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Quintanilla K, Joo KM, La Torre HL, Neyra-Rivera CD, Gutierrez EL, Parodi JF, Runzer-Colmenares FM. Association between Subclinical Hypothyroidism and Glycemic Control in Older Adults in a Medical Center in Peru. Curr Gerontol Geriatr Res 2024; 2024:2156630. [PMID: 39258119 PMCID: PMC11387086 DOI: 10.1155/2024/2156630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 08/09/2024] [Indexed: 09/12/2024] Open
Abstract
Objective To determine whether there is an association between subclinical hypothyroidism and glycemic control in older adults who received care at the "Centro Médico Naval" from 2010 to 2015. Methods This retrospective analytical study analyzed a secondary database of the care of elderly in the study hospital. The sample was comprised of 1,385 older adults. To detect an association between variables, the Poisson regression with robust variance was used at a significance level of 95%. The analyses were carried out with the STATA 16 program. Results Of the elderly 45.6% were between 71 and 80 years old; 58.4% were women and 43.8% had a normal body mass index. There was evidence of inadequate glycemic control in 8.1% and subclinical hypothyroidism in 15.2% of the elderly patients. Subclinical hypothyroidism was more frequent in the inadequate glycemic control vs. adequate glycemic control populations (41.1% vs. 13.0%). In the multivariance analysis, subclinical hypothyroidism (aPR = 2.22 95% CI [1.47-3.36]) was independent factor associated with inadequate glycemic control (p < 0.001). Conclusions A significant association was detected between subclinical hypothyroidism and inadequate glycemic control in older adults who presented at the "Centro Médico Naval" from 2010 to 2015.
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Affiliation(s)
- Karen Quintanilla
- Universidad Científica del Sur Facultad de Ciencias de la Salud Carrera de Medicina Humana CHANGE Research Working Group, Lima, Peru
| | - Karla M Joo
- Centro de Investigación del Envejecimiento (CIEN) Facultad de Medicina Humana Universidad San Martín de Porres, Lima, Peru
| | - Hellen L La Torre
- Centro de Investigación del Envejecimiento (CIEN) Facultad de Medicina Humana Universidad San Martín de Porres, Lima, Peru
| | | | - Ericson L Gutierrez
- Universidad San Ignacio de Loyola Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - José F Parodi
- Centro de Investigación del Envejecimiento (CIEN) Facultad de Medicina Humana Universidad San Martín de Porres, Lima, Peru
| | - Fernando M Runzer-Colmenares
- Universidad Científica del Sur Facultad de Ciencias de la Salud Carrera de Medicina Humana CHANGE Research Working Group, Lima, Peru
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Brask-Thomsen PK, Itani M, Karlsson P, Kristensen AG, Krøigård T, Jensen TS, Tankisi H, Sindrup SH, Finnerup NB, Gylfadottir SS. Development and Progression of Polyneuropathy Over 5 Years in Patients With Type 2 Diabetes. Neurology 2024; 103:e209652. [PMID: 39008800 DOI: 10.1212/wnl.0000000000209652] [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] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There is a need for knowledge regarding the natural course of diabetic polyneuropathy (DPN), a complication in type 2 diabetes (T2D). The aim of this study was to examine the development of DPN over time. METHODS Patients with newly diagnosed T2D, recruited from a national cohort, and controls without diabetes of similar age and sex, underwent sensory phenotyping in 2016-2018. The Toronto consensus criteria were used to classify patients into possible, probable, and confirmed DPN. For this 5-year, observational, follow-up, cohort study, all participants were invited to a reexamination combining bedside sensory examination, quantitative sensory testing (QST), nerve conduction studies (NCSs), and skin biopsies measuring intraepidermal nerve fiber density (IENFD) in order to compare phenotypic and diagnostic changes over time. RESULTS Of the baseline 389 patients and 97 controls, 184 patients (median [interquartile range] diabetes duration 5.9 [4.1-7.4] years, mean hemoglobin A1c [HbA1c] 51 ± 11 mmol/mol at baseline) and 43 controls completed follow-up (46.9%). Confirmed DPN was present in 35.8% and 50.3%, probable DPN in 27.2% and 14.6%, possible DPN in 17.2% and 16.6%, and no DPN in 15.2% and 17.9% at baseline and follow-up, respectively. The estimated prevalence (95% CI) of confirmed DPN was 33.5% (24.9-42.1) compared with 22.7% (17.5-28.0) at baseline. During the follow-up period, 43.9% of patients with probable DPN developed confirmed DPN. Progression of neuropathy occurred in 16.5% and 24.7% and regression in 5.9% and 18.6% of patients based on NCS and IENFD, respectively. Progression based on NCS and/or IENFD was associated with higher baseline waist circumference and triglycerides, and regression with lower baseline HbA1c. Patients with at least probable DPN at baseline but neither patients without DPN nor controls developed increased spread of hyposensitivity, more hyposensitivity on QST and lower NCS z-scores at follow-up, and worsening of nerve parameters at follow-up correlated with higher baseline triglycerides. DISCUSSION In patients with well-regulated T2D, the proportion of patients with confirmed DPN increased over 5 years driven by progression from probable DPN. A large proportion of patients progressed, and a smaller proportion regressed on nerve parameters. Higher triglycerides correlated with this progression and may constitute a risk factor.
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Affiliation(s)
- Peter Kolind Brask-Thomsen
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Mustapha Itani
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Pall Karlsson
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Alexander G Kristensen
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Thomas Krøigård
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Troels S Jensen
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Hatice Tankisi
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Søren H Sindrup
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Nanna B Finnerup
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
| | - Sandra Sif Gylfadottir
- From the Danish Pain Research Center (P.K.B.-T., P.K., A.G.K., T.S.J., N.B.F., S.S.G.), Department of Clinical Medicine, Aarhus University; Steno Diabetes Center Aarhus (P.K.B.-T., T.S.J.), Aarhus University Hospital; Department of Neurology (M.I., T.K., S.H.S.), Odense University Hospital; Core Center for Molecular Morphology (P.K.), Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University; Department of Clinical Neurophysiology (A.G.K., H.T.), Aarhus University Hospital; Department of Neurophysiology (T.K.), Odense University Hospital; Department of Clinical Research (T.K.), University of Southern Denmark, Odense; Department of Clinical Medicine (H.T.), Aarhus University; and Department of Neurology (N.B.F., S.S.G.), Aarhus University Hospital, Denmark
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Amsalu H, Hailu M, Asefa A, Ayenew M, Yosef T. The effect of lifestyle factors on chronic complications of diabetes at public health hospitals in Southwest Ethiopia. Sci Rep 2024; 14:18428. [PMID: 39117686 PMCID: PMC11310197 DOI: 10.1038/s41598-024-69527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 08/06/2024] [Indexed: 08/10/2024] Open
Abstract
Ethiopia faces a significant challenge with increasing non-communicable diseases like diabetes, ranking among the top four in sub-Saharan Africa. However, there is a lack of research on how lifestyle affects chronic complications of diabetes in Ethiopia, highlighting the need for urgent exploration to develop better intervention strategies. This study aimed to evaluate the link between lifestyle factors and chronic complications of diabetes in public health hospitals in Southwest Ethiopia. A cross-sectional study involving 389 diabetes patients from Mizan-Tepi University Teaching Hospital (MTUTH) and Gebretsadik Shawo General Hospital (GSGH) in Southwest Ethiopia was conducted. Data collection methods included interviewer-administered questionnaires, patient medical record reviews, physical examination, and serum analysis. SPSS version 25 was used for data analysis, including descriptive statistics and bivariate and multivariate logistic regression analyses. Statistical significance was determined at a p-value < 0.05. The study revealed a 32.1% prevalence of chronic complications of diabetes, with 13.4% having chronic kidney disease, 8.0% experiencing visual disturbances, and 16.7% suffering from peripheral sensory pain. After adjusting for confounding variables, age (41-60 years [AOR = 1.77; 95% CI 1.01, 3.15] and > 60 years [AOR = 2.18; 95% CI 1.20, 4.33]), duration of diabetes mellitus (> 6 years [AOR = 2.90; 95% CI 1.74, 4.85]), alcohol consumption [AOR = 2.30; 95% CI 1.33, 3.98], physical inactivity [AOR = 2.43; 95% CI 1.38, 4.27], and body mass index (underweight [AOR = 7.66; 95% CI 1.68, 34.8] and obese [AOR = 3.53; 95% CI 1.84, 10.5]) were significantly associated with chronic complications of diabetes. Chronic complications of diabetes are a major problem in the study area. Lifestyle factors strongly influence chronic diabetes complications, highlighting the importance of preventive measures. Implementing health education and prevention programs focusing on modifiable lifestyle factors is crucial.
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Affiliation(s)
- Hailemariam Amsalu
- School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Molla Hailu
- School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Adane Asefa
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.BOX: 260, Mizan-Teferi, Ethiopia
| | - Mengistu Ayenew
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.BOX: 260, Mizan-Teferi, Ethiopia
| | - Tewodros Yosef
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.BOX: 260, Mizan-Teferi, Ethiopia.
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia.
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Wan JF, Chen Y, Yao TH, Wu YZ, Dai HZ. Impact of body mass index on adverse kidney events in diabetes mellitus patients: A systematic-review and meta-analysis. World J Clin Cases 2024; 12:538-550. [PMID: 38322463 PMCID: PMC10841950 DOI: 10.12998/wjcc.v12.i3.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The incidence of chronic kidney disease among patients with diabetes mellitus (DM) remains a global concern. Long-term obesity is known to possibly influence the development of type 2 diabetes mellitus. However, no previous meta-analysis has assessed the effects of body mass index (BMI) on adverse kidney events in patients with DM. AIM To determine the impact of BMI on adverse kidney events in patients with DM. METHODS A systematic literature search was performed on the PubMed, ISI Web of Science, Scopus, Ovid, Google Scholar, EMBASE, and BMJ databases. We included trials with the following characteristics: (1) Type of study: Prospective, retrospective, randomized, and non-randomized in design; (2) participants: Restricted to patients with DM aged ≥ 18 years; (3) intervention: No intervention; and (4) kidney adverse events: Onset of diabetic kidney disease [estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 and/or microalbuminuria value of ≥ 30 mg/g Cr], serum creatinine increase of more than double the baseline or end-stage renal disease (eGFR < 15 mL/min/1.73 m2 or dialysis), or death. RESULTS Overall, 11 studies involving 801 patients with DM were included. High BMI (≥ 25 kg/m2) was significantly associated with higher blood pressure (BP) [systolic BP by 0.20, 95% confidence interval (CI): 0.15-0.25, P < 0.00001; diastolic BP by 0.21 mmHg, 95%CI: 0.04-0.37, P = 0.010], serum albumin, triglycerides [standard mean difference (SMD) = 0.35, 95%CI: 0.29-0.41, P < 0.00001], low-density lipoprotein (SMD = 0.12, 95%CI: 0.04-0.20, P = 0.030), and lower high-density lipoprotein (SMD = -0.36, 95%CI: -0.51 to -0.21, P < 0.00001) in patients with DM compared with those with low BMIs (< 25 kg/m2). Our analysis showed that high BMI was associated with a higher risk ratio of adverse kidney events than low BMI (RR: 1.22, 95%CI: 1.01-1.43, P = 0.036). CONCLUSION The present analysis suggested that high BMI was a risk factor for adverse kidney events in patients with DM.
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Affiliation(s)
- Jing-Fang Wan
- Department of Nephrology, Army Medical University, Chongqing 400042, China
| | - Yan Chen
- Department of Nephrology, Chongqing Western Hospital, Chongqing 400052, China
| | - Tian-Hua Yao
- Health Statistics, Army Medical University, Chongqing 400038, China
| | - Ya-Zhou Wu
- Health Statistics, Army Medical University, Chongqing 400038, China
| | - Huan-Zi Dai
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing 400042, China
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Zheng B, Zhang Y, Huang L, Shen X, Zhao F, Yan S. Early onset age increases the risk of musculoskeletal damage in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1270674. [PMID: 38144561 PMCID: PMC10739489 DOI: 10.3389/fendo.2023.1270674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction It's not clear whether there are differences in musculoskeletal damage and body composition among different age groups of type 2 diabetes. Therefore, the purpose of this study is to analyze the difference between early-onset type 2 diabetes (EOT2D) and non-early-onset type 2 diabetes (NOT2D) in musculoskeletal damage. Methods A total of 964 patients with type 2 diabetes mellitus were selected by 1:1 propensity score matching, including 534 males and 430 females, with an average age of 52 ± 7 years and an average course of 10 ± 8.5 years. Bone mineral density and body composition were measured, and combined with biochemical tests, linear regression and binary logic regression were used to analyze the relationship between EOT2D, NOT2D and musculoskeletal damage. In addition, 414 patients with T2DM were selected according to whether they were hospitalized twice or not, and the median follow-up period was 44 months. COX survival analysis further elucidates the relationship between EOT2D, NOT2D and musculoskeletal damage. Results Compared with patients with non-early-onset type 2 diabetes, A/G was negatively correlated with the age of onset, and had statistical significance. EOT2D has a higher risk of sarcopenia, osteoporosis and even musculoskeletal damage. With the prolongation of the course of the disease, the risk of muscle mass and/or bone mineral density decrease in EOT2D increases. Conclusion EOT2D brings a greater risk of sarcopenia and/or osteoporosis, as well as a higher risk of reduced ASM and BMD. In addition, fat distribution may be more central.
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Affiliation(s)
- Biao Zheng
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yongze Zhang
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Lingning Huang
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ximei Shen
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fengying Zhao
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Sunjie Yan
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Wang W, Ji Q, Ran X, Li C, Kuang H, Yu X, Fang H, Yang J, Liu J, Xue Y, Feng B, Lei M, Zhu D. Prevalence and risk factors of diabetic peripheral neuropathy: A population-based cross-sectional study in China. Diabetes Metab Res Rev 2023; 39:e3702. [PMID: 37490047 DOI: 10.1002/dmrr.3702] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/03/2023] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
AIMS To assess the prevalence of diabetic peripheral neuropathy (DPN) and its risk factors in the type 2 diabetes mellitus (T2DM) population. METHODS This cross-sectional study enroled patients with T2DM between July and December 2017 from 24 provinces in China. Diabetic peripheral neuropathy and its severity were assessed by the Toronto clinical scoring system, neuropathy symptoms score (NSS) and neuropathy disability score. The prevalence of DPN and its risk factors were analysed. RESULTS A total of 14,908 patients with T2DM were enroled. The prevalence of DPN was 67.6%. Among 10,084 patients with DPN, 4808 (47.7%), 3325 (33.0%), and 1951 (19.3%) had mild, moderate, and severe DPN, respectively. The prevalence of DPN in females was higher than in males (69.0% vs. 66.6%, P = 0.002). The prevalence of DPN increased with age and course of diabetes and decreased with body mass index (BMI) and education level (all P for trend <0.05). The comorbidities and complications in patients with DPN were higher than in those without DPN, including hypertension, myocardial infarction, diabetic retinopathy, and diabetic nephropathy (all P < 0.001). Age, hypertension, duration of diabetes, diabetic retinopathy, diabetic nephropathy, glycated haemoglobin, high-density lipoprotein cholesterol, and lower estimated glomerular filtration rate were positively associated with DPN, while BMI, education level, fasting C-peptide, and uric acid were negatively associated with DPN. CONCLUSIONS Among patients with T2DM in China, the prevalence of DPN is high, especially in the elderly, low-income, and undereducated patients.
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Affiliation(s)
- Weimin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiuhe Ji
- Xijing Hospital of PLA Air Force Medical University, Xi'an, China
| | - Xinwu Ran
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
| | - Chenxi Li
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hongyu Kuang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuefeng Yu
- Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Hui Fang
- Tangshan Gongren Hospital, TangShan, China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou, China
| | - Yaoming Xue
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bo Feng
- Department of Endocrinology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Minxiang Lei
- Department of Endocrinology, Xiangya Hospital of Central South University, Changsha, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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7
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Huang Y, Zhang X, Li B, Zhu X, Li C, Zhou C, Gu C, Wang Y, Ma M, Fan Y, Xu X, Chen H, Zheng Z. Association of BMI and waist circumference with diabetic microvascular complications: A prospective cohort study from the UK Biobank and Mendelian randomization analysis. Diabetes Res Clin Pract 2023; 205:110975. [PMID: 37884062 DOI: 10.1016/j.diabres.2023.110975] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
AIMS To investigate the precise association between BMI and waist circumference (WC) and diabetic complications, including retinopathy (DR), nephropathy (DN) and peripheral neuropathy (DPN). METHODS A multivariable-adjusted Cox proportional hazard model was used to evaluate the observed association from 30,541 UK Biobank participants with diabetes. A two-sample Mendelian randomization (MR) framework was applied to summary-level GWASs of BMI and WC comprising a total of 461,460 and 462,166 participants from UK Biobank to explore the potential causal association. RESULTS Higher BMI and WC were associated with increased risks of DR, DN, and DPN (HR (95% CI), per-SD increase: BMI: DR 1.09 (1.04-1.13), DN 1.37 (1.33-1.41), DPN 1.27 (1.20-1.34); WC: DR 1.11 (1.07-1.16), DN 1.41 (1.36-1.46), DPN 1.38 (1.30-1.45)) in the UK Biobank cohort. Univariate MR indicated that increased BMI and WC were causal risk factors for these complications (OR (95% CI), per-SD increase: BMI: DR 1.33 (1.22-1.45), DN 1.74 (1.47-2.07), DPN 2.20 (1.67-2.90); WC: DR 1.43 (1.27-1.61), DN 2.03 (1.62-2.55), DPN 2.80 (1.99-3.92)), and the effect sizes remained significant after adjustment for glycated hemoglobin. CONCLUSIONS Prospective observational and MR analyses provided evidence that high BMI and WC may represent potential causal risk factors for diabetic microvascular complications. Weight control might modify the risks of these complications independently of glycemic control and should be considered as a therapeutic recommendation.
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Affiliation(s)
- Yikeng Huang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Xinyu Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Bo Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Xinyu Zhu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Chenxin Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Chuandi Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Chufeng Gu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Yujie Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Mingming Ma
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Ying Fan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China.
| | - Haibing Chen
- Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University, 301 Middle Yanchang Road, Jingan District, Shanghai 200072, China.
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai Key Clinical Specialty, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, 100 Haining Road, Hongkou District, Shanghai 200080, China.
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8
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Lempesis IG, Varrias D, Sagris M, Attaran RR, Altin ES, Bakoyiannis C, Palaiodimos L, Dalamaga M, Kokkinidis DG. Obesity and Peripheral Artery Disease: Current Evidence and Controversies. Curr Obes Rep 2023; 12:264-279. [PMID: 37243875 PMCID: PMC10220347 DOI: 10.1007/s13679-023-00510-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE OF REVIEW Obesity is a significant public health problem and a major risk factor for the development and progression of atherosclerosis and its cardiovascular manifestations. Lower extremity peripheral artery disease (PAD) affects 3%-10% of the Western population and, if left untreated, can lead to devastating outcomes with both an increased risk of morbidity and mortality. Interestingly, the association between obesity and PAD remains debatable. Whereas it is well known that PAD and obesity frequently overlap in the same patients, many studies have demonstrated a negative association between obesity and PAD and a protective effect of obesity on disease development and progression, a phenomenon described as the "obesity paradox." Possible mechanisms for this paradox may include genetic background, as assessed by mendelian randomization studies, adipose tissue dysfunction, and body fat distribution rather than adiposity, while other factors, such as sex, ethnicity, sarcopenia in the elderly population, or aggressive treatment of co-existing metabolic conditions in individuals with obesity compared to those with normal weight, could have some impact as well. RECENT RINDINGS Few reviews and meta-analyses examining systematically the relationship between obesity and PAD exist. The impact of PAD development due to the presence of obesity remains largely controversial. However, the most current evidence, backed by a recent meta-analysis, suggests a potential protective role of a higher body mass index on PAD-related complications and mortality. In this review, we discuss the association between obesity and PAD development, progression, and management, and the potential pathophysiologic mechanisms linking the two diseases.
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Affiliation(s)
- Ioannis G Lempesis
- Department of Biologic Chemistry, School of Medicine, National and Kapodistrian, University of Athens, Mikras Asias 75, 115 27, Athens, Greece.
| | - Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marios Sagris
- General Hospital of Nikaia, Piraeus, 184 54, Athens, Greece
| | - Robert R Attaran
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
| | - Elissa S Altin
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
| | - Christos Bakoyiannis
- Department of Surgery, Division of Vascular Surgery, Laikon General Hospital, National Kapodistrian University of Athens, 15772, Athens, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria Dalamaga
- Department of Biologic Chemistry, School of Medicine, National and Kapodistrian, University of Athens, Mikras Asias 75, 115 27, Athens, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
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9
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Li C, Wang W, Ji Q, Ran X, Kuang H, Yu X, Fang H, Yang J, Liu J, Xue Y, Feng B, Lei M, Zhu D. Prevalence of painful diabetic peripheral neuropathy in type 2 diabetes mellitus and diabetic peripheral neuropathy: A nationwide cross-sectional study in mainland China. Diabetes Res Clin Pract 2023; 198:110602. [PMID: 36871876 DOI: 10.1016/j.diabres.2023.110602] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
AIM The study aimed to assess the prevalence and risk factors of painful diabetic peripheral neuropathy (PDPN) in patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN) in mainland China. METHODS This nationwide cross-sectional study enrolled T2DM patients with DPN from 25 provinces in China between July 2017 and December 2017. The prevalence, characteristics, and risk factors of PDPN were analyzed. RESULTS Among 25,710 patients with T2DM and DPN, 14,699 (57.2%) had PDPN. The median age was 63 years old. Age over 40 years old, education level, hypertension, myocardial infarction, duration of diabetes of over five years, diabetic retinopathy and nephropathy, moderate total cholesterol, moderate and higher low-density lipoprotein (LDL) increased uric acid (UA) and decreased estimated glomerular filtration rate (eGFR) were independently associated with PDPN (all P < 0.05). Compared with low levels of C-peptide, moderate levels were independently associated with a higher risk of PDPN, while high levels were associated with a lower risk (all P < 0.001). CONCLUSIONS In mainland China, more than half of the patients with DPN have neuropathic pain. Patients with older age, lower education level, longer duration of diabetes, lower LDL, increased UA, decreased eGFR, and comorbidities had an increased risk of PDPN.
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Affiliation(s)
- Chenxi Li
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Weimin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Qiuhe Ji
- Xijing Hospital of PLA Air Force Medical University, Xi'an, Shanxi Province, China
| | - Xingwu Ran
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Hongyu Kuang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xuefeng Yu
- Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Hui Fang
- Tangshan Gongren Hospital, TangShan, Hebei Province, China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Yaoming Xue
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Bo Feng
- Department of Endocrinology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Minxiang Lei
- Department of Endocrinology, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
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10
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Tan KR, Seng JJB, Kwan YH, Chen YJ, Zainudin SB, Loh DHF, Liu N, Low LL. Evaluation of Machine Learning Methods Developed for Prediction of Diabetes Complications: A Systematic Review. J Diabetes Sci Technol 2023; 17:474-489. [PMID: 34727783 PMCID: PMC10012374 DOI: 10.1177/19322968211056917] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND With the rising prevalence of diabetes, machine learning (ML) models have been increasingly used for prediction of diabetes and its complications, due to their ability to handle large complex data sets. This study aims to evaluate the quality and performance of ML models developed to predict microvascular and macrovascular diabetes complications in an adult Type 2 diabetes population. METHODS A systematic review was conducted in MEDLINE®, Embase®, the Cochrane® Library, Web of Science®, and DBLP Computer Science Bibliography databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Studies that developed or validated ML prediction models for microvascular or macrovascular complications in people with Type 2 diabetes were included. Prediction performance was evaluated using area under the receiver operating characteristic curve (AUC). An AUC >0.75 indicates clearly useful discrimination performance, while a positive mean relative AUC difference indicates better comparative model performance. RESULTS Of 13 606 articles screened, 32 studies comprising 87 ML models were included. Neural networks (n = 15) were the most frequently utilized. Age, duration of diabetes, and body mass index were common predictors in ML models. Across predicted outcomes, 36% of the models demonstrated clearly useful discrimination. Most ML models reported positive mean relative AUC compared with non-ML methods, with random forest showing the best overall performance for microvascular and macrovascular outcomes. Majority (n = 31) of studies had high risk of bias. CONCLUSIONS Random forest was found to have the overall best prediction performance. Current ML prediction models remain largely exploratory, and external validation studies are required before their clinical implementation. PROTOCOL REGISTRATION Open Science Framework (registration number: 10.17605/OSF.IO/UP49X).
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Affiliation(s)
| | | | - Yu Heng Kwan
- MOH Holdings Private Ltd.,
Singapore
- Health Services & Systems Research,
Duke-NUS Medical School, Singapore
- Department of Pharmacy, Faculty of
Science, National University of Singapore, Singapore
| | | | | | | | - Nan Liu
- Health Services & Systems Research,
Duke-NUS Medical School, Singapore
- Health Services Research Centre,
Singapore Health Services, Singapore
- Institute of Data Science, National
University of Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System,
Singapore Health Services, Singapore
- Department of Family Medicine and
Continuing Care, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Family Medicine
Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre,
Singapore
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11
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Zhang W, Chen L. A Nomogram for Predicting the Possibility of Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus. Brain Sci 2022; 12:brainsci12101328. [PMID: 36291262 PMCID: PMC9599450 DOI: 10.3390/brainsci12101328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Purpose: Diabetic peripheral neuropathy (DPN) leads to ulceration, noninvasive amputation, and long-term disability. This study aimed to develop and validate a nomogram for forecasting the probability of DPN in type 2 diabetes mellitus patients. Methods: From February 2017 to May 2021, 778 patients with type 2 diabetes mellitus were included in this study. We confirmed the diagnosis of DPN according to the Toronto Expert Consensus. Patients were randomly divided into a training cohort (n = 519) and a validation cohort (n = 259). In the training cohort, univariate and multivariate logistic regression analyses were performed, and a simple nomogram was built using the stepwise method. The receiver operating characteristic (ROC), calibration curve, and decision curve analysis were computed in order to validate the discrimination and clinical value of the nomogram model. Results: About 65.7% and 72.2% of patients were diagnosed with DPN in the training and validation cohorts. We developed a novel nomogram to predict the probability of DPN based on the parameters of age, gender, duration of diabetes, body mass index, uric acid, hemoglobin A1c, and free triiodothyronine. The areas under the curves (AUCs) of the nomogram model were 0.763 in the training cohort and 0.755 in the validation cohort. The calibration plots revealed well-fitted accuracy between the predicted and actual probability in the training and validation cohorts. Decision curve analysis confirmed the clinical value of the nomogram. In subgroup analysis, the predictive ability of the nomogram model was strong. Conclusions: The nomogram of age, gender, duration of diabetes, body mass index, uric acid, hemoglobin A1c, and free triiodothyronine may assist clinicians with the early identification of DPN in patients with type 2 diabetes mellitus.
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Affiliation(s)
| | - Lingli Chen
- Correspondence: ; Tel./Fax: +86-577-555-54543
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12
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Choi YH, Han KD, Cho IR, Lee IS, Ryu JK, Kim YT, Chung KH, Lee SH. Underweight Is Associated with a Higher Risk of Acute Pancreatitis in Type 2 Diabetes: A Nationwide Cohort Study. J Clin Med 2022; 11:jcm11195641. [PMID: 36233509 PMCID: PMC9572046 DOI: 10.3390/jcm11195641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Type 2 diabetes is known as a risk factor for acute pancreatitis, but the risk of acute pancreatitis according to glycemic status and body mass index (BMI) has remained unknown. Therefore, we aim to investigate the risk of acute pancreatitis according to BMI and glycemic status. We included 3,912,496 subjects from the Korean National Health Insurance System cohort who underwent the National Health Screening program in 2009. Each subject’s clinical course was examined through follow-ups until December 2018. BMI and glycemic status were each categorized into five groups. Hazard ratios (HRs) of acute pancreatitis according to BMI and glycemic status were calculated. The adjusted HRs of acute pancreatitis were the highest in the underweight group (BMI < 18.5) in all five glycemic status categories. The HR of acute pancreatitis in the underweight group increased as the glycemic status worsened, excluding the category of diabetes for more than five years (HR 1.381 for normal fasting glucose; 1.805 for impaired fasting glucose; 2.332 for new-onset diabetes; 4.51 for diabetes duration <5 years; 4.135 for diabetes duration ≥5 years). We found that the risk of acute pancreatitis was further increased in the underweight group, depending on the status and duration of type 2 diabetes.
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Affiliation(s)
- Young Hoon Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea
| | - In Rae Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Kwang Hyun Chung
- Division of Gastroenterology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Korea
- Correspondence: (K.H.C.); (S.H.L.); Tel.: +82-31-951-1739 (K.H.C.); +82-2-2072-2199 (S.H.L.)
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: (K.H.C.); (S.H.L.); Tel.: +82-31-951-1739 (K.H.C.); +82-2-2072-2199 (S.H.L.)
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13
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Han X, Wu H, Li Y, Yuan M, Gong X, Guo X, Tan R, Xie M, Liang X, Huang W, Liu H, Wang L. Differential Effect of Generalized and Abdominal Obesity on the Development and Progression of Diabetic Retinopathy in Chinese Adults With Type 2 Diabetes. Front Med (Lausanne) 2022; 9:774216. [PMID: 35692546 PMCID: PMC9184733 DOI: 10.3389/fmed.2022.774216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The relationship between obesity and diabetic retinopathy (DR) remains controversial. The aim of this study was to assess the association of generalized obesity [assessed by body mass index (BMI)] and abdominal obesity [assessed by waist to hip ratio (WHR)] with incident DR, and vision-threatening DR (VTDR), and DR progression among Chinese adults with type 2 diabetic mellitus (T2DM). Method This prospective cohort study was conducted at the Zhongshan Ophthalmic Center, from November 2017 to December 2020. DR was assessed based on the 7-filed fundus photographs using the modified Airlie House Classification. Multivariable logistic regression models were used to evaluate the associations of BMI and WHR with the development and progression of DR after adjusting for age, sex, traditional risk factors, and mutually for BMI and WHR. Results Among the 1,370 eligible participants, 1,195 (87.2%) had no sign of any DR and 175 (12.8%) had DR at baseline examination. During the 2 years follow-up visit, 342 (28.6%) participants had incident DR, 11 (0.8%) participants developed VTDR, 15 (8.6%) demonstrated DR progression. After adjusting for confounders, the BMI was negatively associated with incident DR [relative risk (RR) =0.31; 95% confidence interval (CI), 0.26-0.38; P < 0.001] and incident VTDR (RR = 0.22; 95%CI, 0.11-0.43; P < 0.001), while WHR was positively associated with incident DR (RR = 1.47; 95% CI, 1.27-1.71; P < 0.001). BMI and WHR level were not significantly associated with 2-year DR progression in multivariate models (all P > 0.05). Conclusions This study provides longitudinal evidence that generalized obesity confer a protective effect on DR, while abdominal obesity increased the risk of DR onset in Chinese patients, indicating that abdominal obesity is a more clinically relevant risk marker of DR than generalized obesity.
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Affiliation(s)
- Xiaoyan Han
- The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Huimin Wu
- Shenzhen Children's Hospital, Shenzhen, China
| | - Youjia Li
- The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Meng Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Xia Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Xiao Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Rongqiang Tan
- The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Ming Xie
- The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
| | - Hua Liu
- Department of Ophthalmology, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Lanhua Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China
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14
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Hu Y, Wang J, Zeng S, Chen M, Zou G, Li Y, Zhu L, Xu J. Association Between Serum Albumin Levels and Diabetic Peripheral Neuropathy Among Patients with Type 2 Diabetes: Effect Modification of Body Mass Index. Diabetes Metab Syndr Obes 2022; 15:527-534. [PMID: 35228809 PMCID: PMC8881928 DOI: 10.2147/dmso.s347349] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The role of serum albumin in the risk of diabetic peripheral neuropathy (DPN) remains unclear. This study aimed to explore the relationship between serum albumin level and DPN, and to examine any possible effect modifiers among patients with type 2 diabetes mellitus. METHODS This cross-sectional study was conducted in Jiangxi, China, from May 2012 to December 2014. Serum albumin levels were determined in 523 subjects, and the association between serum albumin level and DPN was evaluated using linear regression models (odds ratio [OR] and corresponding 95% confidence interval [CI]). RESULTS There was a significant inverse association between serum albumin level (per 1 g/L increment, OR 0.95 [95% CI 0.92-0.98]) and the risk of DPN. Accordingly, when serum albumin was assessed as quartiles, a significantly lower risk of DPN was found in participants in quartile 4 (OR 0.49 [95% CI 0.25-0.95]), compared with those in quartile 1. Consistently, higher albumin levels (≥35 g/L) were associated with decreased odds for DPN (OR 0.36 [95% CI 0.17-0.74]) compared with lower levels. Furthermore, the albumin-DPN association was significantly stronger in patients with a relatively high body mass index (BMI; ≥24 kg/m2; OR 0.91 [95% CI 0.85-0.98]) than in those with a low BMI (<24 kg/m2; OR 0.99 [95% CI 0.94-1.04]; P for interaction = 0.042). CONCLUSION These data suggest that serum albumin level could be a novel risk factor for DPN among patients with type 2 diabetes and relatively high BMI (>24 kg/m2).
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Affiliation(s)
- Ying Hu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Jiancheng Wang
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Sha Zeng
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Mengxia Chen
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Guilin Zou
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Yuxia Li
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Lingyan Zhu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Jixiong Xu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
- Correspondence: Jixiong Xu; Jiancheng Wang, Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, Jiangxi, 330006, People’s Republic of China,Tel/Fax +86-791-86836960, Email ;
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15
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Liu R, Li L, Shao C, Cai H, Wang Z. The Impact of Diabetes on Vascular Disease: Progress from the Perspective of Epidemics and Treatments. J Diabetes Res 2022; 2022:1531289. [PMID: 35434140 PMCID: PMC9012631 DOI: 10.1155/2022/1531289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 12/23/2022] Open
Abstract
At present, the global incidence of diabetes has increased in countries with large populations, and the changes in developing regions are particularly worthy of attention. In the past 40 years or so, the income situation in China, India, and other countries has exploded, leading to changes in the way of life and work as well as an increase in the prevalence of diabetes. Metabolic disorders caused by diabetes can lead to secondary vascular complications, which have long-term malignant effects on the heart, kidneys, brain, and other vital organs of patients. Adequate primary prevention measures are needed to reduce the incidence of diabetic vascular complications, and more attention should be given to treatment after the disease. To this end, it is necessary to determine a standardized drug and physical therapy system and to build a more efficient and low-cost chronic disease management system.
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Affiliation(s)
- Runyang Liu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Honghua Cai
- Department of Burn Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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16
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Zhang YZ, Huang LN, Shen XM, Lin J, Zhao FY, Yan SJ. Association between sarcopenic overweight and left ventricular diastolic dysfunction and remodeling in patients with type 2 diabetes. Chin Med J (Engl) 2021; 134:2489-2491. [PMID: 34561327 PMCID: PMC8654449 DOI: 10.1097/cm9.0000000000001759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yong-Ze Zhang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Ling-Ning Huang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Xi-Mei Shen
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Jie Lin
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
| | - Feng-Ying Zhao
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Sun-Jie Yan
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
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17
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Hong X, Huang L, Zhang Y, Shen X, Weng S, Zeng F, Zhao F, Yan S. Stronger Association of Albuminuria with the Risk of Vascular Complications than Estimated Glomerular Filtration Rate in Type 2 Diabetes. Kidney Blood Press Res 2021; 46:550-562. [PMID: 34428770 DOI: 10.1159/000515163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 02/10/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Albuminuria is a risk factor for macro- and microvascular complications of type 2 diabetes (T2D).With an increasing trend of normoalbuminuria, however, of the 2 predictors - estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) - which one is a better predictor of vascular complications of T2D is not clear. OBJECTIVE This study aimed to compare the impacts of albuminuria and eGFR on patients with T2D associated with micro- and macrovascular complications. METHODS This retrospective study recruited 4,715 patients with T2D and grouped them based on the values of UACR (high UACR: ≥30 mg/g, low UACR: <30 mg/g) and eGFR (mL/[min × 1.73 m2]) (G1: eGFR ≥ 90; G2: eGFR = 60-89; G3-5: eGFR < 60) from April 2008 to November 2018. Logistic regression analysis was carried out for risk factors in patients with diabetic retinopathy (DR), diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), left ventricular remodeling, diastolic disorders, and carotid atherosclerotic plaque in 6 different groups: low UACR + G1 (control group), low UACR + G2, low UACR + G3-5, high UACR + G1, high UACR + G2, and high UACR + G3-5. Patients were grouped according to the change in the UACR value (UACR-decreased group: ≤-30%, UACR-stable group: -30 to 30%, and UACR-increased group ≥30%), eGFR value (eGFR-decreased group: >3%, and eGFR-stable group: ≤3%) and followed up. RESULTS Compared with the control group, patients with higher albuminuria and lower eGFR had higher adjusted odds ratio (OR) trends of complications, especially in the high UACR + G3-5 group. The OR of 2.010, 3.444, 1.633, 2.742, and 3.014 were obtained for DR, DPN, PAD, left ventricular remodeling, and diastolic disorders, respectively. No statistically significant difference was found in the risk of complications within each one of 2 phenotypes, regardless of the change in the eGFR. After grouping by eGFR, the regression analysis of the urinary protein level in each stage revealed that a majority of complications had a statistically significant difference, except for DR and PAD in the high UACR + G3-5 group. DR in the follow-up study had a higher risk in the UACR-stable/increased group than the UACR-decreased group (UACR stable: OR = 2.568; 95% confidence interval (CI): 1.128-5.849; p = 0.025; UACR increased: OR = 2.489; 95% CI: 1.140-5.433; p = 0.022). CONCLUSION UACR is a more predictive risk factor for diabetic complications compared with a reduced eGFR.
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Affiliation(s)
- Xinyu Hong
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, China.,Diabetes Research Institute of Fujian Province, Fuzhou, China.,Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lingning Huang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, China.,Diabetes Research Institute of Fujian Province, Fuzhou, China.,Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yongze Zhang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, China.,Diabetes Research Institute of Fujian Province, Fuzhou, China.,Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ximei Shen
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, China.,Diabetes Research Institute of Fujian Province, Fuzhou, China.,Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Suiyan Weng
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, China.,Diabetes Research Institute of Fujian Province, Fuzhou, China.,Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Feihui Zeng
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, China.,Diabetes Research Institute of Fujian Province, Fuzhou, China.,Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fengying Zhao
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, China.,Diabetes Research Institute of Fujian Province, Fuzhou, China.,Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Sunjie Yan
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Province Clinical Research Center for Metabolic Diseases, Fuzhou, China.,Diabetes Research Institute of Fujian Province, Fuzhou, China.,Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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18
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Martins RB, Ordaz-Briseño SA, Flores-Hernández S, Bós ÂJG, Baptista-Rosas RC, Mercado-Sesma AR. Comparison of prevalence of diabetes complications in Brazilian and Mexican adults: a cross-sectional study. BMC Endocr Disord 2021; 21:48. [PMID: 33726717 PMCID: PMC7962221 DOI: 10.1186/s12902-021-00711-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Type 2 diabetes is more frequent in Latin American people than in non-Hispanic whites due to a combination of genetic and lifestyle risk factors. Brazil and Mexico are the most populous countries in Latin America. The present study aimed to compare the results of the National Health Survey "PNS" in Brazil and the National Survey Health and Nutrition "ENSANUT" in Mexico regarding the prevalence, complications and healthcare issues of diabetes in both countries. METHODS A cross-sectional study was conducted with data from the National Health Survey (PNS) of 2013 in Brazil and the National Survey of Health and Nutrition (ENSANUT) of 2018 in Mexico. The prevalence of diabetes, complications and risk factors related to developing diabetes were considered. RESULTS The respondents included 3636 individuals in Brazil and 4555 individuals in Mexico. There were significant differences in age and time living with diabetes between the two countries. Mexican people had twice as likely as Brazilian people to have a complication (p < 0.0001). The principal risk factor (OR 2.47; p ≤ 0.0001) for developing any diabetic complication was living with diabetes for more than 15 years. Visual impairment was the most frequent complication in both countries, but it was more prevalent in Mexico (p ≤ 0.001). CONCLUSIONS Diabetes complications are important health problems in Brazil and Mexico. Visual impairment was the principal complication in both countries. Several factors, such as access to and type of health system, living in a rural area, treatment, BMI and performing preventive actions, affected the risk of developing a complication. However, living with diabetes for more than 15 years was the principal risk factor. National health surveys have added significant information on the impact of diabetes in these Latin American populations. This comparison of data could provide valuable information to guide national policies and program decisions in both countries.
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Affiliation(s)
- Renata Breda Martins
- Biomedical Gerontology at Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Ângelo José Gonçalves Bós
- Biomedical Gerontology at Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raúl C Baptista-Rosas
- Departamento de Salud Enfermedad como proceso individual, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, Mexico
- Multidisciplinary Health Research Center, Centro Universitario de Tonalá/Universidad de Guadalajara (México), 45425, Tonalá, Jalisco, Mexico
| | - Arieh Roldán Mercado-Sesma
- Departamento de Salud Enfermedad como proceso individual, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, Mexico.
- Multidisciplinary Health Research Center, Centro Universitario de Tonalá/Universidad de Guadalajara (México), 45425, Tonalá, Jalisco, Mexico.
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19
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Hukportie DN, Li FR, Zhou R, Zheng JZ, Wu XX, Wu XB. Anthropometric Measures and Incident Diabetic Nephropathy in Participants With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2021; 12:706845. [PMID: 34421824 PMCID: PMC8371436 DOI: 10.3389/fendo.2021.706845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of diabetes is on the rise globally coupled with its associated complications, such as diabetic nephropathy (DN). Obesity has been identified as a risk factor for the development of DN but it is still unclear which obesity index is the best predictor of incident DN. METHODS Data from the participants with type 2 diabetes mellitus (T2DM) in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study were used to examine the sex-specific association between waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) with incident DN risk. RESULTS Among the 8,887 participants with T2DM (5,489 men and 3,398 women), 5,296 participants (3,345 men and 1,951 women) developed the DN composite outcome during a follow-up period of 24302 person-years. Among men, null associations were observed between all anthropometric measures with incident DN in the multivariate analysis although the 3rd quartile of WHtR showed marginally significant results (P = 0.052). However, among women, both central and general obesity measures were associated with increased risks of incident DN. Compared with participants in the WC <88 cm category, the fully adjusted HR and 95% CI for those in the ≥88 cm of WC was 1.35 (95% CI 1.15-1.57). Compared with the lowest quartile, the fully adjusted HRs and 95% CIs for the 2nd to the 4th quartile of WHtR were 1.09 (95% CI 0.96-1.25), 1.12 (95% CI 0.98-1.28), and 1.14 (95% CI 1.00-1.30) respectively; also, compared with the normal BMI category, the fully adjusted HRs and 95% CIs for class I - class III obese were 1.36 (95% CI 1.10 - 1.67), 1.43 (95% CI 1.16 - 1.78) and 1.32 (95% CI 1.05 - 1.66) respectively. CONCLUSIONS Among participants with T2DM, higher levels of both central and general obesity indexes were associated with DN risk among women but not in men. Women with T2DM should maintain a healthy weight targeted at reducing both central and general obesity to enhance nephroprotection. Trial registration: ClinicalTrials.gov., no. NCT00000620.
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Affiliation(s)
- Daniel Nyarko Hukportie
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - Fu-Rong Li
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - Jia-Zhen Zheng
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - Xiao-Xiang Wu
- Department of General Surgery, 157 Hospital, General Hospital of Guangzhou Military Command, Guangzhou, China
- *Correspondence: Xian-Bo Wu, ; Xiao-Xiang Wu,
| | - Xian-Bo Wu
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
- *Correspondence: Xian-Bo Wu, ; Xiao-Xiang Wu,
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20
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Li Y, Zhang Y, Shen X, Zhao F, Yan S. The Value of Ketone Bodies in the Evaluation of Kidney Function in Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2021; 2021:5596125. [PMID: 33937415 PMCID: PMC8055418 DOI: 10.1155/2021/5596125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Recent studies have shown that the slightly elevated circulating levels of ketone bodies (KBs) played a significant role in the treatment of various diseases. This study is aimed at investigating the association between different levels of KBs and kidney function in patients with type 2 diabetes mellitus (T2DM). METHODS A retrospective study of 955 patients with T2DM (426 women and 529 men) admitted to our hospital from December 2017 to September 2019 was conducted. Patients were divided into different groups in line with the levels of KBs (low-normal group: 0.02-0.04 mmol/L, middle-normal group: 0.05-0.08 mmol/L, high-normal group: 0.09-0.27 mmol/L, and slightly elevated group: >0.27 and <3.0 mmol/L). RESULTS In the present study, individuals with high-normal levels of KBs had the lowest risk of diabetic kidney disease (DKD) and increased peak systolic velocity (PSV); those with middle-normal levels of KBs had the lowest risk of increased renal arterial resistive index (RI), with a positive correlation between increased α1-microglobulin and KB concentration. In addition, the indicators of glomerulus, renal tubules, and renal arteries were all poor with slightly elevated circulating levels of KBs, and KB concentration lower than 0.09 mmol/L can be applied as the threshold for low risk of renal function damage. CONCLUSIONS In summary, slightly elevated circulating levels of ketone bodies are not of benefit for renal function in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Yimei Li
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
| | - Yongze Zhang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
| | - Ximei Shen
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
| | - Fengying Zhao
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
| | - Sunjie Yan
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
- Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian 350005, China
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