibited direct correlations with HbA1c there was no correlation between HbA1c and clinical characteristics except for age. Data shows that HbA1c can be used as a predictor of dyslipidemia in diabetic patients there is a significant correlation between HbA1c and an atherogenic lipid profile which highlights the importance of glycemic control in reducing the risk of cardiovascular disease.
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Affiliation(s)
- Rihab Akasha
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Saheem Ahmad
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Rnada Abdeen
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Sara Abulgasim
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Heba Barnawi
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Nagwan Elhussein
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Rehab Hussien A
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Dina Nawaf Alshammari
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Nancy Elafandy
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Sultan Alouffi
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
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Rigon FA, Ronsoni MF, Hohl A, Vianna AGD, Sande-Lee SVD, Schiavon LDL. Intermittently Scanned Continuous Glucose Monitoring Performance in Patients With Liver Cirrhosis. J Diabetes Sci Technol 2024:19322968241232686. [PMID: 38439562 DOI: 10.1177/19322968241232686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
AIM To evaluate the use of intermittently scanned continuous glucose monitoring (isCGM) in patients with liver cirrhosis (LC). METHODS Observational study including 30 outpatients with LC (Child-Pugh B/C): 10 without diabetes (DM) (G1), 10 with newly diagnosed DM by oral glucose tolerance test (G2), and 10 with a previous DM diagnosis (G3). isCGM (FreeStyle Libre Pro) was used for 56 days (four sensors/patient). Blood tests were performed at baseline and after 28 and 56 days. RESULTS No differences were found in the baseline characteristics, except for higher age in G3. There were significant differences between G1, G2 and G3 in glucose management indicator (GMI) (5.28 ± 0.17, 6.03 ± 0.59, 6.86 ± 1.08%, P < .001), HbA1c (4.82 ± 0.39, 5.34 ± 1.26, 6.97 ± 1.47%, P < .001), average glucose (82.79 ± 7.06, 113.39 ± 24.32, 149.14 ± 45.31mg/dL, P < .001), time in range (TIR) (70.89 ± 9.76, 80.2 ± 13.55, 57.96 ± 17.96%, P = .006), and glucose variability (26.1 ± 5.0, 28.21 ± 5.39, 35.31 ± 6.85%, P = .004). There was discordance between GMI and HbA1c when all groups were considered together, with a mean difference of 0.35% (95% SD 0.17, 0.63). In G1, the mean difference was 0.46% (95% SD 0.19, 0.73) and in G2 0.69% (95% SD 0.45, 1.33). GMI and HbA1c were concordant in G3, with a mean difference of -0.10 % (95% SD [-0.59, 0.38]). CONCLUSION Disagreements were found between the GMI and HbA1c levels in patients with LC. isCGM was able to detect abnormalities in glycemic control that would not be detected by monitoring with HbA1c, suggesting that isCGM can be useful in assessing glycemic control in patients with LC.
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Affiliation(s)
- Fernanda Augustini Rigon
- Graduate Program in Medical Sciences, Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Alexandre Hohl
- Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Brazil
| | - André Gustavo Daher Vianna
- Curitiba Diabetes Center, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Simone van de Sande-Lee
- Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Brazil
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Akturk HK, Battelino T, Castañeda J, Arrieta A, van den Heuvel T, Cohen O. Future of Time-in-Range Goals in the Era of Advanced Hybrid Closed-Loop Automated Insulin Delivery Systems. Diabetes Technol Ther 2024; 26:102-106. [PMID: 38377325 PMCID: PMC10890947 DOI: 10.1089/dia.2023.0432] [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: 02/22/2024]
Abstract
The concept of maintaining blood glucose levels within the 70-180 mg/dL range, known as time-in-range, has raised questions regarding its representation of true physiological euglycemia. Some have speculated that focusing on the time spent within the 70-140 mg/dL range, introduced as time in tight range (TITR) through the International Consensus statement, could serve as a more precise metric for assessing normoglycemia in individuals with type 1 diabetes. This article delves into the current status of TITR as an emerging marker and explores how advanced hybrid closed-loop systems may offer a promising avenue for achieving this higher level of glycemic control.
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Affiliation(s)
- Halis K. Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, Colorado, USA
| | - Tadej Battelino
- University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Arcelia Arrieta
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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7
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He B, Fan L, Deng C, Liu F, Xie Y, Zhou Z, Li X. Implications of glycemic risk index across different levels of glycated hemoglobin (HbA1c) in type 1 diabetes. Chin Med J (Engl) 2024; 137:481-483. [PMID: 38225725 PMCID: PMC10876242 DOI: 10.1097/cm9.0000000000002983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Indexed: 01/17/2024] Open
Affiliation(s)
- Binbin He
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Li Fan
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Chao Deng
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Yuting Xie
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Xia Li
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
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Akturk HK. Limitations of 14-Day Continuous Glucose Monitoring Sampling for Assessment of Hypoglycemia and Glycemic Variability in Type 1 Diabetes. Diabetes Technol Ther 2024. [PMID: 38300516 DOI: 10.1089/dia.2023.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Continuous glucose monitoring (CGM) has become the standard of care in diabetes management with the recent advances in technology and accessibility in the last decade. An International Consensus was established to define CGM metrics and its goals in diabetes care. The 2019 International Consensus suggested 14 days of CGM sampling for the assessment of CGM metrics stating the limitations that may occur for hypoglycemia and glycemic variability metrics. Since then, several studies assessed the correlation between CGM metrics and duration of the sampling period. This review summarized the studies that investigated the relationship between 14-day CGM sampling to 90-day CGM data in >70% CGM users for all CGM metrics and highlighted possible solutions for more accurate CGM sampling durations in type 1 diabetes (T1D). Accumulating evidence showed that 14-day CGM sampling correlates well with 90-day CGM data for mean glucose, time in 70-180 mg/dL, and hyperglycemia metrics; however, it correlates weakly for hypoglycemia and glycemic variability metrics. In the studies included in this review, in adults with T1D, minimum sampling duration was 14 days for mean glucose, time in 70-180 mg/dL, and time in hyperglycemia (>180 and >250 mg/dL); however, minimum sampling duration varied between 21 to 30 days for time <70 mg/dL, 30 to 35 days for time <54 mg/dL, and 28 to 35 days for coefficient of variation. Longer than 14 days of CGM, sampling was required to properly assess hypoglycemia and glycemic variability in T1D.
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Affiliation(s)
- Halis Kaan Akturk
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
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Singh A, Singh K, Kaur K, Sharma A, Mohana P, Prajapati J, Kaur U, Goswami D, Arora S, Chadha R, Bedi PMS. Discovery of triazole tethered thymol/carvacrol-coumarin hybrids as new class of α-glucosidase inhibitors with potent in vivo antihyperglycemic activities. Eur J Med Chem 2024; 263:115948. [PMID: 37984299 DOI: 10.1016/j.ejmech.2023.115948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/04/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
Keeping in view the inhibitory potential of monoterpenes thymol and carvacrol as well as coumarin nucleus against α-glucosidase, novel series of thymol/carvacrol-coumarin hybrids was designed, synthesized and evaluated for α-glucosidase inhibitory potential. Among the series of hybrid molecules, AS14 with IC50 value of 4.32 ± 0.11 μM was selective α-glucosidase inhibitor over α-amylase (IC50 = 37.36 ± 0.84 μM). AS14 was non-toxic toward mouse normal fibroblast cells (L929: IC50 > 100 μM). Molecular docking and dynamic simulation studies confirmed desired interactions of AS14 with α-glucosidase responsible for the inhibition of its catalysis capabilities. Acute oral toxicity study confirmed AS14 as safer molecule for in vivo pharmacological investigations with LD50 value of 300 mg/kg. AS14 also showed acute hypoglycaemic effects [reduction in blood glucose levels at 1 h of administration in maltose loading test (at 10 and 20 mg/kg by 62.65 % and 70.12 %) and sucrose loading test (at 10 and 20 mg/kg by 59.65 % and 60.23 %), respectively] as well as long term (28 days) fasting blood glucose reduction (At day 28: 10 mg/kg = 54.69 % and 20 mg/kg = 62.23 % reduction in fasting blood glucose levels) capabilities in streptozotocin induced diabetic rats. Overall study represents, AS14 as potential α-glucosidase inhibitor with adequate efficacy and safety profile and act as an effective hit lead for the further development of potent and safer α-glucosidase inhibitors for the management of postprandial hyperglycemia in diabetic patients.
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Affiliation(s)
- Atamjit Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India.
| | - Karanvir Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Kirandeep Kaur
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Aman Sharma
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Pallvi Mohana
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Jignesh Prajapati
- Department of Microbiology & Biotechnology, University School of Sciences, Gujrat University, Ahmedabad, Gujrat, 380009, India
| | - Uttam Kaur
- University School of Business Management, Chandigarh University, Gharuan, 140413, India
| | - Dweipayan Goswami
- Department of Microbiology & Biotechnology, University School of Sciences, Gujrat University, Ahmedabad, Gujrat, 380009, India
| | - Saroj Arora
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Renu Chadha
- University Institute of Pharmaceutical Sciences, Punjab University, Chandigarh, 160014, India
| | - Preet Mohinder Singh Bedi
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India; Drug and Pollution Testing Laboratory, Guru Nanak Dev University, Amritsar, Punjab, 143005, India.
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Mukherjee S, Yadav P, Ray SK, Jadhav AA, Wakode SL. Clinical Risk Assessment and Comparison of Bias between Laboratory Methods for Estimation of HbA1c for Glycated Hemoglobin in Hyperglycemic Patients. Curr Diabetes Rev 2024; 20:e261023222764. [PMID: 37921160 DOI: 10.2174/0115733998257140231011102518] [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: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Hemoglobin A1c (HbA1c), also known as glycated hemoglobin, is a blood test used to evaluate and track a patient's blood sugar levels over the previous 2-3 months. We have compared the analytical performance of the D10 hemoglobin (HPLC) testing system to that of the immunoturbidimetric technique, which is a light-scattering immunoassay. OBJECTIVES To assess the clinical risk assessment between two methods (Compare the two Immunoturbidometric methods (AU680) vs. HPLC method (D10)) in hyperglycemic patients and assess the acceptability of the respective methods in the Clinical biochemistry laboratory. METHODS The charge of the globins in Hb was used as the basis for the HPLC method used to measure HbA1c. HPLC detects and quantifies even the tiniest Hb fractions and the full spectrum of Hb variants. HbA1c was measured using the immunoturbidimetric (AU 680 Beckmann coulter analyzer) and high-performance liquid chromatography (HPLC) techniques. Experiments also made use of immunoturbidimetric techniques (using an AU 680 Beckmann coulter analyzer equipment). RESULTS There is no statistically significant difference in HbA1c readings between male and female patients, as measured by either the Immunoturbidimetric or HPLC techniques. CONCLUSION The immunoturbidimetric and high-performance liquid chromatography techniques for estimating HbA1c yielded identical results. From the results of this study, we may deduce that both techniques are valid for estimating HbA1c. As a result, it may be suggested that both approaches can be used to estimate HbA1c in diabetic individuals.
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Affiliation(s)
- Sukhes Mukherjee
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Prasant Yadav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Suman Kumar Ray
- Independent Researcher, Bhopal, Madhya Pradesh, 462020, India
| | - Ashish A Jadhav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Santosh L Wakode
- Department of Physiology. All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
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Kassavin D, Mota L, Ostertag-Hill CA, Kassavin M, Himmelstein DU, Woolhandler S, Wang SX, Liang P, Schermerhorn ML, Vithiananthan S, Kwoun M. Amputation Rates and Associated Social Determinants of Health in the Most Populous US Counties. JAMA Surg 2024; 159:69-76. [PMID: 37910120 PMCID: PMC10620677 DOI: 10.1001/jamasurg.2023.5517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/07/2023] [Indexed: 11/03/2023]
Abstract
Importance Social Determinants of Health (SDOH) have been found to be associated with health outcome disparities in patients with peripheral artery disease (PAD). However, the association of specific components of SDOH and amputation has not been well described. Objective To evaluate whether individual components of SDOH and race are associated with amputation rates in the most populous counties of the US. Design, Setting, and Participants In this population-based cross-sectional study of the 100 most populous US counties, hospital discharge rates for lower extremity amputation in 2017 were assessed using the Healthcare Cost and Utilization Project State Inpatient Database. Those data were matched with publicly available demographic, hospital, and SDOH data. Data were analyzed July 3, 2022, to March 5, 2023. Main outcome and Measures Amputation rates were assessed across all counties. Counties were divided into quartiles based on amputation rates, and baseline characteristics were described. Unadjusted linear regression and multivariable regression analyses were performed to assess associations between county-level amputation and SDOH and demographic factors. Results Amputation discharge data were available for 76 of the 100 most populous counties in the United States. Within these counties, 15.3% were African American, 8.6% were Asian, 24.0% were Hispanic, and 49.6% were non-Hispanic White; 13.4% of patients were 65 years or older. Amputation rates varied widely, from 5.5 per 100 000 in quartile 1 to 14.5 per 100 000 in quartile 4. Residents of quartile 4 (vs 1) counties were more likely to be African American (27.0% vs 7.9%, P < .001), have diabetes (10.6% vs 7.9%, P < .001), smoke (16.5% vs 12.5%, P < .001), be unemployed (5.8% vs 4.6%, P = .01), be in poverty (15.8% vs 10.0%, P < .001), be in a single-parent household (41.9% vs 28.6%, P < .001), experience food insecurity (16.6% vs 12.9%, P = .04), or be physically inactive (23.1% vs 17.1%, P < .001). In unadjusted linear regression, higher amputation rates were associated with the prevalence of several health problems, including mental distress (β, 5.25 [95% CI, 3.66-6.85]; P < .001), diabetes (β, 1.73 [95% CI, 1.33-2.15], P < .001), and physical distress (β, 1.23 [95% CI, 0.86-1.61]; P < .001) and SDOHs, including unemployment (β, 1.16 [95% CI, 0.59-1.73]; P = .03), physical inactivity (β, 0.74 [95% CI, 0.57-0.90]; P < .001), smoking, (β, 0.69 [95% CI, 0.46-0.92]; P = .002), higher homicide rate (β, 0.61 [95% CI, 0.45-0.77]; P < .001), food insecurity (β, 0.51 [95% CI, 0.30-0.72]; P = .04), and poverty (β, 0.46 [95% CI, 0.32-0.60]; P < .001). Multivariable regression analysis found that county-level rates of physical distress (β, 0.84 [95% CI, 0.16-1.53]; P = .03), Black and White racial segregation (β, 0.12 [95% CI, 0.06-0.17]; P < .001), and population percentage of African American race (β, 0.06 [95% CI, 0.00-0.12]; P = .03) were associated with amputation rate. Conclusions and Relevance Social determinants of health provide a framework by which the associations of environmental factors with amputation rates can be quantified and potentially used to guide interventions at the local level.
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Affiliation(s)
- Daniel Kassavin
- Division of Vascular Surgery, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Lucas Mota
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Monica Kassavin
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - David U. Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
- School of Urban Public Health, City University of New York at Hunter College, New York, New York
| | - Steffie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
- School of Urban Public Health, City University of New York at Hunter College, New York, New York
| | - Sophie X. Wang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Marc L. Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Moon Kwoun
- Division of Vascular Surgery, Cambridge Health Alliance, Cambridge, Massachusetts
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Desouza CV, Rosenstock J, Kohzuma T, Fonseca VA. Glycated Albumin Correlates With Time-in-Range Better Than HbA1c or Fructosamine. J Clin Endocrinol Metab 2023; 108:e1193-e1198. [PMID: 37259605 PMCID: PMC10583977 DOI: 10.1210/clinem/dgad298] [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: 02/14/2023] [Revised: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023]
Abstract
CONTEXT Intermediate-term glycemic control metrics may represent a viable alternative to continuous glucose monitoring (CGM) in patients without access to CGM. OBJECTIVE This work aimed to compare the relationship between CGM parameters and glycated albumin (GA), glycated hemoglobin A1c (HbA1c), and fructosamine for 24 weeks. METHODS We conducted exploratory comparative analyses of CGM subgroup data from a previously published 24-week prospective study of assay performance in 8 US clinics. Participants included 34 individuals with type 1 (n = 18) and type 2 diabetes (n = 16) undergoing changes to improve glycemic control (n = 22; group 1) or with stable diabetes therapy (n = 12; group 2). Main outcome measures included Pearson correlations between CGM and glycemic indices and receiver operating characteristic (ROC) analysis of glycemic index values predictive of time in range (TIR) greater than 70%. RESULTS At weeks 4 and 8, GA correlations with TIR were higher than HbA1c correlations in group 1. In group 2, GA correlations with TIR were statistically significant, whereas HbA1c correlations were not. In both groups over the first 12 weeks, GA correlations with TIR were higher than fructosamine-TIR correlations. In the ROC analysis, GA predicted a TIR greater than 70% during weeks 2 to 24 (area under the curve >0.80); HbA1c was predictive during weeks 12 to 24. Cutoff values for TIR greater than 70% were 17.5% (sensitivity and specificity, 0.88) for GA and 7.3% (0.86) for HbA1c. CONCLUSION GA is the most accurate predictor of TIR over 8 weeks compared with other glycemic indices, which may assist in clinical evaluation of changes in treatment where CGM is not possible and it is too early to use HbA1c (NCT02489773).
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Affiliation(s)
- Cyrus V Desouza
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Julio Rosenstock
- Velocity Clinical Research at Medical City, Dallas, TX 75230, USA
| | - Takuji Kohzuma
- Research and Development Department, Asahi Kasei Pharma, Tokyo 100-0006, Japan
| | - Vivian A Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA 70112, USA
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Toyoshima MTK, Cukier P, Damascena AS, Batista RL, de Azevedo Correa F, Zanatta Kawahara E, Minanni CA, Hoff AO, Nery M. Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study). Clinics (Sao Paulo) 2023; 78:100240. [PMID: 37390617 PMCID: PMC10338289 DOI: 10.1016/j.clinsp.2023.100240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Glycemic control is important to avoid diabetes complications in individuals with cancer. There is no evidence for HbA1c and fructosamine as reliable biomarkers in these conditions. There are particularities in caring for patients with diabetes and cancer that can alter these biomarkers. OBJECTIVE The aim of this study was to evaluate HbA1c and fructosamine as glycemic biomarkers in people with type 2 diabetes and cancer, undergoing clinical or surgical oncological treatment. METHODS The authors conducted a single-center, retrospective analysis with people who have cancer and diabetes. Comparison of glycemic biomarkers (HbA1c, fructosamine, and Self-Monitoring of Blood Glucose [SMBG]) was performed including evaluation in individuals undergoing chemotherapy, using glucocorticoids, with anemia, hypoproteinemia or with reduced estimated Glomerular Filtration Rate (eGFR). RESULTS There was a strong positive correlation between fructosamine and HbA1c (n = 318, r = 0.66, p < 0.001) in people with diabetes and cancer even in those under chemotherapy (n = 101, r = 0.61, p < 0.001) or using glucocorticoids (n = 96, r = 0.67, p<0.001). There was a strong correlation between HbA1c and fructosamine in subjects with anemia (n = 111, r = 0.66, p < 0.001), hypoproteinemia (n = 54, r = 0.67, p < 0.001), or with eGFR ≥ 60 mL/min/1.73 m2 (n = 189, r = 0.70, p < 0.001), and moderate correlation with hypoalbuminemia (n = 21, r = 0.54, p = 0.001) and with reduced eGFR (n = 67, r = 0.57, p < 0.001). The correlations between fructosamine and HbA1c with SMBG were moderate (n = 164, r = 0.49, p < 0.001; n = 111, r = 0.55, p < 0.001, respectively), strong in subjects undergoing chemotherapy, with hypoalbuminemia or hypoproteinemia, and at least moderate, if eGFR < 60 mL/min/1.73 m2 or with anemia. CONCLUSIONS Fructosamine and HbA1c can be used as glycemic biomarkers in people with diabetes and cancer, even in those with anemia, hypoproteinemia, or undergoing chemotherapy.
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Affiliation(s)
- Marcos Tadashi Kakitani Toyoshima
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Priscilla Cukier
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Serviço de Endocrinologia e Metabologia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aline Santos Damascena
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rafael Loch Batista
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fernanda de Azevedo Correa
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Zanatta Kawahara
- Serviço de Endocrinologia e Metabologia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos André Minanni
- Serviço de Endocrinologia e Metabologia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ana O Hoff
- Serviço de Onco-Endocrinologia, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcia Nery
- Serviço de Endocrinologia e Metabologia. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Sun R, Duan Y, Zhang Y, Feng L, Ding B, Yan R, Ma J, Su X. Time in Range Estimation in Patients with Type 2 Diabetes is Improved by Incorporating Fasting and Postprandial Glucose Levels. Diabetes Ther 2023:10.1007/s13300-023-01432-2. [PMID: 37328714 PMCID: PMC10299970 DOI: 10.1007/s13300-023-01432-2] [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: 05/04/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Time in range (TIR) as assessed by continuous glucose monitoring (CGM) measures an individual's glucose fluctuations within set limits in a time period and is increasingly used together with HbA1c in patients with diabetes. HbA1c indicates the average glucose concentration but provides no information on glucose fluctuation. However, before CGM becomes available for patients with type 2 diabetes (T2D) worldwide, especially in developing nations, fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) are still the common biomarkers used for monitoring diabetes conditions. We investigated the importance of FPG and PPG to glucose fluctuation in patients with T2D. We used machine learning to provide a new estimate of TIR based on the HbA1c, together with FPG and PPG. METHODS This study included 399 patients with T2D. (1) Univariate and (2) multivariate linear regression models and (3) random forest regression models were developed to predict the TIR. Subgroup analysis was performed in the newly diagnosed T2D population to explore and optimize the prediction model for patients with different disease history. RESULTS Regression analysis suggests that FPG was strongly linked to minimum glucose, while PPG was strongly correlated with maximum glucose. After FPG and PPG were incorporated into the multivariate linear regression model, the prediction performance of TIR was improved compared with the univariate correlation between HbA1c and TIR, and the correlation coefficient (95% CI) increased from 0.62 (0.59, 0.65) to 0.73 (0.72, 0.75) (p < 0.001). The random forest model significantly outperformed the linear model (p < 0.001) in predicting TIR through FPG, PPG and HbA1c, with a stronger correlation coefficient 0.79 (0.79, 0.80). CONCLUSIONS The results offered a comprehensive understanding of glucose fluctuations through FPG and PPG compared to HbA1c alone. Our novel TIR prediction model based on random forest regression with FPG, PPG, and HbA1c provides a better prediction performance than the univariate model with solely HbA1c. The results indicate a nonlinear relationship between TIR and glycaemic parameters. Our results suggest that machine learning may have the potential to be used in developing better models for understanding patients' disease status and providing necessary interventions for glycaemic control.
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Affiliation(s)
- Rui Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yanli Duan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yumei Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rengna Yan
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Cho SH, Kim S, Lee YB, Jin SM, Hur KY, Kim G, Kim JH. Impact of continuous glucose monitoring on glycemic control and its derived metrics in type 1 diabetes: a longitudinal study. Front Endocrinol (Lausanne) 2023; 14:1165471. [PMID: 37255973 PMCID: PMC10225713 DOI: 10.3389/fendo.2023.1165471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023] Open
Abstract
Aim We explored the effectiveness of continuous glucose monitoring for 1 year on glycated A1c reduction in adults with type 1 diabetes mellitus. Methods We included type 1 diabetes mellitus adults who were either new continuous glucose monitoring users (N = 155) or non-users who were under standard care (N = 384). Glycated A1c was measured at baseline and 3, 6, 9, and 12 months. Individuals with (N = 155) or without continuous glucose monitoring use (N = 310) were matched 1:2 by propensity score. We used the linear mixed models to identify the quantitative reduction in repeated measures of glycated A1c. Results The change in glycated A1c from baseline to 12 months was -0.5% ± 1.0% for the continuous glucose monitoring user group (N = 155, P < 0.001) and -0.01% ± 1.0% for the non-user group (N = 310, P = 0.816), with a significant difference between the two groups (P = 0.003). Changes in glycated A1c were significant at 3, 6, 9, and 12 months compared with those at baseline in patients using continuous glucose monitoring (P < 0.001), and the changes differed significantly between the groups (P < 0.001). A linear mixed model showed an adjusted treatment group difference in mean reduction in glycated A1c of -0.11% (95% confidence interval, -0.16 to -0.06) each three months. In the continuous glucose monitoring user group, those who achieved more than 70% of time in range significantly increased from 3 months (37.4%) to 12 months (48.2%) (P < 0.001). Conclusion In this longitudinal study of type 1 diabetes mellitus adults, the use of continuous glucose monitoring for 1 year showed a significant reduction in glycated A1c in real-world practice.
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Affiliation(s)
- So Hyun Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seohyun Kim
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Elmalti A, Mukhtar M, Kenz S, Skaria S, Elgzyri T. Transient increase in glucose variability during Ramadan fasting in patients with insulin-treated type 2 diabetes: A preliminary study. Diabetes Metab Syndr 2023; 17:102745. [PMID: 37001416 DOI: 10.1016/j.dsx.2023.102745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/28/2023]
Abstract
AIM We aimed to examine the effect of Ramadan fasting on interstitial glucose control and variability before, during, and after Ramadan in type 2 diabetes patients receiving insulin therapy. METHODS Participants received a flash glucose monitoring (FGM) system one week before Ramadan that was removed on the sixth or seventh day (pre- and early Ramadan periods) of Ramadan and a second FGM system one week before the end of Ramadan that was removed one week after the end of Ramadan (late and post-Ramadan periods). Fasting blood samples were collected during the pre-, early, and late Ramadan study visits and tested for HbA1c, serum creatinine, and plasma glucose levels. RESULTS Thirty-four patients were prospectively included. The standard deviation and coefficient of variation of glucose concentrations were higher in the early Ramadan period than in the pre-Ramadan period, but did not differ in the late or post-Ramadan periods. Changes in the early Ramadan period were restricted to males and patients aged <55 years. No significant changes were observed in the average glucose level, glucose management indicator, time in range, time in hyperglycemia, or time in hypoglycemia at any time point. CONCLUSIONS Ramadan fasting in patients with insulin-treated type 2 diabetes is associated with an initial increase in glucose variability that quickly returned to pre-Ramadan levels. Ramadan fasting was not associated with any significant changes in glycemic control measures.
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Affiliation(s)
- Akrem Elmalti
- Rashid Center for Diabetes and Research, Shiekh Khalifa Medical City Ajman, Ajman, United Arab Emirates
| | - Mamoun Mukhtar
- Rashid Center for Diabetes and Research, Shiekh Khalifa Medical City Ajman, Ajman, United Arab Emirates
| | - Sami Kenz
- Rashid Center for Diabetes and Research, Shiekh Khalifa Medical City Ajman, Ajman, United Arab Emirates
| | - Sijomol Skaria
- Rashid Center for Diabetes and Research, Shiekh Khalifa Medical City Ajman, Ajman, United Arab Emirates
| | - Targ Elgzyri
- Endocrinology Department, Skåne University Hospital, Malmo, Sweden.
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Karges B, Tittel SR, Bey A, Freiberg C, Klinkert C, Kordonouri O, Thiele-Schmitz S, Schröder C, Steigleder-Schweiger C, Holl RW. Continuous glucose monitoring versus blood glucose monitoring for risk of severe hypoglycaemia and diabetic ketoacidosis in children, adolescents, and young adults with type 1 diabetes: a population-based study. Lancet Diabetes Endocrinol 2023; 11:314-323. [PMID: 37004710 DOI: 10.1016/s2213-8587(23)00061-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The effect of continuous glucose monitoring on the risk of severe hypoglycaemia and ketoacidosis in patients with diabetes is unclear. We investigated whether rates of acute diabetes complications are lower with continuous glucose monitoring, compared with blood glucose monitoring, and which metrics predict its risk in young patients with type 1 diabetes. METHODS In this population-based cohort study, patients were identified from 511 diabetes centres across Austria, Germany, Luxembourg, and Switzerland participating in the Diabetes Prospective Follow-up initiative. We included people with type 1 diabetes aged 1·5-25·0 years, with a diabetes duration of more than 1 year, who had been treated between Jan 1, 2014, and June 30, 2021, and had an observation time of longer than 120 days in the most recent treatment year. Severe hypoglycaemia and ketoacidosis rates during the most recent treatment year were examined in people using continuous glucose monitoring and in those using blood glucose monitoring. Adjustments of statistical models included age, sex, diabetes duration, migration background, insulin therapy (pump or injections), and treatment period. Rates of severe hypoglycaemia and diabetic ketoacidosis were evaluated by several continuous glucose monitoring metrics, including percentage of time below target glucose range (<3·9 mmol/L), glycaemic variability (measured as the coefficient of variation), and mean sensor glucose. FINDINGS Of 32 117 people with type 1 diabetes (median age 16·8 years [IQR 13·3-18·1], 17 056 [53·1%] males), 10 883 used continuous glucose monitoring (median 289 days per year), and 21 234 used blood glucose monitoring. People using continuous glucose monitoring had lower rates of severe hypoglycaemia than those using blood glucose monitoring (6·74 [95% CI 5·90-7·69] per 100 patient-years vs 8·84 [8·09-9·66] per 100 patient-years; incidence rate ratio 0·76 [95% CI 0·64-0·91]; p=0·0017) and diabetic ketoacidosis (3·72 [3·32-4·18] per 100 patient-years vs 7·29 [6·83-7·78] per 100 patient-years; 0·51 [0·44-0·59]; p<0·0001). Severe hypoglycaemia rates increased with percentage of time below target glucose range (incidence rate ratio 1·69 [95% CI 1·18-2·43]; p=0·0024, for 4·0-7·9% vs <4·0% and 2·38 [1·51-3·76]; p<0·0001, for ≥8·0% vs <4·0%) and glycaemic variability (coefficient of variation ≥36% vs <36%; incidence rate ratio 1·52 [95% CI 1·06-2·17]; p=0·022). Diabetic ketoacidosis rates increased with mean sensor glucose (incidence rate ratio 1·77 [95% CI 0·89-3·51], p=0·13, for 8·3-9·9 mmol/L vs <8·3 mmol/L; 3·56 [1·83-6·93], p<0·0001, for 10·0-11·6 mmol/L vs <8·3 mmol/L; and 8·66 [4·48-16·75], p<0·0001, for ≥11·7 mmol/L vs <8·3 mmol/L). INTERPRETATION These findings provide evidence that continuous glucose monitoring can reduce severe hypoglycaemia and ketoacidosis risk in young people with type 1 diabetes on insulin therapy. Continuous glucose monitoring metrics might help to identify those at risk for acute diabetes complications. FUNDING German Center for Diabetes Research, German Federal Ministry of Education and Research, German Diabetes Association, and Robert Koch Institute.
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Affiliation(s)
- Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Alexander Bey
- Department of Pediatrics, St Marien Hospital Düren, Düren, Germany
| | - Clemens Freiberg
- Department of Pediatrics and Adolescent Medicine, University of Göttingen, Göttingen, Germany
| | | | - Olga Kordonouri
- Diabetes Center for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
| | - Susanne Thiele-Schmitz
- Department of Pediatric and Adolescent Medicine, St Vincenz Hospital, Paderborn, Germany
| | - Carmen Schröder
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Greifswald, Greifswald, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Diabetes Research, Neuherberg, Germany
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Wan J, Lu J, Li C, Ma X, Zhou J. Research progress in the application of time in range: more than a percentage. Chin Med J (Engl) 2023; 136:522-527. [PMID: 36939244 PMCID: PMC10106225 DOI: 10.1097/cm9.0000000000002582] [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: 06/11/2022] [Indexed: 03/21/2023] Open
Abstract
ABSTRACT Glucose monitoring is an important part of medical care in diabetes mellitus, which not only helps assess glycemic control and treatment safety, but also assists with treatment adjustment. With the development of continuous glucose monitoring (CGM), the use of CGM has increased rapidly. With the wealth of glucose data produced by CGM, new metrics are greatly needed to optimally evaluate glucose status and guide the treatment. One of the parameters that CGM provides, time in range (TIR), has been recognized as a key metric by the international consensus. Before the adoption of TIR in clinical practice, several issues including the minimum length of CGM use, the setting of the target range, and individualized TIR goals are summarized. Additionally, we discussed the mounting evidence supporting the association between TIR and diabetes-related outcomes. As a novel glucose metric, it is of interest to compare TIR with other conventional glucose markers such as glycated hemoglobin A1c. It is anticipated that the use of TIR may provide further information on the quality of glucose control and lead to improved diabetes management.
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Affiliation(s)
- Jintao Wan
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China
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Mohan V, Joshi S, Mithal A, Kesavadev J, Unnikrishnan AG, Saboo B, Kumar P, Chawla M, Bhograj A, Kovil R. Expert Consensus Recommendations on Time in Range for Monitoring Glucose Levels in People with Diabetes: An Indian Perspective. Diabetes Ther 2023; 14:237-249. [PMID: 36705888 PMCID: PMC9943834 DOI: 10.1007/s13300-022-01355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/05/2022] [Indexed: 01/28/2023] Open
Abstract
Keeping up with the global scenario, diabetes prevalence is on rise in India. Inadequate glycemic control is a major cause of diabetes-related morbidity and mortality. The conventional standards of care (SOC) in diabetes, including self-monitoring of blood glucose and measurement of glycated hemoglobin, have supported achievement of glycemic control, yet there are a few limitations. With the use of current technologies and metrics, such as continuous glucose monitoring (CGM) and standardized CGM data reporting, the continuous real-time glucose levels can be measured, and importantly, the percentage of time above, below, and within the target glucose range can be calculated, which facilitates patient-centric care, a current goal in diabetes management. International consensus recommendations endorse the incorporation of CGM and CGM data reporting in SOC for diabetes management. The guidelines provide time in range (TIR) thresholds for different patient populations and different types of diabetes. However, extrapolation of these global guidelines does not aptly cover the Indian population, which has diverse diet, culture, and religious practices. In this context, a consensus meeting was held in India in 2021 with experts in the field of diabetes care. The purpose of the meeting was to develop consensus recommendations for TIR thresholds for different patient profiles in India. Those expert recommendations, together with an evidence-based review, are reported here. The aim of this agreement is to aid clinicians across India to routinely use CGM and CGM data reports for optimizing individualized diabetes care, by implementing clinical targets for TIR.
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Affiliation(s)
| | - Shashank Joshi
- Department of Endocrinology, Lilavati Hospital, Mumbai, India
| | | | - Jothydev Kesavadev
- Department of Endocrinology, Jothydev's Diabetes Research Centres, Trivandrum, Kerala, India
| | - Ambika G Unnikrishnan
- Department of Endocrinology, Chellaram Hospital-Diabetes Care and Multispecialty, Bavdhan, Pune, India
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care Hormone Clinic, Ambawadi, Ahmedabad, India
| | - Prasanna Kumar
- Department of Endocrinology, Center for Diabetes and Endocrine Care, Kalyanangar, Bengaluru, India
| | - Manoj Chawla
- Department of Endocrinology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Abhijit Bhograj
- Department of Endocrinology, Manipal Hospital, Hebbal, Bengaluru, Karnataka, India
| | - Rajiv Kovil
- Department of Diabetology, Dr. Kovil's Diabetes Care, Centre Andheri (West), Mumbai, India
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20
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Psoma O, Makris M, Tselepis A, Tsimihodimos V. Short-term Glycemic Variability and Its Association With Macrovascular and Microvascular Complications in Patients With Diabetes. J Diabetes Sci Technol 2022:19322968221146808. [PMID: 36576014 DOI: 10.1177/19322968221146808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The introduction of continuous glucose monitoring inaugurated a new era in clinical practice by shifting the characterization of glycemic control from HbA1c to novel metrics. The one that gained widespread attention over the past decades was glycemic variability (GV), which typically refers to peaks and nadirs of blood glucose measured over a given time interval. GV can be dichotomized into two main categories: short-term and long-term. Short-term GV reflects within-day and between-day glycemic oscillations, and its contribution to diabetic complications remains an enigma. In this review, we summarize the available data about short-term GV and its possible association with both microvascular and macrovascular complications, evaluating different pathogenic mechanisms and demonstrating nonpharmaceutical, as well as pharmaceutical, therapeutic interventions.
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Affiliation(s)
- Ourania Psoma
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Marios Makris
- UCL Medical School, University College London, London, UK
| | - Alexandros Tselepis
- Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
| | - Vasilis Tsimihodimos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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21
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Lin YH, Lin CH, Huang YY, Chen HY, Tai AS, Fu SC, Hsieh SH, Sun JH, Chen ST, Lin SH. Regimen comprising GLP-1 receptor agonist and basal insulin can decrease the effect of food on glycemic variability compared to a pre-mixed insulin regimen. Eur J Med Res 2022; 27:273. [PMID: 36463197 PMCID: PMC9719195 DOI: 10.1186/s40001-022-00892-9] [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: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that glucagon-like peptide 1 (GLP-1) receptor agonists (RA) can stabilize glycemic variability (GV) and interfere with eating behavior. This study compared the impact of insulin, GLP-1 RA, and dietary components on GV using professional continuous glucose monitoring (CGM). METHODS Patients with type 2 diabetes underwent CGM before and after switching from a twice-daily pre-mixed insulin treatment regimen to a GLP-1 RA (liraglutide) plus basal insulin regimen. The dietary components were recorded and analyzed by a certified dietitian. The interactions between the medical regimen, GV indices, and nutrient components were analyzed. RESULTS Sixteen patients with type 2 diabetes were enrolled in this study. No significant differences in the diet components and total calorie intake between the two regimens were found. Under the pre-mixed insulin regimen, for increase in carbohydrate intake ratio, mean amplitude of glucose excursion (MAGE) and standard deviation (SD) increased; in contrast, under the new regimen, for increase in fat intake ratio, MAGE and SD decreased, while when the protein intake ratio increased, the coefficient of variation (CV) decreased. The impact of the food intake ratio on GV indices disappeared under the GLP-1 RA regimen. After switching to the GLP-1 RA regimen, the median MAGE, SD, and CV values decreased significantly. However, the significant difference in GV between the two regimens decreased during the daytime. CONCLUSION A GLP-1 RA plus basal insulin regimen can stabilize GV better than a regimen of twice-daily pre-mixed insulin, especially in the daytime, and can diminish the effect of food components on GV.
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Affiliation(s)
- Yi-Hsuan Lin
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Chia-Hung Lin
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yao Huang
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Hsin-Yun Chen
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - An-Shun Tai
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
| | - Shih-Chen Fu
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
| | - Sheng-Hwu Hsieh
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Jui-Hung Sun
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Szu-Tah Chen
- grid.454211.70000 0004 1756 999XDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Sheng-Hsuan Lin
- grid.260539.b0000 0001 2059 7017Institute of Statistics, National Chiao Tung University, 1001 University Road, Hsinchu, 300 Taiwan
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22
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de Barreiros Gavazza MLN, Martins E, Ramalho ACR. Association between personality factors and health-related quality of life in type 1 diabetes patients. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:792-799. [PMID: 36219199 PMCID: PMC10118761 DOI: 10.20945/2359-3997000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Objective The objective of the present study was to evaluate a possible association between personality factors (PF) and the health-related quality of life (HRQoL) of type 1 diabetes (T1D) patients. This allows for the investigation of obstacles related to treatment type and the presence of complications in HRQoL. Materials and Methods This cross-sectional study enrolled 78 patients aged 13-67 years from two diabetes clinics. PF was evaluated using the validated questionnaire Inventory of the Five Great Personality Factors. HRQoL was determined using the Brazilian Problem Areas in Diabetes Scale (B-PAID) questionnaire. The chi-square test, Fisher's exact test, and Welch's modified two-sample t-test were used to establish relationships. Results In this sample of 46 women and 32 men with T1D and mean A1C of 8%-9%, we observed great suffering in 58.97% and that HRQoL was worse in women. "Openness" was the most prevalent PF and "extroversion" the least prevalent. "Neuroticism" facilitated a tendency to tolerate suffering. Conclusion T1D patients' personalities influence their treatment. The PF "neuroticism" is potentially related to better HRQoL. Brazilian T1D patients indicated great suffering in their HRQoL, which may be characteristic across the country. Women experienced worse HRQoL, which is in line with world literature. However, the limited sample size in this study warrant further research to test the hypotheses.
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Affiliation(s)
| | - Eduardo Martins
- Universidade Federal da Bahia, Unidade de Vigilância Sanitária do Hospital Universitário Professor Edgar Santos, Salvador, BA, Brasil
| | - Ana Claudia Rebouças Ramalho
- Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Departamento de Medicina Interna e Apoio ao Diagnóstico, Salvador, BA, Brasil
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23
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Park I, Choi KB, Ahn JH, Kim WS, Lee YT, Jeong DS. Impact of diabetes mellitus on long-term clinical and graft outcomes after off-pump coronary artery bypass grafting with pure bilateral skeletonized internal thoracic artery grafts. Cardiovasc Diabetol 2022; 21:243. [PMID: 36380349 PMCID: PMC9667562 DOI: 10.1186/s12933-022-01687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The effect of diabetes mellitus (DM) on the long-term outcomes of coronary artery bypass graft (CABG) remained debatable and various strategies exist for CABG; hence, clarifying the effects of DM on CABG outcomes is difficult. The current study aimed to evaluate the effect of DM on clinical and graft-related outcomes after CABG with bilateral internal thoracic artery (BITA) grafts. METHODS From January 2001 to December 2017, 3395 patients who underwent off-pump CABG (OPCAB) with BITA grafts were enrolled. The study population was stratified according to preoperative DM. The primary endpoint was cardiac death and the secondary endpoints were myocardial infarction (MI), revascularization, graft failure, stroke, postoperative wound infection, and a composite endpoint of cardiac death, MI, and revascularization. Multiple sensitivity analyses, including Cox proportional hazard regression and propensity-score matching analyses, were performed to adjust baseline differences. RESULTS After CABG, the DM group showed similar rates of cardiac death, MI, or revascularization and lower rates of graft failure at 10 years (DM vs. non-DM, 19.0% vs. 24.3%, hazard ratio [HR] 0.711, 95% confidence interval [CI] 0.549-0.925; P = 0.009) compared to the non-DM group. These findings were consistent after multiple sensitivity analyses. In the subgroup analysis, the well-controlled DM group, which is defined as preoperative hemoglobin A1c (HbA1c) of < 7%, showed lower postoperative wound infection rates (well-controlled DM vs. poorly controlled DM, 3.7% vs. 7.3%, HR 0.411, 95% CI 0.225-0.751; P = 0.004) compared to the poorly controlled DM group, which was consistent after propensity-score matched analysis. CONCLUSIONS OPCAB with BITA grafts showed excellent and comparable long-term clinical outcomes in patients with and without DM. DM might have a protective effect on competition and graft failure of ITA. Strict preoperative hyperglycemia control with target HbA1c of < 7% might reduce postoperative wound infection and facilitate the use of BITA in CABG.
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Affiliation(s)
- Ilkun Park
- grid.414964.a0000 0001 0640 5613Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351 Republic of Korea
| | - Kuk Bin Choi
- grid.66875.3a0000 0004 0459 167XDepartment of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota USA
| | - Joong Hyun Ahn
- grid.414964.a0000 0001 0640 5613Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Wook Sung Kim
- grid.414964.a0000 0001 0640 5613Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351 Republic of Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon, Gyeonggi-Do Republic of Korea
| | - Dong Seop Jeong
- grid.414964.a0000 0001 0640 5613Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351 Republic of Korea
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Deshmukh H, Wilmot E, Pieri B, Choudhary P, Shah N, Gregory R, Kilvert A, Lumb A, Christian P, Barnes D, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Time in range following flash glucose monitoring: Relationship with glycaemic control, diabetes-related distress and resource utilisation in the Association of British Clinical Diabetologists national audit. Diabet Med 2022; 39:e14942. [PMID: 36054655 DOI: 10.1111/dme.14942] [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: 02/14/2022] [Revised: 07/20/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to understand the relationship between time in range (TIR) achieved using the isCGM with changes in glycaemic control, diabetes-related distress (DRD) and resource utilisation in people living with diabetes. METHODS Clinicians from 106 National Health System (NHS) UK hospitals submitted isCGM user baseline and follow-up data in a web-based tool held within the UK NHS network. Linear regression analysis was used to identify the relationship between follow-up glucose TIR (3.9-10 mmol/L) categories (TIR% 50-70 and TIR% >70) with change in haemoglobin A1c (HbA1c), DRD and Gold score (measure of hypoglycaemia unawareness, where a score ≥4 suggests impaired awareness of hypoglycaemia). RESULTS Of 16,427 participants, 1241 had TIR follow-up data available. In this cohort, the mean TIR was 44.8% (±22.5). With the use of isCGM, at 7.9 months mean follow-up, improvements were observed in HbA1c (-6.9 [13.5] mmol/mol, p < 0.001), Gold score (-0.35 [1.5], p < 0.001) and Diabetes Distress Screening (-0.73 [1.23], p < 0.001). In the regression analysis restricted to people living with type 1 diabetes, TIR% 50-70 was associated with a -8.9 mmol/mol (±0.6, p < 0.001) reduction in HbA1c; TIR% >70 with a -14 mmol/mol (±0.8, p < 0.001) reduction in HbA1c. Incremental improvement in TIR% was also associated with significant improvements in Gold score and DRD. TIR% >70 was associated with no hospital admissions due to hypoglycaemia, hyperglycaemia/diabetic ketoacidosis, and a 60% reduction in the paramedic callouts and 77% reduction in the incidence of severe hypoglycaemia. CONCLUSION In a large cohort of UK isCGM users, we demonstrate a significant association of higher TIR% with improvement in HbA1c, hypoglycaemia awareness, DRD and resource utilisation.
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Affiliation(s)
- Harshal Deshmukh
- Department of Academic Diabetes and Endocrinology, University of Hull, Hull, UK
- Allam Diabetes Centre, Hull University Teaching Hospital NHS Trust, Hull, UK
| | - Emma Wilmot
- University Hospitals Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Beatrice Pieri
- Department of Academic Diabetes and Endocrinology, University of Hull, Hull, UK
- Allam Diabetes Centre, Hull University Teaching Hospital NHS Trust, Hull, UK
| | - Pratik Choudhary
- Leicester Diabetes Centre Leicester General Hospital, Leicester, UK
| | - Najeeb Shah
- Department of Academic Diabetes and Endocrinology, University of Hull, Hull, UK
- Allam Diabetes Centre, Hull University Teaching Hospital NHS Trust, Hull, UK
| | - Robert Gregory
- Leicester Diabetes Centre Leicester General Hospital, Leicester, UK
| | - Anne Kilvert
- Northampton General Hospital NHS Trust, Northampton, UK
| | - Alistair Lumb
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Jane Patmore
- Allam Diabetes Centre, Hull University Teaching Hospital NHS Trust, Hull, UK
| | - Chris Walton
- Allam Diabetes Centre, Hull University Teaching Hospital NHS Trust, Hull, UK
| | | | - Thozhukat Sathyapalan
- Department of Academic Diabetes and Endocrinology, University of Hull, Hull, UK
- Allam Diabetes Centre, Hull University Teaching Hospital NHS Trust, Hull, UK
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Abstract
First envisioned by early diabetes clinicians, a person-centred approach to care was an aspirational goal that aimed to match insulin therapy to each individual's unique requirements. In the 100 years since the discovery of insulin, this goal has evolved to include personalised approaches to type 1 diabetes diagnosis, treatment, prevention and prediction. These advances have been facilitated by the recognition of type 1 diabetes as an autoimmune disease and by advances in our understanding of diabetes pathophysiology, genetics and natural history, which have occurred in parallel with advancements in insulin delivery, glucose monitoring and tools for self-management. In this review, we discuss how these personalised approaches have improved diabetes care and how improved understanding of pathogenesis and human biology might inform precision medicine in the future.
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Affiliation(s)
- Alice L J Carr
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.
| | - Carmella Evans-Molina
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.
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26
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Kaushal T, Tinsley LJ, Volkening LK, Turcotte C, Laffel LM. Improved CGM Glucometrics and More Visits for Pediatric Type 1 Diabetes Using Telemedicine During 1 Year of COVID-19. J Clin Endocrinol Metab 2022; 107:e4197-e4202. [PMID: 35948357 PMCID: PMC9516076 DOI: 10.1210/clinem/dgac476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The COVID-19 pandemic led to rapid adoption of telemedicine for the care of youth with type 1 diabetes (T1D). We assessed the utility of a primarily virtual care model by comparing glucometrics from a pediatric sample with T1D using continuous glucose monitoring (CGM) both before and during the pandemic. METHODS Pediatric patients aged 1 to 17 years with T1D duration ≥ 1 year if ≥ 6 years old or ≥ 6 months if < 6 years old, with ≥ 1 visit with recorded CGM data both prepandemic (April 1, 2019-March 15, 2020) and during the pandemic (April 1, 2020-March 15, 2021) were included. Data were extracted from the electronic health record. RESULTS Our sample comprised 555 young people (46% male, 87% White, 79% pump-treated), mean age 12.3 ± 3.4 years, T1D duration 5.9 ± 3.5 years, baseline glycated hemoglobin A1c 8.0 ± 1.0% (64 ± 10.9 mmol/mol). Diabetes visit frequency increased from 3.8 ± 1.7 visits/prepandemic period to 4.3 ± 2.2 visits/pandemic period (P < 0.001); during pandemic period, 92% of visits were virtual. Glucose management indicator (GMI) improved slightly from 7.9% (63 mmol/mol) prepandemic to 7.8% (62 mmol/mol) during the pandemic (P < 0.001). Those with equal or greater visit frequency (n = 437 [79% of sample]) had significant improvement in GMI (8.0% to 7.8% [64 to 62 mmol/mol], P < 0.001), whereas those with lower visit frequency did not (7.8 [62 mmol/mol], P = 0.86). CONCLUSIONS Children and adolescents with T1D using CGM before and during the pandemic showed an overall increase in visit frequency using primarily telemedicine-based care and improved CGM glucometrics. Further research is needed to understand factors associated with successful use of telemedicine for pediatric T1D.
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Alkhaddo J, Zhou L, Rossi C, Moheet A, Sonon K, Rayl K, Holmstrand E. Hospital-care utilization and medical cost patterns among patients with insulin-dependent diabetes. Endocr Pract 2022; 28:1132-1139. [PMID: 36126886 DOI: 10.1016/j.eprac.2022.08.008] [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: 04/29/2022] [Revised: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Using claims data from an integrated payer-provider, we compared the costs incurred by insulin-dependent diabetes mellitus (IDDM) patients who received Hospital Inpatient/Observation/Emergency Department care (HIghER care) for diabetes-related events with those who did not receive such care to identify a target population for interventions in future studies. METHODS A retrospective study pooled real-world claims data for IDDM with type 1 or type 2 DM between July 1, 2018 and June 30, 2019. Medical claims were used to calculate the total and diabetes-related allowed medical costs to the Enterprise and per-member per month (pmpm) costs. RESULTS A total of 19,378 members' medical and prescription drug coverage were analyzed. Only 8.4% of the IDDM population received HIghER care but incurred 20% of medical expenses, and nearly 40% of diabetes-related medical costs. For HIghER care patients, medical spending was higher in every inpatient and outpatient category (Wilcoxon two sample tests, all p < 0.0001). Non-diabetes related prescription drug costs were greater in this group (Wilcoxon, Z = 2.2879, p = 0.0221), but diabetes-related prescription drug costs were higher for non-HIghER care (Wilcoxon, Z = -9.5918, p < 0.0001). In a longitudinal study of 29,602 patients over 24 months, prior-year receipt of HIghER care was a significant predictor of HIghER care the subsequent year (odds ratio 3.28) CONCLUSIONS: Medical spending for HIghER care patients was disproportionately high and greater in every inpatient and outpatient category. Receipt of HIghER care in the previous year was highly predictive of HIghER care episodes the following year.
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Affiliation(s)
- J Alkhaddo
- Chief, Division of Endocrinology, Allegheny Health Network (AHN), 320 East North Avenue, 7th Floor, South Tower, Pittsburgh, PA 15212.
| | - L Zhou
- Highmark Health, Pittsburgh, PA 15222
| | - C Rossi
- Allegheny Health Network, Pittsburgh, PA 15222
| | - A Moheet
- Division of Endocrinology, Department of Medicine, University of Minnesota
| | - K Sonon
- Highmark Health, Pittsburgh, PA 15222
| | - K Rayl
- Highmark Health, Pittsburgh, PA 15222
| | - E Holmstrand
- Advanced Analytics, Highmark Health, Pittsburgh, PA 15222
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28
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Elbalshy M, Haszard J, Smith H, Kuroko S, Galland B, Oliver N, Shah V, de Bock MI, Wheeler BJ. Effect of divergent continuous glucose monitoring technologies on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials. Diabet Med 2022; 39:e14854. [PMID: 35441743 PMCID: PMC9542260 DOI: 10.1111/dme.14854] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 12/17/2022]
Abstract
AIMS We aimed to conduct a systematic review and meta-analysis of randomised controlled clinical trials (RCTs) assessing separately and together the effect of the three distinct categories of continuous glucose monitoring (CGM) systems (adjunctive, non-adjunctive and intermittently-scanned CGM [isCGM]), compared with traditional capillary glucose monitoring, on HbA1c and CGM metrics. METHODS PubMed, Web of Science, Scopus and Cochrane Central register of clinical trials were searched. Inclusion criteria were as follows: randomised controlled trials; participants with type 1 diabetes of any age and insulin regimen; investigating CGM and isCGM compared with traditional capillary glucose monitoring; and reporting glycaemic outcomes of HbA1c and/or time-in-range (TIR). Glycaemic outcomes were extracted post-intervention and expressed as mean differences and 95%CIs between treatment and comparator groups. Results were pooled using a random-effects meta-analysis. Risk of bias was assessed using the Cochrane Rob2 tool. RESULTS This systematic review was conducted between January and April 2021; it included 22 RCTs (15 adjunctive, 5 non-adjunctive, and 2 isCGM)). The overall analysis of the pooled three categories showed a statistically significant absolute improvement in HbA1c percentage points (mean difference (95% CI): -0.22% [-0.31 to -0.14], I2 = 79%) for intervention compared with comparator and was strongest for adjunctive CGM (-0.26% [-0.36, -0.16]). Overall TIR (absolute change) increased by 5.4% (3.5 to 7.2), I2 = 71% for CGM intervention compared with comparator and was strongest with non-adjunctive CGM (6.0% [2.3, 9.7]). CONCLUSIONS For individuals with T1D, use of CGM was beneficial for impacting glycaemic outcomes including HbA1c, TIR and time-below-range (TBR). Glycaemic improvement appeared greater for TIR for newer non-adjunctive CGM technology.
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Affiliation(s)
- Mona Elbalshy
- Department of Women’s and Children’s HealthDunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Jillian Haszard
- Division of SciencesUniversity of Otago, New ZealandDunedinNew Zealand
| | - Hazel Smith
- Department of Women’s and Children’s HealthDunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Sarahmarie Kuroko
- Department of Women’s and Children’s HealthDunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Barbara Galland
- Department of Women’s and Children’s HealthDunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Nick Oliver
- Department of Metabolism, Digestion and ReproductionFaculty of MedicineImperial CollegeLondonUK
| | - Viral Shah
- Barbara Davis Center for DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | | | - Benjamin J. Wheeler
- Department of Women’s and Children’s HealthDunedin School of MedicineUniversity of OtagoDunedinNew Zealand
- Paediatric EndocrinologySouthern District Health BoardDunedinNew Zealand
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Zhou Y, Mai X, Deng H, Yang D, Zheng M, Huang B, Xu L, Weng J, Xu W, Yan J. Discrepancies in glycemic metrics derived from different continuous glucose monitoring systems in adult patients with type 1 diabetes mellitus. J Diabetes 2022; 14:476-484. [PMID: 35864804 PMCID: PMC9310046 DOI: 10.1111/1753-0407.13296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/02/2022] [Accepted: 06/26/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Continuous glucose monitoring systems have been widely used but discrepancies among various brands of devices are rarely discussed. This study aimed to explore differences in glycemic metrics between FreeStyle Libre (FSL) and iPro2 among adults with type 1 diabetes mellitus (T1DM). METHODS Participants with T1DM and glycosylated hemoglobin of 7%-10% were included and wore FSL and iPro2 for 2 weeks simultaneously. Datasets collected on the insertion and detachment day, and those with insufficient quantity (<90%) were excluded. Agreements of measurement accuracy and glycemic metrics were evaluated. RESULTS A total of 40 498 paired data were included. Compared with the values from FSL, significantly higher median value was observed in iPro2 (147.6 [106.2, 192.6] vs. 144.0 [100.8, 192.6] mg/dl, p < 0.001) and the largest discordance was observed in hypoglycemic range (median absolute relative difference with iPro2 as reference value: 25.8% [10.8%, 42.1%]). Furthermore, significant differences in glycemic metrics between iPro2 and FSL were also observed in time in range (TIR) 70-180 mg/dl (TIR, 62.8 ± 12.4% vs. 58.8 ± 12.3%, p = 0.004), time spent below 70 mg/dl (4.4 [1.8, 10.9]% vs. 7.2 [5.4, 13.3]%, p < 0.001), time spent below 54 mg/dl (0.9 [0.3, 4.0]% vs. 2.6 [1.3, 5.6]%, p = 0.011), and coefficient of variation (CV, 38.7 ± 8.5% vs. 40.9 ± 9.3%, p = 0.017). CONCLUSIONS During 14 days of use, FSL and iPro2 provided different estimations on TIR, CV, and hypoglycemia-related parameters, which needs to be considered when making clinical decisions and clinical trial designs.
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Affiliation(s)
- Yongwen Zhou
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of DiabetologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Xiaodong Mai
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of DiabetologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Hongrong Deng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of DiabetologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of DiabetologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Mao Zheng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Bin Huang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Linlin Xu
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Jianping Weng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Wen Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of DiabetologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of DiabetologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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Ye J, Deng J, Liang W, Luo H, Wen M, Liu L, Wang M, Shu Y. Time in Range Assessed by Capillary Blood Glucose in Relation to Insulin Sensitivity and β-Cell Function in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in China. J Diabetes Investig 2022; 13:1825-1833. [PMID: 35739637 DOI: 10.1111/jdi.13876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS This study investigated the association of capillary blood glucose (CBG)-assessed time in range (TIR) (3.9-10.0 mmol/L) with insulin sensitivity and islet β-cell function (BCF). MATERIALS AND METHODS We recruited 455 patients with type 2 diabetes mellitus. Seven-point glucose-profile data (pre- and 120-min post-main meals, bedtime) were collected over three consecutive days. Plasma glucose and serum insulin concentrations were measured at 0, 60, and 120 min after a 100-g standard steamed bread meal test. The homeostasis model assessment of insulin resistance (HOMA-IR) and Matsuda index were computed to evaluate insulin resistance (IR). HOMA of β-cell function (HOMA-β) and the area under the curve between insulin and blood glucose (IAUC0-120 /GAUC0-120 ) were used to estimate BCF. RESULTS TIR was positively correlated with 60- and 120-min insulin values, IAUC0-120 , the Matsuda index, HOMA-β, and IAUC0-120 /GAUC0-120 (rs : 0.154, 0.129, 0.137, 0.194, 0.341, and 0.334, respectively; P <0.05) but inversely correlated with HOMA-IR (rs : -0.239, P <0.001). After adjusting for confounders, multinomial multiple logistic regression analysis revealed that the odds ratios (ORs) of achieving the target TIR (>70%) increased by 12% (95% confidence interval [CI]: 3-21%), 7% (95% CI: 1-14%), 10% (95% CI: 5-16%), and 45% (95% CI: 25-68%) for each 10-mIU/L increase in 60- and 120-min insulin value, 10-unit increase in HOMA-β, and unit increase in IAUC0-120 /GAUC0-120 , respectively (P <0.05). Nevertheless, the OR decreased by 10% (95% CI: 1-18%) for each unit increase in HOMA-IR (P <0.05). CONCLUSIONS IR and BCF are related to CBG-assessed TIR.
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Affiliation(s)
- Jingwen Ye
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Jiajin Deng
- Department of Ophthalmology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Weiqiang Liang
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Haizhao Luo
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Mei Wen
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Lei Liu
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Mingzhu Wang
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
| | - Yi Shu
- Department of Endocrinology,the Sixth Affiliated Hospital, South China University of Technology, Guidan Road 120, Foshan, 528200, Guangdong Province, China
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Abstract
Combining technologies including rapid insulin analogs, insulin pumps, continuous glucose monitors, and control algorithms has allowed for the creation of automated insulin delivery (AID) systems. These systems have proven to be the most effective technology for optimizing metabolic control and could hold the key to broadly achieving goal-level glycemic control for people with type 1 diabetes. The use of AID has exploded in the past several years with several options available in the United States and even more in Europe. In this article, we review the largest studies involving these AID systems, and then examine future directions for AID with an emphasis on usability.
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Affiliation(s)
- Gregory P. Forlenza
- School of Medicine, Barbara Davis Center, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | - Rayhan A. Lal
- Department of Medicine & Pediatrics, Divisions of Endocrinology Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
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Fellinger P, Rodewald K, Ferch M, Itariu B, Kautzky-Willer A, Winhofer Y. HbA1c and Glucose Management Indicator Discordance Associated with Obesity and Type 2 Diabetes in Intermittent Scanning Glucose Monitoring System. BIOSENSORS 2022; 12:288. [PMID: 35624589 PMCID: PMC9138367 DOI: 10.3390/bios12050288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/06/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Glucose management indicator (GMI) is frequently used as a substitute for HbA1c, especially when using telemedicine. Discordances between GMI and HbA1c were previously mostly reported in populations with type 1 diabetes (T1DM) using real-time CGM. Our aim was to investigate the accordance between GMI and HbA1c in patients with diabetes using intermittent scanning CGM (isCGM). In this retrospective cross-sectional study, patients with diabetes who used isCGM >70% of the time of the investigated time periods were included. GMI of four different time spans (between 14 and 30 days), covering a period of 3 months, reflected by the HbA1c, were investigated. The influence of clinical- and isCGM-derived parameters on the discordance was assessed. We included 278 patients (55% T1DM; 33% type 2 diabetes (T2DM)) with a mean HbA1c of 7.63%. The mean GMI of the four time periods was between 7.19% and 7.25%. On average, the absolute deviation between the four calculated GMIs and HbA1c ranged from 0.6% to 0.65%. The discordance was greater with increased BMI, a diagnosis of T2DM, and a greater difference between the most recent GMI and GMI assessed 8 to 10 weeks prior to HbA1c assessment. Our data shows that, especially in patients with increased BMI and T2DM, this difference is more pronounced and should therefore be considered when making therapeutic decisions.
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Diabetes-Modifying Antirheumatic Drugs: The Roles of DMARDs as Glucose-Lowering Agents. Medicina (B Aires) 2022; 58:medicina58050571. [PMID: 35629988 PMCID: PMC9143119 DOI: 10.3390/medicina58050571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 02/06/2023] Open
Abstract
Systemic inflammation represents a shared pathophysiological mechanism which underlies the frequent clinical associations among chronic inflammatory rheumatic diseases (CIRDs), insulin resistance, type 2 diabetes (T2D), and chronic diabetes complications, including cardiovascular disease. Therefore, targeted anti-inflammatory therapies are attractive and highly desirable interventions to concomitantly reduce rheumatic disease activity and to improve glucose control in patients with CIRDs and comorbid T2D. Therapeutic approaches targeting inflammation may also play a role in the prevention of prediabetes and diabetes in patients with CIRDs, particularly in those with traditional risk factors and/or on high-dose corticosteroid therapy. Recently, several studies have shown that different disease-modifying antirheumatic drugs (DMARDs) used for the treatment of CIRDs exert antihyperglycemic properties by virtue of their anti-inflammatory, insulin-sensitizing, and/or insulinotropic effects. In this view, DMARDs are promising drug candidates that may potentially reduce rheumatic disease activity, ameliorate glucose control, and at the same time, prevent the development of diabetes-associated cardiovascular complications and metabolic dysfunctions. In light of their substantial antidiabetic actions, some DMARDs (such as hydroxychloroquine and anakinra) could be alternatively termed “diabetes-modifying antirheumatic drugs”, since they may be repurposed for co-treatment of rheumatic diseases and comorbid T2D. However, there is a need for future randomized controlled trials to confirm the beneficial metabolic and cardiovascular effects as well as the safety profile of distinct DMARDs in the long term. This narrative review aims to discuss the current knowledge about the mechanisms behind the antihyperglycemic properties exerted by a variety of DMARDs (including synthetic and biologic DMARDs) and the potential use of these agents as antidiabetic medications in clinical settings.
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Nnakenyi ID, Nnakenyi EF, Parker EJ, Uchendu NO, Anaduaka EG, Ezeanyika LU. Relationship between glycaemic control and lipid profile in type 2 diabetes mellitus patients in a low-resource setting. Pan Afr Med J 2022; 41:281. [PMID: 35855025 PMCID: PMC9250661 DOI: 10.11604/pamj.2022.41.281.33802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/17/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction diabetes mellitus can lead to complications including cardiovascular disease (CVD). Glycated haemoglobin (HbA1C) is a test of glycaemic control in T2DM patients, and its association with CVD can be mediated through modulation of risk factors such as dyslipidaemia. It is suggested that correlation of HbA1c with blood lipids may enable its use as a dual marker for glycaemic status and dyslipidaemia. The aim of this study was to determine the relationship between glycaemic control and blood lipid concentrations in T2DM patients. Methods a cross-sectional study of T2DM patients at Enugu, Nigeria. After obtaining informed consent, questionnaires were administered, and then venous blood was collected for determination of HbA1c and fasting lipid profile. Student T-test was used to compare mean results of two groups and Pearson correlation coefficient was used to determine relationships. A p-value <0.05 was considered to be statistically significant. Results fifty -five (55) T2DM patients comprising of 24 females and 31 males, with mean±SD age 57±12 years were studied. Prevalence of patients with poor glycaemic control (HbA1c≥7%) was 34 (61.8%). More males (36.4%) than females (25.4%) had poor glycaemic control. There was a positive, statistically significant correlation between HbA1c and TC (r=0.406); Low-Density Lipoprotein Cholesterol (LDL-C) (r=0.409); and triglyceride (TG) (r=0.273), p<0.05. Correlation between HbA1c and HDL-C was negative (r=-0.269, p<0.05). Conclusion the significant correlation between HbA1c and various lipid parameters may suggest the importance of glycaemic control as well as managing dyslipidaemia in the reduction of risk for CVD in T2DM patients, for which HbA1c may be used to monitor both, thereby reducing cost.
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Affiliation(s)
- Ifeyinwa Dorothy Nnakenyi
- Department of Chemical Pathology, University of Nigeria, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Emeka Francis Nnakenyi
- Department of Morbid Anatomy, University of Nigeria, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
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Inkeri J, Adeshara K, Harjutsalo V, Forsblom C, Liebkind R, Tatlisumak T, Thorn LM, Groop PH, Shams S, Martola J, Putaala J, Gordin D. Glycemic control is not related to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes. Acta Diabetol 2022; 59:481-490. [PMID: 34778921 PMCID: PMC8917104 DOI: 10.1007/s00592-021-01821-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
AIMS To determine if medium- and long-term blood glucose control as well as glycemic variability, which are known to be strong predictors of vascular complications, are associated with underlying cerebral small vessel disease (cSVD) in neurologically asymptomatic individuals with type 1 diabetes. METHODS A total of 189 individuals (47.1% men; median age 40.0, IQR 33.0-45.2 years) with type 1 diabetes (median diabetes duration of 21.7, IQR 18.3-30.7 years) were enrolled in a cross-sectional retrospective study, as part of the Finnish Diabetic Nephropathy (FinnDiane) Study. Glycated hemoglobin (HbA1c) values were collected over the course of ten years before the visit including a clinical examination, biochemical sampling, and brain magnetic resonance imaging. Markers of glycemic control, measured during the visit, included HbA1c, fructosamine, and glycated albumin. RESULTS Signs of cSVD were present in 66 (34.9%) individuals. Medium- and long-term glucose control and glycemic variability did not differ in individuals with signs of cSVD compared to those without. Further, no difference in any of the blood glucose variables and cSVD stratified for cerebral microbleeds (CMBs) or white matter hyperintensities were detected. Neither were numbers of CMBs associated with the studied glucose variables. Additionally, after dividing the studied variables into quartiles, no association with cSVD was observed. CONCLUSIONS We observed no association between glycemic control and cSVD in neurologically asymptomatic individuals with type 1 diabetes. This finding was unexpected considering the large number of signs of cerebrovascular pathology in these people after two decades of chronic hyperglycemia and warrants further studies searching for underlying factors of cSVD.
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Affiliation(s)
- Jussi Inkeri
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Krishna Adeshara
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Ron Liebkind
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Juha Martola
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jukka Putaala
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Gordin
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Shuang W, Hui X, Ling L, Ping L. Time in range measurements for hyperglycemia management during pregnancy. Clin Chim Acta 2022; 531:56-61. [PMID: 35339452 DOI: 10.1016/j.cca.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
The prevalence of adverse pregnancy outcomes associated with poor glycemic control are increasing. Accordingly, effective blood glucose monitoring during pregnancy has become a subject of intense interest. Continuous glucose monitoring (CGM) displays dynamic changes in blood glucose by using probes to measure glucose concentration in the interstitial fluid, and the rapid development of CGM has enabled the investigation of time in range (TIR) in the glucose target range as a new parameter to evaluate blood glucose. International guidelines have identified TIR as an important blood glucose assessment method for pregnant patients with type 1 diabetes mellitus that overcomes the limitations of conventional gestational blood glucose monitoring, better reflects fluctuation in blood glucose during pregnancy, and effectively improves maternal and neonatal outcomes. However, there is little clinical evidence for the use of TIR in pregnant women with gestational diabetes mellitus and those with pre-pregnant type 2 diabetes mellitus. TIR is expected to become a critical indicator of blood glucose control and management in hyperglycemic pregnant patients. We review the research progress of TIR to help clinicians understand the field of blood glucose monitoring in pregnant women with hyperglycemia.
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Affiliation(s)
- Wang Shuang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shen-yang, Liao Ning 110000, China
| | - Xin Hui
- Department of Endocrinology and Metabolism, Shenyang 242 Hospital ,Shen-yang, Liao Ning 110000, China
| | - Li Ling
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shen-yang, Liao Ning 110000, China
| | - Li Ping
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shen-yang, Liao Ning 110000, China.
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Machine Learning and Smart Devices for Diabetes Management: Systematic Review. SENSORS 2022; 22:s22051843. [PMID: 35270989 PMCID: PMC8915068 DOI: 10.3390/s22051843] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/05/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023]
Abstract
(1) Background: The use of smart devices to better manage diabetes has increased significantly in recent years. These technologies have been introduced in order to make life easier for patients with diabetes by allowing better control of the stability of blood sugar levels and anticipating the occurrence of dangerous events (hypo/hyperglycemia), etc. That being said, the main objectives of the self-management of diabetes is to improve the lifestyle and life quality of patients with diabetes; (2) Methods: We performed a systematic review based on articles that focus on the use of smart devices for the monitoring and better management of diabetes. The search was focused on keywords related to the topic, such as “Diabetes”, “Technology”, “Self-management”, “Artificial Intelligence”, etc. This was performed using databases, such as Scopus, Google Scholar, and PubMed; (3) Results: A total of 89 studies, published between 2011 and 2021, were included. The majority of the selected research aims to solve a diabetes management problem (e.g., blood glucose prediction, early detection of risk events, and the automatic adjustment of insulin doses, etc.). In these studies, wearable devices were used in combination with artificial intelligence (AI) techniques; (4) Conclusions: Wearable devices have attracted a great deal of scientific interest in the field of healthcare for people with chronic conditions, such as diabetes. They are capable of assisting in the management of diabetes, as well as preventing complications associated with this condition. Furthermore, the usage of these devices has improved illness management and quality of life.
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Liang B, Koye DN, Hachem M, Zafari N, Braat S, Ekinci EI. Efficacy of Flash Glucose Monitoring in Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:849725. [PMID: 36992733 PMCID: PMC10012125 DOI: 10.3389/fcdhc.2022.849725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveFlash glucose monitoring (FlashGM) is a sensor-based technology that displays glucose readings and trends to people with diabetes. In this meta-analysis, we assessed the effect of FlashGM on glycaemic outcomes including HbA1c, time in range, frequency of hypoglycaemic episodes and time in hypo/hyperglycaemia compared to self-monitoring of blood glucose, using data from randomised controlled trials.MethodsA systematic search was conducted on MEDLINE, EMBASE and CENTRAL for articles published between 2014 and 2021. We selected randomised controlled trials comparing flash glucose monitoring to self-monitoring of blood glucose that reported change in HbA1c and at least one other glycaemic outcome in adults with type 1 or type 2 diabetes. Two independent reviewers extracted data from each study using a piloted form. Meta-analyses using a random-effects model was conducted to obtain a pooled estimate of the treatment effect. Heterogeneity was assessed using forest plots and the I2 statistic.ResultsWe identified 5 randomised controlled trials lasting 10 – 24 weeks and involving 719 participants. Flash glucose monitoring did not lead to a significant reduction in HbA1c. However, it resulted in increased time in range (mean difference 1.16 hr, 95% CI 0.13 to 2.19, I2 = 71.7%) and decreased frequency of hypoglycaemic episodes (mean difference -0.28 episodes per 24 hours, 95% CI -0.53 to -0.04, I2 = 71.4%).ConclusionsFlash glucose monitoring did not lead to a significant reduction in HbA1c compared to self-monitoring of blood glucose, however, it improved glycaemic management through increased time in range and decreased frequency of hypoglycaemic episodes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42020165688).
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Affiliation(s)
- Bonnie Liang
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Digsu N. Koye
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mariam Hachem
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Neda Zafari
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Elif I. Ekinci
- Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Heidelberg, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
- *Correspondence: Elif I. Ekinci,
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Fan YC, Chou CC, Bintoro BS, Pan WH, Bai CH. Combined Effect of Inflammation and Hyperglycemia on Mild Cognitive Impairment and Associated Dietary Patterns in an Older Taiwanese Population. Front Nutr 2022; 9:791929. [PMID: 35252292 PMCID: PMC8895042 DOI: 10.3389/fnut.2022.791929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrevious studies have demonstrated that C-reactive protein (CRP) and glycated hemoglobin (HbA1c) levels are independently associated with neurodegenerative diseases, which can be improved by altering dietary patterns. This study investigates the combined effect of CRP and HbA1c, as well as the influence of dietary patterns, on the risk of dementia.MethodsA cross-sectional study was conducted with 536 participants aged ≥65 years who were recruited from the Nutrition and Health Survey in Taiwan between 2014 and 2016. The high levels of inflammation and glycation were defined as a CRP level of >0.21 mg/dl and a HbA1c level of ≥6.50%, respectively. Mild cognitive impairment (MCI) was evaluated using the Mini-Mental State Examination (MMSE) score. The dietary patterns associated with CRP and HbA1c levels were assessed using the reduced rank regression (RRR). Multivariate logistic regression analysis of both complete and imputed datasets was performed.ResultsParticipants with high levels of both CRP and HbA1c were associated with the highest odds ratio (OR) of MCI (adjusted OR [aOR] = 3.52; 95% CI = 3.48, 3.56; p < 0.001), followed by a high level of only HbA1c (aOR = 1.73; p < 0.001) and a high level of CRP (aOR = 1.49; p < 0.001). Using the reduced rank regression, an inverse relationship between higher consumption nuts and seeds and lower levels of CRP and HbA1c was found (both factors loading < −0.2). Concerning the combined effect of tertiles among the factor 1 and factor 2 analyzed by dietary patterns, group 1 with both T3 (high tertiles) was associated with the greatest OR of MCI (aOR = 4.38; 95% CI = 4.34, 4.42; p < 0.001) using multiple imputation.ConclusionsThe combined effect of high levels of inflammation and hyperglycemia was associated with an increased likelihood of MCI. Moreover, dietary patterns positively related to inflammation and hyperglycemia were associated with MCI, while eating nuts and seeds promoted better cognition.
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Affiliation(s)
- Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chi Chou
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Bagas Suryo Bintoro
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- *Correspondence: Chyi-Huey Bai
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Saboo B, Erande S, Unnikrishnan AG. A prospective multicentre open label study to assess effect of Teneligliptin on glycemic control through parameters of time in range (TIR) Metric using continuous glucose monitoring (TOP-TIR study). Diabetes Metab Syndr 2022; 16:102394. [PMID: 35078097 DOI: 10.1016/j.dsx.2022.102394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Continuous glucose monitoring (CGM) has been effective in assessing glycemic variability in diabetic patients. This study aims at assessing the effect of Teneligliptin using ambulatory glucose profile (AGP) indicators. METHODS A prospective, multicentre, open label study enrolling 59 type 2 diabetes patients between 18 and 65 years age was done between November 2020-May 2021. Patients were administered Teneligliptin 20 mg once daily, in addition to Metformin. The study included pre-treatment and two post-treatment phases. The data on time in range (TIR) and other AGP indicators of glycemic variability were obtained on each patient in all the three study phases and analysed to understand the effect of Teneligliptin on glycemic variability. Safety evaluation was done based on vital and biochemical parameters. RESULTS The percent TIR in post-treatment phase I was significantly higher than the pre-treatment phase (p < 0.0001), and was maintained till the end of phase II (p = 0.037). There was significant lowering of time above range (≥180 mg/dL) in the phase I (p = 0.003), which was maintained in phase II (p = 0.043), suggesting better control over hyperglycemic state. The reduction in mean glucose level in phase I and II was also significant compared to baseline (p = 0.003 and p = 0.023 respectively). The glucose variability percent and glucose management indicator also showed significant lowering in both the phases. CONCLUSIONS Teneligliptin addition to patients uncontrolled on Metformin monotherapy significantly reduced glycemic variability, as well showed significant glycemic improvement. Since this study was a single arm study, a comparative study with other DPP-4 inhibitors is needed.
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Affiliation(s)
| | - Suhas Erande
- Akshay Hospital, Department of Medicine, Pune, India.
| | - A G Unnikrishnan
- Chellaram Diabetes Institute, Department of Endocrinology, Pune, India.
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Kaushal T, Tinsley L, Volkening LK, Ambler-Osborn L, Laffel L. Improvement in Mean CGM Glucose in Young People with Type 1 Diabetes During 1 Year of the COVID-19 Pandemic. Diabetes Technol Ther 2022; 24:136-139. [PMID: 34524008 PMCID: PMC8817688 DOI: 10.1089/dia.2021.0258] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic likely affected youth with type 1 diabetes (T1D). We used electronic health record-extracted data to compare continuous glucose monitoring (CGM) metrics during 1 year of the pandemic with those of the previous year. The sample comprised CGM users, aged 1 to <18 years, with T1D duration ≥6 months (age <6 years) or ≥1 year (age ≥6 years). The prepandemic sample comprised 641 youth (52% female, aged 12.3 ± 3.5, T1D duration 6.0 ± 3.5 years). The pandemic sample comprised 648 youth (52% female, age 13.3 ± 3.5, duration 6.7 ± 3.8 years), with care delivered primarily through telemedicine. Mean CGM glucose was 6.3 mg/dL lower during the pandemic (187.3 ± 35.6) versus prepandemic (193.6 ± 33.0) (P < 0.001). A higher percentage of youth achieved glucose management indicator <7% during the pandemic than the prior year (P < 0.001). Lower CGM glucose values were observed during the COVID-19 pandemic. Future studies are needed to assess how changes in health care delivery, including telemedicine, and lifestyle during this time may have supported this improvement.
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Affiliation(s)
- Tara Kaushal
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
- Address correspondence to: Tara Kaushal, MD, MSHP, Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA
| | - Liane Tinsley
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Lisa K. Volkening
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Louise Ambler-Osborn
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Lori Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
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Abstract
BACKGROUND Glucose data from intermittently scanned continuous glucose monitoring (isCGM) is a combination of scanned and imported glucose values. The present knowledge of glycemic metrics originate mostly from glucose data from real-time CGM sampled every five minutes with a lack of information derived from isCGM. METHODS Glucose data obtained with isCGM and hemoglobin A1c (HbA1c) were obtained from 169 patients with type 1 diabetes. Sixty-one patients had two observations with an interval of more than three months. RESULTS The best regression line of HbA1c against mean glucose was observed from 60 days prior to HbA1c measurement as compared to 14, 30, and 90 days. The difference between HbA1c and estimated HbA1c (=glucose management indicator [GMI]) first observed correlated with the second observation (R2 0.61, P < .001). Time in range (TIR, glucose between 3.9 and 10 mmol/L) was significantly related to GMI (R2 0.87, P < .001). A TIR of 70% corresponded to a GMI of 6.8% (95% confidence interval, 6.3-7.4). The fraction of patients with the optimal combination of TIR >70% and time below range (TBR) <4% was 3.6%. The fraction of patients with TBR>4% was four times higher for those with high glycemic variability (coefficient of variation [CV] >36%) than for those with lower CV. CONCLUSION The individual difference between HbA1c and GMI was reproducible. High glycemic variability was related to increased TBR. A combination of TIR and TBR is suggested as a new composite quality indicator.
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Affiliation(s)
- Klavs Würgler Hansen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Denmark
- Klavs Würgler Hansen, MD, DMSCI, Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1-3, Silkeborg 8600, Denmark.
| | - Bo Martin Bibby
- Department of Public Health, Section for Biostatistics, Aarhus University, Denmark
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Yang R, Zhang W, Wang X, Wang S, Zhou Q, Li H, Mu H, Yu X, Ji F, Dong J, Chen W. Nonlinear association of 1,5-anhydroglucitol with the prevalence and severity of coronary artery disease in chinese patients undergoing coronary angiography. Front Endocrinol (Lausanne) 2022; 13:978520. [PMID: 36133308 PMCID: PMC9483025 DOI: 10.3389/fendo.2022.978520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postprandial hyperglycemia plays an important role in the pathogenesis of coronary artery disease (CAD). The aim of this study is to determine the associations of 1,5-Anhydroglucitol (1,5-AG), which reflects circulating glucose fluctuations, with the prevalence of CAD and CAD severity in coronary angiography defined Chinese patients. METHODS 2970 Chinese patients undergoing coronary angiography were enrolled. Baseline demographics and medical history data was recorded. Serum 1,5-AG levels and biochemical parameters were measured. Baseline characteristics were compared across 1,5-AG categories in diabetes (DM) and non-DM groups. Logistic regression analysis was performed to evaluate the associations of 1,5-AG with the prevalence and severity of CAD. RESULTS Lower 1,5-AG was significantly associated with higher Gensini scores in both DM and non-DM groups. Logistic regression analysis demonstrated that the associations of low 1,5-AG with the prevalence of CAD, elevated Gensini score and severe CAD robustly dose-response increased from undiagnosed DM with 1,5-AG ≥ 14µg/mL to DM with 1,5-AG < 14µg/mL even after adjusting for fasting blood glucose (FBG) or Hemoglobin A1c (HbA1c). The associations were more significant in persons with DM. Significant modification effect of DM on the relationship of 1,5-AG with elevated Gensini score was found. In addition, nonlinear relationship and threshold effects of 1,5-AG with CAD and severity were observed. CONCLUSION Low 1,5-AG is significantly and independently associated with CAD and CAD severity in Chinese patients undergoing coronary angiography. Measurement of 1,5-AG is useful to differentiate subjects with extensive glucose fluctuations and high CAD risks, especially in DM patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT03072797.
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Affiliation(s)
- Ruiyue Yang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Wenduo Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinyue Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Siming Wang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Qi Zhou
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Hongxia Li
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Hongna Mu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Xue Yu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Dong
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
- *Correspondence: Jun Dong, ; Wenxiang Chen,
| | - Wenxiang Chen
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing, China
- *Correspondence: Jun Dong, ; Wenxiang Chen,
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Yin X, Zhu W, Liu C, Yao H, You J, Chen Y, Ying X, Li L. Association of continuous glucose monitoring-derived time in range with major amputation risk in diabetic foot osteomyelitis patients undergoing amputation. Ther Adv Endocrinol Metab 2022; 13:20420188221099337. [PMID: 35602463 PMCID: PMC9121454 DOI: 10.1177/20420188221099337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/21/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The metrics generated from continuous glucose monitoring (CGM), such as time in range (TIR), are strongly correlated with diabetes complications. This study explored the association of perioperative CGM-derived metrics with major amputation risk in patients with diabetic foot osteomyelitis (DFO). METHODS This study recruited 55 DFO patients with grade 3-4 wounds according to the Wagner Diabetic Foot Ulcer Classification System, all of whom underwent CGM for 5 days during the perioperative period. The CGM-derived metrics were defined in accordance with the most recent international consensus recommendations. RESULTS Patients with major amputation had significantly less TIR and higher time below range (TBR) (all p < 0.05). In binary logistic regression analyses, a lower TIR was associated with the risk of major amputation (odds ratio: 0.83 (95% confidence interval: 0.71-0.99), p = 0.039). This association remained statistically significant after adjustments for age, sex, body mass index, type of diabetes, smoking, drinking, durations of diabetes and DFU, ankle-brachial index, albumin, estimated-glomerular filtration rate, Society for Vascular Surgery wound, ischemia, and foot infection (WIfi) stage, multidrug-resistant organisms, and hemoglobin A1c. Further adjustment for the mean amplitude of glycemic excursion (MAGE) reduced this association. TBR was also independently associated with the risk of major amputation (odds ratio: 1.60 (95% confidence interval: 1.17-2.18), p = 0.003); this association persisted after adjustment for MAGE. CONCLUSION Perioperative TIR (3.9-10.0 mmol/L) and TBR (<3.9 mmol/L) were significantly associated with major amputation in hospitalized patients with DFO.
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Affiliation(s)
| | | | - Chao Liu
- Department of Orthopedics, Zhejiang University
School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Huilan Yao
- Department of Nursing Education, Zhejiang
University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou,
China
| | - Jiaxing You
- Department of Orthopedics, Zhejiang University
School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yixin Chen
- Department of Endocrinology, Zhejiang
University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou,
China
| | - Xiaofang Ying
- Department of Endocrinology, Jiangshan People’s
Hospital, Quzhou, China
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Kesavadev J, Misra A, Saboo B, Agarwal S, Sosale A, Joshi SR, Hussain A, Somasundaram N, Basit A, Choudhary P, Soegondo S. Time-in-range and frequency of continuous glucose monitoring: Recommendations for South Asia. Diabetes Metab Syndr 2022; 16:102345. [PMID: 34920199 DOI: 10.1016/j.dsx.2021.102345] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM The prevalence of diabetes is on its rise and South Asia bears a huge burden. Several factors such as heterogeneity in genetics, socio-economic factors, diet, and sedentary behavior contribute to the heightened risk of developing diabetes, its rapid progression, and the development of complications in this region. Even though there have been considerable advances in glucose monitoring technologies, diabetes treatments and therapeutics, glycemic control in South Asia remains suboptimal. The successful implementation of treatment interventions and metrics for the attainment of glycemic goals depends on appropriate guidelines that accord with the characteristics of the diabetes population. METHOD The data were collected from studies published for more than the last ten years in the electronic databases PubMed and Google Scholar on the various challenges in the assessment and achievement of recommended TIR targets in the SA population using the keywords: Blood glucose, TIR, TAR, TBR, HbA1c, hypoglycemia, CGM, Gestational diabetes mellitus (GDM), and diabetes. RESULTS The objective of this recommendation is to discuss the limitations in considering the IC-TIR Expert panel recommendations targets and to propose some modifications in the lower limit of TIR in older/high-risk population, upper limit of TAR, and flexibility in the percentage of time spent in TAR for pregnant women (GDM, T2DM) for the South Asian population. CONCLUSION The review sheds insights into some of the major concerns in implementing the IC-TIR recommendations in South Asian population where the prevalence of diabetes and its complications are significantly higher and modifications to the existing guidelines for use in routine clinical practice.
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Affiliation(s)
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) President, Diabetes Foundation, (DFI), India.
| | - Banshi Saboo
- Chairman and Chief Diabetologist, Diacare, Diabetes Care & Hormone Clinic, Ahmedabad, India.
| | - Sanjay Agarwal
- Diabetologist, Dr. Sanjay Agarwal's Aegle Clinic in Dhole Patil Road, Pune, India.
| | | | - Shashank R Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital & Research Centre, Bandra (W), Mumbai, India.
| | - Akhtar Hussain
- Faculty of Health Sciences, Chronic Disease-Diabetes, NORD University, Stjørdal, Norway; Faculty of Medicine, Federal University of Ceara, Brazil.
| | - Noel Somasundaram
- Consultant Endocrinologist, National Hospital of Sri Lanka: Colombo, Western, LK, Sri Lanka.
| | - Abdul Basit
- Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Pakistan.
| | - Pratik Choudhary
- Senior Lecturer and Consultant in Diabetes, Department of Diabetes, King's College Hospital, London, UK.
| | - Sidartawan Soegondo
- Internist, Consultant Endocrinologist, Department of Internal Medicine, University of Indonesia, Indonesia.
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Rodríguez de Vera-Gómez P, Piñar-Gutiérrez A, Guerrero-Vázquez R, Bellido V, Morales-Portillo C, Sancho-Márquez MP, Espejo-García P, Gros-Herguido N, López-Gallardo G, Martínez-Brocca MA, Soto-Moreno A. Flash Glucose Monitoring and Diabetes Mellitus Induced by Immune Checkpoint Inhibitors: An Approach to Clinical Practice. J Diabetes Res 2022; 2022:4508633. [PMID: 36387939 PMCID: PMC9652069 DOI: 10.1155/2022/4508633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/01/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The aim of this study is to investigate in depth diabetes mellitus associated with immune checkpoint inhibitors (DM-ICIs) by analysing a case series. We also evaluated the clinical impact of flash glucose monitoring (FGM) systems in the management of this entity. METHODS We conducted an observational cohort study of DM-ICIs diagnosed in two hospitals in Seville (Spain). Patients with a new diagnosis of diabetes mellitus (DM) or with sudden worsening of preexisting DM after starting treatment with ICIs, with a random 5 hour-postprandial C-peptide value of <0.6 nmol/L and without possibility of subsequent withdrawal of insulin treatment, were included. RESULTS A total of 7 cases were identified, mostly males (n = 6; 85.7%), with a mean age of 64.9 years. The mean glycated hemoglobin (HbA1c) upon diagnosis was 8.1%, with diabetic ketoacidosis (DKA) observed in 6 cases (85.7%). Subcutaneous flash glucose monitoring (FGM) systems were used in six cases, with a mean follow-up period of 42.7 weeks. During the first 90 days of use, mean average glucose was 167.5 mg/dL, with a coefficient of variation (CV) of 34.6%. The mean time in the range 70-180 mg/dL (TIR) was 59.7%, with a mean time above range (TAR) 181-250 mg/dL of 27.8% and a mean TAR > 250 mg/dL of 10.2%. The mean time below range (TBR) 54-69 mg/dL was 2%, while the mean TBR < 54 mg/dL was 0.3%. The mean glucose management indicator (GMI) was 7.3%. No significant differences were observed in FGM values for the following 90 days of follow-up. A progressive improvement in all parameters of glycaemic control was observed between the first month of FGM use and the sixth month of FGM use. Of note, there was a decrease in mean CV (40.6% to 34.1%, p = 0.25), mean TAR 181-250 (30.3% to 26%, p = 0.49), mean TAR > 250 mg/dL (16.3% to 7.7%, p = 0.09), mean TBR 54-69 mg/dL (5.2% to 2%, p = 0.16), and mean TBR < 54 mg/dL (1.8% to 0.2%, p = 0.31), along with an increase in mean values of TIR 70-180 mg/dL (46.5% to 60.5%, p = 0.09). The lack of statistical significance in the differences observed in the mean FGM values over the follow-up period may be related to the small sample size. CONCLUSION DM-ICI is recognised by a state of sudden-onset insulinopenia, often associated with DKA. The use of FGM systems may be a valid option for the effective management of DM-ICIs and for the prevention of severe hyperglycaemic and hypoglycaemic episodes in this condition.
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Affiliation(s)
| | - Ana Piñar-Gutiérrez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Raquel Guerrero-Vázquez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Virginia Bellido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | | | - Noelia Gros-Herguido
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Gema López-Gallardo
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Alfonso Soto-Moreno
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Seville, Spain
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van den Boom L, Buchal G, Kaiser M, Kostev K. Multimorbidity Among Adult Outpatients With Type 1 Diabetes in Germany. J Diabetes Sci Technol 2022; 16:152-160. [PMID: 33095037 PMCID: PMC8875064 DOI: 10.1177/1932296820965261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM The aim of this cross-sectional retrospective study was to estimate the prevalence of different physical and psychiatric disorders as well as multimorbidity in outpatients with type 1 diabetes (T1D) in Germany. METHODS A total of 6967 adult patients with T1D from 958 general or diabetologist practices in Germany between January 2015 and December 2019 from the Disease Analyzer database (IQVIA) were included. The main outcome of the study was the prevalence of different diabetes-related and nondiabetes-related disorders within 12 months prior to the last outpatient visit. Multivariate logistic regression models were fitted with multimorbidity differently defined as >2, >3, >4, and >5 different disorders as a dependent variable and age, sex, glycated hemoglobin (HbA1c) values, and insulin pump therapy as impact variables. RESULTS Mean age (standard deviation [SD]) was 45.3 (16.7) years; 42.9% were women, the mean HbA1c was 7.9% (SD: 1.4%). The most frequent disorder was arterial hypertension (31.2%), followed by dyslipidemia (26.4%), dorsalgia (20.4%), diabetic neuropathy (17.3%), and depression (14.6%). The proportion of thyroid gland disorders, retinopathy, urethritis, iron deficiency anemia, and psychiatric disorders was higher in women than in men. Hypertension and mental and behavioral disorders due to the use of tobacco were higher in men. On average, each patient was diagnosed with 3.1 different disorders. Age had the strongest association with multimorbidity, followed by HbA1c value and female sex. CONCLUSION In summary, patients with T1D are often multimorbid, and the multimorbidity is associated with higher gender, female sex, and high HbA1c values. Understanding all of these factors can help practitioners create a risk profile for every patient.
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Affiliation(s)
| | | | - Marcel Kaiser
- Diabetologische Schwerpunktpraxis, Frankfurt, German
| | - Karel Kostev
- Epidemiology, IQVIA, Frankfurt, Germany
- Karel Kostev, DMSc, PhD, Epidemiology, IQVIA, Unterschweinstiege 2-14, Frankfurt am Main, 60549 Germany.
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Tommerdahl KL, Shapiro ALB, Nehus EJ, Bjornstad P. Early microvascular complications in type 1 and type 2 diabetes: recent developments and updates. Pediatr Nephrol 2022; 37:79-93. [PMID: 33852054 PMCID: PMC8527882 DOI: 10.1007/s00467-021-05050-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 12/30/2022]
Abstract
The prevalence of youth-onset diabetes is progressing rapidly worldwide, and poor glycemic control, in combination with prolonged diabetes duration and comorbidities including hypertension, has led to the early development of microvascular complications including diabetic kidney disease, retinopathy, and neuropathy. Pediatric populations with type 1 (T1D) and type 2 (T2D) diabetes are classically underdiagnosed with microvascular complications, and this leads to both undertreatment and insufficient attention to the mitigation of risk factors that could help attenuate further progression of complications and decrease the likelihood for long-term morbidity and mortality. This narrative review aims to present a comprehensive summary of the epidemiology, risk factors, symptoms, screening practices, and treatment options, including future opportunities for treatment advancement, for microvascular complications in youth with T1D and T2D. We seek to uniquely focus on the inherent challenges of managing pediatric populations with diabetes and discuss the similarities and differences between microvascular complications in T1D and T2D, while presenting a strong emphasis on the importance of early identification of at-risk youth. Further investigation of possible treatment mechanisms for microvascular complications in youth with T1D and T2D through dedicated pediatric outcome trials is necessary to target the brief window where early pathological vascular changes may be significantly attenuated.
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Affiliation(s)
- Kalie L Tommerdahl
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 E. 16th Avenue, Box B265, Aurora, CO, 80045, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison L B Shapiro
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 E. 16th Avenue, Box B265, Aurora, CO, 80045, USA
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Edward J Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Petter Bjornstad
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, 13123 E. 16th Avenue, Box B265, Aurora, CO, 80045, USA.
- Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA.
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Liu F, Sirisena S, Ng K. Efficacy of flavonoids on biomarkers of type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 2021:1-27. [PMID: 34842001 DOI: 10.1080/10408398.2021.2009761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A systematic review and meta-analysis of 28 randomized controlled trials (RCTs) to assess the efficacy of flavonoids intake on key biomarkers related to Type 2 diabetes mellitus was conducted. The mean difference (MD) with 95% confidence intervals (95% CI) was pooled using a random-effects model. Significant reduction in fasting glucose (MD: -0.22, 95% CI: -0.34 to -0.09, p = 0.0013), hemoglobin A1c (HbA1c) (MD: -0.26, 95% CI: -0.46 to -0.05, p = 0.021), homeostasis model assessment of insulin resistance (HOMA-IR) (MD: -0.40, 95% CI: -0.66 to -0.15, p = 0.0039), triglyceride (TG) (MD: -0.13, 95% CI: -0.21 to -0.05, p = 0.002), total cholesterol (TC) (MD: -0.14, 95% CI: -0.21 to -0.08, p = 0.0002), and low density lipoprotein-C (LDL-C) (MD: -0.15; 95% CI: -0.24 to -0.07, p = 0.0009) were observed in intervention group compare to placebo at the end of trial. Moreover, flavonoid intake had negative but non-significant effect on insulin (MD: -0.46), 2 h-postprandial glucose (2 h-PPG) (MD: -0.22), homeostasis model assessment of β-cell function (HOMA-β) (MD: -2.81), and insignificantly increased high-density lipoprotein-C (HDL-C) (MD: 0.03). In conclusion, flavonoid intake has modest but statistically significant benefits in glucose metabolism, insulin sensitivity, and lipid metabolism, especially for significantly lowing fasting blood glucose, HOMA-IR, HbA1c, TG, TC, and LDL-C.
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Affiliation(s)
- Fanling Liu
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Sameera Sirisena
- Department of Chemical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Parkville, VIC, Australia
| | - Ken Ng
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
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50
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Jing N, Pan M, Song Y, Guo F, Zhang H, Wang J, Cao Z, Liu S, Wu L, Ji H, Huang F, Ding X, Qi C, Huang S, Yang X, Zhang L, Song C, Qin G, Zhao Y. Renal outcomes and prognostic factors in patients with type-2 diabetes and chronic kidney disease confirmed by renal biopsy. Ther Adv Chronic Dis 2021; 12:20406223211052388. [PMID: 34729158 PMCID: PMC8543721 DOI: 10.1177/20406223211052388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Aim To evaluate the renal outcomes and prognostic factors among patients with type-2 diabetes (T2D) and biopsy-confirmed diabetic nephropathy (DN), non-diabetic renal disease (NDRD) and DN mixed with NDRD (MIX). Design and Methods Patients with both T2D and chronic kidney disease (CKD) who underwent renal biopsy between January 2014 and December 2016 were recruited in this prospective observational study. Participants were divided into DN group, NDRD group, or MIX group according to the baseline pathological diagnosis. The primary endpoint was a composite renal event of end-stage renal disease (ESRD) or ⩾ 40% reduction in estimated glomerular filtration rate (eGFR). Results Among the 292 participants included, 153 (52.4%) belonged to the DN group, 30 (10.3%) belonged to the NDRD group, and 109 (37.3%) belonged to the MIX group. During the median follow-up of 27 months, the adverse renal events occurred in 132 (44.2%) patients. Compared with NDRD group, the multiple adjusted hazard ratios (HRs) for renal events in patients with DN and MIX groups were 3.900 (95% confidence interval [CI]: 1.103-13.788) and 2.691 (95% CI: 0.662-10.936), respectively. Baseline lower eGFR (HR: 1.159, 95% CI: 1.060-1.266), severe proteinuria (HR: 2.047, 95% CI: 1.227-3.416), lower hemoglobin (HR: 1.170, 95% CI: 1.008-1.267), and a family history of diabetes (HR: 1.138, 95% CI: 1.008-2.285) were independent predictors for adverse renal outcomes in patients with DN. Conclusion In patients with T2D and CKD, pure DN and MIX group displayed a worse renal prognosis than NDRD group. Worse renal function, severe proteinuria, lower hemoglobin, and a family history of diabetes may be associated with adverse renal outcomes in patients with DN.
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Affiliation(s)
- Na Jing
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengxing Pan
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Song
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Guo
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haohao Zhang
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Cao
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shiyu Liu
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lina Wu
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongfei Ji
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengjuan Huang
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoxu Ding
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chang Qi
- Department of Clinical Medicine, The Medical College of Zhengzhou University, Zhengzhou, China
| | - Sen Huang
- Department of Clinical Medicine, The Medical College of Zhengzhou University, Zhengzhou, China
| | - Xinyu Yang
- Department of Clinical Medicine, The Medical College of Zhengzhou University, Zhengzhou, China
| | - Li Zhang
- Department of Clinical Medicine, The Medical College of Zhengzhou University, Zhengzhou, China
| | - Chunhua Song
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guijun Qin
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanyan Zhao
- Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou 450052, Henan, China
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