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Nguyen V, Ara P, Simmons D, Osuagwu UL. The Role of Digital Health Technology Interventions in the Prevention of Type 2 Diabetes Mellitus: A Systematic Review. Clin Med Insights Endocrinol Diabetes 2024; 17:11795514241246419. [PMID: 38779330 PMCID: PMC11110501 DOI: 10.1177/11795514241246419] [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: 07/05/2023] [Accepted: 03/26/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives Diabetes in the 21st century presents one of the greatest burdens of disease on the global population. Digitally mediated interventions have become imperative in alleviating this disease epidemic. We aimed to systematically review randomized controlled trials (RCTs) on different health technologies for preventing Type 2 diabetes mellitus, and their efficacy in decreasing diabetes risk-related outcomes in at-risk patients in comparison to standard care. Methods Five electronic databases were searched between October 2021 and December 2022. Studies including digital health technology interventions used for preventing diabetes development by reducing diabetes risk-related outcomes in at-risk adults (⩾18 years) were identified. Data on glycemic levels, incidence of T2DM, weight, and intervention descriptions were extracted, and the risk of bias (ROB) was assessed. Results Nine studies met the inclusion criteria and 5 studies (56%) achieved clinically significant outcomes in at least one of the following: decreased weight (22%), glycemic levels (22%), or incidence of T2DM (11%). Two of the 3 (67%) computer-based interventions effectively reduced the HbA1c levels and mean weight of their study population, and 3 of 6 (50%) mobile based interventions (text messages, mobile app, and telehealth) decreased the incidence of T2DM and HbA1c levels. Four studies each had an overall low ROB and one had a high ROB due to attrition. Conclusion Preliminary evidence identified in our review demonstrated that health technologies for diabetes prevention are effective for improving diabetes risk-related outcomes. Future research into digital technology protocol and studies of longer duration and more diverse populations are needed for clinical feasibility.
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Affiliation(s)
- Vivien Nguyen
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Paige Ara
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Uchechukwu Levi Osuagwu
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
- Bathurst Rural Clinical School (BRCS), School of Medicine, Western Sydney University, Bathurs, NSW, Australia
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Mantskava M, Chkhitauri L, Shekiladze E, Tskhvediani N, Kalmakhelidze S, Momtselidze N, Prantl L, Jung F, Machaliński B, Wojciech P, Sanikidze T. Impact of different severity hyperglycemia on erythrocyte rheological properties1. Clin Hemorheol Microcirc 2024; 87:271-281. [PMID: 38363605 DOI: 10.3233/ch-239104] [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] [Indexed: 02/17/2024]
Abstract
BACKGROUND The triad "insulin resistance, prediabetes, diabetes" is three independent neologies with characteristic features and development. In addition, each are characterized by progression and the possibility of transition from one form to other. Due to the fact that diabetes is one of the common diseases associated with high rates of disability, it is necessary to improve diagnostic methods and educational regimens for successful prevention and treatment of the disease. OBJECTIVE We investigated Band 3 protein (B3p) level, osmotic resistance of erythrocytes, the total antioxidant activity (TAA) of blood serum, level of HbA1 in group patients with insulin resistance (IR), prediabetes, and Type 2 Diabetes Mellitus (T2DM) and comparative with health control group. METHODS We used original, accurate research methods that measure the essence of the studied quantities. RESULTS Disruptions of glucose and insulin homeostasis ay lead to the initiation of oxidative stress (in our study demonstrated by a decrease of TAA of blood serum) increased redox-sensitive PTP activity and aberrant band 3 phosphorylation, potentially leading to reduced erythrocyte deformability. At the same time glycation of Hb during T2DM may affect its cross-link with membrane proteins, in particular with B3p, and although appears to limit its cross-linking and decrease its clusterization ability, induces alterations in the cytoskeletal matrix, and thereby decrease erythrocytes' osmotic resistance making them more susceptible to hemolysis. CONCLUSIONS The osmotic resistance of the erythrocytes can be used as a sensitive marker for the detection of the early stages of hyperglycemia (prediabetes). This set of clinical trials will make it possible to identify diseases that make up the triad at an early stage. Early detection of disorders and continued research in this direction will help in the development of a diagnostic scheme for the prevention of such patients. Based on our data, research into anti-oxidation drugs is very important. With the help of the array of studies described in the article and antioxidant treatment, the likelihood of successful treatment will increase.
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Affiliation(s)
- M Mantskava
- Ivane Beritashvili Center of Experimental Biomedicine, Tbilisi, Georgia
- Tbilisi State Medical University, Tbilisi, Georgia
| | - L Chkhitauri
- Ivane Javakhishvili State University, Tbilisi, Georgia
| | - E Shekiladze
- Tbilisi State Medical University, Tbilisi, Georgia
| | | | - S Kalmakhelidze
- Ivane Beritashvili Center of Experimental Biomedicine, Tbilisi, Georgia
- Tbilisi State Medical University, Tbilisi, Georgia
| | - N Momtselidze
- Ivane Beritashvili Center of Experimental Biomedicine, Tbilisi, Georgia
| | - L Prantl
- University Hospital Regensburg, Regensburg, Germany
| | - F Jung
- Brandenburg University of Technology, Cottbus Senftenberg, Germany
| | | | - P Wojciech
- Pomeranian Medical University, Szczecin, Poland
| | - T Sanikidze
- Ivane Beritashvili Center of Experimental Biomedicine, Tbilisi, Georgia
- Tbilisi State Medical University, Tbilisi, Georgia
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Liu Z, Jia X, Wu P, Wu B, Pan Y, Zhong S, Xiao L, Song Y, Hu J, Zhou K. PMAT variant rs3889348 is associated with metformin-induced gastrointestinal among Chinese Type 2 diabetes patients. Pharmacogenomics 2023; 24:551-560. [PMID: 37458617 DOI: 10.2217/pgs-2023-0078] [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] [Indexed: 08/22/2023] Open
Abstract
Aim: This study examined intronic gene variants for their association with metformin intolerance in a Chinese population, focusing on the plasma monoamine transporter (PMAT) cis-protein expression quantitative trait loci (cis-eQTL) variant rs3889348. Methods: We recruited Type 2 diabetes patients from two hospitals and identified 111 metformin-intolerant patients using a questionnaire, and selected 206 metformin-tolerant patients from 2180 Type 2 diabetes mellitus patients. Genetic testing revealed an association between adverse gastrointestinal (GI) effects and SLC22A1 and PMAT. Results: The single-nucleotide polymorphism rs3889348 is associated with metformin-induced adverse GI effects. Each additional copy of the G allele increases the score by 5.23 (95% CI: 1.82-8.64; p = 0.003). Patients taking more transporter inhibitors were more likely to respond to metformin-induced GI intolerance (p = 0.042). Conclusion: PMAT cis-eQTL rs3889348 was significantly associated with metformin-induced adverse GI effects.
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Affiliation(s)
- Ziqing Liu
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, 10140, China
| | - Xiao Jia
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy & Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin, 300000, China
| | - Peng Wu
- Guangzhou Laboratory, Guangdong Province, China
| | - Benrui Wu
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, 10140, China
- National Laboratory of Biomacromolecules, Institute of Biophysics Chinese Academy of Sciences, Beijing, 100101, China
| | - Ying Pan
- The first people's hospital of Kunshan, Jiangsu Province, China
| | - Shao Zhong
- The first people's hospital of Kunshan, Jiangsu Province, China
| | - Luhua Xiao
- Kunshan community health service center in Bailu, Jiangsu Province, China
| | - Yuehong Song
- Kunshan community health service center in Zhenchuan, Jiangsu Province, China
| | - Jinbo Hu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kaixin Zhou
- Guangzhou Laboratory, Guangdong Province, China
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Li C, Qin J, Liu W, Lv B, Yi N, Xue J, Xue Z. Profiling of Homocysteine Metabolic Pathway Related Metabolites in Plasma of Diabetic Mellitus Based on LC-QTOF-MS. Molecules 2023; 28:molecules28020656. [PMID: 36677712 PMCID: PMC9861464 DOI: 10.3390/molecules28020656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Background: Homocysteine (Hcy) has been found to be closely related to the occurrence of diabetes mellitus (DM) and is considered as one of the risk factors of DM. However, Hcy alone is not enough as a factor to predict DM, and our study analyzed and determined the relationship between the main metabolites involved in the Hcy metabolic pathway and DM. Methods: A total of 48 clinical samples were collected, including 18 health control samples and 30 DM samples. All standards and samples were detected by LC-QTOF-MS. Multivariate statistical analysis and k-means cluster analysis were performed to screen and confirm the metabolites significantly correlated with DM. Results: A total of 13 metabolites of the Hcy metabolic pathway were detected in the samples. The content of Hcy, cysteine, taurine, pyridoxamine, methionine, and choline were significantly increased in the DM group (p < 0.05). Hcy, choline, cystathionine, methionine, and taurine contributed significantly to the probabilistic principal component analysis (PPCA) model. The odds ratios (OR) of Hcy, cysteine, taurine, methionine, and choline were all greater than one. K-means cluster analysis showed that the Hcy, taurine, methionine, and choline were significantly correlated with the distribution of glucose values (divided into four levels: 10.5−11.7 mmol/L, 7.7−9.7 mmol/L, 6.0−6.9 mmol/L, and 5.0−5.9 mmol/L, respectively). Conclusion: Hcy, taurine, methionine, and choline can be used as risk factors for diabetes diagnosis and are expected to be used for the assessment of diabetes severity.
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Affiliation(s)
- Chanyi Li
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
| | - Jiaying Qin
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
| | - Wuping Liu
- International Joint Research Center for Medical Metabolomics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Bo Lv
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
| | - Ning Yi
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
| | - Jinfeng Xue
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
- Correspondence: (J.X.); (Z.X.)
| | - Zhigang Xue
- Department of Regenerative Medicine, School of Medicine, Tongji University, 1239 Siping Road, Shanghai 200092, China
- Translational Center of Stem Cell Research, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
- Hunan Jiahui Genetics Hospital, 72 Xiangya Road, Changsha 410008, China
- Correspondence: (J.X.); (Z.X.)
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Zhang C, Zhang X, Wang P, Zhu Q, Mei Y, Zhang Z, Xu H. Effect of SGLT2 Inhibitors on Risk of Stroke in Diabetes: A Meta-Analysis. Cerebrovasc Dis 2022; 51:585-593. [PMID: 35100586 DOI: 10.1159/000521782] [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: 11/18/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors on reducing the risk of stroke in patients with type 2 diabetes mellitus (T2DM) remains unclear. Thus, we conducted this systemic review and meta-analysis of all relevant studies and trials to explore the role of SGLT2 inhibitors on the stroke prevention. METHODS The present study included articles published before October 2021 and searched in Web of Science, PubMed databases. We used STATA 12.0 software to compute hazard ratio (HR) and 95% confidence interval (CI). RESULTS Meta-analysis indicated that SGLT2 inhibitors showed no significant effects on risk of stroke in diabetes in randomized controlled trials with a fixed effects model (HR = 0.98; 95% CI: 0.88-1.09, I2 = 22.3%, p = 0.272). Compared to other glucose-lowering drugs (oGLD) and insulin, SGLT2 inhibitors alone significantly affected risk of stroke in diabetes in observational studies with a random effects model (HR = 0.87; 95% CI: 0.80-0.95, I2 = 72.2%, p < 0.001). CONCLUSIONS In summary, this meta-analysis indicated that the use of SGLT2 inhibitors did not decrease the risk of stroke. And for some T2DM patients with high-risk factor of stroke, SGLT2 inhibitors therapy may be more suitable compared to some oGLD such as dipeptidyl peptidase-4 inhibitors. The results of this meta-analysis are necessary to be confirmed with further studies and clinical trials.
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Affiliation(s)
- Chunhui Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Xian Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Peng Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Qinghua Zhu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Hui Xu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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Cai XT, Ji LW, Liu SS, Wang MR, Heizhati M, Li NF. Derivation and Validation of a Prediction Model for Predicting the 5-Year Incidence of Type 2 Diabetes in Non-Obese Adults: A Population-Based Cohort Study. Diabetes Metab Syndr Obes 2021; 14:2087-2101. [PMID: 34007195 PMCID: PMC8123981 DOI: 10.2147/dmso.s304994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this study was to derivate and validate a nomogram based on independent predictors to better evaluate the 5-year risk of T2D in non-obese adults. PATIENTS AND METHODS This is a historical cohort study from a collection of databases that included 12,940 non-obese participants without diabetes at baseline. All participants were randomised to a derivation cohort (n = 9651) and a validation cohort (n = 3289). In the derivation cohort, the least absolute shrinkage and selection operator (LASSO) regression model was used to determine the optimal risk factors for T2D. Multivariate Cox regression analysis was used to establish the nomogram of T2D prediction. The receiver operating characteristic (ROC) curve, C-index, calibration curve, and decision curve analysis were performed by 1000 bootstrap resamplings to evaluate the discrimination ability, calibration, and clinical practicability of the nomogram. RESULTS After LASSO regression analysis of the derivation cohort, it was found that age, fatty liver, γ-glutamyltranspeptidase, triglycerides, glycosylated hemoglobin A1c and fasting plasma glucose were risk predictors, which were integrated into the nomogram. The C-index of derivation cohort and validation cohort were 0.906 [95% confidence interval (CI), 0.878-0.934] and 0.837 (95% CI, 0.760-0.914), respectively. The AUC of 5-year T2D risk in the derivation cohort and validation cohort was 0.916 (95% CI, 0.889-0.943) and 0.829 (95% CI, 0.753-0.905), respectively. The calibration curve indicated that the predicted probability of nomogram is in good agreement with the actual probability. The decision curve analysis demonstrated that the predicted nomogram was clinically useful. CONCLUSION Our nomogram can be used as a reasonable, affordable, simple, and widely implemented tool to predict the 5-year risk of T2D in non-obese adults. With this model, early identification of high-risk individuals is helpful to timely intervene and reduce the risk of T2D in non-obese adults.
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Affiliation(s)
- Xin-Tian Cai
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
| | - Li-Wei Ji
- Laboratory of Mitochondrial and Metabolism, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Sha-Sha Liu
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
| | - Meng-Ru Wang
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
| | - Mulalibieke Heizhati
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
| | - Nan-Fang Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
- Correspondence: Nan-Fang Li Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People’s Republic of ChinaTel +86 991 8564818 Email
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Enang OE, Omoronyia OE, Ayuk AE, Nwafor KN, Legogie AO. Diabetes knowledge among non-diabetic hypertensive patients in Calabar, Nigeria. Pan Afr Med J 2020; 36:198. [PMID: 32952842 PMCID: PMC7467622 DOI: 10.11604/pamj.2020.36.198.20522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 06/29/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION among hypertensive patients, the comorbidity of diabetes is not uncommon. Yet, little is known about diabetes prevention among non-diabetic hypertensive patients. This study sought to assess such patients' knowledge about diabetes and its risk factors. METHODS a cross-sectional descriptive study design and random sampling were used to recruit non-diabetic hypertensive patients from University of Calabar Teaching Hospital. A pretested 33-item questionnaire was used to assess various aspects of diabetes knowledge. Participants' alcohol consumption, smoking habits, physical activity, and fresh fruit consumption were also assessed. The p-value was set to 0.05. RESULTS of 212 respondents with a mean age of 45.5 ± 10.8 years, approximately half (49.1%) had inadequate knowledge of diabetes. Most participants demonstrated poor knowledge of diabetes' clinical features (81.1%) and complications (59.4%), while fewer participants showed poor knowledge of causes and risk factors (24.5%) and diabetes management (40.6%). Older subjects, those in the wards, non-drinkers, physically active people, and those who frequently consumed fresh fruit had a significantly greater understanding of diabetes symptoms and complications (p<0.05). CONCLUSION hypertensive patients' diabetes knowledge is generally suboptimal, with greater knowledge deficiencies being apparent in specific areas. More strategic health education initiatives are required, about minimizing the risk of developing diabetes comorbidities.
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Affiliation(s)
- Ofem Egbe Enang
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | | | - Agam Ebaji Ayuk
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
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Njeru JW, Castro MR, Carta KG, Simon G, Caraballo PJ. CLINICAL RECOGNITION AND MANAGEMENT OF PATIENTS WITH PREDIABETES. Endocr Pract 2019; 25:545-553. [PMID: 30865535 DOI: 10.4158/ep-2018-0485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Early identification and management of prediabetes is critical to prevent progression to diabetes. We aimed to assess whether prediabetes is appropriately recognized and managed among patients with impaired fasting glucose (IFG). Methods: We carried out an observational study of Olmsted County residents evaluated at the Mayo Clinic between 1999-2017. We randomly selected 108 subjects with biochemical criteria of IFG and 105 normoglycemic subjects. We reviewed their health records at baseline (1999-2004) and during follow up (2005-2017) collecting demographic and clinical data including vitals, diagnoses, laboratory, and medications associated with cardiovascular comorbidities. The main outcome was documentation of any recognition of prediabetes and management recommendations (lifestyle changes and/or medications). Results: At baseline (1999-2004), 26.85% (29/108) of subjects with IFG were recognized as having prediabetes, and of these 75.86% (22/29) received management recommendations with 6.9% (2/29) getting metformin. During follow-up (2005-2017), 26.67% (28/105) of initial cohort of normoglycemic subjects developed incident IFG and of these, 85.71% (24/28) were recognized as having prediabetes, and 58.33% (14/24) received management recommendations. During the entire study period, 62.50% (85/136) were recognized as having prediabetes of which 75.29% (64/85) had documented management recommendations. High body mass index (BMI) (≥35) was associated with increased recognition (odds ratio [OR] 3.66; confidence interval [CI] 1.065, 12.500; P = .0395), and normal BMI (<25) was associated with a lack of recognition (OR 0.146; CI 0.189, 0.966; P = .0413). Conclusion: Despite evidence supporting the efficacy of lifestyle changes and medications in managing prediabetes, this condition is not fully recognized in routine clinical practice. Increased awareness of diagnostic criteria and appropriate management are essential to enhance diabetes prevention. Abbreviations: BMI = body mass index; CI = confidence interval; EHR = electronic health records; FBG = fasting blood glucose; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; OR = odds ratio.
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Kalaitzoglou E, Fowlkes JL, Popescu I, Thrailkill KM. Diabetes pharmacotherapy and effects on the musculoskeletal system. Diabetes Metab Res Rev 2019; 35:e3100. [PMID: 30467957 PMCID: PMC6358500 DOI: 10.1002/dmrr.3100] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022]
Abstract
Persons with type 1 or type 2 diabetes have a significantly higher fracture risk than age-matched persons without diabetes, attributed to disease-specific deficits in the microarchitecture and material properties of bone tissue. Therefore, independent effects of diabetes drugs on skeletal integrity are vitally important. Studies of incretin-based therapies have shown divergent effects of different agents on fracture risk, including detrimental, beneficial, and neutral effects. The sulfonylurea class of drugs, owing to its hypoglycemic potential, is thought to amplify the risk of fall-related fractures, particularly in the elderly. Other agents such as the biguanides may, in fact, be osteo-anabolic. In contrast, despite similarly expected anabolic properties of insulin, data suggests that insulin pharmacotherapy itself, particularly in type 2 diabetes, may be a risk factor for fracture, negatively associated with determinants of bone quality and bone strength. Finally, sodium-dependent glucose co-transporter 2 inhibitors have been associated with an increased risk of atypical fractures in select populations, and possibly with an increase in lower extremity amputation with specific SGLT2I drugs. The role of skeletal muscle, as a potential mediator and determinant of bone quality, is also a relevant area of exploration. Currently, data regarding the impact of glucose lowering medications on diabetes-related muscle atrophy is more limited, although preclinical studies suggest that various hypoglycemic agents may have either aggravating (sulfonylureas, glinides) or repairing (thiazolidinediones, biguanides, incretins) effects on skeletal muscle atrophy, thereby influencing bone quality. Hence, the therapeutic efficacy of each hypoglycemic agent must also be evaluated in light of its impact, alone or in combination, on musculoskeletal health, when determining an individualized treatment approach. Moreover, the effect of newer medications (potentially seeking expanded clinical indication into the pediatric age range) on the growing skeleton is largely unknown. Herein, we review the available literature regarding effects of diabetes pharmacotherapy, by drug class and/or by clinical indication, on the musculoskeletal health of persons with diabetes.
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Affiliation(s)
- Evangelia Kalaitzoglou
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - John L Fowlkes
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Iuliana Popescu
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Kathryn M Thrailkill
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
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Fuller S, Yu Y, Mendoza T, Ribnicky DM, Cefalu WT, Floyd ZE. Potential adverse effects of botanical supplementation in high-fat-fed female mice. Biol Sex Differ 2018; 9:41. [PMID: 30208938 PMCID: PMC6134698 DOI: 10.1186/s13293-018-0199-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/27/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Insulin resistance underlies metabolic syndrome and is associated with excess adiposity and visceral fat accumulation, which is more frequently observed in males than females. However, in young females, the prevalence of metabolic syndrome is rising, mainly driven by accumulation of abdominal visceral fat. The degree to which sex-related differences could influence the development of insulin resistance remains unclear, and studies of potential therapeutic strategies to combat metabolic syndrome using rodent models have focused predominantly on males. We therefore evaluated the effects of two nutritional supplements derived from botanical sources, an extract of Artemisia dracunculus L. (termed PMI5011) and Momordica charantia (commonly known as bitter melon), on female mice challenged with a high-fat diet in order to determine if dietary intake of these supplements could ameliorate obesity-induced insulin resistance and metabolic inflexibility in skeletal muscle. METHODS Body composition, physical activity and energy expenditure, fatty acid oxidation, insulin signaling, and gene and protein expression of factors controlling lipid metabolism and ectopic lipid accumulation were evaluated in female mice fed a high-fat diet supplemented with either PMI5011 or bitter melon. Statistical significance was assessed by unpaired two-tailed t test and repeated measures ANOVA. RESULTS PMI5011 supplementation resulted in increased body weight and adiposity, while bitter melon did not induce changes in these parameters. Pyruvate tolerance testing indicated that both supplements increased hepatic glucose production. Both supplements induced a significant suppression in fatty acid oxidation in skeletal muscle homogenates treated with pyruvate, indicating enhanced metabolic flexibility. PMI5011 reduced lipid accumulation in skeletal muscle, while bitter melon induced a downward trend in lipid accumulation in the skeletal muscle and liver. This was accompanied by transcriptional regulation of autophagic genes by bitter melon in the liver. CONCLUSIONS Data from the current study indicates that dietary supplementation with PMI5011 and bitter melon evokes a divergent, and generally less favorable, set of metabolic responses in female mice compared to effects previously observed in males. Our findings underscore the importance of considering sex-related variations in responses to dietary supplementation aimed at combating metabolic syndrome.
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Affiliation(s)
- Scott Fuller
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, 70808, USA.,School of Kinesiology, University of Louisiana at Lafayette, Lafayette, LA, 70506, USA
| | - Yongmei Yu
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, 70808, USA
| | - Tamra Mendoza
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, 70808, USA
| | - David M Ribnicky
- Biotech Center, Rutgers University, New Brunswick, NJ, 08901, USA
| | - William T Cefalu
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, 70808, USA
| | - Z Elizabeth Floyd
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, 70808, USA.
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Aguilar-Salinas CA, Bourges-Rodriguez H, Polo-Oteyza E. Prevention of diabetes in Mexico: summary of evidence on preventive interventions presented at the 2014 Nestle Nutrition Conference. Nutr Rev 2017; 75:1-3. [PMID: 28049744 DOI: 10.1093/nutrit/nuw050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carlos A Aguilar-Salinas
- C.A. Aguilar-Salinas is with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutrición, Salvador Zubiran, Mexico City, Mexico. H. Bourges-Rodriguez is with the Direction of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubiran, Mexico City, Mexico. E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundacion Mexicana para la Salud, Mexico City, Mexico.
| | - Hector Bourges-Rodriguez
- C.A. Aguilar-Salinas is with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutrición, Salvador Zubiran, Mexico City, Mexico. H. Bourges-Rodriguez is with the Direction of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubiran, Mexico City, Mexico. E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundacion Mexicana para la Salud, Mexico City, Mexico
| | - Ernestina Polo-Oteyza
- C.A. Aguilar-Salinas is with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutrición, Salvador Zubiran, Mexico City, Mexico. H. Bourges-Rodriguez is with the Direction of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubiran, Mexico City, Mexico. E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundacion Mexicana para la Salud, Mexico City, Mexico
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