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Celik NB, Canoruc Emet D, Canturk M, Ozon ZA, Gonc EN. Dual-basal-insulin regimen for the management of dawn phenomenon in children with type 1 diabetes: a retrospective cohort study. Ther Adv Endocrinol Metab 2023; 14:20420188231220130. [PMID: 38152658 PMCID: PMC10752105 DOI: 10.1177/20420188231220130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/11/2023] [Indexed: 12/29/2023] Open
Abstract
Background Handling of the dawn phenomenon (DP) with multiple daily insulin injection (MDII) regimen is a real challenge. Objective We aimed to demonstrate the effectiveness of a dual-basal-insulin (a long-acting glargine and an intermediate-acting neutral protamine Hagedorn (NPH)) regimen for the management of DP in children with type 1 diabetes mellitus (T1DM). The primary efficacy outcome was to overcome morning hyperglycemia without causing hypoglycemia during the non-DP period of the night. Design Retrospective cohort study. Method Charts of 28 children with T1DM (12 female; 42.8%, mean age 13.7 ± 2.1 years) treated with MDII were retrospectively reviewed. The median duration of diabetes was 4.5 years (range 2-13.5 years). DP was diagnosed using a threshold difference of 20 mg/dL (0.1 mmol/L) between fasting capillary blood glucose at 3 a.m. and prebreakfast. NPH was administered at midnight in addition to daily bedtime (08.00-09.00 p.m.) glargine (dual-basal-insulin regimen). Midnight, 03:00 a.m., prebreakfast and postprandial capillary blood glucose readings, insulin-carbohydrate ratios, and basal-bolus insulin doses were recorded the day before the dual-basal-insulin regimen was started and the day after the titration of the insulin doses was complete. Body mass index standard deviation scores (BMI SDS) at the onset-3rd-12th month of treatment were noted. Results Before using dual basal insulin, prebreakfast capillary blood glucose levels were greater than those at midnight and at 03:00 a.m. (F = 64.985, p < 0.01). After titration of the dual-basal-insulin doses, there were significant improvements such that there were no statistically significant differences in the capillary blood glucose measurements at the three crucial time points (midnight, 03.00 a.m., and prebreakfast; F = 1.827, p = 0.172). No instances of hypoglycemia were reported, and the total daily insulin per kilogram of body weight did not change. The BMI SDS remained steady over the course of the 1-year follow-up. Conclusion In this retrospective cohort study, the dual-basal-insulin regimen, using a long-acting glargine and an intermediate-acting NPH, was effective in overcoming early morning hyperglycemia due to insulin resistance in the DP. However, the effectiveness of the dual-basal-insulin regimen needs to be verified by prospective controlled studies using continuous glucose monitoring metrics or frequent blood glucose monitoring.
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Affiliation(s)
- Nur Berna Celik
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, 06230, Turkey
| | - Dicle Canoruc Emet
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Canturk
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Z. Alev Ozon
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E. Nazli Gonc
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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2
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Lucidi P, Perriello G, Porcellati F, Pampanelli S, De Fano M, Tura A, Bolli GB, Fanelli CG. Diurnal Cycling of Insulin Sensitivity in Type 2 Diabetes: Evidence for Deviation From Physiology at an Early Stage. Diabetes 2023; 72:1364-1373. [PMID: 37440717 PMCID: PMC10866740 DOI: 10.2337/db22-0721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to establish the contribution of insulin resistance to the morning (a.m.) versus afternoon (p.m.) lower glucose tolerance of people with type 2 diabetes (T2D). Eleven subjects with T2D (mean [SD] diabetes duration 0.79 [0.23] years, BMI 28.3 [1.8] kg/m2, A1C 6.6% [0.26%] [48.9 (2.9) mmol/mol]), treatment lifestyle modification only) and 11 matched control subjects without diabetes were monitored between 5:00 and 8:00 a.m. and p.m. (in random order) on one occasion (study 1), and on a subsequent occasion, they underwent an isoglycemic clamp (a.m. and p.m., both between 5:00 and 8:00, insulin infusion rate 10 mU/m2/min) (study 2). In study 1, plasma glucose, insulin, C-peptide, and glucagon were higher and insulin clearance lower in subjects with T2D a.m. versus p.m. and versus control subjects (P < 0.05), whereas free fatty acid, glycerol, and β-hydroxybutyrate were lower a.m. versus p.m. However, in study 2 at identical hyperinsulinemia a.m. and p.m. (∼150 pmol/L), glucose Ra and glycerol Ra were both less suppressed a.m. versus p.m. (P < 0.05) in subjects with T2D. In contrast, in control subjects, glucose Ra was more suppressed a.m. versus p.m. Leucine turnover was no different a.m. versus p.m. In conclusion, in subjects with T2D, insulin sensitivity for glucose (liver) and lipid metabolism has diurnal cycles (nadir a.m.) opposite that of control subjects without diabetes already at an early stage, suggesting a marker of T2D. ARTICLE HIGHLIGHTS In people with type 2 diabetes (T2D), fasting hyperglycemia is greater in the morning (a.m.) versus the afternoon (p.m.), and insulin sensitivity for glucose and lipid metabolism is lower a.m. versus p.m. This pattern is the reverse of the physiological diurnal cycle of people without diabetes who are more insulin sensitive a.m. versus p.m. These new findings have been observed in the present study in people without obesity but with recent-onset T2D, with good glycemic control, and in the absence of confounding pharmacological treatment. It is likely that the findings represent a specific marker of T2D, possibly present even in prediabetes before biochemical and clinical manifestations.
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Affiliation(s)
- Paola Lucidi
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
| | - Gabriele Perriello
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
| | - Francesca Porcellati
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
| | - Simone Pampanelli
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
| | - Michelantonio De Fano
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
| | - Andrea Tura
- CNR Institute of Neuroscience, Padova, Italy
| | - Geremia B. Bolli
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
| | - Carmine G. Fanelli
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
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3
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Can A, Coskun R, Karabacak DE, Tuzer OC, Yegit OO, Karadag P, Oztop N, Beyaz S, Okumus G, Demir S, Gelincik A. Common but neglected problem in chronic spontaneous urticaria: Sleep disturbance. Allergy Asthma Proc 2023; 44:179-185. [PMID: 37160750 DOI: 10.2500/aap.2023.44.230011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background: Association of chronic spontaneous urticaria (CSU) with sleep disturbance has not been evaluated in studies that involve a large number of patients. Objective: In this study, we aimed to evaluate the sleep attitude and circadian rhythm in patients with CSU. Methods: As the patient group, recently diagnosed 100 patients with CSU, 100 patients with allergic rhinitis (AR) as the patient control group, and 100 healthy controls (HCs) were included. The Pittsburgh Sleep Quality Index (PSQI) questionnaire, sleep hygiene index (SHI), Epworth Sleepiness Scale (ESS) questionnaire, and the morningness-eveningness questionnaire (MEQ) were filled to assess sleep quality and circadian rhythm. CSU disease activity was evaluated by urticaria activity score-7 (UAS-7). Patients with concomitant diseases, e.g., psychiatric illnesses, that possibly affect sleep status or those who use related medications and at moderate or high risk of obstructive sleep apnea according to the STOP-Bang questionnaire were excluded from the study. Results: PSQI, SHI, and ESS scores were higher, and the MEQ score was lower in patients with CSU and patients with AR than those in the HCs (p < 0.001, for each score). However, the scores were not different among the patients with CSU and the patients with AR. UAS-7 was only correlated with PSQI scores (r = 0.402, p < 0.001). In addition, blood eosinophil counts and the serum C Reactive Protein (CRP) level were correlated with sleep quality (p = 0.02). Conclusion: The poor sleep quality, impaired sleep hygiene, increased daytime sleepiness, and intermediate type of circadian rhythm were observed in the patients with CSU and the patients with AR. Physicians should be aware of sleep problems in patients with CSU that might affect their quality of life and the success of their treatment.
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Affiliation(s)
- Ali Can
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Raif Coskun
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Cemil Tascioglu City Hospital, Istanbul, Turkey, and
| | - Deniz Eyice Karabacak
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozdemir Can Tuzer
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Ozan Yegit
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Karadag
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nida Oztop
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sengul Beyaz
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gulfer Okumus
- Department of Chest Disease, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semra Demir
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aslı Gelincik
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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4
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Obstructive Sleep Apnea, Circadian Clock Disruption, and Metabolic Consequences. Metabolites 2022; 13:metabo13010060. [PMID: 36676985 PMCID: PMC9863434 DOI: 10.3390/metabo13010060] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic disorder characterized by recurrent episodes of apnea and hypopnea during sleep. It is associated with various cardiovascular and metabolic complications, including type 2 diabetes mellitus (T2DM) and obesity. Many pathways can be responsible for T2DM development in OSA patients, e.g., those related to HIF-1 and SIRT1 expression. Moreover, epigenetic mechanisms, such as miRNA181a or miRNA199, are postulated to play a pivotal role in this link. It has been proven that OSA increases the occurrence of circadian clock disruption, which is also a risk factor for metabolic disease development. Circadian clock disruption impairs the metabolism of glucose, lipids, and the secretion of bile acids. Therefore, OSA-induced circadian clock disruption may be a potential, complex, underlying pathway involved in developing and exacerbating metabolic diseases among OSA patients. The current paper summarizes the available information pertaining to the relationship between OSA and circadian clock disruption in the context of potential mechanisms leading to metabolic disorders.
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5
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Circadian clock, diurnal glucose metabolic rhythm, and dawn phenomenon. Trends Neurosci 2022; 45:471-482. [PMID: 35466006 PMCID: PMC9117496 DOI: 10.1016/j.tins.2022.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/15/2022] [Accepted: 03/26/2022] [Indexed: 01/28/2023]
Abstract
The circadian clock provides cue-independent anticipatory signals for diurnal rhythms of baseline glucose levels and glucose tolerance. The central circadian clock is located in the hypothalamic suprachiasmatic nucleus (SCN), which comprises primarily GABAergic neurons. The SCN clock regulates physiological diurnal rhythms of endogenous glucose production (EGP) and hepatic insulin sensitivity through neurohumoral mechanisms. Disruption of the molecular circadian clock is associated with the extended dawn phenomenon (DP) in type 2 diabetes (T2D), referring to hyperglycemia in the early morning without nocturnal hypoglycemia. The DP affects nearly half of patients with diabetes, with poorly defined etiology and a lack of targeted therapy. Here we review neural and secreted factors in physiological diurnal rhythms of glucose metabolism and their pathological implications for the DP.
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6
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Lou X, Wang H, Tu Y, Tan W, Jiang C, Sun J, Bao Z. Alterations of sleep quality and circadian rhythm genes expression in elderly thyroid nodule patients and risks associated with thyroid malignancy. Sci Rep 2021; 11:13682. [PMID: 34211057 PMCID: PMC8249375 DOI: 10.1038/s41598-021-93106-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/10/2021] [Indexed: 01/05/2023] Open
Abstract
To study the alterations of sleep quality and circadian rhythm genes expressions upon elderly thyroid nodule patients, the risk factors associated with thyroid malignancies, and the potential relationship involved. The elderly people enrolled in our study were divided into three groups according to the thyroid histopathology: malignant nodule group, benign nodule group, and normal group, and the clinical data and sleep quality were collected. Among the patients of surgery, 56 fresh thyroid tissues were collected for real-time PCR, immunohistochemistry and western blotting analysis of CLOCK, BMAL1, CRYs and PERs. Poor sleep quality, sleep latency and daytime dysfunction were the independent risk factors of malignant nodule after adjusted by other impacts. The expression levels of CLOCK, BMAL1 and PER2 in thyroid malignant group were significantly higher than benign and normal groups, while CRY2 was decreased, p < 0.05. In addition, CLOCK and BMAL1 protein levels were positively correlated with PSQI of corresponding patients and CRY2 was negatively correlated. Circadian rhythm genes mainly altered in malignant nodules, and sleep disorders may be involved in the occurrence of elderly thyroid malignancy through the high expressions of CLOCK and BMAL1, and low expression of CRY2.
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Affiliation(s)
- Xudan Lou
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China.,The Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People's Republic of China
| | - Haidong Wang
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China. .,The Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People's Republic of China.
| | - Yanyuan Tu
- The Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People's Republic of China.,Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China
| | - Wen Tan
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China.,The Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People's Republic of China
| | - Cuiping Jiang
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China.,The Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People's Republic of China
| | - Jiao Sun
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China.,The Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People's Republic of China
| | - Zhijun Bao
- The Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040, People's Republic of China. .,Department of Gastroenterology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China. .,Research Center On Aging and Medicine, Fudan University, Shanghai, 200040, People's Republic of China. .,Department of Geriatrics, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, People's Republic of China.
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7
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Huang Y, Xu Y, Qiu J, Jiang C, Tan W, Tao X, Gu Q, Sun J. The impact of dusk phenomenon on total glucose exposure in Chinese people with type 2 diabetes. Medicine (Baltimore) 2021; 100:e25298. [PMID: 33787619 PMCID: PMC8021309 DOI: 10.1097/md.0000000000025298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 03/04/2021] [Indexed: 01/04/2023] Open
Abstract
This study was aimed at assessing the impact of the dusk phenomenon on the total glucose exposure in Chinese people with type 2 diabetes.A total of 380 type 2 diabetes who received a retrospective continuous glucose monitoring system (CGMs) for 72 hours were enrolled in our study, 32 of them failed in CGMs. The patients were first divided into 2 groups: dusk phenomenon (n = 95) and non dusk phenomenon group (n = 253). The magnitude of the dusk phenomenon (δDusk) was quantified by pre-dinner glucose minus post-lunch 2 hours glucose. A persistent δDusk ≥ 0 or a once only δDusk < 0 can be diagnosed with the dusk phenomenon. The participants were secondarily matched for the post-lunch 2 hours glucose to assess the impact of the dusk phenomenon on the overall glucose exposure. The impact of the dusk phenomenon was assessed on high-performance liquid chromatography assay (HbA1c) and 24-hour mean glucose.There were 95 of 348 (27.3%) participants with the dusk phenomenon in the overall population, and the median of δDusk level was -0.8 (-1.8, 0.2) mmol/L. The median of glucose differences between the 2 paired groups were 0.4 (-0.4, 1.0)% for HbA1c, 0.9 (0.2, 1.4) mmol/L for 24 hours mean glucose. The correlation analysis showed no relationship between the magnitude of dawn phenomenon and the dusk phenomenon (r = 0.052, P = .472).The incidence of dusk phenomenon is about 27.3% in people with type 2 diabetes. The impacts of dusk phenomenon on HbA1c and 24-hour mean glucose were about 0.4% and 0.9 mmol/L and the dusk phenomenon was not related with the dawn phenomenon.
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8
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Effect of Type 2 Diabetes Mellitus on the Hypoxia-Inducible Factor 1-Alpha Expression. Is There a Relationship with the Clock Genes? J Clin Med 2020; 9:jcm9082632. [PMID: 32823749 PMCID: PMC7465909 DOI: 10.3390/jcm9082632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/21/2023] Open
Abstract
Limited reports exist on the relationships between regulation of oxygen homeostasis and circadian clock genes in type 2 diabetes. We examined whether the expression of Hypoxia-Inducible Factor-1α (HIF-1α) and HIF-2α relates to changes in the expression of clock genes (Period homolog proteins (PER)1, PER2, PER3, Retinoid-related orphan receptor alpha (RORA), Aryl hydrocarbon receptor nuclear translocator-like protein 1 (ARNTL), Circadian locomotor output cycles kaput (CLOCK), and Cryptochrome proteins (CRY) 1 and CRY2) in patients with type 2 diabetes. A total of 129 subjects were evaluated in this cross-sectional study (48% with diabetes). The gene expression was measured by polymerase chain reaction. The lactate and pyruvate levels were used as surrogate of the hypoxia induced anaerobic glycolysis activity. Patients with diabetes showed an increased plasma concentration of both lactate (2102.1 ± 688.2 vs. 1730.4 ± 694.4 uM/L, p = 0.013) and pyruvate (61.9 ± 25.6 vs. 50.3 ± 23.1 uM/L, p = 0.026) in comparison to controls. However, this finding was accompanied by a blunted HIF-1α expression (1.1 (0.2 to 5.0) vs. 1.7 (0.4 to 9.2) arbitrary units (AU), p ≤ 0.001). Patients with diabetes also showed a significant reduction of all assessed clock genes’ expression. Univariate analysis showed that HIF-1α and almost all clock genes were significantly and negatively correlated with HbA1c concentration. In addition, positive correlations between HIF-1α and the clock genes were observed. The stepwise multivariate regression analysis showed that HbA1c and clock genes independently predicted the expression of HIF-1α. Type 2 diabetes modifies the expression of HIF-1α and clock genes, which correlates with the degree of metabolic control.
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9
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Koopman ADM, Beulens JW, Dijkstra T, Pouwer F, Bremmer MA, van Straten A, Rutters F. Prevalence of Insomnia (Symptoms) in T2D and Association With Metabolic Parameters and Glycemic Control: Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5585878. [PMID: 31603475 PMCID: PMC7110921 DOI: 10.1210/clinem/dgz065] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to determine the prevalence of insomnia and insomnia symptoms and its association with metabolic parameters and glycemic control in people with type 2 diabetes (T2D) in a systematic review and meta-analysis. DATA SOURCES A systematic literature search was conducted in PubMed/Embase until March 2018. STUDY SELECTION Included studies described prevalence of insomnia or insomnia symptoms and/or its association with metabolic parameters or glycemic control in adults with T2D. DATA EXTRACTION Data extraction was performed independently by 2 reviewers, on a standardized, prepiloted form. An adaptation of Quality Assessment Tool for Quantitative Studies was used to assess the methodological quality of the included studies. DATA SYNTHESIS When possible, results were meta-analyzed using random-effects analysis and rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 11 329 titles/abstracts were screened and 224 were read full text in duplicate, of which 78 studies were included. The pooled prevalence of insomnia (symptoms) in people with T2D was 39% (95% confidence interval, 34-44) with I2 statistic of 100% (P < 0.00001), with a very low GRADE of evidence. Sensitivity analyses identified no clear sources of heterogeneity. Meta-analyses showed that in people with T2D, insomnia (symptoms) were associated with higher hemoglobin A1c levels (mean difference, 0.23% [0.1-0.4]) and higher fasting glucose levels (mean difference, 0.40 mmol/L [0.2-0.7]), with a low GRADE of evidence. The relative low methodological quality and high heterogeneity of the studies included in this meta-analysis complicate the interpretation of our results. CONCLUSIONS The prevalence of insomnia (symptoms) is 39% (95% confidence interval, 34-44) in the T2D population and may be associated with deleterious glycemic control.
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Affiliation(s)
- Anitra D M Koopman
- Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
- Correspondence and Reprint Requests: Femke Rutters, Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands, De Boelelaan 1089a, 1081 HV Amsterdam, the Netherlands. E-mail:
| | - Joline W Beulens
- Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, GA Utrecht, the Netherlands
| | - Tine Dijkstra
- Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
| | - Frans Pouwer
- University of Southern Denmark, Department of Psychology, Odense, Denmark
- Deakin University, School of Psychology, Geelong, Australia
- STENO Diabetes Center Odense, Odense, Denmark
| | - Marijke A Bremmer
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
| | - Annemieke van Straten
- Faculty of Behavioural and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit, HV Amsterdam, the Netherlands
| | - Femke Rutters
- Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
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10
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Bao Y, Chen L, Chen L, Dou J, Gao Z, Gao L, Guo L, Guo X, Ji L, Ji Q, Jia W, Kuang H, Li Q, Li Q, Li X, Li Y, Li L, Liu J, Ma J, Ran X, Shi L, Song G, Wang Y, Weng J, Xiao X, Xie Y, Xi G, Yang L, Zhao Z, Zhou J, Zhou Z, Zhu D, Zou D. Chinese clinical guidelines for continuous glucose monitoring (2018 edition). Diabetes Metab Res Rev 2019; 35:e3152. [PMID: 30884108 DOI: 10.1002/dmrr.3152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/22/2019] [Accepted: 02/19/2019] [Indexed: 02/05/2023]
Abstract
Blood glucose monitoring is an important part of diabetes management. Continuous glucose monitoring (CGM) technology has become an effective complement to conventional blood glucose monitoring methods and has been widely applied in clinical practice. The indications for its use, the accuracy of the generated data, the interpretation of the CGM results, and the application of the results must be standardized. In December 2009, the Chinese Diabetes Society (CDS) drafted and published the first Chinese Clinical Guideline for Continuous Glucose Monitoring (2009 edition), providing a basis for the standardization of CGM in clinical application. Based on the updates of international guidelines and the increasing evidence of domestic studies, it is necessary to revise the latest CGM guidelines in China so that the recent clinical evidence can be effectively translated into clinical benefit for diabetic patients. To this end, the CDS revised the Chinese Clinical Guideline for Continuous Glucose Monitoring (2012 Edition) based on the most recent evidence from international and domestic studies.
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Affiliation(s)
- Yuqian Bao
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan City, Shandong Province, China
| | - Liming Chen
- Tianjin Medical University Metabolic Disease Hospital, Tianjin, China
| | - Jingtao Dou
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Leili Gao
- Peking University People's Hospital, Beijing, China
| | - Lixin Guo
- Beijing Hospital of the Ministry of Health, Beijing, China
| | - Xiaohui Guo
- Peking University First Hospital, Beijing, China
| | - Linong Ji
- Peking University People's Hospital, Beijing, China
| | - Qiuhe Ji
- Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shanxi Province, China
| | - Weiping Jia
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongyu Kuang
- The First Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Qifu Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Xiaoying Li
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yanbing Li
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, China
| | - Ling Li
- Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Jianhua Ma
- Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing City, Jiangsu Province, China
| | - Xingwu Ran
- West China Hospital of Sichuan University, Chengdu City, Sichuan Province, China
| | - Lixin Shi
- The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, China
| | - Guangyao Song
- Hebei General Hospital, Shijiazhuang City, Hebei Province, China
| | - Yufei Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianping Weng
- The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, Anhui Province, China
| | - Xinhua Xiao
- Peking Union Medical College Hospital, Beijing, China
| | - Yun Xie
- Tianjin Medical University Metabolic Disease Hospital, Tianjin, China
| | - Guangxia Xi
- Shanxi Dayi Hospital, Taiyuan City, Shanxi Province, China
| | - Liyong Yang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Zhigang Zhao
- Zhengzhou Yihe Hospital Affiliated to Henan University, Zhengzhou City, Henan Province, China
| | - Jian Zhou
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhiguang Zhou
- The Second Xiangya Hospital of Central South University, Changsha City, Hunan Province, China
| | - Dalong Zhu
- Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing City, Jiangsu Province, China
| | - Dajin Zou
- Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
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